Carla Riganti

Adult immunization with 13-valent pneumococcal vaccine in Campania region, South Italy: an economic evaluation.

Pneumococcal pneumonia has a high clinical burden in terms of morbidity, mortality and hospitalization rate, with heavy implications for worldwide health systems. In particular, higher incidence and mortality rates of community-acquired pneumonia (CAP) cases, with related costs, are registered among elderly. This study aimed to an economic evaluation about the immunization with PCV13 in the adult population in Campania region, South Italy. For this purpose we performed, considering a period of 5 y, a budget impact analysis (BIA) and a cost-effectiveness analysis which considered 2 scenarios of immunization compared with lack of immunization for 2 targeted cohorts: first, the high risk subjects aged 50–79 y, and second the high risk individuals aged 50–64 y, together with all those aged 65 y. Regarding the first group, the decrease of pneumonia could give savings equal to €29 005 660, while the immunization of the second cohort could allow savings equal to €10 006 017. The economic evaluation of pneumococcal vaccine for adult groups represents an essential instrument to support health policies. This study showed that both hypothesized immunization strategies could produce savings. Obtained results support the use of pneumococcal conjugate vaccine for adults. This strategy could represent a sustainable and savings-producer health policy.

Different Automatic Mode Switching in DDDR Pacemakers

Mode-switching algorithms are designed to alleviate symptoms related to tracking of atrial arrhythmias, that may result in inappropriately rapid or irregular ventricular pacing[1–19]. The ideal mode-switching algorithm should discriminate sinus tachycardia, a rhythm that should be tracked, from pathological atrial arrhythmias, rhythms that generally should not be tracked. In order to minimize symptoms related to the occurrence of atrial arrhythmias, the mode-switching algorithm should change quickly from a tracking to a non-tracking mode at the onset of the pathological atrial rhythm and remains in this mode until the arrhythmia terminates. Once sinus rhythm has been restored, the pacemaker should revert quickly to the normal atrial tracking mode. There are several potential causes of symptoms that relate to mode switching. First, an irregular paced ventricular intervals at the onset of an atrial arrhythmia before conversion to a non-tracking mode. Second, failure of the device to convert to a non-tracking mode because of intermittent undersensing of the atrial electrocardiogram may result in continued irregular or rapid ventricular pacing [20]. Third, inappropriate reversion to a tracking mode despite persistence of an atrial arrhythmia may also be caused by intermittent undersensing of the atrial electrocardiogram. Fourth, an overly sensitive mode-switching algorithm may result in loss of atrio-ventricular (AV) synchrony in sinus rhythm [2,11,17,19]. Finally, intrinsic AV conduction of an atrial arrhythmia may produce symptoms that are unrelated to the pacemaker [21]. Although all manufacturers of dual chamber pacemakers offer devices that provide mechanisms for managing the occurrence of atrial arrhythmias, the mode-switching algorithms that are available differ significantly in their sensitivity, specificity, and speed of mode conversion at the onset and termination of atrial arrhythmias. There are potential compromises between sensitivity and specificity with these algorithms, the balance of which may determine the frequency of arrhythmia-related symptoms. Atrial-based pacing is associated with a risk of developing atrial fibrillation lower than ventricular-based pacing for patients with sinus node dysfunction [22-25].

Public access defibrillation in the Sorrento Peninsula

Early cardiac defibrillation is the only effective therapy to stop ventricular fibrillation or pulseless ventricular tachycardia. It is still considered the gold standard for the treatment of ventricular tachycardia/fibrillation, and is the only intervention capable of improving survival in cardiac arrest survivors. Timing of intervention, however, is crucial because after only 10 min success rates are very low (0-2%). Unfortunately, adequate relief cannot always be provided within the necessary time. The purpose of the public access defibrillation project in Sorrento was to create fixed and mobile first aid with automated external defibrillators in combination with the local 118 emergency system. With the involvement of pharmacies, bathing establishments and schools, 31 equally distant sites for public access defibrillation were made available. This organization was supplemented by mobile units on the cars of the Municipal Police and Civil Protection, and on patrol boats in the harbor.

Managing Hypertrophic Cardiomyopathy: Screening in Young Subjects

Myocardial diseases (MDs) include an infrequently occurring heterogeneous group of potentially lethal abnormalities in children and young adults. Recent epidemiological studies have shown that dilated and hypertrophic cardiomyopathies are the most frequent morphological substrata of cardiomyopathy in children [1, 2]. Furthermore, MDs have been associated with unexpected sudden death (SD) in apparently healthy people < 35 years old [3]–[9]. Acute myocarditis and hypertrophic cardiomyopathy are the leading causes of SD in this age group. In addition, arrhythmogenic right ventricular cardiomyopathy/dysplasia has been recognized as a relatively frequent cause of SD in southern European countries [4, 9, 10]. In some cases, SD is the first manifestation of disease, although sometimes the child or young adult has had some symptom during their lifetime [11, 12]. The actual incidence and distribution of cardiac SD by sex and age group in well-defined populations are poorly characterized, and only a few observational studies have assessed this problem in children and young adults. Most studies have been done in selected samples or in reference centers, with the consequent bias making it impossible to provide epidemiological data. A population-based observational retrospective study was carried out in children and young adults < 35 years old in the Italian province of Campania between 1998 and 2005 with the aims of assessing the epidemiological and clinical data on MD mortality and determining the causes of SD and non-sudden death (NSD).