Francesca Santomauro

Essential Oil of Artemisia annua L.: An Extraordinary Component with Numerous Antimicrobial Properties

Artemisia annua L. (Asteraceae) is native to China, now naturalised in many other countries, well known as the source of the unique sesquiterpene endoperoxide lactone artemisinin, and used in the treatment of the chloroquine-resistant and cerebral malaria. The essential oil is rich in mono- and sesquiterpenes and represents a by-product with medicinal properties. Besides significant variations in its percentage and composition have been reported (major constituents can be camphor (up to 48%), germacrene D (up to 18.9%), artemisia ketone (up to 68%), and 1,8 cineole (up to 51.5%)), the oil has been subjected to numerous studies supporting exciting antibacterial and antifungal activities. Both gram-positive bacteria (Enterococcus, Streptococcus, Staphylococcus, Bacillus, and Listeria spp.), and gram-negative bacteria (Escherichia, Shigella, Salmonella, Haemophilus, Klebsiella, and Pseudomonas spp.) and other microorganisms (Candida, Saccharomyces, and Aspergillus spp.) have been investigated. However, the experimental studies performed to date used different methods and diverse microorganisms; as a consequence, a comparative analysis on a quantitative basis is very difficult. The aim of this review is to sum up data on antimicrobial activity of A. annua essential oil and its major components to facilitate future approach of microbiological studies in this field.

Predictive factors associated with the acceptance of pandemic and seasonal influenza vaccination in health care workers and students in Tuscany, Central Italy

Assessing the beliefs and attitudes of Health Care Workers (HCW) to influenza and influenza vaccination can be useful in overcoming low compliance rates. The purpose of our study is to evaluate the opinion of HCW and students regarding influenza, influenza vaccine and the factors associated with vaccination compliance. A survey was conducted between October 2010 and April 2011 in the Florence metropolitan area. A questionnaire was administered to HCW in three local healthcare units and at Careggi University Teaching Hospital. Students matriculating in health degree programs at Florence University were also surveyed. The coverage with vaccination against seasonal and pandemic influenza is generally low, and it is lower in students than in HCW (12.5% vs 15% for the seasonal vaccination, 8.5% vs 18% for the pandemic vaccination). Individuals comply with vaccination offer mainly to protect themselves and their contacts. Individuals not receiving vaccination did not consider themselves at risk, had never been vaccinated before or believed that pandemic influenza was not a public health concern. Physicians had the highest compliance to vaccination and women were less frequently vaccinated than men. HCW do not appear to perceive their possible influenza infections as a risk for patients: HCW receive vaccination mainly as a form of personal protection. Low compliance to vaccination is determined by various factors and therefore requires a multi-faceted strategy of response. This should include short-term actions to overcome organizational barriers, in addition to long-term interventions to raise HCW’s level of knowledge about influenza and influenza vaccination.

Beliefs and Opinions of Health Care Workers and Students Regarding Influenza and Influenza Vaccination in Tuscany, Central Italy.

Immunization of health care workers (HCWs) against influenza has been associated with improvements in patient safety. The aim of this study is to assess the beliefs, attitudes, and knowledge of HCWs and health profession students regarding influenza. An anonymous questionnaire was distributed to HCWs in three local Florentine healthcare units, at Careggi University Teaching Hospital, and to students in health profession degree programs. A total of 2576 questionnaires were fully completed. A total of 12.3% of subjects responded that they were “always vaccinated” in all three of the seasonal vaccination campaigns studied (2007–2008 to 2009–2010), 13.1% had been vaccinated once or twice, and 74.6% had not received vaccinations. Although the enrolled subjects tended to respond that they were “never vaccinated,” they considered influenza to be a serious illness and believed that the influenza vaccine is effective. The subjects who refused vaccination more frequently believed that the vaccine could cause influenza and that it could have serious side effects. More than 60% of the “always vaccinated” group completely agreed that HCWs should be vaccinated. Self-protection and protecting family members or other people close to the respondent from being infected and representing potential sources of influenza infection can be considered motivating factors for vaccination. The results highlight the importance of improving vaccination rates among all HCWs through multi-component interventions. Knowledge of influenza should be reinforced.

The “Fluad Case” in Italy: Could it have been dealt differently?

ABSTRACT During the influenza vaccination campaign 2014–2015, the reporting of 3 deaths within 48 hours of vaccination with Fluad brought the Italian Medicines Agency (AIFA) to pronounce the withdrawal of 2 batches of vaccine, based on the precautionary principle. Investigations by the Italian National Institute of Health, and by the Pharmacovigilance Risk Assessment Committee (PRAC), the committee at the European Medicines Agency (EMA) responsible for monitoring and assessing the safety profiles of human drugs, concluded that there was a lack of causality between the reported deaths and the vaccines administered. However, the media impact of the decision taken by AIFA, resulted in a lower influenza vaccination coverage compared with the previous years. The aim of our study was to identify possible critical points that may have led to a non-perfect management of the event. A review of the regulatory framework in place was performed, with a particular focus on the Guidelines on Good Pharmacovigilance Practices developed by the EMA to facilitate the signal management process. The management of reports involves the following steps: signal detection, its validation and confirmation, analysis and prioritization, assessment, recommendations for action and the exchange of information. In our opinion, both the signal detection phase and the phase of validation have been critical: the withdrawal of vaccine batches is possible even in case of a single suspected serious adverse reaction. However, aspects such as the biological plausibility, the presence of potential alternative causes and previous awareness should also be considered. Furthermore, the number of reported deaths was consistent with the expected background mortality rate in the vaccinated cohort. The disproportionate media coverage given to the AIFA decision resulted in a reduced vaccine confidence in the general population and in a decreased immunization coverage. Improving the communication on vaccine safety issues is crucial at this stage to restore a climate of trust in this powerful tool for primary prevention.

Body composition assessment in a sample of eight-year-old children

OBJECTIVE We assessed the body composition of 8-y-old children living in Livorno through the integration of bioelectrical and anthropometric evaluations. METHODS The study, conducted during December 2005, involved 8-y-old third graders of Livorno, Italy. We collected for each subject (449 children, 210 female and 239 male) anthropometric parameters and carried out bioelectrical impedance test with a STA/BIA Soft Tissue Analyzer. Data were processed with SPSS 14.0. RESULTS According to anthropometric parameters, a statistically significant difference between genders was found only for height. Percentages of overweight and obese children by gender were 13.9 and 2.4 for girls and 21.3 and 2.1 for boys (P<0.05). No significant differences were observed for weight, height, and body mass index percentiles from national reference values, whereras significant differences were found in mid-upper arm circumference between our sample and-lacking national data-the reference (U.S.) population for age and gender. With regard to bioelectrical impedance analysis, a common trend of distribution was observed in both genders toward the left and the area above the spatial ellipses and a statistically significant difference between genders for all parameters with the exception of phase angle. A gradual mean impedance shortening vector was observed with an increase of body mass index or mid-upper arm circumference. The comparison of the two techniques showed a good relation between anthropometric and bioelectrical parameters. CONCLUSION An integrated interpretation of bioelectrical impedance analysis and anthropometry, demonstrated by the correlation of many parameters between the two techniques, seems to emerge as a good indication of nutritional status for most children of both genders.

An in vitro evaluation of the antibacterial activity of the non-volatile phenolic fraction from rosemary leaves.

In this study, the aim was to evaluate the antimicrobial action of the non-volatile phenols of rosemary leaves against two Gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa) and two Gram-positive bacteria (Staphylococcus aureus and Staphylococcus epidermidis). Three extracts with different phenolic compositions were tested. By the agar disc diffusion method, Gram-positive bacteria were more sensitive to the extracts, and S. epidermidis showed the highest inhibition zones. Overall, all the extracts tested by the broth dilution method showed higher activity than results from the agar disc diffusion method. The minimal bactericidal concentration values indicated that E. coli was the most susceptible strain. This study demonstrated that the flavonoidic fraction of rosemary leaves does not play a crucial role as antimicrobial agents against these microorganisms. The most active extract was characterised by the highest amount of non-volatile terpenoidic compounds.

Risk of malnutrition in a sample of nonagenarians: Specific versus classic bioelectrical impedance vector analysis

OBJECTIVES The aims were to describe the body composition and the risk of malnutrition in a sample of nonagenarians and to identify what bioelectrical impedance vector analysis (BIVA) approach (classic or specific) is more correlated with either the risk of malnutrition or various anthropometric parameters. METHODS In the Mugello area (Italy), a representative sample of nonagenarians was enrolled in a survey aimed at investigating various health issues, including those related to nutritional status. The nutritional status was investigated using body mass index (BMI), mid-upper arm circumference (MUAC), calf circumference (CC), Malnutrition Universal Screening Tool (MUST), and BIVA. Two different approaches were used for the BIVA data analysis: the classic method and the specific method. RESULTS All measurements were obtained from 321 nonagenarians (65.7% of the enrolled sample; 92 men and 229 women); 74.8% of the subjects were at low risk of malnutrition according to MUST, 62.5% exhibited CC values higher than 31 cm, and 86.8% exhibited MUAC values higher than 22 cm. The bioelectrical parameters varied with nutritional status, independent of the nutritional indicator used; the parameters also varied based on sex and BIVA approach. The bioelectrical parameters obtained by the specific BIVA approach were more strongly correlated with MUST score, MUAC, and CC values compared with the parameters calculated using the classic approach. CONCLUSIONS Our study produced findings relevant to particular aspects of population aging. Above all, the specific BIVA was more effective at assessing nutritional status based on both anthropometric parameters and the risk of malnutrition.

Serum trace elements and risk of malnutrition in institutionalised elderly

Objective:The objective of this work is to evaluate the association between Selenium (Se)-, Copper (Cu)- and Zinc (Zn)-circulating concentrations and indicators of nutritional status.Subjects/Methods:This study enroled 428 institutionalised elderly. The diagnostic tools used are a form to collect data regarding gender, age, duration of stay in nursing home, number of prescribed drugs, chronic diseases, Mini Nutritional Assessment (MNA), anthropometric measurements, albumin, transferrin and serum concentrations of Se, Cu and Zn. The collected data were analysed with descriptive assessments of the differences χ2, Student’s t-test and analysis of variance. Multivariate linear regression were performed to evaluate the association between the concentrations of each trace elements and the other variables.Results:The study population was represented by 327 women and 101 men, of whom 13.8% were 65–75 years old and 47.4% were older than 85 years. According to the MNA score, 58.4% were at risk of malnutrition and 21.3% were malnourished. The results show a significant reduction in the average concentrations of Se and Zn in women when the nutritional status gets worse. The same trend, although not statistically significant, is also observed in men. In both genders, the Cu concentration does not show a statistically significant association with nutritional status. Multivariate linear regression show some positive or negative associations.Conclusions:Our study seems to confirm the association between Se and nutritional status, as well as with some blood chemistry parameters. The length of institutionalisation seems to be an independent predictor of Se concentration.

Safety and perception: What are the greatest enemies of HPV vaccination programmes?

Vaccines stimulate a persons immune system to produce an adequate reaction against a specific infectious agent; i.e. the person is protected from that disease without having to get it first. As vaccines are administrated to healthy subjects, they are held to the highest standards of safety. Regarding human papillomavirus (HPV) vaccines, at present three prophylactic vaccines are licensed (bivalent HPV 16/18, quadrivalent HPV 6/11/16/18 and the nonovalent HPV 6/11/16/18/31/33/45/52/58 vaccine). Pre- and post-licensure studies (i.e. not yet for nonovalent HPV vaccine) confirm that HPV vaccines are generally safe and well-tolerated, site injections symptoms are the most common adverse events (AEs) reported, and pain is the most frequently referred local symptom. Serious AEs are rare and not associated with severe sequelae, at least no vaccine-related deaths have occurred. Despite these scientific evidences, it is still difficult to explain to the population the importance of a good vaccination programme. There are many determinants for HPV vaccines hesitancy which represent a barrier that must be overcome in order to increase vaccine coverage, including psychological reactions, religious or cultural aspects, and fear of possible AEs (demyelinating diseases, Complex Regional Pain Syndrome - CRPS, or Postural Orthostatic Tachycardia Syndrome - POTS). A weak communication strategy which frequently suffers due to spread of unverified news by media and websites may lead to the failure of a vaccination programme. Such a situation happened in Japan (2013), due to which a great number of women remain vulnerable to HPV-related cancers. In order to resolve the issues around HPV vaccines acceptance, it is necessary to use good communication strategies. Multicomponent and dialogue-based interventions seem to be the most effective, especially if an adequate language is used, customized according to the vaccination programme target.

The antimicrobial effects of three phenolic extracts from Rosmarinus officinalis L., Vitis vinifera L. and Polygonum cuspidatum L. on food pathogens

Abstract In this study three phenolic extracts were examined, without volatile fraction, against common food pathogens. The samples, all suitable for food application, were from the leaves of Rosmarinus officinalis L., Vitis vinifera L., and the root of Polygonum cuspidatum L. The microorganisms tested were Escherichia coli O157:H7, Salmonella Enteritidis, Salmonella Typhi, Yersinia enterocolitica and Listeria monocytogenes, well-known as important food pathogens. The results demonstrated a microbicidal activity of all the tested compounds at different concentrations; the rosemary extract showed greater efficacy than the other compounds against the tested microorganisms. In particular, the best results were obtained with rosemary extract against E. coli O157:H7 and L. monocytogenes with values of 200 and 270 μg/mL, respectively. Our results show that rosemary extract, often present as a natural antioxidant in food, can also be proposed as a natural disinfectant in the food field.