Giacomina Chiaradia

An assessment of the effect of hepatitis B vaccine in decreasing the amount of hepatitis B disease in Italy

BackgroundHepatitis B (HBV) infection is an important cause of morbidity and mortality and it is associated to a higher risk of chronic evolution in infected children. In Italy the anti-HBV vaccination was introduced in 1991 for newborn and twelve years old children. Our study aims to evaluate time trends of HBV incidence rates in order to provide an assessment of compulsory vaccination health impact.MethodData concerning HBV incidence rates coming from Acute Viral Hepatitis Integrated Epidemiological System (SEIEVA) were collected from 1985 to 2006. SEIEVA is the Italian surveillance national system that registers acute hepatitis cases. Time trends were analysed by joinpoint regression using Joinpoint Regression Program 3.3.1 according to Kims method. A joinpoint represents the time point when a significant trend change is detected. Time changes are expressed in terms of the Expected Annual Percent Change (EAPC) with 95% confidence interval (95% CI).ResultsThe joinpoint analysis showed statistically significant decreasing trends in all age groups. For the age group 0–14 EAPC was -39.0 (95% CI: -59.3; -8.4), in the period up to 1987, and -12.6 (95% CI: -16.0; -9.2) thereafter. EAPCs were -17.9 (95% CI: -18.7; -17.1) and -6.7 (95% CI: -8.0; -5.4) for 15–24 and ≥25 age groups, respectively. Nevertheless no joinpoints were found for age groups 15–24 and ≥25, whereas a joinpoint at year 1987, before compulsory vaccination, was highlighted in 0–14 age group. No joinpoint was observed after 1991.DiscussionOur results suggest that the introduction of compulsory vaccination could have contribute partly in decreasing HBV incidence rates. Compulsory vaccination health impact should be better investigated in future studies to evaluate the need for changes in current vaccination strategy.

The Health Technology Assessment of bivalent HPV vaccine Cervarix in Italy

INTRODUCTION Health Technology Assessment (HTA) approach was applied to Human Papilloma Virus (HPV) vaccine in the Italian context. METHODS Epidemiology and costs of HPV infection and related diseases, vaccine efficacy, clinical and economic impact of the HPV vaccination and womens knowledge and attitudes towards vaccination were assessed. RESULTS HPV infections pooled prevalence in Italy was 19% (95%CI: 10-30%) and cervical cancer incidence was 9.8/100,000 per year. The mean costs for in situ and invasive carcinoma hospitalisation were estimated respectively in euro1745.87 and euro2616.16. HPV vaccines have demonstrated high efficacy and good safety profile. The meta-analysis on efficacy results in preventing persistent cervical infections by HPV16 and 18 for both HPV vaccines resulted in 87% (95%CI: 80-91%) and 78% (95%CI: 62-87%). Modelling the impact of vaccination with bivalent vaccine, it would reduce cancer cases by 67% and be cost-effective, with a cost per Quality Adjusted Life Years (QALYs) gained of euro22,055. CONCLUSION The thoroughness of the evaluation allowed us accounting for all the aspects of HPV infection/diseases. The HTA report on the HPV vaccine demonstrated to be a comprehensive tool for an informed decision making process.

Quality assessment in meta-analisys

Background : An important characteristic of meta-analysis is that the results are determined both by the management of the meta-analysis process and by the features of studies included. The scientific rigor of potential primary studies varies considerably and the common objection to meta-analytic summaries is that they combine results from studies of different quality. Researchers began to develop quality scales for experimental studies, however now the interest of researchers is also focusing on observational studies. Since 1980, when Chalmers developed the first quality scale to assess primary studies included in metaanalysis, more than 100 scales have been developed, which vary dramatically in the quality and quantity of the items included. No standard lists of items exist, and the used quality scales lack empirically-supported components. Methods : Two of the most important and diffuse quality scales for experimental studies, Jadad system and Chalmers’ scale, and a quality scale used for observational studies, developed by Angelillo et al., are described and compared. Conclusion : The fallibility of meta-analysis is not surprising, considering the various bias that may be introduced by the processes of locating and selecting studies, including publication bias, language bias and citation bias. Quality assessment of the studies offers an estimate of the likelihood that their results will express the truth.

Intrafamilial transmission of hepatitis C virus in Italy: a systematic review

Background Hepatitis C virus (HCV) transmission is mainly due to parenteral exposure; however, in absence of such risk factor, there are reports of intrafamilial spread of HCV and observational studies suggest an increased risk for households of infected subjects. The aim of our study was to systematically review and meta-analyse studies about HCV prevalence among households of HCV patients in Italy. Methods PubMed and Embase were searched to identify Italian studies about HCV intrafamilial transmission. Keywords used were: ‘HCV’, ‘Hepatitis C’, ‘intrafamilial’, ‘family’ and ‘Italy’. Selected studies were reviewed to assess the quality and meta-analysed using StatsDirect software. Results 25 studies were selected. The pooled overall prevalence was 9% (95% CI 7.1% to 11.1%). The highest pooled prevalence was found among sexual partners of index cases: 14.7% (95% CI 10.7% to 19.2%) globally and 9.9% (95% CI 3.6% to 18.8%) and 17.6% (95% CI 12.1% to 24%) in northern and central-southern regions, respectively. The meta-analysis of high-quality studies yielded the lowest HCV prevalence. Conclusion To be a HCV patient household is a risk factor for HCV and counselling for these households should be provided.

An evaluation of a new combined Spo2/PtcCO2 sensor in very low birth weight infants

BACKGROUND: Recently, a new sensor for combined assessment of pulse oximetry oxygen saturation (Spo2) and transcutaneous monitoring of carbon dioxide partial pressure (PtcCO2) has been introduced (TOSCA 500, Radiometer America Inc.). We designed this study to evaluate the usability and reliability of TOSCA in neonates with birth weight ≤1500 g (very low birth weight). METHODS: In a prospective study of 22 newborns, TOSCA was tested, positioning the sensor on the ear pinna with an adhesive attachment clip. Simultaneous monitoring with TOSCA, conventional pulse oximeter (HP; Datex Ohmeda 3740), and a transcutaneous device (TINA TCM3, Radiometer, Copenhagen) was performed for 60 min. PtcCO2 measurement from TOSCA (PtcCO2TOSCA) and TINA (PtcCO2) were compared with Pco2 from blood samples (PCO2EAB) at 1 and 60 min. During the monitoring period, values of PtcCO2TOSCA were compared with PtcCO2, and SatO2 values from TOSCA with those from a pulse oximeter. Corresponding data were compared using Bland–Altman analysis. RESULTS: Bias (precision) at 1 min and at 60 min between PCO2EAB and PtcCO2 values were 3.5 (12.4) mm Hg and 2.8 (10.2), respectively, whereas between PCO2EAB and PtcCO2TOSCA values were 18.3 (30.4) mm Hg and 1.8 (25) mm Hg. Bland–Altman analysis shows a better correspondence PtcCO2/PtcCO2TOSCA between 7 and 15 min. No significant differences were found between Spo2 and SpO2TOSCA. CONCLUSIONS: The TOSCA monitor is safe and easy to apply in very low birth weight newborns. The pulse oximeter measurements may be useful for titrating oxygen therapy. Pco2 measurement with TOSCA is most useful as a trend and independent confirmation of arterial Pco2 is required if an accurate value is needed.

Socio-demographic determinants of coinfections by HIV, hepatitis B and hepatitis C viruses in central Italian prisoners.

BackgroundThe coinfections HIV/HCV/HBV are an important health issue in penitentiary communities. The aim of the study was to examine HIV, HBV and HCV coinfections determinants amongst prisoners in the jails of Southern Lazio (Central Italy), in the period 1995–2000.MethodsDiagnosis of seropositivities for HIV, HBV and HCV was made using ELISA method. A multiple logistic regression analysis was conducted to verify the influence of socio-demographic factors on the HIV/HBV/HCV coinfections.ResultsHIV/HCV, HBV/HCV and HIV/HBV coinfections were detected in 42 (4%), 203 (17.9%) and 31 (2.9%) inmates, respectively. These coinfections are significantly associated with the status of drug addiction (OR = 16.02; p = 0.012; OR = 4.15; p < 0.001; OR = 23.57; p = 0.002), smoking habits (OR = 3.73; p = 0.033; OR = 1.42; p = 0.088; OR = 4.25; p = 0.053) and Italian nationality (OR = 7.05; p = 0.009; OR = 2.31; p < 0.001; OR = 4.61; p = 0.04).ConclusionThe prevalence of HIV, HBV and HCV seropositivity in jails suggests that information and education programs for inmates could be useful to reduce the spread of such infections.

The future of best investing in vaccines: the Health Technology Assessment approach.

Over the past two decades, scientific research has led to the development of a huge number of new health technologies, among which new vaccines. The decision process underlying the introduction of a new vaccine will be of particular concern in the future and a useful tool is needed to orientate decision makers towards better allocation of economic resources. Health Technology Assessment (HTA) is a multidisciplinary tool that aims to examine the clinical, economic, organizational, ethical, juridical, social and cultural implications of the introduction or the implementation of a specific technology; it could so represent an innovative and effective approach in order to support decision-making processes.

Health status of immigrant children: an epidemiological survey among Italian paediatricians

Background : Immigrant children represent the fastest-growing segment of the child population in Italy and an increasing proportion of patients attending the daily practices of paediatricians. The aim of this survey was to investigate the health status of migrant children in Italy and, based on the perceptions of paediatricians, to identify the healthcare needs of this segment of immigrant patients. Methods : The survey was carried out between October 2006 and September 2007 on a sample of Italian paediatricians. Results : The sample included 236 paediatricians, accounting for 190,335 paediatric patients in total; of these, 14,308 (7.5%) were immigrant children. The rates of access to recommended vaccinations of immigrant children compared to national data were as follows: Pertussis (87.9% of sample vs 96.7% National data), Haemophilus influenzae (86.5% vs 96%) and Measles, Mumps and Rubella (MMR) (87.3% vs 89.6%). We also found differences in caesarean birth rate (11.8% of immigrant births being caesarean compared to national data, that reaches about 38.3%) and a high rate of parasitosis in immigrant children. Discussion : The results indicate interesting differences between immigrant and Italian children, especially in vaccination coverage and caesarean birth rate, that further studies could clarify in the future.

The effects of Mediterranean Diet on Cardiovascular diseases: a systematic review

Background: Diet and lifestyle-related factors may be responsible for the different geographical distribution of cardiovascular disease incidence. The aim of our study is to conduct a systematic review of the effect of Mediterranean Diet on cardiovascular diseases (CVD), in terms of prevention of both cardiovascular mortality and cardiovascular events. Methods: We undertook a scientific literature search using MEDLINE, Embase and the Cochrane database for systematic reviews. We selected studies that evaluate the association between mortality and morbidity due to CVD and Mediterranean diet considered as primary or secondary prevention intervention, and found 16 articles concerning 13 studies (2 case-control, 3 cohort studies and 8 randomised clinical trials). Results: The analyzed studies indicate a reduction of adverse cardiovascular events by about 30% and 40%, in terms of primary and the secondary prevention, respectively. Concerning the reduction of mortality, a larger corpus of data is available, demonstrating that the Mediterranean diet significantly reduces mortality by 50% or 70% in terms of secondary prevention, and by about 30% for primary prevention. Conclusions: The Mediterranean diet has positive effects over the CVD both in primary and secondary prevention settings. The estimate of the effect is different in different settings and such variability is attributable to the heterogeneity of the enrolled population, which is obviously lower in the general population compared to those who have already had an adverse cardiovascular event.

Knowledge, attitudes and behaviour about Sexually Transmitted Infections: a survey among Italian university female students

Aims: Improvements have been made in terms of STIs mortality, but young women still have a lack of attention to the STIs prevention. We investigated the knowledge and attitudes about STIs and their prevention among a sample of Italian university female students. Methods: We designed a questionnaire about knowledge and attitudes toward STIs, Papanicolau test (Pap test) and Human Papilloma Virus (HPV) and had it filled out by 285 young women. Chi-square test, Mann-Whitney test and a multivariable analysis were performed in order to identify associated factors. Results: Knowledge about STIs seems weak, oppositely to knowledge about preventive measures. In line with the results of the univariate analyses, the multivariable one confirmed a higher probability to answer rightly for women who knew the effective behaviours for preventing STIs, women who took information about STIs from Internet, books and TV and those using natural methods (OR 2.77 - 95%CI 1.47-5.23, OR 2.99 - 95%CI 1.62-5.53 and OR 2.55 - 95%CI 1.05-6.18, respectively) and a lower one for students from Cassino and those who knew is possible to recover from STIs (OR 0.38, 95%CI 0.17-0.87 and 0.42, 95%CI 0.20-0.88, respectively). Furthermore, about Pap test it also confirmed the role of a medium-high STIs level of knowledge (OR 2.11, 95%CI 1.02-4.37) and a lower probability to know about it for women from Cassino (OR 0.25, 95%CI 0.09-0.73). Conclusions: Young women are not completely aware of STIs risks and preventive measures. Informational and educational campaigns should be implemented to reach this target group and lighten the current and future burden of STIs.