Schioppa F

The efficacy of influenza vaccine for healthy children: a meta-analysis evaluating potential sources of variation in efficacy estimates including study quality.

Background: Two systematic reviews evaluating influenza vaccine efficacy in healthy children have recently been published. Although quantitative summary estimates were similar, authors’ conclusions were quite contrasting. We carried out another meta-analysis reevaluating study inclusion criteria and using metaregression techniques in addition to sensitivity and subgroups analyses to evaluate potential sources of heterogeneity of efficacy estimates, including methodologic quality of studies. Methods: Only randomized clinical studies assessing the efficacy of influenza vaccine in healthy children/adolescents (age ≤18 years) for preventing naturally occurring influenza and/or acute otitis media cases were included. Summary estimates of effect were obtained using a random effects model. The methodologic quality of each study was assessed using 3 systems: Chalmers scale, Jadad scale and Schulz components (randomization, allocation concealment and double-blinding). Results: The overall vaccination efficacy was 36% (95% confidence interval: 31–40%) against clinically diagnosed illnesses (evaluated by 19 randomized clinical studies for a total of 247,517 children); 67% (51–78%) against laboratory-confirmed cases (18 trials, n = 8574); and 51% (21–70%) against acute otitis media (11 trials, n = 11,349). Significant sources of between-study heterogeneity were participants’ age and study quality both directly correlated with the efficacy. When the analysis was performed excluding USSR studies, the overall efficacy of the vaccine in preventing clinical cases substantially increased (from 36% to 61%). Conclusions: These findings may indicate that the vaccine efficacy might be greater than the overall estimates. Although no safety and cost considerations are addressed in this analysis, the present findings support vaccination as a possible option for the prevention of influenza in healthy children and adolescents.

Addition of Teicoplanin or Vancomycin for the Treatment of Documented Bacteremia due to Gram-Positive Cocci in Neutropenic Patients with Hematological Malignancies: Microbiological, Clinical and Economic Evaluation

A prospective, randomized, double-blind trial was conducted on 124 febrile patients with hematological malignancies to compare teicoplanin with vancomycin as an addition to the initial empiric amikacin-ceftazidime regimen after documented bacteremia due to gram-positive cocci. At enrolment, patients in both groups were comparable with respect to age, sex, underlying hematologic disorders and duration of neutropenia. Rates of therapeutic success were 55/63 (87.3%) in the teicoplanin group and 56/61 (91.8%) in the vancomycin group (p = 0.560). The mean duration of treatment was similar, being 12.2 and 11.4 days, respectively (p = 0.216). Patients treated with teicoplanin remained febrile for slightly longer than those treated with vancomycin (4.9 vs. 4.0 days) (p = 0.013). Thirteen patients experienced an adverse drug reaction, but without any significant difference in the two arms. Isolated staphylococci showed a progressive and significant decrease in susceptibility to both glycopeptides during the 8 study years. The economic analysis performed showed that the addition of vancomycin is cost-saving.

Differences in Blood Pressure by Body Position (Supine, Fowler's, and Sitting) in Hypertensive Subjects

BACKGROUND Although blood pressure (BP) differences from supine to sitting position have long been recognized, limited data are available on other commonly used body positions. We performed a cross-sectional study to compare BP values obtained in supine, sitting, and Fowlers positions in essential hypertensive subjects. METHODS Systolic BP (SBP) and diastolic BP (DBP) were recorded using an automatic oscillometric device. Nine measurements were taken: three measurements, in random order, in supine, Fowlers, and sitting position. Two generalized estimating equations models were used to evaluate potential predictors of SBP and DBP adjusting for heart rate and measurement order. RESULTS The sample consisted of 250 subjects (mean age 66.3 ± 13.4 years; 44.4% males). Measured in supine, Fowlers, and sitting position, mean SBPs were 139.3 ± 14.0; 138.1 ± 13.8; 137.2 ± 13.7 mm Hg, respectively, and mean DBPs 80.1 ± 9.1; 81.9 ± 9.4; 83.0 ± 9.6 mm Hg, respectively. At multivariate analysis, mean SBP significantly decreased if measured in Fowlers and sitting positions, as compared to supine. In contrast, DBP significantly increased. A relevant proportion of subjects showed large differences (≤ or ≥10 mm Hg) in mean SBP across positions: i.e., 30.0% comparing supine vs. sitting SBP. An even higher prevalence of large differences was observed according to the measurement order within the same positions, with no univocal direction (random variation). CONCLUSIONS Fowlers position may represent a valid alternative to sitting and supine positions for BP measurement in clinical practice. BP random variability was found to be large regardless of body position, reinforcing the need for operators to closely follow current guidelines that recommend ≥2 recordings at each measurement.

Routine Preoperative Investigation: Results of a Multicenter Survey in Italy

We conducted a study to acquire information on the current behavior of a sample of Italian surgeons and anesthesiologists about prescribing, interpreting, and using routine preoperative investigations. Consultants in surgery and anesthesiology in 60 hospitals in northern, central, and southern Italy were interviewed. Prescription of these procedures by doctors were driven more by personal experience than by updated scientific knowledge. This practice often led to ineffective and inefficient clinical practice, with healthy patients undergoing useless, time-consuming, costly, and sometimes harmful procedures.

Knowledge, Attitudes, and Smoking Behaviours among Physicians Specializing in Public Health: A Multicentre Study

Background. Healthcare professionals have an important role to play both as advisers—influencing smoking cessation—and as role models. However, many of them continue to smoke. The aims of this study were to examine smoking prevalence, knowledge, attitudes, and behaviours among four cohorts physicians specializing in public health, according to the Global Health Profession Students Survey (GHPSS) approach. Materials and Methods. A multicentre cross-sectional study was carried out in 24 Italian schools of public health. The survey was conducted between January and April 2012 and it was carried out a census of students in the selected schools for each years of course (from first to fourth year of attendance), therefore among four cohorts of physicians specializing in Public Health (for a total of n. 459 medical doctors). The GHPSS questionnaires were self-administered via a special website which is created ad hoc for the survey. Logistic regression model was used to identify possible associations with tobacco smoking status. Hosmer-Lemeshow test was performed. The level of significance was P ≤ 0.05. Results. A total of 388 answered the questionnaire on the website (85%), of which 81 (20.9%) declared to be smokers, 309 (79.6%) considered health professionals as behavioural models for patients, and 375 (96.6%) affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 388 (89.7%) heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization. Conclusions. The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in public health, their key role both as advisers and behavioural models, and the limited tobacco training offered in public health schools.

Use of colistin and sorbitol for better isolation of Serratia marcescens in clinical samples

A comparison was made of different culture media and procedures for detection of Serratia marcescens from faecal, pharyngeal and ocular swabs collected from 213 neonates. MacConkey agar and MacConkey agar with sorbitol (1%) and/or colistin (200 i.u./ml) were used both for primary isolation and after enrichment using Mossel Enterobacteriaceae broth with colistin (200 i.u./ml). The use of MacConkey agar supplemented with colistin for primary isolation improved considerably the isolation rate of S. marcescens from faecal swabs but not from pharyngeal swabs; the number of ocular isolations were insufficient to demonstrate differences between procedures. Moreover the enrichment procedures consistently increased the number of S. marcescens isolates especially from pharyngeal and ocular swabs. Use of sorbitol made detection of S. marcescens from clinical specimens easier and time- and cost-efficient.

Cigarette smoking in young-adult workers: a cross-sectional analysis from Abruzzo, Italy

Background : The “Valentino” cross-sectional study is aimed at evaluating the prevalence and pattern of cigarette smoking according to occupational group in a representative sample of workers aged 18-35 years from Abruzzo, Italy. Methods : Randomly selected workers anonymously self-compiled a structured questionnaire containing validated items. Job type was coded according to the International Standard Classification of Occupations. Results : The sample consisted of 3989 workers. Current smoking prevalence was 45.9%, varying across occupational groups and ranged from 37.2% among clerical support workers, up to 57.1% among craft, agricultural and fishery sector workers. After controlling for several potential confounders using logistic regression, craft, agricultural, forestry and fishery workers (adjusted odds ratio 1.65; 95%confidence intervals 1.21-2.27), and call-center operators (1.91; 1.44-2.53) were significantly more likely to be current smokers than professionals and clerical or support workers. Interestingly, when alcohol and cannabis use were included in multivariate analysis, the association between smoking and gender was no longer significant. Conclusions : An independent association was found between specific occupational classes and tobacco smoking, suggesting occupation type should be considered in prioritizing subsets of populations towards which smoking cessation campaigns should be targeted first.

On the use of Disease Staging for clinical management: analysis of untimely admissions in the Abruzzo Region, Italy

Background and aims. The process of decentralization which recently occurred within the Italian National Health Service has transferred substantial responsibility and authority for health care administration to the individual regions. The project is aimed at developing regional benchmarks that can be used as a part of an ongoing system for analysis of resource use and quality of care in the Abruzzo Region of Italy. Methods . All 286 924 hospital admissions for the year 2001 in the region were analysed. Three diseases were chosen for in-depth review: diabetes mellitus; cholecystitis/cholelithiasis; and bacterial pneumonia. There were a total of 9391 admissions for these diagnoses. Severity, length of hospital stay and hospital mortality were analysed using Disease Staging methodology. In addition, the timeliness of hospitalisation was assessed by grouping admissions in three categories: premature or medically unnecessary, timely and late. Results . The rate of medically unnecessary admissions for diabetes mellitus was 72% throughout the region, and the percentage of late hospitalisations for cholelithiasis/cholecystitis was 43%. For both diseases, there were significant variations across Local Health Units in the proportion of late and early admissions. The rate of timely hospitalisations for bacterial pneumonia was higher than 86%. Conclusion . The analysis of discharge abstract data using Disease Staging revealed that in the Abruzzo region there are problems of inappropriate hospital admission, both early and late, for all diseases examined excepted bacterial pneumonia. Data confirmed the validity of Disease Staging to compare the performance of diverse hospitals in terms of length of stay and in-hospital mortality.