Knowledge of, and attitudes towards, adult vaccination among General Practitioners in Piedmont, Italy: results from a cross-sectional study

BACKGROUND

"Life-course immunization" is increasingly recognized as important. In Italy, adults are recommended to receive influenza; pneumococcal; tetanus toxoid, reduced diphtheria toxoid, acellular pertussis (Tdap); and herpes zoster (HZ) vaccines at various ages.

STUDY DESIGN

Cross-sectional study.

METHODS

To study the knowledge and attitudes of Italian general practitioners (GPs) towards adult vaccination, we surveyed 335 GPs in Piedmont from December 2019 through March 2020; and compared the results by GPs' age (≤50 vs >50 years).

RESULTS

The most common vaccination information source was the regional/local educational courses (72.8%), with older vs younger GPs more likely to attend (79.4% vs 64.4%; p=0.002). Approximately half felt that they needed further information on vaccine co-administration (55.5%), duration of protection (49.6%), and safety/tolerability (48.7%), with older vs younger GPs being more interested in safety/tolerability. Overall, most respondents (86.0%) felt that information for the patient would most engage them, and 68.1% planned to co-administer vaccines. Respondents felt most comfortable proposing influenza, but were also comfortable about pneumococcal/Tdap/HZ vaccination. However, younger vs older GPs were more comfortable about proposing Tdap and HZ. The most common ways to inform patients about influenza or pneumococcal/Tdap/HZ vaccination eligibility were personally during a visit (42.7% or 54.3%, respectively) or via an information poster (30.7% or 17.9%).

CONCLUSIONS

The surveyed GPs had favorable attitudes towards adult vaccination and were interested in ongoing education.

BJS-01 SARCOPENIA AND VISCERAL FAT IN PATIENTS WITH INCISIONAL HERNIA AFTER URGENT LAPAROTOMY

Aim

Various risk factors have been associated with the development of incisional hernia (IH). Some recent papers underlined that visceral fat could be a reliable indicator. Another risk factor which is of increasing clinical interest is sarcopenia. Recent studies have identified it as an independent predictor of poor postoperative outcomes following abdominal surgery. We aimed to investigate the role of visceral fat and skeletal muscle as emerging risk factors for IH after urgent laparotomy.

Material & methods

Patients aged 18 years or older who underwent urgent median laparotomy and with continuous direct suturing of the laparotomy were included. They were categorized into two groups: those with a median IH and those without IH at 12-months follow-up. Demographic data were prospectively collected while CT scans were retrospectively reviewed. The data were compared among two groups.

Results

From January 2018 to May 2021, 364 patients underwent urgent surgery in our Department, of whom 222 were aged >18 years-old and underwent median laparotomy. Forty-four patients had diagnosis of median IH, while 41 patients without IH were identified as the control group. Statistically significant differences emerged for BMI and for the area of visceral fat. The association with the presence/absence of sarcopenia was not significant.

Conclusions

When surgery is performed in urgent settings it could be important to identify patients at risk, especially as CT scans are generally available for all patients with urgent abdominal disease. In these patients a prophylactic mesh placement could be evaluated.

A monocentric retrospective analysis about the effects of COVID-19 pandemic on emergency general surgery consultations

OBJECTIVE

The pandemic effects due to the coronavirus SARS-CoV-2 caused a health emergency. We decided to carry out a study with the aim to investigate the changes in patients' tendencies for admission to the emergency department for surgical diseases, and the related hospitalizations and urgent surgery rates.

PATIENTS AND METHODS

We carried out a retrospective, observational study on patients who received emergency general surgery consultation at our University Hospital during the two COVID-19 pandemic periods and on the same dates one year before. The patients' demographic characteristics, their hospitalization in surgical department and the data about those who underwent urgent surgery were retrospectively recorded.

RESULTS

In the period March-April 2020 there were 95 surgical visits recorded; among these patients, 25% required hospitalization and 12.63% underwent urgent surgery. In the period November-December-January 2020-2021 there were 156 surgical consultations, of which 35.26% required hospitalization and 21.15% underwent urgent surgery. In both considered periods we found that the number of surgical consultations decreased compared to the same periods of the previous year. Moreover, we found a higher rate of hospitalization and need for urgent surgery.

CONCLUSIONS

We documented a significant reduction in the overall number of surgical consultations and an increase of hospitalization and urgent surgery rates.

Gastric Bypass after multiple restrictive procedures: Roux-en-Y or One Anastomosis? A retrospective multicentric study

OBJECTIVE

When restrictive surgery fails, conversion to more malabsorptive techniques is frequently proposed. The aim of this study is to evaluate the weight loss figures between Roux-en-Y Gastric Bypass (RYGB) and One Anastomosis Gastric Bypass (OAGB) in patients who have already undergone Multiple Restrictive Procedures (MRP).

PATIENTS AND METHODS

All patients who underwent conversion of Laparoscopic Sleeve Gastrectomy (LSG) to RYGB or OAGB between 2010 and 2019 were retrospectively analyzed. Only patients who had conversion for Weight Regain (WR) or Insufficient Weight Loss (IWL) after both Laparoscopic Gastric Banding (LGB) and LSG entered the study population. Finally, 44 patients underwent conversion to RYGB, and 24 patients to OAGB.

RESULTS

Concerning Excess Weight Loss (%EWL) at 3, 6, 12, 24 postoperative months, the results for RYGB were 33.7%, 47.95%, 61.8%, 61.8%, while for OAGB were 38.3%, 51.9%, 63.75%, 79.45%. A significant difference was recorded in favor of OAGB at 3 (p=0.03) and 24 (p=0.046) postoperative months. % EWL at 24 months in the case of IWL was 57.8% for RYGB, while for OAGB was 72.7% (p=0.047). No significant difference was found considering patients with WR (80.9% and 80.5%; p= 0.999). Patients with better results at 24 months after surgery had a significantly longer time between sleeve and bypass than those with a lower % EWL.

CONCLUSIONS

The results of the present study seem to show that both techniques give good results at 24 months in patients who have undergone MRP. However, OAGB shows overall better results, particularly in patients with IWL.

The early prediction of mortality in acute cholecystitis: Temperature, Neutrophils and Multiple organ failure (TNM) score

OBJECTIVE

Acute Cholecystitis (AC) accounts for a significant proportion of patients presenting to the Emergency Department with abdominal pain. We suggest grading the severity of AC with a simple system: TNM, an acronym borrowed by cancer staging where T indicated Temperature, N neutrophils and M Multiple organ failure. This retrospective-prospective observational study evaluates the predictive value of TNM score on mortality of patients with AC.

PATIENTS AND METHODS

TNM was developed in a training cohort of 178 patients with AC who underwent cholecystectomy from February 2005 to December 2012 (retrospectives data). To verify the prognostic value of TNM score, we prospectively recruited 172 patients who were consecutively included and treated from January 2013 to July 2020 as the validation cohort. After defining the categories T, N and M, patients were grouped in stages. The variables analyzed were age, sex, American Society of Anesthesiologists (ASA) score, blood transfusion, temperature, neutrophils count, preoperative organ failure, immune-compromised status, stage.

RESULTS

In the training cohort TNM staging was: none patient at stage 0; 6 patients at stage I; 71 patients at stage II; 71 patients at stage III; 30 patients at stage IV. Death occurred in 51 patients. ASA score, neutrophils count, preoperative organ failure, stage III-IV emerged as statistically significant different prognostic factors. ASA score (III-IV) and stage (III-IV) were significant independent predictors of post-operative mortality in multivariate analysis. Comparable results were observed in the validation cohort.

CONCLUSIONS

TNM classification is very easy to use; it helps to define the mortality risk and it is useful to objectively compare patients with AC.

Prevalence of Early Childhood Caries (ECC) in a paediatric italian population: An epidemiological study

AIM

The present work aims to evaluate, through an epidemiological study, the prevalence of Early Childhood Caries in an Italian paediatric population, aged up to 71 months, evaluating some determinants that will be illustrated in this study in order to adopt preventive care and intervene as early as possible to limit the development of this disease.

METHODS

The sample consisted of 76 children aged up to 71 months who were examined at the PAediatric Dentistry Clinic of the University of l'Aquila. Parents were informed of the research that was taking place. All read the information sheet explaining the study and signed the informed consent where it was emphasised that the data collected would be treated and stored in a strictly confidential manner, pursuant to the Legislative Decree 196/2003 in force in Italy since June 30, 2003, regarding the protection of individuals with regard to the processing of personal data. At the end of this study, a standardised questionnaire administered. The questionnaire, divided into two parts, made it possible to acquire information regarding the characteristics of the population. First part: General data of the child and the medical history of the mother and father; Second part: The age and gender of the child, the type and duration of breastfeeding, the use of sugary pacifiers, oral hygiene and frequency of consumption of sugars drinks and food, identifying the starting age.

RESULTS

Evaluating the dmft of each child, 40.79% of our sample population is affected by ECC; 57.89% of the children used the pacifier and 13,16% of them have or have used it with honey with a p value of 0.001, therefore this parameter was statistically significant, together with the intake of candies, chocolates and sugar drinks. The data was collected for a period of about 12 months, consequently a descriptive statistical analysis was conducted in which the characteristics of the population under consideration were outlined. Discrete and nominal variables have been described with frequencies and percentages. The percentage differences were evaluated using the chi-square test and the Fisher test. Quantitative variables were expressed in terms of mean and standard deviation and significance was assessed by the Mann-Whitney test. The level of significance was established as p <0.05. A Logistic Regression was conducted to evaluate the risk factors associated with a dmft>0 setting, dmft=0/dmft>0 as the dependent variable and the variables investigated as explanatory variables. The evaluation of the association was reported as the Odds Ratio with the 95% confidence interval. The statistical analysis was carried out using the Stata 12/1C statistical package.

CONCLUSION

ECC is a multifactorial disease in which eating habits play a very important role. A diet that from childhood is characterised by a high consumption of sugar-rich food and drinks is highly associated with the incidence of ECC in later years.

Spontanuous Demand For Meningococcal B Vaccination: Effects On Appropriateness And Timing

When the meningococcus B vaccine was introduced into Italy in 2017, it was recommended for newborns based on national epidemiological data indicating that they were at greater risk. However, the vaccination service of the local health authority of L'Aquila had already been receiving spontaneous parental requests to provide vaccination for children in lower-risk age groups from the beginning of 2016. We therefore decided to use a self-administered questionnaire in order to investigate the parents’ socio-demographic data; their children's history of other recommended vaccinations (against measles, mumps and rubella, varicella, meningococcus C and, for females, human papilloma virus); the information sources concerning meningococcal vaccination; and the timing of its administration.

The questionnaire was completed by 565 parents, and the results showed that the requests mainly came from the parents of children aged 5–11 years. The children whose mothers had received a high school education and were >35 years old were more likely to have received the first dose after the age of one year and to have perceived pain at the inoculation site, and less likely to have experienced mild general reactions. The requests were mainly trigged by the recommendations of healthcare professionals, and the overloading of the vaccination service led to delays in the administration of the doses after the first. The delays (reported by 74.07% of the parents) were mainly due to organisational problems in the service itself, which led 61.52% of the doses being more appropriately administered by staff working as private physicians inside public health facilities, albeit at extra cost.

These findings indicate that organisational factors and excessive demand had a considerable impact on both the efficacy of the immunisation and its appropriateness.

Unparalleled patterns of intussusception and rotavirus gastroenteritis hospitalization rates among children younger than six years in Italy

BACKGROUND

No nationwide studies are available so far in Italy to analyze the annual trend of hospitalizations for intussusception (IS) comparing it with that of rotavirus gastroenteritis (GARV), therefore a survey was undertaken to assess the incidence rates of IS and GARV in children hospitalized between 2005 and 2014 in Italy.

STUDY DESIGN

A retrospective observational study was conducted analyzing the Italian Hospital Discharge Database (HDD), including a study on all hospitalizations bearing a primary or secondary diagnoses coded as 560.0 along the decade 2005-2014.

METHODS

The trend and seasonality of hospitalizations rates (HRs) for IS were analyzed stratifying by gender and age groups. The statistical significance of temporal trend was determined using the analysis of the slope of the regression line. For the same period, data related to national hospitalizations for GARV (code 008.61 in any diagnosis) were analyzed for comparative purpose.

RESULTS

A total of 6,074 hospitalizations for IS in children aged <6 years were recorded. A statistically significant increase of HRs was seen for male, female, 12-23 months and 24-71 months age groups. However, in children within the first year of life there was a downward trend. The analysis of the distribution of the HRs by months of hospitalization showed the absence of seasonality, in contrast to HRs for GARV.

CONCLUSION

Our analysis confirmed the occurrence of the incidence peak of IS hospitalizations in children aged seven months. HRs decreased after the first year of life, replicating an age distribution that is also observed for other paediatric infectious diseases. Nevertheless, the total trend of HR was increasing. In Italy, IS HRs in the pre-vaccination era resulted in line with those described for other European countries, with an increasing trend and the annual slope of IS hospitalization turned out to unparallel the GARV HRs.