Prevalence of smoking habits, attitudes and knowledge on counteractive strategies among a sample of healthcare employees: results of the smoking-free health environments project in the province of Palermo, Italy

Introduction

Tobacco use is responsible for over 7 million deaths annually, making smoking the leading cause of preventable mortality globally. Over the last two decades in Italy, the prevalence of smoking among physicians has consistently decreased, while it remains higher and is gradually decreasing among non-physician healthcare workers. The aim of this study was to investigate the Prevalence of smoking habits, attitudes, and knowledge on counteractive strategies among employees in the Primary Healthcare Facilities in the Province of Palermo, Italy.

Methods

A cross-sectional survey was conducted between June 2020 and December 2020 through a previously validated anonymous questionnaire structured in four sections including 34 items. Data were analyzed using Stata/MP 12.1 statistical software.

Results

Overall, 2,645 participants answered the questionnaire. The prevalence of either current or former smokers was 18.6%. Based on the multivariable analysis conducted, a significantly higher frequency of current smokers was observed among male participants (AdjOR: 1.29; CI95%: 1.02-1.64) and those belonging to the Surgical Unit (AdjOR: 1.92; CI95%: 1.27-2.90). Conversely, the prevalence of current smokers was significantly lower among those with at least one child (AdjOR: 0.67; CI95%: 0.49-0.91), with an educational qualification equal to or greater than a graduation degree (AdjOR: 0.56; CI95%: 0.43-0.73), those who considered second-hand smoke harmful (AdjOR: 0.06; CI95%: 0.008-0.60), those who had observed smoking or detected the smell of smoke in their workplace (AdjOR: 0.64; CI95%: 0.45-0.91). Furthermore, the prevalence of current smokers was significantly lower among participants who believed that healthcare professionals could play a crucial role in influencing their patients' lifestyles (AdjOR: 0.67; CI95%: 0.50-0.90) and among those who recommend their patients to quit smoking (AdjOR: 0.35; CI95%: 0.24-0.51).

Discussion

The results of the current research demonstrate that, despite the decline in smoking prevalence among physicians, the rate of smokers among healthcare facility employees remains unacceptably high. This underscores the need to re-evaluate current anti-tobacco strategies in the workplace.

An Analysis of the Neutralizing Antibodies against the Main SARS-CoV-2 Variants in Healthcare Workers (HCWs) Vaccinated against or Infected by SARS-CoV-2

Although the anti-COVID-19 vaccination has proved to be an effective preventive tool, "breakthrough infections" have been documented in patients with complete primary vaccination courses. Most of the SARS-CoV-2 neutralizing antibodies produced after SARS-CoV-2 infection target the spike protein receptor-binding domain which has an important role in facilitating viral entry and the infection of the host cells. SARS-CoV-2 has demonstrated the ability to evolve by accumulating mutations in the spike protein to escape the humoral response of a host. The aim of this study was to compare the titers of neutralizing antibodies (NtAbs) against the variants of SARS-CoV-2 by analyzing the sera of recovered and vaccinated healthcare workers (HCWs). A total of 293 HCWs were enrolled and divided into three cohorts as follows: 91 who had recovered from SARS-CoV-2 infection (nVP); 102 that were vaccinated and became positive after the primary cycle (VP); and 100 that were vaccinated with complete primary cycles and concluded the follow-up period without becoming positive (VN). Higher neutralization titers were observed in the vaccinated subjects' arms compared to the nVP subjects' arms. Differences in neutralization titers between arms for single variants were statistically highly significant (p < 0.001), except for the differences between titers against the Alpha variant in the nVP and in VP groups, which were also statistically significant (p < 0.05). Within the nVP group, the number of subjects with an absence of neutralizing antibodies was high. The presence of higher titers in patients with a complete primary cycle compared to patients who had recovered from infection suggested the better efficacy of artificial immunization compared to natural immunization, and this further encourages the promotion of vaccination even in subjects with previous infections.

Implant replacement and anaplastic large cell lymphoma associated with breast implants: a quantitative analysis

Introduction

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma associated with breast reconstruction post-mastectomy or cosmetic-additive mammoplasty. The increasing use of implants for cosmetic purposes is expected to lead to an increase in BIA-ALCL cases. This study investigated the main characteristics of the disease and the factors predicting BIA-ALCL onset in patients with and without an implant replacement.

Methods

A quantitative analysis was performed by two independent researchers on cases extracted from 52 primary studies (case report, case series, and systematic review) published until April 2022 and searched in PubMed, Scopus, and Google-Scholar databases using "Breast-Implant" AND/OR "Associated" AND/OR "Anaplastic-Large-Cell-Lymphoma". The statistical significance was verified by Student's t-test for continuous variables, while Fisher's exact test was applied for qualitative variables. Cox model with time-dependent covariates was used to estimate BIA-ALCL's onset time. The Kaplan-Meier model allowed the estimation of the probability of survival after therapy according to breast implant exposure time.

Results

Overall, 232 patients with BIA-ALCL were extracted. The mean age at diagnosis was 55 years old, with a mean time to disease onset from the first implant of 10.3 years. The hazard of developing BIA-ALCL in a shorter time resulted significantly higher for patients not having an implant replacement (hazard ratio = 0.03; 95%CI: 0.005-0.19; p-value < 0.01). Patients with implant replacement were significantly older than patients without previous replacement at diagnosis, having a median time to diagnosis since the first implant of 13 years (7 years in patients without replacement); anyway, the median time to BIA-ALCL occurrence since the last implantation was equal to 5 years.

Discussion

Our findings suggest that, in BIA-ALCL patients, the implant substitution and/or capsulectomy may delay the disease's onset. However, the risk of reoccurrence in an earlier time should be considered in these patients. Moreover, the time to BIA-ALCL onset slightly increased with age. Selection bias, lack of awareness, misdiagnosis, and limited data availability could be identified as limits of our study. An implant replacement should be considered according to a risk stratification approach to delay the BIA-ALCL occurrence in asymptomatic patients, although a stricter follow-up after the implant substitution should be recommended.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42023446726.

Changes in Students' Perceptions Regarding Adolescent Vaccinations through a Before-After Study Conducted during the COVID-19 Pandemic: GIRASOLE Project Study

The COVID-19 pandemic caused a reduction in vaccination coverage for all age groups, especially in non-infant age. The main objective of the present study is to evaluate the effectiveness of an online intervention conducted among adolescents during the COVID-19 pandemic in increasing knowledge and positive attitudes toward vaccinations. The study, which took place online from March to May 2021, involved 267 students from six lower secondary schools in Palermo city (Italy); they filled out the questionnaire before and after the intervention. The questionnaire was based on the protection motivation theory (PMT), which estimates the improvement in vaccination-related knowledge and attitudes. The pre- and post-intervention comparison showed a significant increase in the perception of the disease severity: strongly agree pre-intervention n = 150 (58.6%) and post-intervention n = 173 (67.6%, p < 0.001), rated on a five-point Likert scale. In a multivariate analysis, the factor associated with the improvement in the score after the intervention was the school dropout index (low vs. very high dropout index OR 4.5; p < 0.03). The educational intervention was more effective in schools with lower early school leaving rates, an indirect index of socio-economic status. The topic of vaccination has caught the adolescents' attention, it is, therefore, important that interventions tackling teenagers are tailored to reduce their emotional tension about the perception of adverse effects and improve vaccination coverage.

Defining drivers of under-immunization and vaccine hesitancy in refugee and migrant populations

BACKGROUND/OBJECTIVE

Some refugee and migrant populations globally showed lower uptake of COVID-19 vaccines and are also considered to be an under-immunized group for routine vaccinations. These communities may experience a range of barriers to vaccination systems, yet there is a need to better explore drivers of under-immunization and vaccine hesitancy in these mobile groups.

METHODS

We did a global rapid review to explore drivers of under-immunization and vaccine hesitancy to define strategies to strengthen both COVID-19 and routine vaccination uptake, searching MEDLINE, Embase, Global Health PsycINFO and grey literature. Qualitative data were analysed thematically to identify drivers of under-immunization and vaccine hesitancy, and then categorized using the 'Increasing Vaccination Model'.

RESULTS

Sixty-three papers were included, reporting data on diverse population groups, including refugees, asylum seekers, labour migrants and undocumented migrants in 22 countries. Drivers of under-immunization and vaccine hesitancy pertaining to a wide range of vaccines were covered, including COVID-19 (n = 27), human papillomavirus (13), measles or Measles-mumps-rubella (MMR) (3), influenza (3), tetanus (1) and vaccination in general. We found a range of factors driving under-immunization and hesitancy in refugee and migrant groups, including unique awareness and access factors that need to be better considered in policy and service delivery. Acceptability of vaccination was often deeply rooted in social and historical context and influenced by personal risk perception.

CONCLUSIONS

These findings hold direct relevance to current efforts to ensure high levels of global coverage for a range of vaccines and to ensure that marginalized refugee and migrant populations are included in the national vaccination plans of low-, middle- and high-income countries. We found a stark lack of research from low- and middle-income and humanitarian contexts on vaccination in mobile groups. This needs to be urgently rectified if we are to design and deliver effective programmes that ensure high coverage for COVID-19 and routine vaccinations.

Molecular Epidemiology and Genetic Diversity of Human Respiratory Syncytial Virus in Sicily during Pre- and Post-COVID-19 Surveillance Seasons

Human respiratory syncytial virus (hRSV) is an important pathogen of acute respiratory tract infection of global significance. In this study, we investigated the molecular epidemiology and the genetic variability of hRSV over seven surveillance seasons between 2015 and 2023 in Sicily, Italy. hRSV subgroups co-circulated through every season, although hRSV-B mostly prevailed. After the considerable reduction in the circulation of hRSV due to the widespread implementation of non-pharmaceutical preventive measures during the COVID-19 pandemic, hRSV rapidly re-emerged at a high intensity in 2022-2023. The G gene was sequenced for genotyping and analysis of deduced amino acids. A total of 128 hRSV-A and 179 hRSV-B G gene sequences were obtained. The phylogenetic analysis revealed that the GA2.3.5a (ON1) and GB5.0.5a (BA9) genotypes were responsible for the hRSV epidemics in Sicily.; only one strain belonged to the genotype GB5.0.4a. No differences were observed in the circulating genotypes during pre- and post-pandemic years. Amino acid sequence alignment revealed the continuous evolution of the G gene, with a combination of amino acid changes specifically appearing in 2022-2023. The predicted N-glycosylation sites were relatively conserved in ON1 and BA9 genotype strains. Our findings augment the understanding and prediction of the seasonal evolution of hRSV at the local level and its implication in the monitoring of novel variants worth considering in better design of candidate vaccines.

Diagnostic Role of Combined Electrocochleography and Pure-Tone Audiometry Monitoring During Dehydrating Test in Ménière's Disease: A Case Series

OBJECTIVES

To evaluate the diagnostic role of combined electrocochleography and pure-tone audiometry monitoring during dehydrating test in Ménière's disease and consider its suitability as a diagnostic tool to differentiate those patients with unclear differential diagnosis and therefore identify those with clear endolymphatic hydrops responsive to dehydrating test. To study the efficacy of dehydrating therapy on vertiginous symptoms and hearing loss in patients with Ménière's disease.

STUDY DESIGN

Prospective case series.

SETTINGS

University hospital, secondary referral center.

PATIENTS

Thirty patients, 20 women and 10 men, age range of 25 to 75 years, matching the criteria for definite Ménière's disease according to the Barany Society classification.

INTERVENTION

Diagnostic. During an active phase of the disease, electrocochleography and pure-tone audiometry were performed, and repeated at 30th, 45th, and 60th minutes after intramuscular injection of 40 mg furosemide and 40 mg methylprednisolone.

MAIN OUTCOME MEASURE

Data related to symptoms, electrocochleography, and pure-tone audiometry during the dehydrating test were collected at different times and statistically analyzed.

RESULTS

After the administration of dehydrating therapy, we observed that both summating potential and action potential ratio and summating potential and action potential area ratio were normalized in 21 of 30 subjects. Furthermore, pure-tone audiometry thresholds improved significantly. An improvement of ear fullness was also observed, whereas tinnitus unchangeably persisted.

CONCLUSIONS

The monitoring of the electrocochleography and pure-tone audiometry thresholds during dehydrating tests with furosemide and methylprednisolone could allow to detect an improvement of instrumental features and clinical symptoms related to endolymphatic hydrops, and therefore, it could be used as a diagnostic tool in the identification of those patients affected by Ménière's disease with unclear differential diagnosis.

Wastewater-Based Epidemiology as a Tool to Detect SARS-CoV-2 Circulation at the Community Level: Findings from a One-Year Wastewater Investigation Conducted in Sicily, Italy

Wastewater-based epidemiology is a well-established tool for detecting and monitoring the spread of enteric pathogens and the use of illegal drugs in communities in real time. Since only a few studies in Italy have investigated the correlation between SARS-CoV-2 in wastewater and the prevalence of COVID-19 cases from clinical testing, we conducted a one-year wastewater surveillance study in Sicily to correlate the load of SARS-CoV-2 RNA in wastewater and the reported cumulative prevalence of COVID-19 in 14 cities from October 2021 to September 2022. Furthermore, we investigated the role of SARS-CoV-2 variants and subvariants in the increase in the number of SARS-CoV-2 infections. Our findings showed a significant correlation between SARS-CoV-2 RNA load in wastewater and the number of active cases reported by syndromic surveillance in the population. Moreover, the correlation between SARS-CoV-2 in wastewater and the active cases remained high when a lag of 7 or 14 days was considered. Finally, we attributed the epidemic waves observed to the rapid emergence of the Omicron variant and the BA.4 and BA.5 subvariants. We confirmed the effectiveness of wastewater monitoring as a powerful epidemiological proxy for viral variant spread and an efficient complementary method for surveillance.

Measles Immunization Status of Health Care Workers: A Cross-Sectional Study Exploring Factors Associated with Lack of Immunization According to the Health Belief Model

Suboptimal levels of measles vaccination coverage make Italy a country where the circulation of the virus is still endemic. In the past decade, several nosocomial outbreaks of measles occurred in Italy that rapidly spread the infection among large numbers of hospitalized patients and susceptible healthcare workers (HCWs). A cross-sectional study was conducted at the University Hospital of Palermo (Italy) to estimate the rate of HCWs immunization and to investigate the factors associated with lack of immunization. The attitude to the immunization practice was evaluated by exploring the Health Belief Model. Overall, 118 HCWs were enrolled, with a mean age of 31 years and 59.3% male. About half of the sample (45.8%, n = 54) was found not to be immunized against measles. Multivariable analysis showed that the factors directly associated with the non-immunization status against measles were female sex (OR = 3.70, p = 0.056), being an HCW different from a physician (OR = 10.27, p = 0.015), having a high perception of barriers to vaccination (OR = 5.13, p = 0.047), not being immunized for other exanthematous diseases such as chickenpox (OR = 9.93, p = 0.003), mumps (OR = 33.64, p < 0.001) and rubella (OR = 10.12, p= 0.002). There is a need to contrast the low adherence of HCWs to measles vaccination by identifying effective strategies to increase immunization coverage and limiting the risk of further nosocomial measles outbreaks.

Mastoidectomy in surgical procedures to treat retraction pockets: a single-center experience and review of the literature

PURPOSE

Retraction pocket (RP) is a common event affecting the middle ear when a negative pressure within it causes a retraction of a single part of the tympanic membrane (TM). Patients can be asymptomatic or can experience hearing loss, fullness feeling and/or ear discharge. RP can be stable or develop a cholesteatoma; aim of the study was to investigate if mastoidectomy may play a role in the surgical management of patients suffering from RP, both reporting our experience and discussing the existing literature.

METHODS

Fifty-one patients affected by RP were referred for surgery and randomly divided into two groups. Patients of G1 group underwent tympanoplasty with mastoidectomy, patients of G2 group underwent tympanoplasty only. A systematic review of the literature was then carried out by applying the PRISMA guidelines.

RESULTS

The mean follow-up lasted about 36 months. The G1 and G2 groups reached a postoperative mean air-bone gap (ABG) of 7.1 dB HL and 5.1 dB HL, respectively, with a mean ABG improvement of 13.2 dB HL and 12.4 dB HL. An ABG improvement was observed in the 59.7% of the G1 group and in the 63.2% of the G2 group, respectively (p > 0.5). Only one case of long-term complication was recognized in the G1 group. We combined, integrated and analyzed results of our prospective study with results of the literature review.

CONCLUSIONS

Based on the combined results of our study and literature review we may conclude that there is no evident benefit in performing mastoidectomy for the treatment of RP. In fact, no differences in ABG improvement or in RP recurrence were reported between the two groups.

COVID-19 Vaccination in Migrants and Refugees: Lessons Learnt and Good Practices

The COVID-19 pandemic has exacerbated inequalities between low- and high-income countries. Within the latter, a greater impact is seen in the poorest and most vulnerable people, including refugees, asylum seekers, and migrants. They all may experience poor access to quality healthcare or have suboptimal health-seeking behavior, distrust of governments, or fear of detention and deportation if seeking healthcare. Some refugees and migrants may face multiple barriers to vaccination and access to health systems that are relevant to the administration of COVID-19 vaccines, despite the growing inclusion of these populations in public health policies. Several good practices have emerged to ensure the inclusion of these populations in vaccination and healthcare for COVID-19 globally. However, inequalities persist between high-income and low-/middle-income populations. The inequalities in COVID-19 vaccination reflect the already existing ones in common health services worldwide. Further efforts are necessary to reduce such disparities, to protect the vulnerable, and, by extension, the general population. The initiatives organized, both at global and local levels, to support vaccination campaigns represent a notable example of how complex multilevel structures, such as health systems, as well as limited resource health services, can successfully face, even during a health emergency, the challenges related to global health issues.

Noise-Induced Hearing Loss in Police Officers: Systematic Review

Introduction

Noise-induced hearing loss (NIHL) is defined as the sensorineural hearing loss caused by acute acoustic trauma or chronic exposure to high-intensity noises. Exposure to noises can lead to irreversible damage to the inner ear and, consequently, to a permanent shift of the hearing threshold. Police officers are particularly at risk of acute or chronic hearing damages. The aim of this study is to evaluate the hearing loss of police officers in relation to the occupational risk factors and clinical-anamnestic characteristics by collecting and analyzing existing data and evidence available in public databases.

Materials and Methods

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses group (PRISMA). Studies were included if they met inclusion and exclusion criteria. Study selection, data extraction, and quality assessment were conducted independently by two researchers.

Results

Our initial literature search yielded 29 peer-reviewed articles. Out of 29 papers, only 10 were included in the review, after inclusion and exclusion criteria were applied the.

Conclusions

Hypertension, smoking and alcohol intake significantly affect hearing performance. In addition, a history of acoustic trauma, use of ototoxic drugs, exposure to noise in leisure-time activities and failure to use ear protectors are often found in a fair number of subjects. NIHL is also related to the age of the subjects as well as the extent and duration of noise exposure. Furthermore, NIHL is also influenced by shooting practice sessions police officers are required to undertake as well as by the chronic exposure to traffic noise, especially in motorcycle police officers.

Management of pharyngeal collapse in patients affected by moderate obstructive sleep apnoea syndrome

Objective

This study reports our experience in a selected cohort of patients affected by mild-moderate OSAS, without tonsillar obstruction, and treated with pharyngoplasty.

Methods

In a case-control retrospective study, we compared modified expansion sphincter pharyngoplasty (MESP) to modified barbed reposition pharyngoplasty (MBRP) in adult patients with oropharyngeal transversal collapse with a BMI ≤ 30 kg/m², and mild-moderate obstructive sleep apnoea syndrome (OSAS). A clinical evaluation, including collection of anthropometric data and sleep endoscopy, was performed. Six months after surgery, symptoms recording, clinical evaluation and polysomnography (PSG) were repeated.

Results

We enrolled 20 patients: 10 treated with MESP and 10 treated with MBRP. Mean apnoea-hypoapnoea index (AHI) was 22.8 (± 5.63). We observed in both groups a significant reduction of AHI and oropharyngeal obstruction (p = 0.01), with a success rate, according with Sher’s criteria, of 90% for MESP and 80% for MBRP, respectively. Post-surgical pain and snoring reduction were significantly lower with MBRP.

Conclusions

We recorded similar success rates for both techniques. MBRP may be considered better than MESP due to less surgical time, no potential mucosal damage, absence of knots, and faster recovery with less pain.

Tumours of Nasal Septum: A Retrospective Study of 32 Patients

Objective: Tumours of the nasal septum are a rare and heterogeneous group of lesions in the sinonasal tract. The management of the different lesions of this site is debated. The aim of this study is to share our experience on a rare clinical condition and stimulate other centres to publish theirs. Methods: We retrospectively analysed the databases of sinonasal tumours treated at the Sections of Otolaryngology (ENT) of two University Hospitals (Palermo and Genova) between 2012 and 2020. Results: From the two databases, a cohort of 32 patients with tumours of nasal septum were selected. All patients underwent an endoscopic examination. Large tumours underwent preoperative computed tomography (CT) scan without contrast medium. In 22 (68.7%) cases, the preoperative radiologic evaluation also included magnetic resonance imaging (MRI) with gadolinium to obtain a better differentiation of the lesions and study the vascular pattern. All the large lesions were biopsied under endoscopic guidance using local anaesthesia; the same approach was used to remove the tumours and their attachment with safe resection margins. Conclusions: While malignant lesions require an excision of the mass with resection of all layers of the nasal septum, benign lesions must be typed according to histological considerations in order to plan the most appropriate type of surgical resection.

SARS-CoV-2 Viral Load, IFNλ Polymorphisms and the Course of COVID-19: An Observational Study

The course of SARS-CoV-2 infection ranges from asymptomatic to a multiorgan disease. In this observational study, we investigated SARS-CoV-2 infected subjects with defined outcomes, evaluating the relationship between viral load and single nucleotide polymorphisms of genes codifying for IFNλs (interferon). The study enrolled 381 patients with laboratory-confirmed SARS-CoV-2 infection. For each patient, a standardized form was filled including sociodemographic variables and clinical outcomes. The host’s gene polymorphisms (IFNL3 rs1297860 C/T and INFL4 rs368234815 TT/ΔG) and RtReal-Time PCR cycle threshold (PCR Ct) value on SARS-CoV-2 were assessed on nasal, pharyngeal or nasopharyngeal swabs. Higher viral loads were found in patients aged > 74 years and homozygous mutant polymorphisms DG in IFNL4 (adj-OR = 1.16, 95% CI = 1.01–1.34 and adj-OR = 1.24, 95% CI = 1.09–1.40, respectively). After adjusting for age and sex, a statistically significantly lower risk of hospitalization was observed in subjects with higher RtReal-Time PCR cycle threshold values (adj-OR = 0.95, 95% CI = 0.91, 0.99; p = 0.028). Our data support the correlation between SARS-CoV-2 load and disease severity, and suggest that IFNλ polymorphisms could affect the ability of the host to modulate viral infection without a clear impact on the outcome of COVID-19.

[Breastfeeding in Sicily Region (Southern Italy): analysis of prevalence, of contextual inequalities, and of other associated risk factors]

OBJECTIVES

to describe the prevalence of breastfeeding in Sicily Region (Southern Italy) and to analyze the socioeconomic status and other major risk factors on the attitudes towards exclusive breastfeeding.

DESIGN

information on the practice of breastfeeding in Sicily have been collected from a Regional survey on Sudden Infant Death Syndrome (SIDS). An index of socioeconomic position was created by using data from the 2011 Census of the Italian National Institute of Statistics.

SETTING AND PARTICIPANTS

in May 2015, a questionnaire was distributed to all mothers accessing to immunization services in Sicily for the first vaccination of their children. Two hundred seventy-three (273) vaccination centres have been involved, and 2,692 questionnaires were administered.

MAIN OUTCOME MEASURES

five socio-economic levels were identified and, for each of them, the prevalence of breastfeeding and the risk factors for nonadherence to exclusive breastfeeding were described.

RESULTS

the prevalence of exclusive breastfeeding was 30.6%, unevenly distributed in the region, being the lowest in the Province of Messina (21.4%). Nonadherence to exclusive breastfeeding was associated with the disadvantage of the low context culture (χ2: 14.9), and was more common in the areas with higher socioeconomic deprivation index (odds ratio - OR: 1.81). Among other determinants investigated, being premature was a risk factor for not being breastfed (OR: 1.59).

CONCLUSION

the study confirms a low prevalence of breastfeeding in Sicily and its association with the socioeconomic level, being lower among women living in higher disadvantage areas. Moreover, this study confirms the association with co-sleeping practices (rooming-in and bed-sharing) for preterm babies. However, mother-child bed-sharing is not a guarantee for a successful breastfeeding, indeed being associated with a higher risk of SIDS. Finally, the study suggests the need for appropriate interventions focusing on specific high-risk groups.

Behavioral and clinical characteristics of people receiving medical care for HIV infection in an outpatient facility in Sicily, Italy

AIM

The authors examined a cohort of HIV-positive outpatients at the AIDS Center of Palermo University in Italy in order to identify factors related to the frequency of their visits to the outpatient facility for health care services.

METHODS

Two hundred and twenty-four HIV-infected subjects were enrolled in the study. Demographic and HIV disease characteristics were recorded and assessed with the number of days accessed to our outpatients unit in univariate and multivariate analyses. The potential relationship with immunological status was also analyzed stratifying the patients into groups according to their CD4(+) T-cell counts (≥500 vs <500/mm(3), and ≥200 vs <200/mm(3)).

RESULTS

Both univariate and multivariate analyses showed that duration of antiretroviral therapy <5 years and hypertension were significantly associated with a CD4(+) T-cell count of <500/mm(3), whereas geographic origin (Africa) was associated with a CD4(+) T-cell count of <200/mm(3). Mean number of days the patients sought access to day-care services for laboratory tests was negatively associated with CD4(+) T-cell count.

CONCLUSION

Patients with low CD4(+) T-cell counts showed higher use of health care services, demonstrating how early HIV diagnosis can help to reduce health care costs. The CD4(+) T-cell cut-off of 200 cells emphasizes the importance of identifying and managing HIV infection among hard-to-reach groups like vulnerable migrants. In our sample, the illegal status of immigrants does not influence the management of their HIV/AIDS condition, but the lack of European health card that documents the current antiretroviral status, could interfere with the efforts to eradicate AIDS. A better understanding of the major determinants of HIV treatment costs has led to appropriate large-scale actions, which in turn has increased resources and expanded intervention programs. Further guidance should be offered to hard-to-reach groups in order to improve early AIDS diagnosis, and procedures for identifying and managing these vulnerable subjects should be made available to care commissioners and service providers.

[Imported malaria in Sicily (Italy): epidemiology and recommendations for prevention]

This study analysed cases of imported malaria notified to the District Health Units of Palermo from 1998 to 2014. The aim was to assess epidemiological differences among cases, related to their reasons for travel. Eighty one cases were reported: 83% developed symptoms following a trip to Africa while 17% had travelled to Asia. Seventy-three percent of cases had travelled to visit family or friends in malaria-endemic countries (Visiting Friends and Relatives: VFRs), confirming the need for preventive measures targeted towards this at-risk population group.

Knowledge, Attitudes, and Practices on Energy Drink Consumption and Side Effects in a Cohort of Medical Students

The purpose of this study was to evaluate knowledge, attitudes, and practices concerning energy drink consumption and the prevalence of side effects among medical students. Twenty-two percent of respondents were regular users, particularly men (p < .0005). Users were younger (p = .027) and drank alcohol more frequently (p = .008) than "non-users." Forty-nine percent consumed alcohol associated with energy drinks. Forty-five percent of medical students declared side effects after energy drink consumption, such as palpitations (35%), insomnia (21%), and irritability (20%). The study confirms a large use of energy drinks among students and the occurrence of side effects. The use of energy drinks may influence the ingestion of large amounts of alcohol.

[Visiting friends and relatives (VFRs) role on imported malaria: a literature review]

OBJECTIVE

In the last decades, increased numbers of travel to tropical destinations in combination with the enormous influx of immigrants have led to an increased number of imported malaria cases in developed countries. There is a group of immigrants regularly resident in malaria free areas, which travel to malaria endemic countries to visit their friends and relatives (VFRs). VFRs represent a high-risk group of contracting malaria. Publications presenting original data on malaria in VFRs were selected for a literature review.

METHODS

We considered all data regarding prevalence of malaria in VFRs compared to the other groups of travelers, length of trip, group characteristics such as age, sex, country visited, and adherence to pre-travel recommendations, in particular, the compliance on the use of chemoprophylaxis, where such information was available. Studies related to malaria importation in VFRs in children and pregnant women were also included.

RESULTS

Review of the literature revealed significant variations in the proportion of VFRs among imported malaria cases which may be due to differences in immigrant populations across the reporting countries. However, in studies focused on those at higher risk such as children and pregnant women, the prevalence of imported malaria was significantly higher compared to other types of travelers.

DISCUSSION

Adherence to adequate preventive measures was low in VFRs. Significant reasons for not seeking pre-travel advice were economic and cultural issues, fear of the side effects due to chemoprophylaxis, and misconception about life-long immunity against malaria, and consequently, a low awareness about malaria risk. In order to implement preventive strategies focused on this high-risk group, prospective studies, which better define determinants of the risk of malaria in VFRs, are needed.

Visiting Friends and Relatives (VFRs) travelers and imported malaria in the Palermo district (Sicily)

INTRODUCTION

Although Italy has been malaria-free since 1970, the infection is commonly introduced into the country by travelers and immigrants from endemic areas. The term VFRs refers to immigrants from malaria-endemic countries who are regularly resident in a malaria-free area, and who travel to their countries of origin to visit friends and relatives (VFRs). This group is at special risk of malaria as they are unaware of having lost their transitory immunity to the disease.

METHODS

We conducted a retrospective study at the International Travelers Department of Palermo (Italy), examining records of malaria cases (67) reported over the period from 1998 to 2013.

RESULTS

VFRs represent the highest number of cases (77.6%), followed by workers (16.4%) and tourists (6.0%). All female patients and patients under the age of 18 were VFRs. Plasmodium falciparum was the most frequently-identified species. In all cases, chemoprophylaxis was not taken or was incomplete.

CONCLUSIONS

VFRs are at high risk of contracting malaria. This is probably related to an inequality in health care available to immigrants, as well as to ethnic and cultural conditions.