Vaccine-preventable diseases screening and vaccination programs for healthcare professions students

Background

Students in Healthcare Professions (SHPs) present an increased risk of contracting and transmitting Vaccine-Preventable Diseases (VPDs). Our study aimed to investigate the organizational strategies (screening and immunization for VPDs and vaccination promotion among SHPs) implemented by the healthcare facilities accredited with the University of Milan.

Methods

we sent an e-survey by e-mail to medical residents and first- and last-year students in nursing, midwifery and healthcare assistance.

Results

among 3397 invited SHPs, 645 participated. We included in the analysis 522 SHPs, distributed in 24 facilities across the Lombardy region (mean age 27,4 years; 69,5% female; 69% medical residents, 28% nursing, 2% healthcare assistance, and 1% midwifery students). Although most participants underwent occupational health visit before the traineeship start (47,5%) or within 6 months (29,5%), others hadn't undergone yet (15,1%). The visits included the collection of vaccination history (72,6%; 64,6% from written documentation), serological tests for VPDs (hepatitis B 76,1%, measles and rubella 58,4%, varicella 54,4%), and screening for latent TB (69,7%). Vaccinations were recommended to 226 participants, but only 173 fully (76,5%) or partially (8%) complied. Full compliance was associated with nudges like in-hospital (Chisq. 18,7; p = 0.00) and free vaccinations (Chisq. 31; p = 0.00). Reported facility vaccination policies included campaigns (posters 37,4%, intranet 39,5%, social media 11,5%, general/personalized letters 30,3%/11,5%), time-off incentives (7,7%), on-site (30,5%) and opinion leaders' vaccinations (9,8%). However, SHPs were often unaware of those strategies (mean 48,6%), and intra-facility answers were sometimes discordant (agreement <70% for facilities with >30 respondents).

Conclusions

SHPs are often unaware or discordant regarding vaccination policies carried out by traineeship facilities, suggesting the need of inclusive communication strategies.

Key messages

About half of students in healthcare professions are screened for VPDs after the start of the traineeship. Students in healthcare professions are often unaware of vaccination promotion strategies.

A reasoned action approach to understand vaccination intention among healthcare professions students

Background

Understanding the predictors of vaccination intention among healthcare workers, including students in healthcare professions (SHPs), is crucial for policy making and for the development of evidence-driven training programs. The reasoned action approach (RAA) model includes three components to predict intention: attitude (experiential/instrumental), perceived norm (injunctive/descriptive), and perceived behavioral control (capacity/autonomy). We aimed to investigate the predictors of seasonal Flu vaccination intention among SHPs of the University of Milan.

Methods

We spread an e-survey to all medical residents and first- and last-year SHPs (medicine, nursery, midwifery, healthcare assistance and prevention techniques). The strength of association between measures of RAA components (as well as sociodemographic data, past vaccination behavior, vaccination knowledge, and perceived vaccination facilitation strategies), and vaccination intention was estimated using uni- and multivariate logistic regression models.

Results

Among 5743 invited SHPs, 884 participated in the survey and were included in the descriptive analyses (52,3% medical residents, 19,9% medicine, 21,1% nursing, 3,6% healthcare assistance, 2,7% prevention techniques and 0,5% midwifery students). Twenty-nine psycho-attitudinal items with an overall Cronbach alpha >0.7 were included in the analyses. The regression analyses were performed on 751 subjects who filled in completely the survey. Past vaccination behavior, vaccination knowledge, experiential attitudes, and perceived vaccination facilitation strategies were positive predictors of Flu vaccination intention (OR 8.16, 2.42, 1.96 and 1.15 respectively, p < 0.05).

Conclusions

Our results indicated knowledge, experiential attitudes and facilitation strategies as modifiable predictors of vaccination intention among SHPs. Targeted and lasting interventions are needed in order to pursue a change in the strongest predictor, past vaccination behavior.

Key messages

Past vaccination is the strongest predictor of vaccination intention among students in healthcare professions. Knowledge, attitudes and perceived facilitators predict vaccine propensity among students in healthcare professions.

Vaccination and immunization status among healthcare students: results from the SAVES survey

Background

Adequate vaccination coverage among healthcare workers, including students in healthcare professions (SHPs), is crucial in order to prevent spreading of infections within healthcare facilities. However, vaccination coverage among SHPs is often inadequate. We aimed to describe the vaccination/immunization status of SHPs of the University of Milan.

Methods

We spread an e-survey to the academic e-mail addresses of postgraduate medical residents and to first- and last-year undergraduate SHPs. The questionnaire covered sociodemographic data (age, sex, education, municipality of residence, internship in high-risk wards) and the reported vaccination/immunization status for Influenza (previous flu season), Varicella, MPR and DTaP vaccines.

Results

Among 5743 invited SHPs, 884 participated in the survey. The study sample comprised 462 medical residents and 422 undergraduate SHPs (medicine 176, nursery 186, midwifery 4, healthcare assistance 32, prevention techniques 24). Median age was 27 years (IQR 7); 68.4% participants were female; 91.3% had attended high school in a lyceum, while others in a professional (2.9%) or technical (5.8%) institute; 36.7% lived in municipalities of < 20.000 inhabitants, while 26.1% of > 250.000. Traineeships took place in high-risk wards for 46% of participants. Reported vaccination coverage for Influenza was 33,7% (with higher coverage for pediatric nursing and midwifery students, medicine students and medical residents). Participants reported immunity (either vaccine or natural immunity) to Varicella in 93,3% cases. Declared vaccination coverage for Hepatitis B was 94,1%; 91,7% participants reportedly completed the MPR schedule, 76,2% the recommended DTaP booster.

Conclusions

Influenza vaccination coverage was suboptimal in our sample of SHPs, suggesting the need of specific educational programs and targeted vaccination campaigns, which may help shaping a positive vaccination attitude for future healthcare professionals.

Key messages

Immunization status for VPDs is suboptimal among Italian students in healthcare professions. The monitoring of the immunization status should include healthcare students actively involved in healthcare activities.

[Lactic acidosis and severe hyperkalemia in a diabetic patient treated with metformin and enalapril: influence of acute renal disease and drugs]

A 71 year old hypertensive and non insulin-dependent diabetic patients with moderate renal insufficiency taking 500 mg/d of metformin and 5 mg/d of enalapril, developed metabolic acidosis characterized by fairly elevated anion gap, hyperchloremia, severe hyperkalemia, normal plasma level of beta-hydroxybutyric acid, absence of ketonuria and high plasma level of lactic acid. This biochemical feature allowed us to ascribe the pathogenesis of metabolic acidosis both to the increased plasma level of lactic acid and to the type IV renal tubular acidosis syndrome, the precipitating factor being an infection of urinary tract (as we assumed on the basis of the urine culture). The patient was dehydrated and lethargic; the ECG revealed the presence of nonparoxysmal junctional tachycardia. The clinical evolution was favorable thanks to the treatment with the infusion of isotonic saline solutions, mild alkalinizing solutions, low-dose regular insulin and antibiotics. It is likely that metformin and enalapril, regularly assumed by the patient, could have played a iatrogenic role even if they were taken in low dosages. This event points out the importance of complying with the indications and especially the contraindications of these drugs, to avoid life threatening complications as that one occurred in this case.

[Major histocompatibility complex antigens in a population of insulin-dependent diabetics living in the Province of Varese]

The HLA haplotype was studied in 143 newly diagnosed insulin-dependent diabetic subjects resident in the province of Varese who attended the clinic between March 1987 and June 1993. The frequency with which the various loci of the histocompatibility system were observed was compared with that reported in 83 non-diabetic subjects not related to the diabetics taking part in the study. The relative risk (RR) was calculated using these data and its statistical significance was assessed using the chi-square test. 70.6% of subjects were positive for loci DR3 or DR4, whereas only 7.7% (11 subjects) were found to be carriers of eterozygous DR3-DR4. This percentage is lower than that generally reported in the literature. However, even in the authors personal experience heterozygous DR3-DR4 subjects represent the greatest relative risk in absolute terms (RR = 14.49). The presence of antigen DQw2 is strongly indicative of the disease, both when it is found in an isolated form and in association with DR3 or DR4 (RR = 2.56, 4.03, 3.29 respectively). The DR3/DR4/DQw2 axis gives a RR of 9.17. The associations of B8/DR3/DR4 and B8/DR3/DQw2 give a RR of 9.17, whereas the B8/DR4 axis gives a RR of 10.47. In this series, the lowest risk of developing the disease was provided by the DR2/DR7 axis (RR 0.28); DR2 alone gave a RR of 1.84 and DR7 alone gave a RR of 0.62. The discrepancies reported with the literature may be related to ethnic variations, thus giving added weight to the hypothesis of the heterogeneity of insulin-dependent diabetes mellitus.

Serum lipid pattern as severity indicator of angiographically assessed coronary artery disease

In this study we compared the relative utility of plasma lipid and apolipoprotein pattern as predictor of extent of Coronary Artery Disease as angiographically established. The lipid and apolipoprotein values were plotted in multiple stepwise analysis against coronary score determined as follows: at least 1 coronary artery system (left, anterior, descendent, circumflex, right) with a >/= 25% stenosis 1 point, number of involved vessel 1, 2, 3, .... adjunctive points; sequential lesions +1 point; < = %50% stenosis +1 point; 75-95 % +2 points; > 95% +3 points. The statistical analysis demonstrate a strong influence on extent of disease by total-cholesterol, % HDL-cholesterol on total cholesterol and by the difference between LDL and HDL-cholesterol. We conclude that, in predicting the extension of CAD, is important to know how total cholesterol is distributed in plasma apolipoprotein system.