In Italy, vaccination against seasonal influenza has been recommended for the elderly since 1980, but coverage is still far below the WHO minimum target level of 75%. Effective interventions to ...improve influenza vaccination should take into account socioeconomic determinants of inequalities in vaccine uptake. This study aimed to assess differences in vaccination coverage, by socioeconomic status, among people ≥ 65 years of age residing in the Foggia municipality, Italy.
A Socio-Economic-Health Deprivation Index (SEHDI) was constructed by using a multivariate analysis model. The resident population, for census block, was classified in 5 deprivation groups. Differences in demographic and socioeconomic indicators, the standardized mortality ratios (SMRs), and the average vaccination coverage among deprivation groups were evaluated with the linear F-test. The association between census variables and influenza vaccination coverage, in each deprivation group, was assessed using the Pearson bivariate correlation.
The SEHDI allowed to identify factors related to ageing, housing, household size and composition, and education. Forty percent of people residing in the Foggia municipality lived in conditions of socioeconomic and health deprivation. Belonging to families with 3 or 4 members was associated with increased coverage rates. In the most deprived group, vaccination uptake was positively associated with the dependency ratio.
The results of this study have shown that there is still large room for improving influenza vaccination coverage among subjects belonging to the most deprived areas. Surveillance of trends in influenza vaccine uptake by socioeconomic groups is a feasible contribution to implementing effective, tailored to the frail older persons, vaccine utilization programs.
Abstract
Background
Since 2011-2012, the ECDC coordinates the measurement of Healthcare-associated infections (HAIs) and antimicrobial use (AMU) in European acute-care hospitals through repeated ...point prevalence surveys (PPS) every five years. Here we present the main results of the 3rd ECDC-PPS conducted in Apulia region, Italy, during November 2022, in comparison as a benchmark with data from Italian PPS 2016-2017.
Methods
The ECDC protocols were applied. Prevalence of HAIs and AMU was expressed as percentages. Proportion of isolates resistant to selected AMR markers were also calculated.
Results
Twenty-four/39 Apulian hospitals provided data on 3,710 patients. The prevalence of patients with ≥1 HAI was 9.9% (PPS-2016-17:8.03%). The highest prevalence was recorded in rehabilitation wards (31.6%; PPS-2016-17:16.4%), in large hospitals (10.5%; PPS-2016-17:9.3%), among elderly (11.2%; PPS-2016-17:9.1%), males (11.1%; PPS-2016-17:7.9%), and patients with a rapidly fatal McCabe score (28%; PPS-2016-17:18.8%). The most reported types of HAI were pneumonia (19.8%; PPS-2016-17:22.8%) and urinary tract infections (18.3%; PPS-2016-17:18%). Prevalence of patients with ≥1 antimicrobial was 49.3% (PPS-2016-17:44.5%). At least a positive microbiological result was reported for 66.1% of the HAIs (N = 244/369; PPS-2016-17:53.8%). Klebsiella pneumoniae (14.9%; PPS-2016-17:10.4%) and Escherichia coli (9.8%; PPS-2016-17: 13%) were the most frequently isolated microorganisms. The susceptibility tests were available for 56% of microorganisms (N = 177/316) and a resistant result was reported for 50.3% (PPS-2016-17:42.3%) of tests.
Conclusions
HAI, AMU, and AMR prevalence estimated in Apulia region was higher, when compared with previous national PPS. Efforts in implementing antimicrobial stewardship and reducing HAIs should be established.
Key messages
• HAI and AMR remain a major public health threat in Apulia region, particularly for K. pneumoniae and E. coli.
• Frail patients bear a greater burden of illness.
Department of Cardiac Surgery, University of Naples Federico II, Via A. Falcone 258, 80127 Naples, Italy
*Corresponding author. Tel.: +39-0817462278; fax: +39-0817462501. E-mail address : ...mariomonaco55{at}libero.it (M. Monaco).
Objective : Blood coagulation and fibrinolytic system changes after endovascular repair (EVAR) of aortic pathologies are of great interest. We have examined the risk for consumption coagulopathy and its clinical implications early, and at a mid-term follow-up, in a prospective study. Methods : From June 2002 to June 2004, 41 patients for abdominal aortic aneurysm (AAA), 16 for thoracic aortic aneurysm (TAA) and 13 for acute type-B dissection underwent EVAR. Plasminogen, fibrin degradation products (FDP) and D-dimer were monitored as markers of fibrinolysis. Platelet count, fibrinogen, antithrombin III and prothrombin were assayed as markers of coagulation. The aortic diameters were assessed by computed tomography (CT) scan. Results : FDP and D-Dimer levels significantly increased, while plasminogen values significantly decreased, on postoperative day 1 and 5, coagulation parameters significantly decreased on postoperative day 1 and 5. All parameters recovered on the 1st month of follow-up, except fibrinogen levels that showed a significant increase on month 1 and 6. We did not observe clinical complications related to coagulative disorders. There was no correlation between the preoperative diameter and the coagulative and fibrinolysis variations in the AAA and TAA group. Type-B dissection patients showed a significant correlation between the preoperative presence of a large false lumen and a high level of fibrinolysis. Conclusion : EVAR leads to changes in coagulation and fibrinolysis, with characteristic developments. These latter have no clinical relevance and have no effect on early outcome and on mid-term follow-up.
Key Words: Aortic aneurysm; Type-B dissection; Stent-endografting surgery; Blood coagulation
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ICVTS on-line discussion A
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Interactive CardioVascular and Thoracic Surgery 2006 5: 729.
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Objective To describe our experience of endovascular repair of paraanastomotic aortic aneurysm. Methods and results From March 2001 to December 2004 we identified 6 patients with a paraanastomotic ...aortic aneurysms following previous open repair of abdominal aortic aneurysm. All patients were treated with endovascular surgery under epidural anaesthesia. There were no major complications, surgical conversions or deaths. Four patients received a bifurcated aortic stent-graft, and two an aorto-uniliac stent-graft followed by a femoro-femoral bypass. At follow-up (mean 26.1 ± 10.2 months) there were no deaths, endoleaks or graft migrations observed. Conclusion Endovascular surgery, avoiding general anesthesia and re-laparotomy, is the ideal technique for treatment of this complication resulting from failed primary conventional AAA repair.
This paper presents a single-chip mixed-signal IC for a hearing aid system. The IC consumes 270 mu A of supply current at a 1.1-V battery voltage. The presented circuit and architectural design ...techniques reduce the total IC power to 297 mu W, a level where up to 70 days of lifetime is achieved at 10 h/day for a small zinc-air battery. The measured input referred noise for the entire channel is 2.8 mu Vrms and the average THD in the nominal operating region is 0.02%. The jitter for the on-board ring oscillator is 147 ps rms. The chip area is 12 mm super(2) in a 0.6- mu m 3.3-V mixed-signal CMOS process.
We studied factors influencing early and late results in patients operated on for aortic valve replacement and coronary artery bypass graft.
175 patients were retrospectively analysed over a 10-year ...period ending in December 2002. There were 135 males and 40 females with a mean age of 62.7 +/- 8.9 years; 109 were in NYHA class III/IV; 45 required an urgent operation, and 103 mechanical valves and 72 biological valves were implanted.
There were 11 operative deaths (6.3 %). Statistical analysis (logistic regression) showed that previous myocardial infarction, poor NYHA class, and low LVEF had a significant effect on early death. There were 52 late deaths at a mean follow-up of 82.7 +/- 38.8 months. Using a Cox survival analysis for any causes, age, urgent operation, low LVEF, and creatinine had a strong impact on unfavourable late outcome.
A combination of a patient-related factor (age), cardiac-related condition (low LVEF), co-morbid condition (renal dysfunction), and operative cause (urgent operation) is the most important predictor of late clinical outcome for this combined surgical procedure.
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