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Background: The aim of the study is to describe temporal trend, distribution and characteristics of new HIV infections detected in Puglia Region in years 2007-2011., Methods: Case surveillance data for all individuals newly diagnosed with HIV infection in these years were analysed. Risk factors associated with late presentation at diagnosis were analysed by multivariate logistic analysis., Results: In the years 2007-2011 a total of 632 new diagnoses of HIV infection were notified. 573 (90,7%) of all cases were residents (83,8% Italians, 16,2% migrants). Among residents, 76,8% were males (median age 36 years), 23,2% females (median age 30 years). On the whole, 58,3% were late presenters (LP) and 40,8% were subjects with advanced HIV disease (AHD). At multivariate analysis, older age and being a migrant were risk factors significantly associated with late presentation at diagnosis., Conclusions: Clinical-epidemiological analysis of new HIV diagnosis/infections in Puglia shows a high proportion of LP and AHD. The results of the study strongly suggest the need to promote access to counselling and screening services of subjects at high risk of late presentation for a better targeting of information campaigns.

Background: The objective of this study is to describe the knowledge and skills of managers working in health organizations in the Region of Puglia (South of Italy) on the principles and tools of clinical governance., Methods: A KAP (Knowledge, Attitudes and Practice) survey was conducted using a questionnaire. The target population of the survey was represented by Hospital Directors and Managers of local health care structures (Primary Care Districts, Public Health Departments, and Mental Health Departments)., Results: 92 managers participated at the study (response rate was 90.2%). 98.9% of respondents reported being aware of the concept of clinical governance and believe that clinical governance is an appropriate strategy for the continuous improvement in quality of services. 96.7% of respondents had heard of Evidence Based Practice and 80.6% reported using the method of EBP in nursing practice. The availability of guidelines for consultation was reported by 54.9% of respondents. Of those interviewed, 79.8% knew about Health Technology Assessment. 95.5% reported they have heard of clinical audit and 98.9% knowing the concept of risk management., Conclusion: In our survey, an high value judgment about clinical governance was reported by medical managers. The lower attitudes towards the use of the tools of clinical governance highlights an important discrepancy with respect to knowledge and opinions, which becomes more evident in community care structures. Above and beyond training managers, it is also necessary to change training methods used on all health personnel, which should be oriented towards EBM in order to build an adaptable organizational climate.

In Italy there have been several court appeals registered, which have been driven by individual convictions or group actions or movements and were aimed at obtaining exemption from the obligation to comply with compulsory vaccinations required by law. The aim of the present paper is to provide a quick review of the sentences resulting from activating these disputes, in order to contribute to the debate on overturning compulsory vaccination. The Jurisprudence of the Italian Constitutional Court has repeatedly confirmed the judgment on the constitutionality of rules on obligation, clarifying that only where specific reasons exist that make vaccinating the individual dangerous may non-compliance with the rules on compulsory vaccination be justified. This is in contrast with the case law on enforcement of compulsory vaccination, through the temporary suspension of parental authority. Taking responsibility for promoting immunisation decisions away from Public Health Services and handing it to the courtroom is not advisable, given the very small benefit. The problem must be placed under the careful attention of the Health Service due to communicative implications, which can be serious during the transition from a compulsory system of immunisation to a voluntary one.

Several studies recommend the Mediterranean diet and daily physical activity to prevent cancer development. These recommendations, however must be transformed into public health structured programmes, so that they assume operational effectiveness. The aim of the diet and lifestyle intervention called Med-Food Anticancer Program (MFAP) is to promote the Mediterranean diet and physical activity in the adult population. In particular; the target for participants in the intervention is the increased consumption of legumes, fish, whole grain bread and cereals, fruits and vegetables, and the decreased consumption of meat, cheese and foods of animal origin. At the same time, it is recommended to make at least ten thousand steps a day. Two studies have shown the effectiveness of MFAP.

The 1853 Vaccination Act, adopted in England during XIX century, was the first law about compulsory vaccination in Europe. The Act caused a violent movement of opposition with the birth of Victorian anti-vaccination. The modern anti-vaccination movement was born in 1998 following a paper of Andrew Wakefield published in the Lancet. In this paper Wakefield illustrated a study of twenty patients and concluded that the administration of the MMR vaccine caused autism and some forms of colitis. The publication was later disowned by almost all authors. However the study of Wakefield caused a reduction of compliance to the anti-MMR vaccination in the United Kingdom, resulting in lower coverage and new outbreaks. The theorethical principles of anti-vaccinationists of 19th and 20th century were: the hypothesis that vaccines cause illnesses; the presence of toxic substances in the vaccine; the violation of freedom Personal and People's; the ineffectiveness of vaccinations. Moreover, anti-vaccinationists always refused the scientific methods and the peer-review of their scientific studies.

The reform of the Vth Title of the Italian Constitution has given the Regions autonomous power over planning of their immunization programme and immunization calendar. This amendment has federalized Italy's vaccination system and, is justified by epidemiological evidence however casts doubt on its provision of equal rights to health care. The objective of this current study is to gain insight into the opinion of vaccine services officers in the Apulia region on federal immunization and the regional immunization programme. Research was conducted using an anonymous standardized questionnaire to which 302 vaccines services staff responded. 67.4% of respondents believe that the current federal vaccination programme should be maintained, whilst 20.2% believe that the current system should be eradicated and 12.4% believe it should be phased out gradually. The current apulian vaccination calendar provides free and active immunizations for all newborns for the pneumococcal, meningitis C, chickenpox and hepatitis A vaccines. The interviewees believe that the vaccinations provided in the regional immunization programme are very important (average importance out of 10 = 6.1/7). The positive response to the regional vaccination plan given by the health officers explains, at least in part, the conservative attitude tewards federal vaccination plans. It cannot be excluded that sacrificing regional autonomy over vaccination programmes might be considered by the vaccination officers as being responsible for the abandonment of the Region's long established immunization practices. The success of these practices is evident in the case of the Region's Hepatitis A immunization programme where the active provision of this vaccine has drastically reduced the endemicity of the illness in Apulia. These experiences of good practice should be adequately considered in before opting to phase out the current immunisation programme.

About 180 million people are affected by Diabetes mellitus all over the world and 1.7 million in Italy; it has been rated that numbers could double within 20 years. In Italy, diabetes is the third reason of chronic renal insufficiency, the second of blindness, and it increases cardiovascular mortality by 30%. In Apulia Region, there are about 17,000 hospitalizations/year because of diabetes (rate = 6.4 x 1,000 inhabitants, average age = 60 years) and this is the second disease reported in case of a cerebral and/or cardiovascular ischemic events. During 1995, general practitioners (GP) and diabetes specialists (DS) stared to create a strategy to improve the care of diabetic patients. Integrated care, patients' involvement and the use of shared therapeutic protocols were the main characteristics of this strategy. In 2005, started from these points, the "Italian National Active Prevention Plane" redefined a strategy based on the use of electronic database and the systematic updating of GP and DS. The better work organization, the costs reduction and the care improvement are the main benefits expected by the new strategy while the lack of short term results is the main difficulty met during the unrolling of the Plane. Short term results could be: a quick identification of patients in general and bad aided patients in particular and a discovery of the complications in the right time. The hygienist, with his cultural structure, is the best medical figure to organize the activities of Plane and pledge the results.

HPV infection is common in sexually active women and is an important risk factor for cervical cancer. The aim of this article is to describe the prevalence of HPV infection, the incidence and the mortality rates for cervical cancer and adherence to screening programs in Apulia in the light of recent introduction of anti-HPV vaccines. The prevalence of HPV was evaluated testing biological samples from 1082 women. The 33% resulted positive for HPV (80% for high-risk genotypes and 20% for low-risk genotypes). The 59% of positive samples showed only a single viral type while 37% multiple genotypes. In Apulia, from 1998 to 2005, a total of 1849 women were hospitalized for cervical cancer with a decreasing trend; the 46% had exo cervical cancer; the 22% endocervical cancer, 29% cancer of cervix without specification and 3% infiltrating cervical cancer. The mortality rate was 1,5 x 100.000. Data from PASSI study regarding cervical cancer screening showed that 62% of Apulian women 25-64 years aged had a Pap smear and 54.7% get it every three years. The viral genotypes circulating in Apulia region are present in anti-HPV vaccines; this item could give information on their introduction together with actions to implement the adherence to screening program that results lower than international standard.

Obesity represents one of the most worrying public health concern of the last decades. The objective of the present work was to find out more about the real risky habits of teenagers, in order to think of specific educational programs. The research sample was composed of 721 respondents (aged 11-13 years old) attending the primary schools located in Martina Franca (TA). More than 70% of the sample was formed by normal weight individuals, 24.5% was composed of overweight individuals, 5.5% were obese. The relevant differences existing between normal weight and overweight individuals are basically due to the different daily meals organization and to the specific vegetable consumption habits. More than 83% of normal weight individuals have breakfast in the morning, while among the overweight only 75% do it (OR = 0.6; 95% IC: 0.4-0.9; p < 0.01); more than 94% of normal weight kids have snack breaks between the main meals, while only 82% of overweight respondents are used to do it (OR = 0.2; 95% IC: 0.15-0.43; p < 0.01). 36% of the overweight eat vegetables everyday, among the normal weight 45% eat them (chi2 = 12.5, p < 0.05). No relevant differences in the extra school time management. The main outcome of the present study is that kids basically follow a common eating behavior: high carbohydrates and proteins consumption, low fruit and vegetables consumption, few time spent in physical activities. This is why it is strongly recommended to develop educational programs targeted to individuals in this age range.

A growing desire among women to move away from interventions and hospitals to more "natural" childbirth has emerged over several years. The role and autonomy of midwives, a favourable opinion among women about home childbirth and better cooperation between hospitals and district health facilities are all fundamental in order to implement a home birth project. The opinion of women about "planned" home birth was investigated in the Puglia region through a survey conducted among a sample of women who had just delivered in hospital and a representative sample of the general female population. From 20 to 30% of women in the Puglia region would be basically in favour of home birth project. The main difference between the two groups of women concern the higher proportion of caesarean deliveries among mothers who had just delivered and their demand for more specific training of involved health personnel. Both samples are agreed on the specific training of women during pregnancy and on the presence of a specialist during home delivery. The results of the investigation seem to be in favour of planning a home birth project in the Puglia region.

Public health passive surveillance systems are often affected by low sensitivity level. Enhancement of the reporting by general practitioners is important to improve the sensitivity of notification system. The aim of this work was to evaluate the mandatory notification activities of communicable diseases by general practitioners (GPs) and family pediatricians (FPs) in the Local Health Unit Bari/4, during the years 1999-2000. This study shows that GPs and FPs notified only 39% and 28% of notifiable diseases respectively in 1999 and 2000, although some of these diseases have a very low hospitalization rate. The majority of doctors never notified any case of infectious disease during the period. The study shows also that the doctors who was older and who had larger list of patients had a greater compliance regarding notification. Therefore, a specific training of family doctors and a better facility in the notification procedures (for example, by phone or e-mail) should be very important to improve the sensitivity of surveillance system.

An investigation about N. meningitidis carriers was carried out in Apulia (Italy) among teen-agers. 85 healthy carriers were identified (1.4%): the 81.2% of isolates resulted polyagglutinable, 3.5% autoagglutinable and 1.2% were not classifiable with antisera. The other strains belonged to serogroup B (9.4%), W135 (2.3%), Y (1.2%) and 29E (1.2%). Some Authors report that non-groupable strains are usually isolated from healthy carriers pharynx. The most recent molecular methods permit to subdivide these bacteria in serotype and serosubtype by membrane protein antigens, too. So, today the only identification as serogroup is not able to study N. meningitidis epidemiology.

Hepatitis E virus (HEV) is the causative agent of an enterically transmitted viral hepatitis associated with inadequate hygienic conditions. Hepatitis E is endemic in developing countries where it occurs both in sporadic and epidemic form. Outbreaks have been reported in different areas of the world. The aim of the present work was to assess the seroprevalence of HEV infection in the general population and in different risk groups in the area of Lecce. The presence of anti-HEV antibodies was ascertained by qualitative ELISA (Abbott HEV EIA) and Western Blot (Recomblot HEV IgG/IgM, Mikrogen). The prevalence of anti-HEV in the general population was 2.9% while in intravenous drug users, hemodialized patients and immigrants the seroprevalence rates were 0.7%, 4.3% and 15.3% respectively. Our data show a circulation of HEV at low level in the area of Lecce which is endemic for hepatitis A. Higher seroprevalence rates were found in hemodialized patients and remarkably in immigrants coming from endemic areas like Turkey.

Surveillance of acute flaccid paralysis (AFP) is the milestone to monitor the progress toward poliomyelitis eradication aim, fixed by WHA in 1988. Active AFP surveillance started in Apulia in 1997; this work evaluates five-year period activities. In this period, the total number of cases notified was 48, 7 of which were resident out of Apulia. Twenty-five were males and 23 females; the age ranged between 1 month and 15 years. Any collected serum specimens showed protective antibody levels against polioviruses. Polioviruses type 1 and type 2 Sabin-like were isolated from stool samples collected from two AFP patients. AFP surveillance targets improved in the years, with only exception, in 2001, of second serum specimen collected within 14 days because of children were discharged earlier form the hospitals. Apulia experience demonstrates the achievement of good levels of AFP surveillance targets. System sensitivity has been optimal in 2001 with a number of notified cases threefold the expected value and adequate specimen sampling (80%). Additional involved hospitals and availability of increased and dedicated human resources contributed to this outcome. The effort to achieve WHO targets for AFP surveillance needs to be maintained in next years until global certification of eradication will be declared.

Epidemiological surveillance represents an important tool for the prevention of hepatitis A. In Italy, the surveillance of hepatitis A is based on the routine notification system of infectious diseases (from 1996 it was replaced by SIMI, Computerised System of Infectious Diseases) and on SEIEVA (Epidemiological Integrated System of Acute Viral Hepatitis). From 1997 to 2000 the two surveillance systems have been compared in Puglia region to evaluate match rate, completeness and sensitivity. A total of 7.018 records from SIMI and 4.413 from SEIEVA have been analyzed. During this period, the 37.0% of cases notified to SIMI match SEIEVA records whereas the 58.8% of cases reported to SEIEVA match cases notified to SIMI. Therefore, the match rate between the two systems was 29.0%. The sensitivity of SIMI and SEIEVA resulted 79.4% and 49.9% respectively. The comparison of the two surveillance systems allowed to recognise problems in local organisation. Therefore, a more adequate training should be supplied to workers involved in the surveillance activities.

Salmonellosis is one of the most common forms of foodborne infection. An outbreak of gastroenteritidis associated with a wedding party was investigated, even to value the costs falling on individuals, the health services and society as a whole. One hundred and fifty nine wedding guests were interviewed by phone. Multivariate analysis was used to assess which food were significantly associated with infection. One hundred and thirteen cases were identified; ten stool samples were culture positive for Salmonella enteritidis. Handmade ice-cream and babà (a typical Italian pastry) were significantly associated with infection. The cost of a case was estimated to be between US $ 74 (for non hospitalised patients) and US $ 1,896 (for hospitalised patients). The outbreak was caused by a strain of Salmonella enteritidis and the vehicle of infection were unpasteurised eggs used to prepare the ice-cream. The economic impact of this outbreak was considerable and mainly due to the hospitalisation.