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The Italian National Vaccine Prevention Plan (PNPV) of 2017-19 and subsequent mandatory vaccination law (Law 119/2017) both occurred in the context of a progressive decrease in vaccine coverage levels in Italy and led to important policy changes, including the introduction of new vaccine recommendations and increasing the number of mandatory vaccinations in childhood from four to ten. A survey on a sample of 446 Italian health care workers (HCW) was carried out in order to assess their opinions on policy changes introduced by the PNPV and by the mandatory vaccination law. The convenience sample was selected among participants in a training course on vaccination counselling. The large majority of participants expressed overall satisfaction about the policy changes introduced by the PNPV but some highlighted pitfalls related to its implementation. Moreover, the majority of HCW believe that vaccination coverage for both recommended and mandatory vaccinations has increased thanks to Law 119/2017, therefore expressing a positive attitude towards the enforcement of vaccine mandates.

Rotaviruses (RV) are the most common etiological agents in acute gastroenteritis (GE) in children in the first years of life. Data from the national scientific literature show that RV is responsible of 26% of all cases of hospitalisation for diarrea in children, resulting the most frequently identified agent. The Italian database of hospital discharge, freely available from the web site of the national Ministry of Health, was searched to investigate the epidemiology of RV gastroenteritis. The mean number of hospitalisation for RV enteritis in children in the first 4 years of live was 4.758 in the years 2001, 2002 and 2003, representing 84% of viral enteritis. RV was identified as agent in 17% of all intestinal infectious diseases in this age group. This percentage shows the important role of RV in severe gastrointestinal infections; it is however much lower than the value expected from specifically performed surveys. This underestimation may be attributed to the high number of undefined gastroenteritis found in the database (54%), to the scarce sensitivity of the hospital discharge code, and to the fact that the analysis was performed using only the principal diagnosis. A specific immunisation strategy, safe, effective, cost-effective and easy to perform, could have a great impact on the incidence of the disease and on the associated costs.

Cataracts are a common condition and represent a frequent cause of visual disability. Nevertheless, data regarding the incidence of cataracts and the progression of and loss of vision due to cataracts is scarce. In this study, hospital discharge abstract data was evaluated to estimate the frequency and type of hospitalisations for cataract surgery that occurred in the Puglia region in the years 2000-2002. The results of this study confirm that cataract surgery accounts for a relevant amount of regional healthcare system costs. In fact, every year, over 25,000 lens surgery procedures, most of which age-related, are performed in the Puglia region. Approximately 90% of such procedures involve cataract surgery; age-specific hospitalisation rates show very high rates in the > 50 year old population. Only 25% of total cataract extractions were performed as a day-surgery procedure and the mean length of hospital stay was found to be 2.5 days. This confirms that inappropriate hospitalisations, with respect to both type and duration, do occur. Cataract surgery is performed in over 30 hospitals in Puglia; the availability of health facilities in the region, therefore, seems to be satisfactory. In fact, on average, in the three-year period, only 7.5% of cases underwent the procedure outside the Puglia region.

Hip arthroplasty is one of the major achievements of orthopaedic surgery. In the Puglia region the demand for this procedure is moderately met. This study evaluates the regional distribution of hip arthroplasty procedures in Puglia in the years 1996-2003. Demand and supply was estimated through analysis of discharge abstract forms. Between 1996 and 203, 21,392 hip arthroplasty procedures were performed. of these, 12,491 (58,4%) were total hip arthroplasties, 7,742 (36,2%) were hip endoprostheses and 1,159 (5,4%) wee revisions. The median age of patients undergoing any of these procedures was 70 years and the proportion of females was almost double that of males (64%). The main indication was primary osteoarthrosis and 52,1% of all procedures were performed in the province of Bari. The average annual crude hospitalisation rate for hip arthroplasty procedures was 75,9 cases/100.000 inhabitants; this rate places the Puglia region in an intermediate position with respect to other Italian regions and is lower than that found in the literature. Discharge abstract forms are currently the sole source of data regarding hip arthroplasty procedures and this presents several limits. This factor, in addition to the complexity and high costs of these procedures and to the increasing average life expectancy of the general population all point to the need for a regional Hip arthroplasty Register, which would allow better planning for patients.

One of the more important aspects of the psychiatric care reform in Italy has been the opening of a great number of psychiatric Non-Hospital Residential Facilities (NHRF). However, 22 years have elapsed since the reform and there are still very scarce data regarding such facilities, the type of patients being accomodated, and the types of treatments provided. The "PROGRES" (PROGetto RESidenze - Residential Project) project is the first national study regarding NHRFs ever carried out in Italy. The objectives of "PROGRES" are to make a survey of all NHRFs in Italy (Phase 1) and to perform a detailed assessment of 20% of the surveyed facilities and of the type of patients being treated (Phase 2). This paper reports the survey (Phase 1) results for the Puglia Region. As of March 31, 2003, 113 psychiatric residential facilities were present in Puglia, with a total of 1.479 beds. This results in an average of 13,08 beds per facility and a rate of 3,86 beds per 10.000 inhabitants. The number of NHRFs present in the territory of each Local Health Unit in Puglia is very variable. Most NHRFs (57%) opened after January 1997. Eighty-three percent have a 24-hour staff coverage while only 5,3% has a 2-hour staff coverage. Eighty five percent of the residential facilities are financed by the Italian National Healthcare System, while a small percentage is privately funded. In over half (69,93%) of the NHRFs the predominant patient age group is 40-59 years; 26,4% of the residential facilities accommodate patients below age 40 and only 3,53% accommodate patients over 60 years old.

Vertebral fractures are a relevant problem in public health. This is mainly due to the high prevalence of elderly people and the high social costs implied as regards disability and health care. The authors have carried out a survey about hospitalisation rates for vertebral fractures in Apulia in the years 1998-2000. The gross hospitalisation rate for vertebral fractures without spinal injuries concerned 47.3 people out of 100.000 per year, whereas the rate for fractures with spinal cord injuries concerned 4,0 people out of 100.000 per year. Fractures concerned more frequently the dorso-lumbar tract and males were more affected than women. During the period concerned, the total DRG cost for vertebral fractures was higher than 15 million Euros and the extra-regional mobility rate for vertebral fractures without spinal injuries was 11,2% of all case-studies. The results will allow better health programmes aimed at enhancing treatment of back bone injuries.