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An adequate immunization of the health care workers is essential for infection prevention and control, to avoid consequences not only for them, but for all patients that the health care workers could infect causing serious damage and / or death. Unfortunately, to date, despite the presence of international and national guidelines (Law Decree 119/2017), the vaccination coverage was low, also because of the "vaccine hesitancy" spread among the same health care workers. In light of the above, the aim of our study was to investigate the vaccination coverage of healthcare workers of all the operational units present in our hospital and to evaluate differences between sex, age, professional profile and area of work.A study was conducted from March to June 2018 to investigate the vaccination coverage of healthcare workers at the University hospital "G. Martino" of Messina; data were collected using a self-completion questionnaire based on Attachment 3 of Ministerial Circular 25233 of 18 August 2017. We verified any possible association between physicians and pediatricians and between age classes by the chi square method. Also, a logistic regression was used for each vaccination, considering the vaccination as the variable and the following covariates: type of operative unit, sex, age and area) in order to predict the probability of vaccination.We analyzed a sample of 822 health care workers (324 males and 498 females with an age of 49.5 ± 10.5 SD). The sample was made up of physicians (36%), nurses (21%) and other professional categories (43%). Analyzing the data we obtained vaccination coverages lower than the target required to guarantee "herd immunity"; higher vaccination coverages were found for females, physicians and the clinical area and - for influenza vaccination - in the older age groups and - for all the other vaccinations - in the younger groups.Data analysis revealed a lax attitude towards vaccinations by health care workers and the need for measures aimed at increasing vaccination their coverage to prevent them from becoming a source of dangerous outbreaks.

ntroduction: Authors have carried out a survey to evaluate the appropriateness of the caesarean deliveries performed in a hospital of Sicily (Italy) during 2013. The choices of these surgeries have been compared with italian and sicilian guidelines. Materials: EpiInfo 7.1.4 software (CDC - Atlanta - USA) was used to perform the statistical data analysis (chi-square test). Results: We analyzed a total of 818 medical records related to 50.61% of spontaneous deliveries, :06% induced labor, and 46.33% of cesarean deliveries. Medical records showed that in 32.7% the caesarean section were justified by emergency conditions, whereas in 15.89% the choice was not quite justified according to guidelines parameters. In 39.57% the choice of caesarean delivery is not adequately justified either because the 5.04% is indicated as the reason the request of the woman, and because in 34.53% are not present in the medical record elements sufficient justification as incomplete or absent. Conclusions: More significant results lead to the conclusion that it's important focusing the attention to multiple social and sanitary strategies aimed at not only reducing health care spending but especially encouraging health professionals and pregnant women towards greater responsability in the choices of caesarean delivery for aspects of clinical risk and legal liability.

Gli autori segnalano un caso di propria osservazione riguardante il decesso di giovane uomo, sportivo, con anamnesi familiare e patologica negativa per patologie cardiache, coinvolto in incidente stradale autonomo; la cui causa del decesso veniva inizialmente attribuita (sulla scorta della sola ispezione cadaverica effettuata dal medico del 118 intervenuto sul luogo) ai gravi effetti contusivi cerebrali connessi al trauma cranico. Il successivo esame autoptico, disposto dall’A.G., completato dagli esami di laboratorio, consentiva di individuare la sussistenza di una ampia sostituzione fibro-adiposa del miocardio del ventricolo destro, comprendete la porzione epicardica e gli strati intermedi della parete, in soggetto con riscontro positivo per alcool all’esame tossicologico di screening. Le risultanze del caso in questione confermano l’importanza delle indagini medico-legali quale presupposto fondamentale per la valutazione del nesso causale, anche talora al fine di avere contezza del determinismo dell’evento che ha avuto il suo epilogo nel decesso. Ne deriva, in definitiva, la rilevanza della disciplina medico legale, talora anche a scopo clinico-preventivo in relazione alla potenziale sussistenza di patologie sconosciute di carattere familiare.

none 28 no BACKGROUND: The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses. METHOD: A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer-Salovey-Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters. RESULTS: We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (⩾14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI

Introduction. Rubella can have particularly serious effects on the product of conception if contracted during pregnancy. Thus, the main aim of rubella vaccination programmes is to prevent infection during pregnancy. Materials and methods. A seroepidemiological study was conducted from July 2006 to December 2007 on 1,000 women of childbearing age, 15 to 45 years old, using specific rubivirus antibody assays, IgG and IgM. A questionnaire administered at the same time allowed us to survey how much women knew about this disease. In addition, MMR vaccine coverage rates were analysed for cohorts born in the local health districts of Messina for the period 1993-2006. Results. An analysis of the replies given to the questionnaire showed an estimated 42.8% of the women to have immunity from rubella, while the serological study showed an immunity coverage rate of 80.6%. Vaccination coverage in the local health districts regarding the first dose of MMR was 81% (cohorts 1993-2005), while the rate was only 24% for the second dose (cohorts 1993-2002). Conclusions. Both immunity coverage in women of childbearing age and that for newborns (for the cohort considered) fall below the 95% target set by the National Elimination Plan for Measles and Congenital Rubella (PNEM). It is therefore necessary to provide women with adequate information about the risks of rubella during pregnancy and about the benefits of vaccination, as well as to recoup subjects at risk or those whose immune status is unknown. Public health authorities also need to make continued efforts to increase the number of MMR vaccinations throughout the region., Journal of Preventive Medicine and Hygiene, Vol 50, No 4 (2009)

No Summary, Journal of Preventive Medicine and Hygiene, Vol 49, No 3 (2008)

Introduction. West Nile virus (WNV) is a mosquito-transmitted flavivirus widely distributed in Africa, Middle East, Asia, Southern Europe and in 1999 was first identified in the United States as a cause of disease in New York City. It mainly circulates among birds, but can infect many species of mammals. Epidemics can occur in rural as well as urban areas. Methods. 1,280 sera were collected during 2006 from 80 stable workers, as jockey and grooms, 100 fowlers, 500 blood donors, 600 healthcare workers, 100 veterinary surgeons and 100 hunters in the Messina province to evaluate the prevalence of the WNV infection, by ELISA test, in relation to risk exposure or not. Results. None of the 1280 subjects examined has shown positive for antibodies anti WN virus. Conclusion. Among the strategies of control and surveillance, finally, in our opinion, are and will be indispensable the programs of continuous antibody survey in all the risk categories and in the general population in order to succeed to preview which effects could have the presence of infections from WNV, also imported from other zones where the virus is constantly present, in future and which it could be the impact of geographic factors on the epidemic spread of the disease., Journal of Preventive Medicine and Hygiene, Vol 49, No 1 (2008)

The aim of our research was to identify by bacterial genomicDNA analysis the prevalence of five different species of periodontopathogenic bacteria present in the subgingival biofilm,specifically: Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Bacterioides forsytus (Bf), Treponema denticola (Td).For the analysis we used the systematic Multiplex-PCR-microdentkit with species-specific primers. We studied a group of 48 subjects, 18 males and 30 females, from 18 to 78 years of age. Theinitial clinical screening enabled us to select, among the groupanalysed, 24 subjects with signs of active periodontopathy (GroupA) and 24 patients without identifiable clinical evidence of the disease used as the control group (Group B). Within the two experimental groups (A and B), the test was found to be positive in 75%of subjects from group A, whereas the test was found to be negative in all the subjects from group B. Our research shows thatthe Multiplex-PCR system is reliable. Furthermore, the sensitivity and simplicity of this technique, as well as the decrease inworking times and the possibility of identifying non-culturablebacteria, since the presence of viable organisms is not essential,make this technique indicated for the simultaneous identificationof periodontopathogenic bacteria and might, in perspective, pro-vide a more effective clinical alternative to the techniques of bacterial typing of the subgingival plaque., Journal of Preventive Medicine and Hygiene, Vol 47, No 4 (2006)

Many organisms are able to cause cell vacuolation, but it is unclear if this can be considered a step of apoptosis or necrosis, or a distinct form of cell death. In this study VERO cells were used to evaluate the relationship between vacuolation and cell death pattern caused by exotoxins produced by environmental strains of A. hydrophila. Cell damage has been evaluated morphologically as well as biochemically. Cytotoxic and vacuolating titres were strictly correlated and the vacuolation has to be considered an early indicator of cytotoxicity that causes cell apoptosis or necrosis in relation to the dose. Signs of apoptosis (chromatin condensation and blebbing) were observed at low concentration and TGase activity, referable to apoptosis induction, confirms morphological observations. In fact, putrescine incorporation was related both to cytotoxin concentration and time of incubation. Moreover, the observed doubling cells with necrotic features permit us to suppose that cell sensitivity and death pattern could change during the different phases of cellular cycle.

Although the precise role of transglutaminase in cell death is unknown, several findings demonstrate that tissue transglutaminase selectively accumulates in cells undergoing apoptosis both in vivo and in vitro. Calcium-dependent transglutaminase reactions are also implicated in several neurodegenerative diseases, including alterations in the release of excitatory amino acids. One prevalent theme in cell damage induced by excitotoxic stimuli in different regions of the CNS is that apoptosis may be executed by intracellular caspase proteases. Furthermore, the presence of functional ion channel-gated receptors in glial cells suggests that also astrocytes can be susceptible to glutamate's toxic effects. In this study, we demonstrated that prolonged exposure to glutamate (100 microM) of cultured astrocytes caused an increase in the expression of tissue transglutaminase (tTG). This effect was prevented by preincubation with GYKI 52466, an antagonist of AMPA/KA receptors. Glutamate exposure also promoted an increase in caspase-3 compared with control cultures. Confocal laser microscopy analysis demonstrated the presence of activated caspase-3 in the cytoplasm as well as in the nucleus. The inhibition of TG-catalyzed reactions by cystamine (1 mM) blocked the activation pathway of caspase-3, with an evident reduction of enzyme cleavage. These results suggest that glutamate increased both TG and caspase-3 in astroglial cells early in the excitotoxin-induced events.

A study on hepatitis B and C virus seroprevalence was carried out on blood samples from 327 municipal solid waste workers in Messina (Italy) to verify the hypothesis that this category of workers is at high risk for such diseases. The fact that 32.41% of all the subjects showed previous exposure to hepatitis B virus (HBV) substantiates the need to proceed with compulsory HBV vaccine prophylaxis in this category of workers, also in anticipation of possible medical legal litigations., Journal of Preventive Medicine and Hygiene, Vol 47, No 3 (2006)

The differential diagnosis of vasculitis is often a difficult task due to the frequent morphological similarities that various vasculitic syndromes express when the heart is the target organ. The more the lesions are limited to the arterial tree with absent or almost silent coronary events, the less specific the anatomical and clinical frameworks. To create a series of clinical records and on the basis of these assumptions, the authors report a case concerning the sudden death of a 43-year-old woman which occurred while an ergonometric test was being carried out 28 days after the onset of the symptoms. A subsequent postmortem investigation/autopsy enabled us to detect a granulomatous aortitis process and, in particular, a coronary ostial stenosis and severe involvement of the coronary vessels which was compatible with the pathological framework of Takayasu disease.

[Corneal burn during phacoemulsification surgery: case report and medico-legal considerations] The authors report a case of severe corneal burn, occured a few seconds later the beginning of the surgical procedure of phacoemulsification on a 63 years old woman affected by cataract. The authors analyzed the case as a result of claims for damage to the surgeons and the hospital by the patient. In terms of assessment of responsibility, medico-legal investigation is aimed at identifying whether the responsibility of the event of damage to the patient is to be attributed to the negligent conduct of the surgeon or to defects or damage to the equipment used by the same. The authors underline the importance of an accurateknowledge of the procedures for using in safety the instrumentation and monitoring the adverse reactions connected to the use of the instrumentation itself, even in the global risk management.

Introduction: In Italy the use of caesarean delivery has a rising trend moving away from European standards appeared on Euro-Peristat on maternal and child health, presenting the highest percentage of use of this procedure with significant regional differences. This study have analyzed the most recent data of a Sicilian reality about normal delivery and caesarean sections carried out in a hospital situated in Messina (Italy). Materials and methods: A total number of 1,573 medical records from 1st January 2011 to 31st December 2013 were analyzed and data gathered were statistically examined to describe general and specific parameters of the sample making use of Epi Info 7.1.4 software (CDC Atlanta – USA). Chi-square test was used to show any statistic differences among studied population. Results: Overall data showed that were carried out 38.27% of spontaneous deliveries, 7.06% of induced labor, and 54.67% of caesarean deliveries. There were no significant statistical differences between recourse to caesarean section and vaginal delivery in relation to nationality, age, level of education and/or work. The enrolled group, based on the parameters examined, was divided into appropriate caesarean section, in 79.49% of cases, inappropriate in 7.20% (mother’s request) and unjustified in 13.31% (with no indication, incomplete medical record). An examination of the anesthetic medical records showed that the caesarean section was considered to be urgent in 31.74% of the cases; however in 17.92% of these cases there is no information in the medical records justifying the use of emergency procedures. Conclusion: The reported data from the study that we conducted, lead to medical-legal and juridical considerations, especially as regards the use of caesarean delivery on the woman request. The complexity of the phenomenon requires the development of a variety of intervention strategies, not only for issues related to the reduction of health care costs, but also with regard to the clinical risk management and medical legal aspects related to the several profiles of professional responsibility.