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Background and aim of the work: Even though vaccination is easy to access in Europe, it has been facing several outbreaks caused by vaccine preventable diseases. Trying to balance the right to health of the community with individual self-determination, in Italy was mandate vaccination for ten vaccine preventable diseases in 2017. The project “Sportello Vaccinale” provided a counseling service to parents in kindergarten of Palermo. The main objective of the study was to investigate knowledge and compliance on vaccination by children’s parents after the implementation of mandatory vaccination. Methods: A cross sectional study was conducted among parents accessing to the “Sportello Vaccinale” using a questionnaire. The questionnaire consisted of 34 items divided into three sections: socio-demographic data; knowledge and attitude on mandatory vaccination using Health Belief Model (HBM); Health Literacy (HL) level. Results: A total of 95 questionnaires were garnered in the kindergartens from respondents with a mean age of 36 (±SD=6) years. The respondents who delayed hexavalent or Measles, Mumps, Rubella and Varicella (MMRV) vaccinations were 8 (8%) and the more frequent cause was fear of adverse reaction (87%). The sample had more often high level of health literacy (37%), and 55% had higher HBM score. The factor significantly associated with higher HBM score was the age of respondents (OR= 1.14, p=0.006) after controlling for other variables. Conclusions: Consent to vaccination practice was widely represented, but the results of the study highlighted the need for parents to have more information and more time devoted to the practice of vaccination counseling. Implementing counseling activities at school or at the vaccination service, could support an aware decision process of the parents on vaccination topic.

Background and aim of the work: In response to the alarming reduction of vaccination coverage rates, Italian Ministry of Health approved the law number 119/2017, which has extended the number of mandatory vaccinations, for school attendance, from four to ten. The present study aims to evaluate accesses to the vaccination services of the Palermo Local Health Unit (LHU) and the variation of the vaccination coverage rates for hexavalent and measles, mumps, rubella and varicella (MMRV) vaccines, after the implementation of the law 119/2017. Methods: An extent of opening hours and an involvement of other health-care professionals in the vaccination services of the Palermo LHU have been adopted to manage the excess of accesses after the introduction of 119/2017 law and to limit the discomfort of general population. Vaccination accesses and coverage rates were calculated from the electronic immunization registers. Results: An overall increase of about 15% of single vaccination accesses was observed in the three semester after the introduction of the law in the LHU of Palermo. A peak of 35,516 accesses was observed during the second semester of 2017 (+ 30% compared to the same semesters of 2016 and 2018). From 2016 to 2018, coverage rates for full hexavalent cycle and first dose of MMRV, at 24 and 36 months, and for full MMRV cycle and fourth dose of diphtheria, tetanus, pertussis, poliomyelitis (DTPa+IPV), among 6 years old children, showed considerable increases. Conclusions: Law 199/2017 demonstrated a high efficacy in increase vaccination coverage rates also in Sicily. The synergy established between the LHU and the University of Palermo allowed an excellent management of the accesses to vaccination services, making it possible to respond to the public health needs of the general population.

Introduction. The 2017-2019 Italian National Vaccination Plan promotes the improvement of knowledge and attitudes of healthcare workers about vaccine prevention, in order to spread a vaccination culture among general population. Similarly to the General Practitioner, the Pharmacist represents a fundamental forefront for both patients and healthy people, also in promoting vaccine acceptance. This research aims to analyze knowledge and attitudes about vaccines of Community Pharmacists and to evaluate the burden of vaccination counselling during their work activities. Material and methods. A standardized, self-administered and previously validated questionnaire, including 5 sections and 28 items, was submitted to a sample of Community Pharmacists working in Western Sicily. The survey was carried out through an online questionnaire, that investigated socio-demographic data, knowledge and attitudes towards vaccination and the role of the Pharmacist as vaccination counselor during his work. Results. A total of 120 Pharmacists were surveyed. 99.2% of them were definitely agreed with the Regional Vaccination Schedule. A large majority (n = 114, or 95%) were fully vaccinated and have vaccinated, or would vaccinate in future, their children. According to Community Pharmacists interviewed, at least 90% of clients asked for further explanations about vaccination, and the citizens' trust towards vaccination increased (30%) or remained stable (54.2%) over time in the last 5 years. Finally, as reported by interviewed Pharmacists, a correct counselling provided by General Practitioners (GPs) and Family Pediatricians was the main boost in increasing vaccination confidence, instead of mass-media and web misinformation that has led to skepticisms among general population. Conclusions. The study demonstrated the key role of the Community Pharmacist for their consumers in vaccination counselling. In future, a strong collaboration between Community Pharmacists and all the actors promoting vaccination themes (GPs, family Pediatricians, public health workers) will be essential, as well as a uniform and standardized University training on vaccination themes for all these categories.

There is a lack of evidence about the possible role of the family environment in the occurrence of the bullying phenomenon among school-age children. We carried out a systematic review of the literature to investigate the positive and negative family determinants associated with the bullying phenomenon. Potential classes of determinants-e.g. interparental conflict and/or parenting behaviours-were studied by searching peer-reviewed literature published between the January 2008 and December 2018 on PubMed/MEDLINE, SCOPUS and ISI Web of Science. At the end of the eligibility process, only 3 studies met all the inclusion criteria, and were then included in the narrative synthesis. Mother destructive profile and excessive infant crying resulted significantly associated with child emotional insecurity and conduct/mood problems at the age of 5-6 years, respectively. Moreover, a decrease of medically unexplained symptoms in adolescent was observed after a one-year family functioning therapy. This body of evidences should raise the interest of the researchers in order to invest in depth the family unit impact on the bullying phenomenon in school environment.

INTRODUZIONE Circa il 20% degli Operatori Sanitari (OS) contrae annualmente una patologia da virus influenzale e la vaccinazione stagionale è fortemente raccomandata quale migliore strategia di prevenzione tra gli OS. Diverse iniziative sono state messe in atto a livello nazionale per incrementare le scarse coperture vaccinali antinfluenzali evidenziate tra gli OS. In questo studio viene analizzato il trend di adesione vaccinale degli OS operanti presso l’Azienda Ospedaliera Universitaria (AOU) Policlinico di Palermo nelle ultime otto stagioni vaccinali, valutando l’impatto di differenti strategie comunicative ed informative messe in atto nel corso delle ultime tre stagioni vaccinali (2015/2016 - 2016/2017 - 2017/2018) MATERIALI E METODI Gli OS aderenti alla vaccinazione antinfluenzale hanno compilato un questionario validato ed autosomministrato al termine della seduta vaccinale. Contestualmente, è stato predisposto un modulo di dissenso informato per tutti gli OS che non hanno aderito alla vaccinazione antinfluenzale, compilabile sulla pagina personale (intranet) del portale Web Aziendale. Nelle ultime tre stagioni vaccinali sono state messe in atto diverse iniziative atte a promuovere l’adesione alla vaccinazione antinfluenzale degli OS tra cui: creazione di pagine web (internet e social media) dedicate alla campagna vaccinale, creazione di locandine, slogan e hashtag anche in formato cartaceo da utilizzare per promuovere la vaccinazione, settimana di vaccinazione “on site” nei reparti, formazione preliminare degli OS operanti nei reparti a maggiore rischio (UTI, UTIN, Oncologia, Ginecologia, etc...) RISULTATI La copertura vaccinale è salita progressivamente da un valore medio del 5 (dalla stagione 2010/2011 alla 2014/2015) al 27% nell’ultima stagione 2017/2018 (chi-square for trend: 857, p

The Erice 56 Charter titled "Impact of the environment on the health: from theory to practice" was unanimously approved at the end of the 56th course of the "International School of Epidemiology and Preventive Medicine G. D'Alessandro" held from 3th to 7th November 2019 in Erice - Sicily (Italy) and promoted by the Study Group of "Environment and Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health. The course, that included lectures, open discussions and guided working groups, was aimed to provide a general training on epidemiological and toxicological aspects of the environmental health impact, to be used by public health professionals for risk assessment, without forgetting the risk communications. At the end of the course 12 key points were agreed among teachers and students: they underlined the need of specific training and research, in the perspective of "One Health" and "Global Health", also facing emerging scientific and methodological issues and focusing on communication towards stakeholders. This Discussion highlight the need to improve knowledge of Health and Environment topic in all sectors of health and environmental prevention and management.

Background Bullying is recognized as one of the most significant social and health problems in the school environment for children and adolescents. In Italy, bullying involved 2 in 10 kids between 11–17 years that referred to have been bullied two or more times in a month. In Sicily, the estimated prevalence of children aged 11 to 15 that suffered at least one act of bullying in the last two months was 14% in 2011. Methods A questionnaire consisting of 30 items investigating physical, verbal and indirect bullying, observers of bullying, resiliency, and prosociality was administered to preadolescents of ten first-grade secondary schools within the Palermo Province in order to analyze prevalence and factors associated with bullying phenomenon. Also, a systematic literature review (SLR) analyzing manuscripts that reported prevalence of the bullying phenomenon worldwide was conducted. Results Survey: a total of 867 students, belonging to 35 s and 31 third classes of ten different schools in Palermo, Italy, were recruited in the survey. The values of physical bullying are included between the 4% of the single question method and the almost forty percent detected by the score of 7 method. Verbal bullying oscillates between 15.9% and 66.3%. Observers average values varies from 15.8% to 47.5%. SLR: the estimated prevalence showed a considerable fluctuation. The occurrence of the bullying phenomenon was low in some Northern European countries, while in Anglo-Saxon countries it affected over a quarter of the middle school student population (28% in Maryland, USA and 21% in the UK). Conclusions The prevalence of the bullying phenomenon recorded by this survey with the three different methods used is similar to observations in international literature. In the Sicilian context, a higher prevalence of bullying phenomena was observed in pre-adolescents attending major classes and in schools with lower socio-economic index. Though it remains difficult to obtain univocal data that clarifies the prevalence of different type of bullying, the continuous investigation of prevalence and factors associated with the phenomenon is a necessary starting point to introduce interventions and preventive measures in Public Health programs.

In Italy, following the start of the SARS-CoV-2 vaccination campaign, community pharmacies (CPs) were recruited on a voluntary basis in order to administer COVID-19 vaccines as part of their activities. The aim of the present study was to investigate the knowledge, attitudes, and practices regarding SARS-CoV-2 infection prevention, and vaccine acceptance/hesitancy towards COVID-19 and influenza vaccinations among the community pharmacists operating in the Palermo Province. A cross-sectional study was conducted, with two different questionnaires administered before and after the conduction of the vaccination campaign against SARS-CoV-2 at the COVID-19 vaccination center of the Palermo University Hospital (PUH). The baseline survey showed that 64% of community pharmacists (CPs) declared that they planned to vaccinate against SARS-CoV-2, and 58% were vaccinated against influenza during the 2020/2021 season. Factors significantly associated with willingness to receive the COVID-19 vaccination were confidence in vaccines (adjOR 1.76; CI 1.11–2.80), fear of contracting SARS-CoV-2 infection (adjOR 1.50; CI 1.06–2.11), considering COVID-19 vaccination to be the best strategy to counteract SARS-CoV-2 (adjOR 1.79; CI 1.39–2.29), and adherence to influenza vaccination during the 2020/2021 season (adjOR 3.25; CI 2.23–4.25). The adherence among CPs of the Palermo Province to COVID-19 vaccination was 96.5%. From the post-vaccination survey, the main reasons for changing opinions on vaccination adherence were the introduction of mandatory vaccinations, fear of contracting COVID-19, and limitations on work activities in the case of vaccine refusal. The achievement of very high COVID-19 vaccination coverage rates among healthcare professionals (HCPs) in the present study was mainly due to the mandatory vaccination policies; nevertheless, a willingness for COVID-19 vaccination was relatively high among pharmacists before the beginning of the vaccination campaign. HCPs and CPs should receive training on vaccination, which is recommended in the national immunization plan and is also suggested by the respondents in our study, in order to routinely re-evaluate their own vaccination profiles, as well as those of their patients.

In recent years, vaccination coverage rates against Human Papilloma Virus (HPV) in Europe have shown a decreasing trend and remain below the required standard. The present study aims to assess knowledge and attitudes regarding HPV infection and vaccination among a representative sample of preadolescents of Palermo, Italy. A survey was carried out throughout two questionnaires, before and after carrying out an educational intervention scheduled during school hours. A total of 1702 students attending first-grade secondary schools of the province of Palermo were enrolled (response rate 68.9%). Students attending third classes (adj OR = 1.18, CI 95% 1.03&ndash, 1.36), being of higher socioeconomic status (adj OR = 1.35, CI 95% 1.05&ndash, 1.73), who had previously received information about sexually transmitted diseases (STDs) at home (adj OR = 1.62, CI 95% 1.27&ndash, 2.07) or at school (adj OR = 2.15, CI 95% 1.70&ndash, 2.71) and who had ever heard in the past about HPV (adj OR = 1.80, CI 95% 1.42&ndash, 2.29) showed a significantly higher baseline level of knowledge regarding HPV. Willingness to receive HPV vaccination, in a 10-point Likert scale, significantly increased between the pre- (8.51, SD &plusmn, 1.79) and post- (9.01 SD &plusmn, 1.52) intervention questionnaires (p &lt, 0.001). A total of 188 out of 272 (69.1%) preadolescents attending five out eighteen schools involved in the project, who had not previously received the HPV vaccine, were vaccinated. During past years, education campaigns on HPV were mainly dedicated to adult women, excluding teenagers and omitting young males. It should therefore be of primary importance that school-based education and vaccination programmes be standardized.

Counteract vaccine hesitancy is a public health priority. Main objectives of the cross-sectional study conducted were to evaluate knowledge, attitudes, and behaviors regarding vaccination issues, to estimate the prevalence of vaccine hesitancy and to estimate the effectiveness of vaccination counseling on community advocacy in a sample of general population. An anonymous validated questionnaire was administered in April 2017 at the main shopping center of Palermo and was followed by tailored vaccination counseling interventions. To estimate the effectiveness of the interventions four main connection parameters to the vaccinarsi.org website were evaluated, in the two months before and after the intervention and in the two months before the intervention compared with the same period of previous and following years. Among the 299 subject enrolled 12.7% were hesitant about vaccinations, and 4.7% declared being against vaccinations. General practitioners (GPs) and pediatricians were the most affordable source of information about vaccinations. A higher probability of vaccination hesitancy/refusal was reported among subjects who considered “alternative strategies” the best way for the prevention of infectious diseases (adj-OR=7.01, IC95% 2.88–17.09, p-value < 0.001). A considerable increase of all the vaccinarsi.org website indicators analyzed was observed, from the area in which survey participants lived. Prevalence of vaccine hesitancy among population surveyed is consistent with the literature data. HCWs, such as GPs and pediatricians, should play a key role in modifying personal convictions and choices about vaccinations. A proper vaccination counseling could improve attitudes regarding vaccination issues, such as quality of web-based research.

rappresentano requisiti essenziali per la protezione dell’ambiente. In particolare, la conoscenza dei fenomeni che si instaurano al loro interno, perlopiù di natura biologica, è di fondamentale importanza per la buona riuscita del processo depurativo, sia che si tratti di impianti a tecnologia convenzionale, quali i CAS (Conventional Activated Sludge), o avanzate, quali gli MBR (Membrane BioReactor). Il verificarsi di una disfunzione, a seconda della sua gravità, può comportare il superamento dei limiti previsti per lo scarico per un certo periodo di tempo, causando gravi conseguenze ambientali, nonché un danno economico che deriverebbe sia dall’applicazione di sanzioni amministrative, consumo di reagenti chimici, ecc. Un’approfondita conoscenza dei processi può consentire non solo di trovare adeguate soluzioni per la tempestiva risoluzione dei problemi ma, soprattutto, di poterne prevenire l’insorgenza. Inoltre, tenuto conto della crescente necessità di attuare il virtuoso modello di economia circolare, gli impianti di depurazione non assumono più il solo ruolo di ridurre l’inquinamento delle acque reflue, bensì quello di valorizzarle, attraverso la possibilità di recupero di materia ed energia. In questo contesto, la conoscenza specialistica dei processi, nonché la loro corretta gestione, diventa un prerequisito assolutamente essenziale anche per l’attuazione e l’efficientamento delle pratiche di recupero di energia e materia. Pertanto, la corretta gestione degli impianti di depurazione non assume soltanto un ruolo di garanzia nei confronti della salvaguardia dei corpi idrici ricettori, bensì dell’ambiente in senso lato. Questa memoria pone l’attenzione sulla necessità di una corretta progettazione e individuazione delle apparecchiature elettromeccaniche, soprattutto per gli impianti a tecnologia più evoluta, nonché di un’adeguata conoscenza delle principali criticità che riguardano la gestione degli impianti di depurazione, sia convenzionali (CAS) che avanzati (MBR). In particolare, sono presentate e discusse alcune procedure analitiche, nonché specifici parametri non convenzionali utili per il monitoraggio, la conduzione specialistica dei processi biologici. Inoltre, sono brevemente analizzate le principali disfunzioni che possono verificarsi nei processi che si attuano in ciascuno di essi, nonché le principali soluzioni per il loro monitoraggio e la loro corretta gestione.

La salute e il benessere delle persone sono strettamente legati allo stato dell’ambiente. Un ambiente naturale di buona qualità, in termini soprattutto di aria e acqua pulite, gioca un ruolo di fondamentale importanza nella prevenzione di numerosi stati morbosi globalmente causa di milioni di morti ogni anno. Uno studio pubblicato dalla WHO (Preventing diseases through healthy environments) stima che, nel 2012, 12.6 milioni di morti in tutto il mondo, che rappresentano il 23% (95% CI: 13–34%) delle morti per tutte le cause, siano state attribuibili alla cattiva qualità dello stato dell’ambiente. Se si considerano sia le morti che le disabilità (DALY - Disability-Adjusted Life Years - indicatore della gravità di una patologia espresso in anni persi a causa di tale patologia in termini di morti premature o disabilità), la percentuale di carico globale di malattia attribuibile allo stato dell’ambiente è del 22% (95% CI: 13–32%). In particolare, nei bambini sotto i 5 anni, fino al 26% (95% CI: 16–38%) di tutte le morti potrebbe essere evitata se venissero eliminati i rischi ambientali.

Background and aim of the works:Rotavirus (RV) is considered the main cause of gastroenteritis in children from 0 to 59 months and vaccination represents the only strategy to prevent hospitalizations due to RV. In 2013 Sicilian Region introduced universal RV vaccination for all newborns. The present study aims to estimate the reduction rotavirus gastroenteritis (RVGE) hospitalization rates among Sicilian children and their relations with vaccination coverages of the nine Sicilian Local Health Units (LHUs). Methods: Were analyzed hospital discharge records including a diagnosis of RVGE occurred from January 2009 to December 2017 in hospitalized children aged 0 to 59 months, residents in Sicily. Were reported data on complete RV vaccination cycles among Sicilian children under 12 months of age (vaccination coverage). Results: A 49.2% overall reduction of RVGE hospitalization rates was reported after RV vaccination introduction. A more considerable reduction of hospitalization rates was observed among children aged 0 to 11 months (-61.4%), followed by children aged 12-23 months (-51.2%) and 24-35 months (-48.8%). In all the nine Sicilian Local Health Units (LHUs), a reduction of RVGE hospitalization rates was observed after RV vaccine implementation. Conclusions: This study demonstrated the significant impact of RV vaccination on RVGE hospitalization rates in Sicily, especially among children aged 0 to 23 months. The reduction in RVGE hospitalization rates observed in the Sicilian LHUs after universal vaccination program implementation, were generally higher or consistent with average vaccination coverage reported from 2013 to 2017. (www.actabiomedica.it)