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.

Over the last two decades, growing numbers of parents in the industrialized world are choosing not to have their children vaccinated. The re-emergence of the anti-vaccination movements has been theorized as an important determinant of this phenomenon. The crisis of the «vaccination system» and the resurgence of the anti-vaccination movements is related both, to the increased accessibility to the information from the general population and to the decreased credibility and authority of health professionals. Another critical element in the fight against anti-vaccination movements, in Italy, is the system of assessing the damage from the vaccine, both in pharmacovigilance activities and in the procedures for the compensation of biological damage provided by law. The contrast in these bugs, along with the strengthening of communication skills of the health care workers and to an investment on communication in the mass media, is not to postpone for fighting the anti-vaccination movements.

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.

The aim of this study is to describe the immunization strategies for 23-valent pneumococcal vaccine in the Italian regions. Sixteen regions offer pneumococcal vaccine to elderly people and 18 regions to risk groups. Nine among them offer the vaccine free of charge and perform the call for immunization. Five regions created a database of the risk groups. Data about vaccination coverage are available for seven regions; in the other only the number of administered doses is collected yearly. Different immunization strategies may represent a determinant of health inequalities.

We report a clinical failure of a pneumococcal vaccine in a patient who developed pneumococcal pneumonia. In 2008, an 85-year-old Italian woman was admitted to the Respiratory Disease Unit of a hospital in Southern Italy. The 23-valent pneumococcal vaccine had been administered to the patient 50 days earlier. The chest x-ray disclosed a right basal bronchopneumonic focus. Streptococcus Pneumoniae serotype 19A, a strain included in the 23-valent pneumococcal vaccine, was isolated from the sputum. There is a need for more efficacious conjugated vaccines covering the majority of the pneumococcal serotypes that cause serious illness in older children and adults worldwide.

PURPOSE: A new and more anatomical technique for SLAP II lesions repair is described. It consists in the reattachment of the medial aspect of the biceps anchor to the superior glenoid neck with a mattress stitch posterior and medial to the biceps anchor and a simple stitch placed anteriorly to the biceps. METHODS: From 2011 to 2012, 14 patients matching the inclusion criteria were selected for the study. A visual analogic scale, ROWE, UCLA, ASES and Constant scores were used to make evaluation. The passive ROM before surgery, at final follow-up, and the resumption of sports activities were analysed. RESULTS: The Constant, ASES, UCLA and ROWE scores passed from 64.6 (SD 13.9), 76.9 (SD 22.4), 28.4 (SD 23.8) and 53.6 (SD 20.6) to, respectively, 92.6 (SD 11.8), 108.3 (SD 8.5), 33.6 (SD 2.7) and 96.5 (SD 7.2) at final follow-up. Of the four patients who had participated in agonistic overhead athletics preoperatively, all of them were able to return to their preinjury level. No complications were observed in the present study. CONCLUSION: In our technique, the anatomy is respected leaving the articular aspect of the superior labrum loose and reinforcing the medial side. The clinical relevance of this work is that probably this technique could improve clinical results, giving a better mobility of the shoulder and a return to the same preoperative level in overhead athletes.

A nosocomial outbreak of 2009 pandemic influenza A(H1N1), with eight confirmed cases, occurred in a paediatric oncology ward in Italy, in October/November 2009. The fact that one case was infected despite being isolated and without contact to a symptomatic patient, hints towards potential transmission through a health care worker (HCW) and underlines the importance of vaccination of HCW who are involved in the care of critically ill patients.

PURPOSE: We retrospectively analyzed our results in thoracolumbar and lumbar adolescent idiopathic scoliosis treated during adulthood. METHODS: Fifty-two thoracolumbar and 30 lumbar idiopathic scoliosis surgically treated were reviewed. Mean follow-up was 9.5 ± 6.6 years. All the subjects were analyzed by visual analog scale, Oswestry Disability Index (ODI), and SF-36 scores before and after surgery and at follow-up. The scoliotic curve, thoracic kyphosis, lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT), sacral slope, and C7 plumb line were measured. For the statistical analysis, multivariate multiple regression models were formulated, considering as significative a P < 0.05. RESULTS: A statistically significant clinical and radiological amelioration was noted after surgery and at final follow-up. According to the logistic regression model, ODI was related to lumbar lordosis and spino-pelvic parameters at follow-up. The only determinant of failure was age. CONCLUSIONS: Spino-pelvic recovery is easier in patients aged less than 60 years with PI < 55° and PT < 25°.

AIM: To evaluate the level of microbial contamination of air in operating theatres using active [i.e. surface air system (SAS)] and passive [i.e. index of microbial air contamination (IMA) and nitrocellulose membranes positioned near the wound] sampling systems. METHODS: Sampling was performed between January 2010 and January 2011 in the operating theatre of the orthopaedics department in a university hospital in Southern Italy. FINDINGS: During surgery, the mean bacterial loads recorded were 2232.9colony-forming units (cfu)/m(2)/h with the IMA method, 123.2cfu/m(3) with the SAS method and 2768.2cfu/m(2)/h with the nitrocellulose membranes. Correlation was found between the results of the three methods. Staphylococcus aureus was detected in 12 of 60 operations (20%) with the membranes, five (8.3%) operations with the SAS method, and three operations (5%) with the IMA method. CONCLUSION: Use of nitrocellulose membranes placed near a wound is a valid method for measuring the microbial contamination of air. This method was more sensitive than the IMA method and was not subject to any calibration bias, unlike active air monitoring systems.

Rhinitis and rhinosinusitis (with/without polyposis), either allergic or non-allergic, represent a major medical problem. Their associated comorbidities and relationship with family history have so far been poorly investigated. We assessed these aspects in a large population of patients suffering from rhinosinusal diseases. Clinical history, nasal cytology, allergy testing and direct nasal examination were performed in all patients referred for rhinitis/rhinosinusitis. Fibre optic nasal endoscopy, CT scan and nasal challenge were used for diagnosis, when indicated. A total of 455 patients (60.7% male, age range 4-84 years) were studied; 108 (23.7%) had allergic rhinitis, 128 (28.1%) rhinosinusitis with polyposis, 107 (23.5%) non-allergic rhinitis (negative skin test); 112 patients had associated allergic and non-allergic rhinitis, the majority with eosinophilia. There was a significant association between non-allergic rhinitis and family history of nasal polyposis (OR = 4.45; 95%CI = 1.70-11.61; p = 0.0019), whereas this association was no longer present when allergic rhinitis was also included. Asthma was equally frequent in non-allergic and allergic rhinitis, but more frequent in patients with polyposis. Aspirin sensitivity was more frequent in nasal polyposis, independent of the allergic (p = 0.03) or non-allergic (p = 0.01) nature of rhinitis. Nasal polyposis is significantly associated with asthma and positive family history of asthma, partially independent of the allergic aetiology of rhinitis.

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.

This article described an outbreak of bacterial pneumonia/bronchopneumonia in a group of visitors to a mineral water spa contaminated with Pseudomonas aeruginosa in summer 2009. The epidemiologic investigation was activated after the hospitalization for pneumonia of three people who had undergone therapy at the spa. Discharge with a diagnosis of pneumonia/bronchopneumonia in weeks 27 to 39 of 2009 of four hospitals near the spa were data-linked with the list of spa’s visitors. Environmental samples of thermal water were performed and analysed. Investigations discovered a total of 39 cases of pneumonia among the spa visitors. Checks carried out in the hospitals near the spa revealed more hospitalizations for pneumonia in summer 2009 than the average for the previous five summers. There was a significant association between pneumonia and inhalation therapy (RR=7.33; p<0.0001) and aerosol therapy (RR=8.25; p<0.0001). P. aeruginosa was discovered in the water of the inhalation equipment. The spa micro-environment offers a risk of infection from pathogenic and/or opportunistic micro-organisms and therefore in-house testing, surveillance and prevention systems should be put in place for the well-being of clients.

Objective: An association between streptococcal infections, ABGA positivity, and no comorbidity ADHD (nc-ADHD) has been little investigated. The aim of this study was to evaluate the streptococcal infection frequency, defined entitled serum antistreptolysin O (ASO), and frequency of serum ABGA positivity in a sample of patients with nc-ADHD. Method: In all 40 participants were investigated the ASO titer and ABGA. Results: The results showed that ABGA positivity was statistically significantly higher in patients affected by ADHD than in patients of a control group, and pathological values of ASO were statistically more frequent in the ADHD group than the control group. Conclusion: These data suggest that streptococcal infections and autoimmune reactions against the basal ganglia are more frequent in ADHD patients than patients in a control group.

The aim of this study is to evaluate the vaccination coverage at 24 months of chronological age in a sample of preterm infants discharged by the Neonatal Intensive Care Unit (NICU) of the Bari Policlinico University General Hospital in Italy. The list of infants preterm born discharged during 2013 by the NICU was obtained by hospital database. Vaccination status of each subject at 24 months of chronological age was acquired by the Apulian Regional Vaccination Register (GIAVA). 159 preterm borns were enrolled in this study. 98.1% received the 1st dose of hexavalent vaccine and 98.7% the 1st dose of pneumococcal conjugate vaccine. The 8.8% of hexavalent vaccinations were performed during hospitalization. The percentage of immunized subjects decreased to 91.2% and 87.3% for the 2nd and 3rd dose of hexavalent vaccine and to 90.6% and 86.1% for the 2nd and 3rd dose of pneumococcal conjugate vaccine. Coverage for MMR, MEN C and Varicella vaccines were, respectively 76.4%, 86.0% and 80.9%. Pre-terms received the vaccinations later than the age recommended by public health guidelines. Age at the immunization, for all vaccines, seems to increase for lower gestational age and birth weight and for higher length of hospitalization. This study shows a high risk of vaccine delay among pre-terms born. There is a strong need to improve specific vaccination strategies for this group. Neonatologists might play a key role in informing parents about the vaccination schedule at the moment of NICU discharge and during follow-up, also preparing correct time schedule.

It is well known that total knee replacement surgery decreases pain and improves function, but the effect on postural assessment needs to be studied better with the use of new technological devices. Total knee arthroplasty (TKA) improves motor coordination and stability of the knee. On the other hand, changing joint functionality can modify the balance. The aim of this trial is to record and analyze the static and dynamic baropodometric data of patients in the first few months following joint replacement. For the physiatrist, this tool can be useful to check if the rehabilitation treatment protocols and times are correct.

he study of decomposition by using accumulated degree days (ADDs) has been suggested not only in terrestrial decay but also for water-related deaths. Previous studies have demonstrated that the accumulation of thermal energy as a function of the post-mortem submersion interval (PMSI) can be derived from a descriptive decompositional scoring system (DSS). In order to verify how useful can the total aquatic decomposition score (TADS) for ADD prediction be, a comparative taphonomic study has been performed between two series of bodies: 16 corpses found floating in shallower waters with a presumptive PMSI from 3 to 118 days and exposed to water temperatures (Tw) between 10.5 and 20.3 °C approximately equating from a minimum of 46 to 1.392 ADD; 52 bodies, all victims of a single shipwreck, found in sequestered environments and subjected to constant Tw of 4 °C for 210 days approximately equating to 840 ADD. The two series of bodies have revealed different stages of decay and a large DSS variability. In most of bodies, freshly formed adipocere was able to delay the appearance of later decompositional stages explaining why most of the bodies were in relatively good condition. Although promising, the accuracy of the TADS model can be affected by adipocere and animal activity. The TADS model suffers of the same limitations for ADD calculations as they can give a false perception of accuracy due to the complexity of integrating all changing factors affecting human decay in sequestered and non-sequestered marine environments (currents, animal activity, water temperatures, depth of submersion).

Cardiopathies and osteoporosis are inter-related due to pathogenetic, hormonal, genetic features as well as an increased risk of fragility. An important feature is attributed to the process of atherosclerosis, which is responsible for an osteopenia effect and degeneration of vascular walls. To date the study populations have been limited. To verify the incidence of cardio-vascular disease in a larger osteoporotic population, we designed a retrospective clinical study analyzing the “Hospital Discharge Data” (HDD) in Apulia between 2006 and 2010. All patients over 55 years with a hospitalization for a fragility fracture and/or drugs prescription for osteoporosis were crossed with the diagnosis and/or drugs prescription for cardiovascular disease. We observed that between 2006 and 2010, in Apulia, 177,639 patients were hospitalized and diagnosed as having fragility fractures, 66.3% had a diagnosis of cardiopathy, with a higher prevalence in males and in patients over 80 years. The incidence of fractures were as follows: femur (51.9%), spine (20.2%), humerus (10.6%), forearm (9%), tibial pilon (7.2%) and tarsus and metatarsus (1.1%). Cerebrovascular diseases were the most frequent, followed by arrhythmias, heart failure and cardiomyopathies. In these patients, the most prescribed drugs were anti-coagulants, ACE inhibitors and diuretics. In patients affected by cerebral circulation disorder there is a greater propensity to fall and thus have a fragility fracture, particularly of the femur. The vertebral fracture, misdiagnosed in 60-70% of patients, may compromise the cardio-respiratory function of these patients. We verified a higher incidence of fragility fractures in patients who were prescribed certain categories of drugs for the treatment of cardio-vascular disease. This hypothesis is not supported by the literature, where contradictory results on the potential effects of these drugs on bone have been published. The high incidence of heart disease found in patients with fragility fractures supports the need for specific screening for osteoporosis in the population with cardio-circulatory pathology.

OBJECTIVE: To assess knowledge and attitudes towards cervical cancer prevention in a sample of 2400 Italian women. STUDY DESIGN: Cross-sectional study. METHODS: The study was conducted through a standardized questionnaire administered in the workplace. RESULTS: Regular Pap testing was reported by 65.6% of the sample, and 86.9% were aware of the human papillomavirus (HPV) vaccine. Just over half of the women (51.8%) stated that they would pay for the vaccine for themselves or family members. Significant differences in responses were associated with monthly income and educational level. CONCLUSION: Introduction of payment for the HPV vaccine may increase health inequalities significantly. For overall improvement in the quality of life, effective prevention and treatment services should be made available to all.

The application of laser therapy on soft tissue is used for pain relief, anti-inflammation action and biostimulation. The efficiency of High Energy Laser Therapy has not yet been studied on Achilles tendinopathy. The aim of the study is to evaluate the effectiveness of a flow of Cold air and High Energy Laser Therapy (CHELT) versus Extracorporeal Shock Waves Therapy (ESWT) in the treatment of Achilles tendinopathy. In this prospective, clinical trial, 60 subjects affected by insertional Achilles tendinopathy were enrolled and randomized to CHELT (30 subjects) or to ESWT (30 subjects). In CHELT group the patients received ten daily sessions of 1,200 J and 12 W of laser therapy (wavelength of 1,084, 810 and 980 nm) added to a flow of cold air at -30 °C. In the ESWT group, the patients received three sessions at 3- to 4-day intervals of 1,600 impulses with an energy flux density (EFD) of 0.05-0.07 mJ/mm(2). Both groups of participants performed stretching and eccentric exercises over a 2-month period. The visual analogue scale (VAS), the Ankle-Hindfoot Scale, and the Roles and Maudsley Score were measured before treatment (T0), and at end of the treatment session (T1) and 2 (T2) and 6 months (T3) after treatment during the follow-up examinations. In both groups, we found a statistically significant improvement of the VAS at T1, T2 and T3 (p < 0.01). The difference between the two groups was statistically significant in favour of the CHELT group (p < 0.001). At 2 months, the CHELT group was statistically better for Ankle-Hindfoot Scale and the Roles and Maudsley Score (p < 0.05) and at 6 months only for the Roles and Maudsley Score (p < 0.001). High Energy Laser Therapy gave quicker and better pain relief. It also gave the patient a full functional recovery and greater satisfaction

Macrolide-resistant Mycoplasma pneumoniae (MR-MP) is an increasing problem worldwide. This study describes the clonal spread of a unique strain of MR-MP within a single family. On January 23, 2015, nasopharyngeal swabs and sputum samples were collected from the index case (a 9-year-old girl) in southern Italy. The patient had pneumonia and was initially treated with clarithromycin. MR-MP infection was suspected due to prolonged symptoms despite appropriate antibiotic therapy. Two further cases of pneumonia occurred in relatives (a 7-year-old cousin and the 36-year-old mother of the index case); therefore, respiratory samples were also collected from other family members. Sequence analysis identified mutations associated with resistance to macrolides. Both P1 major adhesion protein typing and multiple loci variable-number tandem repeat analysis (MLVA) typing were performed to assess the relatedness of the strains. The index case, the cousin, the mother, and another 4 family members (twin siblings of the index case, a 3-year-old cousin, and the grandmother) were positive for MR-MP. All strains harbored the mutation A2063G, had the same P1 subtype (1), and were MLVA (7/4/5/7/2) type Z. In addition, the index case's aunt (31 years of age and the probable source of infection) harbored an M pneumoniae strain with the same molecular profile; however, this strain was susceptible to macrolides. This cluster of MR-MP infection/carriage caused by a clonal strain suggests a high transmission rate within this family and highlights the need for increased awareness among clinicians regarding the circulation of MR-MP. Novel strategies for the treatment and prevention of M pneumoniae infections are required.

This study aims to investigate the knowledge, the attitudes and practices on HPV vaccination of health professionals of Mother and Child Service of Puglia Region (Italy). The study was conducted through a standardized questionnaire. Of 455 respondents, 74.2% judged HPV vaccine very important for immunization calendar. 88.9% did not believe that the administration of HPV vaccine implies consent to the initiation of sexual activity but 34.2% sustained that vaccine can give a false sense of protection against sexually transmitted diseases. 62.2% believed that boys should also be vaccinated. Skills necessary in the implementation of strategies in the promotion of health are partially inadequate and appropriate ongoing education should be carried out for health care workers.

In recent years, the application of fibrin sealant has been shown to be efficacious in the management of intraoperative and postoperative hemostasis. We designed a prospective randomized controlled clinical trial to assess the efficacy of two different dosages of fibrin sealant (5 and 10 ml) in patients undergoing total knee arthroplasty, as compared with the untreated control group. A total of 90 patients entered the study, randomly assigned to one of the three groups: treatment with 5 ml fibrin sealant (30 patients), with 10 ml fibrin sealant (30 patients) or no treatment (30 patients). A statistically significant difference in the mean reduction of hemoglobin concentrations was found on the first postoperative day in the treated groups as compared with the controls: 5 ml fibrin sealant (2.6 mg/dl) and 10 ml fibrin sealant (2.5 mg/dl) vs. controls (3.7 mg/dl) (P = 0.024). The mean number of blood transfusions was significantly lower in the treated groups: 5 ml (0.5) and 10 ml (0.3) of fibrin sealant vs. controls (1) (P = 0.0019). Functional recovery was also better in the treated groups: on the seventh day, the joint ROM (range of motion) was statistically superior in the 5 ml group (96.5°) and 10 ml group (98.8°) as compared with the controls (75.5°) (P < 0.0001). This study supports the efficacy of administering fibrin sealant in the perioperative management of bleeding after total knee arthroplasty and shows that a 5 ml dosage yields a comparable outcome to the 10 ml dosage previously reported in the literature.

Background: In the treatment of clavicle fractures, the choice of procedure depends on the possibility of restoring the anatomical functional integrity of the shoulder. Methods: We examined 71 patients (51 males and 20 females, mean age 38.9 years) who were affected by clavicle fracture sequelae. Demographic and clinical data and the site of the lesion were recorded for each partecipant. The dissatisfaction of the patient was determined by the presence of 1 or more affirmative answers on the Simple Shoulder Test. The Constant Shoulder Score was also included in the functional and clinical exams. We measured the length of the healthy clavicle and the previously fractured clavicle, and we expressed the difference in length in mm and in percentage shortening. We then examined the correlations between the shortening of the bone and the clinical and functional outcomes of the patients. Results: Sixty patients had a lesion of the diaphysis, 8 patients had a lesion of the lateral third of the clavicle, and 3 patients had a lesion of the medial third of the clavicle. The mean Constant Shoulder Score was 77.9, and 51 of the 71 patients were satisfied with their treatment. Radiography showed a mean clavicle shortening of 10 mm (mean percentage 6.5%). In the 20 dissatisfied patients, the mean clavicle shortening was 15.2 mm (9.7%). In these patients, we found a highly significant association between dissatisfaction with treatment and the amount of bone shortening, (p < 0.0001), as well as with a diaphyseal location (p < 0.05) and with the female sex (p = 0.004). No other variable related to the patient, the type of treatment or the fracture characteristics correlated with the treatment outcome. Conclusions: In the literature, measurements of the shortening of the bone segment following a fracture range between 15 and 23 mm, and marked shortening is correlated with the failure of conservative treatment. However, these data need to be reinterpreted in light of the physiological variability of the clavicle length, which ranges from 140 to 158 mm in the healthy population. Shortening of the bone by more than 9.7% should be the cut-off for predicting failure of conservative treatment.

Temporal trends of Hepatitis A cases and vaccination coverage data against Hepatitis A Virus have been investigated to analyse the impact of the universal routine vaccination strategy more than 10 years from its introduction in Puglia (region of Southern Italy). The basic reproductive number (R(0)) before vaccination introduction and the effective reproductive number (Re) after introduction have been calculated. A progressive decrease in incidence has been recorded in Puglia during last 10 years. Vaccination coverage is actually 64.8% (95% CI: 52.7-76.9%) for children aged 12-24 months and of 67.6% (95% CI: 58.4-76.8%) for 12-year-old adolescents. R(0) estimated in 1996 was 2.01; actually R(e) is 0.651. Theoretical age at infection is 31.82 years. Universal routine vaccination aimed at the control of direct transmission remains the milestone in the strategy for the containment of the disease in settings at an intermediate level of endemicity.

Background: Diagnosis and treatment of mood disorders in youth are still problematic because in this age the clinical presentation is atypical, and the diagnostic tools and the therapies are the same as that used for the adults. Mood disorders are categorically divided into unipolar disorders (major depressive disorder and dysthymic disorder) and bipolar disorder in Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision), but mood symptoms are also comprised in the diagnostic criteria of the adjustment disorder (AD), which occur in many different psychiatric disorders, and may also be found in some physical conditions. The differential diagnosis is not much addressed in the midst of clinical investigation and so remains the major problem in the clinical practice. Aims: The associations between some variables and the depressive disorder and AD were analyzed to make considerations about differential diagnosis. Patients and methods: We reported a retrospective study of 60 patients affected by depressive disorder and AD. The analysis has evaluated the association between some variables and the single diagnostic categories. We have considered 10 variables, of which 6 are specific to the disorders, and 4 have been considered related problems. Results: The statistical analysis showed significant results for the associations of 3 variables (prevalent symptoms, treatment, and family history) with the single diagnostic categories. Conclusion: The discriminate analysis resulted in statistically significant differences between patients with depressive disorders and those with AD on 3 variables, of which 2 are specific to the disorders, and 1 is included in the related problems. The other variables were weakly associated with the single diagnostic categories without any statistically significant differences. The 3 variables that were associated with the single diagnostic categories support the distinct construct validity of the 2 diagnostic categories, but, to date, it is difficult to establish if these variables can be considered diagnostic predictors. On the other hand, the other variables did not support the distinct construct validity of the 2 diagnostic categories, which suggest an overlapping and dimensional concept. The spectrum approach could unify categorical classification that is essential with a dimensional view. Combination of dimensional and categorical principles for classifying mood disorders may help to reduce the problems of underdiagnosis and undertreatment. Keywords: depressive

OBJECTIVE: To identify factors that can hinder condom use in a sample of young adults. METHODS: The survey was carried out using a self-administered standardised anonymous questionnaire modified from the self-efficacy scale Condom Use Skill Measure. The questionnaire was administered to 1091 school-leavers who were attending a pre-university study course in August 2008 at Bari University, Italy. RESULTS: Of those interviewed, 88% had had sexual intercourse and the average age at the first experience was 16.8 years. The frequency of condom use at the most recent sexual intercourse was 52.6%. Non-condom use was associated with not having a condom immediately available, with problems in the partner accepting this particular barrier method, with the belief that proposing its use could lead to problems between the couple, with the assumption of not risking anything, with the fear that it causes irritation and with the belief that it does not feel natural. CONCLUSION: Our survey shows that there are opinions and attitudes held by young adults which hinder condom use. They should be a targeted by health education.

BACKGROUND: In literature there is a general consensus that the use of the mirror improves proprioception. During rehabilitation the mirror is an important instrument to improve stability. In some sports, such as dancing, mirrors are widely used during training. The purpose of this study is to evaluate the effectiveness of the use of a mirror on balance in young dancers. Sixty-four young dancers (ranging from 9-10 years) were included in this study. Thirty-two attending lessons with a mirror (mirror- group) were compared to 32 young dancers that attended the same lessons without a mirror (non-mirror group). Balance was evaluated by BESS (Balance Error Scoring System), which consists of three stances (double limb, single limb, and tandem) on two surfaces (firm and foam). The errors were assessed at each stance and summed to create the two subtotal scores (firm and foam surface) and the final total score (BESS). The BESS was performed at recruitment (T0) and after 6 months of dance lessons (T1). RESULTS: The repeated measures ANOVA analysis showed that for the BESS total score there is a difference due to the time (F = 3.86; p < 0.05). No other differences due to the group or to the time of measurement were found (p > 0.05). The analysis of the multiple regression model showed the influence of the values at T0 for every BESS items and the dominance of limb for stability on an unstable surface standing on one or two legs. CONCLUSIONS: These preliminary results suggest that the use of a mirror in a ballet classroom does not improve balance acquisition of the dancer. On the other hand, improvement found after 6 months confirms that at the age of the dancers studied motor skills and balance can easily be trained and improved.

BACKGROUND: This study aims to evaluate the effectiveness of pre-travel counselling carried out in Travel Clinics. METHODS: This is a retrospective cohort. Three hundred international travellers were enrolled; 150 people were from users of Bari Travel Clinic, 150 were users of a travel agency. Enrolled subjects were interviewed using a questionnaire. RESULTS: The average age of the enrolled subjects was 37.5 ± 13.9, without statistically significant differences between the two groups. 86% of cases and 19.3% of the controls reported the use of anti-malaria prophylaxis (p < 0.0001). Vaccination against cholera was given to 62% of cases and 7.3% of the controls (p < 0.001). Travel Clinic users, 6% reported diarrhoea and these figures were 27% in the control group (p < 0.0001). The proportion of those interviewed who reported fever (3.7) or insomnia (1.3) did not differ between the two groups. Mosquito bites were reported by 8% of cases and 20% of the controls (p = 0.003). Three cases of malaria were reported among the controls but no cases were detected among the cases (chi-square = 3.03; p = 0.08). CONCLUSIONS: Our study demonstrated the effectiveness of pre-travel counselling; in the future, new studies must investigate the cost-effectiveness of pre-travel prevention measures.

BACKGROUND: Streptococcus pneumoniae, lancet-shaped, gram-positive, facultative anaerobic organisms, are common inhabitants of the respiratory tract and may be isolated from the nasopharynx of 5% to 70% of healthy adults. OBJECTIVE: The aims of the study were to estimate the vaccination coverage for pneumococcal 23-valent polysaccharide vaccine and to assess the impact its introduction in the Italian region of Puglia, where a program to provide this vaccination has been operative since 2000. METHODS: Estimation of the coverage for pneumococcal 23-valent polysaccharide vaccine was implemented by a 2-step study consisting of data collection from local health unit vaccination registers between 2000 and 2008 in Puglia and of a cluster sampling study among general practitioners to validate routine data collected during the first step. Moreover, hospitalization for invasive pneumococcal diseases was studied. RESULTS: From 2000 to 2004, among individuals > or =65 years, the overall coverage rate estimated by routine data amounted to 26.3%; between 2005 and 2007, annual coverage rates did not exceed 8%/year. Between 2002 and 2007, the overall coverage rate estimated by interviewing general practitioners was 46.6% (95% confidence interval: 39.9-53.4). The coverage rate in chronic patients by routine data was approximately 23%, whereas the rate provided by general practitioners was 17.6% (95% confidence interval: 12.5-22.8). From 2001 to 2007, hospitalization data did not show a reduction in invasive pneumococcal disease trends among the elderly population in Puglia. CONCLUSION: The results of this study demonstrate the need for improving vaccine coverage and implementing new immunization strategies and practices.

Increased risk of osteoporosis and its clinical significance in patients with diabetes is controversial. This study aims to increase the data which are available regarding the prevalence of diabetes mellitus in patients affected by fragility fracture in Italy. We retrospectively studied Hospital Discharge Data (HDD) in the Apulian database for the period 2006–2010 to identify a fragility fracture diagnosis in males over 65 years of age and in females over 50. The database was then checked for drug prescriptions to identify those persons who had taken at least one osteoporosis drug. Within this latter group, thanks to hospital admission and prescription records, the subjects affected with diabetes mellitus were identified. Between 2006 and 2010 in Apulia 177,639 patients were hospitalized and diagnosed as having fragility fracture. The greatest number of those fragility fractures were found to be in the 70 to 79 age range (64,917 total; females 56,994, males 7,923). The prevalence of diabetes subjects in Apulia in this period was estimated at 6.5%. In the same region and period 21.1% of subjects affected by diabetes experienced a fragility fracture; in particular, this number was 27% for males and for 20.5% females. This is the first study providing data on the prevalence of fragility fractures and diabetes in the Apulian population. The data confirm that diabetes is a risk factor which influences bone density and risk of fractures and therefore the need of osteoporosis screening and treatment in diabetic patients.

BACKGROUND AND AIMS: Pulmonary embolism (PE) is a relatively common cardiovascular emergency: present evidence suggests that PE is the third most acute cardiovascular disease after cardiac ischemic syndromes and stroke. The aim of this study is to evaluate hospital admissions for PE in the Apulia Region of Italy in the period 2001-2007 through an analysis of the Apulia Region hospital patient discharge database. METHODS: Patients were selected on the basis of admissions between 01/01/2001 and 31/12/2007 with ICD-9-CM code of 415.11 (Iatrogenic pulmonary embolism and infarction) or 415.19 (Other pulmonary embolism and infarction) as principal or secondary diagnosis. RESULTS: The number of patients selected from the database was 4,303. The raw annual admission data shows an increasing trend from 13.9x100,000 residents in 2001 to 18.9 x 100,000 residents in 2007. The average patient age was 68.7 years and 59% were females and 41%. There were 470 deaths in hospital (10.9% of patients). CONCLUSIONS: PE is associated with much health care and a substantial economic burden, yet many PE and general venous thromboembolism (VTE) events are preventable. It remains the responsibility of individual hospitals to identify specific areas in which they can improve their VTE prophylaxis rates to obtain positive results from the reporting initiatives and incentive programs.

Serological studies have many important epidemiologic applications. They can be used to investigate acquisition of various infections in different populations, measure the induction of an immune response in the host, evaluate the persistence of antibody, identify appropriate target groups and the age for vaccination. Serological studies can also be used to determine the vaccine efficacy. Since 1995 a varicella vaccine is available and it has been recommended in several countries (e.g. USA, Australia, Canada, Costa Rica, Ecuador, etc.). Nevertheless few varicella seroprevalence studies in countries that adopted an URV are available. It is related to the relatively recent introduction of the vaccination and to the lack of structured and collaborative surveillance systems based on serosurvey at national or regional level. Varicella seroprevalence data collected before the introduction of vaccination strategies allowed to establish the age of vaccination (e.g., indicated the opportunity to offer the vaccine to Italian susceptible adolescents). In the post-vaccination era, seroprevalence data demonstrated vaccine as immunogenic and excluded an increase of the age of infection linked to the vaccination strategy. New seroprevalence studies should be performed to answer to open questions, such as the long-term immunity and the change of the herpes zoster epidemiological pattern related to the vaccine.

The peculiar anatomical characteristics and precarious vascularization of the carpal scaphoid are responsible for a difficult healing of fractures and a fairly frequent subsequent evolution to pseudoarthrosis. Recently, extracorporeal shockwaves therapy (ESWT) has yielded encouraging results in the treatment of pseudoarthrosis of various bone segments. We report a retrospective study comparing the results of application of three sessions of shockwaves therapy (SW) with energy flux density (EFD) impulses of 0.09 (SD = 0.02) mJ/mm(2) ESWT emitted by an electromagnetic generator in 58 patients (group I) affected by pseudoarthrosis of the carpal scaphoid, with the results of surgical treatment consisting of stabilization and bone graft according to the Matti-Russe technique, performed in 60 subjects (controls, group II). There were no statistically significant differences in the mean duration of the pseudoarthrosis (p = 0.46), sex distribution (p = 0.41) and mean age at recruitment (p = 0.95) between the two patient groups. Posttreatment clinical-functional assessment, based on the Mayo Wrist Score, showed a significantly improved score, rising from 28-74.6 in group I already after 2 mo (p &lt; 0.001), with 86.3% of the results judged as satisfactory or excellent; in group II the mean score rose from 27.5-74.2 after 2 mo, with 83.4% of the results judged as satisfactory or excellent (p &lt; 0.001). At the same two-months follow-up (FU), radiographic consolidation was shown in 75.9% of patients in group I and 76.7% in group II. These improvements persisted at the subsequent controls at six and 12 mo in both groups. The Mayo Wrist Score and X-rays did not show statistically significant differences at the various FU visits in the two groups (p &gt; 0.05). On the basis of our data, we can conclude that the results of ESWT are comparable with those of surgical stabilization and bone graft in the treatment of scaphoid pseudoarthrosis. In view of their minimal invasiveness, shockwaves should therefore be considered the treatment of choice of this disorder.

A survey was proposed to Italian Prevention Department Directors to investigate the opinions on the value of the cocoon strategy and its introduction. Cocoon was considered the most efficacious strategy to protect newborns against pertussis by 76% of the interviewees. Prevention Departments should promote and coordinate locally the strategy in 75% of the respondents. Cocoon should be recommended by Regional Authority in 82% of the interviewees.

BACKGROUND: Raw seafood consumption was identified as the major risk factor for hepatitis A during the large epidemic of 1996 and 1997 in Puglia (South Italy). In Puglia, vaccination for toddlers and preadolescents has been recommended since 1998.The aim of the study was to evaluate the incidence, seroprevalence, molecular epidemiology, and environmental circulation of hepatitis A virus (HAV) in Puglia more than ten years after the introduction of anti-HAV vaccination in the regional immunization program. METHODS: Data on the incidence of acute hepatitis A in Puglia were analyzed. Characteristics and risk factors of 97 acute hepatitis A cases occurring in 2008-2009 were analyzed. Serum samples from 868 individuals aged 0 to 40 years were tested for anti-HAV antibodies. Fecal samples from 49 hepatitis A cases were analyzed by sequence analysis in the VP1/P2A region. In 2008, 203 mussel samples and 202 water samples from artesian wells were tested for HAV-RNA. RESULTS: Between 1998 and 2009, the incidence of acute hepatitis A declined from 14.8 to 0.8 per 100,000. The most frequent risk factors reported by cases in 2008-2009 were shellfish consumption (85%) and travel outside of Puglia or Italy (26%). Seroepidemiologic survey revealed high susceptibility to HAV in children and adults up to age 30 (65%-70%). None of the mussel or water samples were HAV-positive. Phylogenetic analysis revealed co-circulation of subtypes IA (74%) and IB (26%) and clustering of strains with strains from Germany and France, and those previously circulating in Puglia. CONCLUSION: Vaccination and improved sanitation reduced the incidence of hepatitis A. Strict monitoring and improved vaccination coverage are needed to prevent disease resurgence

The aim of this study was to evaluate the level of poliomyelitis immunization in refugees residing in the Asylum Seeker Center in Bari. The study was carried out during 2008 and involved 573 refugees. An antibody titer >or=1:8 was found in 99.6% for poliovirus 1, in 99.8% for poliovirus 2, and in 99.5% for poliovirus 3.

We aimed to investigate the Web site contents of Italian National Health System structures regarding health care-associated infection (HAI). For each Web site a form inquiring about the availability of information about HAI issues and their prevention was filled in. An HAI section was available in the Web site of 19.3% of facilities. In 1.6% of Web sites this information was available on the homepage. The most frequently reported information was related to infection control practitioners, HAI surveillance systems, and handwashing hygiene. In conclusion, the communication of risks related to clinical practice should be part of risk management systems and should assume a significant position in content strategy activities. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

OBIETTIVI: Il presente studio si propone di valutare la presenza dei fenomeni di bullismo e di cyber bullismo nei preadolescenti (10 – 13 anni), le modalità e la frequenza con cui questi episodi si verificano e la relazione con l’ambiente familiare e scolastico in cui i preadolescenti vivono. La scelta del target più giovane, rispetto alle analisi finora condotte, risiede soprattutto nella mancanza di evidenze in merito ai fenomeni di cyber bullismo in questa fascia d’età. Lo studio si propone, inoltre, di descrivere la diffusione e l’uso, tra i preadolescenti, delle tecnologie e degli strumenti informatici di ultima generazione e valutarne la correlazione con l’aumento degli episodi di cyberbullismo. METODI E AZIONI: È stato effettuata una ricerca nel territorio di Ruffano (Le) presso l’Istituto Comprensivo Statale di Ruffano presso cui è stata svolta un’indagine conoscitiva attraverso l’utilizzo di un questionario modificato, costruito ad hoc utilizzando parte degli items contenuti nel “Questionario sulle prepotenze tra i ragazzi a scuola” [versione originale a cura di Dan Olweus (1991) e di I. Whitney& P.K. Smith (1993)], tradotto e adattato da A. Fonzi, M.L. Genta e E. Menesini (1993) del Dipartimento di Psicologia Generale dei Processi di Sviluppo e Socializzazione dell’Università degli Studi di Firenze e un questionario sviluppato dalla sezione di Psichiatria della Facoltà di Medicina dell’Università di Foggia come strumento per valutare il fenomeno del cyberbullismo. RISULTATI : Il campione oggetto di indagine era costituito da 200 bambini e ragazzi appartenenti a quattro classi di quinta elementare e cinque classi di prima media. Hanno aderito allo studio 85 bambini e ragazzi, di cui il 54,1% (n=46) erano di erano di sesso femminile. Il tasso di adesione allo studio risulta pari al 42,5%. È stato possibile osservare un altissimo tasso di diffusione degli strumenti elettronici tra i preadolescenti attraverso cui, la metà degli intervistati ha dichiarato di aver subito atti assimilabili ad episodi di cyberbullismo. CONCLUSIONI: Un dato preoccupate è rappresentato dal fatto che il 70% dei ragazzi intervistati ha affermato di utilizzare il pc per navigare su Internet in totale autonomia, senza il controllo di un adulto, 268 e quasi due terzi ha la consuetudine di giocare on-line. I ragazzi hanno mostrato di avere buona conoscenza ed esperienza dello strumento Internet: conoscono i social network e sono iscritti ad almeno uno di questi, Facebook in particolare nonostante l’iscrizione sia consentita solo ai maggiori di 18 anni e li utilizzano abitualmente per chattare con amici e parenti. A fronte di questa esperienza, l’indagine ha mostrato come in realtà i bambini non abbiano consapevolezza della possibilità di incorrere in episodi di cyberbullismo: 44 ragazzi hanno dichiarato di essere stati oggetto di episodi assimilabili a comportamenti di cyberbullismo, ma solo 5 di loro hanno affermato di esserne stati vittima. La valutazione della reazione dei genitori nei confronti degli atti di prepotenza attuati dai propri figli ha messo in luce come in molti casi i genitori siano impreparati di fronte a tali eventi: infatti solo una proporzione ridotta di genitori cercano di indagare le motivazioni che spingono i loro figli a compiere atti di prepotenza nei confronti di altri bambini. PAROLE CHIAVE: Cyberbullismo, internet, preadolescenti.

The purpose of the present study was to monitor any improvement in orienteering skills attributable to acquiring a better mental representation of space. Two groups were examined: the experimental group, who attended 6 mo. of orienteering lessons, versus the control group, who did jogging training instead. Each group, consisting of 20 children, was tested on the Corsi Block-tapping Test, run Forward and Backward, and the Star-Butterfly Test. Pre- and post-tests were administered. In the experimental group, scores increased in mean complexity from pre- to post-test on the Forward and the Backward Corsi tests, while on the Star-Butterfly Test both time and mistakes had decreased after the training. In the control group, mean complexity and Star-Butterfly Test scores were unchanged from pre- to post-test. These results showed that after continual training in orienteering techniques, the orienteering group was able to remember and repeat sequences of events with greater precision than before the training, while these skills were unchanged in the control group after training in jogging.

La carie è stata identificata come la malattia singola cronica piú comune dell’infanzia; il suo controllo e prevenzione dovrebbe essere una priorità per gli odontoiatri. Scopo di questo studio è descrivere la correlazione tra le carie precoci dell’infanzia (ECC) ed il fenomeno della negligenza su minori. Ad un campione random di genitori afferenti a diversi servizi di pediatria a Bari è stato consegnato un questionario contenente dati socioeconomici, demografici e riguardo le cure odontoiatriche; il questionario è stato completato da una visita odontoiatrica. Su 63 bambini esaminati, il 61.9% (n=39; 95% CI=49.9-73.9) presentava ECC; il 47.6% (n=30; 95% CI=34.9-60.6) erano ECC di tipo I, il 12.7% (n=8; 95% CI=5.6-23.5) di tipo II e l’1.6% (n=1; 95% CI=0-8.5) di tipo III. In particolare, la frequenza di ECC di tipo II e III è risultata maggiore nei bambini provenienti da famiglie con reddito basso (chi-quadro=8.50; p=0.03).

Dental caries was identified as the single most common chronic childhood disease; its control and prevention should be a priority for dentists. Aim of our work is to describe the correlation between early childhood caries (ECC) and the phenomenon of child neglect. To a random sample of parents afferent to pediatric services in Bari was delivered a questionnaire recording socioeconomic, demographic and dental service-use data, completed by a dental examination. Of the 63 children examined, 61.9% (n=39; 95% CI=49.9-73.9) presented with ECC, of which 47.6% (n=30; 95% CI=34.9-60.6) were classified as Wyne’s Type I; 12.7% (n=8; 95% CI=5.6-23.5) were classified as Type II; and 1.6% (n=1; 95% CI=0-8.5) as Type III. In particular, the frequency of Types II and III were shown to be higher in low-income families (chi-square=8.50; p=0.03).

Bacillus cereus, a ubiquitous bacterium, can be isolated in various starchy food items, causing both emetic and diarrhoeal disease. The real burden of B. cereus outbreaks is actually poorly known in Italy. We report a B. cereus foodborne outbreak that occurred in a pub in Bari (Italy) on January 22nd 2012 during a birthday party, promptly reported by the pub owner.

BACKGROUND: Ceramic bearings in total hip arthroplasty (THA) have been introduced in clinical practice to minimize the problem of polyethylene particle-induced osteolysis. The aim of the study is to report the results of 68 consecutive alumina-on-alumina THAs done in 61 patients for avascular necrosis (AVN) of the femoral head. MATERIALS AND METHODS: In all implants a press-fit cup was used; it was combined with a 32-mm alumina head and with titanium-alloy stems. The mean age at surgery was 50 years. At an average follow-up of 13 years two hips have been revised, one for periprosthetic infection and one for excessive abduction of the cup. RESULTS: No revision for aseptic loosening is recorded; one anatomical cementless femoral stem had radiological evidence of definite aseptic loosening. No dislocations occurred, and no osteolysis was observed. CONCLUSIONS: The results support the application of alumina-alumina THA for long-lasting replacements.

Influenza vaccination is strongly recommended for Italian healthcare professionals, but vaccine coverage is low. Since 2012, vaccination is also offered to medical students as part of the National Immunization Plan; however, few Medical Schools has implemented the plan so far. To study determinants of vaccination compliance, we conducted a survey among medical students at the University of Bari, where influenza vaccination has been actively offered since 2013. Information was obtained by means of an online anonymous questionnaire administered in April 2014. We enrolled 669 students, 383 (57%) vaccinated; 54% were female and the average age was 23.9 ± 4.9 y. Determinants of getting vaccinated were analyzed in a multivariate logistic model. Receiving invitation from the University (aOR = 3.8; 95%CI = 1.2-12.3; p = 0.026), the opinion that vaccine is safe (aOR = 2.8; 95%CI = 1.5-5.0; p = 0.001) and useful (aOR = 3.4; 95%CI = 1.7-6.7; p<0.0001), a specific training about influenza vaccination during the course (aOR = 1.5; 95%CI = 1.1-2.1; p = 0.043), and considering himself as at a major risk of influenza complication (aOR = 1.8; 95% CI = 1.1-2.9; p = 0.001) were significantly associated with vaccine acceptance. Active invitation and training are confirmed as key actions (as in children vaccination strategies) and, according to our results, they could be routinely used to promote vaccination in hard-to-reach groups such as healthcare workers.

OBJECTIVES: Today the school is no more designed as an istitution of information and sociality, but as a formative agency, also with the help of new didactic technologies like new media and computer science. Radiokreattiva project for the education to legality act in this assumption. The purpose of this research work is test which changes are found in students that have done the project, such as adherence at social rules and perception of istitutions and police. METHODOLOGY: In scolastic year 2011-2012 a questionnaire of Prof. Diana, Marra (2009) was submitted in test-retest to 285 students of 11-13 years (135 males, 150 females) in 28 schools of Bari, and significative differences in anwers given to same items were identified. The items were about student’s attitudes and beliefs on istitutions, rules, laws and society. RESULTS: A significative improvement seems to emerge about declared knowledge of laws (p=0,02) and confidence in istitution and political men (p=0,04) at test-retest. About reaction at acts of violence a significative halving (p=0,01) of people that wouldn’t talk with anybody was identified. Also admiration level about police increased. Level of indifference instead decreased. DISCUSSION: Significative positive variations seems to emerge about attitudes on istitutions and police, and there is an increased discrimination between legal or illegal behaviours. A more complete knowledge of laws and constitution was detected, while conspiracy of silence decreased. There are also critical areas, like a little confidence on other people. Radiokreattiva would proceed in this direction in the future: peer to peer education may be an important support to prevention and primary intervention in school ambit

The Orthopedic Multidimensional Prognostic Index (Ortho-MPI) was performed and validated in order to ameliorate the decision-making process as regards the elderly with hip or neck femur fractures. A retrospective study was performed. 95 patients 65 years old and over with a diagnosis of hip or femur fracture were enrolled. A standardized comprehensive orthopedic geriatric assessment was performed. It included information on: depressive symptoms, functional and instrumental activities of daily living, cognitive and nutritional status, laboratory tests, risk of pressure sore, comorbidities and comorbidity. The Ortho-MPI was calculated. After six months their initial assessment, patients were recalled in order to know if they live too or not. The survival condition was associated to the prognostic capacity calculated by the Ortho-MPI. Results showed that higher Ortho-MPI Index value was associated with higher six months-later mortality. In an unvaried analysis model the Ortho-MPI index was associated with death event of the elderly patients enrolled (OR=1.05; 95% CI, 1.01-1.10; z=2.27; p=0.023). This association was also validated by considering different ages between participants (OR=1.05; 95% CI, 1.004-1.11; z=2.13; p=0.033). Furthermore, each specific index considered in the total Ortho-MPI was associated with the death event of the elderly patients. In conclusion it was shown that the Ortho-MPI Index could be used to predict outcome in the elderly with hip or femur fracture

ABSTRACT: BACKGROUND: In overhead sports like volleyball, the onset of a rotator cuff tendinopathy due to functional overload is a common observation. An angiofibroblastic etiopathogenesis has been hypothesized, whereby a greater anaerobic metabolism occurs in critical zones of the tendon with a lower degree of vascularization; this would induce collagen and extracellular matrix degradation, that could then trigger a compensatory neovascularization response. We performed a clinical observational study of 80 elite volleyball players, monitoring the perfusion values of the rotator cuff tendons by oximetry. RESULTS: No statistically significant differences were found between the oximetry data and age, sex or years of sports activity, nor when comparing the right and left arm or the dominant and non-dominant arm. A statistically significant difference was found for the dominant arm values in relation to the competitive role, higher values being obtained in outside hitters (62.7%) middle hitters (53.7%), opposite hitters (55.5%) and libero players (54.4%) (p<0.05), whereas there was no difference in players with the role of setter (56.2%) (p>0.05). CONCLUSIONS: The different tendon vascularization values found in players with different roles in the team may be attributed to a response to the specific biomechanical demands posed by the different overhead throwing roles.

HPV type-specific distribution was evaluated in genital samples collected from 151 women from West Africa and Horn of Africa, living in the Asylum Seeker Center in Bari Palese (Italy), undergoing voluntary screening correlated with cytological abnormalities. HPV-DNA was assayed by Linear Array HPV genotyping test. HPV DNA was detected in 39.1 % of the women, 42.5 % of which had multiple infection and 69.5 % had high-risk HPV infection. Age-prevalence rates evidenced a peak of HPV infection in women ≤20 years of age (53.1 %). HPV 53 and 16 were the most common viral types (13.5 and 12.0 % respectively). Abnormal Pap test results were found in 4.4 % of women with known cytological result. Although a prevalence of HPV positive women higher in African than in European women was expected, the differing rate between residents and migrants African women must be investigated in future studies.

BACKGROUND: The aim of this study was to assess the prevalence of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) serological markers and the prevalence of VDRL positive subjects in a population of refugees of various nationalities, living in the Asylum Seeker Centre in Bari Palese, Southern Italy. METHODS: The study was carried out in the period May-July 2008 and recruited only voluntarily enrolled healthy refugees. HBsAg, anti-HBc, anti-HCV and anti-HIV virus antibodies were detected. VDRL syphilis screening was also carried out on the serum samples. RESULTS: A total of 529 refugees, 442 males and 87 females, aged between 7 and 52 years, were studied. Of these, 510 were from Africa and 19 from Asia.Forty-four individuals (8.3%) were HBsAg positive and 241 (45.6%) were anti-HBc positive. A total of 24 (4.5%) individuals were anti-HCV positive. Eight asylum seekers (1.5%) were HIV positive. VDRL tests were performed on 269 subjects and 4 (1.5%) were positive. 12.3% of the study population had serological markers of chronic and transmissible infections with potential blood-borne or sexual transmission. CONCLUSIONS: In Italy, a suitable protocol is necessary for the early diagnosis of infectious diseases on entering Asylum Centres, so allowing the adoption of prevention measures to safeguard the health of the individuals, the residents and workers in the Centres and the general population.

This survey aimed to investigate the perception of Italian Paediatricians regarding the promotion of physical activity.

Fibromyalgia (FM) is a rheumatic disease which affects fibrous tissues and muscles; it is characterized by chronic pain and it is often associated with craniomandibular disorders (CMD). 31 patients were assessed from March 2012 to October 2012 through the administration of specific questionnaires and following neurologic and gnatologic assessment. A relevant corre-lation between FM and CMD emerges from the present study, as 80.6% of our patients report CMD symptoms with high prevalence of myofascial pain (84%). Multivariate regression analysis revealed that the patients in the present study did not differ in score of quality of life questionnaires from patients with fibromyalgia. The neuropathic pain diagnostic question-naire (DN4) scores were positively affected by belonging to group II of Research Diagnostic Criteria of Temporomandibular Disorders (RDC/ TDM) classification, suggesting the possibility of a neuropathic component in chronic pain in this CMD group, as already speculated in our study on the correlation between burning mouth syndrome and CMD and by other au-thors in studies on chronic low back pain. However, further clinic and instrumental studies are needed in order to test this as-sumption.

We describe an outbreak of varicella at a preschool center in Southern Italy, in the period January-May 2009, among children with a vaccination coverage of 53.9% for one dose. The outbreak occurred in a small community in Puglia and enrolled 41 children. The attack rates for unvaccinated and vaccinated children were 72.3% and 12.7%, respectively. The vaccine effectiveness against disease was 82.4%. Our findings add a further piece of evidence in supporting the routine use of a second dose of vaccine for all children without a history of disease, as recently recommended by the ACIP of the CDC.

BACKGROUND: The introduction of universal pertussis immunization and the high coverage achieved in most developed countries have largely changed the epidemiology of the disease. Although vaccination rates are high in the first year of life, the rates of booster doses are unsatisfactory and lead to the onset of outbreaks. This report describes an outbreak of pertussis affecting school students already immunized in a town of Puglia (Italy), detected at the end of April 2009. METHODS: Vaccine effectiveness is measured by calculating the incidence rates (attack rates- AR) of disease among vaccinated (ARV) and unvaccinated (ARU) people and determining the percentage reduction in the incidence rate of disease among vaccinated people compared to unvaccinated people. RESULTS: The index case was a healthy child, female, 9-years-old who attended a local elementary school and developed pertussis on 27 April 2009. The secondary cases were the aunt and the cousin of the index case who developed a cough on 10 May 2009. In the elementary class of the index case, a cluster occurred. The overall AR was 15.8%, in particular 20% in children who did not receive the booster doses at 5-6 years old (ARU) and 14.3% in children receiving the booster (ARV). The VE of booster dose in this setting was 28.5%. Moreover, only the index case developed a persistent cough; the VE against moderate to severe pertussis was 100%. A cluster was detected in the middle school class that the cousin of the index case attended; AR was 44.4% (12/27); ARU was 50% (10/20) and ARV 28.6% (2/7). VE in this setting was 42.8%. CONCLUSIONS: Our results confirm the need to administer booster doses; failure the booster is the principal determinant for the outbreak onset.

BACKGROUND: The aim of this study is to explore the association between celiac disease and menstrual cycle, gestation and puerperal disorders. METHODS: The association between celiac disease and menstrual cycle, gestation and puerperal disorders in a sample of 62 childbearing age women (15-49 age) was assessed within an age and town of residence matched case-control study conducted in 2008. Main outcome measures were the presence of one or more disorders in menstrual cycle and the presence of one or more complication during pregnancy. RESULTS: 62 celiac women (median age: 31.5, range: 17-49) and 186 healthy control (median age: 32.5, range: 15-49) were interviewed. A higher percentage of menstrual cycle disorders has been observed in celiac women. 19.4% frequency of amenorrhea was reported among celiac women versus 2.2% among healthy controls (OR = 33, 95% CI = 7.17-151.8;, p = 0.000). An association has been observed between celiac disease and oligomenorrhea, hypomenorrhea, dysmenorrhea and metrorrhagia (p < 0.05). The likelihood of having at least one complication during pregnancy has been estimated to be at least four times higher in celiac women than in healthy women (OR = 4.1, 95% CI = 2-8.6, p = 0.000). A significant correlation has emerged for celiac disease and threatened abortion, gestational hypertension, placenta abruption, severe anaemia, uterine hyperkinesia, intrauterine growth restriction (p < 0.001). A shorter gestation has on average been observed in celiac women together with a lower birth weight of celiac women babies (p < 0.001). CONCLUSIONS: The occurrence of a significant correlation between celiac disease and reproductive disorders could suggest to consider celiac disease diagnostic procedures (serological screening) in women affected by these disorders.

INTRODUCTION: This study aims to determine risk factors for the acquisition of HIV, HBV and HCV infections among Injection Drug Users (IDUs) who attended the out-patient clinic of the Department of Pathological Dependence at Bari Hospital in Bari Province (Italy). METHODS: The study was conducted in the year 2008 using the information available in the out-patient files of 291 drug addicts who were undergoing treatment. RESULTS: Their average age was 29.3 and 133 (45.7%) of them were affected by HIV/HBV/WHCV. The use of injected heroin, being separated or divorced, and having committed a crime were found to be risk factors for infection by HIV/ HBV/ HCV, while having a school diploma or a university degree and the use of cannabinoids were negatively associated with the infective diseases. DISCUSSION AND CONCLUSIONS: While the data from the Italian Departments of Pathological Dependence concerning HIV diffusion in treated patients have been showing a reduction in the number of cases of seropositivity, drug addiction in industrialized countries is still the second most important risk factor, after promiscuous sexual behaviour, for infection by parenteral transmission. Correct risk assessment is essential for the planning of effective strategies for primary and secondary prevention.

In recent decades in South-Italy, drastic epidemiological changes in the pattern of the enterically transmitted diseases were recorded. This work aims to support the hypothesis that universal routine vaccination against hepatitis A started in Puglia in 1998 could be also effective in reducing contamination in seafood. Three studies on different samples of Mitylus edulis lamellibranch were conducted over 20 years. Microbiological analysis measured both the standard bacteriological indexes (faecal coliforms, Escherichia coli, Salmonella spp.) and the presence of hepatitis A, enterovirus, norovirus and rotavirus. Between 1989 and 2009, the highest number of hepatitis A cases was reported in 1996 and in 1997 (mean incidence rate of 130 per 100,000). Since 1999, the number of cases progressively decreased, reaching 29 cases in 2006 (incidence rate of 0.7 per 100,000). A progressive improvement in vaccination coverage of newborns was recorded ranging from 1997 (38.3%) to 2005 birth-cohorts (63.4%). Vaccination coverage of 12-year-old adolescents was 67.6% (95% CI: 58.4-76.8%). Hepatitis A was detected in 3.7% of samples in the 1987 study, in 18.3% of samples in the 1999-2000 study and it was absent in the 2007 study. The decreasing of HAV circulation in humans and in shellfish provides support for the link between vaccination efforts and the safety of molluscs

Mobbing may cause the appearance of reactive mental disorders related and based to a pathogen and peculiar working environment. Usually in “Mobbing” cases we analyze the point of view of the patient, what he believes he has suffered, we listen to his reasons, we record his suffering but often it’s not possible to check and verify if this is true checking with the other party, with the Employer. Our purpose is to understand and recognize if the Mobbing situation is really in place and the quality of the Mobbing action accomplished by the employer. Our aim is to evaluate the psychological aspect that are usually examined only from the patient / “alleged victim” point of view, both clinical and forensic. The doctor has no tool to evaluate – very rarely it happens – about complains, about the mobbing environment, about downgrading of duties. For this reason, the research on data and records for years 2010-2014 provided by INAIL – Apulia Region, even if based only on official acts and documents, is in our point of view important: we have been able to have a better understanding on a complex phenomenon like the Mobbing and regarding the damage evaluation of the medical/ legal, psychological, psychiatric/forensic aspects.

I Servizi per le Dipendenze Patologiche (SerD) assolvono annualmente al debito informativo con il Ministero della Salute relativo alle attività svolte e agli utenti in carico attraverso il flusso informativo SIND. Questo rapporto raccoglie i dati relativi alle principali forme di dipendenza patologica per le quali gli utenti si sono rivolti ai SerD della regione Puglia nel corso dell’anno 2015. Il rapporto si suddivide in tre sezioni principali: Dipendenze negli utenti in carico; Altri utenti; Monitoraggio biologico degli utenti.

To compare the effectiveness of Doctor Tecar TherapyTM with that of laser therapy in the management of low back pain (LBP), a total of 60 patients with LBP were enrolled. The participants were randomly divided into two groups: a Tecar group (experimental group, 30 subjects), and a laser group (control group, 30 subjects). All the subjects received 10 sessions of therapy: one each day from Monday to Friday and the same again the following week. All the subjects were evaluated for pain (VAS) and disability (Roland and Morris score and Oswestry score) at baseline (T0), and 2 weeks (T1), 1 month (T2) and 2 months (T3) after the end of treatment. The pain and disability presented a trend to improvement over time in both groups. This improvement was statistically significant at all follow-ups (FUs) in the Tecar group but only at T1 for the Laser group (p less than 0.01). Comparing the two methods, there emerged a significant difference in favour of the Tecar group at T2 and T3 (p less than 0.01). The results show that Tecar therapy determined significant improvement already by the end of the treatment. Moreover, at the first and second month FUs, the Tecar therapy showed statistically better results than laser therapy.

The aim of this study was to evaluate the presence of wild poliovirus or sabin-like poliovirus in 152 stool samples from migrants in the Accommodation Center in Italy and liquid waste from the sewage systems. Two surveys were performed in 2008 and 2011. All stool samples were negative for enterovirus and poliovirus. One of the liquid samples analyzed was positive for Coxsackievirus type B5.

Introduction Extracorporeal shockwave therapy (ESWT) produces good results in the treatment of insertional Achilles tendinopathy. The efficacy of combined administration of dietary supplements with ESWT has not yet been studied. Methods In this prospective, randomized clinical trial, Shock Waves therapy and Arginine for Achilles Tendinopathy (SWAAT), subjects affected by insertional Achilles tendinopathy were enrolled. Between January and October 2011, all participants underwent three sessions of ESWT. In addition, the patients in the experimental group received a daily dietary supplement containing arginine, Vinitrox (Bio Serae Laboratories SAS, Bram, France), collagen, methyl-sulfonyl-methane, vitamin C, and bromelain, while the control group patients received placebo. Results There was no statistically significant difference in the visual analog scale (VAS) score between the two groups at 2 months (3.9 vs. 5.1; P = 0.07), whereas at 6 months the value was significantly lower in the experimental group (2.0 vs. 2.9; P = 0.04). The difference in the Ankle-Hindfoot Scale score at 2 and 6 months of follow-up (FU) was significantly in favor of the experimental group (2 months: 85.4 vs. 72.1; P = 0.0035; 6 months: 92.4 vs. 76.5; P = 0.0002). The Roles and Maudsley score also showed a statistically significant difference between the two groups in favor of the experimental arm as regards patient satisfaction (at 2 months: 1.7 vs. 2.8; P &lt; 0.0001; at 6 months: 1.5 vs. 2.3; P &lt; 0.001). There was a statistically significant reduction in tissue oximetry values compared to baseline in both treatment groups at 2 and 6 months of FU. Comparing the groups, only at the last FU, at 6 months, was a significantly lower oximetry value observed in the experimental group versus controls (60.2 vs. 66.0; P = 0.007). Conclusion On the basis of the results obtained in this study, the authors conclude that in the treatment of insertional Achilles tendinopathy, ESWT induces a hemodynamic re-equilibrium with an in tendon trophism. The addition of specific dietary supplements could improve the therapeutic response

Objectives: Showering before entering a swimming pool is highly recommended to reduce the risk of biological and chemical contamination. This study evaluated the behaviour of users of indoor swimming pools, analysed the variables associated with lack of showering, and assessed awareness of the importance of showering. Study design: Cross-sectional study. Methods: A self-administered questionnaire was used to collect data about users of swimming pools located in five different Italian cities. The association between specific variables and the lack of showering was assessed. P < 0.05 was considered to indicate statistical significance. Results: In total, 4356 questionnaires were analysed. Sixty-five percent of interviewees always showered before entering the pool. The main reason given for pre-swim showering was ‘to wash oneself’ (50.5%) or ‘to get used to the temperature of the water’ (44.3%), and 5.2% answered ‘for both reasons’. Risk factors significantly associated with lack of showering were: female sex [odds ratio (OR) 1.37, 95% confidence interval (CI) 1.2e1.59], age 14e17 years (OR 5.09, 95% CI 3.40e7.64), not reading the swimming pool rules (OR 1.24, 95% CI 1.10e1.41), living in Central Italy (OR 3.3, 95% CI 2.65e4.1) or Southern Italy (OR 1.35, 95% CI 1.18e1.55), and previous/current attendance of a swimming course (OR 1.7, 95% CI 1.48e1.97). Conclusions: The results revealed low compliance with the rule of showering before entering a swimming pool, and little awareness of the preventive role of showering in the hygienic management of swimming pools. There is a need for targeted educational interventions to inform swimming pool users of the reasons for the importance of showering before entering a pool.

Due to a growing numbers of lateral fragility fractures of the femur and their high social costs the need to work out an effective strategy in order to find a better solution for these patients is warranted. From January 2010 to July 2011, we carried out a prospective randomized clinical study comparing the results of patients with femoral lateral fractures treated by nail and cephalic hydroxyapatite coated screws (study group including 27 patients) compared to the patients with the same fractures treated with nail and head standard screws (control group including 27 patients). We defined the two parts of the femoral neck as ROI 1 (under the head screw) and ROI 2 (above the femoral screw) on the AP view. The bone density of the two areas was calculated using DEXA at T0 (1st day post-surgery), at T1 (40th day post-surgery), at T2 (3 months later), at T3 (1 year later). The clinical-radiography evaluations were based on the Harris Hip Score (HHS), ADL test and x-ray views of the hip. As far as the bone mineral density average of ROI 1 and ROI 2 is concerned, we found a significant statistical increase at T1 and T3 in the study group, while it was not significant in the control group. We could account for this data through the higher mechanical stability of hydroxyapatite coated screws than standard screws. In fact, this material was responsible for improved implant osteointegration. Thanks to a 1 year follow-up we were able to demonstrate the implant utility associated with augmentation and the importance of densitometry exams such as easily repeatable and low cost diagnostics to prevent the onset of complications linked to screw loosening

Abstract BACKGROUND: Cardiovascular and renal disease are nowadays among the leading cause of morbidity and mortality in Western Countries. Low birth weight has been recently considered a key factor in determining cardiovascular disease and long term renal disease in adulthood. METHODS: In our study we analyzed, through echocardiography, eco color Doppler of carotid arteries, ultrasound of abdominal aorta and kidneys, morphological characteristics of cardiovascular and renal system, in a in a group of children born preterm with very low birth weight, (birth weight<1500 grams) and in a group of children, age and sex matched, born at term with weight appropriate for gestational age. 15 children born very low birth weight preterm (cases), aged from 3 to 5 years, and 15, age and sex matched children, born appropriate for gestational age at term (controls) were enrolled in the study. RESULTS: The two groups were homogeneous for interventricular septum diameter, left ventricular end-systolic diameter, left atrial diameter, and ejection fraction. Left ventricular end diastolic diameter was higher in case compared to controls (p=0.04), while aortic diameter root smaller (p=0.005). E and A waves peak velocities and E/A ratio resulted lower in cases compared to controls (p=0.02, p<0.001and p <0.001, respectively). Tei index, S, e' and a' waves velocities were similar in the two groups, while E/e' ratio was higher in cases (p=0.046). Intima-media thickness and antero-posterior diameter of abdominal aorta values did not differ in cases versus controls. Longitudinal diameters of both kidneys were reduced in cases compared to controls (p <0.05). CONCLUSIONS: Although limited by the small sample size, our study highlighted an increased size of the left ventricle and altered left ventricular diastolic function in children born very low birth weight preterm, but no long term consequences on systolic performance and vascular structure have been found. The finding of smaller kidneys in ex-preterm very low birth weight children could explain their higher susceptibility to develop renal disease in adulthood.

Pneumococcal disease epidemiology has changed after introduction of pneumococcal conjugate vaccines. Seven-valent vaccine (PCV7) has been effective in reducing invasive pneumococcal disease (IPD). In europe, PCV13 effective-ness was estimated at 78% (95% CI:-18–96%) for 2-priming doses. In Italy, PcV7 was introduced in 2006 in the childhood immunization schedule and replaced with PcV13 in 2010. In apulia, vaccination coverage has reached 95.1% (birth-cohort 2010). We estimated PCV program effectiveness and its impact on S.pneumoniae diseases. PCV Effectiveness: We used the screening method. We calculated the Proportion of Population Vaccinated from immunization registries and detected cases through a laboratory-confirmed surveillance among hospitalized children ≤60 months. a confirmed IPD case was a child with PCR positive for S.pneumoniae. Differences among children were assessed with the chi-square or the Fisher exact test (P value < 0.05). PCV Impact: We constructed time series using outcome-specific Poisson regression models: hospitalization rate in pre-PcV era and hospitalization Risk Ratios (RRs) with 95% cIs for both PcV7 and PcV7/PcV13 shifting era. We calculated hospitalization RR with 95% Cls comparing pre-PcV years with vaccination period. The PCV effectiveness was 84.3% (95% CI: 84.0–84.6%). In May 2010-January 2013, we enrolled 159 suspected IPD of whom 4 were confirmed. Two (fully vaccinated) were caused by serotype 9V,1(not vaccinated) by serotype 3, 1 (vaccinated with 2 PcV13 doses) by 15B/c. The most important reduction was for pneumococcal pneumonia (RR: 0.43, 95% CI: 0.21–0.90). The PcV program show promising results in terms of both PCV13 effectiveness and its impact in reducing IPD in children < 5 years.

BACKGROUND: Tuberculosis (TB) is a social disease that is common in immigrants who are forced to live in difficult circumstances. In Italy, the guidelines for preventing TB include X-ray screening and application of the Mantoux test for migrants from high-TB-endemic countries as soon as possible after admission to Italy. This article describes a field survey conducted in the reception center for asylum seekers in Bari Palese in southern Italy following the death of a center resident from pulmonary TB. METHODS: A Mantoux screening test, followed by chest X-ray, was carried out in March 2009 on 982 immigrants, representing 97.5% of the residents of the center. RESULTS: A positive Mantoux test result was seen in 60.7% of the residents screened. The chest X-rays were performed on 92.9% of cuti-positive patients and on cuti-negative patients who were recent contacts of the deceased TB case and/or with symptoms suspicious for TB. Eight residents were diagnosed with active TB (0.8% of residents), and 117 residents (11.9%) had TB sequelae. In our survey, the Mantoux test demonstrated 88% sensitivity, 17% specificity, and a positive predictive value of 1% for active TB. CONCLUSION: The survey results suggest that residents in asylum centers are a special type of immigrant. Specific risk factors, such as overcrowding, may expose these residents to a greater risk for infectious diseases.

This study describes an outbreak of varicella, in a small town in the region of Puglia, Southern Italy, in the period between February-March 2011. This outbreak presented the opportunity to assess varicella vaccine effectiveness and its determinants. The outbreak occurred in a small community in Puglia; parents of the children attending the schools of the community were contacted by telephone and information was gathered on current disease and varicella history. Varicella vaccination history was verified through the immunization registry of the Local Health Unit. Before the outbreak, immunization coverage was 86.6% of children attending preschool and 51.9% of children attending elementary school. In day care center where the outbreak was happened, the attack rate in vaccinated individuals was 32.1% and 80% in susceptible unvaccinated individuals. VE is therefore estimated as 59.9% (95% CI = 48.3-69.8). In the elementary school the VE can be calculated as 69.2% (95% CI = 50.5-88.1), since the attack rate in unvaccinated children was of 23.1% and in vaccinated of 7.1. The time between vaccination and the onset of the epidemic appears higher in children with a vaccine failure. The results of this study highlight the need for a reflection on the desirability of adopting a shorter schedule in Italy, with a minimum 1 mo interval between MMRV doses

Background: In the general population visual-spatial ability is better in males, due to the influence of biological and socio-cultural factors. We know that sport activity improves motor skills. The aim of this work is to determine if these gender differences exist in young athletes. The orientation test described by Terzi and standardized by Cesaroni, used to measure spatial ability, was carried out on 60 volleyball or 60 tennis athletes as well as on 60 non-sporting subjects. Results: The data analysis revealed a worse performance for non-athletes in comparison with athletes in both components of test (p < 0.0001; p = 0.04), with no differences between the volleyball and tennis groups. As far as gender comparison is concerned, as expected in the non- sport group the males presented better values (p < 0.001; p = 0.006). However in both sports groups there weren’t any gender differences in either part of the test (p = 0.18; p = 0.056). Conclusions: These results confirm that during athletic preparation in volleyball and tennis the specific training is able to develop spatial ability. Besides, boys and girls have similar performance demands and training experience. It appears that this specific training could be responsible for modifying gender differences in performance of spatial ability during adolescence

Studies of meningococcal carriage are essential in improving knowledge of the epidemiology of meningococcal disease. The aim of this study is to ascertain the carrier rate and the serogroups of Neisseria Meningitidis circulating in a sample of students from the University of Bari. The population consisted of university students from the University of Bari - School of Medicine, who were invited to take a nasopharyngeal swab. The swabs were plated on selective plate medium; cultural and MLST tests were performed. Of 583 university students 12 carriers were identified (2%). 9 isolates proved auto-agglutinable. The other strains belonged to serogroups B, W135 and Y. Auto-agglutinable strains belonged to different clonal complexes, of which ST-53 was the most common. Only one strain, that belonged to ST-23/cluster A3 clonal complex, could cause meningococcal disease. No type C serogroup strain was detected and this could be directly related to immunization policies that provided meningococcal serogroup C conjugate vaccines for newborns and adolescents. The changing pattern of circulating serogroups of Neisseria meningitidis in healthy carriers could support a new immunization strategy which could provide quadrivalent meningococcal conjugate vaccines to pre-adolescents and adults.