bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Technology Assessment and vaccine: new needs and opportunities?
Authors: La Torre Giuseppe , Chiaradia Giacomina , De Waure Chiara , Mannocci Alice , Capri Stefano , Bruno Stefania , Cicchetti Americo , Bucci Roberto , Bamfi Francesco , Patarnello Francesca , Marocco Alessia , Ricciardi Walter
Published: June 2024

Health Technology Assessment (HTA) can represent an innovative and effective approach to supply decisionmakers with a valid instrument to improve the allocation of resources in the field of vaccines. We proposed a HTA approach for considering the introduction of a new vaccine that could potentially have a great impact on the population’s health, using as an example the vaccine against Human Papilloma Virus (HPV). This approach could be of great interest when the decision making process involves choices regarding new vaccines. We developed a HTA approach for assessing all of the aspects involved in the introduction of vaccines against HPV in Italy, considering the following issues: - epidemiological evaluation of HPV infection and related pathologies through the consultation of data banks and the scientific literature; - evaluation of health care resources utilisation by people suffering from the infection/ related diseases, through the consultation of hospital archives; - systematic review and meta-analysis of randomised clinical trials on HPV vaccination effectiveness and safety; - mathematical modelling and economic evaluation of the vaccination using a cost-effectiveness analysis; - evaluation of the impact of vaccination on the Health System [organisational aspects, vaccine surveillance, relationship between different decisional levels (national, regional)]; - analysis of the ethical, social (acceptability, availability, accessibility, information) and legislative aspects of vaccination. A HTA report on the new vaccine could represent an new important tool to support the choice of decision makers in order to better inform the allocation of economic resources and maximize healthcare services, since it takes into account not only the burden and the epidemiology of the disease, and the economic evaluation of different scenarios, but also the social, legal and bioethical aspects. For HTA to support the introduction of new technologies, and new vaccines can be considered in this sense, there to utilise a process that is well defined, transparent and widely used.
Public Health Genomics European Network: Report from the 2nd Network Meeting in Rome
Authors: Rosenkötter Nicole
Published: June 2024

Dear Sirs,
The Public Health Genomics European Network (PHGEN) is a mapping exercise for the responsible and effective integration of genome-based knowledge and technologies into public policy and health services for the benefit of population health. In 2005, the European Commission called for a “networking exercise…to lead to an inventory report on genetic determinants relevant for public health”[1], this lead to the funding of a PHGEN three year project (EC project 2005313).This project started in early 2006 with a kick-off meeting in Bielefeld / Germany.The project work is comprised of, according to the public health trias, three one year periods of assessment, policy development and assurance.At the end of the assessment phase a network meeting was held in Rome from January, 31st to February 2nd 2007 with over 90 network members and network observers in attendance. The participants represented different organisations throughout the European Union with expertise in areas such as human genetics and other medical disciplines,epidemiology,public health, law, ethics, political and social sciences. The aim of the meeting was to wrap up the last year’s assessment period and to herald the policy development phase.The assessment period of PHGEN was characterised by several activities: - Contact and cooperation with other European and internationally funded networks and projects on public health genomics or related issues (e.g. EuroGenetest, EUnetHTA, Orphanet, IPTS, PHOEBE, GRaPHInt, P3G) - Identification of key experts in public health genomics in the European members states, applicant countries and EFTA/EEA countries from different disciplines (e.g. human genetics and other medical disciplines, public health, law, philosophy, epidemiology, political and social sciences) - Building up national task forces on public health genomics in the above mentioned countries - Establishing and work in three working groups: public health genomics definitions, genetic exceptionalism and public health genomics issues and priorities - Participation in the development process on OECD and European Council documents on genetic testing - Dissemination of results in journals, on websites and in conferences.
Monitoring expenditure and utilisation of medicines in the European Union. A public health approach
Authors: Folino-Gallo Pietro
Published: June 2024

Background Thousands of medicinal products are licensed in the European Union Member States.This large quantity of medicines has an important impact on individual and public health but the information available on the licensed medicines, their clinical properties, prices, utilisation and expenditure is difficult to retrieve. Thus there is a need for monitoring the price, expenditure and utilisation of medicines and their impact on the population’s health. For these reasons the European Commission funded a project to define a set of indicators and to build a European database of medicines.
Methods A collaboration of academics and government agencies was formed to undertake the project which aims to fill the information gap on medicines in Europe by identifying the available data sources, defining a set of EU pharmaceutical indicators, and building a European database of medicines available on the internet.
Results The project has formed a Library of European Union Pharmaceutical Indicators. This includes recommendations for national registers (to produce valid and comparable data), and a set of indicators (price, expenditure, utilisation) for monitoring pharmaceutical policies. Moreover, the project has built a (beta version) database of licensed medicines in Europe, which can be freely accessed on the internet.The database provides, in a simple manner, useful information difficult to retrieve by other sources.
Conclusions The EURO-MED-STAT project has defined a set of indicators to monitor the utilisation and expenditure of medicines from a public health perspective. It has also proven that a European database of medicines is feasible and can provide useful information to stakeholders.
The EurMedStat proposals on indicators for price and utilisation
Authors: Walley Tom , Folino-Gallo Pietro , Barry Michael , Bruzzone Mario , DeJoncheere Kees , Rosian Ingrid , Schröder Helmut , Tilson Lesley , Vogler Sabine
Published: June 2024

Medicines account for an increasing proportion of healthcare budgets in all European countries. The EuroMedStat project aims to establish methods and systems for comparing the publicly funded pharmaceutical markets across Europe. A key issue is how to compare prices across countries. There are established methods for bilateral comparisons between two countries which are used in pricing negotiations but no means of a broader overview. Difficulties exist because of: a lack of directly comparable packages of individual medicines across Europe; currency conversion in some countries, despite the use of the euro; a range of different prices from different parts of the supply chain that could be studied; differences even within what are included in prices across countries (e.g. pharmacy fees etc); and most important, lack of availability of data on many of these points. Our aim was to produce pragmatic suggestions and these are presented. We suggest that the price used in the pharmacy retail price; that the denominator for price is the defined daily dose; and that the package size selected is that which most closely equates to one month’s treatment at the most commonly used dosage. From this, we derive a number of markers of the efficiency of national markets. It is important that the limitations of these are understood and that they are sued only as broad indicators to begin exploring areas of possible concern, and not for instance in price setting. These indicators now need field testing and the project will extent to include the new accession countries.
Respiratory symptoms and pulmonary function in the population of Parona (PV) according to tobacco smoke exposure
Authors: Gallotti Cristina , Rabagliati Claudio , Corsico Angelo , Pacileo Guglielmo , Comelli Mario , Pretti Giorgio , Tenconi Maria Teresa
Published: June 2024

Background: The health status of a population sample living in Parona (Pavia) was surveyed to evaluate the association between exposure to active and passive smoke and chronic respiratory symptoms.
Methods: 483 subjects were studied. The protocol included a questionnaire administrated by a physician, pulmonary function test and blood analysis.
Results: 124 subjects were current smokers, 104 subjects were past smokers and 252 were non-smokers. Sixty two (12.9%) of the subjects had pathological PFT: 48 (10%) had airflow obstruction and 14 (2.9%) had restriction of lung volumes. The prevalence of pathological tests was significantly higher in males than in females (p < 0.05). Most of pathological tests have been found in smokers: the prevalence was 16.9% in current smokers, 14.4% in quitters, 11.8% in ETS-exposed people and 9.4% in ETS-non-exposed. The frequency of pathological PFTs was significantly higher in subjects exposed (p< 0.05). The mean value of FVC% predicted tended to be lower in smokers, intermediate in ETS exposed subjects.
Conclusions: Chronic respiratory symptoms were reported significantly more often by smokers. The prevalence of pathological pulmonary function tests was significantly higher and FVC tended to be lower in subjects exposed to active and/or passive smoking than in non-exposed. Our results demonstrate the health impact of smoke on the general population of a low polluted area. Besides smoking cessation, lowering ETS exposure could represent one of the most important tool to improve respiratory health, and may contribute to prevent and reduce progression to COPD .
Patient safety in public health
Authors: Folino-Gallo Pietro , Ricciardi Walter
Published: June 2024

In 1991 the publication of the Harvard Medical Practice Study gave a new light to the problem of patient safety. Because of its rigorous methodology, its dimensions (more than 30,000 clinical records from 51 hospitals) and number and variety of the departments involved (medicine, surgeries, emergence, etc) the Harvard study represents a milestone in the patient safety research.
It unequivocally demonstrated that errors happen in the hospitals, they can be life-threatening and most of them are preventable. A wide number of other reports have followed the Harvard study, most of them refer to hospitals while the rate of errors in primary care is less known.These more recent studies represent an important progress because the Harvard study is considered old in its approach describing errors as the result of negligence or misconduct and missing totally the problems of the medical environment (the system approach).
Patient Safety: Making it Happen! Luxembourg Declaration on Patient Safety
Authors: Declaration Luxembourg
Published: June 2024

Access to high quality healthcare is a key human right recognised and valued by the European Union, its Institutions and the citizens of Europe. Accordingly, patients have a right to expect that every effort is made to ensure their safety as users of all health services.
Background:The health sector is a high-risk area because adverse events,arising from treatment rather than disease, can lead to death, serious damage, complications and patient suffering. Although many hospitals and healthcare settings have procedures in place to ensure patient safety, the health care sector still lags behind other industries and services that have introduced systematic safety processes. A number of investigations from all over the world have underlined the need for and the possibility of reducing the number of adverse events in the health sector. Current data show that almost half of all preventable adverse events are a consequence of medication errors.
The World Alliance for Patient Safety
Authors: Fletcher Martin , Hafner Valentina
Published: June 2024

Despite enormous strides in our knowledge about quality health services, and the continuously growing interest in the safety of patients among policy makers and clinical leaders, much remains to be done to avoid unintentionally harm occurring in health care. In May 2004, the Fifty-seventh World Health Assembly supported the creation of the World Alliance for Patient Safety which aims to coordinate, spread and accelerate improvements in patient safety worldwide. The Forward Programme 2005 of the World Alliance for Patient safety sets out an important and comprehensive programme of international work in areas such as reporting and learning, patient involvement and safety solutions. The experience of other high risk industries, suggests that patient safety problems are primarily a function of deficiencies in system design, organization and operation. Understanding and improving the design of processes, structures and culture of health care delivery is therefore central to making care safer. A number of core challenges emerge across many European countries including the need to continue to build strong political will and commitment to address patient safety problems, stronger engagement and leadership from health care professionals, and promoting positive cultural changes with health care.
Patient safety and medication errors
Authors: Skrepnek Grant H. , Bootman J. Lyle
Published: June 2024

The morbidity and mortality of drug-related problems has most recently been estimated to cost $177.4 billion annually within the United States alone. Empirical investigations have also suggested that almost one-fifth of all medical errors are drug-related within hospital settings, with over half of these being of a preventable nature. As such, minimizing medication errors has emerged as a priority area to ensure patient safety within healthcare systems worldwide, as several nations have implemented broad initiatives to improve the medication use system. Due to the numerous complexities involved, multifaceted and systemwide approaches to redesigning processes are most often advocated. Given the importance of appropriate medication use in achieving optimal patient outcomes, this paper addresses the various nomenclature and taxonomies of error within healthcare as well as the incidence, risk factors, causes, and prevention of medication errors.
Measuring patient safety: the Agency for Healthcare Research and Qualityís patient safety indicators
Authors: Kelley Ed , Marano Cinzia
Published: June 2024

There is a lot of interest in patient safety, but there is still little useable national level information on the actual magnitude of patient safety problems that can be used by providers and policy makers to judge performance.
The AHRQ Patient Safety Indicators (PSIs) are a set of measures that can be used with hospital inpatient administrative (discharge) data to provide a perspective on patient safety. They screen for problems that patients experience as a result of exposure to the healthcare system and that are likely amenable to prevention by changes at the system or provider level. There is a growing interest in the possible use of the AHRQ PSIs in international settings.
The Organization for Economic Cooperation and Development (OECD) maintains an ongoing project on Health Care Quality Indicators (HCQI) and whose goal is to develop a set of quality indicators that can be used to reliably assess quality of care across countries and raise questions about differences in quality of care internationally. Work is ongoing though a partnership between AHRQ and the Italian National Observatory on Health in the Italian Regions to test the AHRQ QIs with the Italian national hospital discharge data set. Preliminary results indicate that many of the operational issues associated with differences in coding schemes and data set structure are surmountable. With additional refinements on their clinical specificity, increased stability in their definitions over time to permit long-term monitoring and country interest within organizations such as the OECD to build on the existing scientific work of these indicators, their to help answer questions about patient safety worldwide will be significantly enhanced.
The UK experience: the National Patient Safety Agencyís Patient Safety Observatory
Authors: Scobie Sarah , Thomson Richard
Published: June 2024

The National Patient Safety Agency (NPSA) was set up in 2001 in order to make changes at a national level, and lead work on improving patient safety in England and Wales. A core function of the NPSA is to identify trends and patterns in patient safety problems, using its own National Reporting and Learning System (NRLS) and data from other sources.
Almost all reports to the NRLS come directly from local risk management systems; staff can also report directly to the NPSA via an electronic form. By the end of August 2005, nearly 230,000 incidents had been reported to the NRLS; 76% of these were reported from acute/general hospitals.
The analysis of data in the NRLS is a function of the NPSA’s Patient Safety Observatory (PSO), which has been established to quantify, characterise and prioritise patient safety issues in order to support the NHS in making healthcare safer. The PSO works with key national organisations which hold data relevant to patient safety, such as healthcare regulators, patient’s organisations, clinical negligence bodies and national information and statistics functions. Triangulating information from different data sources enables a fuller picture of the nature and severity of patient safety incidents to be obtained. The key challenges for the PSO are to strengthen the quality of NRLS data, extend the ways in which feedback from the NRLS is provided, and continue to develop methods and tools for the systematic analysis of the huge volumes of incidents reported to the NRLS.
Patient safety in Dutch hospitals
Authors: Wagner Cordul , Cuperus-Bosma Jacqueline , Van der Wal Gerrit
Published: June 2024

In various studies outside the Netherlands, it has been shown that a substantial number of patients suffer from some kind of harm during their treatment in hospital. The incidence of these so-called adverse events varies between 2.9% and 16.6%; it is estimated that between over a quarter and a half of these are considered to be avoidable.
Preventable adverse events can be considered to be a starting point for interventions to increase patient safety. In response to this, a study was initiated in Dutch hospitals investigating the nature and extent of adverse events and their causes. Lessons learnt will be discussed within the European Research Network on Quality in Health Care (ENQual), where researchers and policy makers come together to exchange knowledge and experiences. Two important goals of the Dutch study are to reach a consensus on basic concepts and to improve research methodology. An unintended event resulting in harm caused by healthcare is called an adverse event in international literature. Preventable adverse events are especially important for prevention, in these cases the harm can be attributed to unintended events in the care process, caused by insufficient action according to professional standards and failures within the care system. Most adverse events, caused as they may seem by human action or failing to act at first sight, are often partly caused by a care process that has not been properly organized. Uniform concepts are needed in order to facilitate European comparisons, which would allow, for example, the comparison of Dutch research results with those from other countries, and the identification of specific concepts. One of the six action areas of the WHO’s World Alliance for Patient Safety is the development of a ‘patient safety taxonomy’.
Medication safety in an acute teaching hospital: an Irish perspective
Authors: Relihan Eileen C. , Treacy Veronica M. , Flanagan Shaun P.
Published: June 2024

Background In line with international trends, patient safety has become a priority health issue in the Irish healthcare system in recent years. In August 2004, a medication safety facilitator (MSF) was appointed in an acute teaching hospital in Ireland for the investigation of medication safety events (MSEs).
Methods The MSF designed a pilot medication safety reporting system for trial in three ward areas over seven months. The system was subsequently expanded to the entire hospital.
Results During the first year of the appointment of the MSF, reporting levels increased by 290% relative to the same period the previous year. The majority of reports involved potential risks, near misses and medication errors that reached the patient but caused no discernable harm. For the more serious events, a root cause analysis was undertaken and action plans were developed by collaboration between the MSF and ward staff. A system of regular feedback to staff was introduced to encourage continued reporting and heightened awareness of medication safety issues. Proactive safety reviews were undertaken for high-risk medications, resulting in the introduction of system changes to optimise safety. Guidance was provided to staff in the form of bulletins, alerts and education sessions.
Future plans Expansion plans for the second year of the project involve the development of a network of safety champions across the hospital. These individuals will undergo root cause analysis training and then liaise with the MSF with regard to the communication of safety messages and the implementation of action plans.
Building a Safer NHS for Patient. Improving Medication Safety
Authors: Murianni Laura , Marano Cinzia
Published: June 2024

Medication errors occur in all health care systems and in all health care settings. If the errors are identified through an active management and effective reporting system they can be removed before they can cause harm to patients. In order to reduce the risk it is important to understand the causes of medication errors.
The NHS Report aims to provide a guide to current knowledge of the frequency, nature and causes of errors, the risk factors inherent in current medication processes and helping the NHS organizations and health professionals in achieving a reduction in serious medication errors. In July 2001 the UK Government established the National Patient Safety Agency (NPSA, http:// www.npsa.nhs.uk) which, in 2004, implemented a national reporting and learning system to enable the NHS to report all type of adverse incidents including those involving medicines. The NPSA core purpose is to improve patient safety and to accomplish this task; it looks at the identification of patterns and trends in avoidable adverse events so that the NHS can entrust practice and management to reduce the risk of recurrence. Before the establishment of the NPSA, there had been no attempt to establish a unified mechanism for reporting and analyzing medication errors. Despite the many published studies there is no clear definition for medication errors and thus they do not distinguish between errors and adverse drug reactions. The Report defines and highlights the differences between medical errors and drug reactions.
Legionnaires’ disease: an increasing risk
Authors: Panatto Augusto
Published: June 2024

Even if the pathogen of Legionnaires’ disease has been discovered thirty years ago there are many unanswered questions about it’s aetiology, epidemiology, clinical presentation and prevention.
As a matter of fact, Legionnaires’ disease, as with many others infectious diseases, represents a perfect example of a multidisciplinary approach involving both medical and engineering aspects, in a variety of settings such as hospitals, hotels and thermal facilities.
Issues such as these will be debated within the present meeting.
Legionella detection from clinical and environmental samples
Authors: Ricci Maria Luisa
Published: June 2024

Several methods are used for diagnosis of legionellosis: culture, urinary antigen detection, serologic tests, PCR etc., characterised by different level of specificity, sensitivity and rapidity. Microbiological diagnosis is an essential tool to for the prompt adoption of an adequate antimicrobial therapy and to understand the real diffusion of legionellosis.
Likewise, the environmental samples analysis allows us to know the distribution of the Legionella in the environment and to detect the origin of the infection during an outbreak by comparing clinical and environmental strains.
The Italian Multicentric Study on Legionnaires’ disease
Authors: Borella Paola
Published: June 2024

The general objective of the Italian Multicentric Study on Legionnaires’ disease is the investigation of some of the critical aspects of this emerging disease, with a specific interest in the Italian situation.
An epidemiological study is being conducted in different Italian localities to evaluate the diffusion of Legionella spp in the environment and the efficiency of some of the control strategies to detect cases, study their related risk factors and to establish the frequency of infection within groups at different exposure levels.
The first results obtained from the research project are presented below.
Legionnaires' disease prevention: more doubts than certainties
Authors: Sodano Luisa
Published: June 2024

This short paper focuses on some of the troubling issues concerning Legionnaires’ disease prevention.
Examples of such are its constant under-reporting, the lack of consensus concerning environmental surveillance (when and where these tests should be performed) as well as the threshold for Legionella colonisation (CFU/L).
Even environmental treatment aspects are not completely agreed upon by all researchers.
Molecular tools for epidemiological investigations into Legionella pneumophila environmental diffusion: applications for the prevention
Authors: Boccia Stefania , Spica Vincenzo Romano , Ricciardi Walter
Published: June 2024

Microbiological typing is a useful tool in the epidemiological investigations of infectious diseases, given that it allows for the identification of specific clones among a set of isolates.
 In the last ten years several studies have demonstrated how genotyping methods can be useful in Legionella spp investigations in hospital setting (e.g., epidemic events). Pulsed field gel electrophoresis and amplified fragment length polymorphisms are the current typing methods of choice, even though multilocus sequence typing will probably be the gold standard of the future.
Legionnaires’ disease and occupational risk: a case report
Authors: Mansi Antonella , Paba Emilia , Marcelloni Anna Maria , Bruni Roberta , Spagnoli Giuseppe
Published: June 2024

We report results of environmental microbiological sampling in an office building whose occupants referred different symptoms ascribable to the air conditioning system.
Legionella pneumophila serogroup 1 was detected in water samples drawn from the cooling tower with counts that ranged from 1.4 x105 to 1.5x107 CFU/L.
 This biological agent is classified in the second risk group according to Italian law (D.Lgs. 626/94), consequently proper control measures in order to re-establish acceptable hygienic environment conditions and to assure healthy workplace are needed.
Evaluation of benzene exposure in petrol pump attendants and in mechanics by urinary trans, trans-muconic acid (t, t-MA) determination
Authors: Cirillo Teresa , Arnese Antonio , Spagnoli Giuseppe , Amodio Cocchieri Renata , Del Prete Umberto
Published: June 2024

Occupational exposure to benzene in petrol pump attendants and in mechanics was studied by examining the benzene content in both the air breathed and in the urinary metabolite trans,trans-muconic acid (t,t-MA). Thirty petrol pump attendants and thirty mechanics (as exposed workers) and thirty adult male office workers (as non exposed workers) were involved in the study. Measures were taken at the begin and at the end of the working shifts.
 The benzene concentrations in the breathing air samples varied from 2 to 88 μg m-3, lower than the EU acceptable limit for occupational environment. The average urinary t,t-MA in the petrol pump attendants at the begin and at the end of the working shifts ranged between 133 ± 69 and 255 ± 174 μg g-1 creatinine and in the mechanics between 204 ± 139 and 300 ± 211 μg g-1 creatinine, respectively.
In all the participants the mean levels of urinary t,t-MA at the end of the working shifts were significantly higher than those at the beginning. In the exposed workers mean levels of urinary t,t-MA were significantly higher than in those of the non-exposed workers. The influence of the smoking was demonstrated by the urinary t,t-MA levels in smoking non-exposed subjects.
Il contesto della Sanità Pubblica italiana tra globalizzazione e devolution
Authors: Renga G.
Published: June 2024

La salute della popolazione europea e di quella italiana nello specifico sta raggiungendo traguardi inimmaginabili fino a pochi anni fa: l’attesa di vita aumenta di tre mesi ogni anno che passa, grazie alla riduzione della mortalità per la maggior parte delle cause.
La mortalità infantile è scesa sotto i 5 morti per 1000 nati, mettendo l’Italia all’avanguardia in Europa. La sopravvivenza per i tumori sta mostrando una accelerazione non prevedibile fino a pochi anni fa, e anche in questo campo l’Italia si mostra in buona posizione. Il World Health Report del 2000 collocava l’Italia al terzo posto come performance complessiva del sistema sanitario e al secondo posto come efficienza del sistema stesso [1]. Cionondimeno vi sono ancora ambiti in cui è possibile ottenere ‘guadagni di salute’ consistenti e permangono nuovi e vecchi rischi per la salute che è necessario contrastare. Basterà citare il rallentamento della discesa nella mortalità nei giovani (25-44 anni) che si è osservato nell’ultimo decennio, provocato da patologie indicatori indiretti di disagio giovanile (overdose, AIDS, incidenti stradali), oppure alle differenze sociali nella salute che sono delle vere e proprie riserve di salute a cui dobbiamo ancora attingere, oppure ancora al primato negli incidenti sul lavoro che ancora l’Italia detiene.
Nuovi e vecchi rischi sono contrastabili qualche volta utilizzando con efficacia gli strumenti propri dell’Igiene tradizionale, oppure investendo gli operatori dei difficili ruoli di promotori e integratori di tutte le professionalità sanitarie, sociali ed economiche che sono coinvolte nella gestione di una salute che si va sempre più demedicalizzando.
Nuove strategie per la prevenzione
Authors: Carreri V.
Published: June 2024

1. Premessa: il 2003 è iniziato con la guerra in Iraq che ha reso precaria la sopravvivenza dell’ONU, quando i rapporti internazionali dovrebbero essere fondamentali per uniformare i livelli di qualità della vita e della salute. La vicenda della Sindrome Respiratoria Acuta Severa (SARS) ha confermato la globalizzazione di alcune epidemie. Questi eventi hanno rilanciato tematiche di interesse ed attualità, alcune negative come la guerra e il bioterrorismo, altre positive come la dimostrazione dell’efficacia di un intervento internazionale coordinato. 2. Lo stato della prevenzione: non mancano esperienze positive, soprattutto dove il mondo dei Servizi collabora con Università e centri di ricerca. L’invecchiamento della popolazione impone nuove strategie per la educazione sanitaria e la prevenzione, mentre ancora limitati sono gli interventi per contenere le malattie di maggior rilevanza sociale.
Le vaccinazioni nell' ambito dei livelli essenziali di assistenza per la prevenzione
Authors: Conversano M. , Lagravinese D. , Gallo G. , Di Stanislao F.
Published: June 2024

Trasparenza, razionalizzazione degli interventi sanitari e standard di cure garantiti per tutti sono i tre fondamenti su cui si basa la filosofia che è venuta a improntare il Servizio Sanitario Nazionale con l’entrata in vigore dei Livelli Essenziali di Assistenza (LEA).
I LEA hanno rappresentato una novità nel panorama della sanità italiana in quanto hanno fornito una definizione di tutto ciò che il SSN considera come essenziale e, quindi, garantito dal servizio pubblico a tutta la popolazione.
Fra le tre cosiddette macroaree all’interno delle quali il servizio pubblico garantisce il proprio intervento, la classificazione dei livelli prevede specificatamente l’assistenza sanitaria collettiva in ambiente di vita e di lavoro. In questo ambito si colloca la subarticolazione “Interventi di profilassi e di educazione per prevenire il diffondersi delle malattie infettive” tra cui certamente vanno annoverate le vaccinazioni.
C’è quindi un esplicito riconoscimento dell’importanza delle vaccinazioni nella sfera della medicina preventiva e del territorio.
Criteri per l'inserimento di nuovi vaccini nei programmi d'immunizzazione della collettivitá
Authors: Gasparini R. , Moiraghi A. , Ciriminna S. , Lucioni C. , Grilli G.
Published: June 2024

I progressi nel campo dell’epidemiologia, delle conoscenze sulla patogenesi delle malattie infettive, dell’immunologia e della biologia molecolare rendono particolarmente fervido d’applicazioni e quindi di potenziali e reali miglioramenti l’utilizzo delle vaccinazioni.
Attualmente, gli Istituti vaccino-produttori mettono a disposizione nuovi vaccini. Ne deriva la necessità di migliorare le strategie vaccinali. Senza dubbio le conoscenze epidemiologiche stanno alla base di qualsiasi intervento preventivo, perché definiscono le dimensioni del danno che la malattia arreca alla comunità.
La conoscenza epidemiologica implica una continua sorveglianza degli eventi sanitari. Purtroppo, nel nostro Paese, talora, l’impatto di determinate patologie non è ben definito. Ne consegue che soluzioni adottate in altre realtà epidemiologiche sono trasferite in Italia, ove potrebbe essere meglio dedicare risorse ad altre esigenze di salute. Così, non è la Sanità Pubblica a condizionare le scelte strategiche degli Istituti vaccino-produttori, ma viceversa.
L’adeguatezza delle procedure diagnostiche, il miglioramento dei sistemi informativi ed un maggiore e razionale ricorso ai sistemi informatizzati potrebbero migliorare le cose
Incidenza di meningiti nell'ASL di Brescia nei primi mesi del 2003
Authors: Magoni M. , Gelatti U. , Indelicato A. , Donato F. , Carasi S. , Nardi G. , Scarcella C.
Published: June 2024

Obiettivi: nell’ASLdi Brescia durante i mesi di gennaiomaggio 2003 si è verificato un consistente aumento di casi di meningite che ha allarmato oltre agli operatori sanitari anche l’opinione pubblica locale.
Metodi: i dati riguardanti i casi di meningite verificatisi dal gennaio 1999 al maggio 2003 sono stati raccolti dal Servizio Igiene Pubblica dell’ASLdi Brescia.
Tenuto conto della omogeneità dei dati nel quadriennio 1999- 2002 e della stagionalità che le meningiti possono avere, sono stati calcolati i tassi di incidenza per i primi cinque mesi dell’anno per tutte le meningiti in generale e per agente eziologico, durante il quadriennio 1999-2002. Tali tassi sono stati confrontati con i tassi corrispondenti nei primi mesi del 2003.
Risultati: nel primi 5 mesi del 2003 si sono registrati in tutto 48 casi, di cui 9 da meningocco, 13 da pneumococco, 14 virali, 3 da altri agenti batterici e 8 senza agente microbico identificato. Nei 4 anni precedenti erano stati notificati 66 casi di meningite nei primi 5 mesi dell’anno, con una media annua di 16.5. Il tasso di incidenza di meningite in gennaio-maggio è stato quindi il triplo nel 2003 (rischio relativo = 2.9) rispetto ai 4 anni precedenti (p=0.0001). L’eccesso di incidenza si è riscontrato per tutti i tipi di meningite considerati in base all’agente eziologico.
L’analisi per diverse età ha mostrato un aumento di incidenza sia nei bambini che nei giovani adulti e negli anziani. Non si è riscontrata alcuna differenza statisticamente significativa tra l’incidenza nel comune di Brescia (area urbana) rispetto all’intera ASL nel periodo in studio.
Conclusioni: l’aumento di incidenza per meningitiosservato nel 2003 non sembra spiegabile in termini di variabilità casuale del fenomeno da un anno all’altro e riguarda tutti i tipi di meningite e tutte le categorie d’età, non sostenendo l’ipotesi di epidemia da singolo agente microbico.
Human and animal health in Europe: the view from the European Academies Science Advisory Council (EASAC) on challenges in infectious disease
Authors: Fears Robin , Ter Meulen Volker
Published: June 2024

For the last seven years, the European Academies Science Advisory Council (EASAC) has conducted a series of projects defining and clarifying priorities for European policy in infectious disease. Both human and animal populations are increasingly threatened by emerging and re-emerging infections, including zoonoses, partly attributable to the impact of environmental change on the distributions of pathogens, hosts and vectors. Among the key challenges to be faced are the impact of climate change, the increase of antibiotic resistance and the need to develop novel global surveillance and early warning systems worldwide. Multidisciplinary approaches are required to build the new interfaces between human and animal medicine (One Health), with new connections between epidemiological and environmental data for surveillance, communication and risk assessment. This multidisciplinarity involves integration between microbiology, immunology, genetics and genomics, entomology, ecology and the social sciences, among other disciplines. Improved understanding of patterns of both human and animal disease also requires commitment to standardisation of surveillance methodologies and better analysis, co-ordination and use of the data collected. There must be sustained support for fundamental research, for example to explore how pathogens cross the species barrier, encouragement for industry innovation in developing diagnostics, therapeutics and vaccines, and the increased use of scientific evidence to inform coherent strategic development across different policy-making functions and to support international leadership. Our paper is intended as an introduction to some of the issues for building collaboration between human and animal medicine, to be discussed in greater detail in the other contributions to this Issue....
Strengthening the Reporting of Genetic Risk Prediction Studies: The GRIPS Statement
Authors: Janssens A. Cecile J.W. , Ioannidis John P.A. , Van Duijn Cornelia M. , Little Julian , Khoury Muin J.
Published: June 2024

The rapid and continuing progress in gene discovery for complex diseases is fuelling interest in the potential application of genetic risk models for clinical and public health practice. The number of studies assessing the predictive ability is steadily increasing, but the quality and completeness of reporting varies.A multidisciplinary workshop sponsored by the Human Genome Epidemiology Network developed a checklist of 25 items recommended for strengthening the reporting of Genetic RIsk Prediction Studies (GRIPS), building on the principles established by prior reporting guidelines.These recommendations aim to enhance the transparency of study reporting, and thereby to improve the synthesis and application of information from multiple studies that might differ in design, conduct or analysis.A detailed Explanation and Elaboration document is published separately in PLoS Medicine as Supporting Information (S1) and in Janssens AC, Ioannidis JP, van Duijn CM, Little J, Khoury MJ; GRIPS Group. Strengthening the reporting of genetic risk prediction studies: the GRIPS statement. Eur J Epidemiol 2011; 26(4): 255-9....
Post-migration living difficulties as a significant risk factor for PTSD in immigrants: a primary care study
Authors: Aragona Massimiliano , Pucci Daniela , Mazzetti Marco , Geraci Salvatore
Published: June 2024

Background: recent research shows that severe/very severe post-migration living difficulties (PMLD) have a negative impact on the mental health and social integration of refugees and asylum seekers. This study focuses on the role of PMLD in primary care “ordinary” immigrants.
Methods: 443 primary care immigrants were asked to complete a self-administered questionnaire measuring the number and severity of pre-migratory potentially traumatic events (PTE), PMLD, and the current prevalence of a post-traumatic stress disorder (PTSD). The frequency of PMLD was assessed in the whole sample and compared in patients with and without PTSD. The effect of the number of PMLD on the risk of having a PTSD was studied by means of a regression analysis, adjusted by the number of PTE.
Results: 391 patients completed the questionnaire and were enrolled into the study. The prevalence of PTSD was 10.2%. In the whole sample the most frequent PMLD were “no permission to work” (38.6%) and “poverty” (34.5%). All PMLD (except “communication difficulties”) were more frequent in patients with a PTSD. The number of PMLD significantly increased the likelihood to have a PTSD independently from PTE. Conclusions: severe/very severe post-migration living difficulties (PMLD) increase significantly the risk of PTSD in primary care “ordinary” migrants. Our hypothesis is that they have a retraumatizing effect on individuals who are already vulnerable and with a low capacity to handle resettlement stress due to their previous traumatic history. The implications in clinical practice and for immigration policies are discussed.
Determinants of health in recently arrived young migrants and refugees: a review of the literature
Authors: Pfarrwaller Eva , Suris Joan-Carles
Published: June 2024

Background: adolescent migrants are in a state of double vulnerability because of their age and migration experience. The purpose of this review was to identify risk and protective factors serving as a base for health promotion of young recent migrants.
Methods: we assessed 95 papers identified through a MEDLINE search. Thirty-five papers were retained for review and analysed within the following themes: general health, mental health, cigarette smoking and sexual health.
Results: young migrants’ health was considered good at arrival, but deteriorated with length of stay due to factors linked to migration. Mental health was determined by pre-migration factors, such as violence, and was strongly related to post-migration factors, such as asylum procedures, discrimination and low socio-economic status. Social support and family cohesion were identified as protective factors. We found a lack in epidemiologic data about tobacco use and sexual health issues. Results from North America indicated less frequent smoking in certain groups of immigrants. Some data suggested more frequent teenage pregnancies and abortions in young refugee women as compared to the host population. We also found some evidence about increased risk of sexually transmitted infections and HIV/AIDS in certain immigrant populations.
Conclusions: migrant adolescents are generally healthy at arrival. The migration process and social inequalities after arrival influence their long-term health. A comprehensive approach to health promotion is necessary, taking into account risk and protective factors. More research is needed, in order to obtain more specific epidemiologic data about adolescent migrants, as well as longitudinal and qualitative data.
Midwives unable to overcome language barriers in prenatal care
Authors: Fransen Mirjam P. , Wildschut Hajo I.J. , Mackenbach Johan P. , Steegers Eric A.P. , Essink-Bot Marie-Louise
Published: June 2024

Background: the present study aims to explore to what extent midwives experience barriers in providing information about prenatal screening for Down syndrome to women from diverse ethnic backgrounds, and to assess their competences to overcome these barriers.
Methods: midwives from 24 Dutch midwifery practices in Rotterdam completed a structured webbased questionnaire (n=57). Data were obtained on perceived ethnic-related differences and barriers in providing information on prenatal screening, preparedness to provide cultural competent care, and the use of translated materials and professional translators. A group interview was conducted to further explore the results emerging from the questionnaire (n=23).
Results: almost all midwives (95%) experienced barriers in informing women from non-Western ethnic backgrounds about prenatal screening. Midwives especially felt incompetent to provide information to pregnant women that hardly speak and understand Dutch. In total 58% of the midwives reported that they never used translated information materials and 88% never used professional interpreters in providing information on prenatal screening. The main reasons for this underutilization were unawareness of the availability of translated materials and unfamiliarity with the use of professional interpreters.
Conclusions: although language barriers were reported to be the main difficulty in providing cultural competent care to patients from diverse ethnic backgrounds, only a minority of the midwives used translated materials or professional interpreters. In order to enable all pregnant women to make an informed decision whether or not to participate in prenatal screening, midwives’ competences to address language barriers should be increased.
Infant feeding patterns and risk of acute respiratory infections in Baghdad/Iraq
Authors: Al-Sharbatti Shatha S. , AlJumaa Lubna I.
Published: June 2024

Background: exclusive breastfeeding has been shown to protect infants from contracting various diseases. The aims of this study were: to examine the relationships between infant feeding patterns and the risk of Acute Respiratory Infections (ARI), and to assess the importance of some factors that can increase such risk.
Methods: a case-control study was carried out during the period between February 1st 2005 - May 1st 2005. The study included 137 infants who were hospitalized in the Children Welfare Teaching Hospital for ARIs during the period of study (a case definition of acute lower respiratory infection as given by the WHO (1995) was used). The Control group included 157 healthy infants who were randomly selected from two primary health care centers of the AI-Karkh sector of Baghdad for immunization. The risk of various factors thought to be associated to ARI were studied, these being: non-modifiable (age, gender, birth order, parent education, crowded residence, family history of asthma and history of ARIs in household members in previous 2 weeks) and modifiable (short duration of breastfeeding, cigarette smoking in proximity to the infant, delayed immunization and malnutrition). Logistic regression was used to adjust for confounders and for calculating adjusted odds ratios.
Results: formula fed infants had a 2.7 times higher risk (CI:1.6-4.68) for ARIs compared to breast fed infants. Infants who had undergone a short duration of breastfeeding (<3 months) had a 1.4 times increased risk or ARI (CI: 0.89—2.23). Additional factors that were associated with higher ARIs were, female gender (OR= 2.0, CI:1.3-3.3), low educational level of mothers (OR= 6.4, CI:3.2-12.7) and fathers (OR=4.5, CI:2.27-8.78), crowded residence (OR= 4.5, CI: 2.6-7.8), positive history of ARIs in household members in the 2 weeks prior to the study (OR= 5.5, CI:3.3-9.3), family history of asthma (OR = 2.6, CI:1.4-4.9), and daily smoking of ≥7 cigarettes in proximity to the infant (OR = 2.0, CI:1.1-3.4). Age, birth order, delayed immunization and malnutrition, were not found to significantly increase the infants’ risk of ARIs. Multiple logistic regression showed that ARIs in household members during the 2 weeks prior to the study, low educational level of mothers, short duration of breastfeeding, living in a crowded residence, and family history of asthma or allergy were all significantly associated with an increase in the risk of ARIs.
Conclusions: short duration of breastfeeding is the only modifiable factor which showed a significant relationship with ARIs. The Promotion of breastfeeding is highly recommended as a strategy to reduce the risk of ARIs in infants.