bluuebunny/crossref_metadata_2025 huggingface dataset:
Forestry work in the Italians alps: metabolic demand assessed by heart rate
Authors: Rodio Angelo , Fattorini Luigi , Delussu Anna Sofia , Marchetti Enrico , Marchetti Carmelina , Rosponi Alessandro
Published: June 2024

Objective: This research aims to: a) assess the energy expenditure during typical forestry activities; b) assess the actual workload of forestry work; c) define the eventual relationship between oxygen uptake ( ) and heart rate during the studied working phases.
Methods: Eleven healthy skilled forestry workers were studied. Using a portable device, oxygen uptake ( ), carbon dioxide output ( ), pulmonary ventilation ( ) and heart rate (HR) were measured. The forestry work was divided into four phases: walking uphill, felling, limbing & chain-sawing and complementary activities. A work time report was kept and in each phase a weighted average (WA) of all parameters was obtained.
Results:Walking uphill, felling, limbing & chain-sawing activities did not show significant statistical differences between each other and were classified as heavy activities (mean 2.17 lmin-1,mean HR 157 beatmin-1). The complementary activity was found to be less demanding and statistically differed in respect to the others ( 0.55 l min-1, HR 98 beat min-1). By theWA, the actual workload of forestry work resulted in a moderate to heavyoptimal job ( and HR being 1.51 l min-1 and 133.5 beat min-1 respectively in a typical working day). Furthermore it was possible to set up a relationship between and HR for the forestry work.
Conclusions: Forestry activity can be classified as moderate to heavy-optimal. Finally, a good and linear correlation between and HR proved to be an easy tool to evaluate the metabolic demand.
Aflatoxins in foods
Authors: Pietri Amedeo , Piva Gianfranco
Published: June 2024

Aflatoxins are mycotoxins produced by Aspergillus flavus and A. parasiticus. The aflatoxin group is comprised of aflatoxin B1 (AFB1), B2, G1 and G2. In addition, aflatoxin M1 (AFM1), a hydroxylated metabolite of AFB1, is excreted in the milk of dairy cows consuming an AFB1-contaminated ration. AFB1 has shown extreme acute and chronic toxicity and carcinogenic activity in animals; the acute toxicity of AFM1 is nearly equal to that of AFB1, but its potential carcinogenic hazard is about one order of magnitude less than that of AFB1. The International Agency for Research on Cancer classified AFB1 as a human carcinogen (group 1) and AFM1 as a possible carcinogen (group 2A). Recently, the possibility of a synergistic carcinogenic interaction between HBV chronic infection and dietary exposure to AFB1 arose from the observation of their co-existence in countries with high incidences of HCC and was confirmed by further experimental and epidemiological studies. However, the carcinogenic potency of AFB1 is considered much lower in populations where chronic hepatitis infections are rare. For the first time in 2003, significant problems arose in Italy, due to the aflatoxin contamination of maize. The summer was extremely hot and dry and A. flavus is very competitive under these conditions as the plants are stressed. Maize grain is normally utilized in the food supply for dairy cows and as such led to the severe and widespread contamination of milk with AFM1. In the following years (2004-2006), different climatic conditions as well as better compliance with guidelines by farmers, led to a dramatic reduction of the problem.
Risk assessment and emerging chemicals hazards in foods
Authors: Moscato Umberto
Published: June 2024

The main beliefs relating to the risk assessment of chemicals in foods, new chemicals in raw material as well as in food processing are briefly presented. Evaluation reviews of representative chemicals found in traditional and novel foods are given. Old and new processes or newly recognized compounds, that require careful assessment in terms of their potential human health impact, are discussed. As example of processing-related contaminants, a risk assessment for acrylamide, is described, providing two different approaches in food safety assessment and the management of carcinogenic contaminants.
Source of information, knowledge, and sexual behaviour related to HIV/AIDS amongst university students in an inland territory of central Italy
Authors: Sammarco Michela L. , Ripabelli Giancarlo , Ferrucci Fabio , Grasso Guido M.
Published: June 2024

Italian university students were investigated for: sources of information about HIV, knowledge of HIV risk behaviours, as well as sexual behaviours and condom use. A self completed anonymous questionnaire was administered to 430 university students in Campobasso, Italy (mean age 23,1; males 35,8%). Although TV, radio and the printed press were the most common sources of HIV information (>60% of respondents), most respondents preferred to receive information from physicians or resource centres (50 and 51%). Most students (>97%) were aware that specific sexual behaviours (unprotected vaginal or anal intercourse) and sharing of needles with illegal injecting drug users could transmit HIV. Most students (>50%) did not regularly use condoms (despite understanding their protective effect), and continued to engage in behaviours considered risky. Males were significantly more likely than females to engage in vaginal sex (84 vs. 67%) or anal sex (37 vs. 13%) with both regular and casual partners. Although knowledge of HIV in itself is not enough to produce behaviour change, increases in students’ levels of knowledge may be useful.
The "Quit and Win" campaign to promote smoking cessation in Italy: results and one year follow-up across three Italian editions (2000-2004)
Authors: Gianti Annamaria , Vianello Stefano , Casinghini Contardo , Roncarolo Federico , Ramella Francesca , Maccagni Marinella , Tenconi Maria Teresa
Published: June 2024

The “Quit and Win” Campaign is a health promotion campaign that aims to encourage smoking cessation. It is in its fourth edition in Italy and in its sixth edition in Finland. In Italy, it originally started in one region (Veneto, the Italian Coordinating Centre) and has spread to incorporate 11 regions in its latest edition. The aim of this study is to assess the effectiveness, results and trends within the various editions of the campaign. This initiative has been carried out thanks to the collaboration and partnership that exists among the participating regions and the different community services. The involvement of local press and the media have also been utilized to promote the initiative. In addition to this, substantial efforts were made to inform general practitioners, chemists and other health care personnel of the scheme in order that they would promote it by disseminating brochures. Efforts were also made in order to secure sponsorship for the programme. The results from all of the Italian editions have shown an increase in the number of participants, from 5,938 participants in 2000 to 8,185 in 2004 (latest edition). This one ahowed, in 2004, a participation of 4,812 males (M) and 3,373 females (F), a rate of 58.7% and 41.2% respectively; with the largest amount of participants falling into the age class of 25-34 years, accounting for 35.5% M and 32.6% F. 43.4% M and 40.6% F had been smoking for 20 years or more. Strong smokers (> 40 cigarettes/day) accounted for 9.5% of M and 3.1% F. Among all subjects, 47.2% had previously attempted to quit smoking at least once or twice. Among those who had quit smoking for at least four weeks, 39.5% remained non-smokers after one year of follow-up (2004 edition). Most quitters didn’t use any support to replace the effects of the nicotine (79.7%) and half of them didn’t receive any support from those people around them (55.2%). Smokers received information about the campaign in the first edition mainly from health care personnel (46.3%), while in the latest edition the most frequently reported means of obtaining information was via the web-site (31.7%).
Legionella pneumophila serogroup 5 infection in the presence of multiple environmental contamination. The importance of a bacteriological diagnosis
Authors: Montagna Maria Teresa , Ricci Maria Luisa , Napoli Christian , Tatò Daniela , Scaturro Maria , Barbuti Giovanna , Pierucci Giuseppe , Castellani Pastoris Maddalena
Published: June 2024

Legionella pneumophila is a pathogen that causes severe pneumonia in humans; L. pneumophila serogroup 1 accounts for at least 90% of infections. This is not linked to an environmental predominance of Legionella pneumophila 1, but may be due to a greater virulence of the strain. L. pneumophila sg 5 has also been reported, albeit less frequently, to be a cause of the disease. We report a case of L. pneumophila sg 5 occurring in a large hospital in southern Italy (Apulia region), where both L. pneumophila sg 1 and sg 5 were detected in the water supply; the nosocomial origin was demonstrated by molecular subtyping (PFGE). An environmental investigation, performed immediately after diagnosis of the case of legionellosis, identified a ow L. pneumophila sg 5 contamination level. Our experience highlights that in hospital, risk assessment, in rder to institute control measures for Legionella, should be carried out not only in response to a case of the disease and/or in risk wards only, as described in the Italian Guidelines, but periodically in every ward. The present study confirms that, although in the community L. pneumophila sg 1 is the most frequent strain isolated in both outbreaks and isolated cases, in hospital other serogroups and species may often cause infection because of the high susceptibility of the hosts.
The demographic revolution and our common future: quo vadimus?
Authors: Diczfalusy Egon
Published: June 2024

Professor Egon Diczfalusy reflects on a lifetime of experience, drawing insights from not only the great masters of the arts, philosophy and the sciences but also from a time in history in which he has witnessed some of the greatest triumphs in science as well as some of the greatest tragedies against humanity. This paper highlights some of the most pressing public health issues facing the world today, such as population growth and the changing global population structure, examining factors such as longevity and the progressive imbalance between the number of elderly persons in our communities and the number of persons who are able to support them. Finally he discusses the falling rates in fertility, stressing its multifactorial aetiology. In his closing remarks he poses three major problems that face the scientific community today. The use and misuse of science The growing discrepancy between scientific development and our moral/ethical development. The need to convince todays and future generations that fanatic faith, fundamentalism and obscurantism will not improve the quality of life of their children and grandchildren. His final reflections remind us that we belong to a humanistic science one in which we should not only strive to achieve the wisdom of humility but also the wisdom of hope.
Why utilisation of medicines is a public health interest
Authors: Folino-Gallo Pietro , Ricciardi Walter
Published: June 2024

Utilisation of medicines exerts important effects on public health and health systems in different ways, including their pharmacological properties, their economic impact on health systems and their impact on the environment. Medicines cause intended therapeutic effects. Medicines are able to treat diseases, slow their progression or prevent their appearance as well as relieve symptoms. This is the reason why physicians prescribe, patients use and governments pay for medicines. Some therapeutic classes of drugs represent important progress in medicine and have dramatically improved the therapeutic approach to several diseases.As an example antiulcer agents have changed a severe disease (with fatal complications), requiring gastric surgical resection, into a disease requiring only the consumption of few pills each day for a short period of time, with a substantial improvement in prognosis and quality of life for patients. Avoiding the surgical intervention of gastric resection, and all of its complications, has resulted in substantial gains for individual patients and public health as well as a substantial reduction in the costs of hospitalisation. For other therapeutic classes the benefits are more limited, while the advantages of their use in everyday practice are less evident.
Recommendations for national registers of medicinal products with validated ATC codes and DDD values
Authors: Rønning Marit , Litleskare Irene , Addis Antonio , Batel-Marques Francisco , Carvajal Alfonso , Sainz Maria , Folino-Gallo Pietro , Jansen Petra , Santiago Luis , Vander Stichele Robert
Published: June 2024

Medicines have important effect on population health and it is important to have a system for assessing their effects and monitoring their use, expenditure and price. The basis for all these objectives is the availability of an internationally valid classification system of medicines and a measurement system of their utilisation. Since 1996 the WHO Headquarter has adopted and proposed the ATC (Anatomical Therapeutical Chemical) classiifcation and the DDD (Defined Daily Dose) as the global standard for medicine classification and utilisation sudies, respectively. The EURO-MED-STAT project has defined the criteria for the production, validation and maintenance of national registers with validated ATC codes and DDD values, as suggested by WHO. A register with a valid ATC code and DDD value is able to provide reliable information allowing calculation of utilisation and expenditure indicators (Utilisation in DDD; DDD/1000inh/day and Expenditure per DDD).
Pubertal timing and health-related behaviours in adolescence - socio- economic outcomes in a follow-up study from Finland
Authors: Koivusilta Leena K , Rimpelä Arja H
Published: June 2024

Background. Pubertal timing is connected with health-related lifestyle in adulthood. We studied whether early or late pubertal timing is predictive of socio-economic outcomes in early adulthood and whether the associations are mediated by health behaviours.
Methods. Survey data (1981, 1983, 1985, 1987) from samples of 14-year-old Finns (N=4246, response rate 85%) were linked with respondents’ attained educational level, socio-economic and labour market position in 2001 (ages 28-34). Ages of menarche and first ejaculation indicated pubertal timing.
Results. As compared to adolescents with average age pubertal timing, boys and girls maturing at an early age more often participated in health-compromising behaviours, while those maturing at a later age participated less frequently. Pubertal timing was not associated with attained educational level or socioeconomic position in girls and not with labour market position at the time of follow-up in either sex. In boys, independently of health behaviours, early or late onset of puberty predicted low educational level, while late onset predicted low socio-economic position.
Conclusion. Timing of puberty has a stronger connection with socio-economic outcomes in boys than in girls. Deviance from the normative pace of physical development, especially late maturation, is among boys slightly depicted in the hierarchy of socio-economic positions of the society. As pubertal timing is connected with health-related behaviours – especially with smoking – the pacing of developmental transitions should be considered in planning programmes preventing unhealthy behavioural patterns often linked with negative attitudes towards schooling.
Patient safety in Europe: challenges and opportunities
Authors: Donaldson Liam
Published: June 2024

Healthcare has been relatively slow in comparison to other industries to recognize itself as a high risk activity. Recent estimates suggest that 1 in 10 patients admitted to hospital experience some form of unintended harm. In both human and economic terms, the need to reduce these unacceptable levels of harm is impossible to ignore. Patient safety is a serious concern for many EU Member States.
This has been given impetus by both the UK and Luxembourg Presidencies of the European Union, both of which have made patient safety a headline health priority theme.
The overriding aims of patient safety activity during the UK Presidency have been to ensure that:
 • patient safety becomes a key priority on the European health agenda, both at EU level and in individual Member States there are concrete mechanisms and practical programmes of activity established at the EU level to take forward patient safety issues
 • Activity at the European level also aims to build upon the programme established by the World Health Organization through the World Alliance for Patient Safety and the work of other key partners.
Much remains to be done to achieve safer care for patients across Europe. Action at the European level has a vital role to play in ensuring that safe care is a core part of health system improvements in all countries. Safe care can never be an optional extra; it is the right of every patient who entrusts their care to our health care systems.
From the Harvard Medical Practice Study to the Luxembourg Declaration. Changes in the approach to patient safety. Closing remarks
Authors: Damiani Gianfranco , De Belvis Antonio Giulio , Gainotti Sabina
Published: June 2024

Since the Harvard Medical Practice Study was published in 1991 the growing mass of international literature has demonstrated that medical adverse events can cause iatrogenic illnesses, prolonged hospitalisations and increased costs. In 1999-2001, reports made by the Institute of Medicine (IOM) in the USA, the Department of Health (DoH) in the UK and the Australian Patient Safety Foundation (APSF) stressed the necessity for creating a safer environment and a reporting culture throughout healthcare systems. They also emphasized the need for researchers to investigate means of turning policies into practice. Since their publication a lot of effort has gone into collecting data on adverse events and near misses. As a result, in 2001, the AHRQ published a Health Technology Assessment report on best practices for patient safety. While in Australia national meetings have been dedicated to address important issues across the whole spectrum of healthcare. In the UK the Audit Commission has published a report that is also focused on medication safety: “A spoonful of sugar”. In 2004 the World Health Organisation promoted a Patient Safety Alliance; while in April 2005the Standing Committee of European Doctors organised a Conference in Luxembourg called “Patient safety - Making it happen!”. The issue of patient safety is therefore seen as a priority by EU institutional bodies and by many European health stakeholders.
The milestones in patient safety -The Harvard Medical Practice Study I , Study II and Study III
Authors: La Torre Giuseppe , Mannocci Alice , Agostinelli Alessandro
Published: June 2024

Over the past decade there has been a steady increase in the number of malpractice claims brought against healthcare providers [1,2] and in the monetary damages awarded to plaintiffs [1,3]. This increase has precipitated numerous state programs designed to moderate the number of claims and encourage providers to develop quality of care initiatives [4,5].
It is important to develop more reliable estimates of the incidence of adverse events and negligence in hospitalized patients.An adverse event is defined as an injury caused by medical management (rather than the underlying disease) that prolongs the hospitalization and results in disability at the time of discharge, or both. Negligence is defined as care that has fallen below the standard expected of physicians in their community.
The Harvard Medical Practice Study (HMPS) was first published in 1991 and was based on 1984 case records of more than 30,000 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals.The study attempts to measure the extent of medical malpractice in hospitals in the state of New York, and compare the resulting patterns with the negligence claims actually filed [6-8]. The HMPS reviews randomly selected records with disability injuries caused by medical treatment.To establish that an adverse event or negligence has occurred, it uses as a criterion an average confidence score of four or more (on a six point scale). Data identified are age, sex, and primary discharge diagnosis. The significance of the differences in rates of adverse events and negligence according to sex and age were tested.
To err is human. Building a safer health system
Authors: Marano Cinzia , Murianni Lauraq , Sticchi Laura
Published: June 2024

Human beings, make errors Healthcare Services is a complex industry prone to accidents.The IOM Report [1] points out that some systems are more prone to accidents than others. When a system fails there are often multiple faults. In healthcare,human errors are the greatest contributors to accidents,however when human error is to blame it often depends upon failures within the system.These failures exists in the system before the error occurs, the same as with latent errors which are difficult to identify since they may be hidden in computers or within the various managerial layers.
Most of the errors can be prevented by designing systems that make it hard for people to do the wrong thing and easy for people to do the right thing. In healthcare, this means designing processes that are able to ensure that patients are safe from accidental injury. As healthcare and the system that delivers it become more complex, the opportunities for errors abound. The IOM report “To Err is Human” proposes an approach for reducing medical errors and improving patient safety.The environment within which this occurs has a critical influence on quality.This influence may contain two dimensions; the first consists of the domain of quality which includes the practice that is consistent with current medical knowledge. The second dimension consists of forces in the external environment that can drive quality improvement in the delivery system. Although the risk of dying as a result of a medical error, far surpasses the risk of dying in an airline accident, public attention has been more focused on improving safety in the airline industry than in healthcare systems. Because of the absence of standardized nomenclature, it is important to define what an error is and what is an adverse event, the IOM Report defines them in the following way: “An error is the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.” An adverse event is an injury caused by medical management rather than the underlying condition of the patient. An adverse event attributable to error is a “preventable adverse event”.
The Quality of Health Care in Italy: the Osservasalute Report 2005
Authors: Marano Cinzia
Published: June 2024

The Osservasalute Report intends to provide independent information of a high level on health and quality of care in the Italian Regions and to provide information for supporting decisions and choices of health programs and resource allocation.
The Osservasalute Report represents a pilot experience in using regional data and when possible using data at provincial or local health trust level. The report is based on an in-depth analysis of the geographic variations and regional differences and the study allows for the identification of ideal performances that every region should strive to achieve.
Comparable regional data was compiled from different sources in order to use them for monitoring and benchmarking the performance of regional health and healthcare systems.
Legionella is an emerging Public Health problem
Authors: Borella Paola
Published: June 2024

The issue of Legionnaires’ disease has emerged as a major public health problem, interesting not only researchers, but also managers of public and private organisations, those responsible for public health, the general population and occasionally magistrates.
The cases of legionellosis are increasing as a result of improved etiological diagnostic methods, population lifestyles and characteristics which favour the presence of the responsible organism in the environment which leads to the frequent exposure and transmission of the disease to at-risk groups whose relative numbers are growing.
Legionella spp is an opportunistic waterborne pathogen that finds its ideal habitat in warm-humid environments, it is able to survive in conditions unfavourable to other germs (elevated temperatures, presence of biocides, etc.) and multiply in particular ecological niches (amoebas and other protozoa, biofilm).
Because of this, it frequently colonises the hot water systems of houses, hotels, campsites, sports centres, hospitals, tertiary care centres, etc., as well as air-conditioning cooling towers, evaporative condensers and places where water stagnates at temperatures of at least 20°C. From our experience,the disease is frequently contracted by inhaling aerosols from the contaminated water systems of houses or work places, but it has also been contracted during stays in holiday accommodation, from using baths/showers in sports and recreation centres and finally during hospital stays.
Legionnaires’ disease Surveillance in Italy
Authors: Ricci Maria Luisa , Rota Cristina
Published: June 2024

In the report presented, data on legionellosis diagnosed in the year 2003 in Italy and notified to the National Surveillance System are analysed. Overall, 617 cases were notified, of which 517 were confirmed and 46 were presumptive.
The characteristics of the patients are very similar to those reported in the previous years in terms of male/female ratio, age–specific distribution, occupation, etc. Legionella pneumophila serogroup 1 was responsible for approximately 90% of the cases.
Determinants of drug use in sport: a survey of Italian athletes
Authors: La Torre Giuseppe , Limongelli Francesco , Masala Daniele , Brancaccio Paola , D’Aponte Antonio , Canonico Raffaele , Capelli Giovanni , Mannocci Alice , Ricciardi Walter
Published: June 2024

The aim of this survey was to study the socio-demographic determinants of drug use in sporting activities at an amateur level in Italy. In 2000 a cross-sectional study was carried out in two Italian regions (Latium and Campania). The participants were 1056 athletes (age range: 16-35 years; 660 males and 396 females).
The results show that 28.3% thought “doping” was creatine, 14.7% said racemed amino-acids, 5.8% said proteins, 24.7% did not know and finally 35.7% correctly recognised it as growth hormone. When asked if using drugs was acceptable in order to improve sporting performance, significant results were associated with age (OR = 1.64 for 18-24 years old and OR = 2.22 for 25-30 years old); gender (males were more prone to consider them acceptable); type of sport undertaken (OR = 1.34 for athletes who practice team sport); educational level (athletes with an elementary level education are at higher risk), and knowledge of the effects of anabolic agents (OR = 0.6 for athletes with poor knowledge).
The findings of our study confirm the need to implement preventive interventions, with a special focus on healthier behaviour, for reducing factors that encourage the use and the willingness to use licit and illicit drugs.
On the use of Disease Staging for clinical management: analysis of untimely admissions in the Abruzzo Region, Italy
Authors: Manzoli Lamberto , Romano Ferdinando , Schioppa Francesco S. , Staniscia Tommaso , Vitullo Felice , Marasco Giovanna , Louis Daniel Z. , Gonnella Joseph S.
Published: June 2024

Background and aims. The process of decentralization which recently occurred within the Italian National Health Service has transferred substantial responsibility and authority for health care administration to the individual regions. The project is aimed at developing regional benchmarks that can be used as a part of an ongoing system for analysis of resource use and quality of care in the Abruzzo Region of Italy.
Methods. All 286 924 hospital admissions for the year 2001 in the region were analysed. Three diseases were chosen for in-depth review: diabetes mellitus; cholecystitis/cholelithiasis; and bacterial pneumonia. There were a total of 9391 admissions for these diagnoses. Severity, length of hospital stay and hospital mortality were analysed using Disease Staging methodology. In addition, the timeliness of hospitalisation was assessed by grouping admissions in three categories: premature or medically unnecessary, timely and late.
Results. The rate of medically unnecessary admissions for diabetes mellitus was 72% throughout the region, and the percentage of late hospitalisations for cholelithiasis/cholecystitis was 43%. For both diseases, there were significant variations across Local Health Units in the proportion of late and early admissions. The rate of timely hospitalisations for bacterial pneumonia was higher than 86%.
Conclusion. The analysis of discharge abstract data using Disease Staging revealed that in the Abruzzo region there are problems of inappropriate hospital admission, both early and late, for all diseases examined excepted bacterial pneumonia.
Data confirmed the validity of Disease Staging to compare the performance of diverse hospitals in terms of length of stay and in-hospital mortality.
Long term effects of preventive activities of youth health care in The Netherlands: results of a four-part study
Authors: Wiegersma Pieter A. , Hofman Albert , Zielhuis Gerhard A.
Published: June 2024

Background. In this article the results are presented of a four part study on the effect of screening for scoliosis and (repeated) well-care visits and freely accessible consultation hours at secondary schools, on the incidence and prevalence of (para)suicide, mental health, adolescent health compromising behaviour and lastly obesity.
Methods. An ecologic case-referent study design was used with data from the Netherlands Bureau of Statistics, the Ministry of Defence, the 1992 High-School Student Study, all of the youth health care departments in The Netherlands and relevant censuses.
Results. Attention to mental and physical health and health compromising behaviour, either during screening, open consultation hours or during well-care visits seems to be ineffective and in some instances even detrimental to youth health.
Of the 18 different outcome measurements, 5 were significantly negative and none were significantly positive.
Conclusions. This four part study does not support the hypothesis that on a population level, the preventive activities of youth health care departments such as screening for scoliosis, (more) frequent well-care visits or offering open consultation hours at secondary schools, have a beneficial effect on prevention of (para)suicide, poor mental health, health compromising behaviour or obesity.
The health in the Italian regions. Synthesis of the Osservasalute Report 2004
Authors: Folino-Gallo Pietro , Ricciardi Walter
Published: June 2024

Osservasalute is the Italian Health Observatory (http://www.osservasalute.it) and it is aimed to study performances of regional health systems, to monitor quality of care in the Italian regions, to disseminate the main results of these activities and provide information to support decisions and choices of health programs and the allocation of resources.[1]
In 2004 Osservasalute has published the results of its activity in the Osservasalute report 2004.
A critical analysis of the data reported has revealed some phenomena of particular interest:
 1. the good health of the Italian population;
 2. the remarkable improvements obtained in last the 10-20 years, accompanied by a substantial reduction in regional differences;
 3. a good level of regional health services;
 4. the persistence of geographical variations;
 5. the risk of incoherent and disconnected policy planning between several of the regions.
Health Technology Assessment (HTA) in a changing social and health care context
Authors: Granados Alícia
Published: June 2024

Health Technology Assessment (HTA) has been defined in different ways, nevertheless it can be described briefly as a multidisciplinary process of analysis dealing with evidence and context to inform decision making in health care. For decades HTA and related fields, aimed to produce and encourage the use of scientific evidence to inform decision making, at all levels of the health care system, from policy making and management to clinical decision making [1,2].
Scientific evidence involved in the HTA process may refer to efficacy, effectiveness, safety, needs, appropriateness, efficiency, equity, acceptability and some other issues related to the effect of the introduction, use and diffusion of medical technologies on health and health care. The evaluation, with formal rules, of the quality of a
vailable scientific information is an important step of the HTA process as are the skills required for literature searching. The source of scientific information should not be limited to clinical literature, but also exploit other areas of knowledge such as epidemiology, social sciences,economics,health services research among others [1].The best method to be used in the HTA analysis process obviously depends on the uncertainties to be assessed. It could range from the synthesis and/or integration of scientific information to production of primary data.The latter is the option of choice when there is insufficient existing evidence or its quality is poor.
The assessments often require a multidisciplinary and multi-method approach, the former, of course,must be chosen after translating the uncertainty into sound research questions.
La prevenzione basata su prove di efficacia
Authors: Valsecchi M. , Panà A. , Muzzi A. , Carreri V. , Amadei A. , Pavan A.
Published: June 2024

Le attività di prevenzione nel nostro Paese si sono confrontate con le prove di efficacia in relativo ritardo rispetto a quanto verificatosi per le altre branche della medicina. Malgrado l’acquisizione di prove di efficacia siano state precocemente raccolte per alcune attività di prevenzione (dalla validità di alcuni precetti igienici ippocratici, ai primi tentativi di vaccinazione) si nota un ritardo, rispetto ad altre branche della medicina, di applicazione diffusa dei moderni metodi di valutazione della efficacia degli interventi sanitari.
Valutazione che ha assunto i connotati di una vera e propria disciplina dando vita al movimento di fornire basi scientifiche (“Evidence-based”) alle azioni decisionali che riguardino la medicina clinica (evidence-based medicine), la prevenzione (evidence-based prevention), la sanità pubblica (evidence based public health), l’assistenza sanitaria nel suo complesso (evidence based health care) e persino la politica (evidence-based policy).
Salute, ambiente e prevenzione in Europa: il ruolo della ricerca e dei servizi
Authors: Monarca S. , Ortaggi G. , Zapponi A.
Published: June 2024

Da alcuni anni si assiste in tutto il mondo ad una crescente preoccupazione per la relazione fra ambiente e salute, studiata sempre più approfonditamente con un approccio multidisciplinare da tecnici e ricercatori di Igiene Ambientale (Environmental Health).
Questa disciplina si interessa della valutazione, del controllo e della prevenzione dei fattori di rischio ambientali che possono compromettere direttamente o indirettamente la salute umana e gli equilibri ecologici essenziali anche per le generazioni future.
È stato stimato che nel mondo il 25-33% delle principali patologie può essere attribuibile a fattori ambientali, verso i quali la vulnerabilità varia da individuo ad individuo, con i poveri, le donne, gli anziani, i bambini e i malati considerati gruppi particolarmente a rischio.
Sicurezza sul lavoro in un sistema di gestione integrata
Authors: Boccia A. , Triassi M. , Lizza M. , Annino I.
Published: June 2024

Il Sistema di Gestione Integrata, può essere definito come un insieme di persone inserite in una struttura organizzativa, dove sono presenti delle risorse, delle procedure e delle responsabilità, con la finalità di raggiungere e mantenere nel tempo gli obiettivi di miglioramento definiti dall’azienda, in materia di qualità, efficienza ambientale, sicurezza degli impianti e salute dei lavoratori.
Il sistema deve essere definito in modo da poter fornire un’adeguata dimostrazione dell’attuazione e del raggiungimento di tali obiettivi. L’esigenza e l’utilità per una Azienda dell’implementazione di un Sistema sicurezza integrato con quelli della qualità e della gestione ambientale riconosce le proprie radici nelle profonde trasformazioni culturali e gestionali imposte dalle normative emanate dalla Comunità Europea nell’ultimo decennio e recepite dai singoli governi.
Questa filosofia, meglio conosciuta con la sigla ISO 9000, per quanto finora avulsa dallo scenario italiano in materia di sicurezza sul lavoro racchiude concetti molto importanti anche per chi deve applicare correttamente il D.Lgs. 626/94.
Modello metodologico per il monitoraggio degli incidenti stradali in Trentino
Authors: Fateh-Moghadam P. , Piffer S. , Furlanello C. , Dallago G. , Zanon G. , Demonti S.
Published: June 2024

Obiettivi: realizzazione di un’infrastruttura informatica, per l’unificazione tempestiva dei flussi sugli incidenti stradali (ISTAT-ACI) e sanitari con la georeferenziazione degli eventi a partire dall’anno 2000.
Materiali e Metodi: dall’archivio di Trentino emergenza sono stati estratti gli interventi per incidente stradale selezionando la combinazione: descrizione patologica: “traumatismi”, tipologia luogo: “strada”, tipologia incidente. Dai dati di ogni Pronto soccorso è stato costruito un archivio unico contenente il totale degli accessi e sono stati estratti gli accessi per “incidente stradale” e quelli per lesioni accidentali in generale. Dall’archivio SDO si sono selezionati sia i ricoveri con il criterio “3” alla variabile mtraav (=incidente stradale) che quelli per traumatismi.
Nell’ambito del progetto “Metodi informatici predittivi per la mitigazione del rischio da incidenti stradali” (Mitris), finanziato dal Ministero della Salute, è stata realizzata l’immissione tramite interfaccia internet o decodifica automatica dei verbali informatizzati delle Forze dell’ordine, e la contestuale realizzazione di un interfaccia WebGISin grado di visualizzare la localizzazione degli incidenti stradali.
Risultati: tramite la combinazione “data nascita”,“data incidente”, “sesso” è stato eseguito un primo collegamento tra gli archivi. Aggiungendo alla data incidente uno o più giorni, è stato costruito un nuovo archivio PS contenente il 97,4% degli eventi raccolti dalle forze dell’Ordine e contenuti nel data base Mitris. Approccio analogo è stato seguito per il linkage con SDO e 118. Tramite interfaccia WebGIS è stata creata una mappa degli incidenti interrogabile on-line, che oltre alla semplice localizzazione riporta dinamica e esiti con possibilità di produrre statistiche e grafici. Il sistema copre attualmente, con la collaborazione di Vigili Urbani e Carabinieri, il comune di Trento.
Conclusioni: l’utilizzo integrato dei dati sanitari e incidentologici consente, sulla base di un modello digeoreferenziazione, l’implementazione di un efficientesistema di sorveglianza degli incidenti stradali.Health Services Research
Studio di prevalenza delle polmoniti in un'Azienda ospedaliera di Bologna
Authors: Leoni E. , Aporti M. , Lazzari C. , Legnani P.P. , Sacchetti R.
Published: June 2024

Obiettivi: nell’ambito di un progetto di sorveglianza attiva dei casi di polmonite da legionella, è stata studiata la prevalenza di tutti i casi di polmonite ricoverati in un ospedale di Bologna, allo scopo di definirne la distribuzione per origine (comunitaria o nosocomiale), eziologia, caratteristiche individuali e di confrontarle con le polmoniti da legionella.
Metodi: per ogni caso con diagnosi clinica e/o radiologica di polmonite è stato compilato un questionario, raccogliendo le informazioni dalle cartelle cliniche. Tutti i casi di polmonite non specificata sono stati inoltre sottoposti al test per la ricerca dell’antigene di legionella nelle urine.
Reducing hazards for humans from animals: emerging and re-emerging zoonoses
Authors: Saegerman Claude , Dal Pozzo Fabiana , Humblet Marie-France
Published: June 2024

Pathogens that are capable of infecting more than one host, more than one taxonomic order and wild hosts, all present a higher relative risk of (re-)emergence. A long environmental persistence gives pathogens a more selective advantage. In case of an emerging or re-emerging zoonosis, the prevalence of infection in animals and the exposure determine the incidence in humans. Human exposure to zoonotic agents depends on lifestyle and occupation (e.g., veterinarians and farmers are more at risk for zoonoses related to livestock). Efforts to increase awareness, provide information on prevention, and apply biosecurity are essential. Moreover, a substantial decline in the incidence of human disease implies the prevention, the control or the elimination of zoonoses in the animal compartments. The only way to prevent health hazards is to adapt the existing systems of health governance at global, regional, national and local levels in a harmonised and coordinated manner. To achieve such a goal, the One Health strategy was recently developed to expand interdisciplinary collaborations and communications on all aspects of health care for humans and animals, veterinary, human medical, public health professionals and stakeholders....
Reducing hazards for animals from humans
Authors: Pastoret Paul-Pierre
Published: June 2024

If animals may be a source of hazards for humans, the reverse is equally true. The main sources of hazards from humans to animals, are the impact of human introduction of transboundary animal diseases, climate change, globalisation, introduction of invasive species and reduction of biodiversity.There is also a trend toward reducing genetic diversity in domestic animals, such as cattle; there are presently around 700 different breeds of cattle many of which at the verge of extinction (less than 100 reproductive females). The impact of humans is also indirect through detrimental effects on the environment. It is therefore urgent to implement the new concept of “one health"....
Comparative medicine - with some thoughts about the integration of medical and veterinary education
Authors: McConnell Ian
Published: June 2024

The common pool of knowledge between veterinary and medical medicine has been frequently exploited to provide insights into basic biomedical science and its application in such areas as vaccine development, therapeutics and diagnostics. In this paper the essential interplay between the disciplines of medicine and veterinary medicine is discussed and illustrated in detail in such areas as prion diseases, zoonotic infectious diseases and genetic diseases of dogs.Considerations are also made about the integration of medical and veterinary education, with indications of the critical needs for maximizing the opportunities for “One Medicine" both in medical and veterinary education and for research.The essential and fascinating interplay between medicine, veterinary medicine and basic biomedical sciences can do more to advance knowledge in both medicine and veterinary medicine than either can achieve on their own....
Health Technology Assessment of the Negative Pressure Wound Therapy for the treatment of acute and chronic wounds: efficacy, safety, cost effectiveness, organizational and ethical impact
Authors: Rossi Paolo Giorgi , Camilloni Laura , Todini Anna Rita , Fortino Antonio , Di Bernardo Livia , Frigerio Leonardo , Furnari Giacomo , Borgia Piero , Guasticchi Gabriella
Published: June 2024

Background: the aim of the study was to assess the safety, efficacy and cost-effectiveness of negative Pressure wound therapy (nPT) for people with chronic and acute wounds.
Methods: the scope and the final draft of the report have been submitted to the stakeholders (producers, payers and patients). safety issues were addressed through a systematic review of the meta-literature. efficacy was addressed through a systematic review and meta-analysis of randomized controlled trials (rcTs) comparing nPT and other standard therapies in patients with chronic or acute lesions. cost-consequence was analyzed through a systematic review of the existing studies.
Results: we retrieved 19 studies, 13 of which were included in the meta-analysis. Many studies had biases that may have resulted in a better performance for nPT. nPT showed: a slightly shorter healing time (-10.4 days, p=0.001), with no heterogeneity, apart from one small study with very positive results, and 40% more patients healed (p=0.002, no heterogeneity).We identified 15 original research papers on nPT costs and cost per outcome. The costs-per-patient- treated varied from +29% to -60%, with several studies reporting savings for nPT.
Conclusions: despite serious methodological flaws, the body of evidence available was sufficient to prove some clinical benefit of nPT in severe chronic and acute wound treatment. There is a need for independent and contextualized cost analyses....
A pilot study of Internet usage patterns in a group of Italian university students
Authors: Coniglio Maria Anna , Sidoti Enza , Pignato Sarina , Giammanco Giuseppe , Marranzano Marina
Published: June 2024

Background: despite growing interest in Internet addiction disorder (Iad) among the high school population, very little is known about the potential risks of the use of the Internet for university students. The present survey aimed to collect information on Internet usage patterns in a group of Italian university students.
Methods: the sample comprised 600 Italian university students enrolled in various faculties, in two different universities: catania (n=300; 150 males and 150 females) and Palermo (n=300; 150 males and 150 females). The diagnostic Questionnaire for Iad based on 8 criteria was used to categorize the Internet users. In order to better describe students’ Internet usage patterns, 4 other criteria were added. chi-square test (P<0.05) was applied to examine differences between the two groups of students (catania versus Palermo), and for comparisons between male and female students.
Results: respondents were ‘minimal’ (82.5%) or ‘moderate’ (17.5%) Internet users. none of the enrolled university students met the criteria of definite Iad, although a fairly high level of at-risk Internet attitudes and behaviors was found. Finally, some gender differences in Internet attitudes and behaviors were found.
Conclusions: the implications drawn from this study, including the adequacy of the available measurement instruments for Iad, are discussed....