bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing quality of life in children and adolescents: development and validation of the Italian version of the EQ-5D-Y
Authors: Scalone Luciana , Tomasetto Carlo , Matteucci Maria C. , Selleri Patrizia , Broccoli Serena , Pacelli Barbara , Cavrini Giulia
Published: June 2024

Background: Although assessment of Health Related Quality of Life (HRQoL) in paediatric populations is gaining interest, it is not sufficiently assessed. While a number of specific paediatric instruments have been developed, some users appear to prefer generic tools such as the EQ-5D, which is a widely used and recommended tool to describe and value health across many different adult populations. We adapted the EQ-5D generic instrument into the EQ-5D-Y(youth) for the assessment of HRQoL in children and adolescents, and investigated the feasibility, acceptability, validity and reliability of this new version of the tool.
Methods: The Italian version of the EQ-5D-Y was administered to 415 children and adolescents from a general population aged between 8 and 15, and to 25 paediatric patients diagnosed with Acute Lymphoblastic Leukaemia (ALL).
Results: The Italian version of the EQ-5D-Y was found to be feasible and acceptable for self-completion in the target age-group, with less than 1% refusing to complete it and no invalid answers given. Convergent and divergent validity tested with a child specific standard instrument was satisfactory overall. The test-retest reliability was moderate to good in all the domains of the descriptive system, and the Visual Analogue Scale (VAS) showed optimal levels of reliability (Intraclass Correlation Coefficient = 0.82). As regards known-group validity, compared with the youths from general population, the ALL patients reported more difficulties in four of the five domains of the descriptive system and, on average, had a lower VAS score.
Conclusions:The Italian version of the EQ-5D-Y shows to be a promising tool for assessing HRQoL in children and adolescents from 8 to 15 years of age. Future studies should further investigate and optimize its applicability to clinical research and carry out economic evaluations within the health system.
Technological changes and cancer registries: an opportunity?
Authors: Galasso Rocco , Del Riccio Lucian , Colasurdo Antonio P.
Published: June 2024

Cancer registration has come a long way in the last 70 years. The basic function of a population based cancer registry is to record all new cases (of cancer) in a defined population (most frequently a geographical area) [1] and the core activity of a cancer registry is to generate statistics on the incidence of cancer, classified according to their site of origin and histology.
Validation of the Global Health Professions Students Survey questionnaire in Italy
Authors: Gualano Maria Rosaria , Bontempi Claudio , Saulle Rosella , Ricciardi Walter , La Torre Giuseppe
Published: June 2024

Background: The World Health Organization, the U.S. Centers for Disease Control and Prevention (CDC), and the Canadian Public Health Association have developed the Global Health Professions Student Survey (GHPSS) questionnaire in order to collect data on tobacco use and cessation counselling among health- profession students. The aims of the study were to evaluate the reliability and validity of the GHPSS questionnaire in Italy among health-profession students and to examine the prevalence of tobacco use, knowledge and attitudes to it and tobacco cessation training among students attending Italian medical schools using the standardised GHPSS approach.
Methods: Before testing tobacco use prevalence, knowledge and attitudes, and tobacco cessation training, we calculated the Cronbach’s alpha to assess the internal validity with the intention of avoiding misleading results. The questionnaire was administered to 100 health-profession students and data were collected in March 2009, during regular class sessions among students of two Italian Schools of Medicine. The original GHPSS instrument was translated into the Italian language and modified by adding three specific questions regarding I) the knowledge about the use of antidepressants, ii) Acetylcholine Receptor Partial Agonists, and iii) counselling techniques used in tobacco cessation programs. Statistical analysis was performed using SPSS 13.0, statistical software for windows.
Results: Cronbach’s alpha was higher on 17 items (alpha= 0.872), belonging to section I and IV (respectively: “Tobacco Use Prevalenceú and “Behaviour/Cessationú). The addition, also, of only one more of the others items (section)made the alpha value worse. Cronbach’s alpha for section VI for all items together (n. 44 items) was 0.815, which implies that the questionnaire had a very satisfactory internal validity. The prevalence of current smokers was 33%, while only 12% of students declared to be tobacco users. Interestingly, students who were tobacco users were 80% less likely to consider that health professionals needed training on smoking cessation techniques in comparison to non tobacco users.
Conclusions: The questionnaire showed excellent reliability properties in the sample studied. In terms of internal consistency and validity, it appears to have an acceptable performance. Given the high prevalence of smokers among medical students, teaching them about the damages related to tobacco use, and how to help them quit smoking or tobacco use, emerged as important issues. Further studies to investigate these important issues, using a standardized method like GHPSS, are needed.
Violence against women during pregnancy in some Asian countries: a review of the literature
Authors: Kashif Mobina , Murtaza Kashif , Kirkman Maggie
Published: June 2024

Background: Violence against women is a recognized violation of human rights and an important public health concern. Violence during pregnancy is a risk to both the woman and her baby. Aims: The aim of this review was to identify what the literature reveals about violence during pregnancy in Asian countries.
Methods: A systematic, integrated review was conducted of peer-reviewed literature published 1995-2009. Four databases were searched using the terms ‘intimate partner violence’, ‘domestic violence’, ‘pregnancy’, ‘Asia’, and ‘developing countries’. Reported results were compared within identified themes: prevalence, associated factors, interaction of violence and pregnancy, impact on women’s health, and the cultural role of children.
Results: Twenty three eligible papers were found; 14 reported quantitative methods, 3 reported qualitative methods, and 6 reported both. Research was conducted in Bangladesh, Pakistan, India, China, Thailand, and Iran. The prevalence of violence during pregnancy ranged from 4.3% to 48%. Adverse effects of violence were evident on women’s physical and mental health and on their babies. Variables found to interact with violence were unintended pregnancy, woman’s age, partner’s education, social support, previous history of family violence, and the cultural value of children. The existing pattern and intensity of violence in the relationship were not found to change consistently with the woman’s pregnancy.
Conclusions: The limited literature suggests that violence during pregnancy is a problem in at least some Asian countries as throughout the world. Further research is needed to increase knowledge of this important matter of significance both to women’s health and well-being and to social coherence.
Disaster planning for mass trauma care: implications for low income countries
Authors: Khan Fawad J. , Hassan Maleeha
Published: June 2024

Disasters are an important public health issue with an excessive mortality, high survivor morbidity and functional limitations on daily living. According to the International Strategy for Disaster Reduction (ISDR), the total number of reported people killed between 1991 to 2005 were 960,502 [1]. The total number of reported people affected by a disaster in the same time period was 3.5 billion with economic costs totaling $1193 billion dollars [1]. The number of disasters around the world has increased by more than four times in the last 20 years [2]. Furthermore, the increasing disaster rate has disproportionately affected poorer nations and communities [2]. This has contributed significantly to the downward spiraling effect on the economic, political and public health conditions of several developing nations.
Past violence and future work-related violence: a case-control study of Minnesota nurses
Authors: Grice Mira M. , Gerberich Susan G. , Alexander Bruce H. , McGovern Patricia M. , Ryan Andrew D.
Published: June 2024

Background: Violence in healthcare settings places nurses at risk for physical assaults (PA) and non-physical violence (NPV -- threat, sexual harassment, verbal abuse). Studies on life-span violence suggest that persons with violence histories are more likely to experience future PA. Yet, little is known about the relation between violence history and risk of current violence among healthcare workers. The aim of the study was to investigate whether or not reported history of work-related and non-work-related PA and NPV was associated with the risk of current work-related PA among nurses.
Methods: From a comprehensive survey of 6,300 randomly selected Minnesota nurses, a nested case control study (N= 310 cases and 944 controls) was conducted. Multivariate logistic regression analyses were used o estimate odds ratios (OR) and 95% confidence intervals (CI). Directed acyclic graphs identified potential onfounders. Horvitz-Thompson reweighting was applied to adjust for unknown eligibility and non-response.
Results: Reported histories of work-related PA and work-related threat were associated with levated risks f current work-related PA (OR = 12.8; 95% CI = 2.2, 73.9 and OR = 4.8; CI = 1.1, 20.9, respectively). Risks ere elevated, but not important, for histories of work-related sexual harassment (OR = 1.8; CI = 0.5, 6.3) and verbal abuse (OR = 1.9; CI = 0.6, 5.7). History of non-work-related PA was not associated with current work-related PA, nor was history of non-work-related NPV.
Conclusions: Results identified increased risks of current work-related violence among nurses who reported work-related violence histories. These results serve as a basis for targeted interventions and further research.
Policy suggestions to deal with intimate partner violence in Pakistan
Authors: Jalal Sabeena
Published: June 2024

Injury is one of the leading causes of mortality and disability in the world. It is a significant public health problem that is often over looked in the developing world. The burden of noncommunicable diseases (including injuries) is increasing and currently accounts for nearly half of the global burden of disease among all ages [1]. Five million people worldwide lose their lives annually as a result of trauma and injury [2]. Globally, among the age range of 15-44 years, the leading cause of fatal injury are traffic collisions, inter personal violence, self harm, war, drowning and exposure to fire.
Injury prevention in the developing world
Authors: Branas Charles C.
Published: June 2024

Injuries are rapidly escalating by-products of growth and urbanization in developing nations and have become the number one global health threat to children, young adults, and developing nations. Injuries are also highly preventable with scientifically evaluated, cost-effective solutions. Yet these same injuries are highly underappreciated as a global health threat and receive inadequate attention and funding. Because injuries so heavily affect individuals in their most productive years, their continued growth is sure to hamper or wipe away economic gains in many developing nations and further health inequities between developed and developing nations. Injury prevention in developing countries thus represents an enormous opportunity since attention and funding has been limited even in the face of evidence-based, cost-effective solutions. This opportunity should be pursued in developing nations by choosing prevention programs that address key injury threats and, at the same time, affect long-term, sustainable, and measurable injury reductions. Such programs should have strong local buy-in, a history of evaluation (preferably in developing nations), high returns-on-investment, make use of existing infrastructures when possible, and include an implementation plan that is to be carried out by the developing nation itself.
Visibility, accessibility and quality of Italian public health institutional websites
Authors: Chiadò Piat Simone , Gianino Maria Michela , Icardi Gianpiero , Specchia Maria Lucia , Renga Giovanni , Siliquini Roberta
Published: June 2024

Background: Since the large volume of health information available on the Web has the potential to improve health, Public Health institutions must represent a strong Internet presence with accessible and scientific information. The aims of the study were to verify the presence and visibility of Italian Institutions on the Web and to evaluate the accessibility and quality of the information provided.
Methods: In a focus group setting, 21 keywords were generated, and launched in search-engines Google and MSN. Researchers noted the first 30 results found and determined the position of institutional websites. The accessibility of 303 Public Health websites was assessed in relation to the logo presence and web validation of XHTML, CSS and WAI indicators. Regarding the quality of information, the presence of the HONcode logo in the websites’ homepage was checked.
Results: A high percentage of the keywords selected did not lead to any institutional website in the first three pages of Google (19.0%) and MSN (42.8%). Few institutional websites presented the logo indicator and a full web validation. Considering the XHTML indicator, only for 34.0% of the websites there was concordance between the logo presence/absence and results of direct validation, 50.2% for CSS. The quality level seemed to be extremely low.
Conclusions:In order to achieve a larger visibility and guarantee accessibility, Public Health websites have to be correctly designed, edited and maintained. Common and strict European laws about health information on the Web have to be arranged, deeply monitored and carefully adjourned in order to guarantee and support the positive role of institutional websites.
Acne as a public health problem
Authors: Semyonov Leda
Published: June 2024

Although acne is the most common skin disorder, epidemiological data on this condition are scarce. The social and economic effects of acne are mostly related to the high prevalence of this pathology, so much so that we can consider acne as a public health problem. Our proposal is to realize a computerized case sheet for each acne sufferer based on a minimum data set. This should include: patient’s age, sex, clinical form of acne and grade of severity. This information should then be introduced into a database management system. Examining the data collected we hope to contribute to the efficient use of health care resources and to improve management of public health problems highlighted in prior epidemiological investigations.
Comparing linear regression and quantile regression to analyze the associated factors of length of hospitalization in patients with gastrointestinal tract cancers
Authors: Pourhoseingholi Mohamad Amin , Vahedi Mohsen , Pourhoseingholi Asma , Moghimi-Dehkordi Bijan , Safaee Azadeh , Maserat Elham , Ghafarnejad Fatemeh , Reza Zali Mohammad
Published: June 2024

Objectives: The aim of this study is to compare linear regression and quantile regression to analyze the predictors of duration of staying in hospital for patients with GI cancers.
Methods: This study was designed as a retrospective cross-sectional survey included all consecutive GI cancer patients admitted over one year period in a random selected hospital group located in Tehran metropolitan in 2006. Residence, age, sex and type of cancer were analyzed respectively using linear and quantile regression.
Results: A total of 2,674 GI tract cancer patients were included in the study. There were 1,616 men (60.43%) and 1,058 women (39.57%). Results of the linear regression analyses showed that only type of cancer was significant. The diagnostic criteria showed that only 7% of variation has been predicted by linear regression. In spite of linear regression sex and type of hospital were significance in quantile regression analysis.
Conclusions: The results have demonstrated that if the duration data showed major skewness, using quantileregression leads to better interpretation and richer inference.
Reprocessing single-use cardiac catheters for interventional cardiology. A cost-minimization model for estimating potential saving at departmental scale and national level
Authors: Tessarolo Francesco , Disertori Marcello , Guarrera Giovanni M. , Capri Stefano , Nollo Giandomenico
Published: June 2024

Background: The utilization of single-use percutaneous catheters (SUDs) is a common practice in interventional cardiology, but the increasing of cardiac interventions and the consequent economic load demand for assessing SUDs’ reuse. The study aimed at estimating the potential saving for Italian cardiology departments in the hypothesis that reprocessing and reuse of SUD is performed by guaranteeing safety and efficiency of the reconditioned device as high as the new marketed one.
Methods: A cost-minimization model was applied from the perspective of the health national service. Input parameters for the model were settled by reviewing published data on technical, hygiene and functional properties of reprocessed electrophysiology (EP) and percutaneous transluminal coronary angioplasty (PTCA) catheters. Potential saving at department level was calculated as percentage of the actual expenditure for purchasing single-use devices. Two-ways sensitivity analysis was conducted on main cost drivers. Finally, saving at national level was estimated.
Results: The revision of technical and safety data showed the feasibility of reprocessing and reuse of EP and PTCA catheters under determined constrains. Potential savings of 39%, and 12% were calculated at department level for EP and PTCA catheters, respectively. Sensitivity analysis showed saving was dependent primarily on departmental workload. Major variations in saving occurred in the range between one and 200 catheters per year. The cut-off between benefit and charges was also related to regeneration rate and maximum number of uses. The estimate of potential saving at national level ranged in the interval from €19.85M to €24.24M.
Conclusions:When safety and efficiency is assured by certified reuse processing, substantial saving could be achieved both at departmental and national level contributing to optimize budget allocation for the healthcare system.
Measuring Quality of Life in TMD: use of SF-36
Authors: Deli Roberto , Macrì Ludovica Antonella , Mannocci Alice , La Torre Giuseppe
Published: June 2024

Aim: Temporomandibular disorders (TMD) occur frequently in the population and measuring health-related quality of life may prove to be a very useful complementary measure. The aim of our study was to evaluate both the correlation and the agreement between SF-36 and the Axis II of Research Diagnostic Criteria for TMD in the assessment of health-related quality of life in TMD patients.
Methods: This study was conducted on consecutives patients referred to our Department from 1 July 2007 to 31 January 2008. Each subject completed the Axis II and SF-36 questionnaires. Correlation of the SF-36 vs. the Axis II scales (graded chronic pain, depression, somatization with and without pain, jaw disability checklist) was calculated using non-parametric Spearmen coefficient.
Results: The examined sample was composed by 146 subjects (30 males, 116 females; mean age 35,2 ±14,38 years). There isn’t significant gender difference in age (p=0.083). All the considered Axis II scales are significantly inversely related with all the SF-36 domains.
Conclusion: Due to the good agreement with Axis II, SF-36 can be used for measuring Health Related Qualit of Life in TMD patients.
Molecular methods for the detection of human papillomavirus infection: new insights into their role in diagnostics and epidemiological surveillance
Authors: Piana Andrea , Sotgiu Giovanni , Castiglia Paolo , Pischedda Stefania , Dettori Marco , Cocuzza Clementina , Muresu Elena , Maida Alessandro
Published: June 2024

Human papillomaviruses (HPVs) comprise more than 180 genotypes. HPV infection is mainly diagnosed by molecular methods. The aim of our study was to review the main molecular methods used to diagnose HPV infection, underscoring their characteristics. Several methods have been developed for molecular diagnosis of Papilloma infection, such as those based on PCR technique. Another commercial non-PCR based diagnostic method is Hybrid Capture test; it is the only commercially available HPV DNA detection test approved by the FDA. Several Authors have suggested that viral load and E6/E7 transcripts could be used as surrogate markers of persistent HPV infection, being more specific predictors of progressive disease than the simple presence of HPV DNA. Validating clinical sensitivity and specificity of each technique and improving the interpretation of the results are essential; consequently, there is a clear need for well characterized international quality control panels to compare the various diagnostic methods. HPV DNA testing could be useful both as a primary screening test, alone or in combination with a Pap smear, for the early detection of cervical cancer precursors, and as triage test to select women with minor cytological abnormalities who will need further follow-up and to predict possible treatment failure in women with diagnosed high-grade intraepithelial lesions who have undergone excisional therapy. In the next future surveillance for HPV infections, based on these molecular methods, could represent an important step for the development of primary and secondary prophylactic interventions, such as new vaccines targeted to genotypes who might replace those previously prevalent.
The impact of social context on the perception of dental appearance in 8-9 years old children
Authors: Deli Roberto , Oliva Bruno , Macrì Ludovica Antonella , Clementini Marco , De Vito Elisabetta , Nicolotti Nicola , La Torre Giuseppe
Published: June 2024

Background: Several studies have tried to clarify the role that malocclusion has on an individual’s selfconcept or on level of satisfaction with one’s dental or facial appearance, but little research on psycho-social attitudes towards malocclusion has been conducted on pre-adolescent children. The aim of our study was to investigate the impact of socio-economic status (SES) on the perception of dental appearance in third-grade school-children.
Methods: A pilot survey was conducted in 2008 in order to collect data from a representative sample of 101 eight-nine years-old children (62 M - 39 F), examined by trained orthodontists. Each child filled in the Children’s Orthodontic Attitude Survey (COAS) questionnaire, and then they were examined by 3 residents. The clinical parameters were correlated with the questionnaire findings and with the SES. The latter was assessed using a previously validated scale, graded into classes from I to V reflecting the parents’ job activity. Statistical analysis: Statistical analysis was performed by using SPSS 12.0 for Windows, using Chi Square Test for nominal variables and Kruskal-Wallis test for ordinal scales. Statistical significance was set at p < 0.05.
Results: A statistical association was found between clinical status and SES only for the Oral Hygiene level (p = 0.022). Chi-Square test also showed a statistically significant association between SES and R.O.M.A. Index (p = 0.009). The relation between questionnaire findings and SES was significantly observed only for the following question “Does the way your teeth look bother you” (p = 0.022).
Conclusions: Familial SES is not a determinant in children’s satisfaction with dental appearance. Children with different SES demonstrate they have almost completely the same approach towards braces.
Public Health Nutrition
Authors: Hillger Christiane , Kirch Wilhelm , Wolfram Nicole
Published: June 2024

Abraham Maslow (1908 – 1970) has set up a hierarchy of five levels of basic needs. Of those that are considered to be basic physiological needs hunger, thirst as well as bodily comforts are considered to be the most important. Physiological needs are the strongest needs because if a person were deprived on all needs it is these physiological needs that would take the highest priority. As food is characterized as a basic need, we should have a special view on our daily food and our handling of it. Most people do not act careful with their daily intake of food. In the last decades, the increases of nutrition-associated diseases such as overweight and obesity and on the other hand underweight have been recorded. From a life-span approach, the problem has its offset point in the early age of development, namely in children and adolescents. Malnutrition, overweight and obesity limit children’s personal quality of life in terms of unhappiness with their own body, opposition or even rejection in peer group communication and general difficulties in day-to-day social interaction. A close connection between physical stature and the development of a negative self-concept and a low self-esteem is postulated.
Worksite health promotion research: challenges, current state and future directions
Authors: Bauer Georg F.
Published: June 2024

Background: Worksite health promotion (WHP) addresses diverse individual and work-related health determinants. Thus, multiple, non-standardized interventions as well as company outcomes other than health have to be considered in WHP research.
Methods: The article builds primarily on published research reviews in WHP and related fields. It discusses key practical and research challenges of the workplace setting. The evidence available on the effectiveness of WHP is summarised and conclusions are drawn for future WHP practice and research.
Results: WHP research on health-oriented, behavioural interventions shows that the level of evidence ranges from suggestive to acceptable for key prevention areas such as physical activity, nutrition, fitness, smoking, alcohol and stress. Such interventions are effective if key conditions are met. Future research is needed on long-term effects, on multi-component programs and on programs, which address environmental determinants of health behaviour as well. Research on work-related determinants of health shows the economic and public health relevance of WHP interventions. Reviews of work-oriented, organisational interventions show that they produce a range of individual and organisational outcomes. However, due to the complexity of the organisational context, the generalisability and predictability of such outcomes remain limited.
Conclusions: WHP research shows success factors of WHP and provides evidence of its effectiveness. In future, the evidence base should be expanded by developing adaptive, company-driven intervention approaches which allow for continuous optimisation of companies from a health perspective. Also, approaches for active dissemination of such a systemic-salutogenic occupational health management approach should be developed to increase the public health impact of WHP.
Evaluation of the effectiveness of a nutrition education intervention performed by primary school teachers
Authors: Agozzino Erminia , Del Prete Umberto , Leone Chiara , Manzi Elisabetta , Sansolone Natalina , Russo Krauss Pio
Published: June 2024

Background: Long-term interventions based on the active involvement of students, carried out by properly prepared staff using didactic support material (brochures, games etc.) including the participation/involvement of mothers or associates in community interventions; seem to be the most effective ones. This study evaluates the effectiveness of nutrition education interventions carried out by teachers with active didactic methodologies.
Methods: The research was carried out by administering a frequency of food intake questionnaire, before and after the intervention. To compare the answers given before and after the educational intervention the Wilcoxon-test was applied to dependent data discriminating the group with “sufficient implementation” of the project versus “insufficient implementation”.
Results: Our data demonstrates that a substantial percentage of children do not report an adequate nutritional intake, making education interventions not only opportune but necessary. In both groups there was an increase in the number of subjects having breakfast, particularly in terms of bread and biscuits intake. In the group with “sufficient implementation” there was an increase in the intake of all kinds of food with respect to the previous day’s intake and a decrease in the intake of meat, fish and legumes consumed during the previous week; in the group with “insufficient implementation” only fish intake increased significantly while vegetable intake decreased in a non-significant way. So this educational intervention appears to have been particularly effective in modifying breakfast habits and reducing snack.
Evaluation of airborne respirable particulate matter and polycyclic aromatic hydrocarbon exposure of asphalt workers
Authors: Cirillo Teresa , Arnese Antonio , Del Prete Ernesto , Del Prete Umberto , Amodio Cocchieri Renata
Published: June 2024

Introduction: Assessment of exposure to the airborne respirable particles (PM10) and polycyclic aromatic hydrocarbons (PAHs) of asphalt manufacturing and road paving workers in the Campania region (Italy).
Materials and Methods: A study was carried out during 2006 and involved 5 firms producing and employing bitumen in road paving activities. The workers studied were categorized on the basis of their job as workers in bitumen manufacturing, in road paving and in workers not exposed at bitumen fume considered like controls.
Results: In the manufacturing plants the average concentrations of airborne PM10 were 1125±445 ìg/m3 in the HMA manufacturing workers’ areas; 314±81 ìg/m3 in the process surveyors’ cabins and 92±27 ìg/m3 in the controls’ areas (administrative offices). Within the breathing zones of the worker, the average PAHs levels in air were as follows: 367±198 ng/m3 for HMA manufacturing workers; 348±172 ng/m3 for process surveyors; 21±2 ng/m3 for the controls. At the road paving sites the average airborne PM10 levels were 1435±325 ìg/m3 for roller operators; 1610±356 ìg/m3 for paver operators; 319±108 ìg/m for the controls (traffic controllers). PAHs in the breathing zones were 1220±694 ng/m3 for the paver operators; 1360±575 ng/m3 for the roller operators’ and 139±135 ng/m3 for the traffic controllers’. The results show that the more consistent hazard for asphalt workers’ health is derived from exposure to airborne PM10 both in exposed and in non-exposed (controls) workers.
Health care services to diabetics in the territory of the Lha Napoli 2: quality perceived
Authors: Parlato Antonino , Russo Paolo , Ugliano Daniela , Visciano Aniello , Liguori Giorgio
Published: June 2024

Background: Worldwide, diabetes mellitus is a chronic disease which now appears to be substantially increasing especially in industrialized countries. In recent years important improvements have been achieved in the treatment of the disease and the prevention of complications, but adherence of health care workers to these indicators varies considerably and often the results are inadequate. Our study relates to health care services supplied to diabetics within the territory of LHA (Local Health Agency) Napoli 2 in Italian region of Campania. The results obtained from 3 district areas were then compared.
Methods: The prevalence study was carried out by interviewing diabetes-affected patients (aged 18-64) in the territory examined. For each area, a representative number of patients was selected through simple casual sampling.
Results: A minimal knowledge of risk factors associated with diabetes in respect to those registered at a national level, an incomplete adherence to recommended actions, a good perception of the quality of healthcare services and a good level of information were recorded from all of the 462 subjects interviewed.
Conclusions: This study draws attention to the critical aspects in healthcare services supplied to diabetics. The data collected could be useful to more effective and efficient strategies of “disease management” resulting in the better allocation of resources.
Public dentistry, which direction? The Italian anomaly and its new perspectives
Authors: Reali Daniela , Dinelli Francesca , Rolla Paolo
Published: June 2024

Italian National Health Service (INHS) provides hospital, district and preventive cares in many medical areas but dental cares are a small part of all treatments provided. It is estimated that it only answers a 5% of need. In Italy dental treatments are predominantly provided by private practitioners: it means little access equity to cares. Nowadays, just 1,5% of the INHS expense is aimed at public dentistry because most of dental cares are believed “not urgent”. Why oral diseases are not considered so invalidating to have relief in INHS? They should get the same attention of the other pathologies because they worsen the quality of life in term of physical and psychological health. Need of public dentistry performances has recently increased, as confirmed by larger and larger waiting lists: it has revealed the growing dental need of the weakest part of the Italian society that, because of economic, social, cultural reasons, can hardly afford private cares (private practitioners are now facing a crisis, too). Dentists’ ethical code is not essentially different from physicians’ one even if most of the oral pathology is not worrying about patients’ life. “Bioethics in Dentistry” (2005), an issue by the National Bioethics Committee says: “public dentistry is actually absent in helping the weak part of the society. Just consider that in Italy oral cares are not included in Essential Care Levels (ECL) and they are not provided by Local Health Authorities whereas requirements to State exams include minimum tooth number and good oral health, because of the high importance of oral wellness.
Health Impact Assessment as tool for public health grown
Authors: Siliquini Roberta , Ricciardi Walter
Published: June 2024

In recent years some of the most accredited health agencies have expressed a growing interest in Health Impact Assessment.
This interest has arisen from the scientific evidence that demonstrates possible future health gains, especially in highly developed countries, can result not only from direct health interventions (both preventive and curative) but, above all, by the development of social, economic and environmental policies that take into consideration the policies impact on citizens’ health; many determinants do not originate from the health sector.
Health is often central or the first ranked topic of each pending political decision. Strong and rigorous epidemiological approaches employed in health during the past decade or so have allowed us to identify causal relationships for diseases as well as health promoting factors. In the same way, epidemiological observation has provided us with a number of well-founded interpretative elements concerning the current situation, for example,health inequities among different social groups
Economic valuation of effects on health within Health Impact Assessments
Authors: Nowacki Julia , Fehr Rainer
Published: June 2024

Public health experts widely agree that policies, programs and projects from numerous sectors have a decided influence on health determinants, hence the surge of interest in prospective “Health Impact Assessments” (HIA). Likewise, economic considerations currently pose a major challenge throughout the field; health economists developed a range of approaches to calculate (in)direct costs of diseases, treatments etc. The question arises then, if and how can economic valuation of health effects within HIAs take place now or in the future. To investigate this issue, the Department of Public Health, University Bielefeld, along with the Institute of Public Health North-Rhine Westphalia (loegd), Germany, conducted an email-survey. The answers of 68 participating experts and practitioners from 16 countries and from international organizations showed that so far, only a small fraction of them (7%) have conducted economic valuations; more than one third (37%), however, at least sometimes discusses this option. The main obstacles seem to be: lack of knowledge about methodological details, existing uncertainties, and various problems in defining economic value for effects on health. Cost-benefit, cost-effectiveness, and cost-utility analysis were nominated most frequently as candidate methods. Participants also provided nearly 300 commentaries concerning potentials and/or risks that these economic valuations might have. This paper is mostly about the basic and quantitative results from the survey; it is planned to publish the qualitative results (with detailed discussion of the range of arguments “pro” and “con”) in a separate paper.
Reconstruction of railroads at Klaipéda da National Seaport: Local Health Impact Assessment Case in Lithuania
Authors: Zurlytè Ingrida , Mačiūnas Erikas , Strička Marius , Ščupakas Davidas , Burbienè Regina , Burkauskienè Ilona , Poliakovienè Ramunè , Buzytè Viktorija
Published: June 2024

Background: Introduction of health impact assessment (HIA) as a national legal requirement for planned economic activity projects in 2002 and the further development of related procedures and methodological requirements has boosted the number of HIAs carried out both as an integrated part of environmental impact assessment (EIA) procedures as well as an independent activity. Most of HIAs have been conduct for local projects. The HIA for the reconstruction of the southern section of the railroads in Klaip da National Seaport is one of the local HIAs in Lithuania carried out as an independent procedure. Methods: The HIA for the reconstruction of the southern section of the railroads in Klaipda National Seaport was carried out following the national legal procedure for the cases not foreseen in the Law on Environmental Impact Assessment of Planned Economic Activity and the national HIA methodological regulations. The HIA included a literature review, analysis of related technical documentation, data on existing and estimated air pollution and environmental noise levels and possible health consequences, analysis of local demographic and health statistics; interviews with the residents living in proximity of the planned activity, analysis of public complaints on existing activities at Klaip da National Seaport, site visit and round table discussions with the proponent of the planned activity, planning company and representatives of the public health authority. The standard or intermediate type of perspective HIA was applied. Results: The HIA report has pointed out noise, vibration, ambient air pollution, psychological factors as related to possible negative impact on health of residents living in the mostly exposed locations. Interviews with inhabitants living in proximity of the planned activity have shown that majority of them knew nothing about the reconstruction plans. Recommendations were provided in the report how to minimise existing and prevent newly emerging negative health impacts from the planned economic development related to ambient air and environmental noise pollution as well as recommendations for communication improvement. with the residents. Conclusion: The HIA provided the proponent of planned activity, as well as the regional public health authority and the concerned public with relevant information on the main health determinants and possible health impacts of the planned reconstruction of the railway segment. HIA recommendations stimulated the proponent to agree on additional measures reducing negative health impact of the planned activity. This case of HIA also revealed some strengths and weaknesses of the overall HIA framework in Lithuania.
Phenotypic and genotypic characterization of vancomycin-resistant enterococci in a university hospital of southern Italy
Authors: Liguori Giorgio , Villari Paolo , Boccia Stefania , Gallè Francesca , Di Onofrio Valeria , Marzuillo Carolina , Amore Rosarita , Rossano Fabio
Published: June 2024

Background: In the last decades vancomycin-resistant enterococci (VRE) have emerged as important pathogens responsible for hospital-acquired infections. To analyze the spread and clonal relatedness of VRE, a two-year study of isolates was carried out in the hospital of the University “Federico II” in Naples.
Methods: Enterococcus species were identified by using API-2 Strep and antibiotic susceptibility was determined through the use of four tests: disk diffusion, broth dilution methods, Etest and Vitek 2. Polymerase Chain Reaction (PCR) was used to analyse glycopeptide resistance. Pulsed-field gel electrophoresis (PFGE) and arbitrarily primed (AP)-polymerase chain reaction were used for molecular typing of the strains.
Results: Thirty-two isolates of enterococci (18 E. faecium and 14 E. faecalis) showed resistance to vancomycin and teicoplanin and all the strains were vanA-positive. AP-PCR showed a unique clone of E. faecium, as well as for E. faecalis isolates. Identical results were obtained by PFGE for E. faecalis isolates, while three different PFGE patterns emerged for E. faecium.
Conclusions: The low degree of genetic diversity among the isolates strongly suggests a clonal spread of antibiotic-resistant strains among hospitalized patients in high-risk wards. This report represents the first step to understanding VRE spread in our hospital as well as contributing to the comparison among different antibiotic susceptibility tests and molecular typing methods.
The North Karelia lessons for prevention of cardiovascular disease
Authors: Laatikainen Tiina , Vartiainen Erkki , Puska Pekka
Published: June 2024

Background: As a result of the high cardiovascular disease (CVD) rates in Finland in late 1960’s, which became a source of national concern, a major community based programme for CVD prevention called the North Karelia project was established. Aim: The aim of the project was to carry out a programme of comprehensive community based interventions to reduce coronary heart disease (CHD) mortality and morbidity.
Methods: Using lifestyle modification methods and strategies for environmental change the programme aimed to reduce three main risk factors: smoking, elevated blood cholesterol and blood pressure. Several intervention settings and strategies in the community were used.
Results: Since the 1970’s the CHD mortality in North Karelia has declined by more than 80%. Major reductions have been seen across the main three cardiovascular risk factors. Among both men and women, total serum cholesterol levels within the population declined by almost 20% and systolic blood pressure by about 10%. Smoking among men decreased from 52% to 33%, while among women a slight increase in smoking prevalence was recorded.
Conclusions: The North Karelia project has shown that a comprehensive, determined, theory-based community program can have a meaningful and positive effect on risk factors and lifestyles. Furthermore, these changes are associated with favorable changes in chronic disease rates and the health of the population.
The Moli-Sani Project, a randomized, prospective cohort study in the Molise region in Italy; design, rationale and objectives
Authors: Iacoviello Licia , Bonanni Americo , Costanzo Simona , De Curtis Amalia , Di Castelnuovo Augusto , Olivieri Marco , Zito Francesco , Donati Maria Benedetta , De Gaetano Giovanni
Published: June 2024

Background: Cardiovascular disease and malignancies account for more than 70% of all causes of mortality and morbidity in Italy. There is a subtle balance between genetic determinants and lifestyle, that often defines the line between health and sickness. So far studies aiming at identifying risk factors have mainly come from Northern Europe and the USA. It was to understand this balance between genetics and environmental determinants better, and to tailor appropriate preventive strategies for Italian and other Southern European populations, that theMoli-sani project was launched, transforming a small Italian region into a large scientific laboratory: the “Molise lab”.
Methods: Each participant receives a thorough medical check-up at no cost to either him/her or the national health service, resulting in thousands of hours of free public health care. With a completely computerized system, Moli-sani is a “paperless” study, in which researchers and participants communicate using recently developed technologies such as mobile phone text messages (SMS). The newly established biological data bank (the “MoliBank”) will be one of the largest in Europe. Results: Early results of 8000 participants so far show a slightly worrying pattern of risk factors for a Mediterranean population. The prevalence of obesity, hypertension and metabolic syndrome is growing at rates close to those of other Western countries. Hypertension and, to a lesser extent, high blood glucose levels, are under-diagnosed and underestimated by patients, and appropriate therapy appears under-used and not very successful. However, cholesterol management appears more efficient.
Conclusions: Paying particular attention towards innovation and new technologies, theMoli-sani project has placed itself at the cutting edge of a new paradigm crossing research and prevention.
Stroke prevention in Italy: the role of the family doctor
Authors: Mazzaglia Giampiero , Filippi Alessandro , Brignoli Ovidio , Cricelli Claudio
Published: June 2024

Stroke is the third leading cause of mortality and the first cause of disability in Italy, with an estimated incidence of non-fatal cases of stroke of 10 cases/1000 person years among hypertensive patients, and a prevalence of ischemic stroke in the year 2001 of 5.4/1000 persons. The main responsibility for the primary prevention of stroke should be with the primary care physicians as they are best positioned to determine an atrisk population and to initiate educational, lifestyle, and cardiovascular risk reduction treatments. In primary prevention, only well-documented and potentially modifiable risk factors should be tackled. Recognition of the most relevant modifiable risk-factors leads to corresponding interventions. However, data from surveys conducted in general practice clearly demonstrate an overall under-monitoring or under-treatment for themost relevant risk factors, such as high blood pressure, smoking status, high cholesterol level, atrial fibrillation, and left ventricular hypertrophy, which led to a corresponding low treatment prevalence amongmoderate and highrisk stroke patients. In this context, the use of automatic electronic reminders has shown promising results in improving the performances of primary care physicians in the primary prevention of high-risk cardiovascular patients. This suggests there is a need for further research in general practice to evaluate the effect of such a system in improving the prognosis of individuals at high-risk of stroke.