bluuebunny/crossref_metadata_2025 huggingface dataset:
Public Health History Corner Edmund Pellegrino: a modern day prophet for medical humanities in the US
Authors: Bucci Roberto
Published: June 2024

Abraham Flexner lit the fire that freed American doctors from obsolete aspects of their training. Edmund Pellegrino was the prudent fireman who acknowledged the risk of too broad a fire and put in place safe guards to protect those aspects that needed to be saved. The prodigious leap forward in medicine due to the “laboratory centred” training introduced by Flexner’s proposals for medical training began to have negative effects in daily medical practice, particularly with regards to the increasing technological input in medicine and the perception that there was a lack of sensitivity to the humanistic aspects of health. It took a strong and genial personality, no less than Abraham Flexner, to correct the course of medical training in the USA and to restore the balance between these two dimensions.
Primary care in the Netherlands: current situation and trends
Authors: De Bakker Dinny H. , Groenewegen Peter P.
Published: June 2024

Background: Primary care in the Netherlands has a strong international reputation. However, this picture may be qualified in two respects. First of all, the Dutch primary care system is less cohesive than is sometimes suggested. Secondly, there are major challenges in the Dutch system (as is the case with other European health care systems), which have to be resolved in order to maintain and improve primary care. Methods: Description of primary care in the Netherlands based on nationally and internationally published sources. Identification of challenges and trends. Narrative review of the literature.
Results: GPs have a strong position in the Netherlands. Their numbers are relatively low; they have a gatekeeping position, and there is no cost-sharing for GP care (unlike other forms of care). The primary care system as a whole, however, is characterised by weak coherence. Individual primary care disciplines have their own separate modes of funding. Challenges include a growing and changing demand for primary care services, and changes in manpower and organisation, that affect the balance between demand and supply regarding primary care services.
Conclusions: Among the threats to strong primary care are the risk of increasing fragmentation of care, negative side effects of a transformation process from cottage industry to service industry, and reluctance to invest in integrated primary care. An opportunity lies in the consensus among stakeholders that integrated primary care has a future. Technological developments support this, especially the development of electronic patient records.
News from EUPHA
Authors: Vari Autori
Published: June 2024

It is very good news for Italian participation at this year’s EUPHA meeting, which will be held in Lodz (Poland). From 25 to 28 November the joint annual conference EUPHA-ASPHER will see a peaceful “invasion” from Italy. Out of the 63 Italian abstracts submitted to the conference organisers, only 5 (7.9%) were rejected. Overall, 11.6% of all of the accepted abstracts are Italian, 9.8% of the oral presentations and 13% of the poster presentations. These results pay testimony to the high quality of European public health research and practice reached in several fields and settings (academic, public health regional agencies, and local health units). Highlights from Italy include the ongoing work in the field of infectious disease control, Stefania Bruno (Catholic University) will present the Roman experience of Tubercolosis surveillance in the homeless. Maria De Giusti (Sapienza University) presents “Knowledge, attitudes and behaviour towards Methicillin-resistant Staphylococcus aureus skin infections and S. aureus nasal colonisation”; while Chiara de Waure (Catholic University) will present “Rapid screening tests for MRSA carriage at hospital admission: a systematic review”.
Public Health History Corner Abraham Flexner: the iconoclast
Authors: Bucci Roberto
Published: June 2024

Abraham Flexner, in 1910, led an attack on the inadequacy of the medical schools in the United States. In opposition to the traditional clinical type training he proposed a new laboratory centred model, with a strong emphasis on basic sciences. These university lab experiments were one of the main driving forces in the development of medical sciences in the USA. The work of a pedagogue caused a real medical revolution, the outcomes of which were important but not all positive.
New challenges in public health education and training in the Slovak Republic
Authors: Gulis Gabriel , Katreniakova Zuzana , Kollarova Jana
Published: June 2024

Background: The Slovak Republic joined the European Union (EU) on May 1st 2004. The public health systemof the country is under continuous transition including public health education and training. The aim of the presented paper is to describe and discuss how far the transition of public health education of the countrywent during last time period.
Methods: Web site review, documentation search and curriculum content analysis were the main methodsemployed within presented paper.
Results: There are 7 universities offering public health education on bachelor, master and doctoral level.Among them 6 could be found in list of accredited universities of the Ministry of Education by AccreditationCommittee of the Government of the Slovak Republic. The three levels of education are fully harmonized withthe Bologna principles. The Accreditation Committee of the Government of the Slovak Republic describes very detailed aims of a public health education program including recommended study subjects. Universities add to additional, mostly clinical medicine or hygiene subjects to recommend study subjects leaving likely verylittle time for research at universities.
Conclusions: Despite large progress further effort is needed to clarify what is public health, what kind of subject should be included in curricula and on introduction of public health research at universities.
Cardiovascular comorbidity and cardiovascular risk factors in patients with chronic inflammatory skin diseases: A case-control study utilising a population-based administrative database
Authors: Schmitt Jochen , Maywald Ulf , Schmitt Natalie M. , Meurer Michael , Kirch Wilhelm
Published: June 2024

Background: : Psoriasis (PSO) and atopic eczema (AE) are chronic inflammatory disorders that primarily affect the skin. Data on cardiovascular comorbidity in PSO is scarce, and studies on the association of cardiovascular disease/cardiovascular risk factors and AE are missing. Methods: We performed two separate case-control studies for PSO and AE utilising an administrative health care database including approximately 250,000 individuals from Germany. Cases with AE (n=6,296) and cases with PSO (n=3,156) were individually-matched (1:1) to controls with the same age and sex. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated based on the observed prevalences of cardiovascular morbidity among cases and controls.
Results: Patients with AE had a higher risk of obesity (OR,95%CI 1.24, 1.07-1.44). None of the other cardiovascular risk factors or diseases studied was associated with AE. PSO was significantly associated with hypertension (OR,95%CI 1.45, 1.27-1.66), diabetes mellitus type-2 (OR,95%CI 1.35, 1.13-1.61), obesity (OR,95%CI 1.58, 1.34-1.85), dyslipidemia (OR,95%CI 1.42, 1.14-1.77), and atherosclerosis (OR,95%CI 1.81, 1.37-2.41). Despite their unfavorable cardiovascular risk factor profile, patients with PSO were not at increased risk of adverse cardiovascular events (myocardial infarction OR,95%CI 1.14, 0.74-1.77; cerebral apoplexy OR,95%CI 0.94, 0.57-1.55).
Conclusions: Chronic inflammation due to AE does not appear to cause adverse cardiovascular comorbidities. In contrast, PSO is associated with an adverse cardiovascular risk factor profile, but this does not necessarily appear to translate into a higher risk for cardiovascular events. This study does not rule out that specific treatments for AE or PSO modify the risk of cardiovascular disease.
Clinical epidemiology of IgE-mediated cutaneous and oculo-conjunctival allergic diseases
Authors: De Renzi Giuseppe , Nicolotti Nicola , De Filippi Marco , Lovato Laura , Feyles Gianfranco , Ferrario Enrico , Siclari Nicola , Mazzarello Maria Gabriella , Torriglia Angelo Michele , Perfumo Mascja , Cremonte Luigi Giovanni , Capizzi Silvio , La Torre Giuseppe
Published: June 2024

Background: IgE-mediated allergic disease may clinically manifest itself with either a single symptom or a multisymptomatic disease involving different organs. In this work we investigated whether gender and age of the patients and reactivity to specific allergens are related to different clinical presentations of IgE-mediated allergic disease, considering in particular eye-conjunctival and cutaneous symptoms, alone or in combination.
Methods: Epidemiological and clinical data related to patients of the Local Health Unit of Torino and Alessandria were collected. Measuring of specific Immunoglobulin E (IgE) was carried out by using allergenic extracts and by the employment of the chemiluminescence method. Clinical outcomes were the presence of eye-conjunctival, cutaneous (with also other symptom), and only cutaneous symptoms. The covariates under study were the type of allergen (mite, epithelium, poaceae, food, trees and grasses), number and localisation of the allergic reactions, gender, age over 30 years. For each clinical outcome, a logistic regression analysis was performed. Statistical significance was set at p < 0.05.
Results: 844 patients with allergic problems (clinical manifestations of allergic disease) entered the study. We found that exposure to epithelium [OR=3,61; IC 95% (2,17; 6,00)], poaceae [OR=2,24; IC 95% (1,46; 3,42)], grasses [OR=2,06; IC 95% (1.35; 3,14)] and age over 30 years [OR=2,05; IC 95% (1,35; 3,13)] are risk factors for the development of eye-conjunctival symptoms. With regard to cutaneous allergic reactions, exposure to mite [OR=1,49; IC 95% (1,07; 2,08)], food [OR=4,16; IC 95% (3,01; 5,75)] and multidistrict symptoms [OR=3,63; IC 95% (2,54; 5,20)] should be risk factors. Instead, considering only cutaneous reactions, possible risk factor is the exposure to food [OR=3,58; IC 95% (2,54; 5,03)]. The exposure to trees is associated with a reduction of the likelihood to have cutaneous [OR=0,45; IC 95% (0,26; 0,76)] and only cutaneous reactions [OR=0,24; IC 95% (0,11; 0,53)]. For only cutaneous symptoms, a reduction in probability is present for the exposure to the grasses [OR=0,60; IC 95% (0,38; 0,94)] too.
Conclusions: The study highlighted significant associations between subgroups of allergens and specific symptoms. As a consequence, in the presence of cutaneous symptoms, IgE tests could be restricted to mite and food, and to epithelium, poaceae and grasses in the presence of oculo-conjunctival symptoms.
A new model dependency ratio for European cities
Authors: Zamaro Gianna , Green Geoff , Tsouros Agis , Chiavon Enrico
Published: June 2024

Background: Sometimes referred to as ‘the demographic time bomb,’ the European Union, state and local governments are concerned about the impact of an ageing population on both sustainable economic development and the demand for health and social support services. Seeking to mitigate these pressures, the Organisation for Economic Co-operation and Development (OECD) has developed a policy framework Live Longer: Work Longer and the World Health Organization (WHO) has set a policy framework for Active Ageing which maintains that early life course interventions can reduce levels of disability and dependency in older age. The WHO European Healthy Cities Network (WHO-EHCN) promotes healthy urban planning to encourage healthy lifestyles and maintain older people as a resource in the workplace and to their communities. Our objective is to develop a new model dependency ratio (NMDR) for European cities which synthesises these three policy frameworks.
Methods: Starting from the classic formulation of the dependency ratio (DR), which compares the 'dependent' population segments with the working-age or 'productive' segments, the model is developed in six stages, drawing on data from secondary European and national sources and from primary sources contained in Healthy Ageing Profiles of fifteen (WHO-EHCN) cities.
Results: From an orthodox baseline, the second stage of modelling increases the DR by moving economically inactive people of working age from denominator to numerator. Thereafter, refinements introduced in stages three to six, gradually reduce the DR.
Conclusions: The NMDR challenges the 'demographic time bomb' predicted by orthodox formulations and can be used as a tool by city decision makers.
Parental perception of childhood obesity in an inner-city area of Palermo, Italy
Authors: Bianco Antonino , Mammina Caterina , Bellafiore Marianna , Farina Felicia , Palma Antonio
Published: June 2024

Background: The objective of this study was to evaluate in a sample of parents living in an inner-city area of Palermo, Italy, the perception of weight excess as a problem in childhood and the awareness about the role of physical activity, beliefs about contributors and parties having responsibility in counteracting the obesity crisis.
Methods: A cross-sectional survey was performed on a convenience sample of parents of 6-13 year-old children who attended grades 1, 3 and 5 of primary and grades 1 and 3 of secondary public schools, respectively. Thirteen schools were selected in an inner urban district of Palermo, Italy, this district being characterized by having a population of low to medium income residents. Parents were asked to come to the school and participate in the investigation. The survey was administered in the spring of 2006. After a descriptive analysis, role of specific demographic and social characteristics – education, gender, age class and BMI - of respondents was assessed by univariate and multivariate logistic regression analysis.
Results: Three hundred eleven parents completed the questionnaire. Eighty-three percent believed that being obese in childhood is a serious health hazard, but one third still interpreted the child’s weight excess as an expression of health. The most significant contributors to childhood obesity were thought to be junk food and beverages (78.0%) and fast food (63.2%), followed by lack of exercise in school curriculum (48.7%). Beliefs about responsibilities for combating childhood obesity significantly varied according to education level.
Conclusions: Public support for environmental changes could more effectively rise with the increasing public awareness that many interrelated obesogenic factors in the modern environment are playing a key role.
Obesity nutritional aspects and life style from a survey on a sample of primary school pupils in the Pavia province (Northern Italy)
Authors: Arpesella Marisa , Campostrini Stefano , Gerzeli Simone , Lottaroli Stefano , Pane Adelina , Traverso Maria Alessandra , Vandoni Matteo , Coppola Liliana
Published: June 2024

Background: The increased risk of chronic diseases requires effective strategies to promote health, facilitating the adoption of proper life styles from childhood. In order to do that, the local health authority in Pavia has undertaken a pilot study with the aim of estimating the level of overweight and obese children in primary schools and of identifying the life styles that entail health risks.
Methods: A cross-sectional study based on a sample of 460 children in their last year of primary school in the Province of Pavia was performed. Pupils were classified by Body Mass Index, and a face-to-face questionnaire about children’s use of time was administered. A multiple logistic regression analysis has been applied in order to identify risks or preventive health factors linked to physical activity and eating habits.
Results: 12.6% of the children were obese and 26.3% overweight, with the percentage of obesity nearly double in those who do not practice organized sports activities at least once a week, in those who don’t have breakfast in the morning and in those who don’t spend their free time in movement games. From a multiple logistic regression it results that the risk of being obese is twice and three times higher for the children living respectively in medium and small towns than for the ones living in large towns.
Conclusions: In the Province of Pavia the prevalence of overweight and obese 10-year-old children exceed the data reported in recent studies all over Italy. The life styles that entail obesity risks are significantly linked both to eating habits and to physical activity: living in middle- and small sized towns and not having breakfast before going to school emerge as risk factors, while practicing movement games in the free time after school appears to be a protecting factor.
Nutrition sciences as part of school education on secondary level
Authors: Hillger Christiane , Wolfram Nicole , Kirch Wilhelm
Published: June 2024

Background: The following article focuses on nutrition related topics that had been implemented in the curricula of secondary level schools in Saxony, Germany, during their reorganisation. The overall aim was to make children and adolescents more sensitive to nutrition related topics in their daily lives. Thus, the lesson plans that have been created for the teachers will be introduced and a preview of further steps will be given.
Methods: For the subject economics-technology-household exemplary lesson plans within the framework of the Saxon curricula were created for secondary level schools from grades eight to ten. Furthermore, conceptions for project days and different kinds of courses were prepared for nutrition related topics. After the lesson plans were tested and three teachers were consulted, feedback from all of the subject teachers was obtained via interview for qualitative analysis. Fifty-two pupils were asked to answer a questionnaire. The responses according to the lessons were taken partially standardised and were evaluated.
Results: Teachers as well as pupils appreciated the complex lesson plans and materials on scientific basis.The consulted subject teachers emphasised that the lesson plans can be regarded as a fundamental preparation for their further work. If necessary they need to be adapted to the teacher’s ideas and special circumstances in school.
Conclusions: With the preparation of the lesson plans important steps were realised within the restructuring process of Saxon curricula. Thus, the implementation of nutrition related topics in school curricula could be achieved.
Obesity intervention on the healthy lifestyle in childhood: results of the PRESTO (PrEvention STudy of Obesity) Study
Authors: Dietrich Sabine , Pietrobelli Angelo , Dämon Sabine , Widhalm Kurt
Published: June 2024

Background: Due to increasing problems with childhood and adolescent obesity in Austria PRESTO (PrEvention STudy of Obesity) created a school based intervention program for promoting a healthy lifestyle in Austrian youth.
Methods: PRESTO was carried out by a multi-disciplinary team including a physician, a psychologist, a nutritionist and an exercise physiologist. The study was carried out in 12 first grade school classes in Austria (2002-2004), mainly in Vienna (N=260). The control group consisted of 231 subjects. Medical examinations were performed and the participantsf knowledge on good nutrition and dietary habits were collected. Twelve nutrition sessions, one hour per week in each class, were conducted. Teachers were advised to discuss health issues in their classes and specific exercise physiologists were informed about how to integrate appropriate exercises into their lessons.
Results: In comparison with control group, classes who performed PRESTO showed a significant knowledge of nutrition, consuming less unhealthy foods. These effects could be observed in the short term (14 weeks) and at follow up (10 months). 24% subjects could be classified as being overweight (BMI .90.Perc.).
Conclusions: School-oriented intervention programs/studies, like PRESTO, are a potential way to demonstrate positive effect on nutrition, physical activity and healthy behaviours in youth, especially if carried out on a long-term basis. Ultimately PRESTO has proven to be a suitable programme to be disseminated onto schools throughout Austria.
Undernutrition among Integrated Child Development Services (ICDS) Scheme Children aged 2-6 years of Arambag, Hooghly District, West Bengal, India: A serious public health problem
Authors: Mandal Gopal Chandra , Bose Kaushik , Bisai Samiran , Ganguli Sanjib
Published: June 2024

Background: Childhood undernutrition is a major public health problem in developing countries. In view of this, the objective of the present study was to evaluate the rates of stunting, underweight and wasting among 2-6 year old rural children of Bengalee ethnicity.
Methods: In this study, 20 Integrated Child Development Services (ICDS) Centres of Bali gram panchayet, Arambag, Hooghly District, West Bengal, India, were selected. A total of 1012 (boys = 498; girls = 514) 2-6 year old children were studied. Height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) < -2 z-scores were used to evaluate stunting, underweight and wasting, respectively, following the National Center for Health Statistics (NCHS) Guidelines. Classification of severity of malnutrition was done based on the World Health Organization recommendations.
Results: Boys were significantly heavier than girls at ages 2-4 years; they were significantly taller at ages 2 and 4. Significant age differences existed in mean height and weight in both sexes. Mean HAZ, WAZ and WHZ were less than those of NCHS for both sexes at all ages. The overall (age and sex combined) rates of stunting, underweight and wasting were 26.6 %, 63.3 % and 50.0 %, respectively. The prevalence of stunting (boys = 24.9 %; girls = 28.2 %), and underweight (b = 62.2 %; g = 64.4 %) was higher among girls whereas that of wasting was higher among boys (b = 52.4 %; g = 47.4 %). Based on World Health Organization classification of severity of malnutrition, the overall prevalence of stunting was medium (20 . 29 %), whereas those of underweight (. 30 %) and wasting (. 15 %) were very high, in both sexes.
Conclusions: The nutritional status of the subjects was unsatisfactory indicating a major public health problem. There is scope for much improvement in the form of enhanced supplementary nutrition.
Health promoting factors in public work places
Authors: Fjell Ylva , Alexanderson Kristina , Bildt Carina
Published: June 2024

Objectives: The main objective of this study was to explore potential health-promoting work factors and theirspecific associations with self-rated general and mental health, life satisfaction, and low levels ofmusculoskeletal pain among women and men employed in the public sector.Methods: A questionnaire based survey was conducted among 2523 public employees (87% women) in 124work places. The workplaces were distributed between five occupational sectors: the provincial hospital,schools, home care services, domestic/catering, and administrative services. The response rate was 92%.Analyses of variance were used to compare the mean scores of the groups. Spearman’s rank correlation testwas used to assess the associations between the work factors and the health measures.Results: Many of the potential health promoting work factors were associated with the measures of self-ratedhealth. However the correlations differed according to both gender and occupational sector. The maindifferences between the sectors were the characteristics of decision latitude-influence and learning-development with the best conditions in the administrative services and schools, and the worst in home careservices. Men rated higher in decision latitude-influence than women and had significantly better“opportunities to learn new and to develop in the profession”. Having enough time to complete the worktasks had the highest overall correlation with good health. In addition good relations with and support ofsupervisors were crucial for well-being among the employees.Conclusions: The results highlight the importance of high levels of decision latitude-influence, learning-development, and a fair and impartial attitude among supervisors for the promotion of good health in publicwork places.
Patient migration among the Italian regions in 2003
Authors: Messina Gabriele , Vigiani Nicola , Lispi Lucia , Nante Nicola
Published: June 2024

Background: In the Italian National Health Service hospital planning was influenced by two aspects: the patients’ freedom to choose their health care provider and the equal distribution of centers spread throughout Italy. While every Italian Region should be able to meet the health needs of its own inhabitants, consistent migration among regions exists. Retrospective studies of cross boundaries patient flows can be useful for health planning purposes, providing precious information about citizens’ preferences, and helping health managers to think about inequality and adjust the offer of care. The aim of this study is to describe cross boundary flows which occurred across all the Italian Regions in 2003.
Methods: The hospital discharges for 2003 were obtained from the General Directorate for Health Planning of the Italian Ministry of Health. We analyzed regional cross boundary flows using the Gandy Nomogram. This tool, which assesses patient mobility, can be used to describe regions’ ability to satisfy their internal health demand and their own capability in attracting foreign patients.
Results: All of the regions, for the most part, were able to satisfy internal health care demands, and are placed in the upper right corner of the Gandy Nomogram. Umbria, Emilia Romagna, P. A. di Bolzano, Tuscany, Lombardy, Friuli V. Giulia, Lazio, Abruzzo were the regions that appeared to perform best. The Lombardy region attracts the most patients.
Conclusions: This study briefly provides an evaluation of hospital supply of services giving indications about patients’ perception of the quality and organization of services. A deeper analysis of patient migration may be undertaken by looking at specific diseases. This kind of research could be useful for planning and maximising supplies when making decisions about healthcare.
Using latent variables in logistic regression to reduce multicollinearity, A case-control example: breast cancer risk factors
Authors: Pourhoseingholi Mohamad Amin , Mehrabi Yadolah , Alavi-Majd Hamid , Yavari Parvin
Published: June 2024

Background: Logistic regression is one of the most widely used models to analyze the relation between one or more explanatory variables and a categorical response in the field of epidemiology, health and medicine. When there is strong correlation among explanatory variables, i.e.multicollinearity, the efficiency of model reduces considerably. The objective of this research was to employ latent variables to reduce the effect of multicollinearity in analysis of a case-control study about breast cancer risk factors.
Methods: The data belonged to a case-control study in which 300 women with breast cancer were compared to same number of controls. To assess the effect of multicollinearity, five highly correlated quantitative variables were selected. Ordinary logistic regression with collinear data was compared to two models contain latent variables were generated using either factor analysis or principal components analysis. Estimated standard errors of parameters were selected to compare the efficiency of models. We also conducted a simulation study in order to compare the efficiency of models with and without latent factors. All analyses were carried out using S-plus.
Results: Logistic regression based on five primary variables showed an unusual odds ratios for age at first pregnancy (OR=67960, 95%CI: 10184-453503) and for total length of breast feeding (OR=0). On the other hand the parameters estimated for logistic regression on latent variables generated by both factor analysis and principal components analysis were statistically significant (P<0.003). Their standard errors were smaller than that of ordinary logistic regression on original variables. The simulation showed that in the case of normal error and 58% reliability the logistic regression based on latent variables is more efficient than that model for collinear variables.
Conclusions: This research indicated that logistic regression based on latent variables is more efficient than logistic regression based on original collinear variables.
Health Promoting Hospitals – Assessing developments in the network
Authors: Pelikan Jürgen M.
Published: June 2024

Hospitals are specific organizational settings for health promotion efforts. As health care institutions they are already oriented at health, or better at ill health, but with a rather limited focus on health outcomes for patients. Therefore, the Ottawa Charter explicitly asks for the reorientation of health services. And, hospitals also have considerable health effects for other stakeholder populations. This specific potential and challenge has been taken up by the WHO network of Health Promoting Hospitals (HPH), in the last two decades. Based on available literature the article relates the HPH concept to a more general paradigm of health promoting organizational settings; reconstructs the developmental phases of the international WHO HPH Network; elaborates on its concept development and implementation experiences, and discusses its rather limited investments in evaluation studies and the few assessments from outside. HPH has developed a convincing comprehensive concept by demonstration projects, using systematically action and evaluation research. To a lesser degree, the same holds true for its developments of health promotion policies for selected vulnerable groups and linking HPH to quality methodology. But there is no systematic evaluation of health promotion in and by hospitals, especially for the networks and member hospitals of HPH. Even if much of the relevant evidence for HPH comes and will have to come from more general clinical epidemiological, health promotion, quality, organizational and management research, there is need for specific HPH evaluation research, to better utilize, what can be learned from the social experiment of HPH.
The Latium acute stroke registry: data quality and validation of the NIH Stroke Scale in predicting in-hospital death
Authors: De Luca Assunta , Lauria Laura , Gabriele Stefania , Sera Francesco , Fiorelli Marco , Guasticchi Gabriella
Published: June 2024

Background and Purpose: The experimental phase of the stroke registry for the region of Lazio, completed in 2003, collected clinical data using an ad hoc survey on emergency room (ER) patients who presented with suspected stroke. We evaluated the accuracy and completeness of the data collected and assessed the validity of the National Institute of Health Stroke Scale (NIHSS) in predicting in-hospital mortality.
Methods and Results: Two different indicators were developed to evaluate the quality of the registry: the response (% ER patients surveyed with suspected stroke) and the coverage rates (% ER patients surveyed discharged with stroke). Their values by type of emergency service were respectively: first aid ER =59.3% and 45.5%; level one ER =39.7% and 27.6%; level two ER =17.2% e 12.0%. Stroke severity, age, type of emergency facility and time of arrival at the ER were associated with the accuracy and completeness of the registry. The in-hospital mortality predictive model showed good discriminative ability (area under the receiveroperating characteristic (ROC) curve (AUC)=0.79 (95%CI 0.75, 0.84)) and good calibration (Hosmer- Lemeshow’s goodness-of-fit (HL) test p=0.48). AUC and HL tests, estimated after applying the linear predictor to an external validation cohort, were 0.79 (95%CI 0.74, 0.84) and p=0.23 respectively.
Conclusions: Survey completeness and accuracy were associated with patient and facility characteristics, suggesting that it could be improved. The NIHSS calculated at ER admission is a good predictor of inhospital mortality.
Health Impact Assessment: a useful tool for decision makers
Authors: Turco Livia
Published: June 2024

Health Impact Assessment is defined as ‘the combination of procedures, methods and tools through which it is possible to evaluate a policy, a program or a development plan concerning possible effects on public health and their distribution in the general population’. In a constructive debate this definition points out some interesting observations: - health is not the result of health policies alone, but it is often defined by the attention given to it in other contexts; - health is however the result of policies and it therefore must deserve the attention of Decision Makers; - health must not be taken into consideration without taking into account an evaluation of its distribution and its determinants within a population. Particular attention must therefore be paid into inequalities; - following the Council of the European Union recent conclusions on Health in All Policies we have to consider that everyday environments such as day-care centers, schools,workplaces,neighborhoods and the commute between them have significant effects on health and that health, in turn, has an effect on the economy by enabling active and productive participation in working life. In the past 20 years huge progress has been achieved in the epidemiological contest to define risks. Nowadays, it is known that a low cultural level lowers the capacity to respond to prevention, that elevated pollution levels do represent a health risk, and that the scarce social relationships that elderly people have in our society have strong consequences on their health and their quality of life.
Health Impact Assessment in a Swedish context: The Route 73 case study
Authors: Knutsson Ida , Linell Anita
Published: June 2024

Background: Health issues are being allocated increasingly higher priority on the political agenda in Sweden, due to initiatives taken by both the Parliament (the Riksdag) and the Government over the last few years. The Riksdag has recently adopted a bill for public health.
Methods: The case study was performed in accordance with the framework for the project “The effectiveness of Health Impact Assessment”, which includes a common questionnaire and a model for evaluating effectiveness. During the study, six interviewees representing different actors and stakeholders in the decision-making process were contacted. The analysis of effectiveness of the HIA on Route 73 is based on the “partial HIA”, i.e. the HIA that is incorporated into the EIA, but the case study also illustrates the benefits of performing a complementary HIA in accordance with the new guidelines in Sweden.
Results: The case study on Route 73 shows that the partial HIA had general health effectiveness and general or direct community effectiveness. With respect to equity effectiveness, the answers varied. If the complementary HIA had been used as a basis instead of the partial HIA, it would have highlighted equity aspects much more since the complementary HIA focuses on priority groups and gender throughout the assessment and makes them an important part of the assessment.
Conclusions: There is a growing awareness of public health in Sweden today due to the policies adopted by the Riksdag and the Government. Public health objectives, the pinpointing of prioritised groups, health determinants and indicators constitute a good framework for conducting HIA in accordance with the new public health policy and represent its prime facilitators.
Exploring Health Impact Assessment in Europe
Authors: Wismar Matthias , Ernst Kelly , Blau Julia
Published: June 2024

Background: Health impact assessment (HIA) prospectively judges the potential health impacts of pending decisions and feeds the assessment back into the decision making process. HIA is considered as a key tool for intersectoral collaboration. This article presents selected results of a mapping exercise on HIA in Europe. The mapping exercise is complemented by the presentation of a conceptual framework on the effectiveness of HIA and illustrative examples.
Method: Two methodologies are employed in this article: First, the use of HIA across Europe is based on a survey conducted by 21 teams in 19 countries. A semi standardized questionnaire was employed, using a wide variety of sources. Second, for the discussion on the effectiveness of HIA, a conceptual framework using four types of effectiveness was employed. Results: HIA is a common practice only in a handful of European countries. In most of Europe, HIA is at an early developmental stage. The mapping exercise, however, provides evidence that HIA can work across all sectors and at all political level, although there is currently a focus on the local level. HIA is conducted in different countries by different sets of actors and organizations, reflecting the existing setup. The evidence on the effectiveness of HIA is still inconclusive. However, single case studies and upcoming evidence suggests that HIA has the capacity to inform and influence the decision making process.
Conclusions: HIA can work and deliver. The variations in context across European countries have resulted in different forms of implementation and different dynamics of developing HIA.
Epidemiological trends of Tubercolosis in Italy, 1990-2004
Authors: De Vito Corrado , Marzuillo Carolina , Del Cimmuto Angela , Vacchio Maria Rosaria , Anastasi Daniela , Villari Paolo
Published: June 2024

Background: During the last two decades, tuberculosis (TB) has once again emerged as a significant public health problem in Western Countries. The aim of this study is to describe the epidemiology of TB in Italy in the last fifteen years. All routine information sources available (annual notifications, mortality and hospital discharges) were used, and attempts to investigate gender and geographical differences were made. Methods: Age-standardized annual notification, mortality and hospital discharge rates were calculated. Time trends of annual notifications, mortality and hospital discharges for TB were modelled through Poisson regression, and whenever necessary, negative binomial regression.
Results: The analysis of the temporal trend of TB using the three indicators shows an increase until the middle of 1990s and a following decrease. TB is more frequent in men than in women, with a decremental. North to South gradient. There are important geographical and gender differences of the TB decline in Italy, since the decrease of TB frequency is more pronounced in men than in women and it is less evident in the central and, to a lesser extent, the southern parts of the country.
Discussion: Italian guidelines for TB control, which are largely consistent with the international recommendations for low-incidence countries, need to be fully implemented throughout the entire country in order to reach the ultimate goal of disease eradication. Given the high number of TB cases among foreignborn persons, a strong public health commitment on TB control for immigrants, which includes screening, prophylaxis and treatment, is urgently needed.
Socio-economic position and adolescents’ health in Italy: the role of selfesteem and self-efficacy
Authors: Zambon Alessio , Lemma Patrizia , Dalmasso Paola , Borraccino Alberto , Cavallo Franco
Published: June 2024

Background: To underline the importance of self-esteem and self-efficacy as aspects of health promotion, we investigated the hypothesis that self-esteem and self-efficacy mediate the effect of socio-economic position on adolescents’ health. This association has been confirmed by our data.
Methods: Data derive from the international Health Behaviours in School-aged Children (HBSC) study, 2001- 02 edition: a representative sample of Italian children (age groups of 11, 13 and 15years, N=4386) was administered a questionnaire at school. We tested with a multivariate model the effect of economic wellbeing on health and behavioural outcomes, first excluding, and then including, self-esteem and self-efficacy among the determinants.
Results: Perceiving poorer health, not eating enough fruits and vegetables and doing too little physical activity are conditions affected by economic well-being (O.R. of best-off to worst-off are 0.65, 0.83 and 0.46, all statistically significant), while smoking habit is not affected. Including self-esteem and self-efficacy into the model significantly lowers, or annihilates, the effect of economic conditions on these outcomes.
Conclusions: Economic well-being affects adolescents’ health (perceived health and health behaviours) in Italy, but it is reasonable to hypothesize that self-esteem and self-efficacy are among the mediators of this effect. Targeted interventions aimed at enhancing self-esteem and self-efficacy could therefore help in mitigating the effect of health inequalities.
The effects of Mediterranean Diet on Cardiovascular diseases: a systematic review
Authors: Ricco Annalisa , Chiaradia Giacomina , Piscitelli Mariantonietta , La Torre Giuseppe
Published: June 2024

Background: Diet and lifestyle-related factors may be responsible for the different geographical distribution of cardiovascular disease incidence. The aim of our study is to conduct a systematic review of the effect of Mediterranean Diet on cardiovascular diseases (CVD), in terms of prevention of both cardiovascular mortality and cardiovascular events. Methods: We undertook a scientific literature search using MEDLINE, Embase and the Cochrane database for systematic reviews. We selected studies that evaluate the association between mortality and morbidity due to CVD and Mediterranean diet considered as primary or secondary prevention intervention, and found 16 articles concerning 13 studies (2 case-control, 3 cohort studies and 8 randomised clinical trials). Results: The analyzed studies indicate a reduction of adverse cardiovascular events by about 30% and 40%, in terms of primary and the secondary prevention, respectively. Concerning the reduction of mortality, a larger corpus of data is available, demonstrating that the Mediterranean diet significantly reduces mortality by 50% or 70% in terms of secondary prevention, and by about 30% for primary prevention. Conclusions: The Mediterranean diet has positive effects over the CVD both in primary and secondary prevention settings. The estimate of the effect is different in different settings and such variability is attributable to the heterogeneity of the enrolled population, which is obviously lower in the general population compared to those who have already had an adverse cardiovascular event.
The new EU regulations for food safety
Authors: Comodo Nicola , Bonaccorsi Guglielmo
Published: June 2024

The inspirational principles of the norms known as the “Hygiene package”: the framework of new perspectives on food safety. At the beginning of the 1980s, all member states of the World Trade Organisation (WTO) subscribed to international agreements regarding strategies for food production and its marketing. These agreements, known as TRIPS (Agreement on Trade- Related Aspects of Intellectual Property Rights), GATT (General Agreement on Tariffs and Trade), GATS (General Agreement on Trade in Services) and TRIMS (Agreement on Trade-Related Investment Measures) [1] signalled the beginning of a new, globalized, commercial strategy on food products which has also caused importantrepercussions within the European boundaries, but with some fundamental differences.
Food safety and risk communication: cases history and best practice (in avian flu)
Authors: Aroldi Piermarco , Carlo Simone , Colombo Fausto
Published: June 2024

The paper discusses the role of institutional communication in the case of health risks and emergencies. The article is divided in three sections. The first section examines the most recent theories on risk and on its communicational aspect; the second analyses a recent state of emergency crisis, specifically the panic which stemmed from the perceived danger of an avian flu pandemic in Italy; and finally an example of best practice in the form of a food safety handbook designed and edited by the Italian Ministry of Rural Affairs, which was based on the skills and knowledge acquired during the avian flu emergency.
Salmonella enterica serotype Infantis in southern Italy from 2000-2005: molecular typing of isolates from human and non human sources
Authors: Mammina Caterina , Di Noto Anna Maria , Aleo Aurora , Costa Antonella , Romani Cristina , Nastasi Antonino
Published: June 2024

Serotype Infantis ranks within the top-five Salmonella serotypes in many European countries. An association between this serotype and the poultry ecosystem is apparent in some geographic areas and could account for its persistent or emergent role as causative agent of human salmonellosis. Recently, in southern Italy isolation from eggs and poultry has become increasingly frequent, and in one case the egg yolk also cultured positive. Molecular typing was performed to assess the possible relationship among isolates from human, food and animal sources. Isolates of serotype Infantis identified in southern Italy between 2000 and 2005 rom various sources were submitted to pulsed field gel electrophoresis (PFGE) by a CHEF-Mapper apparatus fter endonuclease digestion of DNA by XbaI. PFGE patterns of isolates from swine and poultry reservoirs showed distinctive PFGE profiles and human solates shared pulsotypes with isolates from both sources. Moreover, egg isolates from different farms ppeared very similar to each other. Epidemiological investigation and risk assessment can obtain reliable and useful pointers from he pplication of molecular epidemiology techniques.
Epidemiology of emerging foodborne pathogens
Authors: De Giusti Maria , De Medici Dario , Tufi Daniela , Carolina Marzuillo , Boccia Antonio
Published: June 2024

Foodborne diseases still represent an important global public health issue, including Europe and Italy, which endangers the health of the population and leads to socio-economic costs and a threat to the market trend. In developed countries it is estimated that up to one third of the population are affected by microbiological foodborne diseases each year. In these countries, it has been observed that traditional infectious foodborne diseases have decreased while re-emerging and emerging pathogens like Escherichia coli O157, Listeria monocytogenes, Campylobacter jejuni, Norovirus and Hepatitis A virus have increased. In 2004, in Italy the incidence for Listeriosis was 0.06 per 100,000 population and is included among the statutory notifiable diseases. E. coli O157:H7 is not subject to statutory notification in Italy; however, a voluntary national surveillance system for HUS in paediatric patients and for VTEC, has lead to the notification of 429 paediatric HUS cases and 344 clinical cases of VTEC from 1988 to 2004. Data on campylobacteriosis are available thanks to the voluntary notifications received from the Enternet Laboratories: 582 cases were isolated from human clinical specimens in 2004. Furthermore, data from a specific surveillance system for acute viral hepatitis (SEIEVA) shows that the incidence of reported cases in Italy is declining. The necessity to alert the authorities responsible for epidemiological surveillance nationally remains paramount. Communication as well as educational campaigns aimed at different target groups, for example consumers, will play an important role in the prevention of foodborne diseases.