Rosa AC, Finocchietti M, Bellini A
… +10 more, Masiero L, Fiaschetti P, Lombardi I, Ricci A, Cardillo M, Feltrin G, Pierobon S, Zanforlini M, Ledda S, Belleudi V
BACKGROUND: maintenance immunosuppressive therapy, indicated for patients after solid organ transplantation - kidney (R), liver (F), heart (C), lung (P) - and aimed at preventing rejection, involves the intake of at leas...BACKGROUND: maintenance immunosuppressive therapy, indicated for patients after solid organ transplantation - kidney (R), liver (F), heart (C), lung (P) - and aimed at preventing rejection, involves the intake of at least one Calcineurin (CNI) inhibitor (Cyclosporin - CsA - or Tacrolimus - TAC) in combination with an Antimetabolite (Antim) (Mycophenolate Mofetil or Mycophenolic Acid - MMF - or Azathioprine - AZA) or a proliferation signal inhibitor (mTOR) (Sirolimus - SIR - or Everolimus - EVE) with the possible addition of corticosteroids (in particular Prednisone - PRED). The possibility of comparing prescribing patterns identified through different data sources represents an important methodological challenge and could shed light on the accuracy, advantages, and limitations of different information sources, aspects that must be considered when planning future observational studies. OBJECTIVES: to assess, within a cohort of solid organ transplant patients, the levels of concordance in the definition of post-transplant immunosuppressive therapy between health administrative flows and what is reported by the medical specialist during the patient's periodic follow-up visit. DESIGN: analysis of the level of concordance of information on post-transplant maintenance immunosuppressive therapy collected from two different data sources: the regional health administrative databases (SIS) and the national transplant information system (SIT). This analysis was performed as part of a retrospective cohort study - the CESIT study - including all patients undergoing single solid organ transplantation (heart, liver, lung, kidney) between 2009 and 2019 in four Italian regions (Lombardy, Lazio, Veneto, Sardinia). The therapeutic combinations of immunosuppressants were identified by means of specific algorithms applied to the SIS data and subsequently compared with the therapeutic patterns recorded by specialist physicians during follow-up visits (FU) and entered electronically in the SIT flow sheets. The analysis focuses mainly on the therapy delivered in the 30 days following hospital discharge (index therapy); it is then extended to comparisons made over longer time windows (at 1, 2, and 3 years from the date of hospital discharge). MAIN OUTCOME MEASURES: the level of agreement between the two data sources in defining the index therapy was assessed using three methods: 1. Cohen's k statistic: this method allowed quantification of the level of agreement at the level of individual active substance; 2. proportion of active ingredients in common: an ordinal categorical variable was calculated for each patient indicating the level of concordance between the sources: null (no active ingredient in common), low (<40 % of ATCs in common), medium (40-59 %), high (>60 %), perfect (identical combinations); 3. Levenshtein distance (LS): considering polypharmacies from a formal point of view as strings, the computational effort that would be required to make them equal was estimated. RESULTS: there were 2,692 solid organ transplant patients for whom index therapy information was available from both SIS and SIT (C: 6.8%; F: 44.9%; P: 5.2%; R: 43.1%). In comparison to CNI immunosuppressants, Cohen's k coefficient showed high levels of concordance for all transplant types (CsA heart: 0.78; CsA liver: 0.96 - TAC heart: 0.74; TAC kidney: 0.92); while for MMF, differential performance by organ type was evident (MMF heart: 0.51; MMF kidney: 0.78). For the Preds, there was greater discordance in particular in R and F. When comparing immunosuppressive therapy as a whole, the 'high/perfect' concordance levels concerned on average 80.1% of the patients (F: 70.1%; R: 91.3%). The results were comparable by applying LS. Finally, the concordance at 1, 2, and 3 years after discharge reported a less good performance than with index therapy, which was, however, stable over the time intervals considered. CONCLUSIONS: the level of concordance between therapeutic combinations for the same patient detected between different sources was generally high: despite this, the level of agreement varied according to the individual active substance, the type of transplant and the time window examined. The results of this work show that SIS are a valuable tool for defining immunosuppressive maintenance therapies and offer useful elements to consider when planning observational studies based on the two data flows.
BACKGROUND: when facing growing environmental and social challenges, it is essential to involve citizens and social actors to increase the probability of success of the interventions, after establishing a cohesive and ha...BACKGROUND: when facing growing environmental and social challenges, it is essential to involve citizens and social actors to increase the probability of success of the interventions, after establishing a cohesive and harmonised working group. OBJECTIVES: to illustrate the tools for risk communication activity developed as part of the 'One Health Citizen Science' Project (OHCS), the actions undertaken and the preliminary results that offer an overview of the context and perspectives; to analyse the results of the internal survey of the group of experts working in OHCS on the issues of risk perception and communication in the specific context of citizen science (CS). DESIGN: description of the actions undertaken in the OHCS communication sector and a transversal study on risk perception and CS. SETTING AND PARTICIPANTS: within the OHCS project, the following tools were produced during various meetings: information sheets, to be compiled for each of the 7 polluted sites and the 2 regional waste plans, containing useful information for setting up a risk communication programme; a methodological document for risk communication, to be used as a guide for the construction of specific communication plans in each area; an internal questionnaire, consisting of 29 questions to deepen the knowledge of the project partners, administered through the Google Forms platform. MAIN OUTCOME MEASURES: description of the actions undertaken in the OHCS communication sector and a transversal study on risk perception and CS of the experts, part of the project team; quantitative and qualitative analysis of the information sheets; evaluation of the impact of the methodological document for risk communication; analysis of the data obtained from the internal questionnaire, through descriptive statistical methods and multivariate analysis, implemented with R Software. RESULTS: the information sheets contain useful information for risk communication, but need to be updated. The methodological document is still only partially used. The internal questionnaire administered to the experts of the project team saw the participation of 46 adults (between 30 and 59 years old: N. 35; 76,09%), mainly female (N. 31; 67,39%), with a high level of education. The results confirm the awareness, expected in sector operators, that dangers involve risks and reinforce the indication to work directly to mitigate them. Over two thirds of respondents have not participated in CS projects, and the majority declared themselves convinced that there are protection and prevention measures that can be implemented immediately, involving the responsible authorities and providing widespread information dedicated to different stakeholders. CONCLUSIONS: the OHCS project, launched in 2023, has developed useful tools for collecting information and preparing environmental monitoring and biomonitoring activities. The results obtained so far show an improvement in the quality and quantity of the information collected, which is useful for involving social actors. The approaches used promote systematic methodologies that can facilitate the participation of all stakeholders. Internal communication actions within the project have contributed to the consolidation of the project team and the mapping of citizens' social actors, and have developed awareness of the importance of CS for the planned activities and replicability in other contexts.
BACKGROUND: survival rates for childhood cancers have significantly improved over recent decades, with 5-year survival now approaching 90% for many types. However, documented variations in survival across European countr...BACKGROUND: survival rates for childhood cancers have significantly improved over recent decades, with 5-year survival now approaching 90% for many types. However, documented variations in survival across European countries and Italian regions highlight the need to address inequalities. One of the most critical prognostic factors is the extent of tumour spread at diagnosis (tumour stage). OBJECTIVES: the BENCHISTA-ITA aims to enhance understanding of regional differences in childhood cancer survival and to promote the widespread adoption of the Toronto Guidelines (TG) by Italian cancer registries for the most common solid paediatric tumours. DESIGN: the study will examine stage distribution and survival for nine solid paediatric cancers: medulloblastoma, neuroblastoma, Wilms tumour, retinoblastoma, and ependymoma (age: 0-14 years), as well as astrocytoma, osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma (age: 0-19 years). SETTING AND PARTICIPANTS: the study will include all children under 15 or 20 years (depending on the tumour type) diagnosed between 01.01.2013 and 31.12.2017, with relevant histological codes. Participating Italian cancer registries will assign tumour stage at diagnosis using the Toronto Guidelines. STATISTICAL ANALYSIS: the statistical power to detect differences in stage distribution and survival rates among regions is limited by the number of incident cases per tumour type and region. Therefore, analyses will be descriptive, with 95% confidence intervals. Overall survival for each tumour type will be estimated using the Kaplan-Meier method. CONCLUSIONS: BENCHISTA-ITA represents an important step toward a more complete and standardized registration of childhood cancers in Italy. The results may support targeted interventions to reduce inequalities and improve outcomes for paediatric patients.
OBJECTIVES: to review pneumococcal vaccination recommendations in at-risk adults and people aged 65 years or over across the Italian Regions. DESIGN: mapping review of available online resources, both at regional and loc...OBJECTIVES: to review pneumococcal vaccination recommendations in at-risk adults and people aged 65 years or over across the Italian Regions. DESIGN: mapping review of available online resources, both at regional and local health unit level, on pneumococcal vaccination programmes by age and risk group. SETTING AND PARTICIPANTS: the review included institutional websites of regional and local health authorities, freely accessible to the public via generic search engines, containing information on pneumococcal vaccination in frail people. MAIN OUTCOME MEASURES: the following information was collected and classified: • populations targeted by the immunization programme; • type of recommended vaccine (conjugate and/or polysaccharide); • adopted vaccination schedule; • mode of patient contact; • involved health professional; • availability of vaccination registry; • availability of vaccination coverage data; • presence of online awareness campaigns. RESULTS: a total of 24 institutional websites, representative of all Italian Regions, were included in the review. More than 90% of the recommendations collected were published between 2023 and 2024. In 75% of the analyzed documents, the Regions offer pneumococcal vaccination to the cohort aged 65 years; in 46% of the documents, the offer is extended to all persons aged 65 years and over. In 96% of the resources, the vaccination programme includes at-risk adults, and 75% of these give details of the diseases for which vaccination is recommended. In seven resources, it is reported that Regions recommend a single dose of the 20-valent pneumococcal conjugate vaccine, in the others the use of the pneumococcal conjugate vaccine (PCV) followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is indicated, with different schedules. In at-risk adults, 83% of the documents recommend the sequential schedule with PCV followed by PPSV23, with time schedules defined in 63% of cases. The mode of patient contact is reported in 7 web resources, 4 of which include sending an invitation letter at 65 years of age. Vaccination center health professionals (16/24) and general practitioners (15/24) are the healthcare providers most involved in promoting and administering vaccination. In 71% of the resources, the regional health authorities were reported to have promoted targeted communication campaigns. Data on PCV coverage by age were available for 6 Regions, but not by risk group. CONCLUSIONS: the findings of this study highlight significant heterogeneity in the offer of pneumococcal vaccination to at-risk adults and people aged 65 years and older among Italian Regions. Greater efforts are needed to standardize and harmonize vaccination policies and to coordinate vaccination communication. The integration of immunization registries with high-risk patient clinical data will allow the systematic identification of vaccine candidates and facilitate the monitoring of vaccination coverage.
Martorana M, Mehanović E, Renna M
… +10 more, Viola E, Sciutto A, Giraudi G, Sacchi C, Ginechesi M, Vullo C, Ceccano A, Casella P, Faggiano F, Vigna-Taglianti F
BACKGROUND: gambling is a widespread phenomenon among adolescents, with increasing prevalence among preadolescents. OBJECTIVES: to describe the prevalence of gambling and problematic gambling in a sample of secondary sch...BACKGROUND: gambling is a widespread phenomenon among adolescents, with increasing prevalence among preadolescents. OBJECTIVES: to describe the prevalence of gambling and problematic gambling in a sample of secondary school students of Piedmont Region (Northern Italy) and Lazio Region (Central Italy) which participated in the "GAPUnplugged" experimental study. METHODS: data were collected through an anonymous questionnaire created ad hoc and administered between November 2022 and January 2023. Prevalence of gambling in the past 12 months and 30 days and of problematic and at-risk behaviour measured through the SOGS-RA scale were estimated. RESULTS: 1,874 students aged 12 to 14 participated in the study. Prevalence of gambling was 55.7% in the last 12 months and 36.4% in the last 30 days. Sixteen percent of students engaged in regular gambling (3 or more times in the last 30 days), 7.2% had at risk gambling behaviour, and 3.4% had problematic gambling behaviour. Prevalence was higher among males and among students of schools of the city of Rome. CONCLUSIONS: gambling among preadolescents is a widespread phenomenon, with a proportion of students at risk or exhibiting problematic behaviours similar to other addictive risk behaviours. It is needed to create and implement specific preventive interventions to limit early exposure to gambling in adolescence and preadolescence.
The one health approach provides a conceptual framework capable of activating multidisciplinary competences and skills in an original way in order to limit the threats that endanger life and the planet's ecosystems. Ther...The one health approach provides a conceptual framework capable of activating multidisciplinary competences and skills in an original way in order to limit the threats that endanger life and the planet's ecosystems. There are many applications in the environmental and health fields, while interest is growing in the epistemological, ethical, and philosophical fields. The topic of communication is explored and illustrated with examples that clarify its dimensions and links to governance issues.
Problematic smartphone and social media use among adolescents has rapidly become a social emergency with significant mental health implications. Recent studies show an increase in psychiatric symptoms and suicidal behavi...Problematic smartphone and social media use among adolescents has rapidly become a social emergency with significant mental health implications. Recent studies show an increase in psychiatric symptoms and suicidal behaviors related to patterns of addictive use rather than total exposure time. This phenomenon, amplified by neurocognitive reward mechanisms and the possibility of continuous access, compromises attention, sleep, and interpersonal skills. Prevention strategies are structured on three levels: technical and legal control (use restrictions and school bans), educational and family empowerment (digital education and family use plans), and health prevention through screening and counseling. The article concludes with the hope for a change in strategy: not only limiting use, but also fostering a conscious and critical relationship with technology through coordinated, evidence-based policies.
Juvenile prisons represent a jumble of dilemmas and choices for those concerned about the health and future of young detained people. While often presented as an opportunity for "rescue" and even social redemption, juven...Juvenile prisons represent a jumble of dilemmas and choices for those concerned about the health and future of young detained people. While often presented as an opportunity for "rescue" and even social redemption, juvenile justice facilities offer a variety of approaches, ranging from the more advanced ones that allow effective interactions with the "outside" (family, school, and the world of work) to the more closed ones where the lack of support and activities exposes the most serious aspects of any incarceration: violence, isolation, and various forms of addiction. Italy's main and largest juvenile prison, named after Cesare Beccaria (an Italian philosopher universally renowned for laying the conceptual foundations against the death penalty and torture), has been experiencing a period of great difficulty for years, characterized by widespread violence, inadequate care for the needs of young people in prison, staff frustration, and social criminalization of inmates, accompanied by the stigmatization of those who work there. The author analyses the risks for young people detained in such places and invites to reflect about what general conclusions can be drawn about juvenile prisons in today's Italian society.
BACKGROUND: urban areas face growing challenges from climate change, especially in the form of extreme heat events that disproportionately affect vulnerable populations. Turin, a large city in Northern Italy, in past yea...BACKGROUND: urban areas face growing challenges from climate change, especially in the form of extreme heat events that disproportionately affect vulnerable populations. Turin, a large city in Northern Italy, in past years has developed a policy framework integrating health equity into urban planning through the "Health in All Policies" approach. OBJECTIVES: to assess climate-related health risks in Turin by identifying spatial patterns of social vulnerability associated with Urban Heat Islands (UHIs), with the goal of guiding targeted adaptation and mitigation strategies. DESIGN: cross-sectional ecological risk assessment using the IPCC framework, integrating data on hazard, exposure, and vulnerability. SETTING AND PARTICIPANTS: the analysis focused on the municipality of Turin (847,237 residents), with a specific emphasis on individuals aged over 65 years. The spatial unit of analysis was the census tract (N. 3,852). MAIN OUTCOME MEASURES: an index of climate risk was developed for each census tract by aggregating normalized indicators for climatic hazard (UHI intensity), exposure (elderly population), and vulnerability (socioeconomic, demographic, health, and environmental indicators). RESULTS: the analysis revealed significant spatial disparities in climate risk across the city. Northern and peripheral neighbourhoods showed the highest levels of social vulnerability and climate risk, while green and less densely populated areas displayed lower risk. The approach enabled the identification of high-priority areas for urban health interventions. CONCLUSIONS: the study demonstrates the feasibility and policy relevance of applying a structured climate health risk assessment framework at the urban level. The methodology supports evidence-based planning for climate adaptation, helping local authorities target actions to protect vulnerable populations and reduce health inequalities. The results contribute to ongoing efforts in Turin to integrate climate resilience into citywide health and social policy agendas.
OBJECTIVES: to estimate the improvement of thermal comfort at a microclimatic level after using Nature-based Solutions (NBS) and albedo mitigation strategies in a square located in a densely built-up district of the city...OBJECTIVES: to estimate the improvement of thermal comfort at a microclimatic level after using Nature-based Solutions (NBS) and albedo mitigation strategies in a square located in a densely built-up district of the city of Rome and subject to the phenomenon of Urban Heat Island. DESIGN: on the basis of the microclimatic simulation results of the current conditions of the area, obtained using the ENVI-met software, several microclimate cooling scenarios were developed and simulated; these scenarios included the integration of different layers of vegetation (herbaceous, shrubby, and arboreal) with different configurations and in different quantities and of different surfaces with high albedo index. SETTING AND PARTICIPANTS: the studio area is Piazza Mancini, located in the Flaminio district of Rome. MAIN OUTCOME MEASURES: the main outcome measures calculated from the simulations were the intensity of the Urban Heat Island (UHI) and the Universal Thermal Climate Index (UTCI) to estimate the perceived discomfort associated with heat and the potential improvement of such perceptions through the scenarios considered. RESULTS: the simulations based on data from 22.07.2021 showed a progressive reduction of UTCI and of the UHI in the three considered scenarios. From the first scenario, which provides for greening and replacement of the asphalt with a higher albedo, it goes to the second and third scenario, which included also changes in the structure of the square (scenario 2) and functional optimization by inserting a shading structure (scenario 3). Scenarios 2 and 3 show a decrease in UTCI of almost 7ºC and UHI of about 2ºC compared to the actual state. CONCLUSIONS: the three presented scenarios show how it is possible to improve the conditions of the healthiness of space (reducing the UHI by about 1.5°C) and that it is possible to transform mitigation actions into opportunities for the regeneration and enhancement of urban public spaces.
BACKGROUND: green areas are often present in the space surrounding primary schools, where they are usually used as playing/recreation or sport areas. Regular maintenance of such areas may help reduce the risk of allergic...BACKGROUND: green areas are often present in the space surrounding primary schools, where they are usually used as playing/recreation or sport areas. Regular maintenance of such areas may help reduce the risk of allergic reactions and asthma exacerbations in children. OBJECTIVES: to evaluate the effects on the respiratory and allergic health of children in a primary school in the city of Palermo (Sicily Region, Southern Italy) following a maintenance intervention in the adjacent green area. DESIGN: non-randomized, controlled, longitudinal intervention study. SETTING AND PARTICIPANTS: all the children attending the third, fourth, and fifth grades (7-11 years) of the Orestano school institute (No. 211) were invited to participate in the study. MAIN OUTCOME MEASURES: on 14.03.2022, the children completed a questionnaire on sociodemographic characteristics and the presence of symptoms/exposure to secondhand smoke in the last 7 days. On 21.03.2022, maintenance was carried out on the green area adjacent to the San Ciro building, but not the Conte Federico building. On 08.04.2022, the children filled out the questionnaire again. The pre-post variation in symptom prevalence was compared between the two buildings using logistic regression models with mixed effects, adjusted for sex, age, and exposure to secondhand smoke, with time-building interaction effects. RESULTS: the study was completed by 132 children (50% San Ciro). Statistically significant increases in the prevalence of nasal and general symptoms were observed in San Ciro, while also ocular and respiratory symptoms increased in Conte Federico. Exposure to secondhand smoke was associated with a greater risk of skin (OR: 2.38), nasal (OR: 2.1), respiratory (OR: 5.47), and general (OR: 3.07) symptoms. The pre-post increase in the prevalence of ocular and respiratory symptoms was significantly greater in the Conte Federico building. CONCLUSIONS: these preliminary results show that regular green area maintenance, with weed removal and pruning scheduling, can help reduce respiratory and allergy symptoms in primary school children.
OBJECTIVES: to estimate the microclimatic improvement due to the introduction of Nature-based Solutions (NbS) in a small square (about 1,500 m²) located in a densely built area of the city of Genoa (Liguria Region, North...OBJECTIVES: to estimate the microclimatic improvement due to the introduction of Nature-based Solutions (NbS) in a small square (about 1,500 m²) located in a densely built area of the city of Genoa (Liguria Region, Northern Italy), and subject to the Urban Heat Island phenomenon (UHI). DESIGN: through the microclimatic simulation results of the current state, obtained via the ENVI-met V 4.4.5 software, different microclimatic cooling scenarios were developed and simulated, introducing different vegetation layers (herbaceous, shrubby, arboreal), in increasing quantities per scenario, and clear surfaces. One of them was then selected for the implementation of the pilot project. SETTING AND PARTICIPANTS: the study was done on Piazza Metastasio in the Cornigliano neighbourhood (VI District) in Genoa, in an area delimited by Via Cornigliano (North), Polcevera mouth (South), railway station (West), and Fiumara commercial complex (East). This area was particularly critical due to population density, absence of significant green areas, and weather and climate conditions. MAIN OUTCOME MEASURES: Evaluating the Universal Thermal Climate Index (UTCI) allowed to estimate the users' feelings of well-being/malaise inside the examined area, and the potential improvement of these perceptions through targeted greening scenarios. RESULTS: the simulations of the selected scenario for the pilot project (scenario with minimum greening and with the best microclimatic performance), carried out for one of the hottest days of the last 20 years, show a decrease in the air temperature lower by around 1.8°C, compared to the current state (t current state: 34.4°C, t scenario: 32.6°C). The UTCI shows a decrease of around 4.1°C, compared to the current state, in correspondence with the trees (t current state: 42.0°C, t scenario: 37.9°C). CONCLUSIONS: the kind and the coverage ratio of the plant layers play a fundamental role on the microclimatic parameters with thermal comfort improvement (up to -1.8°C t air, up to -5.4°C UTCI), despite a reduction in the air flow (up to -0.3 m/s).