OBJECTIVES: to develop tools to identify the most appropriate and/or prioritized sets of patients with stable chronic conditions who are eligible for management by territorial services, to be included in a dedicated care...OBJECTIVES: to develop tools to identify the most appropriate and/or prioritized sets of patients with stable chronic conditions who are eligible for management by territorial services, to be included in a dedicated care pathway within Community Health Centers (CdC), as outlined in Italian Ministerial Decree 77/2022. DESIGN: retrospective observational study. SETTING AND PARTICIPANTS: subjects residing in the territory of the Health Protection Agency of Milan (ATS Milano) in the year 2023. MAIN OUTCOME MEASURES: prevalence of hospitalizations, visits to the Emergency Room (ER) and patients receiving polytherapy, defined by specific criteria, to select chronic condition and cohort with potential territorial management. Duration of the disease and visits to the general practitioner (GP) clinic for the chronic population eligible for care in Community Houses provided for by the Italian Ministerial Decree No. 77 (DM77). RESULTS: starting from a population of 3.5 million inhabitants in the ATS Milano, 35% suffer from at least one chronic condition. The most represented pathologies are arterial hypertension (254,232 cases) and hypercholesterolemia (156,314 cases). Applying selection criteria on hospital discharge, access in emergency room, and therapy, 16 chronic pathologies of interest for territorial assistance were identified. The 15% of patients had the disease for less than 1 year while the 36,2% for over 10 years. Over 60,000 patients (10,2%) included in the cohort with potential territorial management did not even make one visit to the GP clinic during 2023. CONCLUSIONS: through this model, approximately 600,000 subjects were identified as eligible for territorial care, based on the integration between the GP and the Community House, to be managed preferably within a Territorial Operations Center. This work represents a proposal for the application of a model to the information system available in a structure of the Italian National Health System for the planning of the care of the population affected by chronic diseases, as indicated by the DM77. The possibility of validating and developing similar approaches at a national level could represent a significant step towards better management of chronic conditions.
In humanitarian crises, quantifying the number of victims contributes to estimating the needs for assistance, advocating for additional resources, promoting diplomatic actions, supporting transnational justice, and infor...In humanitarian crises, quantifying the number of victims contributes to estimating the needs for assistance, advocating for additional resources, promoting diplomatic actions, supporting transnational justice, and informing political decisions. It also provides a clearer understanding of the severity of a crisis within its historical, geographical, political, and social contexts. However, data collection in conflict settings is frequently hindered by insecurity and political barriers.Relevant studies of war mortality have used epidemiological methods, such as prospective community surveillance, body count, retrospective household surveys, capture-recapture analysis, and key informant interviews. The present paper describes the advantages and limitations of each of these approaches. Subsequently, it summarises and tabulates estimates of mortality indicators in 19 humanitarian crises taking place in African countries, Syria, Iraq, and Yemen over the last twenty years. Most estimates were based on household surveys. Attention is brought to the difficulties in the assessment of indirect war-related mortality.Mortality indicators are politically sensitive. As a result, politicisation of numbers in armed conflicts has not been uncommon: cases of data manipulation to serve political goals are described.Improvements in humanitarian practice and public health interventions have contributed to the decline of reported mortality rates in recent years. However, challenges in measurement and data standardisation still need to be addressed. Public health information remains an underfunded and under-prioritised part of humanitarian assistance, despite the growing emphasis by donor governments on the importance of quantitative evidence to inform decision-making and justify aid budgets.
Bertola F, Micali S, Ticonosco M
… +14 more, Ioverno E, Dal Lago E, Busolo A, Ramirez Morales R, Buonfantino G, Di Giorgi A, Busardò FP, Nikitsenka K, Ruggero G, Zamboni M, Fin G, Foletto E, Biggeri A, Montano L
OBJECTIVES: to evaluate the association between exposure to per- and polyfluoroalkyl substances (PFAS) and semen quality in young adulthood, with particular attention to different exposure metrics: serum and seminal conc...OBJECTIVES: to evaluate the association between exposure to per- and polyfluoroalkyl substances (PFAS) and semen quality in young adulthood, with particular attention to different exposure metrics: serum and seminal concentrations of perfluorooctanoic acid (PFOA) and perfluorosulfonic acid (PFOS), foetal exposure, duration of exposure. DESIGN: cross-sectional study. SETTING AND PARTICIPANTS: 1,000 subjects aged 18-35 years residing in the Veneto area with water contamination by PFAS, enrolled in the period 2022-2023; this interim analysis involves 507 subjects out of the 1,000 enrolled. MAIN OUTCOMES MEASURES: only the 2 main semen parameters were considered: sperm count, motility and morphology. RESULTS: from this interim analysis an association between sperm motility and morphology and duration of residence emerges: OR 1.14 (90%CI 0.99; 1.31) p=0.065 (an age-matched conditional logistic regression tested the linear trend between duration of residence in years and presence/absence of alterations in motility <42% or morphology <4% of the spermatozoa). CONCLUSIONS: these results strengthen the literature on reproductive health risks related to exposure to PFAS and in particular to PFOA and PFOS. They also highlight the importance of duration of exposure and exposure starting from foetal life. The study here presented is part of a larger project still underway regarding analytical determinations on the biological samples provided. It was possible to anticipate the results of the interim analysis on 507 subjects out of the 1,000 enrolled.
BACKGROUND: urge urinary incontinence (UUI) is the involuntary loss of urine accompanied or immediately preceded by a sudden and strong desire to urinate that cannot be delayed or that is difficult to postpone. Data clai...BACKGROUND: urge urinary incontinence (UUI) is the involuntary loss of urine accompanied or immediately preceded by a sudden and strong desire to urinate that cannot be delayed or that is difficult to postpone. Data claim that UUI increases significantly from 40 to 65 years, which is why this specific age group, which has been little studied in the literature, deserves to be investigated. Moreover, they are socially active and working women who represent a social and economic resource for the country: therefore, their malaise is not only a personal problem, but also a problem for the society. OBJECTIVES: to investigate the prevalence, quality of life, social impact, and costs of urinary incontinence in women aged 40 to 65 years. METHODS: a narrative review of the literature was performed through the following databases: PubMed, CINAHL, Web of Science, and Embase. The search string was processed using the PEO acronym. Source selection was conducted and reported according to the PRISMA flowchart, following the established inclusion and exclusion criteria. A total of 21 articles were included and analyzed in the review: 11 about the prevalence and 10 about quality of life, social impact, and costs. RESULTS: the prevalence of UUI varies according to the considered age group. In the 40-65-year age range, there is a progressive increase in the onset of UUI symptoms worldwide, with a prevalence of around one fifth of the female population. It also emerged that the quality of life of patients suffering from UUI is negatively affected: urine leakage is accompanied by feelings of embarrassment, frustration, and anxiety, which contribute to reduce the psychosocial, occupational and sexual activities of the affected patients, imposing high costs for the treatment, and management of the disorder and its comorbidities. CONCLUSIONS: considering the wide prevalence of UUI in women aged 40-65 years and given the growth prospects of the phenomenon, it is important to increase the attention of women and health professionals regarding this disorder. In order to support the clinical practice with scientific evidence, it would be appropriate for future research to focus on the predictors of UUI and their prevention, too. The development of new educational and rehabilitative programmes is necessary to increase awareness, prevention, diagnosis, and UUI effective management.
OBJECTIVES: to analyse the prevalence and characteristics of the hikikomori phenomenon in Italy within a representative sample of students aged 15 to 19 years, assessing the factors associated with this behaviour to guid...OBJECTIVES: to analyse the prevalence and characteristics of the hikikomori phenomenon in Italy within a representative sample of students aged 15 to 19 years, assessing the factors associated with this behaviour to guide preventive interventions. DESIGN: cross-sectional study based on anonymous data collected through the ESPAD®Italia (European School Survey Project on Alcohol and other Drugs) survey using a self-administered questionnaire. SETTING AND PARTICIPANTS: a representative sample of Italian high-school students is selected annually to ensure the comparability of ESPAD®Italia estimates. In this study, the pooled 2021-2023 sample consists of 36,868 students (50.8% male), with an average age of 17.0 years (standard deviation: 1.4). MAIN OUTCOMES MEASURES: the outcomes analysed are having experienced voluntary social withdrawal for at least six months over a lifetime (Lifetime Hikikomori) and the current behaviour of never leaving the house during the week (Current Withdrawal). RESULTS: in 2023, 2.0% of students reported having voluntarily isolated themselves for at least six months in their lifetime, with a slightly higher prevalence among girls. Current withdrawal involved 11.3% of students, a significant increase compared to the previous two years. In the pooled 2021-2023 sample, the analysis of independent variables showed that the hikikomori phenomenon is associated with the use of psychotropic drugs, cigarette smoking, having been a victim of cyberbullying, feelings of exclusion, dissatisfaction in friendships, risky behaviours related to internet and video game use, and belonging to non-traditional families. The current withdrawal is directly associated with cigarette smoking, lack of enjoyment in social interactions, overweight/obesity, and belonging to non-traditional families. CONCLUSIONS: the study provided the first quantitative estimate of voluntary social withdrawal among Italian students aged 15-19 years, confirming that the phenomenon is widespread and concerning, especially among girls. Factors such as the perception of social exclusion, problematic online behaviours and the use of psychotropic drugs are strongly associated with the phenomenon. Future longitudinal research could further explore these relationships and support the development of integrated educational strategies in schools to identify and support at-risk students.
OBJECTIVES: to describe the 'IDA' study, which aims to estimate the prevalence of School Readiness Vulnerability (SRV) in children at the beginning of primary school and the associated socioeconomic characteristics, to s...OBJECTIVES: to describe the 'IDA' study, which aims to estimate the prevalence of School Readiness Vulnerability (SRV) in children at the beginning of primary school and the associated socioeconomic characteristics, to stimulate the attention of decision-makers on the consequences of the COVID-19 pandemic and the need for specific and timely interventions by the school community, thus preventing negative effects on children's present and future health. DESIGN: cross-sectional study based on a random sample of children extracted using the cluster sampling technique on the first primary school classes. SETTING AND PARTICIPANTS: in October 2022, the IDA study assessed the SRV prevalence and associated risk factors in 628 children of the Lazio Region, aged 67-89 months, 328 males and 292 females. MAIN OUTCOMES MEASURES: the individual school readiness score was calculated by a validated questionnaire (Early Identification of Learning Difficulties, IPDA); socioeconomic characteristics were measured by administering a questionnaire to parents (child's age, kindergarten attendance, parents' education, parents' occupation). RESULTS: the SRV prevalence was 44.9%. The most affected development areas were motor skills, pre-mathematics, and pre-literacy. SRV was associated with low educational levels of the mother, father, or both parents, and maternal and paternal unemployment. The comparison with reference values (pre-pandemic) places the subjects studied one year behind in terms of psycho-motor development. CONCLUSIONS: because of potential negative effects, institutions and stakeholders need to intervene to promote children's reinforcement activities and equity of access to education.
BACKGROUND: the exposure-response relationship between pleural mesothelioma and asbestos has been traditionally described by models that predicted incidence to increase indefinitely by latency. Studies with long observat...BACKGROUND: the exposure-response relationship between pleural mesothelioma and asbestos has been traditionally described by models that predicted incidence to increase indefinitely by latency. Studies with long observation showed that the increase flattens out beyond 40 years of latency. It has been, therefore, proposed to introduce an exponential decay function into the models Objectives: to show characteristics and implications as to the relevance of remote and recent exposures, by conducting a simulation exercise based on data available from the literature. METHODS: the traditional and decay models that best fit mortality from pleural cancer during the initial 40 years of observation in the Italian pooled cohort of asbestos workers were selected. The mesothelioma incidence predicted by such models as a function of age at first exposure, exposure duration, and age at risk was compared. It was also compared the proportional weight assigned to remote, intermediate, and recent exposure, by dividing the whole exposure period in three parts of equal duration. RESULTS: the decay, but not the traditional, model fits well the trend observed after 40 years. According to the traditional model, remote exposures have maximum and recent exposures minimum weight: for instance, following an exposure starting at age 20 and lasting 18 years, the incidence at age 80 would be attributed to remote exposures by 47% and by 21% to the recent ones. The decay model predicts only minor differences and even of reversed weight: 34% and 31%, respectively, in this case. CONCLUSIONS: remote exposures do not necessarily have overwhelming weight in determining pleural mesothelioma risk. The balance between different exposure periods depends on the time-distribution of exposure.
BACKGROUND: Italy, as many other developed Countries, is experiencing a deepening decline in birth rates, turning it into a structural issue that has led many Maternity Units to operate below the minimum delivery thresho...BACKGROUND: Italy, as many other developed Countries, is experiencing a deepening decline in birth rates, turning it into a structural issue that has led many Maternity Units to operate below the minimum delivery threshold. To ensure safe access to maternal healthcare, the 2010 State-Regions Agreement set a minimum target of 500 births per year for facility in areas with significant geographic challenges. OBJECTIVES: to describe the model developed by the Italian National Agency for Regional Healthcare Services (AgeNaS) which intend to assess accessibility to Maternity Units, considering both potential service areas and existing territorial coverage, and to allow for the simulation of network reconfiguration scenarios. DESIGN: a gravity model was adopted and tailored to the healthcare setting. The model is the Modified Three-Step Floating Catchment Area, divided into three stages: 1. calculation of access probability (using Huff's probability model); 2. estimation of the hospital bed capacity of the regional network of Maternity Units; 3. calculation of an accessibility index for each area to the Maternity Unit network. To implement the gravity model, AgeNaS designed and developed a software application to process distance matrices based on road networks, which allow for accurate calculation of travel times and distances from municipalities to hospitals Results: the model highlights that activity data and territorial characteristics can redefine both current and potential future service areas, offering a transparent and replicable assessment. The potentiality of the AgeNaS model was demonstrated through a series of case studies: Montevarchi (Tuscany), Iglesias (Sardinia), and Orvieto (Umbria). CONCLUSIONS: the AgeNaS methodology is a valuable tool for regions and the central level, both applicable to the network of Maternity Units and to other territorial healthcare networks. This approach is flexible, adaptable, and can be standardized through known parameters, making it suitable for replicable analysis.
The "One Health and Citizen Science" (OHCS) project aims to provide an integrated intervention model useful for characterising the state of environmental quality, assessing population exposure to pollutants, investigatin...The "One Health and Citizen Science" (OHCS) project aims to provide an integrated intervention model useful for characterising the state of environmental quality, assessing population exposure to pollutants, investigating the association between environmental risk factors and health outcomes, and measuring the impacts associated with contamination and remediation scenarios. In pursuing this objective, the activation of participatory pathways and the use of risk communication strategies are envisaged.Within the OHCS project, training and discussion meetings were planned on a number of issues deemed central. The first of these meetings focused on the theme of environmental justice. By embracing this theme, researchers explicitly acknowledged several essential elements: the value of a transdisciplinary approach in enriching our understanding, the non-neutrality of knowledge, and the prioritization of public health. Environmental justice, through this perspective, can represent the trait d'union of different disciplines and, in this circumstance, it was a fertile ground for exchanges between epidemiology, history, and social sciences allowing the historical and narrative reconstruction of the events affecting a place and its community as a result of personal and collective reflections.This contribution, therefore, explores the perspectives that can be developed around the topic of environmental justice. These perspectives are investigated by adopting a transdisciplinary approach, which on the one hand integrates the contributions of these different disciplines, on the other includes knowledge of other natures, with a view to peer collaboration in the production of knowledge. The theoretical reflections are complemented by the description of the training workshop experience, presented as a practical example for the construction of a useful dialogue space for local communities and technicians.
The area known as Piana di Venafro is situated between the Mainarde and Matese massifs in the extreme western Region of Molise (Southern Italy). This valley was formerly designated as Campania felix, a moniker derived fr...The area known as Piana di Venafro is situated between the Mainarde and Matese massifs in the extreme western Region of Molise (Southern Italy). This valley was formerly designated as Campania felix, a moniker derived from the global esteem in which its crops were held. Nowadays, the valley is traversed by numerous high-volume thoroughfares, rendering it challenging to maintain the designation of felix. The presence of significant industrial facilities along its periphery has resulted in the valley becoming a heavily polluted area. This contribution provides an overview of the significant activities undertaken by the non-profit organisation 'Mamme per la Salute e l'Ambiente ODV ETS' (Mums for Health and Environment) in their efforts to safeguard the Venafro Plain region and address the environmental concerns they have identified.
The Italian Association of Epidemiology's experience during the COVID-19 pandemic and its collaboration on a national project focused on contact tracing have prompted significant insights essential for the management of...The Italian Association of Epidemiology's experience during the COVID-19 pandemic and its collaboration on a national project focused on contact tracing have prompted significant insights essential for the management of future pandemics in Italy and the development of new pandemic plans. In particular, the Italian Association of Epidemiology highlighted the need to collect, analyse and interpret data, and produce indicators of effectiveness and efficiency in a consistent manner across the country to support the governance of the pandemic response. During the COVID-19 pandemic in Italy, this capacity was severely hampered by structural and regulatory factors and the limited availability of specific expertise. The lack of applications developed for contact tracing purposes and the absence of interoperability between existing information systems highlighted the need to invest in integration among ICT, Epidemiology, and Public Health Services. The absence of predefined indicators made it impossible to compare different organisational solutions for contact tracing. From the regulatory point of view, there is an urgent need for clarification of the legitimacy and legal basis of the use of data already available to the National Health System collected for different purposes to be used for the performance of proactive medicine and prevention activities. Finally, investment in training for health workers and decision-makers at all levels and community awareness raising are essential to building a resilient community. The Italian National Pandemic Plan 2024-2028 is an opportunity to prepare an effective and efficient response to future health emergencies, through coordinated plans and the valorisation of the pandemic experience.
Fasciana T, Antonelli A, Bianco G
… +23 more, Lombardo D, Codda G, Roscetto E, Perez M, Lipari D, Arrigo I, Galia E, Tricoli MR, Calvo M, Niccolai C, Morecchiato F, Errico G, Stefani S, Cavallo R, Marchese A, Catania MR, Ambretti S, Rossolini GM, Pantosti A, Palamara AT, Sabbatucci M, Serra N, Giammanco A
Carbapenem-resistant Enterobacterales (CREs) are globally considered to be a major threat to public health. National and international guidelines emphasize the importance of routine active surveillance policies to preven...Carbapenem-resistant Enterobacterales (CREs) are globally considered to be a major threat to public health. National and international guidelines emphasize the importance of routine active surveillance policies to prevent their transmission. Consequently, screening for the evaluation of the status of colonization by CREs in hospitalized patients in Italy is considered essential to contain and control the spread of these microorganisms and their evolution towards infection. The Italian Ministry of Health funding the CCM Project "Phenotypic and molecular screening methodologies for the detection of colonizations due to carbapenem-resistant enterobacterales (CRE)", carried out between February 2018 and January 2021 with the aim of evaluating phenotypic and molecular tests as methods able to detect patients colonized by CRE in Italian hospital setting. To assess the impact of the SARS-CoV-2 pandemic on CRE colonization, the observation period was divided into two periods: September 2018-September 2019 (first period) and October 2019-September 2020 (second period).As general objective of the project, the evaluation of the effectiveness of the methods has been appropriately foreseen. In addition, four specific objectives have been envisaged: 1. to standardize and to compare phenotypic and molecular methods, in terms of Turnaround Time (TAT); 2. to quantify the frequency of colonization at the admission and during hospitalization in Intensive Care Unit (ICU) and non-ICU wards; 3. to evaluate the effectiveness of screening interventions; 4. to provide activities that attest to the importance of screening.In order to evaluate the role of hospitalization in CRE-colonization, 11,063 patients were enrolled to perform rectal swabs on admission, and, if negative, weekly for three weeks during hospitalization. The data were collected in a dedicated IT platform.The molecular test demonstrated to be able to detect colonized patients and presence of resistance markers within 60 minutes from the sample arriving.The prevalence of CRE has increased during SARS-CoV-2 pandemic, especially in hospitals in South Italy. K. pneumoniae was the species most frequently associated with patients colonized by CRE.Training activities have been started for hospital staff, in order to reduce the frequency of colonization of patients. All the participating centres have defined the procedures to be applied locally for the screening of CRE colonized patients and have started screening activities.
Hearing and vision disorders in newborns are a serious social and public health problem. To improve the effectiveness and efficiency of screening protocols, it is necessary to use standardized procedures and ensure their...Hearing and vision disorders in newborns are a serious social and public health problem. To improve the effectiveness and efficiency of screening protocols, it is necessary to use standardized procedures and ensure their implementation at a national level. This is the first set of Italian national practice recommendations for professionals involved in the diagnosis, treatment, and management of hearing and eye screening that will guide the development of multidisciplinary services and public health policies to prevent and/or treat hearing and vision impairment in newborns. This document refers to art. 38 of the Italian Prime Ministerial Decree of 12th January 2017 defining the essential levels of assistance. It also provides an overview - albeit not exhaustive - of the current organization of the screening system as a whole and the potential areas of implementation.