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Some kinds of "carbon less copy-paper" presently used in Italy were examined. The analysis showed the presence on the paper of mycrocapsules containing special inks formed by organic dyes dissolved in mineral oil and, sometimes, polychlorobyfenils. Therefore there is a possible risk for the workers using carbon less copy-paper. It is necessary therefore to complete the research in order to demonstrate this hypothesis also from biological point of view.

The Istituto Superiore di Sanità (ISS) has been asked for rapid technical and scientific advice to the State and Regions during Sars-CoV-2 pandemic preparedness.An ad hoc Working Group on Scientific Literature updates (WG SL) was set up at ISS (March-May 2020) to screen pre-prints and peer reviewed papers from arXiv, medRxiv, bioRxiv, and Pubmed to provide a real time knowledge and empirical evidence addressed to health-workers.The WG SL screened a total of 4,568 pre-prints and 15,590 peer reviewed papers, delivered as daily summary report of pre-print selection for ISS President activity in the National Scientific Technical Committee framework and a weekly open access publication (COVID Contents) on peer-reviewed papers of interest for health professionals, monitored by a satisfaction questionnaire.Promoting heath literacy, with a cross-cutting approach is a powerful heritage of Public Health Institutes and a proven effective non pharmacological intervention.

The paper reviews the literature available on value based health care and relates it to rare diseases. Starting from the economic definition of value and healthcare evaluation, efficacy and efficiency, it includes the equity dimension to define value-based healthcare. It embraces also the cultural framework associated to the concepts of health and disease, normal and pathological, right or wrong for the patient. The paper highlights that a prevention and recovery view and global evaluation of costs/benefits ratio for rare diseases make difficult and limited the applicability of the value-based approach to rare diseases. Since epidemiology of rare diseases identified a series of difficulties in applying value-based public health strategies to rare diseases, the paper underlines the necessity of new culture of health and well-being, radically re-examining how to organise the delivery of prevention, and healthcare services, and finding alternative ways of empowering and giving voice to vulnerable and marginalised groups.

Measuring access to assistive technology (AT) has become a global priority. Recently, the World Health Organization (WHO) has developed the rapid assistive technology assessment (rATA), a population-based household survey that measures the use, need, unmet need, and barriers to accessing AT.The aim of this paper is to report on the translation and adaptation process undertaken to implement the rATA survey in the Italian context.The Translate, Review, Adjudicate, Pretest, and Document (TRAPD) approach was used to translate and adapt the rATA from English to Italian. Eleven independent reviewers and 23 AT users were involved to validate the Italian translation of the rATA and pilot the survey, respectively.The feedback provided by the first users of the rATA indicate that the data collected are reliable and well reflect the state of AT provision in Italy.This study confirmed the applicability of the rATA survey to the Italian context. The Italian version of the rATA can be used to support the government, the health system as well as the civil society to monitor the current state of AT access (and abandonment) in the country.

In Italy, regional governments are in charge of implementing cervical, breast and colorectal cancer screening programmes. The 2020 Coronavirus pandemic led to a national lockdown and the temporary suspension of several non-urgent healthcare activities, including cancer screening. This paper aims to describe the results of a national survey carried out by the National Centre for Screening Monitoring (ONS) on cervical, breast and colorectal cancer screening activities in 2020.A national survey was conducted by ONS in 2020 to assess: the number of screening invitations by Region; the volumes of screening tests and the attitude to attend the screening programme compared to 2019; the number of delayed diagnoses of malignant or pre-malignant lesions caused by the slowing down of screening programmes, based on the average Region-specific screening detection rate for cervical, breast and colorectal cancers.Screening tests for breast, colorectal and cervical cancer decreased by 37.6%, 45.5% and 43.4% in 2020 compared with 2019. In 2020 the estimated numbers of undiagnosed lesions are: 3,324 breast cancers, 1,299 colorectal cancers, 7,474 colorectal advanced adenomas and 2,782 CIN2 or more severe cervical lesions. Participation in cancer screening programmes decreased by 15%, 15% and 20%, for cervical, breast and CRC screening, respectively.An urgent call to action is needed to prevent further delays and to limit the impact of the pandemic on cancer diagnosis and prevention.

Aim of this paper is to present a guide for translating to practice an evidence-based set of Quality Criteria and Recommendations (QCR) to promote the implementation of policies and practices in the field of health promotion, disease prevention and care for people with chronic diseases.The guide is based on real-world experiences of eight European pilot actions using QCR as a framework for practice design, development, implementation, monitoring and evaluation. All partners implemented their respective practices by following the same agreed process.The implementation method was summarized in seven steps where each of one outline a particular phase of the process. The guide provides a step-by-step tutorial for the implementation of QCR.Practical experiences from the pilot actions show the potential value of using the QCR in designing and implementing practices to improve the quality of care for people with chronic diseases.

Both pregnancy and the postpartum are typical periods for the onset or relapse of psychiatric symptoms and disorders, with depression and anxiety being the most common. The prevalence of suicide spectrum behaviour is significantly higher among women with a diagnosis of depressive or bipolar disorder. Suicide during pregnancy and postpartum is a multifactorial phenomenon and a history of psychiatric illness is only one of the possible risk factors involved in suicide spectrum behaviour. The present paper highlights the importance of a complete screening for both depression and suicide risk during peripartum.

Digital health (DH) is nowadays fundamental for physicians. Despite the improvement of information and communications technology (ICT), Italian medical doctors' (MDs) education system seems inadequate in this area. Moreover, due to the COVID-19 pandemic, societies are waking up to their limitations. The aim of this paper is to analyze the Italian status quo in DH.The Italian Young Medical Doctors Association (Segretariato Italiano Giovani Medici - SIGM) proposed a web-based survey to assess DH awareness and previous knowledge among young doctors. Investigated areas were: big data, -omics technology and predictive models, artificial intelligence (AI), internet of things, telemedicine, social media, blockchain and clinical-data storage.A total of 362 participants answered to the survey. Only 13% had experience in big data during clinical or research activities, 13% in -omics technology and predictive models, 13% in AI, 6% had experience in internet of things, 22% experienced at least one telemedicine tool and 23% of the participants declared that during their clinical activities data collection was paper-driven.Three categories of MDs, high-tech, low-tech and no-tech, can be identified from the survey-based investigation. Our survey's results indicate an urgent need for integration of pre- and post-graduation training in digital health to provide adequate medical education.

Sex and gender are important determinants of health and influence research findings in a variety of ways, yet they are often overlooked and underreported. This oversight limits the generalizability of research findings and their applicability to clinical practice. The objective of this paper is to point out how journal editors can influence better reporting of sex and gender in research by establishing a methodological framework directly addressing authors of scientific publications, as well as referees, and indirectly affecting all the stakeholders in the research cycle, from funders to policy-makers and citizens. Such a framework is represented by the Sex And Gender Equity in Research (SAGER) guidelines, developed by the European Association of Science Editors (EASE) to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. The paper includes the rationale and basic principles of the SAGER guidelines.

The aim of this study is to make a critical analysis of the different definitions of health literacy to provide a framework of the concept.A literature search was conducted in PubMed, Embase, PsycINFO, ERIC, Health Evidence, Centre for Reviews and Dissemination and Cochrane Library. Google and OpenGrey were searched to find additional papers and unpublished works.Among 7000 papers founded, we selected 26 works. During the 1990s, authors began to systematically study the relationship between health literacy and health status, according to a public health view. In the first decade of the new century, a new fundamental definition established three progressive degrees of health literacy: functional, interactive and critical health literacy. Sørensen (in 2012) provided a framework for the development of new assessment tools and interventions.The improvement of health literacy is a powerful tool for the development of a new type of relationship between individuals and the health system.

During the past 20 years or so, more has become known about the properties of khat, its pharmacology, physiological and psychological effects on humans. However, at the same time its reputation of social and recreational use in traditional contexts has hindered the dissemination of knowledge about its detrimental effects in terms of mortality. This paper focuses on this particular deficit and adds to the knowledge-base by reviewing the scant literature that does exist on mortality associated with the trade and use of khat. We sought all peer-reviewed papers relating to deaths associated with khat. From an initial list of 111, we identified 15 items meeting our selection criteria. Examination of these revealed 61 further relevant items. These were supplemented with published reports, newspaper and other media reports. A conceptual framework was then developed for classifying mortality associated with each stage of the plant's journey from its cultivation, transportation, consumption, to its effects on the human body. The model is demonstrated with concrete examples drawn from the above sources. These highlight a number of issues for which more substantive statistical data are needed, including population-based studies of the physiological and psychological determinants of khat-related fatalities. Khat-consuming communities, and health professionals charged with their care should be more aware of the physiological and psychological effects of khat, together with the risks for morbidity and mortality associated with its use. There is also a need for information to be collected at international and national levels on other causes of death associated with khat cultivation, transportation, and trade. Both these dimensions need to be understood.

Ibuprofen is one of the widespread used non-steroidal anti-inflammatory drugs. Ibuprofen active ingredient is manufactured in many sites located all around the world. The aim of this paper was to classify the geographical source of ibuprofen active pharmaceutical ingredients (APIs) from the legal market, based on chemical characteristics and its impurity pattern and to define a geographical fingerprint.To classify ibuprofen in different geographical groups, the chemometrics by principal component analysis (PCA) and Cluster analysis was applied to HPLC, 1H-NMR data of twenty-four samples of APIs from approved manufacturers located in different European and Asian countries.The PCA showed clearly two different geographical groups, based on particular patterns of European or Indian samples; the cluster analysis showed the similarity of group.The chemometric analysis is an important tool for tracking the geographical origin of APIs. This could be useful to supplement the quality control ensuring safety of the medicinal products in legal market and dealing with the evolving changes of the illegal market.

Nowadays digital ultrasound-cardiovascular devices are able to send out directly digital images and films. Thanks to the large adoption of such devices, the echocardiographic world is facing new ways of exchanging images and collaborating. What we present in this paper is a review of the experimental projects carried in Lombardy, meant to support the work of specialists by means of second opinion and telemedicine services. On the medical point of view echocardiography is a widely used activity where operators are perfectly accustomed to do repetitive operations and steps. Tele-echocardiography (T-E) introduces new methods and technologies into stable and everyday medical practice, causing disruptions either on the side of the specialists' way of working or on the new opportunities and service. Introducing such a service means to properly model it in order to reduce the changes in the operators' way of working while maximizing the benefits. A proper method of modelling the operators' needs is then a key factor which must be correctly addressed. This paper will present some successful projects and the assessment procedure but it will also discuss a possible service modelling method, which has been adopted for the described experiences.

The paper reviews the international literature on quality of life (QoL) for persons with neurodevelopmental disorders (NDD) in order to define the theoretical frame for optimal assessment. The application of the QoL approach to assessment procedures should be based on three main aspects: shared QoL, personal QoL and family QoL. The first aspect refers to characteristics of individual life that are shared with other people. The second aspect proceeds from the fact that each individual has a changing set of personal attributes that determine the subjective experience of life. In the third aspect the previous two are applied to the family that includes a person with NDD. Disability impacts the whole family and the determination of appropriate conceptualization of family outcomes requires an understanding of the impact of members with a disability on family QoL. At any level, it seems best to take a comprehensive approach to assessing QoL, integrating subjective and objective aspects, self-reports and hetero-evaluations. The QoL approach is above all a way to explore the rich intricacies of personal quality of life. Such assessment may be used effectively with people with NDD, independently from the severity of their functioning impairment. Individuals with profound ID may express their inner states through consistent behavioural repertoires, which can be discerned by persons closest to them and validated by more independent others. Attention must be paid in using non-generic instruments, such as those that measure health-related QoL. Although they do focus on the individual person, they still support a theoretical perspective of QoL that has not departed significantly from the traditional medical approach. Currently available generic tools, although they have some common conceptual and evaluation characteristics, still show considerable differences in the areas to be included in "shared QoL", the dimensions used to evaluate "Individual QoL", and the role attributed to indicators of QoL. QoL assessment should not represent a classification of individuals, services or systems, but it should help provide, within service systems and organizations, a value system that is consistent with those values held by people with NDD.

The Mental Health Department of Piacenza has recently activated a special program for persons diagnosed with autism spectrum disorders (ASD). The Program engages a number of stakeholders: the users, their families, social and psychiatric services as well as specific associations for autism. The program is aimed to grant a complete and individualized assistance to people with ASD and it is especially focused on the transition to adulthood. In this period, it is necessary to build the "life project" in order to improve functioning and quality of life of users. The elective areas of the individual plan have to deal on how to reach autonomy in daily living and related skills, obtaining and maintaining a job, as well as starting and reinforcing significant relationships. This paper is especially focused on job placement for people with ASD.

Supporting individuals with NDD is extremely demanding, with significant exposure to critical contexts and events, and painful ongoing experiences. Stress and burnout condition is a main concern with growing interest in research, despite the lack of consensus on theoretical explanatory models and modification standards.The paper provides an up-to-date review of risk factors and involved processes, and presents evidence-based procedures and protocols to implement effective preventive actions addressing both organizational and individual factors. The aim is to offer a global understanding of the subject and offer examples of practical plans to increase the impact on the quality of life of clients and staff members.

The specific "outcome-oriented" pattern of the emotional intelligence (EI) should be considered of capital importance for teenagers in order to promote mental health. Nevertheless it is rarely evaluated because a specific tool, useful for routinely use, is not available. In this paper the authors describe the effectiveness of a new approach of public health to improve the EI "outcome-oriented", by a specific index.A comparison of two samples: experimental (i.e. applying the program) vs control group, without randomization.12 classes belonging to 3 different schools.A sample of 276 students, 146 (53%) belonging to the experimental classes.A program of 20 meetings, once a week, based on the handbook Intervento psicoeducativo per la promozione del benessere psicologico e dell'intelligenza emotiva nelle scuole (Psycho-educational intervention for promoting psychological well-being and emotional intelligence at school) in order to stimulate a "peer to peer student approach".Index of emotional intelligence (15 items), inventory idea questionnaire (19 items), learning ability questionnaire (6 items).Nonparametric tests were used.The authors found significant statistical differences at the conclusion of the study for all considered measures.The results show a remarkable and positive impact of the approach above all on the "outcome-oriented" EI. Significant results were also observed about the indicator concerning irrational beliefs. The same significant results were found about learning abilities (goal definition, problem-solving and communication skills). The main limit is the study design (lack of randomization). Further evaluation is needed.

The directive 2001/20/UE and the research involving patients with docs. Research involving patients with disorders of consciousness (DOCs) deserves special ethical and legal attention because of its Janus-faced nature. On the one hand, it raises concerns about the risk to expose the involved subjects to disproportionate risks not respecting their individual dignity, particularly their right to be cared for; on the other hand, research is an essential tool in order to improve the clinical condition of patients with DOCs. The present paper concerns the ethical and legal dimensions of biomedical research involving patients with disorders of consciousness. In particular, it focuses on informed consent to experimental treatments, which is a challenging issue both from an ethical and legal point of view. The first part reads the Directive 2001/20/EU in the light of the experimentation of patients with DOCs, and suggests a revision in order to better assess the issue of informed consent. The particular case of informed consent for observational studies of non-communicative patients. The second part presents an informed consent form for studies through video-recording of patients unable to communicate their own consent. This form has been elaborated by the bioethics unit of the project "Review of the nosography of vegetative states: application of methods of behavioral analysis to individuals in coma or vegetative state" developed at the Italian National Institute of Health. Relevance of the suggested form. The paper describes the conceptual framework of the form for informed consent to studies through video-recoding, which is a relevant example of what issues should be included in an informed consent for any type of studies through video-recording of patients unable to express their own consent. The article has been sent on November the 7th 2013, before the adoption of the Regulation (EU) no. 536/2014 (and consequent abrogation of the Directive 2001/20/EU) and the release of the new edition of the Italian Code of Medical Ethics.

Applied Computer technologies can address the needs of individuals with autism spectrum disorders (ASD). Data on the efficacy of assistive technology in ASD is limited, and its effectiveness in supporting and facilitating skill acquisition in this specific population must be still demonstrated. 63 Italian ASD subjects underwent learning activities administered by cardboards or a touch screen support. The support preference was evaluated in a choice trial, and quantitative analysis was performed on items regarding communication and challenging behaviours. Touch devices are attractive especially for males without intellectual disability and a lower communication and cooperation behaviours with the use of touch screen compared with paper support was shown depending on activities. Overall, our data do not confirm the hypothesis that touch screen presentation improves activity completion and behavioural performance for each individual with ASD. Data discourage an indiscriminate use of these devices and suggest analysing with more attention the core ingredients that should shape digital devices when used for people on ASD.

Numerous municipalities in Italy currently experience asbestos health impact, in particular excesses of pleural mesothelioma incidence and mortality. This paper presents an integrated analysis of epidemiological studies and communication actions in affected municipalities to highlight how communication has been implemented depending on health impact evidence and involvement of local stakeholders.Four case studies are identified concerning industrial and natural sources of asbestos exposure having different diseases burden. This integrated analysis benefited from multidisciplinary skills.Evidence of different stakeholders engagement is presented to emphasize their role in the communication process. Similarities and differences among case studies allowed us to identify lessons-learned to be transferred in other asbestos contaminated sites.The adoption of communication strategies and practices, since the very early evidence of asbestos health impact, represents a relevant contribution for epidemiological and health surveillance, particularly for those communities where asbestos health impact has only been recently reported.

On 27 September 2018 the Italian Committee for Bioethics (ICB) adopted an opinion regarding the possibility of an exception to the anonymity obligation when both parties agree and have signed an appropriate informed consent form. According to the IBC any contact between the donor's family and recipient must be managed by a third-party body pertaining to the National Health Service, established to guarantee strict control over the expression of consent in order to avoid any risk of inappropriate behaviour. The paper traces how Reg and Maggie Green, on holiday from California, donated the organs of their seven-year old son, Nicholas, to seven Italians after he had been shot in a carjacking on the Salerno-Reggio Calabria highway in 1994. Reluctant as a foreigner to propose a change in Italian law that effectively prevents the two sides from contacting each other, Reg Green held back for 22 years until, at age 87, he began a public campaign to voice his concern that the law was hurting transplant families rather than helping them.

Tobacco cigarette smoke (TCS) was previously demonstrated to affect the innate and adaptive immune responses as a consequence of oxidant generation which play a pivotal role in neutrophilic airway inflammation. Aim of this paper was to investigate whether electronic cigarette smoke (ECS) generates reactive oxygen species (ROS) similarly to cigarette smoke.By means of a house made apparatus, ECS and TCS were collected in fetal bovine serum (FBS) which was used to grow immune cells isolated from rats. As index of oxidative products nitrite, superoxide, and thiobarbituric acid-reactive substances (TBARS) were determined in the medium before and after cell growth.The results showed that: i) ECS caused a remarkable increase of nitrites and TBARS although in lesser extension than TCS; ii) the spleen and lymph node cells grown in ECS and TCS-exposed medium were able to reduce TBARS but not nitrites present in the medium; iii) PBMC in TCS-exposed medium were able to reduce nitrites and TBARS more efficiently than spleen and lymph node cells, but released more superoxide anion; iv) TCS and ECS not influence the PBMC and spleen T cell subtype populations (CD4+, CD8+).As ECS nicotine-free gave the same results of unexposed medium, we can support the hypothesis that the increase of ROS in ECS exposed medium was prevalently due to nicotine.

Dosimetry based on the detection by electron paramagnetic resonance (EPR) spectroscopy of ionizing radiation-induced radicals is an established method for the retrospective dosimetry of past exposures and the dosimetry of potentially exposed persons in radiological emergencies. The dose is estimated by measuring the physical damage induced in materials contained in objects placed on or next to the potentially exposed person. The aim of this paper is to survey the current literature about methodologies and materials that have been proposed for EPR dosimetry, in order to identify those that could be suitable for population triage according to criteria such as ubiquity, non invasiveness and easy sample collection, presence of a post-irradiation EPR signal, negligible background signal, linearity of dose-response relationship, minimum detection limit and post-irradiation signal stability. The paper will survey the features of sugar, plastics, glass, clothing tissues, and solid biological tissues (nails, hair and calcified tissues).

This paper, after an introduction on the origin, development and principal aims of the National Union of Associations for Mental Health (UNASAM), briefly describes what happened in the last 30 years in the field of mental health in Italy. This period covers roughly the lifespan of the Italian Law 180, from the beginnings, the closure of psychiatric hospitals, to the difficulties of present days. The second part of the paper is a summary of a study commissioned to UNASAM by Istituto Superiore di Sanità and conducted in collaboration with the Istituto di Ricerche Farmacologiche "Mario Negri" of Milan. This research was aimed at evaluating the quality of mental health services in four Italian Regions. Members of patients' families participated with enthusiasm, filling up a questionnaire and engaging in fieldwork, which required more than 3000 working hours and produced significant and useful results.

This paper will focus on the impact of the rapid expansion in the use of biometric systems in migration management on the rights of individuals; it seeks to highlight legal issues for consideration in implementing such systems, taking as the starting point that the security interests of the state and the rights of the individual are not, and should not be, mutually exclusive. The first part of this paper briefly describes the type of biometric applications available, how biometric systems function, and those used in migration management. The second part examines the potential offered by biometrics for greater security in migration management, and focuses on developments in the use of biometrics as a result of September 11. The third part discusses the impact of the use of biometrics in the management of migration on the individual's right to privacy and ability to move freely and lawfully. The paper highlights the increasing need for domestic and international frameworks to govern the use of biometric applications in the migration/security context, and proposes a number of issues that such frameworks could address.

The Italian Dementia National Plan was formulated in October 2014 by the Italian Ministry of Health in close cooperation with the regions, the National Institute of Health and the three major national associations of patients and carers. The main purpose of this strategy was to provide directive indications for promoting and improving interventions in the dementia field, not limiting to specialist and therapeutic actions, but particularly focusing on the support of patients and families throughout the pathways of care. Four main objectives are indicated: 1) promote health- and social-care interventions and policies; 2) create/strengthen the integrated network of services for dementia based on an integrated approach; 3) implement strategies for promoting appropriateness and quality of care; and 4) improve the quality of life of persons with dementia and their families by supporting empowerment and stigma reduction. These objectives and the pertaining actions are described in the present paper.

A checking form was introduced in order to test the completeness of electronic and paper patient's charts in a radiotherapy department which had introduced record-and-verify system (RVS) and to improve tha staff performance. The chosen items for the electronic chart were 9 and 5 for paper chart. 223 patients were reviewed in two phases. The data analysis was based on a scoring method, attributing a positive score (+1) to the operator's good behaviour, a negative score (-1) to the lack of data input and a neutral score (0) to the inapplicable situation. The average global score increased from 0.4 to 0.7: in A (lowest complexity) category from 0.37 to 0.64, in B category from 0.4 to 0.89, in C category from 0.48 to 0.61.

Little is known about programmes or interventions for the screening, monitoring and surveillance of frailty at population level.Three systematic searches and an opportunistic grey literature review from the countries participating in the ADVANTAGE Joint Action were performed.Three studies reported local interventions to screen for frailty, two of them using a two-step screening and assessment method and one including monitoring activities. Another paper reviewed both providers' and participants' experiences of screening activities. Three on-going European projects and population-screening programmes in primary care await evaluation. An electronic Frailty Index for use with patients' primary care records has been recently validated. No study described systematic processes for the surveillance of frailty.There is insufficient evidence for the effectiveness of population-level screening, monitoring and surveillance of frailty. Development and evaluation of community-based two-step programmes including those that incorporate electronic health records, particularly in primary care, are now needed.

Although frailty is common among community-dwelling older adults, its prevalence in Europe and how this varies between countries is unclear.A systematic review and meta-analysis of literature on frailty prevalence in 22 European countries involved in the Joint Action ADVANTAGE was conducted.Sixty-two papers, representing 68 unique datasets were included. Meta-analysis showed an overall estimated frailty prevalence of 18% (95% confidence interval, CI, 15-21%). The prevalence in community (n = 53) vs non-community based studies (n = 15) was 12% (95% CI 10-15%) and 45% (95% CI 27-63%), respectively. Pooled prevalence in community studies adopting a physical phenotype was 12% (95% CI 10-14%, n = 45) vs 16% (95% CI 7-29%, n = 8) for all other definitions. Sub-analysis of a subgroup of studies assessed as high-quality (n = 47) gave a pooled estimate of 17% (95% CI 13-21%).The considerable and significant heterogeneity found warrants the development of common methodological approaches to provide accurate and comparable frailty prevalence estimates at population-level.

Frailty is a dynamic syndrome and may be reversible. Despite this, little is known about trajectories or transitions between different stages of frailty.A systematic review was conducted, selecting studies reporting frailty trajectories or transition states for adults in any settings in European ADVANTAGE Joint Action Member States.Only three papers were included. Data were from longitudinal community-based cohorts in the United Kingdom, Netherlands and Italy. The English study investigated the effect of physical activity on the progression of frailty over a 10-year period. Two presented data on the proportion of participants experiencing at least one frailty transition over time (32.6% in the Italian sample aged ≥ 65 years followed for 4.4 years; 34.3% in the Dutch sample aged 65-75 years, followed for 2 years).Data on frailty trajectories and transition states were limited and heterogeneous. Well-designed prospective studies and harmonized approaches to data collection are now needed.

Italian External Quality Assessment (IEQA) Program in Cytogenetics, established in 2001 by the Istituto Superiore di Sanità (ISS), covers both Constitutional and Oncohaematological diagnosis. In 2013, performance criteria were defined and adopted. In this paper, we present the data from the first 4 years of activity (2013-2016) following the introduction of performance criteria.The enrollment is voluntary, fee-based and open to both public and private Italian laboratories. The scheme is annual and retrospective; a national panel of experts assess technical, analytical and interpretative performance.Overall, 95 distinct Italian laboratories participated in different Cytogenetics IEQA schemes over the 2013-2016 years and most of the laboratories took part in Constitutional diagnosis. General hospitals and local health centers represented 40% of the total participants and the percentage of laboratories from Northern Regions was more than 45% of total participants throughout the 4-year period. As regards the performance evaluation, on average, 11, 9 and 23% of participants were marked as poor performers in Prenatal, Postnatal and Oncohaematological schemes, respectively. With regard to critical errors, ISCN nomenclature in Prenatal and Postnatal schemes, and interpretation in Oncohaematological diagnosis, were identified as main issues. On the other hand, karyotype errors and inadequate analysis decreased strongly, over the 4 years, in Constitutional and Oncohaematological diagnosis, respectively.Our data show that the introduction of poor performance encourages laboratories to address critical issues, and the IEQA participation helps to improve quality in cytogenetic testing.

The purpose of the present paper is to review the origin and development of the epidemiology of mesothelioma in Italy, starting with the detection and investigation of the major outbreak of the disease observed in Casale Monferrato, Piedmont Region. Over the last four decades, mortality among the cohort of ex-Eternit workers has been measured at three points in time. More recently, population based case-control studies in the area of Casale Monferrato have provided new light on the dose-response curve of the relationship between asbestos exposure and mesotheliomas. The publication of the first Casale Monferrato study had a major impact in the country and contributed to the decision of the Italian Parliament to ban the use of asbestos. The experience of Casale Monferrato represents a lesson in several terms, from the epidemiological surveillance to the health care of the victims and the relationship between epidemiologists, victims, their relatives and residents in contaminated areas.