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Although in Italy there is currently no effective law on physician-assisted suicide or euthanasia, Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 established that an individual who, under specific circumstances, has facilitated the implementation of an independent and freely-formed resolve to commit suicide by another individual is exempt from criminal liability. Following this ruling, some citizens have submitted requests for assisted suicide to the public health system, generating a situation of great uncertainty in the application processes. As a matter of fact, shared and defined procedures are lacking as Decision 242/2019 merely added some principles on which the legislature will have to base its future intervention. This paper analyses the advisory role that the Decision attributes to territorial ethics committees with the aim of stimulating discussions on their role in oversight mechanisms. The proposed conclusion is that the envisaged role does not appear consistent with the functions of these bodies and is ultimately substantially undefined and unjustified. [ABSTRACT FROM AUTHOR]

The identification of territorial clusters where the population suffers from worse health conditions is an important topic in social epidemiology, in order to identify health inequalities in cities and provide health policy interventions. This objective is particularly challenging because of the mechanism of self-selection of individuals into neighborhoods, which causes selection bias. The aim of this paper consists in the identification of neighborhood clusters where elderly people living in Turin, a city in north-western Italy, are exposed to an increased risk of hospitalized fractures. The study is based on administrative data and is a retrospective, observational cohort study. It is composed by a first phase, in which the individual confounding variables are balanced across neighborhoods in order to make them comparable, and a second phase in which the neighborhoods are aggregated into clusters characterized by significantly higher health risk. In the first phase we exploited a balancing technique based on partially ordered sets (poset), called Matching on poset based Average Rank for Multiple Treatments (MARMoT). On the balanced dataset, we used a spatial scan to identify the presence of clusters and we checked whether the risk of fracture is significantly higher in some contiguous areas. The combination of both MARMoT procedure and spatial scan makes it possible to highlight two clusters of neighborhoods in Turin where the risk of incurring hospitalized fractures for elderly people is significantly higher than the mean. These results could have important implications for the implementation of health policies. [ABSTRACT FROM AUTHOR]

Earthquakes can generate large volumes of debris which may threaten public health, hinder reconstruction and impact the environment. The present paper aims at investigating how the current Italian regulatory framework may be further developed to improve communities' ability to manage debris from earthquakes. Since the lack of preparedness for managing disaster debris is not confined to Italy, the paper may be valuable to stimulate a broader debate on this issue. The research work is based on selected case studies (L'Aquila 2009, Regione Emilia-Romagna—Circolare n. 2 of 12.06.2012 (2012) "Provisions for the resumption of production activities according to art. 3 paragraphs 7 to 10 of Legislative Decree June 6, 2012 n. 74" and Central Italy 2016–2017 earthquakes) and the review of the relevant literature and legislation. It shows that preparedness could have contributed to reducing or avoiding significant delays and problems in managing debris after the above-mentioned Italian earthquakes. It further suggests that disaster debris management in Italy could benefit from the existence of a comprehensive ex ante regulatory framework including a range of different tools (laws, guidelines, contingency plans and the like) and from the proper implementation of laws that are already part of our legal order. The above findings may directly feed into decision-making addressing disaster debris management. Overall, the paper focuses on a research topic which is becoming increasingly relevant, given the rise in the number and severity of natural disasters, but which is still not widely explored. [ABSTRACT FROM AUTHOR]

Introduction: A new national survey has been carried out by the Italian Centers for Cognitive Disorders and Dementias (CCDDs). The aim of this new national survey is to provide a comprehensive description of the characteristics, organizational aspects of the CCDDs, and experiences during the COVID-19 pandemic. Methods: A list of all national CCDDs was requested from the delegates of each Italian region. The online questionnaire is divided in two main sections: a profile section, containing information on location and accessibility, and a data collection form covering organization, services, treatments, activities, and any service interruptions caused by the COVID-19 outbreak. Results: In total, 511 out of 534 (96%) facilities completed the profile section, while 450 out of 534 (84%) CCDDs also completed the data collection form. Almost half of the CCDDs (55.1%) operated for 3 or fewer days a week. About one-third of the facilities had at least two professional figures among neurologists, geriatricians and psychiatrists. In 2020, only a third of facilities were open all the time, but in 2021, two-thirds of the facilities were open. Conclusion: This paper provides an update on the current status of CCDDs in Italy, which still shows considerable heterogeneity. The survey revealed a modest improvement in the functioning of CCDDs, although substantial efforts are still required to ensure the diagnosis and care of patients with dementia. [ABSTRACT FROM AUTHOR]

Aim: The goal of this paper is to analyze the COVID-19 policies of 10 European countries, including Sweden, Finland, Norway, Italy, France, Germany, Poland, Belgium, the Netherlands, and Hungary, with a time-series policy analysis tool. Subject and methods: The results of the COVID-19 policy analysis are based on a single time-series indicator, or daily population mortality rate: the number of COVID-19 daily cumulative deaths divided by the population in millions. The lower the score, the better the policy. Although many experts believe that the COVID-19 policy outcome analysis is premature, time series analysis is an excellent analysis that can provide information on the progress and transition of policy outcomes. In other words, the proposed time series analysis tool allows policymakers to identify and quantify when mistakes were made during the on-going COVID-19 pandemic. Results: The COVID-19 policy analysis discovered many useful facts. Sweden failed due to the herd immunity approach. Hungary made a fundamental mistake in COVID-19 tactics. Countries such as Sweden, Hungary, Belgium, and Poland showed time-series changes that differed from the others. Conclusion: Public health interventions can play a key role in mitigating the COVID-19 pandemic. The proposed policy analysis tool, hiscovid demonstrated the effectiveness of the time-series score behavior for discovering when policymakers made mistakes. [ABSTRACT FROM AUTHOR]

Data about the epidemiology of primary intracranial tumours (PIT) are still heterogeneous depending on different methodological approach in collecting data. In Valle d'Aosta, north west side of Italy, we have carried out a prospective consecutive population based study to calculate the incidence of PIT in the last decade (1992–1999) and to compare these rates with the previous period (1986–1991), data reported in a previous paper. The mean annual PIT incidence rate (ri) per 100,000 inhabitants was 25.48. The mean annual incidence rates in the two period of comparison were adjusted to the 1991 Italian population by the direct method. The standardised ratio was 26.43 in the previous period and 23.24 in the second decade. There is no statistically significant difference. The mean annual PIT incidence rates by tumour types were meningiomas 13.27/100,000 (men 9.77; women 16.7), neuroepithelial group 9,3 (men 10.62; women 8,1), adenomas 1.26, neurinomas 0,7. Mean annual incidence rates by tumour class were also stable. The stable incidence rate in the two periods and the similar incidence in England (21.04 /100,000 person year), strengthen the evidence for a stable incidence rate of PIT in the last decade. These three papers used similar methodology. The homogeneous methodology allows comparison and further evaluation. [ABSTRACT FROM AUTHOR]

In this paper I discuss the ethical justifiability of the limitation of freedom of movement, in particular of the ban on running outdoors, enforced in Italy as a response to the COVID-19 outbreak in the spring of 2020. I argue that through the lens of public health ethics literature, the ban on running falls short of the criterion of proportionality that public health ethics scholars and international guidelines for the ethical management of infectious disease outbreak recommend for any measure that restricts essential individual freedoms, such as the freedom of movement. The public health ethics framework, however, falls short of explaining the widespread public support that the running ban has had in Italy. I discuss possible factors which could explain the public support for the ban in Italy. Finally, I raise the question of what societal implications the abandonment of the public health ethics framework based on proportionality might have. I conclude that if it is the case, as the history of pandemics teaches us, we will experience further waves of COVID-19 outbreaks, it becomes very important to raise these questions now, with an eye towards informing public health policies for the management of future COVID-19 outbreaks. This discussion should not become politicized along the lines of liberal pro-lockdown/conservative anti-lockdown. Instead, we should reflect on the trade-offs of lockdown policies according to a pluralist framework, in which COVID-19 related deaths are not the only possible value to pursue. [ABSTRACT FROM AUTHOR]

The reforms that have reshaped the public health care systems have often been coupled with devolution. However, this process has frequently been accompanied by widespread soft budget constraint policies. In this paper we argue that the soft budget constraint arises from a cooperative game between local authorities that force Central Government to bail them out. Our theoretical model is tested using data for Italian regions for the period 2002-2006 and our hypothesis is verified. Although the model uses Italy as a benchmark, we believe that the framework we propose could be extended to other federal contexts where resources are distributed unevenly and preferences are asymmetric. [ABSTRACT FROM AUTHOR]

Feasibility, acceptability and effectiveness data of a virtual adaptation of the WHO Caregiver Skills Training (CST; n = 25) were compared with those of a pilot RCT of CST delivered in person (n = 43) against treatment as usual (TAU; n = 43). Virtual CST was delivered with high levels of integrity, but received lower ratings in some caregiver- and facilitator-rated acceptability and feasibility dimensions. Qualitative analysis identified both benefits (flexibility, convenience, clinical usefulness) and challenges, (technological issues, distraction from family members, emotional distance). Virtual and in-person CST improved significantly more on caregiver competence than TAU; there were no other significant effects. Potential for use of virtual CST as a clinical response in contexts where in-person delivery is not possible is discussed. [ABSTRACT FROM AUTHOR]

In this paper, an analysis of air quality data is provided for the municipal area of Taranto (southern Italy) characterized by high environmental risks as formally decreed by the Italian government in the 1990s with two administrative measures. This is due to the massive presence of industrial sites with elevated environmental impact activities along the NW boundary of the city conurbation. The aforementioned activities have effects on the environment and on public health, as a number of epidemiological researches concerning this area reconfirm. The present study is focused on particulate matter as measured by PM10 concentrations at 13 monitoring stations, equipped with analogous instruments based on the Beta absorption technology, either reporting hourly, two-hourly, or daily measurements. Daily estimates of the PM10 concentration surfaces are obtained in order to identify areas of higher concentration (hot spots), possibly related to specific anthropic activities. Preliminary analysis involved addressing several data problems: (1) due to the use of two different validation techniques, a calibration procedure was devised to allow for data comparability; (2) imputation techniques were considered to cope with the large number of missing data, due to both different working periods and occasional malfunctions of PM10 sensors; and (3) reliable weather covariates (wind speed and direction, pressure, temperature, etc.) were obtained and considered within the analysis. Spatiotemporal modelling was addressed by a Bayesian kriging-based model proposed by Le and Zidek () characterized by the use of time varying covariates and a semiparametric covariance structure. Advantages and disadvantages of the model are highlighted and assessed in terms of fit and performance. Estimated daily PM10 concentration surfaces are suitable for the interpretation of time trends and for identifying concentration peaks within the urban area. [ABSTRACT FROM AUTHOR]

To make hospitals more patient-centered it is necessary to intervene on patient flow logistics. The study analyzes three innovative redesign projects implemented at three Italian hospitals. The three hospitals have reorganized patient flow logistics around patient care needs using, as proxies, the expected length of stay and the level of nursing assistance. In order to do this, they have extensively revised their logistical configuration changing: (1) the organization of wards, (2) the hospital’s physical lay-out, (3) the capacity planning system, and (4) the organizational roles supporting the patient flow management. The study describes the changes implemented as well as the results achieved and draws some general lessons that provide useful hints for those other hospitals involved in such type of redesign projects. The paper ends by discussing some policy implications. In fact, the results achieved in the three cases investigated provide interesting material for further discussion on clinical, operational, and economic issues. [ABSTRACT FROM AUTHOR]

The aims of this work were to apply the Environmental Cleanliness and Clutter Scale (ECCS) in order to assess domestic squalor in dwellings of hoarders, prevent sanitary risks, and intervene in solving the problem. Methods: The ECCS is a domestic squalor scale, developed as a quantitative descriptive tool, based on ten items and a four-point scale. ECCS was applied in addition to the usual procedure during 40 site inspections in Milan, in two different surveys of dwellings of hoarders (2016 and 2019). A correction only for companion animal hoarders was introduced. Results: In the first investigation, which included animal accumulation, our 20 raters reported six cases of mild squalor and six and eight respectively of moderate and severe squalor. After our correction for animal hoarders' dwellings, we identified six cases of mild, four of moderate, and ten of severe squalor. In the second part of our assessment involving another 20 home visits, object hoarding only was assessed in order to evaluate the reliability of the ECCS method. We found varying total scores between the operators with different experience on this issue, but the same evaluation of the severity of the squalor in 14/15 (93%) cases therefore resulted in the same type of intervention. Conclusion: The ECCS score made an evaluation of the severity of hoarding/squalor, and supported the Local Health Protection Agency personnel in making decisions about timing and type of intervention. [ABSTRACT FROM AUTHOR]

Background: The efficacy of public measures for reducing the transmission of the COVID-19 infection relies on citizens' voluntary adherence with prescribed actions. Drawing on prior literature about compliant behavior, this study aimed to identify factors associated with people engagement in health-protective behaviors by including a conjoint complement of instrumental/self-oriented, normative/community-based, and affective variables. Method: A cross-sectional study involving a non-representative sample of 4045 Italian citizens was carried out during the first stage of the pandemic (April–May 2020). Variables associated with health-protective behaviors were perceived personal and societal concerns and perceived effectiveness of the institutional response to the outbreak (instrumental dimensions), and family and friends perceived norms and sense of community responsibility (normative dimensions). Two negative emotions (anxiety and fear) were included as mediators between personal and societal concerns and outcome behaviors. Results: Results showed the importance of both self-interest and community-based factors. Indeed, self-interest concerns, family perceived norms, and sense of community responsibility were significant predictors of people's decisions to engage in health-protective behaviors. Conclusions: The research findings show that compliance with public health prescriptions is a multimodal phenomenon and integrating self-interest and community-based factors can offer a better understanding of people's decision to engage in health-protective behaviors. Further, this study unveils that a shared sense of community is effective in encouraging adherence to recommended behaviors so as behavioral changes can be sustained by targeting the recommendations not only on risk minimization for oneself but also on the allocation of personal responsibility toward the belonging community. [ABSTRACT FROM AUTHOR]

Parents of children with ASD (N = 86; mean age 44.8 months; 67 boys) were randomized to either WHO Caregiver Skills Training (CST) delivered in public health settings in Italy or enhanced treatment-as-usual. Primary blinded outcomes were 3-months post-intervention change scores of autism severity and engagement during caregiver-child interaction. CST was highly acceptable to caregivers and feasibly delivered by trained local clinicians. Intention-to-treat analysis showed a large and significant effect on parent skills supporting joint engagement and a smaller significant effect on flow of interaction. Expected changes in child autism severity and joint engagement did not meet statistical significance. Analysis of secondary outcomes showed a significant effect on parenting stress, self-efficacy, and child gestures. Strategies to improve the effectiveness of CST are discussed. [ABSTRACT FROM AUTHOR]

The response to the COVID-19 epidemic requires people to undertake actions such as mask-wearing or vaccination that also confer benefits to the whole community, and therefore, are akin to public good contributions. This is the case also for participation to the mass testing that took place between November 18th and 25th, 2020 in the South Tyrol region of Italy, where 361,781 out of 500,607 (72.3%) eligible residents volunteered to take a COVID-19 rapid antigen test. We examine the community characteristics that are associated with higher testing rates. Our findings point to a number of key community determinants of people's willingness to volunteer. Convenience and social capital were important factors. Beyond that, socioeconomic status and religiosity were also both positively related to greater testing, while childhood vaccinations refusal rates show a negative relationship. [ABSTRACT FROM AUTHOR]

Aim: To evaluate how researchers in the field of Public Health (PH) use graphical representations in the context of a scientific meeting. Subjects and methods: We evaluated 159 graphs contained in the oral presentations given at the 2006 European Conference on Public Health. An ad-hoc data extraction form was developed on the basis of the available literature to evaluate type and characteristics of the graphs (e.g. format of axes, scales, legend, use of colours, presence of distortions). Principal component analysis (PCA) was performed to identify latent variables. Results: We found that the majority of graphs were simple univariate displays such as bar diagrams (59.1%), and linear graphs (18.2%). Distortions were present in about 1 out of 3 graphs and they were less common in graphs made by researchers from northern and western European countries than in graphs made by researchers from other countries. Two factors emerged from PCA: clarity of the graph and appropriate use of colours. Conclusion: The ability of PH researchers to fully exploit the visual potential of graphs appeared limited. Clarity and use of colours characterised use of graphics in oral presentations. [ABSTRACT FROM AUTHOR]

The article discusses a study which compared the performance of Information Extraction (IE) algorithms. Topics covered include the advantages and disadvantages of Injury Surveillance Systems based on traditional hospital records or clinical data, the common sources of injury surveillance data and the integration of clinical based registries with unconventional data sources like newspaper stories.

Aim: Waste, including waste from electrical and electronic equipment, has been increasing for many years. This pilot study aims to describe hospital waste management in three European countries (including collection, disposal and recycling). Subject and methods: The survey was carried out in eight hospitals, two in Rome (Italy), three in Dresden (Germany) and three in Belgrade (Serbia). A questionnaire was used to gain more knowledge about hospital waste management, especially regarding electrical and electronic equipment. Results: The survey results show that treatment of electrical and electronic equipment is a difficult and expensive task in all studied hospitals and countries. Only one half of the hospitals have a standardised procedure for waste treatment. While one eighth has a procedure for some equipment, 37.5% do not have one; and whereas one quarter do not have an office of waste management, a waste register is available in 62.5% of the hospitals. Conclusion: Either waste management procedures differ between the eight studied hospitals and countries, or there is no (prescribed) waste management procedure at all. With regard to the two facts, common regulations are necessary to manage waste disposal and treatment in European countries and hospitals. [ABSTRACT FROM AUTHOR]

Smoking is recognized as the major cause of lung cancer. Healthcare professionals play an important role in lung cancer prevention policies, as they act as a source of guidance for patients and advocates. The following survey evaluated prevalence, knowledge, and attitudes toward tobacco smoking among a sample of workers in "IRCCS Istituto Tumori "Giovanni Paolo II" of Bari, an Italian cancer hospital. An anonymous questionnaire was completed by 104 healthcare professionals to collect personal and occupational data about smoking status, knowledge about the harms of smoking, current legislation in place, Second-Hand Smoke (SHS) awareness, and, for ex-smokers, the reasons for quitting. Among participants, 17.8% were current smokers, 26.2% former smokers, and 56% never smoked. Only 40% acknowledged that the smoking ban is generally respected, and 63.2% reported that they smoke during working hours. Most of the participants perceived tobacco control policy as an efficient way to protect public health. Currently, the implementation of Italian anti-smoking legislation has so far improved neither smoking cessation rates nor the will to quit smoking completely. Our experience highlights that to date the anti-smoking strategies have limited efficacy even in a cancer center; in fact, there is still a large prevalence of smokers among hospital personnel. Therefore, it is strongly suggested that interventions be shared with all healthcare workers, specifically aimed at developing a culture of health promotion. [ABSTRACT FROM AUTHOR]

Aim: Due to the introduction of the compulsory vaccination law in Italy, and the following intense debate, the aim of this study was to assess the opinion of Italian Public Health residents and their knowledge on this issue. Subjects and methods: Data were collected using a previously developed and validated online questionnaire that was sent by email to Public Health Residents attending the 35 Post-Graduate Schools of Hygiene and Preventive Medicine in Italy. Multivariate stepwise logistic regression was performed for data analysis, and a 0.05 level of significance was chosen. Results are expressed as adjusted odds ratio (aOR) with 95% confidence intervals (CI). Results: Out of 554 medical doctors, 359 filled in the questionnaire, of which 56.8% were female. Those who had a positive opinion about the Law also strongly agreed/agreed with the following statements: caregivers who do not comply with the mandatory vaccination law should be fined; the Law is the only way to prevent, contain and reduce public health risks; documentation of legally mandated vaccines should be required for children to attend preschools; mandatory vaccinations are necessary and the Decree Law should not be modified; the Law emphasises the importance of all the vaccinations provided by the National Immunisation Plan. Conclusion: Italian Public Health residents agree with compulsory vaccination, considering it a useful and effective tool aimed at increasing the vaccination coverage rate. [ABSTRACT FROM AUTHOR]

Recent advances in technology, information technology, Internet networks, and, more recently, fiber optics in industrialized countries allow the exchange of a huge amount of data, in real time, across the globe. The acquisition of increasingly sophisticated technologies has made it possible to develop telemedicine, by which the specialist's evaluation can be carried out on the patient even remotely. In Italy, this very useful tool, although possible from a technological and information technology point of view, has not been developed because of the lack of clear and univocal rules and of major administrative obstacles related to the Italian Public Health System. To promote telemedicine implementation in Italy, the Italian Society of Clinical Neurophysiology and the Italian Society of Telemedicine together with the National Centre for Telemedicine and New Assistive Technologies of the Italian Higher Institute of Health prepared these inter-society recommendations. Because of potential forensic value of these recommendations, they were prepared considering the current regulations and the General Data Protection Regulation and will provide the basis for a Consensus Conference planned to discuss and prepare National Telemedicine Guidelines. [ABSTRACT FROM AUTHOR]

The pandemic of coronavirus disease 2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, is generating a high number of deaths worldwide. One of the current questions in the field of environmental science is to explain how air pollution can affect the impact of COVID-19 pandemic on public health. The research here focuses on a case study of Italy. Results suggest that the diffusion of COVID-19 in cities with high levels of air pollution is generating higher numbers of COVID-19 related infected individuals and deaths. In particular, results reveal that the number of infected people was higher in cities with more than 100 days per year exceeding limits set for PM10 or ozone, cities located in hinterland zones (i.e. away from the coast), cities having a low average speed of wind and cities with a lower average temperature. In hinterland cities having a high level of air pollution, coupled with low wind speed, the average number of infected people in April 2020—during the first wave of the COVID-19 pandemic—is more than tripled compared to cities with low levels of air pollution. In addition, results show that more than 75% of infected individuals and about 81% of deaths of the first wave of COVID-19 pandemic in Italy are in industrialized regions with high levels of air pollution. Although these vital results of the first wave of the COVID-19 from February to August 2020, policymakers have had a low organizational capacity to plan effective policy responses for crisis management to cope with COVID-19 pandemic that is generating recurring waves with again negative effects, déjà vu, on public health and of course economic systems. [ABSTRACT FROM AUTHOR]

Background: Migration has a significant impact on overall health and pregnancy outcome. Despite the fact that growing volume of migration flows significantly engaging the public health system of European host countries, there is a lack of evidence concerning pregnancy outcomes of newly arrived asylum-seeking women. Methods: Data about pregnant asylum seekers hosted in the Italian Reception Centers between the 1 st June 2016 and the 1st June 2018 were retrospectively collected and analysed in the present study. We examined the following pregnancy outcomes: miscarriage, self-induced abortion, voluntary pregnancy termination, live-birth; and studied potentially related socio-demographic factors. Results: Out of the 110 pregnant women living in the reception centers, 44 (40%) had eutocic delivery, 8 (7.3%) dystocic delivery, 15 (13.6%) miscarriage, 17 (15.5%) self-induced abortion and 26 (23.6%) underwent voluntary pregnancy termination. Nigerian women were at a significantly higher risk of abortive outcomes for voluntary pregnancy termination (p < 0.001), miscarriage (p = 0.049) and self-induced abortion (p < 0.001). Being unmarried was significantly associated with voluntary pregnancy termination and self-induced abortion. Women who chose to undergo unsafe abortion did not result to have significantly lower educational levels, compared to women who preferred medical abortion. Conclusion: This study offers first insights into pregnancy outcomes among asylum-seeking women in Italy. The country of origin and marital status seem to significantly impact on pregnancy outcome. We identified sub-groups of migrant women at increased risk of abortive outcomes, and highlight the need to improve care in order to promote migrant women's reproductive health. [ABSTRACT FROM AUTHOR]

Over the last four decades, childhood overweight/obesity has dramatically increased, becoming a significant public health concern. The main aims of this study were to investigate the prevalence of overweight/obesity among first-year primary schools children in Modena and to identify the associated risk factors. Data were collected on the socio-demographic characteristics of family and weight, height, dietary habits and sedentary behaviours of the children, and on the parents' perception of their child's weight status, through an anonymous questionnaire administered to parents. The questionnaires were delivered by 660 out of 890 (74.2%) families, and after excluding those without anthropometric data, 588 children were included in the study. The prevalence of overweight/obesity among the children was 25.2%, significantly lower in children born to parents with a high education, and higher among children born to foreign parents and overweight/obese mothers. The multivariable analysis showed that the children most likely to become overweight/obese were those who skipped breakfast (OR 2.3, 95%CI 1.3–4.2) and/or mid-morning snacks (OR 3.2, 95%CI 1.5–6.5). Breakfast consumption was positively associated with higher parental education levels, whereas skipping mid-morning snacks is more frequent among children born to foreign parents and overweight/obese mothers. Moreover, 84.7% of the parents of overweight/obese children underestimated their child's weight status. One in four 6–7 year-old children is already overweight or obese. Childhood overweight/obesity is significantly associated with unhealthy lifestyles and family lifestyle. It is therefore essential to implement public health intervention programs aimed at both parents and children, in order to promote healthy lifestyles in early childhood. [ABSTRACT FROM AUTHOR]

This work investigates the determinants of health care expenditures, such as drug prescriptions, inpatient care, and outpatient care, of the resident population of the Region of Friuli Venezia Giulia (Italy). The phenomenon of interest is examined here by considering a cross-sectional register-based dataset on individual expenditures exhibiting a cross-classified hierarchical structure. In fact, patients (about 1,000,000) are grouped by general practitioners and municipalities. Does the evidence in individual data analyses support the results of the micro- and macroeconomic literature? The adoption of disaggregated data allows us to disentangle the role of the micro- and macroeconomic determinants of the expenditures. Moreover, the degree of interdependence between neighbouring municipalities is measured by accounting for the spatial correlation in the error convolution. A feasible two-stage Heckit method has to be adapted to encompass the zero-inflation issue, to consider the hierarchical structure of data and to study the spatial diffusion process of the expenditures in the sample selection model framework. The main results on the determinants of health care expenditures at the macro-level are confirmed in our analysis on disaggregated data. On the contrary, however, the substitution effect, which is typically observed in aggregated data, has not been confirmed by the present research. Moreover, the selection process appears to be relevant in drug prescriptions and outpatient care expenditures and a significant spatial correlation in both the selection and the outcome equations emerges from the structure of error components. [ABSTRACT FROM AUTHOR]

Chickenpox is a highly contagious disease caused by primary infection of varicella zoster virus (VZV). The disease is spread worldwide and is usually benign but, in some groups of population like pregnant women, can have a severe outcome. Due to a not optimal vaccination coverage, a relatively high number of childbearing-aged women in a European country such as Italy tested seronegative for VZV and so are currently at risk of acquiring chickenpox during pregnancy, especially if they live in contact with children for family or work reasons. Only few data are available about the risk of infection in this setting: the incidence of chickenpox may range from 1.5 to 4.6 cases/1000 childbearing females and from 1.21 to 6 cases/10,000 pregnant women, respectively. This review is aimed to focus on the epidemiology and the clinical management of exposure to chickenpox during pregnancy. Particular emphasis is given to the accurate screening of childbearing women at the time of the first gynecological approach — the females who tested susceptible to infection can be counseled about the risks and instructed on procedure should contact occur — and to the early prophylaxis of the at-risk exposure. Lastly, the achievement of adequate vaccination coverage of the Italian population remains a cornerstone in the prevention of chickenpox in pregnancy. [ABSTRACT FROM AUTHOR]

The article focuses on practice guidelines for stroke units. In their paper Essential Requirements for Practice Guidelines at National and Local Levels, F. Nonino and A. Liberati have addressed a relevant problem in Italy. They explored the local practice guidelines on stroke management from 7 Italian stroke units, using explicit criteria to evaluate the internal and external validities. Particularly, they used the best evidence obtained through systematic reviews as a requirement for the internal validity of the guidelines.

COVID-19 outbreak has quickly spread worldwide, causing a high pressure on the health-care system. In Italy, from March 8, 2020, all the deferrable clinical activities have been suspended to increase the health care offer for COVID-19 patients. The hospital organization has been modified also in order to assure non-COVID-19 patients assistance. The Scleroderma Unit of ASST Pini-CTO Hospital, in Milan, in the region mostly hit by SARS-CoV-2 in Italy, follows more than 600 patients affected by systemic sclerosis (SSc). Patients with SSc need a close follow-up with a regular screening of organ involvement and frequent intravenous treatments. All SSc patients have been educated about ministerial directives to limit COVID-19 spread. The organization of our Scleroderma Unit has been quickly rethought to assure SSc patients assistance in safety for them and for health-care workers during urgent visits or infusion therapies. Using electronic way of communication with frequent virtual contact and guarantying home deliveries of some therapies, we allowed a continuity of care also outside the Hospital. [ABSTRACT FROM AUTHOR]

Giardia duodenalis and Cryptosporidium spp. are common intestinal pathogens of humans and animals. Dogs may be infected by zoonotic isolates of G. duodenalis and Cryptosporidium spp. that, consequently, have high interest under public health perspective. This study estimated the occurrence of these protozoa in canine faeces polluting public areas of Padua municipality (Northern Italy), towards a potential evaluation of health risks for dogs and humans. A total of 705 canine stools was collected in green ( n = 270) and urban ( n = 435) areas and processed by duplex real-time PCR and real-time PCR SYBR® Green I for the detection of both protozoa. Positive samples were submitted to specific nested PCRs (i.e. β-giardin/SSU-rRNA genes for Giardia; SSU-rRNA gene for Cryptosporidium) to obtain detailed information on the isolates retrieved. Giardia and Cryptosporidium prevalence were 28.9% and 1.7%, respectively. Twenty-one Giardia-positive samples were successfully identified as dog-specific assemblages C and D, and 1 as the human-specific assemblage B. One isolate was identified as Cryptosporidium canis, while the other 11 were confirmed to belong to the Cryptosporidium parvum species complex. Contrariwise to the Cryptosporidium low prevalence, the wide distribution of Giardia suggests a high risk of infection for dogs attending public areas. Although data indicate a limited risk for human health, it is necessary to improve general education to reduce canine faecal pollution towards a widespread awareness of health risks. [ABSTRACT FROM AUTHOR]

People aged 90 and older represent a fast-growing population segment who deserve specific attention and research. Aging is associated with a progressive decrease in hemoglobin concentration, which predicts adverse outcome, such as mortality, morbidity, frailty and disability. Whether this association is independent from increased prevalence of comorbidity, causing both anemia and reduced physical function is yet under debate. The aim of this study is to explore the relationship between hemoglobin concentration and self-reported disability and reduced physical performance in a community dwelling population of nonagenarians. Data presented were collected in the framework of the Mugello Study, a clinical epidemiologic survey of nonagenarians living in the Mugello area (Tuscany, Italy). 251 persons (177 women, age 93.2 ± 3.3 years; 74 men, age 92.2 ± 2.5 years) underwent a blood draw. Along with hemoglobin concentration, self-reported disability (basic and instrumental activities of daily living), physical performance (Short Physical Performance Battery), self-reported physical activity and muscular strength (handgrip measurement) were assessed. Covariates, inherent sociodemographic and health indicators and comorbidities were also included in the analysis. This study confirms that anemia is very common in the oldest old, with a significantly higher prevalence in males (50% in men vs 24% in women). Multiple linear regression analysis, including all the comorbid conditions as confounding factors, shows that hemoglobin concentration is independently associated with handgrip strength, self-reported physical activity and disability in dressing, and taking a shower/bath. In conclusion, results from this study confirm that in the oldest old, low hemoglobin concentration is strongly associated with self-reported disability and decline of physical performance independent of comorbidity. [ABSTRACT FROM AUTHOR]

Loss of well-being, rising rates of depression and various psychological illnesses are a public health concern. This study aims to explore the associations between cultural access and mental illness. Applying a panel methodology to the 20 Italian regions (2002-2007 period) the relationship between public health expenditure per-capita (the dependent variable) and hospital discharge rates for different illnesses (the regressors) has been estimated. Then the impact of the private spending in culture (the regressors) on the mental illness-as approximated by the discharge rate for mental illness-(the dependent variable), has been verified via generalised method of moments (GMM) approach. Data came from the National Census of the Italian Institute of Statistics (ISTAT). The results of empirical analysis have highlighted how the discharge rate for mental illness is substantially improved by some forms of cultural consumptions. The coefficients associated with unemployment rates (the control variables) have a positive impact on mental illness, thus suggesting that unemployment has an impact on the discharge rate for mental illness; the greatest impact is observed for the long- term unemployment rate. The results are beneficial for designing and implementing preventive strategies to reduce mental illness and public health expenditure by considering the impact of cultural access. [ABSTRACT FROM AUTHOR]

Introduction: A large number of epidemiological trials clearly show the impact of the main cardiovascular disease risk factors in term of hospitalization and related cost, but relatively less frequently if this reflect the health needs of a given population. Aim: To develop a model for the health needs-assessment that will be applied to verify if and how the prevalence of some classical risk factors for cardiovascular disease predicts mortality and hospitalisation episodes at 3 years, and if it could express the health need of that population. The long-life clinical record of 1,704 subjects, recruited during the 2004 Brisighella Heart Study survey, has been monitored. We defined the health profile of these subjects at 2004 (based on clinical history, smoking and dietary habits, physical activity, drug use, anthropometric data, blood pressure, and hematological data) and then sampled data relative to their hospitalisations, mortality, and general medical assistance. Results: Our results shows that age over 65 years (OR 4.08; 95 % CI 2.74-6.08), hypertension (OR 3.44; 95 % CI 2.36-5.01) and hypercholesterolemia (OR 1.33; 95 % CI 0.92-1.94) increase the probability to get hospitalised. Furthermore, the burden of care was defined and computed for our sample. Vascular and respiratory diseases [Burden of health care (Bc) = 24.5 and 36.5, respectively] are the most costly DRGs which means that the biggest part of our resources directed to cardiovascular patients were provided for these diagnoses. Conclusion: The application of the proposed model could help policy makers and researchers in directing resources and workforce in the treatment of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Gambling has seen significant growth globally, and particularly in Italy: it has rapidly evolved from a simple recreational activity to represent 4% of Italian GDP in 2010.A sample of 4.494 gamblers was drawn from IPSAD-Italia2007-2008 (Italian Population Survey on Alcohol and Drugs) in order to examine different gambling patterns (assessed using the Canadian Problem Gambling Index Short form scale).Separate analysis was performed on young adults, age 15-24 ( n = 1,241; male 56.2%), and adults, age 25-64 ( n = 3,253; male 53.8%): compared with adults, Italian youth, although they gambled less (35.7% vs. 45.3%), appeared to have higher prevalence of low risk gambling (6.9% vs. 5.8%) and moderate risk or problem gambling (2.3% vs. 2.2%). Males are more likely to be moderate-risk or problem gamblers. Those with only a primary education are more likely to be moderate-risk or problem gamblers (young adults: RRR = 5.22; adults: RRR = 3.23) than those with a university education, just like those youth who use depressants, but only among younger (RRR = 3.38).A fundamental issue, 'do not disapprove of gambling', seems to relate to problematic gambling: a specific Italian legislation, the Abruzzi Decree Law, could have influenced the perception that gambling may contribute positively to provide additional funds to the government for social good as well as to add needed jobs. Regardless of such potential social benefits, gambling is a social epidemic and if this association should be confirmed by more focused studies, policy makers should evaluate ways to affect this perception as soon as possible. [ABSTRACT FROM AUTHOR]

High ambient temperatures have been associated with increased mortality across the world. Several studies suggest that timely preventive measures may reduce heat-related excess mortality. The main aim of this study was to detect the temporal modification of heat-related mortality, in older adults (aged 65-74) and in elderly ≥75 years old, in the Florentine area by comparing previous (1999-2002) and subsequent (2004-2007) periods to the summer of 2003, when a regional Heat-Health Warning System (HHWS) was set up. Mortality data from 1999 to 2007 (May-September) were provided by the Mortality Registry of the Tuscany Region ( n = 21,092). Weather data were used to assess daily apparent temperatures (AT). Case-crossover time-stratified designs and constrained segmented distributed lag models were applied. No significant heat-related mortality odds ratio (OR) variations were observed among the sub-periods. Nevertheless, a general OR decrease dating from 1999-2002 (OR 1.23; lack of HHWS) to 2004-2005 (OR 1.21; experimental HHWS running only for Florence) and to 2006-2007 (OR 1.12; official HHWS extended to the whole Florentine area) was observed when the maximum AT was considered. This modification was only evident in subjects ≥75 years old. The heat effect was higher and sustained for more days (until lag 9) during the period 1999-2002 than 2004-2007. The decrease of the excessive heat effect on mortality between periods with the absence and existence of a HHWS is also probably due to the mitigation of preventive measures and the implementation of a HHWS with specific interventions for safeguarding the health of the 'frail elderly'. [ABSTRACT FROM AUTHOR]

Background: The spread of methicillin-resistant Staphylococcus aureus (MRSA) is of increasing concern, especially for particular populations such as school or university students. This study compares the knowledge, attitudes and behaviour towards MRSA skin infections between a group of medical and public health students who attend courses and practice in a teaching hospital setting to a general population group represented by their family members, cohabitants and friends. Methods: In the period March-April 2009, a survey was conducted on 166 students and their cohabitants (182). After informed consent, a self-administered questionnaire was given to each participant, containing questions concerning socio-demographic (age, gender, educational level, job activity) and leisure-time items (physical activity) as well as knowledge regarding the localisation, symptoms, means of transmission of a MRSA infection, susceptible groups, therapeutic and diagnostic aspects, and the correct behaviour for preventing transmission to others. All the students were belonging to medical and public health Technician school in a teaching hospital setting. Results: Study participants were 116 biomedical students and 182 family members, cohabitants and friends. The comparison among the levels of knowledge revealed a significant difference between the two groups. One-third (30.1%, 50/166) p = 0,006 of biomedical students ignore the anatomical site of MRSA infection while 20.5% (34/166) do not known the determinants involved in increasing the risk and ignore the possible development resistance to the antibiotics of S. aureus causing intractable infection ( p = 0,001). Regarding attitude and behaviour toward MRSA, the distribution of answers were statistically different among the two groups in the questions regarding the diagnosis, the choice of the person to be seen if infected and the question on the prevention measures to be adopted in case of infection. Moreover, more than half of the participants are willing to pay 100 € (the maximum amount proposed) to have the best care in case of staph infection. Conclusion: Most of the participants had a poor or even a very poor knowledge of the pathogen, mechanism of transmission, risk determinants and preventive measures. There is a strong need to implement targeted educational programs within current university curricula and for the general population. [ABSTRACT FROM AUTHOR]

The annual incidence of myasthenia gravis (MG) ranges from 3 to 30 per 1,000,000 people. Since the mid-1980s, an increasing incidence has been reported, mainly due to late-onset MG. Whether the increase was due to population aging, improved diagnosis and case collection, or a true excess of incidence cases is still under debate. We used a complete enumeration approach by reviewing all possible sources of case collection in the province of Ferrara, Italy, to estimate the MG incidence and its temporal trend over the study period (1985-2007). The mean annual age-adjusted incidence of MG was 18 per 1,000,000, without any significant temporal trend. The incidence rates in the period 1985-1990 were 14 both for early and late-onset MG. Thereafter, a significant increase in incidence of late-onset MG ( p < 0.05), and a decrease in early onset MG were detected ( p < 0.01). These findings were related to nonthymoma MG. The median age at onset of the disease steadily increased over time. A changing pattern of MG incidence with an increase in frequency of late-onset and a decrease of early onset MG was found in the last years, giving a significant shift to older age at onset of the disease. Unknown environmental factors may have driven this change in MG epidemiology. [ABSTRACT FROM AUTHOR]

Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8-55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients' outcomes. [ABSTRACT FROM AUTHOR]

When the construction of the Lyon-Turin segment of the new European high-speed rail network was first publicly announced at the beginning of the 1990s, it immediately found fierce opposition from the inhabitants of Susa Valley, Italy, one of the areas to be cut across by such infrastructure. At issue were the project’s potential environmental impact and its consequences on public health. This study intends to clarify environmental risk perception and public debate between the national government, local advocacy groups, and the inhabitants of Susa Valley. Two major phases of public reaction were identified: (1) an initial rebellious period of no real dialog among the project’s major stakeholders (exemplified by the popular “No TAV” [No High Speed Train] movement), followed by (2) a yielding period of intense multilateral negotiations centered on the activities of the “Lyon-Turin Environmental Observatory.” The results of a qualitative cross analysis of the residents’ perception of the proposed high-speed rail revealed that public acceptance of risk in Susa Valley was influenced by the characteristics of hazards perceived by the residents and by the communicative approach used by the project’s various stakeholders. It also emerged that early dialog among all the parties involved was critical in forming a personal viewpoint on risk, which, once consolidated, defied new information and perspectives. Likely, a greater and earlier care taken by the other stakeholders to inform and consult the local population about the railway would have greatly eased the public debate. [ABSTRACT FROM AUTHOR]

To estimate the mesothelioma risk and environmental asbestos exposure (EAE) due to an asbestos-cement plant. A spatial case–control study including 48 malignant mesothelioma (MM) cases occurred in the period 1993–2003 selected from the regional mesothelioma register (RMR) and 273 controls. The disease risk was estimated by means of a logistic-regression model, in which the probability of disease-occurrence is expressed as a function of the classes of distances. A non-parametric method was applied to estimate the full relative risk surface. Significant MM odds ratio of 5.29 (95 CI: 1.18–23.74) was found for people living within a range up to 500 m centered on the plant. The non-parametric estimation of relative risk surface unveiled a marked peak near the plant not paralleled by the spatial distribution of controls. Evidence of an association between mesothelioma risk and EAE is highlighted. The role played by the RMR in increasing the public health local authorities awareness is stressed. [ABSTRACT FROM AUTHOR]

Objective: In order to evaluate the prescribing pattern in the Italian paediatric population, prescriptions involving 923,353 children under 14 years old and dispensed during 2006 by the retail pharmacies of 22 Italian local health units were analysed.Materials and Methods: A total of 561,237 children (61%) received at least one drug prescription. The prescription prevalence rate was highest in children 3 years of age (78%), decreased with increasing age and was higher in boys than in girls (chi(2)=655; p<<0.001). Each treated child received an average of 3.2 prescriptions and 4.8 boxes.Results: Antibiotics and anti-asthmatics were the more prescribed therapeutic classes and represented 80% of prescriptions. Amoxicillin+clavulanic acid was the most prescribed drug (24% of the overall population; 17% of all boxes), followed by inhaled beclometasone and amoxicillin. A total of 620 different drugs were prescribed and the ten leading drugs represented 64% of the prescribed boxes. Six of the ten most prescribed drugs were the same in all age groups. Wide differences were found in the prevalence rate between the different local health units; these ranged between 50.1 and 68.4% (p<<0.001). The prescription prevalence increased in the 2000-2002 period (from 62.2 to 68.3%) and slightly decreased afterwards.Conclusion: Despite some limitations, the systematic monitoring of prescriptions is a valuable tool for evaluating the appropriateness of the care. [ABSTRACT FROM AUTHOR]

Data on the burden of rotavirus gastroenteritis in Europe are needed to help understand the potential impact of introducing new rotavirus vaccines. As part of prospective observational study (Rotavirus gastroenteritis Epidemiology and Viral types in Europe Accounting for Losses in Public Health and Society Study, REVEAL) conducted in 2004–2005 in seven European countries, we studied, the characteristics of acute gastroenteritis and rotavirus gastroenteritis in children less than 5 years in primary care, emergency room and hospital settings (Padova, Italy). A total of 757 children with acute gastroenteritis were included and enzyme-linked immunoabsorbent assay (ELISA) results were available for 725 cases. The overall estimated annual incidence for rotavirus gastroenteritis was 4.7%. Overall, rotavirus gastroenteritis was estimated to account for 43.6% of acute gastroenteritis cases. Among children with acute gastroenteritis (AGE) aged 6–23 months, 61.2% were rotavirus positive. Rotavirus gastroenteritis (RVGE) was responsible for 68.8% of hospitalizations, 61% of emergency consultations, and 33% of primary care consultations. The most prevalent serotype was G9 (84.4%) followed by G1 (11.8%). The relative risk for rotavirus gastroenteritis of being referred to hospital after an initial consultation in primary care was 3.37 (95% CI: 1.77–6.43) and 3.38 (95% CI: 2.28–5.01) for emergency room referral. Children with rotavirus gastroenteritis generally had more severe disease than children with rotavirus-negative gastroenteritis. Rotavirus accounts for a significant proportion of acute gastroenteritis cases in children less than 5 years in Italy, many of whom require frequent primary care consultations, or care in emergency room or hospital settings. [ABSTRACT FROM AUTHOR]

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder causing vascular dysplasias. About 70–80% of HHT patients carries mutations in ENG or ACVRL1 genes, which code for a TGFβ receptor type III and I respectively. Molecular data on a large cohort of Italian HHT patients are presented, discussing the significance of missense and splice site mutations. Mutation analysis in ENG and ACVRL1 genes was performed using single strand conformation polymorphisms (SSCP), denaturing high performance liquid chromatography (DHPLC) and subsequent direct sequencing. Overall, 101 mutations were found, with ACVRL1 involved in 71% of cases. The highest number of mutations (28/101 subjects, 14/76 different mutations referring to both genes) was in ACVRL1, exon 3. Mutation analysis was then extended to a total of 356 family members, and 162 proven to carry the mutation. New polymorphisms were identified in both genes, and evidence that ENG P131L change is not a disease-causing mutation was also provided. An in silico analysis was performed in order to characterize splice-site mutations. These results were compared to other European national studies and data from Italy, France and Spain were consistent for an higher incidence of ACVRL1 mutations. [ABSTRACT FROM AUTHOR]

Childhood injuries are a major public health problem in Italy. From a study conducted in 1984, injury rates were found to be higher in Trieste, in the north-east of the country, than in other Italian areas. We conducted a new study to evaluate whether injury rates and patterns have changed in Trieste. There are three emergency rooms (ER) in Trieste. We collected and analyzed information on all injured children 0-16 years of age attending these ER in 2003 (child population 0-16 years of age was 28,000). We calculated the annual injury risk overall and by age. We described characteristics of the children (age, sex) and injuries (place, cause, type, affected body part, severity). 5,928 injured children attended the ER, and the annual injury risk was 21.5%. The home was the most frequent place where injuries occurred, especially among the youngest children. The most commonly injured body parts were the limbs and, among the youngest children, the head and face. Approximately 20% of children had moderate to severe injuries (AIS>1), and less then 3% were admitted to the hospital. In comparison to the previous study, there have been no significant changes in the annual risk of childhood injury and in the injury patterns. On the contrary, we observed a dramatic reduction in the frequency of hospitalization, which is probably attributable to the recent implementation of short observation and to the improvement of diagnostic/therapeutic paths in the ER. In conclusion, childhood injuries are still a relevant public health problem in this Italian area and new efforts are needed to prevent them. [ABSTRACT FROM AUTHOR]

In the framework of the EXPOLIS study in Milan, Italy, 48-h carbon monoxide (CO) exposures of 50 office workers were monitored over a 1-year period. In this work, the exposures were assessed for different averaging times and were compared with simultaneous ambient fixed-site concentrations. The effect of gas cooking and smoking and different methods of commuting on the microenvironment and exposure levels of CO were investigated. During the sampling the subjects completed a time-microenvironment-activity diary differentiating 11 microenvironments and three exposure influencing activities: gas cooking, smoking and commuting. After sampling, all exposure and time allocation data were stored in a relational database that is used in data analyses. Ambient 48-h and maximum 8-h distributions were similar compared to the respective personal exposures. The maximum 1-h personal exposures were much higher than the maximum 8-h exposures. The maximum 1-h exposures were as well higher than the corresponding ambient distribution. These findings indicate that high short-term exposures were not reflected in ambient monitoring data nor by long-term exposures. When gas cooking or smoking was present, the indoor levels at “home-” and in “other indoor” microenvironments were higher than without their presence. Compared with ambient data, the latter source was the most affective to increase the indoor levels. Exposure during commuting was higher than in all other microenvironments; the highest daily exposure contribution was found during “car/taxi” driving. Most of the CO exposure is acquired in indoor microenvironments. For the indoor microenvironments, ambient CO was the weakest predictor for “home indoor” concentrations, where the subjects spent most of their time, and the strongest for “other indoor” concentrations, where the smallest fraction of the time was spent. Of the main indoor sources, gas cooking, on average, significantly raised the indoor exposure concentrations for 45?min and tobacco smoking for 30?min. The highest exposure levels were experienced in street commuting. Personal exposures were well predicted, but 1-h maximum personal exposures were poorly predicted, by respective ambient air quality data. By the use of time-activity diaries, ETS exposure at the workplaces were probably misclassified due to differences in awareness to tobacco smoke between smokers and nonsmokers.Journal of Exposure Analysis and Environmental Epidemiology (2004) 14, 312-322. doi:10.1038/sj.jea.7500327 [ABSTRACT FROM AUTHOR]

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The article reflects the opinion of the author on the challenges encountered with the nomination for the president of Istituto Superiori di Sanita (ISS), the public health institute of Italy. The author said, the nomination made by health minister Livia Turco to Enrico Garaci for his third term as president of ISS was due to the situation Turco was facing wherein she was caught in a web of power politics. Likewise, he added that many has regarded the nomination as problematic.

Volcanic eruptions increasingly present catastrophic natural risks with hundreds of millions of people now living in areas of active volcanism and major conurbations around active eruptive centres. Interdisciplinary studies in disaster reduction have an important role in volcanic emergency management through advancing our understanding of thephysical impacts of eruptive phenomena and the causes of death and injury in explosive eruptions. Numerical modelling of pyroclastic flows, amongst the most destructive of eruptive phenomena, provides new opportunities to improve the evaluation of the potential destructiveness of volcanic events and their human impacts in densely populated areas. In this work, the results of numerical modelling of pyroclastic flow propagation at Vesuvius have been analysed in terms of the physical parameters (temperature, ash in air concentration, and dynamic pressure) that are most critical for human survival. Our numerical simulations of eruptions of Vesuvius indicate that a large area exists where total destruction may not be inevitable in small to medium scale events, a finding that has prompted us to explore further the implications for human survival as part of an interdisciplinary approach to disaster reduction. The lessons of modelling at Vesuvius should be integrated into civil protection plans for other urban centres threatened by volcanoes. [ABSTRACT FROM AUTHOR]