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Increasing numbers of hepatitis E cases are being reported in several European countries, including Italy, but the burden of hepatitis E virus (HEV) infection is largely unknown in the latter. To gain a better understanding of HEV epidemiology at national level in Italy, we piloted a strengthened and integrated human (epidemiological and virological) and environmental HEV surveillance system between 2012 and 2016. Over the 5-year period, 169 confirmed hepatitis E cases were identified, with a national annual incidence of 0.72 cases per 1,000,000. Of 65 HEV-RNA positive samples of sufficient quality for molecular analysis, 66% were genotype HEV3, 32% HEV1 and 1% HEV4. The most frequent risk factor reported by all HEV3 infected cases, was the consumption of undercooked pork and sausage. For the environmental surveillance, 679 urban sewage samples were collected from 53 wastewater treatment plants and HEV-RNA was detected in 38/679 of the samples. Among these, 25 (66%) were genotype HEV3 and the remaining were HEV1. We demonstrate that autochthonous transmission and environmental circulation of genotype HEV3 is adding to travel-related HEV transmission in Italy. We recommend the ‘One Health’ approach to integrated surveillance, and to include HEV-related messages within health information campaigns focussing on food security.

The primary objective of this study was to investigate the prevalence of clinically important potential drug-drug interactions (DDIs) in elderly patients attending the public primary health care system in Brazil. The secondary objective was to investigate possible predictors of potential DDIs. A cross-sectional study was carried out in 5 Brazilian cities located in the Ourinhos Micro-region, Sao Paulo State, between November 2010 and April 2011. The selected sample was divided according to the presence (exposed) or absence (unexposed) of one or more potential DDIs (defined as the presence of a minimum 5-day overlap in supply of an interacting drug pair). Data were collected from medical prescriptions and patients’ medical records. Potential DDIs (rated major or moderate) were identified using 4 DDI- checker programs. Logistic regression analysis was used to study potential DDI predictors. The prevalence of clinically important potential DDIs found during the study period was 47.4%. Female sex (OR = 2.49 [95% CI 2.29–2.75]), diagnosis of ≥ 3 diseases (OR = 6.43 [95% CI 3.25–12.44]), and diagnosis of hypertension (OR = 1.68 [95% CI 1.23– 2.41]) were associated with potential DDIs. The adjusted OR increased from 0.90 [95% CI 0.82–1.03] in patients aged 60 – 64 years to 4.03 [95% CI 3.79 – 4.28] in those aged 75 years or older. Drug therapy regimens involving ≥ 2 prescribers (OR = 1.39 [95% CI 1.17–1.67]), ≥ 3 drugs (OR = 3.21 [95% CI 2.78–3.59]), ≥ 2 ATC codes (OR = 1.19 [95% CI 1.12–1.29]), ≥ 2 drugs acting on cytochrome P450 (OR = 2.24 [95% CI 2.07–2.46]), and ATC codes B (OR = 1.89 [95% CI 1.05–2.08]) and C (OR = 4.01 [95% CI 3.55–4.57]) were associated with potential DDIs. Special care should be taken with the prescription and therapeutic follow-up of patients who present characteristics identified as predictors. Knowledge of potential DDI predictors could aid in developing preventive practices and policies that allow public health services to better manage this situation.

Introduction.The prevalence of overweight and obesity in children is rapidly increasing in many countries. For that it has been interesting to investigate the eating habits of 8-9 y-old Tuscany children by paying attention to their meals frequency per day and their food choices in total and in relation to children?s Body Mass Index (BMI) classes. In addition we considered some environment factors that could affect the children eating behaviours, such as mother?s BMI and their education level. Methods. A statistical sample of 3,076 (1,583 males, 1,493 females), 8-9 year-old school-children was collected; weight and height were measured using standardized personnel and instruments. BMI classes were calculated using Cole et al.?s cutoff for children and adolescents. In order to evaluate the consumption frequency of individual meals and various foods, a Food Frequency Questionnaire (FFQ) was used, which was completed by the children themselves at school. A self-administered questionnaire revealed the weight and height of parents and their educational levels. Three educational levels were established: high, medium and low. Results. The results showed that 92.3% of children ate breakfast from 4-7 times a week, the vast majority at home, while only 3% declared consuming breakfast never or almost never. The most preferred breakfast consisted of milk and biscuits for all children?s BMI classes. 95.9% of children reported having mid-morning snack at school; fruit juice and tea are the most frequently consumed liquid foods, and pizza, salami sandwiches and pre-packaged snacks are the most frequently consumed solid foods in all BMI classes. 93.6% ate afternoon snack for the most part at home, even if 12% of children reported consuming it elsewhere; fruit juice and tea with pizza, sandwiches and pre-packaged snacks are still the most highly consumed foods by all children?s BMI classes. The consumption frequency of breakfast (P inf. 0.001), mid-morning (P inf. 0.05) and afternoon snack (P inf. 0.05) of 8-9 y-old Tuscany children decrease with increase the children?s BMI classes. The same tendency may be noted for the consumption frequency of breakfast in relation to mother?s BMI (P inf. 0.05) and their education level (P inf. 0.05). This data strengthens the thesis that some home environments can affect the children?s eating behaviours. Conclusion. No substantial differences in food choices at the meals analyzed were determined among normal weight, over weight and obese children. Children of normal weight had a greater tendency to consume meals more regularly. Mother?s BMI and their education level can have influence on children?eating behaviours., Journal of Preventive Medicine and Hygiene, Vol 47, No 3 (2006)

Obiettivi: il fumo in gravidanza è estremamente dannoso per il feto; il basso peso alla nascita e la prematurità sono le conseguenze più frequenti. Obiettivo dello studio è capire l’efficacia dei corsi di preparazione al parto nella cessazione del fumo in gravidanza.Metodi: lo studio è stato effettuato da maggio 2000 a marzo 2002. Sono stati somministrati dei brevi questionari durante gli incontri dei corsi di preparazione al parto effettuati dal Servizio di Ginecologia e Ostetricia della Zona Amiata Senese dell’Azienda USL 7 di Siena. I questionari sono stati compilati in tre incontri diversi, l’ultimo dopo il parto.Risultati: su 111 donne intervistate 82 hanno partecipato al II° incontro e 59 anche al III°. Al I° incontro le fumatrici sono il 18%, le ex fumatrici il 28,8% e le non fumatrici il 53,2%. La prevalenza di fumatrici passa dal 18% al 12,2% ed al 10,2% nelle sedute successive; il numero medio di sigarette fumate rimane costante nei tre momenti (5/6). Considerando solo le donne che hanno partecipato a tutti gli incontri si nota che il 33,3% di quelle che fumavano all’inizio non lo fanno più al II° incontro ed il 45,5% al III°. Un dato molto interessante e che il 43,8% delle ex fumatrici ha smesso quando si è accorta di aspettare un bambino. Una sola donna ha smesso di fumare in gravidanza per poi ricominciare dopo il parto. Un’altra donna, al I° incontro ha dichiarato di fumare 2 sigarette al giorno, ma ha aggiunto che prima della gravidanza ne fumava 20.Conclusioni: la prevalenza di donne che continuano a fumare in gravidanza, soprattutto alla fine, è abbastanza bassa, anche se non si può essere soddisfatti di un risultato parziale. Questi dati dimostrano l’utilità di interventi di sensibilizzazione per tutte le donne fumatrici che intendono affrontare una gravidanza.

La Regione Toscana nel 2001/2002 ha partecipato al progetto pilota nazionale “Sorveglianza ed educazione nutrizionale basata su dati locali per la prevenzione delle malattie cronico degenerative correlate all’obesità” al fine di sperimentare una metodologia per l’implemantazione di un sistema di sorveglianza nutrizionale in età pediatrica a livello regionale.Obiettivi: scopo di questo lavoro è approfondire le conoscenze sullo stato nutrizionale e descrivere la relazione che questo ha con il livello di istruzione materna e l’ampiezza demografica del comune di residenza.Metodi: il campione è composto da 3076 bambini di cui 1585 maschi e 1491 femmine di 8-9 anni. Lo stato nutrizionale è stato valutato tramite la rilevazione delle misure antropometriche, peso e altezza, ed il successivo calcolo dell’Indice di Massa Corporea (IMC); le classi di IMC sono state individuate secondo le indicazioni di Cole et al.; il livello di istruzione della madre è stato suddiviso in tre classi: basso, medio ed alto livello. Risultati: dall’analisi dei dati è emerso che la prevalenza del sovrappeso è del 22,6% (22,7% nei maschi e 22,5% nelle femmine) e quella dell’obesità dell’8,8% (9,4% nei maschi e 8,2% nelle femmine). Il 58% dei bambini normopeso e il 43% degli obesi ha la madre con livello di istruzione alto, mentre il 4% dei normopeso e il 10,5% degli obesi ha la madre con livello di istruzione basso. La percentuale più bassa di obesità (6,5%) è stata riscontrata in comuni con ampiezza demografica superiore ai 30000 abitanti.Conclusioni: la prevalenza del sovrappeso e dell’obesità in età pediatrica in Toscana è più bassa rispetto alla media nazionale. Esiste una relazione inversa tra l’Indice di Massa Corporea del bambino ed livello di istruzione della madre (p‹ .001).

The association of insulin-dependent diabetes mellitus (IDDM) and progressive optic atrophy, occasionally associated with other disorders, is known as Wolfram syndrome. Here is reported the case history of a 14 years old girl who presented IDDM, progressive optic atrophy, hearing loss, disturbed colour vision, hemeralopia and retarded sexual maturation.

Introduction. Overweight and obesity in the developmental age has become a public health problem. For this reason, prevention projects must be developed in advance with the aim to involve not only children, but their parents as well. Our objective is to evaluate the accuracy of the mothers? perceptions of adolescent nutritional status. Methods. Cross-sectional study. We selected a statistical sample of 3,076 subjects (1,583 males, 1,493 females), 8-9 y-old school-children of 164 3rd-grade elementary school classes from throughout Tuscany, as well as their mothers. The mothers? information was gathered via self-administered questionnaires, while the children were given an eating behaviour survey under the supervision of qualified personnel. Mothers? education level (self-reported) height and weight were collected; children?s height and weight were measured. The former were asked how they perceived their children?s body image. Results. A correlation exists between the mothers? perceptions of the nutritional state of their children via the silhouettes and the BMI classes of the children, which is equal to 80% with a k-Cohen for agreement equal to 0.58 (SE = 0.02; P : 0.0001). However, no correlation exists between the mothers? responses to the question ?In your opinion, is your child ??? and the child?s actual BMI class (the exact percentage correlation is equal to 75%, with a k-Cohen for agreement equal to 0.43 SE = 0.014; P : 0.0001). Discussion. Mothers have an accurate perception of the nutritional status of their children, correctly choosing the silhouette that corresponds to the child?s BMI profile without variation by gender. We can assume that mothers in our sample have a good concept about healthy nutritional status., Journal of Preventive Medicine and Hygiene, Vol 47, No 1 (2006)

Introduction. Road traffic injuries constitute a major public health issue. The Province of Grosseto is one of the territories most affected in the Region of Tuscany. The objective of the study, part of the Road Safety Provincial Council?s project, is to describe the epidemiology of the road accidents in order to contribute to the reduction of the burden of deaths and injuries. Methods. The data relative to road accidents occurring in the Province were drawn from the various sources available: Death Certificates (1991-2005), Police Reports (1991-2003), Hospital Discharge Records (1996-2005), Emergency Room visits (2004-2005). Results. On average, each year road accidents cause 30 deaths, at least 530 hospitalizations, and approximately 3,300 Emergency Room visits. The standardized mortality rate (2003-2005, males: 20.6; females: 6.0), the mortality ratio (2003: 34.6 deaths for every 1,000 accidents), and the severity ratio (2003: 1,432 injured for every 1,000 accidents) are higher than regional figures. Discussion. The greater relative number of fatalities, casualties and crashes can be explained by various physical and social environmental factors such as vast flatland, few greater urban settlements, deprived area. The territory specifically demonstrates an accentuated seasonality in August, a month in which a peak in both the number of accidents and their severity is reported, brought about by the intense volume of commuter and transit traffic, and highlighted by the fact that in that same month approximately half of Emergency Room visits concern non-residents. Conclusion. The complexity of the issue, the number of determinant factors involved, and the disproportionately greater impact on the more disadvantaged and vulnerable segments of society require the development of inter-sectoral strategies and the sharing of responsibility among individuals, groups and communities., Journal of Preventive Medicine and Hygiene, Vol 48, No 4 (2007)