Annali dell'Istituto Superiore di Sanità
Not a member yet
755 research outputs found
Sort by
Dietary supplements for human health. What do we really know? A systematic review of umbrella reviews
Full text linkBackground and objective. The potential benefits of dietary supplements for human health have been known since ancient times, but high-quality evidence on their efficacy is lacking. Furthermore, the overwhelming amount of available studies contributes to the vagueness of this topic. The aim of this systematic review was to summarize the evidence on the health benefits of dietary supplements. Methods. A Medline search (via PubMed) was performed. Results. 62 umbrella reviews (also known as reviews of reviews) were retrieved. Most of the results/findings (41.3%) suggested potential beneficial effects of dietary supplements on human health, but with low to very low certainty of evidence. Twenty results/findings (26.7%) supported the efficacy of dietary supplements in improving biochemical parameters and preserving human health, with moderate to high certainty of evidence. All other studies showed uncertain/conflicting results or inefficacy. Conclusions. The demonstration of the beneficial properties of dietary supplements is far from conclusive and high-quality studies are needed
Erratum for: Efficacy of sodium oxybate plus disulfiram for the maintenance of alcohol abstinence in treatment-resistant patients with alcohol use disorder: a multicentre retrospective study Ann Ist Super Sanità 2024 | Vol. 60, No. 4: 252-257 DOI: 10.4415/ANN_24_04_03
No full textIntroduction. Disulfiram (DF), acamprosate, naltrexone, baclofen and sodium oxybate (SO) are currently the medications approved for the treatment of alcohol use disorder (AUD). In this context, combined pharmacological interventions and sex differences arean interesting area in the treatment of non-responder AUD patients.Aim. To evaluate the efficacy of SO in combination with DF in maintaining alcohol abstinence in patients with AUD who failed to achieve abstinence either with SO or DF alone.Methods and results. 126 detoxified AUD patients, previously treated with only SO or DF, were retrospectively enrolled from 2018 to 2022. At the end of treatment, a higher number of females than males (74.1% vs 66.3%: p=0.03) maintained continuous abstinence from alcohol, and all the females responded completely or partially to the treatment.Conclusions. This study shows that the combination of SO and DF may be considered a further pharmacological opportunity for AUD patients (particularly in females) who do not respond to mono-therap
Worldwide prevalence of tattoos with a focus on younger age groups: a literature review
Full text linkBackground. From 11.7% to 31.5% of the population in Western countries has tattoos. Given the potential health implications, it is important to obtain reliable estimates of the prevalence of the tattooed population.Objective. To estimate the prevalence of tattoos in the general population and among younger age groups worldwide, and the settings in which tattoos are performed.Methods. We conducted a literature review by searching MEDLINE, Scopus, and Web of Science for relevant articles published between January 1, 2000, and September 17, 2025. Studies were included if they reported data on the prevalence of tattoos and/or the settings in which tattooing occurred, drawn from the general population or specific age groups and students.Results. From the 7,921 potential articles identified, 86 were included in our review. We found a global prevalence ranging from 0.18% to 63.9% (from 5.2% to 35.3% in developed countries), with a significantly increasing trend. The data revealed a higher tattoo prevalence among younger individuals. In Western countries, from 64% to 93.9% of the samples got their tattoos in authorized parlours.Conclusions. The data demonstrate a clear increase in tattooing worldwide. This represents a matter of concern from a public health perspective, as it is likely to be accompanied by a corresponding increase in health risks and requests for tattoo removal
Needs for a shared operational methodology to draft guidelines and good practices in legal medicine
Full text linkIntroduction. Article 5 of Law n. 24/2017 established the obligation for medico-legal professionals to adhere to guidelines and good clinical-care practices, except in specific cases. However, the methodologies developed for clinical practice are not entirely applicable to the field of legal medicine, which presents unique characteristics in terms of regulatory context, objectives, and evaluative processes. Legal medicine does not primarily focus on diagnosis or treatment but on standardized assessment procedures, legal defensibility, and consistency of judgments.Objectives. Starting from the experience of the Central Health Department (Sovrintendenza Sanitaria Centrale, SSC) of the Italian National Institute for Insurance against Accidents at Work (Istituto Nazionale per l’Assicurazione contro gli Infortuni sul Lavoro, INAIL), the goal is to develop a dedicated manual outlining the appropriate methods for developing guidelines and best practices in legal medicine, proposing a methodological framework.Methods. The authors conduct a review of the literature on the topic related to the methodology for developing guidelines and best practices in forensic medicine. They took inspiration from the methodological manual for the production of clinical practice guidelines by the Italian National Institute of Health (Istituto Superiore di Sanità, ISS).Discussion. The authors highlight the lack of literature specifically addressing the development of guidelines and best practices in forensic medicine. The methodological manual for the production of clinical practice guidelines by the Italian National Institute of Health (ISS) requires some adaptations but certainly represents a highly useful tool for creating relevant recommendations for legal medicine. Therefore, the authors propose a specific methodology and a dedicated manual tailored to legal medicine. The manual should be adapted from the ISS methodologies used in clinical settings, revised to reflect the unique needs of medico-legal practice, and developed in close collaboration with the relevant scientific societies and institutions.Conclusions. The method used for INAIL’s SSC recommendations has proven effective in guiding internal medico-legal practices. Building on the ISS methodological manual, the authors propose a tailored approach for developing guidelines (LGML) and best practices (RBPML) in legal medicine. Given the unique challenges of the discipline – often not fully addressed by existing regulations or literature – standardized solutions are necessary to ensure consistent, high-quality medico-legal outcomes. Therefore, the establishment of a dedicated Working Group in collaboration with the ISS is essential to develop a structured methodology. INAIL’s prior experience in this field provides a solid foundation for this initiative
Paternity and parental leave in Italy: the parents’ perspective
Full text linkBackground. Growing recognition of fathers’ role in childcare highlights paternity and parental leave policies. The aim of this study is to investigate the perspectives of parents in Italy on the paternity and parental leave utilisation by fathers.Materials and methods. A cross-sectional study was carried out, using web-based questionnaires targeting parents of children born between 2018 and 2023. Descriptive statistics and multivariate logistic regression models were used to analyse quantitative data, while qualitative content analysis was applied to open-ended responses.Results. A total of 3,811 mothers and 720 fathers responded. Paternity leave was used by 72.6% of fathers. Non-use was primarily attributed to ineligibility (58.4%). Fathers’ parental leave utilisation was low (20.4%). Most parents agreed that mothers need longer leave for the dyad’s needs, like breastfeeding. Living in southern Italy and having lower educational levels reduce the likelihood to take leave.Conclusions. Paternity and parental leave are underutilised by fathers in Italy. There is a need for better-paid and more accessible leave policies to promote active fatherhood and gender equality
Sodium oxybate and acamprosate association for maintenance of alcohol abstinence: a case series
Full text linkBackground. Disulfiram, acamprosate (ACM), naltrexone, and nalmefene are medications currently approved for the treatment of Alcohol Use Disorder (AUD). Baclofen and sodium oxybate (SO) have been approved for the treatment of AUD and alcohol withdrawal syndrome in France and Italy, respectively. However, concerning the effectiveness of combined therapies for AUD, data from the current literature are contrasting.Aims. To investigate the outcomes of combined therapy of SO and ACM for the maintenance of alcohol abstinence.Methods. A sample of 48 AUD patients consecutively enrolled and treated with SO (50-100 mg/kg of body weight, t.i.d.) plus ACM (666 mg three times daily; with dosage reduced in patients with body weight <60 kg) was observed for 12 weeks.Results. At the 3-month visit, continuous abstinence from alcohol was maintained by 34 patients (70.8%). Fifteen patients (31.3%) reported side effects like nausea, dizziness, and abdominal pain, with no significant differences between abstinent and not abstinent patients.Conclusion. SO plus ACM may be an effective and safe pharmacological combination for maintaining alcohol abstinence in AUD patients. Future ad hoc clinical trials are needed to test this therapeutic association for AUD treatment
Evaluating screen exposure in very young children: insights from the Italian Surveillance System of children aged 0-2 years
Full text linkObjective. To describe screen exposure and its association with socio-economic characteristicsin a large representative sample of children aged 0-2 years in Italy.Materials and methods. Data from the 2022 Italian Surveillance of children aged 0-2 years, collected on 35,550 mothers, were analysed to estimate the prevalence of screen exposure. Logistic regression was used to investigate the association between exposure and potential predictors.Results. Overall, 39.2% of children aged 2-15 months were exposed to digital screens. The exposure prevalence increased with age, ranging from 13.9% at 2-3 months to 61.9% at 13-15 months. Screen exposure was significantly more frequent among children of mothers with non-Italian citizenship, having lower levels of education, reporting economic difficulties, non-participating in antenatal classes (ACs), and residing in the center-south.Conclusions. Most babies, particularly from low socio-economic status (SES) families, were exposed to screens in a period when this may interfere with responsive caregiving and thus with early child development. It is imperative to inform parents and caregivers about the risks of early exposure since the first months of life
Antenatal care services and pregnancy outcomes during the COVID-19 pandemic in Milan, Lombardy
Full text linkBackground. During the COVID-19 pandemic maternity healthcare seeking and provision reduced worldwide. We explored the indirect effects of the pandemic on key pregnancy outcomes and access to antenatal care services.Methods. Observational cross-sectional study on all pregnancies between years 2019- 2020 in Milan metropolitan area (Lombardy, Italy). Multiple logistic regression analysis was used to assess the access to antenatal care (ANC) services (timing of first contact, ultrasound examinations (US) and ANC contacts) and pregnancy outcomes (preterm births, perinatal deaths and surgically treated ectopic pregnancies). Data were retrieved from both administrative (public healthcare) and self-reported sources (public and private services).Results. The first antenatal contact was slightly delayed in pandemic year 2020. Adequate levels of antenatal care were maintained according to self-reported data, though a decrease in public healthcare was noted (administrative data). Perinatal death and preterm birth risk did not worsen, while it increased for surgically managed ectopic pregnancies
Monitoring prevalence of breastfeeding and associated factors: results of the 2022 data collection of the Italian surveillance of children aged 0-2 years
Full text linkObjective. To describe breastfeeding and associated factors in a large representative sample of children aged 0-2 years in Italy.Materials and methods. Data from the 2022 Italian surveillance of children aged 0-2 years, comprised of 35,550 mothers, were analysed to estimate rates of EBF (exclusive breastfeeding), any breastfeeding (BF) and never breastfed (NBF). Logistic regression was used to investigate the association of EBF, BF and NBF with potential predictors.Results. EBF among children aged 2-3 months varied from 36.4% in the South Italy to 54.0% in the North, decreasing respectively to 19.6% and 35.8% at 4-5 months. At 12-15 months BF ranged between 29.2% (South) and about 40% (Centre and North). Women with Italian citizenship, having a lower educational level, those who never attended antenatal classes (AC), and those residing in the South were significantly less likely to exclusively breastfeed or to breastfeed after the first year of life of the child.Conclusions. The data underscore the gap between recommendations and actual breastfeeding practices, offering the first national perspective that highlights territorial disparities. The findings emphasize the need for targeted interventions, particularly in light of identified regional and socio-economic differences
Relative excess measures of effect and their use in health impact assessment
Full text linkIntroduction. In health impact assessment, relative excess measures of effect are used in combination with exposure and outcome data to estimate the health impacts under an alternative exposure scenario. This study aims to propose: a classification ofrelative excess measures of effect functional for health impact assessment; a standard and general framework for calculating health impacts; different approaches when using data at different spatial resolutions.Methods and results. A classification of the relative excess measures of effect was presented, introducing a new measure. A standard framework for calculating attributable and preventable cases based on the nature of the exposure and the imagined change in exposure was described. The marginal and conditional approaches to calculate health impacts using data at different spatial resolutions were illustrated.Conclusions. The proposed methods and frameworks are designed to be applicable to a range of different situations. As health impact assessment continues to evolve, the insights and tools provided in this paper could help guide effective and equitable assessments, ultimately contributing to better public health decisions and outcomes