Annali dell'Istituto Superiore di Sanità
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Sustainability of Italian seaports located near contaminated sites: results of an exploratory analysis
Get PDFIntroduction. Ports are strategic areas of economic importance, but they are also very critical contexts. Many Italian ports are included in contaminated sites of concern for remediation, with the presence of pressure factors that overload the burden capacity of local ecosystems and communities.Aim. The aim of this study is to characterize Italian seaport areas through a general theoretical path on the theme of ports-sustainability-local communities, identifying the ports located in municipalities included in contaminated sites studied by the SENTIERI Project (Epidemiological Study of Residents in Italian Contaminated Sites). Many of the selected ports, are being part of complex industrial areas, where, in addition to the port area, there are other sources of environmental contamination potentially harmful to health.Results. Excesses risk were observed for mesothelioma and for respiratory diseases, pathologies for which there is epidemiological evidence of an excess of risk associated withresidence in port areas.Discussion. The strong environmental pressures that characterize these areas make itnecessary to adopt adequate environmental and health protection measures
Diagnostic assessment, therapeutic care and education pathways in persons with autism spectrum disorder in transition from childhood to adulthood: the Italian National Ev.A Longitudinal Project
Get PDFIntroduction. The transition from childhood to adulthood is one of the main critical points in the network of services for taking care of people with autism spectrum disorder (ASD). Within the framework of the national research programs on autism, an exploratorylongitudinal multicentre study was conducted. This research program, called “Ev.A Project (Developmental and Adult Age)”, was proposed by the Italian National Institute of Health (Istituto Superiore di Sanità, ISS) and the aim was the development and testing ofa diagnostic, therapeutic, assistance and educational pathway (PDTAE) for autism.Aim. The present study aimed to evaluate two impact outcomes of the care protocol: the response obtained by the ASD person, and the perception of the change in the family context.Methods. Participants underwent an initial clinical evaluation and then after one year. Over the course of the year, participants undertook a program of intervention. The measures of adaptive functioning, need for support, psychiatric symptomatology and familyquality of life were used for the outcome assessment. Linear mixed models were constructed for each measure to estimate the explanatory/predictive behavior of the intensity of the interventions, adjusted for the participant’s level of symptom severity.Results. The results estimate a main effect of Intervention Group (b=-27.22, p<0.001) and severity level (b=-41.87, p<0.001) on the adaptive functioning of the ASD person, but no effect on performance on the dimension of Family Quality of Life (b=0.523, p=0.455).Conclusions. The most significant predictor of the impact on the ASD person is the activation of the service network, which must take into account the level of severity of the presented symptoms
Fluoro-edenite non-neoplastic diseases in Biancavilla (Sicily, Italy): pleural plaques and/or pneumoconiosis?
Get PDFBackground. A mesothelioma cluster in Biancavilla (Sicily, Italy), drew attention to fluoro-edenite, a fibre classified by International Agency for Research on Cancer as carcinogenicto humans. Significant excesses in mortality and morbidity were observed for respiratorydiseases and a significant excess of pneumoconiosis hospitalizations was reported.Objective. Aim of this study is to assess the characters of the lung damage in Biancavillaresidents hospitalized with pneumoconiosis or asbestosis diagnoses.Methodology. Medical records, available radiographs and computed tomography scanswere collected. The obtained imaging was reviewed by a panel of three specialists andfocused on pleural and parenchymal abnormalities. Cases with an ILO-BIT or ICOERDscore equal or greater than 2 were considered positive for a pneumoconiosis-like damage,cases with a score lower than 2 or insufficient quality of imaging were considered inconclusive. If no pneumoconiotic aspects were present the cases were classified asnegative.Results. Out of 38 cases, diagnostic imaging for 25 cases were found. Ten cases out of 25showed asbestosis-like features, nine subjects were considered negative. In six patients’results were inconclusive.Conclusions. Asbestosis-like features were substantiated in Biancavilla residents withoutknown occupational exposure to asbestos. Further studies to estimate population respiratory health are required. Experimental studies on the fibrogenic potential of fluoro-edenite are needed
Architecture of the health system as an enabler of better wellbeing
Get PDFIntroduction. Health systems worldwide have heterogenous capacities and financingcharacteristics. No clear empirical evidence is available on the possible outcomes of these characteristics for population wellbeing.Aim. The study aims to provide empirical insight into health policy alternatives to supportthe development of health system architecture to improve population wellbeing.Method and results. We developed an unsupervised neural network model to cluster countries and used the Human Development Index to derive a wellbeing model. The results show that no single health system architecture is associated with a higher level of population wellbeing. Strikingly, high levels of health expenditure and physical health capacity do not guarantee a high level of population wellbeing and different health systems correspond to a certain wellbeing level.Conclusions. Our analysis shows that alternative options exist for some health system characteristics. These can be considered by governments developing health policy priorities
Effects of combined strength and endurance training on exercise capacity in kidney transplant cyclists and runners
Get PDFIntroduction. After transplantation, engaging in regular physical activity (PA) or sport is recommended for health. Participation to competitive sports is increasingly common among kidney transplant recipients while little is known on how training affects the physical performance in transplanted athletes.Aim. The purpose of this case study was to assess the effects of a tailored training programon exercise parameters in kidney transplant cyclists (CKTRs) and runners (RKTRs).Methods. Twelve male transplanted athletes were enrolled. The workload at aerobic and anaerobic thresholds, the submaximal aerobic power (V’O2 stage) and rate of perceived exertion (RPE) during an incremental cycling or running test, and the peak instantaneous force (PIF) during a countermovement jump were assessed at baseline (T0) and after 6 months of tailored training (T6) consisting in strength and aerobic exercises. Exercise adherence, blood lipid profile and renal function were also investigated.Results. Eight CKTRs and 4 RKTRs completed the 6-month training period, with a significantincrease of training volume (minutes/week). The exercise adherence was met by 90% in both groups. At T6, there were significant (p<0.05) improvements of maximum workload attained, the workload corresponding to the aerobic threshold and PIF, while workloads at anaerobic threshold, V’O2 stage and RPE were unchanged. Blood cholesterol significantly decreased (p<0.01), while the other blood parameters were unchanged.Conclusions. These findings indicate that the combined strength and endurance training is well tolerated and may improve exercise performance in this selected population of KTRs
Determinants of COVID-19 vaccination acceptance or hesitancy in Italy: an overview of the current evidence
Get PDFIntroduction. Vaccine hesitancy is a major public health issue and a challenge for the implementation of COVID-19 immunization campaigns. The objective of this study was to address the determinants of COVID-19 vaccination acceptance or hesitancy in the Italian population.Materials and methods. We conducted a rapid systematic review by searching PubMed until May 3rd, 2022, according to Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Articles assessing determinants of Italians’ attitudes towards COVID- 19 vaccination in terms of hesitancy and/or acceptance were considered eligible. Quality and risk of bias assessment was performed through the Newcastle Ottawa Scale appraisal tool. Determinants were grouped in three categories: contextual, individual and group, and vaccine/vaccination specific influences.Results. Out of 606 articles, 59 studies were included in the analysis. Included studies demonstrated that, in Italy, COVID-19 vaccination acceptance or hesitancy is mostly influenced by perceived safety, efficacy and usefulness of the vaccine.Conclusion. These findings should be considered to plan tailored interventions for counteracting COVID-19 vaccination hesitancy in Italy