Annali dell'Istituto Superiore di Sanità
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Knowledge, attitudes and practices regarding HIV/AIDS and STIs among youths and key populations in informal settlements of Nairobi, Kenya
Get PDFKenya is home to one of the worst HIV/AIDS epidemics, with higher prevalence rates in youths in urban slums. We conducted a cross-sectional mixed-methods study in Nairobi informal settlements. The aim was to investigate knowledge, attitudes and behaviours of this marginalized community, and to identify, with a bottom-up approach, the most appropriate interventions to increase the utilization of HIV/STIs services. Preliminary qualitative research was used to draw questionnaires, which assessed: STIs/HIV/AIDS knowledge, attitudes, and behaviours; access and barriers to STIs/HIV/AIDS services; perceived quality of services; the impact of COVID-19. 1054 respondents completed the questionnaire. 48.3% were youth in the community, 23% youth in school, 16.8% young mothers, 6.9% drug users and 5% people attending a technical-vocational training. We found unsatisfactory knowledge of STIs/HIV/AIDS transmission and prevention, and low condom use, mainly due to difficult access, poverty, and gender-based violence. We also found limited use of health services, and lack of trust due to poor attitude of the staff. COVID-19 has widened barriers to access to health services. To reach this population, it is necessary to implement educational interventions, facilitate access to free condoms, and train health centre staff to be more welcoming. Respondents found proximity strategies more efficient, including door-to-door testing and community outreac
Effectiveness of different local actions to control vitamin D prescription in Italy
Get PDFIntroduction. In the last decade, the significant expenditure and consumption increase of vitamin D in Italy led some regions to adopt strategies to improve prescribing appropriateness and contain expenditure.Materials and methods. Using the statistical analysis method of interrupted time series for consumption and expenditure of cholecalciferol, different types of interventions adopted in four Italian regions and their efficacy were evaluated.Results. Molise achieved the best results by adopting a health professionals’ education program in addition to a prescriber-sanction system. Emilia-Romagna also opted for a medical education strategy, but the results were less relevant due to the lack of penalties.Lazio obtained a slowdown in consumption growth by targeting on the utilization of lower-cost per defined daily dose (DDD) packs and adopting a therapeutic plan. Sardinia showed a decrease in expenditure by adopting a target threshold of lower-cost formulation.Conclusion. The reimbursement of the lowest-cost packs within the National Health Service (NHS) undoubtedly influences spending trend, but it does not solve prescriptive inappropriateness
The rare malformation holoprosencephaly: pathogenesis, association with pregestational diabetes and the possible link with food pollutants
Get PDFBackground. Holoprosencephaly is a rare (1/16,000 livebirths) and severe brain malformation occurring during early embryogenesis. The malformation originates from absent or incomplete forebrain division and is associated with altered embryonic patterning.Objectives. A narrative review to identify and assess the evidence on non-genetic risk factors.Results. Genes involved include sonic hedgehog, Zinc finger protein, SIX homeobox 3. Pregestational diabetes, with periconceptional hyperglycaemia, is the main non-genetic risk factor; increased oxidative stress in neuroectoderm, in particular neural crest cells,appears as the main mechanism. Several widespread pollutants, including inorganic arsenic, PFAS and PCBs, may increase the risk of pregestational diabetes by altering metabolic factors, including lipids and insulin. A scenario “widespread exposures-rare outcomesin susceptible subjects” suggests that exposure to dietary pollutants may increase the risk of pregestational diabetes, hence of holoprosencephaly in susceptible embryos.Conclusions. This complex pathway is plausible and worth being investigated; moreover, it highlights the importance of assessing risk factors, and the associated uncertainties, in order to support primary prevention strategies for multifactorial malformations
The new Italian National Immunization Technical Advisory Group (NITAG) and its commitment to endorse a new efficient National Immunization Plan in COVID-19 times
Get PDFAmong the objectives of the WHO Global Vaccination Action Plan 2020-2025, there is the establishment, in all countries, of a National Immunisation Technical Advisory Group (NITAG), an independent body with the aim of supporting and harmonising vaccination policies. Italy firstly established a NITAG in 2017; it contributed to the country\u27s vaccination policies but did not achieve the goal of becoming a real reference body. The new NITAG, recently appointed, made up of 28 independent experts, has the ambitious goal to promote the new National Immunisation Prevention Plan (PNPV), to harmonise the current vaccination schedule with the anti-COVID-19 campaign, and to recover the vaccination coverage decline that occurred during the pandemic. To reach these goals the interaction with the ECDC EU/EEA, the WHO Global NITAG networks and all the national stakeholders need to be strengthened. This paper describes the structure, organisation, and strategy of the new Italian NITAG
Exploratory study on the endogenous ouabain in idiopathic pulmonary arterial hypertension patients
Get PDFIntroduction. Endogenous ouabain (EO) is a steroid hormone secreted by the adrenal glands associated with adverse cardiovascular outcomes. However, EO plays other roles as brain protection against traumatic injury and seems involved in the adaptive response to hypoxia. Recently, we detected, for the first time, EO in a healthy human group of acute hypoxia and diving animals. Methods. This study complements the above as we considered a human model of chronic hypoxia. The aim is to detect EO in five idiopathic pulmonary arterial hypertension patients. Results and Discussion. We found that these patients had higher plasma concentrations of EO than control subjects. In addition, EO plasma concentrations were negatively correlated with the mean pulmonary arterial pressure and total pulmonary vascular resistance. The results could suggest that high concentrations of EO are predictive of better adaptation of the right ventricular afterload. Conclusion. Although the results are preliminary, they can represent a helpful hint for future investigations for possible therapeutic and diagnostic approaches
Rural-urban variation in willingness to donate blood in Ibadan Region, Nigeria
Get PDFBackground. Although there are ongoing blood donation campaigns in Nigeria, the prevalence of voluntary blood donation is about 10% and there is limited information about the determinants of blood donation behavior, especially across rural-urban geographic areas. This study examines the rural-urban differences in willingness to donate blood.Method. A cross-sectional study addressing adults from three rural and three urban communities was performed in 2021 to evaluate willingness, knowledge, attitude and practice of blood donation.Results. A total of 287 individuals were surveyed. Most of the respondents across all communities have never donated blood (72%). Females aged 18-25, highly educated, and from urban communities were more incline to donate blood compared to their counterparts.The main reasons for not donating blood for rural dwellers were: never thought of it (39% vs 34.7%) and no one asked (34.4% vs 17%); fear of needles was declared mostly by urban dwellers (21.8% vs 12.5%) (p=0.02).Conclusions. Willingness to donate blood varies across rural and urban communities and is influenced by socio-demographic characteristics. The gap between willingness to donate and actual blood donation has consequences for the establishment of blood transfusion services. Targeted public health interventions are required to enhance awareness and knowledge and modify attitudes towards blood donation
Gender and burden differences in family caregivers of rare disease patients
No full textObjectives. Gender differences in caregiving may determine social and/or health inequalitiesamong family caregivers (FCs). This study aimed to analyse gender specific differences of burden and quality of life (QoL) in FCs belonging to ten different rare diseases (RD).Methods. Burden levels and QoL data, derived from a sample of 210 FCs of RD patients, were analysed by student t-test, Anova and Kruskal-Wallis followed by multiple comparisons and evaluation of factors, including sex, by correlation and multiple regression analyses.Results. FCs caring for Prader Willi, X-fragile, mucopolysaccharidosis and epidermolysisbullosa patients showed significant higher levels of burden as compared to other RDs.Burden is related to FC’s QoL and can be down modulated by the reduction of the number of hours/week devoted to care and by the improvement of patient’s QoL. No gender-specific burden differences were observed among all FCs. However, female FCs devoted to care significant more numerous hours/week than men and perceived more emotional/physical burden and poorer psychological health than males. Women, who are more frequently early retired from work, not occupied or homemakers than men, suffered more burden as compared to men in the same conditions.Conclusions. This study showed gender specific differences in RD caregiving, which are important for planning personalized health prevention policies
Estimation of ethanol and methanol exposure through jarred fruit purees
Get PDFIntroduction. Chemicals in foods enter the human body from early life likely posing chronic toxic health risks in the future. This study aimed to estimate the exposure to ethanol and methanol in children consuming an acceptable daily amount of fruit purees.Methods. Different fruit purees were purchased and measured for methanol and ethanol by using HS-GC. The exposure dose of these alcohols was calculated based on a consumption of 125-250 g of fruit purees in children weighing 7, 12 and 16 kg.Results. The highest methanol was found in carrot-apple puree (29.07 mg/dL) and ethanol in peach-banana puree (42.07 mg/dL). Daily methanol exposure was estimated between 4.54 and 6.06, and ethanol between 6.57 and 8.76 mg/kg bw.Conclusions. Our results show higher exposure doses of methanol and ethanol than allowable ones (methanol 2 and ethanol 6 mg/kg/day) in children consuming fruit purees.This should be handled as a public health risk and further comprehensive studies should be enrolled on the chronic toxic effects of food-derived alcohols. Besides, food-derived exposure to toxic chemicals from early life should be more questioned by physicians (inassessing chronic diseases), and related authorities should establish a sustainable, safe, and healthy food production policy
Epidemiology of perinatal depression in Italy: systematic review and meta-analysis
Get PDFIntroduction. This review aims to synthesise the studies that have estimated the prevalenceof perinatal depression in Italy, summarising the results of the existing literature based on their quality.Materials and methods. Systematic searches were conducted in four major databases, and a random effect meta-analysis was performed to achieve the pooled variance of perinatal depression.Results. The pooled prepartum risk of depression prevalence was 20.2% (CI 95% 15.3- 24.5) while the postpartum risk of depression prevalence was 27.5% (CI 95% 17.8-37.3) for an Edinburgh Postnatal Depression Scale (EPDS) cut-off score ≥9 and 11.1% (CI 95% 6.0-16.2) for an EPDS cut-off score ≥12. Significant publication bias was found and was determined by the presence of a small study with a low prevalence and a large study with a high prevalence.Conclusion. The prevalence of perinatal risk of depression is similar to that reported in other countries. The high prevalence of prepartum risk suggests the need to activate specific prevention actions during this period