Annali dell'Istituto Superiore di Sanità
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Could we fight healthcare-associated infections and antimicrobial resistance with probiotic-based sanitation?
Get PDFHealthcare-associated infections (HAI) affect every year about 4 million hospitalized patients in the EU, causing over 33,000 deaths as a direct consequence and over 1.1 billion € associated costs. Besides the persistent microbial contamination of the hospital environment, a major cause is the rampant antimicrobial resistance (AMR) of the HAI-associated pathogens. The hospital environment itself is in fact a reservoir of resistant pathogens, apparently not sufficiently controlled by conventional chemical-based sanitation. A recently published study, the SAN-ICA study, performed in Italy, suggests that the fight against AMR may involve probiotic-based sanitation approaches, as they might stably reduce AMR surface pathogens, finally reducing HAI incidence. Here we discuss the reported results and argue that their use may provide a novel approach which deserves exploration
Syringomyelia and Chiari Syndrome Registry: advances in epidemiology, clinical phenotypes and natural history based on a North Western Italy cohort.
Get PDFBackground. Syringomyelia and Chiari Syndrome are classified as rare diseases, but current known occurrence in Europe is missing. The increased ability to diagnose these pathologies by magnetic resonance imaging and its widespread availability has led to an increase of reported cases, often asymptomatic, with the need to standardize definitions, diagnostic criteria and treatments.Aims. We present shared Interregional Recommendations developed with the primary aim to estimate Syringomyelia and Chiari Syndrome prevalence and incidence in North Western Italy, with special reference to symptomatic forms.Methods. An agreement for the standardization of definitions, classifications, diagnostic criteria and surgical Recommendations was reached by the multidisciplinary Interregional Piemonte and Valle d’Aosta Chiari-Syringomyelia Consortium (Delphi method); next, in 2011 a census for Syringomyelia and Chiari Malformation was performed through the Interregional Piemonte and Valle d’Aosta Rare Disease Registry, integrated by a dedicated form in order to estimate prevalence and incidence.Results. 436 patients, 292 females, met shared interregional diagnostic criteria. Syringomyelia prevalence was estimated in 4.84:100 000; Chiari Malformation prevalence was 7.74:100 000; incidence was 0.82:100 000 and 3.08:100 000 respectively. Demographics, neuroradiological parameters and aetiology were reported (in symptomatic and asymptomaticforms). Finally, symptoms and signs, familiar and natural history were analyzed.Conclusions. First Italian epidemiological data (prevalence, incidence) on Chiari and syringomyelia was collected, according to shared diagnostic Recommendations. Future perspectives include the adoption of these Recommendations at national level to standardize the access to diagnosis and care process and promote multicenter clinical trials
Italian pool of asbestos workers cohorts: asbestos related mortality by industrial sector and cumulative exposure
Get PDFObjective. Italy has been a large user of asbestos and asbestos containing materialsuntil the 1992 ban. We present a pooled cohort study on long-term mortality in exposedworkers.Methods. Pool of 43 Italian asbestos cohorts (asbestos cement, rolling stock, shipbuilding,glasswork, harbors, insulation and other industries). SMRs were computed by industrialsector for the 1970-2010 period, for the major causes, using reference rates by age,sex, region and calendar period.Results. The study included 51 801 subjects (5741 women): 55.9% alive, 42.6% died(cause known for 95%) and 1.5% lost to follow-up. Asbestos exposure was estimated atthe plant and period levels. Asbestos related mortality was significantly increased. Allindustrial sectors showed increased mortality from pleural malignancies, and most also from peritoneal and lung cancer and asbestosis, with exposure related trend. Increased mortality was also observed for ovarian cancer and for bladder cancer.Discussion. The study confirmed the increased risk for cancer of the lung, ovary, pleura and peritoneum but not of the larynx and the digestive tract. A large increase in mortality from asbestosis was observed
Need for a sustainable use of medicinal products: the impacts on the environment of ivermectin
No full textIt is worldwide recognized that the use of pharmaceuticals for human and veterinarypurposes could lead to unsustainable effects on the environment. A strategy to reducethe impact of pharmaceuticals on the environment has been recently established at European level, where guidelines to evaluate the impacts of veterinary drugs used to treatanimal diseases are in place. The aim of this article is to focus on the worldwide used antiparasitic drug ivermectin (IVM) and its potential impact on the environment. A specificsection is related to the IVM resistance that the massive use of this drug could generateenhancing the risk scenarios also for human health. The application of stringent measuresfor the veterinary use of this substance, in line with the recommendations providedby International frameworks such as One Health and EcoHealth, is recommended
Taking care of minor migrants’ health: the professionals’ perception and training needs.
Get PDFIntroduction. In Italy, minor migrants represent 21.8% of the non-EU citizens. The careof minor migrants might be challenging as this population is characterized by highervulnerability and special needs. The study aim was to describe the perceptions on theprovision of care, the bio-psycho-social needs of migrant children and the professionaltraining needs.Methods. The study is qualitative descriptive. In May 2019 three focus group, involvinghealth and social professionals, cultural mediators and NGOs operators, were organized.Results. The study explored different areas of the provision of care to minor migrants includingbio-psycho-social needs, care provision, barriers to care and professionals’ trainingneeds.Discussion and conclusions. The provision of care should consider the specific migrationjourney and narrative. In some cases healthcare is fragmented, generating obstaclesto access especially in minors with lower levels of health literacy. Training plays a key rolein the development of cultural competence
A few ethical issues in translational research for medicinal products discovery and development
Get PDFIt is worldwide recognized that the use of pharmaceuticals for human and veterinarypurposes could lead to unsustainable effects on the environment. A strategy to reducethe impact of pharmaceuticals on the environment has been recently established at Europeanlevel, where guidelines to evaluate the impacts of veterinary drugs used to treatanimal diseases are in place. The aim of this article is to focus on the worldwide used antiparasitic drug ivermectin (IVM) and its potential impact on the environment. A specificsection is related to the IVM resistance that the massive use of this drug could generateenhancing the risk scenarios also for human health. The application of stringent measuresfor the veterinary use of this substance, in line with the recommendations providedby International frameworks such as One Health and EcoHealth, is recommended
Young people’s health in Italy: data from the Health Behaviour in School-aged Children (HBSC) survey 2018 and suggestions for action. Preface
Get PDFThis is a Preface of Monographic section
Prevalence and correlates of food insecurity among children in high-income European countries. A systematic review
Get PDFBackground. In Europe, there is not routinely collected data on children’s food insecurity. Indirect data show that food insecurity is on the rise in Europe, which may have a great impact on children’s health.Methods. Considering that, we systematically reviewed any evidence coming from European countries in the last 10 years that reported the prevalence and correlates of food insecurity among children, intending to serve as a starting point for policymakers and guidelines.Results. We report worrying prevalence rates of food insecurity among children from 9 studies. There is a lack of evidence regarding this issue in many EU countries, especially Eastern Europe. Hence, the need for increased attention towards food insecurity among children in European countries.Conclusions. Achieving food security means designing targeted policies and interventions, both at a national and EU level. Policymakers and governments should make the appropriate efforts to deliver food security as a public good
Microbiological ascertainment in patients with pneumonia: the experience of a teaching hospital in Rome
Get PDFObjectives. Pneumonia still remains a problem from the clinical and public health viewpointbecause of the relevant epidemiological burden. The etiological diagnosis is importantin the light of avoiding unnecessary antibiotic treatment and choosing the mostappropriate therapeutical approach. This study is aimed at providing evidence on theproportion of microbiological ascertainment in pneumonia-related hospitalizations inone of the most important teaching hospitals in Rome.Methods. The study relied on the record linkage of two administrative databases of thesame hospital: the electronic hospital discharge register and the microbiology laboratorysurveillance database.Results. 2819 records were identified, where 46% had a microbiological ascertainment,significantly higher in males than in females (51% vs 40%) and in cases of pneumoniareported in secondary diagnosis instead of primary diagnosis (52% vs 42%). Medical patientshad significantly lower proportion of ascertainment compared to surgical patients(43% vs 67%) whereas there were not differences between patients with emergency andelective admission. The overall mortality was 17%. Mortality was significantly higher: insurgical compared to medical patients (27% vs 15%), in ventilated compared to not ventilatedpatients (41% vs 11%), in cases with secondary diagnosis of pneumonia comparedto a primary diagnosis (23% vs 11% ) and in hospitalized in intensive care unit-ICUratherthan in non-ICU (71% vs 12%).Conclusion. The proportion of microbiological ascertaiment in pneumonia remains lessthan 50%. Albeit in line with other evidence, this result should call the attention on theimpact of unknown etiological diagnosis on antibiotic treatment and resistance