Annali dell'Istituto Superiore di Sanità
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HIV prevalence among adults in Rome: results of the MeDi (Measuring health Disparities in HIV prevention) survey. Part 2
Get PDFBackground. In Italy, out of 60 millions of inhabitants, 3000 (2700-4000) new HIV infections are estimated each year. As combined antiretroviral therapy (ART) prolongs life for HIV sufferers, the prevalence of HIV-infection is likely to increase over time. Few studies have assessed factors associated with being HIV positive in people accessing public outpatient clinics and, in particular, the influence of socio-economic circumstances on HIV prevalence. This study aims to evaluate the association between subjects’ serostatus and socio-economic determinants measured at the individual and neighbourhood levels.Methods. Data from a large anonymous survey performed in 2012-2014 on more than 10 000 individuals 18-59 years old who underwent 21 public ambulatories in Rome were analysed. Subjects’ socio-demographic characteristics, sexual orientation, number of sexual partners, HIV risk behaviour and HIV testing uptake were collected by a selfadministered questionnaire. Level of area deprivation was measured at the postal code level by the index of social disadvantage (ISD). Multilevel Poisson regressions were carried out to take heterogeneity between clusters (post code and clinics) into account.Results. Self-reported HIV-prevalence was 2.0% among subjects ever been tested (13.7% for the homosexual/lesbians 7.0% for the bisexual and 1.3% for the heterosexual). About 1% of subjects self-identified as low risk was HIV infected. This prevalence increased up to 2% in the age group 18-34 and up to 5% in the non-heterosexuals (i.e. self- identified homosexuals/lesbians and bisexuals). At the individual level, HIV-prevalence decreased linearly from lowest to highest levels of education. Living in a deprived neighbourhood was not associated with HIV-infection.Conclusions. Our study confirms high HIV prevalences among homosexuals/lesbians. Some infections occur in subjects who do not report high risk behaviours for HIV transmission
Epidemiological research as a driver of prevention: the Sibaté study
Get PDFAlthough asbestos exposure and risks can be prevented, only five countries in Latin America have banned asbestos, including Colombia. Beginning in 2011, a collaboration between the Istituto Superiore di Sanità in Italy and Universidad de los Andes in Colombia was established, bringing together relevant expertise aiming to improve our understanding of the asbestos problem. An important result of this collaboration was a recently published study conducted in Sibaté, Colombia, a municipality where an asbestos-cement facility has operated since 1942. The evidence collected suggests the presence of a mesothelioma cluster in Sibaté. Landfilled zones with an underground layer of friable asbestos were also discovered in the urban area of the municipality. The importance of this type of collaboration can go beyond understanding the impact of asbestos at the local level, which is crucial, and may also contribute in solving unanswered questions of the problem in countries that banned asbestos decades ago
The increasing need for a new Italian legislation to facilitate execution of observational studies assuring ethics and the highest standards of scientific and methodological quality
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Life planning for people with neurodevelopmental and intellectual disability: effective support, quality of life, and community engagement. Preface
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Prevalence and attitudes to HIV testing among adults visiting public outpatient clinics in Rome: results of the MeDi (Measuring health Disparities in HIV prevention) survey. Part 1
Get PDFBackground. It is estimated that, in Italy, 12 000-18 000 (11-13% of 130 000) HIV-infected subjects are not aware of their serostatus. People in this condition may visit the healthcare system multiple times without being diagnosed. If tested on one of these occasions, they could modify their high-risk behaviours and benefit from treatment, factors that reduce HIV transmission. In Italy, no data on HIV testing in the general population are available so far and little is known on the relationship between socioeconomic determinants (at individual and neighbourhood levels) and testing uptake.Methods. A large anonymous survey was performed in 2012-2014 on more than 10 000 individuals 18-59 years old who underwent 21 public ambulatories in Rome to determine the proportion of subjects tested for HIV and factors related to testing uptake. Subjects’ socio-demographic characteristics, sexual orientation, number of sexual partners, HIV risk behaviour, HIV testing uptake were collected by a self-administered questionnaire. Level of area deprivation was measured at the postal code level by the index of social disadvantage (ISD). Multilevel Poisson regressions were carried out to take heterogeneity between clusters (post code and clinics) into account.Results. Among people participating in the study, 58.1% of subjects self-reported to have been tested at least once for HIV. Those who had one high risk behaviour for HIVinfection were 11% more likely to test than those not reporting any, and subjects who had had a STI (sexually-transmitted-infection) in the past were 12% more likely to test than those who had not had a STI. However only 44% (54% among subjects aged 18-35 years) of those with self-reported risks of contracting HIV had been tested at least once in life. This percentage increases, as expected, with the level of education, but, even so, about 40% of university educated subjects self-reporting risks of contracting HIV had never undergone an HIV test.Conclusions. This study highlights that, while the percentage of subjects tested is even higher than observed in other western nations, only 44% of subjects, self-reporting risks of contracting HIV, had tested at least once in life and about 40% of university educated subjects self reporting risks of contracting HIV had never tested.
Male circumcision: ritual, science and responsibility
Get PDFIntroduction and objectives. In Italy, four minors have died in the last year as a resultof male circumcision (MC) procedures performed for cultural and religious reasons byunqualified persons in unhygienic conditions.Results and discussion. After illustrating the historical and ethical outlines of the moraladmissibility of MC within a comparative perspective, we examine the features of theItalian healthcare system with particular regard both to the heterogeneity of servicesavailable in the various Regions and to the risks engendered by excluding MC from thepublic health setting.Conclusion. In order to adequately safeguard public health, particularly that of minors,there is a pressing need for thorough discussion of whether the National Health Serviceshould perform MC on minors free of charge or, at least, for a reduced fee. The implementationof targeted campaigns may raise awareness of the importance of proper safetymeasures in MC
Application of effect-based methods (EBMs) in a river basin: a preliminary study in Central Italy
Get PDFIntroduction. Effect-based methods (EBMs), i.e. in vitro and in vivo bioassays, represent innovative tools for the effect detection of environmental chemical pollutants on living organisms. The aim of this study was to evaluate the water quality of a river ecosystem implementing two in vivo bioassays on target freshwater animal species: the crustacean Daphnia magna and the small fish Danio rerio, also known as zebrafish.Materials and methods. The methods applied in this study, i.e. the Daphnia sp. Acute Immobilisation assay and the Fish Embryo Acute Toxicity (FET) test, are commonly used in water quality research and their application in short-term ecotoxicity detection is suggested by recent European projects. Two sampling sites were chosen in the urban part of the Tiber River in Rome, while a third one was chosen as a reference site in the Farfa River, a tributary upstream of the city. The sites in the Tiber River are potentially affected by different pollution sources, including urban and industrial wastewater discharges, the pesticide release, livestock waste products, and waste dumps.Results and discussion. The results of the study showed wide differences between the two applied bioassays. The FET test was generally more sensitive in detecting even low effects in all the water samples, but the strongest statistically results were observed with the D. magna Acute Immobilisation test. The results of this research confirm the effectiveness of EBMs in investigating and monitoring water chemical pollution, and stress the need for performing further studies, e.g. chemical analyses and other bioassays, to improve the knowledge of the health status of the Tiber River basin.Conclusions. Further results will aim to support the local authorities in adopting measures to reduce and to eliminate the sources of chemical pollution in the study area
Classification of the Ibuprofen Active Pharmaceutical Ingredients by chemical patterns combining HPLC, 1H-NMR spectroscopy and Chemometrics: Traceability of legal medicines.
Get PDFIntroduction. Ibuprofen is one of the widespread used non-steroidal anti-inflammatorydrugs. Ibuprofen active ingredient is manufactured in many sites located all around theworld. The aim of this paper was to classify the geographical source of ibuprofen activepharmaceutical ingredients (APIs) from the legal market, based on chemical characteristicsand its impurity pattern and to define a geographical fingerprint.Methods. To classify ibuprofen in different geographical groups, the chemometrics byprincipal component analysis (PCA) and Cluster analysis was applied to HPLC, 1HNMRdata of twenty-four samples of APIs from approved manufacturers located in differentEuropean and Asian countries.Results. The PCA showed clearly two different geographical groups, based on particularpatterns of European or Indian samples; the cluster analysis showed the similarity ofgroup.Conclusion. The chemometric analysis is an important tool for tracking the geographical origin of APIs. This could be useful to supplement the quality control ensuring safety of the medicinal products in legal market and dealing with the evolving changes of the illegal market
COVID-19 mortality among migrants living in Italy
Get PDFWe aimed to compare COVID-19-specific and all-cause mortality rates among natives and migrants in Italy and to investigate the clinical characteristics of individuals dying with COVID-19 by native/migrant status. The mortality rates and detailed clinical characteristics of natives and migrants dying with COVID-19 were explored by considering the medical charts of a representative sample of patients deceased in Italian hospitals (n=2,687). The migrant or native status was assigned based on the individual’s country of birth. The expected all-cause mortality among natives and migrants living in Italy was derived by the last available (2018) dataset provided by the Italian National Institute of Statistics.Overall, 68 individuals with a migration background were identified. The proportions of natives and migrants among the COVID-19-related deaths (97.5% and 2.5%, respectively) were similar to the relative all-cause mortality rates estimated in Italy in 2018 (97.4% and 2.6%, respectively). The clinical phenotype of migrants dying with COVID-19 was similar to that of natives except for the younger age at death. International migrants living in Italy do not have a mortality advantage for COVID-19 and are exposed to the risk of poor outcomes as their native counterparts
