Annali dell'Istituto Superiore di Sanità
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Italian external quality assessment program for cystic fibrosis sweat chloride test: a 2015 and 2016 results comparison
Get PDFBackground: Diagnostic testing in cystic fibrosis (CF) is based on the sweat chloride test (SCT) in the context of appropriate signs and symptoms of disease and results of the gene mutation analysis. In 2014 the Istituto Superiore di Sanità (ISS) established a pilot Italian external quality assessment program for CF sweat chloride test (Italian EQA-SCT). In 2015 this activity was recognized as a third party service carried out by the ISS and the first official round was carried out. Aim of the present paper is to compare 2015 and 2016 results and experiences. Methods: the scheme is prospective; participation is open to Italian laboratories performing sweat test analysis for CF diagnosis. Enrollment is voluntary and since 2015 the payment of a fee is required. Participants are registered and identified through a dedicated web-facility; each participant is identified by a specific Identification Number (ID) known only to the scheme organizer (ISS). Assessment covers analysis, interpretation and reporting of results. Results: thirteen and fifteen laboratories, belonging to the Italian public Referral Centers for CF, participated in the 2015 and 2016 round respectively. Seven laboratories participated constantly in the Italian EQA-SCT from 2014, eleven participated both in 2015 and 2016 and four participated in 2016 for the first time. Variability in scores of chloride titration and heterogeneity in interpretation/reporting results were detected in both rounds. A total of 18 critical errors in chloride titration were made by eight different participants (3 laboratories participated to both 2015 and 2016 schemes). Four laboratories made errors in chloride titration samples in 2015 but drastically improved their performance in 2016. In 2016 poor performance criteria were established and adopted: three laboratories (one participating in both 2015 and 2016 rounds and two first time participating) were marked as poor performers. Conclusions: even though results show variability in performance of laboratories, constant and mandatory participation may contribute to the improvement of performance and quality reached by laboratory
Surveillance of childhood overweight: comparison of “OKkio alla SALUTE” survey and general paediatrics data in the Province of Trento
Get PDFThe estimates of childhood overweight and obesity for Trentino provided by the 2014 “OKkio alla Salute” survey (national surveillance programme for weight and nutrition in children) were compared with estimates provided by paediatric health forms completed at the age of six. The Province of Trento is the only region that makes use of the information gathered through these forms, which are completed by primary care paediatricians as part of the 6-year health evaluation. Okkio alla Salute data for children in Trentino, obtained from students enrolled in the third year of primary school in 2014 (845 subjects), was compared with data collected at the age of 6 for cohorts born in 2006, evaluated in 2012-2013 (3,101 subjects). The following prevalence figures were revealed: overweight: 17.4% Okkio alla Salute and 11.7% 6-year evaluation; obese: 4.1% OKkio alla Salute and 3.5% 6-year evaluation; severely obese: 1.4% Okkio alla Salute and 1.0% 6-year evaluation. The two information sources provide similar estimates, suggesting the potential for their integrated use
Patient-physician alliance: from Hippocrates to Post-Genomic Era
Get PDFPatients need clinical competence, appropriate diagnosis and therapies in overcoming their disease. Yet this is insufficient. The illness experience tends to frighten people and the resulting emotional aspects could become relevant factors in coping with a sickness and disability. Hippocrates was the first to urge physicians to look beyond the physical features of diseases and to consider the patient as a unique psychosomatic entity. Additionally, the scientist spurred physicians to make the patient an active participant in combating the disease. According to Hippocrates, ‛The Medical Art has three actors: the physician, the patients and the disease. The physician and the patient must be allied against the disease in order to fight it.’ In the ‛Post Genomic Era’, an effective therapeutic approach merits a patient-physician participation, based on scientific understandings and human considerations. These recommendations are even more urgent for Rare Diseases
Fostering public health awareness on risks in contaminated sites. Capacity building and dissemination of scientific evidence
Get PDF The article focuses on the multidisciplinary nature of public health and the need to develop target oriented capacity building and dissemination plans taking into account both scientific evidence and the information needs of the different stakeholders. In particular, issues regarding stakeholders’ involvement in epidemiological studies in contaminated sites, considering their different levels of awareness on risk characterization and management, are discussed. In a public health perspective, the main stakeholders in ntaminated sites re researchers and public health officers, risk managers and policy makers, population esiding in the contaminated areas, environmental associations, patient’s organizations. The different components of a dissemination strategy addressed to different stakeholders are analyzed with the objective to create awareness and preparedness to facilitate management in contaminated sites, foster scientific knowledge and informed decisions to consolidate risk perception through science-driven information.
A cross-disciplinary approach to global environmental health: the case of contaminated sites
Get PDFCross-disciplinary approaches to Global Environmental Health are essential to address environmental health threats within and beyond national boundaries, taking into account the links among health, environment and socio-economic development. The aim of this study is to present a cross-disciplinary approach where knowledge and findings from environmental epidemiology and social research are integrated in studying environmental health issues, focusing on environmental health inequities, public and environmental health literacy, and international scientific cooperation. In the case of contaminated sites, environmental epidemiology can contribute investigating the ultidimensionality of equity for sustainable development practices. These practices entail a better understanding of environmental contamination, health effects pathways and improved capacities of different stakeholders to identify policy options for environmental risk prevention, remediation and management that will foster informed participation in decisions influencing communities. International scientific cooperation frameworks adopting equity principles shared by scientific community, populations and decision-makers may be of valuable support to this task
A survey on lifestyle and level of biomarkers of environmental exposure in residents in Civitavecchia (Italy)
Get PDFBackground. The assessment of individual exposure to toxicants in industrially contaminated areas is difficult when multiple productions are active close to residential areas. Two thermoelectric power plants and a large harbor have been operating since the ’60s in the area of Civitavecchia (North of Rome). Methods. The ABC (Ambiente e Biomonitoraggio nell’area di Civitavecchia, Environment and Biomonitoring in Civitavecchia) program involved, in the period 2013-2014, residents in Civitavecchia and in the nearby municipalities (Santa Marinella, Allumiere, Tolfa and Tarquinia). They were randomly selected from the Municipal Register’s data and their residence addresses were geocoded using GIS techniques. Biomonitoring of the following urinary metals, Sb, Be, Mo, Cd, Sn, W, Ir, Pt, Hg, Tl, V, Cr, Mn, Co, Ni, Cu, Zn, Rh, Pd, As were performed. Glucose and lipid metabolism, liver, renal, and endocrine function were evaluated through blood laboratory tests. Tests of lung function were also carried out as well as saturometry (oxygen rate in the blood with an illuminated sensor placed on the fingertip), anthropometric and blood pressure measurements. Information on individual characteristics, histories of exposure, such as the consumption of local food, occupational history, lifestyle and medical history were collected through a validated questionnaire. Samples of nails and hair were also collected. The biological material (blood, urine, nails and hair) was stored in a biobank for future analysis related to the possible mechanisms of biological damage. The study protocol received the approval of the local ethics committee. Results. A total of 1177 residents were enrolled (58% female, 60% with a secondary or graduate school degree). No particular differences in metal concentrations based on the municipality of residence were observed. For arsenic, mercury, lead, and tungsten some differences between the two geographical areas were observed, probably due to different diet, lifestyle (e.g., alcohol consumption, smoking, use of jewelry and piercings, tattoos, physical activity, hormonal and mineral supplements, and drugs), and occupational exposure. Conclusions. The undergoing study on the association between biomarkers concentration and pollutants concentrations − estimated using a dispersion modeling approach, and adjusting for personal characteristics and concomitant other environmental exposure − could clarify the individual exposure of the residents in this industrial area
Pertussis in infants and the resurgence of a vaccine preventable disease: what to do?
Get PDFPertussis or whooping cough remains one of the most poorly controlled vaccine-preventable diseases across the world. Universal vaccination has dramatically reduced its incidence but has failed to bring it completely under control. In the last decades, changes in pertussis epidemiology have been noted, likely related to the introduction of acellular pertussis vaccines. Increasing incidence is recorded among adolescents and adults who have become a reservoir for transmission to unimmunized infants, who are at risk of severe disease and death. In Italy, experimental evidences suggest a sustained circulation of Bordetella pertussis in the adult population and a significant health burden of pertussis among infants less than six months of age. Public health systems are currently exploring new vaccination strategies, including a cocooning strategy to prevent the transmission of the disease from family members to the newborn and vaccination of pregnant mothers to transmit protective antibodies to the offspring, and neonatal vaccination. An integrated approach for pertussis control and prevention need to enhance the current surveillance system providing an accurate estimate of the real burden of pertussis in our Country, particularly among infants
TELERETINOGRAPHY INTO DIABETES INTEGRATED CARE: AN ITALIAN EXPERIENCE
Get PDFIntegrated care allows information exchange among health professionals. In diabetes, a better control of outcomes and a reduction of the need for hospital admission were noticed worldwide. Teleretinography, performed in Diabetology Units (DUs), graded by a remote ophthalmologist, and forwarded to general practitioners (GPs), can cost-effectively identify retinal microangiopathy. In our DU, participating in a national diabetes integrated care program (IGEA), in a ten-month period teleretinography was performed in 362 new patients not having undergone fundus examination in the last year or more. Retinal imaging allowed discovering stages of diabetic retinopathy (DR) to be referred to the hospital setting, and a series of comorbidities. The suggested care path and follow-up were rapidly forwarded to GPs for all patients, thus improving their adherence to guidelines. These advantages and other important ones, such as reducing fundus examinations in ophthalmic settings and conveying information into the patient\u27s Electronic Health Record, make teleretinography worth becoming part of the integrated care process in diabetic patients.