Annali dell'Istituto Superiore di Sanità
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The changing phenotype of iodine deficiency disorders: a review of thirty-five years of research in north-eastern sicily
Get PDFIodine deficiency disorders (IDD) still represent a major public health problem, with almost 30% of the world population being exposed to the consequences of nutritional iodine deficiency (ID). In Italy, despite a sustained policy of iodine prophylaxis, more than 10% of people is still affected with goiter, and a presumably higher rate of subjects may suffer from minor cognitive deficits due to inadequate iodine supply during antenatal life. This review of systematic observational studies carried out over thirty-five years (1980-2015) in a sentinel ID area in North-eastern Sicily highlights the changing phenotypes of IDD in this region. Over the years profound improvements in nutritional iodine status in North-eastern Sicily has occurred, due to both silent and active iodine prophylaxis. Endemic cretinism, resulting from severe iodine deficiency, has been progressively replaced by less serious deficits of intellectual and cognitive abilities, which nevertheless deserve proper attention.
Barriers to the development of pediatric palliative care in Italy
Get PDFIntroduction. In recent years the emergence of new types of patient, clinical situations, technological frontiers and “health” objectives have changed considerably the needs of ill children, this also concerns pediatric palliative care (PPC). In Italy, despite the introduction of legislation (Law 38/2010) stipulating the right of children and families to access appropriate services for pain control and pediatric palliative care, the availability of these services is still limited. Aim. The aim of this study is to highlight, through a review of the existing data and published literature, the critical issues that obstacle the planning and development of PPC services in Italy. Results. Four main areas identified were: socio-cultural setting; types of patients and nature of diseases requiring PPC; training for PPC providers; regulatory and political issues. Conclusions. This type of analysis can provide the rational for advancing proposals and developing supportive, corrective and implementation strategies.
Association of non-alcoholic fatty liver disease and cardiometabolic risk factors with early atherosclerosis in an adult population in Southern Italy
Get PDFAim. The prevalence of risk factors for cardiovascular and metabolic diseases was inves-tigated in an adult population of the city of Cittanova, Southern Italy. Methods. The study was conducted among 992 randomly selected adults aged 18-75 years, between April 2009 and January 2011. Results. Prevalence rates of non-alcoholic fatty liver disease (NAFLD), overweight, obe-sity, and metabolic syndrome (MS) were 24.8%, 41.5%, 27.1%, and 34.4%, respectively. For the components of MS, prevalence of central obesity was 47.4%, impaired fasting glucose (IFG) 34.7%; hypertension 53.7%, low high-density lipoprotein (HDL) choles-terol 34.2%, and hypertriglyceridemia 27.2%. Conclusions. Hypertension, central obesity, IFG, low HDL cholesterol, hypertriglyc-eridemia, MS, and increased carotid artery intima-media thickness (IMT) were sig-nificantly associated with NAFLD after adjustment for age and sex. With additional adjustment for body mass index (BMI), IMT and MS (depending on the prevalence ra-tio that was investigated), the positive association between the NAFLD and increased IMT lost statistical significance, while that with body mass index (BMI) and MS re-mained significant
Organ transplantation from marginal and non-standard risk donors: ethical requisites for consent from recipients
Get PDFIn order to close the gap between available organs and patients needing transplants, the selection criteria for donors have gradually become more relaxed and many countries have defined expanded criteria for donor variables. However, the use of organs from marginal and non-standard risk donors poses considerable ethical issues. The acceptability of the risk/benefit ratio depends primarily on a clinical assessment, and information given to the recipient and his/her eventual consent are crucial. Some of the requisites concerning information and consent are mandatory. Once these requisites have been defined in binding regulations, adequate margins must be allowed for their personalisation and to account for the unique nature of each physician/patient relationship. Each decision should be specific for a particular person, and it must be accepted that similar clinical situations may give rise to differing solutions that are nonetheless agreed by the physician and the patient
Hospital efficiency: How to spend less maintaining quality?
Get PDFINTRODUCTION: The recent global economic crisis is pushing governments worldwide to obtain a more explicit and urgent rationing of resources. The purpose of this study is to provide, through Data Envelopment Analysis (DEA), a methodological framework useful for investigating technical efficiency of hospital care.METHODS: To validate such framework, we compared 50 Italian public hospital trusts (AOs) to identify relative efficient using inputs and outputs from national databases. We also evaluated if, and how, efficiency is affected by various exogenous factors.RESULTS: On average, Italian AOs had an efficiency score of 77% (SD 0.12). Tobit regression model identified a positive association between efficiency and a lower case-mix index, being in the north of the country, in a region with fiscal autonomy, with a higher public and a lower private expenditure on health as % of GDP.CONCLUSIONS: DEA may provide useful and especially objective information regarding the technical efficiency of hospital care and support hospital management and policy makers decisions
Do I need training in public health ethics? A survey on Italian residents\u27 beliefs, knowledge and curricula.
Get PDFIntroduction: Ethics is needed to support the decision-making process in public health and to face moral issues during practice. However, professionals are often not adequately trained.Objectives: In 2015, the National Conference of Public Health Medical Residents of the Italian Society of Public Health started the ‘Public Health Ethics’ workgroup to evaluate how the Italian Schools of Public Health train their residents in ethics, and which are residents’ beliefs, knowledge and attitudes about public health ethics. Methods: A survey was built and emailed to the Italian public health residents.Results: Residents are interested in ethics/bioethics (83.2%) and are aware of its importance for professional practice (97.2%). However, few of them (19.6%) evaluated their competence above a satisfactory level. They believe that a training in ethics should be offered during residency (92.1%). Nonetheless, in Italy only two schools required a course on bioethics, and one a course in public health ethics. According to residents, a public health ethics trainer should be a public health professional (23.2%) or a social scientist (22.8%).Conclusions: In Italy, Schools of Public Health do not train future professionals in ethics or public health ethics during residency. Training should be implemented in curricula, and trainers should have a strong competence in both public health and ethics
Educational action in the rehabilitation of severe acquired brain injuries: the role of self-awareness
Get PDFSevere acquired brain injuries (ABI) cause a range of short-or long-term limitations in physical and neuropsychological abilities. The aim of rehabilitation is to promote the harmonious development of the individual through collaboration between medical and educational sciences, involved in the educability of the whole person, in which the aim is not only functional recovery but also social- reintegration. This “functional synergy” permits the development of the person, and establishes an indissoluble link between functions and attitudes, thus allowing the achievement of the greater possible autonomy. In this way classical and pedagogical rehabilitation may be combined in a single concept of educational action. To realize this integrated educational process it is important to evaluate and promote awareness development, based on the possibilities of brain plasticity and on the presence of multiple intelligences skillfully in-tertwined each other. Therefore, self-awareness plays a prime role in educational actions for the rehabilitation of persons with severe ABI
Molecular characterization of Babesia and Theileria species in ticks collected in the outskirt of Monte Romano, Lazio Region, Central Italy
Get PDFIn 2012-2013, an investigation was carried out in the Viterbo province, Lazio region, on ticks and tick-borne Apicomplexan protozoa of the Babesia and Theileria genera. This followed the reporting of high density of ticks by soldiers operating in a military shooting range, and the signaling by owners and local veterinary authorities of several cases of babesiosis among cattle. A total of 422 ticks were collected from 35 heads, whereas 96 ticks were collected by dragging. Ticks were identified as Rhipicephalus (Boophilus) annulatus Say (n=373), Rhipicephalus bursa Canestrini & Fanzago (n=63), Rhipicephalus sanguineus/turanicus (n=32), Hyalomma marginatum Koch (n=49) and Dermacentor marginatus Sulzer, 1776 (n=1). A randomly selected sample of ticks (235 from animals and 36 by dragging) was analyzed using molecular methods to detect species of Babesia and Theileria. In total, 11 ticks collected from animals (4.7%) and two ticks (5.5%) collected by dragging were positive. Sequencing of PCR products of the small subunit ribosomal RNA gene revealed Babesia caballi (n=2), Babesia bigemina (n=3), Theileria sergenti/buffeli/orientalis (n=7) and Theileria equi (n=1). None of the detected species has been associated with human infection