Annali dell'Istituto Superiore di Sanità
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Emerging trends in consuming behaviours for non-controlled substances by Italian urban youth: a cross sectional study
Get PDFIntroduction. We investigated legal recreational substances use in a cross sectional study on urban Italian adolescents and young adults, the reasons for consumption and risk perception as function of age, the relation with lifestyles and finally risk factors associated. Methods. The survey methodology involved the administration of an anonymous questionnaire. It consisted of 68 questions, divided into five sections: personal details, socioeconomic characteristics, family and peer group, free time and lifestyles, and substances use. Results. A total of 2621 adolescents and young adults (14-35 years old) from seven different Italian cities. The substances examined were mainly used recreationally (alcohol, energy drinks and smart-drugs) or to improve physical and sexual performance (physical performance-enhancing drugs, anabolic steroids and male sexual enhancement). The knowledge of the health related harm arising from the use of these products was very high for alcohol (>90%), high for smart-drugs (>70%), but significantly lower for anabolic steroids, drugs for sexual enhancement (~60%), physical performance-enhancing drugs or energy drinks (~55%). The principal risks factors for consumption were: the influence of friends (OR:8.8), attending recreational places (OR:5.4) aged between 25-35 years (OR:3.0), be male (OR:2.5) and having a bad relationship with the mother (OR:2.1). Conclusions. These results have implication for prevention and early intervention programs of new legal recreational substance use, which similarly to what is frequently advised for classical illicit drugs should focus on information campaigns and awareness initiatives especially addressed to young male adults who go clubbing, live outside the family and showed closed links with peers.
The right to food, food donation and microbiological problems of food safety: an experience in the territory of Florence
Get PDFAim. The aim of this study is to understand whether the freezing without a rapid blast chiller represents a storage method for food at the end of shelf life that guarantees microbiological food safety, so to be considered an effective tool for the appropriate management of food in charitable organizations. Methods. The study has been performed on 90 food samples, among those that a charitable foodservice trust receives by the large-scale distribution. The products have been frozen using a domestic refrigerator. The indicators used were: total aerobic microbial count, Escherichia coli, Salmonella spp, Staphylococcus aureus, Campylobacter spp, sulphite reducing clostridia. Results. The results show that the preservation of the chosen fresh products at the end of shelf life in refrigerators, frozen without the use of chillers, is a potential management strategy to avoid the loss of edible food, while maintaining the safety standards.
Telemedicine in palliative care: a review of systematic reviews
Get PDFAims. To evaluate the quality of systematic reviews on telemedicine applications in palliative care. Methods. A structured literature review was conducted to identify systematic reviews dealing with telemedicine in palliative care; the AMSTAR – Assessment of Multiple Systematic Reviews – checklist was used to appraise the evidence related to the systematic reviews. Results: 405 records were initially identified; of these 14 were eligible for full-text analysis. In summary, the research strategy allowed the identification of 6 reviews to be included which showed a medium quality (AMSTAR score in between 4 and 7). All the included systematic reviews considered telemedicine applications as a feasible means to be used in palliative care; however, the positive findings are counterbalanced by several critical issues mainly related to the evidence from the primary studies included in each single review. Conclusions. Results of this first attempt to appraise the evidence in the field of telemedicine applications in palliative care highlighted that there is still limited evidence related to this approach. Strengths and weaknesses that impact on the general quality of the reviews were identified and relevant points to be taken into account for future research were suggested
Healthcare for all in emerging countries: a preliminary investigation of facilities in Kolkata, India
Get PDFIntroduction. India is one of the five countries with the lowest public health spending levels: the private medical services are one of the most developed fields, meanwhile public health ones are totally inadequate with the most number of health facilities concentrated in cities, where only the 25% of the population lives. Public facilities are mainly made up of primary level and not well distributed on the territories, so they do not guarantee accessibility to a wide sample of population, who live in rural areas of India. Methodology. Starting from the analysis of three different health care levels in the Indian context, the research team developed a meta-project that considers all the current criticisms and the Indian customs through a flexible layout that responds to the healthcare needs of population. Result and Discussion. The research work is aimed to develop a meta-project that considers all the current criticisms and the Indian customs through flexible layouts that responds to the healthcare needs of population. Conclusion. The innovation of the research work is to develop the hygienic aspects, the layout and the distribution, the sub-division of the medical functions through the Indianculture and the needs of the country.The choice of lowly technologies permits to promote the usage
Sex-based differences in autoimmune diseases
Get PDFAutoimmune diseases are characterized by an exaggerated immune response leading to damage and dysfunction of specific or multiple organs and tissues. Most autoimmune diseases are more prevalent in women than in men. Symptom severity, disease course, response to therapy and overall survival may also differ between males and females with autoimmune diseases. Sex hormones have a crucial role in this sex bias, with estrogens being potent stimulators of autoimmunity and androgens playing a protective role. Accumulating evidence indicates that genetic, epigenetic and environmental factors may also contribute to sex-related differences in risk and clinical course of autoimmune diseases. In this review, we discuss possible mechanisms for sex specific differences in autoimmunity with a special focus on three paradigmatic diseases: systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis.
Scaling-up innovation as a means of tackling health inequalities
Get PDFIssue. The introduction of inclusive healthcare innovations as a means of improving the welfare of marginalized groups is now being witnessed in developing countries as a crucial process of modernization and industrialization. Towards this end, there has been much discussion regarding the most effective strategies of scaling up innovative health interventions in these parts of the world.Evidence. The topics of discussion have included accessibility and cost-effectiveness; sustainability; infrastructure to support implementation; political will; advocacy; strong leadership; tailoring the scaled-up approach to the local context; and various potential models of funding.Implications. Because policy advocacy plays a critical role in creating a favourable environment for inclusive healthcare innovations, intensive lobbying will be necessary as a means to achieve effective scaling-up in addition to tackling the respective development challenges more efficiently. With this in mind, funders will need to mobilize substantial investment for innovations that respond to the most pressing global public health issues.
Parent training education program: a pilot study, involving families of children with Prader-Willi syndrome
Get PDFIntroduction. Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by severe hypotonia during the neonatal period and the first two years of life, the onset of hyperphagia with a risk of obesity during infancy and adulthood, learning difficulties and behavioral or severe psychiatric problems. This complex disease has severe consequences and difficult management issues also for patients’ families. Parents of children with PWS need appropriate psychoeducational intervention in order to better manage their children with PWS. The purpose of this study was the implementation and evaluation of a PWS psychoeducational parent training program. Methods. The Italian National Center for Rare Diseases implemented a pilot parent training program offered to parents of children with PWS. The intervention’s effects was evaluated using questionnaires comprised of 11 items rated on a 7 point Likert scale. Results. The intervention was offered to 43 parents. The behavior problems management, dietary restrictions, autonomy and relationships were indicated by parents as the priority topics which needed to be addressed. Evaluations, immediately post-intervention and after 6 months, were reported by parents, fulfilling specific questionnaires. 90% of parents involved in the study, appreciated the methodology, 86% felt more informed about PWS, 47-62% felt more capable to better approach behaviour’s problems, 20-25% felt better about the child’s health situation and future expectations. Feeling more capable to help the child autonomy and relationships were reported in 62% and 63% of parents respectively, which decreased significantly (p < 0.05) according to the evaluation 6 months after the intervention. Younger age of parents (< 44 years of age) was significantly correlated with better understanding on how to help the child’s autonomy (OR: 0.05; CI: 0.04-0.8) and to better collaborate with the child’s teachers (OR: 0.02; CI: 0.001-0.9). Conclusion. Parent training is a promising intervention for parents of children with behavior’s problems. Interventions with a behaviorally oriented program, addressed to parents of PWS affected children, is a useful tool in increasing their ability to manage the problems related to the disease.
A study of human behavior simulation in architectural design for healthcare facilities
Get PDFIntroduction. Current tools and methods in architectural design do not allow predicting and evaluating how people will use designed environments before their actual realization. Objective. To investigate how computational simulation can help in evaluating design proposals as far as their use by people is concerned. Methods. Simulation of a medicine distribution procedure in a general hospital facility, while accounting for serendipitous social interactions made possible by the presence of different users in the same space, at the same time. Discussion. The simulation shows how use patterns are influenced by the social and physical context in which actors are situated, and demonstrates the significance of the proposed method of evaluating hospital designs before construction. The system allows simulating use patterns with different degrees of complexity, and enables architects to ask new types of questions related to the interactions between people and physical settings