Annali dell'Istituto Superiore di Sanità, Volume: 49, Issue: 1, Published: 2013
  • A busy time for science editors Editorial

    Alleva, Enrico; Napolitani, Federica
  • Global health - multiple definitions, single goal Commentaries

    Marušić, Ana

    Abstract in English:

    Although there is a wealth of research on and attention of both the public and the researchers about global health, there is still some controversy and uncertainty about the real meaning of the term "global health". In a multidisciplinary and intersectorial field such as global health, common definition is important for clear and effective communication among all involved in global health.
  • On the paradoxes of informed consent: strictness with unlikely risks, tolerance with certain harm Commentaries

    Petrini, Carlo

    Abstract in English:

    The different approaches of two nations to the issues surrounding informed consent by persons with no or limited capacity of understanding are compared. It is important that efforts to ensure formal compliance with consent procedures should not be allowed to distract attention from the risks of harm to individuals.
  • Invertebrate welfare: an overlooked issue Original Articles and Reviews

    Horvath, Kelsey; Angeletti, Dario; Nascetti, Giuseppe; Carere, Claudio

    Abstract in English:

    While invertebrates make up the majority of animal species, their welfare is overlooked compared to the concern shown to vertebrates. This fact is highlighted by the near absence of regulations in animal research, with the exception of cephalopods in the European Union. This is often justified by assumptions that invertebrates do not experience pain and stress while lacking the capacity for higher order cognitive functions. Recent research suggests that invertebrates may be just as capable as vertebrates in experiencing pain and stress, and some species display comparable cognitive capacities. Another obstacle is the negative view of invertebrates by the public, which often regards them as pests with no individual personalities, gastronomic entities, or individuals for scientific experimentation without rules. Increasingly, studies have revealed that invertebrates possess individual profiles comparable to the personalities found in vertebrates. Given the large economic impact of invertebrates, developing certain attitude changes in invertebrate welfare may be beneficial for producers while providing higher welfare conditions for the animals. While the immense number and type of species makes it difficult to suggest that all invertebrates will benefit from increased welfare, in this review we provide evidence that the topic of invertebrate welfare should be revisited, more thoroughly investigated, and in cases where appropriate, formally instituted.
  • A geoprocessing model for the selection of populations most affected by diffuse industrial contamination: the case of oil refinery plants Original Articles and Reviews

    Pasetto, Roberto; De Santis, Marco

    Abstract in English:

    INTRODUCTION. A method to select populations living in areas affected by diffuse environmental contamination is presented, with particular regard to oil refineries, in the Italian context. The reasons to use municipality instead of census tract populations for environment and health small-area studies of contaminated sites are discussed. METHODS. Populations most affected by diffuse environmental contamination are identified through a geoprocessing model. Data from the national census 2001 were used to estimate census tract level populations. A geodatabase was developed using the municipality and census tract layers provided by the Italian National Bureau of Statistics (ISTAT). The orthophotos of the Italian territory - year 2006 - available on the geographic information systems (GIS) of the National Cartographic Portal, were considered. The area within 2 km from the plant border was used as an operational definition to identify the area at major contamination. RESULTS. The geoprocessing model architecture is presented. The results of its application to the selection of municipality populations in a case study are shown. CONCLUSIONS. The application of the proposed geoprocessing model, the availability of long time series of mortality and morbidity data, and a quali-quantitative estimate of contamination over time, could allow an appraisal of the health status of populations affected by oil refinery emissions.
  • Human biomonitoring for Cd, Hg and Pb in blood of inhabitants of the Sacco Valley (Italy) Original Articles and Reviews

    D'Ilio, Sonia; Forastiere, Francesco; Draicchio, Assunta; Majorani, Costanza; Petrucci, Francesco; Violante, Nicola; Senofonte, Oreste

    Abstract in English:

    INTRODUCTION. The Sacco Valley (Lazio, Italy) is characterized by high density population and several industrial chemical productions that during the time had led to a substantial amount of by-products. The result was a severe environmental pollution of the area and in particular of the river Sacco. In 1991, the analysis of water and soils samples of three industrial landfills revealed the presence of organochlorine compounds and heavy metals. A research project named "Health of residents living in Sacco Valley area", coordinated by the regional Department of Epidemiology, was undertaken and financed to evaluate the state of health of the population living near those polluted areas. MATERIALS AND METHODS. Cd, Hg and Pb were quantified in 246 blood samples of potentially exposed residents of the Sacco Valley by quadrupole inductively coupled plasma mass spectrometry (Q-ICP-MS). RESULTS. Individuals who agreed to be sampled did not exhibit high levels of the elements. The distance from the river does not seem to be directly connected with the elements levels in blood. The contribution of these contaminants to the total intake due to ingestion of food was difficult to evaluate. The unclear trend of data would require a characterization of the polluted site with environmental sampling of different matrices.
  • A home assistance model for dementia: outcome in patients with mild-to-moderate Alzheimer's disease after three months Original Articles and Reviews

    Carbone, Gabriele; Barreca, Francesca; Mancini, Giovanni; Pauletti, Giovanni; Salvi, Veronica; Vanacore, Nicola; Salvitti, Carla; Ubaldi, Fiorella; Sinibaldi, Luigi

    Abstract in English:

    The treatment of dementias, which are currently incurable pathologies, requires an approach to care that involves both the patients and their families. The effect of alternative interventions, besides the pharmacological approach, therefore warrants evaluation. In this paper, we describe one such intervention, which was provided by our home care team for Alzheimer's Disease. Patients were granted a three-month period of home care assistance, which included physical and cognitive rehabilitation as well as interventions on the home environment and the family, such as psychological support for the main caregivers. The assistance was provided in thrice-weekly sessions, each lasting six hours. Twenty-two patients (age 78.4±6.5 yrs), all of whom had received a diagnosis of probable AD, were enrolled. There was a statistically significant improvement in the NPI score (p = 0.004), Barthel index (p = 0.01), Tinetti's scale (p = 0.013) and CBI score (p = 0.016) at the end of the 3-month treatment period. The patients' caregivers also reported a significant improvement in the physical and social burden at the CBI at the end of the period of home care assistance (p = 0.026 and p = 0.006). In a further evaluation performed 3 months after the end of the treatment period, the beneficial effect previously observed in both patients and caregivers was no longer present.
  • Pharmaco-epidemiological description of the population of the Marche Region (central Italy) treated with the antipsychotic drug olanzapine Original Articles and Reviews

    Mignini, Fiorenzo; Sabbatini, Maurizio; Pascucci, Chiara; Petrelli, Fabio; Grappasonni, Iolanda; Vanacore, Nicola

    Abstract in English:

    BACKGROUND. In Italy, even though olanzapine has been discouraged for treatment of behaviour disorders in older patients affected by dementia, some physicians chose to prescribe for them. In response to this situation, the Italian Drug Agency (Agenzia Italiana del Farmaco, AIFA) promulgated a cautionary note. MATERIALS AND METHODS. This study examined epidemiological indices for olanzapine prescriptions between 2004 and 2007 in the Marche Region of central Italy and in its provinces, to assess physician compliance with the AIFA note, and to determine whether there were differences in drug prescription between populations of the same territory, or differences based on gender or age group. RESULTS. Our analyses revealed high olanzapine use among young men and mature women, suggesting that these groups are most prone to psychotic symptoms. Analysis revealed that olanzapine prescription in elderly patients was reduced in some provinces, in line with the AIFA note. CONCLUSIONS. Prudent use of olanzapine prescription, in compliance with the AIFA note, was noted throughout the Region. Furthermore, this work offers details that may be useful in future studies of adverse drug reactions.
  • Molecular epidemiology of measles virus in Italy during 2008 Original Articles and Reviews

    Magurano, Fabio; Fortuna, Claudia; Baggieri, Melissa; Filia, Antonietta; Benedetti, Eleonora; Bucci, Paola; Marchi, Antonella; Nicoletti, Loredana

    Abstract in English:

    INTRODUCTION. In view of the goal of measles elimination, it is of great importance to assess the circulation of wild-type measles virus (MV). Genetic analysis is indispensable to understand the epidemiology of measles. A large measles outbreak occurred in Italy in 2008, with over 4000 cases reported to the enhanced measles surveillance system introduced in 2007, 37% of which were laboratory confirmed. METHODS. Urine and saliva samples were collected during 2008. A phylogenetic analysis of measles sequences was performed in order to understand the epidemiological situation of wild-type (MV) circulation in that period. RESULT AND DISCUSSION. Data showed predominant circulation of the genotype D4. Genotypes A, D8, D9 and H1 were also detected in a small number of samples, probably representing imported cases.
  • Medical humanities in healthcare education in Italy: a literature review Original Articles and Reviews

    Fieschi, Laura; Matarese, Maria; Vellone, Ercole; Alvaro, Rosaria; De Marinis, Maria Grazia

    Abstract in English:

    OBJECTIVE. The introduction of medical humanities (MH) in undergraduate medical education in Italy has been an issue of debate since the 90's and few years later it was extended to other healthcare degrees. The aims of this Italian literature review, after considering the international scene, are: to evaluate the extent to which the interest in this subject has gradually developed throughout the country; which professional groups have contributed to the debate; to identify which theoretical constructs led to the introduction of MH in undergraduate medical education; to identify whether a clear and shared definition of MH exists in Italian literature; to verify what kinds of MH experiences have been accomplished in Italy. MATERIALS AND METHODS. A comprehensive literature search was conducted, including electronic databases, bibliographies, manual sorting of articles in paper format, congress proceedings. RESULTS. The analysis of the chosen articles underlines that, however limited, Italian literature does not present a very different picture from the international scene. It emerges that teaching MH is believed to be an important feature in undergraduate education of healthcare professionals who intend to propose a bio-psychological-social approach to care, in spite of the difficulty to measure its short and long term effectiveness. The lack of a multidisciplinary, multi-professional approach is also evident. CONCLUSION. Further research aiming to implement the quantity and quality of MH studies in the curricula of undergraduate healthcare education is desirable.
  • Blood thiamine, zinc, selenium, lead and oxidative stress in a population of male and female alcoholics: clinical evidence and gender differences Original Articles and Reviews

    Mancinelli, Rosanna; Barlocci, Eleonora; Ciprotti, Maria; Senofonte, Oreste; Fidente, Rosanna Maria; Draisci, Rosa; Attilia, Maria Luisa; Vitali, Mario; Fiore, Marco; Ceccanti, Mauro

    Abstract in English:

    INTRODUCTION. Long term alcohol abuse is associated with deficiencies in essential nutrients and minerals that can cause a variety of medical consequences including accumulation of toxic metals. Aim. The aim of this research is to get evidence-based data to evaluate alcohol damage and to optimize treatment. Thiamine and thiamine diphosphate (T/TDP), zinc (Zn), selenium (Se), lead (Pb) and oxidative stress in terms of reactive oxygen metabolites (ROMs) were examined in blood samples from 58 alcohol dependent patients (17 females and 41 males). RESULTS. T/TDP concentration in alcoholics resulted significantly lower than controls (p < 0.005) for both sexes. Serum Zn and Se did not significantly differ from reference values. Levels of blood Pb in alcoholics resulted significantly higher (p < 0.0001) than Italian reference values and were higher in females than in males. ROMs concentration was significantly higher than healthy population only in female abusers (p = 0.005). CONCLUSION. Alcoholics show a significant increase in blood oxidative stress and Pb and decrease in thiamine. Impairment occurs mainly in female abusers confirming a gender specific vulnerability.
  • Advancing the science of cancer cost measurement: challenges and opportunities Original Articles and Reviews

    Francisci, Silvia; Yabroff, K. Robin; Gigli, Anna; Mariotto, Angela; Mezzetti, Maura; Lipscomb, Joseph

    Abstract in English:

    OBJECTIVES. Cancer accounts for a major proportion of national health expenditures, which are expected to increase in the future. This paper aims to identify major challenges with estimating cancer related costs, and discuss international comparisons, and recommendations for future research. METHODS. It starts from the experience of an international workshop aimed at comparing cancer burden evaluation methods, improving results comparability, discussing strengths and criticisms of different approaches. RESULTS. Three methodological themes necessary to inform the analysis are identified and discussed: data availability; costs definition; epidemiological measures. CONCLUSIONS. Cost evaluation is applied to cancer control interventions and is relevant for public health planners. Despite their complexity, international comparisons are fundamental to improve, generalize and extend cost evaluation to different contexts.
  • Validation of the Italian version of the Screening Questionnaire for Disaster Mental Health (SQD) in a post-earthquake urban environment Original Articles and Reviews

    Valenti, Marco; Fujii, Senta; Kato, Hiroshi; Masedu, Francesco; Tiberti, Sergio; Sconci, Vittorio

    Abstract in English:

    INTRODUCTION. Aim of this study was to implement and validate the Italian version of the Screening Questionnaire for Disaster Mental Health (SQD), a tool for the screening of post-traumatic stress disorder (PTSD) and depression in the long-term aftermaths of a natural disaster. METHODS. A convenience sample of 116 subjects living in L'Aquila after the 2009 earthquake were administered the SQD and two gold-standard instruments for PTSD and depression. Reliability, concurrent validity and convergent validity of SQD were estimated. RESULTS. Cronbach's alpha was 0.86. Concurrent validity as measured by the Spearman correlation coefficient resulted statistically significant both for PTSD and depression SQD subscales, as well as convergent validity as measured by ROC-AUC method. CONCLUSIONS. SQD is a valid, efficient and easy-to-use screening instrument for PTSD and depression after natural disasters.
  • A student manual for promoting mental health among high school students Brief Notes

    Gigantesco, Antonella; Del Re, Debora; Cascavilla, Isabella

    Abstract in English:

    OBJECTIVES. We describe a school program based on a student manual for promoting mental health and preventing mental illness. METHODS. A preliminary version of the manual was assessed for face validity by two focus groups. The final version was evaluated for acceptability among 253 students in 10 high schools and 1 middle school in Italy. RESULTS. The manual included 18 chapters (or "units") which address skills for enabling students to cope with their daily lives: communication skills, problem-solving, assertive skills, negotiation, stress management, anger management and conflict resolution. The manual was found to have been acceptable by high school students. CONCLUSIONS. The effectiveness of the manual in actually promoting mental health and preventing mental illness is currently being evaluated.
  • Medical progress, psychological factors and global care of the patient: lessons from the treatment of childhood leukemia Brief Notes

    Digilio, Girolamo; Digilio, Marina

    Abstract in English:

    The history of treatment of childhood leukemia is a meaningful model of ethical, bioethical and organizational repercussions of medical progress. Specifically, it has provided precious indications and very useful tools to cope with several of the more important problems of modern medicine: the value of controlled randomized studies; the risks of intense medicalization impairing the quality of care; the importance of a valid doctor-patient relationship; the psycho-emotive involvement of the pediatric staff; and last but not least, the need of an unrelenting effort of humanization of the procedures and environments, hand in hand with the frequent adjustments of the protocols according to scientific and technological progress. Finally, the authors comment upon the first cures (1962-1966) observed in the Pediatrics Clinic of the Sapienza University of Rome.
  • Book reviews, notes and comments

    Cheyne, Federica Napolitani
  • Publications from International Organizations on Public Health

    Rossi, Anna Maria
Istituto Superiore di Sanità Roma - Rome - Italy
E-mail: annali@iss.it