• Procedures for the ethical review of public health surveillance protocols Commentaries

    Petrini, Carlo

    Abstract in English:

    The present commentary is based on the following considerations: 1) for the purposes of authorisation, a distinction is drawn between "research" and "intervention". The procedures for authorising the former are more complex, the relevant controls are stricter and approval has to be granted by a Research Ethics Committee (REC); 2) although the debate is still open, it is barely credible to claim that public health surveillance is not a form of research. It should, therefore, be subject to rigorous ethical assessment; 3) when addressing specifically the issue of surveillance, it would be appropriate to shift the focus of attention from the type of procedure (research/intervention) to the risk implied in that procedure; 4) much emphasis has hitherto been placed on the risks that public health surveillance may imply for the protection of personal data; 5) the emphasis on the protection of personal data is frequently excessive and the risks should be examined in a broader context.
  • Research into cost and value in medical education: can we make findings more generalisable? Commentaries

    Walsh, Kieran

    Abstract in English:

    In recent years a growing number of papers have started to appear in the literature on the subject of cost and value in medical education. However many of the articles describe tactical projects within specific areas. As a result the generalisability of such articles is often questionable. Lack of generalisability will mean that progress in research and practice in this field will be slow. Generalisability of cost-value analyses in any discipline is not always straightforward. However reports on cost and value in medical education should ideally ensure absolute clarity with regard to study centres, enrolment of learners, alternative options, perspectives of stakeholders, resources used and their costs, instruments used, variability, and any problems with the analyses (such as incomplete data).
  • Contrasting the anti-vaccine prejudice: a public health perspective Commentaries

    Stefanelli, Paola; Rezza, Giovanni

    Abstract in English:

    Although immunization is one of the most successful and cost-effective health interventions, there has been always opposition to vaccines. This may be due to several factors, some of which are : 1) the vaccines are given to healthy individuals to prevent disease; 2) the perception of the vaccine value paradoxically declines when the use of a vaccine reduces or eliminates the risk of a disease. Contrasting anti-vaccine movements/ feelings is important in order to keep vaccinate coverage rates high. Specific training of health care workers and other vaccine providers is needed in order to understand the reasons of reluctant parents, and to deal with prejudice and misinformation.
  • Psychoactive natural products: overview of recent developments Original Articles and Reviews

    Ujváry, István

    Abstract in English:

    Natural psychoactive substances have fascinated the curious mind of shamans, artists, scholars and laymen since antiquity. During the twentieth century, the chemical composition of the most important psychoactive drugs, that is opium, cannabis, coca and "magic mushrooms", has been fully elucidated. The mode of action of the principal ingredients has also been deciphered at the molecular level. In the past two decades, the use of herbal drugs, such as kava, kratom and Salvia divinorum, began to spread beyond their traditional geographical and cultural boundaries. The aim of the present paper is to briefly summarize recent findings on the psychopharmacology of the most prominent psychoactive natural products. Current knowledge on a few lesser-known drugs, including bufotenine, glaucine, kava, betel, pituri, lettuce opium and kanna is also reviewed. In addition, selected cases of alleged natural (or semi-natural) products are also mentioned.
  • Neurobehavioral toxicity in progeny of rat mothers exposed to methylmercury during gestation Original Articles and Reviews

    Gandhi, Dinesh N.; Panchal, Govind M.; Dhull, Dinesh K.

    Abstract in English:

    INTRODUCTION: Methylmercury (MeHg) is recognized as one of the most hazardous environmental pollutants. This may be a concern to long-term consumption of contaminated fish and seafood for health risk to pregnant women and their children. AIM: An animal study was conducted to assess the effect of MeHg exposure on rodent offspring following in utero exposure. METHODS: Pregnant Wister rats were treated by gavage with MeHg at dose levels of 0.5, 1.0 and 2.0 mg/kg/day from gestation day (GD) 5 till parturition, and then were allowed to deliver. RESULTS: Dams treated with 2.0 mg/kg/day MeHg group showed signs of toxicity such as gait alterations and hyperactivity resulting in the failure to deliver sustainable viable pups. MeHg had significant effects on body weight gain of dams during GD 5 till parturition. MeHg had no significant effects on the ages of physical developments such as pinna detachment, incisor eruptions or eye opening as well as alter cliff avoidance, surface righting, swimming ontogeny, startle reflex, pivoting, negative geotaxis, or forelimb and hindlimb grip strength in either sex. Exposure to 1.0 mg/kg/day MeHg treatment group prolonged gestation period, retard mid-air righting in male pups, shortened forelimb grip strength measured on rotating rod in either sex and enhanced open field behaviour in male pups. Data obtained from Functional Observation Battery (FOB) also revealed impairment of neuromotor performance in male pups. The male pups appeared to be more susceptible than the female pups. CONCLUSION. Overall, the dose level of MeHg in the present study produced a few adverse effects on the neurobehavioral parameters, and it may alter neuromotor performance of the male pups.
  • Access to health services for problematic use of illegal psychoactive substances among natives and non-natives: a study in the metropolitan area of Bologna Original Articles and Reviews

    Pavarin, Raimondo Maria

    Abstract in English:

    AIM: To estimate access to health services among subjects with problems due to the use of psychoactive substances among people born abroad (non-natives) and to draw comparisons with those born in Italy (natives) using several data sources. DESIGN Analysis of the new accesses for problematic use of illegal substances in the health services (hospital, emergency unit) and in the services dedicated to drug addicts (SERT) in the metropolitan area of Bologna in the period 2004/2011. RESULTS: No significant differences are recorded in regard to the substances used and the standardized incidence rate per 10 000 (natives males 10.72, females 3.93; non-native males 10.39, females 3.23). Among the non-natives, younger and with a higher percentage of females as compared with the Italians, there is a lower likelihood of access to the SERT. CONCLUSIONS: The data reported describe the complexity of a problem that ought to be carefully monitored in the territory
  • Discrepancies between clinical and autoptic diagnoses in Italy: evaluation of 879 consecutive cases at the "Policlinico of Bari" teaching hospital in the period 1990-2009 Original Articles and Reviews

    Sblano, Sara; Arpaio, Alessandra; Zotti, Fiorenza; Marzullo, Andrea; Bonsignore, Alessandro; Dell'Erba, Alessandro

    Abstract in English:

    INTRODUCTION: In spite of the benefits of autopsies, there has been in recent years a drastic decline in the number of autopsies performed, mainly due to an apparent unattractive cost-benefit ratio and fears of the medico-legal consequences. MATERIAL AND METHODS: A retrospective study was conducted on the reports of all the 879 consecutive autopsies performed at "Policlinico of Bari" from 1990 to 2009. RESULTS: All clinical diagnoses were compared with autopsy findings showing 558 concordant diagnoses (most of all neoplasms); 123 certain discordant diagnoses (69 of them with potential impact on survival, such as acute myocardial infarctions, pulmonary thromboembolisms, internal haemorrhages, surgery complications, aortic aneurism ruptures, and so on); 116 uncertain discrepant diagnoses; 82 unclear diagnoses. CONCLUSIONS: The rate of discrepancy allows the authors to hypothesize that a better diagnostic assessment could lead to a different outcome. In terms of risk-management this negative performance needs to be carefully analysed and requires a comprehensive audit of all services provided. In this sense, the authors underline the crucial importance of autopsy as an essential tool to address unresolved clinical questions and highlight previously undiagnosed medical conditions.
  • Health care for immigrant women in Italy: are we really ready? A survey on knowledge about female genital mutilation Original Articles and Reviews

    Caroppo, Emanuele; Almadori, Aurora; Giannuzzi, Valeria; Brogna, Patrizia; Diodati, Alessandra; Bria, Pietro

    Abstract in English:

    BACKGROUND: Because of immigration, female genital mutilation (FGM) is an issue of increasing concern in western countries. Nevertheless operators without a specific training may ignore the health condition of women subjected to this practice and fail to provide them adequate assistance. The purpose of the study was to estimate the current knowledge about FGM among social and health care assistants working with asylum seeker. MATERIAL AND METHODS: From October to December 2012, a questionnaire was used to interview 41 operators working in CARA (Shelter for Refugees and Asylum Seekers) in central and southern Italy. RESULTS: Only 7.3% of respondents states to know well FGM, while 4.9% do not know it at all. 70.7% declare to have never met or assisted a woman with FGM, nevertheless all respondents work with asylum seeker from countries where FGM are performed. CONCLUSIONS: Migration fluxes to Italy over the past decade created a healthcare challenge: women with FGM have specific medical and psychological problems that doctors, nurses and social assistants without specific training are not usually able to manage.
  • The effect of contraceptive counselling in the pre and post-natal period on contraceptive use at three months after delivery among Italian and immigrant women Original Articles and Reviews

    Lauria, Laura; Donati, Serena; Spinelli, Angela; Bonciani, Manila; Grandolfo, Michele E.

    Abstract in English:

    INTRODUCTION: Contraceptive counselling in the pre and post-natal period may be important for the use of postpartum contraception and prevention of induced abortion. This paper evaluates the use of postpartum contraceptives and the factors associated with it in a sample of Italian and immigrant women. MATERIALS AND METHODS: Data are drawn from two population-based follow-up surveys conducted to evaluate the quality of maternal care in 25 Italian Local Health Units in 2008/9 and 2010/1. Descriptive analyses and logistic regression models for complex survey data were used. RESULTS: The use of effective contraceptives in the postpartum period is similar between Italians and immigrants (65%). Fifty-nine percent of Italians and 63% of immigrants received contraceptive counselling by natal care services. Women who received counselling are more likely to use effective contraceptives (Italians OR = 2.55 95% CI 2.06 - 3.14; immigrants OR = 4.01 95% CI 2.40 - 6.70). CONCLUSIONS: This study supports the notion that health professionals should take every opportunity during pregnancy, childbirth and puerperium to provide information and counselling to improve knowledge and awareness of contraception.
  • From bench to bedside and to health policies (and back): ethics in translational research Original Articles and Reviews

    Petrini, Carlo

    Abstract in English:

    INTRODUCTION: The medical aim of translational research is to smooth the transition of discoveries made through basic research from the laboratory bench to their diagnostic or therapeutic applications for patients. These applications may be extended to current clinical practice and to health policies. AIM: The converse is also important: health policies should provide a point of departure when identifying research priorities. Translational research poses the same ethical problems as trials with human subjects - albeit in different ways. One of the more significant problems is the risk for participants in trials: it is thus necessary to ensure that the risks to which these subjects are exposed are not out of proportion to the expected benefits. DISCUSSION: Translational research does not require new ethical principles, but existing biomedical principles need to be adjusted to the specific context. The well-being of participants should always be the primary objective; these persons should never be considered as means for the advancement of knowledge or for the improvement of applications.
  • Clinical assessment instruments validated for nursing practice in the Italian context: a systematic review of the literature Original Articles and Reviews

    Palese, Alvisa; Tameni, Alberta; Ambrosi, Elisa; Albanese, Silvia; Barausse, Marta; Benazzi, Barbara; Togni, Stefano De; Doro, Roberta; Eccher, Cristina; Fattori, Maurizio; Franchini, Paola; Girlanda, Massimiliano; Gobbetti, Dania; Lorenza Guarino,; Lazzeri, Renata; Moreale, Renzo; Ricci, Nicola; Venturini, Margherita; Villa, Giulia; Zonzini, Emanuela; Saiani, Luisa

    Abstract in English:

    AIMS: With the aim to identify the instruments validated for Italian nursing practice, a systematic review of the literature was undertaken. RESULTS: A total of 101 instruments emerged. The majority (89; 88.1%) were developed in other countries; the remaining (14; 13.9%) were developed and validated in the Italian context. The instruments were developed to measure patient's problems (63/101; 62.4%), outcomes (27/101; 26.7%), risks (4/101; 4%) and others issues (7/101; 6.9%). The majority of participants involved in the validation processes were younger adults (49; 48.5%), older adults (40; 39.5%), children (4; 4%), adolescents (3; 3%), and children/adolescents (1; 1%). The instruments were structured primarily in the form of questionnaires (61; 60.4%), as a grid for direct observation (27; 26.7%) or in other forms (12; 11.9%). Among the 101 instruments emerged, there were 1 to 7 validation measures documented with on average 3.2 (95% CI 2.86-3.54) for each instrument. CONCLUSIONS: Developing validation studies giving priority to those instruments widely adopted in the clinical nursing practice is recommended.
  • The process and criteria for diagnosing specific learning disorders: indications from the Consensus Conference promoted by the Italian National Institute of Health Original Articles and Reviews

    Lorusso, Maria Luisa; Vernice, Mirta; Dieterich, Marina; Brizzolara, Daniela; Mariani, Enrica; Masi, Salvatore De; D'Angelo, Franca; Lacorte, Eleonora; Mele, Alfonso

    Abstract in English:

    A Consensus Conference on Specific Learning Disorders has been promoted by the Italian National Institute of Health (Istituto Superiore di Sanità, ISS). The Consensus Conference consisted in a systematic review of the international literature addressing the issues of diagnosis, risk factors and prognosis, treatment, service delivery and organizational models for Specific Learning Disorders (reading, spelling/writing, calculation). Selected papers were examined by a group of Evaluators and then discussed by a Scientific and Technical Committee, whose conclusions were examined and approved by a Jury Panel. The part on diagnostic issues is presented here, encompassing a systematic discussion of the use and appropriateness of diagnostic criteria, parameters, tasks and psychometric indexes as illustrated in the literature, and providing recommendations for clinical practice. Special attention has been devoted to the collection, analysis and discussion of published data concerning languages with transparent orthography. Controversial issues such as discrepancy criteria, role of reading comprehension and importance of accuracy and fluency are discussed.
  • Temporal pattern of microbial indicators of ready-to-eat rocket salads during shelf life Original Articles and Reviews

    Giusti, Maria De; Solimini, Angelo G.; Cottarelli, Alessia; Vito, Corrado De; Aurigemma, Caterina; Tufi, Daniela; Piccinato, Ludovico; Boccia, Antonio; Marinelli, Lucia

    Abstract in English:

    INTRODUCTION: From 2001-2009 there have been numerous community alerts and notifications about the rocket salad produced in Italy and distributed in Europe. Our study describes the evolution of the microbial quality of ready to eat rocket salad during shelf life among three different Italian producers. MATERIAL AND METHODS: Total Mesophilic Count (TMC) and Escherichia coli (EC) count were measured in 248 samples. We used Wilcoxon test to compare the median values of TMC and EC counts and Kruskal Wallis test to compare the producers. RESULTS: The TMC and EC values differed among producers at the stages of raw material and in the finished product (Kruskall Wallis test, p < 0.05). The evolution of bacterial charges had significant differences among producers at expiration date (Wilcoxon test, p < 0.05). More than half of the samples (54.8%) exceed reference standard for TMC after 48 h from packaging. CONCLUSION: Differences among producers may linked to the different minimal processing technologies adopted after harvesting.
  • First isolation of Salmonella enterica serovar Napoli from wild birds in Italy Brief Note

    Mancini, Laura; Marcheggiani, Stefania; D'Angelo, Annamaria; Puccinelli, Camilla; Chiudioni, Filippo; Rossi, Flavia; Delibato, Elisabetta; Medici, Dario De; Dionisi, Anna Maria; Owczarek, Slawomir; Luzzi, Ida

    Abstract in English:

    Salmonella enterica serovar Napoli (S. Napoli) is an emerging serovar in Italy. It accounts for 2-4% of all serovars isolated from human infections. The zoonotic origin of this serovar is still unknown and this makes difficult to apply any control intervention. We report here the isolation of S. Napoli from a river nightingale (Cettia cetti, Temminck 1820) which represents the first description of this serovar from wild birds. This finding adds knowledge to the ecology of S. Napoli and addresses further studies aimed to assess the epidemiologic link between S. Napoli isolated from wild birds, food, environmental sources and human infections.
  • Untitled document Book Reviews, Notes and Comments

  • Untitled document Publications from International Organizations on Public Health

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