Scielo RSS <![CDATA[Annali dell'Istituto Superiore di Sanità]]> http://www.scielosp.org/rss.php?pid=0021-257120150002&lang=en vol. 51 num. 2 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>Medicine and philosophy</b>: <b>back to the antiquity</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Prevention of disease caused by fluoro-edenite fibrous amphibole</b>: <b>the way forward</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200002&lng=en&nrm=iso&tlng=en Few months after the publication of the monographic section of Annali dell'Istituto Superiore di Sanità second issue of 2014 "Health impact of fibres with fluoro-edenitic composition", the carcinogenicity of fluoro-edenite was assessed by the International Agency for Research on Cancer (IARC) in the frame of Monograph 111. The IARC Working Group concluded that there is sufficient evidence in humans that exposure to fluoroedenite fibrous amphibole causes mesothelioma, and sufficient evidence of carcinogenicity in experimental animals. Fluoro-edenite was allocated to Group 1 (the agent is carcinogenic to humans). Now, in view of the recent IARC evaluation, preventive action in Biancavilla requires an upgrade. First of all, environmental monitoring has to be further implemented. All operations of house cleaning should be performed employing wet tools, in order to avoid dust-raising. It is very important that environmental and biological monitoring be related to epidemiological surveillance. The recently approved act of the Sicilian Government concerning a plan of health interventions in Biancavilla will favour cooperation between national, regional and local health institutions with the common goal of improving the quality and appropriateness of diagnostic and therapeutics procedures offered by the health services. <![CDATA[<b>Preface</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200003&lng=en&nrm=iso&tlng=en Few months after the publication of the monographic section of Annali dell'Istituto Superiore di Sanità second issue of 2014 "Health impact of fibres with fluoro-edenitic composition", the carcinogenicity of fluoro-edenite was assessed by the International Agency for Research on Cancer (IARC) in the frame of Monograph 111. The IARC Working Group concluded that there is sufficient evidence in humans that exposure to fluoroedenite fibrous amphibole causes mesothelioma, and sufficient evidence of carcinogenicity in experimental animals. Fluoro-edenite was allocated to Group 1 (the agent is carcinogenic to humans). Now, in view of the recent IARC evaluation, preventive action in Biancavilla requires an upgrade. First of all, environmental monitoring has to be further implemented. All operations of house cleaning should be performed employing wet tools, in order to avoid dust-raising. It is very important that environmental and biological monitoring be related to epidemiological surveillance. The recently approved act of the Sicilian Government concerning a plan of health interventions in Biancavilla will favour cooperation between national, regional and local health institutions with the common goal of improving the quality and appropriateness of diagnostic and therapeutics procedures offered by the health services. <![CDATA[<b>Study population, questionnaire, data management and sample description</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200004&lng=en&nrm=iso&tlng=en INTRODUCTION: This article describes methodological issues of the "Sportello Salute Giovani" project ("Youth Health Information Desk"), a multicenter study aimed at assessing the health status and attitudes and behaviours of university students in Italy. MATERIALS AND METHODS: The questionnaire used to carry out the study was adapted from the Italian health behaviours in school-aged children (HBSC) project and consisted of 93 items addressing: demographics; nutritional habits and status; physical activity; lifestyles; reproductive and preconception health; health and satisfaction of life; attitudes and behaviours toward academic study and new technologies. The questionnaire was administered to a pool of 12 000 students from 18 to 30 years of age who voluntary decided to participate during classes held at different Italian faculties or at the three "Sportello Salute Giovani" centers which were established in the three sites of the Università Cattolica del Sacro Cuore (Catholic University of the Sacred Heart of Rome). RESULTS: The final study sample was composed by 8516 university students. The mean age of responders was 22.2 (Standard Deviation 2.0) and 5702 (67.0%) were females. According to the distribution in age classes, 3601 (43.3%) belonged to the 18-21 one, 3796 (44.5%) to the 22-24 class and 1019 (12.2%) to the 25-30 class. With respect to socio-economic status, data were available for 8410 responders and showed that 50.3% of students belonged to the middle class. DISCUSSION: The project took into consideration a large number of individuals from different regions of the country and therefore may be considered representative of the general population of Italian university students. Furthermore, it is the first to address, at the same time, several issues, in particular attitudes and behaviours toward health, in Italian university students. CONCLUSION: The analysis of data from such a large sample of university students sets the basis for identifying the most appropriate interventions in order to address the specific needs of this population. <![CDATA[<b>Nutritional habits in Italian university students</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200005&lng=en&nrm=iso&tlng=en INTRODUCTION: Dietary habits have been indicated by research as key elements in both disease pathogenesis and prevention and health promotion. MATERIALS AND METHODS: We analyzed data collected from Italian university students regarding consumption of fruits, vegetables, fast-foods, sweets, energizing drinks, and coffee, average number of eating episodes per day and regularity of breakfast habits. RESULTS: 44% of the university student population eats in average at least 1 portion of fruit per day. 22.5% eats at least 2 portions of vegetables per day. 8.5% eats in average 5 times per day with 48.6% declaring an average of 3 eating episodes per day. 11.3% consumes eccessive amounts of caffeine. 49.1% of the females reaches the recommended consumption of fruit, compared to only 33.8% of males (p < 0.05). 27.7% of females eats at least 2 portions of vegetables per day, compared to 12.0% of males (p < 0.05). Eccessive coffee drinkers pass from 8.9% in the 18-21 age group to 16% in the 25-30 year old age group (p < 0.05). DISCUSSION: This study showed that the eating habits of young adults do not follow national recommendations. Less than 50% of university students eats at least 1 portion of fruit per day and less than 1 out of 4 eats at least 2 portions of vegetables per day. Less than 10% of the students eats in average 5 times per day and more than 1 out of 3 does not have breakfast regularly every morning. CONCLUSION: Interventions targeting university students are required in order to increase their knowledge on healthy eating habits and to ameliorate their dietary behaviours. <![CDATA[<b>Physical activity and health promotion in Italian university students</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200006&lng=en&nrm=iso&tlng=en INTRODUCTION: Physical activity, diet plans, the mantainment of a certain Body Mass Index (BMI) and the use of various types of supplementation are common elements in the search for disease prevention, health promotion and well-being. MATERIALS AND METHODS: We analyzed the data regarding Italian university students' BMI, dieting behaviour, personal body perception, exercise habits, and use of dietary supplements and of doping substances. RESULTS: 13.7% resulted being underweight, 75.1% was in the normal range, 9.8% was overweight, and 1.4% was obese. 11.0% were on a diet. 25.8% of the students reported never doing any type of physical activity. 0.9% admitted consuming doping substances. The percentage of overweight/obese students increases from 8.8% of the 18-21 year olds to 18.1% of the 25-30 year olds. Similarly, the prevalence of overweight/obesity was 18.5% among male population and 7.5% among the female one. DISCUSSION: The data deriving from this questionnaire showed that while the majority of university students has a BMI in the normal range, 11.2% of the study population is overweight/obese. Males present a higher risk of being overweight or obese. An important part of the population showed to be sedentary even though data coming from our study are aligned to further evidence. CONCLUSION: The most important concern arising from the questionnaire is represented by physical inactivity. Indeed, it is necessary to encourage and plan initiatives aimed at promoting physical activity in university students. <![CDATA[<b>Risky behaviours among university students in Italy</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200007&lng=en&nrm=iso&tlng=en BACKGROUND: The use of psychoactive substances is one of the most important public health issues. Tobacco, alcohol and illicit drugs are among the top risk factors for ill-health defined by World Health Organisation. The risky behaviours acquired in teenage can be magnified or decreased during university when a person starts having more awareness about the importance of own wellness. This paper describes the results of the project "Sportello Salute Giovani" ("Youth Health Information Desk") with respect to risky behaviours in a large sample of Italian university students. MATERIALS AND METHODS: 18 questions of the survey "Sportello Salute Giovani" dealing with risky behaviors, the use of psychoactive substances such as tobacco, alcohol and illicit drugs were included. Absolute and relative frequencies were calculated. Besides, chi square test were used to test the differences in sex, age class and socio-economic status. RESULTS: About 24% of the interviewed students currently smokes. 89% and 42.2% respectively drinks at least rarely or weekly beer, wine or spirits. About 40% of students smoked at least a joint and about 2% used other drugs (mostly cocaine). CONCLUSION: The "Sportello Salute Giovani" survey suggests that the frequency of risky behaviours in Italian university students is not reassuring, although they should be aware about the negative consequences on their and others health because of their educational level. <![CDATA[<b>Sexual behaviours and preconception health in Italian university students</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200008&lng=en&nrm=iso&tlng=en INTRODUCTION: Risky sexual behaviours have been recognized as a threat for sexual and reproductive health. AIM: This article shows the results of the "Sportello Salute Giovani" project ("Youth Health Information Desk") in relation to determining how a large sample of university students in Italy cope with preconception health, especially in the domains of sexual transmitted infections (STIs), fertility and vaccination preventable disease. METHODS: Twentythree questions of the "Sportello Salute Giovani" survey about sexual behaviour and reproductive health were analysed. Besides, results were stratified for sex, age class and socio-economic status. RESULTS: 19.7% of students have had first sexual intercourse before age 15. 21.8% of female students used emergency contraception. 66.4% of the 74.0% sexual active students reported using contraceptives, but about 32% of them used methods ineffective against STIs. A general low coverage for rubella, measles and mumps vaccination was revealed. 63.7% of men and 30.9% of woman never had urologic or gynaecological examinations. DISCUSSION: Overall, young adults in Italy are not still enough sensitized on fertility and preconception care. High schools and universities should increase awareness towards preservation of male and female fertility and preconception care. <![CDATA[<b>Italian university students' self-perceived health and satisfaction of life</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200009&lng=en&nrm=iso&tlng=en INTRODUCTION: Health is defined as a state of complete physical, social and mental wellbeing, therefore, it should not be considered as simply the absence of disease. In this light, the assessment of self-perceived health and life satisfaction plays an important role as it allows addressing the subjective perception of physical health, as well as mental health and social functioning. MATERIAL AND METHODS: This study analyzed data from 8516 university students enrolled in the "Sportello Salute Giovani" project ("Youth Health Information Desk"). In particular, it addressed self-perceived health and life satisfaction, reported somatic and psychological symptoms and ability to cope with daily problems of university students from 18 to 30 years old. RESULTS: Overall, 77.1% of students declared to have a good or very good health and the mean score of life satisfaction was 7.46. In respect to somatic and psychological symptoms, 25.8% of students reported to suffer almost daily of at least one among headache, stomach pain, back pain, tiredness, nervousness, dizziness and troubles falling asleep. Results varied on the basis of sex, with women showing lower self-perceived health compared to men and reporting more symptoms. Furthermore, self-perceived health was shown better in younger students and in those belonging to higher socio-economic level. DISCUSSION: The survey showed that concern exists with respect to university students' self-perceived health, which is different from that arising from other evidence. Female students had a significant lower self-perceived health and reported somatic and psychological symptoms more commonly than men. On the other hand, results about life satisfaction seem to be aligned with the literature. CONCLUSION: One of the most important implications of the study is the need to address self-perceived health and reported symptoms in university students in order to monitor them and initiate interventions aimed at improving well-being and controlling inequalities. <![CDATA[<b>Study habits and technology use in Italian university students</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200010&lng=en&nrm=iso&tlng=en BACKGROUND: Students' ability of learning is influenced by study habits. Among these, the use of technologies has assumed a controversial role. The aim of this paper is to analyse studying approach, the use of technologies and how they affect study habits in a population of university students addressed by the "Sportello Salute Giovani" ("Youth Health Information Desk") questionnaire. METHODS: 16 questions referred to the approach to studying and the use of technologies (number 77-93) were analyzed. Absolute and relative frequencies were calculated. Stratification for sex, age and socio-economic status were performed and Chi square test was used to test the difference between sex, age class and socio-economic groups. RESULTS: 99.7% of students declared to have at least one mobile phone and 68.7% to use smartphones, i-phones and i-pads. Males (20.9% vs 14.9% female, p < 0.05), older students (31.7% among 25-30 years old students vs 21.3% among 18-21 years old, p < 0.05) and students with the highest socio-economic level (87.8% vs 54.2% of the lowest) seem more likely to use digital technologies/Internet for educational purposes. CONCLUSION: Our survey revealed that most college students still prefer approach the study using books instead of digital tools, but this attitude is conflicting with how many hours they use computers and surf Internet per weeks. Therefore, further studies are needed to understand better technology influence on study habits and its implication on health. <![CDATA[<b>Appropriateness of clinical and organizational criteria for intra-articular injection therapies in osteoarthritis</b>: <b>A Delphi method consensus initiative among experts in Italy</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200011&lng=en&nrm=iso&tlng=en OBJECTIVE: The aim of the study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile, as well as the medico-legal and organizational aspects of intra-articular injection therapies for osteoarthritis. METHODS: A committee of 10 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Fifty-two clinicians from a large number of Italian medical centers specialized in intra-articular injection therapy took part in a Delphi process aimed at obtaining consensus statements among the participants. RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical device choice; treatment efficacy; and appropriate setting. CONCLUSIONS: The consensus statements developed by a large number of experts may be used as a practical reference tool to help physicians treat osteoarthritis patients by means of intra-articular injection therapies. <![CDATA[<b>Migratory behaviour of tumour cells</b>: <b>a scanning electron microscopy study</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200012&lng=en&nrm=iso&tlng=en BACKGROUND: Tumour cells utilize different migration strategies to invade surrounding tissues and elude anticancer treatments. It is therefore important to understand the mechanisms underlying migration process, in order to aid the development of therapies aimed at blocking the dissemination of cancer cells. AIMS: In this study tumour cell lines of different histological origin were analysed by combining 2D and 3D in vitro assays, biochemical tests and high resolution imaging by scanning electron microscopy (SEM) in order to look insight strategies adopted by tumour cells to invade extracellular matrix. RESULTS: Quantitative (computer-assisted colour camera equipped-light microscopy) and qualitative analysis (SEM) indicated that the most aggressive tumour cells adopt an "individual" behaviour. The analysis of intracellular signalling demonstrated that the highest invasive potential was associated with the activation of AKT, ERK, FAK and ERM proteins. The "individual" behaviour was positively related to the expression of VLA-2 and inversely related with the E-cadherin expression. CONCLUSIONS: The combination of 2D and 3D in vitro assays, biochemical tests and ultrastructural investigations proved to be a suitable test for the investigation of tumour cell migration and invasion. The high resolution imaging by SEM highlighted the interrelationships between cells in different migratory behaviours of tumour cells. <![CDATA[<b>Prevalence of major cardiovascular risk factors among oil and gas and energy company workers</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200013&lng=en&nrm=iso&tlng=en INTRODUCTION: Cardiovascular diseases (CVD) remain the biggest cause of disability and premature death throughout the world. AIM: The aim of this study was to describe and determine the prevalence of major cardiovascular risk factors emerged at the first medical examination carried out by a group of an oil and gas contractor company workers in the observation period 2000-2010. METHODS: An observational cross-sectional study was conducted on 1073 workers (mean age 41 years, SD = 9.5) presenting overweight BMI (body mass index) values, hypertension and cholesterol problems. RESULTS: In particular, we found that workers &gt; 45 years had significant higher risk to have obesity (OR = 3.8, CI 95% = 2.5-5.7), hypertension (OR = 2.7, CI 95% = 2.1-3.6), high blood fasting glucose (OR = 2.6, CI 95% = 1.2-5.5), high cholesterol (OR = 2.7, CI 95% = 2.0-3.6), high triglycerides (OR = 1.8, CI 95% = 1.4-2.4) compared to younger (< 45 years). <![CDATA[<b>Assessment of lifestyle and eating habits among undergraduate students in northern Italy</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200014&lng=en&nrm=iso&tlng=en AIM AND METHODOLOGY: Dietary habits of university students were analyzed in order to investigate any differences between students living at and away from home. Two hundred and fifty-eight undergraduate students attending University of Ferrara completed a self-administered questionnaire on demographic characteristics, food frequency consumption habits and body weight perception. RESULTS: Students living at home practiced more sport and consumed more frequently raw and cooked vegetables, fish, meat and poultry, fresh fruit, eggs, bread/cereals. Conversely, students living away from home consumed more often packaged/ready food, beer and spirits, milk and chips. The majority of students living alone reported a modification of dietary habits since leaving family. Furthermore they perceived to have a weight condition different from normal in a greater extent than students living with family. DISCUSSION: Students living alone encountered more difficulties in adopting a healthy diet so it would be desirable to adopt nutritional educational interventions on university students, usually neglected by these measures. <![CDATA[<b>Cesarean section on maternal request</b>: <b>should it be formally prohibited in Italy?</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200015&lng=en&nrm=iso&tlng=en BACKGROUND: Cesarean section on maternal request (CSMR) could represent an avoidable quota of cesareans. In Italy, this is a topical problem of health-policy, involving ethical, juridical and medical issues. AIM AND METHODS: A 5-questions questionnaire to quantitatively assess the perspectives of medical, juridical and ethical issues of planned CSMR was administered to obstetricians and gynecologists, midwives, lawyers and pregnant women. It was assessed to what extent those issues matter on the final decision of planning a CSMR. RESULTS: Non-homogeneous answers of stakeholders suggest different perspectives about issues on CSMR. The juridical issue seems to have the greatest impact on the final decision. CONCLUSION: Planning a CSMR associates overall with juridical issues in each group of respondents. Therefore, an obstetrician and gynecologist is unable to counsel a patient on CSMR from a medical point of view. The most direct way for reducing cesareans in Italy could be the formal prohibition of CSMR. <![CDATA[<b>Biomarkers of effect in endocrine disruption</b>: <b>how to link a functional assay to an adverse outcome pathway</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200016&lng=en&nrm=iso&tlng=en The development of in vitro testing strategies may achieve a cost-effective generation of comprehensive datasets on a large number of chemicals, according to the requirements of the European Regulation REACH. Much emphasis is placed on in vitro methods based on subcellular mechanisms (e.g., nuclear receptor interaction), but it is necessary to define the predictive value of molecular or biochemical changes within an adverse outcome pathway (AOP). AOP pivots on the description of the flow from a molecular initiating event through a cascade of intermediate events needed to produce a specific adverse effect at organism level: downstream responses at cell level are, therefore, essential to define an AOP. Several in vitro assays are based on human cell lines representative of endocrine-targeted tissues (e.g., prostate) and on functional biomarkers of clinical relevance (e.g., PSA secretion in human prostate epithelial cells). We discuss the implementation of such functional biomarkers in the AOP context. http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200017&lng=en&nrm=iso&tlng=en The development of in vitro testing strategies may achieve a cost-effective generation of comprehensive datasets on a large number of chemicals, according to the requirements of the European Regulation REACH. Much emphasis is placed on in vitro methods based on subcellular mechanisms (e.g., nuclear receptor interaction), but it is necessary to define the predictive value of molecular or biochemical changes within an adverse outcome pathway (AOP). AOP pivots on the description of the flow from a molecular initiating event through a cascade of intermediate events needed to produce a specific adverse effect at organism level: downstream responses at cell level are, therefore, essential to define an AOP. Several in vitro assays are based on human cell lines representative of endocrine-targeted tissues (e.g., prostate) and on functional biomarkers of clinical relevance (e.g., PSA secretion in human prostate epithelial cells). We discuss the implementation of such functional biomarkers in the AOP context. <![CDATA[<b>Publications from International Organizations on Public Health</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712015000200018&lng=en&nrm=iso&tlng=en The development of in vitro testing strategies may achieve a cost-effective generation of comprehensive datasets on a large number of chemicals, according to the requirements of the European Regulation REACH. Much emphasis is placed on in vitro methods based on subcellular mechanisms (e.g., nuclear receptor interaction), but it is necessary to define the predictive value of molecular or biochemical changes within an adverse outcome pathway (AOP). AOP pivots on the description of the flow from a molecular initiating event through a cascade of intermediate events needed to produce a specific adverse effect at organism level: downstream responses at cell level are, therefore, essential to define an AOP. Several in vitro assays are based on human cell lines representative of endocrine-targeted tissues (e.g., prostate) and on functional biomarkers of clinical relevance (e.g., PSA secretion in human prostate epithelial cells). We discuss the implementation of such functional biomarkers in the AOP context.