• The "cost disease" in medical education Editorial

    Walsh, Kieran
  • Atrial fibrillation and the 4P medicine Commentaries

    Censi, Federica; Cianfrocca, Cinzia; Purificato, Ivana

    Abstract in English:

    Although the paradigm of the 4P medicine - Predictive, Personalized, Preemptive, and Participatory - has been suggested several years ago, its application to atrial fibrillation is still far away. Given the increasing prevalence and incidence of this pathology it is the time to promote preventive strategies, by identifying the risk factors associated to life style and by incentivizing innovative diagnostic technologies. The promotion of the correct life style and of the use of diagnostic devices based on innovative and reliable technologies, represent a first step towards the full realization of the revolution of 4P medicine in atrial fibrillation.
  • Asbestos case and its current implications for global health Commentaries

    Marsili, Daniela; Comba, Pietro

    Abstract in English:

    Notwithstanding a major body of evidence on the carcinogenicity of all asbestos fibres and a general consensus of the scientific community on the health impact of this agent, asbestos is still produced and used in a large number of countries, thus determining further harm for future generations. Prevention of asbestos-related disease requires international cooperation, transfer of know-how and dissemination of successful procedures in order to contrast asbestos exposure in the frame of a global environmental health approach.
  • Effect of low-level laser irradiation on osteoblast-like cells cultured on porous hydroxyapatite scaffolds Original Articles and Reviews

    Parenti, Serena Incerti; Panseri, Silvia; Gracco, Antonio; Sandri, Monica; Tampieri, Anna; Bonetti, Giulio Alessandri

    Abstract in English:

    OBJECTIVE: To determine the effect of laser irradiation at a low dose on human osteoblastlike cells. Materials and methods: 32 porous hydroxyapatite scaffolds currently used for bone tissue engineering were seeded with MG63 cells and irradiated or not with a GaAlAs diode laser (wavelength 915 nm, dose 2 J/cm²) using different power density and exposure duration. RESULTS: After 72-h incubation, cells showed well spread morphology and good adhesion on both laser-treated and untreated scaffolds. Laser irradiation did not interfere in cell viability and proliferation as compared with the non-irradiated controls. CONCLUSION: This study suggests that there is no effect of 915 nm laser irradiation at a dose of 2 J/cm² on the proliferation rate of MG63 cells. Future investigations are needed to compare different dose and wavelength regimens in order to determine the optimal set of laser parameters for maximum cell yield and safe clinical application.
  • Comparative evaluation of the accuracy of linear measurements between cone beam computed tomography and 3D microtomography Original Articles and Reviews

    Mangione, Francesca; Meleo, Deborah; Talocco, Marco; Pecci, Raffaella; Pacifici, Luciano; Bedini, Rossella

    Abstract in English:

    OBJECTIVE: The aim of this study was to evaluate the influence of artifacts on the accuracy of linear measurements estimated with a common cone beam computed tomography (CBCT) system used in dental clinical practice, by comparing it with microCT system as standard reference. MATERIALS AND METHODS: Ten bovine bone cylindrical samples containing one implant each, able to provide both points of reference and image quality degradation, have been scanned by CBCT and microCT systems. Thanks to the software of the two systems, for each cylindrical sample, two diameters taken at different levels, by using implants different points as references, have been measured. Results have been analyzed by ANOVA and a significant statistically difference has been found. RESULTS AND DISCUSSION: Due to the obtained results, in this work it is possible to say that the measurements made with the two different instruments are still not statistically comparable, although in some samples were obtained similar performances and therefore not statistically significant. CONCLUSION: With the improvement of the hardware and software of CBCT systems, in the near future the two instruments will be able to provide similar performances.
  • Are age and gender associated to tobacco use and knowledge among general practitioners?: Results of a survey in Italy Original Articles and Reviews

    Unim, Brigid; Del Prete, Giuseppe; Gualano, Maria Rosaria; Capizzi, Silvio; Ricciardi, Walter; Boccia, Antonio; La Torre, Giuseppe

    Abstract in English:

    OBJECTIVES: The aim of this study was to assess knowledge and opinions of Italian general practitioners about the effectiveness of smoking cessation interventions and physicians' attitudes in addressing tobacco-related issues. METHODS: The survey was carried out through a questionnaire administered to general practitioners (GPs) attending a medical refresher course. 133 Italian GPs participated in the study with a mean age of 51.4 years (SD = 6.2). RESULTS: The GPs had good knowledge about the predictors of smoking onset, pharmacotherapies for tobacco cessation and the clinical guidelines recommendations. Wrong answers were encountered for the prevalence of smokers in Italy, the Fagerstrom Test for nicotine dependence and minimal advice. Females were more subjected to higher knowledge about tobacco, and at lower risk to be a smoker/ex smoker. Furthermore, physicians > 50 years old living in northern Italy had higher knowledge score. CONCLUSIONS: Physician education on tobacco counseling is associated to increased comfort and practice in advising patients who smoke. Tobacco cessation training might increase the success rate of helping patients to quit smoking.
  • Dietary exposure to trace elements and radionuclides: the methodology of the Italian total diet study 2012-2014 Original Articles and Reviews

    D'Amato, Marilena; Turrini, Aida; Aureli, Federica; Moracci, Gabriele; Raggi, Andrea; Chiaravalle, Eugenio; Mangiacotti, Michele; Cenci, Telemaco; Orletti, Roberta; Candela, Loredana; Sandro, Alessandra di; Cubadda, Francesco

    Abstract in English:

    This article presents the methodology of the Italian Total Diet Study 2012-2014 aimed at assessing the dietary exposure of the general Italian population to selected non-essential trace elements (Al, inorganic As, Cd, Pb, methyl-Hg, inorganic Hg, U) and radionuclides (40K, 134Cs, 137Cs, 90Sr). The establishment of the TDS food list, the design of the sampling plan, and details about the collection of food samples, their standardized culinary treatment, pooling into analytical samples and subsequent sample treatment are described. Analytical techniques and quality assurance are discussed, with emphasis on the need for speciation data and for minimizing the percentage of left-censored data so as to reduce uncertainties in exposure assessment. Finally the methodology for estimating the exposure of the general population and of population subgroups according to age (children, teenagers, adults, and the elderly) and gender, both at the national level and for each of the four main geographical areas of Italy, is presented.
  • Ethical considerations for evaluating the issue of physical restraint in psychiatry Original Articles and Reviews

    Petrini, Carlo

    Abstract in English:

    This article examines some of the ethical issues associated with the use of physical restraint in psychiatry and neurology. It offers no specific answers to individual operational problems, but a methodological matrix is proposed as an aid to experts in the various settings in which decisions are taken. The subject is addressed mainly by considering two sources: reference documents published by eminent organisations, and the theoretical framework of ethical values (or principles). A number of analytical criteria arising from these sources are then identified and proposed. The proposed criteria can be applied in cases for which the legitimate use of restraint may be an option, bearing in mind that restraint is an extremely serious affront to human dignity and is widely held to be of no therapeutic value. Its abuse is illegitimate in both ethical and legal terms.
  • HPV vaccination acceptability in young boys Original Articles and Reviews

    Tisi, Giancarlo; Salinaro, Federica; Apostoli, Pietro; Bassani, Raffaella; Bellicini, Anna; Groppi, Lavinia; Donarini, Paolo; Pecorelli, Sergio

    Abstract in English:

    PURPOSE: The aim of this study was to evaluate the comprehension and acceptance of HPV vaccination in parents of adolescent boys aged 11 to 15 years. METHODS: A cross-sectional survey was conducted by means of questionnaires sent directly to the homes of all families with young males aged between 11 and 15, residents of three municipalities of the Province of Brescia, Italy. The documentation also contained an informative leaflet summarizing the HPV-related disease characteristics, the burden of disease and the available strategies for prevention and treatment, illustrating the rationale of vaccination and describing the project and its phases. The questionnaire included questions on demographic data, acceptance and motivations for HPV vaccination. The collected data was analyzed using descriptive statistics. At the end of the study, parents who received the questionnaires were also offered the possibility of vaccinating their male sons for free. RESULTS: From a total of 1072 questionnaires sent, 161 where returned from the three selected municipalities (average response rate 15%); 97% of adolescent males involved in the study were Italian and 91% Catholic; 97% of parents declared themselves to be willing to vaccinate their sons: the principal motivation given (92%) was prevention of the disease, cancerous or not, related to viral infection. Among the respondents not willing to vaccinate their sons, the motivation was lack of information about the vaccine and the disease. At the end of the study, around 71 boys were vaccinated. DISCUSSION: To our knowledge, this is the first survey in Italy exclusively conducted on parents of adolescent males about the acceptability and feasibility of vaccination against HPV: a very high percentage of respondents was favorable to accept the vaccination for their sons, the main motivation being the fact that parents considered protecting their sons from HPV-related diseases highly important. Of the 161 boys targeted by the questionnaire, 71 decided to receive the 3 doses of HPV vaccination (44%). Data suggests that HPV vaccination is acceptable to families for their male sons and that information is important in the decision-making process.
  • University psychiatry in Italy: organisation and integration of university clinics and the National Health Service Original Articles and Reviews

    Furlan, Pier Maria; Oliva, Francesco; Picci, Rocco Luigi

    Abstract in English:

    INTRODUCTION: In the Italian psychiatric system, community-based care has become increasingly important and widespread since the national reform of 1978. This report aims to provide an overview of the involvement of university medical schools in this process, considering their responsibility for teaching and training specialist practitioners and professionals. METHODS: The study was carried out between early 2010 and February 2011. An 18-items, self-administered, questionnaire was designed to investigate the number of faculty members that are responsible both for running a clinical ward and for providing community-based healthcare. RESULTS: Nine out of 53 faculty members (17%) manage a Mental Health Department, 9 (17%) manage a University Department, and 2 (3.8%) manage both types of department. Less than half of the teachers have full responsibility (hospital and community); however the percentage reaches 73.2% if we include the hospital wards open to the community emergencies. The remaining 26.8% have no responsibility for community psychiatry. Moreover there were undoubtedly still too many universities with specialisation schools that are without an appropriate network of facilities enabling them to offer complex psychiatric training. DISCUSSION: As expected, there were several types of healthcare management that were not uniformly distributed throughout Italy and there were also marked differences between mental health care provision in the North, Centre, and South of Italy. The university involvement in clinical responsibility was great, but at the management level there was a lack of equality in terms of clinical care, which risks being reflected also on the institutional functions of teaching and research.
  • Technique for bone volume measurement from human femur head samples by classification of micro-CT image histograms Original Articles and Reviews

    Marinozzi, Franco; Bini, Fabiano; Marinozzi, Andrea; Zuppante, Francesca; De Paolis, Annalisa; Pecci, Raffaella; Bedini, Rossella

    Abstract in English:

    INTRODUCTION: Micro-CT analysis is a powerful technique for a non-invasive evaluation of the morphometric parameters of trabecular bone samples. This elaboration requires a previous binarization of the images. A problem which arises from the binarization process is the partial volume artifact. Voxels at the external surface of the sample can contain both bone and air so thresholding operates an incorrect estimation of volume occupied by the two materials. AIM: The aim of this study is the extraction of bone volumetric information directly from the image histograms, by fitting them with a suitable set of functions. METHODS: Nineteen trabecular bone samples were extracted from femoral heads of eight patients subject to a hip arthroplasty surgery. Trabecular bone samples were acquired using micro-CT Scanner. Hystograms of the acquired images were computed and fitted by Gaussian-like functions accounting for: a) gray levels produced by the bone x-ray absorption, b) the portions of the image occupied by air and c) voxels that contain a mixture of bone and air. This latter contribution can be considered such as an estimation of the partial volume effect. RESULTS: The comparison of the proposed technique to the bone volumes measured by a reference instrument such as by a helium pycnometer show the method as a good way for an accurate bone volume calculation of trabecular bone samples.
  • Immunokinetics: a new approach to vaccines. A working hypothesis Brief Notes

    Silvestrini, Bruno

    Abstract in English:

    This paper outlines the working hypothesis that immune response is triggered, beside antigenicity referred to by the two major theories of Burnet (1959) and Jerne (1974) by the kinetics of the antigen that enters the body or, in the case of an endogenous origin, there is released from compartments where it is normally sequestered. This hypothesis, for simplicity called immunokinetics, postulates that the intensity of the immune response grows with the increase of the rapidity of the above contact or release and, conversely, declines with its decrease. Sublingual administration allows, by speeding up the vaccines absorption, to optimize their efficacy, safety and uses. Kinetics is also discussed in connection with homeostatic and adaptive processes involved in evolution.
  • Cugini's syndrome: its clinical history and diagnosis Brief Notes

    Gasbarrone, Laura

    Abstract in English:

    INTRODUCTION: This article deals with the description and diagnosis of a new nosographic syndrome, which received the eponym of "Cugini's syndrome" by the name of the Author who discovered its clinical picture. This syndrome is characterized by the binomial: "minimal target organ damage associated to monitoring prehypertension". CLINICAL HISTORY AND DIAGNOSIS: Between the years 1997 and 2002, the Author published a series of investigations regarding some office normotensives who inexplicably showed incipient signs of target organ damage (TOD). Investigated via ambulatory (A) blood (B) pressure (P) monitoring (M), these subjects were surprisingly found not to be hypertensive. Neverthless, the office normotensives with TOD exibited the daily mean level of their systolic (S) and diastolic (D) BP (DML SBP/DBP) significantly more elevated as compared to true normotensives. Because of these ABPM findings, the Author realized that the investigated subjects were false normotensives whose TOD was associated with a monitoring prehypertension (ABPM-diagnosable prehypertension alias monitoring prehypertension alias masked prehypertension). The year after the last Cugini's investigation, the INC-7 Reports introduced the term: "prehypertension" in its classification of arterial hypertension, as an office sphygmomanometric condition in between office normotension and office hypertension. The ABPM cut-off upper limits for a differential diagnosis between monitoring normotension, prehypertension and hypertension are reported, as calculated by the Author in its collection of ABPMs. The eponym of "Cugini's syndrome" was assigned in 2007 and confirmed in 2009. CONCLUSIVE REMARKS: The monitoring prehypertension is a further condition of discrepancy between office sphygmomanometry and ABPM, as per a masked prehypertension, whose diagnosis has to be immediately diagnosed, for preventing the onset of a TOD. There are reported the present investigations dealing with the possible need for an early antihypertensive treatment of prehypertension. A pharmacological treatment seems to be especially justified in the presence of a Cugini's syndrome.
  • Idiopathic macular hole: post-operative morpho-functional assessment and prognostic factors for recovery of visual acuity Brief Notes

    Tirelli, Flavio; Sasso, Paola; Scupola, Andrea

    Abstract in English:

    INTRODUCTION: Idiopathic macular hole (MH) is a full-thickness retinal damage typical of the advanced age with a high social impact because, as it affects the macula, it produces severe loss of vision. AIM: This study aims to evaluate the therapeutic efficacy of surgery and to determine prognostic factors, considering how hypovision weighs on individual quality of life and on public health. METHODS: All patients affected by MH were evaluated with an ophthalmic visit, measurement of visual acuity and Optical Coherence Tomography (OCT) documentation before surgical intervention. Surgical treatment followed and, subsequently, all the patients were examined with the same documentation at 7 days, 1 month, 3 months, 6 months and 12 months. RESULTS: Surgical therapy, with the modern techniques available, demonstrated the efficacy of anatomical recovery and retinal function. Furthermore, the quantitative characteristics of the MH in the OCT scanning revealed an important prognostic function.
  • Untitled document Book Reviews, Notes and Comments

  • Publications from International Organizations on Public Health Publications from International Organizations on Public Health

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