Although hospital hygiene has a long history in Italy it is necessary to reflect about it because of the innovation in healthcare systems and because of the evolution due to European Union related activities. Different traditions exist in European countries about hospital hygiene and European Centre for Disease Prevention and Control (ECDC) adopted the term of "infection control and hospital hygiene" which includes all the engaged European healthcare professionals. We propose to modify hospital hygiene as "healthcare organisation hygiene" in order to focalise the attention to all care settings not only hospitals and to adopt the following definition: "all activities aimed to guarantee, in an appropriate, scientifically sound and efficient way, that structures and processes support healthcare practices in a safe comfortable and healthy environment both for patients, caregivers and healthcare workers". Hospital hygiene and its professionals, besides the long tradition, still remain a relevant pillar in guaranteeing quality and safety of healthcare in Italy.
OBIETTIVI: I farmaci biotech, prodotti attraverso la biologia molecolare, costituiscono una grande innovazione in oncologia. Il loro alto costo può tuttavia rappresentare una criticità per la sostenibilità del servizio sanitario nazionale ed è pertanto rilevante valutarne con attenzione i benefici ed i rischi, per giustificarne l'utilizzo e definirne appropriatezza prescrittiva ed implicazioni di politica sanitaria. Attraverso la tecnica della revisione sistematica della letteratura e della meta-analisi abbiamo analizzato l'efficacia, la sicurezza e l'appropriatezza del Trastuzumab, importante farmaco biotech per la terapia del tumore della mammella. MATERIALI: Sono stati analizzati tutti gli studi randomizzati controllati (RCT) che hanno valutato l'efficacia e la sicurezza del Trastuzumab da solo o in associazione versus chemioterapia standard in donne di ogni età, con tumore mammario HER-2 positivo. La ricerca degli studi si è svolta su MEDLINE, EMBASE, TOXNET, BIOSIS, ASCO e sul registro del Cochrane Breast Cancer Group. Due revisori hanno valutato la qualità degli RCT. I risultati sono stati sintetizzati e inseriti nelle meta-analisi dividendo gli studi in sottogruppi: tumore precoce e metastatico, alta e bassa qualità, durata del trattamento, somministrazione sequenziale e concomitante. I risultati sono espressi come hazard ratio (HR) per i dati di sopravvivenza e rischio relativo (RR) per gli outcome binari e riportano gli intervalli di confidenza al 95% (IC). RIASSUNTO: Sono stati inclusi 8 RCT riguardanti il tumore mammario precoce e 4 sul tumore metastatico. I dati sulla sopravvivenza e sopravvivenza libera da malattia o da progressione favorivano significativamente i regimi contenenti Trastuzumab sia nel tumore precoce (HR 0.66, IC 0.57-0.77 e HR 0.60, IC 0.50-0.71) che in quello metastatico (HR 0.79, IC 0.67-0.94 e HR 0.56, IC 0.48-0.64). Si evidenziava peraltro anche un aumentato rischio di scompenso cardiaco grave (RR 5.11, IC 2.70-9.66 e RR 3.75, IC 1.68-8.39), ! soprattu tto nelle pazienti trattate per più di 6 mesi. L'efficacia del trattamento non era influenzata dallo stato linfonodale od ormonale, dalle dimensioni del tumore o dall'età. CONCLUSIONI: Il Trastuzumab migliora certamente la sopravvivenza delle pazienti. Ci troviamo però insicuri riguardo alla magnitudine del beneficio del farmaco ed alla durata dello stesso nel tempo. I dati rivelano, infatti, che il farmaco è gravato da un'importante cardiotossicità, che erode il beneficio netto. Gli studi analizzati, inoltre, sono caratterizzati da bias, che potrebbero enfatizzare erroneamente l'efficacia reale. È necessario pertanto definire con cautela l'appropriatezza prescrittiva di questo farmaco.
Objectives: We assess the individual willingness to pay for diseases arising from risky lifestyles and investigate the personal factors that influence such willingness. Study design: We conducted an online survey with 821 respondents in Italy. The questionnaire was distributed via Facebook® in July and August 2016. The questionnaire covered sociodemographic characteristics, health status, behaviour and psychological attitudes, economic status, and opinion about covering the healthcare costs related to overeating, unhealthy diet, sedentary lifestyles, alcohol abuse, tobacco smoking, driving under the influence of alcohol, and illegal drug use by. Methods: We performed the following: (1) the study of the patterns in the dependent variables by principal component analysis; (2) analysis of the determinants by Holdout Variable Importance measure obtained in Random Forest; and (3) we used ordered logit models. Results: Participants agreed with the idea that public health care should be provided for problems arising from bad eating habits and sedentary lifestyle (50.4%), whereas the health care consequences of the other risky behaviours should not be publicly financed by the Italian National Health Service. Conclusions: Our study gives an overview of the willingness to pay of a population living in a country where financing of the Health Service is based on general taxation. So, these results may be generalized, with due caution, to all the countries where the Health Service offers universal coverage and is operated by the government, but of course not to scenarios related to market-based or social health insurance systems.
The first case of Coronavirus Disease 2019 in Italy was detected on February the 20th in Lombardy region. Since that date, Lombardy has been the most affected Italian region by the epidemic, and its healthcare system underwent a severe overload during the outbreak. From a public health point of view, therefore, it is fundamental to provide healthcare services with tools that can reveal possible new health system stress periods with a certain time anticipation, which is the main aim of the present study. Moreover, the sequence of law decrees to face the epidemic and the large amount of news generated in the population feelings of anxiety and suspicion. Considering this whole complex context, it is easily understandable how people "overcrowded" social media with messages dealing with the pandemic, and emergency numbers were overwhelmed by the calls. Thus, in order to find potential predictors of possible new health system overloads, we analysed data both from Twitter and emergency services comparing them to the daily infected time series at a regional level. Particularly, we performed a wavelet analysis in the time-frequency plane, to finely discriminate over time the anticipation capability of the considered potential predictors. In addition, a cross-correlation analysis has been performed to find a synthetic indicator of the time delay between the predictor and the infected time series. Our results show that Twitter data are more related to social and political dynamics, while the emergency calls trends can be further evaluated as a powerful tool to potentially forecast new stress periods. Since we analysed aggregated regional data, and taking into account also the huge geographical heterogeneity of the epidemic spread, a future perspective would be to conduct the same analysis on a more local basis.
This paper outlines the characteristics of scientific leadership and the role of Scientific Associations with their specific activities. The recent activities of the Lombard Academy of Public Health are subsequently described, including the creation, in 2019, of the Academy of young leaders in public health. Comparing to other sectors, scientific leadership dynamics take into consideration different aspects. Besides awards (Nobel Prize or several other) and prestigious affiliations, eventual indicators might be academic roles, fundraising abilities, relevant positions among scientific associations, editors of prestigious journals or editorial series and, more recently, high bibliometric indicators. The peculiar topics of public health encompass interactions with institutions, authorities, politicians, involved in different levels in health policies. Recently, in Italy, the Ministry of Health has identified parameters to be accreditated as a scientific and technical association. The role of SItI (Italian Society of Hygiene), EUPHA, ASPHER, and WFPHA appears relevant in PH, in national and international contexts, with Italian praiseworthy members constantly achieving leading roles. Considering that few training opportunities aimed to improve research and leadership skills are available, Accademia Lombarda di Sanità Pubblica (ALSP) designed the AYLPH (Academy of Young Leaders in Public Health) program. AYLPH program is a 1-year training to shape leadership skills among young professionals. A set of didactic, theoretical and practical methods was offered and evaluated.
L'igiene ospedaliera in Italia ha una lunga e solida storia che però richiede una necessaria riflessione per poter restare al passo con quelle che sono le innovazioni e gli sviluppi dei sistemi sanitari anche connessi a quelle che sono le attività dell'Unione Europea. A livello europeo infatti esistono diverse tradizioni nazionali che riguardo l'igiene ospedaliera e per questo motivo l'European Centre for Disease Prevention and Control (ECDC) ha adottato il termine "controllo delle infezioni e igiene ospedaliera" per poter così includere tutti i professionisti sanitari dei singoli Paesi. La nostra proposta è sia quella di modificare il termine di "igiene ospedaliera" in "igiene delle organizzazioni sanitarie" per poter focalizzare l'attenzione anche ai numerosi livelli di cura non ospedalieri, sia di adottare la seguente definizione: "tutte le attività volte a garantire, in modo appropriato, scientificamente valido ed efficiente, l'assistenza in un ambiente sicuro, confortevole e salubre per i pazienti, i caregiver e gli operatori sanitari". L'igiene ospedaliera ed i suoi professionisti sono un pilastro necessario per garantire la qualità e la sicurezza dell'assistenza sanitaria in Italia. ; Although hospital hygiene has a long history in Italy it is necessary to reflect about it because of the innovation in healthcare systems and because of the evolution due to European Union related activities. Different traditions exist in European countries about hospital hygiene and European Centre for Disease Prevention and Control (ECDC) adopted the term of "infection control and hospital hygiene" which includes all the engaged European healthcare professionals. We propose to modify hospital hygiene as "healthcare organisation hygiene" in order to focalise the attention to all care settings not only hospitals and to adopt the following definition: "all activities aimed to guarantee, in an appropriate, scientifically sound and efficient way, that structures and processes support healthcare practices in a safe comfortable and healthy environment both for patients, caregivers and healthcare workers". Hospital hygiene and its professionals, besides the long tradition, still remain a relevant pillar in guaranteeing quality and safety of healthcare in Italy.
