Suchergebnisse

The paper traces the evolution of vaccination policies in Italy in the first 40 years of the National Health Service. Four phases have been identified: the first (1978-98) characterized by the eradication of smallpox, the hopes of further eradications and the introduction of hepatitis B and acellular antipertussis vaccines; the second (1999-2008) coincided with the first national vaccination plans and with the hypothesis of a progressive transition from mandatory vaccinations to nudging initiatives with the relevant experimentation in the Veneto Region; the third phase (2009-14) was characterized by the spread of health information on the web and social networks, by anti-scientific judgments and by an increasingly vaccines hesitancy that led to incorrect perceptions, falls in coverage rates and re-ignition of some epidemics; in the last phase (2015-18) there was a strong political committment that led to the approval of the National Plan (PNPV) 2017-19, to the extension of the mandatory vaccinations and to the sanctions against the anti-vaxxers doctors. This has led to a rapid rise in coverage, but also to a heated political and media debate on the ethical and social aspects linked to the admission bans and sancions of unvaccinated children in schools. (www.actabiomedica.it) Riassunto. Il lavoro ripercorre l'evoluzione delle politiche vaccinali in Italia nei primi 40 anni del Servizio Sanitario Nazionale. Sono state identificate quattro fasi: la prima (1978-98) caratterizzata dall'eradicazione del vaiolo, dalle speranze di ulteriori eradicazioni e dall'introduzione dei vaccini antiepatite B e antipertosse acellulare; la seconda (1999-2008) è coincisa con i primi piani vaccinali nazionali e con l'ipotesi di un progressivo passaggio dall'obbligo all'adesione consapevole, segnata dall'importante sperimentazione della Regione Veneto; la terza fase (2009-14) è stata caratterizzata dalla diffusione dell'informazione sanitaria su web e social, da sentenze giudiziarie antiscientifiche e da una sempre più diffusa vaccine ...

Since the beginning of the COVID-19 epidemic in Italy, the Italian Government implemented several restrictive measures to contain the spread of the infection. Data shows that, among these measures, the lockdown implemented as of 9 March had a positive impact, in particular the central and southern regions of Italy, while other actions appeared to be less effective. When the true prevalence of a disease is unknown, it is possible estimate it, based on mortality data and the assumptive case-fatality rate of the disease. Given these assumptions, the estimated period-prevalence of COVID-19 in Italy varies from 0.35% in Sicily to 13.3% in Lombardy.

Forensic epidemiology (FE) implies the use of epidemiological data in the processes and the involvement of epidemiologists in judicial proceedings. FE is essential for the assessment of causal association between the exposure to specific agents and the occurrence of diseases. In this paper we describe FE principles and applications in the Italian context as in recent years FE emerged increasingly as well as the need of experienced and trained epidemiological experts able to navigate legal proceedings. In the literature, the principles of FE have been widely described by different authors, among them: Kennet Rothman who introduced the definition of cause, Sir Austin Bradford Hill who proposed an analytic framework to assess the causal association, and recently by Sana Loue who described the actual legislation and application of FE in the United States. Despite the legislation varies among different countries epidemiological methods and theories represent the foundation for the application of FE we illustrate in this paper. The association between environmental pollution and disease, mobile phones and cancer, vaccines and autism, asbestos and pleural mesothelioma are all situations that underscore the need for FE investigations in criminal acts. Causal association is a complex process: in real life only in limited cases causal associations are assessed by gathering robust scientific evidence, while cases with doubts and situations where different approaches to questions may lead to discordant arguments to questions may lead to discordant arguments are more frequent. Therefore, during the assessment of causation in civil and criminal matters the choice the epidemiological expert - with his knowledge and expertise - and the evidence from well-designed studies are crucial to fill the gaps between clinical and epidemiological data and the low. (www.actabiomedica.it)

The health of a population is important from a public health and economic perspective as healthy individuals contribute to economic growth. Vaccination has the potential to contribute substantially to improving population health and thereby economic growth. Childhood vaccination programmes in Europe can offer protection against 15 important infectious diseases, thus preventing child fatalities and any serious temporary and permanent sequelae that can occur. Healthy children are more able to participate in education, thus preparing them to become healthy and productive adults. Vaccination programmes can also prevent infectious diseases in adolescents, thus allowing them to continue their development towards a healthy adulthood. Protecting adults against infectious diseases ensures that they can fully contribute to productivity and economic development by avoiding sick leave and lower productivity. Vaccination in older adults will contribute to the promotion of healthy ageing, enabling them to assist their familiy with, for instance, childcare, and also help them avoid functional decline and the related impacts on health and welfare expenditure. Effective vaccination programmes for all ages in Europe will thus contribute to the European Union's 2020 health and economic strategies. Indeed, beyond their impact on healthcare resources and productivity, reductions in mortality and morbidity also contribute to increased consumption and gross domestic product. Therefore, assessment of the value of vaccines and vaccination needs to consider not just the direct impact on health and healthcare but also the wider impact on economic growth, which requires a macroeconomic analysis of vaccination programmes.

AbstractIntroduction: WHO highlighted the need to strengthen the relationship between health and built environment; in particular, environmental factors and inadequate housing conditions are the most harmful risk factors for NCDs. Local Health Rules (LHRs) and Building Codes (BCs) are useful tools to provide safety and hygiene in building construction. The paper presents a survey on the adoption and updating of LHRs and BCs in Italian municipalities. Methodology: The survey analyses the state-of-the-art of LHRs, BCs and Municipal Development Plans (MDPs) on a sample of 553 cities, with different demographic and geographic characteristics from each other. Results: the survey highlights the serious shortage of updated LHRs, especially in small and medium municipalities. Instead, BCs and MDPs are much more current and updated, but only 30% of them are previously validated by Local Health Authorities. Conclusion: According to the analysis, it is necessary to introduce ever more performance guidelines, instead of prescriptive rules. The Government is taking steps to give rise to a National Building Code guidelines and this initiative could also be expanded to invest LHRs' issues.

Introduction. WHO has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Local Health Rules (LHRs) and Building Regulations (BRs) are tools which provide safety and building hygiene in construction practices. Currently the Italian Government is considering to establish a National Building Regulation and, related to the following purpose, this paper presents a survey on the status of adoption and updating of LHRs and BRs in Italian municipalities. Methodology. The current Italian state of LHRs, BRs and Municipal Development Plans (MDPs) have been examined by a survey considering a sample of about 550 cities, with different demographic and geographic features, starting from the previous research work by Signorelli et al. (1999). Results. The analysis underlines a serious shortage of updated LHRs, especially in small and medium-sized municipalities whereas BRs and MDPs are widespread. Only 30% of them are previously approved and validated by Local Health Authorities. Conclusion. Starting from a survey, the present scenario of Building Regulations requires the introduction of further performance guidelines instead of normative ones and, therefore, the current actions to give rise to a National Building Regulation could be integrated by building hygiene contents of LHRs.

RISK MANAGEMENT: THE NEW NORMATIVE SCENARIO AND THE ROLE OF TRAINING AND EDUCATION The article focuses on the important issue of Risk Management in health. In particular, it describes and critically appraises the new Italian law on patients' safety and professional responsibility, and expand on the educational and training needs to implement it on the ground. On the basis of the new law the role of Risk Managers, responsible for quality and safety of healthcare services, becomes of crucial importance in both public and private hospitals in Italy. In such context, education and training of risk managers should be multi disciplinary, ad hoc designed on recent regulations, and, more in general, help to build a new era in healthcare management. (www.actabiomedica.it)

On December 2014 the Employment, Social Policy, Health and Consumer Affairs Council (EPSCO) of the European Union adopted the Council Conclusions on "Vaccinations as an effective tool in public health," a crucial step to strengthen EU action supporting Member States (MS) to implement effective immunization policies and programs. As a contribution to the ongoing pan-European discussion and to the Italian commitment to stay at the forefront of promoting vaccination polices, the Erice Declaration was drafted by Italy's best experts in the field of immunization to transpose to the national level the goals set by the EPSCO Conclusions. The aim of the current letter is to present to the broader international audience the Italian perspective as a case study to assess different immunization policy models, challenges and priorities.

Background: Following the earthquake in L'Aquila of 04.06.2009 more than 65,000 people lost their homes. In order to provide rapid accommodation to those people, the Italian Government implemented the CASE project (Complex Anti-seismic Sustainable Environment-friendly), with the construction of 19 "New town" in the surrounding areas of the city. The New towns are built in rural areas, far from the center of the city, without many basic services. The purpose of this study was to evaluate the prevalence of mental disorders, the levels of psychological symptoms and quality of life in a sample of the population living in such reality. Methods: Brief Symptom Inventory (BSI), the Impact of Events Scale-Revised (IES-R), and the Manchester Short Assessment of Quality of Life (MANSA), were used. Results: 107 people were interviewed. The mean scores of the GSI of the BSI were 0.70 (SD=0.55). The total score of the IES-R scale was used and the cut-off represented by the 33 value, was exceeded by 59.81% of the sample. The average value was 37.85 (SD=19.49) (range 0-83). 14 people of them (21.88%) obtained an average value ≥ 60. The mean score on the MANSA was 4.5 (SD=0.98), range 1.8-6.3. Conclusion: From the results, it appears that this housing solution could be an additional element of trauma that overlaps with that suffered during the quake.

THE MISSED CONSTITUTIONAL REFORM AND ITS POSSIBLE IMPACT ON THE SUSTAINABILITY OF THE ITALIAN NATIONAL HEALTH SERVICE The rejection of the Constitutional Law Bill No.1429-D in the December 2016 referendum, has stimulated a cause for reflection on current health legislation and the future prospects of the Italian National Health Service; also in the context of the recent approval of the new Essential Levels of care (LEA) and other relevant laws approved by the Parliament. This article analyzes possible future legislative and organizational scenarios with particular regard to issues related to National health system's sustainability. (www.actabiomedica.it)

Background: Vaccine hesitancy has increased worldwide, leading to reduction in vaccination coverage rates. In particular, reduction in the coverage for the trivalent Measles-Mumps-Rubella vaccine has led to an increase of measles cases. The aim of this study is to analyze the coverage rates for the MMR vaccine in the Emilia-Romagna Region (RER) and Sicily Region (SR) between 2009 and 2018, and to correlate any significant change to index events which could have modified the trend of vaccination rates. Methods: Official aggregate data on vaccination coverage at 24 months provided by the RER and the SR were analyzed through trend analysis and related to important index events. Results: The two regions showed similar results; both achieved the lowest coverage rates in 2015 and both showed an increase in the rates after the introduction of mandatory vaccinations for access to schools. In 2018, both reached the starting point before the decrease. Conclusions: Our results confirm the effectiveness of legislative coercive measures in favor of vaccination. A potential decrease in the coverage rates may be observed as a result of an attenuation of the positive effects of coercive measures over time. It is thus necessary to combine these measures together with information campaigns and political initiatives at different levels (i.e., national, regional).

New challenges in vaccination policies: the role of General Practitioners. The phenomenon of "Vaccine Hesintacy" and the consequent decrease in vaccination coverage with the re-ignition of some epidemic outbreaks has led Italian national and regional authorities to set a new vaccination plan (PNPV 2017-19) and even coercive measures such as the the Law n.119/2017. In addition, there have been initiatives by scientific societies also in order to increase involvement of professionals in information and education campaigns. Among the professional figures involved, the general practitioners represents the starting point from which to regain the citizen's trust. This article assesses their important role in the implementation of vaccination policies in Italy by identifying the essential points of the campaigns carried out on their patients.

INDOORS AND HEALTH: RESULTS OF A SYSTEMATIC LITERATURE REVIEW ASSESSING THE POTENTIAL HEALTH EFFECTS OF LIVING IN BASEMENTS A new law approved in March 2017 in the Lombardy Region makes it possible to live in basements. Basements are defined as buildings partly below curb level but with at least one-half of its height above the curb. Basements' features and structural characteristics might pose risks to human health. In this paper we adopt a multidisciplinary approach to assess the potential health effects of living in basements. In particular, we define a conceptual framework to describe basements' structural characteristics which are risk factors, as well as the mechanisms through which they impact on human health. We also conduct a systematic review on the scientific databases PubMed, Embase, DOAJ, Proquest and EBSCO to retrieve, pool and critically analyze all available research that quantified the risk of living in basements for different health outcomes. Available evidence suggests living in basements increases the risk of respiratory diseases (asthma and allergic disorders); more heterogeneous data are available for cancers and cardiovascular diseases. As more quantitative data need to be prospectively retrieved to assess and monitor the risk of living in basements for human health, clear minimum requirements for light, air, sanitation and egress are to be defined by technical experts and enforced by policy makers. (www.actabiomedica.it) BACKGROUND: Recentemente è stata approvata in Regione Lombardia la legge LR 10 Marzo 2017 "Recupero dei vani e locali seminterrati esistenti" che consente di utilizzare gli ambienti seminterrati a scopo abitativo. Questo ha dato origine a un interessante dibattito perché, se da un lato il legislatore si pone l'obiettivo di attivare processi virtuosi di riqualificazione urbana e di risparmio di suolo a fini edilizi, dall'altro le caratteristiche strutturali degli ambienti seminterrati possono costituire fattori di rischio per la salute umana. OBIETTIVI E METODI: Obiettivo ...

As part of the strategies to promote health in urban areas, the Italian Society of Hygiene (SItI) has updated its recommendations for "healthy, safe and sustainable housing". They were issued by an ad hoc SitI working group on the basis of the best available evidence retrieved from a review of the scientific and legal literature on the topic and in line with World Health Organisation, European Union, and other international bodies statements. SItI document includes recommendations for environmental comfort, mental and social wellbeing, environmental protection as well as the safety of people who dwell houses. In addition to typical issues (such as relative humidity parameters, ventilation, and safety rules), SItI recommendations address innovative aspects such as building compatibility between different functions, building safety management and green area design. In this context, SItI recommendations emphasise the need of a strengthened interaction between architects and public health experts to ensure the complete wellbeing in houses where people spend more than 50% of their lives.