Leila Fabiani

The effectiveness of a school-based substance abuse prevention program: EU-Dap cluster randomised controlled trial

OBJECTIVE To evaluate the effectiveness of the school-based drug abuse prevention program developed in the EU-Dap study (EUropean Drug Abuse Prevention trial) in preventing the use of tobacco, alcohol and drugs at the post-test. METHODS Cluster Randomised Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12-14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. A pre-test survey assessing past and current substance use was conducted before the implementation of the program. The program consisted in 12-hour class-based curriculum based on a comprehensive social-influence approach. A post-test survey was carried out in all participating schools, 3 months after the end of the program. The association between program condition and change in substance use at post-test was expressed as adjusted Prevalence Odds Ratio (POR), estimated by multilevel regression model. RESULTS Program effects were found for daily cigarette smoking (POR=0.70; 0.52-0.94) and episodes of drunkenness in the past 30 days (POR=0.72; 0.58-0.90 for at least one episode, POR=0.69; 0.48-0.99 for three or more episodes), while effects on Cannabis use in the past 30 days were of marginal statistical significance (POR=0.77; 0.60-1.00). The curriculum was successful in preventing baseline non-smokers or sporadic smokers from moving onto daily smoking, but it was not effective in helping baseline daily smokers to reduce or stop smoking. CONCLUSION School curricula based on a comprehensive social-influence model may delay progression to daily smoking and episodes of drunkenness.

Italian multicenter study on infection hazards during dental practice: Control of environmental microbial contamination in public dental surgeries

BackgroundThe present study assessed microbial contamination in Italian dental surgeries.MethodsAn evaluation of water, air and surface microbial contamination in 102 dental units was carried out in eight Italian cities.ResultsThe findings showed water microbial contamination in all the dental surgeries; the proportion of water samples with microbial levels above those recommended decreased during working. With regard to Legionella spp., the proportion of positive samples was 33.3%. During work activity, the index of microbial air contamination (IMA) increased. The level of microbial accumulation on examined surfaces did not change over time.ConclusionThese findings confirm that some Italian dental surgeries show high biocontamination, as in other European Countries, which highlights the risk of occupational exposure and the need to apply effective measures to reduce microbial loads.

Water Hardness and Cardiovascular Mortality Rate in Abruzzo, Italy

For the years 1969-1978, the authors studied the pattern of mortality resulting from cardiovascular diseases (390-438 International Classification of Diseases [ICD]), ischemic heart diseases (410-414 ICD), and cerebrovascular diseases (430-438 ICD), and then correlated mortality rate with water hardness. The study took place in the region of Abruzzo, Italy, which has a population of 594,323. An inverse correlation between drinking water hardness and mortality due to cardiovascular disease, already reported by other authors in many countries, is also confirmed in this research for the disease group 390-438 and for the group of individuals aged 45-64 yr.

Exposure to active and passive smoking during pregnancy and severe small for gestational age at term

Objective. The objective of this study was to assess the relationship between active smoking as well as environmental tobacco smoke (ETS) exposure and severe small for gestational age (SGA) at term in a sample of pregnant Italian women. Methods. A case–control study was conducted in nine cities in Italy between October 1999 and September 2000. Cases of severe SGA were singleton, live born, at term children with a birth weight ≤ 5th percentile for gestational age. Controls (10:1 to cases) were enrolled from among singleton at term births that occurred in the same hospitals one or two days after delivery of the case, with a birth weight > 10th percentile for gestational age. A total of 84 cases of severe SGA and 858 controls were analyzed. A self-administered questionnaire was used to assess active smoking and ETS exposure, as well as potential confounders. Results. Multivariate logistic regression analysis showed a relationship between active smoking during pregnancy and severe SGA (adjusted odds ratio (OR) 2.10, 95% confidence interval (CI) 1.13–3.68). ETS exposure was associated with severe SGA (adjusted OR 2.51, 95% CI 1.59–3.95) with a dose–response relationship to the number of smokers in the home.

Influenza vaccination coverage among medical residents: an Italian multicenter survey

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011–2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P < 0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011–2012 season (P < 0.001). “To avoid spreading influenza among patients” was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future.

Survey of nursing knowledge on bioterrorism

With the aim of identifying intervention programmes within the framework of basic and permanent nursing training, we evaluated the knowledge of 187 nurses and nursing students concerning biological emergencies. A questionnaire was used to identify their knowledge of the pathogens that may be used in a terrorist attack and measures for containing them, and their perception of the danger to public health. Analysis of the responses showed that the undergraduates studying for the Triennial Degree were the best informed, and those studying for the specialist degree were the least informed. The question relating to the precautions adopted against transmission of Bacillus anthracis was the most predictive of the total score because it was the only one with a substantial number of correct answers (79/187). It seems that the information derived more from the generalist media than from academic training. We conclude that there is a need to train qualified personnel capable of responding to a possible emergency in terms of both preventive and interventional medicine.

A Case Study on the Integration of Heterogeneous Data Sources in Public Health

The paper reports on a case study regarding the integration of heterogeneous data sources, coming from different institutions, needed to support several studies related to the health status of the population of L’Aquila (Italy) after the earthquake of April 6th 2009. In detail, the paper initially describes all the health studies, then the data sources required to support them, finally proposes a simplified federated architecture and a straightforward technological solution to implement it.

Cardiovascular Risk and Physical Activity: Simulated Analysis in GeneralPractice Patients Based on a Risk Score System

Abstract Aim: This cross-sectional study was aimed at evaluating the association between physical activity (PA), overweight and CV risk in a large sample of Italian general practice patients and forecast the impact of increasing PA in a general population. Methods: Regression analysis on single CV risk factors and stratification of global risk score have been carried out on 45,862 records with normal/overweight and active/inactive conditions as primary explanatory variables. Moreover a hypothetical attributable risk was calculated on the basis of expected cases. Results: HDL cholesterol resulted the risk factor most correlated with PA. Systolic blood pressure and fasting plasma glucose levels seemed to be more correlated to overweight than to PA. Active women and men would respectively have a 15% and 17% lower probability of experiencing a major cardiovascular event in the subsequent ten years than their inactive counterparts, adjusting for overweight. If inactive subjects became active at the lowest level, 818.8 cases/100,000 men and 201.5 cases/100,000 women aged 35-69 years would be protected during the same period. Conclusion: As counsellors for active lifestyle, general practitioners could contribute in reducing the absolute number of CV major events in the ‘healthy’ general population.

Gli infortuni lavorativi in minori: risultati di uno studio multicentrico italiano

Obiettivi : gli infortuni lavorativi, in particolare quelli subiti da minorenni, rappresentano un problema di notevole importanza sociale: in Italia, da dati INPS, risultano lavorare circa 68 adolescenti su 1000. L’obiettivo di questo studio e stato quello di raccogliere informazioni sugli infortuni lavorativi avvenuti a minori (14-17 anni) in 14 citta italiane nel periodo gennaio-giugno 2000. Metodi : si tratta di uno studio epidemiologico descrittivo, basato sulle informazioni raccolte consultando direttamente le cartelle cliniche presso centri di Pronto Soccorso (PS) attivi nelle citta coinvolte. Sono stati presi in considerazione tutti gli infortuni avvenuti a minori: tra questi sono stati considerati come lavorativi quelli accaduti nel corso di attivita descritta come lavorativa e quelli occorsi “in itinere”. Le analisi statistiche sono state condotte con SPSS; e stata effettuata una cluster analysis per evidenziare eventuali sottogruppi omogenei. Risultati: la popolazione residente nelle aree indagate di eta tra 14 e 17 anni e stata stimata in circa 850.000 soggetti, pari al 31% della popolazione italiana della stessa eta: gli infortuni totali sono risultati 13423 di cui 317 lavorativi (2.4%). I soggetti di sesso maschile, diciassettenni, impiegati nel comparto industriale sono risultati il gruppo maggiormente coinvolto: la prognosi e risultata per lo piu inferiore a 8 giorni. Sono apparse due diverse tipologie di infortunio: una riguarda i casi avvenuti in itinere, con caratteristiche molto simili agli incidenti stradali, e un’altra, piu specifica, riguarda gli eventi sul posto di lavoro, dove si registrano lesioni al polso, alle mani, al capo e agli occhi con frequenza superiore rispetto agli infortuni in genere. Conclusioni : il fenomeno e risultato non trascurabile, soprattutto tenendo conto del fatto che si riferisce solamente al lavoro minorile regolarmente denunciato. Nonostante le notevoli lacune nelle informazioni si e potuto rilevare come vi sia una tipologia di infortunio minorile peculiare, che merita provvedimenti di prevenzione specifici.