Roberto Bucci

The Agro Pontino, climate change and malaria

Recently in Italy a case of malaria was reported (November 2009). The patient was an Italian man of 44 years of age who had not travelled out of the country. The man apparently contracted malaria during a 2 weeks stay in August 2009 in a former malaria endemic area, the “Agro Pontino” (60-100 km South of Rome). Although confirmation of the Plasmodium species and the results of the epidemiological investigation undertaken by the Ministry of Health are still not available, the case seems unlikely to be linked with accidental contact of the patient with imported vectors or contaminated blood. This case raised concern over the possible recrudescence of malaria in Italy, especially in light of current and future climate change. Given the importance of the topic, this article will provide a brief review of the history of malaria in the Agro Pontino and the recent discussions that have appeared in scientific journals concerning the link between malaria and climate change.

Archie’s beautiful adventure

Archibald “Archie” Cochrane is the brilliant creator of the evidence-based medicine (EBM). His book “Effectiveness and Efficiency: random reflections on health services” is one of the fundamental texts of Medicine today. For his influence on the progress of medicine, Cochrane may be considered one of the greater physicians of all time. He gave an exceptional boost to the improvement of medical practice worldwide. Cochrane’s vision of medicine and his great scientific achievements are still alive through the Cochrane Collaboration, an organization which provides valuable impulses to improving the quality of medical care. Also he was a great epidemiologist, very proud of his epidemiological work, and his life is interesting for adventurous events and extraordinary examples of righteousness and generosity.

Acting as a unit". A praiseworthy story from Cleveland

This is a story that comes from Cleveland. It’s a story of zealous and ingenious men, of ideas and of cooperation. A story that is the result of various personal and diverse professional experiences, from different historical moments, all converged towards a single cause: excellence in health care. It is also a story about a private institution but nevertheless it offers many public health teachings: it’s the story of Albert Kanoti and the Cleveland Clinic Foundation. The Cleveland Clinic was founded on February 5 1921 as an independent, not-for-profit academic medical center engaged in patient care, research, and education. In 1924 it added a 184-bed hospital to its outpatient facilities. It has also experienced tragic moments, when on May 15, 1929, nitrate-based x-ray films ignited in the original building, releasing poisonous fumes; 123 people died, including Dr. Phillips, one of the founders. Despite losses from the disaster and the stock market crash, the institution stayed afloat on the good will of prominent members of the community, and the large surgical practice of Dr. Crile, another of its founders. It expanded greatly after World War II, focusing on specialized medicine. The Cleveland Clinic Research Division investigated kidney disease, blood circulation, and artificial organs, including the artificial kidney. ClevelandClinic physicians, researchers and nurses pioneered enterostomal therapy, dialysis, and kidney transplant techniques, and were first to identify carpal tunnel syndrome and isolate serotonin, and all before 1960.

Public health history corner: The far-sighted: Alessandro Seppilli

Alessandro Seppilli is one of the main protagonists for the planning and establishment of the Italian National Health Service [1]. As Chairman of the Commission for the study of health reform in the Italian Consiglio Superiore di Sanita (Higher Council of Health). As a lecturer and researcher he promoted and led several important lines of research, always ahead of its time and with great foresight. His curiosity led him to be involved in a variety of Public Health disciplines: water and sanitation, safe milk distribution, as well as demonstrating, through research, the influence of atmospheric electrical changes on biological phenomena in respect to the vital effects of electric fields changes. He also conducted pioneering research into the study of anticaries fluoride and the carcinogenic effects of active and passive cigarette smoke. Last but not least he studied the use of low temperatures for food storage, investigated the distribution of drinking water by alternative systems and undertook studies on environmental carcinogenesis.

A historical laboratory in Rome

Visitors who climb the austere stairs of the Giuseppe Sanarelli Institute, headquarters of the Public Health Sciences Department, in the University La Sapienza of Rome, may experience a strange feeling: the steps follow one another identically, yet each seems taller and more difficult than the last. It is as if, with every step, time reveals its stories, experiences; ever larger and harder to sustain. Following the corridor it is impossible not to pause and reflect upon the displays of memories and details belonging to the past. There is a constant sensation, almost tangible: it is as if each of the objects, so dense with memories, want to take you on a fantastic voyage to another time and place. Objects made of wood, copper and other materials that come from the past, filled with the scent of a world that no longer exists.

From a Pope’s nightmare, a great public health institution: the Santo Spirito in Saxia Hospital, in Rome

Sometimes even bad dreams can have a positive effect on reality. Legend states that Pope Innocent III had a nightmare in which he imagined that fishermen pulling in their fishing nets from the Tiber between the Mole Adriana and the old bridge Neroniano, found the soft little bodies of infants that had been thrown into the river by unfortunate women, eager to suppress the fruits of their sins. Two XV Century frescoes depicting this legend, “Fishing macabre” and “The Dream of Innocent III”, XV Century’s frescoes, can be found in the Sistine Chapel of the Santo Spirito Hospital. The Pope, horrified by his vision, ordered the establishment of a safe haven for girls in need who were without family, the sick, the infirmed and the abandoned. This refuge was established at the Hospital of Santo Spirito in Saxia. Investigating the history of the hospital leads you along a fascinating journey into the history of healthcare in Rome, a journey that helps to explain how Public Health in Italy, and in particular Rome, was founded. Furthermore it explains how health care assistance, funded by charities, both private and religious, developed into the social imperative that it is today guaranteed by the state. The hospital was rebuilt after 1198, when a fire burnt.

Robert J. Levine: a distinguished problem solver

Robert Levine: a man capable of intelligent and constructive criticism, who could accept with humility the criticisms of others. A man who left a deep mark in the history of research, both inside and outside the United States. Above all, a great problem solver. A brilliant doctor and refined bioethicist, he was able to deal with the disasters of research on human subjects and to remedy to them. He fought against the application in clinical practice of ethical principles valid only for research, but also against the universalisation of the rules of informed consent, which are applicable only to Western cultures. A researcher who deserves to be known by all, especially by young people.

Ernst L. Wynder: A pioneer of no tobacco world.

Ernst L Wynder was a great epidemiologist who devoted his career to investigate harmful effects of tobacco smoke, in particular his studies represent a landmark in the history of epidemiological research on lung cancer. The commitment of Ernst Wynder was not limited to the risk factors related to tobacco. In fact, he studied also the role of nutritional factors in the incidence of tumors. His talent, enthusiasm and tireless energy have allowed him to obtain a complete victory despite the difficulties and the initial loneliness.

INTERMEDIATE CARE UNITS IN PROGRESSIVE PATIENT CARE MODEL: A SYSTEMATIC LITERATURE REVIEW

Background : Progressive patient care (PPC) has been defined as a systematic classification and segregation of patients based on their medical and nursing needs. Aim of the present research was to perform a systematic literature review about existing medical intermediate care unit organizational models and their performance strengths and weaknesses with a specific focus on Italian implementation, respect to US model. Methods : Databases PubMed, Cinahl, Google and Google Scholar were searched until September 2017. The search was limited to Italian and English studies. All study design are included in the review. Results : Ten studies were included in the review. The American studies showed, after the PPC reorganization, an increase in level of satisfaction and nursing care, a reduction in average length of stay, costs and tensions between nurses and an improvement in nurse-physician communication. An Italian study reported the results of a project carried out in three case studies (Forli, Foligno and Pontedera hospital), redesigning hospital patient flow logistics around the concept of intensity of care: in all three cases, after the reorganization, an increase in bed occupancy rate (before: 71%,81%,65%; after: 78%,84%,82%, respectively) and in hospital case-mix complexity (average DRG weight - before: 0.99,1.07,1.12; after: 1.19,1.09,1.61, respectively) and a reduction in turn-over ratio (before: 2.5,1.4,2.8; after: 1.5,1.2,1.7, respectively) was recorded. Considering Italian healthcare professionals’ point of view, majority of internists supported a hospital remodeling according to PPC model. Conclusions : The PPC model, theorized in US, has found several applications in Italian regional realities. Improvements in quality of care, appropriateness and productivity in healthcare facilities, that adopted the PPC program, were observed.

Public Health History Corner: Giulio Alfredo Maccacaro

Giulio Alfredo Maccacaro was a biometrist, a scientist using statistical methods to calculate the laws and phenomena of the biological system. Well known in the international arena, he...