Rosella Saulle

Cost and Cost-Effectiveness of the Mediterranean Diet: Results of a Systematic Review

The growing impact of chronic degenerative pathologies (such as cardiovascular disease, type 2 diabetes and Alzheimer’s disease) requires and pushes towards the development of new preventive strategies to reduce the incidence and prevalence of these diseases. Lifestyle changes, especially related to the Mediterranean diet, have the potential to modify disease outcomes and ultimately costs related to their management. The objective of the study was to perform a systematic review of the scientific literature, to gauge the economic performance and the cost-effectiveness of the adherence to the Mediterranean diet as a prevention strategy against degenerative pathologies. We investigated the monetary costs of adopting Mediterranean dietary patterns by determining cost differences between low and high adherence. Research was conducted using the PubMed and Scopus databases. Eight articles met the pre-determined inclusion criteria and were reviewed. Quality assessment and data extraction was performed. The adherence to the Mediterranean diet has been extensively reported to be associated with a favorable health outcome and a better quality of life. The implementation of a Mediterranean dietary pattern may lead to the prevention of degenerative pathologies and to an improvement in life expectancy, a net gain in health and a reduction in total lifetime costs.

Potential Risk Factors Associated with Human Cystic Echinococcosis: Systematic Review and Meta-analysis.

Background Scientific literature on cystic echinococcosis (CE) reporting data on risk factors is limited and to the best of our knowledge, no global evaluation of human CE risk factors has to date been performed. This systematic review (SR) summarizes available data on statistically relevant potential risk factors (PRFs) associated with human CE. Methodology/Principal Findings Database searches identified 1,367 papers, of which thirty-seven were eligible for inclusion. Of these, eight and twenty-nine were case-control and cross-sectional studies, respectively. Among the eligible papers, twenty-one were included in the meta-analyses. Pooled odds ratio (OR) were used as a measure of effect and separately analysed for the two study designs. PRFs derived from case-control studies that were significantly associated with higher odds of outcome were “dog free to roam” (OR 5.23; 95% CI 2.45–11.14), “feeding dogs with viscera” (OR 4.69; 95% CI 3.02–7.29), “slaughter at home” (OR 4.67; 95% CI 2.02–10.78) or at “slaughterhouses” (OR 2.7; 95% CI 1.15–6.3), “dog ownership” (OR 3.54; 95% CI 1.27–9.85), “living in rural areas” (OR 1.83; 95% CI 1.16–2.9) and “low income” (OR 1.68; 95% CI 1.02–2.76). Statistically significant PRFs from cross-sectional studies with higher odds of outcome were “age >16 years” (OR 6.08; 95% CI 4.05–9.13), “living in rural areas” (OR 2.26; 95% CI 1.41–3.61), “being female” (OR 1.38; 95% CI 1.06–1.8) and “dog ownership” (OR 1.37; 95% CI 1.01–1.86). Conclusions/Significance Living in endemic rural areas, in which free roaming dogs have access to offal and being a dog-owner, seem to be among the most significant PRFs for acquiring this parasitic infection. Results of data analysed here may contribute to our understanding of the PRFs for CE and may potentially be useful in planning community interventions aimed at controlling CE in endemic areas.

Mediterranean diet and familial dysmetabolism as factors influencing the development of acne

Aim: To investigate the effects of adherence to the Mediterranean diet and familial dysmetabolisms on acne development. Methods: A community-based case–control study was carried out in Italy enrolling cases as acneic outpatients of a dermatological ambulatory service and controls as clinically healthy acne-free subjects. Food consumption were evaluated with a validated food-frequency questionnaire, exploring the consumption of pasta, meat, cheese, fish, fruit, vegetables, and olive oil. Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean diet scale that incorporated the main characteristics of this diet. A logistic regression analysis estimated the variables who predicted the odds of being case, using those variables that at the univariate analysis yielded a p-value <0.25. Results are presented as odds ratio (OR) or adjusted OR (AOR). Results: The study included 93 cases (36.6% males, median age 17 years) and 200 controls (32% males, median age 16 years). The Mediterranean diet score ≥6 revealed a protective effect towards acne (crude OR 0.22, 95% CI 0.08–0.64). Logistic regression analysis showed that familial hypercholesterolaemia, diabetes, and hypertension are strong risk factors for acne (AOR 8.79, 95% CI 1.67–46.22; 3.32, 95% CI 1.27–8.63; and 2.73, 95% CI 1.07–6.96, respectively), while the Mediterranean diet represents a protective factor (score ≥6, AOR 0.31, 95% CI 0.11–0.89). Conclusions: The odds for familial dysmetabolisms was higher in cases than in controls, confirming their role in determining or maintaining acne. Moreover, this is the first study demonstrating a protective role of the Mediterranean diet in the pathogenesis of acne.

Economic evaluation of Varicella vaccination: results of a systematic review

Introduction: The aim of the present study is to review the economic burden of varicella disease and the benefit of universal varicella vaccination in different settings pending its implementation in all Italian regions. Materials and Methods: Research was conducted using PubMed, Scopus and ISI databases. Score quality and data extraction were performed for all included studies. Results: Twenty-three articles met the criteria: 15 cost-effectiveness, 8 cost-benefit and one cost-utility analysis. Varicella vaccination could save the society from €637,762 (infant strategy) to 53 million annually (combined infant and adolescent strategy). The median and the mean quality scores resulted in 91.8% and 85.4% respectively; 11 studies were considered of high quality and 12 of low quality. Discussion: The studies are favorable to the introduction of universal varicella vaccination in Italy, being cost saving and having a positive impact on morbidity. The quality score of the studies varied greatly: recent analyses were of comparable quality to older studies.

Validation of the Global Health Professions Students Survey questionnaire in Italy

Background : The World Health Organization, the U.S. Centers for Disease Control and Prevention (CDC), and the Canadian Public Health Association have developed the Global Health Professions Student Survey (GHPSS) questionnaire in order to collect data on tobacco use and cessation counselling among health- profession students. The aims of the study were to evaluate the reliability and validity of the GHPSS questionnaire in Italy among health-profession students and to examine the prevalence of tobacco use, knowledge and attitudes to it and tobacco cessation training among students attending Italian medical schools using the standardised GHPSS approach. Methods : Before testing tobacco use prevalence, knowledge and attitudes, and tobacco cessation training, we calculated the Cronbach’s alpha to assess the internal validity with the intention of avoiding misleading results. The questionnaire was administered to 100 health-profession students and data were collected in March 2009, during regular class sessions among students of two Italian Schools of Medicine. The original GHPSS instrument was translated into the Italian language and modified by adding three specific questions regarding I) the knowledge about the use of antidepressants, ii) Acetylcholine Receptor Partial Agonists, and iii) counselling techniques used in tobacco cessation programs. Statistical analysis was performed using SPSS 13.0, statistical software for windows. Results : Cronbach’s alpha was higher on 17 items (alpha= 0.872), belonging to section I and IV (respectively: “Tobacco Use Prevalenceu and “Behaviour/Cessationu). The addition, also, of only one more of the others items (section)made the alpha value worse. Cronbach’s alpha for section VI for all items together (n. 44 items) was 0.815, which implies that the questionnaire had a very satisfactory internal validity. The prevalence of current smokers was 33%, while only 12% of students declared to be tobacco users. Interestingly, students who were tobacco users were 80% less likely to consider that health professionals needed training on smoking cessation techniques in comparison to non tobacco users. Conclusions : The questionnaire showed excellent reliability properties in the sample studied. In terms of internal consistency and validity, it appears to have an acceptable performance. Given the high prevalence of smokers among medical students, teaching them about the damages related to tobacco use, and how to help them quit smoking or tobacco use, emerged as important issues. Further studies to investigate these important issues, using a standardized method like GHPSS, are needed.

Knowledge, Attitudes, and Smoking Behaviours among Physicians Specializing in Public Health: A Multicentre Study

Background. Healthcare professionals have an important role to play both as advisers—influencing smoking cessation—and as role models. However, many of them continue to smoke. The aims of this study were to examine smoking prevalence, knowledge, attitudes, and behaviours among four cohorts physicians specializing in public health, according to the Global Health Profession Students Survey (GHPSS) approach. Materials and Methods. A multicentre cross-sectional study was carried out in 24 Italian schools of public health. The survey was conducted between January and April 2012 and it was carried out a census of students in the selected schools for each years of course (from first to fourth year of attendance), therefore among four cohorts of physicians specializing in Public Health (for a total of n. 459 medical doctors). The GHPSS questionnaires were self-administered via a special website which is created ad hoc for the survey. Logistic regression model was used to identify possible associations with tobacco smoking status. Hosmer-Lemeshow test was performed. The level of significance was P ≤ 0.05. Results. A total of 388 answered the questionnaire on the website (85%), of which 81 (20.9%) declared to be smokers, 309 (79.6%) considered health professionals as behavioural models for patients, and 375 (96.6%) affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 388 (89.7%) heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization. Conclusions. The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in public health, their key role both as advisers and behavioural models, and the limited tobacco training offered in public health schools.

Green areas and health outcomes: a systematic review of the scientific literature

Background : Growing medical evidence shows that access to the natural environment improves health and wellbeing, prevents disease and helps people recover from illness. Experiencing nature in the outdoors can help tackle obesity and coronary heart disease. Green areas exert their benefits on both physical and mental health, promoting physical activity and strengthening the sense of community thus positively influencing social interaction. Urbanization poses problems through effects such as environmental pollution, accidents, heat island effects, climate change and a consequent demand for urban green areas. Material and methods : We performed literature searches of electronic journal databases for studies and reviews that focused on the relationship between green spaces and health. We looked at the effects on physical health, mental health, social health, physical activity and well-being in its broadest sense and then we categorically organized our findings. Results : We found many contradictory and unexpected results. However, the reported findings were generally consistent and supported the current view that urban design and the availability of urban green spaces are key elements of prosperity and individual/collective comfort, so as to influence both the perceived health and the objective physical conditions in a measurable way. A weak relationship between physical activity levels and green space availability is observed. Conclusions : The occasionally contradictory results that emerged in this study suggest that a opulation’s esponse to urban design interventions is often unpredictable. Further research is needed to quantify the trength of relation between green spaces and urban health, but also to investigate the social and behavioural spects which are more difficult to measure and understand.

How Much do Needlestick Injuries Cost? A Systematic Review of the Economic Evaluations of Needlestick and Sharps Injuries Among Healthcare Personnel

OBJECTIVE To provide an overview of the economic aspects of needlestick and sharps injury (NSI) management among healthcare personnel (HCP) within a Health Technology Assessment project to evaluate the impact of safety-engineered devices on health care METHODS A systematic review of economic analyses related to NSIs was performed in accordance with the PRISMA statement and by searching PubMed and Scopus databases (January 1997–February 2015). Mean costs were stratified by study approach (modeling or data driven) and type of cost (direct or indirect). Costs were evaluated using the CDC operative definition and converted to 2015 International US dollars (Int

Prevalence of smoking habits, attitudes, knowledge and beliefs among Health Professional School students: a cross-sectional study

). RESULTS A total of 14 studies were retrieved: 8 data-driven studies and 6 modeling studies. Among them, 11 studies provided direct and indirect costs and 3 studies provided only direct costs. The median of the means for aggregate (direct + indirect) costs was Int

Demographic Characteristics, Nicotine Dependence, and Motivation to Quit as Possible Determinants of Smoking Behaviors and Acceptability of Shocking Warnings in Italy

747 (range, Int