[Hygienic and sanitary aspects in urban planning: contradiction in national and local urban legislation regarding public health]. / Aspetti igienico-sanitari in ambito urbanistico: conflittualità nelle norme urbanistiche nazionali e locali in tema di sanità pubblica.

Nowadays, the majority of world population lives in urban areas and this portion is going to increase in the coming decades. The health impact of urban areas is well established and described in scientific literature. Italian health and hygiene legislation dealing with urban health is fragmented and not coordinated with the regulation about environment and city planning. The overlapping of legal competences between different authorities and the conflict of attribution between the Central State and Regional Governments deeply contributed to generate uncertainty. The authors here analyse the Italian regulatory framework and depict its lacks in terms of public health protection.

Why do people renounce dental health care? An analysis of data from the Italian population.

OBJECTIVES: Oral diseases affect a large number of people in the world and have a great influence on their quality of life. Nevertheless, oral health promotion and prevention initiatives are lacking. The aim of this study was to identify characteristics of individuals in Italy who renounce dental care in order to better support institutional prevention campaigns. METHODS: Using data from the Italian National Institute of Statistic (ISTAT) survey "Health condition and use of health services", we divided the sample into two groups: individuals who renounced dental care even when needed and those who accessed dental healthcare. We then compared information about socio-economic and oral health profile of the two groups. RESULTS: People who renounced dental treatments are mostly young adults, smokers, belonging to the middle-low socioeconomic level, not married and unemployed. Economic resources are often the main reason behind renouncing dental treatments. CONCLUSIONS: Our study underlines that economic conditions play a leading role in renouncing dental care. In order to avoid additional costs to the Italian healthcare system, our proposal is to implement a specific prevention campaign for oral diseases, targeting young adults living in Italy.

Is epicardial fat depot associated with atrial fibrillation? A systematic review and meta-analysis.

Aims: Atrial fibrillation (AF) is the leading rhythm disorder in western countries. A direct relationship between left atrium (LA) enlargement and electromechanical remodelling has been established. A causative link between epicardial fat (EF), visceral adipose tissue deposited around the heart, and AF has been hypothesized. Several reports suggested the association between EF and the presence of AF. The aim of this study was to verify the relationship between AF and EF depot, performing a meta-analysis of observational case series studies. Methods and results: Studies were identified by searching electronic databases by two independent investigators using 'atrial fibrillation' and 'epicardial fat' as keywords. Comparisons between healthy participants and AF cases were performed using a random effect meta-analysis estimating standardized mean difference among comparison groups. Meta regression was used to address the effect given by potential biological and technical confounders. Through a search result of 502 articles, only 7 were selected to conduct the present study. The comparison between all AF with respect to healthy participants resulted in a 32.0 ml of EF difference (95% confidence interval (CI) = 21.5, 42.5) showing that EF volume is higher in AF cases. A statistical significant difference of EF was observed when comparing both persistent and paroxysmal AF subtypes with respect to healthy participants (EF difference 48.0 ml (95% CI = 25.2, 70.8) and 15.7 ml (95% CI = 10.1, 21.4) for persistent and paroxysmal, respectively). A significant EF difference resulted also when comparing persistent to paroxysmal AF subtypes (29.6 ml (95% CI = 12.7, 46.5)). Conclusions: The present work expands the strength of previously reported association between EF amount and atrial arrhythmia.

Self-reported medication adherence and beliefs among elderly in multi-treatment: a cross-sectional study.

AIM: To evaluate the association between adherence to treatment and beliefs about medications in multi-treated elderly patients. BACKGROUND: A large body of evidence documented the importance of adherence to therapy in predicting clinical outcomes, and the association between adherence and medication beliefs in patients of various ages and with different health conditions. However, so far only a few studies have specifically investigated the associations between medication beliefs and adherence among elderly in polypharmacy. METHODS: In this multicenter cross-sectional study we used the MMAS-8 and BMQ Scales to assess medication adherence and beliefs about medications, respectively. RESULTS: The final sample consisted of 567 patients. Patients reporting higher levels of necessity or concerns about their medicines showed higher adherence (OR: 1.61, and 2.02, respectively; both p<.001). Accepting patients (high necessity and low concerns) were less likely (OR: 0.24; p<.001) to report adherence than ambivalent ones (high necessity and concerns). CONCLUSIONS: Medication adherence is related to high necessity and concern about treatment. In nursing practice it is important to understand the specific barriers to adherence and to engage patients in the implementation of strategies to improve adherence.

How walkable is the city? Application of the Walking Suitability Index of the Territory (T-WSI) to the city of Rieti (Lazio Region, Central Italy).

A method to evaluate the walkability of an urban neighbourhood based on direct observation has been applied. This tool, called the Walking Suitability Index of the Territory (T-WSI), measures the walkability of every street of an environmental area. It includes 12 weighted indicators, each divided into 4 categories: practicability, safety, urbanity, and pleasantness. Each indicator can obtain one of the following values: excellent (100), good (75), poor (35), bad (0). T-WSI is applied to 12/15 urban neighbourhoods of Rieti, a small city (47,912 inhabitants) located in Lazio Region (Central Italy). The average of T-WSI scores range from 24.2 to 61.2 among urban neighbourhoods. On average, safety and urbanity are the categories which reach very low scores. The T-WSI allows to underline several street criticalities that could hinder walkability and could be a good basis to support public decision-makers about health policy and local development aimed at encouraging physical activity.

[Italian Society of Hygiene (SItI) recommendations for a healthy, safe and sustainable housing]. / Documento d'indirizzo della Società italiana di igiene (SItI) per una casa sana, sicura e sostenibile.

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.

Green areas and public health: improving wellbeing and physical activity in the urban context.

INTRODUCTION: The green areas play an important role in improving the environmental quality and climate of the city. However, despite the undoubted importance of these areas, the benefits to public health are still under investigation. RESULTS: The Authors perform a review of studies on the relationship between health and green areas and describe the main areas for which evidence on this relationship is currently available. They include: effects on air quality, on social cohesion, on mental health, with particular reference to the stress, and on physical activity. CONCLUSIONS: Most of the evidence comes from cross-sectional and descriptive studies and the approaches used to measure the association show themselves to be often unsatisfactory. The Authors conclude the review stressing the need for greater integration between the different professionals involved in urban planning and in health care analysis in order to identify research approaches more appropriate to understand such complex issues, striving toward a planning design of green areas that will satisfy both environmental sustainability and health requirements.

Safety of transvenous lead extraction according to centre volume: a systematic review and meta-analysis.

BACKGROUND: Transvenous lead extraction (TLE) is a complex invasive procedure and the experience of the operator and the team is a major determinant of procedural outcomes. AIM: Because of very limited data available on minimum procedural volumes to enable training and ongoing competency for TLEs, we performed a meta-analysis aimed at assessing the outcomes of TLE in the centres with low, medium, and high volume of procedures. METHODS: Of the 280 papers initially retrieved until February 2013, 66 observational studies met inclusion criteria and were included in at least one stratified meta-analysis: 17 were prospective studies; 47 had a retrospective design; and 2 were defined 'experience studies'. We included only articles published after the introduction of laser technique (year 1999). We divided the studies in low, medium, and high volume centres utilizing either the European Heart Rhythm Association (EHRA) or Lexicon classification criteria. RESULTS: When meta-analyses were carried out separately for the studies with larger and smaller sample sizes, either using EHRA or Lexicon classification criteria, no clear differences emerged in the combined rate of major complications or intraoperative deaths. In contrast, both minor complications and mortality at 30 days decreased as centre volume increased. CONCLUSIONS: In our meta-analysis of observational studies, patients who have been treated in higher volume centres have a lower probability of minor complications and death at 30 days regardless of the infection rate, length of lead duration, type of device, and type of extraction.

AHRQ prevention quality indicators to assess the quality of primary care of local providers: a pilot study from Italy.

BACKGROUND: Outside the USA, Agency for Healthcare Research and Quality (AHRQ) prevention quality indicators (PQIs) have been used to compare the quality of primary care services only at a national or regional level. However, in several national health systems, primary care is not directly managed by the regions but is in charge of smaller territorial entities. We evaluated whether PQIs might be used to compare the performance of local providers such as Italian local health authorities (LHAs) and health districts. METHODS: We analysed the hospital discharge abstracts of 44 LHAs (and 11 health districts) of five Italian regions (including ≈18 million residents) in 2008-10. Age-standardized PQI rates were computed following AHRQ specifications. Potential predictors were investigated using multilevel modelling. RESULTS: We analysed 11 470 722 hospitalizations. The overall rates of preventable hospitalizations (composite PQI 90) were 1012, 889 and 988 (×100 000 inhabitants) in 2008, 2009 and 2010, respectively. Composite PQIs were able to differentiate LHAs and health districts and showed small variation in the performance ranking over years. CONCLUSION: Although further research is required, our findings support the use of composite PQIs to evaluate the performance of relatively small primary health care providers (50 000-60 000 enrollees) in countries with universal health care coverage. Achieving high precision may be crucial for a structured quality assessment system to align hospitalization rate indicators with measures of other contexts of care (cost, clinical management, satisfaction/experience) that are typically computed at a local level.

Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours: a large multi-centre prospective study.

AIMS: This multi-centre prospective field study evaluated whether peripheral venous catheter site of insertion influences the risk of catheter-related phlebitis. Potential predictors of phlebitis were also investigated. BACKGROUND: Millions of patients worldwide use peripheral venous catheters, which frequently cause local complications including phlebitis, infection and obstruction. Although phlebitis predictors have been broadly investigated, uncertainties remain on the potential effect of cannulation anatomical site, duration and the appropriate time for catheter removal. DESIGN: A prospective cohort design was carried out from January-June 2012. METHODS: The clinical course of each patient who received a new peripheral venous catheter for any cause in five Italian hospitals was followed by trained nurses until catheter removal. The presence of phlebitis was assessed every 24 hours using the Visual Infusion Phlebitis score. Analyses were based upon multilevel mixed-effects regression. RESULTS: The final sample consisted of 1498 patients. The average time for catheters in situ was 65·6 hours and 23·6% of the catheters were in place beyond 96 hours. Overall phlebitis incidence was 15·4%, 94·4% of which were grade 1. The likelihood of phlebitis independently increased with increasing catheter duration, being highest after 96 hours. Compared with patients with catheter placed in the dorsum of the hand (22·8% of the sample), those with the catheter located in the antecubital fossa (34·1%) or forearm were less likely to have a phlebitis of any grade. CONCLUSIONS: Antecubital fossa and forearm veins may be preferential sites for peripheral venous cannulation. Our results support Centers for Disease Control and Prevention recommendations to replace catheters in adults no later than 96 hours. A relevant proportion of healthcare personnel did not adhere to such guidelines - more attention to this issue is required.

[Housing quality and its health impact in Italy: current knowledge, methodological issues, new evaluation models]. / Impatto sanitario del disagio abitativo: stato delle conoscenze, problematiche metodologiche e nuovi modelli valutativi.

A literature search was performed to evaluate the current state of knowledge regarding housing quality in Italy and the adequacy of methods used to assess it. The simple adoption of current criteria required by national and local legislation for the evaluation of dwellings seems to be inadequate, because some crucial parameters, including radon testing and evaluation of accessibility are not considered. Also, current assessment methods have been used exclusively at the local level, and the health impact of housing quality in Italy has never been estimated. There is a strong need for more sensitive methods of evaluation of indoor environments, to be validated on large and representative samples. The authors discuss two possible alternative models which may ensure a multifactorial, holistic assessment of the quality of housing spaces, also by including an evaluation of psycho-social components.

Multicentric cohort study on the long-term efficacy and safety of electronic cigarettes: study design and methodology.

BACKGROUND: While electronic cigarettes are forbidden in several countries, their sales are exploding in many others. Although e-cigarettes have been proposed as long-term substitutes for traditional smoking or as a tool for smoking cessation, very scarce data are available on their efficacy and safety.We describe the protocol of a 5-year multicentric prospective study aimed to evaluate short- and long-term adherence to e-cigarette smoking and the efficacy of e-cigarettes in reducing and/or quitting traditional cigarette smoking. The study will also compare the health effects of electronic vs traditional vs mixed cigarette smoking. METHODS/DESIGN: From June to December 2013, we will enroll adult smokers of: (EC) e-cigarettes (self-reported inhaling ≥ 50 puffs per week since ≥ 6 months); (TC) traditional cigarettes (≥ 1 per day since ≥ 6 m); (Mixed) both electronic and traditional cigarettes (≥ 1 per day since ≥ 6 m). Eligible subjects will be requested participation through newspaper advertisements and direct contact at the shops. Each subject will have to compile a structured questionnaire at enrolment and after 6, 12, 24, 36 and 60 months. The level of carbon monoxide in expired after breath will be evaluated in all subjects declaring no traditional cigarette smoking in any follow-up phase, using portable carbon monoxide analyzers. The primary outcomes are traditional smoking cessation rates and number of smoked cigarettes. Secondary outcomes include adherence to e-cigarettes, self-reported adverse events, quality of life, and time to hospital admission for one among cardiovascular diseases, chronic obstructive pulmonary diseases, cancer of the lung, esophagus, larynx, oral cavity, bladder, pancreas, kidney, stomach, cervix, and myeloid leukemia. Admissions will be checked using official discharge data of the Abruzzo Region. A minimum of 500 subjects in each group will be enrolled, for a total of 1500 participants. Cox proportional hazards analysis will be used to calculate adjusted relative hazards of smoking cessation by each variable. DISCUSSION: Data on long-term efficacy and safety of e-cigarettes will be of utmost importance to form the basis for guidelines and regulatory decisions on e-cigarettes. TRIAL REGISTRATION: The protocol has been registered (NCT01785537) and approved by the Ethics Committee of the University of Chieti (Record n. 6; 25-03-2013).

[The abdominal typhus outbreak in Civitella del Tronto (Teramo, Italy) during the first half of 1817]. / Notizie sull'epidemia di tifo addominale in Civitella del Tronto (Teramo) durante la prima metà dell'anno 1817.

The authors describe the characteristics of the large outbreak of typhoid fever in Civitella del Tronto (Italy) in the year 1817. As reported in the "Rapporti Periodici sulla Salute Pubblica" ("Public Health Reports") periodically written by general practitioners, from March to June 1817 the morbidity rate was over 1% and both genders were equally affected. The most affected age group was the 30 to 40 year-old. Only 13% of the cases involved children aged 0 to 10 years. Epidemiological data suggest that the disease was not very infectious: it affected a slight number of individuals and only marginally infected the inhabitants of the areas around the main town of Civitella del Tronto. Public Health authorities of the Kingdom of Naples were likely able to efficiently control the sanitary conditions of the territories bordering the state.

Housing and Health: Here We Go Again.

Housing is one of the major determinants of human health and the current COVID-19 pandemic has highlighted its relevance. The authors summarize the main issues, including dimensional standards, indoor air quality, safety, accessibility, neighborhoods, and area characteristics. The authors propose an operating scheme in order to implement actions to improve residential wellbeing on a local, national, and international level.

Primary Subcutaneous Umbilical Endometriosis: Case Report and Review of the Literature.

We report the case of a patient diagnosed with primary umbilical endometriosis intending to discuss the diagnostic and therapeutic management of this rare disease. A 45-year-old woman suffering from a painful swelling located in the umbilical region, with intact and normal cutaneous aspect, came to our attention. Ultrasonography of the umbilical region showed a nodule with a nonhomogeneous echotexture pattern. Partial omphalectomy was performed under local anesthesia in day care setting surgery. Histology confirmed the diagnosis of umbilical endometriosis. Pre- and postoperative clinical controls showed no evidence for other endometriosis localization. No medical treatment was administered. No signs of recurrence were observed after 5 years from surgery. A review of the literature of the last 10 years was generated based on MEDLINE research, selecting some specific keywords. Several lesions can occur in the umbilical region, and endometriosis has to be ruled out even in patients without any surgery in their medical history. Surgery is the gold standard treatment for this condition: partial and radical omphalectomy are the two treatment options. We believe that given the significant psychological and aesthetical value of the umbilicus, surgical treatment has to be tailored and in case of a small endometrial umbilical nodule, partial omphalectomy (local excision of the umbilical endometrial nodule) with a 3 mm free border, even without adjuvant hormonal treatment, could ensure adequate and effective treatment.

Design and hygiene issues in sports facilities. A pilot study which investigates fitness centres by using a multidisciplinary tool.

INTRODUCTION: Awareness of the benefits of the physical activity on health by the general public has increased the number of people who is practicing it in the recent years. The gyms are the primary place - as the main indoor environment - for practicing physical activity. METHODS: A multidisciplinary tool was used primarily to investigate and analyse the general aspects of fitness centres then an assessment tool was created to evaluate a specific aspect such as the location, dimension, maintenance, etc. from the design, hygiene and safety points of view. Each section of the tool consisted of a series of questionnaires where the facility managers and the researches must have answered. DISCUSSION: The tool was tested on various cases by analysing the critical issues which affects the quality of spaces and end users' health. CONCLUSIONS: The critical points observed from the tool that has an impact on the design of the gyms will help to shape future of these facilities. Several design and management strategies were also highlighted to improve the hygiene and health issues of fitness centres.

[Preservative surgery of the kidney for haemorrhagic angiomyolipoma: a report of two cases]. / Chirurgia conservativa del parenchima renale per angiomiolipoma emorragico: due casi clinici.

Renal angiomyolipomas are very rare benign tumours (3% of renal tumours) that may present as isolated tumours or tumours associated with other pathologies, particularly tuberous sclerosis (40%), neurofibro-matosis, or Sturge-Webers disease. Clinically, renal angiomyolipoma is asymptomatic until the tumour becomes larger than 4 cm, causing urinary symptoms such as pain, infection, and microhaematuria. Rarely, in cases of large hypervascularised lesions, the clinical picture at onset may consist in spontaneous haemorrhage due to vessel rupture. The therapy consists in non-operative treatments for small tumours (< 4 cm) and surgical treatment, probably preservative, for larger tumours. In complicated haemorrhagic cases, an angiographic approach or surgical treatments, possibly conservative, are possible, offering the opportunity for further elective treatment. On the basis of case reports starting with haemorrhage and treated in urgency and of a review of the literature, we conclude that it is possible and mandatory to perform emergency preservative treatments of the kidney with an angiographic or surgical approach, and to ensure haemostasis. Treatment of the disease can be postponed when clinical and environmental conditions are better. Furthermore, we stress the need, once the clinical urgency/emergency is over, to submit the patient to suitable examinations to detect possible associated pathologies (tuberous sclerosis, neurofibromatosis, Sturge-Webers disease) in other parts of the body.

[Treatment of splenic trauma in paediatric age]. / Trattamento del trauma splenico in età pediatrica vs età adulta. Nostra esperienza.

The splenic trauma in children presents some peculiarity that differentiates it from that one in adult age. Therefore we have see again our relative experience on splenic trauma, in the period 2001-2006, confronting two groups of patients, one of inferior age to fourteen years (A Group) and one of advanced age (B Group). We have estimated the following parameters: aetiology, type of lesion, association with others trauma, type of treatment, compliance, mortality, number of transfusions and hospital stay. On a total of 75 splenic trauma (M:52, F:23 of age comprised between 5 and 71 years) 18 belongs to the A group (medium age of 9.2 years) and 57 to the B group (medium ages of 47.4 years). The prevailing aetiology in the A group is domestic accident (39%) and the fall from bicycle (33%), while in the B group it is the street accident (69%). The lesions found in pediatric age are of smaller gravity if compared with B group, for lesion gravity and for association with abdominal and/or extra-abdominal others trauma. In the children group we have performed nonoperative management or conservative surgery in the 83% of cases versus the 26% in the B group. The rate of conversion from a nonoperative treatment in to an operative treatment has been of 7%. The post-operative complicance are absent in the A group and of 5.5% in the B group. The mortality rate in the surgical patients has been of the 14.3% for serious toraco-abdominal trauma in A group and of 11.1% in B group. No mortality is detected in the groups with nonoperative treatment. The medium number of transfusions is of 1.8 units in the paediatric patients and of 2.5 units in the adults. The medium stay in hospital is of eighteen days in the A group and of thirteen days in the B group. In conclusion the marked difference in the two groups examines stays in the type of treatment, more often nonoperative or conservative in the children group.