The Erice 58 Charter on 'The health of migrants. An equity challenge for the public health system'.

Abstract: The Erice 58 Charter titled "The Health of Migrants: a Challenge of Equity for the Public Health System", was unanimously approved at the conclusion of the 58th Residential Course of the School of Epidemiology and Preventive Medicine 'Giuseppe D'Alessandro' entitled "The Health of Migrants: a Challenge of Equity for the Public Health System. Epidemiological, clinical-relational, regulatory, organisational, training and public communication aspects at international, national and local level', which took place from 28 March to 2 April 2022 in Erice (Sicily, Italy), at the 'Ettore Majorana' Foundation and Centre for Scientific Culture. The Course was promoted by the Italian Society of Migration Medicine (S.I.M.M.) and the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI), with the collaboration and patronage of the Istituto Superiore di Sanità (ISS). 72 learners participated (mainly resident doctors in 'Hygiene and Preventive Medicine' but also other health service professionals), whose average age was 37 years; on the basis of territorial origin, 13 of the 20 Italian regions were represented. During the intense learning experience, which consisted of 18 frontal lessons (with 20 lecturers from the bio-medical, socio-anthropological and journalistic fields) and 7 working group sessions (supported by 4 classroom tutors in addition to the lecturers) in 'blended learning' mode, the various dimensions and critical issues related to the possibility of guaranteeing truly inclusive health policies for foreigners/migrants, throughout the country, were identified and discussed from an 'Health Equity' perspective. This enabled a small editorial group to draw up the basic document that, in the last session of the Course, was discussed and modified by all participants into the version of the 'Erice 58 Charter' presented here.

Celebrating Public Health lives.

At the age of 91, Maria Antonietta Modolo, retired Professor of Hygiene at the University of Perugia, passed away on 26 November 2020 and the entire Italian Public Health community mourns her sudden death.

Impact of the environment on the health: From theory to practice.

The Erice 56 Charter titled "Impact of the environment on the health: from theory to practice" was unanimously approved at the end of the 56th course of the "International School of Epidemiology and Preventive Medicine G. D'Alessandro" held from 3rd to November 7, 2019 in Erice - Sicily (Italy) and promoted by the Study Group of "Environment and Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health. The course, that included lectures, open discussions and guided working groups, was aimed to provide a general training on epidemiological and toxicological aspects of the environmental health impact, to be used by public health professionals for risk assessment, without forgetting the risk communications. At the end of the course 12 key points were agreed among teachers and students: they underlined the need of specific training and research, in the perspective of "One Health" and "Global Health", also facing emerging scientific and methodological issues and focusing on communication towards stakeholders. This Discussion highlight the need to improve knowledge of Health and Environment topic in all sectors of health and environmental prevention and management.

Effectiveness of face masks for the population.

Background: Health authorities and organizations consider non-medical face masks as an additional passive means to prevent virus diffusion. Communication strategies disseminate information among the population that such masks are essential for mitigating virus diffusion. However, scientific studies are not conclusive in showing the undisputed filtration efficiency of fabric/cloth facial masks (both commercial and homemade). Objectives: This study examines scientific data about the effectiveness of face masks before and during the COVID-19 emergency. Present trends in the making of commercial and homemade fabric/cloth face masks are also examined. Methods: Statistical data of published studies are analyzed and compared. Main considerations and sugge-stions are also extracted and discussed. Current approaches are examined for assessing the characteristics and effectiveness of fabric/cloth commercial and homemade face masks intended for the population. Results: Conflicting data exist as to whether non-medical masks have a protective effect from the spread of respiratory viruses. Both medical masks (MDs) and respiratory personal protection equipment (PPE) show a given effectiveness value. Conclusion: Concerning commercial and homemade fabric/cloth masks, giving general indications on the choice of materials and their assemblage is difficult as it is not possible to assess the effectiveness of the filter media with respect to the kind of multiphase fluid that may be emitted upon breathing, sneezing, or coughing under different environmental conditions. This is particularly important because airflow rate, temperature, humidity, and duration of use will affect the performance of filter media. Moreover, while a mask may have excellent filter media, droplets may leak into the face-piece unless there is an adequate facial seal. In the presence of leaks, any type of mask may actually offer less protection independently of its nominal filtering effìciency.

Face masks. Technical, technological and functional characteristics and hygienic-sanitary aspects related to the use of filtering mask in the community.

INTRODUCTION: The health emergency caused by the spread of SARS-COV-2 virus has required the adoption of passive measures against contagion, such as social distancing. The use of filtering masks, of the different types available on the market, such as surgical and facial filtering masks (FFP1, FFP2 and FFP3), is also recommended. OBJECTIVES: The aim of this paper, within the Italian and European regulatory reference framework, is to suggest a rational application of existing methodologies that enable to know and assess the features and/or make a face mask intended to be used by the community. In addition to this, the study aims to provide a correct regulatory framework and useful information for a correct use and disposal of face masks. Another purpose is the assessment of the hygienic, sanitary and regulatory aspects related to the use and disposal of face masks. METHODS: The analysis of filtering masks is based on the review of scientific literature, the state of art of technology and the filtering means/materials available. Reference is made to filtering mechanisms and devices, the testing methods, the technical, manufacturing and performance features, and to the Italian and European regulatory reference framework. Reference is also made to the hygienic, sanitary and regulatory aspects related to the use and disposal of face masks. RESULTS: Surgical masks or, alternatively, filtering masks with a filtration efficiency between 90% and 95% for 3-µm particles, are the most practicable choice with minor contraindications. The reusable type of mask is conceptually superior compared to single-use masks, but cleaning procedures to be followed are quite complex and not always described in a clear way. CONCLUSIONS: The definition of rigorous and repeatable tests on mask filtration capacity, breathability, wearability, duration of use, regeneration, as well as safe disposal methods, are the main way to provide users with correct selection and use criteria. The results must be disclosed and disseminated quickly.

A survey on knowledge and awareness on the issue "microplastics": a pilot study on a sample of future public health professionals.

BACKGROUND: Microplastics pollution represents a global public health concern. Since the greatest amount of microplastics are of anthropogenic origin, one of the most relevant strategies to reduce microplastics pollution is to raise awareness among the population and this is even more important for all those involved in public health prevention interventions. The aim of this study was to assess the level of knowledge and awareness on microplastics of a samples of future healthcare workers. STUDY DESIGN: A cross-sectional study was performed on 151 university students in the field of Public Health, both pre- and post-graduate, attending the Sapienza University of Rome courses. METHODS: A questionnaire consisting of three sections was administered to the participants. The first section assessed knowledge and awareness on microplastics, the second consisted of an informative brochure on microplastics, the third evaluated the awareness after reading the brochure, and interventions considered useful to manage microplastics pollution. RESULTS: About 25% of participants had never heard of microplastics. The scores on knowledge about microplastics were low, and differences between the investigated courses were not statistically significant (p-Value=0.134). Internet was the main source of information on microplastics, while the scores describing concern about the investigated issue resulted always higher after reading the informative brochure respect to before reading. CONCLUSIONS: The lack of knowledge about microplastics pollution highlights that future public health workers should be better informed and, therefore, able to transfer essential information to the population. Increasing general population's knowledge and awareness would increase risk perception and make all individuals more active actors for reducing microplastics pollution.

Mind the GAP! Pathological gambling, a modern defy to public health.

Due to its clinical aspects, pathological gambling is of paramount interest for Psychology and Psychiatry; however, it also has such characteristics that call for the interest and the intervention of Public Health, both at national and international level. This pathology is a growing problem in our society, particularly in some groups of vulnerable people; has a strong psycho-social impact on the individuals, their families, their social environment and the society as a whole; requires an organized, competent, structured and integrated intervention of the Public Health care services and of specialized private organizations; and, finally, it represents important economic implications. As far as the Italian situation is concerned, it is estimated that up to 50% of the population has experienced gambling at least once; consequently, the political world has taken interest in the problem, producing in 2016 a governmental Report on Pathological Gambling to the Parliament; moreover, pathological gambling has been included into the 2017 revision of the Essential Levels of Health Care Regulations, whose validity is nationwide, provided that, usually, the Regions legislate autonomously on health assistance aspects. Recently, the Observatory on Contrast to Pathological Gambling and to Serious Gambling Addiction has published specific ad hoc guidelines and the Italian Parliament approved a law forbidding every form of gambling advertising (Law No. 96/2018). However, even considering the interest of the National Health Service in contrasting pathological gambling, the problem is far from its solution; firstly, because the State itself earns a considerable amount of money from the taxation of "legal" gambling, thus creating a resounding conflict of interest; secondly, because the peripheral branches of the National Health Service have responded unevenly so far when trying to organize the contrast. What is needed for the future is an effort of coordination between the National Health Service - at State, Region and local level - and the Non-Governmental Organizations, in order to face the cultural, political, communicational, organizational, technological and public health aspects of such a contrast, balancing incentives and disincentives wisely.

Erice 2018 Charter on the role of the National Health Service in the prevention of doping

The Erice 2018 Charter was unanimously approved at the conclusion of the 53rd Residential Course of the International School of Epidemiology and Preventive Medicine "Adapted Physical Activity in Sport, Wellness and Fitness; the role of the Departments of Prevention and of the National Health Service in doping prevention and health promotion", held on 15-19 May 2018 in Erice, Italy, at the "Ettore Majorana" Foundation and Centre for Scientific Culture, and promoted by the Study Group on "Movement Sciences for Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health. The event was part of a larger project supported by the Ministry of Health aimed at preventing doping in the general population involved in sport and physical activities. After an intense discussion the participants focused on ten statements involving the following critical issues: responsibility, priority, message, alphabetization, networks and alliances, school promoting health, player and opportunities, competences, know-how, programming and acting. These statements provide hints to approach doping within a public health frame and summarize the role of the Departments of Prevention and NHS in promoting and coordinating preventive actions with other institutions and stakeholders. Doping represents a complex phenomenon related to cultural, social, economic and legal issues. In addition to regulatory or repressive actions, education to health and legality is proposed as the fundamental strategy to contrast doping by promoting healthy lifestyles, based on scientific knowledge and respect for legality.

Strategies for Disease Prevention and Health Promotion in Urban Areas: The Erice 50 Charter.

The Erice 50 Charter titled "Strategies for Diseases Prevention and Health Promotion in Urban Areas" was unanimously approved at the conclusion of the 50th Residential Course "Urban Health. Instruments for promoting health and for assessing hygienic and sanitary conditions in urban areas", held from 29th March to 2nd April 2017 in Erice, at the "Ettore Majorana" Foundation and Centre for Scientific Culture and promoted by the International School of Epidemiology and Preventive Medicine "G. D'Alessandro" and the Study Group "Building Hygiene" of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI). At the conclusion of the intense learning experience during the Course, with more than 20 lectures, workshops and long-lasting discussions between Professors and Students, the participants identified the major points connecting urban features and Public Health, claiming the pivotal role of urban planning strategies for the management of Diseases Prevention and Health Promotion activities. The Erice 50 Charter is configured as a Decalogue for Healthy Cities and as a Think Tank for designing effective strategic actions and best practices to develop urban regeneration interventions and improve the urban quality of contemporary cities. The Decalogue is structured into the following key strategic objectives: 1. Promoting urban planning interventions that address citizens towards healthy behaviours; 2. Improving living conditions in the urban context; 3. Building an accessible and inclusive city, with a special focus on the frail population; 4. Encouraging the foundation of resilient urban areas; 5. Supporting the development of new economies and employment through urban renewal interventions; 6. Tackling social inequalities; 7. Improving stakeholders' awareness of the factors affecting Public Health in the cities; 8. Ensuring a participated urban governance; 9. Introducing qualitative and quantitative performance tools, capable of measuring the city's attitude to promote healthy lifestyles and to monitor the population's health status; 10. Encouraging sharing of knowledge and accessibility to informations. Finally, all the participants underlined that a multidisciplinary team, composed of Physicians specialized in Hygiene, Preventive Medicine, Public Health and Technicians as Architects, Urban planners and Engineers, is needed to deepen the research topic of Urban Health.

The Museum of the Department of Public Health and Infectious Diseases, Sapienza University of Rome.

This paper illustrates in detail the birth of the Museum of Public Health of the Sapienza University of Rome, which has been one of the most successful achievements of Prof Carmine Melino in the last few years of his academic career. Backed by a very thin group of enthousiastic coworkers and colleagues, he recuperated all the instruments which had been used by the research groups active since 1880 at the former Institute of Hygiene, to which he added samples of the different pieces of laboratory furniture, ancient reagents, etc. The goal was not to simply collect, restore and maintain the documents of the Institute's past, but to rebuild a vintage laboratory, as it was inhabited by the hygienists of the past and to describe the kinds of research being performed during a period more than a century long. Beginning from the days when Hygiene became a scientific discipline, he tried to demonstrate that only the transformation of Hygiene into an experimental discipline made it possible the numberless achievements, including the improvements of the environmental conditions, the reduction of infectious diseases and the successful fight against the chronic, degenerative diseases of the present times.

Nutrition between sustainability and quality.

This lecture describes the complex interrelations existing between human nutrition, quality of aliments, their safety and the sustainability of the feeding habits adopted by the different cultures in the World. At present, a significant part of the developing World is still affected by insufficient availability of nutricious and safe food, and these difficulties are due more to political events as wars and less to natural events as famine. It is equally true that in the developed World, where abundance reigns and international trade grants a large variety of foods everywere, the existing health problems arise from the excess of nutrition, worsened by sedentarity, because the fatigue due to manual work has disappeared and people maintain their feeding habits; but such problems depend also on the diet composition, which in some countries is too rich in meat and animal fats. As a consequence, chronic degenerative pathologies and a progressive dependance of people in their third age are becoming more and more common. But this situation could be overturned by corrective interventions driven by good epidemiological knowledge, as teach us the great international institutions as UNO and WHO. The goal is not to expand without limits the production of food, but to better distribute it socially and geographically, to minimize losses and wastes and also to change those diets based on foods which consume too many natural resources and, therefore, do not respect sustainability. Sustainability can be measured under different aspects: ecology (use of water, energy and soil), economy and health protection. Accurate analyses and evaluations have brought to the conclusion that the least sustainable diets are those, quite popular in the Anglosaxon countries and northern and eastern Europe, rich in meat and animal fats, while those based on cereals, legumes and fish - like the Japanese and the Mediterranean diets - respect much more the environment, consume less resources and improve health and longevity (or, better, longevity in good health). The Mediterranean diet has been identified, classified and scientifically documented as the one that can guarantee longevity in good health by the US physiologist Ancel Keys, who lived many years in the Italian area of Cilento, the Italian creadle of such a diet, and died at the age of 100. The Mediterranean diet has been recognized in 2010 as an intangible cultural patrimony of Humanity by UNESCO, and is practiced also in many areas of Spain, Portugal, Greece, Morocco and Cyprus. Good diets per se are not sufficient to improve health if they are not accompanied by a daily physical exercise, which is necessary to replace the physical fatigue, represented in the past by the manuality of almost all jobs, with new practices as swimming, bicycling or at least walking enough time every day Another aspect to be developed is the capacity of the Mediterranean Diet to safeguard the cultural aspects, like conviviality and sharing of food, which are good mechanisms for socialization and improving the life of families and communities.

[Hospitals of the future confronting a changing epidemiology and the advance of medical research]. / Gli ospedali del futuro di fronte ad una epidemiologia che cambia ed alle nuove prospettive della ricerca medica.

A review is offered of the most consistent sociological and epidemiological modifications taking place in this country, and their impact on the behaviour of diseases in the community. Following this picture on-the-move, analysis is performed on how designing, building and managing of the new hospitals are to be modified accordingly. In any case, new hospitals, specifically devoted to acute cases, will enter an assistance network including also territorial institutions, specifically devoted to the management of chronic pathologies.

[Travelling and migration are not the same thing. So, why do we continue to overlap their health issues?]. / Viaggiare e migrare non sono la stessa cosa. E allora perché continuiamo ad associare la medicina delle migrazioni con quella dei viaggi?

Not rarely, the health issues regarding travellers and immigrants are overlapped, both at national (Italy) and international level. The fact is that, in general, 'mobility' is the only common connecting factor between the two groups. The article examines critically all the existing differences (socio-economical background, aims, temporality, resources available at arrival, prevalent health risks and correlated prevention methods and tools, health coverage possibilities, etc.). The authors conclude that the health dimensions of the two considered groups need a distinct scientific approach, different competence and distinguished health care services.

[Microbiological pollution of operating rooms: critical analysis of two decades of surveillance]. / Inquinamento microbiologico delle sale operatorie: analisi critica di due decenni di sorveglianza.

The objective of this study was to analyze the results of microbiological air sampling of operating rooms (OR) over the last two decades at the Sapienza University Hospital of Rome, in order to describe the time trends of contamination levels and to assess any significant changes. Microbiological air sampling carried out in 14 surgical units between 1992 and 2010 were examined. The sampling results have been aggregated into four time periods (prior to 1996, 1996-2000, 2001-2005, 2006-2010) and the time trend of sampling results was analyzed in comparison with the standard reported by ISPESL for OR at-rest (< or = 35 CFU/mc). The same analysis was repeated after stratification by risk level of the OR (high risk (AR) and low risk (BR)). To verify the significance level of the temporal variations in the distribution of results x2 test for trend was performed. There was a significant downward trend in the number of OR with contamination levels higher of the standard (x2 for trend = 8.94, P < 0.025). This reduction mainly regards AR-OR (x2 for trend = 7.33, P < 0.05). The results suggest that the preventive measures performed in AR-OR have been effective. More attention must be given to BR-OR.