Alcohol Addiction: One Entity or Different Entities? A DSM-4-Based Attempt Toward a Geographicization of Alcohol Addiction and Abuse.

AIM: To examine whether in Europe perceptions of 'alcoholism' differ in a discrete manner according to geographical area. METHOD: Secondary analysis of a data set from a European project carried out in 2013-2014 among 1767 patients treated in alcohol addiction units of nine countries/regions across Europe. The experience of all 11 DSM-4 criteria used for diagnosing 'alcohol dependence' and 'alcohol abuse' were assessed in patient interviews. The analysis was performed through Multiple Correspondence Analysis. RESULTS: The symptoms of 'alcohol dependence' and 'alcohol abuse', posited by DSM-IV, were distributed according to three discrete geographical patterns: a macro-area mainly centered on drinking beer and spirit, a culture traditionally oriented toward wine and a mixed intermediate alcoholic beverage situation. CONCLUSION: These patterns of perception seem to parallel the diverse drinking cultures of Europe.

[Reassessment of burden of occupational fatal injuries in Italy, 1951-2017]. / Rivalutazione del carico di danni dovuti agli infortuni mortali sul lavoro in Italia, 1951-2017.

BACKGROUND: occupational injuries in Italy are registered primarily by the Italian National Institute for insurance against accidents at work (Inail); its statistics show the number of events by consequence type (temporary, permanent, fatal). Data prior to 2001 include fatalities only if benefits were paid to survivors entitled to compensation, typically spouse and/or children. OBJECTIVES: to estimate the number of fatal injuries occurred to workers without survivors entitled to compensation, not considered in INAIL statistics for the period 1951-2000; to evaluate years lived with disability (YLD) years of life lost (YLL), disability-adjusted life years (DALY) caused by all occupational injuries occurred in Italy, period 1951-2016. DESIGN: evaluation of the stability of the ratio among fatal accidents with and without survivors, along the period of observation (2001-2017); retrospective application of such ratio to data related to the period 1951-2000; linkage of individual injury data to Global Burden of Disease injury categories and calculation of corresponding YLLs, YLDs, DALYs; calculation of mean values by main type of consequences (temporary, permanent, fatal); application of above means to Italian data 1951-2017. SETTING AND PARTICIPANTS: occupational injuries compensated by Inail in Italy, 1951-2017. MAIN OUTCOME MEASURES: number of injuries, YLDs, YLLs, DALYs. RESULTS: fatal occupational injuries, not considered in official statistics for the period 1951-2000, are estimated to be 26,218 cases, corresponding to 1.4 millions of YLLs. In the same period, total occupational injuries (with temporary, permanent or fatal consequences) correspond to 11.5 millions of DALYs, fatal component corresponded to 5.1 millions of YLLs. CONCLUSIONS: Estimated total number of fatal occupational injuries in 1951-2000 is 28% higher than official Inail data. Considering YLLs, such increase rises up to 37%. Such difference reflects younger mean age and consequent longer life expectancy of workers without survivors. Considering DALYs, the increase is 14%. Throughout the period 1951-2017, a progressive reduction of the burden of injury is observed. At the same time a qualitative change is observed, with reduction from 55% to 30% of YLL/DALY ratio.

Italian translation and validation of the Perinatal Grief Scale.

AIMS: The short version of the Perinatal Grief Scale (PGS) has 33 items of Likert type whose answers vary from 1 (strongly agree) to 5 (strongly disagree), and is used to assess the grief after perinatal loss and to identify women at major need of specific support. This is the first attempt to validate an Italian version of PGS. MATERIALS AND METHODS: The English version of PGS by Potvin et al. was translated into Italian by a professional mother tongue English translator. The survey was administered at 3 different times (translated Italian version; original English version after 10 days; and same Italian version after other 10 days) to 16 Italian/English bilingual women who had experienced a perinatal loss. The reproducibility among the three administrations and concordance were assessed using Cronbach's alpha and Cohen's kappa, respectively. RESULTS: Considering the PGS, median score ranged from 74.5 (58.5-94.5) to 78 (64-95), with no significant difference among the three questionnaire administrations (p = 0.616). No significant difference emerged among the three administered questionnaires for subscales (p = 0.095, 0.410 and 0.410 for 'active grief' AG, 'difficulty in coping' DC and 'despair' D scores, respectively). Concordance varied from good to very good among all questionnaire administrations. CONCLUSIONS: This Italian version of the PGS can be used by clinicians to assess Italian women's responses to stillbirth and perinatal loss, as well as by researchers for research purposes.

Stillbirth and perinatal care: Are professionals trained to address parents' needs?

OBJECTIVE: To assess current practices of health care providers (HCPs) caring for women experiencing a stillbirth and to explore their needs for training to better support bereaved families. DESIGN: Nationwide cross-sectional survey. The main outcome measures were the evaluation of HCPs cognition, emotions and behaviours with regard to the care of women with a stillbirth care, as well as their compliance with international guidelines. PARTICIPANTS: 750 HCPs, in 11 Italian hospitals, were administered a multiple-choice questionnaire. FINDINGS: The response rate was 89.9%; the majority (94.1%) were female, with a mean age of 37.6 (SD = 10.4) years. Midwives were the most represented (72.8%). Half of the respondents recommended immediate birth; only 55% routinely bathed and dressed stillborn babies for their parents to see, while 44.4% of HCPs immediately took the babies away without allowing parents to properly say goodbye to them. More than half felt inadequate and some even reported having failed to provide support to the family when caring for a woman with stillbirth in the past. The need for professional training courses was expressed by 90.2%, and three-quarters had never previously attended a course on perinatal bereavement care. When answers by Italian HCPs are systematically evaluated with reference to international guidelines, the results were very poor with only 27.9% of respondents reported having created memories of the baby and less than 3% complied with all recommendations in the areas of respect for baby and parents, appropriate birth options, and aftercare. KEY CONCLUSIONS: There is a substantial gap between the standards of care defined by international guidelines and the practices currently in place in Italy. Italian HCPs feel an urgent need to be offered professional training courses to better meet the needs of grieving families. IMPLICATION FOR PRACTICE: Perinatal HCPs should be aware of their pivotal role in helping bereaved parents after stillbirth and perinatal loss, and seek appropriate training.

Influenza vaccination 2014-2015: Results of a survey conducted among general practitioners in Italy.

INTRODUCTION: The aim of the present study was to evaluate orientation, organizational procedures implemented and difficulties faced by general practitioners (GPs) during the 2014/15 seasonal influenza vaccination programme, as well as GPs' general attitude towards vaccinations. METHODS: An ad hoc online survey was developed and administered to general practitioners members of the Italian Federation of GPs (Federazione Italiana Medici di Medicina Generale - FIMMG). Overall, 10,000 survey invitations were sent. Data were analysed with R 3.3.2 software for analyses. Odds ratios (OR) were calculated in univariable and multivariable analyses. RESULTS: A sample of 1,245 GPs participated in the survey. Only slightly more than one third achieved a vaccination coverage comprised between 61% and 75%. In over half of the cases, the local health unit does not allow the GPs to choose the type of vaccine; 8.8% did not receive operational information at the beginning of the vaccination campaign and almost half did not receive feedback information at the end of the campaign. Almost three quarters reported that the vaccination uptake should increase. One tenth of GPs totally disagreed with the statement that vaccinating healthcare workers is crucial to prevent and control infections, and one fifth had not been vaccinated in the prior decade. DISCUSSION: The efforts made to vaccinate elderly individuals did not reach the expected results; still many GPs complained about lack of information by the relevant public health institutions and organizational difficulties. A stronger commitment of public health authorities would entail a higher vaccination uptake.

Reduction of excavation face collapse risk in tunnelling.

Two large road tunnels, recently developed near Florence, showed instabilities of the excavation face which subsequently caused sixteen collapses. Due to the risk for workers' safety, the public authority for occupational health and safety (ASL) has monitored the failure rate and other background variables in order to assess the possible correlations between risk reductions, its own actions, and those of the various safety actors involved. OBJECTIVES: To evaluate if the interventions carried out by the design team were able to reduce the risks of collapse and which of the ASL actions and/or which other factors were more effective in changing the attitudes of the parties involved, leading to a more expensive but safer project variant. RESULTS: After adoption of the second of two project variants, no more collapses were observed. No correlation was found between trend of ASL inspections and observed variation of collapse rate. Conversely, the adoption of strongly coercive measures and investigation reporting by local media coincided with periods of risk reduction, even if the low number of events does not allow for statistical evaluation. CONCLUSIONS: These findings appear to be coherent with the ratio of the cost of penalties related to health and safety infringements (thousands of euros) to the overall cost of the safer project variant (a hundred times greater).  The safer variant required 7% more labour but avoided forced interruptions caused by the collapses, allowing a 13% faster excavation rate.

[Fatal injuries at work in Tuscany Region (Central Italy): content analysis of newspapers]. / Infortuni mortali sul lavoro in Toscana: analisi dei contenuti informativi della stampa quotidiana.

OBJECTIVES: to describe how journalists report events such as fatal accidents work through the newspapers. DESIGN: analysis of the textual content of titles and texts, using qualitative and quantitative techniques. SETTING AND PARTICIPANTS: 184 articles related to 180 work-related fatalities occurred in Tuscany Region (Central Italy) in the period 2008-2009 were examined. MAIN OUTCOME MEASURES: frequency of citation of significant adjectives relating to the use of frames in titles was measured; frequency of citation of the laquo;subjects attended the venue for office tasksraquo; and laquo;subjects whose statements are reported in relation to the eventraquo; in relation to the circumstances of the event and some available demographic features was also evaluated. RESULTS: compared to texts, titles of the articles are characterized by higher frequency of adjectives that describe the emotional intensity. Articles describing tractors or road accidents and articles that describe sudden deaths are shorter than the others. Among the subgroups of subjects quoted in the text of the articles, health authorities are less mentioned in the articles dealing with road accidents, while they are more common in those due to falls from a height, where also social forces which issue statements to the press are more frequently mentioned. The analysis of co-occurrences visually shows which activities are carried out by these subgroups of subjects in the texts of the selected articles. CONCLUSION: the study shows the message that is conveyed to the public by the mass medium newspaper. Hopefully, in the future, following results of similar studies, it will be easier focusing awareness and transmission of information, which are essential for prioritization process of public health initiatives to be taken. This study was preliminary in nature, opening a field of interest so far little practised in our Country.