Proposal for an Alliance Between Healthcare and Legal Area Professionals for Shared Public Health and Preventive Strategies in Italy and Europe.

Following the implementation of the new Italian legislation on responsibility of healthcare workers, a multi-professional framework, involving representatives of the Italian public health professionals and legal professionals expert in the field, drafted a proposal of the actionable recommendations to be implemented in the management of civil and penal disputes arising from the practice of public health interventions. In order to prevent legal disputes concerning some public health fields such as vaccinations, cancer screening, environmental health surveillance, and hospital management, it should be primary taken into account to update guidelines in supporting decision-making processes, in accordance with the "best scientific evidence available." Furthermore, a multidisciplinary alliance between public health and legal area professionals should be encouraged and should be promoted both at national and European level.

COVID-19 and Living space challenge. Well-being and Public Health recommendations for a healthy, safe, and sustainable housing.

BACKGROUND AND AIM OF THE WORK: The ongoing pandemic of COVID-19 is a strong reminder that the lockdown period has changed the way that people and communities live, work, and interact, and it's necessary to make resilient the built environment, both outdoor and mainly the indoor spaces: housing, workplaces, public buildings, and entertainment facilities. How can we re-design the concept of Well-being and Public Health in relation to the living places of the future? METHODS: According to the previous statements and scenario, this paper aims to integrate the building hygiene and well-being, focusing the possible responses, both existing and for the new buildings, taking home a strong message from this "period" of physical distancing. RESULTS: The Well-being and Public Health recommendations for a healthy, safe, and sustainable housing are framed into the following key points: 1. Visible and accessible green elements and spaces; 2. Flexibility, adaptability, sharing, and crowding of living spaces, and compliant functions located into the buildings; 3. Re-appropriation of the basic principles and archetypes of sustainable architecture, thermal comfort and Indoor Air Quality (IAQ); 4. Water consumption and Wastewater Management; 5. Urban Solid Waste Management; 6. Housing automation and electromagnetic fields; 7. Indoor building and finishing materials. CONCLUSIONS: The Well-being and Public Health recommendations for a healthy, safe and sustainable housing may provide a useful basis for Designers, Policy Makers (fostering tax incentives for building renewal), Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform living places in healthier and Salutogenic spaces.

The homes in the COVID-19 era. How their use and values are changing.

The long lockdown, the frequent adoption of smart working, the online lessons for both school and university pupils, and the domestic isolation of many people in order to stop the spread of the SARS-CoV-2, have changed the way millions of people lived their home spaces in the last few months. This also led to a backlash on real estate values, enhancing some characteristics and penalizing others.

COVID-19 and Cities: from Urban Health strategies to the pandemic challenge. A Decalogue of Public Health opportunities.

BACKGROUND AND AIM OF THE WORK: The ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it's necessary to make resilient the systems and local capacities to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities? METHODS: According to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the "period" of physical distancing.  Results. Immediate Actions are 01. program the flexibility of city schedules; 02. plan a smart and sustainable mobility network; 03. define a neighborhood services' plan; 04. develop a digitization of the urban context, promoting the smart communities; 05. re-think the accessibility to the places of culture and tourism.  Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces; 07. re-think building typologies, fostering the presence of semi-private or collective spaces; 08. renovate the basic care services' network; 09. integrate the existing environmental emergency plans, with those related to the health emergencies; 10. improve stakeholders' awareness of the factors affecting Public Health in the cities. CONCLUSIONS: The Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments. (www.actabiomedica.it).

COVID-19: Hygiene and Public Health to the front.

Public Health professionals and academics have been on the frontline of Italian history during the COVID-19 response like they never did before. Ancient professors of Hygiene such as Celli, Pagliani, Sclavo, Petragnani, Seppilli and Giovanardi flanked politicians in other critical moments. They helped them to manage healthcare reforms, earthquakes response, Seveso Dioxin disaster, cholera and poliomielitis epidemics and other health threats.   The ongoing COVID-19 epidemic has highlighted the paramount importance of the practical application of basic concepts of public health, which were considered so far became obsolete, such as personal hygiene, quarantine, individual protective devices or basic epidemiological measures. Hygiene and Public Health used to have a targeted audience in professionals and lecturers. Nowadays, these topics are critical and of concern of a much larger audience. Public Health women and men are now asked to act in task forces, media broadcasts, webinars and consulting activities.   In phase 2 of this epidemic - which is about to begin when this volume is to be published - the role of Public Health professionals could become even more relevant. However, this unexpected season must be managed with seriousness and intelligence, capitalizing it also for the future. If our Post-Graduate Schools of Public Health ("Igiene e Medicina Preventiva"), our scientific associations, our academic lecturers and our officers do not prove to be up to the situation, a dull future for the discipline might very well be. On the contrary, if as we all hope, we will be able to ride the wave of a dramatic health crisis, transforming it into a relevant scientific and professional opportunity, then we will be able to build on the post-COVID-19 a cutting-edge, a more attractive, relevant and modern discipline. This Supplement of Acta Biomedica, planned before the onset of the epidemic emergency in Italy, but already successful in presenting two papers on COVID-19, is further proof of how current and lively our discipline is.

[Life and achievements of an hospital director: Enrico Ronzani]. / Ricordo di un direttore sanitario illuminato: Enrico Ronzani

The paper illustrates the life and the achievements of Enrico Ronzani, born in Padua and graduated in Medicine at the Bologna University. He directed the hospitals of Florence and the Ospedale Maggiore of Milan, promoting its growth until it became the seat of the Medical School promoted by Prof Mangiagalli, and he himself became Full Professor of Hygiene. In such a position he taught Hygiene also to Architets and Engineers, built the new Institute of Hygiene and helped to design and build the new great Hospital of Niguarda. But, most of all, he was successful in designing, promoting and officializing the job of the Hospital Directors, which was subsequently recognized by the law; and, publishing a series of books on the role of the modern hospitals, he prefigured their position in a web of medical institutions to include also those devoted to pre- and post-hospital assistance to the population. Practically he foresaw what was realized many years later through the creation of the Italian National Health Service (Law 833 of 1978).

The contribution of professors of Hygiene to the progress and development of public health in Italy: one hundred years of history.

In 1917 Achille Sclavo, a distinguished researcher and founder of the Italian Society of Hygiene, ended up the first term as Rector of the University of Siena. Since then, the contribution of professors of hygiene in Italian universities has ranged over several relevant topics including vaccinations, environmental hygiene, hospital hygiene, healthcare organization and management, with an important contribution to the health reform of 1978 by Augusto Giovanardi and Alessandro Seppilli. Several Academic Schools (Roman, Neapolitan, Genoese, Sicilian, Venetian, Lombard, etc.) have produced excellent researchers, teachers and mentors who have also occupied important positions in the panorama of the Italian health system. This note analyzes the main research topics, the most famous institutes and departments of hygiene and public health and the contributions of the most famous professors for the development of the discipline, the management of the post- graduated Schools in hygiene and preventive medicine, the commitment in scientific associations and the role of some of them in important institutional positions. Even through its contribution and constant commitment to the institutions, Italian public health has achieved the reputation of being one of the best known and appreciated in the international scientific community.

Health literacy, emotionality, scientific evidence: Elements of an effective communication in public health.

The importance of healthcare providers' communication abilities is still underestimated. Informing the population on the basis of documented evidence is essential but not enough to induce a change in the beliefs of who is doubtful or does not accept preventive interventions, such as vaccination. Lining up the offer of prevention to the knowledge of the citizens, also improving Health Literacy skills, is a critical step toward their empowerment and behavior change. The 2017 Erice Declaration was drafted to propose to the Institutions and the scientific community the main goals to improve communication and counteract Vaccine Hesitancy, at a very critical time, when mandatory vaccination was introduced in Italy.

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.

Adapted Physical Activity for the Promotion of Health and the Prevention of Multifactorial Chronic Diseases: the Erice Charter.

The Erice Charter was unanimously approved at the conclusion of the 47th Residential Course "Adapted Physical Activity in Sport, Wellness and Fitness: New Challenges for Prevention and Health Promotion", held on 20-24 April 2015 in Erice, Italy, 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 on Movement Sciences for Health of the Italian Society of Hygiene, Preventive Medicine and Public Health. After an intense discussion the participants identified the main points associated with the relevance of physical activity for Public Health, claiming the pivotal role of the Department of Prevention in coordinating and managing preventive actions. The participants underlined the importance of the physicians specialized in Hygiene, Preventive Medicine and Public Health. The contribution of other operators such as physicians specialized in Sport Medicine was stressed. Further, the holders of the new degree in Human Movement and Sport Sciences were considered fundamental contributors for the performance of physical activity and their presence was seen as a promising opportunity for the Departments of Prevention. Primary prevention based on recreational physical activities should become easily accessible for the population, avoiding obstacles such as certification steps or complex bureaucracy. The Sport Doctor is recognized as the principal referent for preliminary physical evaluation and clinical monitoring in secondary and tertiary prevention actions based on adapted physical activities. Developing research in the field is essential as well as implementing higher education on physical activity management in Schools of Public Health.

Towards the eradication of HPV infection through universal specific vaccination.

BACKGROUND: The Human Papillomavirus (HPV) is generally recognized to be the direct cause of cervical cancer. The development of effective anti-HPV vaccines, included in the portfolio of recommended vaccinations for any given community, led to the consolidation in many countries of immunization programs to prevent HPV-related cervical cancers. In recent years, increasing evidence in epidemiology and molecular biology have supported the oncogenic role of HPV in the development of other neoplasm including condylomas and penile, anal, vulvar, vaginal, and oro-pharyngeal cancers. Men play a key role in the paradigm of HPV infection: both as patients and as part of the mechanisms of transmission. Data show they are affected almost as often as women. Moreover, no screening procedures for HPV-related disease prevention are applied in men, who fail to undergo routine medical testing by any medical specialist at all. They also do not benefit from government prevention strategies. DISCUSSION: A panel of experts convened to focus on scientific, medical, and economic studies, and on the achievements from health organizations' intervention programs on the matter. One of the goals was to discuss on the critical issues emerging from the ongoing global implementation of HPV vaccination. A second goal was to identify contributions which could overcome the barriers that impede or delay effective vaccination programs whose purpose is to eradicate the HPV infection both in women and men. SUMMARY: The reviewed studies on the natural history of HPV infection and related diseases in women and men, the increasing experience of HPV vaccination in women, the analysis of clinical effectiveness vs economic efficacy of HPV vaccination, are even more supportive of the economic sustainability of vaccination programs both in women and men. Those achievements address increasing and needed attention to the issue of social equity in healthcare for both genders.

[Economic class syndrome: epidemiological features and preventive measures]. / La sindrome da classe economica: aspetti epidemiologici e misure di prevenzione.

The term "economic class syndrome" is generally used to describe the occurrence of venous thromboembolism (VTE) in travelers after long-distance airline travel in economic class. However, cases of VTE have also been reported in business class travelers and in subjects exposed to prolonged periods of immobilization while using other forms of transportation such as automobile, train, and bus. VTE manifests with deep vein thrombosis and pulmonary embolism but may also present with less severe, reversible manifestations such as headache, vertigo, and respiratory symptoms. Epidemiological studies have shown that the risk of VTE doubles following airline travel lasting longer than four hours. The risk of VTE increases with increased duration of air travel even in the presence of multiple stop-overs. In subjects with known risk factors, incidence of VTE depends on the degree of risk (low, medium, high) and on the duration of the flight. The main factor leading to VTE is prolonged immobilization and the pathogenesis is based on Virchow's triad: venous stasis, vessel wall injury, and hypercoagulability of blood. Specific characteristics of airline travel such as jet lag, low air quality and dehydration may increase the risk of VTE with respect to other forms of travel. This article discusses epidemiological aspects and pathogenesis of travel-related VTE and prophylactic measures that should be undertaken.

Knowledge of vaccination of allergic children among Italian primary care pediatricians, hospital pediatricians and pediatric residents.

A cross-sectional survey of Italian pediatricians and pediatric residents was carried out between 15 September and 18 October 2008 in order to evaluate their knowledge concerning the administration of vaccines to children with suspected or proved allergies. Of the 750 physicians who accepted to participate (620 pediatricians and 130 residents), 630 (84.0%; 407 females; mean age 43.5 ± 11.2 years) returned completed questionnaires: 268 primary care pediatricians (42.5%), 244 hospital pediatricians (38.8%), and 118 pediatric residents (18.7%). Knowledge concerning the vaccination of children with suspected or proved allergies was far from optimal, with the poorest knowledge being shown by the pediatric residents and no difference between the primary care and hospital pediatricians. Since pediatricians are the main parents' advisors regarding vaccinations, these results indicate an urgent need for educational programmes (especially for residents) and evidence-based guidelines concerning vaccinations in children with suspected or proved allergies.

Can hexavalent vaccines be simultaneously administered with pneumococcal or meningococcal conjugate vaccines?

BACKGROUND: Local immunization programs may include hexavalent and conjugate pneumococcal or meningococcal vaccines administered in the same vaccination visit. Information based on evidence is necessary for correctly planning schedules and for parents who often fear the administration of too many vaccines. We reviewed the available literature to assess the effects on immunogenicity and safety of simultaneous administration of hexavalent and conjugate pneumococcal and meningococcal C vaccines in healthy children. METHODS: We searched for papers including a comparison of coadministration and single administration of hexavalent with conjugate pneumococcal or meningococcal C vaccines. Data sources included Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Immunogenicity and safety results were extracted and compared. We calculated the absolute risk increase of being a non responder to any antigen and of experiencing common adverse events. RESULTS: Four relevant articles were included in the review. Immunogenicity of components included in the hexavalent vaccines was maintained with coadministration of conjugate pneumococcal and meningococcal C vaccines. However individuals who received hexavalent vaccine with conjugate pneumococcal vaccines were 18% more likely to have anti-PRP < 1 microg/mL after the third dose although this difference disappeared after the fourth dose, and titres against meningococcal C antigens were higher when vaccines were administered separately. Children who received simultaneous administration of hexavalent vaccines with conjugate pneumococcal vaccines had a 13-17% additional risk of experiencing fever compared with single administration. CONCLUSION: Few studies deal with coadministration of vaccines. Hexavalent and conjugate pneumococcal or meningococcal vaccines may however be administered simultaneously without noteworthy negative effects on immunogenicity or safety profile. Parents of vaccinees should be appropriately informed on the effects of coadministration to improve their compliance. Studies on vaccine coadministration should be promoted and unpublished studies realized for vaccine registration should be made available.