The Hospital Burden of Flu in Italy: a retrospective study on administrative data from season 2014-2015 to 2018-2019.

BACKGROUND: Every year in Italy, influenza affects about 4 million people. Almost 5% of them are hospitalised. During peak illness, enormous pressure is placed on healthcare and economic systems. This study aims to quantify the clinical and economic burden of severe influenza during 5 epidemic seasons (2014-2019) from administrative claims data. METHODS: Patients hospitalized with a diagnosis of influenza between October 2014, and April 2019, were analyzed. Clinical characteristics and administrative information were retrieved from health-related Administrative Databases (ADs) of 4 Italian Local Health Units (LHUs). The date of first admission was set as the Index Date (ID). A follow-up period of six months after ID was considered to account for complications and re-hospitalizations, while a lookback period (2 years before ID) was set to assess the prevalence of underlying comorbidities. RESULTS: Out of 2,333 patients with severe influenza, 44.1% were adults ≥ 65, and 25.6% young individuals aged 0-17. 46.8% had comorbidities (i.e., were at risk), mainly cardiovascular and metabolic diseases (45.3%), and chronic conditions (24.7%). The highest hospitalization rates were among the elderly (≥ 75) and the young individuals (0-17), and were 37.6 and 19.5/100,000 inhabitants/year, respectively. The average hospital stay was 8 days (IQR: 14 - 4). It was higher for older individuals (≥ 65 years, 11 days, [17 - 6]) and for those with comorbidities (9 days, [16 - 6]), p-value < 0.001. Similarly, mortality was higher in elderly and those at risk (p-value < 0.001). Respiratory complications occurred in 12.7% of patients, and cardiovascular disorders in 5.9%. Total influenza-related costs were €9.7 million with hospitalization accounting for 95% of them. 47.3% of hospitalization costs were associated with individuals ≥ 65 and 52.9% with patients at risk. The average hospitalisation cost per patient was € 4,007. CONCLUSIONS: This retrospective study showed that during the 2014-2019 influenza seasons in Italy, individuals of extreme ages and those with pre-existing medical conditions, were more likely to be hospitalized with severe influenza. Together with complications and ageing, they worsen patient's outcome and may lead to a prolonged hospitalization, thus increasing healthcare utilization and costs. Our data generate real-world evidence on the burden of influenza, useful to inform public health decision-making.

Adverse skin reactions to personal protective equipment during COVID-19 pandemic in Italian health care workers.

To avoid exposure to SARS-COV-2, healthcare professionals must use personal protective equipment (PPE). Their use has been related to a series of adverse effects; the most frequent adverse events were headache, dyspnoea, and pressure injuries. Skin adverse effects are very common, including contact dermatitis, itching, erythema, and acneiform eruptions. The objective of this study is to evaluate the skin problems caused by personal protection equipment (PPE) in health care workers (HCWs) and to individuate eventual risk factors. From May to June 2020 a retrospective observational multi-centric study conducted by an online survey sent by email, involving 10 hospital centers, was performed. We considered as independent variables gender and age, occupational group and sector, time of utilization, type and material of PPE. We tested 3 types of PPE: gloves, bonnet, and mask for different time of utilization (<1, 1-3, 3-6, >6 h). We performed a multiple logistic regression model to correlate them with skin adverse events occurrence. Among all the 1184 participants, 292 workers reported a dermatological pathology: 45 (15.41%) had psoriasis, 54 (18.49%) eczema, 38 (13.01%) acne, 48 (16.44%) seborrheic dermatitis, and 107 (36.64%) other. In our sample previous inflammatory dermatological conditions, female sex, prolonged use of PPE were significant risk factors for developing skin related adverse events considering all the PPE considered. The use of PPE is still mandatory in the hospital setting and skin adverse reactions still represent a global problem. Although data from Europe are limited, our study highlighted the importance of the problem of PPE skin reactions in a large sample of Italian healthcare professionals.

Sex and gender differences in migraines: a narrative review.

INTRODUCTION: Gender medicine is a new medical approach aimed at the study of the differences between women and men in terms of prevention, diagnosis, and the outcome of all diseases. Migraines are among these. They represent the most common neurological illness; they are most prevalent in adults between 20 and 50 years of age and are three to four times more frequent in woman than in men. Affecting people in working age, migraines are a problem that strongly impacts the psychophysical health and productivity of workers, regardless of the specific job task they have. METHODS: A narrative review was performed, searching for the most relevant articles describing gender differences in people suffering from migraines, and particularly in workers. RESULTS: Migraine global prevalence is 20.7% in women and 9.7% in men whereas prevalence in Italy is 32.9% for women and only 13.0% for men. This difference is partly explained by hormonal differences, as well as by differences in brain structure, genetic polymorphisms and neuronal pathways. Sex differences may also play a role in the progression from episodic to chronic migraine. In workers, migraines are mostly associated with strenuous physical work in men, whilst migraines triggered by night shifts, lack of sleep, or irregular sleep patterns are more common in women. CONCLUSIONS: To this day, the reasons of sex/gender disparity for migraine are still obscure. However, migraines, chronic migraine in particular, have a negative impact on the lives of all individuals affected by this disease, but particularly in women in which family cares and working activity are often superimposed. Migraine prevention strategies should be planned in workers through the occupational health physician.

A new tool to evaluate burnout: the Italian version of the BAT for Italian healthcare workers.

BACKGROUND: Healthcare workers (HCWs) represents one of the highest-risk population to develop burnout symptoms. Recently, a new tool has been designed to measure several dimensions that capture an exhaustive expression of burnout symptoms by six dimensions (i.e., exhaustion; mental distance; cognitive impairment; emotional impairment; psychological distress; psychosomatic complaints). METHODS: The current study aims to adapt the Burnout Assessment Tool (BAT) to an Italian Healthcare workers' sample confirming the original second-order factorial structure. Furthermore, we expected to find good indexes of reliability and validity tests. Participants were 697 Italian Health Care Workers (Female = 68.44%; mean age = 36.47; SD = 11.20). Data were collected by self-report questionnaires submitted by the snowball method. RESULTS: Findings show a good fit of the BAT's structure, confirming the hypothesized second-order factorial model. Furthermore, good reliability has been established with the study's measures. CONCLUSIONS: The BAT for HCWs is eligible as a new tool to evaluate burnout in the at-risk HCWs as a multi-facet constellation of symptoms.

Mental health and discrimination among migrants from Africa: An Italian cross-sectional study.

This study aimed to assess depression, anxiety, posttraumatic stress disorder (PTSD) and discrimination in African migrants and investigate determinants. A cross-sectional study was conducted in Italy (July 2019-February 2020). Inclusion criteria: being a citizen of an African country or having parents who are citizens of an African country. Questionnaires included tests for depression, anxiety, PTSD, discrimination. Multivariable regressions were performed. Participants were 293. The prevalence of depression, anxiety, and PTSD was: 12.1%, 12.1%, and 24.4%. Only 7.2% declared not to be discriminated. Among significantly associated factors, waiting for/being in possession of temporary permits and discrimination were associated with all mental outcomes. Being (or having parents from) Sub-Saharan Africa increased the likelihood of discrimination. A relevant prevalence of mental illnesses was reported. Particularly, Sub-Saharan Africans potentially offer a unique point of view. Migrants' mental health should be a priority for national and international programs of health monitoring.

Nitrous oxide occupational exposure in conscious sedation procedures in endoscopic ambulatories: a pilot retrospective observational study in an Italian hospital.

SUMMARY: Introduction. Nitrous oxide (N2O) is widely used to induce sedation also outside of operating rooms; there is a chance of workplace exposures for the operators engaged in the outpatient use of nitrous oxide. The aim of this research is to assess nitrous oxide exposure in gastroenterology outpatient settings. Methods. We performed an observational study marked by N2O environmental testing in a gastroenterology outpatient care; environmental research was supported by biological monitoring with urinary N2O analysis in exposed operators. The research was conducted both without and using a collective security device (NIKI mask). Results. The study was rolled out in 10 sessions of day shift procedures, totaling 4105 samples. The average N2O concentration in the environment was 27.58 (SD 1.76) and 449.59 (SD 35.29), respectively with and without NIKI Mask; the distribution of gases in the environment under investigation was not homogeneous (Anovatest P=0.001). Biological testing revealed a substantial rise in urinary concentration of 8.97 (p=0.001) between the start and the end of the shift, and the use of the NIKI-mask was effective (p=.003). Discussion. The exposure levels reported exceed the limits of 50 ppm (Italy operating rooms threshold value) as well as the value of 25 ppm (NIOSH threshold-value), indicating a significant issue in the outpatient use of N2O. Technical measures are needed to contain the occupational risk from N2O exposure outside of operating rooms; for the exposure results detected in this research, it is also evident that workers exposed to N2O must be subject to adequate health surveillance accounting for this occupational risk.

Empowering seizure management skills: Knowledge, attitudes, and experiences of school staff trained in administering rescue drugs in Northern Italy.

PURPOSE: The administration of rescue medication at school concerns students for which it may be essential, on doctor's prescription, to take therapy during school hours. In this case, since the parents are absent, the first rescuer is necessarily the school staff, who should be properly trained because prolonged seizures can cause severe harm and even death. METHODS: Every year, the Local Health Unit "TO3" in Northern Italy, provides training for school staff to administrate rescue medication at school. From December 2019 to February 2020, the same questionnaire was administered to school staff trained for seizures at the end of the course, while the staff trained for other diseases completed it before the course. RESULTS: About 60% of the sample (N = 123) had been trained in seizure management at least once in their lifetime. Median knowledge score in subjects with no seizures training was 7 (Q25/Q75: 5/8), while it was 9 (Q25/Q75: 6/10) in subjects with seizures training (p < 0.001). The self-reported level of confidence in their skills to administer rescue medication was high in 10.2% of subjects not trained for seizures and in 62.9% of those trained (p < 0.001). CONCLUSION: Results suggest that medical training for school staff increases knowledge scores and levels of self-confidence relating to the administration of rescue medication. Moreover, after the training, the school staff changed attitude toward seizures, no longer considering them a problem, and became more aware, less fearful, and more inclined to act in case of need, making school a better place for all students.

Prevalence of gastro-oesophageal reflux symptoms: An Italian cross-sectional survey focusing on knowledge and attitudes towards lifestyle and nutrition.

INTRODUCTION: The gastro-oesophageal reflux disease (GERD) is a public health issue for its prevalence and association with low life quality and substantial costs. Since most of Italian data refer to over a decade ago, the aim was to provide an updated estimate of GERD symptoms prevalence. Knowledge about appropriate nutrition and behaviours in presence of GERD was assessed. Predictors for symptoms presence and knowledge were explored. METHODS: This study was an online cross-sectional survey that investigated socio-demographics, knowledge about nutrition/behaviours in case of GERD (Knowledge Score KS: percentage of right answers), nutrition/lifestyle attitudes. The questionnaire included the GerdQ to assess symptoms (presence if score ≥8). Adults resident in Italy were enrolled between June and August 2019 through convenience sampling on the major social networks (sample size = 559). Descriptive analyses were run. Multivariable regressions were performed to explore predictors of symptoms presence and KS. RESULTS: The 27.7% had GERD symptoms. Among them, 33.8% never received GERD information by their general practitioner (GP). Body mass index (P = .036), secondary education (P = .040) were associated with higher symptoms risk. Weekly exercise was associated with lower risk (P < .001). Median KS was 92% (IQR = 12). Sleeping on the left side, chocolate, citrus fruit, mint reported the lowest right answers percentages. None/basic education was negatively associated with KS (P < .001), being female (P = .004) and in a relationship (P = .012) positively. CONCLUSIONS: A high prevalence was reported, consistently with the worldwide increasing trend. Despite overall knowledge was high, specific gaps were found. GPs should improve communication and awareness campaigns targeted to less known aspects must be planned.

Monitoring the impact of COVID-19 pandemic on mental health: a public health challenge? Reflection on Italian data.

A recent Italian report on medicines use during COVID-19 epidemic outlined a non-significant increase in outpatient pharmaceutical antidepressant consumption in March and a significant increase in anxiolytic consumption. Along with this, an analysis of psychiatric hospitalizations in Lombardy revealed a reduction in voluntary admissions in the 40 days after the beginning of COVID-19 epidemic in Italy. Nevertheless, several studies reported a greater prevalence of depressive and anxiety symptoms in the Italian general population during the lockdown compared to before the pandemic. Furthermore, the request for psychological support by the Italian population appeared to be high during lockdown. Indeed, the Italian Ministry of Health declared that more than 50,000 calls to the telephone number for psychological support activated by the Ministry of Health and the Civil Protection because of the pandemic, with peaks during the lockdown. In addition, looking at Google Trends, the greatest searching activity for "psychological support" in recent years was detected the week of the 26th April 2020, followed by the week of the 22nd March 2020. We think that stronger indicators of mental health status and psychological well-being should be found to understand the long-term effects of the pandemic. The necessity of research for population-level and universal strategies is urgent, through repurposing, developing, and testing interventions to create evidence-based action plans for the entire population. Lastly, it is also essential to keep offering a psychological support suitable for all as done in past months to help individuals who have fewer opportunities to access care.

Prevalence of musculoskeletal disorders among perioperative nurses: a systematic review and META-analysis.

BACKGROUND: To evaluate the prevalence of work-related musculoskeletal disorders (WRMSDs) in perioperative nurses and to explore their association with personal characteristics. METHODS: Medline, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library and Joanna Briggs Institute Database were systematically searched. A meta-analysis calculating event rates, and relative 95% Confidence Intervals (CI) was performed for each musculoskeletal body region. The contribution of perioperative nurses' sex, age, and BMI was assessed through a meta-regression. RESULTS: Twenty-two studies, considering 3590 perioperative nurses, were included in the systematic review. The highest prevalence of WRMSDs was found for the lower-back (62%; 95% CI 0.54-0.70), followed by knee (47%; 95% CI 0.36-0.59), shoulder (44%; 95% CI 0.37-0.51), waist (42%; 95% CI 0.31-0.53), neck (39%; 95% CI 0.29-0.51), ankle-feet (35%; 95% CI 0.22-0.51), upper-back (34%; 95% CI 0.25-0.44), hand-wrist (29%; 95% CI 0.20-0.40), and elbow (18%; 95% CI 0.12-0.26). Meta-regression showed that sex, age, and BMI were not significant predictors of low-back disorders (p = 0.69; R2 = 0). CONCLUSIONS: WRMSDs represent a high prevalence issue among perioperative nurses. Perioperative nurses, in general, are steadily exposed to both physical and temporal risk factors. Further studies should be addressed to identify specific interventions aimed at reducing the burden of WRMSDs including ergonomic education and physical rehabilitation. Our data could be used in future studies as a reference to assess the risk of WRMSDs in other health-care professionals' population.

Orthorexia Nervosa, a challenging evaluation: analysis of a sample of customers from organic food stores.

An excessive control of quality of food can turn into Orthorexia Nervosa (ON). The organic store customers (OSCs) can be apopulation at risk for ON. The aims of this study were to assess ON symptoms prevalence among them, comparing them with non-OSCs and investigate potential predictors of ON. Across-sectional survey was carried among 121 OSCs and 119 non-OSCs. The questionnaire assessed socio-demographic characteristics and investigated current dietary habits. The main outcome measures used were ORTO-15 and Eating Habits Questionnaire (EHQ). Chi-squared analyses were performed to assess differences between groups (OSCs and non-OSCs). Logistic and linear regressions were performed to evaluate potential predictors of ON symptoms and to compare questionnaires. As main results, OSCs had ahigher probability to result positive at ORTO-15 compared to non-OSCs. The prevalence among OSCs was 69.4% and 23.1% (using ORTO-15 with 40 and 35 cut-offs). Higher EHQ scores were reported among OSCs (p < 0.001). Potential predictors were mainly being an OSC or following food restrictions. Predictors varied using different cut-offsof ORTO-15 and EHQ. These results suggest the association between OSCs and ON symptoms. Some differences were found between ORTO-15 and EHQ. Further studies need to be performed to improve diagnostic tools.

Exploring University Students' Attitudes towards Primary Care: Evidence from a Cross-Sectional Study.

The general practitioner (GP) has a significant role in primary care, being more than a gatekeeper to health services access. In Italy, if a citizen moves for studies for at least 3 months, he/she can choose temporarily another GP in the new city (the so-called "Healthcare Domicile" (HD)). The aims were to estimate the university students' knowledge about the HD, evaluate the frequency of the transition to another GP, and assess the university students' attitudes towards the primary care services. In 2018, a cross-sectional pilot study was performed in study rooms among students attending the University of Turin Participation was voluntary, anonymous, and without compensation. A 25-item questionnaire collected information about the sociodemographic characteristics, health services use, health conditions and medications, HD knowledge, and HD use. The outcomes were having the GP far away, knowing HD, and not moving the GP even if aware of HD. Chi-square test, Mann-Whitney U-test, and logistic regression analyses were performed. The significance level was p ≤ 0.05. Participants were 388 and those who knew HD were 45.36%. Among those who moved to Turin (44.85%), 77.67% knew HD but did not move the GP anyway. The 72.68% used medications without prescription (the most taken: nonsteroidal anti-inflammatory drugs and antibiotics). Age, nationality, and degree course type could be predictors for outcomes considered. HD knowledge was associated with a different use of healthcare resources. The data of the present paper suggest that further studies are required to better understand the framework connected with the university students' access to primary healthcare. Our results highlighted the need to implement campaigns targeted to university students to spread information about the HD and a more appropriate use of the healthcare services and medications.

The impact of intergenerational programs on children and older adults: a review.

ABSTRACTBackground:Elderly are at particular risk of social isolation. This condition significantly affects health; on the contrary, social involvement can be extremely advantageous. In this context, intergenerational programs improve interactions between different ages. Then, we conducted a review regarding intergenerational programs, to summarize the effects of these activities on both elderly and children. METHODS: Our review followed the PRISMA statements. We considered papers reporting data about intergenerational programs involving children (preschool and elementary) and elderly. RESULTS: The final selection obtained 27 sources. Ten studies evaluated children's outcomes outlining the positive impact of intergenerational programs upon children's perception of elderly. The effects on older participants were variegated considering well-being, depression, self-reported health, and self-esteem. Moreover, the retrieved studies outlined the importance of a careful organization and of a specific training for all staff members. The staff involved in similar programs appeared, overall, highly satisfied. DISCUSSION: The positive impact on children of intergenerational programs is proved at both short- and long-term. Moreover, despite the different outcomes considered and the variable results, these programs resulted overall beneficial on elderly participants. Finally, similar activities resulted feasible even in case of older adults with dementia.

HIV screening in pregnant women: A systematic review of cost-effectiveness studies.

INTRODUCTION: Vertical transmission represents the major route of HIV infection for children. However, the preventive interventions available are extremely effective. This review summarizes evidence regarding the cost-effectiveness of mother-to-child-transmission preventive screenings, to help policy makers in choosing the optimal antenatal screening strategy. METHODS: A systematic review following PRISMA guidelines was conducted, using 3 databases: PubMed, Scopus, and Cost-Effectiveness Analysis Registry. All articles regarding HIV screening to avoid vertical transmission were included. RESULTS: The review included 21 papers. Seven studies assessed the cost-effectiveness of universal antenatal screening during early gestation. Two papers considered the integration of HIV screening with other medical interventions. Eight works estimated the cost-effectiveness of HIV screening in late pregnancy. Finally, 4 papers considered the combination of multiple strategies. The selected papers focused on both developed and developing countries, with a different HIV prevalence. The characteristics and methodology of the studies were heterogeneous. However, all studies agreed about the main findings, outlining the cost-effectiveness of both universal antenatal screening and HIV rescreening in late pregnancy. Cost-effectiveness improved when HIV burden increased. The major findings were proved to be robust across various scenarios when tested in sensitivity analysis. CONCLUSIONS: The review confirmed the cost-effectiveness not only of HIV universal antenatal screening but also of rescreening in late gestation in both developed and developing countries. Universal screening is cost-effective even in case of extremely low HIV prevalence. Therefore, to maximize screening, coverage appears as a worldwide priority. In certain settings, a targeted screening towards high-risk groups could be a valuable option.

[Technology and prevention in the era of mobile health: applications for cancer screening programs]. / Tecnologia e prevenzione nell'era della Mobile Health: quali applicazioni per gli screening oncologici?

The Italian national health system provides screening to detect breast, colorecatal and cervical cancers, however, population adherence is not as high as expected. Smartphones and their applications (apps) could be used as a tool to communicate with the population and to help improve adherence. The aim of this study was to analyze the features and functions of smartphone applications aimed at secondary prevention of oncological diseases. In February 2016, we reviewed online app stores, using specific key-words, to search for available apps for cancer screening. We identified 32 apps meeting our inclusion criteria. The most frequent types of app are breast cancer (13/32) and cervical cancer (4/32) screening apps. We also found apps addressing secondary prevention of cancers for which screening is not provided to the Italian population (melanoma, prostate cancer and hepatocellular carcinoma). The most common features are: information providers (22/32), risk calculators (10/32), reminders for appointments and tests (7/32). Only one app has been validated for diagnostic accuracy or utility using established international certification (CE Marking). The results show a large potential for development and utilization of applications in secondary prevention. Despite their potential usefulness, there are also disadvantages such as language barriers (only 2 of 32 apps are in Italian), and the digital divide. Future efforts should focus on improving education regarding approaches to technologies, strengthen national and international regulations and monitoring inequalities in access to services.

[An effective clinical leadrship to strenghten the immunization policies in Italy]. / Una leadership medica efficace a tutela della prevenzione vaccinale in Italia.

Effective governance for health is a prerequisite for implementing a transformation in healthcare. Any change, in order to be fully implemented, requires a strong and transparent leadership. The recent drop in vaccine cover has led our National Health Service to implement a number of changes in health prevention and immunization strategies that make vaccination an optimal paradigm of how healthcare leadership should not remain the focus of few scientists and public health specialists, but it should be more and more widespread at all levels. In fact, as in other areas of health, the implementation of a national evidence-based planning through efficient organization and management is not sufficient to ensure good results, but it is necessary that the whole system - institutions, policy makers, healthcare professionals, media and citizens themselves - is actively involved in driving change, promoting ethical, economic and social value of vaccinations.

Lack of association between polymorphisms in the CYP1A2 gene and risk of cancer: evidence from meta-analyses.

BACKGROUND: Polymorphisms in the CYP1A2 genes have the potential to affect the individual capacity to convert pre-carcinogens into carcinogens. With these comprehensive meta-analyses, we aimed to provide a quantitative assessment of the association between the published genetic association studies on CYP1A2 single nucleotide polymorphisms (SNPs) and the risk of cancer. METHODS: We searched MEDLINE, ISI Web of Science and SCOPUS bibliographic online databases and databases of genome-wide association studies (GWAS). After data extraction, we calculated Odds Ratios (ORs) and 95% confidence intervals (CIs) for the association between the retrieved CYP1A2 SNPs and cancer. Random effect model was used to calculate the pooled ORs. Begg and Egger tests, one-way sensitivity analysis were performed, when appropriate. We conducted stratified analyses by study design, sample size, ethnicity and tumour site. RESULTS: Seventy case-control studies and one GWA study detailing on six different SNPs were included. Among the 71 included studies, 42 were population-based case-control studies, 28 hospital-based case-control studies and one genome-wide association study, including total of 47,413 cancer cases and 58,546 controls. The meta-analysis of 62 studies on rs762551, reported an OR of 1.03 (95% CI, 0.96-1.12) for overall cancer (P for heterogeneity < 0.01; I(2) = 50.4%). When stratifying for tumour site, an OR of 0.84 (95% CI, 0.70-1.01; P for heterogeneity = 0.23, I(2) = 28.5%) was reported for bladder cancer for those homozygous mutant of rs762551. An OR of 0.79 (95% CI, 0.65-0.95; P for heterogeneity = 0.09, I(2) = 58.1%) was obtained for the bladder cancer from the hospital-based studies and on Caucasians. CONCLUSIONS: This large meta-analysis suggests no significant effect of the investigated CYP1A2 SNPs on cancer overall risk under various genetic models. However, when stratifying according to the tumour site, our results showed a borderline not significant OR of 0.84 (95% CI, 0.70-1.01) for bladder cancer for those homozygous mutant of rs762551. Due to the limitations of our meta-analyses, the results should be interpreted with attention and need to be further confirmed by high-quality studies, for all the potential CYP1A2 SNPs.

Analysis of users and reasons for use of a physician-on-call service in an Italian local health unit.

BACKGROUND: In recent years, several countries have proposed changes to primary care organisation. OBJECTIVE: Our study investigated the characteristics of 'physician-on-call' usage in a local health unit of Lombardy (ASL MI1). METHODS: We analysed the incoming calls to the Operative Medical Central Station and collected the user characteristics, the call reasons and the outcomes from 1 October to 31 December 2012. Then, we randomly extracted 10% of the call sample from this period. We focused on two outputs: telephone advice (TA) and emergency department referral. We fit a logistic regression model to identify potential predictors of these outputs. RESULTS: In total, we evaluated 2146 calls. Women made most of the calls. Older age was associated with the referral to emergency care [adjusted odds ratio (aOR) 3.1], while paediatric calls were associated with TA (aOR 1.9). Information requests were related to TA (aOR 2.3), while cardiovascular symptoms (aOR 3.5), pain (aOR 2.6) and traumas (aOR 4.7) were linked to emergency care. CONCLUSIONS: Our study outlined the increasing use of TA, particularly for calls regarding paediatric patients. In contrast, calls for elderly patients were more frequently referred to emergency care. These findings led to the implementation of an age-targeted educational programme. Overall, our observations highlighted that women used the physician-on-call service more frequently than men. Furthermore, some reasons for calling were significantly associated with emergency care.

Development of Guidelines for Health Impact Assessment in Southern Italy.

Health impact assessment (HIA) is a multidisciplinary method aimed at assessing the health effects of policies, plans, and projects using quantitative, qualitative, and participatory techniques. In many European countries, such as in Italy, there is a lack of implementation of HIA procedures and it would be necessary to develop instruments and protocols in order to improve the specific skills of professionals involved in the assessment process. This article aims to describe the development and implementation of HIA guidelines, promoted by the Italian National Agency for Regional Health Services (AGENAS), in 4 Southern Italian regions. Public health search engine and institutional Web sites were consulted to collect international data existing in this field. Monthly workshops were then organized with regional representatives to discuss the scientific literature and to identify the guidelines' contents: source of data, stakeholders, screening- and scoping-phase checklist tools, priority areas, monitoring, and reporting plans. Four regions (Calabria, Campania, Puglia, and Sicilia) took part in the project. This article describes the methodology of development and implementation of HIA guidelines in the Italian context. The tools created to collect data and assess health consequences (such as screening and scoping grids) are reported. This project represents the first structured initiative proposed and supported by the Ministry of Health aiming to introduce HIA in Italy. HIA should be considered a priority in the public health agenda, as a fundamental instrument in helping decision makers to make choices about alternatives to prevent disease/injury and to actively promote health.

Job satisfaction among radiology assistants: a multicentre cross-sectional study in Italy.

OBJECTIVES: Job satisfaction among physicians is an important occupational health issue since it is related to different factors such as work motivation or career decisions. The aim of this study was to investigate  job satisfaction among radiology assistants for the first time in Italy. METHODS: In 2012, a cross-sectional survey was conducted among a convenience sample of radiology assistants drawn from all Italian regions who submitted an electronic or paper-based self-administered questionnaire. The data collected were analysed using logistic regressions in order to assess the role of socio-demographic variables. RESULTS: Overall, 574 radiology assistants were interviewed. More than half of the subjects were males and  were younger than 40 years old. Around 76% of the sample was not satisfied  as regards salary. Moreover, the majority of the participants (66.1%) was not satisfied  with the professional refresher courses. Compared with males, females were more satisfied in terms of professional enrichment (OR=1.79, 95% CI: 1.23-2.62) but less satisfied with their relationships with superiors (OR=0.57, 95% CI: 0.38-0.85). CONCLUSIONS: Since radiology assistants and, in general, healthcare workers assist medical doctors, thus playing a  significant role  in safeguarding patients' health , it would be  desirable to give  due importance to the issue of job satisfaction,  from all points of view.