The PRECEDE-PROCEED model as a tool in Public Health screening: a systematic review.

OBJETCTIVE: The aim of this systematic review was to summarize the scientific literature concerning the use of the Precede-Proceed model (PPM) applied to educational programs and health screenings contextsV. STUDY DESIGN: Systematic review. METHODS: The search process was based on a selection of publications listed in Medline and Scopus. The keywords used were "Precede-Proceed" AND ("screening" OR "educational programs"). Studies included in the systematic review were subdivided into those applying the model in a screening context, and those applying it within educational programs. RESULTS: Twenty-seven studies were retrieved, mostly performed in the USA and, generally, the promoting center was the University. In the context of cancer screening, the PPM model was most of all applied to Mammography Screening (5 of 13 studies in cancer screening), and Cervical Cancer Screening (5 of 13). Another three studies within the cancer field investigated Menopause-Inducing Cancer Treatments, Oral cancer prevention, and cancer screening in general. In the remaining studies, the model was applied in various screening areas, particularly chronic and degenerative diseases. There were many different study designs, most of which cross-sectional (8), though several RTCs (8) and focus groups (5) were also found. For the cross-sectional studies the methodological quality varied between 3/10 and 9/10, whilst for the RCTs it ranged from 2/5 to 3/5. CONCLUSIONS: The PPM provides an excellent framework for health intervention programs especially in screening contexts, and could improve the understanding of the relationship between variables such as knowledge and screening. Given the complexity of a behavioral change process, certain important predisposing factors could be measured in future studies, and during health intervention planning.

The combined effect of surgeon and hospital volume on health outcomes: a systematic review.

OBJECTIVES: To explore the interaction between surgeon volumes (SVs) and hospital volumes (HVs) on health outcomes. MATERIALS AND METHODS: We searched MEDLINE, Embase, CINAHL, Web of Science as of May 2017. We included studies investigating the interaction between high or low SVs operating in high or low HVs. Review process follows the PRISMA guidelines. We assessed the methodological quality of the included studies using validated critical appraisal checklists. RESULTS: Sixteen studies were included. Due to the heterogeneity of studies, it was not possible to perform a quantitative analysis. Heath outcome are worse when high SV operating in low HV vs high HV, for the majority of the conditions (colorectal cancer, cystectomy, liver resection, mitral valve surgery, pancreatico-duodenectomy). Results for low SV are better when operating in high HV vs low HV for patients undergoing pancreatic-duodenectomy for mortality, 30 days complications and length of stay. Results for low SV are worse vs high SV when operating in high HV for most considered conditions. Results were in favour of higher SV vs low SV when operating in low HV for digital replantation success after injuries, 30 days mortality and complications after pancreatic-duodenectomy. CONCLUSIONS: The available evidence is limited. It is necessary to increase the monitoring of the association between surgeons volumes and hospitals volumes in which they operate, to ensure fairness and accuracy of care for better health outcomes.

Counseling intervention to improve quality of life in patients with pre-existing acute myocardial infarction (AMI) or chronic obstructive pulmonary disease (COPD): a pilot study.

BACKGROUND: In the light of diagnostic and therapeutic advances, patients with a previous myocardial infarction or with a diagnosis of chronic obstructive pulmonary disease are vulnerable and need continuous monitoring over time. These pathological frameworks have a strong impact on the economy and on the status of the population and require effective and low-cost solutions. AIMS: The objective of this clinical trial is to evaluate the efficacy in the short term of a telephone counseling intervention to modify the lifestyles of these two patient populations. METHODS: In May 2015, all the patients included in the study underwent a questionnaire to evaluate their eating and smoking habits and their quality of life. After randomization in two groups, the intervention group received telephone counseling related to the correct lifestyles. The control group did not undergo any intervention. In September-October 2015, the same initial questionnaire was administered to evaluate changes in patients' behavior. RESULTS: 64 patients were included in the study: 34 were assigned to the intervention group and 30 to the control group. The outcomes evaluated were: quality of life, assessment of eating habits and smoking status. After the telephone counseling, the intervention group (34 persons) showed a significant improvement in the score of adherence to the Mediterranean diet (p = 0.01) and a significant reduction in the percentage of smokers (p = 0.01) compared to the population that did not receive any intervention (30 persons). On the other hand, the changes related to the quality of life questionnaire were not significant. CONCLUSIONS: A single telephone counseling intervention is effective in modifying the lifestyles of patients with a previous myocardial infarction or diagnosed with chronic obstructive pulmonary disease in the short term, reducing their risk profile.

"GiochiAMO": a school-based smoking and alcohol prevention program for children - a pilot randomized field trial. Part 2.

BACKGROUND: Young people who begin to smoke at an early age are at a higher risk of becoming occasional or regular smokers and establishing a premature dependence. It is fundamental to act as soon as possible, from very early childhood, to prevent harmful behaviors for health such as smoking and drinking alcohol. Young people must be encouraged to adopt healthy lifestyles. OBJECTIVES: The aim of the study is two-fold. First, increasing the knowledge about the negative health effects of cigarette smoking and alcohol consumption among children aged 9-10 years; and second, to introduce and reinforce life skills in order to learn how to tackle social influences that encourage children to smoke and to drink alcohol. METHODS: A pilot randomized field trial was conducted in May-June 2017. Four primary school classes in Rome were randomized to either the intervention or the control group. Both groups participated in an oral presentation about the risks and consequences of smoking and alcohol consumption, and the concept of life skills. The intervention group participated in two gaming sessions, each lasting 1.5 hours. Children were involved in six games aiming to deliver and reinforce knowledge about the target themes of the study. A 21 multi-response questions questionnaire was handed out to both groups at the beginning and at the end of the study. Eleven questions were about smoking; five questions about alcohol; five questions about life skills. Each question item included one correct answer. For each domain, a score was computed (total; smoking; alcohol; life skills). RESULTS: 67 children participated in the study (34 in the intervention and 33 in the control group). Univariate analyses showed significant differences among the intervention group before and after the intervention for total score (p<0.001), smoke score (p<0.001), and life skills score (p=0.003). No significant differences among the intervention group before and after the intervention were reported for alcohol score (p=0.076). Regarding the control group univariate analysis showed significant differences in total score (p=0,001) and life skills score (p=0.005). Multivariate analysis revealed that enrollment in the intervention was the only variable that had a significant positive influence on smoking knowledge score (beta=1.070, p=0.05). CONCLUSION: This pilot study shows that the intervention was effective among the intervention group for all the scores: total score, smoke score and life skills score, but ineffective for alcohol. Overall, the combination of a presentation and games was effective in increasing life skills knowledge.

Can the Local Health Unit staff serve as role model for positive health behaviours? Results from an observational study in Italy.

BACKGROUND: Lifestyles as well as health behaviors and attitudes are a matter of personal health and a public health concern for healthcare providers. The aims of the study were to examine lifestyles and health behaviors - i.e., smoking habit, diet, predisposition to undergo for cancer screening tests among the staff of a Local Health Unit in Rome and the prevalence of some of the major preventable chronic degenerative pathologies associated to lifestyles. METHODS: The survey was carried out through the administration of a questionnaire. Descriptive and univariate analyses were performed and binary logistic regression models were used to identify possible associations with an unhealthy lifestyles. Hosmer-Lemeshow test was performed. The level of significance was set at p ≤ 0.05. RESULTS: 355 employees entered the study (87,8%); 43.4% resulted in overweight/obesity and 36.6% is a current smoker. Those with a high degree of studies had an higher odds to be smokers (for low education OR=0.76; 95% CI:0,61-0.94) and healthcare workers were less likely to follow an unhealthy diet than administrative staff (OR=0.52; 95% CI: 0.29-0.91). CONCLUSION: Despite the Local Health Unit employees have, in the specific context of their workplace, an important role in promoting healthy lifestyles, in our survey they show unhealthy habits and lifestyles.

Improving knowledge and behaviors on diet and physical activity in children: results of a pilot randomized field trial.

BACKGROUND: The aim of this study was to increase the knowledge of healthy eating, to encourage change in nutritional behavior in accordance with the Mediterranean diet and to promote physical activity in children aged 7 to 9 years and their parents in a school setting through the use of cards and board games of the project Giochiamo (Let us play). METHODS: This experimental randomized field trial enrolled children in a school setting. The trial consisted of two phases. The first phase, including both intervention and control groups, encompassed a informative session about the food pyramid and physical activity (PA) by experts of public health and preventive medicine. The second phase, including only the experimental groups, involved games focusing on the main concepts of the food pyramid and PA. A questionnaire was administered before the intervention and after one month in order to assess changing in knowledge and behavior scores. RESULTS: Eighty-nine children were randomly allocated in the intervention (22 children of the fourth year, 22 children of the second year) and the control group (23 children of the fourth year, 22 children of the second year). The univariate analyses showed significant differences (p = 0,004) between intervention and control groups for behavior score after the intervention. In particular, in a stratified analysis classes of the second year showed significant differences for knowledge score (p = 0,005) and for behavior score (p = 0,002), resulting higher among the intervention group. No significant differences resulted in classes of the fourth year for both scores. CONCLUSIONS: The results of the Giochiamo project clearly demonstrate that the lecture and the games were effective to improve knowledge and behavior habits on the Mediterranean diet and PA. Second year students showed significant differences for knowledge and behavior score in comparison to fourth year students suggesting that, the earlier the intervention occurs, the better are the results in terms of improvement of knowledge and eating habits and PA behaviors.

[GiochiAMO! The protocol of a school based intervention for the promotion of physical activity and nutrition among children].

BACKGROUND: It is necessary to increase knowledge of healthy eating in children aged 5 to 9 years and their parents and to promote physical activity in order to tackle obesity and overweight in children. METHODS: This paper describes the research protocol of a field intervention that aims to: a) increase knowledge of food pyramid; b) change nutritional behavior according to the Mediterranean diet, particularly increasing fruit and vegetable consumption; c) promote physical activity. Children of primary schools will be included and will be randomly allocated to the intervention or the control groups. The intervention will include the use of games (cards and board games) and also physical activities. CONCLUSIONS: GiochiAMO represents an innovation in the Italian school panorama, in a context in which it is a priority to create environment and school policies aimed at promoting the Mediterranean diet pattern and physical activity.

Cardiovascular Diseases Risk Factors in oil and gas workers: a ten years observational retrospective cohort.

OBJECTIVES: The study aim was to examine the trend of major clinical biochemistry factors associated with cardiovascular diseases and dyslipidemia onset over a 10-year period (2000-2010) in Oil and Gas workers. METHODS: The information extracted from "Computerized management of individual medical services database" regarding 439 Italian workers of an oil and gas company were analysed. RESULTS: A constant and significant increase of the average Body Mass Index and serum cholesterol were found, and in particular in workers < 36 years: BMI was 24.4 (2000) and 25.8 (2010) with p < 0.001, and cholesterol was 188.3 mg/dL (2000) and 206.5 mg/dL (2010) with p < 0.001. CONCLUSION: Analysed variables are the most important risk factor for cardiovascular, neurological and neoplastic diseases, as well as they reduce life expectancy. Occupational medicine in particular in extreme working environmental conditions, such as for workers in oil and gas companies, monitoring health status and promoting healthy life style, has a strategic role to perform cost-effective strategies to reduce health risks, thus improving the workers lifestyle.

Human papillomavirus and cancerous diseases of the head and neck: a systematic review and meta-analysis.

The increasing incidence of head and neck cancer (HNSCC) highlights the need to better understand the role of human papillomavirus (HPV) in the development of these cancers. The aims of this study were to conduct a systematic review and a meta-analysis concerning observational studies on the association between HPV infection and HNSCC and to quantify this association, thereby obtaining a reliable estimation of the risk of HPV infection in the development of head and neck cancer. Literature searches were performed using PubMed and Scopus databases. StatsDirect 2.7.8 program was used for the analysis. We found 15 case-control studies, 63 prevalence studies, and no cohort studies. The pooled odds ratio (OR) for all the included case-control studies resulted in a value of 1.63 (95% CI 1.27-2.09; P < 0.0001). The highest pooled OR resulted from the analysis of all the studies that examined HPV 16 genotype in association oral cavity (OR 5.36; 95% CI 1.4-20). The strong evidence of association between HPV infection and HNSCC highlights the importance of the introduction of specific tests in the cancer prevention practices to evaluate the presence of the virus, especially in the oral cavity, and the possibility of an extension of the vaccine anti-HPV in the male population too.

[Randomized controlled trial on the promotion of healthy lifestyles among adolescents in the orthodontic setting: study protocol]. / Trial clinico randomizzato sulla promozione di corretti stili di vita tra gli adolescenti in ambito ortodontico: protocollo dello studio.

Many studies have shown that the bad lifestyles are the major factors thought to influence susceptibility to many diseases in our society and often these habits during the adolescence begin. The aim of the study was to evaluate the health promotion intervention effect in an orthodontic adolescent sample, in particular: deterring adolescents from smoking; discourage the use and abuse of alcoholic beverages; encourage the adherence to the Mediterranean style diet. A blinded randomized controlled trial will be performed. The participants will be adolescents aged 10 to 14 years that will receive a medical examination in the Complex Unit of Orthodontics. The sample will be followed for three years. The collected evidence would be a scientific support for decisions in public health, in order to increase the health of the young generations.

[Social marketing and public health]. / Marketing sociale e danità pubblica.

Social marketing uses the principles and techniques of commercial marketing by applying them to the complex social context in order to promote changes (cognitive; of action; behavioral; of values) among the target population in the public interest. The advent of Internet has radically modified the communication process, and this transformation also involved medical-scientific communication. Medical journals, health organizations, scientific societies and patient groups are increasing the use of the web and of many social networks (Twitter, Facebook, Google, YouTube) as channels to release scientific information to doctors and patients quickly. In recent years, even Healthcare in Italy reported a considerable application of the methods and techniques of social marketing, above all for health prevention and promotion. Recently the association for health promotion "Social marketing and health communication" has been established to promote an active dialogue between professionals of social marketing and public health communication, as well as among professionals in the field of communication of the companies involved in the "health sector". In the field of prevention and health promotion it is necessary to underline the theme of the growing distrust in vaccination practices. Despite the irrefutable evidence of the efficacy and safety of vaccines, the social-cultural transformation together with the overcoming of compulsory vaccination and the use of noninstitutional information sources, have generated confusion among citizens that tend to perceive compulsory vaccinations as needed and safe, whereas recommended vaccinations as less important. Moreover, citizens scarcely perceive the risk of disease related to the effectiveness of vaccines. Implementing communication strategies, argumentative and persuasive, borrowed from social marketing, also for the promotion of vaccines is a priority of the health system. A typical example of the application of social marketing, as mentioned in the manuscript, is the campaign to promote the proper practice of HPV vaccination through the use of effective and cost-saving communication strategies.