Prevalence of smoking habits, attitudes and knowledge on counteractive strategies among a sample of healthcare employees: results of the smoking-free health environments project in the province of Palermo, Italy.

Introduction: Tobacco use is responsible for over 7 million deaths annually, making smoking the leading cause of preventable mortality globally. Over the last two decades in Italy, the prevalence of smoking among physicians has consistently decreased, while it remains higher and is gradually decreasing among non-physician healthcare workers. The aim of this study was to investigate the Prevalence of smoking habits, attitudes, and knowledge on counteractive strategies among employees in the Primary Healthcare Facilities in the Province of Palermo, Italy. Methods: A cross-sectional survey was conducted between June 2020 and December 2020 through a previously validated anonymous questionnaire structured in four sections including 34 items. Data were analyzed using Stata/MP 12.1 statistical software. Results: Overall, 2,645 participants answered the questionnaire. The prevalence of either current or former smokers was 18.6%. Based on the multivariable analysis conducted, a significantly higher frequency of current smokers was observed among male participants (AdjOR: 1.29; CI95%: 1.02-1.64) and those belonging to the Surgical Unit (AdjOR: 1.92; CI95%: 1.27-2.90). Conversely, the prevalence of current smokers was significantly lower among those with at least one child (AdjOR: 0.67; CI95%: 0.49-0.91), with an educational qualification equal to or greater than a graduation degree (AdjOR: 0.56; CI95%: 0.43-0.73), those who considered second-hand smoke harmful (AdjOR: 0.06; CI95%: 0.008-0.60), those who had observed smoking or detected the smell of smoke in their workplace (AdjOR: 0.64; CI95%: 0.45-0.91). Furthermore, the prevalence of current smokers was significantly lower among participants who believed that healthcare professionals could play a crucial role in influencing their patients' lifestyles (AdjOR: 0.67; CI95%: 0.50-0.90) and among those who recommend their patients to quit smoking (AdjOR: 0.35; CI95%: 0.24-0.51). Discussion: The results of the current research demonstrate that, despite the decline in smoking prevalence among physicians, the rate of smokers among healthcare facility employees remains unacceptably high. This underscores the need to re-evaluate current anti-tobacco strategies in the workplace.

Implant replacement and anaplastic large cell lymphoma associated with breast implants: a quantitative analysis.

Introduction: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma associated with breast reconstruction post-mastectomy or cosmetic-additive mammoplasty. The increasing use of implants for cosmetic purposes is expected to lead to an increase in BIA-ALCL cases. This study investigated the main characteristics of the disease and the factors predicting BIA-ALCL onset in patients with and without an implant replacement. Methods: A quantitative analysis was performed by two independent researchers on cases extracted from 52 primary studies (case report, case series, and systematic review) published until April 2022 and searched in PubMed, Scopus, and Google-Scholar databases using "Breast-Implant" AND/OR "Associated" AND/OR "Anaplastic-Large-Cell-Lymphoma". The statistical significance was verified by Student's t-test for continuous variables, while Fisher's exact test was applied for qualitative variables. Cox model with time-dependent covariates was used to estimate BIA-ALCL's onset time. The Kaplan-Meier model allowed the estimation of the probability of survival after therapy according to breast implant exposure time. Results: Overall, 232 patients with BIA-ALCL were extracted. The mean age at diagnosis was 55 years old, with a mean time to disease onset from the first implant of 10.3 years. The hazard of developing BIA-ALCL in a shorter time resulted significantly higher for patients not having an implant replacement (hazard ratio = 0.03; 95%CI: 0.005-0.19; p-value < 0.01). Patients with implant replacement were significantly older than patients without previous replacement at diagnosis, having a median time to diagnosis since the first implant of 13 years (7 years in patients without replacement); anyway, the median time to BIA-ALCL occurrence since the last implantation was equal to 5 years. Discussion: Our findings suggest that, in BIA-ALCL patients, the implant substitution and/or capsulectomy may delay the disease's onset. However, the risk of reoccurrence in an earlier time should be considered in these patients. Moreover, the time to BIA-ALCL onset slightly increased with age. Selection bias, lack of awareness, misdiagnosis, and limited data availability could be identified as limits of our study. An implant replacement should be considered according to a risk stratification approach to delay the BIA-ALCL occurrence in asymptomatic patients, although a stricter follow-up after the implant substitution should be recommended. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42023446726.

Knowledge and adherence to the Mediterranean diet in individuals practicing regular amatorial physical activity: a cross-sectional study conducted in the Metropolitan Area of Palermo, Italy.

Introduction: Mediterranean Diet (MD) is a universal model of nutrition that prevents several metabolic, cardiovascular, and oncological diseases. Main objective of the present study was to analyze adherence and knowledge regarding MD principles in a sample of individuals practicing amatorial sports from the Metropolitan Area of Palermo. Methods: A cross-sectional study was conducted in 10 Sports Centers, between October 2020 and September 2021, through a previously validated anonymous questionnaire structured in five sections including 74 items. Results: Overall, 337 subjects answered to the questionnaire. Based on the multivariable analysis conducted, a higher knowledge score (KS) on MD principles was observed among individuals daily consuming vegetables (OR: 3.32; CI95%: 1.82-6.02) and in the ones more adherent to MD principles (OR: 10.15; CI95%:5.47-18.85). More in depth, using MEDAS score to analyze the adherence to MD, a significant lower adherence was observed among overweight/obese (OR: 0.57; CI95%:0.33-0.99) and among employed subjects (OR: 0.52; IC95%: 0.28-0.98); while, a higher adherence was highlighted among daily consumers of vegetables (OR: 2.52; CI95%:1.52-4.17), daily consumers of fruit (OR: 1.77; CI95%:1.08-2.90), and in individuals that have daily breakfast (OR: 4.29; CI95%:1.15-15.96). Discussion: In accordance with the WHO Europe Gaining Health Campaign, Public Health Authorities should simplify accessibility to healthy food among general population, promoting principles and accessibility to MD.

Impact of Preventive Strategies on HPV-Related Diseases: Ten-Year Data from the Italian Hospital Admission Registry.

Human papillomavirus (HPV)-related diseases are still a challenge for public health. Some studies have shown the effects of preventive strategies on them, but studies at the national level are few in number. Therefore, a descriptive study through hospital discharge records (HDRs) was conducted in Italy between 2008 and 2018. Overall, 670,367 hospitalizations due to HPV-related diseases occurred among Italian subjects. In addition, a significant decrease in hospitalization rates for cervical cancer (average annual percentage change (AAPC) = -3.8%, 95% CI = -4.2, -3.5); vulval and vaginal cancer (AAPC = -1.4%, 95% CI = -2.2, -0.6); oropharyngeal cancer; and genital warts (AAPC = -4.0%, 95% CI = -4.5, -3.5) was observed during the study period. Furthermore, strong inverse correlations were found between screening adherence and invasive cervical cancer (r = -0.9, p < 0.001), as well as between HPV vaccination coverage and in situ cervical cancer (r = -0.8, p = 0.005). These results indicate the positive impact of HPV vaccination coverage and cervical cancer screening on hospitalizations due to cervical cancer. Indeed, HPV vaccination also resulted in a positive impact on the decrease in hospitalization rates due to other HPV-related diseases.

Acceptability of HPV Vaccination in Young Students by Exploring Health Belief Model and Health Literacy.

Evidence on the human papillomavirus (HPV) vaccine shows that it is effective in reducing the burden of HPV-related diseases. For more than 15 years the HPV vaccine has been offered free of charge in Italy to girls from the age of 12. Over time, the free offer of the HPV vaccine has also been extended to boys and to young adults at risk of developing HPV lesions. Despite the HPV vaccine's effectiveness and availability, vaccination coverage is low in Italy, with a reported value of 46.5% in 2020. Furthermore, in the southern administrative regions, vaccination coverage is even lower than national values, with 25.9% coverage in Sicily. A cross-sectional study was conducted among university and high school students in the Palermo area (Sicily, Italy) in order to identify the determinants of HPV vaccination adherence by using a questionnaire that investigated factors of HPV vaccine practice. The study explored the behavioral attitude by using the Health Belief Model (HBM), and also used the SILS test and the METER test to investigate the level of health literacy (HL). Overall, 3,073 students were enrolled, and less than a third reported they had completed the vaccination schedule (n = 925, 30.1%). Multivariable analysis showed that the factors directly associated with the adherence to HPV vaccination were female sex (OR = 4.43, p < 0.001), high HBM total score (OR = 4.23, p < 0.001), good HL level (OR = 1.26, p = 0.047), parents (OR = 1.78, p = 0.004), general practitioner (OR = 1.88, p = 0.001), and educational material provided by public vaccination services (OR = 1.97, p = 0.001) as HPV vaccine information sources. Further health-promotion programs focused on improving HL and perception of the HPV vaccine's benefits should be implemented in order to achieve the desirable 95% vaccination coverage.

Does access to care play a role in liver cancer survival? The ten-year (2006-2015) experience from a population-based cancer registry in Southern Italy.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most frequent primary invasive cancer of the liver. During the last decade, the epidemiology of HCC has been continuously changing in developed countries, due to more effective primary prevention and to successful treatment of virus-related liver diseases. The study aims to examine survival by level of access to care in patients with HCC, for all patients combined and by age. METHODS: We included 2018 adult patients (15-99 years) diagnosed with a primary liver tumour, registered in the Palermo Province Cancer Registry during 2006-2015, and followed-up to 30 October 2019. We obtained a proxy measure of access to care by linking each record to the Hospital Discharge Records and the Ambulatory Discharge Records. We estimated net survival up to 5 years after diagnosis by access to care ("easy access to care" versus "poor access to care"), using the Pohar-Perme estimator. Estimates were age-standardised using International Cancer Survival Standard (ICSS) weights. We also examined survival by access to care and age (15-64, 65-74 and ≥ 75 years). RESULTS: Among the 2018 patients, 62.4% were morphologically verified and 37.6% clinically diagnosed. Morphologically verified tumours were more frequent in patients aged 65-74 years (41.6%), while tumours diagnosed clinically were more frequent in patients aged 75 years or over (50.2%). During 2006-2015, age-standardised net survival was higher among HCC patients with "easy access to care" than in those with "poor access to care" (68% vs. 48% at 1 year, 29% vs. 11% at 5 years; p < 0.0001). Net survival up to 5 years was higher for patients with "easy access to care" in each age group (p < 0.0001). Moreover, survival increased slightly for patients with easier access to care, while it remained relatively stable for patients with poor access to care. CONCLUSIONS: During 2006-2015, 5-year survival was higher for HCC patients with easier access to care, probably reflecting progressive improvement in the effectiveness of health care services offered to these patients. Our linkage algorithm could provide valuable evidence to support healthcare decision-making in the context of the evolving epidemiology of hepatocellular carcinoma.

Adolescent idiopathic scoliosis screening: Could a school-based assessment protocol be useful for an early diagnosis?

BACKGROUND: Adolescent idiopathic scoliosis screening still needs a considerable implementation, particularly throughout a school-based assessment protocol. OBJECTIVE: This study aims to evaluate the effectiveness of clinical examinations currently in use for the diagnosis of adolescent idiopathic scoliosis, through a survey carried out in secondary schools to standardize a screening protocol that could be generalized. METHODS: In their classrooms, the adolescents underwent an idiopathic scoliosis screening through three examinations: Adam's test, axial trunk rotation (ATR) and plumb line. In case of single positivity to one of the three examinations, a column X-ray examination was recommended. RESULTS: The sensitivity and diagnostic specificity of Adam's test or ATR were 56.3% and 92.7%, respectively. The positivity to at least one between ATR or plumb line showed that sensitivity was higher than specificity: 91.3% versus 80.8%; the positivity to at least one between Adams's test or plumb line showed a sensitivity of 95.2% and a specificity of 81.5%. Finally, the positivity to all three examinations showed an increase in specificity (99.7%). CONCLUSIONS: Taken together, our findings show that this school-based screening protocol had a very high specificity in early diagnosis of adolescent idiopathic scoliosis.

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.

Human Papilloma Virus Infection and Vaccination: Pre-Post Intervention Analysis on Knowledge, Attitudes and Willingness to Vaccinate Among Preadolescents Attending Secondary Schools of Palermo, Sicily.

In recent years, vaccination coverage rates against Human Papilloma Virus (HPV) in Europe have shown a decreasing trend and remain below the required standard. The present study aims to assess knowledge and attitudes regarding HPV infection and vaccination among a representative sample of preadolescents of Palermo, Italy. A survey was carried out throughout two questionnaires, before and after carrying out an educational intervention scheduled during school hours. A total of 1702 students attending first-grade secondary schools of the province of Palermo were enrolled (response rate 68.9%). Students attending third classes (adj OR = 1.18; CI 95% 1.03-1.36), being of higher socioeconomic status (adj OR = 1.35; CI 95% 1.05-1.73), who had previously received information about sexually transmitted diseases (STDs) at home (adj OR = 1.62; CI 95% 1.27-2.07) or at school (adj OR = 2.15; CI 95% 1.70-2.71) and who had ever heard in the past about HPV (adj OR = 1.80; CI 95% 1.42-2.29) showed a significantly higher baseline level of knowledge regarding HPV. Willingness to receive HPV vaccination, in a 10-point Likert scale, significantly increased between the pre- (8.51; SD ± 1.79) and post- (9.01 SD ± 1.52) intervention questionnaires (p < 0.001). A total of 188 out of 272 (69.1%) preadolescents attending five out eighteen schools involved in the project, who had not previously received the HPV vaccine, were vaccinated. During past years, education campaigns on HPV were mainly dedicated to adult women, excluding teenagers and omitting young males. It should therefore be of primary importance that school-based education and vaccination programmes be standardized.

Epidemiology and biological characteristics of male breast cancer in Italy.

AIM: To evaluate the epidemiology of male breast cancer (MBC) in Italy and to describe incidence and survival data in relation to age, morphology, year of incidence, geographic area, and possible association with other cancers compared with female BC. METHODS: Cases were extracted from 40 Italian Cancer Registries. Standardized incidence rates (SIR), age-specific rates, and 5-year survival were calculated. The association with second tumors was also evaluated. All data were compared with data from female BCs. RESULTS: In the 2000-2014 period, 2175 new cases of MBC were registered, with an SIR of 1.7 × 100,000. The incidence showed a slight upward trend and increased with increasing age. The 5-year survival was 82% in the first two periods (2000-2004, 2005-2009), lower than in females (87%). The most frequent morphology was the ductal carcinoma (84%). Stage at diagnosis was 39.5% stage I, 33.1% stage II, 20.9% in stage III, and 6.4% in stage IV. Concerning receptor status, 96.4% had ER+ and 82.5% PR+; 46.5% had high Ki67 and 14.7% HER2 amplified. The risk of BC increased if the man had already had a previous tumor in any site (excess absolute risk, EAR = 2.7) and especially if he had had prostate cancer (EAR = 5.1). Instead, males with a previous diagnosis of BC had an increased risk of testicular, kidney and lung cancer. CONCLUSIONS: MBC requires more attention in terms of diagnosis and treatment as clinicians tend to follow the guidelines that have been developed for female BC management.

Evaluation of the Burden of HPV-Related Hospitalizations as a Useful Tool to Increase Awareness: 2007-2017 Data from the Sicilian Hospital Discharge Records.

In light of the implementation of human papillomavirus (HPV) prevention strategies, epidemiological studies in different geographical areas are required in order to assess the impact of HPV-related diseases. The purpose of the present study was to describe the burden of HPV-related hospitalizations in Sicily. A retrospective observational study estimated 43,531 hospitalizations attributable to HPV from 2007 to 2017. During the observed period, there was a decrease for all HPV-related conditions with a higher reduction, among neoplasms, for cervical cancer (annual percent change (APC) = -9.9%, p < 0.001). The median age for cervical cancer was 45 years old, with an increasing value from 43 to 47 years (p < 0.001). The age classes with greater decreases in hospital admissions for invasive cancers were women aged 35 years or more (APC range from -5.5 to -9.86) and 25-34 years old (APC = -11.87, p < 0.001) for women with cervical carcinoma in situ. After ten years for vaccine introduction and sixteen years for cervical cancer screening availability, a relatively large decrease in hospital admissions for cervical cancer and other HPV-related diseases in Sicily was observed. Some clinical characteristics of hospitalization, such as increasing age, are suggestive clues for the impact of preventive strategies, but further research is needed to confirm this relationship.

Burden and Prevention of HPV. Knowledge, Practices and Attitude Assessment Among Pre-Adolescents and their Parents in Italy.

Despite infections due to HPV nowadays represent the most common sexually transmitted diseases worldwide with recognized effective and safe preventive strategies, knowledge, attitudes; however, awareness on HPV is considerably low. The present study has two main objectives: 1. To conduct a literature review to analyze the evolution of preventive tools, the complexity of the vaccine choice process, and the challenges posed by HPV vaccine hesitancy and refusal among pre-adolescents and their parents; 2. To assess knowledge, practices and attitudes toward HPV infection and vaccination in a sample of Italian pre-adolescents and their parents. The observational study was carried out through the use of two anonymous and self-administered pre- and postintervention questionnaires dedicated to the target populations. Between the administrations of the pre- and postintervention questionnaires, an educational intervention on HPV infection and related diseases, and prevention strategies was conducted. All participants demonstrated suboptimal knowledge and positive attitudes in the preintervention questionnaire. Higher levels of knowledge and attitudes were observed among pre-adolescents thatused social networks and had heard of sexually transmitted diseases at home/school/physician and from parents and also who had heard of HPV from General Practitioners, Gynecologists, family members and newspapers. A significant increase in HPV vaccination awareness was observed among pre-adolescents after the educational sessions. Health education programs aimed at increasing knowledge, attitudes and awareness on HPV are needed to implement the outcomes of HPV immunization programs, especially if supported by the physicians involved in counselling and recommendation processes.

Anisakis sensitization in different population groups and public health impact: A systematic review.

Anisakis simplex spp. sensitization rates have increased worldwide, with a significant impact on health-care systems. To date, no clear-cut diagnostic criteria and laboratory algorithm have been established, so anisakiasis still represents an under-reported health problem whose clinical manifestations, when present, mimic the much more common allergic and digestive disorders. Aim of the study was to systematically review the available literature on the prevalence of sensitization against Anisakis in the general population and in specific population groups, taking into account the impact of the different available diagnostic techniques on the epidemiological data. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, relevant papers reporting Anisakis sensitization epidemiological data were found covering a period ranging from 1996 to February 2017. Overall, 41 studies comprising 31,701 participants from eleven countries were included in the qualitative synthesis. General asymptomatic population resulted sensitized to Anisakis in 0.4 to 27.4% of cases detected by means of indirect ELISA or ImmunoCAP specific IgE detection, and between 6.6% and 19.6% of the samples by Skin prick test (SPT). Occupationally exposed workers (fishermen, fishmongers and workers of fish-processing industries) documented specific IgE between 11.7% and 50% of cases, whereas SPT positivity ranged between 8% and 46.4%. Symptomatic allergic patients to any kind of allergen were found to be positive to Anisakis specific IgE detection between 0.0% (in children with mastocytosis) to 81.3% (among adults with shellfish allergy). Results highlighted that hypersensitivity prevalence estimates varied widely according to geographical area, characteristics of the population studied, diagnostic criteria and laboratory assays. Further studies are needed to overcome the documented misdiagnosis by improving the diagnostic approach and, consequently, providing more affordable estimates in order to address public health interventions on populations at high risk of exposure to Anisakis and to tailor health services related to specific groups.

Childhood and Adolescence Cancers in the Palermo Province (Southern Italy): Ten Years (2003⁻2012) of Epidemiological Surveillance.

Italy has one of the highest paediatric cancer incidence rates in Europe. We compared cancer incidence and survival rates in children (0⁻14 years) and adolescents (15⁻19 years) residing in Palermo Province (PP) with statistics derived from Italian and European surveillance systems. We included all incident cancer cases, malignant tumours and non-malignant neoplasm of central nervous system (benign and uncertain whether malignant or benign), detected in children and adolescents by the Palermo Province Cancer Registry (PPCR) between 2003 and 2012. A jointpoint regression model was applied. Annual Average Percentage Changes were calculated. The Besag⁻York-Mollie model was used to detect any cluster. The 5-year survival analysis was computed using Kaplan-Meier and actuarial methods. We identified 555 paediatric cancer incident cases (90% “malignant tumours”). No difference in incidence rates was highlighted between PPCR and Italy 26 registries and between PPCR and Southern Europe. No jointpoint or significant trend was identified and no cluster was detected. The 5-year overall survival didn’t differ between PP and the Italian AIRTUM pool. A borderline higher statistically significant survival was observed in age-group 1⁻4 when comparing PPCR to EUROCARE-5. The epidemiological surveillance documented in the PP was a paediatric cancer burden in line with Italy and southern Europe. The study supports the supplementary role of general population-based cancer registries to provide paediatric cancer surveillance of local communities.

Increased Vaccination Coverage among Adolescents and Young Adults in the District of Palermo as a Result of a Public Health Strategy to Counteract an 'Epidemic Panic'.

During the summer of 2016 four cases of invasive meningococcal disease in rapid succession among young adults in the district of Palermo, Italy, resulting in one death, were widely reported by local and national mass media. The resultant 'epidemic panic' among the general population overloaded the vaccination units of the Palermo district over the following months. Strategies implemented by the Sicilian and local public health authorities to counteract 'meningitis fear' included the following: (a) extension of active and free-of-charge anti-meningococcal tetravalent vaccination from age class 12⁻18 to 12⁻30 years old; (b) implementation of vaccination units during normal clinic hours in rooms tailored for vaccine administration; (c) development of informative institutional tools and timely communication throughout local mass media to reassure the general population. In 2016, an increase in the anti-meningococcal coverage was observed in the Palermo district (+18% for 16-year-olds and +14% for 18-year-olds) and at the regional level (+11.2% and +13.5%, respectively). Concurrent catch-up of other recommended vaccinations for age (diphtheria-tetanus-pertussis-poliomyelitis and papillomavirus) resulted in a further increase of administered doses. The fear of meningitis, managed by the Sicilian public health authorities, had positive impacts in terms of prevention. In particular, the communication strategies that were adopted contributed to educating Sicilian young adults about vaccination issues.

Factors Associated with HPV Vaccine Refusal among Young Adult Women after Ten Years of Vaccine Implementation.

In Italy, the Human Papillomavirus (HPV) vaccination was implemented for twelve years old girls in 2007, but its coverage was lower than the recommended level. Sicily is one of the Italian administrative regions with lower vaccination coverage, with a value of 59% for those born in 1996 increasing to 62% coverage for those born in 1999. The aim of the study was to investigate factors associated with the refusal of HPV vaccination among young adult women of Palermo, Italy. The study was approved by the Ethics Committee of the Policlinico “Paolo Giaccone” Hospital (Palermo 1) and the questionnaire was validated in a convenience sample representing 10% of the young women. A cross-sectional study was conducted through the administration of a telephone questionnaire, consisting of 23 items on HPV infection and vaccination knowledge based on the Health Belief Model framework. The eligible population were young women (18–21 years old) who had at least a vaccination among all included in the Sicilian vaccination schedule, without starting or completing HPV vaccination. Overall, 141 young women were enrolled (response rate 22%). Among them, 84.4% were unvaccinated and 15.6% had at least one dose of the HPV vaccine. In multivariate analysis, the factors associated with the refusal of the HPV vaccination were a bachelor’s as the education level (OR = 10.2, p = 0.041), lower participation at school seminar on HPV (OR = 0.2, p = 0.047) and lower perception of HPV vaccine benefits (OR = 0.4, p = 0.048). Public health educational program focusing and tailored on benefits perception of HPV vaccine and HPV disease severity, carried out at school or during medical visits, can be useful to improve HPV vaccination uptake.