Prevalence and Burden of Illness of Rome IV Irritable Bowel Syndrome in the United States: Results From a Nationwide Cross-Sectional Study.

BACKGROUND & AIMS: The estimated prevalence of irritable bowel syndrome (IBS) using Rome IV criteria in the United States (US) ranges from 4.7% to 5.3%, although these estimates arise from studies with relatively small sample sizes. This study assessed the prevalence of IBS and its associated burden of illness using a nationally representative data set with nearly 89,000 people in the US. METHODS: From May 3 to June 24, 2020, we performed an online survey described to participating adults aged ≥18 years old as a "national health survey." We recruited a representative sample of people in the US to complete the survey, which included the Rome IV IBS questionnaire, National Institutes of Health Patient-Reported Outcome Measurement Information System (PROMIS) gastrointestinal scales, and questions on health care-seeking behavior. RESULTS: Overall, 88,607 people completed the survey, of whom 5414 (6.1%) met Rome IV IBS criteria: mixed IBS (n = 1838 [33.9%]), constipation-predominant IBS (n = 1819 [33.6%]), diarrhea-predominant IBS (n = 1521 [28.1%]), and unsubtyped IBS (n = 236 [4.4%]). Women had higher odds for IBS compared with men, whereas racial/ethnic minorities had lower odds for IBS vs non-Hispanic Whites. Across the 3 main subtypes, 68.2% to 73.2% of people reported ever seeking care for their IBS symptoms, whereas 53.8% to 58.9% did so in the past 12 months. CONCLUSIONS: In this nationwide US survey, we found that Rome IV IBS is slightly more prevalent (6.1%) vs prior estimates (4.7%-5.3%). Additional research is needed to determine whether this higher prevalence is in part due to the coronavirus disease 2019 pandemic during which this study was conducted.

Drinking Water Quality Assessment Using a Fuzzy Inference System Method: A Case Study of Rome (Italy).

Drinking water quality assessment is a major issue today, as it is crucial to supply safe drinking water to ensure the well-being of society. Predicting drinking water quality helps strengthen water management and fight water pollution; technologies and practices for drinking water quality assessment are continuously improving; artificial intelligence methods prove their efficiency in this domain. This research effort seeks a hierarchical fuzzy model for predicting drinking water quality in Rome (Italy). The Mamdani fuzzy inference system is applied with different defuzzification methods. The proposed model includes three fuzzy intermediate models and one fuzzy final model. Each model consists of three input parameters and 27 fuzzy rules. A water quality assessment model is developed with a dataset that considers nine parameters (alkalinity, hardness, pH, Ca, Mg, fluoride, sulphate, nitrates, and iron). These nine parameters of drinking water are anticipated to be within the acceptable limits set to protect human health. Fuzzy-logic-based methods have been demonstrated to be appropriate to address uncertainty and subjectivity in drinking water quality assessment; they are an effective method for managing complicated, uncertain water systems and predicting drinking water quality. The proposed method can provide an effective solution for complex systems; this method can be modified easily to improve performance.

Prevalence and Burden of Illness of Rome IV Chronic Idiopathic Constipation, Opioid-Induced Constipation, and Opioid-Exacerbated Constipation in the United States.

INTRODUCTION: Chronic idiopathic constipation (CIC) and opioid-induced constipation (OIC) are disorders that negatively affect quality of life. We sought to assess the prevalence, symptom severity, and medication use among people with Rome IV CIC, OIC, and opioid-exacerbated constipation (OEC) using a nationally representative data set with nearly 89,000 people in the United States. METHODS: From May 3, 2020, to June 24, 2020, we recruited a representative sample of people in the United States ≥ 18 years to complete an online national health survey. The survey guided participants through the Rome IV CIC and OIC questionnaires, Patient-Reported Outcome Measurement Information System gastrointestinal scales (percentile 0-100; higher = more severe), and medication questions. Individuals with OEC were identified by asking those with OIC whether they experienced constipation before starting an opioid and whether their symptoms worsened afterward. RESULTS: Among the 88,607 participants, 5,334 (6.0%) had Rome IV CIC, and 1,548 (1.7%) and 335 (0.4%) had Rome IV OIC and OEC, respectively. When compared with people with CIC (Patient-Reported Outcome Measurement Information System score, 53.9 ± 26.5; reference), those with OIC (62.7 ± 28.0; adjusted P < 0.001) and OEC (61.1 ± 25.8, adjusted P = 0.048) had more severe constipation symptoms. People with OIC (odds ratio 2.72, 95% confidence interval 2.04-3.62) and OEC (odds ratio 3.52, 95% confidence interval 2.22-5.59) were also more likely to be taking a prescription medication for their constipation vs those with CIC. DISCUSSION: In this nationwide US survey, we found that Rome IV CIC is common (6.0%) while Rome IV OIC (1.7%) and OEC (0.4%) are less prevalent. Individuals with OIC and OEC have a higher burden of illness with respect to symptom severity and prescription constipation medication use.

Prevalence and impact of faecal incontinence among individuals with Rome IV irritable bowel syndrome.

BACKGROUND: Little is known about faecal incontinence (FI) in individuals with irritable bowel syndrome (IBS). AIMS: To compare characteristics of people with IBS reporting FI, compared with people with IBS who do not report FI. METHODS: We collected demographic, gastrointestinal and psychological symptoms, healthcare usage, direct healthcare costs, impact on work and activities of daily living, and quality of life data from individuals with Rome IV-defined IBS. We asked participants about FI, assigning presence or absence according to Rome-IV criteria. RESULTS: Of 752 participants with Rome IV IBS, 202 (26.9%) met Rome IV criteria for FI. Individuals with FI were older (p < 0.001), more likely to have IBS-D (47.0% vs. 39.0%, p = 0.008), and less likely to have attained a university or postgraduate level of education (31.2% vs. 45.6%, p < 0.001), or to have an annual income of ≥£30,000 (18.2% vs. 32.9%, p < 0.001). They were more likely to report urgency (44.6% vs. 19.1%, p < 0.001) as their most troublesome symptom and a greater proportion had severe IBS symptom scores, abnormal depression scores, higher somatic symptom-reporting scores or higher gastrointestinal symptom-specific anxiety scores (p < 0.01 for trend for all analyses). Mean health-related quality of life scores were significantly lower among those with, compared with those without, FI (p < 0.001). Finally, FI was associated with higher IBS-related direct healthcare costs (p = 0.002). CONCLUSIONS: Among individuals with Rome IV IBS, one-in-four repo rted FI according to Rome IV criteria. Physicians should ask patients with IBS about FI routinely.

Investigating metropolitan change through mathematical morphology and a dynamic factor analysis of structural and functional land-use indicators.

We presented an operational rationale grounded on complex system thinking to quantify structural and functional landscape transformations along three stages representative of post-war metropolitan development in Rome, Italy (urbanisation with population/settlement densification, 1949-1974; suburbanisation with medium-density settlement expansion, 1974-1999; counter-urbanisation with settlement sprawl, 1999-2016). A mathematical morphology approach assessing the geometric form of land patches and a multi-way factor analysis (MFA) of landscape metrics were used to investigate the joint evolution of urban form and land-use functions over time. The empirical results of the MFA delineated the multivariate relationship between nine land-use classes (with distinctive socioeconomic functions) and seven morphological types (reflecting different landscape structures) according to four observation times (1949, 1974, 1999, 2016). Taken as an intrinsic attribute of complex landscape systems experiencing intense transformations, an estimation of the 'rapidity-of-change' in the form-functions relationship at a given development stage was derived from MFA outcomes separately for urbanisation, suburbanisation, and counter-urbanisation. A simplified form-functions relationship, reflecting the spatial polarisation in compact settlements and rural (low-density) landscapes, was observed with compact urbanisation. By stimulating urban sprawl into fringe farmland, suburbanisation resulted in patchy and heterogeneous rural landscapes. Counter-urbanization was associated with the fragmentation of built-up settlements leading to a chaotic mosaic of land structures that mixes urban and rural traits. Rapidity-of-change in form-function relationships was greater during suburbanisation than urbanisation and counter-urbanisation. It reflects the intrinsic pressure of economic growth in contemporary cities.

Quality of Life and Stress Management in Healthcare Professionals of a Dental Care Setting at a Teaching Hospital in Rome: Results of a Randomized Controlled Clinical Trial.

In the healthcare environment, more and more people experience work-related stress. The Faculty of Medicine and Dentistry of Sapienza University of Rome, having observed the need to take care of healthcare professionals, has set itself the objective of providing useful tools such as additional and necessary personal protective equipment for healthcare professionals. OBJECTIVE: To promote health through better management, skills, and the use of strategies and solutions to identify, decompress, and neutralize those responsible for work-related stress mechanisms in order to take care of those who care (CURARE CURANTES). MATERIALS AND METHODS: A randomized controlled clinical trial was conducted. The participants were enrolled by three departments of the Department of Dental and Maxillofacial Sciences of Rome; in consideration of emotional involvement of health professionals who work there. A motivational program was offered. RESULTS: There were 17 and 16 healthcare professionals in the intervention and control groups, respectively. Levels of the mental composite score (MCS) varied both in the pre-post phase of the intervention group (p = 0.002), and between the intervention group and control group in the post phase (p = 0.006). No significant differences were observed for the physical composite score (PCS). Similarly, there were no significant differences regarding the positivity scale (PS) and the two dimensions of work-related stress (job demand and decision latitude). CONCLUSION: This study demonstrates the efficacy of yoga training practiced directly in the workplace and wearing work clothes, entering the work context, not weighing further on the healthcare workload, and being a way to carry out physical activity even in those cases in which professionals do not have the time to do it in their free time.

Socioeconomic inequalities in health status and survival: a cohort study in Rome.

OBJECTIVES: To analyse the association between individual and contextual socioeconomic position (SEP) with health status and to investigate the role of SEP and baseline health status on survival. DESIGN: Cross-sectional and cohort study. SETTING: Rome, Italy. PARTICIPANTS, PRIMARY AND SECONDARY OUTCOMES: We selected the 25-99 year-olds included in the Rome 2011 census cohort. As a measure of health status on the census reference date (09 October 2011), we used the presence of chronic or rare conditions from the Disease-Related Co-payment Exemption Registry, a database implemented to provide free care to people with chronic or rare diseases. We used logistic regression to analyse the association between both individual (educational attainment) and contextual SEP (neighbourhood real estate price quintiles) with baseline health status. We analysed the role of SEP and the presence of chronic or rare conditions on 5-year survival (until 31 December 2016) using accelerated failure time models with Weibull distribution, reporting time ratios (TRs; 95% CI). RESULTS: In middle-aged, subjects with low SEP (either individual or contextual) had a prevalence of chronic conditions comparable with the prevalence in high SEP individuals 10 years older. Adjusted logistic models confirmed the direct association between SEP and baseline health status in both women and men. The lowest educated were up to 67% more likely to have a chronic condition than the highest educated, while the difference was up to 86% for lowest versus highest contextual SEP. Low SEP and the presence of chronic conditions were associated with shorter survival times in both sexes, lowest versus highest educated TR was TR=0.79 for women (95% CI: 0.77 to 0.81) and TR=0.71 for men (95% CI: 0.70 to 0.73). The contextual SEP shrunk survival times by about 10%. CONCLUSION: Inequalities were present in both baseline health and survival. The association between SEP and survival was independent of baseline health status.

Evaluation of dental demands and needs of people experiencing homelessness in the city of Rome, Italy.

OBJECTIVE: Poor oral health and oral diseases are common among people experiencing homelessness. The aim of this study was to evaluate the dental demands and needs of a population of homeless persons in the city of Rome, Italy. PATIENTS AND METHODS: The clinical records of 165 homeless patients admitted between October 2020 and October 2021 to the dental service of the Primary Care Services of the Eleemosynaria Apostolica, Vatican City, were retrospectively reviewed. The service employed dentists to evaluate dental needs and oral conditions in patients experiencing homelessness. The main dental and oral pathological conditions were noted. RESULTS: One hundred and sixty-five records of homeless patients were included in the study. The sample consisted in 138 males (76.97%) and 27 females (23.03%) with a mean age of 46.9 years (range 7-85 years). Acute tooth pain was reported by 132 (80%) patients, 42 (25.45%) had edentulism or missing teeth and 18 (10.91%) patients had oral lesions. Both dental and oral pathologies were intercepted and managed in secondary healthcare facilities. CONCLUSIONS: Given the specific peculiarities of this vulnerable population, it is important to implement strategies that facilitate the access of persons experiencing homelessness to dental evaluation with a preventive and curative perspective.

Direct healthcare costs of Rome IV or Rome III-defined irritable bowel syndrome in the United Kingdom.

BACKGROUND: Previous studies have demonstrated a substantial economic impact of irritable bowel syndrome (IBS). AIMS: To provide contemporaneous estimates of direct healthcare costs of IBS in the United Kingdom. METHODS: We collected demographic, gastrointestinal and psychological symptoms, quality of life and healthcare usage data from adults with Rome IV or Rome III IBS in the United Kingdom. We calculated the mean annual direct healthcare costs of IBS per person and used contemporaneous IBS prevalence data, together with census data, to estimate annual direct costs of IBS. We also examined predictors of higher costs. RESULTS: The mean annual direct cost of IBS per person among 752 individuals with Rome IV IBS was £556.65 (SD £1023.92) and £474.16 (SD £897.86) for 995 individuals with Rome III IBS. We estimate the annual direct healthcare cost of IBS in the United Kingdom is £1.27 billion if the Rome IV criteria are used to define IBS, and £2.07 billion using Rome III. Among individuals with Rome IV IBS, mean annual costs were higher in those with opiate use (£907.90 vs £470.58, p < 0.001), more severe symptoms (p < 0.001 for trend), a shorter duration of IBS (1 year, £1227.14 vs >5 years £501.60, p = 0.002), lower quality of life (p < 0.001 for trend), and higher depression, somatisation and gastrointestinal symptom-specific anxiety scores (P < 0.001 for trend for all). CONCLUSION: We estimate annual direct healthcare costs of IBS of between £1.3 and £2 billion in the United Kingdom.

Assessment of the Impact of COVID-19 Lockdown on the Nutritional Status and Lipid Profile of Employees in a Teaching Hospital in Rome: A Retrospective Cohort Study.

Background: on the 9 March 2020, the Italian government declared a state of lockdown on the entire national territory aimed at reducing the spread of SARS-CoV-2, causing strong repercussions for people's lifestyles. The aim of the study was to analyze the impact of the lockdown on the nutritional status and lipid profile of employees of an Italian teaching hospital. Methods: an observational retrospective cohort study was carried out at the Department of Occupational Medicine of the Umberto I General Hospital of Rome, including all employees who underwent two consecutive occupational medical examinations before and after the first lockdown (9 March 2020−18 May 2020). Employee medical records were used as a data source. Results: 1014 employees were involved in the study (50.6% nurses, 31% physicians, 14.8% technical staff, 3.6% administrative staff). Post lockdown BMI, total cholesterol and LDL values increased statistically significantly compared to pre lockdown ones. Nurses showed a significant association with increased BMI (p < 0.001), while workers with heart disease were inversely associated with total cholesterol (p < 0.001) and LDL (p < 0.001). Conclusion: this study showed that lockdown had a significant impact on employees' lifestyles. Further studies are needed to understand changes in health-related behaviors, such as diet and physical activity, of specific categories of workers over time under lockdown conditions.

Pathogenic camps, therapeutic city? Roma, healthcare, and the negotiation of citizenship rights in Rome.

While equality in healthcare implementation constitutes one of the precepts of the European Roma inclusion programs, health disparities are still one of the most problematic areas contributing to the marginality of residents in 'Roma camps'. The implementation of the right to health and access to healthcare services and resources represents a major challenge in their everyday experience. If we consider citizenship as a set of natural and legal rights to be protected as a symbolic and material link between a nation-state and a subject either born there or formally belonging to its national community, healthcare emerges as a technology of government where such rights are challenged, limited, or denied. Based on an ethnographic work on the role of public healthcare in 'Roma camps', this contribution focuses on contemporary topographies of health in the city of Rome through the lens of Roma marginalization within its urban spaces. How do camps residents experience the city through their relationship with its healthcare resources? And how does the healthcare system become a powerful tool of exclusion? Healthcare access in an urban context is an illustration of the dialectics of political power, knowledge, and expertise as a crucial factor in the administration of marginalized groups. From this perspective, the analysis focuses on precarity in the urban healthcare landscape, and on what living in a 'Roma camp' means in terms of healthcare. Both dimensions interrogate citizenship as a set of rightful entitlements that includes access to state-provided medical services.

Barbarigenesis and the collapse of complex societies: Rome and after.

"Barbarism" is perhaps best understood as a recurring syndrome among peripheral societies in response to the threats and opportunities presented by more developed neighbors. This article develops a mathematical model of barbarigenesis-the formation of "barbarian" societies adjacent to more complex societies-and its consequences, and applies the model to the case of Europe in the first millennium CE. A starting point is a game (developed by Hirshleifer) in which two players allocate their resources either to producing wealth or to fighting over wealth. The paradoxical result is that a richer and potentially more powerful player may lose out to a poorer player, because the opportunity cost of fighting is greater for the former. In a more elaborate spatial model with many players, the outcome is a wealth-power mismatch: central regions have comparatively more wealth than power, peripheral regions have comparatively more power than wealth. In a model of historical dynamics, a wealth-power mismatch generates a long-lasting decline in social complexity, sweeping from more to less developed regions, until wealth and power come to be more closely aligned. This article reviews how well this model fits the historical record of late Antiquity and the early Middle Ages in Europe both quantitatively and qualitatively. The article also considers some of the history left out of the model, and why the model doesn't apply to the modern world.

Urban Health and Social Marginality: Perceived Health Status and Interaction with Healthcare Professionals of a Hard-to-Reach Community Living in a Suburban Area of Rome (Italy).

The study reports an urban health investigation conducted in Bastogi, an outskirt of Rome (Italy) characterised by social marginalization and deprivation. Our aim was to analyse the health perception, health-related behaviours, and interaction with healthcare professionals of the inhabitants of Bastogi compared to the population living in the area of the same local health unit (ASL). The Progresses of Health Authorities for Health in Italy questionnaire (PASSI) was administered to a sample of 210 inhabitants of Bastogi. Data were analysed and compared to those of the ASL collected in 2017-2018. The socio-economic indicators showed an overall worse condition for the inhabitants of Bastogi, with a significantly higher proportion of foreign and unemployed residents and a lower educational level compared to the ASL. Significant differences in the prevalence of non-communicable diseases, mental health complaints, and participation in prevention strategies, including cancer screening, were found. The questionnaire showed a lower help-seeking behaviour and a lack of reliance on health professionals in Bastogi inhabitants. Our findings highlight how social determinants produce health inequities and barriers to accessing healthcare. The difficulties of conducting quantitative research in complex and hard-to-reach contexts, characterized by high social vulnerability, are outlined.

Development of a low-cost sensing platform for air quality monitoring: application in the city of Rome.

Air pollution in urban areas is a problem of complex nature and one of its principal characteristics is the variability of pollutants concentrations even at short distances from main road arteries. Nevertheless, the common approach for air pollution monitoring is by means of fixed stations, which are expensive, complex and provide low spatial resolution data, as they are low density deployed. These stations satisfy legislative requirements but do not provide data about local gradients of pollutants concentrations that can be significant for health protection: space-time variables are increasingly important to adequately characterise urban air quality. A possible solution to increment spatial resolution data in a city is by means of low-cost sensors, which are small and portable. Although these sensors do not allow the same accuracy and precision as certified analysers, they are increasingly used and tested all over the world and have the potential to integrate regulatory air pollution monitoring stations and promoting community engagement. In this paper LILI-1, a prototype of a low-cost air quality platform, is presented. It allows measuring meteoclimatic parameters and concentrations of principal air quality pollutants (NO2, O3, PM10 and PM2.5) by means of electrochemical and optical sensors. LILI-1 has been tested in the city of Rome and compared with certified analysers, showing very encouraging results for all the monitored pollutants. It has also been used by mounting it on a bicycle and showing its ability to increment spatial resolution and obtain distributed data throughout the city.

Health and social conditions of children living in disadvantaged neighborhoods in the city of Rome, Italy.

OBJECTIVE: The number of children living in socio-economically disadvantaged neighborhoods in developed countries is constantly growing, resulting in important implications for children's development, physical and psychological health and increased future disparities. In this study, we explored several key elements of children living in poor neighborhoods, such as demographic characteristics, access to public health assistance and school, and availability of housing and basic hygienic conditions. PATIENTS AND METHODS: The study included 711 children aged 0-17 years referring to primary care services in the suburbs of the city of Rome, Italy. RESULTS: Most children were born in Italy, while almost none of their parents were. Nearly 60% of the children did not have access to basic pediatric care, causing possible misdiagnosis and delayed treatment for acute and chronic conditions. A smaller percentage of the children did not have access to basic housing (8%) and hygienic facilities, such as heating, running water, and refrigerator (3.2%), leading to malnutrition, isolation and poor physical and psychological development. CONCLUSIONS: This study confirms a critical condition for children living in disadvantaged neighborhoods, whose vulnerability is further worsened by the limited access to paediatric health assistance and, in some cases, to basic facilities with a severe impact on their physical and psychological development.

Disparities in emergency department use between Italians and migrants residing in Rome, Italy: the Rome Dynamic Longitudinal Study from 2005 to 2015.

BACKGROUND: The Emergency Department (ED) can be considered an indicator of accessibility and quality and can be influenced in period of economic downturns. In the last fifteen years, the number of migrants in Italy has doubled (from 2.4 million in 2005 to 5.2 in 2019, 4.1 and 8.7% of the total population, respectively). However, evidence about migrants' healthcare use is poor, and no studies focused on the ED utilisation rate during the Great Recession are available. This study aims to analyse trends in all-cause and cause-specific ED utilisation among migrants and Italians residing in Rome, Italy, before and after 2008. METHODS: Longitudinal study based on data from the Municipal Register of Rome linked to the Emergency Department Register from 2005 to 2015. We analysed 2,184,467 individuals, aged 25-64 in each year. We applied a Hurdle model to estimate the propensity to use the ED and to model how often individuals accessed the ED. RESULTS: Migrants were less likely to be ED users than Italians, except for Africans (RR = 1.46, 95%CI 1.40-1.52) and Latin Americans (RR = 1.04, 95%CI 1.00-1.08) who had higher all-cause utilisation rates than non-migrants. Compared to the pre-2008 period, in the post-2008 we found an increase in the likelihood of being an ED user (OR = 1.34, 95%CI 1.34-1.35), and a decrease in ED utilisation rates (RR = 0.96, 95%CI 0.96-0.97) for the whole population, with differences among migrant subgroups, regardless of cause. CONCLUSIONS: This study shows differences in the ED utilisation between migrants and Italians, and within the migrant population, during the Great Recession. The findings may reflect differentials in the health status, and barriers to access primary and secondary care among migrants. In this regard, health policies and cuts in health spending measures may have played a key role, and interventions to tackle health and access disparities should include policy measures addressing the underlying factors, adopting a Health in All Policies perspective. Further researches focusing on specific groups of migrants, and on the causes and diagnoses related to the ED utilisation, may help to explain the differences observed.

Mortality inequalities by occupational status and type of job in men and women: results from the Rome Longitudinal Study.

OBJECTIVES: Socioeconomic inequalities have a strong impact on population health all over the world. Occupational status is a powerful determinant of health in rich societies. We aimed at investigating the association between occupation and mortality in a large metropolitan study. DESIGN: Cohort study. SETTING: Rome, capital of Italy. PARTICIPANTS: We used the Rome Longitudinal Study, the administrative cohort of residents in Rome at the 2001 general census, followed until 2015. We selected residents aged 15-65 years at baseline. For each subject, we had information on sex, age and occupation (occupational status and type of job) according to the Italian General Census recognition. MAIN OUTCOME MEASURES: We investigated all-cause, cancer, cardiovascular and accidental mortality, major causes of death in the working-age population. We used Cox proportional hazards models to investigate the association between occupation and all-cause and cause-specific mortality in men and women. RESULTS: We selected 1 466 726 subjects (52.1% women). 42 715 men and 29 915 women died during the follow-up. In men, 47.8% of deaths were due to cancer, 26.7% to cardiovascular causes and 6.4% to accidents, whereas in women 57.8% of deaths were due to cancer, 19.3% to cardiovascular causes and 3.5% to accidents. We found an association between occupational variables and mortality, more evident in men than in women. Compared with employed, unemployed had a higher risk of mortality for all causes with an HR=1.99 (95% CI 1.92 to 2.06) in men and an HR=1.49 (95% CI 1.39 to 1.60) in women. Compared with high-qualified non-manual workers, non-specialised manual workers had a higher mortality risk (HR=1.68, 95% CI 1.59 to 1.77 and HR=1.30, 95% CI 1.20 to 1.40, for men and women, respectively). CONCLUSIONS: This study shows the importance of occupational variables as social health determinants and provides evidence for policy-makers on the necessity of integrated and preventive policies aimed at improving the safety of the living and the working environment.

Prevalence and attitudes to HIV testing among adults visiting public outpatient clinics in Rome: results of the MeDi (Measuring health Disparities in HIV prevention) survey. Part 1.

BACKGROUND: It is estimated that, in Italy, 12 000-18 000 (11-13% of 130 000) HIV-infected subjects are not aware of their serostatus. People in this condition may visit the healthcare system multiple times without being diagnosed. If tested on one of these occasions, they could modify their high-risk behaviours and benefit from treatment, factors that reduce HIV transmission. In Italy, no data on HIV testing in the general population are available so far and little is known on the relationship between socioeconomic determinants (at individual and neighbourhood levels) and testing uptake. METHODS: A large anonymous survey was performed in 2012-2014 on more than 10 000 individuals 18-59 years old who underwent 21 public ambulatories in Rome to determine the proportion of subjects tested for HIV and factors related to testing uptake. Subjects' socio-demographic characteristics, sexual orientation, number of sexual partners, HIV risk behaviour, HIV testing uptake were collected by a self-administered questionnaire. Level of area deprivation was measured at the postal code level by the index of social disadvantage (ISD). Multilevel Poisson regressions were carried out to take heterogeneity between clusters (post code and clinics) into account. RESULTS: Among people participating in the study, 58.1% of subjects self-reported to have been tested at least once for HIV. Those who had one high risk behaviour for HIV-infection were 11% more likely to test than those not reporting any, and subjects who had had a STI (sexually-transmitted-infection) in the past were 12% more likely to test than those who had not had a STI. However only 44% (54% among subjects aged 18-35 years) of those with self-reported risks of contracting HIV had been tested at least once in life. This percentage increases, as expected, with the level of education, but, even so, about 40% of university educated subjects self-reporting risks of contracting HIV had never undergone an HIV test. CONCLUSIONS: This study highlights that, while the percentage of subjects tested is even higher than observed in other western nations, only 44% of subjects, self-reporting risks of contracting HIV, had tested at least once in life and about 40% of university educated subjects self reporting risks of contracting HIV had never tested.