Italian revised memory and behavior problems checklist (It-RMBPC): validation and psychometric properties in Alzheimer's disease caregivers.

Behavioral and psychiatric symptoms (BPSD), common in persons with Alzheimer's disease (AD), are known to be associated with caregiver burdening. Therefore, early recognition of BPSD is necessary to protect these caregivers. The aim of this validation study was to test the internal consistency, test-retest reliability and concurrent validity of an Italian translation of the revised memory and behavior problems checklist (RMBPC), as it demonstrated high plasticity in timely measuring the day-to-day BPSD changes that challenge caregivers. A cohort of 355 dyads composed of AD subjects and their principal caregivers were assessed with the Italian version of RMPBC capitalizing on the information provided by the latter ones. The results were compared with the ones from other predictors (i.e., the Zarit Burben Interview, the Hospital Anxiety and Depression Scale, the EurQuality of Life, the neuropsychiatric symptoms). The validity and stability of the It-RMBPC resulted being solid and concurrent reliability resulted having higher correlations with principal caregiver anxiety level. Future studies on the role of BPSD in fostering anxiety in AD principal caregivers are merited.

[Focus on electronic cigarettes]. / Focus sulle sigarette elettroniche.

There is no clear regulation on electronic cigarettes (e-cig); their health effects are not yet fully investigated and there is insufficient standardisation and quality control of the product. Moreover, the e-cig could be a gateway for young people to nicotine addiction and traditional cigarette smoking. In Italy, the Ministry of Health banned the sale of e-cig with nicotine firstly to adolescents aged <16 years, then to people <18 years. Until further scientific evidence is available, it is mandatory to regulate the production and marketing of e-cigs, to make them less attractive, to forbid their use in enclosed areas, and prevent them from being promoted. E-cigs, however, seem to be much less dangerous than traditional cigarettes, although the few studies conducted are not sufficient to demonstrate either a clear therapeutic efficacy of e-cig or their total harmlessness. If e-cig had a known content, were made according to clear rules and in certified laboratories, without toxic substances, it could be used to help heavy smokers to quit, or at least to reduce smoking habits. There is a large proportion of smokers who are unable to quit. The revision of the European Directive (the proposal is being evaluated and we are waiting for its final approval) on tobacco recommends free sale for a minority of e-cigs only, those with a nicotine content <4 mg/ml. This will be difficult, considering that the business is just the free sale of e-cig and the much more dangerous tobacco cigarettes are still sold without any restriction.

Predictors of protective behaviours during the Italian Covid-19 pandemic: an application of protection motivation theory.

OBJECTIVE: The study investigated whether Protection Motivation Theory (PMT) constructs predicted recommended protective behaviours soon after the Italian lockdown and 1-year later. DESIGN: A three-wave longitudinal design was used. Three-hundred-fifty-two adults completed online questionnaires with PMT and intention measures assessed during the Italian lockdown (T1), and behaviour measures assessed after 1-month (T2) and 1-year (T3). OUTCOME MEASURES: Intentions to adopt behaviours (T1) and behaviour adherence at T2 and T3. RESULTS: From T2 to T3, participants reported less adoption of distance behaviours, but higher face masks use. In SEM models, self-efficacy and perceived severity were the strongest predictors of intentions to engage in protective behaviours. Intentions (ß = 0.490, p < 0.001) and fear arousal (ß = 0.134 p = 0.035) predicted protective behaviours at T2. Intentions (ß = 0.302, p = 0.001) and perceived severity (ß = 0.431, p < 0.001) predicted protective behaviours at T3. CONCLUSION: To increase intentions, intervention should highlight the severity of getting infected and target perceptions of one's ability to perform the protective behaviours. In addition, interventions should consider that at the beginning of the pandemic, fear predicted the adoption of preventive behaviours while perceived severity of the disease had a greater impact over time.

The Impact of Positivity and Parochial Altruism on Protective Behaviours during the First COVID-19 Lockdown in Italy.

Implementation of COVID-19 protective behaviours, such as social distancing or frequent hand washing during the lockdown, was critical to prevent the spread of the COVID-19 pandemic. In this cross-sectional study, we examined the effect of positivity and parochial altruism on implementing COVID-19 health-protective behaviours during the Italian lockdown. A sample of 460 participants completed an online questionnaire that included demographic measures, Positivity Scale and COVID-19 measures of health-protective behaviours. To measure parochial altruism, we used a hypothetical dictator game played with others who could vary in their social distance from the participants. Results showed that participants in the hypothetical game gave more money to parents and siblings than to best friends, cousins, neighbours, and strangers. Furthermore, both positivity and parochial altruism (more altruism toward close vs. distant people) were positively associated with implementing hygiene behaviours but not with social distancing. Finally, mediation analysis showed that increases in parochial altruism mediated the effect of positivity on hygiene behaviour. These findings extend knowledge about the factors beyond the implementation of COVID-19 health-protective behaviours during a lockdown situation.

Prevalence of amyotrophic lateral sclerosis in Latium region, Italy.

OBJECTIVE: Prevalence estimate of amyotrophic lateral sclerosis (ALS) ranged between 1.1/100,000 and 11.2/100,000 inhabitants with different design of the study (prospective or retrospective) and sample size. The aim of this study is to conduct for the first time an estimate of the ALS prevalence in the Latium region. MATERIALS AND METHODS: The study was performed in Latium, a region located in the center of Italy, with a population, as of January 1, 2016, of 5888.472 inhabitants. In this region, a network of 15 clinical centers (of which 4 referral ALS centers are located in Rome) and 10 local health authorities involved in the diagnosis and treatment of ALS patients has been identified. Each patient was classified according to the El Escorial revised criteria. RESULTS: The prevalence study in 2016 identified 353 ALS cases (200 males). By considering population aged >=20 years, the total crude prevalence rate resulted 7.33 (CI95% 6.59-8.14) × 100,000 and 8.75 and 6.05 in males and females, respectively. Age-specific prevalence rates did not differ among males and females in the population aged less than 49 years. The difference emerged in population aged > 50 years. This type of diagnosis was recorded for 343 patients (11 missing). 68% of these patients have a definite diagnosis, 14% likely, 11% possible, and 12% defined as suspect. CONCLUSIONS: The estimate of prevalence rates observed in this study is probably in line with the values reported in the literature for prospective prevalence studies.

Capacity Building of Health Professionals on Genetics and Genomics Practice: Evaluation of the Effectiveness of a Distance Learning Training Course for Italian Physicians.

BACKGROUND: The rapid spread of personalized medicine requires professionals to manage the "omics revolution." Therefore, the genetics/genomics literacy of healthcare professionals should be in line with the continuous advances in this field, in order to implement its potential implications for diagnosis, control and treatment of diseases. The present study investigates the effectiveness of a distance learning course on genetics and genomics targeted at medical doctors. METHODS: In the context of a project funded by the Italian Ministry of Health, we developed a distance learning course, entitled Genetics and Genomics practice. The course focused on genetic/genomics testing, pharmacogenetics and oncogenomics and was developed according to andragogical training methods (Problem-based Learning and Case-based Learning). We used a pre-test vs. post-test study design to assess knowledge improvement on a set of 10 Multiple Choice Questions (MCQs). We analyzed the proportion of correct answers for each question pre and post-test and the mean score difference stratified by gender, age, professional status and medical discipline. Moreover, the test was submitted to the participants 8 months after the conclusion of the course (follow-up), in order to assess the retained knowledge. RESULTS: The course was completed by 1,637 Italian physicians, most of which were primary care physicians (20.8%), public health professionals (11.5%) and specialist pediatricians (10.6%). The proportion of correct answers increased in the post-test for all the MCQs. The overall mean score significantly increased, from 59.46 in the pre-test to 71.42 in the post-test (p < 0.0001). The comparison in test performance between follow-up and pre-test demonstrated an overall knowledge improvement. CONCLUSION: Genomics literacy among healthcare professionals is essential to ensure optimal translation to healthcare delivery of research. The results of this course suggest that distance-learning training in genetic/genomics practice represents an effective method to improve physicians' knowledge in the immediate and mid-term time scale. A preprint version of this paper is available at: https://www.researchsquare.com/article/rs-10083/v1.

Sleep problems affect quality of life in Parkinson's disease along disease progression.

OBJECTIVES: Non-motor symptoms (NMS) frequently impact health-related quality of life (HRQoL) in patients with Parkinson's Disease (PD). Sleep problems represent one of the main NMS complained by PD patients. In this observation study, sleep problems measured by Parkinson's Disease Sleep Scale - 2nd version (PDSS-2), and HRQoL measured by Parkinson's Disease Questionnaire-39 (PDQ39) were quantified in patients with PD ranging from mild to moderate-advanced disease stages, and correlated to motor impairment and anti-PD therapy. METHODS: We included idiopathic PD patients who underwent PDSS-2 and PDQ39. Moreover, we assessed patients' motor symptoms by rating the Unified Parkinson's Disease Rating Scale (UPDRS) - III section (motor examination), patients' PD status following H&Y stage, and levodopa equivalent daily dose (LEDD). RESULTS: One-hundred and fifty-four patients with PD were included and distributed for H&Y stage. PDSS-2 and PDQ39 total and sub-items scores significantly increased with the H&Y stage. PDSS-2 total score significantly correlated with PDQ39 total score (γ = 0.63, P < 0.01). Finally, distributing PD patients according to the PDSS-2 cut-off for detecting sleep disturbances, we found in poor sleepers (n = 58) higher PDQ39 scores than good sleepers (n = 89). CONCLUSIONS: Sleep problems are very common in patients with PD and severely impact on HRQoL. Sleep impairment and low HRQoL occur from the early stages of the disease and deteriorate along disease progression. Further studies investigating sleep and quality of life should be planned for targeting sleep improvement to increase HRQoL and possibly reduce motor impairment.

A National Survey of Centers for Cognitive Disorders and Dementias in Italy.

BACKGROUND: Italy has one of the oldest populations in the World and more than one million dementia cases can be estimated at the national level. OBJECTIVE: The objectives of this national survey include: 1) to report the administrative features and the professional competencies of Centers for Cognitive Disorders and Dementias (CCDDs); 2) to document possible discrepancies by geographic macro-area; and 3) to identify the features of CCDDs that are associated with a better quality in the provision of care. METHODS: A survey of Italian CCDDs was conducted between February 2014 and December 2015. A list of CCDDs was obtained through direct interactions with designed delegates from each Italian region. A questionnaire was defined on five sections concerning: 1) location of the CCDD; 2) access to the CCDD; 3) organization of the CCDD; 4) services and treatments provided; and 5) quantitative data on the activities of the CCDD. RESULTS: Overall, 577 out of the 597 eligible CCDDs returned the completed survey questionnaire (response rate: 96.6%): 260 (45.1%) from Northern Italy, 103 (17.8%) from Central Italy, and 214 (37.1%) from Southern-Islands Italy. More than a third of CCDDs were open only once or twice weekly. A median of 450 (IQR: 200-800) patients regularly attended these services. Most patients (70%) were affected by dementia or mild cognitive impairment (19%). CONCLUSION: We have provided a snapshot of the organization and activities of CCDDs in Italy and documented existing inequalities in the provision of care.

Correction to: Sleep dysregulation, memory impairment, and CSF biomarkers during different levels of neurocognitive functioning in Alzheimer's disease course.

An amendment to this paper has been published and can be accessed via the original article.

Sleep dysregulation, memory impairment, and CSF biomarkers during different levels of neurocognitive functioning in Alzheimer's disease course.

BACKGROUND: Alzheimer's disease (AD) is frequently accompanied by sleep impairment, which can induce AD-related neurodegeneration. We herein investigated the sleep architecture, cognition, and cerebrospinal fluid (CSF) biomarkers (tau proteins and ß-amyloid42) during AD progression from subjective cognitive impairment (SCI) to mild cognitive impairment (MCI) and eventually to AD dementia, and compared the results with cognitively normal (CN) subjects. METHODS: We included patients affected by SCI, MCI, mild AD, and moderate-to-severe AD in our study along with CN subjects as controls. All the subjects underwent nocturnal polysomnography to investigate sleep, neuropsychological testing to evaluate cognition, and lumbar puncture for CSF AD biomarkers assessment. RESULTS: Sleep (both rapid eye movement (REM) and non-REM sleep) and memory function are both progressively impaired during the course of AD from SCI to mild and subsequently to moderate AD. Further, sleep dysregulation appears earlier than cognitive deterioration, with a reduction of CSF ß-amyloid42 level. CONCLUSION: Sleep, memory, and CSF AD biomarkers are closely interrelated in AD progression from the earliest asymptomatic and preclinical stages of the disease related in AD since the earliest and preclinical stages of the disease.

A Systematic Review and Meta-Analysis on the Prevalence of Dementia in Europe: Estimates from the Highest-Quality Studies Adopting the DSM IV Diagnostic Criteria.

BACKGROUND: Dementia, including Alzheimer's disease (AD), is one of the most burdensome medical conditions. Usually, the reviews that aim at calculating the prevalence of dementia include estimates from studies without assessing their methodological quality. Alzheimer's Disease International (ADI) proposed a score to assess the methodological quality of population-based studies aimed at estimating the prevalence of dementia. During the last three years, the European Commission has funded three projects (Eurodem, EuroCoDe, and ALCOVE) in order to estimate the prevalence of dementia in Europe. OBJECTIVE: The aim of this study was to perform a systematic review and meta-analysis of data on the prevalence of dementia in Europe derived from studies that included only subjects with a diagnosis of dementia according to the DSM IV criteria, and that had a high quality score according to ADI criteria. METHODS: We considered the studies selected by the two projects EuroCoDe (1993-2007) and Alcove (2008-2011), and we performed a new bibliographic search. For the systematic review, we only selected the subset of articles that included subjects with a diagnosis of dementia according to the DSM IV criteria. The studies were qualitatively assessed using the ADI tool. RESULTS: The meta-analysis considered 9 studies that were carried out in Europe between 1993 and 2018 including a total of 18,263 participants, of which 2,137 were diagnosed with dementia. The prevalence rate standardized for age and sex resulted 7.1%. DISCUSSION: This is the first systematic review on the prevalence of dementia in Europe considering only high-quality studies adopting the same diagnostic criteria (i.e., DSM IV).

Use of neuropsychological tests for the diagnosis of dementia: a survey of Italian memory clinics.

AIM: Providing an overview of the neuropsychological tests used in Italian memory clinics (defined as Centers for Cognitive Disorders and Dementias-CCDD in Italy) for the diagnosis of cognitive disorders and dementias. METHODS: A total of 501 CCDD, out of all 536 active CCDD, were surveyed between February 2014 and August 2015 to verify the characteristics of the centres who performed a comprehensive neuropsychological assessment (NPA), defined as the administration of at least one test for verbal and visual episodic memory, attention, constructional praxis, verbal fluency and executive functions (minimum core tests-MCTs), as part of the diagnostic process. RESULTS: A total of 45.7% of Italian CCDD performed a comprehensive MCT as part of the diagnostic process. The logistic regression model showed that the probability of including at least one psychologist in the team was higher in the CCDD that reported using a comprehensive NPA (OR 4.55; 95% CI 2.92 to 7.1), that CCDD in Southern Italy had a lower probability of using an MCT (OR 0.56; 95% CI 0.35 to 0.89) and that the use of an MCT was higher in university/Institute for Scientific Research and Healthcare CCDD (OR 10.97; 95% CI 3.85 to 31.25). CONCLUSION: Almost half of the CCDD administered a set of MCTs; while the remaining centres only performed few tests or screening procedures. The neuropsychological tests used in Italian CCDD were comparable with those used in other European countries. Performing a comprehensive NPA remains the best way to assess and monitor cognitive deficits over time, thus further debate on the current status of NPAs in clinical practice is needed.

An Estimate of Attributable Cases of Alzheimer Disease and Vascular Dementia due to Modifiable Risk Factors: The Impact of Primary Prevention in Europe and in Italy.

BACKGROUND: Up to 53.7% of all cases of dementia are assumed to be due to Alzheimer disease (AD), while 15.8% are considered to be due to vascular dementia (VaD). In Europe, about 3 million cases of AD could be due to 7 potentially modifiable risk factors: diabetes, midlife hypertension and/or obesity, physical inactivity, depression, smoking, and low educational level. AIMS: To estimate the number of VaD cases in Europe and the number of AD and VaD cases in Italy attributable to these 7 potentially modifiable risk factors. METHODS: Assuming the nonindependence of the 7 risk factors, the adjusted combined population attributable risk (PAR) was estimated for AD and VaD. RESULTS: In Europe, adjusted combined PAR was 31.4% for AD and 37.8% for VaD. The total number of attributable cases was 3,033,000 for AD and 873,000 for VaD. In Italy, assuming a 20% reduction of the prevalence of each risk factor, adjusted combined PAR decreased from 45.2 to 38.9% for AD and from 53.1 to 46.6% for VaD, implying a 6.4 and 6.5% reduction in the prevalence of AD and VaD, respectively. CONCLUSION: A relevant reduction of AD and VaD cases in Europe and Italy could be obtained through primary prevention.

[Characteristics and effectiveness of smoking cessation programs in Italy. Results of a multicentric longitudinal study]. / Interventi per la cessazione dell'abitudine al fumo in Italia: offerta ed efficacia nella pratica. Risultati di uno studio longitudinale multicentrico.

AIM: to describe the characteristics and effectiveness of various smoking cessation programs offered by Italian treatment services operating within the National Health Service. DESIGN: prospective longitudinal multicentre study involving 41 smoking cessation services in 16 Italian regions. STUDY POPULATION: the study population includes patients entering smoking cessation programs between April 2003 and June 2004. The "study population" includes 1226 patients (54.2% males and 45.4% females), mean age 47 years. Patients have a middle/high level of education and a long history of smoking; most are highly dependent on nicotine and report previous attempts to quit smoking. METHODS: treatment effectiveness in smoking cessation is assessed six months after entering treatment service. Logistic Regression Model was used to determine the predictors of successfiul cessation, independent of treatment typology. The predictors were included as confounding variables in the logistic regression model that was used to evaluate the effectiveness of treatments. Besides the effect of treatment completion on smoking cessation was estimated. RESULTS: predictors of successful smoking cessation are: being male, presence of a partner, strong motivation to quit, previous attempts to give up smoking, mild nicotine dependence, and not suffering from mood disturbances. All treatments are effective in helping people to stop smoking: cessation rate ranges between 25.00% for patients receiving a single session of motivational counselling and 65.3% for those receiving nicotine replacement therapy combined to group therapy. Compared to a single session of motivational counseling, nicotine replacement therapy combined to group therapy is the most effective therapeutic program (OR 5.4; 95%CI 12.5-12.0). Treatment completion is a strong determinant ofsuccess (OR 4.8; 95%CI 3.5-6.4). CONCLUSION: enrolling people in any type of therapeutic program, in particular nicotine replacement therapy combined with group therapy increases the probability of successfully quitting smoking; moreover, patients that begin a smoking cessation program should be encouraged to complete the therapy

Survey of health and social-health services for people with dementia: methodology of the Italian national project.

People with dementia have special assistance needs. Worldwide problem is to ensure access to quality health services. Our study supported by the Italian Ministry of Health reports methodology features of a large survey project conducted to identify and to collect information on health and social health services for people with dementia in Italy. Among all Italian regions, about two thousand services available to individuals with dementia disease and their caregivers were identified. These services included memory clinics, daycare centers and residential care facilities, totally or partially covered by the public healthcare service. A survey questionnaire was designed to collect information and a web-platform system was developed to manage data from all services. Of great importance, the web-platform is capable to display surveyed services as an on-line map regularly updated and easily accessible from the Dementia Observatory website (www.iss.it/demenza).

[From mild cognitive impairment to dementia: what is the role of public health?] / Dal mild cognitive impairment alla demenza: qual è il ruolo della sanità pubblica?

Mild cognitive impairment (MCI) is a nosological entity proposed by Petersen in 1999 with the objective of identifying an early stage of dementia. The new diagnostic criteria for dementia, both those promoted by the International Working Group (IWG) and those defined by the National Institute of Aging (NIA), subsequently introduced a new model that starts with a preclinical phase, then proceeds with a prodromal phase, and ends with a phase of dementia. The condition known as subjective cognitive disorder (SCD) is included between the preclinic and the prodromal phases. Most clinicians improperly consider MCI and SCD as diseases, and not as risk factors for dementia. This ambiguous scenario requires the application of a public-health standard. A diagnosis of either SCD or MCI comes with several uncertainties, raising issues pertaining to both the research setting and clinical practice. A large proportion of subjects with either SCD or MCI will never progress to dementia, and part of them may even revert to a normal cognitive profile. Thus, communicating of these diagnoses to a subject has ethical implications that cannot be underestimated. The frequency of these diagnoses in general population is starting to show the characteristics of both the phenomena of over-diagnosis, and consequently over-treatment. Moreover, the new criteria require the use of biomarkers, that are not yet validated for the use in clinical practice. No population studies are currently available performed based on the new diagnostic criteria for dementia. This means that future estimates will probably be more than twice the current ones, and will include also subjects that will not progress to dementia. This undefined framework, thus, urges the implementation of public-health programs aimed at both the primary and secondary prevention of dementias. Moreover, clinical trials on drugs in MCI currently use endpoints based on non-validated biomarkers, thus raising the issue of the external validity. A public guideline would thus be crucial to support clinicians in identifying all the possible causes that can determine a cognitive decline people that are mainly elder, with multiple comorbidities, and taking multiple medications. Moreover, the widespread use of neuro-psychological assessment tools in current clinical practice requires an accurate validation of these instruments.

Construct validity of the Free and Cued Selective Reminding Test in older adults with memory complaints.

INTRODUCTION: The Free and Cued Selective Reminding Test (FCSRT) is the memory test recommended by the International Working Group on Alzheimer's disease (AD) for the detection of amnestic syndrome of the medial temporal type in prodromal AD. Assessing the construct validity and internal consistency of the Italian version of the FCSRT is thus crucial. METHODS: The FCSRT was administered to 338 community-dwelling participants with memory complaints (57% females, age 74.5 ± 7.7 years), including 34 with AD, 203 with Mild Cognitive Impairment, and 101 with Subjective Memory Impairment. Internal Consistency was estimated using Cronbach's alpha coefficient. To assess convergent validity, five FCSRT scores (Immediate Free Recall, Immediate Total Recall, Delayed Free Recall, Delayed Total Recall, and Index of Sensitivity of Cueing) were correlated with three well-validated memory tests: Story Recall, Rey Auditory Verbal Learning test, and Rey Complex Figure (RCF) recall (partial correlation analysis). To assess divergent validity, a principal component analysis (an exploratory factor analysis) was performed including, in addition to the above-mentioned memory tasks, the following tests: Word Fluencies, RCF copy, Clock Drawing Test, Trail Making Test, Frontal Assessment Battery, Raven Coloured Progressive Matrices, and Stroop Colour-Word Test. RESULTS: Cronbach's alpha coefficients for immediate recalls (IFR and ITR) and delayed recalls (DFR and DTR) were, respectively, .84 and .81. All FCSRT scores were highly correlated with those of the three well-validated memory tests. The factor analysis showed that the FCSRT does not load on the factors saturated by non-memory tests. CONCLUSIONS: These findings indicate that the FCSRT has a good internal consistency and has an excellent construct validity as an episodic memory measure.

The Italian Dementia National Plan. Commentary.

The Italian Dementia National Plan was formulated in October 2014 by the Italian Ministry of Health in close cooperation with the regions, the National Institute of Health and the three major national associations of patients and carers. The main purpose of this strategy was to provide directive indications for promoting and improving interventions in the dementia field, not limiting to specialist and therapeutic actions, but particularly focusing on the support of patients and families throughout the pathways of care. Four main objectives are indicated: 1) promote health- and social-care interventions and policies; 2) create/strengthen the integrated network of services for dementia based on an integrated approach; 3) implement strategies for promoting appropriateness and quality of care; and 4) improve the quality of life of persons with dementia and their families by supporting empowerment and stigma reduction. These objectives and the pertaining actions are described in the present paper.

A helpline telephone service for tobacco related issues: the Italian experience.

Antismoking helplines have become an integral part of tobacco control efforts in many countries, including Italy. The demonstrated efficacy and the convenience of telephone based counselling have led to the fast adoption of antismoking helplines. However, information on how these helplines operate in actual practice is not often readily available. This paper provides an overview of the Italian Antismoking Helpline, an increasingly popular telephone service for tobacco problems operating in Italy since 2000. As many states, regions and nations are contemplating various telephone programs as part of large scale anti-tobacco campaigns, this paper briefly discusses the reasons the helpline is well suited to lead the cessation component of a comprehensive tobacco control program, how it operates and how it can be used in conjunction with other tobacco control activities. The Italian Antismoking Helpline provides Italians with free services that include counselling, cessation related information, self help quit kits and current legislation information. The helpline is promoted statewide by media campaigns, health care providers, local tobacco control programs and public school system. The Helpline is centrally operated through the Istituto Superiore di Sanità and it has served over 17.000 tobacco users and others.

National survey of the smoking cessation services in Italy.

This investigation is aimed at providing information about structural and organizational characteristics of smoking cessation services (SCS) set up within the Italian National Health Service. Local health units and hospitals are the main institutions connected with SCS which are mainly located within the Department of Drug Addiction and the Department of Lung and Breath Care. SCS provide different tobacco-use cessation programs. Although pharmacotherapy is always used, a combination of therapeutic treatments is highly preferred. This study shows the importance of maintaining a national coordination among different SCS supporting their activity and encouraging the start up of additional services throughout the country.