An insight into the occurrence of suicides in jails of an Italian region.

The objective of this study is to explore the personal and environmental causes of suicides in jails of an Italian region, by evaluating the extent of the phenomenon, in order to devise strategies for prevention. The examined documentation deals with all cases of suicide among detainees in the 14 prisons of the region Lazio between 01/01/2008 and 31/12/2014. The factors considered for evaluation concerns the are socio-demographics (age, gender, nationality) as well as legal aspects, prison characteristics (type of crime, judicial state) and method used for the suicide. The results show that the method to commit suicide in prisoners of Lazio is hanged. Suicides occur especially in Italian prisoners. Most prison inmates commit suicide less than one year before the end of the detention period. Since the majority of risk factors for suicide are present before the subject enters prison, it is not easy to observe and check the prisoners once they are in jail. The evaluation of the prisoners should be done during the phase when they first enter the jail and not after the intervening variables associated with the detention have had their effects. This suggests that further studies are necessary to better understand the phenomenon and evaluate the possibility to introduce effective preventive measures.

The human papillomavirus vaccination: a review of the cost-effectiveness studies.

BACKGROUND: The Human Papillomavirus (HPV) is one of the most common sexually transmitted viruses, its infection with certain subtypes is the primary cause of cervical cancer. Several countries conducted specific cost-effectiveness evaluations toward HPV vaccination. The constant growth of healthcare demand, in an economic context characterized by limited resources, requires that the decision-making process be based on the comparison of alternative choices. This study offers an overview of the published cost-effectiveness studies about HPV vaccination. BIBLIOGRAPHIC RETRIEVAL METHOD: The research was performed on the scientific databases MEDLINE and SCOPUS in order to find out journal articles focused on cost-effectiveness of the HPV vaccination. The rational for any exclusion criteria of data in the search is mainly due to lack of relevance to cost-effectiveness information. RESULTS: The literature results were presented according to different groups of countries worldwide. A total of 24 articles were finally retrieved. In spite of the different models and assumptions, most studies showed the cost-effectiveness of vaccination; only two studies considered the vaccination as not cost effective. CONCLUSIONS: HPV vaccination may determine a cost reduction for country-specific National Health Systems. However, the cost-effectiveness of universal HPV vaccination still remains an open debate. It is important that economic analysis of universal HPV vaccination adopts large perspectives than is the case with the existing literature, focusing on the critical issues that still exist in many areas. Reducing cost, increasing duration of efficacy, and integrating vaccines into existing screening and treatment procedures in a cost-effective manner are of crucial importance even as they are a major challenge.

Environmental tobacco smoke: health policy and focus on Italian legislation.

Worldwide tobacco smoking kills nearly 6 million people each year, including more than 600,000 non-smokers who die from smoke exposure. Environmental tobacco smoke (ETS, also called secondhand smoke, involuntary smoke, or passive smoke) is the combination of sidestream smoke, the smoke given off by a burning tobacco product and mainstream smoke, the smoke exhaled by smokers. People may be exposed to ETS in homes, cars, workplaces, and public places, such as bars, restaurants, and recreational settings. In addition, there is another type of smoke which until now has not been recognized: the so-called thirdhand smoke, that comes from the reaction of mainstream smoke and environmental nitrous acid (HNO2) making carcinogenic tobacco-specific nitrosamines (TSNAs). The effects of ETS on human health are well-known, passive smoking is harmful to those who breathe the toxins and it is a serious problem for public health. The smoking ban in Italy had reduced ETS pollution, as in the United States and in other countries all over the world. However, the implementation of comprehensive legislation on smoking policy will necessitate other tobacco control measures for its successful fulfillment: increased media awareness, telephone smoking cessation helplines and smoking cessation support services could be an opportunity to ensure awareness, comprehension and support to those who want to quit smoking. The effectiveness of legislative efforts will also depend on successful enforcement of smoking bans and compliance with the legislation. This review summarizes the evidences about the effect of ETS and provides an overview of smoke-free laws and policies.

Perception of smoke-free policies among workers in an Italian Local Health Agency: survey of opinions, knowledge and behaviours.

AIM: This study evaluated the opinions and knowledge of the Health-Care-Workers and other employees about smoking in the workplace and investigated their perceptions about the implementation and strengthening of smoke-free policies and their views of proposed smoking cessation course. METHODS: This cross-sectional study analyzed data resulting from a questionnaire administered in the Local Health Agency of Rieti (Italy). Comparisons have been made according to smoking status of participants: Ever Smokers (ES) or Never Smokers (NS). RESULTS: The study was conducted on a sample of 300 workers, the majority of whom think that the smoking ban is not observed in the workplace due to lack of respect for colleagues (59.2% of NS vs 40% of ES, p=0.022). Exposure to Secondhand smoke (SHS) is reported by 15.2% of ES and 30.3% of NS (p=0.006). About 50% of the participants think that the smoking ban has led to an improvement in the quality of interpersonal relationships. Strengthening the smoking ban through frequent inspections would be very effective according to 78% of ES and 88% of NS (p=0.043); having smoking cessation courses within the agency would be considered useful by 56% of ES and 68% of NS (p= 0.064). Relatively few respondents knew of the association between smoking and bladder cancer (35.2% of ES and 47.2% of NS, p=0.061), and asthma exacerbation (66% of ES and 77% of NS, p=0.040). Logistic regression models adjusted for age, gender, work categories and smoking status show that ES report that they are less likely to be exposed to SHS (OR= 0.42, 95% CI 0.22-0.78, p=0.006) and to think that people smoke because of lack of respect (OR= 0.46, 95% CI 0.24-0.87, p=0.018). More frequent inspections (OR= 0.50, 95% CI 0.26-0.95, p=0.037) and smoking cessation courses (OR= 0.61, 95% CI 0.37-1.00, p=0.053) are considered less effective by ES. ES are less likely to know that smoking is a cause of bladder cancer (OR= 0.54, 95% CI 0.32-0.90, p=0.019) and asthma exacerbation (OR= 0.53, 95% CI 0.31-0.92, p=0.023). Fifty-seven percent of current smokers would like to quit, but only 41% would join a cessation course in the agency. CONCLUSION: The results obtained may be used to analyze the effectiveness of tobacco control policy and programs aimed at freeing companies from smoke. Policy makers should provide the best possible protection for workers against exposure to SHS, in particular with enforcement of the smoking ban and smoking cessation courses tailored to maximize potential benefits for both workers and employers.

The HPV infection in males: an update.

The role of Human papillomavirus (HPV) in malignant and non-malignant genital diseases in females is well known and the corresponding epidemiological burden has been widely described, in males instead, less is known about the role of the virus in anal, penile and head and neck cancer, and the burden of malignant and non-malignant HPV-related diseases. There are many types of HPV that can infect the epithelium: some types can cause genital warts (low risk genotype), other types (high risk genotypes) can cause cancers of the penis, anus or oropharynx. Relative to females, males tend to be less knowledgeable about the infection: some may view its consequences as less likely and severe for themselves than for females, and thus could perceive vaccination as unnecessary. Including boys in the vaccination program generally exceeded conventional thresholds of good value for money, even under favorable conditions of vaccine protection and health benefits; however, uncertainty still exists in many areas that can either strengthen or attenuate the findings achieved.

A pilot study of the effect of pantothenic acid in the treatment of post-operative ileus: results from an orthopedic surgical department.

OBJECTIVES: Post-operative ileus can also occur in other types of surgery not strictly related to abdomen. The objective of this study was to investigate the efficacy of pantothenic acid administration to stimulate intestinal peristalsis in case of post-operative ileus and estimate the most effective dose. This vitamin can be used for the treatment of chronic atonic intestine or for chronic constipation, but therapeutic indications are not precise in these conditions. PATIENTS AND METHODS: This pilot study has used patients divided in groups treated in post-operative period with physiological solution for patients in control group (Placebo) and Dexpantenolo, which is a derivative in alcohol of pantothenic acid, for all the actively treated patients. The treatments were administered intravenously during the second and third post-operative day, according to the treatment schedule. RESULTS: 60 patients were recruited and they were allocated to five treatment groups or one control group. For males, the median time of the first bowel evacuation was 90 hours while for females the median time was 84 hours (p=0.891). For patients who received a spinal anesthetic, the median time was 72 hours, while for those who received a peridural anesthetic the median time was 96 hours (p=0.571). Between six treatment groups, instead, there is a significant difference between the median times from the operation to the first bowel evacuation (p<0.001). Linear regression model obtained using as outcome evacuation hours after surgery show that only variable which significantly affects time between operation and the first bowel evacuation is treatment dose (Beta = -0.868, p<0.001). DISCUSSION: This study would seem to indicate that pantothenic acid is effective for treatment of post-operative intestinal ileus; there is a dose response relationship between pantothenic acid and the decreasing time from surgical operation to first bowel evacuation. However, this study is preliminary; further studies are necessary, preferably randomized and with a larger number of patients.

Pilot study of the effect of vitamin B6 on the motility of guinea pigs ileum: possible implications for human intestinal motility.

OBJECTIVES: To evaluate the effect of vitamin B6 and neostigmine on the intestinal motility of guinea pigs, to obtain beneficial effects on human health. MATERIALS AND METHODS: Segments of the ileum of guinea pigs have been removed and mounted in an organ bath in order to record their motility when treated with vitamin B6, atropine and neostigmine. This motility has been compared with the contraction produced by acetylcholine. These substances were injected into the cuvette of the apparatus both singularly and in combination. RESULTS: The isolated segments of the ileum of guinea pigs exposed to vitamin B6 (5.91 x 10(-8) M) have asthenic contraction of 59.38 + 11.28 (mean + SD) compared with the peak observed for acetylcholine. When atropine (2.76 x 10(-7) M) was administered during the contraction produced by the vitamin B6, the contraction was blocked. Neostigmine (1.50 x 10(-5) M) on its own produced asthenic contraction 59.16 + 10.11 (mean + SD) compared with the peak observed for acetylcholine. Neostigmine administered after vitamin B6 (5.91 x 10(-8) and 1.48 x 10(-7) M) produces a mean contraction of 104.50 + 8.77 and 108.8 + 12.65 (mean + SD) compared with acetylcholine. CONCLUSIONS: Data reported show that vitamin B6 has an effect on the motility of the ileum of guinea pigs. The contraction produced by the combination of vitamin B6 and neostigmine is greater and more prolonged than that produced by neostigmine alone. This association could improve the efficacy of neostigmine to resolve intestinal asthenia as quickly as possible to obtain beneficial effects on human health.

Dietary habits in Italy: the importance of the Mediterranean diet.

The Mediterranean diet is the heritage of millennia of exchange of people, cultures and foodstuffs throughout the Mediterranean basin. This diet is characterized by abundance of vegetables and fruits, bread, fish, olive oil, poultry, a relatively low consumption of red meat and a moderate consumption of wine during a meal and is well-defined by the food pyramid. Nowadays a standard Western diet has become far more common in Italy, against Mediterranean diet, which stands as a model of health sustainability: it is therefore necessary also to promote suitable resource management and to support quality in food. Practical and large scale projects should be activated, aimed to produce advice about meals both for families and for the different kinds of community, respectively.

A world wide public health problem: the principal re-emerging infectious diseases.

The extraordinary progress in the knowledge of infectious disease, the discovery of antibiotics and effective vaccines are among the great achievement of the nineteenth and twentieth centuries. These achievement have led to a dramatic reduction in the levels of mortality from these diseases. According to the World Health Organization, the term "re-emerging infectious diseases" refers to infectious diseases, which although well known, have not been of recent public health importance. However, climate change, migration, changes in health services, antibiotic resistance, population increase, international travel, the increase in the number of immune-depressed patients ,etc have lead to the re-emergence of these diseases. The climate changes are exposing sectors of the population to inadequate fresh air, water, food and resources for survival which, in consequence, provoke increases in both internal and international migration. In this particular period in which we find ourselves, characterized by globalization, the international community has become aware that the re-emergence of these diseases poses an important risk for public health underlines the necessity to adopt appropriate strategies for their prevention and control. The re-emerging diseases of the twenty-first century are a serious problem for public health and even though there has been enormous progress in medical science and in the battle against infectious diseases, they are still a long way from being really brought under control. A well organized monitoring system would enable the epidemiological characteristics of the infectious diseases to be analyzed and the success or otherwise of preventive interventions to be precisely evaluated. For this reason, the World Health Organization and the European Union have discussed the formation of a collaborative network for the monitoring and control of re-emerging diseases and has initiated special programmes. The battle between humanity and infectious disease has a history lasting thousands of years and is destined to continue in the future emphasizing the need to adopt combined policies for the prevention and control of re-emerging diseases.

Aging populations: the health and quality of life of the elderly.

The progressive tendency for the age structure of the population to shift towards the elderly has been observed in all developed countries and this has important implications for health, society, economics and epidemiology. According to the most recent estimates for the world, the number of persons aged over 60 years will double from the present number, 756 to 1400 millions by 2030. In Italy, by the year 2050, 34.6% of the population will be aged more than 65 years. This will have important implications for health. There are medical conditions that occur almost exclusively among the elderly and these are sometimes referred to as syndromes or geriatric pathologies; other conditions that can occur at younger ages, may present with different symptoms, and cause complications in the elderly. More than just the single pathologies, the presence of two or more conditions simultaneously may have a critical impact on the health status of the elderly. As their ages increase, the elderly may be considered "frail"; factors, not only physical but also psychological cognitive and social, contribute to this syndrome and all must be considered together in the diagnosis and treatment of the elderly patient. These subjects are at greater risk of physical and cognitive decline, disability and death. As the elderly are an increasing fraction of the total patient load, their problems require that the structure and organization of health services be accordingly adjusted and also that the cultural and professional training of doctors and other medical personnel is appropriate. As a consequence, the objective of governments should be to promote the health and the quality of life of the elderly and this would include primary secondary and tertiary prevention applied in a variety of different settings. The choice of the preventive measures should be determined by the general health status of the elderly individuals, of whom 60-75% are classified as healthy, 20-30% are diagnosed as suffering chronic diseases, and 2-10% are regarded as "frail". For pathologies which do not require hospitalization, among the other existing services there is also Integrated Home Help (Assistenza Domiciliare Integrata, ADI) and Medically Assisted Residences (Residenze Sanitarie Assistenziale, RSA).

Obesity in school-aged children: Interpretation of the Body Mass Index in a sample of children and adolescents in Rome.

OBJECTIVES: To evaluate overweight and obesity in a sample of children of school age in the city of Rome (Italy). MATERIALS AND METHODS: A sample of 18.299 school children (9.531 males and 8.768 females) aged between 3 and 15 years was studied. Height and weight have been measured in order to calculate the BMI. The percentile distribution of BMI has been determined and then subdivided according to the categories proposed by Cole. The analysis has been done using the program "Statistica" produced by StatSoft, Italia. RESULTS: The prevalence of overweight exceeded 20% in all age groups with the exception of the two extremes 3 years old and 15 years old in which the prevalence was 11.8% and 15.4% respectively. Children between 5 and 10 years old have the highest rates of obesity. The prevalence of obesity was highest in females between 4 and 8 years, while for the males it was 8 to 15 years. However the difference in the prevalence between males and females was statistically significantly different only in ages 9 and 10. CONCLUSIONS: The prevalence of overweight rises to a peak at age 9, reaching 30%, but declines at older ages. The prevalence of obesity peaks at an earlier age reaching between 12% and 15% at ages 5-8 years. The prevalence of obesity declines as the children get older.

[Climate change and Kyoto protocol]. / Le conseguenze dei cambiamenti climatici sulla salute e sull'am- biente. Il protocollo di Kyoto.

Due to industrial revolution and the heavy use of fossil fuels, the concentration of greenhouse gases in the atmosphere has increased dramatically during the last hundred years, and this has lead to an increase in mean global temperature. The environmental consequences of this are: the melting of the ice caps, an increase in mean sea-levels, catastrophic events such as floodings, hurricanes and earthquakes, changes to the animal and vegetable kingdoms, a growth in vectors and bacteria in water thus increasing the risk of infectious diseases and damage to agriculture. The toxic effects of the pollution on human health are both acute and chronic. The Kyoto Protocol is an important step in the campaign against climatic changes but it is not sufficient. A possible solution might be for the States which produce the most of pollution to adopt a better political stance for the environment and to use renewable resources for the production of energy.

[Emerging and re-emerging diseases]. / Evoluzione delle malattie infettive: malattie emergenti e riemergenti.

The extraordinary progress in the knowledge of infectious disease, the discovery of antibiotics and effective vaccines are among the great achievements of the nineteenth and twentieth centuries. These achievements have led to a dramatic reduction in the levels of mortality from these diseases. However some factors may suggest that new infective agents may develop, that those diseases that already exist may become more aggressive, and that those diseases that had been practically conquered, may re-emerge in the future. Such factors include: antibiotic resistance, national and international migration, population increase and ageing, increase in the number of immuno-suppressed patients.

[The control of infectious diseases: obligatory or optional vaccination? Poliomyelitis: towards eradication?]. / Il controllo delle malattie infettive attraverso l'obbligo o la libera scelta delle vaccinazioni. La poliomielite: verso l'eradicazione?

The change from obligatory to optional or recommended vaccination seems to be inevitable. With obligatory vaccination more than 90% of children are adequately vaccinated against diphtheria, tetanus, poliomyelitis and hepatitis B. In contrast, with an optional or recommended vaccination strategy, it is difficult to obtain control and eradication. At the present time, polio eradication is about 99% but to achieve total eradication will require a considerable organizational and economic investment. Surveillance of AFP (acute flaccid paralysis) indicates the state of polio eradication. Only by monitoring and prevention can we be sure that there is no circulation of wild poliovirus.

[Overweight and obesity]. / Il problema del sovrappeso e dell'obesità.

Being over-weight and obesity are conditions which are becoming ever more common and this trend presents a series of social and psychological problems, apart from the well known health risks such as hypertension, heart disease, type 2 diabetes, orthopaedic problems, cancers of the endometrium and breast etc. The prevention and control of excess weight and obesity is largely based on adopting a healthy lifestyle and above all on diet and exercise. These ideas are also included in the Health Plan for 2002-2004, and are among the ten most important strategic objectives for promoting healthy living, disease prevention and informing the public on health matters.

[Cardiovascular diseases and risk factors]. / Malattie cardiovascolari e fattori di rischio.

The main risk factors for cardiovascular disease which are amenable to intervention for prevention are described. These include smoking, hypertension, hypercholesterolaemia, obesity etc. These risk factors can be ranked in order of importance according to the ratio of the attributable risk to the prevalence of the exposure to the factor in the population.