HAPPY MAMA Project (Part 2)-Maternal Distress and Self-Efficacy: A Pilot Randomized Controlled Field Trial.

INTRODUCTION: The aim of the pilot randomized controlled field trial is to assess if a midwifery intervention is able to increase the maternal self-efficacy and reduce the stress level during the first six months after birth. METHODS: The study was conducted in two different hospitals in Rome, Italy, involving women delivering at or beyond term, aged >18 years old and with normal APGAR scores of the infant. The participants were randomly divided into two groups: "Individual Intervention Group" (they received home midwifery assistance for one month after birth, I) and the "Control Group" (C). A self-administered questionnaire was administered four times: at the baseline about one week after the hospital delivery (T0), after the intervention about one month after the delivery (T1), and at three months (T2) and at six months after birth (T3). The questionnaire included different validated scales needed to assess maternal perceived self-efficacy (KPCS), parental stress scale stress (PSS) and maternal depressive risk symptoms (EPDS). RESULTS: The study population counted 51 mothers: 28 women in the "C" group and 23 women in the "I" group. The PSS score was statistically higher in the "C" than "I" group at T1 (p = 0.024); whereas the KPCS score was statistically higher in the "I" (p = 0.039) group; EPDS score did not show significant difference between the two groups in the follow-up period. An inverse significant correlation between KPCS and PSS was found during the study window time (p < 0.0001). CONCLUSIONS: These results potentially give the opportunity to explore this area of focus further, in order to better address maternal individual needs for the successful transition to motherhood. More research in this area is required.

[Association between socio-demographic factors and eye diseases of italian university employees subjected to health surveillance: an observational study]. / Associazione fra fattori socio-demografici e le patologie oculari dei dipendenti di un Ateneo italiano sottoposti a sorveglianza sanitaria: uno studio osservazionale.

SUMMARY: Background. Workers exposed to occupational hazards for the ocular apparatus are subject to health surveillance which includes an eye examination. Objectives. To assess the prevalence of eye diseases among University employees and analyze the association between socio-demographic factors and eye conditions by analyzing computerized data. Methods. A cross-sectional study was conducted on the collected data. A univariate analysis and a logistic regression were performed to verify the association between eye diseases and socio-demographic factors, such as gender and age. This study was carried out using a database of computerized eye charts of a University of Rome, referring to the 2017-2018 period. Results. The sample study consists of 4503 employees, 44.86% men 55.13% women. The average age was 44.53 years. The most frequent eye conditions in University workers are refractive ones: myopia (53.87%), astigmatism (37.95%), presbyopia (34.06%), hypermetropia (14.25%). Multivariate analysis shows that increasing age is associated with an increase in risk with all outcome variables, except for myopia (OR = 0.98; 95% CI: 0.97 - 0.98). Moreover, women have a lower risk of astigmatism (OR = 0.83; C 95%: 0.73 - 0.94), keratoconus (OR = 0.22; 95% CI: 0.09 - 0.54) and dyschromatopsia (OR = 0.08; 95% CI: 0.02 - 0.34). Conclusions. Considering the high number of workers involved in the study, the frequency of exposure to occupational risks and the exposure to multiple risk factors at the same time in some categories of workers, the health surveillance resulted to be a useful tool for monitoring and control of eye diseases in workers at risk.

Smoking Prevalence, Attitudes and Behavior among Dental Students in Poland and Italy.

The aim of the study was to perform preliminary research to compare the smoking prevalence, attitudes and behavior between dentistry students in two universities in Europe using the standardized Global Health Professions Student Survey (GHPSS) questionnaire. This was cross-sectional carried out among dentistry students from the Medical University in Bialystok, Poland and Sapienza University of Rome, Italy. There were 582 participants; 282 were Italians, 202 were smokers and 42% were Italians. The response rate was 79.9% of Italian students and 79.6% of Polish students. The prevalence of smoking was significantly higher among Italian students (42% vs. 28.0%). Attitudes and behaviour of smokers and non-smokers differed statistically. Polish and Italian dental students presented statistically different behavior regarding the time to smoke the first cigarette, the willingness to stop smoking and trying to stop smoking in the last year. The multiple logistic regression analysis revealed that two independent variables, exposure to second-hand smoke (SHS) both at home and in public places (OR = 3.26 and OR = 5.9, respectively), showed a significantly higher occurrence of smoking. There is a high use of tobacco among dental students, which is particularly high in Italian dental students. Students realizes the positive perception of their own tobacco counsellor role in a dental setting. Dental students should be role models to their peers and patients.

ImmunizziAMO: A School-Based Field Trial to Teach New Generations the Importance of Vaccination through Games and to Fight Vaccine Hesitancy in Italy.

BACKGROUND: Vaccines simulate the first contact with infectious agents and evoke the immunological response without causing the disease and its complications. High rates of immunization among the population guarantee the interruption of the transmission chain of infectious diseases. Therefore, the population should be aware of the value of vaccination and motivated. In order to implement the spread of a correct culture about these issues, schools were recognized as a privileged operational setting. The aim of this project was to transmit knowledge and convey educational messages on the importance of vaccines, through the use of games, in elementary school children, their families and teachers. MATERIALS AND METHODS: A field trial study was implemented between April and October 2019. Sample size calculations highlighted the need to recruit at least 136 students in the schools. The intervention involved 10 classes (five first grade and five s grade classes) and was structured in frontal teaching sessions and gaming sessions. Knowledge was assessed comparing the results of a questionnaire administered before and after the intervention. The questionnaires referred to the following items: dangerousness of bacteria and viruses; capability of defending from microorganisms; the role of antibodies; functioning of the vaccine in a child; type of disease for which a vaccine is efficacious; duration of a vaccine; mother- child transmission of antibodies; herd immunity. RESULTS: 143 children participated in all the phases of the study. The comparison between the scores at the beginning and end of the intervention showed a significant increase in the knowledge about vaccines and immunity. The mean knowledge score arose from 3.52 (SD = 1.67) to 5.97 (SD = 1.81). CONCLUSIONS: This study suggests that the use of games in an elementary school effectively increase the knowledge related to the important topic of vaccination starting at childhood.

Are There Effective Interventions to Increase Physical Activity in Children and Young People? An Umbrella Review.

BACKGROUND: Obesity and physical inactivity among children and young people are public health concerns. While numerous interventions to promote physical activity are available, little is known about the most effective ones. This study aimed to summarize the existing evidence on interventions that aim to increase physical activity. METHODS: A systematic review of reviews was conducted. Systematic reviews and meta-analyses published from January 2010 until November 2017 were identified through PubMed, Scopus and the Cochrane Library. Two reviewers independently assessed titles and abstracts, performed data extraction and quality assessment. Outcomes as level of physical activity and body mass index were collected in order to assess the efficacy of interventions. RESULTS: A total 30 studies examining physical activity interventions met the inclusion criteria, 15 systematic reviews and 15 meta-analyses. Most studies (N = 20) were implemented in the school setting, three were developed in preschool and childcare settings, two in the family context, five in the community setting and one miscellaneous context. Results showed that eight meta-analyses obtained a small increase in physical activity level, out of which five were conducted in the school, two in the family and one in the community setting. Most promising programs had the following characteristics: included physical activity in the school curriculum, were long-term interventions, involved teachers and had the support of families. CONCLUSION: The majority of interventions to promote physical activity in children and young people were implemented in the school setting and were multicomponent. Further research is needed to investigate nonschool programs.

Yoga and Mindfulness as a Tool for Influencing Affectivity, Anxiety, Mental Health, and Stress among Healthcare Workers: Results of a Single-Arm Clinical Trial.

Mindfulness-based interventions have emerged as unique approaches for addressing a range of clinical and subclinical difficulties such as stress, chronic pain, anxiety, or recurrent depression. Moreover, there is strong evidence about the positive effects of yoga practice on stress management and prevention of burnout among healthcare workers. The aim of this study was to conduct a single-arm clinical trial to assess the effectiveness of an intervention based on mindfulness-based stress reduction and yoga in improving healthcare workers' quality of life. Healthcare workers of two hospitals in Rome were enrolled in a 4-week yoga and mindfulness course. Four questionnaires were administered at different times (Short Form-12 (SF-12), State-Trait Anxiety Inventory (STAI) Y1 and Y2, and Positive and Negative Affect Schedule (PANAS)) to evaluate the efficacy of the intervention. Forty participants took part to the study (83.3 %). The Mental Composite Score-12, that is part of the quality of life assessment, passed from a median of 43.5 preintervention to 48.1 postintervention (p = 0.041), and the negative affect passed from a score of 16 in the preintervention to 10 in the postintervention (p < 0.001). Both the forms of the STAI questionnaires showed a decrease after the intervention. Yoga and mindfulness administered together seem to be effective to reduce stress and anxiety in healthcare workers, providing them with more consciousness and ability to manage work stressful demands.

Health-related quality of life and its associated factors: results of a multi-center cross-sectional study among university students.

BACKGROUND: The decline of health among university students represents an important and growing public health concern. Health problems and unhealthy lifestyle habits are common among many students, but factors influencing students' health are not fully understood. METHODS: Italian university students from different study programs and curriculum years were asked to fill out a self-administered questionnaire, collecting data about age, gender, curriculum year, study program and health-related quality of life (QOL). Two latent factors were extracted: physical component summary score and mental component summary score. T-test, one-way ANOVA, multivariate and age and sex-stratified analyses were performed. RESULTS: Students scored relatively poor on health-related QOL, with an overall mental component summary score of 41,3% (± 10,0) and physical component summary score of 52,9% (±6,0), with significantly higher mental component summary score for male students (P = < 0,005). Studying economics, law (b = -2,513, P = 0,007) or engineering (b = -2,762; P = 0,001) was associated to negatively influence students' health. CONCLUSIONS: Factors such as study program are associated with health-related QOL. Further longitudinal studies assessing additional socio-demographic factors are needed to fully assess what influences students' health. Students' health should be at the top of the agenda of public health researchers, academic supervisors and policy-makers.

"GiochiAMO," a Gaming Intervention to Prevent Smoking and Alcohol Habits Among Children: A Single-Arm Field Trial.

Objectives: To evaluate the efficacy of the "GiochiAMO" prevention program on modifying children's knowledge and belief regarding the use and abuse of alcohol and tobacco smoking. Materials and Methods: "GiochiAMO" is a multicomponent single-arm field trial based on card and board games to teach and enhance knowledge about risk factors related to smoking and alcohol consumption. A structured questionnaire was administered before and after the intervention to assess any change in knowledge. Results: A total of 167 students between 9 and 11 years of age took part in the intervention. Data concerning knowledge about cigarette smoking showed a statistically significant improvement (P = 0.008) with an increase of the mean scores from 5.93 (standard deviation [SD] = 2.05) to 7.90 (SD = 2.03). The scores related to the life skills of the intervention performed in the fourth grade classes demonstrated statistically significant improvements (P = 0.027). The scores related to the knowledge about alcohol consumption highlighted a statistically significant improvement (P < 0.001), with mean scores that rose from 7.44 (SD = 1.99) to 9.41 (SD = 1.94). The scores related to the life skills of the intervention performed in the fifth grade classes demonstrated improvements, although they were not statistically significant (P = 0.770). Conclusions: "GiochiAMO" demonstrated significantly improved knowledge about the risk and consequences of cigarette smoking and alcohol consumption on health. Longer follow-up studies, including a larger sample size, will be needed.

["Enjoy the Sport - Schools against doping and drug dependence": a health education intervention in secondary schools]. / "Enjoy the Sport - la scuola contro il doping e le dipendenza 2.0". Intervento di educazione alla salute sul doping e droga: uno studio di campo nella scuola secondaria.

INTRODUCTION: The use of doping substances is growing not only in young athletes performing competitive and non-competitive sports, but also in amateur sports, thereby representing a social and public health problem. The aim of this study was to measure knowledge, attitudes and opinions on doping and drugs and their effects, among students of secondary schools, and to assess the effectiveness of a health education intervention. "Enjoy the Sport- the school against doping and addiction 2.0" is a program developed to discourage the use of drugs, in particular doping drugs, by introducing information on the origins, on the effects of drugs and examples of appropriate lifestyles. This project was conceived by C.I.S.C.O.D. (Comitato Italiano Sport Contro Droga), an association of the C.O.N.I. and carried out with its support. MATERIALS AND METHODS: The "Enjoy" project was a study with a one-arm experimental design and with a pre-post evaluation. A multiple-choice questionnaire was used to measure adolescents' knowledge, attitudes and opinions on doping and its effects. A descriptive analysis and post-pre intervention comparison was performed with the McNemar test. RESULTS: There was a significant increase in participants' knowledge of doping substances indicated by the WADA (World Anti-Doping Agency) (p<0.001) and a better understanding of the meaning of the term "doping". A decrease in the number of adolescents who would use doping substances (pre = 0.06%; post = 0.0%) was observed, as well as an increase in the number of adolescents who do not consider fair that athletes of any level should use substances that alter their performance (pre = 83.7%; post = 85%). A significant increase was observed in the proportion of participants who believe that athletes should not use doping substances because they are harmful to the human organism (pre = 38.6%; post = 51.7%) (p<0.001). CONCLUSIONS: The project "Enjoy the Sport" contributed to increasing the health literacy of secondary school students about doping (and consequent awareness of the negative aspects of drug use). Schools, therefore, are an appropriate setting for implementing educational interventions for the prevention of doping. However, it is fundamental to integrate knowledge and action, especially in the context of family, sport and sports associations.

[Return to work in patients with colorectal cancer: a systematic review]. / Il ritorno al lavoro nei pazienti con cancro del colon retto: una revisione sistematica.

OBJECTIVES: to estimate the effect on the return to work of patients with neoplastic colorectal disease. Specifically, it was assessed whether and how the return to work affects the quality of life, and the psychological and social sphere of patients with colorectal carcinoma. DESIGN: in June 2018, a systematic review of the literature was performed, investigating the Medline (PubMed) and Scopus databases. SETTING AND PARTICIPANTS: the studies included in the review focused on patients with a diagnosis of colorectal cancer as a test population. MAIN OUTCOME MEASURES: return to work in patients with a diagnosis of colorectal cancer. RESULTS: after the screening process, 10 articles were included in the research: • 6 studies assessed the effects that work and return to employment have on patients diagnosed with cancer; • 1 study assessed the effects of the disease and treatments on personal finances; • 1 study assessed the influence of medical treatments on the ability to return to work; • 1 study assessed the effect of the diagnosis of cancer on employment; • 1 study assessed the management of cancer diseases by employers. The included studies show a significant impact on the subjects' emotional sphere, with repercussions on employment levels that fall from 39% to 31% in the first 15 months after diagnosis. Complications and critical issues related to therapeutic pathways influence private finances. When compared to healthy subjects, cancer patients show a greater reduction in expenses for food or clothing (39% vs. 27%; p=0.001) and a higher probability of requiring loans (18% vs. 11%; p=0.007). CONCLUSION: among the interventions that protect the well-being of the patient after the tumour disease, the returning to work is a crucial aspect. The impact that employment has on the quality of life of the patient and on the achievement of economic and social well-being for the individual and for the community are important.

Effectiveness over time of a multimodal intervention to improve compliance with standard hygiene precautions in an intensive care unit of a large teaching hospital.

Background: Standard hygiene precautions are an effective way of controlling healthcare-associated infections. Nevertheless, compliance with hand hygiene (HH) guidelines among healthcare workers (HCWs) is often poor, and evidence regarding appropriate use of gloves and gowns is limited and not encouraging. In this study, we evaluated the ability over time of a multimodal intervention to improve HCWs compliance with standard hygiene precautions. Methods: Trend analysis of direct observations of compliance with HH guidelines and proper glove or gown use was conducted in the medical/surgical intensive care unit (ICU) of Umberto I Teaching Hospital of Sapienza University of Rome. The study consisted of two phases: a six-month baseline phase and a 12-month post-intervention phase. The multimodal intervention was based on the World Health Organization strategy and included education and training of HCWs, together with performance feedback. Results: A total of 12,853 observations were collected from November 2016 to April 2018. Overall compliance significantly improved from 41.9% at baseline to 62.1% (p < 0.001) after the intervention and this improvement was sustained over the following trimesters. Despite variability across job categories and over the study period, a similar trend was observed for most investigations. The main determinants of compliance were job category (with nurses having the highest compliance rates), being a member of ICU staff and whether delivering routine, as opposed to emergency, care. HH compliance was modified by glove use; unnecessary gloving negatively affected HH behaviour while appropriate gloving positively influenced it. Conclusions: The multimodal intervention resulted in a significant improvement in compliance with standard hygiene precautions. However, regular educational reinforcement and feedback is essential to maintain a high and uniform level of compliance.

What public health strategies work to reduce the tobacco demand among young people? An umbrella review of systematic reviews and meta-analyses.

OBJECTIVE: To perform an umbrella review of systematic reviews and meta-analyses of health policy and health promotion strategies to reduce the tobacco demand in adolescents, youth and young adults. METHODS: Reviewers independently performed an electronic database search, reviewed titles and abstracts, assessed articles' eligibility for inclusion and quality, and extracted relevant data. Only systematic reviews and meta-analyses reporting data on tobacco policies and interventions focusing on individuals aged <25 years were included. The Framework Convention on Tobacco Control was used to guide data synthesis. RESULTS: 13 articles were included. Studies were of mixed quality with five studies ranked as critically low and seven as high quality. Overall, mixed results were found on the effectiveness for tobacco policies and interventions. Strategies such as increasing taxes on tobacco products were most promising. CONCLUSION: Though data on a variety of measures to reduce smoking is available, conclusions concerning the effectiveness are inconclusive. Tobacco policies and interventions have the potential to reduce smoking, but conclusions are hampered due to both lack of high-quality trials and numerous biases in primary studies. Further high-quality research is required to examine the effectiveness of interventions and policies to reduce the tobacco demand in adolescents, youth and young adults.

Socioeconomic Deprivation Status and Air Pollution by PM10 and NO2: An Assessment at Municipal Level of 11 Years in Italy.

The aim of this observational study was to assess the relationship between environmental risk factors and some aspects of social economic status (SES) of the population in different Italian municipalities. Nitrogen dioxide (NO2) and particulate matter (PM10) annual means were extracted from ISPRA-BRACE (environmental information system of 483 Italian municipalities, 6% of the total amount of administrative units) from 2002 to 2012. As an indicator of sociodemographic and SES data, we collected the following: resident population, foreign nationality, low level of education, unemployment, nonhome ownership, single-parent family, and overcrowding. Low educational level, unemployment, and lack of home ownership were indirectly associated with the higher mean values of NO2 at the statistically significant level (p < 0.05). Major resident population and rental housing percentage determined higher levels of PM10. Northern regions showed similar results compared to the national level, with the exception of foreign residency that showed direct correlation with the increase of PM10. The central regions showed a direct relationship between NO2 and PM10 levels and higher educational levels and between NO2 levels and percentage of single-parent family. In the southern areas, higher NO2 levels were correlated with a higher rental housing percentage, as well as higher PM10 levels with a higher percentage of unemployment and lower housing density. The study shows high heterogeneity in the findings but confirms the relationship between high educational level and employment with the increased concentration of pollutants. The higher rental housing percentage may increase the pollutants' levels too. The housing density does not seem to be in relationship with NO2 and PM10 at the national level. The analysis stratified by geographical areas showed that the direction of the correlations was different over time as the analysis was at a national level. The study represents an example of how data from national information systems can provide a preliminary evaluation and be a comparative tool for policy-makers to assess environmental risk factors and social inequalities.

Health related quality of life and physical activity in prison: a multicenter observational study in Italy.

Background: Inmates have a poorer health status than the general population. The physical activity is well know that improve the wellness of the people. This multicentric cross-sectional study aimed to assess the relationship between Quality of Life (QoL) and physical activity levels among Italian prisoners. Methods: Inmates from eight prisons compiled a questionnaire. The Metabolic Equivalent of Task (MET) was used to measure inmates' weekly physical activity levels (MATwk). Their QoL was measured using two components of Short Form with 12 items (SF12): MCS (mental score) and PCS (physical score). Results: A total of 636 questionnaires were compiled. High level of MET was significantly (P <0.05) associated with both PCS (OR = 1.02) and MCS (OR = 1.03). The correlations between PCS, MCS vs. METwk scores were respectively significant: r = 0.17 and r = 0.10, P < 0.05. The number of years of detention was associated to higher MET (OR = 1.04 P < 0.05). The presence of Physical Exercise Areas (PEAs) within Jails did not improve the QoL level. Conclusions: Jails may not seem like the ideal place to fight sedentary behavior, but, in any case, health promotion can occur within its walls. The heterogeneity of Italian jails, and particularly relative PEAs therein (areas had different characteristics between jails), suggests that such spaces should be regulated or well defined. Furthermore, the implement of training schedules could be done in a standardized way. Despite this heterogeneity both the physical and mental components of inmates' quality of life were associated to a high level of physical activity.

[Physical activity and its importance in the workplace]. / Attività lavorativa ed attività fisica: un binomio inscindibile.

The present study aims to highlight the importance of physical activity in the workplace and its fundamental role for the wellness of an individual. The relationship between sedentary lifestyle and health is supported by several epidemiological studies and inactivity is one of the main risk factors for cardiovascular disease, chronic conditions and cancer. According to the World Health Organization, physical activity represents: "any bodily movement produced by skeletal muscles that requires energy expenditure". The promotion of regular physical activity, including its promotion in the workplace is of fundamental importance since a close correlation exists between good health and physical activity. Moreover, regular physical activity improves psycho-physical performance, social relationships, work performance and reduces sickness, absenteeism from work and work injuries.

Influenza and Pneumococcal Vaccination in Hematological Malignancies: a Systematic Review of Efficacy, Effectiveness, and Safety.

BACKGROUND: The risk of getting influenza and pneumococcal disease is higher in cancer patients, and serum antibody levels tend to be lower in patients with hematological malignancy. OBJECTIVE: To assess flu and pneumococcal vaccinations efficacy, effectiveness, and safety in onco-hematological patients. METHODS: Two systematic reviews and possible meta-analysis were conducted to summarize the results of all primary study in the scientific literature about the flu and pneumococcal vaccine in onco-hematological patients. Literature searches were performed using Pub-Med and Scopus databases. StatsDirect 2.8.0 was used for the analysis. RESULTS: 22 and 26 studies were collected respectively for flu and pneumococcal vaccinations. Protection rate of booster dose was 30% (95% CI=6-62%) for H1N1. Pooled prevalence protection rate of H3N2 and B was available for meta-analysis only for first dose, 42.6% (95% CI=23.2 - 63.3 %) and 39.6 % (95% CI=26%-54.1%) for H3N2 and B, respectively. Response rate of booster dose resulted 35% (95% CI=19.7-51.2%) for H1N1, 23% (95% CI=16.6-31.5%) for H3N2, 29% (95% CI=21.3-37%) for B. CONCLUSION: Despite the low rate of response, flu, and pneumococcal vaccines are worthwhile for patients with hematological malignancies. Patients undergoing chemotherapy in particular rituximab, splenectomy, transplant recipient had lower and impaired response. No serious adverse events were reported for both vaccines.