An improved in vitro model simulating the feto-maternal interface to study developmental effects of potentially toxic compounds: The example of titanium dioxide nanoparticles.

The study of developmental effect of xenobiotics in humans is limited and often relies on epidemiological data. Whether and to which extent potentially toxic compounds may cross the placental barrier, and whether adverse effects on embryo development are the consequence of direct or indirect placental-mediated action is debated. The availability of in vitro models simulating the feto-maternal interface could contribute to elucidate this issue. Here, we report the development of a novel in vitro model using murine blastocyst derived trophoblast stem cells (TSC) to mimic the placental barrier and mouse embryoid bodies (EBs) to represent the embryonic tissues. We demonstrate that this model can be used for translocation studies, as well as embryotoxicity assessment of titanium dioxide nanoparticles (TiO2NPs). By evaluating trans-epithelial electrical resistance, translocation of fluorescein isothiocyanate-dextran beads and expression of junctional complex proteins, we show that TSCs cultured on transwell inserts under differentiating condition form syncytia. We also show that TiO2NPs administered in the upper transwell compartment are able to reach the lower compartment and interfere with EB differentiation when no TSC are cultured on the insert. On the contrary, when TSC are present, NPs translocate to a lesser extent and do not affect EB development. These results indicate that the proposed in vitro model is suitable to study the correlation between translocation and toxicity of TiO2NPs and suggest a direct effect of the particles on EB development. We propose that this model could be exploited to study developmental effect of other xenobiotics.

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.

Health System Response during the European Refugee Crisis: Policy and Practice Analysis in Four Italian Regions.

The decentralization of the provision of health services at the subnational level produces variations in healthcare offered to asylum seekers (ASs) across the different Italian regions, even if they are entitled to healthcare through the national health service. The present study aims to map the healthcare path and regional policies for ASs upon arrival and identify challenges and best practices. This is a multicentric, qualitative study of migrant health policies and practices at the regional level within four Italian regions. For the analysis, a dedicated tool for the systematic comparison of policies and practices was developed. The collection and analysis of data demonstrated the presence of many items of international recommendations, even if many gaps exist and differences between regions remain. The analysis of practices permitted the identification of three models of care and access. Some aspects identified are as follows: fragmentation and barriers to access; a weakness in or lack of a governance system, with the presence of many actors involved; variability in the response between territories. The inclusion of ASs in healthcare services requires intersectoral actions, involving healthcare sectors and other actors within local social structures, in order to add value to local resources and practices, reinforce networks and contribute to social integration.

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.

[Mortality inequalities in Rome: the role of individual education and neighbourhood real estate market]. / Differenziali di mortalità a Roma: il ruolo dell'istruzione e dei prezzi immobiliari del quartiere di residenza.

OBJECTIVES: to investigate the association between real estate prices, education, and mortality. DESIGN: cohort study. SETTING AND PARTICIPANTS: residents in Rome at the 2011 Italian Census, not living in institutions, and living in the address reported in the Census survey. People aged 18-99 years were followed from 2011 to 2016 using anonymous record linkage procedures with administrative databases. The Census includes several individual information, such as gender, age, education, residential neighbourhood. Data and cause of death were collected from mortality register. Real estate prices (euros/m2) were available for each neighbourhood. MAIN OUTCOME MEASURES: adjusted Cox regression models (hazard ratios - HRs and 95%CIs) were used to estimate the association among individual education, real estate price in the neighbourhood, and mortality. RESULTS: the subjects selected were 2,051,376 (54% women, 22.5% with high education level). During the follow-up, 127,352 subjects died. Taking into account gender, age, marital status, and real estate prices, education level was strongly associated with all-cause mortality; compared to highly educated the higher mortality, risk was 35% (95%CI 32%-37%) for low education level and 16% (95%CI 14%-19%) for medium education level. Taking into account the same factors and education level, each increase of 1,000 euros in price/m2 was inversely associated with mortality (HR 0.96, 95%CI 0.96-0.97). CONCLUSIONS: there is an independent association between the two indicators and mortality in Rome. A simple indicator such as real estate prices can be used to tackle inequalities.

[Urban health and inequalities in highly socially marginalised settings in Rome]. / Salute urbana e disuguaglianze a Roma in contesti a elevata marginalità sociale.

OBJECTIVES: to describe hospitalisation, access to emergency care, and mortality of people living in marginalized urban areas which include public housing buildings in the North-West suburb of Rome, and to compare the results with those observed among people living in the neighbouring area. DESIGN: cross sectional study. SETTING AND PARTICIPANTS: resident population in the XIII and XIV Municipality of Rome, subdivided into five urban areas, in 2011-2018. MAIN OUTCOME MEASURES: hospitalisation, access to emergency care, and mortality rates and rates ratios based on hospital discharges and emergency department visits derived from the Health Information Systems and from the Mortality Registry of Lazio Region (Central Italy), stratified by urban areas. RESULTS: the results show a higher use of hospital assistance and emergency care services as well a higher mortality among residents of urban areas characterized by marginalization and social disadvantage in the North-West suburb in Rome, compared to the surrounding area. The association is stronger for the residents of ex-Bastogi, a compound particularly marginalised and socially disadvantaged, where excesses in hospitalisation, emergency care admission, and mortality of +60%, +150%, and +140%, respectively, occurred. CONCLUSIONS: the excesses of hospital use, emergency care visits, and mortality observed among the residents of marginalized urban areas suggest the need to reorganize the preventive and primary care services considering the socioeconomic disadvantage in such housing contexts. The use of both qualitative and quantitative approaches allows to understand the complexity of such contexts.

Seasonal influenza vaccination among health-care workers: the impact of different tailored programs in four University hospitals in Rome.

Seasonal influenza vaccination (SIV) of health-care workers (HCWs) is recommended in most countries to protect them and their patients from infection. Although SIV can reduce the risk of influenza complications among vulnerable patients, vaccination uptake is generally unsatisfactory. The present study aimed to assess the impact of different programs in promoting SIV uptake among HCWs during the season 2017/2018 in four teaching hospitals in Rome. A multicentric cross-sectional study was carried out, in order to describe the four different campaigns and to assess their impact by identifying and developing a set of indicators that provide information about the vaccination services, the percentage of invited HCWs, the vaccinators' workforce and the vaccination coverage rates.The hospitals organized different strategies: Hospital 1, 3 and 4 organized educational courses for HCWs and actively invited every single HCW through e-mail. All the hospitals organized a dedicated unit for influenza vaccination, and Hospital 1 added on-site vaccination sessions that required a large number of staff. Hospital 1 and hospital 4 registered a comparable vaccination coverage rate, 12.97% and 12.76%, respectively, while it was 6.88% in Hospital 2 and 4.23% in Hospital 3. Our indicators demonstrated to be effective and useful for analyzing the different SIV campaigns. The results suggest that the best practice to promote SIV among HCWs should include multiple approaches. Among those, an easy access to the vaccination site seems to play a key role in determining a higher vaccination coverage.

Healthy Design and Urban Planning Strategies, Actions, and Policy to Achieve Salutogenic Cities.

Starting from a previous experience carried out by the working group "Building and Environmental Hygiene" of the Italian Society of Hygiene and Preventive Medicine (SItI), the aim of the present work is to define new strategic goals for achieving a "Healthy and Salutogenic City", which will be useful to designers, local governments and public bodies, policy makers, and all professionals working at local health agencies. Ten key points have been formulated: 1. climate change and management of adverse weather events; 2. land consumption, sprawl, and shrinking cities; 3. tactical urbanism and urban resilience; 4. urban comfort, safety, and security perception; 5. strengths and weaknesses of urban green areas and infrastructures; 6. urban solid waste management; 7. housing emergencies in relation to socio-economic and environmental changes; 8. energy aspects and environmental planning at an urban scale; 9. socio-assistance and welfare network at an urban scale: importance of a rational and widespread system; and 10. new forms of living, conscious of coparticipation models and aware of sharing quality objectives. Design strategies, actions, and policies, identified to improve public health and wellbeing, underline that the connection between morphological and functional features of urban context and public health is crucial for contemporary cities and modern societies.

[The progressive patient care program as a model of field training of public health practitioners: the experience of the Roman Public Health Academy]. / L'ospedale ad Intensità di cura come modello di formazione condivisa sul campo: l'esperienza dell'Accademia Romana di Sanità Pubblica.

The management of healthcare facilities has become increasingly complex in recent years, leading to a greater demand for public health physicians in Italy. Public Health physicians are responsible for evaluating community needs, with particular attention to health determinants and, at the same time, to final user feedback. During their training, they must acquire the competencies to manage a wide range of problems. The Roman Public Health Academy (ARSP) was developed to motivate young residents in Public Health to acquire the knowhow, skills and abilities required of a public health practitioner. It therefore implemented a special training program offering different educational opportunities for residents. In particular, the program offers a team of three young residents field training opportunities, allowing them to become engaged in solving complex technical and management problems. In this paper we describe the methods through which, following a specific request by the director of a hospital in Rome, the team supported a project involving the reorganization of several hospital wards. The aim of the reorganization was to enhance the performance and efficiency of the wards, according to the Progressive Patients Care program.

Le politiche per la tutela della salute dei migranti: il contesto europeo e il caso Italia

Intendendo la salute come un diritto umano fondamentale che non si esaurisce alla dimensione biologica ma si estende a quella sociale, economica e politica, gli autori, dopo aver descritto brevemente le politiche che a livello europeo sono state emanate per tutelare la salute dei migranti, analizzano l’esperienza italiana alla luce delle direttive internazionali. L’Italia rappresenta infatti un caso particolare ed avanzato di tutela della salute dei migranti; la sua politica sanitaria decisamente inclusiva riconosce parità di diritti e doveri ai cittadini regolarmente presenti ed ammette ampie possibilità di protezione ed assistenza anche per gli immigrati privi di permesso di soggiorno. Tuttavia, anche in un contesto avanzato come quello italiano, è necessaria un’evoluzione da un approccio di tipo assistenzialistico ad uno più ampio di promozione della salute attraverso politiche di natura intersettoriale, alla luce della teoria dei determinanti sociali di salute. Affrontare la tematica della salute del popolo migrante rappresenta un’occasione per rendere i servizi sanitari in particolare e le politiche migratorie in generale più attente ad ogni persona, alla sua storia e al contesto nel quale essa vive.(AU)

Understanding health as a fundamental human right, not limited only to the biological dimension, but including the social, economic, and political ones, the authors, after briefly describing the politics enacted at the European level to protect migrant health, analyzethe Italian experience in the light of international guidelines. Italy is, in fact, a specific and advanced case of migrant health protection; it’s very inclusive health policy recognizesthe equality in rights and responsibilities of legal citizens and offers protection and assistance to immigrants without legal authorization to reside in the country. However, even in an advanced context such as the Italian, it is important to transition from an assistance-based approach to a broader one of health promotion through intersectoral policies in light of the theory of the social determinants of health. Addressing the issue of migrant health represents an opportunity for the health services and, in general, for migration policies to become more focused on each person, his/her history, and the context in which he/she lives in.(AU)