Epidemiologia & Prevenzione最新文献

The study of health of migrant and immigrant populations is of particular interest and actual in recent years, and there is a lack of research assessing aspects of aging of permanently resident immigrants, chronic non-communicable diseases, multimorbidity, and study of second generations. This contribution proposes to describe the relationship between health and immigration and their association with frailty through the anthropological concept of syndemics. Syndemics represents a set of closely interconnected and mutually enhancing health problems, significantly influencing the overall health status of a population. This occurs within the context of a perpetual pattern of harmful social conditions. Among the syndemics described in the literature, the most interesting in this area is the one concerning the increased frailty due to the interaction among diabetes, depression, immigration, and social distress, called VIDDA (Violence, Immigration, Depression, Diabetes, and Abuse), first identified in Mexican immigrant women in the United States. The main limitation of using the syndemic approach to study the health of immigrant populations is the difficulty in moving from the anthropological, primarily qualitative approach to the epidemiological-quantitative approach. Despite this, the epidemiological study of immigrant populations could benefit from the syndemic approach, because it can better describe complex causal relationships and provide evidence for modification of the clinical approach.

This paper describes the experience carried out in a general hospital, implemented in collaboration with a city network of associations involved in the care of migrant populations. Considering the vulnerability of these populations, the difficulty of access to healthcare facilities, and the linguistic and cultural barriers, an organisational model was designed characterised by the concentration of highly complex care (hub centre) supported by a network of peripheral reception centres (spoke centres) responsible for selecting patients and sending them to the centre of reference with the aim of offering screening for sexually transmitted infections, tuberculosis, taking charge of pathologies, including non-infectious ones, treatment, and follow-up. The effectiveness of the model was measured in relation to the continuum of care and its effectiveness with reference to the Joint Commission International guidelines.

Background: the Coronavirus disease 2019 (COVID-19) pandemic may have aggravated existing social and healthcare inequalities among particular population groups, such as ethnic minorities, who showed increased susceptibility to SARS-CoV-2 infection.

Objectives: to characterize risk profiles or determinants of delayed healthcare access, as well as knowledge, risk perception, behaviour, and social stigma concerning SARS-CoV-2 infection in the immigrant population in the city of Catania (Sicily Region, Southern Italy).

Design: pilot, descriptive study.

Setting and participants: the immigrant population in Catania.

Main outcomes measures: an ad-hoc questionnaire was prepared and administered to the participants of the target population. In addition, a web-based data collection platform and a web-based survey addressed to healthcare providers were developed.

Results: 74 immigrant subjects (mean age: 39 years) voluntarily compiled the questionnaire with varying response rates per question: 77% of the participants were male, 59.5% were from Africa, 29.7% from Asia, 6.7% from South America, and 4.1% did not specify their origin. Fifty-three percent (35/66 responses) found it easy to access healthcare services. However, 25.8% (17/66 responses) found it difficult to understand written information concerning their health. Regarding vaccination services, 67.3% of subjects (35/62 responses) had no difficulty in receiving information on mandatory vaccinations and/or vaccination centres in Italy, and 79.7% (51/64 responses) were vaccinated against COVID-19. In relation to other primary prevention issues, 71.4% of participants (45/63 responses) stated they did not know or had never been tested for HIV, 64.4% (38/59 responses) declared they had not heard of or knew nothing about antibiotic resistance, and 30.4% (21/69 responses) had not heard or knew nothing about antibiotic use.

Conclusions: health services seem to be accessible and effective among the immigrant population in Catania. However, identified determinants of delayed healthcare access included factors concerning mainly health literacy and possibly the socioeconomic status of the population studied. Primary prevention issues that need to be addressed due to low awareness or stigmatization among the immigrant population include antibiotic use and resistance, and infectious diseases such as HIV/AIDS.

In recent years, the number of members of the Italian Association of Epidemiology (AIE) has increased considerably, and their profile has undergone many changes. The aim of this work is to describe the characteristics of the members, with particular attention to those who have been continuously enrolled. To evaluate these characteristics, the data from membership forms submitted to the Association and information available on the new website in the personal profile area (period 2016-2024) were used. The characteristics considered were: gender, age, education, and job position of the member, Region, and type of affiliated institution. Members with at least three registrations during the period considered, including at least one in the last three years (2022-2024), are considered continuous members.In 2024, AIE counts 557 members, of whom 340 (61.0%) are female and 182 (32.7%) are under 35 years old. This data confirms the growing trend observed since 2015, when the number of members was just above 300, considering that each year there is a quota of new members amounting to about 30%. A total of 382 members can be considered continuous. Over 90% of these members work in 8 Regions (Lazio, Piedmont, Emilia-Romagna, Lombardy, Tuscany, Veneto, Puglia, and Sicily), while the other regions are scarcely or not represented at all. Over time, and with the arrival of new members, the Association is shifting towards the academic world, while the proportion of professionals working in public health institutions has decreased. Members are overall highly educated; however, while older cohorts have predominantly a medical and biological education, younger cohorts increasingly have statistical/mathematical education. Seventy percent of the members have a permanent contract, 5% have a fixed-term contract, and 13% have an atypical contract. Precarious contracts tend to be lower among medical graduates and remain higher in other health professions and non-health-related degrees.AIE is dealing with a period of dynamism and openness, marked by the increase in the number of the members and the transformation of their occupational and educational profile. It is crucial to support and promote the ongoing positive changes, such as the wider geographic representativeness and the entry of new recruits, also facilitated by multiple activities carried out by AIE, including congresses, working groups, webinars, training courses, and collaborations with other scientific societies. At the same time, it might be useful to open a discussion on the meaning and consequences of the increase of academic members and the reduction, at least in relative terms, of individuals coming from public health. Finally, it will be necessary to approach some critical issues, such as the still poor multidisciplinarity and the persistence of job insecurity, especially among graduates in educational pathways that still do not fit into the professional profiles recognized by the NHS.

Refugees and migrants remain one of the most vulnerable people and the COVID-19 pandemic has posed additional challenges both in terms of increased risk of infection and death experienced, highlighting existing inequities in access to and utilization of health services, as underlined by World Health Organization in 2020 in the Health and Migration Programme. In the context of the Programme 'Epidemiological surveillance and control of COVID-19 in metropolitan urban areas and for the containment of the circulation of SARS-CoV-2 in the migrant population in Italy', coordinated by the Italian Centre for Disease Control and Prevention (CCM) and funded by the Italian Ministry of Health, an experimental epidemiological, virological, and molecular SARS-CoV-2 surveillance system addressed to migrant populations in Sicily through Mediterranean routes was implemented. To this end, a multidisciplinary network supported by a hub&spoke system of laboratories was established in Sicily Region (Southern Italy), using molecular and Next Generation Sequencing (NGS) techniques to identify different SARS-CoV-2 strains in relation to migration flows. Herein, the lesson learnt through this integrated surveillance model, that was in place from February 2021 till the end of the COVID-19 emergency in Italy, are reported. Overall, the data emphasized the need for enhancing molecular surveillance in the areas of the globe where testing and sequencing resources are limited. The epidemiological, virological, and molecular SARS-CoV-2 monitoring, targeted to the migrant population, may also provide a valuable experimental model.

The June 25, 2024 Judgment of the Court of Justice of the European Union is based on the Industrial Emissions (Integrated Pollution Prevention and Control) Directive 2010/75/EU and confirms its applicability to the Taranto steel plant, reiterating that the concept of pollution includes damage to the environment and human health; the health impact assessment of polluting industrial activities, such as the Ilva steelworks in Southern Italy, must constitute an internal act in the procedures for granting and reviewing the operating permission; all pollutants attributable to the plant that are scientifically recognized as harmful to health must be considered in the assessment procedures. In the case of serious and significant danger to the integrity of the environment and human health, the operation of the installation must be suspended. The Judgment highlights important elements on the level of principle and application, which are extraordinarily useful for environment and health personnel, for open-minded and aware local, regional, and national administrators, and above all for the citizens and communities most exposed to pollutants recognized as harmful to health. Preventive environmental health impact assessments gain renewed strength as tools for evaluative and authorized decision-making on production activities, in a sense of full integration between environment and health. The right to environmental and health protection and prevention is an integral part of the defence of human rights, especially in sacrifice zones such as Taranto and many other sites to be reclaimed, considered by the UN as "places where residents suffer devastating physical and mental health consequences and human rights violations".

Objectives: to estimate the contribution of locally-grown food consumption to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) human exposure.

Design: residents of a PFAS-contaminated community of the Veneto Region (North-Eastern Italy) were categorized into two exposure groups, which refer to the period after the determination of serum levels of PFOA and PFOS conducted at baseline: 1. people drinking water filtered with double granular activated carbon (GAC) and not consuming locally-grown foods at all (reference group); 2. people drinking the same filtered water and which continue to consume only locally-grown foods. For each group, PFOA and PFOS daily intake rates (IR, ng/kg-day) were derived from measured PFOA and PFOS concentrations in treated water and local vegetable and animal food matrices. Then a one-compartment pharmacokinetic model was applied to predict PFOA and PFOS serum concentrations over time and the time needed to fall below a clinically significant threshold level of PFOA and PFOS (e.g., 20 ng/mL).

Setting and participants: the study area included 21 municipalities and 3 provinces (Vicenza, Verona, and Padua) located in the Veneto plain. Approximately 127,000 people lived in the most PFAS-contaminated areas on 31.12.2016; those aged 9 to 65 years were invited to participate in the Health Surveillance Plan (HPS), including laboratory tests and medical examination.

Main outcomes measures: predicted PFOA and PFOS serum levels (ng/mL) among residents in the contaminated area.

Results: compared to the reference group, residents who continued to consume locally-grown foods had an approximately 24% higher IR of PFOA and PFOS and this resulted in 3 more years for their PFOA and PFOS concentrations to fall below the threshold level of 20 ng/mL.

Conclusions: this study showed that the contribution of locally-grown food consumption cannot be ignored for people living in PFAS-contaminated areas.

Objectives: to document existing geographical inequalities in health in the city of Milan (Lombardy Region, Northern Italy), examining the association between area socioeconomic disadvantage and health outcomes, with the aim to suggest policy action to tackle them.

Design: the analysis used an ecological framework; multiple health indicators were considered in the analysis; socioeconomic disadvantage was measured through indicators such as low education, unemployment, immigration status, and housing crowding. For each municipal statistical area, Bayesian Relative Risks of the outcomes (using the Besag-Yorkand-Mollié model) were plotted on the city map. To evaluate the association between social determinants and health outcomes, Spearman correlation coefficients were estimated.

Setting and participants: residents in the City of Milan aged between 30 and 75 years who were residing in Milan as of 01.01.2019, grouped in 88 statistical areas.

Main outcomes measures: all-cause mortality, type-2 diabetes mellitus, hypertension, neoplasms, respiratory diseases, metabolic syndrome, antidepressants use, polypharmacy, and multimorbidity.

Results: the results consistently demonstrated a significant association between socioeconomic disadvantage and various health outcomes, with low education exhibiting the strongest correlations. Neoplasms displayed an inverse social gradient, while the relationship with antidepressant use varied.

Conclusions: these findings provide valuable insights into the distribution of health inequalities in Milan and contribute to the existing literature on the social determinants of health. The study highlights the need for targeted interventions to address disparities and promote equitable health outcomes. The results can serve to inform the development of effective public health strategies and policies aimed at reducing health inequalities in the city.