Epidemiologia & Prevenzione最新文献

Objectives: to evaluate the association between exposure to per- and polyfluoroalkyl substances (PFAS) and semen quality in young adulthood, with particular attention to different exposure metrics: serum and seminal concentrations of perfluorooctanoic acid (PFOA) and perfluorosulfonic acid (PFOS), foetal exposure, duration of exposure.

Design: cross-sectional study.

Setting and participants: 1,000 subjects aged 18-35 years residing in the Veneto area with water contamination by PFAS, enrolled in the period 2022-2023; this interim analysis involves 507 subjects out of the 1,000 enrolled.

Main outcomes measures: only the 2 main semen parameters were considered: sperm count, motility and morphology.

Results: from this interim analysis an association between sperm motility and morphology and duration of residence emerges: OR 1.14 (90%CI 0.99; 1.31) p=0.065 (an age-matched conditional logistic regression tested the linear trend between duration of residence in years and presence/absence of alterations in motility <42% or morphology <4% of the spermatozoa).

Conclusions: these results strengthen the literature on reproductive health risks related to exposure to PFAS and in particular to PFOA and PFOS. They also highlight the importance of duration of exposure and exposure starting from foetal life. The study here presented is part of a larger project still underway regarding analytical determinations on the biological samples provided. It was possible to anticipate the results of the interim analysis on 507 subjects out of the 1,000 enrolled.

Background: Italy, as many other developed Countries, is experiencing a deepening decline in birth rates, turning it into a structural issue that has led many Maternity Units to operate below the minimum delivery threshold. To ensure safe access to maternal healthcare, the 2010 State-Regions Agreement set a minimum target of 500 births per year for facility in areas with significant geographic challenges.

Objectives: to describe the model developed by the Italian National Agency for Regional Healthcare Services (AgeNaS) which intend to assess accessibility to Maternity Units, considering both potential service areas and existing territorial coverage, and to allow for the simulation of network reconfiguration scenarios.

Design: a gravity model was adopted and tailored to the healthcare setting. The model is the Modified Three-Step Floating Catchment Area, divided into three stages: 1. calculation of access probability (using Huff's probability model); 2. estimation of the hospital bed capacity of the regional network of Maternity Units; 3. calculation of an accessibility index for each area to the Maternity Unit network. To implement the gravity model, AgeNaS designed and developed a software application to process distance matrices based on road networks, which allow for accurate calculation of travel times and distances from municipalities to hospitals Results: the model highlights that activity data and territorial characteristics can redefine both current and potential future service areas, offering a transparent and replicable assessment. The potentiality of the AgeNaS model was demonstrated through a series of case studies: Montevarchi (Tuscany), Iglesias (Sardinia), and Orvieto (Umbria).

Conclusions: the AgeNaS methodology is a valuable tool for regions and the central level, both applicable to the network of Maternity Units and to other territorial healthcare networks. This approach is flexible, adaptable, and can be standardized through known parameters, making it suitable for replicable analysis.

Background: reducing air emissions is the fundamental action necessary to mitigate the negative health effects caused by air pollution. However, increased public awareness has highlighted the need to identify protective measures that can mitigate the personal health risks associated with air pollution.

Objectives: examine the evidence regarding personal protection strategies capable of mitigating the health effects caused by air pollution, with a focus on healthy individuals and at-risk categories.  Design: narrative review.

Setting and participants: this study examines the most effective personal protection strategies for healthy and at-risk individuals, considering children, the elderly, and individuals with cardiovascular and respiratory diseases; the examined strategies include the use of air purifiers, respiratory masks, exposure limitation, physical activity, alternative means of transportation, and environmental monitoring systems.

Main outcomes measures: reduction of individual exposure to air pollution, respiratory and cardiovascular outcomes, total and all-cause mortality.

Results: the evidence indicates that these measures can reduce exposure and promote well-being. For at-risk individuals, it is crucial to limit exposure during periods and in locations with high pollution levels, with an emphasis on physical activity. The use of high-efficiency air purifiers can reduce the negative effect of air pollution on individuals with respiratory and cardiovascular conditions, especially those with asthma. In healthy individuals, multiple mitigation actions have been identified, with evidence suggesting that the benefits of physical activity persist even in environments with high levels of air pollution.

Conclusions: this narrative review provides an overview of personal strategies capable of reducing air pollution exposure and consequently mitigating its negative impact on health. These findings can support the development of recommendations and communication and prevention interventions, promoting risk reduction policies and increased awareness and engagement from both healthcare and non-healthcare networks at the local level. Although more robust systematic approaches are needed, this review serves as a useful tool for stakeholders and citizens, while also providing a simple instrument with significant communicative potential, applicable on a large scale.

Hearing and vision disorders in newborns are a serious social and public health problem. To improve the effectiveness and efficiency of screening protocols, it is necessary to use standardized procedures and ensure their implementation at a national level. This is the first set of Italian national practice recommendations for professionals involved in the diagnosis, treatment, and management of hearing and eye screening that will guide the development of multidisciplinary services and public health policies to prevent and/or treat hearing and vision impairment in newborns. This document refers to art. 38 of the Italian Prime Ministerial Decree of 12th January 2017 defining the essential levels of assistance. It also provides an overview - albeit not exhaustive - of the current organization of the screening system as a whole and the potential areas of implementation.

The Social Report (SR) is a form of measurement and reporting, transparency, and communication, essential for sharing decisions, activities, and the value an institution generates with stakeholders from a social responsibility perspective. It is a useful tool for screening programmes to understand their objectives and structure, assess their effectiveness, and promote informed participation by citizens and stakeholders.This contribution explores the implementation of the SR in oncological screening programmes - a project conducted in the CCM 2019 Programme 'Guidelines for Social Reporting of Screening Programmes', coordinated by the Institute for Cancer Research, Prevention and Clinical Network (ISPRO) in Tuscany Region in collaboration with the Centre for Oncological Screenings of Reggio Emilia (Emilia-Romagna Region) and the Population Screening Programmes Service of ATS Valpadana (Lombardy Region) - conducted between 2020 and 2022.The project general objective was to review the Guidelines for Social Reporting of Oncological Screening Programmes developed in 2012. This was achieved through a training and knowledge-deepening phase and an experimental phase in a co-creation logic with all stakeholders involved, particularly with Corporate Management, Regional Screening coordinators, and Associations of citizens and patients.The project had three specific objectives: to spread the culture and practice of social reporting through training courses for professionals working in screening programmes; to experiment with drafting SR in three pilot projects and subsequently update the guidelines; to disseminate the updated guidelines to regional screening coordination and promote informed and conscious involvement of stakeholders.At the end of the project, three SRs were produced for mammography, cervical, and colorectal screening programmes, structured into homogeneous sections and enriched with specific local content. This experience demonstrated the importance of the SR as an accountability tool, but also highlighted difficulties due to the pandemic and the need for earlier and more integrated stakeholder involvement. The updated Guidelines reflect the commitment towards more comprehensive, comparable, and inclusive reporting, to be systematically adopted within screening programmes.

The project "Experimentation of new integrated hospital-territory organizational models for the prevention and control of sexually transmitted infections: facilitated diagnostic-care pathways and offer of free targeted screening" was developed as part of the CCM 2019 programme, funded by the Italian Ministry of Health, being coordinated by the Italian National Health Institute (ISS), in collaboration with Sapienza University of Rome. Three clinical units located in Turin, Milan, and Cagliari, specialized in sexually transmitted infection (STI) diagnosis and treatment, and three highly specialized microbiology laboratories located in Trieste, Florence, and Palermo were involved.The objectives were to develop an innovative network model for the treatment of STIs based on multidisciplinary centres with high quality of care for STIs (hub-IST) and territorial structures (spoke-IST), to plan and test integrated facilitated care pathways for STIs, to evaluate the priorities, feasibility, and sustainability of prevention interventions.A focus group of 12 experts, together with other members from the participating units, defined the characteristics of hub-IST and spoke-IST centres and outlined the integrated care pathway (PIC) for STIs based on the hub&spoke model.A 4-month field trial was subsequently started, applying the proposed PIC in 3 participating units. Improvements were immediately observed in care (increased access to the centre, reduced waiting times, increased number of visits), in the direct connection with intrastructure specialists, in prevention interventions, and in the information provision.The hub&spoke model applied to STIs proved to be innovative, transferable, and adaptable to different Italian regional situations, establishing itself as the currently most functional model for modern care for this type of infections. By reducing barriers to healthcare access, expanding the number of attendees, reducing costs for the community, and implementing targeted and effective prevention interventions, the epidemic chain can be interrupted and the spread of STIs reduced. Based on these results, in Italy, it is urgent to develop an STI strategic prevention plan at a national level.

This work is the third in a series of articles dedicated to the EASY-NET network programme. The first article described the rationale, structure, and methodologies; while the second evaluated the adherence of individual audit&feedback A&F interventions tested in EASY-NET to literature recommendations. This contribution provides a concise summary of the effectiveness results of A&ented by clinical and organizational areas: chronic disease management, emergency territorial and hospital care for acute conditions, post-acute rehabilitation, hospital oncology care, childbirth, and caesarean sections. In alignment with existing literature, the results on the effectiveness of A&F, in terms of measurable improvement, were observed across all settings, although to varying degrees and more significantly in processes than in outcomes. Key elements that proved to be fundamental to the implementation of A&F interventions include the importance of institutions in making A&F systematic, continuous, and a priority for healthcare professionals; the central role of the required and available data for preparing feedback; the involvement of A&F recipients in the whole path, from the design of the interventions to the discussion of results and improvement actions. A final consideration, in light of the activities conducted and the results achieved, suggests that integrating research into practice and practice into research is essential to ensure, on one hand, the transferability of evidence into operations and, on the other hand, the design of studies that are feasible and integrable into daily activities - a necessary aspect to optimize resources.