Showing papers in "Journal of preventive medicine and hygiene in 2019"

The Spanish Influenza Pandemic: a lesson from history 100 years after 1918.

Abstract: In Europe in 1918, influenza spread through Spain, France, Great Britain and Italy, causing havoc with military operations during the First World War. The influenza pandemic of 1918 killed more than 50 million people worldwide. In addition, its socioeconomic consequences were huge. "Spanish flu", as the infection was dubbed, hit different age-groups, displaying a so-called "W-trend", typically with two spikes in children and the elderly. However, healthy young adults were also affected. In order to avoid alarming the public, several local health authorities refused to reveal the numbers of people affected and deaths. Consequently, it was very difficult to assess the impact of the disease at the time. Although official communications issued by health authorities worldwide expressed certainty about the etiology of the infection, in laboratories it was not always possible to isolate the famous Pfeiffer's bacillus, which was, at that time, deemed to be the cause of influenza. The first official preventive actions were implemented in August 1918; these included the obligatory notification of suspected cases and the surveillance of communities such as day-schools, boarding schools and barracks. Identifying suspected cases through surveillance, and voluntary and/or mandatory quarantine or isolation, enabled the spread of Spanish flu to be curbed. At that time, these public health measures were the only effective weapons against the disease, as no vaccines or antivirals were available. Virological and bacteriological analysis of preserved samples from infected soldiers and other young people who died during the pandemic period is a major step toward a better understanding of this pandemic and of how to prepare for future pandemics.

Vaccination coverage in healthcare workers: a multicenter cross-sectional study in Italy

Abstract: IntroductionIn recent years, a phenomenon known as "vaccine hesitancy" has spread throughout the world, even among health workers, determining a reduction in vaccination coverage (VC). A study aimed at evaluating VC among healthcare workers (HCWs) in 10 Italian cities (L'Aquila, Genoa, Milan, Palermo, Sassari, Catanzaro, Ferrara, Catania, Naples, Messina) was performed.Materials and methodsAnnex 3 of the Presidential Decree n. 445 of 28 December 2000 was used to collect information on the vaccination status of HCWs. The mean and standard deviation (SD) were calculated with regard to the quantitative variable (age), while absolute and relative frequencies were obtained for categorical data (sex, professional profile, working sector, vaccination status). The connection between VC and the categorical variables was evaluated by chi-square method (statistical significance at p<0.05). The statistical analyses were performed by SPSS and Stata software.ResultsA total of 3,454 HCWs participated in the project: 1,236 males and 2,218 females. The sample comprised: physicians (26.9%), trainee physicians (16.1%), nurses (17.2%) and other professional categories (9.8%). Low VC was generally recorded. Higher VC was found with regard to polio, hepatitis B, tetanus and diphtheria, while coverage was very low for measles, mumps, rubella, pertussis, chickenpox and influenza (20-30%). ConclusionsThis study revealed low VC rates among HCWs for all the vaccinations. Measures to increase VC are therefore necessary in order to prevent HCWs from becoming a source of transmission of infections with high morbidity and/or mortality both within hospitals and outside.

Skin safety and health prevention: an overview of chemicals in cosmetic products.

Abstract: Introduction. Cosmetic products contain a wide range of chemicals to which we are exposed every day. The aim of the study was to determine the presence of potential dangerous substances which can cause adverse health effects by examining product labels. Methods. A total of 283 products were collected from various shops in Lecce (Italy) and divided into 3 categories: rinse-off, leave-on and make-up. The label of every product was examined and a list including fragrances, preservatives and other chemicals of concern was created. Results. Fragrances were present in 52.3% of the examined products, mostly limonene (76.9%) and linalool (64.6%) but also citronellol (34.1%), geraniol (31.5%), coumarin (30%) and hexyl cinnamal (29.2%). Preservatives showed a rate of 60% and the most frequently identified were phenoxyethanol (48.7%), sodium benzoate (35.6%), potassium sorbate (22%), methylparaben (15.2%) and MI/MCI (9.9%). The other chemicals of concern were detected in 58% of products; included PEGs (62.3%), acrylate copolymer (34%), petrolatum (17.2%), polysorbates (14,8%), BHT (14.7%), ethylhextyl methoxycinnamate (13.6%), benzophenone-1 (3.7%), benzophenone-3 (4.9%), BHA (1.6%), cocamide DEA and toluene (1.2%). Conclusions. The use of many of these substances is allowed within certain limits, due to their toxicity at higher concentrations. Other important aspects should be considered as, for instance, the possibility of long-term effects. On the other hand, other substances may induce several acute adverse side-effects, i.e. contact dermatitis and allergic reactions. For these reasons, an enhancement of the criteria used for cosmetics formulation is required since many chemicals used singularly or combined are potentially unsafe.

Knowledge of sexually transmitted infections and risky behaviours: a survey among high school and university students.

Abstract: Introduction STIs are a serious public health problem. Worldwide, 500 million people a year acquire a STI, and young are the most affected. Methods This study was conducted administering an anonymous questionnaire to 1228 Sicilian students of high school and university. Results The students had variable understanding of STIs and their complications. The results demonstrate an extreme variability in the knowledge of STIs. Multiple linear regression showed that sexual health knowledge was associated with age and sexual orientation. Conclusions Our results show that knowledge of STIs is poor and inadequate. This finding can put students at risk of STIs.

Training to improve resilience and coping to monitor PTSD in rescue workers

Abstract: Background: few studies focus on the role training has on rescue workers who are active as volunteers or actual workers in emergency situations such as an earthquake. In October 2016, a strong earthquake hit Central Italy and in particular the province of Macerata in the Marche region. Lots of rescuers were called to deal with the emergency. The aim of this study was, therefore, to examine their preparation, studying resilience and coping strategies, as these qualities can protect against complications brought on by traumatic situations (post traumatic stress disorder). Study design : an observational study of 70 rescue workers who were active in the area affected by the disaster within the province of Macerata was carried out. Methods: the questionnaire proposed by the Coping Inventory for Stressful situations (CISS) was used, while individual levels of resilience were measured with the Resilience Scale. Both methods were employed in two separate interviews conducted before and after their intervention in the disaster area. Results : the sample showed medium to high levels of coping (91.6%) and resilience (89.6%) were present in both interviews. Some areas relative to coping mechanisms, such as social avoidance and distraction are preferred by women, while men prefer avoidance and task-oriented activity. Results for resilience show a slight difference for perseverance in men. Conclusions : the ability to use mechanisms of self-preservation like coping and resilience helps rescue workers to better respond in emergency situations. Surely one of the most appropriate ways to reach this result is provided by their preparation.

Psychoactive drug consumption among truck-drivers: a systematic review of the literature with meta-analysis and meta-regression.

Abstract: Few studies have assessed the extent of psychoactive drug consumption in the occupational setting. The trucking sector, in particular, is an important cause for concern, since psychoactive substance use has a relevant impact on the drivers' health and safety, increasing the risk of injuries and traffic accidents, potentially affecting the general public health as well. A systematic review of the literature and meta-analysis was performed in order to provide Occupational Health Professionals and policy-makers with an updated epidemiological perspective regarding this important issue. The results showed a prevalence of overall drug consumption of 27.6% [95%CI 17.8-40.1], particularly high considering illicit CNS-stimulants (amphetamine consumption of 21.3% [95%CI 15.7-28.1], and cocaine consumption of 2.2% [95%CI 1.2-4.1]). It appears that truck-drivers choose stimulant substances as a form of performance enhancing drug, in order to increase productivity. However, chronic and high dose consumption has been shown to decrease driving skills, placing these professional drivers at risk for health and road safety. Further research is required, particularly in Europe, in order to fill the knowledge gap and improve the strength of evidence.

Quality improvement of medical records through internal auditing: a comparative analysis.

Abstract: Introduction The systematic evaluation of the quality of medical records is crucial. Nevertheless, even if the improvement of medical records quality represents a priority for every health organization, it might be difficult to realize. This is the first study to assess the efficacy of internal audit as a tool to improve the quality of medical records in hospital setting. Methods The program was carried out in a third level teaching hospital. Trained ad hoc evaluation teams carried out two retrospective assessments of quality of medical records using a random sampling strategy. The quality assessment was performed using a 48-items evaluation grid divided into 9 domains: General; Patient Medical History and Physical Examination; Daily Clinical Progress Notes; Daily Nursing Progress Notes; Drug Therapy Chart; Pain Chart; Discharge Summary; Surgery Register; Informed Consent. After the first evaluation of 1.460 medical records, an audit departmental program was set up. The second evaluation was carried out after the internal auditing for 1.402 medical records. Results Compared to the first analysis, a significant quality amelioration in all the sections of the medical chart was shown with the second analysis, with an increase of all the scores above 50%. The differences found for each section of medical records between the first and second analysis are all significant (p<0.01). Conclusions Internal audits are not just measurement activities but a necessary activity to support the organization in achieving its objectives and assessing the quality of clinical care and maintaining high quality professional performance.

The reliability of self-reporting chronic diseases: how reliable is the result of population-based cohort studies.

Abstract: Objectives To evaluate the reliability of self-reporting chronic diseases in the baseline data of the Ravansar Non-Communicable Diseases (RaNCD) cohort study in Kermanshah province, western Iran. Methods The study was conducted in RaNCD cohort study. To assess the reliability of self-report of chronic disease, a random sample of 202 participants were asked about some of chronic conditions 30-35 days (mean = 32) after recruitment. Results A range of kappa agreement between 39.52-100%, which the lower statistics was for hypertension and hepatitis and the higher one for cancer, cardiac ischemic, and diabetes. Conclusion The self-report of chronic diseases was relatively reliable. Therefore self-reporting data for some conditions can be used in situations where the validity is acceptable.

Long-term persistency of hepatitis B immunity: an observational cross-sectional study on medical students and resident doctors.

Abstract: Hepatitis B virus (HBV) is a main cause of chronic and acute hepatitis. Healthcare workers (HCWs), including medical students and resident doctors, have an occupational risk of HBV infection. The study aimed to evaluate the long-term persistence of protective anti-HBs antibody levels in healthcare students and resident doctors at risk for occupational exposure to HBV at 15 years after primary vaccination course. Further objective was to evaluate the anamnestic response observed in non-seroprotected subjects receiving a booster dose. Data were collected from the clinical documentation filled in during the occupational medical check of medical students and resident doctors undergoing Occupational Health Surveillance by the University of Ferrara. Of the 621 included individuals, 27.7% had an anti-HBs concentration < 10 mIU/mL. Subjects vaccinated during infancy had more frequently a concentration < 10 mIU/mL than those vaccinated during adolescence (42.7% vs 6.9%; p-value < 0.001). Multivariate analysis confirmed the statistical significance of the vaccination age. 94 subjects who had an anti-HBs concentration < 10 mIU/mL received a booster dose. The proportion of subjects who had an anamnestic response was higher in those vaccinated in infancy rather than during adolescence (94.1% vs 77.8% respectively). These findings suggest that the anti-HBs concentration decreases below 10 mIU/mL more frequently in subjects vaccinated during infancy. Immunological memory seems to persist after the decline of the anti-HB titer, as observed in response to a booster dose. In conclusion, vaccinated subjects at increased risk of HBV infection should be monitored and a booster dose administered if anti-HBs titer is below 10 mIU/mL.

Impact assessment of an education course on vaccinations in a population of pregnant women: a pilot study.

Abstract: Background Although benefits of vaccinations have been extensively demonstrated, poor knowledge of the population has resulted in non-optimal vaccine coverage as a result of the hesitancy and negative perception of many parents toward vaccination. Materials and Methods To assess the impact of a course on the knowledge and attitudes of future mothers on vaccination, 214 pregnant women participated in a research project undertaken at the Obstetrics and Gynaecology Department of the Careggi University Hospital in Florence (Italy). This involved completion of anonymous questionnaires administered before and after the intervention. A descriptive and statistical analysis was carried out on the results of the collected data by performing comparative evaluations of the responses obtained before and after the intervention. Results There was good adherence to the initiative (98%): the sample population was initially not hostile to vaccines, albeit poorly or insufficiently informed (43%). The educational intervention had a positive impact, especially as a vaccine information tool and for correctly addressing the vaccine hesitancy. After the intervention, women who considered their level of knowledge about vaccines as poor or insufficient were reduced by 30% and the "hesitant" ones were reduced with respect to all aspects of the study, especially about the decision to be vaccinated during pregnancy. Conclusions Hesitancy finds its roots in the absence of accurate information. Healthcare professionals need to improve their communication skills. Competent education delivered during pregnancy, when women are more receptive, may have a highly positive impact. These observations will have to be considered in the planning of delivery preparation courses.

Smoking behaviour among nursing students: attitudes toward smoking cessation.

Abstract: Introduction: The purpose of the study was to assess tobacco smoking habits among nursing students and how these are influenced by family members and cohabitants. Methods: Cross-sectional study. An anonymous papery questionnaire was administered to nursing students of the three-year course of the University of Palermo. Adjusted Odds Ratio (aOR) are presented. Results: 301 nursing students (63.12 % female) completed the questionnaire (response rate 61.17%). The average age of the sample is 21.88 years (SD ± 2.80). Considering as a dependent variable: “I currently smoke”, the statistically significant independent variables associated are: “Male gender” (aOR 2.09), “Single” (aOR 2.06), “Second year of study of the degree course in nursing” (aOR 0.46), “Third year of study of the degree course in nursing” (aOR 0.43), “Don’t think that warnings and pictures on cigarette packs can help stop smoking” (aOR 6.38), “Mother smoked in the past” (aOR 2.25) and “Brother or sister smoked in the past” (aOR 5.50). Conclusions: Students and graduate nurses need to be aware of current knowledge in the smoking cessation field and they have an influential role in modifying patient behavior in order to assist them to smoking cessation.

Burden of typhoid fever and cholera: similarities and differences. Prevention strategies for European travelers to endemic/epidemic areas.

Abstract: The burden of diarrheal diseases is very high, accounting for 1.7 to 5 billion cases per year worldwide. Typhoid fever (TF) and cholera are potentially life-threatening infectious diseases, and are mainly transmitted through the consumption of food, drink or water that have been contaminated by the feces or urine of subjects excreting the pathogen. TF is mainly caused by Salmonella typhi, whereas cholera is caused by intestinal infection by the toxin-producing bacterium Vibrio cholerae. These diseases typically affect low- and middle-income countries where housing is overcrowded and water and sanitation are poor, or where conflicts or natural disasters have led to the collapse of the water, sanitation and healthcare systems. Mortality is higher in children under 5 years of age. Regarding their geographical distribution, TF has a high incidence in sub-Saharan Africa, India and south-east Asia, while cholera has a high incidence in a few African countries, particularly in the Horn of Africa and the Arabian Peninsula. In the fight against these diseases, preventive measures are fundamental. With modern air travel, transmissible diseases can spread across continents and oceans in a few days, constituting a threat to global public health. Nowadays, people travel for many reasons, such as tourism and business. Several surveys have shown that a high proportion of travelers lack adequate information on safety issues, such as timely vaccination and prophylactic medications. The main objective of this overview is to provide information to help European travelers to stay healthy while abroad, and thus also to reduce the potential importation of these diseases and their consequent implications for public health and society. The preventive measures to be implemented in the case of travel to countries where these diseases are still endemic are well known: the adoption of safe practices and vaccinations. It is important to stress that an effective preventive strategy should be based both on vaccinations and on hygiene travel guidelines. Furthermore, the emergence of multidrug-resistant strains is becoming a serious problem in the clinical treatment of these diseases. For this reason, vaccination is the main solution.

Detection of bacterial pathogens in the hands of rural school children across different age groups and emphasizing the importance of hand wash.

Abstract: Introduction Contaminated hands remain the mainstay cause of infection in children. Infections like diarrhoea and pneumonia were found to be common among children who have limited knowledge on the importance of hand wash. The present study was aimed to assess the relationship between the bacterial load sampled from the hands of school children and their routine hand wash practice methods. Methods Samples were collected from both the hands of 200 rural school children. Bacterial colonies isolated from the swabs were identified by standard microbiological procedures. Questionnaire was provided to gather matrix of routine hand wash practice from the subjects. Proper handwashing technique was demonstrated to children. Results More than 95% of the children harbored commensal like CoNS and Aerobic spore formers. Other pathogenic bacteria isolated include Acinetobacter species (36.5%), Pseudomonas species 4% (15), Enterococcus species (2%), Klebsiella species (3.5%), Flavobacterium species (1.7%), Escherichia coli (2%), and Enterobacter species (0.75%). It was found that the male children harbored more bacteria in their hands when compared to female population. Bacterial population like Pseudomonas species, Klebsiella species and Enterococcus species were predominant in the hands of children belonging to 7-10 years of age whereas Acinetobacter species, Escherichia coli and Flavobacterium species were slightly higher among 11-15 years of age. This information corresponds to the poor hand washing practices among the children. Conclusions It can thus be concluded from our study that simple handwashing practices can efficiently reduce the transmission of pathogenic bacteria from our hands and greatly reduce the transmission of infection.

Improvement of hand hygiene compliance among health care workers in intensive care units

Abstract: Aim: The purpose of this study was to measure the HH compliance among health care workers (HCWs) in intensive care units at Beni-Suef university hospital, Egypt before and after an intervention program. Methods: Data were collected by direct observation of HCWs, using the standardized WHO method for direct observation ‘‘Five moments for HH’’ approach. Observations were conducted before (March to April 2017) and after (July to August 2017). The study included 608 opportunities (observations) collected before and 673 opportunities collected after the intervention. Results: Overall, HH compliance increased significantly from 30.9 (95% CI: 27.2-34.6%) before intervention to 69.5 (95% CI: 65.2-72.6%) post intervention. HH compliance rate among nurses was significantly higher compared with compliance of physicians and other HCWs (P = 0.001). HH compliance rates after body fluid exposure, before aseptic procedures, and after patient contact were significantly higher compared with compliance rates before patient contact and after patient surrounding contact (P=0.001). In logistic regression analyses, there was a statistically significance for compliance of HH among events of before and after patient contact (OR = 1.399, 95% CI: 1.004–1.948) P=0.047. Conclusions: The educational programs improved the HH compliance among HCWs in the intensive care units at Beni-Suef university hospital. The hospital should conduct continuous monitoring in observing the monthly trend of the units and sharing the findings to spread best practices. It is important to provide sustained intensified training programs to help efficient and effective HH into all elements of care delivery.

Impact assessment of an educational course on vaccinations in a population of medical students.

Abstract: The inadequate formation and knowledge about vaccinations of healthcare workers, including doctors, has certainly contributed to the spread of the vaccine hesitancy in recent years. Therefore, it is essential to improve the level of knowledge of future doctors so that they can deal with any hesitation within the population in order to increase the vaccination coverage. The aim of the study is to evaluate the impact of a course about vaccination on the knowledge of medical students. In order to evaluate the efficacy of a certain lecture about vaccinations on medical students, they were asked to complete an anonymous questionnaire before and after the seminar. The two questionnaires contained the same 10 questions regarding knowledge and attitudes about vaccines. Only the students who had attended the lecture were allowed to complete the post-lecture questionnaire. The students could fulfil the questionnaires through the learning management system (LMS) called ‘Moodle’. A descriptive statistical analysis of the data collected through the comparative evaluation of the answers before and after the seminar was performed. The seminar aroused much interest among the students: 100 of them completed the pre-lecture questionnaire and 81 of them completed the post-lecture questionnaire. The results show a positive impact of the seminar, especially about some specific themes: knowledge of the students on the indication of the MPR vaccine strongly improved after the seminar, the number of students who would recommend vaccination for pertussis and influenza during pregnancy increased by 37% and 19% respectively after the seminar, and those aware of the need for Herpes Zoster vaccination over the age of 65 increased by 22%. For future doctors, a thorough knowledge about vaccinations is increasingly required in order to deal with vaccine hesitancy. It is, therefore, important for them to get the opportunity to develop a mastery over these topics. An extracurricular seminar about vaccines, provided in the second half of the course of study, can have a highly positive impact and could stimulate the future healthcare personnel to improve their knowledge on vaccination.

The prevalence and predictive factors of somatization and its relationship with anxiety and depression in Iranian population.

Abstract: Introduction: Today mental disorders are important concerns of health care system in all countries. Among different mental disorders; depression, anxiety, and somatization are more frequent. This manuscript was conducted to evaluate the frequency of somatization symptoms, its related factors and the correlation between somatization symptoms and anxiety and depression disorders in Iranian population. Methods: The cross-sectional study was conducted in Kerman, Iran, 2017. Participants were selected from patients who referred to the Clinics of Educational Hospitals using convenience sampling method. The PHQ-15 and HADS questionnaire were used to assess the somatization and depression and anxiety, respectively. The univariate and multivariate logistic regression was used to determine the predictive factors of somatization symptoms. The correlations between each PHQ-15 item score and anxiety and depression score were expressed. Results: The frequency of mild, moderate and severe levels of somatization was 66.3%, 20.5% and 13.1%, respectively. Considering multivariate logistic regression analysis; age was associated with somatic symptoms, significantly. The risk of somatic symptoms was 3.4 times more in Divorced/Widowed participants than single ones (p-value: 0.035). There were significant positive correlations between anxiety and depression scores. Each additional score of anxiety and depression were associated with 1.14 times more likely (p-value: <0.001) and 1.11 times less likely (p-value: 0.003) of having somatic symptoms, respectively. Conclusion: The burden of somatization, depression and anxiety is high in Iranian population. Psychologists and policy-makers should consider these predictive factors for primary prevention of somatization at the personal and community level, respectively.

Effectiveness of a training course on smoking cessation knowledge and behaviour for health profession students: the SISMA project.

Abstract: Introduction University students are at risk of starting smoking or continuing and increasing the consumption of tobacco products The aim of the study was to assess the impact of the training course, Sisma Project, about smoking in healthcare degree courses, in terms of knowledge, behaviour and to evaluate the course Methods SISMA project was a pre- post study about an intervention delivered to healthcare profession students about smoking and smoking cessation It had a before-after design and was an online optional course available on the eLearning platform Moodle 2 The course was structured in four lessons of sixty minutes, a debate among experts and a final test of evaluation The McNemar test was used to measure the effectiveness of Sisma on smoking behaviour of students after the intervention Students rated the course assigning a score from one to ten, and expressed free comments about point of strength and weakness of Sisma project Results The participants were 365 students, 285% males and 715% females, most were nursing 194 (532%) and dental hygienists students 105 (288%) Current smokers were 161 (441%) before and 142 (389%) after the course, there was statistical significant difference in smoking status after attending the course (p < 0001) Students evaluated the course giving a high score with a mean of 813 (SD: 11); the main points of strength were the content (332%), the structure (156%) and knowledge given by the course (126%) The main point of weakness were the online structure 62 (37%), problem related to length and time 17 (10%) and the final test 15 (9%) Discussion Given the central role health professionals play in patient care, students need to be aware and trained in tobacco cessation techniques Our results indicate that smoking behaviour significantly changed after attending a university course for smoking cessation and students appreciated its contents and structure

Dangerous passengers: multidrug-resistant bacteria on hands and mobile phones.

Abstract: Introduction It is recognized that mobile phones may play a role in microorganism transmission and that hand hygiene, is considered the most important action for preventing infections and the spread of pathogens. The objective of this study was to determine presence and circulation bacteria on hands and mobile phones capable of causing infections in people and also determine if disinfection with gel-alcohol is useful to reduce the bacterial colonization. Methods The bacterial evaluation included 596 hands of participants and 256 mobile phones. Isolated colonies were identified by biochemical test and confirmed by gene 16S rRNA sequencing. Antimicrobial susceptibility was performed using the automated instrument Vitek®2-Compact and disk-diffusionmethod. Results In total, 92.9% of mobile phones and 98.3% of participants in study demonstrated evidence of bacterial contamination with different types of bacteria. Surprisingly, we observed that 18.6% plaques inoculated with disinfected fingers showed bacterial growth. In general, Gram negative isolates showed resistance to a higher number of antibiotics tested than Gram positive isolates. Conclusions Our results could help to raise awareness in our society about the importance of hand hygiene, as well as frequently used devices, reducing bacterial contamination and limiting the possibility of transmission of resistant multi-drug bacteria.

Young people, young adults and binge drinking

Abstract: Introduction and purpose The consumption of alcohol among young people and young adults has undergone, in recent decades, a sharp upsurge with the increasingly frequent intake of large quantities of alcohol. The aim of our study was to investigate socio-demographic, economic and behavioural factors that have a major impact on the voluntary alcohol habit in young people. Methods The survey was conducted via administration of an anonymous questionnaire based on "the WHO Alcohol Use Disorders Identification Test", disseminated on-line, to young people and young adults (aged 18 to 35). Results We examined a sample of 365 subjects. Consumption of wine and beer were predominant followed by super-alcohol mixes. We found correlations between alcohol use and the following variables: marital status (p < 0.001), parental education (mother p < 0.05; father p < 0.001), income level (p < 0.05), physical activity (p < 0.05) and voluptuous habits (smoke and coffee: p < 0.001.The 5% of men and 1% of women had car accidents during the previous year due to alcohol use and 15% said they did not remember what happened in an alcoholic evening once or twice a month. Conclusions The phenomenon of alcohol consummation is deeply ingrained in our reality, with dangerous episodes of binge drinking in young adults with a higher prevalence in the female sex.

Smoke-free environment policy in Vietnam: What did people see and how did they react when they visited various public places?

Abstract: Introduction : Since Vietnam has signed WHO framework on tobacco control (FCTC) in 2003 and has issued tobacco control law in 2013, there has been little research concerning about what impacts smoke-free regulations have had on public compliance. The objective of this study was to assess public exposure to secondhand smoke and reaction toward smoke-free policy regulations in Vietnam and the associated factor. Methods: Using the design of GATS (Global Adult Tobacco Survey), a nationally representative sample of 8,996 adults were approached for data collection. Logistic regression was used to examine the associated factor. Results: The study revealed that the prevalence of respondents exposed to secondhand smoke was much higher in bars/cafe/tea shops (90.07%) and restaurants (81.81%) than in any other public places, universities (36.70%), government buildings (31.12%), public transport (20.04%), healthcare facilities (17.85%) and schools (15.84%). 13.23% of respondents saw smokers violate smoke-free regulations. Among those who saw them violate smoke-free regulations, just one-third cautioned them to stop smoking. Strikingly, a higher rate of cautioning smokers to stop smoking was observed among the older, married, and better educated respondents. Respondents who were married, better educated and in lower economic status were more likely to remind smokers to stop smoking. Conclusions : The study has called for strengthening two of the six MPOWER ( Monitor, Protect, Offer, Warn, Enforce and Raise ) components of the tobacco free initiative introduced by WHO, Monitoring tobacco use and prevention policies and Protecting people from tobacco smoke.

Human trichinellosis in italy: an epidemiological review since 1989

Abstract: Objectives Trichinellosis is a worldwide zooantroponosis caused by a nematode of the genus Trichinella. The main source of human infection is the consumption of raw or undercooked meat (especially from pigs, wild boars and horses). Infection with Trichinella was one of the most frequent parasitic diseases inItaly until 1959 when obligatory screening for these parasites in slaughtered swine was introduced. The aim of our review was to describe the epidemiology of Trichinellosis inItaly, because the last review on this topic was performed in 1989. Study Design We performed a systematic research in MEDLINE Methods We included in our review studies that were published in the peer reviewed literature using the MESH terms “Trichinellosis” and “Italy”. The only restrictions were the language (articles should be in English, Italian, Spanish or French) and the date of publication: from 1989 to March 2017. We excluded all the articles which referred to trichinellosis in the animals or which focused only on molecular biology of trichinella or on diagnostic techniques. Results We found 56 studies, but only 8 studies were considered. A total of 764 cases of Trichinellosis occurred inItaly since the 1990:13.75%caused by T. Britovi and 84.42% by T. spiralis; in 14 cases the identification of the parasite was not performed. The outbreaks occurred inUmbria, Piedmont, Apulia (500 cases in 1990, by T. spiralis),Basilicata,Tuscany, Abruzzo, Emilia Romagna,Sardinia. In 2001 and in 2008 two outbreaks occurred in Lazio andVeneto respectively, but imported from abroad. The most important sources of infections were: horse meat (82.19%); wild boar (11.91%); pig (5.89%). Conclusion Trichinellosis is an old disease, still present in our country, but often forgotten by general practitioners and infectious diseases specialists. Our review shows how it is impossible to define a region with a negligible risk, and how physicians and veterinarians should be regularly trained about this parasitic disease. A strict surveillance, especially on meat products from endemic countries or from wild animals is necessary to considerably reduce the risk of acquiring the infection.

Extracellular vesicles in biological fluids. A biomarker of exposure to cigarette smoke and treatment with chemopreventive drugs.

Abstract: Extracellular vesicles (EVs) are released from cells and enter into body fluids thereby providing a toxicological mechanism of cell-cell communication. The present study aimed at assessing (a) the presence of EVs in mouse body fluids under physiological conditions, (b) the effect of exposure of mice to cigarette smoke for 8 weeks, and (c) modulation of smoke-related alterations by the nonsteroidal anti-inflammatory drug celecoxib, a selective cyclooxygenase-2 inhibitor. To this purpose, ICR (CD-1) mice were either unexposed or exposed to cigarette smoke, either treated or untreated with oral celecoxib. EVs, isolated from bronchoalveolar lavage fluid (BALF), blood serum, and urines, were analyzed by nanoparticle tracking analysis and flow cytometry. EVs baseline concentrations in BALF were remarkably high. Larger EVs were detected in urines. Smoking increased EVs concentrations but only in BALF. Celecoxib remarkably increased EVs concentrations in the blood serum of both male and female smoking mice. The concentration of EVs positive for EpCAM, a mediator of cell-cell adhesion in epithelia playing a role in tumorigenesis, was much higher in urines than in BALF, and celecoxib significantly decreased their concentration. Thus, the effects of smoke on EVs concentrations were well detectable in the extracellular environment of the respiratory tract, where they could behave as delivery carriers to target cells. Celecoxib exerted both protective mechanisms in the urinary tract and adverse systemic effects of likely hepatotoxic origin in smoke-exposed mice. Detection of EVs in body fluids may provide an early diagnostic tool and an end-point exploitable for preventive medicine strategies.

Association of mother's handwashing practices and pediatric diarrhea: evidence from a multi-country study on community oriented interventions.

Abstract: Introduction Improved hand hygiene in contexts with high levels of diarrheal diseases has shown to reduce diarrheal episodes in children under five years. A quasi-experimental multi-country study with matched comparisons was conducted in four rural districts/sub districts in Cambodia, Guatemala, Kenya and Zambia. Methods Community oriented interventions including health promotion for appropriate hand washing was implemented in the intervention sites, through community health workers (CHW) and social accountability mechanisms. Community councils were strengthened/established in all study sites. Using household surveys, information on mother’s handwashing practices and diarrhea incidence of children 2 weeks preceding the study was obtained. Results and Conclusion Access to safe drinking water was reportedly higher for communities in Guatemala and Zambia (>80%), than those in Cambodia and Kenya ( 40%); intervention sites reporting significantly higher levels, except for Zambia. Hand washing index; hand washing before food preparation, after defecation, attending to a child after defecation, and before feeding children was significantly higher for intervention sites in Cambodia, Guatemala and Kenya (Cambodia, 2.4 vs 2.2, p 24m), and female children. The findings suggest that caretaker handwashing with soap or ash has a protective effect on prevalence of diarrhea in children.

Sexually-transmitted infections: what is the true prevalence? A cross-sectional online survey of men who have sex with men in the Veneto Region of Italy

Abstract: Introduction Rates of sexually-transmitted infections (STIs) remain high among men who have sex with men (MSM), posing serious public health concerns. The MSM population is recognized as a vulnerable, high-risk group due to barriers to preventive healthcare services and homophobic stigma. Methods A cross-sectional online survey was conducted using a questionnaire based on European Man-for-Man Internet Survey 2010 (EMIS 2010) and European Centre for Disease Prevention and Control (ECDC) core indicators specific for behavioral risks. MSM were reached between June and August 2017, using Facebook and dating apps. Descriptive statistics and multivariate logistic regression were used to analyze the data. Results A total of 324 respondents were analyzed, 88 subjects (27.2% of the sample) reported having experienced at least one STI, the most common being gonorrhea and HPV. Ten respondents reported having HIV infection, and 7 subjects (70%) of them were co-infected with other STIs. The 49.7% (161 subjects) had seen a doctor specifically for STIs. As concerns HPV vaccination, only 4.0% of the total respondents had been vaccinated. Restricting the sample to the 161 respondents who consulted an STI clinic, the 88 individuals who reported having had at least one STI amount to 54.6%. A more consistent use of condoms and larger numbers of sexual partners were significantly associated with a lower and higher risk of STI, respectively. Conclusions Comprehensive STI prevention strategies are needed to improve sexual health among MSM. Such strategies should include implementing programs to improve awareness about routine screening, and promote a consistent use of condoms by MSM.

The local Socio-Economic Health Deprivation Index: methods and results.

Abstract: Introduction. A socio-economic (SE) deprivation index is a measure which aim is to provide an indication of a SE condition of hardship and disadvantage in the population. This study provided ten Socio-Economic and Health Deprivation Indices (SEHDI) calculated with a shared methodology. The peculiar construction method makes them suitable for investigating the relationships between SE inequalities and aspects of health and prevention in the population. Materials and methods. Data on the demographic and SE situation of the populations derived from the 2011 Census at Census Tract (CT) level (2001 for Rome municipality). For the construction of the SEHDIs only the variables statistically significant correlated with the SMRs of general mortality were subjected to a tolerance test of linearity in order to eliminate the collinear ones. On them, a PCA analysis was applied to obtain the factors to be linearly combined into the SEHDI. The final values were scaled from minimum to maximum deprivation, and the quantitative scale was converted in five ordinal normalized population groups. The SEHDIs were validated at the SE level by comparison with the trends of the main synthetic SE indices of the 2011 Census (2001 for Rome municipality). A validation at the health level was made by comparison with the trends of some causes of death. Both comparisons were made by the ANOVA. Regarding the vaccination coverage, the data were collected from the general practitioners, using, as a proxy for coverage, the geo-referencing of medical offices at CT level, in order to estimate the percentage of vaccinated over-65 years on population of the same age. To evaluate the role of SE differences on vaccination coverage, the latter was compared though the deprivation groups, calculating the differences in coverage between groups applying ANOVA testing. Results. The ten considered areas were the municipalities of Cagliari, Ferrara, Florence, Foggia, Genoa, Rome, Palermo, Sassari, Siena, and the ULSS 7 Veneto area. For each one a specific SEHDI was computed and the different variables part of each index stressed the peculiar aspects of the SE and health deprivation at area level. The SEHDIs showed good percentages of explained variance (from 72.2% to 49.1%), and, a linear distribution of the main statistical SE indices and of the general mortality in each area, according with the scientific literature about the relationship among SE condition and health status of population. The analyses about the by-cause mortality distribution through the SEHDIs deprivation clusters were discussed in other articles, which developed the findings of the study in each area. Conclusion. The SEHDIs showed good ability in identifying the elements of SE inequalities that impact on the health conditions of populations, in describing the distribution of death causes sensitive to SE differences for which aspects of the social and family support structure are relevant, in describing the characteristics that underlie the differences in vaccine coverage through the different groups of deprivation. From a public health perspective these results are relevant, because they make it possible to direct the vaccination promotion actions on the basis of the characteristics that define the deprivation groups.

Prevalence, trends and risk factors of thinness among Greek children and adolescents.

Abstract: Introduction Thinness affects more children and adolescents than obesity. Thus, the aim of the study is to examine the recent estimates of thinness and associated risk factors, and to identify trends in thinness, among Greek schoolchildren. Methods Epidemiological study. Population data from the recent estimates are derived from a school-based health survey polled in 2015 on 336,014 participants aged 4- to 17-years-old. To assess trends of thinness (1996-2015) we included a total of 300,104 children aged 8- to 9-years-old. Physical activity, dietary habits and sedentary activities were assessed through self-completed questionnaires. The gender and age-specific body mass index cut-off points proposed by International Obesity Task Force were used in order to define weight groups. Results Percent 8.4% of girls and 6.5% of boys were thin (all grades included). The prevalence of thinness decreased with age more in boys (from 13.8% at 4-years-old to 5.1% at 17-years-old, p < 0.001), than in girls (from 10.9% at 4-years-old to 8.7% at 17-years-old, p < 0.001). Sufficient dietary habits (OR: 0.87, 95% CI: 0.77-0.97) and adequate physical activity levels (OR: 0.92, 95% CI: 0.85-0.99) were associated with decreased risk of thinness. Thin schoolchildren performed better in aerobic fitness test than normalweight ones. Between 1996 and 2015, thinness rates decreased from 8.0% to 6.5% in boys (p = 0.046) and from 10.6% to 8.4% in girls (p = 0.036). Conclusions Our results suggest that thinness is a significant overlooked phenomenon. Although the prevalence of thinness has decreased the last two decades among Greek schoolchildren, actions need to be taken from public policy makers in order to establish and maintain a healthy body weight.

Impact of training conferences on high-school students' knowledge of sexually transmitted infections (STIs).

Abstract: This study, part of the health promotion program of a high school in Milan (Italy), was aimed at evaluating the impact of training conferences on the awareness of STIs among adolescents aged 16-17. Students attending the 3rd class of a Scientific and Linguistic High School in Milan (Italy) participated in this study in November 2017. All students gave their anonymous answers on a voluntary basis in a pre-test survey, designed by psychologists and infectious diseases specialists, to test their basic knowledge, accuracy, and awareness of STIs. After a two-hour interactive conference, the students were asked to answer the post-test survey. A higher awareness of the spread and the mode of transmission of STIs, of high risk sexual and behavioural practices and prevention methods was observed in the post-test compared to the pre-test. These findings outline both the need for sexual-health communication campaigns targeted at adolescents, who are at great risk of exposure and mostly unaware of STIs other than HIV/AIDS, and the short-term efficacy of a direct approach to the problem, guided by experts in infectious diseases and psychology. A long-term assessment of the effects of training conferences needs to be evaluated.

Application of socio-economic-health deprivation index, analysis of mortality and influenza vaccination coverage in the elderly population of Tuscany.

Abstract: Objective The aim of this paper is to describe the results obtained from the application of a specific local deprivation index, calculated on the basis of 2011 Census sections, to general and cause-specific mortality and influenza vaccination coverage among elderly people of the municipality of Florence. Methods General and cause-specific mortality data (2009-2013) and influenza vaccination coverage data (2015/16 and 2016/17) have been collected for subjects aged ≥65 years residing in the municipality of Florence (Tuscany), at the 2011 Census section level. Socio-Economic and Health Deprivation Index (SEHDI) has been constructed and validated by using socio-economic indicators and mortality ratios. Results Half the Florence population belongs to the medium deprivation group; about 25% belongs to the two most deprived groups, and the remaining 25% is wealthy. Elderly people mostly belong to the high deprivation group. All-cause mortality and cause-specific mortality (cancer and respiratory diseases) reach the highest values in the high deprivation group.Influenza vaccination coverage (VC) is 54.7% for the seasons 2015/16 and 2016/17, combined. VC shows a growing linear trend as deprivation increases. VC appears to be correlated with different factors in the different deprivation groups. Conclusions Socio-economic deprivation plays an important role in health choices, so the application of SEHDI allows to identify the characteristics of the main sub-groups of the population with a low adherence to influenza vaccination. Results of the present study should be spread to General Practitioners in order to help them to promote influenza vaccination to their patients.

Do HCWs adequately know about meningitis and 4CmenB vaccine and recommend its use to parents? A cross sectional analysis in Campania Region, Italy

Abstract: Invasive meningococcal disease (IMD) is a severe disease caused by various Neisseria meningitidis serogroups that represents a serious public health problem worldwide. In Italy, serogroups B and C are the major causes of IMD. On 14 January 2013, the European Medicines Agency authorized the use of the first vaccine available to protect against meningococcal serogroup B (4CMenB). The aim of this study was to assess the IMD epidemiology knowledge and 4CMenB vaccine attitudes of healthcare workers (HCWs) with regard to recommending this vaccine for use, vaccine practices and infectious disease control in the Campania region in Italy. A cross-sectional study was conducted among 293 HCWs (49.5% physicians and 46.4% nurses)interviewed using a self-administered questionnaire. The majority of the HCWs had sufficient knowledge about the disease incidence and lethality, but they were less informed about the higher risk age categories and the serogroups most frequently involved. Additionally, their knowledge about the vaccine was poor with regard to the targeted categories and side effects. Approximately30.0% of the HCWs reported incidences of fever and pain and swelling at the injection site. Moreover,32.8% of the HCWs knew that the risk of developing adverse reactions increases when the 4CMenB vaccine is co-administered with other vaccines. Overall, all of the HCWs were convinced that vaccinations are an important instrument for preventing infectious diseases, and they were aware of their central role in promoting the 4CmenB vaccination and their need to be better informed.

Smoking and alcoholism among adult population and its association with outlet density in a hilly area of North India.

Abstract: Background: The rising burden of non-communicable diseases is a threat to India. The behavioural risk factors having largest contribution to NCDs. Neighbourhood retailing of tobacco products, and alcohol are important risk factors. The objectives of the present study was to determine the prevalence of smoking and alcoholism among adult of Srikot, Uttarakhand, and to determine its relationship with tobacco, and alcohol retail outlet density.Materials and Methods: The study design was a community based cross sectional study, which was done in Srikot, Uttarakhand among adults aged above 20 years, selected by systematic sampling. A semi-structured questionnaire was used. The outlet density was measured mapped using android application.Results: A total of 155 were enrolled in the study of which 61.3% were females. A total of 11.6% of the study participants were smokers. On multivariate analysis male gender, and alcohol use was significantly associated with increased risk of smoking (p<0.05). A total of 16.8% of the study participants were alcohol user. On multivariate analysis it was found male gender, and smoking was significantly associated with increased risk of alcohol use (p<0.05). On mapping the study area, it was found that total tobacco selling outlets were 40. There was no alcohol-selling outlet in the study area.Conclusion: The community is in an early stage of urbanization as evident from the burden of smoking, and alcohol use. This burden of smoking might be worsened by outlet density of tobacco seller.