Passive smoking indicators in Italy: does the gross domestic product matter?

BACKGROUND: The aim of this study is to analyse the correlation between regional values of Gross Domestic Product (GDP) and passive smoking in Italy. METHODS: The outcome measures were smoking ban respect in public places, workplaces and at home, derived from the PASSI surveillance for the period 2011⁻2017. The explanatory variable was GDP per capita. The statistical analysis was carried out using bivariate and linear regression analyses, taking into consideration two different periods, Years 2011⁻2014 and 2014⁻2017. RESULTS: GDP is showed to be positively correlated with smoking ban respect in public places (r = 0.779 p < 0.001; r = 0.723 p < 0.001 in the two periods, respectively), as well as smoking ban respect in the workplace (r = 0.662 p = 0.001; r = 0.603 p = 0.004) and no smoking at home adherence (r = 0.424 p = 0.056; r = 0.362 p = 0.107). In multiple linear regression GDP is significantly associated to smoking ban respect in public places (adjusted β = 0.730 p < 0.001; β = 0.698 p < 0.001 in the two periods, respectively), smoking ban in workplaces (adjusted β = 0.525 p = 0.020; β = 0.570 p = 0.009) and no smoking at home (adjusted β = 0.332 p = 0.070; β = 0.362 p = 0.052). CONCLUSIONS: Smoking ban is more respected in Regions with higher GDP. For a better health promotion, systematic vigilance and sanctions should be maintained and strengthened, particularly in regions with low compliance with smoking bans

The reform of the Italian legislation on childhood immunization

Upon the proposal of the Italian government, Law n. 191/2017 has been enacted, meant to considerably raise the number of mandatory vaccinations, while leaving several others merely "recommended" (non-mandatory). Such a reform has proven necessary in light of the latest epidemiologic data reflecting a steady decrease in the rates of immunization coverage in most Italian regions over the past few years, including mandatory vaccinations. Court rulings that held vaccinations may have caused autism, or even a child's death, have probably contributed to decrease in coverage. Early interventions to mandate immunization had been put in place at the regional level, yet the Italian Government and Parliament have opted for a national piece of legislation devised to make mandatory vaccinations a requirement to gain access to the preschool system or day care services. The authors elaborate on the reform's contents and shed a light on the medical, ethical and legal elements underpinning the mandate to immunize children. As a matter of fact, possible risks arising from vaccinations are rare, and largely offset by the benefits to both the children and society at large. On the heels of the reform in question, the doctor-patient relationship is still at the forefront. In fact, citizens need to understand the value and usefulness of non-mandatory, recommended vaccines as well. Therefore, it appears necessary to improve the quality of vaccination counseling practices in childcare, but such activities need to take place within the framework of a broader strategy, centered on the fostering of a culture of prevention, backed by scientific research to the fullest extent possible

The use of yoga to manage stress and burnout in healthcare workers: a systematic review

The purpose of this systematic review is to analyze and summarize the current knowledge regarding the use of yoga to manage and prevent stress and burnout in healthcare workers. In February 2017, a literature search was conducted using the databases Medline (PubMed) and Scopus. Studies that addressed this topic were included. Eleven articles met the inclusion criteria. Seven studies were clinical trials that analyzed yoga interventions and evaluated effectiveness by gauging stress levels, sleep quality and quality of life. A study on Chinese nurses showed statistical improvement in stress levels following a six-month yoga program (χ2 = 16.449; p &lt; 0.001). A population of medical students showed improvement in self-regulation values after an 11-week yoga program (from 3.49 to 3.58; p = 0.04) and in self-compassion values (from 2.88 to 3.25; p = 0.04). Four of the included articles were observational studies: They described the factors that cause stress in the work environment and highlighted that healthcare workers believe it is possible to benefit from improved physical, emotional and mental health related to yoga activity. According to the literature, yoga appears to be effective in the management of stress in healthcare workers, but it is necessary to implement methodologically relevant studies to attribute significance to such evidence

The reform of the Italian Legislation on Childhood immunization

Over the past few decades, giant strides have been made in the field of vaccinations, the range of vaccines available has been broadened, with a higher degree of safety and effectiveness. Paradoxically, distrust towards childhood immunization has also increased in the public opinion, a significant share of which sees not so much its advantages as the possibility of potentially serious side-effects. Vaccinations pose an issue as to the reconciliation of interests pertaining, on the one hand, to the safeguard of health, spelled out in art.13 of the Italian Constitution, and to the freedom of personal choice, protected in art.13, on the other. Therefore, the question to which the authors of this paper have sought to answer reads as follows: should immunization, and childhood immunization in particular, be deemed mandatory treatment, or is it best left up to the parents to choose? The legislation on the subject appears outdated and untimely, and the dichotomy between “mandatory vaccination” and “recommended vaccination” only adds to the sense of confusion in the public opinion. It appears necessary to improve the quality of vaccination counseling practices in childcare, but such activities need to take place within the framework of a broader strategy, centered on the fostering of a culture of prevention, backed by scientific research to the fullest extent possible. The paper’s authors point to the absolute necessity for a new, updated set of national regulations aimed at overcoming current inconsistencies and the discrepancies in guidelines set forth by each region

Estrelas e Ases: o retrato fotográfico em Portugal (1916-1936)

Desde o final da década de 1910 e durante os anos 1920, a Fotografia Brasil, uma firma de retrato fotográfico de Lisboa, dirigida por Joaquim da Silva Nogueira, introduziu práticas modernas na fotografia portuguesa, praticamente dominada ainda por um gosto Oitocentista que tinha forte presença na maior parte dos estúdios fotográficos portugueses. Lisboa era escala frequente de artistas internacionais que itineravam a América do Sul e, em particular, o Brasil. O trabalho de Silva Nogueira beneficiou das sessões de pose com esses artistas que escalavam Lisboa durante as tournées artísticas. Desde 1920, a Fotografia Brasil tornou-se a principal fornecedora de retratos de artistas para a imprensa ilustrada portuguesa, sedenta de imagens do teatro. As origens da Fotografia Brasil podem justificar, por exemplo, as ousadas sessões com a bailarina e cantora de origem italiana, Adria Rodi, cujas poses audazes foram captadas pelo olhar moderno de Silva Nogueira, surpreendendo a conservadora sociedade portuguesa e introduzindo um novo padrão estético no retrato fotográfico. Muitos dos mais populares artistas de palco portugueses passaram a fotografar-se no seu estúdio e pontuaram as páginas das secções teatrais dos magazines ilustrados partilhadas com as estralas internacionais, que realçavam a modernidade das imagens de Silva Nogueira. Embora a maior parte dos artistas dos palcos portugueses tenham recorrido a Silva Nogueira durante os cinquenta anos de actividade do estúdio, foi durante os anos 1920 que ele se destacou em especiais cumplicidades com alguns desses artistas como Luísa Satanela que protagonizou um papel chave na transformação da cena teatral portuguesa. Satanela introduziu figurinos, cenários e coreografias modernistas nas representações da revista à portuguesa, um género teatral muito popular em Portugal. Silva Nogueira retratou Satanela de forma extensa em séries fotográficas de modernidade surpreendente, inovando sucessivamente num processo invulgar de cumplicidade, dando o mote para uma renovação decisiva da actividade do retrato fotográfico com ênfase no grande plano e na imagem do corpo. Os jovens artistas e intelectuais procuraram afirmar os valores modernistas na conservadora sociedade portuguesa. Destacou-se António Ferro. Como crítico teatral promoveu o modernismo nos palcos, em particular na revista. A campanha que pôs em 3 marcha nos jornais teve considerável sucesso. Mas Ferro usou a mesma abordagem ao intervir na propaganda, a se dedicou ainda antes de assumir a direcção do SPN. António Ferro teve um papel crucial na afirmação da visualidade em diversos âmbitos da sociedade portuguesa, da literatura ao jornalismo, do teatro à política. Na propaganda política nacional, Ferro suscitou a fotografia e o retrato fotográfico, entre outras áreas das artes para afirmar o novo regime, o Estado Novo, bem como os seus líderes, em particular o Presidente do Conselho, Oliveira Salazar. A afirmação visual do perfil discreto de Salazar representou um desafio particular para Ferro. Em última instância Ferro convocou a capacidade de um fotógrafo moderno, Silva Nogueira para conseguir capturar a imagem oficial de Salazar. Esse retrato esteve presente em todas as repartições públicas e escolas. Por fim, o modernismo, através do retrato fotográfico tinha conseguido assumir-se como a imagem institucional do país.From late 1910’s and throughout the 1920’s the Fotografia Brasil, a Lisbon commercial portraiture studio, led by Joaquim da Silva Nogueira, introduced modernist practices in Portuguese photography, still dominated by late 19th century taste that had a strong expression in most Portuguese photographic studios. Lisbon was then a frequent scale to South America, and especially to Brazilian ports. The work of Silva Nogueira benefited a lot from the posing sessions with foreign artists that scaled Lisbon during their artistic tours. Since 1920, Fotografia Brasil became the leading supplier of artist portraits to the Portuguese illustrated press eager of pictures from theatrical activity. The background of the Fotografia Brasil photographic portraits activity may justify, for instance, the daring photo sessions with the Italian born dancer and singer Adria Rodi, whose audacious poses captured by Silva Nogueira’s modern photographic look surprised the conservative Portuguese society and established a model to the changes in photographic portrait practice. Photographs of other popular artists soon started to be regularly published in special sections of illustrated magazine face to face with international stars highlighting Silva Nogueira’s modern portraits. Though most of Portuguese stage artists called upon the services of Silva Nogueira throughout fifty year of his studio’s activity, it was during the 1920’s that he stood out establishing a special relationship with the actress, singer and dancer Luísa Satanela who played a key role in the transformation of the Portuguese theatrical scene. Satanela introduced modernist design costumes, sceneries and dancing choreographies in the stage performances of revista, a theatrical genre quite popular in Portugal. Silva Nogueira extensively portrayed Satanela in surprisingly modern photographic series, innovating over and over in an unusual complicity process, setting the pace for the decisive renewal of the Portuguese photographic portrait activity with emphasis in close-up and body image. Portuguese young artists and intellectuals tried to assert modernism in Portuguese’s conservative society. António Ferro stood out in this role. As theatre critique he promoted modernist taste in theatrical productions, particularly in light theater. The campaign Ferro carried out in the press gave noticeable results. A transformation in theatre was noticed closing it to the cosmopolitan international productions. But Ferro also followed the same form of intervention in political propaganda, to which he started to devote himself even earlier of his nomination as director of the National Propaganda Secretariat. António Ferro had a crucial role in visuality’s assertion in different aspects of the Portuguese society, from literature to journalism, theater and particularly politics. In national political propaganda, Ferro called upon photography and photographic portrait among other areas of visual arts to disclose the new regime, the Estado Novo, as well as his leaders, particularly the Prime Minister Oliveira Salazar. The assertion of Salazar’s visual discreet profile represented a major challenge to Ferro. Ultimately Ferro called the skills of the modernist photographer Silva Nogueira to succeed in capturing the official image of Salazar. That portrait stood in every governmental office and school. Finally modernism, throughout photographic portrait stand out as Portuguese’s institucional image

Knowledge and perception about climate change among healthcare professionals and students: A cross-sectional study

Aim:&nbsp;The aim of this study was to assess knowledge on Climate Change (CC) and related consequences among students and professionals of healthcare setting. Methods:&nbsp;A cross-sectional study involving 364 people was conducted. The survey was performed at Sapienza University (Rome) using questionnaire previously developed and validated by the same research group. Results:&nbsp;Findings indicate awareness about CC and its effects and correct identification of practices that could help to mitigate its repercussions. The majority of the participants believed that CC had an impact on the health of humans (96.7%), animals (99.5%) and on the environment (99.7%). Results from the multivariate analysis regarding overall knowledge, show an increased odd in professionals (OR=2.08; 95%CI=1.02-4.26), individuals from the North (OR=3.34; 95%CI=1.37-8.15) and from the Center (OR=2.07; 95%CI=1.17-3.66). Regarding factors able to modify Earth's climate, correct answer had higher odds of being chosen by professionals (OR=2.83; 95%CI=1.41–5.70), and from individuals from South/Islands than by the ones from the Center (OR=0.65; 95%CI=0.40-1.06). The main sources of information resulted to be TV and school/university. Conclusions:&nbsp;These new evidences could guide policymakers on increasing the awareness of the population about this fundamental subject. Funding:&nbsp;This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Knowledge and perception about climate change among healthcare professionals and students: A cross-sectional study

Aim: The aim of this study was to assess knowledge on Climate Change (CC) and related consequences among students and professionals of healthcare setting. Methods: A cross-sectional study involving 364 people was conducted. The survey was performed at Sapienza University (Rome) using questionnaire previously developed and validated by the same research group. Results: Findings indicate awareness about CC and its effects and correct identification of practices that could help to mitigate its repercussions. The majority of the participants believed that CC had an impact on the health of humans (96.7%), animals (99.5%) and on the environment (99.7%). Results from the multivariate analysis regarding overall knowledge, show an increased odd in professionals (OR=2.08; 95%CI=1.02-4.26), individuals from the North (OR=3.34; 95%CI=1.37-8.15) and from the Center (OR=2.07; 95%CI=1.17-3.66). Regarding factors able to modify Earth's climate, correct answer had higher odds of being chosen by professionals (OR=2.83; 95%CI=1.41–5.70), and from individuals from South/Islands than by the ones from the Center (OR=0.65; 95%CI=0.40-1.06). The main sources of information resulted to be TV and school/university. Conclusions: These new evidences could guide policymakers on increasing the awareness of the population about this fundamental subject. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. &nbsp; Author contributions: Conceptualization, G.L.T. and A.D.C..; Methodology, G.L.T. and A.M..; Formal Analysis, A.D.P.B., C.S., R.A.C., D.B.; Investigation, A.D.P.B., C.S., R.A.C., D.B.; Data Curation, A.D.P.B., C.S.; Writing – Original Draft Preparation, R.A.C., D.B.; Writing – Review &amp; Editing, R.A.C., D.B., A.M..; Supervision, G.L.T..; Project Administration, G.L.T. &nbsp; Conflicts of interest: None declare

I percorsi della cronicita' alla luce della riforma del Sistema Sanitario della Regione Toscana.

Il progetto di tesi espone i caratteri salienti della riforma del Sistema Sanitario della Regione Toscana che entrerà in vigore a partire dal 1 Gennaio 2016 focalizzandosi in dettaglio sul progetto delle case della salute e sulla strutturazione dei percorsi della cronicità

The use of yoga and mindfulness-based interventions to reduce stress and burnout in healthcare workers. An umbrella review

Background: Mental health problems are common in healthcare workers as they are exposed to a variety of risk factors. Healthcare professionals face extraordinary stressors in the medical environment. They demonstrate high levels of stress, anxiety, depression and burnout, and sleep disorders, which inevitably lead to medication errors and lower standards of care. Methods: We conducted a wide-ranging review to analyze how the use of yoga and mindfulness-based interventions reduce stress, anxiety, and burnout in healthcare workers. The main scientific databases we consulted, such as PubMed, Scopus, Cochrane Library, Web of Sciences, APA PsycInfo, and CINAHL, contain all the systematic reviews present in the literature. No restrictions of year, publication, or language were applied. Based on PRISMA guidelines, 12 reviews were included in this paper. Quality assessment of the systematic reviews included in the research was done using the AMSTAR checklist. Results: In accordance with the literature, the study shows that increasing the use of yoga and mindfulness-based interventions can provide support to healthcare workers in achieving stable psycho-physical well-being, which can enhance their value within their work environment. Conclusion: Employers in the healthcare industry should consider implementing workplace wellness programs that integrate these methods to promote the well-being of their staff. MBI and yoga are effective interventions that can help the psychological functioning of healthcare professionals; however, further high-quality research is needed before this finding can be confirmed

Healthcare quality management and integrated care pathways (ICPs)

Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the largest causes of morbidity and chronic mortality and a public health problem of high importance. In Italy, COPD afflicts 5.6% of adult (3.5 million people) and is responsible for 55% of all deaths related to respiratory diseases. Smokers have a higher risk, in fact up to 40% develop the disease. From the Covid-19 pandemic, the most affected population is the elderly (mean age 80 years old), with previous chronic diseases, in 18% with chronic respiratory. The aim of the present work was to validate and measure the outcomes produced by the recruitment and care of COPD patients enrolled by an Healthcare Local Authority in the corresponding Integrated Care Pathways (ICPs) in order to measure how a multidisciplinary, systemic and e-health monitored care impacts upon mortality and morbidity. Materials and methods: Enrolled patients were stratified through the GOLD guidelines classification, a unified method to discriminate the various degrees of severity of COPD, using specific spirometric cut-points and providing homogeneous classes of patients. Monitoring examinations include simple spirometry, global spirometry, diffusing capacity measurement, pulse oximetry, EGA, 6-minute walk test. Chest Rx, chest CT, ECG may also be required. The severity of COPD identifies the timing of monitoring, which involves a fixed annual re-assessment for mild offset clinical forms, biannually in case of exacerbation, a quarterly cadence in moderate forms that becomes bimonthly in severe forms. Results: In 2344 enrolled patients (46% women and 54% men, mean age 78 yo) 18% had GOLD severity 1, 35% GOLD 2, 27% GOLD 3 and 20% GOLD 4. In addition, 73% of patients had at least one other chronic comorbidity, mainly diabetes or hypertension, and in 48% both. The data analysis showed that the population followed in e-health presented a 49% reduction in improper hospital admissions and a 68% reduction in clinical exacerbations compared to the population enrolled in the ICPs but not followed also in e-health. Smoking habits present at the time of patient enrollment in the ICPs remained in 49% of the total population enrolled and in 37% of the population enrolled in e-health. The patients enrolled in GOLD 1 and 2 obtained the same benefits both if treated in e- health and if treated in the clinic. However, GOLD 3 and 4 patients instead presented better compliance if treated in e-health and continuous monitoring allowed punctual and early interventions such as to reduce complications and hospitalization. Conclusion: The e-health approach made possible to ensure proximity medicine and personalization of care. Indeed, the implemented diagnostic treatment protocols, if properly followed and monitored, are able to control complications and impact the mortality and disability of chronic disease. The advent of e-health and ICT tools are demonstrating a great support capacity for care taking that also allows greater adherence to patient care pathways, even more than the protocols up to now identified, characterized by a monitoring programmed over time, enhancing a patients and their families quality of life improvement