Health inequalities and inadequate housing. The case of exceptions to hygienic requirements for dwellings in Italy

Negli ultimi decenni, i requisiti igienici italiani per le abitazioni sono stati modificati da più deroghe. Scopo del presente lavoro è analizzare le deroghe introdotte a livello nazionale, regionale e locale. Le deroghe più importanti riguardavano l'uso abitativo di seminterrati e sotterranei e il restauro di edifici. Il documento descrive anche le norme in materia di indennità per violazione degli abusi nell'edilizia. Gli autori sottolineano la necessità di maggiore uniformità e chiarezza nella determinazione degli standard sanitari delle abitazioni, nonché di una semplificazione della legislazione esistente.In the past decades, Italian hygienic requirements for dwellings have been modified by multiple derogations. Aim of the present work is to analyse the derogations introduced at a national, regional, and local level. The most important derogations were related to the habitable use of semi-basements and garrets, and building restoration. The paper also describes the regulations regarding indemnity for infringement of building abuses. The authors underline the need for more uniformity and clarity in the determination of health standards of dwellings, as well as for a simplification of the existing legislation

Il ruolo delle Sottoprefetture nella tutela dell’igiene e della sanità pubblica in Italia, corsi e ricorsi storici

This work is based on 18-months eld research I carried out among Eritrean and Ethiopian Pentecostals in Rome (Italy). One of the topics of my work focused on the meaning they give to the evil: I collected different illness narratives and various cases. In this paper, I would like to shed light upon some dimensions of the sickness that go beyond the disease itself. By proposing a case of a woman who became sick during her high school period, because of a witchcraft attack, I will try to analyze the various stakes we can nd in the interpretation of the evil, in the etiology of the sickness and in her illness narratives. The various issues will be also analyzed by putting them in the wider picture of the con ict between Pentecostalism and local “tradition”, represented, in this case, by the local Orthodox (tewahdo) Church and its therapeutic practices, considered by Pentecostals to be devilish

Early impact of bariatric surgery on type II diabetes, hypertension, and hyperlipidemia: a systematic review, meta-analysis and meta-regression on 6,587 patients

Background This study aims to evaluate the 12–24-month impact of bariatric surgery on the foremost modifiable traditional risk factors of cardiovascular disease. Methods A systematic review and meta-analysis of prospective interventional studies reporting the most commonly performed laparoscopic surgical procedures, i.e., Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and cardiovascular risk reduction after surgery. Results The bibliographic research conducted independently by two authors yielded 18 records. When looking at RYGB and AGB separately, we observed a relevant heterogeneity (I 2 index ≥87 %) when BMI reduction was considered as the main outcome. When hypertension, type II diabetes, and hyperlipidemia risk reduction was estimated, a highly significant beneficial effect was found. The risk reduction was 0.33 [0.26; 0.42] for type II diabetes, 0.52 [0.42; 0.64] for hypertension, and 0.39[0.27; 0.56] for hyperlipidemia (P < 0.0001 for all outcomes considered). When looking at surgical technique separately, a higher but not statistically significant risk reduction for all outcomes considered was found. Results from the meta-regression approach showed an inverse relation between cardiovascular risks and BMI reduction. Conclusions The present study showed an overall reduction of cardiovascular risk after bariatric surgery. According to our analysis a BMI reduction of 5 after surgery corresponds to a type II diabetes reduction of 33 % (as reported by Peluso and Vanek (Nutr Clin Pract 22(1):22–28, 2007); SAS Institute Inc., (2000–2004)), a hypertension reduction of 27 % (as reported by Buchwald and Oien (Obes Surg 23(4):427–436, 2013); Valera-Mora et al. (Am J Clin Nutr 81(6):1292–1297, 2005)), and a hyperlipidemia reduction of 20 %(as reported by Adams et al. (JAMA 308(11):1122–31, 2012)); Alexandrides et al. (Obes Surg 17(2):176–184, 2007). In summary, our study showed that laparoscopic bariatric surgery is an effective therapeutic option to reduce the cardiovascular risk in severe obese patients

A Systematic Review of Clinical Practice Guidelines for Caries Prevention following the AGREE II Checklist.

Untreated oral diseases are detrimental to overall well-being and quality of life and are in close relationship with social and economic consequences. The presence of strong evidence for caries primary and secondary prevention is a compulsory tool for the development of clinical practice guidelines (CPGs). This paper was aimed to assess systematically the importance of clinical practice guidelines in caries prevention management considering both the adult and pediatric populations and evaluate them using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Checklist. Records were extracted from EMBASE, SCOPUS, PubMed/Medline and seven other relevant guideline databases between 6 January and 14 February 2023. Two reviewers independently conducted the appraisal using the web-based platform My AGREE PLUS. Twenty-one guidelines/papers met the inclusion criteria and were reviewed. Eight CPGs included both primary and secondary prevention interventions, whereas thirteen presented a single preventive model. Overall, 12 guidelines were published in the USA. The mean AGREE II scores ranged from 35.4% to 84.3%. Of the total twenty-one included guidelines, twelve were classified as "Recommended", ranging from 56.3% to 84.3%, the others were described as "Recommended with modification", ranging from 35.4% to 68.9%. From the AGREE II analysis carried out, the CPGs included in this survey adopted a punctual methodological rigor but lacked applicative power. The present survey showed that the public, as the primary beneficiary, played a limited role in the development of the twenty-one CPGs. Hence, methodological improvement can better support high-quality CPG development in the future

Aspetti igienico-sanitari in ambito urbanistico: conflittualità nelle norme urbanistiche nazionali e locali in tema di sanità pubblica [Hygienic and sanitary aspects in urban planning: contradiction in national and local urban legislation regarding public health]

Nowadays, the majority of world population lives in urban areas and this portion is going to increase in the coming decades. The health impact of urban areas is well established and described in scientific literature. Italian health and hygiene legislation dealing with urban health is fragmented and not coordinated with the regulation about environment and city planning. The overlapping of legal competences between different authorities and the conflict of attribution between the Central State and Regional Governments deeply contributed to generate uncertainty. The authors here analyse the Italian regulatory framework and depict its lacks in terms of public health protection

Leadership Effectiveness in Healthcare Settings: A Systematic Review and Meta-Analysis of Cross-Sectional and Before-After Studies

To work efficiently in healthcare organizations and optimize resources, team members should agree with their leader's decisions critically. However, nowadays, little evidence is available in the literature. This systematic review and meta-analysis has assessed the effectiveness of leadership interventions in improving healthcare outcomes such as performance and guidelines adherence. Overall, the search strategies retrieved 3,155 records, and 21 of them were included in the meta-analysis. Two databases were used for manuscript research: PubMed and Scopus. On 16th December 2019 the researchers searched for articles published in the English language from 2015 to 2019. Considering the study designs, the pooled leadership effectiveness was 14.0% (95%CI 10.0-18.0%) in before-after studies, whereas the correlation coefficient between leadership interventions and healthcare outcomes was 0.22 (95%CI 0.15-0.28) in the cross-sectional studies. The multi-regression analysis in the cross-sectional studies showed a higher leadership effectiveness in South America (beta = 0.56; 95%CI 0.13, 0.99), in private hospitals (beta = 0.60; 95%CI 0.14, 1.06), and in medical specialty (beta = 0.28; 95%CI 0.02, 0.54). These results encourage the improvement of leadership culture to increase performance and guideline adherence in healthcare settings. To reach this purpose, it would be useful to introduce a leadership curriculum following undergraduate medical courses

Clinical efficacy of ivabradine in patients with inappropriate sinus tachycardia: a prospective, randomized, placebo-controlled, double-blind, crossover evaluation

Objectives The purpose of this study was to investigate the role of ivabradine in the treatment of symptomatic inappropriate sinus tachycardia using a double-blind, placebo-controlled, crossover design. Background Due to its If blocking properties, ivabradine can selectively attenuate the high discharge rate from sinus node cells, causing inappropriate sinus tachycardia. Methods Twenty-one patients were randomized to receive placebo (n = 10) or ivabradine 5 mg twice daily (n = 11) for 6 weeks. After a washout period, patients crossed over for an additional 6 weeks. Each patient underwent symptom evaluation and heart rate assessment at the start and finish of each phase. Results After taking ivabradine, patients reported elimination of >70% of symptoms (relative risk: 0.25; 95% CI: 0.18 to 0.34; p < 0.001), with 47% of them experiencing complete elimination. These effects were associated with a significant reduction of heart rate at rest (from 88 ± 11 beats/min to 76 ± 11 beats/min, p = 0.011), on standing (from 108 ± 12 beats/min to 92 ± 11 beats/min, p < 0.0001), during 24 h (from 88 ± 5 beats/min to 77 ± 9 beats/min, p = 0.001), and during effort (from 176 ± 17 beats/min to 158 ± 16 beats/min, p = 0.001). Ivabradine administration was also associated with a significant increase in exercise performance. No cardiovascular side effects were observed in any patients while taking ivabradine. Conclusions In this cohort, ivabradine significantly improved symptoms associated with inappropriate sinus tachycardia and completely eliminated them in approximately half of the patients. These findings suggest that ivabradine may be an important agent for improving symptoms in patients with inappropriate sinus tachycardia

Hygienic and sanitary requirements of gyms in force in Italy. National issues and analysis of regional regulations

Negli ultimi anni la consapevolezza dei benefici dell'attività fisica per la salute è cresciuta e con essa il numero di persone che la praticano; parallelamente, anche il numero di palestre è sostanzialmente aumentato. A livello nazionale non esistono organiche normative che regolamentino i requisiti igienico-sanitari delle palestre, ma diversi legislatori a livello regionale hanno provveduto a colmare questo vuoto. Nel presente studio gli autori analizzano le normative tecniche del CONI ed i citati provvedimenti regionali, sottolineando le criticità, fra le quali anche la possibile ubicazione delle palestre in locali seminterrati o interrati. Infine concludono sottolineando la necessità di maggiori univocità e chiarezza nella determinazione dei requisiti igienico-sanitari su scala nazionale.In recent years, the awareness of the importance of physical activity for human health is growing, as people practicing it; the number of gyms has also substantially increased. Currently, in Italy there is not a consistent regulation regarding hygienic and sanitary requirements of gyms. Several Italian regions issued laws about this topic. The authors analyse the standards required by the Italian Olympic Committee (CONI) and the regional laws, highlighting the numerous issues, among which the possible location of gyms in semi-basements and basements. They eventually call for a national regulation that should clearly transpose the hygienic and sanitary requirements of gyms into a satisfactory rule of la