The pharmaceutical care and the rejected constitutional reform: what might have been and what is

This study analyzes the current state of legislation pertaining to pharmaceutical/health care in a period of normative ferment characterized by continuous changes, after countless discussions that have been held on a proposed constitutional reform (rejected by the will of the people at the end of 2016). After a general reflection on the division of legislative powers between the State and its Regions, in the light of attempts to bring about a reform, we will analyse specific problems: from the recent, but in some ways already defined as historic, approval of the new Essential Levels of Care (LEC), the approval of the 2017 Budget Law (concerning important items such as the purchase of drugs), until we reach the Draft Law on competition which is in the process of being approved. All this is taking place in the context of loyal, unavoidable cooperation between State, Regions and local institutions, in the spirit of the ascendancy of the right to health over economic/financial interests in the country

Metabolic syndrome, hypertension, and nervous system injury: Epidemiological correlates

Metabolic syndrome (MetS) is a common and complex disorder combining hypertension, obesity, dyslipidemia, and insulin resistance. MetS represents a risk factor for changes in cognitive functions in older age, and several studies have suggested that MetS may be linked to dementia. This article reviews the main evidences about the relationship between MetS and neurodegenerative disease. Starting from an epidemiological point of view, the article analyzes medico-social aspects related to MetS, considering the reduction of work capacity and the condition of disability that it involves. Some authors affirm that on the basis of current Italian legislation, it is possible to consider the syndrome as a disability. This is because all the diseases that make up MetS are high-risk clinical pathological conditions. For these reasons, a joint action is required to contain the incidence of MetS, the high social costs, and the loss of productivity related to the syndrome. In conclusion, healthcare initiatives could be adopted in order to increase the understanding of the pathogenic contributions of each element on MetS and how they can be modified. These actions will be useful to reduce healthcare costs and can lead to more effective prevention of metabolic disease, thus promoting good health. Abbreviations: MetS: Metabolic syndrome; WHO: World Health Organization; CVD: cerebrovascular diseases; AD: Alzheimer's Disease; VaD: Vascular Dementia; IDF: International Diabetes Federation; T2DM: type 2 diabetes mellitus; CAD: coronary artery disease; MCI: mild cognitive impairment; NCDs: Non Communicable Diseases; BMI: Body Mass Index; ICIDH: International classification of impairments, disabilities and handicaps

J Clin Microbiol

Serotype 1 is an important cause of invasive pneumococcal disease in South Africa and has declined following the introduction of the 13-valent pneumococcal conjugate vaccine in 2011. We genetically characterized 912 invasive serotype 1 isolates from 1989 to 2013. Simpson's diversity index (D) and recombination ratios were calculated. Factors associated with sequence types (STs) were assessed. Clonal complex 217 represented 96% (872/912) of the sampled isolates. Following the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13), ST diversity increased in children 14 years (D, 0.35 to 0.54, P 14 years (242/305 [79%] versus 96/148 [65%], P = 0.001), whereas ST-9067 increased (4/684 [0.6%] versus 24/228 [11%], P < 0.001). Three subclades were identified within ST-217: ST-217C1 (353/382 [92%]), ST-217C2 (15/382 [4%]), and ST-217C3 (14/382 [4%]). ST-217C2, ST-217C3, and single-locus variant (SLV) ST-8314 (20/912 [2%]) were associated with nonsusceptibility to chloramphenicol, tetracycline, and co-trimoxazole. ST-8314 (20/912 [2%]) was also associated with increased nonsusceptibility to penicillin (P < 0.001). ST-217C3 and newly reported ST-9067 had higher recombination ratios than those of ST-217C1 (4.344 versus 0.091, P < 0.001; and 0.086 versus 0.013, P < 0.001, respectively). Increases in genetic diversity were noted post-PCV13, and lineages associated with antimicrobial nonsusceptibility were identified.2016-04-25T00:00:00Z26962082PMC484471

Substance use and knowledge among Italian High School students.

This study was aimed for evaluation of Italian students' attitudes to addictive substances, their knowledge and personal experience, and their awareness about the risks. The research was realized among high school students from Marche region in the Central Italy in the year 2006; the study group was randomly chosen from all schools in the region. 4118 appropriately completed questionnaires returned. The statistic processing was carried out by using chi-square test for two qualitative variables. 29.9 % of the students have tried drugs; 36.4 % of the interviewed reckon alcohol, tobacco and antidepressants for drugs. A relationship between the use of licit and illicit addictive substances and a correlation between the use of illicit substances and the use of liquors and tobacco in family was found. The students, who drink frequently, smoke regularly and use drugs, believe that the drugs create dependence only if overused; only a quarter of them classify themselves as drug addicts. The study indicates a lack of information on the drugs among the young people. It emerges that the young people do not sufficiently know the risk of the dependence. A change of the preventive strategies should be considered

Survey on food hygiene knowledge on board ships

Background and aim: The aim of the study was to evaluate the knowledge and attitudes on food hygiene in seafarers.Materials and methods: The study was conducted using an anonymous questionnaire presented to the workers of 7 tankers of an Italian shipping company (Finaval S.p.A.). As a reference, the analysis was extended to office employees of the same firm. Data were divided according to the rank of seafarers to assess possible differences in perceiving the risk.Results: Overall knowledge on food safety concept was not high among seafarers. In general, galley and catering workers group provided a lower percentage of correct answers than other crew members. Foodservices staff revealed little awareness of the risks linked with handling food and their perception of risk of disease transmission through food was low. Answers about risk related to specific food (eggs and fish) showed that knowledge about these problems was less than satisfactory. Moreover, the percentage of ‘I don’t know’ answers was high. These findings suggest that this personnel is aware of the right stepsof health protection in terms of food hygiene, but does not understand why it is necessary.Conclusions: Galley and catering group workers were not the most informed about food hygiene problems.This highlights the need to hire qualified personnel of the food industry on board ships. All those working inthe food service area should be properly trained on food hygiene. Seafarers should be the target of specificinformative campaigns about health risks linked with aliments, possible consequences of it and also oneson how to minimise the exposure to potentially dangerous agents/behaviours during travel/life at sea

Food safety on board tankers. Results of analysis from ‘Healthy Ship’ project

Background: Microbiological monitoring of surfaces used for food preparation, as required by the Hazard Analysis and Critical Control Points (HACCP) plan, is important in risky conditions as those observed in the kitchens of ships. Limits to introduce a classification of risk levels and methods to adopt in conditions as those occurring in tankers have not been investigated. This paper presents the results of the “Healthy Ship” project on HACCP monitoring of surfaces used in food preparation on Italian flag tankers.  Materials and methods: Microbiological monitoring was carried out on 19 tankers between 2013 and 2017. Food handlers were also trained on board ship according to HACCP standards. Contact plates (ISO 18593:2004 compliant) were used to determine the colonies and bacterial charge according to the Wirtanen and Salo’s method.  Results: A total of 1074 samples, 108 before the first course, 168 after the first course, 390 during the period of refresher (2015–2016), and 408 after the refresher training, were obtained from the three main kitchen surfaces: the worktop, cutting board, and kitchen sink. A good level of hygiene was observed in 56.9% of all samples, 0.1% were classified as adequate, and the remaining 43% as poor. The highest contamination was observed on the cutting board and kitchen sink and involved the total aerobic count. The only surface with inadequate levels of hygiene was the worktop. A reduction of contaminated samples was noted after training.  Conclusions: Our results suggest that continuous training should be provided for personnel responsible for handling foodstuffs on board ships.

Recommendations for assessing water quality and safety on board merchant ships

Introduction: Health and diseases on board ships may depend on water. Interventions to improve the quality of water may bring to significant benefits to health and water stores/supply and should be controlledto protect health. This paper has reviewed the main regulations for the control of water safety and qualityon board ships and presents some practical recommendations for keeping water healthy and safe in passenger and cargo merchant ships.Methodology: The main international regulations and guidelines on the topic were analysed. Guidelines forWater Quality on Board Merchant Ships Including Passenger Vessels of Health Protection Agency, World Health Organisation (WHO) Guide to Ship Sanitation, WHO Guidelines for Drinking Water Quality, WHO Water Safety Plan and the United States Center for Disease Control and Prevention Vessel Sanitation Program were examined. Recommendations for passenger and, if available, for cargo ships were collected and compared. Recommended questionnaire: A questionnaire summarising the main information to collect for assessingthe enough quality of water for the purposes it should be used on board is proposed. The need of havinga crew member with water assessment duties on board, trained for performing these activities properlyis discussed.Conclusions: Water quality on board ships should be monitored routinely. Monitoring should be directedto chemical and microbiological parameters for identifying possible contamination sources, using specifickits by a designed crew member. More detailed periodic assessments should be under the responsibility ofspecialised personnel/laboratories and should be based on sample collection from all tanks and sites of waterdistribution. It is important to select a properly trained crew member on board for monitoring water quality