Post-graduate medical education in public health: The case of Italy and a call for action

Public health technical expertise is of crucial importance to inform decision makers\u2019 action in the field of health and its broader determinants. Improving education and training of public health professionals for both practice and research is the starting point to strengthen the role of public health so that current health challenges can be efficiently tackled. At the Association of Schools of Public Health in the European Region (ASPHER) Deans\u2019 & Directors\u2019 2017 Annual Retreat, we presented the structure and management of public health training system in Italy, and we reported recent data on Italian public health specialists\u2019 educational experience, employment opportunities and job satisfaction. Public health training in Italy is implemented in the context of the post-graduate medical education residency programme in Hygiene and Preventive Medicine, delivered by 34 University-based Schools of Public Health. We report relatively high employment rates across the county and wide spectrum of career opportunities for young public health specialists. However, job security is low and training expectations only partially met. We call upon other Schools of Public Health to scale up the survey within the broad ASPHER community in a shared and coordinated action of systematically collecting useful data that can inform the development of public health education and training models, their implementation and fruitful interaction with population health, health systems and services

Attitudes towards compulsory vaccination in Italy: Results from the NAVIDAD multicentre study

ABSTRACT: Background: Vaccine hesitancy is a considerable issue in European countries and leads to low coverage rates. After a long debate, Italy has made vaccination mandatory for admission to its schools. Methods: In the NAVIDAD study (a cross-sectional multicentre study), a 63-item questionnaire was administered to 1820 pregnant women from 15 Italian cities. The questionnaire assessed the interviewee's opinion on mandatory vaccines, as well as their socioeconomic status, sources of information about vaccines, confidence in the Italian National Healthcare Service (NHS), and intention to vaccinate their newborn. Results: Information sources play a key role in determining the opinion on restoration of mandatory vaccines; in particular, women who obtained information from anti-vaccination movements are less likely to accept the vaccines (OR: 0.35, 95% CI: 0.21\u20130.58, p < 0.001). Women who had confidence in healthcare professional information agreed more on mandatory vaccination than did the other women (OR: 2.66, 95% CI: 1.62\u20134.36, p < 0.001); those who perceived that healthcare professionals have economic interest in child immunization and who declared that healthcare providers inform only on vaccinations benefits not on risks were less likely to agree on compulsory vaccination (OR: 0.66, CI 95%: 0.46\u20130.96, p = 0.03; OR: 0.66, CI 95%: 0.46\u20130.95, p = 0.03, respectively). Conclusion: Information sources and confidence towards health professionals are the main determinants of acceptance of mandatory vaccine restoration. To increase the acceptability of the restoration and reduce vaccine hesitancy, these aspects need to be strengthened

A pilot study of internet usage patterns in a group of italian university students.

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: despite growing interest in Internet addiction disorder (Iad) among the high school population, very little is known about the potential risks of the use of the Internet for university students. The present survey aimed to collect information on Internet usage patterns in a group of Italian university students.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: the sample comprised 600 Italian university students enrolled in various faculties, in two different universities: catania (n=300; 150 males and 150 females) and Palermo (n=300; 150 males and 150 females). The diagnostic Questionnaire for Iad based on 8 criteria was used to categorize the Internet users. In order to better describe students’ Internet usage patterns, 4 other criteria were added. chi-square test (P&amp;lt;0.05) was applied to examine differences between the two groups of students (catania versus Palermo), and for comparisons between male and female students.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: respondents were ‘minimal’ (82.5%) or ‘moderate’ (17.5%) Internet users. none of the enrolled university students met the criteria of definite Iad, although a fairly high level of at-risk Internet attitudes and behaviors was found. Finally, some gender differences in Internet attitudes and behaviors were found.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: the implications drawn from this study, including the adequacy of the available measurement instruments for Iad, are discussed....&lt;/p&gt

Pregnancy-induced hypertension is an independent risk factor for meconium aspiration syndrome: A retrospective population based cohort study

Objective: Meconium aspiration syndrome (MAS), possibly resulting from fetal hypoxia, is a respiratory distress disorder in the infant. Pregnancy-induced hypertension (PIH) can cause placental dysfunction and lead to fetal hypoxia, which may induce the development of MAS. Therefore, the aim of this study was to determine the association between PIH and MAS and to identify the predictive risk factors. Materials and methods: This was a retrospective cohort study. We selected patients with newly diagnosed PIH and a matched cohort group from the Taiwan National Health Insurance Research Database (NHIRD), from January 1, 2000 till December 31, 2013. For each patient in the PIH cohort, 4 subjects without PIH, matched for age and year of delivery, were randomly selected as the comparison cohort. The incidence of meconium aspiration syndrome was assessed in both groups. Results: Among the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and 116,052 matched controls were identified. Patients who experienced PIH had a higher incidence of MAS than did those without PIH. According to a multivariate analysis, PIH (odds ratio [OR] ¼ 1.70, 95% confidence interval [CI] ¼ 1.49e1.93, p &lt; 0.0001) was independently associated with increased risk of MAS. Additionally, age 30 years (OR ¼ 1.26, 95% CI ¼ 1.12e1.42, p ¼ 0.0001), nulliparity (OR ¼ 1.13, 95% CI ¼ 1.01e1.27, p ¼ 0.0367) and patients with diabetes mellitus (OR ¼ 3.09, 95% CI ¼ 1.35e7.09, p ¼ 0.0078) were also independent risk factors of MAS. Conclusion: Patients with PIH obtained higher subsequent risk for the development of MAS than those without PIH. Besides, age 30 years, nulliparity and patients with diabetes mellitus are the independent risk factors of developing MAS

Role of anthropometric factors, self-perception, and diet on weight misperception among young adolescents: a cross-sectional study

Adolescence overweight and obesity have increased considerably, and the misperception of their weight status could reduce the efficiency of intervention programs. The aim of this study was to evaluate the prevalence rate of misperception and to assess the relationship between weight perception and anthropometric parameters, self-perception, physical activity, and adherence to the Mediterranean diet

A Prospective, Multi-Center Trial to Identify the Prevalence of Inducible Ischemia in Patients Presenting with Diabetes and Suspected or Known Coronary Artery Disease: Preliminary Results

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with diabetes mellitus and these patients have an elevated prevalence of silent myocardial ischemia. Aim of this study was to assess the prevalence of inducible ischemia by sestamibi SPECT in patients with diabetes and suspected or known CAD.Material and Methods: Between December 2003 and September 2004, 758 consecutive patients (282 women and 476 men, mean age 63±9 years), with at least a five-year history of diabetes mellitus were unrolled in an ongoing multi-center trial. All patients underwent rest and stress sestamibi SPECT imaging with physical exercise (n=346) or dipyridamole (n=412) (0.142 mg/kg/min intravenous over 4 minutes). SPECT studies were interpreted by two independent observers utilizing a 20-segment scoring system to determine summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS). SPECT studies with a SRS or SSS>3 were considered abnormal. The SDS was used to determine the presence of inducible ischemia and to assess the extent and severity of perfusion defects. Patients without history of CAD were referred for SPECT imaging for recurrence of atypical symptoms, for risk assessment before general surgery, or for screening of CAD due to presence of multiple cardiac risk factors.Results: 290 patients (38% of the total) had documented CAD, while 468 (62%) patients had no history of CAD or evidence of previous myocardial infarction on ECG. Among patients with CAD, 104 (36%) were symptomatic and 186 (64%) were symptom-free. Among patients without CAD, 200 (43%) were symptomatic and 268 (57%) were symptoms-free. Inducible ischemia at SPECT was detected in 69% of the patients with CAD and in 50% of the patients without CAD. The prevalence of ischemia was not different in symptomatic and symptom-free patients in both groups of patients with (63% and 75%, respectively, p=NS) and without CAD (49% and 51% respectively, p=NS). In both groups of patients with or without CAD, the extent and the severity of ischemia was not related to symptoms status, considering that SDS were not different between patients with and without symptoms

Role of SPECT imaging in the definition of cardiac risk in diabetic patients with no history of coronary artery disease: results of a prospective, multi-center trial

Coronary artery disease (CAD) is the leading causes of morbidity and mortality in patients with diabetes mellitus. In these patients an elevated prevalence of silent myocardial ischemia has been reported. Thus, noninvasive assessment of cardiac risk may guide clinical decision-making in diabetic patients. This study assessed the role of SPECT imaging over clinical data for cardiac risk stratification in diabetic patients without known CAD.Materials and Methods: We enrolled 512 consecutive patients (265 men; mean age 63±8 years) with at least a five-year history of diabetes without known CAD or evidence of previous myocardial infarction on ECG. All patients underwent rest/stress Tc-99m sestamibi SPECT imaging with physical exercise (n=246) or dipyridamole (n=266) (0.142 mg/kg/min intravenous over 4 minutes). SPECT studies were interpreted by two independent observers utilizing a 17-segment model to determine summed stress, summed rest and summed difference scores. A computer program (CADENZA) was used to determine pre- and post-test likelihood of CAD. Beside diabetes, the program considered for analysis of pre-test likelihood of CAD the clinical variables based on Framingham risk factors. Taking into account SPECT imaging results, the program determined the patient’s post-test likelihood of CAD.Results: Based on the clinical variables, diabetic patients were divided into 3 groups: low (n=297), intermediate (n=145) and high (n=70) pre-test likelihood of CAD. An abnormal SPECT study was present in 44% of the patients. At analysis of variance, the total extent and severity of ischemic myocardium at SPECT was not significantly different among the 3 groups. After the addition of SPECT results, 299 patients were at low, 93 at intermediate and 120 at high likelihood of CAD. The likelihood of disease was significantly different when preand post-test likelihood of CAD were compared (Person chi-square, P<0.05). In particular, 22% of patients with low pre-test likelihood shifted in the intermediate (n=29) and high (n=37) posttest likelihood of CAD; 63% of patients with intermediate pre-test likelihood shifted in the low (n=67) and high (n=24) post-test likelihood of CAD; and 16% of patients with high pre-test likelihood shifted in the low (n=1) and intermediate (n=10) post-test likelihood of CAD. Conclusions: This study confirms that diabetic patients without known CAD may have myocardial ischemia at SPECT irrespective from the classical risk factors and suggests that SPECT imaging is useful in the definition of cardiac risk in these patients, particularly in those with intermediate pre-test likelihood of disease