Epidemiology of leprosy in Italy (1920-2019): A comprehensive review on existing data

Background and aims: Incidence of leprosy in Italy has declined steadily over the last century, but available evidence remains fragmentary. Our review aims to summarize available data on the epidemiology of leprosy cases in Italy. Methods: The following keywords were used to explore PubMed and Embase: leprosy, Hansen’s disease, (Mycobacterium) leprae, Italy, without any chronological restriction. Results: We identified a total of 39 reports, including 7 national reports, 11 international reports, 20 case reports. Notified leprosy cases were: 839 between 1925 and 1948; 434 between 1955 and 1979; 76 cases for the decade 1980-1989; 112 between 1990 and 1999; 62 between 2000 and 2009, and a total of 25 cases since 2009. Since 2003, 53% of all cases occurred in illegal residents. Focusing on individual cases, latency between early signs/symptoms and a proper diagnosis ranged between 2 and 20 years in 52.1% of individual cases. Conclusion: Imported cases of leprosy are responsible for most leprosy incidence in Italy, and social stigma, the unfamiliarity of healthcare professionals with such disorders, and difficulties of some high-risk groups to be appropriately assessed hint to a possible under-diagnosis. Professionals should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic. (www.actabiomedica.it)

Knowledge, experiences, and attitudes toward Mantoux test among medical and health professional students in Italy: A cross-sectional study

BACKGROUND: The World Health Organization's Action Framework for tuberculosis elimination in low-tuberculosis incidence countries includes the screening for active and latent tuberculosis in selected high-risk groups, including health care workers. In this context, medical and health profession students, exposed to nosocomial tuberculosis transmission during training and clinical rotations, are target populations for tuberculosis screening. No updated data are available on tuberculosis screening practice and knowledge of medical and health profession students in Italy. METHODS: Within the activities Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health, we carried out a multicentre cross-sectional study to assess knowledge, attitude and practices on tuberculosis prevention and control among Medical, Dentistry, Nursing and other health professions' students. Students were enrolled in the study on a voluntary basis and were administered a previously piloted structured questionnaire. Logistic regression models were applied to explore knowledge on tuberculosis prevention by selected socio-demographic variables and University-based tuberculosis prevention practice. RESULTS: Students of seventeen Universities across Italy participated in the study, and 58.2% of them received compulsory tuberculin skin test either at enrollment or while attending clinical practice. A total of 5,209 students filled the questionnaire. 37.7% were medicine and dentistry students (Group 1), 44.9% were nursing students (Group 2) and 17.4% were other health professions' students (Group 3). Age and gender had different distributions by groups, as well as knowledge and practice on tuberculin skin test. 84.4% of the study population (95% CI = 83.3-85.3) was aware of the existence of the tuberculin skin test, 74.4% (95% CI = 73.2-75.6) knew what is the first-level screening test for latent tuberculosis and only 22.5% (95% CI = 21.4-23.6) knew how to proceed after a positive tuberculin skin test result. Overall, knowledge on tuberculosis prevention was higher in Group 2 and lower Group 3, as compared to Group 1. CONCLUSION: In Italy, the knowledge on tuberculosis screening among University students is generally good. To reduce some of the criticalities found among the different study courses, it would be appropriate to harmonize both the regulations on tuberculosis screening practices for admission to University courses, and the educational activities on the topic of tuberculosis, to be extended to all workers involved in health care setting

Association between smoking and cancers among women: Results from the FRiCaM multisite cohort study

Background: Smoking is one of the leading causes of death worldwide, and it is strongly associated with several human cancers. However, the differential effects of cigarette smoke on the development and progression of different types of cancer remain unclear, and related data are limited. Methods: In this longitudinal cohort study conducted among 75,324 women aged 41-76 years, we aimed to evaluate the effect of exposure to tobacco smoke on cancer development. The participants completed a questionnaire assessing socio-demographic characteristics, anthropometric measures, health status, and lifestyle habits, including smoking and dietary habits; Cox proportional hazards regression modelling was used to evaluate the association between smoking and 21 different types of cancer. Results: After a 15-year follow-up, we identified 9,487 cases of cancer through record linkage with the Cancer Registry of Milan. Smoking was found to be positively associated with all neoplasms, with a Hazard Ratio (HR) of 1.10 (95% Confidence Interval (CI), 1.04-1.16). Regarding the specific types, we found the following associations: Cancer of the oral cavity HR = 2.63 ( 95% CI 1.72-4.01]), oesophagus HR = 3.09 (95% CI 1.37-6.96), stomach HR = 1.52 (95% CI 1.10-2.11), pancreas HR = 1.69 (95% CI 1.29-2.21), larynx HR= 34.81 (95% CI 8.07-150.14), lung HR = 8.48 (95% CI 7.09-10.14), cervix uteri HR = 2.51 (95% CI 1.38-4.57), and bladder and urinary tract HR = 5.67 ( 95% CI 3.96-8.14); lymphoma HR = 1.37 (95% CI 1.03-1.83); and colorectal cancer HR = 1.30 (95% CI 1.11-1.51). Conclusions: Our results thus demonstrate how smoke exposure increases the risk of several types of cancer. Considering the increasing prevalence of smoking among women, our results highlight the need to prioritize the development of anti-smoking campaigns targeted at women in order to contrast the evident gender inequality with respect to healthcare

Measuring health outcomes of OECD countries’ urban greenspace, with a special focus on Milan (Italy)

Background Urban world population has raised to 4.2 billion in 2018, with 2.5 billion more forecasted by 2050. Cities are places of opportunities but, at the same time, sites of environmental and social risk factors. Scientific evidence about urban green's environmental benefits is abundant, but Public Health outcomes are seldom carefully defined. The project aims at assessing the Public, Urban and Mental Health outcomes of urban green areas in Organisation for Economic Co-operation and Development (OECD) countries, and at exploring citizen urban greenspace perception in Milan, Italy. Methods A systematic review of literature was conducted according to the 2015 PRISMA statement. Two online databases (Medline and Embase), were consulted, and inclusion criteria were set, ruling in all OECD countries-based, English-written studies from 2000 to December 2019. Only objectively measurable health outcomes were deemed suitable for analysis. Based on the main review findings, a community-based survey was created, targeting residents of Milan and its suburban area to understand better how they benefit from the urban green areas in their city. The study is being carried out by an interdisciplinary team of medical doctors and architects. Results We grouped health outcomes into five separate domains, namely cardiovascular, obesity, respiratory, neoplasia and mental health. We found negative associations between disease prevalence and urban greenspace overall quantity. Size, perceived quality and accessibility were powerfully explanatory variables. Milan community-based survey drafting is underway. Results are still preliminary and will be presented by tables, graphs and plots. Conclusions Cities are increasingly becoming critical points for many emerging Public Health challenges. The results of our study may help urban planners, key stakeholders, policymakers and communities to preserve and increase existing green spaces, and to improve Urban Public Health

Understanding leprosy in a nonendemic area: A pilot study on knowledge, attitudes, beliefs of medical professionals from north-western Italy

Background: Describing knowledge, attitudes and beliefs about leprosy amongst Medical Professionals in a nonendemic area (Parma Province, North-Western Italy). Methods: A cross-sectional study was carried among a sample of Medical Professionals (MP; No. 242) during June and July 2019 as an on-line self-administered questionnaire including 21 true/false items about epidemiology, diagnosis, and clinical characteristics of leprosy. Effectors of better knowledge status (KS) and higher risk perception (RP) were assessed through calculation of respective multivariate odds ratios (OR) and 95% confidence intervals (95%CI) in two logistic regression analysis models. Results: A total of 102 questionnaires were retrieved (participation rate 42.1%; 67.6% of respondents <50 year-old). Of them, 10.8% had previously interacted with at least one leprosy case. Knowledge status (KS) was unsatisfying (59.7% correct answers), and also RP was relatively low, as 91.2% of them acknowledged leprosy as a severe disease, but only 42.2% identified leprosy as highly communicable. Knowledge gaps affected particularly understanding of epidemiology and non-dermatological issues. Moreover, 30.4% of respondents ignored that a treated leprosy case may remain in the community be-fore disease eradication. The main effector of KS was having interacted with a leprosy case (OR 4.881 95%CI 1.245-36.905), while RP was negatively associated with a better KS (OR 0.094 95%CI 0.027-0.334), and working as general practitioner (OR 0.133 95%CI 0.031-0.562). Conclusions: While individual expertise of European MP on leprosy slowly disappears, significant knowledge gaps and the high share of misconceptions collectively stress that refresher training may improve early diagnosis and management of incident cases. (www.actabiomedica.it)

Epidemiology of leprosy in Italy (1920-2019): A comprehensive review on existing data

none8Background and aims: Incidence of leprosy in Italy has declined steadily over the last century, but available evidence remains fragmentary. Our review aims to summarize available data on the epidemiology of leprosy cases in Italy. Methods: The following keywords were used to explore PubMed and Embase: leprosy, Hansen’s disease, (Mycobacterium) leprae, Italy, without any chronological restriction. Results: We identified a total of 39 reports, including 7 national reports, 11 international reports, 20 case reports. Notified leprosy cases were: 839 between 1925 and 1948; 434 between 1955 and 1979; 76 cases for the decade 1980-1989; 112 between 1990 and 1999; 62 between 2000 and 2009, and a total of 25 cases since 2009. Since 2003, 53% of all cases occurred in illegal residents. Focusing on individual cases, latency between early signs/symptoms and a proper diagnosis ranged between 2 and 20 years in 52.1% of individual cases. Conclusion: Imported cases of leprosy are responsible for most leprosy incidence in Italy, and social stigma, the unfamiliarity of healthcare professionals with such disorders, and difficulties of some high-risk groups to be appropriately assessed hint to a possible under-diagnosis. Professionals should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic. (www.actabiomedica.it).noneRicco M.; Vezzosi L.; Balzarini F.; Mezzoiuso A. G.; Ranzieri S.; Vaccaro F. G.; Odone A.; Signorelli C.Ricco, M.; Vezzosi, L.; Balzarini, F.; Mezzoiuso, A. G.; Ranzieri, S.; Vaccaro, F. G.; Odone, A.; Signorelli, C