GHPSS Multicenter Italian Survey: Smoking Prevalence, Knowledge and Attitudes, and Tobacco Cessation Training among Third-Year Medical Students

Aims and background

Healthcare professionals have an important role to play both as advisers – influencing smoking cessation – and as role models. The aims of this study were to examine smoking prevalence, knowledge and attitudes among Italian university students attending medical schools using the Global Health Professions Student Survey (GHPSS) approach.

Methods and study design

A multicenter cross-sectional study was conducted among University students of 9 Italian medical schools (age ranging between 19 and 29 years). The GHPSS questionnaire was self-administered. A logistic regression model was used to identify possible factors associated with tobacco smoking status. Data were analyzed with the software SPSS 19.0 for Windows.

Results

Seven hundred thirty medical students (response rate 100%) were enrolled. The prevalence of current smokers was 20.4% (males 22.4%, females 19.1%). Of the total sample, 87.7% believed that health professionals should receive specific training in techniques to quit smoking, and 65% believed that health professionals had a role in giving advice or information about smoking cessation. However, 89.4% answered that they had not received specific training on smoking cessation techniques. Multivariate analysis showed that students belonging to universities in southern Italy were more likely to be smokers (OR = 2.00; 95% CI: 1.03–3.97).

Conclusions

This Italian multicenter survey found that one fifth of future medical doctors are smokers. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.

Peginterferon Beta-1a Shows Antitumor Activity as a Single Agent and Enhances Efficacy of Standard of Care Cancer Therapeutics in Human Melanoma, Breast, Renal, and Colon Xenograft Models

Because of its tumor-suppressive effect, interferon-based therapy has been used for the treatment of melanoma. However, limited data are available regarding the antitumor effects of pegylated interferons, either alone or in combination with approved anticancer drugs. We report that treatment of human WM-266-4 melanoma cells with peginterferon beta-1a induced apoptotic markers. Additionally, peginterferon beta-1a significantly inhibited the growth of human SK-MEL-1, A-375, and WM-266-4 melanoma xenografts established in immunocompromised mice. Peginterferon beta-1a regressed large, established WM-266-4 xenografts in nude mice. Treatment of SK-MEL-1 tumor-bearing mice with a combination of peginterferon beta-1a and the MEK inhibitor PD325901 ((R)-N-(2,3-dihydroxypropoxy)-3,4-difluoro-2-(2-fluoro-4-iodophenylamino)benzamide) significantly improved tumor growth inhibition compared with either agent alone. Examination of the antitumor activity of peginterferon beta-1a in combination with approved anticancer drugs in breast and renal carcinomas revealed improved antitumor activity in these preclinical xenograft models, as did the combination of peginterferon beta-1a and bevacizumab in a colon carcinoma xenograft model.

How are the temporary workers? Quality of life and burn-out in a call center temporary employment in Italy: a pilot observational study

OBJECTIVES

The aim of this study was to quantify the level of health related quality of life and burnout in a call centers sample of precarious workers.

METHODS

An observational study was carried out in Italy. A self-reported anonymous questionnaire was administered to temporary workers in order to estimate burn-out and quality of life levels.

RESULTS

227 questionnaires were collected. 78% of the sample was female and the mean age was 35.48 years (SD=9.91). Among the participants, 40% were smokers, 42% regularly drinkers, 65% changed the body weight (more than 5 kg, in 1 year). The mental component score (MCS) was significantly better in subject that have a regularly life style, for example in those no change their body weight (p=0.001), sleep more than 7 hours (p=0.018) and followed a diet (p=0.035). The DP (depersonalization) is significant higher in former smokers (p=0.031), in underweight subjects (p=0.025) and in the group that have a precarious employment of over 2 years (p=0.013).

CONCLUSIONS

This investigation shows that in this particular category of atypical workers depressive symptoms and quality of life were lower than the general population. It is important to underline that the interpretation of the results is limited partly by the observational character of the study.

[Survey to assess educational needs of personnel working at Departments of Prevention, Health Districts and Hospital Directions in Italy: questionnaire validation and preliminary results]

AIM

The aim was of this pilot study was to validate a questionnaire to collect information on the number of health professionals, doctors and veterinarians working in the Departments of Prevention, Health Districts and Hospital Directions, their sociodemographic characteristics and cultural-background, define their educational needs, and subsequently extending the study to the maximum number of professionals in the classified services under study.

METHODS

The survey was conducted through the use of a questionnaire, designed and prepared by the working group and subsequently reported on-line. Internal consistency of the questionnaire was measured by Cronbach's alpha.

RESULTS

Overall, 128 health professionals were enrolled in the study. Their mean age was 57.5 years; 83.6% have a medical degree and 6.3% a degree in veterinary medicine. Most participants (64.8%) are employed by a Health District, 21.1% work in a Department of Prevention and 2.3% are part of a hospital clinical management staff. 32.3% are specialists in only one area, and, in particular, 22% of the sample is a Public Health specialist, 4% respectively are specialists in Occupational Medicine and Forensic Medicine. The alpha values for each section were, for Section A, 0.914; Section B, 0.963; Section C, 0.802; and Section D, 0.945.

CONCLUSION

The questionnaire was shown to have good internal reliability. Identifying the educational needs of public health professionals, and the innovative and emerging issues that impact public health is essential to allow for National Health Service staff to be able to respond to the rapid cultural changes that characterize the current global health context.

Action against vaccine-preventable infectious diseases and tuberculosis in Nomad Camps: the experience of a Local Health Unit in Rome

In Italy the highest incidence of Tuberculosis (TB) cases is in young adult migrants. In 2011, the sanitarystaff of the Local Health Unit (ASL) Roma A promoted a vaccination campaign conducting several public health interventions in Nomad Camps. After notification of a case of TB in the Camp of Via Salaria, out of 357 Mantoux skin tests performed, 93 were positive (26%); subsequently, 5 subjects with radiographic positivity were hospitalized. The vaccination campaign was carried out to prevent the spread of infectious diseases in immigrant communities at high risk of contagion and to avoid the consequent transmission in the host country. As a result, vaccinations coverage among the residents of the Camps increased: 367 vaccinated subjects (30% more than previous year) and 612 administered vaccinations.

A multicenter study on the appropriateness of hospitalization in obstetric wards: application of Obstetric Appropriateness Evaluation Protocol (Obstetric AEP)

The cross-sectional study has been based on the implementation of the Obstetric Appropriateness Evaluation Protocol (OAEP) in seven hospitals to determine inappropriate hospital admissions and days of stay. The outcomes were: inappropriateness of admission and "percentage of inappropriateness" for one hospitalization. A total number of 2196 clinical records were reviewed. The mean percentage of inappropriateness for hospitalization was 22%. The percentage of inappropriateness for the first 10 d of hospitalization peaked in correspondence of the fourth (42%). The logistic regression model on inappropriated admission reported that emergency admission was a protective factor (OR = 0.4) and to be hospitalized in wards with ≥30 beds risk factor (OR = 5.12). The second linear model on "percentage of inappropriateness" showed that inappropriated admission and wards with ≥30 beds increased the percentage (p < 0.001); whereas the admission in Teaching Hospitals was inversely associated (p < 0.001). The present study suggests that the percentage of inappropriate admission depends especially on the inappropriate admission and the large number of beds in obstetric wards. This probably indicates that management of big hospitals, which is very complex, needs improving the processes of support and coordination of health professionals. The OAEP tool seems to be an useful instrument for the decision-makers to monitor and manage the obstetric wards.

[Health risks associated with urban environmental pollution in Europe: results of the HEREPLUS multicentre study in Rome (Italy)]

Urban air pollution is known to cause numerous health problems. The HEREPLUS project aims to evaluate the association between environmental air pollution and health and to provide guidelines for the management and organization of the urban environment. Risk maps were developed by georeferentiation, using hospitalization data and concentration levels of ozone and pollution matter. Data for four European cities involved in the project (Rome, Madrid, Dresden, and Athens) were analysed for the period 2003-2004. In this article, we report results for Rome only. Study findings demonstrated that the green area in a city reduces pollution in a city reduces pollution levels in the atmosphere, thus reducing health risks.

Impact on knowledge and behaviour of the general population of two different methods of solid waste management: An explorative cross-sectional study

The objectives of the present study were to evaluate knowledge among general population about the risks factors of waste management, to estimate the feeling of anxiety concerning the waste, and to compare knowledge of two different methods for collecting municipal solid waste (MSW): a street separate collection system and a door-to-door separate collection system. A cross-sectional study was performed, administering an anonymous questionnaire to 180 inhabitants in Aprilia, Latium, Italy. The study sample consisted of 183 citizens: 64 in the intervention group and 119 in the control group. The intervention was represented by a campaign of door-to-door collection. The correct implementation of separate collection of waste was 87.5% in the intervention group and 63% in the control group (p<0.001). For both groups, the favourite type of waste collection was door-to-door (p=0.013); a high difference concerning the quality of information was found (p<0.0001): in the intervention group, 84% declared to be satisfied (67% sufficient and 17.2% good), while in the control group, 21% declared to be satisfied (16.8% sufficient and 4.2% good). The advice mainly reported from the control group respondents was to increase the size of the information pack (80.7%, p=0.024). The information campaign seemed to increase people's awareness about the problem, improving the management of waste and household waste. The door-to-door collection was appreciated and preferred by both groups. The adoption of a door-to-door scheme seems to be a winning option mostly because it is supported by an information and education system for the citizens.

H1N1 pandemic influenza: habits and behaviour of the nurses. A public health issue

BACKGROUND

One of the main concerns related to pandemic H1N1 influenza 2009 is the overwhelming burden on medical structures. The aim of this work is to study the behaviour and attitudes of Nurses in relation to the spreading pandemic in order to develop public health strategies.

METHODS

During the spread of Pandemic, in winter 2009, an anonymous questionnaire online of thirty-four questions was available for participants. Data obtained were analyzed using descriptive, univariate and multivariate statistics.

RESULTS

A total of 2313 nurses were interviewed. In univariate analysis 72.6% of 573 males (versus 63.9% of 1740 females) have been talk to a doctor (p<0.001). The female group appear less likely to get vaccinated (60.3% vs 51.1%, p<0.001). Multivariate analysis revealed that to be worried (OR=2.82 95% CI: 2.31-3.46), female (OR=0.62 95% CI: 0.51-0.77), age group 30-49 (OR=0.72 95% CI: 0.58-0.90) were associated with the willingness of Get vaccinated.

CONCLUSIONS

Prevention, as washing hands and vaccination, are crucial in pandemics events. Given the low rates of acceptance of pandemic vaccination among nurses, public health bodies should consider campaign education, in order to prevent nosocomial transmission, to protect patients and the continuity of the essential health-care infrastructure.

Are public health professionals prepared for public health genomics? A cross-sectional survey in Italy

Background

Public health genomics is an emerging multidisciplinary approach, which aims to integrate genome-based knowledge in a responsible and effective way into public health. Despite several surveys performed to evaluate knowledge, attitudes and professional behaviors of physicians towards predictive genetic testing, similar surveys have not been carried out for public health practitioners. This study is the first to assess knowledge, attitudes and training needs of public health professionals in the field of predictive genetic testing for chronic diseases.

Methods

A self-administered questionnaire was used to carry out a cross-sectional survey of a random sample of Italian public health professionals.

Results

A response rate of 67.4% (797 questionnaires) was achieved. Italian public health professionals have the necessary attitudinal background to contribute to the proper use of predictive genetic testing for chronic diseases, but they need additional training to increase their methodological knowledge. Knowledge significantly increases with exposure to predictive genetic testing during postgraduate training (odds ratio (OR) = 1.74, 95% confidence interval (CI) = 1.05–2.88), time dedicated to continuing medical education (OR = 1.53, 95% CI = 1.14–2.04) and level of English language knowledge (OR = 1.36, 95% CI = 1.07–1.72). Adequate knowledge is the strongest predictor of positive attitudes from a public health perspective (OR = 3.98, 95% CI = 2.44–6.50). Physicians show a lower level of knowledge and more public health attitudes than other public health professionals do. About 80% of public health professionals considered their knowledge inadequate and 86.0% believed that it should be improved through specific postgraduate training courses.

Conclusions

Specific and targeted training initiatives are needed to develop a skilled public health workforce competent in identifying genomic technology that is ready for use in population health and in modeling public health genomic programs and primary care services that need to be developed, implemented and evaluated.

Temporal pattern of microbial indicators of ready-to-eat rocket salads during shelf life

INTRODUCTION

From 2001-2009 there have been numerous community alerts and notifications about the rocket salad produced in Italy and distributed in Europe. Our study describes the evolution of the microbial quality of ready to eat rocket salad during shelf life among three different Italian producers.

MATERIAL AND METHODS

Total Mesophilic Count (TMC) and Escherichia coli (EC) count were measured in 248 samples. We used Wilcoxon test to compare the median values of TMC and EC counts and Kruskal Wallis test to compare the producers.

RESULTS

The TMC and EC values differed among producers at the stages of raw material and in the finished product (Kruskall Wallis test, p < 0.05). The evolution of bacterial charges had significant differences among producers at expiration date (Wilcoxon test, p < 0.05). More than half of the samples (54.8%) exceed reference standard for TMC after 48 h from packaging.

CONCLUSION

Differences among producers may linked to the different minimal processing technologies adopted after harvesting.

Microbiological safety of glasses dispensed at 3D movie theatres

Recent popularity of three-dimensional movies raised some concern about microbiological safety of glasses dispensed into movie theatres. In this study, we analysed the level of microbiological contamination on them before and after use and between theatres adopting manual and automatic sanitation systems. The manual sanitation system was more effective in reducing the total mesophilic count levels compared with the automatic system (P < 0.05), but no differences were found for coagulase-positive staphylococci levels (P = 0.22). No differences were found for mould and yeast between before and after levels (P = 0.21) and between sanitation systems (P = 0.44). We conclude that more evidences are needed to support microbiological risk evaluation.

[How would plain packaging and pictorial warning impact on smoking reduction, cessation and initiation?]

The European Commission has proposed a review of the directive on tobacco products on labeling and packaging of tobacco products by introducing warning text with pictorial warning that occupies 75% of the cigarette packages. The aim of the survey was to assess the impact of plain packaging and pictorial warning in smoking reduction, cessation and initiation among a sample of adult. The cross-sectional study was conducted in Rome between September and November 2012. The questionnaires administered were 227, with a response rate of 82.4%. 35.8% (No. 67) of the respondents considered the image of the gangrene the most effective in communicating smoking-related damages, followed by the image on lung cancer (No. 60; 32.1%). Distinguishing between smokers and non-smokers (both former and never smokers), the picture on lung cancer was the most effective for smokers (No. 22; 38.6%); if cigarette packages have pictorial warnings like the ones shown, more than half (No. 33; 57.9%) of smokers would change brand; 66.7% (No. 38) of them would feel uncomfortable in showing the package. Comparing the 3 packagings, classic packaging, plain packaging with textual warning, and plain packaging with both textual and pictorial warning, the majority of people declared that the third is the most effective in preventing smoking initiation (No. 169; 90.9%), in motivating to quit (No. 158; 84.9%), and in changing smoking habits (No. 149; 80.5%). The survey, although its small sample size and being not representative of all strata of Italian population, shows that the plain packaging with pictorial warning is the most convincing in the three outcomes considered.

Are age and gender associated to tobacco use and knowledge among general practitioners? Results of a survey in Italy

OBJECTIVES

The aim of this study was to assess knowledge and opinions of Italian general practitioners about the effectiveness of smoking cessation interventions and physicians' attitudes in addressing tobacco-related issues.

METHODS

The survey was carried out through a questionnaire administered to general practitioners (GPs) attending a medical refresher course. 133 Italian GPs participated in the study with a mean age of 51.4 years (SD = 6.2).

RESULTS

The GPs had good knowledge about the predictors of smoking onset, pharmacotherapies for tobacco cessation and the clinical guidelines recommendations. Wrong answers were encountered for the prevalence of smokers in Italy, the Fagerström Test for nicotine dependence and minimal advice. Females were more subjected to higher knowledge about tobacco, and at lower risk to be a smoker/ex smoker. Furthermore, physicians ≥ 50 years old living in northern Italy had higher knowledge score.

CONCLUSIONS

Physician education on tobacco counseling is associated to increased comfort and practice in advising patients who smoke. Tobacco cessation training might increase the success rate of helping patients to quit smoking.

Economic evaluation of Varicella vaccination: results of a systematic review

INTRODUCTION

The aim of the present study is to review the economic burden of varicella disease and the benefit of universal varicella vaccination in different settings pending its implementation in all Italian regions.

MATERIALS AND METHODS

Research was conducted using PubMed, Scopus and ISI databases. Score quality and data extraction were performed for all included studies.

RESULTS

Twenty-three articles met the criteria: 15 cost-effectiveness, 8 cost-benefit and one cost-utility analysis. Varicella vaccination could save the society from €637,762 (infant strategy) to 53 million annually (combined infant and adolescent strategy). The median and the mean quality scores resulted in 91.8% and 85.4% respectively; 11 studies were considered of high quality and 12 of low quality.

DISCUSSION

The studies are favorable to the introduction of universal varicella vaccination in Italy, being cost saving and having a positive impact on morbidity. The quality score of the studies varied greatly: recent analyses were of comparable quality to older studies.

[Effectiveness of a training course on influenza vaccination in changing medical students' and healthcare workers' attitudes towards vaccination]

A questionnaire study was performed to evaluate the effectiveness of a continuing medical education course on influenza vaccination, held in October 2011, in changing physicians', medical students' and other health care workers' attitudes towards receiving vaccination for seasonal influenza. The questionnaire contained questions regarding influenza, influenza vaccination, and attitudes towards vaccination. Results show that course participants were more likely to get vaccinated against seasonal influenza in 2011 (i.e. following the course) with respect to 2010 and that all professional categories, except students, were positively influenced by the course.

GHPSS multicenter Italian survey: smoking prevalence, knowledge and attitudes, and tobacco cessation training among third-year medical students

AIMS AND BACKGROUND

Healthcare professionals have an important role to play both as advisers - influencing smoking cessation - and as role models. The aims of this study were to examine smoking prevalence, knowledge and attitudes among Italian university students attending medical schools using the Global Health Professions Student Survey (GHPSS) approach.

METHODS AND STUDY DESIGN

A multicenter cross-sectional study was conducted among University students of 9 Italian medical schools (age ranging between 19 and 29 years). The GHPSS questionnaire was self-administered. A logistic regression model was used to identify possible factors associated with tobacco smoking status. Data were analyzed with the software SPSS 19.0 for Windows.

RESULTS

Seven hundred thirty medical students (response rate 100%) were enrolled. The prevalence of current smokers was 20.4% (males 22.4%, females 19.1%). Of the total sample, 87.7% believed that health professionals should receive specific training in techniques to quit smoking, and 65% believed that health professionals had a role in giving advice or information about smoking cessation. However, 89.4% answered that they had not received specific training on smoking cessation techniques. Multivariate analysis showed that students belonging to universities in southern Italy were more likely to be smokers (OR = 2.00; 95% CI: 1.03-3.97).

CONCLUSIONS

This Italian multicenter survey found that one fifth of future medical doctors are smokers. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.

[Systematic review of the literature regarding the risk of mortality, cancer and cardiovascular diseases in professional drivers]

BACKGROUND

Possible ill- health effects of exposures incurred by professional drivers have been reported by several studies with more or less statistically significant results, and continue to be debated in the medical literature. The aim of the present study was to review the existing literature regarding the association between working as a professional driver, mortality, cancer and cardio-vascular diseases.

METHODS

The authors considered studies published until May 2012. The literature review was conducted by searching PubMed and EMBASE and using the following research entries: "professional drivers", "mortality", "cancer", "cardiovascular diseases", "health risks", "air-pollution" and "urban air".

RESULTS

Of 1,497 studies reviewed, 25 were included in the final analysis. Nine studies were found assessing mortality. Of these, one study indicated that professional drivers had a significantly increased risk for all- cause mortality compared to the general population (Standardised Mortality Ratio, SMR=1.15); five studies indicated a significantly higher risk of lung cancer mortality (SMR ranged 1.16 and 2.12). Seven studies evaluating cardio-vascular diseases focused on myocardial infarction. These reported a higher risk in professional drivers with respect to controls, with crude Odds Ratios (OR) between 1.66 and 3.3, Relative Risks (RR) ranging from 1.19 to 1.6. In five of the above studies, potential confounders were considered. Five of 11 studies reported a statistically significant increased risk of lung cancer in professional drivers with respect to the general population or to other workers, with ORs included between 1.21 and 1.85, and RRs between 1.2 and 1.4.

CONCLUSIONS

The reviewed studies had many limitations, such as poor exposure assessment and lack of information on relevant confounders. In addition, heterogeneity in the studies led to problems in summarizing the results. Despite this, study findings suggest the existence of an association between this professional activity and risk for lung cancer and cardiovascular diseases.

A cross-sectional study on dermatological diseases among male prisoners in southern Lazio, Italy

BACKGROUND

Prisoners have heightened health needs, and only recently has the importance of skin diseases in this group been recognized. The aim of this study was to estimate the prevalences of dermatological diseases among prisoners in the jails of southern Lazio and to investigate the determinants of these.

METHODS

A cross-sectional study was carried out in three jails in southern Lazio. Retrospective data collection for sociodemographic characteristics, lifestyle habits, and health status was realized using patients' charts.

RESULTS

The study sample consisted of 2653 male prisoners detained during 1995-2000. A total of 7.9% of the sample were found to have dermatological disease. The most common diseases were nonspecific dermatitis (3.1%), acne (1.5%), mycosis (1.4%), and scabies (0.7%). Multiple regression analyses were conducted to establish the associations of skin diseases with substance addiction status and age. In addition, a highly significant association emerged between length of detention and rate of dermatological disease.

CONCLUSIONS

This study shows that habitual offenders, foreign inmates, prisoners serving long sentences, and prisoners who are illiterate are the most affected by dermatological disease. The conditions of detention may be the main reason; preventative strategies such as limiting overcrowding and the provision of electronic case sheets and a centralized database to collect and maintain patient clinical data might be effective in improving public health in jails.

Do the quality of the trials and the year of publication affect the efficacy of intervention to improve seasonal influenza vaccination among healthcare workers?: Results of a systematic review

INTRODUCTION

Despite longstanding recommendations by public-health authorities vaccination coverage in health care workers worldwide are poor. The aim of this study is to conduct a systematic review of the trials conducted to increase seasonal influenza vaccination rates among health care workers.

RESULTS

Ten articles met the pre-determined criteria. For all article the score calculation was performed.

DISCUSSION

The combination of an educational and a promotional element appared the most effective in augmenting the influenza vaccination coverage among health care workers. But some cases, the intervention did not contribute to increasing the vaccination rates among health care workers. In any case, the quality of controlled trials plays an important role in the results obtained by carrying out a specific intervention and contributed to obtaining this debatable results.

MATERIALS AND METHODS

Research was conducted using Scopus and PubMed database. We selected all clinical trials to perform the meta-analyses.

Epidemiology of home injuries: a large observational study among adult mothers in Italy

AIMS

The aims of the study were to describe the epidemiology of home injuries (HI) among Italian students' mothers and to identify the possible predictors of having HI.

METHODS

An anonymous questionnaire was used in several Italian schools. In order to identify predictors of having HI, a multivariate analysis was performed.

RESULTS

In our sample (3,610 women), the prevalence of HI was 18%; 6.2% of the interviewed had a severe HI. The multivariate analyses showed that increasing age, to spend more than 13 hours a day at home and to be housewife are risk factors for having HI.

CONCLUSIONS

This study reports a high prevalence of HI, highlighting an urgent need for undertaking interventions to develop an adequate culture of safety and prevention.

[Adolescents' affectivity and sexuality: a randomized trial of the efficacy of a school health promotion intervention in a primary school]

A cluster randomised trial was conducted to evaluate the efficacy of a health promotion intervention aimed at improving knowledge and preventing sexually transmitted diseases (STD) amongst Grade 9 primary school students in Salerno (Italy). Students were randomized to either one of two groups: intervention group or control group. The intervention group was required to attend three meetings, each lasting one and a half hours. A questionnaire was then administered to both groups to evaluate knowledge of STD, contraception, sexuality, affectivity, satisfaction with interpersonal relationships with family, social groups and healthcare professionals. Variations of knowledge in the two groups were evaluated through calculation of odds ratios. Three hundred twenty-two students participated in the study. All students who received the study intervention were able to identify at least one STD post-intervention, while 2.5% of students in the control group did not indicate any. Students in the intervention group were more likely to select condoms as the most suitable contraception for young people (OR 5.54; 95% CI 3.27 -9.38), compared to controls (OR 1.91; 95% CI 1.20 - 3.05) (p = 0.002). They were also better aware of the possibility of contracting a STD even after incomplete sexual intercourse (OR 0.21, 95% CI 0.13 to 0.35), with a statistically significant difference (p &lt;0.001) compared to the control group (OR 0.71, 95% CI 0.45 to 1.11). In addition, students in the intervention group were more likely to turn to their own parents when having doubts about sexual issues (p = 0.004) and female students to consider their gynecologist as a reference figure. In conclusion, the findings indicate that students randomized to the intervention group were more informed and aware of issues related to sexuality and its associated risks.

Influenza vaccination recommended for all adults aged between 50 and 64 years: conceptual basis and methodological limitations

In the first half of this year the experts of the Italian Society of Hygiene (SItI), along with those of other National Scientific Societies, agreed with the recommendations made by the USA CDC in 2009, and developed a proposal for a vaccination schedule (Vaccine Schedule for Life), in which influenza vaccination is recommended for all adults aged between 50 and 64 years. In the National Plan for Vaccinal Prevention 2012-2014, which was published just before the issue of the SItI Calendar but concluded earlier (end of 2011), influenza vaccination is recommended "only" for all persons > or = 65 years or included in one of the many at-risk categories. The issue is controversial and has generated considerable debate at national and international level. This short note discusses the logical processes and the scientific evidence in support or against the decision to extend the influenza vaccination. The Authors conclude that the epidemiological approach used by SItI experts is appropriate. In any case, further studies on the topic are strongly needed, and their results should be taken into account in the drafting of future vaccination schedules.

[Workplace safety in private companies of freights and on the road workers: comparison between small and medium enterprises]

BACKGROUND

The road freight and passenger transport sector exposes the workers of this sector to a considerable health risk. Application of the relative legislation to safeguard worker's safety is an obligation for the employer.

OBJECTIVES

The aim of the study was to assess the application of current legislation in the trucking sector and ascertain whether there are differences between large and small enterprises.

METHODS

The study was conducted through direct interview with managers of road freight and passenger transport companies in the Lazio Region in 2009. Information was collected using a questionnaire composed of 77 items concerning risk assessment and organization aspects in the enterprises. The enterprisers were stratified by number of workers and drivers. To detect possible associations the Chi-squared and Fisher's Exact tests were used.

RESULTS

A total of 42 enterprisers participated in the study. Significant differences were found between larger enterprisers (10 workers) and smaller enterprises (< 10 workers), concerning risk assessment from vibrations (p = 0.006), night work (p = 0.026), microclimatic conditions (p = 0.047). Regarding risk prevention/management aspects, the enterprisers with a higher number of workers were more likely to have a workers' representative for safety compared to the smaller enterprises (respectively 88.9% versus 50.0%) and a road accidents Register (77.8% versus 16.7%), with p < 0.001 significance levels.

CONCLUSIONS

The risks most frequently assessed, in decreasing order, were: vibrations, manual handling of loads, stress, noise, awkward postures, night work, alcohol consumption, drug addiction and microclimatic conditions. Vibrations, night work and microclimatic conditions risks were assessed to a lower degree in the smaller enterprisers compared to the larger enterprises.

[School teachers' knowledge, attitudes and behaviors towards road safety: results from a multicenter cross-sectional study in Italy]

The aim of this study is to investigate knowledge, attitudes and behaviors of secondary school teachers towards traffic safety behaviors. The study is concerning data coming from a cross-sectional study using a self-administered questionnaires filled in by school teachers of Lazio and Campania regions. 262 teachers entered into the study. Among the scooter holders, 69.2% did use helmet; 95.8% of people who drives car uses seatbelts. The scooter and bicycle helmet is considered useful for 99.6% and 57.4% of participants. The accident rate depends on the means of transportation used: 10.8% and 19% for bicycle and scooter riders, respectively, and 44.6%for the car drivers. Regarding injuries using a bicycle, teachers with less than 40 years are less involved in accidents compared to the over 40 years (OR = 0.19; p = 0.05), as well as teachers who are married (OR = 0.16; p = 0.03) compared to the other group (single/widowed/divorced). Car accidents involve less frequently women (OR = 0.60; p = 0.05) compared to males. Road accidents prevention is part of the health priorities indicated in the National Health Plan, the National Prevention Plan and Regional Prevention Plans. School teachers' can play an important role in students' education on road safety, and there is the need to improve knowledge and behaviors in this field.

Quality of life among healthcare workers: a multicentre cross-sectional study in Italy

OBJECTIVE

To evaluate the quality of life among doctors, nurses, and occupational safety and health technologists (OSHT).

STUDY DESIGN

Cross-sectional study was undertaken in a population of healthcare workers in 10 Italian regions.

METHODS

The Italian version of short form-36 (SF-36) was anonymously and voluntarily self-administered by participants to assess the perceived health-related quality of life (HRQOL). The HRQOL scores for the sample and the Italian population were compared. A multiple linear regression was performed to assess the influence of age, gender, role, socializing time, working time, years spent in healthcare and years spent in the specific department on the SF-36 score.

RESULTS

The sample included 324 healthcare workers [57.1% women, mean age 39.0 (standard deviation 10.2) years]: 52.6% were medical doctors, 36.8% were nurses and 10.5% were OSHTs. Workers with a career of >15 years achieved a general health score lower than that of workers with a shorter career, while those who spent more time in socializing activities achieved a higher mental health score. The multivariate analysis showed that increasing age is positively related to role emotional levels (β = 0.243; P = 0.002), while it appears to be inversely related to general health (β = -0.218; P = 0.007) and physical function (β = -0.246; P = 0.001). Nurses had lower scores for bodily pain (β = -0.214; P < 0.001), social function (β = -0.242; P = 0.001) and role emotional (β = -0.211; P = 0.006) compared with doctors. Compared with the general Italian population, healthcare workers had higher scores for general health, physical function, role physical, bodily pain and mental health, and lower scores for vitality, social function and role emotional.

CONCLUSIONS

Healthcare workers have different levels of HRQOL related to their professional role. In particular, nurses have lower quality of life. These results may help to identify the main roles and attitudes that could cause frustration, dissatisfaction and emotional stress in healthcare workers.

Oral contraceptives and venous thromboembolism: a systematic review and meta-analysis

BACKGROUND

An association between oral contraceptive (OC) use and venous thromboembolism (VTE) has long been recognized. However, no summary estimates of the increase in VTE risk associated with OC use have been available since 1995, and no meta-analyses have evaluated the VTE risk of new preparations containing drospirenone.

OBJECTIVE

The aim of the study was to carry out a meta-analysis to summarize existing evidence on the association between venous VTE and OC use, and to investigate how such an association may vary according to the type of OC, OC user characteristics, study characteristics and biases.

METHODS

Relevant cohort or case-control studies were searched in MEDLINE and other electronic databases up to May 2010, with no language restriction. Data were combined using a generic inverse-variance approach. Meta-regression in addition to stratification was used to explore potential predictors of the summary estimate of risk.

RESULTS

Sixteen cohort and 39 case-control studies were included in at least one comparison. Overall, the odds ratio (OR) of OC users versus non-users was 3.41 (95% CI 2.98, 3.92). This estimate was based upon nine cohort studies evaluating approximately 12 000 000 person-years, and 23 case-control studies including approximately 45 000 women. VTE risk for OC users was significantly lower in studies evaluating 'all VTE cases' than in those evaluating 'idiopathic VTE only' (OR 3.09 and 4.94, respectively). Among the carriers of genetic mutations G20210A and Factor V Leiden (FVL), OC users showed a significantly increased VTE risk compared with non-users (OR 1.63; 95% CI 1.01, 2.65, and OR 1.80; 95% CI 1.20, 2.71, respectively). When the newest OCs containing drospirenone were compared with non-drospirenone-containing OCs (except those containing levonorgestrel only), VTE risk did not significantly increase (OR 1.13; 95% CI 0.94, 1.35).

CONCLUSIONS

This meta-analysis confirms that OC use significantly increases VTE risk. The strength of this association, however, varies according to the generation of OC, type of outcome and presence of a genetic mutation, with ORs ranging from 3 to 5.

[Systematic review and meta-analysis of the prevalence of overweight and obesity among school-age children in Italy]

OBJECTIVE

The objective of the study was to obtain reliable data from recent surveys carried out in Italy on the prevalence of overweight (OW) and obesity (OB) in children.

DESIGN

We searched in MEDLINE/Pubmed and Scopus. The keywords included "overweight ", "obesity", "children", "aged 6-11 years", "Italy", associated to the boolean operators AND/OR. The limits applied to the research were: English AND/OR Italian language, publication time period January 2000-September 2010, target of 6-11 years; Body Mass Index assessed according to IOTF criteria. StatsDirect 2.7.8 was utilized to perform statistical analysis.

RESULTS

25 studies have been select, the percentage of overweight varied between 18% and 33,7% and obesity between 5,5% and 21,9%. The highest values were in Southern Italy (OW: 25,6%, CI95% 24,8-26,3; OB: 15,2%, CI95% 13-17,5) vs Central Italy (OW: 22,6%, CI95% 21-24,1; OB: 9,3%, CI95% 7,9-10,7) vs Northern Italy (OW: 21%, CI95% 19,6-22,3; OB: 8,2%, CI95% 6,8-9,7).

CONCLUSION

A relevant prevalence of overweight and obesity was found In Italian children; the excess weight concerns one child out of four. There are significant differences in the prevalence of overweight and obesity in relation to geographical distribution (Northern, Central and Southern Italy), the high prevalence of overweight and obesity resulted statistically significant in the Southern compared to Central and Northern Italy. These differences are likely linked to different geographical areas in relation to socioeconomic and environmental condition that must be further investigated. There is a need of promoting better eating habits in young children in Italy, above all in areas with highest prevalence.

Data display format and hospital ward reports: effects of different presentations on data interpretation

BACKGROUND

Graphs are often used in medical communication, both in clinical practice and health management. They can help the processing of quantitative information but may also contribute to drawing wrong conclusions. The aim of the survey is to study the graphical perception of the data at the management level and its possible effects, showing how some criteria of appraisal of a phenomenon are influenced by the graphical format.

METHODS

One hundred and five medical doctors and health direction professionals of hospitals in Naples, Rome, Siena and Turin were interviewed. Four different graphs or table related to the same hypothetical data on average hospital stay in the period January 2000 to September 2003 were shown to participants, and their impressions were recorded.

RESULTS

Less than one-fourth of the participants understood that the data set was the same for the different diagrams. The process of understanding is mostly correlated with being a director, having a degree in medicine and working in central-northern cities. The table seems easier for interpretation (98.1%), more suitable (84.8%), more used (92.4%) and more pleasant than other data presentation. On the other hand radar format had worse results in all questions.

CONCLUSIONS

The choice of a graphical format may influence the understanding of data. Further research is needed in order to sustain the improvement of medical and health professionals' knowledge in the display data format.

Socioeconomic differences in tobacco smoking in Italy: is there an interaction between variables?

OBJECTIVES

To assess the influence of sociodemographic factors on smoking habits in Italy and if an interaction exists between these variables.

METHODS

Data from the national survey "Health Conditions and Healthcare Services Use" in 2005 were used. The independent association between tobacco smoking and sociodemographical variables was assessed using logistic regression analysis. Interactions between variables were investigated calculating the synergism index (SI).

RESULTS

Sample population consists of 109.829 subjects (over 15 years). 21.9% are current and 21.8% are former smokers. Current smokers are mostly 45-54-years old males, from Central Italy, unemployed, divorced or separated but having a good health status without chronic medical conditions. Ever smokers are mostly 45-54 years old males, from Northeast Italy, unemployed, with chronic conditions. People with a university degree and with a good household income have the lowest OR for both conditions. A synergistic effect was found between marital status and educational level (for ever smokers SI = 1.96; for current smokers SI = 1.67).

CONCLUSIONS

Smoking is prevalent in lower socioeconomic groups and there is the strong need to increase social, economic and cultural capital in order to reduce it.

[Impact of cigarette packages warning labels in relation to tobacco-smoking dependence and motivation to quit]

OBJECTIVE

the principal aim was to assess the impact of health warnings on cigarette packages in Italy, the reduction of daily number of cigarette smoked, in relationship to the tobacco-smoking dependence and motivation to quit. The second aim was to compare the impact of text warnings versus graphi depictions.

DESIGN

cross-sectional study (survey).

SETTING AND PARTICIPANTS

the study was conducted through interviews to an opportunistic sample of smokers.The subject enrolled were adult smokers (years ≥ 18), living in the province of Rome. Data were collected in two outpatient clinics located in Morlupo and Rome. Interviews were administered in the waiting rooms, to patients or to their relatives/ helpers. The survey was conducted in June-September 2010. The sample size (266 participants) was computed using a power of 80%, a confidence level of 95%, an expected frequency of smokers with a low motivation to quit who reduced number of cigarettes due to warnings of 15%, and a frequency of smokers with a higher motivation to quit who reduced number of cigarettes due to warnings of 30%.

MAIN OUTCOME MEASURES

the effect of the health warnings used in Italy on smoking reduction was measured with the following self-reported items: "Are you or have you been influenced by the health warnings on cigarettes packages (in relation to the daily number of cigarettes smoked)?"; "Have you changed your smoking habits due to the warnings (for example: don't smoking after a coffee.)?"; "Have you ever stopped smoking due to the warnings?" The effect of labels that used shock images on cigarette boxes was measured using followed self-reported questions: "If shocking images were used on cigarette boxes, would they have greater effect than simple warning text currently used?"; "If your favourite cigarettes brand decide to change the look of its cigarette boxes with shocking images on smoking health damages, would you be driven to change it?"

RESULTS

thanks to the health warnings, 95% of the 270 participants were informed on smoking damages, 14% (34 smokers) reduced the number cigarettes per day, and 5% (12 smokers) attempted to quit. Forty-five percent of smokers did not know the real impact of light cigarettes on their health, and 49% decided to smoke light cigarettes after having read the warnings. Women were more susceptible to immediate consequences of smoking (appearance of wrinkles; p<0.001), and were more prone to switch to light cigarettes (p=0.002). Smoking dependence, computed with Fagerstrom's test, showed significant differences by age groups (higher in smokers aged 30-45 years; p=0.001), and in smokers who were not interested to deepen knowledge of smoking effects (p=0.009). Individuals more motivated to quit were younger smokers (p=0.012). Smokers aged ≥ 45 years (OR=2.54; 95%CI 1.05-6.17), more motivated to quit (OR=2.92; 95%CI 1.17-7.30), those who reported they do not like the smoking smell on their own clothes (OR=3.6; 95%CI 1.4-9.0), those who reported warning messages are important (OR=4.93; 95%CI 1.55-15.71), those who changed their own smoking behavior due the warnings (OR=3.31; 95%CI 1.10-9.99) were more likely to reduce daily number of cigarettes due the health warnings. Forty-seven percent thought that health warnings with text and images could have a higher impact in comparison to text-only warnings. Moreover, women were more motivated to change cigarette brand if a brand should introduce pictorial warnings (OR=2.54; 95%CI 1.41-4.56).

CONCLUSION

our study showed some positive effects of the introduction of health warnings on cigarette packages. In fact, almost all were informed on tobacco effects, 14% of them reduced the amount of daily smoking, and 5% attempted to quit. Many smokers still believe that switching to lighter cigarettes (e.g. those with less nicotine and tar contents) reduces smoking-related diseases. More than 50% of smokers recognized the importance of health warnings in communicating health risks of smoking, while women were more impressed than men by shocking pictorial warnings.

[Implementation of the stewardship model in public health: proposal of an assessment tool for the Italian national prevention plan]

The stewardship model has been adopted as a system of governance in several countries. In Italy, the Ministry of Health has proposed the use of the stewardship model for implementing the activities of the National Prevention Plan 2010-2012. The authors present the conceptual foundations and methodology used in the development of an assessment tool (audit tool) for evaluating the level of implementation of the stewardship model with regards to the activities of the national prevention plan in all Italian regions.

[EpiInfo as a research and teaching tool in epidemiology and statistics: strengths and weaknesses]

EpiInfo is a free software developed in 1988 by the Centers for Disease Control and Prevention (CDC) in Atlanta to facilitate field epidemiological investigations and statistical analysis. The aim of this study was to assess whether the software represents, in the Italian biomedical field, an effective analytical research tool and a practical and simple epidemiology and biostatistics teaching tool. A questionnaire consisting of 20 multiple-choice and open questions was administered to 300 healthcare workers, including doctors, biologists, nurses, medical students and interns, at the end of a CME course in epidemiology and biostatistics. Sixty-four percent of participants were aged between 26 and 45 years, 52% were women and 73% were unmarried. Results show that women are more likely to utilize EpiInfo in their research activities with respect to men (p = 0.023), as are individuals aged 26-45 years with respect to the older and younger age groups (p = 0.023) and unmarried participants with respect to those married (p = 0.010). Thirty-one percent of respondents consider EpiInfo to be more than adequate for analysis of their research data and 52% consider it to be sufficiently so. The inclusion of an EpiInfo course in statistics and epidemiology modules facilitates the understanding of theoretical concepts and allows researchers to more easily perform some of the clinical/epidemiological research activities.

[Risk communication during health crises: results of a cross-sectional study to evaluate the effectiveness of adopted corporate communication strategies during the H1N1 influenza pandemic in Italy and on the training needs of health professionals]

The objectives of this study were to evaluate the effectiveness of corporate communication activities carried out during the A(H1N1) pandemic influenza in Italy and to identify educational needs of health professionals with regards to crisis communication. The study compared two samples representing respectively the general population and health professionals, living in different regions of northern, central and southern Italy. A self-administered questionnaire was used, with questions on knowledge about preventive measures during a pandemic and on satisfaction with the adopted communication campaigns. Study results highlight that both samples had very little knowledge of appropriate preventive behaviors to be adopted during a pandemic. The sample of health professionals received a greater amount of information about the pandemic with respect to the general population and showed a strong interest toward the problem of receiving adequate training in risk communication. The degree of knowledge about preventive measures is directly proportional to the existence of institutional communication activities and to having consulted a health professional.

Hepatitis C Virus infections trends in Italy, 1996-2006

BACKGROUND

The World Health Organization (WHO) estimates that about 180 million people, 3% of the world population, are infected with the hepatitis C virus (HCV). In Italy, the prevalence in the general population is reported to be greater than 5% and 9% among households of HCV-positive patients.

OBJECTIVES

The aim of this study was to estimate the trends of HCV infection in Italy in the period 1996-2006.

MATERIALS AND METHODS

The formula ln (rate) = b × years was applied for logarithmic transformation of the incidence rates to obtain time trends of HCV infection, using the join-point regression program software version 3.3.1. Linear graphs representing trends and the annual percentage change (APC) were considered for each joinpoint. Time changes are expressed as expected annual percentage change (EAPC) with the respective 95% confidence intervals (CIs); significance levels of time trends are also reported. The null hypothesis was tested using a maximum of 3 changes in slope with an overall significance level of 0.05 divided by the number of joinpoints in the final model.

RESULTS

Considering all age groups, the incidence rate decreased from 2.02 to 0.55 per 100,000. The join-point analysis showed a statistically significant decrease in the incidence rates of HCV infection. No join-points were found in any age groups. Our data show that the incidence rates of HCV infections have considerably decreased in each age group throughout the studied period (1996-2006).

CONCLUSIONS

This decreasing trend in HCV infections is, in part, attributable to behavioral and social changes. Improved hygiene, use of precautions in medical settings, blood screening, and sexual educational campaigns seem to have contributed to reduce the transmission of infection during the last 10 years.

[Revision of the behavior of Italian universities towards the HBV vaccination and tuberculosis prophylaxis]

Diagnostic screening for hepatitis B and tuberculosis infection bears a very important role for health care professionals even considering the decreasing epidemiological trends. According to the WHO predictions in 2030 these diseases will remain at third and fourth places among the causes of death for infectious diseases in industrial countries. The aim of this study is to verify the presence of hepatitis B and tuberculosis prophylaxis among the entry requirements for Medical Schools (MED) and Healthcare Professions Degree (PS) courses in 2011/2012 enrollment announcements. We examined 39 websites of Italian Public and Private Universities and we discovered 38 different announcements for MED and PS courses looking for any reference about hepatitis B and tuberculosis vaccinations and Mantoux skin test. The statistical analysis is descriptive (frequency tables). Hepatitis B vaccination was required in 7 (18.4%) enrollment announcements for MED and 6 (13.6%) for PS, respectively. Tuberculosis vaccination and/or Mantoux skin test were found among requirements of only 10 announcements for MED and 7 for PS, respectively. According to this study there is a great and unexpected variability among the different universities. A homologation of these requirements would be strongly desirable among Italian regions and on the entire national territory.

[The scientific contributions by the Roman School of Hygiene on the microbiological quality of the surface waters of Rome and her County from 1890 to 2010. A systemic review]

Research on quality of surface waters has been performed also in Italy during the development of the large urban areas, and in Rome this has been the duty of the Istituto di Igiene of the Sapienza University since 1890. Using MedLine--and also traditional consultation for papers printed before 1968--we identified 100 articles printed in the period 1890-2010. Thirty of them met the inclusion criteria (to have been written by researchers belonging to the Rome universities and to contain microbiological informations about the surface waters of Rome). The majority of papers identified (46.6%) were produced during the years Sixties and Seventies of the 20th century, and 30% in the twenty years to follow (1980-1999). The most frequent microbiological descriptors were "Total coliforms" and "Streptococci". The waterbodies most investigated were the Tiber river and the coastal waters around Fiumicino, where the Tiber flows into the Tyrrhenian sea. The quality of surface waters has always been a central interest of the research performed by the Hygienists of the Roman School. The good quality of the past research and the renovated interest of International Organizations and of the European Union should encourage the public health researchers toward a strategic field of investigation which has strong interconnections with the protection of the individual and community health and also with the protection of the environment.

Knowledge, attitude, and behaviour of public health doctors towards pandemic influenza compared to the general population in Italy

Aim: To study differences between public health physicians’ and general population’s knowledge, attitude, and behaviours towards an influenza pandemic. Methods: During winter 2009, an anonymous questionnaire online ( www.ijph.it ) of 34 questions was available for participants, structured into three parts: socio-demographic information, people’s knowledge, and behaviours about influenza H1N1. Results: 836 persons were interviewed (335 physicians and 501 not physicians). Of these, 50.8% of physicians and 78.1% of not physicians were aged less than 50 years and 57.6% of physicians and 31.7% of not physicians were male. Physicians were more interested to be updated about the pandemic (90.6% versus 88.4% of not physicians; p = 0.003); not physicians were more inclined to avoid crowded places (29.7% versus 17.6% of physicians; p < 0.001); and physicians were more prone to get vaccinated (56.4% versus 23.6% of not physicians; p < 0.001). Broadly, physicians had a better ability to deal the pandemic, both for knowledge and behaviours. Particularly, a significant difference ( p < 0.001) was found concerning the principle source of information on the pandemic, for physicians being the internet (41.5%), followed by the health facilities’ internal communication (33.1%), while for not physicians being watching the national television news (34.1%) and surfing the internet (30.9%). Conclusions: During the spread of the pandemic flu, a lot of information was propagated chaotically. The information given were not always truthful and often they were interpreted incorrectly or sometimes only partially understood by the population, and this needs to be taken into account for future successful communication in cases of emergency.

Knowledge about pandemic flu among Italian health care workers (HCWs): an Italian survey

INTRODUCTION

In case of pandemics, healthcare workers (HCWs) are the main actors and, at the same time, one of the main targets of preventive measures. This is what occurred in 2009 during the A/HINI pandemic flu. The aim of our survey was to get information about HCWs' knowledge of the A/HINI pandemic flu prevention.

MATERIALS AND METHODS

A survey of 32 questions, 11 of which about knowledge towards A/H1N1 pandemic flu, created on the basis of a similar one by the Harvard School of Public Health, was made available on the Italian Journal of Public Health website during the month of October 2009. The survey was advertised with links from various professional websites and by emailing to HCWs' addresses taken from the Italian Society of Hygiene and Public Health (SItI) databases. Descriptive and univariate analyses were conducted in order to assess whether differences exist on the level of knowledge of HCWs (specifically Nurses and Physicians) about preventive measures against the A/H1N1 pandemic flu.

RESULTS

1,960 HCWs answered to the questionnaire, 1,711 (87.3%) Nurses and 249 (12.7%) Physicians. Both Nurses and Physicians seemed to have a high or moderately high interest for A/H1N1 pandemic flu (86.1% vs. 91.2% respectively, p = 0.03). Nurses indicated national newscasts (38.6%) and communications within hospitals or other workplaces (33.8%) as the source of most information about A/H1N1 pandemic flu. On the other hand Physicians got information mostly from Internet (41.8%), but also from communications within their hospital or other workplace (34.5%) (p < 0.001). Not all the Nurses and Physicians knew that contagion is possible by close contact (less than 1 metre) wit someone affected (74.0% and 88.0% respectively, p < 0.001), while 82.3% of Nurses and 71.1% of Physicians reported that face masks protected from getting infected (p < 0.001).

CONCLUSION

Information and awareness campaigns on the influenza pandemic should be conducted firstly among HCWs, because of their importance--especially in case of pandemics--as a valuable resource at risk, as a contagion vehicle and as a source of information for the general population.

[The INHES cohort study on the health status of nurses in Italy: research protocol]

Due to the intense emotional involvement and the often problematic working conditions characterizing their profession, Nurses appear to be especially susceptible to the negative effects of a complex set of stressors, with important repercussions to their health. Nevertheless, scientific literature assessing the health status of Nurses in Italy is still scarce. With INHES (Italian Nurses' HEalth Study), we propose to remedy this gap by implementing a cohort study which will start from the analysis of some local healthcare facilities and which may subsequently extend throughout the country. Study participants will be Nurses selected according to the following inclusion criteria: 1) age between 30 and 55 years; 2) having been employed in the current healthfacilityfor the last five years; 3) having performed care duties in wards or in day care services for the last five years. The objectives of this study, which will be carried out through the administration of a validated questionnaire, are the following: to measure the incidence and prevalence rates of a series of diseases in the nursing population, highlighting potential correlations with working activity, job-related stress or environmental and personal risk factors; to assess the quality of life and psychological health of the participants, evaluating the interference of psychophysical disorders with their work and social activities; to investigate the implementation of wellness promotion, prevention, case management and disability management policies by healthcare facilities. The evidence gathered will provide a valid scientific support for the development of more effective policies for protecting Nurses' health, with positive social and economic repercussions for the entire community.