Literacy in the time of Coronavirus: an Italian perspective: Value of literacy in the context of a pandemic

BACKGROUND

COVID-19 pandemic, with its dramatic impact on society, poses a challenge to Health Pro-motion and to its principles of empowerment, social cohesion and citizens' democratic participation in health policies. In this pressing emergency, public health strategies aimed at preventing the spread of the pandemic have been primarily oriented towards restrictive measures (travel restrictions, use of PPE) in absence of an adequate educational communication, aimed at increasing citizens' knowledge and skills in regard to the emergency context.

AIM

To offer a perspective on the Italian situation, in terms of health literacy and life skills in the context of COVID-19 pandemic, aimed not only at identifying deficits, but particularly at determining opportuni-ties and resources (assets) - offered by the peculiar context of crisis - useful to provide citizens with the necessary tools to comprehend the criticalities linked with the emergency and to shape their behaviour to new requirements, in absence of external obligations, as well as to promote future participation of the population - both effective and informed - in a social and political context.

METHODS

A non-systematic review of literature on the subject of health literacy and social cohesion in emergency contexts has been supported by a qualitative assessment, based on the model of assets and on the Italian condition in the last trimester of 2020.

RESULTS

The scarce ability of the population to independently adequate habits and behaviour to new criti-calities required by the risk of infection - as well as the necessity to suspend their empowerment and capa-bility from government authorities to protect public health - has been firstly traced back to a widespread lack of literacy and life skills at a general population level. The current situation of crisis offers a peculiar opportunity of tools, circumstances and receptiveness to highlight such deficits, as well as an intervention on multiple fronts, in order to increase literacy and capability, both on an individual and on a community level, through inclusive and sustainable initiatives.

CONCLUSION

A prevention strategy based on the critical understanding of risk and risk-related criticalities is the only one which can aspire to last over time, while offering an effective tool for the safeguarding of public health, along with an opportunity of being prepared to contrast future emergencies more effectively. The development of such strategies represents one of the most significant contributions Health Promotion can offer in the time of Coronavirus.

Global survey of limestone used in poultry diets: calcium content, particle size and solubility

Limestone is used in poultry diets as a calcium (Ca) source. Feed formulation is often based on an estimate of limestone Ca content or, less frequently, wet chemistry analysis. However, limestone composition may vary, which has not previously been studied on a large scale. In this study, 641 limestone samples supplied to poultry feed mills in 40 countries across eight global regions were collected and analysed for macro- and micromineral content, particle size (geometric mean diameter, GMD), and in vitro solubility. Mean Ca content of fine limestone (GMD<1000 μm, n=566) was 37.8% (range 33.3-39.7%) and for coarse limestone (GMD>1000 μm, n=75) was 38.0% (range 34.7-40.0%). There was marked variation among and within regions in the concentration of other macro minerals and microminerals. Particle size (GMD) of fine limestone was 288 μm (range 37.7-991.9 μm) and 1,689 mm for coarse limestone (range 301.6-3,067.9 μm). In vitro solubility of fine limestone (5 min incubation, pH=3.0) was 68.4% (range 18.8 to 99.4%). Particle size only explained 52% of the variation in 5 min incubation solubility (R2=0.52). For coarse limestone, mean solubility (30 min incubation) was 65.5% (range 23.2-96%) which was not correlated (R2=0.09) with particle size. Particle size and solubility rate of limestone have been shown to alter Ca and phosphorus utilisation in broilers and laying hens. Hence, better understanding of variation in mineral analysis, particle size and solubility rate would enable more accurate feed inclusion and subsequently digestibility to support health and performance.

Study retention prediction with AI

Introduction

Openness, conscientiousness, extroversion, agreeableness and neuroticism are dimensional personality traits known as the Big Five. Study attrition is a common but often hard to anticipate problem. Artificial intelligence (AI) could examine both fronts to mitigate the unpredictability of the latter.

Objectives

To investigate whether AI could predict study attrition employing personality traits scores.

Methods

Data from 2,697 questionnaires were analysed using an AI. The short form of the International Personality Item Pool was used to assess the Big Five personality traits on the first of three planned waves. The personality traits scores were employed to predict the missing of at least one wave. Overall attrition was 17.6%. The AI was conservatively tuned to minimize the negative likelihood ratio when confronting predicted and real attrition. The free and open source programming language R was used for all the analyses. Dataset source: Hansson, Isabelle; Berg, Anne Ingeborg; Thorvaldsson, Valgeir (2018), “Can personality predict longitudinal study attrition? Evidence from a population-based sample of older adults”, Mendeley Data, V1, doi: 10.17632/g3jx8zt2t9.1

Results

Predictions obtained a negative likelihood ratio of 0.333 and a negative predictive value of 0.933. The results were indicative of fair performance.

Conclusions

AI might be useful to predict study retention. Furthermore, the results of this study might indicate a moderate effect of the Big Five on the probability of study retention. Finally, the AI used in this study is freely available, allowing anyone to experiment.

Disclosure

No significant relationships.

Female sexual dysfunction after breast cancer surgery prediction with AI

Introduction

Female sexual dysfunction (FSD) can be overlooked. Different types of breast cancer surgery could have a different impact on the sexuality of women. Artificial intelligence (AI) could help to determine the relation between those conditions.

Objectives

To investigate whether AI could predict FSD relying primarily on the time elapsed after treatment and the type of breast cancer surgery.

Methods

Data of age, time elapsed after treatment and type of surgery (breast-conserving therapy and mastectomy) were employed to predict FSD status in 128 subjects using an AI. Women with and without steady relations were included in the analysis. FSD prevalence was 27.3%. The AI was conservatively tuned to maximize the positive likelihood ratio considering predicted and real FSD statuses. The free and open source programming language R was used for all the analyses. Dataset source: Nowosielski, Krzysztof; Krzystanek, Marek; Kowalczyk, Robert; Streb, Joanna; Kucharz, Jakub; Głogowska, Iwona; Lew-Starowicz, Zbigniew; Cedrych, Ida (2018), “Data for: Factors affecting sexual function and body image of early stage breast cancer survivors in Poland: A short-term observation.”, Mendeley Data, V1, doi: 10.17632/948n98trm6.1

Results

Predictions obtained a positive likelihood ratio of 5.314. The results were indicative of fair performance.

Conclusions

AI might be useful to predict FSD in women who undergo breast cancer surgery. Furthermore, the results of this study might indicate a moderate effect of age, time after treatment and type of surgery on the probability of FSD occurrence. Finally, the AI used in this study is freely available, allowing anyone to experiment.

Big five personality traits prediction with AI

Introduction

Openness, conscientiousness, extroversion, agreeableness and neuroticism are known as the Big Five personality traits (BFPT). They are theoretical building blocks of the personality and comprise wide and interconnected spectra. Artificial intelligence (AI) could help to grasp their complexity.

Objectives

To investigate whether AI could predict the BFPT from themselves.

Methods

Data from 2,697 questionnaires were analysed using an AI. The short form of the International Personality Item Pool was used to assess the BFPT. Four of the BFPT scores were employed to predict the fifth one and the procedure was repeated for all of them alternatively. The AI was conservatively tuned to maximize the one-way random intraclass correlation coefficient (ICC) between predicted and real values. Their Pearson’s r was calculated too. The free and open source programming language R was used for all the analyses. Dataset source: Hansson, Isabelle; Berg, Anne Ingeborg; Thorvaldsson, Valgeir (2018), “Can personality predict longitudinal study attrition? Evidence from a population-based sample of older adults”, Mendeley Data, V1, doi: 10.17632/g3jx8zt2t9.1

Results

Openness, conscientiousness, extroversion, agreeableness and neuroticism predictions obtained ICC of 0.219, 0.146, 0.306, 0.354, 0.121 and Pearson’s r of 0.254, 0.149, 0.393, 0.446, 0.122 respectively. The results for extroversion and agreeableness were indicative of fair performance.

Conclusions

AI might be useful to predict personality traits, mainly extroversion and agreeableness. This could be utile in many situations, such as dealing with missing data or deciding whether to formally test someone. Finally, the AI used in this study is freely available, allowing anyone to experiment.

Ssri-treated psychiatric disorders prediction with AI

Introduction

SSRI-treated psychiatric disorders (STPD), such as general anxiety disorder and major depression disorder, are common psychiatric diagnoses. Serotonin-mediated effects of solar insolation are an active topic of research. Artificial intelligence (AI) could help to better examine that complex relation.

Objectives

To investigate whether AI could predict the STPD relying primarily on average ambient temperature and annual solar insolation.

Methods

Data of age, average ambient temperature and annual solar insolation were employed to predict STPD status in 7,587 subjects using an AI. To simplify the data analysis, only individuals with white ethnicity were assessed. SPTD prevalence was 17.1%. The AI was conservatively tuned to maximize the positive likelihood ratio considering predicted and real STPD statuses. The free and open source programming language R was used for all the analyses. Dataset source: Wortzel, Joshua; Kent, Shia; Avery, David; Al-Hamdan, Mohammad; Turner, Brandon; Norden, Justin; Norden, Michael; Haynor, David (2018), “Data for: Ambient temperature and solar insolation are associated with decreased prevalence of SSRI-treated psychiatric disorders”, Mendeley Data, V1, doi: 10.17632/trs43ybh92.1

Results

Predictions obtained a positive likelihood ratio of 4.850. The results were indicative of fair performance.

Conclusions

AI might be useful to predict STPD. Furthermore, the results of this study might indicate a moderate effect of age, average ambient temperature and annual solar insolation on the probability of STPD occurrence. Finally, the AI used in this study is freely available, allowing anyone to experiment.

Dark triad personality traits prediction with AI

Introduction

The dark triad is composed by the personality traits Machiavellianism, narcissism and psychopathy (MNP). Their complexity can make them difficult to interrelate. Artificial intelligence (AI) could help in this endeavour.

Objectives

To investigate whether AI could predict MNP from themselves.

Methods

Data from 210 questionnaires were analysed using an AI. The short Dark Triad questionnaire (SD3) was used to assess MNP. Two of the MNP scores were employed to predict the third one and the procedure was repeated for all of them alternatively. The AI was conservatively tuned to maximize the one-way random intraclass correlation coefficient (ICC) between predicted and real values. Pearson’s r was calculated too. The free and open source programming language R was used for all the analyses. Dataset source: Borráz-León, Javier I. (2020), “Dark triad, attractiveness, mate value, and sexual partners”, Mendeley Data, V1, doi: 10.17632/87vx6jfnrp.1

Results

Machiavellianism, narcissism and psychopathy predictions obtained ICC of 0.593, 0.335, 0.505 and Pearson’s r of 0.608, 0.346, 0.548 respectively. The results were indicative of fair performance, mainly for Machiavellianism and psychopathy.

Conclusions

AI might be useful to predict MNP. This could be utile in many situations, such as dealing with missing data or deciding whether to formally test someone. Finally, the AI used in this study is freely available, allowing anyone to experiment.

Disclosure

No significant relationships.

Hemorrhoid laser procedure with suture-pexy (HeLPexx): a novel effective procedure to treat hemorrhoidal disease

BACKGROUND

The hemorrhoid laser procedure with suture-pexy (HeLPexx), consisting of Doppler-guided hemorrhoidal dearterialization with laser and the addition of anal mucopexy, is a novel non-excisional procedure to treat hemorrhoids. The aim of the present study was to describe the technique and report the clinical and long-term results.

METHODS

A prospective study was conducted on patients with grade III hemorrhoids who had HeLPexx from January 2012 to February 2018. Pre- and postoperative assessment included a thorough clinical examination, constipation and incontinence scoring systems and a symptom questionnaire which was administered at all patients before surgery and at each follow-up visit to evaluate bleeding, prolapse, manual reduction, discomfort or pain, and impact on quality of life. Each symptom had a score between 0 and 4, (0 indicates no symptoms and 4 indicates daily symptoms). The sum of the score for each symptom constituted the Hemorrhoid Symptom Score. Resolution of symptoms, pain, morbidity, need for further medical and/or surgical therapy were also recorded.

RESULTS

One hundred and seventy consecutive patients with grade III hemorrhoids [74 females; mean age 49.5 years (range 22-79) years] were included. Median length of follow-up was 36 (range 12-72) months. Postoperative morbidity included urinary retention (7 patients, 4.1%), bleeding not requiring transfusion (1 patient, 0.6%) and thrombosis of hemorrhoidal piles (2 patients, 1.2%). The mean postoperative pain VAS score at 1 week postoperatively was 1.8 ± 1.1 (range 0-5) and 12 (7%) patients used pain medications for more than 1 week postoperatively while none of the patients reported any pain by the end of the third week postoperatively. The Hemorrhoid Symptom Score significantly improved from 15.83 ± 3.04 to 1.3 ± 2.4 (p ≤ 0.001) and showed a statistically significant improvement in all items. Recurrent symptoms were reported in 12 patients (7%) who required further treatment. Severe chronic constipation prior to surgery was found to be a predictive factor of failure (p = 0.04).

CONCLUSIONS

HeLPexx appears to be safe and effective for treatment of symptomatic hemorrhoids. Further studies are needed to confirm our results.

Effects of a bioactive olive pomace extract from Olea europaea on growth performance, gut function, and intestinal microbiota in broiler chickens

The present study aims to investigate the effects of supplementing broiler diets with a bioactive olive pomace extract (OE) from Olea europaea on growth performance, digestibility, gut microbiota, bile acid composition, and immune response. To this end, three hundred and six 1-day-old broiler chickens (Ross 308) were housed in floor pens (6 pens/treatment, with 17 birds/pen). Animals were fed with a standard non-medicated starter diet for 21 D, and from 22 to 42 D of age with their respective experimental diet: a negative control with no additives (Control), a positive control with 100 ppm of monensin (Monensin) and the basal diet supplemented with 750 ppm of an OE (Lucta S.A., Spain). Feed intake and growth rate were monitored weekly throughout the trial. From 21 to 42 D of age, no significant differences in feed intake were observed among dietary treatments; however, lower average daily gain and higher feed conversion ratio (P < 0.05) was observed in birds fed the Control compared to Monensin and OE groups. Performance of birds fed OE or Monensin was similar throughout the trial. The apparent ileal digestibility of crude protein was higher in birds fed Monensin than Control treatment (P < 0.05). No significant changes on bacterial composition at a family level were observed in the caeca of birds fed the experimental diets. Moreover, no significant differences on plasma and intestinal bile acid composition were observed among treatments. Birds fed the OE showed a significant decrease of IL-8 expression in the ileum (P < 0.05). Additionally, the expression of TGF-β4, and Bu-1 was significantly upregulated (P < 0.01) in broilers fed the OE and Monensin diets compared to those fed the Control. In conclusion, the inclusion of 750 ppm of a bioactive olive pomace extract from Olea europaea in broiler chicken diets improved animal growth likely as result of its anti-inflammatory properties.

Health and web for women: preliminary results of “SEI Donna” survey

Background

In 2018, 52% of the European population use the Web to seek health information and 77% consider it a useful tool to improve their knowledge about health. The Italian survey “SEI Donna” aims to investigate knowledge, perceptions and use of the web tools in women regarding health issues.

Methods

We used an online questionnaire to collect data including the type of online research and the degree of trust towards different sources. We also assessed health literacy (HL) and eHealth literacy scale (eHEALS) using validated tests.

Results

Of 7291 women who completed the questionnaire, 96% (n = 7022) seeks health information online. The 33% of women follows social media groups on health. One third of sample (31%) purchased a health product online, particularly cosmetics (75%) and supplements (41%). More than one third of sample thinks that information retrieved by web improve their health (35%) and influence their habits (34%). Half of sample (52%) searched online for a second opinion after medical examination. The reason was the need of a deepening in the 67% of cases. Overall, the HL is functional in 34% of cases, marginal in 56% and low in the rest (10%). Women with low HL trust less health information reported by institutional websites than women with functional HL, respectively 73% vs 86% (p &lt; 0.001) and the eHEALS score of women less trusting is lower than those trusting, 23±7 vs 28±7 (p &lt; 0.001).

One third of women declares not to be able to evaluate the reliability of a website particularly women with low HL (36%) compared to those with functional HL (20%), p &lt; 0.001. Women reporting not to be able to evaluate the reliability of a website have eHEALS score lower than women who indicated an institutional website, respectively 24±7 vs 28±7 (p &lt; 0.001).

Conclusions

The results confirm the large use of the web as a tool to seek health information, have a second opinion and buy health products. A good level of HL and eHEALS seem to make women more skilled in surfing the web.

Key messages

The results confirm the importance to put effort on strategies aiming to improve health literacy and eHealth literacy in the population. In the public health communication perspective, the fact that one third of women thinks that information retrieved by web improve their health and influence their habits, must be considered.

Effects of supplementing a milk replacer with sodium butyrate or tributyrin on performance and metabolism of Holstein calves

The effects of butyrate supplementation in diets of calves are inconsistent in the literature. Fifty-one Holstein calves (45.7 ± 5.8 kg of bodyweight and 11.8 ± 3.1 days of age; mean ± s.d.) were randomly allocated to three treatments to assess the effects of supplementing the milk replacer at 0.3% dry matter with butyrate in the form of sodium butyrate or tributyrin compared with no supplementation (CTR). Calves were fed 4 L/day of milk replacer (25% crude protein and 19.2% ether extract) and starter feed (20% crude protein and 3.8% ether extract) ad libitum over a period of 6 weeks. Individual intake was measured daily and bodyweight and blood β-hydroxybutyrate, glucose-like peptide-1, glucose and insulin were measured fortnightly. A glucose tolerance test was performed on Days 0 and 35 of the study. No effects of butyrate supplementation were found on starter and total dry matter intake. CTR calves had greater average daily gain than tributyrin calves. CTR calves tended to have greater final bodyweight than tributyrin and sodium butyrate calves. Gain : feed ratio tended to be greater for CTR calves. There were no differences in plasma glucose, insulin, β-hydroxybutyrate and glucose-like peptide-1 concentrations throughout among treatments the study. During the glucose tolerance test, no differences on insulin sensitivity were found among treatments. In conclusion, no apparent advantages of supplementing milk replacer with sodium butyrate or tributyrin were found on performance and glucose metabolism in calves.

Influence of dietary flavours on sheep feeding behaviour and nutrient digestibility

The aim of the present study was to assess whether the feeding pattern displayed by sheep exposed to a monotonous ration is modified when the same ration is presented in a diversity of flavours and if such diversity influences nutrient intake and digestibility. Twelve commercial crossbred wether lambs were assigned to two groups. Six lambs/period (three lambs/group.period) were housed in metabolic crates during two successive periods. One group of lambs (Diversity, D) was fed simultaneously an unflavoured ration of alfalfa, barley, beet pulp and urea (55 : 35 : 9 : 1) and the same ration supplemented (0.2%) with one of the following two flavours: (1) sweet, and (2) umami. The other group (Monotony, M) received only the unflavoured ration. All animals were fed their respective rations ad libitum from 0800 hours to 1600 hours for 26 days in each period. Day 19 was used for assessing the lamb feeding pattern every 30 min for 8 h, and the last 6 days of the period were used for estimating in vivo food digestibility. Lambs in D tended to ingest more acid detergent fibre (ADF; P = 0.10) and to have a lower crude protein digestibility (P = 0.08) than did lambs in M. Nevertheless, average daily DM intake did not differ between treatments (P = 0.22) and lambs in M and D digested the same amount of DM, neutral detergent fibre, ADF and N (P > 0.10). Flavour diversity did not affect N retained, N retained/N consumed, or ruminal pH 1 h after feeding (P > 0.10). Lambs in D showed greater intakes than did those in M during 30 (P = 0.006), 60 (P = 0.02), 90 (P = 0.02), 120 (P = 0.04) and 180 min (P = 0.07) after offering the rations. Results suggest that changes in eating behaviour occurred only during the first part of the feeding period, leading to slight changes in ADF intake and crude protein digestibility, which did not impact nutrient utilisation.

Trauma- and stressor related disorders in the tuareg refugees of a cAMP in burkina faso

Background:

Post-traumatic stress disorder (PTSD) is reported to be common among refugees. We set out to explore risk of Trauma- and Stress-or-Related Disorders and the associated burden of psychological distress in a refugee camp of Malian Refugees in Burkina Faso.

Methods:

One out of five persons living in the camp was selected randomly and interviewed using the French version of the Short Screening Scale for PTSD and the validated K6 scale to measure psychiatric morbidity.

Results:

Around 60% of the interviewed sample (N=408) met the criteria for Trauma- and Stress-or-Related Disorders and also reported severe mental distress on K6 scores. Women aged 40 and over were found to be at higher risk of Trauma- and Stress-or-Related Disorders whereas young people (39 or younger) scored higher on K6 ratings. Around 83% of the surveyed subjects had a family member killed in the war, 91% a relative in the war, more than 80% had a family member suffering from physical injuries, and 90% reported problems with food and housing. The frequency of these life events was not surprisingly higher in persons with Trauma- and Stress-or-Related Disorders, with the death of a family member and severe problems with food being specifically related to them.Conclusion: These results point to important psychological suffering in a population that is often ignored by the media and international political authorities. Immediate steps are required to provide urgent legal and humanitarian protection to those who are forced to flee their homes and cross international borders because of disasters.

[Collaboration between general practitioners and the school: survey about student's dietary habits in the first classes of secondary school in the province of Carbonia-Iglesias, Sardinia]

WHO stresses the importance of promoting balance diet among adolescents. The general practitioners are called at the forefront in the prevention of disorders related to eating habits. The present study describes a project to promote nutrition, created and run by general practitioners in the first classes of 20 secondary schools in seven municipalities, in the province of Carbonia-Iglesias (Italy), for a sample of 509 students (220 females and 289 males). The results also offer an expanded view of the eating habits of adolescents. The results show that adolescents do not give importance to the breakfast that is often not complete or is not consumed, and only 50% of respondents drink milk. The highest percentage of students consuming the first and second course (45-59%) at lunch and dinner consumption of protein was high ranging between 64 and 80% for lunch and dinner at 63 and 66%. That is evidenced by these results can be a valuable aid for future health promotion interventions.

The Italian national trends in smoking initiation and cessation according to gender and education

OBJECTIVES. This study aims to assess the trend in initiation and cessation of smoking across successive birth cohorts, according to gender and education, in order to provide useful suggestion for tobacco control policy. STUDY DESIGN. The study is based on data from the "Health conditions and resort to sanitary services" survey carried out in Italy from October 2004 to September 2005 by the National Institute of Statistics. Through a multisampling procedure a sample representative of the entire national territory was selected.

METHODS

In order to calculate trends in smoking initiation and cessation, data were stratified for birth cohorts, gender and education level, and analyzed through the life table method.

RESULTS

The cumulative probability of smoking initiation, across subsequent generations, shows a downward trend followed by a plateau. This result highlights that there is not a shred of evidence to support the hypothesis of an anticipation in smoking initiation. The cumulative probability of quitting, across subsequent generations, follows an upward trend, highlighting the growing tendency of smokers to become an "early quitter", who give up within 30 years of age.

CONCLUSION

Results suggest that the Italian antismoking approach, for the most part targeted at preventing the initiation of smoking emphasising the negative consequences, has an effect on the early smoking cessation. Health policies should reinforce the existing trend of "early quitting" through specific actions. In addition our results show that men with low education exhibit the higher probability of smoking initiation and the lower probability of early quitting, and therefore should be targeted with special attention.

Participative risk communication in an industrial village in Sardinia

OBJECTIVE

In Italy the law on industrial risk has emphasised the necessity of building a local information process to answer people's questions on safety and provide greater community participation in risk management. The aim of this research is to analyse the local population's ideas and expectations of a participatory approach in risk management in order to design a risk communication programme based on health promotion principles.

DESIGN, SETTING AND PARTICIPANTS

The study was carry out in Portoscuso (Italy), an industrial district. A questionnaire was administrated through home interviews to 147 citizens.

MAIN RESULTS

Six risk management styles were identified on the basis of citizens' trust in the different stakeholders. Additional parameters (importance of information, organisations they would trust to get information on industrial risks, preferred risk communication methodologies) were analysed according to the management styles.

CONCLUSIONS

On the basis of these elements, a multi-approach strategy could be proposed. Each management style can have different roles. A programme of public forums could involve citizens with an interactive approach, interactive courses could involve citizens with a semi-participative approach, and leaflets and booklets could inform citizens oriented towards unidirectional communication. The participative process should always be open to new contributions from citizens who are not directly involved, and should allow for flexibility in the form and nature of partnership, as well as the details of implementation.

Smoking trends in Italy from 1950 to 2000

STUDY OBJECTIVE

To assess how the prevalence of smokers in Italy from 1950 to 2000 has changed, in parallel with law development and the growing attention towards smoking prevention.

DESIGN, SETTING, AND PARTICIPANTS

Historical data on smoking trends have been obtained using data collected in 2000 by the National Institute of Statistics. A correction coefficient is proposed to overcome the bias of differential mortality reported in other papers. The sample is made up of 102 261 people aged 15-69 years.

MAIN RESULTS

A general downward trend is seen; there is a more pronounced decrease starting from 1975 to 1980. In both sexes the peak prevalence tends to decrease according to the birth cohort because of the earlier age in which they gave up. A partial exception to the decline of tobacco use in recent years may be made for the 15-19 year-old age group, which has remained stable since 1990.

CONCLUSIONS

Although a comprehensive community programme against tobacco was not developed, the different prevention actions implemented in Italy have contributed to a change in attitude and behaviour. The effect of tobacco control strategies implemented in Italy until now is more evident in relation to the breaking of the smoking habit, which happens at an increasingly younger age, although it is not clear how much it is able to prevent people from starting smoking.

Design, synthesis and in vivo activity of 9-(S)-dihydroerythromycin derivatives as potent anti-inflammatory agents

The synthesis of a new class of 9-(S)-dihydroerythromycin derivatives and their anti-inflammatory activity on in vivo PMA assay are described. Modifying the desosamine sugar on the C-3' amino group, it was possible to differentiate between anti-biotic and anti-inflammatory action. The compounds are completely devoid of anti-microbial effects but their anti-inflammatory properties are enhanced. These results strongly suggest the potential of macrolides as a new class of anti-inflammatory agents.

[Gastrectomy and laparoscopic lymphadenectomy for carcinoma: preliminary experience with 59 cases]

BACKGROUND

Laparoscopic surgery has been used in the treatment of gastric cancer with low mortality and morbidity and improvement in patient's quality of life.

AIM

To evaluate the results of laparoscopic gastric resection.

METHODS

A retrospective review of 59 patients after laparoscopic surgery for gastric cancer was performed. The patients were 31 males and 28 females with a mean age of 67 (+/- 11) years (min 39, max 90).

RESULTS

Tumor stage was IA in 15 patients, IB in 10, II in 9, IIIA in 6, IIIB in 9, and IV in 10. In 15 cases the tumor was an early gastric cancer. The mean number of dissected lymph nodes was 29 +/-10. Conversion rate was 16%. Morbidity rate was 37%. The median length of hospital stay was 10 days. Operative mortality was 3%. The mean time of follow-up was 23 months. Two-year survival was 75%.

CONCLUSIONS

Laparoscopic radical total or subtotal gastrectomy with extended lymphadenectomy for gastric cancer is a feasible, safe, and oncologically effective procedure.

[Risk target effect on risk perception in an industrial area]

This study describes the results of a survey, carried out by the Department of Public Health between October and December 2002, about the perception of the main risk factors for health and environment in Portoscuso (Ca), an industrial area in south west of Sardinia, declared "Environmental high-risk area " with DPCM 23.04.1993. The aim of survey was to investigate the different risk perception between local and global level analyzed by McNemar test. The results showed that risk perception was significantly higher at global level. We didn't observe any difference about local problematics as industrial pollution, work accidents, acid rain, industrial accident. Regarding risk factors, as food safety and life style, the "unrealistic optimism effect" described by Sjöberg with people risk perception higher at global level, is confirmed. Perception of industrial risk, considered only similar and not higher than in other areas, is influenced by citizens' consciousness of living in an area declared at high risk of environmental crisis. These results should be taken into account in future risk communication process in order to avoid interpretation bias.

[Adolescent nutrition promotion: real and false problems]

This study shows the relationship between BMI of 3000 adolescents and their perceived-weight status, and the strategies for weight loss. The finding indicate that substantial numbers of teenage females perceive themselves as overweight when BMI suggest they are not, while males have a reasonably accurate weight. Diet was the most frequently selected method for losing weight especially among females that wrongly perceive themselves overweight (O.R. = 5.54 I.C. 95% 4.28-7.19); while males were as likely to use diet as a strategy to lose weight only if they were really overweight (O.R. = 6.00; I.C. 95% 2.26-15.92). Exercise was selected as a method for losing weight by males independently to be overweight and by females only that perceive themselves overweight. The study shows that the young people of Sardinia need a health program to empower their knowledge the difference between health and aesthetic.

Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature

BACKGROUND

Laparoscopic cholecystectomy (LC) is the gold standard treatment of gallstones. Nevertheless, there are some pitfalls due to the limits of current technology and the use of inappropriate ligature material, with a relevant risk of injuries and postoperative, mainly biliary, complications. Ultrasonically activated scissors may divide both vessels and cystic duct, with no need of further ligature, and possibly reduce the risk of thermal injuries.

METHODS

A prospective nonrandomized clinical trial was started in 1999 to test harmonic shears (Ultracision, Ethicon Endo-Surgery, Cincinnati, OH, USA) in 461 consecutive patients undergoing LC in order to evaluate the theoretical benefits of ultrasonic dissection and the possible reduction in intraoperative bile duct injuries (BDIs) and postoperative complications. Patients were divided in two groups: in group 1 (HS; 331 patients) the operation was performed by Ultracision (including coagulation-division of cystic duct and artery); in group 2 (LOOP; 130 patients) the cystic duct, after coagulation-division by harmonic scissors, was further secured with an endo-loop. Both groups were further divided into two subgroups: expert and surgeon-in-training. The following categories of data were collected and analyzed: individual patient data, indication for laparoscopic cholecystectomy, surgical procedure data (associated procedures, intraoperative cholangiography, intraoperative complications, length of surgery, and conversion to open), and postoperative course data (postoperative morbidity, postoperative mortality, reinterventions, and postoperative hospital stay). Furthermore, biliary complications were analyzed as a single parameter comparing the incidence within groups and subgroups. Cumulative complications (intraoperative and postoperative) were also analyzed as a single parameter comparing their incidence in the series of each surgeon within the surgeon-in-training subgroup to the average results of the expert subgroup. Finally, length of surgery, postoperative complication rate, and length of postoperative hospital stay within subgroups were analyzed to evaluate the learning curve.

RESULTS

Overall conversion rate was 0.87%. The mean operating time was 76.8 min (median, 70 min) in group 1 and 97.5 min (median 90 min) in group 2. BDI occurred in 1 case (0.32%) in the surgeon-in-training subgroup. Overall BDI rate was 0.22% (1/461). The overall incidence of postoperative bile leak was 2.7% (9 patients of subgroup 1 and 1 patient of subgroup 2). Clinical observation with spontaneous resolution occurred in 4 patients, and in 1 case the management consisted in an endoscopic biliary drainage; surgery was requested in the remaining cases. A laparoscopic approach was successfully attempted in all cases. Overall morbidity rate was 8.76% in group 1 and 13.84% in group 2. Rates of major complications, overall biliary complication, and postoperative bile leaks within the expert and surgeon-in-training subgroup differ significantly (p = 0.026, p = 0.03, and p = 0.049, respectively). There was 1 death (0.22%) due to sepsis that resulted from a small bowel injury by trocar insertion. Mean postoperative stay was 4.28 days for group 1 and 5.05 days for group 2.

CONCLUSION

No significant difference was found in both patient groups regarding postoperative mortality and complications, biliary complications, and especially cystic duct leaks. A retrospective comparison of literature data showed that use of ultrasonic dissection during LC seems to reduce the risk of BDI. Nevertheless, a learning curve in the use of ultrasonic-activated devices is required: a significant differences in postoperative major complications and biliary complications between the expert and the surgeon-in-training subgroups was shown. Furthermore, ultrasonic scissors misuse may cause bowel injuries in patients with severe adhesions, and this could represent a possible limitation for surgical safety.

[Endoscopic sphincterotomy in acute biliary pancreatitis. A multicenter study]

BACKGROUND

Severe acute pancreatitis are still dangerous, as can be seen from the high mortality rate (around 30%). It's commonly known that in the last years diagnostic ability, precise stadiation and control over the disease development were increased. Surgical therapy is directed mainly to achieve the control over septic evolution, and in biliary pancreatitis to resolve hypertension and infection inside the biliary tree (now widely accepted as the real cause of this disease). Recently, some authors demonstrated that the prognosis of a pancreatitis can be greatly improved by stopping the evolution toward a severe phase with necrosis and multiple organ failure without any surgical operation. They believe that's possible to achieve this result performing an early endoscopic sphincterotomy in all biliary pancreatitis (recognised by means of echography and CT scan), before the development of necrosis.

METHODS

In our department, following this address, very good results have been obtained: that's why a multicentric trial has been carried out to appraise the results obtained by endoscopic sphincterotomy within 48 hours from the disease onset. Answers from 114 hospitals were received, with a total survey of more than 10,000 pancreatitis. Endoscopic sphincterotomy was performed in 55% of billiary pancreatitis, which were estimated at the onset, on second or third degree of Balthazar classification.

RESULTS

In 86% of patients, endoscopic sphincterotomy was performed within 48 hours from symptoms onset. Complications related to this treatment are reported in less than 4% of patients.

CONCLUSIONS

The procedure, avoiding the evolution toward necrosis and sepsis, allowed the reduction of surgical operations to 6.7%, and of the mortality amongst all cases gathered to 2.5%.

[Duodenal leiomyosarcoma with left hepatic metastasis treated by total exeresis (author's transl)]

A case of duodenal leiomyosarcoma associated with a single liver metastasis successfully treated by gastro-duodenal resection and left lateral hepatic segmentectomy in one stage is reported. The result of hepatic resection for metastatic cancer depends on the location and the histological nature of the primary tumor, on the type of hepatic resection and on the number of metastatic deposits. The patient is alive 26 months postoperatively and there is no evidence of any recurrence.