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Background: Social restrictions due to COVID-19 might have had a significant impact on mental health. The aim of this study was to assess the prevalence of four emotional domains (nervousness, anger, numbness, physiological arousal) in a sample of citizens during the first pandemic wave in 2020, and their association with sociodemographic characteristics, housing conditions and lifestyle modifications. Methods: A cross-sectional study based on a self-administered online questionnaire was set up to investigate emotions. Respondents were recruited through a non-probabilistic snowball sampling approach. The SPAN questionnaire was used to measure emotions in the interviewed population. The association between emotions and independent variables (gender, age, marital status, educational level, working condition, housing condition, COVID-19 positivity, sleep disturbance, increase in alcohol consumption and decrease in physical activity) was assessed through the multivariate Poisson regression. Results: A total of 6,675 subjects were included in the analysis. Almost half of respondents (48.9%) experienced nervousness, 41.3% anger, 15.6% numbness and 18.8% physiological arousal. Females were more likely to face nervousness, anger and physiological arousal. For all the outcomes a decreasing trend was observed from younger to older. Singles were more likely to experience numbness compared to married people. Increase in alcohol consumption was associated with nervousness, anger and numbness. Decrease in physical activity was associated with nervousness, anger and physiological arousal. Restless sleep was the variable most associated with all emotional domains. Conclusions: The first COVID-19 pandemic wave had a significant emotional impact on this sample, especially among younger people, singles and females. Even without reaching clinical relevance, these emotions could represent a form of psychological distress, which requires the implementation of preventive strategies, in particular regarding lifestyle care. [ABSTRACT FROM AUTHOR]

Background: Detailed epidemiology of Chronic Respiratory Diseases (CRDs) and of their risk and protective factors is needed to plan preventive interventions to reduce the burden of CRDs on population health. This study determines the prevalence of doctor-diagnosed CRDs and its associated factors in the adult Italian population. Methods: Data was collected from adults participating in the ongoing cross-sectional Italian Behavioural Risk Factor Surveillance System (PASSI) between 2013 and 2015. Results: Among 108 705 respondents, 7.0% reported a CRD (3.4% asthma, 2.6% COPD, 1.0% Asthma-COPD Overlap Syndrome). Current smoking was more frequent in the group with CRD compared to those without (30.8% vs. 25.2%, P < 0.001), as was physical inactivity (41.9% vs. 36.4%, P 0.009) and overweight/obesity (52.4%vs. 41.4%, P 0.009). Adults with CRDs also reported appropriate perception of insufficient physical activity and excessive body weight, adopted protective behaviours and received preventive interventions more often than those without CRDs. Conclusions: Italian adults with CRDs are more likely to be exposed to aggravating factors but are also knowledgeable of their condition and amenable to behaviour change. Since effective interventions for modifying these factors are available, there is an opportunity to reduce the significant disease burden of CRDs through specifically targeted health promotion interventions. [ABSTRACT FROM AUTHOR]

Background: International migration rapidly increased in the last decade, raising a renewed attention to its impact on public health. We evaluated differences in rubella immunization rate (RIR) between immigrant and Italian women of childbearing age and tried to identify the driving factors causing them. Methods: We analyzed data from the Italian behavioral surveillance system PASSI collected in 2011–2015 in a nationally representative sample of residents in Italy. The analysis was performed using log-binomial models to compare RIR between 41,094 Italian women and 3140 regular immigrant women of childbearing age (18–49 years), stratifying the latter by area of origin and length-of-stay in Italy (recent: ≤ 5-years; mid-term: 6-10-years; long-term: > 10-years). Results: Immigrant women showed a RIR of 36.0% compared to 60.2% among Italian women (RIR-ratio = 0.60, 95% confidence interval (CI): 0.57–0.63). Adjusting for demographic characteristics (i.e., sex, age and area of residence), socio-economic factors (i.e., education, occupation, family composition and economic status) and an indicator of the presence of at least one health-risk behavior (i.e., physical inactivity, current cigarette smoking, excessive alcohol consumption and excess weight) did not significantly change this difference (RIR-ratio = 0.56, 95% CI: 0.53–0.59). Recent immigrants (RIR-ratio = 0.47, 95% CI: 0.42–0.53) and immigrants from high migratory pressure countries (HMPC) in sub-Saharan Africa (RIR-ratio = 0.41, 95% CI: 0.31–0.56) and Asia (RIR-ratio = 0.42, 95% CI: 0.33–0.53) showed the greatest differences in RIR compared with Italian women. Conclusions: Differences in RIR between immigrant and Italian women were not explained by different demographic, socioeconomic and health-risk behaviors characteristics. As entitlement to free-of-charge immunization in Italy is universal, regardless of migration status, other informal barriers (e.g., cultural and barriers to information access) might explain lower RIRs in immigrant women, especially recent immigrants and those from HMPC in sub-Saharan Africa and Asia. Further investigations are needed to identify obstacles and appropriate promotion and access-enabling strategies for rubella immunization. [ABSTRACT FROM AUTHOR]

This study explored electronic cigarette (e-cigarette) use as an aid to quit smoking and compared abstinence rates for different quitting methods in a representative sample of the Italian population. In the 2014-2015 PASSI survey, the ongoing Italian behavioural risk factor surveillance system, 6112 adults who smoked and made at least one quit attempt in the previous 12months, were categorized into three groups according to the method used in their most recent quit attempt: e-cigarette only, no aid, other quitting methods (medications; programmes delivered in smoking cessation services; other unspecified methods). The primary outcome was self-reported abstinence for a period ≥6months, adjusted for potential confounders. Eleven percent used e-cigarettes only, 86% no aid, 3% other quitting methods. Smoking abstinence was reported among 9% of those using no aid; 8% of e-cigarette users; 15% of those using other methods. No significant differences in abstinence were observed for e-cigarette users compared with those reporting no aid (adjusted Prevalence Ratio [aPR]=0.81; 95%Confidence Interval (CI)=0.58-1.14). Changing the reference group to e-cigarette users, those using other quitting methods were significantly more likely to report abstinence than e-cigarette users (aPR=1.76; 95%CI=1.07-2.88). One out of ten smokers who attempted to quit in 2014-2015 in Italy used e-cigarettes. E-cigarettes users were as likely to report abstinence as those using no aid, but were less likely to report abstinence than users of established quitting methods. Further studies are needed to understand the relationship between e-cigarette types used to quit and abstinence rates. [ABSTRACT FROM AUTHOR]

PURPOSE: Field substitution of nonrespondents can be used to maintain the planned sample size and structure in surveys but may introduce additional bias. Sample weighting is suggested as the preferable alternative; however, limited empirical evidence exists comparing the two methods. We wanted to assess the impact of substitution on surveillance results using data from Progressi delle Aziende Sanitarie per la Salute in Italia-Progress by Local Health Units towards a Healthier Italy (PASSI). METHODS: PASSI is conducted by Local Health Units (LHUs) through telephone interviews of stratified random samples of residents. Nonrespondents are replaced with substitutes randomly preselected in the same LHU stratum. We compared the weighted estimates obtained in the original PASSI sample (used as a reference) and in the substitutes' sample. The differences were evaluated using a Wald test. RESULTS: In 2011, 50,697 units were selected: 37,252 were from the original sample and 13,445 were substitutes; 37,162 persons were interviewed. The initially planned size and demographic composition were restored. No significant differences in the estimates between the original and the substitutes' sample were found. CONCLUSIONS: In our experience, field substitution is an acceptable method for dealing with nonresponse, maintaining the characteristics of the original sample without affecting the results. This evidence can support appropriate decisions about planning and implementing a surveillance system. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Field substitution of nonrespondents can be used to maintain the planned sample size and structure in surveys but may introduce additional bias. Sample weighting is suggested as the preferable alternative; however, limited empirical evidence exists comparing the two methods. We wanted to assess the impact of substitution on surveillance results using data from Progressi delle Aziende Sanitarie per la Salute in Italia—Progress by Local Health Units towards a Healthier Italy (PASSI). Methods: PASSI is conducted by Local Health Units (LHUs) through telephone interviews of stratified random samples of residents. Nonrespondents are replaced with substitutes randomly preselected in the same LHU stratum. We compared the weighted estimates obtained in the original PASSI sample (used as a reference) and in the substitutes' sample. The differences were evaluated using a Wald test. Results: In 2011, 50,697 units were selected: 37,252 were from the original sample and 13,445 were substitutes; 37,162 persons were interviewed. The initially planned size and demographic composition were restored. No significant differences in the estimates between the original and the substitutes' sample were found. Conclusions: In our experience, field substitution is an acceptable method for dealing with nonresponse, maintaining the characteristics of the original sample without affecting the results. This evidence can support appropriate decisions about planning and implementing a surveillance system. [Copyright &y& Elsevier]

Background: Flexible employment is increasing across Europe and recent studies show an association with poor mental health. The goal of the current study is to examine this association in the Italian population to assess the possible mediating role of financial strain.Methods: Data were obtained by two Italian cross-sectional studies (PASSI and HIS) aimed at monitoring the general population health status, health behaviours and determinants. Mental health status was assessed using alternatively two validated questionnaires (the PHQ-2 and the MCS-12 score) and Poisson regression models were performed to assess if precarious work was associated with poor mental health. A formal mediation analysis was conducted to evaluate if the association between precarious work and mental health was mediated by financial strain.Results: The analyses were performed on 31,948 subjects in PASSI and on 21,894 subjects in HIS. A nearly two-fold risk of depression and poor mental health was found among precarious workers, compared to workers with a permanent contract, which was strongly mediated by financial strain.Conclusions: Even with the limitations of a cross-sectional design, this research supports that precarious employment contributes through financial strain to reduce the mental health related quality of life and to increase mental disorders such as symptoms of depression or dysthymia. This suggests that when stability in work cannot be guaranteed, it would be appropriate to intervene on the wages of precarious jobs and to provide social safety nets for ensuring adequate income. [ABSTRACT FROM AUTHOR]

Introduction: Cervical cancer (CC) poses a substantial burden in low-and middle-income countries (LMICs), where challenges in implementing effective screening programs and achieving high participation rates persist. Aims: This study sought to compare different strategies for recruiting women for CC screening in Albania, Montenegro, and Morocco, and compared usual care (ongoing invitation method) with an alternative approach (intervention strategy). Methods: Within each country, the following comparisons were made: face-to-face (FF) invitations versus phone calls (PCs) in Albania, PCs versus letter invitations in Montenegro, and FF invitations to women attending healthcare centers versus a combined approach termed "Invitation made in Morocco" (utilizing PC and FF for hard-to-reach women) in Morocco. Questionnaires that assessed facilitators and barriers to participation were administered to women who either attended or refused screening. Results: In Albania, significant differences in the examination coverage were observed between the invitation methods (PC: 46.1% vs. FF: 87.1%, p < 0.01) and between the rural and urban settings (rural: 89.1% vs. urban: 76.3%, p < 0.01). In Montenegro, the coverage varied based on the recruitment method (PC: 17.7% vs. letter invitation: 7.6%; p < 0.01), the setting (urban: 28.3% vs. rural: 13.2%; p < 0.01), and age (<34 years: 10.9% vs. 34+: 9.6%, p < 0.01). In Morocco, no significant differences were observed. Common screening facilitators included awareness of CC prevention and understanding the benefits of early diagnosis, while key barriers included a limited perception of personal CC risk and the fear of testing positive. Discussion: FF appeared to be effective in promoting participation, but its broader implementation raised sustainability concerns. PC invitations proved feasible, albeit necessitating updates to population registries. Restricting FF contacts for hard-to-reach communities may enhance the affordability and equity. [ABSTRACT FROM AUTHOR]

Background Cardiovascular (CV) diseases are a major cause of the disease burden worldwide and contribute substantially to health care costs, in particular in people with diabetes. Their incidence can be reduced by multi-factorial interventions. This study intends to describe the occurrence of CV risk and protective/preventive factors in the adult population resident in Italy, to better target public health interventions. Methods Data collected in 2016–19 from adults aged 18–69 years, participating in the Italian Behavioural Risk Factor Surveillance System (PASSI) based on a cross-sectional design, were used. The frequency of CV risk/protective factors was estimated in people with and without diabetes. The contribution of socioeconomic level (SEL) to CV risk was also explored. Results Among 129 989 respondents, 4.7% received a diagnosis of diabetes. Many CV risk factors were significantly more frequent in people with diabetes, who often presented multiple risk factors. At the same time, they adopted protective behaviours and received treatments and preventive interventions more often than those without diabetes. Relevant disparities were observed between SEL groups in diabetic people, with the least advantaged showing a worse risk profile. Conclusions Adults resident in Italy with diabetes are exposed to CV risk factors more often than those without diabetes. However, they show an increased attention to control these factors and receive more frequent health care, although less than ideal in absolute terms. There is an opportunity to reduce the important CV disease burden in the population through preventive/health promotion targeted interventions, prioritizing people with diabetes and of lower SEL. [ABSTRACT FROM AUTHOR]

Introduction: Few epidemiological studies have assessed the risk of parkinsonisms after prolonged use of neuroleptics. We aimed to examine the long-term risk of degenerative parkinsonisms (DP) associated with previous use of neuroleptics.Methods: All residents in Piedmont, Northern-west Italy, older than 39 years (2,526,319 subjects), were retrospectively followed up from 2013 to 2017. Exposure to neuroleptics was assessed through the regional archive of drug prescriptions. The development of DP was assessed using the regional archives of both drug prescriptions and hospital admissions. We excluded prevalent DP cases at baseline as well as those occurred in the first 18 months (short-term risk). The risk of DP associated with previous use of neuroleptics was examined through Cox regression, using a matched cohort design.Results: The risk of DP was compared between 63,356 exposed and 316,779 unexposed subjects. A more than threefold higher risk of DP was observed among subjects exposed to antipsychotics, compared to those unexposed (HR = 3.27, 95% CI 3.00-3.57), and was higher for exposure to atypical than typical antipsychotics. The risk decreased after 2 years from therapy cessation but remained significantly elevated (HR = 2.38, 95% CI 1.76-3.21).Conclusions: These results indicate a high risk of developing DP long time from the start of use and from the cessation for both typical and atypical neuroleptics, suggesting the need of monitoring treated patients even after long-term use and cessation. [ABSTRACT FROM AUTHOR]

Background: In response to the COVID-19 pandemic, drastic measures for social distancing have been introduced also in Italy, likely with a substantial impact in delicate conditions like pregnancy and puerperium. The study aimed to investigate the changes in lifestyle, access to health services, and mental wellbeing during the first Italian lockdown in a sample of Italian pregnant women and new mothers.Methods: We carried out a web-based survey to evaluate how pregnant women and new mothers were coping with the lockdown. We collected data about healthy habits (physical exercise and dietary habits), access to health services (care access, delivery and obstetric care, neonatal care, and breastfeeding), and mental wellbeing (psychological well-being and emotive support). Descriptive analysis was performed for both groups of participants, whereas a Poisson analysis was used to measure the association between some structural variables (age, education, socio-economic data, partner support, contact, free time, previous children, and pregnancy trimester) and anxiety or depression, difficulties in healthy eating and reduction in physical activity after lockdown started. Chi2 and Adjusted Prevalence Ratios were estimated only for pregnant women.Results: We included 739 respondents (response rate 85.8 %), 600 were pregnant (81.2 %), and 139 (18.8 %) had delivered during lockdown (new mothers). We found a high score for anxiety and depression in 62.8 % of pregnant women and 61.9 % of new mothers. During the lockdown, 61.8 % of pregnant women reduced their physical exercise, and 44.3 % reported eating in a healthier way. 94.0 % of new mothers reported to have breastfed their babies during the hospital stay. Regarding the perceived impact of restrictive measures on breastfeeding, no impact was reported by 56.1 % of new mothers, whereas a negative one by 36.7 %.Conclusions: The high prevalence of anxiety and depressive symptoms in pregnant women and new mothers should be a public health issue. Clinicians might also recommend and encourage "home" physical exercise. On the other hand, about half of the sample improved their approach towards healthy eating and a very high breastfeeding rate was reported soon after birth: these data are an interesting starting point to develop new strategies for public health. [ABSTRACT FROM AUTHOR]

Background: Up to 53.7% of all cases of dementia are assumed to be due to Alzheimer disease (AD), while 15.8% are considered to be due to vascular dementia (VaD). In Europe, about 3 million cases of AD could be due to 7 potentially modifiable risk factors: diabetes, midlife hypertension and/or obesity, physical inactivity, depression, smoking, and low educational level. Aims: To estimate the number of VaD cases in Europe and the number of AD and VaD cases in Italy attributable to these 7 potentially modifiable risk factors. Methods: Assuming the nonindependence of the 7 risk factors, the adjusted combined population attributable risk (PAR) was estimated for AD and VaD. Results: In Europe, adjusted combined PAR was 31.4% for AD and 37.8% for VaD. The total number of attributable cases was 3,033,000 for AD and 873,000 for VaD. In Italy, assuming a 20% reduction of the prevalence of each risk factor, adjusted combined PAR decreased from 45.2 to 38.9% for AD and from 53.1 to 46.6% for VaD, implying a 6.4 and 6.5% reduction in the prevalence of AD and VaD, respectively. Conclusion: A relevant reduction of AD and VaD cases in Europe and Italy could be obtained through primary prevention. [ABSTRACT FROM AUTHOR]

Background: Over the past 50 years there was a substantial decrease in the prevalence of smoking in Italy. The objective of this work is to describe attempts to quit and cessation success in Italian smokers. Methods: A surveillance on health-related behaviors (PASSI) was conducted in 2007-13 on a sample of 203 610 Italian adults 25-64 years of age. An analysis of smokers' characteristics and behaviors was performed, focusing on attempts to quit and quit success. Data from national surveys (ISTAT) from 1983 to 2013 (Italian adults, 25-64 years of age, 1983: 46 634; 1987: 40 915; 1990: 36 622; 2000: 77 531; 2005: 71 032; 2013: 64 205) were used to explore if a cessation trend in Italy exists. Results: Smokers who quit in the previous year and were still abstinent when interviewed increased from 1990 to 2013. In the years 2011-13, 38% of people who had smoked in the last 12 months reported at least a quit attempt during the same period and 7% were still abstinent when interviewed. An association of successful recent quit attempts with higher educational level, absence of economic difficulties and younger age was found. In the years 2007-13, the great majority tried to stop unaided. Having received assistance from a cessation program did not increase the probability of enduring abstinence. Conclusions: In Italy interventions to drive more smokers to quit should be focused in particular on disadvantaged groups. Initiatives have to be studied not only to incentive more smokers to try to quit, but also to maintain abstinence over time. [ABSTRACT FROM AUTHOR]

Background: Many studies on migrant health have focused on aspects of morbidity and mortality, but very few approach the relevant issues of migrants' health considering behavioral risk factors. Previous studies have often been limited methodologically because of sample size or lack of information on migrant country of origin. Information about risk factors is fundamental to direct any intervention, particularly with regard to non-communicable diseases that are leading causes of death and disease. Thus, the main focus of our analysis is the influence of country of origin and the assimilation process. Method: Utilizing a surveillance system that has been collecting over 30,000 interviews a year in Italy since 2008, we have studied migrants' attitudes and behaviors by country of origin and by length of stay. Given 6 years of observation, we have obtained and analyzed 228,201 interviews of which over 9000 were migrants. Results: While migrants overall present similar conditions to native-born Italians, major differences appear when country of origin or length of stay is considered. Subgroups of migrants present substantially different behaviors, some much better than native-born Italians, some worse. However, integration processes generally produce a convergence towards the behavioral prevalence observed for native-born Italians. Conclusions: Health programs should consider the diversity of the growing migrant population: data and analyses are needed to support appropriate policies. Many migrants' subgroups arrive with healthier behaviors than those of their adopted country. However, they are likely to have a less favorable social position in their destination countries that could lead to a change towards less healthy behaviors. Interventions capable of identifying this tendency could produce significant better health for this important part of the future (multicultural) populations. [ABSTRACT FROM AUTHOR]