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Cardiac arrest (CA) is the third cause of death in Europe. This paper highlights the various treatments for the prevention and early management of CA and provides an overview of available evidence on the CA center concept. The experience of Maggiore Hospital of Bologna, Italy over the last 11 years is also outlined along with the treatments applied to patients with CA and their impact on improving outcomes. The new concept of the "Systems Saving Lives" approach is presented as a potential way for implementing Italian healthcare systems involved in the management of CA patients. Finally, the future perspective of implementation of CA centers in Italy is also described encouraging the healthcare professionals involved in the treatment of CA patients to consider a multidisciplinary approach (including a cardiologist, emergency physician, neurologist, physiatrist, radiologist, and intensivist).

Severe mitral regurgitation represents the second most common indication for valve surgery in Europe. In the last decade, transcatheter mitral valve repair has become an established effective and safe treatment option for patients at high or prohibitive operative risk. A relevant proportion of these patients develop significant tricuspid regurgitation. Once considered a benign and reversible finding, nowadays increasing attention is being paid to the coexistence of this valvular disease, as a growing body of evidence points towards its negative prognostic role. Over the last few years, transcatheter repair has been performed successfully also for the treatment of significant tricuspid regurgitation in patients at high surgical risk. Therefore, combined transcatheter repair is emerging as a treatment strategy for high surgical risk patients with both severe mitral and tricuspid regurgitation. In this review, we provide a comprehensive summary of the epidemiology, pathophysiology, and prognostic role of the coexistence of severe mitral and tricuspid regurgitation. We then discuss the evidence in favor of combined surgical treatment and the emerging data supporting combined transcatheter treatment, with attention to available treatment technologies. The paper is further enriched with three practical case reports and with the suggestion of a decision-making algorithm for the management of this complex subset of patients.

Competing Interests: Conflict of interest statement Armando Stefanati, Erica d’Anchera, Francesco De Motoli and Marta Savio declare no conflict of interest. Giovanni Gabutti declares that he does not have a specific conflict of interest related to this paper; however, he reports grants from Sanofi Pasteur MSD, GSK Biologicals SA, Pfizer, Sanofi Pasteur Italy, MSD Italy, Emergent BioSolutions and Seqirus for taking part in advisory boards, expert meetings, acting as speaker and/or organizer of meetings/congresses and acting as principal investigator and chief of OU in RCTs.

The area of mental health is directly affected by the pandemic and its consequences, for various reasons: 1-the pandemic triggered a global lockdown, with dramatic socioeconomic and therefore psychosocial implications; 2-mental health services, which treat by definition a fragile population from the psychological, biological and social points of view, have a complex organizational frame, and it was expected that this would be affected (or overwhelmed) by the pandemic; 3-mental health services should, at least in theory, be able to help guide public health policies when these involve a significant modification of individual behaviour. It was conducted a narrative review of the publications produced by European researchers in the period February-June 2020 and indexed in PubMed. A total of 34 papers were analyzed, which document the profound clinical, organizational and procedural changes introduced in mental health services following this exceptional and largely unforeseen planetary event.Among the main innovations recorded everywhere, the strong push towards the use of telemedicine techniques should be mentioned: however, these require an adequate critical evaluation, which highlights their possibilities, limits, advantages and disadvantages instead of simple triumphalist judgments. Furthermore, should be emphasized the scarcity of quantitative studies conducted in this period and the absence of studies aimed, for example, at exploring the consequences of prolonged and forced face-to-face contact between patients and family members with a high index of "expressed emotions".

A revised version of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) guidelines on myocardial revascularization has recently been published. These guidelines represent the third time that the ESC and EACTS have brought together cardiologists and cardiac surgeons in a joint Task Force to review the available evidence, with the mission of drafting balanced, patient-oriented, clinical practice guidelines on myocardial revascularization. During the last 4 years, a large body of evidence has become available and brought substantial changes to the guidelines. This paper aims to summarize what is new in the 2018 ESC/EACTS guidelines on myocardial revascularization.

Sleep disorders and related diseases are becoming increasingly relevant for the health and wellbeing of the general and working populations. Sleep disorders affect all aspects of health, showing a bi-directionality with health conditions and comorbidity with several diseases. Consequently, sleep disorders may have severe negative consequences both for the individual and the enterprise, as well as for society on the whole, in terms of health, productivity and social costs. When considering the disturbances of the sleep/wake cycle, it is important to distinguish between those connected with endogenous biological factors from those related to socio-environmental conditions, including work, and those associated with mental and physical diseases, that are often associated and interact with each other. Many sleep disorders are still underestimated and under-valued in clinical practice and, to a much greater extent, in workers' health surveillance. The present paper is aimed at drawing the attention of the occupational health physician to some key issues, particularly regarding excessive daytime sleepiness, obstructive sleep apnea syndrome and shift and night work, as well as their implications in terms of health and occupational consequences. Information on the main aspects of clinical diagnosis and health surveillance, as well as risk management and prevention at the workplace, are provided.

Introduction: This paper presents an innovative device for measuring artificial optic radiations (AOR). AOR are required to be measured in accordance with both Italian and European regulations. The traditional measurement methods do not provide a quantitative measurement of the energy affecting the retina and in particular the fovea. Hence, they are not suitable to assess the real risk to the eye. Furthermore traditional methods are not even able to measure the exposure time (in relation to the position of the head with respect to the source)., Materials and Methods: The device permits the acquisition of essential information about AOR source direction and position so as to obtain an evaluation of the relative impact on worker's everyday activity. The device acts as both a wearable personal dosimeter and an instantaneous radiance detector. The main components are: a colour light sensor mounted at the centre of a pair of safety goggles (placed on the same line of the worker's sight) used to determine AOR intensity; an inertial/position sensor used for measuring head position/movement, and lastly a video camera to localize emission sources and generate the background in augmented reality visualization. The device is connected by means of a thin, flexible cable to a datalogger and/or netbook? for recording data., Results: the experiments were carried out in order to evaluate AOR sources during work activity; the results obtained and duly processed are presented in the paper., Conclusion: the aims are to achieve work place safety zoning so as to distinguish unsafe from safe areas, and not only specific dangerous areas, via analysis and integration of the overlapping pieces of information obtained with the proposed device.

The aim of this paper was to provide a detailed description of the EuroQol- 5 Dimension (EQ-5D) useful for those member of staff in rehabilitation setting who wish to use it properly. EQ-5D is an instrument which evaluates the generic quality of life developed in Europe and widely used. The EQ-5D descriptive system is a preference-based HRQL measure with one question for each of the five dimensions that include mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The answers given to ED-5D permit to find 243 unique health states or can be converted into EQ-5D index an utility scores anchored at 0 for death and 1 for perfect health. The EQ-5D questionnaire also includes a Visual Analog Scale (VAS), by which respondents can report their perceived health status with a grade ranging from 0 (the worst possible health status) to 100 (the best possible health status). Finally the specific utility (in clinical and research setting) of each one of them is discussed.

Disclosure of potential conflicts of interest (COI) is used by biomedical journals to guarantee credibility and transparency of the scientific process. COI disclosure, however, is not systematically nor consistently dealt with by journals. Recent joint editorial efforts paved the way towards the implementation of uniform vehicles for COI disclosure. This paper provides a comprehensive editorial perspective on classical COI-related issues. New insights into current COI policies and practices among European Society of Cardiology national cardiovascular journals, as derived from a cross-sectional survey using a standardised questionnaire, are discussed.

A standardized and evidence-based approach to the cardiological management of patients undergoing noncardiac surgery has been recently defined by Task Forces of the American Heart Association (AHA), American College of Cardiology (ACC) and the European Society of Cardiology (ESC) that published their guidelines in 2007 and 2009, respectively. Both the recommendations moved from risk indices to a practical, stepwise approach of the patient, which integrates clinical risk factors and test results with the estimated stress of the planned surgical procedure. In the present paper the main topics of the guidelines are discussed, and moreover, emphasis is placed on four controversial issues such as the use of prophylactic coronary revascularization in patients with myocardial ischemia, the perioperative management of patients with congestive heart failure, the routine use of betablockers and statins, and, finally, the management of antiplatelet therapies in patients with coronary stents. In addition to promoting an improvement of immediate perioperative care, the preoperative cardiological evaluation should be a challenge for identifying subjects with enhanced risk of cardiovascular events, who should be treated and monitored during a long-term follow-up.

Objective: Aim of the paper is to examine the characteristics and the trend of mortality in immigrants in Tuscany in the last decade, and to compare it with that observed in Italians resident in the same region., Design: it is a descriptive study using the data 1997- 2008 of the Regional Mortality Registry of Tuscany., Setting and Participants: Immigrants have been defined those who are resident in Tuscany with non Italian citizenship.They have been classified in immigrants from countries at high migration rates (PFPM) and immigrants from developed countries (PSA)., Main Outcome Measures: Proportional mortality for the period 1997-2008 and trends of standardized (standard: European population) mortality truncated rates (20-64 years) per 100 000 in the period 2002-2008 by citizenship (PFPM, PSA and Italians), gender, age-class and causes of death., Results: In the period 1997-2008, in Tuscany, 4 755 deaths have been registered in immigrants: 3 055 residents (1 782 from PFPM and 1 273 from PSA) and 1 700 not residents. Trends for all and the main causes of death show an increasing gap in mortality between immigrants from PFPM and Italians, with higher rates for Italians.On the contrary infant mortality is higher in children from PFPM and the gap is increasing in the last years. Also the mortality for accidents (1° and 3° cause of death respectively in male and female PFPM) and the mortality for infectious diseases are higher in PFPM immigrants., Conclusion: Mortality study on immigrants in Tuscany highlighted specific health problems of this population deriving from living conditions in the home country as well in the host country. It will be necessary to continue to monitor the mortality trend and characteristics of this population because it represents a good indirect tool to evaluate his socioeconomic integration (considering also his use of our health system), and because this population is still expected to raise in the next decades.

The 1853 Vaccination Act, adopted in England during XIX century, was the first law about compulsory vaccination in Europe. The Act caused a violent movement of opposition with the birth of Victorian anti-vaccination. The modern anti-vaccination movement was born in 1998 following a paper of Andrew Wakefield published in the Lancet. In this paper Wakefield illustrated a study of twenty patients and concluded that the administration of the MMR vaccine caused autism and some forms of colitis. The publication was later disowned by almost all authors. However the study of Wakefield caused a reduction of compliance to the anti-MMR vaccination in the United Kingdom, resulting in lower coverage and new outbreaks. The theorethical principles of anti-vaccinationists of 19th and 20th century were: the hypothesis that vaccines cause illnesses; the presence of toxic substances in the vaccine; the violation of freedom Personal and People's; the ineffectiveness of vaccinations. Moreover, anti-vaccinationists always refused the scientific methods and the peer-review of their scientific studies.

Objective: the study describes the burden of the Italian epidemiological research compared to that of the other 26 countries belonging to the European Union and to that of the United States, in the period 2007-2009. This is accomplished for both scientific published papers and grants obtained., Design and Setting: the searching in Medline database (February 2010) was done through complex search strings based on keywords corresponding to the various epidemiological research fields; grants were identified through 7th Framework Program (FP7), among those funded within February 2010., Main Outcome Measures: proportions of epidemiological papers published by researchers of the different countries and total number and amount of granted research projects for each European country., Results: in the period 2007-2009 epidemiological papers by Italian researchers account for about one-eighth of the total European production. This makes of Italy the second country in production, after the United Kingdom. Moreover, Italy is involved in 51.3%of the 374 studies granted through FP7: at least one Italian research body participates in 154 projects and Italian researches co-ordinate 38 projects., Conclusion: in Italy biomedical and epidemiological research is in a developing phase despite the difficulties due to the decrease in the amount of funds available.Moreover, Italian research is carried out mainly by public bodies and by Universities, even if a deeper involvement of local health authorities and regional agencies is desirable.

Objectives: This paper examines the history of an occupational disease which has now disappeared: acroosteolysis of manual tank cleaners in the production of polyvinyl chloride (PVC), which is a rare disease characterized by destructive alterations of the distal phalanges of the hands., Methods: All the available literature on this disease was examined. The history of acroosteolysis was studied within the general framework of the history of the discovery of adverse health effects of exposure to vinyl chloride, and this history was studied up to the end of the 1960's., Results: The disease was observed for the first time in mid-1963 in Belgium (Jemeppe) in a chemical plant operated by Solvay, and affected two workers whose job was the manual cleaning of vessels used for the polymerization of vinyl chloride; similar cases occurred in almost all PVC production plants all over the world, but not in the plants where the main activity was the production of vinyl chloride monomer (VCM). Little more than one hundred cases are described in the scientific literature, and this number increases by a few dozen if we consider known but unpublished cases. These figures confirm the rarity of the disease, which peaked at the end of the 1960's and disappeared during the 1970's, probably due to the complete elimination of manual reactor cleaning. Observation of the disease lasted no more than fifteen years and the disease was not replicated in experimental conditions on animals., Discussion: The disease was clinically characterized, had a short latency (from several months to several years), was rare and unequivocally linked to the manual cleaning of PVC polymerization tanks. However many questions still remain open: the period when the disease first appeared (many years after the start of PVC production in the world), the etiology of the disease (the most accredited hypothesis considers three concomitant factors: a chemical factor--one of the many substances used during polymerization, and particularly vinyl chloride monomer, a physical factor--microtraumas of the fingers during manual cleaning, individual susceptibility), the pathogenetic mechanism (in particular: the role of skin, respiratory, or digestive system, as entrance door), a method (or test) to screen subjects potentially predisposed to the disease. In our view acroosteolysis of manual tank cleaners in PVC production is an occupational disease which is distinct from "vinyl chloride disease" as identified by Viola (1974).

Objective: the present introductory paper illustrates the general framework of the Project EpiAir <>, of the Italian Centre for Disease Control and Prevention, Italian Ministry of Health. The project was designed to provide methods and criteria for epidemiological surveillance of the health effects of air pollution in large Italian cities., Method: we considered the relevant information available on the health effects of air pollution in Europe and in Italy, and the aspects critical to running a surveillance program., Results: the project made available a system of data and information to evaluate the health effects of air pollution. Health outcomes of interest are daily mortality (non accidental causes, cardiovascular, and respiratory causes) and cardiorespiratory hospital admissions. The project collected standardized data for the years 2001-2005 in ten Italian cities (Turin, Milan, Mestre, Bologna, Florence, Pisa, Rome, Taranto, Palermo, Cagliari). A network of public institutions in the field of environmental control and public health participated in the project. The surveillance system was set up for the period 2001- 2005 in order to evaluate future trends in the environmental and health circumstances (2006-2010) using reliable and standardized methods., Conclusion: we set up a long-term surveillance program of the health effects of air pollution.

In Italy during the last three decades important changes in employment have occurred. During the '70s, thanks to a variety of factors, the hygiene conditions of work have undergone a process of slow, but gradual improvement, which has not been arrested during the following decades. New legislation, partly deriving from European directives, has been introduced, and processes of outsourcing have moved the most burdensome and pollutants industrial productions to developing countries. Nevertheless, the estimates of the number of exposed (or even potentially so) workers, to carcinogens remain quite high. Currently, in absence of the planned National Information System on Prevention, it is impossible to estimate in how many and which workplaces primary prevention plans and facilities have been already installed. This paper aims to describe the situation related to most occupationally diffused carcinogenic agents: asbestos, wood and crystalline silica dusts, each one for its specificity. It also describes the innovations introduced by the most recent legislation, in particular with regard to the asbestos risk control. Finally, it stresses the need for a reform of the insurance premiums in order to introduce a mechanism for rewarding those employers who implement primary prevention facilities and penalizing those who don't. The economic advantages should gradually cover the cost of risk control technology.

This article describes a proposal for a nursing curriculum in general, clinical and paediatric nursing sciences (this scientific area is named MED/45 in Italian legislation) at the first cycle of higher education for general nurses in Italy (level 6 according to the European Qualifications Framework). Future change in university syllabus, need to revise nursing curriculum starting from specific competences acquisition, lack of professional national nursing standards, and uncertain evolution of a scientific academic sector for nurses in Italy, led to this work. It consists in evaluation and revision of what has been implemented in a nursing pre-registration degree at University of Insubria. Key principles orienting nursing sciences educational activities revision of this degree course has been the following: centrality of the person in the curing process, choice of a conceptual nursing model to guide personalisation of care, development of therapeutic relationship skills, and adherence to professional principles and values. Aims, educational objectives, and educational activities planned to teach nursing discipline in the three year course, are presented in this paper. Nursing discipline has been articulated into four knowledge areas: general nursing, nursing methodology, clinical nursing (general and applied), advanced nursing practice. Evaluation of this curriculum, implemented since 2000 and modified in 2008, helped the students to acquire a clear professional identity. Further comments are added in the conclusion on matching educational objectives to didactic units, identification of four knowledge areas for nursing sciences, and choice to deal with advanced nursing practice during the third year of the degree course.

The management of patients with syncope is recognized as one of the main issues of contemporary clinical medicine. The present paper discusses the most innovative aspects of the recent, specific European Society of Cardiology Guidelines and addresses the scenarios following the dissemination process undertaken in Italy by Scientific Associations.

Travel for business or tourism has become increasingly common in the age we live in. The great volume of national and international traffic and the speed of transportation are inevitably linked to a possible increased risk of acquiring certain illnesses such as Legionellosis, which, in fact, has shown a consistently increased incidence in recent years. In this paper, a brief introduction regarding the etiology and clinical and epidemiological characteristics of the disease, is followed by recent national and international data regarding its diffusion and guidelines for its prevention and control.

Created in 1996, the Foederatio Europea Orthodontica or European Federation of Orthodontics represents, today, 15 associations counting almost ten thousands European colleagues. Committed to establish and develop good relationships between the national scientific orthodontic societies of the European Continent and to pursue a common goal to communicate and share an up-to-date orthodontic information, it has undertaken, with a minimal budget (one Euro/orthodontist as annual fee), several actions including a valuable and user friendly internet site (www.Feoonline.com) - an annual award for the best scientific paper published in Europe - a list of excellent speakers ready to communicate, an objective support for the national association which is selected for hosting the general assembly and a newsletter on the web that will be soon published in national journals of the FEO members. Thanks to devoted professionals that have actively contribute in the founding and the management of the federation, FEO is now grown up and ready to plan and finalize, with the specially created think tank, new common actions and some exciting steps for the future. It is time for those that have been reluctant in the past, to join the group and be part of its further development.

There has been a proliferation of Orthodontic Boards across the world but there is no uniformity in standards, purposes or in the type of examination. In order to promote discussion at the International Orthodontic Congress in Paris in September 2005 a questionnaire was sent out to 80 Orthodontic Societies on the World Federation of Orthodontists list. There was a limited response to the questionnaire but the results are described in this paper. It illustrated that there were mainly two types of Board, mandatory ones that acted to license the Orthodontist in that country on the Specialist register and voluntary ones where the orthodontist demonstrates his excellence. The paper describes the answers to the various questions asked on the purpose, eligibility and type of examination of the Boards. They were also asked about the feasibility of an International Board. This was rejected as an option but an affiliation of Boards was recommended.

Several clinical trials show that cardiac resynchronization therapy (CRT) in patients with moderate-severe heart failure increases survival, improves quality of life and reduces hospital admissions. The high cost of this new technology, incurred by health organizations at the moment of the implant, requires to assess whether its use is economically rational for the Italian Health Service. The paper summarizes evidences of the impact of CRT on the use of hospital resources and on quality of life, and presents a model to calculate incremental costs per quality adjusted life years (QALYs) gained in patients with moderate-severe heart failure treated with optimal medical therapy. The model is based on efficacy data drawn from clinical trials and on other information concerning the Italian context collected and validated by a team of experts from Assobiomedica and the Italian Federation of Cardiology. The model estimates that the incremental cost per QALY gained attributable to CRT is Euro 63,225 if all effects (years of life gained, increased quality of life and reduction of hospital costs) are censored at the end of the first year after the implant and Euro 21,720 if all effects are censored at the end of the third year. Cost-effectiveness of CRT is thus strongly dependent upon the duration of its effects: longer benefits of the therapy compensate initial costs and thus make the technology more cost-effective. In order to get better estimates of the economic profile of CRT it is required to collect more precise data from routine practice on survival, quality of life and hospital resources. The model presented can be easily adapted to take into account new evidence and to calculate cost per QALY gained in regional and local contexts.

Target of this paper is to draw the relationship between environmental factors and some impacts due to human activity, in order to outline environmental quality restoring strategies for water bodies, which include among result indicators also biological parameters expected for Italian regulation and European directives. Morphologic equilibrium and correct knowledge of processes regulating fluvial dynamic, as basic factor of ecosystem functionality condition, are highlighted. Statistic evaluation processes of water quality data and implementation and validation of mathematical models are described.

Aim: The aim of this paper was to evaluate how many patients with syncope should be hospitalized according to the 2001 European Society of Cardiology (ESC) Guidelines on the management of syncope., Methods: Starting from August 2002 we prompted a Syncope Unit (SU), as a multi-disciplinary functional structure including the Emergency Department. One of the main objectives of the SU was the implementation of the 2001 ESC Guidelines on Syncope and of the relevant criteria for hospitalization. All the clinical data concerning the patients presenting with syncope were prospectively collected and stored in a dedicated database., Results: Between September 1, 2002 and April 30, 2003, 402 patients were observed for a syncope. Out of these, 19 had a cardiogenic syncope, 3 focal neurologic disorders, 25 a severe trauma, 4 severe orthostatic hypotension and 5 carotid syncope. Therefore, 56 patients out of 402 were found to have indication to therapeutical hospitalization. Among the remaining 346 patients, 83 patients were found to have a structural heart disease and/or an abnormal ECG, 1 had syncope during exercise, 3 presented a familial history of sudden death. Thirty-three were found to have severe comorbidities and further 14 had occasional indication to hospitalization. Thus, 190 out of the 402 patients with syncope (47.3%) presented at least 1 criterion for hospitalization according to the ESC Guidelines., Conclusion: The implementation of the ESC Guidelines on Syncope is technically feasible. Nevertheless, even when the Guidelines are strictly observed, a high percentage of patients with syncope has still to be hospitalized. Our data suggest that new criteria should be established for a safe Emergency Department discharge of the patients with syncope, particularly of those with structural heart disease or abnormal ECG.

An accurate Leishmania classification was defined since 1980s by the use of isoenzyme analysis. To date, this procedure still represents the reference identification technique, despite the increasing use of molecular approaches. Studies and surveillance methods on leishmaniases are strongly conditioned by the knowledge and mapping of all the parameters characterizing each nosogeographical entity. On this respect, the identification of parasites from all the actors of the natural life cycle plays a key role. With the increasing population movements and climate changes, novel risk factors could be identified associated to Leishmania geographical distribution and spreading: a) the introduction into Italy of new populations of L. infantum from other countries; b) the introduction of new Leishmania species that may find a suitable milieau to support their life cycle in our country. The objective of this report is to present the surveillance activity on imported leishmaniases by the Leishmania Identification Reference Centre, ISS. Two different methodologies were routinely applied: a) isoenzyme electrophoretic analysis, which requires parasite culture, and b) a number of molecular techniques, used for both diagnosis and parasite identification, differently applied according to the geographical origin of the suspected leishmaniasis case. When possible, both types of methodologies were applied. From 1986 to June 2002, 38 imported cases of leishmaniases were identified: 9 visceral (VL) and 29 cutaneous (CL) cases, of which 22 from the Old and 7 from the New World. Pathology, Leishmania species/zymodeme and geographical origin features are reported in the paper. Seven out of 9 VL patients were HIV positive, of whom 5 detected in the period 1993-1995. This high importation rate can be associated to the general increase in Mediterranean Leishmania/HIV coinfections in that period. Following HAART treatment, VL imported cases became occasional; no introduction of new L. infantum populations has been detected. On the other hand, our findings show an increase of CL imported cases from different areas of the Old and New Worlds. This phenomenon, however, is so far limited to new Leishmania species that could hardly be introduced in our country, because of their strict biological requirements (i.e. vectors and/or natural reservoir hosts). Since June 2002, 10 further suspected imported cases were recorded. For these patients--whose Leishmania identification is still in course--the origin/visited geographical areas were only slight different from the previous. However, the characteristics of the patients are changing: there are more immigrants that occasionally visited their place of origin, and Italian military staff.

This paper is an attempt to individuate some principles and guidelines apt to regulate the relationship between orthodontists and financing third parties, applicable to most western European Countries. The concepts of orthodontic treatment need, orthodontic treatment request and orthodontic screening are discussed, alongside with a short overview of some of the most common indexes to assess the severity of the malocclusion and/or the treatment priority. The screening method introduced by the Danish Ministry of Health is presented; its importance lies in the fact that for the first time a direct correlation between health risk and individual malocclusions is recognized and assessed. In the discussion, it is stressed how the screening system tightly depends on the chosen general model for orthodontic care. Different models of orthodontic care organization as presently used in many European countries are presented and shortly discussed; among these, the Norwegian model is described more in details, because of its simplicity. Eventually, some guidelines considered necessary in order to achieve satisfactory standards of quality and efficiency are presented and discussed.

The diffusion of acupuncture in Europe begun in the 50ies, following 2 main trends: traditional (or energetic) acupuncture and reflexotherapeutic acupuncture. In 1973, in Turin, Italy, the Italian Society of Reflexotherapy, Acupuncture and Auricolotherapy (SIRAA) was founded. This Society over the years tried to integrate the 2 different trends, whose main characteristics are analysed in this paper. The first aim of SIRAA, since its foundation, has been to study acupuncture and auricolotherapy by means of research and by scientific trials, in order to promote the understanding of its mechanisms of action and to clearly show all its therapeutic applications. The development of acupuncture in Italy, the activities of SIRAA from the origins up to now and the future aims of this Association are described. Among the aims, particularly important is to propose scientific research models compatible with evidence based medicine, but also able to warrant the adequacy of the acupunctural method. In conclusion, it is pointed out the necessity to address the future research on acupuncture not only towards the study of the mechanisms of action and the evaluation of therapeutic results, but also towards some new branches now considered with increasing attention, such as preventive medicine, rehabilitation and palliative cares.

Today's approach to the treatment of patients with arterial hypertension is no longer based solely on reducing high pressure values but forms part of a broader context designed to reduce the overall cardiovascular risk. The very decision of whether to begin anti-hypertensive treatment or not depends both on the degree of hypertension and on the presence or otherwis of other risk factors, organ damage or associated pathological conditions. The present paper summarises recent indications provided by the guidelines issued in 2003 by the European Society of Hypertension and the European Society of Cardiology. The criteria for planning anti-hypertensive treatment in patients with a different level of cardiovascular risk are the subject of particularly concentrated discussion and the approach to the hypertens patient in special clinical conditions such as ageing, diabetes mellitus, the presence of renal, cerebrovascular or coronary pathology and pregnancy will be treated separately.

Over recent years the possibility that adverse effects on health could result from exposure to electromagnetic fields has become one of considerable scientific, political and economic importance. In response to this, there has been intense activity, both at the international and national level, on the evaluation of biological effects literature and assessment of health hazards of human exposure to non-ionizing electromagnetic radiation. The health authorities of an increasing number of countries, including Italy, become involved in the development of recommendations, regulations or technical advice to limit the exposure of the workers and the general public and they are looking to the international organizations, particularly to the International Commission on Non-Ionizing Radiation Protection (ICNIRP), for some guidance in this respect. In this paper an attempt will be made to present a comparative analysis of the existing or recently proposed standards.

This paper presents a computerised system for the monitoring of integrated cervical screening, i.e. the integration of spontaneous Pap smear practice into organised screening. The general characteristics of the system are described, including background and rationale (integrated cervical screening in European countries, impact of integration on monitoring, decentralised organization of screening and levels of monitoring), general methods (definitions, sections, software description, and setting of application), and indicators of participation (distribution by time interval since previous Pap smear, distribution by screening sector--organised screening centres vs public and private clinical settings--, distribution by time interval between the last two Pap smears, and movement of women between the two screening sectors). Also, the paper reports the results of the application of these indicators in the general database of the Pathology Department of Imola Health District in northern Italy.

According to an Anglo-Saxon pun, "gout is the king of diseases and the disease of Kings". In fact, it is well-known that in past times a quantity of famous persons, including Kings and Popes, were affected with this rheumatic disorder. In this paper biographical anecdotes on several Popes (Pius III, Julius II, Julius III, Clement VIII, Innocent XI, Clement XII and Pius VIII), King George IV and Queen Anne of England, as well as on some members of the Lorraine lineage, all suffering from gout, are sketched out. These historical data are briefly discussed in relation to the celebrated Hippocrates's aphorisms on gout.

This paper provides comments on the European Directive 2002/44/CE of 25 June 2002 on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (vibration) (sixteenth individual Directive according to Article 16(1) of Directive 89/291/EEC). The European Directive on mechanical vibration was published in the Official Journal of the European Communities L 177/13 on 6 July 2002. The Directive includes the definitions of hand-arm vibration and whole-body vibration, establishes the daily exposure limit values and action values for mechanical vibration, and gives provisions related to (i) determination and assessment of risks, (ii) measures aimed at avoiding or reducing exposure, (iii) information, training, consultation and participation of workers, (iv) health surveillance of the exposed workers, and (v) derogations and transitional periods for the implementation of the obligations of employers when the daily exposure limit values are exceeded. The author discusses the strong link which exists between the assessment of risk due to vibration exposure at the workplace and the health surveillance of the exposed workers. The occupational health physician, as a specialist with expertise in human factors and in the early detection of vibration-related adverse health effects, will have an important role in the assessment of risks arising from mechanical vibration in order to implement an effective health surveillance of the exposed workers. The Member States must bring into force the requirements of the Directive no later than 6 July 2005.

The security of electronic medical information is very important for health care organisations, which have to ensure confidentiality, integrity and availability of the information provided. This paper will briefly outline the legal measures adopted by the European Community, Italy and the United States to regulate the use and disclosure of medical records. It will then go on to highlight how information technology can help to address these issues with special reference to the management of organisation policies. To this end, we will present a modelling example for the security policy of a radiological department.

The present paper focuses on the Italian registries: their actual achievements, future developments and the possible critical states. The present setting is analysed in perspective with the international and European framework of cancer registries. Given the recent development of new cancer registries in Italy, and their participation to traditional and new international publication of their data, there is an increasing delay in publication time, both in Italy and abroad International and national institutions played an important role in helping and supporting registries' development, but delays in publications and some uncertainty in coordinating incidence and survival analyses in a unique framework is posing an unavoidable challenge.

The data related to abuse and seizures of the main classes of controlled drugs in Europe and Italy are presented. The system of keeping up-to-date the tables of controlled drugs in Italy is briefly discussed. In the end, a list of the main new drugs in the clandestine market of synthetic drugs in Italy is presented, by taking into account the street names, doses and pharmacological effects. The paper ends with a brief description of the new trend of purchasing controlled drugs on internet sites.

Moving from the most recent progresses in some address international acts on bioethics of the research, the Convention of human rights and biomedicine and La declaration universelle sur le génome humain e les droits de l'homme, this paper describes the legislative acts which regard many aspects of theoretical and practical scientific research, both in the Italian national and supra-national fields. This legislation concerns mainly the following topics: rights of the human subjects of research, informed consent, privacy on the personal data, activity on organ transplantation, research in genetics, activity in the field of treatment of human gametes and embrios. The author here quotes these legislative acts referring briefly to national and international laws.

This paper is an up-to-date review of the scientific evidence on mechanisms of pollutant generation and health effects for a number of urban air pollutants. The review focuses on main sources and health effect of ozone and photochemical smog, benzene, polycyclic aromatic hydrocarbons, and particulate matter. These agents are "priority pollutants", generated by vehicle traffic, and their regulation is currently being examined by the European Council and the European Commission. The aim is to reach, by the year 2010, values lower than 180 micrograms/m3 for ozone as maximum hourly concentration, 2.5 micrograms/m3 for benzene as an annual average, 93 micrograms/m3 for nitrogen dioxide as 98 degrees percentile of hourly concentrations, 50 micrograms/m3 for particulate as a daily average. The goal can be achieved only by means of immediate interventions on emissions.

Legislation for the control of sexually transmitted diseases (STD) in Europe dates back several centuries, with laws specifying criteria for STD notification, diagnosis, and therapy, as well as guaranteeing treatment and medical visits at no cost. However, there still exist gross differences among European countries in terms of the geographical distribution of facilities and resources and in patients' access to services. This paper describes the STD legislation of the past 10 years for 14 European countries and compares this legislation with that in Italy.

During the '80s, evidence was collected that air pollutants concentrations close to, or lower than, air quality standards could negatively influence public health at short term, i.e. within a few days. The European Union financed, between 1993 and 1995, the study "Short term effects of Air Pollution on Health: a European Approach using epidemiological time-series data" (APHEA-1 project), involving more than 25 millions inhabitants in 15 cities, investigated between 1977 and 1991. In this paper, the main results, already published in various scientific journals, are reported. The health effects were studied as mortality for natural causes, cardiovascular and respiratory diseases, and as emergency hospital admissions for all respiratory diseases, bronchial asthma, and chronic obstructive pulmonary disease (COPD). The pollutants whose measures were available for the analysis are sulphur dioxide (SO2), nitrogen dioxide (NO2), particulate matter (PM) measured either as black smoke or total suspended particulate, and ozone (O3). The analysis was carried out by each participating group following a detailed protocol, defined during various workshops, through the construction of Poisson regression models, adjusted for autocorrelation and overdispersion, accounting for variables influencing the daily count of deaths, such as long time trends, season, temperature, day of the week. This paper reports the results of the meta-analysis, performed using the values of each city, as relative risk of dying or being admitted to hospital associated with increases of 50 micrograms/m3 in the 24 hours average concentrations of each pollutant. The daily number of natural deaths was associated with increases in the levels of PM, SO2, O3, and NO2. Cardiovascular and respiratory deaths were associated with increases of the levels of PM, SO2, and O3; cardiovascular deaths were associated also with increases of NO2 concentrations. Emergency hospital admissions for the whole group of respiratory disorders are less consistently associated with PM, SO2, and NO2, whereas there is evidence of association with O3. COPD admissions are related to the air pollutant levels, especially those of O3. Lastly, NO2 levels may play a role in exhacerbating asthma, and SO2 levels can have an effect on asthma in children. A second study is currently going on, involving over 40 millions residents in 34 cities. The aims of this project are: to evaluate the dose-response relationship, to investigate on synergy among pollutants, on the "harvesting" phenomenon, on the geographical differences inside Europe and with the U.S. through the collaboration with a similar American study now in progress. The existence of an association between daily variations in the levels of urban air pollution and adverse health effects was confirmed in Europe. This association is weak, but it involves the whole resident population, so it is a major cause of concern from the public health point of view.