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Introduction: Noise-induced hearing loss (NIHL) is defined as the sensorineural hearing loss caused by acute acoustic trauma or chronic exposure to high-intensity noises. Exposure to noises can lead to irreversible damage to the inner ear and, consequently, to a permanent shift of the hearing threshold. Police officers are particularly at risk of acute or chronic hearing damages. The aim of this study is to evaluate the hearing loss of police officers in relation to the occupational risk factors and clinical-anamnestic characteristics by collecting and analyzing existing data and evidence available in public databases. Materials and Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses group (PRISMA). Studies were included if they met inclusion and exclusion criteria. Study selection, data extraction, and quality assessment were conducted independently by two researchers. Results: Our initial literature search yielded 29 peer-reviewed articles. Out of 29 papers, only 10 were included in the review, after inclusion and exclusion criteria were applied the. Conclusions: Hypertension, smoking and alcohol intake significantly affect hearing performance. In addition, a history of acoustic trauma, use of ototoxic drugs, exposure to noise in leisure-time activities and failure to use ear protectors are often found in a fair number of subjects. NIHL is also related to the age of the subjects as well as the extent and duration of noise exposure. Furthermore, NIHL is also influenced by shooting practice sessions police officers are required to undertake as well as by the chronic exposure to traffic noise, especially in motorcycle police officers.

Introduzione: Sovrappeso ed obesità rappresentano un problema di crescente interesse nell’ambito dei programmi sanitari nazionali dei Paesi industrializzati, sia perché la prevalenza è in costante aumento, sia perché l’eccesso ponderale è associato al rischio di sviluppare altre patologie quali diabete, malattie cardiovascolari, e alcune forme di tumore. Obiettivi: Descrivere un profilo di prevalenza del sovrappeso e dell’obesità in Italia utilizzando i dati derivanti dall’indagine Multiscopo Istat sulle “Condizioni di Salute e ricorso ai servizi sanitari” per gli anni 2005 e 2013, ed analizzare il contributo che i principali fattori di rischio hanno nel determinare una diversa distribuzione della prevalenza dell’eccesso ponderale sul territorio nazionale.Metodi: Al fine di valutare il grado di associazione tra lo stato ponderale e l’insieme dei potenziali fattori di rischio dell’eccesso ponderale presi in esame, per la stima dei Prevalence Risk Ratio, si è scelto di ricorrere a modelli di Poisson, tenendo conto anche delle variabili previste dal disegno di campionamento dell’indagine. La categoria dei soggetti sottopeso è stata esclusa dalle analisi. Le analisi sono state condotte per il 2005 ed il 2013. Risultati: Dal confronto con i risultati relativi al 2005, nel 2013 è emerso che la prevalenza dei soggetti obesi in Italia ha subito un incremento (da 10,2% a 11,4%). Al contempo, si osserva una modesta riduzione della prevalenza di soggetti in sovrappeso (da 35,4% a 34,7%). I risultati delle analisi, pur confermando il differenziale Nord-Sud, mostrano livelli di eccesso ponderale inferiore in soggetti con più elevati livelli di istruzione, indipendentemente dalla localizzazione territoriale. Analogamente, valori crescenti dell’eccesso ponderale si osservano al crescere dell’età. Il giudizio sulle risorse economiche mostra valori significativi per le femmine in tutte le ripartizioni geografiche ad eccezione delle regioni del Sud e valori non significativi per i maschi in tutte le ripartizioni geografiche. Al contrario, come riportato in letteratura, meno chiara appare la relazione tra fumo ed eccesso ponderale. Conclusioni: I risultati del presente lavoro hanno mostrato un gradiente Nord-Sud in Italia per quanto attiene all’eccesso ponderale. Invero, tale gradiente appare anche per altri aspetti relativi allo stato di salute della popolazione Italiana che sembra pertanto dipendere dalla diversa distribuzione dei fattori di rischio dell’eccesso ponderale nelle regioni Italiane. Bassi livelli di istruzione, ridotta attività fisica e maggiori livelli di deprivazione nelle regioni del Sud rispetto a quelle del Nord, contribuiscono all’acuirsi dei differenziali riscontrati nei livelli di eccesso ponderale. D’altra parte, la recente crisi finanziaria ed i tagli operati nell’ambito del sistema sanitario nazionale possono determinare un peggioramento generale dei principali indicatori di stato di salute ed un aumento delle differenze tra le diverse regioni.

Overweight and obesity represent a topic of growing interest for most of the national healthcare plans of developed countries, mainly due to the increasing prevalence of overweight and obesity, and to their presence as a risk factor for many other noncommunicable diseases. The present work aims at providing a profile of overweight and obesity in Italy, and to analyze the impact of different territorial and socioeconomic risk factors. Data derived from Istat survey on “Health conditions and healthcare utilization” 2005 and 2013 are used, and Prevalence Risk Ratio estimates are derived through modified Poisson regression models. The results show higher prevalence of overweight and obesity in the South, which depends mainly from the different distribution of exposed to risk factors, rather than on differences in their mix. From the policy perspective, the results could orient specific prevention actions oriented to high-risk population segments, withouth ignoring the territorial dimension of social inequalities.

IntroduzioneLa celiachia è una malattia sistemica autoimmune innescata dall’ingestione di glutine in individui geneticamente predisposti. Nell’adulto le presentazioni atipiche con sintomi extraintestinali e gastrointestinali aspecifici sono sempre più comuni. In particolare, la celiachia può indurre cambiamenti psicologici nell’individuo affetto, influenzando principalmente la percezione del benessere. Una dieta rigorosamente priva di glutine (DGF) da seguire per tutta la vita rappresenta l’unica terapia disponibile. Tuttavia, il rispetto rigoroso di una DGF può potenzialmente influenzare la qualità di vita del celiaco e, d’altra parte, l’ atteggiamento e le aspettative del paziente hanno un impatto sostanziale sul rispetto della DGF. Obiettivi. Analizzare gli effetti della DGF in pazienti celiaci su alcune dimensioni della qualità della vita. MetodiCome caso studio vengono analizzati i dati relativi all’indagine multiscopo Istat sulle condizioni di salute e ricorso ai servizi sanitari 2013. A partire dai soggetti che hanno dichiarato di essere celiaci, è stata analizzata, tramite modelli regressivi, la relazione tra la presenza di una DGF ed alcuni indicatori sulla percezione dello stato di salute, quali indice di stato fisico (PCS), psicologico (MHS) e mentale (MH), al netto di caratteristiche sociodemografiche e comportamentali (titolo di studio, risorse economiche familiari, ripartizione geografica, età, genere ed abitudine al fumo) dei soggetti in studio. RisultatiDall’indagine multiscopo Istat 2013, la percentuale di soggetti che ha dichiarato di essere affetto da celiachia è di circa lo 0.6%. Di questi, il 47.3% circa afferma di osservare una DGF. I risultati delle analisi mostrano un’associazione diretta tra la presenza di una DGF e indice di stato fisico (Beta=1.773, p-value=0.018), mentre non sembra esservi associazione tra l'osservanza di una DGF e indice di stato psicologico (MCS) e mentale (MH). ConclusioniDopo la diagnosi di celiachia, il paziente deve accettare da un lato l’impatto biologico del convivere con una malattia cronica, dall’altro, il bisogno di aderire ad una dieta restrittiva che richiede importanti cambiamenti di stile di vita permanenti con un impatto psicosociale rilevante. Diversi studi hanno dimostrato che tutti questi cambiamenti hanno un impatto negativo sulla qualità della vita dei pazienti. D’altra parte però alcuni autori dimostrano come la qualità della vita, così come i sintomi, migliorino con la terapia dietetica. Il nostro studio conferma una relazione positiva tra DGF e qualità della vita in termini di indice di stato fisico, confermandone l’importanza come unica terapia ad oggi disponibile nella remisione dei sintomi. Tuttavia, sarebbero necessari studi longitudinali volti a determinare se tale effetto sulla qualità della vita sia permanente nel tempo.

This study reports our experience in a selected cohort of patients affected by mild-moderate OSAS, without tonsillar obstruction, and treated with pharyngoplasty.In a case-control retrospective study, we compared modified expansion sphincter pharyngoplasty (MESP) to modified barbed reposition pharyngoplasty (MBRP) in adult patients with oropharyngeal transversal collapse with a BMI ≤ 30 kg/mWe enrolled 20 patients: 10 treated with MESP and 10 treated with MBRP. Mean apnoea-hypoapnoea index (AHI) was 22.8 (± 5.63). We observed in both groups a significant reduction of AHI and oropharyngeal obstruction (p = 0.01), with a success rate, according with Sher's criteria, of 90% for MESP and 80% for MBRP, respectively. Post-surgical pain and snoring reduction were significantly lower with MBRP.We recorded similar success rates for both techniques. MBRP may be considered better than MESP due to less surgical time, no potential mucosal damage, absence of knots, and faster recovery with less pain.Gestione del collasso faringeo in pazienti affetti da sindrome delle apnee ostruttive di grado moderato.Riportare la nostra esperienza in una coorte selezionata di pazienti affetti da sindrome da apnee ostruttive del sonno (OSAS) lieve-moderata, senza ipertrofia tonsillare, trattati con faringoplastica.Confrontare in uno studio retrospettivo caso-controllo la Expansion Sphincter Pharyngoplasty modificata (MESP) e la Barbed Reposition Pharingoplasty modificata (MBRP) in pazienti adulti con collasso trasversale orofaringeo con BMI ≤ 30 e OSAS lieve-moderata. È stata effettuata una valutazione clinica, con raccolta di dati antropometrici e sleep endoscopy. Sei mesi dopo l’intervento sono stati rivalutati i sintomi e ripetuta la polisonnografia (PSG).20 pazienti, dieci trattati con MESP e dieci trattati con MBRP. Indice di apnea-ipopnea (AHI) medio di 22,8 (± 5,63). Abbiamo osservato in entrambi i gruppi una riduzione significativa dell’AHI e dell’ostruzione orofaringea (p = 0,01), con un tasso di successo secondo i criteri di Sher del 90% per MESP e 80% per MBRP. Il dolore post-operatorio e la riduzione del russamento erano significativamente più bassi nella MBRP.Abbiamo registrato percentuali di successo simili per entrambe le tecniche. L’MBRP può essere considerata superiore alla MESP per minor tempo chirurgico, assenza di potenziali danni alla mucosa, assenza di nodi e un recupero più rapido con meno dolore.

Breast cancer screening through periodic mammography has been effective in decreasing mortality and reducing the impact of this disease. However, adherence to screening does not meet the desired expectations from all populations. The main objective of this review is to explore the barriers that affect adherence to breast cancer–screening programs in vulnerable populations according to race and/or ethnicity in order to propose measures to reduce the lack of adherence. We conducted a search of publications in the PubMed Central and Scopus databases. The eligible criteria for the articles were as follows: original quantitative studies appearing in SJR- and/or JCR-indexed journals from 2016 to 2021 in English or Spanish. Most of them present common barriers, such as race/ethnicity (47%), low socioeconomic (35.3%) and educational levels (29.4%), no family history of cancer and being single (29.4%), medical mistrust and a health information gap (23.5%), lack of private health insurance (17.6%) and not having annual health checks (17.6%). The target populations with the lowest adherence were Black, Asian, Hispanic and foreign women. Implementing awareness campaigns focused on these populations should be promoted, as well as working on diversity, cultural acceptance and respect with healthcare workers, in order to improve breast cancer–screening adherence worldwide.

Introduction : The increased life expectancy of HIV patients in the era of highly active antiretroviral therapy has had profound consequences for the healthcare systems that provide their care. It is useful to assess whether healthcare resources need to be adapted to the different stages of HIV infection or to patient characteristics [1]. To study how patient features influence utilization of out patient services, we retrospectively analyzed the electronic health record of HIV-positive patients who had followed day-care programs at the AIDS Center of the University of Palermo, Italy. Materials and Methods : 223 HIV-infected subjects were recruited and divided into two groups according to CD4 cell counts (117 with a CD4 count ≤500/mm 3 and 106 with CD4 count ≥500/mm 3 ). Data on age, gender, race, lifestyle habits (including educational level, drug abuse history, smoking status, alcohol consumption, sexual behaviour) BMI, HIV-RNA, CD4+ T-cell count, antiretroviral therapy (ART), comorbidities such as HCV co-infection, osteoporosis biomarker, dyslipidemia, diabetes, renal function and systolic and diastolic blood pressure were recorded in a purposely designed database and were analyzed in relation to AIN by uni- and multivariable logistic regression. Results : Table 1 shows the characteristics of enrolled patients; the average age of the recruited patients was 45.4±9.5 years. 163 individuals were male (73%), 26 were immigrants (12%) and 91 (40%) were treatment-naive. Mean day care access for laboratory tests to evaluate stage of HIV and for treatment monitoring was 6.5 days for CD4 cell count measurements and 9.6 for HIV RNA/drug-resistance testing. When patients were stratified according to CD4 count, mean day care access for laboratory tests to evaluate HIV stage and to monitor treatment was negatively correlated with CD4 cell counts. Conclusions : Only patients with CD4 counts ≤500/mm 3 showed higher rates of healthcare utilization; these data may be useful for monitoring and revising implementation plans for the different phases of HIV disease. (Published: 2 November 2014) Citation : Abstracts of the HIV Drug Therapy Glasgow Congress 2014 Di Carlo P et al. Journal of the International AIDS Society 2014, 17(Suppl 3) :19611 http://www.jiasociety.org/index.php/jias/article/view/19611 | http://dx.doi.org/10.7448/IAS.17.4.19611

Objective: Tumours of the nasal septum are a rare and heterogeneous group of lesions in the sinonasal tract. The management of the different lesions of this site is debated. The aim of this study is to share our experience on a rare clinical condition and stimulate other centres to publish theirs. Methods: We retrospectively analysed the databases of sinonasal tumours treated at the Sections of Otolaryngology (ENT) of two University Hospitals (Palermo and Genova) between 2012 and 2020. Results: From the two databases, a cohort of 32 patients with tumours of nasal septum were selected. All patients underwent an endoscopic examination. Large tumours underwent preoperative computed tomography (CT) scan without contrast medium. In 22 (68.7%) cases, the preoperative radiologic evaluation also included magnetic resonance imaging (MRI) with gadolinium to obtain a better differentiation of the lesions and study the vascular pattern. All the large lesions were biopsied under endoscopic guidance using local anaesthesia; the same approach was used to remove the tumours and their attachment with safe resection margins. Conclusions: While malignant lesions require an excision of the mass with resection of all layers of the nasal septum, benign lesions must be typed according to histological considerations in order to plan the most appropriate type of surgical resection.

OBJECTIVE: First, to assess the appropriateness of requests for albumin using current guidelines; second, to evaluate physicians' compliance with this protocol. DESIGN: Descriptive, prospective study. SETTING: 'Paolo Giaccone' University Hospital in Palermo (Italy). PARTICIPANTS: The six departments with the highest orders for albumin. INTERVENTION: An experimental, pharmacist-driven process for daily orders of albumin was activated over a period of 1 month. Pharmacy personnel handed out order forms on six different wards. Physicians were required to select one of a number of intended uses listed on the form. MAIN OUTCOME MEASURES: Data on albumin and serum protein levels; number of vials and grams of albumin requested/day; number of vials and grams of albumin/day needed to normalize serum albumin levels; informed consent; indications and appropriateness of use. RESULTS: A total of 126 forms were collected. Mean serum albumin and protein levels of patients in the different wards were close to normal (2.5 and 5 g/dl, respectively). The albumin doses requested by the various wards were 2 to 7 times higher than expected. 37.3% of the requests were for appropriate indications, 40.5% were for occasionally appropriate indications and 18.2% were inappropriate. According to current guidelines, 83.3% of requests were appropriate. 45% of orders from the Intensive Care ward were for inappropriate indications. CONCLUSIONS: The introduction of a well-defined, flexible pharmacist-driven ordering process for albumin could reduce omissions in albumin indications and aid request assessment. It would allow pharmacists to collaborate with physicians in verifying whether requests are appropriate and whether prescriptions comply with current guidelines.

In the last decades, increased numbers of travel to tropical destinations in combination with the enormous influx of immigrants have led to an increased number of imported malaria cases in developed countries. There is a group of immigrants regularly resident in malaria free areas, which travel to malaria endemic countries to visit their friends and relatives (VFRs). VFRs represent a high-risk group of contracting malaria. Publications presenting original data on malaria in VFRs were selected for a literature review.We considered all data regarding prevalence of malaria in VFRs compared to the other groups of travelers, length of trip, group characteristics such as age, sex, country visited, and adherence to pre-travel recommendations, in particular, the compliance on the use of chemoprophylaxis, where such information was available. Studies related to malaria importation in VFRs in children and pregnant women were also included.Review of the literature revealed significant variations in the proportion of VFRs among imported malaria cases which may be due to differences in immigrant populations across the reporting countries. However, in studies focused on those at higher risk such as children and pregnant women, the prevalence of imported malaria was significantly higher compared to other types of travelers.Adherence to adequate preventive measures was low in VFRs. Significant reasons for not seeking pre-travel advice were economic and cultural issues, fear of the side effects due to chemoprophylaxis, and misconception about life-long immunity against malaria, and consequently, a low awareness about malaria risk. In order to implement preventive strategies focused on this high-risk group, prospective studies, which better define determinants of the risk of malaria in VFRs, are needed.

Introduction. Although Italy has been malaria-free since 1970, the infection is commonly introduced into the country by travelers and immigrants from endemic areas. The term VFRs refers to immigrants from malaria-endemic countries who are regularly resident in a malaria-free area, and who travel to their countries of origin to visit friends and relatives (VFRs). This group is at special risk of malaria as they are unaware of having lost their transitory immunity to the disease. Methods. We conducted a retrospective study at the International Travelers Department of Palermo (Italy), examining records of malaria cases (67) reported over the period from 1998 to 2013. Results. VFRs represent the highest number of cases (77.6%), followed by workers (16.4%) and tourists (6.0%). All female patients and patients under the age of 18 were VFRs. Plasmodium falciparum was the most frequently-identified species. In all cases, chemoprophylaxis was not taken or was incomplete. Conclusions. VFRs are at high risk of contracting malaria. This is probably related to an inequality in health care available to immigrants, as well as to ethnic and cultural conditions.