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A Health Impact Assessment (HIA) is an evidence-based methodology that includes health promotion and protection goals in decision-making. HIA has been introduced and/or institutionalized to various extents in different countries. In order to promote HIA and preventive health assessments in Italy, a research methodology was followed to identify specific obstacles or facilitators. The experiences of various countries reported in the literature were analyzed in terms of facilitating or hindering the introduction and institutionalization of HIA. A consultation with the proponents of projects and plans in Italy was carried out with a multi-approach methodology in order to characterize the national context. A general implementation plan was drawn up from the international experiences. In Italy this is not yet in place. Specific areas of intervention need to be addressed, including: 1) data availability; 2) tools and methods; 3) engagement of stakeholders; 4) capacity building. The research suggests that the institutionalization of HIA in Italy rests on the government's commitment to providing specific legislation regarding HIA so that skills, intersectoral coordination and dedicated budgets can be built and maintained.

The lack of participatory tools in Health Impact Assessment (HIA) to support decision-makers is a critical factor that negatively affects the impacts of waste policies. This study describes the participatory HIA used in deciding on the possible doubling of the municipal solid waste incinerating plant located near the city of Arezzo, Italy. Within the framework of the new waste management plan, a methodology for the democratic participation of stakeholders was designed adopting the Local Agenda 21 methodology. Communication and participation events with the stakeholders were set up from the plan’s development to its implementation. Eleven different categories of stakeholders including individual citizens were involved in 21 local events, reaching over 500 participants in three years. Actions were performed to build the commitment and ownership of the local administrators. Then, together with the environment and health agencies and a representative from the local committees, the local administrators collaborated with scientists and technicians in the knowledge-building and scoping stages. Focus groups of voluntary citizens worked together with the researchers to provide qualitative and quantitative evidence in the assessment stage. Periodic public forums were held to discuss processes, methods and findings. The local government authority considered the HIA results in the final decision and a new waste strategy was adopted both in the short term (increased curbside collection, waste sustainability program) and in the long term (limited repowering of the incinerator, new targets for separate collection). In conclusion, an effective participatory HIA was carried out at the municipal level to support decision makers in the waste management plan. The HIA21 study contributed to evidence-based decisions and to make a broadly participatory experience. The authors are confident that these achievements may improve the governance of the waste cycle and the trust in the public administration.

Background Before Pre-Exposure Prophylaxis (PrEP) was officially recommended and made available, a few surveys among gay and bisexual men, and persons living with HIV/AIDS (PLWHA), identified an informal use of antiretrovirals (ARVs) for PrEP among HIV-negative individuals. Before PrEP availability in Italy, we aimed to assess whether PLWHA in Italy shared their ARVs with HIV-negative individuals, whether they knew people who were on PrEP, and describe the level of awareness and discussion on this preventive measure among them and people in their close circle. Methods Two anonymous questionnaires investigating personal characteristics and PrEP awareness, knowledge, and experience were proposed to HIV specialists and their patients on ARVs in a one-week, cross-sectional survey (December 2013–January 2014). Among PLWHA, a Multivariable Logistic Regression analysis was conducted to identify factors associated with PrEP discussion with peers (close circle and/or HIV associations), and experience (use in close circle and/or personal ARV sharing). Results Eighty-seven specialists in 31 representative Infectious Diseases departments administered the questionnaire to 1405 PLWHA. Among specialists, 98% reported awareness, 65% knew the dosage schedule, and 14% had previously suggested or prescribed PrEP. Among PLWHA, 45.6% were somehow aware, discussed or had direct or indirect experience of PrEP: 38% “had heard” of PrEP, 24% were aware of studies in HIV-negative individuals demonstrating a risk reduction through the use of ARVs, 22% had discussed PrEP, 12% with peers; 9% reported PrEP use in close circle and 1% personal ARV sharing. Factors predictive of either PrEP discussion with peers or experience differed between men and women, but across all genders were mainly related to having access to information, with HIV association membership being the strongest predictor. Conclusions At a time and place where there were neither official information nor proposals or interventions to guide public policies on PrEP in Italy, a significant number of PLWHA were aware of it, and approximately 10% reported PrEP use in their close circle, although they rarely shared their ARVs with uninfected people for this purpose. Official policies and PrEP availability, along with implementation programs, could avoid risks from uncontrolled PrEP procurement and self-administration practices. Electronic supplementary material The online version of this article (10.1186/s12879-017-2819-5) contains supplementary material, which is available to authorized users.

In 2012, we conducted a retrospective cross-sectional study to assess the number of people living with HIV linked to care and, among these, the number of people on antiretroviral therapy. The health authority in each of the 20 Italian Regions provided the list of Public Infectious Diseases Clinics providing antiretroviral therapy and monitoring people with HIV infection. We asked every Public Infectious Diseases Clinic to report the number of HIV-positive people diagnosed and linked to care and the number of those on antiretroviral therapy during 2012. In 2012, 94,146 people diagnosed with HIV and linked to care were reported. The majority were males (70.1%), Italians (84.4%), and aged between 25 and 49 years (63.4%); the probable route of transmission was heterosexual contact in 37.5% of cases, injecting drug use in 28.1%, and male-to-male contact in 27.9%. Among people in care, 20.1% had less than 350 CD4 cells/μl, 87.6% received antiretroviral therapy, and among these, 62.4% had a CD4 cell count higher than 350 cells/μl. The overall estimated prevalence of individuals diagnosed and linked to care in 2012 in Italy was 0.16 per 100 residents (all ages). Adding the estimated proportion of undiagnosed people, the estimated HIV prevalence would range between 0.19 and 0.26 per 100 residents. In Italy, the majority of people diagnosed and linked to care receive antiretroviral therapy. A higher prevalence of individuals diagnosed and linked to care was observed in Northern Italy and among males. More information for developing the HIV care continuum is necessary to improve the entire engagement in care, focusing on test-and-treat strategies to substantially reduce the proportion of people still undiagnosed or with a detectable viral load.

to evaluate whether exposure to an urban waste incinerator plant operating in Arezzo (Tuscany Region, Central Italy) since the 2000 is associated with mortality and morbidity.a population-based cohort study of inhabitants living close to the incinerator in the period 2001-2010 was conducted. The individual exposure histories to the incinerator and other sources in the area were estimated using a dispersion model producing PM10 concentration maps for each source (ADMS-URBAN model). Hazard Ratios (HR) with 95% Confidence Interval (95%CI) adjusted for the other environmental exposures, age and socioeconomic status were estimated for the highest class of exposure using the lowest one as reference. Trends of HR were evaluated too.mortality and hospitalization causes with induction-latent period overlapping the incinerator activity period were analysed.morbidity analysis showed an increased risk for cardiovascular diseases (No. 732; HR: 1.18; 95%CI 1.06-1.32; trend of HR: 1.08, p=0.006) and a trend of HRs for urinary diseases (trend: 1.13; p=0.063). Mortality analysis showed a trend of HRs for general mortality in males (trend: 1.10; p=0.014), for cardiovascular diseases in males (trend: 1.15; p=0.036), for respiratory diseases in females (trend: 1.30; p=0.098), and an excess of acute respiratory diseases in females with the highest exposure (No. 11; HR=2.54; 95%CI 0.84-7.68).the cohort study allowed to characterise the environmental exposures considering the most relevant pollution sources and providing estimation of individual environmental exposures. Residual confounding due to the overlapping of concentration maps cannot be excluded and further investigations are needed. However, the increased risks for cardiovascular and respiratory diseases reinforce the limited epidemiological evidence on health effects of incinerators.

The Emilia-Romagna regional government decided to develop a monitoring and surveillance system, known as MonITER (Incineration Monitoring on the Emilia-Romagna Territory), in 8 areas characterized by the presence of municipal waste incinerating plants.The project was divided into 7 lines, among these the number 6 developed a procedure of Health Impact Assessments (HIA) to support the planning of new facilities for incineration or combustion. Line number 6 is divided into 3 actions n action 1 aimed to developing and validating a participative HIA methodology, as well tools for the impact assessment and recommendations for implementing HIA on future plants; n action 2 analysed connected issues on communication; n action 3 was focused to developing a methodology for integrating HIA models into existing tools for mandatory impact assessment.Tailoring the HIA model development to the waste management context has highlighted the fundamental differences of the HIA approach with the other mandatory assessment tools, being theoretically founded on the principles of public involvement, equity, sustainable development and ethical use of evidence.

The study describes briefly the current situation of the surveillance of congenital anomalies in Italy and gives an insight into the province of Siracusa in order to better characterise health status of populations residing in an area at high environmental risk.The authors, who coordinate the Italian registries of congenital malformations, have collaborated with the Eastern Sicily Registry of congenital malformations (ISMAC) and the registry of diseases of the Siracusa province.Data collected by the ISMAC Registry were used to calculate the prevalence of malformed newborns, resident in the municipalities of the province of Siracusa between 1991-2000. This prevalence was compared to that observed in the rest of the Siracusa province (RSP), in the whole area covered by the ISMAC Registry (ESR) and to the mean prevalence at birth of the North-East, Emilia Romagna, Toscana and Campania Registries (IR). Comparisons were made for all malformations and for groups of malformations (with the exclusion of groups with a 10 year frequence10 cases in the province of Siracusa). In addition, heterogeneity among the municipalities of the province and temporal trends were statistically tested.Total, groups and specific congenital malformations.Results were statistically borderline considering all malformations when the Priolo-Augusta-Melilli area was compared to IR and ESR (standardized morbidity ratio SMR(IR)=1.1, SMR(ESR)=1.2) and statistically significant when compared to RSP (prevalences ratio PR(RSP)=1.9). Significant excesses resulted in this area also for hypospadias (SMR(IR)=1.9, SMR(ESR)=2.4, PR(RSP)=2.5) and anomalies of the digestive system (SMR(IR)=2.1, SMR(ESR)=1.9, PR(RSP)=2.6).Following these results a case-control study on malformations observed in excess has been activated and a protocol for the surveillance of sensitive diseases in areas at environmental risk is being elaborated.