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Given the increasing popularity of electronic cigarettes (ECs) and a lack of regulation of EC advertising, this study aimed to analyse online videos promoting ECs to assess the main marketing messages that could influence consumers' perceptions of associated risks and benefits. A web search of EC advertising videos was performed on YouTube by using keywords related to EC promotion. An evaluation grid was used to analyse promotional messages contained in each video. The most frequent promotional messages were related to health benefits (67.7%) and to the possibility of quitting smoking (57.4%). Messages that could also be appealing to adolescents and young adults, such as those promoting the multiple flavors available and the technological improvement of ECs, were present in 41.2% and 42.7% of the videos respectively. ECs similar to traditional cigarettes in appearance were included in 52.9% of the videos. EC promotional videos address messages not only to smokers who want to quit or decrease tobacco consumption but also to nonsmokers, especially young people. The use of ECs similar to traditional cigarettes may be a gateway to tobacco cigarette use. Since EC use may represent an important public health concern, regulatory policies on EC advertising should be established.

Purpose Nowadays, the development of antibiotic resistance represents one of the most important issues of the global public health. The incorrect use of antimicrobial drugs is recognized as one of the leading causes of antibiotic resistance. Therefore, a better understanding of the existing pieces of evidence pertaining knowledge and attitudes about antibiotic and antibiotic resistance in the general population worldwide is advisable. Methods A systematic review and proportion meta-analyses were performed through PubMed and Scopus scientific databases. Cross-sectional studies published from January 2000 to November 2013 and investigating knowledge about antibiotic use and antibiotic resistance were included. Results Overall, 26 studies have been selected for the systematic review, and 24 of these were included in the meta-analyses. A lack of knowledge about antibiotics was detected. In particular, 33.7% (95%CI 25.2–42.8) of the sample did not know that antibiotics can treat bacterial infections, and 53.9% (95%CI 41.6–66.0) of them did not know that antibiotics are not useful against viruses. Besides, although 59.4% (95%CI 45.7–72.4) of the sample was aware of antibiotic resistance, 26.9% (95%CI 16.6–38.7) of them did not know that misuse of antibiotics can lead to this problem. Finally, 47.1% (95%CI 36.1–58.2) of the subjects stop taking antibiotics when they start feeling better. Conclusions It would be necessary to strengthen educational initiatives in the community and to push physicians to correctly inform patients in order to make them aware of the importance of a correct behavior concerning antibiotic consumption. Copyright © 2014 John Wiley & Sons, Ltd. key words—antibiotics; resistance; knowledge; attitude; meta-analysis; pharmacoepidemiology

OBJECTIVES We assessed sex differences in a sample of first-admission psychiatric inpatients with and without comorbid substance use disorder (SUD) to identify possible risk factors and targets for sex-tailored treatment interventions. METHODS A retrospective study of first admissions to the University Psychiatry Ward, "Maggiore della Carita" Hospital, Novara, Italy, between 2003 and 2012 was accomplished. The clinical charts of patients with (N = 362) and without comorbid SUD (N = 1111) were reviewed. RESULTS Differences in employment, educational, and marital statuses were found between male and female psychiatric patients with and without comorbid SUD. Having a degree was a protective factor for males, whereas it was a risk factor for females. Being divorced and having family problems were both risk factors for comorbidity in females. Regarding the diagnosis, results overlapped in males and females, and both affective and other disorders were risk factors for a comorbid SUD. CONCLUSIONS A significant difference between male and female psychiatric patients with a comorbid SUD was the males' overall poorer psychosocial functioning. Marital status and family problems were risk factors for comorbid SUD in females. Both males and females showed various pathways of access to and choices of substances and, eventually, experienced different impacts on their lives. Hospitalization might help to set up a targeted intervention for patients with comorbidity, while accounting for sex differences. With respect to males, a treatment approach focused on the substance alone might help improve their functioning; females might have a greater benefit from a treatment approach focused on distress, family problems, and relational issues.

This European public health news is looking at the future, and foremost at putting the health of our citizens first. Public health needs to move forward and the way forward includes support, collaboration, integration and an investment in the future public health professionals. Ricciardi emphasizes both the need for collaboration and the need for science, but especially the need for a change in the culture of the public health professionals. Our EUPHAnxt coordinators emphasize this change of culture and aim to prepare the next generations of public health professionals to be committed and engaged. Jakab reaffirms the need for participatory and intersectoral health systems and Borg commits to continuous support to European Union (EU) member states to invest in our future by investing in the health of our citizens. If we all work in the same direction, the future of public health is indeed looking bright. # President's Column {#article-title-2} Twentieth century health systems were dominated by clinicians, effectiveness and efficiency. The two revolutions, the control of infectious disease and the battle against non-communicable disease, are both still ongoing, but the results of these revolutions are very different if we compare the situation in the developed world and in the developing countries. The infant mortality rate is 5.1 in Canada and 97.1 in Haiti, the rate of maternal deaths is 35 times higher in Latin America than in North America and the lifetime risk of death is 1 in 7.700 deliveries in Canada and 1 in 17 in Haiti. In Western industrialized countries, the success of public health has in many cases changed the nature of these societies, making them ‘health societies’, putting health as a main theme in social and political life, and as a major individual goal with a high life expectancy and ageing populations and an expansive health and medical care …

Objective. The aim of the present work is to describe the state of the art of tobacco habits in Italy, eight years after the law was introduced.Methods. Time series analyses, based on estimates of smoking prevalence/consumption derived from the openly available data of national surveys performed during the 2001–2013 period, were performed. Data have been expressed in percentage of smokers and daily cigarettes consumption. Time changes are expressed as expected annual percentage change (EAPC).Results. Over time, the percentage of Italian smokers shows a constant and statistically significant decrease (from 28.9% in 2001 to 20.6% in 2013, EAPC = −2.6%, andP<0.001). Regarding data stratified by gender, we found a stronger reduction among men (EAPC = −2.9%,P<0.001) than in women (EAPC = −2.5%,P<0.001). Similarly, the consumption of tobacco smoking, measured as the number of daily cigarettes smoked, registered a downward trend (P<0.001). No join point (time point when a significant trend change is detected) resulted from the trend analysis.Conclusions. Data show a constant decrease of tobacco consumption in Italy, with no join point related to the introduction of the banning law. These findings require to reflect on the priorities of the smoking banning policies that may be focused on other intervention activities such as to increase the price of cigarettes.

The potential effects of laparoscopic surgery on intra- and postoperative intraocular pressure (IOP) are not completely understood. Although prior studies have reported that pneumoperitoneum may increase IOP, it is not clear whether this increase is related to the effects of pneumoperitoneum or to the patient’s position, such as the Trendelenburg position. This study aimed to evaluate the potential fluctuations of IOP during colorectal laparoscopic surgery in two groups of patients: those with and those without Trendelenburg positioning. For this prospective study 45- to 85-year-old patients undergoing laparoscopic colorectal surgery were enrolled after a thorough ophthalmologic assessment. The study protocol included measurement of IOP at eight different time points (before, during, and after surgery) using a contact tonometer in both eyes. The study enrolled 29 patients: 17 (58.6 %) with Trendelenburg position placement during surgery and 12 (41.4 %) without Trendelenburg positioning. The two groups did not differ in terms of gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, or operative time. In all the patients, pneumoperitoneum induction led to a mild rise in IOP, averaging 4.1 mmHg. The patients with Trendelenburg positioning showed a greater increase than the patients without it (5.05 vs 4.23 mmHg at 45 min; p = 0.179), but IOP evaluation 48 h after surgery showed no substantial differences between the two groups. Among the 29 patients, 17 (58.6 %) showed an increase in IOP of 5 mmHg or more during surgery. A greater percentage of the patients who underwent Trendelenburg positioning showed an IOP increase of 5 mmHg or more (76.5 vs 33.3 %; p = 0.020). At the multivariate analysis, no potential predictors of increased IOP during surgery was identified. Standard pneumoperitoneum (≤14 mmHg) led to mild and reversible IOP increases. A trend was observed toward a greater IOP increase in patients with Trendelenburg positioning. Thus, the patient’s position during surgery may represent a stronger risk factor for IOP increase than pneumoperitoneum-related intraabdominal pressure.

SummaryIntroduction Vertical transmission represents the major route of HIV infection for children. However, the preventive interventions available are extremely effective. This review summarizes evidence regarding the cost-effectiveness of mother-to-child-transmission preventive screenings, to help policy makers in choosing the optimal antenatal screening strategy. Methods A systematic review following PRISMA guidelines was conducted, using 3 databases: PubMed, Scopus, and Cost-Effectiveness Analysis Registry. All articles regarding HIV screening to avoid vertical transmission were included. Results The review included 21 papers. Seven studies assessed the cost-effectiveness of universal antenatal screening during early gestation. Two papers considered the integration of HIV screening with other medical interventions. Eight works estimated the cost-effectiveness of HIV screening in late pregnancy. Finally, 4 papers considered the combination of multiple strategies. The selected papers focused on both developed and developing countries, with a different HIV prevalence. The characteristics and methodology of the studies were heterogeneous. However, all studies agreed about the main findings, outlining the cost-effectiveness of both universal antenatal screening and HIV rescreening in late pregnancy. Cost-effectiveness improved when HIV burden increased. The major findings were proved to be robust across various scenarios when tested in sensitivity analysis. Conclusions The review confirmed the cost-effectiveness not only of HIV universal antenatal screening but also of rescreening in late gestation in both developed and developing countries. Universal screening is cost-effective even in case of extremely low HIV prevalence. Therefore, to maximize screening, coverage appears as a worldwide priority. In certain settings, a targeted screening towards high-risk groups could be a valuable option.

Background : The misuse of antibiotics is one of the leading causes of antibiotic resistance. Paediatric patients are highly involved in this issue, as they are those who receive the largest amount of prescriptions of these drugs. Therefore, this study aimed to investigate the general knowledge regarding the use of antibiotics, as well as the attitudes related to the administration of these drugs to children, amongst parents of children in the paediatric age-group. Methods : In 2014, a multicentre cross-sectional study was conducted amongst parents of children aged 0–14. A questionnaire made up of 33 items was administered in waiting rooms of outpatient departments. Multivariable logistic regression models were performed, in order to assess the potential predictors of a better knowledge about antibiotics. Results : A total of 1247 parents took part to the survey. Around 33% of the samples declared that antibiotics are useful for viral infections, 20.6% that antibiotics are useful for every kind of pain and inflammation, while 14% of the parents stated that they stop giving antibiotics to their children when they start feeling better. Multivariable models showed that males, unemployed and those with lower levels of education are less prone to answer correctly to the questions about antibiotics. Conclusion : The present study demonstrates that parents have a lack of knowledge regarding the use of antibiotics, which results in bad habits and inappropriate attitudes when it comes to giving antibiotics to their children. Attention should be particularly focused on disadvantaged parents.

Objectives In 2009, the World Health Organization (WHO) introduced the "Hand Hygiene Self-Assessment Framework" (HHSAF) to evaluate the level of the application of the Multimodal Hand Hygiene Improvement Strategy (MHHIS), which defines preventive interventions, standards, and tools conceived to improve hand hygiene in healthcare facilities. The aim of our study was to evaluate the implementation of the MHHIS in Piedmont healthcare units in 2014 using the HHSAF document. Methods Our surveillance was performed through collection and analysis of the data from 50 Piedmont healthcare facilities recorded through the HHSAF in 2014. The HHSAF describes the hand hygiene level evaluating the following 5 parameters: system changes, education/staff training, evaluation and feedback, reminders in the workplace, and promotion of an institutional safety climate. Results We reported that 70.4% of the healthcare facilities involved in the study achieved the intermediate hand hygiene level, 19% the advanced level, and 11% the basic level. No facility exhibited an inadequate level of WHO multimodal implementation. Only 55% of the healthcare units provided information about hand hygiene to patients, and only 15% actively involved patients and their families. Conclusions The implementation of the MHHIS has achieved important results all over the world in terms of hand hygiene. Piedmont has reached an overall good level, particularly in terms of the supply and availability of hand washing products and staff education. Our results revealed, however, some critical issues related to direct and indirect monitoring of hand hygiene, providing reminders and the active involvement of patients, family members, and caregivers.

Rationale, aims, and objectives In Italy, since 2008, the surveillance of surgical site infections (SSIs) has been conducted following ECDC recommendations, according to the protocol of the National System of Surveillance of Surgical Site Infections. In 2009, in Piedmont region, where the study was conducted, it was introduced a survey of a “bundle” for every patient under SSIs surveillance. The bundle includes 5 items: infection risk index calculation, preoperative shower, trichotomy, antibiotic prophylaxis, and body temperature control. The aim of this study is the evaluation of the incidence rate of the SSIs in relation to the implementation of the bundle from January 1st to December 31st, 2012. Method This study is an observational study (retrospective cohort). The regional surveillance system collected 3314 surgical operations during the year 2012 from 37 hospitals. The represented surgical categories were hip prosthetic surgery (HPRO: 1992 cases) and colon surgery (COLO: 1322 cases). The bundle was implemented in 1114 and 671 operations, respectively. Univariate and multivariate analysis were conducted stratifying the sample for hip surgery and colorectal surgery, with the purpose to identify an association between the implementation of the bundle and a decrease of the rate of SSIs. Results From the analysis, the bundle resulted as a protective factor for the infection risk in colon surgery (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.38-0.78). The main risk factors were American Society of Anesthesiologists score ≥ 3 (OR, 1.57; 95% CI, 1.10-2.24) and contamination class ≥ 3 (OR, 2.02; 95% CI, 1.37-2.97). In the hip surgery, the application of the bundle was not statistically associated to a decrease of the risk of infection. Conclusion The use of surgical bundle seems to reduce significantly the SSIs rate in the colon surgery.

Background: Telemedicine has demonstrated to improve access and quality of health services in underserved area, curtailing the costs, therefore its application to the delivery of health care in prison would be desirable. Little is known about its use across European penal institutions. Our study aimed to assess the state of telemedicine within the European jails. Methods: To maximize data availability, we used two different approaches. A bottom-up approach was used by gathering information directly from prison directors of every single penal establishment of the 28 European members. A top-down approach was used to collect information from persons involved in prison administration or project leaders at national level. In both approaches questions were sent by mail. Results: Information gathered directly by contacting prison directors and/or persons in charge come from all the 28 EU members. In total, we contacted 211 prison directors and 116 persons in charge, with a total response rate of 67%. We have found that telemedicine, as additional healthcare delivery model, is used only in 11 countries, especially among members of Northern and Western Europe. Only Romania showed to have a pilot project for a nationwide program of telemedicine. Conclusions: Telemedicine services among European penitentiaries appear still poorly developed. Given the numerous and demonstrated advantages of this technology, it would be desirable to implement its utilization in penal healthcare and to integrate it in the routine services, as benefit not only for prison environments but also for the whole community of each country.

Objective Literature shows bibliotherapy can be helpful for moderate depression treatment. The aim of this systematic review is to verify the long-term effects of bibliotherapy. Methods After bibliographic research, we included RCTs articles about bibliotherapy programme treatment of depression published in English language between 1990 and July 2017. All RCTs were assessed with Cochrane's Risk of Bias tool. Results Ten articles (reporting 8 studies involving 1347 subjects) out of 306 retrieved results were included. All studies analyze the effects of bibliotherapy after follow-up periods ranging from 3 months to 3 years and show quiet good quality in methods and analyses. The treatment was compared to standard treatments or no intervention in all studies. After long-term period follow-ups, six studies, including adults, reported a decrease of depressive symptoms, while four studies including young people did not show significant results. Conclusion Bibliotherapy appears to be effective in the reduction of adults depressive symptoms in the long-term period, providing an affordable prompt treatment that could reduce further medications. The results of the present review suggest that bibliotherapy could play an important role in the treatment of a serious mental health issue. Further studies should be conducted to strengthen the evidence of bibliotherapy's efficacy.

Background In recent years, several countries have proposed changes to primary care organisation. Objective Our study investigated the characteristics of 'physician-on-call' usage in a local health unit of Lombardy (ASL MI1). Methods We analysed the incoming calls to the Operative Medical Central Station and collected the user characteristics, the call reasons and the outcomes from 1 October to 31 December 2012. Then, we randomly extracted 10% of the call sample from this period. We focused on two outputs: telephone advice (TA) and emergency department referral. We fit a logistic regression model to identify potential predictors of these outputs. Results In total, we evaluated 2146 calls. Women made most of the calls. Older age was associated with the referral to emergency care [adjusted odds ratio (aOR) 3.1], while paediatric calls were associated with TA (aOR 1.9). Information requests were related to TA (aOR 2.3), while cardiovascular symptoms (aOR 3.5), pain (aOR 2.6) and traumas (aOR 4.7) were linked to emergency care. Conclusions Our study outlined the increasing use of TA, particularly for calls regarding paediatric patients. In contrast, calls for elderly patients were more frequently referred to emergency care. These findings led to the implementation of an age-targeted educational programme. Overall, our observations highlighted that women used the physician-on-call service more frequently than men. Furthermore, some reasons for calling were significantly associated with emergency care.

Dual diagnosis (DD) is the coexistence of severe mental illness (SMI) and substance use disorder (SUD). The increase of DD observed in recent years has important implications for mental health services organization. The aim of this study is to assess the prevalence and features of DD over a decade, comparing the periods 2003–2004 and 2013–2014. We performed a retrospective study retrieving sociodemographic and clinical data from the medical records of patients at their first admission to the Psychiatric Ward of University Hospital “Maggiore della Carita” in Novara, Italy. Patients with SMI and comorbid SUD (SMI-SUD) and patients with SMI without comorbidity (SMI) were compared in the two periods, 2003–2004 versus 2013–2014. SMI-SUD patients in both 2-year periods were more likely to be male, younger, unemployed, living with parents (or alone, for the 2013–2014 period) rather than with a family of their own, and single (or divorced, in 2003–2004). The 2003–2004 patients were more frequently diagnosed with a personality disorder, whereas the 2013– 2014 patients had mixed diagnoses. We have found differences in the possible predictors of substance abuse in the two periods as well: in both periods, male gender was associated with an increased risk of DD, whereas age >61 years was associated with decreased risk. Only in the first period (2003–2004) was having a university degree associated with a decreased risk of DD, whereas the diagnosis of a personal‐ ity disorder was associated with an increased risk of DD; on the contrary, in the second period (2013–2014), living in a protective environment was associated with a decreased risk of DD. The identification of changes in the prevalence of first admission DD patients and their clinical and sociodemographic features may help to highlight an evolving pattern of substance use and to identify possible risk factors that may be the target of prevention and treatment approaches. © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The aim of the study is to evaluate the availability and accuracy of the existing Italian-language medical information about living donor kidney transplantation on YouTube®. For each video, several data were collected, and each video was classified as "useful," "moderately useful" and "not useful." Globally, the search resulted in 306 videos: 260 were excluded and 46 included in the analysis. The main message conveyed by the video was positive in 28 cases (60.9%), neutral in 16 (34.8%) and negative in 2 (4.4%). The mean amount of visualizations was 3103.5 (range: 17-90,133) and the mean amount of "likes" 2.7 (range: 0-28). Seven videos (15.2%) were classified as "useful," 21 (45.7%) as "moderately useful" and 18 (39.1%) as "not useful." This study showed that a very few videos in Italian about living donor kidney transplantation are available on YouTube, with only 15 percent of them containing useful information for the general population.

Introduction Psychiatric management of inpatients with suicidal behavior involves psychiatrists and psychiatric nurses. Specific precautions should be adopted: observation on a one to one basis with the cooperation of qualified nurses and accommodating the patient in a room close to the infirmary is usually recommended. An ongoing assessment of suicidal risk is warranted to check the response to treatment over time. Aim To compare the severity of depressive symptoms in depressed inpatients admitted after an attempted suicide and in depressed inpatients admitted for any other reason; to assess the severity of attempted suicide and the management of suicidal risk in the clinical setting. Material and method We divided the sample in two subgroups: patients with a diagnosis of depression admitted for a current suicide attempt and depressed patients without a current suicide attempt. Socio-demographic and clinical features were gathered; assessment included the Montgomery-Asberg Depression Rating Scale (MADRS) and the Nurses’ Global Assessment of Suicide Risk (NGASR). Results 46 patients were recruited in a 1-year period and were eligible for our study: 20 had been admitted to the hospital after attempting suicide, while the other 26 had not attempted suicide and were admitted for other reasons related to their depression. The multivariate analysis yielded a statistically significant correlation between the use of antidepressants and current suicide attempt. The occurrence of suicidal attempt was not significantly related to the severity of depressive symptoms. In the current suicide attempters subgroup, NGASR suicide risk levels at discharge were significantly lower than those measured at admission. Current suicide attempters had a higher number of suicide attempts in their clinical history, compared to the other group. Conclusion We found no significant correlation among psychiatric diagnosis, severity of depressive symptoms and current suicide attempt. Antidepressant therapy was found to play the role of protective factor for suicide attempts. History of suicide attempts was one of the major predictor for reattempted suicide. A more thorough understanding of the complex phenomenon of suicide and of the reasons underlying suicidal behaviors is warranted.

In recent years, there was a spread of "proanorexia" Web sites. The aim of our study is to investigate the presence, popularity, and content of the "proana" accounts on Twitter. On January 2015, we used "Twitter Search" to retrieve the "proana" accounts. For each account, we analyzed the number of followers, tweets, and the biographical information of the users. We followed these accounts for 4 weeks, assessing the variations in followers and tweets. We also investigated the most used hashtags and the main contents of these profiles. We retrieved 341 accounts. These accounts were popular (mean followers: 2360.9, range: 5-32,700) and active (mean tweets: 4351.2, range: 5-85,700). The users were mostly girls (97.9 percent), in general teenagers (mean age: 17.9 years, range: 12-28). Only around six percent of the accounts presented a warning text about the dangerous content. Each week, we found a mean increase in both followers and tweets. The five most used hashtags resulted in descending order as follows: "thinspo," "thinspiration," "Thin15," "EDprobs," and "proana." The most commonly used contents were in the following order: autobiographic, "thinspiration" photos (inspirational photos of extremely thin girls), "thinspiration" quotes (motivational mottos), "ana tips" (advices for weight loss), and "fasting competition." We underlined a concerning high number and popularity of Twitter proanorexia groups. These accounts contain dangerous information, especially considering the young age of the users. Given the lack of warnings in almost all the accounts, a first step to control this phenomenon could be the increase of such written alerts.

Introduction The therapeutic use of animals has been debated for decades, and its use explored in a variety of settings and populations. However, there is no uniformity on naming these interventions. Evidence based knowledge is essential to implement effective strategies in hospital. This review focused on the use of animal programs for hospitalized patients, and considered the potential risks. Methods The following databases were searched: PubMed, Scopus, PsychInfo, Ebsco Animals, PROQUEST, Web of Science, CINAHL, and MEDLINE, and PRISMA guidelines were adhered to. Results Out of 432 articles were identified 36 articles suitable for inclusion into the review. Data was heterogeneous in terms of age of patient, health issue, animals used and the length of interactions, which made comparison problematic. Studies on children, psychiatric and elderly patients were the most common. The animal-intervention programs suggested various benefits such as reducing stress, pain and anxiety. Other outcomes considered were changes in vital signs, and nutritional intake. Most studies used dogs, but other animals were effectively employed. The major risks outlined were allergies, infections and animal-related accidents. Zoonosis was a possible risk, as well as common infections as Methicillin-resistant Staphylococcus Aureus. The implementation of simple hygiene protocols was effective at minimizing risk. The literature suggested that the benefits outweighed by far the risks. Conclusion The human relationship with animals can be useful and relatively safe for inpatients with various problems. Moreover, the implementation of security precautions and the careful selection of patients should minimize the risks, particularly those infection-related. Many aspects remain unclear, further studies are required.

IntroductionResilience is commonly defined as positive adaptation to adverse events or as the ability to maintain or regain mental health after exposure to difficulties. According to the bio-psycho-social model, resilience is influenced by self-esteem, coping strategies and personality traits. In schizophrenic patients, resilience seems to affect real-life functioning, while in mood disorders, resilience influences the longitudinal course of the disorder, reducing the frequency of relapses and improving drugs response.ObjectivesThe aim of this study is to asses levels of resilience and self-esteem, coping strategies, perceived quality of life and temperament characteristics in a sample composed by patients with major depressive disorder and patients affected by schizophrenia.MethodsWe collected a sample composed by 40 patients with major depressive disorder and 40 patients affected by schizophrenia patients recruited at the “Maggiore della Carità” Hospital in Novara, Italy. The assessment protocol included: Resilience Scale for Adults (RSA), Coping Orientation to Problems Experienced Inventory–Brief (BRIEF–COPE), Rosenberg Self-esteem Scale (RSES), Paykel List Of Stressful Events, Temperamental and Character Inventory (TCI) and Short form 36 (SF-36). Comparison of qualitative data was performed by means of the χ2, a t-test was performed for continuous normal-distribution variables otherwise a non-parametric Mann–Whitney test was performed. Statistical significance was set at P ≤ 0.05.ConclusionsIn patients with major depressive disorder resilience were associated with a good self-perception of physical and mental health, higher self-esteem levels and problem-focused/emotion focused coping strategies. In schizophrenic patients, sample there was no positive correlation between resilience and perceived quality of life. Further implications will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Aim The aims of this study were to examine tobacco use prevalence, knowledge and attitudes, and tobacco cessation training among students attending Italian medical schools using the Global Health Professions Student Survey approach and to identify possible factors associated with smoking status. Subjects and Methods A multicentre cross-sectional pilot study was carried out in five Italian Schools of Medicine from March to April 2009. Questionnaires were administered in anonymous, voluntary and self-administered form to third year students attending medical schools. The outcome measure was “being a current smoker”. A logistic regression was used to evaluate possible factors associated with smoking status. Results The prevalence of current smokers was 31.4%. More than half considered health professionals as models for patients, and around 90% thought health professionals have a role in giving advice or information about smoking cessation. Only 5.8% of responders had received smoking cessation training during medical school. Medical students who considered healthcare professionals as behavioural models had lower likelihood of smoking (OR = 0.52). Conclusions Given the high prevalence of smokers among medical students and the poorness of smoking cessation programmes, it is important to create tobacco control training programmes addressed to healthcare students.

Health impact assessment (HIA) is a multidisciplinary method aimed at assessing the health effects of policies, plans, and projects using quantitative, qualitative, and participatory techniques. In many European countries, such as in Italy, there is a lack of implementation of HIA procedures and it would be necessary to develop instruments and protocols in order to improve the specific skills of professionals involved in the assessment process. This article aims to describe the development and implementation of HIA guidelines, promoted by the Italian National Agency for Regional Health Services (AGENAS), in 4 Southern Italian regions. Public health search engine and institutional Web sites were consulted to collect international data existing in this field. Monthly workshops were then organized with regional representatives to discuss the scientific literature and to identify the guidelines' contents: source of data, stakeholders, screening- and scoping-phase checklist tools, priority areas, monitoring, and reporting plans. Four regions (Calabria, Campania, Puglia, and Sicilia) took part in the project. This article describes the methodology of development and implementation of HIA guidelines in the Italian context. The tools created to collect data and assess health consequences (such as screening and scoping grids) are reported. This project represents the first structured initiative proposed and supported by the Ministry of Health aiming to introduce HIA in Italy. HIA should be considered a priority in the public health agenda, as a fundamental instrument in helping decision makers to make choices about alternatives to prevent disease/injury and to actively promote health.

BackgroundSchistosomiasis is a highly prevalent parasitic disease in Senegal. The early symptoms are hematuria and dysuria. Children's comprehension of the disease is fundamental to preventing the infection.ObjectivesThe aim of this study was to investigate the knowledge attitudes, and practices related to schistosomiasis among schoolchildren in 2 rural villages in Northern Senegal and to evaluate their impact on the disease.MethodsA cross-sectional study was conducted. Data about children's knowledge of schistosomiasis, behavior, and preventive measures were collected through a questionnaire.FindingsQuestionnaire responses from 575 schoolchildren were analyzed. Correct answers about risky behavior for schistosomiasis were associated with early symptoms ('P' = 0.010). Wearing shoes and washing hands with soap were associated with not having hematuria and dysuria ('P' = 0.007 and 0.049, respectively). Playing in rivers was associated with the aforementioned symptoms (P < 0.001). Children who had good knowledge of schistosomiasis reportedly did not have symptoms ('P' = 0.002). A logistic regression model showed that female sex (odds ratio = 0.35; 'P' = 0.01) and attending a primary school (odds ratio = 0.13; 'P' < 0.001) were significant predictors of a lower risk of the early symptoms of urinary schistosomiasis.ConclusionsThis study revealed that the level of knowledge among children in North Senegal about the causes, transmission, prevention, and treatment of schistosomiasis warrants implementing educational intervention.

Objective: Only a few studies have investigated the changes in carotid intima-media thickness (IMT) over time, and uncertainties remain on the underlying mechanisms linking depression and subclinical atherosclerosis. We carried out a prospective cohort study to evaluate whether depression is associated with changes in carotid IMT in subjects with cardiac risk factors but free from coronary heart disease (CHD), and to what extent the atherogenicity of depression can be explained by inflammatory markers and autonomic nervous system dysfunction. Methods: During baseline and follow-up visits: all participants were asked to provide blood samples and compile a structured questionnaire; trained physicians assessed depression symptoms using Beck Depression Inventory (BDI); altered cardiac autonomic tone was measured using time-domain components of heart rate variability in 24 h Holter recordings; measurements of carotid IMT were carried out using B-mode ultrasound image acquisition. Logistic and linear regression analyses were used to adjust for potential confounders and explore potential mediators. Results: A total of 381 subjects completed the 5-year follow-up. The mean carotid IMT significantly increased in all subjects but the amount of increase was significantly larger among subjects with depression symptoms: mean IMT increased by 0.16 +/- 0.14 mm; 0.31 +/- 0.28 mm and 0.61 +/- 0.54 mm among the subjects with no, mild and moderate/severe depression, respectively (all p < 0.01). The association between moderate/severe depression and IMT increase remained highly significant even after controlling for all the variables considered, however when both IL-6 and CRP were included in multivariate models the regression coefficient decreased by 42.3%. Some of the inflammation markers and autonomic nervous system dysfunction were also independently correlated with carotid IMT increase. Conclusion: Depression symptoms are independently associated with an accelerated progression of carotid IMT in subjects with CHD risk factors, and inflammation may substantially modulate the association between depression and carotid IMT progression

Background In Public Health, a thorough review of abstract quality evaluations and the publication history of studies presented at scientific meetings has never been conducted. To analyse the long-term outcome of quality abstracts submitted to conferences of Italian Society of Hygiene and Public Health (SItI) from 2005 to 2007, we conducted a second analysis of previously published material aiming to estimate full-text publication rate of high quality abstract presented at Italian public health meetings, and to identify predictors of full-text publication. Methods The search was undertaken through scientific databases and search engines and through the web sites of the major Italian journals of Public Health. For each publication confirmed as a full text paper, the journal name, impact factor, year of publication, gender of the first author, type of study design, characteristics of the results and sample size were collected. Results The overall publication rate of the abstracts presented is 23.5 %; most of the papers were published in Public Health journals (average impact factor: 3.007). Non universitary affiliation had resulted in a lower probability of publication, while some of the Conference topics had predisposed the studies to an increased likelihood of publication as well as poster form presentation. Conclusions The method presented in this study provides a good framework for the evaluation of the scientific evidence. The findings achieved should be taken into consideration by the Scientific Societies during the contributions selection phase, with the aim of achieving a continuous improvement of work quality. In the future, it would be interesting to survey the abstract authors to identify reasons for unpublished data.

New scenarios are emerging in the European and worldwide context: the ageing of society, the climate changes, the increasing of health inequalities and the financial crisis. In this context, the scientific community and the decision-makers agree on the role of health in all policies (HiAP) strategy in improving the population’s health. The HiAP takes into account factors not strictly related to health but with important health consequences. To bring public health in all policies a change is needed, but there are some obstacles to overcome: for instance, the lack of evidence regarding the governance tools and frameworks for HiAP, the difficulty of convincing stakeholders and producing a cultural change in the political positioning of decision-makers. Consequently, it is necessary: i) to implement stronger and responsible decision-support approaches, such as health impact assessment and health technology assessment; ii) to encourage and coordinate all relevant sectors in playing their part in reducing health gaps within the European Union; iii) to strengthen cooperation and make better use of existing networks and existing public health and related institutions. The final aim will be to monitor the impact of the health determinants in order to promote the effective implementation of HiAP approach. Significance for public health This paper makes public health professionals aware of the pivotal role that they could play in reducing health inequalities and in helping to overcome the crisis of the European health systems. It discusses how, thanks to a systematic approach based on new instruments like health impact assessment and health technology assessment, and thanks also to a stronger cooperation among stakeholders and policy makers, it is possible to monitor the health determinants and consequently to bring health in all policies.

In this European public health news, the economic crisis’ impact on health and health spending is again on the agenda. It needs an effort from the public health professionals to inform policy makers regarding the impact of their decisions on health (Ricciardi, Jakab). It also needs a continued commitment both from the professionals (Bert, van der Star) and from those beyond the field of public health (Borg). # EUPHA President’s Column {#article-title-2} During the past 2 decades, most European countries have made impressive progress in population health. This progress has, however, been uneven, and the health divide across the European region is unacceptably large. The noteworthy heterogeneity of health progress in the European population could result from intrinsic differences in resources for health care (including support for basic measures such as control of tobacco and hypertension), in willingness to take action, or in negative effects of political divisions.1 We at EUPHA argue that conditions that improve population health have to be shaped in the policy arena to suit national and regional circumstances. If so, what measures are available to policy makers in Europe to increase the success of public health policies in the face of the financial crisis and ageing populations? Examining the health status of European citizens, but also including a comparative analysis of the effectiveness of European health policy over the past decades, is a challenge for our public health community. We need to assess the health effects of different social and economic policies and the associations between health and health systems. We have also to improve our understanding of the remarkably low life expectancy in the Commonwealth of Independent States (and the related quality of health care) and better analyze migrants’ difficulties in accessing health services. In times of economic downturn, people who are disadvantaged are more affected than others. Going …

IntroductionThe level of express emotion (EE) is a measure of the attitude of close relatives towards a patient and include dimensions as critical comments, hostility and emotional over-involvement. Anger and impulsivity may lead to self-injurious and aggressive behaviours, and often represent an obstacle to treatment.AimsTo compare anger expression, impulsivity and expressed emotion in ED and SCHZ, and to explore the different level of caregivers’ EE in the two groups.MethodsTwenty-five female with ED diagnosis and 25 patients with schizophrenia, were recruited at the Psychiatry Ward and outpatient Service of AOU – Novara, during one year period. Patient's assessment included Global Assessment of Functioning (GAF), Structured Clinical Interview (SCID 1-2), Level of Expressed Emotion Scale (LEE), Paykel scale, State and Trait Anxiety Inventory (STAY 1-2), State-Trait Anger Expression Inventory (STAXY), Barratt Impulsiveness Scale (BIS-11).ResultsLevels of anxiety (both state and trait) are higher in the ED group than in SCHZ. As far as the STAXY is concerned, SCHZ patients score higher than ED ones on control over anger, while general index of anger expression was higher in ED patients. We did not find significant differences in EE between two groups, except for the patient's emotional response of the patient to the disease, which was greater among SCHZ. Both SCHZ and ED patients scored higher on the LEE, Paykel and STAY than their caregivers.ConclusionsSCHZ and ED patients show different patterns of anxiety and anger, but similar profile as far as EE is concerned. Implications for treatment will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The aim of this study was to determine the effects of the pneumoperitoneum used in colorectal procedures on peripapillary retinal nerve fibre layer (RNFL) thickness. We also analysed the dynamics of ocular anterior segment structures. In this prospective clinical pilot study, 29 patients aged between 45 and 85 years old underwent laparoscopic surgery for selected colorectal diseases. The pneumoperitoneum induced a mean intraocular pressure (IOP) increase of 4 mmHg. Visual acuity, IOP, corneal thickness, angle opening distance (AOD) and the trabeculo-iris space area (TISA) at 500 microns and 750 microns anterior to the scleral spur, RNFL thickness and visual field were measured before and after surgery using Sloan charts, Visante™ optical coherence tomography (OCT) (Zeiss, Oberkochen, Germany), Spectralis® OCT (Heidelberg Engineering, Heidelberg, Germany) and Humphrey Visual Field System® (Zeiss, Oberkochen, Germany). Patients were categorised in two groups to understand the behaviour of IOP: in group one (n=17), patients were in Trendelenburg position; in group two (n=12), patients were in reverse Trendelenburg position. The IOP was measured during surgery by the Icare® Tonometer (Icare, Vantaa, Finland) according to a standardised protocol; the IOP was measured before and after surgery by Goldmann applanation tonometer (Haag-Streit, Koniz, Switzerland). Patients with previous diagnosis of both open or angle-closure glaucoma or anterior segment anomalies were excluded. No statistically significant differences in increase of IOP were found between the two groups (p>0.05); no statistically significant differences in RNFL thickness, visual field, AOD and TISA were found before and after surgery in all patients (p>0.05). In our study we have demonstrated that a mean IOP increase of 4 mmHg over a short period of time is safe for a healthy optic nerve.

Importance The prognostic significance of regression in primary melanoma has been debated for many years. There is no consensus regarding the need for sentinel lymph node (SLN) biopsy when regression is present within the primary tumor. Objective To review the evidence that regression may affect SLN status. Data Sources A systematic review was performed by searching in MEDLINE, Scopus, and the Cochrane Library from January 1, 1990, through June 2014. Study Selection All studies that reported an odds ratio (OR) or data on expected and observed cases of SLN positivity and histologic regression were included. Data Extraction and Synthesis Primary random-effects meta-analyses were used to summarize ORs of SLN positivity and histologic regression. Heterogeneity was assessed using the χ 2 test and I 2 statistic. To assess the potential bias of small studies, we used funnel plots, the Begg rank correlation test, and the Egger weighted linear regression test. The methodologic quality of the studies was assessed according to the Strengthening of Reporting of Observational studies in Epidemiology (STROBE) checklist, and 2 different meta-analyses were performed based on those criteria. Main Outcomes and Measures Summary ORs of histologic regression of primary melanoma and SLN status. Results Of the 1509 citations found in the search, 94 articles were reviewed, and 14 studies comprising 10 098 patients were included in the analysis. In the combined 14 studies, patients with regression had a lower likelihood to have SLN positivity (OR, 0.56; 95% CI, 0.41-0.77) than patients without regression. On the basis of study quality, we found that patients with regression enrolled in high-quality studies had a lower likelihood to have SLN positivity (OR, 0.48; 95% CI, 0.32-0.72) compared with results of low-quality studies (OR, 0.73; 95% CI, 0.53-1.00). Examination of the funnel plot did not provide evidence of publication bias. Conclusions and Relevance The results of this analysis showed that the risk of SLN positivity was significantly lower in patients with histologic regression compared with those without. Regression may be used in these cases to make a selection of which patients should be the most appropriate for this procedure.