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Charles Everett Koop was a great Surgeon General, probably the most influential in the history of the United States of America. He never missed courage in his life and often he had used it to tackle professional and personal tough problems. In his public activity, he faced controversial health problems of American people as smoking, abortion and the first occurrence of the epidemic Acquired Immune Deficiency Syndrome (AIDS). Koop was a rigorous man. The lodestar that guided Koop in his work, as a public servant was to do the best for health of Americans. In his prestigious and difficult role, he faced the pressing problems of health of millions of people trying to avoid political influence. During his mandate of eight years, Koop increased the influence and authority of his role. His appearance and behaviour were unmistakable: Lincolnesque beard and uniform, conduct hard and pure, exclusively oriented to the health of citizens, over the personal conveniences, political pressure and lobbying. An exemplary man, who for his passion for medicine and his sincere interest in promoting public health, was affectionately considered the "Family Doctor of America".

Archibald “Archie” Cochrane is the brilliant creator of the evidence-based medicine (EBM). His book “Effectiveness and Efficiency: random reflections on health services” is one of the fundamental texts of Medicine today. For his influence on the progress of medicine, Cochrane may be considered one of the greater physicians of all time. He gave an exceptional boost to the improvement of medical practice worldwide. Cochrane’s vision of medicine and his great scientific achievements are still alive through the Cochrane Collaboration, an organization which provides valuable impulses to improving the quality of medical care. Also he was a great epidemiologist, very proud of his epidemiological work, and his life is interesting for adventurous events and extraordinary examples of righteousness and generosity.

Lorenzo Tomatis was a great doctor in the broadest sense: he gave a major contribution to cancer research, devoting himself to study cancer causes and prevention. His job was not only to serve Public Health but to denounce social and health inequalities without threats by political and economic constraints.

It’s well known all over the world that Italy is the birthplace of Bernardino Ramazzini (1633 - 1714), the real founder of occupational medicine, and that Italian doctors had a great importance in scientific and cultural development in occupational medicine. One of the most celebrated of them was Luigi Devoto, Professor of Medical Pathology at Pavia in 1901, who undertook a free course of Occupational medicine, creating in the same year the fortnightly journal "Work" - that became "Occupational medicine" since 1925 - and opening a Labour Clinic in Milan in 1910. In 1907 the first two Italian schools of occupational medicine arose in Milan and in Naples. In 1901 Giulio Yule Giglioli wrote the first systematic treatise about workers’ diseases. In this cultural background Gaetano Pieraccini grew and developed his original cultural approach to the field of occupational medicine, which got from him a new dimension: the Social Medicine.

Background: At global level, the vulnerability of aquifers is deteriorating at an alarming rate due to environmental pollution and intensive human activities. In this context, Local Health Authority ASL Lecce has launched the M.I.N.O.Re. (Not Compulsory Water Monitoring Activities at Regional level) project, in order to assess the vulnerability of the aquifer in Salento area (Puglia Region) by performing several non-compulsory analyses on groundwater samples. This first paper describes the quali-quantitative approach adopted under the M.I.N.O.Re. project for the assessment of environmental pressures suffered by groundwater and determines the number of wells to be monitored in specific sampling areas on the basis of the local potential contamination and vulnerability of the aquifer. Methods: We created a map of the entire Lecce province, interpolating it with a grid that led to the subdivision of the study area in 32 quadrangular blocks measuring 10 km &times, 10 km. Based on current hydrogeological knowledge and institutional data, we used GIS techniques to represent on these 32 blocks the 12 different layers corresponding to the main anthropic or environmental type of pressures potentially impacting on the aquifer. To each kind of pressure, a score from 0 to 1 was attributed on the basis of the potential impact on groundwater. A total score was assigned to each of the 32 blocks. A higher number of wells was selected to be monitored in those blocks presenting higher risk scores for possible groundwater contamination due to anthropic/environmental pressures. Results: The range of total scores varied from 2.4 to 42.5. On the basis of total scores, the 10 km &times, 10 km blocks were divided into four classes of environmental pressure (1st class: from 0,1 to 10,00, 2nd class: from 10,01 to 20,00, 3rd class: from 20,1 to 30,00, 4th class: from 30,01 to 42,50). There were 11 areas in the 1st class, 9 areas in the 2nd class, 8 areas in the 3rd class and 4 areas in the 4th class. We assigned 1 monitoring well in 1st class areas, 2 monitoring wells in 2nd class areas, 3 monitoring wells in 3rd class areas and 4 monitoring wells in 4th class areas. Conclusion: The methodology developed under the M.I.N.O.Re. project could represent a useful model to be used in other areas to assess the environmental pressures suffered by aquifers and the quality of the groundwater.

Seasonal influenza vaccination (SIV) of health-care workers (HCWs) is recommended in most countries to protect them and their patients from infection. Although SIV can reduce the risk of influenza complications among vulnerable patients, vaccination uptake is generally unsatisfactory. The present study aimed to assess the impact of different programs in promoting SIV uptake among HCWs during the season 2017/2018 in four teaching hospitals in Rome. A multicentric cross-sectional study was carried out, in order to describe the four different campaigns and to assess their impact by identifying and developing a set of indicators that provide information about the vaccination services, the percentage of invited HCWs, the vaccinators’ workforce and the vaccination coverage rates. The hospitals organized different strategies: Hospital 1, 3 and 4 organized educational courses for HCWs and actively invited every single HCW through e-mail. All the hospitals organized a dedicated unit for influenza vaccination, and Hospital 1 added on-site vaccination sessions that required a large number of staff. Hospital 1 and hospital 4 registered a comparable vaccination coverage rate, 12.97% and 12.76%, respectively, while it was 6.88% in Hospital 2 and 4.23% in Hospital 3. Our indicators demonstrated to be effective and useful for analyzing the different SIV campaigns. The results suggest that the best practice to promote SIV among HCWs should include multiple approaches. Among those, an easy access to the vaccination site seems to play a key role in determining a higher vaccination coverage.

Background: Progressive patient care (PPC) has been defined as a systematic classification and segregation of patients based on their medical and nursing needs. Aim of the present research was to perform a systematic literature review about existing medical intermediate care unit organizational models and their performance strengths and weaknesses with a specific focus on Italian implementation, respect to US model. Methods: Databases PubMed, Cinahl, Google and Google Scholar were searched until September 2017. The search was limited to Italian and English studies. All study design are included in the review. Results: Ten studies were included in the review. The American studies showed, after the PPC reorganization, an increase in level of satisfaction and nursing care, a reduction in average length of stay, costs and tensions between nurses and an improvement in nurse-physician communication. An Italian study reported the results of a project carried out in three case studies (Forlì, Foligno and Pontedera hospital), redesigning hospital patient flow logistics around the concept of intensity of care: in all three cases, after the reorganization, an increase in bed occupancy rate (before: 71%,81%,65%; after: 78%,84%,82%, respectively) and in hospital case-mix complexity (average DRG weight - before: 0.99,1.07,1.12; after: 1.19,1.09,1.61, respectively) and a reduction in turn-over ratio (before: 2.5,1.4,2.8; after: 1.5,1.2,1.7, respectively) was recorded. Considering Italian healthcare professionals’ point of view, majority of internists supported a hospital remodeling according to PPC model. Conclusions: The PPC model, theorized in US, has found several applications in Italian regional realities. Improvements in quality of care, appropriateness and productivity in healthcare facilities, that adopted the PPC program, were observed.

Size spectra exhibit common patterns of variation and predictable responses to pressures across ecosystem types, functional guilds and taxonomic groups. Here, we extend the size spectra approach to phytoplankton ecological status assessment in transitional waters by developing, testing and validating a multi-metric index of size spectra sensitivity (ISS-phyto), which integrates size structure metrics with others such as phytoplankton diversity, biomass and sensitivity of size classes to anthropogenic disturbance. The ability of various theoretical models of size spectra sensitivity to discriminate between disturbed and undisturbed ecosystems and levels of anthropogenic stress was evaluated. We used data on phytoplankton samples collected in 14 Mediterranean and Black sea transitional water ecosystems (coastal lagoons) from Italy, Albania, Greece, Bulgaria and Romania, and compared the models’ efficiency by looking at their pressure–impact response along salinity and enrichment gradients, the latter quantified as variations in dissolved inorganic nitrogen (DIN) and dissolved inorganic phosphorus (DIP). Data from a fifteenth Mediterranean lagoon was used for external validation purposes. Right asymmetric models of size class sensitivity, implying higher sensitivity of smaller cell size classes, were found to contribute to the ISS-phyto multimetric tool more effectively than symmetric and left asymmetric models, distinguishing disturbed from undisturbed lagoons and disturbed from undisturbed stations within the same lagoon. When based on right asymmetric sensitivity models, i.e., those that were most efficient in identifying anthropogenic impacts, ISS-phyto also showed the best fit of pressure–response relationships along the salinity and enrichment gradients; at low to high levels of impact ISS response was driven by size class sensitivity and at very high impacts by phytoplankton biomass. A scheme for the classification of Ecological Quality Status based on ISS-phyto is proposed and validated. The validation procedure found that ISS-phyto is an effective and sensitive monitoring tool, robust, easy to apply and to inter-calibrate among laboratories.

Background: Healthcare professionals play a key role in tobacco use prevention because they are considered as model by patients. This multicenter study was aimed to evaluate smoking prevalence, knowledge and attitudes towards tobacco among Italian hospital professionals. Methods: A crosssectional study was carried out using a questionnaire administered to healthcare professionals in seven Italian hospitals, to investigate personal and occupational data, knowledge, attitudes, job setting, clinical activities, smoking habits and pattern for current smokers. Potential predictors of current smoking habits were evaluated using multiple logistic regressions. Results: Sample population was comprised of 1082 health professionals (51.4% females; mean age was 37.3 years: 25.3% were nurses, 24.5% medical doctors, 17.1% students and 33.1% other healthcare workers). Smoking prevalence was 44%. Among responders, 67.7% considered healthcare professional as a model for citizens, 90.5% declared to see colleagues smoking cigarettes inside the hospital (47.4% in the dependents’ toilets, 33.4% in the department kitchens and 4.7% in the patient room). Multivariate analysis showed that healthcare professionals working in Naples had a higher risk to be smokers in comparison to Rome [odds ratio (OR) = 2.29; 95% confidence interval (CI) 1.40–3.73]. Compared to medical doctors, post-graduate students (OR = 3.42; 95% CI: 1.81–6.44), nurses (OR = 2.48; 95% CI 1.51–4.08), nursing students (OR = 1.91; 95% CI 1.08–3.38) and auxiliary personnel (OR = 2.72; 95% CI 1.51–4.88), showed a higher likelihood of smoking. Conclusions: Among Italian hospital personnel there is a paradoxically large prevalence of smokers, higher than in the general population. Interventions aimed for the development of an adequate culture of health promotion, among these professionals, are urgently needed.

The article describes the clinical history of a young patient at risk of suicide. The timely contact with the therapist, with whom the patient has established a solid alliance, and the route taken together, have significant impact on the understanding of suicide attempts. It is highlighted as a multipersonal approach can significantly contribute to the co-construction of meaning of the life experiences of the young patient.

“Giant” is the most frequent word in commemorating Avedis Donabedian. Rarely there was such agreement among scholars worldwide to define the role of a scientist in the field of Public Health. And it’s impossible to disagree. Avedis Donabedian had a really huge role in the progress in Public Health studies. It’s not exaggerated even to say that his insights influenced all scientific research.

Gruppoanalisi e salute mentale (F. Fasolo)Recensione di Ivan AmbrosianoL’insegnante sufficientemente buono (F. Pergola)Recensione di Roberto Bucci

The article was inspired by an event that occurs quite frequently in a therapeutic community: the birth of an emotional bond between two guests. The evolution of the emotional vicissitudes of the pair is compared with the reactions of the group of residents and that of the clinicians. From a brief review of the literature conflicting views emerge from the line to be taken against an event like this. The present paper investigates the psychological and socio-cultural determinants of the attitude of the clinicians compared to a couple's relationship in the community.Keywords: therapeutic community, couple relationship, sexuality

Austin Bradford Hill was born on July 8, 1897, third son of Sir Leonard Erskine Hill, a distinguished medical physiologist, Professor of Physiology at The London Hospital. He grew up in an upper class Victorian family. Sir Leonard, who created an ingenious instrument for blood pressure measuring, had a deep influence on his son. In fact, Bradford decided to follow his father example. He attended Chigwell Grammar School, which was established in 1629, but unfortunately, Bradford’s decision to join the Faculty of Medicine coincided with a really big event: First World War. Bradford entered British naval aviation and...

The stability of methyl p -hydroxybenzoate during 60 Co γ-radiolysis was studied in the solid state and in 10 μM water solution. The work was undertaken as a model to be extended to radiolytic sterilization of pharmaceutical preparations. Only in water moderate decomposition was observed at high doses (50 KGy, whilst at 5 kGy sterilization was verified. Methylparaben labelled with carbon-14 on the carboxyl group provided the decomposition yield by the reverse isotope dilution method; mass balances were drawn and mechanisms suggested.

Ernst L Wynder was a great epidemiologist who devoted his career to investigate harmful effects of tobacco smoke, in particular his studies represent a landmark in the history of epidemiological research on lung cancer. The commitment of Ernst Wynder was not limited to the risk factors related to tobacco. In fact, he studied also the role of nutritional factors in the incidence of tumors. His talent, enthusiasm and tireless energy have allowed him to obtain a complete victory despite the difficulties and the initial loneliness.

Robert Levine: a man capable of intelligent and constructive criticism, who could accept with humility the criticisms of others. A man who left a deep mark in the history of research, both inside and outside the United States. Above all, a great problem solver. A brilliant doctor and refined bioethicist, he was able to deal with the disasters of research on human subjects and to remedy to them. He fought against the application in clinical practice of ethical principles valid only for research, but also against the universalisation of the rules of informed consent, which are applicable only to Western cultures. A researcher who deserves to be known by all, especially by young people.

Health Technology Assessment (HTA) can represent an innovative and effective approach to supply decisionmakers with a valid instrument to improve the allocation of resources in the field of vaccines. We proposed a HTA approach for considering the introduction of a new vaccine that could potentially have a great impact on the population’s health, using as an example the vaccine against Human Papilloma Virus (HPV). This approach could be of great interest when the decision making process involves choices regarding new vaccines. We developed a HTA approach for assessing all of the aspects involved in the introduction of vaccines against HPV in Italy, considering the following issues: - epidemiological evaluation of HPV infection and related pathologies through the consultation of data banks and the scientific literature; - evaluation of health care resources utilisation by people suffering from the infection/ related diseases, through the consultation of hospital archives; - systematic review and meta-analysis of randomised clinical trials on HPV vaccination effectiveness and safety; - mathematical modelling and economic evaluation of the vaccination using a cost-effectiveness analysis; - evaluation of the impact of vaccination on the Health System [organisational aspects, vaccine surveillance, relationship between different decisional levels (national, regional)]; - analysis of the ethical, social (acceptability, availability, accessibility, information) and legislative aspects of vaccination. A HTA report on the new vaccine could represent an new important tool to support the choice of decision makers in order to better inform the allocation of economic resources and maximize healthcare services, since it takes into account not only the burden and the epidemiology of the disease, and the economic evaluation of different scenarios, but also the social, legal and bioethical aspects. For HTA to support the introduction of new technologies, and new vaccines can be considered in this sense, there to utilise a process that is well defined, transparent and widely used.

This is a story that comes from Cleveland. It’s a story of zealous and ingenious men, of ideas and of cooperation. A story that is the result of various personal and diverse professional experiences, from different historical moments, all converged towards a single cause: excellence in health care. It is also a story about a private institution but nevertheless it offers many public health teachings: it’s the story of Albert Kanoti and the Cleveland Clinic Foundation. The Cleveland Clinic was founded on February 5 1921 as an independent, not-for-profit academic medical center engaged in patient care, research, and education. In 1924 it added a 184-bed hospital to its outpatient facilities. It has also experienced tragic moments, when on May 15, 1929, nitrate-based x-ray films ignited in the original building, releasing poisonous fumes; 123 people died, including Dr. Phillips, one of the founders. Despite losses from the disaster and the stock market crash, the institution stayed afloat on the good will of prominent members of the community, and the large surgical practice of Dr. Crile, another of its founders. It expanded greatly after World War II, focusing on specialized medicine. The Cleveland Clinic Research Division investigated kidney disease, blood circulation, and artificial organs, including the artificial kidney. ClevelandClinic physicians, researchers and nurses pioneered enterostomal therapy, dialysis, and kidney transplant techniques, and were first to identify carpal tunnel syndrome and isolate serotonin, and all before 1960.

Public Health is not a discipline with clearly defined boundaries. This feature has taken many contributions from different cultural contexts. In its most recent development, Public Health has also emphasized the enhancement of the human element for the proper functioning of health facilities and the provision of quality care. The vision of public health only through its processes, resources, rules and protocols and any other part of the “structural” component, is certainly simplistic and of the past. This vision of the efficiency of health organization has positive aspects but certainly cannot disregard the fact that things do not have just procedures, but also involve who perform them and how these are managed. So ‘new’ public health contained a new focus on human rights and sought to address social and environmental change. At its root was the common thought that the general context for health had been marginalized only by medically generated concerns.

Alessandro Seppilli is one of the main protagonists for the planning and establishment of the Italian National Health Service [1]. As Chairman of the Commission for the study of health reform in the Italian Consiglio Superiore di Sanità (Higher Council of Health). As a lecturer and researcher he promoted and led several important lines of research, always ahead of its time and with great foresight. His curiosity led him to be involved in a variety of Public Health disciplines: water and sanitation, safe milk distribution, as well as demonstrating, through research, the influence of atmospheric electrical changes on biological phenomena in respect to the vital effects of electric fields changes. He also conducted pioneering research into the study of anticaries fluoride and the carcinogenic effects of active and passive cigarette smoke. Last but not least he studied the use of low temperatures for food storage, investigated the distribution of drinking water by alternative systems and undertook studies on environmental carcinogenesis.

The reactivity features of radiolytically ( 60 Co γ-rays) generated unsolvated trifluoromethyl cation CF 3 + toward pyrrole, N-methylpyrrole, furan, and thiophene have been measured under conditions, i.e. 7 Torr of C 2 H 4 added, ensuring depletion of conccomitant radicalic processes. Experiments have been carried out at atmospheric pressure and in the presence of variable concentrations of a gaseous base (NMe 3 , 0-5 Torr). The mechanism of the ionic trifluoromethylation process and of subsequent isomerization of the relevant ionic intermediates is discussed and the intrinsic positional selectivity of CF 3 + ions evaluated

Gas-phase kinetic data concerning the electrophilic attack of free, unsolvated cations, such as CH 3 + , C 2 H 5 + , i-C 3 H 7 + , t-C 4 H 9 + , C 6 H 5 + , CF 3 + , (CH 3 ) 2 F + , (CH 3 ) 3 Si + , CH 3 CO + , and C 6 H 5 CO + , toward simple five-membered heteroarenes have been embodies into Klopman's charge and frontier orbital control reactivity model

In Italy, the year 1946 was characterized, on one hand, by the growing concern for the lack of public structures and, on the other, by the hopes placed in the research sector, namely the apparently inexhaustible properties of penicillin and antibiotics. Consistently, Igiene e Sanità Pubblica reflected the general mood of the hygienists, swinging between the strong protests against a far too slow political system incapable of spurring scientific research, and the constant engagement aimed at enhancing the future role of public health. Besides facing many institutional problems, such as claiming an official recognition for their profession, hygienists also managed to make Italians understand the real value of a discipline conceived for the community service.

Atrazine is completely destroyed when dissolved in water and moderately irradiated (doses 0.1–50 kGy) with 60 Co; the radiolytic products and their mass balances were determined.

The decomposition of gaseous cyclopropyl-methylbromonium ions has yielded the cyclic hydro-carbons cyclopropane and methylcylclopropane, and methyl bromide.

The thermal gaseous cyclo-C3H5BrCH3+ ion, formed by the reaction of CH3ClCH3+ ion, but not of CH3FCH3+ ion, with cyclopropyl bromide, reacts with benzene as a methylating and as an allylating agent with equal facility. The loss of the cyclic structure results either from a concerted ring cleavage during the attack or from rearrangement of cyclopropylarenium ion after the attack. The methylating ability of cyclopropyl(methyl)bromonium ion toward benzene falls between those of dimethylfluoronium and dimethylchloronium ions, i.e. CH3FCH3+ > cyclo-C3H5-BrCH3+ > CH3ClCH3+.

The gase-phase reactions of 3HeT+, CX3+, and C6X5+(X = H or T), produced by β– decay, with cyclopropyl bromide were studied by analysis of the radioactive neutral products. Competition between the ring and the bromine atom as reaction sites was observed. A comparison with previous gas-phase and condensed-phase studies is given.

CX3+ ions (X = H, T), formed by the spontaneous β– decay of CX4, were allowed to react with gaseous CH3Y (Y = F, Cl, and Br) in the presence of a trace amount of toluene. The formation of radioactive isomeric xylenes, arising from the attack of CH3YCH3+ ion to C7H8, is discussed.