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The aim of this systematic review was to summarize the scientific literature concerning the use of the Precede-Proceed model (PPM) applied to educational programs and health screenings contextsV.Systematic review.The search process was based on a selection of publications listed in Medline and Scopus. The keywords used were "Precede-Proceed" AND ("screening" OR "educational programs"). Studies included in the systematic review were subdivided into those applying the model in a screening context, and those applying it within educational programs.Twenty-seven studies were retrieved, mostly performed in the USA and, generally, the promoting center was the University. In the context of cancer screening, the PPM model was most of all applied to Mammography Screening (5 of 13 studies in cancer screening), and Cervical Cancer Screening (5 of 13). Another three studies within the cancer field investigated Menopause-Inducing Cancer Treatments, Oral cancer prevention, and cancer screening in general. In the remaining studies, the model was applied in various screening areas, particularly chronic and degenerative diseases. There were many different study designs, most of which cross-sectional (8), though several RTCs (8) and focus groups (5) were also found. For the cross-sectional studies the methodological quality varied between 3/10 and 9/10, whilst for the RCTs it ranged from 2/5 to 3/5.The PPM provides an excellent framework for health intervention programs especially in screening contexts, and could improve the understanding of the relationship between variables such as knowledge and screening. Given the complexity of a behavioral change process, certain important predisposing factors could be measured in future studies, and during health intervention planning.

Background Autism Spectrum Disorder (ASD) is a neuro-developmental disorder that affects communication and behavior with a prevalence of approximately 1% worldwide. Health outcomes of interventions for ASD are largely Participant Reported Outcomes (PROs). Specific guidelines can help support the best care for people with ASD to optimize these health outcomes but they have to adhere to standards for their development to be trustworthy. Objective The goal of this article is to describe the new methodological standards of the Italian National Institute of Health and novel aspects of this guideline development process. This article will serve as a reference standard for future guideline development in the Italian setting. Methods We applied the new standards of the Italian National Institute of Health to the two guidelines on diagnosis and management of children/adolescents and adults with ASD, with a focus on the scoping, panel composition, management of conflict of interest, generation and prioritization of research questions, early stakeholders’ involvement, and PROs. Recommendations are based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision frameworks. Results Following a public application process, the ISS established two multidisciplinary panels including people with ASD and/or their caregivers. Seventy-nine research questions were identified as potentially relevant for the guideline on children and adolescents with ASD and 31 for the one on adults with ASD. Questions deemed to have the highest priority were selected for inclusion in the guidelines. Other stakeholders valued their early involvement in the process which will largely focus on PROs. The panels then successfully piloted the development of recommendations using the methodological standards and process set by the ISS with a focus on PROs. Conclusions In this article, we describe the development of practice guidelines that focus on PROs for the diagnosis and management of ASD based on novel methods for question prioritization and stakeholder involvement. The recommendations allow for the adoption or adaptation to international settings.

In the light of diagnostic and therapeutic advances, patients with a previous myocardial infarction or with a diagnosis of chronic obstructive pulmonary disease are vulnerable and need continuous monitoring over time. These pathological frameworks have a strong impact on the economy and on the status of the population and require effective and low-cost solutions.The objective of this clinical trial is to evaluate the efficacy in the short term of a telephone counseling intervention to modify the lifestyles of these two patient populations.In May 2015, all the patients included in the study underwent a questionnaire to evaluate their eating and smoking habits and their quality of life. After randomization in two groups, the intervention group received telephone counseling related to the correct lifestyles. The control group did not undergo any intervention. In September-October 2015, the same initial questionnaire was administered to evaluate changes in patients' behavior.64 patients were included in the study: 34 were assigned to the intervention group and 30 to the control group. The outcomes evaluated were: quality of life, assessment of eating habits and smoking status. After the telephone counseling, the intervention group (34 persons) showed a significant improvement in the score of adherence to the Mediterranean diet (p = 0.01) and a significant reduction in the percentage of smokers (p = 0.01) compared to the population that did not receive any intervention (30 persons). On the other hand, the changes related to the quality of life questionnaire were not significant.A single telephone counseling intervention is effective in modifying the lifestyles of patients with a previous myocardial infarction or diagnosed with chronic obstructive pulmonary disease in the short term, reducing their risk profile.

Background Cardiovascular diseases are the leading causes of mortality and morbidity in Western countries. The possible synergistic effect of poor adherence to a Mediterranean diet (MD) and other risk factors for acute myocardial infarction (AMI) such as hypertension, cholesterol, ever smoker, BMI> 25, diabetes, has not been deeply studied. Design Case-control study. Methods Patients with first AMI and controls from four tertiary referral Italian centers were screened for enrolment. Dietary information was collected through a questionnaire and a MD adherence score was calculated. Physical activity and smoking habits were also registered. The Synergy Index was calculated according to Rothman. Results 127 cases and 173 controls were enrolled. The analysis was conducted using a dichotomous variable for the MD score with values ≥7 representing good adherence. Multivariate analysis showed the following variables associated to AMI: ever smoker (OR = 2.08), diabetes (OR = 1.42), hypertension (OR = 2.08), hypercholesterolemia (OR = 2.47), BMI> 25 (OR = 1.99), while a protective effect emerged both in subjects scoring > 7 on the MD score (OR = 0.55) and in subjects resident of Southern Italy (OR = 0.38). A synergistic effect does exist between poor adherence to the MD and the following risk factors: hypertension, hypercholesterolemia, BMI >25, diabetes and being a resident in central and northern Italy. Conclusion Synergy between heart disease risk factors and MD underlines the need to enlarge the list of known modifiable cardiovascular risk factors to include and promote adherence to Mediterranean dietary habits.

Background: Despite knowledge about HPV may be an important determinant for vaccine acceptance and uptake, only few studies have assessed HPV-related knowledge in young females. The aim of this study was to assess the reliability and validity of the questionnaire, in Italian women ≥18 years old, as a tool to examine knowledge, attitudes and behaviors towards screening and vaccination against HPV and reliable source of information. Methods: The questionnaire was administered to 30 girls in anonymous, voluntary and self -administered form with close-ended type of questions, except for the socio-demographic characteristics. It was composed in 3 sections for a total of 69 items. Participation in the study was entirely voluntary and anonymous. Descriptive analyses were performed using frequencies, percentages, and frequency table for categorical variables. Reliability analysis was tested and content validity was evaluated using Cronbach's alpha to check internal consistency and avoid misinterpretation of the results. The study was conducted in 4 Italian cities: Ferrara, Rome, Cassino and Palermo, to represent the different Italian geographical areas and knowledge, attitudes and behaviors towards screening and vaccination against HPV and reliable source of information. Data were collected in October 2010. Statistical analysis was performed with the statistical software for Windows SPSS, version 19.0. Results: The highest value of Cronbach's alpha resulted on 24 items (alpha= 0,774); the addition of other items, one at a time, decreased the value. Cronbach's alpha on all the 3 sections together resulted in a value of 0, 059. Young women generally knew that HPV can cause cervical cancer (93.3%) and genital warts (16.7%) and 76.7% of them recognized Pap-test as a screening tool. The main sources of information about HPV vaccination are represented by magazines / books (33.3%), TV (26.7%), and gynecologists (23.3%). Conclusions: This pilot study demonstrated that a short version of the questionnaire has very good reliability properties in the study and this needs to be taken into account for future studies.

The ratio of bad habits, mouth breathing and malocclusion is an important issue in view of prevention and early treatment of disorders of the craniofacial growth. While bad habits can interfere with the position of the teeth and normal pattern of skeletal growth, on the other hand obstruction of the upper airway, resulting in mouth breathing, changes the pattern of craniofacial growth causing malocclusion. Our crosssectional study, carried out on 3017 children using the ROMA index, was developed to verify if there was a significant correlation between bad habits/mouth breathing and malocclusion. The results showed that an increase in the degree of the index increases the prevalence of bad habits and mouth breathing, meaning that these factors are associated with more severe malocclusions. Moreover, we found a significant association of bad habits with increased overjet and openbite, while no association was found with crossbite. Additionally, we found that mouth breathing is closely related to increased overjet, reduced overjet, anterior or posterior crossbite, openbite and displacement of contact points. Therefore, it is necessary to intervene early on these aetiological factors of malocclusion to prevent its development or worsening and, if already developed, correct it by early orthodontic treatment to promote eugnatic skeletal growth.Il rapporto fra abitudini viziate, respirazione orale e malocclusione è fondamentale in tema di prevenzione e trattamento precoce dei disturbi della crescita cranio-facciale. Infatti così come le abitudini viziate possono interferire negativamente con la posizione dei denti e con il normale pattern di crescita scheletrica cranio-facciale, così l’ostruzione delle vie aeree superiori, con conseguente respirazione orale, cambia il modello di crescita craniofacciale con sviluppo di malocclusioni da moderate a severe. Questo studio trasversale, effettuato su 3.017 bambini applicando il ROMA index, vuole verificare l’esistenza di una correlazione significativa tra abitudini viziate/respirazione orale e malocclusione. Dai risultati emerge che all’aumentare del grado dell’indice aumenta anche la prevalenza di abitudini viziate e respirazione orale, significando che questi fattori sono associati alle malocclusioni più gravi. Inoltre abbiamo riscontrato un’associazione statisticamente significativa fra abitudini viziate e overjet e openbite aumentati, ma non con il morso inverso. Dal lavoro è emerso che la respirazione orale è strettamente correlata ad overjet aumentato, overjet inverso, morso crociato, openbite e displacement. Riteniamo quindi che abitudini viziate e respirazione orale, rientrando fra i fattori di rischio di malocclusione, vadano intercettati e corretti precocemente per prevenire lo sviluppo di malocclusioni o il peggioramento di quelle preesistenti.

Aims and background Healthcare professionals have an important role to play both as advisers – influencing smoking cessation – and as role models. The aims of this study were to examine smoking prevalence, knowledge and attitudes among Italian university students attending medical schools using the Global Health Professions Student Survey (GHPSS) approach. Methods and study design A multicenter cross-sectional study was conducted among University students of 9 Italian medical schools (age ranging between 19 and 29 years). The GHPSS questionnaire was self-administered. A logistic regression model was used to identify possible factors associated with tobacco smoking status. Data were analyzed with the software SPSS 19.0 for Windows. Results Seven hundred thirty medical students (response rate 100%) were enrolled. The prevalence of current smokers was 20.4% (males 22.4%, females 19.1%). Of the total sample, 87.7% believed that health professionals should receive specific training in techniques to quit smoking, and 65% believed that health professionals had a role in giving advice or information about smoking cessation. However, 89.4% answered that they had not received specific training on smoking cessation techniques. Multivariate analysis showed that students belonging to universities in southern Italy were more likely to be smokers (OR = 2.00; 95% CI: 1.03–3.97). Conclusions This Italian multicenter survey found that one fifth of future medical doctors are smokers. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.

Background Our study aimed to estimate the prevalence of pregnancy e-health seekers in a large Italian sample; to explore the factors influencing the choices of the childbearing women regarding their lifestyles after internet consultation; and finally to investigate potential differences between primiparous and multiparous women in internet use to find information about pregnancy. Methods A multicentre survey was carried out in seven Italian cities. Data were collected through a validated questionnaire administered in waiting rooms of outpatient departments by medical doctors. Respondents were questioned about their sociodemographic status, their use of the internet to seek pregnancy information and their consequent choices to modify their lifestyles. Data were analysed using descriptive statistics and logistic regression. Results Almost all women were pregnancy e-health seekers (95%), including those who also received information from healthcare professionals. Indeed, the main reason for searching the web was the need of further knowledge on pregnancy-related topic, over and beyond other key advantages of the net such as anonymity, simplicity and rapidity. A higher likelihood of changing lifestyle after pregnancy e-health was observed among the women who searched institutional websites; declared more confidence in the information retrieved; participated into pregnancy-centred forum online; and were residents in Italy. Conclusions To reduce the likelihood for women of both finding erroneous information or misinterpreting correct ones, healthcare professionals should commit to fill the information gap and guide pregnant women in the online searches. Also, future studies are strongly needed to analyse the quality and accuracy of health information found on the web.

The stewardship model has been adopted as a system of governance in several countries. In Italy, the Ministry of Health has proposed the use of the stewardship model for implementing the activities of the National Prevention Plan 2010-2012. The authors present the conceptual foundations and methodology used in the development of an assessment tool (audit tool) for evaluating the level of implementation of the stewardship model with regards to the activities of the national prevention plan in all Italian regions.

Background: Growing medical evidence shows that access to the natural environment improves health and wellbeing, prevents disease and helps people recover from illness. Experiencing nature in the outdoors can help tackle obesity and coronary heart disease. Green areas exert their benefits on both physical and mental health, promoting physical activity and strengthening the sense of community thus positively influencing social interaction. Urbanization poses problems through effects such as environmental pollution, accidents, heat island effects, climate change and a consequent demand for urban green areas.Material and methods: We performed literature searches of electronic journal databases for studies and reviews that focused on the relationship between green spaces and health. We looked at the effects on physical health, mental health, social health, physical activity and well-being in its broadest sense and then we categorically organized our findings.Results: We found many contradictory and unexpected results. However, the reported findings were generally consistent and supported the current view that urban design and the availability of urban green spaces are key elements of prosperity and individual/collective comfort, so as to influence both the perceived health and the objective physical conditions in a measurable way. A weak relationship between physical activity levels and green space availability is observed.Conclusions: The occasionally contradictory results that emerged in this study suggest that a opulation’s esponse to urban design interventions is often unpredictable. Further research is needed to quantify the trength of relation between green spaces and urban health, but also to investigate the social and behavioural spects which are more difficult to measure and understand.

Health and wellbeing is the most value that a person can have [1]. Baccus, Tobacco and Venus want to give a chance to take an active awareness and knowledge, about people’s “health”, “safety” and “life” in order to tobacco, alcohol and sexually transmitted diseases themes, aiming to promote “prolonging life” through more scientific-oriented studies. In this context, it’s necessary base focus on social-economic and cultural challenges - occurred during 20th- century in most industrialized countries- and on progress - made over the last twenty years - occurred in countries whose rapidly growing economies and that have determined and conducted to wellbeing and to the hope of a better life, even if in some case within country differences could exist [2]. However, wellbeing, but also behavioural lifestyle-related diseases (especially chronic diseases), paradoxically grew at the same time. We must not forget that not only personal characteristics and behaviour, but also economic and cultural surroundings, are the determinants of health [3].

Background: The World Health Organization, the U.S. Centers for Disease Control and Prevention (CDC), and the Canadian Public Health Association have developed the Global Health Professions Student Survey (GHPSS) questionnaire in order to collect data on tobacco use and cessation counselling among health- profession students. The aims of the study were to evaluate the reliability and validity of the GHPSS questionnaire in Italy among health-profession students and to examine the prevalence of tobacco use, knowledge and attitudes to it and tobacco cessation training among students attending Italian medical schools using the standardised GHPSS approach.Methods: Before testing tobacco use prevalence, knowledge and attitudes, and tobacco cessation training, we calculated the Cronbach’s alpha to assess the internal validity with the intention of avoiding misleading results. The questionnaire was administered to 100 health-profession students and data were collected in March 2009, during regular class sessions among students of two Italian Schools of Medicine. The original GHPSS instrument was translated into the Italian language and modified by adding three specific questions regarding I) the knowledge about the use of antidepressants, ii) Acetylcholine Receptor Partial Agonists, and iii) counselling techniques used in tobacco cessation programs. Statistical analysis was performed using SPSS 13.0, statistical software for windows.Results: Cronbach’s alpha was higher on 17 items (alpha= 0.872), belonging to section I and IV (respectively: “Tobacco Use Prevalenceú and “Behaviour/Cessationú). The addition, also, of only one more of the others items (section)made the alpha value worse. Cronbach’s alpha for section VI for all items together (n. 44 items) was 0.815, which implies that the questionnaire had a very satisfactory internal validity. The prevalence of current smokers was 33%, while only 12% of students declared to be tobacco users. Interestingly, students who were tobacco users were 80% less likely to consider that health professionals needed training on smoking cessation techniques in comparison to non tobacco users.Conclusions: The questionnaire showed excellent reliability properties in the sample studied. In terms of internal consistency and validity, it appears to have an acceptable performance. Given the high prevalence of smokers among medical students, teaching them about the damages related to tobacco use, and how to help them quit smoking or tobacco use, emerged as important issues. Further studies to investigate these important issues, using a standardized method like GHPSS, are needed.