Italian Ministerial Decree Research Articles

The meta-projects of the new community health centers, community hospitals and local operative centers for the Italian country.

COVID-19 highlighted significant criticalities of the Italian National Healthcare System (NHS) and recently the Italian Government approved the National Recovery and Resilience Plan (NRRP) to relaunch its economy and at the same time to promote health, sustainability and digital innovation. Specifically, M6C1 (Mission 6 Component 1) wants to introduce Community Health Centers (CHCs), Community Hospitals (CHs) and Local Operative Centers (LOCs)to strength territorial healthcare services. Starting from the Italian Ministerial Decree n. 77 (2022), AGENAS (National Agency for Regional Healthcare System) and POLIMI (Politecnico di Milano) working group developed the meta-design guidelines for CHCs, CHs and LOCs facilitieswith the aim of supporting decision-makers to define spatial features and building performances in order to be responsive to functional issues. The spatial strategies of these facilities have been elicited through three different steps: a) a survey about the current national and international scenario regarding the territorial healthcare; b) a review of all national and regional regulations; c) the development of the meta-design guidelines have been elaborated from the analysis of the a) and b) steps. The regulatory instructions and scientific indications collected through the literature have been translated into spatial and functional layouts. The services have been organized by homogeneous macro-areas and defined in a synoptic framework which shows the performance approach and their features. Each macro-area, sorted by type of functions, has been subdivided into a list of all its specific spatial units. The study conducted aims at supporting the planning of these facilities in relation to the catchment area and their sizing. It will be necessary to define the location by evaluating the possibility of setting them up within existing hospitals, as well as to guarantee a sustainable approach in the realization of these infrastructures.

Assessment of the Physiological Values and the Reference Histological Profile Related to Sex Steroids in Veal Calves

Among forbidden substances included in the European Union legislation, endogenous steroids constitute a challenge in the framework of veterinary Official Monitoring Plans. They can be naturally present in body fluids at variable levels depending on the species, sex and age of the animals. Considering the significant advances achieved in breeding conditions and in the selection of producing traits in meat cattle, the aim of this study was to verify by analytical method, in veal calves housed under controlled conditions, if the level of natural steroids hormones assumed as physiological are still actual. The second aim of the study was to verify if the normal histological pattern of growth promoters in target organs is influenced accordingly. Bovine male sex organs are currently analysed in the frame of the Italian histological plan to monitor illicit treatments trend, highlighting microscopic, induced alterations. The levels of 17β-estradiol and progesterone residues resulted under the Limit of Quantitation of the approved official methods and the level of testosterone resulted below the level stated in the Italian Ministerial Decree in force. Male target organs appeared within the limits of the standard histological features.

Building envelope resilience to climate change under Italian energy policies

As a result of recent geopolitical events, zero-energy buildings must include a climate change prevention strategy. Policies are moving in the direction of an energy transition. Italian regulations, complying with European directives, are driving toward increasingly thermally insulated buildings. An important objective of this study is to determine whether updates to building energy efficiency regulations from 2005, particularly for the envelope, will result in increased envelope resilience to climate change. The building was analyzed without air conditioning, simulating an extreme case of a long period without gas supply. It has been located in all Italian climate zones and adapted to respect the local requirements imposed by national regulations for each climate zone. The legal requirements investigated are Italian Legislative Decree 192/2005, Italian Ministerial Decree 26/6/2015, and Italian Ministerial Decree 6/8/2020. The forecasting analyses were carried out considering the years 2030, 2050, and 2070 and three Representative Concentration Pathway scenarios (RCP 2.6, 4.5, and 8.5). The analysis of the results focused on trends of heating, cooling and total thermal performance index from the years 2030–2070. For all RCP scenarios, the 2015 and 2020 requirements optimize total envelope performance in terms of total thermal performance index and perform particularly well with the 2020 limits. It is clean that lowering the transmittance of the envelope components leads to an improvement in the total thermal performance index which, however, by maintaining the same trend over the years with the different scenarios, suggests that the resilience of the envelope to climate change is actually little affected by the transmittance value of the component structures.

Ecotoxicity of marine sediments: Sampling and laboratory artifacts and their impacts on risk classification

Assessing the ecotoxicological risk of marine sediments is now a critical factor in deciding how to treat dredged material in harbor and coastal areas. Although ecotoxicological analyses are routinely required by some regulatory agencies in Europe, laboratory skills necessary to perform them are often underestimated. According to the Italian Ministerial decree No. 173/2016, ecotoxicological tests are performed on the solid phase and elutriates, and the classification of sediment quality is defined using the “Weight of Evidence” (WOE) approach. However, the decree does not provide adequate information regarding the preparation techniques and laboratory skills. As result, a wide variability among laboratories occurs. An error in the classification of ecotoxicological risk has a negative impact on the whole environmental quality and/or the economy and management of the interested area. Thus, the main aim of this study was to determine if such variability can affect the ecotoxicological outcomes of tested species and WOE associated classification, producing different options for the management of dredged sediments. Four different sediment types were selected to assess the ecotoxicological responses and their changes as a function of variability of the following factors: a) the storage time laps (STL) for both the solid phase and the elutriates; b) the methods used to prepare the elutriates (centrifugation vs. filtration), and the conservation method used for the elutriates (freshly prepared vs. freezing). Results suggest a wide variability of ecotoxicological responses among the four sediment samples here considered, differentiated according to chemical pollution, grain-size texture, and macronutrient contents. The storage time laps significantly affect the physicochemical parameters and the ecotoxicity of both the solid phase test and elutriates. For the elutriates preparation, centrifugation is preferred to filtration to preserve a better representation of sediment heterogeneity. Freezing of elutriates does not seem to show any significant effects on the toxicity. Findings allow to define a weighted schedule of the storage time of sediments and elutriates useful for laboratories to scale analytical priority and strategies related to different sediment types.

Road Infrastructure Safety Management: Proactive Safety Tools to Evaluate Potential Conditions of Risk

The identification of highly critical sections in a road network is possible by examining the network operation, with the goal of determining the risk factors and observe the critical issues, in order to better plan possible improvements.Therefore, this study proposes a method to evaluate the coherence of existing road layouts, through the analysis of the geometric characteristics, theoretical speeds and drivers operating speeds, under different environmental and flow conditions.The analysis focuses on the road network managed by ANAS SpA in the Veneto Region, for which the reconstruction of the road axes geometry, the curvature graph and the theoretical design speed profile have been obtained, according to the indications of the Italian Ministerial Decree 05/11/2001. The theoretical design speed profile has then been compared with the information relating to the road users’ mobility, in terms of the 85th percentile speeds, obtained from the extraction and analysis of the Floating Car Data (FCD). The data were processed by reconstructing the continuous profile of operating speeds with a specific regression function known as “smoothing cubic spline”. The comparison with the theoretical design speeds allows to observe whether the users assume a behavior close to or distant from what is expected, based on the technical and geometrical characteristics of the road layout.The proposed methodology can contribute to the implementation of a proactive road safety check, aimed at recognizing and assessing the potential risk conditions for road traffic, with particular attention to the point of view of the road user.

Metals release from stainless steel knives in simulated food contact

ABSTRACT The release of chromium, nickel, and manganese from knives stainless steel produced in Italy and People’s Republic of China was investigated with the aim to check their quality and compliance with Italian Ministerial Decree 21.03.73, which is the most detailed text for the hygiene regulation of packaging, containers, and tools intended for food contact. Temperature effect on metal release is investigated in 18 sets of knives. Tests are performed by simulating discontinuous contact using a 3% glacial acetic acid solution in distilled water at 50°C and 100°C. Chromium, nickel, and manganese quantification is performed by total reflection X-Ray fluorescence. Chemical composition highlights low sulphur content, and most of them belong to the American Iron and Steel Institute (AISI) 420 type A stainless steel group. Tests performed at 100°C revealed higher concentration of released metals. Only three knives tested at 100°C exceed the limit of 100 µg L−1.

Comparison of different ecotoxicological batteries with WOE approach for the environmental quality evaluation of harbour sediments.

This study was conducted under the Italian Ministerial Decree D.M. 173/2016 which regulates the assessment of the Sediment Class Quality in Italy using ecotoxicological bioassay and chemical analysis (Weight-Of-Evidence model). The aim of this work was to evaluate the real classification obtained by the theoretically equivalent responses of nine different combinations of batteries based on six different species: Aliivibrio fischeri (inhibition of bioluminescence), Phaeodactylum tricornutum, Skeletonema costatum, Dunaliella tertiolecta (inhibition of algal growth), Paracentrotus lividus and Crassostrea gigas (embryotoxicity). Bioassays, in many cases, showed a non-bioavailability effect of the pollutants; these one highly revealed by the chemical analyses. Algal species showed responses very similar from each other. Otherwise, species used for embryotoxicity produced wide responses, consequently modifying the quality class of sediments and the handling management (i.e. landfill confinement or beach nourishment) allowed by the Law.

How lockdown measures, during COVID-19 pandemic, matter on psoriatic patient’s perception: Study on 600 patients on biologic therapy

BackgroundThe outbreak of coronavirus disease-2019 (COVID-19) is a public health crisis of global proportion. In psoriatic patients treated with biologic agents, evidence is not yet available on susceptibility to infection with the novel SARS-CoV-2 coronavirus, and data about the perception of COVID-19 and its impact on these patients are lacking. AimsThe aim of this observational, spontaneous study was the evaluation of the impact of anti COVID-19 measures in “fragile population” such as patients with a chronic inflammatory disease. Thus, we evaluated the impact of perceived risk on quality of life of patients with moderate to severe psoriasis, in our outpatient clinic, and how their perceptions changed before and after the adoption of Covid-19 emergency measures following the Italian Ministerial Decree in March 9, 2020. MethodsUsing a series of questions, our study surveyed adult patients with moderate to severe psoriasis receiving treatment with biologic agents (n = 591), before and after the adoption of COVID-19 emergency measures. ResultsMost patients (97%) had been sufficiently informed by healthcare staff about COVID-19 spread. A significant change was observed in social activity reduction before and after the adoption of the measures (18% vs. 90% of patients; P < 0.0001). Similarly, patients were more likely to suspend ongoing therapy after the measures were adopted than before (87% vs. 34% of patients; P < 0.0001). Following the measures, older patients were significantly more inclined to suspend therapy and reduce social activities than younger patients. ConclusionsGovernment COVID-19 emergency measures further curtailed already reduced social activities in psoriatic patients, and led to a greater inclination to suspend biologic therapy, more so in older patients, despite there being no evidence to support this suspension. These vulnerable patients may need support from clinicians in order to maintain treatment adherence.

Vinyl-Asbestos Floor Risk Exposure in Three Different Simulations.

Vinyl floors are widely used in public areas for their low cost and easy cleaning. From 1960 to 1980, asbestos was often added to improve vinyl floor performances. The Italian Ministerial Decree (M.D.) 06/09/94 indicates asbestos vinyl tiles as non-friable materials and, therefore, few dangerous to human health. This work aims to check through three different experimental tests if asbestos floor tiles, after decades of use, maintain their characteristics of compactness and non-friability. The effect of a small stone fragment stuck in the sole of rubber shoes was reproduced by striking the vinyl floor with a crampon. A vinyl tile was broken into smaller pieces with the aid of pliers to simulate what normally happens when workers replace the floors or sample it to verify the presence of asbestos. The third test reproduced the abrasion of the tile surface due to the dragging of furniture or heavy materials or sand grains that remain attached to the soles of shoes. The tests were carried out in safe conditions, working under an extractor hood with a glove box. Airborne sampling in the hood obtained the concentration of asbestos fibers produced in each test. The simulation tests performed confirms the possible release of fibers if the vinyl tiles are cut, abraded or perforated, as indicated by the Italian M.D.

Impact of lockdown on the microbiological status of the hospital water network during COVID-19 pandemic

The COVID-19 pandemic started in China in early December 2019, and quickly spread around the world. The epidemic gradually started in Italy at the end of February 2020, and by May 31, 2020, 232,664 cases and 33,340 deaths were confirmed. As a result of this pandemic, the Italian Ministerial Decree issued on March 11, 2020, enforced lockdown; therefore, many social, recreational, and cultural centers remained closed for months. In Apulia (southern Italy), all non-urgent hospital activities were suspended, and some wards were closed, with a consequent reduction in the use of the water network and the formation of stagnant water. This situation could enhance the risk of exposure of people to waterborne diseases, including legionellosis.The purpose of this study was to monitor the microbiological quality of the water network (coliforms, E. coli, Enterococci, P. aeruginosa, and Legionella) in three wards (A, B and C) of a large COVID-19 regional hospital, closed for three months due to the COVID-19 emergency. Our study revealed that all three wards' water network showed higher contamination by Legionella pneumophila sg 1 and sg 6 at T1 (after lockdown) compared to the period before the lockdown (T0). In particular, ward A at T1 showed a median value = 5600 CFU/L (range 0–91,000 CFU/L) vs T0, median value = 75 CFU/L (range 0–5000 CFU/L) (p-value = 0.014); ward B at T1 showed a median value = 200 CFU/L (range 0–4200 CFU/L) vs T0, median value = 0 CFU/L (range 0–300 CFU/L) (p-value = 0.016) and ward C at T1 showed a median value = 175 CFU/L (range 0–22,000 CFU/L) vs T0, median value = 0 CFU/L (range 0–340 CFU/L) (p-value < 0.001).In addition, a statistically significant difference was detected in ward B between the number of positive water samples at T0 vs T1 for L. pneumophila sg 1 and sg 6 (24% vs 80% p-value < 0.001) and for coliforms (0% vs 64% p-value < 0.001). Moreover, a median value of coliform load resulted 3 CFU/100 ml (range 0–14 CFU/100 ml) at T1, showing a statistically significant increase versus T0 (0 CFU/100 ml) (p-value < 0.001).Our results highlight the need to implement a water safety plan that includes staff training and a more rigorous environmental microbiological surveillance in all hospitals before occupying a closed ward for a longer than one week, according to national and international guidelines.

Productivity and nutritional and nutraceutical value of strawberry fruits (Fragaria x ananassa Duch.) cultivated under irrigation with treated wastewaters.

Agriculture represents a productive sector typically characterized by a high water demand, whereas freshwater (FW) availability is a problem of increasing concern in the world and FW resources are becoming insufficient for sustaining agricultural irrigation. The reuse of treated wastewaters (TWWs) for crop irrigation could be an efficient tool for reducing water shortage. Hence, the present study evaluated the food quality of Fragaria x ananassa (cultivar Camarosa) fruits irrigated with four types of treated wastewaters (TWWs). Strawberries were analysed for yield, sucrose, fructose, glucose, total soluble polyphenols (TSP), total monomeric anthocyanins (TMA), and antiradical and antioxidant capacity. In addition, a targeted quantification of the most representative phenolic compounds of strawberry was performed. TWWs complied the Italian ministerial decree 185/2003 for wastewater reuse, with very few exceptions, mainly represented by chloride concentrations (258-643 mg L-1 versus a legal threshold of 250 mg L-1 ). The reuse of TWWs reduced fruit yield (10-26%) compared to irrigation with tap water as a control. Irrigation with TWWs gave also rise to the decrease of total sugars (14-26%), TSP (2-10%) and TMA (29-49%). Individual phenolic acids, flavonols and flavanols were quite stable in response to the irrigation with TWWs, whereas anthocyanidins decreased significantly. Although TWWs negatively affected fruit quality, the nutritional and nutraceutical parameters determined in the present study were in line with data previously reported for strawberries purchased in the market or cultivated in research orchards, thus suggesting that the use of TWWs does not prevent the fruit marketability. © 2020 Society of Chemical Industry.

Procedure optimization of type 304 and 420B stainless steels release in acetic acid

Stainless steel has always been considered suitable for food contact, even though it has been demonstrated that this material has the tendency to release metal ions when used in food contact applications. In this study, the testing procedure for metal release in simulated food contact proposed by the Italian Ministerial Decree 21.03.1973 highlighted some critical aspects that needed to be improved such as the surface finishing, solution composition and volume, and reproducibility. AISI 304 austenitic and AISI 420 type B martensitic stainless steels were chosen to optimize the parameters of test procedure for release of Chromium, Nickel and Manganese. The effects of the steel chemical composition, the material fabrication cycle and the testing method on metal release were evaluated. Considering the achieved results, a list of suggestions is proposed for the improvement of the Italian law.

Towards an update of the Italian Ministerial Decree July 5th, 1975.

In recent years, the Scientific Community and the Public Health world, in general, have devoted increasing interest to housing conditions, which are considered, to date, one of the main environmental and social determinants of the population's health. In particular, the Scientific Community has identified and studied various indoor well-being factors (e.g. lighting, temperature, ventilation, air quality, etc.). Some of these factors have been regulated by laws and regulations at various levels: the availability of clear and updated health requirements dictated by the regulations is fundamental to effectively protect public health, especially in confined environments. In the present work, we propose a revision of the Italian Ministerial Decree of July 5th, 1975 titled Modificazioni alle istruzioni ministeriali 20 giugno 1896 relativamente all'altezza minima ed ai requisiti igienico sanitari principali dei locali d'abitazione (Modifications to the ministerial instructions of June 20th, 1896 regarding the minimum height and the main hygienic-sanitary requirements of living spaces) in order to update the definition of the essential elements that qualify a space as habitable from the hygienic-sanitary point of view, taking into account the evidence gathered from the technical and scientific literature on the requirements and contents of the Building Codes of the major European countries.

From waste to resource: mycoremediation of contaminated marine sediments in the SEDITERRA Project

Port-dredging activities produce large volumes of contaminated sediments. Dredged sediments are considered a waste by national laws, but recently the desire to consider them a resource has become widespread and remedies for their contamination are being searched to allow their reuse. In this work, we studied, developed, and tested a method for remediate marine-dredged sediments contaminated by heavy metals using native fungi and a microporous membrane, in order to achieve the sediment quality and allow their reuse. Activity was carried out on port sediments from Genoa, Leghorn, Pisa, and Cagliari (Italy). Autochthonous fungi were isolated from each sediment and employed in mycoremediation tests. Two plastic boxes were prepared (for each Port) with 5 kg of sediment in each box, employed for metal bioaccumulation using a sterile polyester membrane inoculated with fungi. Membranes were analyzed at 15, 30, and 60 days after inoculums, and sediments were analyzed after 60 days at the end of the experiment to verify metal contamination degree. Recovery efficiency (RE%) and difference recovery efficiency (DRE%) were calculated for each experiment: the first shows the absorption capability of the membrane-fungi consortium; the second evidences only the fungal contribution to the metal absorption. To assess sediment contamination before and after the mycoremediation treatment, we considered chemical levels of reference L1 (the lowest chemical level of reference) and L2 (the highest chemical level of reference), and the evaluation of chemical hazard (HQ) for the chemical contaminants defined by the Italian Ministerial Decree 173/2016. Fungi from Genoa sediments increase the membrane absorption of Cu and Zn. Regarding Leghorn results, RE (%) increases and reaches the maximum value after 60 days of treatment for each considered metal. Cr tot, Ni, and Mn appear to be hyper-bioaccumulated. DRE values of Pisa sediments show that Mn is excluded by fungi and it does not bioaccumulate, while other metals and in particular Cd, Cr tot, Zn, and Sb are bioaccumulated. Cagliari DREs show that fungi are not able to bioaccumulate Cr tot, Ni, and Mn and their accumulation is due to the membrane, while As and Cd are bioaccumulated. Our work evidenced that selected fungi are able to grow on a microporous support and actively reduce metal concentrations in the sediments, achieving their quality. This biomembrane system may represent an important instrument for the remediation of the residual metal contamination of port sediments.

A bottom-up spatially explicit methodology to estimate the space heating demand of the building stock at regional scale

The paper presents a spatially explicit and “bottom-up” methodology for the building stock analysis of the residential sector. It integrates different input data in a Geographical Information System (GIS), without using the “archetypes approach” and simulation tools. In particular, the energy balance at the building level (BL) for the whole Valle d'Aosta region (Italy) is addressed, using the Italian Ministerial Decree 26/06/2009 and the UNI/TS 11300-1:2014 standard. Main outputs are the estimation of the geo-referenced heating demand of the residential buildings for the case study area (almost 42,000 buildings), and the development of a methodology that can be applied at different scales. The application of the methodology to the case study slightly overestimates the total thermal demand of the residential building stock, especially referring to the more energy demanding buildings. However, being the method influenced by data availability, the quality is expected to improve with newly available data. The proposed GIS-based methodology is designed to be part of a broader Spatial Decision Support System (SDSS) for sustainable energy plans that integrate renewable sources in the building stock energy renovation.

IT tools for the management of multi - representation geographical information

The goal of this research was the creation of software tools for managing instances of a multi - representation geodatabase, able to define multiple representations and topological constraints, in relation to modeled objects and structures according to the classification of the Italian national technical specifications of the November 10, Italian Ministerial Decree 2011. After the development of a conceptual scheme, encoded in its corresponding logical mode, various computer artifacts were designed and developed from scratch to perform the upload, management and display of data: a Scheme Designer, which allows users to define the logical model and implement the physical model of an instance of Oracle; a Loader, which allows users to populate the database; a GUI, which is a graphical interface to the tools and Schema Designer Loader; a DB Navigator, which is the web interface to the database multi - representation.

Enteric Viruses and Fecal Bacteria Indicators to Assess Groundwater Quality and Suitability for Irrigation.

According to Italian Ministerial Decree No. 185 of 12 June 2003, water is considered suitable for irrigation if levels of fecal bacteria (i.e., Escherichia coli and Salmonella) are within certain parameters. The detection of other microorganisms is not required. The aim of this study is to determine the bacteriological quality of groundwater used for irrigation and the occurrence of enteric viruses (Norovirus, Enterovirus, Rotavirus, Hepatovirus A), and to compare the presence of viruses with the fecal bacteria indicators. A total of 182 wells was analyzed. Widespread fecal contamination of Apulian aquifers was detected (141 wells; 77.5%) by the presence of fecal bacteria (i.e., E. coli, Salmonella, total coliforms, and enterococci). Considering bacteria included in Ministerial Decree No. 185, the water from 35 (19.2%) wells was unsuitable for irrigation purposes. Among 147 wells with water considered suitable, Norovirus, Rotavirus, and Enterovirus were detected in 23 (15.6%) wells. No Hepatovirus A was isolated. Consequently, 58 wells (31.9%) posed a potential infectious risk for irrigation use. This study revealed the inadequacy of fecal bacteria indicators to predict the occurrence of viruses in groundwater and it is the first in Italy to describe the presence of human rotaviruses in well water used for irrigation.

Verification of the New Ministerial Decree about Minimum Requirements for the Energy Performance of Buildings

The Italian Ministerial Decree 26/06/2015 specifies the requirements of nearly zero-energy buildings (nZEBs) and demands that the energy performance of the new building is compared with that of a reference or target building, which has the same location, function, size, but reference insulation level and technical systems efficiencies.The research aims both to investigate the technical feasibility of design solutions complying with the legislative requirements and to verify the reference building approach. The analysis is applied to a residential building in three Italian climatic zones. The calculations are conducted by means of quasi-steady (UNI/TS 11300) and dynamic (Energy Plus) methods.

Speed behaviour in work zone crossovers. A driving simulator study

Reductions in speed and, more critically, in speed variability between vehicles are considered an important factor to reduce crash risk in work zones. This study was designed to evaluate in a virtual environment the drivers’ behaviour in response to nine different configurations of a motorway crossover work zone. Specifically, the speed behaviour through a typical crossover layout, designed in accordance with the Italian Ministerial Decree 10 July 2002, was compared with that of eight alternative configurations which differ in some characteristics such as the sequence of speed limits, the median opening width and the lane width. The influence of variable message signs, of channelizing devices and of perceptual treatments based on Human Factor principles were also tested. Forty-two participants drove in driving simulator scenarios while data on their speeds and decelerations were collected. The results indicated that drivers’ speeds are always higher than the temporary posted speed limits for all configurations and that speeds decreases significantly only within the by-passes. However the implementation of higher speed limits, together with a wider median opening and taller channelization devices led to a greater homogeneity of the speeds adopted by the drivers. The presence of perceptual measures generally induced both the greatest homogenization of speeds and the largest reductions in mean speed values.

La Risonanza Magnetica Nucleare nei pazienti portatori di Dispositivi Impiantabili attivi: implicazioni legali

[Nuclear Magnetic Resonance in patients with Active Implantable Medical Devices: legal implications] The Italian Ministerial Decree 02.08.1991 prohibits to perform Nuclear Magnetic Resonance (NMR) in patients with Active Implantable Medical Devices. This Decree is still in force despite the commercialization of new devices that, according to manufacturer, are compatible with NMR. The lacking of Decree updating generates a variety of behaviors, since physicians themselves are not in agreement concerning the decisions to take, especially in those cases in which there is uncertainty about the compatibility of the device. In these cases, the decision is left to the physician. This article provides a broad overview on the evolution of jurisprudence concerning the role and the responsibilities of physicians. Starting from the right to selfdetermination and the right to health guaranteed by Italian laws to the patients, informed consent was rendered compulsory, hypothesizing a different relationship between patients and doctors, more patient- than doctor-centered. However, rather than creating a more mature relationship among the two players, jurisprudence has evolved in the sense of growing responsibilities given to physicians, who are now harassed by several lawsuits. We hope that the still evolving healthcare jurisprudence will create a more serene atmosphere for healthcare professionals.