Italian National Health Institute Research Articles

A New Human-Derived Acellular Dermal Matrix for Breast Reconstruction Available for the European Market: Preliminary Results.

The introduction of acellular dermal matrices (ADMs) contributed to the growing diffusion of direct-to-implant breast reconstruction (DTI-BR) following mastectomy for breast cancer. According to specific legislations, European specialists could not benefit from the use of human-derived ADMs, even though most evidence in the literature are available for this kind of device, showed optimal outcomes in breast reconstruction. The Skin Bank of the Bufalini Hospital (Cesena, Italy) obtained in 2009 the approval for the production and distribution of a new human cadaver-donor-derived ADM (named with the Italian acronym, MODA, for matrice omologa dermica acellulata) from the Italian National Transplant Center and National Health Institute. We report preliminary results of MODA application in direct-to-implant breast reconstruction following nipple-areola complex (NAC)-sparing mastectomy for breast cancer treatment. We prospectively enrolled all women undergoing NAC-sparing mastectomy for breast cancer and DTI-BR in our breast surgical unit from June 2015 to January 2017. We enrolled a selected population without previous chest wall irradiation, not being heavy tobacco smokers or diabetic, with a BMI<30kg/m2 and requiring less than 550cc silicone implants. We assessed short-term outcomes, defined as postoperative complications presenting in the first 30 postoperative days and long-term outcomes at 6 and 12months. From June 2015 to January 2017, we treated 56 breasts. At a mean follow-up of 14months, we observed only two minor complications described as limited wound dehiscences, conservatively managed with complete resolution without implant exposure or re-intervention. Our preliminary results show very good performance of MODA in direct-to-implant breast reconstruction following NAC-sparing mastectomy for breast cancer treatment. This is particularly relevant for the European market, where no other human-derived devices are available for breast reconstruction due to regulatory restrictions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Drinking water contamination from perfluoroalkyl substances (PFAS): an ecological mortality study in the Veneto Region, Italy.

Perfluoroalkyl substances (PFAS), a heterogeneous group of highly stable man-made chemicals, have been widely used since 1960s and can be detected almost ubiquitously in all environmental matrices. In Italy, on January 2014, drinking water contamination in an area of the Veneto Region was detected mainly due to the drain of fluorinated chemicals by a manufacturing company operating since 1964. The present ecological mortality study was aimed at comparing mortality for some causes of death selected on the basis of previous reported associations, during the period 1980-2013, in municipalities with PFAS contaminated and uncontaminated drinking water on the basis of the levels indicated by the Italian National Health Institute (ISS). Sex-specific number, standardized mortality rates and rate ratios (RR) for PFAS contaminated and uncontaminated areas were computed for each cause of death through the ENEA epidemiological database. In both sexes, statistically significant RRs were detected for all causes mortality, diabetes, cerebrovascular diseases, myocardial infarction and Alzheimer's disease. In females, RRs significantly higher than 1.0 were also observed for kidney and breast cancer, and Parkinson's disease. Increased risk, although not statistically significant, was observed for bladder cancer in both sexes, and for testicular cancer, pancreatic cancer and leukemia in males only. Higher mortality levels for some causes of death, possibly associated with PFAS exposure, were detected in contaminated municipalities in comparison with uncontaminated ones with similar socioeconomic status and smoking habits. These results warrant further individual level analytic studies to delineate casual associations.

Hormonal contraception and the risk of venous thrombosis: Management recommendations from the Piedmont Region and the Consensus Conference of the Italian National Institute of Health

Hormonal methods are used by many fertile women who require contraception. They are highly effective, but their use is associated with an increased risk of venous thromboembolism. This report summarizes the recommendations of the Public Health Service of Italy’s Piedmont Region for the prescription of hormonal contraception (November 2007) and the results of the Consensus Conference of the Italian National Health Institute on the prevention of thromboembolism related to hormonal contraception (July 2009). Although hormonal contraception increases the relative risk for venous thromboembolism, both documents agreed that the absolute risk remains very small. Assessments of eligibility for hormonal contraception must be based on complete medical history that include medical conditions, drugs used, and family history. Unnecessary medical barriers, such as routine screening for thrombophilia, are not recommended. Most women can safely use hormonal contraception. Physicians and women should discuss the risks, benefits, and uncertainties associated with hormonal contraception so that women will be able to make informed decisions regarding their use.

Vancouver Charter: bringing ski and snowboard helmet legislation to Canada

The Vancouver Charter on Skiing Safety is based on skiing and snowboarding safety and the Turin Charter (approved in the context of the 2006 Turin Winter Olympic Games) and was...

Contraccezione ormonale e rischio tromboembolico: dalle raccomandazioni della Regione Piemonte alla conferenza di consenso dell’Istituto Superiore di Sanità

Summary Hormonal methods are used by many fertile women who require contraception. They are highly effective, but their use is associated with an increased risk of venous thromboembolism. This report summarizes the recommendations of the Public Health Service of Italy's Piedmont Region for the prescription of hormonal contraception (November 2007) and the results of the Consensus Conference of the Italian National Health Institute on the prevention of thromboembolism related to hormonal contraception (July 2009). Although hormonal contraception increases the relative risk for venous thromboembolism, both documents agreed that the absolute risk remains very small. Assessments of eligibility for hormonal contraception must be based on complete medical history that include medical conditions, drugs used, and family history. Unnecessary medical barriers, such as routine screening for thrombophilia, are not recommended. Most women can safely use hormonal contraception. Physicians and women should discuss the risks, benefits, and uncertainties associated with hormonal contraception so that women will be able to make informed decisions regarding their use.

EpiSouth: a network for communicable disease control in the Mediterranean region and the Balkans

The countries around the Mediterranean Sea share epidemiological characteristics and public health problems. In 2006 the EpiSouth Project was started as a framework for collaboration for communicable diseases surveillance and training in the Mediterranean Basin. As of December 2008, 26 countries from southern Europe, the Balkans, North Africa and the Middle-East are members of EpiSouth and several international organisations and institutions collaborate: the European Commission (EC), the European Centre for Disease Prevention and Control (ECDC), the Italian Ministry of Work, Health and Social Policies and the World Health Organization (WHO). The project is coordinated by the Italian national public health institute and three work packages (WPs) Cross-border epidemic intelligence, vaccine preventable diseases and migrants and Cross-border emerging zoonoses are operated by the national institutes of France, Bulgaria and Greece. These WPs constitute technical pillars on which the project develops. Networking and Training are WPs dedicated to capacity building and are run by the Padua Teaching Hospital (Italy) and the Spanish national public health institute. A steering committee guides EpiSouth's activities while all countries collaborate through WP steering teams and focal points. A number of outcomes have been accomplished and documents with results are available from the EpiSouth website which hosts a public website and a restricted area for direct sharing of information among the participants. Five electronic bulletins were published, two trainings for 63 participants performed, national epidemic intelligence systems were evaluated, a preliminary survey on vaccine-preventable diseases and migrants performed, and a list of priorities for emerging zoonoses in the Mediterranean area was selected. Overall the network succeeded in creating cohesion, mutual trust and concrete collaboration on cross-border public health issues in a geographical area that is not addressed as a whole by any other initiative or organisation.

T11-O-05 MODI DI: a national health survey of gay, lesbian, bisexual people in Italy

Objective The research project MODI DI was funded by the Italian National Health Institute (ISS) and it is the first large-scale study on the health of lesbian, bisexual and gay people in Italy. Design and method: Through widely disseminated questionnaires, statistical data were collected on a number of major themes: health status, health-compromising and protective behaviores (smoking, alcohol and drug use, sexual risk taking), coming out and social resources, perceived discrimination in the health services, HIV-status and HIV-related expectancies and skills. 2084 women and 4690 men answered to the questionnaire. The majority lived in the North of the country, most of these participants were young, with an average age of 31. Results Coming out and discolsure to significant others of the respondents is linked to age and geographic place of residence.: the most difficult situation to “come out” is undoubtedly the work environment; discolsure of sexual orientation in the family of origin is related to relational status. The majority of subjects have not disclosed their sexual orientation to their general practitioners and to gynaecologist. Expection of discrimination is a predictor of actual use of health services. Lesbian, bisexual and gay people reported high prevalence of smoking and alcohol use. As regards men's health, 5% reported to be HIV-positive and almost one third not tested; almost one third reported unsafe anal intercourse. Psychosocial predictors of testing and safer sex are presented. Implications for health promotion programs are discussed.

Surveillance of Suspected Adverse Reactions to Natural Health Products

Natural health products are promoted to the public as equally or more effective and less toxic than conventional drugs. However, some 'natural' medicines are known to have adverse effects. From April 2002 to August 2007, 18 suspected adverse reactions associated with propolis-containing products were reported to the national surveillance system of natural health products, coordinated by the Italian National Health Institute. Sixteen reports concerned allergic reactions (with dermatological or respiratory symptoms), while two concerned the digestive tract. Some of the reactions were serious: six patients were admitted to hospital or visited an emergency department and in two of these a life-threatening event was reported. In seven patients (four of whom were children), an allergic predisposition was indicated. Propolis, a resinous substance collected by honeybees from the buds of living plants, has been used for several purposes (dermatitis, laryngitis, oral ulcers) because of its wide range of suggested activities (antibacterial, antiviral, antifungal, anti-inflammatory, antioxidant and chemopreventive actions). However, propolis is also a potent sensitizer and should not be used in patients with an allergic predisposition, in particular an allergy to pollen. In Italy, products containing bee derivatives (bee pollen, royal jelly or propolis) are available to the public as food supplements. No label warning of possible adverse reactions is found on the packaging, although it is well known that atopic and asthmatic individuals may be at an increased risk of allergic reactions after using these products. The public and healthcare practitioners should be aware of the risk of allergic reactions to products derived from bees and a warning should be added to the packaging of these products.