Abstract: Alcohol and tobacco use are important determinants of illness and have important country-specific dimensions. It's important to also consider them at community and primary health care (PHC) levels. A collaborative qualitative research (Delphi study and focus groups methodology) was conducted during the process of 10 new countries joining the European Union (EU) and implemented in culturally socio-economically different European countries: four EU (Belgium, Brussels region; Hungary, Pest County; Italy, Friuli Venezia Giulia region; Latvia, Riga region; Slovenia, Ljubljana region) and two Eastern European countries (Bulgaria, Sofia region; Russia, St. Petersburg region). Countries were chosen from the WHO international project according to the criteria noted in the application for EU INCO-COPERNICUS funding. Focus groups were conducted among lay people and PHC professionals in order to identify factors that influence (facilitate and prevent or minimize) PHC management of alcohol- and tobacco use-related problems. A Delphi study was conducted among four different groups in order to develop tasks for instances to be involved in community health policies. There are some limitations of such a qualitative study; e.g., such studies give ideas that cannot simply be transformed to actions in every country. In order to manage tobacco-and alcohol-related problems a comprehensive community-based approach, that also include PHC teams and policymakers, would be supported in participating countries.
Abstract: Aims: the study aimed to evaluate the feasibility of adapting a shorter version of the WHO AUDIT Questionnaire (Alcohol
Use Disorders Identification Test) in a setting of primary health care in Italy. The ten questions version of the AUDIT has shown
too many limitations, for its use in a primary health care setting, as evidenced in the results of recent pilot studies, carried out in
Italy. To this purpose, the Ministry of health has funded a project to prepare and test a three- questions shorter version of the AUDIT,
for the Italian context. Methods: 232 questionnaires previously administered to an opportunistic sample of GP clients, were
examined to verify the internal validity of the first three items of the AUDIT Questionnaire, in comparison to the full set of ten
questions. We used parametric (Pearson) and non-parametric (Spearman) tests to analyse the predictive value of the first three
questions with a cut-off point of 5. Results: both Spearman test (r=.991) (considering the non ordinal nature of the items) and
Pearson test (r=.954) (considering that the value is the sum of all the other values) evidenced that the first three questions are
predictive of the same results obtained by using all ten questions. Conclusions: Notwithstanding the limitations that arise from its
application to a local context, this study wants to contribute to the development of national strategies for the systematic application
of the AUDIT early identification and brief intervention in the primary health care settings.
Keywords: Early identification, AUDIT, Risk, Alcohol consumption, Primary care
Abstract: BACKGROUND: In most developed countries the prevalence of smoking habits is decreasing in men, while in women the prevalence seems to decline in Northern Europe but to increase in the Mediterranean area. The present research aims at assessing time trends in smoking habits in Italy. METHODS: In the frame of the Italian Study on Asthma in Young Adults (ISAYA) a random sample of the Italian population aged 20-45 years was administered a mailed questionnaire in 9 Italian centers between 1998 and 2000. Cumulative response was 72.7% (18873/25969). Kaplan-Meier survival curves and log-rank test were used to compare probability of remaining a life-time non-smoker across birth cohorts (1953-58, 1959-63, 1964-68, 1969-73, 1974-78). Probability to quit smoking was also evaluated among ever-smokers. RESULTS: Probability to persist as a non-smoker significantly increased across subsequent generations in both sexes. At the age of 20 years this probability amounted to 41.7% (95% CI 39.4-44.0%) in men and 52.7% (50.4-54.9%) in women born between 1953 and 1958, and it increased to 57% (54.8-59.1%) in men and 68.7% (66.6-70.7%) in women born in 1969-73, but no further decline in smoking habits was observed in the next birth cohort (1974-78). Also the probability to quit smoking significantly increased from the 1953-58 birth cohort to the 1969-73 one. CONCLUSIONS: Smoking has declined among Italian young adults of both genders. Further efforts are necessary to promote active anti-smoking campaign, especially among adolescents, which are at higher risk of starting to smoke.
Abstract: Risky alcohol consumption is a major public health issue and represents the second avoidable cause of death in the world. Early identification and brief intervention are two simple methodologies that, if systematically applied in primary care, are cost effective and practical to be implemented. General Practitioners (GPs) are reliable primary care workers that could play an outstanding role in the dissemination of these methodologies. This article summarises their perceived barriers and incentives to systematically perform such interventions. Methods: A questionnaire was administered to a random sample of 200 GPs in each of the thirteen participant Countries of a WHO collaborative study. 18 barriers and 11 incentives were proposed to the professionals. A four point scale from 1 'not at all' to 4 'very much' was used and responses of 'don't know' were excluded from analysis. Statistical analysis was performed by a steering group. Perceived barriers and incentives were grouped into categories. Results: Lack of government policies, health schemes, time and reimbursement were the most important barriers while patients’ requested advice, availability of support services and proof of efficacy of early intervention were the most important perceived incentives. Conclusion: This study underlines the importance of new epidemiologic data to be acquired and the importance of general practice in the development
of new public health policies. It analyses some of the barriers and incentives that can influence GPs’ confidence and motivation in the field of early identification and brief intervention towards risky drinkers. The majority of the interviewed professionals, representing a large group of Countries, share the same feelings.
Abstract: BACKGROUND: Few data are available on the management of asthma in the general population. The aim of this study was to evaluate the level of asthma control in Italian patients, a decade after the publication of the international guidelines. MATERIALS AND METHODS: Within the framework of a multicentre, population-based study on people aged 20-44 years, 18 873 subjects replied to a postal screening questionnaire (response rate = 72.7%) on the presence of asthma symptoms and exacerbations, and their impact on daily life. All subjects reporting having ever had a doctor diagnosis of asthma and either taking medicine for asthma when interviewed or having had an asthma attack in the last 12 months, were considered current asthmatics. RESULTS: Of the screened subjects, 649 (3.4%) were current asthmatics. Of these, only 14% did not report exacerbations or had been symptom-free in the last 12 months. More than 20% of current asthmatics had their daily life activities seriously impaired and 54 patients (8%) had at least one hospital/emergency department admission as a result of asthma exacerbation in the last 12 months. The life impairment and the rates of hospitalization significantly increased as the control of the symptoms worsened. The use of asthma drugs was quite common in current asthmatics: 586 (90.2%) reported having been under pharmacological treatment in the last 12 months. Only 63 patients (10%) had the disease under control (neither symptoms nor life impairment): they had a significantly higher percentage of drug use (100%vs 89%) and of daily use prescriptions (50%vs 36%) than non/moderately controlled asthmatics. Poorly controlled asthmatics had a significantly higher percentage of women (63%vs 44%), of patients with the coexistence of chronic cough and phlegm (47%vs 30%) than moderately/well-controlled asthmatics. The comparison between our data and similar data collected in 1991 in Italy showed that the use of asthma drugs increased by about 12%, while the control of symptoms did not improve in the last decade. CONCLUSION: Despite the high percentage of drug users, the control of symptoms and exacerbations was overall poor in Italy and resulted in a heavy individual and social burden, pointing out that the guideline goals have far from been reached in Italy.
Abstract: BACKGROUND: Environmental factors are likely to be involved in explaining the wide geographical variation in asthma and atopic diseases that has been documented in many recent epidemiological studies. AIM: To evaluate to what extent climate and outdoor NO2 pollution can explain the geographical variation in the prevalence of asthma and allergic rhinitis, and to estimate the relative risk for exposure to different levels of these two factors. METHODS: The impact of climate and long-term exposure to nitrogen dioxide (NO2) pollution on asthma and allergic rhinitis was assessed in a cross-sectional study, carried out during 1998 to 2000 on young adults aged 20 to 44 years (n = 18 873), living in 13 areas from two different Italian climatic regions (subcontinental and Mediterranean). RESULTS: Mediterranean areas had a significantly higher prevalence of asthma-like symptoms (P < 0.001), higher annual mean temperature (16.2 degrees C vs. 12.9 degrees C), lower temperature range (16.0 C degrees vs. 22.1 degrees C) and lower NO2 levels (31.46 microg/m3 vs. 57.99 microg/m3) than subcontinental ones. Mediterranean climate was associated with an increased risk of wheeze (OR = 1.23; 95% CI 1.13 to 1.35), tightness in the chest (OR = 1.21; 95% CI 1.11 to 1.33), shortness of breath (OR = 1.21; 95% CI 1.08 to 1.36) and asthma attacks (OR = 1.19; 95% CI 1.07 to 1.31). After adjusting for climate, an increase of 18.3 microg/m3 in NO2 levels moderately increased the risk of asthma attacks (OR = 1.13; 95% CI 0.98 to 1.32), tightness in the chest (OR = 1.11; 95% CI 0.98 to 1.26) and wheeze (OR = 1.11; 95% CI 0.96 to 1.28). When the levels of outdoor NO2 exposure rose, the prevalence of allergic rhinitis increased significantly in the Mediterranean region (OR = 1.38; 95% CI 1.12 to 1.69), but not in the subcontinental one (OR = 1.03; 95% CI 0.83 to 1.28). CONCLUSION: Our results show that the prevalence of asthma increases when annual mean temperature increases and temperature range decreases. Furthermore, climate interacts with NO2 outdoor exposure, increasing the risk for allergic rhinitis in people exposed to high stable temperatures. A long-term role for the effect of traffic pollution on asthma is also suggested.
Abstract: This paper is about a community action for the implementation of a WHO Collaborative Project on the reduction of hazardous drinking in Primary Health Care Settings called "Drink-less". The article stresses the need to shift the attention from alcoholic treatment towards the reduction of alcohol consumption. After the development of a valid screening instrument and counselling material ("Drink-less" Package), the strategies to involve General Practitioners in early intervention are studied. A Pilot Project was implemented in the City of Udine by the Municipality through its Healthy City Project Office. "Healthy City" is a WHO project that stimulates Local Administrations to implement health promotion and Community actions through an intersector work. Besides the undoubted validity of the overall "Drink-less Project", the study emphasizes the importance of GPs in secondary prevention of hazardous drinking and the necessity to re-orient programmed action in Public Health and health promotion. "Healthy City WHO Project" can be an important tool for the implementation of Community actions in Public Health.
Abstract: 165 patients (106 males, 59 females) entered an open group comparative study of a 12-week test treatment on bronchial hyperresponsiveness (BHR) determined by methacholine challenge. Patients were randomly allocated to receive nedocromil sodium (4 mg q.i.d.), sodium cromoglycate (10 micrograms q.i.d.) and beclomethasone dipropionate (500 micrograms t.i.d.). At the end of the study, an 2.25-fold increase of the PD20FEV1 was noted in all the treated patients. No significant difference was noted among the treatments.
