Journal of Public Health Research <p><strong>The Journal of Public Health Research</strong> is an online Open Access, peer-reviewed scholarly journal in the field of public health science. The aim of the journal is to stimulate debate and dissemination of knowledge in the public health field in order to improve efficacy, effectiveness and efficiency of public health interventions to improve health outcomes of populations. This aim can only be achieved by adopting a global and multidisciplinary approach. <br><br> <strong>The Journal of Public Health Research </strong>publishes contributions from both the 'traditional' disciplines of public health, including hygiene, epidemiology, health education, environmental health, occupational health, health policy, hospital management, health economics, law and ethics as well as from the area of new health care fields including social science, communication science, eHealth and mHealth philosophy, health technology assessment, genetics research implications, population-mental health, gender and disparity issues, global and migration-related themes. In support of this approach, the Journal of Public Health Research strongly encourages the use of real multidisciplinary approaches and analyses in the manuscripts submitted to the journal. In addition to <em>Original research</em>, <em>Systematic Review,</em> <em>Meta-analysis</em>, <em>Meta-synthesis</em> and <em>Perspectives</em> and <em>Debate</em> articles, the Journal of Public Health Research publishes newsworthy <em>Brief</em> <em>Reports</em>, <em>Letters</em> and <em>Study Protocols</em> related to public health and public health management activities.</p> en-US <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li>the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li>a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> (Emanuela Fusinato) (Tiziano Taccini) Thu, 20 Dec 2018 00:00:00 +0100 OJS 60 Social egg freezing under public health perspective: Just a medical reality or a women’s right? An ethical case analysis <p>In recent years, a social trend toward delaying childbearing has been observed in women of reproductive age. A novel technomedical innovation was commercialized for non-medical reasons to healthy, ostensibly fertile women, who wished to postpone motherhood for various reasons such as educational or career demands, or because they had not yet found a partner. As a consequence, these women may be affected by age-related infertility when they decide to conceive, and fertility preservation techniques can be obtained through the so-called <em>social egg freezing</em>. This paper examines, from an ethical point of view, the impact of social egg freezing under some aspects that can involve policy making and resources allocation in public health. Due to the increasing demand for this procedure, some debated issues regard if it is reasonable to include social egg freezing in Public Healthcare System and consequently how to manage the storage of cryopreserved oocytes also from individual donors, how to support these egg banks and how to face, in the future, with the possibility that egg freezing will play a role in enabling childbearing for gays, lesbians, and unmarried persons. Social freezing may be advertised to harmonise gender differences, but we wonder if it is the proper solution to the problem or if it could also create further challenges. An ethical argumentation on these topics should address some questions that will be discussed.</p> Ana Borovecki, Pamela Tozzo, Nicoletta Cerri, Luciana Caenazzo ##submission.copyrightStatement## Thu, 20 Dec 2018 10:33:24 +0100 Unreasonable obstinacy: Ethical, deontological and forensic medical problems <p>Especially in oncology and in critical care, the provision of medical care can require therapeutic choices that could go beyond the patient’s will or intentions of the protection of his health, with the possible adoption of medical behaviors interpreted as <em>unreasonable obstinacy</em> or, at the opposite extreme, as euthanasia. In some cases, the demand for obstinate therapeutic services could come from the patient or from his relatives, in which case the dilemma arises for the health professional between rejecting such a request, in respect of their professional autonomy, or abiding by it for fear of a professional care responsibility for therapeutic abandonment. We analyzed and commented on emblematic clinical cases brought to court for alleged wrong medical conduct due to breach of the prohibition of <em>unreasonable obstinacy</em>. In healthcare it is impossible to fix a general rule defining any therapeutic act as appropriate, because on one hand there are technical assessments of medical competence, and on the other the perception of the patient and of his family members of the usefulness of the health care provided, which may be in contrast. The medical act cannot make treatments that are inappropriate for the needs of care or even be <em>unreasonable</em>; conversely, before the request by the patient or by his family members for disproportionate health services in relation to the results they may give in practice, in compliance with the legislative and deontological provisions, the doctor can refuse them, thus safeguarding both his decision-making autonomy and, therefore, his professional dignity.</p> Claudia Casella, Vincenzo Graziano, Pierpaolo Di Lorenzo, Emanuele Capasso, Massimo Niola ##submission.copyrightStatement## Thu, 20 Dec 2018 10:32:52 +0100 Perceptions of health professionals about the quality of communication and deliberation with the patient and its impact on the health decision making process <p>The information process is considered a core element in decision-making and an obligatory matter of concern for the health professional. Rather than information <em>per se</em>, we should perhaps mention the need for communication between the health professional and the patient, which should be appropriate to each specific case and situation. Interaction and communication during the relationship generates a degree of trust that contributes to improving care quality and health-related results. The aim of this study is to know the perception of professionals on the quality of communication and its impact on the decision-making process of the patient and the degree of involvement of health professionals in the process of communication with the patient. A sample of 2186 health professionals (1578 nurses, 586 physicians, and 22 pharmacists) was studied. A questionnaire composed of 20 items dealing with the process of communication with the patient and obtaining informed consent was administered. Our study revealed the high consideration that professionals hold of their communication skills with patients since almost 80% of those surveyed, think they are sufficiently skilled in this area. Professionals refers that nurses are most skilled at communicating with patients. Communication in the clinical relationship must not only serve as a way for the professional to obtain information from the patient on their pathology, but also as a means to inform patients so that they understand their illness. Patients also like to feel that they are being listened to and are co-participants in the care process. Communication should be a continuous object of study for all health professionals, both in primary and specialised attention.</p> Eduardo Osuna, Antonio Pérez-Carrión, María D. Pérez-Cárceles, Francisco Machado ##submission.copyrightStatement## Thu, 20 Dec 2018 10:29:59 +0100 Analysis of the information in mandatory reporting in victims of gender violence <p>The healthcare professional plays a key role in the detection and subsequent channeling of a situation of violence to a judicial level for appropriate investigation. The mandatory reporting of gender violence has become a controversial issue among health care practitioners and victims. The objective of this study was to analyze the quality of the way in which injury reports on victims of gender violence is completed, through an analysis of the information they include, the readability and the degree to which the document can be understood. A retrospective study in a sample of 197 injury reports were performed from health services (primary care, hospital services and emergency services). We analyzed 22 variables related to the content, readability of the document, the victim’s identification data as well as identification of the doctor responsible for assistance, the moment of assistance and the characteristics of the injury. The most frequent deficiencies in the data are identification of the doctor responsible for medical attention, the date on which the aggression occurred, a description of the injuries and the judgment of compatibility between the cause of injury (according to the victim) and the actual injury they have. The injury reports do not conform to the legal requirements needed in a document of such extraordinary importance. Greater awareness in health professionals concerning the importance of the injury report as a medicolegal document is needed so that the correct information can be provided to the relevant judicial authority.</p> Belen Reynaldos, Faustina Sánchez-Rodríguez, Isabel Legaz, Eduardo Osuna ##submission.copyrightStatement## Thu, 20 Dec 2018 10:24:00 +0100 Impact of asbestos on public health: a retrospective study on a series of subjects with occupational and non-occupational exposure to asbestos during the activity of Fibronit plant (Broni, Italy) <p>The goal of this study is to understand more about the role of asbestos in causing human diseases, first of all mesothelioma, by investigating a large series of deaths due to asbestos-related diseases (ARDs). The main aim is to clarify if even very low amounts of asbestos can cause mesothelioma and other ARDs, as well as to find out if a different individual vulnerability can be important. This retrospective study included 188 subjects who died from asbestos related diseases in 2000-2017 in the area around Broni, Italy, where an important asbestos cement factory had been active from 1932 until 1993. In each case, a forensic autopsy has been performed. In order to perform the present study, the records were retrieved, including the clinical files, the autopsy, and the histological report. The statistical analysis performed showed that there was a significant relation between the cause of death (mesothelioma, lung cancer or asbestosis) and the kind of exposure (occupational, neighborhood or household), showing that all the subjects not exposed occupationally (and, therefore, exposed to lower amounts of asbestos) died from mesothelioma, whereas the individuals who used to work at the plant died also from other caused (asbestosis, lung cancer). Significant differences were highlighted examining the distribution of the causes of death according to the smoking habits. Moreover, among the mesothelioma patients, the survival time was shorter in the subjects with a neighborhood or household exposure than in the occupationally exposed individuals. The study provided meaningful data about the role of asbestos in causing human pathologies. In particular, the present data appear to support the hypothesis that even an exposure to a very little amount of asbestos can cause mesothelioma in hypersusceptible subjects (probably, on a genetic basis).</p> Silvia D. Visonà, Simona Villani, Federica Manzoni, Yao Chen, Giorgio Ardissino, Francesca Russo, Matteo Moretti, Gulnaz T. Javan, Antonio Osculati ##submission.copyrightStatement## Thu, 20 Dec 2018 10:19:12 +0100 Vaccination policy in Italy: An update <p>The effective control of vaccine-preventable diseases generally requires indefinite maintenance of extremely high rates of timely vaccination. Therefore, vaccine hesitancy is of paramount importance and needs to be addressed. In Italy, regulations about vaccinations are controversial and, to some extent, inconsistent. Even though the childhood vaccinations are mandatory by law (Italian Law n. 891/1939, n. 292/1963, n.51/1966 and n. 165/1991), the limited deterrent effectiveness of the sanctioning system, and the changes introduced by the Italian Constitutional Law n. 3/2001 (devolution of almost all the competences and responsibilities in health matters to the Regions and the Autonomous Provinces), were the fertile ground in which new vaccine policies were generated and developed, radically different from the existing ones: many Regions, based on what was decided in 2005 - on an experimental basis - by the State-Regions Conference, decided to abolish the vaccination obligation and/or to stop the imposition of administrative sanctions on non-compliant parents. In addition, since then, there is a worrying tendency to decline vaccinations due to the parents’ mistrust in pharmaceutical companies and health policies. Therefore, recently, the Italian government decided to deploy an emergency ordinance (Italian Decree Law n. 73/2017). In this article, the authors are going to illustrate the current situation in Italy concerning vaccination policy, from a legislative and social point of view.</p> Stefano Crenna, Antonio Osculati, Silvia D. Visonà ##submission.copyrightStatement## Thu, 20 Dec 2018 10:17:59 +0100 Ethics in public health <p>Not available</p> Adelaide Conti ##submission.copyrightStatement## Thu, 20 Dec 2018 10:15:41 +0100 The protection of health in the care and trust relationship between doctor and patient: Competence, professional autonomy and responsibility of the doctor and decision-making autonomy of the patient <p>The Authors review Law No. 219/2017, with its important contribution to defining the roles and responsibilities of subjects in care relationship – a dynamic relationship (over time, for the condition of the interested party, to people who may be involved) – and regulating advance directives and shared planning of care. The Law promotes and enhances the relationship of care and trust between doctor and patient, which includes the competence, professional autonomy and responsibility of the doctor and the decisional autonomy and right to self-determination – to make an informed and voluntary choice about treatment proposed by the doctor - of the patient. For concrete implementation of the Law, an adequate information system and all the measures to guarantee certainty about the consequences of behaviour and protection of the rights of all the subjects involved are now essential. In addition, for advance directives, it is essential to reflect on the adequacy of medical information required by the Law itself for its drafting, considering that the citizen can contact qualified professionals and also independently find this information autonomously, selecting the sources of information.</p> Paola Delbon ##submission.copyrightStatement## Thu, 20 Dec 2018 10:13:17 +0100 Challenges of migration and culture in a public health communication context <p>Not available</p> Rukhsana Ahmed ##submission.copyrightStatement## Thu, 08 Nov 2018 08:58:21 +0100 Predicting the outcome of occupational accidents by CART and CHAID methods at a steel factory in Iran <p><em>Background</em>: A large number of occupational accidents happen at steel industries in Iran. The information about these accidents is recorded by safety offices. Data mining methods are one of the suitable ways for using these databases to create useful information. Classification and regression trees (CART) and chisquare automatic interaction detection (CHAID) are two types of a decision tree which are used in data mining for creating predictions. These predictions could show characteristics of susceptible people exposed to occupational accidents. This study was aimed to predict the outcome of occupational accidents by CART and CHAID methods at a steel factory in Iran. <br><em>Design and methods:</em> In this study, the data of 12 variables for 2127 cases of occupational injuries (including three categories of minor, severe and fatal) from 2001 to 2014 were collected. CART and CHAID algorithms in IBM SPSS Modeler version 18 were used to create decision trees and predictions. <br><em>Results:</em> Five predictions for the outcome of occupational accidents were created for each method. The most important predictor variables for CART method included age, the cause of accident and level of education respectively. For CHAID method, age, place of accident and level of education were the most important predictor variables respectively. Furthermore the accuracy of CART and CHAID methods were 81.78% and 80.73%, respectively for predictions. <br><em>Conclusions:</em> CART and CHAID methods can be used to predict the outcome of occupational accidents in the steel industry. Thus the rate of injuries can be reduced by using the predictions for employing preventive measures and training in the steel industry.</p> Gholam Abbas Shirali, Moloud Valipour Noroozi, Amal Saki Malehi ##submission.copyrightStatement## Thu, 08 Nov 2018 08:20:29 +0100