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INTRODUCTION: Current lengthening of average life and constant increase of population ageing associated to forces that include rapid unplanned urbanisation and globalisation of unhealthy behaviours have determined the huge relevance of noncommunicable diseases (NCDs). Monitoring key modifiable behavioural risk factors has resulted to be crucial both in spatial terms and as per temporal trends in order to allow comparisons between different geographic areas or levels and over time. MATERIALS AND METHODS: In Italy, PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia) and Passi d'Argento are the ongoing Behavioural Risk Factor Surveillance Systems (BRFSSs), respectively, on adults (people aged 18-69) and elderly (65 and older). RESULTS: The two Italian surveillances are information systems providing data not only on the third Sustainable Development Goal (SDG) that explicitly addresses ensuring healthy lives and promoting well-being for all, but on a total of nine health-related SDGs (HRSDGs) and 19 HRSDG targets/indicators. We describe these pairs more in detail specifying where in case of BRFSS core indicators (N = 14 HRSDG targets/indicators) concerning six HRSDGs or, on the other hand, as per BRFSS further in-depth analysis (N = five HRSDG targets/indicators) in regard of four different HRSDGs. About the HRSDG 3, HRSDG target 3.4, HRSDG indicator 3.4.1, from the PASSI and Passi d'Argento data it is possible not only to detect the prevalence of NCDs in adults and elderly living in Italy, but also to evaluate the social determinants of health, such as gender, age group, educational level, economic difficulties, as well as the associations with modifiable lifestyle risk factors. CONCLUSIONS: The two Italian BRFSSs generate accurate data, which are highly relevant to design, implement, monitor, and evaluate programs and policies at different levels (local, regional, national) for NCD prevention and health promotion. They provide numbers which can also serve as propaedeutic or, in some cases, complementary ground to address a robust measurement of several HRSDG patterns.

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INTRODUCTION: The avoidable mortality (ME)represents the share of deaths that occurs at an early age (0-74 aa) for causes that cannot be faced by means of public health or health care measures. The work develops a strategic intervention plan aimed at the reduction of ME by identifying local priority actions based on epidemiologic and social-health data. METHODS: a working group among the Department of Prevention, Health Information Systems and Health District was set up. The databases used were: "State of Health Lazio" of the Department of Epidemiology of the Lazio Region; ASL Roma 2 local health data on general mortality (2014-2016) and the local health profile of the surveillance systems "OKkio alla Salute", Passi and HBSC Lazio. The analysis results in an estimation of Asl Roma 2's data and in a comparison of this data set with the regional level of three indicators: avoidable mortality, prevalence and incidence of chronic diseases and lifestyle profile. RESULTS: in the three-year period (2014-2016) there were about 1,900 avoidable deaths per year; in the ASL Roma2 the ME represents about 16% of the total mortality and 60% of them are borne by the male sex. 51% of ME concerns cancer, 27% is linked to cardio-vascular diseases, 10% to trauma and poisoning. A preliminary comparison of standardized ASL Roma 2 rates of prevalence and incidence with regional values shows higher figures for some pathologies in ASL Roma 2: COPD prevalence (114 vs 107), breast neoplasia incidence (174 vs 153), incidence of lung neoplasia (71 vs 65). Prevalence and incidence of chronic diseases at the District level are not entirely consistent with the regional values according to a two level score. Incorrect lifestyles are widespread in at least 30% of the population and are more frequent in families with low educational level and with reported economic difficulties. CONCLUSIONS: despite the intrinsic limitations of a precise estimate of the data and the possible biases in a process of inference, the method has allowed to identify the priorities to assign in primary and secondary prevention interventions planning and for the improvement of health care; this analysis has been structured in a three years Local Strategic Plan to face the ME and was articulated in general and operational objectives and actions measured by indicators both process and, where possible, outcome evaluation.

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BACKGROUND: In Italy, organized screening programmes invite the vast majority of the population for cervical and breast cancer, and about one half of the population for colorectal cancer. Programme activity and quality are closely monitored. Nevertheless, there is a vast spontaneous activity, both public and private, for which information on service and coverage is missing. To estimate actual population coverage for the three types of screening the extent of spontaneous screening needs to be known. METHODS: PASSI is a national telephone-interview surveillance system that continuously collects information about behavioural health risk factors and the diffusion of preventive health interventions. From 2010 to 2013, more than 151,000 18- to 69-year-olds were interviewed. During 2013, 136 out of 147 Italian local health authorities participated in the survey. Information about screening includes: test uptake (Pap smear, HPV, mammography, faecal occult blood test, colonoscopy), date of the last test, provider of the last test (whether paid or for free, proxy of the organized screening programme), reason for not participating in screening, and screening promotion/recommendation received. Individual information on socio-economic characteristics is available. RESULTS: Seventy-seven percent of the 25-64 year-old women interviewed said they had undergone a Pap smear or HPV test in the three years before the interview, 40%within the screening programme, 37% spontaneously and paying. Seventy percent of the 50-69 year-old women interviewed reported having had a mammography in the two years before the interview, 51% within the screening programme, 19% spontaneously and paying. Thirty-eight percent of the 50-69 year olds interviewed reported having undergone colorectal screening in the two years before the interview, 31% within the screening programme, 7% spontaneously and paying. All three screening programmes showed a decreasing North-South trend in coverage. From 2010 to 2013, coverage increased for all types of screening; the trend was stronger in the South; the increase was mostly due to the tests performed within the organized programmes. People with low education, economic problems, and immigrants from high migration pressure countries had lower coverage levels. In regions with well-implemented organized screening programmes, test coverage was higher and differences for socio-economic factors were smaller than in regions with incomplete programme activation.

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The new Plan for Elimination of Measles and Congenital Rubella 2010-15 recommends the local health unit (ASL) to analyze the immunization coverage data available in the adult population cohorts, in order to identify susceptible people. The aim of this paper is to estimate the susceptibility to rubella in resident women of childbearing age, through integration of all ASL data sources, in order to implement the most appropriate vaccination strategy for susceptible women. In ASL Roma C, the "PASSI" surveillance system estimates a 53% prevalence of childbearing age women immune to rubella; as many as 43 % is not aware of her immune status and 4% is certainly susceptible because of reporting a negative result "rubeotest" (years 2008-10). The data extracted from the database of the ASL Roma C laboratory (year 2010) estimate a prevalence of approximately 20% of susceptibility among women who spontaneously perform a rubeotest at the hospital laboratory for any reason (control or pregnancy). Childbearing age women susceptible to rubella, residing in the territory of our ASL, are definitely more than 5%, ranging from 4% estimated by the "PASSI" surveillance system to 20% detected by hospital laboratory.

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Monitoring perceptions, knowledge, attitudes and behaviors of populations during pandemic flu outbreaks is important as it allows communication strategies to be adjusted to meet emerging needs and assessment to be made of the effects of recommendations for prevention. The ongoing Italian Behavioral Risk Factor Surveillance System (PASSI) offered the setting for investigating people's opinions and behaviors regarding the A/H1N1 pandemic. PASSI surveillance is carried out in 126/148 Italian Local Health Units (LHU) through monthly telephone interviews administered by public health staff to a random sample of the resident population 18-69 years. In fall 2009 additional questions exploring issues related to the A/H1N1 flu were added to the standard questionnaire. The pandemic module was administered on a voluntary basis by the 70 participating LHUs from November 2nd, 2009 to February 7th, 2010; 4 047 interviews were collected. Overall 33% of respondents considered it likely that they would catch flu, 26% stated they were worried, 16% reported having limited some daily activities out of home and 22% said they would accept vaccination if offered. All these indicators showed a decreasing trend across the four-month period of observation. The most trusted sources of information were family doctors (81%). Willingness to be vaccinated was associated with worry about pandemic, age, sex, having a chronic disease and timing of the interview. The surveillance allowed us to gather relevant information, crucial for devising appropriate public health interventions. In future disease outbreaks, systems monitoring people's perceptions and behaviors should be included in the preparedness and response plans.

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Long-term immunoprophylaxis with anti-HBs immunoglobulins (HBIg) is used to prevent hepatitis B (HBV) reinfection after liver transplantation for HBV-related cirrhosis. This approach is highly expensive. A recent report proposed posttransplant HBV vaccination with a reinforced schedule as an alternative strategy to allow HBIg discontinuation. We investigated the efficacy of a reinforced triple course of HBV vaccination in 17 patients transplanted for HBsAg-positive cirrhosis 2 to 7 years earlier. The first cycle consisted of 3 double intramuscular doses (40 microg) of recombinant vaccine at month 0, 1, and 2, respectively. This was followed, in nonresponders, by a second cycle of 6 intradermal 10 microg doses every 15 days. All nonresponders then received a third cycle identical to the first one. Vaccination started 4.5 months after HBIg discontinuation, and lamivudine (100 mg/day) was given throughout the study. All patients were seronegative for HBsAg and HBV-DNA (by PCR) and positive for anti-HBe, and 7 were positive for anti-HDV. After the first cycle one patient (#5, 53 years old, male) developed an anti-HBs titer of 154 IU/L, another (#12) reached a titer of 20 IU/L and the remainder had titers <10 IU/L. At month 7, patient #5 reached a titer of 687 IU/L. After the second cycle only one additional patient (#9) had a slight response (an anti-HBs titer of 37 IU/L). After the third cycle patient #9 rose to an anti-HBs titer of 280 IU/L, patient #12 dropped to 10 IU/L, and no other patient responded. In conclusion, a highly reinforced HBV vaccination program is effective only in a few patients who had liver transplants for HBV-related cirrhosis.

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