Zadig (Italy)

The decision aid "Donnainformata-mammografia" (https://www.donnainformata-mammografia.it/en/) has been developed with the aim of providing clear information on the benefits and harms of breast cancer screening, and the controversies on the relationship between mortality reduction and overdiagnosis. It was evaluated in a randomized clinical trial showing it increases informed choice and does not decrease participation in screening.This article describes the framework, the guiding principles, and the operational phases of the tool development.The project was developed within the national screening programme. The promoters decided to state their placement, to start from the information needs of women and what is already known, and to balance spontaneous navigation with "nudging" to key contents. Three focus groups with 18 women and 4 interviews were organized. Participants expressed a favourable attitude towards screening, and no knowledge of the debate on screening efficacy and overdiagnosis. A literature review and a comparison of decision aids were conducted. The online tool included the results of these steps. The home page presents key information with links to relevant topics, so that the person can decide to stop there having an overview or to continue. The «ready to decide» button, which leads to the section of decision support, can be clicked on every page. Here, the person can evaluate a list of key points on the basis of her values, in order to decide to participate in screening or not.

positive.The HCWs who voluntarily applied for the Ebola team more often reported positive experiences -less stress and anxietythan HCWs who were mandatorily appointed.Our results underline the importance of a supportive working environment suitable for crises.Training and simulation exercises were seen as helpful for dealing with this new situation with a high risk of infection. ConclusionsOur study shows that, while preparing for outbreaks, a general working environment that meets the needs of the individual and ensures the support of the team and the managers is crucial.The experiences of HCWs dealing with patients with suspected Ebola can direct improvements in generic preparedness for highly transmissible diseases.

AimsMost public health agencies and learned societies agree that the prostate-specific antigen (PSA) test in asymptomatic men should not be recommended, on account of its potential for harm. Yet PSA is still widely used as a screening test and is not being abandoned. This remains a significant public health issue, and citizens’ engagement is needed. This study was designed to produce a deliberation on the PSA screening test by a citizens’ jury.MethodsFifteen citizens were selected and balanced for sex, age, and education. They received an information booklet and participated in a two-day meeting with experts to reach a deliberation on the question “Should the National Health Service discourage or recommend PSA as an individual screening test for prostate cancer in men 55–69 years old?”. A facilitator ran the jurors’ discussion.ResultsAll except three of the jurors decided that the National Health Service should discourage the use of PSA as an individual screening test for prostate cancer in 55–69 year-old men. The jury was particularly convinced by the uncertainty of the test outcomes, the utility of the test, and its cost/benefit ratio. Before the meeting 60% of jurors would have recommended the test to a relative, and all the male jurors would have done so. After the meeting these percentages fell to 15% and 12%.ConclusionsThis experience confirms the feasibility and effectiveness of delegating to a group of citizens the responsibility to decide on public health issues on behalf of the community. Public health authorities should invest in information campaigns aimed at the public and in educational initiatives for physicians. This also provided an opportunity to disseminate information on screening, over-diagnosis, and over-treatment.

IntroductionWhen monitoring population health-related behaviours it is important to assess the effectiveness of delivering health related information to specific target groups such that any need for improved communication can be identified. The Italian Behavioural Risk Factors Surveillance System Passi is conducted through Local Health Units (LHUs) personnel interviewing a random sample of 18–69 year olds monthly. PinC, the Programme of Information and Communication for Gaining Health, promoted a training project for Passi care workers the aim of which was to achieve competency in communication using methods that were pre-tested and effective.MethodsForty operators from 25 LHUs participated in the six-monthly-training: three one day meetings (22 April 2010, 24 June 2010, 11 November 2010) and two rounds of two-monthly-activities in the field. A password-protected portal was used for exchanging materials among participants at a distance.ResultsThe seven inter-regional Working Groups planned communication, performed and tested materials using surveillance results for specific target groups at a local level. The need for effective approaches to communication was highlighted. Draft materials (leaflets for older women, posters for young people, charts for GPs, papers for policy makers/stakeholders) were tested on selected target groups. The two lay target populations (women, children) evaluated the tools positively, critiquing images, recommending clear and essential messages, clarifying what should be done to improve health. The professional groups suggested editing of text and space for graphs/tables. Materials will be modified accordingly and delivered.ConclusionSurveillance systems are valuable tools for advocacy at a local level. Communication is fundamental for knowledge, awareness and empowerment processes in specific target groups, professional and lay. To be effective, materials must be carefully planned and tested.

Italian media are very attentive to health and medicine issues. They face them--nonetheless--without any critical approach. Clinically tested medicine and "alternative" practices are presented as if they were both part of the same context. Such a lack of critical sense is no longer a question connected with sole medicine. It applies also to several different fields: from economics to foreign politics. The above situation is the result of a deep and radical change in the work organisation of the Italian mass media system. This change induced experienced professionals to leave their editorial offices--in so doing media critical esprit was no longer nourished. This change was the (avoidable) consequence of the exceptional increase in "infos" reaching the editorial offices through new telematics. The new situation led to a new conception of job organization and hierarchical structure. Where once small top managers' groups lived next to numerous specialised journalists, now editorial offices are composed by over 60 percent of staff concerned only with selection of news incoming through press agencies.