Istituto Superiore di Sanita (ISS), Italy
Emanuele Scafato, MD
Claudia Gandin, MD
The Istituto Superiore di Sanità (ISS) was established in 1934 and it is the leading technical and scientific public body of the Italian National Health Service. Its activities include research, control, training and consultation in the interest of public health protection.
Research and Trial
The Institute conducts scientific research in a wide variety of fields, from cutting-edge molecular and genetic research to population-based studies of risk factors for disease and disability. Research priorities are based on those set forth in the National Health Plan. The Institute is also involved in several major clinical trials, which are frequently conducted in cooperation with the Scientific Institutes for Research and Care (IRCCS) network and Hospitals.
Inspection, Monitoring and Certification
An important activity of the Institute, which is mandated by the Minister of Health or the Regions, is certification of the chemical and biological purity of drugs and vaccines, as well as inspection and quality control of medical and diagnostic devices and equipment, food products and packaging. It monitors trends in disease, mortality and other health factors and provides technical support for health-related environmental surveys and for investigations of epidemics and other public health problems at national, regional and local level. It also supervises the laboratories engaged in the testing of prohibited substances in sport and the national veterinary institutes. Finally, it has an important role in monitoring and coordinating blood transfusion services and plasma production in Italy.
Documentation, Information and Publication
The Institute serves as a major source of information relating to public health and biomedicine in Italy through online connections to national and international scientific databases and data banks. It also serves as the national reference centre for MEDLARS (MEDical Literature Analysis and Retrieval System), a comprehensive international data bank coordinated by the US National Library of Medicine (NLM). The Institute produces numerous publications, including a quarterly peer-reviewed journal, technical reports, a monthly newsletter describing the Institute's major research activities, and a national epidemiological bulletin.
Training and Scientific Meetings
The Institute plans, implements and evaluates training activities in a wide variety of areas, with courses designed to address the needs of the National Health Service. It develops and tests innovative training methods, including web-based distance learning. Training is provided for various categories of professionals; methods range from short courses and hands-on workshops to more structured and formal courses at national and international level. The topics addressed include health service management and evaluation, epidemiology and biostatistics, training methods, laboratory techniques, diseases control and priority public health issues, and health promotion. The Institute also organises congresses, conferences, workshops and seminars for national and international participants on fundamental public health issues linked to its institutional activities and research. These events are often organised in cooperation with international organisations such as the European Union, specialised UN Agencies and non-governmental organisations with which the Institute maintains close relations.
The Institute plans, implements and evaluates international health projects, ranging from cooperative research and development projects to humanitarian assistance. It actively promotes cooperation at three different levels of involvement: scientific partnerships with industrialised countries (USA, European partners, Japan); scientific and development projects in partnership with economies in transition (including China, South Africa, the Central Asian Republics and countries in Latin America, the Balkans and the Middle East); development partnerships in Africa and countries in turmoil, where humanitarian and technical assistance is provided in close collaboration with the Italian Ministry of Foreign Affairs, various UN Agencies and the World Bank, as well as the Global Fund for AIDS, Tuberculosis and Malaria. Several members of the Institute serve on panels of experts for the Fund as well as on other international committees and commissions. Current projects include research into the prevention and treatment of HIV/AIDS and poverty-related diseases, capacity-building for central health administrations, technology transfer in health management and technical support for national public health authorities, usually within the context of health care reform. There is growing interest and cooperation in the application of telematics to health issues, in keeping with the priorities recently established by the G8 and the Italian government.
National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS) at ISS
The mission of the National Centre is to develop and apply epidemiological and biostatistical methods to monitor and protect human health and to evaluate health services.
The Centre is involved in determining the incidence, prevalence and mortality of the major infectious and non-infectious diseases. It conducts research, including on-site data collection, on health determinants, such as smoking, alcohol consumption, physical activity, nutrition, etc. and on risk factors for major diseases.
At present, research is being conducted on the elderly and on Alzheimer's disease, diabetes, cardiovascular disorders, cancer and primary infectious diseases. The Centre is also responsible for drug surveillance and control, as well as for conducting Pharmacoepidemiological studies to evaluate the appropriateness of prescription practices and health care costs. The Centre is also involved in evaluating the quality of health services and in developing and implementing surveillance systems for public health emergencies, including rapid alert and response systems. It monitors the outcomes of hospital procedures, such as coronary artery bypasses, in order to compare and improve the quality of services.
The Centre has recently produced cardiovascular risk tables for the guidance of doctors and specialists in primary prevention. In the field of infectious diseases, the Centre plays a leading role in the national plan to eradicate measles; it collects and disseminates epidemiological data on the major infectious diseases and provides advice on vaccine testing. The Centre is also involved in training and cooperates in research and monitoring activities with national, regional and local institutions and with international organisations such as the European Union, WHO, OECD and major foreign public health institutes. Moreover, the centre houses the ISS Statistics Office.
Population Health and Health Determinants Unit (PHU) at CNESPS-ISS
The PHU integrates epidemiology, health monitoring and health promotion through studies, population surveys, monitoring, counselling and training.
The main activities are aimed at:
Producing scientific evidence by means of statistical and epidemiological information;
- Implementing models and monitoring systems;
- Creating data banks;
- Formulating guidelines on early diagnosis, prevention and health promotion regarding the main health determinants, risk factors and diseases.
In particular the PHU is engaged in the following areas:
- The relationship between the main determinants of health and risk factors and prevalence, incidence and natural history of chronic pathologies;
- The development of systems of simple and complex indicators to monitor, assess and evaluate the health condition of the population and health system performance;
- Ageing: disability, comorbidity, cognitive impairments; predictivity of biological, genetical and psychodiagnostic markers and progression of the cognitive impairment in dementia and Alzheimer disease; study of the transition from the preclinical stage to the evident disease;
- Quality of care for the elderly, dynamics of access to health services, planning and implantation of specific data banks and their implementation;
- The development of prevention and health promotion activities for national health planning and policy; expert guidance to the National Health Service on the environmental determinants of human health;
- Epidemiology of alcohol consumption and abuse; monitoring of consumption in the at risk population, particularly under-age, young people and elderly; early detection of alcohol abuse and brief intervention strategies; prevention strategies in general practice and in other health settings; training of health professional;
- Health promotion campaigns and information activities (via websites and dedicated services), on alcohol use, abuse and other alcohol-related pathologies;
- Epidemiological studies on the relationship between exposure to electromagnetic fields and human pathologies;
- Etiological studies on the relationship between exposure to pesticides and human pathologies;
- Management of the national registry on workers exposed to phytosanitary products.
The PHU collaborates with various national and international research bodies and is the site of the World Health Organization Collaborating Center for Research and health promotion on alcohol and alcohol-related problems, and of the National Observatory on Alcohol.
The Unit is the main contributors in "cognitive" field as National leader and coordinator of the main population based projects on Alzheimer disease (I.PR.E.A. project "Italian Project on the Epidemiology of Alzheimer's disease"), dementia, cognitive impairment and Ageing (ILSA project "Italian Longitudinal Study on Aging", with hundred of scientific publications) as well as research group on the methodologies aimed at refining and updating definitions and indicators for monitoring and reporting on cognitive impairment.
PHU acts as Subsecretariat of the European Commission Working Party on Health Indicators - European Community Health Indicators and Monitoring, via the ECHIM group. Furthermore, PHU is the main partner of the VINTAGE project: Good health into older age funded by EU, Public Health Programme 2008-2013, with the main objective to build capacity at the European, country and local levels by providing the evidence base and collecting best practices to prevent the harmful use of alcohol amongst older people, including the transition from work to retirement, and to invest in older people's health and well-being.