POPULATION HEALTH AND HEALTH DETERMINANS UNIT NIH.doc

OSSERVATORIO NAZIONALE ALCOL WHOCOLLABORATING CENTRE
REPARTO SALUTEDELLA POPOLAZIONE FOR RESEARCH AND HEALTH PROMOTION
E SUOI DETERMINANTI ON ALCOHOL AND ALCOHOL-RELATED
C.N.E.S.P.S. HEALTH PROBLEMS
Direttore: EMANUELE SCAFATO
ISTITUTO SUPERIORE DI SANITA’
CENTRO NAZIONALE DI EPIDEMIOLOGIA, SORVEGLIANZA E PROMOZIONE DELLA SALUTE
Via Giano della Bella, 34 - 00162 Roma, ITALIA
Tel. (+39) 06 4990 4028-4029 Fax (+39) 06 4990 4193 Cell. (+39) 346 6959152
e-mail: emanuele.scafato@iss.it – alcol@iss.it
Population Health and Health Determinants Unit (PHU)
National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS)
Istituto Superiore di Sanità (ISS), Rome, Italy
BRIEF REPORT OF THE ACTIVITIES

ISTITUTO SUPERIORE DI SANITA’
The Istituto Superiore di Sanità (ISS) is the
leading technical and scientific public body
of the Italian National Health Service
(NHS). 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
Publications
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 NHS. 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.
International Activities
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.
ISS National Centres
According to the ISS Presidential Decree of
January 24, 2003, the ISS National Centres
are technical scientific structures which
carry on research, control, advice and
training activities, also involving different
departments within the ISS and play a
coordinating role with institutions outside
the ISS. The ISS National Centres are:
- Center for Immunobiologicals
Research and Evaluation
- National AIDS Centre
- National Blood Centre
- National Centre for Chemical
Substances
- National Centre for Epidemiology,
Surveillance and Health Promotion
- National Centre for Rare Diseases
- National Italian Transplant Centre.
National Centre for Epidemiology,
Surveillance and Health Promotion
(CNESPS)
The mission of the CNESPS is to develop
and apply epidemiological and biostatistical
methods to monitor and protect human
health and to evaluate health services.
The CNESPS 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.

Population Health and Health
Determinants (PHU)
Under the CNESPS, the Population Health
and Health Determinants Unit (PHU),
directed by Prof. Emanuele Scafato,
integrates epidemiology, health monitoring
and health promotion through studies,
population surveys, monitoring, health
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:
1. the relationship between the main
determinants of health and risk factors
and prevalence, incidence and natural
history of chronic pathologies;
2. the development of systems of simple
and complex indicators to monitor,
assess and evaluate the health
condition of the population and health
system performance;
3. 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;
4. quality of care for the elderly,
dynamics of access to health services,
planning and implantation of specific
data banks and their implementation;
5. the development of prevention and
health promotion activities for national
health planning and policy; expert
guidance to the NHS on the
environmental determinants of human
health;
6. epidemiology of alcohol consumption
and abuse; monitoring of consumption
in the population at risk; early
detection of alcohol abuse and brief
intervention strategies; prevention
strategies in general practice and in
other health settings; training of health
professional;
7. health promotion campaigns and
information activities (via websites
and dedicated services), on alcohol
use, abuse and other alcohol-related
pathologies.
The Unit collaborates with various national
and international research bodies and is
acknowledged internationally by the World
Health Organization (WHO) in the quality
of WHO Collaborating Centre for Research
and Health promotion on Alcohol and
alcohol-related problems - WHO CC
(http://apps.who.int/whocc/Detail.aspx?cc_r
ef=ITA-79&cc_code=ita )
Actually, the WHO CC activities are aimed
to:
1. provide expert consultation &
assistance to the WHO Regional
Office for Europe (EURO) Alcohol &
Drug programme on alcohol
consumption, alcohol policies &
health promoting strategies in Europe;
2. participate in WHO research, data
collection & implementation projects

& provide assistance to the European
Alcohol Information System;
3. reinforce alcohol-related problems &
disease prevention through
multidisciplinary training & health
promotion;
4. reinforce national activities for an
early detection of harmful alcohol use,
warning & intervention strategies to
reduce alcohol damage and harm in
the general population;
5. assist the EURO in planning &
implementing annual meetings &
conferences;
6. support the implementation &
evaluation of the Framework for
Alcohol Policy in EURO;
7. contribute to the increase knowledge,
information and action on the alcohol
and ageing research area.
PHU incorporates also the National
Observatory on Alcohol (NOA), the formal
body for monitoring and reporting on
alcohol issues, deserving its activities to
research, assessment, prevention and
training in Epidemiology and Public Health
particularly on surveys on alcohol
consumption/abuse, evaluation and
assessment of alcohol-related harm,
assessment and analysis of population health
status trends. PHU provides formal
periodical reports for the National Statistic
System and for the Parliament (125/2001
Law). Since year 2000 PHU and NOA have
received the governmental mandate to deal
with the identification and implementation
of strategies aimed at curbing under-age
drinking, prevention programmes on
harmful drinking, providing scientific
evidence for the policy decision-makers and
for the implementation of the National
Alcohol and Health Plan.
PHU is the National Focal point, the
scientific and technical expert and advisor
appointed by the Italian Ministry of Health
and the Government representative on the
issues of a) alcohol and alcoholism, b)
alcohol policy, c) research, prevention and
health promotion related to alcohol use and
abuse.
The Unit is also committed in contributing
in aging research field mainly focusing on
epidemiology of age associate cognitive
decline, cognitive impairment, Alzeheimer
disease and dementia as National leader and
coordinator of the main population based
projects on Alzheimer disease (IPREA
project "Italian PRoject on the
Epidemiology of Alzheimer's disease") and
of the national cohort of the ILSA project,
"Italian Longitudinal Study on Aging", with
hundred of scientific publications produced
also oriented in providing research
protocols, guidelines and methodologies
aimed at refining and updating definitions
and indicators for monitoring and reporting
on cognitive impairment.
By the Unit is active the Subsecretariat of
the European Commission Working Party
on Health Indicators - European Community
Health Indicators and Monitoring, via the
ECHIM group.

SELECTION OF THE MAIN
CURRENT RESEARCH
ACTIVITIESCARRIED OUT BY THE
POPULATION HEALTH UNIT,
CNESPS, ISS
1. AMPHORA – Alcohol Measures for
Public Health Research Alliance
(European Commission 7th Framework
Programme)
http://www.amphoraproject.net
AMPHORA is a Europe wide project
involving researches and research institution
from 14 European Countries, and
counterparts and organizations from all 27
Member States.
PHU is involved in this project as National
Partner.
AMPHORA will provide new scientific
evidences for the best public health
measures to reduce the hard done by alcohol
through addressing social and cultural
determinants, marketing and advertising,
taxes and pricing, availability and access,
early diagnosis and treatment of disease,
interventions in drinking environments, and
safer untaxes alcohol products. Cost
effectiveness analyses will be undertakes in
multiple settings, geographical regions and
for different gender and age groups to guide
integrated policy making to reduce the harm
done by alcohol. Using time series analysis,
longitudinal intervention research, policy
mapping, cost effectiveness analyses, and
other policy relevant research
methodologies, recent and current alcohol
policy changes will be evaluated throughout
European Member States. Current alcohol
policy related infrastructures will be
documented and their impact on effective
policy development and implementation
analyzed. The interaction between social and
cultural determinants on alcohol policy and
policy and preventive measures will be
studied to determine the extent to which the
implementation and impact of effective
alcohol policies is culturally determined.
Methodologies will be developed to allow
tools for benchmarking and comparative
analysis at the European level, advancing
the state of the art in alcohol policy research
and enhancing cooperation between
researchers in Europe and other geographic
regions to promote integration and
excellence of European research in alcohol
policy. AMPHORA will provide the
evidence base to inform policy and decision
makers at European, national and local
levels to implement effective interventions
to reduce the harm done by alcohol
throughout a wide range of policies
implemented in different sectors and
settings.
The AMPHORA project and the Swedish
Society of Medicine jointly organised a
symposium (Berzelius Symposium 87 – the
Fifth European Alcohol Policy conference
“European debate on evidence-based alcohol
policy” – 18-19th October 2012 –
Stockholm, Sweden), to support dialogue
between alcohol science and policy and
inform the future directions of European
action.
This European conference was the final
event of the AMPHORA project, and as
such aimed to share the outcomes of the
project and discuss their value for national
and local policies and practice, and future
research. The event also succeeded in
stimulating debate and creative thinking
among the many and varied delegates from
European countries and networks about the
best opportunities and innovative strategies
for tackling alcohol-related problems. The
meeting further offered a major opportunity
to share learning experiences and innovative
ideas across countries about ways to
enhance and promote evidence-based
policies and practice.
During the conference the AMPHORA
MANIFESTO was launched. The

AMPHORA MANIFESTO summarises the
key messages and recommendations coming
out of the project. The AMPHORA
MANIFESTO full document is available at:
http://www.amphoraproject.net/files/file/A
MPHORA%20manifesto%20on%20alcohol
_October%202012.pdf
An accompanying video was also developed
in order to give an overview of the main
points in the manifest. The video is available
at:
http://www.amphoraproject.net/view.php?id
_cont=57
The translation into local languages and
dissemination of AMPHORA MANIFESTO
is ongoing as well as the publication of
scientific manuscripts.
The Italian version of the MANIFESTO is
already available at:
http://www.epicentro.iss.it/temi/alcol/pdf/M
anifesto%20Amphora%20ITA.pdf
2. ODHIN – Optimizing Delivery of Health
Care INterventions (European
Commission 7th Framework Programme)
http://odhinproject.eu/
ODHIN is a Europe wide project involving
research institutions from 9 European
countries that will help to optimize the
delivery of health care interventions by
understanding how better to translate the
results of clinical research into every day
practice.
Partner and as WP6 “Assessment Tool”
leader.
ODHIN will use the implementation of
Identification and Brief Intervention (IBI)
programmes for Hazardous and Harmful
Alcohol Consumption (HHAC) in primary
health care (PHC) as a case study. There is
strong evidence for the effectiveness and
cost-effectiveness of IBI in reducing HHAC
and its consequences, which include more
than 60 clinical diagnoses and conditions. A
series of systematic reviews investigating
the impact of different behavioural,
organizational and financial strategies in
changing provider behaviour across a range
of clinical lifestyle interventions will be
undertaken. The knowledge base of potential
barriers and facilitators to implementing IBI
will be updated. A stepped cluster
randomised controlled trial will be
undertaken with five arms and three time
phases to test the incremental effect of
strategies. Phase A will aim at raising
awareness, insight, and acceptance of
performance of IBI in PHC. Phases B and C
will aim at acceptance, change and
maintenance of implementation with
financial and organisational strategies used
in a different order to test the impact of both
separately and in sequence. Modelling
studies will test the impact of different IBI
approaches on changes in alcohol
consumption and the resulting impacts on
healthcare costs and health-related quality of
life. ODHIN will build a clinical evidence-
based database on effective and cost-
effective IBI measures for use in PHC and
will develop a tool to assess the extent of
provision of clinical practice. A project
website and a series of scientific
publications, reports and fact sheets will
widely disseminate the documented and
evaluated conceptual models across diverse
health care settings throughout Europe.
3. BISTAIRS – Good Practice on brief
interventions to address alcohol use
disorders in primary health care,
workplace health service, emergency
care and social services (European
Commission, Second Programme of
Community Action in the Field of Public
Health 2008-2013)
http://www.bistairs.eu/

The BISTAIRS (Brief InterventionS in the
Treatment of Alcohol use disorders In
Relevant Settings) project partnership aims
to intensify the implementation of Brief
Interventions (BI) in a range of relevant
settings by identifying, systematising and
extending good practice of BI across the EU.
The project partnership is consisting of
seven partners from six EU Member States,
pursuing the common goal to increase the
impact of evidence-based brief interventions
on alcohol related disorders in Europe.
Partner and WP7 “Guidelines” leader.
Most experience in BI implementation has
been gathered in PHC settings in high
income countries, the project aims to foster
BI implementation in further settings
(workplace health services, emergency care
and social services) and countries, to
contribute to a widespread BI
implementation in the EU.
The call of this project is listed under the
second specific priority area “promote
health” of the EU programme on health
2008-2013. By addressing the issue of
alcohol use disorders, BISTAIRS is tackling
one of the major EU public-health
determinates and will contribute to the EU
programme's aim to reduce alcohol related
health inequalities in Europe. A key
component is the development and
dissemination of evidence-based
professional health information in terms of
policy recommendations and guidelines.
BISTAIRS wil address policy makers,
networks and associations as well as
professionals being in contact with harmful
alcohol drinkers. This will lead to an
advanced understanding of stakeholders
about the importance of secondary
prevention on alcohol in the EU and,
secondly, to an improvement of
competences among professionals.
To identify and systematise the status quo of
BI implementation and good practice,
sources of information will include
published systematic reviews in the
scientific literature, as well as gray literature
and country guidance. Further, a brief
questionnaire will be sent out to members of
the respective networks, to create a map of
the current implementation status of BI in
the EU. For the tailoring of BI toolkits, the
renown experts of the scientific board will
select BI approaches to be evaluated in field
tests, by using a pro-con analysis in the
framework of a scientific board meeting. A
minimum of four field tests (one in each
setting) will be conducted in 5 countries
(three of them with lower experience in the
implementation of BI) by taking into
account specific different contexts
(identification, BI, referral to treatment).
Focus groups will be used for field-test
evaluation. For guideline preparation, a
second scientific board meeting will be used
for decision-making purposes, applying
adequate methodologies for consensus
finding (e.g. Delphi-technique). To
disseminate the project results, a concrete
dissemination plan will be developed, using
the results of the first work packages and the
close connection to implemented key
networks in the field (e.g. the Primary
Health Care European Project on Alcohol -
PHEPA). The project website will provide a
portal to key resources (e.g. training
material, presentations) and function as
platform for stakeholders in the EU. To
ensure the methodological quality of the
project, BISTAIRS will be monitored by a
continuous process evaluation.
BISTAIRS will result in a comprehensive
set of tailored and field-tested BI tools,
methods and materials. This will include an
updated evidence report with a special focus
on BI in workplace health care, emergency
care and social services, and a map of their
current implementation status across the EU.
Based on this, guidelines for the
development and rolling out of future BI

implementation approaches in Europe will
be provided, including a concrete plan for
further dissemination across the EU.
4. ALICE RAP – Addiction and Lifestyles
in Contemporary Europe Reframing
Addictions Project (European
http://www.alicerap.eu/
ALICE RAP (Addiction and LIfestyles in
Contemporary Europe - Reframing
Addictions Project is a five year European
research project, co-financed by the
European Commission that brings together
over 100 scientists from more than 25
countries and 29 different disciplines. PHU
is involved in this project as Collaborating
Partner.
ALICE RAP aims to strengthen scientific
evidence to inform the public and political
dialogue and to stimulate a broad and
productive debate on current and alternative
approaches to addictions.
The vision Statement is to promote well-
being through a synthesis of knowledge to
redesign European policy and practice to
better address the challenges posed by
substance use and addictive behaviours, and
the mission Statement, advance synergy
among sciences that address substance use
and addictive behaviours, through a five-
year programme of European trans-
disciplinary research.
The project is divided into seven areas and
twenty one work packages (three in each
area), making up an integrated
multidisciplinary research strategy.
In addition, two specialist consultation
groups will input to the direction and work
of the project as a whole:
- A media and communications advisory
group will be consulted and oversee the
provision of public information. Blogs
and websites will make all the findings
generated in the project available in real-
time, providing spaces for continuous
public input.
- A global science group, brings together
renowned scientists from around the
world, to embed the project in a global
context and enable a global overview of
the governance of addictions, providing
relevant comment and input of other
related initiatives, societal trends in
relation to governance and public policy
responses that are going on outside
Europe.
5. EWA – European Workplace and
Alcohol (European Commission, Second
Programme of Community Action in the
Field of Public Health 2008-2013)
http://www.eurocare.org/eu_projects/ew
a
The primary aim of EWA is to develop
effective methods of engaging with
workplaces, and their workforces, to raise
awareness and bring about individual and
organisational change that leads to reduced
alcohol consumption and alcohol-related
harm.
PHU is involved in this project as
Collaborating Partner.
EWA will inform the development of
alcohol-related health policies at European,
regional, country and local levels. EWA
aims to engage with workplaces to:
- raise awareness amongst employees
about how, in relation to alcohol, they
can live healthier lives;
- inform employers how, in relation to
alcohol, they can support their workforce
to live healthier during and outside
working hours;
- encourage employees to change their
alcohol-related behaviour to live more
healthily;

- encourage employers to adopt a
workplace culture that, with respect to
alcohol, is supportive of healthier living.
EWA targets medium to large workplaces in
the public and private sectors and their
workforces – including multi-national
companies and firms employing manual
workers.
EWA will, in 12 member states, including
three eastern European countries and three
southern European countries, pilot, assess
and disseminate the lessons from innovative
interventions that engage workplaces and
their workforces in addressing alcohol-
related health issues.
The overall objective of the project is to
culminate in the development and
dissemination of a practical and robust
cross-cultural tool-kit able to support the
delivery of workplace-based interventions
that will bring about reduced alcohol
consumption and alcohol-related problems
amongst the European workforce. The
project will also produce a report identifying
best practice and recommendations for
European, national, regional and local
policy-makers. Finally, the project will
improve the health and well-being of
European citizens, contribute to the
objectives of the Lisbon agenda, and enable
workplaces to mitigate the potential negative
consequences of the economic recession on
alcohol-related harm.
Based on twenty one European studies,
Anderson & Baumberg (2006) estimated
that productivity losses contributed 47% of
the total €125bn social cost of alcohol to
Europe. A large recent Australian study
found clear evidence that detrimental
drinking patterns increased the risk of
absenteeism (Roche et al 2008), with
frequent high risk drinkers being as much as
22 times more likely to report alcohol-
related absenteeism.
Harmful alcohol use and episodic heavy
drinking also increase the risk of
presenteeism, including arriving to work late
and leaving work early or disciplinary
suspension, resulting in loss of productivity;
turnover due to premature death;
disciplinary problems or low productivity
from the use of alcohol; inappropriate
behaviour (such as behaviour resulting in
disciplinary procedures); theft and other
crime; and poor co-worker relations and low
company morale (Mangione et al. 1999).
Structural factors at the work place can
increase the risk of alcohol use disorders
(Head et al 2004), and work place-related
burnout can increase the risk of alcohol
dependence (Ahola et al 2006). Despite the
structural relationships between the work
environment and the risk of alcohol use
disorders, surprisingly few intervention
studies have investigated the impact of
changing work structures on reducing
workplace alcohol-related harm, with brief
advice programmes, and programmes
attempting to change workplace attitudes
toward on-the-job substance use, in addition
to training workers to recognize and
intervene with co-workers who have a
problem being the most promising (Webb et
al 2009). There is thus an enormous
potential for the better development and
implementation of workplace policies and
actions that improve wellness at work and
lessen the impact of alcohol on health and
productivity at the work place, as well as
reducing the wider social costs due to
alcohol.
Historically, poor information and
understanding of the risks of alcohol are
perceived by the European population, and
extensive evidence suggests that the impact
of school-based and public education is very
limited in changing alcohol-related
behaviour (WHO 2009). This would suggest
the need for more targeted interventions,
such as brief interventions in primary health

care settings and those at the work place.
The workplace is also important in reaching
the middle aged, who are at increasing risk
of hazardous and harmful alcohol
consumption and of alcohol-related harm,
which, unless prevented, could track through
to retirement and older age (Anderson
2009). However, it should also be noted that,
and although this is not a main aim of EWA,
to be effective, work place alcohol polices
and other similar targeted interventions need
to be embedded within and backed up by
broader effective and cost-effective
structural policies, such as those that
regulate the price, availability and marketing
of alcohol (Anderson et al 2009).
Throughout Europe, little is known about
the extent and depth of work place policies
on alcohol.
6. INEBRIA – International NEtwork on
BRief Interventions for Alcohol
Problems
http://www.inebria.net/Du14/html/en/Du
14/index.html
INEBRIA was formed in 2004 following the
end of Phase IV of the WHO Collaborative
Project on Identification and Management of
Alcohol-related Problems in Primary Health
Care and was established to provide an
international network for researchers and
practitioners interested in the potential of
brief interventions in medical and other
settings to reduce alcohol-related harm. At
the Annual General Meeting of the network
in Boston, USA in September 2011, it was
agreed to expand the network to include
brief interventions for other psychoactive
substances besides alcohol, although the
main emphasis would continue to be on
reducing alcohol problems.
The revised overall aim is to provide global
leadership in the development, evaluation
and implementation of evidence-based
practice in the area of early identification
and brief intervention for hazardous and
harmful substance use.
The objectives are:
- to share information, experiences,
research findings and expertise in the
area of early identification and brief
intervention for hazardous and harmful
substance use;
- to promote best practice and encourage
the development of guidelines for the
wide dissemination and implementation
of evidence-based early identification
and brief intervention for hazardous and
harmful substance use;
- to identify gaps and need for research in
the field of early identification and brief
intervention for hazardous and harmful
substance use, promote international
research co-operation and set standards
for research;
- to promote the integration of the study of
brief interventions for hazardous and
harmful substance use with the wider
context of measures to prevent and
reduce sustance-realated harm.
INEBRIA is supported by a secretariat based
at the Health Department of Catalonia in
Barcelona and includes a semi-autonomous
branch located in Brazil (INEBRIA-Latina).
The network currently has 250 members
who are able to communicate ideas, request
advice and share opionions regarding early
identification and brief interventions by
meas of a google group.
INEBRIA have held nine annual conference
located in Barcelona, Spain (2004), Munster,
Germany (2005), Lisbon, Portugal (2006),
Brussels, Belgium (2007), Ribeirao Preto,
Brazil (2008), Gateshead, UK (2009),
Gothenburg, Sweden (2010), Boston, USA
(2011) and Barcelona, Spain (2012).

The next conference will be held in Rome,
Italy, on the 18-20th September 2013
organized by Prof. Emanuele Scafato..
( http://www.inebria.net/Du14/pdf/10_inebria_roma.pdf ).
The previous conferences have resulted in
the publication of proceedings in peer-
reviewed internationaljournals. Although the
membership is predominantly based at
present in Europe, the USA and Latin
America, the explicit aim of the INEBRIA
Co-ordinating Committe is to expand to all
continents of the world in due course. In
addition to regular annual conference, the
network organizes smaller meeting and co-
operates with NGOs in co-sponsoring
relevant events. Several international
research collaborations have been initiated
through researchers’ participation in
INEBRIA and its events.
7. Italian PRoject on Epidemiology of
Alzheimer's disease –IPREA (Italian
Ministry of Health, Targeted
Alzheimer’s disease Programme -
Progetti strategici di Ricerca finalizzata
sulla malattia di Alzheimer, Art.12
D.Lgs. 502/92 and Art. 12bis D. Lgs.
229/99)
The Italian “Targeted research” (ricerca
finalizzata) is mainly aimed at issues related
with health, health planning, health system,
health care and management biomedicine. It
is agreed by the Minister of Health with the
Minister of University, Education and
Research in order to coordinate the activities
performed. On 2000, a specific interest has
been solicited and priority research items
have been developed and funded on
Alzheimer Disease. The main drivers for the
Alzheimer’s disease programme were the
needs of acquired a national scenario on
aging population with cognitive
impairments, to meet the needs of elderly
with dementia’s, their families and
caregivers. There were three key
requirements for the initiative:
interdisciplinary approach, collaboration and
acquisition of national knowledge on
Alzheimer’s disease in Italy. The Italian
Project on Epidemiology of Alzheimer's
disease (IPREA), coordinated by the Istituto
Superiore di Sanità (Italian National Health
Institute), part of the Alzheimer’s disease
programme 2000 of the Italian Ministry of
Health, is the first multicentre population-
based prospective study specifically
designed to investigate the preclinical phase
of dementia, including AD, in Italy.
PHU is project leader.
The main objectives of IPREA were to
define the prevalence, incidence, and risk
factors of the preclinical phase of dementia,
analyzing also the transition to dementia and
the predictive value of an extensive
neuropsychological battery and of biological
and instrumental markers.
A random sample of 4,785 individuals aged
65-84 years, both community dwelling and
institutionalized, was selected from the
demographic lists of 12 municipalities
located across Italy, and stratified by age
and sex using an equal allocation strategy.
The IPREA cohort was first examined in a
survey initiated in 2003. After an interval of
one year from baseline, all subjects
identified as affected by cognitive
impairment without dementia were re-
examined, following the same protocol.
Both surveys had a two phase design,
comprising a screening and a confirmation
phase (Scafato et al. 2005). The choice of
conducting the second survey after only one
year was due to the scarce amount of
funding at disposal, while, as demonstrated
in other studies, a more reliable assessment
of the progression to dementia should have
needed a longer period of observation.
As a result of the IPREA longitudinal study,
which included also the creation of a
biological bank and the execution of
Magnetic Resonance Imaging (MRI) in a

sub-sample of subjects, a comprehensive
data set, containing information on
sociodemographic characteristics, family
and medical history, life-habits, disability,
biological characteristics, depression, and an
extensive evaluation of cognitive domains,
is available. These socio-demographic and
health indicators may be essential to reach a
better delineation of the preclinical stages of
dementia, evaluating risk and protective
factors associated with progression to
dementia.
Being a longitudinal study this project is
subject to periodic follow-up and continuous
evaluation.
8. ILSA - Italian Longitudinal Study on
Aging (Targeted project on aging-
Progetto finalizzato invecchiamento of
the National Research Council -CNR,
and ISS)
The Italian Longitudinal Study on Aging
(ILSA) represents one of the major
longitudinal cohorts on aging in Italy. The
objectives of the ILSA study was to
investigate frequency, risk and protective
factors of major age-associated conditions -
cardiovascular diseases (hypertension,
myocardial infarction, angina pectoris,
cardiac arrhythmia, congestive heart failure),
diabetes, peripheral artery disease, stroke,
dementia, parkinsonism, and distal
symmetric neuropathy - and to study
physical and functional changes among an
Italian elderly cohort.
In short, the ILSA was an extensive three-
wave prospective study with 10-year follow-
up of vital status. A random sample of 5,632
subjects aged 65-84 years, both community
dwelling and institutionalized, was selected
from the demographic lists of eight
municipalities located across Italy. The
sample of each centre was stratified by age
and sex, using an equal allocation strategy
(88 subjects of each gender for each of the
four 5-year age classes). The ILSA cohort
was first examined in 1992-1993 and re-
examined in two longitudinal waves
initiated in 1995 and 2000. All surveys had a
two phase design, comprising a screening
and a clinical confirmation phase (Maggi et
al 1994; The Italian Longitudinal Study on
Aging Working Group 1997).
As a result of ILSA longitudinal study, a
comprehensive data set is available
(including more than 9,000 variables), with
a wide range of information on socio-
demographic characteristics, clinical and
subclinical conditions (diagnosed through
standardized criteria), health and familial
diseases history, life-habits, cognitive and
disability status, biochemical and
anthropometric measures, etc., examined
both as explanatory and/or outcome
variables. The ILSA data bank has been and
still is particularly useful to reach a better
delineation of aging in our country, by
means of the large number of scientific
papers through which ILSA main findings
have been disseminated providing precious
suggestions in order to lower the impact of
potentially modifiable risk factors, and
reduce unnecessary sufferings, excessive use
of health care resources and adverse impact
on quality of life of elderly subjects.
Being a longitudinal study this project is
subject to periodic follow-up and continuous
evaluation by PHU that is the project leader
and coordinator.
9. Impact of neurological aging and
cognitive impairment on hospitalization
and mortaliy in an Italian elderly
general population cohort (Italian
Ministry of Health, Targeted Research -
Ricerca Finalizzata, 2009).

This project, coordinated and carried out by
the PHU, gives continuity and adds value to
the IPREA project which was the first
multicentre population-based prospective
study specifically designed to investigate the
preclinical phase of dementia, in a large
sample of elderly Italian subjects (4,785
aged 65-84). Through the record linkage
between the 2,985 subjects, who participated
in the screening phase of the IPREA
baseline survey, with the Italian National
Mortality Database (NMD) and the Multiple
Causes of Death Records (MCDR), and the
Italian Hospital Discharge Registry (HDR),
it will be possible to analyze the progression
and natural history of non-dementia
cognitive impairment in different sub-groups
of elderly subjects (defined according to
different sets of diagnostic criteria, different
degrees of cognitive domains impairment,
presence/absence of associated factors),
estimating total and cause-specific mortality
and hospitalization rates for the various sub-
groups of subjects, observed over a period of
about 7 years.
The innovative approach of the record
linkage between data deriving from the
IPREA longitudinal study database and the
principal Italian official administrative data
sources on mortality and hospitalization will
allow to save time and money, reducing
survey costs and response burden but
maintaining the advantages and reliability of
a longitudinal epidemiological study design.
The expected results will contribute to a
better definition of risks associated to the
preclinical phase of dementia, providing a
deeper insight into its heterogeneous
evolution.
The project will meet the EC challenge to
tackle the social and health impact
associated with AD and dementias, helping
to plan early and cost-effective strategies for
delaying or preventing further cognitive
decline, allowing for earlier rehabilitation
and treatment in order to maintain functional
autonomy as long as possible.
Moreover, the identification of the risk
factors associated with the observed
outcomes (onset of dementia, mortality,
hospitalization) will be very useful in a
public health perspective, providing
evidence-based and valuable indications for
a better allocation of health-care expenses,
helping to plan cost-effective primary and
secondary prevention policies and
programmes.
Since the project is mainly based on a record
linkage procedure and on data analysis, no
external unit is foreseen, although
cooperation with the 12 original IPREA
units will be possible for some operational
tasks.
The general objective of the present project
is to give continuity to the IPREA
multicenter community-based prospective
study, in order to evaluate the impact of
non-dementia cognitive impairment, defined
through different sets of diagnostic criteria
and different cognitive domains impairment,
in relation to specific outcomes, such as
hospitalization and mortality. In this way it
will be possible to identify predictive and
potential risk factors, and to describe the
progression and natural history of the
preclinical phase of dementia in different
sub-groups of elderly subjects, observed for
a period of about 7 years.
The specific objectives of the present project
will be:
- to analyze and compare mortality and
hospitalization in the different
diagnostic groups resulted from the
baseline of the IPREA study:
- normal cognitive function;
- depressive pseudomentia;
- dementias (Alzheimer’s disease-
AD, Vascular Dementia-VaD,
Parkinson's dementia, dementia
with Lewy bodies, etc.);

- cognitive deficit without
dementia (defined according to
the most common sets of
diagnostic criteria, such as
Aging Associated Cognitive
Decline-AACD, Mild Cognitive
Impairment-MCI, Cognitive
Impairment Not Dementia-
CIND, and to the impairment of
different cognitive domains);
- to investigate cause specific mortality,
with particular attention to causes
concerning the neurological area, in
the above mentioned diagnostic
groups;
- to examine hospital discharge
certificates in order to identify the
extent and causes of hospitalization in
the different diagnostic categories;
- to analyze the role of socio-
demographic characteristics, health
history, life-habits, disability, and
other possible protective or risk factors
in mediating the observed relationship
between different definitions of non-
dementia cognitive impairment, and
degrees of cognitive domains
impairment, and the outcomes.
The project will contribute to a better
definition of risks associated to the
preclinical phase of dementia, giving us an
in insight into its heterogeneous evolution.
Through the longitudinal analysis of
subgroups with different risk factors, natural
history and transition rates to dementia, it
will meet the EC challenge to tackle the
social and health impact associated with AD
and dementias, helping to plan early and
cost-effective strategies for delaying or
preventing further cognitive decline,
allowing for earlier rehabilitation and
treatment in order to maintain functional
autonomy as long as possible.
10. DESCRIPA Study – Early Diagnosis of
Alzheimer’s disesase (European
http://www.descripa.eu/
The DESCRIPA study is a European
collaborative study on the early diagnosis of
Alzheimer’s disease. The DESCRIPA study
aims to develop screening guidelines and
clinical criteria for Alzheimer’s disease in
non-demented subjects. The clinical criteria
will be based on a prospective cohort study
of non-demented subjects from a memory
clinic. The screening guidelines will be
based on a meta-analysis of prospective
population-based cohort studies in Europe.
In the study participate 25 centres from 11
European countries. PHU is involved in this
project as Collaborating Partner.
Background and objectives: AD is one of
the most common neurodegenerative
disorders. The diagnosis of AD can
currently be made only if a subject is
demented. However, subjects with AD
already experience symptoms before they
are demented. It would be important to
identify subjects with AD in the predementia
stage, as this will allow to start interventions
that may improve cognition or prevent the
progression of the disease in an earlier stage
than is possible now.
The overall aim of the study is to reach an
evidence-based European consensus on the
identification of subjects with AD in the
predementia stage.
The specific aims are:
- The development of diagnostic criteria
for predementia AD in a clinical setting.
- The development of screening guidelines
for predementia AD in the general
population.
Approach and methodology:
Development criteria for predementia AD

Clinical criteria were developed on the basis
of a prospective cohort study of 880 subjects
with mild cognitive impairments from 20
outpatient memory clinics in 11 European
countries. Inclusion criteria were referral
because of cognitive impairment and age
above 55 year. Exclusion criteria were
medical conditions that cause cognitive
impairment.
At baseline, a number of variables were
collected that could be a diagnostic marker
for predementia AD. The study had a
pragmatic design closely following standard
clinical procedures. As a result, rating scales
and cognitive tests could vary between
centres and some predictor variables were
investigated in a subset of centres only. In
addition, blood and cerebrospinal fluid was
stored for future analysis with new
diagnostic markers.
Subjects received annual follow-up
assessments for 2 to 3 years. The diagnosis
of predementia AD at baseline was made if
the patient met criteria for probable or
possible AD at follow-up.
For data analysis, the criteria of predementia
AD will be based on the variables collected
at baseline and the outcome at follow-up.
The primary outcome measure is AD-type
dementia at follow-up. Because subjects
with predementia AD may convert to AD-
type dementia at longer follow-up intervals,
a secondary outcome measure of cognitive
decline was used. This outcome measure
included all subjects with AD-type dementia
at follow-up and also non-demented subjects
with persistent memory impairment or
memory decline. Two approaches will be
used to develop these criteria. The first
approach is based on the Preclinical
Alzheimer's Disease Scale (PAS, Visser et
al. 2002). The second approach will be data
driven and makes use of stepwise
multivariate logistic regression.
The data collection started 1 January 2003
and at 1 July 2007 the 2-year follow-up was
completed. Data analysis is ongoing. It is
planned to extend the follow-up to 5 years.
Development screening guidelines for
predementia AD
Screening guidelines will be based on a
meta-analysis of 8 ongoing population-based
studies in Europe. These studies are: the
Maastricht Aging Study (MAAS), the
Longitudinal Aging Study Amsterdam
(LASA), the Italian Longitudinal Study of
Aging (ILSA), the Eugeria study of
cognitive aging, the Personnes Agées QUID
study (PAQUID), the Prospective
Population Study of Women and the
Gerontological and Geriatric Population
Study (H70 study) in Gothenburg, and the
Leipzig Longitudinal Study of the Aged
(LEILA 75+). Subjects were included that
did not have dementia at baseline.
The baseline assessment varied between the
studies. Therefore, not all diagnostic
markers or risk factors were available for all
studies.
Subjects were reassessed at intervals of 1 to
3 years and subjects with dementia and
Alzheimer-type dementia were identified.
The follow-up length was between 2 and 12
years depending on the study. The diagnosis
of predementia AD at baseline was made if
the patient met criteria for probable or
possible AD at follow-up.
For data analysis, the screening guidelines
of predementia AD will be based on the
variables collected at baseline and the
outcome at follow-up. The main outcome
measure is a diagnosis of AD-type dementia
at follow-up. Secondary analyses will be
conducted with dementia at follow-up as
outcome measure. Two approaches will be
used. The first approach is based on the PAS
(see above). The second approach will be
data driven and makes use of stepwise
multivariate logistic regression. Data
pooling started 1 January 2006 and is
currently being finalized.

11. Identificazione Precoce Intervento Breve
- IPIB Project (the Italian Presidency of
the Council of Ministers – Department of
antidrug policies)
Early Identification and Brief Intervention
(EIBI) for hazardous and harmful drinkers in
the PHC services of the NHS were explicitly
included in the Italian National Health Plan
2000-2003. From that time, a number of
strategies and actions were identified and
carried out in Italy under the frame of
different national and international
programmes.
PHU has been indicated by the National
Committee on Alcohol as the national
provider of the training activities for the
implementation of EIBI in PHC in tight
connection with the Italian Society on
Alcohology (SIA) and the Regions.
The national implementation of EIBI in
PHC at the ISS has been first supported by
the Italian PRoject on prevention,
Identification and Strategies Management
for Alcohol-related problems in primary
health care (PRISMA funded by the “Fondo
Nazionale Intervento Lotta alla Droga,
Presidenza del Consiglio dei Ministri” and
representing the implementation at national
level of the phase IV of the WHO project on
alcohol, coordinated by the NOA, WHO CC
at the ISS) and later, under the frame of the
PHEPA project (Primary Health Care
European Project on Alcohol, co-financed
by the European Commission and the
Department of Health of the Government of
Catalonia, Spain, www.phepa.net ) finding
also a relevant inclusion among the activities
of the National Plan on Alcohol and Health
endorsed in April 2007 by the State-Regions
Conference.
For the EIBI activities, a national working
team has been created “Gruppo IPIB -
Identificazione Precoce Intervento Breve”
at the ISS. The group started its activities in
April 2006 to deliver a communication
strategy and to organise conferences to
announce, promote and disseminate the IPIB
training programme. IPIB is actually the
formal institutional standard of training in
Italy.
At the moment, IPIB is funded by the
Presidency of the Council of Ministers,
Department of antidrug policies -
Presidenza del Consiglio dei Ministri,
Dipartimento Politiche Antidroga”. It allows
to participants for each of the planned
courses to train themselves and to train other
professionals.
The training standard PHEPA has been
approved and formally recommended by the
National Committee on Alcohol (set by the
law 125/2001), which received a good
evaluation in terms of credits to be earned
through the Continuous National Training
Programme (ECM), compulsory for the
professionals of the NHS.
The preparation, translation and adaptation
of the PHEPA English documentation and
related materials and the organizations of
few well-managed meetings has tried to put
in the optimal condition the presentation and
the starting of the training programme as
well as the dissemination and the promotion
and implementation in the PHC settings.
It has been also developed a communication
strategy, and local conferences have been
organised to announce and promote the
programme. The web page of the ISS
publishes regularly the call for selection of
candidate to the training programmes IPIB
as well as the programme of the course. The
training course has been opened to general
practitioners (GPs) and generally speaking
to all the physicians involved in the PHC.
Furthermore, it has been left open the
definition of professionals working in the
wide area of the PHC settings including at
national level, for example, the work of
occupational and school physicians. In order
to reach subgroups of population at risk but
otherwise not reachable by GPs (i.e. adult,

young people and women), as a novelty for
the Italian landscape we judged appropriate
to open the course also to experts from other
services and speciality such as to the
Ser.T.S. (public drug treatment units for
drug and alcohol dependency) of the NHS,
to family advice bureau, professionals
involved in the workplace prevention
setting, psychiatrists and psychologists.
From 2007 many other courses have been
carried out at territorial level and at PHU,
CNESPS, ISS. The next course will be taken
at the ISS on November 29-30
(http://www.iss.it/binary/esps/cors/pieghevol
e_programma_formazione_ipib_novembre_
2012.pdf ) .
12. National initiatives for the prevention of
alcohol related problems (Alcohol
prevention day, national preventive
campaigns, centro servizi
documentazione alcol-CSDA, Italian
Ministry of Health)
The NOA at CNESPS, ISS organized and
sponsored eleven editions of the Alcohol
Prevention Day (APD). The 2012 event
(http://www.epicentro.iss.it/alcol/apd12.asp
was held, as usual, in collaboration with the
Italian MoH, the SIA, the AICAT - Italian
Association of Territorial Alcoholism Clubs
and the EUROCARE, as part of the yearly
initiative that promotes the month of April
as “Month of alcoholism prevention”. The
APD is a unique experience every year to
share practical and effective reality of
numerous regional, municipal and territorial
based on the experience and commitment of
voluntary associations and self-and mutual-
help, including Alcoholics Anonymous, Ala-
teen and Ala NON, and many non-
conventional or formal associations of
invaluable support to those who are in
dramatic need of help in the difficult process
of rehabilitation and social reintegration. An
occasion of this day which is the central
moment of a debate that goes beyond the
limit of Congress and reverberates
throughout the year, through the timely
attention of the institutions, policy makers,
media, civil society certainly more aware
that in the past, thanks to the constant and
continuous attention of the NOA, CNESPS
and to the WHO CC at the ISS aimed to
underline the need for concrete action in
response to a problem that is social as well
than health.
Regarding National Preventive Campaigns,
the NOA at CNESPS, ISS is the formal
national, European and International focal
point of the ISS for research, prevention,
and training on alcohol and alcohol-related
problems. Since 2005, the NOA has been
charged for the exploitation of the
campaigns of the Ministry of Health
promoted by mean the 125/2001 frame law
on alcohol; by mean formal agreements the
NOA at the ISS devotes its activities to the
setting and realization of the prevention
activities in the settings delineated by the
art. 3 of the Italian law no. 125/2001
specifically youth meeting places, schools,
military barracks. The NOA is the
independent technical and scientific
advisory body for the Ministries, the First
Minister Office, the European Commission,
and the World Health Organization.
13. Epidemiology and alcohol-related
monitoring in Italy in support to the
implementation of the activities of the
National Alcohol and Health Plan
(Ministry of Health)
Monitoring and reporting the activities of
the structures devoted to care and
rehabilitation of drug dependents and
alcohol dependents are set by two different
Italian law decrees that establish a common
standard of data collection, standard
changed periodically in order to improve the

capacity to rapidly react to the fast changes
in the epidemiological findings and to better
organize the treatment structures. Different
sources of information are taken into
account to monitor and report the impact of
alcohol on the population and to assess the
performance of the treatment systems in
reply to the changing trends observed by
mean the monitoring system. Together with
the specific treatment system evaluation
(structures) the MoH evaluates and reports
on alcohol consumption patterns, alcohol
mortality, alcohol attributable hospital
discharges and other quantitative as well as
qualitative data coming from the regional
monitoring and reporting activities set by
law. Data are elaborated and reported by
mean two different yearly formal reports of
the MoH (for drugs and for alcohol) and
represent a significant part of two much
more complete reports submitted formally
each year to the Parliament:
- the report on alcohol for the
implementation of the 125/2001
frame law on alcohol of the MoH to
the Parliament (Relazione del
Ministro del lavoro, della salute e
delle politiche sociali al parlamento
sugli interventi realizzati ai sensi
della legge 30.3.2001 n. 125 legge
quadro in materia di alcol e
problemi alcol correlati, 2011
(2009-2010) available at:
http://www.salute.gov.it/imgs/C_17_
pubblicazioni_1686_allegato.pdf
- the report on drug dependency by the
Presidency of the Council of the
Ministries (Annual Report on drugs,
2012) available at:
http://www.politicheantidroga.it/prog
etti-e-ricerca/relazioni-al-
parlamento/relazione-annuale-
2012.aspx
The NOA at CNESPS, ISS contributes to the
annual reports on alcohol to the Parliament.

SELECTION OF THE RECENT PAST
MAIN RESEARCH ACTIVITIES
CARRIED OUT BY THE POPULATION
HEALTH UNIT, CNESPS, ISS
1. VINTAGE – Good health into older age
Project (European Commission, Second
http://www.epicentro.iss.it/vintage/default.as
p
VINTAGE Project was funded by the
European Commission under the Second
Field of Health 2008-2013.
The Project, coordinated by PHU, was
guided by a network of seven institutions
from as many European countries (Czech
Republic, Finland, Italy, Netherlands,
Slovenia, Spain, United Kingdom). The
network played an essential role in the
development of a joint effort to provide a
valuable source of information for the
accomplishment of the project objectives.
The general objective of the VINTAGE
project was devoted 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.
The specific objectives were:
- to review the evidence on the impact of
alcohol on the health and well-being of
older people and on prevention of
harmful alcohol use among them;
- to collect European examples of best
practices, laws and infrastructures to
prevent alcohol harmful use among older
people;
- to disseminate main findings to those
responsible for alcohol policy and
programme development or working in
the fields of health and welfare of the
elderly, at European, country and local
level.
The project outputs are still available at
http://www.epicentro.iss.it/vintage/outputs.a
sp as follows:
- VINTAGE Report “Alcohol and older
people: a public health perspective”:
results of the systematic review of
formal scientific literature on the impact
of alcohol consuption on the health and
well-being of older people;
- VINTAGE Report “Best practices on
preventing the harmful use of alcohol
amongst older people, including
transition from work to retirement”:
results of the survey addressed to
professionals and researchers throughout
Europe and the grey literature review
concerning effective policies and
programmes on the prevention of
alcohol use among older people;
- VINTAGE “Database on Best
Practices”: information on the main
initiatives aimed at preventing or
reducing harmful alcohol use among
older people collected through the
survey conducted at European level;
- VINTAGE “Grey Literature
Database”: information on all
documents retrieved through the grey
literature review of projects, programs,
good practices, laws and infrastructures
aimed at preventing the harmful alcohol
use in the elderly.
2. PHEPA Primary Health Care European
Project on Alcohol, and PHEPA II Project
on disseminating brief interventions on
alcohol problems Europe wide (European
Commission, Programme of Community

Action in the Field of Public Health 2003-
2008 – Second Programme of Community
2013)
http://www.gencat.cat/salut/phepa/units/phe
pa/html/en/Du9/index.html
The European PHEPA Project (Integrating
health promotion interventions for HHAC
into PHC professionals’ daily work) has
been funded by the European Commission
for the Health Promotion Program in
December 2002. The project was presented
to the SANCO/G/3 under the field of Health
education and/or promotion, information
and training in the field of public health. The
project also supports the European
Community’s Public Health strategy and the
European Charter on Alcohol and the
European Alcohol Action Plan of the WHO.
PHU has been involved in this project as
National Partner.
PHEPA has been managed by the
Directorate General of Substance Abuse and
Aids with the contribution of institutions and
experts of 18 European Member States
(Belgium, Denmark, England, Finland,
France, Germany, Greece, Ireland, Italy,
Netherlands, Portugal, Spain and Sweden)
,WHO and European Commission.
The project aimed to work towards the
integration of health promotion interventions
for hazardous and harmful alcohol
consumption into primary health care
professionals’ daily clinical work.
The main activities and tools developed
were:
- European recommendations and clinical
guidelines on best practice for health
care purchasers and providers;
- a training programme for primary health
care professionals;
- a comprehensive Internet site database
on good practice, providing the evidence
base in the domains of efficacy,
economics, health outcomes and policy;
- and a series of country specific
dissemination strategies.
The aim of the guidelines is to summarize
the evidence of the harm done by alcohol
and how to manage HHAC in PHC. The
guidelines also describe alcohol dependence
and how it can be managed, so primary
health care providers know what to expect
when more difficult to manage patients are
referred for specialist help.
The guidelines are based on a review of the
evidence, and upon the experience of a task
force created to draw up the guidelines. The
guidelines rely, where possible, on evidence
from well-designed research studies. Where
this evidence was not available,
recommendations are based upon
appropriate clinical experience. The
evidence is summarized in each chapter. The
intention is to provide evidence that guides
rather than dictates interventions, education
and professional development. The
guidelines are not intended to replace
existing country based guidelines; rather,
they aim to stimulate the development and
implementation of guidelines in all
countries. The guidelines are available at:
pa/pdf/cg_1.pdf.
The training programme is the result of a
joint effort made by the scientists and
professionals who have participated in the
European PHEPA project.
The aims of the training manual were:
- To raise awareness on alcohol-related
issues, especially in the area of risky
drinking, among PHC professionals,
helping to reframe outdated conceptions;
- To enhance the skills of PHC
professionals in the management of
alcohol-related issues;

- To provide policy makers and Health
Authorities with a tool that allows them
to promote the dissemination of SBI
techniques in PHC settings.
The training programme has been developed
under the following principles:
- Be clear, simple and flexible;
- Help PHC professionals to solve already
existing problems. Takes into account
resistances against screening;
- Be delivered in few hours and integrated
in the regular continuing medical
education;
- Be adaptable to self-training formats;
- Provide user friendly tools & materials
that can be used in the daily practice.
The training manual is available at:
pa/pdf/tripa_training_ok.pdf
The country based strategy developed by 13
country based teams for the implementation
of the programme to integrate interventions
for hazardous and harmful alcohol
consumption in PHC settings are available
at:
pa/html/en/dir360/index.html.
The PHEPA II Project on Disseminating
brief interventions on alcohol problems
Europe wide has been still funded by the
European Commission under the
Field of Public Health and builds on the
scientific evidence for the effectiveness of
different strategies in disseminating brief
interventions and on the experience of
PHEPA I and Phases III and IV of the WHO
project on EIBI in primary care.
PHU has been still involved in PHEPA II
project as National Partner.
The PHEPA project has been managed by
the Program on Substance Abuse of the
Department of Health of the Government of
Catalonia and has involved 25 associated
partners (from Belgium, Bulgaria, Czech
Republic, Denmark, England, Estonia,
Finland, France, Germany, Greece,
Hungary, Ireland, Italy, Latvia, Lithuania,
Netherlands, Poland, Portugal, Romania,
Slovakia, Slovenia, Spain, Sweden and
Turkey) and 10 collaborating partners (from
Belgium, Italy, Netherlands, Spain, Poland,
Switzerland and Europrev). In addition, 9
experts acted as consultant partners to the
network.
The general aim of the PHEPA II project
was to build on the experience and products
of PHEPA I and promote the dissemination
of best practice on EIBI on alcohol problems
within the general population.
The project had five general objectives:
- The first general objective was to create
a sustained European Platform of health
professionals and brief interventions
with representation in all partner
countries, and with two meetings of the
platform;
- The second general objective was to
develop a model, an assessment tool and
a registry to assess and document the
current status of services for brief
interventions in all partner countries
from a health systems perspective;
- The third general objective was to build
an Internet based resource centre for
health professionals, policy makers and
providers, on brief interventions;
- The fourth general objective was to roll
out a training programme throughout
Member States to upwardly harmonize
the skills of European health
professionals;
- The fifth general objective was to roll
out clinical guidelines throughout
Member States to upwardly harmonize
the quality of brief interventions.
The platform has been composed of a total
of 88 professionals and the exact numbers
and composition of the country varies from

country to country from one member to a
maximum of 9
members. The recommended representation
comprised members of 4 different types of
organizations: Governmental, Non-
governmental, health professional
organizations and/or groups and scientific
organizations and/or groups.
The Platform representatives in all partner
countries have met twice throughout the
duration of the project, once in year one, and
once in year two. The purpose of the
Platform has been to share and document
experience, and to identify strengths and
weaknesses of the different country
approaches to disseminating brief
interventions and to promote the
dissemination of best practice on early
identification and brief interventions on
alcohol problems within the general
population.
A model, an assessment tool and a registry
to assess and document the current status of
services or brief interventions in all partner
countries from a health systems perspective
has been developed.
The model has been based on systematic
reviews of the literature and describes all the
elements that are required for effective
dissemination of brief interventions within a
health care systems perspective including
the domains of:
- organization of health care,
- support for providing brief interventions,
- availability of brief interventions,
- provision of effective brief interventions
by health care providers and
- uptake of effective brief interventions by
the general population.
The tool was developed based on the final
model aimed at documenting the current
status of brief interventions in each of the
partner countries, identifying strengths and
limitations in the five health care system
domains. The tool has been designed to:
- Provide a baseline description of
services for managing HHAC,
identifying areas where services may
require development or strengthening;
- Provide a mechanism for monitoring
service provision over time;
- Allow sharing of information and
examples of practice;
- Provide a mechanism for coalitions or
partnerships to discuss and have a shared
view on services for managing
hazardous and harmful alcohol
consumption.
- It is primarily intended to help service
development within countries; it is not to
compare one country with the other.
The tool (available at
pa/html/en/dir532/index.html) consists of a
questionnaire and some template documents
that need to be completed for 24 questions
distributed across 7 key sections, which
includes the following topics:
- presence of a country coalition or
partnership,
- community action and media education,
- health care infrastructure (integrated
health care system, structures for quality
of care, research and knowledge for
health, health care policies and
strategies, structures to manage the
implementation of treatment within
health services, and funding health
service and allocating resources),
- support for treatment provision
(screening and quality assessment
systems, protocols and guidelines,
reimbursement for health care
providers),
- intervention and treatment (availability
and accessibility),
- health care providers (clinical
accountability and treatment provision),
- health care users (knowledge and help
seeking behaviour).

The participating countries were requested
to complete the questionnaire and the
information gathered through the data
collection has helped to have a general
overview of the country situation and to
compare the countries according to the
different variables.
The general results and the results in each
country, once re-scaled and analyzed, have
been placed in the report on the registry of
Europe wide practice
(http://www.gencat.cat/salut/phepa/units/phe
pa/pdf/phepa_final_report_annex3.pdf) to
allow a general overview and sharing of
experience from country to country in the
different topics covered by the tool.
During the project it has been created and
promoted the use of an Internet based
resource centre for health professionals,
policy makers and providers, on brief
interventions providing information in the
domains of effectiveness, cost effectiveness,
policy, epidemiology and evaluation. The
complete database is included under the
heading “Evidence for B.I.” of the Phepa
website available at: http://www.phepa.net.
Under each heading (health effects,
identifying HHAC policy measures), there is
a list of key findings. For each key finding,
there is a brief commentary and links to
supporting evidence.
The training programme was developed in
the PHEPA I project and can be downloaded
from the
project website. In order to upwardly
harmonize the skills of European health
professionals, associated partners have been
working towards adapting and adopting the
uptake of training in their country, based on
the Training Program developed in the
PHEPA I project (available at
pa/html/en/dir361/doc9736.html).
The clinical guidelines were developed in
the PHEPA I project and can be downloaded
from the project website. In PHEPA II, in
order to upwardly harmonize the quality of
Brief interventions, associated partners have
been working in adapting and adopting the
development and implementation of Clinical
guidelines in their country (available at
http://www.phepa.net/units/phepa/html/en/di
r361/doc13210.html).
3. WHO Collaborative Project on Detection
and Management of Alcohol-related
Problems in Primary Health Care PHASE
IV – Development of Countrywide Strategies
for implementing Early Identification and
Brief Intervention in Primary Health Care.
http://www.gencat.cat/salut/phaseiv/welcom
e.htm?84,32
The aims of the WHO Collaborative Project
are fully consistent with the European
Charter on Alcohol and with the European
Alcohol Action Plan. PHASE IV follows
logically the previous phases of the
Collaborative Project:
- Phase I: a reliable and valid screening
instrument for detecting hazardous and
harmful drinkers in PHC settings was
developed (the AUDIT questionnaire);
- Phase II: a clinical trial of screening and
brief intervention in PHC was carried
out;
- Phase III: the current practices and
perceptions of general medical
practitioners (GPs) were assessed in-
depth telephone interviews with GPs and
personal interviews with key informants
were conducted and methods for
encouraging the uptake and utilization of
a screening and brief interventions
package by GPs were evaluated in a
controlled trial.
Given that in previous phases of the WHO
Project an effective screening method has
been developed for use with brief

interventions in PHC, the effectiveness of a
form of brief intervention in PHC has been
demonstrated in a cross-cultural randomized
controlled trial, and obstacles to widespread
implementation EIBI have been identified
and methods for their initial dissemination
and deployment in PHC have been
evaluated, what remains to be done in this
programme of research? The answer to this
question, which forms the undelying
rationale for PHASE IV, is that what
remains is the development and application
of country-wide strategies for the
widespread, routine and enduring
implementation of EIBI in PHC throughout
participating countries.
PHU has been involved in this Project as
participating countries and actively
contributed to the “Report on PHASE IV,
Development of Country-Wide Strategies
for Implementing EIBI in PHC” available at
http://www.who.int/substance_abuse/publica
tions/identification_management_alcoholpro
blems_phaseiv.pdf.
4. ECAT To Empower the Community in
response to Alcohol Threats (European
Commission, Programme of Community
2008)
http://ec.europa.eu/eahc/projects/database.h
tml?prjno=2005327
PHU has been involved in ECAT Project as
National Partner.
General objectives:
To raise the effectiveness of alcohol
prevention campaigns through the
elaboration of tailored messages towards
different target groups and through the
embedding of the campaigns in a local
alcohol policy and inclusive approach. By
translating the gathered evaluated results of
the national ECAT-prevention campaigns
into a general applicable manual of
guidelines, an important added value is
created on a European level.
Strategic objectives:
- to define prior target groups and topics
through the conduct of a quick scan for
community analysis (social,
epidemiological, behavioural and
environmental assessment);
- to design a local community alcohol
policy based on the results of the
community analysis, including an
information and sensibilization
campaign directed at the prior target
groups and focused on prior topics;
- to develop evidence based guidelines for
tailor-made alcohol prevention
campaigns on a local community level;
- to set up local, cross-sectoral networks
of stakeholders (e.g. general
practitioners), in order to respond to the
needs and questions of the target groups;
- to evaluate the reach, visibility and
impact of the campaigns;
- to synthesize the best practices in a
manual and to present the results and
developed concept at a closing European
conference.
Outputs:
1. Conceptual manual for local alcohol
prevention campaigns, including:
- guidelines for elaborating an alcohol
prevention policy plan on a local
community level;
- guidelines for the build-up of a local
network of stakeholders (e.g. general
practitioners);
- guidelines for tailored alcohol
prevention campaigns, based on
evidence based practices;
- methodological guidelines for
supporting actions, e.g. quick scan
method for community analysis and
evaluation tool for measuring the reach,
visibility and impact of campaigns.
2. European ECAT-conference for all EU-
member states, including:

- presentation of the conceptual outline
and the main findings
- presentation of good practices within the
ECAT-project
- workshops on different sub topics
(community approach in collaboration
with networks of stakeholders,
evaluation of community based alcohol
campaigns, results of specific
campaigns.
5. ECHIM European Community Health
Indicators Monitoring Project and Joint
Action for ECHIM (European Commission,
Field of Public Health 2003-2008 – Second
http://www.echim.org/
ECHIM was a three-year project designed to
develop and implement health indicators and
health monitoring in the European Union. It
was one of the core actions of the EC Public
Health Programme 2003–2008, under the
strand of Health Information and
Knowledge. It followed the work of the
ECHI (European Community Health
Indicators, phase 1) and ECHI-2 projects,
which were conducted between 1998 and
2005.
The ECHIM Core Group consisted of 28
members from different European countries
and the WHO Regional Office for Europe.
ECHIM also acted as the scientific
secretariat for the Working Party Indicators,
created by the EC in 2005 to both develop
and implement health indicators in Europe,
and to develop the EU-wide health
information system as a whole. Working
Party Indicators comprised members from
all EU Member States, leaders of the five
other Working Parties of the Public Health
Programme, project leaders of nine health
indicator relevant projects funded by the
Public Health Programme 2003–2008, and
representatives from Eurostat, the OECD
and the WHO Regional Office for Europe.
Working Party Indicators both ensured that
indicator development was in line with the
needs of the European health information
and knowledge system, and that the
necessary preconditions for indicator
implementation were put in place.
PHU has been involved in ECHIM Project
as Member of the Core Group and as
Scientific Secretariat for the Working Party
Indicators.
The ECHIM Core Group consisted of 28
members. Much of the practical work was
carried out by the Central Secretariat in
Helsinki (KTL and STAKES) and by the
other four Secretariats at the national Public
Health Institutes in Berlin (RKI), Rome
(ISS-PUH), Bilthoven (RIVM) and
Bielefeld (LIGA.NRW). The collaborating
partners were from Belgium, Greece,
Hungary, Ireland, Spain, Sweden, the United
Kingdom and the WHO Regional Office for
Europe.
The ECHIM Core Group of experts and the
Secretariats were selected to provide the
highest European expertise and experience
in health policy, in health information and
knowledge at large, both on national and EU
level, in data gathering from registers and by
surveys, in data analysis and indicator
development, and in health reporting and
information dissemination. As a whole the
group had the deepest possible expertise in
public health planning and development,
programme and project management, and in
relevant research. The contributing experts
and institutes have also been involved both
in the Health Monitoring Programme and in
the Public Health Programme.
Members of the ECHIM Core Group have
participated in or led important projects such
as the DG SANCO financed ECHI, ECHI-2,
HIS/HES, EHRM, FEHES, EUHSID,
EUPHIX, EUHPID, EURO-URHIS,
ISARE, Hospital Data Project, Developing

Health Monitoring in the EU, Eurostat
working groups and task forces related to
public health statistics, and WHO’s
EUROHIS.
ECHIM was based on health policy needs
and it was a key action for the development
of the EU health information system. Its
work was directly related to the annual work
plans of the European Commission’s Public
Health Programme 2003–2008, which
mandated the creation of a health
information and knowledge system. In this
context ECHIM has played a central role by
drawing together experts from all Member
States and international organisations to
consider a) what health indicators are
needed at EU level, b) what data would be
needed to establish them, and c) what
actions would be needed to implement them.
ECHIM was the backbone for developing
the whole Health Information and
Knowledge System. Its actions were a
cornerstone of the strategy for improving the
health information system in the EU and all
Member States. The strategic importance of
ECHIM is evident if we imagine a future
without these efforts. Europe would
continue to have very uneven and poorly
comparable data on health in different
Member States.
ECHIM worked closely with all Member
States and EU bodies to achieve real
improvements and to lay the foundation for
a sustainable Health Information System.
The establishment of a broad range of
indicators covering more dimensions than
ever before, and laying the groundwork for
implementation, make ECHIM a forerunner
in European health information.
Outcomes:
- A network of health indicator experts
comprising all Member States;
- A new release of the ECHI shortlist
and the Documentation Sheets:
indicator definitions, interpretations
and preferred data sources;
- A review of and recommendations for
data gathering, quality assurance,
analysis, dissemination and reporting;
- ECHIM Products website and
database;
- Country Specific Section on the
availability and comparability of the
ECHI shortlist indicator data, sources,
reporting and ideas on the
prerequisites for implementation in
each country;
- Final report of ECHIM project
including proposals for
implementation;
- Recommendations for improvements
of the ECHI shortlist indicators, data
gathering, reporting and information
dissemination;
- ECHIM has become a brand.
The Joint Action for ECHIM, still funded by
the EC, under the Second Programme of
Community Action in the field of Health,
defined the specific objectives as follows:
- to improve, document and maintain the
ECHI Indicators;
- to develop guidelines and country-
specific plans for the ECHI shortlist
implementation in participating
countries, at regional and EU-level, as
needed;
- to implement the ECHI shortlist
indicators in participating countries and
to achieve good coverage;
- to maintain a network of national health
indicator experts for ECHI Indicators
and the necessary data collection;
- to design the data flow for the shortlist
indicators not yet available in
international sources;
- to support the EC in producing an
electronic data presentation based on the
ECHI shortlist indicators in HEIDI,

which is hosted by the European
Commission;
- to review the data integration process for
the HEIDI Data Tool covering the ECHI
shortlist indicators that are available
from international databases;
- to design and test a pilot data collection
of ECHI shortlist indicators that are
currently unavailable from international
data sources, based on the
operationalisation specified in the
ECHIM documentation sheets;
- to provide the data collected through the
pilot data collection for integration into
the HEIDI Data Tool;
- to produce the first joint analysis and
report on data based on ECHI shortlist
indicators.
Much work has been done towards these
long-term aims in the previous phases of
ECHIM. During the Joint Action for
ECHIM, the aim was to further develop their
definitions and content, and to establish
them as continuous actions and permanent
structures.
The Joint Action for ECHIM published a
new release of the ECHI shortlist and
regularly updated the Documentation Sheets
(available at
http://www.echim.org/indicators.html). The
new release contained improvements and
refinements to existing indicator definitions
as well as some additions and deletions; all
driven by changing policy priorities, new
scientific insights and improved ways of
collecting health information based on
experience in the current and previous
ECHI(M) projects.
A new shortlist release was put out just
before the end of the project.
The ECHIM Products website, which
contains all detailed information on the
ECHI shortlist, was updated accordingly.
6. ERA-AGE European Research Area on
AGEing and ERA-AGE2 European Resarch
Area on Ageing Extension (European
Commission 6th and 7th Framework
Programme – ERA-NET ACTIONS)
http://era-age.group.shef.ac.uk/
The ERA-AGE consortium of 12 countries
is the only ERA-NET in the broad
multidisciplinary ageing field.
PHU has been involved in ERA AGE and
ERA AGE 2 projects as National Partner.
It arose from the Coordinating Action (CA)
FORUM project under FP5 and, therefore,
has accumulated a unique body of skills,
knowledge and experience in coordinating
ageing research. By carefully assembling the
collaborative framework necessary to make
a lasting impact on the European research
area ERA-AGE went from strength to
strength in achieving its original objectives
and then surpassing them by launching a
joint call between eight of the partners (the
FLARE doctoral programme – see below).
The following step forward was to enlarge
the consortium to a critical mass and use this
to mount Europe’s first ageing research
programme supported principally by the
Member States: the New European
Dynamics of Ageing Programme (NEDA).
The main aims of this extension of ERA-
AGE (ERA-AGE 2) were to develop and
deliver one research funding programme
(FLARE 2 – see below) to undertake an
extensive networking and community
building programme to engage with the
various stakeholders in the ageing field to
create the basis for a major programme
(NEDA) and to progressively extend the
membership of ERA-AGE, starting with 3
new members: Bulgaria, Latvia and Spain.
In addition there were continuing activities
that require coordination, such as the
FLARE postdoctoral research programme,
the maintenance of existing ERA-AGE
databases and the development of new ones.

Thus the seven major objectives of ERA-
AGE 2 were to:
- develop and implement the framework
for a second call for the FLARE
postdoctoral programme (FLARE 2),
based on the highly successful
implementation of the first FLARE call.
This included a common specification,
peer review arrangement,
commissioning panel, procedures and
documentation;
- provide the continuing European
framework for the existing FLARE
programme by arranging networking
opportunities for the post-doctoral
fellows;
- ensure that the key stakeholders
regionally, nationally and European
were engaged in the activities of ERA-
AGE and, thereby, contributing to the
research response to the ageing
challenge. The selected stakeholders
were from the societal and political
arenas. ERA-AGE’s dissemination
activities followed these directions;
- continue ERA-AGE essential knowledge
transfer activities including further
development of its databases aimed at
providing evidence for policy, practice
and product development in response to
the ageing challenge;
- engage the majority of European
countries as ERA-AGE members
following an explicit programme of
engagement and clear eligibility criteria;
- ensure a lasting basis for strategic
collaboration between the ERA-AGE
partners;
- develop the framework for and agree an
open memorandum of understanding
concerning the NEDA programme to
follow ERA-AGE 2, covering partner
responsibilities, methods and levels of
funding.
The solid foundations of ERA-AGE 2
project have been laid under the FP6
European Research Area in Ageing (ERA-
AGE) ERA-Net comprising 12 partners and
3 associate partners. ERA-AGE has been
carried out from March 2004 to March 2009.
It was the first ERA-NET to bid successfully
to extend its membership. The central
mission of the current ERA-AGE project
was to build the foundations for an ERA in
the field of population ageing research and,
thereby, to enable Europe to gain maximum
added value from national investments in
this field. It focused on the coordination of
existing national research programmes and
related activities and also promoted the
development of new interdisciplinary
programmes based on partnership between
countries. Its remit covered only existing
national research programmes on ageing at
the management level and its key objectives
were to share information and good
practices in the management of ageing
research programmes and to create the basis
for a European research area in this field. A
major step in this direction was
accomplished in 2007 by the mounting of
Europe’s first joint programme on ageing
funded collaboratively by Member States.
The Future Leaders of Ageing Research in
Europe (FLARE) post-doctoral programme
was a joint venture between eight countries.
It responded directly to two of the key
recommendations of the FORUM CA under
FP5 for post-doctoral training opportunities
in ageing research and for more expertise in
multidisciplinary research. The FLARE
programme was making an important
contribution to the European Research Area
and serves as a model for other fields.
ERA-AGE had five main objectives:
- to facilitate the coordination of existing
ageing research programmes;
- to promote joint multi- and
interdisciplinary research activities
between countries;

- to share good practice in the
coordination and management of ageing
research programmes;
- to support the production of European
priorities for ageing research;
- to help break down the barriers between
ageing research and policy and practice
so that Europe’s older people may
benefit from research.
The consortium has been highly successful
in achieving its objectives. The end point of
this first phase of ERA-AGE was due to be a
memorandum of understanding concerning a
future joint call. In fact that goal has been
surpassed by the FLARE joint call in 2007.
ERA-AGE partners have played leading
roles in establishing National Forums,
planning and organising meetings,
conferences and lobbying activities in order
to increase collaboration, information
sharing and to raise the profile of ageing
research.
The systematic exchange of information has
led to the establishment of the ERA-AGE
database of ageing research programmes,
research institutes and centres which is made
available via the ERA-AGE website:
www.sheffield.ac.uk/era-age. The database
of research funders, centres and programmes
receives an average of 6,474 unique visitors
per month, 208 visitors per day, and is the
main portal for ageing research in Europe.
The most important ERA-AGE initiative,
and one which has exceeded our and the
EC’s original expectations, is the FLARE
pilot joint multidisciplinary funding
initiative. The currently commissioned post-
doctoral programme involved the
development of complex administrative
processes leading up to the FLARE
Commissioning Review Panel meeting
which was held in Berlin, September 2007.
The high quality of submitted applications
resulted in a decision to award 18 3-year
post doctoral grants – that is, two more than
originally agreed by the participating
countries. The first Summer School for
FLARE fellows was hosted by a partner
organisation, the Swedish Council for
Working Life (FAS) and the Vardal
Foundation for Health Care Sciences and
Allergy Research in Sweden, June 2008.
The Summer School included lectures and
presentations given by multidisciplinary
experts in the field and sessions on strategic
career themes for post doctoral scholars.
(http://www.summerflare.blogg.se/).
The consortium has hosted numerous other
highly successful and productive events to
promote multi- and interdisciplinary
research activities, share good practice and
identify research priorities between
European Member States. Meetings
typically involved key European
stakeholders including funders, researchers,
policy makers, NGOs and other end users.
ERA-AGE deliverables were the following:
- launched a pilot joint post-doctoral
fellowship call (FLARE), the first of its
kind in Europe;
- created national agency research forums
in 11 countries (based on the UK
model);
- hosted the first Summer School for
FLARE fellows in Sweden;
- created joint databases of European
research centres, programmes and
scientific peer reviewers;
- generated a comprehensive schedule of
key research priorities for future ageing
research;
- hosted 5 successful European Forum and
Good Practice meetings, 4
scientific/expert workshops and
produced 9 associated reports that
comprise key research
priorities/recommendations in the field
of ageing;
- produced two good practice guides on
research programme management and
involving older users in research;

- created a state of the art website plus 10
editions of the ERA-AGE;
- established partnerships among ERA-
AGE members including a co-funding
initiative between Finland and the UK.
7. FUTURAGE - A Roadmap for Ageing
Research (European Commission 7th
Framework Programme)
FUTURAGE was a two-year project funded
by the European Commission, under the
Seventh Framework Programme, to create
the definitive road map for ageing research
in Europe for the next 10-15 years.
PHU was involved in this project as
National Partner.
Drawing on experts and specialists from
Europe and beyond, the road map represents
the most extensive consultation ever
conducted in this field involving all of the
major stakeholder groups and end users of
ageing research, and spanning a 2 year
period. A specially designed iterative
process ensured that the specific research
priorities were not identified by scientists
alone and were subjected to a high degree of
reflection and cross-examination from a
wide range of stakeholder perspectives,
including policy makers, practitioners,
business people, older people and their
NGOs as well as scientists. This process led
to an extraordinary broad and deep
consensus on the major future priorities. It
identified the main priorities on ageing and
health from a multi-disciplinary perspective.
Through a chain of events, academic and
non-academic stakeholders were engaged in
a state-of-the-art assessment of research
priorities, emerging fields and methods to
build consensus on the research priorities in
ageing until 2025.
The major priority themes for future ageing
research included in the road map are:
- Healthy Ageing for More Life in
Years
- Maintaining and Regaining Mental
Capacity
- Inclusion and Participation in the
Community and in the Labour
Market
- Guaranteeing the Quality and
Sustainability of Social Protection
Systems
- Ageing Well at Home and in
Community Environments
- Unequal Ageing and Age-Related
Inequalities
- Biogerontology: from Mechanisms
to Interventions.
The FUTURAGE project was completed in
December 2011. The road map is available
at:
http://futurage.group.shef.ac.uk/assets/files/
Final%20road%20map/FUTURAGE%20A
%20Road%20Map%20for%20European%2
0Ageing%20Research%20-
%20October%202011.pdf
8. SIVEAS (SIstema Nazionale di
VErifica e controllo sull’Assistenza
Sanitaria - “National System for
Monitoring and control health care”,
Ministry of Health)
The identification of priorities for the
planning and intervention in health care and
public health is the main activity of any
prevention strategy. The tools used need to
satisfy a number of technical and scientific
requirements to ensure efficient support to
the choices of policy-makers and decision-
makers to define: health interventions
targeted basing on careful evaluation and
expert analysis of emerging priorities of the
main risk factors at local, regional, national
level. The project “Strumenti flessibili basati
sulla evidenza per la determinazione delle
priorità sanitarie” - "Flexible tools based on
the evidence for the determination of health
priorities", funded by the Italian MoH to the

ISS as part of the activities SiVeAS
(“Sistema nazionale di Verifica e controllo
sull’Assistenza Sanitaria” – “National
System for Monitoring and control health
care”) has developed an evaluation model,
based on the experience in the USA
conducted by the Centers for Disease
Control and Prevention (CDC) in Atlanta in
collaboration with PHU of the CNESPS, ISS
for the entire project phase, producing a
methodology and expanded the original data
updated to the Italian situation.
The project's objective is the definition of a
methodology for assessing the priorities of
health intervention at national level or
regional level, by analyzing
multidimensional risk factors. The proposed
methodology considers the opportunity to
determine actions or interventions to
counteract the risk factors or conditions to
greater global impact, fulfilling the need to
optimize resources and to facilitate the
ability of the National Health System (NHS)
interventions, actions and measures that can
affect primarily the factors that determine
the greatest burden of disease or disability,
avoiding the use of approaches which do not
take into account all the evidence currently
available or verifiable. The most interesting
feature of the instrument, which is made
available on this website dedicated National
Institute of Health, is the high flexibility
despite the complexity and completeness of
the dimensions examined. Further details are
available at: http://siveas.cnesps.it/

POPULATION HEALTH AND HEALTH DETERMINANS UNIT NIH.doc

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