Annali dell'Istituto Superiore di Sanità
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Immigrants and cancer in Italy: a literature review
Get PDFImmigration is a growing flow in Italy. Also specific health needs could be imported. We focused on cancer. A systematic search for literature in PubMed was performed on 10th March 2016, limited to articles published between 1st March 1996 and 1st March 2016. Papers were reviewed focusing on: specific risks, prevention and care. Cancer incidence is generally lower for immigrants than for natives, also for the health immigrant effect. However, cancers with an infective etiology may have, among some groups of immigrants, a great relevance. Primary or secondary cancer prevention could be greatly improved among immigrants. Moreover, another specific aspect of immigration is at seeking cancer care for children. Specific preventive strategies should be customized for immigrants to get higher compliance, e.g. for those at high risk for cervical cancers. Moreover, the capability of the Italian health system to cope more comprehensively with sick immigrated children and their families should be improved
Trends in thyroid cancer incidence and mortality in Central Serbia, 1999-2014
Get PDFIntroduction. Thyroid cancer (TC) is the the most common malignant disease of the endocrine system. The incidence of the TC has been increasing worldwide, especially in female population. However, mortality from TC is low in both males and females. The objective of the paper was to determine and analyze incidence and mortality trends of TC in males and females in the central Serbia in the period 1999-2014. Method. Descriptive study was used. Data were obtained from the Serbian Cancer Registry. Crude and age-adjusted rates (ASR) of incidence and mortality were calculated. Trend and annual percentage change (APC) of the incidence and mortality rate with corresponding 95% confidence intervals (CI) were calculated by performing Jointpoint regression analyses. Results. A total number of new cases of TC was 3113. TC was diagnosed in 2343 females and 770 males (female-to-male ratio, 3 to 1). A total number of fatal cases was 770 (while 504 female and 266 male died from TC, female-to-male ratio, 2 to 1). TC was not common before 30 years of age. The highest incidence was recorded both in males and females aged 50-59. Joinpoint regression analysis showed the statistically significant increase of ASR of TC incidence in males in 1999-2014 period with APC of 6.2% (95%CI:4.2-8.3, p<0.001) and there was also significant increase of ASR of TC incidence in females in the same study period with APC of 6.1% (95%CI: 4.2-8.0, p<0.001). Joinpoint regression analysis showed an insignificant increase of ASR of TC mortality in males with APC of 2.4% (95%CI:-0.5-5.5, p=0.1). There was an insignificant decrease of ASR of TC mortality in females with APC of -1.3% (95%CI: -4.4-1.9, p=0.4). Conclusion. The increasing trend of age-adjusted incidence rate of TC both in males and females and decreasing trend of age-adjusted mortality rates of TC in during the period were registered. Females had higher age-adjusted incidence and mortality rates than males. Female to male ratio of incidence was 3:1 and for mortality 2:1. Measures of primary and secondary prevention are needed.
Adverse reproductive outcomes associated with exposure to a municipal solid waste incinerator
Get PDF Introduction. The association between reproductive health outcomes and exposure to municipal solid waste incinerators (MSWIs) is inconclusive. This study investigates the association between exposure to a MSWI and various reproductive outcomes (preterm birth, low birth weight, small for gestational age, and sex ratio), taking into account other sources of pollution (industrial plants, highway, major roads with high traffic flows) and maternal factors, including the socioeconomic status. Methods. PM10 concentration maps were used for the exposure assessment to the MSWI and to other sources of pollution in the study area. Information on resident births and maternal covariates were selected from the delivery certificates referred to the period 2001-2010. Mothers’ addresses were geocoded in order to attribute the individual level of exposure. Odds ratio (OR) with a 95% confidence interval (CI) adjusted for maternal covariates and exposure to other pollutant sources were calculated. Results. A total of 3,153 newborns to 2,401 mothers residing in area during the study period were analyzed. A risk of preterm birth associated with increased exposure was detected (OR=1.61; 95%CI: 0.88-2.94; p test for trend 0.098). When newborns to primiparous women were considered an OR of 2.18 (95%CI: 1.05-4.53) and a significant trend were observed (p=0.033). No significant results for the other investigated outcomes were observed. Conclusions. The study detected a slight association between exposure at MSWI and preterm births. The results are in agreement with those of a previous multi-site study with similar design, and they strengthen the recommendation to consider gestational age in studies and surveillance in areas with MSWIs and similar sources of pollution
The product of the human AHI-1 (Abelson helper integration site) gene: experimental in vitro data point to its involvement in tumor cell invasion
Get PDFIntroduction. Each of the steps involved in invasion of tumors requires specific molecular program in which the modulation of adhesive and migratory properties of disseminating cells plays an essential role. The improvement in the knowledge of these mechanisms can lead to discovery of new target candidates in drug development. In this study we focused attention on the product of the human AHI-1 (Abelson helper integration site) gene Jouberin (Jbn). Methods. In particular, we explore by in vitro invasion assay, AHI-1 knockdown and electron microscopy, if Jbn is involved in the signaling machinery that regulates tumor invasion. To this purpose tumor cells of different histological derivation (brain, breast, skin) were employed. Results. We found that Jbn expression correlates with the proliferation, invasive potential and invasion strategy of the tested tumor cells, and that its downregulation reduces their capability of migrating and invading the extracellular matrix. Conclusions. The results obtained in this study for the first time point to Jbn as a new candidate involved in the invasion process of tumor cells, and as potential molecular target in anticancer therapy
On transparency in health care guidelines
Get PDFAccessibility is one of the core requirements for health care guidelines. The present article offers some considerations on the subject and briefly describes the general situation in Canada following provisions recently adopted by the Supreme Court and, more specifically, developments in Québec (regulations adopted by the Assemblée Nationale du Québec), where the Collège des Médecins du Québec has issued a “Practice Guideline for Medical Aid in Dying” (“Guide d’Exercice sur l’Aide Médicale à Mourir”). Without entering into the merits of the arguments dividing the supporters and opponents of euthanasia, the present article shows how access to the guideline is subject to restrictions that are unjustified from the point of view of medical ethics.
Molecular characterization of Neisseria gonorrhoeae on non-cultured specimens from multiple anatomic sites
Get PDFIntroduction. The aim was to characterize Neisseria gonorrheae collected from multiple sites in the same patient without a cultured strain. The use of N. gonorrhoeae multiantigen sequence typing (NG-MAST) together with the gene sequence analysis of antimicrobial resistance (AMR) target genes permit to depict these samples.Materials and methods. Seventeen genital and extra-genital samples from eight patients (7 were men who have sex with men, MSM, and 1 women who have sex with men, WSM) with gonorrhoea symptoms were analyzed.For 7, of the 8 patients, conventional culture method has been used to identify gonorrhoea. All the samples were tested with the rapid molecular method CEPHEID. Amplification and sequencing of porB and tbpB, to identify the Sequence Type (ST) by NG-MAST, and penA, mtrR, porB1b, ponA genes were also performed.Antimicrobial susceptibility by Etest, for the available culture positive samples, was carried out.Results. For 7 patients it was obtained the ST (Sequence Type) and for 6 the complete sequence analysis of the antimicrobial resistance target genes. For the majority of them, samples collected from multiple sites confirm the presence of the same gonorrhoea strain. In particular, for 5 patients the same STs and changes in the AMR target genes were identified.Conclusion. Molecular characterization on non-cultured or culture negative specimens for gonorrhoea permit to predict the presence of the same strain in the patients with infection in multiple anatomic sites and the genetic antimicrobial susceptibility pattern
Capturing the chance for pneumococcal vaccination in the hospital setting
Get PDFIntroduction: Because of the relevant burden of pneumococcal diseases, people at risk and elderly are recommended vaccination but coverage is still low because of problems in catching them. This study evaluates the proportion of eligible patients in the hospital in the view of assessing its potential role in vaccination campaigns.Methods: this is a retrospective analysis of discharge data from all patients over 49 years of age admitted between 2011 and 2013 to ‘A. Gemelli’ teaching hospital. Eligibility for pneumococcal vaccination was evaluated based on ICD-9 codes.Results: among 65,047 unique patients, 53.2% were eligible for pneumococcal vaccination. Most common eligibility criteria were chronic heart diseases, cancer and diabetes. Considering also age ≥ 65 as an indication to vaccination, the proportion of eligible patients reached 76.8%. In absolute terms the most of eligible patients were seen in medical sciences, general surgery, cardiovascular medicine and neurosciences departments.Conclusions: the proportion of patients eligible to vaccination is high in the hospital and the latter may play an important role in catching them
Estimate of the prevalence of subjects with gambling-related problems requiring treatment: a study in Northern Italy
Get PDFThe aims of this study, which analyzes the data related to subjects who for the first time turned to a hospital or to a Public Service Dedicated to Drug Addicts or to a Community Mental Health Center for problems related to pathological gambling in the metropolitan area of Bologna (Northern Italy) in the period 2000/2015, were: to describe characteristics and problems of pathological gamblers (PGs); to estimate the prevalence of PGs using the capture-recapture method. 495 residents were identified, with an estimate of 1570 PGs and a prevalence of 1.78 per 1000. We highlight a high number of new cases in the period after 2010. Most patients are males, aged from 40 to 50 years, 12% was born abroad, one in three suffers from other mental disorders, 9% has alcohol dependence, 8% drug dependence. We should point out the low level of education and the high presence of unemployed subjects.
Using health care audit to improve quality of clinical records: the preliminary experience of an Italian Cancer Institute
Get PDFIntroduction: Audit and feedback are recognized as part of a strategy for improving performance and supporting quality and safety in European health care systems. These considerations lead the Clinical Management Staff of an Italian Cancer Institute to start a project of self-assessment of the quality of clinical records and organizational appropriateness through a retrospective review. Materials and methods: The evaluation about appropriateness and congruity concerned both clinical records of 2013 and of 2015. At the end of the assessment of clinical records of each Care Unit, results were shared with medical staff in scheduled audit meetings. Results: One hundred and thirteen clinical records (19%) did not meet congruity criteria, while 74 (12,6%) resulted as inappropriate. Two surgical Care Units produced a high negative difference in terms of economic value, 7 Care Units produced about the same medium difference and 2 Care Units had a positive difference. Concerning the quality assessment of clinical records of 2015, the most critical areas were related to medical documents and Hospital Discharge Form compilation. Conclusions: Our experience showed the effectiveness of clinical audit in assessing the quality of filling in medical records and the appropriateness of hospital admissions and the acceptability of this tool by clinicians