Annali dell'Istituto Superiore di Sanità
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Cesarean section on maternal request: should it be formally prohibited in Italy?
Get PDFBackground. Cesarean section on maternal request (CSMR) could represent an avoidable quota of cesareans. In Italy, this is a topical problem of health-policy, involving ethical, juridical and medical issues. Aim and methods. A 5-questions questionnaire to quantitatively assess the perspectives of medical, juridical and ethical issues of planned CSMR was administered to obstetricians and gynecologists, midwives, lawyers and pregnant women. It was assessed to what extent those issues matter on the final decision of planning a CSMR. Results. Non-homogeneous answers of stakeholders suggest different perspectives about issues on CSMR. The juridical issue seems to have the greatest impact on the final decision. Conclusion. Planning a CSMR associates overall with juridical issues in each group of respondents. Therefore, an obstetrician and gynecologist is unable to counsel a patient on CSMR from a medical point of view. The most direct way for reducing cesareans in Italy could be the formal prohibition of CSMR.
Cancer burden trends in Umbria region using a joinpoint regression
Get PDFIntroduction. The analysis of the epidemiological data on cancer is an important tool to control and evaluate the outcomes of primary and secondary prevention, the effectiveness of health care and, in general, all cancer control activities. Materials and methods. The aim of the this paper is to analyze the cancer mortality in the Umbria region from 1978 to 2009 and incidence from 1994-2008. Sex and sitespecific trends for standardized rates were analyzed by “joinpoint regression”, using the surveillance epidemiology and end results (SEER) software. Results. Applying the jointpoint analyses by sex and cancer site, to incidence spanning from 1994 to 2008 and mortality from 1978 to 2009 for all sites, both in males and females, a significant joinpoint for mortality was found; moreover the trend shape was similar and the joinpoint years were very close. In males standardized rate significantly increased up to 1989 by 1.23% per year and significantly decreased hereafter by -1.31%; among females the mortality rate increased in average of 0.78% (not significant) per year till 1988 and afterward significantly decreased by -0.92% per year. Incidence rate showed different trends among sexes. In males was practically constant over the period studied (not significant decrease 0.14% per year), in females significantly increased by 1.49% per year up to 2001 and afterward slowly decreased (-0.71% n.s. estimated annual percent change − EAPC). Conclusions. For all sites combined trends for mortality decreased since late ’80s, both in males and females; such behaviour is in line with national and European Union data. This work shows that, even compared to health systems that invest more resources, the Umbria public health system achieved good health outcomes
Twenty years of surveillance of Invasive Meningococcal Diseases in Puglia, Italy
Get PDFData of all the cases of Invasive Meningococcal Diseases are collected in the frame of the National Surveillance System coordinated by the National Reference Laboratory (NRL) of the Istituto Superiore di Sanità, which performs further microbiological characterization on collected isolates. In Puglia, from 1994 through 2014, the average incidence was 0.2 per 100.000 inhabitants, lower than the national value (0.33), with a peak in 2013 of 0.46 per 100.000 inhabitants. Patients tended to be older (median age 19 vs16). The case-fatality rate was 20.4% in Puglia vs 13.3% in Italy. Serogroups B and C were the most identified. Fourty-seven percent of the isolates showed a decreased susceptibility to penicillin G. Serogroups C and Y presented a fairly clonal pattern, whereas serogroup B isolates were rather genetically heterogeneous. Surveillance system is essential to monitor possible changes in the epidemiology of invasive meningococcal disease consequent to immunization strategies adopted locally and nationally
NGF and therapeutic prospective: what have we learned from the NGF transgenic models?
Get PDFIt has been shown that topical nerve growth factor (NGF) administration induces healing action on human cutaneous, corneal and pressure ulcers, glaucoma, maculopathy and retinitis pigmentosa suggesting a therapeutic potential of NGF in human ophthalmology and cutaneous ulcers. A similar therapeutic suggestion has emerged for the NGF gene therapy of Alzheimer’s disease and ischemic heart injury. Moreover, over the last few years, the role and biological properties of NGF have also been investigated with transgenic mice over-expressing and down-expressing NGF. However, the results obtained with these transgenic mice seem suitable to confirm and/or support the evidence obtained with exogenous administration of NGF regarding the suggested clinical potentiality of NGF. The aim of the present brief review is to report and comment on these two different findings of NGF’s healing properties
A quality assessment of systematic reviews on telerehabilitation: what does the evidence tell us?
Get PDFAims. To evaluate the quality of systematic reviews on telerehabilitation. Methods. The AMSTAR – Assessment of Multiple Systematic Reviews – checklist was used to appraise the evidence related to the systematic reviews. Results. Among the 477 records initially identified, 10 systematic reviews matched the inclusion criteria. Fifty percent were of high quality; anyway the majority of them did not report the following aspects: i) analysis of the grey literature; ii) a list of the excluded studies and their haracteristics; iii) the identification of possible source of bias and the assessment of its likehood; iv) an appropriate method to combine the findings of the included studies addressing the heterogeneity as well. From the main findings of the highscored systematic reviews telerehabilitation resulted at least as effective as usual care: 1) in the short term treatment of mental health related to people affected by spinal cord injury; 2) in rural communities for treating patients affected by chronic conditions; 3) in treating common pathologies (mainly asthma) affecting children and adolescents. As for stroke, evidence is currently insufficient to reach conclusions about its effectiveness. As for costs, there is insufficient evidence to confirm that telerehabilitation is a cost-saving or cost-effective solution. Conclusions. In the authors’ knowledge this is the first attempt to evaluate the quality of systematic reviews on telerehabilitation. This work also identified the main findings related to the high-scored systematic reviews; the analysis confirms that there is a mounting evidence concerning the effectiveness of telerehabilitation, at least for some pathologies
The role of associative and non-associative learning in the training of horses and implications for the welfare (a review)
Get PDFHorses were domesticated 6000 years ago and since then different types of approaches have been developed to enhance the horse’s wellbeing and the human-horse relationship. Even though horse training is an increasingly important research area and many articles have been published on the subject, equitation is still the sport with the highest rate of human injuries, and a significant percentage of horses are sold or slaughtered due to behavioral problems. One explanation for this data is that the human-horse relationship is complex and the communication between humans and horses has not yet been accurately developed. Thus, this review addresses correct horse training based on scientific knowledge in animal learning and psychology. Specifically, it starts from the basic communication between humans and horses and then focuses on associative and non-associative learning, with many practical outcomes in horse management from the ground and under saddle. Finally, it highlights the common mistakes in the use of negative reinforcement, as well as all the implications that improper training could have on horse welfare. Increased levels of competence in horse training could be useful for equine technicians, owners, breeders, veterinarians, and scientists, in order to safeguard horse welfare, and also to reduce the number of human injuries and economic loss for civil society and the public health system
Pathologic diagnosis of malignant mesothelioma: chronological prospect and advent of recommendations
Get PDFMalignant mesothelioma (MM) is rare and difficult to diagnose. Its identification dependsupon pathological investigation (cyto-histological assessment and immunohistochemistry)supported by clinical and radiological evidence. In the last decade, thestandardization of diagnostic methods has become a major focus of debate among pathologistsand clinicians. This has led to the writing of guidelines and recommendationfor the diagnosis to achieve the goal of a standard diagnosis. In this article, a chronologicalview relating to the pathological diagnosis of MM is presented together with a reviewof guidelines and recommendations.
