1,721,055 research outputs found
Health right across the Mediterranean - tackling inequalities and building capacities
No full textThe Mediterranean has been – and is, to date – a battlefield for hope and despair, solidarity and segregation, knowledge and prejudice. The differences in ancestry, culture and heritage brought by the stream of refugees from Africa and Middle East, far from being sources of growth, are cause of conflict. While the principle of health right is repeatedly stated, the presence of striking inequalities in health status, healthcare and health promotion is dramatically apparent.
This co-operative volume is based on a workshop which was focussed on one key question: what are the key actions to tackle health inequalities and improve health for people living on or moving across the Mediterranean?
The current situation regarding health and healthcare in the Mediterranean area was explored by applying the lenses of global health and public health. By the mean of a multidisciplinary discussion, the respective responsibilities for national and international agencies emerged, along with the role for lay organisations, decision makers and citizens
Adoption of Guidelines concerning medical examinations on arrival for asylum seekers and refugees: systematic review of literature and proposals for an implementation plan in Italy
No full textIs a proper name the proper name? A survey on attitude of clinical geneticists towards eponyms in Italy
No full textBrief HTA report: Genotipo di polimorfismi del gene dell’IL28B (IFNL3): utilizzo clinico in pazienti con HCV
No full textBackground:
PEG-Interferon-α and Ribavirin association is currently the standard regimen for treatment of patients suffering from HCV infection. The genotype of polymorphisms located in the IL28B (IFNL3) gene is considered a reliable predictor of response to therapy, as measured by the mean of the sustained virologic response (SVR).
Aims:
The purpose of the present document is to provide information about the application in the clinical practice of the pharmacogenetic test based on IL28B genotyping to guide the administration of PEG-Interferon-α-based therapy in patients with HCV infection. The use of this test within the Regional Health System was also evaluated. Economic evaluations were not considered.
Methods:
A focused literature review was accomplished; a systematic search was performed to identify available systematic reviews and meta-analyses. A telephone survey was performed to identify laboratories offering the IL28B pharmacogenetic test within the Regional Health System and collect current activity.
Analytic validity:
The genetic test is routinely based on real-time PCR allelic discrimination of the rs12979860 single nucleotide polymorphism. Despite the lack of large studies on the analytic performance, the test procedure is robust and was reported to be readily implemented in the pipeline of molecular pathology laboratories.
Clinical validity:
According to all the meta-analyses reviewed in the present assessment, the genotype of the IL28B rs12979860 polymorphism is a valid predictor of sustained virologic response in previously untreated patients with HCV. Carriers of the rs12979860 CC genotype show a more favourable response rate, as compared to non-CC carriers. Genotyping of other IL28B polymorphisms is not suggested.
The association between response and IL28B genotypes was demonstrated for HCV genotype 1 and 4, while in genotype 2 and 3 was not definitely confirmed. The association with other endpoints, such as the rapid virologic response, was not extensively studied.
Clinical utility:
Though the sustained virologic response can be considered a valid measure of the clinical outcome and was widely used as endpoint in clinical studies, no evidence was found supporting the hypothesis that a regimen guided by IL28B genotyping is associated with a more favourable clinical outcome with respect to standard protocol. No clinical measure of efficacy, other than virologic response, was consistently evaluated in primary studies. Also occurrence of adverse events was not explored in association studies on IL28B genotype.
Noteworthy, a multivariate model including both clinical variables and IL28B genotyping as predictors was preliminarily demonstrated to more accurately predict virologic response with respect to IL28B alone. Clinical pathways incorporating the pharmacogenetic test of IL28B were not formally evaluated in clinical trials and currently are not recommended in clinical guidelines. Ongoing studies were found in the clinical trial database.
There is no literature exploring the ethical, legal and social implications of IL28B testing. However, this type of test does not raise specific concerns, provided that good practices are applied.
Provision of IL28B genotyping by laboratories of the Regional Health System:
The survey detected three laboratories offering pharmacogenetic IL28B testing. Approximately 550 test/year were performed in the 2012-2013 period.
The ability of each laboratory to perform a larger number of test should be further estimated. It could also be considered to what extent efficiency can be improved by gathering samples in one laboratory. In addition, it should be also investigated to what extent laboratories performing few tests can guarantee a timely response, as this is a critical requisite to guarantee the proper use of the pharmacogenetic tests
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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