1,721,102 research outputs found
Obesity: epidemics or crisis worldwide?
Full text linkThe rapid increase in the level of obesity and overweight worldwide is
recognized as a major health problem: obesity poses a major risk for serious dietrelated
diseases, including diabetes mellitus, cardiovascular disease, hypertension,
stroke and cancer; therefore, it increases the risk of premature death.[1] In
particular, abdominal obesity - an increased amount of intra-abdominal fat - has
been associated with a number of cardiovascular disease (CVD) risk factors,
CVD and all-cause mortality [2]. Recent research demonstrated that high BMI
values are associated with increased sympathetic activity, which results in
decreased Heart Rate Variability (HRV). [3]
Obesity can also be related to psychiatric disorders. [4,5] Some research
suggests that depression and anxiety might lead to obesity through the adoption
of an inactive lifestyle; however, the opposite direction is also possible. [6]
The rising epidemic reflects the profound changes in society and in
behavioural patterns of communities over recent decades. While genes are
important in determining a person's susceptibility to weight gain, energy
balance is determined by calorie intake and physical activity [7]. Economic
growth, modernization, urbanization and globalization of food markets are just
some of the forces thought to underlie the obesity trend. Based on the existing
prevalence, trend data and the epidemiological evidence linking obesity with
health conditions, it is reasonable to describe obesity as a public health crisis
that severely impairs the quality of life, adds to national health care budgets. [8
Where the italian journal of public health is going? a tale of the last two years
Full text link[No abstract available
How to report a review? [Come si scrive una review?]
No full textIn this contribution we would like to underline another issue: how to report a review?
The need of specific reporting guidelines for medical journals is beyond dispute. With that regard a number of statements were developed by groups of experts to facilitate reporting of research studies. Most medical journals, including British Medical Journal (BMJ), the Journal of the American Medical Association (JAMA), The Lancet, and New England Journal of Medicine, often require compliance to all or some of the following guidelines: CONSORT Statement (reporting of randomized controlled trials), STARD (reporting of diagnostic accuracy studies), STROBE (reporting of observational studies in epidemiology), PRISMA (reporting of systematic reviews and meta-analyses) and MOOSE (reporting of meta-analyses of observational studies).
The present letter concerns the standards of reporting in research, publication in medical journals and wishes to give an emphasis to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement.
There is no doubt that, according to the PRISMA statement [2], the number of authors for a systematic review needs to be at least 2 (“Eligibility assessment to be performed independently in an unblended standardized manner by 2 reviewers”)
Identification of delivery models for the provision of genetic testing, policies governing the use of genomic applications and evaluation of genetic services: a multicentre study
Full text linkThe provision of genetic services, along with research in the fields of genomics and genetics, has evolved in recent years to meet the increasing demand of consumers interested in prediction of genomic diseases and various inherited traits (e.g. ability in sports, nutrigenomics, ancestry, etc.). Consumer demand and commercial interests have paved the way for the premature introduction, in the public and private healthcare sectors, of genetic tests with insufficient data on analytical and clinical validity, as well as clinical utility. There is also lack or insufficient evidence of cost-effectiveness of several genetic applications already introduced in clinical and public health practice. These concerns contribute to the lack of evidence on what constitutes an optimal genetic service delivery model, defined as the broad context within the Public Health Genomics framework in which genetic services are offered to individuals and families with or at risk of genetic disorders.
The aim of this dissertation is to identify existing genetic service delivery models, policies governing the use of genomic applications, and measures to evaluate genetic testing and related services in Europe and extra-European (Anglophone) countries (Canada, USA, Australia, or New Zealand). Two methodological approaches have been employed, a systematic review of the literature and a cross-sectional study addressing healthcare professionals with good knowledge and/or experience on the provision of BRCA1/2, Lynch syndrome, familial hypercholesterolemia, and inherited thrombophilia genetic testing, policies on genetic applications and evaluation of genetic services.
The identification and evaluation of existing genetic service delivery models are important steps towards the enhancement and standardization of genetic service provision. Current models of genetic services require the integration of genetics in all medical specialties, collaboration among different healthcare professionals, and redistribution of professional roles. Prior to implementation in clinical and public health practice, genetic tests should be evaluated based on available efficacy and cost-effectiveness data and offered to the citizens as right to benefit from innovative healthcare. The proper implementation of genomics application in mainstream medicine can be achieved through professional education, training, adequate funding, public policies, and public awareness of the field of genomic medicine
Requirements for cabin crew medical examinations and assessments
Full text linkThe aim of the current study is to review current regulations relatively to medical requirements necessary to achieve suitability to fly of the cabin crew. There are three classes of flight crew medical standards and licensing. A first class medical certificate is required for all pilots who perform professional flights or skydiving instructors. A second class medical certificate is required only for persons who do not perform professional flights, skydiving activities or any other professional activity related to aircraft piloting (cabin crew, holders of Light Aircraft Pilot’s Licence - LAPL, remote pilot operators). Finally, a third class medical certificate is required for workers engaged in air traffic control
Identificazione di modelli organizzativi di offerta di test genetici predittivi: proposta di un protocollo di studio multicentrico europeo
No full textLa genomica in sanità pubblica è un ambito multidisciplinare che ha stabilito basi scientifiche per una corretta implementazione dei progressi della genomica nella pratica clinica e di sanità pubblica. Tuttavia, tale implementazione è ancora nelle fasi iniziali con numerosi quesiti non ancora risolti. La rapida diffusione dei test genetici e la loro commercializzazione hanno un impatto sul sistema sanitario e sollevano preoccupazioni per quanto riguarda la corretta fornitura di servizi di genetica medica. La preoccupazione principale è l'introduzione precoce di test genetici predittivi, sia nel settore pubblico che nel privato, di cui la validità analitica e clinica, nonché l'utilità delle strategie diagnostiche e di screening non sono ben documentate. Una grande varietà di test genetici sono attualmente offerti direttamente ai consumatori (Direct-To-Consumer, DTC) da parte di imprese private presenti soprattutto negli Stati Uniti, ma anche in Europa. La maggior parte delle aziende opera via internet e senza il coinvolgimento di un professionista sanitario. Pertanto, è necessario un programma di ricerca globale per trasferire le scoperte del genoma umano nella pratica clinica, massimizzando i benefici per la salute e minimizzando i danni alle popolazioni: aspetti di cui si occupa la ricerca traslazionale. I modelli organizzativi di offerta di test genetici predittivi sono nella fase T3 della ricerca traslazionale che studia i modelli per l’implementazione delle linee guida evidence-based nella pratica clinica, attraverso ricerche sulle modalità di trasferimento, disseminazione e diffusione delle nuove tecnologie.
Obiettivi. Gli obiettivi del progetto sono: 1) descrivere e classificare i modelli organizzativi di offerta di test genetici predittivi esistenti in Europa e nei paesi extra-europei (USA, Canada, Australia, Nuova Zelanda) mediante una revisione sistematica della letteratura; 2) valutare i modelli organizzativi di offerta di test genetici predittivi tramite interviste a testimoni privilegiati e la raccolta degli indicatori di processo e di esito dai modelli organizzativi identificati in letteratura; 3) valutare le competenze dei professionisti di sanità pubblica provenienti da 26 paesi europei membri dell’European Public Health Association (EUPHA), tramite survey sull’uso appropriato delle tecniche genetiche in ambito preventivo.
Risultati attesi. Lo studio fornirà un contributo alla descrizione e alla valutazione dei modelli più idonei per la fornitura di test genetici predittivi, rendendo possibile l’individuazione di modelli organizzativi internazionali e delle best practices da adattare alla realtà italiana. Inoltre, lo studio sarà utile per rilevare il fabbisogno formativo e le esigenze informative dei professionisti di sanità pubblica nell’ambito della medicina predittiva
Hepatitis B immunization in health care workers: Needs and opportunities
No full text[No abstract available
How should genetic tests be evaluated? Final Results of a systematic review of the existing
No full textProcedura per la comunicazione di eventi avversi al paziente e alla famiglia.
No full textLa comunicazione trasparente ed onesta degli eventi avversi e delle loro conseguenze realizza un principio etico ed deontologico che permette di rafforzare la relazione di fiducia tra operatori sanitari e pazienti ed i loro familiari, e favorisce l'apprendimento dall'errore e il miglioramento della pratica clinica. Saper comunicare e' una componente indispensabile di una sanita' che pone la persona al centro dei propri interessi
Role of pap-test in cervical cancer prevention: a systematic review and meta-analysis<subtitle>Brigid Unim</subtitle>
No full textBackground
Cervical cancer is third in incidence and fourth in mortality
among cancers of women worldwide. Screening-test, such as
conventional cytology, are used to identify pre-cancers, to
prevent the occurrence of invasive cancers or to diagnose an
early stage of disease, permitting a well-timed treatment. This
systematic review and meta-analysis investigates the effective-
ness of pap test in the prevention of cervical cancer.
Methods
A systematic review and meta-analysis were performed. The
literature review, from 1979 to 2013, was based on Pubmed,
Scopus, Google Scholar and ISI engines using the keywords
‘‘pap test AND study design (RCT, cohort, case-control, cross
sectional) AND cervical cancer’’. The selection of articles was
carried out independently by four authors. Predefined study
quality indicators were applied for evaluation of articles: Jadad
scale was used for randomized clinical trials (RCTs) and New
Castle-Ottawa Scale for other studies. Four different meta-
analyses were carried out, one for each study design, using the
RevMan software version 5 for Windows.
Results
From the 3372 screened citations, 360 met our inclusion
criteria (86 cohort, 119 RCT, 62 cross-sectional and 93 case-
control). All papers were selected for title, abstract and study
design pertinence. Up to 81 doublets, 871 cohort, 526 RCT,
1046 cross sectional and 669 case-control studies were
excluded. Meta-analysis shows that Pap test reduces mortality
from and incidence of advanced cervical cancer compared to
no screening [mortality risk ratio (RR) 0.65, 95% CI 0.47-0.90;
incidence RR 0.56, 95% CI 0.42-0.7]. In a cohort study pap test
reduced the risk of invasive cervical cancer diagnosis compared
to no screening (RR 0.38, 95% CI = 0.23-0.63. Furthermore, a history of two negative Pap test rather than one is associated
with a decreased risk of developing cancer of the cervix (OR
1.33, 95% CI 0.93-1.90 vs OR 1.55, 95% CI 1.15-2.10).
Conclusions
Pap test is an effective screening tool, it is protective and
associated with a reduced risk of incidence of and mortality for
advanced cervical cancer. Risk-relative should be stratified for
women’s age, ethnic group, number of previous pap smears,
and time of follow-up.
Key messages
- Cytological screening programs play a major role in
reducing both incidence and mortality of invasive cervical
cancers. - The importance of Pap-test in early diagnosis of cervical can-
cer remains unaltered despite the availability of new screen-
ing methods, different HPV-DNA tests and HPV vaccines
- …
