• Cancer burden trends in Umbria region using a joinpoint regression Original Articles and Reviews

    Masanotti, Giuseppe Michele; Cioccoloni, Francesca; Stracci, Fabrizio; Bianconi, Fortunato; Duca, Emilio; La Rosa, Francesco

    Abstract in English:

    INTRODUCTION. 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 site-specific 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 thereafter 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 increase 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.
  • The influence of patients' complexity and general practitioners' characteristics on referrals to outpatient health services in an Italian region Original Articles and Reviews

    Valent, Francesca; Deroma, Laura; Franzo, Antonella; Gobbato, Michele; Simon, Giorgio; Canciani, Luigi; Zanier, Loris

    Abstract in English:

    BACKGROUND. Patient referrals to outpatient health services may affect both health outcomes and health expenditures. General practitioners (GP) have a crucial role in driving the use of outpatient services and recognizing factors which affect referrals is important for health managers and planners. OBJECTIVES. We investigated patient- and physician-related determinants of patient referrals in an Italian region. METHODS. This was cross-sectional study based on the individual linkage of administrative databases from the health information system of the Friuli Venezia Giulia region. For each GP of the region, the association of the number of patient referrals to different types of outpatient services with the proportion of patients with chronic conditions, with the number of hospital admissions and drug prescriptions in 2012, and with GP's characteristics was investigated through multilevel multivariable Poisson regression models. RESULTS. Some chronic conditions (e.g., cancer, autoimmune diseases, endocrine diseases, digestive system diseases) were positively associated with the number of referrals, as were hospital admissions and drug prescriptions. Time since GP's graduation was inversely related with referrals. CONCLUSION. Patient complexity and GP's experience affect referral rates. These factors should be considered in case of a reorganization of the general practice structure in Friuli Venezia Giulia.
  • Recent entomological enquiry on mosquito fauna in Circeo National Park Original Articles and Reviews

    Liberato, Claudio De; Magliano, Adele; Farina, Flavia; Toma, Luciano

    Abstract in English:

    The present study was carried out in Circeo National Park (Lazio region, Central Italy), in order to collect data about mosquito (Diptera, Culicidae) fauna in a protected area for biodiversity. From 2003 to 2004 seasonal surveys allowed to collect and to identify 380 larvae and 713 adult mosquitoes in 6 sites. A total of 15 mosquito species belonging to 6 genera were recorded; the most abundant species were Culex pipens Linnaeus, 1758 known as the main West Nile virus vector, Ochlerotatus detritus (Haliday, 1933) and Culiseta annulata (Dhrank, 1776). Present data show a noteworthy number of other mosquito species, even if less abundant, reflecting the considerable environmental richness. Respect to the past collections of Anophelinae mosquitoes carried out in the same area once affected by malaria, the present research represents the first monitoring of the whole Culicidae Family in Circeo National Park, up to now. This paper reports the collected data as a first base for a future checklist in this protected area.
  • Mechanical qualification of collagen membranes used in dentistry Original Articles and Reviews

    Ortolani, Emanuela; Quadrini, Fabrizio; Bellisario, Denise; Santo, Loredana; Polimeni, Antonella; Santarsiero, Anna

    Abstract in English:

    AIM. The aim of this work is the qualification of commercially available collagen membranes in a comparative manner. The natural origin of collagen makes standardization difficult. Nevertheless, through dimensional and mechanical measures it is possible to mechanically qualify collagen membranes, and compare them. METHODS. Three commercially available collagen membranes used in Guided Bone Regeneration (GBR) and in Guided Tissue Regeneration (GTR) techniques, namely Bio-Gide, Collprotect and Jason, were chosen for the comparison. Quasi-static (tensile tests) and time-dependent (stress relaxation test) mechanical tests together with a functional test (tear test) were done to determine the responses of collagen membranes under different loading conditions. RESULTS. The tested membranes exhibited different behaviours, different deformability values and thickness, Jason being the thinnest and Bio-Gide the thickest. Similar differences were also observed in terms of surface density. DISCUSSION. Even though clinical observations were not within the aim of this study, our findings indicate that a better understanding of the correlation between mechanical properties and thickness could lead to a more rational design and use of these membranes in the face of specific clinical cases.
  • Antihypertensive drug use during pregnancy: a population based study Original Articles and Reviews

    D'Amore, Carmen; Trotta, Francesco; Cas, Roberto Da; Zocchetti, Carlo; Cocci, Alfredo; Traversa, Giuseppe

    Abstract in English:

    PURPOSE. The study aimed at assessing if the European guideline on the use of antihypertensive drugs (AD) in pregnancy are followed in clinical practice. We also evaluated the association between the use of non-recommended drugs and individual characteristics. METHODS. This study analyzed a cohort of 86 171 singleton deliveries occurring between 2009-2010 in the Lombardy region, Italy. Women with first prescription of AD during pregnancy were considered as incident users. Methyldopa, labetalol and nifedipine were considered as "recommended drugs"; all other AD were considered as "non-recommended". Odds Ratio and 95% confidence intervals were estimated. RESULTS. Among the 1009 patients (1.2%) exposed to AD during pregnancy, 675 (66.9%) were incident users. Among the incident users, 31% received non-recommended drugs; this proportion decreased to 18% among women who started treatment in the third trimester. Women with at least four concomitant diseases had an elevated risk of receiving non-recommended drugs in pregnancy (OR 2.68; 95% CI 1.10-6.73). CONCLUSIONS. Exposure to recommended antihypertensives increased during pregnancy. Nevertheless, a fraction of users that continued or began treatment with non-recommended medications was still present.
Istituto Superiore di Sanità Roma - Rome - Italy
E-mail: annali@iss.it