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There is a lack of agreement about which routine invitation strategy should be adopted in colorectal cancer screening. We conducted an observational study to assess the impact of three invitation strategies on participation. Invitation records for the years 2005–2009 were evaluated. There were 2,234,276 invitations from 1,230,683 individuals. Among first invitations, participation associated with direct mailing of the faecal occult blood test kits was slightly lower (relative risk, RR 0.985; 95% confidence interval 0.979–0.990) than that of the reference invitation strategy, that is, the distribution of the test kits by pharmacies. In repeated invitations/previous non‐responders, the participation associated with the direct mailing of the test kits was even lower (RR 0.914; 95% confidence interval 0.895–0.933) and this was also the case for the distribution of the test kits by primary care centres (RR 0.983; 95% confidence interval 0.971–0.995). In contrast, in repeated invitations/previous responders, the impact of primary care centres and direct mailing of the test kits was greater than the use of pharmacies, showing only modest RRs: 1.021 (95% confidence interval 1.019‐1.023) and 1.029 (95% confidence interval 1.025–1.033) respectively. The faecal occult blood test mailing strategy modestly increased participation in previous responders. [ABSTRACT FROM AUTHOR]

Background: The Italian register of cardiovascular diseases is a surveillance system of fatal and nonfatal cardiovascular events in the general population aged 35–74 years. It was launched in Italy at the end of the 1990s with the aim of estimating periodically the occurrence and case fatality rate of coronary and cerebrovascular events in the different geographical areas of the country. This paper presents data for cerebrovascular events. Methods: Currentevents were assessed through record linkage between two sources of information: death certificates and hospital discharge diagnosis records. Events were identified through the ICD codes and duration. To calculate the number of estimated events, current events were multiplied by the positive predictive value of each specific mortality or discharge code derived from the validation of a sample of suspected events. Attack rates were calculated by dividing estimatedevents by resident population, and case fatality rate at 28 days was determined from the ratio of estimated fatal to total events. Results: Attack rates were found to be higher in men than in women: mean age-standardized attack rate was 21.9/10,000 in men and 12.5/10,000 in women; age-standardized 28-day case fatality rate was higher in women (17.1%) than in men (14.5%). Significant geographical differences were found in attack rates of both men and women. Case fatality was significantly heterogeneous in both men and women. Conclusions: Differences still exist in the geographical distribution of attack and case fatality rates of cerebrovascular events, regardless of the north-south gradient. These data show the feasibility of implementing a population-based register using a validated routine database, necessary for monitoring cardiovascular diseases. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

In epidemiological studies both questionnaire results and GIS modeling have been used to assess exposure to environmental risk factors. Nevertheless, few studies have used both these techniques to evaluate the degree of agreement between different exposure assessment methodologies. As part of a case-control study on lung cancer, we present a comparison between self-reported and GIS-derived proxies of residential exposure to environmental pollution. 649 subjects were asked to fill out a questionnaire and give information about residential history and perceived exposure. Using GIS, for each residence we evaluated land use patterns, proximity to major roads and exposure to industrial pollution. We then compared the GIS exposure-index values among groups created on the basis of questionnaire responses. Our results showed a relatively high agreement between the two methods. Although none of these methods is the "exposure gold standard", understanding similarities, weaknesses and strengths of each method is essential to strengthen epidemiological evidence., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Some contaminants emitted by municipal waste incinerators are believed to adversely affect reproductive health in the exposed populations; yet only limited and conflicting epidemiologic evidence on this issue has been provided so far. In this study we analyzed rates of spontaneous abortion and prevalence at birth of congenital anomalies in women residing or working near the municipal solid waste incinerator of Modena, northern Italy, during the 2003--2006 period and who experienced higher levels of exposure to polychlorinated dibenzo-p-dioxins and dibenzofurans, compared to the remaining municipal population. In women residing in two areas close to the incinerator plant with increasing exposure to dioxins, we did not detect an excess risk of miscarriage (relative risk [RR] 1.00, 95% confidence interval [CI] 0.65-1.48) and of birth defects (RR 0.64, 95% CI 0.20-1.55), nor did any indication of dose-response relation emerge. Among female workers employed in the factories located in the exposed areas, we did not observe a higher risk of spontaneous abortion (RR 1.04, 95% CI 0.38-2.30); however, an increase in prevalence of birth defects was noted (RR 2.26), although this risk estimate was statistically very unstable (95% CI 0.57-6.14). Overall, the study results provide little evidence of an excess risk of adverse pregnancy outcomes in women exposed to emissions from a modern municipal solid waste incinerator.

Since 1980 the WHO has proposed at least tree indices to characterize health status (impairment, disease, disability). Their relationships have been examined in some chronic diseases, but little is known about elderly at risk of frailty. We studied the influence of gender, age and living conditions on these indices and on their relationships. A sample of 100 home-dwelling elderly subjects underwent a multidimensional assessment at home to collect biological, symptomatic and functional measures. The sample consists of 48 males and 47 females, their mean age was 80.2 years, the mean schooling was 4.7 years. Living at home alone 14%, with spouse 60%, other 26%. Applying a MANOVA that considered the above mentioned items as factors and the biological, symptomatic and functional measures as dependent variables, no significant difference was found in biological measures, whereas the interaction of (i) gender and living conditions, (ii) gender and age classes showed differences in affective symptoms. Moreover, gender alone resulted a significant source of differences in instrumental activities of daily living (IADL). To assay the impact of biological, symptomatic scores on disability, a backward linear regression was applied. The principal index of postural control, Tinetti scale score, alone explained 50% of variance in activities of daily living (ADL), this index together with the measures, respectively, of cognitive functioning (Camcog score) and behavioral profile neuro-psychological inventory (NPI) score resulted to be the main sources of the IADL variance. These preliminary data allow us to identify both medical and social factors able to enhance the risk of frailty; is worth wile to stress that prevention programs could be targeted on possible modification of these factors.

Background and Aim: General practitioners (GPs) are being increasingly asked to play a key role in the shared care of people with diabetes mellitus, but data concerning the effects of this in Italy are still scarce. We therefore evaluated the 4-year follow-up changes in outcomes and performance indicators in type 2 diabetic patients cared for by GPs in the framework of the "Modena Diabetes Project"., Methods and Results: Seventy-four percent of the local GPs participating in the project (387 out of 521) sent 5260 paired baseline and follow-up datasheets. The baseline characteristics of the type 2 diabetic patients (49.6% male) were a mean age of 67.3+/-11.2 years, a mean disease duration of 10.9+/-7.4 years, a mean BMI of 28.7+/-4.8 kg/m2, and a mean HbA1c level 7.56+/-1.52%. After four years follow-up, the individual before/after match-paired outcomes revealed an improvement in glycemic control: HbA1c levels significantly decreased to 7.39+/-1.31%, and the percentage of patients with HbA1c level of <6.5% significantly increased from 15.7% to 22.1%. There was also a significant decrease in body weight (from 78.3+/-14.8 to 77.6+/-14.6 kg) and BMI (from 28.8+/-4.8 to 28.5+/-4.9 kg/m2). The time trends of glycemic control significantly improved during the 4-year follow up, but those of the body weight and BMI values did not. Furthermore, the percentages of performance indicators matching the expected rate of recurrence per each year of follow-up significantly improved during the study period., Conclusions: Long-term glycemic control and the performance indicators relating to the type 2 diabetic patients participating in our shared care programme progressively improved.

The province of Ferrara represents one of the areas with the highest mortality rate for lung cancer in Italy. The aim of the study is to evaluate the relative importance of the main known risk factors for lung cancer in that area. It is a case control study based on the population where the cases under study (249) are selected from subjects deceased over the period 1988-1993 in the territory of the ex USL 33 (Local Health Authority) of Comacchio, while the controls (500) lived in the same area. The statistical analysis showed the same information that can be found in other medical literature regarding the known risk factors: smoking (OR = 3.7-44.9 per n. cigarettes/die), spouse passive smoking (OR = 1.1), passive smoking due to social setting (pubs) (OR = 1.9), vegetable diet (OR = 0.4). A important role was played by the factors linked to socio-economic differences. There was a significant increase in risk for those who had lived in "casazze" in the area, which are typical homes of the poorer social classes. There was also a significant increase in risk for subjects with a lower level of education. To obtain these results the analysis method known as "classification trees" was also used in order to verify its possible use in the public health sector.

Anatomoclinical and chronobiological aspects of sudden death (SD) of 671 subjects observed at the Emergency Room of Ferrara Hospital from January 1983 to December 1991 were prospectively investigated. 3 groups stratified by age were considered: group A with age < 65 years (no. = 251, 37.4%), group B with age between 65 and 74 years (no. = 210, 31.3%), and group C with age > or = 75 years (no. = 210, 31.3%). SD was classified on the basis of either anatomopathological (i.e.: acute myocardial infarction, acute myocardial failure, intracerebral hemorrhage, rupture of aortic aneurysm, pulmonary embolism), and clinical findings (i.e.: arrhythmic death and circulatory failure death). Patients were grouped into six 4-hour periods according to the time of onset of symptoms, and circadian distribution was tested for uniformity by a chi 2 test for goodness of fit. The analysis found in group C an increased frequency of SD due to pulmonary embolism and rupture of aortic aneurysm, and an increment of males/females ratio in deaths from cardiac causes. In group C the mean age of SD, in particular from acute myocardial infarction, pulmonary embolism or arrhythmic death proved higher in females compared to males. Only for group B was a significant circadian periodicity found for SD from acute myocardial infarction and arrhythmic death, with a peak in the morning.

The circadian patterns in the onset of symptoms of acute myocardial infarction were assessed in a prospective study involving 450 patients. Analysis of the data in the 424 patients in whom the time of onset was known did not show any statistically significant circadian rhythms, either for the group as a whole or for subgroups divided according to sex, age group (< 60, 60-69, 70-79 and > or = 80 years old), or the presence or absence of diabetes mellitus. The frequency of onset of symptoms was highest in the morning (06.01-12.00 h) for the group as a whole (29.2%). Patients aged < 70 and > or = 80 years old showed a peak in the morning, whereas patients aged 70-79 years old showed a peak in the afternoon (12.01-18.00 h).

The investigation intends to estimate the frequency of some Sentinel health events (SHE) in order to evaluate, preliminarily in methodological terms, the applicability of the survey on some probable SHE, which derive from the death certificates sent to Public health board. The work load has been estimated in relation to the different demographic economic and social realities existing in Emilia Romagna Region. Moreover, the suitability (applicability), in operative terms, of the list suggested by the National group for the SHE (CISM), has been examined. In the end, some questions have been raised and some organizational suggestions have been proposed, in order to guarantee the constancy and validity of the survey and above all the knowable acceptance of the insiders.