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Introduction Cost-effectiveness analysis provides a ratio that indicates the value created per unit of money by a given therapy but says nothing about the total expected costs or net health and social impact of this therapy in a particular population of interest. Objective The main objective of this study is to define a methodology to calculate the effects of interventions from a local perspective. This will help determine parameters that provide information about resource planning and management to local decision makers. Methods The described methodology calculates four indicators using local demographic and epidemiological data and a Markovian decision tree approach. Results The method was applied to evaluate the economic, health and social impact of introducing a new cancer drug, Trastuzumab, for the early treatment of breast cancer in the Veneto Region of Italy. Discussion The indicators described in this study allow public policy makers to clearly understand the benefits and costs of a particular health intervention in a local population and to compare it with other strategies.

BCG vaccine, vaccinia vaccine and certain pathogens that were shown in previous studies to protect against melanoma have antigenic determinants homologous in their amino acids sequence with the melanoma antigen HERV-K-Mel, encoded by a human endogenous retrovirus K (HERV-K), which is expressed in about 95% of malignant melanocytes. Yellow fever vaccine (YFV) likewise contains an antigenic determinant with a close homology to HERV-K-MEL and might therefore also confer protection against Melanoma. To investigate this possibility we carried out a cohort study (28,306 subjects) and a nested case-control study (37 melamona cases and 151 tumors not expressing HERV-K-MEL) in Veneto region (North-Eastern Italy). The standardized incidence ratio was 1.33 (95% confidence interval, 0.84-2.11), 1.59 (0.97-2.59) and 0.59 while the age- gender-adjusted odds ratios were 1.00, 0.96 (0.43-2.14) and 0.26 (0.07-0.96), (0.19-1.84), at 0-4, 5-9, and >= 10 years elapsed from YFV administration, respectively. The risk of melanoma may therefore be lowered 10 years after vaccination with yellow fever vaccine. (C) 2008 Elsevier Ltd. All rights reserved.

The aim of this study was to determine what made people want to change their choice of general practitioners (GP). Furthermore, the study aimed to correlate the perceived quality of patient-GP communication with the motives inducing individuals to change their doctors. All people requesting to change their GPs were asked by the office staff to complete a questionnaire. The study identifies the following main reasons for changing GP: patients perceived the doctor as unwilling to listen to them; patients did not receive the services that they considered useful for their health; and patients perceived the doctor’s disorganization as an obstacle to accessibility. These findings suggest several actions to improve the doctor–patient relationship, including training for physicians to develop their communication skills; involving public health operators in helping to understand the rights and obligations of patients and doctors; and a reorganization of the GP’s workload.

ObjectiveThe influence of moderate alcohol consumption on renal function is not clear in elderly people. The aim of the present study was to investigate the relationship between alcohol consumption and renal function, expressed as serum creatinine levels and glomerular filtration rates (GFR), in an elderly population.DesignPerspective cohort study.SettingPopulation-based study on an elderly Italian population.SubjectsA sample of 3404 Italian people (1619 women and 1785 men), aged 65–84 years, from the Italian Longitudinal Study on Aging (ILSA).ResultsPrevalence and cumulative risk of impaired renal function (defined as GFR ≤ 60 ml/min) were estimated by sex and alcohol consumption groups. Logistic regression analysis adjusting for confounders (age, education, smoking, BMI and medications) and intermediate factors (blood cholesterol and fibrinogen, systolic hypertension and diabetes) showed that alcohol consumption level was not significantly related to the prevalence of mild renal impairment in elderly women. In men, both prevalence and incidence results seemed to suggest an inverse linear relationship between moderate alcohol consumption and the risk of mild renal impairment. A U-shaped association was shown for women at the incidence phase, suggesting a higher risk of developing renal impairment for women who drink more than 24 g alcohol/d.ConclusionsOur results suggest that, in accordance with the recommendations on alcohol consumption in the elderly, moderate quantities of alcohol are not injurious to renal function in elderly men.

Flight personnel are exposed to cosmic ionizing radiation, chemicals (fuel, jet engine exhausts, cabin air pollutants), electromagnetic fields from cockpit instruments, and disrupted sleep patterns. Only recently has cancer risk among these workers been investigated. With the aim of increasing the precision of risk estimates of cancer incidence, follow-up studies reporting a standardized incidence ratio for cancer among male flight attendants, civil and military pilots were obtained from online databases and analysed. A meta-analysis was performed by applying a random effect model, obtaining a meta-standardized incidence ratio (SIR), and 95% confidence interval (CI). In male cabin attendants, and civil and military pilots, meta-SIRs were 3.42 (CI=1.94-6.06), 2.18 (1.69-2.80), 1.43 (1.09-1.87) for melanoma; and 7.46 (3.52-15.89), 1.88 (1.23-2.88), 1.80 (1.25-2.58) for other skin cancer, respectively. These tumors share as risk factors, ionizing radiation, recreational sun exposure and socioeconomic status. The meta-SIRs are not adjusted for confounding; the magnitude of risk for melanoma decreased when we corrected for socioeconomic status. In civil pilots, meta-SIR was 1.47 (1.06-2.05) for prostate cancer. Age (civil pilots are older than military pilots and cabin attendants) and disrupted sleep pattern (entailing hyposecretion of melatonin, which has been reported to suppress proliferative effects of androgen on prostate cancer cells) might be involved. In male cabin attendants, meta-SIR was 21.5 (2.25-205.8) for Kaposi’s sarcoma and 2.49 (1.03-6.03) for non-Hodgkin’s lymphoma. AIDS, which was the most frequent single cause of death in this occupational category, likely explains the excess of the latter two tumors.

Twenty-two workers exposed to styrene and acetone in two fiberglass industries were monitored on Monday and Thursday for 8 hours using passive dosimeters. Urine samples were collected at the end of the workshift and before the start of the work on the next morning (Tuesday and Friday). The charcoal disks of the passive dosimeters were analysed by gas-chromatography. Mandelic acid (MA) and phenylglyoxylic acid (PGA) were measured using a HPLC method; values were expressed in mg/g of creatinine. The 8-h TWA exposure values for styrene and acetone ranged respectively from 22 to 522 mg/m 3 and 40-1581 mg/m on Monday; 25–423 mg/m3 and 55–579 mg/m3 on Thursday. Styrene TWA exposure values significantly correlate with the sum of metabolites at the end of workday (r = 0.70 on Monday and r = 0.95 on Thursday) and also at the next morning (r = 0.86 on Tuesday and r = 0.85 on Friday). A styrene exposure level of 213 mg/m3 (ACGIH-TLV) was associated with an excretion of metabolites (MA+PGA) higher on Thursday (803 mg/g Great) than on Monday (570 mg/g creat). The same result was found on Friday (459 mg/g creat) compared with Tuesday (305 mg/g creat). Moreover our data show that the simultaneous exposure to acetone does not modify the excretion of MA. In conclusion the TLV of styrene is associated with different values of metabolites at the beginning and at the end of the work-week.

Linkage of various archives (municipal, hospital, autopsy) has enabled the authors to reconstruct the flow of information regarding death due to tracheal, bronchial or lung cancer (TBL ca) for the population residing within the Municipality of Ferrara during the period 1983–1985. The authors subsequently attempted to verify the cause of death by performing quality controls on clinical charts, radiologic findings, cytohistologic examinations and autopsy findings. Analysis of the data obtained in this manner suggests that municipal records are more « accurate » than are hospital records. The authors likewise indicate the usefulness and importance of the autopsy for a correct diagnosis of cause of death.

Eighty-four workers exposed to toluene (printing industry), styrene (fiberglass industries), n-hexane, and other solvents (shoe industry) were monitored with a total of 248 sequential samples. Sampling times varied between a minimum of 2 hours and a maximum of 3.5 hours. Highly significant correlations were found between exposure levels to solvents (as daily time-weighted averages) and concentrations of the respective urinary metabolites (hippuric acid, mandelic acid, phenylglyoxylic acid 2,5-hexanedione), confirming that these metabolities are good indices for routine monitoring of subjects occupationally exposed to the above solvents. In view of their results, the authors believe that monitoring individual exposure with personal sequential samples covering the whole workshift can be viewed as the procedure which provides the best information (exact estimate of time-weighted average and evaluation of variable exposures during the workday) for improved understanding of the relations between envir...

The correlation for diastolic and systolic blood pressure was studied in two samples of quartets each consisting of two pairs. The first sample comprised pairs of sisters and their husbands, and the second sample was comprised of brothers and their wives. All siblings were between 30 and 55 years of age and had been married for at least 5 years. It was found that unrelated men married to sisters had a significant correlation in both diastolic (r = 0.28) and systolic (r = 0.41) pressure. For systolic blood pressure, the correlation between pairs of unrelated men married to sisters was significantly larger than the homologous correlation existing in pairs of brothers married to unrelated women. The correlations of systolic and diastolic pressure in sisters were significantly smaller than the same correlations measured in the wives of brothers. The correlations in height for men, used as an internal control to compare marital and genetic effects, were unaffected by marriage, as expected. The correlations in height for pairs of sisters, however, were no larger than those observed in pairs of unrelated women married to brothers. It was concluded that in adult married men and women of the Ferrara population, aged 30 to 55 years, the influence of genetic factors on blood pressure is less important than the influence of cultural factors.