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The effectiveness of a screening programme for HIV infection among prisoners is discussed, in relation to validity of screening test, natural history ad modalities of transmission of the infection, hypothetical objectives of the programme, in comparison with alternatives prevention programmes. The association between HIV infection, e.v. drug abuse and sexual behaviours is analyzed. On the basis of available evidences the hypothesis of lack of effectiveness and possible harmfulness of this screening programme is proposed.

In 1985-1986, 634 adult dialysis patients were tested prior to hepatitis B vaccination, representing 40% of the total patients in Latium, an Italian region. HBsAg and anti-HBs prevalences were 7.1 and 36.0%, respectively. Merck, Sharp & Dohme (MSD) and Pasteur plasma-derived vaccines were randomly allocated to the 44 dialysis units. An anti-HBs response greater than or equal to 10 IU/l was elicited in 58.5% of 236 subjects tested at 6 months, 63.4% MSD and 52.4% Pasteur (p n.s.). The relatively low response to the vaccine in this high-risk group stresses the need to improve the efficacy of the vaccination and to maintain policies of environmental control.

A survey on knowledge, attitudes, and practice regarding breast and cervical cancer screening was conducted in Rome on a sample of women aged 18-64 years. Of the 793 interviewees, 31.9% had undergone at least one breast imaging examination; examinations were more frequent in women over 35 and in those familiar with breast self-examination and female pathophysiology. Seventy percent of the women had had at least one Pap smear. Women were classified as Pap smear underusers (26.0%), appropriate users (28.8%), and overusers (45.2%) as compared to standard screening recommendations, according to their age and their lifetime number of smears. Age over 35 was associated with both underuse and overuse. Such inappropriate screening patterns could be related in part to the fact that the women reported that their physicians recommendations for Pap smear frequency were once a year or more in 62%, and once every two or three years in only 2%.

After the Chernobyl accident serious concern spread throughout Italy about the possible effects of the consequent exposure to radioactivity on fetuses. A reduction of births in the first three months of 1987, and particularly in February (7.2% reduction in the birth rate), was observed throughout Italy. In April-June 1987 a 4.8% increase in the number of births was observed. The magnitude of both phenomena varied in different areas of the country. The total number of births in the first six months of 1987 was very similar to the expected (264,241 versus 263,659). Induced abortions increased in Lombardia (northern Italy) in June (+1.6%) and July of 1986 (+3.4%) and in Campania (southern Italy) in June (+12.7%) and August (+4.3%). No increase in legal abortions was detected in Lazio (central Italy). Italian data suggest a voluntary decrease in the number of planned pregnancies and the termination of some of them in the first weeks after the accident as a consequence of postdisaster stress.

A case-referent study has been carried out to test the hypothesis that silica-exposed ceramic workers have an increased risk of lung cancer. Next-of-kin interviews were conducted for 72 lung cancer cases and 319 referents, all deceased, to collect work histories and smoking habits. The diagnosis of silicosis was ascertained by checking the individual files of cases of silicosis where compensation had been received. It was found that, after controlling for age, period of death and smoking, workers in the ceramic industry had a higher lung cancer risk than those in other occupations in which there was no exposure to silica (Mantel-Haenszel rate ratio = 2.0; 95% confidence interval (CI) = 1.1-3.5). This increased risk was mainly due to a rate ratio of 3.9 (95% CI = 1.8-8.3) for silicotic individuals, while for non-silicotic ceramic workers it was only 1.4 (95% CI = 0.7-2.8). Exposure to other carcinogens in the workplace seems not to play any role in the development of lung cancer. Furthermore, the data do not suggest an increased risk for silicotic non-smokers. The results of the study tend to confirm previous evidence of an excess risk among silicotic subjects and points to a possible etiological role of the silicotic process itself in lung cancer.

The effectiveness of premarital screening program for HIV infection is discussed, in relation to hypothetical objectives: improvement of individual health, prevention of transmission of HIV infection and estimate of prevalence among sexually active population. Taking into account validity of screening test, natural history of HIV infection, availability of effective early treatment and possible social outcomes, the hypothesis of lack of effectiveness of this program is held.

A historical cohort study of 406 workers was undertaken to evaluate the possible health hazards of employment in traditional electric power plants with particular regard to cancer mortality. The total mortality was below that expected [observed 40, standardized mortality ratio (SMR) 87] on the basis of national rates. Cancer mortality was slightly increased (SMR 112), mainly because of an excess of respiratory cancer (observed 9, SMR 171, 90% CI 89-299). Lung cancer deaths were higher than expected among those less than 60 years of age and among those with a duration of exposure and a latency period since first employment of over 10 years (observed 7, SMR 184). Furthermore, the increase was more pronounced among maintenance workers and workers in general services. Previous data indicated that there had been past exposure to some known respiratory carcinogens (ie, asbestos, polycyclic aromatic hydrocarbons). This study suggests that a possible lung cancer risk from traditional electricity generating plants should be considered and further studied.

Employment in the soap production industry in Italy has entailed some exposure to sulfuric acid vapors and nickel dusts, both agents under suspicion of being carcinogenic for the respiratory tract. A mortality study, together with an incidence study for laryngeal cancer, has been conducted among 361 men with a minimum employment of one year in soap production. Mortality from all causes was lower than expected, but lung cancer and laryngeal cancer deaths were increased, although without statistical significance. Five new laryngeal cancer cases were detected during the study period, while about one was expected. All the men with respiratory cancer had been working for several years, and the latency time was greater than 10 years. Even though the mechanism of a causal link is difficult to assess, the possibility of a carcinogenic effect of sulfuric acid is suggested.

A mortality study was carried out on 595 workers who were compensated for silicosis in the Latium region, Italy, during the period 1946-84 who died between 1 January 1969 and 31 December 1984. Respiratory disorders, tuberculosis, lung cancer, bone cancer, and cirrhosis of the liver showed significantly increased risk ratios (4.1, 3.7, 1.5, 4.1, and 1.9 respectively); excesses of brain cancer and leukaemia did not reach statistical significance. Lung cancer mortality was further analysed by age, period of compensation, final degree of disability, and occupational activity. The possible confounding role of smoking was assessed by comparing the lifetime smoking habits of a sample of silicotic subjects with those of the general male population as estimated by a national health survey; the prevalence of ever smokers among silicotic subjects (70.7%) was similar to that estimated for the general population (68.5%). The present study indicates that silicosis is associated with lung cancer even though it does not clarify the respective roles of exposure to silica and silicosis.

The Italian death rates and years of potential life lost (YPLL) for all causes and for 12 selected aggregations of causes are reported for 1979 and 1983, with the latter compared to United States data. Cancer is the leading cause of YPLL in Italy (23.8 per cent of total YPLL), followed by unintentional injuries (16.3 per cent) and heart disease (11.2 per cent). Rates of YPLL for all causes decreased 12.0 per cent from 1979 to 1983, the strongest declines in absolute terms being observed for prematurity and unintentional injuries, and in percentage decline for pneumonia and influenza, and infectious diseases; during the same period, YPLL for diabetes increased. The rates of YPLL are higher for males than for females (rate ratio = 1.9) especially for causes related to lifestyle factors. Premature mortality is lower in Italy than in the USA, because of the striking difference in mortality from injuries and heart diseases.