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Background: Bcl2 is an important prognostic parameter in human breast cancer. However, the evaluation of Bcl2 expression by immunohistochemistry is carried out using arbitrary scoring criteria. In the present study, we evaluated the clinical relevance of a novel, semiquantitative classification of the Bcl2 immunostaining based on both the distribution and the intensity of the staining reaction. Patients and methods: The proposed classification was first validated in 69 breast cancer specimens by comparing the Bcl2 immunostaining with the Bcl2 messenger RNA (mRNA) levels evaluated by real-time RT-PCR. Since a highly significant association was found between protein and mRNA for Bcl2, the immunohistochemical scoring system was applied to 442 patients with infiltrating ductal carcinomas of the breast with long-term follow-up (median observation time 106 months). Results: In the entire series, the Bcl2 variable was an independent predictor of clinical outcome, and its prognostic independence was maintained when lymph node-negative and -positive patients were considered separately. In this regard, of particular interest was the observation of a subgroup of node-negative breast cancer patients with a negative Bcl2 immunostaining, who had a very high probability of relapse or death (respectively about five and seven times greater than patients with a positive Bcl2 immunostaining). Moreover, the Bcl2 variable retained prognostic significance also in subgroups of patients treated with either adjuvant endocrine therapy or chemotherapy. Conclusions: Our results demonstrated that in breast cancer, Bcl2 protein expression parallels its mRNA level, and it has a highly significant and independent prognostic relevance. [ABSTRACT FROM AUTHOR]

Background: Literature suggests that Specific Learning Disorders (SpLD) can cause impairment of Health-Related Quality of Life (HRQoL) and psychological well-being of children, and that this condition potentially affects parents' quality of life and well-being too., Aims: This study aims first to explore HRQoL and psychological well-being among children with SpLD and second among mothers of children with SpLD., Methods and Procedures: Thirty children aged 8-14 years diagnosed as having SpLD and their mothers completed a battery of scales to assess children's HRQoL and psychological well-being. Mothers also completed a battery of instruments to explore their personal HRQoL and psychological well-being., Results: Compared with the general population, children with SpLD reported significantly lower level of psychosocial health, and mothers had a higher probability of being anxious and/or depressed., Conclusions and Implications: This study supports previous research about impaired HRQoL, symptoms of generalized anxiety, school-related anxiety and depressed mood in children with SpLD. Moreover, it provides evidence that mothers of children with SpLD may experience stress in coping with their child's disability and develop socio-emotional symptoms such as anxiety. Implications concern the need to implement effective supportive services among children with SpLD and their parents., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Research on the choices of childcare arrangements in Italy shows the fundamental role of grandparents in providing informal childcare. Therefore, it is important to understand how grandparents provide different types of childcare, especially in terms of differences in their socio-economic, demographic and physical status, jointly with the characteristics of their grandchildren. Grandparents aged 50 and over with at least one non-co-resident grandchild aged 13 years or less were selected from the 2009 Italian household survey. Multilevel multinomial logistic regression models for grandmothers and grandfathers were used to identify the determinants of the probability of providing childcare intensively, occasionally or during school holidays rather than never. The probability of a grandparent providing intensive childcare is significantly reduced by being: male, unmarried, in bad health and with inadequate economic resources. Nevertheless, when analysing the probability of providing childcare occasionally or during holidays, the individual characteristics of grandparents and grandchildren are less significant compared to intensive childcare, meaning that grandparents provide non-intensive care regardless of their individual characteristics, and this is particularly true for grandmothers. Results confirm the fundamental importance of grandparents in providing informal childcare in Italy, and they offer useful information to understand the individual characteristics associated with different types of grandparental childcare.

Against the background of a 'new wave' of empirical studies investigating various aspects of grandparenthood across a broad range of regional contexts, this article aims to take stock of what has been achieved so far and which lessons we can learn from this for the future. Our focus is on the measurement of grandparenthood and grandparenting in quantitative social surveys and the implications this has for the substantive questions we can ask and the answers we can get out of such data. For several broader questions-who is a grandparent and when does this transition happen; what does it mean to be a grandparent; and what are the implications of grandparenthood for families?-we review previous questionnaire items from a variety of surveys as well as studies in which they were used. We identify relevant issues related to these questions which cannot be adequately addressed with currently available data, but should be considered in new or ongoing survey projects. The answers provided by recent studies as well as the many still open questions identified here indicate excellent prospects for scholarship on grandparents in the years to come., Competing Interests: Compliance with ethical standardsThe authors declare that they have no conflict of interest.

Background: Psychiatric symptoms and conflictual relationships (CR) may negatively affect the delivery of care in residential facilities (RF). This study aims to analyze neuropsychiatric symptoms, their correlations with CR among older people living in RF, and their associations with the prescription of psychotropic drugs., Methods: A total of 1215 RF residents in five Italian regions were selected for this cross-sectional study. Psychiatric symptoms and CR were assessed with the Neuropsychiatric Inventory and the Resident Assessment Instrument, respectively. Associations between Neuropsychiatric Inventory items, CR, and the use of psychotropic drugs were tested via multiple logistic regressions., Results: About half (52.7%) of the RF residents experienced one or more clinically relevant neuropsychiatric symptoms. At least one category of CR was reported for 223 residents (19%). Although reciprocal associations were found between different categories of CR, only conflictuality with other residents was associated with the use of antipsychotics (odds ratio (OR) = 2.12). Significant associations were found with irritability (with staff: OR = 2.35; with relatives: OR = 3.09), aberrant motor behaviour (with staff: OR = 2.02), and elation (with relatives: OR = 10.55)., Conclusions: Neuropsychiatric symptoms and CR are common among RF residents and are reciprocally associated. Further research with longitudinal design is needed to better understand this relationship., (© 2016 The Authors. Psychogeriatrics © 2016 Japanese Psychogeriatric Society.)

Objectives: The principal purpose of this epidemiological cross-sectional study was to evaluate the frequency of foot problems associated with the wearing of safety footwear (SFW)., Methods: We examined 509 workers from 12 separate metal-working factories, representing all workers employed in these factories. All subjects wore SFW on a daily basis. The study was based on an interviewer-administered questionnaire and a clinical examination of the feet, with particular attention to skin lesions., Results: 81% of the workers had at least one foot problem. The most frequently reported shoe concern was the hot/wet conditions inside the SFW (42%), followed by weight (27.5%), fit (22.9%) with narrowness (19%) and poor sole flexibility (16.3%)., Conclusions: Preventive measures should be implemented to reduce the risk associated with SFW. To achieve this goal, it is necessary on one hand to improve the comfort of SFW from a physiological and ergonomic point of view and, on the other hand, to make an appropriate choice of this personal protective device from the various brands and models available on the market., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by Aracne Editrice, Roma, Italy.)

Purpose: To evaluate the effect of excess weight, lifestyle factors, and body image on HRQoL in a sample of school-aged children., Methods: Cross-sectional data of 4,338 thirteen-year-old children were collected in 2007 as part of the So.N.I.A project, a nutritional surveillance study in a northern Italian region. A two-stage sampling design was used in order to gain a Health District representative sample of the regional population. HRQoL was assessed using the EQ-5D-Y questionnaire completed by the children at school. The association between weight categories, defined by means of the International Obesity Task Force cut points, physical exercise, and body image perception and HRQoL as measured by the EQ-Visual Analogue Scale was studied by means of a quantile regression analysis., Results: Of the participants, 891 (20.5 %) and 210 (4.84 %) were overweight and obese, respectively, with 1,922 (44.3 %) children exercising <2 h per week. Results from the quantile regression showed a decreased HRQoL for girls compared with boys, overweight or obese children who do little weekly exercise, and body image dissatisfaction, especially in the lower tail of the VAS distribution., Conclusions: Excess weight, sedentary behavior, and an unsatisfactory self-perception are associated with reduced HRQoL in this population-based sample. Quantile regression can help to highlight differences in the effects along all of the outcome distribution.

The two basic mainstays of gastrointestinal stromal tumours (GIST) treatment are surgery and imatinib, a selective tyrosine kinase inhibitor that allows achieving a stable or responding disease in about 80% of patients with unresectable/metastatic GIST. Response to imatinib mainly depends from KIT and PDGFRα mutational status. Nevertheless, some patients with a potentially responsive genotype do not respond, and others develop a pattern of resistance to imatinib which is not associated with secondary mutations. This emphasizes the presence of mechanisms of resistance other than the receptor-related genotype, and the need of biological predictors to select the optimal therapeutic strategy, particularly now that other potent inhibitors are available. We investigated a panel of 31 polymorphisms in 11 genes, potentially associated with the pharmacogenetics of imatinib, in a group of 54 unresectable/metastatic GISTs treated with imatinib 400mg daily as first line therapy. Included in this analysis were polymorphisms in the transporters' family SLC22, SLCO, ABC, and in the metabolizing genes CYP-3A4 and -3A5. Time to progression was significantly improved in presence of the C allele in SLC22A4 (OCTN1 rs1050152), and the two minor alleles (G) in SLC22A5 (OCTN2 rs2631367 and rs2631372). Importantly, multivariate analysis, adjusting for age, gender, KIT/PDGFRα mutational status, and tumour size, revealed that all the three genotypes maintained independent predictive significance. In conclusion, in this study we showed that SLC22A4 and SLC22A5 genotypes may be an important predictor of time to progression in GIST patients receiving imatinib therapy. Further investigations are required in an attempt to further personalize GIST therapy., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Purpose: The objective of this study was to assess whether the EQ-5D independently predicts all-cause mortality and first hospitalization in a generic elderly population and to evaluate the relationship between the EQ-5D "Class of problems," the EQ-5D index, the EQ-Visual Analogue Scale (EQ-VAS), and the number of hospitalizations occurring over a 2-year period., Methods: The data were collected in a longitudinal study (over 5 years) conducted on 9,644 elderly people in northern Italy with 5,256 completed questionnaires returned. Multivariate Cox's proportional hazards models were used to assess the effect of the EQ-5D questionnaire on 12 and 24 month mortality and first hospitalization risk, controlling for sociodemographic and medical covariates. Multivariate Zero-Inflated Poisson models were performed to test the association between the EQ-5D "Class of problems," the EQ-5D index and EQ-VAS and the number of hospitalizations over 2 years., Results: The EQ-5D "Class of problems," EQ-5D index, and EQ-VAS were consistently associated with mortality and first hospitalization rates. The EQ-VAS was associated with the number of hospitalizations over 2 years, though the EQ-5D "Class of problems" and EQ-5D index were not., Conclusions: The EQ-5D questionnaire is a useful predictor of mortality and first hospitalization in a generic elderly population in Italy. This suggests that it would be a good instrument for evaluating the effect of social/medical actions in a population-based study.

Purpose: To develop a self-report version of the EQ-5D for younger respondents, named the EQ-5D-Y (Youth); to test its comprehensibility for children and adolescents and to compare results obtained using the standard adult EQ-5D and the EQ-5D-Y., Methods: An international task force revised the content of EQ-5D and wording to ensure relevance and clarity for young respondents. Children's and adolescents' understanding of the EQ-5D-Y was tested in cognitive interviews after the instrument was translated into German, Italian, Spanish and Swedish. Differences between the EQ-5D and the EQ-5D-Y regarding frequencies of reported problems were investigated in Germany, Spain and South Africa., Results: The content of the EQ-5D dimensions proved to be appropriate for the measurement of HRQOL in young respondents. The wording of the questionnaire had to be adapted which led to small changes in the meaning of some items and answer options. The adapted EQ-5D-Y was satisfactorily understood by children and adolescents in different countries. It was better accepted and proved more feasible than the EQ-5D. The administration of the EQ-5D and of the EQ-5D-Y causes differences in frequencies of reported problems., Conclusions: The newly developed EQ-5D-Y is a useful tool to measure HRQOL in young people in an age-appropriate manner.

Purpose: To examine the feasibility, reliability, and validity of the newly developed EQ-5D-Y., Methods: The EQ-5D-Y was administered in population samples of children and adolescents in Germany, Italy, South Africa, Spain, and Sweden. Percentages of missing values and reported problems were calculated. Test-retest reliability was determined. Spearman's rank correlation coefficients with other generic measures of HRQOL were calculated. Known groups' validity was examined by comparing groups with a priori expected differences in HRQOL., Results: Between 91 and 100% of the respondents provided valid scorings. Sweden had the lowest proportion of reported problems (1-24.9% across EQ-5D-Y dimensions), with the highest proportions in South Africa (2.8-47.3%) and Italy (4.3-39.0%). Percentages of agreement in test-retest reliability ranged between 69.8 and 99.7% in the EQ-5D-Y dimensions; Kappa coefficients were up to 0.67. Correlation coefficients with other measures of self-rated health indicated convergent validity (up to r = -0.56). Differences between groups classified according to presence of chronic conditions, self-rated overall health and psychological problems provided preliminary evidence of known groups' validity., Conclusions: Results provide preliminary evidence of the instrument's feasibility, reliability and validity. Further study is required in clinical samples and for possible future applications in economic analyses.

This paper introduces Health and Place readers interested in studying the latent concept of satisfaction to the methodology of latent variable analysis. In particular, some suitable methods for analyzing individual opinions expressed on ordinal scales are illustrated. The basic theory behind these methods is explained and a step by step description of how they should be used in practice is given. The discussion of the subject starts with the simplest methods, in which opinions are grouped into two categories: typically positive and negative. Furthermore, more complex methods are presented to deal with opinions expressed on ordinal scales (e.g., very satisfied, somewhat satisfied, and not satisfied). All methods are described by showing various results obtained through the analysis of a dataset containing patients' opinions about their satisfaction with hospital care, collected through a survey conducted after their discharge from an Italian hospital. The database was created using a questionnaire covering different aspects of satisfaction and a five-point Likert scale. This represents an example of multi-level data: patients are clustered according to the hospital ward in which they were hospitalized. Thus, some specific latent variable methods able to deal with this particular structure of the data are also described.

The objective of our article is to survey the prevalence of overweight and obesity among 6- and 9-year-old children in Emilia-Romagna, a region of Central-North Italy, and to study the eating habits and behaviours of these children and their families. During 2003 and 2005, we analysed a stratified sample of the general population of children attending pre-school (2681 children aged 6 years) and primary school (2955 children aged 9 years). Their height and weight were measured by healthcare workers. In the 6-year-old children, information concerning their eating habits was collected by means of a questionnaire completed by their parents. The prevalence of overweight was 16.5% in 6-year-old children and 20.6% in 9-year-old children. The increase of overweight from 6- to 9-year-old children was observed in males (13.5% in 6-year-old/21.3% in 9-year-old boys), but not in females. The prevalence of obesity was 8.9% in children aged 6 years and 9.0% in those aged 9 years, and it was higher in comparison with Italian surveys carried out in 1993 and in 2001: 7.5% in 6-year-old and 7.8% in 9-year-old children in 1993, and 6.6% in 6-year-old and 7.2% in 9-year-old children in 2001. In pre-school children, overweight and obesity were closely influenced by the education level, occupation and nutritional status of the parents.

Background and Purpose: Carotid artery stenting procedures are increasingly being performed with devices such as the MO.MA or the Parodi system that involve endovascular clamping of the common carotid artery, thus exposing the ipsilateral hemisphere to the risk of hypoperfusion. The aim of the present study was to look for predictors of carotid clamping intolerance by means of transcranial Doppler., Patients and Methods: We analysed the findings of an earlier Italian multicentre prospective study (SCITEA, Italian Cooperative Study of Transcranial Doppler in Carotid Endarterectomy) in which 513 consecutive patients (males/females 397/116, mean age 67 +/- 7 years, mean carotid stenosis 81 +/- 11%, NASCET method) scheduled to undergo carotid endarterectomy had been investigated non-invasively with transcranial Doppler, and we correlated the data obtained preoperatively with the need to insert a shunt during surgery as an index of intolerance to carotid clamping., Results: Four hundred and thirty-nine patients (85.6%) underwent surgery without and 74 (14.4%) with the insertion of a shunt. Patients who needed a shunt (intolerant) had a significantly higher decrement in mean flow velocity in the ipsilateral middle cerebral artery (MCA) after compression of the ipsilateral common carotid artery (71.8 +/- 22 vs. 30.6 +/- 24%) and were significantly more likely to have non-recruitable collateral pathways (75 vs. 18%). Logistic regression analysis confirmed that an MCA decrement of >85% (p = 0.005) and no potential collateralization (p = 0.011) were independent predictors of clamping intolerance. Combining the results of both compression tests (MCA decrement and collateral recruitment) yielded a sensitivity of 64%, a specificity of 99%, a positive predicted value of 88%, a negative predicted value of 95% and an overall accuracy of 95% in predicting shunt insertion., Conclusions: The preoperative assessment of recruitable collaterals and of maximal decrement in MCA mean flow velocity after carotid compression are useful predictors of carotid clamping intolerance. The criteria derived from carotid endarterectomy need to be applied and validated in a prospective series of patients undergoing carotid artery stenting procedures., (2008 S. Karger AG, Basel.)

Objective: This study was performed to ascertain the relative relevance of some inflammatory markers in insulin resistance., Research Design and Methods: Four inflammatory markers (leukocyte count, erythrocyte sedimentation rate [ESR], high-sensitivity C-reactive protein [CRP], and C3 complement) were assessed as possible determinants of the homeostasis model assessment (HOMA) index, together with the five elements of the metabolic syndrome (National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel III] definition), total cholesterol, physical activity, and four indicators of adiposity (BMI, waist circumference, percent body fat, and hepatic steatosis) in an unselected population of 990 subjects aged 65-91 years (the Pianoro Study)., Results: In univariable analysis, C3, CRP, and leukocyte count, but not ESR, were significantly correlated with HOMA index. In multivariable analysis, C3 remained associated with insulin resistance with the highest partial R(2) value (0.049), independently of all other covariates. The other most significant (P < 0.0001) determinants of HOMA index were total cholesterol (inverse association, R(2) = 0.026), waist circumference (R(2) = 0.023), triglycerides (R(2) = 0.022), and hepatic steatosis (R(2) = 0.021) (R(2) = 0.450 for the whole model). The adjusted relative risks of having the metabolic syndrome for the subjects with inflammatory markers in the high tertile, with respect to those with lower values, were (prevalence ratio [95% CI]): 1.77 (1.41-2.22) for C3, 1.38 (1.12-1.70) for leukocyte count, 1.17 (0.94-1.46) for CRP, and 1.13 (0.91-1.40) for ESR., Conclusions: Of the four inflammatory markers simultaneously assessed in our elderly population, only C3 was strongly associated with insulin resistance, independently of the components of the metabolic syndrome and the main indexes of abdominal and general obesity.

Background: Bcl2 is an important prognostic parameter in human breast cancer. However, the evaluation of Bcl2 expression by immunohistochemistry is carried out using arbitrary scoring criteria. In the present study, we evaluated the clinical relevance of a novel, semiquantitative classification of the Bcl2 immunostaining based on both the distribution and the intensity of the staining reaction., Patients and Methods: The proposed classification was first validated in 69 breast cancer specimens by comparing the Bcl2 immunostaining with the Bcl2 messenger RNA (mRNA) levels evaluated by real-time RT-PCR. Since a highly significant association was found between protein and mRNA for Bcl2, the immunohistochemical scoring system was applied to 442 patients with infiltrating ductal carcinomas of the breast with long-term follow-up (median observation time 106 months)., Results: In the entire series, the Bcl2 variable was an independent predictor of clinical outcome, and its prognostic independence was maintained when lymph node-negative and -positive patients were considered separately. In this regard, of particular interest was the observation of a subgroup of node-negative breast cancer patients with a negative Bcl2 immunostaining, who had a very high probability of relapse or death (respectively about five and seven times greater than patients with a positive Bcl2 immunostaining). Moreover, the Bcl2 variable retained prognostic significance also in subgroups of patients treated with either adjuvant endocrine therapy or chemotherapy., Conclusions: Our results demonstrated that in breast cancer, Bcl2 protein expression parallels its mRNA level, and it has a highly significant and independent prognostic relevance.

The best prioritization of patients with hepatocellular carcinoma (HCC) waiting for liver transplantation under the model for end-stage liver disease (MELD) allocation system is still being debated. We analyzed the impact of a MELD adjustment for HCC, which consisted of the addition of an extra score (based on the HCC stage and waiting time) to the native MELD score. The outcome was analyzed for 301 patients with chronic liver disease listed for liver transplantation between March 1, 2001 and February 28, 2003 [United Network for Organ Sharing (UNOS)-Child-Turcotte-Pugh (CTP) era, 163 patients, 28.8% with HCC] and between March 1, 2003 and February 28, 2004 (HCC-MELD era, 138 patients, 29.7% with HCC). In the HCC-MELD era, the cumulative dropout risk at 6 months was 17.6% for patients with HCC versus 22.3% for those patients without HCC (P = NS), similar to that in the UNOS-CTP era. The cumulative probability of transplantation at 6 months was 70.3% versus 39.0% (P = 0.005), being higher than that in the UNOS-CTP era for patients with HCC (P = 0.02). At the end of the HCC-MELD era, 12 patients with HCC (29.3%) versus 57 without HCC (58.8%) were still on the list (P = 0.001). Both native and adjusted MELD scores were higher (P < 0.05) and progressed more in patients with HCC who dropped out than in those who underwent transplantation or remained on the list (the initial-final native MELD scores were 17.3-23.1, 15.5-15.6, and 12.8-14.1, respectively). The patients without HCC remaining on the list showed stable MELD scores (initial-final: 15.1-15.4). In conclusion, the present data support the strategy of including the native MELD scores in the allocation system for HCC. This model allows the timely transplantation of patients with HCC without severely affecting the outcome of patients without HCC.

Background: The use of the Model for End-Stage Liver Disease (MELD) score to prioritize patients on liver waiting lists must take the bias of different laboratories into account., Methods: We evaluated the outcome of 418 patients listed during 1 year whose MELD score was computed by two laboratories (lab 1 and lab 2). The two labs had different normality ranges for bilirubin (maximal normal value [Vmax]: 1.1 for lab 1 and 1.2 for lab 2) and creatinine (Vmax: 1.2 for lab 1 and 1.4 for lab 2). The outcome during the waiting time was evaluated by considering the liver transplantations and the dropouts, which included deaths on the list, tumor progression, and patients who were too sick., Results: Although the clinical features of patients were similar between the two laboratories, 36 (13.1%) out of 275 were dropped from the list in lab 1, compared to 5 (3.5%) out of 143 in lab 2 (P<0.01). The differences were mainly due to the deaths on the list (8% lab 1 vs. 2.1% lab 2, P<0.05). The competing risk analysis confirmed the different risk of dropout between the two labs independently of the MELD score, blood group, and preoperative diagnosis. The bias on MELD calculation was considered and bilirubin and creatinine values were "normalized" to Vmax of lab 1 (corrected value=measured value x Vmax lab 1/Vmax lab 2). By comparing receiver operating characteristic curves, the ability of MELD to predict the 6-month dropouts significantly increased from an area under the curve of 0.703 to 0.716 after "normalization" (P<0.05)., Conclusions: Normalization of MELD is a correct and good compromise to avoid systematic bias due to different laboratory methods.

Background and Aims: To survey all Residential Facilities (RFs) for older people (more than 50% residents over 65 years of age) in five Italian regions (Calabria, Sardinia, Sicily, Umbria, Veneto), and to evaluate their logistic and organizational characteristics and staff and resident features., Methods: Structured interviews with RF managers; selected RFs operating in five regions., Results: A total of 853 RFs were operating in the five regions, with an average of 198.0 beds per 10,000 older people - a rate showing marked regional variability. The number of RFs actually surveyed was 754 (88.4% of sample pool). The mean number of RF beds was 59.8 (+/-65.0; median: 34), and the great majority (96%) had 24-hour staff cover. A large proportion (29%) were managed by local municipal authorities, religious non-profit associations (approx. 24%) and other non-profit organizations (approx. 21%). In the RFs 24,456 workers were employed; the number of staff per facility also showed great variability. The mean number of workers directly involved in resident care was 27.8 (+/-39.0; range: 1-331); the median number of staff members was 14, and the resident/staff ratio was 2.1. These 754 RFs hosted 42,687 residents, with an average of 53.5 (+/-58.5) older people in each facility, and 3.2 residents below the age of 65. The mean age of the entire resident sample was 79.3 years (+/-5.2) and there was a high proportion of residents with neurological (including dementia), psychiatric and medical disorders., Conclusions: The five regions varied considerably in residential bed provision; many other RF characteristics, including staff/resident ratios, showed similar variability. Most RFs hosted older people with a variety of neurological, psychiatric and medical disorders. Future phases of the project will aim at shedding light on many other features in these institutions, which care for 2.1% of the older population in Italy and may serve even greater proportions of older people in the future.

The efficacy of the Meld system to allocate livers has never been investigated in European centers. The outcome of 339 patients with chronic liver disease listed according to their Meld score between 2003 and 2005 (Meld era) was compared to 224 patients listed during the previous 2 years according to their Child score (Child era). During the Meld era, hepatocellular carcinomas (HCCs) had a 'modified' Meld based on their real Meld, waiting time and tumor stage. The dropouts were deaths, tumor progressions and too sick patients. The rate of removals from the list due to deaths and tumor progressions was significantly lower in the Meld than in the Child era: 10% and 1.2% versus 16.1% and 4.9%, p < 0.05. The 1-year patient survival on the list was significantly higher in the Meld era (84% vs. 72%, p < 0.05). The prevalence of transplantation for HCC increased from 20.5% in the Child to 48.9% in the Meld era (p < 0.001), but between HCCs and non-HCCs of this latter era the dropouts were comparable (9.4% vs. 14.9%, p = n.s.) as was the 1-year patient survival on the list (83% vs. 84%, p = n.s.). The Meld allocation system improved the outcome of patients with or without HCC on the list.

Objective: Cancer incidence predictions for the period 2002-2006 in the Province of Modena applying a Bayesian APC (Age Period Cohort) model., Design: Population based descriptive study., Setting: Patients with cancer diagnosed between 1988 and 2001 recorded in Modena Cancer Registry., Main Outcome Measures: Number of cases, crude and standardized incidence rates., Results: Cancer incidence in 2002-2006 is expected to increase in both sexes, with the exception of stomach cancer (males and females) and lung cancer in males, both expected to decrease. The difference between the number of cases predicted for 2002 and observed data was about 0.7%., Conclusion: Prediction based on APC model seems to be reliable for most of the cancer sites, but should be used cautiously. In particular, projected number of breast and prostate cancer cases is clearly overestimated due to diagnostic anticipation effect which gives rise to an excess in recent years.

Objective: To survey all Residential Facilities (RFs) for the elderly in five Italian Regions (Calabria, Sardinia, Sicily. Umbria and Veneto), and to evaluate their logistic and organizational characteristics, staff and residents' features., Design: Structured interviews were conducted with RF managers., Setting: All RFs operating in the five Italian Regions., Results: In the five Regions there are 853 RFs with an average of 198.0 beds per 10000 elderly inhabitants; this rate shows a marked variability between different Regions. The mean number of beds in the RFs is 59.8 (median: 34). The large majority (96%) have a 24-hour staff cover. In terms of management, the RFs are handled by local municipalities (29%), religious non-profit associations (24%), and other non-profit organizations (21%). In the 754 RFs surveyed (91.1% of the sample) there were 24.456 workers employed, even the number of staff in each facility shows a great variability. The mean number of workers directly involved in residents' care is 27.8, and the ratio residents/staff is 2.1, which becomes lower (1.8) if we consider the ratio non-independent residents/staff. In the 754 RFs there were 42,687 residents, with an average of 53.5 elderly residents for each facility and 3.2 residents below the age of 65; the mean age of the resident sample was 79.3 years, and there is an high proportion of residents with neurological (including dementia), psychiatric or medical disorders., Conclusion: There is marked variability in the provision of residential places between different Regions; many other characteristics of RFs for the elderly, including staff/residents ratios, show a similar variability Most RFs host elderly with a variety of neurological, psychiatric and medical disorders. The future waves of the project will shed light on many features of these institutions, which care for 2.1% of the elderly population in Italy and may serve larger proportions of the elderly in the future.

The MALVA (MAntova LongeVA) study aims at investigating the socio-demographic, clinical and genetic characteristics of all subjects over 98 years of age residing in the province of Mantova (Northern Italy). In this paper we present the study protocol and the main demographic results. Absolute number, prevalence ratio and female/male ratio of the subjects aged 98+ and of the centenarians in the Mantova province (370,645 inhabitants at 31st December 1997) were checked at the baseline of the study (31st March 1998) as well as in the two years preceding and following the study. A total of 117 subjects aged 98+ (including 39 centenarians) were traced at 31st March 1998; the prevalence ratio was 31.6 per 100000 (12.1 for centenarians), and the female/male ratio was 6.3 (6.5 for centenarians). The distribution of the oldest old according to places of birth and residence was non-homogeneous across the provincial territory. Seventy-seven subjects (66% of the identified subjects) were enrolled in the study and administered a protocol including an interview about socio-economic conditions, lifetime habits and pathological and pharmacological case histories, as well as medical examination, performance-based tests and blood sample collection. Data on the socio-demographic characteristics and the health status of very old people in the province of Mantova are discussed and compared to findings from previous studies on Italian centenarians.

Background: Liver transplantation is currently offered to a limited number of patients with hepatocellular carcinoma (HCC) because of strict criteria introduced in the past to avoid recurrence. Immunosuppression represents a risk factor for tumor growth; the schedules of the immunosuppressant drugs have been modified through the years, aiming to reduce their dosage to the effective minimum., Methods: A series of 106 consecutive patients with HCC who underwent transplantation over a 15-year period at a single institution was retrospectively reviewed to ascertain whether tumor recurrence was influenced by the Milano criteria presently adopted in patient selection and whether the dosage of immunosuppressant agents administered was associated with tumor recurrence. Fifteen patients who died postoperatively and 9 with a follow-up of less than 1 year were excluded; presence of the Milano criteria, tumor-node-metastasis staging, and the cumulative dosage of the single immunosuppressants given at different intervals in the first postoperative year were analyzed in the remaining 82 patients. The influence of these variables on overall and recurrence-free survival was assessed statistically., Results: The Milano criteria did not influence recurrence-free survival, which was instead associated with the cumulative dosage of cyclosporine administered in the first postoperative year (93% 5-year recurrence-free survival for patients given low dosage vs. 76% for those given high dosage; P=0.01); T3 and T4 tumors did worse than T1 and T2 tumors., Conclusions: Current limits to transplantation for HCC might be reassessed in view of modified patient management; immunosuppression should be minimized in these patients.

Background: Although pathologic stage is currently the main prognostic indicator for patients with colorectal carcinoma (CRC), mounting evidence suggests that, in its current form, it is insufficient to predict clinical outcome. To assess biologic markers of primary CRC that may improve clinical staging and provide useful information for the application of novel therapeutic strategies, the authors investigated a panel of markers that included transforming growth factor alpha (TGF alpha), epithelial growth factor receptor (EGF-R; the protein product of the c-erb B2/HER-2 oncogene), matrix metalloproteinase 2 (MMP-2), insulin-like growth factor II (IGF-II), vascular endothelial growth factor (VEGF), and angiogenesis, as evaluated by microvessel density (MVD)., Methods: Two groups of CRC were studied: 1) surgical samples from patients who achieved a disease free survival of at least 6 years (CRC-M0) and 2) surgical specimens of both primary tumors and synchronous or metachronous liver metastases (CRC-M1)., Results: Chi-square analysis revealed that expression levels of TGF-alpha, c-erb B2/HER-2, MMP-2, IGF-II, VEGF, and MVD (but not EGF-R) were significantly higher in CRC-M1 samples compared with CRC-M0 samples (P < 0.001, P < 0.05, P < 0.001, P < 0.001, P < 0.01, and P < 0.001, respectively). Logistic regression analysis showed that TGF-alpha, IGF-II, and MMP-2 had significantly greater expression in CRC-M1 samples independent of the other variables (including tumor classification, histologic grade, and patient age). If all three markers had > or = 25% expression, then the probability of developing liver metastasis was 99.5%., Conclusions: Based on the evidence of this study, TGF-alpha MMP-2, and IGF-II seem suitable candidates for a selective panel of markers designed to provide significant additional information with respect to the current pathologic staging system for patients with colorectal carcinoma., (Copyright 2002 American Cancer Society. DOI 10.1002/cncr.10277lthough pathologic stage is currently the main)

The purpose of this study was to determine the duration of patch test reactions and the frequency of long-lasting allergic patch test reactions (LLAPTR), and to identify the possible factors related to the development of the LLAPTR. For this purpose, a group of 263 patients positive to 1 or more allergens in the GIRDCA standard series was recruited. Readings were made for each patient 2 and 3 days after patch test application and continued every 2nd and 3rd day until the disappearance of all palpable erythema. The % of LLAPTR out of the total of reactions was high: 17.9%). Kathon CG was the hapten that caused LLAPTR most frequently, with 16 cases, a frequency of 76.1%), and a mean duration of the patch test reactions of 25.4 days. Risk factors investigated were age, sex, atopy, intensity of the patch test reaction and sensitivity to some allergens with the greatest number of positive patch tests. The relative importance of each risk factor was calculated by multivariate stepwise logistic regression analysis. It was found that a Kathon CG sensitivity was the most important risk factor for LLAPTR. 2nd was atopy, followed by strong patch test reaction. Rejected risk factors were sex, age and sensitivity to nickel sulfate, potassium dichromate, Disperse Blue 124, fragrance mix and p-phenylenediamine.

The sympathetic nervous system (SNS) is thought to play an important role in the pathogenesis of essential hypertension and many studies have established a relationship between plasma levels of norepinephrine (NE) and epinephrine (E) and sympathetic nervous activity (SNA). Furthermore, it has been suggested that climacteric women are more exposed to psychosocial stress which can produce a transient rise in blood pressure (BP) and, with time, determine a hypertensive state. Plasma NE and E levels were measured at rest and after physiological stimulation (head-up tilt test) in 20 hypertensive (BP: 146 +/- 13/101 +/- 4 mm Hg) and in 20 normotensive women (BP: 132 +/- 7/85 +/- 4 mm Hg). Women in each of these two groups were further subdivided according to their climacteric status (10 premenopausal and 10 postmenopausal women). No difference in NE values at rest was found between groups and subgroups. During head-up tilt test, Ln NE plasma values increased in normotensive and hypertensive groups; the rise was significantly higher in hypertensive than in normotensive women (P < 0.01). In climacteric subgroups, Ln NE appeared markedly increased above resting levels in pre- and postmenopausal hypertensive women when their position was changed from supine to upright (P < 0.01). Since high plasma NE levels after stimulation (head-up tilt) are associated with sympathetic overactivity, we conclude that SNA is involved in the pathogenesis of essential hypertension in climacteric women.

The aim of elective neurotraumatology is to outline new and valid therapeutic strategies in early post-trauma in order to obtain a more favourable long-term outcome for cranial and spinal trauma patients than usually achieved with conventional intensive therapies. After a critical review of all drugs and measures currently used for the treatment of damage due to cerebral trauma and a brief mention of new agents still being studied, the results of a retrospective study of 128 patients with severe head injury are reported. For all patients a complete clinical and pharmacological history of their traumatic event, which had occurred from 5 to 14 years before the present evaluation, was available. Eighty-nine had undergone traditional therapies and 39 had been given complementary neuroprotective drugs, variously associated with traditional therapies. There was no statistically significant difference between the groups in terms of the global clinical outcome, (assessed by a 5-point scale: death, worsening, unchanged condition, improvement, recovery), and some sequelae, such as decubitus, impairment of sphincter control, neurological focal deficits and post-traumatic epilepsy. On the contrary, cognitive impairment and depression resulted statistically less frequent in patients who underwent conventional therapies and early complementary neuroprotective treatments than in the controls. In conclusion it would be very interesting to perform controlled clinical studies to confirm these preliminary results and the effectiveness of early neuroprotection on the long-term clinical outcome of patients with severe head injury. The therapeutic approach in early post-trauma is still not completely standardised and the purpose of elective neurotraumatology is to emphasise and promote the importance of such a standardisation.