Colorectal cancer screening is fundamental to decreased mortality related to the target disease. This pathology is diffused worldwide for both men and women and its curability rate, when identified ...at stage I, is up to 90%. Fecal occult blood test is currently the methodology adopted in many countries as a screening on population, but it shows a very high percentage of false positives, leading to non-operative colonoscopies performed on people who are often elderly and already debilitated. The use of an economic and easy-to-use method alongside fecal occult blood test would improve effectiveness of the screening. Here, the results so far obtained in the clinical validation protocol, started in May 2016, using a patented device with a core of chemoresistive gas sensors, are shown. The device can identify the difference between the fecal exhalation odor of two categories of subjects: healthy and those affected by high-risk adenomas or tumors. Moreover, further calibration of the instrument for the recognition of low-risk adenomas is on-going. The tests are compared to fecal occult blood test positives and colonoscopy results. In this work the most recent results as well as improvements in screening method are presented, useful for future large-scale production of the device.
Among the major challenges of medicine today there is the early detection of tumors, in order to prevent their degeneration into malignant stages and/or metastases. In particular, the colorectal ...cancer shows a high curability rate, up to 90%, if identified when in stage I. This is the reason why a reliable screening protocol is strictly necessary to avoid colorectal cancer progression. The Protocol discussed here is proposed to implement the clinical validation of a device, consisting of an array of chemoresistive semiconductor gas sensors, capable of identifying the difference between fecal exhalation of healthy subjects and of subjects suffering from high-risk colorectal adenomas or cancers. The analysis done are compared to the results of fecal occult blood test and colonoscopy as a gold standard. The difference among the two classes of fecal samples is due to the presence of tumor gaseous biomarkers, produced by cancerous cells through membrane peroxidation process and metabolic alterations. Our method combines a specific algorithm appositely created for data acquisition with principal component analysis and support vector machine. The test resulted capable of recognizing all the colorectal cancer plus high risk adenomas and the 98% of healthy subjects. The recognition capability of low-risk adenomas is progressively increasing (45%) along with statistics.
Objective
To assess the effectiveness of an HPV vaccination programme in reducing the risk of cervical abnormalities identified at subsequent screening.
Design
Retrospective cohort study using ...administrative health data.
Setting
General population of Ferrara Province, Italy.
Population
Female residents born in 1986–1993 and participating in the organized cervical screening programme in 2011–2018, who were eligible for HPV vaccination in catch‐up cohorts.
Methods
Logistic regression to evaluate the potential association between abnormal cervical cytology and one, two, three or at least one dose of HPV vaccine.
Main outcome measures
Cervical abnormalities, as predicted by low‐grade or high‐grade cytology, by number of vaccine doses, stratified by age.
Results
The sample consisted of 7785 women (mean age 27.5 years, SD 2.3). Overall, 391 (5.0%) were vaccinated with ≥1 dose and 893 (11.5%) had abnormal cytology. Women receiving at least one vaccine dose were significantly less likely to have an abnormal cytology (adjusted odds ratio 0.52; 95% confidence interval 0.34–0.79). Similar results were observed for women receiving a single dose, for both bivalent and quadrivalent vaccines, and applying buffer periods (excluding cytological outcomes within 1 month, 6 months and 1 year of the first dose).
Conclusions
In the context of an organised cervical screening programme in Italy, catch‐up HPV vaccination almost halved the risk of cytological abnormalities.
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Among Ferrara women, vaccination against human papillomavirus halved the risk of screening cervical abnormalities.
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Among Ferrara women, vaccination against human papillomavirus halved the risk of screening cervical abnormalities.
Up to now, few cost-of-illness (COI) studies have estimated the cost of adult asthma at an individual level on general population samples. We sought to evaluate the cost of current asthma from the ...societal perspective in young Italian adults and the determinants of cost variation.
In 2000, a COI study was carried out in the frame of the Italian Study on Asthma in Young Adults on 527 current asthmatics (20-44 years) screened out of 15,591 subjects from the general population in seven centres. Detailed information about direct medical expenditures (DMEs) and indirect costs due to asthma was collected at an individual level over the past 12 months.
The mean annual cost per patient was EUR 741 (95% CI: 599-884). DMEs represented 42.8% of the total cost, whereas the remaining 57.2% was indirect costs. The largest component of DMEs was medication costs (47.3%; 23.0% was due to hospitalization). The mean annual cost per patient ranged from EUR 379 (95% CI: 216-541)for well-controlled asthmatics to EUR 1,341 (95% CI: 978-1,706) for poorly controlled cases that accounted for 46.2% of the total cost. Poor control, coexisting chronic cough and phlegm, and low socio-economic status were significantly associated with high DMEs and indirect costs.
In Italy, asthma-related costs were substantial even in unselected patients and were largely driven by indirect costs. Since about half of the total cost was due to a limited proportion of poorly controlled asthmatics, interventions aimed at these high-cost patients could reduce the economic burden of the disease.
Abstract Objective To quantify the impact of organized cervical screening programs (OCSPs) on the incidence of invasive cervical cancer (ICC), comparing rates before and after activation of OCSPs. ...Methods This population-based investigation, using individual data from cancer registries and OCSPs, included 3557 women diagnosed with ICC at age 25–74 years in 1995–2008. The year of full-activation of each OCSP was defined as the year when at least 40% of target women had been invited. Incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs) were calculated as the ratios between age-standardized incidence rates observed in periods after full-activation of OCSPs vs those observed in the preceding quinquennium. Results ICC incidence rates diminished with time since OCSPs full-activation: after 6–8 years, the IRR was 0.75 (95% CI: 0.67–0.85). The reduction was higher for stages IB–IV (IRR = 0.68, 95% CI: 0.58–0.80), squamous cell ICCs (IRR = 0.74, 95% CI: 0.64–0.84), and particularly evident among women aged 45–74 years. Conversely, incidence rates of micro-invasive (stage IA) ICCs increased, though not significantly, among women aged 25–44 years (IRR = 1.34, 95% CI: 0.91–1.96). Following full-activation of OCSPs, micro-invasive ICCs were mainly and increasingly diagnosed within OCSPs (up to 72%). Conclusion(s) Within few years from activation, organized screening positively impacted the already low ICC incidence in Italy and favored down-staging.
Since 1996, the Emilia-Romagna Region has been promoting screening programmes for cervical cancer, selecting resident women aged 25-64 as a target population. This analysis concerns a second round of ...screening performed in the city of Ferrara and its province. A total of 103,971 women were invited to be screened, but only 55.51% of them arrived on the day of the scheduled screening. We therefore decided to investigate the reasons for this lack of participation using preliminary findings from the local screening program registry. These indicated that non-attendance was related to variables such as area of residence and age, and significant differences were observed between localities, with a consistently greater participation in industrial neighbourhoods and their surroundings than in rural areas. In order to elucidate these observations further, a cross-sectional survey, placing special emphasis on setting, area of residence, age and level of education, was performed by structured telephone questionnaire, in order to identify the reasons behind non-attendance. Approximately 94% of the contacted women agreed to be interviewed, thereby demonstrating that a telephone interview is a valid means of collecting data in such cases. It should be noted that, among the women unwilling to respond to the questionnaire, a marked increase in percentage was observed for those resident in rural areas, of whom approximately 50% fell into the under-40 age group. The results of the survey indicated, as demonstrated by several previous studies, that age and the area of residence are both determining factors in the decision or not to participate in a screening programme. It was also observed that women who had completed the lower and upper secondary school education were shown to pay greater attention to health matters than those who had not.
The guidelines for asthma recommend that the use of anti-inflammatory therapy should be adapted to the severity of the disease. However, few data are available to assess the adequacy of the use of ...drugs and its influence on the control of asthma in 'real life'.
The adequacy of the current use of anti-asthmatic medication according to the Global Initiative for Asthma (GINA) guidelines was assessed in a random sample of 400 asthmatics identified in the frame of the Italian Study on Asthma in Young Adults. Asthma severity was assessed using the GINA criteria; accordingly, a patient was classified as receiving inadequate treatment if his/her current use of drugs was lower than that suggested by the guidelines for the corresponding severity level. The absence of asthma attacks in the last 3 months was used as an indicator of the disease control.
Fifty-five percent of the patients had persistent asthma. Overall, 48% (95% CI 41.2-54.8) of persistent asthmatics were receiving inadequate treatment, and 66% (95% CI 59.5-72.4) had not used their medication daily over the past 3 months. Persistent asthmatics who were inadequately treated had a significantly greater frequency of asthma attacks (geometric mean ratio 3.7; 95% CI 2.1-6.6) than those using an adequate dose of medication. Mild and moderate persistent asthmatics using an adequate medication regimen reported a low number of asthma attacks (median 0). At the multivariate analysis, a good control of the disease was positively associated with an adequate dose of anti-inflammatory medication (OR = 2.2; 95% CI 1.1-4.5) and was negatively associated with a later onset of asthma (OR = 0.96; 95% CI 0.93-0.99) and severe asthma (OR = 0.37; 95% CI 0.17-0.81).
Despite the increase in the use of inhaled corticosteroids, half of the persistent asthmatics from the general population are using a medication regimen below their severity level. When the use of drugs follows the GINA guideline recommendations, a good control of asthma is also achievable in the daily management of the disease, particularly in the case of mild and moderate asthmatics.
Background: The knowledge of the natural history of asthma from birth to adulthood could provide important clues for its cause and for the understanding of epidemiologic findings.
Objective: This ...study is aimed at assessing the incidence and remission of asthma from birth to the age of 44 years by using data from 18,873 subjects involved in a large, nationally representative, cross-sectional study carried out in Italy from 1998 through 2000.
Methods: The onset of asthma was defined as the age at the first attack, and remission was considered present when a subject was neither under treatment nor had experienced an asthma attack in the last 24 months. Person-years and survival techniques were used for the analysis.
Results: The average annual incidence rate for the 1953 to 2000 period was 2.56/1000 persons per year. Incidence peaked in boys less than 10 years of age (4.38/1000 persons per year) and in women 30 years of age or older (3.1/1000 persons per year) and showed a generational increase (incident rate ratio = 2.63 and 95% CI = 2.20-3.12 for 1974-1979 vs 1953-1958 birth cohort). The overall remission rate was 45.8% (41.6% in women and 49.5% in men,
P < .001). Asthmatic patients in remission had an earlier age at onset (7.8 vs 15.9 years,
P < .001) and a shorter duration of the disease (5.6 vs 16.1 years,
P < .001) than patients with current asthma. The probability of remission was strongly (
P < .001) and inversely related to the age at onset (62.8% and 15.0% in the <10- and ≥20-years age-at-onset groups, respectively).
Conclusion: With respect to its natural history, asthma presents 2 different forms: early-onset asthma, which occurs early in childhood, affects mainly boys, and has a good prognosis, and late-onset asthma, which generally occurs during or after puberty, mainly affects women, and has a poor prognosis. The minority of patients with early-onset asthma who do not remit represents more than 35% of patients with current asthma in the general young adult population. (J Allergy Clin Immunol 2002;110:228-35.)
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