Carolina Ianuale

The link between genetic variation and variability in vaccine responses: Systematic review and meta-analyses

Although immune response to vaccines can be influenced by several parameters, human genetic variations are thought to strongly influence the variability in vaccine responsiveness. Systematic reviews and meta-analyses are needed to clarify the genetic contribution to this variability, which may affect the efficacy of existing vaccines. We performed a systematic literature search to identify all studies describing the associations of allelic variants or single nucleotide polymorphisms in immune response genes with vaccine responses until July 2013. The studies fulfilling inclusion criteria were meta-analyzed. Thirteen studies (11,686 subjects) evaluated the associations of human leukocyte antigen (HLA) and other immunity gene variations with the responses to single vaccines, including MMR-II (measles and rubella virus), HepB (hepatitis virus), influenza virus, and MenC (serogroup C meningococcus) vaccines. Seven HLA genetic variants were included in the meta-analyses. The pooled ORs showed that DRB1*07 (2.46 [95% CI=1.60-3.77]; P for heterogeneity=0.117; I(2)=49.1%), DQA1*02:01 (2.21 [95% CI=1.22-4.00]; P for heterogeneity=0.995; I(2)=0.0%), DQB1*02:01 (2.03 [95% CI=1.35-3.07]; P for heterogeneity=0.449; I(2)=0.0%), and DQB1*03:03 (3.31 [95% CI=1.12-9.78]; P for heterogeneity=0.188; I(2)=42.4%) were associated with a significant decrease of antibody responses to MMR-II, HepB, and influenza vaccines. The pooled ORs showed that DRB1*13 (0.52 [95% CI=0.32-0.84]; P for heterogeneity=0.001; I(2)=85.1%) and DRB1*13:01 (0.19 [95% CI=0.06-0.58]; P for heterogeneity=0.367; I(2)=0.0%) were associated with a significant increase of antibody responses to the above vaccines. While our findings reinforce the concept that individuals with a particular HLA allelic composition are more likely to respond efficiently to vaccines, future studies should be encouraged to further elucidate the link between genetic variation and variability of the human immune response to vaccines.

Economic impact of adult obesity on health systems: a systematic review

BACKGROUND Obesity represents an important public health issue. An assessment of its costs would be useful to provide recommendations for policy and decision-making strategies. The aims of our study were to carry out a systematic review to assess the economic burden of adult obesity in terms of direct and indirect costs and to perform a quality appraisal of the analysed studies. METHODS A literature search was carried out on PubMed, Scopus and Cochrane Library to retrieve cost-of-illness (COI) analyses focused on adult (aged 18 years or more) overweight or obese people and published up to 2013. COI analyses that considered direct and indirect costs were included. Each included manuscript was independently appraised by three groups of researchers on the basis of the British Medical Journal Drummonds checklist. RESULTS Approximately 2044 articles were initially retrieved, and 17 were included in the current review. The included studies showed a medium-high-quality level. The available studies seemed to be heterogeneous both in terms of methodology and results reporting. However, as many studies have been conducted from the payer perspective, just direct medical costs can be considered exhaustive. As only three studies included considered also indirect costs, there is no strong evidence to give a comprehensive picture of this phenomenon also from the societal perspective. CONCLUSION The review confirmed that obesity absorbs a huge amount of health-care resources. Further research is therefore needed to better understand the economic impact and to identify and promote public health strategies to tackle obesity.

Public Health Genomics education in post-graduate schools of hygiene and preventive medicine: a cross-sectional survey

BackgroundThe relevance of Public Health Genomics (PHG) education among public health specialists has been recently acknowledged by the Association of Schools of Public Health in the European Region. The aim of this cross-sectional survey was to assess the prevalence of post-graduate public health schools for medical doctors which offer PHG training in Italy.MethodsThe directors of the 33 Italian public health schools were interviewed for the presence of a PHG course in place. We stratified by geographical area (North, Centre and South) of the schools. We performed comparisons of categorical data using the chi-squared test.ResultsThe response rate was 73% (24/33 schools). Among respondents, 15 schools (63%) reported to have at least one dedicated course in place, while nine (38%) did not, with a significant geographic difference.ConclusionsResults showed a good implementation of courses in PHG discipline in Italian post-graduate public health schools. However further harmonization of the training programs of schools in public health at EU level is needed.

A systematic review and meta-analysis of the diagnostic accuracy of anti-heat shock protein 70 antibodies for the detection of autoimmune hearing loss

Objective We reviewed case-control studies concerning the diagnostic accuracy of Heat Shock Protein 70 (Hsp-70) auto antibodies in the detection of immunomediated inner ear disease. Materials and Methods We searched for relevant articles published in English language on PubMed and Scopus up to December 2011. A quality assessment of the retrieved articles was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool. Pooled data on the accuracy of the test were calculated, where possible. Results Three articles were deemed eligible. Among them, 2 evaluated the relationship between Hsp-70 and immunomediated inner ear disease by using the Western blot, whereas one report used the enzyme-linked immunosorbent assay method. Pooled sensitivity of Western blot test for Hsp-70 was 0.70 (95% confidence interval [CI], 0.59–0.80), with a large heterogeneity (I2 = 72.7%), and pooled specificity was 0.98 (95% CI, 0.87–1.00), with an I2 of 61.0%. Pooled positive likelihood ratios (LR) was 14.7 (95% CI, 2.1–104.1; I2 = 31.4%), and pooled negative LR was 0.32 (95% CI, 0.10–0.70; I2 = 78.8%). Sensitivity and specificity of enzyme-linked immunosorbent assay test for Hsp-70 auto antibodies was 0.85 (95% CI, 0.55–0.98) and 0.98 (95% CI, 0.86–1.00). Risk of bias was performed by using QUADAS 2 tool, with high scores obtained for patient selection and index test domains and low for the applicability criterion. Discussion This review shows that studies on autoimmune hearing loss diagnosis based on the detection of Hsp-70 autoantibodies used different inclusion and methodologic criteria and are affected from potential bias. Additional studies are actually required to identify an accurate laboratory diagnostic method for the autoimmune hearing loss.

A systematic review of the cost-effectiveness of lifestyle modification as primary prevention intervention for type 2 diabetes mellitus

Background: diabetes is one of the leading causes of death, and has a huge economic impact on the burden of society. Lifestyle interventions such as diet, physical activity and weight reducing are proven to be effective in the prevention of diabetes. To encourage policy actions, data on the costeffectiveness of such strategies of prevention programmes are needed. Methods: a systematic review of the literature on the cost-effectiveness of prevention strategies focusing on lifestyle interventions for diabetes type 2 patients. A weighted version of Drummond checklist was used to further assess the quality of the included studies. Results: six studies met the inclusion criteria and were therefore considered in this paper. Intensive lifestyle intervention to prevent diabetes type 2 is cost-effective in comparison to other interventions. All studies were judged of medium-to-high quality. Conclusions: policy makers should consider the adoption of a prevention strategy focusing on intensive lifestyle changes because they are proven to be either cost-saving or cost-effective.

Ethical Implications and Legislative Control of Direct-to-Consumer Genetic Testing in Europe

Since their first commercialization in 2007, the use of Direct To Consumer (DTC) genetic testing (GT) has rapidly increased. From the consumer viewpoint, the possibility to access genetic information without supervision of a medical doctor could allow for free choice and self-diagnosis (1), and in principle leads to an increased attention on...

Public Mental Health

The Diagnostic and Statistical Manual, fourth edition, of the American Psychiatric Association (DSM-IV) has defined mental health disorders as conditions characterized by deregulation of mood, thought, and/or behaviour. The global burden of disease attributable to neuropsychiatric conditions is 13.8 %. Depression alone accounts for 7 % of the disease burden and is among the leading causes of disability. The World Health Organization (WHO) has predicted that by 2030, neuropsychiatric conditions will cause the greatest overall increase in disability-adjusted life years (DALYs), with economic consequences both in terms of direct (outpatient care, drug costs, and hospitalization) and indirect costs. This chapter aims to review the current evidences regarding public mental health, helping health professionals and stakeholders to promote best practices in terms of prevention. In this chapter, we describe the most prevalent mental health disorders: mood disorders, in particular depressive disorder, anxiety disorders, schizophrenia, Alzheimer’s disease, and other dementias.

Cost-effectiveness of HCV screening: A systematic review of the literature from 2007 to 2012

Background: currently, 123-170 million people in the world are infected with Hepatitis C Virus (HCV) and 75% of them remain undiagnosed. HCV-positive individuals will develop Chronic Hepatitis C (CHC) or hepatocellular carcinoma (HCC) within 25 years in 20-30% of cases. Early detection of HCV has been demonstrated to increase quality-adjusted life years (QALY) and to improve the behaviour of the infected population. Current national policies usually recommend regular screenings only for at-risk populations. A systematic review of the recent evidence on long-term cost-effectiveness of HCV screening in different populations was performed. Methods: resources were searched on publicly available databases (PubMed, ScienceDirect, NHS EED, Cochrane Library) and Google®. Studies were considered eligible if published between 2007 and 2012 and if providing measures of incremental cost-effectiveness ratio (ICER) or incremental cost utility ratio (ICUR ) of HCV screening in terms of cost/life years gained (LYG) and cost/QALY. All the costs were converted into Euro (€) for 2011. A weighted version of the Drummond checklist was used to further assess the quality of the included studies. Results: six articles were selected and analysed. Three U.S. and one Japanese studies suggested a positive cost-effectiveness profile of broad birth-cohort and population screening. Other studies conducted in Italy and the UK demonstrated high variability in the cost-effectiveness in different study populations. All the studies were judged of medium-high quality. Conclusions: cost-effectiveness of HCV screening significantly varies among countries and study populations. Prevalence in the population should be one of the criteria for policy-makers for future decisions and recommendations. New Direct-Acting Antiviral agents might increase the costeffectiveness of early HCV screening. Future studies should also focus on migrants and men who have sex with men (MSM) populations.