Caterina Bianca Neve Aurora Bianchi

Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study

BackgroundBreast and cervical cancer screening are widely recognized as effective preventive procedures in reducing cancer mortality. The aim of this study was to evaluate the impact of socioeconomic disparities in the uptake of female screening in Italy, with a specific focus on different types of screening programs.MethodsA cross-sectional study was conducted using data from the 2004-2005 national health interview survey. A sample of 15, 486 women aged 50-69 years for mammography and one of 35, 349 women aged 25-64 years for Pap smear were analysed. Logistic regression models were used to estimate the association between socioeconomic factors and female screening utilization.ResultsEducation and occupation were positively associated with attendance to both screening. Women with higher levels of education were more likely to have a mammogram than those with a lower level (OR = 1.28; 95% CI = 1.10-1.49). Women of intermediate and high occupational classes were more likely to use breast cancer screening (OR = 1.77; 95% CI = 1.55-2.03, OR = 1.63; 95% CI = 1.40-1.91) compared to unemployed women. Women in the highest occupational class had a higher likelihood of cervical cancer screening compared to those in the lowest class (OR = 1.81; 95% CI = 1.63-2.01). Among women who attended screening, those with lower levels of education and lower occupational classes were more likely than more advantaged women to attend organized screening programs rather than being screened on the basis of their own initiative.ConclusionsInequalities in the uptake of female screening widely exist in Italy. Organized screening programs may have an important role in increasing screening attendance and tackling inequalities.

Modeling the ternary complex TCR-Vβ/collagenii(261-273)/HLA-DR4 associated with rheumatoid arthritis

Background It is known that genetic predisposition to rheumatoid arthritis (RA) is associated with the MHC class II allele HLA-DR4 and that residues 261–273 of type II collagen (huCollp261) represent an immunodominant T cell epitope restricted by the DR4 molecule. Despite recent advances in characterization of MHC and T cell receptor (TCR) contacts to this epitope, the atomic details of TCR/huCollp261/HLA-DR4 ternary complex are not known. Methodology/Principal Findings Here we have used computational modeling to get insight into this interaction. A three-dimensional model of the TCR Vβ domain from a DR4+ patient affected by RA has been derived by homology modeling techniques. Subsequently, the structure of the TCR Vβ domain in complex with huCollp261/HLA-DR4 was obtained from a docking approach in conjunction with a filtering procedure based on biochemical information. The best complex from the docking experiments was then refined by 20 ns of molecular dynamics simulation in explicit water. The predicted model is consistent with available experimental data. Our results indicate that residues 97–101 of CDR3β are critical for recognition of huCollp261/HLA-DR4 by TCR. We also show that TCR contacts on p/MHC surface affect the conformation of the shared epitope expressed by DR alleles associated with RA susceptibility. Conclusions/Significance This work presents a three-dimensional model for the ternary complex TCR-Vβ/collagenII(261–273)/HLA-DR4 associated with rheumatoid arthritis that can provide insights into the molecular mechanisms of self reactivity.

The impact of level of education on adherence to breast and cervical cancer screening: Evidence from a systematic review and meta-analysis

OBJECTIVE To assess the inequalities in adherence to breast and cervical cancer screening according to educational level. METHODS A systematic review was carried out between 2000 and 2013 by querying an electronic database using specific keywords. Studies published in English reporting an estimation of the association between level of education and adherence to breast and/or cervical cancer screening were included in the study. Two different meta-analyses were carried out for adherence to breast and cervical cancer screening, respectively: women with the highest level of education and women with the lowest level of education were compared. The level of heterogeneity was investigated and subgroup analyses were carried out. RESULTS Of 1231 identified articles, 10 cross-sectional studies were included in the analysis. The meta-analyses showed that women with the highest level of education were more likely to have both screenings with an overall OR=1.61 (95% CI 1.36-1.91; I(2)=71%) for mammography and OR=1.96 (95% CI 1.79-2.16; I(2)=0%) for Pap test, respectively. Stratified meta-analysis for breast cancer screening included only studies that reported guidelines with target age of population ≥50 years and showed a reduction in the level of heterogeneity and an increase of 36% in the adherence (95% CI 1.19-1.55; I(2)=0%). CONCLUSIONS This study confirms and reinforces evidence of inequalities in breast and cervical cancer screening adherence according to educational level.

Socio-economic status and prevention of cardiovascular disease in Italy: evidence from a national health survey

BACKGROUND Cardiovascular disease (CVD) is the leading cause of death and disability in the world. Many cardiovascular risk factors can be prevented. We assessed whether socio-economic factors are associated with individual preventive behaviours in Italy. METHODS A cross-sectional analysis of a nationally representative sample of 47,391 adults aged 40-69 years was undertaken using 2004-05 National Health Interview Survey data. Logistic regression models were developed to assess the association between socio-economic status (SES) and regular monitoring of blood pressure, cholesterol, body mass index and glycaemia. SES was estimated according to education and occupation. RESULTS SES was significantly associated with regular monitoring of risk factors for CVD. The most educated were more likely to monitor cholesterol levels than those with less education [men odds ratio (OR) 1.64, 95% confidence interval (CI) 1.46-1.86; women OR 1.36, 95% CI 1.19-1.55]. Individuals in the highest occupational class controlled weight more frequently than those disadvantaged with an OR of 1.24 (95% CI 1.04-1.49) for men and an OR of 1.26 (95% CI 1.12-1.42) for women. CONCLUSION Socio-economic disparities in the prevention of risk factors for CVD were clearly observed among Italian adults, generally favouring higher socio-economic groups.

Effects of indobufen on platelet thromboxane B2 production in patients with myocardial infarction

The role of platelets in initiating coronary artery thrombosis and acute myocardial infarction has been well established. Controlled clinical trials of anti-platelet prophylaxis with drugs in patients with unstable angina have shown a trend towards a reduced incidence of recurrent myocardial infarction and death (reviewed in [1] ). Several anti-aggregating agents have been proposed for the prevention of coronary thrombosis, including aspirin [2], dipyridamole [3], sulfinpyrazone [4] and ticlopidine [5]. Aspirin inhibits TXAa-dependent platelet functions by irreversibly acetylating platelet cyclooxygenase, the enzyme which converts arachidonate released from membrane phospholipids into prostaglandin endoperoxides [6]. With the exception of aspirin, non steroidal antiinflammatory drugs reduce platelet aggregation by reversibly inhibiting the biosynthesis of TXA:. Indobufen, 2-[p(1-oxo-2-iso-indolinyl)-phenyl]-butyric acid, is a novel cyclooxygenase inhibitor, which has been found in shortterm studies in man to be an effective inhibitor of platelet aggregation both in vitro and ex vivo [7-9]. Marked inhibition of platelet function after Indobufen (200 mg b.i.d.) has been demonstrated in patients with cardiovascular disease [10]. In this paper the timeand dose-dependence of platelet cyclooxygenase inhibition, as reflected by serum TXB: levels, was evaluated in patients with myocardial infarction after repeated oral dosing with indobufen. 12 patients (10 males and 2 females, age range 40-68 y) with acute myocardial infarction were randomized to 1week of treatment with indobufen 100 mg b.i.d, or 200 mg b.i.d. Drug administration started 3 to 10 days after the onset of acute myocardial infarction. On the morning of the first day of the study peripheral venous blood was sampled before (08.00-09.00 h) and 2, 4, 8 and 12 h after drug administration. Each patient received the drug at 12 h intervals for 7 days. On the morning of the 7th day of drug therapy blood was again sampled before drug administration and then at the same intervals as on the first day, and 12 h after the last dose of Indobufen. Platelet TXAa production in response to endogenous thrombin was studied by allowing triplicate 1 ml aliquots of whole blood to clot in glass tubes at 37 ~ for 60 rain. TXB2 concentration in sera was determined by RIA [11, 12]. Statistical analysis was performed by two way ANOVA. The basal serum TXB2 concentration averaged 217 (10) ng.ml 1 (mean and (SD)). Indobufen administration caused a statistically significant (P < 0.0001) reduction in platelet thromboxane production, as shown in Fig. 1. Both doses, 100 and 200 mg b. i. d., inhibited platelet cyclooxygenase activity from the second hour onwards. The inhibition remained unchanged throughout the study, with no apparent attenuation at the end of the treatment period. No significant difference in platelet thromboxane

Complications in thyroid surgery. Harmonic Scalpel, Harmonic Focus versus Conventional Hemostasis: A meta-analysis

BACKGROUND To evaluate the incidence of postoperative complications, hemostatic effects and safety of Total Thyroidectomy (TT) performed using the Harmonic Scalpel (HS), the Harmonic Focus (HF) or Conventional Hemostasis (CH). METHODS The meta-analysis was performed according to PRISMA guidelines. A literature search was conducted from 2003 to 2014 and stringent criteria were required for inclusion. Thirteen studies concerning an overall population of 1458 compared HS versus CH, whilst 8 studies with 1667 patients compared HF versus CH. RESULTS There was a significant reduction of operative time (Mean Difference [MD] = -25.49 min.; 95% CI -32.43 to -18.55), intraoperative blood loss (MD = -30.49 mL; 95% CI -53.01 to -7.97), postoperative drainage volume (MD = -12.90 mL; 95% CI -22.83 to -2.98) and postoperative pain (MD = -0.87; 95% CI -1.27 to -0.46) in patients underwent TT with HS. Regarding HF group, a significant reduction of operative time (MD = -25.99 min., 95% CI -34.56 to -17.41), length of hospital stay (MD = -0.57; 95% CI -0.97 to -0.17), transient hypocalcemia (OR = 0.56; 95% CI 0.39 to 0.81) and postoperative pain (MD = -1.33 days; 95% CI -2.49 to -0.17) resulted. CONCLUSIONS HS TT can be a safe, useful and fast alternative to conventional TT. The newer HF can reduce the rate of hypocalcemia. Future RCTs of larger patient cohorts with more detailed data of postoperative complications, cost-effectiveness and cosmetic results, randomization procedures, intention-to-treat analyses and blinding of outcome assessors are needed to draw more meaningful conclusions.

0340 Insight into measles epidemics

In March 2017, 8 cases of measles appear (5 nurses, 2 students, 1 doctor) in the Emergency Department of a big Italian hospital in a national context of one of the worst measles epidemics in the post-vaccination era. How can we stop quickly the epidemics? Stopping measles in ED is what we verified.