Danila Basso

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.

Color Doppler velocimetry and three-dimensional color power angiography of cervical carcinoma

To investigate the blood flow within invasive cervical carcinoma by transvaginal two‐dimensional (2D) color spectral Doppler and three‐dimensional (3D) color power angiography and to correlate these parameters with the clinicopathological characteristics.

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.

Interventions to evaluate fitness to drive among people with chronic conditions: Systematic review of literature

When an health condition has been identified, the question of whether to continue driving depends not on a medical diagnosis, but on the functional consequences of the illness. The complex nature of physical and mental impairments and their relationship with safe driving make the availability of evidence based tools necessary for health professionals. The review aims at identifying and summarizing scientific findings concerning the relationship between neuropsychological and clinical screening tests and fitness to drive among people with chronic conditions. Studies were searched for driving ability evaluation by road test or simulator, clinical/neuropsychological examinations of participants with chronic diseases or permanent disablement impairing driving performance, primary outcomes as fatal/non-fatal traffic injuries and secondary outcomes as fitness to drive assessment. Twenty-seven studies fulfilled the inclusion criteria. Some studies included more than one clinical condition. The illness investigated were Alzheimer Disease (n=6), Parkinson Disease (n=8), Cardiovascular Accident (n=4), Traumatic Brain Injuries (n=3), Sleep Apnea Syndrome (n=2), Narcolepsy (n=1), Multiple Sclerosis (n=1) and Hepatic Encephalopathy (n=1), comorbidities (n=3). No studies match inclusion criteria about Myasthenia Gravis, Diabetes Mellitus, Renal Diseases, Hearing Disorders and Sight Diseases. No studies referred to primary outcomes. The selected studies provided opposite evidences. It would be reasonable to argue that some clinical and neuropsychological tests are effective in predicting fitness to drive even if contrasting results support that driving performance decreases as a function of clinical and neuropsychological decline in some chronic diseases. Nevertheless we found no evidence that clinical and neuropsychological screening tests would lead to a reduction in motor vehicle crashes involving chronic disabled drivers. It seems necessary to develop tests with proven validity for identifying high-risk drivers so that physicians can provide guidance to their patients in chronic conditions, and also to medical advisory boards working with licensing offices.

Angiographic Power 3-Dimensional Quantitative Analysis in Gynecologic Solid Tumors Feasibility and Reproducibility

Objective. To determine the reproducibility of a simplified method of power Doppler 3‐dimensional (3D) sonographic examination. Methods. Twenty‐nine patients with solid pelvic masses underwent transvaginal 3D power Doppler evaluation. The volume of interest was obtained by drawing the margins of the largest section of the mass in the 3 orthogonal planes. The 3D vascular parameters (“relative color,” “average color,” and “flow measure”) obtained by our method were compared with those calculated by a manufacturer‐suggested model based on several parallel section planes drawn on the longitudinal frames. The intraobserver variability was quantified on 5 different 3D images acquired by the same operator at 5‐minute intervals for each patient. The intraobserver variability was also assayed in 10 patients at 24‐hour intervals. Ten patients were scanned by a second sonographer for interobserver variability. Results. There was high agreement between the 3D parameters obtained with the 2 methods. The 3D indices were similar in repeated observations at 5‐minute intervals (median coefficients of variation for relative color, average color, and flow measure, 10.9, 4.5, and 13.0, respectively) and at 24‐hour intervals (intraclass correlation coefficients for relative color, average color, and flow measure, 0.920, 0.978, and 0.978) and by the second sonographer (interclass correlation coefficients for relative color, average color, and flow measure, 0.978, 0.966, and 0.997). Conclusions. The acceptable rates of intraobserver and interobserver variability make this approach potentially suitable for research protocols.

Factors Influencing Quality of Life for Disabled and Nondisabled Elderly Population: The Results of a Multiple Correspondence Analysis

Objectives. The aim of our study is to examine the role of some factors (sociodemographic patterns, social relationship support, and trust in healthcare actors) on structure of quality of life among the Italian elderly population, by stratifying according to presence or absence of disability. Methods. Using data of the Italian National Institute of Statistics (ISTAT) survey, we obtained a sample of 25,183 Italian people aged 65+ years. Multiple Correspondence Analysis (MCA) was used to test such a relationship. Results. By applying the MCA between disabled and nondisabled elderly population, we identified three dimensions: “demographic structure and social contacts,” “social relationships,” “trust in the Italian National Health Services (INHS).” Furthermore, the difference in trust on the INHS and its actors was seen among disabled and non-disabled elderly population. Conclusions. Knowledge on the concept of quality of life and its application to the elderly population either with or without disability should make a difference in both peoples life and policies and practices affecting life. New domains, such as information and trusting relationships both within and towards the care networks nodes, are likely to play an important role in this relationship.

OP05.10: Transvaginal ultrasonography and magnetic resonance in the evaluation of invasive cervical cancer

A. C. Testa1, M. Ludovisi2, R. Manfredi3, G. Zannoni4, B. Gui5, D. Basso1, A. Di Legge1, G. Scambia1, G. Ferrandina2 1Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy, 2Department of Oncology, Catholic University of the Sacred Heart, Campobasso, Italy, 3Department of Radiology, University of Verona, Verona, Italy, 4Institute of Human Pathology, Catholic University of Sacred Heart, Rome, Italy, 5Department of Radiology, Catholic University of Sacred Heart, Rome, Italy

OC25.02: The role of sonographic examination in the follow up of gynecological neoplasms

IUGR group. Small thymus was determined by two and three standard deviations (SD) compared with normal. We calculated the sensitivity, specificity, and predictive values (PPV and NPV) of the small thymus in the diagnosis of the IUGR. Results: Using 2 SD as the cutoff value, 11 of 17 fetuses with small thymus were IUGR at birth. All three fetuses with normal thymus were normal or constitutionally small. Sensitivity, specificity, PPV, and NPV were 100%, 33%, 65%, and 100%. Using 3 SD, 10 of 12 fetuses with small thymus were IUGR. Six of eight fetuses with normal thymus were normal or constitutionally small. Sensitivity, specificity, PPV, and NPV were 83% 75%, 83%, and 75%. Conclusion: Small thymic diameter may be a useful finding in the diagnosis of IUGR on the prenatal ultrasound.

OC185: Ultrasound features of the different histopathological subtypes of borderline ovarian tumors

and this therapy was continued for eight weeks. The reduction of the volume as well as the weight of the xenografts was significantly shown by this combined therapy, in comparison to a group of the drug used alone, ultrasound irradioation alone, or in the controls. No major side effect was observed in any mice of the groups. The effect of anti-angiogenesis for this tumor was remarkably demonstrated on real-time by contrasted color ultrasound, non-invasively. The microvessel density of the tumors was significantly decreased in this combination therapy compared to other groups. These results suggest that there is an accelerated (boosting) effect of ultrasound for anti-angiogenesis drug therapy for human uterine sarcoma and this combination therapy might be a potential candidate for a new cancer treatment.