Giulia Silvestrini

Survey on Knowledge, Attitudes, and Training Needs of Italian Residents on Genetic Tests for Hereditary Breast and Colorectal Cancer

Objectives. The aim of the study was to assess knowledge and attitudes of medical residents working in Università Cattolica del Sacro Cuore, Rome, Italy, on genetic tests for breast and colorectal cancer. Methods. We distributed self-administered questionnaire to the residents. Logistic regression models were used to evaluate the determinants of knowledge and attitudes towards the tests. Results. Of 754 residents, 364 filled in questionnaire. Around 70% and 20% answered correctly >80% of questions on breast and colorectal cancer tests, respectively. Knowledge on tests for breast cancer was higher among residents who attended course on cancer genetic testing during graduate training (odds ratio (OR): 1.72; 95% confidence interval (CI): 1.05–2.82) and inversely associated with male gender (OR: 0.55; 95% CI: 0.35–0.87). As for colorectal cancer, residents were more knowledgeable if they attended courses on cancer genetic testing (OR: 2.08; 95% CI: 1.07–4.03) or postgraduate training courses in epidemiology and evidence-based medicine (OR: 1.95; 95% CI: 1.03–3.69). More than 70% asked for the additional training on the genetic tests for cancer during the specialization school. Conclusion. The knowledge of Italian residents on genetic tests for colorectal cancer appears to be insufficient. There is a need for additional training in this field.

Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review

Purpose Cardiovascular diseases are the leading cause of death and disability worldwide. Among these diseases, heart failure (HF) and acute myocardial infarction (AMI) are the most common causes of hospitalization. Therefore, readmission for HF and AMI is receiving increasing attention. Several socioeconomic factors could affect readmissions in this target group, and thus, a systematic review was conducted to identify the effect of socioeconomic factors on the risk for readmission in people aged 65 years and older with HF or AMI. Methods The search was carried out by querying an electronic database and hand searching. Studies with an association between the risk for readmission and at least one socioeconomic factor in patients aged 65 years or older who are affected by HF or AMI were included. A quality assessment was conducted independently by two reviewers. The agreement was quantified by Cohen’s Kappa statistic. The outcomes of studies were categorized in the short-term and the long-term, according to the follow-up period of readmission. A positive association was reported if an increase in the risk for readmission among disadvantaged patients was found. A cumulative effect of socioeconomic factors was computed by considering the association for each study and the number of available studies. Results A total of eleven articles were included in the review. They were mainly published in the United States. All the articles analyzed patients who were hospitalized for HF, and four of them also analyzed patients with AMI. Seven studies (63.6%) were found for the short-term outcome, and four studies (36.4%) were found for the long-term outcome. For the short-term outcome, race/ethnicity and marital status showed a positive cumulative effect on the risk for readmission. Regarding the educational level of a patient, no effect was found. Conclusion Among the socioeconomic factors, mainly race/ethnicity and marital status affect the risk for readmission in elderly people with HF or AMI. Multidisciplinary hospital-based quality initiatives, disease management, and care transition programs are a priority for health care systems to achieve better coordination.

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.

Quality of dementia clinical guidelines and relevance to the care of older people with comorbidity: evidence from the literature.

Purpose The aim of this paper was to explore the applicability of dementia clinical guidelines (CGs) to older patients, to patients with one or several comorbidities, and to both targets in order to evaluate if an association between the applicability and quality of the CGs exists. Materials and methods A systematic search strategy conducted on electronic databases identified CGs on diagnosis and treatment of dementia published from 2000 to 2013. In addition, websites of organizations devoted to the treatment and awareness of dementia were searched. The quality of evidence was assessed using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Two investigators independently scored the relevance of the CGs by means of a specific tool. Descriptive and inferential analyses were performed (Mann–Whitney test, 0.05 α-level). Results Twenty-two CGs met our inclusion criteria. On average, the quality of the CGs was higher than 70% in three of six domains measured by the AGREE tool. The domains with lower mean scores (less than 50%) were “Applicability” and “Editorial independence”. Considering applicability to older patients, 20 CGs (91%) addressed issues of treatment for older patients, five of them (23%) classified older patients by age, and 13 CGs (60%) addressed issues of comorbidity. Only seven (32%) discussed the quality of evidence for patients with multiple comorbid conditions. Thirteen CGs (60%) reported recommendations for patients with at least one comorbid condition, while seven of them (32%) reported on several comorbid conditions. No statistically significant association between CG quality and relevance to care of older people with or without comorbidity was found (P>0.05). Conclusion This study showed that dementia CGs poorly address treatment for older patients with comorbidities, regardless of their quality. Therefore, they scarcely satisfy the need of modern clinical practice.

Tuberculosis case finding based on symptom screening among immigrants, refugees and asylum seekers in Rome

BackgroundIn Italy the proportion of cases of tuberculosis in persons originating from high-prevalence countries has been increasing in the last decade. We designed a study to assess adherence to and yield of a tuberculosis screening programme based on symptom screening conducted at primary care centres for regular and irregular immigrants and refugees/asylum seekers.MethodsPresence of symptoms suggestive of active tuberculosis was investigated by verbal screening in migrants presenting for any medical condition to 3 free primary care centres in the province of Rome. Individuals reporting at least one symptom were referred to a tuberculosis clinic for diagnostic workup.ResultsAmong 2142 migrants enrolled, 254 (11.9%) reported at least one symptom suggestive of active tuberculosis and 176 were referred to the tuberculosis clinic. Of them, 80 (45.4%) did not present for diagnostic evaluation. Tuberculosis was diagnosed in 7 individuals representing 0.33% of those screened and 7.3% of those evaluated for tuberculosis.ConclusionThe overall yield of this intervention was in the range reported for other tuberculosis screening programmes for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population. Further evaluation of this approach appears to be warranted.

Healthcare utilization among urban homeless followed by an outpatient clinic: more intensive use by migrant groups.

Introduction: The increasing share of homeless represents a challenge for the healthcare system. In Rome, Italy, a large ambulatory care centre for the homeless had adopted several measures to improve access to health care facilities by migrants. We aimed to determine the rate of utilization among migrants as compared to the Italian homeless. Methods: We collected data on 2604 homeless adults who had their first medical examination between 2007 and 2011. We conducted Poisson regression to analyse the association of medical and demographic variables with the number of revisits within 1 year after the first contact. Results: As compared to the Italian-born homeless, the number of revisits among the migrants which included undocumented migrants, homeless EU citizens, forced migrants and refugees, was increased. These differences were also noted among those with chronic conditions detected on the first contact. The differences were substantial among males but not among females. A greater frequency of revisits was also observed among the uneducated and those who were not registered with the National Health Service. Conclusion: The specialised services in this clinic were able to achieve relatively high rates of revisits among the homeless of foreign background. This suggests that the utilization of health care services by these people may be effectively increased by the implementation of a series of migrant-oriented practices.

The role of the Student’s involvement in GlobalHealth Medical Education: the results of a surveyconducted in four Medical Schools in Rome

2010 as reached universal salt iodization (USI). After this time, researches on iodine deficiency at the national level were not held in Kazakhstan. Objectives: The evaluation of the situation on iodine intake at the national level by urine iodine excretion, revelation of salt iodization quality and the awareness level of the population on iodine deficiency, comparison of indicators overtime in RK. Methods A cross-sectional survey of 2011 included 64 clusters on 22 women in each cluster. The women of reproductive age (15-49 years) were interviewed and 1145 salt samples were collected from their households for quantitative determination of iodine, and 1296 their urine samples were analyzed on content of iodine by ammonium persulfate digestion method, based on the Sandell-Kolthoff reaction. It was conducted a comparative analysis of the results with data from national studies before adopting USI strategy (1999) and MICS (2006). Results The urinary iodine median at women in 2011 was 181.1 mg/l, in 2006 235.9 mg/l, in 1999 93.9 mg/l. The prevalence of iodine deficiency of women was 22.8% in 2011, it was 15.9% in 2006, and 54.2% in 1999. In 2011 the percentages of salt samples with adequately iodized salt (?15 ppm) were 95.9%, in 2006 91.4 %, in 1999 29%. In 2011 among interviewed women 92.7%, n = 1303 knew that salt is iodized, in 2004 these were 93,3%, n = 1 500, and only 58.6% were aware of the need to use iodized salt, n = 4800 in 1999. Conclusions Since the adoption of the Law on mandatory salt iodization consumption percentage of adequately iodized salt has increased, which in turn affected the rising of urinary iodine levels at the population. After 8 years of USI median of urinary iodine excretion decreased slightly comparing with 2006, but remained in the normal range on the Background of adequately iodized salt coverage more than 90%. It indicates the necessity of periodic biological monitoring and continuing communication activity among population on long-term and constantly basis. Key message After 8 years of USI median of urinary iodine excretion decreased slightly comparing with 2006, but remained in the normal range.