Epidemiologia e prevenzione (EPIDEMIOL PREV)

Publications in this journal

• Article: [Building an integrated process of research and prevention in Taranto (Southern Italy)].

  Bruna de Marchi
  Epidemiologia e prevenzione 11/2012; 36(6):302-4.
• Article: [Effective organised screening programme reduces disparity of access].

  Valentina Minardi, Antonio Federici, Nicoletta Bertozzi, Giuliano Carrozzi, Massimo Oddone Trinito
  Epidemiologia e prevenzione 11/2012; 36(6):371.
• Article: [Survival for all cancers is increasing, especially in men, but only thanks to PSA].

  Enzo Coviello, Ivan Rashid, Carlotta Buzzoni, Mario Fusco
  Epidemiologia e prevenzione 11/2012; 36(6):372.
• Article: [Time trends of process and impact indicators in Italian breast screening programmes (2000-2010)].

  Livia Giordano, Daniela Giorgi, Leonardo Ventura, Roberta Castagno, Eugenio Paci, Nereo Segnan
  [show abstract] [hide abstract]
  ABSTRACT: Since its establishment in 1990, one of the main tasks of the Italian group for breast cancer screening (GISMa) is the systematic data collection on the activity of the organised breast cancer screening programmes implemented in Italy. Data are collected in an aggregated way and gathered through a standardised form to calculate process and impact parameters. Data analysis from 2000-2010 shows that crude attendance rate reached the acceptable 50% standard, presenting a higher level of participation in Northern and Central Italy compared to Southern Italy/Islands, where attendance rates are still inadequate and do not reach the acceptable standard. In areas where a more complete regional extension (referring frequently to a more centralised management) exists, the participation rate was higher compared to those with partial regional extension and no centralised management. The differences range from 5% in 2005 to 22% in 2010. The time trends of the other analysed parameters showed, in 2010, a good overall quality of the performance. For example, benign/malignant surgical biopsy ratio (B/M ratio) reached 0.19 at first screening and 0.11 at subsequent screening; detection rate for in situ and small cancers (≤10 mm) showed a good trend, reaching 0.9‰ and 1.2‰, respectively, at first screening, and 0.6‰, and 1.5‰ for subsequent screening, respectively. On the contrary, excess referral rate at first screening persisted (9.2%) in the year 2010, while RR is improved at subsequent screening (from 4.2% in 2009 to 3.9% in 2010). The overall detection rate is improved both at first and subsequent screening (5.2‰ in 2010 vs. 5.7‰ in 2009 and 4.7‰ in 2010 vs. 5.7‰ in 2009, respectively). Although further analyses are needed to better interpret these trends, results continue to be consistent with those achieved by other European programmes, and they are reassuring for all Italian breast cancer screening professionals.
  Epidemiologia e prevenzione 11/2012; 36(6 Suppl 1):28-38.
• Article: [Extension of organised cervical cancer screening programmes in Italy and their process indicators, 2010 activity].

  Guglielmo Ronco, Pamela Giubilato, Carlo Naldoni, Manuel Zorzi, Emanuela Anghinoni, Aurora Scalisi, Paolo Dalla Palma, Loris Zanier, Alessandra Barca, Claudio Angeloni, Maria Donata Gaimo, Rocco Maglietta, Ettore Mancini, Renato Pizzuti, Anna Iossa, Nereo Segnan, Marco Zappa
  [show abstract] [hide abstract]
  ABSTRACT: Italian national guidelines recommend to regions the implementation of organised screening programmes for cervical cancer. As in previous years since 1998 we collected aggregated tables of data from Italian organised cervical screening programmes in order to centrally compute process indicators. Data on women invited during 2010 and screened up to April 2011 were considered. In 2010, the target population of Italian organised screening programmes included 13,538,080 women, corresponding to 80.1% of Italian women aged 25-64 years. Compliance to invitation was 39.8%, with a strong North-South decreasing trend. However, it should be considered that many women are screened outside organised programmes. Among screened women, 4.7% were referred for repeat cytology and 62.7% of them complied; 2.5% of screened women were referred to colposcopy. Compliance with coldeposcopy referral was 85.9% among women referred because of ASC-US or more severe cytology and 88.7% among those referred because of HSIL or more severe cytology. The positive predictive value (PPV) of referral because of ASC-US or more severe cytology for CIN2 or more severe histology was 16.0%. The unadjusted detection rate of CIN2 or more severe histology was 3.2 per 1,000 screened women (3.5 standardised on the Italian population, truncated 25-64).
  Epidemiologia e prevenzione 11/2012; 36(6 Suppl 1):39-54.
• Article: Exploratory biomonitoring study among workers of livestock farms of the Taranto Province

  Ivano Iavarone, Elena De Felip, Anna Maria Ingelido, Nicola Iacovella, Annalisa Abballe, Silvia Valentini, Valentina Marra, Nicola Violante, Sonia D’Ilio, Oreste Senofonte, Francesco Petrucci, Costanza Majorani, Alessandro Alimonti, Michele Conversano
  [show abstract] [hide abstract]
  ABSTRACT: to conduct a survey on blood levels of metals and organochlorine compounds (dioxins and PCBs) among workers of livestock farms, and to identify the factors able to explain the magnitude and variability of the measured concentrations. exploratory human biomonitoring study. a sample of 45 workers from farms (masserie) located in the Province of Taranto was included in the study. The farms, located between 6 and 43 km from the industrial area, are family owned and animals (mainly sheep and goats) are locally reared outdoors. The study subjects have similar eating habits, including food consumption resulting from their production. manganese concentrations and, to a lesser extent, arsenic, cadmium and lead are in the medium-high range of levels observed in the Italian general population. This study does not identify factors able to explain the variability in the blood levels of metals. The amount of dioxins and PCBs, on the other hand, is strongly associated both with subjects age and the distance of farm from the industrial site. the results of this survey are suggestive of research hypotheses that need to be confirmed by biomonitoring studies of adequate design and size, in particular the hypothesis that the blood level of dioxins and PCBs decreases with increasing distance from the industrial site. We recommend ad hoc studies to better characterize the exposure of farmers (also associated with agricultural activities), and of the inhabitants of Taranto, to environmental persistent pollutants, also in terms of food matrices locally produced and consumed.
  Epidemiologia e prevenzione 11/2012; 36(6):321-331.
• Article: [What is to be done in Taranto? Prevention, thorough research, health promotion and no medicalization].

  Eugenio Paci, Benedetto Terracini, Maria Luisa Clementi
  Epidemiologia e prevenzione 11/2012; 36(6):298.
• Article: [Public health actions in Taranto (Italy): environmental and epidemiological surveillance].

  Francesco Forastiere, Annibale Biggeri
  Epidemiologia e prevenzione 11/2012; 36(6):299-301.
• Article: [Environment and Health in Taranto, Southern Italy: epidemiological studies and public health recommendations].

  Pietro Comba, Roberta Pirastu, Susanna Conti, Marco De Santis, Ivano Iavarone, Giovanni Marsili, Antonia Mincuzzi, Giada Minelli, Valerio Manno, Sante Minerba, Loredana Musmeci, Ivan Rashid, Eleonora Soggiu, Amerigo Zona
  [show abstract] [hide abstract]
  ABSTRACT: in Taranto IPS (Italian polluted site, made up of 2 municipalities) the Decree defining site boundaries lists the presence of a refinery, a steel plant, a harbour area and waste landfills together with illegal dumping sites. Previous environmental and epidemiological investigations in the area documented the presence of environmental contamination and increased mortality from respiratory and cardiovascular diseases as well as a number of cancer sites; for these same health outcomes the cohort study of residents showed increased risk both in terms of mortality and morbidity. to describe the health status of residents in Taranto IPS analyzing different health indicators available at municipal level, i.e. mortality (2003-2009), mortality time trend (1980-2008) and cancer incidence (2006-2007). the analyses were carried out for residents in Taranto IPS. Mortality update (SENTIERI Project, 2003-2009) regards 63 single or grouped causes (all ages, both genders); for a selection of causes 0-1 and 0-14 age classes were analyzed (both genders combined). Standardized mortality ratio crude (SMR) and deprivation adjusted together with 90% confidence intervals (90%CI) were computed using regional rates for comparison. Mortality time trend (1980-2008, triennial intervals) were analyzed calculating standardized rates (0-99 years, both genders, per 100,000, Italian population at 2001 Census as reference) and 90%CI. Time trends were computed for all causes, all neoplasms (and lung cancer), cardiovascular diseases (and ischemic heart diseases), respiratory diseases (also acute and chronic) and all causes infant mortality (both genders combined). For cancer incidence (2006-2007) Standardized incidence ratio (SIR) and 90%CI were calculated for both genders; incidence rates of cancer registries of the macroarea South and Islands (2005-2007) and rates of Taranto Province excluding SIN municipalities (2006-2007) were used for comparison. in Taranto IPS mortality among men is in excess in both periods (SENTIERI Project 1995-2002 and 2003-2009) for all causes, all neoplasms (including lung and pleural cancer), dementia, cardiovascular diseases (including hypertension and ischemic heart diseases), respiratory diseases (including the acute ones) and digestive diseases (including liver cirrhosis). All causes infant mortality is in excess in both periods. Time trends show that Taranto IPS rates are higher than regional average in the majority of time intervals for most causes in both genders. Rates are often higher than national average form any triennial intervals. Among males, over the whole period, mortality in Taranto IPS is higher than regional and national average for causes as lung cancer, diseases of the respiratory system, including the chronic ones. Among females, since the early Nineties, lung cancer and ischemic heart diseases are in excess in Taranto IPS. Also infant mortality is higher for the whole period in Taranto IPS than regional and national averages. Cancer incidence results show excesses for cancer sites already indicated by mortality data. mortality analyzed in the context of SENTIERI Project (1995-2002 and 2003-2009), time trend mortality (1980-2008) and cancer incidence (2006- 2007) show, in both genders, excesses for causes for which an etiologic role of environmental exposure present in Taranto IPS are either ascertained or suspected on the basis of a priori evaluation of the epidemiological evidence. The finding of excess infant mortality is of the utmost importance in public health terms. Most diseases showing an increased risk have multifactorial etiology, therefore interventions of proven efficacy, such as smoking cessation, food education, measures for cardiovascular risk reduction and breast cancer and colon screening programmes should be planned. To build a climate of confidence and trust between citizens and public institutions study results and public health actions are to be communicated objectively and transparently.
  Epidemiologia e prevenzione 11/2012; 36(6):305-20.
• Article: [Climate change and communicable diseases].

  Paolo Vineis
  Epidemiologia e prevenzione 11/2012; 36(6):367-8.
• Article: [The diffusion of screening programmes in Italy, year 2010].

  Marco Zappa, Gabriella Dardanoni, Paolo Giorgi Rossi, Grazia Grazzini, Carlo Naldoni, Eugenio Paci, Maria Elena Pirola, Renato Pizzuti, Nereo Segnan, Manuel Zorzi, Antonio Federici
  [show abstract] [hide abstract]
  ABSTRACT: The national meeting of the National Centre for Screening Monitoring (ONS) was given the title "The screening during the crisis" as we realize that the severe economical crises of our Country influences all the health policies and, as a consequence, screening programmes. Within this global scenarios, the results of 2010 concerning screening programmes can be considered as still positive even if the gap between the North and the Centre as compared to the South remains. In short, in 2010 almost 9.5 millions people were invited to undergo a screening examination (3,450,000; 2,496,000 and 3,464,000 for cervical, mammographic and colorectal cancer respectively). As compared to the previous year, a large increase was observed for colorectal screening.Whereas a slight decrease was observed both for cervical and for mammographic screening. The latter trend was partially due to the overload consequent to the extension of the programme to women younger than fifty in a couple of regions (Emilia-Romagna and Piemonte). More than 4.3 millions of subjects actually complied to the invitation (1,375,000; 1,382,000 and 1,582,000 for cervical, mammographic and colorectal cancer, respectively). As a consequence of these activities were identified 6,015 breast cancers (31% of annual occurring breast cancers in Italy in the age group 50-69 years according to the most update estimates of breast cancer occurrence), 4,597 CIN2 or more severe cervical lesions, 2,916 colorectal cancers (15% of annual occurring CRC cancer in Italy in the age group 50-69 years) and 15,049 advanced adenomas.
  Epidemiologia e prevenzione 11/2012; 36(6 Suppl 1):3-7.
• Article: [Health indicators in the time of crisis in Italy].

  Giuseppe Costa, Michele Marra, Stefania Salmaso
  [show abstract] [hide abstract]
  ABSTRACT: to estimate for the first time in Italy the consequences of the national current economic crisis on health and on social determinants of health, assessing its impact on a set of distal determinants (development and economic wellbeing, labour and environment) and of prossimal ones (material, psychosocial, professional, environmental and behavioural risk factors) on health care performance and on health outcomes normally related to economic trends, as self-perceived health, depression, number of suicides attempts, road traffic incidents and work injuries. The analysis is therefore aimed at identifying the most promising entry points in order to plan and implement either health care and other policies to tackle the negative effects of crisis on health. using the main international and national references on the measure of wellbeing and on the role of social determinants, this paper draws a conceptual framework of all the connections between recession and health. For each mechanism identified, it examines the value of the main available indicators before and during the crisis in order to measure its impact, adjusting if possible for the trend observed in the previous years. Indicators have been selected according to their availability in the main Italian national informative sources and, when not possible, circumscribing the analysis to the regional or local level. regarding the short term impact, results have shown an association between the recession and the raise of mental health related problems (measured in terms of number of suicides, depression and substance misuse), especially on the most disadvantaged groups because of their higher job and financial insecurity. A first ex-ante impact assessment on long term effects allows to attribute almost two hundred deaths a year due to the increase of unemployment rate. Regarding the budget cuts on public expenditure of the health care sector, significant reductions have been shown in specialist care and in drug prescriptions, associated with the increase of co-payment and with a stronger effect on the most vulnerable socioeconomic groups. Nevertheless the crisis does not seem to be associated with a reduction of indicators of quality, continuity and outcomes of the health care, at least in the considered clinical pathways (diabetes and maternal and child health). At the same time the crisis seems to be associated with the reduction in the rate of injuries in the workplace (although it has been observed an increase of the serious ones) and car crashes, probably explained by the reduction of industrial production and of household consumptions. the conceptual framework seems to be the appropriate tool to set an Italian surveillance system for assessing the short and medium term impact of crisis on health, in particular the health of the most disadvantaged groups, mainly focusing on unemployed which are the most vulnerable target.
  Epidemiologia e prevenzione 11/2012; 36(6):337-66.
• Article: [Smoke: prevalence is decreasing, but the gap between socioeconomic categories remains].

  Gianluigi Ferrante, Valentina Minardi, Valentina Possenti, Elisa Quarchioni, Maria Masocco, Stefania Salmaso, Marco Braggion, Stefano Campostrini, Sandro Baldissera
  Epidemiologia e prevenzione 11/2012; 36(6):371.
• Article: [Mammography breast cancer screening in Italy: 2010 survey].

  Daniela Giorgi, Livia Giordano, Leonardo Ventura, Alfonso Frigerio, Eugenio Paci, Marco Zappa
  [show abstract] [hide abstract]
  ABSTRACT: This report is an update of similar previous papers that have been published by the ONS (Osservatorio nazionale screening, National Centre for Screening Monitoring) since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2010, the first slight decrease in theoretical extension was recorded. Currently, all Italian regions have implemented screening programmes. In 2010, almost 2,496,000 women aged 50-69 years were invited to have a screening mammogram, and more than 1,382,000 were screened. Theoretical extension was 91.7%, while actual extension was 69.1%. An imbalance in extension is still present when comparing northern and central Italy to southern Italy, which only has a 75% coverage by organised screening. The Italian mean value (69%) of two-year extension (period 2009-2010) suggests that, at full capacity, Italian programmes are able to invite only three quarters of the target population. The percentage of women screened during 2010 was 36.7% of the national target population. During the last few years, participation rates were substantially stable, around 55-57% for crude rate, and 59-61% for adjusted rate, respectively. A decreasing trend towards the South of Italy is evident for this parameter, too. Many programmes work with low volumes of activity (below 10,000 or even 5,000 examinations per year), and only one region surpassed the desirable level of at least 20,000 examinations for each programme. Referral rates of 8.8% at first screening and 4.6% at repeat screening were recorded. Direct standardised detection rate was 6.2x1,000 at first screening and 4.3x1,000 at repeat screening, while benign to malignant ratio for first and repeat screening was 0.26 and 0.12, respectively. Detection rate of invasive cancers ≤10 mm was 1.36x1,000 at first screening and 1.49x1,000 at repeat screening; the proportion of in situ carcinomas was 13.9% and 13.4% for first and repeat screening, respectively. Indicators by 5-year age group confirm greater diagnostic problems at younger ages (50-54 years), with higher referral rates, higher frequency of surgical procedures with benign outcome (B/M ratio), and a substantially lower detection rate as compared to older age groups.
  Epidemiologia e prevenzione 11/2012; 36(6 Suppl 1):8-27.
• Article: [Audit system on quality of breast cancer diagnosis and treatment: results of quality indicators on screen-detected lesions in Italy, 2010].

  Antonio Ponti, Maria Piera Mano, Mariano Tomatis, Diego Baiocchi, Alessandra Barca, Rosa Berti, Luigi Bisanti, Denise Casella, Silvia Deandrea, Daria Delrio, [......], Paola Mantellini, Carlo Naldoni, Lorenzo Orzalesi, Giovanni Pagano, Francesca Pietribiasi, Alessandra Ravaioli, Maria Laura Sedda, Mario Taffurelli, Luigi Cataliotti, Nereo Segnan
  [show abstract] [hide abstract]
  ABSTRACT: This survey, conducted by the Italian breast screening network (GISMa), collects yearly individual data on diagnosis and treatment on about 50% of all screen-detected, operated lesions in Italy. The 2010 results show good overall quality and an improving trend over time. Critical issues were identified, including waiting times and compliance with the recommendations on not performing frozen section examination on small lesions. Preoperative diagnosis improved constantly over the years, but there is still a large variation between regions and programmes. For almost 90% of screen-detected invasive cancers the sentinel lymph node technique (SLN) was performed on the axilla, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN for ductal carcinoma in situ deserves further investigation. The detailed results have been distributed, also by means of a web data warehouse, to regional and local screening programmes in order to allow multidisciplinary discussion and identification of the appropriate solutions to any issues documented by the data. It should be assigned priority to the problem of waiting times. Specialist Breast Units with adequate case volume and enough resources would provide the best setting for making monitoring effective in producing quality improvements with shorter waiting times.
  Epidemiologia e prevenzione 11/2012; 36(6 Suppl 1):87-95.
• Article: [Screening for colorectal cancer in Italy, 2010 survey].

  Manuel Zorzi, Chiara Fedato, Grazia Grazzini, Priscilla Sassoli De' Bianchi, Carlo Naldoni, Melania Pendenza, Romano Sassatelli, Carlo Senore, Carmen Beatriz Visioli, Marco Zappa
  [show abstract] [hide abstract]
  ABSTRACT: We present the main results of the 2010 survey of the Italian screening programmes for colorectal cancer carried out by the National centre for screening monitoring (Osservatorio nazionale screening, ONS) on behalf of the Ministry of health. By the end of 2010, 105 programmes were active, 9 of which had been activated during the year, and 65% of Italians aged 50-69 years were residing in areas covered by organised screening programmes (theoretical extension). Twelve regions had their whole population covered. In the South of Italy and Islands, 5 new programmes were activated in 2010, with a theoretical extension of 29%. The majority of programmes employed the faecal occult blood test (FIT), while some adopted flexible sigmoidoscopy (FS) once in a lifetime and FIT for non-responders to FS. Overall, about 3,404,000 subjects were invited to undergo FIT, 47.2% of those to be invited within the year. The adjusted attendance rate was 48% and approximately 1,568,796 subjects were screened. Large differences in the attendance rate were observed among regions: 10% of programmes reported values lower than 24%. Positivity rate of FIT programmes was 5.5% at first screening (range: 1.6-11.3%) and 4.3% at repeat screening (range: 3.2-6.7%). The average attendance rate to total colonoscopy (TC) was 81.4% and in one region it was lower than 70%. Completion rate for total colonoscopy (TC) was 88.7%. Among the 740,281 subjects attending screening for the first time, the detection rate (DR) per 1,000 screened subjects was 2.4 for invasive cancer and 10.3 for advanced adenomas (AA - adenomas with a diameter ≥1 cm, with villous/tubulo-villous type or with high-grade dysplasia). As expected, the corresponding figures in the 843,204 subjects at repeat screening were lower (1.2‰ and 7.6‰ for invasive cancer and AA, respectively). The DR of cancer and adenomas increased with age and was higher among males. Many programmes reported some difficulties in guaranteeing TC in the appropriate time frame to FIT+ subjects: in 16% of cases the waiting time was longer than two months. Nine programmes employed FS as the screening test: 98% of the target population (about 60,000 subjects) were invited, and 13,629 subjects were screened, with an attendance rate of 24%. Overall, 87% of FS were classified as complete. TC referral rate was 9.5% and the DR per 1,000 screened subjects was 2.8 and 40.6 for invasive cancer and AA, respectively.
  Epidemiologia e prevenzione 11/2012; 36(6 Suppl 1):55-77.
• Article: [Environmental epidemiology and communication in the Taranto crisis].

  Fabrizio Bianchi
  Epidemiologia e prevenzione 11/2012; 36(6):332-6.
• Article: [Estimate of the spatial variability of exposure to airborne pollutants in urban areas].

  Andrea Ranzi
  [show abstract] [hide abstract]
  ABSTRACT: Several Italian and international studies investigated the short-term effects of air pollution in different geographical areas, while knowledge on the association between long-term exposure to pollutants and mortality due to natural causes and cardio are fully comprehensive at present. The spatial variability of pollutants within urban areas was analyzed with different modelling techniques. The aim of the present work is an introduction to the Land Use Regression (LUR) model, a promising approach to the estimation and representation of intraurban air pollution for epidemiological studies. Starting from the experiences available in the literature, a methodological framework of the procedure is presented, highlighting the advantages and limitations, especially in relation to the applicability of these models to exposure assessment of populations living in urban areas.
  Epidemiologia e prevenzione 09/2012; 36(5):287-95.