[Show abstract][Hide abstract] ABSTRACT: Previous research suggests that first-generation immigrants have a lower suicide risk than those both born in Sweden and with both parents born in Sweden (natives), while the suicide risk in the second generation seems higher. The aim of this study was to investigate to what extent suicide risk in first-generation and second-generation (both parents born abroad) and intermediate-generation (only one parent born abroad) immigrants compared with natives is associated with sociodemographic factors, labour market marginalisation and morbidity.
A prospective population-based cohort study of 4 034 728 individuals aged 16-50 years was followed from 2005 to 2010. HRs for suicide were calculated for first-generation, intermediate-generation and second-generation immigrants compared with natives. Analyses were controlled for sociodemographic factors, morbidity and labour market marginalisation.
The HR of suicide was significantly lower in first-generation immigrants (HR 0.83 CI 0.76 to 0.91), and higher in second-generation (HR 1.32, CI 1.15 to 1.52) and intermediate-generation immigrants (HR 1.20, CI 1.08 to 1.33) in comparison to natives. The excess risk was explained by differences in sociodemographics, morbidity and labour market marginalisation. In the fully adjusted models, a higher HR remained only for the Nordic second generation (HR 1.29, CI 1.09 to 1.52). There were no sex differences in HRs.
The risk of suicide was shown to be lower in the first generation and higher in the second generation compared with natives. The higher HR in the Nordic second generation was not explained by differences in sociodemographics, labour market marginalisation and morbidity. Further research is warranted to investigate factors underlying this excess risk.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Journal of Epidemiology & Community Health 12/2014; · 3.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims
To present the interim results of a phase I trial on stereotactic radiosurgery (SRS) delivered using volumetric modulated arc therapy (VMAT) in patients with primary or metastatic tumours in different extracranial sites.
Materials and methods
Patients were enrolled in different arms according to tumour site and clinical stage, and sequentially assigned to a given dose level. Acute toxicity, tumour response and early local control were investigated and reported.
One hundred lesions in 65 consecutive patients (male/female: 30/35, median age: 66 years; range: 40–89) were treated. Of these 100 lesions, 21 were primary or metastatic lung tumours, 24 were liver metastases, 30 were bone metastases, 24 were nodal metastases and one was a primary vulvar melanoma. The prescribed dose ranged from 12 (BED2Gy,α/β:10 = 26.4 Gy) to 28 Gy (BED2Gy,α/β:10 = 106.4 Gy) to the planning target volume. Twenty-one patients (32.3%) experienced grade 1–2 acute toxicity, which was grade 2 in only two cases. The overall response rate based on computed tomography/magnetic resonance imaging was 52% (95% confidence interval 40.1–63.2%) and based on positron emission tomography scan was 90% (95% confidence interval 76.2–96.4%). As of November 2013, the median duration of follow-up was 11 months (range = 1–38). Recurrence/progression within the SRS-VMAT treated field was observed in nine patients (total lesions = 18): the inside SRS-VMAT field local control expressed on a per lesion basis was 87.8% at 12 months and 71.9% at 24 months.
The maximum tolerable dose has not yet been reached in any study arm. SRS-VMAT resulted in positive early clinical results in terms of tumour response, local control rate and acute toxicity.
[Show abstract][Hide abstract] ABSTRACT: The Italian Alliance of vaccination strategies project was born with the aim of informing healthcare workers and the general population about vaccination through Facebook. The evaluation of the account has been carried out using 3 indicators: friend membership, numbers of "I like," and amount of "share" of contents for type of news and for day of the week. The survey was performed on 743 users. Institutional events were the most popular type of news; the day of the week in which users were most likely to be attracted by links was Friday. Press releases were the communication form most shared by users. Social media marketing carries the advantages of low cost, rapid transmission and user interaction.
Human Vaccines and Therapeutics 10/2014; · 3.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The cross-sectional study has been based on the implementation of the Obstetric Appropriateness Evaluation Protocol (OAEP) in seven hospitals to determine inappropriate hospital admissions and days of stay. The outcomes were: inappropriateness of admission and ''percentage of inappropriateness'' for one hospitalization. A total number of 2196 clinical records were reviewed. The mean percentage of inappropriateness for hospitalization was 22%. The percentage of inappropriateness for the first 10 d of hospitalization peaked in correspondence of the fourth (42%). The logistic regression model on inappropriated admission reported that emergency admission was a protective factor (OR ¼ 0.4) and to be hospitalized in wards with !30 beds risk factor (OR ¼ 5.12). The second linear model on ''percentage of inappropriateness'' showed that inappropriated admission and wards with !30 beds increased the percentage (p50.001); whereas the admission in Teaching Hospitals was inversely associated (p50.001). The present study suggests that the percentage of inappropriate admission depends especially on the inappropriate admission and the large number of beds in obstetric wards. This probably indicates that management of big hospitals, which is very complex, needs improving the processes of support and coordination of health professionals. The OAEP tool seems to be an useful instrument for the decision-makers to monitor and manage the obstetric wards.
Journal of Maternal-Fetal and Neonatal Medicine 09/2014; · 1.21 Impact Factor
Alice Mannocci, Elisabetta Salvatori, Rosella Saulle, Guido Incerti, Antonio Boccia, Fausto Manes, Giuseppe La Torre
[Show abstract][Hide abstract] ABSTRACT: Urban air pollution is known to cause numerous health problems. The HEREPLUS project aims to evaluate the association between environmental air pollution and health and to provide guidelines for the management and organization of the urban environment. Risk maps were developed by georeferentiation, using hospitalization data and concentration levels of ozone and pollution matter. Data for four European cities involved in the project (Rome, Madrid, Dresden, and Athens) were analysed for the period 2003-2004. In this article, we report results for Rome only. Study findings demonstrated that the green area in a city reduces pollution in a city reduces pollution levels in the atmosphere, thus reducing health risks.
[Show abstract][Hide abstract] ABSTRACT: The ideal preparation regimen for pediatric colonoscopy remains elusive, and available preparations continue to represent a challenge for children. The aim of this study was to compare the efficacy, safety, tolerability, and acceptance of 4 methods of bowel cleansing before colonoscopy in children.METHODS: This randomized, investigator-blinded, noninferiority trial enrolled all children aged 2 to 18 years undergoing elective colonoscopy in a referral center for pediatric gastroenterology. Patients were randomly assigned to receive polyethylene glycol (PEG) 4000 with simethicon (PEG-ELS group) or PEG-4000 with citrates and simethicone plus bisacodyl (PEG-CS+Bisacodyl group), or PEG 3350 with ascorbic acid (PEG-Asc group), or sodium picosulfate plus magnesium oxide and citric acid (NaPico+MgCit group). Bowel cleansing was evaluated according to the Boston Bowel Preparation Scale. The primary end point was overall colon cleansing. Tolerability, acceptability, and compliance were also evaluated.RESULTS: Two hundred ninety-nine patients were randomly allocated to the 4 groups. In the per-protocol analysis, PEG-CS+Bisacodyl, PEG-Asc, and NaPico+MgCit were noninferior to PEG-ELS in bowel-cleansing efficacy of both the whole colon (P = .910) and colonic segments. No serious adverse events occurred in any group. Rates of tolerability, acceptability, and compliance were significantly higher in the NaPico+MgCit group.CONCLUSIONS: Low-volume PEG preparations (PEG-CS+Bisacodyl, PEG-Asc) and NaPico+MgCit are noninferior to PEG-ELS in children, representing an attractive alternative to high-volume regimens in clinical practice. Because of the higher tolerability and acceptability profile, NaPico+MgCit would appear as the most suitable regimen for bowel preparation in children.
[Show abstract][Hide abstract] ABSTRACT: To assess the prognostic role of baseline clinical, biochemical and radiological characteristics of patients with hepatocellular carcinoma (HCC) treated with the first transarterial chemoembolization (TACE) procedure.
World journal of gastroenterology : WJG. 07/2014; 20(25):8158-65.
[Show abstract][Hide abstract] ABSTRACT: Healthcare workers, including medical, dentistry and nursing students, have an increased risk of Mycobacterium tuberculosis infection. In this study the prevalence of tuberculin skin test (TST) positivity (defined as induration ≥ 5 mm) among healthcare students enrolled at the Sapienza University of Rome (Italy) in the years 2011-2012 was evaluated. Overall, 2,519 students with a mean age of 20.6 years were tested, of whom 62.4% were female, 0.4% were vaccinated with BCG and 4.6% were foreign-born. Eighty-two students (3.3%) were found to have a positive TST. Prevalence varied by age and geographical place of birth. A baseline evaluation of medical and other healthcare students' TST status at the beginning of their training is essential to better implement infection and control measures for tuberculosis infection.
[Show abstract][Hide abstract] ABSTRACT: The increasing incidence of head and neck cancer (HNSCC) highlights the need to better understand the role of Human papilloma virus (HPV) in the development of these cancers. The aim of this study is to conduct a systematic review and a meta-analysis concerning observational studies on the association between HPV infection and HNSCC and to quantify this association obtaining a reliable estimation of the risk infection in its development.
[Show abstract][Hide abstract] ABSTRACT: The objectives of the present study were to evaluate knowledge among general population about the risks factors of waste management, to estimate the feeling of anxiety concerning the waste, and to compare knowledge of two different methods for collecting municipal solid waste (MSW): a street separate collection system and a door-to-door separate collection system. A cross-sectional study was performed, administering an anonymous questionnaire to 180 inhabitants in Aprilia, Latium, Italy. The study sample consisted of 183 citizens: 64 in the intervention group and 119 in the control group. The intervention was represented by a campaign of door-to-door collection. The correct implementation of separate collection of waste was 87.5% in the intervention group and 63% in the control group (p<0.001). For both groups, the favourite type of waste collection was door-to-door (p=0.013); a high difference concerning the quality of information was found (p<0.0001): in the intervention group, 84% declared to be satisfied (67% sufficient and 17.2% good), while in the control group, 21% declared to be satisfied (16.8% sufficient and 4.2% good). The advice mainly reported from the control group respondents was to increase the size of the information pack (80.7%, p=0.024). The information campaign seemed to increase people's awareness about the problem, improving the management of waste and household waste. The door-to-door collection was appreciated and preferred by both groups. The adoption of a door-to-door scheme seems to be a winning option mostly because it is supported by an information and education system for the citizens.
Waste management & research : the journal of the International Solid Wastes and Public Cleansing Association, ISWA. 06/2014; 32(6):556-561.
[Show abstract][Hide abstract] ABSTRACT: There is an increasing interest of European Institutions towards economical impact assessment of animal health control programmes . The implications of bovine tuberculosis (bTB) for Public Health and trade are well known. Notwithstanding the economic effort and political commitments of the European Union (EU), the eradication of bTB has not been achieved in Europe.
The aim of this study was to quantify the direct costs of the bTB eradication plan carried out in the twelve Local Health Units (LHU) of the Latium region from 2007 to 2011. The secondary objectives were the description of costs trend, and the relationship between the estimated costs and the EU co-funding.
The perspective of the regional government was adopted, by following a three-step procedure: identification and quantification of resources and attribution of the economic value. Three types of relevant resources were identified as follows: personnel, transportation and supplies. Data were collected mainly from official EU report and a face-to-face questionnaire submitted to the heads of the Veterinary Service of the LHUs.
The estimated cost over the whole study period was € 5,814,210. We found that costs significantly decreased when a territory was declared disease-free, the personnel accounted for almost 90% of the total cost, and the EU co-funding covered 9.5% of the total cost. Costs evaluation is a necessary step to implement a full economic analysis, and this study represents an evidence-based methodology applied in the field of Animal Health.
VI International M.bovis Conference, Cardiff (UK); 06/2014
[Show abstract][Hide abstract] ABSTRACT: A growing importance has been placed on the recognition and supervision of non-motor features of Parkinson's disease (PD). Depression has been estimated to affect 1 in 3 individuals with PD and can lead to worse health outcomes and decreased quality of life. Anxiety, apathy and anhedonia further complicate PD outcomes. In this double-blind, placebo-controlled trial, participants (individuals with mild to moderate PD; n = 24) were randomly assigned to treatment (800 mg/d docosahexaenoic acid (DHA) and 290 mg/d eicosapentaenoic acid, a precursor to DHA) or placebo (an equicaloric amount of corn oil). Treatment duration was 6 months. Treatment had no statistically significant effect on rate of change on either Unified Parkinson's Disease Rating Scale or Hoehn-Yahr Scale score. However, 75% of DHA-treated patients, reduced Hamilton Rating Scale for Depression total score by at least 50%, compared with only 25% into the placebo group. At the end of the six-month study, DHA integration reduced the depressive symptoms.
[Show abstract][Hide abstract] ABSTRACT: Vancomycin-resistant enterococci (VRE) represent a major problem in healthcare settings worldwide. It is still unclear which is the most effective infection control and prevention (ICP) measure to reduce the spread of hospital-acquired VRE.
Cochrane databases, MEDLINE, EMBASE and CINAHL were searched until June 2012 to find studies comparing wards/hospitals where ICP measures to prevent VRE transmission were investigated. In the absence of heterogeneity, a fixed-effects model was used to estimate the pooled risk ratio (RR). Study quality was assessed according to Cochrane Effective Practice and Organisation of Care (EPOC) criteria.
The search strategy retrieved 549 studies and 9 studies (1 randomized clinical trial, 3 controlled clinical trials and 5 interrupted time series) with 30 949 participants were included. The overall study quality was low. Implementation of hand hygiene was associated with a 47% decrease in the VRE acquisition rate (pooled RR 0.53, 95% CI 0.39-0.73, I(2) 26%) while contact precautions did not significantly reduce the VRE acquisition rate (pooled RR 1.08, 95% CI 0.63-1.83, I(2) 0%). Due to the low number of studies, meta-analysis was not applied for surveillance screening, environmental cleaning and antibiotic formulary interventions. No studies were available on the effectiveness of isolation and cohorting of patients and staff.
Available evidence on the ICP measures to reduce VRE spread in adult hospitalized patients is poor. This systematic review suggests a significant role for the implementation of hand hygiene. Further studies with appropriate study design are urgently needed to define ICP measures able to reduce the acquisition of VRE among hospitalized patients.
Journal of Antimicrobial Chemotherapy 01/2014; · 5.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives. The aim of this study was to quantify the level of health related quality of life and burnout in a call centers sample of precarious workers. Methods. An observational study was carried out in Italy. A self-reported anonymous questionnaire was administered to temporary workers in order to estimate burn-out and quality of life levels. Results. 227 questionnaires were collected. 78% of the sample was female and the mean age was 35.48 years (SD = 9.91). Among the participants, 40% were smokers, 42% regularly drinkers, 65% changed the body weight (more than 5 kg, in 1 year). The mental component score (MCS) was significantly better in subject that have a regularly life style, for example in those no change their body weight (p = 0.001), sleep more than 7 hours (p = 0.018) and followed a diet (p = 0.035). The DP (depersonalization) is significant higher in former smokers (p = 0.031), in underweight subjects (p = 0.025) and in the group that have a precarious employment of over 2 years (p = 0.013). Conclusions. This investigation shows that in this particular category of atypical workers depressive symptoms and quality of life were lower than the general population. It is important to underline that the interpretation of the results is limited partly by the observational character of the study.