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Cozzolino C, Buja A, Rugge M, Miatton A, Zorzi M, Vecchiato A, Del Fiore P, Tropea S, Brazzale A, Damiani G, dall'Olmo L, Rossi CR, Mocellin S. Machine learning to predict overall short-term mortality in cutaneous melanoma. Discov Oncol 2023; 14:13. [PMID: 36719475 PMCID: PMC9889591 DOI: 10.1007/s12672-023-00622-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cutaneous malignant melanoma (CMM) ranks among the ten most frequent malignancies, clinicopathological staging being of key importance to predict prognosis. Artificial intelligence (AI) has been recently applied to develop prognostically reliable staging systems for CMM. This study aims to provide a useful machine learning based tool to predict the overall CMM short-term survival. METHODS CMM records as collected at the Veneto Cancer Registry (RTV) and at the Veneto regional health service were considered. A univariate Cox regression validated the strength and direction of each independent variable with overall mortality. A range of machine learning models (Logistic Regression classifier, Support-Vector Machine, Random Forest, Gradient Boosting, and k-Nearest Neighbors) and a Deep Neural Network were then trained to predict the 3-years mortality probability. Five-fold cross-validation and Grid Search were performed to test the best data preprocessing procedures, features selection, and to optimize models hyperparameters. A final evaluation was carried out on a separate test set in terms of balanced accuracy, precision, recall and F1 score. The best model was deployed as online tool. RESULTS The univariate analysis confirmed the significant prognostic value of TNM staging. Adjunctive clinicopathological variables not included in the AJCC 8th melanoma staging system, i.e., sex, tumor site, histotype, growth phase, and age, were significantly linked to overall survival. Among the models, the Neural Network and the Random Forest models featured the best prognostic performance, achieving a balanced accuracy of 91% and 88%, respectively. According to the Gini importance score, age, T and M stages, mitotic count, and ulceration appeared to be the variables with the greatest impact on survival prediction. CONCLUSIONS Using data from patients with CMM, we developed an AI algorithm with high staging reliability, on top of which a web tool was implemented ( unipd.link/melanomaprediction ). Being essentially based on routinely recorded clinicopathological variables, it can already be implemented with minimal effort and further tested in the current clinical practice, an essential phase for validating the model's accuracy beyond the original research context.
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Affiliation(s)
- C Cozzolino
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, PD, Italy.
| | - A Buja
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - M Rugge
- Veneto Tumor Registry (RTV), Azienda Zero, Padua, Italy
- Pathology and Cytopathology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - A Miatton
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - M Zorzi
- Veneto Tumor Registry (RTV), Azienda Zero, Padua, Italy
| | - A Vecchiato
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, PD, Italy
| | - P Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, PD, Italy
| | - S Tropea
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, PD, Italy
| | - A Brazzale
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - G Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - L dall'Olmo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, PD, Italy
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy
| | - C R Rossi
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy
| | - S Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, PD, Italy
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy
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Buja A, De Luca G, Gatti M, Bonaldi F, Gardi M, Bortolami A, Sepulcri M, Baldo V, Scioni M, Basso U. Estimated direct costs of renal cancer by stage and care phase: a whole disease modeljuj. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Renal cell carcinoma (RCC) is the seventh most common neoplasm in high-income countries. New clinical pathways have been developed to deal with this tumor, which include costly drugs that pose an economic threat to the sustainability of healthcare services. This study provides an estimate of the direct costs of care for patients with RCC by stage of disease (early vs advanced) at diagnosis, and disease management phase along the pathway recommended by local and international guidelines.
Methods
Considering the clinical pathway for RCC adopted in the Veneto region (north-east Italy) and the latest guidelines, we developed a very detailed “whole-disease” model that covers the probabilities of all potentially necessary diagnostic and therapeutic action involved in the management of RCC. Based on the cost of each procedure according to the Veneto Regional Authority's official reimbursement tariffs, we estimated the total and average per-patient costs by stage of disease (early or advanced) and phase of its management.
Results
In the first year after diagnosis, the mean expected cost of a patient with RCC is €12,991 if it is localized or locally-advanced, and reaches €40,586 if it is advanced. For early disease, the main cost is incurred by surgery, whereas medical therapy (first and second line) and supportive care become increasingly important for metastatic disease.
Conclusions
It is crucially important to examine the direct costs of care for RCC, and to predict the burden on healthcare services of new oncological therapies and treatments, as the findings could be useful for policy-makers planning the allocation of resources.
Key messages
An estimation of the direct costs of renal cell carcinoma, and in general for cancer, appears fundamental to predict the burden of new oncological therapies and treatments on healthcare services. Our model could represent a useful tool for policy-makers in the optimization of resources allocation, especially in a time of budget constraints.
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Affiliation(s)
- A Buja
- Dpartment of Cardio, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - G De Luca
- Dpartment of Cardio, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Gatti
- Statistics Department, University of Padua, Padua, Italy
| | - F Bonaldi
- Dpartment of Cardio, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Gardi
- Unit of Urology, Ospedale Sant'Antonio, Azienda Ospedale Università di Padova, Padua, Italy
| | - A Bortolami
- Rete Oncologica Veneta, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - M Sepulcri
- Radiotherapy Unit, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - V Baldo
- Dpartment of Cardio, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Scioni
- Statistics Department, University of Padua, Padua, Italy
| | - U Basso
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
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3
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De Polo A, Buja A, Pasello G, Bortolami A, Zorzi M, Schiavon M, Marchetti M, Baldo V, Rugge M, Conte PF. Non–Small-Cell Lung Cancer: Real-World Cost Consequence Analysis. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The present work aimed at conducting a real-world data analysis on the management costs and survival analysis comparing data from non-small-cell lung cancer (NSCLC) cases diagnosed in the Veneto region before (2015) and after (2017) the implementation of a regional diagnostic and therapeutic pathway including all new diagnostic and therapeutic strategies.
Methods
This study considered 254 incidental cases of NSCLC in 2015 and 228 in 2017 within the territory of the Padua province (Italy), as recorded by the Veneto Cancer Registry. Tobit regression analysis was performed to verify if total and each item costs (2 years after NSCLC diagnosis) are associated with index year, adjusting by year of diagnosis, sex, age, and stage at diagnosis. Logistic regression models were run to study overall mortality at 2 years, adjusting by the same covariates.
Results
The 2017 cohort had a lower mortality odd (odds ratio, 0.93; P = .02) and a significant increase in the average overall costs (P = .009) than the 2015 cohort. The Tobit regression analysis by cost item showed a very significant increase in the average cost of drugs (coefficient = 5,953, P 5 .008) for the 2017 cohort, as well as a decrease in the average cost of hospice care (coefficient = -1,822.6, P = .022).
Conclusions
Our study showed a survival improvement for patients with NSCLC as well as an economic burden growth. Physicians should therefore be encouraged to follow new clinical care pathways, while the steadily rising related costs underscore the need for policymakers and health professionals to pursue the most rational utilization of public resources.
Key messages
Our work underscores the importance of real-world assessment of costs in oncology, especially in case of a disease like NSCLC, which has such a high impact on treatment costs and patient outcomes. New therapies prolong survival for patients with NSCLC but their sustainability reminds of the importance of prevention: the earlier the diagnosis, the longer the survival and the lower the costs.
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Affiliation(s)
- A De Polo
- Scuola di Specializzazione in Igiene, Medicina Preventiva e Sanità Pubblica, University of Padova, Padua, Italy
| | - A Buja
- Scuola di Specializzazione in Igiene, Medicina Preventiva e Sanità Pubblica, University of Padova, Padua, Italy
| | - G Pasello
- Oncologia Medica 2, Istituto Oncologico Veneto, I.R.C.C.S., Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - A Bortolami
- Rete Oncologica Veneta, Istituto Oncologico Veneto, I.R.C.C.S., Padua, Italy
| | - M Zorzi
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
| | - M Schiavon
- Scuola di Specializzazione in Igiene, Medicina Preventiva e Sanità Pubblica, University of Padova, Padua, Italy
| | | | - V Baldo
- Scuola di Specializzazione in Igiene, Medicina Preventiva e Sanità Pubblica, University of Padova, Padua, Italy
| | - M Rugge
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
| | - PF Conte
- Oncologia Medica 2, Istituto Oncologico Veneto, I.R.C.C.S., Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
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4
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Pasello G, Lorenzi M, Pretelli G, Pezzuto F, Comacchio G, Buja A, Bonanno L, Guarneri V, Conte P, Rea F, Calabrese F. 1157P Diagnostic therapeutic pathway (DTP) of early stage non-small cell lung cancer (eNSCLC): A real-world focus on EGFR status detection in resected patients (pts). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Damiani G, Pascucci D, Sessa G, Morini M, Fantini MP, Buja A, Lonati F, Adja KYC. [Fragility in a Public Health perspective: principles and tools for a "life course" approach prevention- oriented]. Ig Sanita Pubbl 2021; 77:381-403. [PMID: 33883749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The Covid-19 pandemic significantly increased the workload for the Italian Health Service. There is few information in the literature on the pediatric population and on the management of pediatric hospitals. The aim of this article is to describe the management of healthcare services during Covid-19 emergency in Regina Margherita Children's Hospital. The Regina Margherita Children's Hospital is specialized in the prevention, diagnosis and treatment of pediatric diseases. About 1000 health worker work in this Hospital and 278 hospitalization places are available.
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Affiliation(s)
- G Damiani
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - D Pascucci
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - G Sessa
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - M Morini
- Coordinatore Gruppo di lavoro Assistenza Primaria Società Italiana Igiene e Medicina Preventiva
| | - M P Fantini
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna, Italia
| | - A Buja
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università di Padova, Italia
| | - F Lonati
- Presidente Associazione APRIREnetwork-Salute a Km0
| | - K Y C Adja
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna, Italia
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Buja A, Vianello FA, Zaccagnini F, Pinato C, Maculan P. Health issues in female Moldovan migrants in a north-eastern Italian region. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Migration from Eastern Europe to Italy is still massively expanding, with a subsequent increase of migrants in the job market who are traditionally employed in low specialized and high strain jobs. In this context Health Literacy is a known factor contributing to immigrant health disparities. The purpose of this study was to evaluate the health status of a population of migrant Moldovan women and their access to health care services in northern Italy by age class and health literacy level.
Methods
We administered an ad-hoc questionnaire to adult Moldovan women to assess their lifestyles, employment status, reported health status, access to Health Services and Health Literacy. Moreover, the study compared our data with a sample of Italian women of the same age range living in North-Eastern region interviewed in 2015. Analysis employs descriptive statistics.
Results
The sample included 170 Moldovan women (age 46.5 ±12.3). Prevalence of active smokers was found double in women with a low Health Literacy. Health Literacy status also determined the different access to Public Health Services, with women with higher literacy using more programmed health services and screening programs, and women with lower literacy conversely using more emergency health services. Overall reported health status was found worse in our sample than in Italian women and reported disease prevalence among age ranges was different than Italian ones with an increased probability for allergies, lumbar diseases and depression.
Conclusions
Some diseases have a higher prevalence in Moldovan than in Italian women. Health literacy is associated with lifestyles and use of health care services also in migrants, as previously demonstrated for native population.
Key messages
Tailored prevention programs and intervention should be designed in Moldovan women to address high prevalence diseases in this population. Strategy to improve health literacy should involve immigrants. Some diseases resulted well-spread over the whole sample and not influenced by age or employment; the difficulties migrants have to overcome might influence their health status.
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Affiliation(s)
- A Buja
- Cardiologic-Thoracic-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - F A Vianello
- Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padua, Italy
| | - F Zaccagnini
- Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padua, Italy
| | - C Pinato
- Melanoma and Sarcoma Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - P Maculan
- Cardiologic-Thoracic-Vascular Sciences and Public Health, University of Padova, Padua, Italy
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7
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De Luca G, Buja A, Rivera M, De Polo A, Marchetti M, Scioni M, Pasello G, Bortolami A, Schiavon M, Conte PF. Estimated direct costs of non-small-cell lung cancer by stage and care phase: a whole disease model. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Non-small-cell lung cancer (NSCLC) is the first cause of cancer-related death among men and the second among women worldwide. It also poses an economic threat to the sustainability of healthcare services. This study estimates the direct costs of care for patients with NSCLC by stage at diagnosis and management phase of pathway recommended in local and international guidelines.
Methods
Based on the most up-to-date guidelines we developed a detailed “whole-disease” model that lists the probabilities of all potentially necessary diagnostic and therapeutic actions involved in the management of each stage of NSCLC. Then we assigned the cost sustained by the public authorities to each procedure, obtaining an estimate of the total and average per-patient costs of each stage of the disease and management phase in Veneto Region, Italy.
Results
The mean expected cost of a patient with NSCLC is 22,968 € in the first year: 20,222 € in stage I, 23,935 € in stage II, 23,027 € in stage III, 22,915 € in stage IV and 31,749 € for Pancoast's tumors. In the second year the mean per patient-costs patient ranged from 2,722 €, for a patient with stage I disease, to 13,396 € for a patient with stage IV, with an overall average cost of 8,307 €. In the early stages, the main cost was due to surgery, whereas in the more advanced stages radiotherapy, medical therapy, treatment for progressions and supportive care become variously more important.
Conclusions
Our study enabled a prediction of the direct costs and outcomes for patients diagnosed with NSCLC on a two-year timeline after the diagnosis. An estimation of the direct costs of NSCLC, and in general for cancer, appears fundamental to predict the burden of new oncological therapies and treatments on healthcare services, and, in our opinion, our model could represent a useful tool for policy-makers in the optimization of resources allocation.
Key messages
Whole disease model allows an economic evaluation of a clinical pathway. The model is able to estimate direct costs of NSCLC by disease stage and management phase within a time horizon of two years. High cost-surgery makes the early stages no less expensive than advanced stages during the first year. In the second year, an advanced stage case costs almost five times more than an early stage case.
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Affiliation(s)
- G De Luca
- Dpartment of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - A Buja
- Dpartment of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Rivera
- Dpartment of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - A De Polo
- Dpartment of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Marchetti
- National Centre for Health Technology Assessment, National Institute of Health, Rome, Italy
| | - M Scioni
- Statistics Department, University of Padua, Padua, Italy
| | - G Pasello
- Department of Oncology, Veneto Institute of Oncology, Padua, Italy
| | - A Bortolami
- Department of Oncology, Veneto Institute of Oncology, Padua, Italy
| | - M Schiavon
- Dpartment of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - P F Conte
- Department of Oncology, Veneto Institute of Oncology, Padua, Italy
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Buja A, Rivera M, De Polo A, Zorzi M, Carpin E, Vecchiato A, Del Fiore P, Martin G, Saia M, Baldo V, Rugge M, Rossi C. Real‐world data for direct stage‐specific costs of melanoma healthcare. Br J Dermatol 2020; 183:171-172. [DOI: 10.1111/bjd.18896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A. Buja
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health University of Padova Padova Italy
| | - M. Rivera
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health University of Padova Padova Italy
| | - A. De Polo
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health University of Padova Padova Italy
| | - M. Zorzi
- Surgical Oncology Unit Veneto Institute of Oncology IOV‐IRCCS Veneto Italy
| | - E. Carpin
- Surgical Oncology Unit Veneto Institute of Oncology IOV‐IRCCS Veneto Italy
| | - A. Vecchiato
- Department of Surgery, Oncology and Gastroenterology University of Padova Padova Italy
| | - P. Del Fiore
- Department of Surgery, Oncology and Gastroenterology University of Padova Padova Italy
| | - G. Martin
- Surgical Oncology Unit Veneto Institute of Oncology IOV‐IRCCS Veneto Italy
| | - M. Saia
- Clinical Governance Unit Azienda Zero Veneto Regional Authority Veneto Italy
| | - V. Baldo
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health University of Padova Padova Italy
| | - M. Rugge
- Surgical Oncology Unit Veneto Institute of Oncology IOV‐IRCCS Veneto Italy
| | - C.R. Rossi
- Veneto Tumor Registry Azienda Zero Veneto Regional Authority Veneto Italy
- Department of Surgery, Oncology and Gastroenterology University of Padova Padova Italy
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Baldovin T, Cocchio S, Fonzo M, Bennici SE, Buja A, Bertoncello C, Baldo V. Awareness of HPV and drivers of HPV vaccine uptake among university students in Italy. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
HPV vaccination is a milestone in primary prevention. However in Italy, vaccine coverage is still nowhere near the target of 95%. We investigated drivers of vaccine uptake among university students, as they are likely to have just assumed a central role in their healthcare decision-making and potential barriers may differ from parents.
University students aged 18-25 were asked to fill in a questionnaire. The effect of socio-demographic and behavioural characteristics on HPV awareness was assessed with a logistic regression adjusting for age, gender, nationality, degree course, relationship, age at first intercourse, number of sexual partners, smoking, sexual orientation, past diagnosis of STDs and knowledge of people who had received HPV vaccine. A second regression adjusting also for information sources, awareness and knowledge investigated drivers of vaccine uptake.
9,988 questionnaires were included; awareness of HPV and vaccine was 83.3% and 69.9%, respectively. Awareness (adjOR: 3.3 95%CI 2.3-4.6) and a good knowledge positively affected acceptability, as well as a previous diagnosis of STDs and knowledge of vaccinated people. Healthcare workers (adjOR 1.6 95%CI 1.4-1.9) and family members (adjOR 1.7 95%CI 1.4-2.1) were the most influencing information sources, even if knowledge of vaccinated people was by far more persuasive (adjOR 2.7 95%CI 2.2-3.3). Only 12% of participants were acquainted with skin to skin HPV transmission, while 75% believed in a full effectiveness of condom; less than 22% associated HPV with cancer (other than cervical cancer).
Efforts to increase awareness are likely to be worth considering that: awareness is the main determinant of vaccine uptake; only 50% of individuals not interested in receiving vaccine were aware of it; males are much less aware (adjOR 0.09 95%CI 0.07-0.11). Moreover, this study spotlights some misconceptions and may provide suitable evidence in tailoring more efficacious communication strategies.
Key messages
There is room for improving the awareness of HPV. Efforts are likely to be worth since it remains the main determinant of vaccine uptake. Awareness has been growing but a gender gap still persists. Communication should focus more on HPV involvement in neoplasia other than cervical cancer; transmission via skin to skin contact; multiple sex partnership; partial protection of condom.
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Affiliation(s)
- T Baldovin
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - S Cocchio
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - M Fonzo
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - S E Bennici
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - A Buja
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - C Bertoncello
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - V Baldo
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
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Fonzo M, Bertoncello C, Cocchio S, Zanovello S, Bennici SE, Baldovin T, Buja A, Napoletano G, Russo F, Baldo V. Health professionals as parents are not immune to vaccine hesitancy – an Italian national survey. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Vaccine hesitancy is a growing concern in many European countries, including Italy, as instanced by alarming results from Eurobarometer 488 dated April 2019. In the view of the current magnitude of the phenomenon, our aim was to investigate its determinants among parents, with a specific view on those working as health professional.
In 2017, parents of children aged 3-84 months were recruited online. Based on self-reported vaccine status and timeliness of vaccinations, parents were classified as pro-, hesitant, or anti-vaccine. The association between baseline characteristics and hesitancy was investigated with logistic regression adjusting for child’s and parents’ age, prematurity, presence of older children, previous vaccine adverse reaction in the child at issue, parents’ nationality, education and employment status, health profession of at least one parent, single parenting, vegetarian lifestyle and perceived economic security.
A total of 3,865 questionnaires were collected (64% pro-, 32% hesitant, 4% anti-vaccine). Families with at least one health professional as parent were 20% of the sample.
Vegetarian lifestyle (aOR 3.0; 95%CI 2.20-4.08), unsatisfactory (aOR 1.67 95%CI 1.08-2.58) and partially satisfactory perceived economic security (aOR 1.40; 95%CI 1.09-1.78) and previous vaccine adverse reactions (aOR 1.25; 95%CI 1.05-1.48) were associated with vaccine hesitancy, while having older children resulted as a protective factor (aOR 0.82; 95%CI 0.69-0.98). No significant association was found with other abovementioned variables, including parent employed as health professional (aOR 0.99; 95%CI 0.81-1.22).
Vaccine hesitancy seems to be part of a lifestyle choice and, to a smaller extent, associated with previous vaccine adverse reactions and lower socioeconomic status. Interestingly, parents’ level of education and employment in healthcare do not affect vaccine acceptance. The latter poses a challenge, given their crucial role in promoting vaccination.
Key messages
Hesitancy is associated with lifestyle choices, experience of adverse reactions and socioeconomic status, while education and employment as health professional seem not to be relevant. Whether they are health professionals or not, parents’ attitude towards their child’s vaccinations is the same.
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Affiliation(s)
- M Fonzo
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - C Bertoncello
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - S Cocchio
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - S Zanovello
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - S E Bennici
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - T Baldovin
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - A Buja
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - G Napoletano
- Servizio Promozione e Sviluppo Igiene e Sanità Pubblica, Direzione Prevenzione, Regione Veneto, Venezia, Italy
| | - F Russo
- Servizio Promozione e Sviluppo Igiene e Sanità Pubblica, Direzione Prevenzione, Regione Veneto, Venezia, Italy
| | - V Baldo
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
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Cocchio S, Bertoncello C, Fonzo M, Zanovello S, Bennici SE, Baldovin T, Buja A, Napoletano G, Russo F, Baldo V. Opinions and beliefs in vaccine hesitant parents in Italy: what makes the difference. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Vaccine hesitancy has been defined as the delay of acceptance or refusal of vaccines. Hesitant parents’ (HP) fluctuate between anti-vaccine (AP) and pro-vaccine parents’ (PP) positions. In the light of alarming results from recent Eurobarometer 488, our aim was to identify sensitive topics harbouring the widest opinion gap between HP and PP.
In 2017, an online questionnaire was administered to parents with children aged 3-84 months. Parents were classified as PP, HP or AP based on self-reported vaccine status and timeliness of vaccinations. Agreement with 25 items was assessed with 5-point Likert scale. Items were combined into 8 topics (benefit/risk of vaccines, trust/mistrust in healthcare workers, administration policies, complacency, sense of community, freedom of choice) and scores calculated. Internal consistency was evaluated with Cronbach’s α; t-tests (sig. <.05) were used (Norman G, 2018).
The study included 3,865 parents (64% PP; 32% HP; 4% AP). Cronbach’s α ranged 0.77-0.92. The widest gap concerned the sense of community: HP (2.7/5.0) cared significantly less than PP (4.7) about the usefulness of vaccine in protecting other children and claimed for a complete freedom in decision to vaccinate (3.6) more than PP (1.8). HP were worried (4.1) about current vaccination schedule (PP 2.1): simultaneous administration and age at vaccination (considered too young) were matter of concern. Among HP, mistrust of healthcare workers (3.7) and fear of side effects (3.8) played an important role, but the gap with PP was narrower compared with abovementioned topics; awareness in vaccine benefits reached 3.7. Agreement with complacent attitudes was low (2.2) with the least difference with PP (1.2).
HP showed to partially consider benefits of vaccines on a community scale, claiming for a private nature of this choice. The existence of a consistent opinion gap about the vaccination schedule may suggest the need for a sharper focus on current communication tools and strategies.
Key messages
While hesitant parents share some concerns with pro-vaccine, relevant opinion gaps may serve as warning lights, pointing at topics potentially harbouring the most sensitive drivers of hesitancy. Communication strategies should primarily focus on raising acquaintance of hesitant parents with benefits arising from herd immunity and compliance with the suggested vaccination schedule.
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Affiliation(s)
- S Cocchio
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - C Bertoncello
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - M Fonzo
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - S Zanovello
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - S E Bennici
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - T Baldovin
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - A Buja
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
| | - G Napoletano
- Servizio Promozione e Sviluppo Igiene e Sanità Pubblica, Direzione Prevenzione, Regione Veneto, Venezia, Italy
| | - F Russo
- Servizio Promozione e Sviluppo Igiene e Sanità Pubblica, Direzione Prevenzione, Regione Veneto, Venezia, Italy
| | - V Baldo
- Hygiene and Public Health Unit, DCTV, University of Padova, Padova, Italy
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12
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Baldovin T, Bertoncello C, Cocchio S, Fonzo M, Gazzani D, Buja A, Majori S, Baldo V. Perception and knowledge of HPV-related and vaccine-related conditions among a large cohort of university students in Italy. Hum Vaccin Immunother 2019; 15:1641-1649. [PMID: 30689506 DOI: 10.1080/21645515.2018.1564432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
HPV is involved in cervical, anal, penile, vulvar and oropharyngeal cancers, as well as genital warts. It is important to investigate knowledge and attitudes among university students, considering in this age a shift in healthcare decision-making from parents to students themselves. The aim of this study was to estimate knowledge and perception of HPV in terms of potential shame for HPV-related conditions, trust in vaccine efficacy and worry for potential side effects. The study involved students (18-25 years old) from the Universities of Padua and Verona, Italy. Socio-demographic and behavioural characteristics were collected with a questionnaire (n = 9988). Female gender and older age were positively associated with higher knowledge. The adjusted logistic regression showed an association between the set of perceptions investigated and the vaccination status, while a direct connection with knowledge was not found. However, another adjusted linear regression showed that a good set of perceptions could be partially explained by a high level of knowledge. Perceptions seem to fill an intermediate position between the knowledge and the decision to get vaccinated. The potential shame deriving from asking for HPV-vaccination was not identified as a relevant barrier. Having received information from healthcare workers, family and school showed to be positively associated with the adhesion to the vaccination policy. This study identifies university students as a possible target for HPV vaccination and pinpoints specific areas that might be targeted as first to encourage vaccine uptake. Primary prevention together with screening programmes remains essential in further reducing the burden of HPV-related diseases.
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Affiliation(s)
- T Baldovin
- a Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua , Padua , Italy
| | - C Bertoncello
- a Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua , Padua , Italy
| | - S Cocchio
- a Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua , Padua , Italy
| | - M Fonzo
- a Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua , Padua , Italy
| | - D Gazzani
- b Department of Public Health and Community Medicine, Hygiene and Environmental, Occupational and Preventive Medicine Division, University of Verona , Verona , Italy
| | - A Buja
- a Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua , Padua , Italy
| | - S Majori
- b Department of Public Health and Community Medicine, Hygiene and Environmental, Occupational and Preventive Medicine Division, University of Verona , Verona , Italy
| | - V Baldo
- a Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua , Padua , Italy
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13
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De Battisti E, Buja A, Rivera M, Corti MC, Avossa F, Schievano E, Rigon S, Baldo V, Boccuzzo G, Ebell MH. Multimorbidity and health outcomes in high-need, high-cost elderly patients. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Buja
- University of Padua, Padua, Italy
| | - M Rivera
- University of Padua, Padua, Italy
| | - MC Corti
- Veneto Regional Authority, Venice, Italy
| | - F Avossa
- Veneto Regional Authority, Venice, Italy
| | | | - S Rigon
- Veneto Regional Authority, Venice, Italy
| | - V Baldo
- University of Padua, Padua, Italy
| | | | - MH Ebell
- University of Georgia, Athens, USA
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14
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Bertoncello C, Amoruso I, Fonzo M, Zanzot D, Baldo V, Buja A, Baldovin T. Epidemiology of intestinal parasitic diseases in Nepalese children. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - M Fonzo
- Università di Padova, Padova, Italy
| | - D Zanzot
- Università di Padova, Padova, Italy
| | - V Baldo
- Università di Padova, Padova, Italy
| | - A Buja
- Università di Padova, Padova, Italy
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15
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Buja A, Bertoncello C, Vian P, Vittadello F, Simeoni E, Sperotto M, Pieretti G, Genetti B, Lion C. Parental gambling is associated with adolescents’ attitude to gambling. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Buja
- Department of Cardiological, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - C Bertoncello
- Department of Cardiological, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - P Vian
- Explora Center for Research and Statistical Analysis, Padua, Italy
| | - F Vittadello
- Explora Center for Research and Statistical Analysis, Padua, Italy
| | - E Simeoni
- Italian Department for Antidrug Policies-Presidency of the Council of Ministers, Rome, Italy
| | - M Sperotto
- Explora Center for Research and Statistical Analysis, Padua, Italy
| | - G Pieretti
- Department of Sociology and Business Law, University Of Bologna, Bologna, Italy
| | - B Genetti
- Explora Center for Research and Statistical Analysis, Padua, Italy
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16
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Buja A, Lago L, Lago S, Vinelli A, Zanardo C, Baldo V. Marital status and stage of cancer at diagnosis: A systematic review. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28850741 DOI: 10.1111/ecc.12755] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 12/22/2022]
Abstract
Early cancer detection is fundamental to the promotion of better health in the community, but disparities remain in the likelihood of cancer being detected at an early stage, some of which relate to socio-demographic factors such as marital status. The aim of this study was to conduct a systematic review of research on the association between marital status and stage at diagnosis of different types of cancer. A comprehensive systematic literature search was run in the Medline and Scopus databases (from January 1990 to June 2014), identifying 245 and 208 articles on PubMed and Scopus respectively. Of these 453 studies, 18 were judged eligible for this systematic review. A quality assessment was performed on the studies using the 22 items in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist. This review confirmed the important influence of being married on the earlier detection of cancer. None of the studies considered identified more cases of cancer in a later stage among married patients, and the majority of them reported a statically significant association between marital status and stage at diagnosis, with a positive effect of marriage on the likelihood of cancer being diagnosed at an early stage, for various types of malignancy. In particular, our meta-analysis showed that the unmarried have higher odds of having a later stage of breast cancer (OR = 1.287 95% CI: 1.025-1.617) or melanoma (OR = 1.350 95% CI: 1.161-1.570) at diagnosis. Specific interventions should be developed for the unmarried population to improve their chances of any neoplasms being diagnosed at an early stage, thereby reducing health disparities in the population at large.
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Affiliation(s)
- A Buja
- Dept. of Cardiologic, Vascular, Thoracic Sciences and Public Health, Laboratory of Health Care Services and Health Promotion Evaluation, Unit of Hygiene and Public Health, University of Padova, Padova, Italy
| | - L Lago
- Master course in Sciences of the Public Health and Prevention Professions, University of Padova, Padova, Italy
| | - S Lago
- Nursing School, University of Padova, Padova, Italy
| | - A Vinelli
- School of Hygiene and Preventive Medicine, University of Padova, Padova, Italy
| | - C Zanardo
- School of Hygiene and Preventive Medicine, University of Padova, Padova, Italy
| | - V Baldo
- Dept. of Cardiologic, Vascular, Thoracic Sciences and Public Health, Laboratory of Health Care Services and Health Promotion Evaluation, Unit of Hygiene and Public Health, University of Padova, Padova, Italy
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17
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Sutton AJ, Vohra RS, Hollyman M, Marriott PJ, Buja A, Alderson D, Pasquali S, Griffiths EA. Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology. Br J Surg 2016; 104:98-107. [PMID: 27762448 DOI: 10.1002/bjs.10317] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/29/2016] [Accepted: 08/15/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a 'delayed' operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease. METHODS Using data from a prospective population-based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model-based cost-utility analysis was conducted from the perspective of the UK National Health Service, with a 1-year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impact of parameter uncertainty on the results obtained from the model. RESULTS Emergency cholecystectomy was found to be less costly (£4570 versus £4720; €5484 versus €5664) and more effective (0·8868 versus 0·8662 QALYs) than delayed cholecystectomy. Probabilistic sensitivity analysis showed that the emergency strategy is more than 60 per cent likely to be cost-effective across willingness-to-pay values for the QALY from £0 to £100 000 (€0-120 000). CONCLUSION Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.
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Affiliation(s)
- A J Sutton
- Health Economics Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,National Institute for Health Research Diagnostic Evidence Co-operative Leeds, Leeds, UK
| | - R S Vohra
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - M Hollyman
- West Midlands Surgical Research Collaborative, Birmingham, UK
| | - P J Marriott
- West Midlands Surgical Research Collaborative, Birmingham, UK.,Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - A Buja
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua
| | - D Alderson
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - S Pasquali
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK
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18
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Baldo V, Cocchio S, Gallo T, Furlan P, Clagnan E, Del Zotto S, Saia M, Bertoncello C, Buja A, Baldovin T. Impact of pneumococcal conjugate vaccination: a retrospective study of hospitalization for pneumonia in North-East Italy. J Prev Med Hyg 2016; 57:E61-8. [PMID: 27582630 PMCID: PMC4996041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Pneumonia remains a common reason for hospitalizing infants and the elderly worldwide, and streptococcal infection is often responsible. The aim of this study was to assess the burden of pneumonia in a large general population. METHODS All pneumonia-related hospitalizations from 2004 to 2013 in north-east Italy were identified from the hospital records with a first-listed diagnosis on discharge of bacterial pneumonia, or a first-listed diagnosis on discharge of meningitis, septicemia or empyema associated with a secondary diagnosis of bacterial pneumonia. We identified major comorbidities, calculated agespecific case-fatality rates (CFR), and estimated the related cost to the health care system. RESULTS Of the 125,722 hospitalizations identified, 96.9% were cases of pneumonia, 2.4% of septicemia, 0.4% of meningitis, and 0.3% of empyema; 75.3% of hospitalizations involved ≥ 65-yearolds. The overall CFR was 12.4%, and it increased with age, peaking in people over 80 (19.6%). The mean annual pneumonia-associated hospitalization rate was 204.6 per 100,000 population, and it peaked in 0- to 4-year-old children (325.6 per 100,000 in males, 288.9 per 100,000 in females), and adults over 65 (844.9 per 100,000 in males, 605.7 per 100,000 in females). Hospitalization rates dropped over the years for the 0-4 year-olds, and rose for people over 80. The estimated overall annual cost of these pneumonia-related hospitalizations was approximately € 41 million. CONCLUSIONS This study shows that the burden on resources for pneumonia-related hospitalization is an important public health issue. Prevention remains the most valuable tool for containing pneumonia, and vaccination strategies can help in the primary prevention of infection, possibly reducing the number of cases in all age groups.
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Affiliation(s)
- V. Baldo
- Institute of Hygiene, University of Padua, Italy;,Correspondence: Vincenzo Baldo, Institute of Hygiene, University of Padua, Istituto di Igiene, via Loredan 18, 35121 Padova, Italy - Tel. +39 0498275 - Fax +39 0498275392 - E-mail:
| | - S. Cocchio
- Institute of Hygiene, University of Padua, Italy
| | - T. Gallo
- EuroHealth Net, Friuli Venezia Giulia Region Health Directorate, Italy
| | - P. Furlan
- Institute of Hygiene, University of Padua, Italy
| | - E. Clagnan
- EuroHealth Net, Friuli Venezia Giulia Region Health Directorate, Italy
| | - S. Del Zotto
- EuroHealth Net, Friuli Venezia Giulia Region Health Directorate, Italy
| | - M. Saia
- EuroHealth Net, Veneto Region Health Directorate, Italy
| | | | - A. Buja
- Institute of Hygiene, University of Padua, Italy
| | - T. Baldovin
- Institute of Hygiene, University of Padua, Italy
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19
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Baldovin T, Lazzari R, Russo F, Bertoncello C, Buja A, Furlan P, Cocchio S, Palù G, Baldo V. A surveillance system of Invasive Pneumococcal Disease in North-Eastern Italy. Ann Ig 2016; 28:15-24. [PMID: 26980506 DOI: 10.7416/ai.2016.2081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND From 2007, in the Veneto Region (Italy), a surveillance system for invasive pneumococcal diseases (IPD) was implemented to estimate the regional epidemiology of IPD and to evaluate the impact of 13-valent pneumococcal conjugate vaccine (PCV13) vaccination. METHODS Data were collected from 2007 to 2014 and the total, annual and age-specific IPD notification rates were calculated. A Poisson regression model was used to identify the possible risk factors for developing IPD. RESULTS A total of 713 IPD cases were notified and the overall IPD notification rate was equal to 2.0 cases per 100,000 population (95% CI: 1.7-2.1), with an increasing trend between 2007 and 2014. The pneumococcal serotypes were identified in 608 (85.3%) isolates from biological specimens, and the most distributed serotypes were those contained in PCV13. Children <5 year-old and the adults over 65 year-old showed the highest PCV13 vaccine-type IPD notification rate, equal to 2.7/100,000 and 2.8/100,000, respectively. The risk to develop IPD was greater in children aged <5 years (RR = 8.9, 95% CI: 5.1-15.9; p<0.0001) and in adults aged >65 years (RR = 4.3, 95% CI: 2.7-6.9; p<0.0001), especially in males > 65 years of age (RR = 1.7, 95% CI: 1.0-2.8; p = 0.042). The invasive pneumococcal disease was mainly caused by the PCV13 serotypes (RR = 2.9, 95%CI: 2.3-3.9; p<0.0001), principally after the PCV13 introduction (RR = 2.3, 95% CI: 1.4-3.8; p<0.001). In spite of that, a significant reduction of the overall IPD incidence is evident in the period following the PCV13 vaccine introduction (RR = 0.4, 95% CI: 0.3-0.5; p<0.0001), particularly in children aged <5 years (RR = 0.3, 95% CI: 0.2-0.7; p = 0.002), demonstrating the real efficacy of PCV13 immunization for children. CONCLUSIONS In the Veneto Region, the surveillance system has allowed to describe the detailed epidemiological profile of invasive pneumococcal disease, pointing out that the most circulating pneumococcal serotypes were those contained in the PCV13 vaccine.
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Affiliation(s)
- T Baldovin
- Department of Molecular Medicine, Section of Public Health, Institute of Hygiene University of Padova, Padova, Italy
| | - R Lazzari
- Department of Molecular Medicine, Section of Public Health, Institute of Hygiene University of Padova, Padova, Italy
| | - F Russo
- Service of Hygiene Promotion and Development and Public Health, Veneto Region, Dorsoduro, Venezia, Italy
| | - C Bertoncello
- Department of Molecular Medicine, Section of Public Health, Institute of Hygiene University of Padova, Padova, Italy
| | - A Buja
- Department of Molecular Medicine, Section of Public Health, Institute of Hygiene University of Padova, Padova, Italy
| | - P Furlan
- Department of Molecular Medicine, Section of Public Health, Institute of Hygiene University of Padova, Padova, Italy
| | - S Cocchio
- Department of Molecular Medicine, Section of Public Health, Institute of Hygiene University of Padova, Padova, Italy
| | - G Palù
- Department of Molecular Medicine, Unit of Microbiology, University of Padova, Padova, Italy
| | - V Baldo
- Department of Molecular Medicine, Section of Public Health, Institute of Hygiene University of Padova, Padova, Italy
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Abstract
In June 2009, the World Health Organization (WHO) issued a pandemic alert concerning the spread of an influenza A (H1N1) virus that showed distinctive genetic characteristics vis-à-vis both seasonal influenza strains and vaccine strains. The main mutation occurred in the gene coding for hemagglutinin (HA). Mathematical models were developed to calculate the transmissibility of the virus; the results indicated a significant overlap with the transmissibility of previous pandemic strains and seasonal strains. The remarkable feature of A/(H1N1)pdm09, compared with seasonal strains, is its high fatality rate and its higher incidence among younger people. Data provided by the WHO on the number of deaths caused by A/(H1N1)pdm09 only include laboratory-confirmed cases. Some authors suggest that these data could underestimate the magnitude of the event, as laboratory confirmation is not obtained in all cases. It is important to bear in mind that the A/(H1N1)pdm09 virus is still circulating in the population. It is therefore essential to maintain its epidemiological and virological surveillance.
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Affiliation(s)
- V Baldo
- Department of Molecular Medicine, Public Health Section, University of Padua, Italy
| | - C Bertoncello
- Department of Molecular Medicine, Public Health Section, University of Padua, Italy
| | - S Cocchio
- Department of Molecular Medicine, Public Health Section, University of Padua, Italy
| | - M Fonzo
- Department of Molecular Medicine, Public Health Section, University of Padua, Italy
| | - P Pillon
- Department of Molecular Medicine, Public Health Section, University of Padua, Italy
| | - A Buja
- Department of Molecular Medicine, Public Health Section, University of Padua, Italy
| | - T Baldovin
- Department of Molecular Medicine, Public Health Section, University of Padua, Italy
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Damiani G, Acampora A, mBonelli L, Arandelovic A, Ricciardi W, Buja A. Publication trends on population medicine programs in Primary Health Care: a bibliometric study. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gallimberti L, Buja A, Goméz Peréz LJ, Chindamo S, Rabensteine A, Marini E, Terraneo A, Baldo V. Problematic mobile phone use in late childhood and early adolescence in Padua, Italy, 2014–15. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Buja A, Toffanin R, Rigon S, Sandona P, Carraro D, Damiani G, Baldo V. OOH: demands, referral patterns, frequent attenders characteristics in a Veneto Region (Italy) LHA. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Zampieron A, Buja A, Fusco M, Linder D, Bortune M, Piaserico S, Baldo V. Quality of life in patients with scalp psoriasis. GIORN ITAL DERMAT V 2015; 150:309-316. [PMID: 25236315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aims of this study were to describe the quality of life (QoL) in patients suffering of scalp psoriasis and to assess the impact of the socio-demographic and clinical features of this condition on patients' health-related QoL, using general and specific QoL scales. METHODS This research is a cross-sectional study. The study involved 55 patients attending their first examination at the Dermatology Clinic of Padua University over the course of one year (April 2010-March 2011). The outcome was quality of life analyzed by means Scalpdex and SF-36 questionnaire. RESULTS The sample's mean Scalpdex score was 43.60±17.52, while the mean SF-36 score was 68.28±20.32. The SF-36 identified statistically significant differences between the psoriasis patients and the Italian general population in two domains, i.e. general health (P=0.0075) and emotional role (P=0.0048). The severity of patients' scalp lesions emerged as a factor associated with a reduced QoL in these patients, irrespective of the severity of their disease as a whole. Sex, age, schooling and other socio-demographic factors also characterized patients' perceived QoL. CONCLUSION Patients with scalp psoriasis suffered from a lower QoL relating to the highly visible site of their psoriatic lesions. Specific supportive measures should be dedicated to these patients by health care workers.
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Affiliation(s)
- A Zampieron
- School of Pediatric Nursing, Padua University Hospital, Padua, Italy -
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Baldo V, Lombardi S, Cocchio S, Rancan S, Buja A, Cozza S, Marangon C, Furlan P, Cristofoletti M. Diabetes outcomes within integrated healthcare management programs. Prim Care Diabetes 2015; 9:54-59. [PMID: 24746417 DOI: 10.1016/j.pcd.2014.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 03/13/2014] [Accepted: 03/19/2014] [Indexed: 11/23/2022]
Abstract
AIM The aim of this observational study was to assess mortality of patients with type 2 diabetes by type of healthcare delivery system, i.e. through specialist centers or generalist doctors, or integrated care. METHODS The study was conducted at the "Vicentino Ovest" Local Health District in the Veneto Region (north-eastern Italy) from January 1, 2008 to December 31, 2010. Patients with diabetes (≥ 20 years old) were identified using different public health databases. They were grouped as: patients followed up by specialists at diabetes clinics (DS); patients seen only by their own general practitioner (GP); and patients receiving integrated care (DS-GP). Cox's regression analysis was used to estimate adjusted hazard ratios for available potential predictors of death by level of care. RESULTS The crude mortality rate was highest in the GP group (26.1 per 1000 person-years), the difference being minimal when compared with the DS group (21.7 per 1000 person-years) and more marked when compared with the DS-GP group (8.8 per 1000 person-years). Patients followed up by their GPs had a 2.7 adjusted RR for mortality by comparison with the DS-GP group. CONCLUSIONS The findings of the present study could demonstrate that it is safe and cost-effective, after a first specialist assessment at a diabetes service, for low-risk diabetic patients to be managed by family physicians as part of a coordinated care approach, based on the specialist's clinical recommendations; GPs can subsequently refer patients to a specialist whenever warranted by their clinical condition.
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Affiliation(s)
- V Baldo
- Department of Molecular Medicine, Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Italy.
| | - S Lombardi
- Distretto Socio Sanitario, Local Health District n̊5 "Vicentino Ovest", Veneto Region, Italy
| | - S Cocchio
- Department of Molecular Medicine, Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Italy
| | - S Rancan
- Distretto Socio Sanitario, Local Health District n̊5 "Vicentino Ovest", Veneto Region, Italy
| | - A Buja
- Department of Molecular Medicine, Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Italy
| | - S Cozza
- Distretto Socio Sanitario, Local Health District n̊5 "Vicentino Ovest", Veneto Region, Italy
| | - C Marangon
- Distretto Socio Sanitario, Local Health District n̊5 "Vicentino Ovest", Veneto Region, Italy
| | - P Furlan
- Department of Molecular Medicine, Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Italy
| | - M Cristofoletti
- Distretto Socio Sanitario, Local Health District n̊5 "Vicentino Ovest", Veneto Region, Italy
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Fusco M, Buja A, Furlan P, Casale P, Marcolongo A, Baldovin T, Bertoncello C, Baldo V. Older adults in Emergency Department: management by clinical severity at triage. Ann Ig 2014; 26:409-17. [PMID: 25405371 DOI: 10.7416/ai.2014.2000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The elderly are involved in an ever-increasing proportion of Emergency Department (ED) visits, consuming a large share of the available resources. The aim of this study was to assess elderly individuals' demand for ED hospital care, in terms of the management process and outcomes by level of urgency at triage. METHODS The design was a retrospective cohort study. Details on ED attendance were drawn from the 2010 dataset of the Local Health Agency n°18 (n=18,648) in the Veneto Region, North-East Italy and the participants were resident seniors seen at the ED aged 65 or more. RESULTS At triage on arrival, their priority was most often (in 38.63% of cases) considered non-urgent (white triage tag - Wt). In the majority of these cases, the elderly patients were self-referred, although about 1 in 5 of them had been referred by their General Practitioners. The consumption of resources for specialist visit and routine X-rays is higher for non-urgent patients. Injuries, requests for specialist examinations and musculoskeletal disorders account for a large proportion of the reasons why elderly people classified as Wt at triage had gone to the ED. CONCLUSIONS Our findings show that older patients have high rates of non-urgent ED attendance, especially for minor traumatic events or requests to see a specialist. This picture emphasizes the need to develop new organizational models for delivering care to meet the most common health care needs of this special frail population.
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Affiliation(s)
- M Fusco
- M. Fusco is MD, School of Hygiene and Preventive Medicine, Department of Molecular Medicine, Section of Public Health, Laboratory of Public Health and Population Studies, University of Padua
| | - A Buja
- A. Buja is PhD, P. Furlan is SD, T. Baldovin is BS and PhD, C. Bertoncello is MD and PhD and V. Baldo is Full Professor, Department of Molecular Medicine, Section of Public Health, Laboratory of Public Health and Population Studies, University of Padua
| | - P Furlan
- A. Buja is PhD, P. Furlan is SD, T. Baldovin is BS and PhD, C. Bertoncello is MD and PhD and V. Baldo is Full Professor, Department of Molecular Medicine, Section of Public Health, Laboratory of Public Health and Population Studies, University of Padua
| | - P Casale
- P. Casale is SD, Azienda ULSS 18 Rovigo, Region Veneto
| | - A Marcolongo
- A. Marcolongo is MD and Regional Director of Health, Friuli Venezia Giulia Region
| | - T Baldovin
- A. Buja is PhD, P. Furlan is SD, T. Baldovin is BS and PhD, C. Bertoncello is MD and PhD and V. Baldo is Full Professor, Department of Molecular Medicine, Section of Public Health, Laboratory of Public Health and Population Studies, University of Padua
| | - C Bertoncello
- A. Buja is PhD, P. Furlan is SD, T. Baldovin is BS and PhD, C. Bertoncello is MD and PhD and V. Baldo is Full Professor, Department of Molecular Medicine, Section of Public Health, Laboratory of Public Health and Population Studies, University of Padua
| | - V Baldo
- A. Buja is PhD, P. Furlan is SD, T. Baldovin is BS and PhD, C. Bertoncello is MD and PhD and V. Baldo is Full Professor, Department of Molecular Medicine, Section of Public Health, Laboratory of Public Health and Population Studies, University of Padua
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Bertoncello C, Furlan P, Baldovin T, Marcolongo A, Casale P, Cocchio S, Buja A, Baldo V. Health consequences of road accidents: insights from local health authority registries. Ann Ig 2013; 25:215-23. [PMID: 23598805 DOI: 10.7416/ai.2013.1924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Road accidents are a major public health problem that affect all age groups but their impact is most striking among the young. The aim of this study is to quantify the burden of road traffic injuries, their mortality and direct in-patient economic costs and to identify the age classes at highest risk for severe road traffic injuries, through analysis of data collected by information systems of an Italian Local Health Authority. METHODS The study was conducted in a Local Health Authority of Veneto Region. Injured people were selected from Emergency Department (2006-2010). Data were linked to the Hospital Information System for hospital admissions and to the Mortality Registry to check 30-day mortality. The direct costs associated to hospitalizations were estimated through Diagnosis Related Group reimbursement rates. Multivariate analysis was performed using hospitalization and mortality as the dependent variables and gender, age, day of week when accident occurred as the independent variables. Traffic injury, hospitalization and mortality incidence rates were calculated by gender and age per 100,000 residents per year. RESULTS The road traffic injuries were 9,192, decreasing from 2,112 in 2006 to 1,980 in 2010. Among injured persons 55.3% were male (68.1% among 15-19 age class); 41.7% young people aged 15-34 years (43.9% among male, 39.0% among female). Total hospitalisation rate was 5.9%. Overall mortality rate was 0.3% (0.9% among aged 65 or older). The cost of hospital admission was euro 2,742,505 (hospitalization mean cost euro 5,097). Risk of hospitalization and death was higher in male, in elderly and during week end. Young people aged 15-19 had the highest incidence of visits (2,258.4 per 100,000) and high hospitalisation weekend and mortality rates (respectively 101.5 and 8.5). CONCLUSIONS Analysis at local level, using current data sources, permits to estimate the burden of injuries caused by road-traffic, to describe the characteristics of injured persons and finally to estimate costs of care. All this information could be used to make the population aware of its own risk for road accidents. Linkage of these data with police and transport data is required to focus prevention on higher risk groups and to adopt effective local road safety strategies.
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Affiliation(s)
- C Bertoncello
- Department of Molecular Medicine, Institute of Hygiene, University of Padua, Italy
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Zampieron A, Buja A, Dorigo M, Bonso O, Corso M. A comparison of student motivation in selecting bachelors of nursing or paediatric nursing at an Italian university. Int Nurs Rev 2012; 59:525-31. [DOI: 10.1111/j.1466-7657.2012.01025.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Buja A, Vinelli A, Baldovin T, Gallimberti L, Bardelle G, Rausa G, Baldo V. [Which prevention programs effectively reduce the risk of alcohol consumption in young people?]. Ann Ig 2012; 24:25-39. [PMID: 22670335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Alcohol consumption among young people is a major public health problem and the Italian National Health Institute considers it the leading cause of death for people under 24 years old, mainly due to road accidents. This study summarizes the evidence emerging from three Cochrane Collaboration reviews, aiming to orient the choice of alcohol prevention programs for young people. The first review considered schemes implemented at school to prevent alcohol consumption under 18 years of age; the second concerned studies on programs to reduce alcohol abuse by means of social norms; the third examined 56 trials on schemes for preventing young people from drinking. In the first review, 6 of 11 alcohol prevention schemes showed some signs of efficacy, and 14 of 39 schemes to combat substance abuse generally induced a significantly alcohol use reduction. The second review included three specific programs for alcohol-related problems with a > 17-month follow-up and they were effective. In the third review, 15 of 39 schemes proved effective in the short-term, 9 of 12 with medium follow-up were no longer effective (and alcohol consumption even increased in 2), while 3 long-term trials and 2 of 3 community schemes proved effective. These Cochrane reviews did not assess all strategies for preventing alcohol abuse in the young which have been implemented in different countries, because many interventions has been conducted spontaneously without any evaluation of their efficacy. An international registry on substance abuse prevention measures is warranted, with shared criteria for assessing their effects, to orient public health policies.
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Affiliation(s)
- A Buja
- Dipartimento Medicina Ambientale e Sanità Pubblica, Università degli Studi di Padova, Italy.
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Perissinotto E, Buja A, Maggi S, Enzi G, Manzato E, Scafato E, Mastrangelo G, Frigo AC, Coin A, Crepaldi G, Sergi G. Alcohol consumption and cardiovascular risk factors in older lifelong wine drinkers: the Italian Longitudinal Study on Aging. Nutr Metab Cardiovasc Dis 2010; 20:647-655. [PMID: 19695851 DOI: 10.1016/j.numecd.2009.05.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 05/07/2009] [Accepted: 05/25/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS A protective effect of moderate alcohol consumption on the cardiovascular system has consistently been reported, but limited evidence has been produced on the association of alcohol with metabolic factors in the elderly. The aim of this study was to investigate the association between different levels of current alcohol consumption and cardiovascular risk factors in a representative sample of elderly Italian men, mainly wine drinkers. METHODS AND RESULTS This is a cross-sectional multi-centre study on a population-based sample of Italian men aged 65-84 years, drawn from the Italian Longitudinal Study on Aging (ILSA) cohort. The analyses included 1896 men. Almost all the drinkers (98%) drank wine as a lifelong habit. Adjusted ORs for risk levels for cardiovascular factors (BMI, waist circumference, fibrinogen, α2 protein, white blood cells, HDL cholesterol, Apo A-I, total cholesterol, Apo B-I, triglycerides, LDL, glycated hemoglobin, insulin, fasting plasma glucose, HOMA IR, systolic and diastolic blood pressure) were estimated, comparing drinkers with teetotalers using multivariate logistic regression models. We found alcohol consumption in older age associated with healthier hematological values of fibrinogen, HDL cholesterol, Apo A-I lipoprotein and insulin, but it was also associated with a worse hematological picture of total, LDL cholesterol levels, and systolic pressure. CONCLUSION Our results indicated in elderly moderate wine drinkers a noticeably safe metabolic, inflammatory and glycemic profile that might balance higher blood pressure, leading to a net benefit. These findings however need to be placed in relation to the known adverse social and health effects of heavy drinking.
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Affiliation(s)
- E Perissinotto
- Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy.
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Buja A, Cavinato M, Perissinotto E, Rausa G, Mastrangelo G, Toffanin R. Why do patients change their general practitioner? Suggestions on corrective actions. Ir J Med Sci 2010; 180:149-54. [DOI: 10.1007/s11845-010-0571-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 08/26/2010] [Indexed: 10/19/2022]
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Buja A, Scafato E, Sergi G, Maggi S, Suhad MA, Rausa G, Coin A, Baldi I, Manzato E, Galluzzo L, Enzi G, Perissinotto E. Alcohol consumption and metabolic syndrome in the elderly: results from the Italian longitudinal study on aging. Eur J Clin Nutr 2009; 64:297-307. [DOI: 10.1038/ejcn.2009.136] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Gangemi E, Berchialla P, Buja A, Gregori D, Stella M. Bayesian networks for pathological scarring due to burn injuries. Burns 2009. [DOI: 10.1016/j.burns.2009.06.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mastrangelo G, Krone B, Fadda E, Buja A, Grange JM, Rausa G, de Vries E, Koelmel KF. Does yellow fever 17D vaccine protect against melanoma? Vaccine 2008; 27:588-91. [PMID: 19010368 DOI: 10.1016/j.vaccine.2008.10.076] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 10/23/2008] [Accepted: 10/27/2008] [Indexed: 10/21/2022]
Abstract
BCG vaccine, vaccinia vaccine and certain pathogens that were shown in previous studies to protect against melanoma have antigenic determinants homologous in their amino acids sequence with the melanoma antigen HERV-K-MEL, encoded by a human endogenous retrovirus K (HERV-K), which is expressed in about 95% of malignant melanocytes. Yellow fever vaccine (YFV) likewise contains an antigenic determinant with a close homology to HERV-K-MEL and might therefore also confer protection against melanoma. To investigate this possibility we carried out a cohort study (28,306 subjects) and a nested case-control study (37 melamona cases and 151 tumors not expressing HERV-K-MEL) in Veneto region (North-Eastern Italy). The standardized incidence ratio was 1.33 (95% confidence interval, 0.84-2.11), 1.59 (0.97-2.59) and 0.59 (0.19-1.84), while the age- gender-adjusted odds ratios were 1.00, 0.96 (0.43-2.14) and 0.26 (0.07-0.96), at 0-4, 5-9, and > or =10 years elapsed from YFV administration, respectively. The risk of melanoma may therefore be lowered 10 years after vaccination with yellow fever vaccine.
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Affiliation(s)
- G Mastrangelo
- Department of Environmental Medicine and Public Health, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
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Coin A, Perissinotto E, Enzi G, Zamboni M, Inelmen EM, Frigo AC, Manzato E, Busetto L, Buja A, Sergi G. Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia. Eur J Clin Nutr 2007; 62:802-9. [PMID: 17637603 DOI: 10.1038/sj.ejcn.1602779] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aims of this study were to investigate the relationship between sarcopenia, dietary intake, nutritional indices and hip bone mineral density (BMD) in the elderly, and to estimate the risk of low BMD due to specific independent predictor thresholds. SUBJECTS AND METHODS Body mass index (BMI), serum albumin, energy and protein intake were studied in 352 elderly outpatients (216 women aged 73.5+/-5.3 years and 136 men aged 73.9+/-5.6 years). BMD at different hip sites and appendicular skeletal muscle mass (ASMM) were assessed by dual-energy X-ray absorptiometry. RESULTS The prevalence of osteoporosis was 13% in men and 45% in women, while the prevalence of sarcopenia (50%) and hypoalbuminemia (5%) were similar in both genders. BMI, albumin and ASMM were significantly associated with BMD in both genders: so was protein intake, but only in men. By multiple regression analysis, the variables that retained their independent explanatory role on total hip BMD, were BMI and protein intake in men, and BMI and albumin in women. By logistic regression analysis, men risked having a low BMD with a BMI <22 (OR=12) and a protein intake <65.7 g/day (OR=3.7). Women carried some risk already in the BMI 25-30 class (OR=5), and a much greater risk in the BMI <22 class (OR=26). Albumin <40 g/l also emerged as an independent risk factor (OR=2.6). CONCLUSIONS BMI in both genders, albumin in women and protein intake in men have an independent effect on BMD. BMI values <22 are normal for younger adults but carry a higher risk of osteoporosis in the elderly, particularly in women. Age-related sarcopenia does not seem to be involved in bone mass loss.
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Affiliation(s)
- A Coin
- Department of Medical and Surgical Sciences, Geriatrics Unit, University of Padova, Italy
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Lange JH, Mastrangelo G, Buja A. Smoking and alcohol use in asbestos abatement workers. Bull Environ Contam Toxicol 2006; 77:338-42. [PMID: 17033859 DOI: 10.1007/s00128-006-1071-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 08/14/2006] [Indexed: 05/12/2023]
Affiliation(s)
- J H Lange
- Envirosafe Training and Consultants, Post Office Box 114022, Pittsburgh, PA 15239, USA
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Lange JH, Mastrangelo G, Fadda E, Priolo G, Montemurro D, Buja A, Grange JM. Elevated lung cancer risk shortly after smoking cessation: is it due to a reduction of endotoxin exposure? Med Hypotheses 2005; 65:534-41. [PMID: 15913904 DOI: 10.1016/j.mehy.2005.02.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 02/24/2005] [Indexed: 11/27/2022]
Abstract
Several reports indicate that the risk of lung cancer increases slightly for a short period of time after cessation of smoking while the risk of adverse cardiovascular events drops immediately. Recent studies on subjects occupationally exposed to organic dust-containing endotoxin have revealed lower than expected rates of lung cancer. There is experimental evidence that stimulation of the immune system by endotoxin has a protective effect against cancer. Tobacco smoke has been shown to contain high levels of endotoxin. We therefore postulate that cessation of smoking eliminates the protective effect of endotoxin. Any benefit conferred by endotoxin does not, however, justify smoking. As the inverse relationship between exposure to endotoxin and the risk of lung cancer is a strong one, endotoxin-like substances could form the basis of vaccination strategies.
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Affiliation(s)
- J H Lange
- Envirosafe Training and Consultants, P.O. Box 114022, Pittsburgh, PA 15239, USA
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Lange JH, Thomulka KW, Sites SSL, Priolo G, Buja A, Mastrangelo G. Personal exposure during abatement of various asbestos-containing materials in the same work area. Bull Environ Contam Toxicol 2005; 74:1034-6. [PMID: 16158837 DOI: 10.1007/s00128-005-0684-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- J H Lange
- Envirosafe Training and Consultants, PO Box 114022, Pittsburgh, PA 15239, USA
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Lange JH, Wang M, Buja A, Mastrangelo G. Area and personal exposure measurements during asbestos abatement of a crawl space and boiler room. Bull Environ Contam Toxicol 2005; 74:388-390. [PMID: 15841982 DOI: 10.1007/s00128-004-0596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- J H Lange
- Envirosafe Training and Consultants, Post Office Box 114022, Pittsburgh, PA 15239, USA
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Abstract
We investigate parallel analysis (PA), a selection rule for the number-of-factors problem, from the point of view of permutation assessment. The idea of applying permutation test ideas to PA leads to a quasi-inferential, non-parametric version of PA which accounts not only for finite-sample bias but sampling variability as well. We give evidence, however, that quasi-inferential PA based on normal random variates (as opposed to data permutations) is surprisingly independent of distributional assumptions, and enjoys therefore certain non- parametric properties as well. This is a justification for providing tables for quasi-inferential PA. Based on permutation theory, we compare PA of principal components with PA of principal factor analysis and show that PA of principal factors may tend to select too many factors. We also apply parallel analysis to so-called resistant correlations and give evidence that this yields a slightly more conservative factor selection method. Finally, we apply PA to loadings and show how this provides benchmark values for loadings which are sensitive to the number of variables, number of subjects, and order of factors. These values therefore improve on conventional fixed thresholds such as 0.5 or 0.8 which are used irrespective of the size of the data.
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Buja A, Hurley C. [OMEGA (Online Multivariate Exploratory Graphical Analysis): Routine Searching for Structure]: Comment. Stat Sci 1990. [DOI: 10.1214/ss/1177012167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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