Seasonal Variation in Skin Cancer Diagnosis.

PURPOSE: Seasonality of skin cancer is well known, and it is influenced by a number of variables, such as exposure and personal characteristics, but also health service factors. We investigated the variations in the diagnosis melanoma skin cancer (MSC) and non-melanoma skin cancer (NMSC) during the year. METHODS: We analyzed incident cases recorded in the Umbria Regional Cancer registry from 1994 to 2010 (1745 cases of MSC, 50% females, and 15,992 NMSC, 41% females). The Walter-Elwood test was used to assess seasonal effects. Relative risks were analyzed using negative binomial regression and splines. RESULTS: Seasonality of MSC and NMSC was similar. Incidence peaks were observed in weeks 8, 24, and 43 (February, July, and October) and troughs in weeks 16, 32, 52, and 1 (August and December). Both NMSC and MSC cancers showed most elevated risks in autumn. A seasonal effect was present for trunk (p < 0.001) and absent for face cancers (p = 0.3). CONCLUSION: The observed pattern of diagnoses presumably depends on health service factors (e.g., organization of melanoma days, reduced access to care in August and during Christmas holidays) and personal factors (e.g., unclothing in the summer and delays in seeking care). High incidence rates in autumn could also in part depend on a late cancer progression effect of UV exposure. More efforts should be placed in order to guarantee uniform access to care through the year.

Cancer burden trends in Umbria region using a joinpoint regression.

INTRODUCTION: The analysis of the epidemiological data on cancer is an important tool to control and evaluate the outcomes of primary and secondary prevention, the effectiveness of health care and, in general, all cancer control activities. MATERIALS AND METHODS: The aim of the this paper is to analyze the cancer mortality in the Umbria region from 1978 to 2009 and incidence from 1994-2008. Sex and site-specific trends for standardized rates were analyzed by "joinpoint regression", using the surveillance epidemiology and end results (SEER) software. RESULTS: Applying the jointpoint analyses by sex and cancer site, to incidence spanning from 1994 to 2008 and mortality from 1978 to 2009 for all sites, both in males and females, a significant joinpoint for mortality was found; moreover the trend shape was similar and the joinpoint years were very close. In males standardized rate significantly increased up to 1989 by 1.23% per year and significantly decreased thereafter by -1.31%; among females the mortality rate increased in average of 0.78% (not significant) per year till 1988 and afterward significantly decreased by -0.92% per year. Incidence rate showed different trends among sexes. In males was practically constant over the period studied (not significant increase 0.14% per year), in females significantly increased by 1.49% per year up to 2001 and afterward slowly decreased (-0.71% n.s. estimated annual percent change - EAPC). CONCLUSIONS: For all sites combined trends for mortality decreased since late '80s, both in males and females; such behaviour is in line with national and European Union data. This work shows that, even compared to health systems that invest more resources, the Umbria public health system achieved good health outcomes.

[Evaluation of the healthcare continuity quality in Umbria (Italy)]. / Valutazione della qualità dei servizi di continuità assistenziale in Umbria.

The aim of the study was to evaluate the quality of hospital-territorial services relationship and community care to ensure continuity of care and to avoid, or reduce, the risk of hospitalization for complications or problems in the Health Districts of Umbria region (Italy). They are considered some of the outcome indicators proposed by the Assessment Document on Determinants of Health and the Strategies of the SSR, sponsored by the Region of Umbria in 2004 and based on Agency for Healthcare Research and Quality Indicators : the rate of unplanned readmission to hospital within 28 days after hospitalization for hip fracture, stroke, acute myocardial infarction, asthma, and the rate of hospitalization for chronic complications of diabetes, pneumonia and influenza. The most significant feature is the marked variability between different districts of the region. This variability requires careful verification, as well as the quality of intra-hospital, also the quality of the relationship hospital-territorial services and the different skills and ways of taking care of patients by the health district. To reduce the risk of rehospitalization/readmission not programmed for specific diseases, even considering that this risk is influenced by various determinants, it is desirable to improve the quality of community services.

[Hospital-territorial services and integration of health care: the Protected Discharge program in the Umbria Region from 2005 to 2010]. / Integrazione ospedale-territorio: le Dimissioni Protette nella Regione Umbria (anni 2005-2010).

In order to address the management of patients with chronic diseases, national and international regulatory guidelines have developed policies and operational tools aimed at integration and implementation of pathways of continuity of health care between different healthcare settings. "Protected Discharge" programs have been developed for the organized transfer of patients from one setting of care (hospital) to another (territory) in order to ensure their continuity of care and assistance. The aim of this study was to assess the degree of implementation the program in the context of continuity of healthcare in the Umbria region (Italy). An analysis of the regional archive of hospital discharge records was performed to examine trends of the various types of hospital discharges during the years 2005 to 2010. A slow but steady increase of protected discharges was observed from 2005 (0.9%) to 2010 (1.9%). The percentages observed are higher than those at the national level (except for transfer to RSA); however, results indicate insufficient implementation of hospital-territorial services integration and hence of the principle of continuity of health and social care.