Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study.

The aim of this cohort study was to assess the risk of developing cancer, specifically leukaemia, tumours of the central nervous system and lymphoma, before the age of 15 years in children previously exposed to computed tomography (CT) in Germany. Data for children with at least one CT between 1980 and 2010 were abstracted from 20 hospitals. Cancer cases occurring between 1980 and 2010 were identified by stochastic linkage with the German Childhood Cancer Registry (GCCR). For all cases and a sample of non-cases, radiology reports were reviewed to assess the underlying medical conditions at time of the CT. Cases were only included if diagnosis occurred at least 2 years after the first CT and no signs of cancer were recorded in the radiology reports. Standardised incidence ratios (SIR) using incidence rates from the general population were estimated. The cohort included information on 71,073 CT examinations in 44,584 children contributing 161,407 person-years at risk with 46 cases initially identified through linkage with the GCCR. Seven cases had to be excluded due to signs possibly suggestive of cancer at the time of first CT. Overall, more cancer cases were observed (O) than expected (E), but this was mainly driven by unexpected and possibly biased results for lymphomas. For leukaemia, the SIR (SIR = O/E) was 1.72 (95 % CI 0.89-3.01, O = 12), and for CNS tumours, the SIR was 1.35 (95 % CI 0.54-2.78, O = 7). Despite careful examination of the medical information, confounding by indication or reverse causation cannot be ruled out completely and may explain parts of the excess. Furthermore, the CT exposure may have been underestimated as only data from the participating clinics were available. This should be taken into account when interpreting risk estimates.

Mortality risk associated to arsenic exposure after a major disaster. Results from the Manfredonia occupational cohort study 1976-2021.

BACKGROUND: On September 1976, due to the explosion of an ammonia-washing column at the petrochemical plant in Manfredonia (Italy), 39 tonnes of arsenic were released into the atmosphere, contaminating the plants and the neighbourhoods close to it. The aim of this study is to present the results of a 45-year follow up of exposed workers with a focus on residential exposure. METHODS: We contacted Italian General Registries Offices and updated the vital status of persons involved in the clean-up activities following the disaster. The outcome of interest was the overall and cause-specific mortality. An accelerated failure time (AFT) approach was used when appropriate to model the risk of mortality. RESULTS: 1772 workers contributing 67,743 person years were considered in the analysis. For overall mortality, results of the age-adjusted AFT model show an accelerator factor of 0.89 (95%CI 0.80-0.99) among contract workers, which means a shortening of survival in comparison to the reference category (plastic area workers). When accounting for latency greater than 20 years, higher mortality rates for lung cancer were observed among workers residing in Manfredonia. DISCUSSION: An increased risk of mortality among workers who were more exposed to arsenic during the clean-up activities has been observed. In fact, a loss of 5 years of life among more exposed workers was calculated. Furthermore, the mortality rates of residents in Manfredonia were higher than those of workers residing elsewhere.

Pattern of care and results of radiotherapy in patients 80 years old and over.

BACKGROUND AND AIMS: Cancer incidence increases with age and several cancer types are observed in older patients, so the need for radiotherapy (RT) in treatment of older patients with cancer is also on the rise. This study's aims to evaluate retrospectively the pattern of care and the feasibility of RT in elderly patients (80 years old and over) treated with different intents, and the impact of RT prescription on survival. MATERIALS AND METHODS: We reviewed 191 patient charts from the years 2005-2007, recording age, intent of treatment, site, and type of RT. Crude and actuarial survival were estimated. RESULTS: One hundred patients were males (M) and 91 females (F); 162 were seen on an outpatient basis, 29 as inpatients. A total of 138 patients were recruited for RT; 113 were treated, 112 completed RT. The ratio to all treated patients was 113/2125 (5.3%). Overall (treated and non-treated) cumulative survival probability was 71% for the first year, 45% for the second and 27% for the third. For treated patients, the cumulative survival probability was 67% for the first year, 43% for the second year and 23% for the third year, while for untreated patients it was 76% for the first year, 47% for the second year and 32% for the third year (Log-rank test: p = 0.23). CONCLUSIONS: RT did not decrease survival in elderly patients.

[Multivariate analysis of prognostic factors and survival in patients with "glioblastoma multiforme"]. / Multivariate analysis of prognostic factors and survival inpatients with "glioblastoma multiforme".

PURPOSE: The aim of this study was to evaluate the survival of patients with "glioblastoma multiforme", to analyse the prognostic factors influencing the survival rate and to review recent results in the literature. MATERIALS AND METHODS: Seventy five patients underwent radiation treatment between May 1998 and April 2003. Among the factors under investigation we ascertained that sex, chemotherapy, conformal treatment, surgery, and the choice of the irradiation area (whole brain or only the involved field) did not influence the survival in a statistically significant manner. RESULTS: Whereas age and total dose were the 95% statistically significant variables. Hazard ratio of patients older than 58 years compared to younger patients was 1.69. The death risk was 69% in older than younger patients. A greater irradiation dose improved the survival with an increase of the median survival days. The total dose lower than 6000 cGy caused an increase of 81.8% in the death risk. The median survival from the diagnosis to the death was 14.7 months (446 days) and 1-, 2- and 3- year survival rate was 69.3%, 38.4%, and 14.7% respectively. CONCLUSIONS: The current medical literature and our experience attests that the use of temozolomide improves the survival of these patients.

Incidence and costs of hip fractures compared to acute myocardial infarction in the Italian population: a 4-year survey.

INTRODUCTION: Few data are available about the incidence and costs of hip fractures in Italy. We aimed to determine the impact of hip fractures vs. acute myocardial infarction (AMI). METHODS: We studied the national hospitalization database to calculate their incidence and costs in adults aged >or=45 between 1999 and 2002. RESULTS: In 2002, there were 86,719 hip fractures with a 10.0% increase over 4 years. We observed a predominance of women (77.1%) and a strong age effect: 92.7% of patients were >or=65 years old and 80% of fractures occurred in women aged >or=75, showing a clear relationship with the incidence of osteoporosis. Hospitalizations due to AMI after 45 years of age in 1999 were only 9% higher than those for hip fracture, although this difference increased over the 4 examined years up to 24%. Considering the DRGs costs, hip fractures resulted in being more expensive than AMI overall and concerning elderly people. CONCLUSIONS: This study shows that in the Italian population aged >or=45, hospitalizations following hip fracture and AMI between 1999 and 2002 were comparable, while hip fractures' direct costs were higher and grew faster than costs for AMI. Hip fractures in Italy are a serious medical problem and a leading health-cost driver.

Subjective health status assessment: evaluation of the Italian version of the SF-12 Health Survey. Results from the MiOS Project.

BACKGROUND: SF-12 is a generic short form health survey, developed in the USA from the original SF-36. It produces two summary measures evaluating physical and mental self-perceived health that are interchangeable with those from the SF-36. SF-12 has been successfully tested in nine Western European countries on large samples of the general population, where it has proved its brevity, comprehensiveness, reliability, validity and cross-cultural applicability. The present analysis directly assesses the SF-12 for the first time in various Italian settings, including the general population and specific patient groups. METHODS: Data for this report were collected from five different samples; in four of them the SF-12 was used as a 'stand-alone' instrument, while in the other one (used as the reference) it was embedded in the SF-36. Descriptive statistics, Spearman's correlation coefficients, confirmatory factor analysis, ordinal uni- and multi-variate least squares regression model and covariance analysis were used to evaluate the summary measures in each sample, and across relevant subgroups. Studies were ordered according to the expected deviance, from the 'normal' health status of the reference group to the sample with the expected highest level of illness. RESULTS: Overall, more than 11,000 subjects were evaluated. Response rates ranged from 63 to 100%, while missing items accounted only for 0.2-8.2% of all items. Uni- and multi-variate analyses showed a positive association between both physical component summary (PCS) and mental component summary (MCS) scores and their respective items in all examined samples. MCS scores were fairly similar across all samples, with the only exception being patients recently discharged from hospital, whose subjective mental health perception was higher than expected and the highest of all (52.2). Finally, we found a substantial impact of ageing on physical health perception, while the MCS was shown to be less sensitive to the age effect. CONCLUSIONS: This analysis shows that the SF-12 has good validity, while some issues related to its most appropriate mode of administration and target groups might require further attention.