Association between menopausal hormone therapy, mammographic density and breast cancer risk: results from the E3N cohort study.

BACKGROUND: Menopausal hormone therapy (MHT) is a risk factor for breast cancer (BC). Evidence suggests that its effect on BC risk could be partly mediated by mammographic density. The aim of this study was to investigate the relationship between MHT, mammographic density and BC risk using data from a prospective study. METHODS: We used data from a case-control study nested within the French cohort E3N including 453 cases and 453 matched controls. Measures of mammographic density, history of MHT use during follow-up and information on potential confounders were available for all women. The association between MHT and mammographic density was evaluated by linear regression models. We applied mediation modelling techniques to estimate, under the hypothesis of a causal model, the proportion of the effect of MHT on BC risk mediated by percent mammographic density (PMD) for BC overall and by hormone receptor status. RESULTS: Among MHT users, 4.2% used exclusively oestrogen alone compared with 68.3% who used exclusively oestrogens plus progestogens. Mammographic density was higher in current users (for a 60-year-old woman, mean PMD 33%; 95% CI 31 to 35%) than in past (29%; 27 to 31%) and never users (24%; 22 to 26%). No statistically significant association was observed between duration of MHT and mammographic density. In past MHT users, mammographic density was negatively associated with time since last use; values similar to those of never users were observed in women who had stopped MHT at least 8 years earlier. The odds ratio of BC for current versus never MHT users, adjusted for age, year of birth, menopausal status at baseline and BMI, was 1.67 (95% CI, 1.04 to 2.68). The proportion of effect mediated by PMD was 34% for any BC and became 48% when the correlation between BMI and PMD was accounted for. These effects were limited to hormone receptor-positive BC. CONCLUSIONS: Our results suggest that, under a causal model, nearly half of the effect of MHT on hormone receptor-positive BC risk is mediated by mammographic density, which appears to be modified by MHT for up to 8 years after MHT termination.

Assessing vaccine hesitancy and vaccine literacy among the European prison population and staff: A multicentre observational study.

Vaccination is the most efficient and cost-effective public health intervention. Prison population, for its low social distancing, constant turnover, and high percentage of migrants, should be an important target of vaccination campaign. However, vaccination coverage in prison is low. In this study we estimated vaccine hesitancy and vaccine literacy among the prison population and staff and assessed their correlation. We conducted a cross-sectional study in 13 prisons of 4 European countries. The sample included 847 people living in prison and 755 staff members. Through a structured questionnaire we assessed vaccine hesitancy, vaccine literacy, general health literacy, previous vaccine refusal and socio-demographic characteristics of participants. Exploratory factor analysis was used to extract three components of vaccine hesitancy. Logistic regression was applied to assess the association between previous vaccine refusal and vaccine hesitancy; linear regression was applied to assess the association between vaccine hesitancy and vaccine and general health literacy. All analyses were adjusted for socio-demographic variables. We identified three components of vaccine hesitancy explaining 49% of the total variance: Mistrust, Concern and Conspiracy. In both people living in prison and staff, all the components were associated to previous vaccine refusal (p-value < 0.001) and presented good internal consistency (Cronbach's alpha = 0.90, 0.73 and 0.78). Young participants presented the highest levels of vaccine hesitancy; migrant people living in prison had the lower levels of Mistrust and the higher level of Concern; all three factors were lower among participants with the highest degree of education. Mistrust and Concern were inversely associated with vaccine literacy while all three subscales were inversely associated with general health literacy (all p-values < 0.001). This study suggests that educational interventions aimed at increasing vaccine literacy in people living and working in prison could decrease vaccine hesitation and consequently increase vaccination uptake among the prison population and staff.

Hospital clinical pathways for children affected by juvenile idiopathic arthritis.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most common pediatric chronic rheumatic disease, which requires constant follow-up over the years, due to relapses during its progression. To maintain a good quality of life, it is important to limit admissions as far as possible. With the development of a Diagnostic Therapeutic Assistance Pathway (DTAP), we aim to select patients with suitable clinical conditions to be moved from routine hospital management to day care or outpatient treatment, evaluating the number of patients to whom this would apply. METHODS: Monocentric study regarding admissions for JIA between 2014 and 2016 in a Pediatric Unit of a university hospital in Milan. Through an analysis of the medical records, relevant information was extracted and collected in a Microsoft™ Excel database; starting from the data collected during the first year, a DTAP was prepared for patients with active arthritis and appropriate clinical conditions. RESULTS: The study includes data from 223 JIA hospitalization cases involving 127 patients. Applying DTAP criteria, 32% patients would have avoided admissions and 23% would have been admitted less frequently. The data concerning the activities of the Unit for JIA patients showed a relevant drop in the number of hospitalizations since 2015, from 89 in 2014 to 66 and 68 in 2015 and 2016 respectively. CONCLUSION: The opportunity offered by DTAP, has suggested feasible changes in hospitalization management and it's use would promote the possibility of treating the children without hospitalization, or minimizing it. In conclusion DTAP application is a priority for the continuous improvement of clinical practice and quality of life for patients and their families.