Human papillomavirus prevalence in paired urine and cervical samples in women invited for cervical cancer screening.

With the introduction of Human papillomavirus (HPV) vaccination in young girls in 2007, it is important to monitor HPV infections and epidemiological changes in this target population. The present study has evaluated the detection of human papillomavirus DNA in paired cervical and urine samples to understand if HPV testing in urine could be used as non-invasive method to monitor HPV status in young women. The study enrolled 216 twenty five-year-old women, resident in Florence and invited for the first time to the cervical cancer Screening Program within a project evaluating the impact of HPV vaccination. HPV genotyping was performed on 216 paired urine and cervical samples. The overall concordance between cervix and urine samples, investigated by HPV genotyping (INNO-LiPA HPV Genotyping Extra), was: 85.6% (184/215), 84.6% (182/215), 80% (172/215) when the same HPV, at least the same HR HPV and all HR HPV, respectively, were detected. HPV type specific concordance in paired urine and cervical samples was observed in 85.8% (175/204) of women with normal cytology and in seven out of nine women with abnormal cytology. Urine seems to be a suitable and reliable biological material for HPV DNA detection as evidenced by the high concordance with HPV detected in cervical samples. These results suggest that urine could be a good noninvasive tool to monitor HPV infection in vaccinated women.

Malignant mesotheliomas in textile rag sorters.

OBJECTIVES: To analyse the asbestos exposure characteristics and mesothelioma trend in textile workers operating in the larger Tuscan textile industrial province of Prato between 1988 and 2012. METHODS: All cases of textile workers recorded by the Tuscan mesothelioma register are considered. The demographic and clinical characteristics and asbestos exposure of cases working in the province of Prato are examined. Crude incidence rates between 1988 and 2012 and their 95% confidence intervals (CI) are calculated in rag sorters and other textile workers. The trends of standardized rates are also evaluated, as well as the sources of occupational asbestos exposure from occupational histories of cases affected by other asbestos-related diseases in rag sorters. RESULTS: One hundred and seventy-two malignant mesotheliomas (MMs) have been diagnosed in textile workers in Tuscany. Among these, 46.5% were residents in the province of Prato at the time of diagnosis, half of whom working as rag sorters. All rag sorters with MM are classified as occupationally asbestos exposed, while 71.7% are other textile workers exposed to asbestos. The estimated crude incidence rate in rag sorters in Prato ranges from 74.1×100000 (95% CI: 52.5-101.8) to 166.8×100000 (95% CI: 118.1-229.0). The standardized rates in Prato rag sorters appeared higher throughout the 1990s while in other Prato textile workers the rates increased later on, at the very end of the 1990s. Another 40 cases of asbestos-related diseases in rag sorters were also collected. CONCLUSIONS: A very high incidence of MMs was observed in textile workers in Prato, especially among rag sorters. This result, together with the high number of other asbestos-related diseases in rag sorters, strongly supports the hypothesis of diffuse asbestos exposure in rag sorting, in the absence of any other relevant aetiological factor for malignant mesothelioma.

HPV vaccination for boys? A systematic review of economic studies.

INTRODUCTION: HPV vaccination is recommended in many countries, including Italy, for girls in their twelfth year of age. In some countries, the goal of vaccination coverage has not been reached, and extension to boys has thus been debated. OBJECTIVE: Aim of this study is to perform a systematic review of pharmaco-economic studies considering the extension of HPV vaccination to boys. METHODS: An electronic literature search was performed on Pubmed to identify studies published from 2005 to 2015 in English and Italian. Four search strategies were used, including the terms «HPV¼, «boys¼, «vaccination¼, «economic evaluation¼, «cost effectiveness¼, and «epidemiological impact¼. Screening of titles, abstracts, and full texts was conducted, and economical evaluation of the extension of HPV vaccination to males was considered a criteria of inclusion. A total of 289 articles were identified. Only 15 articles were finally considered pertinent. RESULTS: The extension of HPV vaccination to boys was cost-effective or potentially cost-effective in 53%and 7%of the studies, respectively. Six studies did not positively evaluate the implementation of this intervention. However, taking into account both the new two-dose vaccination schedule available for all subjects ≤13 years, and the dramatic reduction in the price of vaccines in the last few years, the advantages of universal vaccination are more consistent. CONCLUSION: The extension of HPV vaccination to boys is therefore foreseen to become increasingly implemented in the near future.

[Mortality for accident in Tuscany Region (Central Italy) in immigrants from countries at high migration rates]. / La mortalità per causa violenta negli immigrati in Toscana dai Paesi a forte pressione migratoria.

OBJECTIVE: to examine the characteristics and mortality trends for specific type of accident in immigrants resident in Tuscany and to compare them to those observed in Italians resident in the same region. DESIGN: descriptive study using the data of the Regional Mortality Registry of Tuscany. SETTING AND PARTICIPANTS: 1997-2008 deaths for accidents by citizenship ("Italians" and "Immigrants" from Countries with strong migratory pressure or PFPM) in residents in Tuscany. MAIN OUTCOME MEASURES: number of deaths, proportional mortality and standardized (standard: European population) mortality 15-64 truncated rates per 100,000 for each specific accidental cause of death, by gender and population (PFPM and Italians), in 1997-2008, and confidence intervals at 95% (95%CI); trends in mortality standardized truncated rates for specific accidental cause in immigrants and Italians in 2002-2008. RESULTS: in the period 1997-2008, 315 deaths for accidents have been registered in immigrants. The comparison between immigrants and Italians did not reveal any significant difference in mortality for road and at work accidents. Suicides are significantly higher in Italian males (rate in Italians 9.3; 95%CI 8.7-10.0 vs. rate in PFPM 4.3; 95%CI 2.4-6.2), while homicides are higher in male immigrants (rate in Italians 0.6; IC95% 0.4-0.8 vs. rate in PFPM 3.2 95%CI 1.7-4.7). Deaths from other injuries are more frequent in Italians in both genders. Trends in mortality rates indicate a reducing gap between immigrants and Italians. CONCLUSION: in Tuscany, mortality rates for some specific accidental causes are significantly different between immigrants and Italians, nevertheless trends of the last evaluated period seem to reveal a reducing gap suggesting a progressive integration of immigrants.

[Mode of transport by car of 6-12-year-old children in Florence]. / Modalità di trasporto in auto di bambini di 6-12 anni a Firenze.

OBJECTIVE: To estimate the use, during transport by car, of restraint/booster seats by children of 6-12 years old in Florence. DESIGN, SETTING AND PARTICIPANTS: To examine children's use, knowledge and behaviors regarding safety devices in cars, a questionnaire has been administered to 537 students attending 17 primary schools in Florence, during their visit to an area equipped for street education. Sociodemographic data (nationality, level of education and parents' work) have been collected as well to assess the socioeconomic membership. Collected data have been analyzed using SPSS 17.0. Chi squared test has been used to evaluate differences in the frequency of distribution of the use of safety devices by available variables. Univariate and multivariate logistic regressions have been used to calculate the degree of association among the modes of transport and the available variables. MAIN OUTCOME MEASURES: Prevalence of use of restraint/booster seats, risk of having been incorrectly transported. RESULTS: 39.1% children, during the last travel, has been correctly transported, i.e. on the booster seat with fastened seat belt, 38.0% only with fastened seat belt and 22.9% free.The risky behaviors were not so much related to socioeconomic indices, but rather to some geographical variables and parents' nationality (especially of the mother).Children whose parents were both Italian were more frequently transported correctly compared to foreigners. We also observed peculiar and different modes of transport within specific ethnic minorities. CONCLUSIONS: It is necessary to design and implement interventions aimed at promoting interventions for improving safety for the whole population, but with specific safeguarding social and territorial specificities as regards to territory and ethnicity.

[Use of seat belts and mobile phone while driving in Florence: trend from 2005 to 2009]. / Uso delle cinture di sicurezza e del cellulare alla guida a Firenze: trend dal 2005 al 2009.

OBJECTIVE: to evaluate the trend over time of the use of seat belts by drivers and passengers of cars and vans and the use of hand held mobile phone while driving in Florence from 2005 to 2009. DESIGN, SETTING AND PARTICIPANTS AND MAIN OUTCOME MEASURES: direct observations (58,773 vehicles) have been conducted to detect the use of seat belts by occupants of cars and vans, and the use of mobile phone while driving. It has been carried out correlation analysis between the use of the seat belt by occupants of vehicles and between the simultaneous use of this device and mobile phone while driving.Moreover, it has been carried out time series analysis (ARIMA Box Jenkins) of in the prevalence of the use of seat belts by occupants of vehicles observed, of mobile phone by drivers and the trend of the risk to drive using the mobile phone with unfastened seat belt rather than to drive using the mobile phone with fastened seat belt. RESULTS: seat belts were used on average by 75.7% of drivers, 75.5% of front passengers and 25.1% of rear passengers. The average mobile phone use while driving was 4.5%. Drivers most frequently fasten seat belt if front passengers use it and while they do not use mobile phone. The use of seat belts by drivers and front passengers has not changed over time, whereas the use of mobile phone while driving has significantly increased. The prevalence of using mobile phone with unfastened seat belt rather than to use it with fastened seat belt while driving has significantly decreased over the years, indicating an increase in the use of mobile phone, especially among those who fasten the seat belt. CONCLUSIONS: it is necessary to plan and realize stronger interventions in the whole area.

Risk of malnutrition in a sample of nonagenarians: Specific versus classic bioelectrical impedance vector analysis.

OBJECTIVES: The aims were to describe the body composition and the risk of malnutrition in a sample of nonagenarians and to identify what bioelectrical impedance vector analysis (BIVA) approach (classic or specific) is more correlated with either the risk of malnutrition or various anthropometric parameters. METHODS: In the Mugello area (Italy), a representative sample of nonagenarians was enrolled in a survey aimed at investigating various health issues, including those related to nutritional status. The nutritional status was investigated using body mass index (BMI), mid-upper arm circumference (MUAC), calf circumference (CC), Malnutrition Universal Screening Tool (MUST), and BIVA. Two different approaches were used for the BIVA data analysis: the classic method and the specific method. RESULTS: All measurements were obtained from 321 nonagenarians (65.7% of the enrolled sample; 92 men and 229 women); 74.8% of the subjects were at low risk of malnutrition according to MUST, 62.5% exhibited CC values higher than 31 cm, and 86.8% exhibited MUAC values higher than 22 cm. The bioelectrical parameters varied with nutritional status, independent of the nutritional indicator used; the parameters also varied based on sex and BIVA approach. The bioelectrical parameters obtained by the specific BIVA approach were more strongly correlated with MUST score, MUAC, and CC values compared with the parameters calculated using the classic approach. CONCLUSIONS: Our study produced findings relevant to particular aspects of population aging. Above all, the specific BIVA was more effective at assessing nutritional status based on both anthropometric parameters and the risk of malnutrition.

Adherence to Mediterranean diet in a sample of Tuscan adolescents.

OBJECTIVE: The aim of this study was to estimate the level of adherence to the Mediterranean diet in a group of Italian high school students, in relation to their lifestyles and social and family contexts, and to compare the nutrition habits of the sample with other similar groups. METHODS: The KIDMED index and an ad hoc questionnaire were administered to 1127 students (mean age 16.8 ± 1.6 y) in the province of Florence. Any significant associations between the level of adherence to the Mediterranean diet and the aforementioned variables were assessed by the χ(2) test and by logistic regression analysis. RESULTS: The adherence to the Mediterranean diet was good in 16.5%, average in 60.5%, and poor in 23% of the students. The students attending technical high schools, those who played sports less than "almost every day", those who spent >3 h/d in sedentary activities, those who defined their school performance as worse than "more than sufficient," and those who referred to use of a car/moped as the most frequent mode of transportation, had significantly higher odds of poor rather than average or good adherence to Mediterranean diet. Moreover, being normal weight or overweight/obese, and referring to health workers as source of information on diet, seem to be protective factors against poor adherence to Mediterranean diet. CONCLUSIONS: Our sample presents a departure from the Mediterranean dietary pattern. It is certainly necessary to implement public health policies targeting teenagers to promote healthier lifestyle choices; the nutritional patterns of the Mediterranean diet should be among these choices.

Evaluation of bivalent human papillomavirus (HPV) vaccine safety and tolerability in a sample of 25 year old Tuscan women.

The aim of this study was to gather data on the safety of the HPV-16/18 AS04-adjuvated vaccine among women aged 25, evaluating the frequency and severity of adverse events reported after vaccination and to compare the results obtained with previously published data regarding a sample of Italian preadolescents. Every woman residing in the province of Florence and in the age group targeted by the cervical cancer screening was invited to participate. Participants registered daily, for 14 d post-vaccination, solicited local and systemic reactions, as well as unsolicited adverse events in a developed ad hoc safety diary card. Data were collected in a database in Access and analyzed using STATA 11 SE statistical software. A total of 271 participants were recruited in the study group. All three diary cards were completed and delivered by 186 subjects (85.7% of participants). In all, a total of 616 diary cards were collected: 216 after the 1st dose, 209 after the 2nd dose and 191 after the 3rd dose. No severe symptoms were registered. The most frequently reported adverse reaction proved to be pain at the site of injection (83.4% of doses), followed by local swelling (20.8%) and pyrexia (14.6%). The safety and tolerability of the HPV-16/18 AS04-adjuvated vaccine in this sample of adult women aged 25 did not differ much from that previously observed in a sample of preadolescents Italian girls. Fever and local pain were however more frequently registered in our sample of adult women.