Cancer mortality in Common Mental Disorders: A 10-year retrospective cohort study.

PURPOSE: Individuals with Common Mental Disorders (CMDs) may have a higher cancer mortality. The purpose of this study was to examine cancer-related mortality among patients with CMDs and verify which cancer types are predominantly involved. METHODS: We used the Regional Mental Health Registry of the Emilia-Romagna region, in Northern Italy to identify patients aged ≥ 18 years who received an ICD 9-CM diagnosis of CMDs (i.e., depressive and neurotic disorders) over a 10 year period (2008-2017). Information on cause of death was retrieved from the Regional Cause of Death Registry. Comparisons were made with data from the regional population without CMDs. RESULTS: Among 101,487 patients suffering from CMDs (55.7% depression; 44.3% neurotic disorders), 3,087 (37.8%) died from neoplasms. The total standardized mortality ratio (SMR) was 1.82 (95% CI 1.78-1.86) while the SMR for all neoplasms was 2.08 (95% CI 2.01-2.16). Individuals of both genders, with both depressive and neurotic disorders had a higher risk of death from almost all cancers compared with the regional population. CONCLUSION: Patients with CMDs have considerably higher cancer mortality risk than the general population. Higher mortality was observed for a broad range of cancers associated with different aetiologies. It is imperative to promote cancer awareness, prevention and treatment for people with CMDs.

Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy.

OBJECTIVE: To examine cancer-related mortality in patients with severe mental disorders (SMI) in the Emilia Romagna (ER) Region, Northern Italy, during the period 2008-2017 and compare it with the regional population. METHODS: We used the ER Regional Mental Health Registry identifying all patients aged ≥18 years who had received an ICD-9CM system diagnosis of SMI (i.e., schizophrenia or other functional psychosis, mania, or bipolar affective disorders) during a 10-year period (2008-2017). Information on deaths (date and causes of death) were retrieved through the Regional Cause of Death Registry. Comparisons were made with the deaths and cause of deaths of the regional population over the same period. RESULTS: Amongst 12,385 patients suffering from SMI (64.1% schizophrenia spectrum and 36.9% bipolar spectrum disorders), 24% (range 21%-29%) died of cancer. In comparison with the general regional population, the mortality for cancer was about 50% higher among patients with SMI, irrespective if affected by schizophrenia or bipolar disorders. As for the site-specific cancers, significant excesses were reported for stomach, central nervous system, respiratory, and pancreas cancer with a variability according to psychiatric diagnosis and gender. CONCLUSIONS: Patients suffering from SMI had higher mortality risk than the regional population with some differences according to cancer type, gender, and psychiatric diagnosis. Proper cancer preventive and treatment interventions, including more effective risk modification strategies (e.g., smoking cessation, dietary habits) and screening for cancer, should be part of the agenda of all mental health departments in conjunction with other health care organizations, including psycho-oncology.

Mortality in mental health patients of the Emilia-Romagna region of Italy: A registry-based study.

Evidence from previous research demonstrated a gap in mortality between patients with mental disorders and the general population. However, a more exhaustive assessment is required to address this public health issue. The aim of this study was to provide comprehensive analysis of mortality examining all causes of death and all psychiatric diagnoses. We conducted a 10-year retrospective cohort study, including all in and out patients registered in the Mental Health Registry of Emilia-Romagna, Italy. Standardized mortality ratios (SMRs) were calculated. The cohort consisted of 137,351 patients 11,236 of whom died during the study period and the overall SMR was 1.99. 85.9 % of excess mortality was attributable to a broad range of natural causes. Diseases of circulatory and respiratory systems as well as neoplasms were the principal contributors to the mortality gap. All psychiatric conditions led to a higher risk of death. The greatest excess was due to neoplasms in depressed and neurotic patients and to cardiovascular diseases in patients with schizophrenia and personality disorders. Our results highlight the need for close collaboration between mental and primary health care services with the aim of reducing excess mortality as a result of medical diseases among all patients suffering from psychiatric condition.

An ecological study on health inequalities in the city of Bologna (Emilia-Romagna Region, Northern Italy): bridging knowledge and action.

BACKGROUND: since January 2017, a multidisciplinary research group, involving the Local Health Authority, the Municipality, and the University of Bologna, carried out a city-wide action-research project on health inequalities consisting of an ecological study over the years 2011-2015 based on indicators that are routinely available within health and social services. OBJECTIVES: to document existing geographical inequalities in health outcomes and use of healthcare services in the city of Bologna (Emilia-Romagna Region, Northern Italy), with the aim to suggest policy action to tackle them. DESIGN: the results of the first phase of the above-mentioned project were reported: five related to the social determinants of health (exposure) and five related to the social determinants of ill-health (outcomes). For each municipal statistical area, the distribution of the exposures as well as rates and Bayesian Relative Risks of the outcomes were plotted on the city map. To evaluate the association between social determinants and health outcomes, Spearman correlation coefficients were estimated. SETTING AND PARTICIPANTS: residents in the city of Bologna aged >=18 years in the period 2011-2015, grouped into 90 statistical areas. RESULTS: a North-South divide was apparent for most of the socioeconomic and ill-health indicators, with a high concentration of adverse outcomes in the North-Western part of the city. Adherence to cancer screening represented an exception, being greater in the areas with higher proportion of unfavourable health outcomes. An inverse association between education level and health outcomes was found. Low family income was weakly to moderately correlated with health outcomes. Proportion of residents in council houses and of the teenage foreign population showed a moderate to strong association with all outcomes, but mortality and screening adherence. CONCLUSIONS: an ecological analysis based on data that are routinely collected by local health and social institutions can be effective in revealing the geographical patterns of health inequalities. When accompanied by strategic choices aimed at bridging knowledge and action, this approach may facilitate the direct engagement of local actors towards health equity.

[Trends in educational inequalities in premature mortality between 2001 and 2016: results from the Emilian Longitudinal Study]. / Andamento delle disuguaglianze per livello di istruzione nella mortalità prematura tra il 2001 e il 2016 nello Studio longitudinale emiliano.

OBJECTIVES: to describe changes in relative and absolute inequalities in mortality by education level between 2001 and 2016 in the Emilian longitudinal study (SLEm) and to estimate the impact of these inequalities at population level. DESIGN: closed cohort study based on record-linkage between municipal population registries, Census archives of 2001 and 2011, and the mortality register. SETTING AND PARTICIPANTS: 2001- and 2011-Census respondents >=30 years old residing in Bologna, Modena, or Reggio Emilia followed up to the age of 75 years, death, emigration, or end of follow-up (December 2006 or December 2016). MAIN OUTCOME MEASURES: premature mortality for all causes and for 16 groups of causes known to be associated with socioeconomic position. In order to capture various aspects of the inequalities, the association with the education level is assessed through summary regression-based indexes (Relative and Slope Index of Inequality) and the Attributable Population Fraction. RESULTS: premature mortality declined across all educational level between 2001-2006 and 2011-2016; declines were greater among men than women. Among men, relative inequalities in mortality slightly increased (RII from 1.86 in 2001 to 2.13 in 2011), while absolute inequalities declined (SII from 382.3 to 360.6). Among women, both relative and absolute inequalities increased (RII from 1.23 to 1.65, SII from 73.7 to 137.4). Educational inequalities in lung cancer, respiratory and cerebrovascular diseases mortality decreased among men and increased among women. The proportion of the low educated shrank over time (men: from 40% to 36%; women: from 43% to 35%); nonetheless, the fraction of the deaths attributable to educational inequalities showed an upward tendency (from 18.5% to 21.9% in men and from 9.7% to 15.6% in women); the groups of causes that contribute most to this increase were malignant cancers, especially lung cancer, diseases of the circulatory and respiratory systems, and accidents. CONCLUSIONS: relative inequalities slightly increased in both genders, while absolute inequalities only in women. A reduction in the population impact could be achieved by tackling educational inequalities in mortality due to lung cancer, diseases of the circulatory and respiratory systems, and accidents.

Perceived work ability at return to work in women treated for breast cancer: a questionnaire-based study.

BACKGROUND: Breast cancer survivors often perceive reduced work ability upon returning to work. OBJECTIVES: To identify predictors of perceived reduced work ability following return to work among women treated for breast cancer and to describe workplace interventions and support after returning to work. METHODS: A questionnaire was sent to 18-65 years-old women (no. 1578) treated for breast cancer and residing in the catchment area of the Bologna Local Health Authority between 2010 and 2012. The study population was identified through a Hospital Discharge Database. The questionnaires included items about personal characteristics, cancer and work-related factors, perceived work ability and the return to work process. A multivariable logistic regression analysis was performed to identify predictors of reduced work ability upon returning to work. RESULTS: Among the 841 respondents, 503 questionnaires were evaluable. In the study, 43.5% of the respondents reported reduced work ability with respect to the pre-diagnosis period. Reduced work ability was more common in non-cohabiting (OR=1.81, 95%CI 1.10-2.98) than in cohabiting/married women, and after mastectomy (OR=2.77, 95%CI 1.26-6.11) than after breast-conserving surgery. Office staff/sales assistants and managers were less likely to report reduced work ability (OR=0.51, 95%CI 0.30-0.88 and OR=0.21, 95%CI 0.06-0.76, respectively) than labourers. Women who perceived reduced work ability reported more frequently adjustment of work assignments, consultation of an occupational physician, insufficient support from employers and colleagues and discrimination. CONCLUSIONS: Reduced work ability is commonly perceived among women who return to work after treatment for breast cancer. Occupational physicians and general practitioners should be aware of a wide range of factors influencing this perception in order to facilitate a successful return to work.

Acupuncture As an Integrative Approach for the Treatment of Hot Flashes in Women With Breast Cancer: A Prospective Multicenter Randomized Controlled Trial (AcCliMaT).

PURPOSE: To determine the effectiveness of acupuncture for the management of hot flashes in women with breast cancer. PATIENTS AND METHODS: We conducted a pragmatic, randomized controlled trial comparing acupuncture plus enhanced self-care versus enhanced self-care alone. A total of 190 women with breast cancer were randomly assigned. Random assignment was performed with stratification for hormonal therapy; the allocation ratio was 1:1. Both groups received a booklet with information about climacteric syndrome and its management to be followed for at least 12 weeks. In addition, the acupuncture group received 10 traditional acupuncture treatment sessions involving needling of predefined acupoints. The primary outcome was hot flash score at the end of treatment (week 12), calculated as the frequency multiplied by the average severity of hot flashes. The secondary outcomes were climacteric symptoms and quality of life, measured by the Greene Climacteric and Menopause Quality of Life scales. Health outcomes were measured for up to 6 months after treatment. Expectation and satisfaction of treatment effect and safety were also evaluated. We used intention-to-treat analyses. RESULTS: Of the participants, 105 were randomly assigned to enhanced self-care and 85 to acupuncture plus enhanced self-care. Acupuncture plus enhanced self-care was associated with a significantly lower hot flash score than enhanced self-care at the end of treatment (P < .001) and at 3- and 6-month post-treatment follow-up visits (P = .0028 and .001, respectively). Acupuncture was also associated with fewer climacteric symptoms and higher quality of life in the vasomotor, physical, and psychosocial dimensions (P < .05). CONCLUSION: Acupuncture in association with enhanced self-care is an effective integrative intervention for managing hot flashes and improving quality of life in women with breast cancer.

A Randomized Controlled Trial of Tong Len Meditation Practice in Cancer Patients: Evaluation of a Distant Psychological Healing Effect.

CONTEXT: Tong Len meditation is an important therapeutic tool in the Tibetan medicine, and it can be used for self-healing and/or to heal others. Currently, in the West, there is no scientific study concerning the efficacy of a Tong Len distant healing effect on psychological disorders in cancer patients. OBJECTIVES: To evaluate a distant healing effect of Tong Len meditation on stress, anxiety, depression, fatigue, and self-perceived quality of life in cancer patients. These psychological objectives were chosen as a consequence of the limited scientific literature of present day. DESIGN: We performed a double-blind randomized controlled trial on 103 cancer patients with tumors. Overall, 12 meditators used Tong Len in aid of 52 patients randomly selected as experimental group, while the remaining 51 patients constituted the control group. Patients and meditators did not know each other. All patients completed profile of mood states (POMS) and European Quality of Life-5 dimensions (EQ-5D) questionnaires before treatment (T0), after two (T1) and three months of treatment (T2), and one month after treatment cessation (T3). RESULTS: With regard to the parameters related to depression, a statistically significant improvement (P = .003) was observed in the treatment group compared to controls. On the other hand, the vigor/activity parameter saw significant improvements in the control group (P = .009). Both groups exhibited significant improvements in the other factors assessed in the POMS and EQ-5D questionnaires. CONCLUSIONS: This study did not provide sufficient evidence supporting an efficacy of Tong Len meditation in distant psychological healing as compared to a control condition. The research highlighted some psychological improvements through Tong Len distant meditation in a group of patients unknown to meditators. Therefore, the enhancement detected in most parameters in both treatment and control groups raises interest on in-depth analysis and evaluation of distant meditation on cancer patients to mitigate psychological problems caused by the disease.

Socio-Economic and Clinical Factors as Predictors of Disease Evolution and Acute Events in COPD Patients.

BACKGROUND: Socio-economic, cultural and environmental factors are becoming increasingly important determinants of chronic obstructive pulmonary disease (COPD). We conducted a study to investigate socio-demographic, lifestyle and clinical factors, and to assess their role as predictors of acute events (mortality or hospitalization for respiratory causes) in a group of COPD patients. METHODS: Subjects were recruited among outpatients who were undertaking respiratory function tests at the Pneumology Unit of the Sant'Orsola-Malpighi Hospital, Bologna. Patients were classified according to the GOLD Guidelines. RESULTS: 229 patients with COPD were included in the study, 44 with Mild, 68 Moderate, 52 Severe and 65 Very Severe COPD (GOLD stage). Significant differences among COPD stage, in terms of smoking status and fragility index, were detected. COPD stage significantly affected the values of all clinical tests (spirometry and ABG analysis). Kaplan-Meier estimates showed a significant difference between survival curves by COPD stage with lower event-free probability in very severe COPD stage. Significant risk factors for acute events were: underweight (HR = 4.08; 95% CI 1.01-16.54), having two or more comorbidities (HR = 4.71; 95% CI 2.52-8.83), belonging to moderate (HR = 3.50; 95% CI 1.01-12.18) or very severe COPD stage (HR = 8.23; 95% CI 2.35-28.85). CONCLUSIONS: Our findings indicate that fragility is associated with COPD stage and that comorbidities and the low body mass index are predictors of mortality or hospitalization. Besides spirometric analyses, FeNO measure and comorbidities, body mass index could also be considered in the management and monitoring of COPD patients.

Promyelocytic leukemia protein interacts with the apoptosis-associated speck-like protein to limit inflammasome activation.

The apoptosis-associated speck-like protein containing a caspase-activating recruitment domain (ASC) is an essential component of several inflammasomes, multiprotein complexes that regulate caspase-1 activation and inflammation. We report here an interaction between promyelocytic leukemia protein (PML) and ASC. We observed enhanced formation of ASC dimers in PML-deficient macrophages. These macrophages also display enhanced levels of ASC in the cytosol. Furthermore, IL-1ß production was markedly enhanced in these macrophages in response to both NLRP3 and AIM2 inflammasome activation and following bone marrow-derived macrophage infection with herpes simplex virus-1 (HSV-1) and Salmonella typhimurium. Collectively, our data indicate that PML limits ASC function, retaining ASC in the nucleus.

Treatment of keloids and hypertrophic scars with bleomycin and electroporation.

BACKGROUND: Keloids and hypertrophic scars are the result of abnormal healing responses and dermal tissue proliferation; current surgical procedures can give rise to exuberant scarring and permanent functional loss or disfigurement. Considering the promising results reported when treating keloids and hypertrophic scars with intralesional bleomycin injection and the enhanced effect of bleomycin when combined with electroporation, the authors hypothesized that electrochemotherapy should be used to treat keloids and hypertrophic scars when other treatments have failed. METHODS: Twenty patients with keloids or hypertrophic scars were treated with one or more sessions of electrochemotherapy and followed prospectively. Bleomycin was administered intravenously followed by application of electrical pulses to the lesion site. Treatment efficacy was determined either by clinical evaluation (e.g., volume, flattening, pliability, erythema) or by the patient's self-reported symptomatology (e.g., pruritus, pain). RESULTS: Treatment was well tolerated by patients, and no serious adverse events were observed. A median reduction of 87 percent (range, 41 to 100 percent) was observed in volume size, and 33 lesions (94 percent) showed a volume reduction of more than 50 percent. Scar pliability and erythema scores were also significantly reduced (p < 0.0001). A reduction in hitching was observed in 89 percent of patients (p < 0.0001), and a reduction in pain was observed in 94 percent (p < 0.0001). Only one recurrence was observed after 18 months. CONCLUSION: Electroporation in combination with bleomycin is an effective treatment for patients affected by large keloids or hypertrophic scars or patients who are nonresponders to other treatments. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study.

OBJECTIVE: In countries with universal health coverage, socioeconomic status is not expected to influence access to effective treatment and its prognosis. We tested whether socioeconomic status affects the rates of elective total hip replacement and whether it plays a role in early and late outcomes. DESIGN: Multicity population-based longitudinal study. SETTING AND PARTICIPANTS: From Hospital Registries of four Italian cities (Rome, Milan, Turin, and Bologna), we identified 6140 residents aged 65+ years undergoing elective total hip replacement in 1997-2000. MAIN OUTCOME MEASURES: An area-based (census block) income index was used for each individual. Poisson regression yielded rate ratios (RR) of population occurrence by income level. Logistic regression estimated odds ratios (OR) of selected outcomes within 90 days. Cox proportional hazard models evaluated effects of income on rates of revision of total hip replacement and mortality up to 31 December 2004. Analyses were adjusted for age, gender, city of residence, and coexisting medical conditions. RESULTS: Low-income people were less likely than high-income counterparts to undergo total hip replacement [RR = 0.87, 95% confidence interval (CI) 0.81-0.95]; the effect was stronger among those aged 75+ years (RR = 0.76, 95% CI = 0.66-0.86). Low income was associated with higher risk of acute adverse medical events (P trend = 0.05) and of general infections and decubitus ulcer (P trend = 0.02) within 90 days. The effects were even higher among those aged 75+ years. No effects were found either for orthopaedic complications within 90 days or for revision and mortality. CONCLUSIONS: Total hip replacement is underutilized among elderly deprived individuals. Disadvantaged patients seem more vulnerable to acute adverse medical events after surgery. The evidence of unmet need and poor prognosis of low social class people has important implications for health care policy.