Women's satisfaction with mammography and predictors of participation in an organized breast cancer screening program: Perspectives of a Local Health Unit in Rome.

OBJECTIVES: The aims of the study were to evaluate satisfaction with the mammography service of the Local Health Unit RMA (Rome, Lazio Region) among women who have attended the program and to identify the predictors of participation. STUDY DESIGN: Cross-sectional study. METHODS: A telephone-based questionnaire was administered to women eligible for mammography screening. The respondents were randomly selected and interviewed by the health center staff. RESULTS: A total of 502 women were interviewed, of which 264 (52.6%) have attended the screening program at least once. The attendees received the invitation letter more often than the non-attendees (88.3% vs 77.7%; P = 0.002), were more willing to participate (85.6% vs 69.3%; P = 0.001), they considered the letter very clear (15% vs 10.8%; P = 0.003), and information obtained through the hotline appropriate (64.7% vs 56.7%; P = 0.002). Overall satisfaction was high. Critical issues were lack of response from the hotline staff, medium-long waiting time for the results and further examinations. Age >61 years (odds ratio [OR] = 2.747; 95% confidence interval [CI] = 1.842-4.096), receiving the invitation letter (OR = 2.539; 95% CI = 1.519-4.242), and intention to participate (OR = 3.086; 95% CI = 1.938-4.915) were significantly associated with participation in the screening program. CONCLUSIONS: Women's satisfaction with mammography is an important aspect of service utilization. Implementation of strategies to reduce waiting time, increase operating hours, and improve the invitation procedure and the hotline service could enhance satisfaction and attendance rate.

Can the Local Health Unit staff serve as role model for positive health behaviours? Results from an observational study in Italy.

BACKGROUND: Lifestyles as well as health behaviors and attitudes are a matter of personal health and a public health concern for healthcare providers. The aims of the study were to examine lifestyles and health behaviors - i.e., smoking habit, diet, predisposition to undergo for cancer screening tests among the staff of a Local Health Unit in Rome and the prevalence of some of the major preventable chronic degenerative pathologies associated to lifestyles. METHODS: The survey was carried out through the administration of a questionnaire. Descriptive and univariate analyses were performed and binary logistic regression models were used to identify possible associations with an unhealthy lifestyles. Hosmer-Lemeshow test was performed. The level of significance was set at p ≤ 0.05. RESULTS: 355 employees entered the study (87,8%); 43.4% resulted in overweight/obesity and 36.6% is a current smoker. Those with a high degree of studies had an higher odds to be smokers (for low education OR=0.76; 95% CI:0,61-0.94) and healthcare workers were less likely to follow an unhealthy diet than administrative staff (OR=0.52; 95% CI: 0.29-0.91). CONCLUSION: Despite the Local Health Unit employees have, in the specific context of their workplace, an important role in promoting healthy lifestyles, in our survey they show unhealthy habits and lifestyles.

[The Dialysis Outcomes and Practice Patterns Study (DOPPS): results of the Italian cohort]. / Lo studio DOPPS (Dialysis Outcomes and Practice Patterns Study): risultati della coorte italiana.

BACKGROUND: The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international prospective, longitudinal, observational study examining the relationship between dialysis unit practices and outcomes for hemodialysis (HD) patients in seven developed countries France, Germany, Italy, Spain, United Kingdom, Japan and the United States. Results of the DOPPS in Italy are the subject of this report. METHODS: A national representative sample of 20 dialysis units (21 in Germany) was randomly selected in each of the European DOPPS countries (Euro-DOPPS). In these units, the HD in-center patients were included on a facility census, and their survival rates continuously monitored. A representative sample of incident (269 in Italy, 1553 in the Euro-DOPPS) and prevalent (600 in Italy, 3038 in the Euro-DOPPS) patients was randomly selected from the census for more detailed longitudinal investigation with regard to medical history, laboratory values and hospital admission. RESULTS: Comparing the Italian and Euro-DOPPS cohorts we found comparable mean age for prevalent patients (61.4 vs. 59.5 yrs), but incident patients were older in Italy. Italian prevalent patients had less cardiovascular disease, more satisfactory nutritional status and more frequent use of native vascular access. These data were associated with a comparable mortality (15.7 vs. 16.3 deaths/100 patient yrs), but morbidity was lower in Italy. Kt/V levels were comparable in the two cohorts (1.32 vs. 1.37), but 35% of Italian patients showed a Kt/V below the recommended target. Moreover, hemoglobin levels were below 11 g/dL in 60% of Italian patients. CONCLUSIONS: The DOPPS results bring to light several positive aspects and the opportunity for further possible improvements for Italian patients, but at the same time highlight some critical points that could represent a risk for dialysis quality.

Does anemia correction by rHuEPO improve uremic cardiopathy?

The correction of renal anemia by recombinant human erythropoietin (rHuEPO) makes it possible to assess the effect of anemia on uremic cardiopathy (UC). So far, conflicting results have been reported. We studied 10 hemodialyzed patients aged (51 +/- 18 years, dialytic age 47 +/- 18 months) before and after rHuEPO treatment. All patients underwent an echocardiogram before, and six months after stable hematocrit (31 +/- 2) was obtained. The results show a reduction in LVDD. No improvement in ejection fraction and in ventricular hypertrophy was observed, probably owing to an increase in blood pressure. Finally, there is a possibility that the myocardium of hemodialyzed patients undergoes anatomical changes which may not improve, even after anemia correction.

Enalapril in the treatment of hypertension associated with renal failure: results from a multicenter study.

Forty-eight hypertensive patients affected by various levels of renal failure entered this open, non controlled study, lasting 12 weeks. Patients were divided into two groups according to baseline creatinine clearance: Group I (29 patients): creatinine clearance greater than or equal to 25 ml/min but less than 45 ml/min; Group II (19 patients): creatinine clearance greater than or equal to 10 ml/min but less than 25 ml/min. Patients in Group I started with enalapril 5 mg q.d. and patients in Group II with enalapril 2.5 mg q.d. Enalapril could be titrated up to 20 mg/day. At the end of the study in both groups of patients blood pressure normalization was reached in a high percentage of patients without any significant change in renal function parameters. Plasma potassium showed a significant increase during the study but no patient discontinued treatment due to hyperkaliemia. In conclusion this study shows antihypertensive therapy with enalapril during chronic renal insufficiency to be effective at low dosage (5-10 mg) in lowering blood pressure and to have a good safety profile.

HBV infection in hemodialysis patients: monitoring and prevention.

From 1986 to 91, 174 dialysis patients were studied. The prevalence of previous HBV infection and of chronic carriers was 33.3 and 4.6%, respectively. Immunization rate after vaccination (3 doses) was 63%. In 1991, we proposed a vaccination with 4 doses and recommend a 6-monthly anti-HBs evaluation to assess the timing of any booster dose needed.

Multicentric experience with combined hemodialysis/hemoperfusion in chronic uremia.

A multicentric study was carried out to investigate the safety and effectiveness of long-term treatment of chronic uremic patients by a regular combination of hemodialysis and charcoal hemoperfusion. 39 RDT patients from five dialysis centers were treated for up to 12 months. The combined treatment proved to be safe, well tolerated and effective in improving certain dialysis-resistant uremic signs, mainly severe peripheral neuropathy, asthenia, anorexia, nausea, lack of well-being and relapsing pericarditis. There was also a marked decrease, after several weeks of combined treatment, in plasma values of urea, uric acid and creatinine.