Validation of a semiconductor next-generation sequencing-based protocol for preimplantation genetic diagnosis of reciprocal translocations.

OBJECTIVE: We aim to validate a semiconductor next-generation sequencing (NGS)-based method to detect unbalanced chromosome translocation in preimplantation embryos. METHODS: The study consisted of a blinded retrospective evaluation with NGS of 145 whole-genome amplification products obtained from biopsy of cleavage-stage embryos or blastocysts, derived from 33 couples carrying different balanced translocations. Consistency of NGS-based copy number assignments was evaluated and compared with the results obtained by array-comparative genomic hybridization. RESULTS: Reliably identified with the NGS-based protocol were 162 segmental imbalances derived from 33 different chromosomal translocations, with the smallest detectable chromosomal segment being 5 Mb in size. Of the 145 embryos analysed, 20 (13.8%) were balanced, 43 (29.6%) were unbalanced, 53 (36.5%) were unbalanced and aneuploid, and 29 (20%) were balanced but aneuploid. NGS sensitivity for unbalanced/aneuploid chromosomal call (consistency of chromosome copy number assignment) was 99.75% (402/403), with a specificity of 100% (3077/3077). NGS specificity and sensitivity for unbalanced/aneuploid embryo call were 100%. CONCLUSIONS: Next-generation sequencing can detect chromosome imbalances in embryos with the added benefit of simultaneous comprehensive aneuploidy screening. Given the high level of consistency with array-comparative genomic hybridization, NGS has been demonstrated to be a robust high-throughput technique ready for clinical application in preimplantation genetic diagnosis for chromosomal translocations, with potential advantages of automation, increased throughput and reduced cost.

PGD for reciprocal and Robertsonian translocations using array comparative genomic hybridization.

BACKGROUND: Fluorescence in situ hybridization (FISH) is the most widely used method for detecting unbalanced chromosome rearrangements in preimplantation embryos but it is known to have several technical limitations. We describe the clinical application of a molecular-based assay, array comparative genomic hybridization (array-CGH), to simultaneously screen for unbalanced translocation derivatives and aneuploidy of all 24 chromosomes. METHODS: Cell biopsy was carried out on cleavage-stage embryos (Day 3). Single cells were first lysed and DNA amplified by whole-genome amplification (WGA). WGA products were then processed by array-CGH using 24sure + arrays, BlueGnome. Balanced/normal euploid embryos were then selected for transfer on Day 5 of the same cycle. RESULTS: Twenty-eight consecutive cycles of preimplantation genetic diagnosis were carried out for 24 couples carrying 18 different balanced translocations. Overall, 187/200 (93.5%) embryos were successfully diagnosed. Embryos suitable for transfer were identified in 17 cycles (60.7%), with transfer of 22 embryos (mean 1.3 ± 0.5). Twelve couples achieved a clinical pregnancy (70.6% per embryo transfer), with a total of 14 embryos implanted (63.6% per transferred embryo). Three patients delivered three healthy babies, during writing, the other pregnancies (two twins and seven singletons) are ongoing beyond 20 weeks of gestation. CONCLUSIONS: The data obtained demonstrate that array-CGH can detect chromosome imbalances in embryos, also providing the added benefit of simultaneous aneuploidy screening of all 24 chromosomes. Array-CGH has the potential to overcome several inherent limitations of FISH-based tests, providing improvements in terms of test performance, automation, sensitivity and reliability.

Reduction incidence of myocardial infarction associated with a national legislative ban on smoking.

AIM: The aim of the present study was to assess change in admissions for acute myocardial infarction (AMI) in the period immediately subsequent to the coming into force of law no. 3/2003 ''Protection of the health of non-smokers''. METHODS: Four Italian regions (Piedmont, Friuli Venezia Giulia, Lazio and Campania) took part in the study. Data regarding admissions for AMI were taken from the daily discharge papers of patients aged between 40 and 64 (cod. ICD9-CM 410.), in the period 10 January-10 March 2001-2005. Repeated admissions were excluded. Admission rates standardised by age and overall total, and specifically by region, age and gender were calculated. The hypothesis of a significant reduction between 2005 and 2004 was also checked. RESULTS: The results showed a decrease in the number of cases and in the standardised rates between 2004 and 2005. The number of admissions estimated with a linear regression model for 2005 was significantly higher than that really observed (+13%). The decrease between the 2005 and 2004 rates was noteworthy for all four regions. Analysis by gender shows that the effect is observed only in male patients and in the age classes 45-49 and 50-54. CONCLUSION: This study shows that there has been an appreciable reduction in the incidence of heart attacks in the period immediately subsequent to the coming into force of the non-smoking Law in the populations surveyed, and that this reduction mainly regards men of working age. The reduction reverses a trend that has been evident for a number of years, namely that of a decidedly upward trend in the number of admissions for AMI.

Italy: the first European country to forbid smoking in closed spaces. First results.

Second-hand smoke is a well-known risk factor for several diseases, including lung cancer, chronic obstructive pulmonary disease, asthma. Evidence exists that smoke-free policies have an effect on reducing or eliminating the exposure to second-hand smoke, decreasing the prevalence of smokers, encouraging smokers to quit or preventing the initiation of smoking, and reducing cigarettes consumption among smokers. Italy has been the first European country to forbid smoking in closed places, also in working areas not open to the public, as protection to the health of the entire population. This article describes the first results obtained from the application of this new law, the positive effects and unexpected modifications in the behaviour and social habits of the Italian people, thus, revealing itself an important instrument to protect public health.

Impact of HIV infection on non-AIDS mortality among Italian injecting drug users.

OBJECTIVES: To estimate the excess mortality of injecting drug users (IDU) stratified by HIV serostatus compared with the general population in Italy. To compare total and cause-specific mortality in HIV-positive versus HIV-negative IDU, in order to identify possible HIV-related non-AIDS causes of death in this population. METHODS: All IDU attending two drug-treatment centres in Rome who underwent HIV testing between 1985 and 1991 were enrolled into a prospective study. The end-point of the study was death from any cause by 31 December 1991. Mortality rates were compared using age-adjusted standardized mortality ratios and person-time techniques. RESULTS: Of the 2431 IDU, 1661 (68.3%) were HIV-seronegative and 82 seroconverted. Of 181 deaths, comprising 89 from AIDS and 92 from other causes, the mortality rate was 4.5 and 0.8 per 100 person-years in HIV-seropositives and HIV-seronegatives, respectively. For non-AIDS mortality in HIV-seropositives, the overall rate was 1.7 per 100 person-years. Deaths from overdose and endocarditis/embolus tended to be higher in HIV-seropositive than HIV-seronegative IDU, although there was no difference in the rate of deaths due to pneumonia by HIV serostatus. CONCLUSIONS: These data are consistent with other studies demonstrating a higher frequency of mortality among HIV-seropositive IDU. The excess in overdose mortality among HIV-seropositives is disturbing and merits further investigation.

Understanding the dynamics of the HIV epidemic among Italian intravenous drug users: a cross-sectional versus a longitudinal approach.

We studied annual human immunodeficiency virus (HIV) seroprevalence and incidence in a large number of intravenous drug users attending drug treatment centers in three Italian urban areas. We also evaluated risk factors for HIV seropositivity and for HIV seroconversion. The results showed that HIV prevalence and incidence are declining. HIV prevalence declined dramatically in study participants that were < 25 years old. Prevalent HIV cases were associated with older age and longer duration of intravenous drug use; however, short duration of drug use increased the risk of seroconversion. The findings of our study suggest that comparing cross-sectional and longitudinal data contributes to a better understanding of the dynamics of the HIV epidemic among intravenous drug users.

Fatty acid dietary intake and the risk of ischaemic stroke: a multicentre case-control study. UFA Study Group.

A low dietary intake of unsaturated fatty acids has been found in male patients with stroke as compared with controls in Italy, and a high consumption of meat has been associated with an increased risk of stroke in Australia. We present a case-control study, comparing the unsaturated and saturated fatty acids content of red cell membranes (which reflects the dietary intake of saturated and unsaturated fats) in 89 patients with ischaemic stroke and 89 controls matched for age and sex. In univariate analysis, besides hypertension, atrial fibrillation, ischaemic changes in ECG and hypercholesterolaemia, stroke patients showed a lower level of oleic acid (P = 0.000), but a higher level of eicosatrienoic acid (P = 0.009). Conditional logistic regression (dependent variable; being a case) showed that the best model included atrial fibrillation, hypertension, oleic acid and eicosatrienoic acids. These results confirm a possible protective role of unsaturated fatty acids against vascular diseases; however, we did not find any difference in the content of omega3 acids, which have been considered in the past to protect against coronary heart disease. We conclude that the preceding diet of patients with ischaemic stroke may be poor in unsaturated fatty acids (namely, oleic acid), and this defect is independent of other vascular risk factors. Only further studies will show whether changes in diet and/or supplement of unsaturated fatty acids might reduce the incidence of ischaemic stroke.

Immigration and health: the Italian National Focal Point experience.

This report is a description of the situation of migrant populations in Italy. It was written by a committed team of experts from public institutions, non-governmental organisations (NGO) and volunteer associations that for three years have been part of the Italian National Focal Point (NFP) within the European Project "AIDS & Mobility", which is being co-ordinated by the Netherlands Institute for Health Promotion and Disease Prevention (the Netherlands) and financed by the European Commission DG/V. This year the Italian National Focal Point, co-ordinated by the Telefono Verde AIDS of the Istituto Superiore di Sanità, has produced a second report (the first one was published in 1998) on health issues related to migrant populations. Besides providing an updated picture on the presence of foreigners in Italy, such report illustrates the present legislative situation within the sanitary area and some interventions regarding prevention, treatment and rehabilitation provided by each structure in the Italian NFP to foreign citizens. The initiatives carried out during the year 1999 by public institutions, NGO and volunteer associations are also reported in order to detect the psycho-social-sanitary needs of immigrants and target prevention programmes to their particular and specific needs.

Immigration and health: the Italian situation. Italian National Focal Point (NFP) of the AIDS & Mobility Project.

This report is a description of the situation of migrant populations in Italy. It was written as part of the European project "AIDS & Mobility", which is being co-ordinated by the Netherlands Institute for Health Promotion and Disease Prevention and financed by the European Union (EU). The report was written by the Italian National Focal Point (NFP) of the AIDS & Mobility Project, which consists of a committed team of experts from public institutions, non-governmental organizations, volunteer associations, and researchers from the Telefono Verde AIDS (National AIDS Help-line of Italy) of the Centro Operativo AIDS (COA, National AIDS Unit of Italy) of the Istituto Superiore di Sanità. The report illustrates the phenomenon of immigration in Italy, with demographic data (updated at 31 December 1997) on the presence of non-Italians and a review of the current laws pertinent to this phenomenon, with particular reference to health care laws. Moreover, epidemiological data on HIV/AIDS and on sexually transmitted diseases are provided, particularly as they relate to drug addiction and prostitution. Finally, following an accurate analysis of the situation and in light of the experience gained, the report includes proposals for identifying needs, objectives to pursue, and strategies to adopt, with respect to confronting the issue of immigration.

A multicentre follow-up of clinical aspects of traumatic spinal cord injury.

STUDY DESIGN: Prospective, multicentred follow-up (FU) observational study. OBJECTIVES: Prospectively evaluate survival, complications, re-admissions and maintenance of clinical outcome in people experiencing traumatic spinal cord injury (SCI). SETTING: Seven spinal units and 17 rehabilitation centres participating in the previous GISEM (ie Italian Group for the Epidemiological Study of Spinal Cord Injuries) study. METHOD: A total of 511 persons with SCI, discharged between 1997 and 1999 after their first hospitalisation, were enrolled. A standardised questionnaire was administered via telephone. RESULTS: Of the 608 persons originally enrolled, 36 died between discharge and follow-up (mean 3.8+/-0.64 years). Of the remainder, 403 completed telephone interviews, 72 refused to participate and 97 could not be contacted. More than half of the patients interviewed (53.6%) experienced at least one SCI-related clinical problem in the 6 months preceding interview; the most frequent being urological complications (53.7%). At least one re-admission was recorded in 56.8% of patients between discharge and FU interview. Of the patients interviewed, 70.5% reported bowel autonomy and 86% bladder management autonomy. On multivariate analysis, lack of bowel/bladder autonomy was the most common variable with a strong predicting value for mortality, occurrence of complications and re-admissions. CONCLUSION: Re-admission and major complications seem common after SCI and should be considered when planning facilities. Failure to obtain bowel/bladder autonomy upon discharge from rehabilitation proved to be the most common predictive factor of poor outcome during the period between discharge and FU interview.

HIV infection among foreign people involved in HIV-related risk activities and attending an HIV reference centre in Rome: the possible role of counselling in reducing risk behaviour.

Between September 1993 and December 1995, 528 foreign individuals at risk of HIV infection attended the drug treatment centre located in the Santo Spirito Hospital in Rome, undergoing medical examination, HIV testing and counselling. The geographic distribution showed that the majority of the participants were from South America (40.0%), most of whom were transsexual sex workers (from Brazil or Columbia), and from North Africa (37.5%); all the individuals coming from Western and Eastern Europe and the USA were heroin users. The overall HIV prevalence was high (21.6%), though it varied by nationality, ranging from 5.1% among North Africans to 68.3% among Brazilian transsexuals. During the study period, 170 of the individuals returned for at least one follow-up visit. Three seroconversions occurred among the 118 initially HIV-negative immigrants who were retested, all three among the 26 HIV-negative Columbian transsexuals; the seroconversion rate within this group was 10.1 per 100 persons/years. During follow-up, there was no reduction observed in drug-related practices associated with HIV infection, yet a general increase in regular condom use was reported. The increasing number of foreign persons contacting our programme emphasizes the need for easy access to care and treatment for marginalized populations possibly engaging in behaviour at risk for HIV infection. Counselling strategies seem to be relatively effective in promoting safer sex among these population groups.

Spinal cord injury in Italy: A multicenter retrospective study.

OBJECTIVE: To investigate certain factors influencing the length of stay (LOS) in a rehabilitation center, the incidence of pressure ulcers, and the neurologic improvement of patients with traumatic (T/SCI) and nontraumatic spinal cord injury (NT/SCI). DESIGN: A multicenter retrospective study of patients with SCI admitted to rehabilitation centers between 1 January 1989 and 31 December 1994 (only first admissions). SETTING: Seven Italian rehabilitation centers. PATIENTS: A total of 859 consecutively admitted adult patients with SCI. INTERVENTION: Examined medical records of patients admitted to rehabilitation centers. MAIN OUTCOME MEASURES: Pressure ulcers on admission as an indicator of nursing care in acute phase, LOS in rehabilitation centers, and neurologic improvement on discharge (using the Frankel classification system). Other measures included level of lesion, associated lesions (if T/SCI), surgical stabilization (if T/SCI), and time from the event to admission to a rehabilitation center. RESULTS: In all cases, the time from event to admission to a rehabilitation center exceeded 30 days (average +/- standard deviation: T/SCI, 54.6 +/- 43.7d; NT/SCI, 166.9 +/- 574d); pressure ulcers on admission were present in 34.1% of T/SCI and 17.1% of NT/SCI patients. The average LOS in a rehabilitation center was 143.1 +/- 89.1 days for T/SCI and 91.7 +/- 78.9 days for NT/SCI; Frankel grades improved by 1 or more in 34.4% of T/SCI and 34.1% of NT/SCI patients. The presence of pressure ulcers on admission, rehabilitation LOS, and neurologic improvement on discharge correlated highly with severe neurologic damage on admission in both T/SCI and NT/SCI patients as well as with management of the patient immediately before admission to a rehabilitation center, mainly in NT/SCI patients. CONCLUSIONS: Severe neurologic damage is the major determining factor in predicting neurologic recovery. Pressure ulcer prevention is statistically associated with neurologic improvement and the shortening of rehabilitation LOS. Patient management immediately before admission to rehabilitation has a statistical correlation with neurologic improvement in all patients studied and on both rehabilitation LOS and incidence of pressure ulcers in the NT/SCI patients.

Syphilis serology among transvestite prostitutes attending an HIV unit in Rome, Italy.

Sixty-seven transvestite prostitutes from Latin America (49 from Brazil and 18 from Colombia) who attended an HIV unit located in the inner city of Rome between January 1991 and June 1992 were studied for syphilis markers by means of both the Treponema pallidum haemoagglutination test (TPHA) and a solid phase haemadsorption test for detection of specific IgM (SPHA-IgM) which are typically present in recent infections. All participants reported more than 500 sexual partners in the past year, and 67.1% of them more than 1500 partners (between 5 and 10 partners per working day). The overall prevalence of anti-HIV antibodies in this population was 65.7%. The prevalence of positive TPHA tests in the population studied was 73.1%, while that of positive SPHA-IgM tests was 10.4%. The prevalence of positive TPHA and SPHA-IgM tests was higher among Columbians than among Brazilians (83.3% vs 69.4% and 22.2% vs 6.1%, respectively) and also showed a positive correlation with the duration of their permanence in Italy. The TPHA and SPHA-IgM positivities were significantly higher among subjects older than 29 years. Positive TPHA was also significantly higher in subjects who reported a history of heroin and/or cocaine abuse while positive SPHA-IgM was higher in subjects who did not use condoms or reported irregular use of them than in subjects who regularly used condoms. No overall correlation was evident between TPHA positivity and anti-HIV positivity, while SPHA-IgM positivity was found to be higher among anti-HIV-negative subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Sexual lifestyle / behavioral changes in a cohort of intravenous drug users.

PIP: This article reports on a study of HIV seroprevalence and sexual lifestyles among Italian intravenous drug users (IVDUs). Unlike the situation in the US and most of Europe, where HIV infection is found primarily among homosexual and bisexual men, intravenous drug users account for 66% of the hiv cases in Italy. This study, which ran from January through March of 1990, involved interviews with 124 IV heroin users having methadone treatment in a Public Assistance Center in Rome. The goals of the study included conducting a demographic survey and investigation of the serological condition of IVDUs, investigating the sexual behavior of both HIV positive and negative subjects, and investigating any changes in the sexual habits of the subjects following awareness of their serological condition. 34 of those interviewed were women and 90 were men. Ages ranged from 18-41 years. Of the 124 subjects, 120 were heterosexual, 2 homosexual, and 2 bisexual. 39 heterosexuals, as well as the 2 homosexuals and the 2 bisexuals, tested HIV positive. 96% of the IVDUs interviewed reported being sexually active, and 67% indicated having at least 1 sexual intercourse a week (28% reported 10 or less sexual intercourses in a year). Although all those interviewed acknowledged being aware of the risk of sexually transmitted AIDS, 60% of the HIV positive and 88% of the HIV negative subjects did not use condoms regularly (56% of the HIV negative subjects never used condoms). The article lists some of the reasons given for irregular use of condoms. Concerning changes in sexual habits, 46% of the HIV negative and 63% of the HIV positive subjects indicated reducing the number of sexual partners and/or using condoms.^ieng

Behavioural patterns and HIV infection among drug using transvestites practising prostitution in Rome.

Fifty-seven male prostitutes who were also drug users, underwent HIV-1 testing in a drug dependency unit in Rome. The overall prevalence of HIV antibody was 74% (42/57). Of the 57 subjects, 46 completed a standard questionnaire and were interviewed by a trained psychologist about use of drugs, sexual and AIDS-related behaviours. Among the 46 patients responding to the questionnaire, the prevalence of HIV was 67% (31/46). HIV prevalence increased with the duration of drug use, rising from 48% for less than 2 years use, to 64% for 2 to 4 years, and 100% for more than 4 years. It also increased with duration of stay in Italy: from 59% for less than 2 years, 78% for 2-4 years and to 83% for more than 4 years. Prevalence of HIV antibody was higher among those who reported injecting drugs (73% vs 63%), or who reported needle sharing (83% vs 62%). Higher prevalence was also related to the number of partners in the last year (74% for more than 1,500 partners vs 50% for less than 1,500), and to non-use of condoms (70% for 'sometimes/never' vs 50% for 'always'). The results indicate that further educational outreach efforts are required among male transvestite prostitutes since they may constitute a potential source of infection for their clients.

HIV infection among foreign transsexual sex workers in Rome: prevalence, behavior patterns, and seroconversion rates.

BACKGROUND: The Azienda Sanitaria Locale Roma E (ASL-RME) outpatient clinic is the main reference center in Rome for HIV testing of foreign people. GOAL: To define the prevalence and incidence of HIV infection among foreign transsexual sex workers attending the center. STUDY DESIGN: A cross-sectional, follow-up study was conducted. RESULTS: Between 1993 and 1999, 353 transsexuals attended the ASL-RME. They were from Colombia (n = 208), Brazil (n = 122), and other countries (n = 23). Most of these transsexuals reported having 5 to 10 partners per day. The overall HIV prevalence was 38.2%, which multivariate analysis found to be associated with origin from Brazil and a higher number of sex partners. The observed HIV seroconversion rate was 4.1 per 100 person-years, and non-regular condom use was the only factor related to seroconversion. CONCLUSIONS: The data from this study suggest that promotion of safer sex practices and regular condom use still is the main priority among marginalized population subgroups, such as foreign prostitutes, involved in sex activities that put them at risk for HIV infection.

Longitudinal outcome 6 years after spinal cord injury.

STUDY DESIGN: Multicentered follow-up with centralized data collection based on retrospective study. OBJECTIVES: To assess the outcome in a population of patients with spinal cord injury (SCI). The assessed outcomes are mortality, state of health, occupation, mobility, autonomy, social and partner relationships, quality of life (QoL), with the identification of any relation between results and demographic-clinical data. SETTING: Two rehabilitation centers (Udine and Trevi) and a Spinal Injuries Unit (Torino). METHODS: A total of 251 patients with SCI discharged after first hospitalization from rehabilitation facilities between 1989 and 1994 were enrolled. A questionnaire was administered by telephone. RESULTS: During the time between discharge and follow-up, 25 out of the 251 patients had died, yielding a mortality rate of 9.96%. A total of 80 patients did not give their consent. The 146 patients' mean interval from discharge from the rehabilitation facility was 6 years. At least 25% has been hospitalized again. The descriptive analysis also shows that 29.5% of patients were working, 48.6% were able to drive, 63.7% would leave their home alone, 61% would leave home every day, 63% reported of a change in their relationships, 48.6% were happy with their love lives. Significant correlations have emerged between certain items and age: those who had a job, who could drive, were more autonomous and had a higher QoL are generally younger. Level of injury appear to be only associated with the degree of autonomy, which seems to be inferior for tetraplegic subjects. The injury's completeness and etiology do not exhibit any correlation. QoL is associated with a number of items: a higher QoL is linked to the possibility to work, especially if it is a paid job, to the ability to drive, to a good degree of autonomy, to a lack of change in the social and partner relationships, and to a satisfactory love life. CONCLUSION: At 6 years after discharge from rehabilitations, the effects of trauma on work and social and partner relationships, domains correlated with autonomy and QoL, are evident. Further investigation by means of a prospective study over the years are therefore necessary.

Changes in regular condom use among immigrant transsexuals attending a counselling and testing reference site in central Rome: a 12 year study.

OBJECTIVE: To analyse data from male to female transsexuals attending between 1992 and 2003 an outpatient clinic considered the main HIV counselling and testing site in Rome for foreign people. METHODS: Data collected between 1992 and 2003, from a routine anti-HIV testing and counselling activity, were analysed. A brief standard interview was performed at each test. A cross sectional analysis to assess the association of regular condom use with demographic and behavioural variables using multiple logistic regression was performed. A follow up analysis to define the effect of single factors on the occurrence of new anti-HIV seroconversions was also performed. The incidence of anti-HIV seroconversion was calculated in person years of observation. RESULTS: Overall, 473 transsexuals sex workers were tested. Most of them (99%) were from South America (mainly Columbia and Brazil). Anti-HIV prevalence was 32%, but a progressive decrease over time was observed (from 57% in 1993 to 12% in 2003). The proportion of patients reporting regular condom use at enrolment was 75%. A progressive increase in regular condom use was reported over time (from 43% in 1992-3 to 79% in 2002-3). 15 new HIV infections were observed during follow up (incidence 2.1 per 100 person years). Though the proportion of patients reporting regular condom use increased over time, 10 out of the 15 new infections occurred in patients reporting unprotected sex during follow up (rate 8.4 per 100 person years). CONCLUSIONS: Our data suggest that counselling may lead to an increase in safe sex practices among immigrant transsexuals. However, the incidence of new HIV infections is still high and mainly related to non-regular condom use, which still remains the primary objective of prevention.

Why do Italian stroke patients receive CT scans earlier than UK patients? International Stroke Trial Collaborators in Italy and the UK.

Computed tomography (CT) scanning is important prior to acute stroke treatment. We wished to identify factors associated with being able to obtain a CT scan quickly, from a recent large stroke treatment trial. A questionnaire survey on the organisation of CT scanning services for stroke was sent to 179 UK and Italian hospitals who had randomised patients into the International Stroke Trial and performed at least one pre-randomisation CT scan. Data from the questionnaire were analysed in conjunction with other patient data. Italian doctors expected the CT scans to be done more quickly than UK doctors, their hospitals were more likely to have a CT scanner operating all the time, and a porter was used less frequently to take the patient to the CT scanner. A few simple changes in the way CT scanning is organised for stroke patients in the UK could speed access to CT considerably.