Estimating canine cancer incidence: findings from a population-based tumour registry in northwestern Italy.

BACKGROUND: Canine cancer registry data can be put to good use in epidemiological studies. Quantitative comparison of tumour types may reveal unusual cancer frequencies, providing directions for research and generation of hypotheses of cancer causation in a specific area, and suggest leads for identifying risk factors. Here we report canine cancer incidence rates calculated from a population-based registry in an area without any known specific environmental hazard. RESULTS: In its 90 months of operation from 2001 to 2008 (the observation period in this study), the population-based Piedmont Canine Cancer Registry collected data on 1175 tumours confirmed by histopathological diagnosis. The incidence rate was 804 per 100,000 dog-years for malignant tumours and 897 per 100,000 dog-years for benign tumours. Higher rates for all cancers were observed in purebred dogs, particularly in Yorkshire terrier and Boxer. The most prevalent malignant neoplasms were cutaneous mastocytoma and hemangiopericytoma, and mammary gland complex carcinoma and simplex carcinoma. CONCLUSIONS: The Piedmont canine cancer registry is one of few of its kind whose operations have been consistently supported by long-term public funding. The registry-based cancer incidence rates were estimated with particular attention to the validity of data collection, thus minimizing the potential for bias. The findings on cancer incidence rates may provide a reliable reference for comparison studies. Researches conducted on dogs, used as sentinels for community exposure to environmental carcinogens, can be useful to detect excess risks in the incidence of malignant tumours in the human population.

Association of an indel polymorphism in the 3'UTR of the caprine SPRN gene with scrapie positivity in the central nervous system.

The aim of this study was to analyse the SPRN genes of goats from several scrapie outbreaks in order to detect polymorphisms and to look for association with scrapie occurrence, by an unmatched case-control study. A region of the caprine SPRN gene encompassing the entire ORF and a fragment of the 3'UTR revealed a total of 11 mutations: 10 single-nucleotide polymorphisms and one indel polymorphism. Only two non-synonymous mutations occurring at very low incidence were identified. A significant association with scrapie positivity in the central nervous system was found for an indel polymorphism (602_606insCTCCC) in the 3'UTR. Bioinformatics analyses suggest that this indel may modulate scrapie susceptibility via a microRNA-mediated post-transcriptional mechanism. This is the first study to demonstrate an association between the SPRN gene and goat scrapie. The identified indel may serve as a genetic target other than PRNP to predict disease risk in future genetics-based scrapie-control approaches in goats.

A relevant long-term impact of the circulation of a potentially contaminated vaccine on the distribution of scrapie in Italy. Results from a retrospective cohort study.

A sudden increase in the incidence of scrapie in Italy in 1997 was subsequently linked to the use of a potentially infected vaccine against contagious agalactia. The relative risk for the exposed farms ranged between 6 and 40. The aim of this study was to assess the long-term impact of exposure to the potentially scrapie-contaminated vaccine on the Italian classical scrapie epidemic. We carried out a retrospective cohort study, fitting mixed-effects Poisson regression models, dividing national geographic areas into exposure categories on the basis of the vaccine circulation levels. We took into account the sensitivity of the surveillance system applied in the different areas. The population attributable fraction (PAF) was used to assess the impact on the total population of farms associated with the effect of circulation of the vaccine. The provinces where the vaccine was more often sold were noted to have a higher level of disease when compared to those provinces where the vaccine was sold less often (incidence rate ratio [IRR]: 2.7; 95% confidence interval [CI]: 1.1-6.5). The population attributable fraction was high (68.4%). Standardization techniques allowed to account for the potential of geographical variability in the sensitivity of the Italian surveillance system. Although the number of the directly exposed farms was limited, an important long-term impact of the vaccine circulation could be quantified in terms of secondary outbreaks likely due to the exchange of animals from directly exposed flocks.

[Environmental micropollutants in livestock products from Susa Valley, Piedmont]. / La contaminazione ambientale da microinquinanti degli allevamenti della Val di Susa.

OBJECTIVE: to describe the contamination due to dioxins and dioxin-like PCBs of cattle dairy and meat products in cattle herds from Susa Valley (Piedmont) since the second half of 2004. DESIGN: descriptive study based on a biomonitoring campaign on bovine bulk milk and muscle. SETTING AND PARTICIPANTS: the official samplings have been carried out between 2004 and 2010: the dataset refers to 99 mass milk samples and 24 muscle samples from 51 cattle herds based in 23 municipalities of the valley. MAIN OUTCOME MEASURES: counts and frequencies of samples exceeding either the maximum levels or the action levels set by the European legislation; moreover relative distributions of congeners (profiles) were considered. RESULTS: DL-PCBs showed median concentration values double when compared with dioxins values and a couple of congeners (2,3,4,7,8-PeCDF, 118 DL-PCB) were particularly abundant. More than 60% of both the milk samples and herds exceeded the action levels with the involvement of 10 municipalities most of which located nearby a local steel smelter. The DL-PCB values in milk were associated with the distance of each herd from the steel plant. However, the temporal trend highlights a clear decrease of the contamination over the 2004-2010 period, when the plant was renewed and the production levels where negatively impacted by the global economical crisis. CONCLUSION: the findings of the monitoring activity allowed the understanding of the origin and the spatio-temporal evolution of the contamination: this knowledge may be helpful in orienting future controls and the risk mitigation strategies.

Health Policies for Rare Disease Patients: A Scoping Review.

OBJECTIVE: To identify and map the available evidence on the implementation of public health policies directed at individuals with rare diseases, and to compare the implementation of these health policies between Brazil and other countries. METHOD: A scoping review guided by the PRISMA-ScR and JBI checklists. The search for articles was conducted in eight electronic databases, MEDLINE/Pubmed, Embase, Cochrane Library, Web of Science, Scopus, CINAHL, PsycINFO, and LILACS, using controlled descriptors, synonyms, and keywords combined with Boolean operators. All steps of this review were independently conducted by two researchers. The selected studies were classified by evidence hierarchy, and a generic quantitative tool was used for the assessment of the studies. RESULTS: A total of 473 studies were identified, of which 13 which met all the inclusion criteria were selected and analyzed. Of these studies, 61.5% (n = 8) had final scores equal to or greater than 70%, i.e., they were classified by this tool as being well-reported. The comparative analysis of international rare diseases demonstrates that public authorities' priorities and recommendations regarding this topic also permeate and apply to the Brazilian context. CONCLUSIONS: The evaluation and monitoring of public policies directed at rare disease patients are urgent and necessary to improve and implement such policies with less bureaucracy and more determination for this unique population that requires timely and high-quality care.

Using network analysis to identify seasonal patterns and key nodes for risk-based surveillance of pig diseases in Italy.

The description of the pattern of livestock movements between herds provides essential information for both improving risk-based surveillance and to understand the likely spread of infectious diseases. This study provides a description of the temporal pattern of pig movements recorded in Italy on a 4-year period (2013-2016). Data, provided by the National Livestock registry, were described by social network analysis and the application of a walk-trap algorithm for community detection. Our results show a highly populated community located in Northern Italy, which is the focal point of the Italian industrial pig production and as a general pattern an overall decline of medium and backyard farms and an increase in the number of large farms, in agreement with the trend observed by other EU pig-producing countries. A seasonal pattern of all the parameters evaluated, including the number of active nodes in both the intensive and smaller production systems, emerged: that is characterized by a higher number of movements in spring and autumn, linked with the breeding and production cycle as pigs moved from the growing to the finishing phase and with periods of increased slaughtering at Christmas and Easter. The same pattern was found when restricting the analysis to imported pig batches. Outbreaks occurring during these periods would have a greater impact on the spread of infectious diseases; therefore, targeted surveillance may be appropriate. Finally, potential super-spreader nodes have been identified and represent 0.47% of the total number of pig holdings (n = 477). Those nodes are present during the whole study period with a similar ranking in their potential of being super-spreaders. Most of them were in Northern Italy, but super-spreaders with high mean out-degree centrality were also located in other Regions. Seasonality, communities and super-spreaders should be considered when planning surveillance activity and when applying disease control strategies.

Local context and environment as risk factors for acute poisoning in animals in northwest Italy.

Animal and bait poisoning data for northwest Italy collected between 2012 and 2017 were described and analyzed to estimate the risk of exposure to hazardous substances by animals. In about 4% of animals necropsied (n = 356/9512), the cause of death was poisoning and domestic pets (9.5%) and synanthropic animals (12.2%) appear to be the most involved. Furthermore, 294 out of 728 baits (40.4%) were positive for toxic substances and/or inert hazardous material. Application of a mixed-effects Poisson regression model and local cluster analysis evidenced increased risk of exposure to poisoning with altimetry (>600 m.a.s.l.) and municipality (PR = 1.6, 95%CI 1.2-2.1 for poisoning, PR = 2.2, 95%CI 1.2-4.2 for poisoning by insecticides and PR = 2.9, 95%CI 1.4-6.2 for poisoning by metaldehyde). Since the mountainous areas in the region are mostly devoted to pasture and extensive farming, the high frequency of animal and bait poisoning events may be related to farmers' need to protect their livestock and crops against foxes, wolves, rodents or wild boars. Summarizing, the type of land use and context may influence the frequency and type of toxin chosen to kill animals considered a nuisance for hunting, farming, agriculture and apiculture. Despite bans and limitations, the use of harmful substances is not perceived as an environmental threat but rather as routine pest control. Animal and bait poisoning constitute a public health concern because it is potentially harmful to humans and the environment. Our findings may inform risk communication strategies, as well as prevention and control measures for the reduction of illegal and non-targeted species poisoning.

Breast cancer screening in Brazil. Barriers related to the health system.

OBJECTIVE:: Identify factors related to the health system that lead to a late diagnosis of breast cancer in Brazil. METHOD:: We performed a systematic review in the PubMed and LILACS databases using as keywords "Breast cancer," "system of health" and "Brazil or Brasil." We evaluated the content of the articles using the PRISMA methodology based on PICTOS. The final date was 12/16/2015. We were able to identify 94 publications in PubMed and 43 publications in LILACS. After assessing the title and summary, and excluding 21 repeated publications, we selected 51 publications for full evaluation. At this stage, we excluded 21 articles, with 30 publications remaining for study. RESULTS:: The population coverage is low, and there are problems related to the quality of mammography. Patients with lower income, nonwhite and less educated are more vulnerable. We observed punctual and initial experiences in breast cancer screening. Diagnosis and treatment flows must be improved. The inequality in mortality reflects the differences related to screening structure and treatment. Better results are observed in well-structured services. CONCLUSION:: There are several barriers in the health system leading to advanced stage at diagnosis and limiting the survival outcomes. The establishment of a rapid and effective order for diagnosis and treatment, based on hierarchical flow, are important steps to be improved in the public health context.

Detection of West Nile and Usutu Viruses in Italian Free Areas: Entomological Surveillance in Piemonte and Liguria Regions, 2014.

West Nile virus and Usutu virus have established in different parts of Italy over the past 10 years. Piemonte and Liguria Regions (Northwestern Italy) are known to be nonendemic areas, despite the presence of competent vectors and environmental conditions conducive to maintaining infection. This work evidences for the first time, through an entomological surveillance implemented on the basis of risk factor approach, the presence of West Nile and Usutu viruses in Piemonte and Liguria Regions (Northwestern Italy).

West Nile Virus Surveillance in 2013 via Mosquito Screening in Northern Italy and the Influence of Weather on Virus Circulation.

West Nile virus (WNV) is a recently re-emerged health problem in Europe. In Italy, an increasing number of outbreaks of West Nile disease, with occurrences of human cases, have been reported since 2008. This is particularly true in northern Italy, where entomological surveillance systems have been implemented at a regional level. The aim of this study was to use, for the first time, all the entomological data collected in the five regions undergoing surveillance for WNV in northern Italy to characterize the viral circulation (at a spatial and temporal scale), identify potential mosquito vectors, and specify relationships between virus circulation and meteorological conditions. In 2013, 286 sites covering the entire Pianura Padana area were monitored. A total of 757,461 mosquitoes were sampled. Of these, 562,079 were tested by real-time PCR in 9,268 pools, of which 180 (1.9%) were positive for WNV. The largest part of the detected WNV sequences belonged to lineage II, demonstrating that, unlike those in the past, the 2013 outbreak was mainly sustained by this WNV lineage. This surveillance also detected the Usutu virus, a WNV-related flavivirus, in 241 (2.6%) pools. The WNV surveillance systems precisely identified the area affected by the virus and detected the viral circulation approximately two weeks before the occurrence of onset of human cases. Ninety percent of the sampled mosquitoes were Culex pipiens, and 178/180 WNV-positive pools were composed of only this species, suggesting this mosquito is the main WNV vector in northern Italy. A significantly higher abundance of the vector was recorded in the WNV circulation area, which was characterized by warmer and less rainy conditions and greater evapotranspiration compared to the rest of the Pianura Padana, suggesting that areas exposed to these conditions are more suitable for WNV circulation. This observation highlights warmer and less rainy conditions as factors able to enhance WNV circulation and cause virus spillover outside the sylvatic cycle.

Data on milk dioxin contamination linked with the location of fodder croplands allow to hypothesize the origin of the pollution source in an Italian valley.

Polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (dl-PCBs) have similar toxic, endocrine-disrupting, and carcinogenic activity. They are classified as persistent organic pollutants accumulating in the environment and the tissues of living organisms. High concentrations of PCDD/F and dl-PCB have been detected in bovine milk collected in a Piedmont valley (Northwestern Italy) since 2004. This geographic study describes the local distribution of pollution from PCDD/Fs and dl-PCBs. Since their presence in animal products could be traced back to the ingestion of contaminated fodder, dioxin levels in cow milk were related to the distribution of fodder cropland parcels. Specifically, the aim of the study was to determine, through an exploratory approach, whether the contamination was consistent with one common point source of contamination or different scattered sources. Data for PCDD/F and dl-PCB concentrations in the bulk milk from 27 herds, sampled over a 4-year period (2004-2007), were matched to the georeferenced land parcels the dairy farmers used for growing fodder. Isopleth maps of dioxin concentrations were estimated with ordinary kriging. The highest level of pollution for both PCDD/Fs and dl-PCBs was geographically juxtaposed: in both instances, the location of the local steel plant was within this extremely highly polluted area. The study results support the hypothesis for one common point source of contamination in the valley. The exploratory spatial analysis applied in this research may provide a valuable, novel approach to straightforward identification of a highly likely source of dioxin contamination of dairy products (even in the absence of top soil contamination data).

Breast cancer screening in Brazil. Barriers related to the health system / Rastreamento do câncer de mama no Brasil. Barreiras relacionadas ao sistema de saúde

Summary Objective: Identify factors related to the health system that lead to a late diagnosis of breast cancer in Brazil. Method: We performed a systematic review in the PubMed and LILACS databases using as keywords "Breast cancer," "system of health" and "Brazil or Brasil." We evaluated the content of the articles using the PRISMA methodology based on PICTOS. The final date was 12/16/2015. We were able to identify 94 publications in PubMed and 43 publications in LILACS. After assessing the title and summary, and excluding 21 repeated publications, we selected 51 publications for full evaluation. At this stage, we excluded 21 articles, with 30 publications remaining for study. Results: The population coverage is low, and there are problems related to the quality of mammography. Patients with lower income, nonwhite and less educated are more vulnerable. We observed punctual and initial experiences in breast cancer screening. Diagnosis and treatment flows must be improved. The inequality in mortality reflects the differences related to screening structure and treatment. Better results are observed in well-structured services. Conclusion: There are several barriers in the health system leading to advanced stage at diagnosis and limiting the survival outcomes. The establishment of a rapid and effective order for diagnosis and treatment, based on hierarchical flow, are important steps to be improved in the public health context.

Resumo Objetivo: Identificar fatores relacionados ao sistema de saúde que determinam atraso no diagnóstico do câncer de mama no Brasil. Método: Utilizou-se metodologia de revisão sistemática nas bases de dados PubMed e LILACS, pesquisando os termos "Breast cancer", "system of health" e "Brazil or Brasil". Não se avaliou a qualidade da publicação, mas seu conteúdo, sendo ele categorizado em função da metodologia PRISMA baseada no PICTOS. Na data limite de 16/12/2015, foi possível identificar 94 publicações na PubMed e 43 publicações na LILACS. Avaliando o título e resumo, e excluindo-se 21 publicações repetidas, foi possível identificar 51 publicações para avaliação completa, na qual foram excluídos 21 artigos, restando 30 publicações. Resultados: Observou-se que a base de mamógrafos é limitada, o tempo até o diagnóstico é elevado, e o estadio ao diagnóstico é avançado. A cobertura populacional é baixa, havendo problemas na qualidade da mamografia. As pacientes de menor renda, menor escolaridade e etnia não branca são as mais vulneráveis. Observam-se exemplos de mutirões e experiências iniciais de rastreamento. Necessita-se de aprimoramento do fluxo de diagnóstico e tratamento. A desigualdade na mortalidade é reflexo da estrutura para rastreamento e tratamento, observando-se melhores resultados em serviços públicos bem estruturados. Conclusão: Há diversas barreiras relacionadas ao sistema de saúde que refletem no estádio avançado ao diagnóstico e limitam os resultados na sobrevida. O estabelecimento de um fluxo de diagnóstico e tratamento rápidos e efetivos, dentro de um contexto hierarquizado, são importantes etapas a serem aprimoradas dentro do contexto da saúde pública.

Atençäo em saúde bucal: condiçäo atual do acesso a trabalhadores e adultos nos sistemas locais de saúde / Oral health care: present condition of workers and adults acess in the local health systems

Pesquisa as condicoes do acesso de trabalhadores e adultos aos servicos publicos odontologicos nos Sistemas Locais e Regionais de Saude, a partir das informacoes prestadas pelos gestores de Escritorios Regionais de Saude do Estado de Sao Paulo (ERSA) e Secretarias Municipais de Saude das Capitais (SMS). O foco de interesse buscou apreender essas condicoes pelo recorte da universalizacao da assistencia a saude, um dos principios norteadores do SUS. Utilizou-se um questionario de tipo nao-diretivo, o qual sinalizava os topicos de interesse para a pesquisa. Os resultados indicam que adultos/trabalhadores sao atendidos pelos servicos nos casos de urgencia/emergencia, que a atencao/assistencia e ofertada de modo irregular, e que a crianca continua a ser grupo social de eleicao para os servicos publicos odontologicos

Informação compatível com a realidade para permanência maior que 24 horas em leitos de observação dos hospitais / Information compatible with reality to stay longer than 24 hours in observation beds in hospitals

Pode-se concluir que o preenchimento incorreto de dados relacionados à movimentação de pacientes na unidade de emergência e urgência distorce vários indicadores formados com esses dados, tanto na unidade de internação quanto na própria unidade de emergência, podendo levar a erros de diagnóstico de como está funcionado as respectivas unidades dentro do estabelecimento de saúde, interferindo e dificulta a análise e proposituras sistêmicas para modificar incoerências, superlotação e insuficiência de leitos no município(AU)

Informação compatível com a realidade para permanência maior que 24 horas em leitos de observação dos hospitais

Pode-se concluir que o preenchimento incorreto de dados relacionados à movimentação de pacientes na unidade de emergência e urgência distorce vários indicadores formados com esses dados, tanto na unidade de internação quanto na própria unidade de emergência, podendo levar a erros de diagnóstico de como está funcionado as respectivas unidades dentro do estabelecimento de saúde, interferindo e dificulta a análise e proposituras sistêmicas para modificar incoerências, superlotação e insuficiência de leitos no município