Epidemiologic surveillance of mesothelioma in Umbria.

BACKGROUND: Malignant mesothelioma (MM) is becoming a prominent health issue due to its low survival and for its increasing incidence in various countries. The objectives of this study were to evaluate epidemiological characteristics and trends of MM in the Umbrian Region for the period 2003-2013. METHODS: All cases of MM reported to Umbrian Population Cancer Registry between 2003 and 2013. Incidence Annual Standardized Rates (ASRs) were analyzed for all histological types of MM. Estimated Annual Percent Change (APC) and joinpoint regression analysis were used to out light the time trend of MM. Geographical distribution of the relative risk for each municipality was calculated by Standardized Incidence Ratios SIRs. RESULTS: 191 (156 males) MM cases were recorded in Umbrian residents in the period 2003-2013. Pleural mesothelioma affected 92.1% of the total. Gender ratio M/F was 5.9:1. ASRs for MM was 3.2 among men and 0.6 among women. Joinpoint analysis showed a decrease in females APC -8.4 (95% IC -33.7-26.6) and an increase in males APC 5.8 (95% IC -0.9-13.0). An occupational exposure was identified in 43.7% of females and in 90.7% of males. CONCLUSIONS: The protracted cancer latency and the continued asbestos existence as environmental contaminant in existing buildings, as well as a carcinogenic risk for the workers involved in removing operations of material containing asbestos justifies the investment in a specific surveillance system. Also important would be to implement a national risk communication strategy addressed to the general population, environment surveillance of the high risk areas and guarantee that all workers involved that even may deal with asbestos are always fully equipped and trained, not only for their individual risk but also for the potential risk of non correct disposal.

Knowledge about tuberculosis among undergraduate health care students in 15 Italian universities: a cross-sectional study.

BACKGROUND: The Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health conducted a multicentre survey aiming to evaluate undergraduate health care students' knowledge of tuberculosis and tuberculosis control measures in Italy. METHODS: In October 2012-June 2013, a sample of medical and nursing students from 15 Italian universities were enrolled on a voluntary basis and asked to complete an anonymous questionnaire investigating both general knowledge of tuberculosis (aetiology, clinical presentation, outcome, screening methods) and personal experiences and practices related to tuberculosis prevention. Data were analysed through multivariable regression using Stata software. RESULTS: The sample consisted of 2,220 students in nursing (72.6%) and medicine (27.4%) courses. Our findings clearly showed that medical students had a better knowledge of tuberculosis than did nursing students.Although the vast majority of the sample (up to 95%) answered questions about tuberculosis aetiology correctly, only 60% of the students gave the correct responses regarding clinical aspects and vaccine details. Overall, 66.9% of the students had been screened for tuberculosis, but less than 20% of those with a negative result on the tuberculin skin test were vaccinated. Multivariable regression analysis showed that age and type of study programme (nursing vs. medical course) were determinants of answering the questions correctly. CONCLUSIONS: Although our data showed sufficient knowledge on tuberculosis, this survey underlines the considerable need for improvement in knowledge about the disease, especially among nursing students. In light of the scientific recommendations concerning tuberculosis knowledge among students, progress of current health care curricula aimed to develop students' skills in this field is needed.

Incidence of multiple primary cancers following respiratory tract cancer in Umbria, Italy.

UNLABELLED: Improvements in cancer survival and life expectancy have placed a focus on long-term risks following a primary cancer, including that of developing other primary malignancies. The purpose of this study was to evaluate the risk, in patients with respiratory tract cancers, of developing a second primary malignancy. METHODS: Standardized incidence ratios (SIR) of observed to expected cases were calculated for residents of Umbria diagnosed with laryngeal and lung cancer between 1994 and 2008. Significance and 95% confidence intervals were determined assuming a Poisson distribution. RESULTS: In total, 189 and 340 cases of second primary cancers were observed respectively among laryngeal and lung cancer patients. Male laryngeal cancer patients were found to have a significantly increased risk of lung cancer (SIR=4.10), non-melanoma skin cancer (SIR=2.10), bladder cancer (SIR=2.25) and pancreatic cancer (SIR=3.85). In females, a significantly increased risk was observed only when all sites combined were considered. Male lung cancer patients were found to have a significantly increased risk for laryngeal cancer (SIR=4.36), esophageal cancer (SIR=3.97), kidney cancer (SIR=3.40), multiple myeloma and malignant plasma cell neoplasm (SIR=2.97), bladder cancer (SIR=2.20) and non-melanoma skin cancer (SIR=1.55). In females, the risk of developing a second cancer was higher but was not significant for non-melanoma skin cancers, colon and breast cancer. CONCLUSIONS: Study results show an excess risk of other primary malignancies in respiratory tract cancer patients, particularly males. This may be due to shared risk factors, genetic susceptibility, effect of first cancer treatments and increased diagnostic surveillance.

Sense of Coherence in Nurses: A Systematic Review.

Background: Nurses experience high levels of distress due to the nature of their work and workplaces; Antonovsky's salutogenic theory shows that individual and work-related factors can influence human health. The aim of this paper is to analyze the possible correlations with different work-related and individual variables, which influence or are influenced by Sense of Coherence (SOC) and verify the possible use of SOC scales to prevent negative health determinants in workplaces. Methods: Electronic databases were searched with selected studies compared for sample, sample size, study design and basic results. Cross-sectional studies were reviewed for correlations between individual physical and mental health, distress, burnout, job satisfaction and SOC, with intervention studies used to assess the possible impact of training on nurses' SOC. Results: The review found several correlations between SOC and different work-related variables; but also with several individual characteristics. Conclusion: The review found that SOC was predictor of depressive state, burnout, job dissatisfaction among female nurses; therefore, SOC could be a health promoting resource.

Intensive tobacco cultivations, a possible public health risk?

The cultivation of tobacco has serious consequences for the environment: it impoverishes the soil by assimilating its nutrients, it involves an intensive use of highly polluting pesticides, it perturbs the ecosystem through deforestation, and it releases nicotine into the environment, which is toxic for humans. Italy is the first producer of raw tobacco in Europe and the Valtiberina area is among the most profitable. The first cultivations can be reconducted to the period around 1400. The objective of this experimental work is to verify the sustainability of tobacco cultivation near other crops using nicotine as an indicator. The nicotine on medicinal and wild plants adjacent to tobacco crops has been analyzed, assessing whether it is present or not and which is the concentration. To measure the nicotine present with ultra-high-performance liquid chromatography (UHPLC), LC/MS (liquid chromatography-mass spectrometry) method was used with LOQ (quantification limit) of 0.005 mg/kg. A total of 300 lots of aromatic herbs were sampled, and nicotine was detected in 82.3% of the samples in 2015 and 62.9% in 2016. Furthermore, in 2015, 121 samples of wild material were analyzed, of which 88.4% showed traces of nicotine. These first results indicate a possible potential threat for the population health. This shows that the tobacco cultivation should not be in close proximity to other plantation destined for nutrition, neither for man and nor animals. The elevated impact of nicotine on the ecosystem has negative consequences not only for the economy but it is also a potential public health threat.

Cancer burden trends in Umbria region using a joinpoint regression.

INTRODUCTION: The analysis of the epidemiological data on cancer is an important tool to control and evaluate the outcomes of primary and secondary prevention, the effectiveness of health care and, in general, all cancer control activities. MATERIALS AND METHODS: The aim of the this paper is to analyze the cancer mortality in the Umbria region from 1978 to 2009 and incidence from 1994-2008. Sex and site-specific trends for standardized rates were analyzed by "joinpoint regression", using the surveillance epidemiology and end results (SEER) software. RESULTS: Applying the jointpoint analyses by sex and cancer site, to incidence spanning from 1994 to 2008 and mortality from 1978 to 2009 for all sites, both in males and females, a significant joinpoint for mortality was found; moreover the trend shape was similar and the joinpoint years were very close. In males standardized rate significantly increased up to 1989 by 1.23% per year and significantly decreased thereafter by -1.31%; among females the mortality rate increased in average of 0.78% (not significant) per year till 1988 and afterward significantly decreased by -0.92% per year. Incidence rate showed different trends among sexes. In males was practically constant over the period studied (not significant increase 0.14% per year), in females significantly increased by 1.49% per year up to 2001 and afterward slowly decreased (-0.71% n.s. estimated annual percent change - EAPC). CONCLUSIONS: For all sites combined trends for mortality decreased since late '80s, both in males and females; such behaviour is in line with national and European Union data. This work shows that, even compared to health systems that invest more resources, the Umbria public health system achieved good health outcomes.

Effect of healthcare on mortality: trends in avoidable mortality in Umbria, Italy, 1994-2009.

OBJECTIVE: Avoidable mortality trends over the period 1994-2009 were calculated to evaluate health intervention by the health system of Umbria, a region of central Italy. MATERIALS AND METHODS: Mortality data were supplied by the regional causes of death registry. Rates were standardized to the 2001 census Italian population. Joinpoint regression was used to analyze the trends. RESULTS: Overall avoidable mortality rates decreased significantly both in males (-3.9% per year) and in females (-3.6% per year). Mortality rates from ischemic heart and cerebrovascular disease about halved in the study period in both sexes. Avoidable mortality increased slightly only for a few causes (e.g. lung cancer in females). CONCLUSION: The overall trend of avoidable mortality indicates that the regional health/ preventive system is performing well.