[Employment status and perceived health in Italy: data from the European Union Statistics on Income and Living Conditions (EU-SILC) longitudinal study]. / Condizione occupazionale e salute percepita in Italia: evidenze da dati longitudinali EU-SILC.

The aim of this study was to investigate the relationship between employment status (permanent employment, fixed-term employment, unemployment, other) and perceived health status in a sample of the Italian population. Data was obtained from the European Union Statistics on Income and Living Condition (EU-SILC) study during the period 2009 - 2012. The sample consists of 4,848 individuals, each with a complete record of observations during four years for a total of 19,392 observations. The causal relationship between perceived/self-reported health status and employment status was tested using a global logit model (STATA). Our results confirm a significant association between employment status and perceived health, as well as between perceived health status and economic status. Unemployment that was dependent on an actual lack of work opportunities and not from individual disability was found to be the most significant determinant of perceived health status; a higher educational level produces a better perceived health status.

Apple intake and cancer risk: a systematic review and meta-analysis of observational studies.

OBJECTIVE: Conflicting results on the association between fruit consumption and cancer risk have been reported. Little is known about the cancer preventive effects of different fruit types. The present meta-analysis investigates whether an association exists between apple intake and cancer risk. DESIGN: Relevant observational studies were identified by literature search (PubMed, Web of Science and Embase). A random-effect model was used to estimate the cancer risk in different anatomical sites. Between-study heterogeneity and publication bias were assessed using adequate statistical tests. RESULTS: Twenty case-control (three on lung, five on colorectal, five on breast, two on oesophageal, three on oral cavity, two on prostate and one each on pancreas, bladder, larynx, ovary, kidney and brain cancer) and twenty-one cohort (seven on lung, two on colorectal, three on breast and one each on oesophageal, pancreas, bladder, kidney, endometrial, head-neck, urothelial and stomach cancer) studies met the inclusion criteria. Comparing the highest v. lowest level of apple consumption, the reduction of lung cancer risk was statistically highly significant in both case-control (OR=0·75; 95% CI 0·63, 0·88; P=0·001, I 2=0 %) and cohort studies (relative risk=0·89; 95% CI 0·84, 0·94; P<0·001, I 2=53 %). Instead, in the case of colorectal (OR=0·66; 95% CI 0·54, 0·81; P<0·001, I 2=55%), breast (OR=0·79; 95% CI 0·73, 0·87; P<0·001, I 2=1 %) and overall digestive tract (OR=0·50; 95% CI 0·36, 0·69; P<0·001, I 2=90 %) cancers a significant preventive effect of apples was found only in case-control studies while prospective studies indicated no effect. No evidence of publication bias could be detected for colorectal, oral cavity, oesophageal and breast cancer. However, some confounding effects may be present and related to the consumption of other fruit which have not been considered as adjusting factors. CONCLUSIONS: The present meta-analysis indicates that consumption of apples is associated with a reduced risk of cancer in different anatomical sites.

Garlic consumption and colorectal cancer risk in man: a systematic review and meta-analysis.

OBJECTIVE: Colorectal cancer shows large incidence variations worldwide that have been attributed to different dietary factors. We conducted a meta-analysis on the relationship between garlic consumption and colorectal cancer risk. DESIGN: We systematically reviewed publications obtained by searching ISI Web of Knowledge, MEDLINE and EMBASE literature databases. We extracted the risk estimate of the highest and the lowest reported categories of intake from each study and conducted meta-analysis using a random-effects model. RESULTS: The pooled analysis of all fourteen studies, seven cohort and seven case-control, indicated that garlic consumption was not associated with colorectal cancer risk (OR=0·93; 95 % CI 0·82, 1·06, P=0·281; I 2=83·6 %, P≤0·001). Separate analyses on the basis of cancer sites and sex also revealed no statistically significant effects on cancer risk. However, when separately analysed on the basis of study type, we found that garlic was associated with an approximately 37 % reduction in colorectal cancer risk in the case-control studies (combined risk estimate=0·63, 95 % CI 0·48, 0·82, P=0·001; I 2=75·6 %, P≤0·001). CONCLUSIONS: Our results suggest that consumption of garlic is not associated with a reduced colorectal cancer risk. Further investigations are necessary to clarify the discrepancy between results obtained from different types of epidemiological studies.

[Use Of Hospital Services By The Immigrant Population In Umbria, Italy]. / Utilizzo dei servizi ospedalieri da parte della popolazione immigrata in Umbria.

The aim of this study was to identify possible inequalities in the quality of health care services for the management of conditions such as cardiovascolar diseases, psychiatric disorders, appendectomy, and hysterectomy, offered to the immigrant population in the Umbria region (central Italy). Hospital discharge data covering the period 2009-2012 were analysed and crude and standardized hospitalization rates per 100,000 calculated. Immigrants were found to have an increased risk of undergoing procedures such as appendectomy and hysterectomy for benign disease, indicating a greater degree of nonappropriateness in this category of users. In the young immigrant population, admissions were mainly due to reproductive health problems in women, and injuries/trauma in men. The results of this study confirm that, despite regional efforts to reduce social inequalities and consequently inequalities in health, through regional legislation, information to the population, training of healthcare personnel, and cultural mediation, some inequalities are present in the quality of health care delivered to foreign-born persons in the region. Hence, there is a need to strengthen information campaigns for immigrants, to keep them informed of their rights, and to strengthen training courses among healthcare and social workers.

Professional competencies in health promotion and public health: what is common and what is specific? Review of the European debate and perspectives for professional development.

According to the Nairobi Call to Action, the growth of practitioners' skills can be favoured by setting accreditation standards and by reorienting professional competencies of current and future health workers. This will make it possible to develop a critical mass of competent practitioners, foster training, and increase visibility of the professional field. Through a review of the literature, the authors offer an overview of competency-based strategies for professional development in health promotion. The main research questions discussed were as follows: Is there a shared definition of public health?; Is there a shared definition of health promotion?; Who are the main stakeholders for public health and health promotion in Europe?; What is the meaning of professional competencies in education and practice for public health and health promotion?; Is there a shared system of professional core competencies in public health and health promotion?;What is common and what is specific between the two systems of professional competencies?; Is it useful and feasible to create specific strategies of professional development for public health and health promotion? A transformative use of competencies makes it possible to inform students, professionals, employers, and political decision-makers about what is expected from a specific profession and its values.

Maternal and Perinatal Health in Umbria region in 2012.

BACKGROUND: Pregnancy and childbirth still involve risk for pregnant women and their babies and health in the perinatal period remains an important public health priority. This study addresses the question of perinatal health in Umbria region. METHODS: Data were obtained from the administrative source of the regional Standard Certificate of Live Births in Umbria in 2012. We used population data, which merges data from each mother and her baby for a total of 7964 records. To describe perinatal health we considered pathological pregnancy, fetal growth defect, birth weight, gestational age, Apgar scores at 5 minutes and stillbirth such as indicators of Maternal and Neonatal Health in according with population characteristics and risk factors (maternal age, parity, mothers' educational level and mothers' country of birth). RESULTS: In Umbria, in 2012 we have: - 29 stillbirths corresponding to a rate of stillbirths of 3.52 ‰ (stillbirths per 1000 births) - a perinatal mortality rate ( stillbirths and deaths in the first week of life) of 4.9 per 1000 live births and stillbirths - an Infant mortality rate (within the first year of life) of 2.5 per 1000 live births The 1.4 % of infants underwent neonatal resuscitation. This percentage detects an indicative Apgar score of important neonatal suffering (0-3) in the 1% of neonates. The frequency of infants with birth weight less than 2500 grams (LBW) was 6.4 %, with higher values ​​in females (7.3%) than males (2.7%). The frequency of infants with birth weight less than 1500 grams is 0.8%. The preterm birth (<37 weeks of gestation) rate is 6.3% of the total: 5.6% are pregnancies among the 32 and 36 weeks of gestation and 0.7% are pregnancies under the 32nd week of gestation. The pathological pregnancies are 7.9% and the Fetal Growth Restriction (FGR) is 2.7%. The health perinatal indicators considered were different in different population subgroups. The most representative population was Italian women (76.8%), with maternal age between 25-34 years (56.4%), primiparous (61.9%) and mothers with medium education levels (48.1%). CONCLUSIONS: Results highlight the existence of differences in perinatal health. Worse maternal condition and neonatal status were observed especially for less advantaged social classes (i.e., foreign or poorly educated). Such inequalities should be examined in all areas of public policy and public services, to ensure equal opportunity for all.

The care of pregnant women and their babies: empirical data from Umbria region.

BACKGROUND: The promotion of the concept of evidence-based health care in the field of maternity care began in the 1980s; the indicators in this field were devised to enable us to know key components of care for mothers and babies and to relate them to health outcomes. METHODS: The study is based on data from the Standard Certificate of Live Birth (SCLB) forms of the Umbria region (Italy) during 2012, which merges data from each mother and her baby for a total of 7964 records. We followed the healthcare indicators recommended by World Health Organization for monitoring and evaluating maternal and child health services. We considered number of prenatal medical visits and timing of first antenatal visit such as indicators of Antenal care, and mode of delivery and place of birth by volume of deliveries such as indicators of Intrapartum care in healthcare maternal and child services. Odds ratios were calculated to indicate the likelihood of some individual and social variables across appropriate access to prenatal care. RESULTS: It is present an association between social disadvantage (mothers' educational level and mothers' country of birth) and inappropriate access to prenatal care, low number of prenatal medical visits (below 4) and late timing of first visit (after more than 12 gestational weeks). In Umbria there are 11 place of birth, 9 of I level and 2 of II level. Overall, 29.3% births occurred in 6 maternity units with fewer than 500 births in 2012 (in Italy is 7.3%). The average rate of cesarean section observed in the NTSV sample (Nulliparous, Terminal, Single, Vertex), was 28.2%. This value was higher than expected, especially in this class with an indication for the physiological birth. The World Health Organization recommends that the caesarean section rate should not be higher than 10% to 15%. Moreover there is a wide variability between birth centers (7.2% -41.4%). CONCLUSIONS: The use of mother and child prenatal care services was associated with individual characteristics of the mothers from less advantage social classes (i.e., unemployed or poorly educated); cesarean section was higher than expected, especially in the NTSV sample; we foresee an important role for application of indicators that proactively help health-care professionals to deliver the right care at the right time.

Prevention of healthcare-associated infections: knowledge among dental students in seven Italian universities.

BACKGROUND: Lack of knowledge is the major reason for non-compliance with correct healthcare-associated infections (HAI) prevention procedures. The aim of this study was to evaluate knowledge of the Dental School (DSS) and Dental Hygiene (DHS) students with regard to the prevention of HAI, as basic knowledge for improving and harmonizing the educational content in the different Italian Universities. METHODS: A cross-sectional study was carried out using an anonymous questionnaire that was completed by DSS (I, II, III, IV, and V year) in seven Universities and DHS (I, II, and III year) in three Universities. The questions dealt with three specific areas: healthcare-associated infections, standard precautions and hand hygiene. Factors associated with an unacceptable level of knowledge (score <17.5) were analyzed using a logistic regression model. A p value <0.05 was considered to be significant. RESULTS: Five hundred and four questionnaires were collected: 81.5% for DSS and 18.5% for DHS. Mean overall score (±DS) achieved by the total number of students was 18.2±2.93 on an overall perfect score of 25; 18.2±3.04 for DSS and 17.8±2.31 for DHS. Stratifying by area, the average score 2.7±1.07 (53%) for HAI, 10.3±1.61 (85.9%) for standard precautions, and 5.2±1.44 (64.8%) for hand hygiene was observed. A significantly different level of knowledge (p<0.001) between DSS and DHS was observed only for HAI (2.8±1.07 for DSS vs 2.1±0.96 for DHS). Significant differences among the academic years were found only for DSS concerning HAI and standard precautions. The logistic regression model showed that an age <23 years was a risk factor for lack of knowledge on HAI, but a protective factor for lack of knowledge about standard precautions and hand hygiene; attending DH degree course was associated with lack of knowledge on HAI. CONCLUSIONS: Although the overall score obtained both by DSS and DHS indicated an acceptable level of knowledge, lack of knowledge was highlighted, in particular, for hand hygiene. Therefore, it is necessary to implement and validate effective teaching models in undergraduate courses in order to provide the scientific basis and the theoretical and practical preparation for the prevention and control of HAI.

Employment status and perceived health condition: longitudinal data from Italy.

BACKGROUND: The considerable increase of non-standard labor contracts, unemployment and inactivity rates raises the question of whether job insecurity and the lack of job opportunities affect physical and mental well-being differently from being employed with an open-ended contract. In this paper we offer evidence on the relationship between self-reported health and the employment status in Italy using the Survey on Household Income and Wealth (SHIW); another aim is to investigate whether these potential inequalities have changed with the recent economic downturn (time period 2006-2010). METHODS: We estimate an ordered logit model with self-reported health status (SRHS) as response variable based on a fixed-effects approach which has certain advantages with respect to the random-effects formulation: the fixed-effects nature of the model also allows us to solve the problems of incidental parameters and non-random selection of individuals into different labor market categories. RESULTS: We find that temporary workers, first-job seekers and unemployed individuals are worse off than permanent employees, especially males, young workers, and those living in the center and south of Italy. CONCLUSION: Health inequalities between permanent workers and job seekers widen over time for male and young workers, and arise in the north of the country as well.

Socio-demographic determinants and access to prenatal care in Italy.

BACKGROUND: Many governments have made commitments to examine inequalities in healthcare access based on studies assessing the association between several socio-demographic factors and late initiation or fewer prenatal examinations. This study addressed the question of whether socio-demographic determinants were significant in explaining differences in prenatal care in one administrative region of Italy, Umbria. METHODS: Data were obtained from the administrative source of the regional Standard Certificate of Live Births between 2005 and 2010, and were merged with Census data to include a socio-economic deprivation index. Standard and multilevel logistic regression models were used to analyze the magnitude of various individual-level maternal characteristics and socio-demographic indicators, such as nationality, employment status, education with respect to late access to the first examination, and low number of medical visits. RESULTS: The study involved approximately 37,000 women. The heterogeneous effects of socio-demographic variables were documented on the prenatal care indicators analyzed. A multivariate model showed that women born outside Italy had a higher probability of making their first visit later than the 12th week of pregnancy and low numbers of prenatal medical visits; the estimated odds ratio for the analyzed indicators range from 2.25 to 3.05. Inadequate prenatal healthcare use was also observed in younger and pluriparous women and those with low education; in addition, having a job improved the use of services, possibly through transmission of information of negative consequences due to delayed or few prenatal visits. Interestingly, this study found a substantial reduction in the number of pregnant women who do not use prenatal healthcare services properly. CONCLUSIONS: The aim of this research is to provide more accurate knowledge about the inadequate use of prenatal healthcare in Italy. Results highlight the existence of differences in healthcare use during pregnancy, especially for women from less advantaged social classes (i.e., unemployed or poorly educated). Such inequalities should be examined in all areas of public policy and public services, to ensure equal opportunity for their use.

[Evaluation of the healthcare continuity quality in Umbria (Italy)]. / Valutazione della qualità dei servizi di continuità assistenziale in Umbria.

The aim of the study was to evaluate the quality of hospital-territorial services relationship and community care to ensure continuity of care and to avoid, or reduce, the risk of hospitalization for complications or problems in the Health Districts of Umbria region (Italy). They are considered some of the outcome indicators proposed by the Assessment Document on Determinants of Health and the Strategies of the SSR, sponsored by the Region of Umbria in 2004 and based on Agency for Healthcare Research and Quality Indicators : the rate of unplanned readmission to hospital within 28 days after hospitalization for hip fracture, stroke, acute myocardial infarction, asthma, and the rate of hospitalization for chronic complications of diabetes, pneumonia and influenza. The most significant feature is the marked variability between different districts of the region. This variability requires careful verification, as well as the quality of intra-hospital, also the quality of the relationship hospital-territorial services and the different skills and ways of taking care of patients by the health district. To reduce the risk of rehospitalization/readmission not programmed for specific diseases, even considering that this risk is influenced by various determinants, it is desirable to improve the quality of community services.

[Knowledge about sexual health in Italian adolescents girls and women: the need for intergenerational communication]. / Conoscenze sulla salute sessuale di un gruppo di ragazze adolescenti e donne adulte in Italia: il bisogno di comunicazione tra generazioni.

The aim of this study, performed between September to November 2010, was to provide insight into Italian girls' and women's knowledge of sexual health and sexuality, in particular regarding the physiology of human reproduction, contraception, sexuality, cervical cancer screening and abortion. The data used were obtained through face-to-face interviews with two groups of women, performed by a trained interviewer using a structured multiple-choice questionnaire. The first group was composed of young women aged 17 to 20 years, randomly selected from five high-school institutes in the inner-city area of Perugia (Italy), while the second group was made up of women aged 30 to 43 years, recruited amongst women undergoing postpartum checks at a regional hospital. The number of correct answers for each group of questions and the total number of correct answers in the questionnaire were calculated. A Poisson regression model was used to identify the main determinants of answering correctly. Adult women gave a higher rate of correct answers for each topic, except for those related to abortion, contraception, and HPV. Characteristics of adult women associated with a better knowledge about sexuality were: discussing about sexuality with friends or partner, being Italy-born and having an open and relaxed attitude toward sex. For younger women, better knowledge was associated with being Italy-born, having attended affectivity education courses and having an open and relaxed attitude towards sex. Results suggest that no sex education or information source by itself is effective but what is needed is a combination of various information sources, both formal and informal, including parent-adolescent communication.

Risk of childhood leukaemia and non-Hodgkin's lymphoma after parental occupational exposure to solvents and other agents: the SETIL Study.

AIM: In the context of the Italian Multicentric Epidemiological Study on Risk Factors for Childhood Leukaemia and Non-Hodgkin's Lymphoma (SETIL), the risk of childhood cancer was investigated in relation to parental occupational exposures. METHODS: All cases of childhood leukaemia and non-Hodgkin's lymphoma (NHL) in children aged 0-10 years were identified. Controls were chosen at random from the local population in each region. Parents were interviewed using a structured questionnaire. The collected data were blindly reviewed by expert industrial hygienists in order to estimate exposure to a list of agents. Statistical analyses were performed for each agent using unconditional multivariable logistic regression models, taking into account timing of exposure. RESULTS: 683 cases of acute childhood leukaemia, 97 cases of NHL and 1044 controls were identified. Increased risk of childhood leukaemia was found for maternal exposure to aliphatic (OR 4.3) or aromatic hydrocarbons (OR 3.8) in the preconception period, and for paternal exposure to diesel exhaust (OR 1.4), lead exposure (OR 1.7) and mineral oils (OR 1.4)[corrected]. Risk of NHL appeared to be related to paternal exposure to oxygenated solvents (OR 2.5) and petrol exhaust (OR 2.2). CONCLUSIONS: We found increased risk for childhood leukaemia associated with maternal occupational exposure to aromatic and aliphatic hydrocarbons, particularly in the preconception period; increased risks were also observed for paternal exposure to diesel exhaust fumes, mineral oils and lead. The risk of NHL appeared to be related to paternal exposure to oxygenated solvent and petrol exhausts.

[Hospital-territorial services and integration of health care: the Protected Discharge program in the Umbria Region from 2005 to 2010]. / Integrazione ospedale-territorio: le Dimissioni Protette nella Regione Umbria (anni 2005-2010).

In order to address the management of patients with chronic diseases, national and international regulatory guidelines have developed policies and operational tools aimed at integration and implementation of pathways of continuity of health care between different healthcare settings. "Protected Discharge" programs have been developed for the organized transfer of patients from one setting of care (hospital) to another (territory) in order to ensure their continuity of care and assistance. The aim of this study was to assess the degree of implementation the program in the context of continuity of healthcare in the Umbria region (Italy). An analysis of the regional archive of hospital discharge records was performed to examine trends of the various types of hospital discharges during the years 2005 to 2010. A slow but steady increase of protected discharges was observed from 2005 (0.9%) to 2010 (1.9%). The percentages observed are higher than those at the national level (except for transfer to RSA); however, results indicate insufficient implementation of hospital-territorial services integration and hence of the principle of continuity of health and social care.

Immunologic profile of excessive body weight.

The purpose of this paper is to identify immunologic hallmarks of excessive bodyweight. The analysis is based on 176 adults (106 women, 70 men) who participated in a nested case-control study in Italy. All participants were healthy at the time of blood collection and aged between 36 and 75 years. We employed multivariate analysis of variance and a nonparametric Bayesian additive regression tree approach along with a receiver operating characteristic (ROC) curve analysis to determine the immunologic signature of excessive body weight (i.e., obesity and overweight). Interleukin 8 (IL-8), IL-10, interferon γ, and inducible protein 10 were shown to be predictive of excessive body weight with an area under the ROC curve of 71% (p < 0.0002). We propose that by using this profile-based approach to define immunologic signatures, it might be possible to identify unique immunologic hallmarks of specific types of obesity.

[Environment and health: the case of the built environment and obesity]. / Ambiente e salute: il caso dell'ambiente costruito ed obesità

Diseases of affluence such as obesity and type II diabetes mellitus represent a challenge for modern day Public Health. Since the 1980s the frequency of such diseases has greatly increased. Obesity can now be considered as an environmental disease since issues closely linked to the organization and structure of the built environment can clearly influence the lifestyle of citizens including physical activity and eating behaviours. A multi-layered approach to the issue thus becomes essential, both in terms of assessing the impact of the built environment on the state of physical and mental wellbeing of citizens, and in terms of the organization of the environment itself based on the social and health needs of the community.

Promoting healthy eating in childhood: results from the COcONUT (Children PrOmOting Nutrition throUght Theatre) project.

BACKGROUND: Despite several international initiatives aimed to contrast childhood overweight and obesity, these still represent a major public health problem. Recently, the World Health Organization called for a new type of preventive action, requiring stakeholders from both governments and civil society, to play a decisive role in shaping healthy environments, especially for children. METHODS: COcONUT (Children PrOmOting Nutrition throUght Theatre) was a nutrition education project, involving children aged 5-12 years, aimed to raise awareness on healthy eating, through theatrical and practical workshops. Within this project we conducted an observational study assessing i) children adherence to the Mediterranean Diet, using the KIDMED questionnaire, and ii) parental nutritional knowledge and families' food habits using the ZOOM8 questionnaire. The non-parametric Wilcoxon and the McNemar's test were used. Statistical significance was fixed p<0.05. RESULTS: Our data show a statistically significant improvement in Mediterranean Diet adherence among children (p=0.0004). Moreover, we found positive trends in some families' food habits, as for instance less perceived barriers in fruits/vegetables/pulses consumption, less perceived barriers in doing sports and less consumption of unhealthy snacks. CONCLUSIONS: Our results confirm the important role played by funny and active learning in health promotion initiatives.

Meta-analysis of thyroidectomy with ultrasonic dissector versus conventional clamp and tie.

BACKGROUND: We conducted a systematic review to evaluate the role of Ultrasonic dissector (UAS) versus conventional clamp and tie in thyroidectomy. MATERIALS AND METHODS: We searched for all published RCT in into electronic databases. To be included in the analysis, the studies had to compare thyroidectomy with UAS versus conventional vessel ligation and tight (conventional technique = CT). The following outcomes were used to compare the total thyroidectomy group with UAS versus CT group: operative duration, operative blood loss, overall drainage volume during the first 24 hours, transiet laryngeal nerve palsy, permanent laryngeal nerve palsy, transiet hypocalcaemia and permanent hypocalcaemia. RESULTS: There are currently 7 RCT on this issue to compare thyroidectomy with UAS versus CT. From the analysis of these studies it was possible to confront 608 cases: 303 undergoing to thyroidectomy with UAS versus 305 that were treated with CT. Actually, it was shown a relevant advantage of cost-effectiveness in patients treated with UAS; there is a statistically significant reduction of the operative duration (weighted mean difference [WMD], -18.74 minutes; 95% confidence interval [CI], (-26.97 to -10.52 minutes) (P = 0.00001), intraoperative blood loss (WMD, -60.10 mL; 95% CI, -117.04 to 3.16 mL) (P = 0.04) and overall drainage volume (WMD, -35.30 mL; 95% CI, -49.24 to 21.36 mL) (P = 0.00001) in the patients underwent thyroidectomy with UAS. Although the analysis showed that the patients who were treated with USA presented more favourable results in incidence of post-operative complications (transient laryngeal nerve palsy: P = 0.11; permanent laryngeal nerve palsy: not estimable; transient hypocalcaemia: P = 0.24; permanent hypocalcaemia: P = 0.45), these data didn't present statistical relevance. CONCLUSION: This meta-analysis shown a relevant advantage only in terms of cost-effectiveness in patients treated with UAS; it is subsequent to statistically significant reduction of operation duration, intraoperative blood loss and of overall drainage volume during the first 24 hours. Although the analysis showed that the patients who were treated with UAS presented more favourable results in incidence of post-operative complications (transiet laryngeal nerve palsy; transiet hypocalcaemia and permanent hypocalcaemia), these data didn't present statistical relevance.

[MI NUTRO (MIgrants NUTRition knOwledge per l'integrazione): un intervento di educazione alimentare tra gli immigrati, Perugia - uno studio pilota]. / MI NUTRO (MIgrants NUTRition knOwledge for integration): a nutrition education intervention among immigrants, Perugia (Italy) - pilot study.

Riassunto. Introduzione. MI NUTRO (MIgrants NUTRition knOwledge per l'integrazione) ha avuto come obiettivi: valutare le conoscenze nutrizionali dei migranti, aumentare le informazioni sulla dieta sana e misurare l'effetto delle lezioni di cucina sulle conoscenze. Metodi. MI NUTRO è uno studio pilota quasi sperimentale. Tutti i partecipanti sono stati inclusi su base volontaria e l'intervento si è basato su seminari teorici e lezioni pratiche. È stato utilizzato un questionario validato. Il test non parametrico di Wilcoxon è stato usato per confrontare il punteggio pre- e post-intervento. Risultati. Il punteggio medio di conoscenza nutrizionale era 11,4 ± 3,8 (deviazione standard - DS) prima e 27,5 ± 5,6 DS dopo l'intervento, con una differenza statisticamente significativa. Discussione. I dati mostrano un aumento significativo delle conoscenze nutrizionali dei migranti dopo l'intervento. Le lezioni di cucina offerte sono state sessioni di apprendimento interattive in cui ogni migrante ha avuto la possibilità di prendere parte al processo di preparazione degli alimenti. Inoltre, alla fine di ogni lezione ricercatori e migranti hanno cenato insieme, favorendo il processo di scambio culturale.

Metachronous malignancies in men with previous prostate cancer in Umbria, Italy, 1994-2003.

Data about second primary tumors after prostate carcinoma are controversial. Some authors emphasize an increased incidence of some cancer sites, others an overall diminution. With the aim to provide further information to define the issue, we have analyzed the frequency of second metachronous primary malignancies in patients with diagnosed prostate cancer in the Umbria region of Italy. A total of 410 metachronous cancers among 4528 prostate cancer patients were abstracted from incident cases of the RTUP, over the period 1994-2003. This cohort was compared with all cases (except prostate cancers) recorded in the RTUP archive. The expected number of cases was obtained from indirect standardization with regional incidence rates of several sites. The significance of the observed/expected ratios and the corresponding 95% confidence intervals were based on the Poisson distribution. A significant standardized incidence ratio was found for all sites but prostate, with 410/351 observed/expected cases. The significance disappears considering all sites except prostate and skin non-melanomas. Among several sites, significant standardized incidence ratios were found for skin non-melanomas, for bladder, for rectum, but not for colon cancers. Kidney, ureter and urethra showed a nonsignificant standardized incidence ratio. Nasopharynx showed a significant standardized incidence ratio, but the result was based on a very small number of cases. In our data, the increase in urinary bladder and rectal cancers, after prostate cancer diagnosis, seems to be real: it is plausible that the number of second cancers may be due to increased urologist surveillance, which, in our Region, does not seem to be reduced in elderly men.