Nickel dermatitis from earrings 15 years after EU directive implementation: a clinical-epidemiological study and a market survey in Rome, Italy.

BACKGROUND: Nickel (Ni) dermatitis remains a highly prevalent allergic condition in Italy. There is a continuous need for clinical and epidemiological surveillance to evaluate whether or not European Ni Directive has been effective in contact allergy prevention. OBJECTIVES: To assess the prevalence of Ni dermatitis among patch-tested patients and self-interviewed school students and to analyse Ni release from earlobe jewellery. METHODS: Results of patch tests performed in 2006-2007, 2015-2016 and 2017-2018 were retrieved. A questionnaire was compiled by 315 secondary school students. Ni release from earring parts was analysed with the EN1811:2015 method. RESULTS: A significant time trend of decreasing Ni positivity from 2006-2007 to 2017-2018 was observed both in the overall population (44.1% in 2006-2007, 33.0% in 2015-2016, 31.6% in 2017-2018, P < 0.0001) and in female patients (P < 0.0001). Conversely, change was not significant in males (P = 0.16). Decrease was significant for all age groups, except for those aged >60 years (P = 0.51). Among 242 students who reported earring use, 130 (54%) reported symptoms at earlobes, mostly associated with jewellery of materials other than gold and silver (59% of those with earlobe symptoms). Ni release exceeded the migration limit in 4/21 (20%) earring parts. CONCLUSIONS: A high prevalence of Ni dermatitis and earlobe symptoms were found in Rome. A decreasing time trend was noted, with a significant decline in Ni sensitivity compared to the situation observed right after Ni Directive implementation. This most likely represents the consequence of reduced Ni content in earring parts, although a major care in the use of Ni-containing objects could contribute to explain these findings.

Sun protection among Spanish beachgoers: knowledge, attitude and behaviour.

This study aims to investigate the level of awareness on the risks related to sun exposure, attitude towards sun protection and sun protection behaviour in Spanish beachgoers. During the summer of 2009, trained assistants conducted a structured interview with 630 sunbathers at the beaches of Valencia, Spain, via administrating a questionnaire including the following: (a) general data (age, gender, education, profession), (b) "knowledge" and "attitude" items and (c) self-assessed sun sensitivity, sun exposure and sun protection characteristics. The health belief model was used to evaluate factors that may influence on engaging healthy behaviour. The median age was 30 (2-82) years; the M/F ratio was 0.60. Despite the widespread regular ("often" or "always", 80%) use of high (>15) sun-protective factor sunscreens, current recommendations on sun protection were not regularly followed, and a history of sunburns is very common (70%). At multivariate analysis, female gender, age, fair hair, freckles, all-day use of sunscreens and wearing sunglasses were independent factors associated with having sunburn history. A high knowledge and a fairly good attitude emerged (median scores, 6/7 and 22/30, respectively). Age class (p = 0.032), educational level (p < 0.0001), sunscreen use (p = 0.048) and adequate timing of the first application of sunscreens (p = 0.015) were predictors of awareness, while factors associated with a more favourable attitude were educational level (p < 0.0001) and regular use of hats (p = 0.001). Wrong beliefs mainly concern sunscreens (false safety); the attractiveness of a tanned look is the main unfavourable attitude. Physical and motivational barriers are common (80%). The findings by highlighting constitutional and psychosocial factors involved in unhealthy behaviour provide useful information to promote sun-safe interventions in this population.

Improving sun-safe knowledge, attitude and behaviour in parents of primary school children: a pilot study.

Excessive sun exposure, mainly in childhood, represents one of the major skin cancer risk factors. Sun protection habits should start early in life to be effective. The purpose of this study was to investigate knowledge, attitude and sun protection behaviour in parents (P) and in their children (C). The educational intervention addressed the parents of 131 primary school pupils in Valencia, Spain, during the school year 2007-2008. A self-administered pre- and post-intervention questionnaire was handed in during school hours to be filled in by parents. Parents' compliance was very high (88 %). At baseline, regular high-sun-protective-factor (>15) sunscreen use was common (P, 64 %; C, 95 %); wearing clothing (T-shirt: P, 34 %, C, 62 %; hat: P, 29 %, C, 64 %) and sun avoidance at midday (P, 23 %; C, 29 %) were less frequent. Almost 70 % of parents reported difficulties, mainly due to the children's refusal. A high knowledge score (median, 6/7) and a medium/high attitude score (median, 24/30) in parents were observed; however, lifetime sunburn history was generally reported (P, 88 %; C, 24 %). Factors associated with parents' knowledge were a personal history of sunburns and regularly repeating sunscreen application to children (median score: 6 vs 5; p ≤ 0.01) Predictors of a more favourable attitude were female caretakers and having daughters (median score: 30 vs 25 and 25 vs 24, respectively; p ≤ 0.01). A trend towards limited post-intervention positive changes emerged; however, sun avoidance habit decreased (35 vs 20 %, p = 0.01). Despite a high level of parents' knowledge, sun protection in children is not adequate, and sunburns are not uncommon. Unfavourable beliefs and attitudes need to be overcome and quality of messages improved to achieve sun-safe exposure in children.

High risk human papillomavirus genotyping in clinical samples: evaluation of different commercial tests.

The aim of the present study is to compare the performance of several commercial human papillomavirus (HPV) tests in a cohort of 281 women. The hybrid capture II, the PreTect-HPV-Proofer, the linear array, and DR.HPVTMIVD were utilized to detect and type HPV in parallel with in-house PCR tests followed by direct automated sequencing or by sub-cloning and sequencing. The concordance levels along with other tests were evaluated with a Cohen's K value varying between 0.60 to 0.88, indicating good correlation with nearly perfect agreement between hybrid capture II, (HCII) and the linear array test. High sensitivity was recorded by the linear array and HCII with 100% (95% CI, 0.8021 to 1.0000) detection of cervical intraepithelial neoplasia (CIN) III by both methods. Conversely, the PreTect-HPV-Proofer showed high specificity with 12% (95% CI, 0.7966 to 0.9163) positivity on normal samples. The genotyping analysis showed that agreement among tests was only low to moderate with great differences between different HPV types. Multiple infections were detected with poor concordance and sub-cloning assays revealed the presence of a lower number of HPV in comparison to the other methods. In summary, the use of different HPV tests applied to the same group of cervical smears may possibly lead to incongruent results, suggesting the need to standardize type-specific sensitivity of genotyping methods and the need to evaluate their accuracy in detecting multiple HPV infections. This would be a prerequisite for the use of genotyping assays in cervical cancer screening programs.

Predictors of human papilloma virus (HPV) infection in Italian women.

HPV infection is a "necessary cause" of cervical cancer and it is sexually transmitted. Due to upcoming mass vaccination investigation on risk factors for infection is the basis to implement prophylactic strategy even in older women. The aim of the study was to evaluate predictors of high-risk (HR) HPV infection in adult women. Between 2006 and 2008, 100 women aged >18 years, with no previous treatment for cervical lesions, were screened for HR HPV infection in Rome, Italy. Risk factors for HPV infection were investigated through a questionnaire including: ethnicity, religion, education, marital status, sexual behavior, gynecological and obstetrical history, smoking and alcohol intake. Multivariate analysis identified the "never married-separated/divorced" status (OR: 3.38; 95% CI: 1.14-10.12) as predictor of HPV infection, while having a higher age at the first sexual intercourse (FSI) shows a protective effect (OR: 0.84; 95% CI: 0.71-1.00). A trend for the association between the infection and having more than three lifetime partners was also observed (OR: 2.57; 95% CI: 0.86-7.71). No significant association was found for other demographic characteristics investigated. These findings provide a contribution in the knowledge of an adult population defining a "high-risk" sexual behavioral profile and could be helpful to target prophylactic strategies in older woman.

"Self and parent-assessed skin cancer risk factors in school-age children".

OBJECTIVE: To evaluate sunburn, sun sensitivity factors and sun protection behavior in school-age children. METHODS: 2002 to 2004 survey of 2942 children in primary schools of Valencia, Spain, and their parents, using a self-administered questionnaire filled by the children with the help of their parents. RESULTS: Having a fair skin (OR: 2.05; 95% CI: 1.38-3.04), light coloured eyes (OR: 1.38; 95% CI: 1.12-1.68), freckles (OR: 1.32; 95% CI:1.12-1.56), and older age (OR: 2.34; 95% CI:1.96-2.80) were associated with occurrence of sunburns. Hair color, gender, use of sunscreens, wearing T-shirts and sunglasses were not. Wearing hats (OR: 0.64; 95% CI: 0.54-0.75) was inversely associated. Parents were significantly more inclined to protect younger and fair-skinned children with sunscreen and T-shirts. CONCLUSIONS: As expected, phenotype is related to sunburns and appears to influence parent's sun protection behaviours.

Childhood melanoma in Europe since 1978: a population-based survival study.

The existence of the EUROCARE database now makes it possible to compare population-based survival for childhood melanoma in different European populations. The database contains verified information, including histological data, from cancer registries in 17 European countries, and as such it represents a particularly important source of survival information on a very rare cancer like childhood melanoma. The aim of the present paper was to describe survival in children with melanoma (MM), by sex, age and subsite, diagnosed during the period 1978--1989, using analysis of the data of the European pool of cases. Five year-survival for childhood MM diagnosed in 1978--1989 in Europe, is relatively good (80%; 95% confidence interval (CI) 47--95 for boys and 78%; 95% CI 58--91 for girls). Analysis by subsite, revealed the survival for MM on the head and neck, legs and arms was generally higher than survival for MM on other cutaneous sites (trunk, neck and scalp). For skin melanomas outcome for girls was better than boys, adjusting for age and sub-site. We suggest that the good survival observed in childhood MM seems to be related to early diagnosis.

A randomized phase II study comparing sequential versus simultaneous chemo-radiotherapy in patients with unresectable locally advanced squamous cell cancer of the head and neck.

BACKGROUND: Single-modality radiotherapy is still considered standard treatment for patients with locally advanced unresectable cancer of the head and neck. As treatment outcome is poor, attempts to integrate chemotherapy into the overall management of these patients are ongoing. PATIENTS AND METHODS: A randomized study was undertaken to compare a sequential with a simultaneous chemoradiotherapy program. Between February 1986 and February 1991, 93 eligible patients with locally advanced unresectable cancer of the head and neck were stratified by WHO PS, T and N class and primary site and then randomized to receive either three courses of neoadjuvant chemotherapy with cisplatin (100 mg/m2 i.v. d 1) and 5-fluorouracil 1000 mg/m2/days 1-5 by continuous i.v. infusion every 3 weeks prior to definitive conventional radiotherapy of 65-70 Gy (sequential treatment), or cisplatin 100 mg/m2 on days 1, 22, 43 given simultaneously for the duration of the same conventional radiotherapy (simultaneous treatment). RESULTS: At the end of the entire treatment 18 complete responses (47%) in the sequential-treatment arm and 18 (41%) in the simultaneous treatment arm were obtained. No statistically significant differences in the 5-yr progression-free survival, in the median time to loco-regional and distant progression and in the 5-yr overall survival were observed. Leukopenia was more frequent in the simultaneous than in the sequential arm (p = 0.03), whereas alopecia (p = 0.008) and phlebitis (p < 0.0001) were more frequent in the sequential-treatment arm. A better compliance was associated with the concomitant treatment, with 87% of the patients completing the entire radiotherapy program versus 63% of those in the sequential arm (p = 0.01). CONCLUSIONS: In the present study, the two treatment arms showed similar activity (complete response, progression-free and overall survival rates). Compliance to treatment was better in the concomitant arm. These data suggest that concomitant chemo-radiation therapy might be considered an option in unresectable locally advanced cancer of the head and neck. Phase III studies are needed in order to establish the superiority of this combination of cisplatin and radiotherapy versus radiotherapy alone.

Phase II trial of high-dose epirubicin and cyclophosphamide in advanced breast cancer.

Between February 1990 and December 1991 high-dose epirubicin (Epi)(120 mg/m2) plus cyclophosphamide (CTX)(600 mg/m2) were given every 3 weeks to 52 patients with locally advanced and metastatic breast cancer. 26 patients with locally advanced disease received four courses of this regimen before and after local treatments. 26 patients had metastatic disease: they received eight courses unless progression or unacceptable toxicity occurred. Responses were seen in 37/48 (77%) evaluable patients including 14 complete responses (CR), 23 partial responses (PR), nine stable disease, two progressive disease. Among the 25 evaluable patients with locally advanced disease, 9 had a CR and 11 a > 80% decrease in tumour volume. 6 patients (24%) had a pathologically confirmed complete response. 18 patients (72%) had a tumour reduction to 0-2 cm. The 3-year disease-free survival was 60%. Of the 23 evaluable patients with metastatic disease, 5 obtained a CR and 10 a PR, yielding an overall response rate of 65%. Myelosuppression was substantial with a grade 3-4 leucopenia in 76% of the patients even if neutropenic fever occurred in only 7% of the courses. A clinical congestive heart failure occurred in 1 patient following a total Epi dose of 960 mg/m2 and a bilateral quadrantectomy and radiotherapy. We conclude that (1) high-dose Epi + CTX is a very active regimen, in particular for the patients with locally advanced breast cancer; (2) breast conservation after this regimen in some of these patients may be considered; (3) neutropenia is the dose-limiting toxicity. Currently, a phase II study using the same combination given every 2 weeks together with r-methuG-CSF is ongoing.

[Essential mixed cryoglobulinemia with liver involvement: a still open problem]. / Crioglobulinemia mista essenziale con coinvolgimento epatico: un problema ancora aperto.

Essential mixed cryoglobulinemia (EMC) is a syndrome characterized by cryoglobulinemia and clinical features including purpura, arthralgia, asthenia (Meltzer-Franklin syndrome) without evidence of any systemic disease Liver involvement in the course of EMC is described in 50-84% of patients. It consists of mild silent hepatosplenomegaly and slightly rise of serum amino transferase. Eleven patients with clinical and laboratory findings suggestive for EMC (five type II and six type III) underwent percutaneous liver biopsy to evaluate the degree of liver involvement. Two liver cirrhosis, two chronic active hepatitis, one chronic persistent hepatitis and a case of hepatic steatosis were found. A type III cryoglobulinemia was present in four of the six patients with liver involvement. All the patients were Hbs Ag negative but three of them were Hbs Ab positive. The pathogenesis of liver involvement in the course of EMC is still now uncertain. The authors believe that a previous HBV infection plays no role in the pathogenesis of EMC syndrome. This syndrome must be considered different from mixed cryoglobulinemia secondary to chronic liver disease. They suggest that liver biopsy is mandatory during the course of EMC even when clinical and laboratory data are silent.