[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.

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.

[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.

[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.

Modulatory activity of a Lactobacillus casei strain on 1,2-dimethylhydrazine-induced genotoxicity in rats.

The present study was designed to investigate the putative antigenotoxic effects of supplementing the diet of rats treated with the colon carcinogen 1,2-dimethylhydrazine hydrochloride (DMH) with a Lactobacillus casei strain using an in vivo approach. The antigenotoxic response was evaluated in colon and liver cells using the alkaline comet assay. Since the balance between the bioactivation and detoxification metabolic pathways is crucial for the formation of toxic and genotoxic metabolites, alterations in the level of some xenobiotic metabolizing enzymes (XME) were studied in liver preparations. In the challenge group (L. casei + DMH), lactobacilli-supplemented diet, there was a decrease in the extent of DMH-induced DNA damage, especially in colon cells. Compared with control rats, there was less basal DNA damage in colon cells of rats fed on a lactobacilli-supplemented diet. These findings are the first to give clear evidence of DNA-protective effects of lactobacilli against basal DNA damage. Moreover, the chemopreventive effects were accompanied by changes in the activities of several XME. The observed decrease in the concentration of nonenzymatic antioxidants (i.e. GSH) and the reduced activity of enzymatic antioxidants (i.e., GST, GPx, and SOD) in liver could reflect an overall reduction in the level of oxidative stress in rats on a diet supplemented with the L. casei suspension compared with control rats (basal state). Thus, the concentrations of GSH and the activities of GST, GPx, and SOD could be downregulated by supplementing the diet with L. casei as a response to an improved antioxidant status.

Primary DNA damage and genetic polymorphisms for CYP1A1, EPHX and GSTM1 in workers at a graphite electrode manufacturing plant.

BACKGROUND: The results of a cross-sectional study aimed to evaluate whether genetic polymorphisms (biomarkers of susceptibility) for CYP1A1, EPHX and GSTM1 genes that affect polycyclic aromatic hydrocarbons (PAH) activation and detoxification might influence the extent of primary DNA damage (biomarker of biologically effective dose) in PAH exposed workers are presented. PAH-exposure of the study populations was assessed by determining the concentration of 1-hydroxypyrene (1OHP) in urine samples (biomarker of exposure dose). METHODS: The exposed group consisted of workers (n = 109) at a graphite electrode manufacturing plant, occupationally exposed to PAH. Urinary 1OHP was measured by HPLC. Primary DNA damage was evaluated by the alkaline comet assay in peripheral blood leukocytes. Genetic polymorphisms for CYP1A1, EPHX and GSTM1 were determined by PCR or PCR/RFLP analysis. RESULTS: 1OHP and primary DNA damage were significantly higher in electrode workers compared to reference subjects. Moreover, categorization of subjects as normal or outlier highlighted an increased genotoxic risk OR = 2.59 (CI95% 1.32-5.05) associated to exposure to PAH. Polymorphisms in EPHX exons 3 and 4 was associated to higher urinary concentrations of 1OHP, whereas none of the genotypes analyzed (CYP1A1, EPHX, and GSTM1) had any significant influence on primary DNA damage as evaluated by the comet assay. CONCLUSION: The outcomes of the present study show that molecular epidemiology approaches (i.e. cross-sectional studies of genotoxicity biomarkers) can play a role in identifying common genetic risk factors, also attempting to associate the effects with measured exposure data. Moreover, categorization of subjects as normal or outlier allowed the evaluation of the association between occupational exposure to PAH and DNA damage highlighting an increased genotoxic risk.

Effects of co-exposure to extremely low frequency (50 Hz) magnetic fields and xenobiotics determined in vitro by the alkaline comet assay.

In the present study, we used human peripheral blood leukocytes from 4 different donors, to investigate in vitro the possible genotoxic and/or co-genotoxic activity of extremely low frequency magnetic fields (ELF-MF) at 3 mT intensity. Two model mutagens were used to study the possible interaction between ELF-MF and xenobiotics: N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) and 4-nitroquinoline N-oxide (4NQO). Primary DNA damage was evaluated by the alkaline single-cell microgel-electrophoresis ("comet") assay. Control cells (leukocytes not exposed to ELF-MF, nor treated with genotoxins) from the different blood donors showed a comparable level of basal DNA damage, whereas the contribution of individual susceptibility toward ELF-MF and the tested genotoxic compounds led to differences in the extent of DNA damage observed following exposure to the genotoxins, both in the presence and in the absence of an applied ELF-MF. A 3 mT ELF-MF alone was unable to cause direct primary DNA damage. In leukocytes exposed to ELF-MF and genotoxins, the extent of MNNG-induced DNA damage increased with exposure duration compared to sham-exposed cells. The opposite was observed in cells treated with 4NQO. In this case the extent of 4NQO-induced DNA damage was somewhat reduced in leukocytes exposed to ELF-MF compared to sham-exposed cells. Moreover, in cells exposed to ELF-MF an increased concentration of GSH was always observed, compared to sham-exposed cells. Since following GSH conjugation the genotoxic pattern of MNNG and 4NQO is quite different, an influence of ELF-MF on the activity of the enzyme involved in the synthesis of GSH leading to different activation/deactivation of the model mutagens used was hypothesized to explain the different trends observed in MNNG and 4NQO genotoxic activity in the presence of an applied ELF-MF. The possibility that ELF-MF might interfere with the genotoxic activity of xenobiotics has important implications, since human populations are likely to be exposed to a variety of genotoxic agents concomitantly with exposure to this type of physical agent.

Effects of co-exposure to extremely low frequency (ELF) magnetic fields and benzene or benzene metabolites determined in vitro by the alkaline comet assay.

In the present study, we investigated in vitro the possible genotoxic and/or co-genotoxic activity of 50 Hz (power frequency) magnetic fields (MF) by using the alkaline single-cell microgel-electrophoresis (comet) assay. Sets of experiments were performed to evaluate the possible interaction between 50 Hz MF and the known leukemogen benzene. Three benzene hydroxylated metabolites were also evaluated: 1,2-benzenediol (1,2-BD, catechol), 1,4-benzenediol (1,4-BD, hydroquinone), and 1,2,4-benzenetriol (1,2,4-BT). MF (1 mT) were generated by a system consisting of a pair of parallel coils in a Helmholtz configuration. To evaluate the genotoxic potential of 50 Hz MF, Jurkat cell cultures were exposed to 1 mT MF or sham-exposed for 1h. To evaluate the co-genotoxic activity of MF, the xenobiotics (benzene, catechol, hydroquinone, and 1,2,4-benzenetriol) were added to Jurkat cells subcultures at the beginning of the exposure time. In cell cultures co-exposed to 1 mT (50 Hz) MF, benzene and catechol did not show any genotoxic activity. However, co-exposure of cell cultures to 1 mT MF and hydroquinone led to the appearance of a clear genotoxic effect. Moreover, co-exposure of cell cultures to 1 mT MF and 1,2,4-benzenetriol led to a marked increase in the genotoxicity of the ultimate metabolite of benzene. The possibility that 50 Hz (power frequency) MF might interfere with the genotoxic activity of xenobiotics has important implications, since human populations are likely to be exposed to a variety of genotoxic agents concomitantly with exposure to this type of physical agent.

In vitro protective effects of Terminalia arjuna bark extracts against the 4-nitroquinoline-N-oxide genotoxicity.

We determined the antimutagenic potential of chloroform, acetone, methanol, methanol+HCl, diethyl ether, and ethyl acetate extracts of Terminalia arjuna bark against the model mutagen 4-nitroquinoline-N-oxide (4-NQO) using the Salmonella/microsome, comet, and micronucleus (MN) tests. Salmonella typhimurium TA100 strain and human peripheral white blood cells were coincubated with various concentrations (from 5 to 500 microg) of the six extracts and 4-NQO (from 0.05 to 2 microg). We found that the 4-NQO mutagenicity was inhibited by more than 70% in the Salmonella/microsome test at the highest nontoxic extract dose of ethyl acetate (50 microg/plate), chloroform (100 microg/plate), acetone, (100 microg/plate), and methanol (500 microg/plate). A less marked antimutagenicity activity (inhibition of about 40-45%) was observed for the acidic methanol and diethyl ether extracts. The comet assay showed that acetone extract (100 microg/mL) was more effective in reducing the DNA damage caused by 4-NQO (ca. 90%), whereas the chloroform, ethyl acetate, and diethyl ether extracts were cytotoxic. In the MN test, the decrease in 4-NQO clastogenicity was observed by testing the mutagen especially with chloroform and ethyl acetate extracts (inhibition about 40-45%). The acetone and methanol extracts showed a less marked activity (33% and 37%, respectively). The results of the present study suggest that T. arjuna bark contains some nonpolar as well as polar compounds with antimutagenic activity against 4-NQO. Several explanations can be suggested, but further investigations are necessary to definitely identify the active compounds.