Validation of full-remote reporting for cervicovaginal cytology: the Caltagirone-Acireale distributed lab.

INTRODUCTION: Cervical cancer is the fourth most common cancer in women, and its prevention is based on vaccination and screening. Screening consists of molecular human papillomavirus (HPV) testing and cytologic analysis of cervical smears, which require expensive equipment and the interaction of numerous professionals such as biologists, cytologists, laboratory technicians, and pathologists. MATERIALS AND METHODS: We centralize the cervical samples from more than 51 clinics in 1 main laboratory, where automated HPV testing is performed. HPV-positive cases are collected and used to prepare a liquid-based cytology slide, which is stained and immediately scanned. The resulting whole-slide images (WSIs) are immediately available in a remote laboratory where they are examined by experienced cytologists using virtual microscopy. This setup was validated by making each of the 3 readers independently diagnose 506 specimens in random order, using both conventional light microscopy (CLM) and WSIs, with a minimum wash-out period of 3 weeks and with a final discussion for all cases. RESULTS: Intraobserver agreement among CLM and WSI ranged from 0.71 to 0.79, and interobserver agreement for the 3 readers compared with the consensus diagnosis was similar for the 2 modes of assessment. Readers subjectively felt confident in their WSI diagnosis for inadequate and negative cases, but less so in other cases. The perceived difficulty was slightly higher in WSI readings. CONCLUSIONS: Interobserver agreement in cervicovaginal cytology is moderate and does not vary if the slides are examined conventionally or digitally. Despite higher reported subjective difficulty and lower confidence in the WSI diagnosis, we did not observe a deterioration in diagnostic performance using WSI compared with CLM.

Pesticide exposure assessed through agricultural crop proximity and risk of amyotrophic lateral sclerosis.

BACKGROUND: Epidemiologic studies have raised the possibility that some pesticide compounds induce the neurodegenerative disease amyotrophic lateral sclerosis (ALS), though the available evidence is not entirely consistent. METHODS: We conducted a population-based case-control study in two Italian populations to assess the extent to which residence in the vicinity of agricultural crops associated with the application of neurotoxic pesticides is a risk factor for ALS, using crop acreage in proximity to the residence as an index of exposure. RESULTS: Based on 703 cases and 2737 controls, we computed an ALS odds ratio of 0.92 (95% confidence interval 0.78-1.09) for those in proximity to agricultural land. Results were not substantially different when using alternative exposure categories or when analyzing specific crop types, with the exception of a higher risk related to exposure to citrus orchards and olive groves in Southern Italy, though based on few exposed subjects (N = 89 and 8, respectively). There was little evidence of any dose-response relation between crop proximity and ALS risk, and using long-term residence instead of current residence did not substantially change our estimates. CONCLUSIONS: Though our index of exposure is indirect and subject to considerable misclassification, our results offer little support for the hypothesis that neurotoxic pesticide exposure increases ALS risk.

Increasing frequency of multiple sclerosis in Catania, Sicily: a 30-year survey.

BACKGROUND AND OBJECTIVE: The objective of this study was to determine the prevalence and incidence of multiple sclerosis (MS) and its temporal profiles from 1975 to 2005 in the city of Catania. METHODS: The incidence of MS from 1975 to 31 December 1999 had been previously investigated by the same group. The frequency of MS in the community of Catania from 1 January 2000 to 31 December 2004 was studied in a population of 313,110 inhabitants (2001 census). All patients who satisfied Poser's criteria were considered as prevalent and incident cases. RESULTS: Three hundred and ninety-eight patients with MS who had experienced the clinical onset of the disease before 31 December 2004 were found in a population of 313,110 inhabitants. The prevalence rate was 127.1/100,000 [95% confidence interval (CI) 115.1-140.4]. From 2000 to 2004, 108 patients with MS had clinical onset of the disease. The mean annual incidence was 7.0/100,000 (95% CI 5.7-13.7) and was higher in women (8.4/100,000; 95% CI 6.4-10.5) than in men (5.3/100,000; 95% CI 3.7-7.2). The mean length of time between the date of clinical onset and the date of the diagnosis was 1.4 ± 1.7 years. During the last 30 years the incidence of MS in this population increased from 1.3/100,000 during the first quinquennium (1975-9) to 7.0/100,000 during 2000-4. CONCLUSIONS: Incidence rates have further increased in this population, suggesting that the risk of MS is still increasing.

[Health effects of environmental contamination due to volcanic ash of Mount Etna in autumn 2002]. / Effetti sulla salute della popolazione derivanti dalla contaminazione amibientale delle ceneri dell'Etna nell'autunno 2002.

OBJECTIVE: During autumn 2002 a large eruption of Mount Etna (Sicily, Italy) occurred. High levels (over 200 microg/m3) of total suspended particles (PM10) were recorded. The aim of the study was to evaluate the acute health effects on mortality and hospital admissions in the area around the volcano. DESIGN: Deaths and hospital admissions occurring during the eruption period were compared with the corresponding figures during the same periods of the previous year (same day of the week). Relative risks, RR, and their 95% confidence intervals, CI, were computed. Variations in daily hospital admissions for cardiovascular diseases associated with daily level of PM10 were estimated. RESULTS: No effects on overall and cause-specific mortality were observed during the eruption period. Increases were observed in hospital admissions for cardiovascular diseases (ischemic diseases: RR 1.31, 95% CI 1.10-1.56; myocardial infarction: RR 1.34, 95% CI 1.02-1.76) and for cerebrovascular diseases (RR 1.24, 95% CI 1.05-1.47). The excesses were stronger among the elderly. Daily admissions for cardiovascular diseases were not associated to PM10 levels. CONCLUSION: The effects of the eruption of Mount Etna were limited to a temporary increase of cardiovascular morbidity, especially among the elderly, possibly as a consequence of stress.