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1.
Epidemiol Prev ; 36(1 Suppl 1): 1-104, 2012 Jan.
Artigo em Italiano | MEDLINE | ID: mdl-22418841

RESUMO

OBJECTIVE: to synthesize scientific evidences about methods to increase cervical, breast and colorectal cancer screening participation. METHODS: a multidisciplinary working group has been set up to define the scope of the report and to conduct the evaluation. The scope and the final evaluation have been submitted to a stakeholder committee, including the Ministry of Health, the National Screening Observatory, regional screening program coordinators, scientific societies, and Lega Italiana Lotta ai Tumori, for comments and integrations. A systematic review of the principal biomedical and social literature databases was conducted to identify experimental and observational studies, updating the existing review by Jepson and coll. (Health Technol Assess. 2000;4(14):i-vii, 1-133). RESULTS: 5900 have been identified, 900 relevant for the topic.Among those, 148 reported quantitative information on intervention efficacy, other 90 came from the previous review. Organised screening programmes, based on invitation letter or on GP involvement,were consistently effective in increasing participation compared to spontaneous screening. Interventions are classified according to their target: individual, community, test simplification, health operators, health service organization. The report presents meta-analyses on efficacy, analyses of cost-effectiveness, impact on organisation and social inequality, and ethical and legal issues, of all the intervention reported in the literature. CONCLUSIONS: there are several interventions consistently effective in any context, some of them have minimal impact on costs and health service resources.


Assuntos
Detecção Precoce de Câncer/psicologia , Promoção da Saúde/métodos , Programas de Rastreamento/psicologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/prevenção & controle , Colonoscopia/economia , Colonoscopia/ética , Colonoscopia/psicologia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Participação da Comunidade , Confidencialidade , Análise Custo-Benefício , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/ética , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Europa (Continente)/epidemiologia , Feminino , Promoção da Saúde/economia , Promoção da Saúde/ética , Promoção da Saúde/legislação & jurisprudência , Promoção da Saúde/organização & administração , Humanos , Itália/epidemiologia , Masculino , Mamografia/economia , Mamografia/ética , Mamografia/psicologia , Mamografia/estatística & dados numéricos , Programas de Rastreamento/economia , Programas de Rastreamento/ética , Programas de Rastreamento/legislação & jurisprudência , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Programas de Rastreamento/estatística & dados numéricos , Sangue Oculto , Aceitação pelo Paciente de Cuidados de Saúde , Comunicação Persuasiva , Revelação da Verdade , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/economia , Esfregaço Vaginal/ética , Esfregaço Vaginal/psicologia , Esfregaço Vaginal/estatística & dados numéricos
2.
Tumori ; 95(2): 146-52, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19579858

RESUMO

AIM AND BACKGROUND: Cervical cancer is the second most common cancer in European women aged 15-44 years. The aim of this study was to estimate the direct cost of managing invasive cervical cancer in Italy. METHODS: Data from the Italian Network of Cancer Registries were used to estimate the annual number of new cervical cancer cases. To assess the management costs, a typical management pathway for each FIGO (Fédération Internationale de Gynécologie et d'Obstétrique) cervical cancer stage was derived from published guidelines. Data from the Modena Cancer Registry were used to estimate the proportion of patients by FIGO stage. This algorithm was combined with tariffs for outpatient and inpatient procedures to obtain a mean cost for each FIGO stage. RESULTS: An estimated 2,927 new cases of cervical cancer occurred in Italy in 2005 (crude incidence 9.7/100,000; world age-standardized incidence 6.0/100,000). The estimated numbers of new cases by FIGO stage were: FIGO I, 1,927; FIGO II, 556; FIGO III, 259; and FIGO IV, 185. Costs for the most frequent procedures were estimated as: Euro 6,041 for radical hysterectomy or other surgery; Euro 4,901 for radio-chemotherapy; Euro 1,588 for brachytherapy; and Euro 3,795 for palliative chemotherapy. Mean management costs for incident cases (including 10 years of follow-up) were estimated at: FIGO I, Euro 6,024; FIGO II, Euro 10,572; FIGO III, Euro 11,367; FIGO IV, Euro 8707; and Euro 5,854 for the terminal phase (1 month). The total direct management cost was estimated at Euro 28.3 million per year. CONCLUSIONS: This is one of the first studies to estimate the direct cost of treating patients newly diagnosed with invasive cervical cancer in Italy. Although according to current management pathways real treatment costs are likely to be underestimated, this information is necessary to design evidence-based vaccination policies able to harmonize primary and secondary prevention of cervical cancer.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Itália/epidemiologia , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia
3.
BMC Public Health ; 9: 71, 2009 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-19243586

RESUMO

BACKGROUND: We estimated the number of women undergoing cervical cancer screening annually in Italy, the rates of cervical abnormalities detected, and the costs of screening and management of abnormalities. METHODS: The annual number of screened women was estimated from National Health Interview data. Data from the Italian Group for Cervical Cancer Screening were used to estimate the number of positive, negative and unsatisfactory Pap smears. The incidence of CIN (cervical intra-epithelial neoplasia) was estimated from the Emilia Romagna Cancer Registry. Patterns of follow-up and treatment costs were estimated using a typical disease management approach based on national guidelines and data from the Italian Group for Cervical Cancer Screening. Treatment unit costs were obtained from Italian National Health Service and Hospital Information System of the Lazio Region. RESULTS: An estimated 6.4 million women aged 25-69 years undergo screening annually in Italy (1.2 million and 5.2 million through organized and opportunistic screening programs, respectively). Approximately 2.4% of tests have positive findings. There are approximately 21,000 cases of CIN1 and 7,000-17,000 cases of CIN2/3. Estimated costs to the healthcare service amount to 158.5 million euro for screening and 22.9 million euro for the management of cervical abnormalities. CONCLUSION: Although some cervical abnormalities might have been underestimated, the total annual cost of cervical cancer prevention in Italy is approximately 181.5 million euro, of which 87% is attributable to screening.


Assuntos
Neoplasia Intraepitelial Cervical/economia , Custos de Cuidados de Saúde , Programas de Rastreamento/economia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adulto , Distribuição por Idade , Idoso , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/patologia , Análise Custo-Benefício , Detecção Precoce de Câncer , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Itália/epidemiologia , Pessoa de Meia-Idade , Teste de Papanicolaou , Sistema de Registros , Medição de Risco , Sensibilidade e Especificidade , Displasia do Colo do Útero/economia , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal
4.
Bioorg Med Chem Lett ; 19(6): 1718-21, 2009 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-19217287

RESUMO

Emerging clinical and pre-clinical data indicate that both insulin-like growth factor receptor (IGF-IR) and members of the epidermal growth factor (EGF) family of receptor tyrosine kinases (RTKs) exhibit significant cross-talk in human cancers. Therefore, a small molecule that successfully inhibits the signaling of both classes of oncogenic kinases might provide an attractive agent for chemotherapeutic use. Herein, we disclose the structure activity relationships that led to the synthesis and biological characterization of 14, a novel small molecule inhibitor of both IGF-IR and members of the epidermal growth factor family of RTKs.


Assuntos
Antineoplásicos/síntese química , Química Farmacêutica/métodos , Receptores ErbB/antagonistas & inibidores , Receptores ErbB/metabolismo , Receptores Proteína Tirosina Quinases/antagonistas & inibidores , Receptores de Somatomedina/antagonistas & inibidores , Receptores de Somatomedina/metabolismo , Antineoplásicos/farmacologia , Linhagem Celular Tumoral , Dimerização , Desenho de Fármacos , Humanos , Pulmão/metabolismo , Modelos Químicos , Neoplasias/metabolismo , Fosforilação , Pirimidinas/química , Receptores Proteína Tirosina Quinases/química , Transdução de Sinais
5.
Bioorg Med Chem Lett ; 17(19): 5406-9, 2007 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-17689078

RESUMO

A high throughput screen of Abbott's compound repository revealed that the pyrazolo[3,4-d]pyrimidine class of kinase inhibitors possessed moderate potency for IGF-IR, a promising target for cancer chemotherapy. The synthesis and subsequent optimization of this class of compounds led to the discovery of 14, a compound that possesses in vivo IGF-IR inhibitory activity.


Assuntos
Pirazóis/síntese química , Pirazóis/farmacologia , Pirimidinas/síntese química , Pirimidinas/farmacologia , Receptores de Somatomedina/antagonistas & inibidores , Administração Oral , Animais , Desenho de Fármacos , Avaliação Pré-Clínica de Medicamentos , Injeções Intravenosas , Camundongos , Fosforilação , Receptores Proteína Tirosina Quinases/antagonistas & inibidores , Relação Estrutura-Atividade
6.
Stud Health Technol Inform ; 124: 441-6, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17108559

RESUMO

In order to estimate the cost of generic clinical guidelines based on telemedicine services for chronic patients, an economic model (E-DIMEM) has been defined. This model is designed to help health suppliers and managers to plan for the future. It is essentially a workflow composed by diagnosis and therapeutic activities. The cost of each workflow activity is related to healthcare providers (activity agents), drugs, instruments, telemedicine services, and type of specialized healthcare centers used (hospital, clinics, etc.). This model performs multidimensional analysis. A web service based on the E-DIMEM has been implemented.


Assuntos
Gerenciamento Clínico , Modelos Econômicos , Telemedicina , Protocolos Clínicos , Custos e Análise de Custo , Humanos , Software
7.
J Med Chem ; 49(13): 3832-49, 2006 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-16789740

RESUMO

Methionine aminopeptidase-2 (MetAP2) is a novel target for cancer therapy. As part of an effort to discover orally active reversible inhibitors of MetAP2, a series of anthranilic acid sulfonamides with micromolar affinities for human MetAP2 were identified using affinity selection by mass spectrometry (ASMS) screening. These micromolar hits were rapidly improved to nanomolar leads on the basis of insights from protein crystallography; however, the compounds displayed extensive binding to human serum albumin and had limited activity in cellular assays. Modifications based on structural information on the binding of lead compounds to both MetAP2 and domain III of albumin allowed the identification of compounds with significant improvements in both parameters, which showed good cellular activity in both proliferation and methionine processing assays.


Assuntos
Aminopeptidases/química , Antineoplásicos/síntese química , Metaloendopeptidases/química , Albumina Sérica/química , Sulfonamidas/síntese química , ortoaminobenzoatos/síntese química , Animais , Antineoplásicos/química , Antineoplásicos/farmacologia , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Humanos , Técnicas In Vitro , Espectrometria de Massas , Metionina/metabolismo , Modelos Moleculares , Ligação Proteica , Conformação Proteica , Estrutura Terciária de Proteína , Ratos , Relação Estrutura-Atividade , Sulfonamidas/química , Sulfonamidas/farmacologia , ortoaminobenzoatos/química , ortoaminobenzoatos/farmacologia
8.
J Photochem Photobiol B ; 83(1): 39-47, 2006 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-16427301

RESUMO

The aim of this work was to investigate the apoptosis induction and mitochondria alteration after photodamage exerted by incubation of HeLa cells with Rose Bengal acetate-derivative (RBAc) followed by irradiation for a total dose of 1.6 J/cm2. This treatment was previously demonstrated to reduce cell viability under mild treatment conditions, suggesting the restoration of the photoactive molecule in particularly sensitive cell sites. Indeed, Rose Bengal (RB) is a very efficient photosensitizer, whose photophysical properties are inactivated by addition of the quencher group acetate. The RBAc behaves as a fluorogenic substrate by entering easily the cells where the original, photoactive molecule is restored by specific esterases. Different intracellular sites of photodamage of RB are present. In particular, fluorescence imaging of Rodamine 123 and JC-1 labelled cells showed altered morphology and loss of potential membrane of mitochondria. MTT and NR assays gave indications of alteration of mitochondrial and lysosomal enzyme activities. These damaged sites were likely responsible for triggering apoptosis. Significant amount of apoptotic cell death (about 40%) was induced after light irradiation followed RBAc incubation as revealed by morphological (modification of cell shape and blebs formation), cytochemical (FITC-Annexin-V positive cells) and nuclear fragmentation assays.


Assuntos
Apoptose/efeitos dos fármacos , Mitocôndrias/efeitos dos fármacos , Rosa Bengala/análogos & derivados , Apoptose/efeitos da radiação , Células HeLa , Humanos , Microscopia Eletrônica de Varredura , Mitocôndrias/efeitos da radiação , Mitocôndrias/ultraestrutura , Rosa Bengala/farmacologia , Raios Ultravioleta
9.
Bioorg Med Chem ; 12(10): 2691-708, 2004 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-15110851

RESUMO

A series of bis-aryl substituted guanidines have been discovered as potent NPY Y5 antagonists. The SAR and in vitro metabolic stability of these compounds are discussed.


Assuntos
Guanidinas/síntese química , Guanidinas/farmacologia , Receptores de Neuropeptídeo Y/antagonistas & inibidores , Animais , Células CHO , Cricetinae , Cricetulus , Guanidinas/química , Estrutura Molecular , Ensaio Radioligante , Relação Estrutura-Atividade
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