Taste and Smell Disorders in COVID-19 Patients at a Local Healthcare Trust in Northern Italy: a Cross-Sectional Study.

Background: In Italy, since the beginning of the COVID-19 pandemic, patients testing positive for SARS-CoV-2 through nasopharyngeal swab have reported taste and smell alterations. As these symptoms are quite uncommon in other respiratory infections, their specificity and prevalence are useful features for the differential diagnosis of COVID-19. The objective was to describe taste and smell alterations in patients diagnosed with SARS-CoV-2 infection and to define the onset of those disorders during the clinical course of the disease. Study design: Cross-sectional study. Methods: This study was conducted on adult patients testing positive for SARS-CoV-2 infection through nasopharyngeal swab at a Local Healthcare Trust in Northern Italy between April 27th and May 27th, 2020. In order to investigate the clinical course, the onset of the first symptoms, smell and/or taste alterations, a phone-based questionnaire was administered during the programming of the second nasopharyngeal swab. Results: We recruited 168 patients; the mean age was 52 years old, and 94 (56.0%) were female. Among the 135 symptomatic patients, 87 (64.4%) reported taste and smell alterations. Patients with a mild clinical course showed the highest prevalence for taste and smell disorders (76.6%), which were also associated with a more benign clinical course of the disease (P = 0.0166). Furthermore, in 33 (37.9%) of these patients, changes in smell and taste perception appeared before the acute phase of the disease. Among the 14 patients with a severe clinical course of SARS-CoV-2 infection, 8 reported a variation of taste and smell perception before the hospitalization, with a median of 4 days (IQR 2-7). Conclusions: Smell and taste disorders can be listed among the first symptoms of SARS-CoV-2 infection and may anticipate the acute phase of the disease. Noteworthy, they seem to be associated with a more benign clinical course.

Obesity in Prader-Willi syndrome: physiopathological mechanisms, nutritional and pharmacological approaches.

Prader-Willi syndrome (PWS) is a genetic disorder caused by the lack of expression of genes on the paternally inherited chromosome 15q11.2-q13 region. The three main genetic subtypes are represented by paternal 15q11-q13 deletion, maternal uniparental disomy 15, and imprinting defect. Clinical picture of PWS changes across life stages. The main clinical characteristics are represented by short stature, developmental delay, cognitive disability and behavioral diseases. Hypotonia and poor suck resulting in failure to thrive are typical of infancy. As the subjects with PWS age, clinical manifestations such as hyperphagia, temperature instability, high pain threshold, hypersomnia and multiple endocrine abnormalities including growth hormone and thyroid-stimulating hormone deficiencies, hypogonadism and central adrenal insufficiency due to hypothalamic dysfunction occur. Obesity and its complications are the most common causes of morbidity and mortality in PWS. Several mechanisms for the aetiology of obesity in PWS have been hypothesized, which include aberration in hypothalamic pathways of satiety control resulting in hyperphagia, disruption in hormones regulating appetite and satiety and reduced energy expenditure. However, despite the advancement in the research field of the genetic basis of obesity in PWS, there are contradictory data on the management. Although it is mandatory to adopt obesity strategy prevention from infancy, there is promising evidence regarding the management of obesity in adulthood with current obesity drugs along with lifestyle interventions, although the data are limited. Therefore, the current manuscript provides a review of the current evidence on obesity and PWS, covering physiopathological aspects, obesity-related complications and conservative management.

Factors Predicting Patient's Allocation to Short- and Long-Term Therapeutic Community Treatments in the Italian VOECT Cohort Study.

The Evaluation of Therapeutic Community Treatments and Outcomes (VOECT) study was conducted in 131 Italian Therapeutic Communities (TCs) in 2008/2009. All of the patients entering residential treatment for drug or alcohol dependence were invited to participate. Data regarding patient socio-demographic characteristics, drug and alcohol consumption, health and psychopathological status, prior treatments and outcomes, and their motivation score were collected upon enrolment onto the study. The aim of this work was to identify the factors associated with allocation to short- versus long-term programmes in drug or alcohol dependent patients entering TCs in Italy. Of the 2470 patients included in the analysis, 30.8% were allocated to short-term treatment and 69.2% to long-term treatment. Several factors were significantly associated with the allocation to short- and long-term treatments: unstable living conditions; entering the TC when not detoxified; a high Symptom Checklist-90 somatization score; prior cessation episodes; previous in-patient detoxification treatments; psychosocial treatments; entering the TC by oneself; and a low motivation score.

Are physical activity interventions equally effective in adolescents of low and high socio-economic status (SES): results from the European Teenage project.

The aim was to study whether physical activity (PA) interventions in European teenagers are equally effective in adolescents of low versus high socio-economic status (SES). Based on a systematic review (Project TEENAGE), three school-based studies for secondary analyses were selected. SES stratified analyses were run in: (i) a Belgian multi-component intervention, (ii) a French multi-component intervention and (iii) a Belgian computer-tailored education trial. Results of the secondary analyses showed that no overall significant differences between low and high SES groups were found, but some interesting specific effects were revealed. Results from the first study showed an increase in objective PA in the low SES group (P = 0.015) compared with no significant effects in the high SES group. In the second study, larger effects were found in adolescents of high SES (increase of 11 min day(-1) P < 0.001), compared with adolescents of lower SES (increase of 7 min day(-1), P = 0.02) at the longer term. The third study showed a positive effect on school-related PA in adolescents of high SES (P < 0.05) and on leisure time transportation in adolescents of low SES (P < 0.05). To conclude, we were not able to show a significant widening or narrowing of inequalities in European adolescents.

Effects of clinical pathways in the joint replacement: a meta-analysis.

BACKGROUND: A meta-analysis was performed to evaluate the use of clinical pathways for hip and knee joint replacements when compared with standard medical care. The impact of clinical pathways was evaluated assessing the major outcomes of in-hospital hip and knee joint replacement processes: postoperative complications, number of patients discharged at home, length of in-hospital stay and direct costs. METHODS: Medline, Cinahl, Embase and the Cochrane Central Register of Controlled Trials were searched. The search was performed from 1975 to 2007. Each study was assessed independently by two reviewers. The assessment of methodological quality of the included studies was based on the Jadad methodological approach and on the New Castle Ottawa Scale. Data analysis abided by the guidelines set out by The Cochrane Collaboration regarding statistical methods. Meta-analyses were performed using RevMan software, version 4.2. RESULTS: Twenty-two studies met the study inclusion criteria and were included in the meta-analysis for a total sample of 6,316 patients. The aggregate overall results showed significantly fewer patients suffering postoperative complications in the clinical pathways group when compared with the standard care group. A shorter length of stay in the clinical pathway group was also observed and lower costs during hospital stay were associated with the use of the clinical pathways. No significant differences were found in the rates of discharge to home. CONCLUSION: The results of this meta-analysis show that clinical pathways can significantly improve the quality of care even if it is not possible to conclude that the implementation of clinical pathways is a cost-effective process, because none of the included studies analysed the cost of the development and implementation of the pathways. Based on the results we assume that pathways have impact on the organisation of care if the care process is structured in a standardised way, teams critically analyse the actual organisation of the process and the multidisciplinary team is highly involved in the re-organisation. Further studies should focus on the evaluation of pathways as complex interventions to help to understand which mechanisms within the clinical pathways can really improve the quality of care. With the need for knee and hip joint replacement on the rise, the use of clinical pathways might contribute to better quality of care and cost-effectiveness.

Recombinant interferon beta or glatiramer acetate for delaying conversion of the first demyelinating event to multiple sclerosis.

BACKGROUND: Immunomodulatory drugs have been shown to be only modestly effective in clinically definite relapsing remitting multiple sclerosis (RRMS). It has been hypothesized that their efficacy could be higher if used at the first appearance of symptoms, that is in the clinically isolated syndromes (CIS) suggestive of demyelinating events, a pathology which carries a high risk to convert to clinically definite MS (CDMS). OBJECTIVES: The objective of this review was to assess the effects of immunomodulatory drugs compared to placebo in adults in preventing conversion from CIS to CDMS which means the prevention of a second attack. SEARCH STRATEGY: We searched the Cochrane MS Group Trials Register (June 2007), Cochrane Central Register of Controlled Trials (CENTRAL)The Cochrane Library Issue 3, 2007, MEDLINE (January 1966 to June 2007), EMBASE (January 1974 to June 2007) and reference lists of articles. We also contacted manufacturers and researchers in the field. SELECTION CRITERIA: The trials selected were double-blind, placebo-controlled, randomised trials of CIS patients treated with immunomodulatory drugs. DATA COLLECTION AND ANALYSIS: Study selection have been independently done by two reviewers. Two further reviewers independently assessed trial quality and extracted and analysed data. Study authors were contacted for additional informations. Adverse effects information was collected from the trials. MAIN RESULTS: Only three trials tested the efficacy of interferon (IFN) beta including a total of 1160 participants (639 treatment, 521 placebo); no trial tested the efficacy of glatiramer acetate (GA). The metanalyses showed that the proportion of patients converting to CDMS was significantly lower in IFN beta-treated than in placebo-treated patients both after one year (pooled OR 0.53; 95% CI, 0.40 to 0.71; p <0.0001) as well as after two years of follow-up (pooled OR 0.52; 95% CI, 0.38 to 0.70; p <0.0001). Early treatment with IFN beta was associated with the side effect profile reported by the randomised controlled trials with this drug. Since side effects were reported with some heterogeneity in the three studies the metanalysis was possible only for the frequency of serious adverse events, not significantly different in IFN beta-treated or placebo-treated patients. AUTHORS' CONCLUSIONS: The efficacy of IFN beta treatment on preventing the conversion from CIS to CDMS was confirmed over two years of follow-up. Since patients had some clinical heterogeneity (length of follow-up, clinical findings of initial attack), it could be useful for the clinical practice to further analyse the efficacy of IFN beta treatment in different patient subgroups.

[Quality of central venous catheter management protocols in Oncology centres of an Italian region]. / La qualità dei protocolli per la gestione dei cateteri venosi centrali.

The aim of this study was to evaluate the quality of central venous catheter (Port-a-cath, Groshong and Hohn) management protocols in Oncology centres in an Italian region. A retrospective study was performed in 25 hospitals, only 10 of which provided evidence that they utilized a central venous catheter management protocol. The submitted protocols were evaluated in terms of completeness and of adherence to manufacturers' indications and to recommendations of the Centre for Diseases Control. Study results show that overall, there is poor adherence to the basic quality requirements considered and only two of the ten protocols examined were found to be complete. Also, there is wide variability between the protocols with significant differences in the type of instructions provided in the different hospitals.

School-based prevention for illicit drugs' use.

BACKGROUND: Drug addiction is a chronic, relapsing disease. Primary interventions should be aimed to reduce first use, or prevent the transition from experimental use to addiction. School is the appropriate setting for preventive interventions. OBJECTIVES: To evaluate the effectiveness of school-based interventions in improving knowledge, developing skills, promoting change, and preventing or reducing drug use versus usual curricular activities or a different school-based intervention . SEARCH STRATEGY: MEDLINE , EMBASE, ERIC, PSYCHINFO, Cochrane Library, ACP Journal Club, Cochrane Drug and Alcohol Group Register, updated to February 2004, were searched. Bibliography of papers was checked and personal contacts were made to identify other relevant studies. SELECTION CRITERIA: RCTs, CCTs or Controlled Prospective Studies (CPS) evaluating school-based interventions designed to prevent substance use. DATA COLLECTION AND ANALYSIS: Data were selected and extracted independently by two reviewers. Quality was assessed with the CDAG checklist. Interventions were classified as skills, affective, knowledge-focused and other characteristics were also studied (teaching, follow-up implementation, context activation). MAIN RESULTS: 32 studies (29 RCTs and 3 CPSs) were included. 28 were conducted in the USA; most were focused on 6th-7th grade students, and based on post-test assessment. RCTs: (1) Knowledge vs usual curricula: Knowledge focused programs improve drug knowledge (SMD=0.91; 95% CI: 0.42, 1.39).(2) Skills vs usual curricula: Skills based interventions increase drug knowledge (WMD=2.60; 95% CI: 1.17-4.03), decision making skills (SMD=0.78; CI95%: 0.46-1.09), self-esteem (SMD=0.22; CI95%: 0.03-0.40), peer pressure resistance (RR=2.05; CI95%: 1.24-3.42), drug use (RR=0.81; CI95%: 0.64, 1.02), marijuana use (RR=0.82; CI95%: 0.73, 0.92) and hard drug use (RR=0.45; CI95%: 0.24-0.85). (3) Skills vs knowledge: No differences are evident.(4) Skills vs affective: Skills-based interventions are only better than affective ones in self-efficacy (WMD=1.90; CI95%: 0.25, 3.55). (5) Affective vs usual curricula: Affective interventions improve drug knowledge (SMD=1.88; CI95%: 1.27, 2.50) and decision making skills (SMD=1.35; CI95%: 0.79, 1.9). (6) Affective vs knowledge: Affective interventions improve drug knowledge (SMD=0.60; CI95%: 0.18,1.03), and decision making skills (SMD=1.22; CI95%: 0.33, 2.12). Results from CPSs: No statistically significant results emerge from CPSs. AUTHORS' CONCLUSIONS: Skills based programs appear to be effective in deterring early-stage drug use. The replication of results with well designed, long term randomised trials, and the evaluation of single components of intervention (peer, parents, booster sessions) are the priorities for research. All new studies should control for cluster effect.

Effect of Sardinian heritage on risk and age at onset of type 1 diabetes: a demographic case-control study of Sardinian migrants.

BACKGROUND: Children of Sardinian heritage are at high risk of type 1 diabetes, whereas no data are available in young adults. Age at onset of type 1 diabetes could be associated with different relative weight of genetic susceptibility and environmental determinants in the pathogenesis of the disease. We test this hypothesis in subjects with Sardinian heritage 0-29 years of age living in the city of Turin, a highly industrialized area in Northern Italy. METHODS: In all, 202 cases with onset of type 1 diabetes aged 0-29 years during 1984-1991 and 1010 controls randomly selected from residents of the city of Turin, frequency-matched by sex and year of birth to cases, were included in this study. Name and place of birth of parents were ascertained by postal inquiry and linkage with city population and census files. Social class was based on the highest educational level of parents abstracted from 1991 and 1981 census files. RESULTS: Differential effects on risk of type 1 diabetes of Sardinian heritage and social class in the age groups 0-14 and 15-29 years were found. In children with one and both Sardinian parents the odds ratios (OR) were 2.09 (95% CI : 0.85-5.15) and 3.20 (95% CI : 0.75-13.64); in young adults 0.81 (95% CI : 0.18-3.64) and 1.95 (95% CI : 0.51-7.40), respectively. In subjects with low social class the OR were 1.16 (95% CI : 0.68-1.97) in children and 0.66 (95% CI : 0.41-1.05) in young adults. CONCLUSIONS: This study shows higher risk of type 1 diabetes in subjects of Sardinian heritage; higher risk in children than in young adults and a protective effect of low social class in young adults. These findings are consistent with the hypothesis of heterogeneity of type 1 diabetes by age at onset, with prevailing genetic effect in childhood and environmental determinants in adulthood.

Relative validity and reproducibility of a food frequency dietary questionnaire for use in the Italian EPIC centres.

A pilot questionnaire was developed for the EPIC centres of northern Italy, and validated in the feasibility part of the cohort project. The questionnaire was self-administered and of the food frequency type with portion size estimated by means of pictures. It was structured by courses within a meal characteristic of Italian dietary habits. Dietary intake estimated by the questionnaire was compared to the corresponding estimates obtained from 8-14 24-hour recall interviews administered over a 1-year period. The reference method was validated by means of urinary nitrogen in 4-6 repeated 24-hour urine collections. One hundred and ninety-seven volunteers (47 men and 150 women) were enrolled and completed the study lasting 1 year. They filled out two questionnaires at the beginning and at the end of the study, and had a 24-hour recall interview once a month. Twenty-four-hour urine samples were collected at regular intervals. Usual intake of energy, the major nutrients and some vitamins were estimated for the questionnaires and the reference method by means of food composition tables compiled for this study. The agreement between the questionnaire and the 24-hour recalls was only good for alcohol consumption: Pearson's correlation was 0.73 and 0.77 in men and women respectively. Otherwise the relative validity of the questionnaire ranged between 0.28 for fat to 0.52 for carbohydrates in men and 0.25 and 0.50 in women for the same nutrients. The validity of the two interview methods in estimating protein intake, compared to mean urinary nitrogen was 0.24 (M) and 0.18 (W) for the questionnaire and 0.63 (M) and 0.48 (W) for 24-hour recalls. The main causes of low performance of the questionnaire were identified to be the estimated intake of dressing and cooking fats, vegetables and meat. Remedies were devised and introduced in the final version of the questionnaire currently in use in the EPIC project.

Tuberculosis incidence in Turin, Italy, 1973-1999.

SETTING: Turin, Italy, 1973-1999. OBJECTIVE: To estimate tuberculosis (TB) incidence rates in Turin between 1973 and 1999. DESIGN: Incidence study. An active search of new TB cases was carried out by examining the clinical records of the three major TB care services in the city. New cases were defined as patients treated for the first time. To evaluate the completeness of this series, data were linked with the TB Notification Register and the Regional Hospital Discharges Register for the years 1997-1999. RESULTS: TB incidence rates declined from 25.6 cases per 100,000 population in 1973 to 6.4 in 1999. TB/human immunodeficiency virus (HIV) co-infection increased after 1985, reaching a peak (16.5%) in 1994-1996, and significantly decreasing in 1997-1999. Foreign-born cases started to increase after 1988, reaching 25.8% of total cases in 1997-1999. TB infections in Italian-born, non-HIV-infected cases occurred mostly among the elderly, while HIV/TB co-infections and TB in immigrants occurred mostly in younger age groups. The study captured 59% of cases diagnosed in Turin in 1997-1999. CONCLUSIONS: In recent years, new cases of TB have been diagnosed mostly among HIV-positive people and immigrants. Preventive and control strategies should focus on these population groups, improving quick identification and effective treatment of cases, and implementing accessible services.

Cancer risk and social inequalities in Italy.

STUDY OBJECTIVE: To investigate social differences in cancer incidence in Turin, Italy in 1985-87. DESIGN: A cancer incidence follow up study of the turin population in relation to socioeconomic characteristics was performed through record linkage between the 1981 census and the cancer registry. A case-control study nested in the cohort was analysed, where cases were subjects with a new diagnosis of cancer in 1985-87 and controls were a sample of the Turin population, frequency matched by sex and age group. Incidence odd ratios (ORs) were calculated for social classes (defined by education, housing tenure, and socioeconomic group) using a logistic regression model. SETTING: The study population comprised subjects included in the 1981 Turin census (n approximately equal to 1,100,000) who were still alive, 20-69 years old, and were resident in Turin in the middle of study period. PARTICIPANTS: The analyses were based on 4215 male and 3451 female cases, and on 16,913 male and 13,838 female controls. MAIN RESULTS: Compared with the highest educational level, the men in the lowest one showed an OR > 2 for respiratory cancers; OR = 1.48 for stomach cancer; and ORs < 0.7 for skin, colorectal, and prostate cancers. Women with a primary school education were protected against colorectal (OR = 0.71), skin (OR = 0.59), and breast cancer (OR = 0.66) compared with university degree women, but were at risk for cancer of the cervix (OR = 2.33) and stomach cancer (OR = 2.84). The association between educational level (primary school v university) and lung cancer risk is negative for men (OR = 2.47) and positive for women (OR = 0.62), while the association with housing tenure is negative for both sexes (OR = 1.44). CONCLUSIONS: The socioeconomic distribution of some risk factors (for example smoking, alcohol, and diet) in Italy can partially explain the differences in respiratory and digestive cancers. "Unbalanced" health promotion interventions, targeted at social groups with the highest prevalences of risk factors, and national policies for increasing the level of education in the country may play an important role in reducing social differences in cancer risk.

Social class and cancer survival in Turin, Italy.

STUDY OBJECTIVE: This study aimed to investigate social differences in cancer survival in residents of Turin, Italy. DESIGN: Incident cases from the Piedmont cancer registry were linked to municipality files and 1981 census data, and followed up from 1985-92. The census provided data on education and housing tenure, which were used as indicators of social class. The case fatality ratio (CFR) was estimated through a proportional hazard model, with socioeconomic indicators as risk factors. MAIN RESULTS: Educated people of both sexes showed better survival for all malignant neoplasms together and, particularly among men, for tumours which show a better prognosis such as cancer of colon-rectum, larynx, prostate, and bladder. The relative risk of dying, compared with people who had only primary school education, decreased from 0.91 for those with middle school education to 0.67 for those who held a university degree. CONCLUSION: There were major differences in cancer survival showing a poorer outcome for those from the lower social stratum, particularly in sites for which effective treatments are available. Since is unlikely that the observed differences could be totally explained by extraneous factors, such as competing mortality, it is concluded that even in a country where the health system offers universal coverage, non-financial barriers act by creating differences in opportunities for better care.

Thyroid function and anti-thyroid antibodies in MS patients screened for interferon treatment. A multicenter study.

Interferon beta (IFNB) treatment for multiple sclerosis (MS) has been associated with thyroid disorders (TD), in particular in patients with subclinical TD or anti-thyroid (AT) autoantibodies (autoAb) before starting treatment. TD and AT autoAb frequency was reported increased in MS. To determine whether MS patients have subclinical thyroid function abnormalities or anti-thyroid autoimmunity predisposing to develop TD, we performed a prospective multicenter screening of thyroid function and autoimmunity in 152 relapsing-remitting (RR) MS patients selected to receive IFNB treatment and in 437 healthy normothyroidal controls. Thyroid-related hormones and anti-thyroid microsomal antigen (anti-TMA) autoAb were tested with sensitive immunoradiometric or chromatographic assays. Cases were stratified for different progressively decreasing or increasing cutoff values of thyroid-stimulating hormone (TSH) (0.3, 0.2, 0.1, 3 and 5 mIU/l), and odds ratios (OR) with 95% confidence intervals (CI) calculated using logistic regression adjusted for gender, age, and anti-TMA autoAb positivity. The frequency of cases below or above the TSH cutoff values was not significantly different in MS patients and controls, and the risk to have an abnormal TSH level was not significantly increased in MS patients (OR ranging 0.37-0.84; CI, 0.05-3.01), even if anti-TMA autoAb positive (OR ranging 0.35-0.85; CI, 0.04-3.00). Frequencies of subclinical hypothyroidism and of anti-TMA autoAb positivity were, however, trending higher in MS men (ranging 5-7%) than in controls (3%). MS patients do not have an increased risk of subtle thyroid function abnormalities, subclinical TD, or anti-TMA autoAb positivity that may predispose to develop thyroid dysfunction during IFNB treatment. The positive trend for subclinical hypothyroidism and anti-TMA autoAb positivity, however, advises a longitudinal study of thyroid function and autoimmunity during IFNB treatment to see whether patients with baseline subclinical thyroid dysfunction develop clinically significant alteration during treatment.

Patterns of drug use among young men in Piedmont (Italy).

Increasing alarm is shown regarding patterns of polydrug use among young people, particularly regarding recreational drugs. Prevalence of recreational drug usage in Europe is not clearly defined, varying for ecstasy, from 0.2% (Finland, 1995) to 9.2% (UK, 1995) and suggesting a tendency to increase in the last years. The aim of this study is to present patterns of polydrug use among a sample of the general population of young males in Piedmont (Northern Italy), focusing particularly on ecstasy consumption. A cross sectional study was carried out between September and November 1998 on a continuous sample of 3274 18-year-old conscripts. A self-administered anonymous questionnaire on socio-demographic characteristics and substances use was submitted during routine tests. Results showed that the overall lifetime prevalence of drug use is 36.6%; prevalence of polydrug use is 30% and the more frequently associated drugs are LSD, cocaine, inhalants and ecstasy. One hundred and forty five (4.6%) subjects reported having taken ecstasy at least once in their life; 20 of the 145 (13.8%) suffered from negative effects and three (2%) presented to a hospital or to a physician. The risk of ever taking ecstasy is inversely related to father's education, with a trend that is quite similar to that of heroin consumption but that is different from the trend for cannabis. In conclusion the four major results of this study are: (i) a prevalence of drug consumption similar to other European estimates, with a clear tendency to polydrug use; (ii) for ecstasy, a very high association rate with other substances; (iii) the moderately high prevalence of self-reported symptoms, and (iv) a social distribution of use similar to the one observed for heroin. This last consideration suggests that a high level of attention and further research should be addressed to the natural history of ecstasy use.

Methadone maintenance at different dosages for opioid dependence.

BACKGROUND: Methadone maintenance treatment (MMT) is a long term opioid replacement therapy, recognised as effective in the management of opioid dependence. Even if MMT at high dosage is recommended as therapy for reducing illicit opioid use and promoting longer retention in treatment, at present day "the organisation and regulation of the methadone maintenance treatment varies widely". OBJECTIVES: To evaluate the efficacy of different dosages of MMT for opioid dependence in modifying health and social outcomes and in promoting patients' familial, occupational and relational functioning. SEARCH STRATEGY: The following sources were scanned: - MEDLINE (OVID 1966-2001)- EMBASE (1988-2001)- ERIC (1988-2001)- Psychinfo (1947-2001)- Cochrane Controlled Trials Register (CCTR) (1947-2001)- Register of the Cochrane Drug and Alcohol Group (CDAG) (1947-2001)The CDAG search strategy was applied together with a specific MESH strategy. Further studies were searched through: letters to the authors of selected trials or to experts in order to obtain unpublished data. check of references of relevant reviews. SELECTION CRITERIA: Randomised Controlled Trials (RCT) and Controlled Prospective Studies (CPS) evaluating methadone maintenance at different dosages in the management of opioid dependence were included in the review. Non-randomised trials were included when proper adjustment for confounding factors was performed at the analysis stage. DATA COLLECTION AND ANALYSIS: Extraction of data was performed separately by two reviewers. Discrepancies were resolved by a third reviewer. RevMan software was used for analysis. Quality assessments of the methodology of studies were carried out using CDAG checklist. MAIN RESULTS: 22 studies were excluded from the review. 21 studies were included; of them, 11 were RCTs with 2279 people randomised and 10 were CPSs with 3715 people followed-up. OUTCOMES: Retention rate - RCTs: High vs low doses at shorter follow-ups: RR=1.36 [1.13,1.63], and at longer ones: RR=1.62 [0.95,2.77]. Opioid use (self reported), times/w - RCTs: high vs low doses WMD= -2.00 [-4.77,0.77] high vs middle doses WMD= -1.89[-3.43, -0.35] Opioid abstinence, (urine based) at >3-4 w - RCTs: high vs low ones: RR=1.59 [1.16,2.18] high vs middle doses RR=1.51[0.63,3.61] Cocaine abstinence (urine based) at >3-4 w - RCTs: high vs low doses RR=1.81 [1.15,2.85]Overdose mortality - CPSs: high dose vs low dose at 6 years follow up: RR=0.29 [0.02-5.34] high dose vs middle dose at 6 years follow up: RR=0.38 [0.02-9.34] middle dose vs low dose at 6 years follow up: RR=0.57 [0.06-5.06] REVIEWER'S CONCLUSIONS: Methadone dosages ranging from 60 to 100 mg/day are more effective than lower dosages in retaining patients and in reducing use of heroin and cocaine during treatment. To find the optimal dose is a clinical ability, but clinician must consider these conclusions in treatment strategies.

Histological typing and nuclear evaluation of endometrial adenocarcinoma.

On the basis of the nuclear pattern "homologous adenocarcinoma" of the endometrium, arising in women under 40, may be divided into three cytologically distinguishable entities: 1) atypical adenomatous hyperplasia Grade 1; 2) atypical adenomatous hyperplasia Grade 2; 3) adenocarcinoma; probably different also at biological level.

[Diagnostic problems in adenocarcinoma of the endometrium in women less than 40 years of age]. / Problemi diagnostici in tema di adenocarcinoma dell'endometrio in donne al di sotto dei quaranta anni

Endometrial adenocarcinoma in women under the age of forty presents a different course according to its histology. Adenocarcinomas of the endometrium may be classified into 4 main types: type 1, homologous or endometrioid; type 2, fallopian-like; type 3, cervical-like; type 4, unclassifiable. The majority of homologous adenocarcinomas have a relatively benign course, whereas the other types are definitely malignant. There is no room for doubt between adenocarcinoma and atypical endometrial hyperplasia in women under forty unless the histological pattern is of the homologous or endometrioid type, because the other patterns are definitely malignant.

Dietary habits, internal migration and social class in a sample of a northern Italian population.

The study of migrants has generated interesting hypotheses on the etiology of different types of cancer. In particular, it has been suggested that both colon and breast cancer could be related to living conditions, including diet, in the country of immigration. Considerable internal migration occurred in Italy in the sixties. We studied a random sample of 1,400 subjects living in the city of Torino and the province of Varese. They were interviewed with a detailed questionnaire about their dietary habits, and the consumption of several nutrients was considered according to the area of birth and social class. The hypothesis we tested was whether, after controlling for social class, there were different dietary habits among the migrants and the native population, and whether such differences could help in the formulation of etiologic hypotheses on cancer. We found that the intake of saturated fatty acids and cholesterol was lower among the migrants from the south, whereas they consumed higher levels of vegetables than people born in the north. The different intake of saturated fatty acids and cholesterol seemed to be attributable mainly to the consumption of butter, for which the south/north ratio was as low as 0.47 in men and 0.56 in women. Important gradients by social class were also suggested for several nutrients.

Incidence of breast cancer in Piedmont: 1979-1981.

A population-based survey of histologically diagnosed breast cancer was carried out among residents in Piedmont. A total of 5267 incident cases occurring in 1979-1981 was collected, corresponding to an age-standardized (on the world population) incidence rate of 49.5/100,000 per year. Rates (standardized on the population of Piedmont in 1981) were highest in the city of Torino (112.4/100,000 per year) and lowest in the province of Cuneo (67.5), whereas in the other provinces they ranged between 85.3 and 90.0. Estimation of rates in the 54 Local Health Authorities of Piedmont detected up to 2-fold differences between adjacent areas. A correlation was found between rates and size of the population of town of residence. Comparison with age-specific incidence rates from the Cancer Registry of the nearby province of Varese suggested a loss of nonhistologically confirmed cases selectively in older age groups. The distribution of cases diagnosed in 1979 by histologic type is presented. The proportion of diagnoses reported in terms which were consistent with the 1978 WHO Histological Typing of Breast Tumours was 61.3%. It was highest among cases identified in Pathology Services located in University Hospitals and/or diagnosing more than 50 breast cancers per year.