The epidemiology of malignant mesothelioma in women: Gender differences and modalities of asbestos exposure

INTRODUCTION: The epidemiology of gender differences for mesothelioma incidence has been rarely discussed in national case lists. In Italy an epidemiological surveillance system (ReNaM) is working by the means of a national register. METHODS: Incident malignant mesothelioma (MM) cases in the period 1993 to 2012 were retrieved from ReNaM. Gender ratio by age class, period of diagnosis, diagnostic certainty, morphology and modalities of asbestos exposure has been analysed using exact tests for proportion. Economic activity sectors, jobs and territorial distribution of mesothelioma cases in women have been described and discussed. To perform international comparative analyses, the gender ratio of mesothelioma deaths was calculated by country from the WHO database and the correlation with the mortality rates estimated. RESULTS: In the period of study a case list of 21 463 MMs has been registered and the modalities of asbestos exposure have been investigated for 16 458 (76.7%) of them. The gender ratio (F/M) was 0.38 and 0.70 (0.14 and 0.30 for occupationally exposed subjects only) for pleural and peritoneal cases respectively. Occupational exposures for female MM cases occurred in the chemical and plastic industry, and mainly in the non-asbestos textile sector. Gender ratio proved to be inversely correlated with mortality rate among countries. CONCLUSIONS: The consistent proportion of mesothelioma cases in women in Italy is mainly due to the relevant role of non-occupational asbestos exposures and the historical presence of the female workforce in several industrial settings. Enhancing the awareness of mesothelioma aetiology in women could support the effectiveness of welfare system and prevention policies

Meta-analysis of published studies or meta-analysis of individual data? Caesarean section in HIV-positive women as a study case

Very few comparative evaluations of meta-analysis of published data and meta-analysis using individual patient data have appeared in the medical literature. The association between type of delivery and HIV perinatal transmission appears to be an excellent study case, given the recent publication of the meta-analysis of individual patient data by the International Perinatal, HIV Group. In this paper, we report the results of a meta-analysis of the published studies, which show a statistically significant reduction of perinatal HIV transmission rate with Caesarean section. The results are surprisingly similar to those of the recently published meta-analysis of individual patient data, indicating that, in the absence of significant confounding, the two meta-analytic methods are likely to give consistent results. In this era of constrained resources for biomedical research, caution should be taken in abandoning meta-analysis of published data for studying epidemiological associations of public health interest. (C) 2003 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved

Drug eluting stents versus bare metal stents in percutaneous coronary interventions (A meta-analysis)

This meta-analysis combined the results of randomized clinical trials to compare the efficacy of drug-eluting stents with that of bare metal stents in percutaneous coronary interventions to ascertain which revascularization strategy is most safe and effective. The literature identified 13 published studies, and 8 were included in the main metaanalysis, thus allowing a meta-analysis on 3,860 patients for the effect on all major adverse clinical events (MACEs) combined and for target vessel revascularization. Metaanalyses were performed for combined MACEs, patient MACEs, and thrombosis. Regression meta-analyses were performed to examine the effect of certain variables on the efficacy of drug-eluting stents compared with bare metal stents. Meta-analysis of all trials showed that drug-eluting stents produced significant decreases in the need for percutaneous revascularization (relative risk [RR] 0.30, 95% confidence interval [CI] 0.22 to 0.40) and coronary artery bypass grafting (RR 0.54, 95% CI 0.32 to 0.89). Drugeluting stents significantly decreased all MACEs combined (RR 0.40, 95% CI 0.33 to 0.49) but were not associated with an increased risk of stent thrombosis or death. These results were confirmed at analysis as stratified by type of eluting stent, because the need for percutaneous revascularization was significantly lower for sirolimus-eluting stents (RR 0.23, 95% CI 0.15 to 0.35) and paclitaxel-eluting stents (RR 0.39, 95% CIl 0.29 to 0.53)