Network models in Health

Il presente lavoro di ricerca intende analizzare l’importanza dei modelli organizzativi a reti per rispondere alla sfida della complessità del momento storico, politico, sociologico, economico; in modo particolare in Sanità per rispondere all’esigenza di mettere al centro la persona nel percorso di cura ed ottenere una migliore integrazione delle cure. Sebbene i vantaggi delle reti siano bene descritti in letteratura sono ancora pochi gli studi nell’ambito della valutazione. Il caso di studio ha riguardato la rete oncologica romagnola così come percepita dagli informatori chiave, dagli operatori (medici, infermieri, amministrativi) e dalle persone con esperienza di tumore. Dall’analisi degli informatori chiave emerge forte che la rete nasce per dare risposte di qualità ai bisogni dei pazienti, mentre per gli operatori quanto sia importante la dimensione delle relazioni umane e avere valori condivisi per raggiungere obiettivi di efficacia e qualità delle cure. Per quanto riguarda invece la percezione delle persone con esperienza di tumore si rileva quanto sia importante l’appropriatezza della traiettoria di cura nonché l’avere continuità in un percorso, già di per sé difficile, oltre all’importanza dell’umanizzazione dei servizi e della corretta comunicazione medico paziente.The purpose of the present research project is to analyze the importance of the networks organization model to answer to the challenge of the complexity of this historical, political, sociological and economic period; in particular, as far as the health networks are concerned, to respond to the exigency of putting the person in the centre of the care pathway and obtain a better integration of cares. Although the advantages of the networks model are well described in the literature , still there are only few studies in the area of evaluation. The case of study has treated the cancer network in the Romagna area as well as it was perceived from key informants, stakeholders (doctors, nurses, administrative workers) and persons with tumour experience. The analysis of the key informants brought out strongly the fact that the network was born to give quality answers to the patients needs, while from the analysis of the stakeholders emerged how the human relationships are important and the significance of having shared values to achieve the goals of care efficacy and quality. Instead, as far as the perception of the persons with tumour experience is concerned, the importance of the appropriateness of the care trajectory emerged as well as to have a continuity in the pathway , already difficult by itself, in addition to the importance of the services humanization and the correct doctor-to-patient communication

Oral contraceptives and colorectal cancer risk: a systematic review and meta-analysis

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Coffee drinking and hepatocellular carcinoma: An update

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SARS-CoV-2 pandemic: An overview

By the end of May 2020, SARS-CoV-2 pandemic caused more than 350,000 deaths worldwide. In the first months, there have been uncertainties on almost any area: infection transmission route, virus origin and persistence in the environment, diagnostic tests, therapeutic approach, high-risk subjects, lethality, and containment policies. We provide an updated summary of the current knowledge on the pandemic, discussing the available evidence on the effectiveness of the adopted mitigation strategies

Dietary patterns and oral and pharyngeal cancer using latent class analysis

The methods traditionally used to identify a posteriori dietary patterns are principal components, factor and cluster analysis. The aim of our study is to assess the relationship between dietary patterns derived with latent class analysis (LCA) and oral/pharyngeal cancer risk (OPC), highlighting the strengths of this method compared to traditional ones. We analyzed data from an Italian multicentric case-control study on OPC including 946 cases and 2,492 hospital controls. Dietary patterns were derived using LCA on 25 food groups. A multiple logistic regression model was used to derive odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for OPC according to the dietary patterns identified. We identified four dietary patterns. The first one was characterized by a high intake of leafy and fruiting vegetable and fruits (Prudent pattern), the second one showed a high intake of red meat and low intake of selected fruits and vegetables (Western pattern). The last two patterns showed a combination-type of diet. We labeled "Lower consumers-combination pattern" the cluster that showed a low intake of the majority of foods, and "Higher consumers-combination pattern" the one characterized by a high intake of various foods. Compared to the "Prudent pattern", the "Western" and the "Lower consumers-combination" ones were positively related to the risk of OPC (OR = 2.56, 95% CI: 1.90-3.45 and OR = 2.23, 95% CI: 1.64-3.02). No difference in risk emerged for the "Higher consumers-combination pattern" (OR = 1.28, 95% CI: 0.92-1.77)

Treatment with ACE inhibitors or ARBs and risk of severe/lethal COVID-19: a meta-analysis

Objective: It has been hypothesised that the use of ACE inhibitors and angiotensin receptor blockers (ARBs) might either increase or reduce the risk of severe or lethal COVID-19. The findings from the available observational studies varied, and summary estimates are urgently needed to elucidate whether these drugs should be suspended during the pandemic, or patients and physicians should be definitely reassured. This meta-analysis of adjusted observational data aimed to summarise the existing evidence on the association between these medications and severe/lethal COVID-19. Methods: We searched MedLine, Scopus and preprint repositories up to 8 June 2020 to retrieve cohort or case-control studies comparing the risk of severe/fatal COVID-19 (either mechanical ventilation, intensive care unit admission or death), among hypertensive subjects treated with: (1) ACE inhibitors, (2) ARBs and (3) both, versus untreated subjects. Data were combined using a random-effect generic inverse variance approach. Results: Ten studies, enrolling 9890 hypertensive subjects were included in the analyses. Compared with untreated subjects, those using either ACE inhibitors or ARBs showed a similar risk of severe or lethal COVID-19 (summary OR: 0.90; 95% CI 0.65 to 1.26 for ACE inhibitors; 0.92; 95% CI 0.75 to 1.12 for ARBs). The results did not change when both drugs were considered together, when death was the outcome and excluding the studies with significant, divergent results. Conclusion: The present meta-analysis strongly supports the recommendation of several scientific societies to continue ARBs or ACE inhibitors for all patients, unless otherwise advised by their physicians who should thus be reassured

Mediterranean Diet and Breast Cancer Risk

Abstract: The Mediterranean diet has been related to a reduced risk of several common cancers but its role on breast cancer has not been quantified yet. We investigated the association between adherence to the Mediterranean diet and breast cancer risk by means of a hospital-based case-control study conducted in Italy and Switzerland. 3034 breast cancer cases and 3392 controls admitted to the same network of hospitals for acute, non-neoplastic and non-gynaecologic diseases were studied. Adherence to the Mediterranean diet was quantitatively measured through a Mediterranean Diet Score (MDS), summarizing the major characteristics of the Mediterranean dietary pattern and ranging from 0 (lowest adherence) to 9 (highest adherence). We estimated the odds ratios (ORs) of breast cancer for the MDS using multiple logistic regression models, adjusting for several covariates. Compared to a MDS of 0–3, the ORs for breast cancer were 0.86 (95% confidence interval, CI, 0.76–0.98) for a MDS of 4–5 and 0.82 (95% CI, 0.71–0.95) for a MDS of 6–9 (p for trend = 0.008). The exclusion of the ethanol component from the MDS did not materially modify the ORs (e.g., OR = 0.81, 95% CI, 0.70–0.95, for MDS ≥ 6). Results were similar in pre- and post-menopausal women. Adherence to the Mediterranean diet was associated with a reduced breast cancer risk

Adherence to the Traditional Mediterranean Diet and Human Milk Composition: Rationale, Design, and Subject Characteristics of the MEDIDIET Study

Introduction: Knowledge about how a lactating woman's diet influences the composition of her breast milk is still very limited. In particular, no study has evaluated the role of adherence to the Mediterranean diet on human milk characteristics.Aim: We carried out an observational study to investigate the influence of mother adherence to a Mediterranean diet on her breast milk composition.Methods: Between 2012 and 2014, 300 healthy mothers, who exclusively breastfed their babies, were enrolled from five centers across Italy. During a visit to the hospital center 6 weeks after childbirth these women were asked to provide a sample of their freshly expressed breast milk and to answer a series of questions on personal characteristics and lifestyle factors. The application of a validated food frequency questionnaire allowed the collection of detailed dietary habits. Milk was collected and then stored until chemical analyses were performed. The study has been registered (Trial Registration: Dutch Trial register NTR3468). Descriptive analyses on baseline characteristics of mothers and babies were carried out on the participants, overall and stratified by center.Results: The participants had a mean age of 33 years (SD = 4.06), and a pre-pregnancy BMI of 22.3 Kg/m2 (SD = 3.22). Forty-seven percent gave birth to their first child, 40% to the second 13% to the third or subsequent child. Babies had a mean birth weight of 3,324 g (DS = 389), and a mean length of 51 cm (SD = 1.94). Fifty-three percent were males.Conclusion: The present work provides the general description and the characteristics of mothers and babies included in the MediDiet study