Provision of follow‑up care for women with a history of breast cancer following the 2016 position paper by the Italian Group for Mammographic Screening and the Italian College of Breast Radiologists by SIRM: a survey of Senonetwork Italian breast centres

Introduction In 2016, the Italian Group for Mammography Screening and the Italian College of Breast Radiologists by the Italian Society of Medical and Interventional Radiology recommended that screening programmes and specialist breast centres actively invite women with a history of breast cancer to follow-up imaging. Objective A survey of breast centres associated with Senonetwork, the Italian network of breast cancer services, has ofered the opportunity to assess the implementation of this recommendation. Methods A national, cross-sectional, voluntary, online survey was developed, pre-tested, and administered during the months July–October 2020. Five of the 73 questionnaire items concerned breast cancer follow-up. Results The response rate was 82/128 (65%). Of the 82 respondent centres, 69 (84%) were involved in a screening programme. Fifty-six (68%) reported the presence of a programme of active invitation to breast cancer follow-up targeted at patients living in their catchment area, with a signifcant north-to-south gradient. Four centres (5%) reported that the screening programme was responsible for actively initiating follow-up during the 10-year period since diagnosis. Only after 10 years did the proportion increase moderately. Conclusion Screening programmes have still a marginal role in active breast cancer follow-up

Morphometric analysis of lymphatics vessels in fibrotic human lung

In pulmonary fibrosis, the usual interstitial pneumonia (UIP) pattern is characterised by heterogeneous, patchy fibrosis, with areas of normal lung adjacent to areas of complete destruction (honeycombing) and by fibroblastic foci (FF). The NSIP pattern which is characteristic of systemic sclerosis, is characterised by a more homogeneous involvement of the lung without honeycombing and FF. Little is known on lymphatic vessels in lung fibrosis. Defective lymphatic clearance could lead to prolonged exposure to pathogenic antigens and/or pro-inflammatory/pro-fibrotic mediators. We evaluated the distribution and morphology of lymphatic vessels in lung biopsies of 6 patients with UIP, 6 NSIP and 5 controls. Consecutive sections were stained with Movat’s pentachrome and with double immunostaining for von Willebrand factor and podoplanin (D2-40). Area, perimeter and position were recorded for vessels with a diameter > 5µm. We investigated separately in lintralobular, sub-pleural, and interlobular spaces. Lymphatics were consistently larger in subpleural spaces and in interlobular septa than in intralobular tissue. In the latter, the density of lymphatic vessels was significantly reduced in NSIP and in UIP (both 21±1 mm-2) compared to controls (35±4 mm-2) . In controls, 85±6% of the intralobular lymphatics were close (< 100 µm) to a blood vessel, and only 5±4% were in the proximity of bronchoalveolar spaces, while in the disease groups they were less frequently perivascular (NSIP 55 ±3%, UIP 56 ±2%) and more frequently associated with the bronchoalveolar lumen (NSIP 85 ±3%, UIP 69 ±2%). By contrast, in interlobular septa, lymphatic density was significantly increased in NSIP (303±28 mm-2) and in UIP (286±124 mm-2) compared to controls (96±69 mm-2). No differences in lymphatic density was seen in subpleural spaces. Thus, our data show a marked redistribution of lymphatic vessels within the lung in pulmonary fibrosis, without noticeable differences between the NSIP and UIP patterns

Integrating mammography screening programmes into specialist breast centres in Italy: insights from a national survey of Senonetwork breast centres

Background: Despite recommendations, mammography screening is often insufficiently integrated into specialist breast centres. A national, cross-sectional, voluntary, online survey on this issue was carried out among the Italian breast centres associated with Senonetwork, the Italian network of breast cancer services. Methods: A 73-item questionnaire was created, pre-tested and piloted. Centres integrating and not integrating a screening programme were compared using the unified theory of acceptance and use of technology (UTAUT) model. Centres' clustering was performed using the Gower's distance metric. Groups and clusters were compared with the equality-of-means test. Results: The response rate was 82/128 (65%). Overall, 84% (69/82) breast centres reported a collaboration with a screening programme in performing and/or reading mammograms and in the diagnostic work-up of women with abnormal screening results. The same proportion was observed among those centres responding to all questions (62/74). Performance expectancies (or the perceived usefulness of integration in terms of clinical quality, patient convenience, ease of job, and professional growth), satisfaction and motivation were higher in those centres collaborating with the screening programme. Effort expectancy indicators (or the degree to which the respondents believe that the integration is easy to implement) and those concerning the existence of facilitating conditions were lower both in centres collaborating and not collaborating with the screening programme. Among the former, six clusters of centres, distributed from 'no integration' to 'high', were identified. In cluster analysis, the highest level of integration was associated with higher agreement that integration eases the job, offers better opportunities for professional growth, and makes the working environment more satisfactory. The least integrated cluster assigned the lowest score to the statement that local health authority made available the resources needed. Conclusions: While confirming the positive effects of integrating screening programmes into breast centres, this survey has brought to light specific difficulties that must be faced. The results provide insights into the importance of integration focusing on the perspectives of professional career and motivation. The deficiency of facilitating conditions to integration is modifiable. Screening professionals' societies may have a role as initiators of the integration. Other supporting actions may be included in health laws at the national and regional level

Cost-effectiveness of Ambulatory Oxygen in improving quality of life in fibrotic lung disease: Preliminary evidence from the AmbOx Trial

Ambulatory oxygen may be cost-effective in improving quality of life in fibrotic lung disease. To be more conclusive, we need to understand societal willingness to pay for quality of life improvements and whether improvements are sustained. http://bit.ly/2pAiBJ

Respiratory symptoms in children living near busy roads and their relationship to vehicular traffic: results of an Italian multicenter study (SIDRIA 2)

BACKGROUND: Epidemiological studies have provided evidence that exposure to vehicular traffic increases the prevalence of respiratory symptoms and may exacerbate pre-existing asthma in children. Self-reported exposure to road traffic has been questioned as a reliable measurement of exposure to air pollutants. The aim of this study was to investigate whether there were specific effects of cars and trucks traffic on current asthma symptoms (i.e. wheezing) and cough or phlegm, and to examine the validity of self-reported traffic exposure. METHODS: The survey was conducted in 2002 in 12 centers in Northern, Center and Southern Italy, different in size, climate, latitude and level of urbanization. Standardized questionnaires filled in by parents were used to collect information on health outcomes and exposure to traffic among 33,632 6-7 and 13-14 years old children and adolescents. Three questions on traffic exposure were asked: the traffic in the zone of residence, the frequency of truck and of car traffic in the street of residence. The presence of a possible response bias for the self-reported traffic was evaluated using external validation (comparison with measurements of traffic flow in the city of Turin) and internal validations (matching by census block, in the cities of Turin, Milan and Rome). RESULTS: Overall traffic density was weakly associated with asthma symptoms but there was a stronger association with cough or phlegm (high traffic density OR = 1.24; 95% CI: 1.04, 1.49). Car and truck traffic were independently associated with cough or phlegm. The results of the external validation did not support the existence of a reporting bias for the observed associations, for all the self-reported traffic indicators examined. The internal validations showed that the observed association between traffic density in the zone of residence and respiratory symptoms did not appear to be explained by an over reporting of traffic by parents of symptomatic subjects. CONCLUSION: Children living in zones with intense traffic are at higher risk for respiratory effects. Since population characteristics are specific, the results of validation of studies on self-reported traffic exposure can not be generalized

Observation of CP Violation in Charm Decays

A search for charge-parity (CP) violation in D-0 -> K-K+ and D-0 -> pi(-)pi(+) decays is reported, using pp collision data corresponding to an integrated luminosity of 5.9 fb(-1) collected at a center-of-mass energy of 13 TeV with the LHCb detector. The flavor of the charm meson is inferred from the charge of the pion in D* (2010)(+) -> D-0 pi(+) decays or from the charge of the muon in (B) over bar -> D-0 mu(-)(nu) over bar X-mu decays. The difference between the CP asymmetries in D-0 -> K-K+ and D-0 -> pi(-)pi(+) decays is measured to be Delta A(CP) = [-18.2 +/- 3.2(stat) +/- 0.9(syst)] x 10(-4) for pi-tagged and Delta A(CP) = [-9 +/- 8(stat) +/- 5(syst)] x 10(-4) for mu-tagged D-0 mesons. Combining these with previous LHCb results leads to Delta A(CP) = (-15.4 +/- 2.9) x 10(-4), where the uncertainty includes both statistical and systematic contributions. The measured value differs from zero by more than 5 standard deviations. This is the first observation of CP violation in the decay of charm hadrons

Morphometric analysis of intralobular, interlobular and pleural lymphatics in normal human lung

In spite of their presumed relevance in maintaining interalveolar septal fluid homeostasis, the knowledge of the anatomy of human lung lymphatics is still incomplete. The recent discovery of reliable markers specific for lymphatic endothelium has led to the observation that, contrary to previous assumptions, human lymphatic vessels extend deep inside the pulmonary lobule in association with bronchioles, intralobular arterioles or small pulmonary veins. The aim of this study was to provide a morphometric characterization of lymphatic vessels in the periphery of the human lung. Human lung sections were immunolabelled with the lymphatic marker D2-40, followed by blood vessel staining with von Willebrand Factor. Lymphatic vessels were classified into: intralobular (including those associated with bronchovascular bundles, perivascular, peribronchiolar and interalveolar), pleural (in the connective tissue of the visceral pleura), and interlobular (in interlobular septa). The percentage area occupied by the lymphatic lumen was much greater in the interlobular septa and in the subpleural space than in the lobule. Most of the intralobular lymphatic vessels were in close contact with a blood vessel, either alone or within a bronchovascular bundle, whereas 7\% were associated with a bronchiole and < 1\% were not connected to blood vessels or bronchioles (interalveolar). Intralobular lymphatic size progressively decreased from bronchovascular through to peribronchiolar, perivascular and interalveolar lymphatics. Lymphatics associated with bronchovascular bundles had similar morphometric characteristics to pleural and interlobular lymphatics. Shape factors were similar across lymphatic populations, except that peribronchiolar lymphatics had a marginally increased roundness and circularity, suggesting a more regular shape due to increased filling, and interlobular lymphatics had greater elongation, due to a greater proportion of conducting lymphatics cut longitudinally. Unsupervised cluster analysis confirmed a marked heterogeneity of lymphatic vessels both within and between groups, with a cluster of smaller vessels specifically represented in perivascular and interalveolar lymphatics within the alveolar interstitium. Our data indicate that intralobular lymphatics are a heterogeneous population, including vessels surrounding the bronchovascular bundle analogous to the conducting vessels present in the pleural and interlobular septa, many small perivascular lymphatics responsible for maintaining fluid balance in the alveolar interstitium, and a minority of intermediate lymphatics draining the peripheral airways. These lymphatic populations could be differentially involved in the pathogenesis of diseases preferentially involving distinct lung compartments

Impact of National Smoke-Free Legislation on Educational Disparities in Smoke-Free Homes: Findings from the SIDRIAT Longitudinal Study

Families with lower socioeconomic status are less likely to adopt household smoking bans (HSB). The aim of this study was to determine whether socioeconomic disparities in HSB prevalence in Italy decreased 7–9 years after the introduction of the Italian ban on smoking in public places. A longitudinal, 12-year, two-wave study was conducted on a sample of 3091 youths aged 6–14 years in 2002; 1763 (57%) were re-interviewed in 2012–2014. A Poisson regression with a robust error variance was used to assess the association between socioeconomic disparities and HSB prevalence. The adoption of HSBs significantly increased from 60% in 2002 to 75% in 2012–2014, with the increase recorded in youths with ≥1 smoking parent only (from 22% at baseline to 46% at follow-up). The presence of HSBs at baseline was more likely in families with ≥1 graduate parent compared to those with no graduate parents (prevalence ratio (PR) = 1.34, 95% confidence interval (CI) = 1.15–1.57), either in families with ≥1 smoking parent (PR = 1.36, 95% CI = 1.17–1.58) or in families with non-smoking parents (PR = 1.61, 95% CI = 1.01–2.56). Conversely, at follow-up socioeconomic disparities dropped since families with no graduate parents were 1.5-fold more likely to introduce a HSB between the two waves. The Italian ban on smoking in public places may have increased the adoption of smoke-free homes in families with smoking and non-graduate parents, causing the drop of the socioeconomic gap in smoke-free homes

Smoke-free homes and youth smoking behavior in Italy: Findings from the SIDRIAT longitudinal study

Introduction: Few studies have explored whether smoke-free homes (SFH) can promote reductions of smoking onset in children, particularly in households with smoking parents. The aim of this study was to determine whether youths living in SFH were less likely to progress to smoking. Methods: We conducted a longitudinal, 11-year, two-wave study on 778 children aged 6-7 years and 985 adolescents aged 13-14 in 2002. At baseline, youths were asked whether or not adults smoked at home (SFH); at follow-up, in 2012-2014, whether a household smoking ban (HSB) had been implemented during the course of the study. Logistic regression was used to investigate SFH effects on youth smoking behaviors. Results: Sixty-nine percent of children and 54% of adolescents reported SFH at baseline; 80% of children and 71% of adolescents reported HSB at follow-up. Youths living in non-SFH at baseline were twice as likely to become established smokers at follow-up compared with those living in SFH (children + adolescents: odds ratio [OR] = 1.99; 95% confidence interval [CI] = 1.39-2.94; adolescents: OR = 2.15; 95% CI = 1.36-3.42; children: OR = 1.69; 95% CI = 0.80-3.56), either for youths living with nonsmoking parents at baseline and follow-up (OR for both children and adolescents = 3.06; 95% CI = 1.70-5.51) or for youths with ≥1 smoking parent at baseline and follow-up (OR = 2.12, 95% CI = 1.01-4.46). The effect was greater in youths living in the worst situation (non-SFH at baseline + non-HSB at follow-up) compared with those in the best situation (SFH at baseline + HSB at follow-up; children: OR = 3.20; 95% CI = 1.10-9.35; adolescents: OR = 5.41; 95% CI = 2.66-10.97). Conclusions: Household smoke-free policies had a significant impact in protecting youths from becoming established smokers. Implications: The results of the SIDRIAT longitudinal study showed that youths living in homes where people smoked at baseline were twice as likely to become established smokers 11 years later at follow-up, compared with youths living in SFH. The lower number of established smokers among youths living in SFH at baseline was recorded not only in households with nonsmoking parents but also in those with smoking parents. Implementing a home smoking ban is recommended in all households. Living in homes with no ban may be a risk factor for smoking initiation, which is independent of having smoking parents