Predictors of medication use during pregnancy: a cohort study

Background Sociodemographic characteristics and health behaviours are associated with medication use in pregnancy, but it is unclear if they are independent predictors because women´s health status has hardly been accounted for. We aimed to identify predictors of use of medications and of iron/folic acid. Methods This cohort included pregnant women recruited in a prenatal clinic in Trieste, Italy, from 2007 to 2009. Dispensations were obtained from the regional outpatient dispensation database through record linkage. We calculated the Odds Ratio (OR), with 95% confidence interval (95%CI), of ≥ 1 dispensation of (a) any medication and (b) iron/folic acid, using unconditional logistic regression. The final model adjusted for age, partner education, housing size, comorbidities.   Findings Of 767 women, 70.5% had ≥ 1 dispensation of any medication and 46.1% of iron/folic acid. Use of any medication was predicted by immigrant status of the woman (OR 1.21; 95%CI 0.57–2.53) or of her partner (1.51; 0.67–3.40), ≤ high school degree of the woman (1.11; 0.61–2.03) or of her partner (1.21; 0.75–1.95), unemployment (1.47; 0.72–2.98), smoking (1.25; 0.65–2.40), alcohol consumption (≥5 drinks/week: 2.78; 1.78–4.34), and obesity (1.33; 0.59–2.99). Use of iron and/or folic acid was predicted by ≤ high school degree (0.65; 0.40–1.08), smoking (0.80: 0.47–1.37), and obesity (0.62; 0.31–1.25). Discussion In this cohort, characteristics including education, immigrant and employment status, smoking, alcohol consumption, and obesity independently predicted medication use. Interventions to promote safe use of medications should carefully consider women´s characteristics

A computational index derived from whole-genome copy number analysis is a novel tool for prognosis in early stage lung squamous cell carcinoma.

AbstractSquamous cell carcinoma of the lung is remarkable for the extent to which the same chromosomal abnormalities are detected in individual tumours. We have used next generation sequencing at low coverage to produce high resolution copy number karyograms of a series of 89 non-small cell lung tumours specifically of the squamous cell subtype. Because this methodology is able to create karyograms from formalin-fixed paraffin-embedded material, we were able to use archival stored samples for which survival data were available and correlate frequently occurring copy number changes with disease outcome. No single region of genomic change showed significant correlation with survival. However, adopting a whole-genome approach, we devised an algorithm that relates to total genomic damage, specifically the relative ratios of copy number states across the genome. This algorithm generated a novel index, which is an independent prognostic indicator in early stage squamous cell carcinoma of the lung

Targeting Motor Neuron - Immune System Crosstalk to Modulate the Disease Progression in Amyotrophic Lateral Sclerosis Mouse Model

ALS is a fatal neurodegenerative disease characterised by remarked heterogeneity, which might stem from the multisystemic, non-cell-autonomous and complex nature of the disease. The early deterioration of the peripheral compartment has led to ALS being recognised as distal axonopathy, whereby muscles and nerves actively contribute to neurodegeneration. However, the contribution of the inflammatory response in the CNS starkly contrasts to the periphery, revealing its pivotal role at promoting phenomena of protection and/or toxicity. We corroborated these observations showing a higher activation of the MCP1 chemokine within MNs and peripheral compartment of C57SOD1G93A than 129SvSOD1G93A mice. Therefore, we surmised that the higher peripheral degeneration and faster disease progression of 129SvSOD1G93A mice stemmed from this defective immune response. To decipher the contribution of the peripheral immune response in ALS progression, the therapeutic potential of MCP1 was assessed. The chemokine was induced alongside the motor units of the two SOD1G93A models through a single intramuscular injection of a scAAV9 vector engineered with MCP1 (scAAV9_MCP1). The scAAV9_MCP1-mediated boosting of the immune response prevented the degeneration of the peripheral compartment whilst the chemokine induction within MNs led to a neuroprotective activity, resulting in the amelioration of the clinical phenotype in C57SOD1G93A but not 129SvSOD1G93A mice. This discrepancy pointed the nature and temporal activation of the immune response out as discriminating factors to promote the peripheral compartment regeneration and slow-down ALS progression. The analysis of ALS patients muscles validated our findings, demonstrating a direct correlation between the immune cells inflammatory fingerprint and the rate of the disease progression. These observations candidate the peripheral compartment as a primary target for the development of therapeutic interventions effective at influencing the ALS progression. Moreover, the comprehension of the MCP1 role within the motor unit of SOD1G93A mice might provide innovative evidence regarding the contribution of the immune response in ALS

Mortality in a cohort of asbestos-exposed workers undergoing health surveillance

9noBackground: The coastal area of Friuli Venezia Giulia (FVG) region, north-eastern Italy, was characterized by work activities in which asbestos was used until the early 1990s, particularly in shipbuilding. A public health sur- veillance program (PHSP) for asbestos-exposed workers was established, although limited evidence exists about the efficacy of such programs in reducing disease occurrence and mortality. Objectives: To compare mortality in a cohort of 2,488 men occupationally exposed to asbestos, enrolled in a PHSP in FVG between the early 1990s and 2008, with that of the general population of FVG and Italy. Methods: Standardized Mortality Ratios (SMR), with 95% Con- fidence Interval (95% CI), for all causes, all cancers, lung (LC) and pleural cancer (PC) were estimated in the cohort and in subgroups of workers with the first hire in shipbuilding that caused asbestos exposure (<1974, 1974-1984, 1985-1994). Results: A strong excess in mortality for PC with reference to FVG (SMR=6.87, 95% CI 4.45-10.17) and Italian population (SMR=13.95, 95% CI 9.02-20.64) was observed. For LC, the FVG-based SMR was 1.49 (95% CI 1.17-1.89) and the Italy-based 1.43 (95% CI 1.12-1.81). Mortality among workers with the first hire in shipbuilding before 1974 was high for PC (FVG-based SMR=8.98, 95% CI 5.56-13.75; Italy-based SMR=18.41, 95% CI 11.40-28.17) and for LC (FVG-based SMR =1.60, 95% CI 1.18-2.11; Italy-based SMR=1.54, 95% CI 1.14-2.03). Further, for LC between 1974 and 1984, the FVG-based SMR was 2.45 (95% CI 1.06-4.82), and the Italy-based SMR was 2.33 (95% CI 1.01-4.60). Conclusions: This cohort experienced an excess mortality for pleural and lung cancer, compared with regional and national populations. For lung cancer, the excess was stronger in workers with the first hire in shipbuilding before 1985, suggesting a key role of asbestos exposure.reservedmixedFabiano Barbiero, Tina Zanin, Federica Edith Pisa, Anica Casetta, Valentina Rosolen, Manuela Giangreco, Corrado Negro, Massimo Bovenzi, Fabio BarboneFabiano, Barbiero; Tina, Zanin; Federica Edith Pisa, ; Anica, Casetta; Rosolen, Valentina; Manuela, Giangreco; Negro, Corrado; Bovenzi, Massimo; Barbone, Fabi

Predictors of discrepancies between electronic medical records medication list and dispensing data in elderly inpatients with dementia

Background: Inaccuracies in pre-admission medication list are common and have been associated with adverse outcomes. Patients with dementia are frequently in polypharmacy and hospitalized. Discrepancies between hospital records and multiple integrated sources (e.g. community pharmacy, GPs letters, and patient owned medications) have been associated with increasing number of medications and emergency admission. Objectives: To assess predictors of discrepancies between hospital Electronic Medical Records (EMR) pre-admission medication list and prescription data in inpatients with dementia. Methods: Source of information: Hospital Services and Outpatient prescription Databases, hospital EMRs; Study design: retrospective cohort; Study population: all patients hospitalized at the Udine University Hospital, Italy, from 01.01.2012 to 31.12.2014 with primary or secondary ICD-9-CM discharge code for dementia and continuous enrolment for ≥1 year before admission; Data collection: for each hospitalization (a) the EMR pre-admission medication list; (b) all prescriptions dispensed within 3 months prior to the date of admission through record linkage with prescription database. An omission was defined as any dispensed medication not registered in EMR; an addition as any medication not dispensed registered in EMR. Statistical analysis: conditional logistic regression odds ratio (OR), with 95% confidence interval (95% CI), of ≥1 omission or ≥1 addition through generalized estimating equations to account for repeated hospitalizations of the same patient. Final model adjusted for type of admission (planned and emergency), patient age and sex, number of pre-admission prescriptions, and neuropsychiatric disturbances. Analysis performed with SAS© software, version 9.3 (SAS, Cary, NC, USA). The protocol was approved by the FVG regional Ethics Committee

Mortality in a cohort of asbestos-exposed workers undergoing health surveillance

Background: The coastal area of Friuli Venezia Giulia (FVG) region, north-eastern Italy, was characterized by work activities in which asbestos was used until the early 1990s, particularly in shipbuilding. A public health sur- veillance program (PHSP) for asbestos-exposed workers was established, although limited evidence exists about the efficacy of such programs in reducing disease occurrence and mortality. Objectives: To compare mortality in a cohort of 2,488 men occupationally exposed to asbestos, enrolled in a PHSP in FVG between the early 1990s and 2008, with that of the general population of FVG and Italy. Methods: Standardized Mortality Ratios (SMR), with 95% Con- fidence Interval (95% CI), for all causes, all cancers, lung (LC) and pleural cancer (PC) were estimated in the cohort and in subgroups of workers with the first hire in shipbuilding that caused asbestos exposure (<1974, 1974-1984, 1985-1994). Results: A strong excess in mortality for PC with reference to FVG (SMR=6.87, 95% CI 4.45-10.17) and Italian population (SMR=13.95, 95% CI 9.02-20.64) was observed. For LC, the FVG-based SMR was 1.49 (95% CI 1.17-1.89) and the Italy-based 1.43 (95% CI 1.12-1.81). Mortality among workers with the first hire in shipbuilding before 1974 was high for PC (FVG-based SMR=8.98, 95% CI 5.56-13.75; Italy-based SMR=18.41, 95% CI 11.40-28.17) and for LC (FVG-based SMR =1.60, 95% CI 1.18-2.11; Italy-based SMR=1.54, 95% CI 1.14-2.03). Further, for LC between 1974 and 1984, the FVG-based SMR was 2.45 (95% CI 1.06-4.82), and the Italy-based SMR was 2.33 (95% CI 1.01-4.60). Conclusions: This cohort experienced an excess mortality for pleural and lung cancer, compared with regional and national populations. For lung cancer, the excess was stronger in workers with the first hire in shipbuilding before 1985, suggesting a key role of asbestos exposure