Extension of the target age range of mammography screening programme and governance of mammography practice in the Emilia-Romagna Region (Northern Italy)

"OBJECTIVES: to evaluate the effectiveness of the regional law No.1035 enacted in 2009 by the local government of the Emilia- Romagna Region (Northern Italy) with the purpose of revising the rules of access to breast-care services. The law dictated the extension of the organised mammography screening programme to women aged 45-49 and 70-74 years in order to decrease their spontaneous screening rates and, thus, the waiting times for the access to diagnostic mammography by women of all ages

EFFICACIA SUL CAMPO DELLA VACCINAZIONE (VE) ANTINFLUENZALE DURANTE LA STAGIONE EPIDEMICA 2014/2015 IN EMILIA ROMAGNA

Introduzione.La VE dell’influenza dipende principalmente dalla prevalente circolazione di virus omologhi ai ceppi vaccinali e dall’età. L’epidemia del 2014/2015 è risultata tra le stagioni più intense degli ultimi anni. Obiettivo dello studio è stato stimare la VE nei confronti sia dell’influenza in generale sia verso ciascuno dei tre ceppi circolanti in Emilia Romagna (ER) attraverso l’attività del Centro di sorveglianza virologica dell’influenza, presso l’Unità di Sanità Pubblica dell’Università degli Studi di Parma. Metodi. Tra i tamponi faringei/nasali inviati da medici di medicina generale, pediatri di libera scelta e reparti ospedalieri eseguiti in soggetti con ARI (Acute Respiratory Illness) o ILI (Acute Influenza-like Illness), sono stati selezionati 1210 campioni in cui erano disponibili i dati di vaccinazione. La VE è stata stimata come 1-OR (IC95%). Risultati. Il 44,9% è risultato positivo per virus influenzale, il 46,2% per A/H3N2, il 40,7% per A/H1N1pdm2009 e il 13,1% per il tipo B. Tra i bambini (0-14 anni), che costituivano il 54,5% del campione, è stata osservata la percentuale più elevata di positività (49,6%). I virus A hanno co-circolato a partire dalla 52a settimana del 2014 mentre il tipo B è comparso successivamente. Il 19,2% aveva ricevuto il vaccino inattivato trivalente. La VE generale è risultata del 23% (IC95% -2,8-43) in accordo alla diffusa circolazione del sottotipo A/H3N2 mutato rispetto al ceppo vaccinale A/Texas/50/2012. La VE verso A/H1N1 è risultata del 64% (IC95% 41–78) e del 76% (IC95% 34–92) verso il tipo B. Tra i bambini, la VE è risultata maggiore (77% e 86% rispettivamente). Conclusioni.Bassi tassi di copertura vaccinale e virus circolanti variati, espongono la popolazione più fragile alle complicanze gravi dell’influenza. Il vaccino, invece, quando allineato ai ceppi circolanti dimostra grande efficacia. L’integrazione tra sorveglianza virologica ed epidemiologica risulta indispensabile strumento di prevenzione

HIV-1 early and late diagnosis in the Emilia Romagna Region (Italy): A three year study

It is crucial to establish the timing of infection and distinguish between early and long-lasting HIV-1 infections not only for partner notification and epidemiological surveillance, but also to offer early drug treatment and contain the spread of infection. This study analyzed serum and/or plasma samples with a first positive HIV antibody/antigen result coming from different Medical Centers in the Emilia Romagna Region, North East Italy, using the avidity assay, Western Blotting, RNA viral load, CD4 cell counts and genotyping assay. From May 2013 to May 2016, we certified 845 new HIV-1 infections, 18.7% of which were classified on the basis of avidity index as recent infections and 81.3% as long-lasting infections, with an estimated conversion time exceeding six months at the time of study. Western Blotting showed reactivity to only one or two HIV-1 proteins in recently infected patients (RIPs), while a complete pattern to gag, env and pol proteins was observed in most long-lasting infected patients (LLIPs). The median age, gender, nationality and risk transmission factors were comparable in RIPs and LLIPs. Phylogenetic analysis performed in available plasma disclosed B strains, non-B subtypes and circulating recombinant forms (CRFs) in both groups of patients, with a major presence of CRFs in non-Italian HIV subjects. The large number of patients unaware of their HIV status makes it crucial to discover hidden epidemics and implement appropriate targeted public health interventions

Comparison between Cerebroplacental Ratio and Umbilicocerebral Ratio in Predicting Adverse Perinatal Outcome in Pregnancies Complicated by Late Fetal Growth Restriction: A Multicenter, Retrospective Study

The role of cerebroplacental ratio (CPR) or umbilicocerebral ratio (UCR) to predict adverse intrapartum and perinatal outcomes in pregnancies complicated by late fetal growth restriction (FGR) remains controversial

Advanced breast cancer rates in the epoch of service screening: The 400,000 women cohort study from Italy

Background The objective of this study was to evaluate if mammography screening attendance is associated with a reduction in late-stage breast cancer incidence. Methods The cohort included over 400,000 Italian women who were first invited to participate in regional screening programmes during the 1990s and were followed for breast cancer incidence for 13 years. We obtained individual data on their exposure to screening and correlated this with total and stage-specific breast cancer incidence. Socio-economic status and pre-screening incidence data were used to assess the presence of self-selection bias. Results Overall, screening attendance was associated with a 10% excess risk of in situ and invasive breast cancer (IRR = 1.10; 95% confidence interval (CI): 1.06â\u80\u931.14), which dropped to 5% for invasive cancers only (IRR = 1.05; 95% CI: 1.01â\u80\u931.09). There were significant reductions among attenders for specific cancer stages; we observed a 39% reduction for T2 or larger (IRR = 0.61; 95% CI: 0.57â\u80\u930.66), 19% for node positives (IRR = 0.81; 95% CI: 0.76â\u80\u930.86) and 28% for stage II and higher (IRR = 0.72; 95% CI: 0.68â\u80\u930.76). Our data suggest that the presence of self-selection bias is limited and, overall, invited women experienced a 17% reduction of advanced cancers compared with pre-screening rates. Conclusions Comparing attenders' and non-attenders' stage-specific breast cancer incidence, we have estimated that screening attendance is associated with a reduction of nearly 30% for stages II+

Energy content and carbon emission audit of building materials

The main thesis examined in this research is that "the embedded energy of construction is much more significant than the operational energy for buildings in a tropical country such as Sri Lanka". All building elements (e.g. brickwall), materials (e.g. bricks) and "primitive" raw materials (e.g. clay) are placed in an aggregation-decomposition hierarchy. The process analysis carried out here basically captures most of the energy inputs associated with levels 1 and 2 in the IFIAS (1974) scheme, and accounts for around 90% of the embedded energy in a product. These calculations are based on Tonnes of Oil Equivalent (TOE). The data required to estimate these embedded energies were collected from building materials manufacturers. A computerised database was implemented using a relational database management system. This can be used to represent and calculate the embedded energies and carbon coefficients of building materials and elements that are hierarchically arranged. It can also handle multiple sources of data and perform calculations to give the average, maximum and minimum embedded energies, which are also classified according to fuel type and process stage. Though the analysis was done assuming that the final building is located in the City of Colombo, these database values can be used, with some caution, for buildings even outside the Colombo City or District. The embedded energy requirements were also calculated on the basis of the lowest quality energy (bio-equivalent energy), in addition to the more conventional basis of TOE. According to energy quality calculations carried out (based on efficiency considerations), 1GJ of energy from electricity is equivalent to 5 GJ of biomass energy, 1 GJ of fossil fuel energy is equivalent to 1.8 GJ of biomass energy and 1 GJ of electrical energy is equivalent to 2.78 GJ of fossil fuel energy. It is seen that the price per unit of biomass energy based on the actual prices of products is around one third of the actual price per unit of biomass energy. For fossil fuel and electricity on the other hand, the actual prices of products are much higher than the actual prices of the energy sources used for their production. In order to minimise adverse energy effects and to give a beneficial effect to halting global warming, policy measures to promote timber products are desirable. It is also seen that though materials which use timber fuels (e.g. bricks and tiles) consume more energy, the use of timber fuels is more competitive when compared on a bio-equivalent unit basis. Furthermore, with respect to carbon emissions, wood fuels are considered to be self sustaining. The use of timber, whether as a construction material or a fuel, will require properly planned re-forestation strategies. The energy contribution from walls for a typical two storey house is from 10 - 44%; for a single storey house it is from 29 - 49%. The contribution from roofs for the two storey house is from 4 - 7%, whereas it is 8 - 16% for the single storey house. The contribution from windows is 0.6 - 3% for the single storey house and 0.2 - 4.5% for the two storey. house. The contribution from the floor slab for the two storey house is 6 - 7%. The above ranges are a result of the difference of the between the use of low and high energy materials. The ratio between total embedded energy and annual operational energy for the buildings selected lies between 14 to 35 for the houses while for an office building with air conditioning loading it is 5. Though air conditioning has a large contribution towards the annual operational energy of a building, the total number of air conditioned buildings are small for a developing country such as Sri Lanka. Nevertheless, the results of the analysis show that the focus of energy efficient designs for buildings with air conditioning has to be on the operational energy. On the other hand, for houses, which are largely not air conditioned, the way to promote efficiency is by reducing the embedded energy through the appropriate choice of building materials. This is borne out not only by the high ratio of construction to operational energy ratio obtained, but also by the fact that the ratios for houses with low energy materials is almost half those for the houses with high energy materials. Key Words : Embedded Energy, Process Analysis, Building Materials, Carbon Emissions, Energy Databas