Characteristics of the colorectal cancers diagnosed in the early 2000s in Italy. Figures from the IMPATTO study on colorectal cancer screening

The impact of organized screening programmes on colorectal cancer (CRC) can be observed at a population level only several years after the implementation of screening. We compared CRC characteristics by diagnostic modality (screen-detected, non-screen-detected) as an early outcome to monitor screening programme effectiveness. Data on CRCs diagnosed in Italy from 2000 to 2008 were collected by several cancer registries. Linkage with screening datasets made it possible to divide the cases by geographic area, implementation of screening, and modality of diagnosis (screen-detected, non-screen-detected).We compared the main characteristics of the different subgroups of CRCs through multivariate logistic regression models. The study included 23,668 CRCs diagnosed in subjects aged 50-69 years, of which 11.9%were screendetected (N=2,806), all from the North-Centre of Italy. Among screen-detected CRCs, we observed a higher proportion of males, of cases in the distal colon, and a higher mean age of the patients. Compared with pre-screening cases, screen-detected CRCs showed a better distribution by stage at diagnosis (OR for stage III or IV: 0.40, 95%CI: 0.36-0.44) and grading (OR for poorly differentiated CRCs was 0.86, 95%CI: 0.75-1.00). Screen-detected CRCs have more favourable prognostic characteristics than non-screen-detected cases. A renewed effort to implement screening programmes throughout the entire country is recommended

Incidence trends of colorectal cancer in the early 2000s in Italy. Figures from the IMPATTO study on colorectal cancer screening

We utilised the IMPATTO study's archives to describe the 2000-2008 colorectal cancer (CRC) incidence rate trends in Italy, once screening programmes based on the faecal immunochemical test were implemented in different areas. Data on CRCs diagnosed in Italy from 2000 to 2008 in subjects aged 40-79 years were collected by 23 cancer registries. Incidence rate trends were evaluated as a whole and by macro-area (North-Centre and South-Islands), presence of a screening programme, sex, ten-year age class, anatomic site, stage at diagnosis, and pattern of diagnosis (screen-detected, non-screen-detected). The annual percent change (APC) of incidence rate trends, with 95% confidence intervals (95%CI), were computed. The study included 46,857 CRCs diagnosed in subjects aged 40-79 years, of which 2,806 were screendetected. The incidence rates in the North-Centre were higher than in the South and on the Islands. During the study period, screening programmes had been implemented only in the North-Centre and had a significant effect on incidence rates, with an initial sharp increase in incidence, followed by a decrease that started in the 3rd-4th years of screening. These incidence rate trends were exclusively due to modifications in the rates of stage I cases. After screening programmes started, incidence increased in all anatomic sites, particularly in the distal colon. The differential figures introduced by the implementation of screening programmes warrant a continuous surveillance of CRC incidence and mortality trends to monitor the impact of screening at a national level

Il parto cesareo. Quali determinanti medici e non medici? Analisi della casistica della Regione Emilia-Romagna

Nei dati pi\uf9 recenti la percentuale in Italia di parti cesarei \ue8 del 38%, valore che supera di molto la proporzione del 15% raccomandata dall\u2019Organizzazione Mondiale della Sanit\ue0. Percentuali al di sopra del 15% non produrrebbero alcun beneficio aggiuntivo in termini di salute n\ue9 per la madre n\ue9 per il neonato, ma anzi si ritiene che in situazioni di sovra-utilizzazione, proporzioni pi\uf9 basse di parti cesarei rappresentino una migliore qualit\ue0 dell\u2019assistenza. Obiettivo della ricerca riportato in questo capitolo di libro \ue8 stata quella di identificare in una coorte di donne che hanno partorito in Emilia Romgna i principali determinanti del parto cesareo. Oltre ai determinanti clinici che gi\ue0 si conoscevano dalla letteratura, sono risultati essere determinanti del taglio cesareo in questa coorte: l\u2019essere nubile, l\u2019essere divorziata, l\u2019essere disoccupata, l\u2019avere un basso titolo di studio e l\u2019aver effettuato un trattamento di procreazione medicalmente assistita. Un altro obiettivo della ricerca era di confrontare le percentuali di parto cesareo tra tutte le strutture che in Emilia Romagna effettuano parti al netto della complessit\ue0 della casistica clinica. A seguito dell\u2019aggiustamento per fattori di rischio clinici e caratteristiche socio-demografiche, la variabilit\ue0 delle percentuali di parto cesareo nei diversi ospedali (che nei dati grezzi andava dall\u201915% al 57%) \ue8 addirittura aumentata, \ue8 quindi importante utilizzare modelli di risk-adjustment quando si vogliono operare confronti

Parti cesarei

parti cesare

Parti cesarei ed et\ue0 materna

Esiste un unanime consenso che il taglio cesareo (TC) nei paesi industrializzati sia una procedura soggetta a sovra-utilizzazione: la proporzione di parti cesarei ha subito infatti negli ultimi anni un costante incremento in tutti i paesi occidentali, compresa l\u2019Italia, con un aumento dal 1999 al 2004 di 5 punti percentuali, raggiungendo uno tra i valori pi\uf9 elevati al mondo. La proporzione di parti cesarei sia a livello nazionale che a livello regionale continua ad essere in costante crescita, presentando grandi variabilit\ue0 interregionali. Il parto cesareo risulta essere un argomento di grande interesse per la ricerca clinica e per i servizi sanitari, poich\ue9, nonostante sia indiscutibile che in determinate circostanze cliniche rappresenti un intervento necessario per la madre e/o il neonato, \ue8 utile approfondire la grande variabilit\ue0 osservata nell\u2019utilizzo di tale procedura e valutare i rischi e le possibili complicanze che da esso possono derivare

Salute materno-infantile

salute materno-infantil

Peripartum hysterectomy and cesarean delivery: a population-based study.

OBJECTIVE: To estimate the incidence of peripartum hysterectomy in an Italian Region (Emilia-Romagna) and investigate its association with cesarean delivery. DESIGN: Population-based retrospective study using hospital discharge records. SETTING: All public and private hospitals in Emilia-Romagna region, Italy. POPULATION: A total of 151,494 women delivering between 2003 and 2006, 131 of whom had a peripartum hysterectomy. METHODS: Peripartum hysterectomy was defined as a hysterectomy performed at the time of delivery or afterwards during the same hospitalization. Incidence rates were calculated by type of delivery. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated with logistic regression to evaluate the association between peripartum hysterectomy and delivery type. MAIN OUTCOME MEASURES: Incidence rates of peripartum hysterectomy by type of delivery; odds of peripartum hysterectomy after primary or repeat cesarean compared with vaginal delivery without previous cesarean. RESULTS: A total of 131 peripartum hysterectomies were performed among 151,494 deliveries (0.86/1,000 deliveries; 95% CI 0.72-1.03) with 20.7% primary and 9.6% repeat cesarean deliveries. Women undergoing a primary caesarean delivery were more likely to have a peripartum hysterectomy than women having a vaginal delivery who had never had a cesarean delivery (OR 6.48; 95% CI 4.16-10.07). Women undergoing a repeat caesarean delivery were also at increased risk (OR 3.69; 95% CI 2.11-6.46). CONCLUSIONS: In this population, primary and repeat cesarean deliveries are associated with an increased risk of peripartum hysterectomy. These results are of particular concern given the steady increase in the cesarean delivery rate in many countries. The pathological mechanism of this association requires further investigation