The evaluation of a health education campaign on the use of leave from work during pregnancy

<p>Abstract</p> <p>Background</p> <p>The Italian Protective Maternity Legislation allows a woman to apply for early maternity leave from work during pregnancy if she is affected by health problems (option A) or if her working conditions are incompatible with pregnancy (option B). A community based health education program, implemented between 1995 to 1998 in North Eastern Italy, provided counseling (by a team of gynecologists, pediatricians, geneticists, psychologists and occupational physicians), and an information leaflet detailing the risks during pregnancy and the governmental benefits available to expectant mothers. This leaflet was distributed to women who were under occupational medical surveillance and to women attending any healthcare office and outpatient department and was also mailed to women working at home as shoemakers.</p> <p>The effectiveness of this intervention has been evaluated in this investigation using an evidence based approach.</p> <p>Methods</p> <p>A quasi-experimental design was adopted, applying several outcome measurements before (1989 to 1994) and after (1999 to 2005) the intervention. The outcome (ratio B/A) is the number of women receiving approval for B (circumstance where the pregnant woman is employed to undertake activities forbidden under the Article 7 of Law 151/2001, and it is impossible to change her duties) to those receiving approval for A (risky pregnancy due to personal medical conditions, Article 17 of the same Law). A linear regression coefficient (for B/A against years) was obtained separately for time periods "before" (1989-94) and "after" (1999-2005) the intervention program. The two regression coefficients were compared using a t-test.</p> <p>Results</p> <p>The trend over-time for the ratio B/A was steady before the initial intervention (y = 0.008x - 16.087; t = 2.09; p > 0.05) then increased considerably (y = 0.0426x - 84.89; t = 19.55; p < 0.001) in coincidence with the start of the education campaign. There was a significant difference between the two regression coefficients (t = 7.58; p < 0.001).</p> <p>Conclusion</p> <p>From a bureaucratic perspective Option B is far more complicated than A. In fact it implies an active approach involving an arrangement between the claimant and the employer, who has to certify to the relevant Authority that the woman's working conditions are incompatible with pregnancy. The increasing number of women availing of option B, as recommended, therefore suggests the suitability of such educational campaign(s).</p

Increased Risk of Hepatocellular Carcinoma and Liver Cirrhosis in Vinyl Chloride Workers: Synergistic Effect of Occupational Exposure with Alcohol Intake

Hepatocellular carcinoma (HCC) and liver cirrhosis (LC) are not well-established vinyl chloride monomer (VCM)–induced diseases. Our aim was to appraise the role of VCM, alcohol intake, and viral hepatitis infection, and their interactions, in the etiology of HCC and LC. Thirteen cases of HCC and 40 cases of LC were separately compared with 139 referents without chronic liver diseases or cancer in a case–referent study nested in a cohort of 1,658 VCM workers. The odds ratios (ORs) and the 95% confidence intervals (CIs) were estimated by common methods and by fitting models of logistic regression. We used Rothman’s synergy index (S) to evaluate interactions. By holding the confounding factors constant at logistic regression analysis, each extra increase of 1,000 ppm × years of VCM cumulative exposure was found to increase the risk of HCC by 71% (OR = 1.71; 95% CI, 1.28–2.44) and the risk of LC by 37% (OR = 1.37; 95% CI, 1.13–1.69). The joint effect of VCM exposure above 2,500 ppm × years and alcohol intake above 60 g/day resulted in ORs of 409 (95% CI, 19.6–8,553) for HCC and 752 (95% CI, 55.3–10,248) for LC; both S indexes suggested a synergistic effect. The joint effect of VCM exposure above 2,500 ppm × years and viral hepatitis infection was 210 (95% CI, 7.13–6,203) for HCC and 80.5 (95% CI, 3.67–1,763) for LC; both S indexes suggested an additive effect. In conclusion, according to our findings, VCM exposure appears to be an independent risk factor for HCC and LC interacting synergistically with alcohol consumption and additively with viral hepatitis infection

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P &lt; .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

EUSeaMap. A European broad-scale seabed habitat map

In order to most benefit from the potential offered by the European marine basins in terms of growth and employment (Blue Growth), and to protect the marine environment, we need to know more about the seafloor. European Directives, such as the MSFD, but also the Horizon 2020 roadmap explicitly called for a multi-resolution full coverage of all European seas including bathymetry, geology and habitats. The present work, following on a suite of past initiatives, has made a big step forward in this direction. It has first boosted the collation of existing maps from surveys by setting up a framework and a procedure to encourage people to submit their maps and data. This resulted in a more attractive EMODnet seabed habitat portal and a snowball effect with more and more people willing to join. However, collation will eventually come to an end and as new creations of seabed habitat maps are so complex and time-consuming, a cost-efficient way to meet the need for a full-coverage habitat map was found to be low-resolution maps and models to predict seafloor habitat types. The broad-scale map referred to as EUSeaMap has been created by this project and after the first two phases it now covers all European basins from the Barents Sea to Macaronesia and to the Black Sea. By harmonising mapping procedures - based on the EUNIS classification - and fostering a common understanding among seabed mappers in Europe, EUSeaMap provides today the community with a comprehensive, free and ready-to-use map that can find applications at regional scale for management and conservation issues. Tables and maps for all basins can be found in section 3 “Results and disciussions”. The project has played a key role in giving feedback to other EMODnet communities dealing with bathymetry, geology and biology, all essential data sources for the broad-scale map. It has also improved the understanding of the EUNIS habitat classification - with a focus on the Adriatic and the Black Sea - by better specifying transitions between classes based on benthic ground-truth data. It has fostered the development of oceanographic variables such as light, waves and currents that have a strong bearing on habitats. Finally it has also been instrumental in developing map confidence assessment methods that account for the broad spatial variation in data sources quality and for uncertain boundaries between habitat classes. The EUSeaMap methods are repeatable and ensure that the predictive maps can continue to be improved in the future, as a result either of EUNIS enhancements or increase in resolution. From today’s 250m resolution it is likely that new deliveries of enhanced source layers due to steady progress in oceanography and geophysics will enable constant refinement of the maps over time

Mapping seabed habitats over large areas: prospects and limits

Since its inception, in 2009, EMODnet Seabed Habitats has brought together a European consortium of specialists in benthic ecology and seabed habitat mapping to develop a transnational broad-scale seabed habitat map, named EUSeaMap. EUSeaMap is the only pan-European cartographic product that provides a standardised trans-boundary overview of the spatial distribution of seabed habitats across Europe. As such, it has been extensively used in various applications such as Marine Protected Area evaluation or cumulative impact of stressors on habitats, and it is likely to be used again in the future in various marine ecosystem assessments. It is therefore important to continue to update it regularly when significant improvements to the data products that constitute its basis, i.e. the seabed substrate, bathymetry or environmental variables, are published. In addition to EUSeaMap, it would be desirable to provide stakeholders with products on the spatial distribution of targeted habitats/biotopes such as those of conservation interest (e.g. kelp forest, seagrass meadows, coral reefs). Some techniques, hereafter referred to as "SDMs", are acknowledged to be effective in mapping these habitats. We argue that a program that would use these techniques to map these key habitats/biotopes in European waters would be invaluable, but such a program can only be achieved if there is a significant improvement in the spatial resolution of environmental variables. An important message of this report is therefore that the EU should consider funding a project that would develop spatially explicit high-resolution (at least 500 m) data products on key variables (light availability, hydrodynamics, wave exposure, temperature, oxygenation, chlorophyll-a, phosphate, nitrate, etc.) that would spatially cover all European waters