Determinants of oral contraceptive use in northern Italy

Socio-demographic characteristics, general lifestyle habits, reproductive and medical histories were compared of 328 women who had ever used oral contraceptives and 2306 never users from a case-control surveillance conducted in Northern Italy. Oral contraceptive use was positively and strongly related with the level of education and indicators of social class. The rate ratio of ever use (adjusted for age and diagnostic category) was 3.3 for women with 12 years of education or more compared with less than 7 years, and 3.0 for women of highest compared with lowest social class. The frequency of pill use was lower among never married women, and significantly elevated among smokers (rate ratio = 2.4 for heavy smokers). In contrast, no relation was evident between alcohol or coffee consumption and pill use. Likewise, ever users of oral contraceptives were not significantly different from women who had never used the pill with regard to major reproductive factors (parity and age at first pregnancy) or several medical variables of potential interest (e.g., diabetes, hypertension, hyperlipidemia), with the only possible exclusion of obesity which was less frequent among pill users. Thus, this study indicates that the major determinants of the persistently low frequency of oral contraceptive use in this Northern Italian population are social rather than reproductive or medical factors. These findings have important implications for epidemiological research on oral contraceptive and disease in this population, and underline the importance of selection and screening of oral contraceptive users on the basis of knowledge of medical factors and lifestyle habits.     

Whole exome association of rare deletions in multiplex oral cleft families

By sequencing the exomes of distantly related individuals in multiplex families, rare mutational and structural changes to coding DNA can be characterized and their relationship to disease risk can be assessed. Recently, several rare single nucleotide variants (SNVs) were associated with an increased risk of nonsyndromic oral cleft, highlighting the importance of rare sequence variants in oral clefts and illustrating the strength of family‐based study designs. However, the extent to which rare deletions in coding regions of the genome occur and contribute to risk of nonsyndromic clefts is not well understood. To identify putative structural variants underlying risk, we developed a pipeline for rare hemizygous deletions in families from whole exome sequencing and statistical inference based on rare variant sharing. Among 56 multiplex families with 115 individuals, we identified 53 regions with one or more rare hemizygous deletions. We found 45 of the 53 regions contained rare deletions occurring in only one family member. Members of the same family shared a rare deletion in only eight regions. We also devised a scalable global test for enrichment of shared rare deletions.     

Underreporting of AIDS cases in Lazio,Italy

One of the most important aspect of any surveillance system is completeness. We conducted an evaluation of the completeness of the AIDS surveillance system (SSAIDS) of Lazio region. We estimated the underreporting of AIDS cases in SSAIDS of Lazio in the period 1996-1998 through a linkage with the regional Hospital Information System (HIS) for the same years. A logistic regression model was used to estimate the relative risk (Odds Ratios--OR) of being unreported by demographic and clinical characteristics. A total of 56 cases had not been reported in the period 1996-1998, corresponding to 3.6% of underreporting. The risk of not being reported was associated with undetermined value of CD4 at diagnosis of AIDS (OR 15.40), unknown modality of exposure (OR 3.15) and with AIDS defining illness at diagnosis (ADI) as mycobacteriosis (OR 11.65), encephalopaties (OR 4.47) and toxoplasmosis (OR 8.67). Differences were also observed by clinical centre of diagnosis. In conclusion, the degree of underreporting is lower in our region than in other countries and the SSAIDS has a high completeness in Lazio. In agreement with other studies, underreporting is more frequent for cases with undermined value of CD4 at diagnosis of AIDS and unknown modality of exposure. The results regarding ADI need further investigation.     

Organization and estimated patient-borne costs of oral anticoagulation therapy in Italy

Background

The management of the large patient population in Italy receiving long-term oral anticoagulation therapy (OAT) poses organizational challenges that are traditionally approached with a centralized procedure, relying on hospital-based clinics and/or GPs. However, the availability of near-patient testing devices for the monitoring of OAT effectiveness (international normalized ratio measurement) allows for alternative or complementary management models, in which adequately trained patients perform the test themselves and possibly make decisions about dosing adjustments (patient self-monitoring). Patient self-monitoring has been proven to be effective and safe, and is economically attractive. However, in order to assess its potential economic impact in Italy, there is a need for data on current treatment patterns and relative costs, which are currently not available.

Objective

To establish prevalent management patterns and costs incurred by Italian OAT patients.

Methods

An ad hoc questionnaire was developed and administered to OAT patients with the support of the main Italian OAT patients association. Returned questionnaires were checked for consistency and valid data were summarized. Resources used were costed according to published prices.

Results

A total of 4722 valid questionnaires were returned from all over Italy. The prevalent OAT management model in this sample relied on hospital-based anticoagulation clinics. Significant earning losses, transportation costs and other out-of-pocket expenses were incurred by patients, with an estimated mean overall monthly cost of approximately €30 (year 2008 value). There was a wide distribution of costs in this population, depending mainly on monitoring frequency, home-to-clinic distance and employment status.

Conclusion

This study contributes to clarifying the organizational models of the Italian OAT population and delivers data on treatment patterns and costs that may be used when planning and evaluating alternative management options.     

Scheduling delay in suspected cases of oral cancer

The objective of the study was to evaluate scheduling delay of dental exams in the city of S?o Paulo of patients suspected of having oral cancer. A cross-sectional study was performed in which telephone conversations simulated clinical situations that represented two types of patients: one presenting symptoms suggestive of oral cancer (CA), and another one suggesting the need for prostheses (PR). The scheduling delay was evaluated by the days until an appointment for care; and among public offices, by type of schedule (emergency or routine). Negative binomial regression was used (95% statistical significance). Five hundred and seventy-five public and private dental offices participated in the study. The mean scheduling delay for the CA group was 2.88 days, and for the PR group, 4.34 days (p = 0.01). The mean scheduling delay was shorter in private dental offices (2.59 days) than in offices that accepted health insurance (2.74 days) (p = 0.01); the delay was shorter when performed by the dentist rather than by the dental assistant, 2.45 versus 4.21 days (p = 0.01). In public services, 69% of patients in the cancer group were sent to the emergency service. Dental services were accessible for scheduling clinical examinations among patients suspected of having oral cancer.     

翼点入路经侧裂显微手术治疗60例岛叶胶质瘤

目的 探讨显微外科治疗脑岛叶胶质瘤的手术入路和疗效.方法 采用翼点入路经侧裂显微手术切除60例岛叶胶质瘤.结果 显微镜下肿瘤全切除51例,次全切除9例.术后除8例出现暂时性运动性失语,6例出现暂时性对侧肢体偏瘫外,均恢复良好.术后均无严重并发症出现,无死亡病例.36例患者随访3个月至3年,3例复发.结论 翼点入路经侧裂显微手术治疗岛叶胶质瘤,具有路径短、显露佳的特点,是切除岛叶胶质瘤的有效术式.     

Occupation and cancer of the oral cavity or oropharynx in Turin, Italy

In a population-based case-referent study, the occupational experience of 86 men with oral or oropharyngeal cancer and 373 referents was analyzed with respect to employment in 41 occupations and 40 industries, as well as to exposure to 16 chemicals, as estimated via a job-exposure matrix. Among the occupations and industries at higher risk were machinery operator (odds ratio [OR] 2.0; 95% confidence interval [95% CI] 1.0-4.0), plumber (OR 5.0, 95% CI 1.2-21.5), building industry (OR 2.5; 95% CI 1.3-4.5), textile industry (OR 2.5; 95% CI 0.6-4.6), and electricity production (OR 2.8; 95% CI 0.7-12.1). All the OR estimates were adjusted for age, education, area of birth, tobacco smoking, and alcohol consumption. An association between formaldehyde exposure and oral cancer was suggested (OR for any exposure 1.6, 95% CI 0.9-2.8; OR for probable or definite exposure 1.8, 95% CI 0.6-5.5). No other chemical included in the matrix showed any risk pattern. The evidence of an association between formaldehyde exposure and oral or oropharyngeal cancer is strengthened by the results of this study.     

口服过氧乙酸13例

过氧乙酸是一种杀菌能力较强的高效消毒剂，广泛应用于家庭消毒。由于随意存放偶有口服意外事故发生。口服过氧乙酸以往少有报道，近年来多为个案报告。现对我院2003年5月至2004年5月收治的13例口服过氧乙酸患者的临床资料进行总结分析，并探讨急救治疗措施。     

Phylogenetic analysis of isolates from new cases of HBV infection in Southern Italy

The level of endemicity of hepatitis B virus (HBV) infections in Italy is low and genotype D infections predominant. New HBV strains may however be introduced as a result of movements of people from regions of high endemicity. The aim of the present study was to determine whether strains from new cases of acute hepatitis B detected in southern Italy were due to endemic or new HBV strains. We studied 34 isolates from patients with acute hepatitis B infection, and 35 from chronic hepatitis B patients. A phylogenetic analysis of preS/S region was done by comparing the sequences from the acute and chronic cases with references sequences. The study showed that 44% of strain from acute hepatitis B patients were of genotype A, 53% of genotype D, and 3% of genotype E. The molecular analysis of isolates from acute hepatitis B patients from Sicily showed a change in the local epidemiology of this infection, with an increase in HBV/A infections and a clustering effect for HBV D2, possibly correlated to immigration. The introduction of new genotypes , could have an effect on HBV-correlated diseases due to the different association between genotype, liver disease and response to antiviral therapy.     

儿童口腔内科疾病病例分析

目的:了解儿童口腔内科疾病的发生和分布情况,为防治此类疾病提供一些参考资料.方法:对我院口腔门诊就诊的15岁以下的2278例口腔内科疾病患儿的性别、年龄、乳、恒牙数、牙位进行分析.结果:①根尖周病最多,其次为龋病,再次为牙髓病,牙周病最少;②病变牙90%以上是乳牙;③乳牙的口腔内科疾病的就诊高峰在4～7岁;④乳牙的根尖周病、龋病、牙髓病的好发牙住由高到低顺序均为下颌磨牙、上颌磨牙、上颌前牙.结论:儿童口腔健康状况较差,需加强口腔卫生宣教,改进防治措施.     

口服氯氮平中毒2例报道

回顾性分析2例氯氮平中毒病例临床资料。氯氮平中毒最常见症状是过度镇静或精神异常，主要并发症为吸入性肺炎，可伴有肝肾功能及心肌酶等多项指标异常或多系统损伤。     

2034例口腔急诊患者一般构成分析

目的 探讨综合性医院口腔疾病急诊特点.方法 对2007年1月至2009年3月杭州师范大学附属医院口腔科收治的2 034例口腔急诊病例的临床特点进行分析.结果 本组口腔急诊病例分类构成以口腔颌面部炎症最多见,占急诊病例的81.2%,其中又以急性牙髓炎、急性根尖周炎为主;其次为组织损伤,占急诊病例的16.8%;其余依次为拔牙后出血、牙龈出血、颌面部异物等,占急诊病例的1.97%.结论 口腔急诊以颌面部炎症为主,其次为组织损伤及出血.     

口服戊二醛中毒5例临床分析

回顾性分析5例口服戊二醛中毒患者的临床表现及诊治经过。口服戊二醛中毒表现为上消化道水肿、糜烂、溃疡及出血。消化道黏膜损伤有一定的自限性，治疗上以早期禁食、营养支持、质子泵抑制剂联合抗生素等措施为主，严密监测，警惕胃肠穿孔。     

口服药物中毒110例临床分析

本文就我科2001年度接诊的110例口服药物中毒者的抢救处置及转归做了分析总结。本组病例以口服镇静催眠药物中毒为主，特别以服用安定等苯二氮革类镇静剂最多。经救治患者无一例死亡，作者认为彻底洗胃、导泻、利尿及保护肝、肾功能是抢救成功的关键。