结直肠癌患者住院费用构成及其影响因素分析

目的 分析结直肠癌患者住院费用构成及其影响因素,为控制结直肠癌患者住院费用的增长以及降低结直肠癌患者的疾病经济负担提供参考。方法 以江苏省某三级中医院2015年1月—2019年12月主要诊断为结直肠癌的6 967份有效病案为研究对象,运用描述性分析、单因素分析、多元逐步回归分析法探讨结直肠癌住院费用的影响因素,利用灰色关联法分析费用变动的主要影响因素。结果 6 967例结直肠癌患者次均住院费用为20 586.11元,住院费用中位数为10 976.64元;次均住院天数为10.06天,中位数为7天。影响住院费用的因素包括：年龄、住院科室、出院年份、是否手术、手术并发症、是否化疗、是否放疗以及是否中医药治疗。结直肠癌患者住院费用变动因素前三位依次是西药费、检验费和材料费。结论 西药费、检验费和材料费是影响结直肠癌患者住院费用的关键因素,应加强对西药费、检验费和材料费使用的监管,进一步规范临床路径、优化医保支付方式等来合理控制结直肠癌患者住院费用的过快增长,减轻患者的经济负担。     

DRGs支付改革前后结直肠癌手术病例住院费用分析

目的：分析DGR支付模式对中医医院结直肠癌手术患者住院费用的影响，为进一步完善DRG改革方案提供有益的参考依据。方法：收集某市三甲中西医结合医院DGR支付改革前后结直肠癌手术病例的住院病案首页数据，统计比较2组病例年龄、性别、住院天数、例均费用等数据的差异。结果：与DRG支付改革前相比，改革后结直肠癌手术病例例均总费用由54017.67元下降到47 077.32元，下降了12.85%，其中西药费下降明显，诊断费和其他类费用也有所下降；改革后结直肠癌手术病例的住院费用结构也发生变化，西药费、其他类费用占比下降，材料费占比上升明显，中医治疗费、手术治疗费、护理费和中药费占比有所上升，差异具有统计学意义。结论：DRG支付方式在中医医院的实践中减少了结直肠癌病例住院部分项目费用支出，从而降低了住院总费用，具有一定的代表性。     

结直肠肿瘤手术患者DRGs分组效果与费用分析

目的:分析结直肠恶性肿瘤手术患者的住院费用与DRGs分组情况,探讨结直肠手术病种DRGs分组的规律,为DRGs付费推广作参考,为医疗机构费用管理作借鉴。方法:回顾搜集2015年结直肠肿瘤相关数据,回归分析费用及DRGs分组的主要影响因素。结果:次均费用中位数为88 642元;分为15组DRGs、主要集中在GB23组和GB25组;平均住院日、病理类型、专病科室与否、肿瘤部位,是不同DRGs分组的主要差异因素。结论:要根据肿瘤病种的治疗阶段与方案,进一步细化病种的DRGs分布,一方面政府应积极、科学发挥支付制度的杠杆作用,另一方面医疗机构应强化多部门合作,摸清肿瘤病种规律,为DRGs付费作铺垫。     

直肠肿瘤手术患者费用负担影响因素的树分析

目的:分析直肠恶性肿瘤手术患者的住院费用负担情况,探讨其影响因素和分组路径,为医疗机构费用管理作借鉴,为减轻患者负担作参考。方法:回顾搜集2014年1月—2015年12月直肠肿瘤住院手术患者数据,应用树模型来推断住院费用负担的相关影响因素。结果:根治手术、超声刀与高频电刀的使用与住院费用可能存在统计学关联,造瘘手术与否、DRGs分组是患者住院费用及基金申报的主要判别因素。结论:医保待遇差异影响患者负担水平,手术术式及DRGs分组影响病种疾病负担,一方面政府应充分发挥医保的引导和杠杆作用,另一方面医疗机构宜细化病种费用管理、强化病种成本核算,共同推动肿瘤专业的三医联动。     

1381例结直肠癌患者住院费用分析

目的探讨结直肠癌患者住院费用的变化及其影响因素,为控制住院费用的不合理增长及结直肠癌的防治提供参考依据。方法选取2006-2011年山西省某三级甲等综合医院收治的1 381例结直肠癌患者为研究对象,采用方差分析和多元逐步回归分析法对其住院费用的影响因素进行分析。结果 1 381例结直肠癌患者平均住院天数为19 d（中位数）,平均年龄为（59.66±12.18）岁,人均住院费用为19 267.92元（中位数）,且呈逐年增长趋势;其中64.88%的住院患者为农民;住院费用构成中,药品费所占的比例最大（33.61%）;影响住院费用的主要因素依次为:住院天数、手术与否、住院年份、药占比等;实施手术患者的住院费用高于无手术患者（P<0.001）。结论 6年间结直肠癌患者住院费用呈逐年上升趋势,支付方式发生变化;应不断提高诊疗水平,制定合理的单病种管理措施,控制住院费用不合理增长,减少患者的疾病负担。     

1 381例结直肠癌患者住院费用分析

目的 探讨结直肠癌患者住院费用的变化及其影响因素,为控制住院费用的不合理增长及结直肠癌的防治提供参考依据.方法 选取2006-2011年山西省某三级甲等综合医院收治的1 381例结直肠癌患者为研究对象,采用方差分析和多元逐步回归分析法对其住院费用的影响因素进行分析.结果 1 381例结直肠癌患者平均住院天数为19 d(中位数),平均年龄为(59.66±12.18)岁,人均住院费用为19 267.92元(中位数),且呈逐年增长趋势;其中64.88％的住院患者为农民;住院费用构成中,药品费所占的比例最大(33.61％);影响住院费用的主要因素依次为:住院天数、手术与否、住院年份、药占比等;实施手术患者的住院费用高于无手术患者(P＜0.001).结论 6年间结直肠癌患者住院费用呈逐年上升趋势,支付方式发生变化;应不断提高诊疗水平,制定合理的单病种管理措施,控制住院费用不合理增长,减少患者的疾病负担.     

基于路径分析的视角验证慢性肾衰竭DRGs分组流程

目的:采用路径分析对慢性肾衰竭病住院费用各相关因素进行分析,以获取DRGs分组的主要影响因素,为复杂类型病种DRGs分组流程提供方法学上的借鉴和思路,为医保政策制定提供参考.方法:收集新疆某三级甲等综合医院2012年肾病科慢性肾衰竭病例及患者相关资料,应用路径分析对其住院费用影响因素进行分析,获得慢性肾衰竭DRGs分组流程主要影响因素.结果:慢性肾衰竭住院患者的医疗费用主要由治疗费、药费、检查费用构成,影响因素主要包括住院天数、透析方式、是否ICU、附加诊断个数、并发症、年龄分组等.结论:为达到医、患、保三方认同的住院费用支付方式的适宜路径,DRGs分组流程应结合本地区、本医院的数据加以分析后,确定分组因素,有目的的进行费用控制.同时DRGs-PPS可以尝试使用路径分析对实际的病种及费用进行分析后再进行DRGs分组.     

按病种付费下高值医用耗材医疗服务价格政策现状、影响及建议——以经内镜逆行性胰胆管造影术(ECRP)为例

本文结合病种付费制度改革和ERCP技术推广的现状,分析了ERCP价格政策及对患者费用影响,并提出政策建议。ERCP耗材属于"低价"高值医用耗材,但9类疾病患者住院费用中耗材费占比达到35.81%~48.25%,是导致费用昂贵的主要因素之一。由于ERCP耗材未纳入医保支付范围,目前这类患者手术自付比率高、医疗费用昂贵。建议:(1)重视历史结算数据,科学制定病种收费标准;(2)参考治疗方式差异,分类制定病种支付标准;(3)规范手术操作编码,为病种费用测算提供精准数据支持。     

DRG支付下甲状腺大手术患者住院费用影响因素研究

[目的]探讨某院甲状腺大手术患者住院费用的影响因素,为疾病诊断相关分组(DRG)细化分组和住院费用控制提供参考。[方法]根据医院2022年1-10月医保DRG系统的分组结果,收集乳腺甲状腺外科甲状腺大手术患者住院病例的病案首页信息,采用描述性统计分析患者住院时间、住院费用及费用构成差异;使用单因素分析患者住院费用的相关影响因素;运用结构方程验证各影响因素与住院费用的相关性。[结果]本研究共纳入643名患者,平均住院日为7 d,平均住院费用为19,009.57元。以重庆市DRG支付中甲状腺大手术的支付标准为参考,该院乳腺甲状腺外科甲状腺大手术超支病例组患者医疗资源消耗高于正常病例组(P<0.05),显著影响患者的住院费用;单因素分析显示,甲状腺大手术患者住院费用与患者住院时间、手术部位、其他诊断数量、其他手术数量、是否使用机器人辅助操作有关;结构方程显示,住院费用的主要影响因素为是否使用机器人辅助操作,其他影响因素从大到小依次为：其他手术数量、手术部位、住院时间和其他诊断数量。[结论]在DRG支付方式下,甲状腺大手术可参考住院费用的相关影响因素结果,将患者是否使用机器人辅助操作纳入...     

病例组合方法在确定急性阑尾炎患者住院费用中的运用

目的:为建立以病例组合为基础的住院费用的研究提供方法上的参考。方法:采用病例组合方法对708例急性阑尾炎患者住院费用进行分组,计算各组的标准费用。结果:通过研究,提取出了影响费用的主要因素:住院天数、治疗结果、有无并发症或伴随症、病种类型、年龄、术前天数。按主要因素对样本进行分组,得到了9个病例组,并对无并发症或伴随症的3个病例组进行了标准费用的计算。结论:经组合后取得的住院费用更为切合实际。     

A dual-perspective analysis of the hospital and payer-borne burdens of selected in-hospital surgical complications in low anterior resection for colorectal cancer

Objectives: The economic burden of surgical complications is borne in distinctly different ways by hospitals and payers. This study quantified the incidence and economic burden – from both the hospital and payer perspective – of selected major colorectal surgery complications in patients undergoing low anterior resection (LAR) for colorectal cancer.

Methods: Retrospective, observational study of patient undergoing LAR for colorectal cancer between 1/1/2010 and 7/1/2015. Analyses were replicated in two large healthcare administrative databases: Premier (hospital discharge and billing data; hospital perspective) and Optum (insurance claims data; payer perspective). Multivariable analyses evaluated the association between infection (surgical site or bloodstream), anastomotic leak, and bleeding complications and the following outcomes: hospital length of stay (LOS), non-home discharge, 90-day all-cause readmission, index admission costs to the hospital, index admission payer expenditures, and index admission +90-day post-discharge payer expenditures.

Results: 9,738 eligible LAR patients were included (7,479 in Premier; 2,259 in Optum). Overall, the incidences of infection, anastomotic leak, and bleeding complications were 6.4%, 10.6%, and 10.9%, respectively, during the index hospitalization. Each complication was associated with statistically significant longer LOS, higher risk of non-home discharge, higher risk of 90-day readmission, greater costs to the hospital, and higher payer expenditures.

Conclusions: In-hospital infection, anastomotic leak, and bleeding were associated with a substantial economic burden, for both hospitals and payers, in patients undergoing LAR for colorectal cancer. This study provides information which may be used to quantify the potential economic value and impact of innovations in surgical care and delivery that reduce the incidence and burden of these complications.     

中国人群消化系统癌症疾病负担分析

目的 了解中国人群消化系统癌症的发病、死亡情况及不同危险因素所导致的疾病负担的变化趋势。方法 资料来源于GLOBOCAN 2020和2019年全球疾病负担研究数据库中的中国人群数据,应用Excel 2019和R 4.2.1软件,采用年龄标化发病率（ASIR）、年龄标化死亡率（ASMR）、年龄标化伤残调整寿命年（DALY）率及其变化率等指标,描述消化系统癌症归因于各类危险因素的疾病负担及其变化趋势。结果 2020年中国消化系统癌症的ASIR为83.00/10万,ASMR为63.80/10万,发病和死亡例数均随年龄增长而增加,且各年龄组男性消化系统癌症发病及死亡例数均高于女性。1990-2019年中国食管癌、胃癌、肝癌的年龄标化DALY率呈下降趋势（变化率分别为-45.26%、-46.87%、-65.63%）,而胰腺癌、结直肠癌、胆囊胆管癌的年龄标化DALY率呈上升趋势（变化率分别为67.61%、30.52%、7.21%）,死亡率的变化趋势与DALY率一致。与归因于行为因素的年龄标化DALY率的比例相比,1990-2019年食管癌、肝癌、胰腺癌和结直肠癌归因于代谢因素的年龄标化DALY率占该癌种总年龄标化DALY率的比例均逐年升高。1990-2019年中国胃癌、肝癌、胰腺癌、胆囊胆管癌不同归因的年龄标化DALY率排序无显著变化,但食管癌和结直肠癌年龄标化DALY率的部分归因因素排序有所提前（食管癌：高BMI;结直肠癌：低牛奶摄入、低全谷物摄入）。结论 2020年中国消化系统癌症的发病及死亡流行情况严重,1990-2019年中国消化系统癌症归因于代谢因素的疾病负担比例逐年上升,且部分消化系统癌症的疾病负担归因次序发生了显著变化。     

南通市2020例乳腺癌患者住院费用影响因素的通径分析

目的:通过分析乳腺癌病例的住院费用,了解乳腺癌患者住院费用情况及主要影响因素,为合理控制医疗费用过快增长提出建议。方法:收集南通市两家医院2004～2009年的2 020份有效病历,采用描述性分析、单因素分析和通径分析。结果:影响乳腺癌患者住院费用的主要因素为住院天数、住院年份、是否手术、转归情况、年龄和费用负担形式,住院天数、转归情况、费用负担形式直接影响住院费用,其中住院天数是最主要因素;住院年份、是否手术、年龄既可直接影响住院费用,又可通过住院天数间接影响住院费用。结论:可通过合理缩短住院天数、完善医疗保险制度改革、健全社区卫生服务、加强医德医风教育等方式控制乳腺癌患者的住院费用。     

基于DRG付费的经皮冠状动脉支架植入病组住院患者费用结构变化的影响研究*

目的：探索 DRG支付方式改革后 FM19病组住院患者的费用结构变化及影响因素，为合理管控此类医疗费用提供参考。方法：采用统计学描述方法，对烟台市8家DRG试点医院FM19病组住院患者的信息以及高值耗材的使用情况进行分析；运用结构变动度分析法，分析费用变化的主要类别和方向。结果：住院患者人次增加，次均住院费用与耗材费下降趋势明显。2019—2021年住院患者次均住院费用的结构变动度为46.50%，其中耗材费、手术和治疗费是影响住院费用变动的主要项目，累计贡献率为84.24%。结论：FM19病组住院患者的费用下降明显，费用结构逐渐趋于合理化，但体现医务人员劳动价值的服务设施费增幅有限，同时为避免高值耗材的滥用，应持续加强基金监管。     

Quality and scientific accuracy of patient-oriented information on the internet on minimally invasive surgery for colorectal cancer

ObjectivesAppropriate information on minimally invasive surgery for colorectal cancer would help the patients and their caretakers to understand the treatment process. We aimed to assess the readability, quality and scientific content of patient-oriented information on minimally invasive surgery for colorectal cancer on the internet.MethodsInternet search on “minimally invasive surgery for colorectal cancer”, “laparoscopic surgery for colorectal cancer” and “robotic surgery for colorectal cancer” was performed on search engines (Google, Yahoo! and Bing). Quality and readability were assessed by DISCERN instrument and validated Flesch Reading Ease Score (FRES) respectively.ResultsFifty-five websites were analysed. The median DISCERN score was 41(range:24–66) and the median FRES score was 33.9(range:10.4–59.8) indicating low readability. Twenty-seven sites (49.1%) were affiliated with hospitals or clinics. Benefits of surgery and the surgical procedure were mentioned in 76.4% and 81.8% respectively. However, pre-op preparation, surgical complications, and quality of life were not mentioned in 49(82.1%), 42(76.4%) and 44(80%) sites respectively. Overall on DISCERN, 7(12.73%) were identified as “Excellent”, 25(45.45%) as “Good” or “Moderate” and 23(41.82%) as “Poor”.ConclusionAnalysis of the quality and scientific content of patient information on MIS for CRC revealed a considerable deficiency in the information provided and sub-standard readability. Several aspects such as pre-op preparation, surgical complications and post-operative quality of life which are of concern to the patient were not discussed in a considerable proportion of articles. As the internet is expanding as a readily available source of information, steps should be taken to ensure the highest quality information.     

术前肠内免疫营养对结肠癌病人免疫功能的影响

目的:探讨术前应用肠内免疫营养支持对结肠癌病人免疫功能的影响. 方法:将40例结肠癌病人随机分为两组,每组20例.试验组术前给予瑞能肠内免疫营养支持7 d,对照组术前常规饮食准备.观察术前和术后免疫指标以及术后感染性并发症的发生率及住院时间. 结果:术后两组病人各项免疫指标水平均有不同程度下降,但试验组手术前后各项指标无显著性差异;而对照组术后第3天的外周血淋巴细胞总数、CD4 /CD8 和术后第7 天的淋巴细胞总数、CD3 、CD4 、CD4 /CD8 、血清IgG、IgM水平均较入院时显著降低(P＜0.05);试验组术后第7天淋巴细胞总数、CD3 、CD4 、CD4 /CD8 和血清IgG、IgM水平明显高于对照组(P＜0.05);试验组术后感染性并发症的发生率显著低于对照组(P＜0.05);两组住院时间无显著性差异(P＞0.05). 结论:术前使用肠内免疫营养制剂,能明显改善结肠癌病人的免疫状况,减少术后感染性并发症的发生.     

Moves Afoot To Shore Up Sagging Malpractice Coverage

Abstract

Objective: Venous thromboembolism (VTE) is a common complication in cancer patients. This review summarizes some of the most current knowledge of the epidemiology, risk factors, risk models, prophylaxis, and treatment of VTE in cancer patients. Methods: A literature search was conducted using Pub Med; the search terms were venous thromboembolism, anticoagulation, and cancer. The bibliographies of pertinent studies and review articles were reviewed for additional references. Results: Venous thromboembolism is the second leading cause of death in patients with cancer. Cancer patients with VTE have poorer outcomes compared with noncancer patients with VTE. Many risk factors have been identified for VTE in patients with cancer that are patient-related, cancer-related, or treatment-related. Several biomarkers have been identified as potentially predictive of VTE risk. Risk assessment models such as the Khorana Risk Score stratify cancer patients with low, intermediate, and high risk of developing VTE based on baseline clinical and laboratory variables. Currently, enoxaparin is the preferred anticoagulant for initial VTE treatment in cancer patients. Low molecular weight heparin (LMWH) is recommended for both initial and long-term management of cancer-related VTE. Because the optimal duration of anticoagulation in cancer patients with VTE is unknown, the decision to extend anticoagulation requires weighing the risk of recurrent thrombosis against the risk of major bleeding. Patients with recurrent VTE can be bridged with LMWH, transitioned to full-dose LMWH or treated with LMWH dose escalation. While there is insufficient data to determine whether anticoagulation should be held in the setting of thrombocytopenia, full-dose anticoagulation is typically considered unsafe when platelets are < 50 000/μL. Inferior vena cava filters are currently recommended only for patients with acute VTE and contraindications to anticoagulation. Although management of catheter-associated thrombosis has not been well studied in cancer patients, it is recommended that cancer patients with catheter-associated thrombosis be treated with therapeutic anticoagulation for ≥ 3 months. Venous thromboembolism prophylaxis with UFH, LMWH, or fondaparinux is recommended in all hospitalized nonsurgical cancer patients and cancer patients undergoing major cancer surgery. Primary thromboprophylaxis is only currently recommended in high-risk ambulatory cancer patients such as multiple myeloma patients receiving thalidomide-or lenalidomide- based therapy. Conclusion: Cancer-associated thrombosis is a common problem. As we begin to better understand the risk factors and biomarkers for cancer-associated VTE, we can further refine and develop risk-assessment models to determine those patients who would most likely benefit from anticoagulation. While LMWH products are generally preferred in cancer-related VTE, more research will continue to evolve our understanding of treatment and thrombopprophylaxis in cancer-associated VTE.     

基于常见遗传变异和传统风险因素的中国南方汉族人群结直肠癌风险预测模型研究

目的 基于结直肠癌全基因组关联研究(GWAS)发现的易感位点,联合传统风险因素建立中国南方汉族人群结直肠癌风险预测模型。方法 对1 066例结直肠癌患者和3 880例健康对照的21个GWAS候选位点进行基因分型,分析其与结直肠癌易感性之间的关联。通过遗传风险评分(GRS)和加权遗传风险评分(wGRS)计算显著候选位点的联合效应。以不同方式组合遗传风险评分和传统风险因素,构建结直肠癌风险预测模型,并绘制受试者工作特征曲线评价模型优劣性。结果 7个候选位点与结直肠癌易感性显著相关。随着风险评分的升高,人群患结直肠癌的风险也随之升高(GRS:P=0.002 6,wGRS:P<0.000 1),相比于四分位分组中最低一组,GRS和wGRS最高的一组OR值分别为1.33(95%CI:1.12~1.58,P=0.001 0)和1.76(95%CI:1.45~2.14,P<0.000 1)。联合传统风险因素和wGRS的模型为最优模型,其曲线下面积为0.593(95%CI:0.573~0.613)。结论 结直肠癌易感位点间存在显著的联合作用。相比于传统风险因素模型,传统风险因素结合加权遗传风险评分模型能更好预测结直肠癌的患病风险。     

快速康复外科在结直肠癌手术中的应用

目的 探讨快速康复外科在结直肠癌手术中的应用.方法 选取80例结直肠癌手术患者,按随机数字表法分为观察组和对照组,每组40例,分别采用快速康复外科治疗及传统方法 治疗,比较两组术后首次排气、排便时间及住院时间、术后并发症发生率、再住院率及住院费用.结果 观察组首次排气、排便时间及住院时间[分别为(2.7±0.9)、(2.9±0.1)、(5.8±1.0)d]明显短于对照组[分别为(3.9±0.5)、(4.2±0.3)、(8.3±1.2)d],术后并发症发生率[7.5%(3/40)]及住院费用[(1.83±0.22)万元]也明显低于对照组[分别为27.5%(11/40)、(2.35±0.36)万元],差异均有统计学意义(P＜0.05).结论 采用快速康复外科技术可以有效促进结直肠癌患者术后胃肠道功能的恢复,减少并发症的发生并节省住院费用.

Abstract：

Objective To investigate the feasibility of fast-track surgery in colorectal surgery.Methods Eighty consecutive patients with colorectal cancer admitted for colorectal surgery were divided into two groups by random digits table with 40 cases each. Group A was treated with the new concept of fasttrack surgery and group B was treated with the traditional methods of operation. The time of postoperative bowel venting and defecation,hospital stay time, the rate of complication, the rate of readmission and the total cost during hospitalization were compared. Results The time of postoperative bowel venting and defecation,hospital stay time were shorter in group A [(2.7 ± 0.9), (2.9 ± 0.1 ), (5.8 ± 1.0) d,respectively]than those in group B [( 3.9 ± 0.5 ), (4.2 ± 0.3 ), ( 8.3 ± 1.2) d, respectively] and the rate of complication and the total cost during hospitalization in group A [7.5%(3/40), ( 1.83 ± 0.22) ten thousand yuan] were lower than those in group B[27.5%(11/40), (2.35 ± 0.36) ten thousand yuan](P＜ 0.05). Conclusion The new concept of fast-track surgery can accelerate recovery after colorectal resection,reduce the rate of overall complications and total cost during hospitalization.     

Cancer incidence among the NATO peacekeeping forces in Bosnia and Kosovo: a systematic review and metanalysis

Background:A few cohort studies of the NATO peacekeepers in the Bosnia and Kosovo war reported inconclusive results on cancer risk. A systematic review and metanalysis of such studies might help to resolve the interpretative limitations.Methods:Relevant publications were retrieved through a PubMed search and from the list of references of the selected reports. Five epidemiological studies, one each from Denmark, Italy, the Netherlands, Norway, and Sweden, satisfied the selection criteria. Random and fixed effect estimators were calculated. Heterogeneity across studies was formally tested for all cancer outcomes.Results:Incidence of all cancers was below the expectation, as was the case for lung cancer and cancer at most other organs. The incidence of Hodgkin’s lymphoma exceeded expectation in the first years after deployment in the Italian cohort but not in the subsequent years of follow-up. The risk of colorectal cancer and bone cancer was increased in the Danish cohort, and so was the risk of leukaemia in the Swedish cohort. Bladder cancer cases were non significantly more than expected in the three Scandinavian studies. The Cochrane’s Q-test was indicative of significant heterogeneity across studies for total cancer, colorectal cancer, melanoma, and leukaemia. The meta-estimate of risk of bladder cancer was increased two-fold (fixed effect summary [FES] = 2.16 (95% CI 1.35 – 2.97), based on three studies.Discussion:Exposure to depleted uranium, metals, and ultrafine particles has been claimed as responsible for the cancer cases observed among peacekeepers. None of these would account for the excess of bladder cancer. The hypothesis of viral epidemics around the deployment area of the Italian military as contributing to the temporary excess of Hodgkin’s Lymphoma cases would be worth exploring.