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E Buiatti

Publications and source records attributed to E Buiatti.

At least 37 records · Page 2Linked to original sources
PubMed1998

Evaluation model of the Mexican national program for early cervical cancer detection and proposals for a new approach.

INTRODUCTION: An evaluation model on cervical cancer (CC) prevention in Mexico was carried out during 1990-95, using three observation units: women at risk, screening providers, and use of health services. METHODS: A diagnostic procedure of the pitfalls was applied to the following steps of the screening procedure: Pap sampling quality, cytological diagnosis validity, compliance of women, and determinants of nonparticipation. RESULTS: The low effectiveness of screening for CC is due principally to factors associated with quality and coverage. Quality of Pap is deficient; 64 percent of a random sample of specimens lacked endocervical cells. Reading centers presented false negative indices between 10 and 54 percent. Women seek screening in a late stage of disease (55 percent with CC seek care because they have symptoms). In addition, coverage is low; in women between 15 and 49 years of age in Mexico City, 64.2 percent have a history of Pap smears, compared with 30 percent in rural areas. Knowledge of what the Pap is used for strongly determines use of screening. In rural areas, only 40 percent know the purpose of the Pap. CONCLUSIONS: This information justifies an intervention to reorganize CC screening in Mexico, through strategies for improving compliance, quality, follow-up, and treatment for abnormal screens.

Adolescent↗
PubMed1998

High suicide mortality soon after diagnosis among cancer patients in central Italy.

A high suicide mortality risk has been documented among a population-based cohort of 27 123 cancer patients resident in central Italy where the general suicide rate is low. Forty-one suicides were observed (SMR = 2.36) which were only 0.2% of all deaths. However, the highest risk (SMR = 27.7) during the first 6 months after diagnosis, represents a greater contrast with the general population than has been observed in other studies.

Adolescent↗
PubMed1998

Alcohol-related mortality in Italy.

This study evaluated the impact of alcohol drinking habits on mortality in Italy during the 1980-1990 period. Alcohol Attributable Fractions for a list of Alcohol-Related Diseases were assessed from national and international medical literature and then applied to national mortality data according to 5 y age groups, sex, and place of residence for each year of the 1980-1990 period. Mortality rates and 95% Confidence Intervals were standardized with the direct method. Years of potential life lost (YPLL) were calculated for 1990. 18,033 Italian residents died during 1990 from causes related to alcohol drinking, representing 3.3% of general mortality (males 4.6%; females 2.0%) which corresponded to over 200,000 YPLL up to age 70 y. Chronic diseases account for 65% of alcohol-related mortality. Age-adjusted death rates declined in both genders during 1980-1990. Geographic differences in death rates are well evident. Alcohol drinking is a strong determinant of mortality in Italy. The variability of alcohol-related death rates across the country and the comparison with the results from other populations suggest that health consequences, mainly liver damage, of alcohol intake in Italy may be affected by other factors than alcohol itself. The need for further methodological efforts to improve alcohol attributable fraction estimates is recommended.

Adolescent↗
PubMed1997

Tobacco smoking and gastric cancer: review and meta-analysis.

Although declining, gastric cancer (GC) is estimated to be second in frequency worldwide. Major causes appear to be environmental rather than genetic. A relationship has been suggested between tobacco smoking and GC. A number of epidemiological studies have been performed dealing with this question. All the cohort studies showed a significantly increased risk of GC of the order of 1.5-2.5 for cigarette smokers. Evidence from case-control studies is less consistent. We have carried out a meta-analysis on the 40 studies providing a quantitative estimate of the association between GC risk and tobacco smoking. Results suggest a risk of stomach cancer among smokers of the order of 1.5-1.6 as compared to non-smokers. The summary relative risk was higher in men (1.59) than in women (1.11). Several studies examined the dose-response relationship which existed in 4 cohort studies and 6 case-control studies. We estimated the number of GC cases attributable to tobacco smoking occurring worldwide: in total, over 80,000 cases of GC (11% of all estimated cases) may be attributed to tobacco smoking each year. This figure is larger than that estimated for other cancers for which association with tobacco smoking is clearly established, such as pancreatic and renal cancers.

Aged↗
PubMed1997

Incidence of second primary cancers in three Italian population-based cancer registries.

This is the first population-based study carried out in a southern European region to evaluate the risk of a cohort of cancer patients for developing further cancers. The Tuscany Tumour Registry, the Ragusa Cancer Registry and the Cancer Registry of Romagna, three of the 14 population-based cancer registries active in Italy, were involved in the present study. Overall, 19,252 incident cases of cancer of the female breast, and of the colon, rectum, lung and stomach were followed-up for 48 358.3 person-years. Only second metachronous cancers were considered. Controlateral breast cancers were analysed separately. Multiple primaries (MPs) were defined according to the IACR-IACR rules. The observed (O) numbers of MPs were compared with those expected (E) from age-, sex- and registry-specific incidence rates. Overall, 463 MPs were diagnosed (O/E = 0.87, P < 0.001). The O/E ratios for cancers of the colon (O/E = 0.66), rectum (O/E = 0.72) and all sites combined (O/E = 0.78) in males were significantly lower than expected. The deficit of observed MPs was significant during the first period (2-12 months) and increased over time. Patients over 65 years of age had a significant lower risk of MP, whereas young cancer patients had significantly higher risks for all cancers and for female breast cancer. Male lung cancer patients had a significantly reduced O/E ratio for stomach cancer (O/E = 0.21). Rectal cancer patients had reduced risks of developing stomach cancer and tumours of all sites combined and a 3-fold increased risk of kidney cancers. Colon cancer patients had an overall reduction in risk of MPs, but female colon cancer patients had a significantly increased risk for tumours of the ovary and small intestine; no significant results were found for primary stomach cancers. Female breast cancer patients had a significantly increased risk of rectal cancer (O/E = 1.97), and when synchronous and bilateral breast cancers were considered, significant overall increases in risk were seen for all cancer sites (O/E = 1.6) and for rectal (O/E = 2), and especially for breast cancers (O/E = 3). The cohort analysed had a lower risk of developing further independent tumours than the general population. Several artefacts may have biased these results: the exclusion of synchronous cancers greatly reduced the overall MP risk, and the age-related differences may have been due to reduced medical surveillance and diagnostic aggressiveness. We have confirmed the increased risk for kidney cancers in rectal cancer patients and the association between cancers of the colon and ovary. The significantly increased risk for rectal cancer in female breast cancer patients is probably due to hormonal and dietary factors. For female breast cancer patients, controlateral breast cancer represented the highest risk. The increased risk of cancer of the small intestine in patients with colon cancer may be due to overdiagnosis within increased medical surveillance.

Aged↗
PubMed1997

Survival after AIDS diagnosis in Tuscany (Italy), 1985-1992.

The study evaluated the overall survival after AIDS diagnosis of 1,014 patients reported to the Italian AIDS Registry as resident in Tuscany, stratified by age, gender, year of diagnosis, HIV transmission category, initial AIDS-defining disease and CD4+ cells count. The study was a population-based survival analysis, carried out through Kaplan-Meier method (mean survival times-MST-, 1, 2 and 3-year observed survival) and Cox models (crude and adjusted relative risk-RR). The MST was 12.4 months for all cases, increasing from 4-7 months in 1985-1987 to 14 months in 1991-1992. The observed survival was 51.4% at the first year of follow-up, 28.4% at the second year and 14.5% at the third year. The multivariate analysis showed an independent prognostic effect of age, year of diagnosis, initial AIDS-defining disease and CD4+ cells count. The prognosis was worse in cases aged over 44 (reference: 25-29), diagnosed before 1988 (reference: 1991) and with wasting syndrome, toxoplasmosis, HIV encephalopathy or multiple diseases (reference: PCP alone); and better in cases with more than 100 CD4+ cells/mm3 (reference: < or = 50 cells/mm3). The differences in gender and among HIV transmission categories disappeared after age-adjustment. The study confirmed, in an European population-based series, the poor long-term AIDS prognosis and, once AIDS has became clinically manifest, the prognostic value of some clinical and demographic variables.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Epidemiology of carcinoid tumours in central Italy.

Between 1985 and 1991, 83 carcinoid tumours were diagnosed in the province of Florence where the Tuscany Tumour Registry is active. There were 44 males and 39 females. The age-adjusted incidence was 0.65 cases/100,000 population/year. The most common location was the lung (30.1%), followed by colorectum (25.2%) and small intestine (22.8%). The 5-year observed and relative survival rates were 70.8% and 78.9% respectively. The relative risk of developing multiple primary cancers was 0.79 (CI 95% 0.28-8.33).

Carcinoid Tumor↗
PubMed1997

The cervical cancer screening program in Mexico: problems with access and coverage.

A cross-sectional study was carried out in two geographic regions of Mexico - Oaxaca (rural area) and Mexico City (urban area) - to determine the main factors for predicting participation in Cervical Cytology Screening Programs (CCSP), in populations with high mortality due to cervical cancer. We included 4,208 women aged between 15 and 49 years, randomly selected through a national household-sample frame. Knowledge of what the Pap test is used for strongly predisposes use of CCSP in Mexico City (odds ratio [OR] = 46.1, 95 percent confidence interval [CI] = 33.1-64.1) and Oaxaca state (OR = 61.5, CI = 42.0-89.9), as well as high socioeconomic level (Mexico: OR = 2.0, CI = 1.1-7.6; Oaxaca: OR = 4.1, CI = 3.1-5.3), high education level (Mexico: OR = 3.6, CI = 1.5-8.8; Oaxaca: OR = 5.3, CI = 2.8-10.0), and access to social security (Mexico: OR = 1.7, CI = 1.4-2.2; Oaxaca: OR = 2.2, CI = 1.8-2.7). Low coverage of the CCSP is confirmed as an important problem in Mexico.

Adolescent↗
PubMed1997

Histological diagnosis of precancerous lesions of the stomach: a reliability study.

BACKGROUND: Within the framework of a chemoprevention trial on stomach cancer, two substudies based on repeat measurement were undertaken to evaluate reliability of histological diagnoses of gastric precancerous lesions. METHODS: A subgroup of 45 subjects received two endoscopies separated by a period of one month. The two biopsies were reviewed by a single pathologist. A second subsample of 50 subjects had a single endoscopy and the biopsy results were reviewed by two pathologists. Agreement between the two diagnoses was assessed by Cohen's Kappa and by repeat frequency. RESULTS: When the same samples were reviewed by the pathologists involved in the trial, agreement was very high for advanced lesions (repeat frequency = 0.96 for intestinal metaplasia and 1.00 for dysplasia) but lower for less advanced lesions (repeat frequency = 0.73 for superficial gastritis and chronic gastritis, 0.65 for atrophic gastritis). When the same pathologist reviewed two sets of biopsies taken less than 2 months apart, the combination of random observer error and biopsy sampling error gave rise to quite low agreement, especially for early lesions, mainly attributable to biopsy sampling error. Comparison of diagnoses made at routine reading and at review by the same pathologist and by different pathologists showed substantial overall agreement with the exception of one pathologist for whom agreement was moderate. CONCLUSIONS: These results confirm that misclassification of histological diagnosis may be a relevant problem in chemoprevention trials of stomach cancer, more so when baseline diagnosis is taken into account in the analysis to estimate progression and regression rates of precancerous lesions. Further, the results suggest that misclassification is limited to early lesions, while diagnostic reliability of severe lesions is quite high.

Adult↗
PubMed1997

Surveillance and intervention studies on respiratory cancers in asbestos-exposed workers.

A systematic review of the literature on the surveillance of workers at presumed increased risk for respiratory cancer because of their exposure to asbestos revealed surveillance programs at the national, population, industrial, and factory (workplace) levels. Furthermore, 3 randomized chemoprevention trials involving workers exposed to asbestos were found. The nationwide programs to survey problems related to occupational exposure to asbestos were conducted in Europe. Some of the countries have policies for the surveillance of workers exposed either currently or formerly to asbestos. The results of the chemoprevention trials suggest that there are, as yet, no practical tools for efficient, safe chemoprevention of asbestos-induced respiratory malignancies.

Anticarcinogenic Agents↗
PubMed1997

Damage to the nasopharyngeal mucosa induced by current levels of urban air pollution: a field study in lambs.

This study concerns the effects of urban air pollution on the nasopharyngeal epithelium, with the aim of evaluating the possible harmful activity of levels of atmospheric pollution which are not currently considered to be dangerous. Over a 3 month period, 10 lambs kept in a zone characterized by numerous vehicles were sacrificed at regular intervals, and their nasopharyngeal mucosa was examined by scanning electron microscopy and image analysis. Two lambs kept in a rural area were used as controls. The local levels of some airborne contaminants (NO(x), NO2, NO, SO2, CO and particulate matter with aerodynamic diameter < or =10 microm (PM10)) were monitored throughout the experiment. The urban air had an irritating effect, inducing hypersecretion of mucus and morphological damage to the ciliated epithelium. These alterations increased with the duration of exposure to urban air and with increasing pollution levels, although the levels remained below current legal levels. We conclude that the harmful effects of airborne contaminants are probably underestimated. Moreover, physicochemical evaluation of pollution parameters should be complemented by morphological study of upper respiratory epithelium in exposed animals, since this mucosa is a sensitive target for irritating agents.

Air Pollutants↗
PubMed1996

Determinants of plasma anti-oxidant vitamin levels in a population at high risk for stomach cancer.

Our objective was to identify the determinants of plasma levels of anti-oxidant vitamins which have been linked with decreased risk of cancer and other chronic diseases. Correlation analyses were performed between baseline plasma levels of ascorbic acid, alpha- and beta-carotenes, cryptoxanthin, lycopene and alpha- and gamma-tocopherols and baseline information on dietary and other demographic and life-style factors among 1,364 subjects 35-69 years of age, who are participants in a chemoprevention trial on pre-cancerous lesions of the stomach in Venezuela. Males had lower levels of ascorbic acid, alpha- and beta-carotene and cryptoxanthin and higher levels of alpha-tocopherol than females. This finding was confirmed in non-smokers and non-drinkers. In females, but not in males, age was positively associated with levels of ascorbic acid, cryptoxanthin, alpha- and beta-carotene and gamma-tocopherol. Male tobacco users had lower plasma levels of ascorbic acid, alpha- and beta-carotene and cryptoxanthin than nonusers, and regular alcohol drinkers had a decreased plasma levels of beta-carotene compared with non-drinkers. Female tobacco users had lower levels of ascorbic acid and cryptoxanthin than non-users, and regular alcohol drinkers had lower levels of ascorbic acid and lycopene than non-drinkers. Frequencies of consumption of fresh fruits, fruit juice, raw vegetables and plantains showed weak positive associations with plasma levels of several vitamins studied in both sexes. Sex, age in females, tobacco and alcohol use and dietary consumption affected plasma anti-oxidant vitamin levels in this population significantly. These factors may influence the effect of anti-oxidant treatment in intervention trials.

Adult↗
PubMed1996

Problems related to the coding of multiple primary cancers.

There is growing interest in multiple primary cancers (MPs), but the lack of a universally agreed definition can both modify the results for one series and hamper comparisons among cancer registries. The aim of this study was to compare agreement on the coding of MPs between two cancer registries, the Danish Cancer Registry and the Tuscany Tumour Registry, that adhere to different rules for accepting MPs, and to study whether coding according to common international rules (IACR) would increase the comparability. Data on 200 patients recorded as having more than one cancer were extracted at random from the two registers. The agreement on MP status between coders, one from each registry, using local rules and definitions on MP, was good (kappa value, 0.70). Exclusion of 11 expected discordant cases increased the agreement (kappa = 0.86). The agreement reached with the use of the IACR rules was very high (kappa = 0.80). We conclude that registries should present data according to international rules, in particular for the study of MPs. Registries should at least clearly indicate deviations from the agreed international standards, in order to facilitate comparisons on incidences.

Denmark↗
PubMed1996

Colorectal cancer survival--population-based rates in the province of Florence.

This study aimed to evaluate survival in 2,339 colorectal cancer patients diagnosed in 1985-87 in the province of Florence, where the Tuscany Tumour Registry is active. The effect of sex, site (colon, rectum), sub-site, disease diffusion (localized, regional, distant, unspecified), year of diagnosis, place of residence (municipalities involved in the screening programme, Florence, others) and source of diagnosis (Center for the Study and Prevention of Cancer-CSPO, others) were evaluated. Five-year observed and relative survivals were 37.9 and 48.1% respectively. Five-year prognosis was worse in men, in older age groups, in advanced stages and in patients not diagnosed at the CSPO. No differences were shown in residents of municipalities involved in the screening programme. Relative 5-year survival in Florence was among the highest in Europe for cancers of both the colon and the rectum. Sex, age, disease diffusion and source of diagnosis showed an independent prognostic effect. The effect of screening was not evident, probably due to the low compliance during the period under study and to the use of a low sensitivity test.

Adult↗
PubMed1996

Chronic lymphocytic leukaemias and non-Hodgkin's lymphomas by histological type in farming-animal breeding workers: a population case-control study based on a priori exposure matrices.

OBJECTIVES: A population based case-control study was conducted in a highly agricultural area in Italy to investigate the association between chronic lymphocytic leukaemias (CLLs) and non-Hodgkin's lymphomas (NHLs), and subtypes, and exposure to pesticides in farming-animal breeding workers. METHODS: 187 cases of CLLs and NHLs and 977 population controls were interviewed on medical, residential, family, and occupational history. Detailed information was collected about cultivated crops and animals bred from subjects who worked in farming and animal breeding. Information on crop diseases and pesticides used (and their quantity and duration) was also obtained. A priori job-exposure matrices were applied when a crop disease was reported, estimating the most probable pesticide and, when possible, an estimate of the cumulative dose. Odds ratios (ORs) were calculated by unconditional logistic analysis with adjustment for relevant confounders in farmers who bred animals and in farmers alone, for the main crops, types of animals, and pesticides categories. First recall and then the matrices were used for defining exposure, as it affected CLLs and NHLs and then separately on CLLs and low grade NHLs. Finally, the dose-response was investigated for those pesticides which had shown some association. RESULTS: No variable under study was associated with work in farming alone. In farming and animal breeding, no crop or animal showed an association with CLLs and NHLs when adjusted by exposure during childhood to farming and animal breeding (an indicator of life in a farming and animal breeding environment before the age of 13, which behaved as an independent risk variable). A non-significant association was found with stannates, arsenates, phosphates, and dichloro-diphenyl-trichloroethane (DDT) based on recall, and for stannates, arsenates, and DDT after the application of the matrices. When CLLs together with low grade NHLs were considered, the association with insecticides in general, carbamates, and phosphates became significant according to personal recall (ORs and 95% confidence intervals (95% CIs) 2.46, 1.07-5.63; 3.08, 1.05-9.00; 2.97, 1.28-6.91, respectively). The application of the matrices also showed a risk of borderline significance for stannates and dithiocarbamates. A significant dose-response effect was found for phosphates (for logarithmic unit increase, OR 1.17, 95% CI 1.00-1.57); a strong trend for stannates and carbamates did not reach significance. CONCLUSION: The association of CLLs and NHLs with work in farming-animal breeding is partially explained by exposure to pesticides-namely insecticides (carbamates, phosphates, and DDT) and stannates-possibly related to their use in animal breeding. The association is limited to cases of CLL and low grade NHL. The independent effect of the variable exposure during childhood suggests that early exposures, including possible contact with animals, may play a part in the pathogenic process of these neoplasms.

Animal Husbandry↗