The role of Pap test screening against cervical cancer: a systematic review and meta-analysis.

OBJECTIVE: The first aim of this article is to quantify the role of Pap test in cervical cancer prevention, updating the pool of available studies included in a previous meta-analysis. Potential sources of meta-analysis heterogeneity were investigated as second aim. Further evidence of cost-effectiveness has been provided about age and best time interval to perform Pap test screening. DATA SOURCES: The articles' search was conducted using four medical electronic databases: PubMed, Google Scholar, ISI Web, and Scopus. Papers published until the 30th November 2013 were included. The research on Google Scholar was limited to the first 10 pages of web for each study design. METOD OF STUDY SELECTION: A systematic review/meta-analysis was performed according to PRISMA Statement. New-Castle-Ottawa Scale and Jadad have been adopted for articles quality assessment. From 4143 screened articles, 34 met eligibility criteria and 30 case-control studies were included in meta-analysis. Meta-analysis was carried out using StatsDirect2.8.0. Heterogeneity was investigated with qualitative and quantitative approaches in sensitivity-analysis. TABULATION, INTEGRATION AND RESULTS: Despite a great heterogeneity (Cochran Q=504.466, df=29, p<0.0001; I²=94.3%; 95%CI=93.1%-95.1%), a significant protective effect of Pap test has been identified (OR=0.33; 95%CI=0.268-0.408, P <0.00011) through the meta-analysis. Sensitivity analysis did not provide significant results (R=0.358 R2=0.128 p<0.469). CONCLUSIONS: The protective role of Pap test against cervical cancer has been confirmed especially among women <40 years. Annual screening still remains the most cost-effective preventive strategy.

CDKN2A and BAP1 germline mutations predispose to melanoma and mesothelioma.

BAP1 germline mutations predispose to a cancer predisposition syndrome that includes mesothelioma, cutaneous melanoma, uveal melanoma and other cancers. This co-occurrence suggests that these tumors share a common carcinogenic pathway. To evaluate this hypothesis, we studied 40 Italian families with mesothelioma and/or melanoma. The probands were sequenced for BAP1 and for the most common melanoma predisposition genes (i.e. CDKN2A, CDK4, TERT, MITF and POT1) to investigate if these genes may also confer susceptibility to mesothelioma. In two out of six families with both mesothelioma and melanoma we identified either a germline nonsense mutation (c.1153C > T, p.Arg385*) in BAP1 or a recurrent pathogenic germline mutation (c.301G > T, p.Gly101Trp) in CDKN2A. Our study suggests that CDKN2A, in addition to BAP1, could be involved in the melanoma and mesothelioma susceptibility, leading to the rare familial cancer syndromes. It also suggests that these tumors share key steps that drive carcinogenesis and that other genes may be involved in inherited predisposition to malignant mesothelioma and melanoma.

[Social marketing and public health]. / Marketing sociale e danità pubblica.

Social marketing uses the principles and techniques of commercial marketing by applying them to the complex social context in order to promote changes (cognitive; of action; behavioral; of values) among the target population in the public interest. The advent of Internet has radically modified the communication process, and this transformation also involved medical-scientific communication. Medical journals, health organizations, scientific societies and patient groups are increasing the use of the web and of many social networks (Twitter, Facebook, Google, YouTube) as channels to release scientific information to doctors and patients quickly. In recent years, even Healthcare in Italy reported a considerable application of the methods and techniques of social marketing, above all for health prevention and promotion. Recently the association for health promotion "Social marketing and health communication" has been established to promote an active dialogue between professionals of social marketing and public health communication, as well as among professionals in the field of communication of the companies involved in the "health sector". In the field of prevention and health promotion it is necessary to underline the theme of the growing distrust in vaccination practices. Despite the irrefutable evidence of the efficacy and safety of vaccines, the social-cultural transformation together with the overcoming of compulsory vaccination and the use of noninstitutional information sources, have generated confusion among citizens that tend to perceive compulsory vaccinations as needed and safe, whereas recommended vaccinations as less important. Moreover, citizens scarcely perceive the risk of disease related to the effectiveness of vaccines. Implementing communication strategies, argumentative and persuasive, borrowed from social marketing, also for the promotion of vaccines is a priority of the health system. A typical example of the application of social marketing, as mentioned in the manuscript, is the campaign to promote the proper practice of HPV vaccination through the use of effective and cost-saving communication strategies.

[School teachers' knowledge, attitudes and behaviors towards road safety: results from a multicenter cross-sectional study in Italy]. / Conoscenze, attitudini e comportamenti degli insegnanti in materia di sicurezza stradale: risultati di uno studio trasversale multicentrico in Italia.

The aim of this study is to investigate knowledge, attitudes and behaviors of secondary school teachers towards traffic safety behaviors. The study is concerning data coming from a cross-sectional study using a self-administered questionnaires filled in by school teachers of Lazio and Campania regions. 262 teachers entered into the study. Among the scooter holders, 69.2% did use helmet; 95.8% of people who drives car uses seatbelts. The scooter and bicycle helmet is considered useful for 99.6% and 57.4% of participants. The accident rate depends on the means of transportation used: 10.8% and 19% for bicycle and scooter riders, respectively, and 44.6%for the car drivers. Regarding injuries using a bicycle, teachers with less than 40 years are less involved in accidents compared to the over 40 years (OR = 0.19; p = 0.05), as well as teachers who are married (OR = 0.16; p = 0.03) compared to the other group (single/widowed/divorced). Car accidents involve less frequently women (OR = 0.60; p = 0.05) compared to males. Road accidents prevention is part of the health priorities indicated in the National Health Plan, the National Prevention Plan and Regional Prevention Plans. School teachers' can play an important role in students' education on road safety, and there is the need to improve knowledge and behaviors in this field.