Work-related stress and cortisol levels: is there an association? Results of an observational study.

OBJECTIVE: Chronic exposure to work-related stress (WRS) stimulates the hypothalamic-pituitary-adrenal (HPA) axis to increase glucocorticoid secretion, including cortisol, and these hormones can be measured both in serum and urine. The Health Safety Executive Toolkit (HSE) questionnaire is used to assess WRS risk objectively. The scope of our study is to investigate whether serum or urinary cortisol levels could be used as alternative objective indicators of WRS, specifically in those subjects who are chronically exposed to it. PATIENTS AND METHODS: 130 patients (75 males and 55 females, mean age 47.7 ± 11.3 years) were evaluated at a specialized Centre for Secondary Hypertension, where both their serum (8 AM) and 24-hours urinary cortisol were measured and they were asked to complete two questionnaires: one questionnaire to collect data about their socio-demographic and job characteristics, and the HSE questionnaire to evaluate WRS. RESULTS: Multiple linear regression analysis showed an association of urinary cortisol with several variables: tobacco smoke (ß = 69.6; p = 0.003); female gender (ß = -37.3; p = 0.041); exposure to physical risks (ß = 51.8; p = 0.032); control score (ß = -22.7; p = 0.039); role score (ß= 39.3; p = 0.020). Age was the only variable associated with serum cortisol levels (ß = -3.6; p = 0.042). CONCLUSIONS: Urinary cortisol levels, but not serum levels, are associated with variables linked to WRS (score control and role) and to socio-demographic variables, namely gender and tobacco smoke. Thus, urinary cortisol can be considered a useful and non-invasive biological indicator to quantify WRS.

Peri-implant diseases and metabolic syndrome components: a systematic review.

OBJECTIVE: Metabolic syndrome (MetS) is defined as a spectrum of conditions associated with an increased risk of developing CVD and type 2 diabetes. MetS include: hyperglycemia, hypertension, visceral obesity, dyslipidemia with elevated values of triglycerides (TG) and low levels of HDL. The aim of this review is to provide current knowledge of the relationship between MetS, its components and peri-implant diseases. MATERIALS AND METHODS: An electronic literature search was conducted in the English language in several databases. The Newcastle-Ottawa Scale was used for quality assessment of cohort and cross-sectional studies; while systematic reviews were evaluated through AMSTAR; results were reported according to the PRISMA Statement. RESULTS: A total of 272 records were identified through database searching, six studies were included for qualitative analysis. No study directly related to MetS was found, there was inconsistent and controversial evidence regarding association with cardiovascular disease. A higher risk of peri-implantitis was detected in people with hyperglycemia. CONCLUSIONS: Future research should be orientated in assessing the risk of peri-implant diseases, evaluating patient's therapeutic response, analyzing directionality of the relationship between MetS, its components and biologic implant complications.

Non-pegylated liposome-encapsulated doxorubicin citrate plus cyclophosphamide or vinorelbine in metastatic breast cancer not previously treated with chemotherapy:a multicenter phase III study.

We conducted a phase III multicenter randomized trial to compare the efficacy of the combination of liposome encapsulated doxorubicin (Myocet(©)) plus either cyclophosphamide (MC) or vinorelbine (MV). Since July 2006, 233 patients affected with metastatic breast cancer were randomized to receive the combination of Myocet (M) 60 mg/m(2) i.v. plus cyclophosphamide (C) 600 mg/m2 on Day 1 of a 21­day cycle (Arm A) or Myocet (M) at 50 mg/m2 plus vinorelbine (V) 25 mg/m2 i.v. on Day 1 and V 60 mg/m2 orally on Day 8 on a 21­day cycle (Arm B). The primary endpoints of the study was time to progression (TTP); secondary endpoints were RR, toxicity and OS. Response was observed in 53/116 (45.7%) evaluable patients of Arm A vs. 51/112 (45.5%) of Arm B, respectively (P=NS). Median TTP was 41 weeks (95% CI, 32­51) and 34 weeks (95% CI, 26­39), for M/C and M/V, respectively (P=0.0234). The difference in median OS was not statistically significant (131 vs. 122 weeks; P=0.107). With regard to toxicity, patients treated with MV showed a slight increase of neutropenia and constipation, as compared to those treated with MC. No clinical signs of cardiotoxicity were observed. The MC combination remains as an unbeaten 'standard' in first line treatment of MBC.

Single dose of palonosetron plus dexamethasone to control nausea, vomiting and to warrant an adequate food intake in patients treated with highly emetogenic chemotherapy (HEC). Preliminary results.

INTRODUCTION: The aim of our study was to evaluate the efficacy of a single-dose palonosetron plus dexamethasone to control emesis in patients (pts) receiving HEC. Moreover, we evaluated the amount of their food intake (FI) in the week following therapy, in order to measure any reduction of calories consumption related to Chemotherapy-induced nausea and vomiting (CINV). METHODS: Patients affected with advanced cancer were treated with palonosetron 250 mcg plus dexamethasone 20 mg before HEC. Nausea, vomiting, and FI were monitored by a 7-day diary. Complete Response (CR: no vomiting and no rescue therapy) was the primary endpoint, Complete Control (CC: CR and no more than mild nausea) and the evaluation of FI were the secondary endpoints. The endpoints were evaluated during the acute (0-24 h), the delayed (25-168 h) and overall (0-168 h) phases. RESULTS: Thirty-five patients were enrolled; 85.7% and 82.9% of patients achieved CR and CC respectively, during the acute phase; 82.9% and 77.1% of patients achieved CR and CC, during the delayed phase; 80% and 77.1% of patients achieved CR and CC, during the overall phase. During the acute phase, patients with a CC without nausea had a median daily FI of 1,575 kcal, whereas patients with CC and presence of mild nausea had a median daily FI of 1,040 kcal (-535 kcal; p < 0.0001). CONCLUSIONS: Our preliminary results confirm the efficacy of a single-dose palonosetron plus dexamethasone to prevent both acute and delayed nausea and vomiting. Moreover, the efficacy of palonosetron in nausea and vomiting control seems to warrant adequate caloric intake in these patients.

[The association of asbestos and cigarette smoke in lung cancer. Note 2]. / L'associaione asbesto-fumo di sigaretta nel cancro polmona- re. Nota 2.

This work follows up the previous edited in the year 2004, and deals with the still serious and discussed problem of work risks even though the use of asbestos has been forbidden since 10 years, and the tobacco's smoke since one year. The Authors discuss the question related to the genetic point of view as a first and multiplying action caused at the some time by the tobacco's smoke and asbestos dust in the working places. This work report an up-to-date list of law about environmental prevention.

[Topical notes about work diseases rules]. / Nuovo elenco delle malattie professionali a denuncia obbligatoria.

The Authors explain the text of the Decree April 27 2004 related to the new list of work diseases to be reported as by law enacted, instead of the previous Decree April 18 1973. The Decree follows up the latest UE Recommendation 2003/670 in order to bring up to date the European list of work diseases. The Authors examine several topical points of this decree, wishing for Italy a new up to date list for work diseases as from the last DPR April 13, 1994 no 336.

[Child labour]. / Il lavoro minorile.

The authors emphasize the violation of children's and adolescents' rights as a result of the exploitation of child labour. Besides the legal aspect, they pointed out the medical features related to the delicate growing process of the child in the phases of development and adaptation of the main organs to hard work. Currently the problem is being supervised by those states that recognize the right for minors to be protected against any kind of physical, mental, spiritual and moral risk.

[Pregnancy and work]. / Gravidanza e lavoro.

In the last decades there has been an increase of women's presence in the working field. That has been a consequence of the use of an advanced technology, of a different organization of work, of the rules about men/women equality, as wellas of the women's emancipation. As a result women have been exposed to a greater amount of risks both for their health and for their reproductive function. In this work, we highlighted the pathogenic effects resulting from the interaction of different substances present in the working place with the female organism, with special interest in the effects on pregnancy. Furthermore, we laid stress on the rules and on the guidelines that safeguard women's right to work as well as their right to be mothers both at a national and at an european level.

[The association of lung cancer with asbestos and tobacco smoking]. / L'associazione asbesto-fumo di sigaretta nel cancro polmonare.

This work summarises the potential association link for lung cancer between asbestos and smoking. This link emerges not only from different epidemiological and experimental studies, but also from a wide data collection carried out by an omogeneous Italian industrial group. The examination of the data set has led to the conclusion that the simultaneous exposition to asbestos and tobacco's smoke entails a factor, usually multiplicative and also partially additive, in relation to lung cancer; on the other hand, it does not seem to have a great relevance for mesothelioma pleurico. On the basis of this evidence, the Authors focus in particular on the measures of prevention in the contest of work conditions, in order to highlight the impact of the two carcinogenic agents in workers.

Recent trends of ophthalmic diseases in Italy: are official data reliable?

PURPOSE: The aim of the study was to investigate the epidemiological trends of ocular diseases using hospital discharge forms as our data source. MATERIALS AND METHODS: We examined official Italian Statistical Institute (ISTAT) data concerning patients discharged from ophthalmologic wards. Our analysis was limited to the years when ISTAT managed health service data (1986, 1990 and 1994); whilst currently this duty has been transferred to the Ministry of Health. RESULTS: The diseases encountered most frequently were cataract, glaucoma and retinal detachment. Patients over 65 years of age represented 54% in 1986 and 67% in 1994. We observed a general trend toward shorter hospital stays (10.5 days in 1986 and 6.4 days in 1994). We applied an indirect analysis that included masculinity and chi 2 homogeneity that were aimed to evaluate results de spite the questionable reliability of ISTAT gross data. CONCLUSIONS: The results of indirect analysis (masculinity and chi 2 homogeneity, of data combined with the significant number of charts presenting incomplete diagnostic information strongly question the reliability of official documentation. The increase of hospitalisation for ophthalmic surgery and a higher average age of affected subjects were confirmed. We observed a reduction of mean hospital stay per admission, indicating a positive achievement in terms of cost reduction.

[Clinical investigation of hyaluronidase and nerve growth factor (NGF) at the ocular level: detailed review of the international literature]. / Sperimentazione clinica di ialuronidasi e del nerve growth factor (NGF) a livello oculare: revisione accurata della bibliografia internazionale.

In this paper the authors analyse the international bibliography about clinic tests on hyaluronic acid and Nerve Growth Factor at ocular level. This study was performed on request of a private oculistic clinic in the centre of Rome about the clinic test of the drugs mentioned above. Therefore, this paper is a joint work of Public Health physicians and oculists.

[Kerion of the vulva. Report of a case and review of the literature]. / Kerion a localizzazione vulvare. Descrizione di un caso e revisione della letteratura.

We report a case of a 43 year old woman who developed an extensive vulvar kerion caused by Trichophyton menthagrophytes that was initially mistaken for a bacterial infection. The peculiarity of this case lies in the fact that the kerion is rarely located in the vulva and it has not yet been described in the literature. On the contrary, cases have been found in the scalp, beard, eye-brow, etc. We discuss the etiopathogenetic aspects, criteria for differential diagnosis and therapy management of this rare clinical picture.

[T-lymphocyte subpopulations in old age]. / Studio della sottopopolazine linfocitaria T nell'anziano.

The subpopulation of lymphocytes were studied in 25 subjects old age and in 20 adult subjects as control. The results demonstrate an appreciable difference in the percentage of rosettes values at +4 degrees C for 18 hours between the old age subjects (mean value 83,5%) and the control subjects (mean value 66,2%). It is difficult to interpret these variations but it is possible that there is a different distribution on the cell membrane of lymphocyte T for the receptors for SRBC. The probable relation ship with variations of the citoskeleton and more specifically the distribution of the "Tubuline".