How to increase uptake in oncologic screening: a systematic review of studies comparing population-based screening programs and spontaneous access.

BACKGROUND: Cervical, breast and colorectal cancer (CRC) screenings are universally recommended interventions. High coverage of the target population represents the most important factor in determining their success. This systematic review aimed at assessing the effectiveness of population-based screening programs in increasing coverage compared to spontaneous access. METHODS: Electronic databases and national and regional websites were searched. We included all studies on interventions aimed at increasing screening participation published between 1999 and 2009; for those published before, we consulted the Jepson et al. review (2000). We compared spontaneous access (including no intervention) vs population-based screening programs actively inviting the target population. Among the latter, we compared GP-based vs invitation letter-based interventions. RESULTS: The invitation letter vs no intervention showed significantly more participation (RR=1.60 95%CI 1.33-1.92; RR=1.52 95%CI 1.28-1.82; RR=1.15 95%CI 1.12-1.19, for breast, cervical and CRC screenings, respectively). GP-based interventions, although more heterogeneous, showed a significant effect when compared with no intervention for breast (RR=1.74 95%CI 1.25-2.43), but not for cervical and CRC. No significant differences were found between invitation letter-based and GP-based organization (RR=0.99 95%CI 0.94-1.05; RR=1.08 95%CI 0.99-1.17, for breast and cervical cancer, respectively). CONCLUSION: Population-based programs are more effective than spontaneous screening in obtaining higher testing uptake. Both invitation letter-based and GP-based programs are effective.

[Efficacy and critical implications of food handlers' professional training: analysis of an experience]. / Efficacia e aspetti critici della formazione degli operatori alimentari: analisi di un'esperienza.

UNLABELLED: Our study aimed at both assessing the efficacy of the same training course in different contexts and training course repeated in the same context. We examined the most critical aspects, on which to develop further aimed course. In 1998 the Laboratory of Environmental Microbiology of the Institute of Hygiene (UCSC) has implemented 2 professional training courses both for food handlers of a refectory (course A) and of a hospital canteen (course B). Two years after a following course (C) in the hospital canteen. At the beginning and at the end of every course a questionnaire of 25 questions has been gathered in five areas. The data drawn by the questionnaires have been compared using the percentage of exact answers before and after the course. Correct answers beginning and end course: A 89% and 94%, B 68% and 77%, C 76% and 78%. The correct answers beginning course C and end course B are not significatively different (p = 0.1963). Critical areas of the C and B courses have been "microbiological risks" and "correct temperatures"; at the end of the training both the areas had sensitive improvements (C 40% to 59%, 60% to 78%-B 31% to 69%, 45% to 78%). CONCLUSION: Food handlers professional training have been effective both in the same context and in a different context; the training should be based on both the operator's knowledge and difficulties met during the training; knowledge obtained by training is kept unchanged for some years, and it is supposed to repeat the course after one or two years; the analysis of the areas has confirmed the existence of critical problems, common causes of epidemics in collective catering services.

[Comparison of 0.125% bupivacaine and 0.2% ropivacaine in obstetric analgesia]. / Confronto tra bupivacaina 0.125% e ropivacaina 0.2% nell'analgesia del parto.

This comparative study of low doses of ropivacaine was conducted in order to identify the most effective form of analgesia during labour with the aid of supplementary low doses of fentanyl and clonidine. 60 ASA I and II parturient primipares who had asked for epidural analgesia were randomly assigned to two groups. Group R was given 5-7 ml 0.2% ropivacaine and Group B 0.125% bupivacaine with both groups receiving 75 ng clonidine and 50 ng fentanyl with their first bolus of local anaesthetic. The parameters measured included the speed and spread of the sensory blockade and the scale of any motor blockade. The material haemodynamics and VAS pain relief scores were also measured at 30-minute intervals during labour and all side-effects (nausea, vomiting, localised or generalised itching, headache etc) were also monitored. Apgar anaesthetics and other drugs was decided on the basis of the VAS score (a further dose was given to women with a VAS of > 3-4). The study was completed by a telephone interview 6 months after delivery and the data were analysed using the Student's t-test and the chi 2 test. The analgesic effect was satisfactory in both groups and no statistically significant differences were found between the two groups under most of the headings analysed, apart from the top-up doses needed to maintain adequate analgesia. The average time between the first VAS to parturition was 292 mns in Group B and 267 mns in Groups R. Top-up doses of local anaesthetic (2.35 vs 5.05) came on average to 15.8 ml in Group B compared to 24.1 ml in Group R. There were 20% Caesarian sections in Group R and 13.8% in Group B. Optimum analgesia was achieved in Group R, the level of analgesia was insufficient or barely sufficient in 3.3% of cases. There was no Apgar score < 7 in either group. It was therefore concluded that both bupivacaine and ropivacaine offer excellent analgesia during labour and have no significant side effects on mothers or babies.

Radiographic indicants of adult celiac disease assessed by double-contrast small bowel enteroclysis.

The number of folds and lumen diameter of the proximal jejunum and distal ileum were retrospectively measured in 40 double-contrast small bowel enteroclysis studies of patients with a biopsy-proven diagnosis of adult celiac disease (ACD) and in 46 healthy control subjects. For both parameters an inverse radiographic pattern was found in celiacs compared to control subjects, in whom the number of folds and lumen calibers are physiologically greater in proximal jejunum than in the distal ileum. Mean differences in the jejuno-ileal number of folds (-7.1) and lumen calibers (-1.3 cm.) were in fact negative in ACD patients, in whom the values of both the parameters are less in the proximal jejunum than in the distal ileum. Particularly, the sign of "reversal of jejuno-ileal caliber" was both sensitive and specific for diagnosis of ACD in this retrospective series. Double-contrast small bowel enteroclysis can play an important role in excluding or confirming the presence of ACD, provided that an assessment of reproducibility and a prospective re-evaluation of operative characteristics of such radiographic signs are performed.