Estimation of national colorectal-cancer incidence using claims databases.

Background. The aim of the study was to assess the accuracy of the colorectal-cancer incidence estimated from administrative data. Methods. We selected potential incident colorectal-cancer cases in 2004-2005 French administrative data, using two alternative algorithms. The first was based only on diagnostic and procedure codes, whereas the second considered the past history of the patient. Results of both methods were assessed against two corresponding local cancer registries, acting as "gold standards." We then constructed a multivariable regression model to estimate the corrected total number of incident colorectal-cancer cases from the whole national administrative database. Results. The first algorithm provided an estimated local incidence very close to that given by the regional registries (646 versus 645 incident cases) and had good sensitivity and positive predictive values (about 75% for both). The second algorithm overestimated the incidence by about 50% and had a poor positive predictive value of about 60%. The estimation of national incidence obtained by the first algorithm differed from that observed in 14 registries by only 2.34%. Conclusion. This study shows the usefulness of administrative databases for countries with no national cancer registry and suggests a method for correcting the estimates provided by these data.

Impaired adaptation of cardiopulmonary receptors to Western diet in normotensive black immigrants.

A blood pressure increase was reported in black immigrants from Africa to Western countries. The present study was undertaken to evaluate whether an impairment of the cardiopulmonary reflex might make blacks unable to adapt peripheral vascular resistance to increased sodium intake. Ten normotensive clinically healthy blacks (aged 38+/-6 years) who had recently migrated from Mogadishu, Somalia to Florence and 10 age- and gender-matched healthy white subjects were investigated. Cardiopulmonary baroreceptor reflex was studied after 7 days of normal (108 mEq) and low (30 mEq) sodium intake by assessing forearm vascular resistance (FVR) and central venous pressure (CVP) during the application of lower body negative pressure (LBNP) at -10 and -20 mm Hg. With a normal sodium diet the gain in cardiopulmonary baroreceptor reflex, expressed as the FVR increase per mm Hg of CVP reduction, was significantly lower in blacks than in white subjects (2.6+/-1.1 v 5.1+/-1.1 U per mm Hg of CVP, P < .001). Differences between the groups disappeared with a low-sodium diet because the reduction of the efficiency of the cardiopulmonary baroreceptor reflex was lower in blacks than in whites (2.4+/-0.7 v 3.3+/-0.7 U per mm Hg of CVP, P = .09). In conclusion, the efficiency of the cardiopulmonary reflex is lower in normotensive black immigrants than in whites. The lower adaptation of the cardiovascular system to the Western sodium diet could contribute to reported long-term blood pressure increase.

Fibrinogen and factor VIIag in healthy adolescents: the Floren-teen (Florence teenager) Study.

At least five studies based on more than twenty thousand healthy subjects indicated that fibrinogen is an independent risk factor for cardiovascular events; less clear-cut is the relation between factor VII and risk for arterial thrombotic disorders, which was demonstrated in two of the three studies investigating this association. However, no study has investigated the behaviour of fibrinogen and factor VII in an adolescent population. In a study of Preventive Medicine and Education Program, fibrinogen (clotting method) and factor VIIag (ELISA), in addition to other metabolic parameters, life-style and familial history, were investigated in 451 students (313 females and 138 males, age 15-17 years) from two high schools of Florence. Fibrinogen levels were significantly higher in women than in men, whereas factor VIIag levels did not significantly differ. Both fibrinogen and factor VIIag significantly correlated with total cholesterol (p < 0.05) while only fibrinogen correlated with body mass index (p < 0.01). Factor VIIag was significantly correlated with systolic blood pressure (p < 0.001). This study provides information on coagulation risk factors in a population of adolescents which may be of importance in planning coronary heart disease prevention programs.

Twenty-four-hour blood pressure changes in young Somalian blacks after migration to Italy.

Blood pressure changes induced by migration from Somalia to Italy were studied in 25 normotensive clinical healthy blacks (aged 29 +/- 6 years) who had immigrated from Mogadishu to Florence. Basal and 24-h ambulatory blood pressure, venous compliance, and daily urinary electrolyte excretion were measured on arrival and 6 months later. After 6 months both basal pressure (P < .05 for systolic blood pressure, P < .01 for diastolic blood pressure) and 24-h blood pressure (P < .004 for systolic blood pressure, P < .01 for diastolic blood pressure) had significantly increased. Urinary sodium excretion had also increased (P < .001), whereas plasma renin activity was significantly reduced (P < .05). The ambulatory pressure increase was significantly related to the urinary sodium increase (r = 0.49; P < .01). At follow-up 8 of 25 blacks were hypertensive according to the WHO definition (basal diastolic blood pressure > 90 mm Hg). In conclusion, an increase in 24-h blood pressure is detectable after immigration and changes seems to be mainly related to higher sodium intake in the Western diet.

Physical exercise and hemostasis.

A number of hemostatic changes involving platelets, coagulation and fibrinolysis have been reported after acute physical exercise. Results have sometimes been controversial, due to differences in subjects investigated, type of exercise and methods used for hemostatic evaluation. On the whole, physical exercise has been shown to induce: (1) increases in platelet number and activity, (2) activation of coagulation leading to a slight but significant thrombin generation and (3) activation of fibrinolysis. These changes are short lasting. Less known are hemostatic changes induced by exercise training programs: a few data are available on the effects on platelets and coagulation, whereas studies performed on fibrinolysis show a decrease in plasminogen activator inhibitor-1 levels at rest and an increase in fibrinolytic capacity after training.

[The circulation of the hepatitis A and B viruses in the Somali population]. / Ricerche sulla circolazione del virus A e del virus B dell'epatite nella popolazione somala.

We report the results of a study carried out to evaluate the extent of hepatitis A virus (HAV) and hepatitis B virus (HBV) circulation in Somalia. Serum samples were collected from 593 subjects (age range 0-83 years) and tested for anti-hepatitis A (HAV) and anti-HAV IgM. Serum samples taken from 1272 individuals (age range 0-83 years) were tested for HBsAg, anti-HBsAg, anti-HBcAg, HBeAg and anti-HBeAg. We confirmed a very high rate of HAV exposure (about 90% of the subjects tested had circulating anti-HAV) as is typical of fecal-orally transmitted infectious agents. The age-specific anti-HAV IgM prevalence suggests that HAV infection is acquired very early in life. Our data also indicate a high rate of HBsAg carriers (range: 10.5%-27.4%) in the Somalian population. When all markers are considered, 60% of the adult population showed evidence of HBV exposure. HBV spreads very subtly: in fact, it is generally transmitted via non-overtly percutaneous routes. In Somalia, hepatitis A virus infection is highly endemic and occurs very early in life. Hepatitis B virus infection is also widespread in this country.

Primary hepatitis A virus infection in developing countries: decline of maternal antibodies and time of infection.

In developing countries, HAV seems to be responsible for a widespread, inapparent and protective infection during early childhood. This report emphasizes early infection and its relationship to protection by passive immunity from maternal antibody in a highly endemic area such as Somalia. Our result show that HAV infection in Somalia primarily occurs during the first 4 years of life (4 months to 4 years). Cases are infrequent in the first 3 months due to passive immunity secondary to maternal antibody (cord-blood and colostrum anti-HAV). As the level of protection declines, the rate of acute infection rises as determined by the presence of IgM-specific anti-HAV.