Awareness and perception of accuracy of the Undetectable=Untransmittable message (U=U) in Italy: results from a survey among PLWHA, infectious-diseases physicians and people having unprotected sex.

Evidences on the absence of risk of sexual transmission of HIV by persons living with HIV/AIDS (PLWHA) with undetectable plasma HIV-RNA (HIV-RNA <200 copies/ml) led to the worldwide campaign "U = U" (undetectable = untransmittable). The purpose of this study was to evaluate the perceived accuracy of this message among PLWHA, HIV-negative people having unprotected sex (PHUS) and infectious diseases' (ID) physicians in Italy. A nationwide survey has been conducted using three different anonymous questionnaires (for ID physicians, PLWHA and PHUS). A total of 1121 participants filled the questionnaires: 397 PLWHA; 90 physicians; 634 PHUS. Awareness of U = U message has been reported in 74%, 92% and 47% of PLWHA, ID physicians and PHUS, respectively. The perception of accuracy of the U = U message among those aware was reported as high in 80.4%, 79.5% and 67.3% of PLWHA, ID physicians and PHUS, respectively. Physicians perceived that 11% of PLWHA have a high rate of perception of U = U, whereas among PLWHA, only 34% reported definitive positive messages from physicians. Discrepancies between awareness and perception of accuracy of the message U = U in PLWHA and physicians have been found, suggesting still low confidence in the community regarding the message itself.

Serum cotinine as a marker of environmental tobacco smoke exposure in epidemiological studies: the experience of the MATISS project.

To describe serum cotinine levels in a rural Italian population and to examine its usefulness as an epidemiologic biomarker of nicotine exposure, cross-sectional data collected in 1993 for the MATISS Project (2098 men and 1352 women, aged 20-79 years) were used. The study population consisted of 977 current smokers, 882 nonsmokers reporting exposure to environmental tobacco smoke (ETS) and 1520 nonsmokers reporting no ETS exposure. Mean values of serum cotinine measured by radioimmunoassay for never smokers, ex-smokers and current smokers (including four categories of cigarette consumption), and for categories of ETS exposure in all nonsmokers were calculated. In univariate analysis, there was a positive association between self-reported nicotine exposure and serum cotinine levels in all groups. Using self-reported status as truth, sensitivity and specificity for various cotinine cutoff points were estimated to distinguish nonsmokers from smokers. The value of 15 ng/mL represented the best combined levels of sensitivity (95%) and specificity (96%). Using this cutoff point, the overall misclassification rate for self-reported nonsmokers was 2.1% and about two times greater for the more vs. the less educated. In multivariate analysis, reported ETS exposure among nonsmokers was significantly associated with serum cotinine even after adjusting for age, socio-demographic and behavioural factors, though the strength of the association was not strong. In conclusion, serum cotinine represents a reliable epidemiological marker of nicotine intake and may be helpful when studying ETS exposure. Improved information collection is needed to reduce misclassification among nonsmokers and enhance our understanding of the relationship between ETS and cotinine measures.

Reproductive male-mediated risk: spontaneous abortion among wives of pesticide applicators.

This study was conducted among 32 pesticide applicators occupationally exposed to pesticides to determine whether paternal exposure is associated with an increased risk of spontaneous abortion. The ratio of abortion was compared between applicators and a group of 51 food retailers (control population). The ratio of abortions/pregnancies for applicators was 0.27 and for retailers 0.07. OR for spontaneous abortion adjusted for age of wife and smoking of parents is 3.8 times greater than for the control population in the multiple logistic regression model and 7.6 times with interaction effects model.

[Cardiovascular risk factors in women in menopause]. / Fattori di rischio cardiovascolare nella donna in menopausa.

BACKGROUND: During menopause, women are more exposed to cardiovascular risk factors, some of them can be easily modified by primary and secondary prevention. This paper describes some demographic indicators and cardiovascular risk factors among Italian women. METHODS: This study describes the Italian women's cardiovascular risk, using the data collected and updated at the end of the 1990s, within the Cardiovascular Epidemiological Observatory, an Italian Collaborative Project of the Istituto Superiore di Sanità and the Italian Association of Cardiologists. RESULTS: Women aged 60 years and over represent 13% of the population; regional differences on mean values of cardiovascular risk factors are evident. Hypertension, hypercholesterolemia, diabetes and obesity are prevalent particularly in Southern Italy and among the social classes in the lowest education level. CONCLUSIONS: The data confirm the importance of the main objectives stated by the National Health Plan 1998-2000: promotion of healthier dietary habits, of physical activity, and reduction of smoking habits. This requires specific action to improve women's health condition, to provide for their special needs and to create awareness among women about the importance of preventive action also during the aging process.

[Activity of the Istituto Superiore di Sanitá regarding medically assisted reproduction]. / Attività dell'Istituto Superiore di Sanità in tema di procreazione medico-assistita.

In vitro fertilization and embryo transfer, embryo cryo-preservation, multiple pregnancies, embryo reduction, embryo and gamete donation: each of these questions deserves an articulate ethical and medical discussion. In Italy until this moment we do not have a legislation for the regulation of medically assisted reproduction. One of the most suitable means to monitoring large scale initiatives for medically assisted procreation is through registries that collect standardized information on all treatment cycles performed. In 1992, the Italian national registry on medically assisted procreation was established at the Istituto Superiore di Sanità (ISS, the Italian National Health Institute). The Registry collects data sent voluntarily by centers to the ISS for each cycle of treatment started and for each outcome. The data collected can be used to conduct an adequate statistical-epidemiological analysis and to better evaluate results of specific techniques.

[Study of the health status of subjects born with medical-assisted reproduction: the connexion between epidemiology and bioethics]. / Studio dello stato di salute dei soggetti nati con tecniche di procreazione medico-assistita: connessioni tra epidemiologia e bioetica.

The knowledge of the newborns' health status from medical assisted procreation techniques represents the main objective of public health in this field. It is not acceptable, in fact, the use of fertilisation and artificial insemination techniques without a correct evaluation of these newborns' health status. As probable risks exist in medical protocols of treatments (mothers' exposition to hormonal drugs, manipulations of gametes, embryo development in growing coculture with different animal cells, cryopreservation, lack of natural selection of spermatozoa in intracytoplasmatic sperm injection techniques), a check of the results of these techniques is extremely necessary. Newborns' health status must be detected not only at delivery time but also in the following period to evaluate the right physical and psychological development. To estimate infertility risk that these children might run after their mothers' hormonal treatment, it is necessary to follow these subjects till adult age.

Anophthalmia and benomyl in Italy: a multicenter study based on 940,615 newborns.

Following the report on clusters of anophthalmia and microphthalmia in England and Wales and their possible relation to the pesticide Benomyl, we analyzed the situation in Italy for the period 1986 to 1990 using data from the Italian registries of congenital malformations and national data on Benomyl use. Of 940,615 consecutive births, 33 cases of clinical anophthalmia and 78 cases of microphthalmia were reported (birth prevalence: 0.35 and 0.83/10,000). Birth prevalence by region for 18 of Italy's 20 political regions was evaluated for the two malformations, grouped together after exclusion of defects associated with chromosomal anomalies, no dishomogeneity in space or time among registries or among regions was observed for the study period. In no region was a statistically significant difference identified between observed and expected overall birth prevalence. Correlation analysis between the prevalence of micro/anophthalmia and Benomyl use by region showed a negative, nonsignificant coefficient, and an inverse correlation was found when the 18 regions were divided into four groups by increasing levels of Benomyl use. Parental occupation in agriculture did not seem to be associated with micro/anophthalmia when compared to a control group affected with isolated prearicular tags (odds ratio 0.63; CL 0.07-2.52). On the basis of these results, though the limits intrinsic to ecologic correlation studies must be taken into account, an association between Benomyl use and congenital micro/anophthalmia appears to be unlikely.

The prediction of coronary heart disease in different population samples.

Two population samples of men aged 46-65 years were examined for the measurement of some cardiovascular risk factors and followed up for 6.5 years. The two groups were: 1) 3338 men belonging to occupational groups examined in Rome (ROG) in 1979-81 and 2) 1543 men belonging to two demographic samples of rural areas located in northern and central Italy (IRA) examined in 1965. In men free from previous myocardial infarction the rate of fatal coronary events was 18.0 in the ROG group and 17.5 per 1000 in the IRA group. Five established risk factors (age, systolic blood pressure, serum cholesterol, cigarette consumption and body mass index) were used in a multivariate model for predicting coronary deaths. The coefficients of the multiple logistic function were similar in the two populations group. However, when the IRA coefficients were applied to the ROG factors, they predicted 43 events instead of 58 (under-estimation of 26%; p < 0.05), whereas the ROG coefficients predicted 31 events instead of 26 in the IRA sample (over-estimation of 19%; p = n.s.). A model which included the pool of the two populations and a dummy-variable for the identification of each of them, suggested that being a member of the ROG group is accompained, everything else being equal, by an extra risk of 26%.

Effect of acute or chronic administration of imipramine on spinal and supraspinal micturition reflexes in rats.

Acute imipramine administration (15 mg/kg i.p. 60 min before) increased the threshold for activating the spinal but not the supraspinal vesico-vesical micturition reflex in urethane-anesthetized rats. On the other hand, "chronic" imipramine administration (15 mg/kg i.p./day for 5 consecutive days) increased selectively the threshold of the supraspinal micturition reflex. Intravenous administration of cumulative doses of imipramine (up to 14 mg/kg) exerted a progressive inhibitory effect on the supraspinal reflex and voiding efficiency, possibly related to direct inhibition of muscular contractility at the bladder level. However, with the dose regimen used to compare the action of imipramine on spinal and supraspinal reflexes (15 mg/kg i.p., 60 min before), imipramine did not affect the volume-pressure curve or myogenic activity in decentralized bladders (bilateral removal of pelvic ganglia). The effect of acute imipramine on threshold of the spinal vesico-vesical reflex was absent in rats receiving oral p-chlorophenylalanine to deplete 5-hydroxytryptamine stores in the central nervous system. On the other hand, p-chlorophenylalanine pretreatment did not prevent the action of chronic imipramine administration on the supraspinal reflex. Acute administration of desipramine, the major metabolite of imipramine, increased threshold of the spinal but not supraspinal micturition reflex. These findings indicate that the ability of imipramine to modulate vesico-urethral motility at the central nervous system level may involve different mechanisms. Inhibition of 5-hydroxytryptamine reuptake in nerve terminals may be important for the acute modulatory effect of imipramine on the spinal reflex.

The effect of SC-19220, a prostaglandin antagonist, on the micturition reflex in rats.

SC-19220 (5-20 mg/kg i.v.), a competitive receptor antagonist of PGE, increased the bladder capacity and reduced the voiding efficiency of micturition (elicited by slow transvesical filling) of urethane-anesthetized rats. The effect of SC-19220 was prevented by indomethacin pretreatment, whereas indomethacin per se mimicked the effects of SC-19220. SC-19220 produced a competitive rightward shift of the dose-response curve for the contractile effect induced by PGE2 on strips of rat detrusor muscle in vitro, whereas the amplitude of nerve-mediated twitches was unaffected. These findings support the hypothesis that endogenous PGE2 is physiologically involved in the regulation of vesicourethral motility in this species by facilitating attainment of the micturition threshold during the collection phase of the cystometrogram.

Prostanoids modulate reflex micturition by acting through capsaicin-sensitive afferents.

Topical application of exogenous prostanoids (PGE2, TBX B2) on the serosal surface of the urinary bladder of urethane-anaesthetized rats activated reflex micturition. Likewise, intravesical instillation of PGE2 during the cystometrogram lowered the threshold for reflex micturition. Both effects were prevented by systemic capsaicin desensitization (50 mg/kg s.c., 4 days before). Indomethacin pretreatment and systemic capsaicin desensitization each increased the micturition threshold without affecting the amplitude of micturition contraction. However, the effect of the two treatments combined was not greater than the effect of either alone. These findings support the idea that endogenous prostanoids facilitate reflex micturition by stimulating or sensitizing, directly or indirectly, the subset of bladder mechanoreceptors which is capsaicin-sensitive in adult rats.

The effects of baclofen on spinal and supraspinal micturition reflexes in rats.

1. The effect of (+/-)-baclofen on micturition reflexes was investigated in urethane-anaesthetized rats. A 'low' dose of (+/-)-baclofen (0.5 mg/kg i.v.) barely affected the early phase of the transurethral cystometrogram (CMG) which involves activation of a spinal vesico-vesical excitatory reflex. 2. At a higher dose (2.5 mg/kg i.v.) (+/-)-baclofen suppressed both the spinal and supraspinal components of the bladder response to transurethral saline filling. 3. When the bladder was filled by the transvesical route a series of regular voiding cycles was obtained which are due to activation of a supraspinal vesico-vesical excitatory reflex. In this model, voiding efficiency of the rat bladder was markedly reduced even after a low dose of (+/-)-baclofen (0.5 mg/kg) and almost suppressed at 2.5 mg/kg. 4. (+/)-Baclofen reduction of voiding efficiency was mainly ascribable to an inhibitory effect on the expulsive phase of the voiding cycle which, in rats, depends critically upon the activation of a reflex which induces a twitch-like contraction of urethral/periurethral skeletal muscles. 5. (+/-)-Baclofen produced a small inhibition of the pinching-induced somatovesical excitatory reflex. (+/-)-Baclofen (2.5 mg/kg i.v.) produced also a marked but transient inhibition of bladder contractions induced by preganglionic nerve stimulation. However the time course of this effect was markedly shorter as compared to the long lasting suppression of voiding cycle observed with this same dose of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)