Sociodemographic profile, health-related behaviours and experiences of healthcare access in Italian transgender and gender diverse adult population.

PURPOSE: Information on the general health of transgender and gender diverse (TGD) individuals continues to be lacking. To bridge this gap, the National Institute of Health in Italy together with the National Office against Racial Discriminations, clinical centres, and TGD organizations carried out a cross-sectional study to define the sociodemographic profile, health-related behaviours, and experiences of healthcare access in Italian TGD adult population. METHODS: A national survey was conducted by Computer-Assisted Web Interviewing (CAWI) technique. Collected data were compared within the TGD subgroups and between TGD people and the Italian general population (IGP). RESULTS: TGD respondents were 959: 65% assigned female at birth (AFAB) and 35% assigned male at birth (AMAB). 91.8% and 8.2% were binary and non-binary TGD respondents, respectively. More than 20% of the TGD population reported to be unemployed with the highest rate detectable in AMAB and non-binary people. Cigarette smoking and binge drinking were higher in the TGD population compared with IGP (p < 0.05), affecting TGD subgroups differently. A significant lower percentage of AFAB TGD people reported having had screening for cervical and breast cancer in comparison with AFAB IGP (p < 0.0001, in both cases). Over 40% was the percentage of AFAB and non-binary TGD people accessing healthcare who felt discriminated against because of their gender identity. CONCLUSIONS: Our results are a first step towards a better understanding of the health needs of TGD people in Italy in order to plan the best policy choices for a more inclusive public health.

Psychopathological chronic sequelae of the 2009 earthquake in L'Aquila, Italy.

BACKGROUND: To date, there are no data available among the general adult population on the long-term psychological sequelae of the earthquake that occurred in the town of L'Aquila, Italy in 2009. We investigated the prevalence of post-traumatic stress disorder (PTSD) and major depression (MD) and identified risk factors for these disorders among adult survivors more than one year after the earthquake. METHODS: Telephone interviews were conducted among a random sample of 957 resident adults. The interviews were performed using a questionnaire on exposure to the earthquake, the Mini-International Neuropsychiatric Interview for PTSD, and the Patient Health Questionnaire 8 for MD. Univariate and multivariate logistic regression analyses were conducted to assess potential risk factors. RESULTS: The prevalence rates of PTSD and MD were 4.1% (95% CI=3.0-5.5) and 5.8% (95% CI=4.5-7.5), respectively. The risk factors for PTSD were economic difficulties not necessarily related to the earthquake, chronic disease, death of a relative or friend, and serious economic difficulties as consequence of the earthquake, whereas those for MD were female gender, economic difficulties not necessarily related to the earthquake, not having a permanent job and living in L'Aquila. LIMITATIONS: The major limitations were the cross sectional design and the uncertain accuracy of the diagnoses compared with clinical diagnoses. CONCLUSIONS: Psychological symptoms are frequent even 14-19 months after the L'Aquila earthquake. The mental health care providers in the area of L'Aquila should be aware of the possibility of PTSD or MD among their users.

The role of sampling in mycotoxin contamination: an holistic view.

The need to obtain a representative sample deserves particular consideration since a wrong sampling plan can greatly affect the reliability of the measured levels of mycotoxins. This can even result in legal disputes and barriers to trade. Reported here is an holistic view for an ideal sampling plan, which is based on two consecutive steps: (i) To establish 'why, where and when' sampling has to be performed by assessing the purpose, the appropriate time and the site for collecting the samples; (ii) To establish 'how' to draw samples by assessing practical ad hoc guidelines, considering that, for bulk goods in particular, mycotoxins are not at all homogeneously distributed in a lot. So far, step 1 is not yet covered by specific guidelines while for step 2, European regulations establish the procedures for the sampling of bulk and retail products potentially contaminated by mycotoxins.

Clinical and pressure-flow changes after long-term treatment with alfuzosin SR.

OBJECTIVES: The aim of our study was to evaluate the symptomatic and urodynamic changes after 1-5 years of treatment with alfuzosin in patients with benign prostatic hyperplasia. METHODS: Out of 255 patients with lower urinary tract symptoms observed from 1992 to 1997, who completed the International Prostatic Symptom Score (I-PSS) and underwent full urodynamic investigation, 161 were found to be obstructed (Schäfer classes 2-6). One hundred and two subsequently consented to a second clinical and urodynamic evaluation. Out of these, 46 underwent surgical treatment, 20 were elected for watchful waiting (WW) and 36 received a medical treatment. Twenty out of these, with a mean age of 65 years, a mean prostatic volume of 44 ml (20-70) a median Schäfer's obstruction class of 3 (range 2-5) were treated with slow release alfuzosin 5 mg twice a day. We re-evaluated these 20 patients with a second I-PSS and pressure-flow study after 1-5 years (mean: 2 years) of treatment. The patients in the WW group with comparable baseline characteristics were considered as controls. The Wilcoxon matched-pairs signed rank test and the Kruskal-Wallis test were used for statistical analysis. RESULTS: In the group treated with alfuzosin, no differences were noted for I-PSS (14.9 +/- 6,8; 13.3 +/- 5); maximum flow (124 +/- 6; 14 +/- 6) and projected isometric pressure (105 +/- 36; 105 +/- 26). Statistically significant differences were noted for residual urine (103 +/- 100; 33 +/- 38, p = 0.02); detrusor pressure at maximum flow (64.4 +/- 23; 53 +/- 12, p = 0.04), minimum urethral opening pressure (36.5 +/- 9; 31 +/- 9, p = 0.02), Schäfer class (2.7 +/- 0.7; 2 +/- 0.8, p = 0.04); urethral resistance algorithm (34.7 +/- 11; 27 +/- 7, p = 0.02). Statistically significant differences between baseline and follow-up were noted for none of the clinical and urodynamic parameters in the WW group. CONCLUSIONS: Patients with bladder outlet obstruction seem to remain clinically stable and to improve urodynamically when treated with alfuzosin for a long period of time.

Successful treatment of hepatosplenic candidiasis in an elderly patient with acute myeloid leukemia using liposomal daunorubicin and fluconazole.

Fungal infections are an increasing cause of morbidity and mortality in patients with haematological malignancies. The organism most often responsible are Candida spp., particurarly Candida Albicans. This report describes our experience in a 63-year-old man who developed symptoms of hepatosplenic candidiasis caused by Candida tropicalis after treatment for acute myeloid leukaemia (AML). The fungal infection was successfully controlled using fluconazole, and the patient has been disease-free for more than 11 months after antileukemic chemotherapy without any recurrence of Candida infections. Our experience suggests that AML and chemotherapy associated fungal infections can be controlled with an appropriate therapeutic regimen.

[Unilateral primary vesico-ureteral reflux: uni- or bilateral reimplantation?]. / Reflux vésico-urétéral primitif monolatéral: réimplantation mono ou bilatérale?

The need of bilateral reimplantation in unilateral reflux is still stressed by some authors. The following represents the rationale for this surgical management. 1. correction of unilateral reflux may increase bladder pressure and in this way induce a contralateral reflux; 2. the operation on one side may lead to changes in the muscles and cause reflux on the opposite one; 3. reflux, though unilateral, is the result of a malformation involving the whole trigone. Nevertheless, the authors regard as unjustified the reimplantation of a normal ureterovesical junction being in-acceptable the risk, even if low, of operative failure on a ureter without reflux. Literature data show an incidence of contralateral reflux after unilateral reimplantation of 11-32%. Such incidence, however, tends to decrease (1.9-20%) one year after the operation due to the spontaneous resolution of reflux in most of the cases. The grade of reflux was low (I-II grade) in the majority of cases. The authors report on 38 cases of unilateral primitive vesico-ureteral reflux who underwent unilateral ureteral reimplantation between 1981 and 1982. Minimum follow-up was 2 years. After surgery, contralateral reflux occurred in 4 cases (10.5%) but it spontaneously subsided within 3 years in all of them. Contralateral reflux was asymptomatic in 3 cases and in no cases caused renal scars. The authors conclude that unilateral ureteral reimplantation is the procedure of choice in children with unilateral reflux. Bilateral reimplantation, however, will be performed in patients with bilateral reflux who showed disappearance of reflux on one side before the operation.

[Current trends in the therapy of C.I.N. (cervical intraepithelial neoplasia)]. / Attuali orientamenti nella terapia delle C.I.N. (cervical intraepitelial neoplasia).

The Authors examine the epidemiological data on cervical intraepithelial neoplasia (C.I.N.) and review the various therapeutic methods available for it's treatment, paying special attention to the outpatient treatment of these precancerous portio lesions.