[Improving vaccination social marketing by monitoring the web]

Immunisation is one of the most important and cost- effective interventions in Public Health because of their significant positive impact on population health.However, since Jenner's discovery there always been a lively debate between supporters and opponents of vaccination; Today the antivaccination movement spreads its message mostly on the web, disseminating inaccurate data through blogs and forums, increasing vaccine rejection.In this context, the Società Italiana di Igiene (SItI) created a web project in order to fight the misinformation on the web regarding vaccinations, through a series of information tools, including scientific articles, educational information, video and multimedia presentations The web portal (http://www.vaccinarsi.org) was published in May 2013 and now is already available over one hundred web pages related to vaccinations Recently a Forum, a periodic newsletter and a Twitter page have been created. There has been an average of 10,000 hits per month. Currently our users are mostly healthcare professionals. The visibility of the site is very good and it currently ranks first in the Google's search engine, taping the word "vaccinarsi" The results of the first four months of activity are extremely encouraging and show the importance of this project; furthermore the application for quality certification by independent international Organizations has been submitted.

Increased salience of gains versus decreased associative learning differentiate bipolar disorder from schizophrenia during incentive decision making

BACKGROUND

Abnormalities in incentive decision making, typically assessed using the Iowa Gambling Task (IGT), have been reported in both schizophrenia (SZ) and bipolar disorder (BD). We applied the Expectancy-Valence (E-V) model to determine whether motivational, cognitive and response selection component processes of IGT performance are differentially affected in SZ and BD.

METHOD

Performance on the IGT was assessed in 280 individuals comprising 70 remitted patients with SZ, 70 remitted patients with BD and 140 age-, sex- and IQ-matched healthy individuals. Based on the E-V model, we extracted three parameters, 'attention to gains or loses', 'expectancy learning' and 'response consistency', that respectively reflect motivational, cognitive and response selection influences on IGT performance.

RESULTS

Both patient groups underperformed in the IGT compared to healthy individuals. However, the source of these deficits was diagnosis specific. Associative learning underlying the representation of expectancies was disrupted in SZ whereas BD was associated with increased incentive salience of gains. These findings were not attributable to non-specific effects of sex, IQ, psychopathology or medication.

CONCLUSIONS

Our results point to dissociable processes underlying abnormal incentive decision making in BD and SZ that could potentially be mapped to different neural circuits.

Abstract P5-01-10: Clinical-pathological features and outcomes of Invasive lobular (ILC) vs Invasive ductal (IDC) breast cancer (BC): a mono-institutional series

Purpose: The aim of our study was to investigate different clinico-biological behavior associated to ILC compared to IDC evaluating implications on survival outcomes

Methods: We analyzed data from 3749 cases of IBC treated from 1995 to 2008 and categorized as having ILC, IDC and mixed/other. Associations between clinical-pathological variables and the ILC/IDC histotype were assessed using a χ2 test. Log-rank test and Cox regression model were performed to evaluate the impact of hystologic types on overall survival (OS), Event Free Survival (EFS) and Post-Progression Survival (PPS).

Results: We identified 445 (12%) ILC, 3021 (80.5%) IDC, 149 mixed (ductal-lobular) BC (3.9%) and 134 other hystotypes (3.6%). Median age was 61 (25–97) years. Compared with IDC, ILC occurred significantly (p < 0.001) more likely in older age, larger in size (T≥2: 46 vs 34%) with frequent axilla involvement (43 vs 37%). It was associated with better differentiated tumors usually presenting low ki67, high level of ER expression and HER2 negative status. Mastectomies were more frequent (45%) in ILC than in IDC (37%). As ILC showed higher ER expression rates, adjuvant hormonal (± previous chemo) therapy was more frequently given to them than IDC (77 vs 64%). At a median follow up of 77 (0–272) months, there were not significant differences in EFS (81.4 vs 82.1%, p = 0.7) and OS (82.8 vs 84.6%; p = 0.19) between ILC vs IDC. Relapses, contralateral and second tumors were 65 (15%), 9 (2%) and 22 (5%) in ILC vs 404 (13%), 84 (2.8%) and 174 (5.7%) in IDC. Local recurences were 16 (3.6%) vs 175 (5.7%) in ILC vs IDC; preferential sites of distant relapses were similar in both histotypes. Median time to first event was 38.3 in ILC vs 35.23 months in IDC. PPS was 16.5 m (0–100) in ILC and 22.2 m (0–187) in IDC. ILC showed worse prognosis than IDC within luminal A (86.9 vs 93.5%; p = 0.003), C (70.4 vs 88.5%; p = 0.028) and in triple negative subtypes (50 vs 73.1%; p = 0.021). No difference in OS was seen for age, size, hormonal and nodal status, except in N >3 ILC pts, in whom a trend of worse prognosis (55.6 vs 60.2%) was observed.

Conclusions: Despite the quite favorable biological pattern, ILC did not show a better outcomes than IDC.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-01-10.

Linguistic production and syntactic comprehension in schizophrenia and bipolar disorder

OBJECTIVE

To explore linguistic abilities in schizophrenia and bipolar disorder. Specifically, the aims of this study were to: i) investigate microlinguistic (lexicon, morphology, syntax) and macrolinguistic (discourse coherence, pragmatics) dimensions of speech production and ii) evaluate syntactic comprehension skills in both schizophrenia and bipolar disorder.

METHOD

Linguistic performance of 30 Italian-speaking patients with schizophrenia, 30 participants with bipolar disorder and 30 healthy controls comparable for age and educational level has been assessed using a story-telling task and a computer-based test of syntactic comprehension.

RESULTS

In narrative production, compared with healthy participants, those with schizophrenia had slight problems in speech rate and deficits at both local and global discourse coherence, whereas patients with bipolar disorder showed reduced mean length of utterance. As regards syntactic comprehension, both groups of patients collected more grammatical errors than controls, but they differed with regard to the number and kind of grammatical construction they missed.

CONCLUSION

Linguistic deficits have been detected in both groups of patients, being, however, more severe and generalized in schizophrenia than in bipolar disorder. Such results help us in improving our understanding of the potential psychopathological overlapping between these disorders.

Frequency of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from Trentino, North East Italy

OBJECTIVE

Triple negative breast carcinomas (TNT) are infiltrating breast carcinomas (BC) with negative oestrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER-2) expression, and are associated with frequent BRCA1/BRCA2 mutations. The aim of the present study is to analyze the frequency and distribution of TNT in our population where a breast cancer screening program for women aged between 50 and 69 years is effective since 2001 with 85% accrual.

METHODS

We investigated the records of 2112 consecutive BC and 153 interval BC (i.e. BC detected in the screened negative women in the interval between screening rounds). Tumours with complete negative expression of ER, PgR and Her2 were considered TNT; tumours with negative ER and PgR status and faint Her2 expression (score 1) were considered as possible TNT (pTNT).

RESULTS

We identified 82 (3.8%) TNT and 20 (0.9%) pTNT in the series of 2112 consecutive BC and 7 TNT and 1 pTNT (5.2%) in the series of 153 interval BC. In the consecutive series, TNT/ pTNT were observed in 6.5% patients below 50 years and in 4.3% of patients above 50 years. A high proliferation rate (Ki-67 labelling > 36%) was observed in 87.8% of TNT (median labelling 56.3%) and in 60% of pTNT (median labelling 48.4%).

CONCLUSIONS

Since TNT/pTNT occurring in women < 50 years is a criterion for selecting patients whom genetic counselling and BRCA1 testing should be offered, our study is of help in foreseeing the workload of the Unit of Medical Genetics and the Laboratory of Molecular Pathology.

White-matter abnormalities in the right posterior hemisphere in generalized anxiety disorder: a diffusion imaging study

BACKGROUND

Prior imaging studies have shown structural, functional and biochemical impairments in patients with generalized anxiety disorder (GAD), particularly in the right hemisphere. In this study we investigated, for the first time to the best of our knowledge, the white-matter microstructure organization in GAD.

METHOD

A total of 12 patients with DSM-IV GAD and 15 matched healthy controls underwent a magnetic resonance imaging session of diffusion weighted imaging, exploring white-matter water molecules by the means of apparent diffusion coefficients (ADCs). Regions of interests were placed in the frontal, parietal, temporal and occipital lobes and in the splenium and genu of the corpus callosum, bilaterally.

RESULTS

ADC measures were significantly greater in patients with GAD in the right splenium and right parietal cortex compared with healthy controls (p⩽0.002). No significant correlations between ADCs and age or clinical variables were found.

CONCLUSIONS

We provide evidence that GAD is associated with disrupted white-matter coherence of posterior right hemisphere regions, which may partly sustain the impaired cognitive regulation of anxiety. Future diffusion imaging investigations are expected to better elucidate the communication between the parietal cortex and other right hemisphere regions in sustaining the cognitive processing of social and emotional stimuli in patients with GAD.

[Evaluation and containment of cardiovascular risk in a large number of "healthy" subjects]

Cardiovascular diseases are the primary cause of death and represent a public health problem both in terms of mortality and morbidity. Since many risk factors for cardiovascular disease can be corrected with active interventions, we proposed a structured model operating in ways similar to cancer screening: active recall of healthy subjects, offers to intervene in selected subjects. In the experimental model adopted by the Local Health Unit n. 17--Este and the Local Health Unit n. 7--Pieve di Soligo, after pre-evaluation/exclusion by the general practitioner subjects aged between 45 and 59 years were recalled and evaluated by a trained health assistant using anthropometric measurements, screening blood pressure, fasting blood glucose, and evaluation of lifestyle. If their values were abnormal, the health assistant invited them to participate, and counseled them on some initiatives to make changes. The proposed model was demonstrated to be a good model both because using previously tested structured models, it revealed an elevated number of subjects with hypertension and hyperglycemia that were before undetected and because it placed up front strategic actions of the Prevention Departments. In addition, in follow-up, improvements in lifestyle were seen in subjects who had been counseled to alter them.

P5-14-23: Clinical Outcomes of Different Subtypes Detected by Immunohistochemistry of Early Invasive Breast Cancers in a Monoinstitutional Series

Background

Early invasive breast cancer (EIBC) is an heterogeneous disease. Immunohistochemical (IHC) markers can be used to classify tumors in different biological subtypes with different clinical behavior.

Purpose: The aim of our study was to evaluate survival outcomes for patients (pts) with different subtypes of EIBC as classified using four ICH markers (ER, PR, HER2 and Ki67).

Methods: We evaluated data from 3403 consecutive cases of EIBC treated from 1995 to 2008 and classified as: luminal A (positive ER and PR, negative HER2 and Ki67&lt; 14%), luminal B (positive ER and/or PR, negative HER2 and Ki67&gt;14%), luminal C (positive ER and/or PR, positive HER2, any Ki67), HER2+ (negative ER and PR, positive HER2, any ki67), triple negative (negative ER and PR, negative HER2, any ki67). Log-rank test and Kaplan-Meyer estimator were performed to evaluate the impact of ICH subtypes on overall survival (OS), Event Free Survival (EFS) and their correlation with other known prognostic factors such as N, G, Size, Age.

Results: We identified 917 luminal A (26.9%), 1731 luminal B (50.9%), 279 (8.2%) luminal C, 183 HER2 + (5.4%) and 293 triple negative (8.6%). Median age was 61 years. Luminal A was more frequently (p&lt;0.001) associated with older age, smaller size, negative axilla involvement, low grading. Observed events (relapses, contralateral and second tumors) were: 54 in luminal A (6%), 215 in luminal B (16%), 40 in luminal C (14%), 42 in HER2+ (23%) and 59 in triple negative (20%). Disease free interval (DFI) was shorter in luminal C, HER2 and TN (median DFI: 30, 26 and 19 months) than in Luminal A and B (median DFI: 51 and 41 month). Luminal A and B presented more bony and less visceral recurrences than luminal C, HER2 and triple negative tumors. At median follow up of 51 months EFS was 94.1% in luminal A, 87.5% in luminal B, 85.5% in luminal C, 76.8% in HER2+ and 79.7% in triple negative. Corresponding OS was 95.3% in luminal A, 89% in luminal B, 89.2% in luminal C, 80.9% in HER2+, 81.9% in triple negative. Different subtypes EFS according to nodal status, grading, tumor size and age, was reported in table 1.