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Menozzi GC, Depaoli A, Ramella M, Alessandri G, Frizziero L, De Rosa A, Soncini F, Sassoli V, Rocca G, Trisolino G. High-Temperature Polylactic Acid Proves Reliable and Safe for Manufacturing 3D-Printed Patient-Specific Instruments in Pediatric Orthopedics-Results from over 80 Personalized Devices Employed in 47 Surgeries. Polymers (Basel) 2024; 16:1216. [PMID: 38732685 PMCID: PMC11085401 DOI: 10.3390/polym16091216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Orthopedic surgery has been transformed by 3D-printed personalized instruments (3DP-PSIs), which enhance precision and reduce complications. Hospitals are adopting in-house 3D printing facilities, using cost-effective methods like Fused Deposition Modeling (FDM) with materials like Polylactic acid (PLA) to create 3DP-PSI. PLA's temperature limitations can be overcome by annealing High-Temperature PLA (ann-HTPLA), enabling steam sterilization without compromising properties. Our study examines the in vivo efficacy of ann-HTPLA 3DP-PSI in pediatric orthopedic surgery. (2) Methods: we investigated safety and efficacy using ann-HTPLA 3DP-PSI produced at an "in-office" 3D-printing Point-of-Care (3DP-PoC) aimed at correcting limb deformities in pediatric patients. Data on 3DP-PSI dimensions and printing parameters were collected, along with usability and complications. (3) Results: Eighty-three ann-HTPLA 3DP-PSIs were utilized in 33 patients (47 bone segments). The smallest guide used measured 3.8 cm3, and the largest measured 58.8 cm3. Seventy-nine PSIs (95.2%; 95% C.I.: 88.1-98.7%) demonstrated effective use without issues. Out of 47 procedures, 11 had complications, including 2 infections (4.3%; 95% CI: 0.5-14.5%). Intraoperative use of 3DP-PSIs did not significantly increase infection rates or other complications. (4) Conclusions: ann-HTPLA has proven satisfactory usability and safety as a suitable material for producing 3DP-PSI in an "in-office" 3DP-PoC.
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Affiliation(s)
- Grazia Chiara Menozzi
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (M.R.); (G.R.)
| | - Alessandro Depaoli
- Rizzoli Sicilia Department, IRCCS Istituto Ortopedico Rizzoli, 90011 Bagheria, Italy;
| | - Marco Ramella
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (M.R.); (G.R.)
| | - Giulia Alessandri
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.A.); (L.F.); (A.D.R.)
| | - Leonardo Frizziero
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.A.); (L.F.); (A.D.R.)
| | - Adriano De Rosa
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.A.); (L.F.); (A.D.R.)
| | - Francesco Soncini
- Unit of Hygiene, Epidemiology and Emergency Management, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Valeria Sassoli
- Pharmacy Service, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Gino Rocca
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (M.R.); (G.R.)
| | - Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (M.R.); (G.R.)
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Mazzini E, Soncini F, Cerullo L, Genovese L, Apolone G, Ghirotto L, Mazzi G, Costantini M. A focused ethnography in the context of a European cancer research hospital accreditation program. BMC Health Serv Res 2021; 21:446. [PMID: 33975580 PMCID: PMC8111912 DOI: 10.1186/s12913-021-06466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/28/2021] [Indexed: 05/31/2023] Open
Abstract
Background A quality accreditation program (AP) is designed to guarantee predefined quality standards of healthcare organizations. Evidence of the impact of quality standards remains scarce and somewhat challenging to document. This study aimed to investigate the accreditation of a cancer research hospital (Italy), promoted by the Organization of European Cancer Institutes (OECI), by focusing on the individual, group, and organizational experiences resulting from the OECI AP. Methods A focused ethnography study was carried out to analyze the relevance of participation in the accreditation process. Twenty-nine key informants were involved in four focus group meetings, and twelve semistructured interviews were conducted with professionals and managers. Inductive qualitative content analysis was applied to examine all transcripts. Results Four main categories emerged: a) OECI AP as an opportunity to foster diversity within professional roles; b) OECI AP as a possibility for change; c) perceived barriers; and d) OECI AP-solicited expectations. Conclusions The accreditation process is an opportunity for improving the quality and variety of care services for cancer patients through promoting an interdisciplinary approach to care provision. Perceiving accreditation as an opportunity is a prerequisite for overcoming the barriers that professionals involved in the process may report. Critical to a positive change is sharing the values and the framework, which are at the basis of accreditation programs. Improving the information-sharing process among managers and professionals may limit the risk of unmet expectations and prevent demotivation by future accreditation programs. Finally, we found that positive changes are more likely to happen when an accreditation process is considered an activity whose results depend on managers’ and professionals’ joint work.
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Affiliation(s)
- Elisa Mazzini
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Francesco Soncini
- Istituto Ortopedico Rizzoli - IRCCS, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Loredana Cerullo
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Lucia Genovese
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Giovanni Apolone
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Luca Ghirotto
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Giorgio Mazzi
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Massimo Costantini
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy.
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Panciroli G, Forresi B, Soncini F, Botosso E, Di Pietro E, Scarpini G, Scaini S, Aggazzotti G, Caffo E, Righi E. Parental and offspring psychopathological disorders after the 2012 Italian earthquake. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Parental mental health can affect offspring Post-Traumatic Stress Disorder (PTSD), but up to now few data focused on families exposed to natural disasters. Thus, this study aimed at investigating the association between parental and youth psychopathology after the Italian earthquake of 2012.
Methods
In this cross-sectional study, 1162 parents and 682 children and adolescents (9-14 years) living in two districts, earthquake area (EA) and control area (CA), were assessed for psychopathological distress two years after the earthquake. Children filled in the UCLA PTSD-Index for DSM-IV, an exposure questionnaire, and the Strengths and Difficulties Questionnaire (SDQ); parents the Symptom Checklist-90 (SCL-90).
Results
Parents in EA showed a higher frequency of psychopathological difficulties than those in CA (28% vs 17.5% had a SCL-90 global score over the cutoff, p < 0.001). Sleep disturbances were the most prevalent disorder, followed by obsessive-compulsive disorder, depression, somatization and anxiety. Compared to fathers, mothers had significantly higher scores, especially in the EA sample.
Both SCL90 total and symptom domain scores correlated with PTSD total and clusters scores, especially for hyperarousal and re-experiencing. Parental anxiety, depression and somatization showed the highest correlations. Considering SDQ, mothers' psychopathology resulted to be associated mainly with offspring's emotional and peer problems, while fathers' disorders affected mainly children's hyperactivity.
Conclusions
This study showed a significant association between parental mental health and both PTSD and emotional/behavioral problems among offspring after earthquake. These results should be carefully considered when planning mental health support interventions in areas affected by earthquakes.
Key messages
Parental psychopathology and PTSD and other emotional/behavioral difficulties in children tend to cluster in families exposed to natural disasters, especially earthquakes. Parental and offspring psychopathological disorders should be considered when planning mental health support interventions in areas affected by earthquakes.
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Affiliation(s)
- G Panciroli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - B Forresi
- Sigmund Freud University, Milan, Italy
| | - F Soncini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - E Botosso
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - E Di Pietro
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - G Scarpini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - S Scaini
- Sigmund Freud University, Milan, Italy
| | - G Aggazzotti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - E Caffo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - E Righi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Abstract
To investigate the relation between estrogen receptor (ER) status and timing of relapse, we retrospectively studied two groups of patients (200 cases in each group) who underwent radical mastectomy and developed an early relapse (within 3 years of the surgery) or a long-term relapse (more than 8 years after surgery). One-hundred and eighty-two (91%) patients who developed a long-term relapse were ER-positive (ER+), whereas only 64% of patients who developed an early relapse were ER+ (P<0.001), supporting the hypothesis that a long-term relapse is more frequently associated with an ER+ tumor. A review of the literature, which indicated that a long-term relapse arises more frequently in patients in whom a partial hormone control is maintained, seems to support this finding, albeit the presence of 18 ER-negative (ER-) cases in our study. However, this apparent contradictory observation could be explained by the fact that 12 of our patients were in premenopause and that ER-status could have been false ER- results due to the binding of endogenous estradiol to ER.
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Affiliation(s)
- S Basso-Ricci
- Divisione di Radioterapia B, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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Soncini F, Odone A, Lalic T, Miduri A, Paroni S, Vezzosi L, Privitera G, Signorelli C. [Employment opportunities and job satisfaction in the field of Public Health: a survey among recent graduates of the Hygiene and Preventive Medicine residency in Italy]. Ig Sanita Pubbl 2017; 73:567-577. [PMID: 29573384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We conducted an on-line survey among 255 specialists in Hygiene and Preventive Medicine in Italy who completed their training between October 2014 and July 2016, to assess their training experience, employment opportunities and current job satisfaction. Response rate was 49%. Mean age was 35 years. A high employment rate within two years from obtaining specialist qualification was reported by the 125 specialists who completed the questionnaire (76% are currently employed). The three main work settings of the participating specialists are hospital health directions (37%), universities (19%) and local Prevention Departments (16%). Two thirds (66%) have temporary positions and only 6% permanent positions. Job, pay, and training satisfaction are often below expectations with geographical differences that would need to be further investigated.
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Affiliation(s)
- Francesco Soncini
- Direzione Medica Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia, Italia
| | - Anna Odone
- Dipartimento di Medicina e Chirugia, Università degli Studi di Parma, Parma, Italia
| | - Tijana Lalic
- Dipartimento di Medicina e Chirugia, Università degli Studi di Parma, Parma, Italia
| | - Alessia Miduri
- Dipartimento di Medicina e Chirugia, Università degli Studi di Parma, Parma, Italia
| | - Samuel Paroni
- Dipartimento di Medicina e Chirugia, Università degli Studi di Parma, Parma, Italia
| | - Luigi Vezzosi
- Dipartimento di Medicina Sperimentale, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italia
| | - Gaetano Privitera
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italia
| | - Carlo Signorelli
- Dipartimento di Medicina e Chirugia, Università degli Studi di Parma, Parma, Italia
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De Santis M, Di Salvo F, Bonfantini F, Di Cosimo S, Mantero E, Riboldi V, Dispinzieri M, Soncini F, Cosentino V, Bianchi G, Gennaro M, Sant M, Valdagni R, Pignoli E, Lozza L. PO-0662: Target therapy and hypofractionated whole breast radiotherapy: an unexpected protective factor. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31099-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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De Santis MC, Bonfantini F, Di Salvo F, Dispinzieri M, Mantero E, Soncini F, Baili P, Sant M, Bianchi G, Maggi C, Di Cosimo S, Agresti R, Pignoli E, Valdagni R, Lozza L. Factors influencing acute and late toxicity in the era of adjuvant hypofractionated breast radiotherapy. Breast 2016; 29:90-5. [PMID: 27476083 DOI: 10.1016/j.breast.2016.07.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/11/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate toxicity in breast cancer patients treated with anthracycline and taxane based chemotherapy and whole breast hypofractionated radiotherapy, and to identify the risk factors for toxicity. METHODS AND MATERIALS 537 early breast cancer patients receiving hypofractionated radiotherapy after conservative surgery were enrolled from April 2009 to December 2014, in an Italian cancer institute. The dose was 42.4 Gy in 16 daily fractions, 2.65 Gy per fraction. The boost to the tumor bed was administered only in grade III breast cancer patients and in patients with close or positive margins. Acute and late toxicity were prospectively assessed during and after radiotherapy according to RTOG scale. The impact of patients clinical characteristics, performed treatments and dose inhomogeneities on the occurrence of an higher level of acute skin toxicity and late fibrosis has been evaluated by univariate and multivariate analysis. RESULTS The mean age was 74 (range 46-91 yrs). 27% of patients received boost. 22% of cases (n = 119) received also chemotherapy. The median follow-up was 32 months. G1 and G2/G3 acute skin toxicity were 61.3% and 20.5% and G1 and G2/G3 late fibrosis 12.6% and 4.3% respectively. Chemotherapy (p = 0.04), diabetes (p = 0.04) and boost administration (p < 0.01) were found to be statistically significant on the occurrence of late fibrosis, but a multivariate analysis did not show any factors connected. The boost administration (p < 0.01), the breast volume (p = 0.05), dose inhomogeneities (p < 0.01) and boost volume (p = 0.04) were found to be statistically significant as concerns the occurrence of acute skin reaction at the univariate analysis, but only the boost administration (p = 0.02), at multivariate analysis. CONCLUSIONS The results of our study, according to the large randomized trials, confirmed that hypofractionated whole breast irradiation is safe, and only the boost administration seems to be an important predictor for toxicity. Chemotherapy does not impact on acute and late skin toxicity.
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Affiliation(s)
- M C De Santis
- Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - F Bonfantini
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F Di Salvo
- Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Dispinzieri
- Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E Mantero
- Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F Soncini
- Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - P Baili
- Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Sant
- Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Bianchi
- Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C Maggi
- Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Di Cosimo
- Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Agresti
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E Pignoli
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Valdagni
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano.Director, Radiation Oncology 1 and Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Lozza
- Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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De Santis M, Di Salvo F, Bonfantini F, Dispinzieri M, Franceschini M, Soncini F, Mantero E, Cosentino V, Postè D, Baili P, Sant M, Pignoli E, Lozza L. PV-0513: The impact of chemotherapy on toxicity in the era of hypofractionated radiotherapy. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31763-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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De Santis M, Bonfantini F, Diletto B, Meroni S, Mantero E, Soncini F, Cosentino V, Posté D, Pignoli E, Lozza L. EP-1193: Axillary coverage by whole breast irradiation in 1 to 2 positive sentinel lymph nodes breast cancer patients. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Costantino C, Cinquetti S, Garavelli E, Marcantoni C, Murru C, Pieroni G, Privitera G, Ricciardi W, Soncini F, Tedesco D, Triassi M, Vitale F, Campanella F. [The key role of public health medical resident education for future public health challenges]. Epidemiol Prev 2014; 38:115-119. [PMID: 25759356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The Italian Committee of medical residents in Hygiene, Preventive Medicine and Public Health is a member of the Italian Society of Hygiene, Preventive Medicine and Public Health with the aim of developing a network among Italian resident in public health and promoting the educational path improvement through comparisons and debates between postgraduate medical schools. In this perspective, during last years account has been taken of some essential topics concerning education of public health medical residents, which represent future health-care and public health experts. METHODS Cross-sectional researches were conducted among Italian public health medical residents (PHMRs) through self-administered and web-based questionnaires. Each questionnaire was previously validated by pilot studies conducted during the 46th National Conference of the Italian Society of Hygiene, Preventive Medicine and Public Health. RESULTS Seventy percent of Italian PHMRs considered the actual length of Public Health postgraduate medical school excessively long, with regard to predetermined educational goals. Confirming this statement, 90% of respondents were inclined to a reduction from 5 to 4 years of postgraduate medical school length, established by Law Decree 104/2013. Seventy seven percent of surveyed PHMRs stand up for a rearrangement on a national setting of the access contest to postgraduate medical schools. Moreover 1/3 of Italian schools performed less than 75%of learning and qualifying activities specified in Ministerial Decree of August 2005. In particular, data analysis showed considerable differences among Italian postgraduate schools. Finally, in 2015 only four Italian Universities (Napoli Federico II, Palermo, Pavia, Roma Tor Vergata) provide for the Second Level Master qualify for the functions of occupational doctor. This offer makes available 60 positions against a request of over 200 future Public Health medical doctors who have shown interest in the Master. CONCLUSIONS In Italy, after the introduction of Ministerial Decree 285/2005, the educational course of PHMRs was significantly improved. The standardization of learning and qualifying activities allowed for the first time the attendance at medical directions or Local Health Units. Nevertheless, the excessive lenght of postgradute schools and the differences about training among Italian Universities are critical and actual issue. Moreover, the remarkable interest shown by PHMRs in the Master could suggest a poor job replacement prospect for young medical specialist in Hygiene, Preventive Medicine and Public Health.
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Affiliation(s)
- Claudio Costantino
- Dipartimento di scienze per la promozione della salute e materno infantile, Università di Palermo.
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Soncini F, Silvestrini G, Poscia A, Ciorba V, Conti A, Murru C, Rinaldi A, Zoccali A, Azzolini E, Baldini C, Bandini L, Bernardini I, Boemo D, Burrai V, Camia P, Campanella F, Caruana A, Costantino C, D'Andrea E, Di Gregori V, D'Ippolito E, Ferioli S, Furnari R, Garavelli E, Gilardi F, Giraldi G, Goi G, Gregoraci G, Guaccero A, Guerra R, La Maestra G, La Rosa E, Licitra G, Lucaroni F, Marcantoni C, Marra F, Martinese M, Marzulli T, Montante A, Napolitano F, Nioteni C, Palladino R, Parisi S, Passaro M, Pastori M, Pelullo P, Puggelli F, Ravaioli C, Reggiani S, Santoru R, Sironi S, Soumelis A, Tanini T, Tedesco D, Tricarico P, Vallorani S, Vighi V, Zazzara F, Ziglio A, Zucco R. Public Health Physicians and Empathy. Are we really empathic? The Jefferson Scale applied to Italian resident doctors in Public Health. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt124.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Godoi F, Soncini F, Hipólide D, Oliveira M, Tufik S. 127 SLEEP IN THE LIGHT, DARK OR BOTH: EFFECTS OF DIFFERENT SLEEP SCHEDULES DURING CHRONIC SLEEP RESTRICTION ON ATTENTIONAL PERFORMANCE IN RATS. Sleep Med 2009. [DOI: 10.1016/s1389-9457(09)70129-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Di Russo A, Bonfante V, Viviani S, Devizzi L, Santoro A, Zanini M, Soncini F, Villani F, Valagussa P, Bonadonna G. Prospective randomized trial in the treatment of early stage hodgkin's disease (ESHD) using involved field radiation therapy (IFRT) vs. subtotal nodal irradiation (STNI) after a short chemotherapy (CT) course. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80815-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Villani F, Viviani S, Bonfante V, De Maria P, Soncini F, Laffranchi A. Late pulmonary effects in favorable stage I and IIA Hodgkin's disease treated with radiotherapy alone. Am J Clin Oncol 2000; 23:18-21. [PMID: 10683067 DOI: 10.1097/00000421-200002000-00004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Radiotherapy (RT) in patients with favorable-stage Hodgkin's disease can induce clinical and subclinical evidence of pulmonary damage lasting over the years. In this study, we monitored 36 patients with stage IA-IIA Hodgkin's disease treated with subtotal nodal RT. The planned dose of RT was 40 Gy to 44 Gy to the involved areas and 36 Gy to the adjacent uninvolved areas. Pulmonary function was evaluated by chest radiograph, spirometric parameters, arterial blood gas analysis, and single-breath CO transfer factor (DLCO). The tests were performed before and at the end of irradiation, and during the follow-up 1 and 3 to 5 years after the treatment. At the end of RT, we found a significant decrease of total lung capacity, vital capacity, forced expiratory volume in 1 second, residual volume, and DLCO. Spirometric parameters improved during the follow-up period, whereas the decline of DLCO (-6.4%) was persistent. No correlation was found between mantle RT dose and DLCO changes. Four patients showed a decline of DLCO of >20% from pretreatment values but only one was symptomatic. Our study confirms that RT induces a pulmonary-restrictive disease at a subclinical level that seems to be reversible in the majority of patients.
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Affiliation(s)
- F Villani
- Division of Cardiology and Respiratory Physiopathology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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Viviani S, Bonfante V, Santoro A, Zanini M, Devizzi L, Di Russo AD, Soncini F, Villani F, Ragni G, Valagussa P, Bonadonna G. Long-term results of an intensive regimen: VEBEP plus involved-field radiotherapy in advanced Hodgkin's disease. Cancer J Sci Am 1999; 5:275-82. [PMID: 10526668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE This pilot study was conducted to evaluate the efficacy and toxicity of a new intensive drug regimen, combined with involved-nodal-field radiotherapy, in advanced Hodgkin's disease not treated by chemotherapy. PATIENTS AND METHODS From September 1990 to March 1993, 73 evaluable patients with newly diagnosed stage IIB, III (A and B), and IV (A and B) Hodgkin's disease or who were relapsing after primary subtotal or total nodal irradiation were treated with eight cycles of etoposide, epirubicin, bleomycin, cyclophosphamide, and prednisolone (VEBEP) followed by radiotherapy (30-36 Gy) to the nodal site or sites of pretreatment disease. The median duration of follow-up was 68 months. RESULTS The complete remission rate was 94% (95% CI: 86-98). At 6 years, freedom from progression and overall survival rates were 78% (95% CI: 68-88) and 82% (95% CI: 73-91), respectively. There was one episode of fatal sepsis after bone marrow aplasia that occurred after VEBEP and extended-field irradiation. Hematologic toxicity during chemotherapy was acceptable; without the support of growth factors, grade IV leukopenia and grade IV neutropenia, as determined within cycles, occurred in 38% and 85% of patients, respectively, but was reversible in the vast majority of patients by the day of treatment recycle. No episodes of epidoxorubicin-related cardiomyopathy or symptomatic pulmonary toxicity were documented. Overt and/or subclinical hypothyroidism occurred in 38% of cases. Gonadal damage was evident in the large majority of male patients but reversible in half of them, whereas permanent sterility was observed in females at least 35 years of age. No secondary leukemia has been so far detected. DISCUSSION VEBEP followed by involved-nodal-field radiotherapy is an effective treatment for chemotherapy-naive Hodgkin's disease and is associated to acceptable rates of acute and intermediate-term toxicity. This intensive regimen, which does not routinely require the support of hematopoietic growth factors and can be delivered in an outpatient setting, warrants a prospective comparison in a randomized trial versus one of the more effective standard-combination regimens.
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Affiliation(s)
- S Viviani
- Division of Medical Oncology A, Istituto Nazionale Tumori, Milan, Italy
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Bonfante V, Viviani S, Santoro A, Devizzi L, Di Russo A, Zanini M, Soncini F, Soto Parra H, Valagussa P, Bonadonna G. Ifosfamide and vinorelbine: an active regimen for patients with relapsed or refractory Hodgkin's disease. Br J Haematol 1998; 103:533-5. [PMID: 9827930 DOI: 10.1046/j.1365-2141.1998.00989.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Twenty-six patients with relapsed or refractory Hodgkin's disease (HD) were treated with an intensive salvage regimen combining ifosfamide (3000 mg/m2/d, days 1-4 through continuous intravenous infusion) and vinorelbine (25 mg/m2, i.v. days 1 and 5) with mesna uroprotection and G-CSF support. Courses were given at 3-week intervals. Ten patients achieved a complete and 10 patients a partial response, yielding an overall response rate of 77%. The main toxic effect was neutropenia and the combination was well tolerated.
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Affiliation(s)
- V Bonfante
- Division of Medical Oncology A, Istituto Nazionale Tumori, Milan, Italy
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Santoro A, Bonfante V, Viviani S, Zanini M, Devizzi L, Soto Parra H, Di Russo A, Soncini F, Villani F, Valagussa P, Bonadonna G. Four cycles of ABVD followed by involved field irradiation (IF-RT) is the treatment of choice for early-stage Hodgkin's disease (HD): 5-year results of a randomized trial. Eur J Cancer 1997. [DOI: 10.1016/s0959-8049(97)86095-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bonfante V, Santoro A, Viviani S, Devizzi L, Balzarotti M, Soncini F, Zanini M, Valagussa P, Bonadonna G. Outcome of patients with Hodgkin's disease failing after primary MOPP-ABVD. J Clin Oncol 1997; 15:528-34. [PMID: 9053474 DOI: 10.1200/jco.1997.15.2.528] [Citation(s) in RCA: 145] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study analyzed long-term results in patients with Hodgkin's disease who were resistant to or relapsed after first-line treatment with MOPP and ABVD. Response to salvage treatments and prognostic factors were also evaluated. PATIENTS AND METHODS The study population included 115 refractory or relapsed patients among a total of 415 patients treated with alternating or hybrid MOPP-ABVD followed by radiotherapy (25 to 30 Gy) to initial bulky sites. The median follow-up duration of the present series was 91 months. Thirty-nine of 115 patients (34%) showed disease progression while on primary treatment (induction failures); 48 relapsed after complete remissions that lasted < or = 12 months and 28 after complete remission that lasted more than 12 months from the end of all treatments. RESULTS At 8 years, the overall survival rate was 27%, being 54% and 28% in patients whose initial complete remission was longer or shorter than 12 months, respectively, and 8% in induction failures (P < .001). Response to first-line chemotherapy and disease extent at first progression significantly influenced long-term results, as well as the incidence and duration of complete remission. CONCLUSION The present data confirm previous observations that showed the main prognostic factors to influence outcome after salvage treatment are response duration to first-line therapy and disease extent at relapse. The results indicate that patients who relapse after the alternating MOPP/ABVD regimen have a prognosis similar to that of patients who relapse after a four-drug regimen (MOPP or ABVD alone). Re-treatment with initial chemotherapy seems the treatment of choice for patients who relapse after an initial complete remission that lasts greater than 12 months, while the real impact of high-dose chemotherapy or new regimens should be assessed in resistant patients.
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Affiliation(s)
- V Bonfante
- Division of Medical Oncology, Istituto Nazionale Tumori, Milano, Italy
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Viviani S, Bonadonna G, Santoro A, Bonfante V, Zanini M, Devizzi L, Soncini F, Valagussa P. Alternating versus hybrid MOPP and ABVD combinations in advanced Hodgkin's disease: ten-year results. J Clin Oncol 1996; 14:1421-30. [PMID: 8622055 DOI: 10.1200/jco.1996.14.5.1421] [Citation(s) in RCA: 126] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To compare, in a prospective randomized trial, the efficacy of two different sequences of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy in untreated advanced Hodgkin's disease. PATIENTS AND METHODS From June 1982 to September 1990, 427 consecutive previously untreated patients with pathologic stage IB, IIA bulky, IIB, III (A and B), and IV (A and B) disease were prospectively randomized to receive two different sequences of MOPP and ABVD for a minimum of six cycles followed by radiotherapy (median dose, 30 Gy) to the nodal site(s) of pretreatment bulky disease. Of 415 assessable patients, 211 received one cycle of MOPP monthly, alternated with one cycle of ABVD (alternating regimen), and 204 patients received one-half cycle of MOPP alternated with one-half cycle of ABVD within a 1-month period (hybrid regimen). RESULTS The complete remission (CR) rate was 91% with the alternating regimen and 89% with the hybrid regimen. At 10 years, the freedom-from-progression (FFP) rate was 67% versus 69% and the overall survival (OS) rate was 74% versus 72%, respectively. After attainment of CR, 85 patients relapsed in nodal (n = 60) versus extranodal with or without nodal (n = 25) sites. In patients given consolidative radiation because of bulky lymphoma, the true recurrence rate was 13%. A total of 23 second malignancies (6%) were documented, including 11 cases of acute nonlymphocytic leukemia. No cases of congestive heart failure attributable to doxorubicin or pulmonary toxicity related to bleomycin were documented. CONCLUSION By delivering MOPP and ABVD, it is possible to cure approximately 70% of patients with advanced Hodgkin's disease. The two different drug sequences yielded superimposable results.
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Affiliation(s)
- S Viviani
- Division of Medical Oncology, Istituto Nazionale Tumori, Milan, Italy
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Zanini M, Viviani S, Santoro A, Soncini F, Bonfante V, Devizzi L, Villani F, Castellani MR, Negretti E, Zucali R. Extended-field radiotherapy in favorable stage IA-IIA Hodgkin's disease (prognostic role of stage). Int J Radiat Oncol Biol Phys 1994; 30:813-9. [PMID: 7525516 DOI: 10.1016/0360-3016(94)90354-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE The study was undertaken to evaluate the long-term results in a favorable subset of patients with pathological Stage IA-IIA treated with irradiation alone. METHODS AND MATERIALS One hundred and forty-seven adults with laparotomy- Staged IA-IIA "favorable" Hodgkin's disease were treated with primary subtotal nodal irradiation. Patients with infradiaphragmatic presentation were irradiated through paraortic and inguino-iliac node chains (inverted Y field) followed by prophylactic mediastinal and supraclavicular fields. RESULTS Actuarial overall survival (OS) at 7 years (median follow-up 77 months) was: 93% for the whole series, 94% for Stage I, and 92% for Stage II. The freedom from first progression (FFP) (80% for the whole series) showed a statistically significant difference (p = 0.008) between Stage I (88%) and Stage II (71%). By univariate analysis, stage alone had an independent prognostic significance for OS and FFP. Of the 29 relapsed patients, 8 were previously classified as Stage I and 21 as Stage II; 16 of 29 (55%) of the relapses occurred in the pelvis and 9 in extranodal sites. After salvage treatment with chemotherapy all patients achieved a second complete remission. Seven second malignancies (two acute nonlymphocytic leukemias, one preleukemic syndrome, and four solid tumors) have been detected so far. Hypothyroidism was observed in 16% of patients and a reversible pulmonary restrictive syndrome in 14% of cases, respectively. CONCLUSIONS Within 7 years from radiation therapy, about one-quarter of the patients with Stage II disease will experience a relapse and need intensive salvage chemotherapy. This is not invariably successful and safe, for it may be complicated by either acute or potentially fatal long-term adverse effects, such as second malignancies and cardiac or pulmonary sequelae, in about 5% of patients. The high frequency of relapse in Stage IIA patients suggests a combined modality approach with relatively short-term chemotherapy not including alkylating agents.
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Affiliation(s)
- M Zanini
- Division of Radiation Therapy, Istituto Nazionale Tumori, Milano, Italy
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