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Chiavarini M, Giacchetta I. Need for evidence-based indications for CS delivery. Evid Based Nurs 2024:ebnurs-2023-103851. [PMID: 38575211 DOI: 10.1136/ebnurs-2023-103851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Manuela Chiavarini
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and PublicHealth, Polytechnic University of the Marche Region, 60126 Ancona, Italy
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Chiavarini M, Rosignoli P, Sorbara B, Giacchetta I, Fabiani R. Benzene Exposure and Lung Cancer Risk: A Systematic Review and Meta-Analysis of Human Studies. Int J Environ Res Public Health 2024; 21:205. [PMID: 38397694 PMCID: PMC10887806 DOI: 10.3390/ijerph21020205] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
Lung cancer is a leading cause of death with nearly 1.8 million deaths estimated worldwide in 2020. Although benzene is classified as a human carcinogen (Group 1) on the basis of its association with acute myeloid/non-lymphocytic leukaemia, there is still limited evidence that it may influence lung cancer risk. This study examined the potential link between benzene exposure and risk of lung cancer using a systematic review of epidemiological studies and meta-analysis. We searched through PubMed, Web of Science and Scopus databases up to 10 February 2023 to identify all articles on the association between benzene exposure and lung cancer (incidence or prevalence) and/or mortality. We extracted the risk estimates of the highest and the lowest reported categories of benzene exposure and conducted a meta-analysis using a random-effects model. Heterogeneity and publication bias were analysed using an I2 test and funnel plots asymmetry, respectively. Twenty-one studies were included in the final analysis, with a total of 10,750 lung cancer cases and 2899 lung cancer deaths. Overall, risk estimates of lung cancer prevalence and mortality in association with benzene exposure were 1.20 (n = 14; 95% CI 1.05-1.37) and 1.15 (n = 13; 95% CI 1.02-1.30), respectively. In all cases, heterogeneity was quite large, while no significant publication bias was observed. When only studies that adjusted for smoking habit were selected, the risk for lung cancer increased by up to 34% (n = 9; 95% CI 1.10-1.64). Our data, which show a strong association between benzene exposure and lung cancer risk, may have important public health implications. However, further studies are needed to identify the lung cancer risk associated with benzene exposure considering different smoking conditions.
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Affiliation(s)
- Manuela Chiavarini
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, 60126 Ancona, Italy;
| | - Patrizia Rosignoli
- Department of Chemistry, Biology and Biotechnology, University of Perugia, 06123 Perugia, Italy; (P.R.); (B.S.)
| | - Beatrice Sorbara
- Department of Chemistry, Biology and Biotechnology, University of Perugia, 06123 Perugia, Italy; (P.R.); (B.S.)
| | - Irene Giacchetta
- Department of Medicine and Surgery, Section of Public Heath, School of Hygiene and Preventive Medicine, University of Perugia, 06123 Perugia, Italy;
| | - Roberto Fabiani
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, 60126 Ancona, Italy;
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Fabiani R, Rosignoli P, Giacchetta I, Chiavarini M. Hysterectomy and thyroid cancer risk: A systematic review and meta-analysis. Glob Epidemiol 2023; 6:100122. [PMID: 37860218 PMCID: PMC10582318 DOI: 10.1016/j.gloepi.2023.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
Background Incidence rates of thyroid cancer have increased. Recent studies findings suggest that women who underwent a hysterectomy have an elevated relative risk of thyroid cancer. The aim of our meta-analysis is to summarize the evidence about the association between hysterectomy and thyroid cancer risk. Methods PubMed, Web of Science, and Scopus database were searched for studies published up to 5 September 2023. The PRISMA statement was followed. Heterogeneity was explored with Q statistic and the I2 statistic. Publication bias was assessed with Begg's and Egger's tests. Results Sixteen studies met the criteria. The pooled analysis showed a significantly 64% increment of thyroid cancer risk in association with any hysterectomy (OR 1.64, 95% CI 1.48-1.81; I2 = 28.68%, p = 0.156). Hysterectomy without oophorectomy was a stronger predictor of risk than hysterectomy with oophorectomy. The pooled analysis of data regarding hysterectomy without oophorectomy showed a statistically significant increment of thyroid cancer risk by 59%. Hysterectomy with oophorectomy was associated with an increase of thyroid cancer risk of 39% (OR 1.39, 95% CI 1.16-1.67; I2 = 42.10%, p = 0.049). Significant publication bias was not detected. Conclusions Our findings help with decision making around these surgeries.
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Affiliation(s)
- Roberto Fabiani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia 06122, Italy
| | - Patrizia Rosignoli
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia 06122, Italy
| | - Irene Giacchetta
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia 06132, Italy
| | - Manuela Chiavarini
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, 60121 Ancona, Italy
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Primieri C, Chiavarini M, Giacchetta I, de Waure C, Bietta C. COVID-19 Vaccination Actual Uptake and Potential Inequalities Due to Socio-Demographic Characteristics: A Population-Based Study in the Umbria Region, Italy. Vaccines (Basel) 2023; 11:1351. [PMID: 37631919 PMCID: PMC10458483 DOI: 10.3390/vaccines11081351] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023] Open
Abstract
Socio-demographic factors are responsible for health inequalities also in vaccination. The aim of this study was to evaluate their role at the population level through a population-based study performed on the whole population entitled to receive COVID-19 vaccines in the Umbria Region, Italy, and registered to the Regional Healthcare Service as of 28 February 2021. Socio-demographic characteristics and vaccination status in terms of uptake of at least one dose of any available vaccine, completion of the primary vaccination cycle and uptake of the booster doses as of 28 February 2022 were collected from the Umbria regional database. The percentage of eligible population who did not initiate the COVID-19 vaccination, complete the full vaccination cycle and get the booster dose was 11.8%, 1.2% and 21.5%, respectively. A younger age, being a non-Italian citizen, and not holding an exemption for chronic disease/disability and a GP/FP were associated with all the endpoints. Females, as compared to males, were more likely to not initiate the vaccination but less likely to not receive the booster dose. On the contrary, the findings did not show a significant association between the deprivation index and the vaccine uptake. The findings, beyond confirming current knowledge at the population level, provide new inputs for better tailoring vaccination campaigns.
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Affiliation(s)
- Chiara Primieri
- Local Health Unit 1 of Umbria, Prevention Department, Epidemiology Service, 06126 Perugia, Italy; (C.P.); (C.B.)
| | - Manuela Chiavarini
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, 60121 Ancona, Italy;
| | - Irene Giacchetta
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | - Carla Bietta
- Local Health Unit 1 of Umbria, Prevention Department, Epidemiology Service, 06126 Perugia, Italy; (C.P.); (C.B.)
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Chiavarini M, De Socio B, Giacchetta I, Fabiani R. Overweight and Obesity in Adult Birth by Cesarean Section: A Systematic Review With Meta-analysis. J Public Health Manag Pract 2023; 29:128-141. [PMID: 36715592 DOI: 10.1097/phh.0000000000001687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CONTEXT Overweight/obesity is one of the most important health problems. Birth by cesarean section has been shown to influence long-term health outcomes including obesity. OBJECTIVE The aim of this systematic review-meta-analysis is to update acknowledgment of the increased risk of cesarean section on offspring's overweight/obesity. METHODS This study follows the PRISMA guidelines. A systematic literature search was conducted on Scopus, PubMed, and Web of Science; we have selected all the articles published until January 2, 2022. For inclusion, studies must have reported either (i) both birth by cesarean section and adult (≥18 years) offspring's body mass index; (ii) cohort or case-control study design; and (iii) a risk estimate. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by the Egger test and the Begg test. Meta-analysis was performed through a random-effects model. RESULTS Twelve studies with a combined population of 180 065 subjects were included in the meta-analysis. The overall analysis (N = 19) yielded a combined risk estimate for overweight/obesity of 1.19 (95% CI, 1.08-1.30) and the test of heterogeneity resulted into Q = 57.44 ( I2 = 68.67%, P ≤ .001). The risk of offspring obesity is 1.23 (95% CI, 1.09-1.39) and the test of heterogeneity resulted into Q = 39.55 ( I2 = 69.66%, P ≤ .001). Children born by cesarean section have an increased risk of obesity in adulthood.
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Affiliation(s)
- Manuela Chiavarini
- Department of Medicine and Surgery, Section of Public Heath (Dr Chiavarini), Nursing and Midwifery Science (Ms De Socio), Department of Chemistry, Biology and Biotechnology (Dr Fabiani), and Department of Medicine and Surgery, Section of Public Heath, School of Hygiene and Preventive Medicine (Dr Giacchetta), University of Perugia, Perugia, Italy
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Primieri C, Bietta C, Giacchetta I, Chiavarini M, de Waure C. Determinants of COVID-19 vaccination acceptance or hesitancy in Italy: an overview of the current evidence. Ann Ist Super Sanita 2023; 59:10-25. [PMID: 36974700 DOI: 10.4415/ann_23_01_03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Vaccine hesitancy is a major public health issue and a challenge for the implementation of COVID-19 immunization campaigns. The objective of this study was to address the determinants of COVID-19 vaccination acceptance or hesitancy in the Italian population. MATERIALS AND METHODS We conducted a rapid systematic review by searching PubMed until May 3rd, 2022, according to Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Articles assessing determinants of Italians' attitudes towards COVID-19 vaccination in terms of hesitancy and/or acceptance were considered eligible. Quality and risk of bias assessment was performed through the Newcastle Ottawa Scale appraisal tool. Determinants were grouped in three categories: contextual, individual and group, and vaccine/vaccination specific influences. RESULTS Out of 606 articles, 59 studies were included in the analysis. Included studies demonstrated that, in Italy, COVID-19 vaccination acceptance or hesitancy is mostly influenced by perceived safety, efficacy and usefulness of the vaccine. CONCLUSION These findings should be considered to plan tailored interventions for counteracting COVID-19 vaccination hesitancy in Italy.
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Affiliation(s)
- Chiara Primieri
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università of Perugia, Perugia, Italy
| | - Carla Bietta
- Azienza USL Umbria 1, Dipartimenti di Prevenzione, Servizio di Epidemiologia, Perugia, Italy
| | - Irene Giacchetta
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università of Perugia, Perugia, Italy
| | - Manuela Chiavarini
- Dipartimenti di Medicina e Chirurgia, Sezione di Sanità Pubblica, Università di Perugia, Perugia, Italy
| | - Chiara de Waure
- Dipartimenti di Medicina e Chirurgia, Sezione di Sanità Pubblica, Università di Perugia, Perugia, Italy
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Calabrò GE, Boccalini S, Bechini A, Panatto D, Domnich A, Lai PL, Amicizia D, Rizzo C, Pugliese A, DI Pietro ML, Zanella B, Parente F, Trombetta CS, Saraceno G, Sottile S, Abreha FM, Giacchetta I, Properzi S, Santolini G, D'Ambrosio F, Maida A, Scardigno A, LA Gatta E, Petrella L, Bonanni P, DE Waure C. [Health Technology Assessment: a value-based tool for the evaluation of healthcare technologies. Reassessment of the cell-culture-derived quadrivalent influenza vaccine: Flucelvax Tetra ® 2.0]. J Prev Med Hyg 2022; 63:E1-E140. [PMID: 37034835 PMCID: PMC10079375 DOI: 10.15167/2421-4248/jpmh2022.63.4s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Giovanna Elisa Calabrò
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
- VIHTALI (Value In Health Technology and Academy for Leadership & Innovation), Spin-off dell'Università Cattolica del Sacro Cuore, Roma, Italia
| | - Sara Boccalini
- Dipartimento di Scienze della Salute, Università degli di Studi di Firenze, Firenze, Italia
| | - Angela Bechini
- Dipartimento di Scienze della Salute, Università degli di Studi di Firenze, Firenze, Italia
| | - Donatella Panatto
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
- Centro Interuniversitario di Ricerca sull'Influenza e le altre Infezioni Trasmissibili (CIRI-IT), Genova, Italia
| | | | - Piero Luigi Lai
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
- Centro Interuniversitario di Ricerca sull'Influenza e le altre Infezioni Trasmissibili (CIRI-IT), Genova, Italia
| | - Daniela Amicizia
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
- Centro Interuniversitario di Ricerca sull'Influenza e le altre Infezioni Trasmissibili (CIRI-IT), Genova, Italia
| | - Caterina Rizzo
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italia
| | - Andrea Pugliese
- Dipartimento di Matematica, Università di Trento, Trento, Italia
| | - Maria Luisa DI Pietro
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Beatrice Zanella
- Dipartimento di Scienze della Salute, Università degli di Studi di Firenze, Firenze, Italia
| | - Flavio Parente
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
| | | | | | - Sara Sottile
- Dipartimento di Matematica, Università di Trento, Trento, Italia
| | - Fasika Molla Abreha
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Irene Giacchetta
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italia
| | - Sara Properzi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italia
| | - Giulia Santolini
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italia
| | - Floriana D'Ambrosio
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Ada Maida
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Anna Scardigno
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Emanuele LA Gatta
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Luigi Petrella
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Paolo Bonanni
- Dipartimento di Scienze della Salute, Università degli di Studi di Firenze, Firenze, Italia
| | - Chiara DE Waure
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italia
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Chiavarini M, Naldini G, Giacchetta I, Fabiani R. Exogenous Hormone Factors in Relation to the Risk of Malignant Melanoma in Women: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14133192. [PMID: 35804961 PMCID: PMC9264834 DOI: 10.3390/cancers14133192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
The influence of exogenous female hormones on the risk of developing malignant melanoma in women remains controversial. The aim of our review and meta-analysis is to summarize the evidence and derive a more accurate estimation of the association between oral contraceptives (OCs) or menopausal hormone therapy (MHT) and the risk of developing malignant melanoma in women. PubMed, Web of Science, and Scopus database were searched for studies published up until October 2021. The PRISMA statement and MOOSE guidelines were followed. Studies were pooled using a random effects model. Heterogeneity was explored with the chi-square-based Cochran’s Q statistic and the I2 statistic. Publication bias was assessed with Begg’s test and Egger’s test. Forty-six studies met the eligibility criteria. The pooled analysis (26 studies) on OC use and the risk of developing cutaneous malignant melanoma (CMM) showed no significant association, but demonstrated significant association for cohort studies (OR 1.08, 95% CI 1.01–1.16; I2 = 0.00%, p = 0.544). The pooled analysis (16 studies) showed a significantly increased risk of CMM in association with MHT (OR 1.15, 95% CI 1.08–1.23; I2 = 25.32%, p = 0.169). Stratifying the results by study design showed that a significant increased risk of CMM was associated with MHT in the cohort studies (OR 1.12; 95% CI 1.04–1.19; I2 = 0%, p = 0.467). No significant publication bias could be detected. Further studies are needed to investigate the potential association with formulation, duration of use, and dosage of use, and to better understand the role of possible confounders.
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Affiliation(s)
- Manuela Chiavarini
- Department of Experimental Medicine, Section of Public Heath, University of Perugia, 06129 Perugia, Italy;
| | - Giulia Naldini
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, 06129 Perugia, Italy;
| | - Irene Giacchetta
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, 06129 Perugia, Italy;
- Correspondence:
| | - Roberto Fabiani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, 06129 Perugia, Italy;
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Chiavarini M, De Socio B, Giacchetta I, Fabiani R. Caesarean section and offspring overweight and obesity in adult life. Obes Rev 2022; 23:e13421. [PMID: 35040552 DOI: 10.1111/obr.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/29/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Manuela Chiavarini
- Department of Medicine and Surgery, Section of Public Heath, University of Perugia, Perugia, Italy
| | - Benedetta De Socio
- Degree in Nursing and Midwifery science, University of Perugia, Perugia, Italy
| | - Irene Giacchetta
- Department of Medicine and Surgery, Section of Public Heath, School of Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
| | - Roberto Fabiani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
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Calabrò GE, Boccalini S, Panatto D, Rizzo C, Di Pietro ML, Abreha FM, Ajelli M, Amicizia D, Bechini A, Giacchetta I, Lai PL, Merler S, Primieri C, Trentini F, Violi S, Bonanni P, de Waure C. The New Quadrivalent Adjuvanted Influenza Vaccine for the Italian Elderly: A Health Technology Assessment. Int J Environ Res Public Health 2022; 19:ijerph19074166. [PMID: 35409848 PMCID: PMC8998177 DOI: 10.3390/ijerph19074166] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/15/2022]
Abstract
Background. The elderly, commonly defined as subjects aged ≥65 years, are among the at-risk subjects recommended for annual influenza vaccination in European countries. Currently, two new vaccines are available for this population: the MF59-adjuvanted quadrivalent influenza vaccine (aQIV) and the high-dose quadrivalent influenza vaccine (hdQIV). Their multidimensional assessment might maximize the results in terms of achievable health benefits. Therefore, we carried out a Health Technology Assessment (HTA) of the aQIV by adopting a multidisciplinary policy-oriented approach to evaluate clinical, economic, organizational, and ethical implications for the Italian elderly. Methods. A HTA was conducted in 2020 to analyze influenza burden; characteristics, efficacy, and safety of aQIV and other available vaccines for the elderly; cost-effectiveness of aQIV; and related organizational and ethical implications. Comprehensive literature reviews/analyses were performed, and a transmission model was developed in order to address the above issues. Results. In Italy, the influenza burden on the elderly is high and from 77.7% to 96.1% of influenza-related deaths occur in the elderly. All available vaccines are effective and safe; however, aQIV, such as the adjuvanted trivalent influenza vaccine (aTIV), has proved more immunogenic and effective in the elderly. From the third payer’s perspective, but also from the societal one, the use of aQIV in comparison with egg-based standard QIV (eQIV) in the elderly population is cost-effective. The appropriateness of the use of available vaccines as well as citizens’ knowledge and attitudes remain a challenge for a successful vaccination campaign. Conclusions. The results of this project provide decision-makers with important evidence on the aQIV and support with scientific evidence on the appropriate use of vaccines in the elderly.
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Affiliation(s)
- Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, 50121 Florence, Italy; (S.B.); (A.B.); (P.B.)
| | - Donatella Panatto
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (D.P.); (D.A.); (P.L.L.)
| | - Caterina Rizzo
- Clinical Pathways and Epidemiology Unit-Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Maria Luisa Di Pietro
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Fasika Molla Abreha
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Marco Ajelli
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN 47405, USA;
| | - Daniela Amicizia
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (D.P.); (D.A.); (P.L.L.)
| | - Angela Bechini
- Department of Health Sciences, University of Florence, 50121 Florence, Italy; (S.B.); (A.B.); (P.B.)
| | - Irene Giacchetta
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (I.G.); (C.P.); (S.V.); (C.d.W.)
| | - Piero Luigi Lai
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (D.P.); (D.A.); (P.L.L.)
| | - Stefano Merler
- Center for Health Emergencies, Bruno Kessler Foundation, 38122 Trento, Italy; (S.M.); (F.T.)
| | - Chiara Primieri
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (I.G.); (C.P.); (S.V.); (C.d.W.)
| | - Filippo Trentini
- Center for Health Emergencies, Bruno Kessler Foundation, 38122 Trento, Italy; (S.M.); (F.T.)
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, 20136 Milan, Italy
| | - Sara Violi
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (I.G.); (C.P.); (S.V.); (C.d.W.)
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, 50121 Florence, Italy; (S.B.); (A.B.); (P.B.)
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (I.G.); (C.P.); (S.V.); (C.d.W.)
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11
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Calabro' GE, Carini E, Tognetto A, Giacchetta I, Bonanno E, Mariani M, Ricciardi W, de Waure C. The Value(s) of Vaccination: Building the Scientific Evidence According to a Value-Based Healthcare Approach. Front Public Health 2022; 10:786662. [PMID: 35359753 PMCID: PMC8963736 DOI: 10.3389/fpubh.2022.786662] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/31/2022] [Indexed: 02/04/2023] Open
Abstract
ObjectivesTo provide a new value-based immunization approach collating the available scientific evidence on the topic.MethodsFour value pillars (personal, allocative, technical, and societal) applied to vaccination field were investigated. A systematic literature review was performed querying three database from December 24th, 2010 to May 27th, 2020. It included studies on vaccine-preventable diseases (VPDs) that mentioned the term value in any part and which were conducted in advanced economies. An in-depth analysis was performed on studies addressing value as key element.ResultsOverall, 107 studies were considered. Approximately half of the studies addressed value as a key element but in most of cases (83.3%) only a single pillar was assessed. Furthermore, the majority of papers addressed the technical value by looking only at classical methods for economic assessment of vaccinations whereas very few dealt with societal and allocative pillars.ConclusionsEstimating the vaccinations value is very complex, even though their usefulness is certain. The assessment of the whole value of vaccines and vaccinations is still limited to some domains and should encompass the wider impact on economic growth and societies.
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Affiliation(s)
- Giovanna Elisa Calabro'
- Section of Hygiene, University Department of Life Sciences and Public Health; Catholic University of the Sacred Heart, Rome, Italy
- VIHTALI (Value In Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elettra Carini
- Section of Hygiene, University Department of Life Sciences and Public Health; Catholic University of the Sacred Heart, Rome, Italy
- *Correspondence: Elettra Carini
| | | | - Irene Giacchetta
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ester Bonanno
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marco Mariani
- Section of Hygiene, University Department of Life Sciences and Public Health; Catholic University of the Sacred Heart, Rome, Italy
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health; Catholic University of the Sacred Heart, Rome, Italy
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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12
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Chiavarini M, Naldini G, Giacchetta I, Fabiani R. Effect of Exogenous Hormones and Reproductive Factors in Female Melanoma: A Meta-Analysis [Letter]. Clin Epidemiol 2022; 14:211-212. [PMID: 35228819 PMCID: PMC8882010 DOI: 10.2147/clep.s356205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/09/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Manuela Chiavarini
- Department of Medicine and Surgery, Section of Public Health, University of Perugia, Perugia, Italy
| | - Giulia Naldini
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
| | - Irene Giacchetta
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
- Correspondence: Irene Giacchetta, University of Perugia, Tel +39 3515225514, Email ;
| | - Roberto Fabiani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
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13
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Chiavarini M, Naldini G, Giacchetta I, Fabiani R. Postmenopausal exogenous hormone therapy and Melanoma risk in women: A systematic review and time-response meta-analysis. Pharmacol Res 2022; 176:106054. [PMID: 34979234 DOI: 10.1016/j.phrs.2021.106054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Manuela Chiavarini
- Department of Experimental Medicine, Section of Public Heath, University of Perugia, Perugia, Italy.
| | - Giulia Naldini
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy.
| | - Irene Giacchetta
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy.
| | - Roberto Fabiani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy.
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14
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Giacchetta I, Primieri C, Cavalieri R, Domnich A, de Waure C. The burden of seasonal influenza in Italy: A systematic review of influenza-related complications, hospitalizations, and mortality. Influenza Other Respir Viruses 2021; 16:351-365. [PMID: 34704361 PMCID: PMC8818820 DOI: 10.1111/irv.12925] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 12/13/2022] Open
Abstract
Reliable country‐specific data on influenza burden play a crucial role in informing prevention and control measures. Our purpose was to provide a comprehensive summary of the available evidence on the burden of seasonal influenza in Italy. We performed a systematic literature review of articles published until July 31, 2020. PubMed, Embase, and Web of Science were searched using terms related to burden, influenza, and Italian population. We included studies investigating seasonal influenza‐related complications, hospitalizations, and/or mortality. Sixteen studies were included: eight (50%) analyzed influenza‐related complications, eight (50%) hospitalizations, and seven (43.8%) influenza‐related deaths. Only three studies (19.7%) concerned pediatric age. The synthesis of results showed that patients with chronic conditions have an increased risk for complications up to almost three times as compared with healthy people. Hospitalizations due to influenza can occur in as much as 5% of infected people depending on the study setting. Excess deaths rates were over sixfold higher in the elderly as compared with the rest of population. Although there are still gaps in existing data, there is evidence of the significant burden that influenza places each year especially on high‐risk groups. These data should be used to inform public health decision‐making.
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Affiliation(s)
- Irene Giacchetta
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Chiara Primieri
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Riccardo Cavalieri
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alexander Domnich
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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15
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Giacchetta I, Primieri C, Cavalieri R, Domnich A, de Waure C. The burden of seasonal influenza-associated complications in Italy: a systematic review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Influenza is the infectious disease with the highest impact on population health in the European Union in terms of disability-adjusted life years. Reliable country-specific influenza-associated burden estimates play a crucial role in informing prevention and control measures to minimize the health and economic burden of the disease. Our purpose was to provide a comprehensive summary of available scientific literature on the burden of seasonal influenza on the Italian population.
Methods
We performed a systematic literature review of articles published until 31 July 2020. PubMed, Embase and Web of Science were searched. The search strategy included a combination of search terms related to burden, influenza and Italian population. We included studies investigating seasonal influenza-related complications and/or mortality in Italy. A meta-analysis of data was not pre-planned because of the expected heterogeneity in study populations and outcomes.
Results
A total of 16 studies were included in the qualitative synthesis, out of an original yield of 9,268 articles. Ten (62.5%) and 8 (50%) studies analyzed influenza-related complications and hospitalizations, respectively, while 8 (50%) assessed influenza-related deaths. Only 3 studies (19.7%) concerned pediatric age. The synthesis of results showed that patients with chronic conditions might have an increased risk for complications up to almost 3 times as compared to healthy people. Hospitalization due to influenza can occur from less than 1% to more than 5% according to the study setting (general practice or emergency room). Excess deaths rates were estimated to be over 6-fold higher for the elderly than for the rest of population.
Conclusions
Although there are still gaps in existing data, there is evidence of the significant burden that influenza places each year especially on high-risk groups. Summaries of the available data may inform decision-making in regard to vaccine strategies and public health policies.
Key messages
Existing data show evidence of significant burden of influenza on Italian population, especially on high-risk groups. Summaries of country-specific influenza-related burden are crucial in informing vaccine strategies.
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Affiliation(s)
- I Giacchetta
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - C Primieri
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - R Cavalieri
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - A Domnich
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - C de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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16
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de Waure C, Calabrò GE, Tognetto A, Carini E, Giacchetta I, Bonanno E, Mariani M, Ricciardi W, de Waure C. Evidence and recommendations for a value-based decision making on vaccinations. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue/problem
Vaccinations are one of the most successful public health measures and contribute to the achievement of Sustainable Development Goals. Despite this, there are still several challenges, such as poor resources, unequal access, and vaccine hesitancy. An exploitation of the full value of vaccinations could help contrasting them.
Description of the problem
A dual approach was followed to exploit full value of vaccinations. First, the four pillars of value pinpointed by the Expert Panel on Effective Ways of Investing in Health of the European Commission, namely personal, societal, allocative, and technical value, were considered to carry out a systematic review of available papers addressing the value of vaccinations. The synthesis of data was the submitted to a panel of international experts in vaccinations who gave inputs on recommendations to drive a value-based decision-making.
Results
Overall, 54 papers published from 2010 onwards addressed at least one pillar of value with most of them (83.3%) assessing a single one. Two-thirds of papers addressed the technical pillar, namely the economic value, in most cases without catching the broad economic implications. Very few studies addressed allocative and societal value highlighting the need to generate evidence to support the application of these pillars. Furthermore, some aspects of the allocative pillar, such as equity, accessibility, and appropriate use, were not addressed so far. Recommendations on research on full value of vaccinations, decision-making process and public engagement were eventually issued.
Lessons
The project allowed to apply for the first the value-based approach to vaccinations. This led to the identification of current gaps in the assessment of full value of vaccinations and to recommendations to foster a value-based decision-making. These results have international relevance because of the growing attention to the value-based approach for sustainable health systems.
Key messages
The full value of vaccinations need to be further investigated according to the four pillars pinpointed by the Expert Panel on Effective Ways of Investing in Health. Different actions could be promoted with respect to research, decision-making process and public engagement in order to exploit the full value of vaccination and drive a value-based decision-making.
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Affiliation(s)
- C de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - GE Calabrò
- Section of Hygiene, University Department of Life Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- VIHTALI, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Tognetto
- Section of Hygiene, University Department of Life Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Carini
- Section of Hygiene, University Department of Life Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Giacchetta
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - E Bonanno
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - M Mariani
- Section of Hygiene, University Department of Life Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - W Ricciardi
- Section of Hygiene, University Department of Life Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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17
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Rossi G, Giambra V, de Waure C, Giacchetta I, Minervini MM, Abbenante MC, Spadano R, La Torre A, Scalzulli PR, Cascavilla N. Log reduction of leukemic cells and minimal residual disease by flow cytometry represent effective predictors of clinical outcome in elderly patients with acute myeloid leukemia. Cytometry B Clin Cytom 2021; 102:26-33. [PMID: 33983682 DOI: 10.1002/cyto.b.22010] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Nowadays minimal residual disease (MRD) and log-reduction of leukemic cells are poorly investigated in elderly patients with acute myeloid leukemia (AML) treated with hypometilating agents (HMAs). Studies focusing on MRD in elderly AML patients who received HMAs are scant and devoid of rigorous criteria for both enrollment and monitoring. Log-reduction has never been investigated in these patients. Thus, the purpose of our study was to compare the prognostic impact of MRD and log-reduction of leukemic cells at the optimal time of assessment in older AML patients. METHODS Elderly patients who completed at least six cycles of HMAs and showed suitable leukemia-associated immunophenotypes (LAIPs) for the MRD and log-reduction assessment by flow cytometry were enrolled in the study. RESULTS After comparing the times of assessment C4 (4-cycles) and C6 (6-cycles), C6 has been chosen as optimal. Patients who achieved MRD negativity or 2-log-reduction of leukemic cells at C6 had a significantly longer DFS. Particularly, results of 2-log-reduction were confirmed a multivariate analysis. Patients with MRD negativity or 2-log reduction of leukemic cells showed an improvement of their OS, although not significantly. CONCLUSIONS Our data confirmed the predictive role of MRD and 2-log reduction also in older AML patients treated with HMAs.
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Affiliation(s)
- Giovanni Rossi
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Vincenzo Giambra
- Institute of Stem Cells Biology, Regenerative Medicine and Innovative Therapies (ISBReMIT), Fondazione IRCCS "Casa Sollievo della Sofferenza-IRCCS", San Giovanni Rotondo, Italy
| | - Chiara de Waure
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Irene Giacchetta
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Maria Marta Minervini
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Maria Chiara Abbenante
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | | | - Antonella La Torre
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Potito Rosario Scalzulli
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Nicola Cascavilla
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
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18
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Naldini G, Chiavarini M, Giacchetta I, Fabiani R. Association between menopausal hormone therapy and melanoma: a systematic review and meta-analysis. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Age-specific incidence rates of cutaneous Malignant Melanoma (MM) are higher in women during their reproductive years, while the rate of increase slows after menopause, supporting the speculation that hormones might influence the risk of developing cutaneous MM. The aim of our systematic review and meta-analysis is to summarize the evidence on the association between Menopausal Hormone Therapy (MHT) and the risk of MM.
Methods
Medline and Web of Science were systematically searched for eligible publications until December 2019. Our review and meta-analysis follow the PRISMA guidelines. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by Egger's test and Begg's test. Meta-analysis was performed using a random effect model.
Results
The pooled analysis of all 19 studies (9 cohort and 10 case-control) showed a significant positive association of MHT with risk of MM (OR 1.19; 95% CI 1.13-1.26; I2=41.93%, p = 0.029). Excluding Uveal and intraocular MM (3 studies), MHT increased the risk of cutaneous MM (OR 1.19; 95% CI 1.13-1.26; I2=35.73%, p = 0.077). No significant publication bias could be detected. Stratifying by study design, MHT significantly increased the risk of cutaneous MM (OR 1.19; 95% CI 1.12-1.27; I2=42.52%, p = 0.107) in the cohort studies; no significant association was found in case-control studies.
Conclusions
This meta-analysis of available literature resulted in an increased risk of MM in women used MHT. Further investigations are necessary to increase the reliability of the results and estimate the relationship of other characteristics of MHT, such as type (opposed and unopposed estrogens) and route of administration, with MM.
Key messages
Menopausal Hormone Therapy (MHT) significantly increases the risk of Malignant Melanoma (MM). Further awareness of clinical practitioners should be raised on the potential association of MHT with MM.
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Affiliation(s)
- G Naldini
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
| | - M Chiavarini
- Department of Experimental Medicine, Section Public Health, University of Perugia, Perugia, Italy
| | - I Giacchetta
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
| | - R Fabiani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
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de Waure C, Giacchetta I, Violi S, Martini C, Favaretti C. The application of Health Technology Assessment to health apps: what is the evidence? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In the last years, many health apps have been developed to support citizens' and patients' health management. Nevertheless, a thorough evaluation is necessary to support the decision to incorporate them into healthcare systems. Health technology assessment (HTA) could be considered a valid evaluation tool allowing considering different stakeholders' perspectives. This research aimed to look for studies that applied HTA to health apps and to analyze feasibility and limits of HTA in this field.
Methods
A systematic review was performed considering three databases, namely PubMed, Web of Science (WoS) and University of York-Centre for Reviews and Dissemination database. Being the topic of health app assessment new, articles were considered eligible if they assessed at least two of the domains of the HTA core model suggested by the European network for Health Technology Assessment (EUnetHTA). Furthermore, only articles published in English in the last 5 years were considered.
Results
A total of 850 articles were found: 383 articles from PubMed, 462 from WoS and 5 from York. After removing duplicates, 708 articles remained and 43 were eventually included after the screening process. Seven articles were focused on apps used by healthcare professionals, while 36 dealt with apps aimed to support patients. None of the papers explicitly mentioned HTA as assessment tool. Indeed, not all the domains of the HTA core model were assessed in any article. Apps' technical description, clinical effectiveness and social aspects were the domains considered more often. On the contrary, costs and economic evaluation was clearly faced by one article only.
Conclusions
Even though the scientific literature on health apps is growing, the adoption of standardized methods for their evaluation, such as HTA, is still scant. This might be due to peculiarities of health apps and points out the importance of adapting existing methods in order to let a thorough assessment possible.
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Affiliation(s)
- C de Waure
- Deaprtment of Experimental Medicine, University of Perugia, Perugia, Italy
| | - I Giacchetta
- Deaprtment of Experimental Medicine, University of Perugia, Perugia, Italy
| | - S Violi
- Deaprtment of Experimental Medicine, University of Perugia, Perugia, Italy
| | - C Martini
- Deaprtment of Experimental Medicine, University of Perugia, Perugia, Italy
| | - C Favaretti
- Section of Hygiene, Institute of Public Health, Catholic University of the Sacred Heart, Rome, Italy
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20
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Giacchetta I, Chiavarini M, Naldini G, Fabiani R. Association between Oral Contraceptives and cutaneous melanoma: a systematic review and metanalysis. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The probability of developing invasive cutaneous malignant melanoma (CMM) is higher in women than in men up until the age of 49. Several studies investigated the association between hormonal factors and CMM. The aim of this systematic review and meta-analysis is to summarize the evidence on the association between Oral Contraceptives (OC) and the risk of CMM.
Methods
This review and meta-analysis follow the PRISMA guidelines. A systematic literature search was conducted on Medline and Web of Science until December 2019. Studies were eligible if reported a risk estimate for the association between OC and CMM. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by Egger's test and Begg's test. Meta-analysis was performed using random effect model.
Results
The results of the pooled analysis of all 32 studies showed no significant association between OC and the risk of CMM (OR 1.02; 95% CI 0.94-1.11; I2=39.32%, p = 0.013). The stratified analyses by study design found no significant association between OC and the risk of CMM neither in the 18 case-control studies (OR 1.02; 95% CI 0.87-1.21; I2=56.91%, p = 0.002) nor in the 14 cohort studies (OR 1.04; 95% CI 0.98-1.11; I2=0.00%, p = 0.557). No significant publication bias could be detected by Egger's test or Begg's test.
Conclusions
This meta-analysis of available literature suggests no significant association between OC and the risk of developing CMM. Further investigations are needed to evaluate the possible relationship of OC use and other hormonal factors potentially contributing to the increased risk of CMM in women during their reproductive years.
Key messages
Oral contraceptives (OC) do not significantly contribute to the risk of Cutaneous Malignant Melanoma (CMM). Further studies are needed to investigate the potential role of other hormonal factors in the increased probability of developing CMM in women during their reproductive years.
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Affiliation(s)
- I Giacchetta
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
| | - M Chiavarini
- Department of Experimental Medicine, Section Public Health, University of Perugia, Perugia, Italy
| | - G Naldini
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
| | - R Fabiani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
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Rossi G, Giambra V, Minervini MM, de Waure C, Giacchetta I, la Torre A, Ciavarella M, Melillo LM, Scalzulli PR, Carella AM, Cascavilla N. Clearance of leukemic blasts by flow cytometry versus minimal residual disease as predictors of clinical outcome in elderly patients with acute myeloid leukemia. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19514 Background: Lower-intensity regimens, such as hypomethylating agents (HMAs) are better tolerated and more effective than standard chemotherapy in elderly patients( > 65 years old) with acute myeloid leukemia (AML). Scoring systems to predict clinical outcome in these patients are mainly based on cytogenetic assays and morphological response to therapy. Minimal residual disease (MRD) represents a powerful risk- stratification in younger AML patients but it remains poorly investigated in older patients, particularly in those undergone HMAs. In this subset, the survival benefit is not limited to patients achieving morphologic complete remission (CR). The clearance of leukemic blasts was never be valued as a predictive parameter of outcome in older patients. Thus, in this study we evaluated the most effective and predictive factor of outcome at the optimal time-point among leukemic blasts clearance by flow cytometry (FC), MRD and morphological response in older patients treated with HMAs. Methods: From april 2015 to may 2019, 76 older patients ( > 60 years old) with newly diagnosed AML were treated con azacitidine and decitabine. Among them, 56 completed at least six cycles but 31were properly monitored by FC. Log Clearance was defined as logarithmic ratio between the percentage of blast cells at specific time point and that at the diagnosis. Results: A total of 31 elderly patients with a median age 72 (60-85) were evaluated after 4(T4) and 6(T6) cycles of HMAs. A Median of 10 cycles were administered, equally distributed between azacitidine and decitabine. A higher frequency of CR (73.3%vs 20%) and MRD negativity (16.6% vs 0) was found at T6 compared to T4, thus T6 was chosen for the analysis. Performance status (PS > 2),Hgb < 10 g/dl, MRD positivity and a Log-reduction lower than 2 log predicted a significantly shorter DFS at univariate analysis. However, Log-reduction and PS only confirmed to predict a short DFS also at multivariate analysis, together with CRi (CR with incomplete recovery) and partial remission (PR). When the OS was investigated, only PS represented a strong indicator of prognosis at both univariate and multivariate analysis. Conclusions: Our results suggest that patients achieving 2 Log at least of blasts-reduction by FC had a longer DFS. Dynamic monitoring of blast –reduction stratified better and more widely than the absolute value of MRD in older AML patients. Having a high PS and achieving a CRi instead of a CR showed an unfavorable outcome in terms of both DFS and OS
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Affiliation(s)
- Giovanni Rossi
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo (FG), Italy
| | - Vincenzo Giambra
- Institute of Stem Cells Biology, Regenerative Medicine and Innovative Therapies (ISBReMIT), Fondazione IRCCS "Casa Sollievo della Sofferenza-IRCCS", San Giovanni Rotondo (FG), Italy
| | - Maria Marta Minervini
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italy
| | - Chiara de Waure
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Irene Giacchetta
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Antonella la Torre
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italy
| | - Michele Ciavarella
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italy
| | | | - Potito Rosario Scalzulli
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italy
| | - Angelo Michele Carella
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italy
| | - Nicola Cascavilla
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italy
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