Trend of change of sperm count and concentration over the last two decades: A systematic review and meta-regression analysis

BACKGROUND

Since the 1970s, several studies found that sperm concentration (SC) and total sperm count (TSC) constantly worsened over time, mainly in high-income countries.

OBJECTIVES

To evaluate whether the decreasing trend in sperm count is continuing in Western European countries and USA, we performed a systematic review and meta-regression analysis.

MATERIALS AND METHODS

Embase and Pubmed/Medline were searched papers published in English in the 2000-2020 period limiting the search to data collected in the USA and Western European countries.

RESULTS

We identified 62 articles and pooled information on 24,196 men (range 10-2,523), collected from 1993 to 2018. Considering all the studies, random-effects meta-regression analyses showed no significant trend for SC (slope per year -0.07 mil/mL, p-value = 0.86). Negative trends of SC were detected in Scandinavian countries (slope per year -1.11 mil/mL, 95% CI: -2.40 to +0.19; p-value = 0.09), but the findings were statistically not significant. No significant trends of SC were detected in Central Europe (slope per year +0.23, 95% CI -2.51 to +2.96; p-value = 0.87), the USA (slope per year +1.08, 95% CI -0.42 to +2.57; p-value = 0.16), and Southern Europe (slope per year +0.19, 95% CI -0.99 to +1.37; p-value = 0.75). We have analyzed separately findings from studies including sperm donors, fertile men, young unselected men (unselected men, study mean age < 25 years) and unselected men (unselected men, study mean age ≥ 25 years). No significant trends of SC were observed among sperm donors (slope per year -2.80, 95% CI -6.76 to +1.17; p-value 0.16), unselected men (slope per year -0.23, 95% CI -1.58 to +1.12; p-value 0.73), young unselected men (slope per year -0.49, 95% CI -1.76 to +0.79; p-value 0.45), fertile men (slope per year +0.29, 95% CI -1.09 to +1.67; p-value 0.68).

DISCUSSION AND CONCLUSION

The results of this analysis show no significant trends in SC, in USA, and selected Western European countries.

A systematic review on maternal and perinatal factors influencing breast development

BACKGROUND

A secular trend towards earlier age at menarche has been reported, but the trend in breast development is less clear. We reviewed the evidence on the relationship between in utero and early life events and breast onset/development.

METHODS

Eligible studies were identified in PubMed and Embase databases. We selected studies in which female human exposure during fetal or the first years of life was measured or estimated, and associations with breast onset or development were evaluated.

RESULTS

Of the 49 cohort studies and 5 cross-sectional studies identified, 43 provided sufficient data to assess associations. High maternal weight, primiparity, and early weight gain, were related to an increased risk of early breast onset/development in most of the studies that analysed these associations, whereas late breast onset/development was associated with preterm birth. Results were inconsistent for smoking in pregnancy, maternal hypertensive disorders, breastfeeding, diabetes, and small for gestational age. No association emerged for maternal age at delivery, alcohol drinking, and selected drug use during pregnancy, and low birth weight.

CONCLUSIONS

The results of this review show that high maternal weight, primiparity and early weight gain were associated with an increased risk of early breast onset/development. Late breast onset/development was associated with preterm birth. Breast development is a key physical marker of puberty onset, and early puberty development is linked to consequences that can reverberate throughout life. Answering the questions about the interconnections between pre/postnatal environmental exposures and their impact on puberty, represents an important area of multidisciplinary research.

Cancer mortality and predictions for 2022 in selected Australasian countries, Russia, and Ukraine with a focus on colorectal cancer

OBJECTIVE

We aimed at predicting cancer mortality rates for the current year for the Russian Federation, Ukraine, Israel, Hong Kong SAR, Japan, Korea, and Australia, with a focus on colorectal cancer.

METHODS

We retrieved official death certification and population data from the WHO and the United Nations Population Division databases. We analyzed mortality for all cancers combined and for 10 major cancer sites from 1970 to 2019, or the latest available year. We predicted numbers of deaths and age-standardized mortality rates for 2022 using Poisson joinpoint regression models. We estimated the number of averted deaths over the period 1994-2022 because of the decline in mortality rates.

RESULTS

Total cancer mortality declined in all countries and both sexes. Russia had the highest total cancer predicted rates for 2022: 156.4/100 000 (world standard) in men and 81.4 in women; the lowest rates were reported in Israeli men (90.6/100 000) and Korean women (44.5/100 000). Between 1994 and 2022, a total of 1 487 000 deaths were estimated to be avoided in Russia, 502 000 in Ukraine, 58 000 in Israel, 102 000 in Hong Kong SAR, 1 020 000 in Japan, 533 000 in the Republic of Korea, and 263 000 in Australia. Colorectal cancer mortality trends were downward for the last decades with favorable predictions for 2022 in both sexes.

CONCLUSION

In the countries considered, predicted downward trends started later and were less marked than those in the European Union and the USA. Despite overall favorable predictions, colorectal cancer remains one of the major causes of cancer mortality.

Comorbidity patterns, family history and breast cancer risk: a latent class analysis

BACKGROUND

Limited evidence exists on how the presence of multiple conditions affects breast cancer (BC) risk.

METHODS

We used data from a network hospital-based case-control study conducted in Italy and Switzerland, including 3034 BC cases and 3392 controls. Comorbidity patterns were identified using latent class analysis on a set of specific health conditions/diseases. A multiple logistic regression model was used to derive ORs and the corresponding 95% CIs for BC according to the patterns, adjusting for several covariates. A second model was fitted including an additional effect of FH on the comorbidity patterns.

RESULTS

With respect to the 'healthy' pattern, the 'metabolic disorders' one reported an OR of 1.23 (95% CI 1.02 to 1.49) and the 'breast diseases' an OR of 1.86 (95% CI 1.23 to 2.83). The remaining two patterns reported an inverse association with BC, with ORs of 0.77, significant only for the 'hysterectomy, uterine fibroids and bilateral ovariectomy'. In the second model, FH was associated with an increased risk of the 'breast diseases' pattern (OR=4.09, 95% CI 2.48 to 6.74). Non-significant increased risk of the other patterns according to FH emerged.

CONCLUSION

We identified mutually exclusive patterns of comorbidity, confirming the unfavourable role of those related to metabolic and breast disorders on the risk of BC, and the protective effect of those related to common surgical procedures. FH reported an incremented risk of all the comorbidity patterns.

IMPACT

Identifying clusters of comorbidity in patients with BC may help understand their effects and enable clinicians and policymakers to better organise patient and healthcare management.

Peptic ulcer as mediator of the association between risk of gastric cancer and socioeconomic status, tobacco smoking, alcohol drinking and salt intake

BACKGROUND

Peptic ulcer disease (PUD) and gastric cancer (GC) are more prevalent in individuals with low socioeconomic status (SES) and share several risk factors. The aim of this study was to investigate the mediating role of PUD in the association between established risk factors and GC.

METHODS

We conducted a pooled analysis of 12 studies from the Stomach Cancer Pooling Project Consortium, including a total of 4877 GC cases and 11 808 controls. We explored the mediating role of PUD in the association between SES, tobacco smoking, heavy alcohol drinking and salt intake, and GC. Also, we assessed the ORs and 95% CIs of the risk factors and both PUD and GC.

RESULTS

PUD mediated 36% of the smoking effect mainly among men. Other risk factors were only slightly mediated by PUD (SES, 5.3%; heavy alcohol drinking, 3.3%; and salt intake, 2.5%). No significant difference was found when excluding PUD diagnosed within 2 years from GC.

CONCLUSIONS

Our study provides innovative information on the mechanism of stomach mucosal damage leading to PUD and GC, with respect to the effect of tobacco smoking in particular.

Chronic obstructive pulmonary disease (COPD) mortality trends worldwide: An update to 2019

BACKGROUND AND OBJECTIVE

Chronic obstructive pulmonary disease (COPD) incidence, prevalence, mortality and socioeconomic burden are considerable and vary across countries. The aim of the present study was to update the analysis of COPD mortality worldwide using data from the World Health Organization (WHO) up to 2019.

METHODS

We obtained COPD mortality and population data for 22 European countries and the European Union (EU) as a whole, 10 American countries and six other countries from the WHO mortality database. We calculated age-standardized mortality rates in both sexes and examined trends by country with joinpoint analysis between 1994 and 2019.

RESULTS

Between 2005-2007 and 2015-2017, overall COPD mortality decreased in EU men (-16.3%) but increased in women (12.7%) to reach rates of 14.0/100,000 in men and of 6.4/100,000 in women. In the United States, mortality declined in men to 21.3/100,000 but rose in women to 18.3/100,000. Mortality declined in most Latin American countries and all Asian countries, while an increase in Australian women was observed.

CONCLUSION

A steady decrease in COPD mortality was observed in most of countries for men, whilst a different trend was observed in women in several countries. These trends are largely explained by changes in smoking habits, with an additional contribution of air pollution and occupational exposures. Despite past and ongoing tobacco control initiatives, this condition still remains a leading cause of death, in particular in countries with lower socio-demographic indices.

Allium vegetables intake and the risk of gastric cancer in the Stomach cancer Pooling (StoP) Project

BACKGROUND

The role of allium vegetables on gastric cancer (GC) risk remains unclear.

METHODS

We evaluated whether higher intakes of allium vegetables reduce GC risk using individual participant data from 17 studies participating in the "Stomach cancer Pooling (StoP) Project", including 6097 GC cases and 13,017 controls. Study-specific odds ratios (ORs) were pooled using a two-stage modelling approach.

RESULTS

Total allium vegetables intake was inversely associated with GC risk. The pooled OR for the highest versus the lowest study-specific tertile of consumption was 0.71 (95% confidence interval, CI, 0.56-0.90), with substantial heterogeneity across studies (I² > 50%). Pooled ORs for high versus low consumption were 0.69 (95% CI, 0.55-0.86) for onions and 0.83 (95% CI, 0.75-0.93) for garlic. The inverse association with allium vegetables was evident in Asian (OR 0.50, 95% CI, 0.29-0.86) but not European (OR 0.96, 95% CI, 0.81-1.13) and American (OR 0.66, 95% CI, 0.39-1.11) studies. Results were consistent across all other strata.

CONCLUSIONS

In a worldwide consortium of epidemiological studies, we found an inverse association between allium vegetables and GC, with a stronger association seen in Asian studies. The heterogeneity of results across geographic regions and possible residual confounding suggest caution in results interpretation.

Adult lifetime body mass index trajectories and endometrial cancer risk

OBJECTIVE

To identify body mass index (BMI) trajectories in adult life and to examine their association with endometrial cancer (EC) risk, also exploring whether relations differ by HRT use.

DESIGN

Pooled analysis of two case control studies.

SETTING

Italy and Switzerland.

POPULATION

A total of 458 EC cases and 782 controls.

METHODS

We performed a latent class growth model in order to identify homogenous BMI trajectories over 6 decades of age, with a polynomial function of age. Odds Ratios (ORs) and the corresponding 95% confidence intervals (CI) for EC risk were derived through a multiple logistic regression model, correcting for classification error.

MAIN OUTCOME MEASURES

The relation of BMI trajectories with endometrial cancer.

RESULTS

We identified 5 BMI trajectories. Compared with women in the 'Normal weight-stable' trajectory, a reduction by about 50% in the risk of EC emerged for those in the 'Underweight increasing to normal weight' (95% CI=0.28-0.99). The 'Normal weight increasing to overweight' and the 'Overweight-stable' trajectories were associated to, respectively, an excess of 3% (95% CI=0.66-1.60) and of 71% (95% CI= 1.12-2.59) in cancer risk. The OR associated to the trajectory 'Overweight increasing to obese' was 2.03 (95% CI= 1.31-3.13). Stronger effects emerged among HRT never users (OR= 2.19 for the 'Overweight-stable' trajectory and OR=2.49 for the 'Overweight increasing to obese' trajectory).

CONCLUSIONS

Our study suggests that longer exposure to overweight and obesity across lifetime is associated with an increased risk of endometrial cancer. Weight during adulthood also appears to play an important role.

Obstetric and neonatal outcomes in women with pregnancy associated cancer: a population-based study in Lombardy, Northern Italy

BACKGROUND

Pregnancy associated cancer (PAC) may lead to adverse obstetric and neonatal outcomes. This study aims to assess the association between PACs and adverse perinatal outcomes [i.e. labor induction, iatrogenic delivery, preterm birth, small for gestational age (SGA) newborn, low Apgar score, major malformations, perinatal mortality] in Lombardy, Northern Italy.

METHODS

This population-based historic cohort study used the certificate of delivery assistance and the regional healthcare utilization databases of Lombardy Region to identify beneficiaries of National Health Service who delivered between 2008 and 2017. PACs were defined through oncological ICD-9-CM codes reported in the hospital discharge forms. Each woman with PAC was matched to four women randomly selected from those cancer-free (1:4). Log-binomial regression models were fitted to estimate crude and adjusted prevalence ratio (aPR) and the corresponding 95% confidence interval (CI) of each perinatal outcome among PAC and cancer-free women.

RESULTS

Out of the 657,968 deliveries, 831 PACs were identified (1.26 per 1000). PAC diagnosed during pregnancy was positively associated with labor induction or planned delivery (aPR=1.80, 95% CI: 1.57-2.07), cesarean section (aPR=1.78, 95% CI: 1.49-2.11) and premature birth (aPR=6.34, 95% CI: 4.59-8.75). No association with obstetric outcomes was found among PAC diagnosed in the post-pregnancy. No association of PAC, neither during pregnancy nor in post-pregnancy was found for SGA (aPR=0.71, 95% CI: 0.36-1.35 and aPR=1.04, 95% CI: 0.78-1.39, respectively), but newborn among PAC women had a lower birth weight (p-value< 0.001). Newborns of women with PAC diagnosed during pregnancy had a higher risk of borderline significance of a low Apgar score (aPR=2.65, 95% CI: 0.96-7.33) as compared to cancer-free women.

CONCLUSION

PAC, especially when diagnosed during pregnancy, is associated with iatrogenic preterm delivery, compromising some neonatal heath indicators.

Dietary patterns and oesophageal cancer: a multi-country latent class analysis

BACKGROUND

The considerable differences in food consumption across countries pose major challenges to the research on diet and cancer, due to the difficulty to generalise and reproduce the dietary patterns identified in a specific population.

METHODS

We analysed data from a multicentric case-control study on oesophageal squamous cell carcinoma (ESCC) carried out between 1992 and 2009 in three Italian areas and in the Canton of Vaud, Switzerland, which included 505 cases and 1259 hospital controls. Dietary patterns were derived applying LCA on 24 food groups, controlling for country membership, and non-alcoholic energy intake. A multiple logistic regression model was used to derive odds ratio (ORs) and corresponding 95% CIs for ESCC according to the dietary patterns identified, correcting for classification error.

RESULTS AND CONCLUSION

We identified three dietary patterns. The 'Prudent' pattern was distinguished by a diet rich in fruits and vegetables. The 'Western' pattern was characterised by low consumption of these food groups and higher intakes of sugar. The 'Lower consumers-combination pattern' exhibited a diet poor in most of the nutrients, preferences for fish, potatoes, meat and a few specific types of vegetables. Differences between Italy and Switzerland emerged for pattern sizes and for specific single food preferences. Compared to the 'Prudent' pattern, the 'Western' and the 'Lower consumers-combination' patterns were associated with an increased risk of ESCC (OR=3.04, 95% CI=2.12-4.38 and OR=2.81, 95% CI=1.65-4.76).

Reproducibility of A Posteriori Dietary Patterns across Time and Studies: A Scoping Review

Few studies have considered if a posteriori dietary patterns (DPs) are generalizable across different centers or studies, or if they are consistently seen over time. To date, no systematic search of the literature on these topics has been carried out. A scoping review was conducted through a systematic search on the PubMed database. In the current review, we included the 34 articles examining the extent to which a posteriori DPs were consistently seen: 1) across centers from the same study or across different studies potentially representing different populations or countries (here indicated as cross-study reproducibility) and 2) over longer time periods (i.e., ≥2 y) (here indicated as stability over time). Selected articles (published in 1981-2019, 32% from 2010 onwards) were based on observational studies, mostly from Europe and North America. Five articles were based on children and/or adolescents and 14 articles included adults (2 men; 12 women, of whom 3 were pregnant women). A posteriori DPs were mostly derived (32 articles) with principal component or factor analyses. Among the 9 articles assessing DP reproducibility across studies (number of centers/studies: 2-27; median: 3), 5 provided a formal assessment using statistical methods (4 index-based approaches of different complexity, 1 statistical model). A median of 4 DPs was reproduced across centers/studies (range: 1-7). Among the 25 articles assessing DP stability over time (number of time-occasions: 2-6; median: 3), 19 provided a formal assessment with statistical methods (17 index-based and/or test-based approaches, 1 statistical model, 1 with both strategies). The number and composition of DPs remained mostly stable over time. Based on the limited evidence collected, most identified DPs showed good reproducibility across studies and stability over time. However, when present within the single studies, the criteria for the formal assessment of cross-study reproducibility or stability over time were generally very basic.

Reproducibility and Validity of A Posteriori Dietary Patterns: A Systematic Review

The effective use of dietary patterns (DPs) remains limited. There is a need to assess their consistency over multiple administrations of the same dietary source, different dietary sources, or across different studies. Similarly, their generalizability should be based on a previous assessment of DP construct validity. However, to date, no systematic reviews of reproducibility and validity of a posteriori DPs have been carried out. In addition, several methodological questions related to their identification are still open and prevent a fair comparison of epidemiological results on DPs and disease. A systematic review of the literature on the PubMed database was conducted. We identified 218 articles, 64 of which met the inclusion criteria. Of these, the 38 articles dealing with reproducibility and relative and construct validity of DPs were included. These articles (published in 1999-2017, 53% from 2010 onwards) were based on observational studies conducted worldwide. The 14 articles that assessed DP reproducibility across different statistical solutions examined different research questions. Included were: the number of food groups or subjects; input variable format (as well as adjustment for energy intake); algorithms and the number of DPs to retain in cluster analysis; rotation method; and score calculation in factor analysis. However, we identified at most 3 articles per research question on DP reproducibility across statistical solutions. From another 15 articles, reproducibility of DPs over shorter (≤1 y) time periods was generally good and higher than DP relative validity (as measured across different dietary sources). Confirmatory factor analysis was used in 15 of the included articles. It provided reassuring results in identifying valid dietary constructs characterizing the populations under consideration. Based on the available evidence, only suggestive conclusions can be derived on reproducibility across different statistical solutions. Nevertheless, most identified DPs showed good reproducibility, fair relative validity, and good construct validity.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research Recommendations and the Risk of Breast Cancer

The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) introduced in 2007, and updated in 2018, nutrition-related recommendations for cancer prevention. Previous studies generally reported inverse associations of breast cancer with the 2007 recommendations, while no study has yet evaluated the association with the 2018 guidelines. We investigated the association between adherence to the 2018 WCRF/AICR recommendations and breast cancer risk in a case–control study from Italy and Switzerland (1991–2008) including 3034 incident histologically-confirmed breast cancer cases and 3392 hospital controls. Adherence to the 2018 guidelines was summarized through a score incorporating eight recommendations (body fatness, physical activity, consumption of wholegrains/vegetables/fruit/beans, “fast foods” and other processed foods high in fat, starches, or sugars, red/processed meat, sugar-sweetened drinks, alcohol, breastfeeding), with higher scores indicating higher adherence. Odds ratios (OR) were estimated using multiple logistic regression models. We also conducted a meta-analysis including 15 additional studies using random-effects models. In our case–control study, adherence to the 2018 WCRF/AICR guidelines was inversely associated with breast cancer, with ORs of 0.60 (95% confidence interval (CI), 0.51–0.70) for a score ≥5.5 vs. ≤4.25, and of 0.83 (95% CI, 0.79–0.88) for a 1-point increment. In our study, 25% of breast cancers were attributable to low-to-moderate guideline adherence. In the meta-analysis, the pooled relative risks (RRs) were 0.73 (95% CI, 0.65–0.82, p heterogeneity among studies < 0.001) for the highest vs. the lowest WCRF/AICR score category, and 0.91 (95% CI, 0.88–0.94, p heterogeneity < 0.001) for a 1-point increment. This work provides quantitative evidence that higher adherence to the WCRF/AICR recommendations reduces the risk of breast cancer, thus opening perspectives for prevention.

Dietary Patterns in Italy and the Risk of Renal Cell Carcinoma

Background: Conclusive evidence on foods, nutrients, or dietary patterns and the risk of renal cell carcinoma (RCC) is lacking in the literature. Methods: We considered data from an Italian hospital-based case–control study (1992–2004) on 767 incident RCC cases and 1534 controls. A posteriori dietary patterns were identified by applying principal component factor analysis on 28 nutrients derived from a 78-item food-frequency questionnaire. We estimated the odds ratios (ORs) of RCC and corresponding 95% confidence intervals (CIs) for each quartile category (compared to the lowest one) using conditional multiple logistic regression models providing adjustment for major confounding factors. Results: We identified four dietary patterns, named “Animal products”, “Starch-rich”, “Vitamins and fiber”, and “Cooking oils and dressings”. Higher intakes of the “Starch-rich” pattern were positively associated with RCC risk (OR = 1.38, 95% CI: 1.04–1.82 for the highest quartile, p = 0.018). The association was inverse with the “Cooking oils and dressings” pattern (OR = 0.61, 95% CI: 0.47–0.80, p < 0.001), whereas no association was found with “Animal products” and “Vitamins and fiber” patterns. Conclusions: Higher intakes of starch-related foods may increase RCC risk, whereas consumption of olive and seed oils may favorably influence RCC risk.

Dietary patterns and oral and pharyngeal cancer using latent class analysis

The methods traditionally used to identify a posteriori dietary patterns are principal components, factor and cluster analysis. The aim of our study is to assess the relationship between dietary patterns derived with latent class analysis (LCA) and oral/pharyngeal cancer risk (OPC), highlighting the strengths of this method compared to traditional ones. We analyzed data from an Italian multicentric case-control study on OPC including 946 cases and 2,492 hospital controls. Dietary patterns were derived using LCA on 25 food groups. A multiple logistic regression model was used to derive odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for OPC according to the dietary patterns identified. We identified four dietary patterns. The first one was characterized by a high intake of leafy and fruiting vegetable and fruits (Prudent pattern), the second one showed a high intake of red meat and low intake of selected fruits and vegetables (Western pattern). The last two patterns showed a combination-type of diet. We labeled "Lower consumers-combination pattern" the cluster that showed a low intake of the majority of foods, and "Higher consumers-combination pattern" the one characterized by a high intake of various foods. Compared to the "Prudent pattern", the "Western" and the "Lower consumers-combination" ones were positively related to the risk of OPC (OR = 2.56, 95% CI: 1.90-3.45 and OR = 2.23, 95% CI: 1.64-3.02). No difference in risk emerged for the "Higher consumers-combination pattern" (OR = 1.28, 95% CI: 0.92-1.77).

Coverage and outcomes of antenatal tests for infections: a population based survey in the Province of Trento, Italy

BACKGROUND

Rubella, syphilis, toxoplasmosis, cytomegalovirus (CMV), hepatitis B (HBV) and C (HCV), HIV, and Group B Streptococcus (GBS) infections may have very severe outcomes during pregnancy, and for this reason, monitoring of infections in pregnant women is a requirement of prenatal assistance.

AIMS

To describe coverage and outcome of the screening for rubella, syphilis, toxoplasmosis, CMV, HBV, HCV, HIV, and Group B Streptococcus in pregnancy in the Autonomous Province of Trento, Northern Italy (538,600 inhabitants).

METHODS

We analysed the coverage and outcome of the above-mentioned screenings among women who delivered in the hospitals of the Province of Trento between 2007 and 2014 (N = 38,712). Screenings were grouped according to characteristics such as recommendation by national and local guidelines, scheduling of the tests, operating methods, and charge. We also estimated odds ratios (ORs) for missing screening for selected infections through multiple logistic regression.

RESULTS

Estimated uptake of antenatal screening was 99.7% for rubella, 99.3% for syphilis, 99.7% for toxoplasmosis, 98.1% for HIV infection, 99.0% for HBV, 98.9% for HCV, 94.0% for GBS infection, and 75.4% for CMV infection. The overall prevalence of immunity was 94.1% for rubella, 24.2% for toxoplasmosis, and 64.2% for CMV. The rate of seroconversion in pregnant women was 0.02% for rubella, 0.29% for toxoplasmosis, and 0.75% for CMV. The overall prevalence of infection was 0.94% for HBV, 0.53% for HCV, 22.3% for GBS, 0.29% for syphilis, and 0.13% for HIV. We found a significant positive association for all screening tests, between lack of testing and late first medical examination in pregnancy (ORs ranging from 1.20 to 1.66 for the first medical visit in the second trimester and ORs ranging from 1.60 to 5.88 for the first medical visit in third trimester, compared to early medical visit in the first trimester). Compared to Italian citizenship, foreign citizenship of the mother was also positively associated with absence of screening (ORs ranging from 1.30 to 1.53). A significant inverse association was observed for calendar year of delivery (ORs ranging from 0.71 to 0.97, for 1 year increment). Less educated mothers and pluriparae were also at higher risks of not being tested. Analysis of the association with mother age showed different heterogeneous effects.

CONCLUSIONS

Our study indicates that the attention to screening and detecting infected cases is growing over the time. In addition, care delivered during pregnancy has a leading role in determining coverage of the examinations. Immigrant, pluriparous and less educated women need particular attention.

Assessing Nephrological Competence among Geriatricians: A Proof of Concept Internet Survey

Chronic kidney disease (CKD) is highly prevalent in the elderly and negatively impacts survival and health status. Thus, nephrological competence is mandatory for a skilled geriatrician. The present study aimed to assess nephrological competence in a sample of geriatricians recruited through a web survey. To this aim, a 12-items questionnaire was produced by an expert panel of nephrologists and geriatricians and was available online for members of the Italian Society of Gerontology and Geriatrics (SIGG). Two-hundred-eighty-seven geriatricians volunteered to fill in the questionnaire. The majority of them indirectly estimated the glomerular filtration rate (GFR) using mainly the Cockroft-Gault (C-G) formula. Selected nephrological exams, such as urinary Na and serum D-vitamin measurements, did not qualify as routine exams although the majority of geriatricians supplemented their patients with fat-soluble secosteroids. Ten percent of geriatricians asked for nephrological consultation only for stage 5 CKD patients and 30,9% only for stage 4 or 5. Erythropoietin supplementation was common practice for the majority of geriatricians, while only one third of them systematically used a procedure intended to prevent the contrast induced nephropathy (CIN). Finally, an alleged 50% adherence to the international guidelines for the management of CKD patients emerged from the questionnaire. Overall, results from this survey strongly recommend promoting nephrological education among geriatricians. Didactic standards for in training geriatricians need to be updated and the cooperation between geriatrics and nephrological societies promoted.