Inclusiveness of Access Policies to Maternity Care for Migrant Women Across Europe: A Policy Review

INTRODUCTION

Despite the interconnectedness of the European Union, there are significant variations in pregnant women's legal status as migrants and therefore their ability to access maternity care. Limited access to maternity care can lead to higher morbidity and mortality rates in migrant women and their babies. This study aimed to investigate and compare maternal health access policies and the context in which they operate across European countries for women who have migrated and are not considered citizens of the host country.

METHODS

The study adopted a mixed-methods research design exploring policies on migrant women's access to maternity care across the migration regimes. Data were extracted from legal documents and research reports to construct a new typology to identify the inclusiveness of policies determining access to maternity care for migrant women.

RESULTS

This study found inconsistency in the categorisation of migrants across countries and significant disparities in access to maternity care for migrant women within and between European countries. A lack of connection between access policies and migration regimes, along with a lack of fit between policies and public support for migration suggests a low level of path dependency and leaves space for policy innovation.

DISCUSSION

Inequities and inconsistencies in policies across European countries affect non-citizen migrant women's access to maternity care. These policies act to reproduce structural inequalities which compromise the health of vulnerable women and newborns in reception countries. There is an urgent need to address this inequity, which discriminates against these already marginalised women.

Cumulative trauma and perceived community resilience: A serial mediation model

Communities affected by cumulative trauma can experience negative psychological reactions but also posttraumatic growth and community resilience, which promote adaptation and preparation for future traumatic events. This study aims to investigate the mechanisms that mediate the relationship between traumatic events and perceived community resilience. Participants were 118 Italian adults who experienced cumulative trauma and were recruited to complete an online survey. A serial multiple mediation model was estimated to assess whether the impact of the Morandi bridge collapse and posttraumatic growth mediated the relationship between the psychological impact of the Covid-19 pandemic and perceived community resilience. The impact of the collapsed bridge and posttraumatic growth in serial partially mediated the relationship between the impact of the Covid-19 pandemic and perceived community resilience. The impact of cumulative trauma can be considered through an ecological perspective that considers the consequences of these events in relation to community resilience.

Exploring the Role of Birth Environment on Italian Mothers' Emotional Experience during Childbirth

The physical environment is one of the factors that affect mother's experience of childbirth and psychological health. A woman's childbirth experience has been found to influence not only the mother's own health and future births but also the well-being of her child and family. The present study's objective was to investigate mothers' perceptions of spatial-physical humanization, affective quality of place, and emotions during childbirth. To achieve this goal, the first part of our work was dedicated to selecting two birth environments (hospital and birth center) with different degrees of humanization. The methods include observations and field survey which mainly concerned the environmental quality of the spaces and the layout of the birth unit, and self-report questionnaire about perceived environment, affective quality attributed to place, and delivery experience. Participants are 66 low-risk women, choosing hospital or birth center. The findings indicate an enhanced perception of both the spatial-physical aspects and the social and functional aspects of the care unit among mothers who give birth at the birth center. These same mothers also report a more positive perception of the childbirth experience. In conclusion, this study contributes to the understanding of the role of birth environments in shaping mothers' emotional experiences during childbirth.

Through a relational lens: reflections about foster care experience in Italian emancipated foster youth

The study aimed to investigate relational outcomes of Italian emancipated foster youth across open-ended reflections about their perceptions of their relationships with the biological and foster family, with partner and peers. A total of 26 Italian emancipated foster youth (19-25 years old) recruited by social services completed a single in-depth interview. A qualitative thematic analysis was selected for this study. The results revealed two major themes of foster care experience that emerged often simultaneously from the participants' narration: (1) Positive Relational Outcomes including "Feeling supported," "Sense of belonging," "Good memories," "Relationship with family of choice," and "Staying in touch"; and (2) Negative Relational Outcomes referring "Devaluation," "Refuse," "Bad memories," and "Isolation." Foster care experience leads to complex relational perceptions in emerging adulthood according to different relational outcomes and ways of processing foster care experience. Professionals could work on relational outcomes and memories, especially during a critical transition like emerging adulthood, to support youth in making sense of their past experiences.

Home Away from Home: Comparing Factors Impacting Migrants’ and Italians Sense of Psychological Home

Psychological home is an understudied concept within community psychology, especially focused on migrants. Previous literature on psychological home found a positive relationship with well-being and resilience in general populations and migrants. Studying psychological home in migrants may provide important tools to buffer various stresses associated with migration. The present study explored the relationship between psychological home and demographic factors, including dwelling type and situation between migrants (n = 132) and Italian citizens’ population (n = 76). Results offer theoretical reasons explaining the differences in the meaning of home between migrant and non-immigrant populations.

A Broad Study to Develop Maternity Units Design Knowledge Combining Spatial Analysis and Mothers' and Midwives' Perception of the Birth Environment

OBJECTIVES

This article investigates how the physical birth environment is perceived by the users (women and midwives) in different settings, a midwife-led unit and an obstetric-led unit, placed in Italy.

BACKGROUND

In the field of birth architecture research, there is a gap in the description of the spatial and physical characteristics of birth environments that impact users' health, specifically for what concerns the perception by women.

METHODS

The study focuses on multi-centered mixed methods design, employing both quantitative and qualitative research methods (questionnaire, spatial analysis) and covering different disciplines (architecture, environmental psychology, and midwifery).

RESULTS

The results revealed significant differences between the two settings and some associations between perceived and spatial data concerning: calm atmosphere, greater intimacy, spacious birth room, clarity of service points, clarity in finding midwives, sufficient space for labor, noise, privacy, and the birth room adaptability.

CONCLUSIONS

The findings confirm the importance of the spatial layout and indicate documented knowledge as an input to consider when designing birth spaces in order to promote user well-being.

The Meaning of Home in Male Migration: Listening to Men’s Experiences

We assessed the sense of psychological home among adult men (n = 17; M age = 29.7 years old) who had experienced migration to Italy, focusing on the relationship between psychological home and the process of integration into the new country. Psychological home is a dynamic process in which people sense a safe and secure environment that ranges beyond the confines of a structured dwelling, a process which is reflective and which communicates one’s self-identity. Participants engaged in a semistructured interview with the aim of establishing a generic concept of psychological home and identifying the issues that arise at the intersection of psychological home and migration. The results highlighted certain themes about the meaning that psychological home assumes in the lives of migrants and about the way in which the migration experience acts to support or hinder the process of building this sense of home. Of special interest is the idea that individuals might develop multiple psychological homes related to the different places and relationships that they experience. In this sense, establishment of a psychological home might be considered the ideal affective state for psychological adaptation to a new country.

Fear of hypoglycemia in Italian mothers of children with type 1 diabetes: the mediating role of resilience

Objective

Fear of hypoglycemia for children with diabetes influences parental life and could increase parental stress. The present study aimed to explore the association between resilience, the self-perception of the parental role, and fear of hypoglycemia in mothers of children with type I diabetes (T1DM).

Methods

Ninety mothers (mean age: 44.20 years) of children with a T1DM diagnosis (mean age: 11.48 years) were recruited from an association for parents and completed an online self-report questionnaire packet that includes: Fear of Hypoglycemia Survey, Self-Perception of the Parental Role and Resilience Scale for Adults. Participants were recruited in 2017. Data collection lasted 10 months. Data analysis was performed using the SPSS statistical package, version 22, and the PROCESS macro program by Hayes.

Results

The analysis of the mediation model shows that resilience assumes a mediational role in the relationships between the parental role and preoccupation with hypoglycemia. In particular, the mother's perceived competence and role balance can influence the development and increase of the mother's resilience, which in turn can allow a decrease in the mother's worry about the possible hypoglycemic episode of her child.

Conclusion

The findings suggest that resilience is a significant topic to focus on in interventions designed to increase the self-perception of the parental role and reduce fear of hypoglycemia in mothers.

Community dimensions and emotions in the era of COVID-19

Following an ecological perspective, reactions to a disaster—such as the COVID‐19 pandemic—should be analysed in the interdependence between individual and community dimensions. The present study aims to analyse individual emotional dimensions (anxiety, joy, fear or depressive feelings) and their community dimensions (connectedness, emotional sharing and solidarity) with a longitudinal approach among university students from Italian universities. Participants were 746 university students at t1 (during the lockdown) and 361 at t2 (after the lockdown) recruited in six Italian universities from different areas of Italy. Comparing emotional dimensions in the two times, t2 is characterized by a generalized ambiguity: both happiness or joy because of the end of limitations and a kind of ‘post‐lockdown anxiety’ because of a sense of individual inadequacy in facing the return to normality, conducting daily activities and attending community spaces. Data confirms that after the so‐called ‘honeymoon phase’ in community dimensions (first phase of t1 time), a sort of ‘depressive reaction’ arises at t2: Italian university students seem more aware of the need for individual and social responsibility and that many events are not under their personal control. The reconstruction phase and exit from the emergency are perceived as necessary but also as a difficult and risky period. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Unaccompanied migrant minors in Europe and U.S.: A review of psychological perspective and care challenges

Unaccompanied migrant minors are youth under the age of 18 who migrate alone, traveling separately from both parents. These youth may be asylum seekers, recognized refugees, or other externally displaced persons. Unaccompanied migrant minors have become an increasingly prevalent global issue. However, this phenomenon might be better understood considering the peculiarities of their contexts, since there are differences related to specific conditions and reception systems. The present study reviewed and compared visually previously reported psychological perspective of unaccompanied migrant minor receiving services from select European countries and the U.S. Unaccompanied migrant minors create a challenge on a nation's care system because these minors are the most vulnerable group in the context of migration. Our explorative assessment suggested underlining similarities and differences between contexts, reflecting the unique needs of the unaccompanied migrants and proposed services and intervention models.

Migration in the context: Perspectives, methodologies, and cultural issues

The present article introduces the issue migration in the context: perspectives, methodology, and cultural issues. International migrations and their changing patterns pose new challenges to community social psychologists and new questions to be explored. Community psychologists' attention is necessary to develop a perspective about migration more suitable to effective interventions in global and local communities. Therefore, methods aimed at study migration issues should be implemented at micro-system, community, and national levels. Through this series of papers, we aim to contribute to the debate about how social and community psychologists can engage in community development strategies aimed at improving migrant well-being too. Indeed, they can give relevant contributions to the deepening of migration issues through research, methodologies, and interventions in different contexts and at different levels of analysis.

How Could Self-Determination Theory Be Useful for Facing Health Innovation Challenges?

This paper offers a presentation of the characteristics of self-determination theory (SDT) in the health context as well as attempts to identify how this theory could be useful for facing health innovation challenges. Health innovation is based on scientific advances that have more complex relationships with health. This paper encourages the use of the SDT approach to face health innovation, both for physiological and pathological processes. In particular, the focus is on the changes and lifestyle choices related to physiological pregnancy and birth and to oncological genetic tests in the Italian context. The health innovation paradigm focuses on patients taking responsibility for making important health-related choices, and we think that SDT can offer new stimuli in light of the changes implemented from innovations in the field of health. The aim is that this manuscript will stimulate researchers to test the potential of this theory in the field of changing health-related processes. Practitioners are called upon to revise their orientation toward patients and, according to SDT, they should support autonomy rather than control the promotion of health-related change.

The Caregiving Experiences of Fathers and Mothers of Children With Rare Diseases in Italy: Challenges and Social Support Perceptions

Family caregiving is a growing phenomenon with the increased prevalence of chronic illness and shorter hospitalizations. Rare diseases pose significant challenges not only to patients living with these kinds of pathologies but also to those who care for these patients. The caregiving role has specific characteristics. The present work aims to increase knowledge of the challenges that are common or specific to fathers and mothers of children diagnosed with a rare disease. Moreover, the paper analyses the kinds of social support they experience according to gender. A descriptive study was conducted using grounded theory methodology. A semi-structured interview with open-ended questions was conducted with 15 parents of children with a rare disease. The interview was organized into three main areas: personal experiences in caring for a child with a rare disease, family changes and perceived social support. The transcriptions were analyzed using NVivo 11 software. From data analysis, themes emerged regarding the challenges shared by fathers and mothers, but some aspects also emerged that were gender-specific. The analyses of differences between mothers' and fathers' narratives showed that there is a specific experience of the impact that caregiving has on parents' relationships with their jobs and on their worries. Self-help group is the main source of social support for all respondents. We discuss these findings in relation to possible appropriate specific interventions and support for family caregiving.

Psychological well-being and healthy communities: Women as makers of relational well-being by social street strategies

This paper presents a Social Street experience born of the perception of a lack of solidarity among neighbors and the desire to create a new neighborhood model. The goal was to explore the Social Street phenomenon through the relationship between individuals and their community. Furthermore, the goals include promoting the awareness of the critical issues of the territory to activate empowerment and change, analyzing the effectiveness of Social Street through the study of social networks, and investigating differences in social participation and in social cohesion. The most relevant result is that gender emerges as a context variable because Social Street members are mostly women. In fact, the role of women is relevant in structuring relational contexts and improving community networks and relationships.

Challenging gender perspective in the community to promote well-being and health

The community is an excellent potential arena in which to challenge gender perspective and change power structures in society because of its pivotal role in socializing gender and shaping social context. The community influences the availability of positive and negative role models, the accessibility of specific settings, the ease with which relationships are formed, and a variety of emotions and attitudes. The literature shows that paying attention to gender equity affects numerous indicators of community well-being. Attention to gender equity makes communities more competent, which creates human and social capital that enables community well-being. We will examine the role of gender not only as a social construction but also as a context to create a healthy setting in the community and to promote the health and wellness of gender perspectives in the scientific domain, which seems resistant to change.

Gender matters and the challenge for improving community health and well-being

The present paper introduces present issue focused on community gender perspective and health in an Italian context. After a brief analysis of the disparity and inequity that persist in Europe and Italy, we present six papers from different Italian regions that demonstrate different elements of the complex gender matters and challenges of well-being and health in the community. Considering the differences in social vulnerability and risk between men and women, the unequal power relationships between the sexes could improve the efficacy of intervention and preventative actions. Through this series of papers, we aim to contribute to the debate about how gender perspective can shape studies and interventions that promote both individual and community health and well-being. Gender, one of the key determinants of health, is revealed in many ways; it is necessary to better understand and plan health service interventions to improve the health of women and men. Furthermore, more attention and reflection are needed to promote policy interventions for health and to consider the contribution of women to the health of the community.

Acculturation Process and Life Domains: Different Perceptions of Native and Immigrant Adults in Italy

Background:

Acculturation process has taken up a relevant place in cross-cultural psychology by demonstrating the strong relationships between cultural context and individual behavioral development.

Aim:

The purpose of this study is to analyse acculturation strategies and attitudes in different life domains of native and immigrant adults living in Italy, following the Relative Acculturation Extended Model (RAEM).

Methods:

The participants were 250 Italian native and 100 immigrant adults who completed a questionnaire with items to measure their acculturation strategies (real plane) and attitudes (ideal plane), in general and related to different life domains (peripheral and central).

Results:

Results revealed that the acculturation attitude of immigrants is integration, whereas Italians prefer their assimilation.

Conclusion:

However, when different life domains are taken into account, immigrants claim to put in practice and prefer integration in most of the domains, whereas Italians perceive immigrants are separated but they prefer their assimilation or integration, depending on the specific domain.

Family Acculturation in Host and Immigrant Couples: Dyadic Research in an Italian Context

The purpose of this research is to study acculturation strategies and attitudes in central and peripheral domains of host and immigrant couples in an Italian context. The participants were 60 dyads (30 host couples and 30 immigrant couples) who completed a questionnaire based on the Relative Acculturation Extended Model (RAEM). Based on the analysis, we found that the general acculturation attitude preferred by immigrant couples is integration, and Italian couples prefer that immigrants adopt it. Furthermore, Italian partners show moderate internal agreement, whereas immigrant couples show a high degree of agreement. In both groups, the level of agreement between dyadic members is only partially determined by their membership within a social group. The socio-cultural context has a significant role in the internal similarity of Italian couples. In contrast, there is dyadic agreement within immigrant couples.

Domestic Violence in Separated Couples in Italian Context: Communalities and Singularities of Women and Men Experiences

Relationship breakdown and separation represent a critical aspect in domestic violence. Few studies have investigated domestic violence in separated couples. Moreover, there is a need for a more in depth analysis of gender differences that could enhance the comprehension of the phenomenon. The primary aim of this research was to analyze, through a qualitative approach, which kinds of domestic violence are characteristic or major in separated couples in the Italian context, where this phenomenon has not yet been sufficiently investigated. Participants are 60 separated couples (mean age: M = 48; F = 44) who attended a Family Mediation Center. A descriptive study was conducted using grounded theory methodology. A brief narrative task was administered to both ex-partners separately. The transcriptions were analyzed using NVivo 11 software. From data analysis, some themes emerged regarding typology of domestic violence specific of the separation context and shared by both men and women. The analyses of gender differences showed that there is a gender specific experience of domestic violence. Results highlight that women narrate both physical and psychological violence, while men relate only psychological abuse focused on limiting access to children. We discuss these findings in relation to possible appropriate gender specific intervention and prevention efforts.

Emotions in labour: Italian obstetricians' experiences of presence during childbirth

OBJECTIVE

The present study represents a qualitative research aimed to explore the obstetricians' psychological experiences of birth.

BACKGROUND

During labour the role of obstetricians assumes a fundamental importance in hospitalised childbirth. However, literature analysis has shown that the psychological side of birth has been investigated only considering the woman's and midwife's points of view. The obstetricians' psychological experiences have not been considered enough and only a few studies at a quantitative level have been performed.

METHODS

Seven focus groups for a total of 72 obstetricians were conducted in hospital contexts in Italy. The qualitative methodology of grounded theory was adopted.

FINDINGS

The results were divided into three different core themes: obstetricians' approaches to delivery, critical aspects about relationships in the delivery room, and obstetricians' feelings and emotions in the delivery room. Each theme was subdivided into different subthemes.

CONCLUSION

The results highlight different ways obstetricians approach their profession, the complex and multifaceted relationship with the woman and the extraordinary variety of feelings and emotions, which enrich, but also may complicate, life in the delivery room. Further studies could provide more details to help researchers to develop new and more effective strategies to support obstetricians' training and work.

Family Routine Behaviors and Meaningful Rituals: A Comparison Between Italian and Migrant Couples

Routines and meaningful rituals play an important role in the family dynamic system. During the past 30 years, migratory flow into Italy has been constantly increasing. Our aim was to explore the structure of daily life in order to understand and compare family functioning of migrant couples in Italy with the family functioning of couples who were born and bred in Italy. In our study there were 124 participants (31 Italian couples and 31 migrant couples) who completed modified versions of the Family Routine Inventory and the Family Ritual Questionnaire. Participants were contacted by teachers at kindergartens attended by the children of the couples. The results highlighted a significant difference between Italian and migrant couples in the symbolic-significance dimension of rituals. The particularity of this finding is its coexistence with the absence of significant differences in the more pragmatic aspects of rituals. The possible influence of the migration experience and practical implications are discussed.

[Global eradication of dracunculiasis is a reality nowadays]

Global efforts to eradicate dracunculiasis have continued to progress with only 542 cases reported in 2012 versus almost 1 million cases in the 1980s when the initiative was launched. The disease is still endemic, but in only four countries: South Sudan (541 cases), Chad (10 cases), Mali (4 cases), and Ethiopia (4 cases). The International Commission for the Certification of Dracunculiasis Eradication declared that 180 countries were free of the disease by 2013. Dracunculiasis was first eradicated in the former USSR in 1931 when its last case was registered due to the successful implementation of a package of appropriate measures (case detection and management, vector control, and health education, including water filtration from open water sources and behavioral changes). These approaches were actively taken into account when developing the global strategy for dracunculiasis. The World Health Organization has set a goal to eradicate the disease by 2015. However, despite the fact that the global situation looks very optimistic, the time for completing the program will be most likely postponed due to a few operational challenges remaining in the still endemic countries, in South Sudan in particular.

Occipital intermittent rhythmic delta activity only following eye closure in atypical CNS Salmonellosis

OBJECTIVE

A statement recently published on the base of a large retrospective analysis, report that the occipital intermittent rhythmic delta activity (OIRDA) "is associated with epilepsy but not acute encephalopathy" [Gullapalli and Fountain. J Clin Neurophysiol 2003;20:35-41]. Our aim is to report, the exception from a child with an intermittent fever, in which the finding of an occipital intermittent rhythmic delta activity (OIRDA) following the eye closure in the EEG recording was the first clinical sign addressing to a CNS involvement.

METHODS

To review the record from a five-year-old girl with a normal basal electroencephalogram and OIRDA that only appeared following eye closure.

RESULTS

We found OIRDA associated with atypical CNS Salmonellosis. Brain MRI and CSF examination confirmed an acute encephalopathy, which was due to Salmonella infection. The only symptoms of the infection were episodes of nightly fever that had lasted for four weeks, sometimes associated with headache and vomiting. Both OIRDA only induced by eye closing and other symptoms disappeared after starting antimicrobial therapy.

CONCLUSIONS

OIRDA only following eye closure is a non-specific abnormality and the present findings, based on a single case, merely indicate that intracranial infection is among the possible causes.

SIGNIFICANCE

The new clinical association is certainly worth recording, as the presence of this electrophysiological sign may provoke clinicians to then delve further into a diagnostic work up.

Malignant fibrous histiocytoma of the pharynx

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma of late adult life, but is relatively uncommon in the head and neck region. That region has been reported to be the origin of malignant fibrous histiocytoma in 3-10% of cases. Only one case of the tumor occurring in the pharynx has been reported. Histologically it is sometimes hard to distinguish this tumor from some sarcomas and pleomorphic carcinomas. The treatment of choice is a large surgical resection, while radiotherapy and chemotherapy are reserved for recurrences. The authors present a case of oropharyngeal malignant fibrous histiocytoma. The patient complained dysphagia and dyslalia progressively worsening in six months. Pharyngo-laryngoscopy revealed a mass of the left lateral wall of oro and hypopharynx. CT scan examination showed a capsuled mass which displaced but not involved the neck neurovascular structures; there was no evidence of linphonodal involvement. Transoral surgical excision of the mass was performed with the preservation of speech and swallowing. For more than 1 year postoperatively, there has been no evidence of the disease or metastasis.

Schwannoma of the tongue: one case report

The schwannomas are nervous tissue tumours that arise from Schwann cells; they are uncommon in peripheral nerves and rare in the tongue. After, a review of the literature, we present a case of schwannoma which arose in the ventral part of the body of the tongue. The tumour presented as a slowly growing mass producing few symptoms. The diagnosis of schwannoma is usually made post-operatively by histological identification although modern imaging techniques can provide useful indications. The treatment is exclusively surgical and usually enucleation of the mass is uncomplicated. There are no reports of malignant transformation.

Unusual cases of cervical nerves schwannomas: phrenic and vagus nerve involvement

Benign neurogenic tumors (neurilemmoma) arising from the cervical phrenic or vagus nerve are relatively rare. These lesions are benign, asymptomatic and incidentally found. We describe two cases considering different surgical techniques adopted. In the case of phrenic nerve schwannoma we performed a total excision of the tumor including the maternal nerve fiber to prevent tumor recurrence, also in regard to the already present hemidiaphragm palsy. On the other hand in second case, in which the vagus nerve was involved, we proposed a microsurgical approach by monitoring nerve function in order to minimize nerve damage.

[Benign hemangiopericytoma of the bladder: description of a case and review of the literature]

Hemangiopericytoma (HPC) of the viscera is very rare and only six of these tumors arising in the urinary bladder have been previously reported. The differentiation of HPC from other neoplasms with prominent vascular pattern may be a diagnostic problem. The difficulty is further enhanced by the lack of distinctive immunohistochemical features of this tumor. Here is presented a case of benign HPC occurring in the right lateral wall of the bladder of a 37-year-old woman. The mass is completely transurethrally resected. Histologically, the tumor is characterized by a monomorphic population of polygonal or spindle-shaped cells packed around branching vascular channels, with "staghorn" configuration. There are no foci of necrosis or hemorrhage. The mitotic count is 2 per 10 HPF. Immunohistochemically, the tumor cells react with anti-bodies against Vimentin. Cytokeratin, Actin HHF35, S-100, CD 34, Factor VIII-related antigen are not expressed within the lesion. Ultrastructurally, the tumor cells surround endothelium-lined vascular channels. There are pinocytotic vesicles on the cell borders. The cells are separated from one another by deposits of basal lamina-like material and collagen. On the basis of clinical, histological, immunohistochemical and ultrastructural observations, we believe that the case reported is a primary benign HPC of the bladder. There is no evidence of recurrence or metastasis 32 months later.

Chlamydia pneumoniae antibodies and angiographically demonstrated coronary artery disease in a sample population from Italy

Recent reports suggest an association between Chlamydia pneumoniae and chronic coronary heart disease. This case-control study investigates the relationship between the presence of immunoglobin G (IgG) and immunoglobin A (IgA) when measured by means of microimmunofluorescence (MIF) and angiographically diagnosed coronary disease. Cases (n = 150) were angiography patients with at least one coronary artery lesion occupying at least 50% of the luminal diameter. Controls (n = 49) were angiography patients with no detectable signs of coronary artery disease and patients (n = 56) without signs or symptoms of coronary disease and with normal ECG results. No significant differences were revealed between the seroprevalence of IgG and IaA and geometric mean titers (GMT) as measured in cases and controls. When cases were compared with controls whose angiographic results were normal, after adjusting for established risk factors (cholesterol, smoking, hypertension, diabetes, age, gender and family history), the estimated risk of coronary artery disease was 0.79 (95% confidence interval (C.I.), 0.31-1.99) for the presence of IgG and was 0.94 (95 C.I., 0.37-2.39) for IgA. When cases were compared with controls with normal ECG results, the adjusted odds ratio (O.R.) for coronary artery disease was 1.17 (95%, C.I., 0.52-2.62) for the presence of IgG and 0.82 195% C.I., 0.36-1.86) for the presence of IgA. These results do not support an association between C. pneumoniae infection and coronary disease.

Prognostic value of clinicopathologic characteristics including neuroectodermal differentiation in osseous Ewing's sarcoma family of tumors in children

AIMS AND BACKGROUND

The aim of the present study was to determine the relationship between clinico-pathologic parameters, including neuroectodermal differentiation, and their impact on survival in a series of pediatric patients with osseous tumors of the Ewing's sarcoma family admitted to the Pediatric Department of the Istituto Nazionale Tumori of Milan.

METHODS

Seventy-three patients were enrolled. The variables analyzed were sex, age, site of primary tumor, serum lactate dehydrogenase (LDH) level at diagnosis, involvement of periosseous soft tissues by primary tumor, presence of metastatic disease, status of disease after the treatment plan, as well as the presence of mitoses, morphologic and immunocytochemical neural markers, and neuroendocrine markers in the primary tumor.

RESULTS

Neural and neuroendocrine markers were not significantly associated with any of the other parameters. In the univariate analysis, significant risk factors related to unfavorable outcome were elevated LDH, metastatic disease, lack of complete remission after treatment, presence of mitoses and of morphological neural markers; immunocytochemical neural and neuroendocrine markers lacked prognostic value. In the multivariate analysis, only LDH levels and the status of disease following the treatment were retained.

CONCLUSIONS

LDH level at diagnosis might be a useful marker to identify different risk levels; neuroectodermal differentiation might have no clear-cut impact on the clinical management of osseous Ewing's sarcoma family of tumors.

Differentiation in paediatric peripheral primitive neuroectodermal tumours of bone. A critical contribution to its assessment

Differentiation was studied in 73 paediatric peripheral primitive neurorectodermal tumours (pPNETs) of bone observed during 1974 through 1992. The presence of rosettes, pseudorosettes, and/or a rosette-like arrangement of tumour cells (the morphological neural marker, MNM) occurred in 29% of these cases. NSE and N-CAM were expressed by nearly all tumours; synaptophysin was present in 30% of cases, not significantly associated with the MNM status. Neuroendocrine (NE) markers were present in 25% (chromogranin B, secretogranin II) to 40% (chromogranin A, 7B2 protein) of cases. Focal expression of cytokeratins, S100 protein and/or desmin was also noted in a minority of cases. In univariate statistical analysis, only the presence of MNM conferred a significantly higher (about twofold) risk of death than its absence. This study demonstrates the occurrence of at least one immunocytochemical N and/or NE differentiation marker in all pPNETs of bone and a focal expression of cytokeratins, S100 protein and/or desmin in a minority of cases. Synaptophysin and MNM were present each in less than 1/3 of the cases, and no association was noted between them. Statistical analyses highlighted the prognostic role of MNM per se and discourage the sole use of immunocytochemistry in the assessment of neuroectodermal differentiation for prognostic purposes in paediatric pPNETs of bone.

[Proposal for a semiqualitative evaluation method for AgNORs (rap score)]

Nucleolar Organiser Regions (NORs) can be stained in paraffin embedded specimens by a simple silver technique: the black dots formed, called AgNORs, have usually been counted only by eye with "careful focusing", a time-consuming and subjective method. Therefore we propose a new semiquantitative approach based on three patterns of AgNORs configuration of increasing malignancy as previously described by Crocker et al: 1) AgNORs fully aggregated to form a solitary argyrophil structure (pattern RESTING: -R-); 2) AgNORs lying within nucleolus and nucleoplasm (Pattern ACTIVATED: -A-); 3) Numerous small AgNORs distributed through the nucleoplasm, without nucleolar structures (Pattern PROLIFERATING: -P-). We assigned a numerical value to each pattern: R = 1; A = 2; P = 3. These values are multiplied by the relative rate in 100 cells. Eventually we obtain a score (range 100-300): this method shows significant correlation (r = 0.8363: regression equation) compared to the usual count obtained "by eye", tested on a sample of 150 breast cancer. Further studies are under way to validate this method which may represent a cheap and useful tool in AgNORs evaluation.