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N Segnan

Publications and source records attributed to N Segnan.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Cost analysis of a mammographic screening program].

In this paper we evaluate the principal direct costs (staff, capital and maintenance equipment, supplies, hardware and software system, mail, advertising campaign) of the mammographic screening programme "Prevenzione Serena" (Torino), from the recruitment time to the diagnostic assessments of screen positive cases. On the basis of the annual situation of a screening Unit which supplies two-view mammographies, read by two radiologists, and of a 60% attendance rate and a 5% recall rate, we estimate a total annual cost of 1.4 thousand million lire (875,000$), a cost per invited woman of 38,600 lire (24$), per tested woman of 64,400 lire (40$) and per breast cancer detected of 9.2 million lire (5,750$). Staff accounts for about 60% of the total cost. We evaluate also some alternative scenarios, with different hypothesis about the useful life of the equipment, the discount rate, the attendance and the recall rate.

Aged↗
PubMed1994

Who does Pap-test? The effect of one call program on coverage and determinants of compliance.

A pilot phase of a population-based organized screening programme for cervical cancer was run in Turin, Italy, in May-June 1991. Based on the city population lists, 1181 women 25 to 64 years old were invited in two family clinics. Overall compliance to invitation was 41.7%. In order to study the determinants of compliance, a random sample of 372 compliers and 398 non-compliers was interviewed. Interval since last Pap-test was strongly associated with compliance (ORs of complying were 2.52, 1.53, 1.41, 0.50 and 0.16 for intervals longer than 3 years, 1-3 years, 6 months-1 year, 3-6 months and less than 3 months respectively vs. never having had a Pap-test, p < 0.001). Estimated compliance was 39% among never screened women and 65% among those tested since more than 3 years, leading to an over 70% overall estimated coverage (women who complied or had a spontaneous test within 3 years). On the other hand, the effect of a number of sociodemographic variables (age, education, place of birth, marital status) was very weak or opposite (lower compliance among younger and more educated women) to what we found in a previous study on spontaneous Pap-testing. The clinic allocated to pre-fixed appointments had a higher compliance than the clinic with appointments to be arranged (OR = 2.36 95% c.i. 1.66-3.36). Anxiety caused by periodic controls for early diagnosis of cancer was an important negative determinant of compliance (ORs of complying were 0.85, 0.49, and 0.16 for those with mild, moderate and severe levels of anxiety vs. those reassured by the test). We concluded that personal invitations were actually able to reach those women who have a poor level of spontaneous practice and could reduce the selection in access to this preventive practice.

Adult↗
PubMed1993

Cancer mortality in ethylene oxide workers.

A cohort of 1971 chemical workers licensed to handle ethylene oxide was followed up retrospectively from 1940 to 1984 and the vital status of each subject was ascertained. No quantitative information on exposure was available and therefore cohort members were considered as presumably exposed to ethylene oxide. The cohort comprised 637 subjects allowed to handle only ethylene oxide and 1334 subjects who obtained a licence valid for ethylene oxide as well as other toxic gases. Potential confounding arising from the exposure to these other chemical agents was taken into consideration. Causes of death were found from death certificates and comparisons of mortality were made with the general population of the region where cohort members were resident. Seventy six deaths were reported whereas 98.8 were expected; the difference was statistically significant. The number of malignancies for any site exceeded the expected number (standardised mortality ratio (SMR) = 130; 43 observed deaths; 95% confidence interval (95% CI) 94-175) and approached statistical significance. For all considered cancer sites the SMRs were higher than 100 but the excess was only significant (p < 0.05, two sided test) for lymphosarcoma and reticulosarcoma (International Classification of Diseases--9th revision (ICD-9) = 200; SMR = 682; four observed deaths; 95% CI 186-1745). The excess of cases for all cancers of haematopoietic tissue (ICD-9 = 200-208) also approached statistical significance (SMR = 250; six observed deaths; 95% CI 91-544). Focusing the analysis on the subcohort of the ethylene oxide only licensed workers, who are likely to have experienced a more severe exposure to this gas, it became evident that all but one of the observed cases of haematopoietic tissue cancers in the cohort were confined to this subgroup, enhancing the relevant SMR to 700 (95% CI 237-1637) and the SMR of lymphosarcoma and reticulosarcoma to 1693 (95% CI 349-4953).

Adult↗
PubMed1993

Histologic parameters of vulvar invasive carcinoma and lymph node metastases.

We evaluated seven histologic parameters (tumor diameter, histologic grading, depth of stromal invasion, vascular invasion, pattern of invasion, lymphoplasmocytic infiltration and amount of necrosis) of 50 cases of vulvar invasive carcinoma to assess their correlation with groin lymph node metastases. Of 50 patients, 25 had groin lymph node metastases. No lymph node metastasis was found in four cases with depth of invasion < or = 2.0 mm. Among the 31 patients with vascular invasion, 23 (74%) had positive nodes, whereas lymph nodes were metastatic only in two of the 19 patients (10%) without vascular invasion. At univariate analysis, performed with Fisher's exact method, all the parameters considered, except pattern of invasion and amount of necrosis, were significantly associated (P < .05) with lymph node metastases. However, after adjustment by multiple logistic regression for the variables statistically significant at univariate level, only the presence of vascular invasion was significantly associated with nodal involvement and tumor diameter was borderline, whereas the effect of the other variables was almost completely explained by confounding.

Aged↗
PubMed1992

The differential diagnosis of primary lung cancer: inter-observer agreement and contribution of specific diagnostic procedures.

In order to investigate inter-observer variability in the differential diagnosis of primary lung cancer among women and the contribution of specific diagnostic procedures to this diagnosis, a group of 449 suspect cases of this disease was studied. Based on a standard dossier (including clinical data and the reports, if present, of radiology, bronchoscopy and histology) six different physicians independently judged, for each woman, at each diagnostic step, the presence of a primary lung cancer. A final consensus was organized in order to define the true cases. Radiology and especially histology seem to give the most important contribution to the diagnosis. On the other hand bronchoscopy seems to be useful mainly as a guide for biopsy. A predictive value of 90% was found when both radiology and bronchoscopy were positive; in the other cases histology seems to be needed to reach an adequate discrimination. Inter-rater agreement increases with an increasing amount of information but is not very high even when histology is available.

Bronchoalveolar Lavage Fluid↗
PubMed1992

Inter-observer and intra-observer variability of mammogram interpretation: a field study.

To evaluate the performance of radiologists in mammographic mass screening, seven radiologists read blindly the mammograms of 45 women (two views for each breast). The films included 12 normal, 24 benign disease and 9 cancers. The readings were repeated after 2 years. As expected, variability was higher among radiologists than between the two readings of the same radiologist, but general reproducibility was moderate. Kappa values for a positive/negative classification were 0.45 at the first and 0.44 at the second reading (inter-observer comparisons). For the intra-observer comparisons, Kappa values ranged from 0.35 to 0.67 (mean 0.56). Generally, accuracy was low partly due to the difficulty of the cases. A slight increase in sensitivity was observed at the second reading. The level of agreement is a good indicator of accuracy. Proper training and standardization of criteria are essential before mass breast screening is implemented.

Breast Diseases↗
PubMed1991

A randomized trial of smoking cessation interventions in general practice in Italy.

The purpose of this study was to examine the effectiveness of different practice-based approaches to assist patients of primary care physicians to quit smoking and sustain cessation. Forty-four nonsmoking general practitioners volunteered for the study. After a period of training, they randomized 923 smoking clients, unselected for motivation toward quitting, to four different intervention groups: (i) minimal intervention, consisting of one single counselling session and a brief handout on quitting techniques; (ii) repeated counselling including reinforcing sessions at Months 1, 3, 6, and 9; (iii) repeated counselling and use of nicotine gum; and (iv) repeated counselling and spirometry. Biochemically validated smoking status was assessed at six and 12 months after recruitment. The proportion of verified quitters at 12 months was 4.8 percent among subjects randomized to the minimal intervention group, compared to 5.5 percent, 7.5 percent, and 6.5 percent among those randomized to the three repeated-counselling groups. In no treatment group was the outcome significantly different from that for one-time counselling at the (P less than 0.05) level. Lack of power, contamination, and low attendance at reinforcing sessions should be taken into account in interpreting the results.

Adult↗
PubMed1991

Who has Pap tests? Variables associated with the use of Pap tests in absence of screening programmes.

Characteristics associated with the use of Pap tests were studied in a random sample of 581 women 18-69 years old; residents of Turin, Italy. There has been no organized screening programme in the area. (Tests possibly related to symptoms were not considered). Data were analysed by multiple logistic regression. Some 48% of women had never had a smear. The prevalence of women ever undergoing a Pap test was higher in middle-aged, married and more educated women (p less than 0.001 in all these cases). We found a linear trend (p less than 0.05) related to time since last visit to the family physician. A number of 'preventive' behavioural practices (physical exercise, no alcohol consumption) and experience of early diagnostic procedures for cancer e.g. BSE and mammography, were also associated with ever having had a Pap smear. The prevalence of ever-tested women was significantly lower among lifetime non-smokers than among ex-smokers and current smokers who planned to stop smoking but not lower than in current smokers who did not plan to stop. Results were similar when having had a test within the last three years was taken as the outcome. These results may be useful in planning screening strategies and educational programmes designed to improve attendance in an organized screening programme.

Adolescent↗
PubMed1991

[General practitioners and interventions against smoking: a critical review of interventions].

In this review we considered smoking cessation interventions delivered by general practitioners in consideration of their privileged position as health promoters. We selected 11 randomized trials on: a) counselling; b) nicotine gum; c) perception of health hazards in relationship with cigarette smoking. The interventions were delivered to smokers during clinical encounters. Amount of time spent by physicians during clinical encounters and number of reinforcing sessions emerged as the most important factors in a successful intervention. Nicotine gum prescription and perception of health hazards did not show any significant effect but the opportunity as reinforcing sessions.

Adolescent↗
PubMed1990

Practice of early diagnosis of breast and uterine cervix cancer in a northern Italian town.

We studied the practice of screening for breast and uterine cervix cancer in Torino where, currently, no kind of organized program exists and two projects of population screening programs, based on pap smear and mammography, have been developed. Fifty-two percent (95% confidence limits (C.L.): 47%-58%) of women 18-69 years old had had a pap test or colposcopy in the absence of symptoms during their lifetime. Among them 50% had had their last pap test within 18 months of the interview, 77% within 3 and 1/2 years, and only 14% was screened 5 and 1/2 years before or earlier. Thirty percent of never-screened women (95% C.L.: 25-35%) would not accept any of the proposed modalities for screening. Overall, 15% of women had had a mammography for screening purposes. Among women 50 to 59 years old, 23% (95% C.L.: 17-30%) had had at least one mammography for screening purposes in their lifetime, but only 18% (95% C.L.: 13-24%) had had at least 1 screening test at age 50 or after. Half of ever-screened women age 50-69 years had had the last mammography within 2 and 1/2 years. Among all respondents in the same age group this figure was 11% (95% C.L.: 7-15%). Forty-one percent of respondents reported to currently practice BSE (95% C.L.: 36-45%), but this proportion dropped to 10% in the age group 19-39 years and to 4% among women 40-69 years old when only those who had 10-13 examinations each year and judged their performance to be good were considered. Thirty-nine percent (95% C.L.: 34-44%) had had a physical examination of the breast performed by a medical doctor in the absence of symptoms within the last 18 months. Thirty-five percent (95% C.L.: 31-38%) of all women had never had a mammography, did not practice BSE, and had never consulted a physician for control in the absence of symptoms. Analysis by age, birth cohort, education, marital status and place of birth is presented.

Adolescent↗
PubMed1989

A mortality cohort study in a north Italian aircraft factory.

Mortality in a cohort of 8626 workers employed between 1954 and 1981 in an aircraft manufacturing factory in northern Italy was studied. Total follow up was 132,042 person-years, with 76% accumulated in the age range 15 to 54. Median duration of follow up from the date of first employment was 16 years. Vital status was ascertained for 98.5% of the cohort. Standardised mortality ratios were calculated based on Italian national mortality rates. Altogether 685 deaths occurred (SMR = 85). There was a significant excess of mortality for melanoma (6 cases, SMR = 561). Six deaths certified as due to pleural tumours occurred. No significant excess of mortality was found in specific jobs or work areas.

Adolescent↗
PubMed1987

Epidemiology of respiratory cancers related to nickel mining and refining in New Caledonia (1978-1984).

The incidence rate of respiratory (lung and upper respiratory tract) cancer related to the nickel industry was studied in the male population of New Caledonia over a 7-year period (1978-1984). The findings show no excess incidence of lung or upper respiratory tract (larynx, pharynx, nasal cavities) cancer cases in the population of nickel workers compared with the rest of the male population in New Caledonia. This result was corroborated by a case-control study which does not indicate any particular role of hazards specific to the nickel mining and refining industry. Our findings, which may be specific for the type of ore processed in New Caledonia, must nevertheless be confirmed by extending the study to a total of 10 years (1978-1987). The incidence rate of male respiratory cancer in New Caledonia was also compared to that of cancers of this type reported in certain regions of industrialized countries (Australia, France, U.K., USA). Such findings are very similar to those observed in New Caledonia, thereby confirming a predominant role of tobacco and alcohol consumption in a territory which, despite certain characteristics of a developing country, has life-style habits similar to those of industrialized countries.

Adult↗
PubMed1986

[Retrospective evaluation of occupational exposure in epidemiologic studies. Use of the Delphi method].

A method, based on the Delphi technique, for evaluating occupational risks in a quantifiable manner was devised in the course of a case-control study on respiratory cancers in the nickel mining and refining industry in New Caledonia. There were four stages in the evaluation process: identification of eleven potential carcinogenic factors in the company during the 1930-1977 period; grouping of a limited number of work-stations; evaluation of exposure levels for the different factors for each workstation; computation of the cumulative value of exposure for each subject under study. A partial validation study shows that this kind of approach may prove useful for future occupational epidemiological studies.

Carcinogens, Environmental↗