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N Segnan

Publications and source records attributed to N Segnan.

54 records · Page 3Linked to original sources
PubMed1984

Pleural plaques and risk of cancer in Turin, northwestern Italy. An autopsy study.

The relationship between the occurrence of neoplastic diseases and the presence of pleural plaques was studied in a series of 1097 autopsies performed in Turin from the adult general population. In men, pleural plaques showed an association with the presence of laryngeal, pulmonary, esophageal, and colorectal cancer. Only cancer of the larynx was strongly related to the occurrence of such pleural changes. This autopsy investigation confirms previous observations by others based on x-ray findings, and suggests that pleural plaques may be regarded as risk indicators of possibly asbestos-related tumors in the general population.

Aged↗
PubMed1983

Association of father's occupation and cancer in children.

Seven epidemiologic studies on the possible association between parental occupations and cancer in childhood are reviewed. Most were based on the hypothesis of an etiologic role of parental occupations, involving exposure to the broad category of "hydrocarbons". The relevant observations were contradictory, possibly because of the vagueness of the definition of the risk factor. Some findings were significant in at least two studies, such as an excess of machinists and mechanics among fathers of children with Wilms' tumor and an excess of occupations with exposure to paints among children with brain cancer. These and other findings should be considered as hypotheses for further studies.

Adolescent↗
PubMed1981

Evidence of a multiplicative effect between cigarette smoking and occupational exposures in the aetiology of bladder cancer.

A case-control study on urinary tract cancer in men is ongoing in the Province of Torino. The analysis of tobacco smoke and occupational histories of the first 225 case-control pairs is described. The overall relative risks (RR) for tobacco smoke and for occupations known to entail a risk for bladder cancer were respectively 4.8 (95% confidence limits (C.L.) 2.4--9.3) and 1.7 (1.0--2.7). There was a clearcut dose-response relationship between different categories of cigarette consumption and risk for urinary tract cancer. For each level of cigarette consumption, relative risks were compared between men reporting and non-reporting occupation at risk. This analysis suggested a multiplicative effect between the 2 factors.

Aged↗
PubMedDate not supplied

Predictors of smoking cessation following physicians' counseling.

BACKGROUND: The purpose of this study was, to identify predictors of quitting following general practitioners' (GP) anti-smoking counseling. METHODS: We studied determinants (characterized following the Precede framework) of successful quitting (1 year sustained abstinence, biochemically confirmed at 6- and 12-month follow-up) among 861 smokers randomized to the intervention groups based on repeated counseling (RC), RC + spirometric testing, and RC + nicotine gum, in a smoking cessation trial carried out in Turin, Italy. RESULTS: GPs' intervention worked best for male (OR = 2.30; 95% CI, 1.13-4.52) and married (OR = 3.63; 95% CI, 1.37-9.59) smokers, for smokers who had maintained abstinence for at least 1 month in the past (OR = 6.78; 95% CI, 1.56-29.52) or at their first quit attempt (OR = 10.91; 95% CI, 2.37-50.13), and for those who spontaneously reduced their coffee consumption (OR = 3.30; 95% CI, 1.59-6.82); heavy smokers (> = 20 cig/day OR = 0.48; 95% CI, 0.24-0.93) and those living with other smokers (> = 1 smokers in the household: OR = 0.44; 95% CI, 0.22-0.90) were less likely to give up. Previous antismoking advice by the GP represented a strong barrier to success for healthy smokers (OR = 0.19; 95% CI, 0.07-0.52), but not for those reporting symptoms of shortness of breath (OR = 0.63; 95% CI, 0.39-9.20). There were no interactions between predictors and treatment conditions. CONCLUSIONS: Assessment of factors influencing quitting would allow GPs to tailor their message to address existing barriers and to help patients utilize their resources for change.

Adult↗
PubMedDate not supplied

General practitioners and mammographic screening uptake: influence of different modalities of general practitioner participation. Working Group.

AIMS AND BACKGROUND: To compare the impact of different modalities of general practitioner (GP) involvement, including the introduction of target payments, on the attendance rate of organized population-based screening programs for breast cancer in Italy. STUDY DESIGN: The study was conducted between 1994 and 1996 in four Italian cities where mammographic screening programs are active: Caltanissetta (CL), Firenze (FI), Modena (MO) and Torino (TO). The impact on attendance rate of different invitation strategies based on active GP involvement was tested in each center. The additional effect of economic incentives was also assessed. The incentives were proportional to the level of compliance attained by each GP and weighted by the size of his eligible patients' list. RESULTS: In the Firenze project, an invitation signed by the GP and the project co-ordinator attained a statistically significant higher participation (difference: 4.2%, chi2 = 7.42, P = 0.006). In Caltanissetta and Torino there was a significant increase of about 7% in the response rate to the postal reminder in the groups contacted by the GPs. No difference was observed in the Modena project between the two groups. CONCLUSIONS: The main contributions of GP involvement can be: "cleaning up" the invitation lists, especially when computerized archives with the mammographic history of the target population are not available; increasing the women's participation by signing the invitation letter, by counseling and active participation in the invitation phase; co-operating in the reminder phase by recalling women non responders at first invitation. The offer of target payment had a certain impact on the screening uptake, but not easily distinguishable from GP signature of the invitation letter; further studies of appropriate design should be planned. Organizational factors, such as availability of a list of non-responders, might be crucial in order to enhance the effect of the GPs' action.

Family Practice↗
PubMedDate not supplied

[Study of the geographical pathology of laryngeal, bladder and childhood tumors in the Province of Turin].

A previous report has shown that in the non-metropolitan areas of the province of Torino the incidence of cancer of the larynx in men during the period 1965-1969, although lower than in the town of Torino and its suburbs, was 3-6 times higher than in Great Britain, Norway, Sweden and Denmark. In the present study the distribution of these cancers was investigated in the 12 ecological areas and/or subareas forming the non-metropolitan areas of the province. A similar study for bladder cancer in adult men and all cancers (including leukaemias) in children, is also reported. In subareas 36, 37 and 42 of ecological area 01 (i.e., located NW of the capital and its suburbs) as well as in area 02 (located North of the province, around the town of Ivrea) a significant excess of laryngeal cancers have been diagnosed in adult men during the period 1965-1969. Cancer of the bladder was found in excess in men residing in subareas 37 and 43 of area 01 (geographically related to the town of Ciriè, where an epidemic of bladder cancer was recognized among workers of a chemical factory where 2-naphthylamine and benzidine have been widely used in the past), as well as in men residing in area 02. In addition, laryngeal cancer was found in excess among residents in Balangero (where a large asbestos-chrysotilemine has been in operation for a long time) and adjacent towns (observed 12, expected 5.14, p less than 0.01). Bladder cancer was particularly frequent among residents in Ciriè and adjacent towns (19 cases vs. 9.18 expected, p less than 0.01) as well as in those residing in Ivrea and adjacent towns (24 vs. 14.61 expected, p less than 0.02). On the contrary, the whole area situated East and South of Torino and its suburbs seems to be a low-incidence area for both laryngeal and bladder cancer. For both tumor types the highest incidence was found in the town of Torino. Men residing in the 23 suburbs of Torino showed a high incidence of laryngeal cancer and a low incidence of bladder cancer. Cancers in children were fairly uniformly distributed throughout the whole province, including the capital.

2-Naphthylamine↗
PubMedDate not supplied

Breast cancer screening: characteristics and results of the Italian programmes in the Italian group for planning and evaluating breast cancer screening programmes (GISMa).

In 1990, GISMa (Italian Group for planning and evaluating Mammographic Screening - Gruppo Italiano per la pianificazione e la valutazione dei programmi di Screening Mammografico), a working group of operators (radiographers, radiologists, epidemiologists, clinicians, surgeons) involved in screening programmes ongoing in Italy, was created within the Italian School of Senology. The aim of this study is to illustrate data, presented at the GISMa meeting held in April 1994, concerning the characteristics of each programme and some early indicators of effectiveness. To assess these parameters (concerning compliance level, recall rate, benign/malignant biopsy ratio, detection rate, stage distribution, nodal involvement and number of cancers with a diameter under 1 cm, rate of cancer, etc.), 'acceptable' and 'desirable' standards obtained from Italian and North-European cancer screening experiences have been adopted. Most programmes have shown an acceptable standard for most of the indicators, and many of them have attained desirable levels. In most screening programmes the occurrence of interval cancers has not yet been measured, but all centres have (or are working to set up) a systematic active procedure to collect the data. The results indicate that common guidelines can be adopted, even when working in very heterogeneous contexts, and that it is possible to achieve a very high effectiveness and efficacy level. As regards quality control and cost/benefit issues, the goal of extending centralised, population-based screening programmes to other Italian regions becomes a priority.

Aged↗
PubMedDate not supplied

Promoting participation in a population screening program for breast and cervical cancer: a randomized trial of different invitation strategies.

AIMS AND BACKGROUND: Attendance level has been identified as a major determinant of cost-effectiveness of organized screening programs. We tested the effectiveness of 4 different invitation systems in the context of an organized population screening program for cervical and breast cancer. METHODS: Women eligible for invitation--8385 for cervical and 8069 for breast cancer screening--listed in the rosters of 43 and 105 general practitioners (GP), respectively, who had accepted to collaborate in the program, were randomized to 4 invitation groups: Group A--letter signed by the GP, with a prefixed appointment; Group B--open-ended invitation, signed by the GP, prompting women to contact the screening center to arrange an appointment; Group C--letter (same as for group A), signed by the program coordinator, with a prefixed appointment; Group D--extended letter (highlighting the benefits of early cancer detection) signed by the GP, with a prefixed appointment. Assignment to the interventions was based on a randomized block design (block=GP). RESULTS: Assuming Group A as the reference, the overall compliance with cervical cancer screening was reduced by 39% in Group B (RR=0.61; 95% CI, 0.56-0.68) and by 14% in Group C (RR=0.86; 95% CI, 0.78-0.93); no difference was observed for Group D (RR=1.03; 95% CI, 0.95-1.1). The response pattern was similar for breast screening (Group B: RR=0.71; 95% CI, 0.65-0.76; Group C: RR=0.87; 95% CI, 0.81-0.94; Group D: RR=1.01; 95% CI, 0.94-1.08). CONCLUSIONS: Personal invitation letters signed by the woman's GP, with preallocated appointments, induce a significant increase in compliance with screening. Efficiency can be ensured through the adoption of overbooking, provided that attendance levels are regularly monitored.

Adult↗
PubMedDate not supplied

A first survey of organized cervical cancer screening programs in Italy. GISCi working group on organization and evaluation. Gruppo Italiano Screening Citologico.

In Italy, where no national screening program for cervical cancer exists, organized programs have developed on a local basis. We performed the first survey of existing organized programs by mailing a standard questionnaire to a large network of possibly involved services. For the present survey, a program was defined as organized if personal invitations were sent. We identified 29 already active organized programs and 4 others in a starting phase. The target population of active programs included 2,074,820 women in the age range 25-64 years, corresponding to 13.5% of the Italian female population of the same age. The situation is rapidly evolving since many regional programs are being implemented. Most programs followed Italian and European recommendations as regards the age limits, interval between screening rounds, presence of a fail-safe system for women referred for colposcopy, presence of protocols for diagnostic workup and treatment, and presence of referral centers for such phases. However, many programs did not meet national guidelines as regards the size of laboratories interpreting smears, which were frequently small. Second-level referral centers also frequently had a very small activity. The average (weighted for size of the invited population) compliance to invitation and coverage (proportion of women with at least one test in the last 3 years) was 32.6% and 66.0%, respectively, therefore needing to be improved. Compliance to colposcopy (weighted for number of referred women) was 81.4%. We found a very high variability in the proportion of women referred for colposcopy that could only be partly explained by different referral protocols and could depend on different criteria of smear interpretation: the average (weighted for number of tested women) was 2.01%. A need for improvement in the process of evaluation and for homogenization of criteria of cytology interpretation was identified: work in this regard is on-going.

Adult↗
PubMedDate not supplied

[Compliance, conscious participation, and informed consent in tumor screening programs].

Compliance and coverage are supposed to be indicators of effectiveness in screening activities. Yet effectiveness is a necessary but not sufficient condition for a screening programme: adverse effects are intrinsic to screening practice; to persuade to comply to screening programme should imply that the advantages overwhelm the disadvantages; if at community level the balance is in favour of the screening, it is not possible to predict the weight for each individual of any potential harms. To accomplish individual values is fundamental from ethical point of view: we must avoid non responsible participation or uninformed refusal, through a reliable information on screening benefits and harms to the invited population. Therefore the concept of compliance should be abandon: "participation" should be used instead. The consequence of a different approach to participation in screening evaluation should be appreciated: new indicators and standards have to be defined. The following ones are proposed: prevalence of informed target population; prevalence of consent to invitation within the informed population; ratio consent/refusal to invitation; prevalence of participation in the invited group. It is unrealistic to expect an informed participation, to screening programme, from all population but incorporation of patient values and preferences is seen as the next frontier in attempts to devise valid practice guidelines. Research is needed to develop instrument on risk communication and informed consent, taking into account the current organisation of screening programs.

Humans↗
PubMedDate not supplied

[Urinary cotinine as indicator of exposure to passive smoking].

We studied the association between self-reported exposure to passive smoking (ETS) and urinary cotinine among 95 ex-smokers, who had quit in the context of a smoking cessation trial in general practice, and among 33 ex-smokers who had been contacted in the context of a study aimed at estimating the spontaneous cessation rate among smokers, listed in the roosters of the General Practitioners participating in the trial, who had not been offered recruitment. The results of multivariate linear regression analysis indicated that duration of exposure at home was strongly related to cotinine levels (increase of 1 ng/mg every 3 hours of exposure at home), quantified by radioimmunoassay. Duration of exposure in public places showed a similar effect, but the association was significant only among subjects who reported having been exposed in a heavily ETS polluted environment (increase of 1 ng/mg every 45 minutes of exposure). Among subjects exposed at work cotinine concentration was associated to subjects' judgement of the concentration of ETS, rather than to duration of exposure. Standardized questionnaires may provide a reasonably accurate description of ETS exposure and they can be used to assess exposure in etiologic studies. Non-smokers non exposed to ETS at home may not represent an appropriate control group in such studies. Indeed, they may be exposed to other sources, as indicated by the relatively high levels of urinary cotinine among ex-smokers non exposed at home in our study. Misclassification of these subjects may result in a dilution of the effect of the exposure.

Biomarkers↗
PubMedDate not supplied

Preventive practices of general practitioners in Torino, Italy.

Health care reforms introduced in Italy in the late 1970s triggered a profound rethinking of the role of general practitioners (GPs) in prevention. We interviewed 209 GPs registered in the Torino area to delineate their beliefs, attitudes, and practice patterns in relation to prevention. We examined an array of primary and secondary preventive interventions, including influenza vaccination of the elderly; counseling activities related to smoking, alcohol consumption, accidents, contraception, safety helmets, and seat belts; and early detection of hypertension and lung, cervical, and breast cancers. Improvement can still be made in the full implementation of preventive practices. We examine features of the organization of medical practices in Italy that impede the integration of preventive interventions in primary care.

Adult↗
PubMedDate not supplied

Determinants of preventive practices of general practitioners in Torino, Italy.

We conducted a study of general practitioners in Torino, Italy, to determine their patterns of preventive practice. We examined a set of primary and secondary preventive interventions and their determinants. We explored the determinants of primary preventive interventions (antismoking and alcohol abuse counseling, counseling for prevention of accidents at home among the elderly, flu vaccination for the elderly, and counseling on contraceptive use) and cancer early detection techniques (chest x rays and sputum cytology for lung cancer; mammography, physical examination, teaching of breast self-examination, and Papanicolaou [Pap] smear for gynecological cancers). Grouping determinants in cognitive, sociodemographic, and organization factors, we found different patterns for each maneuver. Cognitive factors played an important role, but their importance varied for each intervention. We found that smoking behavior of physicians predicted antismoking counseling. Further, the availability of other primary care services is an important factor in the early detection of gynecological cancers.

Accident Prevention↗
PubMedDate not supplied

[Cost-benefit analysis of a mammography screening program extended to all the national territory].

A cost-effectiveness analysis has been conducted in order to evaluate effects and costs of a nationwide mammographic breast cancer screening programme compared with no screening in a 30 years period. The analysis includes seven different phases of breast cancer, from the screening programme itself to the treatment of terminal illness. The estimates use italian published data and field studies. The calculations were performed with the Miscan computer simulation package: a programme providing for the screening of women aged 50-69 at two years intervals might be expected to result in a 1,650 deaths prevented and 14,500 years of life gained each year. The overall net costs of the programme were assessed at between 2,893 and 3,212 thousand million lire, the cost per life saved between 59.8 and 66.4 million lire and the cost per life-year gained between 6.6 and 7.3 million lire (between 10.7 and 11.5 million lire with a 5% discount rate, an estimate lower than that of German programme). The analysis produces important information for the Italian policy debate over mammography and it also contributes to the development of economic evaluation in our country.

Aged↗