To identify those studies in which economic analysis of predictive genetic and pharmacogenetic te... more To identify those studies in which economic analysis of predictive genetic and pharmacogenetic testing programs have been carried out. Since the Italian National Prevention Plan 2014-2018 foresees the implementation of genetic testing for inherited breast cancer, special attention was given to the cost-effectiveness of BRCA1/2 testing programs. A systematic review of primary economic evaluations (EEs) of predictive genetic and pharmacogenetic testing programs and an overview of previously published systematic reviews of economic evaluations (ERs) was performed. Overall 128 EEs and 11 ERs were identified. The methodological quality of both EEs and ERs was good on average. Both predictive genetic and pharmacogenetic testing programs were mainly concerned with oncological diseases. Seventeen percent of genetic testing programs are cost-saving, while a further 44% of cost/QALY ratios fall under the commonly used threshold of €37,000 per QALY. For BRCA1/2 testing, only cascade genetic sc...
Annali di igiene: medicina preventiva e di comunità
In the first half of this year the experts of the Italian Society of Hygiene (SItI), along with t... more In the first half of this year the experts of the Italian Society of Hygiene (SItI), along with those of other National Scientific Societies, agreed with the recommendations made by the USA CDC in 2009, and developed a proposal for a vaccination schedule (Vaccine Schedule for Life), in which influenza vaccination is recommended for all adults aged between 50 and 64 years. In the National Plan for Vaccinal Prevention 2012-2014, which was published just before the issue of the SItI Calendar but concluded earlier (end of 2011), influenza vaccination is recommended "only" for all persons > or = 65 years or included in one of the many at-risk categories. The issue is controversial and has generated considerable debate at national and international level. This short note discusses the logical processes and the scientific evidence in support or against the decision to extend the influenza vaccination. The Authors conclude that the epidemiological approach used by SItI experts is appropriate. In any case, further studies on the topic are strongly needed, and their results should be taken into account in the drafting of future vaccination schedules.
Currently web health portals are moving away from providing institutional and administrative type... more Currently web health portals are moving away from providing institutional and administrative types of information towards a more interactive type of communication focused on providing citizens and health care professionals various services associated with health promotion and on facilitating access to healthcare services. The aim of this study was to provide guidance in the planning and conduction of online health promotion and protection communication activities that will contribute to the process of community empowerment repeatedly called upon by the WHO. For this purpose, the authors conducted an analysis of the epidemiology of the determinants of health and disease in Italy as well as two systematic revisions of the literature regarding web-based health information needs of citizens and the efficacy of health promotion and preventative interventions administered via the internet. Although current scientific evidence suggests that some interventions (e.g. expert systems or tailored interventions) are more effective with respect to others (e.g. online support groups or other types of interventions), common sense suggests that public health computer platforms such as the " citizens' channel" of the Ministry of Health web portal should implement hybrid models, i.e. models that contain various types of interventions, and should provide access to both general information and to interactive and personalized programs.
The Department of Public Health and Infectious Diseases of Sapienza University of Rome conducted ... more The Department of Public Health and Infectious Diseases of Sapienza University of Rome conducted a critical appraisal of Regional Prevention Plans (RPPs) 2010-2012 aimed at exploring different quality elements of the RPPs, including the coherence with the epidemiological context and with regional health planning, the degree of attention to specific public health issues, the adherence to the principles of Project Cycle Management (PCM) and Evidence-Based Prevention (EBP), as well as at analyzing possible determinants of the quality of RPPs, such as the influence of Recovery Plans. A grid analysis evidence-based was use to conduct, for the two RPPs areas (i.e. strategic and operative planning): 1. the descriptive analysis of RPPs; 2. the analysis of the projects included in RPPs. The analysis showed some strengths and weaknesses in the prevention planning process, including a low adherence to the principles of EBP and a low degree of attention towards the reduction of health inequalities. Furthermore, projects developed by Regions with recovery plans showed a lower quality. The role of the University in the ongoing evaluation of the planning process, but also in monitoring the health status of the population, with particular attention to regional differences, can be crucial to support regional capacity building in prevention planning.
A prevalence study was conducted to evaluate Staphylococcus aureus nasal colonization in two grou... more A prevalence study was conducted to evaluate Staphylococcus aureus nasal colonization in two groups of injection drug users recruited at two drug addiction treatment centres in Rome and Frosinone (Italy). Prevalence of Staphylococcus aureus nasal colonization in the 181 subjects included in the study was 8.83%. Significantly increased carriage rates were found among drug users in Frosinone with respect to those in Rome. No other significant determinants of colonization were identified through multiple logistic regression analysis. Only 2 of 16 Staphylococcus aureus strains (12.5%) were found to be methicillin resistant. Genomic DNA restriction pattern analysis, through SmaI digestion and pulsed field gel electrophoresis, demonstrated wide genetic heterogeneity among the isolates. Although the great majority of PFGE patterns were found in single isolates, in some cases common patterns were identified in isolates obtained from different drug users, clearly indicating the possibility of interhuman transmission of Staphylococcus aureus in this population.
To evaluate the safety and efficacy as a tool of smoking cessation of electronic cigarettes (e-ci... more To evaluate the safety and efficacy as a tool of smoking cessation of electronic cigarettes (e-cigarettes), directly comparing users of e-cigarettes only, smokers of tobacco cigarettes only, and smokers of both. Prospective cohort study. Final results are expected in 2019, but given the urgency of data to support policies on electronic smoking, we report the results of the 12-month follow-up. Direct contact and structured questionnaires by phone or via internet. Adults (30-75 years) were included if they were smokers of ≥1 tobacco cigarette/day (tobacco smokers), users of any type of e-cigarettes, inhaling ≥50 puffs weekly (e-smokers), or smokers of both tobacco and e-cigarettes (dual smokers). Carbon monoxide levels were tested in a sample of those declaring tobacco smoking abstinence. Sustained smoking abstinence from tobacco smoking at 12 months, reduction in the number of tobacco cigarettes smoked daily. We used linear and logistic regression, with region as cluster unit. Follow...
This study was aimed to assess the association between regional financial deficits and Recovery P... more This study was aimed to assess the association between regional financial deficits and Recovery Plans and the quality of the 702 projects developed by the Italian Regions within the National Prevention Plan 2010-13. Multivariate analyses showed significant associations between Recovery Plans and low quality of projects, possibly due to weak regional public health capacities. Regions with Recovery Plans are likely to focus mainly on short-term issues with a high impact on health care costs, leaving few resources available for prevention. A different approach to financial deficit focused on long-term strategies, including those for health promotion and disease prevention, is needed.
With cutbacks being implemented across a wide range of social and government programs throughout ... more With cutbacks being implemented across a wide range of social and government programs throughout Europe and the rest of the world, preventive services have become more vulnerable. In this context, it is essential to properly focus the debate on public healthcare expenditure, stressing that financing preventive services is not merely a cost, but an investment in citizen well-being as well as economic stability and development. In Italy indeed all seem to agree on three priorities: i) strengthening prevention activities; ii) reorganization of hospital care; and iii) reinforcement of primary care. A plenty of data are available in Italy from some recently published authoritative reports. Given that health policies should be driven by a solid evidence base, it is important to look at the available data to understand if these priorities are justified. The Lazio Region, which is particularly under pressure since it is one of the regions with a formal regional recovery plan (Piano di Rient...
Catheter ablation is a common and effective procedure for addressing atrial fibrillation (AF) ref... more Catheter ablation is a common and effective procedure for addressing atrial fibrillation (AF) refractory to antiarrhythmic drugs. AF can be terminated in 3 modes: (1) directly into sinus rhythm (SR); (2) evolving into regular atrial tachycardia (AT) and subsequently into SR; and (3) after direct current (DC) cardioversion if AF persists. Scarce data are available on the relationship between clinical outcomes and termination mode after 1 catheter ablation. The purpose of this study was to evaluate for the first time the association between 1-year ablation efficacy and termination mode after repeated catheter ablations in patients presenting with persistent or long-standing persistent AF. This prospective study involved 400 consecutive patients (age 62.7 ± 7.2 years) who underwent catheter ablation for drug-refractory persistent AF (4.6 ± 2.4 months) using a stepwise ablation approach. AF was terminated by radiofrequency application directly into SR in 135 patients; passing through AT into SR in 195 patients; and through DC cardioversion in 70 patients. After 1-year follow-up with repeated Holter monitoring, the percentages of SR maintenance were 72.6%, 80.0%, and 28.6%, respectively (P < .001). Compared with the subjects who were converted directly into SR, the adjusted hazard ratios (HRs) of SR maintenance were significantly lower for those who required DC cardioversion (HR = 0.54; P < .001) and higher for those converted through AT (HR = 1.69; P = .027). The latter association was even stronger in the 104 subjects who required a second procedure (HR = 6.25; P = .001). Termination of AF through AT during catheter ablation was more effective than both DC shock and direct SR in maintaining stable SR 1 year after both the first and the second procedures.
A systematic review was undertaken to produce an annotated bibliography of meta-analyses in vacci... more A systematic review was undertaken to produce an annotated bibliography of meta-analyses in vaccinology and to evaluate their methodological quality. Based on our evaluation using the Oxman and Guyatt index, the methodological quality of the 121 meta-analyses included in this study is not satisfactory. The most frequent limitations include non-comprehensive bibliographic research; bias in the selection of the studies; lack of quality assessment of individual studies; absence of evaluation of heterogeneity among studies and publication bias. The methodological quality significantly increases with the year of publication and with declared financial support, without differences between profit and non-profit support. Meta-analyses with a higher Oxman and Guyatt quality score are more likely to include only randomized trials and to explore appropriately potential sources of heterogeneity. Most of the methodological deficiencies of meta-analyses in vaccinology could be corrected easily, and meta-analysts should improve the methodological quality of their work to maintain their impact on policy decisions.
To identify those studies in which economic analysis of predictive genetic and pharmacogenetic te... more To identify those studies in which economic analysis of predictive genetic and pharmacogenetic testing programs have been carried out. Since the Italian National Prevention Plan 2014-2018 foresees the implementation of genetic testing for inherited breast cancer, special attention was given to the cost-effectiveness of BRCA1/2 testing programs. A systematic review of primary economic evaluations (EEs) of predictive genetic and pharmacogenetic testing programs and an overview of previously published systematic reviews of economic evaluations (ERs) was performed. Overall 128 EEs and 11 ERs were identified. The methodological quality of both EEs and ERs was good on average. Both predictive genetic and pharmacogenetic testing programs were mainly concerned with oncological diseases. Seventeen percent of genetic testing programs are cost-saving, while a further 44% of cost/QALY ratios fall under the commonly used threshold of €37,000 per QALY. For BRCA1/2 testing, only cascade genetic sc...
Annali di igiene: medicina preventiva e di comunità
In the first half of this year the experts of the Italian Society of Hygiene (SItI), along with t... more In the first half of this year the experts of the Italian Society of Hygiene (SItI), along with those of other National Scientific Societies, agreed with the recommendations made by the USA CDC in 2009, and developed a proposal for a vaccination schedule (Vaccine Schedule for Life), in which influenza vaccination is recommended for all adults aged between 50 and 64 years. In the National Plan for Vaccinal Prevention 2012-2014, which was published just before the issue of the SItI Calendar but concluded earlier (end of 2011), influenza vaccination is recommended "only" for all persons > or = 65 years or included in one of the many at-risk categories. The issue is controversial and has generated considerable debate at national and international level. This short note discusses the logical processes and the scientific evidence in support or against the decision to extend the influenza vaccination. The Authors conclude that the epidemiological approach used by SItI experts is appropriate. In any case, further studies on the topic are strongly needed, and their results should be taken into account in the drafting of future vaccination schedules.
Currently web health portals are moving away from providing institutional and administrative type... more Currently web health portals are moving away from providing institutional and administrative types of information towards a more interactive type of communication focused on providing citizens and health care professionals various services associated with health promotion and on facilitating access to healthcare services. The aim of this study was to provide guidance in the planning and conduction of online health promotion and protection communication activities that will contribute to the process of community empowerment repeatedly called upon by the WHO. For this purpose, the authors conducted an analysis of the epidemiology of the determinants of health and disease in Italy as well as two systematic revisions of the literature regarding web-based health information needs of citizens and the efficacy of health promotion and preventative interventions administered via the internet. Although current scientific evidence suggests that some interventions (e.g. expert systems or tailored interventions) are more effective with respect to others (e.g. online support groups or other types of interventions), common sense suggests that public health computer platforms such as the " citizens' channel" of the Ministry of Health web portal should implement hybrid models, i.e. models that contain various types of interventions, and should provide access to both general information and to interactive and personalized programs.
The Department of Public Health and Infectious Diseases of Sapienza University of Rome conducted ... more The Department of Public Health and Infectious Diseases of Sapienza University of Rome conducted a critical appraisal of Regional Prevention Plans (RPPs) 2010-2012 aimed at exploring different quality elements of the RPPs, including the coherence with the epidemiological context and with regional health planning, the degree of attention to specific public health issues, the adherence to the principles of Project Cycle Management (PCM) and Evidence-Based Prevention (EBP), as well as at analyzing possible determinants of the quality of RPPs, such as the influence of Recovery Plans. A grid analysis evidence-based was use to conduct, for the two RPPs areas (i.e. strategic and operative planning): 1. the descriptive analysis of RPPs; 2. the analysis of the projects included in RPPs. The analysis showed some strengths and weaknesses in the prevention planning process, including a low adherence to the principles of EBP and a low degree of attention towards the reduction of health inequalities. Furthermore, projects developed by Regions with recovery plans showed a lower quality. The role of the University in the ongoing evaluation of the planning process, but also in monitoring the health status of the population, with particular attention to regional differences, can be crucial to support regional capacity building in prevention planning.
A prevalence study was conducted to evaluate Staphylococcus aureus nasal colonization in two grou... more A prevalence study was conducted to evaluate Staphylococcus aureus nasal colonization in two groups of injection drug users recruited at two drug addiction treatment centres in Rome and Frosinone (Italy). Prevalence of Staphylococcus aureus nasal colonization in the 181 subjects included in the study was 8.83%. Significantly increased carriage rates were found among drug users in Frosinone with respect to those in Rome. No other significant determinants of colonization were identified through multiple logistic regression analysis. Only 2 of 16 Staphylococcus aureus strains (12.5%) were found to be methicillin resistant. Genomic DNA restriction pattern analysis, through SmaI digestion and pulsed field gel electrophoresis, demonstrated wide genetic heterogeneity among the isolates. Although the great majority of PFGE patterns were found in single isolates, in some cases common patterns were identified in isolates obtained from different drug users, clearly indicating the possibility of interhuman transmission of Staphylococcus aureus in this population.
To evaluate the safety and efficacy as a tool of smoking cessation of electronic cigarettes (e-ci... more To evaluate the safety and efficacy as a tool of smoking cessation of electronic cigarettes (e-cigarettes), directly comparing users of e-cigarettes only, smokers of tobacco cigarettes only, and smokers of both. Prospective cohort study. Final results are expected in 2019, but given the urgency of data to support policies on electronic smoking, we report the results of the 12-month follow-up. Direct contact and structured questionnaires by phone or via internet. Adults (30-75 years) were included if they were smokers of ≥1 tobacco cigarette/day (tobacco smokers), users of any type of e-cigarettes, inhaling ≥50 puffs weekly (e-smokers), or smokers of both tobacco and e-cigarettes (dual smokers). Carbon monoxide levels were tested in a sample of those declaring tobacco smoking abstinence. Sustained smoking abstinence from tobacco smoking at 12 months, reduction in the number of tobacco cigarettes smoked daily. We used linear and logistic regression, with region as cluster unit. Follow...
This study was aimed to assess the association between regional financial deficits and Recovery P... more This study was aimed to assess the association between regional financial deficits and Recovery Plans and the quality of the 702 projects developed by the Italian Regions within the National Prevention Plan 2010-13. Multivariate analyses showed significant associations between Recovery Plans and low quality of projects, possibly due to weak regional public health capacities. Regions with Recovery Plans are likely to focus mainly on short-term issues with a high impact on health care costs, leaving few resources available for prevention. A different approach to financial deficit focused on long-term strategies, including those for health promotion and disease prevention, is needed.
With cutbacks being implemented across a wide range of social and government programs throughout ... more With cutbacks being implemented across a wide range of social and government programs throughout Europe and the rest of the world, preventive services have become more vulnerable. In this context, it is essential to properly focus the debate on public healthcare expenditure, stressing that financing preventive services is not merely a cost, but an investment in citizen well-being as well as economic stability and development. In Italy indeed all seem to agree on three priorities: i) strengthening prevention activities; ii) reorganization of hospital care; and iii) reinforcement of primary care. A plenty of data are available in Italy from some recently published authoritative reports. Given that health policies should be driven by a solid evidence base, it is important to look at the available data to understand if these priorities are justified. The Lazio Region, which is particularly under pressure since it is one of the regions with a formal regional recovery plan (Piano di Rient...
Catheter ablation is a common and effective procedure for addressing atrial fibrillation (AF) ref... more Catheter ablation is a common and effective procedure for addressing atrial fibrillation (AF) refractory to antiarrhythmic drugs. AF can be terminated in 3 modes: (1) directly into sinus rhythm (SR); (2) evolving into regular atrial tachycardia (AT) and subsequently into SR; and (3) after direct current (DC) cardioversion if AF persists. Scarce data are available on the relationship between clinical outcomes and termination mode after 1 catheter ablation. The purpose of this study was to evaluate for the first time the association between 1-year ablation efficacy and termination mode after repeated catheter ablations in patients presenting with persistent or long-standing persistent AF. This prospective study involved 400 consecutive patients (age 62.7 ± 7.2 years) who underwent catheter ablation for drug-refractory persistent AF (4.6 ± 2.4 months) using a stepwise ablation approach. AF was terminated by radiofrequency application directly into SR in 135 patients; passing through AT into SR in 195 patients; and through DC cardioversion in 70 patients. After 1-year follow-up with repeated Holter monitoring, the percentages of SR maintenance were 72.6%, 80.0%, and 28.6%, respectively (P < .001). Compared with the subjects who were converted directly into SR, the adjusted hazard ratios (HRs) of SR maintenance were significantly lower for those who required DC cardioversion (HR = 0.54; P < .001) and higher for those converted through AT (HR = 1.69; P = .027). The latter association was even stronger in the 104 subjects who required a second procedure (HR = 6.25; P = .001). Termination of AF through AT during catheter ablation was more effective than both DC shock and direct SR in maintaining stable SR 1 year after both the first and the second procedures.
A systematic review was undertaken to produce an annotated bibliography of meta-analyses in vacci... more A systematic review was undertaken to produce an annotated bibliography of meta-analyses in vaccinology and to evaluate their methodological quality. Based on our evaluation using the Oxman and Guyatt index, the methodological quality of the 121 meta-analyses included in this study is not satisfactory. The most frequent limitations include non-comprehensive bibliographic research; bias in the selection of the studies; lack of quality assessment of individual studies; absence of evaluation of heterogeneity among studies and publication bias. The methodological quality significantly increases with the year of publication and with declared financial support, without differences between profit and non-profit support. Meta-analyses with a higher Oxman and Guyatt quality score are more likely to include only randomized trials and to explore appropriately potential sources of heterogeneity. Most of the methodological deficiencies of meta-analyses in vaccinology could be corrected easily, and meta-analysts should improve the methodological quality of their work to maintain their impact on policy decisions.
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