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Objective: The main objective of the present study is to examine a number of suicides among Italian doctors. We further compared data from our sample with those of suicide in the general population and in the literature, in order to detect any differences that can provide preventive recommendations., Methods: This is a retrospective study of 60 suicides committed by doctors from 2009 to 2019, in Italy., Results: The sample was constituted mainly by men (77%, 46 cases) aged between 50 and 69 years (70%, n=42). Most of the suicides took place in Northern Italy (50%, n=30). Among known medical specialization, 26% (n=14) concerned general practitioners, the remaining 74% (n=39) were specialized doctors, with a prevalence of anesthetists (9%, n=5), haematologists (8 %, n=4), pediatricians (6%, n=3), psychiatrists (6%, n=3) and oncologists (6%, n=3). Regarding the suicide method, the most used was precipitation (30%, n=16), followed by poisoning/overdose (24%, n=13), firearm (19%, n=10), suffocation/hanging (19%, n=10) and self-induced injuries (8%, n=4)). The most frequent place of suicide is in 35 cases was at home (59%), followed by the hospital (18%; n=11), or others (23%; n=14). When possible, any reported risk factors and predisposing conditions for suicide were studied, and divided into five categories: depression/psychiatric pathology (28%, n=16); other organic disease (8%, n=5); work-related problems (stress, burn-out, mobbing, work-related judicial problems) (20%, n=12); judicial problems unrelated to the medical profession (8%, n=5); family and relationship problems (12%, n=7)., Conclusions: The risk factors for suicide in our sample of doctors overlap with data from literature for doctors in western countries. Clinical recommendations and prevention strategies for suicide risk are therefore similar.

Objectives: Building a database with the estimates of the observed populations of the Italian Cancer Registries (CR), subdivided into sex, annual age classes and calendar year; making this population database available in the AIRT website; making available an Excel file that allows the input of a population by 5-year age classes in order to obtain an esteem of the annual classes., Design: Employment of different interpolation methods, namely annual age classes starting from 5-year classes, an esteem of the final open class of 85 years and over., Participants: 17 CRs that take part to the incidence and mortality trend study promoted by AIRT in 2003., Setting: AIRT., Main Outcome: A database of the estimated populations observed by the CRs by sex and annual age classes on 31 December of each incidence year., Results: Only for 6 on 17 CRs taking part in the AIRT trend terpolation methods have been used. The performance of these methods, tested with an empirical measure of error called WMISE, have given good results, even if in the elderly classes the fit is poor and sometimes not sufficient., Conclusions: Different interpolation methods have been used to build and make available a database containing reliable data of population, in order to use them as denominators for the incidence and mortality trend analysis. It is also available an Excel file that allows the input of a population by 5-year age classes in order to obtain an esteem of the annual classes.

Aim: The purpose of the present paper is to calculate cancer incidence estimates in the italian regions for the year 2001., Design: Estimates are computed according to the mortality/incidence (M/I) ratio method. Observed data were from Italian areas covered by cancer registration and recently published by Cancer Registries Network (1993-1998), by the Italian National Institute of Health (ISS), that published mortality statistics for the year 1998, and by the National Institute of Statistics (Istat) that provided population figures for the year 2001. Regression coefficients of the M/I ratios specific by cancer site, age class, sex and geographical area were computed and then applied to the observed mortality in the Italian regions in the year 1998. The estimated number of new cancer cases was then computed multiplying the estimated rates for the regional populations in the year 2001, as published by Istat., Results: The total number of estimated new cancers (with the exclusion of skin cancers) in Italy was approximately 160,000 in men and 130,000 in women. The population of the Liguria region, older than other Italian regional populations, showed the highest crude rates, while its risk is similar compared to other Northern regions, as indicated by age-standardised rates. The most frequent tumour sites are the lung cancer (29,500 cases), the colon-rectum cancer (19,900 cases) and the prostate cancer (19,600 cases) in men; the breast cancer (35,000 cases), the colon-rectum cancer (19,500 cases) and the stomach cancer (6,800 cases) in women. The invasive cervical cancer, largely preventable with early diagnosis, is still responsible for approximately 3,000 new cases yearly., Conclusion: Incidence estimates are a useful tool for a better management of health resources. Treatment costs for tumour patients are generally high in the first period for diagnosis and principal treatment, while they fade during follow-up and remission. Costs increase during the terminal phase of disease. In the first period, costs can be predicted thanks to incidence estimates, while in the last period mortality data are more useful.

The Italian Network of Cancer Registries analyzed incidence and mortality cancer trends during the period 1986-1997 Overall, 525,645 incident cancers and 269,902 cancer deaths (in subjects 15 years and older) were included. Age-adjusted rates, joinpoints (points in time where trend significantly changes from linearity) and estimated annual percent changes in rates (EAPC) were computed. Overall cancer incidence was significantly increasing in both sexes and cancer mortality was significantly decreasing (since 1991 among males). Incidence and mortality trends are summarised for single cancer sites. Crude rates are also showed to evaluate the effect of population ageing in terms of diagnostic and therapeutic burden for the National Health System.

The present paper analyses temporal trends for skin cancers including Kaposi's sarcoma in the data set of the Italian Network of Cancer Registries (pool AIRT), during 1986-1997. The estimated annual percent change (EAPC) of the standardised incidence rates for non-melanoma skin cancer (61,586 analysed cases), increased from 1986 to 1997 by 7.5%/year among males and by 5.2%/year among females. Melanoma (8,516 cases and 2,312 deaths) showed increasing incidence, 6.2%/year among males and 5.8%/year among females, and stable mortality. As regards Kaposis sarcoma (1,156 cases), incidence increased among males from 1986 to 1995 by about 13%/year, and then decreased; among females incidence was significantly increasing along the period.

The present paper focuses on the Italian registries: their actual achievements, future developments and the possible critical states. The present setting is analysed in perspective with the international and European framework of cancer registries. Given the recent development of new cancer registries in Italy, and their participation to traditional and new international publication of their data, there is an increasing delay in publication time, both in Italy and abroad International and national institutions played an important role in helping and supporting registries' development, but delays in publications and some uncertainty in coordinating incidence and survival analyses in a unique framework is posing an unavoidable challenge.

This study shows the childhood cancer survival rates of 1,315 cases incident in the 1990-1994 period in Italy. The observed survival shows an increase over the previous period in almost all diagnostic groups. In particular, 5-year survival attained 72% overall, 78% for acute lymphatic leukaemia, about 100% for Hodgkin's disease, 70% for non Hodgkin's lymphomas, 64% for central nervous system tumours, 87% for retinoblastoma, 80% for renal tumours, 67% for hepatic tumours, 71% for bone tumours, and 70% for soft tissue sarcomas. Finally, the findings are comparable to those in other countries (USA, Great Britain, Australia, Slovakia) and they show a progressive improvement in survival.

In this paper we presented materials and methods used for analysing survival of cancer patients recorded by the Italian cancer registries. First, we included first primary malignant tumours and excluded skin carcinomas, and cases identified by death certificate only, or by autopsy. Observed survival has been computed with the life-table method, with one month time lags. We corrected survival rates by the overall mortality effect (relative survival) with the Hakulinen method. The relative survival was age and sex adjusted with the EUROCARE method. Finally we discussed the results presentation issues.

Translation of recommendations on skin cancer prevention formulated by many national and international institutions into efficient steps requires measuring the potential impact in terms of preventable cases. This study analyses the proportion of skin cancers attributable to sun exposure in Turin, Trento and Ragusa. Estimates have been reached by applying the risk models calculated from the case-control study on melanoma in Turin and the Helios multi-centric study on skin carcinomas. The proportion of cases attributable to sun exposure has been subsequently calculated by correcting for the different proportion of skin characteristics among the populations taken into consideration. Attributable risks so calculated show medium to high values for melanoma in Turin (38%) and Trento (29%), while values are lower in Ragusa (17%). As for basal-cell carcinoma, attributable risk values are slightly inferior to those of melanoma. The risk of squamous-cell carcinoma attributable to sun exposure during outdoor work is the highest in Ragusa, with a value of 25%. Taking an annual incidence rate for melanoma of 9 cases per 100,000 inhabitants, and a preventive intervention with 50% of effectiveness, preventable cases should be 2 cases per 100,000 each year. This figure compared with 8 preventable cases of cervix cancer, in a similar population suggests an extremely cautious attitude in taking on programmes aiming to change life styles.

Introduction: The study of social differences in health is today focused on determinants. The knowledge of determinants is useful for the definition of policies to tackle inequities. The aim of this paper is to analyse the social distribution of cancer incidence, fatality and mortality in the city of Turin during the 80's and to estimate the amount of inequality produced within the health system., Sources of Data: The social distribution of the risk of death in Turin during 1981-1989, estimated from the Turin Longitudinal Study, is compared with incidence and fatality during approximately the same time period., Results: Among men, the relative risks for all cancer sites, among social classes, appear to confirm the hypothesis of a multiplicative model of incidence and fatality. In particular, colo-rectal, prostatic, bladder cancers and lymphoma and leukaemia show relative risks similar to the expected ones. Cancers of larynx, lung and stomach seem to be less coherent. Among women, colon-rectum, lung, breast and lymphoma and leukaemia show coherent results, whereas relative risks for uterus are far from the expected., Discussion: The coherence with the expected values of the social distribution of mortality suggests the adequacy of the multiplicative model for the provision of mortality from incidence and fatality. Therefore it is possible to state that the portion of inequality in health originated within the health system is big enough to suggest the need to put the equity in the access to health services in the agenda of interventions.

In most cases head and neck tumors manifest themselves on a local-regional level giving rise to highly mutilating pathologies with psycho-social repercussions. Surgery and radiotherapy are effective treatments for limited neoplasms (stage I-II). On the other hand, after surgery and/or radiotherapy, the treatment of locally advanced tumors (stage III-IV) or local recurrences and/or distant metastases is still problematic. For this reason chemotherapy, initially used only as a palliative, is today associated with other treatments to achieve better results both in terms of survival and disease-free time spans. Hence chemotherapy must be considered part of any multimodal primary treatment for advanced squamous cell carcinoma of the head and neck. In fact, numerous clinical studies have clearly demonstrated that adjuvant or neoadjuvant chemotherapy has a highly relative affect on survival in locally advanced diseases and that the incidence of distant metastases is reduced. This is not, however, followed by a similar reduction in local recurrences which are often the cause of death in such patients. It would, on the other hand, appear that survival is improved with integrated radio-chemotherapy. Immunochemotherapy, which has not as yet provided significant clinical results in cases of advanced tumors and/or metastases, must still be evaluated in the treatment of locally limited neoplasms. Organ preservation, which proves feasible in the larynx, leads one to hope it can be applied in other head and neck sites. The future balance leans in favor of the multidisciplinary approach and multi-center studies must be performed so that an adequate number of cases can be gathered over a brief period. This will make it possible to answer those questions and, at times, illusions which accompany chemotherapy in the treatment of advanced head and neck tumors.

The creation of a tracheo-esophageal fistula, and subsequent positioning of a voice button, has greatly improved the patients' ability to communicate and is the treatment of choice for many. The literature indicates that the success rate for this technique is in the 56-90% range. The present study presents the preliminary results obtained in a group of 30 laryngectomy patients for whom a Provox or Blom-Singer-Indwelling voice button were inserted at a later date. Of these 21 (70%) had undergone pre- or post-operative radiotherapy. On the average insertion of the voice button took place 36 months after the laryngectomy while it was approximately 40 months after radiotherapy. Patient selection was based on widely accepted criteria. In particular, the following factors were take into consideration: patient motivation, positive Taub test, dynamic features of the esophageal wall, video fluoroscopy evaluation. For the Provox voice button the patient was hospitalized for 24 hours while with the Blom-Singer-Indwelling device it was 72 hours. In addition, with the latter device, oral feeding was restored somewhat later although this depends on the difference in positioning. The results of the present study are in line with those presented by other authors. In particular, the immediate success rate was 83% while the long-term success rate reached 96%.

Today laryngeal cancer can be cured by means of a variety of treatments (nearly 60% of the patients in an unselected population are still alive after 5 years). Despite the low incidence, this form of cancer can present a significant social problem because the form of treatment can have an impact on the esthetic, functional and emotional aspects affecting the quality of life (QOL). In the present study 690 laryngeal cancer patients treated with 6 different forms of therapy (total laryngectomy, partial laryngectomy, cordectomy, radiotherapy alone, total laryngectomy plus post-operative radiotherapy, partial laryngectomy plus post-operative radiotherapy) were asked to fill out a specific EORTC CORE QOL Questionnaire (EORTC QLQ C-30) as well as a specific head and neck questionnaire. Six multi-item function scales, 3 symptom scales and 6 individual items assessing both symptoms and economic consequences of the disease were evaluated. A total of 517 patients (74.92%) filled out the questionnaire. For each form of therapy the patients were divided by age (under and over 65 years of age). The results indicate that the quality of life is better in those patients who underwent a single form of treatment (i.e. radiotherapy alone, partial laryngectomy, total laryngectomy) than in those who underwent combination treatments (i.e. surgery plus radiotherapy). Moreover, the results were better in the older patients. Quite often laryngeal cancer patients are subject to psychosocial problems although this did not show up in the present study where the patients tended to consider surgery as a liberation. The social-cultural level of the patient has a significant effect on the quality of life as it proved better in those social classes were physical strength is of prime importance as opposed to those dominated by social parameters such as socialization, communication and aesthetics.

We studied the prevalence of intestinal parasites in a random sample of immigrants and Italians employed in the food industry. Prevalence ranged from 20.8% among immigrants to 5.6% among Italians. Where helminths are widespread among Indochinese, protozoa are more common among africans. Three cases of Entamoeba histolytica in asymptomatic subjects were identified and successfully treated. We observed high levels of Giardia intestinalis both in Italians (2.2%) and immigrants (3.9%). Prevalence of intestinal protozoa was significantly associated with year of immigration, showing higher levels for new immigrants. The public health implications of parasite screening and treatment among recent immigrants were also discussed.

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.