Background. Cervical, breast and colorectal cancer (CRC) screenings are universally recommended interventions. High coverage of the target population represents the most important factor in determining their success. This systematic review aimed at assessing the effectiveness of population-based screening programs in increasing coverage compared to spontaneous access.Methods. Electronic databases and national and regional websites were searched. We included all studies on interventions aimed at increasing screening participation published between 1999 and 2009; for those published before, we consulted the Jepson et al. review (2000). We compared spontaneous access (including no intervention) vs population-based screening programs actively inviting the target population. Among the latter, we compared GP-based vs invitation letter-based interventions.Results. The invitation letter vs no intervention showed significantly more participation (RR = 1.60 95%CI 1.33-1.92; RR = 1.52 95%CI 1.28-1.82; RR = 1.15 95%CI 1.12-1.19, for breast, cervical and CRC screenings, respectively). GP-based interventions, although more heterogeneous, showed a significant effect when compared with no intervention for breast (RR = 1.74 95%CI 1.25-2.43), but not for cervical and CRC. No significant differences were found between invitation letter-based and GP-based organization (RR = 0.99 95%CI 0.94-1.05; RR = 1.08 95%CI 0.99-1.17, for breast and cervical cancer, respectively).Conclusion. Population-based programs are more effective than spontaneous screening in obtaining higher testing uptake. Both invitation letter-based and GP-based programs are effective. (C) 2012 Elsevier Inc. All rights reserved.

SummaryBackgroundA variety of tests have been proposed for colorectal cancer (CRC), giving rise to uncertainty regarding the optimal approach. The efficacy and effectiveness of different tests are related to both screenee participation and the detection rate.AimTo perform a meta‐analysis on adherence and detection rates of CRC screening tests.MethodsRelevant publications were identified by MEDLINE/EMBASE and other databases for the period 1999–2012. A previous systematic review was used for the period before 1966–1999. RCTs and controlled studies including a direct comparison of the uptake rates among different options for CRC screening were included. Adherence and detection rates for advanced neoplasia and cancer were extracted. Risk for bias was ascertained according to CONSORT guidelines. Forrest plots were produced based on random‐effect models.ResultsFourteen studies provided data on 197 910 subjects. Endoscopic strategies were associated with a lower participation (RR: 0.67, 95% CI: 0.56, 0.80) rate, but a higher detection rate of advanced neoplasia (RR: 3.21, 95% CI: 2.38, 4.32) compared with faecal tests. FIT was superior to g‐FOBT with regard to both adherence (RR: 1.16, 95% CI 1.03, 1.30) and detection of advanced neoplasia (RR: 2.28, 95% CI 1.68, 3.10) and cancer (RR: 1.96, 95% CI: 1.2, 3.2).ConclusionThe superior accuracy of endoscopy compared with faecal tests minimised any impact of the participation rate in determining the detection rate of advanced neoplasia in a screening setting.

ObjectiveTo explore the relationship between morbidity, hospitalisation, mortality from Road Traffic Injuries (RTI) and Home Injuries (HI) and socioeconomic status (SES) of the area of residence. Source: RTI and HI surveillance based on the integration between the Emergency Department (ED) Hospital and Mortality data of Lazio region. The SES index (five levels: 1 most privileged areas; 5 most deprived areas) was derived using census data. For each injured subject the SES index of its census tract of residence was obtained.PopulationResidents in Rome, 2005 Italy.AnalysesFor each level of SES, we computed rates for ED visits, hospitalisation and mortality, adjusted by sex and age. IRR and 95% CI have been estimated using Poisson Regression.ResultsOut of 127 129 ED visits, 9576 (7.5%) were followed by a hospitalisation and 594 (0.5%) died within 30 days. SES was estimated for 109 993 cases, 87% of the total. The rates of RTI and HI ED visits were higher among the most deprived level of SES (IRR 1.27 95% CI 1.24 to 1.30; IRR 1.33 95% CI 1.29 to 1.37, respectively) compared to the most privileged ones. A strong relation was found between RTI mortalities and poor level of SES. These findings were more marked for 0–4 year old HI and RTI injured and for males.ConclusionRTI and HI incidence were associated to sociodemographic factors. This finding has implications for targeting injury prevention interventions and resources.

We report preventive measures adopted after tuberculosis(TB) transmission from a nurse to a newborn assessed in late July 2011. All exposed neonates born between January and July 2011 were clinically evaluated and tested by QuantiFERON TB gold in-tube; newborns testing positive were referred for prophylaxis.Of 1,340 newborns, 118 (9%) tested positive and no other active cases of TB were found. Active surveillance for TB will be continued over the next three years for all those exposed.

This article aims to explore some key issues relating to the health districts of the Lazio Region, in particular the major critical aspects as well as some strengths highlighted by the operators. In the Lazio Region there are 12 Local Health Units, divided into 55 health districts. In recent years, the majority of the authors analized theoretical models proposed by regional standards, while the strengths and weaknesses of the district, as well as the organizational difficulties and problems experienced daily by the operators have not been investigated. It was decided to use qualitative methods of research, through open interviews with 50 operators in 15 health districts of the Region. Interviews were analysed utilizing software Nvivo. Some codes were identified to guide interviews. We can summarize the emergency issues at least in three major areas: 1) the organization of the district, 2) the management of personnel and resources, 3) the care pathways. It is hoped that, during next years, the research directed at health district analysis will grow, with particular reference to quantitative and qualitative investigations, in order to build a body of knowledge from practical experience of health professionals.