PAC, especially when diagnosed during pregnancy, is associated with iatrogenic preterm delivery, compromising some neonatal heath indicators.

Healthcare utilisation databases, and other secondary data sources, have been used with growing frequency to assess health outcomes and healthcare interventions worldwide. Their increased popularity as a research tool is due to their timely availability, the large patient populations covered, low cost, and applicability for studying real-world clinical practice. Despite the need to measure Italian National Health Service performance both at regional and national levels, the wealth of good quality electronic data and the high standards of scientific research in this field, healthcare research and public health policies seem to progress along orthogonal dimensions in Italy. The main barriers to the development of evidence-based public health include the lack of understanding of evidence-based methodologies by policy makers, and of involvement of researchers in the policy process. The CRACK programme was launched by some academics from the Lombardy Region. By extensively using electronically stored data, epidemiologists, biostatisticians, pharmacologists and clinicians applied methods and evidence to several issues of healthcare research. The CRACK programme was based on their intention to remove barriers that thwart the process of bridging methods and findings from scientific journals to public health practice. This paper briefly describes aim, articulation and management of the CRACK programme, and discusses why it might find articulated application in Italy.

Identifying clusters of comorbidity in patients with BC may help understand their effects and enable clinicians and policymakers to better organise patient and healthcare management.

Longer exposure to overweight and obesity across a lifetime is associated with an increased risk of endometrial cancer.

Inflammation and immunity are linked to intestinal adenoma (IA) and colorectal cancer (CRC) development. The gut microbiota is associated with CRC risk. Epithelial barrier dysfunction can occur, possibly leading to increased intestinal permeability in CRC patients. We conducted a case-control study including 100 incident histologically confirmed CRC cases, and 100 IA and 100 healthy subjects, matched to cases by center, sex and age. We performed 16S rRNA gene analysis of blood and applied conditional logistic regression. Further analyses were based on negative binomial distribution normalization and Random Forest algorithm. We found an overrepresentation of blood 16S rRNA gene copies in colon cancer as compared to tumor-free controls. For high levels of gene copies, community diversity was higher in colon cancer cases than controls. Bacterial taxa and operational taxonomic unit abundances were different between groups and were able to predict CRC with an accuracy of 0.70. Our data support the hypothesis of a higher passage of bacteria from gastrointestinal tract to bloodstream in colon cancer. This result can be applied on non-invasive diagnostic tests for colon cancer control.

Although disentangling the effects of the various components of fiber-rich foods is complex, our results support a favorable role of selected prebiotic fibers on laryngeal cancers risk.

Aim: We aimed to analyze temporal trends in mortality from intrahepatic (ICC) and extrahepatic (ECC) cholangiocarcinoma in selected countries worldwide. Methods: Official death certification data for ICC and ECC and populations estimates for 29 countries worldwide (17 from Europe, 8 from the Americas, and 4 from Australasia) and for Hong Kong Special Administrative Region of the People’s Republic of China (SAR), from 1995 to 2018, were extracted from the World Health Organization and the Pan American Health Organization databases. Age-standardized mortality rates were computed. A joinpoint regression analysis was performed. Results: In both sexes, ICC mortality rates increased in most countries considered, including the USA, the UK, and Australia; in some countries, including Italy and France, the increasing trends leveled off over the most recent years. In men, around 2016, the highest rates (1.7-2.3/100,000) were observed in Hong Kong SAR, Portugal, France, Spain, Australia, Austria, the UK, and Canada; Latin American countries and some eastern European countries had the lowest rates (0.2-0.8/100,000). A similar pattern was observed in women, but with lower rates (from 1.7/100,000 in Hong Kong SAR to 0.14/100,000 in Argentina). ECC mortality declined in most European and Australasian countries, but it tended to increase in Americas. In both sexes, rates were below 1/100,000 around 2016, with the only exceptions being Japan (2.6/100,000 men and 1.2/100,000 women) and Hungary (1.5/100,000 men and 1.1/100,000 women). Conclusion: ICC mortality increased in most areas of the world, likely due to increased prevalence of risk factors and improved cancer recognition and classification. ECC mortality fell in most countries, largely due to the widespread use of cholecystectomy.

Progress in cancer epidemiology and prevention has been a key determinant of the fall in cancer mortality in Europe. Using mortality and population figures from the WHO and Eurostat databases, we estimated the number of averted cancer deaths in the EU27 over the period 1989-2021, for both sexes, for all cancers, and nine major cancer sites. We also computed the avoided deaths for all cancers in five major European countries and the UK. We estimated a total of 4 958 000 (3 339 000 men and 1 619 000 women) avoided deaths for all neoplasms over the period 1989-2021 and 348 000 (246 000 men and 102 000 women) in 2021 alone in the EU27. For both sexes, we estimated 1 679 000 avoided deaths for stomach cancer, 747 000 for colorectum, 227 000 for bladder, 102 000 for leukemias. Avoided deaths for lung cancer accounted for 1 156 000 in men, while no reduction was estimated for women. For breast and uterine cancer, avoided deaths were about 300 000, for ovary 105 000 and for prostate 352 000. In the UK, a total of 1 061 000 (721 000 men and 340 000 women) deaths was avoided. Elimination of tobacco may avoid a further 20% of cancer mortality by 2050. Control of alcohol, overweight and obesity, and occupational and environmental carcinogens may avoid an additional 10% of cancer deaths. A similar reduction may be due to optimal adoption of cervical, colorectal, breast, and probably, lung and prostate cancer screening. Thus, primary and secondary cancer prevention can avoid an additional third of cancer deaths in Europe up to 2050.

Luigi Mangiagalli (1850-1928) is a well known figure and a “founding father” of obstetrics and gynecology in Italy, but less recognized are the wide range implications of his work on a public health and social level. In fact, apart from its surgical, clinical and academic values, all the activities of Mangiagalli had a public health, and hence a political relevance. Thus, when at age 27 hewas named professor of Obstetrics and Gynecology in Sassari, Sardinia, he not only focused on the improvement of the local obstetrics clinic -when he arrived there were no beds and only a one broken forceps- and the control of puerperal infections, but also to the control of malaria and syphilis in pregnancy.

Record linkage - i.e. the use and linkage of electronic, mainly administrative databases - has been utilized in epidemiologic research for over three decades now, starting from the system implemented in a few US health maintenance organizations (HMO, i.e. the Kaiser Permanente network), a few Nordic countries systems, or the UK general practice research database (UK GPRD, now clinical practice research datalink,CPRD) [1, 2]...

Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58 515 women with invasive breast cancer and 95 067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19–1.45, P<0.00001) for an intake of 35–44 g per day alcohol, and 1.46 (1.33–1.61, P<0.00001) for ⩾45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5–8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98–1.07, and for current smokers=0.99, 0.92–1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver.

&#x0D; Background: major clinical outcomes of anticancer drugs may differ between clinical trials and clinical practice. Administrative databases provide long-term information on safety and effectiveness of these drugs in large unselected populations and in selected subgroups of patients. In addition, these data provide complementary information on topics where evidence from randomized clinical trials is unavailable.&#x0D; Methods: this project will investigate 17 new targeted high cost drugs in Lombardy oncology practice between 2006 and 2010 using data from electronic healthcare databases. Specific objectives are: 1) to estimate the incidence of serious adverse events in clinical practice and their predictors; 2) to estimate survival and progression free survival and their predictors; 3) to compare major clinical outcomes according to different regimen of therapy. We will build a database by record linkage of several regional health service sources: the File F registry (in which the administration of the 17 drugs is recorded), the Regional hospital discharge forms (SDO ) database, the drug prescription database, the outpatients' services database, and the Registry Office database. Subjects resident in Lombardy who received at least one prescription of these drugs from 2006 to 2010 will be considered. Complications warranting hospitalization will be derived from the patients' SDO s after the first drug administration. Vital status will be obtained from the Registry Office database.&#x0D; Results: we will provide estimates of the incidence of serious adverse events of novel anticancer therapies, and of overall and disease free survival in clinical practice, overall and in selected subgroups.&#x0D; Conclusions: these data will contribute to a better effectiveness evaluation, particularly in patients under-represented in clinical trials.&#x0D;

The editors-in-chief, editors, members of the editorial board and publisher of Epidemiology, Biostatistics and Public Health wish to express their sincere gratitude to the referees of the articles considered for the 2013 volume of the Journal. Giuseppe Arbia Fabio Barbone Joana Bastos Stefania Boccia Anna Bossi Silvio Brusaferro Chiara Cadeddu Caterina Caminiti Giovanni Capelli Guido Citoni Gianfranco Damiani Antonio De Belvis Emma De Feo Elisabetta De Vito Chiara de Waure Domitilla Di Thiene Ana Duarte Bruno Federico Monica Ferraroni Alessandra Frustaci Carlotta Galeone Silvano Gallus Maurizio Genuardi Guglielmo Giraldi Maria Rosaria Gualano Carolina Ianuale Farhad Islami Giuseppe La Torre Patrizia Laurenti Laura Lauria Carlo La Vecchia Emanuele Leoncini Alice Mannocci Walter Mazzucco Silvia Miccoli Cristina Montomoli Eva Negri Nicola Nicolotti Caterina Palazzo GianCarlo Paradisi Patrizio Pasqualetti Claudio Pelucchi Brunella Posteraro Delphine Praud Gianluigi Quaranta Luca Sbrogiò Benedetto Simone Giuliana Solinas Maria Lucia Specchia Annamaria Tortorano Fabio Turone Brigid Unim Maria Assunta Veneziano Francesco Vitale Antonella Zambon Alessandro Zanetti.

In addition to improvements in STSs registration, unfavourable mortality rates reported in this study reflect inadequate referral of patients with STSs to high-volume multidisciplinary centres, as well as insufficient advancements in STS prevention, diagnosis, and treatments.