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"Saracci, Rodolfo"
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علم الأوبئة : مقدمة قصيرة جدا
ما المقصود بعلم الأوبئة ؟ وكيف يمكننا تتبع أسباب أحد الأمراض، أو تحديد متى تفشى أحد الأوبئة ؟ في هذا الكتاب من سلسلة «مقدمة قصيرة جدا»، يقدِم رودولفو ساراتشي نظرة متعمقة لمنطق علم الأوبئة ومناهج بحثه، وذلك بهدف توضيح قيمة البحث في أمور الصحة والمرض في المجتمعات السكانية. يشرح ساراتشي المفاهيم الإحصائية الأساسية اللازمة لتخطيط الدراسات الوبائية وتحليلها، فضلا عن أنه يطيح بالمفاهيم الخاطئة الشائعة حول تأويل تلك الدراسات، وذلك دون أن يقتصر تركيزه على تبعاتها الأخلاقية والسياسية، وإنما يمتد ليشمل تأثيراتها على الصحة العامة.
BOOK
The hazards of hazard identification in environmental epidemiology
Hazard identification is a major scientific challenge, notably for environmental epidemiology, and is often surrounded, as the recent case of glyphosate shows, by debate arising in the first place by the inherently problematic nature of many components of the identification process. Particularly relevant in this respect are components less amenable to logical or mathematical formalization and essentially dependent on scientists’ judgment. Four such potentially hazardous components that are capable of distorting the correct process of hazard identification are reviewed and discussed from an epidemiologist perspective: (1) lexical mix-up of hazard and risk (2) scientific questions as distinct from testable hypotheses, and implications for the hierarchy of strength of evidence obtainable from different types of study designs (3) assumptions in prior beliefs and model choices and (4) conflicts of interest. Four suggestions are put forward to strengthen a process that remains in several aspects judgmental, but not arbitrary, in nature.
Journal Article
Insidiosa barbarie
Alla riduzione del numero di migranti verso l’Italia per la rotta del Mediterraneo Centrale che tentano la traversata fa riscontro un netto aumento del rischio di perdere la vita per quelli che tentano. È possibile ipotizzare che al rafforzarsi delle barriere alla migrazione solo i più disperati, in peggiori condizioni globali (incluse quelle delle loro imbarcazioni) e a più alto rischio di morte, siano disposti a tentare la ventura. Qualunque sia la spiegazione, la mortalità in aumento indica che l’insieme dei dispositivi di salvataggio in mare è inadeguato e solleva la questione: la priorità operativa dell’Unione Europea è, come dichiarato, “salvare le vite in mare” o di fatto solo bloccare i flussi?
Journal Article
Prevention in COVID-19 time: from failure to future
The COVID-19 pandemic has developed as a consequence of sheer prevention failures, leading in many countries to a sizeable number of deaths and over-saturation of intensive care units. This triggered the imposition of generalisd quarantine (‘lockdown’) of variable stringency in different countries: with the decrease of the epidemic, the lockdown is now gradually relaxed and replaced by tight tracing and isolation of new cases and their contacts. Prevention, however, remains not a constant priority, as the objective may be avoidance of saturation of intensive care beds or more generally of healthcare facilities rather than the minimisation of the disease incidence. This combined with the fact that notwithstanding repeated warnings in past years the epidemic occurred as a surprise denotes a way of thinking in which prevention is an important option but not a guiding principle of choice and action within the health system. To modify this way of thinking and place prevention at the core of the system, non-negligible changes are required: they may become possible in light of emerging hazards like new viruses and climate change, huge economic costs of failed prevention and initial changes in the health system already induced by the COVID-19 epidemic.
Journal Article
Epidemiology in wonderland: Big Data and precision medicine
Big Data and precision medicine, two major contemporary challenges for epidemiology, are critically examined from two different angles. In Part 1 Big Data collected for research purposes (Big research Data) and Big Data used for research although collected for other primary purposes (Big secondary Data) are discussed in the light of the fundamental common requirement of data validity, prevailing over \"bigness\". Precision medicine is treated developing the key point that high relative risks are as a rule required to make a variable or combination of variables suitable for prediction of disease occurrence, outcome or response to treatment; the commercial proliferation of allegedly predictive tests of unknown or poor validity is commented. Part 2 proposes a \"wise epidemiology\" approach to: (a) choosing in a context imprinted by Big Data and precision medicine—epidemiological research projects actually relevant to population health, (b) training epidemiologists, (c) investigating the impact on clinical practices and doctor-patient relation of the influx of Big Data and computerized medicine and (d) clarifying whether today \"health\" may be redefined--as some maintain in purely technological terms.
Journal Article
Cancer mortality in an international cohort of reinforced plastics workers exposed to styrene: a reanalysis
ObjectiveTo investigate the carcinogenicity of styrene by reanalysing data from a previous international cohort study of workers in the reinforced plastics industry.MethodsMortality from cancers of prior interest was analysed with more detailed consideration of exposure–response relations and an updated classification of leukaemias and lymphomas in data from a previous international cohort study of 37 021 reinforced plastics workers exposed to airborne styrene.ResultsIncreased mortality from non-Hodgkin’s lymphoma (NHL) was associated with the mean level of exposure to styrene in air (relative risk (RR) 2.31, 95% CI 1.29 to 4.12 per 100 ppm), but not with cumulative styrene exposure. Similar associations with mean exposure were observed for the oesophagus (RR 2.44, 95% CI 1.11 to 5.36 per 100 ppm) and pancreas (RR 1.89, 95% CI 1.17 to 3.09). Oesophageal cancer mortality was also associated with cumulative styrene exposure lagged 20 years (RR 1.16, 95% CI 1.03 to 1.31). No other cancer, including lung cancer, was associated with any indicator of styrene exposure.ConclusionThis reanalysis does not substantially change the conclusions of the original study with respect to NHL or lung cancer but new evidence concerning cancers of the oesophagus and pancreas merits further investigation.
Journal Article
“Capovolgere” l’insegnamento della medicina, ieri e oggi
Recently the radical critique has been revived of medicine teaching developed some fifty years ago by G.A. Maccacaro with special focus on Italy. He maintained that a dominating biological perspective obscured all social dimensions of health and disease, educating doctors poorly equipped to grasp the practical relevance of social determinants of diseases and to correctly perceive their own role in society. In fifty years, many aspects of the practice of medicine have however changed: how such changes relate to the current teaching of medicine? Three key developments have taken place. First, separate specialties and subspecialties have multiplied at fast pace, and teaching has usually favoured this increasing fragmentation. Second, in actual practice doctors need to overcome disciplinary segmentation and collaborate, often to a substantial extent: little trace of how best to implement this is present in academic teaching. Third evidence-based medicine and guidelines for preventive, diagnostic and therapeutic interventions have become common currency in medicine: teaching of these topics is, notably in Italy, in general weak, leaving future doctors unprepared to a critical understanding and use of evidence-based medicine and guidelines in the daily practice. Substantial changes in medical teaching appear needed today no less than fifty years ago, but they can only start from a recognition of medicine as it stands today rather than fifty years ago.
Journal Article
European Code against Cancer 4th Edition: Environment, occupation and cancer
People are exposed throughout life to a wide range of environmental and occupational pollutants from different sources at home, in the workplace or in the general environment – exposures that normally cannot be directly controlled by the individual. Several chemicals, metals, dusts, fibres, and occupations have been established to be causally associated with an increased risk of specific cancers, such as cancers of the lung, skin and urinary bladder, and mesothelioma. Significant amounts of air pollutants – mainly from road transport and industry – continue to be emitted in the European Union (EU); an increased occurrence of lung cancer has been attributed to air pollution even in areas below the EU limits for daily air pollution. Additionally, a wide range of pesticides as well as industrial and household chemicals may lead to widespread human exposure, mainly through food and water. For most environmental pollutants, the most effective measures are regulations and community actions aimed at reducing and eliminating the exposures. Thus, it is imperative to raise awareness about environmental and occupational carcinogens in order to motivate individuals to be proactive in advocating protection and supporting initiatives aimed at reducing pollution. Regulations are not homogeneous across EU countries, and protective measures in the workplace are not used consistently by all workers all the time; compliance with regulations needs to be continuously monitored and enforced. Therefore, the recommendation on Environment and Occupation of the 4th edition of the European Code against Cancer, focusing on what individuals can do to reduce their cancer risk, reads: “In the workplace, protect yourself against cancer-causing substances by following health and safety instructions.”
Journal Article