The CALHM1 P86L polymorphism is a genetic modifier of age at onset in Alzheimer's disease: a meta-analysis study.

The only established genetic determinant of non-Mendelian forms of Alzheimer's disease (AD) is the ε4 allele of the apolipoprotein E gene (APOE). Recently, it has been reported that the P86L polymorphism of the calcium homeostasis modulator 1 gene (CALHM1) is associated with the risk of developing AD. In order to independently assess this association, we performed a meta-analysis of 7,873 AD cases and 13,274 controls of Caucasian origin (from a total of 24 centers in Belgium, Finland, France, Italy, Spain, Sweden, the UK, and the USA).

[A conceptual and operational framework for an epidemiology of citizenship].

"Epidemiology of citizenship" is the challenge of a multidisciplinary group of clinicians, epidemiologists, social workers that, with this book, try to approach problems implementing a cross-fertilization of methods, approach, languages and interventions across the different disciplines. The introduction of the book is proposed where its background and philosophy are presented and discussed.

[The Bhopal tragedy 25 (10+15) years after].

Almost 25 years have passed after the world's worst industrial accident: methylisocyanate gas leaked from a pesticide plant owned by the US company, Union Carbide (UC), into a densely populated area of Bhopal, in central India killing than 10000 people, and making hundreds of thousands disabled. After the recent and very mild sentence against Union Carbide against 7 administrator of UC (2 years of jail and a fine of little more than 2000 euros), a contribution published 10 years after the tragedy, that documented the efforts done and problems encountered in assessing responsibilities and setting up networks able to permanently document deaths, disabilities and suffering of people involved.

[Genomics, self-medication, Bophal, citizenship: why should such a mixed bag matter for the nursing profession? ].

The main themes presented in this issue of AIR (the perspective of a specific role of nurses in the area of clinical genetics-genomics, the expected benefits of a self-medication practice as expression of self-determination and consciousness; the dissociation between the "evidence" of the victims of the Bophal tragic accident and the verdict which denies them "habeas corpus") are the occasion for reflecting on their apparent heterogeneity, to find common threads that could be shaped in a research agenda for the nursing profession. A supplementary provocation is proposed in a book on epidemiology and citizenship, which is the last of the themes discussed in the Editorial.

Prognostic value of osteoprotegerin in chronic heart failure: The GISSI-HF trial.

Background: Circulating levels of osteoprotegerin (OPG), a member of the tumor necrosis factor receptor superfamily, is predictive of death and hospitalization for heart failure after acute coronary syndrome. The association between OPG and outcome in patients with chronic heart failure (CHF) is unknown.

Methods: Plasma OPG levels at baseline were assessed in 1,229 patients with CHF recruited from 51 clinical centers and included in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Heart Failure (GISSI-HF) trial.

[Memorandum for the management of clinical trials].

A critical appraisal of the recent legislation on clinical trials is proposed, together with some reflections on the implications on the practice and principles of clinical experimentation. The possible role and contribution of Ethical Committees is discussed.

Meta-analysis: erythropoiesis-stimulating agents in patients with chronic kidney disease.

Background: Previous meta-analyses suggest that treatment with erythropoiesis-stimulating agents (ESAs) in chronic kidney disease (CKD) increases the risk for death. Additional randomized trials have been recently completed.

Purpose: To summarize the effects of ESA treatment on clinical outcomes in patients with anemia and CKD.

Prognostic value of chromogranin A in chronic heart failure: data from the GISSI-Heart Failure trial.

Aims: To assess the association between circulating levels of chromogranin A (CgA) and outcome in a large population of patients with chronic heart failure (HF).

Methods And Results: Plasma CgA levels were measured at randomization and after 3 months in 1233 patients (median age 68 years, 80% male) with chronic, stable HF from the GISSI-HF trial. Circulating CgA levels were associated with several established risk markers in HF, including increased age, diabetes, reduced renal function, and heart rate variability.

Impact of setting of care on pain management in patients with cancer: a multicentre cross-sectional study.

Background: No study has so far addressed whether differences do exist in the management of cancer-related pain in patients admitted to oncology and non-oncology settings.

Patients And Methods: A multicentre cross-sectional study in 48 Italian hospitals has enrolled 819 patients receiving analgesic therapy for cancer-related pain. Demographics and clinical and analgesic therapy information have been prospectively collected by standardized forms.

Effect of valsartan on the incidence of diabetes and cardiovascular events.

Background: It is not known whether drugs that block the renin-angiotensin system reduce the risk of diabetes and cardiovascular events in patients with impaired glucose tolerance.

Methods: In this double-blind, randomized clinical trial with a 2-by-2 factorial design, we assigned 9306 patients with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors to receive valsartan (up to 160 mg daily) or placebo (and nateglinide or placebo) in addition to lifestyle modification. We then followed the patients for a median of 5.

Effect of nateglinide on the incidence of diabetes and cardiovascular events.

Background: The ability of short-acting insulin secretagogues to reduce the risk of diabetes or cardiovascular events in people with impaired glucose tolerance is unknown.

Methods: In a double-blind, randomized clinical trial, we assigned 9306 participants with impaired glucose tolerance and either cardiovascular disease or cardiovascular risk factors to receive nateglinide (up to 60 mg three times daily) or placebo, in a 2-by-2 factorial design with valsartan or placebo, in addition to participation in a lifestyle modification program. We followed the participants for a median of 5.

[A compass for professional updating].

Updating knowledge requires a critical assessment and independent Judgement of information and their sources. Some areas are proposed as examples of the need of adopting a critical approach: the pitfalls of clinical practice guidelines, the drugs proposed as "new" that do not add any benefit compared to the already available treatments, the so called H1N1 pandemia.

[Education to autonomy or obedience? And how?].

The nurses' autonomy should be pursued and practiced at several levels: not only in practice but also in the way the knowledge is updated. Most of the initiatives and teaching-learning methods offered in basic and continuing education are more oriented to contents and techniques that to the development of a critical approach. A nursing approach should be oriented at focusing on the impact of interventions and techniques on patients problems and needs.

N-3 polyunsaturated fatty acids in heart failure: mechanisms and recent clinical evidence.

Over the past 20 years, there has been significant progress in our knowledge of the pathophysiology of heart failure (HF) with consequent considerable development of both pharmacological and non pharmacological approaches. Despite improved therapeutic strategies, HF still remains burdensome in terms of mortality, quality of life, and hospitalization costs. A new and promising medical treatment to improve survival in HF patients stems from the recent results of the Italian study, Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Heart Failure (GISSI-HF).

Sleep disturbances in elderly subjects: an epidemiological survey in an Italian district.

Objectives: Disturbed sleep is common in elderly people and has been related to comorbidities. The aim of this study was to evaluate the prevalence of sleep problems and their relationship with chronic disease in an elderly population.

Materials And Methods: The whole population of subjects aged more than 65 years, in the municipality of Vecchiano, Pisa was considered as eligible and underwent a clinical interview and a questionnaire about insomnia, sleepiness, snoring and sleep apnea.

Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials.

Background: Trials of statin therapy have had conflicting findings on the risk of development of diabetes mellitus in patients given statins. We aimed to establish by a meta-analysis of published and unpublished data whether any relation exists between statin use and development of diabetes.

Methods: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1994 to 2009, for randomised controlled endpoint trials of statins.

Systematic review of trials using vasodilators in pulmonary arterial hypertension: why a new approach is needed.

Background: In a previous meta-analysis on the approved treatments for pulmonary hypertension, we reported that all therapies caused small changes in 6-minute walk distance over a short period, with minimal effects on hemodynamics and no effect on survival. Since that last review, 10 new clinical trials with about 1,500 patients have been published, which has increased the statistical power of our observations.

Methods: A systematic review of all clinical trials in pulmonary arterial hypertension was done.

Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis.

Background: Prone position ventilation for acute hypoxemic respiratory failure (AHRF) improves oxygenation but not survival, except possibly when AHRF is severe.

Objective: To determine effects of prone versus supine ventilation in AHRF and severe hypoxemia [partial pressure of arterial oxygen (PaO(2))/inspired fraction of oxygen (FiO(2)) <100 mmHg] compared with moderate hypoxemia (100 mmHg < or = PaO(2)/FiO(2) < or = 300 mmHg).

Design: Systematic review and meta-analysis.

The predictive value of stable precursor fragments of vasoactive peptides in patients with chronic heart failure: data from the GISSI-heart failure (GISSI-HF) trial.

Aims: Though various neurohormonal systems are concurrently activated during heart failure (HF), their biological effectors are not always easy to measure due to their short life in vivo, instability in biological samples, or very low concentrations. We measured the plasma concentrations of four stable precursor fragments of neurohormonal systems in patients with chronic HF and evaluated their relationship with outcome.

Methods And Results: This study was performed in 1237 patients with chronic and stable HF enrolled in the GISSI-heart failure trial (GISSI-HF).

[Materials for an epidemiology of migration].

The data on the international migration worldwide and in Italy are presented and discussed, not only from the specific point of view of health conditions, but also by framing their "health burden" in the broader context of their contribution to the Italian economy.

[When the daily chronicles coincide with the most "hard" epidemiology: the case of migrants to Europe].

Unlabelled: The migration from Africa to Europe has become one of the most dramatic situations of the violation of fundamental rights of the first decade of the new millennium.

Methods: As the official source of epidemiology do not recognize the data of peoples who die and/or disappear while trying to reach European borders, only "informal" sources can be used to trace the fate of this populations. A Mediterranean Observatory called Fortress Europe (http://fortresseurope.

Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial.

Context: Post hoc analysis of a previous trial has suggested that prone positioning may improve survival in patients with severe hypoxemia and with acute respiratory distress syndrome (ARDS).

Objective: To assess possible outcome benefits of prone positioning in patients with moderate and severe hypoxemia who are affected by ARDS.

Design, Setting, And Patients: The Prone-Supine II Study, a multicenter, unblinded, randomized controlled trial conducted in 23 centers in Italy and 2 in Spain.

Aspirin for primary prevention of cardiovascular events in people with diabetes: meta-analysis of randomised controlled trials.

Objective: To evaluate the benefits and harms of low dose aspirin in people with diabetes and no cardiovascular disease.

Design: Meta-analysis of randomised controlled trials.

Data Sources: Medline (1966-November 2008), the Cochrane central register of controlled trials (Cochrane Library 2008;issue 4), and reference lists of retrieved articles.

Prevalence and prognostic value of elevated urinary albumin excretion in patients with chronic heart failure: data from the GISSI-Heart Failure trial.

Background: Increased urinary excretion of albumin is an early sign of kidney damage and a risk factor for progressive cardiovascular and renal diseases and heart failure. There is, however, only limited information on the prevalence and prognostic role of urinary albumin excretion in patients with established chronic heart failure.

Methods And Results: A total of 2131 patients enrolled in 76 sites participating in the GISSI-Heart Failure trial provided a first morning spot sample of urine at any of the clinical visits scheduled in the trial to calculate the urinary albumin-to-creatinine ratio.