[Economic class syndrome: epidemiological features and preventive measures]. / La sindrome da classe economica: aspetti epidemiologici e misure di prevenzione.

The term "economic class syndrome" is generally used to describe the occurrence of venous thromboembolism (VTE) in travelers after long-distance airline travel in economic class. However, cases of VTE have also been reported in business class travelers and in subjects exposed to prolonged periods of immobilization while using other forms of transportation such as automobile, train, and bus. VTE manifests with deep vein thrombosis and pulmonary embolism but may also present with less severe, reversible manifestations such as headache, vertigo, and respiratory symptoms. Epidemiological studies have shown that the risk of VTE doubles following airline travel lasting longer than four hours. The risk of VTE increases with increased duration of air travel even in the presence of multiple stop-overs. In subjects with known risk factors, incidence of VTE depends on the degree of risk (low, medium, high) and on the duration of the flight. The main factor leading to VTE is prolonged immobilization and the pathogenesis is based on Virchow's triad: venous stasis, vessel wall injury, and hypercoagulability of blood. Specific characteristics of airline travel such as jet lag, low air quality and dehydration may increase the risk of VTE with respect to other forms of travel. This article discusses epidemiological aspects and pathogenesis of travel-related VTE and prophylactic measures that should be undertaken.

Dioxin exposure, from infancy through puberty, produces endocrine disruption and affects human semen quality.

BACKGROUND: Environmental toxicants are allegedly involved in decreasing semen quality in recent decades; however, definitive proof is not yet available. In 1976 an accident exposed residents in Seveso, Italy, to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). OBJECTIVE: The purpose of this study was to investigate reproductive hormones and sperm quality in exposed males. METHODS: We studied 135 males exposed to TCDD at three age groups, infancy/prepuberty (1-9 years), puberty (10-17 years), and adulthood (18-26 years), and 184 healthy male comparisons using 1976 serum TCDD levels and semen quality and reproductive hormones from samples collected 22 years later. RESULTS: Relative to comparisons, 71 men (mean age at exposure, 6.2 years; median serum TCDD, 210 ppt) at 22-31 years of age showed reductions in sperm concentration (53.6 vs. 72.5 million/mL; p = 0.025); percent progressive motility (33.2% vs. 40.8%; p < 0.001); total motile sperm count (44.2 vs. 77.5 x 10(6); p = 0.018); estradiol (76.2 vs. 95.9 pmol/L; p = 0.001); and an increase in follicle-stimulating hormone (FSH; 3.58 vs. 2.98 IU/L; p = 0.055). Forty-four men (mean age at exposure, 13.2 years; median serum TCDD, 164 ppt) at 32-39 years of age showed increased total sperm count (272 vs. 191.9 x 10(6); p = 0.042), total motile sperm count (105 vs. 64.9 x10(6); p = 0.036), FSH (4.1 vs. 3.2 UI/L; p = 0.038), and reduced estradiol (74.4 vs. 92.9 pmol/L; p < 0.001). No effects were observed in 20 men, 40-47 years of age, who were exposed to TCDD (median, 123 ppt) as adults (mean age at exposure, 21.5 years). CONCLUSIONS: Exposure to TCDD in infancy reduces sperm concentration and motility, and an opposite effect is seen with exposure during puberty. Exposure in either period leads to permanent reduction of estradiol and increased FSH. These effects are permanent and occur at TCDD concentrations < 68 ppt, which is within one order of magnitude of those in the industrialized world in the 1970s and 1980s and may be responsible at least in part for the reported decrease in sperm quality, especially in younger men.

Impact on respiratory tract infections of heptavalent pneumococcal conjugate vaccine administered at 3, 5 and 11 months of age.

BACKGROUND: Medical and public health importance of pneumococcal infections justifies the implementation of measures capable of reducing their incidence and severity, and explains why the recently marketed heptavalent pneumococcal conjugate vaccine (PCV-7) has been widely studied by pediatricians. This study was designed to evaluate the impact of PCV-7 administered at 3, 5 and 11 months of age on respiratory tract infections in very young children. METHODS: A total of 1,571 healthy infants (910 males) aged 75-105 days (median 82 days) were enrolled in this prospective cohort trial to receive a hexavalent vaccine (DTaP/IPV/HBV/Hib) and PCV-7 (n = 819) or the hexavalent vaccine alone (n = 752) at 3, 5 and 11 months of age. Morbidity was recorded for the 24 months following the second dose by monthly telephone interviews conducted by investigators blinded to the study treatment assignment using standardised questionnaires. During these interviews, the caregivers and the children's pediatricians were questioned about illnesses and the use of antibiotics since the previous telephone call. All of the data were analysed using SAS Windows v.12. RESULTS: Among the 1,555 subjects (98.9%) who completed the study, analysis of the data by the periods of follow-up demonstrated that radiologically confirmed community-acquired pneumonia (CAP) was significantly less frequent in the PCV-7 group during the follow-up as a whole and during the last period of follow-up. Moreover, there were statistically significant between-group differences in the incidence of acute otitis media (AOM) in each half-year period of follow-up except the first, with significantly lower number of episodes in children receiving PCV-7 than in controls. Furthermore, the antibiotic prescription data showed that the probability of receiving an antibiotic course was significantly lower in the PCV-7 group than in the control group. CONCLUSION: Our findings show the effectiveness of the simplified PCV-7 schedule (three doses administered at 3, 5 and 11-12 months of age) in the prevention of CAP and AOM, diseases in which Streptococcus pneumoniae plays a major etiological role. A further benefit is that the use of PCV-7 reduces the number of antibiotic prescriptions. All of these advantages may also be important from an economic point of view.

[Survey among GP's about their smoking habits, opinions and behaviours in smoking prevention in Lombardy (Northern Italy)]. / Indagine conoscitiva sulle abitudini al fumo, le opinioni e l'attività di prevenzione del tabagismo tra i medici di medicina generale della Lombardia.

OBJECTIVE: to analyze smoking habits, opinions on smoking, curriculum and smoking prevention activities carried out by general practitioners in the Lombardy Region (Northern Italy). DESIGN AND PARTICIPANTS: between 2000 and 2002 a questionnaire about tobacco smoke retrieved from the European Project "GPs Empowerment" has been sent to 5348 general practitioners in the Lombardy Region. The questionnaire focuses on the difference of opinions and activity between smoking and non-smoking physicians. We analyzed 3571 questionnaires voluntarily filled. RESULTS: The prevalence of smokers among the general practitioners in the Lombardy Region was 22.3% (CI95% 21-24%), (M: 24.2%, CI 95% 22-26% and F: 17.8%, CI 95% 15-20%). Physicians could play a role in the prevention of tobacco: 98.7% (CI 95% 98-99%) agree about the effectiveness of counseling but only 65.6% (CI95% 64-67%) regularly counsel their patients about smoking-related diseases and quitting. In this paper, we estimated that 963% (CI95% 96-97%) non smoking GPs consider counseling useful for their patients vs 92.6% (CI 95% 91-94%) of smoking physicians (p <0. 001); GPs who think to represent a model for people are more frequent among non smokers (97.5%, CI95% 97-98% vs 89.3%, CI 95% 87-91%;p <0.001). Those who discuss with their patients about tobacco addiction and cessation are 68.9% (CI95% 67-71%) among non smokers vs 53.4% (CI 95% 50-54%) among smokers (p <0.001). Finally 67% (CI 95 % 65-69%) interviewed physicians lacked a specific training in smoking prevention. Among them, 87.4%(CI 95% 86-89%) would attend the courses. CONCLUSION: this finding could be useful for planning or enhancing activities aimed at improving preventive and cessation methods.

Mortality due to sudden infant death syndrome in Northern Italy, 1990-2000: a baseline for the assessment of prevention campaigns.

The aim of this paper is to estimate the infant mortality rate and the incidence of sudden infant death syndrome (SIDS) in Lombardy, Northern Italy, in the period 1990-2000 and to provide basic information for a subsequent comparison of the SIDS incidence before and after the risk-intervention campaign. A retrospective epidemiological study was carried out using all deaths of resident infants occurring up to 1 year of age as recorded by the health districts mortality registries of the Lombardy region, between 1990 and 2000. The infant mortality rate was 4.1 per 1000 live births, with a significant decreasing trend. This decrease is mainly due to the fall in mortality for congenital malformations and perinatal diseases. The SIDS incidence rate was 0.13 per 1000 live births; the annual incidence of SIDS during the study period decreased significantly by 60% from 0.20 to 0.08 deaths per 1000 live births (P = 0.001). When 'possible SIDS deaths', not directly labelled as SIDS, were also considered, the rate of SIDS was 0.54 per 1000 live births. The incidence of SIDS in Northern Italy appears much lower than anticipated. SIDS remains the single leading cause of death in the first year of life after the early neonatal period.

[Infant mortality and sudden crib death in Lombardy]. / Mortalità infantile e morte improvvisa in culla in Lombardia.

OBJECTIVE: To estimate the infant mortality rate and the incidence of Sudden Infant Death Syndrome (SIDS) which is not known in Italy. DESIGN: Retrospective mortality study using all deaths of resident infants occurring up to one year of age as recorded by the Italian Institute of Statistics, between 1994 and 1996. SETTING: Lombardy, Northern Italy. MAIN OUTCOME MEASURES: Infant mortality rate (deaths occurring in the 1st year of life), early neonatal mortality rate (1st-7th days of life), late neonatal mortality rate (8th day of life-1st month of life), post-neonatal rate (1st month-one year of life), and incidence of SIDS (Sudden Infant Death Syndrome). RESULTS: The infant mortality rate was 4.76 per 1,000 live births, with no significant differences among the three years and lower than the Italian rates. The SIDS incidence rate was 0.14 per 1,000 live births, and 0.39 per 1,000 live births when deaths not directly labelled as SIDS were considered. SIDS was the single leading cause of death in the first year of life after the early-neonatal period. CONCLUSIONS: The decrease of the infant mortality rate is due to the drop in mortality for congenital malformations and perinatal diseases. The incidence of SIDS in Northern Italy turns out to be low, while SIDS remains the single leading cause of death in the first year of life after the early neonatal period.

Residual risk of transfusion-transmitted HCV and HIV infections by antibody-screened blood in Italy.

BACKGROUND: This study was designed to assess the risk of transmitting HCV and HIV by transfusion of antibody-screened blood and to estimate the additional reduction in risk that may be achieved through the implementation of direct viral detection assays in Italy. STUDY DESIGN AND METHODS: Clinical and laboratory data of 2,411,800 blood donations collected from repeat volunteer donors from 1996 through 2000 were analyzed. The risk of transmitting HCV or HIV from screened blood donated during the window period was estimated using a mathematical model. RESULTS: The residual risk of donating antibody-negative infectious blood was estimated at 1 in 127,000 donations for HCV and 1 in 435,000 for HIV. The use of NAT should further reduce such risk by 83 percent for HCV and 50 percent for HIV. CONCLUSION: The residual risk of HCV or HIV transmission through screened blood is currently very small in Italy. The implementation of direct viral detection assays can further improve the safety of blood supply.