[Extending traceability of malignant testicular tumours using hospital discharge records: an experience in Veneto Region (Northern Italy)]. / Estendere la tracciabilità dei tumori maligni del testicolo per mezzo delle Schede di Dimissione Ospedaliera: un'esperienza in Veneto.

OBJECTIVES: validation of codes of hospital discharge records (SDO) for identification of new cases of malignant testicular tumour in the Veneto Region (Northern Italy). DESIGN: record linkage between the regional archive of SDO and the archive of the Veneto Tumour Registry (VTR). SETTING AND PARTICIPANTS: extraction of cases from SDO source with ICD-9-CM 186 code for diagnosis and 62.3-62.4 codes for surgical procedure, and from VTR database using ICD-O-3 C62 code for site and 9060-9062, 9064-9066, 9070, 9071, 9080-9083, 9085, 9100, 9101 codes for morphology, with 5th digit behaviour code equal to "/3". Comparison of the two sources in a classification table using VTR data as gold standard. MAIN OUTCOME MEASURES: positive predictive value and sensitivity of SDO, with 95% confidence interval (95%CI) based on binomial distribution. RESULTS: from 2006 to 2008, in areas covered by the registry, SDO and VTR identified, respectively, 221 and 216 cases of testicular cancer. SDO procedure showed a sensitivity of 92% (95%CI 87%- 95%) and a positive predictive value of 90% (95%CI 85%-93%). CONCLUSIONS: the SDO procedure can be considered an acceptable proxy for testis cancer incidence, thus allowing a wider spatiotemporal observation of the epidemiological trends.

[Geographical analysis of mortality in a municipality of the Veneto region, where a landfill is located, and the surrounding area. Years 1995-2003]. / Analisi geografica della mortalità in un comune del Veneto sede di una discarica di rifiuti e nell'area circostante. Anni 1953-2003.

OBJECTIVE: the study explores whether a potential source of environmental pollution (a dumping ground with different kinds of waste, in Spinea, an area adjacent to Venice, population 25,000) could have led to an excess of mortality from certain pathologies, and in particular some cancers which have been reported to be associated to the presence of dumping grounds. Besides traditional estimation techniques, Bayesian estimators (BMR) have been used, which--if based on appropriate statistical analysis techniques--allow to consider the spatial dependence of the data. The smoothed geographical distribution of mortality in the area surrounding the pollution source is then represented as a map and the presence of particular mortality patterns is verified. Compared to traditional techniques, this approach produces more reliable data in a relatively short time and leads to an analysis with a better information level. Communication to the decision makers and to the population should be based on these data and results. DESIGN: the data were derived from ISTAT mortality reports coded at a local health district level. The following analysis have been carried out: a. a traditional descriptive analysis, i.e. comparison of age. standardized rates in the Spinea municipality and the surrounding area with crude regional rates; b. an analysis of heterogeneity of BMR distribution (reference rates = age-specific rates in the population of the investigated area) in the area itself c. the application of execution of the Martuzzi-Hills test and d. the creation of a mortality distribution map (divided into BMR value classes) in the investigated area. SETTING: the examined area includes Spinea and the surrounding municipalities within the Veneto Region borders, considering Spinea in the centre and a 15 km radius. RESULTS: the total number of deaths in the examined area in the 9 years covered by the present analysis is 49,739 (13% of the regional total). The annual age-standardized rate was 89.91 deaths/10,000. The results of the analysis do not suggest any particular mortality patterns either in the area (compared with the Veneto Region) or within it. CONCLUSIONS: the study has not highlighted geographical mortality clusters of deaths from the causes which have been selected for the analysis.

[A cross-sectional survey to evaluate the cardiovascular risk profile in subjects referred to the Verona-ASL 20 general practitioners]. / Indagine trasversale per la valutazione del profilo di rischio cardiovascolare nella popolazione di soggetti assistibili afferenti ai medici di medicina generale nell'area della ASL 20 di Verona.

BACKGROUND: Most of the studies on the identification of cardiovascular risk factors have been conducted either in northern Europe or in the United States. However, genetic as well as dietary factors may vary across different countries and geographical areas and there are few data about the cardiovascular risk profile in our country. METHODS: A sample of 3144 subjects (1463 males, 1681 females aged 35-74 years) were randomly selected among the population qualifying for healthcare assistance, registered with 170 general practitioners. Demographic data, clinical information, lab tests and current pharmacological treatments were collected using an electronic case report form. RESULTS: The prevalences of cardiovascular risk factors in the population were: smoking habit 22.7%, obesity 12.8%, hypertension 39.2%, hypercholesterolemia 25.5%, hyperglycemia and diabetes 5.5%. Thirty-five point four percent of the subjects presented a low absolute 10-year cardiovascular risk level (< 5%), 31.1% an intermediate risk (5-9%), 24.9% a moderate risk (10-19%), and 8.6% a high risk (> or = 20%) of developing cardiovascular diseases. CONCLUSIONS: In the area of Verona approximately 20,000 out of 231,592 subjects, aged 35-74 years, may present an absolute 10-year cardiovascular risk level > or = 20%. These results represent the epidemiological basis for planning and implementing preventive interventions toward cardiovascular diseases.

Aldosterone to Renin ratio in a primary care setting: the Bussolengo study.

The aim of the study was to evaluate the prevalence of hypertension associated with an elevated aldosterone to renin activity ratio (ARR) in a sample of adults aged 35-74 yr, randomly selected from the population register of the Bussolengo Health District (northern Italy) and representative of the total population of the district. Subjects (n = 1462) were randomly selected from the population register and examined by their general practitioners. Complete data for 1348 individuals were available for final statistical analysis. Apart from verapamil or alpha-blockers, no hypotensive drugs were allowed during the 4 wk before assay. Direct active renin and aldosterone were measured in the plasma of hypertensive patients after 2 h in the upright posture. Of 412 identified hypertensive patients, 287 subjects agreed to give blood (70% response rate). An aldosterone to active renin ratio (AARR) of 32 pg/ml was taken as the cut-off value, equivalent to an ARR of 50 ng/dl/ng/ml.h. An elevated AARR was observed in 32.4% of the hypertensive patients, with increased prevalence in females and in people aged 55 yr or older. As an elevated AARR is frequent in the general hypertensive population, screening should not be limited to the patients referred to specialist units.

[Statistical approaches to test for spatial heterogeneity of relative risks of cause-specific mortality in Alto Vicentino Municipalities (years 1991-2000)]. / Valutazione dell'eterogeneità nei rischi relativi di mortalità per causa: un'applicazione ai Comuni dell'ULSS Alto Vicentino (decessi 1991-2000).

OBJECTIVE: To review the statistical approaches to test for spatial heterogeneity of relative risks. Three different statistical tests (Gail, Martuzzi-Hills and Potthoff-Whittinghill) are reviewed and applied--as motivating example--to the analysis of cause-specific mortality records (years: 1991-2000) of the Municipalities belonging to the Local Health Unit Alto Vicentino. METHODS: Spatial heterogeneity was found in 17 (Martuzzi-Hills) and 18 (Gail, Potthoff-Whittinghill) among 70 selected causes of death. Cohens Kappa test was chosen to assess the agreement among the tests (k = 0.596; p < or = 0.001). CONCLUSION: Spatial heterogeneity must be interpreted with great caution, taking into account the available evidence about risk factors for specific causes of death and carefully evaluating available exposure data.

Association between PM10 concentrations and school absences in proximity of a cement plant in northern Italy.

Dusts are one of the main air pollutants emitted during cement manufacturing. A substantial part of these are breathable particles that are less than 10 µm in diameter (PM10), which represent a potential threat for the health of the exposed population. This study aimed at evaluating the short-term effects of PM10 concentrations on the health of children, aged 6-14 years, who attended the schools in Fumane (Italy), in proximity (1.2 km) to a large cement plant. School absenteeism was used as a proxy indicator of child morbidity. Time series of daily school absences and PM10 concentrations were collected for 3 school-years from 2007 to 2010 (541 school-days, 462 children on average). The associations between PM10 concentrations and school absence rates in the same day (lag0) and in the following 4 days (lag1 to lag4) were evaluated using generalised additive models, smoothed for medium/long term trends and adjusted for day of the week, influenza outbreaks, daily temperature and rain precipitations. The average concentration of PM10 in the period was 34 (range: 4-183) µg/m(3). An average 10 µg/m(3) increase of PM10 concentration in the previous days (lag0-4) was associated with a statistically significant 2.5% (95%CI: 1.1-4.0%) increase in the rate of school absences. The highest increase in the absence rates (2.4%; 95%CI: 1.2-3.5%) was found 2 days after exposure (lag2). These findings provide epidemiological evidence of the acute health effects of PM10 in areas with annual concentrations that are lower than the legal European Union limit of 40 µg/m(3), and support the need to establish more restrictive legislative standards.

Prevalence of hepatitis A among drug users in north-eastern Italy. Is vaccination necessary in low prevalence areas?

BACKGROUND: The authors report on the prevalence of, and risk factors for, hepatitis A virus (HAV) in a group of drug users in Italy. METHODS: 404 heroin users were recruited and compared with a control group of 107 subjects in the general population. RESULTS: Drug users born in north-eastern Italy have a prevalence of anti-HAV similar to the control group. A much higher prevalence was found in drug users born in southern Italy. CONCLUSION: The similar prevalence of anti-HAV in drug users born in north-eastern Italy and in the general population, suggests that their lifestyle does not involve a substantial additional risk of HAV. The much higher prevalence found in drug users born in southern Italy is more likely to be related to infection during infancy.