RESUMO
OBJECTIVES: assessment of the health effects on the resident population around the incinerator for municipal solid waste in Valmadrera (Lombardy Region, Northern Italy) in relation to the exposure level to the pollutants produced by the plant. DESIGN: historical cohort study, based on the resident population from 2003 to 2016 in the study area. With a dispersion model, based on PM10 emitted by the plant, three areas of exposure (high, medium, low) were defined and, on the basis of the residence of the cohort, different exposure levels were attributed to the subjects. The association between level of exposure and health effects were estimated by comparing the high and medium exposure levels with the low exposure level, using a Cox model, adjusted for age and socioeconomic deprivation index. MAIN OUTCOME MEASURES: mortality rates, hospitalization rates, cancer incidence rates, and perinatal outcomes were analysed for the main causes potentially associated with exposure to incineration plants. RESULTS: the subjects enrolled in the cohort were 106,056 (1,000,242 person-years). There were no statistically significant excesses of risk for almost all the outcomes investigated. Excessive mortality and hospitalization were found for liver/biliary cancers (HR women: 2.57; 95%CI 1.15-2.79; HR men: 2.22; 95%CI 1.10-4, 84). In the municipality where the plant is located, an excess prevalence (OR 1.78; 95%CI 1.43-2.21) of hepatitis C was found. CONCLUSIONS: the results suggest the absence of a relationship between residence in areas with different levels of pollutants emitted by the plant and the onset of almost all diseases. The associated causes do not have aetiological plausibility with exposure to pollutants from waste incineration. In particular, for liver/liver and biliary cancer, the association with infectious causes rather than exposure to environmental pollutants is more plausible.
Assuntos
Poluentes Atmosféricos , Poluentes Ambientais , Neoplasias , Poluentes Atmosféricos/efeitos adversos , Estudos de Coortes , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Incineração , Itália/epidemiologia , Masculino , Morbidade , Neoplasias/epidemiologia , Neoplasias/etiologia , GravidezRESUMO
BACKGROUND: Aim of this study was to examine the association between unemployment and mortality, taking into account potential confounders of this association. A secondary objective was to assess whether the association between unemployment and mortality was modified by lack of household economic resources. METHODS: Prospective cohort composed of a representative sample of Italian subjects 30-55 years who participated in the Italian National Health Survey 1999-2000, followed up for mortality up to 2012 (15 656 men and 11 463 women). Data were analyzed using Cox regression models, stratified by gender and adjusted for health status, behavioral risk factors, socioeconomic position and position in the household. The modifying effect of the lack of economic resources was assessed by testing its interaction with unemployment on mortality. RESULTS: Among women, unemployment was not associated with mortality, whereas among men, higher mortality was found from all causes (HR = 1.82), which was not modified by lack of economic resources, and from neoplasms (HR = 1.59), cardiovascular diseases (HR = 2.58) and suicides (HR = 5.01). CONCLUSIONS: Results for men were robust to the adjustment for main potential confounders, suggesting a causal relationship between unemployment and mortality. The lack of effect modification by economic resources supports the relevance of the loss of non-material benefits of work on mortality.
Assuntos
Suicídio , Desemprego , Estudos de Coortes , Feminino , Humanos , Itália/epidemiologia , Masculino , Mortalidade , Estudos Prospectivos , Fatores SocioeconômicosRESUMO
We monitored the burden of cancer in Italy and its trends over the last three decades, providing estimates of cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs), for cancer overall and 30 cancer sites using data from the Global Burden of Disease study 2017. An overview of mortality trends between 1990 and 2017 was also provided. In 2017, there were 254,336 new cancer cases in men and 214,994 in women, corresponding to an age-standardized incidence rate (ASIR) of 438 and 330/100,000, respectively. Between 1990 and 2017, incident cancer cases, and, to a lesser extent, ASIRs significantly increased overall and for almost all cancer sites, but ASIRs significantly declined for lung and other tobacco-related neoplasms. In 2017, there were 101,659 cancer deaths in men (age-standardized death rate, ASDR, 158.5/100,000) and 78,918 in women (ASDR 93.9/100,000). Cancer deaths significantly increased between 1990 and 2017 (+ 18%), but ASDR significantly decreased (- 28%). Deaths significantly increased for many cancer sites, but decreased for stomach, esophageal, laryngeal, Hodgkin lymphoma, and testicular cancer. ASDRs significantly decreased for most neoplasms, with the main exceptions of cancer of the pancreas and uterus, and multiple myeloma. In 2017, cancer caused 3,204,000 DALYs. Between 1990 and 2017, DALYs and age-standardized DALY rates significantly declined (-3.4% and -33%, respectively). Age-standardized mortality rates in Italy showed favorable patterns over the last few decades. However, the absolute number of cancer cases and, to a lower extent, of cancer deaths increased likely due to the progressive ageing of the population, this calling for a continuous effort in cancer prevention, early diagnosis, and treatment.
Assuntos
Efeitos Psicossociais da Doença , Neoplasias Embrionárias de Células Germinativas/epidemiologia , Neoplasias/epidemiologia , Neoplasias Testiculares/epidemiologia , Adulto , Idoso , Detecção Precoce de Câncer , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Neoplasias Embrionárias de Células Germinativas/patologia , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Neoplasias Testiculares/patologiaRESUMO
The 2003 European Council recommendation urging the Member States to introduce or scale up breast, cervical and colorectal cancer screening through an organized population-based approach has had a remarkable impact. We argue that the recommendation needs to be updated for at least two sets of reasons. First, some of the current clinical guidelines include new tests or protocols that were not available at the time of the Council document. Some have already been adopted by organized screening programs, such as newly defined age ranges for mammography screening, Human Papillomavirus (HPV)-based cervical cancer screening, fecal immunochemical test (FIT) and sigmoidoscopy for colorectal cancer screening. Second, the outcomes of randomized trials evaluating screening for lung and prostate cancer have been published recently and the balance between harms and benefits needs to be pragmatically assessed. In the European Union, research collaboration and networking to exchange and develop best practices should be regularly supported by the European Commission. Integration between primary and secondary preventive strategies through comprehensive approaches is necessary not only to maximize the reduction in cancer burden but also to control the rising trend of other noncommunicable diseases sharing the same risk factors.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias Colorretais/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , União Europeia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Adulto JovemRESUMO
OBJECTIVES: to study the impact of social isolation, related to the SARS-CoV-2 epidemic, on lifestyles in Italy, with particular reference to physical activity, alcohol consumption, smoking, and eating habits. Moreover, to investigate the association between lifestyle changes during the pandemic and sociodemographic characteristics. DESIGN: epidemiological investigation based on a cross-sectional study. SETTING AND PARTICIPANTS: between April 21st and June 7th 2020, an electronic questionnaire to collect information on physical activity, alcohol consumption, smoking, and eating habits during the period of home containment was made available on the web. Respondents were recruited through non-probabilistic snowball sampling. The link to the electronic questionnaire was disseminated through institutional websites, social networks (Facebook, Twitter), and messaging systems such as WhatsApp, Telegram, and SMS. A total of 10,758 interviews were collected, of which 7,847 (73%) were complete for a minimum set of indicators (age, gender, and area of residence). MAIN OUTCOME MEASURES: reduction of physical activity, increase in alcohol consumption, increase in cigarette smoking, increase in consumption of unhealthy foods (processed meat, red meat or desserts) without increasing healthy foods (vegetables, legumes or whole grains) and, vice versa, increase in consumption of healthy foods without increasing unhealthy foods. RESULTS: the population under study consists of 7,847 people with a mean age of 48.6 years (standard deviation: 13.9). Most of respondents are women (71.3%), 92.5% have a high school or university degree and 91% live in Northern Italy. During home containment, 56% of interviewees reported they had reduced the time devoted to physical activity. In particular, this happened among older people and those living in large cities. More than 17% of respondents increased their alcohol consumption, especially men, those highly educated and those living in large urban centres. Older age and residence in the Southern Italy represent, instead, protective factors for this outcome. Among smokers, 30% increased cigarette consumption during the period of home containment, on average of 5.6 cigarettes per day. A small proportion of former smokers (0.6%) resumed smoking. With regard to eating habits, 3 out of 10 respondents (29.9%) reported an inappropriate eating behaviour (increasing unhealthy food without increasing healthy ones). This behaviour was less frequent among men (adjusted Prevalence Ratio 0.80, p=0.005). A lower percentage of respondents (24.5%) increased the consumption of healthy foods without increasing the consumption of unhealthy ones. CONCLUSIONS: the results of this survey show that social isolation during the SARS-CoV-2 pandemic has had an impact on citizens' behaviours. In particular, it was found a noteworthy increase in sedentariness, alcohol consumption, and tobacco smoking. A meaningful proportion of respondents reported a worsening of eating habits, especially among women. However, for each of the behavioural risk factors investigated, small proportions of respondents with resilient attitudes were also found, namely, capable of taking advantage of social isolation for improving their daily habits. Studying changes in lifestyles during a pandemic, identifying population groups most at risk of adopting unfavourable behaviours, is a useful tool for policy makers to plan targeted and effective public health interventions.
Assuntos
COVID-19/prevenção & controle , Estilo de Vida , Pandemias , Distanciamento Físico , Quarentena , SARS-CoV-2 , Isolamento Social , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , Dieta Saudável , Ingestão de Energia , Exercício Físico , Comportamento Alimentar , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Comportamento Sedentário , Fumar/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários , Populações Vulneráveis , Adulto JovemRESUMO
OBJECTIVES: to estimate the number of deaths from noncommunicable chronic diseases (NCD) attributable to behavioural risk factors (tobacco smoking, unhealthy nutrition, physical inactivity, overweight, and excessive alcohol use) in 2016 for Italy and for the Italian regions. DESIGN: descriptive study. SETTING AND PARTICIPANTS: mortality data were obtained by the Italian National Institute of Statistics. Causes of deaths from NCD associated with the five RFs were selected. Italian attributable fractions were obtained by the 2016 estimates of the Global Burden of Disease Study and applied to the mortality data. Regional prevalence of risk factors was obtained by the national surveillance system PASSI for the years 2013-2016. MAIN OUTCOME MEASURES: absolute number of attributable deaths, joint attributable fraction, proportion of total deaths attributable to RFs (MAprop). RESULTS: about 191,000 out of 614,307 deaths occurred in Italy in 2016 were attributable to combined RFs (about 37% in males; 26% in women). Joint MAprop was between 33% in men (24% in women) from Val d'Aosta and 40% in men (31% in women) from Campania. In Italy, 17% and 6% of the total amount of deaths were attributable to smoking in men and women, respectively; 6% and 3% to alcohol abuse; 7% and 8% to overweight; 13% and 12% to dietary RFs, and 2% and 3% to low physical activity. The higher proportion of attributable deaths by age-group was recorded in people aged 40-59 years (43% in men; 28% in women). Regional differences in attributable deaths are confirmed by regional RF prevalence recorded by the PASSI surveillance system for the years 2013-2016. CONCLUSIONS: these are the first estimates of the number of deaths due to NCDs attributable to behavioural RFs estimated for each region and for Italy as a whole. Effective primary prevention policies should be reinforced, since these RFs are potentially modifiable.
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Comportamentos de Risco à Saúde , Estilo de Vida , Doenças não Transmissíveis/mortalidade , Adolescente , Adulto , Idoso , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
In Italy, as well as in most European Countries, the loss of almost 70% of the years of life is attributable to cerebro-cardiovascular diseases and cancers. Whereas the Italian population is expected to grow older, with a significant increase in the burden of chronic non-communicable diseases, the reduction in incidence of chronic diseases and the compression of morbidity are priorities. This is the reason why in Italy the implementation of the National Plan for Prevention and related regional plans becomes necessary, as it can promote the co-operation of multidisciplinary skills in several areas: political, health, economic, legal, sociological. In Piedmont (Northern Italy), it seems useful the creation of a regional Laboratory of prevention,which provides support for the development and implementation of the regional prevention plan, through actions and programmes based on cost-effectiveness analyses. The use of resources in prevention should not be exclusively interpreted as a cost, but as an investment, which, in some cases, can become an avoided cost. Using prevention policies makes it possible to gain years of healthy life and to potentially reduce the cost of healthcare system. The creation of the Laboratory of prevention is a multidisciplinary context, so it is an opportunity to involve the stakeholders in order to achieve the regional health objectives.
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Doença Crônica/economia , Doença Crônica/prevenção & controle , Custos de Cuidados de Saúde , Doença Crônica/epidemiologia , Doenças Transmissíveis/economia , Análise Custo-Benefício , Humanos , Incidência , Itália/epidemiologiaRESUMO
Together with the National centre for screening monitoring (ONS), GISMa supports annual collection of data on national breast screening activities. Aggregated data on implementation and performance are gathered through a standardized form to calculate process and impact indicators. Analyzed data belong to 153 local programmes in the period 2006-2011 (2006-2012 for participation rate only). During the whole period, Italian crude participation rate exceeded GISMa's acceptable standard (50%), even though a higher participation in northern and central Italy compared to southern Italy and Islands was observed. Time trend analysis of diagnostic indicators confirmed in 2011 an adequate quality of breast screening performance, especially at subsequent screening. Recall rate at initial screening did not reach the acceptable standard (<7%) and rose slightly over the period. On the contrary, a good performance was achieved at subsequent screening. The same trend was followed by the overall detection rate and positive predictive value. They both showed a progressive reduction (from 6.2 in 2006 to 4.5 in 2011 for DR and from 8.0% in 2006 to 5.2% in 2011 for PPV, respectively) at initial screening and a good, stable trend at subsequent screening. Activity volume analysis shows that in programmes with greater activity (test/year ≥10,000) RR at both initial and subsequent screening has a better performance. This is also true for DR and PPV where programmes with high volumes of activity do better, especially when compared with those that interpret fewer than 5,000 mammograms per year. In spite of a few limits, these results are reassuring, and they reward the efforts made by screening professionals. It is therefore important to continue to monitor screening indicators and suggest, test, and evaluate new strategies for continuous improvement.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/epidemiologia , Mamografia/estatística & dados numéricos , Adulto , Detecção Precoce de Câncer/tendências , Feminino , Humanos , Itália/epidemiologia , Mamografia/tendências , Programas de Rastreamento/tendências , Padrões de Referência , Estudos Retrospectivos , Fatores de TempoRESUMO
Community interventions represent a key component of the current anti-smoking strategies. We propose a conceptual framework for classifying these interventions, based on the concept of community utilised in different studies. We identified 5 different focuses: geographical areas (i.e. city, county, region); targets (sub-group of a population); settings (school, workplace); culture and individual attitudes; multilevel networks. These two latter views refer to functional rather than to structural aspects of a community and they represent the most promising approaches to design intervention strategies. Communities are represented as a group of organizations, systems and social networks investigating individual, environmental and cultural factors that can strongly influence behavioural changes. The great heterogeneity in what the authors mean as community interventions has in our opinion affected the evaluation of their impact. To facilitate their evaluation and to contribute to the detection of determinants, as well as of barriers, it is necessary to compare community interventions sharing similar theoretical approaches and focuses. Also, studies aimed at assessing the steps of the implementation process of community programmes may allow to identify those components related to specific levels of intervention, thus enabling the generalisation of results. To reach this goal it may be helpful to combine study designs allowing for both quantitative and qualitative assessments, such as action research and participatory evaluation research.
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Redes Comunitárias , Prevenção do Hábito de Fumar , HumanosRESUMO
Effective tobacco control policies include law issuing: bans/restrictions on smoking in public areas and workplaces, increasing of taxes on tobacco products, bans on advertising of tobacco products, warning labels on cigarette boxes. For some of these policies the European Union (EU) has introduced specific directives that EU member states have to put into law. This paper briefly presents literature data, EU directives and the laws consequently issued in Italy. The importance of standardizing European legislation, especially for those policies that are not enforced by EU directives is also discussed. In Italy and in some other European countries smoking is forbidden in public and work-places, despite no EU directive. The positive impact of this ban in these countries suggests that it should be considered a priority in the European policies against tobacco in order to reduce the gap between literature recommendations and actions.