Trends in cardiovascular diseases burden and vascular risk factors in Italy: The Global Burden of Disease study 1990-2017.

AIMS: An exhaustive and updated estimation of cardiovascular disease burden and vascular risk factors is still lacking in European countries. This study aims to fill this gap assessing the global Italian cardiovascular disease burden and its changes from 1990 to 2017 and comparing the Italian situation with European countries. METHODS: All accessible data sources from the 2017 Global Burden of Disease study were used to estimate the cardiovascular disease prevalence, mortality and disability-adjusted life years and cardiovascular disease attributable risk factors burden in Italy from 1990 to 2017. Furthermore, we compared the cardiovascular disease burden within the 28 European Union countries. RESULTS: Since 1990, we observed a significant decrease of cardiovascular disease burden, particularly in the age-standardised prevalence (-12.7%), mortality rate (-53.8%), and disability-adjusted life years rate (-55.5%). Similar improvements were observed in the majority of European countries. However, we found an increase in all-ages prevalence of cardiovascular diseases from 5.75 m to 7.49 m Italian residents. Cardiovascular diseases still remain the first cause of death (34.8% of total mortality). More than 80% of the cardiovascular disease burden could be attributed to known modifiable risk factors such as high systolic blood pressure, dietary risks, high low density lipoprotein cholesterol, and impaired kidney function. CONCLUSIONS: Our study shows a decline in cardiovascular mortality and disability-adjusted life years, which reflects the success in reducing disability, premature death and early incidence of cardiovascular diseases. However, the burden of cardiovascular diseases is still high. An approach that includes the cooperation and coordination of all stakeholders of the Italian National Health System is required to further reduce this burden.

Problematic drinking and health problems: an epidemiologic study through general practitioners in the Tuscany Region (Central Italy) and Friuli Venezia Giulia Region (Northern Italy). / Bere problematico e problemi di salute in Toscana e in Friuli Venezia Giulia: uno studio epidemiologico attraverso i medici di medicina generale.

"OBJECTIVES: to identify the differences among patients of general practictioners (GPs) in both Tuscany Region (Central Italy) and Friuli Venezia Giulia (FVG) Region (Northern Italy), which are different for drinking cultures, as to motivation of consultation, hazardous drinking and alcohol dependence, health problems, and use of health services. DESIGN: cross-sectional study by means of both a medical examination and a subsequent structured interview carried out with a questionnaire. Data were analysed using chi-square test, logistic regression and differences in prevalence. SETTING AND PARTICIPANTS: the study was implemented between July and November 2013 on a sample of 492 patients of 30 GPs in FVG, and 451 patients of 25 GPs in Tuscany. RESULTS: although patients in FVG were less likely to drink alcohol (66.7% vs. 70.9%), consumed lower amounts of alcohol on average per day per drinker (10.9 vs. 14.5 grams of alcohol), and were less likely to be hazardous drinkers (11.2% vs. 13.8%) compared to patients in Tuscany, they had a 3.6 to 4.7 times higher risk of alcohol dependence. In addition, the prevalence of diseases (in particular hepato-gastrointestinal diseases, hypertension, and psychiatric problems), smoking, and obesity/ overweighting was higher among clients of FVG, which exceed the Tuscan patients by 5-12 percentage points. Compared to Tuscany, FVG patients were more hospitalized and required more help to GPs or other people for their drinking problems. CONCLUSIONS: compared to Tuscan patients, GPs' patients in FVG has higher prevalence of alcohol addiction and other diseases, as well as of smoking and overweight/obesity, and higher need for health interventions as to their drinking problems."

Changing trends in European alcoholic beverage drinking: selected social, demographic, economic factors, drinking's related harms, and prevention control policies between the 1960s and 2000s.

This study confirms that during the decades following WW II there was a tendency towards closure of consumption of alcoholic beverages among the European countries. The Northern countries, which during the 1960s manifested the lowest rates of alcohol consumption, ended up with greater consumption rates than the Southern countries, manifested the opposite trend; greater amounts of consumptions in the 1960s and lower consumptions in the 2000s. During the same some period, social, demographic and economic indicators--urbanization, rate of elderly males, Income, female education, female employment and mother's age at their childbirths, tended to increase, while the alcoholic beverage control policy strategies showed differences according to the country. Liver disease-related mortality, decreased in most countries. Study limitations are noted.

Italy between drinking culture and control policies for alcoholic beverages.

This paper focuses on whether the on-going dramatic decrease in alcohol consumption in Italy, especially of wine, during 1961-2008, was associated with which parallel sociodemographic and economic changes and with alcohol control policies. The study, using both time series (TS) and artificial neural network (ANN)-based analyses documents that its selected sociodemographic and economic factors, and particularly urbanization, had a definite connection with wine consumption decrease, spirits decrease, and the increase in beer consumption over time. On the other hand, control policies showed no effect on the decline in alcohol consumption, since no alcohol control policy existed in Italy between 1960 and 1987. A few policies introduced since 1988 (BAC and sale restrictions during mass events) may have contributed to reducing or to maintaining the on-going reduction. Study limitations are noted and future needed research is suggested.

Europe. An analysis of changes in the consumption of alcoholic beverages: the interaction among consumption, related harms, contextual factors and alcoholic beverage control policies.

This AMPHORA study's aim was to investigate selected factors potentially affecting changes in consumption of alcoholic beverages in 12 European countries during the 1960s-2008 (an average increase in beer, decreases in wine and spirits, total alcohol drinking decrease). Both time series and artificial neural networks-based analyses were used. Results indicated that selected socio-demographic and economic factors showed an overall major impact on consumption changes; particularly urbanization, increased income, and older mothers' age at their childbirths were significantly associated with consumption increase or decrease, depending on the country. Alcoholic beverage control policies showed an overall minor impact on consumption changes: among them, permissive availability measures were significantly associated with consumption increases, while drinking and driving limits and availability restrictions were correlated with consumption decreases, and alcohol taxation and prices of the alcoholic beverages were not significantly correlated with consumption. Population ageing, older mother's age at childbirths, increased income and increases in female employment, as well as drink driving limitations were associated with the decrease of transport mortality. Study's limitations are noted.

Contextual factors and alcohol consumption control policy measures: the AMPHORA study background.

Drinking alcoholic beverages is deeply rooted in European cultural and economic history, and European consumption trends have varied over time during the decades following WW II. How and why such consumption patterns have changed, and what are the roles that societies' transformations play in these changes are the AMPHORA project's focus. Preventive alcohol consumption control policies have been developed for a long time; during different eras, in different ways and in different countries. How have and do formal policies affect such changes? These questions stimulated a group of 40 researchers from 12 European countries and 14 institutions to investigate the interactions between selected socio-demographic and economic factors, alcohol control policy measures, alcohol consumption and alcohol consumption-related harm that occurred in 12 European countries between 1960 and 2008.

[The health conditions of prison inmates in Tuscany]. / Lo stato di salute della popolazione detenuta all'interno delle strutture penitenziarie della Regione Toscana.

OBJECTIVE: Investigation of health conditions of prison inmates in Tuscany (Italy) compared with non-institutionalized population and literature data. DESIGN: Cross-sectional descriptive study of a sample recruited for a prospective cohort study. SETTING E PARTICIPANTS: Prison inmates detained in Tuscany on June 15th 2009. Istat data concerning the survey "Aspects of daily life" 2006-2009 has been used for comparison. MAIN OUTCOME MEASURES: The measures used for the analysis are prevalence data by age classes and odds ratios obtained through a logistic regression model. Outcome variables are: broad disease groups, in particular infectious and parasitic diseases and psychic disorders. RESULTS: Prison inmates from Northern Africa and Eastern Europe are 40% of the population studied. A high consumption of tobacco is observed, with 70.6% of regular smokers among prisoners vs 33.2% among free citizens. Digestive system diseases are the most frequent diseases (25.1%), followed by infectious and parasitic diseases (15.7%). Among digestive disease,more than half are teeth and oral cavity pathologies that affect 13.7% of prisoners.Other frequently reported disease groups were diseases of the bone-muscular and connective systems (11.0%), of the circulatory system (10.8%), endocrine and metabolic systems (9.2%), traumatisms and poisonings (6.8%), respiratory system diseases (5.9%), and nervous system diseases (4.9%). The prevalence of ischemic heart diseases, diabetes, obesity and esophagitis, gastritis and gastro-duodenal ulcers is significantly higher among prisoners than in the general population. The most frequent infectious and parasitic diseases are Hepatitis C Virus (HCV) infection with a prevalence of 9.0%, Hepatitis B Virus (HBV) infection (2.2%), and Human Immunodeficiency Virus (HIV) infection (1.4%). Hepatitis C, HIV and hepatitis A have a higher prevalence among inmates of Italian nationality, while syphilis is more common among prisoners from Eastern Europe (1.2%). The prevalence of psychic disorders among prison inmates is 33.3% (vs 11.6% in the general population), while it decreases to 29.3% if we exclude the population detained in the Psychiatric Prison. CONCLUSIONS: According to previous national and international studies, the cohort is more affected than the general population by physical and psychic disorders, partly associated to the prison inmate's country of origin.

[New users of mental health services for adults in Tuscany (Italy). Characteristics of cases and pathways of care]. / Nuova utenza dei Servizi di Salute Mentale per adulti della Toscana. Caratteristiche dei casi e percorsi della presa in carico.

The aim of this cross-sectional study was to describe the characteristics and pathways of care for users ("first visits") of adult mental health services in Tuscany. A questionnaire was mailed to healthcare workers of mental health services in Tuscany. Overall 184 psychiatrists and psychologists replied (136 psychiatrists and 48 psychologists) Sixty three percent of new users of mental health services were female, 32.6% were aged 18 to 34 years (32.6%) and 4.4% were foreign-born. Waiting times were lower for seeing a psychiatrist with respect to a psychologist (9.0 days ± 8.5 versus 19.2 days ± 18.7; p < 0.001). Severity of disease was the main reason for accepting persons presenting to the mental health services as patients; this occurred in 87% of cases. Persons accepted as patients were younger (42.2 years ± 14.9 versus 51.0 years ± 20.9; p < 0.05) and had an earlier onset of symptoms with respect to those not accepted as patients (32.1 years ± 15.2 vs 39.7 years ± 19.7; p < 0.05). The average duration of the mental disorder at the time of contact with the mental health service was 10.1 years and only 1/3 contacted the health service within one year of onset of the mental disorder. In conclusion, the duration of the mental disorder of adult patients contacting mental health services is high. This highlights the need for the various community agencies (e.g social services, health agencies, etc.) to facilitate access to care for people with a mental disorder.