Health impact of natural gas emission at Cava dei Selci residential zone (metropolitan city of Rome, Italy).

Natural gas hazard was assessed at Cava dei Selci, a residential neighbourhood of Marino (Rome) by a joint study of gas emissions and related health problems. Here a densely urbanized zone with 4000 residents surrounds a dangerous natural gas discharge where, along the years, dozens of animals were killed by the gas. Gas originates from Colli Albani volcano and consists mostly of CO2 with ~ 1 vol% of H2S. In recent years, several gas-related accidents occurred in the urbanized zone (gas blowouts and road collapses). Some houses were evacuated because of hazardous indoor air gas concentration. Gas hazard was assessed by soil CO2 flux and concentration surveys and indoor and outdoor air CO2 and H2S concentration measurements. Open fields and house gardens release a high quantity of CO2 (32.23 tonnes * day-1). Inside most houses, CO2 air concentration exceeds 0.1 vol%, the acceptable long-term exposure range. In several houses both CO2 and H2S exceed the IDLH level (Immediately Dangerous to Life and Health). An epidemiological cohort study was carried out on the residents of two Cava dei Selci zones with high (zone A) and medium (zone B) gas hazard exposure, using the rest of Marino as reference zone. We found excess mortality and emergency room visits (ERV) related to high exposure to CO2 and H2S; in particular, an increased risk of mortality and ERV for diseases of central nervous system (HR 1.57, 95% CI 0.76-3.25 and HR 5.82, 95% CI 1.27-26.56, respectively) was found among men living in zone A.

[Geocoding one million of addresses using API: a semiautomatic multistep procedure]. / Geocodificare un milione di indirizzi mediante l'utilizzo di API: una procedura semiautomatica a più step.

OBJECTIVES: to geocode all residence addresses from Lazio Health Information System in order to obtain a geographical regional database. DESIGN: a semiautomatic and multistep geocoding procedure using several tools and software. SETTING AND PARTICIPANTS: all residence addresses of resident population of Lazio Region (Central Italy) in 2020. MAIN OUTCOME MEASURES: geographic coordinates at residence addresses and accuracy level of geocoding procedure for more than 1 million of addresses. RESULTS: the 99% of residence addresses in the Lazio Region have been geocoded thanks to the purposed procedure; almost 94% of the addresses have been geocoded with a good level of accuracy (more than 56% at civic number level). In the province of Rome, the percentage of addresses geocoded with a good level of accuracy is higher (97.1%), while in the province of Rieti and Frosinone is lower (82.7% and 84.2%, respectively). CONCLUSIONS: this method is useful to obtain accurate geographic coordinates of residences of the entire regional population. This database will be useful for several epidemiological studies in the Region.

[Spatial analysis for detecting clusters of cases during the COVID-19 emergency in Rome and in the Lazio Region (Central Italy)]. / Analisi spaziale per l'identificazione di cluster di casi durante l'emergenza COVID-19 a Roma e nel Lazio.

BACKGROUND: one of the most affected European countries by the COVID-19 epidemic is Italy; data show the strong geographical heterogeneity of the epidemic. OBJECTIVES: to propose an analysis strategy to ascertain the non-random nature of the spatial spread of COVID-19 cases infection and identify any territorial aggregations, in order to enhance contact tracing activities in specific areas of the Lazio Region (Central Italy) and a large urban area as Rome. METHODS: all cases of COVID-19 of the Lazio Region notified to the Regional Service for Epidemiology, Surveillance, and Control of Infectious Diseases (Seresmi) with daily updates from the beginning of the epidemic to April 27, 2020 were considered. The analyses were carried out considering two periods (the first from the beginning of the epidemic to April 6 and the second from the beginning of the epidemic to April 27) and two different levels of spatial aggregation: the entire Lazio region excluding the Municipality of Rome, where the 377 municipalities represent the area units, and the Municipality of Rome, where the area units under study are the 155 urban areas (ZUR). The Scan statistic of Kulldorff was used to ascertain the non-random nature of the spatial spread of infected cases and to identify any territorial aggregations of cases of COVID-19 infection, using a retrospective spatial analysis in two overlapping periods. RESULTS: analysis was conducted at regional level in the two survey periods and revealed the presence of 7 localized clusters. In the Municipality of Rome, a single cluster (Historic Centre) was identified in the first period which includes 7 urban areas, while in the second period two distinct clusters (Omo and Farnesina) were observed. CONCLUSIONS: Scan statistics are an important surveillance tool for monitoring disease outbreaks during the active phase of the epidemic and a useful contribution to epidemiological surveillance during the COVID-19 epidemic in a specific territory.

[Access to the Emergency Department in the time of COVID-19: an analysis of the first three months in the Lazio Region (Central Italy)]. / L'accesso al pronto soccorso ai tempi del COVID-19: un'analisi dei primi tre mesi nella regione Lazio.

OBJECTIVES: to evaluate the impact of the SARS-CoV-2 epidemic on the access to the emergency services of the Lazio Region (Central Italy) for time-dependent pathologies, for suspected SARS-CoV-2 symptoms, and for potentially inappropriate conditions. DESIGN: observational study. SETTING AND PARTICIPANTS: accesses to the emergency departments (EDs) of Lazio Region hospitals in the first three months of 2017, 2018, 2019, and 2020. MAIN OUTCOME MEASURES: total number of accesses to the emergency room and number of specific accesses for cardio and cerebrovascular diseases, for severe trauma, for symptoms, signs, and ill-defined conditions, and for symptoms related to pneumonia. RESULTS: in the first 3 months of 2019, there were 429,972 accesses to the EDs of Lazio Region; in the same period of 2020, accesses arise to 353,806, (reduction of 21.5%), with a 73% reduction in the last three weeks of march 2020 as compared with the corresponding period of 2019. Comparing the first 3 months of the 2017-2019 with 2020, the accesses for acute coronary syndrome and acute cerebrovascular disease decreased since the 10th week up to more than 57% and 50%, respectively. The accesses due to symptoms, signs, and ill-defined conditions, proxy of potentially inappropriate conditions, decreased since the 8th week, with a maximum reduction of 70%. Access to severe trauma decreased by up to 70% in the 11th week. The accesses for pneumonia increased up to a 70% increment in the 12th week. CONCLUSIONS: the evaluation of accesses to emergency services during the SARS-CoV-2 epidemic can provide useful elements for the promotion and improvement of the planning, for the management of critical situations, and for the reprogramming of the healthcare offer based on clinical and organizational appropriateness.

[More equity in Lazio region health care: results from the Regional Outcome Evaluation Program (PReValE), 2012-2017]. / Accesso alle cure più equo nella regione Lazio: risultati del Programma regionale di valutazione degli esiti (PReValE) 2012-2017.

OBJECTIVES: to evaluate equity in the Lazio regional Health System, both in terms of unequal access to health care among individuals with different educational levels and of heterogeneity in hospital performance, between 2012 and 2017. DESIGN: retrospective cohort study. SETTING AND PARTICIPANTS: all patients living in Lazio region and discharged from a regional facility between 2012 and 2017 were enrolled. Three cohorts of hospitalizations were selected: acute myocardial infarctions with ST segment elevation (STEMI), hip fractures, and deliveries. MAIN OUTCOME MEASURES: the proportions of STEMIs with PCI within 90 minutes, of patients with a hip fracture who underwent surgery within 2 days, and of deliveries with primary caesarean section were evaluated, accounting for patient demographic characteristics and comorbidities that could affect the outcome under study. These proportions were calculated by education and by hospital of admission. The heterogeneity among facilities was assessed through the median odds ratio (MOR). RESULTS: in Lazio region, between 2012 and 2017, an improvement of the quality of care was observed: in 2017, 50.4% of STEMI patients underwent to a PCI within 90 minutes, 54.4% of patients with a hip fracture underwent surgery within 2 days, and 26.2% of women had a C-section. In 2012, when comparing the adjusted proportions of outcomes by educational level, the probability of being treated with a PCI within 90 minutes for STEMIs and with surgery within 2 days for hip fractures was higher for graduated patients than for those with the lowest education. In contrast, graduated women had the highest risk of having a C-section. In 2017, there was no difference anymore between classes of education in STEMIs and C-sections, while in patients with hip fracture the difference was decreased, but still present. For hip fractures, a reduction of heterogeneity of hospital performances was also detected. CONCLUSION: in Lazio region, a reduction in inequalities in access to health care was observed for different clinical areas. The "public disclosure" of the PReValE results and the management strategy applied in mid-2013 could have driven the overall improvement of the health system for the conditions under study, helping to achieve a fairer access to health.

Volume and health outcomes: evidence from systematic reviews and from evaluation of Italian hospital data. / Volumi di attività ed esiti delle cure: prove scientifiche in letteratura ed evidenze empiriche in Italia.

BACKGROUND Improving quality and effectiveness of healthcare is one of the priorities of health policies. Hospital or physician volume represents a measurable variable with an impact on effectiveness of healthcare. An Italian law calls for the definition of «qualitative, structural, technological, and quantitative standards of hospital care¼. There is a need for an evaluation of the available scientific evidence in order to identify qualitative, structural, technological, and quantitative standards of hospital care, including the volume of care above or below which the public and private hospitals may be accredited (or not) to provide specific healthcare interventions. OBJECTIVES To identify conditions/interventions for which an association between volume and outcome has been investigated. To identify conditions/interventions for which an association between volume and outcome has been proved. To analyze the distribution of Italian health providers by volume of activity. To measure the association between volume of care and outcomes of the health providers of the Italian National Health Service (NHS). METHODS Systematic review An overview of systematic reviews was performed searching PubMed, EMBASE, and The Cochrane Library up to November 2016. Studies were evaluated by 2 researchers independently; quality assessment was performed using the AMSTAR checklist. For each health condition and outcome, if available, total number of studies, participants, high volume cut-off values, and metanalysis have been reported. According to the considered outcomes, health topics were classified into 3 groups: positive association: a positive association was demonstrated in the majority of studies/participants and/or a pooled measure (metanalysis) with positive results was reported; lack of association: both studies and/or metanalysis showed no association; no sufficient evidence of association: both results of single studies and metanalysis do not allow to draw firm conclusions on the association between volume and outcome. Analysis of the distribution of Italian hospitals by volume of activity and the association between volume of activity and outcomes: the Italian National Outcome evaluation Programme 2016 The analyses were performed using the Hospital Information System and the National Tax Register (year 2015). For each condition, the number of hospitals by volume of activity was calculated. Hospitals with a volume lower than 3-5 cases/year were excluded. For conditions with more than 1,500 cases/year and frequency of outcome ≥1%, the association between volume of care and outcome was analyzed estimating risk-adjusted outcomes. RESULTS Bibliographic searches identified 80 reviews, evaluating 48 different clinical areas. The main outcome considered was intrahospital/30-day mortality. The other outcomes vary depending on the type of condition or intervention in study. The relationship between hospital volume and outcomes was considered in 47 out of 48 conditions: 34 conditions showed evidence of a positive association; • 14 conditions consider cancer surgery for bladder, breast, colon, rectum, colon rectum, oesophagus, kidney, liver, lung, ovaries, pancreas, prostate, stomach, head and neck; • 11 conditions consider cardiocerebrovascular area: nonruptured and ruptured abdominal aortic aneurysm, acute myocardial infarction, brain aneurysm, carotid endarterectomy, coronary angioplasty, coronary artery bypass, paediatric heart surgery, revascularization of lower limbs, stroke, subarachnoid haemorrhage; • 2 conditions consider orthopaedic area: knee arthroplasty, hip fracture; • 7 conditions consider other areas: AIDS, bariatric surgery, cholecystectomy, intensive care unit, neonatal intensive care unit, sepsis, and traumas; for 3 conditions, no association was demonstrated: hip arthroplasty, dialysis, and thyroidectomy. for the remaining 10 conditions, the available evidence does not allow to draw firm conclusions about the association between hospital volume and considered outcomes: surgery for testicular cancer and intracranial tumours, paediatric oncology, aortofemoral bypass, cardiac catheterization, appendectomy, colectomy, inguinal hernia, respiratory failure, and hysterectomy. The relationship between volume of clinician/surgeon and outcomes was assessed only through the literature re view; to date, it is not possible to analyze this association for Italian health provider hospitals, since information on the clinician/surgeon on the hospital discharge chart is missing. The literature found a positive association for 21 conditions: 9 consider surgery for cancer: bladder, breast, colon, colon rectum, pancreas, prostate, rectum, stomach, and head and neck; 5 consider the cardiocerebrovascular area: ruptured and nonruptured abdominal aortic aneurysm, carotid endarterectomy, paediatric heart surgery, and revascularization of the lower limbs; 2 consider the orthopaedic area: knee and hip arthroplasty; 5 consider other areas: AIDS, bariatric surgery, hysterectomy, intensive care unit, and thyroidectomy. The analysis of the distribution of Italian hospitals concerned the 34 conditions for which the systematic review has shown a positive volume-outcome association. For the following, it was possible to conduct the analysis of the association using national data: unruptured abdominal aortic aneurysm, coronary angioplasty, hip arthroplasty, knee arthroplasty, coronary artery bypass, cancer surgery (colon, liver, breast, pancreas, lung, prostate, kidney, and stomach), laparoscopic cholecystectomy, hip fracture, stroke, acute myocardial infarction. For these conditions, the association between volume and outcome of care was observed. For laparoscopic cholecystectomy and surgery of the breast and stomach cancer, the association between the volume of the discharge (o dismissal) operating unit and the outcome was analyzed. The outcomes differ depending on the condition studied. The shape of the relationship is variable among different conditions, with heterogeneous slope of the curves. DISCUSSION For many conditions, the overview of systematic reviews has shown a strong evidence of association between higher volumes and better outcomes. The quality of the available reviews can be considered good for the consistency of the results between the studies and for the strength of the association; however, this does not mean that the included studies are of good quality. Analyzing national data, potential confounders, including age and comorbidities, have been considered. The systematic review of the literature does not permit to identify predefined volume thresholds. The analysis of national data shows a strong improvement in outcomes in the first part of the curve (from very low to higher volumes) for most conditions. In some cases, the improvement in outcomes remains gradual or constant with the increasing volume of care; in other, the analysis could allow the identification of threshold values beyond which the outcome does not further improve. However, a good knowledge of the relationship between effectiveness of treatments and costs, the geographical distribution and the accessibility to healthcare services are necessary to choose the minimum volumes of care, under which specific health procedures could not been provided in the NHS. Some potential biases due to the use of information systems data should also be considered. The different way of coding among hospitals could lead to a different selection of cases for some conditions. Regarding the definition of the exposure (volume of care), a possible bias could result from misclassification of health providers with high volume of activity. Performing the intervention in different departments/ units of the same hospital would result in an overestimation of the volume of care measured for hospital rather than for department/unit. For the conditions with a further fragmentation within the same structure, the association between volumes of discharge department and outcomes has also been evaluated. In this case, the two curves were different. The limit is to attribute the outcome to the discharge unit, which in case of surgery may not be the intervention unit. A similar bias could occur if the main determinant of the outcome of treatment was the caseload of each surgeon. The results of the analysis may be biased when different operators in the same hospital/unit carried out the same procedure. In any case, the observed association between volumes and outcome is very strong, and it is unlikely to be attributable to biases of the study design. Another aspect on which there is still little evidence is the interaction between volume of the hospital and of the surgeon. A MEDICARE study suggests that in some conditions, especially for specialized surgery, the effect of the surgeon's volume of activity is different depending on the structure volume, whereas it would not differ for some less specialized surgery conditions. The data here presented still show extremely fragmented volumes of both clinical and surgical areas, with a predominance of very low volume structures. Health systems operate, by definition, in a context of limited resources, especially when the amount of resources to allocate to the health system is reduced. In such conditions, the rationalization of the organization of health services based on the volume of care may make resources available to improve the effectiveness of interventions. The identification and certification of services and providers with high volume of activity can help to reduce differences in the access to non-effective procedures. To produce additional evidence to guide the reorganization of the national healthcare system, it will be necessary to design further primary studies to evaluate the effectiveness and safety of policies aimed at concentrating interventions in structures with high volumes of activity.

Mortality and morbidity in a population exposed to multiple sources of air pollution: A retrospective cohort study using air dispersion models.

BACKGROUND AND AIMS: A landfill, an incinerator, and a refinery plant have been operating since the early 1960s in a contaminated site located in the suburb of Rome (Italy). To evaluate their potential health effects, a population-based retrospective cohort study was conducted using dispersion modeling for exposure assessment. METHODS: A fixed cohort was enrolled in the Rome Longitudinal Study in 2001, mortality and hospitalizations were followed-up until 2010. Exposure assessments to the landfill (H2S), the incinerator (PM10), and the refinery plant (SOX) were performed for each subject using a Lagrangian dispersion model. Individual and small-area variables were available (including exposures levels to NO2 from traffic and diesel trucks). Cox regression analysis was performed (hazard ratios, HRs, 95% CI) using linear terms for the exposures (5th-95th percentiles difference). Single and bi-pollutant models were run. RESULTS: The cohort included 85,559 individuals. The estimated annual average exposures levels were correlated. H2S from the landfill was associated with cardiovascular hospital admissions in both genders (HR 1.04 95% CI 1.00-1.09 in women); PM10 from the incinerator was associated with pancreatic cancer mortality in both genders (HR 1.40 95% CI 1.03-1.90 in men, HR 1.47 95% CI 1.12-1.93 in women) and with breast morbidity in women (HR 1.13 95% CI 1.00-1.27). SOx from the refinery was associated with laryngeal cancer mortality in women (HR 4.99 95% CI 1.64-15.9) and respiratory hospital admissions (HR 1.13 95% CI 1.01-1.27). CONCLUSIONS: We found an association of the pollution sources with some cancer forms and cardio-respiratory diseases. Although there was a high correlation between the estimated exposures, an indication of specific effects from the different sources emerged.

[Residential cohort approach in industrial contaminated sites: the ERAS Lazio project]. / Lo studio di coorte di popolazione in aree a forte pressione ambientale: il programma ERAS Lazio.

The population-based cohort study is the best design for assessing the possible health effects resulting fromliving in contaminated sites. The ERAS (Epidemiology,Waste disposal, Environment and Health) Project was established to study the health of people living in close proximity to urban solid waste treatment (RU) plants in Lazio. It was conducted using an integrated approach, which consisted in studying mortality and hospital discharges of residential cohorts surrounding urban waste treatment plants. The level of exposure of each address was assigned using pollution dispersion models and studying the effects on mortality and hospital discharges. Further studies were conducted on residents of areas adjacent to waste disposal sites (includingMalagrotta in Rome), incinerators andmechanical biological treatment plants. The final version of the ERAS Report is available at www.eraslazio.it. The residential cohort approach and the combination of environmental and health-related information proved invaluable in the assessment of the health impact of solid waste treatment in Lazio.

[Health impact assessment of airport noise on people living nearby six Italian airports]. / Valutazione dell'impatto del rumore aeroportuale sulla salute della popolazione residente nelle vicinanze di sei aeroporti italiani.

BACKGROUND: aircraft noise has been associated with several health effects. Because of the great success of low-cost flights, small airports have been turned into international airports thus exposing nearby residents to an increase in noise levels and potential disturbances and health disorders. OBJECTIVE: to estimate the exposure levels and evaluate the health impact of aircraft noise on residents nearby six airports in Italy (Rome: Ciampino; Milan: Linate and Malpensa; Pisa; Turin; Venice) focusing on hypertension, acute myocardial infarction (AMI), annoyance and sleep disturbances. METHODS: residents in the local Municipalities considered at 31.12.2010 were included in the study and their addresses were geocoded. Aircraft noise exposure in 2011 was defined using the Integrated Noise Model linked to each participant's address. Lden (<55, 55-60, 61-65, 65-70 dB), Lnight, Leq (day and night) were calculated. Available exposure-response relationships were used to estimate the number of additional cases of hypertension, AMI, annoyance and sleep disturbances in the local population. RESULTS: 73,272 persons exposed to aircraft noise levels >55dB were considered: 55,915 (76.3%) were exposed to 55-60 dB; 16,562 (22.6%) to 60-65 dB; 795 (1.2%) to 65-70 dB. Exposure to aircraft noise levels above 55 dB was estimated to be responsible each year of 4,607 (95%CI 0-9,923) additional cases of hypertension; 3.4 (95%CI 0-10.7) cases of AMI; 9,789 (95%CI 6,895-11,962) cases of annoyance; 5,084 (95%CI 1,894-10,509) cases of sleep disturbances. CONCLUSIONS: a significant impact of airport noise on the health of residents nearby six Italian airports was estimated. Epidemiological evaluation and noise mitigation measures should be introduced to protect the health of residents.

[Occupational exposure to asbestos and incidence of malignant mesothelioma in the Lazio region, years 2001-2009: results of the activities of the regional register]. / Esposizione ad amianto e incidenza di mesoteliomi maligni nel Lazio, anni 2001-2009: risultati delle attività del registro regionale.

BACKGROUND: The Lazio Regional Mesothelioma Registry records the incident cases of Malignant Mesothelioma (MM) in residents in the Region since 2001. OBJECTIVES: Estimate the incidence of MM in the Lazio Region (2001-2009) and assess possible asbestos exposures. METHODS: The MM cases, notified by hospitals, regional protection and workplace safety units, Italian Workers' Compensation Authority, other regions, or extracted from hospital information systems and the regional registry of causes of death, are included in the register after analysis of diagnostic procedures (CT scan, chest X-ray, pathology reports and patients' records). Possible asbestos exposure is investigated by standardized interview and thereafter defined by a panel of experts, according to RENAM guidelines. The incidence of MM of the pleura and peritoneum (per 100,000 inhabitants) for the period 2001-2009 is calculated. RESULTS: The incidence of MM among Lazio residents in the period 2001-2009 (600 cases) was estimated to be 1.8 among men and 0.5 among women per 100,000 inhabitants. Information on exposures was collectedfor 54% of the cases (251 men and 78 women); 72% of men (n. 179) and 9% of women (n. 7) had been occupationally exposed to asbestos. The study found that the largest number of cases with occupational exposure was among workers in the construction industry. The number of cases with unknown exposure was very high. CONCLUSIONS: The registry's work revealed the existence of asbestos exposure circumstances that were not sufficiently characterized,for which it is suggested that more detailed industrial hygiene investigations be performed, as well as measurement of asbestos bodies and/or fibres in lung tissue.

[Young researchers no more young: who are we?] / I giovani ricercatori non più giovani: chi siamo?

To reflect on the present and the future of the "millennial" epidemiologists in Italy, the starting question is who are we? The online survey "I giovani ricercatori non più giovani: chi siamo? #GIOVANIDENTRO" was launched in 2022 and advertised at conferences of the Italian association of epidemiology to gather voices from all over Italy. Information on training, job position, attitudes and difficulties encountered in our profession and in scientific production activity has been collected and contextualized to answer the starting question and provide food for thought for the perspectives of our profession.

[Millennials looking for their place in epidemiology.] / I millennials alla ricerca del proprio posto nell'epidemiologia.

The "millennial" epidemiologists, born between the beginning of the 80s and the end of the 90s, are the generation that most of all, today, lives between the present and the future of this discipline. This issue of Recenti Progressi in Medicina aims to talk about what young (and no longer young) epidemiologists and public health researchers are dealing with and to reflect on the most relevant topics in our field, with an eye to the future. Starting from the profile of the "millennial" epidemiologists in Italy and the topics on which they work, the issue develops through three parts dealing with relevant topics for the present and the future of Public health. The first part deals with the important issue of finding a balance between the protection of personal data and the protection of health through a dialogue between researchers, jurists and citizens. The second part aims to clarify the issue of big data and its implications for producing health. The third part touches on four relevant topics for the perspectives of epidemiology through reflections and application examples of machine learning, integration between pharmacoepidemiology and environmental epidemiology, health prevention and promotion involving citizens and other stakeholders, and epidemiology of mental health. In a constantly changing world, challenges for those who work to produce health are not lacking, as is the determination to face them. With this issue, we hope to contribute to the awareness of who we are and our potential, to help millennials (but not only) find their place in epidemiology, today and tomorrow.

[Protect your data and protect yourself: balancing privacy and health protection in Public health.] / Proteggi i tuoi dati e proteggi te stesso: alla ricerca dell'equilibrio tra tutela della privacy e tutela della salute in Sanità pubblica.

The General data protection regulation (Gdpr) of 2016, implemented since 2018, has become a crucial issue in the field of epidemiology. The Gdpr concerns the protection of personal data, which includes all information that identifies or can identify a natural person, providing information about their habits, health status, and lifestyle, and regulates their processing. Epidemiological studies rely on the use of personal data and their interconnection. The introduction of this regulation is marking an important transition for the work of epidemiologists. There is a need to understand how this can coexist with the research activities that have always been carried out in epidemiology and public health. This section aims to lay the foundations for a discussion on the topic and provide a framework for researchers and epidemiologists that answers some of the doubts that accompany daily work.

[A cohort study on mortality and morbidity in the area of Taranto, Southern Italy]. / Studio di coorte sulla mortalità e morbosità nell'area di Taranto.

INTRODUCTION: the area of Taranto has been investigated in several environmental and epidemiological studies due to the presence of many industrial plants and shipyards. Results from many studies showed excesses of mortality and cancer incidence for the entire city of Taranto, but there are no studies for different geographical areas of the city that take into account the important confounding effect of socioeconomic position. OBJECTIVE: to assess mortality and hospitalization rates of residents in Taranto, Statte and Massafra through a cohort study,with a particular focus on residents in the districts closest to the industrial complex, taking into account the socioeconomic position. METHODS: a cohort of residents during the period 1998-2010 was enrolled. Individual follow-up for assessment of vital status at 31.01.2010 was performed using municipality data. The census-tract socioeconomic position level and the district of residence were assigned to each participant, on the basis of the geocoded addresses at the beginning of the follow- up. Standardized cause specific mortality/ morbidity rates, adjusted for age, were calculated by gender and districts of residence. Mortality and morbidity Hazard Ratios (HR, CI95%) were calculated by districts and socioeconomic position using Cox models. All models were adjusted for age and calendar period, and were done separately for men and women. RESULTS: 321.356 people were enrolled in the cohort (48.9%males).Mortality/morbidity risks for natural cause, cancers, cardiovascular and respiratory diseases were found to be higher in low socioeconomic position groups compared to high ones. The analyses by districts have shown several excess mortality/morbidity risks for residents in Tamburi (Tamburi, Isola, Porta Napoli and LidoAzzurro), Borgo, Paolo VI and the municipality of Statte. CONCLUSIONS: The results of this study showed a significant relationship between socioeconomic position and health status of people resident in Taranto. People living in the districts closest to the industrial zone have higher mortality/morbidity levels compared to the rest of the area also taking into account the socioeconomic position.

[Cancer incidence and mortality in the cohort of residents close to the Italian nuclear power plants of Borgo Sabotino and Garigliano]. / Incidenza di tumori e mortalità nella coorte dei residenti in prossimità delle centrali nucleari italiane di Borgo Sabotino e del Garigliano.

INTRODUCTION: the potential health impacts due to the decommissioned Nuclear power plants (NPP) located in Borgo Sabotino and Garigliano in Central Italy (active from the early 1960s to the late 1980s) have raised several concerns. Brain, thyroid, breast and lung cancer and leukaemia have been associated with exposure to ionizing radiations, but the health effects of nuclear plants on the resident populations are controversial. OBJECTIVE: to evaluate whether living close to NPPs is associated with an increased risk of cancer incidence and mortality. METHODS: we defined a cohort of residents within 7 km from the NPPs during the period 1996-2002. Individual follow-up for vital status at 01.01.2007 was conducted using municipality data. Gender specific Standardized Incidence and Mortality Ratios, adjusted for age, were calculated (SIR and SMR) using the regional population as reference. Each participant's address was assigned to a distance from the NPP on the basis of a GIS. A relative risk (RR, CI95%), adjusted for age and socioeconomic status, was calculated in 3 bands of increasing radius from the plants: 0-2, 2-4, and 4-7 km (reference group), using a Poisson regression model. RESULTS: the cohort was of 39,775 people, 32%of whom lived near (0-4 km) the NPP. No differences in mortality was found when comparing the cohort with the regional population; among women living within 7 km from the NPP, we found thyroid cancer incidence higher than expected (SIR 1.53 CI95% 1.18-1.95). However, when the analysis was conducted on the basis of the distance from the NPP, we found a statistically significant increase in male mortality only for causes unrelated to radiation exposure (all causes, stomach cancer, and cardiovascular diseases). No mortality excess was observed among women living close to the NPPs. No statistically significant distance-related gradient was observed for cancer incidence both in men and women. CONCLUSIONS: living close to the NPP was not associated with mortality for causes related to radiation exposure. However, the results suggest to continue the epidemiological surveillance of the population.

[Epidemiologic studies on the health status of the population living in the Sacco River Valley]. / Indagini epidemiologiche sullo stato di salute della popolazione residente nell'area della Valle del Sacco.

UNLABELLED: OBIETTIVO: to analyze the health status of the population living in an area close to the Colleferro industrial plant. SETTING AND PARTICIPANTS: the area of the Sacco River Valley, Central Italy nearby Rome, has been heavily polluted over the years by industrial wastes deriving from the chemical industrial plant in Colleferro. In 2006, it was discovered that the herds of livestock were contaminated by beta-hexachlorocycloexane (ß-HCH, an industrial waste belonging, as well as lindane, to the group of hexachlorocycloexane isomers). MAIN OUTCOME MEASURES: the analyses of mortality and morbidity were carried out for the 1998-2007 period (calculation of standardized mortality ratios, SMR), and for the period 2003-2007 (calculation of standardized hospitalization ratios, SHR), respectively. The general population in the Lazio Region has been considered as reference. In addition, a biomonitoring study was conducted on a sample of the population living in 4 areas of the Sacco River Valley with different levels of exposure and the following persistent organic pollutants were measured in the blood (α, ß and γ-HCH, HCB p,p'-DDT and p,p'- DDE, 6 NDL-PCB congeners and 12 DL-PCBs, PCDDs and PCDFs), and heavy metals (Cd, Hg, Pb). RESULTS: cancer mortality in men was increased in the area (SMR=1.20), especially for specific cancer sites (stomach, larynx, lungs, pleura, myeloma); in women an excess of mortality from diabetes was detected (SMR=1.44). The analysis of morbidity indicated an excess of hospitalization for various cancers (larynx, myeloma) in men, for respiratory illness and asthma in both genders and for thyroid disease in women. The biomonitoring study found high mean concentration of ß-HCH (mean: 99.05 ng/g fat, SD=121.3), with higher levels in the population living along the river (mean=150 ng/g fat; SD=153.5), likely occurred through water and local food. CONCLUSION: the area of Colleferro has been polluted by multiple sources and the human population has been exposed to industrial chemicals, toxic substances in the workplace, and to the cumulative accumulation of organic pesticides especially through water and food.

The impact of the SARS COV-2 pandemic on pediatric accesses in ED: A Healthcare Emergency Information System analysis.

BACKGROUND: The Emergency Department (ED) services play a fundamental role in managing the accesses of potential Sars-Cov-2 cases. The aim of this study is to evaluate the impact of the SARS COV-2 pandemic on pediatric accesses in Emergency Department of Lazio Region. METHODS: The population includes all pediatric accesses (0-17 years) in the ED of Lazio Region during 2019 and 2020. Accesses were characterized by age, week and calendar period. Four periods were defined: pre-lockdown, lockdown, post-lockdown and the second wave. The trend of ED accesses (total or for specific cause) in 2020 (by period and week) were compared to them occurred in 2019. ED visits have been described by absolute frequency and percentage variation. Percentage variation of adult was also reported to compare the trend in adult and young population. The Chi-square test was used to compare characteristics of admissions in 2019 and 2020. RESULTS: There is a large decrease of pediatric accesses in 2020 compared to 2019 (-47%), especially for younger age-classes (1-2 years: -52.5% and 3-5 years: -50.5%). Pediatric visits to ED in 2020 decreased following the same trend of adults, but more drastically (-47% vs -30%). ED accesses for suspected COVID-19 pneumonia trend show different characteristics between children and adults: in adults there is an increase in 2020, especially during the 2nd wave period (+321%), in children there is a decrease starting from the lockdown period to the achievement of the lowest level in December 2020 (-98%). CONCLUSIONS: This descriptive study has identified a decrease of total pediatric accesses in ED in 2020 compared to 2019 and a different trend of accesses by adult and young population especially by cause. The monitoring of paediatric accesses could be a useful tool to analyse the trend of COVID-19 pandemic in Italy and to reprogramming of the healthcare offer according to criteria of clinical and organizational appropriateness.

The Impact of the COVID-19 Pandemic on the Neck of the Femur and Hip Fracture Surgery Volumes in the Lazio Region.

This study compares surgery volumes for fractures of the neck of the femur (FNF) and hip replacements during the COVID-19 pandemic compared with previous years. Historical (2018-2019) and pandemic (2020-2021) surgery rates for FNF and hip replacement in Lazio, adjusted for age and gender, were calculated per period and compared with a Poisson regression model. For hip replacement surgery, a comparison of different types of hospitals was also made. Before COVID-19's spread, no difference was found in the volume of surgery of both interventions. From the lockdown to the end of 2021, a decrease in surgery volumes for FNF with stabilization between summer 2020 and summer 2021, as well as an additional decline beginning at the start of Omicron's spread, were found. Hip replacement surgeries showed a greater decline during the lockdown period and increased during summer 2020 and during the Delta wave period. The increment in hip replacements, mainly observed in 2021, is due to private and religious hospitals. These results highlight that the pandemic emergency, caused by SARS-CoV-2, has had an important indirect effect on the population's health assistance in the field of orthopedics.