Short-term effect of colorectal cancer on income: analysis of an Italian cohort.

INTRODUCTION: The ability to return to work after a cancer diagnosis is a key aspect of cancer survivorship and quality of life. Studies have reported a significant risk of income loss for cancer survivors; however, there is limited evidence of the Italian context. METHODS: The Work Histories Italian Panel (WHIP)-Salute database was used to select a cohort of incident cases of colorectal cancer (CRC) among workers in the private sector, based on hospital discharges. A propensity score matching was used to find a balanced control group for several confounders. Ordinary least square and logistic regressions were used to estimate the effect of a CRC diagnosis on annual income and the probability of switching from a full-time contract to a part-time one considering 3 years after the diagnosis. RESULTS: Overall, we identified 925 CRC incident cases from 2006 until 2012. Our results confirm a statistically significant reduction in survivors' income compared with controls. This reduction was greater in the first year and then tend to decrease, with an average income loss over 3 years of about €12 000. Stratified analyses by sex and position confirmed the overall trend while indicating a strong effect modification. Regarding the switching from full-time to part-time employment, the results were never significant. CONCLUSION: Income loss does not seem to be related to an increase in part-time contracts, but rather to survivors' reduced work capacity following the invasive treatments. Further research is needed to investigate the complex dynamics behind this association.

An Assessment on the Efficiency of Clothing with UV Protection among the Spanish Navy School Students.

Concern about the harmful effects that ultraviolet (UV) rays have on the skin of people who are routinely exposed to solar radiation has driven the industry of skin protection creams, sunglasses and clothing. Spanish Navy personnel are subject to different levels of exposure depending on their rank and function. The objective of this research is to analyze the behavioral variables associated to the effects on the skin caused by UV rays, denoted by the combined effects of perceived susceptibility and perceived severity, on their decision to purchase and wear uniforms with UV protection. A confirmatory analysis using a structural equation modeling (SEM) was performed on a sample of 100 respondents. The model results revealed a strong mediating characteristic of the intention to use, variable associated with the exogenous variables. Attitude towards the use of clothing and social influence, as well as the exogenous variable clothing action planning, on the sun protective clothing use during tactical maneuvers. These relationships were significant with p-values close to zero. However, exogenous variables related to perceived susceptibility and perceived severity in exposure to sunlight did not represent a significant influence when mediated by self-efficacy in use. The results revealed the consequence of awareness about the importance of protecting oneself and the influence that usage habits can have on the military with respect to the decision to purchase uniforms with UV protection.

Barriers to Electronic Patient-Reported Outcome Measurement Among Patients with Cancer and Limited English Proficiency.

Importance: Often electronic tools are built with English proficient (EP) patients in mind. Cancer patients with limited English proficiency (LEP) experience gaps in care and are at risk for excess toxic effects if they are unable to effectively communicate with their care team. Objective: To evaluate whether electronic patient-reported outcome tools (ePROs) built to improve health outcomes for EP patients might also be acceptable for LEP patients in the context of oral cancer-directed therapies (OCDT). Design, Setting, and Participants: This qualitative study was conducted at a single National Cancer Institute-designated comprehensive cancer center. In 2019, English-speaking and Spanish-speaking LEP patients with cancer receiving oral chemotherapies were recruited to participate in a qualitative focus group examining patient attitudes toward ePROs and electronic tools that are used to manage adherence and symptoms related to oral therapies. Six focus groups were held for EP patients and 1 for Spanish-speaking LEP patients. LEP was defined as patients who self-identified as needing an interpreter to navigate the health care system. Data analysis was performed April through June of 2019. Exposures: Enrolled patients participated in a focus group lasting approximately 90 minutes. Main Outcomes and Measures: The perspectives of patients with cancer treated with oral chemotherapies on integrating ePROs into their care management. Results: Among the 46 participants included in the study, 46 (100%) were White, 10 (22%) were Latinx Spanish-speaking, 43 (93%) were female, and 37 (80%) were aged at least 50 years or older. Among the 6 focus groups with 6 to 8 EP patients (ranging from 6 to 8 participants) and 1 focus group with 10 Spanish-speaking LEP patients, this qualitative study found that EP and LEP patients had different levels of acceptability of using technology and ePRO tools to manage their OCDT. EP patients felt generally positive toward OCDT and were not generally interested in using electronic tools to manage their care. LEP patients generally disliked OCDT and welcomed the use of technology for health management, particularly when addressing gaps in symptom management by their oncology clinicians. Conclusions and Relevance: Although most electronic interventions target EP patients, these findings reveal the willingness of LEP patients to participate in technology-based interventions. Expanding ePROs to LEP patients may help to manage gaps in communication about treatment and potential adverse events because of the willingness of LEP patients to use ePRO tools to manage their health. This qualitative assessment is a strategic step in determining the resources needed to narrow the digital health gap and extend the value of PROs to the LEP oncology population.

'Scuola sicura': a school screening testing programme to prevent the spread of COVID-19 in students in Piedmont.

BACKGROUND: 'Scuola sicura' (SS) programme aims to monitor the rate of COVID-19 and to contain its spread within the school population through early case isolation. OBJECTIVES: to describe the initial process and outcome evaluation results. DESIGN: descriptive study of an experimental screening testing programme in children in Piedmont Region (Northern Italy) in the period January-March 2021. The data used came from the COVID-19 platform and the Local Health Units, the archives of birth certificates (CedAP), and hospital discharge files (SDO). SETTING AND PARTICIPANTS: the screening programme targeted second and third grade students in first level secondary schools. Participants were subdivided into four groups; one group each week underwent screening, yielding one test per student per month. MAIN OUTCOME MEASURES: it was calculated: 1. number of positive cases detected vs total number of students tested in the SS programme; 2. number of positive cases detected outside the SS program vs. total number of students in the target population. The number of quarantines due to SS and no-SS case identification were detected. To investigate the spread of COVID-19 in households, the mother-child pairs were identified through record linkage between the CedAP and SDO archives, and positive mothers were identified. RESULTS: sixty-nine percent of schools and 19.5% of the students participated in the programme. SS detected 114 positives cases for SARS-CoV-2. On 08.03.2021, the target classes started distance learning: 69 of the 114 positive students were identified before that date, leading to the activation of 67 quarantine measures. Only for 61 out of 69 of those students (88%) was possible to identify the mother; 46 mothers had performed a swab test after the positivity of their child with a positive result in 11 cases. Asymptomatic cases identified at screening during in-class learning period accounted for 26.5% of the total number of cases occurred in the participating classes. CONCLUSIONS: this is one of the few studies (and the first in Italy) to describe the functioning and predictive capacity of school screening testing for SARS-CoV-2 in a real-world situation. The findings provide data-driven suggestions for government agencies when planning large-scale school screening testing programmes.

[Monitoring the trend of occupational injuries: comparison between different indicators]. / Monitorare il trend degli infortuni sul lavoro: confronto tra diversi indicatori.

OBJECTIVES: to compare three injuries indicators to establish which are less affected by underreporting and therefore best suited for the monitoring of the occupational injuries time trend during economic crisis. DESIGN: open cohort. SETTING AND PARTICIPANTS: a national sample of employees in the private sector, blue collars, males aged 15-64 years, extracted from the Work History Italian Panel-Healt archive, which combines data about firms and employee from the National Social Security Institute (Inps) and occupational injuries data from the Italian National Institute for Insurance against Accidents at Work (Inail). MAIN OUTCOME MEASURES: annual injuries rates for the period 2001-2012 classified according to three severity definitions: • serious injuries according to the prognosis (IGP); • serious Injuries according to the type of lesion (IGL); • minor injuries. Time trends and their changes during the economic crisis (2008-2013) were analysed through negative binomial regression models, stratified by country of origin, macroarea of work, firm size, and economic activity. RESULTS: IGP rates decreased more than IGL and minor injuries rates during the economic crisis, highlighting their greater association with the economic cycle. Negatives and significant trend changes were observed in some subgroups: in manufacturing, among workers from high developed countries and Moroccans, in the Northern and Central macroareas of Italy, and in larger firms. CONCLUSIONS: variations in injuries rates were not so much influenced by the underreporting of injuries as by the changes in the working conditions following the economic crisis. To accurately monitor the injuries time trends, it is recommended to report at the same time at least one indicator based on minor injuries and one based on serious injuries.

Perceived Risk in the Population Living near the Turin Incinerator: Comparison between before and at Three Years of Operation.

When the Turin incinerator went into operation in 2013, it was accompanied by surveillance of health effects that included a human biomonitoring survey of 394 residents. They responded to items investigating their awareness of environmental and health issues and perception of environmental health risks. In this study, we compared the questionnaire responses before plant startup and at 3 years of operation. To accomplish this, we investigated changes in perceived risk and evaluated the efficacy of communication strategies. A total of 344 participants equally distributed in an exposed and an unexposed group responded to the follow-up questionnaire. Survey items investigated the perception of a relationship between illness and exposure to environmental pollution, feeling at risk of developing an illness, and concern about natural and anthropogenic hazards. The proportion of 'certain' and 'very probable' responses was compared to the total using the difference-in-differences method. Analyses showed an overall decrease in the differences between the two groups, which suggests that the communication actions undertaken for the exposed group were effective. Future communication plans should also include initiatives targeting the unexposed group.

Human biomonitoring of metals in workers at the waste-to-energy incinerator of Turin: An Italian longitudinal study.

Evidence of negative health effects of solid waste management is uncertain. Available reviews suggests the use of biomarkers in human biomonitoring (HBM) to detect low exposure levels. In September 2013, a waste-to-energy plant located in the Turin (Italy) went into operation. The SPoTT (acronym for Population health Surveillance in the Turin incinerator's area) monitoring program was set up to assess the potential health impact caused by the plant. The paper illustrates the results of HBM of metals in the workers before the plant went into operation and then at 1 year and 3 years. This study is one of the few focusing on workers with a longitudinal design (the first in Italy). Eighteen metals in urine and lead in blood were determined by sector field inductively coupled plasma mass spectrometry. Information on participant habits and other characteristics that could potentially affect metals concentrations were collected via a structured questionnaire. Subjects were classified according to their work role at the facility: administrative staff workers (AW); plant workers (PW). Nonparametric methods were used to evaluate the changes in metals concentration over time. Comparison of the metals concentration in the samples taken at baseline and at the following two-time points shows a general decrease in levels: urinary concentration of beryllium (Be), cobalt (Co), mercury (Hg), Ir, nickel (Ni), tin (Sn), thallium (Tl), and blood level of lead (Pb) among the PW and Ir and Pd among the AW were significantly lower at T2 versus baseline. A decrease was also recorded in arsenic (As) among the PW and in cadmium (Cd), chromium (Cr), palladium (Pd), rhodium (Rh), and zinc (Zn) for both groups, whereas the levels of copper (Cu) and vanadium (V) remained unchanged over time. The downward trend remained also after taking confounding factors into account. The only exceptions were Mn, Pt, Sb among the PW: increase levels between T0 and T2 were recorded, which cannot be specifically attributable to the plant activity. The median urinary and blood concentrations of the metals were lower than those reported in the literature and were below the occupational reference values at all three-time points. Our results are consistent with those reported for the cohort of local residents and with the ambient air measurements.

Biomonitoring of the adult population in the area of turin waste incinerator: Baseline levels of polycyclic aromatic hydrocarbon metabolites.

Exposure to polycyclic aromatic hydrocarbons (PAHs) was assessed in a cohort of 394 subjects, 198 residing in three small municipalities near a new waste-to-energy (WTE) incinerator located in the Turin area, and 196 residing in neighbouring control areas in the town (of Turin). The assessment of exposure to PAHs was part of a human biomonitoring study aimed at assessing potential incremental exposure to pollutants related to incineration activities through the analysis of such pollutants before the plant start-up, and after one and three years of operation. The exposure assessment described in this study was carried out before the start-up of the WTE incinerator. Ten monohydroxy-PAHs (OH-PAHs) were analyzed in urine samples, consisting in the principal metabolites of naphthalene (NAP), fluorene (FLU), phenanthrene (PHE), and pyrene (PYR). Concentrations of the sum of OH-PAHs (Σ10OH-PAHs) were in the range of 525-85200 ng/g creatinine, with P50 equal to 6770 ng/g creatinine. Metabolites of naphthalene were found at the highest concentrations (P50 values of 892 and 4300 ng/g creatinine for 1- and 2-OH-NAP, respectively) followed by the three OH-FLUs (P50 values of individual compounds in the range of 58.2-491 ng/g creatinine), the four OH-PHEs (P50 values in the range of 30.5-145 ng/g creatinine), and 1-OH-PYR (P50 value of 82.8 ng/g creatinine). Concentrations of 1-OH-NAP, 9-OH-FLU, 1-, 2-, 3, 4-OH-PHE, and 1-OH-PYR were significantly lower in subjects living near the WTE plant compared to those living in the town of Turin, with differences between the two groups in the range 14-31%. Smoking habits markedly influence the urinary concentrations OH-PAHs. Median concentrations of the single metabolites in smokers were from 1.4 fold (for 4-OH-PHE) to 14 fold higher (for 3-OH-FLU) than those observed in non-smokers. The heating system used also resulted to be a major contributor to PAH exposure. Concentrations of OH-PAHs were generally comparable with those observed in other industrialized countries. The profile pattern was consistent with those reported in the literature. Concentrations of OH-PAHs assessed in this study may be considered indicative of the background exposure to PAHs for adult population living in an urban and industrialized area.

Differences in work injury risk between immigrants and natives: changes since the economic recession in Italy.

BACKGROUND: It is known that occupational injury rates are higher for immigrant than for native workers, however the effects of the economic cycles on these differences has not been assessed to date. The aim of the paper is to test if the crisis has the same mechanism of selection in the two groups by comparing injury rates in 2005 (before the crisis) and in 2010 (after the crisis). METHODS: The Work History Italian Panel-Salute integrated database was interrogated to identify employment contracts in the metalworking and construction industries for the years 2005 and 2010 and the occupational injuries. A definition based on the type of injury, less likely to be biased by underreporting, was used to select serious events. Immigrants and natives were matched using the propensity score method and injury rates were calculated in the two years. Analyses were stratified by industry. RESULTS: In the metalworking industry injury rates slightly increased over time for both groups, and were higher among immigrant than native workers in both 2005 and 2010. In the construction industry the 2005 injury rate was the same in the two groups, and there was a negative trend over time in both groups. However the decline in the 2010 injury rate for Italian workers was much larger, which led to a considerable increase of the incidence rate ratio of immigrants with respect to native (IRR 3.83, 95% CI 2.52-5.75). CONCLUSIONS: The economic recession had an impact on the risk of workplace injury. Though the main observed factors (18 variables) usually reported in literature to explain the higher injury rates of the immigrant workers were controlled through the matching, there were still differences between immigrants and natives. The main reason is that immigrants continue to be assigned to the more dangerous jobs and the more dangerous tasks within these job. Furthermore, also differences in the perception of workplace injury risks, linguistic barriers, and cultural factors may have a role in explaining this gap.

Risk perception in the population living near the Turin municipal solid waste incineration plant: survey results before start-up and communication strategies.

BACKGROUND: The start-up of the Turin municipal solid waste incineration plant (2013) was accompanied by surveillance of health effects, which included a human biomonitoring campaign. Here we present the results of the risk perception survey of local residents before the plant went into operation. METHODS: The survey sample was 394 local residents: 198 residing near the plant (exposed group) and 196 residing in an area distant from the plant site (unexposed group). The survey questionnaire investigated awareness of environmental and health issues, including a section on the perception of environmental health risks. Multivariate Poisson regressions were performed to determine the differences in risk perception between the two groups (exposed vs. unexposed). RESULTS: The exposed group was more concerned about natural hazards (prevalence ratio [PR] 1.61; 95% confidence interval [CI] 0.99-2.61), anthropogenic hazards (PR 1.35; 95% CI 1.03-1.77), and waste management (PR 1.19; 95% CI 0.94-1.50). There were no significant differences in opinions about environmental pollution-related diseases between the two groups, though the exposed considered themselves to be at risk for developing these diseases. The survey population placed its trust more in health care providers than in any other category. CONCLUSIONS: The risk perception survey questionnaire yielded data that enabled a better understanding and interpretation of the social context: residents living near the incineration plant were more concerned than those living distant from it, especially about anthropogenic hazards. This information was subsequently incorporated into the design the communication tools.

Human biomonitoring health surveillance for metals near a waste-to-energy incinerator: The 1-year post-operam study.

This human biomonitoring (HBM) follow-up survey, within the SPoTT project, assessed the temporal and spatial trends of exposure to 18 metals in a cohort living around the waste-to-energy (WTE) incinerator of Turin (Italy) before (T0, 2013) and after 1-year of plant activity (T1, 2014). Urine of 380 adult individuals (186 exposed and 194 unexposed subjects, classified on fallout maps) were analyzed by sector field inductively coupled mass spectrometry. A decrease trend of the majority of metals in all subjects indicates that the overall air quality of the studied sites was not significantly compromised, also in proximity of the WTE plant, as corroborated also by air monitoring data of the regional agency. The only relevant exception was the higher Cr levels found at T1 than T0 in exposed subjects, suggesting a possible contribution from the WTE plant. Chromium, Mn and Pt urine levels were also higher in the site far from the WTE, in relation to other sources as vehicular traffic, industrial and civil activities. Whilst, As and Cd were influenced by fish intake and tobacco smoke. A very small number of individuals at T1, equally distributed in both areas, exceeded the health-based guidance values and so, at current knowledge, living near the Turin incineration did not significantly influence the exposure status of the population.

Finding causation in occupational fatalities: A latent class analysis.

BACKGROUND: The method "Learning by mistakes" was developed in Italy to conduct occupational injury investigations and to collect information on the genesis of injuries. The aim is to analyze data classified with this method in order to identify patterns among the factors contributing to injury dynamics. METHODS: Data regarding 673 factors, corresponding to 354 occupational fatalities that occurred in the Piedmont region (north-west of Italy) during 2005-2014 were considered. Latent Class Analysis (LCA) was applied to find patterns among these factors. RESULTS: The eight-class model was selected. Most of the factors fell in the class "Fall from height or vehicle rollover due to incorrect practice" (40.56%) while the remaining factors where heterogeneously distributed in the other classes. CONCLUSIONS: All the classes found allow for a logical interpretation. Systematic use of LCA could aid in uncovering new, unexpected patterns of factors not otherwise detectable by analysis of the single fatal accident.

Influence of polymerization time on properties of dual-curing cements in combination with high translucency monolithic zirconia.

PURPOSE: The aim of this in vitro study was to assess conversion degree (DC), micro-hardness (MH) and bond strength of two dual-curing resin cements employed under translucent monolithic zirconia irradiated with different time protocols. METHODS: 84 square shaped samples of 1mm thickness were prepared from high translucency zirconia blocks and divided into two groups (n=24) according to the cement employed: (1) Rely-X Ultimate; (2) Panavia SA. Each group was further divided into 3 subgroups (n=8) according to the irradiation time: (a) no light; (b) 20s; (c) 120s. Light curing was performed 60s after the sample was placed on the diamond support of a FT-IR spectrophotometer with a high power multiLED lamp. Final DC% were calculated after 10min. After 24h, Vickers Test on the cement layer was performed. The same protocol was used to lute composite cylinders in order to evaluate microshear bond-strength test. ANOVA and Bonferroni tests were performed to find differences between MH and bond-strength to zirconia, while for DC% the Scheirer-Ray-Hare two-way test was used. RESULTS: The two cements reached higher DC% in subgroup (b) and (c). As concern MH, statistics showed an increase in curing time was able to improve MH significantly. Bond-strength was not affected by irradiation time only for Panavia SA. CONCLUSIONS: The first null hypothesis has to be rejected since DC% and MH of the dual-cements tested were influenced by the curing time. The second null hypothesis is partially rejected since the bond strength was influenced by the curing time only for Rely-X Ultimate.

Influence of surface coating sealer on resin composite water absorption and discoloration: An in vitro study.

PURPOSE: To evaluate the in vitro efficacy of surface coating sealer (SCS) in reducing the amount of water absorption and stain formation in resin composites. METHODS: To evaluate the amount of water sorption, 40 stainless steel round molds (n=10 per composite) were filled with Filtek Supreme XTE; Venus Diamond; Clearfil Majesty ES-2; Gradia Direct Anterior. Groups were further divided into two subgroups (n=5) according to the presence/absence of SCS (Easy Glaze). Their masses were measured at baseline and reweighed at 1, 4, 12, and 20 weeks. For staining evaluation, 48 resin composite discs, 2 mm-thick, were obtained with the same composites and SCS was applied on a single surface of each sample. After baseline color assessment, samples were immersed in vials containing 5 mL of six different staining solutions. Color evaluation was performed again after 1, 4, 12, and 20 weeks. Three-way ANOVA was performed to evaluate differences in weight gain and color changes (P< 0.05). RESULTS: A significant protective action of SCS (P< 0.001), but not of the composites (P= 0.366) was found. Differences in weight and color change were not influenced by the resin composite, but only by the presence of the coating on the surface of the samples. SCS are well-established materials for polishing and protecting composite restorations from water sorption and color changes. Different staining solutions can still produce different effects on resin composite. CLINICAL SIGNIFICANCE: Surface coating sealers are able to reduce water uptake and discoloration from resin composites, thus leading to less degradation of composite restorations over time.

[Effectiveness of inspections in the construction sites on reducing innjuries: a pilot study in a Health Unit of Piedmont Region (Northern Italy)]. / Efficacia dei controlli nei cantieri sulla riduzione degli infortuni: studio pilota di uno SPreSAL del Piemonte.

OBJECTIVES: to describe a pilot study to evaluate the impact on injury rates of Occupational health and safety (OHS) inspections conducted in the construction sites of the Novara Health Unit territory during 2005-2007. DESIGN: study design is "treated/non treated" where: "treated" are construction companies inspected during 2005-2007 and not inspected in the periods before and after; "non treated" are construction companies never inspected during 2002-2010. SETTING AND PARTICIPANTS: two information sources have been used: Italian Workers' Compensation Authority databases and Novara Health Unit inspection database. The period of analysis is 2002-2010 divided into sub-periods: pre-inspection (2002-2004); inspection (2005-2007); post-inspection (2008-2010). MAIN OUTCOME MEASURES: two injury rates, total and serious, have been calculated and the difference-in-differences (DID) method was used to assess the effectiveness. RESULTS: passing from pre-inspection to post-inspection period, the rate of total injuries in the companies inspected decreased more than the rate of the companies not inspected (DID: -1,95; 95%CI -15,30; 11,39). No effect was shown on severe injuries (DID: -0,27; 95%CI -7,84;7,31). CONCLUSION: the inspections conducted during 2005-2007 on the construction sites operating in the Novara Health Unit territory seem to have had a slight positive impact on reducing the injury rates. The procedures developed in this pilot study can be used in other Italian Health Units. Further research is needed to confirm the results and to clarify the mechanism by which the inspections were effective.

Testosterone Levels Correlate With Grade Group 5 Prostate Cancer: Another Step Toward Personalized Medicine.

BACKGROUND: Controversial results have shown a significant association with either low or high total testosterone (tT) levels and high risk prostate cancer (PCa). We tested the relationship between circulating tT and grade group 5 (G5) PCa at radical prostatectomy (RP) in patients with preoperative low- to intermediate-risk disease. METHODS: Serum sex hormones were assessed the day before RP in a cohort of 846 patients with low- to intermediate-risk PCa. Patients were segregated using the new 5-tiered Gleason grade groups. Restricted cubic spline functions and logistic regression analyses tested the association between sex hormones and G5 PCa. Differences in potential predictive accuracy (PA) were assessed for tT and prostate-specific antigen (PSA) levels. RESULTS: Overall, 27 men (3.2%) had G5 PCa at RP, and this group had higher PSA values than patients with G1-G4 PCa (P = 0.02). The groups did not differ in terms of preoperative mean hormonal values. Both low and high circulating tT values depicted a nonlinear U-shaped correlation with G5 PCa at RP. The lowest and highest (10th and 90th percentiles) tT values and biopsy PCa grade emerged as multivariable independent predictors of G5 PCa at RP (all P < 0.05). PA for G5 PCa did not differ between tT (area under the curve [AUC] 0.631) and PSA (AUC 0.636). CONCLUSIONS: Circulating tT was a significant predictor of G5 PCa at RP in patients with preoperative low- to intermediate-risk disease. Preoperative tT and PSA values showed similar PA for the most aggressive disease, confirming a potential role for circulating androgens in preoperative risk assessment of PCa patients. Prostate 77:234-241, 2017. © 2016 Wiley Periodicals, Inc.

Biomonitoring and exposure assessment of people living near or working at an Italian waste incinerator: methodology of the SPoTT study.

Only few studies on the health effect of waste incinerators were focused on human biomonitoring (HBM). Our aim is to describe a protocol for assessing early variation of selected items in a population group living close to a waste incinerator in Turin, Italy. A cohort of 394 subjects was randomly selected, among residents near the incinerator and residents far from it. To achieve this sample size, 765 subjects were contacted. The cohort was monitored before the start-up of the plant and will be followed up 1 and 3 years after, with measurements of respiratory function, selected blood and urine parameters including 19 metals, 17 congeners of PCDDs/Fs, 12 congeners of DL-PCBs, 30 congeners of NDL-PCBs, 11 OH-PAHs, specific hormones (T3, T4, TSH, cortisol and ACTH) and common health parameters. The same protocol is applied for plant workers and breeders living near the plant. Individual exposure to urban pollution and waste incinerator fallout were assessed through the use of mathematical models. Information on individual habits was assessed using a specific questionnaire. SPoTT is the first Italian study that adopts a longitudinal design of appropriate statistical power to assess health impacts of waste incinerator plants' emission. The initial results comparing the baseline to the first follow-up are due at the end of 2016.

[Population health surveillance of the general population living near Turin (Northern Italy) incinerator (SPoTT): methodology of the study]. / Sorveglianza sulla salute della popolazione nei pressi del termovalorizzatore di Torino (SPoTT): presentazione del programma di sorveglianza.

Si intende qui descrivere il sistema di sorveglianza sugli effetti sulla salute (SpoTT) dell'inquinamento ambientale nelle aree circostanti l'inceneritore di Torino. SPoTT ha 3 linee di attività: 1. monitoraggio epidemiologico degli effetti a breve termine attraverso analisi temporali e misura della correlazione tra livelli giornalieri di emissioni dell'impianto e andamento degli eventi individuati dagli archivi dei dimessi (SDO), di pronto soccorso e di mortalità; sono coinvolti coloro che nel 2013-2018 risiedevano nell'area di ricaduta delle emissioni; 2. sorveglianza epidemiologica degli effetti a lungo termine, stimando tassi standardizzati di mortalità e morbosità; a ogni soggetto è attribuito il valore stimato di esposizione cumulato nel tempo caratteristico della residenza anagrafica; le informazioni sulla salute sono reperite dagli archivi SDO, di mortalità e dai certificati di assistenza al parto; sono studiati due decenni pre-post l'avvio dell'impianto: 2003-2012 e 2013-2022; 3. monitoraggio biologico con misurazione pre-post di metalli, PCDD/F, PCB, OH-IPA; sono coinvolti 196 residenti esposti e 196 di controllo di 35-69 anni, campionati a caso dalle anagrafi comunali; sono effettuate misure di funzionalità endocrina e respiratoria, pressione arteriosa, rischio cardiovascolare; l'esposizione cumulativa sarà stimata per ciascuna persona campionata integrando l'indirizzo di residenza, il tempo di permanenza in ciascun indirizzo e i dati ricavati dai modelli di ricaduta; sarà costituita una biobanca per future indagini di laboratorio; sono coinvolti anche 20 allevatori e i lavoratori dell'impianto. Una quarta linea di attività, non descritta in questo articolo, riguarda il monitoraggio della salute dei lavoratori addetti all'impianto. SPoTT è il primo studio in Italia su inceneritori e salute che adotta un disegno di studio longitudinale di adeguata potenza sia per i residenti sia per i lavoratori. I primi risultati sono attesi nel corso del 2016.

Amyotrophic Lateral Sclerosis Incidence and Previous Prescriptions of Drugs for the Nervous System.

BACKGROUND: An increased frequency of psychotic disorders in amyotrophic lateral sclerosis (ALS) families compared to controls has been reported. Aim of our study was to assess the relationship between nervous system drugs prescriptions and subsequent onset of ALS in a large Italian population. METHODS: The study population consisted of all subjects over 15 years at the 2001 Italian census, resident in Turin since 1996 (n = 687,324), followed up for ALS occurrence from 2002 to 2014. Exposure to nervous system drugs was measured until 2012, or until 1 year before ALS onset. The association was estimated for ever and cumulative exposure, through Cox proportional Hazards models adjusted for sex, age, education, marital status and drug co-exposure. RESULTS: In the analysis for ever exposure, opioids were significantly inversely associated with ALS risk (hazard ratio (HR) 0.59; 95% CI 0.35-0.97), while antiepileptics (HR 1.35; 95% CI 0.92-2.00) showed a marginally significantly positive association. Examining cumulative exposure, the protective role of opioids associated with more than 4 prescriptions and the risk effect of antiepileptics for over 6 prescriptions was confirmed. CONCLUSIONS: The present study revealed associations of ALS onset with previous exposure to opioids, maybe through the activation of δ receptor and σ receptors and antiepileptics, which are novel findings to our knowledge.