Prevalence of Problem Gambling: A Meta-analysis of Recent Empirical Research (2016-2022).

Gambling is widely considered a socially acceptable form of recreation. However, for a small minority of individuals, it can become both addictive and problematic with severe adverse consequences. The aim of this systematic review and meta-analysis is to provide an overview of prevalence studies published between 2016 and the first quarter of 2022 and an updated estimate of problem gambling in the general adult population. A systematic review and a meta-analysis were carried out using academic databases, Internet, and governmental websites. Following this search and utilizing exclusion criteria, 23 studies on adult gambling prevalence were identified, distinguishing between moderate risk/at risk gambling and problem/pathological gambling. This study found a prevalence of moderate risk/at risk gambling to be 2.43% and of problem/pathological gambling to be 1.29% in the adult population. As difficult as it may be to compare studies due to different methodological procedures, cutoffs, and time frames, the present meta-analysis highlights the variations of prevalence across different countries, giving due consideration to the differences between levels of risk and severity. This work intends to provide a starting point for policymakers and academics to fill the gaps on gambling research-more specifically in some countries where the lack of research in this field is evident-and to study the effectiveness of policies implemented to mitigate gambling harm.

Exploring gender differences in medication consumption and mortality in a cohort of hypertensive patients in Northern Italy.

BACKGROUND: This paper aims to assess the presence of gender differences in medication use and mortality in a cohort of patients affected exclusively by hypertension, in 193 municipalities in the Lombardy Region (Northern Italy), including Milan's metropolitan area. METHODS: A retrospective cohort study was conducted (N = 232,507) querying administrative healthcare data and the Register of Causes of Death. Hypertensive patients (55.4% women; 44.6% men) in 2017 were identified; gender differences in medication use (treatment, 80% compliance) and deaths (from all causes and CVDs) were assessed at two-year follow-ups in logistic regression models adjusted for age class, census-based deprivation index, nationality, and pre-existing health conditions. Models stratified by age, deprivation index, and therapeutic compliance were also tested. RESULTS: Overall, women had higher odds of being treated, but lower odds of therapeutic compliance, death from all causes, and death from CVDs. All the outcomes had clear sex differences across age classes, though not between different levels of deprivation. Comparing patients with medication adherence, women had lower odds of death from all causes than men (with a narrowing protective effect as age increased), while no gender differences emerged in non-compliant patients. CONCLUSIONS: Among hypertensive patients, gender differences in medication consumption and mortality have been found, but the extent to which these are attributable to a female socio-cultural disadvantage is questionable. The findings reached, with marked age-dependent effects in the outcomes investigated, suggest a prominent role for innate sex differences in biological susceptibility to the disease, whereby women would take advantage of the protective effects of their innate physiological characteristics, especially prior to the beginning of menopause.

Describing the epidemic trends of COVID-19 in the area covered by Agency for Health Protection of the Metropolitan Area of Milan.

OBJECTIVES: to describe the epidemic trends of COVID-19 over time and by area in the territory covered by Milan's Agency for Health Protection (ATS-MI) from February to May 2020. DESIGN: descriptive study of COVID-19 cases. SETTING AND PARTICIPANTS: a new information system was developed to record COVID-19 cases with positive nasopharyngeal swab. Patients resident in the area covered by ATS-MI with symptom onset between February and May 2020 were selected. Different epidemic periods were considered based on the timeline of the various regional and national containment measures. MAIN OUTCOME MEASURES: case fatality ratios, incidence rates, and reproduction number by epidemic period and sub-area of ATS-MI. RESULTS: a total of 27,017 swab-positive COVID-19 cases were included. Mean age was 65 years and males were 45%. Incidence in the ATS-MI area was 776 per 100,000 population. The number of deaths was 4,660, the crude case fatality ratio was 17.3%, higher in males (21.2%) than in females (14.0%). The estimated reproduction number registered its peak (3.0) in the early stages of the epidemic and subsequently decreased. Territorial differences were observed in the epidemic spread, with a higher incidence in the Lodi area. CONCLUSIONS: estimated incidence and case fatality ratios were higher than national estimates for Italy. Each ATS-MI area had different epidemic spread patterns.

Assessment of the Overall Mortality during the COVID-19 Outbreak in the Provinces of Milan and Lodi (Lombardy Region, Northern Italy).

OBJECTIVES: to describe the overall mortality increase in the provinces of Milan and Lodi - area covered by the Agency for Health Protection of Milan - during the COVID-19 epidemic in the first four months of 2020, compare it with the same time period in the years 2016-2019, and evaluate to what extent the mortality can be directly attributed to the outbreak. DESIGN: cohort study. SETTING AND PARTICIPANTS: using a new information system developed during the pandemic, we gathered data on the number of daily deaths in the population residing in the provinces of Milan and Lodi by Local Health Unit (ASST) and age groups. To describe the case fatality of COVID-19, we performed a record linkage with a database specially constructed during the epidemic to identify deaths that occurred in confirmed cases. MAIN OUTCOME MEASURES: mortality and excess mortality were analysed by comparing the number of observed deaths in the first 4 months of 2020 with the average deaths of the years 2016-2019 in the same calendar period and with expected deaths, estimated using a Poisson model. Furthermore, a measure of relative risk was calculated as observed/expected ratio with a 95% confidence interval. RESULTS: the increase in mortality for all causes occurring in the study population in the first 4 months of 2020 was 48.8%, 30.8% for ages between 60 and 69, 43.9% for ages between 70 and 79, and 56.7% for subjects above 80 years of age. Focusing on the epidemic period, from 1 March to 30 April, the excess is quantifiable as more than 2-fold and mainly concerns the population over 60 years of age. The excess mortality was observed in all local health units (ASSTs). The highest increments were in the province of Lodi and the North-East of Milan (ASST Nord). In the ASSTs of Lodi and Melegnano-Martesana the mortality excess was detectable from March 15th, while for the other ASSTs the increase began in the first week of April. CONCLUSIONS: evaluation of overall mortality in the provinces of Milan and Lodi during the first wave of the Covid-19 epidemic showed a significant excess compared to the first 4 months of the years 2016-2019, mainly in the population over 60 years of age. However, this excess cannot be completely attributed directly to COVID-19 itself. This phenomenon was more intense in the Lodi ASST, with daily deaths up to 5 times higher than expected.

[Analysis of psychological distress between the paediatric population immigrant and resident in a Local Health Unit of Milan Province (Northern Italy)]. / Analisi del disagio psichico nella popolazione pediatrica immigrata e residente in una ASL della Provincia di Milano.

OBJECTIVES: to figure out if there are differences in access to psychiatric services between Italian and immigrant paediatric populations. DESIGN: we analysed the data of the year 2012 from the Banca dati del disagio psichico, a database on psychological distress created by the Epidemiological Unit of the Local Health Unit Milan 1 (Lombardy, Northern Italy). The database is based on a data warehouse system that integrates health and social data, and gives the opportunity to calculate the prevalence rates of the main clusters of psychiatric diseases according to ICD-10 categories. SETTING AND PARTICIPANTS: the sample includes 162,197 residents younger than 18 years (minors), divided into 4 subgroups depending on the place of birth (Italy or abroad) and citizenship (Italian or foreign). MAIN OUTCOME MEASURES: we calculated the standardised treated prevalence of the 11 clusters of mental diseases in the 4 subgroups and evaluated the Standardised Prevalence Ratio (SPR) and their confidence intervals using as reference the Italian paediatric population with Italian citizenship. RESULTS: in 2012, 7.2%minors were diagnosed a mental illness or accessed mental health services or were prescribed psychotropic medicines. We found the lowest SPRs of psychiatric illnesses in immigrants (0.91 born in Italy; 0.74 born abroad) and the higher in Italians born in foreign Countries (1.34). In particular, migrant minors born in Italy have lower SPR of developmental disorders (0.84) and behaviour and emotional disorders (0.68), but higher SPR of mental retardation (1.52) and anxiety disorders (1.36). Migrant minors born abroad have lower SPR of developmental disorders (0.52), but higher rates of mental retardation (1.30). Italians born in foreign Countries show a SPR for personality disorders and mental retardation of 4.86 and 2.02, respectively. CONCLUSIONS: immigrant minors have a lower prevalence of psychiatric diseases than Italian minors; however, Italians born in foreign Countries show a higher prevalence of psychiatric disorders.

Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case-control and population case-control design.

BACKGROUND: COVID-19 epidemic has paralleled with the so called infodemic, where countless pieces of information have been disseminated on putative risk factors for COVID-19. Among those, emerged the notion that people suffering from autoimmune diseases (AIDs) have a higher risk of SARS-CoV-2 infection. METHODS: The cohort included all COVID-19 cases residents in the Agency for Health Protection (AHP) of Milan that, from the beginning of the outbreak, developed a web-based platform that traced positive and negative cases as well as related contacts. AIDs subjects were defined ad having one the following autoimmune disease: rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjogren disease, ankylosing spondylitis, myasthenia gravis, Hashimoto's disease, acquired autoimmune hemolytic anemia, and psoriatic arthritis. To investigate whether AID subjects are at increased risk of SARS-CoV-2 infection, and whether they have worse prognosis than AIDs-free subjects once infected, we performed a combined analysis of a test-negative design case-control study, a case-control with test-positive as cases, and one with test-negative as cases (CC-NEG). RESULTS: During the outbreak, the Milan AHP endured, up to April 27th 2020, 20,364 test-positive and 34,697 test-negative subjects. We found no association between AIDs and being positive to COVID-19, but a statistically significant association between AIDs and being negative to COVID-19 in the CC-NEG. If, as likely, test-negative subjects underwent testing because of respiratory infection symptoms, these results imply that autoimmune diseases may be a risk factor for respiratory infections in general (including COVID-19), but they are not a specific risk factor for COVID-19. Furthermore, when infected by SARS-CoV-2, AIDs subjects did not have a worse prognosis compared to non-AIDs subjects. Results highlighted a potential unbalance in the testing campaign, which may be correlated to the characteristics of the tested person, leading specific frail population to be particularly tested. CONCLUSIONS: Lack of availability of sound scientific knowledge inevitably lead unreliable news to spread over the population, preventing people to disentangle them form reliable information. Even if additional studies are needed to replicate and strengthen our results, these findings represent initial evidence to derive recommendations based on actual data for subjects with autoimmune diseases.

Air Pollution Impact on Pregnancy Outcomes in Como, Italy.

OBJECTIVE: This retrospective observational study investigates the association between maternal exposure to air pollutants and pregnancy adverse outcomes in low urbanization areas. METHODS: We used multivariate regression analysis to estimate, in the Como province (2005-2012), the effects of NO(x), NO2, SO2, O3, CO, and PM10 on low birth weight (LBW), babies small for gestational age (SGA), and preterm birth (PTB). RESULTS: PTB was inversely associated with high (5.5 µg/m³) exposure to SO2 (adjusted odds ratio [aOR] = 0.74, 95% confidence interval [95% CI] = 0.58-0.95) and to CO (1.8 mg/m³, aOR = 0.84, CI = 0.72-0.99). PTB risk increased with second trimester exposure to NO(x) (118.3 µg/m³, aOR = 1.53, CI = 1.25-1.87), while LBW risk increased with third trimester PM10 (56.1 µg/m³, aOR = 1.44, CI = 1.03-2.02). SGA was inversely associated with third trimester NO(x) (115.8 µg/m³, aOR = 0.89, CI = 0.79-0.99). CONCLUSIONS: Exposure to SO2 and CO seems to postpone delivery: a longer gestation could compensate for maternal hypoxemic-hypoxic damage.