[Temporal analysis of the prevalence of congenital hypospadias in the municipality of Gela]. / Analisi temporale della prevalenza di ipospadia congenita nel comune di Gela.

OBJECTIVES: to evaluate the risk profile of hypospadias in Gela, an Italian National Priority Contaminated Site (NPCS) located in Sicily Region (Southern Italy), characterized by a significant excess of hypospadias in newborn residents compared to data from reference on regional, national, and international basis and, until 2014, by the presence of a petrochemical plant. DESIGN: geographical analyses were conducted by comparing the prevalence of the Gela municipality to prevalence found in Sicily, in a territorial area bordering Gela (ALG), and in the NPCSs of Milazzo and Priolo. The geographical comparisons were conducted for the period 2010-2020, the trend within the Gela NPCS was evaluated by comparing two subperiods (2010-2014 and 2015-2020). SETTING AND PARTICIPANTS: children up to 1 year of age with hypospadias resident in the municipality of Gela in the period 2010-2020. MAIN OUTCOMES MEASURES: crude odds ratios (OR) and respective 95% confidence intervals (95%CI) were used to compare the prevalence observed in Gela and that detected in the comparison areas. RESULTS: excess risk for hypospadias was highlighted in 2010-2020 in Gela vs Sicily (OR 4.45; 95%CI 3.45-5.75), vs ALG (OR 4.29; 95%CI 3.02-6.10), and vs the NPCSs of Milazzo (OR 2.32; 95%CI 1.32-4.07) and Priolo (OR 2.37; 95%CI 1.55-3.62). The between-period comparisons in Gela did not show an important difference between 2010-2014 and 2015-2020 (OR 1.37; 95%CI 0.83-2.24), with a prevalence of 98.9 and 72.4 per 10,000, respectively. CONCLUSIONS: the prevalence of hypospadias in 2015-2020 remains very high, although decreasing when compared to 2010-2014 period. The Gela data, despite the refinery being closed after 2014, suggest a complex situation in which multiple risk factors may play a role.

[A regional equity profile to assess the impact of social inequalities on determinants and health outcomes in the population residing in Sicily Region (Southern Italy)]. / Un profilo di equità regionale per la valutazione dell'impatto delle disuguaglianze sociali sui determinanti e sugli esiti di salute nella popolazione residente in Sicilia.

OBJECTIVES: to build an equity profile for assessing the impact of socioeconomic inequalities on the determinants and health outcome in Sicily (Southern Italy). DESIGN: descriptive study aimed to define an equity profile in Sicily by using a rich list of indicators of structure of the resident population and of distribution of determinants and health outcome, derived from the integration of available information and scientific evidence at regional level with high local detail. SETTING AND PARTICIPANTS: the equity profile collects available information on the health status of the population in Sicily, on the determinants, and on the use of health and social services. The characteristics of people or population groups have been explored and can produce inequalities on health which included individual and context socioeconomic status. MAIN OUTCOME MEASURES: using available information sources and study results have explored the effects of the disadvantage on health in the region: mortality, morbidity, oncological incidence, reproductive health, and some of their determinants. RESULTS: the Sicilian population tends to aging. Migration flows tend to compensate the reduction in births in Sicily and it increases the proportion of younger people and women in childbearing age. The proportion of large families tends to get smaller, whereas the proportion of single-component ones increases; the population groups with low education, unemployment, poverty, and income increases. Starting from the first thousand days of life, to continue in the other classes of the population, the different distribution of risk factors on health was identified according to different levels of deprivation. CONCLUSIONS: the Sicilian equity profile has systematized and consolidated previous experiences on the effects of disadvantage on health. Prevention interventions, oriented towards equity, should be based on the results of this study and should take care of the general aspects of actions and, at the same time, focus on vulnerable population groups.

Trends and projections of pleural mesothelioma incidence and mortality in the national priority contaminated sites of Sicily (Southern Italy).

OBJECTIVES: to evaluate short-medium term incidence and mortality projections of pleural malignant mesothelioma (PMM) in Sicily Region (Southern Italy) and in its four National Priority Contaminated Sites (NPCSs). DESIGN: population-based prediction study. SETTING AND PARTICIPANTS: PMM cases from 1998 to 2016 registered by the Regional Operations Centre of the Sicilian Region. MAIN OUTCOME MEASURES: incidence and mortality trends of PMM were estimated for the period 1998-2016 from the relationships among mortality, incidence, and survival. Projections of incidence and mortality rates were obtained up to 2026. RESULTS: age-standardized incidence rates of PMM in Sicily were estimated to increase in men from 1.4 (x100,000) in 1998 to 2.29 in 2021 and to slightly decrease down to 2.2 in 2026. Women age-standardized rates in the same period are estimated to decrease from 0.52 to 0.27. In Biancavilla, age-standardized incidence rates were estimated to remain stable between 8.1 and 8.0 in men, while crude rates increased from 8.3 in 1998 to 10.7 in 2026. For women, the estimated age-standardized incidence rates are increasing from 3.08 to 6.75. In the three pooled NPCSs of Augusta-Priolo, Gela, and Milazzo, the estimates of age-standardized incidence rates show an initial trend to growth followed by a decreasing trend, both in men and women, down to predicted values in 2016 of 3.0 in men and 0.77 in women. Estimated age-standardized and crude mortality rates show, for both sexes and all areas, similar patterns as those estimated for incidence. CONCLUSIONS: in Sicily and in the three NPCSs of Gela, Milazzo, and Priolo, incidence and mortality projections are downward in both sexes. In Biancavilla, mesothelioma occurrence is estimated to increase up to 2026, slightly in males and more significantly in females.

[The epidemiological surveillance in the programme of public health intervention in the national priority contaminated sites of Sicily Region (Southern Italy): update of mortality, hospitalization, and cancer incidence]. / La sorveglianza epidemiologica nel programma regionale di interventi sanitari nei siti di interesse nazionale della Sicilia: aggiornamento della mortalità, dell'ospedalizzazione e dell'incidenza oncologica.

OBJECTIVES: to update the health profile of populations residing in the national priority contaminated sites (NPCSs) in Sicily Region (Southern Italy) through a description of mortality and hospitalization for causes and through cancer incidence. This new profile is part of the implementation of the epidemiological surveillance system within the new Programme of care intervention for health protection in these populations and in the new Regional Prevention Plan. DESIGN: geographic population survey providing, for each NPCS considered in this study, a comparison between the local population and the populations of the neighbouring areas. SETTING AND PARTICIPANTS: the study population included the residents in the municipalities residing in the NPCSs of Augusta-Priolo, Gela, Milazzo, and Biancavilla. MAIN OUTCOME MEASURES: the standardized mortality ratio (SMR), morbidity (SHR), and tumour incidence (SIR), with the respective 95% confidence intervals, were estimated using the Mortality Registry as source for the mortality index, the database of the hospital discharged as source for the morbidity index, and the data from the Regional Network of Tumour Registers as source for the incidence index. RESULTS: in the local comparison, excess of hospitalization in both sexes was reported in Augusta-Priolo for liver cirrhosis, mental disorders, and digestive tract disease, and an excess of incidence and mortality for leukaemia in women and prostate cancer in men. In the NPCS of Gela, there was an excess of hospitalization in both sexes for blood and hematopoietic diseases, circulatory and nervous system diseases, coupled with the same excess of mortality. Excess of incidence and mortality of stomach tumours in men and incidence of lung cancer in women were observed. The area of ​​Milazzo was characterized by an excess of incidence and mortality for melanoma in men. In the municipality of Biancavilla, there is evidence of excess of hospitalization for respiratory diseases and endocrine glands diseases in both sexes, while a mortality excess for circulatory system diseases was highlighted. The excess of incidence of mesothelioma in both men and women was confirmed. CONCLUSION: data from the new surveillance system help to define the health profile in the NPCSs of Sicily. Even using the local level of comparison, that was added to the traditional approach in geographic studies for the NPCSs available to date, the particular impact of some chronic diseases in these populations has been confirmed also in recent years.

North-south differences in incidence and surveillance of cutaneous malignant melanoma in Italy.

BACKGROUND: In Italy, the incidence of cutaneous malignant melanoma is two-fold higher in the north than in the south. This gradient might be associated with differences in incidence trends and disease surveillance. We compared the time trends in incidence rates, mortality rates, dermatologic office visit rates and skin biopsy rates between the Emilia-Romagna Region (northern Italy) and the Sicily Region (southern Italy). METHODS: The cancer registries of Parma, Modena, Ferrara and Romagna (current population, 2,606,465) and Catania-Messina-Enna, Siracusa and Ragusa (2,775,019) provided incidence and mortality records for the years 2008-2017. The records of outpatient services delivered in public health facilities were obtained from the two Regional Administrations. Trends in rates were assessed with the estimated average annual percent change. North-south differences were expressed as age-standardised rate ratios. RESULTS: In the context of a generalised increasing incidence trend, which was more moderate in the female population of the Sicily Region, the standardised rate ratios were: 5.31 (males) and 5.20 (females) for in situ cutaneous malignant melanoma; 2.10 and 2.07 for invasive cutaneous malignant melanoma, with an excess incidence concentrated in lesions ⩽1.00 mm thick (3.58 and 3.05); 3.00 and 2.44 for dermatologic office visits; and 5.25 and 5.02 for skin biopsies. Mortality was stable in both Regions. CONCLUSIONS: In the Emilia-Romagna Region, as compared with the Sicily Region, a higher incidence of cutaneous malignant melanoma -especially of in situ and early invasive cutaneous malignant melanoma- coexisted with a higher level of clinical surveillance. The question of the direction of the cause-effect relationship between increased incidence and increased diagnostic scrutiny remains open.

Endemic hepatitis C virus infection in a Sicilian town: further evidence for iatrogenic transmission.

The prevalence of and risk factors for HCV and HBV infections in the general population and the predictive value of ALT screening in identifying anti-HCV positive subjects have been evaluated in a small Sicilian town. A random 1:4 sampling from the census of the general population was performed. Anti-HCV, HCV-RNA, HCV genotype, HBsAg, and anti-HBc were tested. The linkage between HCV infection and potential risk factors was evaluated by multiple logistic regression analysis. Among 721 subjects studied, 75 (10.4%) were anti-HCV positive. The HCV infection rate increased from 0.4% in subjects 10-29 years of age to 34% in those > 60 years of age. Among the 75 anti-HCV positive subjects, 66.7% were HCV-RNA positive and 36% had abnormal ALT, in contrast abnormal ALT levels were found in 4.3% of the 646 anti-HCV negative subjects (P < 0.01). HCV genotype 1b infected the majority (88.0%) of viremic subjects. Exposure to HBV infection (anti-HBc positivity) was found in 11.2% of subjects; HBsAg positivity was 0.7%. At multivariate analysis, two variables were associated with HCV infection: age > or = 45 years (OR 27.8; CI 95% = 11.0-70.2) and previous hospitalization (OR 2.5; CI 95% = 1.3-4.7). ALT testing had low positive predictive value (PPV = 49.1%) for HCV infection. The positive predictive value was good (88%) in people > or = 60 years of age, but minimal (16.7%) in those below 60. These findings indicate that HCV infection is common in the elderly, perhaps as a result of past iatrogenic transmission. The present low rate of HCV infection among the younger generations coupled with the low progression of the viral related liver damage does not support the projection of a future increasing incidence in the next decades of the burden of HCV-related chronic disease. HBV infection, formerly common in this area, is already in sharp decline. In an area of high HCV endemicity, screening of the general population by ALT cannot be used a surrogate marker to detect HCV infection in those susceptible to treatment.