COVID-19 in the tonsillectomised population.

OBJECTIVE: Interactions between SARS-CoV-2 and pharyngeal associated lymphoid tissue are thought to influence the manifestations of COVID-19. We aimed to determine whether a previous history of tonsillectomy, as a surrogate indicator of a dysfunctional pharyngeal associated lymphoid tissue, could predict the presentation and course of COVID-19. METHODS: Multicentric cross-sectional observational study involving seven hospitals in Northern and Central Italy. Data on the clinical course and signs and symptoms of the infection were collected from 779 adults who tested positive for SARS-CoV-2, and analysed in relation to previous tonsillectomy, together with demographic and anamnestic data. RESULTS: Patients with previous tonsillectomy showed a greater risk of fever, temperature higher than 39°C, chills and malaise. No significant differences in hospital admissions were found. CONCLUSIONS: A previous history of tonsillectomy, as a surrogate indicator of immunological dysfunction of the pharyngeal associated lymphoid tissue, could predict a more intense systemic manifestation of COVID-19. These results could provide a simple clinical marker to discriminate suspected carriers and to delineate more precise prognostic models.

[Effects of high temperature and air pollution on the risk of preterm births. Analysis in six Italian cities, 2001-2010]. / Effetti delle alte temperature e dell'inquinamento atmosferico sul rischio di nascita pretermine. Analisi in sei città italiane, 2001-2010.

OBJECTIVES: to evaluate the association between short term maternal exposure to high temperature and air pollution on preterm births (PBs), which represent the first cause of perinatal mortality and morbidity in developed Countries, and to identify maternal risk factors enhancing individual susceptibility. DESIGN: time series. SETTING E PARTICIPANTS: all singleton live-births occurred in six Italian cities between 1st April and 31st October of each year in the period 2001-2010 were identified through the Certificate of Delivery Care Registry (CedAP). MAIN OUTCOME MEASURES: births occurred between 22nd and 36th week of gestation were defined as preterm births. Daily values were obtained for maximum apparent temperature (MAT), PM10, NO2, and O3. Exposures-preterm births association was estimated using a generalized additive model (GAM) with a Poisson distribution. Exposure and city-specific lag structure were computed using a non-linear distributed lag model (DLNM). RESULTS: 121,797 newborns were enrolled, 6,135 (5.0%) of which were PBs. For MAT, a linear relationship was observed for Turin (Piedmont Region, Northern Italy), Trieste (Friuli Venezia Giulia Region, Northern Italy), Rome (Lazio Region, Central Italy), and Palermo (Sicily Region, Southern Italy), while non-linear relationship was found for Bologna (Emilia-Romagna Region, Northern Italy) and Venice (Veneto Region, Northern Italy). The relative risks (RR) for MAT, computed comparing the 90th vs. the 75th percentile, vary from 1.02 (95%CI 0.95-1.09; lag 0-2) in Palermo to 1.94 (95%CI 1.32-2.85; lag 0-3) in Venice. For pollutants, a significant effect for 10 µg/m3 (IQR) increase of PM10 in Rome (RR: 1.07; 95%CI 1.02-1.12; lag 12-22) and for 16 µg/m3 (IQR) increase of O3 in Palermo (RR: 1.29; 95%CI 1.03-1.62; lag 2-9) was detected. In Rome, a significant effect modification by age and education level of the MAT-PB relationship and by education level and clinical conditions of PM10-PB was found. CONCLUSIONS: results showed a clear positive association between MAT and the risk of NP and a lower and variable effect of pollutants. It is important and necessary to limit the impact of these risk factors on the probability of NP with appropriate prevention programmes.

[Estimate of the prevalence of Parkinson's disease by using electronic health archives]. / Stima della prevalenza della malattia di Parkinson con l'utilizzo di archivi sanitari elettronici correnti.

OBJECTIVE: To estimate the prevalence of Parkinson's disease using electronic health archives and to obtain a knowledge base for its governance. MATERIALS: Drug prescriptions, tax-exemptions and hospital discharge records relating to assisted of Health Services Agency "Triestina" in the year 2011. RESULTS: We identified 909 cases (crude prevalence rate: 380/100.000). The percentage contribution of drug prescriptions, tax-exemptions and hospital discharge records is: 81.5%, 36.1% and 35.2%. CONCLUSIONS: The use of drug prescriptions to detect patients with Parkinson's disease can be effectively supplemented by data of hospital discharges and tax-exemptions, but they still show an underestimation of 17%.

[Air pollution and urgent hospital admissions in 25 Italian cities: results from the EpiAir2 project]. / Inquinamento atmosferico e ricoveri ospedalieri urgenti in 25 città italiane: risultati del progetto EpiAir2.

OBJECTIVE: to evaluate the relationship between air pollution and hospital admissions in 25 Italian cities that took part in the EpiAir (Epidemiological surveillance of air pollution effects among Italian cities) project. DESIGN: study of time series with case-crossover methodology, with adjustment for meteorological and time-dependent variables. The association air pollution hospitalisation was analyzed in each of the 25 cities involved in the study; the overall estimates of effect were obtained subsequently by means of a meta-analysis. The pollutants considered were PM10, PM2.5 (in 13 cities only), NO2 and ozone (O3); this last pollutant restricted to the summer season (April-September). SETTING AND PARTICIPANTS: the study has analyzed 2,246,448 urgent hospital admissions for non-accidental diseases in 25 Italian cities during the period 2006- 2010; 10 out of 25 cities took part also in the first phase of the project (2001-2005). MAIN OUTCOME MEASURES: urgent hospital admissions for cardiac, cerebrovascular and respiratory diseases, for all age groups, were considered. The respiratory hospital admissions were analysed also for the 0-14-year subgroup. Percentage increases risk of hospitalization associated with increments of 10 µg/m(3) and interquartile range (IQR) of the concentration of each pollutant were calculated. RESULTS: reported results were related to an increment of 10 µg/m(3) of air pollutant. The percent increase for PM10 for cardiac causes was 0.34% at lag 0 (95%CI 0.04-0.63), for respiratory causes 0.75% at lag 0-5 (95%CI 0.25-1.25). For PM2.5, the percent increase for respiratory causes was 1.23% at lag 0- 5 (95%CI 0.58-1.88). For NO2, the percent increase for cardiac causes was 0.57% at lag 0 (95%CI 0.13-1.02); 1.29% at lag 0-5 (95%CI 0.52-2.06) for respiratory causes. Ozone (O3) did not turned out to be positively associated neither with cardiac nor with respiratory causes as noted in the previous period (2001-2005). CONCLUSION: the results of the study confirm an association between PM10, PM2.5, and NO2 on hospital admissions among 25 Italian cities. No positive associations for ozone was noted in this period.

[Air pollution and mortality in twenty-five Italian cities: results of the EpiAir2 Project]. / Inquinamento atmosferico e mortalità in venticinque città italiane: risultati del progetto EpiAir2.

OBJECTIVES: this study aims at presenting the results from the Italian EpiaAir2 Project on the short-term effects of air pollution on adult population (35+ years old) in 25 Italian cities. DESIGN: the short-term effects of air pollution on resident people died in their city were analysed adopting the time series approach. The association between increases in 10µg/m(3) in PM10, PM2.5, NO2 and O3 air concentration and natural, cardiac, cerebrovascular and respiratory mortality was studied. City-specific Poisson models were fitted to estimate the association of daily concentrations of pollutants with daily counts of deaths. The analysis took into account temporal and meteorological factors to control for potential confounding effect. Pooled estimates have been derived from random effects meta-analysis, evaluating the presence of heterogeneity in the city specific results. SETTING AND PARTICIPANTS: it was analysed 422,723 deaths in the 25 cities of the project among people aged 35 years or more, resident in each city during the period 2006-2010. MAIN OUTCOME MEASURES: daily counts of natural, cardiac, cerebrovascular, and respiratory mortality, obtained from the registries of each city. Demographic information were obtained by record linkage procedure with the civil registry of each city. RESULTS: mean number of deaths for natural causes ranged from 513 in Rovigo to 20,959 in Rome. About 25% of deaths are due to cardiac diseases, 10% to cerebrovascular diseases, and 7% to respiratory diseases. It was found an immediate effect of PM10 on natural mortality (0.51%; 95%CI 0.16-0.86; lag 0-1). More relevant and prolonged effects (lag 0-5) have been found for PM2.5 (0.78%; 95%CI 0.12-1.46) and NO2 (1.10%; 95%CI 0.63-1.58). Increases in cardiac mortality are associated with PM10 (0.93%; 95%CI 0.16-1.70) and PM2.5 (1.25%; 95%CI 0.17-2.34), while for respiratory mortality exposure to NO2 has an important role (1.67%; 95%CI 0.23-3.13; lag 2-5), as well as PM10 (1.41%; 95%CI - 0.23;+3.08). Results are strongly homogeneous among cities, except for respiratory mortality. No effect has been found for cerebrovascular mortality and weak evidence of association has been observed between ozone and mortality. CONCLUSIONS: a clear increase in mortality associated to air pollutants was observed. More important are the effects of NO2 (on natural mortality), mostly associated with traffic emissions, and of PM2.5 (on cardiac and respiratory mortality). Nitrogen dioxide shows an independent effect from the particulate matter, as observed in the bi-pollutant models.

[Prevalence of malnutrition among institutionalized elderly subjects in Trieste, Northen Italy)]. / Valutazione dello stato nutrizionale di anziani ospiti di strutture residenziali a Trieste.

AIM: to evaluate nutritional status in a representative sample of guests of residential homes for the elderly using the Mini Nutritional Assessment (MNA, Nestlè®) and compare results with data from literature. DESIGN: cross-sectional study of prevalence using cluster sampling in two stages. SETTING AND PARTICIPANTS: the investigation focused on a sample of 420 guests of 37 facilities for the elderly, out of 2,967 residents in 89 facilities in the province of Trieste. The target population was characterised by age 65 years, with different degrees of self-sufficiency. Data were collected during 2010. MAIN OUTCOME MEASURES: nutritional status as defined by the MNA (good, bad, risk of malnutrition). RESULTS: the prevalence of malnutrition and risk of malnutrition are respectively 14.1% (CI95% 10.2-18.0) and 48.6% (CI95%43.4-53.8).The prevalence of malnutrition is higher among people residing in facilities for non self-sufficient guests: 21.4%(14.9 to 27.9) versus 9.5%(4.7 to 14.3) among people residing in facilities for self-sufficient guests. The intracluster correlation coefficients (ICC) and the relative standard error (ES) for the variables "normal nutritional status", "risk of malnutrition " and "bad nutrition" are respectively 0.19 (0.05); 0.02 (0.03); 0.05 (0.04). CONCLUSION: the prevalence of malnutrition and risk of malnutrition in residential facilities for the elderly in the province of Trieste is in line with the literature. The adoption of systematic nutritional screening, under the supervision and the support of the Prevention Departments, would allow a timely adoption of preventive and targeted therapeutic interventions.

[Smoking cessation with the help of community pharmacists]. / Smettere di fumare con l'aiuto dei farmacisti territoriali.

AIM: To investigate the outcome of a protocol for smoking cessation used in the practice of the community pharmacies. DESIGN: Observational descriptive study of a non pharmacological intervention, without parallel control. SETTING AND PARTICIPANTS: Urban community pharmacies in the province of Trieste (n=60). Data have been collected by 31 pharmacists representing 31 pharmacies (52%). MAIN OUTCOME MEASURES: Outcome of a brief intervention aimed to promote the use of nicotine replacement (NRT) or to refer to a smoking cessation clinic. RESULTS: Data of 905 smokers have been analysed: 16.1% (CI 95%: 11.6%-20.5%) purchased NRT and 11.1% (CI 95%: 7.8%-14.5%) accepted to be referred to a smoking cessation clinic. The assessment of the degree of motivation to stop smoking and of the degree of nicotine dependence, according to West, is highly associated to the outcome of the intervention. CONCLUSION: The study encourages the use of no-smoking programs in the community pharmacies. Intervention must be short and simple. West's assessment system is useful and reliable for smokers' evaluation and for decisions regarding the therapeutic strategy of smoking cessation.

[Changes in PM10 and PM2.5 air levels in bars after the enforcement of the smoking ban in the Italian legislation]. / Variazione nelle concentrazioni di PM10 e PM2,5 nei bar dopo l'entrata in vigore della legge sul fumo passivo in Italia.

OBJECTIVE: in Italy law n.3/2003 has banned smoking in closed places, with the exception of private venues and of public venues reserved for smokers and marked as such. The present report estimates the effects of the ban. DESIGN: comparison between periods (before-after enforcement of the law). SETTING: City of Trieste. PARTICIPANTS: Six bars and four shops (convenience sample). MAIN OUTCOME MEASURES: particulate matter fractions PM10 and PM2.5 in bars and stores before and after enforcement of the law, outdoor PM10. Concentrations were estimated over the normal working hours of the premises. RESULTS: after enforcement of the law the concentration of PM2.5 in bars fell by 73% (p < 0.01), whereas the concentration of the PM10-2.5 fraction did not decrease significantly. Overall, the mean concentration of PM2.5 and PM10-2.5 in shops showed no statistically significant change. CONCLUSION: mean hourly PM2.5 concentrations, used as a proxy for indoor pollution caused by environmental tobacco smoke in bars were significantly reduced.

[Exposure to passive smoking in local health units of northern Italy before and after the enforcement of the smoking ban]. / Esposizione a fumo passivo nei locali di una ASL del Nord Italia prima e dopo l'entrata in vigore della legge sul fumo.

OBJECTIVE: to assess smoking habits, environmental tobacco smoke (ETS) exposure and smoking attitudes of workers toward different possible institutional restrictions before and after the implementation of the new Italian legislation about the public health protection from passive smoking (L 3/2003). DESIGN: Descriptive study based on self-reported questionnaires (2004 and 2005) and indoor measurement of particulate matter (PM, 2004 and 2006). SETTING: Local health authority n.1 Triestina (1,067 employees). PARTICIPANTS: 746 workers in 2004, 200 workers in 2005. MAIN OUTCOME MEASURE: percentage of smokers and opinions about different firms of control of smoking (absolute prohibition, smokers' reserved locals). Indoor mean levels of PM2.5 and PM10 in workplaces. RESULTS: smoking employees in 2004 and in 2005 were 28% and 31% (difference non statistically significant). Employees exposed to ETS has been reported decreased from 58% to 47% (p= 0.006). Major reduction has been reported in the offices, while exposure in examination rooms resulted higher in comparison to the offices, both in 2004 and in 2006 Among smokers 43% are available to external helps in order to quit or reduce smoking. Levels of PM2.5 were, in 2006, constantly smaller then those measured in 2004. The same for PM10 (a less specific tobacco smoke indicator) except for the value recorded in one room, slightly higher then in 2004. CONCLUSION: Our results confirm that ETS in the surveyed Local Health Authority has been reduced but not eliminated. It is necessary to implement further interventions finalized to defend health of not smoking people: a greater respect of the law, specific health promotion campaigns and free therapeutic interventions in workplaces.

[Estimate of potential health benefits of the reduction of air pollution with PM10 in Trieste, Italy]. / Stima dei potenziali benefici sanitari della riduzione dell'inquinamento atmosferico da PM10 nella città di Trieste.

OBJECTIVES: Estimate of the possible benefits, in Trieste, of a reduction of PM10 to values not over 60, 50, 40, 30, 20, 10 microg/mc, utilizing data of PM10 of the year 2002 as cause specific deaths and admissions. DESIGN: Cause specific deaths and admissions attributable to short term effects of PM10 calculated by software AirQ, utilizing Relative Risk from MISA 1 study (as published in 2002). SETTING: Trieste (Italy). MAIN OUTCOMES MEASURES: Cause specific deaths and admissions. RESULTS: Using air pollution data for 2002, 1.8% (CI 95% 0.6%; 2.9%) of natural deaths, 2.2% (CI 95% 0.6%; 3.7%) of cardiovascular deaths and 2.5% (CI 95% 0; 7.3%) of respiratory deaths, 1.5% (CI 95% 0.6; 2.4%) of cardiovascular admissions and 1.6% (CI 95% 0; 3.3%) of respiratory admissions were attributable to PM10 concentrations over 20 microg/mc. CONCLUSIONS: AirQ software proved to be a valid and reliable tool to estimate the potential short term effects of air pollution. Special attention is required to choose the relative risks to be utilized.