[Incidence of cancer among children and adolescents (0-19 years) in Lazio Region (Central Italy), 2009-2015]. / Incidenza di tumori nella popolazione infantile e adolescenziale (0-19 anni) della Regione Lazio, anni 2009-2015.

OBJECTIVES: to investigate, for the first time, the incidence of cancer (years 2009-2015) and geographical distribution among children and adolescents with cancer diagnosis in Lazio Region (Central Italy). DESIGN: to compute incidence rates of childhood cancers from Lazio Region Childhood Cancer Registry (LRCCR) database, established in 2015, and to compare results with national figures for 2012 provided by the Italian cancer registries network (AIRTUM). SETTING AND PARTICIPANTS: all new cases of malignant tumours (behaviour: /3 of ICD-O-3 classification) and all central nervous system tumours were selected, regardless of behaviour (/0, /1, /3) in children and adolescents (0-19 years) registered in the LRCCR data base. MAIN OUTCOME MEASURES: it was computed: • the raw and the direct standardised rates for the 0-14-year and the 15-19-year age groups for total malignant tumours of the ICCC-3 classification by area (province level and municipality of Rome); • Relative Risks (RR) for area-specific rate compared with that of the Lazio Region and 95% Confidence Intervals (95%CI). RESULTS: a total of 1,782 incident cases were recorded in 2009-2015; of these, 91.4% were confirmed by a pathology report. Standardized Incidence Rate for all malignant tumours is 207.2×1,000,000 (95%CI 195.5-219.5) in children and 335.1×1,000,000 (95%CI 308.9-361.2) in adolescents. Compared to the Lazio Region, a higher incidence of tumours is observed in Rome municipality (RR 1.09; 95%CI 0.98-1.20) and in the Frosinone province (RR 1.07; 95%CI 0.91-1.25) for the whole 0-19-year age group. CONCLUSIONS: compared to the pooled AIRTUM figures for 2003-2008, Lazio Region showed a higher incidence for all cancers, both in children and adolescents, and for specific tumours, such as leukaemia in children and thyroid carcinoma in adolescents. Apart from the diverse observation period, these differences may be due to a higher registry sensitivity of the childhood specialized registry compared to general population registries. The observed incidence excesses for specific geographical areas and tumours deserve further investigations. Overall, in its first seven years of activity, the Lazio childhood cancer registry was able to provide reliable epidemiological figures of cancer incidence in children and adolescents in the Italian context.

Social network analysis to characterize women victims of violence.

BACKGROUND: In Europe, it is estimated that one third of women had experienced at least one physical or sexual violence after their 15. Taking into account the severe health consequences, the Emergency Department (ED), may offer an opportunity to recognize when an aggression is part of the spectrum of violence. This study applies Social Network analysis (SNA) to ED data in the Lazio region with the objective to identify patterns of diagnoses, within all the ED accesses of women experiencing an aggression, that are signals for gender-based violence against women. We aim to develop a risk assessment tool for ED professionals in order to strength their ability to manage victims of violence. METHODS: A cohort of 124,691 women aged 15-70 with an ED visit for aggression between 2003 and 2015 was selected and, for each woman, the ED history of diagnoses and traumas was reconstructed. SNA was applied on all these diagnoses and traumas, including also 9 specific violence diagnoses. SNA community detection algorithms and network centrality measures were used to detect diagnostic patterns more strongly associated to violence. A logistic model was developed to validate the capability of these patterns to predict the odds for a woman of having an history of violence. Model results were summed up into a risk chart. RESULTS: Among women experiencing an aggression, SNA identified four communities representing specific violence-related patterns of diagnoses. Diagnoses having a central role in the violence network were alcohol or substance abuse, pregnancy-related conditions and psychoses. These high-risk violence related patterns accounted for at most 20% of our cohort. The logistic model had good predictive accuracy and predictive power confirming that diagnosis patterns identified through the SNA are meaningful in the violence recognition. CONCLUSIONS: Routine ED data, analyzed using SNA, can be a first-line warning to recognize when an aggression related access is part of the spectrum of gender-based violence against women. Increasing the available number of predictors, such procedures may be proven to support ED staff in identifying early signs of violence to adequately support the victims and mitigate the harms.

Meat consumption reduction in Italian regions: Health co-benefits and decreases in GHG emissions.

INTRODUCTION: Animal agriculture has exponentially grown in recent decades in response to the rise in global demand for meat, even in countries like Italy that traditionally eat a Mediterranean, plant-based diet. Globalization related dietary changes are contributing to the epidemic of non-communicable diseases and to the global climate crisis, and are associated with huge carbon and water footprints. The objective of the study is to assess inequalities in health impacts and in attributable greenhouse gases-GHG emissions in Italy by hypothesizing different scenarios of reduction in red and processed meat consumption towards healthier consumption patterns more compliant with the recommendations of the Mediterranean food pyramid. METHODS: We used demographic and food consumption patterns from national surveys and risk relationships between meat intake and cardiovascular and colorectal cancer mortality from IARC and other meta-analyses. From the baseline data (year 2005-2006, average 406 gr/week beef and 245 gr/week processed meat), we considered hypothetical meat reduction scenarios according to international dietary guidelines such as the Mediterranean pyramid targets. For each geographical area (Northwest, Northeast, Centre, and South) and gender, we calculated the number of avoidable deaths from colorectal cancer, and cardiovascular disease among the adult population. Moreover, years of life gained by the adult population from 2012 to 2030 and changes in life expectancy of the 2012 birth cohort were quantified using gender-specific life tables. GHG emission reductions under Mediterranean scenario were estimated only for beef by applying the Global Warming Potential (GWP) coefficient to total consumption and to a low carbon food substitution in adult diet. RESULTS: The deaths avoidable (as percentage change compared to baseline) according to the three reduction scenarios for beef consumption were between 2.3% and 4.5% for colorectal cancer, and between 2.1% and 4.0% for cardiovascular disease; higher benefits would be observed in Northwestern areas and among males. In parallel, 5% and 6.4% of colorectal cancer and CVD deaths would be avoided if the Italian population ate the advised quantity of processed meat. Life table analysis suggests that the scenario that is fully compliant with the Mediterranean diet model would save 5 million years of life lost prematurely among men and women over the next 18 years and would increase average life expectancy of future generations by over 7 months. Considering the environmental impact, emissions associated with the actual total intake of beef range from 12,900 to 21,800 Gg CO2 eq; emissions saved according to the Mediterranean scenario are in the range 8000-14000 Gg CO2 eq per year. The per capita reduction is 263 KgCO2eq/year/person with higher reductions in Northwestern and Central areas. CONCLUSIONS: In Italy, scenarios for reducing beef consumption are consistent with significant health and environmental co-benefits on current and future generations. Results support introducing policies to promote healthier behavior towards red and processed meat in the adult population within an overall balanced and healthy dietary pattern. Interventions should address gender, vulnerable population groups, and geographical differences in order to be more effective.

Gestational age and hospital utilization: three-years follow-up of an area-based birth cohort.

OBJECTIVE: To investigate differences by gestational age in emergency department visits and re-hospitalizations during the three years following childbirth discharge. METHODS: We performed a historical cohort study in Lazio Region, Italy, for infants born in 2007-2008 to resident mothers. Health administrative data were used. Analysis was performed by multinomial logistic regression. RESULTS: Of 90 545 infants, more than 50% had at least one emergency department visit, and 18.8% at least one re-hospitalization. After the exclusion of infants with congenital anomalies, relative risk ratios of re-hospitalization and, to a lesser extent, of emergency department visits increased by decreasing gestational age; the two events were also higher for mothers ≤35 years of age, with low education and of Italian nationality. Residency outside the metropolitan area was associated with an increased risk of re-hospitalization and a decreased risk of emergency department visits. CONCLUSION: During the three years following childbirth discharge, re-hospitalizations and, to a lesser extent, emergency department use are inversely related to gestational age at birth; socio-demographic factors have an effect on the risk of infant use of hospital resources independent of gestational age.

[Reduction of meat consumption and greenhouse gas emissions associated with health benefits in Italy]. / Riduzione del consumo di carne e delle emissioni di gas serra e benefici per la salute in Italia.

BACKGROUND: the reduction in red meat consumption has been proposed as one of the climate change mitigation policies associated to health benefits. In the developed world, red meat consumption is above the recommended intake level. OBJECTIVES: the aim is to evaluate health benefits, in term of mortality decline, associated to different bovine meat consumption reduction scenarios and the potential reduction in greenhouse gas (GHG) emissions. DESIGN: meat consumption in Italy has been estimated using the Italian National Food Consumption Survey INRAN-SCAI (2005-2006) and the Multipurpose survey on household (2012) of the Italian National Institute for Statistics. Colorectal cancer and stoke mortality data are derived from the national survey on causes of death in 2012. Bovine meat consumption risk function has been retrieved from systematic literature reviews. Mean meat consumption in Italy is equal to 770 grams/week; gender and geographical variations exist: 69 per cent of the adult population are habitual bovine meat consumers; males have an average intake of over 400 grams/week in all areas of Italy (with the exception of the South), while females have lower intakes (360 grams per week), with higher consumption in the North-West (427 gr) and lower in the South of Italy. Four scenarios of reduction of bovine meat consumption (20%, 40%, 50% e 70%, respectively) have been evaluated and the number of avoidable deaths by gender and area of residence have been estimated. GHG emissions attributed to bovine meat adult consumption have been estimated to be to 10 gigagrams CO2-eq. RESULTS: from low to high reduction scenario, the percentage of avoidable deaths ranged from 2.1% to 6.5% for colorectal cancer and from 1.6% to 5.6% for stroke. Health benefits were greatest for males and for people living in the North-Western regions of Italy. CONCLUSIONS: in Italy, in order to adhere to bovine meat consumption recommendations and to respect EU GHG emission reduction targets, scenarios between 50% and 70% need to be adopted.

[Meat consumption reduction policies: benefits for climate change mitigation and health]. / Politiche di riduzione del consumo di carne in Italia: contrasto ai cambiamenti climatici e benefici per la salute.

Agricultural food production substantially contributes to green house gas (GHG) emissions worldwide and 80% of the agricultural emissions arise from the livestock sector, in particular from ruminants. Meat consumption is generally above dietary recommendations in many countries, including Italy, and it is increasing in developing countries. Although meat is a source of essential nutrients, it provides large amounts of saturated fat, which is a known risk factor for obesity and for several diseases such as stroke, breast cancer and colon cancer. Dietary changes, with lower intake of red and processed meat, are likely to be beneficial for improving health and for the environment by reducing emissions of GHG. Data on meat consumption in Italy among adults, referred to the last ten years, shows heterogeneity among regions, with the highest consumption in the North-western regions and generally with higher consumption among males. We describe meat consumption distribution worldwide, in Europe and Italy. An assessment of the potential environmental and health co-benefits considering different reduction scenarios of red meat consumption in Italy is provided. Dietary changes can substantially lower GHG and coordinated actions are needed across public health and other sectors to promote healthy, low-emission diets.

[Lazio dialysis registry: natives vs foreigners]. / Confronto delle caratteristiche demografiche, cliniche e di sopravvivenza tra dializzati nati in Italia e all'estero: risultati del registro del Lazio.

INTRODUCTION: An increasing number of foreigners was observed in Italy even among chronic dialysis patients. We compared demographic, clinical, treatment characteristics and survival probability between groups of Italian and foreign patients with chronic dialysis in Lazio. METHODS: We analysed data from the Lazio Dialysis and Transplantation Registry from 2004 to 2012 (4,076 prevalent chronic dialysis patients in 31-12-2012). Among 7,970 incident patients, we evaluated, by country of birth, survival probability by using Kaplan-Meier method and mortality risk, through multiple Cox regression. RESULTS AND CONCLUSIONS: We observed an increase of foreigners among chronic dialysis patients in Lazio from 2004 (4.4%) up to 2012 (7.6%, test for trend: p<0,001). Compared with Italians, foreign patients were younger (53.816.3 vs. 68.713.6) and more frequently: women (42.7% vs. 37.7%), HbsAg-positive (18.1% vs. 13.9%), not vaccinated if HBV susceptible (26.8% vs. 20.9%), late referral (21.6% vs. 12.9%) and suitable for kidney transplantation (21.7% vs. 9.9%). Foreigners compared with Italians had higher survival probability at 1 year (91.9% vs. 84.7%) and 5 years (74,6% vs. 51,5%) after chronic dialysis has been started. We observed a lower mortality risk (HR=0.71;IC95%:0.58-0.87) among foreign patients even after adjustment for many potential confounding factors. Our findings suggest that health status and treatment of end stage renal disease, including access to kidney transplantation, were similar between groups of Italian and foreign patients in Lazio. Observed differences in patients' characteristics were probably attributable to younger age of foreigners. However, further analyses are needed to fully explain higher survival probability in chronic dialysis among foreigners compared with Italians.