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1.
Artículo en Inglés | MEDLINE | ID: mdl-34281113

RESUMEN

BACKGROUND: Diagnosis of endometriosis and evaluation of incidence data are complex tasks because the disease is identified laparoscopically and confirmed histologically. Incidence estimates reported in literature are widely inconsistent, presumably reflecting geographical variability of risk and the difficulty of obtaining reliable data. METHODS: We retrieved incident cases of endometriosis in women aged 15-50 years using hospital discharge records and pathology databases of the Friuli Venezia Giulia region in the calendar period 2004-2017. We studied the spatial pattern of endometriosis incidence applying Bayesian approaches to Disease Mapping, and profiled municipalities at higher risk controlling for multiple comparisons using both q-values and a fully Bayesian approach. RESULTS: 4125 new cases of endometriosis were identified in the age range 15 to 50 years in the period 2004-2017. The incidence rate (x100 000) is 111 (95% CI 110-112), with a maximum of 160 in the age group 31-35 years. The geographical distribution of endometriosis incidence showed a very strong north-south spatial gradient. We consistently identified a group of five neighboring municipalities at higher risk (RR 1.31 95% CI 1.13; 1.52), even accounting for ascertainment bias. CONCLUSIONS: The cluster of 5 municipalities in the industrialized and polluted south-east part of the region is suggestive. However, due to the ecologic nature of the present study, information on the patients' characteristics and exposure histories are limited. Individual studies, including biomonitoring, and life-course studies are necessary to better evaluate our findings.


Asunto(s)
Endometriosis , Adolescente , Adulto , Teorema de Bayes , Bases de Datos Factuales , Endometriosis/epidemiología , Femenino , Humanos , Incidencia , Italia/epidemiología , Persona de Mediana Edad , Adulto Joven
2.
Nutrients ; 13(5)2021 Apr 24.
Artículo en Inglés | MEDLINE | ID: mdl-33923157

RESUMEN

Few studies provide a detailed description of dietary habits during pregnancy, despite the central role of nutrition for the health of the mother and offspring. This paper describes the dietary habits, energy and nutrient intake in pregnant women from four countries belonging to the Mediterranean PHIME cohort (Croatia, Greece, Italy and Slovenia) and evaluates their adherence to the European Food Safety Authority (EFSA) recommendations. A total of 1436 women were included in the present analysis. Maternal diet was assessed using a food frequency questionnaire (FFQ). The mean macro and micronutrient intakes were estimated and compared with the dietary reference values (DRVs). The percentage distribution of the 16 food groups in the total intake of each macronutrient was estimated. All women shared a similar diet during pregnancy; almost all the women in the four countries exceeded the DRV for sugars, and the total fat intake was above the DRV in most women in all the countries, as was the contribution of saturated fatty acids (SFAs) to the total energy intake. In all four countries, we observed an increased risk of micronutrient deficiency for iron, folate and vitamin D. Shared guidelines, implemented at both the national and European level, are essential to improve the maternal nutritional status during pregnancy.


Asunto(s)
Ingestión de Alimentos , Conducta Alimentaria , Fenómenos Fisiologicos Nutricionales Maternos , Estado Nutricional , Cooperación del Paciente/estadística & datos numéricos , Ingesta Diaria Recomendada , Adulto , Estudios de Cohortes , Croacia , Dieta , Registros de Dieta , Femenino , Grecia , Humanos , Italia , Embarazo , Eslovenia
3.
Health Policy Technol ; 10(1): 143-150, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33520636

RESUMEN

Objectives: to assess the changes in prevalence, incidence and hospitalisation rates during the first four months of 2020, compared to the same period of 2019, in Friuli Venezia Giulia Mental Health Departments (MHDs); to analyse the features of MHDs patients tested for Sars-Cov-2, and to monitor whether MHDs applied and adhered to regional recommendations. Methods: Observational study using MHDs' administrative data and individual data on suspected and positive cases of Sars-Cov-2. Adherence to recommentations was assessed using 21 indicators. Changes in rates were calculated by Poisson regression analysis, while the Fisher exact test was used for assessing differences between suspected and positive cases. Results: The decrease in voluntary admission rates on 100,000 inhabitants in hospital services was significantly larger from January to April 2020, compared to the same period of 2019 (P<0.001), while no other data showed a significant decrease. Among the 82 cases tested for Sars-Cov-2, five were positive, and they significantly differ from suspected cases only in that they were at home or in supported housing facilities prior to the test. The MHDs mostly complied with the indicators in the month after the publication of recommendations. Conclusions: Outpatient services continued to work normally during the emergency, while hospital services decreased their activities. A low number of positive cases was found among MHDs' users, which might be linked to a rapid reconversion of services, with an extensive use of home visits and telepsychiatry. These preliminary data should be interpreted with caution, due to the small size and the limited period of observation.

4.
Int J Qual Health Care ; 33(1)2021 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-33619561

RESUMEN

BACKGROUND: Increasing efforts toward quality improvement (QI) are necessary in low- and middle-income countries (LMICs) to reduce maternal and perinatal mortality and morbidity and to promote respectful care. In Brazil, perinatal health indicators are below targets in several states despite universal access to perinatal services and very high rates of institutional births, indicating poor quality of care (QoC) as a key issue to be addressed. However, research efforts to develop and test QoC improvement interventions are scarce. OBJECTIVES: We assessed the effects of a 1-year comprehensive QI cycle using a World Health Organization (WHO) assessment and quality tool on maternal and newborn care at hospital level and documented QIs obtained after a 1-year comprehensive QI cycle. METHODS: Uncontrolled, unblinded, pre-post study carried out in six maternity hospitals in Pernambuco, Brazil, accounting for 29 128 live births in 2014. A standards-based and participatory approach based on a WHO quality assessment and improvement tool for maternal and neonatal care at hospital level was used. A national team of assessors supervised by international experts carried out baseline and final assessments. An action plan was developed and implemented to address key quality gaps emerging from the baseline assessment and from two supportive supervision visits. RESULTS: At baseline, hospitals presented a variety of quality gaps, the majority common to all participating centers. Gaps in case management of normal and complicated deliveries and in respectful and holistic care were predominant, in both teaching/tertiary and secondary care hospitals. After one year, several improvements were observed, particularly in respectful care during labor and at delivery, in case management of normal labor and delivery and in neonatal care. CONCLUSIONS: A systematic participatory approach based on a WHO tool produced important QIs in a relatively short time and should be considered for use for large-scale QI programs in Brazil and other LMICs. Its comprehensive, peer-to-peer and action-oriented nature and its capability to document QI over time and to build a QI culture represent important comparative advantages over other QI interventions.


Asunto(s)
Mejoramiento de la Calidad , Calidad de la Atención de Salud , Brasil , Femenino , Hospitales , Humanos , Recién Nacido , Embarazo , Organización Mundial de la Salud
5.
Minerva Urol Nephrol ; 73(3): 349-356, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32026664

RESUMEN

BACKGROUND: The aim of this study was to analyze the incidence, preoperative findings, pathological features and prognosis in patients with incidental prostate cancer (iPCa) detected at radical cystectomy (RC) for bladder cancer (BCa). METHODS: We retrospectively reviewed data of patients who underwent RC for BCa at our Institution between January 2005 and March 2018. Data regarding patient's history, preoperative digital rectal examination (DRE), total serum PSA level were collected from the chart review. Univariable and multivariable Cox regression models addressed the association of iPCa with recurrence-free survival (RFS) and overall survival (OS). RESULTS: We obtained a final study cohort of 177 patients. Median age was 69 years (IQR 42-89) and 80(45.2%) patients had iPCa. Patients with iPCa had higher age, preoperative PSA levels and a significant rate of suspicious DRE (all P<0.05). Four patients had BCR during a median follow-up of 28 months (IQR 6-159) and none died for prostate cancer. In multivariable analyses adjusted for age, bladder cancer BCa pT and pN stage and LVI the ten-years RFS and OS rates were not impacted by iPCa regardless of whether it is a clinically significant cancer or not (HR=1.25, 95% CI: 0.65-2.38, P=0.51 vs. HR=1.37, 95% CI: 0.71-2.64, P=0.35) (HR=1.04, 95% CI: 0.53-1.86, P=0.89 vs. HR=1.20, 95% CI: 0.22-6.72, P=0.83). CONCLUSIONS: iPCa is quite common in our study group and most of cases are organ-confined and well differentiated. Regardless of clinical relevance, iPCa does not have an impact on survival outcomes as BCa is driving the prognosis of these patients.


Asunto(s)
Cistectomía , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Vejiga Urinaria/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/epidemiología , Neoplasias Primarias Múltiples/etiología , Neoplasias Primarias Múltiples/terapia , Pronóstico , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/etiología , Neoplasias de la Próstata/terapia , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Neoplasias de la Vejiga Urinaria/mortalidad
6.
J Epidemiol ; 31(2): 157-163, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-32249266

RESUMEN

BACKGROUND: The extent to which prenatal low-level mercury (Hg) exposure through maternal fish intake and heavy metals exposure affect children's neurodevelopment is controversial and may appear in the long term. In 2007, a prospective cohort, the Northern Adriatic Cohort II (NAC-II), was established to investigate the association between prenatal Hg exposure from maternal fish consumption and child neurodevelopment. The study enrolled 900 pregnant women, and 632 and 470 children underwent neurodevelopmental evaluation at 18 and 40 months of age, respectively. The NAC-II cohort is a part of the Mediterranean cohort in the "Public health impact of long-term, low-level, mixed element exposure in susceptible population strata" project. METHODS: This protocol describes the follow-up assessment of the effects of prenatal low level Hg and other heavy metals exposure on the developing nervous system of the children born within the NAC-II who reached the age of 7 years. Child diet components are estimated through a Diet Diary. Child hair and urine are collected for determination of Hg level. In addition, levels of other potentially neurotoxic metals, namely Manganese, Cadmium, Lead, Arsenic, and Selenium, are also measured in the same matrices. DISCUSSION: This protocol extends to the first years of schooling age the evaluation of the neurotoxicant effect of Mercury and of the other heavy metals on children's neurodevelopment, adjusting for the potential confounders, such as the lifestyles and social economic status of children's families. Longitudinal analysis of neurodevelopment, assessed in different ages (18 months, 40 months, and 7 years), are performed.


Asunto(s)
Fenómenos Fisiologicos Nutricionales Maternos , Metales Pesados/toxicidad , Compuestos de Metilmercurio/toxicidad , Trastornos del Neurodesarrollo/epidemiología , Efectos Tardíos de la Exposición Prenatal , Adulto , Animales , Niño , Preescolar , Encuestas sobre Dietas , Femenino , Peces , Estudios de Seguimiento , Contaminación de Alimentos , Cabello/química , Humanos , Lactante , Italia/epidemiología , Masculino , Metales Pesados/análisis , Metales Pesados/orina , Compuestos de Metilmercurio/análisis , Compuestos de Metilmercurio/orina , Embarazo , Estudios Prospectivos
7.
Int J Hyg Environ Health ; 230: 113604, 2020 Aug 29.
Artículo en Inglés | MEDLINE | ID: mdl-32871542

RESUMEN

Despite a 15-year long effort to define the "safety" of fish intake during pregnancy, there remains still uncertainty on this important public health issue. The evaluation of the toxic effects of contaminants, particularly mercury (Hg) in fish-eating populations is complicated by the fact that sea-food is also rich in beneficial nutrients, such as selenium (Se). There is toxicological plausibility of an antagonistic effects between Se and Hg, and some theoretical support for the inclusion of the Se-Hg interaction to better assess the risk linked with fish intake. To assess the effects of exposure to low-level Hg through fish consumption on the developing brain and the interaction between Hg and Se, we conducted an analysis at age 40 months in Italian children, enrolled in a prospective mother-child cohort, comparing additive and multiplicative models. Participant subjects were the 470 children born within the Northern Adriatic Cohort II (NAC-II) cohort who were tested by using the Bayley Scales of Infant and Toddler Development third edition (Bayley-III) (BSID-III) at age 40. Family demographic and socioeconomic information, pregnancy and delivery history, parental and child medical history and food consumption were assessed through questionnaires. Maternal blood samples were collected during pregnancy, cord blood at birth and maternal milk 1 month after delivery. As other exposures of interest, we considered the level of Se in maternal and cord blood and in breast milk and the potential Se-Hg antagonism. Se and inverse of THg (1:THg) concentrations were categorized according to the tertiles of their distributions, in low, medium and high levels of exposure. The lower end of the composite cognitive score distribution closest to 20% was defined as suboptimal development. Multiple logistic regression were applied to assess the association between the dichotomized composite cognitive score and the categorized exposure to Se and 1:THg, and the antagonism between Se and 1:THg. In the recruiting period, 900 pregnant women were enrolled in the cohort; 767 of these remained in the study at delivery and 470 children at 40 months. After excluding preterm births, 456 children were used in the final analyses. The larger difference in risk for suboptimal neurodevelopment was observed for the category with High THg and Low Se with OR = 2.55 (90% CI 1.02; 6.41) under the multiplicative and OR = 1.33 (90% CI 0.80; 1.87) under the additive model. The category High THg and High Se showed a very slightly better fit of the additive model (OR = 1.07, 90% CI 0.65; 1.50) versus the multiplicative (OR = 1.66, 90% CI 0.73; 1.77). A negative - antagonistic - interaction term for this category was estimated under the multiplicative model giving an OR = 1.17 (90% CI 0.42; 3.28). Although this evidence of the effects of the Se-Hg antagonism on the children neuro-development needs to be confirmed, if Se can counterbalance Hg toxicity, the evaluation of the effect on human health of fish consumption, should also consider the diverse ratios between Se and Hg concentration in different fish species.

8.
BMC Pregnancy Childbirth ; 20(1): 384, 2020 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-32611322

RESUMEN

BACKGROUND: Intrauterine fetal death (IUFD) is a tragic event and, despite efforts to reduce rates, its incidence remains difficult to reduce. The objective of the present study was to examine the etiological factors that contribute to the main causes and conditions associated with IUFD, over an 11-year period in a region of North-East Italy (Friuli Venezia Giulia) for which reliable data in available. METHODS: Retrospective analysis of all 278 IUFD cases occurred between 2005 and 2015 in pregnancies with gestational age ≥ 23 weeks. RESULTS: The incidence of IUFD was 2.8‰ live births. Of these, 30% were small for gestational age (SGA), with immigrant women being significantly over-represented. The share of SGA reached 35% in cases in which a maternal of fetal pathological condition was present, and dropped to 28% in the absence of associated pathology. In 78 pregnancies (28%) no pathology was recorded that could justify IUFD. Of all IUFDs, 11% occurred during labor, and 72% occurred at a gestational age above 30 weeks. CONCLUSION: The percentage of IUFD cases for which no possible cause can be identified is quite high. Only the adoption of evidence-based diagnostic protocols, with integrated immunologic, genetic and pathologic examinations, can help reduce this diagnostic gap, contributing to the prevention of future IUFDs.


Asunto(s)
Muerte Fetal/etiología , Mortalidad Fetal , Adulto , Femenino , Retardo del Crecimiento Fetal/epidemiología , Edad Gestacional , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Italia/epidemiología , Nacimiento Vivo/epidemiología , Edad Materna , Embarazo , Estudios Retrospectivos , Mortinato/epidemiología
9.
BMJ Open ; 10(7): e036857, 2020 07 23.
Artículo en Inglés | MEDLINE | ID: mdl-32709652

RESUMEN

OBJECTIVES: Poor social conditions are strong determinants of poor health but positive health and healthcare changes caused by social interventions are difficult to demonstrate. In 2006, in Trieste (Italy), a social intervention known as 'Habitat Microaree' (HM) project was implemented in eight deprived neighbourhoods. In 2016, an observational study was launched to assess the impact of the HM project on healthcare. DESIGN: Retrospective cohort study. SETTING: The eight geographically defined neighbourhoods of Trieste involved in the 2006 HM project, accounting for a total of 11 380 residents. PARTICIPANTS: Participants were all residents in the intervention areas. By means of a propensity score based on deprivation index, age, sex, Charlson index and drug utilisation, a non-participating, comparison group was defined. INTERVENTION: The community-based intervention consisted of facilitating access to social services and outpatient healthcare facilities, coordinating intersectoral public services and specifically planning hospital discharge. These services were not provided in other areas of the city. OUTCOME MEASURES: Hospital admissions and emergency department access. RESULTS: We followed 16 256 subjects between 2008 and 2015. Living in microareas was associated with an HR for first hospital admission, for all causes, of 0.95 (95% CI 0.91 to 0.99); while the HR for urgent admissions in females was 0.92 (95% CI 0.85 to 1.00). The HR for psychiatric disorders, in females, was 0.39 (95%CI 0.18 to 0.82); in particular, the HR for psychosis was 0.15 (95% CI 0.05 to 0.51). The HR for acute respiratory diseases in females was 0.44 (95% CI 0.21 to 0.95). In males, the HR for genitourinary diseases and heart diseases were 0.65 (95% CI 0.42 to 1.01) and 0.72 (95% CI 0.54 to 0.97), respectively. Concerning urgent multiple admissions, the OR for fractures in females was 0.75 (95% CI 0.58 to 0.97). CONCLUSION: In the study period, the effects on healthcare appear evident, especially in females.


Asunto(s)
Atención a la Salud , Hospitalización , Femenino , Humanos , Italia , Masculino , Alta del Paciente , Estudios Retrospectivos
10.
Environ Pollut ; 265(Pt B): 114826, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32454361

RESUMEN

The aim of this study was to provide urinary levels of total arsenic (TAs) and As species as arsenobetaine (AsB), arsenocholine (AsC), inorganic As (i.e., [As(III)+As(V)]), methylarsonic acid (MMA) and dimethylarsinic acid (DMA) in 7 year-old-children (n = 200) enrolled in the Northern Adriatic Cohort II (NACII), a prospective cohort in a coastal area of Northeast Italy. TAs was determined by sector field-inductively coupled plasma mass spectrometry (SF-ICP-MS) and AsB, AsC, As(III), As(V), MMA and DMA by ion chromatography coupled to ICP-MS (IC-ICP-MS). The geometric mean (GM) for TAs was 12.9 µg/L and for [iAs + MMA + DMA] was 4.26 µg/L. The species AsB (GM of 5.09 µg/L) and DMA (GM of 3.20 µg/L) had the greatest percentage contribution to TAs levels; a greater percentage contribution from AsB is seen at TAs >10 µg/L and from DMA at TAs <10 µg/L. Urinary [iAs + MMA] levels were positively associated with [iAs + MMA + DMA] and DMA with AsB levels. Fish, shellfish and crustaceans consumption increased the AsB and TAs levels, while rice intake, mothers' education level and selenium (Se) concentration influenced the DMA concentration. Children have a high capacity to metabolize and detoxify the iAs because of the higher secondary methylation index (ratio DMA/MMA) with respect to primary methylation index (ratio MMA/iAs). In addition, the median level of [iAs + MMA + DMA] in the whole population of children was lower than the Biomonitoring Equivalent (BE) value for non-cancer endpoints. Also the Margin of Safety (MOS) value based on the population median was greater than 1, thus the exposure to the toxicologically relevant As species was not likely to be of concern.


Asunto(s)
Arsénico/análisis , Arsenicales , Animales , Ácido Cacodílico , Niño , Estudios de Cohortes , Humanos , Italia , Estudios Prospectivos
11.
Int Arch Occup Environ Health ; 93(6): 669-682, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32034472

RESUMEN

OBJECTIVE: Thirty-four geothermal power plants for the production of electricity are currently active in the geothermal areas in Tuscany. The present study aimed to investigate the association between short-term exposure to hydrogen sulfide (H2S) and acute health outcomes. METHODS: This study used individual data on non-accidental, cardiovascular and respiratory mortality, urgent hospital admissions (HA) and emergency department (ED) visits for cardiorespiratory diseases occurring from 2000 to 2017. All cases were georeferenced and matched to daily H2S data, derived from 18 monitoring sites. A case-crossover design following the matched pair interval approach was applied and conditional logistic regression models were fitted to estimate odds ratios and their 90% confidence intervals, adjusting for a set of time-dependent variables, such as influenza epidemics, holidays and temperature. RESULTS: A total of 8054 deaths, 30,527 HA and 15,263 ED visits occurred. Mortality for non-accidental (OR = 1.11, 90% CI 1.02-1.22) and cardiovascular causes (OR = 1.22, 90% CI 1.03-1.44) were associated with an increase of 10 µg/m3 of H2S daily levels only among men. Hospital admissions for respiratory diseases were positively associated with H2S exposure: OR = 1.11 (90% CI 1.00-1.22) among women. No associations were observed in ED visits analyses. CONCLUSIONS: In this case-crossover study in the Tuscan geothermal areas, short-term exposure to H2S was weakly associated with some mortality and morbidity outcomes. Our findings did not show a clear pattern as the results were not homogeneous between mortality and morbidity data or between men and women.


Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Enfermedades Cardiovasculares/epidemiología , Exposición a Riesgos Ambientales/efectos adversos , Energía Geotérmica , Sulfuro de Hidrógeno/efectos adversos , Centrales Eléctricas , Enfermedades Respiratorias/epidemiología , Anciano , Servicio de Urgencia en Hospital , Femenino , Hospitalización , Manantiales de Aguas Termales , Humanos , Italia/epidemiología , Masculino
12.
Epidemiol Prev ; 44(5-6 Suppl 2): 128-135, 2020.
Artículo en Italiano | MEDLINE | ID: mdl-33412803

RESUMEN

OBJECTIVES: to investigate the role of gender, age, province of residence, and nursing home residency on the risk of death for residents in the Friuli Venezia Giulia (FVG) Region (Northern Italy) tested positive for Covid-19, considering recovery as a competing event. The secondary objective is to describe the impact of the Covid-19 epidemic in FVG and in the Regions of Northern and Central Italy in terms of incidence and mortality compared to the national data. DESIGN: retrospective cohort study. SETTING AND PARTICIPANTS: resident population in FVG in the period between 29 February and 25 June 2020. MAIN OUTCOME MEASURES: in order to describe the impact of the Covid-19 outbreak in FVG, in terms of incidence and mortality compared to the national data, the standardized incidence (SIR) and mortality (SMR) ratios and their respective 95% confidence intervals (95%CI) were calculated compared to the Italian population for the northern and central Regions of Italy and the autonomous Provinces (PA) of Trento and Bolzano. A retrospective cohort study was conducted on subjects residing in FVG to whom at least one naso-oropharyngeal swab (hereafter, named swab) resulted positive for Covid-19. For each subject included in the cohort, the observation period started with the first positive swab and ended with the first of the following events: death, recovery or censored, which means that at the end of the observation period the subject was still alive and positive. The cause of death was assigned to Covid-19 if a subject had not yet recovered at the time when the event occurred. Cohort members were considered recovered after two negative consecutive swabs. The sub-hazard ratio (SHR) was estimated by applying the regression model of competing risks by Fine and Gray, in which the event of interest was the death caused by Covid-19 and the competing event was recovery. The explanatory variables included in the multiple models are: gender, age at the beginning of the observation period, the Province of residence, and nursing home residency. The cause-specific hazard was estimated using Cox proportional hazard regression. RESULTS: during the observation period, 3,305 cases and 345 deaths were recorded in FVG; SIR and SMR resulted, respectively, equal to 0.64 (95%CI 0.61-0.68) and 0.43 (95%CI 0.37-0.50). The FVG was the Northern Region one with the lowest incidence and mortality. The cohort consisted of 3,121 residents in FVG with at least one swab with a positive Covid-19 result during the study period. The SHR of dying for Covid-19 is equal to 16.13 (95%CI 9.73-26.74) for people with age 70-79 years and 35.58 (95%CI 21.77-58.15) with age >=80 years respect those with age <70 years. It is higher in males (SHR 1.71; 95%CI 1.34-2.17). There is no evidence that being resident in a nursing home affects the SHR (SHR 0.91 and 95%CI 0.69-1.20). As regards the province as an explanatory variable, the sub-hazard of death in the province of Trieste appears to overlap to the sub-hazard of Pordenone used as a reference; for the provinces of Udine and Gorizia the sub-hazards seem lower than the reference. CONCLUSIONS: while other Northern Regions and autonomous Provinces show higher standardized incidence and mortality compared with Italy, FVG and Veneto do not. In FVG, male gender and age are important determinants of death while there is no evidence that the condition of guest in a nursing home increases the sub-hazard of death.


Asunto(s)
COVID-19/mortalidad , Pandemias , SARS-CoV-2 , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Geografía Médica , Humanos , Incidencia , Lactante , Recién Nacido , Italia/epidemiología , Masculino , Persona de Mediana Edad , Casas de Salud/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Características de la Residencia , Estudios Retrospectivos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Factores Sexuales , Adulto Joven
13.
Epidemiol Prev ; 44(5-6 Suppl 2): 297-306, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33412822

RESUMEN

BACKGROUND: the first confirmed cases of COVID-19 in WHO European Region was reported at the end of January 2020 and, from that moment, the epidemic has been speeding up and rapidly spreading across Europe. The health, social, and economic consequences of the pandemic are difficult to evaluate, since there are many scientific uncertainties and unknowns. OBJECTIVES: the main focus of this paper is on statistical methods for profiling municipalities by excess mortality, directly or indirectly caused by COVID-19. METHODS: the use of excess mortality for all causes has been advocated as a measure of impact less vulnerable to biases. In this paper, observed mortality for all causes at municipality level in Italy in the period January-April 2020 was compared to the mortality observed in the corresponding period in the previous 5 years (2015-2019). Mortality data were made available by the Ministry of Internal Affairs Italian National Resident Population Demographic Archive and the Italian National Institute of Statistics (Istat). For each municipality, the posterior predictive distribution under a hierarchical null model was obtained. From the posterior predictive distribution, we obtained excess death counts, attributable community rates and q-values. Full Bayesian models implemented via MCMC simulations were used. RESULTS: absolute number of excess deaths highlights the burden paid by major cities to the pandemic. The Attributable Community Rate provides a detailed picture of the spread of the pandemic among the municipalities of Lombardy, Piedmont, and Emilia-Romagna Regions. Using Q-values, it is clearly recognizable evidence of an excess of mortality from late February to April 2020 in a very geographically scattered number of municipalities. A trade-off between false discoveries and false non-discoveries shows the different values of public health actions. CONCLUSIONS: despite the variety of approaches to calculate excess mortality, this study provides an original methodological approach to profile municipalities with excess deaths accounting for spatial and temporal uncertainty.


Asunto(s)
COVID-19/epidemiología , Modelos Teóricos , Mortalidad/tendencias , Pandemias , SARS-CoV-2 , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Teorema de Bayes , COVID-19/mortalidad , Ciudades , Femenino , Geografía Médica , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Riesgo , Adulto Joven
14.
Environ Res ; 177: 108627, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31421448

RESUMEN

In recent years, several studies have addressed the issue of prenatal exposure to methylmercury (MeHg); however, few have actually analysed MeHg blood concentrations. Our study population included mothers and their new-borns from Slovenia (central region; N = 584) and Croatia (coastal region; N = 234). We have measurements of total Hg (THg) and MeHg in maternal hair, maternal peripheral blood, and cord blood. Cord blood Hg concentrations were low to moderate (median THg = 1.84 ng/g and MeHg = 1.69 ng/g). The proportion of THg as MeHg (%MeHg) in maternal and cord blood varied between 4% and 100% (coefficient of variation, CV = 32%) and between 8% and 100% (CV = 20%), respectively. Our data shows that variability of %MeHg was higher at lower blood THg levels. Concentrations of MeHg in maternal blood and cord blood were highly correlated (Rs = 0.943), in the case of inorganic Hg correlation was significant but weaker (Rs = 0.198). MeHg levels in maternal blood and cord blood were positively associated with seafood intake, maternal age, and negatively associated with pre-pregnancy BMI. Additionally, MeHg in maternal blood was positively associated with plasma selenium levels, and cord blood MeHg was negatively associated with parity. The results of multiple linear regression models showed that speciation analysis provides more defined estimation of prenatal exposure in association modelling. Associations between Hg exposure and cognitive performance of children (assessed using Bayley Scales of Infant and Toddler development) adjusted for maternal or child Apolipoprotein E genotypes showed higher model R2 and lower p-values when adjusted for MeHg compared to THg. This study demonstrates that Hg speciation improves the association between exposure and possible negative health effects.


Asunto(s)
Exposición Materna , Mercurio/sangre , Compuestos de Metilmercurio/sangre , Croacia , Femenino , Sangre Fetal , Humanos , Recién Nacido , Embarazo , Eslovenia
16.
Environ Res ; 178: 108682, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31450150

RESUMEN

OBJECTIVES: Prenatal exposure of long chain polyunsaturated fatty acids (LCPUFA) are essential for normal fetal growth and neurodevelopment. Availability of LCPUFA depends mostly on maternal fish consumption. Fish consumption also exposes the fetus to mercury which is well known neurotoxicant. We analyzed the associations of combined LCPUFA and mercury from fish consumption during pregnancy on newborn's brain measures and child neurodevelopment in a northern Adriatic coastal area. PATIENTS AND METHODS: The prospective cohort study included 257 mother - infant pairs enrolled in a susceptible population of the Public Health Impact on long-term, low-level, Mixed Element exposure (PHIME) EU Sixth Framework Programme from 2 recruitment areas of the northern part of the Adriatic coast. Umbilical cord blood taken at delivery was used for measuring concentration of total mercury (THg) and specific LCPUFA - docosahexaenoic acid (DHA) and arachidonic acid (ARA). Neonatal cranial sonography was performed at the age of 3 days in 57 newborns. Neurodevelopmental assessment of cognitive, motor and language skills were conducted at 257 children at the age of 18 months using the Bayley Scales of Infant and Toddler Development, Third Edition. The participants were divided into two groups depending on the THg concentration in the umbilical cord blood (exposed > 5.8 µg/L and unexposed < 5.8 µg/L). Dietary habits and exposures to environmental and social factors were assessed through questionnaires. RESULTS: There is a statistically significant difference in the cerebellum length (p = 0.032) and the superior frontal gyrus width (p = 0.023) between the exposed and the unexposed group. In combined analysis, including possible protective variables as DHA and ARA (R2 = 0.22, p = 0.001), the negative contribution of THg on cerebellum length (beta = -0.16, p = 0.001) persisted. We found no correlation between THg concentration in umbilical cord blood and child neurodevelopment scores at the age of 18 months. Language score with receptive and expressive subscores was significantly associated with fish consumption (p < 0.05). CONCLUSION: This analysis demonstrates the existence of morphological brain changes in newborns that are prenatally exposed at mercury concentrations what was diminished in combined analyse including LCPUFA. Our results emphasizes the importance of LCPUFA's and mercury common influence as a predictor of developmental outcome. Fish consumption, not solely LCPUFA contributes to better language development of children at the age of 18 months.


Asunto(s)
Desarrollo Infantil/efectos de los fármacos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminantes Ambientales/toxicidad , Mercurio/toxicidad , Efectos Tardíos de la Exposición Prenatal , Animales , Encéfalo/efectos de los fármacos , Encéfalo/fisiología , Contaminantes Ambientales/metabolismo , Femenino , Humanos , Lactante , Recién Nacido , Mercurio/metabolismo , Embarazo , Estudios Prospectivos
17.
Environ Res ; 176: 108508, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31200128

RESUMEN

Urinary metabolites of organophosphate (OP) and pyrethroid (PYR) pesticides from seven years old children of a birth cohort study (n=199; PHIME cohort of Trieste, Italy) have been measured. Six OP and two PYR metabolites have been investigated, 2-diethylamino-6-methylpyrimidin-4-ol (DEAMPY, pirimiphos metabolite) was the one found at higher concentrations, median 3.4 ng/mL specific gravity adjusted (SG adjusted), followed by 4-nitrophenol (PNP, median 1.4 ng/mL SG adjusted) and 3,5,6-trichloro-2-pyridinol (TCPY, median 0.36 ng/mL SG adjusted), parathion and chlorpyriphos metabolites, respectively. TCPY concentrations were low in comparison to other distributions of OP metabolites in children from other studies. Accordingly, the PHIME cohort showed a distinct OP metabolite distribution with high concentrations of pirimiphos and parathion. Another specific characteristic of this cohort was the high concentration of 3-phenoxybenzoic acid (3-BPA, median 0.36 ng/mL SG adjusted), a general metabolite of PYR pesticides. Evaluation of anthropometric and socio-demographic characteristics of children and families only showed a positive association between family educational level and urinary concentrations of DEAMPY metabolite (p<0.05), which could reflect distinct dietary habits depending on the educational level. Estimated daily intakes were evaluated, all studied metabolites were found within safe levels.


Asunto(s)
Contaminantes Ambientales , Plaguicidas , Piretrinas , Niño , Estudios de Cohortes , Dieta , Exposición a Riesgos Ambientales , Contaminantes Ambientales/metabolismo , Contaminantes Ambientales/orina , Femenino , Humanos , Italia , Masculino , Organofosfatos , Plaguicidas/metabolismo , Plaguicidas/orina , Piretrinas/metabolismo , Piretrinas/orina
18.
Artículo en Inglés | MEDLINE | ID: mdl-30909566

RESUMEN

To determine the acute effects on respiratory function of children exposed to sulphur dioxide (SO2), we conducted two population-based longitudinal investigations near a major oil refinery. We enrolled 233 children, age 8⁻14, in Sarroch (Italy). The first study entailed five monthly spirometric visits (Panel 5). In a subgroup, children positive for history of respiratory symptoms were tested weekly (20 times) with spirometry and fractional exhaled nitric oxide (FeNO) measurement (Panel 20). Baseline questionnaires and daily diaries were recorded. SO2, NO2, PM10 and O3 were measured by monitoring stations. Multiple regression models were fitted. Using a multipollutant model, we found that a 10 µg/m³ SO2 increase at lag0⁻2 days determined a percent variation (PV) of -3.37 (90% confidence interval, CI: -5.39; -1.30) for forced expiratory volume after one second (FEV1) in Panel 5 and a PV = -3.51 (90% CI: -4.77; -2.23) in Panel 20. We found a strong dose-response relation: 1-h SO2 peaks >200 µg/m³ at lag2 days = FEV1 PV -2.49. For FeNO, we found a PV = 38.12 (90% CI: 12.88; 69.01) for each 10 µg/m³ SO2 increase at 8-h time lag and a strong dose-response relation. Exposure to SO2 is strongly associated with reduction of lung function and an increase in airway inflammation. This new evidence of harmful effects of SO2 peaks should induce regulatory intervention.


Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Volumen Espiratorio Forzado/efectos de los fármacos , Inflamación/inducido químicamente , Pulmón/fisiopatología , Dióxido de Azufre/efectos adversos , Adolescente , Bronquios/efectos de los fármacos , Bronquios/fisiopatología , Niño , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Italia , Pulmón/efectos de los fármacos , Masculino , Óxido Nítrico/análisis , Pruebas de Función Respiratoria , Espirometría
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