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1.
Artículo en Inglés | MEDLINE | ID: mdl-34682362

RESUMEN

Risk perception (RP) evaluation during pregnancy and its relationship with lifestyles are considered useful tools for understanding communities living in high-risk areas and preventing dangerous exposure. It is well known that exposure to pollutants and less-healthy lifestyles may result in increased disease occurrence during life. Our work investigated environmental RP through ad hoc questionnaires administered to 611 mothers within the NEHO birth cohort, recruited in three heavily contaminated areas of Southern Italy. Four different RP indices, an exploratory factorial analysis (EFA), and a latent class analysis were evaluated from questionnaires. The highest values of risk perception index were observed in the Milazzo site (0.64 ± 0.16) and the lowest in the Crotone site (0.5 ± 0.18). EFA revealed four latent factors, including different items describing environmental pollution, and subjects were classified into four latent classes with different RP indices. Significant RP profiles were different among the sites (p < 0.001). Our results did not demonstrate any association between RP and lifestyles during pregnancy. Improving healthy lifestyle behaviours, particularly in polluted areas, would generate co-benefits by preventing further risk factors. As remediation interventions can take a long time, it needs to improve healthy lifestyles in residents until remediation is completed.


Asunto(s)
Contaminantes Ambientales , Mujeres Embarazadas , Contaminación Ambiental , Femenino , Humanos , Percepción , Embarazo , Factores de Riesgo
2.
Epidemiol Prev ; 45(3): 155-163, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34212696

RESUMEN

BACKGROUND: the exposure to a coal-fired power plant has been shown to increase mortality both for cardiovascular and respiratory causes among an exposed cohort in comparison with a cohort of unexposed. Hazard ratios between 1.30 and 1.90 were found for cardiovascular and respiratory mortality. OBJECTIVES: to estimate the individual life shortening among the exposed due to power plant emissions. DESIGN: survival for cardiovascular and respiratory disease in the exposed vs unexposed groups was estimated by the Kaplan-Meier method. For each gender and exposure, a fictitious cohort with a cumulative 30-year follow up was built combining three subcohorts of age at entry of 55-64, 65-74, and 75-84 years, with 10 years of follow up each. Survivals at 10 years in the 55-64-year subcohort were used as initial risks for 65-74-year subcohort; then, survivals at 10 years of the 65-74-year subcohort were used as initial risk in the 75-84-year subcohort. Eventually, 30-years cumulative follow up cohorts were obtained by gender and exposure. Individual life-shortening in people exposed was estimated as time from death of an exposed subject to the subsequent time when the unexposed cohort reached the same risk of the exposed subject at that time of the death. Here, it is proposed a method to take into account causes other than those considered. SETTING AND PARTICIPANTS: 144,018 subjects aged 55-74 years at entry of both genders belonging to the open cohort of residents of 12 municipalities (including Savona) from 2001 to 2013 in the area where the coal-fired power plant of Vado-Quiliano (Liguria Region, Northern Italy) is located. MAIN OUTCOME MEASURES: individual life shortening. RESULTS: after 5 years of follow up, the individual life shortening due to cardiorespiratory causes varied between 972 and 1,822 days for males and from 612 and 1,578 days among females. Taking into account other causes of death, reduces slightly (3% for males of 75 years at death) the estimate of life shortening found in this study. The comparison between the cohorts requires that the exposed and unexposed groups are comparable, except for the exposure, and that causes other than those considered are taken into account. Socioeconomic status had been found to have little effect on cause-specific death risk indicating that, at least in terms of socioeconomic status, the exposed and unexposed groups were similar. Taking into account causes other than those considered slightly reduced the found estimates (3% at age 75 in males). According to the proposal, the life-shortening for the considered causes is easy to calculate and provides an individual indicator of damage. Inferring from group statistics individual estimates could be the most controversial point of this approach. The proposed estimates are the most credible estimate of individual damage for each occurred death among the exposed people. CONCLUSIONS: an increased hazard ratio for a wide series of causes is equivalent to a life shortening among the exposed. A method to produce reasonable estimates of life-shortening is proposed as the effect of exposure at individual level. This approach is simple and do not require sophisticated statistical tools. It appears a promising approach for other settings.


Asunto(s)
Carbono , Enfermedades Cardiovasculares , Exposición a Riesgos Ambientales , Centrales Eléctricas , Enfermedades Respiratorias , Anciano , Anciano de 80 o más Años , Carbono/envenenamiento , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Ciudades/epidemiología , Exposición a Riesgos Ambientales/efectos adversos , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Enfermedades Respiratorias/mortalidad
3.
Int J Colorectal Dis ; 36(6): 1097-1110, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33486533

RESUMEN

PURPOSE: Robotic assistance could increase the rate of ileo-colic intra-corporeal anastomosis (ICA) during robotic right colectomy (RRC). However, although robotic ICA can be accomplished with several different technical variants, it is not clear whether some of these technical details should be preferred. An evaluation of the possible advantage of one respect to another would be useful. METHODS: We conducted a systematic review of literature on technical details of robotic ileo-colic ICA, from which we performed a meta-analysis of clinical outcomes. The extracted data allowed a comparative analysis regarding the outcome of overall complication (OC), bleeding rate (BR) and leakage rate (LR), between (1) mechanical anastomosis with robotic stapler, versus laparoscopic stapler, versus totally hand-sewn anastomosis and (2) closure of enterocolotomy with manual double layer, versus single layer, versus stapled. RESULTS: A total of 30 studies including 2066 patients were selected. Globally, the side-to-side, isoperistaltic anastomosis, realized with laparoscopic staplers, and double-layer closure for enterocolotomy, is the most common technique used. According to the meta-analysis, the use of robotic stapler was significantly associated with a reduction of the BR with respect to mechanical anastomosis with laparoscopic stapler or totally hand-sewn anastomosis. None of the other technical aspects significantly influenced the outcomes. CONCLUSIONS: ICA fashioning during RRC can be accomplished with several technical variants without evidence of a clear superiority of anyone of these techniques. Although the use of robotic staplers could be associated with some benefits, further studies are necessary to draw conclusions.


Asunto(s)
Cólico , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Anastomosis Quirúrgica , Colectomía , Humanos , Procedimientos Quirúrgicos Robotizados/efectos adversos
4.
Artículo en Inglés | MEDLINE | ID: mdl-33333178

RESUMEN

BACKGROUND AND AIMS: Whether there is a gender difference in the impact of elevated plasma Lp(a) levels on recurrent coronary events remains unclear. We, therefore, evaluated the association between Lp(a) levels and the occurrence of major adverse coronary events in a large series of coronary patients (32% women). METHODS: This single-center prospective cohort study investigated 3034 consecutive patients admitted to the Coronary Care Unit with a diagnosis of coronary ischemia. According to the inclusion criteria, 2374 patients completed the follow-up (mean of 2 years). The end-points were non-fatal myocardial infarction (MI), revascularization and coronary deaths. RESULTS: Elevated Lp(a) levels were significantly associated with rate of revascularization, but not with non-fatal MI and cardiac death. According to Lp(a) stratification (≤30 mg/dl, >30-50 mg/dl and ≥50 mg/dl), there was a significant rise of revascularization events in the whole sample of participants, with a trend in hazard ratio (HR) of 1.23 (95% CI 1.04-1.46) and a 6% rise for every 10 mg/dl increment in Lp(a) levels. This effect was mainly driven by women (HR 2.04, 95%CI 1.33-3.12) who showed a 14% incremental risk for every 10 mg/dl rise in Lp(a) levels. CONCLUSIONS: In patients with coronary artery disease, elevated plasma Lp(a) levels were found to be a potentially useful predictor of the need for coronary revascularizations, especially in women.


Asunto(s)
Enfermedad de la Arteria Coronaria/sangre , Lipoproteína(a)/sangre , Anciano , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Femenino , Humanos , Isquemia/sangre , Isquemia/diagnóstico , Isquemia/etiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/sangre , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/etiología , Pronóstico , Estudios Prospectivos , Factores Sexuales
5.
Artículo en Inglés | MEDLINE | ID: mdl-32698366

RESUMEN

Chronic arsenic (As) exposure is a critical public health issue. The As metabolism can be influenced by many factors. The objective of this study is to verify if these factors influence As metabolism in four Italian areas affected by As pollution. Descriptive analyses were conducted on 271 subjects aged 20-49 in order to assess the effect of each factor considered on As methylation. Percentages of metabolites of As in urine, primary and secondary methylation indexes were calculated as indicators for metabolic capacity. The results indicate that women have a better methylation capacity (MC) than men, and drinking As-contaminated water from public aqueducts is associated with poorer MC, especially in areas with natural As pollution. In areas with anthropogenic As pollution occupational exposure is associated with a higher MC while smoking with a poorer MC. Dietary habits and genetic characteristics are probably implicated in As metabolism. BMI, alcohol consumption and polymorphism of the AS3MT gene seem not to influence As MC. Arsenic metabolism may be affected by various factors and in order to achieve a comprehensive risk assessment of As-associated disease, it is crucial to understand how these factors contribute to differences in As metabolism.


Asunto(s)
Intoxicación por Arsénico/metabolismo , Arsénico/metabolismo , Exposición a Riesgos Ambientales/efectos adversos , Contaminantes Ambientales/metabolismo , Adulto , Arsénico/análisis , Intoxicación por Arsénico/etiología , Contaminantes Ambientales/efectos adversos , Femenino , Humanos , Italia , Masculino , Metilación , Persona de Mediana Edad , Exposición Profesional , Contaminación del Agua , Adulto Joven
6.
Sci Total Environ ; 706: 135998, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-31862594

RESUMEN

Since the 1990s, in areas with natural geothermal manifestations studies on the association between exposure to pollutants and health effect have become increasingly relevant. These emissions consist of water vapor mixed with carbon dioxide, hydrogen sulfide (H2S), methane and, to a lesser extent, rare gases and trace elements in volatile forms. Considering the indications of the World Health Organization and the growth in the use of geothermal energy for energy production, this review aims to report studies exploring the health status of the populations living in areas where geothermal energy is used to produce heat and electricity. Studies on the health effects of the general population exposed to emissions from both natural geothermal events and plants using geothermal energy at domestic or commercial level have been considered between 1999 and 2019. Studies were classified into those based on health indicators and those based on proxy-individual level exposure metrics. Both statistically significant results (p<0.05) and interesting signals were commented. The 19 studies selected (New Zealand, Iceland and Italy) provide heterogeneous results, with an increased risk for several tumor sites. Exposure to H2S low concentrations is positively associated with an increment of respiratory symptoms, anti-asthma drugs use, mortality for respiratory diseases and lung cancer. Exposure to H2S high levels is inversely related to cancer mortality but associated with an increase in hospitalization for respiratory diseases, central nervous system disorders and cardiovascular diseases. The results indicate that the health of populations residing in areas rich in geothermal emissions presents some critical elements to be explored. The two major limitations of the studies are the ecological design and the inadequate exposure assessment. The authors suggested the prosecution and the systematization of health surveillance and human biomonitoring activities associated with permanent control of atmospheric emissions from both industrial and natural plants.


Asunto(s)
Electricidad , Calor , Humanos , Islandia , Italia , Nueva Zelanda
7.
Sci Total Environ ; 694: 133757, 2019 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-31756804

RESUMEN

BACKGROUND: Coal-fired thermal power plants represent a significant source of air pollutants, especially sulfur dioxide (SO2) that has been associated with an increased risk of mortality and morbidity for respiratory and cardiovascular disease. A coal power plant in Vado Ligure (Italy) (CPPVL) started in 1970 was stopped in 2014 by the Prosecutor's Office on the grounds of environmental and health culpable disaster. OBJECTIVE: To investigate the association between the exposure of residents to atmospheric pollutants emitted by CPPVL and the risk of mortality and hospitalization, considering both cancer and non-cancer causes in a population-based cohort study. METHODS: SO2 and nitrogen oxides (NOx), estimated using the ABLE-MOLOCH-ADMS-Urban dispersion model, were selected as representative surrogates of exposure to CPPVL emissions (SO2-CPPVL) and cumulative emissions from other sources of pollution (NOx-MS), respectively. The relationship between each health outcome and categories of exposure to SO2-CPPVL was estimated by the Hazard Ratio (HR) using multiple sex-specific Cox regression models, adjusted for age, exposure to NOx-MS, and socio-economic deprivation index using SO2-CPPVL first quartile as a reference. RESULTS: 144,019 individuals were recruited (follow-up 2001-2013). An excess of mortality was found for all natural causes (men: 1.49; 95% CI 1.38-1.60; women: 1.49; 95% CI 1.39-1.59), diseases of the circulatory system (men: 1.41; 95% CI 1.24-1.56; women: 1.59; 95% CI 1.44-1.77), of the respiratory system (men: 1.90; 95% CI 1.47-2.45; women: 1.62; 95% CI 1.25-2.09), and of the nervous system and sense organs (men: 1.34; 95% CI 0.97-1.86; women: 1.38; 95% CI 1.03-1.83), and in men for trachea, bronchus, and lung cancers (1.59; 95% CI 1.26-2.00). Results of hospitalization analysis were consistent with those of mortality. CONCLUSION: Results obtained, also when considering multiple sources of exposure, indicate that exposure to CPP emissions represents a risk factor for selected health outcomes as well as the urgently adoption of primary prevention measures and of a specific surveillance programme.


Asunto(s)
Contaminación del Aire/estadística & datos numéricos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Centrales Eléctricas , Contaminantes Atmosféricos/análisis , Enfermedades Cardiovasculares/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Italia/epidemiología , Enfermedades Respiratorias/mortalidad
8.
Ig Sanita Pubbl ; 75(2): 98-104, 2019.
Artículo en Italiano | MEDLINE | ID: mdl-31377755

RESUMEN

In 2008, some general practitioners (GPs) in the area of Empoli (Tuscany Region, Central Italy), reported to the Local Health Authority (LHA), an unusually high frequency of leukemia deaths among their patients residing in a one of the municipalities of the area. The LHA decided to carry out an epidemiological investigation. An interdepartmental working group was set up, led by the Department of Prevention of the LHA, and made up of representatives of the Institute for Study, Prevention and Cancer Network (ISPRO, Florence), the G. Monasterio Foundation/ Institute of Clinical Physiology of the National Council for Research (CNR) of Pisa, the University of Pisa, the Regional Environmental Protection Agency and community members. Several epidemiological analyses were carried out (namely incidence and mortality analysis, assessment of the residential history of all cases and micro-geographical incidence evaluation, assessment and quantification of local environmental pressures, evaluation of congenital abnormalities). The investigation took over two years to be completed. The work agenda was shared with community members, who contributed to decision-making, study design and the communication plan. Thanks to the interaction with community members, researchers had the chance to become aware of their information needs and of local knowledge concerning the research issues. The final report was published online and presented to citizens in several public meetings. Direct involvement of the local community during project development was found to be useful to reduce the perceived distance between public authorities and the local population, as highlighted in the guidelines on cancer cluster investigations.


Asunto(s)
Comunicación , Neoplasias Hematológicas/mortalidad , Salud Pública , Neoplasias Hematológicas/epidemiología , Humanos , Incidencia , Italia/epidemiología , Leucemia/mortalidad , Linfoma/mortalidad
9.
Artículo en Inglés | MEDLINE | ID: mdl-31405116

RESUMEN

In the present research, we evaluated the health effects of exposure to the municipal waste incinerator (MWI) in Pisa, Italy, through a population-based cohort design. The individual exposure pattern in the area was estimated through CALPUFF dispersion models of NOχ (developed by Atmospheric Studies Group Earth Tech, Lowell, Massachusetts), used as pollution proxies of the MWI and the relevant industrial plant, and through land-use regression for NOχ due to traffic pollution. Using Cox regression analysis, hazard ratios (HR) were estimated adjusting for exposure to other sources of pollution, age, and socioeconomic deprivation. An adjusted linear trend of HR (HRt) over the categories of exposure, with the relative 95% CI and p-value, was also calculated. Mortality and hospital discharge were studied as impact outcomes. Mortality analysis on males showed increased trends of mortality due to natural causes (HRt p < 0.05), the tumor of the lymphohematopoietic system (HRt p = 0.01), cardiovascular diseases (HRt p < 0.01); in females, increased trends for acute respiratory diseases (HRt p = 0.04). Morbidity analysis showed a HRt for lymphohematopoietic system tumor in males (HRt p = 0.04). Some of the excesses are in agreement with previous evidence on the health effects of MWIs, although the observation in males but not in females, suggests a cautious interpretation. Confounding due to other sources of exposure cannot be ruled out. The evidence was considered important in the decision-making process of the waste cycle.


Asunto(s)
Exposición a Riesgos Ambientales/efectos adversos , Incineración , Adulto , Anciano , Enfermedades Cardiovasculares/epidemiología , Femenino , Neoplasias Hematológicas/epidemiología , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Morbilidad , Modelos de Riesgos Proporcionales , Trastornos Respiratorios/epidemiología , Estudios Retrospectivos , Adulto Joven
10.
Epidemiol Prev ; 43(2-3 Suppl 1): 1-208, 2019.
Artículo en Italiano | MEDLINE | ID: mdl-31295974

RESUMEN

INTRODUCTION AND OBJECTIVES: This volume provides an update of the health status of the populations living in the National Priority Contaminated Sites (NPCSs) included in the SENTIERI Project. This update is part of an epidemiological surveillance programme carried out in NPCSs, promoted by the Italian Ministry of Health as a further step of a project started in 2006, when the health status of residents in contaminated sites was first addressed within the National Strategic Program "Environment and Health". The Report focuses on five health outcomes: mortality, cancer incidence, hospital discharges, congenital anomalies, and children, adolescents and young adults' health. A key element of SENTIERI project is the a priori evaluation of the epidemiological evidence of a causal association between the considered cause of disease and the exposure. When an a priori evidence is identified, it is given a greater importance in the comment of the study findings. METHODS: The present update of the SENTIERI Project concerns 45 NPCSs including in all 319 Italian Municipalities (out of over 8,000 Municipalities), with an overall population of 5,900,000 inhabitants at the 2011 Italian Census. Standardized Mortality Ratios (SMRs) and Standardized Hospitalization Ratios (SHRs), referring to a time window of 2006-2013, were computed for all the 45 NPCSs, using as a reference the corresponding mortality and hospitalization rates of the Regions where each NCPS is located. Standardized Incidence Ratios (SIRs) were computed by the Italian Association of Cancer Registries (AIRTUM) for the 22 NPCSs served by a Cancer Registry. AIRTUM covers about 56% of Italy, with partly different time-windows. SIRs have been estimated using as reference population the 4 macroareas in which Italy is divided (North-West, North-East, Centre, South). Prevalence of congenital anomalies was computed for 15 NPCSs. RESULTS: An all-cause excess of 5,267 and 6,725 deaths was observed, respectively, in men and women; the cancer death excess was of 3,375 in men and 1,910 in women. It was estimated an excess of cancer incidence of 1,220 case in men and 1,425 in women over a five-year time window. With regard to the diseases with an a priori environmental aetiological validity, an excess for malignant mesothelioma, lung, colon, and gastric cancer, and for non-malignant respiratory diseases was observed. Cancer excess mainly affected NPCSs with presence of chemical and petrochemical plants, oil refineries, and dumping hazardous wastes. An excess of non-malignant respiratory disease was also detected in NPCSs in which steel industries and thermoelectric plants were present. An excess of mesothelioma was observed in NPCSs characterized by presence of asbestos and fluoro-edenite; it was also observed where the presence of asbestos was not reported in the legislative national decrees which define the NPCS areas. It is worth noting that, even if the presence of asbestos is not reported in many NPCSs legislative decrees, petrochemical plants and steel industries, for instance, are often characterized by the presence of a large amount of this mineral that, in the past, was extensively used as an insulating material. For the first time, the present Report includes a focus on the health status of children and adolescents (1,160,000 subjects, aged 0-19 years), and young adults (660,000 subjects, aged 20-29 years). Among infants (0-1 year), an excess of 7,000 hospitalizations was observed, 2,000 of which due to conditions of perinatal origin. In the age class 0-14, an excess of 22,000 hospitalizations for all causes was observed; 4,000 of them were due to acute respiratory diseases, and 2,000 to asthma. Data on cancer incidence for subjects aged 0-24 years were derived from general population cancer registries for twenty NPCSs, and from children cancer registries (age group: 0-19 years) for six NPCSs; 666 cases where diagnosed in the age group 0-24 years, corresponding to an excess of 9%. The main contributions to this excess are from soft tissue sarcomas in children (aged 0-14 years), acute myeloid leukaemia in children (aged 0-14 years) and in the age group 0-29 years, non-Hodgkin lymphoma and testicular cancer in young adults (aged 20-29 years). In seven out of 15 NPCSs, an excess prevalence rate of overall congenital anomalies at birth was observed. Congenital anomalies excesses included the following sites: genital organs, heart, limbs, nervous system, digestive system, and urinary system. CONCLUSIONS: The main findings of SENTIERI Project have been the detection of excesses for the diseases which showed an a priori epidemiological evidence of a causal association with the environmental exposures specific for each considered NPCS. These observations are valuable within public health, because they contribute to priority health promotion activities. Looking ahead, the health benefits of an improved environmental quality might be appreciated in terms of reduction of the occurrence of adverse health effects attributable to each Site major pollutant agents. Due to the methodological approach of the present study, it was not possible to adjust for several confounding factors reported to be risk factors for the studied diseases (e.g., smoking, alcohol consumption, obesity). Even if excesses of mortality, hospitalization, cancer incidence, and prevalence of congenital anomalies were found in several NPCSs, the study design and the multifactorial aetiology of the considered diseases do not permit, for all of them, to draw conclusions in terms of causal links with environmental contamination. Moreover, it must be taken into consideration that economic factors and the availability of health services may also play a relevant role in a diseases outcome. A few observations regarding some methodological limitations of SENTIERI Project should be made. There is not a uniform environmental characterisation of the studied NPCSs in term of quality and detection of the pollutants, because this information is present in different databases which at present are not adequately connected. Moreover, the recognition of a contaminated site as a National Priority Site is based on soil and groundwater pollution, and the available information on air quality is currently sparse and not homogenous. Another limitation, in term of statistical power, is the small population size of many NPCSs and the low frequency of several health outcomes. A special caution must be paid in data interpretation when considering the correspondence between the contaminated areas and the municipality boundaries, as they do not always coincide perfectly: in some cases, a small municipality with a large industrial site, while in other settings only a part of the municipality is exposed to the sources of pollution. Furthermore, all available health information systems are currently accessible at municipality level. The real breakthrough is essentially comprised of the development and fostering of a networking system involving all local health authorities and regional environmental protection agencies operating in the areas under study. The possibility to integrate the geographic approach of SENTIERI Project with a set of ad hoc analytic epidemiological investigations, such as residential cohort studies, case control studies, children health surveys, biomonitoring surveys, and with socioepidemiological studies, might greatly contribute to the identification of health priorities for environmental remediation activities. Finally, as discussed in the last section of the report, there is a need to adopt, in each NPCS, a two-way oriented communication plan involving public health authorities, scientific community, and resident population, taking into account that the history, the cultural frame and the network of relationships specific of each local context play a major role in the risk perception perspective.


Asunto(s)
Contaminación Ambiental/efectos adversos , Adolescente , Adulto , Anciano , Causas de Muerte , Niño , Preescolar , Anomalías Congénitas/epidemiología , Anomalías Congénitas/etiología , Disruptores Endocrinos/toxicidad , Exposición a Riesgos Ambientales/efectos adversos , Restauración y Remediación Ambiental , Femenino , Humanos , Incidencia , Residuos Industriales/efectos adversos , Lactante , Recién Nacido , Italia/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Neoplasias/etiología , Embarazo , Adulto Joven
11.
Neurogastroenterol Motil ; 31(7): e13599, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31012534

RESUMEN

BACKGROUND: Swallowing impairment is frequently present in patients with idiopathic inflammatory myopathies (IIMs), and it represents an important cause of morbidity, dramatically reducing the quality of life of patients. Moreover, dysphagia is associated to a worst prognosis. Unfortunately, no standardized instrumental techniques for the assessment of the upper gastrointestinal tract in IIM patients are available. In this study, we explored the characteristics of the alterations in the upper gastrointestinal tract using oro-pharyngeal-esophageal scintigraphy (OPES) in a cohort of IIM patients and we correlated the alterations with clinical parameters. METHODS: A total of 51 IIM patients were examined with OPES, both with liquids and semisolids, and the data acquired were examined to compute the transit time and the percentage of retention at oral, pharyngeal, and esophageal level. Patient-reported outcome data (PRO) on dysphagia, disease activity, and clinical parameters were collected. KEY RESULTS: Oro-pharyngeal-esophageal scintigraphy identified at least one alteration in all patients, particularly with the semisolid test and oral and pharyngeal levels presented a higher frequency of involvement compared to the esophageal tract (P < 0.05). A very good correlation between dysphagia severity assessed by PRO and many OPES results was identified. In patients with a shorter disease duration, there was a higher prevalence of alterations at the oral and pharyngeal level and they were correlated to higher swallowing difficulties and higher disease activity parameters. CONCLUSIONS & INFERENCES: Our results showed that OPES may represent a novel reproducible tool to assess dysphagia in IIM patients, thus opening new possibilities to evaluate dysphagia in these patients.


Asunto(s)
Trastornos de Deglución/diagnóstico por imagen , Trastornos de Deglución/etiología , Miositis/complicaciones , Adulto , Anciano , Deglución/fisiología , Esófago/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Boca/diagnóstico por imagen , Faringe/diagnóstico por imagen , Cintigrafía/métodos
12.
Artículo en Inglés | MEDLINE | ID: mdl-30477262

RESUMEN

Exposure to air pollution has been shown to increase the risk of developing chronic respiratory diseases. The largest crude oil first treatment plant in Italy emits harmful polluting substances. This cross-sectional study assesses the occurrence of respiratory symptoms in a sample of the adult population living near the plant. A proximal and a reference area were defined in order to recruit 200 subjects. Each subject performed a spirometry test and completed a questionnaire. Associations between the distance from the plant and selected respiratory outcomes were assessed (distance-based approach). The prevalence of outcomes between a proximal and a reference area (area-based approach) were also compared. Odds ratios were adjusted for potential confounders. Living near the plant was associated with a higher prevalence of respiratory symptoms, with significant associations for severe dyspnoea equivalent to the halving of risk as the distance of residence from the plant increased by 1 km (adjusted odds ratio (OR) 0.48, confidence interval at the 95% probability level (95% CI): 0.25⁻0.92). Several signals emerged for respiratory allergic symptoms. The area-based approach generally confirmed the results obtained with the distance-based approach. This is the first study to be carried out on a crude oil first treatment plant aimed at assessing the association with the occurrence of respiratory symptoms. These findings contribute to the evidence supporting the need for a space⁻time surveillance system in the investigated area.


Asunto(s)
Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , Exposición a Riesgos Ambientales/análisis , Industria del Petróleo y Gas , Enfermedades Respiratorias/epidemiología , Adulto , Estudios Transversales , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Petróleo , Prevalencia , Espirometría , Encuestas y Cuestionarios
13.
Epidemiol Prev ; 42(5-6): 356-363, 2018.
Artículo en Italiano | MEDLINE | ID: mdl-30370738

RESUMEN

OBJECTIVES: understanding how selected media conveyed the news about the presentation of the results of the Health Impact Assessment study (HIA) in Val D'Agri (Southern Italy): what conceptual frames are used and their variation over time, the association of topics covered (issues), frames and actors. DESIGN: content analysis of the CNR press review in the period between the presentation of HIA results (06.09.2017-02.01.2018). Descriptive statistics analysis and multiple regression models, with stepwise selection of the most significant variables. SETTING AND PARTICIPANTS: 138 articles read by two authors independently, with analysis of the goodness of concordance. The articles are coded with 6 characteristics; 7 actors, 4 issues, 2 general frames, 4 specific frames. MAIN OUTCOME MEASURES: associations among issues, frames, actors. RESULTS: the «alarmist tone¼ is associated with interviews to politicians while the citation of the study is associated with the «assertive tone¼. The statement «there are no problems¼ is related to interviews to «non-independent researchers¼ and «companies¼. The «trivialization of research¼ is associated with citations or interviews of «non-independent researchers¼ and interviews with «companies¼. The characterization of «propaganda¼ frame is done by the presence of interviews to «politicians¼ and the citation of «public administration¼, which plays a protective role. The «conflict¼ is associated with interviews to «public administration¼ and «politicians¼, as well as with the appearance in opening articles. The presence in the articles of «evidence-based measures¼, «governance measures¼ and «legal measures¼ has increased following the presentation of HIA results. CONCLUSION: the main frames (mutually exclusive) were useful for the analysis. The specific frames help to articulate the analysis, while the issues illustrate the contents. The observations of media in this limited period may be repeated and applied in other cases, and used to monitor the impact of existing risk prevention actions, and to better analyze risk perception at the local level.


Asunto(s)
Comunicación , Evaluación del Impacto en la Salud , Humanos , Italia
14.
Epidemiol Prev ; 42(3-4 Suppl 1): 1-34, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30066535

RESUMEN

INTRODUCTION: Congenital anomalies (CAs) represent one of the main cause of foetal death, infant mortality and morbidity, and long-term disability. CAs have been object of systematic registration activity for a long-time in many geographical areas in Europe and worldwide. CAs are often associated with disabilities of different types and severity, including the developed Countries worldwide. According to the World Health Organization (WHO), each year approximately 3,2 million of children worldwide are born with a CA and approximately 300,000 newborns with a diagnosis of birth defect die within the first 28 days of life. In Europe, CAs are the leading cause of perinatal mortality: the European Surveillance of Congenital Anomalies (EUROC AT) network estimated a perinatal mortality associated with CAs of 9.2 per 10,000 births in 2008-2012. In Italy, the Ministry of Health estimates that, on the average of 500,000 births each year, about 25,000 present at least one CA. Moreover, approximately 25% of infant mortality is due to CAs and about 50% of infant mortality is attributable to perinatal morbidity, almost always of prenatal origin. Regarding long-term survival, a recent population study conducted between 1985 and 2003 in the UK estimated a 20.5-year survival of 85.5% of children born with at least one CA. According to the Centre for Disease Control and Prevention, approximately 3.3% of live births in the United States have a severe birth defect. Since CAs represent a significant public health issue, an effective primary prevention strategy should be a priority for public policies and healthcare system. Regarding aetiology, although in many cases the cause is still unknown, it has been hypothesized that CAs may be developed during the first trimester of pregnancy as a result of hereditary polygenic defects or of a gene-environment interaction. The aetiology is predominantly multifactorial, caused by complex interactions between genes and environment, which modify the normal embryo-foetal development, especially during the organogenesis phase. In particular, environmental factors (e.g., chemical toxicants, infection agents, maternal disease, and exogenous factors) can have preconceptional mutagenic action, postconceptional teratogenic effects, periconceptional endocrine disruption or epigenetic action. Regarding genetic causes, there are genetic chromosomal aberrations or dysgeneses. Furthermore, socioeconomic factors affect reproductive health by differentiating the exposure to the other risk factors as well as the access to prevention measures. In recent years, the importance of the environment as a major factor of reproductive risk has been highlighted. An individual may be exposed to pollutants present in the workplace and the population may be exposed to multiple sources of environmental contamination of water, soil, and air matrices. Pregnant women and the developing foetus are particularly sensitive to the effects of environmental exposure. OBJECTIVE: The aim of the present working paper is to produce an updated review of the epidemiological evidence on the risk of CAs associated with environmental exposures, socioeconomic, and main individual risk factors, such as cigarette smoking and alcohol consumption, according to the approach proposed by Pirastu et al. 2010 in the framework of the SENTIERI Project (the Italian Epidemiological Study of Residents in National Priority Contaminated Sites). DESIGN AND METHODS: Literature search was carried out in PubMed, following the SENTIERI project criteria to evaluate evidence, by selecting articles in English or Italian language published from 2011 to 2016 regarding human studies. For this review, descriptive and analytical epidemiological studies (cohort, case-control, cross-sectional, and ecological), systematic reviews, and metanalyses reporting association estimates between the outcome and at least one of the risk factors were selected. As in Pirastu et al., the sources of environmental exposure have been classified into four macrocategories: industries, mines, landfills, and incinerators. The sources of individual exposure considered were: active and passive cigarette smoking, alcohol consumption, socioeconomic status (SES), occupational and environmental exposures related to air pollutants from vehicular traffic only. The obtained results were assessed according to the evaluation criteria on the epidemiological evidence related to the association between the outcome and exposures predefined and published by the SENTIERI working group (WG). For the evidence assessment, the SENTIERI WG criteria favoured firstly primary sources and quantitative metanalyses, secondly, consistency among sources. The evaluation of the epidemiological evidence for the association between outcome and the exposure has been classified into three categories: sufficient (S), limited (L), inadequate (I). RESULTS: Industries: during the period under review, six single studies evaluating the association between industrial sites exposure and the risk of CAs were found. The epidemiological evidence of association between outcome and exposure has been considered limited. Mines: from the bibliographic research, three single studies investigating possible cause-effect relationship between maternal residential proximity to mines and the risk of CAs have been collected providing inadequate epidemiological evidence. Landfills: during the period under review, one systematic review and one literature review evaluating the causal associations between maternal residential proximity to landfills and CAs were identified. The epidemiological evidence is limited and concerns almost exclusively sites containing industrial or hazardous waste. Incinerators: a systematic review has been selected; it concludes that the evidence for the association between maternal residential proximity to incinerators and CAs are inadequate. Cigarette smoking: the literature search identified eight systematic reviews with metanalysis, five multicentre studies, and ten single studies assessing the causal association between maternal and/or paternal exposure to smoking and the risk of CAs in the offspring providing sufficient evidence for a causal association between maternal exposure to cigarette smoke and the risk of congenital heart defects, oro-facial clefts, neural tube defects, and gastrointestinal malformations. Alcohol: three systematic reviews with metanalysis, two metanalyses, one multicentre study, and four single studies were collected for the period under review. The acquired literature has provided limited epidemiological evidence for associations between alcohol consumption and CAs in the nervous system, particularly for anencephaly and spina bifida. Socioeconomic status: the evidence of an association with socioeconomic factors was inadequate due to an insufficient number of studies selected during the period under consideration. Occupational exposure: the literature search collected one metanalysis, eight multicentre studies, and five single studies. The epidemiological evidence for associations between paternal occupational exposure to solvents and neural tube defects and between maternal pesticide exposure and gold-facial clefts were judged limited. Air pollution: two systematic reviews with metanalyses, two multicentre studies, and nine single studies were selected by literature search; the epidemiological evidence for a causal association between air pollutants exposure and the risk of CAs is still to be considered limited. CONCLUSIONS: For future epidemiological studies, a better exposure assessment, using in particular more accurate spatial measurements or models, a standardized case definition, a larger sample and more accurate control of the recognized or presumed confounding variables are needed.


Asunto(s)
Anomalías Congénitas/epidemiología , Exposición a Riesgos Ambientales/efectos adversos , Humanos , Italia/epidemiología , Factores de Riesgo , Factores Socioeconómicos
15.
Epidemiol Prev ; 42(1): 20-33, 2018.
Artículo en Italiano | MEDLINE | ID: mdl-29506358

RESUMEN

OBJECTIVES: to evaluate the associations among the emissions produced by "Centro olio Val d'Agri" (COVA), with mortality and hospitalization of residents in the Viggiano and Grumento Nova Municipalities, located in Val d'Agri (Basilicata Region, Southern Italy). DESIGN: residential cohort study. SETTINGS AND PARTICIPANTS: Lagrangians dispersion models to estimate the level of exposure at the address of residence to NOX concentrations as tracers of COVA emissions. Based on the tertile of NOX distribution, individual exposure was classified and a Cox model analysis was performed (hazard ratio, HR, trend with relative 95%CI). The association among exposure to NOX and the cohort mortality/hospitalization was evaluated considering age, socioeconomic status, and distance from the high traffic density road. The cohort included 6,795 residents (73,270 person-years) in the period 2000-2014. MAIN OUTCOME MEASURES: causes of mortality and hospitalization due to cardio-respiratory diseases, recognised as associated to air pollution, with medium-short latency induction period, consistent with the period of operation at the COVA. RESULTS: increasing trends were observed on three exposure classes for mortality due to circulatory system diseases (HR trend: 1.19; 95%CI 1.02-1.39), stronger considering women (HR trend: 1.19; 95%CI 1.02-1.39). From hospitalizations results, an increased risk emerges for respiratory diseases (HR trend: 1.12; 95%CI 1.01-1.25) and, for women, for diseases of the circulatory system (HR trend: 1.19; 95%CI 1.03-1.38), for ischemic diseases (HR trend: 1.33; 95%CI 1.02-1.74) and respiratory diseases (HR trend: 1.22; 95%CI 1.03-1.46). CONCLUSIONS: the excesses of mortality and hospitalization emerged in areas most exposed to pollutants of industrial origin are relevant for preventive actions. It is recommended to define and implement a surveillance system for the entire resident population based on indicators of environmental pollution and related health outcomes on the basis of the scientific literature and the results achieved by the present study.


Asunto(s)
Contaminantes Atmosféricos/toxicidad , Cardiopatías/mortalidad , Hospitalización/estadística & datos numéricos , Óxidos de Nitrógeno/toxicidad , Trastornos Respiratorios/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Ciudades , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Encuestas de Atención de la Salud , Cardiopatías/inducido químicamente , Humanos , Lactante , Recién Nacido , Italia , Masculino , Persona de Mediana Edad , Neoplasias/inducido químicamente , Neoplasias/mortalidad , Modelos de Riesgos Proporcionales , Trastornos Respiratorios/inducido químicamente , Factores Socioeconómicos , Adulto Joven
16.
Artículo en Inglés | MEDLINE | ID: mdl-29425136

RESUMEN

Arsenic is ubiquitous and has a potentially adverse impact on human health. We compared the distribution of concentrations of urinary inorganic arsenic plus methylated forms (uc(iAs+MMA+DMA)) in four Italian areas with other international studies, and we assessed the relationship between uc(iAs+MMA+DMA) and various exposure factors. We conducted a human biomonitoring study on 271 subjects (132 men) aged 20-44, randomly sampled and stratified by area, gender, and age. Data on environmental and occupational exposure and dietary habits were collected through a questionnaire. Arsenic was speciated using chromatographic separation and inductively coupled mass spectrometry. Associations between uc(iAs+MMA+DMA) and exposure factors were evaluated using the geometric mean ratio (GMR) with a 90% confidence interval by stepwise multiple regression analysis. The 95th percentile value of uc(iAs+MMA+DMA) for the whole sample (86.28 µg/L) was higher than other national studies worldwide. A statistical significant correlation was found between uc(iAs+MMA+DMA) and occupational exposure (GMR: 2.68 [1.79-4.00]), GSTT gene (GMR: 0.68 [0.52-0.80]), consumption of tap water (GMR: 1.35 [1.02-1.77]), seafood (GMR: 1.44 [1.11-1.88]), whole milk (GMR: 1.34 [1.04-1.73]), and fruit/vegetables (GMR: 1.37 [1.03-1.82]). This study demonstrated the utility of uc(iAs+MMA+DMA) as a biomarker to assess environmental exposure. In a public health context, this information could be used to support remedial action, to prevent individuals from being further exposed to environmental arsenic sources.


Asunto(s)
Arsénico/orina , Arsenicales/orina , Contaminantes Ambientales/orina , Adulto , Monitoreo del Ambiente/métodos , Contaminación Ambiental , Conducta Alimentaria , Femenino , Contaminación de Alimentos , Glutatión Transferasa/genética , Humanos , Italia , Masculino , Exposición Profesional , Adulto Joven
17.
Artículo en Inglés | MEDLINE | ID: mdl-29373506

RESUMEN

The effects of noise on students' health, well-being, and learning are of growing concern among both the general public and policy-makers in Europe. Several studies have highlighted the consequences of noise on children's learning and performance at school. This study investigates the relationship between noise judgment in school goers aged 11-18 and noise measurements aimed at evaluating their exposure at school. For this purpose, a questionnaire was administered to 521 individuals in 28 classrooms in eight schools of four cities in Italy, with different environmental characteristics. Using a Likert-type scale, a selected set of responses related to noise generated an Annoyance Index (AI) score for each student and a classroom median score (MAI). From the noise data acquired, a global noise score (GNS) was assigned to each classroom. A higher AI was found in industrialized areas and among younger students. No significant differences in noise judgment were found by gender. A significant inverse correlation was described between MAI and GNS, thus the better the acoustic quality of the classrooms, the less the perceived noise and annoyance. The results show that noise perception and consequent disturbance are highly correlated with classroom acoustics, and confirm that annoyance represents the most widespread subjective response to noise.


Asunto(s)
Percepción Auditiva , Emociones , Exposición a Riesgos Ambientales/efectos adversos , Ruido/efectos adversos , Instituciones Académicas , Estrés Psicológico/etiología , Estudiantes/psicología , Acústica , Adolescente , Niño , Femenino , Humanos , Italia , Juicio , Masculino , Estrés Psicológico/diagnóstico , Encuestas y Cuestionarios
18.
Epidemiol Prev ; 41(3-4): 187-196, 2017.
Artículo en Italiano | MEDLINE | ID: mdl-28929715

RESUMEN

BACKGROUND: in SENTIERI surveillance system, the health risk assessment in the contaminated sites (CSs) was carried out considering the socioeconomic deprivation index (ID-SENTIERI) at the municipal level as a confounder. Pasetto et al. discussed the use of IDs in ecological studies and proposed to examine the role of ID-SENTIERI as a confounder. OBJECTIVES: to evaluate the initial conditions necessary for the role of confounding, i.e., the verification of an association of the ID-SENTIERI with the risk of some of the diseases for which evidence of a relationship with the socioeconomic state (SES) is documented in the literature. DESIGN: the methodological approach is to exploit ecological correlations in order to assess the relationship between ID and the occurrence of mortality or congenital malformations (CMs). SETTING AND PARTICIPANTS: mortality and CM data from municipalities in the regions of Emilia-Romagna (Northern Italy), Tuscany (Central Italy), and Campania (Southern Italy) were used. Mortality for all causes, all tumours, and lung cancers were analysed for the period 1995-2008. For the CMs, data from the regional registries of Emilia-Romagna, Tuscany, and Campania in the periods 1995-2011, 1992-2011, 2004-2010, respectively, were used. Analyses of the relationship between mortality/CMs and ID-SENTIERI were carried out according to cause, region, gender, and demographic amplitude classes using a GAM-Poisson regression model. RESULTS: the mortality analyses show that, for the male population of the three regions under study, the relationship between ID and mortality is increasing for each outcome for municipalities with less than 50,000 inhabitants; while results for female population differ from region to region. The results of the CMs show growing associations, considering only municipalities under 10,000 inhabitants. CONCLUSIONS: the results of the study suggest that scientific evidence of an association between SES and health should be evaluated taking into account the gender, the study area, and the demographic size of the municipalities. For ID to be used as a confounding variable, it must be associated with the outcomes for which the influence of socioeconomic factors in the reference areas has been ascertained. If there is no such association, the ID cannot be used as a confounder, as it could lead to distortions of estimates and such distortions are difficult to predict. In these cases, ad hoc IDs should be produced.


Asunto(s)
Anomalías Congénitas/epidemiología , Salud Ambiental , Mortalidad/tendencias , Factores Socioeconómicos , Factores de Confusión Epidemiológicos , Monitoreo del Ambiente , Femenino , Humanos , Italia/epidemiología , Masculino
19.
Epidemiol Prev ; 41(2): 134-139, 2017.
Artículo en Italiano | MEDLINE | ID: mdl-28627155

RESUMEN

OBJECTIVES: descriptive evaluation of distributional justice in the epidemiological surveillance system of populations residing in Italian National priority Contaminated Sites (NPCSs) of SENTIERI project. Analysis of the feasibility of monitoring different Environmental Justice dimensions in SENTIERI. DESIGN: descriptive study and ecological meta-analysis. SETTING AN PARTICIPANTS: residents in 298 municipalities included in 44 NPCSs in SENTIERI. Description of their level of deprivation and mortality analysis by deprivation level in the first period evaluated in SENTIERI, years 1995-2002. MAIN OUTCOME MEASURES: an index of multiple deprivation at municipality level DI-SENTIERI, built using 4 indicators based on variables from the Italian 2001 Census, was used to describe deprivation in communities living in NPCSs. The risk of mortality for all causes and all tumors in the pool of NPCSs municipalities by deprivation level was assessed using meta-Standardized Mortality Ratios (meta-SMRs). RESULTS: sixty percent of municipalities (No. 179) in NPCSs belong to the two more deprived quintiles. The socioeconomic disadvantage of communities resident in NPCS has a North-South gradient: the proportion of municipalities belonging to the two more deprived quintiles is 29% in the North, 68% in the Centre, 92% in the South. Meta-SMRs for all causes in less deprived municipalities were 98 (90%CI 95-100) in men e 101 (90%CI 97-104) in women, the values for all cancers were 99 (90%CI 94-103) in men and 100 (90%CI 95-105) in women. The corresponding estimates in more deprived municipalities were, respectively in men and women, 103 (90%CI 101- 104) and 102 (90%CI 100-104) for all causes, 104 (90%CI 102-106) and 102 (90%CI 100-104) for all cancers. CONCLUSIONS: residents in NPCSs are exposed to environmental stressors and are generally more deprived. The socioeconomic disadvantage is mostly affecting Central and Southern Italy populations. Furthermore, in these deprived communities the risk of mortality for all diseases and all cancers is higher. Populations living in NPCSs are affected by distributional injustice. To monitor the different dimensions of Environmental Justice, the DI-SENTIERI should be developed and other socioeconomic indicators implemented.


Asunto(s)
Exposición a Riesgos Ambientales/efectos adversos , Contaminación Ambiental/efectos adversos , Sustancias Peligrosas/efectos adversos , Sitios de Residuos Peligrosos , Neoplasias/epidemiología , Vigilancia de la Población , Estudios de Factibilidad , Femenino , Humanos , Incidencia , Italia/epidemiología , Masculino , Neoplasias/mortalidad , Salud Pública , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo
20.
Ann Ist Super Sanita ; 53(2): 108-117, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28617256

RESUMEN

INTRODUCTION: The limited scientific knowledge on the relationship between exposure and health effects in relation to geothermal activity motivated an epidemiologic investigation of Tuscan geothermal area. AIM: This study aims at describing mortality of populations living in Tuscan municipalities in the period 2003-2012. METHOD: Sixteen municipalities were included in the study area: eight in the northern and eight in the southern area. Mortality data come from the Regional Mortality Registry of Tuscany. Fifty-four causes of death, considered of interest for population health status or consistent with "Project SENTIERI" criteria, are analyzed. RESULTS: Results show a worse mortality profile in the southern area, especially in males, for whom excesses of all cancers and some causes of cancer emerge, while in the northern area an excess of cerebrovascular diseases among females merits attention. Further and more appropriate studies are needed to clarify the etiology of some diseases and to better assess a potential cause-effect relationship.


Asunto(s)
Energía Geotérmica , Mortalidad/tendencias , Adulto , Anciano , Exposición a Riesgos Ambientales , Femenino , Estado de Salud , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Población , Población Urbana
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