Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 11 de 11
Filtrar
1.
J Infect ; 2021 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-34793762

RESUMEN

BACKGROUND: Transmission of antimicrobial-resistant Gram-negative bacteria (AMR-GNB) among hospitalised patients can lead to new cases of carriage, infection and outbreaks, hence the need for early carrier identification. We aim to explore two key elements that may guide control policies for colonisation/infection in hospital settings: screening practices on admission to hospital wards and risk of developing infection from colonisation. METHODS: We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to 2021 reporting on adult patients hospitalised in high-income countries. RESULTS: The search retrieved 11853 articles. After screening, 100 studies were included. Combining target patient groups and setting type, we identified six screening approaches. The most reported approach was all admitted patients to high-risk (HR) wards (49.4%). The overall prevalence of AMR-GNB was 13.8% (95%CI 9.3-19.0) with significant differences across regions and time. Risk of progression to infection among colonised patients was 11.0% (95%CI 8.0-14.3) and varied according to setting and pathogens' group (p value<0.0001), with higher values reported for Klebsiella species (18.1%; 95%CI 8.9-29.3). CONCLUSIONS: While providing a comprehensive overview of the screening approaches, our study underlines the considerable burden of AMR-GNB colonisation and risk of progression to infection in hospitals by pathogen, setting and time.

2.
Artículo en Inglés | MEDLINE | ID: mdl-34501735

RESUMEN

Noise is one of the most diffused environmental stressors affecting modern life. As such, the scientific community is committed to studying the main emission and transmission mechanisms aiming at reducing citizens' exposure, but is also actively studying the effects that noise has on health. However, scientific literature lacks data on multiple sources of noise and cardiovascular outcomes. The present cross-sectional study aims to evaluate the impact that different types of noise source (road, railway, airport and recreational) in an urban context have on blood pressure variations and hypertension. 517 citizens of Pisa, Italy, were subjected to a structured questionnaire and five measures of blood pressure in one day. Participants were living in the same building for at least 5 years, were aged from 37 to 72 years old and were exposed to one or more noise sources among air traffic, road traffic, railway and recreational noise. Logistic and multivariate linear regression models have been applied in order to assess the association between exposures and health outcomes. The analyses showed that prevalence of high levels of diastolic blood pressure (DBP) is consistent with an increase of 5 dB (A) of night-time noise (ß = 0.50 95% CI: 0.18-0.81). Furthermore, increased DBP is also positively associated with more noise sensitive subjects, older than 65 years old, without domestic noise protection, or who never close windows. Among the various noise sources, railway noise was found to be the most associated with DBP (ß = 0.68; 95% CI: -1.36, 2.72). The obtained relation between DBP and night-time noise levels reinforces current knowledge.


Asunto(s)
Hipertensión , Ruido del Transporte , Vías Férreas , Adulto , Anciano , Aeropuertos , Presión Sanguínea , Estudios Transversales , Exposición a Riesgos Ambientales/efectos adversos , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Persona de Mediana Edad , Ruido del Transporte/efectos adversos
3.
JAMA Ophthalmol ; 139(7): 753-761, 2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-34042966

RESUMEN

Importance: Given that depression is treatable and some ocular diseases that cause visual loss are reversible, early identification and treatment of patients with visual impairment who are most at risk of depression may have an important influence on the well-being of these patients. Objective: To conduct a meta-analysis on the prevalence of depression in patients with visual impairment who regularly visit eye clinics and low vision rehabilitation services. Data Sources: MEDLINE (inception to June 7, 2020) and Embase (inception to June 7, 2020) were searched. Study Selection: Studies that obtained data on the association between acquired visual impairment and depression among individuals aged 18 years or older were identified and included in this review. Exclusion criteria comprised inherited or congenital eye diseases, review studies, unpublished articles, abstracts, theses, dissertations, and book chapters. Four independent reviewers analyzed the results of the search and performed the selection and data extraction to ensure accuracy. Data Extraction and Synthesis: Meta-analyses of prevalence were conducted using random-intercept logistic regression models. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Main Outcomes and Measures: Proportion of depression. Results: A total of 27 studies were included in this review, and all but 2 included patients older than 65 years. Among 6992 total patients (mean [SD] age, 76 [13.9] years; 4195 women [60%]) with visual impairment, in 1687 patients with depression, the median proportion of depression was 0.30 (range, 0.03-0.54). The random-effects pooled estimate was 0.25 (95% CI, 0.19-0.33) with high heterogeneity (95% predictive interval, 0.05-0.70). No patient characteristic, measured at the study level, influenced the prevalence of depression, except for the inclusion of patients with cognitive impairment (0.33; 95% CI, 0.28-0.38 in 14 studies vs 0.18; 95% CI, 0.11-0.30 in 13 studies that excluded this with major comorbidities; P = .008). The prevalence of depression was high both in clinic-based studies (in 6 studies, 0.34; 95% CI, 0.23-0.47) and in rehabilitation services (in 18 studies, 0.25; 95% CI, 0.18-0.33 vs other settings in 3 studies, 0.15; 95% CI, 0.05-0.38; P = .17), and did not vary by visual impairment severity of mild (in 8 studies, 0.24; 95% CI, 0.14-0.38), moderate (in 10 studies, 0.29; 95% CI, 0.21-0.39), and severe (in 5 studies, 0.29; 95% CI, 0.12-0.56; P = .51). Conclusions and Relevance: The results of this meta-analysis suggest that depression in patients with visual impairment is a common problem that should be recognized and addressed by the health care professionals treating these patients.

4.
Artículo en Inglés | MEDLINE | ID: mdl-33921453

RESUMEN

In 2014-2015, concentrations of thallium above the recommended reference value (EPA: 2 µg/L) were measured in some parts of the drinking water distribution system in the municipality of Pietrasanta (Tuscany, Italy). An extensive campaign of water samples and human biomonitoring surveys were implemented to quantify the exposure of population. A residential cohort epidemiological study was carried out on the population of the municipality of Pietrasanta, aimed at comparing the health status of residents in the areas affected by thallium contamination with residents living in the rest of the municipality. Cohort included people residing in the municipality of Pietrasanta from 1 January 2000 to 31 December 2015. Residence addresses were georeferenced and each subject living in one of the three contaminated areas were defined as exposed. Mortality, hospital discharge data and adverse pregnancy outcomes were taken from administrative health databases. Cox proportional hazard models and logistic models were used to test the association between thallium exposure and health outcome. This study did not show any excess of risk in terms of mortality and hospitalization in the population residing in the areas served by thallium-contaminated aqueduct branches, compared to the rest of the not contaminated area. Increased risks for low birth weight (OR = 1.43 95% CI 0.91-2.25) and pre-term birth (OR = 1.40 95% CI 0.82-2.37) were observed. In view of the paucity of epidemiological studies on thallium, this study is an important contribution to the state of knowledge of the health effects of chronic exposures to low concentrations of thallium.


Asunto(s)
Agua Potable , Contaminantes Químicos del Agua , Ciudades , Estudios de Cohortes , Exposición a Riesgos Ambientales/análisis , Femenino , Humanos , Italia/epidemiología , Embarazo , Talio/análisis , Contaminantes Químicos del Agua/análisis , Contaminantes Químicos del Agua/toxicidad
5.
PLoS One ; 16(3): e0248370, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33690695

RESUMEN

Measures implemented in many countries to contain the COVID-19 pandemic resulted in a change in lifestyle with unpredictable consequences on physical and mental health. We aimed at identifying the variables associated with psychological distress during the lockdown between April and May 2020 in the Italian academic population. We conducted a multicenter cross-sectional online survey (IO CONTO 2020) within five Italian universities. Among about 240,000 individuals invited to participate through institutional communications, 18 120 filled the questionnaire. Psychological distress was measured by the self-administered Hospital Anxiety and Depression Scale (HADS). The covariates collected included demographic and lifestyle characteristics, trust in government, doctors and scientists. Associations of covariates with influenza-like symptoms or positive COVID-19 test and with psychological distress were assessed by multiple regression models at the local level; a meta-analysis of the results was then performed. Severe levels of anxiety or depression were reported by 20% of the sample and were associated with being a student or having a lower income, irrespective of their health condition and worries about contracting the virus. The probability of being severely anxious or depressed also depended on physical activity: compared to those never exercising, the highest OR being for those who stopped during lockdown (1.53; 95% CI, 1.28 to 1.84) and the lowest for those who continued (0.78; 95% CI, 0.64 to 0.95). Up to 21% of severe cases of anxiety or depression might have been avoided if during lockdown participants had continued to exercise as before. Socioeconomic insecurity contributes to increase mental problems related to the COVID-19 pandemic and to the measures to contain it. Maintaining or introducing an adequate level of physical activity is likely to mitigate such detrimental effects. Promoting safe practice of physical activity should remain a public health priority to reduce health risks during the pandemic.


Asunto(s)
COVID-19/epidemiología , COVID-19/psicología , Universidades/estadística & datos numéricos , Adulto , Ansiedad/epidemiología , Trastornos de Ansiedad/epidemiología , Estudios Transversales , Depresión/epidemiología , Trastorno Depresivo/epidemiología , Femenino , Humanos , Italia/epidemiología , Estilo de Vida , Masculino , Salud Mental/tendencias , Persona de Mediana Edad , Pandemias , Distrés Psicológico , SARS-CoV-2/patogenicidad
6.
Intern Emerg Med ; 16(4): 1071-1083, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33237494

RESUMEN

Not much is known about how accurate and reproducible different thermometers are at diagnosing patients with suspected fever. The study aims at evaluating which peripheral thermometers are more accurate and reproducible. We searched Medline, Embase, Scopus, WOS, CENTRAL, and Cinahl to perform: (1) diagnostic accuracy meta-analysis (MA) using rectal mercury-in-glass or digital thermometry as reference, and bivariate models for pooling; (2) network MA to estimate differences in mean temperature between devices; (3) Bland-Altman method to estimate 95% coefficient of reproducibility. PROSPERO registration: CRD42020174996. We included 46 studies enrolling more than 12,000 patients. Using 38 °C (100.4 â„‰) as cut-off temperature, temporal infrared thermometry had a sensitivity of 0.76 (95% confidence interval, 0.65, 0.84; low certainty) and specificity of 0.96 (0.92, 0.98; moderate certainty); tympanic infrared thermometry had a sensitivity of 0.77 (0.60,  0.88; low certainty) and specificity of 0.98 (0.95, 0.99; moderate certainty). For all the other index devices, it was not possible to pool the estimates. Compared to the rectal mercury-in-glass thermometer, mean temperature differences were not statistically different from zero for temporal or tympanic infrared thermometry; the median coefficient of reproducibility ranged between 0.53 °C [0.95 â„‰] for infrared temporal and 1.2 °C [2.16 â„‰] for axillary digital thermometry. Several peripheral thermometers proved specific, but not sensitive for diagnosing fever with rectal thermometry as a reference standard, meaning that finding a temperature below 38 °C does not rule out fever. Fixed differences between temperatures together with random error means facing differences between measurements in the order of 2 °C [4.5 â„‰]. This study informs practitioners of the limitations associated with different thermometers; peripheral ones are specific but not sensitive.


Asunto(s)
Temperatura Corporal , Termómetros/normas , Pruebas Diagnósticas de Rutina , Diseño de Equipo , Humanos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
7.
PLoS One ; 15(10): e0241223, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33119651

RESUMEN

In 2014, in some parts of the water distribution system of the municipality of Pietrasanta (Tuscany, Italy), thallium (Tl) levels above the recommended limits were measured and some restrictions to water usage for drinking and food preparation were imposed. The study aimed to assess Tl exposure and possible health effects by means of a human biomonitoring survey. In the 2014-2016 time frame, 2154 urine and 254 hair samples were taken from different population groups and from a control group. The levels of Tl found in urine and hair were statistically higher in exposed groups than in controls and compared to the reference values for the general population. Concentrations in urine were significantly associated with the geographical origin of the sample, the consumption of drinking water and food grown in local gardens. A significant association was found between urine and hair. No positive associations were found between the Tl levels in hair or urine and several self-reported symptoms and health effects, except for sleep disturbance. The study indicates that the concentration of Tl in drinking water can be traced by urine analysis. Urine and hair have proven to be biological matrices that can be effectively used for the evaluation of Tl exposure. To date, the study represents the most extensive human biomonitoring campaign for the evaluation of the Tl exposure available at international level.


Asunto(s)
Monitoreo Biológico/métodos , Agua Potable/química , Cabello/química , Talio/orina , Contaminantes Químicos del Agua/orina , Exposición a Riesgos Ambientales/análisis , Humanos , Italia , Medición de Riesgo
8.
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
9.
Sci Total Environ ; 659: 973-982, 2019 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-31096427

RESUMEN

BACKGROUND: Geothermal power plants for the production of electricity are currently active in Mt. Amiata, Italy. The present study aimed to investigate the association between chronic low-level exposure to H2S and health outcomes, using a residential cohort study design. METHODS: Spatial variability of exposure to chronic levels of H2S was evaluated using dispersion modelling. Cohorts included people residing in six municipalities of the geothermal district from 01/01/1998 to 31/12/2016. Residence addresses were georeferenced and each subject was matched with H2S exposure metrics and socio-economic status available at census tract level. Mortality and hospital discharge data for neoplasms and diseases of the respiratory, central nervous and cardiovascular systems were taken from administrative health databases. Cox proportional hazard models were used to test the association between H2S exposure and outcomes, with age as the temporal axis and adjusting for gender, socio-economic status and calendar period. RESULTS: The residential cohort was composed of 33,804 subjects for a total of 391,002 person-years. Analyses reported risk increases associated with high exposure to H2S for respiratory diseases (HR = 1.12 95%CI: 1.00-1.25 for mortality data; HR = 1.02 95%CI: 0.98-1.06 for morbidity data), COPD and disorders of the peripheral nervous system. Neoplasms were negatively associated with increased H2S exposure. CONCLUSIONS: The most consistent findings were reported for respiratory diseases. Associations with increased H2S exposure were coherent in both mortality and hospitalization analyses, for both genders, with evidence of exposure-related trends. No positive associations were found for cancer or cardiovascular diseases.


Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Exposición a Riesgos Ambientales/análisis , Sulfuro de Hidrógeno/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Enfermedades del Sistema Nervioso Central/inducido químicamente , Enfermedades del Sistema Nervioso Central/epidemiología , Enfermedades del Sistema Nervioso Central/mortalidad , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Italia/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/inducido químicamente , Neoplasias/epidemiología , Neoplasias/mortalidad , Centrales Eléctricas , Trastornos Respiratorios/inducido químicamente , Trastornos Respiratorios/epidemiología , Trastornos Respiratorios/mortalidad , Adulto Joven
10.
Environ Sci Pollut Res Int ; 25(9): 8074-8088, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28547375

RESUMEN

Ozone is a highly reactive, oxidative gas associated with adverse health outcome, including mortality and morbidity. Data from monitoring sites worldwide show levels of ozone often exceeding EU legislation threshold and the more restrictive WHO guidelines for the protection of human health. Well-established evidence has been produced for short-term effects, especially on respiratory and cardiovascular systems, associated to ozone exposure. Less conclusive is the evidence for long-term effects, reporting suggestive associations with respiratory mortality, new-onset asthma in children and increased respiratory symptom effects in asthmatics. The growing epidemiological evidence and the increasing availability of routinely collected data on air pollutant concentrations and health statistics allow to produce robust estimates in health impact assessment routine. Most recent estimates indicate that in 2013 in EU-28, 16,000 premature deaths, equivalent to 192,000 years of life lost, are attributable to ozone exposure. Italy shows very high health impact estimates among EU countries, reporting 3380 premature deaths and 61 years of life lost (per 100,000 inhabitants) attributable to ozone exposure.


Asunto(s)
Contaminación del Aire/análisis , Asma/inducido químicamente , Exposición a Riesgos Ambientales/análisis , Ozono/análisis , Niño , Humanos , Italia , Morbilidad , Ozono/química
11.
Sci Total Environ ; 568: 1315-1325, 2016 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-26775834

RESUMEN

The noise impact of the whole railway infrastructure was characterized in the urban environment of Pisa, Italy. The ordinary train transits were considered, nevertheless it was given particular attention also to the noise sources referable to railway operations like manoeuvring, loading and unloading, truck movements, braking, squeals and whistles. These kinds of noise are usually neglected in the noise modelling and are hereafter called "unconventional noises". The characteristics of the railway infrastructure and the receptors' distribution guided the measuring point selection and led to a survey with a sample of 119 people ranging between the ages of 35 and 70 and residents in the area for at least 5 years. The differences between the ordinary noise modelling and the measured noise, including the unconventional ones, were investigated. Dose-effect relationships for %HA and measured or simulated railways noise were calculated and compared with others in literature. The last paragraph of this paper is dedicated to the exposure to railway vibration and its relation with noise exposure. The results show the limitations of traditional noise mapping for railway epidemiological studies based exclusively on ordinary transits and confirm the role of vibrations as enhancing factor for disturbance.


Asunto(s)
Exposición a Riesgos Ambientales , Genio Irritable , Ruido del Transporte/efectos adversos , Vías Férreas , Población Urbana/estadística & datos numéricos , Vibración/efectos adversos , Adulto , Anciano , Femenino , Humanos , Italia , Masculino
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...