Prevalence of multiple sclerosis in Sardinia: A systematic cross-sectional multi-source survey.

BACKGROUND: Partial surveys in sub-regions of Sardinia have suggested a high prevalence of multiple sclerosis (MS) on the island, relative to other Mediterranean populations. We assessed the island-wide prevalence of MS and its detailed distribution in Sardinia. METHODS: The study population consisted of 5677 MS patients, 1735 men and 3942 women, living in Sardinia. Neurologists retrospectively examined electronic and paper-based records of patients with a diagnosis of MS. The data were then linked to the administrative health information systems. Crude, age-, and sex-specific prevalence estimates of disease were calculated. RESULTS: The overall age-adjusted MS prevalence was 330 per 100,000 (95% confidence interval (CI) 321-338) in individuals older than 15 years, 447 in women (95% CI 433-461), and 205 in men (95% CI 195-214). The prevalence was highest in the Ogliastra and Nuoro districts, respectively, 425 (95% CI 372-478) and 419 (95% CI 387-451), and lowest in the Olbia-Tempio district, 217 (95% CI 195-239). Most cases had relapsing-remitting MS (79.3%), 16.3% had secondary-progressive MS, and 4.4% had primary-progressive MS. CONCLUSION: These prevalence are among the highest reported so far worldwide. They provide estimates for comparative analyses in other populations and are essential for public health interventions.

Prevalence and incidence of inflammatory bowel disease in two Italian islands, Sicily and Sardinia: A report based on health information systems.

BACKGROUND: Few epidemiological data about inflammatory bowel disease (IBD) in Italy are available. AIMS: To estimate IBD prevalence and incidence in two Italian regions - Sicily and Sardinia - using regional health information systems. METHODS: Data from hospital discharges and disease-specific payment exemptions register were retrieved and underwent record-linkage procedures. Standardized prevalence and incidence were calculated as rates per 100,000 inhabitants. RESULTS: In Sicily, during the year 2013, the overall IBD incidence rate was 27 per 100,000 inhabitants, while the incidence rate of Crohn's disease (CD) was 16 for males and 13 for females, and the incidence of ulcerative colitis (UC) was 15 and 11 for males and females, respectively. At the date of December 31st, 2013, the standardized prevalence rate of IBD was estimated at 300 cases per 100,000 inhabitants. In Sardinia, during the period 2008-2010, the average IBD incidence rate per 100,000 was 15, with an incidence rate of 5 per 100,000 for CD, and 10 per 100,000 for UC, while the standardized prevalence rate of IBD was estimated at 187 cases per 100,000 inhabitants. CONCLUSIONS: The particularly high incidence of CD in Sicily, and the marked difference of IBD occurrence between the two islands deserve future investigations.

Population-based analysis of hospitalizations for patients with systemic sclerosis in a West-European region over the period 2001-2012.

The aim of this study was to evaluate systemic sclerosis (SSc) hospitalizations through a retrospective population-based study analyzing administrative data during 2001-2012 in Sardinia, an Italian region with universal Health System coverage. Data on hospital discharge records with ICD-9-CM code for SSc (710.1) were obtained from the Department of Health and Hygiene. Two-tailed Cochran-Armitage test for trend was applied to analyze the annual trend for primary and non-primary discharge diagnoses. SSc prevalence was also estimated. This study included 4981 hospitalizations in 736 patients (84.8 % women). Hospitalizations with SSc as primary diagnosis were 3631 (72.9 %). Their annual number significantly increased during study period, from 143 in 2001 to 390 in 2012. Annual trend analysis revealed statistically significant increase in number and percentage of interstitial lung disease (p < 0.0001), pulmonary arterial hypertension (p < 0.0024), osteoporotic fragility fractures (p < 0.0001), ulcers, and gangrene (p = 0.0037) as non-primary diagnoses associated with SSc. Although the number of admissions with SSc as non-primary diagnosis showed a slight reduction during the study period, the annual number and percentage of admissions with respiratory failure (p = 0.0016) and congestive heart failure (p < 0.0001) as primary diagnosis showed a significant upward trend. Admissions for intravenous infusion, mainly day-hospital, accounted for 19.1 % of all hospitalizations for SSc and showed a significant (p = 0.0002) upward trend in 2001-2012. The 2012 SSc prevalence in Sardinia was estimated to be 34.8 per 100,000 inhabitants. Hospital care utilization for SSc is changing over time, showing increased hospitalizations aimed at the early recognition and treatment for the major manifestations and complications of SSc.

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

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

Late preterm: obstetric management.

Late preterm is the recommended definition for infants born at 34 0/7 to 36 6/7 weeks' gestation after the onset of the mother's last menstrual period. Late-preterm infants are known to have greater mortality and morbidity when compared with term infants during the neonatal period. Obstetric management plays a substantial role in influencing neonatal outcomes. We conducted a retrospective study on late-preterm births based on data collected by regional certificates of birth attendance, comparing overall data with those relative to our Department, the aim of our study was to evaluate if obstetric management, related to different delivery settings, could influence the prevalence and the method of delivery in late preterm gestational age. Preterm births represent about 10% of 25,011 births in Sardinia, and 72.6% of them are late preterm. Elective cesarean section results significantly higher in late preterm than in term deliveries. In our Department, both late-preterm delivery rate and elective cesarean sections rate were lower if compared with country region data. Obstetric management strategies play an important role in delaying deliveries and reducing late-preterm birth rates.

A retrospective analysis of human cystic echinococcosis in Sardinia (Italy), an endemic Mediterranean region, from 2001 to 2005.

To assess the current impact of human CE in Sardinia (Italy) and to monitor the changes over time, a survey has been carried out for the period 2001-2005 using hospital inpatient discharge reports (HDR) as information source, supplementing data wherever possible with additional information retrieved directly from medical records. The total of 726 admissions with "Echinococcosis" as primary diagnosis (annual rate of 8.9 per 100,000 inhabitants) concerned 540 CE cases with an annual mean incidence rate of 6.62 per 100,000 inhabitants. Male-to-female ratio was 1.36, suggesting a marked risk associated with traditional male occupations. Age-specific incidence showed increasing rates of clinical CE with age for both genders. The liver was found to be the most common localization, affecting 72% of patients, while pulmonary CE was more frequent in males than in females. CE risk was unevenly distributed in the island. The more pastoral areas had the highest probability of humans becoming infected, with an incidence rate of clinical cases of approximately 14.0 per 100,000 for areas with sheep/inhabitants index of >6. Compared to the past, incidence rates appear to be decreasing both for pulmonary and hepatic localizations, while there is a reversal of the CE "urbanization" trend resulting in "ruralization", accompanied by a greater degree of parasite ecological "isolation" and focus-points of infection risk. In spite of this decrease, the cost of hospital care alone (approximately 4 million euros) suggests that the monetary plus non-monetary costs of CE are still very high but not fully recognised.