[Project of contrast to avoidable mortality in a metropolitan local health authority]. / Progetto di contrasto alla mortalità evitabile in una asl metropolitana.

INTRODUCTION: The avoidable mortality (ME)represents the share of deaths that occurs at an early age (0-74 aa) for causes that cannot be faced by means of public health or health care measures. The work develops a strategic intervention plan aimed at the reduction of ME by identifying local priority actions based on epidemiologic and social-health data. METHODS: a working group among the Department of Prevention, Health Information Systems and Health District was set up. The databases used were: "State of Health Lazio" of the Department of Epidemiology of the Lazio Region; ASL Roma 2 local health data on general mortality (2014-2016) and the local health profile of the surveillance systems "OKkio alla Salute", Passi and HBSC Lazio. The analysis results in an estimation of Asl Roma 2's data and in a comparison of this data set with the regional level of three indicators: avoidable mortality, prevalence and incidence of chronic diseases and lifestyle profile. RESULTS: in the three-year period (2014-2016) there were about 1,900 avoidable deaths per year; in the ASL Roma2 the ME represents about 16% of the total mortality and 60% of them are borne by the male sex. 51% of ME concerns cancer, 27% is linked to cardio-vascular diseases, 10% to trauma and poisoning. A preliminary comparison of standardized ASL Roma 2 rates of prevalence and incidence with regional values shows higher figures for some pathologies in ASL Roma 2: COPD prevalence (114 vs 107), breast neoplasia incidence (174 vs 153), incidence of lung neoplasia (71 vs 65). Prevalence and incidence of chronic diseases at the District level are not entirely consistent with the regional values according to a two level score. Incorrect lifestyles are widespread in at least 30% of the population and are more frequent in families with low educational level and with reported economic difficulties. CONCLUSIONS: despite the intrinsic limitations of a precise estimate of the data and the possible biases in a process of inference, the method has allowed to identify the priorities to assign in primary and secondary prevention interventions planning and for the improvement of health care; this analysis has been structured in a three years Local Strategic Plan to face the ME and was articulated in general and operational objectives and actions measured by indicators both process and, where possible, outcome evaluation.

Epidemiologic determinants affecting cigarette smoking cessation: a retrospective study in a National Health System (SSN) treatment service in Rome (Italy).

This retrospective study aims to evaluate epidemiologic characteristics of patients attending stop smoking courses, based on group therapy, testing their influence on smoking cessation in univariate and multivariate model. A total of 123 patients were included in this study. Mean age was 53 (+/-11). Sixty-seven percent were women. At the end of the courses 66% of patients stopped smoking, after 12 months only 39% remained abstinent. Patients younger than 50 years statistically tended to continue smoking 6 months (P = .02-R.R. = 1.49, C.I. 95%: 1.06-2.44) and 12 months (P = .03-R.R. = 1.37, C.I. 95%: 1.02-2.52) after the end of the courses. A low self-confidence in quitting smoking was significantly related to continuing tobacco consumption after 6 months (P = .016-R.R. = 1.84, C.I. 95%: 1.14-2.99). Low adherence to therapeutic program was statistically associated to maintenance of tobacco use at 6 months (P = .006-R.R. = 1.76, C.I. 95%: 1.32-2.35) and 12 months (P = .050-R.R. = 1.45, C.I. 95%: 1.11-1.88). This association was confirmed at 6 months in the analysis performed on logistic regression model (P = .013).

Protein intake in Parkinsonian patients using the EPIC food frequency questionnaire.

The dietary habits of 45 Italian patients with Parkinson's disease (PD) and their spouses were investigated using the EPIC food frequency questionnaire. Average daily energy intake was similar, but PD patients consumed significantly more vegetable proteins and carbohydrates (both +18%; P = 0.01 and P = 0.001, respectively). Daily protein intake, which interferes with levodopa absorption, was 50% higher than the recommended daily allowance (1.2 vs. 0.8 g/kg) in both PD patients and spouses and was significantly higher in patients with moderate/severe symptoms (1.27 +/- 0.29 vs. 1.07 +/- 0.28 g/kg; P < 0.001). In patients taking levodopa, there was a correlation between daily levodopa dosage and protein intake (P = 0.027). Dietary habits of patients with advanced and/or fluctuating PD should always be checked, with particular reference to protein intake.

Associations between dietary pattern and lifestyle, anthropometry and other health indicators in the elderly participants of the EPIC-Italy cohort.

INTRODUCTION: Epidemiological studies have shown that dietary behaviour is an important aetiological factor in various chronic diseases. We used principal component factor analysis to identify dietary patterns and to examine the associations of these patterns with health-related variables in a sample of elderly (> or =60 years) Italians participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS AND RESULTS: Exploratory factor analysis was applied to the intake of food groups as estimated by semi-quantitative food questionnaires. Individual participants were assigned factor scores, indicating the extent to which their diet conformed to each of the four dietary patterns identified: prudent (cooked vegetables, pulses, cabbage, seed oil and fish); pasta & meat (pasta, tomato sauce, red meat, processed meat, bread and wine); olive oil & salad (raw vegetables, olive oil, soup and chicken); and sweet & dairy (sugar, cakes, ice cream, coffee and dairy). Highly educated people had high scores on prudent and low scores on pasta & meat. The pasta & meat and prudent patterns were strongly positively associated with body mass index (BMI) and waist-to-hip ratio (WHR) in men and women. Hyperlipidaemic men and women consumed more of the prudent and olive oil & salad patterns and less of the sweet & dairy pattern than those with normal lipids. The olive oil & salad was significantly higher and the pasta & meat and sweet & dairy patterns significantly lower in men and women who had dieted over the previous year, suggesting awareness of the health consequences of these patterns. CONCLUSIONS: Dietary pattern analysis provides a characterization of recurrent dietary behaviour in elderly people, and can be used to provide tangible dietary advice to elderly people.

Correlates of age at natural menopause in the cohorts of EPIC-Italy.

A large number of studies have investigated the factors correlated to age at natural menopause in several populations. However, information on genetics and life-style factors influencing the age of onset of menopause in different populations is of current scientific interest. Specifically, for Italian women there are no large population-based data. The EPIC-Italy collaboration is a source of data of this kind; moreover, the geographical distribution of the cohorts (recruited in northern, central and southern Italy) is an added value as regards the scientific interest of these data. A number of biological and life-style-related factors have been analyzed to evaluate their association to the age at natural menopause in 14,454 menopausal women of the EPIC-Italy collaboration. As regards life-style and environmental factors, the main results are: a) women living in different areas of the country have different ages of onset of natural menopause; b) educational level is significantly associated to this age and may explain part of the between-center difference; c) cigarette smoking appears as a major correlate and probably determinant of the age at natural menopause across all the Italian cohorts; d) alcohol consumption does not have any relationship with the age at natural menopause; e) the use of oral contraceptives may influence age at natural menopause. As regards biological factors, short cycles and low parity have been found associated with earlier menopause. Overall, the results concerning menstrual cycles, parity, and cigarette smoking are consistent with the hypothesis that the number of oocytes in the ovary is pre-determined and any acceleration or impairment of the ovarian function leads to reduce the duration of the reproductive life.

Relationship between plasma fatty acid composition and diet over previous years in the Italian centers of the European Prospective Investigation into Cancer and Nutrition (EPIC).

Fatty acid levels in plasma phospholipids were related to food intake over the previous year as estimated by semiquantitative food frequency questionnaires compiled by 280 men and 246 women from the EPIC centers of Varese, Turin, Florence and Ragusa (Italy). Fatty acid content was determined by gas chromatography and analyzed in relation to age, sex and center. The most important finding was that plasma monounsaturated fatty acid levels, mainly oleic acid, were associated with olive oil consumption (r = 0.28 men, r = 0.19 women, both P <0.01). To our knowledge, this is the first time that these non-essential plasma fatty acids have been related to their dietary source in a population eating a varied and freely chosen diet. We confirmed that long-chain n-3 fatty acids in plasma phospholipids are associated with fish consumption and that odd chain 15 : 0 and 17 : 0 fatty acid levels are associated with dairy products and pizza-with-mozzarella consumption. N-6 polyunsaturated fatty acid levels reflected dietary intake of seed oils, mayonnaise and biscuits. Alcohol intake was positively associated with palmitic and palmitoleic acid and negatively associated with linoleic acid. These associations suggest indirect relations between alcohol consumption and other features of diet, and also that ethanol has an effect on fat metabolism. We found numerous indirect relationships (ie, not due to dietary consumption of food sources of the fatty acids) between plasma fatty acids and diet, which we propose as due to the influence of complex life-style factors.