[Prevalence of use of mobile phones while driving in Italy: results of a multicentric observational study]. / La prevalenza di uso del cellulare alla guida in Italia: risultati di uno studio osservazionale multicentrico.

OBJECTIVES: to provide an overview of the use of mobile phone in Italy while driving in the years 2015-2017. DESIGN: road side observational study. SETTING AND PARTICIPANTS: a sample of 145.107 drivers in 28 cities across the national territory with a resident population of more than 10 million inhabitants (17% of the Italian population). For each city, the survey was carried out in Urban (U), Sub-Urban (SU), and Extra-Urban (EXT) areas. Data were aggregated by three geographic areas: North, Centre and South. MAIN OUTCOME MEASURES: monitoring of the use of mobile phone when driving. RESULTS: the prevalence of mobile phone use when driving is 5.6% in the North, 4.1% in the Centre, and 6.3% in the South. The stratification by urban area also shows similar values (U: 5.3%; SU: 5.1%; EXT: 7.4%). CONCLUSIONS: a considerable prevalence of use of mobile phone when driving is observable throughout Italy, with substantially homogeneous values in different territories and in areas with different levels of urbanization. This behaviour increases the risk of road traffic accidents, according to scientific literature. Despite normative sanction of this behaviour, the prevalence is still high, even though comparable to what observed in other industrialized countries. Multilevel actions could be implemented, effective according to scientific literature, not limited only to the regulatory-sanctioning ones. The reduction of the use of the mobile phone while driving can have a significant impact for public health and traffic safety, because on the prevalence data of this study it is possible to assess that potentially up to 24,000 accidents/year could be avoided in Italy.

Violence detection explanation via semantic roles embeddings.

BACKGROUND: Emergency room reports pose specific challenges to natural language processing techniques. In this setting, violence episodes on women, elderly and children are often under-reported. Categorizing textual descriptions as containing violence-related injuries (V) vs. non-violence-related injuries (NV) is thus a relevant task to the ends of devising alerting mechanisms to track (and prevent) violence episodes. METHODS: We present VIDES (so dubbed after VIOLENCE DETECTION SYSTEM), a system to detect episodes of violence from narrative texts in emergency room reports. It employs a deep neural network for categorizing textual ER reports data, and complements such output by making explicit which elements corroborate the interpretation of the record as reporting about violence-related injuries. To these ends we designed a novel hybrid technique for filling semantic frames that employs distributed representations of terms herein, along with syntactic and semantic information. The system has been validated on real data annotated with two sorts of information: about the presence vs. absence of violence-related injuries, and about some semantic roles that can be interpreted as major cues for violent episodes, such as the agent that committed violence, the victim, the body district involved, etc.. The employed dataset contains over 150K records annotated with class (V,NV) information, and 200 records with finer-grained information on the aforementioned semantic roles. RESULTS: We used data coming from an Italian branch of the EU-Injury Database (EU-IDB) project, compiled by hospital staff. Categorization figures approach full precision and recall for negative cases and.97 precision and.94 recall on positive cases. As regards as the recognition of semantic roles, we recorded an accuracy varying from.28 to.90 according to the semantic roles involved. Moreover, the system allowed unveiling annotation errors committed by hospital staff. CONCLUSIONS: Explaining systems' results, so to make their output more comprehensible and convincing, is today necessary for AI systems. Our proposal is to combine distributed and symbolic (frame-like) representations as a possible answer to such pressing request for interpretability. Although presently focused on the medical domain, the proposed methodology is general and, in principle, it can be extended to further application areas and categorization tasks.

[Suicide mortality in Piedmont Region (Northern Italy): epidemiological suggestions for prevention]. / La mortalità per suicidio in Piemonte: spunti epidemiologici per la prevenzione.

OBJECTIVES: to describe intentional self-harm related deaths in Piedmont Region (Northern Italy) analysing trends by gender, age, area of residence, socio-economic level. DESIGN: descriptive study of mortality using data from the Italian National Institute of Statistics (Istat). SETTING AND PARTICIPANTS: resident population in Piedmont Region in the period 2003-2014. MAIN OUTCOME MEASURES: age-standardized suicide (ICD-10: X60-X84) rates, by gender, health district of residence and educational level; frequencies of suicide method and place of occurrence by gender and age. RESULTS: in a context of declining injury related mortality, especially that due to traffic accidents, the regional trend of suicides shows only a slight decrease, becoming the main cause of injury deaths since 2009, equal to 21% of all injury deaths in the studied period. Among the largest Italian Regions, Piedmont is the one with the highest rate of suicide. There are no significant trend variations related to the recent period of economic crisis. The occurrence is higher among men in general and particularly in older people, persons with low educational level and those living in mountain areas. The main suicide method used by women is "jumping from a high place" (36.7%) while the main one for men is "hanging, strangulation and suffocation" (50%). This is globally the most frequent method for all ages. "Self-poisoning" gains importance between 30 and 49 years old. Suicides occur for over half of cases in home, without any difference by gender and age. CONCLUSION: suicides are a public health and social concern. Yet despite its extent, this problem is still not adequately considered in public health prevention programmes. Important contributions to a deeper understanding of the determinants can be obtained from health information systems, in particular data from emergency care and multiple causes of deaths records.

Prevalence of use of safety devices on motorized vehicles in Italy. A multicentric road side observational study.

OBJECTIVES: to give an overview of the use of safety devices in motorized vehicles in Italy in the years 2015-2017. DESIGN: road side observational study. SETTING AND PARTICIPANTS: a sample of 232,283 road users in 28 cities across the Italian territory with a resident population of more than 10 million inhabitants (17% of the Italian population) was considered. MAIN OUTCOME MEASURES: the use of seat belts (front and rear), child restraints, and motorcycle helmets were monitored. For each city, the survey was carried out in urban, sub-urban, and extra-urban areas. Data were aggregated by three geographic areas: North, Centre, and South. Data for front seat belts was also provided for drivers and passengers separately. RESULTS: the use of front seat belts shows a dramatic geographical trend ranging from 82.6% (North) to 36.3% (South). Drivers use seat belts more frequently than passengers (63.3% vs 57.4%). The same North-South trend shows the use of rear seat belts (from 19.0% to 3.3%) and child restraints (from 59.9% to 16.6%). Helmet use was high everywhere in Italy (more than 94%). CONCLUSIONS: despite the use of safety devices, which has been mandatory for many years, compliance seems to depend on the voluntary behaviour of drivers and passengers influenced by socioeconomical and cultural patterns. The use of rear seat belts and child restraints is still far from an acceptable level, as well as the use of front seat belts in the South and in the Centre. The increased use of safety devices would have significant public health and traffic safety implications, as a potential of 327 deaths/year could be saved.

Multiple Chemical Sensitivity: Review of the State of the Art in Epidemiology, Diagnosis, and Future Perspectives.

OBJECTIVE: Systematic bibliography analysis of about the last 17 years on multiple chemical sensitivity (MCS) was carried out in order to detect new diagnostic and epidemiological evidence. The MCS is a complex syndrome that manifests as a result of exposure to a low level of various common contaminants. The etiology, diagnosis, and treatment are still debated among researchers. METHOD: Querying PubMed, Web of Science, Scopus, Cochrane library, both using some specific MESH terms combined with MESH subheadings and through free search, even by Google. RESULTS: The studies were analyzed by verifying 1) the typology of study design; 2) criteria for case definition; 3) presence of attendances in the emergency departments and hospital admissions, and 4) analysis of the risk factors. OUTLOOK: With this review, we give some general considerations and hypothesis for possible future research.

Motor vehicle accidents and obstructive sleep apnea syndrome: A methodology to calculate the related burden of injuries.

The association between motor vehicle accidents (MVAs) and obstructive sleep apnea syndrome (OSAS) has always been quantified as risk of MVAs for individual drivers with OSAS. We evaluated the expected injured patients per year attributable to OSAS-dependent MVAs in a general population. By combining OSAS prevalence and OSAS-dependent MVAs odds ratio, we assessed the population attributable fraction (PAF), an epidemiological tool that can be used to quantify the proportion of road traffic injuries (RTIs) attributable to OSAS. For an apnea hypopnea index >5, the weighed median and combined average of OSAS prevalence were 4.4 (95% confidence interval (CI): 3.7-7.5) and 4.7 (95% CI: 4.2-5.2), respectively; values of risk of OSAS-dependent MVAs were 2.83 (95% CI: 2.72-3.08) and 2.52 (95% CI: 2.07-3.08), respectively. The PAF showed weighed median and combined average values of 6.6 (95% CI: 4.3-9.8) and 7.3% (95% CI: 6.0-13.5), respectively. Our results show that about 7% of RTIs for a population of male drivers involved in MVAs are attributable to OSAS. This value can be used to assess the potential impact, on the reduction of incidence of the motor vehicle injuries, of prevention programs aimed at reducing the number of subjects with an undiagnosed and/or untreated OSAS.

Incidence estimates of hand and upper extremity injuries in Italy.

OBJECTIVE: The purpose of this investigation is to estimate the incidence rates of upper extremity injuries and to give an overview of the most frequent diagnoses. MATERIALS AND METHODS: Two population databases were queried for all injuries in the upper extremities, the SINIACA-IDB (S-IDB: Emergency Department Injury Database in Italy) and the Hospital Discharge Register (HDR). The diagnoses codes of hand trauma were selected from both databases in order to estimate the national incidence rate. RESULTS: According to the S-IDB data of year 2011, total 1 479 510 ED attendances per year in Italy were estimated with an upper extremity injury (incidence rate: 2491 per 100 000 persons/year). About 880 816 Emergency Department (ED) attendances per year are due to hand injuries, while over 653 336 attendances per year concern arm injuries. The incidence rates are 1483 and 1100 per 100 000 person/year respectively. About 201 940 hospitalizations are observed in the HDR because of upper extremity injuries (incidence rate: 340 per 100 000 persons/year). Males have higher incidence rate (387 vs 280 per 100 000 persons per year). The trend in the incidence rates for the age group of inpatients shows two peaks: at age 12 (400 cases per 100 000 persons/year), and in the older age groups (700 cases per 100 000 persons/year).

Use of back protector device on motorcycles and mopeds in Italy.

The international scientific literature reports no data on the prevalence and effectiveness of back protector devices (BPD). In Italy, no data have been collected on BPD because their use is not mandatory. To fill this gap, the National Institute of Health implemented a cross-sectional study in collaboration with the National Traffic Police.Accident cases were collected from 1 December 2011 to 25 October 2013. Overall, data from 2104 accidents involving 2319 injured subjects were analysed: 1821 (78.5%) of these were motorcyclists and 498 (21.5%) mopedists. The use of Hard-shell BPD or jackets with airbags in motorcyclists is higher then in moped drivers (16.2% vs 1.3%,P»0.000). Concerning level of protection, there are no differences between drivers and passengers. In most severely injured motorcyclists (i.e. hospitalized or deceased), the percentage of injuries to the spine was lower (13.6%) among those who used a high level safety device (hard-shell BPD and/or airbags) and rose to 27.3% among those who used only protective clothing (P»0.022). When the variables potentially affecting the results of not using a high-safety device were controlled, a bivariate analysis showed that the odds of serious spinal injury were 2.72 times greater (P»0.049) and a multivariate analysis showed that they were 2.81 times greater (P»0.012). This study points out that greater use of BPD could reduce the number of injuries to the spinal column resulting from road traffic accidents involving motorized two-wheeled vehicles.

Iron deficiency anaemia prevalence in a population of immigrated women in Italy.

BACKGROUND: Martial deficiency and sideropenic anaemia are the most diffused deficiency pathologies in the world. WHO recommends preventive screening of the new immigrant population. No epidemiological data exist on its prevalence among migrant population in Italy. METHODS: A transversal study was conducted at San Gallicano Hospital in Rome through laboratory screening on 821 migrant women and interviews on a sub-sample of 550 women (including socio-demographic, anamnestic and nutritional information). RESULTS: The complete sub-sample (laboratory results and questionnaire) shows a 20.5% [95% confidence interval (CI) 16.8-24.3] prevalence of anaemia and a 22.7% (95% CI 18.9-26.6) prevalence of sideropenia. Sideropenic anaemia was found in 11.5% (95% CI 8.5-14.4) of cases. Results are similar in the rest of the sample. There is significant association between anaemia and the clinical conditions of haemorrhoids [odds ratio (OR) 3.8; P < 0.000], hypermenorrhoea (OR 3.3; P < 0.000) and metrorrhagia (OR 5.9; P < 0.000). Africans were found to be at highest risk of anaemia (OR 5.5; P < 0.000). Feeding habits have a milder effect. Unemployed and low educated people are more likely to be affected by non-iron deficiency anaemia. CONCLUSION: The observed prevalence of sideropenia and sideropenic anaemia is much greater than what the scientific literature reports for Western populations. Pathologies inducing bleeding and the country of origin (i.e. genetic factors, pre-existing conditions) appear to be associated with anaemia. Nutritional factors are less important because of an adequate nutritional income. Prevention programmes should then aim at screening larger samples for improving the access of migrants to health-care services.

Epidemiological and geographical aspects of leishmaniasis in Tigray, northern Ethiopia: a retrospective analysis of medical records, 2005-2008.

Leishmaniasis is one of the most neglected tropical diseases and epidemic outbreaks often occur worldwide. This paper reports some epidemiological features of the disease in Tigray, northern Ethiopia, with the aim of studying the disease distribution and the environmental factors that may have influenced it. Medical records from patients with Leishmania attending the Italian Dermatological Centre of Mekele in the period 2005-2008 were retrospectively reviewed. Age and gender distribution, clinical types, occupation, co-morbidity, urban/rural origin, altitude and rainfall were investigated. The result was 471 patients affected and the prevalent clinical form was cutaneous leishmaniasis (86%). Five main risk areas were identified in the Tigray highlands and only isolated cases were reported at altitudes below 1700m. The variables related to a higher risk of catching leishmaniasis were male gender, age over-14, poor education, outdoor activities and living at high altitudes. Climatic and environmental changes occurring in this region and land degradation are discussed as factors influencing leishmaniasis distribution. Further research including field missions and geomapping is needed to quantify the actual disease burden in the region.

Epidemiology of Fatal Trauma in Italy in 2002 Using Population-Based Registries.

BACKGROUND: Population-based registries have been proposed for epidemiologic studies and quality assessment in trauma care because they consider the entire population of a given geographic area. PATIENTS AND METHODS: Trauma mortality in pre-hospital and in-hospital settings and death time from injury have been calculated for Italy during 2002 by cross-analyzing two national databases: the death certificates register (DCD) and the hospital discharge register (HDR). All diagnosis codes from 800.0 to 939.9 and from 950.0 to 959.9 in both the DCD and the HDR, with the exclusion of femur fractures (820.0 and 821.9) if older than 65, have been included. RESULTS: The total number of people who died during 2002 as a consequence of trauma in Italy was 15,456; of these, 43.5% were older than age 64, and 35.9% belonged to the 15-44 age group. The overall incidence rate of trauma death was 27.23 per 100,000 inhabitants/ year, with a relative risk to men vs. women of 2.3. An analysis of the time distribution of the trauma deaths showed that 46.8% were pre-hospital mortalities, 18% of the deaths occurred within 48 h after hospital admission (acute mortality), 11.2% of the deaths occurred between three and seven days after admission (early mortality), and 24.0% of the patients died more than seven days after admission (late mortality). Patients who died before they arrived at hospital were younger and the proportion of men was higher than for the deaths that occurred after hospital arrival. CONCLUSION: The use of population-based registries proved to be effective in our study because it allowed us to use currently available data to obtain information useful for trauma system planning and design.

Preventable trauma deaths: from panel review to population based-studies.

Preventable trauma deaths are defined as deaths which could be avoided if optimal care has been delivered. Studies on preventable trauma deaths have been accomplished initially with panel reviews of pre-hospital and hospital charts. However, several investigators questioned the reliability and validity of this method because of low reproducibility of implicit judgments when they are made by different experts. Nevertheless, number of studies were published all around the world and ultimately gained some credibility, particularly in regions where comparisons were made before and after trauma system implementation with a resultant fall in mortality. During the last decade of century the method of comparing observed survival with probability of survival calculated from large trauma registries has obtained popularity. Preventable trauma deaths were identified as deaths occurred notwithstanding a high calculated probability of survival. In recent years, preventable trauma deaths studies have been replaced by population-based studies, which use databases representative of overall population, therefore with high epidemiologic value. These databases contain readily available information which carry out the advantage of objectivity and large numbers. Nowadays, population-based researches provide the strongest evidence regarding the effectiveness of trauma systems and trauma centers on patient outcomes.