Rheumatic diseases in migrant patients resident in Tuscany: epidemiological data analysis and single-center experience.

OBJECTIVE: In the last decades, the number of foreigners in Tuscany has considerably increased with a multiethnic distribution. We reviewed the main rheumatic diseases in the foreign population resident in Tuscany and also reported the experience at the Rheumatology Division of the University Hospital of Careggi, Florence, in order to identify the areas of origin of these patients and the main rheumatic diseases observed in them. METHODS: The collaboration with the Tuscan Region provided data about foreign patients residing in Tuscany on January 1, 2021 (country of origin, chronic diseases). Moreover, we conducted a retrospective review of the clinical charts of our Rheumatologic Division from January 1, 2019, to December 31, 2020. RESULTS: In Tuscany, on January 1, 2021, there were 61,373 patients with chronic inflammatory rheumatic diseases, and 3994 of them (6.51%) were foreigners. Most patients were born in Europe (39.03%), followed by the Balkans (15%), South America (11.27%), and North Africa (10.31%). Inflammatory joint diseases, Sjögren syndrome, and systemic lupus erythematosus were the most frequent diseases. In the period 2019-2020, 511 foreign patients visited our Rheumatology Division and mainly originated from the Balkans (34.64%), South America (18%), and European countries (16.44%). In these patients, chronic inflammatory joint diseases and connective tissue diseases (systemic sclerosis, Sjögren syndrome, and systemic lupus erythematosus) were the most prevalent diseases. CONCLUSIONS: This study provides a picture of the rheumatic diseases affecting foreign patients residing in Tuscany that are in agreement with the epidemiological data previously provided.

Epidemiological and clinical characteristics of patients attending STI clinics in Tuscany, Italy: a multicenter report on new infections in 2011.

AIM: The aim of this study was to assess the demographic, behavioral and clinical features associated with newly diagnosed sexually transmitted infections (STIs) among attendees from four STI Clinics during 2011 in Tuscany, Central Italy. METHODS: Electronic and non-electronic medical records of attendees were reviewed to collect socio-demographical and anamnestic characteristics of patients, and to assess the annual incidence and distribution of STIs. RESULTS: The study included 1293 subjects, for a total number of 1394 newly diagnosed STIs. The male/female ratio was about 2:1, and Italian nationality accounted for 84.1% of the sample. MSM represented the 25.9% of the male population. Condom use was very poor in the large majority of our sample. Genital warts and non-gonococcal cervicitis and urethritis were the most frequent STIs. Anamnestic STIs were recorded in 350 subjects. When stratified for sexual preference, men who have sex with men were found at four to ten fold increased risk for syphilis, gonorrhoeae and HIV infection. New diagnoses of syphilis, gonorrhoea, urethritis and molluscum were strictly associated with infections by the same pathogens in the past (re-infections). CONCLUSIONS: Results show that STIs in Tuscany involve a mixed young to adult population, composed by both heterosexual and homosexual subjects who practice unprotected sex and do not seem to be conscious of the associated risks, as demonstrated by the high rates of coinfections and reinfections. These findings reinforce the need for greater education and prevention efforts for HIV and other STIs among the Tuscan population.

Social and behavioral determinants as risk of sexually transmitted diseases. Report by a sample from the Sexually Transmitted Disease Unit in Florence, Italy.

AIM: Sexually transmitted infections (STIs) are increasing worldwide, mostly due to changing sexual behavior s (larger numbers of sexual partners, concurrent relationships, increasing proportion of adolescents engaging in sexual intercourse at young age, and inconsistent condom use with new partners). In Italy, few data are available about STI spread, since most infections are not subjected to mandatory notification. METHODS: In this article, the occurrence of STIs in a random sample attending a STI Unit in Florence, Italy, is reported. Results were obtained through the administration of an anonymous questionnaire that patients could complete spontaneously in the waiting room while waiting for the visit. Self-reported questions allowed to collect information about socio-demographic and clinical data, sexual behavior and perception of risk. RESULTS: Overall, 469 patients (321 males, 148 females) participated in the study. Age ranged from 16 to 70 years. Male patients who referred to engage sexual intercourse with men (MSM) were 133; females who had sex with women (FSF) were 5, while 24 patients declared to have sex with both males and females (bisexual); 59.7% (N.=280) of participants reported they had a stable relationship, but 20% of these reported they had had sex with more than five partners during the last 12 months. The use of condoms is declared to be very infrequent, especially in the two extreme age ranges. Fifty percent of patients had been diagnosed an STI in their life, particularly syphilis (39.3%), genital warts (64.6%) and chlamydial infections (42.9%). Among those subjects who had contracted an STI (including non-curable viral infections, i.e., HIV and herpes genitalis) 32.4% referred they never used condoms. CONCLUSION: The authors discuss their results compared to the existing literature, and focus on identification of risk factors associated with self-reported STIs. Although conducted on a small population, this study provides a basis for targeting prevention and control strategies on our high-risk patients.

Road traffic injuries in the province of Grosseto.

INTRODUCTION: Road traffic injuries constitute a major public health issue. The Province of Grosseto is one of the territories most affected in the Region of Tuscany. The objective of the study, part of the Road Safety Provincial Council's project, is to describe the epidemiology of the road accidents in order to contribute to the reduction of the burden of deaths and injuries. METHODS: The data relative to road accidents occurring in the Province were drawn from the various sources available: Death Certificates (1991-2005), Police Reports (1991-2003), Hospital Discharge Records (1996-2005), Emergency Room visits (2004-2005). RESULTS: On average, each year road accidents cause 30 deaths, at least 530 hospitalizations, and approximately 3,300 Emergency Room visits. The standardized mortality rate (2003-2005, males: 20.6; females: 6.0), the mortality ratio (2003:34.6 deaths for every 1,000 accidents), and the severity ratio (2003: 1,432 injured for every 1,000 accidents) are higher than regional figures. DISCUSSION: The greater relative number of fatalities, casualties and crashes can be explained by various physical and social environmental factors such as vast flatland, few greater urban settlements, deprived area. The territory specifically demonstrates an accentuated seasonality in August, a month in which a peak in both the number of accidents and their severity is reported, brought about by the intense volume of commuter and transit traffic, and highlighted by the fact that in that same month approximately half of Emergency Room visits concern non-residents. CONCLUSION: The complexity of the issue, the number of determinant factors involved, and the disproportionately greater impact on the more disadvantaged and vulnerable segments of society require the development of inter-sectoral strategies and the sharing of responsibility among individuals, groups and communities.

[Mortality in a cohort of alcoholics from Arezzo in 1979-1997]. / La mortalità in una coorte di alcolisti di Arezzo nel periodo 1979-1997.

This study evaluates the risk of mortality in a cohort of Italian alcoholics resident in a rural area characterised by traditional drinking habits. Individual vital status of the 1,037 patients enrolled at the Centro Alcologico in Arezzo during the 1979-1997 period has been traced. Causes of death (ICD-IX) have been retrieved from the Regional Mortality Register. Standardised mortality ratios (SMR) have been computed according to gender and 5-year age group mortality rates of the general population resident in Tuscany during the same period. This cohort is representative of the traditional rural alcoholism of the Tuscany region based on wine consumption. Among the 9,190 person-years followed-up, 333 deaths have occurred, corresponding to approximately 2.6 fold the expected number of deaths (SMR males: 2.6; females: 2.4). In both genders, significantly high SMRs for liver cirrhosis, oesophagus and liver cancer are reported, while SMRs of cancers at all sites, oral and respiratory cancers, injuries as a whole, road and traffic accidents, and suicides are significantly elevated only among males. No relevant variation between expected and observed deaths for pancreatic diseases, colon cancer, female breast cancer, and, despite a large proportion of heavy smokers, for cardiovascular diseases (hypertension, cerebrovascular diseases, coronary heart diseases) has been recorded. This research confirms the high mortality among a cohort of Italian alcoholics. However, causes of death related with violence and trauma are proportionally less represented, in accordance with the social pattern of Mediterranean alcoholism. The absence of cardiovascular mortality risk in a wine-based cohort of alcoholics is an unexpected finding that requires to be further examined. Finally, to prevent smoking related deaths, alcohol addiction services should begin to introduce smoking cessation practices among treatment protocols.