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1.
PLoS One ; 16(9): e0257376, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34506608

RESUMO

OBJECTIVE: To evaluate the effectiveness of Tocilizumab (with or without corticosteroids) in a real-life context among moderate-to-severe COVID-19 patients hospitalized at the Infectious Diseases ward of two hospitals in Lazio region, Italy, during the first wave of SARS-CoV-2 pandemic. METHOD: We conducted a retrospective cohort study among moderate-to-severe COVID-19 pneumonia to assess the influence of tocilizumab (with or without corticosteroids) on: 1) primary composite outcome: risk for death/invasive mechanical ventilation/ICU-transfer at 14 days from hospital admission; 2) secondary outcome: COVID-related death only. Both outcomes were also assessed at 28 days and restricted to baseline more severe cases. We also evaluated the safety of tocilizumab. RESULTS: Overall, 412 patients were recruited, being affected by mild (6.8%), moderate (66.3%) or severe (26.9%) COVID-19 at baseline. The median participant' age was 63 years, 56.5% were men, the sum of comorbidities was 1.34 (±1.44), and the median time from symptom onset to hospital admission was 7 [3-10] days. Patients were subdivided in 4 treatment groups: standard of care (SoC) only (n = 172), SoC plus corticosteroid (n = 65), SoC plus tocilizumab (n = 50), SoC plus tocilizumab and corticosteroid (n = 125). Twenty-six (6.3%) patients underwent intubation, and 37 (9%) COVID-related deaths were recorded. After adjusting for several factors, multivariate analysis showed that tocilizumab (with or without corticosteroids) was associated to improved primary and secondary outcomes at 14 days, and at 28-days only when tocilizumab administered without corticosteroid. Among more severe cases the protective effect of tocilizumab (± corticosteroids) was observed at both time-points. No safety concerns were recorded. CONCLUSION: Although contrasting results from randomized clinical trials to date, in our experience tocilizumab was a safe and efficacious therapeutic option for patients with moderate-to-severe COVID-19 pneumonia. Its efficacy was improved by the concomitant administration of corticosteroids in patients affected by severe-COVID-19 pneumonia at baseline.


Assuntos
Corticosteroides/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , COVID-19/tratamento farmacológico , Pandemias , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
2.
Sci Rep ; 11(1): 6256, 2021 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-33737616

RESUMO

Evidences of an association between air pollution and Covid-19 infections are mixed and inconclusive. We conducted an ecological analysis at regional scale of long-term exposure to air-borne particle matter and spread of Covid-19 cases during the first wave of epidemics. Global air pollution and climate data were calculated from satellite earth observation data assimilated into numerical models at 10 km resolution. Main outcome was defined as the cumulative number of cases of Covid-19 in the 14 days following the date when > 10 cumulative cases were reported. Negative binomial mixed effect models were applied to estimate the associations between the outcome and long-term exposure to air pollution at the regional level (PM10, PM2.5), after adjusting for relevant regional and country level covariates and spatial correlation. In total we collected 237,749 Covid-19 cases from 730 regions, 63 countries and 5 continents at May 30, 2020. A 10 µg/m3 increase of pollution level was associated with 8.1% (95% CI 5.4%, 10.5%) and 11.5% (95% CI 7.8%, 14.9%) increases in the number of cases in a 14 days window, for PM2.5 and PM10 respectively. We found an association between Covid-19 cases and air pollution suggestive of a possible causal link among particulate matter levels and incidence of COVID-19.


Assuntos
Poluição do Ar/efeitos adversos , COVID-19/epidemiologia , Material Particulado/efeitos adversos , COVID-19/etiologia , Humanos , Incidência
3.
Virus Res ; 295: 198283, 2021 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-33418027

RESUMO

The natural course of type I and III interferon (IFN) response in the respiratory tract of COVID-19 patients needs to be better defined. We showed that type I/III IFNs, IFN-regulatory factor 7 (IRF7), and IFN stimulated genes (ISGs), are highly expressed in the oropharyngeal cells of SARS-CoV-2 positive patients compared to healthy controls. Notably, the subgroup of critically-ill patients that required invasive mechanical ventilation had a general decrease in expression of IFN/ISG genes. Heterogeneous patterns of IFN-I/III response in the respiratory tract of COVID-19 patients may be associated to COVID-19 severity.


Assuntos
COVID-19/imunologia , Interferon Tipo I/genética , Interferons/genética , Orofaringe/imunologia , SARS-CoV-2 , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
4.
Artigo em Inglês | MEDLINE | ID: mdl-32962009

RESUMO

BACKGROUND: Wastewater treatment plants (WWTPs) are microbial factories aimed to reduce the amount of nutrients and pathogenic microorganisms in the treated wastewater before its discharge into the environment. We studied the impact of urban WWTP effluents on the abundance of antibiotic resistance genes (ARGs) and antibiotic-resistant Escherichia coli (AR-E. coli) in the last stretch of two rivers (Arrone and Tiber) in Central Italy that differ in size and flow volume. METHODS: Water samples were collected in three seasons upstream and downstream of the WWTP, at the WWTP outlet, and at sea sites near the river mouth, and analyzed for the abundance of ARGs by qPCR and AR-E. coli using cultivation followed by disk diffusion assays. RESULTS: For all studied genes (16S rRNA, intI1, sul1, ermB, blaTEM, tetW and qnrS), absolute concentrations were significantly higher in the Tiber than in the Arrone at all sampling sites, despite their collection date, but the prevalence of target ARGs within bacterial communities in both rivers was similar. The absolute concentrations of most ARGs were also generally higher in the WWTP effluent with median levels between log 4 and log 6 copies per ml but did not show differences along the studied stretches of rivers. Statistically significant site effect was found for E. coli phenotypic resistance to tetracycline and ciprofloxacin in the Arrone but not in the Tiber. CONCLUSIONS: In both rivers, diffuse or point pollution sources other than the studied WWTP effluents may account for the observed resistance pattern, although the Arrone appears as more sensitive to the wastewater impact considering its lower flow volume.


Assuntos
Resistência Microbiana a Medicamentos , Escherichia coli , Genes Bacterianos , Águas Residuárias , Antibacterianos , Resistência Microbiana a Medicamentos/genética , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Itália , RNA Ribossômico 16S , Águas Residuárias/análise
5.
BMC Med ; 18(1): 226, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32762750

RESUMO

BACKGROUND: The spatial spread of many mosquito-borne diseases occurs by focal spread at the scale of a few hundred meters and over longer distances due to human mobility. The relative contributions of different spatial scales for transmission of chikungunya virus require definition to improve outbreak vector control recommendations. METHODS: We analyzed data from a large chikungunya outbreak mediated by the mosquito Aedes albopictus in the Lazio region, Italy, consisting of 414 reported human cases between June and November 2017. Using dates of symptom onset, geographic coordinates of residence, and information from epidemiological questionnaires, we reconstructed transmission chains related to that outbreak. RESULTS: Focal spread (within 1 km) accounted for 54.9% of all cases, 15.8% were transmitted at a local scale (1-15 km) and the remaining 29.3% were exported from the main areas of chikungunya circulation in Lazio to longer distances such as Rome and other geographical areas. Seventy percent of focal infections (corresponding to 38% of the total 414 cases) were transmitted within a distance of 200 m (the buffer distance adopted by the national guidelines for insecticide spraying). Two main epidemic clusters were identified, with a radius expanding at a rate of 300-600 m per month. The majority of exported cases resulted in either sporadic or no further transmission in the region. CONCLUSIONS: Evidence suggest that human mobility contributes to seeding a relevant number of secondary cases and new foci of transmission over several kilometers. Reactive vector control based on current guidelines might allow a significant number of secondary clusters in untreated areas, especially if the outbreak is not detected early. Existing policies and guidelines for control during outbreaks should recommend the prioritization of preventive measures in neighboring territories with known mobility flows to the main areas of transmission.


Assuntos
Aedes/virologia , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/transmissão , Vírus Chikungunya/patogenicidade , Animais , Humanos , Itália/epidemiologia , Análise Espaço-Temporal
6.
Artigo em Inglês | MEDLINE | ID: mdl-32503246

RESUMO

The invasion of Aedes albopictus has played a major role in the resurgence of mosquito-borne diseases in Italy, generating the two largest chikungunya outbreaks in Europe (2007, 2017). Knowledge, attitude and practice (KAP) are important in order to prevent Aedes-borne disease transmission, yet so far they have not been assessed. To this scope we used multivariate logistic regression to investigate KAP of citizen-to-Aedes ecology and transmitted diseases. Data were collated by a structured questionnaire (18 questions) in 2016. Participants were selected in the Lazio region from members of native populations and two resident communities (RC) originating from the Indian subcontinent where Aedes-transmitted diseases are endemic. Results showed that compared to Italians, RC respondents had a higher knowledge and concern of Aedes-transmitted diseases (Odds Ratio = 2.61 (95%CI: 1.03-6.05); OR = 3.13 (2.15-4.65)) as well as their life cycles (OR = 2.49 (1.75-3.56); OR = 9.04 (6.22-13.66)). In contrast, they perceived a lower nuisance due to the presence of Ae. albopictus (OR = 0.2 (0.13-0.32); OR = 0.55 (0.38-0.78). These findings suggest that citizens in the Lazio region are not prepared to face a potential outbreak of arboviruses and further efforts should be made to increase knowledge, awareness and best practices.


Assuntos
Aedes , Febre de Chikungunya , Adulto , Animais , Febre de Chikungunya/epidemiologia , Surtos de Doenças , Feminino , Humanos , Itália/epidemiologia , Mosquitos Vetores , Inquéritos e Questionários
7.
PLoS Negl Trop Dis ; 14(6): e0008159, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32525957

RESUMO

KEY RESULTS: Both outbreaks started in small towns, but cases were also detected in nearby larger cities where transmission was limited to small clusters. The time spans between the first and the last symptom onsets were similar between the 2 outbreaks, and the delay from the symptom onset of the index case and the first case notified was considerable. Comparable infection and transmission rates were observed in laboratory. The basic reproductive number (R0) was estimated in the range of 1.8-6 (2007) and 1.5-2.6 (2017). Clinical characteristics were similar between outbreaks, and no acute complications were reported, though a higher frequency of ocular symptoms, myalgia, and rash was observed in 2017. Very little is known about the immune mediator profile of CHIKV-infected patients during the 2 outbreaks. Regarding public health responses, after the 2007 outbreak, the Italian Ministry of Health developed national guidelines to implement surveillance and good practices to prevent and control autochthonous transmission. However, only a few regional authorities implemented it, and the perception of outbreak risk and knowledge of clinical symptoms and transmission dynamics by general practitioners remained low. MAJOR CONCLUSIONS: Efforts should be devoted to developing suitable procedures for early detection of virus circulation in the population, possibly through the analysis of medical records in near real time. Increasing the awareness of CHIKV of general practitioners and public health officials through tailored education may be effective, especially in small coastal towns where the outbreak risk may be higher. A key element is also the shift of citizen awareness from considering Aedes mosquitoes not only as a nuisance problem but also as a public health one. We advocate the need of strengthening the surveillance and of promoting the active participation of the communities to prevent and contain future outbreaks.


Assuntos
Febre de Chikungunya/epidemiologia , Febre de Chikungunya/transmissão , Surtos de Doenças , Transmissão de Doença Infecciosa/prevenção & controle , Doenças Transmitidas por Vetores/epidemiologia , Doenças Transmitidas por Vetores/transmissão , Animais , Número Básico de Reprodução , Febre de Chikungunya/patologia , Febre de Chikungunya/virologia , Controle de Doenças Transmissíveis/organização & administração , Monitoramento Epidemiológico , Educação em Saúde/organização & administração , Política de Saúde , Humanos , Itália/epidemiologia , Resultado do Tratamento , Doenças Transmitidas por Vetores/patologia , Doenças Transmitidas por Vetores/virologia
8.
Thromb Res ; 190: 52-57, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32302781

RESUMO

BACKGROUND: Short-term exposure to air pollution increases the risk of cardiovascular mortality and morbidity but little evidence is available on pollution effects on venous thromboembolism (VTE), a common vascular disease. METHODS: We conducted a case-crossover analysis of all urgent hospitalizations for deep vein thrombosis (DVT) or pulmonary embolism (PE) among patients >35 years during the period 2006 to 2017 in Rome (Italy). We examined whether 1) short-term exposure to particulate matter with aerodynamic diameter <2.5 µg (PM2.5) increases the risk of hospitalization for DVT or PE, and 2) if the associations are modified by the period of the year (warm and cold seasons), sex, age and comorbidity. RESULTS: We found that short-term exposure to PM2.5 was associated with an increase of PE hospitalization risk of during the warm season (April to September) of 19.6% (95% confidence intervals: 8.3, 31%) per 10 µg/m3, while no statistically significant effects were displayed during the cold season or the whole year or for DVT hospitalizations. The effect of PM2.5 remained significant (%change: 21.3; 95%CI: 5.4, 39.5) after adjustment for nitrogen dioxide (NO2) co-exposure (a marker of traffic sources) and when limiting to primary diagnosis of PE (%change: 19.1; 95%CI: 4.2, 36.1). Age, sex and comorbid conditions did not modify the association. CONCLUSIONS: Our results suggested a positive association between short-term exposure to PM2.5 and pulmonary embolism during the warm period of the year while no evidence emerged for deep vein thrombosis.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Tromboembolia Venosa , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Estudos Cross-Over , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Itália/epidemiologia , Material Particulado/efeitos adversos , Material Particulado/análise , Tromboembolia Venosa/induzido quimicamente , Tromboembolia Venosa/epidemiologia
10.
Environ Epidemiol ; 4(4): e109, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33778350

RESUMO

Cirrhosis is an advanced liver disease affecting millions of people worldwide, involving high healthcare costs. Despite experimental evidence suggesting a possible role of airborne pollutants in liver diseases, epidemiological studies are lacking. We aimed at investigating the association between exposure to air pollutants and incidence of cirrhosis in a large population-based cohort in Rome. Methods: We used an administrative cohort established from the 2001 census. We included all adults of 30 years of age or older who were free of cirrhosis, resulting in a study population of over 1.2 million subjects. Follow-up of the subjects ended on 31 December 2015. We ascertained incident cases of cirrhosis from regional mortality and hospital discharge registries using a validated algorithm. We assessed exposure of the subjects to PM10, PM coarse, PM2.5, PM2.5 absorbance, NO2, NOx, and PM metal components at their residential address using Land Use Regression models. We used Cox regression models, adjusted for relevant covariates, to estimate the association between air pollution exposure and cirrhosis incidence. Results: We observed 10,111 incident cases of cirrhosis, with a crude incidence rate of 67 × 100,000 person-years. Long-term exposure to all pollutants tested was significantly associated with cirrhosis, e.g., PM10 (hazard ratios [HR], 1.05; 95% confidence interval [CI], 1.01-1.09, per 10 µg/m3 increments), PM coarse (HR, 1.11; 95% CI, 1.05-1.17, per 10 µg/m3 increments), PM2.5 (HR, 1.08; 95% CI, 1.03-1.13, per 5 µg/m3 increments), and NO2 (HR, 1.03; 95% CI, 1.02-1.05, per 10 µg/m3 increments). The associations were robust in secondary analyses. Conclusions: Our findings suggest a possible contribution of air pollution to the development of cirrhosis.

11.
Eur J Prev Cardiol ; 2020 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-33913491

RESUMO

AIMS: We aimed at investigating the relationship between particulate matter (PM) and daily admissions for cardiovascular diseases (CVDs) at national level in Italy. METHODS AND RESULTS: Daily numbers of cardiovascular hospitalizations were collected for all 8084 municipalities of Italy, in the period 2013-2015. A satellite-based spatiotemporal model was used to estimate daily PM10 (inhalable particles) and PM2.5 (fine particles) concentrations at 1-km2 resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and cardiovascular admissions. Flexible functions were estimated to explore the shape of the associations at low PM concentrations, also in non-urban areas. We analysed 2 154 810 acute hospitalizations for CVDs (25% stroke, 24% ischaemic heart diseases, 22% heart failure, and 5% atrial fibrillation). Relative increases of total cardiovascular admissions, per 10 µg/m3 variation in PM10 and PM2.5 at lag 0-5 (average of last 6 days since admission), were 0.55% (95% confidence intervals: 0.32%, 0.77%) and 0.97% (0.67%, 1.27%), respectively. The corresponding estimates for heart failure were 1.70% (1.28%, 2.13%) and 2.66% (2.09%, 3.23%). We estimated significant effects of PM10 and PM2.5 also on ischaemic heart diseases, myocardial infarction, atrial fibrillation, and ischaemic stroke. Associations were similar between less and more urbanized areas, and persisted even at low concentrations, e.g. below WHO guidelines. CONCLUSION: PM was robustly associated with peaks in daily cardiovascular admissions, especially for heart failure, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines for PM10 and PM2.5 are not sufficient to protect public health.

12.
Epidemiol Infect ; 147: e103, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30869055

RESUMO

In Sierra Leone, the Ebola virus disease (EVD) outbreak occurred with substantial differences between districts with someone even not affected. To monitor the epidemic, a community event-based surveillance system was set up, collecting data into the Viral Haemorrhagic Fever (VHF) database. We analysed the VHF database of Tonkolili district to describe the epidemiology of the EVD outbreak during July 2014-June 2015 (data availability). Multivariable analysis was used to identify risk factors for EVD, fatal EVD and barriers to healthcare access, by comparing EVD-positive vs. EVD-negative cases. Key-performance indicators for EVD response were also measured. Overall, 454 EVD-positive cases were reported. At multivariable analysis, the odds of EVD was higher among those reporting contacts with an EVD-positive/suspected case (odds ratio (OR) 2.47; 95% confidence interval (CI) 2.44-2.50; P < 0.01) and those attending funeral (OR 1.02; 95% CI 1.01-1.04; P < 0.01). EVD cases from Kunike chiefdom had a lower odds of death (OR 0.22; 95% CI 0.08-0.44; P < 0.01) and were also more likely to be hospitalised (OR 2.34; 95% CI 1.23-4.57; P < 0.05). Only 25.1% of alerts were generated within 1 day from symptom onset. EVD preparedness and response plans for Tonkolili should include social-mobilisation activities targeting Ebola/knowledge-attitudes-practice during funeral attendance, to avoid contact with suspected cases and to increase awareness on EVD symptoms, in order to reduce delays between symptom onset to alert generation and consequently improve the outbreak-response promptness.


Assuntos
Surtos de Doenças , Ebolavirus/fisiologia , Monitoramento Epidemiológico , Doença pelo Vírus Ebola/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Doença pelo Vírus Ebola/virologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Serra Leoa/epidemiologia , Adulto Jovem
14.
Sci Rep ; 8(1): 16435, 2018 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-30401870

RESUMO

Outbreaks of arbovirus infections vectored by invasive Aedes albopictus have already occurred and are predicted to become increasingly frequent in Southern Europe. We present a probabilistic model to assess risk of arbovirus outbreaks based on incident cases worldwide, on the probability of arrival of infected travelers, and on the abundance of the vector species. Our results show a significant risk of Chikungunya outbreak in Rome from mid June to October in simulations with high human biting rates (i.e. when ≥50% of the population is bitten every day). The outbreak risk is predicted to be highest for Chikungunya and null for Zika. Simulated increase of incident cases in selected endemic countries has no major impact on the outbreak risk. The model correctly estimated the number of imported cases and can be easily adapted to other urban areas where Ae. albopictus is the only potential vector present.


Assuntos
Aedes/virologia , Febre de Chikungunya/transmissão , Dengue/transmissão , Surtos de Doenças/estatística & dados numéricos , Mosquitos Vetores/fisiologia , Infecção por Zika virus/transmissão , Animais , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/virologia , Vírus Chikungunya/isolamento & purificação , Dengue/epidemiologia , Dengue/virologia , Vírus da Dengue/isolamento & purificação , Europa (Continente)/epidemiologia , Feminino , Humanos , Modelos Teóricos , Fatores de Risco , Zika virus/isolamento & purificação , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/virologia
15.
PLoS One ; 13(1): e0191112, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29342195

RESUMO

INTRODUCTION: Air pollution represents a serious threat to health on a global scale, being responsible for a large portion of the global burden of disease from environmental factors. Current evidence about the association between air pollution exposure and Diabetes Mellitus (DM) is still controversial. We aimed to evaluate the association between area-level ambient air pollution and self-reported DM in a large population sample in Italy. MATERIALS AND METHODS: We extracted information about self-reported and physician diagnosed DM, risk factors and socio-economic status from 12 surveys conducted nationwide between 1999 and 2013. We obtained annual averaged air pollution levels for the years 2003, 2005, 2007 and 2010 from the AMS-MINNI national integrated model, which simulates the dispersion and transformation of pollutants. The original maps, with a resolution of 4 x 4 km2, were normalized and aggregated at the municipality class of each Italian region, in order to match the survey data. We fit logistic regression models with a hierarchical structure to estimate the relationship between PM10, PM2.5, NO2 and O3 four-years mean levels and the risk of being affected by DM. RESULTS: We included 376,157 individuals aged more than 45 years. There were 39,969 cases of DM, with an average regional prevalence of 9.8% and a positive geographical North-to-South gradient, opposite to that of pollutants' concentrations. For each 10 µg/m3 increase, the resulting ORs were 1.04 (95% CI 1.01-1.07) for PM10, 1.04 (95% CI 1.02-1.07) for PM2.5, 1.03 (95% CI 1.01-1.05) for NO2 and 1.06 (95% CI 1.01-1.11) for O3, after accounting for relevant individual risk factors. The associations were robust to adjustment for other pollutants in two-pollutant models tested (ozone plus each other pollutant). CONCLUSIONS: We observed a significant positive association between each examined pollutant and prevalent DM. Risk estimates were consistent with current evidence, and robust to sensitivity analysis. Our study adds evidence about the effects of air pollution on diabetes and suggests a possible role of ozone as an independent factor associated with the development of DM. Such relationship is of great interest for public health and deserves further investigation.


Assuntos
Diabetes Mellitus/epidemiologia , Material Particulado/toxicidade , Idoso , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Autorrelato
16.
Euro Surveill ; 22(44)2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29113629

RESUMO

A large chikungunya outbreak is ongoing in Italy, with a main cluster in the Anzio coastal municipality. With preliminary epidemiological data, and a transmission model using mosquito abundance and biting rates, we estimated the basic reproduction number R0 at 2.07 (95% credible interval: 1.47-2.59) and the first case importation between 21 May and 18 June 2017. Outbreak risk was higher in coastal/rural sites than urban ones. Novel transmission foci could occur up to mid-November.


Assuntos
Aedes/virologia , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/transmissão , Surtos de Doenças , Mosquitos Vetores/fisiologia , Distribuição Animal , Animais , Vírus Chikungunya , Humanos , Insetos Vetores/fisiologia , Itália/epidemiologia , Modelos Biológicos , Mosquitos Vetores/virologia , Dinâmica Populacional , Fatores de Risco , Estações do Ano
17.
Artigo em Inglês | MEDLINE | ID: mdl-28632149

RESUMO

Despite the large prevalence in the population, possible factors responsible for the induction of atrial fibrillation (AF) events in susceptible individuals remain incompletely understood. We investigated the association between air pollution levels and emergency department admissions for AF in Rome. We conducted a 14 years' time-series study to evaluate the association between the daily levels of air pollution (particulate matter, PM10 and PM2.5, and nitrogen dioxide, NO2) and the daily count of emergency accesses for AF (ICD-9 code: 427.31). We applied an over-dispersed conditional Poisson model to analyze the associations at different lags after controlling for time, influenza epidemics, holiday periods, temperature, and relative humidity. Additionally, we evaluated bi-pollutant models by including the other pollutant and the influence of several effect modifiers such as personal characteristics and pre-existing medical conditions. In the period of study, 79,892 individuals were admitted to the emergency departments of Rome hospitals because of AF (on average, 15.6 patients per day: min = 1, max = 36). Air pollution levels were associated with increased AF emergency visits within 24 h of exposure. Effect estimates ranged between 1.4% (0.7-2.3) for a 10 µg/m³ increase of PM10 to 3% (1.4-4.7) for a 10 µg/m³ increase of PM2.5 at lag 0-1 day. Those effects were higher in patients ≥75 years for all pollutants, male patients for PM10, and female patients for NO2. The presence of previous cardiovascular conditions, but not other effect modifiers, increase the pollution effects by 5-8% depending on the lag. This study found evidence that air pollution is associated with AF emergency visits in the short term.


Assuntos
Poluentes Atmosféricos/toxicidade , Fibrilação Atrial/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Dióxido de Nitrogênio/toxicidade , Material Particulado/toxicidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Fibrilação Atrial/induzido quimicamente , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Tamanho da Partícula , Distribuição de Poisson , Cidade de Roma/epidemiologia
18.
J Water Health ; 14(4): 590-9, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27441854

RESUMO

This study represents the first systematic review and meta-analysis conducted to assess the association between swimming in recreational water and the occurrence of respiratory illness. Most studies focus their attention on gastrointestinal illnesses occurring after exposure to microbial polluted water. Fourteen independent studies that included 50,117 patients with significant heterogeneity (I(2) = 95.3%) were reviewed. The meta-analysis reports that people exposed to recreational water (swimmers/bathers) present a higher risk of respiratory illness compared to non-swimmers/non-bathers [relative risk (RR) = 1.63 (confidence interval at 95% [95% CI]: 1.34-1.98)]. This percentage increases if adjusted RR by age and gender [RR = 2.24 (95% CI: 1.81-2.78)] are considered. A clear association between swimming in recreational water and the occurrence of respiratory illness was found. The surveillance of water quality monitoring systems is crucial not only for gastrointestinal illness, but also for respiratory ones.


Assuntos
Infecções Respiratórias/epidemiologia , Natação , Microbiologia da Água , Praias , Humanos , Recreação , Infecções Respiratórias/microbiologia , Natação/estatística & dados numéricos
19.
PLoS Negl Trop Dis ; 10(6): e0004758, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27333276

RESUMO

Aedes albopictus is a tropical invasive species which in the last decades spread worldwide, also colonizing temperate regions of Europe and US, where it has become a public health concern due to its ability to transmit exotic arboviruses, as well as severe nuisance problems due to its aggressive daytime outdoor biting behaviour. While several studies have been carried out in order to predict the potential limits of the species expansions based on eco-climatic parameters, few studies have so far focused on the specific effects of these variables in shaping its micro-geographic abundance and dynamics. The present study investigated eco-climatic factors affecting Ae. albopictus abundance and dynamics in metropolitan and sub-urban/rural sites in Rome (Italy), which was colonized in 1997 and is nowadays one of the most infested metropolitan areas in Southern Europe. To this aim, longitudinal adult monitoring was carried out along a 70 km-transect across and beyond the most urbanized and densely populated metropolitan area. Two fine scale spatiotemporal datasets (one with reference to a 20m circular buffer around sticky traps used to collect mosquitoes and the second to a 300m circular buffer within each sampling site) were exploited to analyze the effect of climatic and socio-environmental variables on Ae. albopictus abundance and dynamics along the transect. Results showed an association between highly anthropized habitats and high adult abundance both in metropolitan and sub-urban/rural areas, with "small green islands" corresponding to hot spots of abundance in the metropolitan areas only, and a bimodal seasonal dynamics with a second peak of abundance in autumn, due to heavy rains occurring in the preceding weeks in association with permissive temperatures. The results provide useful indications to prioritize public mosquito control measures in temperate urban areas where nuisance, human-mosquito contact and risk of local arbovirus transmission are likely higher, and highlight potential public health risks also after the summer months typically associated with high mosquito densities.


Assuntos
Aedes/fisiologia , Distribuição Animal/fisiologia , Cidades , Animais , Meio Ambiente , Feminino , Masculino , Densidade Demográfica , Cidade de Roma , Estações do Ano , Especificidade da Espécie , Fatores de Tempo
20.
Cancer Causes Control ; 27(5): 595-606, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27076059

RESUMO

PURPOSE: High intake of meat has been inconsistently associated with increased risk of non-Hodgkin lymphoma (NHL). We carried out a meta-analysis to summarize the evidence of published observational studies reporting association between red meat and processed meat intake and NHL risk. METHODS: Analytical studies reporting relative risks with 95 % confidence intervals (95 % CI) for the association between intake of red and/or processed meat and NHL or major histological subtypes were eligible. We conducted random-effects meta-analysis comparing lowest and highest intake categories and dose-response meta-analysis when risk estimates and intake levels were available for more than three exposure classes. RESULTS: Fourteen studies (four cohort and ten case-control) were included in the meta-analysis, involving a total of 10,121 NHL cases. The overall relative risks of NHL for the highest versus the lowest category of consumption were 1.14 (95 % CI 1.03, 1.26) for red meat and 1.06 (95 % CI 0.98, 1.15) for processed meat. Significant associations were present when the analysis was restricted to case-control studies but not when restricted to cohort studies. No significant associations were found for major NHL etiological subtypes. Dose-response meta-analysis could be based only on eight studies that provided sufficient data, and compared to no meat consumption, the overall NHL relative risk increased nonlinearly with increased daily intake of red meat. CONCLUSION: The observed positive association between red meat consumption and NHL is mainly supported by the effect estimates coming from case-control studies and is affected by multiple sources of heterogeneity. This meta-analysis provided mixed and inconclusive evidences on the supposed relationship between red and processed meat consumption and NHL.


Assuntos
Linfoma não Hodgkin/epidemiologia , Carne/efeitos adversos , Estudos de Casos e Controles , Estudos de Coortes , Humanos , Linfoma não Hodgkin/etiologia , Estudos Observacionais como Assunto , Risco
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