Annali dell'Istituto Superiore di Sanità
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Mortality temporal trends and cancer incidence profiles of residents in the petrochemical industrially contaminated town of Gela (Sicily, Italy)
Get PDFObjective. In 2000, a vast area in Gela (Sicily, Italy) was defined as a national priority contaminated site due to pollution from a petrochemical complex. This study is aimed at addressing the influence of the petrochemical complex on the health profile of residents in Gela. Methods. Trend analysis by gender was performed for mortality for all diseases and malignant cancers, in the period 1980-2014 for residents in the municipality of Gela, by directly standardized rates and Joinpoint regressions, using, as a reference population, people resident in the Sicily region. SMRs were computed for 5-year periods in the same timespan. Since the beginning of the period analyzed, the share of population of Gela represents 1.5% of total residents in Sicily. Cancer incidence was analyzed for the period 2007-2012 applying a hierarchical Bayesian model to estimate Standardized Incidence Ratios (SIR). Ranks of these ratios were computed to highlight the most incident diseases affecting the population. Malignant neoplasms of lung, stomach and colon were selected because of a priori interest, as they are associated, in etiological terms, with the main contaminants found in the area. Malignant neoplasms of liver, pancreas and larynx were selected as “control diseases” since they share the same main risk factors (smoke and alcohol consumption) of neoplasms of a priori interest, but are not associated with the priority index contaminants identified in Gela. Results. Mortality rates for all causes combined in both genders in Gela decreased over time, but they were higher than those of the whole Sicilian population. The trend of mortality rates due to all malignant cancers increased in men, especially from 1980 to 1987. This result was confirmed by the Joinpoint regression (annual percentage change (APC) 9.8). SMRs analysis showed significant excesses in mortality due to all diseases for both genders compared to the reference population. Other excesses were observed for mortality due to malignant cancers in men and for circulatory diseases in women. The trend for cancers in women in Gela increased from the mid-nineties but less than in men. SIR estimates were higher than 1 for all the diseases analyzed and in both sexes, and their ranks highlighted that cancer sites of a priori interest hold higher positions than “control diseases”, although credibility intervals overlapped. Conclusions. Results highlight that the health profile of residents in Gela is worse than the one of the reference population. Moreover, cancer incidence is in excess in all the sites analyzed and mortality due to all cancers combined has a trend compatible with a cumulative impact due to petrochemical contamination
Hepatitis B (HBV) reactivation in patients receiving biologic therapy for chronic inflammatory diseases in clinical practice
Get PDFIntroduction and aim. Biologic treatment – particularly with the anti-TNF molecules – is frequently used in clinical practice to treat the severe form for both chronic rheumatic diseases and inflammatory bowel diseases. The immunosuppression induced by biologic therapies increases the risk of infections, including tuberculosis, as well as hepatitis B virus (HBV) reactivation may occur in inactive carriers or occult HBV infection (OBI)subjects during biologic therapy. This study aimed to update data on HBV prevalence and reactivation in patients receiving biologic therapy for either chronic rheumatic diseases or IBD, and to describe their management in clinical practice.Materials and methods. This study was performed in 6 Italian centers (3 Rheumatology Units and 3 Gastroenterology Units). Clinical, biochemical and virological data, as well as follow up information, were recorded and analyzed.Results. 984 patients were considered, including 817 with rheumatic disease and 167 with IBD. A total of 43 showed HBV infection (38 OBI and 5 carriers) accounting for a prevalence of 4%. Among OBI patients, 1 (2.6%) case of HBV reactivation occurred in a male patient with Crohn disease. Among the 5 HBV carriers, two patients (1 with spondyloarthritis and 1 with rheumatoid arthritis) did not received HBV antiviral therapy, and both experienced flare of hepatitis at 47 and 49 months following biologic therapy starting.Discussion. Data of our study highlight that guidelines on management of HBV patients treated with biologic therapies should be still implemented in clinical practice when considering that, although infrequent, HBV reactivation could be potentially lifethreatening
Dioxins and PCBs contamination in milk and dairy products from Province of Taranto (Puglia Region, Southern Italy): a six years spatio-temporal monitoring study
Get PDFIntroduction. Taranto Province (Puglia Region, Southern Italy) is of particular PublicHealth relevance due to the presence of industrial sources of dioxins and PCBs. The aimof this study was to analyze the spatio-temporal distribution of these pollutants in milkand cheese produced from 2013 to 2018.Materials and methods. Raw milk and dairy products were sampled in the farms locatedwithin 20 km from the industrial area.Results. 1005 milk samples were collected. Median (IQR) concentrations were: dioxins0.21 (0.21) pg WHO-TEQ/g fat; dioxins+DL-PCBs 0.83 (0.71) pg WHO-TEQ/g fat;NDL-PCBs 1.92 (1.56) ng/g fat. Overall, only 6 (0.6%) samples were found to be noncompliantfor at least one pollutants group. Temporal analysis showed a decreasing trendin dioxins and PCBs concentrations over the observed years and higher values in the firsttrimester. Spatial analysis showed higher levels of PCBs in areas closest to the industrialpole. 70 dairy products samples were collected. Median pollutants concentrations werefar below the EU limits and no exceedances were observed.Conclusions. The extremely low number of exceedances appeared as an encouragingresult and supported the validity of the Public Health measures adopted by the Departmentof Prevention of Taranto
An Australian perspective on treating perinatal depression and anxiety: a brief review of efficacy and evidence-based practice in screening, psychosocial assessment and management
Get PDFAustralia is at the forefront of developing screening practices, interventions and national public health policy for perinatal women with depression and anxiety. For the last two decades Australian mental health experts and public health administrators have conducted population-wide feasibility studies on screening and incorporated these in national guidelines. This chapter outlines the wider evidence base supporting current Australian practice. Key recommendations include use of the Edinburgh Postnatal Depression Scale or the Patient Health Questionnaire-9 early in pregnancy and at 6-12 weeks postpartum, followed by psychosocial assessment. Positive depression screens need to be followed by diagnostic assessment, and clear treatment pathways must be available. Milgrom and colleagues’ cognitive behavioural treatment is the only Australian program with a solid evidence base demonstrating its effectiveness for depression and associated anxiety. The face-to-face treatment has been further developed into an online program, MumMoodBooster, funded by the Federal government and available to Australian women
Croatian diabetes registry (CroDiab) and implementation of standardised diabetes checklists using Joint Action CHRODIS Recommendations and Criteria
Get PDFIntroduction. Standardized diabetes monitoring checklists is an efficient registry collection tool and diabetes care improvement aid. Aim of this study was to improve the management of diabetes according to international standards and based on Joint Action CHRODIS Recommendations and Criteria, and to improve general practitioners (GPs) awareness of importance of monitoring via diabetes checklists.
Population and methods.Twenty-eight GPs and 1242 diabetic patients were included. GPs were divided in groups regarding the intensity of education and information provided. Quantitative analyses of diabetes quality indicators and their availability as well as qualitative study in intensive group were performed.
Results. Average number of patients with fulfilled checklists per GP increased from 20.2 to 30.8 (52.30%). Most GPs had positive attitude towards checklists but there is still a room for further improvement.
Discussion and conclusions. Checklists are perceived as positive initiatives by GPs; however, there are areas for further improvements. General practitioners education and feedback regarding the checklists may contribute to better monitoring of patients with diabetes
Exploring methods for the assessment of temporal trends in mortality and hospitalization in Italian industrially contaminated sites
Get PDFIntroduction. The Italian contaminated sites of interest for remediation are monitored by SENTIERI, an epidemiological surveillance system describing the health status of populations living nearby these sites. There is an increasing concern on how to assess temporal changes in the health status of these populations. Methods. A sequence of three statistical techniques was adopted to analyse temporal trends of mortality and hospitalization, by using different indicators and reference populations, in a sample of 36 sites with industrial sources of contamination monitored by SENTIERI. Results. Positive temporal trends in health risks are detected reflecting mainly long term effects of industrial activities. The adopted methodology identifies multiple factors influencing the temporal patterns: type of health outcomes, type of disease, and its link with gender and type of emission sources. Conclusions. Reliable methods to assess health profile changes in local populations attributable to contaminations are key elements to measure the impact of remediation activities
A far-reaching Regulation for the Italian National Registry of Implantable Prostheses: a possible model for other health registries
Get PDFMedical device registries are major tools for public health, able to provide early warning systems for increasing the patient safety. We are now at the forefront of a final legal and procedural step to design the Regulation of the Italian Implantable Prostheses Registry (RIPI) and to make data collection mandatory. This can ensure prostheses traceability, recall of patients and fuel biomedical and epidemiological research. Data completeness will be greatly improved when the Regulation is issued. At that time, rules for accessing data and subjects/entities allowed to access the Registry will be clearly defined. Therefore, the Regulation content is crucial, with no chance to fail in its design. The thorough expertise gained at the Italian National Institute of Health (Istituto Superiore di Sanità) by the Italian Arthroplasty Registry in terms of scientific, technical and privacy management may represent a prototypical model for other registries. Our aim is to identify a few key issues to shape a far-reaching Regulation that might permit the flexible and dynamic functioning of RIPI providing suggestions for other registries at national and international level
Covid-19 in pediatric palliative care: lessons learned from the pandemic and future directions
No full textIntroduction. Patients in pediatric palliative care (PPC) live with multiple comorbidities which represent a risk factor for severe form of COVID-19.Methods. This monocentric retrospective study was performed at the PPC Center of Padua (Italy). Testing methodology, prevention strategies and infection characteristics were documented and compared during the first and second peak of SARS-CoV-2 infection.Results. Between April-June 2020 a population swab screening was performed and a strong reduction of the habitual family support was observed. Between November 2020-January 2021 swab testing was limited to specific cases and the support network for families was partially restored. Incidence of COVID-19 was low, resulting in 0.04% of total pediatic cases in the Veneto Region. No severe forms were observed.Conclusion. The use of adequate preventive measures by families and support networks associated with testing in specific contests is safe, cost effective and has a minor impact on caregiver’s care load
