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Answer to comments on "Spatial variability of nitrogen dioxide and formaldehyde and residential exposure of children in the industrial area of Viadana, Northern Italy" by Marcon, Alessandro et al. Environ Sci Pollut Res 28, 28096-28106 (2021), DOI: 10.1007/s11356-020-12015-0
No full textNo abstract availabl
Determinants of lung function decline in adult asthma. Results from the European Community Respiratory Health Survey
Full text linkIntroduzione
Il volume espiratorio forzato in 1 secondo (FEV1) è un predittore della mortalità sia nella popolazione generale che in quella asmatica. I soggetti asmatici hanno un declino del FEV1 nel tempo più accentuato rispetto ai soggetti non asmatici; inoltre alcuni pazienti con asma grave sviluppano un'ostruzione progressiva delle vie aeree che non risulta completamente reversibile con la terapia attualmente disponibile. Inoltre, un FEV1 più basso del predetto è un indicatore di scarso controllo della malattia.
Obiettivi
Questa tesi ha l'obiettivo di incrementare le conoscenze sui fattori associati al declino del FEV1 negli asmatici, con particolare attenzione nel valutare il potenziale effetto protettivo dell’uso di corticosteroidi inalati (ICS) e l’associazione del declino del FEV1 con l'indice di massa corporea (BMI) e con la variazione del peso
corporeo nel tempo.
Metodi
Sono stati analizzati i dati di una coorte internazionale di soggetti asmatici della popolazione generale, identificati nell’indagine European Community Respiratory Health Survey (ECRHS, 1991-1993) e rivalutati nel 1999-2002. La spirometria è stata effettuata in entrambe le occasioni, e il declino del FEV1 è stato messo in relazione con alcuni possibili determinanti misurati all'inizio dello studio e durante il follow-up, utilizzando modelli di regressione lineare ad intercetta casuale.
Risultati
Negli asmatici con immunoglobuline E (IgE) elevate (>100 kU/L), l'utilizzo di ICS per almeno 4 anni durante il follow-up era associato con un minore declino del FEV1 (23 mL/anno; IC 95%: 8-38 rispetto ai non utilizzatori). Questa associazione non è stata riscontrata negli asmatici con IgE più basse. Negli asmatici che non avevano ostruzione delle vie aeree (FEV1/FVC<0.70) basale,
gli obesi avevano il livello iniziale di FEV1 più basso; si è osservato un declino del FEV1 più rapido per i soggetti con BMI intermedio rispetto ai soggetti magri oppure obesi; il declino del FEV1 era associato con l'aumento di peso indipendentemente dal BMI iniziale, e questa associazione è risultata più forte negli uomini (20, IC 95%: 10; 30, mL/anno per kg di aumento di peso)
che nelle donne (7, IC 95%: 2; 11, mL/anno); i valori di declino trovati negli asmatici sono circa il 60% superiori a quelli riscontrati negli uomini e nelle donne della popolazione generale che hanno preso parte a ECRHS.
Negli asmatici con ostruzione iniziale delle vie aeree, l’assenza di sensibilizzazione agli allergeni e un basso BMI iniziale erano associati con un più rapido declino del FEV1, mentre l’aumento di peso non è risultato associato con il declino.
Conclusioni e implicazioni cliniche
I nostri risultati confermano l'associazione favorevole tra utilizzo prolungato di ICS e il declino della funzionalità respiratoria negli asmatici. Tuttavia, suggeriscono che gli asmatici con alti livelli di IgE potrebbero beneficiare massimamente del trattamento prolungato con gli ICS. Di conseguenza, potrebbe essere opportuno calibrare la dose di corticosteroidi in relazione
al livello di IgE totali del paziente, sebbene siano necessari altri studi per chiarire questo aspetto.
L'effetto dannoso dell’aumento di peso sul declino del FEV1 è particolarmente importante negli asmatici che non hanno ancora un'ostruzione stabile delle vie aeree. Questo effetto potrebbe essere maggiore negli asmatici che nei soggetti della popolazione generale. Di conseguenza, si raccomandano fortemente il controllo del peso negli asmatici e la perdita di peso negli
asmatici obesi o sovrappeso.
Tra gli asmatici che avevano ostruzione delle vie aeree iniziale, i soggetti magri non sensibilizzati agli allergeni meritano particolare attenzione, perché sono quelli che hanno dimostrato il maggiore declino del FEV1. L'aumento di peso non è risultato associato al declino, e ciò suggerisce che i meccanismi
tipici dell’asma lieve potrebbero essere meno importanti nell'asma
grave, mentre un’infiammazione seria e di lungo termine potrebbe svolgere un ruolo cruciale.Introduction
Forced expiratory volume in 1 second (FEV1) is a predictor of mortality in the
general, as well as in the asthmatic population. Subjects with asthma have a
steeper decline in FEV1 over time than subjects without, and some patients with
severe asthma develop progressive airflow obstruction that is not fully reversible
with currently available therapy. Moreover, a FEV1 lower than predicted is a
marker of poor asthma control.
Aims
This thesis was aimed at shedding some light on the factors associated with
the decline in FEV1 in subjects with asthma, with particular attention paid to
investigating the potential preventative effect of the use of inhaled corticosteroids
(ICSs), as well as to the association of FEV1 decline with body mass index (BMI)
and change in body weight over time.
Methods
We analysed data from an international, population-based cohort of subjects
with asthma, identified in the European Community Respiratory Health Survey
(ECRHS, 1991-1993) and followed up from 1999 to 2002. Spirometry was
performed on both occasions, and FEV1 decline was related to potential determinants
evaluated at baseline and during the follow-up by random intercept linear
regression models.
Results
In asthmatic subjects with high (>100 kU/L) immunoglobulin E (IgE), the use
of ICSs for 4 years or more during the follow-up was associated with a
lower FEV1 decline (23 mL/y; 95% CI: 8-38 compared with non-users). This
association was not seen in asthmatic subjects with lower IgE.
In asthmatic subjects who did not have airflow obstruction (FEV1/FVC<0.70) at
baseline, obese subjects had the lowest level of FEV1 at baseline; a faster FEV1
decline was observed for subjects with intermediate BMI than for lean and
obese subjects; FEV1 decline was associated with weight gain independently
of baseline BMI, and this association was stronger in men (20, 95% CI: 10;
30, mL/year per kg gained) than in women (7, 95% CI: 2; 11, mL/year); these
figures were about 60% greater than the decline found in men and women
from the general population who took part in the ECRHS.
In asthmatic subjects with airflow obstruction at baseline, the absence of allergen
sensitization and a low BMI at baseline were associated with a faster FEV1
decline, while weight gain was not associated with decline.
Conclusions and clinical implications
Our findings confirm the beneficial association between long-term treatment
with ICSs and lung function decline in asthma. However, they suggest that
asthmatic subjects with high IgE could maximally benefit from prolonged
treatment with ICSs. As a consequence, it could be worth calibrating the
corticosteroid dose according to a patient’s level of total IgE, although further
studies are needed to clarify this.
The detrimental effect of weight gain on FEV1 decline is particularly important
in asthmatic subjects who still do not have an established airflow
obstruction. This effect could be greater in subjects with asthma than in
people from the general population. Accordingly, weight management in
asthma and weight loss in overweight or obese asthmatic individuals are
strongly recommended.
Among asthmatic subjects with airflow obstruction at baseline, lean subjects
without sensitization to allergens deserve particular attention, because they
had the greatest decline in FEV1. Weight gain was not associated with decline,
suggesting that mechanisms that are typical of milder asthma could be
less important in severe asthma, while a serious long-lasting inflammation
may have a crucial role
Air Pollution and Bronchitis: Childhood Exposure, Lifelong Consequences
No full textNo abstract availabl
COPD-Related Mortality and Co-morbidities in Northeastern Italy, 2008-2012: A Multiple Causes of Death Analysis
No full textIntroduction: Analysis of COPD mortality based only on the underlying cause of death (UCOD) derived from death certificates underestimates disease burden. We analyzed the burden of COPD, as well as the pattern of reporting COPD and its co-morbidities in death certificates, using multiple-cause of death (MCOD) records.Methods: All 220,281 death certificates of decedents aged ≥40 years in the Veneto region (northeastern Italy) were analyzed through 2008-2012. The UCOD was selected by the Automated Classification of Medical Entities software. COPD was defined by ICD-10 codes J40-J44 and J47 based either on the UCOD or on any mention of COPD in death certificates (MCOD). Annual age-standardized COPD death rates were computed for 40-85 year-old subjects.Results: COPD was mentioned in 7.9% (and selected as the UCOD in 2.7%) of death certificates. In about half of these, COPD was mentioned in Part II only. After circulatory and neoplastic diseases, the most frequent chronic diseases reported in certificates with any mention of COPD were diabetes (15.2%) and dementia/Alzheimer (8.9%). Between 2008 and 2012, age-standardized death rates (/100,000/year) decreased from 39.8 to 34.0 in males and from 12.7 to 11.3 in females in the UCOD analyses. These trends were confirmed, although figures were three times greater, in the MCOD analyses.Conclusions: MCOD analysis should be adopted to fully evaluate the burden of COPD-related mortality. Our findings support a decreasing trend in COPD-related mortality in northeastern Italy between 2008 and 2012, in line with other recent studies in Europe and beyond
The coexistence of asthma and COPD: some considerations about prevalence and lung function decline
No full textNo abstract availabl
Scultura altomedievale a Maniago (Pordenone): riflessioni su alcune opere di epoca longobarda
No full textIl saggio considera le scultura altomedievali conservate a Maniago, in provincia di Pordenone.The essay discusses the early medieval sculptures preserved in Maniago, in the Pordenone district
Mortality Associated with Idiopathic Pulmonary Fibrosis in Northeastern Italy, 2008-2020: A Multiple Cause of Death Analysis
No full textMortality from idiopathic pulmonary fibrosis (IPF) is increasing in most European countries, but there are no data for Italy. We analysed the registry data from a region in northeastern Italy to assess the trends in IPF-related mortality during 2008-2019, to compare results of underlying vs. multiple cause of death analyses, and to describe the impact of the COVID-19 epidemic in 2020. We identified IPF (ICD-10 code J84.1) among the causes of death registered in 557,932 certificates in the Veneto region. We assessed time trends in annual age-standardized mortality rates by gender and age (40-74, 75-84, and ≥85 years). IPF was the underlying cause of 1310 deaths in the 2251 certificates mentioning IPF. For all age groups combined, the age-standardized mortality rate from IPF identified as the underlying cause of death was close to the European median (males and females: 3.1 and 1.3 per 100,000/year, respectively). During 2008-2019, mortality rates increased in men aged ≥85 years (annual percent change of 6.5%, 95% CI: 2.0, 11.2%), but not among women or for the younger age groups. A 72% excess of IPF-related deaths was registered in March-April 2020 (mortality ratio 1.72, 95% CI: 1.29, 2.24). IPF mortality was increasing among older men in northeastern Italy. The burden of IPF was heavier than assessed by routine statistics, since less than two out of three IPF-related deaths were directly attributed to this condition. COVID-19 was accompanied by a remarkable increase in IPF-related mortality
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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