1,721,360 research outputs found
Effects of Italian smoking regulation on rates of hospital admission for acute coronary events: a country-wide study.
Full text linkBACKGROUND: Several studies have reported a reduction in acute coronary events (ACEs) in the general population after the enforcement of smoking regulations, although there is uncertainty concerning the magnitude of the effect of such interventions. We conducted a country-wide evaluation of the health effects of the introduction of a smoking ban in public places, using data on hospital admissions for ACEs from the Italian population after the implementation of a national smoking regulation in January 2005.
METHODS AND FINDINGS: Rates of admission for ACEs in the 20 Italian regions from January 2002 to November 2006 were analysed using mixed-effect regression models that allowed for long-term trends and seasonality. Standard methods for interrupted time-series were adopted to assess the immediate and gradual effects of the smoking ban. Effect modification by age was investigated, with the assumption that exposure to passive smoking in public places would be greater among young people. In total, 936,519 hospital admissions for ACEs occurred in the Italian population during the study period. A 4% reduction in hospital admissions for ACEs among persons aged less than 70 years was evident after the introduction of the ban (Rate Ratio [RR], 0.96; 95% Confidence Interval [CI], 0.95-0.98). No effect was found among persons aged at least 70 years (RR 1.00; 95% CI 0.99-1.02). Effect modification by age was further suggested by analyses using narrower age categories.
CONCLUSIONS: Smoke-free policies can constitute a simple and inexpensive intervention for the prevention of cardiovascular diseases and thus should be included in prevention programmes
Variation in hospital admission for AMI unlikely to be attributable to smoking legislation: Reply [2]
No full textMonitoring the performance of intensive care units using the variable life-adjusted display: a simulation study to explore its applicability and efficiency
No full textRATIONALE, AIMS AND OBJECTIVES:
Graphical monitoring tools are needed for real-time quality evaluation in intensive care unit. The variable life-adjusted display (VLAD) provides a directly interpretable assessment indicating whether the overall performance is better or worse than expected on the basis of the predicted risk of failure. The aim of this study is to quantify the ability of VLAD charts to early recognize a worsening in clinical performance.
METHODS:
A Monte Carlo experiment simulating the sequence of successes and failures of an intensive care unit is performed; the predicted mortality is calculated by means of the Simplified Acute Physiology Score 3 admission score. From a given position in the admissions sequence, we increased the probability of death; we calculated: (i) the surveillance system delay in responding to the mortality increase; (ii) the percentage of cases where the VLAD has been able to give an alarm within the first 5, 10, 20 and 60 deaths occurred after the increase of probability of death; and (iii) the percentage of false declarations of increase (anticipated alarms).
RESULTS:
The frequency distribution of the alarm delays shows VLAD was not always able to early detect mortality increase. Only a very small number of anticipated alarms were given.
CONCLUSIONS:
Variable life-adjusted display ability to signal is mild and strictly correlated with the institution volume of activity. Therefore, the use of VLAD seems to be not always advisable, and an integration between VLAD and other well-documented tools as CUSUM charts could be preferable
Latent class models for varying catchability and correlation among sources in Capture-Recapture estimation of the size of a human population
No full textFailing to take into account varying catchability of individuals in capture-recapture models is a cause of correlation among sources. Models have been developed for that random components, mainly in ecological experiments where researchers control the capture-mark-recapture technology. In the epidemiological studies the probelm is more complex, as individuals are heterogeneous and the researcher does not control the capture mechanism. After a brief review of the methodology underlying capture-recapture experiments, we focus on the problem underlying epidemiological studies. We propose a class of models that take into account both heterogeneity of individuals and correlations among sources, when no covariates are available. We apply it to the estimation of diabetes in a town of Northern Italy
Computing hospitalization rates in presence of repeated events: impact and countermeasures to avoid misinterpretation
No full textRATIONALE, AIMS AND OBJECTIVES:
The admission rate, including both first and recurrent events, is a clear overall measure of hospital utilization, its variability accounting for individual propensity to disease recurrence.
METHOD:
In this paper, we compared two variance estimators derived from the Poisson and negative binomial distribution of directly and indirectly age/gender-standardized hospitalization rates allowing for multiple events. The latter approach accommodates departures from the assumption of randomness of repeated events required by the Poisson distribution. We apply these methods to a retrospective cohort based on hospital discharge data in 2001 of Piedmont (north-western Italy) residents.
RESULTS:
Estimated standard errors under the negative binomial for both directly and indirectly standardized rates result in almost twice those under the Poisson distribution.
CONCLUSION:
Our analysis confirms that ignoring the typical non-random nature of repeated events underestimates the true variance of rates and can lead to biased optimistic interpretation of study results
Cardiovascular benefits of smoking regulations: The effect of decreased exposure to passive smoking.
No full textOBJECTIVES:Decreases in population rates of acute myocardial infarction (AMI) have been repeatedly seen in the first months after the introduction of regulations banning smoking in public places. By decreasing the exposure to passive smoking and its acute cardiovascular effects, smoking regulations may cause an immediate drop in AMI incidence, beginning from the initial days after their introduction. Using simulations, we quantified this expected decrease.
METHODS:Expected AMI decreases were estimated using several parameters, including prevalence of exposure to passive and active smoking, relative risks of AMI associated with active and passive smoking, decrease in exposure to passive smoking after the introduction of the regulation, and level of susceptibility of active smokers to exposure to passive smoking.
RESULTS:After evaluating several possible combinations of these parameters, we found that AMI reductions of 5-15% seem likely. For example, a scenario with a population average of 5 hours per week of overall exposure to passive smoking, a 50% reduction in this exposure after the introduction of the regulation, an acute relative risk (RR) of AMI of 4.5 in the first hour after passive smoking exposure, and similar susceptibility to passive smoking among both active and passive smokers translates into a 8.6% decrease in AMI.
CONCLUSIONS:Smoking regulations can cause immediate and relevant decreases in AMI through the prevention of exposure to passive smoking
Assenza di associazione tra partite di calcio e rischio cardiovascolare nella popolazione
No full textIntroduzione: il ruolo di possibili eventi precipitanti (triggers) nella manifestazione di patologie cardiovascolari è stato oggetto di diversi studi, che hanno riportato un’associazione tra eventi cardiovascolari e diverse condizioni di stress sia a livello individuale (attacchi di rabbia, esercizio fisico intenso, assunzione di stupefacenti) che a livello collettivo (esperienza di catastrofi come terremoti o scenari di guerra)(1-3). Tali osservazioni hanno spinto alcuni autori a indagare se anche eventi sportivi di grande rilevanza potessero provocare uno stress emotivo nei telespettatori così intenso da aumentare il rischio di eventi cardiovascolari. Un recente studio di Wilpert-Lampen e collaboratori, pubblicato sul New England Journal of Medicine (4), riporta un aumento dei ricoveri per eventi cardiovascolari di 2.7 volte in Baviera, durante i giorni nei quali venivano disputate partite del campionato del mondo di calcio che coinvolgevano la nazionale tedesca. Un aumento di rischio di tale entità, se confermato, potrebbe avere importanti ricadute di sanità pubblica.
Obbiettivi: Valutare l’andamento dei ricoveri per infarto miocardio acuto (IMA) in Italia nel corso di tre competizioni calcistiche internazionali e condurre una revisione sistematica della letteratura su questo argomento per vagliare l’evidenza disponibile.
Metodi: Abbiamo analizzato 25159 ricoveri ospedalieri per IMA (ICD9: 410) avvenuti nella popolazione italiana durante i campionati del mondo di calcio 2002 e 2006, ed i campionati Europei 2004. Per ognuna delle tre competizioni i ricoveri per IMA durante i giorni nei quali la nazionale italiana ha disputato degli incontri sono stati confrontati con quelli durante gli altri giorni. Abbiamo utilizzato modelli di regressione binomiale negativa che includevano le variabili sesso, giorno della settimana, torneo. Poiché il confronto viene fatto tra i giorni di una stessa competizione, abbiamo considerato le stime implicitamente aggiustate per trend di lungo periodo e stagionalità. La revisione sistematica è stata condotta cercando in Pubmed tutte le pubblicazioni che avevano come oggetto l’associazione tra competizioni calcistiche e patologie cardiovascolari.
Risultati: In nessuna delle tre competizioni è stato osservato un aumento dei ricoveri per IMA (Campionati del mondo 2002: RR 1.05, Intervallo di confidenza al 95% [IC 95%] 0.99-1.12; Europei 2004: RR 0.98, IC 95% 0.91-1.06; Campionati del mondo 2006: RR 1.00, IC 95% 0.95-1.05; Stima complessiva: RR 1.02, IC 95% 0.98-1.05). La revisione sistematica della letteratura ci ha permesso di individuare dieci studi. Le differenze negli outcome presi in considerazione dai diversi autori ci hanno spinto a non produrre una stima metanalitica complessiva. E’ comunque possibile notare in figura 1 come, con l’esclusione dello studio di Wilpert-Lampen, le altre stime siano disperse attorno al valore nullo, e che le due stime estreme corrispondano agli studi con minor potenza statistica.
Conclusioni: Lo studio di Wilpert-Lampen sembra essere un outlier ed i suoi risultati andrebbero considerati con cautela. I risultati del nostro studio e della revisione della letteratura non supportano l’ipotesi che la trasmissione televisiva di importanti eventi sportivi possa causare un aumento del rischio cardiovascolare nella popolazione.
Bibliografia
1. Tofler GH, Muller JE. Triggering of acute cardiovascular disease and potential preventive strategies. Circulation 2006 Oct 24;114(17): 1863-72.
2. Bergovec M, Mihatov S, Prpic H, Rogan S, Batarelo V, Sjerobabski V. Acute myocardial infarction among civilians in Zagreb city area. Lancet 1992 Feb 1;339(8788): 303.
3. Leor J, Kloner RA. The Northridge earthquake as a trigger for acute myocardial infarction. Am J Cardiol 1996 Jun 1;77(14): 1230-2.
4. Wilbert-Lampen U, Leistner D, Greven S, et al. Cardiovascular events during World Cup soccer. N Engl J Med 2008 Jan 31;358(5): 475-83
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