ObjectiveTo investigate the association between Saharan dust outbreaks and natural, cardiovascular and respiratory mortality.MethodsA case–crossover design was adopted to assess the effects of ...Saharan dust days (SDD) on mortality in the Emilia-Romagna region of Italy. The population under study consisted of residents in the six main towns of the central-western part of the region who died between August 2002 and December 2006. The association of Saharan dust outbreaks and PM10 concentration with mortality was estimated using conditional logistic regression, adjusted for apparent temperature, holidays, summer population decrease, flu epidemic weeks and heat wave days. The role of the interaction term between PM10 and SDD was analysed to test for effect modification induced by SDD on the PM10-mortality concentration–response function. Separate estimates were undertaken for hot and cold seasons.ResultsWe found some evidence of increased respiratory mortality for people aged 75 or older on SDD. Respiratory mortality increased by 22.0% (95% CI 4.0% to 43.1%) on the SDD in the whole year model and by 33.9% (8.4% to 65.4%) in the hot season model. Effects substantially attenuated for natural and cardiovascular mortality with ORs of 1.042 (95% CI 0.992 to 1.095) and 1.043 (95% CI 0.969 to 1.122), respectively.ConclusionsOur findings suggest an association between respiratory mortality in the elderly and Saharan dust outbreaks. We found no evidence of an effect modification of dust events on the concentration–response relationship between PM10 and daily deaths. Further work should be carried out to clarify the mechanism of action.
Five comedies Goldoni, Carlo; De Michelis, Cesare
Five comedies,
2016, 20160407, 2017, 2016, 2016-01-01, 2016-05-09
eBook
Five Comedies collects a selection of Goldoni's finest plays, annotated and translated into English: The New House, The Coffee House, and "The Holiday Trilogy" (Off to the Country, Adventures in the ...Country, and Back from the Country.
To assess the impact of ambient temperature on faecal immunochemical test (FIT) performance in the colorectal cancer screening programme of Emilia-Romagna (Italy).
A population-based retrospective ...cohort study on data from 2005 to 2011. Positive rate, detection rate, and positive predictive value rate for cancers and adenomas, and incidence rate of interval cancers after negative tests were analysed using Poisson regression models. In addition to ambient temperature, gender, age, screening history, and Local Health Unit were also considered.
In 1,521,819 tests analysed, the probability of a positive result decreased linearly with increasing temperature. Point estimates and 95% Confidence Intervals were estimated for six temperature classes (<5, 5 |-10, 10 |-15, 15 |-20, 20|-25 and ≥25℃), and referred to the 5|-10℃ class. The positive rate ratio was significantly related to temperature increase: 0.99 (0.97-1.02), 1, 0.98 (0.96-1.00), 0.96 (0.94-0.99), 0.93 (0.91-0.96), 0.92 (0.89-0.95). A linear trend was also evident for advanced adenoma detection rate ratio: 1.00 (0.96-1.04), 1, 0.98 (0.93-1.02), 0.96 (0.92-1.00), 0.92 (0.88-0.96), 0.94 (0.88-1.01). The effect was less linear, but still important, for cancer detection rates: 0.95 (0.85-1.06), 1, 1.00 (0.90-1.10), 0.94 (0.85-1.05), 0.81 (0.72-0.92), 0.93 (0.80-1.09). No association or linear trend was found for positive predictive values or risk of interval cancer, despite an excess of +16% in the highest temperature class for interval cancer.
Ambient temperatures can affect screening performance. Continued monitoring is needed to verify the effect of introducing FIT tubes with a new buffer, which should guarantee a higher stability of haemoglobin.
As part of the authorization process for the solid waste incinerator (SWI) in Modena, Italy, a human biomonitoring cross-sectional pilot study was conducted to investigate the degree to which people ...living and working in the proximity of the plant were exposed to SWI emissions.
Between May and June 2010, 65 subjects living and working within 4km of the incinerator (exposed) and 103 subjects living and working outside this area (unexposed) were enrolled in the study. Blood, serum and urinary metals (Pb, Cd, Cu, Zn, Hg, Mn, Ni), urinary benzene, toluene, xylene (BTEX), S-phenylmercapturic acid (SPMA), and urinary polycyclic aromatic hydrocarbons (PAHs) were analysed. Information about lifestyle, anthropometric characteristics, residence, and health status was collected by a self-administered questionnaire. Exposure to particulate matter (PM) emitted from the SWI was estimated using fall-out maps from a quasi-Gaussian dispersion model. A multiple linear regression analysis investigated the relationship between biomarkers and the distance of a subject's place of residence from the SWI plant or the exposure to PM.
Urinary BTEX and SPMA and blood, serum and urinary metals showed no differences between exposed and unexposed subjects. PAHs were higher in exposed than in unexposed subjects for phenanthrene, anthracene, and pyrene (median levels: 9.5 vs. 7.2ng/L, 0.8 vs. <0.5ng/L and 1.6 vs. 1.3ng/L, respectively, p<0.05). Multiple linear regression analysis showed that blood Cd and Hg and urinary Mn, fluorene, phenanthrene, anthracene and pyrene were inversely correlated to the distance of a subject's residence from the SWI. Urinary Mn, fluorene and phenanthrene were directly correlated to PM exposure.
This study, although not representative of the general population, suggests that specific biomarkers may provide information about the degree of exposure the subjects working and living in the proximity of the SWI plant may have to emissions from that facility.
•A human biomonitoring pilot study evaluated exposure to solid waste incinerator fumes.•Some polycyclic aromatic hydrocarbons (PAHs) were higher in exposed subject’s urine.•Some metals and PAHs were inversely correlated to the distance of a subject’s residence.•Urinary Mn and some PAHs were directly correlated to particulate matter exposure.•A larger study is on-going to confirm these preliminary results.
The aims of this study were (1) to explore the behavioral and sociodemographic factors influencing urinary cotinine (COT-U) levels in active smokers and in environmental tobacco smoke (ETS)-exposed ...individuals, (2) to assess the specificity and sensitivity of the questionnaire for identifying active smokers and nonsmokers, and (3) to derive the upper reference value of COT-U in non-ETS exposed individuals. The COT-U levels of 495 adults (age range 18–69 years) who classified themselves as active smokers (29%) or as nonsmokers with (17%) or without (83%) ETS exposure were quantified by LC-MS-MS (quantification limit: 0.1µg/L, range of linearity: 0.1–4000µg/L). Median COT-U levels in these groups were 883, 1.38, and 0.39µg/L, respectively. Significant determinants of COT-U levels in active smokers were the number of cigarettes per day, type of smoking product, smoking environment, as well as time between the last cigarette and urine collection. Among ETS-exposed nonsmokers, significant determinants were living with smokers, being exposed to smoke at home, ETS exposure duration, as well as time between the last exposure and urine collection. When a 30-µg/L COT-U cut-off value was used to identify active daily smoking, the sensitivity and specificity of the questionnaire were 94% and 98%, respectively. For ETS exposure, the COT-U value of 1.78 (0.90 confidence interval 1.75–1.78) µg/L, corresponding to the 95th percentiles of the COT-U distribution in non-ETS-exposed participants, is proposed as upper reference value to identify environmental exposure.
•A cut-off of COT-U 30µg/L is useful to correctly identify active daily smokers.•Questionnaire is an appropriate tool in large population surveys to identify active smokers.•The COT-U value of 1.78µg/L is proposed as upper reference value for ETS exposure.
- Générique /
- Il mondo della luna : acte I / Joseph Haydn, compositeur; Carlo Goldoni, livret; Tito Ceccherini, direction; Orchestre du Conservatoire de Paris; Elèves du Département des disciplines ...vocales du Conservatoire de Paris; Edwin Fardini (Buonafede); Riccardo Romeo (Ecclitico); Lise Nougier (Ernesto); Mariamielle Lamagat (Clarice); Makeda Monnet (Flaminia); Brenda Poupard (Lisetta); Kaëlig Boché (Cecco); Thibault Dhilly, Noé Rollet, Basil Belmudes, choeur
- Il mondo della luna : acte II / Joseph Haydn, compositeur; Carlo Goldoni, livret; Tito Ceccherini, direction; Orchestre du Conservatoire de Paris; Elèves du Département des disciplines vocales du Conservatoire de Paris; Edwin Fardini (Buonafede); Riccardo Romeo (Ecclitico); Lise Nougier (Ernesto); Mariamielle Lamagat (Clarice); Makeda Monnet (Flaminia); Brenda Poupard (Lisetta); Kaëlig Boché (Cecco); Thibault Dhilly, Noé Rollet, Basil Belmudes, choeur
- Il mondo della luna : acte III / Joseph Haydn, compositeur; Carlo Goldoni, livret; Tito Ceccherini, direction; Orchestre du Conservatoire de Paris; Elèves du Département des disciplines vocales du Conservatoire de Paris; Edwin Fardini (Buonafede); Riccardo Romeo (Ecclitico); Lise Nougier (Ernesto); Mariamielle Lamagat (Clarice); Makeda Monnet (Flaminia); Brenda Poupard (Lisetta); Kaëlig Boché (Cecco); Thibault Dhilly, Noé Rollet, Basil Belmudes, choeur
Identifying a single disease as the underlying cause of death (UCOD) is an oversimplification of the clinical-pathological process leading to death. The multiple causes of death (MCOD) approach ...examines any mention of a disease in death certificates. Taking diabetes as an example, the study investigates: patterns of death certification, differences in mortality figures based on the UCOD and on MCOD, factors associated to the mention of diabetes in death certificates, and potential of MCOD in the analysis of the association between chronic diseases.
The whole mortality archive of the Veneto Region-Italy was extracted from 2008 to 2010. Mortality rates and proportional mortality were computed for diabetes as the UCOD and as MCOD. The position of the death certificate where diabetes was mentioned was analyzed. Conditional logistic regression was applied with chronic liver diseases (CLD) as the outcome and diabetes as the exposure variable. A subset of 19,605 death certificates of known diabetic patients (identified from the archive of exemptions from medical charges) was analyzed, with mention of diabetes as the outcome and characteristics of subjects as well as other diseases reported in the certificate as predictors.
In the whole mortality archive, diabetes was mentioned in 12.3 % of death certificates, and selected as the UCOD in 2.9 %. The death rate for diabetes as the UCOD was 26.8 × 10(5) against 112.6 × 10(5) for MCOD; the UCOD/MCOD ratio was higher in males. The major inconsistencies of certification were entering multiple diseases per line and reporting diabetes as a consequence of circulatory diseases. At logistic regression the mention of diabetes was associated with the mention of CLD (mainly non-alcohol non-viral CLD). In the subset of known diabetic subjects, diabetes was reported in 52.1 %, and selected as the UCOD in 13.4 %. The probability of reporting diabetes was higher with coexisting circulatory diseases and renal failure and with long duration of diabetes, whereas it was lower in the presence of a neoplasm.
The use of MCOD makes the analysis of mortality data more complex, but conveys more information than usual UCOD analyses.
Abstract
Background
Changes in smoking habits and predictors of smoking cessation were examined in the randomized ITALUNG lung cancer screening trial.
Methods
In three centers, eligible smokers or ...ex-smokers (55–69 years, ≥20 pack-years in the last 10 years) were randomized to receive annual invitation for low-dose computed tomography for 4 years or usual care. At invitation, subjects received written information for a free smoking cessation program. Quitting outcome was assessed at year 4.
Results
Among participants who completed baseline assessments and year 4 screening, higher quitting (20.8% vs. 16.7%, p = .029) and lower relapse (6.41% vs. 7.56%, p = .50) rates were observed in the active screening group as compared to the usual-care control group. Corresponding figures in the intention-to-treat analysis were as follows: 16.04% versus 14.64% (p = .059) and 4.88% versus 6.43% (p = .26). Quitting smoking was significantly associated to male gender, lower pack-years, and having pulmonary nodules at baseline. Center-specific analyses showed a threefold statistically significant higher probability to quit associated with participating in the smoking cessation program. A subsample of smokers of the scan group from one center showed higher quitting rates over 12-month follow-up as compared to matched controls from the general population who underwent the same smoking cessation program.
Conclusions
Consistently with previous reports, in the ITALUNG trial, screened subjects showed significantly higher quit rates than controls, and higher quit rates were associated with both the presence of pulmonary nodules and participating in a smoking cessation program. Maximal effect on quitting outcome was observed with the participation in the smoking cessation program.
Implications
Participating in lung cancer screening promotes smoking cessation. An effective “teachable moment” may be achieved when the smoking cessation intervention is structured as integral part of the screening clinical visits and conducted by a dedicated team of health care professionals. Standardized guidelines for smoking cessation interventions in lung cancer screening are needed.
The impact of the organised cervical cancer (CC) screening programmes implemented in Europe since the 1990s has been insufficiently evaluated. We investigated the changes in CC incidence following ...the introduction of a screening programme in the Emilia‐Romagna Region (northern Italy). The study period was 1988–2013. The programme, targeting women aged 25–64 years (1,219,000 in 2018), started in 1998. The annual incidence rates that would be expected in 1998–2013 in the absence of screening were estimated, first, by analysing the annual rates in 1988–1997 with a log‐linear model and, second, by analysing the annual rates in 1988–2013 with an age‐period model in which the period effect was enforced to be linear. Cervical adenocarcinoma incidence trend over the entire period was used to validate both estimates. Observed annual rates were compared to the two series of expected ones with the incidence rate ratio (IRR). Incidence remained stable during 1988–1997, peaked in 1998 and then decreased until 2007, when it stabilised. The two series of expected rates were virtually coincident and their trends roughly paralleled the stable adenocarcinoma incidence trend. After 2007, the median IRR was 0.60 (95% confidence interval, 0.45–0.81) based on the log‐linear model and 0.58 (95% confidence interval, 0.34–0.97) based on the age‐period model. Thirty‐six to seventy‐five CC cases were prevented annually for an average annual frequency of 6.5 per 100,000 women in the target population. In summary, consistent circumstantial evidences were obtained that the organised screening programme brought about a 40% reduction in annual CC incidence after 10 years.
What's new?
Evaluations of organized screening programmes for cervical cancer (CC) in Europe remain inadequate. Here the authors report a 40% decrease in annual CC incidence following the introduction of a regional screening programme in 1998. Annual CC incidence rates expected in the absence of screening were robustly determined by two different methods. The programme is now transitioning to screening for human papillomavirus infection.
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