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Sant'Ambrogio di Torino, Italy

Colais P.,Regional Health Service | Faustini A.,Regional Health Service | Stafoggia M.,Regional Health Service | Berti G.,U.S. Environmental Protection Agency | And 9 more authors.
Epidemiology | Year: 2012

BACKGROUND: Although numerous studies have provided evidence of an association between ambient air pollution and acute cardiac morbidity, little is known regarding susceptibility factors. METHODS: We conducted a time-stratified case-crossover study in 9 Italian cities between 2001 and 2005 to estimate the short-term association between airborne particles with aerodynamic diameter <10 μm (PM10) and cardiac hospital admissions, and to identify susceptible groups. We estimated associations between daily PM10 and all cardiac diseases, acute coronary syndrome, arrhythmias and conduction disorders, and heart failure for 167,895 hospitalized subjects ≥65 years of age. Effect modification was assessed for age, sex, and a priori-defined hospital diagnoses (mainly cardiovascular and respiratory conditions) from the previous 2 years as susceptibility factors. RESULTS: The increased risk of cardiac admissions was 1.0% (95% confidence interval [CI] = 0.7% to 1.4%) per 10 μg/m PM10 at lag 0. The effect was slightly higher for heart failure (lag 0, 1.4% [0.7% to 2.0%]) and acute coronary syndrome (lag 0-1, 1.1% [0.4% to 1.9%]) than for arrhythmias (lag 0, 1.0% [0.2% to 1.8%]). Women were at higher risk of heart failure (2.0% [1.2% to 2.8%]; test for interaction, P = 0.022), whereas men were at higher risk of arrhythmias (1.9% [0.8% to 3.0%]; test for interaction, P = 0.020). Subjects aged 75-84 years were at higher risk of admissions for coronary events (2.6% [1.5% to 3.8%]; test for interaction, P = 0.001). None of the identified chronic conditions was a clear marker of susceptibility. CONCLUSIONS: An important effect of PM10 on hospitalizations for cardiac diseases was found in Italian cities. Sex and older age were susceptibility factors. © 2012 Lippincott Williams & Wilkins, Inc.

Stafoggia M.,Rome E Health Authority | Forastiere F.,Rome E Health Authority | Faustini A.,Rome E Health Authority | Biggeri A.,University of Florence | And 9 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2010

Rationale: Acute effects of ozone on mortality have been extensively documented in clinical and epidemiological research. However, only a few studies have focused on subgroups of the population especially vulnerable to these effects. Objectives: To estimate the association between exposure to ozone and cause-specific mortality, and to evaluate whether individual sociodemographic characteristics or chronic conditions confer greater susceptibility to the adverse effects of ozone. Methods: A case-crossover analysis was conducted in 10 Italian cities. Data on mortality were collected for the period 2001 to 2005 (April - September) for 127,860 deceased subjects. Information was retrieved on cause of death, sociodemographic characteristics, chronic conditions from previous hospital admissions, and location of death. Daily ozone concentrations were collected from background fixed monitors. Measurements and Main Results: We estimated a 1.5% (95% confidence interval [CI], 0.9-2.1) increase in total mortality for a 10 μg/m3 increase in ozone (8-h, lag 0-5). The effect lasted several days for total, cardiac and respiratory mortality (lag 0-5), and it was delayed for cerebrovascular deaths (lag 3-5). In the subgroup analysis, the effect was more pronounced in people older than 85 years of age (3.5%; 95% CI, 2.4-4.6) than in 35- to 64-year-old subjects (0.8%; 95% CI,20.8 to 2.5), in women (2.2%; 95% CI, 1.4-3.1) than in men (0.8%; 95% CI, 20.1 to 1.8), and for out-of-hospital deaths (2.1%; 95% CI, 1.0-3.2), especially among patients with diabetes (5.5%; 95% CI, 1.4-9.8). Conclusions:Agreater vulnerability of elderly people and women was indicated; subjects who died at home and had diabetes emerged as especially affected.

Faustini A.,Regional Health Service of Lazio | Stafoggia M.,Regional Health Service of Lazio | Colais P.,Regional Health Service of Lazio | Berti G.,U.S. Environmental Protection Agency | And 6 more authors.
European Respiratory Journal | Year: 2013

Short-term effects of air pollutants on respiratory mortality and morbidity have been consistently reported but usually studied separately. To more completely assess air pollution effects, we studied hospitalisations for respiratory diseases together with out-of-hospital respiratory deaths. A time-stratified case-crossover study was carried out in six Italian cities from 2001 to 2005. Daily particulate matter (particles with a 50% cut-off aerodynamic diameter of 10 μm (PM10)) and nitrogen dioxide (NO2) associations with hospitalisations for respiratory diseases (n5100 690), chronic obstructive pulmonary disease (COPD) (n538 577), lower respiratory tract infections (LRTI) among COPD patients (n59886) and out-of-hospital respiratory deaths (n55490) were estimated for residents aged o35 years. For an increase of 10 μgm-3 in PM10, we found an immediate 0.59% (lag 01 days) increase in hospitalisations for respiratory diseases and a 0.67% increase for COPD; the 1.91% increase in LRTI hospitalisations lasted longer (lag 03 days) and the 3.95% increase in respiratory mortality lasted 6 days. Effects of NO2 were stronger and lasted longer (lag 05 days). Age, sex and previous ischaemic heart disease acted as effect modifiers for different outcomes. Analysing multiple rather than single respiratory events shows stronger air pollution effects. The temporal relationship between the pollutant increases and hospitalisations or mortality for respiratory diseases differs. Copyright © ERS 2013.

Castle P.E.,U.S. National Cancer Institute | Bulten J.,Radboud University Nijmegen | Confortini M.,Institute for Cancer Study and Prevention ISPO | Klinkhamer P.,Laboratory of Pathology | And 4 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2010

Objective To investigate the rate of unsatisfactory cervical cell samples in liquid-based cytology (LBC) versus conventional cytology (CC) by age. Design Randomised clinical trials. Setting Population-based cervical cancer screening in the Netherlands and Italy. Population Asymptomatic women invited for screening enrolled in two randomised trials: Netherlands ThinPrep® versus conventional cytology (NETHCON; 39 010 CC, 46 064 LBC) and New Technologies in Cervical Cancer Screening (NTCC; 22 771 CC, 22 403 LBC). Methods Comparison of categorical variables using Pearson's chi-square test, logistic regression and trend tests. Main outcome measures Proportion of unsatisfactory samples, ratio of LBC versus CC, and variation by 5-year group. Results In NETHCON, a lower percentage of LBC samples were judged to be unsatisfactory compared with CC samples (0.33 versus 1.11%). There was no significant trend in unsatisfactory results by age group for conventional cytology (Ptrend = 0.54), but there was a trend towards an increasing percentage of unsatisfactory results with increasing age for LBC (Ptrend < 0.001). In NTCC, a lower percentage of LBC samples were judged to be unsatisfactory compared with conventional cytology (2.59 versus 4.10%). There was a decrease in the unsatisfactory results by age group with conventional cytology (P trend < 0.001) and with LBC (Ptrend = 0.01), although the latter trend arose from the 55-60-years age group (Ptrend = 0.62 when excluding this group). Conclusions The clinical trial in which the results were collected and the cytologic method used were the most important determinants of unsatisfactory cytology. In all situations, the proportion of unsatisfactory samples was lower in LBC compared with CC. The effects of age depended on the criteria used to define unsatisfactory results. © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.

Ronco G.,Center for Cancer Prevention | Meijer C.J.L.M.,VU University Amsterdam
Current Cancer Therapy Reviews | Year: 2010

Cervical screening based on testing for the DNA of high-risk HPV types as primary screening test detects the precursors of cervical cancers earlier than cytology. This allows longer screening intervals and results in increased effec- tiveness in preventing invasive cervical cancers. Data suggest that protection is similar irrespective whether sole HPV testing or HPV in conjunction with cytology are applied as primary tests. In addition, protection seems similar when di- rectly referring all HPV positive women to colposcopy and when referring only women with abnormal cytology or persis- tent infection (cytological triage). On the other hand, using both tests for primary screening, and especially directly refer- ring to colposcopy all HPV positive women, results in a strong increase of unneeded colposcopies. Therefore stand-alone HPV testing as primary test, at prolonged intervals, with cytological triage is recommendable. With this approach the positive predictive value of colposcopy is similar to that obtained with cytological screening. In younger women HPV based screening could result in large overdiagnosis of regressive lesions and should therefore be avoided. Other triage methods, based on simple HPV test repeat, viral load, p16-INK4A overexpression and testing for the HPV E6/E7 mRNA are under study. Self sampling for HPV is sensitive and specific. Among non-responders to routine screening it obtained higher compliance than regular re-invitation and allowed a relevant yield of CIN2+. 2010 Bentham Science Publishers Ltd.

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