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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.

Chiusolo M.,U.S. Environmental Protection Agency | Cadum E.,U.S. Environmental Protection Agency | Stafoggia M.,Rome E Local Health Authority | Galassi C.,Cancer Epidemiology Unit | And 11 more authors.
Environmental Health Perspectives | Year: 2011

Background: Several studies have shown an association between nitrogen dioxide (NO 2) and mortality. In Italy, the EpiAir multicentric study, "Air Pollution and Health: Epidemiological Surveillance and Primary Prevention," investigated short-term health effects of air pollution, including NO 2. Objectives: To study the individual susceptibility, we evaluated the association between NO 2 and cause-specific mortality, investigating individual sociodemographic features and chronic/acute medical conditions as potential effect modifiers. Methods: We considered 276,205 natural deaths of persons > 35 years of age, resident in 10 Italian cities, and deceased between 2001 and 2005. We chose a time-stratified case-crossover analysis to evaluate the short-term effects of NO 2 on natural, cardiac, cerebrovascular, and respiratory mortality. For each subject, we collected information on sociodemographic features and hospital admissions in the previous 2 years. Fixed monitors provided daily concentrations of NO 2, particulate matter ≤ 10 μm in aerodynamic diameter (PM 10) and ozone (O 3). Results: We found statistically significant associations with a 10-μg/m 3 increase of NO 2 for natural mortality [2.09% for lag 0-5; 95% confidence interval (CI), 0.96-3.24], for cardiac mortality (2.63% for lag 0-5; 95% CI, 1.53-3.75), and for respiratory mortality (3.48% for lag 1-5; 95% CI, 0.75-6.29). These associations were independent from those of PM 10 and O 3. Stronger associations were estimated for subjects with at least one hospital admission in the 2 previous years and for subjects with three or more specific chronic conditions. Some cardiovascular conditions (i.e., ischemic heart disease, pulmonary circulation impairment, heart conduction disorders, heart failure) and diabetes appeared to confer a strong susceptibility to air pollution. Conclusions: Our results suggest significant and likely independent effects of NO 2 on natural, cardiac, and respiratory mortality, particularly among subjects with specific cardiovascular preexisting chronic conditions and diabetes.

Moja L.,University of Milan | Moja L.,IRCCS Galeazzi Orthopedic Institute | Piatti A.,Epidemiological Observatory | Pecoraro V.,University of Milan | And 7 more authors.
PLoS ONE | Year: 2012

Background: To assess the relationship between surgical delay and mortality in elderly patients with hip fracture. Systematic review and meta-analysis of retrospective and prospective studies published from 1948 to 2011. Medline (from 1948), Embase (from 1974) and CINAHL (from 1982), and the Cochrane Library. Odds ratios (OR) and 95% confidence intervals for each study were extracted and pooled with a random effects model. Heterogeneity, publication bias, Bayesian analysis, and meta-regression analyses were done. Criteria for inclusion were retro- and prospective elderly population studies, patients with operated hip fractures, indication of timing of surgery and survival status. Methodology/Principal Findings: There were 35 independent studies, with 191,873 participants and 34,448 deaths. The majority considered a cut-off between 24 and 48 hours. Early hip surgery was associated with a lower risk of death (pooled odds ratio (OR) 0.74, 95% confidence interval (CI) 0.67 to 0.81; P<0.000) and pressure sores (0.48, 95% CI 0.38 to 0.60; P<0.000). Meta-analysis of the adjusted prospective studies gave similar results. The Bayesian probability predicted that about 20% of future studies might find that early surgery is not beneficial for decreasing mortality. None of the confounders (e.g. age, sex, data source, baseline risk, cut-off points, study location, quality and year) explained the differences between studies. Conclusions/Significance: Surgical delay is associated with a significant increase in the risk of death and pressure sores. Conservative timing strategies should be avoided. Orthopaedic surgery services should ensure the majority of patients are operated within one or two days. © 2012 Moja et al.

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.

Faustini A.,Regional Health Service of Lazio | Stafoggia M.,Regional Health Service of Lazio | Berti G.,Regional Environmental Protection Agency of Piedmont | Bisanti L.,Epidemiology Unit | And 8 more authors.
European Respiratory Journal | Year: 2011

The association of air pollutants with natural and respiratory mortality has been consistently reported. However, several aspects of the relationship between particulate matter with a 50% cut-off aerodynamic diameter of 10 μm (PM 10) and respiratory mortality require further investigation. The aim of the present study was to assess the PM 10-respiratory mortality association in Italy and examine potentially susceptible groups. All deaths from natural (n=276,205) and respiratory (n=19,629) causes among subjects aged ≥35 yrs in 10 northern, central and southern Italian cities in 2001-2005 were included in the study. Pollution data for PM 10, nitrogen dioxide and ozone were also obtained. A time-stratified case-crossover analysis was carried out. Different cumulative lags were selected to analyse immediate, delayed, prolonged and best-time effects of air pollution. The shape of the exposure-response curve was analysed. Age, sex, chronic conditions and death site were investigated as potential effect modifiers. We found a 2.29% (95% CI 1.03-3.58%) increase in respiratory mortality at 0-3 days lag. The increase in respiratory mortality was higher in summer (7.57%). The exposure-response curve had a linear shape without any threshold. Sex and chronic diseases modified the relationship between particular matter (PM) and respiratory mortality. The effect of PM on respiratory mortality was stronger and more persistent than that on natural mortality. Females and chronic disease sufferers were more likely to die of a respiratory disease caused by air pollution than males and healthy people. Copyright©ERS 2011.

Sansone V.C.,University of Milan | Sansone V.C.,Instituto Ortopedico Galeazzi IRCCS | Meroni R.,University of Milan Bicocca | Boria P.,Private Practice | And 2 more authors.
Rheumatology International | Year: 2014

Calcifying tendinopathy (CT) of the shoulder is a common painful disorder, although the etiology and pathogenesis remain largely unknown. Recent theories about the role of excessive mechanical load in the genesis of CT have been proposed. Driven by the interest for these new theories, we investigated the hypothesis of a relationship between work-related repetitive movements of the upper arm, considered a potential cause of shoulder overload, and the presence of shoulder CT. A secondary aim was to obtain data on CT prevalence in a female sample from the working-age general population, as little data currently exist. 199 supermarket cashiers and 304 female volunteers recruited from the general population underwent a high-resolution ultrasonography of the rotator cuffs of both shoulders, and the presence of tendinopathies, with or without calcification, was recorded. The prevalence of calcific tendinopathy was 22.6 % in the cashiers group and 24.4 % in the control group. There were no statistically significant differences in the prevalence of calcifications between the two groups (p = 0.585), either for the dominant shoulder [OR = 0.841 (95 % CI 0.534–1.326)] or for the non-dominant shoulder [OR = 0.988 (95 % CI 0.582–1.326)]. We observed bilateral calcifications in 8.5 % of cashiers, and 9.6 % of controls, and an increase in prevalence of CT with age in both groups. Work-related repetitive movements of the upper arm did not induce a higher prevalence of shoulder CT compared with the female sample from the general population. If CT etiopathogenesis is related to mechanical load, CT onset may be influenced not only by loading history, but also by individual factors.Level of evidence Prognosis study, Level II. © 2014, Springer-Verlag Berlin Heidelberg.

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.

Ruggenenti P.,Mario Negri Institute for Pharmacological Research | Porrini E.,Mario Negri Institute for Pharmacological Research | Motterlini N.,Mario Negri Institute for Pharmacological Research | Perna A.,Mario Negri Institute for Pharmacological Research | And 11 more authors.
Journal of the American Society of Nephrology | Year: 2012

Micro- or macroalbuminuria is associated with increased cardiovascular risk factors among patients with type 2 diabetes, but whether albuminuria within the normal range predicts long-term cardiovascular risk is unknown. We evaluated the relationships between albuminuria and cardiovascular events in 1208 hypertensive, normoalbuminuric patients with type 2 diabetes from the BErgamo NEphrologic Diabetes Complication Trial (BENEDICT), all of whom received angiotensin-converting enzyme inhibitor (ACEI) therapy at the end of the trial and were followed for a median of 9.2 years. The main outcome was time to the first of fatal or nonfatal myocardial infarction; stroke; coronary, carotid, or peripheral artery revascularization; or hospitalization for heart failure. Overall, 189 (15.6%) of the patients experienced a main outcome event (2.14 events/100 patient-years); 24 events were fatal. Albuminuria independently predicted events (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02-1.08). Second-degree polynomial multivariable analysis showed a continuous nonlinear relationship between albuminuria and events without thresholds. Considering the entire study population, even albuminuria at 1-2 μg/min was significantly associated with increased risk compared with albuminuria <1 μg/min (HR, 1.04; 95%CI, 1.02-1.07). This relationship was similar in the subgroup originally randomly assigned to non-ACEI therapy. Among those originally receiving ACEI therapy, however, the event rate was uniformly low and was not significantly associated with albuminuria. Taken together, among normoalbuminuric patients with type 2 diabetes, any degree of measurable albuminuria bears significant cardiovascular risk. The association with risk is continuous but is lost with early ACEI therapy. Copyright © 2012 by the American Society of Nephrology.

Mazzucco W.,University of Palermo | Cusimano R.,Provincial Health Agency Palermo | MacAluso M.,Cincinnati Childrens Hospital Medical Center | La Scola C.,University of Palermo | And 6 more authors.
BMC Public Health | Year: 2011

Background: Infant mortality rate (IMR) is a key public health indicator. Maternal age is a well-known determinant of pregnancy and delivery complications and of infant morbidity and mortality. In Italy the Infant Mortality Rate was 3.7/1000 during 2005, lower than the average IMR for the European Union (4.94/1000). Sicily is the Italian region with the highest IMR, 5/1000, and neonatal mortality rate (NMR), 3.8/1000, with substantial variation among its nine districts. The present study compared a high IMR/NMR district (Messina) with a low IMR/NMR district (Palermo) during the period 2004-2006 to evaluate potential determinants of the IMRs' differences between the two districts and specifically the impact of maternal age. Methods. The Death Causes Registers identified all deaths during the first year of life recorded among infants born to residents of the two districts in 2004-2006. For every case, available hospital charts records were abstracted using a standardized form designed to capture information on potential determinants of infant death. For each district and for each year, IMRs and NMRs were computed. Chi-squared statistics tested the significance of differences between district-specific IMRs. A Poisson regression model was used to analyze the relationship between maternal age, district of residence and IMR. Results: The 246 death registry-confirmed cases included 143 (58.1%) males and 103 (41.2%) females, with mean age at death of 33.3 days (SD: 64.5, median: 5.5). The average IMR for 2004-2006 was significantly higher for the Messina district than for the Palermo district (p = 0.0001). The IMR ratio was 1.6 (95%CI: 1.2 - 2.1). The IMRs declined from 2004 to 2006. A significant interaction (p = 0.04) between maternal age and district of residence was documented. Conclusion: The association between advanced maternal age and infant deaths in the Messina district was due in part to the excess of newborns from advanced age mothers, but also to increased risk of death among such newborns. The significant interaction between district of residence and maternal age indicated that the IMR excess in the Messina district cannot be explained by disproportionately high live birth rates among older mothers and suggested the hypothesis that health care facilities in the Messina district could be less well prepared to provide assistance to the excess of high risk pregnancies and deliveries, as compared to Palermo district. © 2011 Mazzucco et al; licensee BioMed Central Ltd.

Pasetto R.,Instituto Superiore Of Sanita | Zona A.,Instituto Superiore Of Sanita | Pirastu R.,University of Rome La Sapienza | Cernigliaro A.,Epidemiological Observatory | And 4 more authors.
Environmental Health: A Global Access Science Source | Year: 2012

Background: The area of Gela was included among the 57 Italian polluted sites of national interest for environmental remediation because of its widespread contamination from a petrochemical complex. The present study investigates mortality and morbidity of the cohort of Gela petrochemical workers with the aim of disentangling occupational from residential risk. Methods: Mortality was assessed for 5,627 men hired from 1960, year of the plant start-up, to 1993; it was followed up for vital status in the period 1960-2002. Morbidity was analysed for 5,431 workers neither dead nor lost to follow-up from 1960 to 2001 and was based on Hospital Discharge Records in the period 2001-2006. The work experience was classified in terms of job categories such as blue collars, white collars, and both - workers who shifted from blue to white collar (95%) or vice versa. An ad hoc mobility model was applied to define qualitative categories of residence in Gela, as residents and commuters. Standardized Mortality Ratios (SMRs) and Mortality Rate Ratios (MRRs) were computed, the latter by using a Poisson regression model. Morbidity was analyzed in terms of Hospital Discharge Odds Ratios (HDORs) through a logistic regression model. While performing the internal comparisons, white collars was the reference category for the job analysis, and commuters was the reference category for the residential analysis. Results: In the light of epidemiological evidence about health risk from petrochemical industries in both occupational and environmental settings, and/or on the basis of information about occupational and residential contamination and health risk in the area of Gela, noteworthy results are shown for lung cancer [MRR: 2.11 (CI 90%; 0.96-4.63) in blue collars; 1.71 (1.09-2.69) in residents], respiratory diseases [HDOR: 2.0 (1.0-3.0) in blue collars; 1.4 (0.96-2.06) in residents] and genitourinary diseases [HDOR: 1.34 (1.06-1.68) in blue collars; 1.23 (1.04-1.45) in residents]. Conclusions: The results support a role of the exposures in the occupational and residential settings, the latter due to the local ascertained contamination, in affecting the workers health. These results underline the urgent need of water, soil, air and food-chain monitoring programs, to discover active sources of exposure and consequently definepublic health interventions. © 2012 Pasetto et al.; licensee BioMed Central Ltd.

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