Epidemiologia & Prevenzione最新文献

Objectives: to assess the frequency of total prostate-specific antigen (PSA) testing in the absence of clinical conditions in the Agency for Health Protection of the Metropolitan Area of Milan (ATS Milan), prior to the launch of the Lombardy regional prostate cancer screening programme.

Design: the study included all men aged 30-84 years residing in the ATS Milan area who underwent at least one PSA test during the years 2018-2019 and 2021-2023. The absence of prostate-related clinical conditions was verified using local health records and the cancer registry of the ATS Milan.

Setting and participants: the study used data from administrative and healthcare databases of ATS Milan. Among the 466,616 citizens with at least one PSA tests recorded during the study period, 414,731 had the test presumably conducted for screening purposes.

Main outcome measures: at least one PSA test in the period.

Results: screening tests accounted for approximately 80% of total PSA tests. On average, 35.6% of male residents underwent at least one preventive PSA test, with low uptake among those under 50, 48.9% in those aged 50-69 years, 60.8% among men in their seventies, and 51.8% in the 80-84 age group. The mean number of PSA test per individual over the study period was 2.3. Testing decreased in 2021-2022, but increased again in 2023. A significant and increasing proportion of individuals undergoing PSA testing had three or more comorbidities. Among the 414,731 initial tests, 47.3% had PSA values <1 ng/mL, 35.4% between 1 and 3, 11.0% between 3 and 6 and 6.3% >=6.

Conclusions: the high frequency of testing among the elderly, the frequent repeat testing, and the growing involvement of individuals with multiple comorbidities highlight the need to transition to an organized screening programme capable of balancing benefits and risks.

Background: the association between air pollution and human health has been extensivelyinvestigated in the epidemiological literature. However, evidence in non-urban areasaffected by industrial activities is still limited.

Objectives: to assess the association between daily exposure to PM10 and cause-specific mortality in municipalities affected by emissions from industrial plants during the period 2006-2015.

Design: two-stage time-series design was applied to assess the relationship between lagged PM10 and the outcomes. In the first stage, the association at the municipal level was analyzed with Poisson regression models adjusted for space-time confounders (trend and temperature). In the second stage, a mixed effects metanalysis of municipal estimates was applied to obtain a pooled estimate. Effect modification for individual variables (sex, age) and type of industrial site (chemical, steel, energy, or mining plant) was assessed.

Setting and participants: using the European Pollutant Release and Transfer Register, industrial plants entailing a combustion process were selected. 4x4 km² buffer around the plant was constructed to select the municipalities to be included in the analysis. Daily PM10 was estimated using machine-learning models based on satellite data.

Main outcomes measures: daily counts of natural, cardiovascular, and respiratory deaths.

Results: the average exposure to PM10 was 28.4 μg/m³ (±SD 16.9). During the period under study, 568,804 deaths from natural causes were observed in the 100 municipalities near the 61 industrial sites identified. Percentage risk variations for 10-units increments of lagged 0-1 PM10 were 1.04% (95%CI 0.67;1.41), 1.04% (95%CI -1.21;3.34), and 7.89% (95%CI 0.16;16.23) for natural, cardiovascular, and respiratory mortality, respectively. Higher risk estimates were observed in municipalities near steel plants, especially for respiratory mortality (8.13%; 95%CI -2.85;20.35). No differences were observed in estimates between different age and sex classes.

Conclusions: although not fully able to capture the industrial component of pollution, the results indicate excess risk of mortality in residents of the municipalities under study, especially when considering the presence of steel plants.

Background: the malignant mesothelioma is a neoplasm caused by the exposure to asbestos in a wide majority of cases; however, in a significant number of these cases, it is not possible to highlight it and, as a consequence, a specific category named 'Asbestos Exposure Unknown' was adopted by the 2003 guidelines of the Italian National Mesothelioma Register (ReNaM).

Objectives: to present a new occurrence of asbestos exposure in a case of mesothelioma diagnosed in a nurse who worked in the operating room, for which the exposure was initially classified as 'Unknown'.

Design, setting and participants: case study.

Methods: in-depth studies were carried out on the tasks performed by the nurse. Samples of anti-heat protective gloves, used in the Eighties in operating rooms, were analysed using the Scanning Electron Microscopy (SEM).

Results: pleural mesothelioma was diagnosed at age 56 and caused patient's death at 59 years. It was possible to confirm that the gloves used for the sterilization of surgical instruments during the years and up to 1990 were made of chrysotile asbestos and that they have been the sole sure cause of the nurse's professional exposure, which lasted 4 years. A possible family exposure has been hypothesized in the washing of parents work clothes. The case was re-classified as 'certain professional cause'; the occupational origin of the tumour has not been recognized from the Italian Workers' Compensation Authority (Inail).

Conclusions: this case-report suggests: a. the need to carry out any possible thorough analysis of the circumstances and of the sources of the exposure, every time this exposure is first classified as unknown, according to the ReNaM guidelines; b. to consider at least likely a professional asbestos exposure in case of frequent use of anti-heat protective gloves for surgical instrument sterilization.

Objectives: to investigate the care pathway of dialysis patients in the final stages of life and to identify possible predictors of the interruption of dialysis treatment.

Design: cohort study.

Setting and participants: the study used data from the Regional Dialysis and Transplantation Registry of Lazio Region, along with data from the Lazio Health Information Systems. The study included haemodialysis patients who died between 2009 and 2022, residing of Lazio, and on dialysis for at least 6 months.

Main outcome measures: using descriptive statistical analysis and both unadjusted and adjusted logistic regression models, the interruption of dialysis treatment (defined as suspension for at least 7 days before death), and the possible predictors of this interruption were analysed.

Results: the final cohort included 6,247 patients, of whom 1,009 (16.2%) interrupted dialysis treatment. The main causes of death include cardiac diseases, cachexia, and infections. The average age of the patients was 76.1 years (10.1 standard deviation); 65.2% were male. Multiple regression analysis identified the number of hospitalizations in the year prior to death (OR: 2.34; 95%CI 1.84-2.97), dialysis vintage (OR 0.80; 95%CI 0.66-0.96), and the presence of non-uremic anaemia (OR 1.46; 95%CI 1.06-2.00) as potential predictors of treatment interruption. Finally, a North-South gradient appears to exist by province of residence, with a higher likelihood of the final stages of life recognition in the province of Viterbo and a lower one in the province of Frosinone.

Conclusions: this study represents the first attempt in Italy, based oh health infromation sistems, to explore end-of-life care in haemodialysis patients, revealing insufficient recognition of end-of-life stages, leading to the continuation of dialysis treatment close to death. These data suggest an excessive medicalization of the end of life and a risk of inappropriate treatments. The introduction of advanced care planning documents, improved training for nephrologists, and the creation of multidisciplinary teams with palliative care specialists could improve patients' quality of life and optimize the use of healthcare resources.

Objectives: to investigate pesticide residues in private gardens near crops in the province of Verona (Veneto Region, Northern Italy) and assess potential risks to human and environmental health.

Design: cross-sectional observational study based on a participatory research approach.

Setting and participants: fifty residential gardens located within 40 metres of cultivated fields, selected through community engagement activities.

Main outcome measures: detection frequency, type, and concentration of pesticides in deciduous leaves; assessment of associated toxicological risk levels.

Results: pesticides were found in over 70% of the samples analysed. Folpet-phthalimide was the most frequently detected compound (55.3%). Several hazardous substances were found within distances below those recommended by regional guidelines.

Conclusions: the findings highlight shortcomings in current protection measures against pesticide drift. Participatory environmental monitoring can strengthen prevention strategies and support public health action.

Background: in 2016, based on data 2000-2012, using gender-specific age-cohort models, the number of mesothelioma cases in Lombardy were predicted for the period 2013-2029.

Objectives: to evaluate accuracy forecasts for the years 2013-2024; to examine the characteristics of affected subjects and to calculate incidence rates for the years 2000-2021.

Design: incidence study.

Setting and participants: Lombardy Region (Northern Italy); individuals recorded in the Lombardy Mesothelioma Registry.

Main outcome measures: mesothelioma incidence.

Methods: the number of observed and predicted cases was compared for the years 2013-2024. Moreover, cases observed in 2000-2021 (years in which all registry activities have been completed) were selected from the registry database, their clinical characteristics and asbestos exposure were described, and crude and age-standardized rates (ASR) were calculated by year and Province of residence.

Results: in the years 2013-2024, 3,588 cases were observed in men, 435 more than the predicted value; in women, 1,671 cases were recorded, 90 less than the predicted value. The yearly number of cases was constant in men and slightly declining in women. In the period 2000-2021, 8,437 cases (7,922 pleural mesotheliomas) were recorded and evaluated, 5,568 in men and 2,869 in women. Evidence of occupational exposure was found for about two thirds of men and for one third of women. Most men had been exposed to asbestos in metalworking and metallurgy industries (35.4%) and in the construction sector (33.7%). Most women had been exposed in non-asbestos textile (53.3%) or clothing (13.4%) industries. In both genders, rates decreased for ages below 70 years, were stable for ages 70-74 years, and increased for ages 75+ years. In both genders, the highest rates were recorded in Pavia Province, where an asbestos cement factory had been operating for a long time.

Conclusions: a fair agreement between observed mesothelioma cases and forecasts as of 2024 was found. The peak occurred in 2013, but in the following years there was no indication of decrease of yearly cases in men and only a slight decrease in women. The highest disease burden concerns individuals aged 75 years or more. Data from this paper indicates that in 2025-2029 in Lombardy there still will be between 350 and 400 cases per year.