Estimating dementia cases amongst migrants living in Europe.

BACKGROUND AND PURPOSE: The phenomenon of dementia amongst migrants and ethnic minorities represents an emerging concern for European healthcare systems, posing additional challenges in terms of clinical approach, access to care and resource utilization. The aim of the present study was to estimate the cases of dementia amongst immigrant older subjects living in Europe and in each European country. METHODS: The estimated cases of dementia amongst older (i.e. 65+) migrants living in the European Union (EU-28) and European Free Trade Association member states were calculated by multiplying the number of migrants (obtained through the data provided by Eurostat) with the age- and sex-specific prevalence rates (derived by a recent meta-analysis). RESULTS: Overall, 6 507 360 older migrants lived in Europe in 2017. In addition, 1 204 671 migrants were registered in Germany in 2010. Nearly 475 000 dementia cases (329 028 women, 147 410 men) were estimated in this population by applying age- and sex-specific prevalence rates. When considering each European country, the number of estimated cases ranged from 108 (Iceland) to 119 161 (France). In parallel, the proportion of dementia cases occurring in migrants ranged from 0.9% (Czech Republic) to 51.2% (Liechtenstein). CONCLUSIONS: The issue of dementia in migrants and ethnic minorities is emerging but already relevant for European healthcare systems. The magnitude of this phenomenon and its complexities reinforce the need for coordinated initiatives both at a national and continental level. These epidemiological data should ideally be integrated with those coming from 'real world' services in order to better calibrate these actions.

Mortality among problem drug users in Rome: an 18-year follow-up study, 1980-97.

AIM: To analyse overall and cause-specific mortality among problem drug users (PDUs) attending treatment centres in Rome and to evaluate differences in mortality between genders. METHODS: A cohort of 11 432 PDUs entering treatment in Rome between 1980 and 1995 was enrolled and followed-up as of May 31, 1997. Directly standardized mortality rates and standardized mortality ratios (SMRs) and their 95% confidence intervals (95% CI) were calculated. RESULTS: The study population included mainly males (82%), heroin users (92%) and had a mean age of 26.6 (SD 5.9) at enrollment. At the end of the study period 1734 deaths were observed. Overall mortality rates began to increase in 1985-86 and decreased slightly afterwards. AIDS mortality peaked in 1991-92 (13.2/1000) and fell in the following years. A slight decrease in overdose mortality also occurred after 1989-90. Mortality for causes other than AIDS and overdose remained high and relatively steady for the whole study period. Women showed higher mortality rates for AIDS but lower mortality rates for overdose than males. Overall mortality risk among drug addicts was about 15 times higher compared to the general population of the same age among men, and 38 times higher among women. CONCLUSIONS: AIDS mortality among drug addicts began to decrease earlier than expected; the decrease was particularly significant in the period 1993-94 for both sexes. Afterwards a continuous but slight decrease was observed among males only. Even though overdose mortality has also decreased slightly in recent years, we still observe high mortality levels for both overdose and all other causes. These findings suggest that interventions directed specifically towards the reduction of baseline mortality are still needed.

Retention in treatment of heroin users in Italy: the role of treatment type and of methadone maintenance dosage.

Retention in treatment among 1503 heroin users attending public treatment centres in 1995 was studied. Three different treatments were considered: methadone maintenance, drug-free program and naltrexone. The retention rate after 1 year was 40% for patients in methadone maintenance, 18% in naltrexone and 15% in drug-free program. For patients in maintenance, methadone dosage and clinic policy were the most important factors for retention. Patients taking > or = 60 mg/day and 30-59 mg/day were respectively 70 and 50% more likely to remain in treatment than those receiving a < 30 mg daily dose. Patients in maintenance-oriented clinics were 30% more likely to remain in treatment than those in abstinence-oriented centres.

A persistent rise in mortality among injection drug users in Rome, 1980 through 1992.

OBJECTIVES: The purpose of the study was to analyze overall and cause-specific mortality among injection drug users in Rome. METHODS: A cohort of 4200 injection drug users was enrolled in drug treatment centers from 1980 through 1988 and followed up until December 1992. RESULTS: The age-adjusted mortality rate from all causes increased from 7.8/1000 person-years in 1985/86 to 27.7/1000 in 1991/92. The rise was mainly attributable to acquired immunodeficiency syndrome (AIDS), but mortality from overdose and other causes increased as well. The cumulative risk of death by the age of 40 was 29.3%. CONCLUSIONS: The impact of AIDS deaths appears to be additional to a persistent increase of mortality for all other causes.

[Characteristics and outcome of interventions offered to drug users attending public treatment centers in Lazio, Italy]. / Caratteristiche ed esito dei trattamenti offerti ai tossicodipendenti che si rivolgono ai servizi pubblici del Lazio.

In 1991 the Lazio Region set up a surveillance system which collects individual data on each drug user attending Public Treatment Centres (PTCs). The analysis of surveillance system data allows not only to describe the characteristics of treatments but also to analyse determinants of treatment outcomes. In this study the outcome of treatment was evaluated in 5.646 drug users who attended public centres in 1992. The outcome was defined in two categories: positive (subjects who completed the therapeutic program, were referred to different service or were still in treatment) negative (subjects who refused or dropped out treatment, arrested or dead). Drug users usually receive more than one treatment in one year, 60% of them successfully completed. Methadone treatment shows the highest level of compliance while naltrexone the lowest. The negative outcome is highly associated with sex, type of treatment, length of treatment and outcome of previous treatment. Males are more likely to experience a negative outcome than females. Those offered naltrexone are more likely to refuse and drop out than those offered psychosocial treatment. Long term treatments are more successful than shorter ones. Furthermore, drop out is higher among those who have dropped out in the past. Although this observational study might not permit conclusions on the efficacy of each type of treatment, it allows an evaluation of the selection procedures at the treatment centres. Treatment centres for drug users in Lazio tend to select clients according to standard therapeutic treatment protocols instead of making treatments more accessible to drug users.

Proline-incorporating cells in chronic active liver diseases.

The incorporation of 3H-proline in cells of liver biopsy specimens from patients with chronic active liver diseases has been studied by light and electron microscopic autoradiography. The labeled proline is incorporated by hepatocytes of the external rows of the residual liver lobule, by the cells of the proliferating bile ductule and very actively by the plasma cells localized at the boundary between the inflammatory infiltrate and the liver lobule. These plasma cells, which are often in close contact with the hepatocytes at the edge of the liver lobule, appear to be either negative or positive after the immunohistochemical tests for the k and lambda chains of immunoglobulins. Results are discussed in relation to both the synthesis of collagen and the role of the immunocompetent cells during the process of the piecemeal necrosis.

Ornithine decarboxylase, transglutaminase, diamine oxidase and total diamines and polyamines in maternal liver and kidney throughout rat pregnancy.

Ornithine decarboxylase (ODC; EC 4.1.1.17), transglutaminase (EC 2.3.2.13), diamine oxidase (DAO; EC 1.4.3.6) and total di- and poly-amines were studied in rat liver and kidney cortex throughout pregnancy. In liver, ODC activity exhibited two major peaks (4.5-5 times the control activities) on days 15 and 17. Also putrescine and spermidine increased biphasically (3-4-fold), but no variation in spermine content was observed. Transglutaminase activity showed slight variations only near the end of gestation. In kidney, ODC activity did not fluctuate significantly during pregnancy, whereas both transglutaminase activity and putrescine content showed three major increases, in very early, middle and late pregnancy. No significant variations in spermidine and spermine were observed. In both organs, DAO activity, very low or undetectable until day 10, dramatically increased (10- and 20-fold in kidney and liver respectively) in the second half of pregnancy, reaching maxima on days 16-17 and 19. The results obtained for transglutaminase, ODC and total di- and poly-amines are interpreted on the basis of hyperplastic and hypertrophic events in the liver and kidney respectively. The behaviour of DAO suggests that the enzyme plays an important role in the control of intracellular diamine concentration.

Regenerative activity in acute hepatitis A virus. Autoradiographic study after in vitro incorporation of 3H-thymidine.

The in vitro incorporation of 3H-thymidine by liver tissue obtained using needle biopsy from 14 patients with acute hepatitis A virus (AHAV) in the fully developed and recovery stage of disease was studied by the autoradiographic technique. Marked incorporation in hepatocyte nuclei was observed in the biopsies of patients in the fully developed stage, while incorporation was absent in the recovery stage of the disease. Results show that hepatocyte regeneration begins early in the course of AHAV disease, during which signs of cellular suffering and necrosis are still present.

Topological location of diamine oxidase in the transverse plane of rabbit liver microsomal membranes.

The transverse topology of diamine oxidase within rabbit liver microsomal membranes was studied by examining the proteolytic digestion of sealed or detergent-permeabilized microsomal vesicles. Trypsin and pronase had no effect on diamine oxidase activity in any incubation conditions tested, while nagarse treatment reduced by 60-70% the enzymic activity of intact microsomes; no further loss of activity was observed in the presence of detergent. These results demonstrate that the active site of diamine oxidase faces the cytoplasmic membrane surface, and suggest that it does not possess or expose on either membrane surfaces bonds susceptible to the proteolytic attack by trypsin or pronase. The possible significance and the biological implications of the results are discussed.

Subcellular localization of diamine oxidase in rabbit kidney cortex.

The intracellular localization of diamine oxidase (EC 1.4.3.6) in rabbit kidney cortex was studied. The distribution of diamine oxidase in the subcellular fractions, obtained by modifying the classical method of Wattiaux-De Coninck, S., Rutgeerts, M.T. and Wattiaux, R. (Biochim. Biophys. Acta (1965) 105, 446-459) demonstrated that this activity is concentrated (greater than 60%) in the microsomal fraction. Biochemical and morphological data indicate a 20-30% contamination of this fraction by plasma membrane and brush border fragments. Subfractionation of the microsomes, obtained by centrifuging in a continuous sucrose-Ficoll gradient (d 1.038-1.064) for 75 min, showed that diamine oxidase is concentrated in membrane deriving from the endoplasmic reticulum. In fact the bulk of diamine oxidase activity was recovered in a subfraction of the gradient which was shown both biochemically and morphologically to derive from the endoplasmic reticulum. The possible significance of this result is discussed.