Sinonasal cancer incidence in Lombardy, Italy, 2008-20.

BACKGROUND: Epithelial sinonasal cancers (SNC) are rare tumours with recognized associations with known/suspected occupational carcinogens (wood/leather dust, nickel/chromium compounds and formaldehyde). In Italy, a national SNC registry organized as a network of regional registries was established by law in 2008. AIMS: To describe SNC time trends, occupational exposures and geographical distribution in Lombardy, North-West Italy, based on population registry data (2008-20). METHODS: The Lombardy SNC Registry records epithelial SNCs using various sources. Interviews to collect occupational history are performed using a standardized questionnaire. Using several standard populations, we calculated yearly crude and age-standardized rates (ASRs per 100,000 person-years). Standardized incidence ratios (SIR) at municipality level were calculated, and Bayesian models were fitted to produce smoothed SIR maps. RESULTS: We recorded 827 cases (553 men, 274 women). Crude (world standardized) ASRs were 0.9 (0.4) in men and 0.4 (0.2) in women, with no time trends. Interviews were obtained for 485 (88%) men and 223 (81%) women. Among men, 217 (45%) had been exposed to occupational carcinogens (wood/leather dust: 150/65 cases, 31%/13%), while only 36 women (16%) were exposed. Among 201 men with adenocarcinoma, exposure to wood/leather dust occurred in 103/50 cases (75%/50%). Areas with elevated SIRs associated with leather dust were found in the Western areas. Exposure to wood dust was more widespread. CONCLUSIONS: This study found a high frequency of occupational exposures (wood and leather dust), particularly in men with SNC. Employment in shoe industries clustered in the Western part, while work in furniture industries was less spatially structured.

Incidence of traumatic spinal cord injury in Italy during 2013-2014: a population-based study.

STUDY DESIGN: Observational prospective population-based incidence study. OBJECTIVES: The main objective of this study was to assess the incidence of traumatic spinal cord injuries (TSCIs) and incidence rates, in order to provide estimates by age, gender, characteristics and cause. SETTING: This study was conducted at acute-care spinal cord injury (SCI) hospitals and SCI centers from 11 Italian regions, between 1 October 2013 and 30 September 2014. METHODS: Data of all consecutive patients with acute TSCI who met the inclusion criteria were obtained through case reporting by clinicians. The data were collected into a web database. Incidence rates and incidence rate ratios were calculated and stratified by age, gender, cause, level and completeness. RESULTS: From 50% of the entire population of Italy, 445 new cases of TSCI were included. The crude incidence rate of TSCI was 14.7 cases per million per year (95% CI: 13.4-16.4); the overall male to female ratio was 4:1 and the mean age was 54. Complete information was available in 85% of the sample and revealed tetraplegia in 58% and incomplete lesion in 67% of cases. The leading cause of TSCI was falls (40.9%) followed by road traffic accidents (33.5%). The leading cause was falls for patients over 55 and road traffic accidents for patients under 55. CONCLUSION: The changing trend of TSCI epidemiology concerns the increase in the average age of TSCI people and the increase of both cervical and incomplete lesions. The etiology shows the primacy of falls over road traffic accidents and suggests the need for a change in prevention policies.

Fine airborne particles: when alarming levels are the standard.

OBJECTIVES: To quantify the contribution of each individual month to the annual mortality burden attributable to particulate matter (PM) in 2015 in Milan, Italy, after authorities and media considered December 2015 as an outlying month carrying an exceptional population exposure to PM. STUDY DESIGN: We used routinely available daily time series of air pollution and mortality to perform an assessment of the impact of PM exposure on population health. METHODS: By combining daily death counts with daily PM levels, as well as the yearly average of the number of deaths with the yearly average of PM concentrations, impact estimates were calculated in terms of deaths attributable (AD) to levels of PM10 and PM2.5 exceeding the daily or the annual European Union (EU) exposure limits. RESULTS: On a monthly basis, the estimated AD for exceeding the daily EU limits for more than 35 days were 18.4 (PM10) and 33.2 (PM2.5) between January and March, and 20.0 and 31.9 between October and December, respectively. On an annual basis, the EU limit for PM10 was almost met and, therefore, the estimated impact in terms of AD was practically null. CONCLUSIONS: Impact results should be interpreted in the light of the skewness of the daily PM concentration distribution. The number of days above the limits is more important than the average annual concentration in determining the number of attributable deaths. The impact of PM on mortality is substantial during the whole winter season irrespective of its annual average concentration. Our estimates further stress the need for a revision of the current European air quality standards.

Daily peer review of abnormal cervical smears in the assessment of individual practice as an additional method of internal quality control.

OBJECTIVE: An important internal quality control system used in the Cancer Prevention and Research Institute cytopathology laboratory in Florence is the peer review procedure, based on the review of all abnormal cytological smears which routinely emerge. Peer review is an important training opportunity for all cytologists, especially for those with less experience. This article shows the results of the peer review procedure. METHODS: Of the 63 754 Papanicolaou (Pap) smears screened in 2011, 1086 were considered to be abnormal [at least atypical squamous cells of undetermined significance (ASC-US+)] on primary screening (selected by a single cytologist) and were subjected to the peer review procedure. The overall performance of the laboratory's cytologists was evaluated using a multiple rater analysis and the comparison of each cytologist with the final diagnosis. Further, the agreement was assessed by means of Cohen's kappa and weighted kappa statistics. RESULTS: In general, a moderate/substantial level of agreement between the ten cytologists and the final diagnoses was evident. Kappa values for each reader compared with the final diagnosis ranged from 0.54 to 0.69. The overall kappa value was 0.62 [95% confidence interval (CI), 0.58-0.66] and overall weighted kappa value was 0.76 (95% CI, 0.74-0.79). The category-specific agreement showed the lowest values for atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). CONCLUSION: In summary, peer review represents an important internal quality control in the evaluation and improvement of inter-observer agreement and of the functioning of the laboratory as a whole. Multi-head microscope sessions may improve particularly the reproducibility of borderline diagnoses and, above all, can be an important training contribution for cytologists.

Use of the parenteral antibiotic Ertapenem as short term prophylaxis in bariatric surgery: a pharmaco-kinetic-pharmacodynamic study in class III obese female patients.

BACKGROUND: The objective of this study was to determine the pharmacokinetics-pharmacodynamics (PK/PD) of Ertapenem in extremely obese female patients (Body Mass Index [BMI] ≥ 40 kg/m²) undergoing bariatric surgery. METHODS: Ten patients received 1 g intravenous Ertapenem 0.5 h prior to surgery as short term prophylaxis. Serum Ertapenem concentrations were determined at baseline, at the end of infusion (30 minutes), then at 1, 2, 4, 8, 12 and 24 hours postinfusion. In patients in whom a liver biopsy was necessitated by clinical need, Ertapenem liver concentrations were determined through intraoperative biopsies at 1 and 2 h postadministration. Peritoneal Ertapenem concentrations were determined in drainage fluid samples collected during the 4-8, 8-12, and 12-24 h intervals after Ertapenem administration. A Monte Carlo simulation was performed to estimate the probability of achieving free drug levels above the minimum inhibitory concentration (fT>MIC) for at least 20% and 40% of the dosing interval as PK/PD targets. RESULTS: Peak drug concentration and 24-h area under the concentration-time curve (AUC) were found to be 191.9 ± 37.4 mg/L and 574.3 ± 110.5 mg·h/L, respectively. Ertapenem liver/serum concentration ratios were 6% at 1 h and 5% at 2 h. Drug concentrations in peritoneal fluid were 28.2 ± 6.4 mg/L at 4-8h, declined to 15.2 ± 5.9 at 8-12h and fell further to 4.79 ± 0.2 mg/L at 12-24 h post-administration. The probability to reach the desired PK/PD targets were never reached at any MICs >0.25 µg/mL with a 90% probability. CONCLUSION: Our data suggest that in extremely obese female patients, the standard dose of 1 g i.v. Ertapenem as short term prophylaxis may not provide optimal clinical levels of free drug for prevention of surgical site infections.

High variability in results of semen analysis in andrology laboratories in Tuscany (Italy): the experience of an external quality control (EQC) programme.

We report the results of the first three trials of an external quality control (EQC) programme performed in 71 laboratories executing semen analysis in Tuscany Region (Italy). At the end of the second trial, participants were invited to attend a teaching course illustrating and inviting to adhere to procedures recommended by WHO (V edition). Results of the first three trials of the EQC documented a huge variability in the procedures and the results. The highest variability was found for morphology (CV above 80% for all the trials), followed by count (CV of about 60% for all the trials) and motility (CV below 30% for all the trials). When results of sperm count and morphology were divided according to the used method, mean CV values did not show significant differences. CV for morphology dropped significantly at the third trial for most methods, indicating the usefulness of the teaching course for morphology assessment. Conversely, no differences were observed after the course for motility and for most methods to evaluate count, although CV values were lower at the second and third trial for the laboratories using the Burker cytometer. When results were divided according to tertiles of activity, the lowest mean bias values (difference between each laboratory result and the median value of the results) for count and morphology were observed for laboratories in the third tertile (performing over 200 semen analysis/year). Of interest, mean bias values for concentration dropped significantly at the third trial for low activity laboratories. In conclusion, lack of agreement of results of semen analysis in Tuscany is mainly because of the activity and the experience of the laboratory. Our study points out the importance of participating in EQC programmes and periodical teaching courses as well as the use of WHO recommended standardized procedures to increase precision and to allow the use of WHO reference values.

Interferon-γ release assays for the diagnosis of Mycobacterium tuberculosis infection in children: a systematic review and meta-analysis.

Data regarding the use of interferon-gamma release assays (IGRAs) for tuberculosis diagnosis are accumulating. We systematically searched PubMed, EMBASE and Cochrane and performed pooled estimates of sensitivity and specificity of QuantiFERON-TB Gold In Tube (QFT-G-IT) and T-SPOT.TB compared to tuberculin skin test (TST). For studies assessing sensitivity, children had to have active tuberculosis. Specificity data were derived from children classified as non-infected. Eleven studies were included in the sensitivity analysis for TST, 10 for QFT-G-IT, and 9 for T-SPOT.TB. Eight studies were included in specificity analysis for TST, 8 for QFT-G-IT, and 7 for T-SPOT.TB. Pooled QFT-G-IT sensitivity was 0.79 (95% CI:0.70-0.89) pooled T-SPOT.TB sensitivity was 0.74 (95% CI:0.59-0.90) and pooled TST sensitivity was 0.82 (95% CI:0.72-0.93). Pooled QFT-G-IT and T-SPOT.TB specificities were 0.95 (95% CI:0.93- 0.97) and 0.96 (95% CI:0.93-1.00), respectively. Pooled TST specificity was significantly lower 0.83 (95% CI:0.74-0.92). IGRA performance in children showed no better sensitivity than TST, but higher specificity.

Interferon-γ release assays for the diagnosis of Mycobacterium tuberculosis infection in children: a literature review.

The role of interferon-gamma release assays (IGRAs) for immunologic diagnosis of tuberculosis in children is under debate. We carried out a narrative review on the studies on IGRAs in paediatric populations. A literature search was conducted using multiple keywords and standardized terminology in Medline, EMBASE and Cochrane databases, up to January 27th, 2011. Study quality was assessed using the MOOSE checklist and results of relevant studies were summarized. Sixty-seven paediatric studies (study population ranging from 14 to 5,244 children) were identified. Non-commercial ELISPOT assay (by means of ESAT-6 and CFP-10 antigens) had been carried out in 11 studies. QuantiFERON-TB Gold (QFT-G), QuantiFERON-TB Gold In-tube (QFT-G-IT), and T-SPOT.TB assays had been performed in 10, 44 and 18 studies, respectively. Most studies reported higher specificity of IGRA than tuberculin skin test (TST), but interpretation of the results is complicated by the fact that a gold standard for the diagnosis of latent TB is lacking. The reported sensitivity for active TB ranged from 51-93 percent for QFT-G/QFT-G-IT and 40-100 percent for ELISPOT assays, suggesting that a negative IGRA result may not exclude tuberculosis. Combining TST and IGRA results increased the diagnostic sensitivity. Rates of indeterminate results largely varied (0 to 35 percent). Most of the studies on young (less than 5 years) or immune-compromised children reported a proportion of indeterminate results exceeding 4 percent. Agreement among TST and IGRA, assessed by the k statistics, ranged from -0.03 to 0.87. Higher rates of discordance were reported in BCG-vaccinated than in non-BCG-vaccinated children. Studies on children less than 5 years and immunocompromised children reported conflicting results, as did studies on serial IGRA determinations. Despite the large amount of literature data, the role of IGRA in the pediatric population is still unclear, especially in young children. Combined use of TST/IGRA may increase diagnostic sensitivity but interpretation of discordant results remains a challenging issue.

Impact of heat on mortality in 15 European cities: attributable deaths under different weather scenarios.

BACKGROUND: High ambient summer temperatures have been shown to influence daily mortality in cities across Europe. Quantification of the population mortality burden attributable to heat is crucial to the development of adaptive approaches. The impact of summer heat on mortality for 15 European cities during the 1990s was evaluated, under hypothetical temperature scenarios warmer and cooler than the mean and under future scenarios derived from the Intergovernmental Panel on Climate Change Special Report on Emission Scenarios (SRES). METHODS: A Monte Carlo approach was used to estimate the number of deaths attributable to heat for each city. These estimates rely on the results of a Bayesian random-effects meta-analysis that combines city-specific heat-mortality functions. RESULTS: The number of heat-attributable deaths per summer ranged from 0 in Dublin to 423 in Paris. The mean attributable fraction of deaths was around 2%. The highest impact was in three Mediterranean cities (Barcelona, Rome and Valencia) and in two continental cities (Paris and Budapest). The largest impact was on persons over 75 years; however, in some cities, important proportions of heat-attributable deaths were also found for younger adults. Heat-attributable deaths markedly increased under warming scenarios. The impact under SRES scenarios was slightly lower or comparable to the impact during the observed hottest year. CONCLUSIONS: Current high summer ambient temperatures have an important impact on European population health. This impact is expected to increase in the future, according to the projected increase of mean ambient temperatures and frequency, intensity and duration of heat waves.

The use of digital images to evaluate the interobserver agreement on cervical smear readings in Italian cervical cancer screening.

OBJECTIVE: The aim of this study was to measure interobserver agreement among cytologists on using a set of digital images. METHODS: A set of 90 selected Papanicolaou-stained cervical smears were digitalized and the digital images circulated among 117 readers, from laboratories spread across almost all Italian regions. Three representative fields of each smear were displayed at 20× and 40× magnification (overall six images for each case). The diagnoses made by the cytologists who provided the images were taken as target diagnoses. RESULTS: The κ values were: very low for the categories atypical squamous cells of undetermined significance (ASC-US), and atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion (ASC-H); poor for the categories atypical glandular cells (AGC), high-grade squamous intraepithelial lesion (HSIL) and invasive cancer; and fair to good for the categories negative and low-grade squamous intraepithelial lesion (LSIL). However, we found a cluster of 42 best concordant readers. The overall κ value and overall weighted κ with the target diagnosis for these 42 readers were 0.45 and 0.66, respectively. This finding is in contrast with the overall κ value and overall weighted κ for the other readers of 0.39 and 0.59, respectively. CONCLUSIONS: As this finding is an estimate of the accuracy of the readers, we can infer that it will be very important to reach this level of concordance for all the participating readers. Future effort will facilitate common experiences in order to improve the reproducibility of diagnostic criteria. Digital images could be the key to reach this aim.

Covariate selection in multivariate spatial analysis of ovine parasitic infection.

Gastrointestinal (GI) strongyle and fluke infections remain one of the main constraints on health and productivity in sheep dairy production. A cross-sectional survey was conducted in 2004-2005 on ovine farms in the Campania region of southern Italy in order to evaluate the prevalence of Haemonchus contortus, Fasciola hepatica, Dicrocoelium dendriticum and Calicophoron daubneyi from among other parasitic infections. In the present work, we focused on the role of the ecological characteristics of the pasture environment while accounting for the underlying long range geographical risk pattern. Bayesian multivariate spatial statistical analysis was used. A systematic grid (10 km×10 km) sampling approach was used. Laboratory procedures were based on the FLOTAC technique to detect and count eggs of helminths. A Geographical Information System (GIS) was constructed by using environmental data layers. Data on each of these layers were then extracted for pasturing areas that were previously digitalized aerial images of the ovine farms. Bayesian multivariate statistical analyses, including improper multivariate conditional autoregressive models, were used to select covariates on a multivariate spatially structured risk surface. Out of the 121 tested farms, 109 were positive for H. contortus, 81 for D. dendriticum, 17 for C. daubneyi and 15 for F. hepatica. The statistical analysis highlighted a north-south long range spatially structured pattern. This geographical pattern is treated here as a confounder, because the main interest was in the causal role of ecological covariates at the level of each pasturing area. A high percentage of pasture and impermeable soil were strong predictors of F. hepatica risk and a high percentage of wood was a strong predictor of C. daubneyi. A high percentage of wood, rocks and arable soil with sparse trees explained the spatial distribution of D. dendriticum. Sparse vegetation, river, mixed soil and permeable soil explained the spatial distribution of the H. contortus. Bayesian multivariate spatial analysis of parasitic infections with covariates from remote sensing at a very small geographical level allowed us to identify relevant risk predictors. All the covariates selected are consistent with the life cycles of the helminths investigated. This research showed the utility of appropriate GIS-driven surveillance systems. Moreover, spatial features can be used to tailor sampling design where the sampling fraction can be a function of remote sensing covariables.

Mortality and cause of death among psychiatric patients: a 20-year case-register study in an area with a community-based system of care.

BACKGROUND: Most mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services. METHOD: All subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population. RESULTS: The overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients [SMR 1.71, 95% confidence interval (CI) 1.6-1.8], and higher still following the first admission (SMR 2.61, 95% CI 2.4-2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95% CI 142.5-328.6) and personality disorders (20.87, 95% CI 5.2-83.4). CONCLUSIONS: This study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals.

The epidemic of lung cancer in Tuscany (Italy): a joint analysis of male and female mortality by birth cohort.

Lung cancer epidemic among males and females was studied at small geographical level in Tuscany Region (Italy), about 3.5 million inhabitants over almost 30 years (1971-1999). The joint analysis of the space-time pattern of relative risk for a given cause on males and females was conducted specifying a series of Hierarchical Bayesian models. Goodness-of-fit, parsimony and robustness under misspecification were used to identify candidate models. We chose birth cohort as relevant time axis and restricted our attention to birth cohorts born between 1905 and 1940. We found very different pattern by gender: the epidemic curve among males had a peak for the birth cohort born around 1930, the younger cohorts being at lower risk. Among females the relative risk was rising almost linearly on the log scale, the younger birth cohorts being at higher risk. Both curves showed two accelerations corresponding to the post-war periods (1915-1929 and 1945-1959), assuming an average age at first exposure of 20 years old. The spatial distribution among the 287 municipalities investigated was characterized by high risks in all industrial areas in males, and limited to large towns in females. The shared spatial clustering component highlighted the historically developed part of the Tuscany Region.

NuGO PPS1 mouse study 1: preliminary statistical analysis.

Time course experiments are aimed at characterizing the dynamic regulation of gene expression in biological systems. Data are collected at different time points to monitor the dynamic behaviour of gene expression. The NuGO PPS Mouse Study 1 investigates the development of high fat-induced insulin resistance (IR) over time in APOE*3Leiden (E3L) mice. The study consists in a series of analyses at time points, which are crucial in the development of central and peripheral IR. Affymetrix arrays have been made on critical organs. We present the results of the preliminary statistical analysis on these microarray data. We used a non-parametric approach to identify genes the expression of which changed over time, separately for three tissues: liver, muscle and white adipose tissue. We specified for each gene a basic ANOVA model, in order to check the null hypothesis that gene expression did not vary over time. We addressed the multiple tests problem calculating positive false discovery rate and q values for the F test statistics. The appropriateness of the hypothesis of homogeneous variances over time was investigated by mean of the Bartlett's test for homoschedasticity. This is a relevant point because heteroschedasticity could be indicative of outlying behaviour of some individuals at specific time points. The necessity to use a moderated F test was evaluated. We found that a considerable part of the genes varied expression over time. For part of the genes, the variance of the response was not homogeneous over time. Response differed by tissue.

Effects of cold weather on mortality: results from 15 European cities within the PHEWE project.

Weather-related health effects have attracted renewed interest because of the observed and predicted climate change. The authors studied the short-term effects of cold weather on mortality in 15 European cities. The effects of minimum apparent temperature on cause- and age-specific daily mortality were assessed for the cold season (October-March) by using data from 1990-2000. For city-specific analysis, the authors used Poisson regression and distributed lag models, controlling for potential confounders. Meta-regression models summarized the results and explored heterogeneity. A 1 degrees C decrease in temperature was associated with a 1.35% (95% confidence interval (CI): 1.16, 1.53) increase in the daily number of total natural deaths and a 1.72% (95% CI: 1.44, 2.01), 3.30% (95% CI: 2.61, 3.99), and 1.25% (95% CI: 0.77, 1.73) increase in cardiovascular, respiratory, and cerebrovascular deaths, respectively. The increase was greater for the older age groups. The cold effect was found to be greater in warmer (southern) cities and persisted up to 23 days, with no evidence of mortality displacement. Cold-related mortality is an important public health problem across Europe. It should not be underestimated by public health authorities because of the recent focus on heat-wave episodes.

[The role of professional activity in arterial hypertension]. / Il ruolo svolto dall'attività lavorativa sull'ipertensione arteriosa.

BACKGROUND: Arterial blood pressure, both systolic (SAP) or diastolic (DAP), has been widely investigated and some studies have shown an association between an increase in these parameters and mortality. The most frequently studied risk factors of arterial hypertension are use of alcohol, smoking and ethnic origin referred to both genetic differences and nutritional habits, while professional factors have been rarely and less deeply considered although significant differences have been found in mean arterial pressure in subjects conducting different professional activities. It seems in fact that "blue collar" workers are more at risk that "white collar" ones. OBJECTIVES: Our aim is to evaluate if work conditions or job strain related to professional activity or to life styles represent a risk factor for arterial hypertension and whether this effect of hypertension is independent of age. In fact, specific factors that may explain this connection have still not been clearly defined. METHODS: Our research method was similar to french inquiries ESTEV (Derriennic, Touranchet, Volkoff) and VISAT (Marquie, Jansou) applied in 6 Italian Regions and involved workers employed in different productive sectors and belonging to 5 age cohorts: 32, 37, 42, 47, 52 years. Information were obtained by occupational health physicians, using 3 questionnaires:--working conditions (exposure to certain risks or job strain);--life styles and self evaluation of health (Nottingham Health Profile);--objective information on health status. The present work consider only parameters that in other studies have been found associated with CVD morbidity, including: (1) working conditions, (2) subjective assessment of work, (3) specific job strain perceived Hypertension was considered as SAP > or =160 mm/Hg and/or DAP > or =90 mm/Hg, or current antihypertensive treatment. RESULTS: The results refer to 1104 workers, 76% men and 24% women. Prevalence of hypertension was found to be higher among the men than women (33% Vs 22%) and was higher with advancing age. Risk estimation showed a statistically significant association with certain work-related factors such as: shift work (O.R. 1.33), awkward posture (O.R. 1.71), exposure heat (O.R. 1.43), sitting work (O.R. 1.48), doing several tasks simultaneous (O.R. 1.41), being interrupted at work (O.R. 1.35), not being able to take eyes off work (O.R. 1.61). The multivariate analysis by logistic regression showed that the variables referred to cognitive aspects and work organization tended to be associated to arterial hypertension even when exposure ceased. CONCLUSIONS: We observed that both some physical aspects of work and cognitive organisation aspects, are strongly associated with arterial hypertension. An important element was found to be the subjective assessment that workers give to their work. From an intervention point of view, this aspects should be considered as possible reducible risk factor.

Avoidable mortality of psychiatric patients in an area with a community-based system of mental health care.

OBJECTIVE: To ascertain the existence of an excess of avoidable mortality among psychiatric patients in an area with a community-based system of care, to identify predictors of higher risk of avoidable mortality and to provide some possible indication to reduce avoidable mortality in modern psychiatric services. METHOD: All patients with an ICD-10 psychiatric diagnosis, living in a catchment area of about 75,000 inhabitants, seeking care in 1982-2001 were included (n = 6956). Mortality and causes of death were ascertained using linkage procedures with other local health databases. Standardized mortality ratios (SMRs) were calculated for each avoidable cause of death. RESULTS: The observed number of deaths for those causes considered avoidable by the European Community was four times greater than the expected (P < 0.01). SMR was higher for deaths preventable with adequate health promotion policies than for those preventable with appropriate health care. Males, alcohol/drug addicted and young patients have the highest avoidable SMRs. CONCLUSION: These findings urgently call for the implementation of health promotion and preventive programs targeted to psychiatric patients. Moreover, mental health services should improve the capacity to manage medical health problems of their patients.

Prevalence of respiratory symptoms in migrant children to Italy: the results of SIDRIA-2 study.

BACKGROUND: Epidemiological studies have documented large international variations in the prevalence of asthma, and 'westernization' seems to play an important role in the development of the disease. The aims of this study were to compare the prevalence of respiratory symptoms in migrant and nonmigrant children resident in Italy, and to examine the effect of length of time living in Italy. METHODS: Data were collected in a large cross-sectional study (SIDRIA-2) performed in 12 Italian centres, using standardized parental questionnaires. For the 29 305 subjects included in the analysis (6-7 and 13-14 years old), information about place of birth and parental nationality was available. RESULTS: There were 1012 children (3%) born outside of Italy, mainly in East Europe. Lifetime asthma and current wheeze were generally significantly less common among children born abroad than among children born in Italy (lifetime asthma: 5.4% and 9.7% respectively, P < 0.001; current wheeze: 5.2% and 6.9%, respectively, P = 0.04). Lower risks for lifetime asthma (prevalence odds ratio, POR = 0.39; 95% CI: 0.23-0.66) and current wheeze (POR = 0.72; 95% CI: 0.47-1.10) were found for children who had lived in Italy <5 years, while migrant children who had lived in Italy for 5 years or more had risks very similar to Italian children. CONCLUSIONS: Migrant children have a lower prevalence of asthma symptoms than children born in Italy. Prevalence increased with the number of years of living in Italy, suggesting that exposure to environmental factors may play an important role in the development of asthma in childhood.

Statistical methods for geographical surveillance in veterinary epidemiology.

Spatial clustering and cluster detection are statistical analysis developed to address relevant scientific hypothesis. The difficulty stays in the large number of alternative hypothesis due to the different mechanisms that could generate the anomalous cases aggregation. We review methods for marked point data (case/control) aimed to describe spatial intensity of disease risk, to test for randomness and to locate significant excesses. Bayesian Gaussian Spatial Exponential models are used to illustrate probabilistic aspects and the link with simpler non parametric tools are shown. We develop an informal guideline to the analysis and used data on faecal contamination and dog parasitic diseases in the city of Naples, Italy. Kernel density estimation resulted very sensitive to bandwidth choice and overemphasized localized excess, Ripley'K function and Cuzick-Edwards test were very consistent each other while the SatScan failed to detect excesses. The spatial range was around 600 meters and justifies several small clusters. Bayesian models were very powerful in reconstructing the phenomenon and allow inference on model parameters in good agreement with the non parametric analysis.

Geographical Information Systems and canine faecal contamination: the experience in the city of Naples (southern Italy).

Geographical Information Systems (GIS) can be used to make transect sampling when non-moving objects are to be counted, involving choosing a line or series of lines along which the counts are to take place. This approach has been used by us in order to study canine faecal contamination in the city of Naples (southern Italy), and to evaluate the consequent presence of canine parasitic elements. A GIS was constructed utilizing the geo-referenced digital photographs and the cadastral maps of Naples. In order to uniformly evaluate the canine faecal contamination throughout the city, a grid representing sub-areas of 1 km x 700 m was overlaid on the city map within the GIS. The territory of Naples was divided in 218 equal, rectangular sub-areas. In each sub-area a 1 km transect was drawn, and digitalized on-screen in the GIS. Canine faeces (copros in Greek) were counted along the transects in 143 sub-areas. In these sub-areas, 415 copros were collected and examined. Out of the 143 sub-areas, 141 contained canine copros. The results of the negative binomial regression model showed a positive association between the number of copros and the human population density. Out of the total of 415 copros, 70 (16.9%) were positive for parasitic elements; eggs of Toxocara canis, Toxascaris leonina, Ancylostoma caninum and Trichuris vulpis were found, as well as oocysts of Isospora canis.