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1.
J Urban Health ; 95(1): 99-110, 2018 02.
Article in English | MEDLINE | ID: mdl-29204843

ABSTRACT

So far, only three small outdated studies have investigated hepatitis C virus (HCV) incidence and risk factors among illicit drug users (DUs) in Italy. Thus, during 2007-2010, we conducted a prospective cohort study among DUs attending 17 Italian rehabilitation centers serving urban areas. Two hundred eighty-four HCV-uninfected DUs were prospectively followed by interview and anti-HCV antibody and RNA testing every 6 months. Incidence was calculated using the person-years method. Infection predictors were assessed by time-dependent Cox analysis. Participants were mostly male (83.4%), under opioid substitution therapy (OST) (78.9%), non-injecting DUs (67.9%), and with a mean age of 30.8. Ninety-one of 224 DUs initially under OST interrupted treatment during the follow-up. Overall HCV incidence was 5.83/100 person-years at risk (PYAR) [95% confidence intervals (CI), 3.63-9.38]. The incidence did not significantly differ according the participants' sociodemographic characteristics or the degree of urbanization of the towns involved in the study. The incidence was higher for DUs under than for those not under OST (6.23 vs 4.50/100 PYAR; p = 0.681). Incidence was also higher for those with than for those without OST interruption (7.17 vs 5.04/100 PYAR; p = 0.55). However, all these differences were non-significant. At last follow-up visit, a significant decrease in frequency of sharing equipment for preparation/using drugs (by injection or not) was observed by analyzing either the whole cohort or DUs under OST only. Anti-HCV seroconversion resulted independently associated with sharing drug preparation/use equipment, backloading, having a HCV-positive sexual partner, or household and (marginally) intravenous injection. In this study, HCV incidence was non-negligible and OST seemed to lack effectiveness in reducing it. In Italy, implementation of combined harm reduction interventions and antiviral treatment of chronically infected DUs would be needed.


Subject(s)
Harm Reduction , Hepatitis C/etiology , Hepatitis C/prevention & control , Illicit Drugs/adverse effects , Opiate Substitution Treatment/methods , Substance Abuse, Intravenous/complications , Adolescent , Adult , Cohort Studies , Female , Hepatitis C/epidemiology , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Prospective Studies , Risk Factors , Substance Abuse, Intravenous/epidemiology , Young Adult
2.
Epidemiol Prev ; 36(5): 253-62, 2012 Sep.
Article in Italian | MEDLINE | ID: mdl-23139111

ABSTRACT

INTRODUCTION: the potential health impacts due to the decommissioned Nuclear power plants (NPP) located in Borgo Sabotino and Garigliano in Central Italy (active from the early 1960s to the late 1980s) have raised several concerns. Brain, thyroid, breast and lung cancer and leukaemia have been associated with exposure to ionizing radiations, but the health effects of nuclear plants on the resident populations are controversial. OBJECTIVE: to evaluate whether living close to NPPs is associated with an increased risk of cancer incidence and mortality. METHODS: we defined a cohort of residents within 7 km from the NPPs during the period 1996-2002. Individual follow-up for vital status at 01.01.2007 was conducted using municipality data. Gender specific Standardized Incidence and Mortality Ratios, adjusted for age, were calculated (SIR and SMR) using the regional population as reference. Each participant's address was assigned to a distance from the NPP on the basis of a GIS. A relative risk (RR, CI95%), adjusted for age and socioeconomic status, was calculated in 3 bands of increasing radius from the plants: 0-2, 2-4, and 4-7 km (reference group), using a Poisson regression model. RESULTS: the cohort was of 39,775 people, 32%of whom lived near (0-4 km) the NPP. No differences in mortality was found when comparing the cohort with the regional population; among women living within 7 km from the NPP, we found thyroid cancer incidence higher than expected (SIR 1.53 CI95% 1.18-1.95). However, when the analysis was conducted on the basis of the distance from the NPP, we found a statistically significant increase in male mortality only for causes unrelated to radiation exposure (all causes, stomach cancer, and cardiovascular diseases). No mortality excess was observed among women living close to the NPPs. No statistically significant distance-related gradient was observed for cancer incidence both in men and women. CONCLUSIONS: living close to the NPP was not associated with mortality for causes related to radiation exposure. However, the results suggest to continue the epidemiological surveillance of the population.


Subject(s)
Neoplasms/epidemiology , Nuclear Power Plants , Adolescent , Adult , Age Distribution , Aged , Cardiovascular Diseases/mortality , Cause of Death , Child , Child, Preschool , Dose-Response Relationship, Radiation , Female , Humans , Infant , Infant, Newborn , Italy , Male , Medical Record Linkage , Middle Aged , Neoplasms/mortality , Neoplasms, Radiation-Induced/epidemiology , Neoplasms, Radiation-Induced/mortality , Radiometry , Risk , Sex Distribution , Thyroid Neoplasms/epidemiology , Young Adult
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