Relations between Air Quality and Covid-19 Lockdown Measures in Valencia, Spain.

The set of measures to contain the diffusion of COVID-19 instituted by the European governments gave an unparalleled opportunity to improve our understanding of the transport and industrial sectors' contribution to urban air pollution. The purpose of this study was to assess the impacts of the lockdown measures on air quality and pollutant emissions in Valencia, Spain. For this reason, we determined if there was a significant difference in the concentration levels of different particulate matter (PM) sizes, PM10, PM2.5, and NOx, NO2, NO, and O3, between the period of restrictions in 2020 and the same period in 2019. Our findings indicated that PM pollutant levels during the lockdown period were significantly different from the same period of the previous year, even if there is variability in the different local areas. The highest variations reduction in the PM10 and PM2.5 levels were observed for the València Centre, València Avd Francia, and València Pista de Silla (all of the urban traffic type) in which there was a reduction of 58%-42%, 56%-53%, and 60%-41% respectively. Moreover, consistent with recent studies, we observed a significant reduction in nitric oxide levels in all the air monitoring stations. In all seven monitoring stations, it was observed, in 2020, NOx, NO2, and NO concentrations decreased by 48.5%-49.8%-46.2%, 62.1%-67.4%-45.7%, 37.4%-35.7%-35.3%, 60.7%-67.7%-47.1%, 65.5%-65.8%-63.5%, 60.0%-64.5%-41.3%, and 60.4%-61.6%-52.5%, respectively. Lastly, overall O3 levels decreased during the lockdown period, although this phenomenon was more closely related to weather conditions. Overall, no significant differences were observed between the meteorological conditions in 2019 and 2020. Our findings suggest that further studies on the effect of human activities on air quality are needed and encourage the adoption of a holistic approach to improve urban air quality.

Does written informed consent adequately inform surgical patients? A cross sectional study.

BACKGROUND: Informed consent (IC) is an essential step in helping patients be aware of consequences of their treatment decisions. With surgery, it is vitally important for patients to understand the risks and benefits of the procedure and decide accordingly. We explored whether a written IC form was provided to patients; whether they read and signed it; whether they communicated orally with the physician; whether these communications influenced patient decisions. METHODS: Adult postsurgical patients in nine general hospitals of Italy's Campania Region were interviewed via a structured questionnaire between the second and seventh day after the surgery at the end of the first surgical follow up visit. Physicians who were independent from the surgical team administered the questionnaire. RESULTS: The written IC form was given to 84.5% of those interviewed. All recipients of the form signed it, either personally or through a delegate; however, 13.9% did not know/remember having done so; 51.8% said that they read it thoroughly. Of those who reported to have read it, 90.9% judged it to be clear. Of those receiving the written consent form, 52.0% had gotten it the day before the surgery at the earliest 41.1% received it some hours or immediately before the procedure. The written IC form was explained to 65.6% of the patients, and 93.9% of them received further oral information that deemed understandable. Most attention was given to the diagnosis and the type of surgical procedure, which was communicated respectively to 92.8 and 88.2% of the patients. Almost one in two patients believed that the information provided some emotional relief, while 23.2% experienced increased anxiety. Younger patients (age ≤ 60) and patients with higher levels of education were more likely to read the written IC form. CONCLUSIONS: The written IC form is not sufficient in assuring patients and making them fully aware of choices they made for their health; pre-operative information that was delivered orally better served the patients' needs. To improve the quality of communication we suggest enhancing physicians' communication skills and for them to use structured conversation to ensure that individuals are completely informed before undergoing their procedures.

Exploring causality of the association between smoking and Parkinson's disease.

BACKGROUND: The aim of this paper is to investigate the causality of the inverse association between cigarette smoking and Parkinson's disease (PD). The main suggested alternatives include a delaying effect of smoking, reverse causality or an unmeasured confounding related to a low-risk-taking personality trait. METHODS: A total of 715 incident PD cases were ascertained in a cohort of 220 494 individuals from NeuroEPIC4PD, a prospective European population-based cohort study including 13 centres in eight countries. Smoking habits were recorded at recruitment. We analysed smoking status, duration, and intensity and exposure to passive smoking in relation to PD onset. RESULTS: Former smokers had a 20% decreased risk and current smokers a halved risk of developing PD compared with never smokers. Strong dose-response relationships with smoking intensity and duration were found. Hazard ratios (HRs) for smoking <20 years were 0.84 [95% confidence interval (CI) 0.67-1.07], 20-29 years 0.73 (95% CI 0.56-0.96) and >30 years 0.54 (95% CI 0.43-0.36) compared with never smokers. The proportional hazard assumption was verified, showing no change of risk over time, arguing against a delaying effect. Reverse causality was disproved by the consistency of dose-response relationships among former and current smokers. The inverse association between passive smoking and PD, HR 0.70 (95% CI 0.49-0.99) ruled out the effect of unmeasured confounding. CONCLUSIONS: These results are highly suggestive of a true causal link between smoking and PD, although it is not clear which is the chemical compound in cigarette smoking responsible for the biological effect.

Can antenatal classes reduce the rate of cesarean section in southern Italy?

BACKGROUND: Among European Countries, Italy has the highest rate of cesarean section (36.8%), and in the Campania region this rate reaches 60.0%. QUESTION: We conducted a retrospective cohort study to evaluate whether participation in antenatal classes during pregnancy reduces the rate of cesarean delivery in southern Italy. METHODS: We selected three local health authorities, with the lowest, the highest, and an intermediate rate of cesarean delivery. The study included 1893 mothers who brought their children for vaccination and were interviewed about their participation in antenatal classes and their obstetric history. FINDINGS: The main causes of cesarean section given in the interview were clinical indications (61.0%), previous cesarean section (31.0%) and woman's request (8.0%). When we excluded emergency cesarean delivery, we found a moderate association between participation in antenatal classes and cesarean section reduction (relative risk=1.27; 95% CI=1.08-1.49; in percentage values from 49.3% to 38.8%). Private hospitals and the two local health authorities with higher baseline rates of cesarean section showed an enhanced reduction of these rates. CONCLUSION: Our paper shows moderate efficacy of antenatal classes, which reduced the occurrence of cesarean section by about 10%. However, the cesarean section rate remained high. As it is possible that different classes have a different level of efficacy, a further study on a standardized model of an antenatal classes is in progress, to assess its efficacy in term of cesarean section reduction, with the purpose of its widespread implementation to the whole region.

Scarce information about breast cancer screening: An Italian websites analysis.

Although the public should have complete and correct information about risk/benefit ratio of breast cancer screening, public knowledge appears generally scarce and oriented to overestimate benefits, with little awareness of possible disadvantages of the screening.We evaluated any document specifically addressed to the general female public and posted on internet by Italian public health services. The presence of false positive, false positive after biopsy, false negative, interval cancer, overdiagnosis, lead-time bias, exposure to irradiation, and mortality reduction was analyzed.Of the 255 websites consulted, 136 (53.3%) had sites addressed to the female public. The most commonly reported information points were the false-positive (30.8% of sites) and radiation exposure (29.4%) rates. Only 11 documents mentioned overdiagnosis, 2 mentioned risk of false positive with biopsy, and only 1 mentioned lead-time bias. Moreover, only 15 sites (11.0%) reported quantitative data for any risk variables.Most documents about breast cancer screening published on the web for the female public contained little or no information about risk/benefit ratio and were biased in favor of screening.