Biomedical and health research: an analysis of country participation and research fields in the EU's Horizon 2020.

We analysed the Horizon 2020 project database, currently the European Union's (EU) largest framework programme for research and innovation-nearly 80 billion euros available over 7 years (2014-2020), to estimate the amount and type of EU-supported biomedical and health research and funding distribution among EU member states and non-European countries. Out of 20,877 projects as of 14th January 2019, a total of 4865 projects were classified as human health related. Ninety-four countries/territories worldwide participated in at least one biomedical project. The EU-15 original member states showed the highest participation as project leaders/partners and for acquired funding. Strong unequal funding distribution and participation between EU-15 and the 13 newest members-with EU-15 receiving about 87% of funding and EU-13 only 3%-have been evidenced. For both EU-15 and EU-13 we detected about 20% of projects involving the public and private sectors, according to Horizon 2020 guidelines. The largest percentage of projects was in the areas of biotechnological research (28.28%) and "basic research" (26.95%); these two sectors together accounted for 46.99% of the total funding assigned (7.9 billion euros). Research in neurosciences and neurological diseases appeared to be an increasing study area. Neurological and mental diseases covered about 21% of projects. Epidemiological studies accounted for about 5% of the total projects and for 14% of funding. Strong correlations were shown by indicators of financial and scientific capacity to identify success rates in obtaining EU funding, making the gap between countries with strong and weak research infrastructures difficult to overcome.

Childhood infectious diseases and risk of non-Hodgkin's lymphoma according to the WHO classification: A reanalysis of the Italian multicenter case-control study.

Since 1960, incidence of non-Hodgkin's lymphoma (NHL) has been increasing in most industrialized countries, but causes of this trend remain unclear. A role of the decreased exposure to infectious agents during childhood has been proposed. Our study evaluates the association between common childhood infectious diseases and the risk of NHL and its major subtypes by a reanalysis of the Italian multicenter case-control study. After exclusion of next-of-kin interviews, 1,193 cases, diagnosed between 1990 and 1993, and 1,708 population-based controls were included in the analyses. OR estimates were obtained by logistic regression, adjusting for gender, age, residence area, education, smoking habit and exposure to radiations, pesticides and aromatic hydrocarbons. Among B-cell lymphomas (n = 1,102) an inverse association was observed for rubella (OR = 0.80, 95% CI: 0.65-0.99), pertussis (OR = 0.74, 95% CI: 0.62-0.88) and any infection (OR = 0.75, 95% CI: 0.61-0.93). A negative trend by number of infections was observed, which was more evident among mature B-cell lymphoma (OR = 0.66 for three infections or more, 95% CI: 0.48-0.90). Our results indicate a potential protective role of common childhood infections in the etiology of B-cell NHL.

Population health and status of epidemiology in Western European, Balkan and Baltic countries.

BACKGROUND: This article is part of a series commissioned by the International Epidemiological Association, aimed at describing population health and epidemiological resources in the six World Health Organization (WHO) regions. It covers 32 of the 53 WHO European countries, namely the Western European countries, the Balkan countries and the Baltic countries. METHODS: The burdens of mortality and morbidity and the patterns of risk factors and inequalities have been reviewed in order to identify health priorities and challenges. Literature and internet searches were conducted to stock-take epidemiological teaching, research activities, funding and scientific productivity. FINDINGS: These countries have among the highest life expectancies worldwide. However, within- and between-country inequalities persist, which are largely due to inequalities in distribution of main health determinants. There is a long tradition of epidemiological research and teaching in most countries, in particular in the Western European countries. Cross-national networks and collaborations are increasing through the support of the European Union which fosters procedures to standardize educational systems across Europe and provides funding for epidemiological research through framework programmes. The number of Medline-indexed epidemiological research publications per year led by Western European countries has been increasing. The countries accounts for nearly a third of the global epidemiological publication. CONCLUSIONS: Although population health has improved considerably overall, persistent within- and between-country inequalities continue to challenge national and European health institutions. More research, policy and action on the social determinants of health are required in the region. Epidemiological training, research and workforce in the Baltic and Balkan countries should be strengthened. European epidemiologists can play pivotal roles and must influence legislation concerning production and access to high-quality data.

Multiple myeloma and occupation: a pooled analysis by the International Multiple Myeloma Consortium.

OBJECTIVE: We investigated occupational risk of multiple myeloma (MM) in a pooled analysis of five international case-control studies. METHODS: We calculated the odds ratio and its 95% confidence interval for selected occupations with unconditional regression analysis in 1959 MM cases and 6192 controls, by pooling study-specific risks using random-effects meta-analysis. Exposure to organic solvents was assessed with a job-exposure matrix (JEM). RESULTS: Gardeners and nursery workers combined, most likely exposed to pesticides, showed a 50% increase in risk (OR = 1.50, 95% CI 0.9-2.3), while other farming jobs did not. Metal processors (OR = 1.55, 95% CI 0.9-2.3), female cleaners (OR = 1.32, 95% CI 1.0-1.8), and high level exposure to organic solvents (OR = 1.38, 95% CI 0.96-1.8) also showed moderately increased risks. CONCLUSIONS: Additional case-control studies of MM aetiology are warranted to further investigate the nature of the repeatedly reported increase in MM risk in several occupational groups.

Is cancer overtaking cardiovascular diseases as the killer number one in men in Tuscany?

AIMS AND BACKGROUND: For the first time in 2006, cancer became the main cause of death in men in Italy, exceeding cardiovascular disease. The aim of the study was to verify whether the overtaking of cancer male mortality occurred also in Tuscany or in some of its 12 subregional areas and whether there was a geographical trend. METHODS: Age-standardized mortality rates from the Tuscan Regional Mortality Registry, 1987-2008, were calculated for neoplasms, cardiovascular diseases, and respiratory diseases, considering the whole region and its 12 areas. Joinpoint analyses were carried out to study temporal trend. RESULTS: Up to 2008, the number of male deaths for neoplasms (6786) in Tuscany did not exceed deaths from cardiovascular disease (7065). Instead, overtaking occurred in some subregional areas from 2004 onwards. When we compared age-standardized mortality rates, cancer became the first cause of death in Tuscany from 2004 onwards (age-standardized mortality rates for cancer 236.5 per 100,000; for cardiovascular disease 227.8 per 100,000). Age-standardized mortality rates for cardiovascular disease recorded an annual 2.4% decrease until 1998, then a 3.5% decrease. Age-standardized mortality rates for all cancers recorded an annual 1.6% decrease in the whole period. CONCLUSIONS: Our study confirmed a geographical trend in cancer overtaking as the main cause of death in males: from the more urbanized areas in northern Tuscany, where the phenomenon occurred earlier, to the southern part.

International collaborations in cancer control and the Third International Cancer Control Congress.

Over the past few decades, there has been growing support for the idea that cancer needs an interdisciplinary approach. Therefore, the international cancer community has developed several strategies as outlined in the WHO non-communicable diseases Action Plan (which includes cancer control) as the World Health Assembly and the UICC World Cancer Declaration, which both include primary prevention, early diagnosis, treatment, and palliative care. This paper highlights experiences/ideas in cancer control for international collaborations between low, middle, and high income countries, including collaborations between the European Union (EU) and African Union (AU) Member States, the Latin-American and Caribbean countries, and the Eastern Mediterranean countries. These proposals are presented within the context of the global vision on cancer control set forth by WHO in partnership with the International Union Against Cancer (UICC), in addition to issues that should be considered for collaborations at the global level: cancer survival (similar to the project CONCORD), cancer control for youth and adaptation of Clinical Practice Guidelines. Since cancer control is given lower priority on the health agenda of low and middle income countries and is less represented in global health efforts in those countries, EU and AU cancer stakeholders are working to put cancer control on the agenda of the EU-AU treaty for collaborations, and are proposing to consider palliative care, population-based cancer registration, and training and education focusing on primary prevention as core tools. A Community of Practice, such as the Third International Cancer Control Congress (ICCC-3), is an ideal place to share new proposals, learn from other experiences, and formulate new ideas. The aim of the ICCC-3 is to foster new international collaborations to promote cancer control actions in low and middle income countries. The development of supranational collaborations has been hindered by the fact that cancer control is not part of the objectives of the Millennium Development Goals (MGGs). As a consequence, less resources of development aids are allocated to control NCDs including cancer.

Occupational exposure to high molecular weight allergens and lymphoma risk among Italian adults.

OBJECTIVES: Exposure to high molecular weight (HMW) allergens that provoke immune reactivity through an IgE-mediated pathway has been associated with a decreased risk of B-cell lymphoma. The present analysis was conducted to assess the associations between occupational exposure to specific HMW allergens and the risk of B-cell, T-cell, and Hodgkin's lymphomas. METHODS: We analyzed data from 2,290 incident lymphoma cases and 1,771 population-based controls enrolled in a multicenter study of hematolymphopoietic malignancies conducted in Italy between 1991 and 1993. All cases were histologically or cytologically confirmed. Controls were frequency-matched to cases based on age, sex, and study center. An industrial hygienist evaluated HMW occupational exposure classifications after an asthma-specific job exposure matrix was applied to participants' job histories. Unconditional logistic regression was used to assess associations between occupational exposures that occurred > or = 10 years before the date of lymphoma diagnosis and B-cell, T-cell, and Hodgkin's lymphomas. RESULTS: Ten percent of cases and 11% of controls were occupationally exposed to HMW allergens. Exposed individuals had a decreased risk for all lymphomas combined (odds ratio, 0.78; 95% confidence interval, 0.63-0.97), particularly for B-cell lymphomas (odds ratio, 0.75; 95% confidence interval, 0.59-0.94). The decreased risks for all lymphomas were also observed when HMW allergen exposure was limited to animal and latex allergens. CONCLUSIONS: These findings support the hypothesis that occupational exposure to immunologically active HMW allergens is inversely associated with the risk for lymphoma. The effect of exposure to specific allergens warrants further assessment.

Prediction of mesothelioma and lung cancer in a cohort of asbestos exposed workers.

BACKGROUND: Several papers have reported state-wide projections of mesothelioma deaths, but few have computed these predictions in selected exposed groups. OBJECTIVE: To predict the future deaths attributable to asbestos in a cohort of railway rolling stock workers. METHODS: The future mortality of the 1,146 living workers has been computed in term of individual probability of dying for three different risks: baseline mortality, lung cancer excess, mesothelioma mortality. Lung cancer mortality attributable to asbestos was calculated assuming the excess risk as stable or with a decrease after a period of time since first exposure. Mesothelioma mortality was based on cumulative exposure and time since first exposure, with the inclusion of a term for clearance of asbestos fibres from the lung. RESULTS: The most likely range of the number of deaths attributable to asbestos in the period 2005-2050 was 15-30 for excess of lung cancer, and 23-35 for mesothelioma. CONCLUSION: This study provides predictions of asbestos-related mortality even in a selected cohort of exposed subjects, using previous knowledge about exposure-response relationship. The inclusion of individual information in the projection model helps reduce misclassification and improves the results. The method could be extended in other selected cohorts.

Autoimmune disorders and risk of non-Hodgkin lymphoma subtypes: a pooled analysis within the InterLymph Consortium.

Some autoimmune disorders are increasingly recognized as risk factors for non-Hodgkin lymphoma (NHL) overall, but large-scale systematic assessments of risk of NHL subtypes are lacking. We performed a pooled analysis of self-reported autoimmune conditions and risk of NHL and subtypes, including 29 423 participants in 12 case-control studies. We computed pooled odds ratios (OR) and 95% confidence intervals (CI) in a joint fixed-effects model. Sjögren syndrome was associated with a 6.5-fold increased risk of NHL, a 1000-fold increased risk of parotid gland marginal zone lymphoma (OR = 996; 95% CI, 216-4596), and with diffuse large B-cell and follicular lymphomas. Systemic lupus erythematosus was associated with a 2.7-fold increased risk of NHL and with diffuse large B-cell and marginal zone lymphomas. Hemolytic anemia was associated with diffuse large B-cell NHL. T-cell NHL risk was increased for patients with celiac disease and psoriasis. Results for rheumatoid arthritis were heterogeneous between studies. Inflammatory bowel disorders, type 1 diabetes, sarcoidosis, pernicious anemia, and multiple sclerosis were not associated with risk of NHL or subtypes. Thus, specific autoimmune disorders are associated with NHL risk beyond the development of rare NHL subtypes in affected organs. The pattern of associations with NHL subtypes may harbor clues to lymphomagenesis.

[Malignant pleural mesothelioma incidence and mortality in Tuscany in 1988-1999]. / Incidenza e mortalità in Toscana per mesotelioma maligno pleurico nel periodo 1988-1999.

In the period 1988-1999, the Tuscan Mesothelioma Registry (ARTMM) recorded 436 cases of pleural malignant mesothelioma (MMP); 81% were males. The Tuscan MMP incidence rate (age standardized on European population; per 100,000 per year), was 0.97 in 1988-1993, 1.64 in 1994-1999 for males; 0.22 and 0.23 for females, respectively. In the period 1988-1999 the Tuscan Mortality Registry (RMR) recorded 676 pleural cancer (TMP) deaths (ICD IX 163; 464 in males). In the periods 1988-1993 and 1994-1999 Tuscan TMP mortality rate (per 100,000 per year) was 1.54; 1.70 for men; 0.46 and 0.53 for women, respectively. The highest incidence and mortality rates for males were recorded in Massa Carrara (MMP incidence in the period 1994-1999: 5.20) e Livorno (MMP incidence in the period 1994-1999: 4.64) provinces. In order to study differences between incidence and mortality for males, an analysis of distribution of incident MMP cases and TMP deaths by municipality in Tuscany was carried out. It is usually assumed for projections of MMP mortality that the ratio of MMP mortality to TMP mortality is 1:1. However, in order to evaluate more precisely projections of MMP mortality, the exact ratio was calculated for men. In the period 1994-1999, 82% (154/188) of the male MMP deaths were correctly coded as TMP deaths in the RMR; 60% (154/256) of male TMP deaths were definite MMP cases, as they were recorded in ARTMM. The ratio of MMP mortality to TMP mortality is, therefore, 0.73:1 (0.60/0.82) for males in Tuscany.

Exposure to benzene and risk of leukemia among shoe factory workers.

OBJECTIVES: The study attempted to add years of follow-up to an earlier study describing excess leukemia among workers exposed to benzene-based glues in a shoe-factory and to conduct a quantitative exposure assessment of the exposure to benzene and the risk of leukemia. METHODS: The cohort comprised 1687 persons with complete work histories, at work on 1 January 1950, and followed through 31 December 1999. For each subject, time-specific cumulative exposure (ppm-years) was calculated as the sum of the products of job-specific concentrations of benzene (ppm) and the duration (years) for each job. Standardized mortality ratios (SMR) were estimated using national and regional rates specific for gender, age, and period. RESULTS: The cumulative exposure ranged from 0 to >500 ppm-years. The SMR values for all hematolymphopoietic malignancies and leukemia for the men and women combined were elevated in all but the lowest exposure category. Leukemia risk was significantly elevated in the highest exposure category and the most evident among the men. The SMR values for the men were 1.4 [95% confidence interval (95% CI) 0.2-5.0], 3.7 (95% CI 0.1-20.6), 3.0 (95% CI 0.4-10.9), and 7.0 (95% CI 1.9-18.0) for benzene, the cumulative exposure equaling <40, 40-99, 100-199, and >200 ppm-years, respectively. CONCLUSIONS: The results indicate that leukemia mortality is associated with exposure to benzene in this factory and that the risk increases with increasing cumulative exposure. The relevance of these findings for estimating risk at much lower levels is limited because of the small study size.

[Impact of smoking in Italy in 1998: deaths and years of potential life lost]. / Impatto dell'abitudine al fumo in Italia nel 1998: decessi e anni potenziali di vita persi.

This report presents the impact of smoking habits on Italian mortality in 1998. Estimates of smoking-attributable fraction (FAF), smoking-attributable mortality (MAF), and years of potential life lost (YPLLf) were calculated using the SAMMEC software (CDC, USA), and the Peto method. During 1998, using the SAMMEC software, smoking caused approximately 83,650 premature deaths in Italy (67,600 in men, 16,000 in women, and 45 in infants), equal to 15.1% of mortality in adults above the age of 35 years (24.4% of mortality in men and 5.8% in women). YPLLf were about 900,000 in men, 221,000 in women, and 3,500 in infants. Using the Peto method, smoking-attributable deaths were about 70,200 (59,600 in men and 10,600 in women), equal to 12.7% of mortality in adults older than 35 years (21.5% of mortality in men and 3.9% in women). YPLLf were about 806,000 in men and 142,000 in women. Among adults, for both methods most smoking-related deaths were attributable to lung cancer, ischemic heart disease, chronic airways obstruction, and cerebrovascular disease. Differences between the estimates of the two methods underline the gap between a more conservative estimate (Peto method) and a less restrictive one (SAMMEC software). Given validity for both methods, it is likely smoking habits caused between 70,000 and 83,000 deaths in Italy during 1998.