Smoking in Italy in 2015-2016: prevalence, trends, roll-your-own cigarettes, and attitudes towards incoming regulations.

PURPOSE: In 2016, a series of selective tobacco regulations, which did not affect tobacco price, came into force in Italy. To understand how Italians accepted the new norms, we analyzed data from our 2 most recent surveys among those we annually conduct on tobacco. METHODS: In 2015 and 2016, we conducted 2 representative cross-sectional studies focused on the new forthcoming tobacco legislation on a total sample of 6,046 Italians aged ≥15 years. RESULTS: Overall, 21.4% of Italians (26.0% of men and 17.2% of women) were current smokers, showing a small but significant decrease in smoking prevalence since 2007 (p for trend = 0.004). No change in smoking prevalence was observed over the last decade among the young (i.e., 15-24 years; 20.1% in 2015-2016). Roll-your-own cigarettes were the most frequent tobacco product for 8.3% of adult smokers and 19.7% of young smokers. According to the attitudes of Italians towards the new regulations, 91.3% supported the smoking ban in cars in presence of minors, 90.2% a more stringent enforcement of the tobacco sales-to-minors regulation, 74.3% the introduction of shocking pictorial images on tobacco packs, and 63.2% the removal from the market of small cigarette packs, usually purchased by the young. CONCLUSIONS: Smoking prevalence only marginally decreased over the last decade among adults, but did not decrease among the young. Roll-your-own tobacco is increasingly used by adults and young people. Before the entrance of the new norms, Italians largely supported them, particularly those targeting children.

Dopamine agonists for the treatment of cocaine dependence.

BACKGROUND: Cocaine misuse is a disorder for which no pharmacological treatment of proven efficacy exists. Advances in neurobiology could guide future medication development. OBJECTIVES: To investigate the efficacy and acceptability of dopamine agonists alone or in combination with any psychosocial intervention for the treatment of of people who misuse cocaine. SEARCH METHODS: We run the search on 12 January 2015. We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE, CINAHL, PsycINFO, ICTRP, clinicaltrials.gov and screened reference lists. SELECTION CRITERIA: Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing dopamine agonists alone or associated with psychosocial intervention with placebo, no treatment or other pharmacological interventions. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. MAIN RESULTS: Twenty four studies, including 2147 participants, met the inclusion criteria. Comparing any dopamine agonist versus placebo, we found no differences for any of the outcomes considered: dropout (moderate quality of evidence), abstinence (low quality of evidence), severity of dependence (low quality of evidence), adverse events (moderate quality of evidence). This was also observed when single dopamine agonists were compared against placebo. Comparing amantadine versus antidepressants, we found low quality of evidence that antidepressants performed better for abstinence (RR 0.25, 95% CI 0.12 to 0.53) based on two studies with 44 participants. No differences were found for dropout or adverse events, for both moderate quality of evidence.The major flaws of the included studies concerned selection bias because most studies did not report information about sequence generation (80%) and allocation concealment methods (86%): half of the included studies were judged at unclear risk of performance bias and 62.5% at unclear risk of detection bias for what concerns subjective outcomes. AUTHORS' CONCLUSIONS: Current evidence from RCTs does not support the use of dopamine agonists for treating cocaine misuse. This absence of evidence may leave to clinicians the alternative of balancing the possible benefits against the potential adverse effects of the treatment. Even the potential benefit of combining a dopamine agonist with a more potent psychosocial intervention, which was suggested by the previous Cochrane Review (Soares 2003), is not supported by the results of this Cochrane Review update.

210Pb and 210Po concentrations in Italian cigarettes and effective dose evaluation.

It has been known for a long time that cigarette tobacco contains naturally occurring radioactive nuclides such as 210Pb and 210Po. In this study, the concentrations of 210Pb and 210Po in the 10 most widely sold cigarette brands in Italy during the year 2010 were measured, and the effective dose to smokers has been calculated. The results of this study show that 210Pb concentration ranged from 11.6 to 20.0 mBq cig-1 with an arithmetic mean of 14.6 mBq cig-1, while the activity concentration of 210Po ranged from 13.1 to 19.0 mBq cig-1 with an arithmetic mean of 15.7 mBq cig-1, thus confirming previous results and showing that the radioactivity concentration was not reduced in the last few years. The annual effective dose for a typical smoker consuming 20 cigarettes per day ranged from an average of 55 µSv y-1 to about 81 µSv y-1. It is finally put in evidence the need to improve the knowledge about crucial data needed for accurate dose assessment deriving from the inhalation of both radioisotopes contained in the cigarettes, namely the dose conversion coefficients, which strongly depend on several parameters such as the inhalation speed through the mouth, the real fraction of radionuclide transferred from cigarette to mainstream smoke, the lung absorption behavior of the radioisotopes inhaled with mainstream smoke, and the AMAD of particles inhaled by smokers.

Weight perception among Italian adults, 2006-2010.

Underweight, overweight and obesity are associated with increased mortality from several chronic diseases, including cancer. Self body weight misperceptions affect weight control. We monitored weight perception in Italy on a total of 14 135 individuals (6834 men, 7301 women), representative of the Italian adult population with available information on body mass index (BMI) derived by self-reported height and weight. Differences in misperception of BMI categories across subpopulations were analysed using unconditional multiple logistic regression models after adjustment for a number of covariates. Overall, 66.4% of individuals accurately perceived, 21.0% underestimated and 12.6% overestimated their category of BMI. In men, 27.2% underestimated and 5.0% overestimated their BMI category the corresponding estimates for women were 15.3% and 19.6%, respectively. The large majority of underweight (64.3%) and obese individuals (93.1%) overestimated and underestimated their weight, respectively. Overall, 13.5% of Italians misperceived (8.9% underestimated and 4.6% overestimated) their BMI category by more than 2 kg/m. By multivariate analysis, we observed significant differences in terms of sex, education, geographic area, marital status, smoking and drinking habit, year of survey and BMI category. In conclusion, misperception of body weight is frequent in Italy, paralleling findings from other countries with more unfavourable overweight and obesity patterns. The fact that one out of three Italian adults misperceive their weight is of great concern and indicates that media intervention campaigns aimed at explaining measurement and correct interpretation of BMI are required.

Implementation of smoking ban: a survey in a public hospital setting.

Smoking in hospitals is banned in most of European countries; nevertheless, implementing a total smoking ban is particularly difficult and policy breaches are frequent. Aim of our study was to monitor the compliance with the smoke-free policy within a hospital district by measuring particulate matters (PM2.5). We designed an observational study and identified six sensitive locations within the hospitals: surgical units, administrative offices, hall, outdoor main entrances and as controls an outdoor and an indoor area. To rule out potential confounders we included in the evaluation the roadways surrounding the hospital district. PM2.5 median concentrations observed in outdoor main entrances and in hall were significantly higher (16.4 and 13.4 µg m(-3)), as compared with the other settings (P < 0.0001). This data warrant an implementation of current policies to protect patients, visitors and employees from passive second-hand smoke leading to a smoking prohibition in any hospital surroundings.

Walking four times weekly for at least 15 min is associated with longevity in a cohort of very elderly people.

OBJECTIVES: This study investigated the role of walking outdoors on longevity, controlling for individual and other life-style factors as possible confounders. METHODS: A 10-year cohort study was conducted with 152 self-caring and mobile, mean age 80 years, were enrolled in the study. Information on socio-demographic characteristics, clinical and biochemical data, diet, physical activity, smoking, depression status, cognitive status and anthropometrics measurements, were obtained for all participants. Cox proportional-hazards models were used to determine independent predictors of longevity. RESULTS: During the 10-years of follow-up, 96 (63%) died. Old age, chronic diseases, smoking, depression, CD4/CD8 ratio and coffee consumption were significantly predictors of mortality. Over-all survival was highest for subjects walking at open air for 4 times weekly for at least 15 min in comparison to subjects walking less than 4 times weekly (40% versus 22%). After adjusting for sex, age, education, chronic diseases, smoking, Body Mass Index and CD4/CD8 ratio, elderly people walking at open air for four times weekly had 40% decreased risk of mortality that individuals who walked less than four times weekly [relative risk (RR)=0.53; 95% confidence interval (CI)=0.32-0.88, p=0.01]. CONCLUSIONS: Findings suggest an independent and protective effect of walking on mortality and supports the encouragement of physical activity in advanced age for increasing longevity.

Overweight and obesity prevalence and determinants in Italy: an update to 2010.

PURPOSE: To provide updated information on trends and determinants of underweight, overweight, and obesity in Italian adults. METHODS: We considered data from 5 surveys conducted annually between 2006 and 2010, on a total of 14,135 subjects aged 18 years or more (6,834 men and 7,301 women), representative of the Italian adult population, including self-reported information on height and weight. RESULTS: Overall, 3.1 % of the Italian adult population was underweight (body mass index, BMI, <18.5 kg/m(2); 0.8 % men, 5.3 % women), 31.8 % overweight (25≤ BMI <30 kg/m(2); 39.8 % men, 24.4 % women), and 8.9 % obese (BMI ≥30 kg/m(2); 8.5 % men, 9.4 % women). We observed no specific pattern of overweight/obesity across calendar years in men (multivariate prevalence ratios, PR, for 2010 vs 2006: 0.95; p for trend: 0.980) and a non-significant decreased trend in women (PR: 0.92; p for trend: 0.051). Prevalence of overweight/obesity significantly increased with age (PRs for ≥65 vs 18-24 years: 2.01 in men, 2.65 in women), decreased with education (PRs for high vs low education: 0.79 in men, 0.54 in women), and was less frequent in single than in married adults (PRs: 0.85 in men, 0.78 in women). Overweight/obesity was significantly more frequent in adults from southern versus northern Italy (PRs: 1.13 in men, 1.32 in women) and in former versus never smokers (PRs: 1.23 in men, 1.19 in women). CONCLUSIONS: In Italy, we did not find unfavorable trends in overweight and obesity prevalence across calendar years. However, there are specific subgroups of the population with elevated prevalence of overweight and obesity, mainly adults from southern Italy and less educated ones.

Attitudes towards the extension of smoking restrictions to selected outdoor areas in Italy.

OBJECTIVES: To estimate the attitudes of Italians on the extension of the smoking ban to selected public outdoor areas. METHODS: The authors considered data from two Italian surveys on smoking conducted in 2009 and 2010 on a total sample of 6233 individuals, representative of the Italian population aged 15 years or over. RESULTS: 64.6% of Italians supported smoke-free policies in public parks, 68.5% in sports stadiums, 62.1% in beaches, 85.9% in school courtyards and 79.9% in outdoor areas surrounding hospitals. Among current smokers, the corresponding estimates were 32.9% for parks, 38.2% for stadiums, 31.2% for beaches, 67.6% for schools and 55.3% for hospitals. CONCLUSIONS: Extension of the smoking ban to selected outdoor areas is supported by the large majority of the Italian population. The overwhelming majority of support for smoke-free school grounds and outdoor areas surrounding hospitals indicates that legislative action is required.

Assessment of prenatal exposure to ethanol by meconium analysis: results of an Italian multicenter study.

BACKGROUND: This study estimated in 7 Italian cities the prevalence of prenatal exposure to ethanol by determining fatty acid ethyl esters (FAEEs; palmitic, palmitoleic, stearic, oleic, linoleic, linolenic, and arachidonic esters) and ethyl glucuronide (EtG) in neonatal meconium samples. METHODS: A total of 607 meconium samples were obtained from neonatal wards of 7 public hospitals: Verona and San Daniele del Friuli in the northeast of the country, Reggio Emilia in the middle east, Florence and Rome in the center, and Naples and Crotone in the southwest of the peninsula. Meconium biomarkers were assessed by a validated methodology using liquid chromatography-tandem mass spectrometry and the results categorized using the accepted cutoff of 2 nmol/g total amount of 7 FAEEs and 2 nmol/g EtG, to differentiate between heavy maternal ethanol use during pregnancy and occasional or no use at all. RESULTS: On the basis of the above-reported cutoffs, the overall prevalence of newborns prenatally exposed to maternal ethanol was 7.9%: 0% in Verona, 4.0% in San Daniele del Friuli, 4.9% in Naples, 5.0% in Florence, 6.2% in Crotone, up to 10.6% in Reggio Emilia, and 29.4% in Rome. Low maternal education level and younger maternal age were associated with biomarker scores over the cutoff. There was also a significant correlation between the highest percentage of prenatal exposure in the capital and certain maternal sociodemographic characteristics. CONCLUSIONS: These results indicate considerable variability in the prevalence of fetal exposure to ethanol in different Italian cities, as determined by the objective measurement of biomarkers in meconium. These data, together with previous ones obtained in Barcelona, Spain, indicate that gestational ethanol exposure is widespread, at least in parts of Europe.

The combination of depressive symptoms and smoking shorten life expectancy among the aged.

BACKGROUND: Depression is a potential risk factor for mortality among the aged and it is also associated with other chronic diseases and unhealthy lifestyles that may also affect mortality. The purpose of this study was to investigate the association between depressive symptoms and mortality, controlling for health, nutritional status, and life-style factors. METHODS: A cohort of elderly people (N = 167) was followed-up for ten years. Information on socio-demographic characteristics, medical history, smoking, and alcohol consumption was collected. The primary outcome was all-cause mortality; the secondary outcome was cancer-specific mortality. The Geriatric Depression Scale (GDS-15) was used to assess depression. Using a multivariable Cox proportional hazards regression, we examined the association between depressive symptoms and mortality. RESULTS: Elderly people with depression (scoring above the depression cut-off of 7) had a 53% increased risk of mortality (relative risk (RR) 1.53; 95%CI: 1.05-2.24) compared to non-depressed subjects. The combination of depressive symptoms with smoking was associated with a particularly higher risk of mortality (RR: 2.61; 95%CI: 1.28-5.31), after controlling for potential confounders. CONCLUSIONS: Depressive symptoms are associated with a significantly increased risk of all-cause mortality. The combination of depressive symptoms and smoking shorten life expectancy among the aged.

Exposure to secondhand smoke in Italian non-smokers 5 years after the Italian smoking ban.

BACKGROUND: No data on secondhand smoke (SHS) exposure are available on a national level in Italy. To assess the prevalence of exposure to SHS in indoor public places, home and cars in non-smoking Italian population, we conducted a survey 5 years after the national smoking ban. METHODS: In 2010, we conducted a survey on a representative sample of the Italian population aged≥15 years. Analyses were conducted on 2365 non-smokers. Current (during the previous week) self-reported exposure to SHS was assessed in public places, at home and in private cars. RESULTS: The prevalence of SHS exposure in any setting (excluding workplaces) was 31.2%. SHS exposure was 10.2% in public places, 15.6% at home and 17.9% in cars. The corresponding estimates among the young (15-24 years) were 54.2% in any setting, 21.4% in public places, 27.1% at home and 32.9% in cars. By multivariate analysis, males, the young, subjects from southern Italy and former smokers were more frequently exposed in any setting. CONCLUSIONS: The Italian smoking ban substantially decreased SHS exposure. However, specific subpopulations, including the young, are still frequently exposed both in public and private places. We observed a relatively high SHS exposure in private vehicles. Thus, further control to improve compliance with the smoking ban and an extension of the smoke-free legislation to motor vehicles are needed.

Dopamine agonists for the treatment of cocaine dependence.

BACKGROUND: Cocaine dependence is a disorder for which no pharmacological treatment of proven efficacy exists, advances in the neurobiology could guide future medication development OBJECTIVES: To investigate the efficacy and acceptability of dopamine agonists alone or in combination with any psychosocial intervention for the treatment of cocaine abuse and dependence SEARCH METHODS: We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE and CINAHL, PsycINFO in June 2011 and researchers for unpublished trials SELECTION CRITERIA: Randomised and controlled clinical trials comparing dopamine agonists alone or associated with psychosocial intervention with placebo, no treatment, other pharmacological interventions DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data MAIN RESULTS: Twenty three studies, 2066 participants, met the inclusion criteria. Comparing any dopamine agonist versus placebo, placebo performed better for severity of dependence, four studies, 232 participants, SMD 0.43 (95% CI 0.15 to 0.71), depression, five studies, 322 participants, SMD 0.42 (95% CI 0.19 to 0.65) and abstinent at follow up RR 0.57 (95% CI 0.35 to 0.93). No statistically significant different for the other outcomes considered. Comparing amantadine versus placebo, results never gain the statistical significance, but there is a trend in favour of amantadine for dropouts and depression. Results on adverse events and depression, were in favour of placebo although the difference do not reach the statistical significance. Comparing bromocriptine and Ldopa/Carbidopa versus placebo, results never reached statistical significance. Comparing amantadine versus antidepressants, antidepressants performed better for abstinence. The other two outcomes considered did not show statistically significant differences although dropouts and adverse events tended to be more common in the antidepressant group.The quality of evidence, assessed according to GRADE method, may be judged as moderate for the efficacy of any dopamine agonist versus placebo and as moderate to high for amantadine versus placebo and versus antidepressants. AUTHORS' CONCLUSIONS: Current evidence from randomised controlled trials does not support the use of dopamine agonists for treating cocaine dependence. This absence of evidence may leave to clinicians the alternative of balancing the possible benefits against the potential adverse effects of the treatment. Even the potential benefit of combining a dopamine agonist with a more potent psychosocial intervention which was suggested by the previous Cochrane review (Soares 2003), is not supported by the results of this updated review.

Smoking in young and adult population, Italy 2009.

AIMS AND BACKGROUND: To monitor smoking prevalence and trends of young and adult populations in Italy. METHOD AND STUDY DESIGN: A survey on smoking was conducted during March-April 2009 on a sample of 3213 participants (1546 men and 1667 women), representative of the Italian population aged 15 years or over. Data from a simplified questionnaire were collected in an over-sample of 1010 young individuals, reaching a total of 1390 participants aged 15-24 years (713 males and 677 females). RESULTS: In 2009, 25.4% of Italians described themselves as current cigarette smokers (28.9% of men and 22.3% of women). Among young people, male smoking prevalence steadily declined from 38% in 2001 to 29% in 2009. Smoking prevalence in young females decreased from 30% in 2001 to 19% in 2008, but increased to 23% in 2009. Among both males and females aged 15-17 years, smoking prevalence was around 10%. This increased in the 18-24 year age group, with 37.6% of current smokers among males and 28.9% among females. Among young current smokers, 45.5% reported that they would reduce the number of cigarettes smoked per day, 11.1% would quit smoking, and 4.3% would switch to hand-rolled cigarettes, assuming that the minimum price of a pack of cigarettes increased to € 5. CONCLUSIONS: Our findings indicate that smoking prevalence has decreased over recent years, particularly in the young. Still, over one-fourth of Italian adults are smokers. An increase in cigarette price represents an effective strategy to control tobacco, particularly in the young.

Smoking prevalence and smoking attributable mortality in Italy, 2010.

OBJECTIVE: To provide updated information on smoking prevalence and attributable mortality in Italy. METHOD: A representative survey on smoking was conducted in 2010 on a sample of 3020 Italian adults (1453 men and 1567 women). We used SAMMEC software to update smoking attributable mortality in Italy. RESULTS: In 2010, 21.7% of Italians (23.9% of men and 19.7% of women) described themselves as current smokers. Smoking prevalence was higher in men than in women in all age groups, except for the middle-aged population (45-64 years; 25.6% in men and 25.9% in women). Age-standardized smoking prevalence was higher in men than in women among less educated subjects and in southern Italy. No substantial difference was observed either in educated subjects or in northern and central Italy. Overall, 71,445 deaths in Italy (52,707 men and 18,738 women, 12.5% of total mortality) are attributable to smoking. CONCLUSION: The overall smoking prevalence of 21.7% in 2010 is the lowest registered over the last 50 years. Since 1998, smoking related deaths declined by almost 15%. Given that Italy has now reached the final stage of the tobacco epidemic, anti-smoking strategies should focus on support for smoking cessation.

Temporal changes of under-reporting of cigarette consumption in population-based studies.

OBJECTIVES: To monitor trends in under-reporting of smoking in Italy over the last two decades. METHODS: A total of 9 representative population-based surveys on smoking conducted in Italy in 1990 and annually between 2001 and 2008, covering 26,397 individuals, were studied. The number of cigarettes per day per person aged 15 years or over, obtained from these interview-based surveys, was compared with official data from legal sales. RESULTS: Over the last two decades, self-reported smoking prevalence progressively decreased from 32% in 1990 to 22% in 2008. Self-reported daily per capita consumption of cigarettes also showed a reduction between 1990 and 2008, notably so over the last few years (from 5.2 in 1990 to 4.0 in 2004 to 3.2 in 2008). According to data from legal sales, number of cigarettes per day per person decreased from 5.3 in 1990 to 5.0 in 1992, levelled off from 1992 to 1997, subsequently increased from 5.0 in 1997 to 5.8 in 2002 (likely due to control of smuggling), and decreased over the last 6 years (to 4.9 in 2008). These figures correspond to an under-reporting of approximately 1% in 1990, 25% in 2001 and up to 35% in 2008. CONCLUSIONS: The difference in cigarette consumption between legal sale and self-reported data has substantially increased over the last two decades in Italy, reflecting increasing under-reporting of cigarette consumption mainly due to a decreasing social acceptability of smoking. Comparisons between interview-based and legal sale data are complicated by factors such as smuggling control and changes in the population (eg, increased proportion of immigrants); however these are able to justify only a small proportion of the gap found in Italy.

Effect of physical fitness and endurance exercise on indirect biomarkers of growth hormone and insulin misuse: Immunoassay-based measurement in urine samples.

Indirect biomarkers of recombinant human growth hormone (rhGH), insulin-like growth factor-I (IGF-I), insulin-like growth factor-II (IGF-II), insulin-like growth factor binding proteins (IGFBP-2 and IGFBP-3) and insulin (C-peptide) were measured together with urinary parameters of renal damage (beta(2)-microglobulin and proteinuria) by immunoassays, in house validated for the purpose, in 61 subjects (36 elite athletes, 18 recreational athletes and 7 sedentary individuals) with different levels of physical fitness and endurance exercise. Validation parameters were good for the evaluated assays, excluding a high inter-assay imprecision and inaccuracy of 24 and 26% obtained for GH assay. The range of concentrations found in urine samples under investigation was generally covered by the calibration curves of the studied immunoassays. However, for the samples below or above the calibration curve, opportune dilution or concentration were performed. Particularly, C-peptide samples had to be diluted 1:5 and beta(2)-microglobulin ones assayed using a triple sample volume, to fall within the calibration range. Urinary C-peptide was the only biomarker statistically higher in samples of elite athletes when compared to recreational athletes and sedentary individuals. Among elite athletes, tae-kwon-do athletes showed the highest IGF-II basal values while weightlifting athletes showed the lower IGF-I and IGFBP-3 basal values. The trend observed in weightlifters' basal samples was confirmed in their training samples: IGF-I, IGF-II, IGFBP-3 and beta(2)-microglobulin were lower in with respect to those from synchronised swimming. Over the training season, within athlete variability was observed for IGFBP-3 for weightlifting athletes. In the studied subjects, no direct associations were found between biomarkers of GH or insulin misuse and urinary parameters of renal damage, eventually due to high-workload endurance training. The variations observed in different biomarkers should be taken in consideration in the hypothesis of setting reference concentration ranges for doping detection.

Risk factors of one year increment of coronary calcifications and survival in hemodialysis patients.

BACKGROUND: Heart and coronary calcifications in hemodialysis patients are of very common occurrence and linked to cardiovascular events and mortality. Several studies have been published with similar results. Most of them were mainly cross-sectional and some of the prospective protocols were aimed to evaluate the results of the control of altered biochemical parameters of mineral disturbances with special regard to serum calcium, phosphate and CaxP with the use of calcium containing and calcium free phosphate chelating agents. The aim of the present study was to evaluate in hemodialysis patients classic and some non classic risk factors as predictors of calcification changes after one year and to evaluate the impact of progression on survival. METHODS: 81 patients on hemodialysis were studied, with a wide age range and HD vintage. Several classic parameters and some less classic risk factors were studied like fetuin-A, CRP, 25-OHD and leptin. Calcifications, as Agatston scores, were evaluated with Multislice CT basally and after 12-18 months. RESULTS: Coronary artery calcifications were observed in 71 of 81 patients. Non parametric correlations between Agatston scores and Age, HD Age, PTH and CRP were significant. Delta increments of Agatston scores correlated also with serum calcium, CaxP, Fetuin-A, triglycerides and serum albumin. Logistic regression analysis showed Age, PTH and serum calcium as important predictors of Delta Agatston scores. LN transformation of the not normally distributed variables restricted the significant correlations to Age, BMI and CRP. Considering the Delta Agatston scores as dependent, significant predictors were Age, PTH and HDL. A strong association was found between basal calcification scores and Delta increment at one year. By logistic analysis, the one year increments in Agatston scores were found to be predictors of mortality. Diabetic and hypertensive patients have significantly higher Delta scores. CONCLUSIONS: Progression of calcification is of common occurrence, with special regard to elevated basal scores, and is predictive of survival. Higher predictive value of survival is linked to the one year increment of calcification scores. Some classic and non classic risk factors play an important role in progression. Some of them could be controlled with appropriate management with possible improvement of mortality.

Immunomodulating properties of gamma-hydroxybutyrate (GHB), flunitrazepam and ethanol in 'club drugs' users.

Despite the increasing concern about gamma-hydroxybutyrate (GHB) toxicity in users, no studies have addressed GHB and other club drugs effects on the immune system under controlled administration. Lymphocyte subsets and functional responsiveness of lymphocytes to mitogenic stimulation were measured in 10 healthy male recreational users of GHB who participated in five experimental sessions within the framework of a clinical trial. The study was randomized, double blind, double dummy and cross-over. Drug conditions were: a single oral dose of GHB (40 mg/kg or 60 mg/kg), ethanol (0.7 g/kg), flunitrazepam (1.25 mg) and placebo. Acute GHB produced a time-dependent immune impairment in the first 4 hours after drug administration associated with an increase in cortisol secretion. Although total leukocyte count remained unchanged, there was a significant decrease in the CD4 T/CD8 T-cell ratio, as well as in the percentage of mature T lymphocytes, probably because of a decrease in both the percentage and absolute number of T helper cells. A significant decrease was also observed in natural killer cells and in functional responsiveness of lymphocytes to mitogenic stimulation. Flunitrazepam administration did not produce any change in the immune system, while ethanol intake produced a decrease in B lymphocytes and in lymphocyte proliferative response to mitogens. These results provide the first evidence that GHB intake under a controlled environmental setting impairs the immunological status and confirms the alterations in the immune function caused by ethanol.