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Background The aim of the present study was to compare the cross-sectional association between smoking and depressive symptoms among adolescents between Sweden and Italy, two countries historically characterized by different norms about tobacco use and different tobacco control efforts. Methods A cross-sectional study including 3283 adolescents 15–16 years of age participating in the Swedish KUPOL study and 1947 same-age adolescents from the Italian BE-TEEN study. Current smoking was defined as any smoking in the past 30 days. Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale for Children (CES-DC) and the internalizing score of the Strengths and Difficulties Questionnaire (SDQ). Country differences were explored in stratified and interaction analyses. Results Current smoking was associated with a 2- to 3-fold increased odds of depressive symptoms among Swedish adolescents using both CES-DC and SDQ internalizing scale. Among Italian adolescents, slightly lower increased odds of 1.5–2.5 for depressive symptoms with smoking were found using the CES-DC but not the SDQ scale. Both multiplicative and additive interactions for country were significant. The association between smoking and depressive symptoms was weaker among Italian compared with Swedish adolescents for both scores. Conclusions Countries with different tobacco norms and control show different associations between smoking and depressive symptoms in adolescence, probably due to different psychosocial profiles of smokers. These findings need to be considered when planning tobacco prevention programmes, e.g. by focusing on early detection of mental health distress among adolescents in settings with declining smoking prevalence and restrictive tobacco control environments. [ABSTRACT FROM AUTHOR]

Polychlorinated biphenyls (PCBs) are human carcinogens, based on sufficient evidence for melanoma and limited evidence for non-Hodgkin lymphoma and breast cancer. Few data are available for liver cancer, although PCBs cause it in rats and determined liver damage in poisoned people. We investigated the association between PCB serum levels and hepatocellular carcinoma (HCC) with a case–control study in a PCB-polluted area in North Italy. We enrolled prospectively 102 HCC incident cases and 102 age and gender-matched hospital controls. Serum concentrations of 33 PCB congeners were determined by a gas chromatograph coupled to mass spectrometry. Of 102 HCC cases, 62 who had lost < 3 kg of body weight in past 3 years were included in the analysis (67.7% males, mean age 68 years). The odds ratio (OR) for HCC for 3rd compared to 1st tertile of PCB distribution was 1.76 (95% confidence interval 0.62–5.03) for total PCB, adjusting for socio-demographic variables and risk factors for HCC by logistic regression. For most PCB congeners, ORs > 1.5 or 2 were found, although the 95% CIs included the null value for almost all of them. This preliminary study suggests that PCBs might play a role in HCC development. [ABSTRACT FROM AUTHOR]

Background: Two biomarkers, the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), have been shown to be indicative of systemic inflammation and predictive of mortality in general population. We aimed to assess the association of NLR and PLR, with risk of death in HIV-infected subjects when also taking account of HIV-related factors.Methods: We conducted a multicenter Italian cohort study from 2000 to 2012 including HIV-infected subjects naïve at antiretroviral treatment. The associations of NLR and PLR with all-cause mortality were tested by univariate and multivariate analyses using both time independent and dependent Cox proportional hazard models. We also fitted models with a cubic-spline for PLR and NLR to evaluate the possible non-linear relationship between biomarkers values and risk of death.Results: Eight-thousand and two hundred thirty patients (73.1% males) with a mean age of 38.4 years (SD 10.1) were enrolled. During a median follow-up of 3.9 years, 539 patients died. PLR < 100 and ≥ 200, as compared to PLR of 100-200, and NLR ≥ 2, as compared to < 2, were associated with risk of death at both univariate and multivariate analyses. Using multivariate models with restricted cubic-splines, we found a linear relationship of increasing risk of death with increasing values for NRL over 1.1, and an U-shape curve for PLR, with higher mortality risk for values higher or lower than 120.Conclusions: Our data suggest that NLR and PLR can reflect the severity of the underlying systemic disturbance of the inflammatory process and coagulation leading to augmented mortality in HIV positive subjects. [ABSTRACT FROM AUTHOR]

Introduction Polychlorinated biphenyls (PCBs) are persistent pollutants classified among endocrine disruptors and human carcinogens. In an urban area in Northern Italy (Brescia), a chemical factory producing PCBs from 1938 to 1984 caused soil and food pollution. Since the discovering of the environmental pollution in the area in 2001, various public health interventions have been implemented to avoid human contamination. Methods Two independent surveys were carried out in 2003 and 2013 using the same study design and methods. A random sample of the adult general population living in four areas of the town with different soil contamination level was enrolled in both surveys. Investigation included serum levels of 24 PCB congeners and of other common clinical-chemical parameters and questions about residential and occupational history as well as current and past diet and consumption of locally produced food. 537 subjects were tested in the 2003 and 488 in the 2013 survey. Results Total PCB serum levels showed a strong correlation with age (Spearman r = 0.71 in 2003 and r = 0.80 in 2013), but not with gender. Consumers of food produced in the most polluted area had higher total PCB serum levels (median 15.6 and 4.7 ng/ml in 2003 and 2013, respectively) than non-consumers (4.1 and 2.3 ng/ml) and consumers of food produced in non-polluted areas (6.5 and 1.9 ng/ml), with increasing trend of PCB serum levels with cumulative local food intake. PCB serum levels from 2003 to 2013 survey declined by around half in all age groups, especially among the youngest people. The total PCB reduction was found to be due to a combination of a birth cohort effect (− 41% every 10 years) and survey period effect (− 18% in 2013 versus 2003), with medium chlorinated CB congeners showing the most relevant reduction (− 30%) between the two surveys. High chlorinated CBs were more strongly associated with birth cohort (− 46% every 10 years): in the 2013 survey they represented 58% of total PCBs in 60–79 years old while they were 37% among the under 40s with a median value 20 times higher in the oldest than in the youngest (3.1 versus 0.16 ng/ml). Conclusions PCBs serum levels declined from the 2003 to 2013 survey though they are still high in the elderly mainly because of past intake of locally produced contaminated food. Present findings suggest that PCBs food chain contamination and human absorption have been interrupted successfully in the area since discovery of the pollution in 2001. [ABSTRACT FROM AUTHOR]

Background: The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), two low cost, routinely available inflammatory indices, have been found to be associated with risk of death in patients with solid cancer, in both general population and HIV-positive subjects. However, no study investigated the role of NLR and PLR as predictive of cancer incidence so far. Methods: The aim of our study was to assess the association of PLR and NLR with risk of developing solid non-AIDS defining cancer (NADC) in HIV-infected subjects. We conducted a multicenter Italian cohort study from 2000 to 2012 including HIV-infected subjects naïve at antiretroviral treatment at enrollment. The associations of NLR and PLR with NADC incidence were evaluated by univariate and multivariate analyses using both time independent and time dependent Cox proportional hazard models. Results: Thirteen thousand five hundred fifty-nine patients (73.3 % males) with a mean age of 36.0 years (SD 10.0) were included. The median (inter-quartile range) of NLR and PLR at baseline were 1.47 (1.03-2.17) and 109.9 (79.6-155.3), respectively. During a median follow-up of 3.9 years, 337 subjects had a first diagnosis of solid NADC. The crude and age- and gender-standardized incidence rates were 3.57 and 3.91 per 1000 person-years, respectively. No statistically significant association was found between NLR and PLR and NADC incidence, using multivariate models, including also time-dependent Cox models with a cubic-spline for NLR and PLR. Conclusion: This study does not sustain the hypothesis that NRL and PLR may be useful for predicting the risk of cancer in HIV positive subjects. [ABSTRACT FROM AUTHOR]

Abstract: Background: Polychlorinated biphenyls (PCBs) have been hypothesized to increase the risk of non-Hodgkin lymphoma (NHL), although conclusive evidence is still lacking. High levels of PCBs were found in soil in some areas close to a PCB-producing factory in Brescia, North Italy. We conducted a population-based case-control study among residents of the town to investigate the possible association between PCB pollution and NHL in this area. Methods: We included both incident and deceased NHL cases, and a random sample of the town residents as controls, frequency matched to cases as regards age and gender. Exposure to PCBs was estimated on the basis of the lifetime residential history of cases and controls in four different areas of the town—A, B and C (polluted areas) and D (control area). Results: A total of 495 cases (287 incident cases) and 1467 controls were enrolled. Positive associations were found between NHL and having resided for at least 10 years in the area A, the most polluted area (odds ratio, OR=1.8; p=0.02) and for having resided in any of the polluted areas considered together (A+B+C) (OR=1.4; p=0.08). However, no associations were evident for having resided 20 years or longer in the polluted areas or when analyzing the association with each subject''s main residence in his/her lifetime. Conclusion: This study provides some evidence for an association between PCB exposure and NHL, though results should be considered with caution in the absence of individual biological measures of exposure. [Copyright &y& Elsevier]

Abstract: Background: Polychlorinated biphenyls (PCBs) may interact with several thyroid functions. Severe environmental pollution by PCBs has been observed in Brescia, Italy, due to the presence of a factory that produced these compounds until 1984. Objectives: We aimed to investigate the correlation between serum levels of total PCBs and PCB 153 and thyroid hormone serum levels in adults in a cross-sectional population-based study. Methods: A total of 527 subjects were enrolled; they were face-to-face interviewed about their history of thyroid disease and provided a blood sample under fasting conditions. The serum levels of free and total triiodothyronine (FT3 and TT3), thyroxine (FT4 and TT4) and thyroid-stimulating hormone (TSH), anti-thyroperoxidase (anti-TPO) and anti-thyroglobulin (anti-TGA), and lipid-adjusted total PCBs and PCB 153 were determined. Results: There was no statistically significant difference in total PCB and PCB 153 concentrations in subjects with and without thyroid disease. Inverse, weak, statistically significant correlations were found between total PCBs and FT3 (Spearman''s r=−0.09) and between total PCBs and PCB 153 and TSH (Spearman''s r=−0.16 and −0.12, respectively). However, multiple regression analysis with FT3 and TSH serum levels as dependent variables and total PCBs and PCB 153 serum levels as predictors, including age, gender and BMI, showed a positive, rather than negative, association of PCBs and PCB 153 with FT3 and no association with TSH. Conclusions: This study does not support the hypothesis that relatively high PCB environmental exposure can determine substantial alterations in thyroid function among adult people. [Copyright &y& Elsevier]

Abstract: It is rarely possible to identify reverse faults that bring portions of substratum solid rock to lie above decomposed rock. Only where the differences between the fresh rock and weathered rock are very clear is it possible to recognise such faults. A “reverse profile” is defined as a slope profile in which fresh rock (granitoids) overlaps rocks which have been greatly altered by mature weathering (saprolite of granitoids). Such a profile occurs along the slopes of Molini Valley to the south of the village of Fabrizia (Calabria, southern Italy) and we interpret the morphological, mechanical and structural evidence as typical of a reverse fault. The mineral-petrographic analysis of the grus on the bed of the fault and of the cover of relatively fresh rock (Schmidt hammer 18–35) confirms that the granular framework can be attributed to subaerial alteration and not to mechanical deformation. The study area is located at the centre of the largest kinematic body of southern Calabria (the Serre massif-exclusively granitoids) until now considered to be only affected by extensional tectonics, creating high angle normal faults. In this area the tectonic processes, the thickness and spread of granitoid weathering mantles and the depth of the valleys, give rise to several landslides. These are generally translational slides with ample cut surfaces between the weathered body and the underlying fresh rock; as a consequence, very large deposits in the valleys can be found, mostly produced by debris flow processes. At the foot of the slopes around Fabrizia, coarse debris avalanches (with cobbles having a volume of over 0.3–0.4 m3) are occasionally observed, unless there is widespread development of a “reverse weathering profile” on the slopes above. [Copyright &y& Elsevier]

The prevalence of atopy and asthma, and their association with familial and environmental factors were investigated among 13- to 14-yr-old children living in Brescia, an industrialized town in North Italy. All the 1450 children attending primary school in the town were invited to participate, and 967 of them (66.7%, 493 males) provided a valid questionnaire filled in by their parents at home. We used a modified version of the questionnaire adopted in the Italian Study of Respiratory Disorders in Childhood and Environment, which is an extended version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Six hundred and twenty-eight subjects underwent skin prick test (SPT), and 308 of them (49%) were positive for at least one of the 12 allergen extracts commonly employed. Ninety-nine children (10.2%) had a physician's diagnosis of asthma – 12.4% of the males and 8.0% of the females (p = 0.03). The prevalence of wheezing in the past 12 months was 6.2%. Atopy was found in 76.8% of the subjects with, and in 45.6% of those without physician's diagnosis of asthma (p < 0.001). Analysis by multiple logistic regression showed an inverse association between physician-diagnosed asthma and female sex (odds ratio, OR = 0.5); presence of relatives in the bedroom in initial years of life (OR = 0.6); attending day care (OR = 0.4) and infant school (OR = 0.4); a positive association with parental history of wheezing (OR = 2.5) and asthma (OR = 3.8); and the child's history of asthmatic bronchitis (OR = 31.9) and atopic eczema (OR = 3.8) in the first 2 yr of life. The strength of the associations did not change when restricting the analysis to atopic asthma. In conclusion, atopy and clinical asthma among 13- to 14-yr-old adolescents are significantly associated with some familial and environmental factors, providing further support for the hygiene hypothesis. Prevalence of atopy, but not of asthma, is high in this industrialized area. The strong association found between atopy and clinical asthma suggests that atopy may play a role in causing asthma in genetically predisposed children only. [ABSTRACT FROM AUTHOR]

Abstract: High levels of PCBs were recently found in soil, food and some farmers living close to a chemical factory which until the 1980s had produced polychlorinated biphenyls (PCBs) in Brescia, North Italy. We performed a survey on a random sample of subjects aged 20–79 years living in various areas of the town with different levels of soil pollution to investigate factors associated with increased levels of PCB in serum (24 congeners were tested). Total PCB values were closely related to age (Spearman r =0.68; p <0.0001). The 166 consumers of locally produced food had higher PCB levels than non-consumers (median=1143 versus 719; 95th centile=9301 versus 2635ng/g lipid) with the highest levels among consumers of food produced in the most contaminated area close to the factory (median=2551; 95th centile=33464ng/g lipid). A dose-effect relationship between consumption of food produced in this area and PCB blood levels was observed (Spearman r =0.52, p =0.0014). Consumers of only plant food produced in this area had higher levels of PCB than non-consumers (median=1100; 95th centile=10800ng/g lipid). Three subjects who had worked at the factory in the past showed high PCB levels. Distribution of PCB congeners did not differ between consumers of locally produced food and non-consumers, apart from PCB 209 which was found at high levels in former factory workers and was more common among consumers of food produced in the polluted area. In conclusion, we found high serum PCB levels in humans living in a highly polluted area in an industrialized town in Italy, due mainly to consumption of food produced in polluted areas. [Copyright &y& Elsevier]

Introduction: A chemical factory located in Brescia, an industrialized town in North Italy, produced polychlorinated biphenyls (PCBs) since the 1930s to the 1980s, determining a relevant pollution of soil, food and people. Since 2001, following a survey carried out in the general population living in the town, the individuals with PCB serum levels higher than the reference entered a follow-up study.Methods: We performed a prospective cohort study including subjects with at least three PCB measures during the period 2003-2015. We evaluated the temporal trends of total PCB serum levels, the most common PCB congeners (PCB 138,153, 170, 180, 194 and 209), and toxic equivalency of dioxin-like PCBs using univariate and multivariate mixed models with and without a cubic-spline term for time.Results: A total of 128 subjects were enrolled (46.1% males, mean age at enrolment 57.7 years). The geometric mean of PCBs decreased from 35.4ng/ml at 0-3 years to 29.3ng/ml at 4-8 years and to 23.0ng/ml at 9-12 years. A 3.8% reduction of total PCB serum levels per year was estimated using both univariate and multivariate mixed models adjusted for age; a similar reduction was found for the most common PCB congeners and for toxic equivalency. Total PCB serum levels decreased over time for each age group: -3.9%, -4.0% and -3.4% for subjects aged ≤55 years, 56-65 and ≥66 years, respectively.Conclusion: A significant decrease of serum concentrations of PCBs was observed in subjects with high serum levels of these chemicals at enrolment over a twelve year period. The decrease was evident for each PCB congener and age group. [ABSTRACT FROM AUTHOR]

Background:Early detection of undiagnosed HIV infected patients is of paramount importance. The attitude of Italian hospital-based Internal Medicine physicians to prescribe HIV testing following the detection of HIV-associated signs, symptoms and behaviours (triggers) has been reported to be poor. The aim of the study is to quantify the extent of the missed opportunities for early HIV diagnosis in Internal Medicine Departments (IMD). Methods:Patients admitted to IMD of a General University Hospital in Italy in March–June 2013 were interviewed using a structured questionnaire investigating the presence of triggers for HIV testing, including patient’s characteristics, symptoms and conditions associated with HIV infection. HIV tests performed during hospitalisation were recorded. Results:HIV testing was performed in 73 (6.6%) out of 1113 hospitalisations (1072 patients), providing positive results in three cases (4.1%). All of them presented ≥1 triggers. Conversely, 853 triggers were identified in 528 hospitalisations with at least one trigger (47.4%). The proportion of hospitalisations where an HIV testing was prescribed was 3.1%, 9.5% and 16.0% in the presence of zero, one-to-two or more triggers, respectively. Age <70 years, female gender, length of hospital stay, haematological disease, HBV infection, multiple sexual partners and lymphadenopathy were predictors of HIV testing by logistic regression analysis. Conclusions:Although chances of an HIV test being performed in patients hospitalised in IMD increases along with the number of triggers, the number of tests being performed in people presenting with triggers is unacceptably low and requires educational interventions in order to obtain individual and public health advantages. [ABSTRACT FROM AUTHOR]

To estimate prevalence and incidence of thrombotic Primary Antiphospholipid Syndrome (PAPS) in the general population aged 18–49 years. The study was carried out in Valtrompia, a valley in northern Italy, in 2011–2015. The identification of PAPS cases leveraged three integrated sources: 1) Rheumatology Unit at the University Hospital; 2) General Practitioners; 3) hospital discharge codes of patients admitted for thrombotic events. Prevalence and incidence were estimated as 22.9 (95% C.I. 11.4–41.0) and 5.0 (2.6–8.7) cases per 100,000 individuals, respectively. The estimates were 28.3 and 4.8, and 17.2 and 5.1 in males and females, respectively. The type of disease onset was mainly of arterial type in men and venous in women. Thrombotic PAPS was found to be a rare disease in this population-based study. Prevalence and incidence were not significantly different between males and females aged 18–49 years, but a different type of onset was observed. [ABSTRACT FROM AUTHOR]

Abstract: Brescia (North Italy) is located in a highly industrialized area with diffuse environmental pollution by polychlorinated biphenyls (PCBs) and with a high incidence of hepatocellular carcinoma (HCC). We aimed to investigate the concentration of PCBs congeners in serum, liver and adipose tissue of patients with HCC living in this area. We enrolled prospectively 101 HCC incident cases. Lipid-adjusted PCBs concentration of single congeners and total PCBs concentration, computed as the sum of 24 PCBs congeners, were measured in the serum of all subjects and in the liver and abdominal fat of 59 HCC cases undergoing surgery. A high correlation was found between PCBs serum and liver (Spearman r =0.79), serum and fat (r =0.91), and liver and fat (r =0.75) concentrations. Serum PCBs concentration in HCC patients did not vary according to demographical, clinical or epidemiological variables, apart from age, as PCBs concentration increased linearly with the subject’s age. This study confirms that serum lipid-adjusted PCBs concentration is a valid measure of PCBs body storage and is highly correlated with PCBs concentration detected in other biological samples. [Copyright &y& Elsevier]

Abstract: Background: Hepatitis C virus (HCV) infection is a global health problem. In Western countries, illicit drug users (IDUs) constitute the largest proportion of HCV patients. International guidelines no longer regard ongoing illicit drug use as a contraindication to antiviral therapy for chronic hepatitis C (CHC). Nonetheless, in clinical practice, few IDUs have access to HCV treatment, likely because many physicians believe these patients will have poor adherence or a lack of treatment efficacy. Objective: The aim of this study was to assess effectiveness and tolerability of combination treatment with ribavirin plus recombinant or pegylated interferon-α in the treatment of CHC in IDUs. Methods: MEDLINE, EMBASE, and the Cochrane Library were searched for relevant studies published in English between 2000 and December 2008. The following terms were searched: chronic hepatitis C, interferons, antiviral agents, methadone, and substance-related disorders. Full-text articles and abstracts were searched using predefined criteria. A manual search of abstracts from 8 international meetings of hepatologists was also conducted. Only prospective studies with a sample size >15 and a homogeneous treatment schedule were included. Articles were extracted independently by 2 of the authors using an electronic standardized form including study quality indicators. Results: Sixteen prospective studies were included, and data from a cohort of 953 IDUs were analyzed. The estimated overall sustained virologic response (SVR) and dropout (DO) rates in IDUs were 52% (95% CI, 44%–60%) and 26% (18%–35%, 95% CI), respectively. The rate of psychiatric severe adverse events (SAEs) that led to treatment discontinuation was 2% (95% CI, 1%–3%). These prevalences were not significantly different from those reported in registration trials of treatment of CHC that excluded IDUs from the study population (SVR, 50% [95% CI, 39%–61%]; DO, 26% [95% CI, 12%–41%]; and psychiatric SAEs, 2% [95% CI, 0%–6%]). By subgroup analysis, active ongoing drug use negatively affected the rate of treatment success (39% [95% CI, 30%–49%] vs 55% [95% CI, 45%–64%]; P = 0.02). Conclusion: Based on data from 16 prospective clinical studies of CHC treatment in IDUs published in the past 10 years, findings on effectiveness and tolerability are comparable to those in the general population. [Copyright &y& Elsevier]

Background: Preschool children with clinically-diagnosed asthma have a higher rate of emergency department visits and consume more resources for management than older children. However, no clinical trials have yet been performed measuring the impact of a combined diagnostic, therapeutic and educational pathway regimen for evaluation of wheezing control in children aged less than 6 years. The purpose of the present study was to assess the impact of a pediatric program developed in Italy, the Diagnostic Therapeutic Educational Pathway (DTEP), for asthma management in children less than 6 years old attending an asthma referral center. Methods: This is a retrospective population-based cohort study performed in children with asthma aged 0–5 years, attending at "Io e l'Asma center", Brescia, Italy between September 2007 and December 2014. The incidence rates (IRs) of hospitalization, emergency room visits, use of outpatient services and drug usage for dyspnea, wheezing, or respiratory symptoms were evaluated for time periods prior to and after DTEP intervention. Results: A total of 741 patients, aged 0–5 years completed the DTEP, including 391 and 350 children aged 0–2 and 3–5 years, respectively. The percentage of children aged 0–2 and 3–5 years showing improved control of wheezing symptoms during the 1st to 3rd visit interval as a result of the DTEP intervention increased from 39.5 to 60.9% and from 25.5 to 75.5%, respectively. During these periods, the IRs showed a significant decrease for all outcomes, from-8.6% to − 80.4%. Although specific IRs for drug prescriptions declined, particularly for LABA plus corticosteroids, antibiotics, and systemic corticosteroids, they increased for SABA, inhaled corticosteroid and leukotriene receptor antagonist usage. Conclusions: The results suggest that a real-world assessment of the integrated DTEP program for preschool children provides evidence for improved wheezing control and reduction of adverse therapeutic related outcomes. [ABSTRACT FROM AUTHOR]

Food Frequency Questionnaires (FFQs) are valuable research tools in nutritional epidemiology. This study aimed to develop and validate a new semi-quantitative FFQ, specifically designed for the Italian population and best fitted for self-administration. During the development process, we adapted to Italian needs the validated FFQ proposed by the Fred Hutchinson Cancer Research Center, revising food items, food frequency scale, portion sizes, and time frame. To assess the validity of the proposed FFQ, we compared the estimated daily intake using FFQ with the mean of 3-day food diaries and one 24-hour recall (considered as reference method). The validation process was conducted among a cohort of 51 healthy subjects enrolled in a clinical trial. Four statistical tests were applied on 23 estimated nutrient intakes. Spearman's coefficients ranged from 0.223 (sodium) to 0.748 (alcohol) and were good (≥0.50) and acceptable (0.20-0.49) for 7 and 16 nutrients, respectively. Cross classification showed a good agreement (≥50% in the same tertile or ≤10% in the opposite tertile) for 7 nutrients. The weighted Cohen's kappa values indicated an acceptable outcome (0.20-0.60) for 13 nutrients. Bland Altman plots did not show heteroscedasticity in the error terms, despite the presence of a bias. Our study provided a new Italian semi-quantitative FFQ for self-administration with an acceptable validation level. Its definitive release requires additional refinements and efforts. [ABSTRACT FROM AUTHOR]

Background: Recent data support the hypothesis that genetic damage occurring early in life during childhood can play an important role in the development of chronic diseases in adulthood, including cancer.Objectives: The objective of this paper, part of the MAPEC_LIFE project, is to describe the frequency of micronuclei and meta-nuclear alterations in exfoliated buccal cells of 6-8year-old Italian children recruited in five Italian towns (i.e., Brescia, Torino, Pisa, Perugia and Lecce) with different air pollution levels.Methods: About 200 children per town were recruited from primary schools. Biological samples were collected twice from the same children, in two different seasons (winter 2014-15 and late spring 2015). Cytogenetic damage was evaluated by the buccal micronucleus cytome assay.Results: Overall,n = 1046 children represent the final cohort of the MAPEC_LIFE study. On the whole, the results showed a higher mean MN frequency in winter (0.42 ± 0.54‰) than late-spring (0.22 ± 0.34‰). MN frequency observed among the five Italian towns showed a trend that follows broadly the levels of air pollution in Italy: the highest MN frequency was observed in Brescia during both seasons, the lowest in Lecce (winter) and Perugia (late-spring).Conclusions: To the best of our knowledge, the number of recruited children included in the analysis (n = 1046) is the highest compared to previous studies evaluating the frequency of MN in exfoliated buccal cells so far. MN frequency was associated with winter season and living in towns at various levels of air pollution, suggesting an important role of this exposure in determining early cytogenetic effects. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the association between persistent low-level viraemia, measured as viraemia copy-years (VCY), and all-cause mortality.Methods: We included 3271 HIV-infected patients who initiated their first combined ART (cART) during 1998-2012 enrolled in the multicentre Italian MASTER cohort. VCY was defined as the area under the curve of plasma viral load (pVL) and expressed in log10 copies · years/mL. VCY was evaluated from cART initiation until the end of follow-up [VCY-overall (VCY-o)], and stratified into before [VCY-early (VCY-e)] and after [VCY-late (VCY-l)] the eighth month from starting cART, and as the ratio of VCY-l to follow-up duration (VCY-l/FUD).Results: The risk of death increased of about 40% for higher than the median levels of VCY-o and VCY-e. Compared with subjects with permanently suppressed pVL after the eighth month from starting cART, mortality increased by 70% for those with VCY-l ≥3 log10 copies·years/mL, and by about 20-fold for those with VCY-l/FUD ≥2.3 log10 copies/mL. Patients who maintained low levels of VCY-l (<3 log10 copies · years/mL) or VCY-l/FUD (<2.3 log10 copies/mL) had a risk of death similar to patients with permanently suppressed pVL. CD4 cell count at baseline was predictive of high risk of death only in subjects with VCY-l ≥3 log10 copies · years/mL.Conclusions: The risk of death did not increase in HIV-infected patients with low levels of VCY-l compared with patients with permanent virological suppression. [ABSTRACT FROM AUTHOR]

Background: We carried out a study to evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae genital infections in school-based adolescents in Northern Italy.Methods: Systematic screening for C. trachomatis and N. gonorrhoeae genital infection was performed in 13th grade students in the province of Brescia, an industrialized area in Northern Italy. Student filled in a questionnaire on sexual behaviour and provided a urine sample for microbiological testing.Results: A total of 2,718 students (mean age: 18.4 years; 59.1% females) provided complete data (62.2% of those eligible). Overall 2,059 students (75.8%) were sexually active (i.e. had had at least one partner), and the mean age at sexual debut was 16.1 years (SD: 1.4). Only 27.5% of the sexually active students reported regular condom use during the previous 6 months, with higher frequency in males than in females (33.8% vs 24.2%). No case of N. gonorrhoeae infection was detected, while C. trachomatis was found in 36 adolescents, with a prevalence of 1.7% (95% CI: 1.2-2.4) among sexually active students, and no statistical difference between females and males (1.9 and 1.4%, respectively). Inconsistent condom use (odds ratio, OR = 5.5) and having had more than one sexual partner during the previous 6 months (OR = 6.8) were associated with an increased risk of Chlamydia infection at multivariate analysis.Conclusion: The prevalence of C. trachomatis infection among sexually active adolescents in Northern Italy was low, despite a high proportion of students who engage in risky sexual behaviour. No cases of N. gonorrhoeae infection were identified. [ABSTRACT FROM AUTHOR]

Back in December 2019, the novel coronavirus disease 2019 (Covid-19) started rapidly spreading worldwide, especially in Italy that was among the most affected countries. The geographical distribution of air pollution and Covid-19 mortality in Italy suggested atmospheric pollution as a worsening factor of severe Covid-19 health outcomes. The present nationwide ecological study focused on all 107 Italian territorial areas, aiming to assess the potential association between Particulate Matter concentration, less than 2.5 μm in diameter (exposure), and Covid-19 mortality rate (outcome) throughout 2020, by looking at 28 potential confounders. A potential positive association between exposure and outcome was observed when performing a multivariate regression analysis with a Negative Binomial model, suggesting that an increase of 1 μg/m3 in the exposure is associated with an increase of 9.0% (95% CI: 6.5%–11.6%) in the average Covid-19 mortality rate, conditional on all 28 potential confounders. A sensitivity analysis, based on the E-value, shows that a hypothetical unmeasured confounder would have to be associated with both PM 2.5 concentration and Covid-19 mortality rate by a rate ratio of at least 1.40-fold each to explain away the exposure-outcome association, conditional on all 28 covariates included in the main analysis model. Moreover, the Observed Covariate E-value (OCE) was reported to provide a contextualization of the E-value on the observed covariates included in the study. The OCE sensitivity analysis shows that a set of unknown confounders similar in size and magnitude to the set of the considered climatic factors could potentially explain away the estimated exposure-outcome association. Consequently, the role of climatic factors in the Covid-19 pandemic is worth of further investigation. [ABSTRACT FROM AUTHOR]

The aim of this population-based study was to assess the incidence rates of infectious diseases in native- (Italian) and foreign-born (immigrants) populations in a North Italy area, in 2006-2010. Crude, age-specific incidence rates (IRs) and age-standardised rate ratios (SRRs) between foreign- and native-born subjects and their 95 % confidence intervals (95 % CI) were estimated. A total of 32,554 cases of infectious diseases were found (9.9 % in foreign-born subjects). The highest SRRs between foreign- and nativeborn subjects were found for tuberculosis (SRR = 27.1; 95 % CI 21.3-34.3), malaria (SRR = 21.1; 14.6-30.4), scabies (SRR = 8.5; 7.6-9.4), AIDS (SRR = 2.5; 1.8-3.4) and viral hepatitis B (SRR = 3.3; 2.1-5.2). The highest IR was found for AIDS in people from the Americas (IR = 4.57; 95 % CI 2.2-8.4), for malaria and tuberculosis in people from Africa (IR = 13.89; 11.6-16.5 and IR = 11.87; 9.8-14.3 respectively). Therefore immigrants are at a higher risk of acquiring some common infectious diseases compared to the native population in Western European countries. [ABSTRACT FROM AUTHOR]

Background Immigrants represent a good epidemiological model to evaluate the relative influence of environmental and inherited factors on the development of allergy. Several studies on allergy in adults have been published, but few data in children are available. We aimed to investigate the differences, between Italian and immigrant children, in clinical characteristics of respiratory allergy. Methods This was a multicentre cross-sectional study involving children born in Italy from Italian parents and children born either in Italy or abroad from immigrants. Children referred firstly for allergic respiratory disease (rhinitis/asthma), with an ascertained clinical diagnosis and IgE sensitization to inhalants, were included. Demographic features, comorbidities, severity of disease, and sensitization profile were compared between Italians and immigrants, separating also those born in Italy from immigrant parents and those born abroad. Results One hundred and sixty-five immigrant allergic children were enrolled (100 male, mean age 8.3 yr), 128 of whose had both parents immigrated. Italian children were 237 (156 male, mean age 8.4 yr). The Italian and immigrant children were similar, apart from pet's ownership and family size. There was no difference in the severity of rhinitis/asthma between the groups, whereas significant differences were found in the pattern of sensitization: immigrant children were more frequently sensitized to house dust mites (73.3% vs. 51%, respectively; p = 0.002) and less to grass (41.8% vs. 57.8%; p = 0.002); this was retained also in monosensitized children. Immigrant children born in Italy (n = 105) had a lower prevalence of rhinitis vs. Italians (68.3% vs. 87.6%, respectively, p = 0.003) and of sensitization to grass (28.3% vs. 49.5%, respectively, p = 0.008). No difference was found among macro-regions of origin and demographic or clinical features. Conclusions Immigrant children born either in Italy or abroad did not show significant differences in the clinical pattern of the respiratory allergic disease when compared to children born from Italian parents. [ABSTRACT FROM AUTHOR]

Objectives: We studied survival and associated risk factors in an Italian nationwide cohort of HIV-infected individuals after an AIDS-defining cancer (ADC) or non-AIDS-defining cancer (NADC) diagnosis in the modern cART era. Methods: Multi-center, retrospective, observational study of HIV patients included in the MASTER Italian Cohort with a cancer diagnosis from January 1998 to September 2012. Malignancies were divided into ADC or NADC on the basis of the Centre for Disease Control-1993 classification. Recurrence of cancer and metastases were excluded. Survivals were estimated according to the Kaplan-Meier method and compared according to the log-rank test. Statistically significant variables at univariate analysis were entered in a multivariate Cox regression model. Results: Eight hundred and sixty-six cancer diagnoses were recorded among 13,388 subjects in the MASTER Database after 1998: 435 (51%) were ADCs and 431 (49%) were NADCs. Survival was more favorable after an ADC diagnosis than a NADC diagnosis (10-year survival: 62.7%±2.9% vs. 46%±4.2%; p = 0.017). Non-Hodgkin lymphoma had lower survival rates than patients with Kaposi sarcoma or cervical cancer (10-year survival: 48.2%±4.3% vs. 72.8%±4.0% vs. 78.5%±9.9%; p<0.001). Regarding NADCs, breast cancer showed better survival (10-year survival: 65.1%±14%) than lung cancer (1-year survival: 28%±8.7%), liver cancer (5-year survival: 31.9%±6.4%) or Hodgkin lymphoma (10-year survival: 24.8%±11.2%). Lower CD4+ count and intravenous drug use were significantly associated with decreased survival after ADCs or NADCs diagnosis. Exposure to cART was found to be associated with prolonged survival only in the case of ADCs. Conclusions: cART has improved survival in patients with an ADC diagnosis, whereas the prognosis after a diagnosis of NADCs is poor. Low CD4+ counts and intravenous drug use are risk factors for survival following a diagnosis of ADCs and Hodgkin lymphoma in the NADC group. [ABSTRACT FROM AUTHOR]

Abstract: A chemical factory which produced polychlorinated biphenyls (PCBs) operated in Brescia, North Italy, (about 200000 inhabitants) from the 1930s to the 1980s. High levels of PCBs were recently found in soil, food and people living in an area close to the factory. We performed a survey among the general population living in non-polluted areas of the town in order to define the reference values (RVs) of the non-exposed population. A random sample of subjects aged 20–79 years (50% males) was selected. Participants underwent PCB determination and were interviewed on their residential and occupational history and current diet. For RV determination, subjects who had resided in the polluted area or consumed any food produced in the area in their lifetime were excluded. Eight hundred and ninety-two subjects were contacted, 579 (65%) of whom agreed to participate; 311 of them were considered for RV determination (53% male, mean age=48.7 years). Total PCB serum levels, computed as the sum of the 24 congeners determined, were: mean=5.15ng/ml (SD=8.83), median=4.11ng/ml, range=0.4–34.12ng/ml, 95th centile=14.38ng/ml. Lipid-adjusted mean and median were 897 and 705ng/g lipid, respectively. PCB values showed positive correlations with age (Spearman’s r =0.76) and with serum concentration of total cholesterol (r =0.40) and triglycerides (r =0.36). No association was found with gender, cigarette smoking, alcohol or diet. Seven PCB congeners, (PCB 180, 153, 138, 170, 194, 118, and 156), including those at higher chlorination, were present in more than 30% of the subjects and contributed 99% of the total PCB levels, with a modest role of dioxin-like congeners. [Copyright &y& Elsevier]

Objective. Celiac disease (CD) is underdiagnosed mainly because of lack of awareness of its heterogeneous clinical presentation. The Center for Surveillance and Control of Celiac Disease (CCD) was set up in June 2000 in the province of Brescia, Northern Italy (1,016,426) inhabitants to enhance case-finding, to standardize diagnostic criteria and to collect epidemiological data. Material and methods. The CCD has prompted an educational "celiac awareness program" in the primary-care setting focusing on selective serological screening of high-risk groups, and has reviewed by standardized criteria all diagnoses made in the province since 1984. Results. A total of 1437 CD patients have been identified by the CCD, 508 of them diagnosed after June 2000 during the 3 years of activity of the Center (M:F 2:1). Annual incidence was 0.11/1000 before and increased to 0.17/1000 during CCD activity, and this increase was greater for adult (from 0.07/1000 to 0.12/1000) than for pediatric CD (from 0.04/1000 to 0.05/1000). Mean age at diagnosis also increased from 20.2 ± 17.7 years to 27.2 ± 19.3 years (p <0.0001) as did the proportion of asymptomatic patients (8% versus 15%) before and during CCD activity. There was a linear trend towards increasing proportions of symptomatic patients with increasing severity of histopathologic lesions (p < 0.03). Conclusions. Our results indicate that educational programs promoting serological screening of CD in high-risk groups are effective for case-finding in large communities, particularly among the adult population, and suggest that primary-care doctors caring for adults should be particularly targeted by "celiac awareness programs". [ABSTRACT FROM AUTHOR]

Background/Aims: The role of coffee in the development of hepatocellular carcinoma (HCC) is debated. The aim of this study was to investigate the role of coffee in HCC, taking the main risk factors into account. Methods: A hospital-based case-control study was conducted in an area of northern Italy. We recruited 250 HCC cases and 500 controls hospitalized for any reasons other than neoplasms, and liver and alcohol-related diseases. Subjects were interviewed on their lifetime history of coffee consumption using a standardized questionnaire. Results: Coffee consumption in the decade before the interview was associated with a decreasing risk of HCC with a clear dose-effect relation. With respect to non-drinking subjects, the odds ratios (ORs) were: 0.8, (95% CI 0.4–1.3) for 1–2 cups/day, 0.4 (95% CI 0.2–0.8) for 3–4 cups/day and 0.3 (95% CI 0.1–0.7) for 5 or more cups/day. The ORs for HCC decreased for drinking >2, compared to 0–2 cups/day of coffee, for an alcohol intake >80g/day (OR from 5.7 to 3.3), for presence of hepatitis B virus infection (OR from 16.4 to 7.3) or hepatitis C virus infection (OR from 38.2 to 9.0). Conclusions: Coffee drinking was inversely associated with HCC regardless of its aetiology. [Copyright &y& Elsevier]

Lombardy, the most populated and industrialized Italian region, was the epicentre of the first wave (March and April 2020) of COVID-19 in Italy and it is among the most air polluted areas of Europe. We carried out an ecological study to assess the association between long-term exposure to particulate matter (PM) and nitrogen dioxide (NO 2) on COVID-19 incidence and all-cause mortality after accounting for demographic, socioeconomic and meteorological variables. The study was based on publicly available data. Multivariable negative binomial mixed regression models were fitted, and results were reported in terms of incidence rate ratios (IRRs) and standardized mortality ratios (SMR). The effect of winter temperature and humidity was modelled through restricted cubic spline. Data from 1439 municipalities out of 1507 (95%) were included in the analyses, leading to a total of 61,377 COVID-19 cases and 40,401 deaths from all-causes collected from February 20th to April 16th and from March 1st to April 30th, 2020, respectively. Several demographic and socioeconomic variables resulted significantly associated with COVID-19 incidence and all-cause mortality in a multivariable fashion. An increase in average winter temperature was associated with a nonlinear decrease in COVID-19 incidence and all-cause mortality, while an opposite trend emerged for the absolute humidity. An increase of 10 μg/m3 in the mean annual concentrations of PM 2.5 and PM 10 over the previous years was associated with a 58% and 34% increase in COVID-19 incidence rate, respectively. Similarly, a 10 μg/m3 increase of annual mean PM 2.5 concentration was associated with a 23% increase in all-cause mortality. An inverse association was found between NO 2 levels and COVID-19 incidence and all-cause mortality. Our ecological study showed that exposure to PM was significantly associated with the COVID-19 incidence and excess mortality during the first wave of the outbreak in Lombardy, Italy. • Lombardy is an industrialized region with one of the worst air quality in Europe. • Lombardy was the epicentre of the first wave of COVID-19 pandemic in Italy. • Long-term exposure to PM was associated with COVID-19 incidence and mortality. • Meteorological variables were associated with COVID-19 incidence and mortality. • Socioeconomic variables were associated with COVID-19 incidence and mortality. [ABSTRACT FROM AUTHOR]

Background: The increase in life expectancy of HIV-infected patients has driven increased costs due to life-long HIV treatment and concurrent age-related comorbidities. This population-based study aimed to investigate the burden of chronic diseases and health costs for HIV+ subjects compared to the general population living in Brescia Local health Agency (LHA) over a 12-year period.Methods: LHA database recorded diagnoses, deaths, drug prescriptions and health resource utilization for all residents during 2003-2014. We estimated HIV prevalence and incidence, HIV-related mortality as well as prevalence of chronic diseases in HIV+ subjects. Observed/expected ratio of chronic diseases was calculated by indirect standardization with the general population as reference. Direct cost of HIV care and determinants were estimates across the period.Results: HIV prevalence increased from 220 to 307 per 100 000 person-years while incidence decreased from 16.1 to 10.8 per 100 000 person-years from 2003 to 2014. Prevalence of most comorbidities increased over time but it reduced significantly (annual mean change - 0.7 %) when adjusting for age and gender. Observed to expected ratio for each chronic disease in HIV+ subjects decreased over time. Cost of HIV+ cures increased (+25 %) mainly due to cost for drugs (+50 %) but it stabilized in recent years. CD4+ cell count at the time of diagnosis was an important predictor of cost for HIV management.Conclusions: Expenditures for HIV-infection are driven mainly by drugs cost and they have increased overtime. However, our findings suggest that spending on public health for HIV care can improve prognosis of HIV-infected patients, reduce transmission of HIV infection and reduce the global burden of chronic diseases, leading to a reduction of HIV global cost in the medium-long time. [ABSTRACT FROM AUTHOR]