Search

Amyotrophic lateral sclerosis (ALS) is a rare and devastating neurological disorder of the adult age with a prognosis of about 2-3 years from the onset of the disease. No clear cause has been identified but it seems to be a multifactorial disease with genetic and environmental components involved. Increments of mortality rates were observed since 1980 both in Italy and in many other countries. The objective of the present study is to describe the distribution of ALS mortality in Italy in the period 1980-2001 detecting single municipalities or clusters with high mortality levels for motor neuron disease (MND). ALS represents the main part (85%) of the MND group which is globally identified by the IX ICD (International Classification of Diseases and Causes of Death) 335.2 code. Death numbers and standardized mortality ratios (SMR) for MND were calculated for all Italian municipalities through the ENEA mortality database system (data source: National Institute of Statistics-ISTAT), using national mortality rates as reference. Subsequently, in order to detect municipal clusters, spatial analysis was performed. Out of the 8,099 Italian municipalities, 132 where characterized by SMR values higher than expected. Moreover 16 clusters with significant high relative risk values (RR) were identified, 12 out of them including only a single municipality. Only 22 of the municipalities with high SMR were included in the clusters. In conclusion, the two different epidemiological methodologies demonstrated to be widely complementary in detecting the geographical distribution of the disease in terms of risk for populations. A first selection of the priority areas where analytical studies should be carried on, in order to identify risk factors associated to ALS, is tentatively suggested.

To describe the mortality rates for motor neuron disease (MND) in Italy both at national level and at three large geographical sub-areas (Northern, Central, Southern Italy).Deaths for MND are coded accordingly to ICD (IX revision) with 335.2 code. Mortality for MND is analysed for the period 1980-99. Mortality rates are age-standardized on the structure of the 1991 Italian population. Mortality data are derived from the National Institute for Statistics (ISTAT) and are made available by the Epidemiological Database of the Italian National Agency for New Technologies, Energy and the Environment (ENEA).Age adjusted mortality rates for MND are calculated for 5-year periods (1980-84, 1985-89, 1990-94, 1995-99) at both national level and three geographical sub-areas (north, center and south); sex and age specific mortality rates are also reported for two decades (1980-89 and 1990-99).During 1980-99 the annual age-standardized mortality rate in Italy was 1.35 x 100000 in males and 1.10 (x 100000) in females. In the period 1995-99 the mortality rates increased by 39.3% in males and 78.2% in females at national level when compared to 1980-84 rates (1.56 vs 1.12 deaths per 100000 for males and 1.39 vs 0.78 per 100000 for females in 1980-84 and 1995-99, respectively). In the three large geographical sub-areas such increases were 37.6%, 29.7% and 57% in males and 73%, 63.1% and 114.3% in females, respectively.The increase reported in this study is probably due to a mix of different factors as population ageing (age-specific rates reach a peak in the age class 70-74 years), better accuracy of death certificates, adoption of new clinical criteria and at last a wide spread of environmental risk factors (metals, solvents, pesticides, electromagnetic fields) and modification of life style (smoking, diet, professional sport).

Amyotrophic lateral sclerosis (ALS) is a rare devastating neurodegenerative disease of unknown etiology. Two recent epidemiological studies showed a high risk for ALS among Italian male soccer players. We present the clinical and occupational history of an Italian professional soccer player affected by sporadic ALS. The early onset of ALS (45 years), the bulbar form, the playing position (midfielder) and the duration of the job as professional soccer (17 years) are four characteristics of this patient that are in good agreement with the findings in the previous epidemiological studies. This patient reports the frequent consumption of fructose 1,6 biphosphate, extracts of suprarenal cortex, crotetamide and cropropamide, and dietary supplements (branched chain amino acids and creatine) during his playing career. Some hypotheses have been proposed to explain this high excess of deaths for ALS among soccer players: (a) vigorous physical activity; (b) soccer specific trauma or microtrauma; (c) use of illegal toxic substances or chronic misuse of drugs (most often anti-inflammatory) and dietary supplements; and (d) exposure to pesticides used on playing fields. The overall available clinical and epidemiological evidence supports the possible relation between the specific occupational environment (soccer) and the occurrence of ALS in this patient.

Mortality for malignant pleural neoplasms (1980-97) was studied in Broni (Pavia) and in the surrounding area in order to update previous studies indicating a high incidence of pleural mesothelioma, due to the presence of an asbestos-cement factory. Observed mortality for pleural neoplasms was compared to expected figures derived from mortality rates of the population resident in Province of Pavia. A significant increase was found in Broni (SMR 825, CI 95%: 604-1, 100, 46 observed). An increased risk of death from malignant pleural neoplasms was evident in both genders, especially in the most recent years, and in younger age groups; this increase in pleural neoplasm mortality also involves some neighbouring municipalities.

Background Sinonasal cancer (SNC) has been related to occupational exposures, but the relative risk associated to specific jobs and/or carcinogen exposures other than wood and leather dust is generally based on small or inadequate sample sizes and the range of observed estimates is large. This paper is aimed at investigating such relationship through a systematic review of the literature followed by a meta-analysis of studies meeting specific inclusion criteria. Methods Systematic search was made with PubMed, Google Scholar and Scopus engines using related keywords. Occupational exposures include wood and leather dust, formaldehyde, nickel and chromium compounds, textile industry, farming and construction. Meta-analysis of published studies after 1985 with a case-control or cohort design was performed, firstly using the fixed-effect model. Heterogeneity was assessed with the Q statistical test and quantified by the I2 index. When the heterogeneity hypothesis appeared relevant, the random-effect model was chosen. Sources of heterogeneity were explored using subgroup analyses. Results Out of 63 reviewed articles, 28 (11 cohort, 17 case-control) were used in the meta-analysis. Heterogeneity among studies was observed and random-effects models were used. Exposure to wood dust results associated with SNC (RRpooled = 5.91, 95% CI: 4.31-8.11 for the case-control studies and 1.61, 95% CI: 1.10-2.37 for the cohort studies), as well as to leather dust (11.89, 95% CI: 7.69-18.36). The strongest associations are with adenocarcinomas (29.43, 95% CI: 16.46-52.61 and 35.26, 95% CI: 20.62-60.28 respectively). An increased risk of SNC for exposures to formaldehyde (1.68, 95% CI: 1.37-2.06 for the case control and 1.09, 95% CI: 0.66-1.79 for the cohort studies), textile industry (2.03, 95% CI: 1.47-2.8), construction (1.62, 95% CI: 1.11-2.36) and nickel and chromium compounds (18.0, 95% CI: 14.55-22.27) was found. Subset analyses identified several sources of heterogeneity and an exposure-response relationship was suggested for wood dust (p = 0.001). Conclusions By confirming the strength of association between occupational exposure to causal carcinogens and SNC risk, our results may provide indications to the occupational etiology of SNC (not only wood and leather dusts). Future studies could be focused on specific occupational groups to confirm causative agents and to define appropriate preventive measures. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1042-2) contains supplementary material, which is available to authorized users.