Concomitant left atrial appendage closure with left ventricular assist device surgery can reduce ischemic cerebrovascular accidents

Background

It remains unknown if concomitant left atrial appendage closure (LAAC) at the time of left ventricular assist device (LVAD) surgery can reduce ischemic cerebrovascular accidents.

Purpose

The purpose of this study is to assess the impact of LAAC at LVAD surgery on the incidence of ischemic cerebrovascular accidents.

Methods

Between January 2012 and November 2021, 310 patients underwent LVAD surgery with HeartMate II or III. Out of 310 patients, 98 patients (31.6%) underwent concomitant LAAC. The cohort was divided into two groups: patients with LAAC (Group A, n=98) and without LAAC (Group B, n=212). To minimize device bias, LVAD surgery with HeartWare HVAD device was excluded. The ischemic cerebrovascular accident was defined as ischemic stroke, hemorrhagic stroke or transient ischemic attack. We reviewed early and long-term clinical outcomes. The incidence of ischemic cerebrovascular accidents was compared between two groups using the Kaplan-Meier method. We also investigated if LAAC was associated with ischemic cerebrovascular accidents by Cox proportional hazards analysis.

Results

There were no significant differences in baseline characteristics between two groups including age (Group A: 55.0±12.3 years old, Group B: 56.9±14.1 years old, p=0.26), preoperative CHADS2 score (Group A: 2.40±1.1, Group B: 2.58±1.1, p=0.19) and history of atrial fibrillation (Group A: 42.9%, Group B: 42.5%, p=0.95). In-hospital mortality was not significantly different between the two groups (Group A: 7.1%, Group B: 12.3%, p=0.16). In terms of postoperative complications, there were no significant differences between two groups in requiring extracorporeal membrane oxygenation, re-exploration for bleeding and newly required hemodialysis. Median follow up period was 474 days. Thirty-five patients (11.2%) developed ischemic cerebrovascular accidents (5 patients in Group A and 30 patients in Group B). The rate of freedom from ischemic cerebrovascular accidents in Group A (94.1% at 500 days and 94.1% at 1500 days) was significantly higher than that in Group B (88.2% at 500 days and 77.4% at 1500 days; log rank=0.024). In a Cox proportional hazards regression analysis including LAAC, age, history of atrial fibrillation, diabetes mellitus and Heartmate 3 device implantation, LAAC was associated with reducing the incidence of ischemic cerebrovascular accidents (hazard ratio 0.37, 95% CI 0.13–0.89, p=0.02).

Conclusion

Concomitant LAAC at the time of LVAD surgery can reduce ischemic cerebrovascular accidents without increasing perioperative mortality and complications.

Funding Acknowledgement

Type of funding sources: None.

What is the Prevalence of Low Health Literacy in European Union Member States? A Systematic Review and Meta-analysis

BACKGROUND

Many studies have shown that low health literacy (HL) is associated with several adverse outcomes. In this study, we systematically reviewed the prevalence of low HL in Europe.

METHODS

PubMed, Embase, and Scopus were searched. Cross-sectional studies conducted in the European Union (EU), published from 2000, investigating the prevalence of low HL in adults using a reliable tool, were included. Quality was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled prevalence estimates. A meta-regression analysis was performed to assess the association between low HL and the characteristics of the studies.

RESULTS

The pooled prevalence of low HL ranged from of 27% (95% CI: 18-38%) to 48% (95% CI: 41-55%), depending on the literacy assessment method applied. Southern, Western, and Eastern EU countries had lower HL compared to northern Europe (β: 0.87, 95% CI: 0.40-1.35; β: 0.59, 95% CI: 0.25-0.93; and β: 0.72, 95% CI: 0.06-1.37, respectively). The assessment method significantly influenced the pooled estimate: compared to word recognition items, using self-reported comprehensions items (β: 0.61, 95% CI: 0.15-1.08), reading or numeracy comprehensions items (β: 0.77, 95% CI: 0.24-1.31), or a mixed method (β: 0.66, 95% CI: 0.01-1.33) found higher rates of low HL. Refugees had the lowest HL (β: 1.59, 95% CI: 0.26-2.92). Finally, lower quality studies reported higher rates of low HL (β: 0.56, 95% CI: 0.06-1.07).

DISCUSSION

We found that low HL is a public health challenge throughout Europe, where one in every three to almost one in every two Europeans may not be able to understand essential health-related material. Additional research is needed to investigate the underlying causes and to develop remedies.

PROSPERO REGISTRATION

CRD42019133377.

Association between non-adequate health literacy and cancer screening adherence: a meta-analysis

Objective

Individuals with non-adequate health literacy (NAHL) are more likely to have poor health outcomes and behaviors, including a limited use of preventive services. This study aimed at summarizing the evidence on the association between NAHL and adherence to cancer screening programs.

Methods

PubMed, Scopus, and Web of Science were searched. Cross-sectional studies conducted in any country, published through January 2020 and quantifying the association between NAHL and cancer screening adherence, were included. An adapted Newcastle-Ottawa Scale was used to assess quality. Inverse-variance random-effects methods were used to produce pooled estimates: overall, by cancer and by HL tool.

Results

Seventeen articles of heterogeneous quality were included in the systematic review and 45 analyses were combined. NAHL was found to negatively influence screening adherence in both the crude (n = 26) and adjusted (n = 19) pooled analyses, and the association was slightly stronger in the latter (OR = 0.70, 95%CI: 0.62-0.79 and aOR=0.66, 95%CI: 0.57-0.76, respectively). Moreover, NAHL was significantly associated with lower adherence in all the types of cancer screening investigated: breast cancer (n = 7), aOR=0.55, 95%CI: 0.38-0.78; cervical cancer (n = 4), aOR=0.63, 95%CI: 0.53-0.75; prostate cancer (n = 1), aOR=0.60, 95%CI: 0.36-0.99, and colorectal cancer (n = 7), aOR=0.85, 95%CI: 0.74-0.97. Lastly, tools measuring NAHL with reading comprehension/numeracy items yielded the strongest association with the outcome (n = 5, aOR= 0.53, 95%CI: 0.35-0.80), that was attenuated in tools with either self-reported comprehension items (n = 7, aOR=0.72, 95%CI: 0.65-0.80) or medical term recognition items (n = 7, aOR=0.74, 95%CI: 0.57-0.95).

Conclusions

This study shows that NAHL may have a significant impact on adherence in all types of screening programs analysed, independently of the tools applied to measure it. Hence, it should be a useful focus for interventions to improve screening participation rates.

Key messages

Non-adequate health literacy negatively influences cancer screening adherence. Efforts to promote the uptake of cancer screening programs should consider and address NAHL.

A new gaming platform to improve cognitive performance and promote healthy behavior: a pilot study

Background

Brain training games can sharpen the mind and potentially prevent cognitive diseases, that are particularly relevant to the population ageing. The EU funded project ACDC, Adult Cognitive Decline Conscientiousness, developed an online training tool to train cognitive functions and promote healthy behaviors in the adult population.

Methods

An online platform, consisting of 16 games with different levels, was built. Three main brain domains were targeted: memory, visuospatial and verbal skill. After the completion of each game level, healthy lifestyle tips were presented to the users. Participants were actively recruited from the project partners; inclusion criteria were adult age (40-70 years) without cognitive diseases. An adapted version of the Montreal Cognitive Assessment was used to assess cognitive performance at the start and after two hours of active gaming. The paired t-test was used to compare the scores before and after the training. A satisfaction questionnaire was administered at the end of the training session.

Results

Fifty-six participants from three European countries (Austria, Spain and Italy) took part in the pilot phase (median age: 57, IQR: 47-66). Most of them were university graduates (38%) or had a high school diploma (41%), employed full-time (46%) and females (82%). Significant improvements were registered in the verbal domain, where the mean score increased from 4.18 to 4.83 (p = 0.047), and in the memory area, where the mean score grew from 4.80 to 6.60 (p < 0.001). The visuospatial mean score improved from 4.55 to 5.16 (p = 0.0518). Most users (84%) were greatly satisfied with the platform and reported a high level of appreciation for the interactive gaming approach.

Conclusions

Despite the small sample size, the pilot phase detected some improvements in cognitive performance and a good appreciation of the training tool. Given these encouraging findings, the study will now be extended to more participants.

Key messages

The newly developed platform represented a promising tool to train cognitive functions. The proposed interactive gaming approach was greatly appreciated by the users.

Multimodal surveillance of healthcare associated infections in an intensive care unit of a large teaching hospital

BACKGROUND

Healthcare-associated infections (HAIs), or nosocomial infections, represent a significant burden in terms of mortality, morbidity, length of stay and costs for patients hospitalized in intensive care units (ICUs). Surveillance systems are recommended by national and international institutions to gather data on HAIs in order to develop and evaluate interventions that reduce the risk of HAIs.

STUDY DESIGN

Here we describe the methodology and the results of the surveillance system implemented in the ICU of the Policlinico Umberto I, a large teaching hospital in Rome, from April 2016 to October 2018.

METHODS

The multimodal infection surveillance system integrates four different approaches: i) active surveillance of inpatients; ii) environmental microbiological surveillance; iii) surveillance of isolated microorganisms; and iv) behavioral surveillance of healthcare personnel. Data were collected on catheter-related bloodstream infections, ventilation-associated pneumonia, catheter-associated urinary tract infections and primary bloodstream infections that developed in patients after 48 h in the ICU. For environmental surveillance 14 points were selected for sampling (i.e. bed edges, medication carts, PC keyboards, sink faucets). The system of active surveillance of HAIs also included surveillance of microorganisms, consisting of the molecular genotyping of bacterial isolates by pulsed-field gel electrophoresis (PFGE). From 1 November 2016, monitoring of compliance with guidelines for hand hygiene (HH) and proper glove or gown use by healthcare personnel was included in the surveillance system. After the first six months (baseline phase), a multimodal intervention to improve adherence to guidelines by healthcare personnel was conducted with the ICU staff.

RESULTS

Overall, 773 patients were included in the active surveillance. The overall incidence rate of device-related HAIs was 14.1 (95% CI: 12.2-16.3) per 1000 patient-days. The monthly device-related HAI incident rate showed a decreasing trend over time, with peaks of incidence becoming progressively lower. The most common bacterial isolates were Klebsiella pneumoniae (20.7%), Acinetobacter baumannii (17.2%), Pseudomonas aeruginosa (13.4%) and Staphylococcus aureus (5.4%). Acinetobacter baumannii and Klebsiella pneumoniae showed the highest proportion of isolates with a multidrug-resistant profile. A total of 819 environmental samples were collected, from which 305 bacterial isolates were retrieved. The most frequent bacterial isolates were Acinetobacter baumannii (27.2%), Staphylococcus aureus (12.1%), Enterococcus faecalis (11.1%), Klebsiella pneumoniae (5.2%) and Pseudomonas aeruginosa (4.7%). All Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae environmental isolates were at least multidrug-resistant. Genotyping showed a limited number of major PFGE patterns for both clinical and environmental isolates of Klebsiella pneumoniae and Acinetobacter baumannii. Behavioral compliance rates significantly improved from baseline to post-intervention phase.

CONCLUSIONS

By integrating information gathered from active surveillance, environmental microbiological surveillance, surveillance of bacterial isolates and behavioral surveillance of healthcare personnel, the multimodal infection surveillance system returned a precise and detailed view of the infectious risk and microbial ecology of the ICU.

Municipal Epidemiological Report (REC): a new fast monitoring tool for exposed population. The experience on Trino municipality, ex nuclear power plant. Mortality 1970-2019

The law of March 2019 established the municipal epidemiological report to make easier the rapid and lowresource monitoring of the exposed population. Environmental observatory active in Trino since 2014 has equipped this tool and making the first evalution of the risk with census sections from 1970 to 2018. The result highlighted that overall mortality (for total gender) show a decreasing trend while for oncological diseases the results are more difficult to interpret especially in areas close to former industrial sites or contaminated sites. Next step is producing a REC with data for 2019 and divided by gender.

Autism spectrum disorders and oral health status: review of the literature

AIM

Autism Spectrum Disorder (ASD) is characterised by impairments in communication and social relationships and by a narrow, repetitive and stereotyped repertoire of activities, behaviours and interests. The aim of this work is to evaluate how these characteristics have an impact on oral health.

MATERIALS AND METHODS

A search was conducted through MEDLINE/PubMed and Web of Science in order to evaluate the oral health status of children with ASD and the correlation between ASD and dental caries, periodontal disease, dental injuries, oral microbiota, as well as the different strategies, approach and treatments in ASD patients. Forty-six articles were selected.

RESULTS

Children with ASD are at higher risk of caries, alteration of the periodontal status, alterations of the oral microbiota and increased risk of traumatic injuries.

CONCLUSION

Since ASD is a haeterogeneous disease with a wide range of expressions in individuals, adapted and specific strategies are needed. ASD children represent a challenge for the dental community.

Prevalence of non-adequate health literacy in Europe: a systematic review and meta-analysis

Background

Many studies show that a low level of health literacy (HL) is associated with several adverse outcomes. The aim of this systematic review was to estimate the prevalence of non-adequate HL (NAHL) in European countries and outline the main needs for interventions.

Methods

The systematic search was performed in April 2019 and updated in June 2019. PubMed, Embase and Scopus were searched. Articles were considered eligible if they were cross-sectional studies published in English after 2000 and estimating the NAHL prevalence in European countries. Globally, 15490 articles were retrieved. Adapted Newcastle-Ottawa Scale was applied for the quality assessment. Several stratified meta-analyses were carried out. We also performed a meta-regression analysis to test the association between variables and NAHL.

Results

In total, 59 articles of heterogeneous quality were included, providing data for 98 studies to include in the proportion meta-analysis. Overall, quantitative analysis yielded a pooled NAHL prevalence of 40% (95%CI, 36%-43%). Despite the prevalence varied considerably by country, it seemed to follow a geographic gradient, with the northern countries clearly having a lower prevalence than the other European counterparts. The pooled prevalence estimates (PEs) varied significantly according to the different type of HL assessment method applied. Also, high study quality was found to be significantly associated with a reduction of NAHL in the PEs. Grouping the sample in general population, oncology patients, chronic disease patients and refugees, the meta-regression analysis showed a significantly lower prevalence of NAHL in oncology patients.

Conclusions

Although the PEs varied in relation to several factors (e.g. either among population groups, or depending on the HL assessment method), this study shows that more than one in every three surveyed participants had NAHL. Targeted strategies and coordinated policies aiming at improving HL in the Region are needed.

Key messages

Despite several variations, a significant proportion of European population has non-adequate health literacy. Targeted public health strategies of intervention are crucial to address this deficit.

Multimodal Surveillance of HAI in an Intensive Care Unit of a Large Teaching Hospital

Background

Healthcare associated Infections (HAIs) represent a significant burden in terms of mortality, morbidity, length of stay and costs for patients in intensive care units (ICU). Surveillance systems are recommended to gather data in order to elaborate and evaluate intervention to reduce HAIs risk. Here we describe results of the multimodal surveillance system implemented in the ICU of a large teaching hospital in Rome from April 2016 to October 2018.

Methods

The surveillance system integrated four different approaches: i) active surveillance focused on inpatients; ii) environmental microbiological surveillance; iii) surveillance focused on isolated microorganisms; iv) behavioral surveillance of the healthcare personnel. The system included the molecular genotyping of bacterial isolates through the pulsed field gel electrophoresis (PFGE). Moreover, an intervention to improve personnel adherence to hand hygiene (HH) guidelines was conducted.

Results

Overall, 773 patients were included in the surveillance. The global incidence rate of the device related HAIs was 14.1 (95%CI: 12.2-16.3) per 1000 patient day. Monthly device related HAIs incidence rate showed a decreasing, from 26.9 per 1000 patient day in October 2016, to 4.9 in September 2018. The most common bacterial isolate was K. pneumoniae (20.7%), the 94.0% of which were multidrug-resistant. A total of 305 environmental bacterial isolates were retrieved and the most frequent was A. baumannii (27.2%), that was always multidrug-resistant. Genotyping showed a limited number of major PFGE patters in clinical and environmental isolates. Behavioral compliance to HH guidelines improved after the educational intervention.

Conclusions

The data showed an overall slight decrease over time of the adjusted risk HAIs rates. Through the integration of information gathered from the four approaches, the application of this model returns a precise and detailed view of the infectious risk and of the microbial ecology of the ICU.

Key messages

Multimodal surveillance systems are effective to monitor HAI incidence and to determine the infectious risk. Genotyping techniques allows to characterize and link the clinical and environmental isolates.

Identification of the faecal indicator Escherichia coli in wastewater through the β-D-glucuronidase activity: comparison between two enumeration methods, membrane filtration with TBX agar, and Colilert®-18

Escherichia coli (E. coli) is one of the most commonly adopted indicators for the determination of the microbiological quality in water and treated wastewater. Two main types of methods are used for the enumeration of this faecal indicator: membrane filtration (MF) and enzyme substrate tests. For both types, several substrates based on the β-D-glucuronidase activity have been commercialized. The specificity of this enzyme for E. coli bacteria has generated considerable use of methods that identify the β-D-glucuronidase activity as a definite indication of the presence of E. coli, without any further confirmation. This approach has been recently questioned for the application to wastewater. The present study compares two methods belonging to the above-mentioned types for the enumeration of E. coli in wastewater: MF with Tryptone Bile X-glucuronide agar and the Colilert^®-18 test. Confirmation tests showed low average percentages of false positives and false negatives for both enumeration methods (between 4 and 11%). Moreover, the counting capabilities of these two methods were compared for a set of 70 samples of wastewater having different origins and degrees of treatment. Statistical analysis showed that the Colilert^®-18 test allowed on average for a significantly higher recovery of E. coli.

Geographical and epidemiological analysis of oncological incidence in paediatric and adolescent ages in a municipality of North-Western Italy: Vercelli, years 2002-2009

INTRODUCTION

This study of the geographical incidence on the oncological mortality in young age (0-44 years) in the City of Vercelli, was aimed to address the concerns of the population and the request of municipal administrators. A detailed and sophisticated study for a City of medium-small size is due for the presence of various sources of pressure, such as a MSW incinerator just a few kilometres from the city and an intensive agricultural activity that characterizes the entire area.

MATERIALS AND METHODS

The study is based on the census analysis of the population, and of the hospital admission cards, and it considers epidemiological standardized estimators and spatial analysis through Bayesian models, as well.

RESULTS

Both approaches highlight Major risks for the area south of the city for major tumours such as total cancer in women (SIR / SMR significant excess of about 50%), colorectal (mean increments SMR / SIR between 3 and 4 times), ovary (mean increments SMR / SIR between 3:04 and times), and nervous system (increases 3 times for both indicators).

CONCLUSION

These results deserve further studies through inferential case-control and cohort analysis, given the marginal role of the possible occupational hazards in the aetiology of juvenile cancer disorders.

Vulvovaginal gingival lichen planus: report of two cases and review of literature

PURPOSE

Oral Lichen Planus (OLP) is a chronic inflammatory disease of skin and mucous membranes. Approximately 20% of women with oral lichen planus develops lesions in the genital mucosa. In 1982, Pelisse described a special form of lichen planus (LP), which consists of a triad of symptoms: vulval, vaginal and gingival (VVG)-LP lesions. Aim of the present report is to report two new cases and review the international literature.

MATERIAL AND METHODS

Two cases of VVG-LP are reported and a review of recent literature is performed.

RESULTS

The onset of erosive or ulcerative mouth lesions may precede or follow by months or even years the onset of vulvovaginal lesions. Vaginal agglutination is associated with the postmenopausal state in conjunction with a dermatologic condition. Intra-lesional corticosteroids have a role in localized chronic ulceration, while systemic therapies such as corticosteroids, azathioprine, mycophenolate mofetil, hydroxychloroquine, ciclosporin, methotrexate, retinoids, thalidomide and photo chemotherapy have been used in more severe cases with varying success.

CONCLUSIONS

VVG-LP is rather a rare condition and has been documented in the literature mainly in the form of case reports. Lack of a precise diagnostic criteria of VVG-LP depends on the specialists.

Incidence of oncological pathologies 2002-2010 in the southwestern Piedmont area, province of Vercelli, neighbouring municipalities of former nuclear sites

The Vercelli Province counts two former nuclear installations: a radioactive waste disposal area in Saluggia and a former nuclear power plant in Trino. This study takes also into account four other neighbouring municipalities, counting 20,000 total inhabitants. We studied the incidence of neoplastic pathologies in the 2002-2010 period. The data sources were Hospital Discharge Form (SDO), histological reports from the Registry of Hospital Charts (RHC) and Italy's National Statistics Institute (ISTAT) reports, and the Cancer Register of Turin. The research highlights the excesses for all type of cancers (SIR=1,11; IC 1,04-1,18), including the ones of nervous system (SIR=2,23 IC 1,47-2,98), leukaemia (SIR=1,94 IC 1,35-2,52), and bones (SIR=12,0 IC 9,22-14,7), according to different aggregation levels by age, sex and housing area. Considering such results, previous studies, and the environmental and occupational risk factors in the area, we believe that further epidemiological and environmental studies should be conducted in this area.

Fate of the fecal indicator Escherichia coli in irrigation with partially treated wastewater

Treated wastewater reuse is increasing in semi-arid regions as a response to the effects of climate change and increased competition for natural water resources. Investigating the fate of bacterial indicators is relevant to assess their persistence in the environment and possible transfer to groundwater or to the food chain. A long-term field-scale experimental campaign and a soil column test were carried out to evaluate the fate of the fecal indicator Escherichia coli (E. coli) in a cultivated soil when contaminated water resources are used for irrigation. For field experiments, fecal contamination was simulated by dosing the indicator to the effluent of a membrane bioreactor, thus simulating a filtration system's failure, and irrigating a test field where grass was grown. The presence of E. coli on grass and topsoil samples was monitored under different scenarios. For evaluating the fate of the same indicator in the subsoil, a set of soil columns was installed next to the field, operated, and monitored for E. coli concentration over time and along depth. Real municipal wastewater was used in this case as source of fecal contamination. Results showed that short- and medium-term effects on topsoil were strongly dependent on the concentration of E. coli in the irrigation water. Limited persistence and no relevant accumulation of the indicator on the grass and in the topsoil were observed. Watering events performed after fecal contamination did not influence significantly the decay in the topsoil, which followed a log-linear model. The trend of the E. coli concentrations in the leaching of the soil columns followed a log-linear model as well, suggesting bacterial decay as the dominant mechanism affecting the underground indicator's concentration.

Exploration study on mortality trends in the territory surrounding an incineration plant of urban solid waste in the municipality of Vercelli (Piedmont, Italy) 1988-2009

BACKGROUND

The places, where the incinerators are located, often present problems of heterogeneous people having different environmental factors. It becomes important to evaluate the possible etiologic role of various environmental risk factors and try to quantify as they affect in the excess epidemiological.

METHODS

This study considers the ISTAT index mortality due to all causes occurred from 1988 to 2009 referred to ten municipalities at south of Vercelli (Piedmont, North Western Italy) placed nearby the active incinerator from 1977 (10 latent years). The risks were calculated considering this area at risk versus the municipalities placed at North of Vercelli and versus the Vercelli.

RESULTS

Some significant statically excesses emerged in the South area such as neoplasia of nervous system, liver and total of tumours.

CONCLUSIONS

The study presents some drawbacks, but it is a work creditable of widening by specific research ad hoc such as cohort and/or control where it is possible to verify various environmental, occupational and occasional factors.

IN VIVO CHARACTERIZATION OF ORAL PEMPHIGUS VULGARIS BY OPTICAL COHERENCE TOMOGRAPHY

Pemphigus vulgaris (PV) is an autoimmune disease that manifests as intraepithelial blisters in skin and mucous membranes. We report the case of a 62-year-old female patient with clinical picture of desquamative gingivitis and a histological and serological diagnosis of pemphigus vulgaris. The aim of this study is to analyse bollous oral diseases in order to evaluate the feasibility to image epithelial architecture of oral mucosae using in vivo optical coherence tomography. Optical coherence tomography seems to be a valid non-invasive auxiliary diagnostic device able to show in vivo the epithelial layers and basal membrane.

Cancer risk among farmers in the Province of Vercelli (Italy) from 2002 to 2005: an ecological study

BACKGROUND

As the link between agricultural pesticides and numerous types of human cancers is wellknown. Farmers living in the Province of Vercelli (Italy) were observed to verify if they have a higher cancer risk than the rest of the local employed population. Literature showed a well-known excess of cancer morbidity and mortality in the Province of Vercelli, but only few studies focused on cancer incidence in local farmers. Studying farmers could allow to assess the causal importance respectively of environmental pressure and professional exposure factors in explaining cancer excesses in the above-mentioned area.

MATERIALS AND METHODS

The present ecological study considered all cancer new cases recorded among the mean employed population with a range of age from 25 to 84 years and resident in the Province of Vercelli during the four-year period 2002-2005. Cancer odds ratios, by gender and type of cancer, between farmers and non-farmers were calculated.

RESULTS

Farmers showed a higher risk for the following tumors: colorectal (OR 2.38, IC95%: 1,76-2,87), leaukaemia (OR 2.65, IC95%:2,12-2,89), digestive system (OR 2.16, IC95% 1,92-2,33), lymphoma OR 2.08, IC95%:1,99-2,23), melanoma (OR 2.90, IC95%:2,54-3,15), myeloma OR 3.55, IC95%:3,23-3,70), pancreas OR 3.38, IC95%:3,14-3,61), lung (1.59, IC95%:1,12-2,38) and kidney (2.70, IC95%:2,41-2,99). Males showed a higher risk for lung cancer, females for liver neoplasm, melanoma and lymphoma.

CONCLUSIONS

Farmers showed a higher risk for several cancers. Further studies are needed, in order to examine in detail the issue, to encourage the use of personal protective equipment and to promote a more responsible pesticides use.

Geographical and epidemiological analysis of oncological mortality in a Municipality of North-Western Italy Vercelli years 2000-2009

BACKGROUND

We performed a geographic analysis study on mortality in the town of Vercelli, in order to respond to the concerns of the population and some local administrators. Main reason to carry out a detailed and sophisticated study for a city of medium-small size was represented by the presence of various sources of environmental and industrial pressure (i.e. old-generation incinerator for solid urban waste, industrial site for chemicals production, intense agricultural activity of rice production…).

METHODS

The study analyzed census, ISTAT death cards, both from the epidemiological point of view with admirers that SMR standardized spatial analysis using Bayesian models.

RESULTS

Overall, both approaches highlighted major risks for the area south of the capital for major cancers such as colorectal and lung and increases worthy of investigation for the young-adult age groups in both genders. And being processed a similar study that considers the incidence oncology.

CONCLUSIONS

The imminent elaboration of the cartography by oncological incidence will allow us to confirm, or less, the areas in excess for the death data, and in the meanwhile observe any excesses for low mortality pathologies (e.g., thyroid) or neoplasies whose present therapies allowed complete recovery and/or very long survivals (e.g. leukaemia, lymphomas and testicle).

[Assessment of the impact of cancer in the Vercelli Local Health Authority from 2002 to 2009]

The object of the study is to provide an epidemiological overview of the impact of neoplasms in an area that has no cancer registry. A descriptive study was conducted within the Local Health Authority of Vercelli. To estimate the number of cases, hospital discharge documents (including passive mobility) were used and integrated with the archives of pathology. The number of cases was calculated on the basis of SIR (specific rates of the Vercelli Local Health Authority divided by age in the years 2002-2009 in comparison with new cases of cancer in the city of Turin from 2005 to 2007, used as standard population). All readings were expressed including intervals of confidence at 95%. For tumors of low lethality for males, extending the period of observation confirms the excess for bladder cancer (SIR = 1.1, 1.07 to 1.21) and lymphoma aggregate (SIR = 1.4, 1.2 to 1.6). for females: thyroid (SIR = 1.5, 1.3 to 1.65) and lymphomas (SIR = 1.25, 1.1 to 1.4). In addition to these tumors in both sexes is observed to decrease colorectal cancer but excess for leukemias and brain. The extension of the study is intended as the base for the creation of a cancer register that will be established, naturally integrating further sources of information. In all cases, data observed indicated several epidemiological peculiarities in the region, probably linked to specific characteristics of local exposure, which should be addressed in terms of Public Health.

[State of health of the population residing in the town of Barengo and in surrounding communities, site of a field used as landfill for MSW: analysis of the general incidence and causes from 2003 to 2009]

The research provides an observational epidemiological study to detect whether there is a cluster or a local excess morbidity rate in Barengo, site of a solid waste quarry, as well as to define the initial hypothesis of causal relationships and then trigger if necessary, more stringent and specific inferential assessments. The population studied consists of all the residents in the eight municipalities that make up the area next to the dump site with Barengo as the central point, site of the plant; the reference population in Barengo, Cavaglietto, Momo, Cavaglio, Briona, Vaprio, Fara and Sizzano add up to about 11,122 residents. The overall mortality data for the years 2000-2009 show excesses for cardiovascular diseases, digestive system as well as nervous and respiratory systems for both sexes; to monitor next would be the frequency of some cancers such as, bone, kidney, small intestine and ovary. Given the current epidemiological considerations, today we cannot derive the determining conditions of health levels observed. The viability of a health risk identification can be achieved only in a second intervention capable of inferring random links in regards to the presence of specific risk situations.

[State of health of the population of Trino (Vercelli): cancer mortalities 2000-2007 and historical analysis of all causes of death from 1980 to 2000]

The survey takes an in-depth look at the state of health of the inhabitants of Trino, in the province of Vercelli. The presence of various industries like cement factories, foundries and the placing of a nuclear plant (E.FERMI) in past decades, led to the carrying out of several surveys in order to reveal possible epidemiological excesses. In the survey in question, a detailed analysis of cancer mortalities occurring from 2000 to 2007 was carried out, examining the results in comparison with the Local Health Authorities of Vercelli and data from the Rencam Registry of the city of Turin from 2004 to 2006. The results highlight and confirm significant excesses for cancers like the nervous system, leukaemia, mesothelioma and peritoneum. Subsequent historical analysis (1980 - 2000) with data from the BDM Piedmont with regards to cancer mortalities confirms part of our data, while for all other causes we highlight the anomaly of amyotrophic lateral sclerosis in both sexes after the age of 65. The combination of these related results and our previous study of cases in Trino certainly require an in-depth epidemiological analysis through etiological studies.

[Comparison of the leukaemia incidence in two cohorts of farmers and traders in the Vercelli province of Italy, 2002-2009]

This study aims to investigate the incidence of leukaemia between 2002 and 2009 (ICDIX 204-208) among farmers active in the Vercelli province (North West Italy), during the period: 1962-1991. The farmer cohort (14397 subjects, 78 cases) was compared with a retail trader cohort (4565 subjects, 11 cases) who were Vercelli province residents as well, but not exposed to the risk factors associated with professional farming. A proportional hazard Cox model shows among the farmers, an approximately double leukaemia incidence with respect to traders (Hazard Ratio = 1,90 P-value 0,043 IC95% 1,00-3,60). Moreover men's incidence appears approximately to double that of women (Hazard Ratio = 1,92 P-value 0,003 IC95% 1,25-2,95).

Biodegradability of pharmaceutical industrial wastewater and formation of recalcitrant organic compounds during aerobic biological treatment

The biodegradability of different wastewater samples originated from the industrial production of three pharmaceuticals (naproxen, acyclovir, and nalidixic acid) was performed through the standard Zahn-Wellens test. Moreover, the wastewater composition before and during the test was evaluated in terms of parent compounds and main metabolites by LC/MS, and the biodegradability of the parent compounds was also assessed by performing extra Zahn-Wellens tests on synthetic solutions. The results, besides showing the relatively good biodegradability of acyclovir and naproxen, evidenced the masking role of the organic matrices, especially in the case of nalidixic acid. The latter compound showed to be recalcitrant and persistent, despite the apparently good performance of the Zahn-Wellens test. Deeper evaluation evidenced that the biodegradation of high concentrations of organic solvents and other biodegradable compound tended to "hide" the lack of removal of the target compound.

Effective organics degradation from pharmaceutical wastewater by an integrated process including membrane bioreactor and ozonation

The enhanced removal of organic compounds from a pharmaceutical wastewater resulting from the production of an anti-viral drug (acyclovir) was obtained by employing a membrane bioreactor (MBR) and an ozonation system. An integrated MBR-ozonation system was set-up by placing the ozonation reactor in the recirculation stream of the MBR effluent. A conventional treatment set-up (ozonation as polishing step after MBR) was also used as a reference. The biological treatment alone reached an average COD removal of 99%, which remained unvaried when the ozonation step was introduced. An acyclovir removal of 99% was also obtained with the MBR step and the ozonation allowed to further remove 99% of the residual concentration in the MBR effluent. For several of the 28 organics identified in the wastewater the efficiency of the MBR treatment improved from 20% to 60% as soon as the ozonation was placed in the recirculation stream. The benefit of the integrated system, with respect to the conventional treatment set-up was evident for the removal of a specific ozonation by-product. The latter was efficiently removed in the integrated system, being its abundance in the final effluent 20-fold lower than what obtained when ozonation was used as a polishing step. In addition, if the conventional treatment configuration is employed, the same performance of the integrated system in terms of by-product removal can only be obtained when the ozonation is operated for longer than 60 min. This demonstrates the effectiveness of the integrated system compared to the conventional polishing configuration.