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Benny D, Giacobini M, Costa G, Gnavi R, Ricceri F. Multimorbidity in middle-aged women and COVID-19: binary data clustering for unsupervised binning of rare multimorbidity features and predictive modeling. BMC Med Res Methodol 2024; 24:95. [PMID: 38658821 PMCID: PMC11040796 DOI: 10.1186/s12874-024-02200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Multimorbidity is typically associated with deficient health-related quality of life in mid-life, and the likelihood of developing multimorbidity in women is elevated. We address the issue of data sparsity in non-prevalent features by clustering the binary data of various rare medical conditions in a cohort of middle-aged women. This study aims to enhance understanding of how multimorbidity affects COVID-19 severity by clustering rare medical conditions and combining them with prevalent features for predictive modeling. The insights gained can guide the development of targeted interventions and improved management strategies for individuals with multiple health conditions. METHODS The study focuses on a cohort of 4477 female patients, (aged 45-60) in Piedmont, Italy, and utilizes their multimorbidity data prior to the COVID-19 pandemic from their medical history from 2015 to 2019. The COVID-19 severity is determined by the hospitalization status of the patients from February to May 2020. Each patient profile in the dataset is depicted as a binary vector, where each feature denotes the presence or absence of a specific multimorbidity condition. By clustering the sparse medical data, newly engineered features are generated as a bin of features, and they are combined with the prevalent features for COVID-19 severity predictive modeling. RESULTS From sparse data consisting of 174 input features, we have created a low-dimensional feature matrix of 17 features. Machine Learning algorithms are applied to the reduced sparsity-free data to predict the Covid-19 hospital admission outcome. The performance obtained for the corresponding models are as follows: Logistic Regression (accuracy 0.72, AUC 0.77, F1-score 0.69), Linear Discriminant Analysis (accuracy 0.7, AUC 0.77, F1-score 0.67), and Ada Boost (accuracy 0.7, AUC 0.77, F1-score 0.68). CONCLUSION Mapping higher-dimensional data to a low-dimensional space can result in information loss, but reducing sparsity can be beneficial for Machine Learning modeling due to improved predictive ability. In this study, we addressed the issue of data sparsity in electronic health records and created a model that incorporates both prevalent and rare medical conditions, leading to more accurate and effective predictive modeling. The identification of complex associations between multimorbidity and the severity of COVID-19 highlights potential areas of focus for future research, including long COVID and intervention efforts.
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Affiliation(s)
- Dayana Benny
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, 10043, Piedmont, Italy.
- Modeling and Data Science, Department of Mathematics, University of Turin, Via Carlo Alberto 10, Turin, 10123, Piedmont, Italy.
| | - Mario Giacobini
- Data Analysis and Modeling Unit, Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Giuseppe Costa
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, 10043, Piedmont, Italy
- Unit of Epidemiology, Regional Health Service, Local Health Unit Torino 3, Grugliasco, Turin, Italy
| | - Roberto Gnavi
- Unit of Epidemiology, Regional Health Service, Local Health Unit Torino 3, Grugliasco, Turin, Italy
| | - Fulvio Ricceri
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, 10043, Piedmont, Italy
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Cortés-Téllez AA, D'ors A, Sánchez-Fortún A, Fajardo C, Mengs G, Nande M, Martín C, Costa G, Martín M, Bartolomé-Camacho MC, Sánchez-Fortún S. Using single-species and algal communities to determine long-term adverse effects of silver nanoparticles on freshwater phytoplankton. Sci Total Environ 2024; 928:172500. [PMID: 38631630 DOI: 10.1016/j.scitotenv.2024.172500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 04/19/2024]
Abstract
The physical and chemical properties of silver nanoparticles (AgNPs) have led to their increasing use in various fields such as medicine, food, and industry. Evidence has proven that AgNPs cause adverse effects in aquatic ecosystems, especially when the release of Ag is prolonged in time. Several studies have shown short-term adverse effects of AgNPs on freshwater phytoplankton, but few studies have analysed the impact of long-term exposures on these populations. Our studies were carried out to assess the effects of AgNPs on growth rate, photosynthesis activity, and reactive oxygen species (ROS) generation on the freshwater green algae Scenedesmus armatus and the cyanobacteria Microcystis aeruginosa, and additionally on microcystin (MC-LR) generation from these cyanobacteria. The tests were conducted both in single-species cultures and in phytoplanktonic communities exposed to 1 ngL-1 AgNPs for 28 days. The results showed that cell growth rate of both single-species cultures decreased significantly at the beginning and progressively reached control-like values at 28 days post-exposure. This effect was similar for the community-cultured cyanobacteria, but not for the green algae, which maintained a sustained decrease in growth rate. While gross photosynthesis (Pg) increased in both strains exposed in single cultures, dark respiration (R) and net photosynthesis (Pn) decreased in S. armatus and M. aeruginosa, respectively. These effects were mitigated when both strains were exposed under community culture conditions. Similarly, the ROS generation shown by both strains exposed in single-species cultures was mitigated when exposure occurred in community cultures. MC-LR production and release were significantly decreased in both single-species and community exposures. These results can supply helpful information to further investigate the potential risks of AgNPs and ultimately help policymakers make better-informed decisions about their utilization for environmental restoration.
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Affiliation(s)
- A A Cortés-Téllez
- Environmental Toxicology Laboratory, Faculty of Chemistry-Pharmacobiology, Universidad Michoacana de San Nicolás de Hidalgo, 403 Santiago Tapia St., 58000 Morelia, Michoacán, Mexico
| | - A D'ors
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - A Sánchez-Fortún
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - C Fajardo
- Dpt. of Biomedicine and Biotechnology, Universidad de Alcalá (UAH), w/n San Diego Sq., 28801 Alcalá de Henares, Spain
| | - G Mengs
- Techincal and R&D Department, Ecotoxilab SL. 10 Juan XXIII., 28550 Tielmes, Spain
| | - M Nande
- Dpt. of Biochemistry and Molecular Biology, Complutense University. w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - C Martín
- Dpt. of Biotechnology-Plant Biology, Universidad Politécnica de Madrid (UPM), 3 Complutense Ave., 28040 Madrid, Spain
| | - G Costa
- Department of Animal Physiology, Faculty of Veterinary Sciences, Complutense University. w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - M Martín
- Dpt. of Biochemistry and Molecular Biology, Complutense University. w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - M C Bartolomé-Camacho
- Environmental Toxicology Laboratory, Faculty of Chemistry-Pharmacobiology, Universidad Michoacana de San Nicolás de Hidalgo, 403 Santiago Tapia St., 58000 Morelia, Michoacán, Mexico
| | - S Sánchez-Fortún
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave., 28040 Madrid, Spain.
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Giorda CB, Picariello R, Tartaglino B, Nada E, Romeo F, Costa G, Gnavi R. Hospitalisation for herpes zoster in people with and without diabetes: A 10-year-observational study. Diabetes Res Clin Pract 2024; 210:111603. [PMID: 38460790 DOI: 10.1016/j.diabres.2024.111603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/11/2024]
Abstract
AIMS This study explores the association between Herpes Zoster (HZ) hospitalizations and diabetes in Piedmont, Italy from 2010 to 2019. Focusing on the burden of HZ hospitalizations in diabetic and non-diabetic groups, it aims to identify risk factors in diabetics to enhance prevention strategies. METHODS In a two-phase study, we first compared age-standardized HZ hospitalization rates between diabetic and non-diabetic individuals from 2010 to 2019. We then examined hospitalization risk factors for HZ within a diabetic patient cohort managed by regional diabetes clinics. RESULTS Of 3,423 HZ hospitalizations in 2010-2019, 17.9 % (613 cases) were diabetic patients, who exhibited higher hospitalization rates (15.9 to 6.0 per 100,000) compared to non-diabetese individuals. Among diabetics subjects risk factors for HZ hospitalization included age over 65, obesity (BMI > 30), and poor glycemic control (HbA1c > 8.0 %). These patients had a 40 % increased rehospitalization risk and a 25 % higher risk of severe complications, such as stroke and myocardial infarction, post-HZ. CONCLUSIONS Diabetes markedly increases HZ hospitalization rates, rehospitalization, and complication risks. These findings underscore the need for preventive strategies, especially improved glycemic control among high-risk diabetic patients, to inform public health policies and clinical practices aimed at mitigating HZ's impact on this population.
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Affiliation(s)
- Carlo B Giorda
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy.
| | | | | | - Elisa Nada
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy
| | - Francesco Romeo
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy
| | - Giuseppe Costa
- Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy; Department of Public Health, University of Torino, Torino, Italy
| | - Roberto Gnavi
- Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy
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Manara R, Brotto D, Barillari MR, Costa G, Villani AV, Perna C, Ziello B, di Salle F, Cantone E, Pasanisi A, De Michele E, Ciancio A, D'Urzo G, Valentino P, Perrotta S, Ricchi P, Tartaglione I. Hearing loss in beta-thalassaemia: An Italian multicentre case-control study. Br J Haematol 2024. [PMID: 38500389 DOI: 10.1111/bjh.19401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Despite numerous studies, the true scenario of hearing loss in beta-thalassaemia remains rather nebulous. MATERIALS AND METHODS Pure tone audiometry, chelation therapy, demographics and laboratory data of 376 patients (mean age 38.5 ± 16.6 years, 204 females, 66 non-transfusion-dependent) and 139 healthy controls (mean age 37.6 ± 17.7 years, 81 females) were collected. RESULTS Patient and control groups did not differ for age (p = 0.59) or sex (p = 0.44). Hypoacusis rate was higher in patients (26.6% vs. 7.2%; p < 0.00001), correlated with male sex (32.6% in males vs. 21.8% in females; p = 0.01) and it was sensorineural in 79/100. Hypoacusis rate correlated with increasing age (p = 0.0006) but not with phenotype (13/66 non-transfusion-dependent vs. 87/310 transfusion-dependent patients; p = 0.16). Sensorineural-notch prevalence rate did not differ between patients (11.4%) and controls (12.2%); it correlated with age (p = 0.01) but not with patients' sex or phenotype. Among adult patients without chelation therapy, the sensorineural hypoacusis rate was non-significantly lower compared to chelation-treated patients while it was significantly higher compared to controls (p = 0.003). CONCLUSIONS Sensorineural hypoacusis rate is high in beta-thalassaemia (about 21%) and it increases with age and in males while disease severity or chelation treatment seems to be less relevant. The meaning of sensorineural-notch in beta-thalassaemia appears questionable.
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Affiliation(s)
- Renzo Manara
- Neuroradiology, Neurosciences Department, University of Padova, Padova, Italy
- DIMED, University of Padova, Padova, Italy
| | - Davide Brotto
- Section of Otorhinolaryngology, Neurosciences Department, University of Padova, Padova, Italy
| | - Maria Rosaria Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Costa
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa Valentina Villani
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Carmine Perna
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Brunella Ziello
- UOSD Malattie Rare del Globulo Rosso, Dipartimento di oncoematologia e pneumologia, AORN Cardarelli, Naples, Italy
| | - Francesco di Salle
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Università di Salerno, Fisciano, Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, "Federico II" University, Naples, Italy
| | - Annamaria Pasanisi
- Centro della Microcitemia "A. Quarta" UOC di Ematologia con trapiannto Ospedale Perrino, Brindisi, Italy
| | - Elisa De Michele
- Medicina Trasfusionale AUO "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Angela Ciancio
- Unità Operativa Ematologia-Day Hospital di Talassemia, Ospedale "Madonna delle Grazie", Matera, Italy
| | - Giovanna D'Urzo
- Dipartimento di Pediatria, Ospedale "Umberto I", Nocera Inferiore, Italy
| | - Pasqualino Valentino
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Paolo Ricchi
- UOSD Malattie Rare del Globulo Rosso, Dipartimento di oncoematologia e pneumologia, AORN Cardarelli, Naples, Italy
| | - Immacolata Tartaglione
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
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Mehanović E, Rosso G, Cuomo GL, Diecidue R, Maina G, Costa G, Vigna-Taglianti F. Risk Factors for Suicide Reattempt among Adolescents and Young Adults: The Role of Psychiatric Disorders. Psychiatr Q 2024; 95:69-84. [PMID: 38057631 DOI: 10.1007/s11126-023-10064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
Suicidal behaviour among young people is a serious public health concern. Each suicide attempt is related to further suicide attempts and completed suicide. This study aims to explore risk factors associated with repeated suicide attempt among adolescents and young adults. The cohort included 510 patients aged 12-29 years residing in Piedmont Region in North-Western Italy, who had been admitted to hospital or emergency department with a diagnosis of suicide attempt between 2010 and 2020. Cox regression models were used to evaluate potential risk factors for repeated suicide attempt. During the 11-years follow-up, 20.6% of adolescents and young adults repeated suicide attempt, 24.8% of females and 12.3% of males. Nearly 90% of youth who attempted suicide had a diagnosis of psychiatric disorder. After adjustment, younger age of onset of suicidal behaviour, and diagnosis of schizophrenia, bipolar disorder, depressive disorder, anorexia nervosa and personality disorder were significantly associated with repeated suicide attempt. The early identification of patients at higher risk of repetition of suicidal behaviour is of crucial importance. Better understanding of risk factors and effective treatment of mental disorders could help suicide prevention to reduce the burden of the problem among young people. Special attention should be paid during the initial months following discharge from hospital or emergency department, when suicide reattempt risk is very high.
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Affiliation(s)
- Emina Mehanović
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy.
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy.
| | - Gianluca Rosso
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gian Luca Cuomo
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Giuseppe Costa
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy
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Barillari MR, Nacci A, Bastiani L, Mirra G, Costa G, Maniaci A, Docimo L, Tolone S, Giumello F, Minichilli F, Chiesa Estomba CM, Lechien JR, Carroll TL. Is there a role for voice therapy in the treatment of laryngopharyngeal reflux? A pilot study. Acta Otorhinolaryngol Ital 2024; 44:27-35. [PMID: 38420719 PMCID: PMC10914355 DOI: 10.14639/0392-100x-n2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/13/2023] [Indexed: 03/02/2024]
Abstract
Objective The aim of this study was to compare the efficacy of voice therapy combined with standard anti-reflux therapy in reducing symptoms and signs of laryngopharyngeal reflux (LPR). Methods A randomised clinical trial was conducted. Fifty-two patients with LPR diagnosed by 24 h multichannel intraluminal impedance-pH monitoring were randomly allocated in two groups: medical treatment (MT) and medical plus voice therapy (VT). Clinical symptoms and laryngeal signs were assessed at baseline and after 3 months of treatment with the Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Voice Handicap Index (VHI) and GRBAS scales. Results Groups had similar scores at baseline. At 3-month follow-up, a significant decrease in RSI and RFS total scores were found in both groups although it appeared to be more robust in the VT group. G and R scores of the GRBAS scale significantly improved after treatment in both groups, with better results in the VT group. The VHI total score at 3 months improved more in the VT group (VHI delta 9.54) than in the MT group (VHI delta 5.38) (p < 0.001). Conclusions The addition of voice therapy to medications and diet appears to be more effective in improving treatment outcomes in subjects with LPR. Voice therapy warrants consideration in addition to medication and diet when treating patients with LPR.
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Affiliation(s)
- Maria Rosaria Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, Naples, Italy
- Laryngology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS)
| | - Andrea Nacci
- ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy
| | - Luca Bastiani
- Clinical Physiology Institute, Consiglio Nazionale delle Ricerche Area della Ricerca di Pisa (CNR), Pisa, Italy
| | - Giuseppina Mirra
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, Naples, Italy
| | - Giuseppe Costa
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, Naples, Italy
| | - Antonino Maniaci
- Laryngology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS)
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Italy
| | - Ludovico Docimo
- Division of General, Mininvasive and Bariatric Surgery, “L. Vanvitelli” University, Naples, Italy
| | - Salvatore Tolone
- Division of General, Mininvasive and Bariatric Surgery, “L. Vanvitelli” University, Naples, Italy
| | - Federica Giumello
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, Naples, Italy
| | - Fabrizio Minichilli
- Clinical Physiology Institute, Consiglio Nazionale delle Ricerche Area della Ricerca di Pisa (CNR), Pisa, Italy
| | - Carlos M. Chiesa Estomba
- Laryngology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS)
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia-Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
| | - Jerome R. Lechien
- Laryngology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS)
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Thomas L. Carroll
- Department of Otolaryngology-Head and Neck Surgery, BWH Voice Program, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
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Van Hemelrijck WMJ, Martikainen P, Zengarini N, Costa G, Janssen F. The impact of estimation methods for alcohol-attributable mortality on long-term trends for the general population and by educational level in Finland and Italy (Turin). PLoS One 2023; 18:e0295760. [PMID: 38096271 PMCID: PMC10721192 DOI: 10.1371/journal.pone.0295760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND AIMS This paper assesses the impact of estimation methods for general and education-specific trends in alcohol-attributable mortality (AAM), and develops an alternative method that can be used when the data available for study is limited. METHODS We calculated yearly adult (30+) age-standardised and age-specific AAM rates by sex for the general population and by educational level (low, middle, high) in Finland and Turin (Italy) from 1972 to 2017. Furthermore the slope index of inequality and relative inequality index were computed by country and sex. We compared trends, levels, age distributions, and educational inequalities in AAM according to three existing estimation methods: (1) Underlying COD (UCOD), (2) Multiple COD (MCOD) method, and (3) the population attributable fractions (PAF)-method. An alternative method is developed based on the pros and cons of these methods and the outcomes of the comparison. RESULTS The UCOD and MCOD approaches revealed mainly increasing trends in AAM compared to the declining trends according to the PAF approach. These differences are more pronounced when examining AAM trends by educational groups, particularly for Finnish men. Until age 65, age patterns are similar for all methods, and levels nearly identical for MCOD and PAF in Finland. Our novel method assumes a similar trend and age pattern as observed in UCOD, but adjusts its level upwards so that it matches the level of the PAF approach for ages 30-64. Our new method yields levels in-between UCOD and PAF for Turin (Italy), and resembles the MCOD rates in Finland for females. Relative inequalities deviate for the PAF-method (lower levels) compared to other methods, whereas absolute inequalities are generally lower for UCOD than all three methods that combine wholly and partly AAM. CONCLUSIONS The choice of method to estimate AAM affects not only levels, but also general and education-specific trends and inequalities. Our newly developed method constitutes a better alternative for multiple-country studies by educational level than the currently used UCOD-method when the data available for study is limited to underlying causes of death.
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Affiliation(s)
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Giuseppe Costa
- Department of Public Health and Microbiology, University of Turin, Turin, Italy
| | - Fanny Janssen
- Netherlands Interdisciplinary Demographic Institute(NIDI)-KNAW/University of Groningen, The Hague, The Netherlands
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
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Serrano-Alarcón M, Ardito C, Leombruni R, Kentikelenis A, d'Errico A, Odone A, Costa G, Stuckler D. Health and labor market effects of an unanticipated rise in retirement age. Evidence from the 2012 Italian pension reform. Health Econ 2023; 32:2745-2767. [PMID: 37667427 DOI: 10.1002/hec.4749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/25/2023] [Accepted: 07/21/2023] [Indexed: 09/06/2023]
Abstract
As retirement ages increase around the world, not all workers may be equally able to extend their working lives. In this article, we examine the health and labor market effects of an Italian pension reform that suddenly increased the normal retirement age up to 7 years for women and up to 2 years for men. To do this, we use linked labor and healthcare administrative data, jointly with survey data and difference-in-difference methods. Our results show that the reform was effective in postponing retirement among both genders, as pension claiming dropped substantially for older workers. However, there were also side effects as the reform significantly pushed previously employed men and women into unemployment and disability pension. Among women only, the reform also increased sick leave and hospitalizations related to mental health and injuries. These effects were driven by women with previously low health status, suggesting that undifferentiated and abrupt increases in pension age might harm more vulnerable workers. Coherently with the milder tightening of retirement age experienced by men, labor market responses were smaller in size, and they did not suffer any significant health effects.
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Affiliation(s)
- Manuel Serrano-Alarcón
- European Commission, Joint Research Centre (JRC), Ispra, Italy
- DONDENA Research Centre, Bocconi University, Milano, Italy
| | - Chiara Ardito
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Roberto Leombruni
- Department of Economics and Statistics, University of Torino, Torino, Italy
| | | | - Angelo d'Errico
- Epidemiology Unit of Piedmont Region, ASL TO3, Grugliasco, Turin, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Giuseppe Costa
- Epidemiology Unit of Piedmont Region, ASL TO3, Grugliasco, Turin, Italy
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - David Stuckler
- DONDENA Research Centre, Bocconi University, Milano, Italy
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De Gobbi A, Lupi A, Massari D, Stellato A, Behr AU, Costa G, Fiorello M. Camposampiero tubeless percutaneous nephrolithotomy (tPCNL): Easy, quick, effective, safe. Urologia 2023:3915603231210352. [PMID: 37933830 DOI: 10.1177/03915603231210352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To describe our technique to perform tubeless percutaneous nephrolithotomy (tPCNL) using hemostatic matrix (i.e. Floseal®) for the closure of the percutaneous tract, developed through the experience gained in our endourology specialized center. To evaluate the procedure efficacy and safety. METHODS tPCNL performed in our center with Floseal® application from February 2017 to December 2019 were retrospectively reviewed. Clinical and surgical data were collected in order to evaluate the success of the procedure and possible complications. Camposampiero technique is reported in detail. RESULTS Sixty-nine patients (45 males, mean age 58 years old) were included. In all patients the procedure was completed successfully and in 88% of subjects no further treatments were necessary; a low complication rate (6.9%) was reported. CONCLUSION In our experience, tPCNL with Floseal application is feasible, safe, and effective.
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Affiliation(s)
- Alberto De Gobbi
- U.O.C. Urologia, Ospedale di Camposampiero, ULSS 6 Euganea, Camposampiero, Italy
| | - Amalia Lupi
- Istituto di Radiologia, Dipartimento di Medicina - DIMED, Università degli Studi di Padova, Padova, Italy
| | - Domenico Massari
- U.O.C. Urologia, Ospedale di Camposampiero, ULSS 6 Euganea, Camposampiero, Italy
| | - Alberto Stellato
- U.O. Radiologia, Ospedale di Camposampiero, ULSS 6 Euganea, Camposampiero, Italy
| | - Astrid Ursula Behr
- U.O.C. Anestesia e Rianimazione, Ospedale di Camposampiero, ULSS 6 Euganea, Camposampiero, Italy
| | - Giuseppe Costa
- U.O.C. Urologia, Ospedale di Camposampiero, ULSS 6 Euganea, Camposampiero, Italy
| | - Mario Fiorello
- U.O.C. Urologia, Ospedale di Camposampiero, ULSS 6 Euganea, Camposampiero, Italy
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Maio S, Gariazzo C, Stafoggia M, Ancona C, Bisceglia L, Caranci N, Cernigliaro A, Cesaroni G, Costa G, Marcon A, Massari S, Nobile F, Ranzi A, Renzi M, Scondotto S, Zengarini N, Verlato G, Viegi G. [BIGEPI project: environmental and health data]. Epidemiol Prev 2023; 47:8-18. [PMID: 38639296 DOI: 10.19191/ep23.6.s3.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVES the BIGEPI project, co-funded by INAIL, has used big data to identify the health risks associated with short and long-term exposure to air pollution, extreme temperatures and occupational exposures. DESIGN the project consists of 5 specific work packages (WP) aimed at assessing: 1. the acute effects of environmental exposures over the national territory; 2. the acute effects of environmental exposures in contaminated areas, such as Sites of National Interest (SIN) and industrial sites; 3. the chronic effects of environmental exposures in 6 Italian longitudinal metropolitan studies; 4. the acute and chronic effects of environmental exposures in 7 epidemiological surveys on population samples; 5. the chronic effects of occupational exposures in the longitudinal metropolitan studies of Rome and Turin. SETTING AND PARTICIPANTS BIGEPI analyzed environmental and health data at different levels of detail: the whole Italian population (WP1); populations living in areas contaminated by pollutants of industrial origin (WP2); the entire longitudinal cohorts of the metropolitan areas of Bologna, Brindisi, Rome, Syracuse, Taranto and Turin (WP3 and WP5); population samples participating in the epidemiological surveys of Ancona, Palermo, Pavia, Pisa, Sassari, Turin and Verona (WP4). MAIN OUTCOME MEASURES environmental exposure: PM10, PM2,5, NO2 and O3 concentrations and air temperature at 1 Km2 resolution at national level. Occupational exposures: employment history of subjects working in at least one of 25 sectors with similar occupational exposures to chemicals/carcinogens; self-reported exposure to dust/fumes/gas in the workplace. Health data: cause-specific mortality/hospitalisation; symptoms/diagnosis of respiratory/allergic diseases; respiratory function and bronchial inflammation. RESULTS BIGEPI analyzed data at the level of the entire Italian population, data on 2.8 million adults (>=30 yrs) in longitudinal metropolitan studies and on about 14,500 individuals (>=18 yrs) in epidemiological surveys on population samples. The population investigated in the longitudinal metropolitan studies had an average age of approximately 55 years and that of the epidemiological surveys was about 48 years; in both cases, 53% of the population was female. As regards environmental exposure, in the period 2013-2015, at national level average values for PM10, PM2.5, NO2 and summer O3 were: 21.1±13.6, 15.1±10.9, 14.7±9.1 and 80.3±17.3 µg/m3, for the temperature the average value was 13.9±7.2 °C. Data were analyzed for a total of 1,769,660 deaths from non-accidental causes as well as 74,392 incident cases of acute coronary event and 45,513 of stroke. Epidemiological investigations showed a high prevalence of symptoms/diagnoses of rhinitis (range: 14.2-40.5%), COPD (range: 4.7-19.3%) and asthma (range: 3.2-13.2%). The availability of these large datasets has made it possible to implement advanced statistical models for estimating the health effects of short- and long-term exposures to pollutants. The details are reported in the BIGEPI papers already published in other international journals and in those published in this volume of E&P. CONCLUSIONS BIGEPI has confirmed the great potential of using big data in studies of the health effects of environmental and occupational factors, stimulating new directions of scientific research and confirming the need for preventive action on air quality and climate change for the health of the general population and the workers.
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Affiliation(s)
- Sara Maio
- Istituto di fisiologia clinica del Consiglio nazionale delle ricerche, Pisa;
| | - Claudio Gariazzo
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale di INAIL, Roma
| | - Massimo Stafoggia
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Carla Ancona
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Lucia Bisceglia
- Agenzia regionale per la salute e il sociale della Puglia, Bari
| | - Nicola Caranci
- Settore innovazione nei Servizi sanitari e sociali, Direzione generale cura della persona, salute e welfare, Regione Emilia-Romagna, Bologna
| | - Achille Cernigliaro
- Dipartimento attività sanitarie e Osservatorio epidemiologico, Assessorato salute, Regione Sicilia, Palermo
| | - Giulia Cesaroni
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Giuseppe Costa
- Servizio sovrazonale di epidemiologia ASL TO3, Grugliasco, Torino
| | - Alessandro Marcon
- Sezione di epidemiologia e statistica medica, Dipartimento di diagnostica e sanità pubblica, Università di Verona
| | - Stefania Massari
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale di INAIL, Roma
| | - Federica Nobile
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Andrea Ranzi
- ARPAE Emilia-Romagna - Dir. Tecnica, struttura ambiente, prevenzione e salute, Bologna
| | - Matteo Renzi
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Salvatore Scondotto
- Dipartimento attività sanitarie e osservatorio epidemiologico, Assessorato salute, Regione Sicilia, Palermo
| | | | - Giuseppe Verlato
- Sezione di epidemiologia e statistica medica, Dipartimento di diagnostica e sanità pubblica, Università di Verona
| | - Giovanni Viegi
- Istituto di fisiologia clinica del Consiglio nazionale delle ricerche, Pisa
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D'ors A, Sánchez-Fortún A, Cortés-Téllez AA, Fajardo C, Mengs G, Nande M, Martín C, Costa G, Martín M, Bartolomé MC, Sánchez-Fortún S. Adverse effects of iron-based nanoparticles on freshwater phytoplankton Scenedesmus armatus and Microcystis aeruginosa strains. Chemosphere 2023; 339:139710. [PMID: 37532199 DOI: 10.1016/j.chemosphere.2023.139710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
Zero-valent nano-iron particles (nZVI) are increasingly present in freshwater aquatic environments due to their numerous applications in environmental remediation. However, despite the broad benefits associated with the use and development of nZVI nanoparticles, the potential risks of introducing them into the aquatic environment need to be considered. Special attention should be focused on primary producer organisms, the basal trophic level, whose impact affects the rest of the food web. Although there are numerous acute studies on the acute effects of these nanoparticles on photosynthetic primary producers, few studies focus on long-term exposures. The present study aimed at assessing the effects of nZVI on growth rate, photosynthesis activity, and reactive oxygen activity (ROS) on the freshwater green algae Scenedesmus armatus and the cyanobacteria Microcystis aeruginosa. Moreover, microcystin production was also evaluated. These parameters were assessed on both organisms singly exposed to 72 h-effective nZVI concentration for 10% maximal response for 28 days. The results showed that the cell growth rate of S. armatus was initially significantly altered and progressively reached control-like values at 28 days post-exposure, while M. aeruginosa did not show any significant difference concerning control values at any time. In both strains dark respiration (R) increased, unlike net photosynthesis (Pn), while gross photosynthesis (Pg) only slightly increased at 7 days of exposure and then became equal to control values at 28 days of exposure. The nZVI nanoparticles generated ROS progressively during the 28 days of exposure in both strains, although their formation was significantly higher on green algae than on cyanobacteria. These data can provide additional information to further investigate the potential risks of nZVI and ultimately help decision-makers make better informed decisions regarding the use of nZVI for environmental remediation.
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Affiliation(s)
- A D'ors
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - A Sánchez-Fortún
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - A A Cortés-Téllez
- Environmental Toxicology Laboratory, Faculty of Chemistry-Pharmacobiology, Universidad Michoacana de San Nicolás de Hidalgo, 403 Santiago Tapia St, 58000, Morelia, (Michoacán), Mexico
| | - C Fajardo
- Dpt. of Biomedicine and Biotechnology, Universidad de Alcalá (UAH), w/n San Diego Sq, 28801, Alcalá de Henares, Spain
| | - G Mengs
- Technical and R&D Department, Ecotoxilab SL, 10 Juan XXIII, 28550, Tielmes, Spain
| | - M Nande
- Dpt. of Biochemistry and Molecular Biology, Complutense University, w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - C Martín
- Dpt. of Biotechnology-Plant Biology, Universidad Politécnica de Madrid (UPM), 3 Complutense Ave, 28040, Madrid, Spain
| | - G Costa
- Department of Animal Physiology, Faculty of Veterinary Sciences, Complutense University, w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - M Martín
- Dpt. of Biochemistry and Molecular Biology, Complutense University, w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - M C Bartolomé
- Environmental Toxicology Laboratory, Faculty of Chemistry-Pharmacobiology, Universidad Michoacana de San Nicolás de Hidalgo, 403 Santiago Tapia St, 58000, Morelia, (Michoacán), Mexico.
| | - S Sánchez-Fortún
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave, 28040, Madrid, Spain.
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12
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Baratta F, Allais G, Gnavi R, Scarinzi C, Enri LR, Rolando S, Spadea T, Costa G, Benedetto C, Mana M, Giaccone M, Mandelli A, Manzoni GC, Bussone G, Brusa P. Triptans utilization in Italian population: A real-life study in community pharmacies. PLoS One 2023; 18:e0291323. [PMID: 37682959 PMCID: PMC10490971 DOI: 10.1371/journal.pone.0291323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
The term Headache Disorders (HD) refers to a number of nervous system pathologies characterised by recurrent headaches. Despite the serious impact HD have on the health system, society, and the economy, these are an underestimated, underdiagnosed, and, hence, undertreated phenomenon. Triptans are the first-line therapy for the acute treatment of moderate to severe migraine but their utilization is still inadequate, perhaps also because in Italy no triptan can be bought without a medical prescription. In this article, the data from a 2016-2017 study has been further analysed with the aim of evaluating any associations between the use of triptans and the other series of variables identified in the questionnaire. This further analysis has been connected to the role that community pharmacies could play on this issue. The questionnaire was administered to 4,424 pharmacy users by 610 purposely trained pharmacists working in 514 pharmacies. The survey was carried out in 19 of the 20 Italian regions. The data shows that only 25% of patients suffering from HDs are prescribed triptans. Older patients, those with definite migraines, and those with a chronic disorder resort more frequently to this class of pharmaceuticals, as do those patients in care at a specialist headache centre. The multivariable analysis also confirmed these results. Our study, which performed a direct detection, in real life, on patients requesting pharmacological treatment for a migraine headache, therefore confirmed the need to investigate the reasons behind the low use and prescription of triptans in the Italian population. Moreover, any future studies should take advantage of community pharmacies, plan actions that would allow a series of evaluations over time of the requirements of migraineurs, and establish a process to put these patients under the care of the pharmacy to ensure adherence to therapy.
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Affiliation(s)
- Francesca Baratta
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Gianni Allais
- Department of Surgical Sciences, Women’s Headache Center, University of Turin, Turin, Italy
- FI.CEF Onlus, Italian Headache Foundation, Milan, Italy
| | - Roberto Gnavi
- Epidemiology Unit, ASL TO3, Grugliasco (Turin), Italy
| | | | | | - Sara Rolando
- Department of Surgical Sciences, Women’s Headache Center, University of Turin, Turin, Italy
| | - Teresa Spadea
- Epidemiology Unit, ASL TO3, Grugliasco (Turin), Italy
| | | | - Chiara Benedetto
- Department of Surgical Sciences, Women’s Headache Center, University of Turin, Turin, Italy
| | | | - Mario Giaccone
- Order of Pharmacists of Turin, Turin, Italy
- FOFI, Federation of the Orders of Italian Pharmacists, Rome, Italy
| | - Andrea Mandelli
- FOFI, Federation of the Orders of Italian Pharmacists, Rome, Italy
| | | | | | - Paola Brusa
- Department of Drug Science and Technology, University of Turin, Turin, Italy
- Order of Pharmacists of Turin, Turin, Italy
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13
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Mehanović E, Rosso G, Cuomo GL, Diecidue R, Maina G, Costa G, Vigna-Taglianti F. Risk factors for mortality after hospitalization for suicide attempt: results of 11-year follow-up study in Piedmont Region, Italy. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02544-7. [PMID: 37552335 DOI: 10.1007/s00127-023-02544-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Suicide attempters are at high risk of premature death, both for suicide and for non-suicidal causes. The aim of this study is to investigate risk factors and temporal span for mortality in a cohort of cases admitted to hospital for suicide attempt. METHODS The cohort included 1489 patients resident in Piedmont Region, North West of Italy, who had been admitted to hospital or emergency department for suicide attempt between 2010 and 2020. Cox regression models were used to identify risk factors for death. The final multivariate model included gender, age, area deprivation index, family composition, psychiatric disorders, malignant neoplasms, neurological disorders, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and intracranial injury or skull fracture. RESULTS During the observation period, 7.3% of patients died. The highest mortality was observed within the first 12 months after suicide attempt, and remained elevated for many years afterwards. Male gender, older age, high deprivation index of the census area, single-parent family, mood disorders, malignant neoplasms, diabetes mellitus and intracranial injuries or skull fracture were independent predictors of death. Risk factors for natural and unnatural causes of death were also identified. CONCLUSIONS The mortality risk of suicide attempters is very high, both in the months immediately following the attempt and afterwards. The identification of high-risk groups can help to plan outpatient care following the hospital discharge. Our findings urge the need to design strategies for the assistance and care of these patients at long term in order to reduce the unfavourable outcomes.
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Affiliation(s)
- Emina Mehanović
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy.
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy.
| | - Gianluca Rosso
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gian Luca Cuomo
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Giuseppe Costa
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy
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14
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Zazueta-Borboa JD, Martikainen P, Aburto JM, Costa G, Peltonen R, Zengarini N, Sizer A, Kunst AE, Janssen F. Reversals in past long-term trends in educational inequalities in life expectancy for selected European countries. J Epidemiol Community Health 2023; 77:421-429. [PMID: 37173136 PMCID: PMC10314064 DOI: 10.1136/jech-2023-220385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Across Europe, socioeconomic inequalities in mortality are large and persistent. To better understand the drivers of past trends in socioeconomic mortality inequalities, we identified phases and potential reversals in long-term trends in educational inequalities in remaining life expectancy at age 30 (e30), and assessed the contributions of mortality changes among the low-educated and the high-educated at different ages. METHODS We used individually linked annual mortality data by educational level (low, middle and high), sex and single age (30+) from 1971/1972 onwards for England and Wales, Finland and Italy (Turin). We applied segmented regression to trends in educational inequalities in e30 (e30 high-educated minus e30 low-educated) and employed a novel demographic decomposition technique. RESULTS We identified several phases and breakpoints in the trends in educational inequalities in e30. The long-term increases (Finnish men, 1982-2008; Finnish women, 1985-2017; and Italian men, 1976-1999) were driven by faster mortality declines among the high-educated aged 65-84, and by mortality increases among the low-educated aged 30-59. The long-term decreases (British men, 1976-2008, and Italian women, 1972-2003) were driven by faster mortality improvements among the low-educated than among the high-educated at age 65+. The recent stagnation of increasing inequality (Italian men, 1999) and reversals from increasing to decreasing inequality (Finnish men, 2008) and from decreasing to increasing inequality (British men, 2008) were driven by mortality trend changes among the low-educated aged 30-54. CONCLUSION Educational inequalities are plastic. Mortality improvements among the low-educated at young ages are imperative for achieving long-term decreases in educational inequalities in e30.
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Affiliation(s)
- Jesus Daniel Zazueta-Borboa
- Aging and Longevity, Netherlands Interdisciplinary Demographic Institute - KNAW/University of groningen, The Hage, The Netherlands
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jose Manuel Aburto
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
- Interdisciplinary Centre on Population Dynamics, Southern Denmark University, Odense, Denmark
| | - Giuseppe Costa
- Department of Public Health and Microbiology, University of Turin, Turin, Italy
| | - Riina Peltonen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Nicolas Zengarini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (Torino), Italy
| | - Alison Sizer
- Department of Information Studies, University College London, London, UK
| | - Anton E Kunst
- Social Medicine, Amsterdam UMC, Locatie AMC, Amsterdam, The Netherlands
| | - Fanny Janssen
- Aging and Longevity, Netherlands Interdisciplinary Demographic Institute - KNAW/University of groningen, The Hage, The Netherlands
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
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15
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Bucciardini R, Zetterquist P, Rotko T, Putatti V, Mattioli B, De Castro P, Napolitani F, Giammarioli AM, Kumar BN, Nordström C, Plantz C, Zarneh YS, Olsson G, Ahrne M, Kilpeläinen K, Lopez-Acuña D, Vantarakis A, Marra M, Nessi C, Costa G. Addressing health inequalities in Europe: key messages from the Joint Action Health Equity Europe (JAHEE). Arch Public Health 2023; 81:89. [PMID: 37170153 PMCID: PMC10173226 DOI: 10.1186/s13690-023-01086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 05/13/2023] Open
Abstract
Health inequalities within and between Member States of the European Union are widely recognized as a public health problem as they determine a significant share of potentially avoidable mortality and morbidity. After years of growing awareness and increasing action taken, a large gap still exists across Europe in terms of policy responses and governance. With the aim to contribute to achieve greater equity in health outcomes, in 2018 a new Joint Action, JAHEE, (Joint Action Health Equity Europe) was funded by the third EU Health Programme, with the main goal of strengthening cooperation between participating countries and of implementing concrete actions to reduce health inequalities. The partnership led by Italy counted 24 countries, conducting actions in five policy domains: monitoring, governance, healthy living environments, health systems and migration, following a three-step implementation approach. Firstly, specific Policy Frameworks for Action (PFA) collecting the available evidence on what practice should be done in each domain were developed. Second, different Country Assessments (CAs) were completed to check the country's adherence to the recommended practice in each domain. The gap between the expected policy response (PFA) and the present policy response (CA) guided the choice of concrete actions to be implemented in JAHEE, many of which are continuing even after the end of JA. Final recommendations based on the best results achieved during JAHEE were elaborated and agreed jointly with the representatives of the involved Ministries of Health. The JAHEE initiative represented an important opportunity for the participating countries to work jointly, and the results show that almost all have increased their level of action and strengthened their capacities to address health inequalities.
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Affiliation(s)
| | | | - Tuulia Rotko
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | | | | | | | | | | | | | | | - Malin Ahrne
- Public Health Agency of Sweden, Stockholm, Sweden
| | | | | | | | - Michele Marra
- Epidemiology Unit, ALSTO3, Piedmont Region, Turin, Italy
| | | | - Giuseppe Costa
- Dept Clinical and Biological Sciences, Turin University, Turin, Italy
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16
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Costa G, Davoli M. [Where the health care system is headed and what contribution epidemiology can offer: tips from the 47° Congress of the Italian Epidemiological Association]. Epidemiol Prev 2023; 47:116-117. [PMID: 37387296 DOI: 10.19191/ep23.3.a637.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- Giuseppe Costa
- già Dipartimento di scienze cliniche e biologiche, Università di Torino;
| | - Marina Davoli
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
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17
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Gnavi R, Eboli I, Alboini PE, D'Alfonso S, Picariello R, Costa G, Leone M. COVID-19 and Health Outcomes in People with Multiple Sclerosis: A Population-Based Study in Italy. Life (Basel) 2023; 13:life13051089. [PMID: 37240734 DOI: 10.3390/life13051089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
People with multiple sclerosis (PWMS) are at high risk of being affected by the disruption of health services that occurred during the COVID-19 pandemic months. The aim of this study was to evaluate the effect of the pandemic on the health outcomes of PWMS. PWMS and MS-free residing in Piedmont (north-west of Italy) were identified from electronic health records and linked with the regional COVID-19 database, the hospital-discharge database, and the population registry. Both cohorts (9333 PWMS and 4,145,856 MS-free persons) were followed-up for access to swab testing, hospitalisation, access to the Intensive Care Unit (ICU), and death from 22 February 2020 to 30 April 2021. The relationship between the outcomes and MS was evaluated using a logistic model, which was adjusted for potential confounders. The rate of swab testing was higher in PWMS, but the positivity to infection was similar to that of MS-free subjects. PWMS had a higher risk of hospitalisation (OR = 1.74; 95% IC, 1.41-2.14), admission to ICU (OR = 1.79; 95% IC, 1.17-2.72), and a slight, albeit not statistically significant, increase in mortality (OR = 1.28; 95% IC, 0.79-2.06). Compared to the general population PWMS with COVID-19 had an increased risk of hospitalization and admission to the ICU; the mortality rate did not differ.
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Affiliation(s)
- Roberto Gnavi
- Epidemiology Unit, ASL TO3 Regione Piemonte, 10095 Grugliasco, Italy
| | - Ilenia Eboli
- Epidemiology Unit, ASL TO3 Regione Piemonte, 10095 Grugliasco, Italy
| | - Paolo Emilio Alboini
- Neurology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Sandra D'Alfonso
- Department of Health Sciences, and CAAD, University of Eastern Piedmont, 28100 Novara, Italy
| | | | - Giuseppe Costa
- Epidemiology Unit, ASL TO3 Regione Piemonte, 10095 Grugliasco, Italy
- Department of Biological and Clinical Sciences, University of Turin, 10128 Torino, Italy
| | - Maurizio Leone
- Neurology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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18
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Giorda CB, Picariello R, Tartaglino B, Nada E, Costa G, Manti R, Monge L, Gnavi R. HEPATOCELLULAR CARCINOMA IN A LARGE COHORT OF TYPE 2 DIABETES PATIENTS. Diabetes Res Clin Pract 2023; 200:110684. [PMID: 37100229 DOI: 10.1016/j.diabres.2023.110684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023]
Abstract
AIMS To elucidate the current burden of hepatocellular carcinoma (HCC) in type 2 diabetes (DM2) with a focus on the associated clinical determinants. METHODS Incidence of HCC between 2009 and 2019 in the diabetic and general population was calculated from regional administrative and hospital databases. Potential determinants of the disease were evaluated with a follow-up study. RESULTS In the DM2 population, the incidence resulted in 8.05 cases per 10,000 yearly. This rate was three times higher than that of the general population. 137158 patients with DM2 and 902 HCC were found for the cohort study. The survival of HCC patients was 1/3 of that of cancer-free diabetic controls. Age, male sex, alcohol abuse, previous viral hepatitis B and C, cirrhosis, low platelet count, elevated GGT / ALT, higher BMI and HbA1c levels were associated with HCC occurrence. Diabetes therapy was not adversely associated with HCC development. CONCLUSION Incidence of HCC in DM2 is more than tripled compared to the general population with high mortality. These figures are higher than those expected from the previous evidence. In parallel with known risk factors for liver disease, such as viruses and alcohol, insulin-resistance characteristics are associated with a higher probability of HCC.
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Affiliation(s)
- Carlo B Giorda
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy.
| | | | | | - Elisa Nada
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy
| | - Giuseppe Costa
- Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy; Department of Public Health, University of Torino, Torino, Italy
| | - Roberta Manti
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy
| | - Luca Monge
- AMD (Clinical Diabetologists Association), Rome
| | - Roberto Gnavi
- Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy
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19
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Long D, Mackenbach JP, Klokgieters S, Kalėdienė R, Deboosere P, Martikainen P, Heggebø K, Leinsalu M, Bopp M, Brønnum-Hansen H, Costa G, Eikemo T, Nusselder WJ. Widening educational inequalities in mortality in more recent birth cohorts: a study of 14 European countries. J Epidemiol Community Health 2023; 77:400-408. [PMID: 37094941 PMCID: PMC10176379 DOI: 10.1136/jech-2023-220342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/01/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Studies of period changes in educational inequalities in mortality have shown important changes over time. It is unknown whether a birth cohort perspective paints the same picture. We compared changes in inequalities in mortality between a period and cohort perspective and explored mortality trends among low-educated and high-educated birth cohorts. DATA AND METHODS In 14 European countries, we collected and harmonised all-cause and cause-specific mortality data by education for adults aged 30-79 years in the period 1971-2015. Data reordered by birth cohort cover persons born between 1902 and 1976. Using direct standardisation, we calculated comparative mortality figures and resulting absolute and relative inequalities in mortality between low educated and high educated by birth cohort, sex and period. RESULTS Using a period perspective, absolute educational inequalities in mortality were generally stable or declining, and relative inequalities were mostly increasing. Using a cohort perspective, both absolute and relative inequalities increased in recent birth cohorts in several countries, especially among women. Mortality generally decreased across successive birth cohorts among the high educated, driven by mortality decreases from all causes, with the strongest reductions for cardiovascular disease mortality. Among the low educated, mortality stabilised or increased in cohorts born since the 1930s in particular for mortality from cardiovascular diseases, lung cancer, chronic obstructive pulmonary disease and alcohol-related causes. CONCLUSIONS Trends in mortality inequalities by birth cohort are less favourable than by calendar period. In many European countries, trends among more recently born generations are worrying. If current trends among younger birth cohorts persist, educational inequalities in mortality may further widen.
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Affiliation(s)
- Di Long
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
| | | | - Silvia Klokgieters
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ramunė Kalėdienė
- Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussel, Belgium
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Kristian Heggebø
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
- NOVA, Oslo Metropolitan University, Oslo, Norway
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Giuseppe Costa
- Department of Clinical Medicine and Biology, University of Turin, Torino, Italy
| | - Terje Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
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20
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Scavarda A, Costa G, Beccaria F. Using Photovoice to understand physical and social living environment influence on adherence to diabetes. Health (London) 2023; 27:279-300. [PMID: 34041947 DOI: 10.1177/13634593211020066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Within the past several years, a considerable body of research on adherence to diabetes regimen has emerged in public health. However, the focus of the vast majority of these studies has been on the individual traits and attitudes affecting adherence. Still little is known on the role of the social and physical context in supporting or hindering diabetes self-management, particularly from a qualitative standpoint. To address these limitations, this paper presents the findings of a Photovoice study on a sample of 10 type 2 diabetic older adults living in a deprived neighbourhood of an Italian city. The findings reveal that the possibility to engage in diet, exercise and blood sugar monitoring seems to be more affected by physical and social elements of the respondents' environment than by the interviewees' beliefs and attitudes. Both environmental barriers and social isolation emerge as barriers to lifestyle changes and self-care activities related to blood sugar monitoring. The predominance of bonding social capital, the scant level of trust and the negative perception of local health services result in a low level of social cohesion, a limited circulation of health information on diabetes management and, consequently, in poor health outcomes.
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Affiliation(s)
- Alice Scavarda
- Università di Torino, Eclectica, Institute for Research and Training, Italy
| | - Giuseppe Costa
- Università di Torino, Servizio Sovrazionale di Epidemiologia, ASL TO3, Italy
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21
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Sanchez T, Mavragani A, Gilcrease W, Macciotta A, Saugo C, Manfredi L, Gnavi R, Strippoli E, Zengarini N, Caramello V, Costa G, Sacerdote C, Ricceri F. Multimorbidity and SARS-CoV-2-Related Outcomes: Analysis of a Cohort of Italian Patients. JMIR Public Health Surveill 2023; 9:e41404. [PMID: 36626821 PMCID: PMC9951075 DOI: 10.2196/41404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/24/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Since the outbreak of the COVID-19 pandemic, identifying the main risk factors has been imperative to properly manage the public health challenges that the pandemic exposes, such as organizing effective vaccination campaigns. In addition to gender and age, multimorbidity seems to be 1 of the predisposing factors coming out of many studies investigating the possible causes of increased susceptibility to SARS-CoV-2 infection and adverse outcomes. However, only a few studies conducted have used large samples. OBJECTIVE The objective is to evaluate the association between multimorbidity, the probability to be tested, susceptibility, and the severity of SARS-CoV-2 infection in the Piedmont population (Northern Italy, about 4 million inhabitants). For this purpose, we considered 5 main outcomes: access to the swab, positivity to SARS-CoV-2, hospitalization, intensive care unit (ICU) admission, and death within 30 days from the first positive swab. METHODS Data were obtained from different Piedmont health administrative databases. Subjects aged from 45 to 74 years and infections diagnosed from February to May 2020 were considered. Multimorbidity was defined both with the Charlson Comorbidity Index (CCI) and by identifying patients with previous comorbidities, such as diabetes and oncological, cardiovascular, and respiratory diseases. Multivariable logistic regression models (adjusted for age and month of infection and stratified by gender) were performed for each outcome. Analyses were also conducted by separating 2 age groups (45-59 and 60-74 years). RESULTS Of 1,918,549 subjects, 85,348 (4.4%) performed at least 1 swab, of whom 12,793 (14.9%) tested positive for SARS-CoV-2. Of these 12,793 subjects, 4644 (36.3%) were hospitalized, 1508 (11.8%) were admitted to the ICU, and 749 (5.9%) died within 30 days from the first positive swab. Individuals with a higher CCI had a higher probability of being swabbed but a lower probability of testing positive. We observed the same results when analyzing subjects with previous oncological and cardiovascular diseases. Moreover, especially in the youngest group, we identified a greater risk of being hospitalized and dying. Among comorbidities considered in the study, respiratory diseases seemed to be the most likely to increase the risk of having a positive swab and worse disease outcomes. CONCLUSIONS Our study shows that patients with multimorbidity, although swabbed more frequently, are less likely to get infected with SARS-CoV-2, probably due to greater attention on protective methods. Moreover, a history of respiratory diseases is a risk factor for a worse prognosis of COVID-19. Nonetheless, whatever comorbidities affect the patients, a strong dose-response effect was observed between an increased CCI score and COVID-19 hospitalization, ICU admission, and death. These results are important in terms of public health because they help in identifying a group of subjects who are more prone to worse SARS-CoV-2 outcomes. This information is important for promoting targeted prevention and developing policies for the prioritization of public health interventions.
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Affiliation(s)
| | | | - Winston Gilcrease
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Orbassano (TO), Italy.,UNESCO Chair in Sustainable Development and Territory Management, University of Turin, Turin, Italy
| | - Alessandra Macciotta
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Orbassano (TO), Italy
| | - Carlo Saugo
- Klinik für Innere Medizin - Gastroenterologie, Hepatologie & Infektiologie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Luca Manfredi
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Orbassano (TO), Italy
| | - Roberto Gnavi
- Unit of Epidemiology, Regional Health Service ASLTO3, Grugliasco (TO), Italy
| | - Elena Strippoli
- Unit of Epidemiology, Regional Health Service ASLTO3, Grugliasco (TO), Italy
| | - Nicolás Zengarini
- Unit of Epidemiology, Regional Health Service ASLTO3, Grugliasco (TO), Italy
| | - Valeria Caramello
- Emergency Department and High Dependency Unit, San Luigi Gonzaga University Hospital, Orbassano (TO), Italy
| | - Giuseppe Costa
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Orbassano (TO), Italy.,Unit of Epidemiology, Regional Health Service ASLTO3, Grugliasco (TO), Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Fulvio Ricceri
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Orbassano (TO), Italy.,Unit of Epidemiology, Regional Health Service ASLTO3, Grugliasco (TO), Italy
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22
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D'Andrea R, Corona C, Poszwa A, Belingard C, Domínguez-Delmás M, Stoffel M, Crivellaro A, Crouzevialle R, Cerbelaud F, Costa G, Paradis-Grenouillet S. Combining conventional tree-ring measurements with wood anatomy and strontium isotope analyses enables dendroprovenancing at the local scale. Sci Total Environ 2023; 858:159887. [PMID: 36351500 DOI: 10.1016/j.scitotenv.2022.159887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Dendroprovenancing provides critical information regarding the origin of wood, allowing further insights into economic exploitation strategies and source regions of timber products. Traditionally, dendroprovenancing relies on pattern-matching of tree rings, but its spatial resolution is limited by the geographical coverage of species-specific chronologies available for crossdating and, in the case of short-distance trades, by scarce environmental variability. Here, we present an approach to provenance timber with high spatial resolution from forested areas that have been exploited intensively throughout history, with the aim to understand the sustainability of the various woodland management practices used to supply timber products. To this end, we combined tree-ring width (TRW), wood anatomical and geochemical analyses in addition to multivariate statistical validation procedures to trace the origin of living oak trees (Quercus robur) sampled in four stands located within a 30-km radius around the city of Limoges (Haute-Vienne, France). We demonstrate that TRW and wood anatomical variables (and in particular cell density) robustly discriminate the eastern from the western site, while failing to trace the origin of trees from the northern and southern sites. Here, strontium isotopic ratios (87Sr/86Sr) and Ca concentrations identify clusters of trees which could not be identified with TRW or wood anatomy. Ultimately, our study demonstrates that the coupling of wood anatomy with geochemical signatures allows to correctly pinpoint the origin of trees. Given the small geographic scale of our study and the limited differences in elevation and climate between study sites, our results are particularly promising for future dendroprovenancing studies. We thus conclude that the combination of multiple approaches will not only increase the accuracy of dendroprovenancing studies at local scales, but could also be implemented at much larger scales to identify trends in historic timber supply throughout Europe.
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Affiliation(s)
- R D'Andrea
- GEOLAB, Université de Limoges, Limoges, France.
| | - C Corona
- GEOLAB, UMR 6042 CNRS, Université Clermont Auvergne, Clermont-Ferrand, France; Climate Change Impacts and Risks in the Anthropocene, Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland; Department F.A. Forel for Environmental and Aquatic Sciences, University of Geneva, Geneva, Switzerland
| | - A Poszwa
- Laboratoire Interdisciplinaire des Environnements Continentaux, Université de Lorraine, Nancy, France
| | - C Belingard
- GEOLAB, Université de Limoges, Limoges, France
| | - M Domínguez-Delmás
- Amsterdam School for Heritage and Memory Studies, University of Amsterdam, Amsterdam, the Netherlands
| | - M Stoffel
- Climate Change Impacts and Risks in the Anthropocene, Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland; Department F.A. Forel for Environmental and Aquatic Sciences, University of Geneva, Geneva, Switzerland; Department of Earth Sciences, University of Geneva, Geneva, Switzerland
| | - A Crivellaro
- Forest Biometrics Laboratory, Faculty of Forestry, University of Suceava, Suceava, Ukraine; Éveha, Bureau d'étude archéologique, Limoges, France
| | | | - F Cerbelaud
- GEOLAB, Université de Limoges, Limoges, France
| | - G Costa
- Laboratoire PEIRENE, Université de Limoges, Limoges, France
| | - S Paradis-Grenouillet
- GEOLAB, Université de Limoges, Limoges, France; Éveha, Bureau d'étude archéologique, Limoges, France
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23
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Costa G, Oprandi A, Bavestrello G, Castellano M, Bertolino M. Biogenic silica in the Posidonia oceanica “matte”, a tool to discover past dynamics of the sponge community. The European Zoological Journal 2022. [DOI: 10.1080/24750263.2022.2140851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- G. Costa
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, Milan, Italy
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
| | - A. Oprandi
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
| | - G. Bavestrello
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
- NBFC, National Biodiversity Future Center, Palermo, Italy
| | - M. Castellano
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
| | - M. Bertolino
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
- NBFC, National Biodiversity Future Center, Palermo, Italy
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24
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Galletti M, Alesini D, Anania MP, Arjmand S, Behtouei M, Bellaveglia M, Biagioni A, Buonomo B, Cardelli F, Carpanese M, Chiadroni E, Cianchi A, Costa G, Del Dotto A, Del Giorno M, Dipace F, Doria A, Filippi F, Franzini G, Giannessi L, Giribono A, Iovine P, Lollo V, Mostacci A, Nguyen F, Opromolla M, Pellegrino L, Petralia A, Petrillo V, Piersanti L, Di Pirro G, Pompili R, Romeo S, Rossi AR, Selce A, Shpakov V, Stella A, Vaccarezza C, Villa F, Zigler A, Ferrario M. Stable Operation of a Free-Electron Laser Driven by a Plasma Accelerator. Phys Rev Lett 2022; 129:234801. [PMID: 36563228 DOI: 10.1103/physrevlett.129.234801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 06/17/2023]
Abstract
The breakthrough provided by plasma-based accelerators enabled unprecedented accelerating fields by boosting electron beams to gigaelectronvolt energies within a few centimeters [1-4]. This, in turn, allows the realization of ultracompact light sources based on free-electron lasers (FELs) [5], as demonstrated by two pioneering experiments that reported the observation of self-amplified spontaneous emission (SASE) driven by plasma-accelerated beams [6,7]. However, the lack of stability and reproducibility due to the intrinsic nature of the SASE process (whose amplification starts from the shot noise of the electron beam) may hinder their effective implementation for user purposes. Here, we report a proof-of-principle experiment using plasma-accelerated beams to generate stable and reproducible FEL light seeded by an external laser. FEL radiation is emitted in the infrared range, showing the typical exponential growth of its energy over six consecutive undulators. Compared to SASE, the seeded FEL pulses have energies 2 orders of magnitude larger and stability that is 3 times higher.
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Affiliation(s)
- M Galletti
- Department of Physics, Università di Roma Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- INFN-Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- NAST Center, Via Ricerca Scientifica 1, 00133 Rome, Italy
| | - D Alesini
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M P Anania
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - S Arjmand
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M Behtouei
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M Bellaveglia
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Biagioni
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - B Buonomo
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - F Cardelli
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M Carpanese
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - E Chiadroni
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
- Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - A Cianchi
- Department of Physics, Università di Roma Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- INFN-Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- NAST Center, Via Ricerca Scientifica 1, 00133 Rome, Italy
| | - G Costa
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Del Dotto
- ENEA, C.R. Brasimone, 40032, Camugnano, Bologna, Italy
| | - M Del Giorno
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - F Dipace
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Doria
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - F Filippi
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - G Franzini
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - L Giannessi
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Giribono
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - P Iovine
- INFN-Napoli, Via Cintia, 80126 Naples, Italy
| | - V Lollo
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Mostacci
- Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - F Nguyen
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - M Opromolla
- Università degli Studi di Milano, Via Celoria 16 20133 Milano Italy
- INFN-Milano, Via Celoria 16, 20133 Milan, Italy
| | - L Pellegrino
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Petralia
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - V Petrillo
- Università degli Studi di Milano, Via Celoria 16 20133 Milano Italy
- INFN-Milano, Via Celoria 16, 20133 Milan, Italy
| | - L Piersanti
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - G Di Pirro
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - R Pompili
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - S Romeo
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A R Rossi
- INFN-Milano, Via Celoria 16, 20133 Milan, Italy
| | - A Selce
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
- INFN-Roma Tre, Via della Vasca Navale 84, 00146 Roma RM, Italy
| | - V Shpakov
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Stella
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - C Vaccarezza
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - F Villa
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Zigler
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
- Racah Institute of Physics, Hebrew University, 91904 Jerusalem, Israel
| | - M Ferrario
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
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25
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Marra M, Strippoli E, Zengarini N, Costa G. Inequalities in the Health Impact of the First Wave of the COVID-19 Pandemic in Piedmont Region, Italy. Int J Environ Res Public Health 2022; 19:14791. [PMID: 36429508 PMCID: PMC9690941 DOI: 10.3390/ijerph192214791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
(1) Introduction: Several studies observe a social gradient in the incidence and health consequences of SARS-CoV-2 infection, but they rely mainly on spatial associations because individual-level data are lacking. (2) Objectives: To assess the impact of social inequalities in the health outcomes of COVID-19 during the first epidemic wave in Piedmont Region, Italy, evaluating the role of the unequal social distribution of comorbidities and the capacity of the healthcare system to promote equity. (3) Methods: Subjects aged over 35, resident in Piedmont on 22 February 2020, were followed up until 30 May 2020 for access to swabs, infection, hospitalization, admission to intensive care unit, in-hospital death, COVID-19, and all-cause death. Inequalities were assessed through an Index of Socioeconomic Disadvantage composed of information on education, overcrowding, housing conditions, and neighborhood deprivation. Relative incidence measures and Relative Index of Inequality were estimated through Poisson regression models, stratifying by gender and age groups (35-64 years; ≥65 years), adjusting for comorbidity. (4) Results: Social inequalities were found in the various outcomes, in the female population, and among elderly males. Inequalities in ICU were lower, but analyses only on in-patients discount the hypothesis of preferential access by the most advantaged. Comorbidities contribute to no more than 30% of inequalities. (5) Conclusions: Despite the presence of significant inequities, the pandemic does not appear to have further exacerbated health inequalities, partly due to the fairness of the healthcare system. It is necessary to reduce inequalities in the occurrence of comorbidities that confer susceptibility to COVID-19 and promote prevention policies that limit inequalities in the mechanisms of contagion and improve out-of-hospital timely treatment.
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Affiliation(s)
- Michele Marra
- Epidemiology Department, Local Health Unit TO3, 10095 Grugliasco, Italy
| | - Elena Strippoli
- Epidemiology Department, Local Health Unit TO3, 10095 Grugliasco, Italy
| | - Nicolás Zengarini
- Epidemiology Department, Local Health Unit TO3, 10095 Grugliasco, Italy
| | - Giuseppe Costa
- Epidemiology Department, Local Health Unit TO3, 10095 Grugliasco, Italy
- Department of Clinical and Biological Sciences, University of Turin, 10126 Torino, Italy
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26
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Ellena M, Ballester J, Costa G, Achebak H. Evolution of temperature-attributable mortality trends looking at social inequalities: An observational case study of urban maladaptation to cold and heat. Environ Res 2022; 214:114082. [PMID: 35964673 DOI: 10.1016/j.envres.2022.114082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND To date, little is known about the temporal variation of the temperature-mortality association among different demographic and socio-economic groups. The aim of this work is to investigate trends in cold- and heat- attributable mortality risk and burden by sex, age, education, marital status, and number of household occupants in the city of Turin, Italy. METHODS We collected daily time-series of temperature and mortality counts by demographic and socio-economic groups for the period 1982-2018 in Turin. We applied standard quasi-Poisson regression models to data subsets of 25-year moving subperiods, and we estimated the temperature-mortality associations with distributed lag non-linear models (DLNM). We provided cross-linkages between the evolution of minimum mortality temperatures, relative risks of mortality and temperature-attributable deaths under cold and hot conditions. RESULTS Our findings highlighted an overall increase in risk trends under cold and heat conditions. All-cause mortality at the 1st percentile increased from 1.15 (95% CI: 1.04; 1.28) in 1982-2006 to 1.24 (95% CI: 1.11; 1.38) in 1994-2018, while at the 99th percentile the risk shifted from 1.51 (95% CI: 1.41; 1.61) to 1.59 (95% CI: 1.49; 1.71). In relation to social differences, women were characterized by greater values in respect to men, and similar estimates were observed among the elderly in respect to the youngest subgroup. Risk trends by educational subgroups were mixed, according to the reference temperature condition. Finally, individuals living in conditions of isolation were characterized by higher risks, with an increasing vulnerability throughout time. CONCLUSIONS The overall increase in cold- and heat- related mortality risk suggests a maladaptation to ambient temperatures in Turin. Despite alert systems in place increase public awareness and improve the efficiency of existing health services at the local level, they do not necessarily prevent risks in a homogeneous way. Targeted public health responses to cold and heat in Turin are urgently needed to adapt to extreme temperatures due to climate change.
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Affiliation(s)
- Marta Ellena
- Dept.Environmnetal Sciences, Informatics, and Statistics, Università Ca' Foscari di Venezia, Mestre, 30172, Italy; Fondazione Centro Euro-Mediterraneo Sui Cambiamenti Climatici, Regional Model and Geo-Hydrological Impacts (REMHI) Division, Caserta, 81100, Italy.
| | - Joan Ballester
- Barcelona Institute for Global Health (ISGlobal), Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, 08003, Spain.
| | - Giuseppe Costa
- Regional Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, 10095, Italy.
| | - Hicham Achebak
- Barcelona Institute for Global Health (ISGlobal), Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, 08003, Spain.
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27
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Costa G. Short introduction to JAHEE and Actions. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Reducing health inequalities is on the agenda of many countries. Despite an increasing concern and awareness on health inequalities a wide gap exists in Europe in terms of political response. The main objective of JAHEE was to strengthen a cooperative approach among participating countries and implement concrete actions to reduce health inequalities. The partnership was composed of 24 countries including many strategically most relevant public health institutions in the European Union, which contributed with different backgrounds, skills and know-how to the achievement of the project objectives. The main results will be presented.
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Affiliation(s)
- G Costa
- Piemonte Region , Turin, Italy
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28
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Strippoli E, Zengarini N, Di Girolamo C, Bartolini L, Aversa C, Costa G. Impact of COVID-19 pandemic on inequalities in mortality: an analysis in Piedmont and Emilia-Romagna. Eur J Public Health 2022. [PMCID: PMC9593877 DOI: 10.1093/eurpub/ckac130.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Italy was heavily hit by the COVID-19 pandemic. According to official statistics, during 2020 there were more than 75,000 excess deaths compared to the average expected mortality in 2015-2019. General mortality (GM) is a good measure of both the direct and indirect effects of the pandemic because it's exempt from potential bias due to misclassification of events. Evidence shows a greater burden of disease and mortality attributable to COVID-19 among disadvantaged populations, with the risk of an exacerbation of existing health inequalities. We aim to analyse the trend of social inequalities in mortality during the first pandemic year in two Italian regions (Piedmont and Emilia-Romagna) using data from Administrative Population Registries (APR) and statistical databases. Methods Data on deaths occurred between Jan 2015 and Jan 2021 in subjects ≥65, stratified by educational level, were obtained from Regional APR and the Census. Using a time series approach, we computed Standardized Mortality Rates (SMR), Relative Index of Inequalities (RII) and Slope Index of Inequalities (SII), adjusted by age, gender, month and region. SMR, RII and SII from March 2020 were forecasted using Holt-Winters method and compared to the observed values in the same period. Results SMRs were higher than expected during the two 2020 epidemic waves (Mar-Apr, Oct-Dec) in both regions. RII didn't increase significantly. Absolute inequalities instead rose in Piedmont during both pandemic waves, mostly among women, and in Emilia-Romagna in March among men. Conclusions The impact of the pandemic on inequalities in GM has been at least of the same size of the impact of other mechanisms of unequal mortality. APR coupled with sociodemographic data are a quick and reliable source for assessing the unequal impact of the COVID-19 pandemic on health. Further research is needed to explore mechanisms underlying these effects e.g. inequalities in cause-specific mortality and access to health services. Key messages
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Affiliation(s)
- E Strippoli
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco , Turin, Italy
| | - N Zengarini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco , Turin, Italy
| | - C Di Girolamo
- Health and Social Care Agency, Emilia-Romagna Region , Bologna, Italy
| | - L Bartolini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - C Aversa
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco , Turin, Italy
| | - G Costa
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco , Turin, Italy
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29
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De Lucia R, Giannini C, Parollo M, Costa G, Barletta V, Giannotti Santoro M, Primerano C, De Carlo M, Angelillis M, Zucchelli G, Petronio AS. Cardiac arrhythmias and conduction disorders monitoring after transcatheter aortic valve replacement procedure, using a mobile electrocardiogram 6 lead device. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In the early post transcatheter aortic valve replacement (TAVR) discharge era, rate of readmission for permanent pacemaker implantation (PPM-I) due to delayed conduction disturbances (CDs) has significantly increased. This issue has powered post procedural ambulatory electrocardiogram (AECG) monitoring by using implantable cardiac monitors or mobile cardiac telemetry devices, despite several disadvantages as frequent electrode changes and costs.
Purpose
In this scenario we aimed to evaluate the incidence of post-TAVR new onset arrhythmias and delayed CDs, performing an AECG monitoring through a 30s spot digital ECG (AeECG), by using a mobile electrocardiogram 6 lead (ME6L) device in a 30 days period after a TAVR procedure.
Methods
Between March 2021 and February 2022 we consecutively enrolled all patients undergoing a TAVR at the University Hospital of Pisa, excepting who already had a PM. At discharge, all patients received ME6L device and were asked to record a spot eECG for 1 month: 1 eECG per day during the first week and then 1 eECG per week. Clinical and follow-up data were collected and analyzed, and eECG scheduling compliance and quality recordings were explored.
Results
Among 185 consecutive TAVR patients, 12 were excluded due to pre-existing pacing device and 33 due to PPM-I <2 days post TAVR; 3 died before enrollment and 10 refused the enrollment; 18 were excluded because failed the ME6L training phase, 6 for severe postprocedural complications and the last 3 because affected by isolated aortic regurgitation.The remaining ones (100) had 30-day AeECG data. Delayed CDs with a Class I/IIa indications for PPM-Ioccurred in 8 patients with a median of 6 days (range 4–8 days) post-TAVR. New onset documented arrhythmias were AT/AF in 3 patients, isolated PVCs in 10 patients, and competitive transitory junctional rhythm in 2 patients. Delayed PPM-I versus non-delayed PPM-Ipatients were more likely to have a non-self-expandable valve (3 vs 69; p=0.02) and longer PR and QRS intervals at discharge (250.00±53,29 ms vs 179.17±39.17 ms; p=0,003; 125±33.38 ms vs 102.55±30.48 ms; p=0,04). The overall eECG schedule level compliance was 96.5%. Out of a total of 965 sent eECGs, 950 (98,4%) have been correctly recorded and transmitted.
Conclusion
Delayed CDs requiring PPM-I are the most important drawback of TAVR procedure. In our study, AeECG was seen to be safe and helpful in the identification and treatment of delayed CDs requiring PPM-I, with a very high eECG schedule level of compliance and quality. Further prospective studies are needed to better identify patient selection for outpatient monitoring, making safer and safer the early post TAVR discharge approach.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R De Lucia
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - C Giannini
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - M Parollo
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - G Costa
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - V Barletta
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - M Giannotti Santoro
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - C Primerano
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - M De Carlo
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - M Angelillis
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - G Zucchelli
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - A S Petronio
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
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30
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Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes R, Rosa J, Campos G, Baptista R, Monteiro P, Monteiro S, Goncalves F, Madeira M, Goncalves L. Comparing the long-term prognosis of myocardial infarction with non-obstructive coronary arteries to myocardial infarction with obstructive coronary artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The long-term survival rates of myocardial infarction with non-obstructive coronary arteries (MINOCA) patients is lower than in the general population. Nevertheless, there are conflicting results regarding the prognosis of MINOCA patients in comparison to myocardial infarction with obstructive coronary artery disease (MI-CAD) patients.
Purpose
The aim of this study was to assess the long-term all-cause mortality of MINOCA patients and compare it to MI-CAD patients.
Methods
Retrospective analysis of 2443 consecutively admitted patients for acute myocardial infarction (AMI), in a single coronary intensive care unit. Only patients with 5 years of follow-up and those who died before the 5-year mark were considered. Patients were divided into two groups according to the presence or absence of obstructive coronary artery disease on angiography (≥50% stenosis). Demographic characteristics, symptoms at presentation, past medical history, laboratory characteristics and medication at discharge were compared using the Mann-Whitney U or χ2 test (according to variable type) to ensure comparability between groups. Five-year all-cause mortality was the target endpoint. Five-year survival was modelled through the Cox proportional hazard regression model. The variable of interest (MINOCA vs MI-CAD) and possible confounders that displayed statistically significant differences in the initial demographic analysis were included in univariable Cox regressions, and those with statistically significant associations were included in a multivariable model. Those that displayed non-significant associations in the multivariable model were subsequently removed until we were left with significant associations only, giving us an adjusted hazard ratio.
Results
Comparison between groups is presented in table 1. MINOCA patients were younger and more often women. They were less likely to have smoking habits, diabetes, or a previous history of AMI. They had a lower Killip class, as well as lower troponin I, serum creatinine and low-density lipoprotein cholesterol at admission. On the other hand, they had higher left ventricular ejection fractions. They were also less likely to have beta-blockers or aspirin prescribed at discharge.
All-cause mortality at 5 years was 13.1% among MINOCA patients and 28.3% among MI-CAD patients, with an unadjusted hazard ratio (HR) of 0.421 (95% CI 0.322–0.550), p<0.001. Adjusting for known confounders, the HR was 0.461 (95% CI 0.261–0.816), p=0.008.
Conclusions
Compared with MI-CAD patients, those with MINOCA were slightly younger and had fewer comorbidities. In spite of having a worse long-term prognosis when compared to the general population, MINOCA patients have a significantly higher 5-year survival rate than MI-CAD patients, even after adjustment of confounding factors.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Barbosa
- Faculty of Medicine University of Porto , Porto , Portugal
| | - J Guimaraes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - D Fernandes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Costa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Gomes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Rosa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Campos
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Baptista
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - P Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - S Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - F Goncalves
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - M Madeira
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
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31
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Costa G, Cardoso J, Goncalves L, Teixeira R. Early aortic valve replacement in asymptomatic severe aortic stenosis with preserved ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) is the most common valvular disease in developed countries. Specific timing of intervention for asymptomatic patients with severe aortic stenosis and preserved ejection fraction remains controversial.
Purpose
To compare the outcomes of early aortic valve replacement (AVR) versus watchful waiting (WW) in asymptomatic AS patients with preserved ejection.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in November 2021, for both interventional or observational studies comparing early-AVR with WW in the treatment of asymptomatic severeAS with preserved ejection fraction criteria. Random-effects meta-analysis was performed.
Results
Eight studies were included in which two were randomized clinical trials. A total of 2672 patients were included, providing a 642 pooled death events (327 in early-AVR and 941 in watchful waiting). In our meta-analysis, early-AVR revealed a significant lower all-cause mortality (pooled OR, 0.39; 95% CI [0.30, 0.51], P<0.01; I2=47%). Additionally, the early-AVR group presented a lower rate of cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P<0.01; I2=64%). Both strategies had similar rate of stroke (pooled OR, 1.30; 95% CI [0.39, 4.27], P=0.67; I2=0%) and myocardial infarction (pooled OR, 0.49; 95% CI [0.14, 1.78], P=0.28; I2=0%). Heart Failure hospitalizations presented a lower trend early-AVR group (pooled OR, 0.22; 95% CI [0.05, 1.08], P=0.36; I2=36%).
Conclusion
Our pooled data suggests that early-AVR strategy is preferable for asymptomatic severe AS patients with preserved ejection fraction.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro hospitalar de Coimbra , Coimbra , Portugal
| | - J Cardoso
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic Surgery , Vila Nova de Gaia , Portugal
| | - L Goncalves
- Coimbra Institute for Clinical and Biomedical Research , Coimbra , Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
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32
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Costa G, Cardoso J, Goncalves L, Teixeira R. Early intervention versus conservative management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) is the most common valvular disease in developed countries. However, the specific timing of intervention for asymptomatic patients with severe AS remains controversial.
Purpose
To compare the outcomes of early aortic valve replacement (AVR) versus watchful waiting (WW) in asymptomatic patients with AS.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in December 2021, for both interventional or observational studies comparing early AVR with WW in the treatment of asymptomatic severe AS. Random-effects meta-analysis was performed.
Results
Thirteen studies were included in which two were randomised clinical trials. A total of 4,679 patients were included, providing a 1,268 pooled death events (327 in early AVR and 941 in WW). Our meta-analysis showed a significantly lower all-cause mortality for the early-AVR compared with WW group, although with a moderate amount of heterogeneity between studies in the magnitude of the effect (pooled odds ratio [OR], 0.41; 95% confidence interval [CI] 0.34, 0.50, P<0.01; I2=60%). An early surgery strategy displayed a significantly lower cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P<0.01; I 2=64%) and heart failure hospitalisations (pooled OR 0.19; 95% CI [0.10, 0.39], P<0.01, I2=7%). However, both groups had similar rates of stroke (pooled OR 1.30; 95% CI [0.73, 2.29], P=0.36, I2=0%) and myocardial infarction (pooled OR 0.49; 95% CI [0.19, 1.27], P=0.14, I2=0%).
Conclusions
Our pooled data suggest that an early-AVR strategy is preferable for asymptomatic patients with severe AS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro hospitalar de Coimbra , Coimbra , Portugal
| | - J Cardoso
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic Surgery , Vila Nova de Gaia , Portugal
| | - L Goncalves
- Coimbra Institute for Clinical and Biomedical Research , Coimbra , Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
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33
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Costa G, Marinho V, Costa M, Goncalves L, Teixeira R. Meta-analysis comparing outcomes in patients undergoing transcatheter aortic valve implantation with versus without percutaneous coronary intervention. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Patients having transcatheter aortic valve implantation (TAVI) routinely undergo coronary angiography before the procedure to define the coronary anatomy and to evaluate the extend of coronary artery disease (CAD). Whether percutaneous coronary intervention (PCI) prior/concomitant with TAVI confers any additional clinical benefit in patients with CAD remains unclear.
Purpose
To compare the outcomes of PCI prior to TAVI in patients with significant coronary artery disease and severe aortic stenosis.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in November 2021, for both retrospective and prospective studies comparing TAVI with PCI versus TAVI alone. Random-effects meta-analysis was performed.
Results
Eleven studies were included in which one was a randomized clinical trial. A total of 2530 patients were included, providing a 145 pooled death events (64 in TAVI with PCI and 81 in TAVI only). In terms of 30-day clinical outcomes, our pooled analysis revealed a similar all-cause mortality (pooled OR, 1.24; 95% CI [0.80, 1.93], P=0.34; I2=27% - Figure), cardiovascular mortality (pooled OR, 1.44; 95% CI [0.56, 3.75], P=0.45; I2=57%) and stroke (pooled OR, 1.07; 95% CI [0.53, 2.13], P=0.86; I2=0%). However, our analysis revealed a higher rate of myocardial infarction (pooled OR, 4.28; 95% CI [1.56, 11.69], P<0.01; I2=0%) and major bleeding events (pooled OR, 1.40; 95% CI [1.02, 1.93], P=0.04; I2=0%) in the TAVI with PCI group. A 1-year clinical outcomes analysis revealed a trend for lower all-cause mortality in TAVI only group (pooled OR, 1.37; 95% CI [0.98, 1.91], P=0.06; I2=0%), similar cardiovascular death rate (pooled OR, 1.15; 95% CI [0.70, 1.89], P=0.59; I2=6%) and major bleeding events (pooled OR, 1.62; 95% CI [0.95, 2.76], P=0.07; I2=0%).
Conclusion
Our pooled data suggests that PCI with TAVI in patients with severe aortic stenosis and concomitant CAD grants no additional clinical advantage.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro hospitalar de Coimbra , Coimbra , Portugal
| | - V Marinho
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
| | - M Costa
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
| | - L Goncalves
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
| | - R Teixeira
- Centro hospitalar de Coimbra , Coimbra , Portugal
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34
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Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes R, Rosa J, Campos G, Costa S, Baptista R, Franco F, Madeira M, Goncalves L. Maximum dose sacubitril/valsartan in heart failure with reduced ejection fraction: does atrial fibrillation compromise the benefits? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In the PARADIGM-HF trial, sacubitril/valsartan (SV) was shown to be superior to enalapril in reducing hospitalizations for worsening heart failure (HF), cardiovascular mortality, and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). The 2021 ESC Guidelines recommends SV as a replacement for angiotensin-converting-enzyme inhibitors to reduce the risk of HF hospitalization and death. There is little information regarding the effects of SV according to atrial fibrillation (AF) status.
Purpose
The aim of this study was to compare the effects of maximum dose SV regarding symptomatic improvement, change in natriuretic peptides levels (NP) and left ventricular ejection fraction (LVEF) in patients with HFrEF with and without AF.
Methods
Retrospective analysis of 137 patients with HFrEF on maximum dose SV (97/103mg twice daily). Patients were divided into two groups according to AF status. Age, gender, relevant comorbidities, usual medication, baseline symptomatic status, NP levels and LVEF were assessed using the Mann-Whitney U or χ2 test (according to variable type) to ensure comparability between groups. Variation in NYHA class, NP levels and LVEF between baseline and 6-month follow-up was evaluated and compared between groups.
Results
Comparison between groups is presented in Table 1. In our studied population, ischemic aetiology was more common in the sinus rhythm group (49.5% vs 30.4%; p 0.034). There were no significant differences between groups regarding age, gender, hypertension, diabetes, and beta-blocker and mineralocorticoid receptor antagonist usage. At baseline, the AF group had higher NT-proBNP levels [median 1421 mg/dL (IQR 743–3087) vs 467 mg/dL (IQR 140–797); p<0.001]. There were no significant differences regarding baseline NYHA class or LVEF. After 6 months of follow-up, reductions in NYHA class [−1 (IQR −2, −1) for AF; −1 (IQR −1, 0) for SR; p=0.437] and NT-proBNP levels [−358 mg/dL (IQR −2275, −47) for AF; −162 mg/dL (IQR −364, 27) for SR; p=0.156], as well as LVEF improvement [11% (IQR 3–15) for AF; 12% (IQR 7–21) for SR; p=0.201], displayed no statistically significant differences between the two groups.
Conclusions
Our study shows that the beneficial effects of SV on symptomatic status, NP levels and LVEF were not compromised by the presence of AF at baseline.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Barbosa
- Faculty of Medicine University of Porto , Porto , Portugal
| | - J Guimaraes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - D Fernandes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Costa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Gomes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Rosa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Campos
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - S Costa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Baptista
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - F Franco
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - M Madeira
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
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35
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Costa G, Cardoso J, Donato H, Goncalves L, Teixeira R. Concomitant tricuspid repair in mitral regurgitation surgery: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Tricuspid Regurgitation (TR) is common in patients with severe mitral disease. However, the evidence is insufficient to inform a decision about whether to perform prophylactic tricuspid-valve repair during mitral-valve surgery in patients who have moderate TR or less-than-moderate regurgitation.
Purpose
To compare the outcomes of concomitant tricuspid repair in mitral valve surgery versus no concomitant tricuspid repair in less-than-severe TR patients.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in December 2021, for interventional studies comparing concomitant tricuspid repair in mitral valve surgery versus no tricuspid intervention. Random-effects meta-analysis was performed.
Results
Four randomised trials were included, providing a total of 651 patients (323 in prophylactic tricuspid intervention group and 328 patients in conservative group). Our meta-analysis showed a similar all-cause mortality for concomitant prophylactic tricuspid repair compared with no tricuspid intervention (pooled OR, 0.54; 95% CI [0.25, 1.15], P=0.11; I2=0%). Additionally, there is a similar New York Heart Association (NYHA) III–IV classes in both groups, despite a lower trend in the tricuspid intervention group (pooled OR, 0.63; 95% CI [0.38, 1.06], P=0.08; I2=0%) (Figure 3). However, there was a significant lower progression of TR (pooled OR, 0.06; 95% CI [0.02, 0.24], P<0.01; I2=0%) and moderate-severe TR (pooled OR, 0.23; 95% CI [0.11, 0.46], P<0.01; I2=27%).
Conclusions
Our pooled analysis suggests that a tricuspid-valve repair at the time of mitral-valve surgery in patients with moderate or less-than-moderate TR does not impact perioperative or postoperative all-cause mortality, despite reducing TR severity and progression of TR following intervention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro hospitalar de Coimbra , Coimbra , Portugal
| | - J Cardoso
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic Surgery , Vila Nova de Gaia , Portugal
| | - H Donato
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
| | - L Goncalves
- Coimbra Institute for Clinical and Biomedical Research , Coimbra , Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
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36
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Ardito C, Costa G. Could a fairer retirement age mitigate health inequalities? Evidence and decision-making. Front Public Health 2022; 10:965140. [PMID: 36249189 PMCID: PMC9561933 DOI: 10.3389/fpubh.2022.965140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Affiliation(s)
- Chiara Ardito
- Department of Economics and Statistics “Cognetti De Martiis,” University of Turin, Turin, Italy,Epidemiology Unit ASL TO3, Turin, Italy,LABORatorio R. Revelli – Centre for Employment Studies, Turin, Italy,NETSPAR – Network for Studies on Pensions, Aging and Retirement, Tilburg, Netherlands,*Correspondence: Chiara Ardito
| | - Giuseppe Costa
- Epidemiology Unit ASL TO3, Turin, Italy,Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Fiorito G, Pedron S, Ochoa-Rosales C, McCrory C, Polidoro S, Zhang Y, Dugué PA, Ratliff S, Zhao WN, McKay GJ, Costa G, Solinas MG, Harris KM, Tumino R, Grioni S, Ricceri F, Panico S, Brenner H, Schwettmann L, Waldenberger M, Matias-Garcia PR, Peters A, Hodge A, Giles GG, Schmitz LL, Levine M, Smith JA, Liu Y, Kee F, Young IS, McGuinness B, McKnight AJ, van Meurs J, Voortman T, Kenny RA, Vineis P, Carmeli C. The Role of Epigenetic Clocks in Explaining Educational Inequalities in Mortality: A Multicohort Study and Meta-analysis. J Gerontol A Biol Sci Med Sci 2022; 77:1750-1759. [PMID: 35172329 PMCID: PMC10310990 DOI: 10.1093/gerona/glac041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Educational inequalities in all-cause mortality have been observed for decades. However, the underlying biological mechanisms are not well known. We aimed to assess the role of DNA methylation changes in blood captured by epigenetic clocks in explaining these inequalities. Data were from 8 prospective population-based cohort studies, representing 13 021 participants. First, educational inequalities and their portion explained by Horvath DNAmAge, Hannum DNAmAge, DNAmPhenoAge, and DNAmGrimAge epigenetic clocks were assessed in each cohort via counterfactual-based mediation models, on both absolute (hazard difference) and relative (hazard ratio) scales, and by sex. Second, estimates from each cohort were pooled through a random effect meta-analysis model. Men with low education had excess mortality from all causes of 57 deaths per 10 000 person-years (95% confidence interval [CI]: 38, 76) compared with their more advantaged counterparts. For women, the excess mortality was 4 deaths per 10 000 person-years (95% CI: -11, 19). On the relative scale, educational inequalities corresponded to hazard ratios of 1.33 (95% CI: 1.12, 1.57) for men and 1.15 (95% CI: 0.96, 1.37) for women. DNAmGrimAge accounted for the largest proportion, approximately 50%, of the educational inequalities for men, while the proportion was negligible for women. Most of this mediation was explained by differential effects of unhealthy lifestyles and morbidities of the World Health Organization (WHO) risk factors for premature mortality. These results support DNA methylation-based epigenetic aging as a signature of educational inequalities in life expectancy emphasizing the need for policies to address the unequal social distribution of these WHO risk factors.
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Affiliation(s)
- Giovanni Fiorito
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- MRC Centre for Environment and Health, School of Public Health, Imperial College
London, London, UK
| | - Sara Pedron
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
- Professorship of Public Health and Prevention, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Carolina Ochoa-Rosales
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Centro de Vida Saludable de la Universidad de Conceptión, Conceptiòn, Chile
| | - Cathal McCrory
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | | | - Yan Zhang
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Munich, Germany
| | - Pierre-Antoine Dugué
- Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Scott Ratliff
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Wei N Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Gareth J McKay
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Giuseppe Costa
- Epidemiology Unit, Regional Health Service TO3, Grugliasco, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Kathleen Mullan Harris
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP 7), Ragusa, Italy
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Fulvio Ricceri
- Epidemiology Unit, Regional Health Service TO3, Grugliasco, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, University of Naples Federico II, Naples, Italy
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Munich, Germany
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
- Department of Economics, Martin Luther University, Halle-Wittenberg, Germany
| | - Melanie Waldenberger
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Pamela R Matias-Garcia
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
| | - Allison Hodge
- Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Lauren L Schmitz
- Robert M. La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Morgan Levine
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jennifer A Smith
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Yongmei Liu
- Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Ian S Young
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | | | - Amy Jayne McKnight
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Joyce van Meurs
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Rose A Kenny
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | | | - Paolo Vineis
- MRC Centre for Environment and Health, School of Public Health, Imperial College
London, London, UK
| | - Cristian Carmeli
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
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Moustgaard H, Tarkiainen L, Östergren O, Korhonen K, Zengarini N, Costa G, Martikainen P. The contribution of alcohol-related deaths to the life-expectancy gap between people with and without depression - a cross-country comparison. Drug Alcohol Depend 2022; 238:109547. [PMID: 35810620 DOI: 10.1016/j.drugalcdep.2022.109547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Alcohol-related deaths may be among the most important reasons for the shorter life expectancy of people with depression, yet no study has quantified their contribution. We quantify the contribution of alcohol-related deaths to the life-expectancy gap in depression in four European countries with differing levels of alcohol-related mortality. METHODS We used cohort data linking population registers with health-care and death records from Denmark, Finland, Sweden and Turin, Italy, in 1993-2007 (210,412,097 person years, 3046,754 deaths). We identified psychiatric inpatients with depression from hospital discharge registers in Denmark, Finland, and Sweden and outpatients with antidepressant prescriptions from prescription registers in Finland and Turin. We assessed alcohol-related and non-alcohol-related deaths using both underlying and contributory causes of death, stratified by sex, age and depression status. We quantified the contribution of alcohol-related deaths by cause-of-death decomposition of the life-expectancy gap at age 25 between people with and without depression. RESULTS The gap in life expectancy was 13.1-18.6 years between people with and without inpatient treatment for depression and 6.7-9.1 years between those with and without antidepressant treatment. The contribution of alcohol-related deaths to the life-expectancy gap was larger in Denmark (33.6%) and Finland (18.1-30.5%) - i.e., countries with high overall alcohol-related mortality - than in Sweden (11.9%) and Turin (3.2%), and larger among men in all countries. The life-expectancy gap due to other than alcohol-related deaths varied little across countries. CONCLUSIONS Alcohol contributes heavily to the lower life expectancy in depression particularly among men and in countries with high overall alcohol-related mortality.
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Affiliation(s)
- Heta Moustgaard
- Helsinki Institute for Social Sciences and Humanities, University of Helsinki, Vuorikatu 3, 00014, Finland; Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, P.O. Box 18, 00014, Finland.
| | - Lasse Tarkiainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, P.O. Box 18, 00014, Finland; Helsinki Institute for Urban and Regional Studies (URBARIA), University of Helsinki, Yliopistonkatu 3, 00100 Helsinki, Finland.
| | - Olof Östergren
- Department of Public Health Sciences, Stockholm University, SE - 106 91 Stockholm, Sweden; Aging Research Center, Karolinska Institutet, Tomtebodavägen 18a, SE-171 65 Solna, Sweden.
| | - Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, P.O. Box 18, 00014, Finland.
| | - Nicolás Zengarini
- Epidemiology Unit, Regional Health Service ASL TO3, Via Sabaudia 164, Turin, Grugliasco (TO), Italy.
| | - Giuseppe Costa
- Epidemiology Unit, Regional Health Service ASL TO3, Via Sabaudia 164, Turin, Grugliasco (TO), Italy.
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, P.O. Box 18, 00014, Finland; Department of Public Health Sciences, Stockholm University, SE - 106 91 Stockholm, Sweden; Laboratory of Population Health, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057 Rostock, Germany.
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de Oliveira V, Santos D, Sinisgalli R, Vancini R, Costa G, Nikolaidis PT, Knechtle B, Weiss K, Andrade M, de Lira C. Factors associated with perceived performance drops and musculoskeletal injuries in Brazilian recreational triathletes. Eur Rev Med Pharmacol Sci 2022; 26:5651-5659. [PMID: 36066136 DOI: 10.26355/eurrev_202208_29498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of the study was to investigate sleep characteristics, use of supplements, and training volume of recreational triathletes, and to verify possible associations with perceived performance drops and occurrence of injuries. MATERIALS AND METHODS Recreational triathletes (n=942) answered a questionnaire inquiring about their demographic characteristics, performance, injuries and training volume. RESULTS When comparing athletes who slept more (9-10 hours) with those who slept less, less sleep was associated with a higher prevalence of perceived performance drops. Regarding difficulties in initiating sleep, the absence of initiating difficulties (p<0.001) was a protective factor against perceived performance drops. Regarding weekly training volume, compared to those who trained more than 20 hours, training less than 3 hours (p<0.001), 3-5 hours (p<0.001), or 12-14 hours (p<0.001) were protective factors against perceived performance drops. Concerning training volume and injuries, we found that compared to those who trained more than 20 hours, training 18-20 hours (p<0.001), 15-17 hours (p<0.001), 12-14 hours (p<0.001), 6-8 hours (p<0.001), or 3-5 hours (p<0.001) were protective factors against injuries. CONCLUSIONS Triathletes with a lower sleep quantity and those who have difficulties initiating sleep frequently experience drops in performance. Training volumes can influence both performance and the likelihood of injuries.
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Affiliation(s)
- V de Oliveira
- Human and Exercise Physiology Division, Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil.
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40
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Savino MS, Cavinato L, Costa G, Fiz F, Torzilli G, Vigano L, Ieva F. Distant supervision for imaging-based cancer sub-typing in Intrahepatic Cholangiocarcinoma. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:1032-1035. [PMID: 36086172 DOI: 10.1109/embc48229.2022.9871262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Finding effective ways to perform cancer sub-typing is currently a trending research topic for therapy opti-mization and personalized medicine. Stemming from genomic field, several algorithms have been proposed. In the context of texture analysis, limited efforts have been attempted, yet imaging information is known to entail useful knowledge for clinical practice. We propose a distant supervision model for imaging-based cancer sub-typing in Intrahepatic Cholangiocar-cinoma patients. A clinically informed stratification of patients is built and homogeneous groups of patients are characterized in terms of survival probabilities, qualitative cancer variables and radiomic feature description. Moreover, the contributions of the information derived from the ICC area and from the peri tumoral area are evaluated. The findings suggest the reliability of the proposed model in the context of cancer research and testify the importance of accounting for data coming from both the tumour and the tumour-tissue interface. Clinical relevance - In order to accurately predict cancer prognosis for patients affected by ICC, radiomic variables of both core cancer and surrounding area should be exploited and employed in a model able to manage complex information.
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41
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Viganò L, Branciforte B, Laurenti V, Costa G, Procopio F, Cimino M, Del Fabbro D, Di Tommaso L, Torzilli G. The Histopathological Growth Pattern of Colorectal Liver Metastases Impacts Local Recurrence Risk and the Adequate Width of the Surgical Margin. Ann Surg Oncol 2022; 29:5515-5524. [PMID: 35687176 DOI: 10.1245/s10434-022-11717-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The histopathological growth pattern (HGP) of colorectal liver metastases (CLM) has been associated with prognosis. This study was designed to elucidate if the HGP is associated with local recurrence risk and impacts the adequate width of surgical margin. METHODS All consecutive patients resected for CLM in 2018-2019 were considered. HGP was prospectively classified as follows: desmoplastic, pushing, and replacement. Surgical margin was classified as follows: R0 (margin ≥ 1 mm), R1vasc (0-mm margin, tumor detachment from intrahepatic vessels), and R1par (tumor exposure along transection plane). R0 resections were further distinguished in R0min (1-mm margin) and R0wide (> 1-mm margin). RESULTS A total of 340 resection areas in 136 patients were analyzed (70 R0min, 143 R0wide, 31 R1vasc, 96 R1par). HGP was desmoplastic in 26 cases, pushing in 221, and replacement in 93. Thirty-six local recurrences occurred (11%, median follow-up 21 months): 1 after R0wide, 4 after R0min, 3 after R1vasc, and 28 after R1par resection. In R1par group, local recurrence rate was high independently of HGP (29%). In R1vasc and R0min groups, local recurrence risk was higher in the replacement group (R1vasc: 29% vs. 4% if pushing/desmoplastic; R0min: 11% vs. 4%). In R0wide group, local recurrence risk was low for all HGP ( < 1%). Independent predictors of local recurrence were replacement HGP (odds ratio = 1.654, P = 0.036), and R1par resection (odds ratio = 57.209, P < 0.001 vs. R0). CONCLUSIONS Replacement HGP is associated with an increased risk of local recurrence. In these patients, a wide surgical margin should be pursued, because R1vasc and R0min resections could be insufficient. R1par resection is inadequate, independently of the HGP.
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Affiliation(s)
- L Viganò
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - B Branciforte
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - V Laurenti
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - G Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - F Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - M Cimino
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - D Del Fabbro
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - L Di Tommaso
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy.,Pathology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - G Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy. .,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy.
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42
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Viganò L, Branciforte B, Laurenti V, Costa G, Procopio F, Cimino M, Del Fabbro D, Di Tommaso L, Torzilli G. ASO Visual Abstract: The Histopathological Growth Pattern of Colorectal Liver Metastases Impacts Local Recurrence Risk and the Adequate Width of the Surgical Margin. Ann Surg Oncol 2022. [PMID: 35639291 DOI: 10.1245/s10434-022-11854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- L Viganò
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - B Branciforte
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - V Laurenti
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - F Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - M Cimino
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - D Del Fabbro
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - L Di Tommaso
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Pathology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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43
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Pompili R, Alesini D, Anania MP, Arjmand S, Behtouei M, Bellaveglia M, Biagioni A, Buonomo B, Cardelli F, Carpanese M, Chiadroni E, Cianchi A, Costa G, Del Dotto A, Del Giorno M, Dipace F, Doria A, Filippi F, Galletti M, Giannessi L, Giribono A, Iovine P, Lollo V, Mostacci A, Nguyen F, Opromolla M, Di Palma E, Pellegrino L, Petralia A, Petrillo V, Piersanti L, Di Pirro G, Romeo S, Rossi AR, Scifo J, Selce A, Shpakov V, Stella A, Vaccarezza C, Villa F, Zigler A, Ferrario M. Free-electron lasing with compact beam-driven plasma wakefield accelerator. Nature 2022; 605:659-662. [PMID: 35614244 DOI: 10.1038/s41586-022-04589-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/25/2022] [Indexed: 11/09/2022]
Abstract
The possibility to accelerate electron beams to ultra-relativistic velocities over short distances by using plasma-based technology holds the potential for a revolution in the field of particle accelerators1-4. The compact nature of plasma-based accelerators would allow the realization of table-top machines capable of driving a free-electron laser (FEL)5, a formidable tool to investigate matter at the sub-atomic level by generating coherent light pulses with sub-ångström wavelengths and sub-femtosecond durations6,7. So far, however, the high-energy electron beams required to operate FELs had to be obtained through the use of conventional large-size radio-frequency (RF) accelerators, bound to a sizeable footprint as a result of their limited accelerating fields. Here we report the experimental evidence of FEL lasing by a compact (3-cm) particle-beam-driven plasma accelerator. The accelerated beams are completely characterized in the six-dimensional phase space and have high quality, comparable with state-of-the-art accelerators8. This allowed the observation of narrow-band amplified radiation in the infrared range with typical exponential growth of its intensity over six consecutive undulators. This proof-of-principle experiment represents a fundamental milestone in the use of plasma-based accelerators, contributing to the development of next-generation compact facilities for user-oriented applications9.
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Affiliation(s)
- R Pompili
- Laboratori Nazionali di Frascati, Frascati, Italy.
| | - D Alesini
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M P Anania
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - S Arjmand
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M Behtouei
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - A Biagioni
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - B Buonomo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Cardelli
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M Carpanese
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - E Chiadroni
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Cianchi
- University of Rome Tor Vergata, Rome, Italy.,INFN Tor Vergata, Rome, Italy.,NAST Center, Rome, Italy
| | - G Costa
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Del Dotto
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M Del Giorno
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Dipace
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Doria
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - F Filippi
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - M Galletti
- University of Rome Tor Vergata, Rome, Italy.,INFN Tor Vergata, Rome, Italy.,NAST Center, Rome, Italy
| | - L Giannessi
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Giribono
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - V Lollo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - F Nguyen
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | | | - E Di Palma
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - L Pellegrino
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Petralia
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | | | - L Piersanti
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - G Di Pirro
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - S Romeo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - J Scifo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Selce
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - V Shpakov
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Stella
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - C Vaccarezza
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Villa
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Zigler
- Laboratori Nazionali di Frascati, Frascati, Italy.,Racah Institute of Physics, Hebrew University, Jerusalem, Israel
| | - M Ferrario
- Laboratori Nazionali di Frascati, Frascati, Italy
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De Almeida Fernandes D, Guimaraes J, Monteiro E, Costa G, Antonio N, Goncalves L. Tachydysrhythmias in patients admitted with COVID-19 pneumonia: prevalence and impact on in-hospital mortality. Europace 2022. [PMCID: PMC9384055 DOI: 10.1093/europace/euac053.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The COVID-19 pandemic has shifted tremendously the paradigm of hospital care and treatment of cardiovascular (CV) patients. According to most recent evidence, due to its multisystemic impact, COVID-19 may lead to an increased risk of cardiac arrhythmias with subsequently increased morbimortality.
Purpose
Determine the prevalence of tachyarrhythmias in patients admitted with COVID-19, possible predictors and impact on in-hospital mortality.
Methods
A retrospective study of 3475 consecutive patients with COVID-19 pneumonia admitted to our hospital between February 2020 and November 2021 were included. The main outcome was tachyarrhythmias (high ventricular rate (HVR) or new-onset atrial fibrillation (AF), HVR or new-onset atrial flutter (AFL), other supraventricular tachycardias (SVT), ventricular tachycardia (VT) and ventricular fibrillation (VF)). Secondary outcome was in-hospital mortality. Sociodemographic variables and clinical data were recorded. Statistical comparison was made between groups, including logistic regression to determine odds ratios (OR).
Results
A total of 215 patients presented HVR AF (6.31%), 79 of which with new-onset AF (36.74%). 8 patients had HVR AFL (0.23%), 5 VT (0.15%), 4 VF (0.12%) and only 3 patients had a SVT identified (0.09%). Patients with tachyarrhythmias were significantly older (77. 74 ± 11.25 68.94 ± 17.51 years, p <0.001) and had more hypertension (p 0.034), heart failure (HF) (p <0.001), severe valvular heart disease (VHD) (p 0.007), coronary artery disease (CAD) (p 0.031), chronic kidney disease (CKD) (p 0.048) and paroxysmal AF (if previously diagnosed (p 0.001). There were no significant differences regarding gender, dyslipidemia, diabetes, cerebrovascular disease and obstructive sleep apnoea (OSA).
Patients with HF had the highest risk of tachyarrhythmia (OR 3.539; 95% CI 2.666-4.698; p <0.001), followed by severe VHD (OR 1.990; 95% CI 1.192-3.365; p 0.009) and CAD (OR 1.575; 95% CI 1.040-2.386; p 0.032). Older patients or patients with hypertension or CKD were also at an increased risk. Also of note, patients previously diagnosed with paroxysmal AF were more likely to have episodes of HVR AF than the ones with persistent or permanent AF (OR 1.819; 95% CI 1.272-2.602; p 0.001)
Regarding the secondary outcome, patients with tachyarrhythmias during hospital stay had an odd almost 3 times higher of death (OR 2.820; 95% CI 2.151-3.695; p <0.001).
Conclusions
Tachyarrhythmias is a common complication in COVID-19 patients during hospital stay that is significantly linked to higher in-hospital mortality. Patients presenting with high CV disease burden are at particularly significant risk and should be carefully managed.
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Affiliation(s)
| | - J Guimaraes
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - E Monteiro
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - G Costa
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - N Antonio
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - L Goncalves
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
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De Almeida Fernandes D, Guimaraes J, Costa P, Monteiro E, Costa G, Antonio N, Martins P, Goncalves L. Prevalence and impact of dysrhythmias in COVID-19 intensive care patients. Europace 2022. [PMCID: PMC9384148 DOI: 10.1093/europace/euac053.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Background The COVID-19 pandemic has had a dramatic impact on clinical practice, amounting to more emergency department and intensive care unit (ICU) admissions. Due to their frequent multiple comorbidities, management in the ICU is challenging. Early studies suggest that cardiac injury is frequent in hospitalized patients with COVID-19, and it is plausible that these patients have a higher risk of cardiac dysrhythmias. Purpose To determine the prevalence of dysrhythmias in ICU patients with COVID-19 pneumonia, identify major predictors and determine the impact on in-hospital mortality. Methods A retrospective study of 98 consecutive patients with COVID-19 Pneumonia admitted to the ICU of a tertiary hospital in 2020. The main outcome was dysrhythmias (including significant bradycardia, high/slow ventricular rate or new-onset atrial fibrillation (AF) or atrial flutter, other supraventricular tachycardias, ventricular tachycardia and ventricular fibrillation). Significant bradycardia was defined as heart rate lower than 40 or need of treatment. Sociodemographic variables and clinical data were retrieved for each patient, severity scores at admission (Apache II, SOFA and SAPS II), number of days on mechanical ventilation or high-flow oxygen and placement on Venovenous Extracorporeal Membrane Oxygenation (ECMO) or prone position were recorded. Statistical comparison was made between groups, including logistic regression adjusting for confounding variables. Results The most frequent arrhythmia was significant sinus bradycardia (28, 28.5%) followed by high ventricular rate AF (14, 14.2%). Patients who had dysrhythmias were older (66.24 ± 10.13 vs 60.85 ± 12.69 years, p 0.024), more severe (SAPS II score 42.55 ± 11.08 vs 35.98 ± 11.26, p 0.006), had more atrial fibrillation (AF) (p 0.022), had higher maximum C-reactive protein (mCRP) (6.56 ± 2.68 vs 6.24 vs 2.86, p 0.009), were mechanically ventilated for a longer time (15.64 ± 13.18 vs 8.92 ± 8.85 days, p 0.004), had longer intubation time (14.52 ± 9.39 vs 8.70 ± 8.21 days, p 0.002) and had higher usage of dexamethasone (p 0.042) and prone position (p 0.016). When adjusted for confounding variables, prone was the most significant predictor (OR 2.800; 95% CI 1.203-6.516) followed by use of dexamethasone (OR 2.484; 95% CI 1.020-6.050). Days intubated, days on mechanical ventilation, age, mCRP and SAPS II on admission were also predictors of dysrhythmia. Regarding mortality, patients with arrhythmic events had a tendency for greater in-hospital death (OR 2.440; 95% CI 0.950-6.310; p 0.065). Conclusions COVID-19 ICU patients are a subset of patients at risk of cardiac arrhythmias. Use of prone position was the main contributor to these events, but clinical history, severity and treatment may also play an important role. Efforts must be made to optimize ventilatory support and treatment in order to reduce the risk of dysrhythmias.
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Affiliation(s)
| | - J Guimaraes
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - P Costa
- Coimbra Hospital and University Center, Intensive Care Medicine, Coimbra, Portugal
| | - E Monteiro
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - G Costa
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - N Antonio
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - P Martins
- Coimbra Hospital and University Center, Intensive Care Medicine, Coimbra, Portugal
| | - L Goncalves
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
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Rosato S, Biancari F, D‘errigo P, Tarantini G, Costa G, Baglio G, Seccareccia F, Tamburino C. P326 SURGICAL VERSUS TRANSCATHETER AORTIC VALVE REPLACEMENT WITH NEWER GENERATION DEVICES IN REAL–WORLD PRACTICE: ONE–YEAR OUTCOMES FROM THE ITALIAN OBSERVANT STUDIES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
To compare the early and 1–year outcomes after transcatheter aortic valve replacement (TAVR) with new–generation devices over surgical replacement (SAVR) among patients with severe aortic stenosis (AS).
Background
TAVR is gaining acceptance for the treatment of lower risk patients with AS after several randomized and observational studies confirmed comparable early results to SAVR. On the other hand, clinical studies have shown that SAVR is still widely used in intermediate and high risk patients. There is need of data from large clinical registries to demonstrate the efficacy and safety of TAVR in the real–world setting, particularly after the introduction of new TAVR technology.
Methods
A total of 5706 AS patients who underwent SAVR and 2989 AS patients who underwent TAVR enrolled in the national, prospective OBSERVANT and OBSERVANT II studies, respectively in 2010–2012 and 2016–2018, were analyzed. Outcomes were adjusted using the propensity score matching. The primary outcomes of interest were all–cause mortality, major adverse cardiac and cerebrovascular events (MACCEs) and hospital readmission due to heart failure at 1–year. Secondary outcomes were major adverse events occurring during the index hospitalization.
Results
Among 1008 propensity score matched pairs, TAVR was associated with significantly lower 30–day mortality (1.8 vs. 3.5%, p = 0.020), stroke (0.8 vs. 2.3%, p = 0.005), acute kidney injury (0.6 vs. 8.2%, p < 0.001), infectious complications (3.8 vs. 6.5%, p = 0.006) and cardiogenic shock (1.4 vs. 5.1%, p < 0.001) compared to SAVR. Moderate–to–severe paravalvular regurgitation (5.9 vs. 2.0%, p < 0.001), major vascular complications requiring invasive treatment (2.2 vs. 0.1%, p < 0.001) and permanent pacemaker implantation (during the index hospitalization, 13.8 vs. 3.3%, p < 0.001) were more frequent after TAVR. At 1–year, TAVR was associated with lower risk of all–cause death (7.9 vs. 11.5%, p = 0.006), MACCE (12.0 vs. 15.8%, p = 0.011), readmission due to heart failure (10.8 vs. 15.9%, p < 0.001) and stroke (3.2 vs. 5.1%, p = 0.033) compared to SAVR.
Conclusions
In a real–world setting, patients with intermediate operative risk treated with newer generation TAVR devices had a low risk of major adverse events during the index–hospitalization and at 1–year follow–up. TAVR could become the treatment of choice for AS in the elderly provided that its durability is proved by long–term follow–up studies.
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Affiliation(s)
- S Rosato
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - F Biancari
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - P D‘errigo
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - G Tarantini
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - G Costa
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - G Baglio
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - F Seccareccia
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - C Tamburino
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
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Di Girolamo C, Gnavi R, Landriscina T, Forni S, Falcone M, Calandrini E, Cesaroni G, Russo A, Leoni O, Fanizza C, Allotta A, Costa G, Spadea T. Indirect impact of the COVID-19 pandemic and its containment measures on social inequalities in hospital utilisation in Italy. J Epidemiol Community Health 2022; 76:jech-2021-218452. [PMID: 35552241 PMCID: PMC9130664 DOI: 10.1136/jech-2021-218452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/28/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND The pandemic may undermine the equity of access to and utilisation of health services for conditions other than COVID-19. The objective of the study is to evaluate the indirect impact of COVID-19 and lockdown measures on sociodemographic inequalities in healthcare utilisation in seven Italian areas. METHODS In this multicentre retrospective study, we evaluated whether COVID-19 modified the association between educational level or deprivation and indicators of hospital utilisation and quality of care. We also assessed variations in gradients by sex and age class. We estimated age-standardised rates and prevalence and their relative per cent changes comparing pandemic (2020) and pre-pandemic (2018-2019) periods, and the Relative Index of Inequalities (RIIs) fitting multivariable Poisson models with an interaction between socioeconomic position and period. RESULTS Compared with 2018-2019, hospital utilisation and, to a lesser extent, timeliness of procedures indicators fell during the first months of 2020. Larger declines were registered among women, the elderly and the low educated resulting in a shrinkage (or widening if RII <1) of the educational gradients for most of the indicators. Timeliness of procedures indicators did not show any educational gradient neither before nor during the pandemic. Inequalities by deprivation were nuanced and did not substantially change in 2020. CONCLUSIONS The socially patterned reduction of hospital utilisation may lead to a potential exacerbation of health inequalities among groups who were already vulnerable before the pandemic. The healthcare service can contribute to contrast health disparities worsened by COVID-19 through more efficient communication and locally appropriate interventions.
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Affiliation(s)
- Chiara Di Girolamo
- Regional Health and Social Care Agency Emilia-Romagna Region, Bologna, Italy
| | - Roberto Gnavi
- Epidemiology Unit, ASL TO3 Piedmont Region, Turin, Italy
| | | | - Silvia Forni
- Regional Health Agency of Tuscany Region, Florence, Italy
| | | | - Enrico Calandrini
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Giulia Cesaroni
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Antonio Russo
- Epidemiology Unit, Agenzia di Tutela della Salute della Citta Metropolitan di Milano, Milan, Italy
| | | | | | - Alessandra Allotta
- Department of Health and Epidemiological Observatory, Regional Health Authority of Sicily Region, Palermo, Italy
| | - Giuseppe Costa
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Teresa Spadea
- Epidemiology Unit, ASL TO3 Piedmont Region, Turin, Italy
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Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes A, Saleiro C, Campos D, Sousa J, Lopes J, Puga L, Teixeira R, Lourenco C, Madeira M, Goncalves L. Inflammation in acute coronary syndrome: prognostic significance. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
In patients with acute coronary syndrome (ACS) the acute phase reactant, C-reactive protein (CRP), might be significantly elevated. Several reports suggest that CRP may play a direct pathophysiological role on the development and progression of atherosclerosis, and CRP values correlate with infarct size when measured by magnetic resonance imaging.
Purpose
The aim of the present study was to evaluate the prognostic value of CRP in patients presenting with an ACS.
Methods
Retrospective analysis of 635 consecutively admitted patients due to ACS in a single coronary intensive care unit. CRP levels were measured at admission. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether CRP was an independent predictor of outcome.
Results
In the studied sample, 75% were male. Median age was 69 [interquartile range (IQR) 57–78]. ST-elevation myocardial infarction (STEMI) occurred in 39.6%, non-ST segment elevation myocardial infarction in 44.9% and unstable angina in 15.5% of the patients. Median left ventricular ejection fraction (LVEF) was 48% (IQR 40–55%) and median CRP level at admission 0.7 mg/dL (IQR 0.5–1.9 mg/dL). Regarding important comorbidities and past medical history, 75.9% had hypertension (HTN), 34.0% diabetes, 20.3% chronic kidney disease (CKD), 68.6% dyslipidaemia and 17.3% heart failure (HF). The median follow-up was 34 months (IQR 22–72). In univariate analysis, CRP was significantly associated with all-cause mortality (HR 1.06 per 1 mg/dL increase, 95% CI 1.04–1.08, p<0.001), as was gender, age, LVEF, STEMI and previous history of diabetes, HTN, CKD or HF. In multivariate analysis, CRP remained significantly associated with the primary endpoint (HR 1.02, 95% CI 1.00–1.05, p=0.033), as did age, LVEF and previous history of HF.
Conclusions
In our study, CRP at admission was an independent risk factor for all-cause mortality following an ACS. This finding indicates that inflammation associated with the acute event has a significant impact in the long-term prognosis. More evidence is needed to determine if treating inflammation (and when, in the course of the disease) could result in better outcomes.
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Affiliation(s)
- E Monteiro
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Barbosa
- Faculty of Medicine University of Porto, Porto, Portugal
| | - J Guimaraes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - D Fernandes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - G Costa
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - A Gomes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - D Campos
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Sousa
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - L Puga
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - R Teixeira
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - M Madeira
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
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Forresi B, Michelini G, Sapuppo W, Costa G, Castellini G, Livellara S, Gregori Grgič R. Anger, personality traits and psychopathological symptoms in subjects exposed to negative interpersonal actions in workplaces: an observational study in a large sample attending a Center for Occupational Stress. Int Arch Occup Environ Health 2022; 95:1763-1773. [PMID: 35511292 DOI: 10.1007/s00420-022-01868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The association between adverse working conditions and mental disorders is well established. In addition to psychopathological symptoms, this study aimed at investigating anger and personality traits in a clinical sample of subjects referring negative interpersonal experiences in workplaces. METHODS 1676 workers attending a Centre for Occupational Stress in Milan (from 2014 to 2016) were administered an assessment protocol including SCL-90 for general psychopathology, STAXI for anger intensity and expression, and MMPI-2 for personality traits. A qualitative checklist was used to collect negative experiences in workplaces. RESULTS Patients reported they were exposed to "threats to the task or the professional career" more than to "attacks to the person". Over 80% scored above the cutoff in all the subscales of the SCL-90, with highest scores in Depression, Obsessive-Compulsive Disorder, Anxiety, Somatization and Paranoia. 60% scored above the 90th percentile in the AX/in subscale, showing intense anger feelings that they mostly suppress. Abnormal elevations at the MMPI scales of Hypochondria, Depression, Hysteria, and Paranoia were found in over 50% of the sample. Women reported higher psychological difficulties and internalized anger than men. Anger towards objects and people, instead, was more common in males. No differences were observed by work sector or employment status. CONCLUSIONS In addition to severe psychological difficulties, individuals reporting negative interpersonal experiences in workplaces have high levels of internalized anger and a distinctive profile of personality traits. While a deeper investigation is needed, anger expression should be considered in future treatment programs.
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Affiliation(s)
- Barbara Forresi
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy.
| | - G Michelini
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy
| | - W Sapuppo
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy.,London South Bank University, London, UK
| | - G Costa
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - G Castellini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Livellara
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy
| | - R Gregori Grgič
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy
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Fransvea P, Costa G, Pepe G, La Greca A, Magalini S, Puccioni C, d'Agostino L, Altieri G, Borello A, Cozza V, Sganga G. Acute intestinal ischemia in patients with COVID-19: single-centre experience and literature review. Eur Rev Med Pharmacol Sci 2022; 26:1414-1429. [PMID: 35253199 DOI: 10.26355/eurrev_202202_28135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Acute Intestinal ischemia (AII) may involve the small and/or large bowel after any process affecting intestinal blood flow. COVID-19-related gastrointestinal manifestations, including AII, have been attributed to pharmacologic effects, metabolic disorders in ICU patients and other opportunistic colonic pathogens. AII in COVID-19 patients may be due also to "viral enteropathy" and SARS-CoV-2-induced small vessel thrombosis. A critical appraisal of personal experience regarding COVID-19 and AII was carried out comparing this with a systematic literature review of published series. PATIENTS AND METHODS A retrospective observational clinical cohort study and a systematic literature review including only COVID-19 positive patients with acute arterial or venous intestinal ischemia were performed. The primary endpoint of the study was the mortality rate. Secondary endpoints were occurrence of major complications and length of hospital stay. RESULTS Patient mean age was 62.9±14.9, with a prevalence of male gender (23 male, 72% vs. 9 female, 28%). The mean Charlson Comorbidity Index was 3.1±2.7. Surgery was performed in 24/32 patients (75.0%), with a mean delay time from admission to surgery of 6.0 ±5.6 days. Small bowel ischemia was confirmed to be the most common finding at surgical exploration (22/24, 91.7%). Acute abdomen at admission to the ED (Group 1) was observed in 10 (31.2%) cases, while 16 (50%) patients developed an acute abdomen condition during hospitalization (Group 2) for SARS-CoV-2 infection. CONCLUSIONS Our literature review showed how intestinal ischemia in patients with SARS-CoV-2 has been reported all over the world. The majority of the patients have a high CCI with multiple comorbidities, above all hypertension and cardiovascular disease. GI symptoms were not always present at the admission. A high level of suspicion for intestinal ischemia should be maintained in COVID-19 patients presenting with GI symptoms or with incremental abdominal pain. Nevertheless, a prompt thromboelastogram and laboratory test may confirm the need of improving and fastening the use of anticoagulants and trigger an extended indication for early abdominal CECT in patients with suggestive symptoms or biochemical markers of intestinal ischemia.
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Affiliation(s)
- P Fransvea
- Emergency Surgery and Trauma - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
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