Cholangiocarcinoma and Occupational Exposure to Asbestos: Insights From the Italian Pooled Cohort Study

BACKGROUND

Recent studies supported the association between occupational exposure to asbestos and risk of cholangiocarcinoma (CC). Aim of the present study is to investigate this association using an update of mortality data from the Italian pooled asbestos cohort study and to test record linkage to Cancer Registries to distinguish between hepatocellular carcinoma (HCC) and intrahepatic/extrahepatic forms of CC.

METHODS

The update of a large cohort study pooling 52 Italian industrial cohorts of workers formerly exposed to asbestos was carried out. Causes of death were coded according to ICD. Linkage was carried out for those subjects who died for liver or bile duct cancer with data on histological subtype provided by Cancer Registries.

RESULTS

47 cohorts took part in the study (57,227 subjects). We identified 639 causes of death for liver and bile duct cancer in the 44 cohorts covered by Cancer Registry. Of these 639, 240 cases were linked to Cancer Registry, namely 14 CC, 83 HCC, 117 cases with unspecified histology, 25 other carcinomas, and one case of cirrhosis (likely precancerous condition). Of the 14 CC, 12 occurred in 2010-2019, two in 2000-2009, and none before 2000.

CONCLUSION

Further studies are needed to explore the association between occupational exposure to asbestos and CC. Record linkage was hampered due to incomplete coverage of the study areas and periods by Cancer Registries. The identification of CC among unspecific histology cases is fundamental to establish more effective and targeted liver cancer screening strategies.

[BRIC-59 study: first results and considerations on the pathway on the access to health care for malignant pleural mesotheliomas]

OBJECTIVES

to define the most frequent health pathways of cases affected by malignant pleural mesothelioma according to those suggested and evaluated by the most recent specific guidelines.

DESIGN

epidemiological descriptive study.

SETTING AND PARTICIPANTS

100 cases histologically or cytologically well defined during 2015-2017 are extracted from the archive of two Regional Mesothelioma Registries: in Tuscany Region (Central Italy) they are randomly extracted, while in Lombardy Region (Northern Italy) cases treated by a highly-specialized health centre are collected.

MAIN OUTCOME MEASURES

frequency of the diagnostic and therapeutic procedures; development and application of the checklist with evaluation of the duration of some phases of the predefined pathway.

RESULTS

all hospital medical records were collected only for 34 cases in Tuscany and 20 cases in Lombardy. The health examinations were supplied according to each case's health condition and it was not possible to define one or more structured and standardized pathways. The pre-diagnostic phase has a variable duration according to the initial health condition of the patient, also for his/her comorbidity, and to the hospital where he/she was hospitalized at first. The examinations in outpatient services (medical examinations, blood chemistry tests and radiological examinations) are several, but they are specially requested during the pre-diagnostic phase and during the period of chemotherapy. The checklist applied to a subset of Tuscan cases shows a large variation of the length of the pre-diagnostic phase (6-330 days), of the time interval between diagnosis and reporting to mesothelioma registry (1-200 days), and of the survival time (8 days - alive at 31.12.2019).

CONCLUSIONS

to obtain the best health pathways for malignant pleural mesotheliomas, it is necessary a strong network among the health regional services with a clinical multiprofessional coordination located in hospitals characterized by a long experience on these cases, and with an active regional monitoring on all clinical, psychological, epidemiological, and legal aspects of the pathway. The regional mesothelioma registries could give a high contribution thanks to their epidemiological skills which are necessary for the monitoring.

The impact of mortality for infectious diseases on life expectancy at birth in Tuscany, Italy

Introduction

The epidemiologic transition describes the reduction of mortality for infectious diseases (ID), followed by an increase in prevalence of non-communicable diseases. During recent years the situation has changed; an increase in mortality for sepsis was observed. Italy is amongst the countries with the highest prevalence of microorganisms resistant to antimicrobial therapy in Europe. The aim of the present work was to evaluate the impact of mortality for ID on life expectancy (LE) in the Tuscany region(Italy).

Methods

Mortality data relative to residents that died during the period 2000/2002- 2013/2015 were provided by the Tuscan Regional Mortality Registry. At first the analysis was performed for whole territory, then for geographic area (Nord-Est:NE, Centrum:C, South-East:SE). The analysis was realized with software Epidat,using the Pollard's method of decomposition of variations in LE for age and cause

of death.

Results

The overall gain in LE was 2.9 years for males and 2.6 years for females. The increase in mortality for ID was responsible for the loss of 0.11 years of LE for males vs. 0.16 years for females. The loss was observed in males aged 45-89, for females from 69 years onwards, with the highest loss between 79-89 years. After analysis for area, geographical differences emerged, for both males and females the highest loss of LE was observed for NE (-0.23 years vs.-0.19), followed by C (-0.15 years vs. -0.16) and SE (-0.12 vs. -0.11).

Conclusions

The result can be partially explained by the transition from ICD-9 to ICD-10 (in 2010), which improved the sensitivity of codification, but also by diffusion of pathogens resistant to antimicrobial therapy. The highest impact of ID was observed in elderly, probably due to the existence of predisposing clinical condition. The ID deserve major attention; the programmes of hospital infection control and antimicrobial stewardship have to be potentiated in order to contain the phenomenon.

Key messages

During the study period an increase in mortality for infectious diseases comported the loss in terms of LE years. The growing diffusion of microorganisms resistent to antimicrobial therapy could have contributed to the higher mortality rates observed during the last period.

The decomposition of gain in life expectancy in Tuscany Region (Central Italy) for age-group and cause of death

BACKGROUND

changing of life expectancy at birth (LE) over time is an important indicator of welfare and healthcare infrastructure of a Country.

OBJECTIVES

to evaluate the impact of age and cause-specific mortality on the change in LE in the Tuscany Region (Central Italy).

DESIGN

the decomposition of LE gain was realized with Pollard's method, using Epidat software.

SETTING AND PARTICIPANTS

mortality data relative to residents that died during the period 1987-2015 were provided by the Tuscan Regional Mortality Registry. The analyzed causes of death were cardiovascular (CVS), respiratory (RESP), infective (INF) diseases and cancer (TUM).

MAIN OUTCOME MEASURES

changing of LE expressed in years in relation to cause and age-specific mortality.

RESULTS

the overall LE gain was 6.5 years for males and 4.3 years for females, the major gain was observed in the age groups 65-89 years (for females 75-89 years) and <1 year. The highest gain (2.6 years) was attributable to the reduction of mortality for CVS, followed by TUM (males: 1.42 vs females: 0.83) and RESP (males: 0.4 vs females: 0.1). The causes responsible for the loss of LE were INF (females: -0.16 vs males: -0.07) and lung cancer in females (-0.13).

CONCLUSIONS

the prompt treatment of acute CVS events and prevention (both primary and secondary) are responsible for the gain in LE. The reduction of mortality for TUM can be attributed to the evolution of diagnostic-therapeutic possibilities, but also to the implementation of the cancer screening programmes. Lung cancer was responsible for the loss of LE in Tuscan females; the targeted anti-smoke campaigns should, therefore, be intensified. The INF comported the loss of LE; explainable by diffusion of multi-drug resistant bacteria. The programmes of Hospital Infection Control and Antimicrobial Stewardship should be potentiated to contain the phenomenon.

Mortality trend for multiple sclerosis in Italy during the period 1980-2015

BACKGROUND

The epidemiology of Multiple Sclerosis (MS) is relevant for health-services planning. Most of MS prevalence and incidence studies in Italy referred to specific geographical areas and periods, whereas mortality data are routinely collected at the national level. The aim was to assess MS mortality trend and geographical differences in Italy from 1980 to 2015.

METHODS

Mortality data were provided by the Italian Institute of Statistics. Due to a low number of annual deaths, mortality data were analysed for both the entire period under study and for sub-periods. Temporal trends were first evaluated using age-adjusted mortality rates (AMRs) comparing each sub-period with the initial one. Then, the annual percent change in mortality was estimated through the joinpoint regression model. Spatial differences between 5 main geographical areas were evaluated using standardized mortality ratios (SMRs).

RESULTS

During the study period, 4,959 deaths for males and 7,434 for females were observed. The higher overall AMR was observed for females (F:0.71 vs. M: 0.56 per 100,000 persons per year). Analysing mortality by gender and geographical area, SMRs 〈 100 were observed in South Italy for both sexes, and in Central Italy for males only, whereas SMRs 〉 100 for Islands for both sexes, and in North-East and North-West for females only. The analysis of the mortality trend through AMRs calculated for sub-periods revealed no difference between the first and the last period for males, whereas a significant increase in mortality was observed for females. The joinpoint regression analysis showed a significant decrease in mortality up to 1995 for males (APC -3.23%) and up to 1999 for females, (APC -1.01%), followed by a significant increase for both sexes, but more marked for females (APC +1.9% M, +2.34% F).

CONCLUSION

The increasing trend of mortality for MS, especially for females, may reflect the increase in the prevalence of MS and the improvement in the quality of diagnosis or coding of the cause of death.

[Causes of death of Tuscan centenarians]

INTRODUCTION

in Italy and Tuscany the resident population aged&gt; 99 reached its all-time high in 2015. Respiratory diseases in men and ischemic heart diseases in women were the leading causes of death for Italian centenarians in 2015. The aim of this study is to describe the mortality of Tuscan centenarians by cause.

MATERIALS AND METHODS

population-based observational study using current health data, extracted from the Tuscan Regional Mortality Register. Main outcome measures are: proportional mortality and annual mortality trend at age &gt;99, age-specific mortality rates (85-89; 90-94; 95-99, &gt;99).

RESULTS

at age &gt;99 ischemic heart diseases, cerebrovascular diseases and respiratory diseases are among the top 5 causes of death as in the less elderly age, the relative frequency of tumors decreases and that of the ill-defined causes increases. If ill-defined and ischemic heart diseases are separated, the first cause of death is cerebrovascular diseases in males and senility in females. In the period 2002-2015 at age &gt;99 all-cause mortality fell on average every year by -0.15% for males and -0.14% for females, mortality due to arteriosclerosis decreases -10% (males) and -12% (females) every year, due to cardiac arrest and other non-specific cardiopathies -5% (males) and -7% (females) and due to cerebrovascular diseases -3% (females). Mortality due to senility increases +6% per year in women.

CONCLUSIONS

in Tuscany the first cause of death is different by gender (cerebrovascular diseases in males and senility in females) and differs from what has been observed nationally. In the 2000s, mortality from cardiovascular diseases without diagnostic significance decreased in Tuscan centenarians and that from senility increased.

[Deaths from noncommunicable diseases attributable to behavioral risk factors in Italy and Italian regions, 2016]

OBJECTIVES

to estimate the number of deaths from noncommunicable chronic diseases (NCD) attributable to behavioural risk factors (tobacco smoking, unhealthy nutrition, physical inactivity, overweight, and excessive alcohol use) in 2016 for Italy and for the Italian regions.

DESIGN

descriptive study.

SETTING AND PARTICIPANTS

mortality data were obtained by the Italian National Institute of Statistics. Causes of deaths from NCD associated with the five RFs were selected. Italian attributable fractions were obtained by the 2016 estimates of the Global Burden of Disease Study and applied to the mortality data. Regional prevalence of risk factors was obtained by the national surveillance system PASSI for the years 2013-2016.

MAIN OUTCOME MEASURES

absolute number of attributable deaths, joint attributable fraction, proportion of total deaths attributable to RFs (MAprop).

RESULTS

about 191,000 out of 614,307 deaths occurred in Italy in 2016 were attributable to combined RFs (about 37% in males; 26% in women). Joint MAprop was between 33% in men (24% in women) from Val d'Aosta and 40% in men (31% in women) from Campania. In Italy, 17% and 6% of the total amount of deaths were attributable to smoking in men and women, respectively; 6% and 3% to alcohol abuse; 7% and 8% to overweight; 13% and 12% to dietary RFs, and 2% and 3% to low physical activity. The higher proportion of attributable deaths by age-group was recorded in people aged 40-59 years (43% in men; 28% in women). Regional differences in attributable deaths are confirmed by regional RF prevalence recorded by the PASSI surveillance system for the years 2013-2016.

CONCLUSIONS

these are the first estimates of the number of deaths due to NCDs attributable to behavioural RFs estimated for each region and for Italy as a whole. Effective primary prevention policies should be reinforced, since these RFs are potentially modifiable.

The decomposition of life expectancy for age and cause of death in Tuscany, Italy

Introduction

Changing of life expectancy at birth (LE) over time reflects variations of mortality rates of a certain population. Italy is amongst the countries with the highest LE, Tuscany ranks fifth at the national level. The aim of the present work was to evaluate the impact of various causes of death in different age groups on the change in LE in the Tuscany region (Italy) during period 1987-2015.

Material and methods

Mortality data relative to residents that died during the period between 1987/1989 and 2013/2015 were provided by the Tuscan Regional Mortality Registry. The causes of death taken into consideration were cardiovascular (CVS), respiratory (RESP) and infective (INF) diseases and cancer (TUM). The decomposition of LE gain was realized with software Epidat, using the Pollard’s method.

Results

The overall LE gain during the period between two three-years periods was 6.7 years for males, with a major gain between 65-89, and 4.5 years for females, mainly improved between 75-89, &lt;1 year for both sexes. The major gain (2.6 years) was attributable to the reduction of mortality for CVS, followed by TUM (1.76 in males and 0.83 in females) and RESP (0.4 in males; 0.1 in females). The major loss of years of LE was attributable to INF (-0.15 in females; -0.07 in males) and lung cancer in females (-0.13), for which the opposite result was observed for males (gain of 0.62 years of LE).

Conclusions

During the study period (1987-2015) the gain in LE was major for males. To the reduction of mortality for CVS have contributed to the tempestuous treatment of acute CVS events and secondary CVS prevention. For TUM the result is attributable to the adherence of population to oncologic screening programmes. The excess of mortality for INF that lead to the loss of LE can be attributed to the passage from ICD-9 to ICD-10 in 2003 (higher sensibility of ICD-10) and to the diffusion of multi-drug resistant bacteria, which lead to elevated mortality in these years.

Key messages

The gain in LE during the period the 1987-2015 was higher in males. The major contribution to gain in LE was due to a reduction of mortality for CVS diseases.

Mortality trends for multiple sclerosis in Italy

Background

Multiple sclerosis (MS) is the immune-mediated inflammatory disease affecting myelinated axons of the central nervous system with enormous socio-economic impact. The aim of this study was to analyze mortality trends for MS in Italy.

Methods

The mortality data relative to period 1980-2015 were provided by Italian Institute of Statistics, data were aggregated in 5 intervals (1980-1986; 1987-1993; 1994-2000; 2001-2008; 2008-2015). The Age-Standardized mortality Rates (SR) with respective 95% confidence intervals (95%CI) were calculated (using the European standard 2013) in order to evaluate the mortality trends (in confrontation to the initial period) and Standardized Mortality Ratios (SMR), in order to confront mortality in 5 major geographic areas: North-East (NE), North-West (NW), Central Italy (CI), South Italy (SI) and Islands (I).

Results

During the study period 4959 deaths for males and 7433 for females were observed. The SRs were significantly higher for females (0.71;95%CI:0.70-0.73 vs. 0.56; 95%CI:0.54-0.57).

Significantly higher SMR were observed for both sexes in I (M:123.3 vs F:112.7), for females also in NE (106.5) and NW (115.8). Significantly lower SMR for both sexes were observed in SI (M:88.8; F:71.4) and for males in CI (90.9).

The observed SRs during the five intervals for males were: 0.65(95%CI 0.60-0.69); 0.52 (95%CI 0.49-0.56); 0.46 (95%CI 0.43-0.49); 0.53 (95%CI 0.49-0.56); 0.59 (95%CI 0.56-0.62); and for females: 0.69 (0.65-0.73); 0.69 (0.65-0.73); 0.61 (0.58-0.65); 0.68 (0.65-0.72); 0.81(0.77-0.84); respectively. An initial decrease of SRs was observed for males until 2001-2007 in confrontation to the initial period (p &lt; 0.05). For females significant increase of SRs was observed in 2008-2015 (p &lt; 0.05).

Conclusions

An increase of mortality for MS, observed for females, especially after 2000 may reflect the raising prevalence of MS in Italy. Important geographical differences were observed for five main areas.

Key messages

During the study period an increase of mortality for MS was observed for females. Important differences were observed between five main Italian geographic areas.

Lung Cancer Mortality Patterns in Women Resident in Different Urbanization Areas in Central Italy from 1987–2002

Aims and background

The aim of the study was to evaluate mortality lung cancer trends, as an indicator of female smoking trends, in women resident in different urbanization areas.

Methods and study design

Data on the 5,782 female lung cancer deaths that occurred in Tuscany, Italy, during the period 1987–2002 were analyzed, using age-period-cohort models by areas at different urbanization levels. Trends were examined with a log-linear regression model, calculating the yearly estimated percent change. Empirical bayesian estimators of the ratios between observed and expected deaths by municipality were calculated for the most recent period and mapped.

Results

The age-adjusted lung cancer mortality rates increased from 1987 to 2002: estimated percentage change values were equal to 24.5% in the urban areas (P <0.001) and 17.2% in the rural areas (P = 0.023). The age-period-cohort model analyses showed a statistically significant drift and non-linear cohort effects. The higher risk was observed for the birth cohort of women born around 1955 (RR, 5.25; 95% CI, 2.83–9.72). In the rural areas, no significant effects were observed, and the age model showed the best fit. In recent years, the risk appeared concentrated in 9 Tuscan municipalities, accounting more than 35% of the female urban population.

Conclusions

The observed significant cohort effect in the age-period-cohort analyses for the urban areas reflects the social impact of living in these areas to induce smoking-related disease like lung cancer in women. The risk appeared particularly relevant in more recent and urbanized generations (women born around 1955), thereby suggesting urgent effective campaigns against smoking, gender dedicated, especially in urban areas.

Exposure to Benzene and Risk of Breast Cancer among Shoe Factory Workers in Italy

Aims and background

Evidence of the association between leukemia and benzene exposure has been provided by several epidemiological studies. An increased risk of breast cancer among women exposed to benzene has also been suggested. The aim of this study was to analyze breast cancer risk in a cohort of 1,002 women exposed to benzene in a shoe factory in Florence, Italy, where an excess of leukemia in men was reported.

Methods

The cohort of women at work on January 1st, 1950, was followed from 1950 to 2003 for mortality and from 1985 to 2000 for incidence of breast cancer. For a sub-cohort of 797 women, cumulative exposure to benzene was available.

Results

Standardized mortality ratios were obtained for the 797 women for whom information on cumulative exposure was available. For those with <30 years of latency the standardized mortality ratio was 58.5 (95% CI, 18.9–181.2, based on 3 deaths) and 151.1 (95% CI, 78.6–290.3, based on 9 deaths) for ≥30 years of latency. In the >40 ppm-year and ≥30 year latency period category, the standardized mortality ratio was 166.0 (95% CI, 62.3–442.2, based on 4 deaths). The standardized incidence ratio for women with a latency period <30 years was 140.9 (95% CI, 75.8–261.9, based on 10 cases) and 108.2 (95% CI, 64.1–182.7) for a latency period ≥30 years. For cumulative exposure >40 ppm-years and a latency period <30 years, the standardized incidence ratio was 211.9 (95% CI, 29.9–1504.1, based on 1 case).

Conclusions

The study moderately supports the hypothesis that benzene represents a risk factor for breast cancer.

Gastric Cancer Mortality Trends in Tuscany, Italy, 1971–2004

Aims, Background, and Methods

In Tuscany, Italy, gastric cancer mortality has been decreasing since 1950, although with relevant geographical variability across the region. In Eastern Tuscan areas close to the mountains (high risk areas), gastric cancer mortality has been and is still significantly higher than that recorded in Western coastal areas and in the city of Florence (low risk areas). High-risk areas also showed higher Helicobacter pylori seroprevalence. Aim of this paper is to study gastric cancer mortality trends in high and low-risk areas, during the period 1971–2004, using age-period-cohort models.

Results

In high-risk areas, gastric cancer mortality rates declined from 61.4 per 100,000 in 1971–74 to 19.8 in 2000–2004 and in low-risk areas from 34.9 to 9.8. Mortality decline in high-risk areas was mainly attributable to a birth cohort effect, whereas in low-risk areas it was due either to a birth cohort effect or a period effect. In low- and high-risk areas, birth-cohort risks of dying decreased over subsequent generations, except for the birth cohorts born around the second world war.

Conclusions

Gastric cancer mortality in areas with higher H. pylori seroprevalence in Tuscany (high-risk areas) showed a predominant decline by birth cohort, in particular for younger generations, possibly due to the decrease of the infection for improvement of living conditions.

[Mortality of immigrants in Tuscany Region (Central Italy), 1997-2013]

OBJECTIVES

to evaluate mortality in immigrants dwelling in Tuscany Region (Central Italy) compared to mortality data relating to the Italian population residing in the same region.

DESIGN

cross-sectional descriptive mortality study relying on a unique data source, i.e., the Regional Mortality Registry of Tuscany, for the period 1997-2013.

SETTING AND PARTICIPANTS

in the analysis, immigrants residing in Tuscany were included; Italian residing in the same region were the comparison population. Immigrants were divided into two categories: immigrants from Countries at High Migration Rates (CHMRs) and immigrants from Developed Countries (DCs).

MAIN OUTCOME MEASURES

proportional general and cause-specific mortality by age and gender for the period 1997-2013; trends of standardized truncated (age 20-64) mortality rates for the Italian population, and for immigrants from CHMRs and from DCs for the period 2002-2013; standardized mortality ratios (SMRs) in people from CHMRs with confidence interval at 95% (95%CI) for all causes and cause-specific mortality.

RESULTS

during 1997-2013, 4,681 deaths were recorded among immigrants, 3,005 of which were in immigrants from a CHMR. Both cause-specific and general mortality trends in Italians and in immigrants from DCs are lowering, while general mortality of immigrants from CHMRs seems to have risen in the last 5 years. Mortality of people from CHMRs for all causes, cardiovascular causes, and cancer is permanently lower than Italian population's mortality in the examined period, but the gap seems to progressively reduce. On the other hand, child mortality among immigrants from CHMRs, despite a declining trend, is consistently higher than Italian population's mortality. Following the SMR analysis, the only exceeding cause of mortality in people from CHMRs - compared to the Italian population - is homicide among men (SMR: 3.46; 95%CI 1.55-5.59).

CONCLUSIONS

this study updates our knowledge on immigrants' mortality - and, indirectly, on their health status - in Tuscany. The gap between mortality of Italians and immigrants from CHMRs is reducing: this could be partially explained by a successful ongoing integration process. For future analyses, it would be important to obtain more complete data relative to non-resident immigrants' mortality, as their number is constantly increasing.

[Avoidable mortality in Tuscany Region (Central Italy) from 1987 to 2008]

OBJECTIVE

to evaluate the impact of avoidable mortality (AM) on the changes in life expectancy at birth (LE) in Tuscany Region (Central Italy) in two periods (1987-1989 and 2006-2008).

SETTING AND PARTICIPANTS

a list of AM causes previously published was used. The AM were divided into two groups: AM by Health Policy Interventions (HPI), AM by Health System Interventions (HSI).

MAIN OUTCOME MEASURES

years of potential life lost (PYLLs), rates of PYLL standardized on the European population (TSPYLLs), and LE were examined.

RESULTS

in 2006-2008, LE increased with a gain of 5.2 in men and 3.8 in women in comparison to 1987-1989 LE (respectively 79 and 84,9 years). If AM did not have occurred, LE would have further increased of 2 years in men and 1.5 in women. AM recorded a 39% decrease: from 25.3% of overall mortality in men in 1987-1989 to 16.1% in 2006-2008; in women from 14.3% to 8.4%. Injury/poisoning and lung cancer are the most frequent IPP. The only increasing AM is lung cancer in women. Disentangling LE increases by group of causes, 25% of the increases in 2006- 2008, compared to 1987-1989, was attributable to HSI reduction, and 4% in women and 16% in men to HPI reduction.

CONCLUSIONS

AM recorded a 39% decrease from 1987-1989 to 2006-2008 in Tuscany. In 2006-2008, about one third of LE increase in women and 2/5 in men was attributable to AM decrease, while 2/3 in women and 3/5 in men to increased survival in eldest people.

Occupational Injuries in Italy

Data collected by the Italian Funds for Occupational Injuries and Diseases (INAIL) on incidence and mortality for occupational injuries in Italy during 1951-2001 are described with respect to the two main occupational sectors, Industry and Services, and Agriculture. Comparisons with other EU countries are included to place the current severe phenomenon in context. An ad hoc analysis aimed at verifying the completeness of the data on occupational fatal accidents collected by INAIL in Tuscany is reported: a linkage between the INAIL data and those registered by the Tuscan Regional Mortality Registry highlights that a number of working areas are not covered by INAIL, a problem whose solution would be useful for primary prevention.

A novel approach combining the Calgary Biofilm Device and Phenotype MicroArray for the characterization of the chemical sensitivity of bacterial biofilms

A rapid method for screening the metabolic susceptibility of biofilms to toxic compounds was developed by combining the Calgary Biofilm Device (MBEC device) and Phenotype MicroArray (PM) technology. The method was developed using Pseudomonas alcaliphila 34, a Cr(VI)-hyper-resistant bacterium, as the test organism. P. alcaliphila produced a robust biofilm after incubation for 16 h, reaching the maximum value after incubation for 24 h (9.4 × 10(6) ± 3.3 × 10(6) CFU peg(-1)). In order to detect the metabolic activity of cells in the biofilm, dye E (5×) and menadione sodium bisulphate (100 μM) were selected for redox detection chemistry, because they produced a high colorimetric yield in response to bacterial metabolism (340.4 ± 6.9 Omnilog Arbitrary Units). This combined approach, which avoids the limitations of traditional plate counts, was validated by testing the susceptibility of P. alcaliphila biofilm to 22 toxic compounds. For each compound the concentration level that significantly lowered the metabolic activity of the biofilm was identified. Chemical sensitivity analysis of the planktonic culture was also performed, allowing comparison of the metabolic susceptibility patterns of biofilm and planktonic cultures.

Is Cancer Overtaking Cardiovascular Diseases as the Killer Number one in Men in Tuscany?

Aims and background

For the first time in 2006, cancer became the main cause of death in men in Italy, exceeding cardiovascular disease. The aim of the study was to verify whether the overtaking of cancer male mortality occurred also in Tuscany or in some of its 12 subregional areas and whether there was a geographical trend.

Methods

Age-standardized mortality rates from the Tuscan Regional Mortality Registry, 1987–2008, were calculated for neoplasms, cardiovascular diseases, and respiratory diseases, considering the whole region and its 12 areas. Joinpoint analyses were carried out to study temporal trend.

Results

Up to 2008, the number of male deaths for neoplasms (6,786) in Tuscany did not exceed deaths from cardiovascular disease (7,065). Instead, overtaking occurred in some subregional areas from 2004 onwards. When we compared age-standardized mortality rates, cancer became the first cause of death in Tuscany from 2004 onwards (age-standardized mortality rates for cancer 236.5 per 100,000; for cardiovascular disease 227.8 per 100,000). Age-standardized mortality rates for cardiovascular disease recorded an annual 2.4% decrease until 1998, then a 3.5% decrease. Age- standardized mortality rates for all cancers recorded an annual 1.6% decrease in the whole period.

Conclusions

Our study confirmed a geographical trend in cancer overtaking as the main cause of death in males: from the more urbanized areas in northern Tuscany, where the phenomenon occurred earlier, to the southern part. Free full text available at www.tumorionline.it

Sinonasal carcinomas: recent advances in molecular and phenotypic characterization and their clinical implications

Sinonasal carcinomas are rare tumors with an aggressive clinical behaviour which frequently pose a number of problems regarding the interpretation of diagnostic findings and the treatment. In addition, in comparison with other malignancies of the head and neck region, an elevated fraction of sinonasal carcinomas can be attributed to occupational exposure. This review is focused on the recent advances in the molecular and phenotypic characterization of sinonasal carcinomas, and their possible implications for the interpretation of epidemiological data, as well as for the diagnosis and treatment of these rare malignancies. The increasing knowledge on their phenotypic and genotypic features is progressively leading to a refinement in diagnosis, especially for poorly differentiated and undifferentiated lesions, as well as to the identification of markers which can be potentially useful to identify the early phases of carcinogenesis, to detect subclinical disease, to predict the response to therapy, and finally, that may represent potential targets for alternative treatments.

Lung Cancer Mortality Trend by Birth Cohort in Men, Tuscany, 1971–2006

Aims and background

In Tuscany, lung cancer mortality in men has shown a decreasing geographical trend over the last 3 decades from the most industrialized north-western coastal areas (Massa-Carrara, Viareggio) to the south-eastern areas (Arezzo, Siena), following the path of the development of industrial activities. The aim of the study was to evaluate lung cancer mortality in males by birth cohort in order to verify whether there was also a decreasing birth cohort trend in male lung cancer mortality rates between north-western and south-eastern Tuscan areas.

Methods

Lung cancer deaths that occurred in men resident in Tuscany, 1971–2006, were analyzed by birth cohort, age group and local health authority area.

Results

Rates in men >65 years were significantly higher in Viareggio and Massa-Carrara than in the south-eastern areas for all generations, in particular for men born in 1896–1926. Rates for men aged 55–64 years were higher in Massa-Carrara and Viareggio than in south-eastern areas for men born before 1926, whereas for younger generations the rates leveled off. For men aged 45–54 years, rates were similar in all areas only for younger generations (men born around 1951 and 1956), whereas for men aged 35–44 years, rates were similar in all areas for all generations considered.

Conclusions

The higher lung cancer mortality rates in men aged >65 years and born in 1896–1926 in the north-western areas than in those born in the south-eastern areas may indicate that the tobacco epidemic spread earlier in the north-western areas of Tuscany, following the path of industrialization. However, the higher mortality rates in north-western than in south-eastern areas are at least in part attributable to the high occupational risks for lung cancer experienced by workers in these areas during the first half of 20th century. Free full text available at www.tumorionline.it

The melanoma epidemic debate: some evidence for a real phenomenon from Tuscany, Italy

Our objective was to evaluate whether or not recent mortality data for the region of Tuscany confirm the hypothesis that an epidemic in the incidence of melanoma is an apparent phenomenon reflecting an overdiagnosis of indolent cases. We considered 1755 melanoma deaths in Tuscany in the period 1987-2003, and 2644 incidence cases of melanoma diagnosed in 1985-2003 in a subset of the same population. We calculated annual mortality and incidence trends using the National Cancer Institute's Joinpoint Program (version 2.6). We observed an increasing mortality from melanoma from 1987 to 2003 in both sexes, but mainly in women (estimated annual percentage changes=2.25; P<0.05). We also observed a statistically significant rise in melanoma incidence in both sexes, mainly of thin lesions. Furthermore, we observed an increase in thick lesions, especially in females (estimated annual percentage changes=2.9; P<0.05), and for lesions without Breslow definition. In conclusion, the rise in melanoma mortality and incidence, especially of thick lesions, suggests that the observed growth in melanoma incidence is not wholly apparent.

[Mortality among the elderly in Tuscany in the period 1987-2003]

AIM

to assess cause-specific mortality and its temporal trend in Tuscan elderly residents.

DESIGN

descriptive epidemiologic study based upon death certificates, collected and registered since 1987 by the Tuscan Regional Mortality Registry (RMR) according to standardized procedures.

METHODS

Major groups of causes: temporal trends are described calculating annual truncated age-adjusted mortality rates (based on age-specfic rates subdivided in three classes: 75-79; 80-84 and > or =85; standard: European population) and estimating annual percent changes (EAPC, Estimated Annual Percent Change) using ]oinpoint regression models. Most frequent specific causes: number of deaths and truncated age-adjusted mortality rates (based on age-specific rates subdivided in three classes: 75-79; 80-84 and > or =85; standard: European population) are compared between the first and the last quinquennium (1987-1991 and 1999-2003) by percent change.

RESULTS

during 1987-2003, an average of 26667 annual deaths (65% of total) occurred in persons aged 75 and over in Tuscany. In the same period the number of elderly residents increased (2003 vs 1987: men +43.6%; women +41.5%) with a consequent increase in number of deaths (2003 vs 1987: men +13.8%; women +15.9%). The truncated age-adjusted rates for all mortality causes decreased (EAPC = -1.35% in males; EAPC = -1.41% in females) while an increase was registered for few specific causes as Alzheimer's disease, senile dementia, arterial hypertension and lung cancer.

CONCLUSIONS

the decreasing mortality trend observed in persons aged 75 and over in Tuscany is consistent with similar trends in other developed countries. The opposing trends for few specific causes of death need to be further investigated.

[Temporal trends in AIDS incidence and mortality in Tuscany (1987-2000)]

OBJECTIVE

To describe temporal trends in AIDS incidence and mortality in an Italian region.

DESIGN

Descriptive study based on incidence and mortality registries.

SETTING

Tuscany.

MAIN OUTCOME MEASURES

AIDS incidence and mortality annual truncated rates, age-standardized; joinpoint analysis highlighted significant changes in the temporal trends.

RESULTS

AIDS incidence rose until 1995 and then decreased by 30% every year; AIDS mortality rose in men until 1995 and in women until 1996, then decreased by 35.9% and 49.7% every year respectively. Differences in AIDS mortality have been found between the residents of the coastline municipalities and those of other municipalities.

CONCLUSION

Differences in the temporal trends may mirror differences in risk group composition and in health-care access.

Saccharomyces cerevisiae biodiversity in spontaneous commercial fermentations of grape musts with 'adequate' and 'inadequate' assimilable-nitrogen content

AIM

To evaluate whether intraspecific diversity of Saccharomyces cerevisiae in wine fermentations is affected by initial assimilable-nitrogen content.

METHODS AND RESULTS

Saccharomyces cerevisiae isolates from two spontaneous commercial wine fermentations started with adequate and inadequate nitrogen amounts were characterized by mitochondrial DNA restriction analysis. Several strains occurred in each fermentation, two strains, but not the same ones, being predominant at frequencies of about 30%. No significant differences were detected by comparing the biodiversity indices of the two fermentations. Cluster analysis demonstrated that the strain distribution was independent of nitrogen content, the two pairs of closely related dominant strains grouping into clusters at low similarity.

CONCLUSIONS

The genetic variability of S. cerevisiae in wine fermentations seemed not to depend on the nitrogen availability in must.

SIGNIFICANCE AND IMPACT OF THE STUDY

Nitrogen content did not affect the genetic diversity but may have induced a 'selection effect' on S. cerevisiae strains dominating wine fermentations, with possible consequences on wine properties.

[A survey on fatal work accidents based on Mortality Registry data: results of the Tuscany study on INAIL and RMR cases in the period 1992-2996]

Work-related deaths are important "sentinel events" of unsuccessful prevention. In Italy the most exhaustive source of such events is the National Fund for Occupational Diseases (INAIL), but the amount of cases from this source seems to be underestimated due to the fact that it refers only to cases occurred to subjects insured by the Fund. A previous survey estimated the real amount of work-related deaths 10-20% higher than that quantified by INAIL. This study evaluated the contribute of the two most important sources (INAIL and the Regional Mortality Registry of Tuscany-RMR) in estimating the number of these cases in Tuscany in the period 1992-96. Cases were identified from each source, and then it was applied a capture-recapture method to size the cases from work-related accident different from road accidents. RMR appeared to be the most exhaustive source with 72.3% completeness versus 56.4% completeness of INAIL source. Nevertheless the last one must be considered the primary source, more specific and accurate, and since few years also timely, than any other one. Work-related deaths from road accident represent 35.9% of INAIL cases but they are difficult to be identified from RMR and were not considered in this study. In conclusion the mortality data should be used for an epidemiologic surveillance system on work-related deaths not due to road accident in order to identify cases occurred to subjects not insured by INAIL (and therefore not defined by the Fund). These deaths are also important in terms of public health. Cases identified only from RMR, occurred in Tuscany in 1992-96, were 155: the vast majority occurred to farmers (mainly pensioners, and due to caterpillar upsetting), to bricklayers, to railway workers, to soldiers and to entrepreneurs.

[Fatal occupational accidents: estimates based on more data sources]

The data reported by INAIL (Istituto Nazionale Assicurazione Infortuni sul Lavoro) on fatal occupational injuries have always been considered complete and reliable. The authors of this article verified the completeness of this information source crossing it with data bases existing in different registration systems (Regional Mortality Registry of Tuscany--RMR; registers and data of the Operative Units of Prevention, Hygiene and Safety in the Workplace--UOPISLL) for the period between 1992 and 1996. In the five years concerned, a total of 458 cases were reported. These cases could be considered fatal injuries at work without taking into account traffic accidents, which were not included in the present study. The results show that the most complete information source was RMR, reporting 80% of the total data, while INAIL reports only 62.2% of the total cases. On the contrary, the UOPISLL source is the least reliable. Using the capture/recapture method, the estimate of events in the period concerned (1992-1996) amounts to nearly 500 (499.8 LC 475.9-523.7), while the three sources systematically explored for the whole period (INAIL, RMR, UOSPILL) report 458 cases. An additional information source, the daily press, which could be systematically tested only two months for each of the five years, reports 10 additional cases, which were ignored by the 3 other sources, indirectly confirming in this way how reliable the performed estimate was. The main cases among the 157 fatal accidents reported by RMR, but not by INAIL, occurred among farmers (70), most of them already retired, but there were several fatal accidents reported in the construction sector (30). Other categories were included only in the RMR data because, in the period concerned, they were not covered by INAIL insurance (18 cases in the Army and Police, 7 on the railways). The survey that was carried out confirms the essential importance of INAIL data for the surveillance system applied to this phenomenon. This also confirms the need--which has been already stressed in the scientific literature--to combine INAIL's registration system at least with the mortality registries. In this way the knowledge and comprehension of the phenomenon could be integrated and completed especially for marginal work areas, where obligatory insurance may be evaded; and for groups of workers not covered by insurance. The relevance of an integrated system of registration of occupational fatal accidents is discussed.

Revision of species delineation in the genus Ectothiorhodospira

When the type strains and other strains of the six currently defined species of the genus Ectothiorhodospira were examined by DNA-DNA reassociation and RFLP of 16S/23S rDNA (ribotype), only four genospecies could be found. The possibility of defining taxonomically meaningful species corresponding to these four genospecies was investigated by combining DNA relatedness and ribotype data with other genotypic and phenotypic characters already described in the literature, an approach known as polyphasic taxonomy. Following this comparison, the type strain and another strain of Ectothiorhodospira vacuolata were found to be very similar to the type strain of Ectothiorhodospira shaposhnikovii and have been transferred to this latter species. Also, the type strain of Ectothiorhodospira marismortui and another previously unidentified strain were found to be very similar to the type strain of Ectothiorhodospira mobilis and have been transferred to this latter species. Due to the limited degree of reciprocal DNA relatedness, strains belonging either to Ectothiorhodospira marina or to Ectothiorhodospira haloalkaliphila are still considered as belonging to separate species, even though they show a remarkable phenotypic similarity. This revision has led to the delineation of only four species in the genus Ectothiorhodospira, namely E. mobilis, E. shaposhnikovii, E. marina and E. haloalkaliphila. E. vacuolata is recognized as a junior synonym of E. shaposhnikovii and E. marismortui as a junior synonym of E. mobilis.

[The mortality due to pulmonary silicosis in the Tuscany region in the last decade demonstrates that the health effects of work exposure to silica are still marked]

An analysis of death certificates from 1987 to 1996 among residents of the Tuscany Region identified 1518 deaths from pneumoconiosis, the large majority from silicosis, a disease explained by occupational exposure to silica dust. A dozen of deaths are from asbestosis, occurred at younger ages and are concentrated in a restricted area where a cement-asbestos factory was active. Deaths from pneumoconiosis occurred mainly among males, and the rates of the disease are decreasing only in the latest years. About 10% of deaths from silicosis are among subjects dying before 65 years of age. Mortality rates are very high in several areas of the Region, approximating those from lung cancer and ischaemic heart disease. For the above reasons the disease is still of concern from the point of view of public health and actions are suggested to obtain a description of prevalence and incidence of the disease.

[Mortality in population migrated from other Italian regions to the Tuscany region in 1989-94]

In the period 1989-94, mortality rates for the most important causes of death in people migrated to the Tuscany from other Italian regions were analysed. The area of birth was assessed according to the information on province of birth recorded on death certificates. For this analysis we classified Italy into Tuscany and five broad areas, each including a number of political regions: North-West, North-East, Centre, South and Islands. The number of person-years for calculation of the mortality risks was based on 1991 census data, which also included information on place of birth and on current residence. The risks of death of subjects born in other Italian areas and resident in Tuscany ("migrated populations") in comparison to Tuscany born population were assessed by means of Poisson multivariate regression models. For most sites (particularly for lung and breast), cancer mortality rates were higher among North-West and North-East born people and lower among Centre, South and Islands born people. Gastric cancer mortality was higher in Tuscany born subjects. Cardiovascular diseases mortality was generally lower among people born outside of the Tuscany, with the exception of ischaemic heart disease (higher in North-West and Islands born people). Liver cirrhosis mortality was generally higher in North-West, North-East, South and Islands born subjects (with some differences between males and females). Diabetes mellitus mortality was higher in South and Islands born people. AIDS and opioids overdose mortality was higher in North-West born subjects. Mortality for external causes was higher in people born outside of the Tuscany. Both in males and females, overall mortality was higher in North-West and lower in South born people and lower in Centre and Islands born males.

Genotypic diversity and typing of cyanobacterial strains of the genus Arthrospira by very sensitive total DNA restriction profile analysis

Arthrospira maxima and A. platensis are two species of cyanobacteria cultivated and sold as health food, animal feed and source of food additives and fine chemicals. The genotypic diversity of several strains attributed to these two species on the basis of morphological criteria was investigated using very sensitive total DNA restriction profile analysis. The restriction profiles were obtained after sodium dodecyl sulphate polyacrylamide gel electrophoresis and silver staining. The unweighted pair-group method using arithmetic averages applied to the matrix of Dice similarity coefficient values clustered the electropherograms of the strains in two well-separated genotypic groups. These clusters corresponded to those obtained with morphological criteria. The molecular approach used was also able to type the examined strains.

Species attribution and strain typing of Oenococcus oeni (formerly Leuconostoc oenos) with restriction endonuclease fingerprints

In several wines, malolactic fermentation is required to improve the organoleptic characters and to stabilize the final product. In order to establish a controlled malolactic fermentation in wine, easy identification and sensitive typing of strains of Oenococcus oeni (new name of the malolactic bacterium Leuconostoc oenos) used as starter cultures are necessary. To accomplish these tasks, several strains of Oenococcus oeni isolated from wines of the Chianti region (Italy), along with reference strains and strains of L. mesenteroides subsp. mesenteroides, L. carnosum, L. fallax, L. pseudomesenteroides, L. lactis and Weisella paramesenteroides, were studied with RFLP of ribosomal genes and ultrasensitive total DNA restriction pattern analysis performed on polyacrylamide gel. With each of four restriction endonucleases used, identical restriction profiles of ribosomal genes were obtained for all strains of O. oeni. These ribopatterns, being strongly dissimilar to profiles of the other lactic acid bacteria tested, appear to be well suited for the attribution of wine lactic acid bacteria to the species O. oeni. Cluster analysis performed on two total DNA restriction profile data sets showed that the species O. oeni possesses a good degree of genomic homogeneity. Very sensitive typing of strains of O. oeni was obtained with total DNA restriction profiles. The potential of an integrated approach using restriction profiles for species assignment and typing of selected malolactic bacteria is demonstrated.

Depletion of the residues of colistin and amoxicillin in turkeys following simultaneous subcutaneous administration

The tissue distribution and depletion of colistin and amoxicillin were studied in 84 turkeys dosed subcutaneously on 4 consecutive days with a formulation containing the two drugs at 0.2 ml/kg per day, corresponding to 50 000 IU of colistin sulphate/kg and 20 mg of amoxicillin trihydrate/kg. All the turkeys were killed 1-30 days after the final dose and samples of muscle, liver, kidney and cutaneous-subcutaneous tissues and of the injection site were taken for analysis for colistin and amoxicillin residues. The colistin concentrations in the liver (117.5 +/- 26.0 ng/g) and cutaneous-subcutaneous tissue (100.0 +/- 35.6 ng/g) were higher than those in kidney (92.0 +/- 34.4 ng/g) or muscle (67.5 +/- 16.9 ng/g) 1 day after the final dose. The concentration of this drug then increased for 9-14 days, followed by a slow decrease. The antibiotic was still present at low concentrations in the kidneys of all the treated birds and in the livers of two turkeys 30 days after the end of treatment. Amoxicillin concentrations were greatest in muscle (389.2 +/- 195.0 ng/g) and at the injection sites (440.3 +/- 213.9 ng/g) 1 day after treatment ceased, with a subsequent rapid decline. This drug was undetectable in the livers and kidneys by 10 days after dosing ceased.

Completeness of AIDS reporting and quality of AIDS death certification in Tuscany (Italy): a linkage study between surveillance system of cases and death certificates

In Italy, the AIDS cases defined according to the CDC criteria are reported to the National AIDS Registry (RAIDS, compulsory surveillance system). The aim of the present study is to evaluate the completeness of AIDS cases reported and the quality of AIDS death certification in an Italian Region (Tuscany, about 3,500,000 inhabitants). The 737 AIDS cases reported to RAIDS as residents in Tuscany (1987-91) were cross-linked (key link: name and date of birth) with the data of the Mortality Registration system of the Region (RMR). For the residents in Tuscany decreased with a 279.1 death diagnosis (the code for AIDS deaths stated by the Italian Census Bureau) and not reported to RAIDS as AIDS cases, the clinical records were reviewed to check whether the diagnosis fitted the 1987-CDC diagnostic criteria. This study shows that there is a high completeness (97-98%) of the AIDS cases resident in Tuscany, reported to the RAIDS. The quality of RAIDS data is not as good with regard to life status assessment (23% of under-reporting of death). In Tuscany, the death certification for AIDS (code 279.1 of ICD IX) has a sensitivity of 88% and a specificity around 100% in comparison to RAIDS. About 50% of 'false negatives' in death certification are due to causes of death presumably unrelated to HIV infection. The evaluation of the quality of AIDS surveillance and mortality data is important in the assessment of the impact for AIDS epidemic in a target population.

[Problems of codification of cause of death: comparison of the mortality data of the ISTAT and the Regional Mortality Registry of Tuscany]

A two-part study was undertaken to assess the comparability of the coding of underlying cause of death between ISTAT (Central Statistics Office providing "national" mortality statistics) and RMR (Mortality Registry of Tuscany Region providing "local" mortality statistics). In Part I was compared mortality data of the Province of Florence (years 1985-1986) from the files of ISTAT with those of RMR. The source of the cause of death is the same for both systems (ISTAT certificate), but the data collection and coding of RMR are different from those of ISTAT. In Part II was compared a set of 219 Tuscany death certificates (year 1988) coded by ISTAT and RMR. The results showed an high degree of completeness of RMR (only--0.65% vs. ISTAT) and a satisfactory level of correspondence in the number of deaths for circulatory diseases, for neoplasms and for cancers of most important sites (lung, stomach, intestine, pancreas, breast). Discrepancies were found for some other diseases; for some of these causes of death, also age-adjusted mortality rates showed discrepancies (for example ischaemic heart disease). The cause of these differences have been analyzed.

DNA restriction fingerprint analysis of the soil bacterium Azospirillum

Total DNAs of 18 strains of Azospirillum from different sources and geographical areas were compared by restriction endonuclease pattern analysis. Fragments obtained with HindIII or BglII were separated by PAGE and stained with silver nitrate. Each strain possessed a unique and reproducible fingerprint with each enzyme, thereby facilitating strain recognition. UPGMA analysis recovered clusters of band patterns that were compared to the distribution of species within the genus Azospirillum.