Gender and Age Influence on Emergency Department Visits for Non-Suicidal Self-Injuries in School Aged Children in Italy: An 11 Years Retrospective Cross-Sectional Study

Objectives: Non-suicidal self-injury (NSSI) poses a threat in developmental ages, yet there is a scarcity of studies on NSSI trends, especially those in emergency departments (ED). Methods: The aim of this cross-sectional study is to describe trends in ED visits for NSSI among young people aged between 5 and 19 years in Italy from 2011 to 2021 in Piedmont. From the ministerial ED discharge information system, all occurring NSSIs were identified by medical report and/or ICD9CM code and reported as a population rate and a visit rate on all ED requests. Results: The general rate of ED visits remained stable, with around 210,000 (55% males) visits each year, along the whole period from 2011 to 2019, then halved during 2020 and 2021. The NSSI population and visits rates increased from 2013, peaking in 2019 at a rate of around 25 and 23 NSSI visits (girls) and 76 and 69 NSSI (boys) per 100,000 ED visits. In 2020 and 2021, the rate of NSSI visits increased, particularly in girls and among older adolescents. Conclusion: The gradual increase of NSSI over the last decade is a rising public health issue, which deserves wider attention to ensure early detection and prevention.

Incidence and mortality of spinal cord injury from 2008 to 2020: a retrospective population-based cohort study in the Piedmont Region, Italy

STUDY DESIGN

Retrospective population-based cohort study.

OBJECTIVES

To determine the incidence and mortality of spinal cord injuries (SCI) in the Piedmont Region of Northwestern Italy.

SETTING

Publicly-funded SCI rehabilitation centres in the Piedmont Region.

METHODS

Administrative databases were used to identify individuals at their first admission to a SCI rehabilitation centre from January 1st, 2008 to December 31st, 2020. Cases were stratified by age and aetiology (traumatic SCI, TSCI; non-traumatic SCI, NTSCI). Age- and aetiology-specific incidence rate and person-year mortality rates were calculated for each year. Case lethality was reported as deaths among prevalent cases for each year.

RESULTS

A total of 892 cases were identified (56.4% TSCI). The average annual crude incidence rate was 17.9 per million population, decreasing from 26.0 in 2008 to 10.8 in 2020. Young adults and the elderly represented the majority of TSCI and NTSCI cases, respectively. Of the 235 individuals who died during the study period, 58.3% had NTSCI. The mortality rate per 1000 person-years decreased from 16.3 in 2009 to 8.5 in 2020, while case lethality more than tripled (from 17.2 in 2009 to 57.1 in 2020).

CONCLUSIONS

We identified a decreasing trend in SCI incidence and mortality rates, with an increased case lethality over the study period, especially in NTSCI. Given these changes in the epidemiology of SCI, community services offered after rehabilitation should be strengthened to enhance their effectiveness and contribute to increased survival in this population.

[The family and community nurse-led proactive management of COPD patients: experience of an Italian health district]

. The family and community nurse-led proactive management of COPD patients: experience of an Italian health district.

INTRODUCTION

Integrated care management for COPD may reduce healthcare utilisation, improving cost-efficiency.

AIM

To assess the primary outcomes of a family and community nurse-led proactive management of COPD patients of an Italian health district.

METHODS

Target population comprised men and women >60 years, resident in the municipalities of Collegno and Grugliasco (metropolitan area of Turin). Administrative databases (hospital discharge records, drug prescriptions, legal exemptions) were first used to identify patients with diagnosis of COPD; the cases were validated by the General Practitioners (GPs). The 335 patients were enrolled from July 1, 2015 to November 30, 2016. Family and community nurses were responsible for anamnesis, spirometry, assessment of adherence to therapy, counselling and healthy lifestyles education. GPs were responsible for the clinical staging and revision of therapy. Patients were followed-up to 12 months.

RESULTS

Improvements were observed in smoking cessation (prevalence of smokers from 23.9% to 20%), BMI normalization (in 13.4% of patients out of standard), physical activity (from 32.5% to 64.5% of patients), and pneumococcal vaccinations (from 14.9% to 58%). The last two outcomes were statistically significant. Patients showed high levels of satisfaction; 12-months compliance was 62.1%.

CONCLUSION

A family and community nurse-led proactive management of COPD patients in primary care is feasible and effective. Interventions should be structured, personalised and multi-component, oriented at motivating, engaging and supporting the patients. Positive results led to continue and extend the programme.

Violence detection explanation via semantic roles embeddings

Background

Emergency room reports pose specific challenges to natural language processing techniques. In this setting, violence episodes on women, elderly and children are often under-reported. Categorizing textual descriptions as containing violence-related injuries (V) vs. non-violence-related injuries (NV) is thus a relevant task to the ends of devising alerting mechanisms to track (and prevent) violence episodes.

Methods

We present ViDeS (so dubbed after Violence Detection System), a system to detect episodes of violence from narrative texts in emergency room reports. It employs a deep neural network for categorizing textual ER reports data, and complements such output by making explicit which elements corroborate the interpretation of the record as reporting about violence-related injuries. To these ends we designed a novel hybrid technique for filling semantic frames that employs distributed representations of terms herein, along with syntactic and semantic information. The system has been validated on real data annotated with two sorts of information: about the presence vs. absence of violence-related injuries, and about some semantic roles that can be interpreted as major cues for violent episodes, such as the agent that committed violence, the victim, the body district involved, etc.. The employed dataset contains over 150K records annotated with class (V,NV) information, and 200 records with finer-grained information on the aforementioned semantic roles.

Results

We used data coming from an Italian branch of the EU-Injury Database (EU-IDB) project, compiled by hospital staff. Categorization figures approach full precision and recall for negative cases and.97 precision and.94 recall on positive cases. As regards as the recognition of semantic roles, we recorded an accuracy varying from.28 to.90 according to the semantic roles involved. Moreover, the system allowed unveiling annotation errors committed by hospital staff.

Conclusions

Explaining systems’ results, so to make their output more comprehensible and convincing, is today necessary for AI systems. Our proposal is to combine distributed and symbolic (frame-like) representations as a possible answer to such pressing request for interpretability. Although presently focused on the medical domain, the proposed methodology is general and, in principle, it can be extended to further application areas and categorization tasks.

Effectiveness of Oncology Network model in pancreas cancer surgery in Piedmont, IT: a survival study

Background

The Oncology Network of Piedmont and Aosta Valley (North-West Italy) was started in 2000 and fully established in 2010 as a regional organisational model offering multidisciplinary care by experienced reference centres for cancer diagnosis and surgical treatment. In particular, the San Giovanni Bosco Hospital in Turin is the regional reference centre for pancreatic cancer since 2015 (50-70 oncologic surgery operations performed annually). The aim of study is to assess the effectiveness of this model for pancreatic cancer surgery by comparing survival outcomes before and after the adoption of the Oncology Network model.

Methods

The study included 178 patients, aged 37-84, who underwent duodenocephalo- or total pancreatectomy for ductal cancer in the years 2007-2019. Clinical data were retrieved from surgical records, whereas the vital status was ascertained through an application connected to the Regional Registry Office. The Kaplan-Meier method was used to estimate survival and the log-rank test was then used to compare survival rates between the two groups (before vs. after 2015). Cox's regression was employed to assess the difference between the groups, also adjusting for age, sex and ASA score.

Results

The median survival for included patients was 19 months. No significant differences were found between patients of the two groups (before vs. after 2015), neither considering all patients (p = 0.4) nor for any single ASA or age category (p-values ranging from 0.1 to 0.6). The multivariate Cox model accounting for ASA, age and sex confirmed absence of significant survival differences between the two groups.

Conclusions

Despite increased case complexity, due to the extension of surgery indication to more critical patients, the Oncology Network model allowed achieving an overall survival in pancreatic cancer surgery that is consistent with international literature and not inferior to survival outcomes previously reached in patients more strictly selected.

Key messages

This study found survival after pancreatic cancer surgery was similar before and after the center entered an Oncological Network, which led to include patients with an increased severity in case-mix. Promoting the implementation of Oncology Networks should be a public health priority as it allows to improve health outcomes and quality of care.

[Suicide mortality in Piedmont Region (Northern Italy): epidemiological suggestions for prevention]

OBJECTIVES

to describe intentional self-harm related deaths in Piedmont Region (Northern Italy) analysing trends by gender, age, area of residence, socio-economic level.

DESIGN

descriptive study of mortality using data from the Italian National Institute of Statistics (Istat).

SETTING AND PARTICIPANTS

resident population in Piedmont Region in the period 2003-2014.

MAIN OUTCOME MEASURES

age-standardized suicide (ICD-10: X60-X84) rates, by gender, health district of residence and educational level; frequencies of suicide method and place of occurrence by gender and age.

RESULTS

in a context of declining injury related mortality, especially that due to traffic accidents, the regional trend of suicides shows only a slight decrease, becoming the main cause of injury deaths since 2009, equal to 21% of all injury deaths in the studied period. Among the largest Italian Regions, Piedmont is the one with the highest rate of suicide. There are no significant trend variations related to the recent period of economic crisis. The occurrence is higher among men in general and particularly in older people, persons with low educational level and those living in mountain areas. The main suicide method used by women is "jumping from a high place" (36.7%) while the main one for men is "hanging, strangulation and suffocation" (50%). This is globally the most frequent method for all ages. "Self-poisoning" gains importance between 30 and 49 years old. Suicides occur for over half of cases in home, without any difference by gender and age.

CONCLUSION

suicides are a public health and social concern. Yet despite its extent, this problem is still not adequately considered in public health prevention programmes. Important contributions to a deeper understanding of the determinants can be obtained from health information systems, in particular data from emergency care and multiple causes of deaths records.

Suicide epidemiology in Italy: a population-based study in Piedmont Region

Background

Among the largest Italian Regions, Piedmont (Northern Italy) is the one with the highest rate of suicide. Aim of the study was to describe intentional self-harm related deaths in Piedmont analyzing trends by gender, age, area of residence, socio-economic level.

Methods

Observational mortality study of the resident population in Piedmont from 2003 to 2014. Age-standardized rates of suicide (ICD-10: X60-X84) were estimated, by gender, health district of residence, mountain/level ground, and educational level. Suicide methods and places of occurrence by gender and age were inquired.

Results

In a context of declining injury related mortality, especially for traffic accidents, the regional trend of suicides shows only a slight decrease, becoming the main cause of injury deaths since 2009, equal to 21% of all injury deaths in the studied period. There are no significant trend variations related to the period of economic crisis. The occurrence is higher among men in general and particularly in older people, persons with low educational level and those living in deprived areas. The main suicide method used by women is “jumping from a high place” (36.7%) while the main one for men is “hanging, strangulation and suffocation” (50%). This is globally the most frequent method for all ages. “Self-poisoning” gains importance between 30 and 49 years old. Suicides occur for over half of cases in home.

Conclusions

Suicides are a public health and social concern. Yet despite its extent, this problem is still not adequately considered in public health prevention programs. Social and geographical gradients highlitght the importance to improve mental health service provision in deprived areas and to enhance public social welfare measures. Further contributions to a deeper understanding of the determinants of self-harm behaviour and suicidal risk can be obtained from health information systems, in particular data from Emergency Departments and multiple causes of deaths records.

Key messages

In Italy, suicides are the main cause of injury deaths, without trend variations. Occurrence is higher among men, older people, persons with low educational level and those living in deprived areas.

RT Accidents mortality in Italy: a population-based study in Piedmont on Vulnerable Road Users

Background

Among the largest Italian Regions, Piedmont (Northern Italy) had in 2017 a crude rate of road traffic accidents (RTA) deaths greater than the national average. RTA injuries remain a leading cause of injury deaths in Italy. Among them in both Piedmont and Italy many victims are vulnerable road users (VRU): pedestrians, cyclists and users of motorcycles or motorpeds. The study was aimed to describe their mechanisms of injury.

Methods

Observational study of the resident population in Piedmont from 2003 to 2015. Transportation Injuries (ICD-10: V01-V99) were considered, because of their greater comparability rate in bridge coding studies. A number of 5,185 RTA deaths was observed. Role, type of vehicle of the victim and collision were studied.

Results

Piedmont in 2017 had a RTA mortality rate (6.35 deaths per 100,000 inhabitants) greater than Italy (IRR = 1.13, 95% CI: 1.00 - 1.29; p < 0.02), 48.4% of the victims were VRU similarly to national data (49.8%). In the period the proportion of VRU on RTA deaths steadily increased from 25.6% in 2003 to 49.1% in 2015, in a significant way (z = 2.79; p = 0.005), because in a context of marked reduction of RTA mortality (-54.5%), the regional trend for VRU shows only a slight decrease (-12,6%). The VRU were: pedestrians (47.0%), motorized two-wheels users (37.4%) and cyclists (15.6%). Among pedestrians 63.9% deaths were caused by collisions with mainly automobiles (82.1%) and heavy vehicles (12.7%). In case of collision the prevalent causes of death were head injuries (41.5%) and multi-trauma (31.8%). Similar patterns were observed for cyclists, while in motorcyclists 56.5% of deaths were due to loss of control or fixed object.

Conclusions

VRU injuries remain a public health and social concern. Yet despite their extent, this problem is still not adequately considered in public health prevention programs. The observed mechanisms of injury evidence the importance to enhance the protection of VRU in road traffic circulation.

Key messages

In Italy, vulnerable road users are becoming a major group among road traffic injury deaths, because they not follow the general trend of large decrease of RTA injuries. Largest VRU group are pedestrians such as cyclists they are hit by cars or heavy vehicles with major trauma, in the motorized two-wheels loss of control and collision with fixed object are important.

Incidence estimates of hand and upper extremity injuries in Italy

OBJECTIVE

The purpose of this investigation is to estimate the incidence rates of upper extremity injuries and to give an overview of the most frequent diagnoses.

MATERIALS AND METHODS

Two population databases were queried for all injuries in the upper extremities, the SINIACA-IDB (S-IDB: Emergency Department Injury Database in Italy) and the Hospital Discharge Register (HDR). The diagnoses codes of hand trauma were selected from both databases in order to estimate the national incidence rate.

RESULTS

According to the S-IDB data of year 2011, total 1 479 510 ED attendances per year in Italy were estimated with an upper extremity injury (incidence rate: 2491 per 100 000 persons/year). About 880 816 Emergency Department (ED) attendances per year are due to hand injuries, while over 653 336 attendances per year concern arm injuries. The incidence rates are 1483 and 1100 per 100 000 person/year respectively. About 201 940 hospitalizations are observed in the HDR because of upper extremity injuries (incidence rate: 340 per 100 000 persons/year). Males have higher incidence rate (387 vs 280 per 100 000 persons per year). The trend in the incidence rates for the age group of inpatients shows two peaks: at age 12 (400 cases per 100 000 persons/year), and in the older age groups (700 cases per 100 000 persons/year).

Proprioceptive Training and Injury Prevention in a Professional Men's Basketball Team: A Six-Year Prospective Study

Single limb stance instability is a risk factor for lower extremity injuries. Therefore, the development of proprioception may play an important role in injury prevention. This investigation considered a professional basketball team for 6 years, integrating systematic proprioceptive activity in the training routine. The purpose was to assess the effectiveness of proprioceptive training programs based on quantifiable instability, to reduce ankle sprains, knee sprains, and low back pain through developing refined and long-lasting proprioceptive control. Fifty-five subjects were studied. In the first biennium (2004-2006), the preventive program consisted of classic proprioceptive exercises. In the second biennium (2006-2008), the proprioceptive training became quantifiable and interactive by means of electronic proprioceptive stations. In the third biennium (2008-2010), the intensity and the training volume increased while the session duration became shorter. Analysis of variance was used to analyze the differences in proprioceptive control between groups, years, and bienniums. Injury rates and rate ratios of injury during practices and games were estimated. The results showed a statistically significant reduction in the occurrence of ankle sprains by 81% from the first to the third biennium (p < 0.001). Low back pain showed similar results with a reduction of 77.8% (p < 0.005). The reduction in knee sprains was 64.5% (not significant). Comparing the third biennium with the level of all new entry players, proprioceptive control improved significantly by 72.2% (p < 0.001). These findings indicate that improvements in proprioceptive control in single stance may be a key factor for an effective reduction in ankle sprains, knee sprains, and low back pain.

Anxiety and dysthymia: local prevalence estimates based on drug prescriptions by general practitioners in Turin (Italy)

BACKGROUND

The aim of the study was to obtain local estimates of the prevalence of anxiety and dysthymic disorders among attendees of primary care at local level, useful to pursue a better management of the health care services.

METHODS

The study was conducted in the Health District no. 2 of Turin (industrial town in northwest Italy). The criteria for identification of cases were based on the drugs prescriptions made by general practitioners (GPs), selected in order to assure high specificity. The study involved 86 physicians (with 87,885 attendees).

RESULTS

As expected, the crude and standardized prevalences were higher in women (anxiety: 2.9% vs 1.3% in men; dysthymia: 3.8% vs 1.7% in men), with a peak in women aged over 75 yrs (anxiety: 4.8%; dysthymia: 6.2%). In comparison to male GPs, female GPs had an higher prevalence of patients with anxious disorders, whereas the prevalences of dysthymia were similar.

CONCLUSIONS

Despite the discussed limitations, the used methodology allows to obtain sufficiently reliable estimates of prevalence of common mental disorders at local level, providing informations useful for organizing the primary care in the Health district.

[Usefulness of databases of general practitioners: the study of chronic cardiovascular diseases in a health district of Turin, Italy]

BACKGROUND

The aim of this study was to evaluate the prevalence of chronic cardiovascular diseases in the territory of a health district in Turin (Italy) to achieve better management of healthcare services according to healthcare needs.

METHODS

In order to assess healthcare needs, we surveyed the prevalence of five cardiovascular chronic diseases in the general population, using data from the general practitioners of one health district.

RESULTS

Eighty-six general practitioners participated in the study, collecting data regarding 87 885 attendees, for the year 2010. Among men, the following prevalence rates were estimated: 2% prior myocardial infarction, 2.4% other forms of chronic ischemic heart disease, 2% cardiac arrhythmias, 0.4% heart failure, 0.9% late effects of cerebrovascular disease. Prevalence rates were lower among women, except for dysrhythmias and heart failure, and were increasing with age. Prevalence rates were higher than those previously reported by the Italian Cardiovascular Epidemiological Observatory for northwestern regions. In addition, differences in disease distribution were observed among patients when comparing male doctors and female doctors.

CONCLUSIONS

Our findings show several critical issues in primary care, suggesting the need for improving the healthcare delivery system within the health district according to local care needs.

Factors Other than Risks in the Workplace as Determinants of Socioeconomic Differences in Health in Italy

To evaluate differences in mortality by social class and to determine the impacts of socioeconomic factors on health inequalities in Italy, mortality data from 1981-2001 were analyzed as a function of social class in Turin, controlling for occupational risks, housing conditions, and education. For general and cause-specific mortality, the weight of each socioeconomic indicator was evaluated on population-attributable fraction to social class. Among men, mortality risk was significantly higher in unskilled blue-collar workers (RR = 1.45). Among women, the differences by social class were slighter. Education and economic status mostly explain the mortality differences by social class in men, while economic status showed the highest contribution in women.

Socio-economic inequalities: a review of methodological issues and the relationships with cancer survival

During the past few decades, many studies on socio-economic factors and health outcomes have been developed using various methodologies with differing approaches. A bibliographic research in MEDLINE/PubMed and SCOPUS was carried out for the period 2000-2011 to describe the influence of socio-economic status (SES) on cancer survival, in particular with reference to the outcome of European research results and the results of some cases of other Western studies. This review is divided into two sections: the first describing the different approaches of the study on individuals and populations of the concept of "social class" as well as methods used to measure the association between deprivation and health (i.e. ecological level studies, deprivation indexes, etc.); and the second discussing the association between socio-economic factors and cancer survival, describing the roles of various determinants of differences in survival, such as clinical and pathological prognostic factors, together with consideration of diagnosis and treatment and some patients' characteristics.

Risk factors for upper extremity musculoskeletal symptoms among call center employees

OBJECTIVES

To investigate the prevalence of musculoskeletal symptoms in the upper extremity (UE) in a sample of Italian call center (CC) operators, and the relationship between the symptoms and potential workplace risk factors.

METHODS

During 2005-2006, 775 workers from seven CCs in the Turin area participated in a questionnaire survey of exposure to ergonomic, organizational and psychosocial factors at work, socio-demographics, lifestyle, symptoms and diseases. Musculoskeletal symptoms were defined as self-reported musculoskeletal symptoms in the UE during the previous 28 days, for which a physician was consulted and/or drugs were taken. Relative risks were estimated through Poisson regression models with the Huber-White sandwich estimator of variance.

RESULT

Overall, 45% of workers reported UE symptoms in the last four weeks. Symptoms in the neck were the most prevalent (39%), followed by the shoulder (22%), hand-wrist (10%) and elbow (4%). Among workplace risk factors, neck-shoulder symptoms were associated with low job control, elevated noise, poor desk lighting and impossibility to lean back while sitting; whereas elbow-hand/wrist symptoms were associated with short intervals between calls, insufficient working space, lack of forearm support, job insecurity and long seniority in the CC industry.

CONCLUSIONS

The high prevalence of UE symptoms in this sample was similar to that reported by other studies conducted in this industry. Our results confirm previously reported associations, such as poor characteristics of the workstation and psychological stressors. The striking difference between the set of risk factors for neck-shoulder and elbow/wrist-hand symptoms indicates that the two regions should be investigated separately.

[Inequalities in protection and promotion of workers' health]

BACKGROUND

Occupational risks contribute to health inequalities, combined with psychosocial, behavioural, and environmental risk factors. Job Strain is a well-known risk factor for cardio-vascular and psychiatric diseases. Furthermore, stressful conditions at work promote unhealthy life styles. Among workers, sex (female), young age and migration are all causes of health inequalities.

CONCLUSIONS

Although evidence on the effectiveness of workplace interventions for addressing inequalities is limited, equity audits to support decisions need to be implemented in conjunction with workability and health promotion programmes, and simultaneously with measures of an environmental and social nature.

[Working conditions and health problems among call-centre operators: a study on self-reported data in the Piedmont Region (Italy)]

BACKGROUND

Currently, about 250,000 workers are employed in the call-centre sector in Italy. The nature and the organization of the work exposes workers to a variety of psychosocial and ergonomic hazards, with a potential impact on physical and psychological health.

OBJECTIVE

The aim of the study was to investigate working conditions and health status among call-centre operators, in order to estimate the prevalence of exposure to psychosocial and ergonomic risk factors, and of potentially work-related health problems.

METHODS

Workers from seven call-centres operating in the Torino area were invited to participate in the survey. During the period 2005-2006, 775 subjects working in telecommunications (70%), telemarketing (14%) and finance (16%) completed a standardized questionnaire on socio-demographics and lifestyle, working conditions, symptoms and diseases.

RESULTS

Poor microclimatic conditions, elevated noise, high levels of exposure to psychosocial factors and a high prevalence of unfavourable ergonomic working conditions were observed With regard to health conditions, the mental health index was lower than that expected for the Italian population. Overall, 60%, of the subjects reported headache, 57% musculoskeletal symptoms and 46% voice disorders, for which they consulted a physician and/or took medication.

CONCLUSION

A high proportion of call-centre operators were exposed to organizational and psychosocial risk factors, while the self-reported prevalence of potentially work-related health conditions was also high, as has been reported by other authors. Although further epidemiological studies are needed to meaningfully evaluate these associations, it also appears necessary to implement interventions on the most frequently encountered hazards in this sector.

[Road accidents in piedmont (Italy): factors affecting mortality among drivers]

OBJECTIVES

Italy is one of the industrialized countries with the highest mortality from road accidents. The mortality index of road accidents in Piemonte is one of the highest in Italy. This study assesses the main factors affecting the mortality among drivers.

DESIGN

Police reports of 95,944 road traffic accidents occurred between 1999 and 2004 in Piemonte, involving 178,230 drivers, were analysed. Multivariate logistic regression models were used to estimate the association of drivers' and accidents' characteristics with mortality among drivers. Analyses were stratified for car, truck and two-wheel vehicle drivers.

RESULTS

Mortality is affected by age and gender. In addition, the main risk factors are night-time, extra-urban roads, mountain areas and two wheel vehicles. The drivers license penalty point regulation law introduced in Italy on July 2003 seems to have had a protective effect on mortality during the early months of application.

CONCLUSIONS

Official data are useful for estimating potential determinants of road injuries' outcome. Factors affecting the occurrence of accidents are not necessarily predictors of outcome severity. An effective prevention policy of frequency of accidents, mortality and disability should be based on drivers'safety education, structural interventions, targeted road controls and law enforcement.

[Carpal tunnel syndrome: example of assessment of the role of occupational exposure based on self-reported data]

BACKGROUND

The prevalence of surgical cases of carpal tunnel syndrome (CTS) tends to increase in the general population in Italy. Nevertheless, it is still unclear what percentage of CTS is attributable to occupational exposure, to ergonomic or psychosocial factors. Moreover, the problem of obtaining a reliable definition of occupational exposure in the absence of direct observation and measurement in the workplace remains unsolved. Piedmont (north-western Italy) is one of the Italian regions with the highest number of musculoskeletal disorders recognized and compensated as work-related. The aim of this study was to estimate the proportion of work-related CTS surgical cases, based on self-reported exposure data.

METHODS

An interview-based questionnaire included items on medical history, workplace exposures and non-occupational risk factors for CTS. The study was carried out between June 2003 and November 2004. A total of 260 adult patients (aged 18-65 years) were interviewed. An evaluation of the questionnaires was made by 3 occupational physicians, assigning every patient a probability score of occupational aetiology. Seventy-four per cent of the sample were female; the mean age was 48.4 years.

RESULTS

Seventy-one percent of the patients reported bilateral CTS. Occupational exposure preceded the onset of CTS symptoms for 184 patients. The probability that CTS was work-related was estimated as high for 66 patients (26% of the sample). Agreement among examiners, evaluated using the kappa statistic, was good.

CONCLUSIONS

Despite the limitations of the study, the number of cases attributable to occupation was much higher than the number of diseases reported to INAIL (National Institute for the Insurance of Industrial Accidents), which suggests that there is substantial under-notification in Italy.

[Carpal tunnel syndrome (CTS) in the Piedmont Region: regional incidence and prevalence of CTS based on hospital records of patients who underwent surgery]

BACKGROUND

Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy of the upper extremities. Despite CTS being a priority for public health, only a few studies have investigated the prevalence and incidence in the general population. In Italy, administrative data are available only for CTS cases which were judged work-related by the Workers Compensation Board. These data indicate a steady increase in CTS over the last decade. Hospital admission archives (SDO) also contain information on CTS patients who underwent surgery.

OBJECTIVES

To determine: 1) the incidence and prevalence of first CTS, based on hospital records of patients who underwent surgery in the Piedmont Region; 2) to describe the geographical and temporal variation.

METHODS

Crude and standardized incidence rates of CTS were computed for the period 2002-2003; geographical variation was assessed using bayesan estimators to detect spatial clusters. Crude and standardized prevalence rates of first hospitalization were calculated for every two-year period between 1996 and 2003.

RESULTS AND CONCLUSIONS

The crude incidence rate was 227.2 (C.I.95% 221.9-232.7) per 100,000 women and 54.4 (C.I. 95% 51.9-57.1) per 100,000 men. The prevalence of first hospitalization was very high and varied widely by geographic area. Two possible explanations for such wide variation between areas include differences in exposure to risk factors for CTS and in the diagnostic criteria used. The increasing prevalence over time was only partly explained by an increase in work-related cases. The development of standardized diagnostic criteria would improve understanding of the effect of workplace exposures on CTS. The number of new cases per year in Piedmont was estimated at 1,500, much higher than the compensation claims related to CTS. Health education campaigns addressed to general practitioners on compensation law could improve reporting to the workers' compensation board.

[Regional surveillance of occupational percutaneous and mucocutaneous exposure to blood-borne pathogens in health care workers: strategies for prevention]

BACKGROUND

Several studies have investigated both the frequency and modality of occurrence of occupational exposure of health-care workers to blood-borne pathogens. At the moment no complete epidemiological data are available covering the hospitals of an entire Region.

OBJECTIVES AND METHODS

To describe the characteristics of mucocutaneous and percutaneous exposure to body fluids of the healthcare workers in 47 out of the 56 public hospitals (90% of a total 15,000 beds, 28,000 health-care workers full time equivalent) in Piedmont, Northern Italy (4.5 million inhabitants) over a three-year period (1999-2002), using SIROH (Studio Italiano Rischio Occupazionale da HIV) model to collect the data.

RESULTS AND CONCLUSIONS

5174 percutaneous injuries (12.7/100 beds) and 1724 mucocutaneous exposure (4.1/100 beds) were recorded. Surveillance data were similar to those collected in other multi-hospital studies. The variability of rates between hospitals was high, most likely due to the amount of underreporting. The categories most at risk of percutaneous and mucocutaneous exposure were, respectively, surgeons (9.3/100 surgeons) and midwives (2.9/100 midwives). Needles (syringe, winged steel, suture) were the medical devices most frequently involved in percutaneous injuries, 60% of which occurred after the use of such devices. Eighty-three per cent of healthcare workers had been HBV-vaccinated versus only 45% of cleaning staff. After percutaneous injuries with exposure to an HIV positive source only 40% of those exposed received post-exposure prophylaxis; in the case of mucocutaneous exposure the rate was 11%. We recorded 2 seroconversions following occupational exposure to an HCV positive source (risk of seroconversion: 0,2%). In order to implement preventive programmes the use of safety devices, an increase in the number of HBV-vaccinated contract workers, the use of chemoprophylaxis for HIV exposure, and the use of protective equipment are deemed necessary.

Prognostic significance of microvessel density and vascular endothelial growth factor expression in sinonasal carcinomas☆

The prognostic significance of microvessel density and proliferative activity of the neoplastic cells, evaluated respectively by CD31 and Ki-67 positivity, and immunohistochemical expression of vascular endothelial growth factor (VEGF) was retrospectively investigated in 105 cases of sinonasal carcinoma (80 surgical specimens and 25 biopsies). The most represented histologic types were intestinal-type adenocarcinoma found in 36 patients (34.3%), squamous cell carcinoma (SCC) in 34 (32.4%), mucinous adenocarcinoma (mainly made up of signet-ring cell patterns) in 15 (14.3%), and adenoid cystic carcinoma in 7 (6.7%). Microvessel density values (in vessels per square millimeter), VEGF, and Ki-67 were not dependent on histologic type but were rather correlated to the histologic grading in SCC. Clinical data were available for 92 (87.6%) of 105 patients, with minimum follow-up of 48 months. Most of the patients (81.5%) were at an advanced stage (T3-T4) at diagnosis. The values of all markers were correlated to tumor stage (P = .03). Multivariate analysis showed that both microvessel density and proliferative activity of the neoplastic cells were independent prognostic parameters (mortality hazard ratio, 1.33 and 1.60, respectively). Although VEGF expression was not correlated to prognosis on the whole series (P = .06), it was a powerful prognostic marker when the analysis was restricted to the group of SCCs (hazard ratio, 3.02; 90% confidence interval, 1.58-5.80). These results show that tumor neoangiogenesis, expressed by microvessel density, together with proliferative activity, is a pathologic marker with a strong prognostic impact in sinonasal carcinomas. Therefore, it may be a useful tool in this field so as to carry out therapeutic protocol planning, which may be further enhanced by the adoption of the more recent antiangiogenic molecules.

[Occupational mortality in the population employed at 1991 Census]

BACKGROUND

Despite limitations and problems connected to occupational surveillance systems based on mortality data, mortality from specific causes continues to be a crucial indicator for evaluating the differences in health among various occupations.

OBJECTIVES

To evaluate the potential of a surveillance system of occupational mortality based on census and mortality data obtained from ISTAT (Italian Central Statistics Institute).

METHODS

By means of record-linkage between Census data and death records from ISTAT, occupational mortality was assessed during the twelve month period following the 1991 census, limited to subjects aged 18-64 years for whom occupational information was available. The study population consisted of deceased subjects, 19,527 of whom were men and 3,547 were women. A cross-sectional model was used to evaluate odds ratios for cause-specific mortality. The risk estimates were then compared to the results obtained in a previous analysis on Census data gathered in the 1981 census.

RESULTS

Among the significantly increased risks observed both in 1981 and 1991, of particular interest are the excesses of mortality from liver cirrhosis in caretakers, janitors, and cleaning staff; and the excess of breast cancer in teachers. Mortality from cirrhosis in masons, porters, and waiters, and from violent causes in transport workers and bar and restaurant workers, was instead significantly in excess only in 1991.

CONCLUSIONS

The data on mortality by occupation does not permit inferences about occupational risks, though they can be useful to highlight socio-economic differences in premature death in the employed segment of the population and to draw attention to possible trends over time.

[Workplace injuries and professional mobility correlated with health problems. The potential and limitations of the ISTAT Labour Force survey--July 1999]

BACKGROUND

Knowledge on the occupational and social factors that influence the relationship between illness, absence from work and occupational mobility is at present insufficient.

OBJECTIVES

To map out, by social class and occupational group, the impact of health problems on work and the distribution of accidents and morbidity associated with occupation.

METHODS

Using data from the National Survey of the Italian Labour Force (ISTAT, 1999), covering a sample of 200,384 subjects, prevalence odds ratios of morbidity, work injuries and change of occupation due to health problems were calculated by social class and occupation, adjusting for age and residence.

RESULTS

The working class showed a higher risk, due to health problems, of a reduction in time worked (OR = 3.70 in men and OR = 4.10 in women), of choosing to work part-time (OR = 2.04 in men and OR = 2.27 in women), or of withdrawing from the workforce (for artisans, skilled manual workers, farmers and agricultural labourers OR = 1.63 in men and OR = 1.47 in women). This class was also at a greater disadvantage not only with respect to accident rates (OR = 1.85 in men and OR = 1.88 in women), but also with respect to the time needed for post-trauma rehabilitation and return to work (for absences of one week to one month: OR = 1.67 and 1.83 for men and women, respectively; for absences of more than one month: OR = 1.29 and OR = 1.69). Moreover, the working class, when compared to other social classes, had a higher rate of suffering from illness, physical impairment or other physical and psychological problems caused or aggravated by working activity (25% in men and 32% in women).

CONCLUSIONS

The ISTAT National Survey provides an estimate of minor accidents with prognoses of less than three days, including those not reported to the National Institute for Insurance against Occupational Accidents and Diseases (INAIL). This allows a preliminary exploration of the relationship between health problems and occupational mobility; however, it seems necessary to collect more detailed information in order to more exhaustively explore the mechanisms which generate the inequalities observed.

[Risk of repeated injuries by economic activity in Italy in the 1990's]

BACKGROUND

Repetitive work injuries are a phenomenon that has not been sufficiently studied. Using data gathered by INAIL (National Institute for Insurance against Occupational Accidents and Diseases), it is possible to study the propensity of having a further injuries at the workplace after the first one.

OBJECTIVES

To identify the risk of experiencing multiple injuries according to occupation, with discussion of how useful the available information systems are.

METHODS

The data base includes workplace injuries, as classified by INAIL in Italy between 1994 and 2000 in the industrial and artisan sectors (2,162,702 subjects, ages 25-55). Selecting data on accidents occurring among 107,082 subjects who had experienced the first accident in 1996-99, in this cohort we assessed the occurrence of further accidents within two years in the same occupation, taking into account job mobility and factors eventually influencing underreporting (geographic area, age, severity of first accident and size of the enterprise). The risk for each occupation was computed stratifying by gender.

RESULTS

There were significant differences between the first and successive accidents when examined by type, age group, severity of physical consequences and company size. Among men, the occupations showing higher risk were those already known to be at high risk for accidents: cleaning staff and refuse workers, foundry workers, masons, pilots, woodworkers, carpenters, transport workers, sailors, farmers, and miners. Among women the occupations most at risk were postwomen and messengers, cleaning staff and refuse workers, waitresses, cooks, bartenders, machine tool operators, woodworkers, and weavers in the textile industry.

CONCLUSIONS

Among men, the risk of recurrent workplace accidents by occupation tends to reflect the frequency of the total accidents in each occupation. The results indicate that the study model employed is efficient and useful in providing risk profiles which allow identification of where to direct future studies, investigations, and preventive measures for each sex.

Type III intestinal metaplasia, Helicobacter pylori infection and gastric carcinoma risk index in an Italian series of 1750 patients

BACKGROUND/AIMS

To evaluate the utility of 2 biopsies of antrum and gastric body on routine endoscopy for the assessment of type III intestinal metaplasia (IM-3) and Helicobacter pylori (Hp), 1750 patients (pts) (895 males; 855 females) were considered from June'98 to June'00.

METHODOLOGY

Specimens were graded 0 to 3 for atrophy, IM-3 and Hp. 610 pts treated previously with antibiotics or not eligible for biopsy were excluded from initial 2360 pts.

RESULTS

IM-3 was found in 118 pts (6.7%), 100 pts (5.7%) only in the antrum. 10 of 355 pts (2.8%) with normal endoscopy and 47 of 702 (6.6%) with non-erosive endoscopic gastritis resulted IM-3 positive in the antrum. 709 pts (40.5%) were positive for Hp in antrum and/or corpus. The presence of Hp and IM-3 in the antrum was not correlated (p=0.99; Spearman test). A positive correlation (p=0.000) between duodenal ulcer and Hp was found when antral Hp positivity was taken into account. The gastric carcinoma risk index (GCRI) was found in 358 pts (20.4%); in this group 131 pts (36.6%) were Hp positive, 81 pts (22.65%) had IM-3 only in the antrum, 184 pts (51.4%) had atrophy.

CONCLUSIONS

The incidence of IM-3 is low (6.7%) in routine endoscopy. Normal endoscopy doesn't exclude the presence of IM-3. Biopsy is necessary to discover IM-3 in the antrum in 5.3% of pts with normal or aspecific endoscopic gastritis. Application of the GCRI might be useful for identifying a group of patients carrying a higher risk for gastric carcinoma.

[Use of pension records for occupational health surveillance: example of record-linkage with hospital discharge records to study the association between work and the incidence of leukaemias, lung and bladder cancer, and miscarriage]

BACKGROUND

Epidemiologic surveillance of occupational health based on routinely collected data allows groups of workers to be studied, whose type of work (e.g. small enterprises, self-employed workers, artisans) makes it difficult to use a traditional cohort study design.

OBJECTIVE

To evaluate the validity of a study design based on the record-linkage between hospital discharge records and INPS social security records (National Institute for Social Security), in order to investigate the association between past employment in an economic sector and occurrence of diseases with a low fraction attributable to occupation and a high frequency in the population, where it is too costly to perform retrospective interviews to gather data from each recruited subject.

METHODS

A case-control study design was used in which hospital discharge records from 1995 in the Piedmont Region represented the source of subjects enrolled. Four series of cases were identified: males aged 40-75 years, with first hospital admission for leukaemia, lung or bladder cancer; and women aged 18-39 years, admitted for miscarriage. The controls were a random sample of patients admitted in the same year and matched by sex and age. The exposure variable was the prevalent economic sector in the occupational history of the subjects enrolled, as inferred from INPS social security records.

RESULTS

No economic sector examined showed a significant excess of incidence of bladder cancer or leukaemia. There was a significant excess of lung cancer in subjects with longest employment in the building industry, in metal working, and in the "foundries, heat pressing, forging, and rolling mills" sector. A significant excess of miscarriages was present only in women working in commerce.

DISCUSSION

The results demonstrated overall a low consistency compared with those obtained via other surveillance systems of occupational morbidity and mortality, as well as by means of analytical studies. The results appear more plausible for the sectors characterized by a low number of job tasks, or by a more homogenous exposure to risk factors among workers in different jobs. Among the limitations of this study the lack of a complete occupational history, the absence of information on potential confounders like smoking and alcohol consumption, and the probable non-differential misclassification of the longest held job need to be stressed

[Study of the relationship among work and demographic characteristics, sickness absence and occupational mobility]

BACKGROUND

The problem of sick absences from work is correlated to a series of organizational, social and psychological factors which interact with risk factors typical of the work performed, and thus determine how frequently absences occur. The correlation between morbidity and work is of interest in itself for studying the processes of occupational mobility.

OBJECTIVES

To examine, using data from administrative sources, the association of sick absence with individual and workplace factors, as well as the relationship between illness and career mobility.

METHODS

Employee sick absence data registered at INPS (National Institute of Social Insurance) in the period 1992-95 were studied using a sample of 124,686 subjects.

RESULTS

The probability of being absent from work due to illness did not appear to be affected by sex or age. The sectors more at risk for sick absences were the service sector, business and commerce. Inequalities were noted in illness rates to the disadvantage of those who had received redundancy payments in the previous years. New hirings and upward mobility were associated with a lower occurrence of illness. A higher probability of illness was observed in those who had lost their jobs and in those who had changed from full-time to part-time work.

CONCLUSIONS

It is likely that formal regulations and practices in use within INPS vary according to the different economic activities. Therefore this source allows investigation of illness only in activities with homogeneous regulatory aspects. The results confirm a link between unstable work situations and illness and between illness and career advancement.

[Risk of workplace injuries by occupation in Italy in the 1990's]

BACKGROUND

In Italy it is not possible to assess the incidence of workplace injuries by occupation due to the absence of denominator data.

OBJECTIVES

To evaluate severe workplace injuries by occupation, age and gender, via discussion of the validity of the available methods and informative systems.

METHODS

The database included injuries in the industrial and artisan sectors in Italy during the period 1995-1999, as classified by INAIL (National Institute for the Insurance against Occupational Accidents and Diseases). A proportional case-control study was used. Three types of severe injuries were analyzed: fatal (3,685), permanently disabling (88,254) and injuries resulting in temporary disability for more than 40 days (238,609). Controls were represented by minor injuries with temporary disability lasting between 8 and 13 days (512,643). The relative risks were calculated by occupation and stratified by age and sex. The control group was chosen in order to minimize distortions and represented a balance between empirical criteria based on the experience of safety technicians and the quality and limits of INAIL archives.

RESULTS

Among men in some construction occupations (operators of construction equipment, crane operators and masons), and in truck drivers, farm workers, messengers, and miners there were elevated risks in all age groups and for all levels of injuries severity. The model was more problematic to apply to women because the control group was less representative of the work population at risk.

CONCLUSIONS

The case-control study model produced results consistent with those in the international literature, even if the use of minor injuries as the control group gives partly distorted risk estimates. The results supply information for decision making and for allocating resources for prevention and safety.

[Severity of workplace injuries by occupation in Italy in the 1990's]

BACKGROUND

The indicators of severity commonly used for studying workplace injuries are somewhat limited. It is possible to use RIDIT Analysis (Relative to an Identified Distribution) as an alternative method

OBJECTIVES

To order occupations in Italy by severity of workplace injuries and discuss the methodological problems and the outcomes from available administrative data.

METHODS

The database included injuries defined by INAIL (National Institute for Insurance against Occupational Accidents and Diseases) in Italy in the period 1995-99 in the industrial and artisan sectors (1,647,220 events). RIDIT Analysis was applied using Bross analysis of ordinal data. A distribution of injuries in Italy for the same period on a six-level scale of severity was used as a reference. The RIDIT value for each occupation was calculated and stratified by age, sex, and occupational sector.

RESULTS

Among men, the occupations in which injuries were more severe than the average in Italy were construction, transport, woodworking, and mining. Above-average injury severity among women was found in transport drivers, postwomen, messengers, and workers in performing arts, the food industry, and tourism. A positive relationship between age and severity of injury was observed in all occupations in both sexes. Average severity was higher among artisans.

CONCLUSIONS

The method used allows ranking of occupations according to injury severity and should be systematically introduced into existing systems of surveillance so that data can be used to foster prevention and workplace safety.

Evolution of toxicity after conformal radiotherapy for prostate cancer

The limiting factor for radiation (RT) dose-escalation is normal tissue toxicity. In dose-escalation studies, it is important to determine the factors associated with toxicity and the length of follow-up period after which a particular RT dose is considered safe. We analyzed 449 prostate cancer patients treated with RT at our institution and followed for a median of 27 months. Genitourinary (GU) and gastrointerological (GI) complications were graded and analyzed using three different statistical models. Univariate and multivariate analyses were conducted for factors associated with toxicity. There was no RTOG grade 4 or 5 toxicity. Only 23 patients (5%) experienced grade 3 toxicity. After treatment, there was an initial rapid decline in the risk of toxicity following treatment, followed by an increase or stabilization of the toxicity with time of follow-up. The breakpoints between the two periods were 2 y (any toxicity) and 1 y (high toxicity) for GU and 9 months (any toxicity, high toxicity) for GI. Age, dose, fraction size, duration of treatment and hospital of treatment emerge as important factors in the probability of developing toxicity. Our study shows that delivering conventional doses using conformal techniques is associated with minimal high-grade toxicity. However, even within a narrow dose range and fraction size used, differences do emerge which should lead one to be cautious in extending the results of dose escalation study to the community practice without a sufficient follow-up.

Mortality of a cohort of road construction and maintenance workers with work disability compensation

BACKGROUND

Surveillance systems of occupational mortality are useful tools to identify cases of diseases suspected as occupational and to monitor their occurrence over time, in space and in population subgroups. Many surveillance systems make use of administrative data in which information about occupations and/or economic sectors of the subjects enrolled is reported, such as death certificates, hospital discharge data, census data, tax and pension records, and workers' compensation archives.

OBJECTIVES

In the present study we analyzed the mortality of a cohort of road construction and maintenance workers enrolled through the Italian national archive of work disability compensations, also in order to evaluate the possible use of this administrative source to monitor occupational mortality.

METHODS

8,000 subjects (7,879 males) receiving a disability compensation while working in the "road construction and maintenance" sector were identified from INAIL (National Institute for Insurance of Accidents at Work) archives. Vital status of these subjects was ascertained using the information available in INAIL archives and in the national tax register. For those found to be deceased from INAIL or tax archives, or without any information on vital status, a mail follow-up was started. We considered as observation period the years from 1980 to 1993. A record linkage with the ISTAT (Italian Institute of Statistics) national mortality registry was performed and the cause of death was retrieved for 964 out of 1,259 subjects. The analysis was restricted to males, leaving altogether 863 observed deaths with ascertained cause (84.7% of 1,019 total male deaths). SMR for overall mortality and PMR for specific cause mortality were computed, using the general Italian male population as reference.

RESULTS

Overall mortality was significantly reduced (SMR = 79.0; 95% CI = 74.2-84.0). Proportional mortality analysis revealed significant excess risks for all malignant tumours (332 deaths, PMR = 1.08) and for digestive diseases (87 deaths, PMR = 1.34), while mortality for cardiovascular diseases was significantly decreased (288 deaths, PMR = 0.90). Among specific causes of death, significant excess mortality was found for cancer of testicles (2 deaths, PMR = 5.98), liver and biliary ducts (32 deaths, PMR = 1.40), and for silicosis (10 deaths, PMR = 3.07) and cirrhosis (64 deaths, PMR = 1.40).

CONCLUSIONS

The excess mortality observed for all cancers, digestive diseases and silicosis, and the decreased risk for cardiovascular diseases are in agreement with the results of other studies conducted on workers in road construction and maintenance. As expected, the low overall mortality and the reduced risk from cardiovascular diseases indicate that these workers present a strong "healthy worker effect".

Self-assessed health-related quality of life in men being treated for prostate cancer with radiotherapy: instrument validation and its relation to patient-assessed bother of symptoms

OBJECTIVES

To develop a psychometrically valid and clinically useful questionnaire to assess health-related quality of life (HRQOL) in patients with prostate cancer (PCa) undergoing external beam radiotherapy. The most important factors in three dimensions (bowel function [BF], urinary function [UF], and sexual function [SF]) were identified by patient survey.

METHODS

Three HRQOL dimensions were assessed using Likert-type questions. Responses were analyzed by factor analysis to create HRQOL scales. Reliability and validity of the scales were assessed. Because patients can suffer symptoms yet not report their lives to be affected, the scales were compared with patient-reported bother.

RESULTS

Two scales were identified within each dimension: BF, urgency and daily living; UF, urgency and weakness of stream; and SF, interest/satisfaction and impotence. Cronbach's alpha for the scales ranged from 0.63 to 0.94, and item-scale correlations and item-scale divergence correlations supported scale validity. Rising median scores correlated with rising levels of perceived bother.

CONCLUSIONS

The questionnaire is a suitable tool for assessing HRQOL in three distinct dimensions for patients undergoing radiotherapy for PCa. Six dimensions of HRQOL were found to be related to bother, suggesting important relationships to be monitored for patients. Urgency of bowel movements, urgency of urination, and level of interest/satisfaction in sex correlated most strongly with bother.