Dental and Dental Hygiene Students' Knowledge and Capacity to Discriminate the Developmental Defects of Enamel: A Self-Submitted Questionnaire Survey.

Background: A prompt and accurate diagnosis of developmental defects of enamel (DDE) is mandatory for proper treatment management. This cross-sectional survey, designed and carried out using anonymous self-administered questionnaires, aimed to assess dental and dental hygiene students' knowledge and their capability to identify different enamel development defects. Methods: The questionnaire consisted of twenty-eight closed-ended questions. Two different samples of undergraduate students were selected and enrolled: a group of dental hygiene (GDH) students and a group of dental (GD) students. A multivariate logistic regression was performed by adopting the correct answers as explanatory variables to assess the difference between the two groups. Results: Overall, 301 completed questionnaires were analyzed: 157 from the GDH and 144 from the GD. The dental student group showed better knowledge than the GDH of enamel hypomineralization and hypoplasia (p = 0.03 for both). A quarter (25.25%) of the total sample correctly identified the period of development of dental fluorosis with a statistically significant difference between the groups (p < 0.01). Amelogenesis imperfecta (AI) was identified as a genetic disease by 64.45% of the sample, with a better performance from the GD (p = 0.01), while no statistical differences were found between the groups regarding molar incisor hypomineralization. Multivariate analysis showed that AI (OR = 0.40, [0.23;0.69], p < 0.01) and caries lesion (OR = 0.58, [0.34;0.94], p = 0.03) were better recognized by the GD. Conclusions: Disparities exist in the knowledge and management of DDE among dental and dental hygiene students in Italy; however, significant knowledge gaps were found in both groups. Education on the diagnosis and treatment of DDE during the training for dental and dental hygiene students needs to be strongly implemented

Estimating the Exposure–Response Relationships between Particulate Matter and Mortality within the APHEA Multicity Project

Several studies have reported significant health effects of air pollution even at low levels of air pollutants, but in most of theses studies linear nonthreshold relations were assumed. We investigated the exposure–response association between ambient particles and mortality in the 22 European cities participating in the APHEA (Air Pollution and Health—A European Approach) project, which is the largest available European database. We estimated the exposure–response curves using regression spline models with two knots and then combined the individual city estimates of the spline to get an overall exposure–response relationship. To further explore the heterogeneity in the observed city-specific exposure–response associations, we investigated several city descriptive variables as potential effect modifiers that could alter the shape of the curve. We conclude that the association between ambient particles and mortality in the cities included in the present analysis, and in the range of the pollutant common in all analyzed cities, could be adequately estimated using the linear model. Our results confirm those previously reported in Europe and the United States. The heterogeneity found in the different city-specific relations reflects real effect modification, which can be explained partly by factors characterizing the air pollution mix, climate, and the health of the population

An ecological time-series study of heat-related mortality in three European cities

BACKGROUND: Europe has experienced warmer summers in the past two decades and there is a need to describe the determinants of heat-related mortality to better inform public health activities during hot weather. We investigated the effect of high temperatures on daily mortality in three cities in Europe (Budapest, London, and Milan), using a standard approach. METHODS: An ecological time-series study of daily mortality was conducted in three cities using Poisson generalized linear models allowing for over-dispersion. Secular trends in mortality and seasonal confounding factors were controlled for using cubic smoothing splines of time. Heat exposure was modelled using average values of the temperature measure on the same day as death (lag 0) and the day before (lag 1). The heat effect was quantified assuming a linear increase in risk above a cut-point for each city. Socio-economic status indicators and census data were linked with mortality data for stratified analyses. RESULTS: The risk of heat-related death increased with age, and females had a greater risk than males in age groups > or =65 years in London and Milan. The relative risks of mortality (per degrees C) above the heat cut-point by gender and age were: (i) Male 1.10 (95%CI: 1.07-1.12) and Female 1.07 (1.05-1.10) for 75-84 years, (ii) M 1.10 (1.06-1.14) and F 1.08 (1.06-1.11) for > or = or =85 years in Budapest (> or =24 degrees C); (i) M 1.03 (1.01-1.04) and F 1.07 (1.05-1.09), (ii) M 1.05 (1.03-1.07) and F 1.08 (1.07-1.10) in London (> or =20 degrees C); and (i) M 1.08 (1.03-1.14) and F 1.20 (1.15-1.26), (ii) M 1.18 (1.11-1.26) and F 1.19 (1.15-1.24) in Milan (> or =26 degrees C). Mortality from external causes increases at higher temperatures as well as that from respiratory and cardiovascular disease. There was no clear evidence of effect modification by socio-economic status in either Budapest or London, but there was a seemingly higher risk for affluent non-elderly adults in Milan. CONCLUSION: We found broadly consistent determinants (age, gender, and cause of death) of heat related mortality in three European cities using a standard approach. Our results are consistent with previous evidence for individual determinants, and also confirm the lack of a strong socio-economic gradient in heat health effects currently in Europe

The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project

BACKGROUND: The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity. METHODS: Heat waves were defined considering both maximum apparent temperature and minimum temperature and classified by intensity, duration and timing during summer. The effect was estimated as percent increase in daily mortality during heat wave days compared to non heat wave days in people over 65 years. City specific and pooled estimates by gender, age and cause of death were calculated. RESULTS: The effect of heat waves showed great geographical heterogeneity among cities. Considering all years, except 2003, the increase in mortality during heat wave days ranged from + 7.6% in Munich to + 33.6% in Milan. The increase was up to 3-times greater during episodes of long duration and high intensity. Pooled results showed a greater impact in Mediterranean (+ 21.8% for total mortality) than in North Continental (+ 12.4%) cities. The highest effect was observed for respiratory diseases and among women aged 75-84 years. In 2003 the highest impact was observed in cities where heat wave episode was characterized by unusual meteorological conditions. CONCLUSIONS: Climate change scenarios indicate that extreme events are expected to increase in the future even in regions where heat waves are not frequent. Considering our results prevention programs should specifically target the elderly, women and those suffering from chronic respiratory disorders, thus reducing the impact on mortality

La fragilit\ue0 e la vulnerabilit\ue0 in sanit\ue0. Sintesi dei risultati di un progetto di ricerca sul campo per identificare determinanti di fragilit\ue0 e vulnerabilit\ue0 sociale e suggerire approcci migliorativi in popolazioni a maggiore rischio.

Obiettivi. Identificare i determinanti di disuguaglianza nella domanda/offerta di salute, in particolare quelli dovuti a fattori di natura sociale, al fine di offrire un contributo concettuale, metodologico ma soprattutto empirico ai fornitori dell\u2019assistenza sanitaria della Regione Lombardia. Metodi. Sono stati coinvolti tutti i medici di medicina generale della ASL-Citt\ue0 di Milano. Lo studio prevedeva due fasi: una \u201cdescrittiva\u201d per quantificare la frequenza di vulnerabilit\ue0 e fragilit\ue0, e una seconda \u201canalitica\u201d, in un campione pi\uf9 selezionato di pazienti per individuare la mancata esecuzione di interventi di screening e riabilitazione (eventi sentinella). Risultati. I valori di fragilit\ue0 e vulnerabilit\ue0 (da 0 a 10) indicati dai medici per i 10.798 pazienti reclutati per la fase descrittiva erano rispettivamente di 3,7 e 3,1. Per la fase analitica dello studio sono stati reclutati 794 pazienti per un totale di 261 eventi sentinella, di cui il pi\uf9 frequente \ue8 stato la mancata esecuzione di riabilitazione post-infarto. Conclusioni. Questo studio, grazie alla buona partecipazione dei medici coinvolti, ha permesso di ottenere una stima di fragilit\ue0 e vulnerabilit\ue0 nella popolazione di assistiti dai medici di medicina generale di Milano e di studiare la prevalenza di alcuni eventi sentinella sul mancato accesso ai servizi del SSN forniti dalla Citt\ue0 di Milano

Implementation of failure mode and effects analysis to the specimens' flow in a population-based colorectal cancer screening programme using immunochemical faecal occult blood tests. A quality improvement project in the Milano colorectal cancer screening programme.

Background: A multidisciplinary working group applied the Healthcare Failure Mode and Effects Analysis (HFMEA) approach to the flow of kits and specimens for the first-level test of a colorectal cancer screening programme using immunochemical fecal occult blood tests. Methods: HFMEA comprised four steps: i) Identification and mapping of the process steps (sub-processes); ii) analysis of failure modes and calculation of the risk priority numbers (RPN); iii) identification of corrective actions; iv) follow-up and evaluation of corrective actions. Results: The team identified nine main failure modes, 12 effects and 34 associated causes. RPN scores ranged from 2 to 96. Failure modes within the first six positions in the ranking list ordered by RPN concerned: ‘degraded Hb in the specimen’, 'mixed-up kits', ‘anonymous specimen’, ‘expired sampling tube’ and ‘lost specimen’. All of these could lead to false negative results and/or subjects with positive tests not being recalled for second-level assessment. The team planned corrective actions for the first five ranks, which resulted in the RPN being reduced by 78.5 %, from a total of 681 before the actions to 147 after. As a result, the follow-up of corrective actions showed a significant decrease in the proportion of anonymous kits from 11.6 to 4.8 per 1000, leading to a reduction in the missed positive tests, complaints concerning the communication of test results to a person who never performed the test, false negative results due either to Hb degradation or an expired sampling tube, and finally to better information leaflets for users. Conclusions: HFMEA is a useful tool for reducing errors in the first level of colorectal cancer screening programmes, characterised by a straightforward interpretation of results and ease of communication to healthcare managers and decision-makers.JRC.F.1-Health in Societ

An ecological time-series study of heat-related mortality in three European cities

Abstract Background Europe has experienced warmer summers in the past two decades and there is a need to describe the determinants of heat-related mortality to better inform public health activities during hot weather. We investigated the effect of high temperatures on daily mortality in three cities in Europe (Budapest, London, and Milan), using a standard approach. Methods An ecological time-series study of daily mortality was conducted in three cities using Poisson generalized linear models allowing for over-dispersion. Secular trends in mortality and seasonal confounding factors were controlled for using cubic smoothing splines of time. Heat exposure was modelled using average values of the temperature measure on the same day as death (lag 0) and the day before (lag 1). The heat effect was quantified assuming a linear increase in risk above a cut-point for each city. Socio-economic status indicators and census data were linked with mortality data for stratified analyses. Results The risk of heat-related death increased with age, and females had a greater risk than males in age groups ≥65 years in London and Milan. The relative risks of mortality (per °C) above the heat cut-point by gender and age were: (i) Male 1.10 (95%CI: 1.07–1.12) and Female 1.07 (1.05–1.10) for 75–84 years, (ii) M 1.10 (1.06–1.14) and F 1.08 (1.06–1.11) for ≥85 years in Budapest (≥24°C); (i) M 1.03 (1.01–1.04) and F 1.07 (1.05–1.09), (ii) M 1.05 (1.03–1.07) and F 1.08 (1.07–1.10) in London (≥20°C); and (i) M 1.08 (1.03–1.14) and F 1.20 (1.15–1.26), (ii) M 1.18 (1.11–1.26) and F 1.19 (1.15–1.24) in Milan (≥26°C). Mortality from external causes increases at higher temperatures as well as that from respiratory and cardiovascular disease. There was no clear evidence of effect modification by socio-economic status in either Budapest or London, but there was a seemingly higher risk for affluent non-elderly adults in Milan. Conclusion We found broadly consistent determinants (age, gender, and cause of death) of heat related mortality in three European cities using a standard approach. Our results are consistent with previous evidence for individual determinants, and also confirm the lack of a strong socio-economic gradient in heat health effects currently in Europe.</p

High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities

RATIONALE: Episode analyses of heat waves have documented a comparatively higher impact on mortality than on morbidity (hospital admissions) in European cities. The evidence from daily time series studies is scarce and inconsistent. OBJECTIVES: To evaluate the impact of high environmental temperatures on hospital admissions during April to September in 12 European cities participating in the Assessment and Prevention of Acute Health Effects of Weather Conditions in Europe (PHEWE) project. METHODS: For each city, time series analysis was used to model the relationship between maximum apparent temperature (lag 0-3 days) and daily hospital admissions for cardiovascular, cerebrovascular, and respiratory causes by age (all ages, 65-74 age group, and 75+ age group), and the city-specific estimates were pooled for two geographical groupings of cities. MEASUREMENTS AND MAIN RESULTS: For respiratory admissions, there was a positive association that was heterogeneous between cities. For a 1 degrees C increase in maximum apparent temperature above a threshold, respiratory admissions increased by +4.5% (95% confidence interval, 1.9-7.3) and +3.1% (95% confidence interval, 0.8-5.5) in the 75+ age group in Mediterranean and North-Continental cities, respectively. In contrast, the association between temperature and cardiovascular and cerebrovascular admissions tended to be negative and did not reach statistical significance. CONCLUSIONS: High temperatures have a specific impact on respiratory admissions, particularly in the elderly population, but the underlying mechanisms are poorly understood. Why high temperature increases cardiovascular mortality but not cardiovascular admissions is also unclear. The impact of extreme heat events on respiratory admissions is expected to increase in European cities as a result of global warming and progressive population aging