Impact of pneumococcal conjugate vaccination: a retrospective study of hospitalization for pneumonia in North-East Italy

Introduction. Pneumonia remains a common reason for hospitalizing infants and the elderly worldwide, and streptococcal infection is often responsible. The aim of this study was to assess the burden of pneumonia in a large general population. Methods. All pneumonia-related hospitalizations from 2004 to 2013 in north-east Italy were identified from the hospital records with a first-listed diagnosis on discharge of bacterial pneumonia, or a first-listed diagnosis on discharge of meningitis, septicemia or empyema associated with a secondary diagnosis of bacterial pneumonia. We identified major comorbidities, calculated agespecific case-fatality rates (CFR), and estimated the related cost to the health care system. Results. Of the 125,722 hospitalizations identified, 96.9% were cases of pneumonia, 2.4% of septicemia, 0.4% of meningitis, and 0.3% of empyema; 75.3% of hospitalizations involved 65 65-yearolds. The overall CFR was 12.4%, and it increased with age, peaking in people over 80 (19.6%). The mean annual pneumonia-associated hospitalization rate was 204.6 per 100,000 population, and it peaked in 0- to 4-year-old children (325.6 per 100,000 in males, 288.9 per 100,000 in females), and adults over 65 (844.9 per 100,000 in males, 605.7 per 100,000 in females). Hospitalization rates dropped over the years for the 0-4 year-olds, and rose for people over 80. The estimated overall annual cost of these pneumonia-related hospitalizations was approximately \u20ac 41 million. Conclusions. This study shows that the burden on resources for pneumonia-related hospitalization is an important public health issue. Prevention remains the most valuable tool for containing pneumonia, and vaccination strategies can help in the primary prevention of infection, possibly reducing the number of cases in all age groups

Somatic disorders and antidepressant use in suicides: A population-based study from the Friuli Venezia Giulia region, Italy, 2003-2013

Background: Many somatic disorders are complicated by depression and increase the risk of suicide. Little is known about whether antidepressants might reduce the suicidal risk in patients with somatic disorders. Methods: Data on diagnoses and antidepressant prescriptions were derived from the Social and Health Information System of the Friuli Venezia Giulia Region. Cases were all suicides that occurred in the region during the years 2003\u20132013 and were sex- and age-matched to controls from the general population. Conditional logistic regression analysis was used to assess the association between suicide and somatic disorders. Results: The suicide rate in Friuli Venezia Giulia decreased from 11.3 to 10.7 per 100,000 inhabitants during the years 2003\u20132013, however patients with somatic disorder had a three times increased risk of suicide. Elderly somatic patients' suicide risk was twice as high as younger patients. The risk increased from 2.6 to 9.8 times as the number of comorbid disorders increased from 1 to 4 and over. Although no significant risk of suicide in patients with somatic disorders was found when patients were adherent to antidepressants, only 11.5% of the suicides was adherent in the year prior to death. Conclusions: Medical illnesses and underlying depressive symptoms may have a synergy effect on the risk of suicide, particularly in older patients and in patients with multiple morbidities. Since medically ill subjects adherent to antidepressants did not showa significant risk of suicide, early identification and adequate treatment of depression in somatic patients should be considered in order to prevent suicide

Increased cancer risk in patients undergoing dialysis: a population-based cohort study in North-Eastern Italy

open116noBACKGROUND: In southern Europe, the risk of cancer in patients with end-stage kidney disease receiving dialysis has not been well quantified. The aim of this study was to assess the overall pattern of risk for de novo malignancies (DNMs) among dialysis patients in the Friuli Venezia Giulia region, north-eastern Italy. METHODS: A population-based cohort study among 3407 dialysis patients was conducted through a record linkage between local healthcare databases and the cancer registry (1998-2013). Person-years (PYs) were calculated from 30 days after the date of first dialysis to the date of DNM diagnosis, kidney transplant, death, last follow-up or December 31, 2013, whichever came first. The risk of DNM, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). RESULTS: During 10,798 PYs, 357 DNMs were diagnosed in 330 dialysis patients. A higher than expected risk of 1.3-fold was found for all DNMs combined (95% CI: 1.15-1.43). The risk was particularly high in younger dialysis patients (SIR = 1.88, 95% CI: 1.42-2.45 for age 40-59 years), and it decreased with age. Moreover, significantly increased DNM risks emerged during the first 3 years since dialysis initiation, especially within the first year (SIR = 8.52, 95% CI: 6.89-10.41). Elevated excess risks were observed for kidney (SIR = 3.18; 95% CI: 2.06-4.69), skin non-melanoma (SIR = 1.81, 95% CI: 1.46-2.22), oral cavity (SIR = 2.42, 95% CI: 1.36-4.00), and Kaposi's sarcoma (SIR = 10.29, 95% CI: 1.25-37.16). CONCLUSIONS: The elevated risk for DNM herein documented suggest the need to implement a targeted approach to cancer prevention and control in dialysis patients.openTaborelli, Martina; Toffolutti, Federica; Del Zotto, Stefania; Clagnan, Elena; Furian, Lucrezia; Piselli, Pierluca; Citterio, Franco; Zanier, Loris; Boscutti, Giuliano; Serraino, Diego for the Italian Transplant & Cancer Cohort Study; Sarah Shalaby, Raffaella Petrara, Patrizia Burra, Giacomo Zanus, Stefano Zanini,Paolo Rigotti; Maria Rendina, AlfredoDi Leo, Francesco Paolo Schena, Giuseppe Grandaliano, Marco Fiorentino, Augusto Lauro, Antonio Daniele Pinna, PaoloDi Gioia, Sara Pellegrini, Chiara Zanfi, Maria Piera Scolari, Sergio Stefoni, PaolaTodeschini, Laura Panicali, Chiara Valentini, Umberto Baccarani, Andrea Risaliti, Gian Luigi Adani, Dario Lorenzin, Giuseppe Maria Ettorre, Giovanni Vennarecci,Marco Colasanti, Manuela Coco, Fabrizio Ettorre, Roberto Santoro, LuciaMiglioresi, Francesco Nudo, Massimo Rossi,Gianluca Mennini, Luca Toti, GiuseppeTisone, Annachiara Casella, Laura Fazzolari, Daniele Sforza, Giuseppe Iaria,Carlo Gazia, Chiara Belardi, ClaudiaCimaglia, Alessandro Agresta, Gianpiero D’Offizi, Ubaldo Visco Comandini,Raffaella Lionetti, Marzia Montalbano, Chiara Taibi, Giovanni Fantola, Fausto Zamboni, Gian Benedetto Piredda,Maria Benigna Michittu, Maria Gavina Murgia, Bruno Onano, Lucia Fratino, Luigino Dal Maso, Paolo De Paoli, Diana Verdirosi,Emanuela Vaccher, Francesco Pisani, Antonio Famulari, Federica Delreno, Samuele Iesari, LindaDe Luca, Maurizio Iaria, Enzo Capocasale,Elena Cremaschi, Silvio Sandrini, Francesca Valerio,Valentina Mazzucotelli, Nicola Bossini, Gisella Setti, Massimiliano Veroux, Pierfrancesco Veroux, Giuseppe Giuffrida,Alessia Giaquinta, Domenico Zerbo, GhilBusnach, Laura Di Leo, Maria Luisa Perrino, Marialuisa Querques, ValerianaColombo, Maria Chiara Sghirlanzoni , Piergiorgio Messa, Antonio Leoni , Laura Galatioto, Salvatore Gruttadauria, Vito Sparacino, FlaviaCaputo, Barbara Buscemi ,Franco Cit-terio, Gionata Spagnoletti, Maria Paola Salerno, Evaldo Favi Giuseppe Paolo Segoloni, Luigi Biancone, AntonioLavacca, Maria Cristina Maresca, CarmeloCascone, Bice Virgilio, Donato Donati, Fiorella Dossi, Andrea Fontanella, Andrea Ambrosini, Marco Di CiccoTaborelli, Martina; Toffolutti, Federica; Del Zotto, Stefania; Clagnan, Elena; Furian, Lucrezia; Piselli, Pierluca; Citterio, Franco; Zanier, Loris; Boscutti, Giuliano; Serraino, Diego for the Italian Transplant & Cancer Cohort Study; Shalaby, Sarah; Petrara, MARIA RAFFAELLA; Burra, Patrizia; Zanus, Giacomo; Zanini, Stefano; Rigotti, Paolo; Maria, Rendina; Alfredodi, Leo; Francesco Paolo Schena, ; Giuseppe, Grandaliano; Marco, Fiorentino; Augusto, Lauro; Antonio Daniele Pinna, ; Paolodi, Gioia; Sara, Pellegrini; Chiara, Zanfi; Maria Piera Scolari, ; Sergio, Stefoni; Paolatodeschini, ; Laura, Panicali; Chiara, Valentini; Umberto, Baccarani; Andrea, Risaliti; Gian Luigi Adani, ; Dario, Lorenzin; Giuseppe Maria Ettorre, ; Giovanni, Vennarecci; Marco, Colasanti; Manuela, Coco; Fabrizio, Ettorre; Roberto, Santoro; Luciamiglioresi, ; Francesco, Nudo; Massimo, Rossi; Gianluca, Mennini; Luca, Toti; Giuseppetisone, ; Annachiara, Casella; Laura, Fazzolari; Daniele, Sforza; Giuseppe, Iaria; Carlo, Gazia; Chiara, Belardi; Claudiacimaglia, ; Alessandro, Agresta; Gianpiero, D’Offizi; Ubaldo Visco Comandini, ; Raffaella, Lionetti; Marzia, Montalbano; Chiara, Taibi; Giovanni, Fantola; Fausto, Zamboni; Gian Benedetto Piredda, ; Maria Benigna Michittu, ; Maria Gavina Murgia, ; Bruno, Onano; Lucia, Fratino; Luigino Dal Maso, ; Paolo De Paoli, ; Diana, Verdirosi; Emanuela, Vaccher; Francesco, Pisani; Antonio, Famulari; Federica, Delreno; Samuele, Iesari; Lindade, Luca; Maurizio, Iaria; Enzo, Capocasale; Elena, Cremaschi; Silvio, Sandrini; Francesca, Valerio; Valentina, Mazzucotelli; Nicola, Bossini; Gisella, Setti; Massimiliano, Veroux; Pierfrancesco, Veroux; Giuseppe, Giuffrida; Alessia, Giaquinta; Domenico, Zerbo; Ghilbusnach, ; Laura Di Leo, ; Maria Luisa Perrino, ; Marialuisa, Querques; Valerianacolombo, ; Maria Chiara Sghirlanzoni, ; Piergiorgio, Messa; Antonio, Leoni; Laura, Galatioto; Salvatore, Gruttadauria; Vito, Sparacino; Flaviacaputo, ; Barbara, Buscemi; Franco, Cit-terio; Gionata, Spagnoletti; Maria Paola Salerno, ; Evaldo Favi Giuseppe Paolo Segoloni, ; Luigi, Biancone; Antoniolavacca, ; Maria Cristina Maresca, ; Carmelocascone, ; Bice, Virgilio; Donato, Donati; Fiorella, Dossi; Andrea, Fontanella; Andrea, Ambrosini; Marco Di Cicco

An integrated assessment of nitrogen source, transformation and fate within an intensive dairy system to inform management change

From an environmental perspective optimised dairy systems, which follow current regulations, still have low nitrogen (N) use efficiency, high N surplus (kg N ha-1) and enable ad-hoc delivery of direct and indirect reactive N losses to water and the atmosphere. The objective of the present study was to divide an intensive dairy farm into N attenuation capacity areas based on this ad-hoc delivery. Historical and current spatial and temporal multi-level datasets (stable isotope and dissolved gas) were combined and interpreted. Results showed that the farm had four distinct attenuation areas: high N attenuation: characterised by ammonium-N (NH4+-N) below 0.23 mg NH4+-N l-1 and nitrate (NO3--N) below 5.65 mg NO3--N l-1 in surface, drainage and groundwater, located on imperfectly to moderately-well drained soils with high denitrification potential and low nitrous oxide (N2O) emissions (av. 0.0032 mg N2O-N l-1); moderate N attenuation: characterised by low NO3--N concentration in drainage water but high N2O production (0.0317 mg N2O-N l-1) and denitrification potential lower than group 1 (av. δ15N-NO3-: 16.4‰, av. δ18O-NO3-: 9.2‰), on well to moderately drained soils; low N attenuation—area 1: characterised by high NO3--N (av. 6.90 mg NO3--N l-1) in drainage water from well to moderately-well drained soils, with low denitrification potential (av. δ15N-NO3-: 9.5‰, av. δ18O-NO3-: 5.9‰) and high N2O emissions (0.0319 mg N2O l-1); and low N attenuation—area 2: characterised by high NH4+-N (av. 3.93 mg NH4+-N l-1 and high N2O emissions (av. 0.0521 mg N2O l-1) from well to imperfectly drained soil. N loads on site should be moved away from low attenuation areas and emissions to air and water should be assessed

Analisi dei tempi d\u2019attesa tra le varie fasi di gestione dei carcinomi mammari screening-detected a Trieste nel biennio 2013-2014: come si pu\uf2 migliorare?

Gli indicatori relativi ai tempi di attesa sono difficili da rispettare, come recentemente evidenziato al XIII Convegno ONS 2015 . Per questo motivo \ue8 fondamentale identificare in quale momento della gestione dei carcinomi screening-detected si concentrino i ritardi e stabilirne le cause (se attribuibili alla paziente o all\u2019organizzazione del programma o intrinseci al tipo di lesione) cos\uec da proporre mirate modifiche migliorative. Metodi: L\u2019analisi riguarda 146 carcinomi screening-detected consecutivi (biennio 2013-2014). Sono stati misurati i tempi tra le varie fasi diagnostiche (Mammografia di I\ub0 livello, Richiamo II\ub0 livello, I\ub0 approfondimento cito/microistologico, Comunicazione diagnosi) e i tempi chirurgici (Visita chirurgica, Intervento chirurgico, Referto istologico con marcatori biologici, Visita oncologica). Per ogni fase sono stati calcolati i tempi medi/mediani rappresentati tramite box plot e giustificati gli outliers.Risultati: La latenza nella presa in carico chirurgica \ue8 legato alla complessit\ue0 degli esami preoperatori (3) (tempo mediano tra richiamo al II\ub0 livello ed intervento: 53 giorni (se unico esame pre-operatorio) vs 73 (se pi\uf9 di un esame pre-operatorio, p<0.0001), mentre rispetto ad un recente studio (4) il tempo mediano tra visita chirurgica e intervento non \ue8 aumentato per i casi con necessit\ue0 di RM (28 vs 26 giorni, p=0.13), perch\ue9 gi\ue0 programmata in fase preoperatoria. Per i casi con mastectomia sempre con ricostruzione, si registra un tempo medio dalla visita chirurgica all\u2019intervento di 7 giorni superiore rispetto alle quadrantectomie. Ulteriore criticit\ue0 \ue8 il tempo mediano tra intervento e visita oncologica (44 giorni), attribuibile in parte ad un \u201critardo\u201d nella disponibilit\ue0 dei marcatori biomolecolari (soprattutto HER2/FISH) ed in parte a rinvii dell\u2019appuntamento da parte della paziente stessa Conclusioni: Soltanto un attento monitoraggio del turnaround time dell\u2019intero percorso delle pazienti con carcinoma screening detected consente l\u2019identificazione dei punti di debolezza su cui intervenire efficacemente per garantire il rispetto degli indicatori

Microbial community and performance of a partial nitritation/anammox sequencing batch reactor treating textile wastewater

Implementation of onsite bioremediation technologies is essential for textile industries due to rising concerns in terms of water resources and quality. Partial nitritation-anaerobic ammonium oxidation (PN/A) processes emerged as a valid, but unexplored, solution. In this study, the performance of a PN/A pilot-scale (9 m3) sequencing batch reactor treating digital textile printing wastewater (10–40 m3 d−1) was monitored by computing nitrogen (N) removal rate and efficiencies. Moreover, the structure of the bacterial community was assessed by next generation sequencing and quantitative polymerase chain reaction (qPCR) analyses of several genes, which are involved in the N cycle. Although anaerobic ammonium oxidation activity was inhibited and denitrification occurred, N removal rate increased from 16 to 61 mg N g VSS−1 d−1 reaching satisfactory removal efficiency (up to 70%). Ammonium (18–70 mg L−1) and nitrite (16–82 mg L−1) were detected in the effluent demonstrating an unbalance between the aerobic and anaerobic ammonia oxidation activity, while constant organic N was attributed to recalcitrant azo dyes. Ratio between nitrification and anammox genes remained stable reflecting a constant ammonia oxidation activity. A prevalence of ammonium oxidizing bacteria and denitrifiers suggested the presence of alternative pathways. PN/A resulted a promising cost-effective alternative for textile wastewater N treatment as shown by the technical-economic assessment. However, operational conditions and design need further tailoring to promote the activity of the anammox bacteria

Wastewater from textile digital printing as a substrate for microalgal growth and valorization

This study aims at evaluating an innovative biotechnological process for the concomitant bioremediation and valorization of wastewater from textile digital printing technology based on a microalgae/bacteria consortium. Nutrient and colour removal were assessed in lab-scale batch and continuous experiments and the produced algae/bacteria biomass was characterized for pigment content and biomethane potential. Microbial community analysis provided insight of the complex community structure responsible for the bioremediation action. Specifically, a community dominated by Scenedesmus spp. and xenobiotic and dye degrading bacteria was naturally selected in continuous photobioreactors. Data confirm the ability of the microalgae/bacteria consortium to grow in textile wastewater while reducing the nutrient content and colour. Improvement strategies were eventually identified to foster biomass growth and process performances. The experimental findings pose the basis of the integration of a microalgal-based process into the textile sector in a circular economy perspective

Investigating “net” provenance, N source, transformation and fate within hydrologically isolated grassland plots

Agricultural landscapes contain many different soil types with heterogeneous nitrogen (N) attenuation capacity. Typically, a zone of contribution (ZOC) surrounding a borehole is used to interpret subsurface hydro-biogeochemical functional capacity. This presents a “net” interpretation of source and attenuation within these calculated areas. Herein, we use the concept of ZOC commonly used for borehole screen intervals but for an end-of-pipe location within four hydrologically isolated plots. Water samples from end-of-pipe and piezometer locations are examined for nitrogen (N), biogeochemical, dissolved gas and isotopic viewpoints to elucidate multi-layered “net” water provenance, N source, transformations and fate. Results showed a nitrate (NO¯3-N) plume migrating in shallow groundwater (between 0.39 and 8.07 mg N/L), with low concentrations in the shallow artificial drainage system (below 3.22 mg N/L). Water provenance data showed distinct signatures of: precipitation and deep groundwater at 3–4 m below ground level (bgl) and water entering, migrating and discharging at the end of pipe location. The latter signature was caused by enrichment of δ¹⁸O-H₂O during migration. This means there was disconnectivity on site with no interaction between water migrating through the drainage pipe at 1 m and deeper groundwater migrating at 3–4 m depth. The analysis of NO¯3-N concentration and its isotopic signature (δ¹⁵N-NO₃¯ and δ¹⁸O-NO₃) identified further connections between screen interval depths and an up-gradient organic point source with elevated NO¯3-N migrating at this depth and different transformation processes occurring at different depths. Temporally NO¯3-N concentrations at this depth have decreased over time. Fenton et al. documented an average of 7.5 (±4.5) mg N/L whereas Ibrahim et al. documented an average of 6.8 (±3.7) mg N/L at this depth. The point source was removed in 2006 and NO¯3-N concentration in the present study have further reduced to an average of 3.9 (±2.8) mg N/L. End-of-pipe data at 1 m bgl highlighted connectivity with the overlying plot and showed different water attenuation functionality than the deeper system. End-of-pipe locations clustered together along the denitrification line. This highlighted a consistency of signals across the four plots in terms of what occurs in the soil profile above the drain installation depth of 1 m. At 3–4 m bgl however, samples varied spatially showing inconsistency between the end-of-pipe locations and plots indicating the occurrence of different processes. A fuller characterisation of dairy farm N sustainability can be deemed using the “net” provenance, N source, N transformation and fate methodology presented. Future work should investigate how drainage design (shallow and groundwater) affects N transformation and the “net” concept developed herein should be rolled out to rank dairy farms in terms of their N attenuation capacity

Investigating “net” provenance, N source, transformation and fate within hydrologically isolated grassland plots

Agricultural landscapes contain many different soil types with heterogeneous nitrogen (N) attenuation capacity. Typically, a zone of contribution (ZOC) surrounding a borehole is used to interpret subsurface hydro-biogeochemical functional capacity. This presents a “net” interpretation of source and attenuation within these calculated areas. Herein, we use the concept of ZOC commonly used for borehole screen intervals but for an end-of-pipe location within four hydrologically isolated plots. Water samples from end-of-pipe and piezometer locations are examined for nitrogen (N), biogeochemical, dissolved gas and isotopic viewpoints to elucidate multi-layered “net” water provenance, N source, transformations and fate. Results showed a nitrate (NO 3 − -N) plume migrating in shallow groundwater (between 0.39 and 8.07 mg N/L), with low concentrations in the shallow artificial drainage system (below 3.22 mg N/L). Water provenance data showed distinct signatures of: precipitation and deep groundwater at 3–4 m below ground level (bgl) and water entering, migrating and discharging at the end of pipe location. The latter signature was caused by enrichment of δ 18 O-H 2 O during migration. This means there was disconnectivity on site with no interaction bet ween water migrating through the drainage pipe at 1 m and deeper groundwater migrating at 3–4 m depth. The analysis of NO 3 − -N concentration and its isotopic signature (δ 15 N-NO 3 − and δ 18 O-NO 3 ) identified further connections between screen interval depths and an up-gradient organic point source with elevated NO 3 − -N migrating at this depth and different transformation processes occurring at different depths. Temporally NO 3 − -N concentrations at this depth have decreased over time. Fenton et al. documented an average of 7.5 (±4.5) mg N/L whereas Ibrahim et al. documented an average of 6.8 (±3.7) mg N/L at this depth. The point source was removed in 2006 and NO 3 − -N concentration in the present study have further reduced to an average of 3.9 (±2.8) mg N/L. End-of-pipe data at 1 m bgl highlighted connectivity with the overlying plot and showed different water attenuation functionality than the deeper system. End-of-pipe locations clustered together along the denitrification line. This highlighted a consistency of signals across the four plots in terms of what occurs in the soil profile above the drain installation depth of 1 m. At 3–4 m bgl however, samples varied spatially showing inconsistency between the end-of-pipe locations and plots indicating the occurrence of different processes. A fuller characterisation of dairy farm N sustainability can be deemed using the “net” provenance, N source, N transformation and fate methodology presented. Future work should investigate how drainage design (shallow and groundwater) affects N transformation and the “net” concept developed herein should be rolled out to rank dairy farms in terms of their N attenuation capacity

Diagnoses and prescriptions of antidepressants in suicides: Register findings from the Friuli Venezia Giulia Region, Italy, 2002\u20132008

Objective: To explore to what extent and under which diagnoses individuals who committed suicide had received psychiatric in-patient care, and how many had previously committed non-lethal self-harm. To investigate the antidepressant treatment received by these individuals. Methods: Case\u2013control study based on a health register. Results: Psychiatric hospitalisation was found in 31.2% of the cases and 2.3% of the controls, and was a strong predictor for suicide with an odds ratio (OR) = 19.5. This did not differ significantly between diagnostic categories (except anxiety disorders with OR = 5.3). Nonlethal self-harm in the study period was committed by 14.3% of the cases and 0.14% of the controls, and was twice as common in female cases than in male cases. Previous self-harm was a very strong independent predictor for suicide with OR = 53.1 when a single episode of self-harm had occurred, and OR = 98.0 for repeated episodes (adjusted for age, gender and hospitalisation). Only 16.1% of the cases were currently on antidepressant medication at the time of suicide. Conclusions: Few of the suicides had previously been psychiatric in-patients. Even fewer had current prescriptions for antidepressants. This suggests that better diagnosis and treatment of psychiatric patients is an important suicide preventive intervention