Prenatal and childhood exposure to per-/polyfluoroalkyl substances (PFASs) and its associations with childhood overweight and/or obesity: a systematic review with meta- analyses

Background. Per-/polyfluoroalkyl substances (PFASs) are persistent organic pollutants and suspected endocrine disrupters. Objective. The aim of this work was to conduct a systematic review with meta-analysis to summarise the associations between prenatal or childhood exposure to PFASs and childhood overweight/obesity. Methods. The search was performed on the bibliographic databases PubMed and Embase with text strings containing terms related to prenatal, childhood, overweight, obesity, and PFASs. Only papers describing a biomonitoring study in pregnant women or in children up to 18 years that assessed body mass index (BMI), waist circumference (WC), or fat mass in children were included. When the estimates of the association between a PFAS and an outcome were reported from at least 3 studies, a meta-analysis was conducted; moreover, to correctly compare the studies, we developed a method to convert the different effect estimates and made them comparable each other. Results. In total, 354 and 565 articles were retrieved from PubMed and Embase, respectively, resulting in a total of 613 articles after merging duplicates. The papers included in this systematic review were 31: 18 evaluating prenatal exposure to PFASs, 11 childhood exposure, and 2 both. Overall, results were conflicting, with positive, negative, and null associations. 17 papers were included in meta-analyses (12 prenatal, 3 children, and 2 both). The method implemented for data conversion allowed a suitable comparison of different effect estimates. Meta-analyses evaluating the associations between prenatal exposure to PFOA, PFOS, PFNA, PFHxS, and the outcomes BMI, WC, and Dual-Energy X-ray Absorptiometry (DXA) showed no significant results. Meta-analyses for the associations between childhood exposure to PFASs and the outcomes BMI showed no significant results except for a negative association between PFNA and BMI (pooled estimate from a random effect model: -0.045; 95%CI: -0.087, -0.002), however, more studies are required to confirm the strength of this association. Conclusion. To increase the reliability of meta-analyses in environmental epidemiology we suggest the conversion of effect estimates to compare different studies. The pooled evidence of the meta-analyses of the present study suggests that there is no overall association between exposure to PFASs and childhood overweight/obesity

The association between a body shape index and cardiovascular risk in overweight and obese children and adolescents

A Body Shape Index (ABSI) and normalized hip circumference (Hip Index, HI) have been recently shown to be strong risk factors for mortality and for cardiovascular disease in adults. We conducted an observational cross-sectional study to evaluate the relationship between ABSI, HI and cardiometabolic risk factors and obesity-related comorbidities in overweight and obese children and adolescents aged 2±18 years. We performed multivariate linear and logistic regression analyses with BMI, ABSI, and HI age and sex normalized z scores as predictors to examine the association with cardiometabolic risk markers (systolic and diastolic blood pressure, fasting glucose and insulin, total cholesterol and its components, transaminases, fat mass%detected by bioelectrical impedance analysis) and obesity- related conditions (including hepatic steatosis and metabolic syndrome). We recruited 217 patients (114 males), mean age 11.3 years. Multivariate linear regression showed a significant association of ABSI z score with 10 out of 15 risk markers expressed as continuous variables, while BMI z score showed a significant correlation with 9 and HI only with 1. In multivariate logistic regression to predict occurrence of obesity-related conditions and above-threshold values of risk factors, BMI z score was significantly correlated to 7 out of 12, ABSI to 5, and HI to 1. Overall, ABSI is an independent anthropometric index that was significantly associated with cardiometabolic risk markers in a pediatric population affected by overweight and obesity

Effects of a multidisciplinary weight loss intervention in overweight and obese children and adolescents: 11 years of experience

Aims To evaluate the effects of an outpatient multidisciplinary weight loss intervention in reducing body mass index (BMI) in children and adolescents suffering overweight and obesity, changes in A Body Shape Index (ABSI, waist circumference normalized to height and weight) and Hip Index (HI, normalized hip circumference) during treatment and correlation between the ABSI and HI with change in BMI z score. Methods We analyze anthropometric data from pediatric patients affected by overweight and obesity aged 2 to 18 years old who entered our multidisciplinary weight loss intervention, which included medical, psychological and nutritional sessions, from January 1st 2006 to December 31st 2016. Lifestyle modification counselling was delivered. Follow-up visits were planned every month for 3 months and subsequently every 2±4 months. BMI, ABSI, and HI were converted to z scores using age and sex specific population normals. Results 864 patients entered our intervention. 453 patients (208 males), mean age 11.2 ±3.1 years, 392 with obesity (86%, z-BMI 2.90 ±0.80 SD) and 61 patients with overweight (z-BMI 1.73±0.21 SD) attended at least 1 follow-up visit. The mean number of visits was 3.5 (± 1.8 SD) in overweight subjects and 3.9 (±2.2 SD) in ones with obesity. At the last attended follow- up visit (at 16 ± 12 months SD) we observed a reduction in mean z-BMI in patients with obesity (to 2.52 ±0.71 SD) and patients with overweight (to 1.46 ±0.5 SD). Most patients (80.8%) reduced their BMI z scores. Mean ABSI and HI z scores showed no significant change. 78/392 patients (19.8%) recovered from obese to overweight, 5/392 (1.2%) from obese to normal weight. The recovery rate from overweight to normal weight was 13.1%. Ina multivariate model, initial BMI z score and number of follow-up visits were significant predictors of weight change, while age, sex, ABSI, and HI were not significant predictors. Conclusions Patients affected by overweight and obesity involved in a multidisciplinary weight loss intervention reduced their mean BMI z score, while ABSI and HI were stable. Weight loss was not predicted by initial ABSI or HI. More visits predict more weight loss, but dropout rates are high. The great majority of patients leave the weight management program before having normalized their BMI

Osservatorio territoriale droga e tossicodipendenze. Il fenomeno delle dipendenze sul territorio della ASL MI 2. Anno 2008- IX Rapporto

Report on the state of legal and illegal substances use in the territory of the Local Healthcare Service-Mi 2, Province of MilanIl report analizza il fenomeno delle dipendenze nel territorio della ASL Milano 2. La descrizione del fenomeno si sviluppa intorno all\u27analisi degli indicatori individuati dall\u27Osservatorio Europeo delle Dipendenze di Lisbona (OEDT): 1-uso di sostanze nella popolazione generale (questo indicatore va a rilevare i comportamenti nei confronti di alcol e sostanze psicoattive da parte della popolazione generale); 2-prevalenza d\u27uso problematico delle sostanze psicoattive; 3-domanda di trattamento degli utilizzatori di sostanze; 4-mortalit? degli utilizzatori di sostanze; 5-malattie infettive. Altri due importanti indicatori che si stanno sviluppando, e che vengono qui illustrati, sono l\u27analisi delle Schede di Dimissione Ospedaliera (SDO) e gli indicatori relativi alle conseguenza sociali dell\u27uso di droghe (criminalit? droga correlata). Inoltre sono state applicate diverse metodologie standard di stima sia per quantificare la quota parte sconosciuta di utilizzatori di sostanze che non afferiscono ai servizi, sia per identificarne alcune caratteristiche

Osservatorio Territoriale droga e tossicodipendenze. Il fenomeno delle dipendenze sul territorio della ASL MI 2. Anno 2007 - VIII Rapporto

Report on the state of legal and illegal substances use in the territory of the Local Healthcare Service-Mi 2, Province of Milan.L\u27analisi del fenomeno delle dipendenze nel territorio della Azienda Sanitaria Locale Provincia di Milano Due rappresenta l\u27ottavo rapporto pubblicato dall\u27OTDT del Dipartimento delle Dipendenze. Come avviene da anni, le analisi e gli approfondimenti contenuti contribuiranno in modo importante a rendere questo strumento utile alla programmazione territoriale di settore e al sistema di controllo di gestione aziendale. La maggior parte delle analisi epidemiologiche e tutti gli aspetti non convenzionali ed innovativi sono stati possibili grazie alla collaborazione con il CNR di Pisa, che ringrazio per l\u27impegno personale dei suoi esperti anche al di l? dei compiti definiti. Devo segnalare con piacere l\u27ampia partecipazione di operatori delle varie Unit? Operative del Dipartimento alla riflessione e poi alla stesura del rapporto. Non voglio entrare nel merito della illustrazione dei capitoli del rapporto e mi limito ad alcune considerazioni. Il rapporto, basato sui dati 2006 con alcune importanti escursioni nel 2007, appare veramente completo. Nell\u27invitare il lettore al diretto approfondimento dei suoi contenuti, mi limito a sottolineare alcuni elementi rappresentativi dell\u27evolvere del fenomeno sul territorio. Aumentano ancora i soggetti in cura alle UO SerT per uso di cocaina: tra i nuovi utenti, questi superano oramai il 50% e sopravanzano i nuovi utenti da eroina del 20% circa. L\u27impatto dei servizi alcologici sul territorio ? sempre pi? evidente, con un progressivo incremento dell\u27utenza in carico. Queste informazioni vanno per? lette alla luce delle stime di prevalenza, condotte anche quest\u27anno, che confermano una forte presenza di consumatori problematici di alcol, eroina e cocaina sul territorio della ASL MI2 e alla luce delle indagini di popolazione condotte dal CNR, qui pubblicate in forma di confronto tra la nostra zona e le tendenze regionali e nazionali. Anche queste indagini, ricche di informazioni e suggestioni, confermano che tra la popolazione generale e giovanile i consumi di sostanze sia legali che illegali sono diffusi e preoccupanti e meritano l\u27attenzione dei programmatori di politiche sanitarie e di educazione alla salute. Il lettore potr? farsi una idea della complessit? dei fenomeni di consumo, abuso e dipendenza, e delle loro relazioni intrinseche ed esterne. L\u27analisi ? organizzata dalla valutazione delle tendenze dei fenomeni sul territorio fino agli interventi di prevenzione cura e riabilitazione. Questo continuum rappresenta la chiave per affrontare con una visione realistica il "che fare". Il rapporto illustra chiaramente quanto "si faccia" nel territorio della ASL MI2 e richiama tutti i soggetti istituzionali a concorrere alla tutela dei cittadini con problemi di abuso e dipendenza da sostanze o comportamenti additivi. L\u27Osservatorio ha raggiunto un elevato standard di servizio utile per rappresentare la base per la redazione del Piano annuale di programmazione del Dipartimento recepito ampiamente nel fondamentale atto di programmazione e coordinamento dei servizi sanitari e socio sanitari curato dalla Azienda Sanitaria Locale. L\u27ampio spazio dedicato alle "regole" regionali e alla riorganizzazione della direzione sociale della ASL giunge in un momento delicato. Mentre scrivo inizia la fase applicativa della delibera di giunta regionale n. 5509 del 10 ottobre 2007 che accelera l\u27applicazione di alcuni principi cardine della filosofia regionale per il settore e i servizi accreditati. Ebbene ai professionisti dei servizi spetta attestare, con l\u27impegno e la competenza, il sostegno alle pi? moderne prassi di lettura dei fenomeni, il supporto operativo ad avanzate procedure istituzionali e l\u27intervento preventivo e clinico. Dott. Prof. Alfio Lucchini Direttore del Dipartimento tecnico funzionale delle Dipendenz

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Acquired Hearing Loss, Anger, and Emotional Distress: The Mediating Role of Perceived Disability

The aim of the study was to test whether acquired hearing loss (AHL)-related perceived disability mediates the association between AHL and psychological outcomes, including anger. Two-hundred ninety-seven consecutive outpatients with AHL assessed by pure tone average (PTA) loss completed the following: Hearing Handicap Inventory for Adults (HHIA), State-Trait Anger Expression Inventory-2 (STAXI-2), Brief Symptom Inventory (BSI), Diagnostic Criteria for Use in Psychosomatic Research (DCPR), and Social Functioning Questionnaire. In the sample, composed of 44.5% males with a mean age of 53.8 and a mean PTA of 30.7, AHL was associated to perceived hearing handicap, also correlating to all psychological measures except DCPR demoralization. Associations were stronger between the HHIA-Emotional Subscale, STAXI-2 State Anger and Feeling Angry, and BSI-Somatization, Interpersonal Sensitivity, Depression, and Psychoticism. Perceived disability predicted the presence of almost all psychosocial outcomes and confirms to be the most significant target of clinical action