Italy's health performance, 1990-2017: findings from the Global Burden of Disease Study 2017

BACKGROUND: Through a comprehensive analysis of Italy's estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we aimed to understand the patterns of health loss and response of the health-care system, and offer evidence-based policy indications in light of the demographic transition and government health spending in the country. METHODS: Estimates for Italy were extracted from GBD 2017. Data on Italy are presented for 1990 and 2017, on prevalence, causes of death, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth and at age 65 years, healthy life expectancy, and Healthcare Access and Quality (HAQ) Index. We compared the estimates for Italy with those of 15 other western European countries. FINDINGS: The quality of the universal health system and healthy behaviours contribute to favourable overall health, even in comparison with other western European countries. In 2017, life expectancy and HAQ Index score in Italy were among the highest globally, with life expectancy at birth reaching 85·3 years for females and 80·8 for males in 2017, ranking Italy eighth globally for females and sixth for males, and an HAQ Index score of 94·9 in 2016 compared with 81·54 in 1990, keeping Italy ranked as ninth globally. Between 1990 and 2017 age-standardised death rates for cardiovascular diseases decreased by 53·7% (95% uncertainty interval -56·1 to -51·4), for neoplasms decreased by 28·2% (-32·3 to -24·6), and for transport injuries decreased by 62·1% (-64·6 to -59·2). However, population ageing is causing an increase in the burden of specific diseases, such as Alzheimer's disease and other dementias (DALYs increased by 77·9% [68·4 to 87·2]) and pancreatic (DALYs increased by 39·7% [28·4 to 51·7]) and uterine cancers (DALYs increased by 164·7% [129·7 to 202·5]). Behavioural risk factors, which are potentially modifiable, still have a strong effect, particularly on cardiovascular diseases and neoplasms. For instance, in 2017, 44 400 (41 200 to 47 800) cancer deaths were attributed to smoking, 12 000 (9600 to 14 800) to alcohol use, and 9500 (5400 to 14 200) to high body-mass index, while 47 000 (31 100 to 65 700) deaths due to cardiovascular diseases could be attributed to high LDL cholesterol, 28 700 (19 700 to 38 500) to diets low in whole grains, and 15 900 (8500 to 24 900) to low physical activity. INTERPRETATION: Italy provides an interesting example of the results that can be achieved by a mix of relatively healthy lifestyles and a universal health system. Two main issues require attention, population ageing and gradual decrease of public health financing, which both pose several challenges to the future of Italy's health status. Our findings should be useful to Italy's policy makers and health system experts elsewhere. FUNDING: Bill & Melinda Gates Foundation

Is age more than manual material handling associated with lumbar vertebral body and disc changes? A cross-sectional multicentre MRI study

Conflicting evidence exists to what extent manual material handling (MMH) causes lumbar disc disease, lack of evidence exist that this effect takes place especially at L5-S1 level, where the greatest moment occurs. The aim was to assess if lumbar vertebral body and disc changes are more common in people whose job involves significant MMH and, if so, to evaluate if lumbar vertebral body and disc changes are more prevalent in the lower part of the lumbar spine (L4-L5 and L5-S1)

Sarcoidosis in a dental surgeon: a case report

<p>Abstract</p> <p>Introduction</p> <p>Although the causes of sarcoidosis are still unknown, past and current studies have provided evidence that this disease may be associated with occupational exposure to specific environmental agents. We describe a case of sarcoidosis in a dental surgeon with long exposure to inorganic dusts. To the best of our knowledge, this is the first report of this kind in the literature.</p> <p>Case presentation</p> <p>At the beginning of 2000, a 52-year-old Caucasian man, who worked as a dental surgeon, presented with shortness of breath during exercise, cough and retrosternal pain. After diagnosis of sarcoidosis, a scanning electronic microscopy with X-ray microanalysis of biopsy specimens was used in order to determine whether the disease could be traced to an occupational environmental agent. Results showed the presence of inorganic dust particles within sarcoidotic granulomas, and demonstrated that the material detected was identical to that found in a powder used by our patient for several years.</p> <p>Conclusions</p> <p>Although these results cannot be considered as definitive proof, they do however provide strong evidence that this disease may be associated with material used by dental surgeons.</p

Reporting only relative effect measures was potentially misleading: some good practices for improving the soundness of epidemiological results

Objective: In the medical and epidemiological literature there is a growing tendency to report an excessive number of decimal digits (often three, sometimes four), especially when measures of relative occurrence are small; this can be misleading. Study Design and Setting: We combined mathematical and statistical reasoning about the precision of relative risks with the meaning of the decimal part of the same measures from biological and public health perspectives. Results: We identified a general rule for minimizing the mathematical error due to rounding of relative risks, depending on the background absolute rate, which justifies the use of one or more decimal digits for estimates close to 1. Conclusions: We suggest that both relative and absolute risk measures (expressed as a rates) should be reported, and two decimal digits should be used for relative risk close to 1 only if the background rate is at least 1/1,000 py. The use of more than two decimal digits is justified only when the background rate is high (i.e., 1/10 py)

Effectiveness of a 'Global Postural Reeducation' program for persistent Low Back Pain: A non-randomized controlled trial

Background. The aim of this non-randomized controlled trial was to evaluate the effectiveness of a Global Postural Reeducation (GPR) program as compared to a Stabilization Exercise (SE) program in subjects with persistent low back pain (LBP) at short- and mid-term follow-up (ie. 3 and 6 months). Methods. According to inclusion and exclusion criteria, 100 patients with a primary complaint of persistent LBP were enrolled in the study: 50 were allocated to the GPR group and 50 to the SE group. Primary outcome measures were Roland and Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). Secondary outcome measures were lumbar Visual Analogue Scale (VAS) and Fingertip-to-floor test (FFT). Data were collected at baseline and at 3/6 months by health care professionals unaware of the study. An intention to treat approach was used to analyze participants according to the group to which they were originally assigned. Results. Of the 100 patients initially included in the study, 78 patients completed the study: 42 in the GPR group and 36 in the SE group. At baseline, the two groups did not differ significantly with respect to gender, age, BMI and outcome measures. Comparing the differences between groups at short- and mid-term follow-up, the GPR group revealed a significant reduction (from baseline) in all outcome measures with respect to the SE group. The ordered logistic regression model showed an increased likelihood of definitive improvement (reduction from baseline of at least 30% in RMDQ and VAS scores) for the GPR group compared to the SE group (OR 3.9, 95% CI 2.7 to 5.7). Conclusions. Our findings suggest that a GPR intervention in subjects with persistent LBP induces a greater improvement on pain and disability as compared to a SE program. These results must be confirmed by further studies with higher methodological standards, including randomization, larger sample size, longer follow-up and subgrouping of the LBP subjects. © 2010 Bonetti et al; licensee BioMed Central Ltd

Vrtlarski rad i izloženost teškim metalima u gradskom okružju

Urban soil may be a source of occupational exposure to various pollutants in gardening and land cultivation. This paper presents data of a one-year follow-up of lead, cadmium, nickel, chromium, and vanadium in the environment of the city of Bologna. Samples of soil and leaves were collected at three locations; gardens from the inner-city high-traffic area, parks in moderatetraffic area, and parks in suburban, low-traffic area. The top and deeper layers of soil and leaves were mainly polluted by lead at all locations, which corresponded to the traffic density. Personal samplers recorded greater concentrations of airborne metals than did the area samplers but the values kept below the threshold limit established by the American Conference of Governmental Industrial Hygienists for the working environment. Due to cumulative nature and interactive effects of toxic metals with other toxic and essential elements, long-term exposure to metals in the urban environment may be a health risk for occupationally exposed gardeners.Gradsko tlo može biti izvorom profesionalne izloženosti različitim onečišćivačima u vrtlara, uključujući otrovne teške metale koji se talože iz onečišćenog zraka na tlo i lišće. U radu su prikazani podaci jednogodišnjeg praćenja koncentracija olova, kadmija, niklja, kroma i vanadija u talijanskom gradu Bologni. Uzorci tla i lišća skupljani su na tri mjesta s različitom gustoćom prometa; u središtu grada s velikom gustoćom prometa, u parkovima s umjerenim prometom u okolišu i u prigradskim parkovima sa slabim prometom. Na svim lokacijama gornji i dublji slojevi tla bili su podjednako onečišćeni ponajprije olovom i to je bilo u svezi s prometnom gustoćom. Koncentracije metala u zraku utvr|ene u filtrima osobnih skupljača bile su više od koncentracija u skupljačima na tlu. Vrijednosti metala u zraku bile su niže od graničnih vrijednosti utvr|enih za radni okoliš od Američke konferencije vladinih industrijskih higijeničara (American Conference of Governmental Industrial Hygienists). Zaključeno je da vrtlari, u usporedbi s općim stanovništvom, i pri niskim razinama izloženosti u gradskom okolišu imaju povećan zdravstveni rizik za štetna djelovanja otrovnih metala i drugih onečišćivača okoliša zbog dugotrajne izloženosti u svezi s njihovim radom

Search strings for the study of putative occupational determinants of disease

Objective To identify efficient PubMed search strategies to retrieve articles regarding putative occupational determinants of conditions not generally considered to be work related. Methods Based on MeSH definitions and expert knowledge, we selected as candidate search terms the four MeSH terms describing 'occupational disease', 'occupational exposure', 'occupational health' and 'occupational medicine' (DEHM) alongside 22 other promising terms. We first explored overlaps between the candidate terms in PubMed. Using random samples of abstracts retrieved by each term, we estimated the proportions of articles containing potentially pertinent information regarding occupational aetiology in order to formulate two search strategies (one more 'specific', one more 'sensitive'). We applied these strategies to retrieve information on the possible occupational aetiology of meningioma, pancreatitis and atrial fibrillation. Results Only 20.3% of abstracts were retrieved by more than one DEHM term. The more 'specific' search string was based on the combination of terms that yielded the highest proportion (40%) of potentially pertinent abstracts. The more 'sensitive' string was based on the use of broader search fields and additional coverage provided by other search terms under study. Using the specific string, the numbers of abstracts needed to read to find one potentially pertinent article were 1.2 for meningioma, 1.9 for pancreatitis and 1.8 for atrial fibrillation. Using the sensitive strategy, the numbers needed to read were 4.4 for meningioma, 8.9 for pancreatitis and 10.5 for atrial fibrillation. Conclusions The proposed strings could help health care professionals explore putative occupational aetiology for diseases that are not generally thought to be work relate

Grand Rounds: Could Occupational Exposure to n-Hexane and Other Solvents Precipitate Visual Failure in Leber Hereditary Optic Neuropathy?

CONTEXT: Leber hereditary optic neuropathy (LHON) is a maternally inherited loss of central vision related to pathogenic mutations in the mitochondrial genome, which are a necessary but not sufficient condition to develop the disease. Investigation of precipitating environmental/occupational (and additional genetic) factors could be relevant for prevention. CASE PRESENTATION: After a 6-month period of occupational exposure to n-hexane and other organic solvents, a 27-year-old man (a moderate smoker) developed an optic neuropathy. The patient had a full ophthalmologic and neurologic investigation, including standardized cycloergometer test for serum lactic acid levels and a skeletal muscle biopsy. His exposure history was also detailed, and he underwent genetic testing for LHON mitochondrial DNA mutations. The patient suffered a sequential optic neuropathy with the hallmarks of LHON and tested positive for the homoplasmic 11778G → A/ND4 mutation. Routine laboratory monitoring revealed increased concentrations of urinary 2.5 hexandione (n-hexane metabolite) and hippuric acid (toluene metabolite) in the period immediately preceding the visual loss. DISCUSSION: In a subject carrying an LHON mutation, the strict temporal sequence of prolonged appreciable occupational exposure followed by sudden onset of visual loss must raise a suspicion of causality (with a possible further interaction with tobacco smoke). RELEVANCE: In this article, we add to the candidate occupational/environmental triggers of LHON and highlight the need for appropriate case–control (and laboratory) studies to validate the causal effect of mixed toxic exposures

Procjena izloženosti ljudi pesticidima u staklenicima i djelotvornosti osobne zaštitne opreme

The exposure to pesticides in a group of workers growing vegetables in greenhouses in farms near Rimini in Italy was evaluated. The pesticides used were organophosphorus compounds, org anochlorine compounds, carbamates, pyrethroids. amide and anilide derivatives. Measurements were carried out in seven greenhouses randomly selected. The environment was free of atmospheric agents which could have influenced the pesticide concentrations in the indoor air. Two types of chemical sampling were performed; environmental and personal. The latter was done in the liquid for washing hands and by means ot pads applied directly to me worker\u27s skin and to the clothes. The aim of the determination of airborne pesticide concentrations was to evaluate mean environmental exposure to pesticides in the sprayed areas. The sampling went on from a fixed point during the entire spraying period. The aim of individual sampling was to determine the active ingredients as contaminants. The values obtained showed a risk of exposure for the greenhouse personnel working without using personal protective devices (masks, gloves and waterproof clothes), considering that pesticides could be absorbed through the skin in between the spraying intervals.Istraživana je izloženost pesticidima u skupini radnika zaposlenih u staklenicima za uzgoj povrća u blizini Riminija LI Italiji. Primjenjivani pesticidi bili su organofosforni, organoklorirani, karbamatni spojevi, piretroidi te derivati amida i anilida. Mjerenja su provedena u sedam slučajno odabranih staklenika. Unutrašnjost staklenika bila je izolirana od vanjskih utjecaja kako pesticidi u vanjskoj atmosferi ne bi utjecali na koncentracije u atmosferi staklenika. Provedene su dvije vrste sakupljanja uzoraka tijekom razdoblja raspršavanja pesticida: iz okoliša i sa ispitanika. U uzorcima zraka sakupljenim u atmosferi staklenika izmjerene su prosječne koncentracije pesticida u području raspršivanja pesticida. Također je sakupljena tekućina za ispiranje ruku radnika i pasivni upijači zagađivala s kože radnika i sa odjeće. Svrha individualnog sakupljanja bila je odrediti aktivne sastojke zagađivala. Dobiveni rezultati pokazuju rizik za izloženost radnika u staklenicima kada rade bez zaštitne opreme (maske, rukavice i vodootporna odjeća) imajući na umu da se pesticidi mogu apsorbirati kožom i u razdoblju između raspršivanja pesticida

Asbestos: a hidden player behind the cholangiocarcinoma increase? Findings from a case–control analysis

PURPOSES: We conducted a case–control analysis to explore the association between occupational exposure to asbestos and cholangiocarcinoma (CC). METHODS: The study was based on historical data from 155 consecutive patients with CC [69 intrahepatic CC (ICC) and 86 extrahepatic CC (ECC)] referred to Sant’Orsola-Malpighi University Hospital between 2006 and 2010. The cases were individually matched by calendar period of birth, sex, and region of residence to historical hospital and population controls. Occupational exposure to asbestos was retrospectively assessed considering job titles obtained from work histories. Separate conditional logistic regression models were applied for ECC and ICC. Estimates were adjusted for smoking status and socioeconomic class. RESULTS: We matched 149 controls (median birth year: 1947; males: 56 %) to 41 cases of ICC (median birth year: 1946; males: 56 %) and 212 controls (median birth year: 1945; males: 48 %) to 59 cases of ECC (median birth year: 1945; males 51 %); 53 cases were not matched due to residence or birth year. We found an increased risk of ICC in workers exposed to asbestos (adjusted OR 4.81, 95 % CI 1.73–13.33); we also observed suggestive evidence that asbestos exposure might be associated with ECC (adjusted OR 2.09, 95 % CI 0.83–5.27). Sensitivity analysis restricted to patients from the Province of Bologna produced confirmatory figures. CONCLUSIONS: Our findings suggest that ICC could be associated with asbestos exposure; a chronic inflammatory pathway is hypothesized. Exposure to asbestos could be one of the determinants of the progressive rise in the incidence of ICC during the last 30 years