Mortality inequalities by occupational status and type of job in men and women: results from the Rome Longitudinal Study

Objectives Socioeconomic inequalities have a strong impact on population health all over the world. Occupational status is a powerful determinant of health in rich societies. We aimed at investigating the association between occupation and mortality in a large metropolitan study. Design Cohort study. Setting Rome, capital of Italy. Participants We used the Rome Longitudinal Study, the administrative cohort of residents in Rome at the 2001 general census, followed until 2015. We selected residents aged 15–65 years at baseline. For each subject, we had information on sex, age and occupation (occupational status and type of job) according to the Italian General Census recognition. Main outcome measures We investigated all-cause, cancer, cardiovascular and accidental mortality, major causes of death in the working-age population. We used Cox proportional hazards models to investigate the association between occupation and all-cause and cause-specific mortality in men and women. Results We selected 1 466 726 subjects (52.1% women). 42 715 men and 29 915 women died during the follow-up. In men, 47.8% of deaths were due to cancer, 26.7% to cardiovascular causes and 6.4% to accidents, whereas in women 57.8% of deaths were due to cancer, 19.3% to cardiovascular causes and 3.5% to accidents. We found an association between occupational variables and mortality, more evident in men than in women. Compared with employed, unemployed had a higher risk of mortality for all causes with an HR=1.99 (95% CI 1.92 to 2.06) in men and an HR=1.49 (95% CI 1.39 to 1.60) in women. Compared with high-qualified non-manual workers, non-specialised manual workers had a higher mortality risk (HR=1.68, 95% CI 1.59 to 1.77 and HR=1.30, 95% CI 1.20 to 1.40, for men and women, respectively). Conclusions This study shows the importance of occupational variables as social health determinants and provides evidence for policy-makers on the necessity of integrated and preventive policies aimed at improving the safety of the living and the working environment

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Le politiche per la tutela della salute dei migranti: il contesto europeo e il caso Italia

Intendendo la salute come un diritto umano fondamentale che non si esaurisce alla dimensione biologica ma si estende a quella sociale, economica e politica, gli autori, dopo aver descritto brevemente le politiche che a livello europeo sono state emanate per tutelare la salute dei migranti, analizzano l’esperienza italiana alla luce delle direttive internazionali. L’Italia rappresenta infatti un caso particolare ed avanzato di tutela della salute dei migranti; la sua politica sanitaria decisamente inclusiva riconosce parità di diritti e doveri ai cittadini regolarmente presenti ed ammette ampie possibilità di protezione ed assistenza anche per gli immigrati privi di permesso di soggiorno. Tuttavia, anche in un contesto avanzato come quello italiano, è necessaria un’evoluzione da un approccio di tipo assistenzialistico ad uno più ampio di promozione della salute attraverso politiche di natura intersettoriale, alla luce della teoria dei determinanti sociali di salute. Affrontare la tematica della salute del popolo migrante rappresenta un’occasione per rendere i servizi sanitari in particolare e le politiche migratorie in generale più attente ad ogni persona, alla sua storia e al contesto nel quale essa vive

Le politiche per la tutela della salute dei migranti: il contesto europeo e il caso Italia

Intendendo la salute come un diritto umano fondamentale che non si esaurisce alla dimensione biologica ma si estende a quella sociale, economica e politica, gli autori, dopo aver descritto brevemente le politiche che a livello europeo sono state emanate per tutelare la salute dei migranti, analizzano l'esperienza italiana alla luce delle direttive internazionali. L'Italia rappresenta infatti un caso particolare ed avanzato di tutela della salute dei migranti; la sua politica sanitaria decisamente inclusiva riconosce parità di diritti e doveri ai cittadini regolarmente presenti ed ammette ampie possibilità di protezione ed assistenza anche per gli immigrati privi di permesso di soggiorno. Tuttavia, anche in un contesto avanzato come quello italiano, è necessaria un'evoluzione da un approccio di tipo assistenzialistico ad uno più ampio di promozione della salute attraverso politiche di natura intersettoriale, alla luce della teoria dei determinanti sociali di salute. Affrontare la tematica della salute del popolo migrante rappresenta un'occasione per rendere i servizi sanitari in particolare e le politiche migratorie in generale più attente ad ogni persona, alla sua storia e al contesto nel quale essa vive

Mortality inequalities in Rome: the role of individual education and neighbourhood real estate market // Differenziali di mortalità a Roma: il ruolo dell’istruzione e dei prezzi immobiliari del quartiere di residenza

OBIETTIVI: studiare l’associazione tra livello di istruzione, prezzi degli immobili nel quartiere in cui si risiede e mortalità per tutte le cause. DISEGNO: studio di coorte. SETTING E PARTECIPANTI: dalla coorte censuaria del 2011 sono stati selezionati i residenti a Roma, viventi (da fonte anagrafica) all’indirizzo del censimento, di età compresa tra i 18 e i 99 anni. I soggetti sono stati seguiti, attraverso record linkage con database amministrativi, fino a dicembre 2016. I dati includono informazioni individuali quali genere, età, istruzione, quartiere di residenza, data di morte. I quartieri sono stati classificati secondo il prezzo degli immobili (euro/m2). PRINCIPALI MISURE DI OUTCOME: mortalità per tutte le cause, analizzata con modelli di Cox. RISULTATI: sono stati inclusi 2.051.376 individui (54% donne, 22,5% con un alto livello di istruzione). Durante il follow-up, sono morte 127.352 persone. L’istruzione è un forte determinante della mortalità. Tenendo conto di età, genere, stato civile e prezzo degli immobili nel quartiere di residenza, rispetto a chi ha un livello di istruzione alto, le persone con un’istruzione media hanno un hazard ratio (HR) di 1,16 (IC95% 1,14-1,19) e quelle con un’istruzione bassa hanno un HR di 1,35 (IC95% 1,32-1,37). Tenendo conto degli stessi fattori e del titolo di studio, a ogni mille euro di aumento del prezzo al m2 degli immobili corrisponde un HR di 0,96 (IC95% 0,96-0,97). CONCLUSIONI: entrambi gli indicatori utilizzati sono associati alla mortalità per tutte le cause. Un semplice indicatore come il prezzo immobiliare può essere utilizzato per mettere in luce disuguaglianze nello stato di salute.OBJECTIVES: to investigate the association between real estate prices, education, and mortality. DESIGN: cohort study. SETTING AND PARTICIPANTS: residents in Rome at the 2011 Italian Census, not living in institutions, and living in the address reported in the Census survey. People aged 18-99 years were followed from 2011 to 2016 using anonymous record linkage procedures with administrative databases. The Census includes several individual information, such as gender, age, education, residential neighbourhood. Data and cause of death were collected from mortality register. Real estate prices (euros/m2) were available for each neighbourhood. MAIN OUTCOME MEASURES: adjusted Cox regression models (hazard ratios - HRs and 95%CIs) were used to estimate the association among individual education, real estate price in the neighbourhood, and mortality. RESULTS: the subjects selected were 2,051,376 (54% women, 22.5% with high education level). During the follow-up, 127,352 subjects died. Taking into account gender, age, marital status, and real estate prices, education level was strongly associated with all-cause mortality; compared to highly educated the higher mortality, risk was 35% (95%CI 32%-37%) for low education level and 16% (95%CI 14%-19%) for medium education level. Taking into account the same factors and education level, each increase of 1,000 euros in price/m2 was inversely associated with mortality (HR 0.96, 95%CI 0.96-0.97). CONCLUSIONS: there is an independent association between the two indicators and mortality in Rome. A simple indicator such as real estate prices can be used to tackle inequalities

The NAD+ precursor NMN activates dSarm to trigger axon degeneration in Drosophila

Axon degeneration contributes to the disruption of neuronal circuit function in diseased and injured nervous systems. Severed axons degenerate following the activation of an evolutionarily conserved signaling pathway, which culminates in the activation of SARM1 in mammals to execute the pathological depletion of the metabolite NAD+. SARM1 NADase activity is activated by the NAD+ precursor nicotinamide mononucleotide (NMN). In mammals, keeping NMN levels low potently preserves axons after injury. However, it remains unclear whether NMN is also a key mediator of axon degeneration and dSarm activation in flies. Here, we demonstrate that lowering NMN levels in Drosophila through the expression of a newly generated prokaryotic NMN-Deamidase (NMN-D) preserves severed axons for months and keeps them circuit-integrated for weeks. NMN-D alters the NAD+ metabolic flux by lowering NMN, while NAD+ remains unchanged in vivo. Increased NMN synthesis, by the expression of mouse nicotinamide phosphoribosyltransferase (mNAMPT), leads to faster axon degeneration after injury. We also show that NMN-induced activation of dSarm mediates axon degeneration in vivo. Finally, NMN-D delays neurodegeneration caused by loss of the sole NMN-consuming and NAD+-synthesizing enzyme dNmnat. Our results reveal a critical role for NMN in neurodegeneration in the fly, which extends beyond axonal injury. The potent neuroprotection by reducing NMN levels is similar to the interference with other essential mediators of axon degeneration in Drosophila

The NAD+ precursor NMN activates dSarm to trigger axon degeneration in Drosophila.

Funder: John and Lucille Van Geest FoundationAxon degeneration contributes to the disruption of neuronal circuit function in diseased and injured nervous systems. Severed axons degenerate following the activation of an evolutionarily conserved signaling pathway, which culminates in the activation of SARM1 in mammals to execute the pathological depletion of the metabolite NAD+. SARM1 NADase activity is activated by the NAD+ precursor nicotinamide mononucleotide (NMN). In mammals, keeping NMN levels low potently preserves axons after injury. However, it remains unclear whether NMN is also a key mediator of axon degeneration and dSarm activation in flies. Here, we demonstrate that lowering NMN levels in Drosophila through the expression of a newly generated prokaryotic NMN-Deamidase (NMN-D) preserves severed axons for months and keeps them circuit-integrated for weeks. NMN-D alters the NAD+ metabolic flux by lowering NMN, while NAD+ remains unchanged in vivo. Increased NMN synthesis by the expression of mouse nicotinamide phosphoribosyltransferase (mNAMPT) leads to faster axon degeneration after injury. We also show that NMN-induced activation of dSarm mediates axon degeneration in vivo. Finally, NMN-D delays neurodegeneration caused by loss of the sole NMN-consuming and NAD+-synthesizing enzyme dNmnat. Our results reveal a critical role for NMN in neurodegeneration in the fly, which extends beyond axonal injury. The potent neuroprotection by reducing NMN levels is similar to the interference with other essential mediators of axon degeneration in Drosophila

Assessing the role of atmospheric dispersion vs. emission strength in the southern Po Valley (Italy) using dispersion-normalised multi-time receptor modelling

In this paper, we applied the Dispersion Normalised Positive Matrix Factorisation (DN-PMF) approach recently proposed in the literature to provide a more realistic picture of the relative importance of emission strength vs. atmospheric dispersion conditions. The disentanglement of such effects is of great concern in pollution hot spots like the Po Valley (Italy), where particulate matter limit values are exceeded despite the existing abatement measures. To explore the potentiality of the DN-PMF approach – still scarcely applied in the literature – a well-chemically characterised PM1 (atmospheric particles with aerodynamic diameter <1 μm) dataset comprising samples collected at different time resolutions at an urban background site (Bologna) in the southern Po Valley was used. Indeed, it is well known that shallow mixing layers promote pollutant accumulation but this observation is not enough to exclude an enhancement of emission strength which could be tackled by appropriate abatement strategies. The source apportionment of sub-micron sized aerosols having a quite long atmospheric residence time in a complex environment like the Po Valley - which is also strongly impacted by secondary aerosol formation on a basin-scale - is generally quite challenging when using receptor models. Due to the availability of a huge dataset with variables having multiple time resolutions, in this work the DN-PMF was implemented in a multi-time resolution approach (MT) to achieve a better source identification and to gain knowledge about the relative importance of atmospheric dilution vs. emissions. A comparison between results obtained by the application of the regular multi time resolution (REG-MT) vs. the DN-MT approach is presented here for the five factors identified (nitrate-dominated, sulphate-dominated, biomass burning, mineral dust, and urban aerosol). The first interesting outcome is that REG-MT and DN-MT results do not point at significant differences in temporal patterns for aerosol components and sources impacting at the basin-scale (i.e. sulphate- and nitrate-dominated aerosol, biomass burning) thus suggesting that the diel modulation of these PM1 emissions is somehow masked by the stronger variability of the mixing layer. Conversely, contributions from local sources with more pronounced diel variation like traffic are quite well reproduced by DN-MT and the ambient concentrations are enhanced compared to REG-MT. This is an important piece of information highlighting that PM1 concentrations from local sources have been likely underestimated by REG-MT assessments. To our knowledge, this is one of the very few applications of DN-MT and the first one at a European site where the huge effort made to implement air pollution containment measures is still not very much effective in reducing PM levels; moreover, in this paper a detailed discussion about the possible interpretation of the output of DN-MT in terms of temporal patterns is reported

On the Redox-Activity and Health-Effects of Atmospheric Primary and Secondary Aerosol: Phenomenology

The RHAPS (Redox-Activity And Health-Effects Of Atmospheric Primary And Secondary Aerosol) project was launched in 2019 with the major objective of identifying specific properties of the fine atmospheric aerosol from combustion sources that are responsible for toxicological effects and can be used as new metrics for health-related outdoor pollution studies. In this paper, we present the overall methodology of RHAPS and introduce the phenomenology and the first data observed. A comprehensive physico-chemical aerosol characterization has been achieved by means of high-time resolution measurements (e.g., number size distributions, refractory chemical components, elemental composition) and low-time resolution analyses (e.g., oxidative potential, toxicological assays, chemical composition). Preliminary results indicate that, at the real atmospheric conditions observed (i.e., daily PM1 from less than 4 to more than 50 ug m-3), high/low mass concentrations of PM1, as well as black carbon (BC) and water soluble Oxidative Potential (WSOP,) do not necessarily translate into high/low toxicity. Notably, these findings were observed during a variety of atmospheric conditions and aerosol properties and with different toxicological assessments. Findings suggest a higher complexity in the relations observed between atmospheric aerosol and toxicological endpoints that go beyond the currently used PM1 metrics. Finally, we provide an outlook to companion papers where data will be analyzed in more detail, with the focus on source apportionment of PM1 and the role of source emissions on aerosol toxicity, the OP as a predictive variable for PM1 toxicity, and the related role of SOA possessing redox-active capacity, exposure-response relationships for PM1, and air quality models to forecast PM1 toxicity

Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study

Background: The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy.Methods: Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018-2021). Outcomes: 30-day mortality; Clavien-Dindo grade >2 complications; removal of >= 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site.Results: LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15-1.096, P = 0.003). The rate of >= 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56-0.85, P = 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41-0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56-0.77, P < 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60-0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52-0.94, P = 0.019) volume centres (vs. VERY HIGH).Conclusion: Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes