Effects of Italian Smoking Regulation on Rates of Hospital Admission for Acute Coronary Events: A Country-Wide Study

BACKGROUND: Several studies have reported a reduction in acute coronary events (ACEs) in the general population after the enforcement of smoking regulations, although there is uncertainty concerning the magnitude of the effect of such interventions. We conducted a country-wide evaluation of the health effects of the introduction of a smoking ban in public places, using data on hospital admissions for ACEs from the Italian population after the implementation of a national smoking regulation in January 2005. METHODS AND FINDINGS: Rates of admission for ACEs in the 20 Italian regions from January 2002 to November 2006 were analysed using mixed-effect regression models that allowed for long-term trends and seasonality. Standard methods for interrupted time-series were adopted to assess the immediate and gradual effects of the smoking ban. Effect modification by age was investigated, with the assumption that exposure to passive smoking in public places would be greater among young people. In total, 936,519 hospital admissions for ACEs occurred in the Italian population during the study period. A 4% reduction in hospital admissions for ACEs among persons aged less than 70 years was evident after the introduction of the ban (Rate Ratio [RR], 0.96; 95% Confidence Interval [CI], 0.95-0.98). No effect was found among persons aged at least 70 years (RR 1.00; 95% CI 0.99-1.02). Effect modification by age was further suggested by analyses using narrower age categories. CONCLUSIONS: Smoke-free policies can constitute a simple and inexpensive intervention for the prevention of cardiovascular diseases and thus should be included in prevention programmes

Feasibility of recruiting a birth cohort through the Internet: the experience of the NINFEA cohort.

The NINFEA cohort is an Italian birth cohort aiming at recruiting pregnant women through the Internet and following-up their children. To understand whether Internet-based recruitment was feasible we started a pilot in July 2005 targeted to pregnant women visiting the hospitals of the city of Turin (900,000 inhabitants), where we advertised the study. For this purpose we constructed a website (www.progettoninfea.it), with on-line questionnaires to be completed during pregnancy and at 6 and 18 months after delivery. Participants' characteristics were compared with those of women giving birth in Turin, which are routinely released as individual anonymous records. We also compared complete with partial respondents. We also carried out a survey of 122 women giving birth in the main Turin obstetric hospital to estimate the proportion of pregnant women with access to the Internet and awareness of the NINFEA cohort. By December 2006, we had recruited 670 women. Participation was associated with being older, a university graduate, primiparous and born in Italy. Complete response (n = 633) was associated with being primiparous and participation after the first trimester. In the survey, 66% (95% confidence interval: 56-74%; n = 80) of the women had access to the Internet and 42% (33-51%; n = 51) were aware of the study; 6.5% (2.9-12.5%; n = 8) had participated in the NINFEA cohort. Our study indicates that recruitment of an Internet-based birth cohort is feasible. As with many other types of birth cohort study, the participants are a self-selected sample. To minimise selection bias analyses should therefore be limited to internal comparisons

DNA methyltransferase 3b (DNMT3b), tumor tissue DNA methylation, Gleason score, and prostate cancer mortality: investigating causal relationships.

PURPOSE: Aberrant DNA methylation plays a role in prostate cancer progression. We studied the relationships among DNA methyltransferase (DNMT) genotype, DNA methylation, Gleason score, and mortality in two cohorts of prostate cancer patients, previously reported with associations between DNA methylation in GSTP1, APC, and RUNX3 and prostate cancer mortality. Herein, we considered possible causal relationships between the studied variables, assuming that (1) DNMT activity affects tumor tissue methylation, (2) methylation status affects tumor morphology, and thus the Gleason score, and (3) DNA methylation affects mortality via Gleason score. METHODS: The cohorts comprised 438 patients diagnosed at one Italian pathology ward before 1997, with DNA obtained from paraffin-embedded tumor tissues. The polymorphism rs406193 in the DNMT3b gene was assessed by allele discrimination in real-time PCR. According to the assumed causal model, we analyzed the effects of rs406193 (T carriers vs others) on the Gleason score without adjusting for gene methylation, and the effects of rs406193 on gene methylation and prostate cancer mortality without adjusting for Gleason score. RESULTS: We found no evidence of association between T carriers and the number of methylated genes. However, T carriers had reduced risk of a Gleason score 8+ (odds ratio = 0.57, 95 % CI 0.39-0.85), and a hazard ratio of 0.81 (0.61-1.09) of dying from prostate cancer, which would have been erroneously estimated of 0.93 if adjusted for Gleason score. CONCLUSIONS: These findings provide clues on the role of a DNMT3b SNP in prostate cancer progression and illustrate the importance of considering possible causal relationships in the analyses

Hospital admissions for Acute Coronary Events (ACEs) in Italy during the period 2002–2006.

<p>Observed (circles) and predicted (solid lines) standardised rates among persons under 70 years of age (A) and persons aged at least 70 years (B). The dashed lines represent the deseasonalised trend of ACEs before and after the introduction of the national smoking regulation.</p

Number of hospital admissions for acute coronary events in Italy, and age-standardised rates (cases/100,000) by year and age group, 2002–2006.

<p>*Age-standardised according to the European Standard Population <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0017419#pone.0017419-Doll1" target="_blank">[33]</a>.</p><p>†December 2006 was not included in the calculations to avoid loss of information for patients admitted in December 2006 and discharged in 2007.</p