Risks of hospitalization and drug consumption in children and young adults with diagnosed celiac disease and the role of maternal education: A population-based matched birth cohort study

Background: Celiac disease (CD) may affect healthcare use in children and young adults. Socio-economic factors may act as a confounder or effect modifier. We assessed such hypotheses in a population-based birth cohort of young celiac subjects and references matched by maternal education. Methods: The cohort included all newborns recorded in the Medical Birth Register of Friuli-Venezia Giulia Region (Italy) between 1989 and 2011. CD incident cases were identified through pathology reports, hospital discharges and copayment exemptions and matched with up to five references by sex, year of birth and maternal education. Cox regression models were used to estimate Hazard Ratios (HRs) for major causes of inpatient diagnosis and drug prescription occurring after diagnosis in CD patients compared to references, stratifying by time of first event and maternal education. Results: We identified 1294 CD cases and 5681 references. CD cases had a higher risk of hospital admission for any cause (HR: 2.34; 95 % CI 2.08-2.63) and for all major ICD9-CM categories except obstetric complications, skin and musculoskeletal diseases, and injuries and poisoning. Prescription of all major ATC drug categories, except dermatologicals and genito-urinary medications, was significantly increased in CD subjects. For most outcomes, HRs were highest in the first year after CD diagnosis but remained significant after five or more years. HRs were similar across different categories of maternal education. Conclusions: Diagnosed CD subjects had a higher risk of hospitalization and medication use compared to the general population, even five or more years after diagnosis, with no effect modification of maternal education

Study on the health status of the population living in Marghera (Venice, Italy) through the use of a Longitudinal Surveillance System

AbstractThe aim of this study is to carry out an investigation to evaluate the industrial area ofPorto Marghera (the only Site of National Interest – SNI – for clearance operations inthe Veneto region) by means of data from the Venetian Epidemiological SurveillanceSystem (SEIVE – Sistema Epidemiologico Integrato di Venezia). In particular, the aimis to assess the extent at which chronic exposure to industrial pollutants contributes tothe genesis of non-communicable diseases such as tumors. We have employed healthcareadministrative databases to analyze health conditions of the population residingin the area of Marghera, separately from the rest of the mainland. The results obtainedhighlight a series of critical problems concerning the population residing in Marghera.These issues, such as an excess in the overall cancer mortality rate, have been observedin both genders, as well as in the lung cancer incidence and mortality rate. In addition,we detected an increase in mortality for respiratory diseases only in the male population

Stima della prevalenza di broncopneumopatia cronico-ostruttiva basata su dati sanitari correnti, mediante l\u27uso di un algoritmo comune, in differenti aree italiane

Aim: to estimate the prevalence of chronic obstructive pulmonary disease (COPD) by integrating various administrative health information systems. Methods: prevalent COPD cases were defined as those reported in the hospital discharge registry (HDR) and cause of mortality registry (CMR) with codes 490*, 491*, 492*, 494* e 496* of the International diseases classification 9th revision. Annual prevalence was estimated in 35+ year-old residents in six Italian areas of different sizes, in the period 2002-2004. We in- Annunziata Faustini,1 Silvia Cascini,1 Massimo Arc?,1 Daniela Balzi,2 Alessandro Barchielli,2 Cristina Canova,3 Claudia Galassi,4 Enrica Migliore,4,5 Sante Minerba,6 Maria Angela Protti,7 Anna Romanelli,7 Roberta Tessari,3,8 Maria Angela Vigotti,9 Lorenzo Simonato3 1Dipartimento di epidemiologia, ASL RME, Roma 2Unit? operativa di epidemiologia, Azienda sanitaria 10, Firenze 3Dipartimento di medicina ambientale e sanit? pubblica, Universit? di Padova 4Servizio di epidemiologia dei tumori, ASO S. Giovanni Battista, CPO Piemonte e Universit? di Torino 5Unit? di pneumologia, CPA-ASL TO2, Torino 6Unit? di statistica ed epidemiologia, ASL 1 Taranto 7Sezione di epidemiologia e ricerca sui servizi sanitari, IFC-CNR, Pisa 8Unit? di epidemiologia, Dipartimento di prevenzione, Azienda ULSS 12 Veneziana 9Dipartimento di biologia, Universit? di Pisa Corrispondenza: Annunziata Faustini, Dipartimento di epidemiologia, ASL RME, via Santa Costanza 53, 00198 Roma; tel. 06 86060486; fax 06 86060463; e-mail [email protected] cluded cases observed in the previous four years who were alive at the beginning of each year. Results: in 2003, age-standardized prevalence rates varied from 1.6% in Venice to 5% in Taranto. Prevalence was higher in males and increased with age. The highest rates were observed in central (Rome) and southern (Taranto) cities, especially in the 35-64 age group. HDR contributed 91% of cases. Healthtax exemption registry would increase the prevalence estimate by 0.2% if used as a third data source. Conclusions: with respect to the National Health Status suraldelvey, COPD prevalence is underestimated by 1%-3%; this can partly be due to the selection of severe and exacerbated COPD by the algorithm used. However, age, gender and geographical characteristics of prevalent cases were comparable to national estimates. Including cases observed in previous years (longitudinal estimates) increased the point estimate (yearly) of prevalence two or three times in each area.Obiettivi: stimare la prevalenza della broncopneumopatia cronico-ostruttiva (BPCO) mediante l\u27utilizzo integrato di dati sanitari correnti. Metodi: la prevalenza ? stata stimata nella popolazione residente di et? superiore ai 34 anni, in sei aree geografiche, per gli anni 2002-2004. I casi prevalenti sono stati individuati dai registri delle schede di dimissione ospedaliera (SDO) e delle cause di morte (RCM), mediante i codici ICD9-CM 490*, 491*, 492*, 494* e 496* della Classificazione internazionale delle malattie 9? revisione (ICD9-CM). Ai casi osservati in ciascun anno sono stati aggiunti i pazienti ricoverati nei quattro anni precedenti e vivi all\u27inizio dell\u27anno di stima. Risultati: la prevalenza della BPCO, stimata mediante tassi standardizzati per et?, varia per il 2003 dall\u271,6% di Venezia sural 5% di Taranto. La prevalenza ? pi? alta negli uomini e aumenta con l\u27et?; Taranto e Roma presentano i valori pi? elevati, specialmente nelle classi d\u27et? dai 35 ai 64 anni. Fonte principale dei casi sono i ricoveri ospedalieri, con un contributo di almeno il 91%. L\u27uso delle esenzioni ticket come terza fonte incrementa la stima di prevalenza dello 0,2%. Conclusioni: la prevalenza della BPCO ? sottostimata dell\u271%-3% rispetto ai dati dell\u27indagine Istat sullo stato di salute; questo ? in parte attribuibile alla selezione dei casi medio- gravi da parte dell\u27algoritmo utilizzato. Tuttavia le stime mantengono le caratteristiche attese nella distribuzione per genere, et? e area geografica. Inoltre, l\u27uso longitudinale dei dati ospedalieri aumenta di 2-3 volte la stima di prevalenza basata sui dati dei singoli anni

Hierarchical Regression for Multiple Comparisons in a Case-Control Study of Occupational Risks for Lung Cancer

BACKGROUND Occupational studies often involve multiple comparisons and therefore suffer from false positive findings. Semi-Bayes adjustment methods have sometimes been used to address this issue. Hierarchical regression is a more general approach, including Semi-Bayes adjustment as a special case, that aims at improving the validity of standard maximum-likelihood estimates in the presence of multiple comparisons by incorporating similarities between the exposures of interest in a second-stage model. METHODOLOGY/PRINCIPAL FINDINGS We re-analysed data from an occupational case-control study of lung cancer, applying hierarchical regression. In the second-stage model, we included the exposure to three known lung carcinogens (asbestos, chromium and silica) for each occupation, under the assumption that occupations entailing similar carcinogenic exposures are associated with similar risks of lung cancer. Hierarchical regression estimates had smaller confidence intervals than maximum-likelihood estimates. The shrinkage toward the null was stronger for extreme, less stable estimates (e.g., "specialised farmers": maximum-likelihood OR: 3.44, 95%CI 0.90-13.17; hierarchical regression OR: 1.53, 95%CI 0.63-3.68). Unlike Semi-Bayes adjustment toward the global mean, hierarchical regression did not shrink all the ORs towards the null (e.g., "Metal smelting, converting and refining furnacemen": maximum-likelihood OR: 1.07, Semi-Bayes OR: 1.06, hierarchical regression OR: 1.26). CONCLUSIONS/SIGNIFICANCE Hierarchical regression could be a valuable tool in occupational studies in which disease risk is estimated for a large amount of occupations when we have information available on the key carcinogenic exposures involved in each occupation. With the constant progress in exposure assessment methods in occupational settings and the availability of Job Exposure Matrices, it should become easier to apply this approach

Physicians' experiences with end-of-life decision-making: Survey in 6 European countries and Australia

Background: In this study we investigated (a) to what extent physicians have experience with performing a range of end-of-life decisions (ELDs), (b) if they have no experience with performing an ELD, would they be willing to do so under certain conditions and (c) which background characteristics are associated with having experience with/or being willing to make such ELDs. Methods: An anonymous questionnaire was sent to 16,486 physicians from specialities in which death is common: Australia, Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Results: The response rate differed between countries (39–68%). The experience of foregoing life-sustaining treatment ranged between 37% and 86%: intensifying the alleviation of pain or other symptoms while taking into account possible hastening of death between 57% and 95%, and experience with deep sedation until death between 12% and 46%. Receiving a request for hastening death differed between 34% and 71%, and intentionally hastening death on the explicit request of a patient between 1% and 56%. Conclusion: There are differences between countries in experiences with ELDs, in willingness to perform ELDs and in receiving requests for euthanasia or physician-assisted suicide. Foregoing treatment and intensifying alleviation of pain and symptoms are practiced and accepted by most physicians in all countries. Physicians with training in palliative care are more inclined to perform ELDs, as are those who attend to higher numbers of terminal patients. Thus, this seems not to be only a matter of opportunity, but also a matter of attitude

Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy

<p>Abstract</p> <p>Background</p> <p>After long term disease free follow up (FUp) patients reconsider quality of life (QOL) outcomes. Aim of this study is assess QoL in prostate cancer patients who are disease-free at least 5 years after radical prostatectomy (RP).</p> <p>Methods</p> <p>367 patients treated with RP for clinically localized pCa, without biochemical failure (PSA ≤ 0.2 ng/mL) at the follow up ≥ 5 years were recruited.</p> <p>Urinary (UF) and Sexual Function (SF), Urinary (UB) and Sexual Bother (SB) were assessed by using UCLA-PCI questionnaire. UF, UB, SF and SB were analyzed according to: treatment timing <it>(age at time of RP, FUp duration, age at time of FUp)</it>, tumor characteristics <it>(preoperative PSA, TNM stage, pathological Gleason score)</it>, nerve sparing (NS) procedure, and hormonal treatment (HT).</p> <p>We calculated the differences between 93 NS-RP without HT (group A) and 274 non-NS-RP or NS-RP with HT (group B). We evaluated the correlation between function and bother in group A according to follow-up duration.</p> <p>Results</p> <p>Time since prostatectomy had a negative effect on SF and a positive effect SB (both p < 0.001). Elderly men at follow up experienced worse UF and SF (p = 0.02 and p < 0.001) and better SB (p < 0.001).</p> <p>Higher stage PCa negatively affected UB, SF, and SB (all: p ≤ 0.05). NS was associated with better UB, SF and SB (all: p ≤ 0.05); conversely, HT was associated with worse UF, SF and SB (all: p ≤ 0.05).</p> <p>More than 8 years after prostatectomy SF of group A and B were similar. Group A subjects (NS-RP without HT) demonstrated worsening SF, but improved SB, suggesting dissociation of the correlation between SF and SB over time.</p> <p>Conclusion</p> <p>Older age at follow up and higher pathological stage were associated with worse QoL outcomes after RP. The direct correlation between UF and age at follow up, with no correlation between UF and age at time of RP suggests that other issues (i.e: vascular or neurogenic disorders), subsequent to RP, are determinant on urinary incontinence. After NS-RP without HT the correlation between SF and SB is maintained for 7 years, after which function and bother appear to have divergent trajectories.</p