An estimate of attributable cases of alzheimer disease and vascular dementia due to modifiable risk factors. the impact of primary prevention in europe and in italy

Background: Up to 53.7% of all cases of dementia are assumed to be due to Alzheimer disease (AD), while 15.8% are considered to be due to vascular dementia (VaD). In Europe, about 3 million cases of AD could be due to 7 potentially modifiable risk factors: diabetes, midlife hypertension and/or obesity, physical inactivity, depression, smoking, and low educational level. Aims: To estimate the number of VaD cases in Europe and the number of AD and VaD cases in Italy attributable to these 7 potentially modifiable risk factors. Methods: Assuming the nonindependence of the 7 risk factors, the adjusted combined population attributable risk (PAR) was estimated for AD and VaD. Results: In Europe, adjusted combined PAR was 31.4% for AD and 37.8% for VaD. The total number of attributable cases was 3,033,000 for AD and 873,000 for VaD. In Italy, assuming a 20% reduction of the prevalence of each risk factor, adjusted combined PAR decreased from 45.2 to 38.9% for AD and from 53.1 to 46.6% for VaD, implying a 6.4 and 6.5% reduction in the prevalence of AD and VaD, respectively. Conclusion: A relevant reduction of AD and VaD cases in Europe and Italy could be obtained through primary prevention

Health profile of the PASSI surveillance system according to the second self-audit data

Background. The surveillance system PASSI (Progresses in ASSessing adult population health in Italy) is centrally coordinated by the Istituto Superiore di Sanita (ISS) and carried on by Local Health Units (LHU) from all the 21 Italian Regional Health Authorities since 2008. PASSI monitors the main behavioural health-related risk factors among the adult population in order to better orient and further elaborate interventions for the prevention of major chronic diseases.Study design. Basing on outcomes from the first pilot study in 2011, we conducted a second self-audit to investigate and map levels of conformity with recognized implementation standards by the protocol for PASSI local management in the 21 Italian Regional Health Authorities.Methods. We designed an online questionnaire supported by an open source application (Google) and sent to the local PASSI coordinators. Data were collected from April to September 2013. 113 out of 148 LHUs from all the 21 Italian Regional Health Authorities participated, with a response rate of 76%.Results. Overall, in the respondent LHUs 1,036 professionals result to differently engage in surveillance activities. Although PASSI is locally-based, where data collection and computerisation are arranged, central support is highly appreciated in terms of quality monitoring, analysis, output processing, professional training, delivery of dissemination material. PASSI data are more used for communication (60%) and planning (80%) than to scientific ends.Conclusions. After a ten-year activity, PASSI as complex public health program requires periodical self-audit rounds in order to assess to what extent relevant performance indicators match the levels indicated in its own operational protocol. The second self-audit showed to be reliable concerning both sustainability and data collection. It then represents an experience that can be renewed and repeated

Is the association between precarious employment and mental health mediated by economic difficulties in males? Results from two Italian studies

Flexible employment is increasing across Europe and recent studies show an association with poor mental health. The goal of the current study is to examine this association in the Italian population to assess the possible mediating role of financial strain. Methods: Data were obtained by two Italian cross-sectional studies (PASSI and HIS) aimed at monitoring the general population health status, health behaviours and determinants. Mental health status was assessed using alternatively two validated questionnaires (the PHQ-2 and the MCS-12 score) and Poisson regression models were performed to assess if precarious work was associated with poor mental health. A formal mediation analysis was conducted to evaluate if the association between precarious work and mental health was mediated by financial strain. Results: The analyses were performed on 31,948 subjects in PASSI and on 21,894 subjects in HIS. A nearly two-fold risk of depression and poor mental health was found among precarious workers, compared to workers with a permanent contract, which was strongly mediated by financial strain. Conclusions: Even with the limitations of a cross-sectional design, this research supports that precarious employment contributes through financial strain to reduce the mental health related quality of life and to increase mental disorders such as symptoms of depression or dysthymia. This suggests that when stability in work cannot be guaranteed, it would be appropriate to intervene on the wages of precarious jobs and to provide social safety nets for ensuring adequate income