Short term reproductive behaviour of foreign women who became mothers between 2002-2006 in Italy

The rapid increase in the number of foreigners in Italy has raised public interest in their demographic behaviour. In 2001-2007 the annual number of births to at least one foreign parent has more than doubled, from about 41,000 to more than 86,000. The main objective of this study is to give an overview of the demographic characteristics of foreign mothers in Italy. We investigate the risk of having another birth for women who became mothers between 2002 and 2006. The new approach in this study is the application of a deterministic record linkage to Italian administrative data on births, which allows a longitudinal analysis of birth histories. The results show that citizenship remains one of the most important factors in explaining the high heterogeneity in the reproductive behaviour among the mothers. The possibility of an `assimilative behaviour' to fertility patterns of native Italians increases for mothers whose partner is Italian.

Green Hydrogels Composed of Sodium Mannuronate/Guluronate, Gelatin and Biointeractive Calcium Silicates/Dicalcium Phosphate Dihydrate Designed for Oral Bone Defects Regeneration

Innovative green, eco-friendly, and biologically derived hydrogels for non-load bearing bone sites were conceived and produced. Natural polysaccharides (copolymers of sodium D-mannuronate and L-guluronate) with natural polypeptides (gelatin) and bioactive mineral fillers (calcium silicates CaSi and dicalcium phosphate dihydrate DCPD) were used to obtain eco-sustainable biomaterials for oral bone defects. Three PP-x:y formulations were prepared (PP-16:16, PP-33:22, and PP-31:31), where PP represents the polysaccharide/polypeptide matrix and x and y represent the weight % of CaSi and DCPD, respectively. Hydrogels were tested for their chemical-physical properties (calcium release and alkalizing activity in deionized water, porosity, solubility, water sorption, radiopacity), surface microchemistry and micromorphology, apatite nucleation in HBSS by ESEM-EDX, FT-Raman, and micro-Raman spectroscopies. The expression of vascular (CD31) and osteogenic (alkaline phosphatase ALP and osteocalcin OCN) markers by mesenchymal stem cells (MSCs) derived from human vascular walls, cultured in direct contact with hydrogels or with 10% of extracts was analysed. All mineral-filled hydrogels, in particular PP-31:31 and PP-33:22, released Calcium ions and alkalized the soaking water for three days. Calcium ion leakage was high at all the endpoints (3 h–28 d), while pH values were high at 3 h–3 d and then significantly decreased after seven days (p < 0.05). Porosity, solubility, and water sorption were higher for PP-31:31 (p < 0.05). The ESEM of fresh samples showed a compact structure with a few pores containing small mineral granules agglomerated in some areas (size 5–20 microns). PP-CTRL degraded after 1–2 weeks in HBSS. EDX spectroscopy revealed constitutional compounds and elements of the hydrogel (C, O, N, and S) and of the mineral powders (Ca, Si and P). After 28 days in HBSS, the mineral-filled hydrogels revealed a more porous structure, partially covered with a thicker mineral layer on PP-31:31. EDX analyses of the mineral coating showed Ca and P, and Raman revealed the presence of B-type carbonated apatite and calcite. MSCs cultured in contact with mineral-filled hydrogels revealed the expression of genes related to vascular (CD31) and osteogenic (mainly OCN) differentiation. Lower gene expression was found when cells were cultured with extracts added to the culture medium. The incorporation of biointeractive mineral powders in a green bio-derived algae-based matrix allowed to produce bioactive porous hydrogels able to release biologically relevant ions and create a suitable micro-environment for stem cells, resulting in interesting materials for bone regeneration and healing in oral bone defects

Assessing COVID-19-Related Excess Mortality Using Multiple Approaches—Italy, 2020–2021

Introduction: Excess mortality (EM) is a valid indicator of COVID-19’s impact on public health. Several studies regarding the estimation of EM have been conducted in Italy, and some of them have shown conflicting values. We focused on three estimation models and compared their results with respect to the same target population, which allowed us to highlight their strengths and limitations. Methods: We selected three estimation models: model 1 (Maruotti et al.) is a Negative-Binomial GLMM with seasonal patterns; model 2 (Dorrucci et al.) is a Negative Binomial GLM epidemiological approach; and model 3 (Scortichini et al.) is a quasi-Poisson GLM time-series approach with temperature distributions. We extended the time windows of the original models until December 2021, computing various EM estimates to allow for comparisons. Results: We compared the results with our benchmark, the ISS-ISTAT official estimates. Model 1 was the most consistent, model 2 was almost identical, and model 3 differed from the two. Model 1 was the most stable towards changes in the baseline years, while model 2 had a lower cross-validation RMSE. Discussion: Presently, an unambiguous explanation of EM in Italy is not possible. We provide a range that we consider sound, given the high variability associated with the use of different models. However, all three models accurately represented the spatiotemporal trends of the pandemic waves in Italy

A population-based cohort approach to assess excess mortality due to the spread of COVID-19 in Italy, January-May 2020

Aims: To assess the impact of the COVID-19 pandemic on all-cause mortality in Italy during the first wave of the epidemic, taking into consideration the geographical heterogeneity of the spread of COVID-19. Methods: This study is a retrospective, population-based cohort study using national statistics throughout Italy. Survival analysis was applied to data aggregated by day of death, age groups, sex, and Italian administrative units (107 provinces). We applied Cox models to estimate the relative hazards (RH) of excess mortality, comparing all-cause deaths in 2020 with the expected deaths from all causes in the same time period. The RH of excess deaths was estimated in areas with a high, moderate, and low spread of COVID-19. We reported the estimate also restricting the analysis to the period of March-April 2020 (first peak of the epidemic). Results: The study population consisted of 57,204,501 individuals living in Italy as of January 1, 2020. The number of excess deaths was 36,445, which accounts for 13.4% of excess mortalities from all causes during January-May 2020 (i.e., RH = 1.134; 95% confidence interval (CI): 1.129-1.140). In the macro-area with a relatively higher spread of COVID-19 (i.e., incidence rate, IR): 450-1,610 cases per 100,000 residents), the RH of excess deaths was 1.375 (95% CI: 1.364-1.386). In the area with a relatively moderate spread of COVID-19 (i.e., IR: 150-449 cases) it was 1.049 (95% CI: 1.038-1.060). In the area with a relatively lower spread of COVID-19 (i.e., IR: 30-149 cases), it was 0.967 (95% CI: 0.959-0.976). Between March and April (peak months of the first wave of the epidemic in Italy), we estimated an excess mortality from all causes of 43.5%. The RH of all-cause mortality for increments of 500 cases per 100,000 residents was 1.352 (95% CI: 1.346-1.359), corresponding to an increase of about 35%. Conclusions: Our analysis, making use of a population-based cohort model, estimated all-cause excess mortality in Italy taking account of both time period and of COVID-19 geographical spread. The study highlights the importance of a temporal/geographic framework in analyzing the risk of COVID-19-epidemy related mortality

Fecondità e maternità: un sistema integrato per la misurazione di fenomeni sanitari e socio demografici

Il lavoro descrive i passi iniziali di progettazione e sperimentazione di un complesso progetto di integrazione tra fonti, finalizzato alla realizzazione del “Sistema integrato sugli esiti del concepimento”. L' integrazione delle fonti è indispensabile per ottenere un quadro completo e dettagliato sui principali aspetti demografici e socio-sanitari degli esiti dei concepimenti, dati i profondi cambiamenti degli ultimi decenni nella regolamentazione sulla raccolta dei dati amministrativi, legati a questioni di semplificazione e di privacy. Nel lavoro si delinea una strategia di integrazione, mettendone in rilievo gli aspetti metodologici e prediligendo soluzioni che possano essere facilmente estese, portate a regime ed inserite in processi di produzione corrente

Twelve Variants Polygenic Score for Low-Density Lipoprotein Cholesterol Distribution in a Large Cohort of Patients With Clinically Diagnosed Familial Hypercholesterolemia With or Without Causative Mutations

: Background A significant proportion of individuals clinically diagnosed with familial hypercholesterolemia (FH), but without any disease-causing mutation, are likely to have polygenic hypercholesterolemia. We evaluated the distribution of a polygenic risk score, consisting of 12 low-density lipoprotein cholesterol (LDL-C)-raising variants (polygenic LDL-C risk score), in subjects with a clinical diagnosis of FH. Methods and Results Within the Lipid Transport Disorders Italian Genetic Network (LIPIGEN) study, 875 patients who were FH-mutation positive (women, 54.75%; mean age, 42.47±15.00 years) and 644 patients who were FH-mutation negative (women, 54.21%; mean age, 49.73±13.54 years) were evaluated. Patients who were FH-mutation negative had lower mean levels of pretreatment LDL-C than patients who were FH-mutation positive (217.14±55.49 versus 270.52±68.59 mg/dL, P<0.0001). The mean value (±SD) of the polygenic LDL-C risk score was 1.00 (±0.18) in patients who were FH-mutation negative and 0.94 (±0.20) in patients who were FH-mutation positive (P<0.0001). In the receiver operating characteristic analysis, the area under the curve for recognizing subjects characterized by polygenic hypercholesterolemia was 0.59 (95% CI, 0.56-0.62), with sensitivity and specificity being 78% and 36%, respectively, at 0.905 as a cutoff value. Higher mean polygenic LDL-C risk score levels were observed among patients who were FH-mutation negative having pretreatment LDL-C levels in the range of 150 to 350 mg/dL (150-249 mg/dL: 1.01 versus 0.91, P<0.0001; 250-349 mg/dL: 1.02 versus 0.95, P=0.0001). A positive correlation between polygenic LDL-C risk score and pretreatment LDL-C levels was observed among patients with FH independently of the presence of causative mutations. Conclusions This analysis confirms the role of polymorphisms in modulating LDL-C levels, even in patients with genetically confirmed FH. More data are needed to support the use of the polygenic score in routine clinical practice

Spectrum of mutations in Italian patients with familial hypercholesterolemia: New results from the LIPIGEN study

Background Familial hypercholesterolemia (FH) is an autosomal dominant disease characterized by elevated plasma levels of LDL-cholesterol that confers an increased risk of premature atherosclerotic cardiovascular disease. Early identification and treatment of FH patients can improve prognosis and reduce the burden of cardiovascular mortality. Aim of this study was to perform the mutational analysis of FH patients identified through a collaboration of 20 Lipid Clinics in Italy (LIPIGEN Study). Methods We recruited 1592 individuals with a clinical diagnosis of definite or probable FH according to the Dutch Lipid Clinic Network criteria. We performed a parallel sequencing of the major candidate genes for monogenic hypercholesterolemia (LDLR, APOB, PCSK9, APOE, LDLRAP1, STAP1). Results A total of 213 variants were detected in 1076 subjects. About 90% of them had a pathogenic or likely pathogenic variants. More than 94% of patients carried pathogenic variants in LDLR gene, 27 of which were novel. Pathogenic variants in APOB and PCSK9 were exceedingly rare. We found 4 true homozygotes and 5 putative compound heterozygotes for pathogenic variants in LDLR gene, as well as 5 double heterozygotes for LDLR/APOB pathogenic variants. Two patients were homozygous for pathogenic variants in LDLRAP1 gene resulting in autosomal recessive hypercholesterolemia. One patient was found to be heterozygous for the ApoE variant p.(Leu167del), known to confer an FH phenotype. Conclusions This study shows the molecular characteristics of the FH patients identified in Italy over the last two years. Full phenotypic characterization of these patients and cascade screening of family members is now in progress

Noi refertiamo così… voi? Guida rapida per la valutazione sonologica della stenosi carotidea.

Da oltre quarant’anni si utilizzano gli ultrasuoni per rilevare una placca carotidea e per seguire nel tempo la sua evoluzione. I protocolli terapeutici hanno ridotto enormemente il suo impatto sulla salute delle persone ma la scelta fra terapia medica e chirurgica si fonda su una valutazione clinica e strumentale che è solo apparentemente semplice. Nei referti di un esame ultrasonografico riportiamo il più delle volte delle percentuali di stenosi, a volte puntuali, a volte in termini di range oppure ci esprimiamo con aggettivi che descrivono la gravità della stenosi ma spesso ci facciamo confondere dai numeri e dalle differenti modalità di calcolo del range di stenosi ed è indubbio che, a volte, le conclusioni risultano ambigue ed estremamente dipendenti dall’interpretazione dell’operatore. Il problema è che l’angiografia digitale, gold standard diagnostico per la stenosi carotidea, adotta delle metriche non del tutto riproducibili con gli ultrasuoni. Con questo documento vogliamo condividere la ricerca di un linguaggio comune, a partire dal referto dei nostri esami. Noi refertiamo così… voi

Familial hypercholesterolemia: The Italian Atherosclerosis Society Network (LIPIGEN)

BACKGROUND AND AIMS: Primary dyslipidemias are a heterogeneous group of disorders characterized by abnormal levels of circulating lipoproteins. Among them, familial hypercholesterolemia is the most common lipid disorder that predisposes for premature cardiovascular disease. We set up an Italian nationwide network aimed at facilitating the clinical and genetic diagnosis of genetic dyslipidemias named LIPIGEN (LIpid TransPort Disorders Italian GEnetic Network). METHODS: Observational, multicenter, retrospective and prospective study involving about 40 Italian clinical centers. Genetic testing of the appropriate candidate genes at one of six molecular diagnostic laboratories serving as nationwide DNA diagnostic centers. RESULTS AND CONCLUSIONS: From 2012 to October 2016, available biochemical and clinical information of 3480 subjects with familial hypercholesterolemia identified according to the Dutch Lipid Clinic Network (DLCN) score were included in the database and genetic analysis was performed in 97.8% of subjects, with a mutation detection rate of 92.0% in patients with DLCN score 656. The establishment of the LIPIGEN network will have important effects on clinical management and it will improve the overall identification and treatment of primary dyslipidemias in Italy

Une méthode d'analyse et d'interprétation des risques concurrents de mortalité par cause

Prati (Sabrina). - A Method of Analysis and Interpretation of Concurrent Cause-specific Death Rates All individuals during their lifetimes are exposed, to mortality from different causes, which are competing risks. Several statistical models have attempted to deal with this problem, but most start with the easier hypothesis that the risks are independent of each other. Such an hypothesis is harder to satisfy in the case of chronic pathological processes, which are strongly correlated with predisposing factors. In such cases, it preferable to introduce individual factors into the analysis (e.g. bio-physiological characteristics or lifestyles). These factors can be used to predict overall mortality rates or those for some major causes of death. A logistic model was applied to individual data obtenaid from a long-term longitudinal study. A vector of probabilities (one for every possible cause) was estimated for each individual. Various issues relating to competing mortality risks from different causes may be approched from a new angle.Prati (Sabrina). - Une méthode d'analyse et d'interprétation des risques concurrents de mortalité par cause Pendant sa vie, chaque individu est exposé simultanément à de multiples risques de décès. Ces risques sont en concurrence dans la mesure où l'expression de l'un empêche les autres de se manifester. De nombreux modèles statistiques s'efforcent de traiter le problème mais la plupart se fondent, par commodité, sur l'hypothèse d'indépendance entre les risques. Cette hypothèse est particulièrement difficile à justifier lorsque l'on s'intéresse à des processus pathologiques de nature chronique, fortement corrélés entre eux par des facteurs prédisposants. Dans de tels cas, une méthode plus satisfaisante consiste à introduire dans l'analyse des facteurs individuels (caractéristiques bio-physiologiques, modes de vie) dotés d'une importante valeur prédictive pour la mortalité générale ou certaines causes majeures de décès. On a appliqué un modèle logistique polytomique à des données individuelles résultant d'une observation longitudinale suivie. On a ainsi estimé pour chaque individu le vecteur des probabilités (un pour chacun des événements possibles) déterminées par le niveau des facteurs de risque dont l'individu est porteur. Ces probabilités permettent d'aborder de façon nouvelle divers problèmes typiques de la concurrence entre risques de décèsPrati (Sabrina). - Un método de análisis e interpretación de los riesgos simultanées de mortalidad рог causa Čada individuo se expone a lo largo de su vida a multiples riesgos simultáneos de de- función. Estos riesgos son concurrentes en la medida en que la aparición de uno impide que los restantes se manifiesten. Los numerosos modelos estadisticos que estudian el problema se basan, por comodidad, en la hipótesis de independencia entre riesgos. Esta hipótesis es particularmente dificil de justificar en el marco de procesos patológicos crónicos, fuerte- mente correlacionados debido a la existencia de factores que determinan la predisposición del individuo. En taies casos, un método más satisfactorio es el que consiste en introducir en el análisis factores individuales (características bio-fisiológicas, modos de vida, etc.) do- tados de importante valor predictivo para la mortalidad general о para ciertas causas mayo- res de defunción. El articulo incluye la aplicación de un modelo logístico policotómico a datos individuales procedentes de observaciones longitudinales continuadas. Para cada individuo se estima el vector de probabilidades (una para cada acontecimiento posible) determinadas por el nivel de factores de riesgo de los cuales el individuo es portador. Estas probabilidades per- miten abordar desde una nueva perspectiva los problemas característicos de los riesgos simultáneos de mortalidad.Prati Sabrina. Une méthode d'analyse et d'interprétation des risques concurrents de mortalité par cause. In: Population, 50ᵉ année, n°4-5, 1995. pp. 1013-1030