Prenatal tobacco smoke exposure increases hospitalizations for bronchiolitis in infants

BACKGROUND: Tobacco smoke exposure (TSE) is a worldwide health problem and it is considered a risk factor for pregnant women's and children's health, particularly for respiratory morbidity during the first year of life. Few significant birth cohort studies on the effect of prenatal TSE via passive and active maternal smoking on the development of severe bronchiolitis in early childhood have been carried out worldwide. METHODS: From November 2009 to December 2012, newborns born at ≥ 33 weeks of gestational age (wGA) were recruited in a longitudinal multi-center cohort study in Italy to investigate the effects of prenatal and postnatal TSE, among other risk factors, on bronchiolitis hospitalization and/or death during the first year of life. RESULTS: Two thousand two hundred ten newborns enrolled at birth were followed-up during their first year of life. Of these, 120 (5.4%) were hospitalized for bronchiolitis. No enrolled infants died during the study period. Prenatal passive TSE and maternal active smoking of more than 15 cigarettes/daily are associated to a significant increase of the risk of offspring children hospitalization for bronchiolitis, with an adjHR of 3.5 (CI 1.5-8.1) and of 1.7 (CI 1.1-2.6) respectively. CONCLUSIONS: These results confirm the detrimental effects of passive TSE and active heavy smoke during pregnancy for infants' respiratory health, since the exposure significantly increases the risk of hospitalization for bronchiolitis in the first year of lif

DIET AND OTHER LIFESTYLE FACTORS IN ADULTHOOD AND INCIDENCE OF CHRONIC DISEASES AND MORTALITY: A PASSIVE-CASE FINDING COHORT STUDY.EVALUATION OF THE POSSIBLE USE OF RECORD LINKAGE IN THE ANALYSIS OF WEAK EXPOSURES.

Introduzione e Obiettivi: Sebbene l'uso integrato di dati amministrativi in sanit\ue0 pubblica e nella ricerca epidemiologica sia di crescente interesse, il loro utilizzo nel mettere in relazione dati provenienti da studi epidemiologici con quelli provenienti da fonti amministrative non \ue8 molto frequente. Ad oggi, pochi studi longitudinali hanno valutato gli effetti degli stili di vita, come la dieta, nella mezza et\ue0 su esiti di salute a lungo termine e comunque i principali si sono focalizzati sulla mortalit\ue0. Gli obiettivi di questo progetto di tesi sono stati: i) ricostruire la storia di un gruppo di soggetti che furono visitati e intervistati tra il 1991 e il 1995, ii) stimare l'incidenza delle principali malattie che si sono verificate durante 20 anni di follow-up e la mortalit\ue0 per tutte le cause, e iii) studiare la relazione tra abitudini alimentari e altri stili di vita raccolti nella mezza et\ue0 e il rischio di sviluppare malattie cardiovascolari (CVD) e morte attraverso l\u2019utilizzo di un follow-up passivo. Soggetti e Metodi: Per illustrare la possibile applicazione dell'uso di dati amministrativi in epidemiologia nutrizionale sono stati utilizzati dati provenienti dallo studio di 'Bollate Study Eye', condotto su un campione di popolazione di et\ue0 compresa tra 40 e 74 anni residente nella Regione Lombardia. Al baseline, 1.693 soggetti furono visitati ed intervistati sull\u2019utilizzo di farmaci, su malattie pregresse, e sugli stili di vita; ai soggetti fu inoltre somministrato un questionario alimentare per frequenza (FFQ) per stimare l'assunzione abituale di 158 alimenti durante l\u2019anno precedente. Lo studio si \ue8 avvalso dell'applicazione di algoritmi sviluppati per identificare i soggetti della coorte nei database dei Servizi Sanitari Regionali (RHSD) dell'Azienda Sanitaria Locale (ASL) di Mi1, utilizzando il codice fiscale e regionale come codici identificativi personali. I due endpoints principali di questo lavoro sono stati l'incidenza delle malattie cardiovascolari (CVD) e il decesso per tutte le cause, che sono stati determinati per mezzo di record linkage deterministici (DRL) con i registri di dimissione ospedaliera e di mortalit\ue0. I dati originariamente raccolti al baseline sono stati integrati con quelli di follow-up in un unico dataset utilizzato per la conduzione delle analisi statistiche. Per valutare il ruolo della dieta, i dati nutrizionali raccolti al baseline sono stati elaborati ed analizzati mediante approcci differenti. In primo luogo \ue8 stata calcolata l\u2019energia proveniente dal consumo dei macronutrienti e categorizzata in terzili, poi \ue8 stato calcolato un indice a priori al fine di valutare l'aderenza alla dieta mediterranea (MeDi) ed infine \ue8 stato applicato un approccio esplorativo a posteriori per caratterizzare i soggetti della coorte sulla base delle loro abitudini alimentari. Inoltre, \ue8 stato valutato l'effetto combinato dei diversi fattori legati agli stili di vita, calcolando un punteggio \u2018salutare\u2019. Lo studio della relazione tra le diverse esposizioni (dieta, attivit\ue0 fisica, abitudine al fumo e punteggio salutare) e l\u2019insorgenza di CVD e la morte per tutte le cause \ue8 stata studiata utilizzando modelli di regressione di Cox, che permettono di stimare i rischi relativi (RRs) espressi come hazard ratios (HRs) con i relativi intervalli di confidenza al 95% (95% CI). Risultati e Conclusioni: Da un punto di vista metodologico, si sono presentate e sono conseguentemente state affrontate diverse problematiche relative alla ricostruzione della coorte e alla determinazione degli outcomes. Attraverso il record linkage, il 95% dei soggetti reclutati nel periodo 1991-1995 \ue8 stato recuperato dai registri regionali (n=1604). Escludendo i soggetti con precedenti di malattie croniche al baseline, 530 soggetti hanno sviluppato CVD e 194 persone sono morte durante il follow-up. I risultati confermano che mantenere un corretto stile di vita, consumare alimenti tipici della dieta mediterranea, come ad esempio l'olio d'oliva, non fumare e svolgere regolare attivit\ue0 fisica sono condizioni che riducono il rischio di CVD e garantiscono un prolungamento della vita, soprattutto considerando questi fattori in combinazione tra di loro. Inoltre, questa tesi ha mostrato una possibile applicazione dell'uso dei dati amministrativi, che in Italia vengono utilizzati raramente in combinazione con studi di epidemiologia. L\u2019utilizzo di questa sorgente di informazioni pu\uf2 rivestire un ruolo promettente nella conduzione di studi di coorte osservazionali che dispongano di numerose informazioni al baseline, e risulterebbe molto vantaggioso sia per la riduzione dei tempi e dei costi rispetto agli studi tradizionali sia per il ridotto numero di persi al follow-up e, conseguentemente, per l\u2019elevato numero di soggetti da poter analizzare.Introduction and Aims: Although the integrated use of administrative data in public health and epidemiological research is of increasing interest, the practice of linking data from epidemiological studies to administrative data is not very common. As far as I know, only few longitudinal studies have been carried out combining historical cohort and administrative data for evaluating the effects of life-styles factors collected in mid-life on long term health outcome, and the main evidence are related to mortality. The aims of this thesis project were: i) to reconstruct the history of a cohort of subjects who were visited and interviewed during the period from 1991-1995, ii) to estimate the incidence of major diseases that occurred during 20-years follow-up and mortality for all causes, and iii) to study the relationship between dietary habits and other lifestyles factors in middle age, and risk of cardiovascular diseases (CVD) and death by means of passive follow-up. Subjects and Methods: The data used for illustrating the possible application of the use of administrative data in the nutritional epidemiology field come from the cross-sectional \u2018Bollate Eye Study\u2019, which was carried out in a population sample of people aged 40-74 resident in Lombardy Region. At baseline, the hospital visits were attended by 1693 subjects and included an interview concerning medical and family history, the past or current use of drugs, lifestyle habits, and a food frequency questionnaire (FFQ) for estimating the usual intake of 158 foods during the year preceding the assessment. The study involved the application of algorithms developed to retrieve subjects of the cohort in the Regional Health Services databases (RHSD) of the Local Health Authority (ASL) of Mi1 by using fiscal and regional code as personal identifiers codes. The main outcomes investigated in this work were the incidence of cardiovascular diseases (CVD) and all-causes death, that were determined by means of deterministic record linkage (DRL) with the Regional Hospital discharge forms and the Mortality registries by using an international coding system of diseases. Baseline data were thereafter aggregated into a single dataset to carry out all of the analyses. For evaluating the role of diet on the two endpoints, the dietary data collected at baseline were processed and analyzed with different approaches. First, energy derived from macronutrient intake was calculated and then categorized in tertiles, then an a priori index was computed in order to assess the adherence to Mediterranean Diet (MeDi) and finally an exploratory a posteriori approach was applied to characterize subjects on the basis of their dietary patterns. Furthermore, the combined effect of lifestyle factors was evaluated by calculating a healthy score. The relationship between exposures (diet, physical activity, smoking habits and the healthy score) and fatal and nonfatal CVD and all-causes death was investigated by means of Cox\u2019s regression models that estimated relative risks (RRs) as hazard ratios (HRs) with their 95% confidence intervals (95%CI). Results and Conclusion: From a methodological point of view, several issues related to the reconstruction of the cohort and to the outcomes definition have been focused and then addressed. After the record linkage procedures, 95% of subjects recruited during the period 1991-1995 were retrieved in the registries (n=1604). Excluding subjects with previous chronic diseases at baseline, a total of 530 CVD occurred and 194 persons died for all causes during follow-up. Results support the evidence of a positive effect of a healthy lifestyle, as adherence to a Mediterranean dietary pattern, the intake of specific components of this pattern, such as olive oil, abstinence from smoking and engaging in regular physical activity on the risk of CVD and all-causes death, particularly when these modifiable risk factors were considered in a healthy score. Furthermore, this thesis showed a possible application of the use of administrative data rarely used for epidemiological analytical study in Italy, suggesting their promising role for carrying out observational cohort studies with a large amount of data collected at baseline, guaranteeing a reduction in times and costs compared to traditional studies, ensuring a minimal number of persons lost to follow-up and resulting in a high number of subjects to analyze

Risk factors for bronchiolitis hospitalization during the first year of life in a multicenter Italian birth cohort

BACKGROUND: Respiratory Syncytial Virus (RSV) is one of the main causes of respiratory infections during the first year of life. Very premature infants may contract more severe diseases and 'late preterm infants' may also be more susceptible to the infection. The aim of this study is to evaluate the risk factors for hospitalization during the first year of life in children born at different gestational ages in Italy. METHODS: A cohort of 33-34 weeks gestational age (wGA) newborns matched by sex and age with two cohort of newborns born at 35-37 wGA and > 37 wGA were enrolled in this study for a three-year period (2009-2012). Hospitalization for bronchiolitis (ICD-9 code 466.1) during the first year of life was assessed through phone interview at the end of the RSV season (November-March) and at the completion of the first year of life. RESULTS: The study enrolled 2314 newborns, of which 2210 (95.5 %) had a one year follow-up and were included in the analysis; 120 (5.4 %) were hospitalized during the first year of life for bronchiolitis. Children born at 33-34 wGA had a higher hospitalization rate compared to the two other groups. The multivariate analysis carried out on the entire population associated the following factors with higher rates for bronchiolitis hospitalization: male gender; prenatal treatment with corticosteroids; prenatal exposure to maternal smoking; singleton delivery; respiratory diseases in neonatal period; surfactant therapy; lack of breastfeeding; siblings <10 years old; living in crowded conditions and/or in unhealthy households and early exposure to the epidemic RSV season. When analysis was restricted to preterms born at 33-34 wGA the following variables were associated to higher rates of bronchiolitis hospitalization: male gender, prenatal exposure to maternal smoking, neonatal surfactant therapy, having siblings <10 years old, living in crowded conditions and being exposed to epidemic season during the first three months of life. CONCLUSION: Our study identified some prenatal, perinatal and postnatal conditions proving to be relevant and independent risk factors for hospitalization for bronchiolitis during the first year of life. The combination of these factors may lead to consider palivizumab prophylaxis in Italy

Whole Dietary Patterns, Cognitive Decline and Cognitive Disorders: A Systematic Review of Prospective and Intervention Studies

Dementia prevalence is a global public health concern. Adherence towards a healthy dietary pattern (DP) may reduce the risk of cognitive decline and dementia. This narrative systematic review aimed to synthesise prospective and intervention study data to evaluate the impact of a-posteriori and a-priori derived DPs on cognitive ageing, from cognitive decline to incident dementia. Ninety-three studies were included: 83 prospective studies and 10 randomised controlled trials (RCT). Most prospective studies (77%) examined a-priori DPs, with the Mediterranean diet examined most frequently. A total of 52% of prospective and 50% of RCTs reported a protective relationship between ‘healthy’ DPs and global cognitive decline. Overall, 59% of prospective studies reported positive associations between healthy DPs and risk of cognitive disorder. Incident cognitive disorder was examined by only one intervention study (subgroup analysis) which reported a beneficial effect of a low-fat diet on risk of probable dementia in women. Unhealthy DPs were examined less frequently (n = 17; 21%), with 41% of these studies reporting associations between adherence and poorer cognitive outcomes. Overall, there were mixed results for healthy and unhealthy DPs on cognition, likely due to between-study heterogeneity. Standardisation of diet exposure and cognitive outcome measurement would help to reduce this. Future research would benefit from investigating effects of culturally appropriate DPs on individual cognitive domains and incident cognitive disorders in diverse and high-risk populations

Pre-existing mental health disorders and fear of COVID-19 pandemic: Data from a phone survey in community-dwelling older adults recruited in the NutBrain study

Background: COVID-19 has caused a parallel epidemic of fear, anxiety, depression, stress, and frustration, particularly among the most fragile and vulnerable individuals, such as older people and those with previous mental health disorders. The present study aims to investigate the association between pre-existing mental health disorders, particularly depressive symptoms and Mild Cognitive Impairment (MCI), and the fear of COVID-19 and to explore which cognitive domains were involved in coping with fear in older people. Materials and methods: In April 2020, we conducted a phone-interview questionnaire on community-dwelling older adults living in Lombardy Region (Italy) who participated in the NutBrain study. At baseline, socio-demographic characteristics along with lifestyles, and medical history were recorded. Participants underwent a neuropsychological battery exploring the global cognitive function and specific cognitive domains, to detect cases of MCI. The Center for Epidemiologic Studies Depression scale (CES-D) was used for screening depressive symptoms. During the phone survey, respondents were assessed using a structured questionnaire querying about fear of the COVID-19 pandemic. We performed multivariate logistic regression models to study the association between MCI and depressive symptomatology and fear. We also explored which cognitive domains were associated with fear. Odds Ratios (OR) with Confidence Intervals (95%CI) were estimated adjusting for potential confounders. Results: Out of the 351 respondents (mean age 73.5 6.1 years, 59.8% women, 49.1% high education), at baseline, 22.9% had MCI and 18.8% had Frontiers in Psychiatry 01 frontiersin.org Perdixi et al. 10.3389/fpsyt.2022.995308 depressive symptoms. In the multivariate analyses gender, age, and body mass index were significantly associated with the fear score. Considering different domains of fear, MCI was associated with fear of being infected themselves (OR 2.55, 95%CI 1.39–4.70) while depressive symptoms were associated with fear of contagion for family members (OR 2.38, 95%CI 1.25–4.52). Impaired executive cognitive function was positively associated with the highest tertile of the fear score (OR 3.28, 95%CI 1.37–7.74) and with fear of contagion for themselves (OR 3.39, 95%CI 1.61-7.17). Conclusion: Older adults experienced different fear reactions, particularly when suffering from neurocognitive disorders and depressive symptoms; executive dysfunction was associated with increased fear. These results highlighted the need to pay attention to the psychological effects of the outbreak of COVID-19 to target intervention, especially among vulnerable subgroups of individuals

Fear of covid-19 for individuals and family members: Indications from the national cross-sectional study of the epicovid19 web-based survey

The study analyzed the association of the fear of contagion for oneself and for family members (FMs) during the first wave of the COVID-19 pandemic, with demographic and socioeconomic status (SES) and health factors. The study was performed within the EPICOVID19 web-based Italian survey, involving adults from April–June 2020. Out of 207,341 respondents, 95.9% completed the questionnaire (60% women with an average age of 47.3 vs. 48.9 years among men). The association between fear and demographic and SES characteristics, contacts with COVID-19 cases, nasopharyngeal swab, self-perceived health, flu vaccination, chronic diseases and specific symptoms was analyzed by logistic regression model; odds ratios adjusted for sex, age, education and occupation were calculated (aORs). Fear for FMs prevailed over fear for oneself and was higher among women than men. Fear for oneself decreased with higher levels of education and in those who perceived good health. Among those vaccinated for the flu, 40.8% responded they had feelings of fear for themselves vs. 34.2% of the not vaccinated. Fear increased when diseases were declared and it was higher when associated with symptoms such as chest pain, olfactory/taste disorders, heart palpitations (aORs > 1.5), lung or kidney diseases, hypertension, depression and/or anxiety. Trends in fear by region showed the highest percentage of positive responses in the southern regions. The knowledge gained from these results should be used to produce tailored messages and shared public health decisions

Gold nanoparticles (AuNPs) impair LPS-driven immune responses by promoting a tolerogenic-like dendritic cell phenotype with altered endosomal structures

Dendritic cells (DCs) shape immune responses by influencing T-cell activation. Thus, they are considered both an interesting model for studying nano-immune interactions and a promising target for nano-based biomedical applications. However, the accentuated ability of nanoparticles (NPs) to interact with biomolecules may have an impact on DC function that poses an unexpected risk of unbalanced immune reactions. Here, we investigated the potential effects of gold nanoparticles (AuNPs) on DC function and the consequences for effector and memory T-cell responses in the presence of the microbial inflammatory stimulus lipopolysaccharide (LPS). Overall, we found that, in the absence of LPS, none of the tested NPs induced a DC response. However, whereas 4-, 8-, and 11 nm AuNPs did not modulate LPS-dependent immune responses, 26 nm AuNPs shifted the phenotype of LPS-activated DCs toward a tolerogenic state, characterized by downregulation of CD86, IL-12 and IL-27, upregulation of ILT3, and induction of class E compartments. Moreover, this DC phenotype was less proficient in promoting Th1 activation and central memory T-cell proliferation. Taken together, these findings support the perception that AuNPs are safe under homeostatic conditions; however, particular care should be taken in patients experiencing a current infection or disorders of the immune system

Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality – a systematic review and dose-response meta-analysis of prospective studies

Background: Questions remain about the strength and shape of the dose-response relationship between fruit and vegetable intake and risk of cardiovascular disease, cancer and mortality, and the effects of specific types of fruit and vegetables. We conducted a systematic review and meta-analysis to clarify these associations. Methods: PubMed and Embase were searched up to 29 September 2016. Prospective studies of fruit and vegetable intake and cardiovascular disease, total cancer and all-cause mortality were included. Summary relative risks (RRs) were calculated using a random effects model, and the mortality burden globally was estimated; 95 studies (142 publications) were included. Results: For fruits and vegetables combined, the summary RR per 200 g/day was 0.92 [95% confidence interval (CI): 0.90–0.94, I2 = 0%, n = 15] for coronary heart disease, 0.84 (95% CI: 0.76–0.92, I2 = 73%, n = 10) for stroke, 0.92 (95% CI: 0.90–0.95, I2 = 31%, n = 13) for cardiovascular disease, 0.97 (95% CI: 0.95–0.99, I2 = 49%, n = 12) for total cancer and 0.90 (95% CI: 0.87–0.93, I2 = 83%, n = 15) for all-cause mortality. Similar associations were observed for fruits and vegetables separately. Reductions in risk were observed up to 800 g/day for all outcomes except cancer (600 g/day). Inverse associations were observed between the intake of apples and pears, citrus fruits, green leafy vegetables, cruciferous vegetables, and salads and cardiovascular disease and all-cause mortality, and between the intake of green-yellow vegetables and cruciferous vegetables and total cancer risk. An estimated 5.6 and 7.8 million premature deaths worldwide in 2013 may be attributable to a fruit and vegetable intake below 500 and 800 g/day, respectively, if the observed associations are causal. Conclusions: Fruit and vegetable intakes were associated with reduced risk of cardiovascular disease, cancer and all-cause mortality. These results support public health recommendations to increase fruit and vegetable intake for the prevention of cardiovascular disease, cancer, and premature mortality

Influenza Vaccination Uptake in the General Italian Population during the 2020–2021 Flu Season: Data from the EPICOVID-19 Online Web-Based Survey

To assess influenza vaccine uptake during the 2020/2021 flu season and compare it with that of the 2019/2020 flu season among respondents to the second phase of the web-based EPICOVID-19 survey, we performed an observational web-based nationwide online survey (January–February 2021) in which respondents to the first survey (April–June 2020) were contacted and asked to complete a second questionnaire. Factors associated with vaccine uptake in the 2020/2021 flu season were assessed by applying a multivariable multinomial logistic regression model. Out of the 198,822 respondents to the first survey, 41,473 (20.9%) agreed to fill out the followup questionnaire; of these, 8339 (20.1%) were vaccinated only during the 2020/2021 season, 8828 (21.3%) were vaccinated during both seasons and 22,710 (54.8%) were vaccinated in neither season. Educational level (medium (aOR 1.33 95%CI 1.13–1.56) and high (aOR 1.69 95%CI 1.44–1.97) vs. low) and socio-economic deprivation according to SES scoring (1 point aOR 0.83 (95%CI 0.78–0.89), 2 aOR 0.68 (95%CI 0.60–0.77) points or ≥3 points aOR 0.42 (95%CI 0.28–0.45) vs. 0 points) were found to be associated with flu vaccine uptake. Our study shows that social determinants seemed to affect flu vaccination uptake and identifies specific categories of the population to target during future influenza vaccination campaigns