Sinonasal cancer in the Italian national surveillance system: Epidemiology,occupation, and public health implications

Background

Sinonasal cancer (SNC) is a rare tumor with predominant occupational etiology associated with exposures to specific carcinogens. The aim of this study is to describe SNC cases recorded in Italy in the period 2000‐2016.

Methods

Clinical information, occupational history, and lifestyle habits of SNC cases collected in the Italian Sinonasal Cancer Register were examined. Age‐standardized rates were estimated.

Results

Overall, 1529 cases were recorded. The age‐standardized incidence rates per 100 000 person‐years were 0.65 in men and 0.26 in women. Occupational exposures were predominant among the attributed exposure settings, primarily to wood and leather dusts. Other putative causal agents included chrome, solvents, tannins, formaldehyde, textile dusts, and pesticides. Many cases had unknown exposure.

Conclusions

Epidemiological surveillance of SNC cases and their occupational history is fundamental for monitoring the occurrence of the disease in exposed workers in industrial sectors generally not considered at risk of SNC as well as in non‐occupational settings.

     

Disproportional impact of the revised AIDS surveillance definition on the AIDS incidence among drug users compared to homosexual men

The impact of changes in 1993 of the old 1987 WHO/CDC AIDS casedefinition was studied in a cohort of 153 HIV-infected injectiondrug users (IDUs) and 502 HIV-infected homosexual men in Amsterdam.It appeared that the extension in Europe of the old AIDS definitionto also include recurrent pneumonia, pulmonary tuberculosisand invasive cervical neoplasia, strongly increases the numberof persons diagnosed with AIDS among IDUs, but will hardly influencethe AIDS incidence among homosexual men. As recurrent pneumoniaand pulmonary tuberculosis are present among drug users withhigh CD4 cell counts, the incidence of these diseases may partlybe determined by environmental factors. The extension of theold 1987 AIDS definition in the USA with CD4 count <200 cells/mm³In addition to the 3 above-mentioned diseases, will also havea larger impact on drug users than on homosexual men.     

Head injury resulting from scooter accidents in Rome: differences before and after implementing a universal helmet law

OBJECTIVES: To estimate the incidence rates and related determinants of head injuries before and after the implementation of a new universal helmet law in Italy. METHODS: The investigation took place in the Emergency Room of the Accident and Emergency Department, Teaching Hospital 'Umberto I', Rome, in 1999 (before the new law), and 2000 (two periods after the new law). Personal data, injury circumstances, helmet use, others involved in injury and health data, were collected. Incidence rates by time period were calculated and differences between groups were analysed. Logistic regression models were conducted to assess the association between head trauma and potential determinants. RESULTS: The incidence rate of all injury among scooter riders rose from 64.36/10,000 person-years before the new law (1999) to 98.05/10,000 person years afterwards. The incidence rate of head trauma among scooter riders showed an opposite trend, i.e. a decrease from 26.65/10,000 person-years (1999) to 8.88/10,000 person-years in the second post-legislation period. Helmet use among injured scooter riders rose from 5% before the new law to 90% afterwards. Helmet use is a protective factor for being a patient with head trauma, in all the periods considered (OR 0.24-0.44). After implementation of the new law, age (18+) showed a protective effect as well (OR 0.42-0.44). CONCLUSION: Helmet use has a protective effect on head trauma among scooter riders. One year after implementing a universal law, helmet use has increased substantially and a sharp reduction in head trauma among persons older than 18 years could be observed.     

A tale of two cities: factors affecting place of cancer death in London and New York

BACKGROUND: Most American and English cancer patients prefer to die at home. Factors associated with greater likelihood of dying at home have been contradictory in many studies and no studies have compared the effects of factors in different countries. The objective of this paper is to compare the factors affecting place of cancer death in two major cities, New York and London. METHODS: We use data on all individuals aged >/=40 dying of cancer in London (59 604) and New York City (51 668) in the years 1995 through 1998. The probability of death at home is examined in each city as a function of gender, age group (40-55, 56-64, 65-74, 75+), year, type of cancer, and area socioeconomic status, using multiple logistic regression. RESULTS: Although the probability of death at home is the same in the two cities (approximately 1 in 5), being female lowers the odds of death at home by approximately 7% in London, and raises it by approximately 22% in New York. Older age is associated with increased odds of dying at home in New York but decreased odds of dying at home in London. Being in the lowest tercile of socioeconomic status (relative to the highest) lowers the odds of death at home by 22% in London and 39% in New York. CONCLUSION: Site of death varies significantly by patient and area characteristics in both cities, an understanding, which should be taken account of in future planning of end-of-life care.     

Diabetes and social conditions in Estonia. A population-based study

BACKGROUND: The aim of this study was to investigate aspects of metabolic control, treatment and complications as well as quality of life in patients with diabetes mellitus from a defined population in Estonia. METHODS: We invited 220 randomly selected diabetes patients recruited to a clinical investigation from a local diabetes register of 1,100 patients in Viljandi, Estonia. The main outcome measures were derived from medical history, physical examination (height, weight and blood pressure), laboratory variables (blood glucose and glycated haemoglobin A1 (HbA1 normal reference range 3.2-5.6%), serum total and HDL cholesterol and creatinine), a questionnaire on disease-related knowledge and quality of life variables. RESULTS: In all, 181 diabetes patients were investigated, of whom 90% were diagnosed with type 2 diabetes. The mean diabetes duration was 8.9 years from clinical diagnosis and mean HbA1 level was 7.3%. The overall proportion of patients treated with insulin was 29.8% and with anti-hypertensive drugs 26.5%. Smoking was present in 14.3%. The proportion of patients with various diabetes complications was high (73.5%), mostly consisting of different manifestations of cardiovascular disease. Foot ulcers or gangrene were observed in 11.6%. A low level of quality of life was registered in many patients, mostly due to difficult living conditions. CONCLUSIONS: Diabetes patients in Viljandi showed an acceptable degree of glucose metabolic control, but reported a high degree of diabetes complications, as well as impaired quality of life. The diabetes complications may therefore be due to detrimental factors other than hyperglycaemia, e.g. the standard of care during previous years as well as current social and living conditions.     

Critical reading of epidemiological papers. A guide

Many clinicians, medical practitioners and decision makers have no formal training in epidemiology but need to understand and sometimes evaluate results in epidemiologic studies. This paper attempts to give guidance to non-epidemiologists on how to read and evaluate the quality of epidemiologic studies and their results critically. Different methodological issues for evaluating whether the results of a study are causal or by bias, chance or confounding are given. This includes criteria for the choice of an appropriate study design followed by problems of the definition of the study population and the sample selection. We will also point to potential sources of bias in the data collection procedure and list some principles for statistical analysis. Finally, we include comments on how the results should be presented and issues which are related to public health and ethical questions. Although it is not usually possible to perform a perfect study and the correct approach to study design and analysis is often highly dependent on specific features of the population and the surroundings, our paper should help to distinguish between weak and strong investigations and papers.     

广西摩托车驾乘人员佩戴头盔的研究

目的　调查了解摩托车驾乘人员佩戴头盔的情况 ,为预防和控制摩托车伤害提出正确佩戴合格头盔的对策。方法　在广西贵港地区 18个观察点 ,通过路边观察和问卷调查的方法估计摩托车驾乘人员的头盔佩戴率、合格头盔佩戴率和合格头盔正确佩戴率。结果　在 4 76 8位接受调查的摩托车驾乘人员中有 2 6 79位佩戴头盔 ,佩戴率为 5 6 .2 %。在头盔佩戴者中 ,只有 32 .7%的人佩戴合格头盔。只有 16 .4 %的摩托车驾乘人员正确佩戴合格头盔。结论　尽管我国的交通法规强制要求摩托车驾乘人员佩戴头盔 ,但实际头盔佩戴率、合格头盔佩戴率和合格头盔正确佩戴率都很低 ,为了有效预防和控制摩托车伤害的发生 ,急需开展正确佩戴合格头盔的综合干预项目。     

Surveillance of HIV infection and related risk behaviour in European prisons. A multicentre pilot study

BACKGROUND: In order to demonstrate the feasibility of human immunodeficiency virus (HIV) infection and related risk behaviour surveillance in European prisons, a multicentre pilot study was undertaken. METHODS: A cross-sectional survey was carried out in six European prisons (France, Germany, Italy, The Netherlands, Scotland and Sweden). Inmates were invited to complete a self-administered and anonymous questionnaire and to give a saliva sample in order to test for HIV antibodies. RESULTS: Eight hundred and forty-seven out of 1,124 inmates participated in the survey (response rate 75%). Saliva from 817 inmates (73%) was collected and processed for HIV antibodies. Twenty-seven per cent reported that they had ever injected drugs and 49% of these reported they had injected whilst in prison. Eighteen per cent of inmates reported that they had been tattooed whilst in prison, which was found to be higher among injecting drug users (IDUs). One and sixteen per cent reported that they had ever had homosexual and heterosexual intercourse in prison respectively. The HIV prevalence among IDUs was 4% (versus 1% among non-IDUs) (p = 0.02). The proportions of inmates previously tested for hepatitis C and vaccinated against hepatitis B were 24 and 16% respectively. CONCLUSION: This survey demonstrates the feasibility of cross-sectional surveys in European prison inmates and highlights the importance of surveillance of HIV prevalence and related risk behaviour among inmates. The continuing high HIV prevalence and potential for HIV spread in prisons should encourage decision makers in implementing or enhancing harm reduction and education programmes and substance abuse treatment services in prison.     

Epidemiology and cost of treatment of genital warts in Spain

Background: Genital warts (GW) are common and increasing inyoung people. Ninety percent of GW are due to Human Papillomavirus(HPV) types 6 and 11. The objective of this study was to assessthe epidemiology and management costs associated with GW inSpain. Methods: A 1-year (2005) retrospective observational study wasperformed among a sample of gynaecologists, dermatologists andurologists in six autonomous regions in Spain. Men and womenwith newly diagnosed, recurrent or resistant GW were included.We estimated the incidence (new and recurrent cases) and prevalence(also including resistant cases) of GW. Healthcare resourceuse were collected and combined with unit costs to assess themean cost of GW management per patient. These figures were extrapolatedto the 14- to 64-year-old Spanish population to estimate thetotal cost of GW management from the Third Party Payer (TPP)and societal perspectives. Results: The overall annual incidence of GW was estimated at160.4 cases per 100 000. Overall prevalence was calculated as182.1 cases per 100 000, corresponding to 56 446 GW cases annually(14- to 64-year-old population). The mean management cost was833 and 1056 per patient from the TPP and societal perspective,respectively. The overall annual cost was estimated at 47 millionand 59.6 million, from the TPP and societal perspective, respectively. Conclusion: This study provides a first overview of the burdenof GW in Spain. A quadrivalent HPV vaccine that prevents HPV6, 11, 16, 18 related diseases will have the potential to significantlydecrease the socio-economic burden associated with GW in Spain.     

Determinants of condom use among intravenous drug users in Spain

Attitudes to and perception of health care delivery are consideredto be important factors for patient compliance in diabetes.To Investigate insulin-treated diabetic patients' use of, experienceof and attitudes to diabetes care a questionnaire was sent to561 patients, 20–50 years old, living in northern Sweden.Four hundred and eighty-eight patients (87%) participated inthe study. Data were analysed against social, medical and geographicalbackground factors. Female patients more often than men hadseen an ophthalmologist (93 versus 87%, p<0.05), a diabetesnurse specialist (74 versus 64%, p<0.05) and a chiropodist(49 versus 30%, p<0.001) at least once during the courseof their diabetes. Women also used the services of a medicalsocial worker (17 versus 10%, p-0.05) or a psychologist (14versus 8%, p<0.01) more often. More men than women were satisfiedwith the health care they had at the onset (65 versus 38%, p<0.001),but no gender difference in attitude to their present care wasfound. Diabetic patients with chronic complications comparedto those without were less satisfied both with the care theyreceived at the onset of diabetes (40 versus 61%, p<0.001)and at the time they answered the questionnaire (59 versus 72%,p<0.01). Patients in the most sparsely populated health districtwere more seldom able to be seen by the same physician (70 versus93% and 94%, p<0.001) and patient-physician continuity waspoorer over a 3 year period (48 versus 80%, p<0.001). Basedon results of this study, we conclude that use of, experienceof and attitudes to diabetes care are primarily related to genderand sickness factors. Living in sparsely populated areas probablyaffects the use and continuity of hearth care depending on themeans available. The differences demonstrated might be an argumentfor planning more individualized care for diabetic patientsin the future.     

Declining prevalence of injection as main route of administration among heroin users treated in Spain, 1991-1993

The objetive of this study was to analyse the temporal and geographictrends and the factors associated with the prevalence of heroininjection (HI) in persons treated for the first time for heroinabuse/dependence in Spain in 1991–1993. The prevalenceof HI was studied in 54,132 admissions to treatment reportedto the State Information System on Drug Abuse. The factors associatedwith HI prevalence were studied by stratified analysis and logisticregression. Regions with similar prevalences were grouped togetherbased on correspondence analysis. The HI prevalence declinedprogressively by year (50% in 1991, 43% in 1992 and 38% in 1993).The regions were grouped into 3 geographic areas, with risingprevalences in the southwest-northeast. Region was the factormost strongly asociated with HI, with an OR of 6.17 in the highprevalence group as compared with the low prevalence group.A declining trend of HI was seen with the more recent year offirst use (OR of 0.15 for those beginning use in the years 1991–1993as compared with those who began before 1982), later age atfirst use and increasing years of use. Male sex and cocaineuse were associated with higher HI. Chasing is progressivelyreplacing injection as a route of heroin administration becausenew users primarily use this route and probably because themost common transition is from injecting to chasing. The impactof the HIV epidemic and control programmes does not sufficientlyexplain this phenomenon. The main explanatory factors couldbe regional differences in the subculture of drug use or inthe heroin market.     

Influence of social environment in smoking among adolescents in Turkey

BACKGROUND: The aim of this study was to examine the social determinants of smoking among adolescents attending school and/or work. METHODS: A survey was carried out on 6012 adolescents aged between 13 and 17 years in 15 cities, recruited from schools, vocational training centres and work places. A self-completed questionnaire was used for data collection. Single- and multi-level regression analyses were run to estimate models. RESULTS: Ever smoking and current smoking rates were 41.1% and 10.5% among girls, and 57.5% and 25.2% among boys. These rates were 47.0% and 13.3% among those who only attended school, 62.2% and 31.7% among those who attended school and worked simultaneously, and 67.5% and 43.0% among those who worked and did not attend school. In multi-level analysis, the major predictors of current smoking were close friends smoking [odds ratio (OR) 3.48; 95% confidence interval (CI) 1.93-6.27], no knowledge of harmful effects of short-term smoking (OR 2.15; 95% CI 1.74-2.67), vulnerability to peer pressure (OR 1.90; 95% CI 1.48-2.46), negative self-perception (OR 1.69; 95% CI 1.31-2.18) and male sex (OR 1.68; 95% CI 1.30-2.16). Mothers higher education was a predictor for girls' smoking, while mother's lower education was a predictor for boys' smoking. At the school level, smoking prevalence was a predictor of current smoking (OR 1.07; 95% CI 1.05-1.08). CONCLUSIONS: Smoking patterns were similar to Western countries in several aspects, while male prevalence rates were higher and the impact of gender-related predictors was significant. Our findings suggest that youth smoking prevention policies should address personal, familial and educational environmental level requirements, taking into consideration the gender differences in addition to international guidelines.     

A capture-recapture study of the prevalence and implications of opiate use in Dublin.

BACKGROUND: To date there have been no studies estimating the hidden prevalence of opiate use in Dublin. METHODS: A multisource enumeration followed by the application of the capture-recapture method with log-linear modelling including age and gender stratification to remove heterogeneity was implemented to provide an estimate of the unknown size of the opiate-using population. Two medical and one legal data sources were used. RESULTS: It was found that the ratio of known to unknown opiate users was 1:1.15 with a total of 13,460 (95% CI: 12,037-15,306) users estimated in Dublin in 1996. CONCLUSION: The findings of this study have important ramifications for service delivery.     

Surgical infections surveillance: Results of a sixmonth incidence study in two Italian hospitals

In a six-month incidence study of surgical wound infections (SWI) in two Italian hospitals, 1,019 surgical patients, in three general surgery wards, and 433 surgical patients in one orthopedics ward were studied. For the SWI surveillance, the DANOP-DATA system was used: this microcomputer program was developed by Danish authors and tested in a European multicenter study coordinated by the World Health Organization in 1989. Two Italian hospitals participated in the multicenter study. The overall infection rate was 1.2 per 100 operations in orthopedics and 4.9/100 in general surgery. The risk of infection increased with age (RR = 2.06; 95% CL = 1.20–3.53), wound class (RR = 3.38; 95% CL = 1.97-5.8), length of pre-operative stay (RR = 2.71; 95% CL = 1.54-4.74), and duration of operation (RR = 2.59; 95% CL = 1.48–4.54).The infection rates ranged from 3.7 to 7.3/100 among the three general surgery wards; this variability by ward was only partially explained by differences in the age distribution of in-patients, wound class, duration of operation and length of pre-operative stay. When all these risk factors were simultaneously taken into account using a logistic regression model, the odds ratio, comparing one of the three general surgical wards with the other two, was still 2.29 (95% CL = 1.23–4.26). The observed variability can be attributed to differences, among the participating wards, in the case-mix of patients treated and/or to differences in the quality of infection control programs implemented.Corresponding Author     

Public health management of an outbreak of group C meningococcal disease in university campus residents.

BACKGROUND: Increasing numbers of outbreaks of Group C meningococcal disease in teenagers and young adults led to a new policy in the UK in 1999 of vaccinating all new college students. The largest of these outbreaks involved seven students in one university, six of whom were from one hall of residence, and two of whom died. METHODS: Control of the outbreak involved close medical surveillance of resident students, mass chemoprophylaxis and vaccination, and wide dissemination of daily information bulletins. Investigation of the epidemiology of the outbreak involved searching for the network of close contacts between cases, a prevalence survey of carriage of meningogocci and a case control study of risk factors for carriage. RESULTS: Clinical cases could be linked by a discrete network of social contacts within the halls of residence, but the Group C epidemic strain (2a P1.5) was not detected in 454 students (upper 95% confidence interval 0.7%). Carriage of any meningococcal strain (19%) was associated with patronage of the campus bar (OR = 3.0, 0.99-9.1). CONCLUSION: Important factors in the control of the outbreak were rapid institution of mass chemopropylaxis and immunisation of residents, and involvement of student organizations in the dissemination of information about the disease and its control. The role of campus bars in dissemination of the carriage of meningogocci deserves further investigation.     

Enhanced HIV-1 surveillance using molecular epidemiology to study and monitor HIV-1 outbreaks among intravenous drug users (IDUs) in Athens and Bucharest

BackgroundA significant increase in HIV-1 diagnoses was reported among Injecting Drug Users (IDUs) in the Athens (17-fold) and Bucharest (9-fold) metropolitan areas starting 2011.MethodsMolecular analyses were conducted on HIV-1 sequences from IDUs comprising 51% and 20% of the diagnosed cases among IDUs during 2011–2013 for Greece and Romania, respectively. Phylodynamic analyses were performed using the newly developed birth–death serial skyline model which allows estimating of important epidemiological parameters, as implemented in BEAST programme.ResultsMost infections (>90%) occurred within four and three IDU local transmission networks in Athens and Bucharest, respectively. For all Romanian clusters, the viral strains originated from local circulating strains, whereas in Athens, the local strains seeded only two of the four sub-outbreaks. Birth–death skyline plots suggest a more explosive nature for sub-outbreaks in Bucharest than in Athens. In Athens, two sub-outbreaks had been controlled (Re < 1.0) by 2013 and two appeared to be endemic (Re ∼ 1). In Bucharest one outbreak continued to expand (Re > 1.0) and two had been controlled (Re < 1.0). The lead times were shorter for the outbreak in Athens than in Bucharest.ConclusionsEnhanced molecular surveillance proved useful to gain information about the origin, causal pathways, dispersal patterns and transmission dynamics of the outbreaks that can be useful in a public health setting.     

A follow-up study of psychosocial factors and musculoskeletal problems among unskilled female workers with monotonous work

BACKGROUND: Musculoskeletal problems are among the most prevalent occupational health problems in industrialised countries and seem to be common among unskilled, female industrial workers. However, cross-sectional studies only reflect the current situation with regard to both exposure and effect, and selection bias may mask work-related musculoskeletal problems so the general assumption is that prospective cohort studies are more valid and informative. The aim with the present study was to follow-up a group of unskilled female workers and determine whether the number of musculoskeletal ailments reported had changed after 3 years on a group and/or on an individual level. The women had earlier participated in a cross-sectional study correlating exposure with different physical and psychosocial factors at work, at home and during leisure time with their reports of musculoskeletal ailments in the neck, shoulders and thoracic spine. METHODS: One hundred and fifty-three women from the original study group of 173 received a mailed questionnaire, including a visual analogue scale (VAS) and a pain drawing. RESULTS: Ninety-three women were included in the final analyses. Some deterioration in general health and, in particular, in psychological health was observed compared with the earlier study but there was less change in the reporting of musculoskeletal ailments. CONCLUSION: Economic decline and its consequences may have had both a direct and an indirect impact on the deterioration in general health but not in musculoskeletal problems of the women still employed.