Smoking in Italy 2005-2006: effects of a comprehensive National Tobacco Regulation

OBJECTIVE: On 10 January 2005 Italy became the first large European country adopting a comprehensive smoke-free legislation. We provide information on smoking prevalence in Italy and evaluate the effects of the 2005 regulations. METHODS: We considered data from three companion surveys on smoking, conducted in 2004, 2005 and 2006 in Italy. Each survey included more than 3000 subjects aged 15 years or over, representative of the general Italian adult population. RESULTS: Current smokers declined from 26.2% (30.0% of men, 22.5% of women) in 2004, to 25.6% (29.3% of men, 22.2% of women) in 2005 and to 24.3% (28.6% of men, 20.3% of women) in 2006. Whereas no significant difference was found comparing smoking prevalence in 2003-2004 vs. 2001-2002, the drop in smoking prevalence in 2005-2006 vs. 2003-2004 was significant (p<0.05) in the total population, in men and in subjects aged 15-44 years. Smokers consumed a mean of 15.4 cigarettes per day in 2004, 14.6 in 2005 and 13.9 cigarettes per day in 2006. Italians reported to go more frequently to restaurants and cafes. CONCLUSION: The drop in smoking prevalence and consumption is due, at least in part and particularly for younger generations, to the comprehensive smoke-free legislation adopted in Italy.     

Governance and regulation in health: challenges for health management in Greater Metropolitan São Paulo, Brazil

This paper discusses the relationship between the public and private sectors in the Unified National Health System (SUS), based on research whose objective was to identify governance strategies and mechanisms for public/private relations in the health sector, considering the search for equity in Greater Metropolitan Sao Paulo, Brazil. Governance was used as an analytical category, with health system regulation as the issue. Municipal and State health secretaries, members of health councils, and SUS staff were interviewed, and the empirical material was classified as: (a) regulatory mechanisms and instruments; (b) power loci; and (c) actors' positions concerning the SUS and its relationship to the private sector. Mechanisms and instruments have been created and used in the municipalities for regulation of their own services. Regulatory measures for the complementary and supplementary healthcare sector are practically nonexistent. There are numerous institutional power loci, seen more as places for submitting demands than as forums for negotiation. Despite some progress, governance appears to be more of a formal issue. Discussion is needed on the relationship between the public and private sectors and its regulation by municipalities in order to improve the health system.     

Protection against cutaneous leishmaniasis by intranasal vaccination with lipophosphoglycan

We previously showed the opposing effect of systemic and mucosal vaccination with whole Leishmania amazonensis antigen (LaAg). Here, the role played by lipophosphoglycan (LPG) as the key disease-promoting component of intramuscular (i.m.) LaAg and its usefulness as a defined intranasal vaccine was investigated in murine cutaneous leishmaniasis. BALB/c mice were twice vaccinated by the i.m. route with 25mug of intact LaAg or with LaAg that was pretreated with anti-LPG 3A1-La monoclonal antibody, prior to infection with L. amazonensis. LPG neutralization rendered the otherwise disease-promoting LaAg antigen protective, as observed by the smaller lesion sizes and reduced parasite burden. The increased resistance was accompanied by a markedly lower antigen-driven TGF-beta and IL-10 responses in the lesion-draining lymph nodes, concomitant with significantly higher IFN-gamma production. To test for intranasal efficacy, 10 microg of affinity-purified LPG and its parental LaAg were twice instilled in the nostrils prior to L. amazonensis infection. In both cases, similarly slower lesion growth and lower parasite burden were found that was associated with increased IFN-gamma and IL-10 responses in the lesion-draining lymph nodes. These results support a role for LPG in the dual route-related effect of LaAg and shows its strong potential as a defined needle-free and adjuvant-free vaccine for cutaneous leishmaniasis.     

Relationship between repetitive work and the prevalence of carpal tunnel syndrome in part-time and full-time female supermarket cashiers: a <Emphasis Type="Italic">quasi</Emphasis>-experimental study

Objectives To investigate the prevalence of Carpal Tunnel Syndrome (CTS) in full-time and part-time supermarket cashiers exposed to a different weekly duration of biomechanical load. Methods All the 269 cashiers and 127 office workers were asked to participate. The protocol included ergonomic risk assessment, collection of personal and clinical data and bilateral electrodiagnostic study of the median nerve. CTS symptoms were defined as past and/or current nocturnal and/or diurnal numbness, tingling, burning or pain involving at least one of the first three fingers. Results were evaluated according to two case definitions based on current symptoms and on the combination of current symptoms and slowing of sensory conduction velocity from wrist to palm, respectively. Difference in proportions of CTS symptoms and cases was evaluated by the Pearson’s chi-square (χ²) test, univariate and multivariate logistic regression analyses were performed to determine the impact of weekly exposure. Results The final female study population included 71 full-time cashiers, 155 part-time cashiers and 98 office workers. Ergonomic risk level was rated 5 for hand activity level and 4 for peak of force according to ACGIH. The intersection of the two values fell on the threshold limit value line, confirming the possible exposure to biomechanical risk factors for CTS. The prevalence of current CTS symptoms was higher among full-time (31.0%) than in part-time cashiers (19.3%) or controls (16.3%) (p = 0.055). A similar pattern was found for CTS past symptoms and cases. Univariate analysis showed that full-time cashiers had a 2.3 fold increased risk for CTS specific current symptoms than control subjects. A similar trend also emerged for CTS cases but was not significant (Odds ratios 1.23). Multivariate logistic regression analysis confirmed the increased risk for CTS current symptoms in full-time cashiers. Conclusions Intensive manual work associated with inadequate recovery time might have generated an impairment of the median nerve at the wrist level proportionally increasing with duration of hand use. Our study can provide useful information both for ergonomic risk assessment and work organization.     

Risk of early or severe pre-eclampsia related to pre-existing conditions

BACKGROUND: Preeclampsia (PE), especially severe or early PE, is a leading cause of morbidity and mortality among mothers and infants. We estimated the population attributable fractions of severe or early PE associated with pre-existing conditions among nulliparous and multiparous women. METHODS: Among 70 924 women in the Danish National Birth Cohort, we used hospital discharge data to identify 2117 cases of PE, of which 449 were early (<37 weeks), 426 were severe (clinically diagnosed) and 228 were both early and severe. Prospective interview data were supplemented with hospital registry data to identify women with pre-existing conditions. Generalized estimating equations were utilized to estimate adjusted relative risks, and population attributable fractions were calculated with 95% CI. RESULTS: Pre-existing hypertension, diabetes, obesity or multiple gestation were associated with 22.3% (19.8-24.9) of all PE cases among nulliparous women. These conditions, or a prior preeclamptic pregnancy, were associated with 52.2% (46.4-57.9) of PE among multiparous women. Early PE was preceded by these pre-existing conditions among 34% (28.3-40.0) of affected nulliparous women and among 50% (37.5-63.4) of multiparous women. The fraction of severe PE associated with these conditions was 23% among nulliparas and 59% among multiparas. Being obese or overweight was associated with 15-17% of the population risk of early PE among nulliparous and multiparous women. CONCLUSIONS: Pre-existing maternal and obstetric conditions are associated with a high proportion of severe or early cases of PE. Obesity and overweight contributed independently to the risk of pre-term PE, a finding with potentially profound public health implications.     

Brain tissue volume changes in relapsing-remitting multiple sclerosis: correlation with lesion load

The aim of this study was to simultaneously measure in vivo volumes of gray matter (GM), normal white matter (WM), abnormal white matter (aWM), and cerebro-spinal fluid (CSF), and to assess their relationship in 50 patients with relapsing-remitting multiple sclerosis (RR-MS) (age range, 21-59; mean EDSS, 2.5; mean disease duration, 9.9 years), using an unsupervised multiparametric segmentation procedure applied to brain MR studies. Tissue volumes were normalized to total intracranial volume providing corresponding fractional volumes (fGM, faWM, fWM, and fCSF), subsequently corrected for aWM-related segmentation inaccuracies and adjusted to mean patients' age according to age-related changes measured in 54 normal volunteers (NV) (age range 16-70). In MS patients aWM was 23.8 +/- 29.8 ml (range 0.4-138.8). A significant decrease in fGM was present in MS patients as compared to NV (49.5 +/- 3.2% vs 53.3 +/- 2.1%; P < 0.0001), with a corresponding increase in fCSF (13.0 +/- 3.8% vs 9.1 +/- 2.4%; P < 0.0001). No difference could be detected between the two groups for fWM (37.5 +/- 2.6% vs 37.6 +/- 2.2%). faWM correlated inversely with fGM (R = -0.434, P < 0.001 at regression analysis), and directly with fCSF (R = 0.473, P < 0.001), but not with fWM. There was a significant correlation between disease duration and EDSS, while no relationship was found between EDSS or disease duration and fractional volumes. Brain atrophy in RR-MS is mainly related to GM loss, which correlates with faWM. Both measures do not appear to significantly affect EDSS, which correlates to disease duration.     

The degree of HIV-1 amino acid variability is strictly related to different disease progression rates

The aim of this study is to evaluate the amino acid variability of HIV-1 Gp41, C2–V3, and Nef in a group of patients characterized by different disease progression rates. HIV-1 sequences were collected from 19 Long term non progressor patients (LTNPs), 9 slow progressors (SPs), and 11 rapid progressors (RPs). Phylogenetic trees were estimated by MEGA 6. Differences in amino acid variability among sequences belonging to the 3 groups have been evaluated by amino acid divergence, Shannon entropy analysis, and the number of amino acid mutations (defined as amino acid variations compared with HxB2). The involvement of amino acid mutations on epitope rich regions was also investigated. The population was mainly composed of males (74.3%) and HIV-1 subtype B strains (B: 92.32%, CRF_12BF, A1, C: 2.56% each). Viral load (log₁₀ copies/mL) and CD4⁺T cell count (cells/mm³) were 3.9 (3.5–4.2) and 618 (504–857) in LTNPs, 3.3 (2.8–4.7) and 463 (333–627) in SPs, and 4.6 (4.3–5.3) and 201 (110–254) in RPs. Gp41 and C2–V3 amino acid divergence was lower in LTNP and SP strains compared to RPs (median value: 0.085 and 0.091 vs. 0.114, p?=?0.005 and 0.042) and a trend of lower variability was observed for Nef (p?=?0.198). A lower entropy value was observed at 10, 3, and 7 positions of Gp41, C2–V3, and Nef belonging to LTNPs and at 7, 3, and 1 positions of Gp41, C2–V3, and Nef belonging to SPs compared with RPs (p?<?0.05). Focusing on epitope rich regions, again a higher degree of conservation was observed in Gp41 and C2–V3 sequences belonging to LTNPs and SPs compared to those belonging to RPs. This study shows that the extent of amino acid variability correlates with a different HIV-1 progression rate. This variability also involves CTL epitope rich regions, thus suggesting its involvement in the immune escape process modulation.