Health effects costs of particulate air pollution.

We conducted a cross-sectional study in December 1994 in three metropolitan areas of the Rhone-Alpes region in France (Lyon, Grenoble, and Chambéry; total number of inhabitants = 970,000) to assess the medical costs resulting from exposure to particulate air pollution. Probability samples of the general population (508 families, 1265 subjects) and of the physicians (395) and 13 hospital respiratory care and emergency units in the study area provided data on the prevalence of respiratory disorders and on medical care usage. Measurements from air-quality monitoring networks were used to ascribe a fraction of the respiratory morbidity to the ambient air particle concentrations present during the study period, on the basis of attributable risk estimates drawn from recent meta-analyses. The medical care usage and absenteeism related to respiratory disorders were converted into direct and indirect medical and social costs by use of a "cost of illness" approach. These costs were extrapolated to annual costs of disease attributable to particulate pollution in 1994, using daily values of air pollution. The average particulate concentrations during the study period were moderate (39, 41, and 10 micrograms/m3 in the three cities), yielding attributable fractions that ranged between 0.6% and 13.8% according to the health condition and to the city. Three hundred ninety-five subjects reported respiratory symptoms (prevalence, 31.2%) during the study period; 1182 patients visited a doctor and 158 used hospital services. The extrapolated annual estimates of the attributable cost of respiratory diseases for a population of 1 million range between 79 and 135 million French francs (FF) (20th and 80th percentiles of the cost distribution, after a Monte Carlo simulation, respectively; 50th percentile, 107 x 10(6) FF [16.3 x 10(6) Euros]). Over-the counter drug consumption represents the largest cost item (approximately 44% of total costs), followed by wage losses (38%). Hospital expenditures amount to a low percentage of total costs (about 5%) because most respiratory disorders do not require hospital care. Mortality was not considered in this study. Most of these costs occur at relatively low levels of air pollution (67% of the total annual costs are incurred during days with particle concentrations lower than 50 micrograms/m3). Such substantial figures are useful for assessing the social impacts of air pollution and for evaluating the cost efficiency of abatement policies.     

Cardiac function in congenital hypothyroidism: Impairment and response to L-T4 therapy

Summary Electrocardiograms (heart rate, QRS voltage, QRS axis in the frontal plane, Q-Tc interval), echocardiograms [left ventricular fractional shortening (LVFS); preejection period (PEP); PEP/left ventricular ejection time (PEP/LVET) ratio; end-diastolic left ventricular free wall and interventricular septum thickness; presence of pericardial effusion], and thyrotropin (TSH), thyroxine (T₄), and triiodothyronine (T₃) serum levels were evaluated before and 1 week, 1 and 2 months after the start ofl-thyroxine (L-T₄) therapy in 11 infants with congenital hypothyroidism (CH), aged 16–59 days when first seen.Before the start of therapy, infants with CH had significantly lower QRS complexes and LVFS and significantly higher values for Q-Tc, PEP, and PEP/LVET than normal infants of the same age. The QTc interval, PEP and PEP/LVET ratio of infants with CH were significantly greater before than 1 week after L-T₄ therapy, and LVFS was significantly lower before than 1 month after L-T₄ therapy. Four of the infants with CH had small pericardial effusions, which disappeared within the first week of therapy.QRS axis in the frontal plane, Q-Tc interval, and PEP were negatively correlated with logT₄ and logT₃ serum levels. PEP/LVET ratios were negatively correlated with logT₄ serum values. The QRS voltage values were positively correlated with logT₄ and logT₃ serum values. The frontal-plane QRS axis, Q-Tc interval, and PEP/LVET ratio were positively correlated with logTSH serum levels. The QRS voltages were negatively correlated with TSH serum levels.Our data show that before therapy infants with CH have the same functional, but not morphological, abnormalities as older hypothyroid ones and that one third of them have small pericardial effusions. L-T₄ therapy rapidly reverses these changes.     

NEOPLASTIC DISEASE AND DELETION 22q11.2: A MULTICENTRIC STUDY AND REPORT OF TWO CASES

Deletion 22q11.2 is a chromosomal abnormality detected in young patients with clinical manifestations of the DiGeorge/velocardiofacial syndrome. Conotruncal heart defects are also associated with del22q11.2. An association of these cardiac malformations with neoplasias has been observed. Our series includes two cases of malignancies, a hepatoblastoma and a renal-cell carcinoma, arising in children with complex cardiac malformations. The aim of the study was to determine if the deletion at 22q11.2 was present and could be responsible for both pathological processes. Del22q11.2 was identified in both cases. Comparative genomic hybridization revealed terminal gains on chromosomes 1q and Xq and terminal loss on 1p in the hepatoblastoma, and gains in 1p, 12q, 16p, 20q, 22q, and whole chromosome 19 and loss of Xq in the renal-cell carcinoma. Our results confirm a common genetic basis for cardiac malformations, and del22q11.2 presents a risk factor for the development of pediatric tumours.     

Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-1 infection. Italian Register for HIV Infection in Children and the Italian National AIDS Registry

CONTEXT: Since the introduction of combined antiretroviral therapy, mortality rates in adults with human immunodeficiency virus type 1 (HIV-1) infection have decreased. However, little information is available outside the setting of controlled trials on survival of perinatally HIV-infected children treated with antiretroviral therapy. OBJECTIVE: To assess effect of availability of antiretroviral therapy on decreasing mortality in perinatally HIV-infected children. DESIGN: Population-based, multicenter longitudinal study involving data collected by the Italian Register for HIV Infection in Children. SETTING: A network of 106 pediatric clinical centers. SUBJECTS: A total of 1142 children born between November 1980 and December 1997 with perinatally acquired HIV infection with a median follow-up of 5.9 years. MAIN OUTCOME MEASURE: Time to HIV-related death calculated for birth cohort and calendar period and grouped by distribution of predominant type of antiretroviral therapy administered over time. RESULTS: Survival was longer in the 1996-1997 birth cohort (crude relative hazard [RH] of death, 0.39; 95% confidence interval [CI], 0.15-0.96) and 1996-1998 calendar period (crude RH of death, 0.65; 95% CI, 0.45-0.95) than in birth cohort and calendar period 1980-1995, but not when adjusted for maternal antiretroviral treatment during pregnancy and clinical condition at time of delivery, gestational age, and birth weight (adjusted RH of death, 0.55; 95% CI, 0.20-1.50, for birth cohort; and adjusted RH of death, 0.71, 95% CI, 0.43-1.16, for calendar period). In a multivariate model with 1980-1995 as comparison, the 1996-1997 birth cohort had an RH of 0.57 (95% CI, 0.22-1.47; P=.27) but RH for calendar period 1996-1998 was 0.63 (95% CI, 0.47-0.85; P<. 01). When the effects of birth cohort, calendar period, and type of antiretroviral therapy were evaluated simultaneously in the same model, the RH of death was not significantly different from 1.0 for the 1996-1997 birth cohort (P=.19) and calendar period 1996-1998 (P=. 83) suggesting a causal relationship between decreased risk of death and use of combination therapy. The RH of death in children receiving monotherapy or double or triple combination therapy was 0. 77 (95% CI, 0.55-1.08), 0.70 (95% CI, 0.42-1.17), and 0.29 (95% CI, 0.13-0.67), respectively, vs no antiretroviral therapy. CONCLUSION: Survival of perinatally HIV-infected children improved in 1996-1998 as a result of the introduction of combined antiretroviral therapies. JAMA. 2000;284:190-197     

A short history of portal hypertension and of its management

The aim of our study was to review the changing trends in the treatment of complications from portal hypertension. A short history of portal hypertension and of the treatment of its complications is reported, underlying the most important achievements and changes.     

The complexity of cancer survivorship: a case for personalized medicine. Report of the 2014 Grandangolo conference

This article reviews the Grandangolo conference on cancer survivorship and highlights the major findings. These include the improvement in survivorship, and the emergence of survivorship related syndromes, such as new neoplasms, cardiomyopathy, neutorpathy fatigue and memory loss. Emotional disorders may include the Lazarus’ Syndrome and the post-traumatic stress disorder. An open question is whether we should have specialists of survivorship or primary care physicians or oncologists could fulfill this role.     

Living well with kidney disease by patient and care-partner empowerment: Kidney health for everyone everywhere

Living with chronic kidney disease (CKD) is associated with hardships for patients and their care-partners. Empowering patients and their care-partners, including family members or friends involved in their care, may help minimize the burden and consequences of CKD related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney disease and re-engagement in life, including an emphasis on patients being in control. The World Kidney Day (WKD) Joint Steering Committee has declared 2021 the year of “Living Well with Kidney Disease” in an effort to increase education and awareness on the important goal of patient empowerment and life participation. This calls for the development and implementation of validated patient-reported outcome measures to assess and address areas of life participation in routine care. It could be supported by regulatory agencies as a metric for quality care or to support labelling claims for medicines and devices. Funding agencies could establish targeted calls for research that address the priorities of patients. Patients with kidney disease and their care-partners should feel supported to live well through concerted efforts by kidney care communities including during pandemics. In the overall wellness programme for kidney disease patients, the need for prevention should be reiterated. Early detection with a prolonged course of wellness despite kidney disease, after effective secondary and tertiary prevention programmes, should be promoted. WKD 2021 continues to call for increased awareness of the importance of preventive measures throughout populations, professionals, and policy makers, applicable to both developed and developing countries.     

Anemia of aging: the role of chronic inflammation and cancer

Aging is associated with increased incidence and prevalence of anemia, leading to a number of adverse health outcomes. These include death, functional dependence, increased risk of therapeutic complications, falls, and dementia. In approximately 30% of cases, anemia in older individuals is due to either relative or absolute erythropoietin (EPO) deficiency. Absolute EPO deficiency may be primary or secondary to declining renal function. Relative EPO deficiency is due to an age-related pro-inflammatory status that reduces the sensitivity of erythropoietic precursors to EPO. Despite this condition of EPO deficiency, the management of anemia of aging with erythropoiesis-stimulating agents (ESAs) is controversial, unless the anemia is due to renal insufficiency. The main concern related to this treatment arises from eight studies of ESAs in cancer, suggesting that ESAs may reduce patient survival in addition to increasing the risk of deep vein thrombosis. The results of these studies contrast with a host of other trials showing the safety of ESAs. The discrepancy may be explained in part by the fact that, in the trials suggesting a detrimental effect of ESAs, the goal was to obtain hemoglobin (Hb) levels higher than 12 g/dL. Because of this concern, correction of anemia in elderly individuals with relative EPO insufficiency should not be attempted outside clinical trials.