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Study design:Retrospective study.Objective:To compare the rehabilitation outcomes of non-traumatic and traumatic spinal cord injury patients.Setting:Spinal cord unit of a rehabilitation hospital in Italy.Patients and methods:In total, 380 patients at first rehabilitation stay after the lesion (144 traumatic patients and 236 non-traumatic patients; 244 men and 136 women; mean age 46.1±19.9 years; mean lesion to admission time 49.6±39.8 days).Interventions:Not applicable.Measures:American Spinal Injury Association standards; Barthel index (BI), Rivermead mobility index and walking index for spinal cord injury. Statistical analysis: Poisson regression models with relative risks and 95% confidence intervals adjusted for the following confounders: age, sex, lesion level and Asia impairment. Models were stratified by age because a strong interaction between different variables and age was found.Results:Traumatic and non-traumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower BI score at admission and significantly better improvement in the BI score by discharge. The two populations were discharged with similar functional outcome. No significant differences were found with regard to the others outcomes.Conclusions:In clinically stable patients, spinal cord injury etiology does not seem to affect the rehabilitative prognosis. At admission, traumatic patients show lower autonomy in daily life activities, probably because of the associated lesions that these patients often have. At discharge, traumatic and non-traumatic spinal cord lesion patients achieved similar results with regard to neurological and functional improvement. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the capability to capture the major number of death cases of different criteria. Home Accidents (HA) data come from a pilot surveillance of all the HA occurring in Lazio Region, Italy 2000. The surveillance is integration between the emergency department information system (ElS), the hospital information system (HIS), and the mortality registry (MR). The gold standard definition of HA mortality in this study was obtained through an analysis of the hospitalization story and of death certificates. Three definitions of HA mortality have been tested: inhospital mortality (IHM); mortality within 30 days from the ED admission or hospital discharge (M30d); and mortality for a trauma/poisoning death cause. High mortality rates has been reported among older people.

A case-control study on lung cancer and radon exposure in dwellings has been carried out in Lazio, a high indoor radon region of Central Italy. A total of about 400 cases and 400 controls were recruited and radon concentration was measured in a total of about 1850 dwellings. In each dwelling, radon concentration measurement devices were placed in both the main bedroom and living room for two consecutive six-month periods. Each radon device, enclosed in a sealed polyethylene bag, contains two LR 115 detectors, each being covered by a thin absorber to reduce the alpha-energy within the detector sensitive range. A quality assurance program, described in this paper, was applied in order to reduce radon concentration measurement uncertainty, which have a significant impact on the results of an epidemiological study. The reported internal quality control and intercomparison results are compared with the results of other studies, and show that the radon measurement precision and accuracy obtained in this study can be considered quite good. [Copyright &y& Elsevier]

Objectives: to evaluate the impact of the SARS-CoV-2 epidemic on the access to the emergency services of the Lazio Region (Central Italy) for time-dependent pathologies, for suspected SARS-CoV-2 symptoms, and for potentially inappropriate conditions., Design: observational study., Setting and Participants: accesses to the emergency departments (EDs) of Lazio Region hospitals in the first three months of 2017, 2018, 2019, and 2020., Main Outcome Measures: total number of accesses to the emergency room and number of specific accesses for cardio and cerebrovascular diseases, for severe trauma, for symptoms, signs, and ill-defined conditions, and for symptoms related to pneumonia., Results: in the first 3 months of 2019, there were 429,972 accesses to the EDs of Lazio Region; in the same period of 2020, accesses arise to 353,806, (reduction of 21.5%), with a 73% reduction in the last three weeks of march 2020 as compared with the corresponding period of 2019. Comparing the first 3 months of the 2017-2019 with 2020, the accesses for acute coronary syndrome and acute cerebrovascular disease decreased since the 10th week up to more than 57% and 50%, respectively. The accesses due to symptoms, signs, and ill-defined conditions, proxy of potentially inappropriate conditions, decreased since the 8th week, with a maximum reduction of 70%. Access to severe trauma decreased by up to 70% in the 11th week. The accesses for pneumonia increased up to a 70% increment in the 12th week., Conclusions: the evaluation of accesses to emergency services during the SARS-CoV-2 epidemic can provide useful elements for the promotion and improvement of the planning, for the management of critical situations, and for the reprogramming of the healthcare offer based on clinical and organizational appropriateness.

Objective: This study was aimed at evaluating differences in breastfeeding initiation rates by maternal place of birth among women giving birth in one of 14 hospitals in Lazio, Italy, between 2006 and 2011., Methods: The data on 14 hospitals for this study were taken from a survey on healthy newborns carried out during the month of October each year. It collected information on maternal characteristics and infant feeding during the hospital stay. The exposure variable was maternal place of birth. The outcome variable was infant feeding during hospital stay classified as exclusive breastfeeding, predominant breastfeeding (PBF), complementary feeding or formula feeding. Both a descriptive analysis and a logistic regression on infant feeding (exclusive/PBF versus partial or non-breastfeeding) by maternal place of birth were carried out. The logistic regression model was adjusted for confounding factors. A random effect model was used to take into account the correlation of data among the hospitals., Results: Among the 6505 mothers included in this study, 18.7% were born in non-industrialized countries. Overall, 64.9% of mothers exclusively breastfed their babies, with lower prevalence among Asiatic mothers. The logistic model confirmed that breastfeeding was lower among infants born to Asian mothers (OR: 0.52; 95% CI: 0.35-0.77) compared with other groups, taking into account the effect of the other variables included in this model. Intracluster correlation was equal to 26%, showing that the hospital's model of care is a strong predictor of the initiation of breastfeeding., Conclusions: These data are useful for targeting disadvantaged groups when promoting breastfeeding.

Background: The fetal and infant life are periods of rapid development, characterized by high susceptibility to exposures. Birth cohorts provide unique opportunities to study early-life exposures in association with child development and health, as well as, with longer follow-up, the early life origin of adult diseases. Piccolipiù is an Italian birth cohort recently set up to investigate the effects of environmental exposures, parental conditions and social factors acting during pre-natal and early post-natal life on infant and child health and development. We describe here its main characteristics., Methods/design: Piccolipiù is a prospective cohort of expected 3000 newborns, who will be recruiting in six maternity units of five Italian cities (Florence, Rome, Trieste, Turin and Viareggio) since October 2011. Mothers are contacted during pregnancy or at delivery and are offered to participate in the study. Upon acceptance, their newborns are recruited at birth and followed up until at least 18 years of age. At recruitment, the mothers donate a blood sample and complete a baseline questionnaire. Umbilical cord blood, pieces of umbilical cord and heel blood spots are also collected. Postnatal follow-up currently occurs at 6, 12, and 24 months of age using on-line or postal self administered questionnaire; further questionnaires and medical examinations are envisaged. Questionnaires collect information on several factors, including mother's and/or child's environmental exposures, anthropometric measures, reproductive factors, diet, supplements, medical history, cognitive development, mental health and socioeconomic factors. Health promotion materials are also offered to parents., Discussion: Piccolipiù will broaden our understanding of the contribution of early-life factors to infant and child health and development. Several hypotheses on the developmental origins of health can be tested or piloted using the data collected from the Piccolipiù cohort. By pooling these data with those collected by other existing birth cohorts it will be possible to validate previous findings and to study rare exposures and outcomes.

The aim of this study was to evaluate the combined influence of several lifestyle, health and housing factors in the occurrence of home injuries (HIs) among the elderly. The subjects were recruited from 10 hospitals in Rome, Italy. This study is a paired case-control study. Cases included subjects, aged 65-85 years, who visited the Emergency Department for an HI and were subsequently hospitalised (15 September 2004-30 June 2005). Controls were the subjects of the same gender, age (±3 years) and area of residence of cases. A conditional logistic regression model was used for analysing the variables obtained. In this study, we enrolled 107 hospitalised cases. It was found that the living room was the place where 33% of the accidents occurred. Eighty-seven per cent of the accidents were falls, and 33% of the accidents were the immediate consequence of sudden malaise. One-half of the cases reported one or more leg fractures. The variables that were independently associated with HI were poor household illumination, poor emotional status, regular physical activities and housekeeping activities. We conclude that this study shows the areas of intervention to target HI prevention activities.

The aim of this population-based study was to estimate the risk of postpartum maternal complications associated with mode of delivery in a population of low-risk pregnancies. Data from 324,883 full-term singleton births between 2001 and 2007 were retrieved from birth and hospital discharge databases of the Lazio Region, Central Italy. Women with breech presentation births and those with chronic/pregnancy-related diseases in the mother/fetus were excluded. The association between mode of delivery and maternal outcome was estimated for women by odds ratios (ORs), adjusted for potential confounders. Of nulliparous women 78.6% intended vaginal delivery, while for multiparous this was 68.6%. Elective cesarean section was associated with a higher risk of hysterectomy, obstetric shock and anesthetic complications compared with women in the intended vaginal delivery group. This suggests there is a need for a program to reduce unnecessary elective cesarean sections.

Background: Many emergency departments use a rating system to establish priority based on urgency: "triage". The aim of this study was to evaluate the validity of triage in predicting hospitalization and mortality compared to that of the ICD-9-CM based Injury Severity Score (ISS)., Sources: The Emergency Information System 2000, the Hospital Information System 2000-2001 and the Mortality Register 2000-2001, of the Lazio Region. Case selection: Emergency department visits for traumas that occurred on the road or at home., Outcomes: Hospitalization and 30-day mortality. For each case, trauma diagnoses from the ICD-9-CM were given a corresponding ISS value. We performed logistic models, including age, sex and, alternatively, triage or ISS. We compared discrimination measures and calibration of the models., Results: Out of 264,709 emergency department visits, 22,249 (8.4%) were followed by a hospitalization and 655 (0.2%) died within 30 days. ISS scores were calculated for 72,179 (27%) cases. Of the most urgent triage (840 patients), 78.3% (658) were hospitalized and 9% (76) died, while among patients with ISS > or = 16 value (1276) 36.4% (464) of were hospitalized and 1.8% (23) died. Measures of discrimination and calibration showed similar results. The triage model had a better fitness in predicting hospitalization probability for home accidents (Hosmer-Lemeshow statistic: chi(2)(triage)=5.5 vs chi(2)(ISS)=34.3) and had a better performance for road accidents (ROC(triage)=0.71 vs ROC(ISS)=0.66). There were no differences between the models in predicting the probability of death., Conclusions: The agreement between the two scales confirms the validity of triage as a clinical management tool in the emergency department, and as a proxy of trauma severity., (2010 Elsevier Ltd. All rights reserved.)

Road traffic injuries represent a relevant public-health problem. In the Lazio region of Italy, a surveillance system was activated. The aim of this work is to describe the surveillance system and report the health information in terms of temporal trends for the 5-year period 2001-2005. We identified all emergency department (ED) visits in the emergency database and then linked them with hospital discharges and mortality registry. From the integrated database, we calculated the rates of emergency room visits, of hospital admissions, and of mortality, reporting the temporal trends. Between 2001 and 2005 the rate of ED visits was 3151 per 100,000 inhabitants. Hospitalisation rates showed a significant decreasing trend. The surveillance identified 22% more deaths in the study period than reported by the official statistics. The surveillance revealed a decreasing trend for hospital admissions and a decline in deaths in 2003 concurrent to the introduction of the driver's licence point system.

A morbidity study of the population of a district of Rome built in part under a 60 kV electric distribution line, included 345 subjects resident in the study area in any period between 1954 and 2003, excluding those deceased before 1998. Residential magnetic field levels were estimated based on current load, line characteristics, and distance of the dwellings from the power line, and the study area was divided into sub-areas with differing magnetic field levels. Standardized morbidity ratios were computed from hospital discharge records dated 1998-2003. Non statistically significant increases were observed for all and primary cancers; primary cancers were significantly increased among subjects with > 30 years' residence and latency. A significant increase for all, primary, and secondary cancers, and a two-fold increase for ischaemic diseases, was observed in subjects in the sub-area with the highest exposure. No increase was seen in neoplastic haematological diseases.

The aim of this study is to evaluate the association between the mode of delivery and the risk of neonatal respiratory complications in a cohort of term newborns in the Lazio region, Italy. Data on 139,379 term singleton infants born in 2003-2005 were retrieved from birth and hospital discharge database. Odds Ratios (ORs) adjusted by age, parity, birth weight, gestational age, and gender were calculated using logistic regression models. The rate of prelabor cesarean section (CS) was 26.2%. The rates of neonatal respiratory morbidity were 29.6/1,000 in infants delivered by prelabor CS and 17.4/1,000 in infants delivered vaginally or by CS in labor. The adjusted risk of neonatal respiratory morbidity associated with prelabor cesarean birth at 37 weeks is four times higher than in intended vaginal birth after 37 weeks. Prelabor cesarean delivery should be performed after at least 38 weeks' of gestation in order to minimize neonatal respiratory morbidity.

Setting: Lazio region (5.15 million, including Rome, 2.8 million), Italy., Objective: To monitor pulmonary tuberculosis (TB) epidemiology from 1997 to 2003., Design: We used data from the mandatory National Infectious Diseases Surveillance system, the regional Hospital Information System and the regional Mortality Register. The number of prevalent pulmonary TB cases hospitalised was determined by linking notifications and hospitalisations. To estimate incidence, we excluded all cases with previous TB hospitalisations since 1995, and those reported as a secondary diagnosis in the Hospital Information System. Mortality rates were ascertained from mortality records reporting TB as the principal cause of death., Results: The record linkage identified 4885 incident cases, 9010 hospital prevalent cases and 217 deaths. Incidence decreased from 15/100000 in 1997 to 11 in 2003, and consistent decreases were also observed in hospitalisation prevalence and mortality (P for trend <0.0005, <0.0005 and =0.063, respectively). The number of AIDS-related TB cases dropped from 85 to 49 (P < 0.0005). The number of incident cases in non-Italians increased significantly, from 171 to 267 (P < 0.0005). Notification underreporting was estimated at 39%., Conclusions: Despite a decreasing trend, TB incidence is still over 10/100000 in Lazio region. Targeted interventions for immigrant populations are essential for controlling TB.

Unlabelled: The aim of this longitudinal study was to test different operational definitions of home accident mortality., Methods: The sources of data were the Emergency Information System, hospital discharge reports and the mortality registry of the Lazio Region, 2000-2001. We selected all emergency room visits for unintentional traumas that occurred at home. A 9-month follow-up was performed to calculate mortality rates. A sensitivity analysis of in-hospital mortality, deaths within 30 days and deaths from home accident E-codes was performed. A gold standard definition of home accident-related deaths was proposed., Results: We observed 598 home accident-related fatalities (29.1% of all the deaths found in the follow-up study). In-hospital mortality, deaths within 30 days and deaths for home accident E-codes had sensitivity values of 63.4%, 63.4% and 59.4%, respectively; positive predictive values were 78.1%, 67.1% and 100%, respectively., Conclusions: The best operational definition of home injury was based on in-hospital mortality, while mortality based on E-codes reported on death certificates was lacking. In order to measure the real burden of home injuries, hospital and mortality data must be integrated.

Background: Various factors contribute to the quality of care of an injured patient at the emergency room (ER), and a correct diagnosis can improve and accelerate care. The aim of this study was to evaluate the agreement between diagnoses assigned in the ER and those assigned after hospital admission to patients with unintentional injuries. We also tried to determine the factors that influenced the disagreement, and to evaluate if discordant diagnoses were associated with higher mortality risk., Methods: All ER visits for unintentional injuries that were followed by hospital admission at the 60 emergency departments in the Lazio Region in 2000. Concordant diagnoses (ER/discharge) were established based on the Barell matrix cells. Logistic regression was used to assess the role of individual and ER care factors on the probability of concordance. A logistic regression was performed, where death within 30 days was the outcome and concordance was the determinant., Results: We considered 22,892 ER visits for injury that were followed by hospital admission. In 62.2% of cases, the ER and discharge diagnoses were concordant. Higher concordance was found for older patients and less urgent cases. Factors influencing concordance were the hour of the visit, ER specialization degree, initial outcome, and length of hospital stay. Patients who had disconcordant diagnoses had a 30% higher probability of death., Conclusions: A correct diagnosis (i.e. confirmed at hospital discharge) at first contact with the emergency room is associated with lower mortality. Comparing administrative ER and hospital discharge data can be useful in emergency department management studies.

Aim: To study the relationship between respiratory/allergic disorders and chronic environmental tobacco smoke (ETS) exposure to husband or at workplace among non-smoking women of a general population in Italy., Methods: Analyses regard 2195 married or employed women. Information was collected through a self-administered questionnaire. ETS exposure was validated by salivary cotinine., Results: Exposure both to husband and at work resulted a significant risk factor for current dyspnoea (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.20-2.16), any shortness of breath at rest (OR 2.81, 95% CI 1.83-4.30), recent wheeze (OR 1.71, 95% CI 1.04-2.82), recent attacks of shortness of breath with wheeze (OR 1.85, 95% CI 1.05-3.26), asthma diagnosis/symptoms (OR 1.50, 95% CI 1.09-2.08), diagnosis of asthma or bronchitis/emphysema (obstructive lung diseases (OLD)) (OR 2.24, 95% CI 1.40-3.58), current cough/phlegm (OR 1.52, 95% CI 1.07-2.15), and rhino-conjunctivitis (OR 1.48, 95% CI 1.13-1.94). Exposure only at work yielded higher adjusted odds ratios for all health conditions, except for rhino-conjunctivitis. Overall, about 24% of shortness of breath at rest, 16% of dyspnoea, 17% of rhino-conjunctivitis, 12% of OLD, and 10% of asthma diagnosis/symptoms are attributable to the effect of exposures to both husband and at work. Twelve percent of shortness of breath at rest and 10% of rhino-conjunctivitis cases might be avoided by eliminating exposure only at work and only to husband, respectively., Conclusions: Lifetime ETS exposure, especially at work, is associated with respiratory symptoms/diseases, and it accounts for a sizeable proportion of such disorders. The combined effect of both exposures is higher than the separate effects.

Objective: The penalty point system was introduced in Italy in June 2003. The aim of this study was to evaluate the health effects of this legislation in the Lazio region., Methods: Poisson models were used to compare emergency department visits, hospitalizations and death between the pre-law and post-law periods (July 2001-June 2003; July 2003-June 2004)., Results: The emergency department visit rate ratio (RR) of the two periods was 0.87 (95% confidence interval (CI) 0.86 to 0.88); the corresponding hospital admission RR was 0.87 (95% CI 0.84 to 0.9). The death RR was 0.93 (95% CI 0.82 to 1.05)., Conclusion: After the legislation was introduced, there were fewer visits to the emergency department, hospitalizations and death from road traffic injuries. However, the effect was lower than expected, and it decreased over time.

Objective: The aim of this study is to quantify the incidence of home injuries using an integrated surveillance system. It aims to estimate home accident mortality., Material and Methods: The sources of data for this epidemiological descriptive study were the emergency information system, the hospital information system and the mortality registry of Lazio Region, 2000-2001. We selected all emergency department (ED) visits for unintentional traumas that occurred at home. We calculated incidence of ED visits, hospitalisation and mortality rates by sex and age., Results: In the year 2000, 145101 persons visited the ED (2700/100000), 8.1% of whom were then admitted to the hospital. Incidence was higher among children and older people. We observed 620 fatalities, a rate of 0.43%. The mortality registry reported 1042 deceased, a home accident-related mortality rate of 31.1/100000., Conclusions: Unintentional injuries in the home are a relevant public health problem. Since none of the databases used in the study give a complete measure of the burden of home injuries, we combined the data from all of them to estimate the mortality and the burden of home injuries. Interventions for prevention must identify the specific accidents/injuries they are trying to reduce in order to focus their intervention on the appropriate population.

Objective: Several studies have suggested an association between snoring and hypertension. An association between rhinitis and hypertension has been recently indicated in men but not in women. Since menopausal status is an important determinant of blood pressure, we evaluated the relationship between rhinitis, snoring and blood pressure taking into account the modifying effect of menopausal status., Design: Cross-sectional survey., Settings: Four areas of Italy: the Po river Delta, Pisa (Tuscany), Viterbo (Lazio) and Rome., Main Outcome Measures: Data were collected by a questionnaire and a medical visit., Participants: One thousand five hundred and fifty-four female non-smokers., Results: Systolic blood pressure (SBP) was significantly related to both occasional and habitual snoring in the overall sample. No associations were found between SBP, snoring, and rhinitis in pre-menopausal women. Both occasional and habitual snoring, but not rhinitis, were significant risk factors for increased SBP in women who stopped menstruating fewer than 11 years previously (beta=10.27 mmHg, 95% confidence interval (CI)=3.5, 17.01 and beta=9.91 mmHg, 95% CI=2.3, 17.5, respectively). However, women who had been menopausal for more than 11 years were found to have an increased SBP if they were occasional snorers (beta=8.94 mmHg 95% CI=1.2, 16.6) or habitual snorers (beta=8.01 mmHg, 95% CI=0.10, 15.9). The increase in SBP was even greater in these women when habitual snoring was associated with rhinitis (beta=11.96 mmHg, 95% CI=1.01, 22.9)., Conclusion: We suggest that the association of snoring with rhinitis may facilitate the development of apnea during sleep, which in post-menopausal women may increase the risk of developing hypertension.

Objective: road traffic and home accidents are one of the leading causes of death for infants and adolescents between 0-18 years of age. This study aimed to describe the injuries of children in the Lazio Region, in the year 2000., Design: retrospective cohort study., Setting: road traffic and home accident injury visits to all Emergency Departments (ED) in the Lazio region during 2000, Hospital discharges in the region during 2000-2001, integrated through deterministic linkage strategy, Participants: all children aged 0-18 who visited one of the ED for home or road traffic injuries., Main Outcome Measures: we computed ED visits and hospitalisation rates and stratified them by sex, age and place of residence. Cases were classified by body region and type of lesion. IRR and 95% confidence intervals have been estimated using Poisson Regression., Results: the rate of home accident visits was particularly high among children aged 1-5 years (55.2/1000), while the highest rate for road traffic injuries was in 14-18 year old children (53.8/1000). Girls had a lower hospitalisation rate than boys. Higher hospitalisation rates were found for children living outside of Rome. The body region most frequently injured in road traffic accidents was the lower extremities (28.4%), while most frequently injured in home accidents was the head and neck (34.8%)., Conclusion: this study shows how integrating different systems of surveillance can provide a more complete picture of injuries from road and home accidents, that is difficult to obtain using other sources. The youngest children are at high risk of home accidents while teen-agers are at risk for road traffic injuries.

Purpose: In the Lazio region, Italy, mammographic screening programmes were gradually activated from 1999 to 2003, providing an opportunity to compare two unselected populations in the same time period: women who were contacted in writing, and those who had not been contacted. In this study, we compare the incidences of treatments for benign and malignant neoplasms in the two groups., Methods: The target population was women aged 50-69 years. We linked all incident cases of surgery for benign and malignant breast neoplasms, from the Hospital Information System (1999-2003) to the Mammographic Screening Information System (1999-2001). We calculated incidence, adjusted for age and standardized breast cancer mortality ratio in each area of residence, for benign and malignant neoplasms surgery in non-yet-contacted and contacted woman. Incidence for contacted women was calculated for the two years following initial contact., Results: The target population in Lazio is 681,000; 116,000 women were contacted during the study period and 3252 malignant and 1566 benign neoplasms were surgically treated. Annual incidence was, respectively, 2.0/1000 and 1.1/1000 for malignant and benign neoplasms in women not contacted, and, respectively, 2.9/1000 and 1.1/1000 in the contacted population. Among the contacted group, annual incidence was 4.3/1000 and 1.5/1000 in compliant women, and 2.0/1000 and 0.9/1000 in non-compliant women. About one-half of the surgeries for benign neoplasms in compliant women were treated against the recommendation of the screening programme., Conclusions: The implementation of the screening programme did not increase the incidence of treatment for benign neoplasms, and detected 50% more malignant neoplasms.

Background: The aim of this study was to compare cotinine determinations in three biological fluids for assessing environmental tobacco smoke (ETS) exposure in female non-smokers (n=1605) in Italy., Methods: Information about ETS exposure at home, in the workplace, and in other places within the previous week was collected via questionnaire. Plasma, salivary and urinary cotinine levels were measured. Cotinine levels of > or =0.1 ng/mL for plasma, > or =0.2 ng/mL for saliva, and > or =0.5 ng/mL for urine were used to determine biochemical exposure., Results: Median cotinine levels were significantly higher in exposed than in unexposed women (0.21 vs. 0.05 ng/mL in plasma, 0.80 vs. 0.41 ng/mL in saliva, and 9.74 vs. 5.30 ng/mL in urine). Self-reported ETS exposure was significantly related to biochemical exposure [odds ratio 2.99, (95% CI 2.40-3.72) for plasma; 1.90 (1.51-2.39) for saliva; and 2.67 (2.14-3.34) for urine]. Cotinine significantly increased with increasing exposure level, regardless of the exposure source. Among self-reported exposed subjects, higher percentages of cotinine level above the cut-off, i.e., indicating exposure, were found in saliva (76%) and urine (75%) than in plasma (52%)., Conclusions: In general, women correctly reported their ETS exposure status. Both non-invasive salivary and urinary cotinine determinations seem preferable in epidemiological studies, in view of their higher sensitivity, when compared to plasma cotinine.

Study Objective: Road crashes are the leading cause of death for young adults in industrialized countries. In most countries, the only data available are the police-based statistics, which report the number of deaths and injuries, without any information about severity or diagnosis. We describe the results of an emergency department (ED)--based integrated surveillance system of road-crash health consequences in the Lazio region (5.3 million inhabitants) for 2000., Methods: We identified all ED visits in the emergency database and then linked them with hospital discharges and mortality registry. Deaths that occurred at the site of the crash were identified in the mortality registry. Cases are classified according to body region affected, nature of the injury, and severity., Results: We found 146,600 cases, for an overall incidence of 2,700 per 100,000 and a peak of 8,000 per 100,000 in 20- to 24-year-old men. There were 597 fatalities for men and 205 female fatalities, with an overall mortality of 15.9 per 100.000 and a hospitalization rate of 224 per 100,000., Conclusion: Our surveillance system reported a 6-times-higher incidence of road-traffic injuries, with 139 more fatalities than the national statistics of the same year. The underreporting in police reports and the absence of diagnostic information reveal the need for health-based surveillance systems of road-traffic injuries.

Background: Several international guidelines have recommended the involvement of general practitioners (GPs) in screening programs, but current evidence suggests this is very difficult. We implemented a survey to understand the attitudes, knowledge, and practices regarding colorectal cancer screening of GPs in the Lazio region., Methods: Survey of all GPs working in 13 of the 50 districts in Lazio using a mail-in questionnaire., Results: Out of 1192 GPs, 699 responded (59%). Ninety-four percent consider CRC a preventable disease. Knowledge about oncological screenings is higher in GPs using the guidelines as source of information. Twenty-five percent properly recommend the available screening tests for colorectal cancer, 22% do not recommend any, 6% under-recommend, and 47% over-recommend. Adequate knowledge of oncological screenings is positively associated with correct recommendation. Thirty-two percent of GPs recommend inappropriate follow-up tests for patients with positive fecal occult blood test., Conclusions: The low response rate reveals the lack of GP's interest in screening. Knowledge about screening and use of guidelines as sources of scientific information are important factors to improve attitudes about screening, but there is a large percentage of well-informed GPs who do not recommend colorectal cancer screening at all. Currently, many GPs do not properly follow the patients up after a positive FOBT.

Aim of the study is to describe the characteristics of road, home and work-related traumas among adult immigrants born in non-industrialised Countries, and to compare the consequent probability of hospitalisation with Italian adults in Lazio Region, year 2000. Source of data is the Emergency-based Surveillance System, which collects all the emergency ward visits in Lazio region. Accident incidence has been estimated using alternatively the residence permits and the roman resident population born in non-industrialised Countries. The 7.7% of all the emergency visits of immigrants are trauma-related. Road traffic accident visits are more appropriate and urgent. Immigrants have a higher risk of hospitalisation both for road and home accidents compared to the Italians (OR = 1.59 and OR = 1.37 respectively). Immigrants use emergency wards for severe and urgent trauma-related accidents, they have higher probability of hospitalisation compared to the Italians. Our analysis highlights the necessity to improve tools to study immigrant health.

We performed a case-control study in Lazio, a region in central Italy characterized by high levels of indoor radon, Mediterranean climate and diet. Cases (384) and controls (404) aged 35-90 years were recruited in the hospital. Detailed information regarding smoking, diet and other risk factors were collected by direct interview. Residential history during the 30-year period ending 5 years before enrollment was ascertained. In each dwelling, radon detectors were placed in both the main bedroom and the living room for 2 consecutive 6-month periods. We computed odds ratios (ORs) and 95% confidence intervals (CIs) for time-weighted radon concentrations using both categorical and continuous unconditional logistic regression analysis and adjusting for smoking, diet and other variables. Radon measurements were available from 89% and 91% of the time period for cases and controls, respectively. The adjusted ORs were 1.30 (1.03-1.64), 1.48 (1.08-2.02), 1.49 (0.82-2.71) and 2.89 (0.45-18.6) for 50-99, 100-199, 200-399 and 400+ Bq/m(3), respectively, compared with 0-49 Bq/m(3) (OR = 1; 0.56-1.79). The excess odds ratio (EOR) per 100 Bq/m(3) was 0.14 (-0.11, 0.46) for all subjects, 0.24 (-0.09, 0.70) for subjects with complete radon measurements and 0.30 (-0.08, 0.82) for subjects who had lived in 1 or 2 dwellings. There was a tendency of higher risk estimates among subjects with low-medium consumption of dietary antioxidants (EOR = 0.32; -0.19, 1.16) and for adenocarcinoma, small cell and epidermoid cancers. This study indicates an association, although generally not statistically significant, between residential radon and lung cancer with both categorical and continuous analyses. Subjects with presumably lower uncertainty in the exposure assessment showed a higher risk. Dietary antioxidants may act as an effect modifier.

The aim of this study was to evaluate whether risk factors associated with cardiovascular or respiratory diseases and lung cancer occur differently among nonsmoking women in Italy with and without exposure to environmental tobacco smoke (ETS) from husbands that smoke. We performed a cross-sectional study of 1,938 nonsmoking women in four areas of Italy. Data on respiratory and cardiovascular risk factors and on diet were collected using self-administered questionnaires. Medical examinations and blood tests were administered; urine cotinine levels were measured. Nonsmoking women ever exposed to husbands' smoking were compared with unexposed women for several factors: education, husband's education, household crowding, number of children, current or past occupation, exposure to toxic substances at work, parental diseases, self-perceived health status, physician-diagnosed hypertension, hypercholesterol, diabetes, osteoporosis, chronic respiratory diseases, blood pressure medications, lifestyle and preventive behaviors, dietary variables, systolic and diastolic blood pressure, body mass index, waist-hip ratio, triceps skin folds, plasma antioxidant (pro-) vitamins (- and ss-carotene, retinol, l-ascorbic acid, -tocopherol, lycopene), serum total and HDL cholesterol, and triglycerides. Women married to smokers were more likely to be less educated, to be married to a less educated husband, and to live in more crowded dwellings than women married to nonsmokers. Women married to smokers were significantly less likely to eat cooked [odds ratio (OR) = 0.72; 95% confidence interval (CI), 0.55-0.93] or fresh vegetables (OR = 0.63; CI, 0.49-0.82) more than once a day than women not exposed to ETS. Exposed women had significantly higher urinary cotinine than unexposed subjects (difference: 2.94 ng/mg creatinine). All the other variables were not more prevalent among exposed compared to unexposed subjects. The results regarding demographic factors are easily explained by the social class distribution of smoking in Italy. A lower intake of vegetables among exposed women in our study is consistent with the available literature. Overall, our results do not support previous claims of more frequent risk factors for cardiovascular and pulmonary diseases among ETS-exposed subjects. In Italy, as elsewhere in Europe and North America, women who have never smoked but are married to smokers are likely to be of lower social class than those married to never-smokers. However, once socioeconomic differences are considered, the possibility of confounding in studies on the health effects of ETS is minimal.