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The aim of the study is to evaluate the association between summer temperatures and emergency department visits (EDVs) in Bologna (Italy) and assess whether this association varies across areas with different socioeconomic and microclimatic characteristics. We included all EDVs within Bologna residences during the summers of 2010–2019. Each subject is attributed a deprivation and a microclimatic discomfort index according to the residence. A time-stratified case-crossover design was conducted to estimate the risk of EDV associated with temperature and the effect modification of deprivation and microclimatic characteristics. In addition, a spatial analysis of data aggregated at the census block level was conducted by applying a Poisson and a geographically weighted Poisson regression model. For each unit increase in temperature above 26 °C, the risk of EDV increases by 0.4% (95%CI: 0.05–0.8). The temperature–EDV relationship is not modified by the microclimatic discomfort index but rather by the deprivation index. The spatial analysis shows that the EDV rate increases with deprivation homogeneously, while it diminishes with increases in median income and microclimatic discomfort, with differences across areas. In conclusion, in Bologna, the EDV risk associated with high temperatures is not very relevant overall, but it tends to increase in areas with a low socioeconomic level.

BACKGROUND: since January 2017, a multidisciplinary research group, involving the Local Health Authority, the Municipality, and the University of Bologna, carried out a city-wide action-research project on health inequalities consistin of an ecological study over the years 2011-2015 based on indicators that are routinely available within health and social services. OBJECTIVES: to document existing geographical inequalities in health outcomes and use of healthcare services in the city of Bologna (Emilia-Romagna Region, Northern Italy), with the aim to suggest policy action to tackle them. DESIGN: the results of the first phase of the above-mentioned project were reported: five related to the social determinants of health (exposure) and five related to the social determinants of ill-health (outcomes). For each municipal statistical area, the distribution of the exposures as well as rates and Bayesian Relative Risks of the outcomes were plotted on the city map. To evaluate the association between social determinants and health outcomes, Spearman correlation coefficients were estimated. SETTING AND PARTICIPANTS: residents in the city of Bologna aged 18 years in the period 2011-2015, grouped into 90 statistical areas. RESULTS: a North-South divide was apparent for most of the socioeconomic and ill-health indicators, with a high concentration of adverse outcomes in the North-Western part of the city. Adherence to cancer screening represented an exception, being greater in the areas with higher proportion of unfavourable health outcomes. An inverse association between education level and health outcomes was found. Low family income was weakly to moderately correlated with health outcomes. Proportion of residents in council houses and of the teenage foreign population showed a moderate to strong association with all outcomes, but mortality and screening adherence. CONCLUSIONS: an ecological analysis based on data that are routinely collected by local health and social institutions can be effective in revealing the geographical patterns of health inequalities. When accompanied by strategic choices aimed at bridging knowledge and action, this approach may facilitate the direct engagement of local actors towards health equity.

Background and aim: Randomized controlled trials have shown that mRNA vaccines are highly effective in preventing SARS-CoV2 infection. We conducted a study to assess the real-world effectiveness of mRNA vaccines (Pfizer-BioNTech or Moderna) in preventing all and symptomatic SARS-CoV2 infections and COVID-19 related hospitalizations in the staff of the Bologna Health Trust (HT), Italy Methods: We followed up retrospectively 9839 staff of the Bologna HT from December 27, 2020 to April 3, 2020 and calculated the effectiveness in partially and fully vaccinated subjects by applying a multivariable Cox proportional hazard model. Results: Vaccine effectiveness in preventing SARS-CoV2 infections is 85.5% (95%CI: 75.9-91.3) in the partially vaccinated and 84.8% (95%CI: 73.2-91.4) in the fully vaccinated. In preventing symptomatic infection effectiveness is 81.7% (95%CI: 62.7-91.0) in the partially and 87.1% (95%CI: 69.3-94.6) in the fully vaccinated. There were no COVID-19-related hospitalizations in the partially or fully vaccinated vs 15 hospitalization in the unvaccinated cohort. Conclusions: Our results confirm the effectiveness of mRNA vaccines in a real-world setting in Northern Italy.

since January 2017, a multidisciplinary research group, involving the Local Health Authority, the Municipality, and the University of Bologna, carried out a city-wide action-research project on health inequalities consisting of an ecological study over the years 2011-2015 based on indicators that are routinely available within health and social services.to document existing geographical inequalities in health outcomes and use of healthcare services in the city of Bologna (Emilia-Romagna Region, Northern Italy), with the aim to suggest policy action to tackle them.the results of the first phase of the above-mentioned project were reported: five related to the social determinants of health (exposure) and five related to the social determinants of ill-health (outcomes). For each municipal statistical area, the distribution of the exposures as well as rates and Bayesian Relative Risks of the outcomes were plotted on the city map. To evaluate the association between social determinants and health outcomes, Spearman correlation coefficients were estimated.residents in the city of Bologna aged=18 years in the period 2011-2015, grouped into 90 statistical areas.a North-South divide was apparent for most of the socioeconomic and ill-health indicators, with a high concentration of adverse outcomes in the North-Western part of the city. Adherence to cancer screening represented an exception, being greater in the areas with higher proportion of unfavourable health outcomes. An inverse association between education level and health outcomes was found. Low family income was weakly to moderately correlated with health outcomes. Proportion of residents in council houses and of the teenage foreign population showed a moderate to strong association with all outcomes, but mortality and screening adherence.an ecological analysis based on data that are routinely collected by local health and social institutions can be effective in revealing the geographical patterns of health inequalities. When accompanied by strategic choices aimed at bridging knowledge and action, this approach may facilitate the direct engagement of local actors towards health equity.

We conducted a cross-sectional study to assess the likelihood of returning for routine breast cancer screening among women who have experienced a false-positive result (FPR) and to describe the possible individual and organizational factors that could influence subsequent attendance to the screening program. Several information were collected on demographic and clinical characteristics data. Electronic data from 2014 to 2016 related to breast screening program of the Local Health Authority (LHA) of Bologna (Italy) of women between 45 and 74 years old were reviewed. A total of 4847 women experienced an FPR during mammographic screening and were recalled to subsequent round; 80.2% adhered to the screening. Mean age was 54.2 ± 8.4 years old. Women resulted to be less likely to adhere to screening if they were not-Italian (p = 0.001), if they lived in the Bologna district (p p = 0.001), if the diagnostic tests were performed in a hospital with the less volume of activity and higher recall rate (RR) (p p

to develop and validate a predictive model of mortality or emergency hospitalization in all subjects aged 65 years and over.cohort study based on 9 different databases linked with each other.the model was developed on the population aged 65 years and over resident at 01.01.2011 for at least two years in the city of Bologna (Emilia-Romagna Region, Northern Italy); 96,000 persons were included.the outcome was defined in case of emergency hospitalization or death during the one-year follow-up and studied with a logistic regression model. The predictive ability of the model was evaluated by using the area under the Roc curve, the Hosmer-Lemeshow test, and the Brier score in the derivation sample (2/3 of the population). These tests were repeated in the validation sample (1/3 of the population) and in the population of Bologna aged 65 years and over on 01.01.2012, after applying the coefficients of the variables obtained in the derivation model. By using the regression coefficients, a frailty index (risk score) was calculated for each subject later categorized in risk classes.the model is composed of 28 variables and has good predictive abilities. The area under the Roc curve of the derivation sample is 0.77, the Hosmer-Lemeshow test is not significant, and the Brier score is 0.11. Similar performances are obtained in the other two samples. With increasing risk class, the mean age, number of hospitalizations, emergency room service consultations, and multiple drug prescriptions increase, while the average income decreases.the model has good predictive ability. The frailty index can be used to support a proactive medicine and stratify the population, plan clinical and preventive activities or identify the potential beneficiaries of specific health promotion projects.

to compare the meta-analysis and the pooled analysis approach to study short-term effects of air pollution on human health in Emilia-Romagna Region (Central Italy) cities, characterised by strong homogeneity of environmental and sociodemographic features.application of fixed-effects meta-analysis and fixed-effects pooled analysis on time-series data of seven cities in Emilia-Romagna in the period 2006-2010. The relationship among adverse health events (deaths due to natural causes, cardiovascular disease, cerebrovascular disease and respiratory disease) and concentrations of PM10, PM2.5 and NO2 was investigated by means of GAM models, using the EpiAir protocol.the pooled analysis application entailed a gain in terms of precision of effect estimates in respect to meta-analysis approach. The interval widths of pooled analysis are lower than those of meta-analytic estimates, with percentage reductions between 7% and 43%. This power increase led to a major number of statistically significant pooled analysis estimates. It has been a generally good correspondence between the two methods in terms of direction and strength of the association among health outcomes and the various pollutants. An exception is the PM10 effect estimate on respiratory mortality, where the meta-analytic estimate was significantly higher and not in line with literature data.the study highlighted the increase in accuracy and stability of effect estimates obtained from a pooled analysis compared to a meta-analysis in a regional context such as the Emilia-Romagna Region, characterised by the absence of heterogeneity in exposure to pollutants and other confounders. In this context, the pooled approach is to be considered preferable to meta-analysis.

We investigated the short-term effects of particles with aerodynamic diameter less than 2.5μm (PM2.5), between 2.5 and 10μm (PM2.5-10) and less than 10μm (PM10) on deaths from diabetes, cardiac and cerebrovascular causes, lower respiratory tract infections (LRTI) and chronic obstructive pulmonary disease (COPD) in 10 European Mediterranean metropolitan areas participating in the MED-PARTICLES project during 2001-2010. In the first stage of the analysis, data from each city were analyzed separately using Poisson regression models, whereas in the second stage, the city-specific air pollution estimates were combined to obtain overall estimates. We investigated the effects following immediate (lags 0-1), delayed (lags 2-5) and prolonged exposure (lags 0-5) and effect modification patterns by season. We evaluated the sensitivity of our results to co-pollutant exposures or city-specific model choice. We applied threshold models to investigate the pattern of selected associations. For a 10μg/m(3) increase in two days' PM2.5 exposure there was a 1.23% (95% confidence interval (95% CI): -1.63%, 4.17%) increase in diabetes deaths, while six days' exposure statistically significantly increased cardiac deaths by 1.33% (95% CI: 0.27, 2.40%), COPD deaths by 2.53% (95% CI: -0.01%, 5.14%) and LRTI deaths by 1.37% (95% CI: -1.94%, 4.78%). PM2.5 results were robust to co-pollutant adjustments and alternative modeling approaches. Stronger effects were observed in the warm season. Coarse particles displayed positive, even if not statistically significant, associations with mortality due to diabetes and cardiac causes that were more variable depending on exposure period, co-pollutant and seasonality adjustment. Our findings provide support for positive associations between PM2.5 and mortality due to diabetes, cardiac causes, COPD, and to a lesser degree to cerebrovascular causes, in the European Mediterranean region, which seem to drive the particles short-term health effects. The authors declare that they have no actual or potential competing financial interests. Research described in this article was conducted under the Grant Agreement EU LIFE + ENV/IT/327. Sí

Background: Few studies have investigated the independent health effects of different size fractions of particulate matter (PM) in multiple locations, especially in Europe. Objectives: We estimated the short-term effects of PM with aerodynamic diameter ≤ ; 10; μm (PM10), ≤ 2.5; μm (PM2.5), and between 2.5 and 10; μm (PM2.5-10) on all-cause, cardiovascular, and respiratory mortality in 10 European Mediterranean metropolitan areas within the MED-PARTICLES project. Methods: We analyzed data from each city using Poisson regression models, and combined city-specific estimates to derive overall effect estimates. We evaluated the sensitivity of our estimates to co-pollutant exposures and city-specific model choice, and investigated effect modification by age, sex, and season. We applied distributed lag and threshold models to investigate temporal patterns of associations. Results: A 10-μg/m3 increase in PM2.5 was associated with a 0.55% (95% CI: 0.27, 0.84%) increase in all-cause mortality (0-1 day cumulative lag), and a 1.91% increase (95% CI: 0.71, 3.12%) in respiratory mortality (0-5 day lag). In general, associations were stronger for cardiovascular and respiratory mortality than all-cause mortality, during warm versus cold months, and among those ≥ 75 versus < 75 years of age. Associations with PM2.5-10 were positive but not statistically significant in most analyses, whereas associations with PM10 seemed to be driven by PM2.5. Conclusions: We found evidence of adverse effects of PM2.5 on mortality outcomes in the European Mediterranean region. Associations with PM2.5-10 were positive but smaller in magnitude. Associations were stronger for respiratory mortality when cumulative exposures were lagged over 0-5 days, and were modified by season and age.

Background: Evidence on the short-term effects of fine and coarse particles on morbidity in Europe is scarce and inconsistent. Objectives: We aimed to estimate the association between daily concentrations of fine and coarse particles with hospitalizations for cardiovascular and respiratory conditions in eight Southern European cities, within the MED-PARTICLES project. Methods: City-specific Poisson models were fitted to estimate associations of daily concentrations of particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5), ≤ 10 μm (PM10), and their difference (PM2.5–10) with daily counts of emergency hospitalizations for cardiovascular and respiratory diseases. We derived pooled estimates from random-effects meta-analysis and evaluated the robustness of results to co-pollutant exposure adjustment and model specification. Pooled concentration–response curves were estimated using a meta-smoothing approach. Results: We found significant associations between all PM fractions and cardiovascular admissions. Increases of 10 μg/m3 in PM2.5, 6.3 μg/m3 in PM2.5–10, and 14.4 μg/m3 in PM10 (lag 0–1 days) were associated with increases in cardiovascular admissions of 0.51% (95% CI: 0.12, 0.90%), 0.46% (95% CI: 0.10, 0.82%), and 0.53% (95% CI: 0.06, 1.00%), respectively. Stronger associations were estimated for respiratory hospitalizations, ranging from 1.15% (95% CI: 0.21, 2.11%) for PM10 to 1.36% (95% CI: 0.23, 2.49) for PM2.5 (lag 0–5 days). Conclusions: PM2.5 and PM2.5–10 were positively associated with cardiovascular and respiratory admissions in eight Mediterranean cities. Information on the short-term effects of different PM fractions on morbidity in Southern Europe will be useful to inform European policies on air quality standards. Citation: Stafoggia M, Samoli E, Alessandrini E, Cadum E, Ostro B, Berti G, Faustini A, Jacquemin B, Linares C, Pascal M, Randi G, Ranzi A, Stivanello E, Forastiere F, the MED-PARTICLES Study Group. 2013. Short-term associations between fine and coarse particulate matter and hospitalizations in Southern Europe: results from the MED-PARTICLES project. Environ Health Perspect 121:1026–1033; http://dx.doi.org/10.1289/ehp.1206151

Giardiasis, the disease caused by the flagellate Giardia duodenalis (syn. G.lamblia, G. intestinalis), is the most commonly reported among the five food- and waterborne parasitic diseases under mandatory surveillance in 24 EU countries. From November 2018 to April 2019, an outbreak of giardiasis occurred in a municipality of the Bologna province, in north-eastern Italy. Microscopy and immunochromatography identified cysts and antigens, respectively, of the parasite in stool samples of 228 individuals. Molecular typing of 136 stool samples revealed a vast predominance (95%) of G. duodenalis assemblage B. Investigations into potential sources indicated tap water as the most likely vehicle of infection, although cysts were not detected in water samples. Control measures mostly aimed at preventing secondary transmission by informing citizens about the outbreak, and by treatment of patients with anti-parasitic drugs. This is the first documented human outbreak of giardiasis in Italy; its investigation has highlighted the difficulties in the timely detection and management of this parasite, which is often overlooked as a cause of human gastroenteritis. The long and variable incubation time, absence of specific symptoms and a general lack of awareness about this pathogen contributed to delay in diagnosis.