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Aims: We conducted a population-based cross-sectional study to assess the prevalence of both preclinical and clinical heart failure (HF) in the elderly. Methods and Results: A sample of 2001 subjects, 65- to 84-year-old residents in the Lazio Region (Italy), underwent physical examination, biochemistry/N-terminal pro brain natriuretic peptide (NT-proBNP) assessment, electrocardiography, and echocardiography. Systolic left ventricular dysfunction (LVD) was defined as left ventricular ejection fraction (LVEF) <50%. Diastolic LVD was defined by a Doppler-derived multiparametric algorithm. The overall prevalence of HF was 6.7% [95% confidence interval (CI) 5.6-7.9], mainly due to HF with preserved LVEF (HFpEF) (4.9%; 95% CI 4.0-5.9), and did not differ by gender. A systolic asymptomatic LVD (ALVD) was detected more frequently in men (1.8%; 95% CI 1.0-2.7) than in women (0.5%; 95% CI 0.1-1.0; P = 0.005), whereas the prevalence of diastolic ALVD was comparable between genders (men: 35.8%; 95% CI = 32.7-38.9; women: 35.0%; 95% CI = 31.9-38.2). The NT-proBNP levels and severity of LVD increased with age. Overall, 1623 subjects (81.1% of the entire studied population) had preclinical HF (Stage A: 22.2% and stage B: 59.1% respectively). A large number of subjects in stage B of HF showed risk factor levels not at target. Conclusions: In a population-based study, the prevalence of preclinical HF in the elderly is high. The prevalence of clinical HF is mainly due to HFpEF and is similar between genders. [ABSTRACT FROM AUTHOR]

RATIONALE: Acute effects of ozone on mortality have been extensively documented in clinical and epidemiological research. However, only a few studies have focused on subgroups of the population especially vulnerable to these effects. OBJECTIVES: To estimate the association between exposure to ozone and cause-specific mortality, and to evaluate whether individual sociodemographic characteristics or chronic conditions confer greater susceptibility to the adverse effects of ozone. METHODS: A case-crossover analysis was conducted in 10 Italian cities. Data on mortality were collected for the period 2001 to 2005 (April-September) for 127,860 deceased subjects. Information was retrieved on cause of death, sociodemographic characteristics, chronic conditions from previous hospital admissions, and location of death. Daily ozone concentrations were collected from background fixed monitors. MEASUREMENTS AND MAIN RESULTS: We estimated a 1.5% (95% confidence interval [CI], 0.9-2.1) increase in total mortality for a 10 microg/m(3) increase in ozone (8-h, lag 0-5). The effect lasted several days for total, cardiac and respiratory mortality (lag 0-5), and it was delayed for cerebrovascular deaths (lag 3-5). In the subgroup analysis, the effect was more pronounced in people older than 85 years of age (3.5%; 95% CI, 2.4-4.6) than in 35- to 64-year-old subjects (0.8%; 95% CI, -0.8 to 2.5), in women (2.2%; 95% CI, 1.4-3.1) than in men (0.8%; 95% CI, -0.1 to 1.8), and for out-of-hospital deaths (2.1%; 95% CI, 1.0-3.2), especially among patients with diabetes (5.5%; 95% CI, 1.4-9.8). CONCLUSIONS: A greater vulnerability of elderly people and women was indicated; subjects who died at home and had diabetes emerged as especially affected. [ABSTRACT FROM AUTHOR]

Background: Although debate on factors associated with a high risk of cesarean delivery has continued for many years, only a few studies have explored the role of socioeconomic position. We studied the effect of educational level on risk of cesarean section in particular the different roles of maternal and paternal education. Methods: We analyzed all 88,698 firstborn live births registered between 1990 and 1996 to mothers who were residents of Rome at the time of delivery. Logistic regression was used to investigate the association between cesarean section and parent education, taking possible confounding factors into consideration. Results: During the study period, the cesarean section rate was 32.5 percent. The direct association between level of education and cesarean delivery, found in the crude analysis, was completely reversed once maternal age was taken into account. Multivariate analyses showed that women with a primary school degree had a 24 percent (95% CI = 12-37) higher risk of cesarean delivery than those with a university degree. The association was even stronger for deliveries in public hospitals. Although both parents' level of education had an effect on the cesarean section rate, maternal education had a stronger effect than and was independent from paternal education. Conclusions: Mothers with little education were consistently more likely to deliver by cesarean section than highly educated women, even when their partner's level of education was taken into account. Effective interventions aimed at reducing cesarean delivery rates in women of lower social class should be a priority for national health services, particularly in countries where the cesarean rate has been increasing. (BIRTH 35:3 September 2008) [ABSTRACT FROM AUTHOR]

Rationale: Out-of-hospital coronary heart disease death is a major public health problem, but the association with air pollution is not well understood.Objectives: We evaluated the association between daily ambient air pollution levels (particle number concentration [PNC]--a proxy for ultrafine particles [diameter < 0.1 microm], mass of particles with diameter less than 10 microm [PM[10]; CO, NO[2], and O[3]) and the occurrence of fatal, nonhospitalized coronary events.Methods: Subjects were 5,144 out-of-hospital fatalities (410-414, International Classification of Diseases-9; 1998-2000) who had been residents of Rome. Hospitalizations during the 3 yr before death were considered to identify comorbidities (e.g., diabetes, hypertension, heart failure, dysrhythmia, chronic obstructive pulmonary disease). Statistical analyses were performed using a case-crossover design.Measurements and Main Results: The association with out-of-hospital coronary deaths was statistically significant for PNC, PM[10], and CO. Air pollution on the day of death had the strongest effect (e.g., 7.6% increase [95% confidence interval, 2.0-13.6%]) for an interquartile range of PNC, 27,790 particles/cm[3]. The 65-74- and 75+-yr age groups were at higher risk than the 35-64-yr age group, and there was a suggestion of effect modification for people with hypertension and chronic obstructive pulmonary disease.Conclusions: Air pollutants originating from combustion processes, including ultrafine particles, are related to fatal, nonhospitalized coronary events. The effect is stronger among people over 65 years of age, but is not limited to a group with a specific comorbidity. [ABSTRACT FROM AUTHOR]

AIMS: To investigate the effects of occupational exposures and residence near to industrial sites on lung cancer mortality in an area in Italy. METHODS: 234 cases of lung cancer and 729 controls matched by sex, age, and date of death were enrolled. Environmental exposure was evaluated using historical residence data. A geographical information system was used to compute distances from residence to pollution source (cement factory, power plants, harbour) and an average distance was computed for each subject. Odds ratios (OR) and 95% confidence intervals (CI) in a logistic regression model were used to estimate the relative risk of lung cancer associated with the risk factors (smoking habits and occupational exposure) collected by questionnaire; ORs for distances from pollution sources and from city centre were computed, adjusting for smoking habits, education, and occupation. RESULTS: Smoking habits (< or =10 cigarettes/day, OR = 2.28; 11-20, OR = 4.64; >20, OR = 6.61) and occupational exposure to asbestos (OR = 3.50) were significantly associated with lung cancer risk. Reported traffic level of area of residence and residence near the four sources were not associated with increased risk of lung cancer. There was a significantly increased risk for those residing outside the city centre, in the southern outskirts (OR = 1.51). CONCLUSIONS: The increased lung cancer risk observed in the area can partly be explained by occupational exposures. The increased risk in the outskirts of the city is consistent with the results of dispersion models that indicate high levels of pollutant deposition in the same area. [ABSTRACT FROM AUTHOR]

There has been growing interest over recent years in the potential preventive role of the Mediterranean diet in the development of cardiovascular disease and cancer. The present study was designed to evaluate the relationship between the components of the Mediterranean diet and lung cancer. A hospital-based, case-control study of lung cancer was conducted on subjects aged 35+ yr living in the Lazio region and admitted to one of the main hospitals in Rome in the period from 1993 to 1996. Cases (n = 342) were patients with newly diagnosed primary lung cancer. Controls (n = 292) were recruited from departments of general surgery, orthopedics, ENT, and general medicine and were frequency matched by sex and age (+/-5 yr) to the cases. Exposure characteristics were obtained by interviewing study subjects. A self-administered food-frequency questionnaire was used. After careful control for several smoking variables, we found a protective effect for high consumption of carrots (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.42-1.05), tomatoes (OR = 0.59, 95% CI = 0.34-1.03), white meat (OR = 0.66, 95% CI = 0.42-1.02), exclusive use of olive oil (OR = 0.67, 95% CI = 0.45-0.99), and regular consumption of sage (OR = 0.43, 95% CI = 0.29-0.65). In a multivariate model, considering all food items simultaneously, the protective effect of exclusive olive oil use and sage remained statistically significant. Our results indicate that some food items typical of the Mediterranean diet are associated with decreased lung cancer risk. [ABSTRACT FROM AUTHOR]

AIM: To evaluate the efficacy of naltrexone maintenance treatment in preventing relapse in opioid addicts after detoxification. DESIGN: A systematic review according to the methodology developed by the Cochrane Collaboration based on either randomized controlled trials (RCTs) or controlled clinical trials (CCTs). PARTICIPANTS: Seven hundred and seven heroin dependent in- and out-patients, or former heroin addicts dependent on methadone and participating in a naltrexone treatment programme; 89% were male. INTERVENTION: Maintenance treatments on opiate dependent people after detoxification, comparing naltrexone with placebo, pharmacological or behavioural treatments. MEASUREMENTS: The outcomes considered were successfully completed treatment, opioid use under treatment (re)-incarcerations during the study period, mean duration of treatment. FINDINGS: The outcomes tended to be slightly although not significantly in favour of the naltrexone groups. Use of naltrexone in addition to behavioural treatment significantly decreased the probability of (re-)incarceration (OR=0.30; 95% CI 0.12, 0.76). The difficulties in producing a quantitative analysis were due mainly to the heterogeneity of the included studies. CONCLUSIONS: From the available clinical trials performed up to this time, there is insufficient evidence to justify the use of naltrexone in maintenance treatment of opioid addicts. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVE: There exists conflicting evidence regarding the higher risk of hysterectomy among women of a lower educational and economic level. This study aims to assess whether in Italy socioeconomic level is related to hysterectomy undertaken for different medical reasons. DESIGN: An area based index was used to assign socieconomic status (SES; four levels defined) to 3141 women (aged 35 years or older) who underwent a hysterectomy in 1997 and were residing in Rome. Data were taken from hospital discharge records. Direct age standardised hospitalisation rates by SES level were calculated for overall hysterectomies and for those performed for either malignant or non-malignant causes. Statistical differences were detected using the ratios of standardised rates and the test for linear trend. MAIN RESULTS: The hysterectomy rate was 36.7 per 10 000 women aged 35 years or more. Hysterectomy for uterine leiomyoma accounted for 41% of all operations and was more frequent among women aged 35-49 years than for those aged 50 years or more (crude rates: 28.6 and 7.7 per 10 000, respectively). The risk of hysterectomy was 35% higher for the lowest SES group, compared with the highest group. No association was found between SES and hysterectomy rates for malignant causes, although less affluent women in age group 35-49 years had 87% higher risk of hysterectomy compared with most affluent women. The inverse association between SES and hysterectomy rates attributable to non-malignant causes was statistically significant for women aged 35-49 years but not for those aged 50 years or more. CONCLUSIONS: The inverse relation between hysterectomy and SES is largely attributable to benign disorders of the uterus, namely leiomyoma and prolapse. More affluent women may have a greater uptake of less invasive techniques for removing uterine leiomyoma compared with less affluent women, who are more likely to undergo unnecessary hysterectomies irrespective of their reproductive age. [ABSTRACT FROM AUTHOR]

A cross-sectional survey was carried out between April 1997 and February 1998 among street prostitutes in Rome. The study population (n = 142) consisted of 102 women and 40 transsexuals: 20% from Western Europe, 38% Eastern Europe, 23% Latin America and 17% Africa. Two-thirds of the population had more than 20 clients during the last week and most respondents (95%) reported always using condoms with clients. Eight per cent of the women and 2% of the transsexuals report a history of injecting drug use. Only 38% of the women with a stable partner reported use of contraceptives and 33% of them had undergone a voluntary abortion during the last year. Only 38% of the women had been checked for STDs during the last year, compared with 80% of the transsexuals. The HIV-prevalence was 6% among the women and 20% among the transsexuals. Four out of the six positive women and one of the positive transsexuals had a history of injecting drug use. Five out of the six HIV-positive women were Italian. Transsexual prostitutes seem to pay more attention to their medical wellbeing compared with females who rarely go for medical check-ups and only a minority uses efficient contraceptive methods. [ABSTRACT FROM AUTHOR]

Objectives: to evaluate the effectiveness of a large-scale, school-based, teacher-delivered campaign for the prevention of HIV infection. Methods: 46 junior and senior high schools in the Lazio Region of Italy were randomized to either an intervention or a control group. The corresponding study population consisted of 645 teachers and 3,866 students. The intervention followed the methods used in a large-scale, teacher-delivered campaign already implemented in the schools of the region. Questionnaires eliciting AIDS-related knowledge, attitudes and risk perceptions were administered to teachers and students in both study groups before and after the intervention. The increments in scores were analysed by a mixed model analysis of variance. Results: the average increment in the teachers' knowledge score was 4.18 points higher in the intervention group than in the control group (p<0.001). Among the students, the differential increment in favour of the intervention was only 0.9 in the knowledge section (p<0.001) and 0.58 in the risk perception section (p=0.08), adjusted for pre-test scores and sociodemographic characteristics. Greater effectiveness was observed among the students who had lower baseline knowledge and in junior high schools. Conclusion: although the large-scale preventive campaign improves the teachers' knowledge, it does little to improve the student's knowledge and risk perception. The effect appeared to be variable across the types of school. This suggests the urgency of differentiating preventive strategies, using only validated models with a proper theoretical support and calibrating the message for populations in different age and social classes. [ABSTRACT FROM AUTHOR]

Background: CD4+ T-lymphocyte (CD4) and platelet counts are good predictors of the 'maturity' of HIV infection and can be used to impute the date of infection/seroconversion in individuals for whom this date is unknown.Methods: Data from the Italian Seroconversion Study were used to develop a Weibull regression model for time since seroconversion as a function of the haematologic markers. The model was used to impute time since HIV infection/seroconversion in individuals from a prevalent cohort, recruited through the Lazio regional HIV surveillance system.Results: The range of the imputed calendar times of infection/seroconversion in 2599 HIV prevalent individuals was 1972-1992; the earliest seroconversions occurred among injecting drug users (IDU). The peak of incidence was reached in 1986 with 340 seroconversions. Among males, the estimated median time from seroconversion to HIV diagnosis was shorter in IDU (30 months) as compared to non-IDU (36 months). This difference was smaller for females (26.6 versus 28.4 in IDU and non-IDU, respectively).Conclusions: This method permits the estimation of population-based curves of HIV incidence, using data from surveillance. The results support the hypotheses of an early spread of the epidemic among IDU in the Lazio region, and of shorter lead times in this population. [ABSTRACT FROM AUTHOR]

Background: Subjects living close to high traffic roads (HTR) are more likely to suffer from air-pollution related morbidity and mortality. The issue has large public health consequences but few studies have described the main socio-demographic characteristics of people exposed to traffic.Objectives: To characterise a large cohort of residents in Rome according to different measures of traffic exposure, socioeconomic position (SEP), and baseline health status.Methods: Residents of Rome in October 2001 were selected. Individual and area-based SEP indices were available. GIS was used to obtain traffic indicators at residential addresses: distance from HTR (> = 10,000 vehicles/day), length of HTR, average daily traffic count, and traffic density within 150 meters of home. Hospitalisations in the 5-year period before enrolment were used to characterise health status. Logistic and linear regression analyses estimated the association between traffic exposure and socio-demographic characteristics.Results: We selected 1,898,898 subjects with complete SEP information and GIS traffic indicators. A total of 320,913 individuals (17%) lived within 50 meters of an HTR, and 14% lived between 50 and 100 meters. These proportions were higher among 75+ year-old subjects. Overall, all traffic indicators were directly associated with SEP, with people living in high or medium SEP areas or with a university degree more likely to be exposed to traffic than people living in low SEP areas or with a low level of education. However, an effect modification by area of residence within the city was seen and the association between traffic and SEP was reversed in the city centre.Conclusions: A large section of the population is exposed to traffic in Rome. Elderly people and those living in areas of high and medium SEP tend to be more exposed. These findings are related to the historical stratification of the population within the city according to age and socioeconomic status. [ABSTRACT FROM AUTHOR]

Background: The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity.Methods: Heat waves were defined considering both maximum apparent temperature and minimum temperature and classified by intensity, duration and timing during summer. The effect was estimated as percent increase in daily mortality during heat wave days compared to non heat wave days in people over 65 years. City specific and pooled estimates by gender, age and cause of death were calculated.Results: The effect of heat waves showed great geographical heterogeneity among cities. Considering all years, except 2003, the increase in mortality during heat wave days ranged from + 7.6% in Munich to + 33.6% in Milan. The increase was up to 3-times greater during episodes of long duration and high intensity. Pooled results showed a greater impact in Mediterranean (+ 21.8% for total mortality) than in North Continental (+ 12.4%) cities. The highest effect was observed for respiratory diseases and among women aged 75-84 years. In 2003 the highest impact was observed in cities where heat wave episode was characterized by unusual meteorological conditions.Conclusions: Climate change scenarios indicate that extreme events are expected to increase in the future even in regions where heat waves are not frequent. Considering our results prevention programs should specifically target the elderly, women and those suffering from chronic respiratory disorders, thus reducing the impact on mortality. [ABSTRACT FROM AUTHOR]