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Backgrounds and aims Health trajectories in aging, rather than single time-point assessments, could be early indicators of the onset of conditions such as dementia. The aim of this study was to identify different aging trajectories and to investigate their influence on the cumulative incidence of dementia. Methods We evaluated data referring to 993 elders from the InveCe.Ab study cohort. All subjects were free from dementia at baseline and re-assessed on at least one other occasion thereafter. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), physical function using the Walking Speed Test (WST), and disability on the basis of the Activities of Daily Living (ADL) score. To describe the different courses of the three outcomes combined, the Group-Based Trajectory Model (GBTM) method was applied. We looked for differences in age, gender, education, ApoE-e4 carrier status and obesity, and then investigated the influence of the observed trajectories on the incidence of dementia. Results Three trajectories were identified: a “good” scenario was observed in 703 (70.2%) individuals, who showed substantially stable cognitive and physical function and no disability; an “intermediate” scenario in 248 subjects (25.5%), who recorded a longer walking time, lower MMSE score, and a one-point higher ADL score; and a “severe” scenario in 42 elders (4.3%), who recorded declines in all the outcomes. Female gender, obesity and low education were most represented in the “severe” group. ApoE-e4 carrier status showed no difference between groups. The estimated cumulative incidence of dementia was higher in the “severe” (37%) than in the “intermediate” (7%) and “good” ( Conclusions Using simple measurements, we built different aging trajectories, and observed that the worst performers had the highest incidence of dementia. Better knowledge of trajectories of aging would be useful for preventive interventions aimed at promoting healthier aging.

The long-term increase in survival from cutaneous malignant melanoma (CMM) is generally attributed to the decreasing trend in tumour thickness, the single most important prognostic factor.To determine the relative contribution of decreased tumour thickness to the favourable trend in survival from CMM in Italy.Eleven local cancer registries covering a population of 8 056 608 (13.4% of the Italian population in 2010) provided records for people with primary CMM registered between 2003 and 2017. Age-standardized 5-year net survival was calculated. Multivariate analysis of 5-year net survival was undertaken by calculating the relative excess risk (RER) of death. The relative contribution of the decrease in tumour thickness to the RER of death was evaluated using a forward stepwise flexible parametric survival model including the available prognostic factors.Over the study period, tumour thickness was inversely associated with 5-year net survival and multivariate RER in both sexes. The median thickness was 0.90 mm in 2003-2007, 0.85 mm in 2008-2012 and 0.75 mm in 2013-2017 among male patients, and 0.78 mm, 0.77 mm and 0.68 mm among female patients, respectively. The 5-year net survival was 86.8%, 89.2% and 93.2% in male patients, and 91.4%, 92.0% and 93.4% in female patients, respectively. In 2013-2017, male patients exhibited the same survival as female patients despite having thicker lesions. For them, the increasing survival trend was more pronounced with increasing thickness, and the inclusion of thickness in the forward stepwise model made the RER in 2013-2017 vs. 2003-2007 increase from 0.64 [95% confidence interval (CI) 0.51-0.80] to 0.70 (95% CI 0.57-0.86). This indicates that the thickness trend accounted for less than 20% of the survival increase. For female patients, the results were not significant but, with multiple imputation of missing thickness values, the RER rose from 0.74 (95% CI 0.58-0.93) to 0.82 (95% CI 0.66-1.02) in 2013-2017.For male patients in particular, decrease in tumour thickness accounted for a small part of the improvement in survival observed in 2013-2017. The introduction of targeted therapies and immune checkpoint inhibitors in 2013 is most likely to account for the remaining improvement.

«Mortality for neurological diseases and pesticides: etiological hypotheses by a spatial analysis in the province of Pavia». Background: Neurological and neurodegenerative diseases are multifactorial and their causes are not well understood yet. Among the relevant risk factors, pesticides and the productive activities in which they are used are included. Objectives: To evaluate the association of mortality from neurological diseases within the Province of Pavia (Italy) with the agricultural activities, as a proxy of pesticides exposure. Methods: Population data for 2012 were provided by the local health unit (ATS) and by the registry office of the Regional Health Service. Spatial analyses were carried out by both a classical and Bayesian approach, to obtain a mortality map of the relative risk for neurological diseases in the Province of Pavia. Spatial distribution of main agricultural activities within the same territory, used as proxy of pesticides use, was made possible by data from the Geoportale Territoriale of the Lombardy region. Finally, a comparison between spatial distribution of mortality from neurological diseases and spatial distribution of main agricultural activities has been conducted. Results: Mortality for neurological diseases in the Province of Pavia in 2012 was 4.41 for men and 6.53 for women per 10,000 subjects living in this area. Female mortality for neurological diseases showed a cluster in the Oltrepò district, where viticulture and fruit/horticulture are more common than elsewhere. More precisely, Bayesian relative risk (RR) had higher values in comparison with the median RR of the Province (100.8), with a posterior probability (PP) between 0.75 and 0.95 (not significant). Similarly, mortality for Parkinson’s disease in women showed RR greater than the median value of the Province (100.6), with PP between 0.25 and 0.75 (not significant). Conclusions: Notwithstanding the ecological nature of the study, our results suggest the need to further investigate the possible link between pesticides exposure or related activities and neurological and neurodegenerative diseases, particularly Parkinson’s disease. An ad hoc study on a random sample of the population living in the Province of Pavia, with the collection of individual data by means of standardized questionnaire, would allow to control for biases usually present when an ecological study design is applied.

Authors’ original file for figure 1