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PubMed2002

Characterization of Shiga toxin-producing Escherichia coli O157:H7 isolated in Italy and in France.

Twenty-one Escherichia coli O157:H7 strains isolated in northern Italy from sporadic cases of hemolytic-uremic syndrome and from cattle and food were characterized by virulence gene analysis, pulsed-field gel electrophoresis (PFGE) of XbaI-digested DNA, enterobacterial repetitive intergenic consensus (ERIC) sequence-based PCR (ERIC-PCR), and antibiotic resistance patterns and compared to 18 strains isolated in France from human cases of diarrhea, cattle, and the environment. Strains isolated in Sicily (southern Italy) from a local farm (one strain) and from calves just imported from France (11 strains) and Spain (six strains) were also typed. Whereas the eae and hlyA genes were always detected, Shiga toxin gene (stx) analysis showed some differences related to geographic areas. Isolates from northern Italy showed a high frequency of stx(1) and stx(2), while strains isolated in France and from French and Spanish calves imported to Sicily more frequently possessed the stx(2c) gene. The majority of the strains isolated in northern Italy were also resistant to one or more antibiotics, while most of the strains isolated in France and Sicily were fully susceptible. ERIC-PCR analysis was not able to differentiate the strains. PFGE typing after XbaI DNA digestion produced a total of 54 distinct restriction endonuclease digestion profiles (REDPs) among the 57 strains. Phylogenetic analysis was unable to cluster REDPs according to geographic origin. All epidemiologically related isolates showed either identical or >/=91% similar REDPs. Our findings suggest a peculiar circulation of antibiotic-resistant, genetically unrelated strains in northern Italy.

Animals↗
PubMedDate not supplied

Accuracy of death certificates for motor neuron disease and multiple sclerosis in the province of Palermo in southern Italy.

Mortality studies based on death certificates (DCs) are relatively inexpensive and easy to conduct. Therefore, they are frequently used to evaluate variations of geographical and temporal patterns, particularly in uncommon diseases. Recent surveys of motor neuron disease (MND) and multiple sclerosis (MS) based on official mortality statistics in Italy showed a decreasing trend of mortality from northern to southern Italy. To evaluate if DCs are homogeneously recorded in Italy and whether or not they can be considered a good instrument for mortality studies, we assessed the accuracy of DCs for MND and MS in the province of Palermo, Italy, and compared our results with those reported in other studies. We searched the archives of the neurological clinic of the University of Palermo for patients affected by one of the two diseases who were residents and were diagnosed in Palermo province. We found 157 patients with definite MND and 360 with clinically definite MS. Seventy-eight out of the 157 MND patients and 43 out of the 360 MS patients had died. Considering the underlying cause of death, the true-positive rate was 48% [95% confidence interval (CI) 36-60%] for MND and 46% (95% Cl 30-62%) for MS. The rates we found for MND were lower than those reported either in Italy or worldwide. This result suggests caution in formulating gradient hypotheses for MND. Concerning MS, the rate we found was low, but similar to that found by others. This indicates that a mortality survey of MS based on DCs is unlikely to be contributory.

Archives↗
PubMed1994

Mortality from skin melanoma in Italy and Friuli-Venezia Giulia region, 1970-1989.

AIMS AND BACKGROUND: Substantial upward trends for skin cancer mortality have been observed in most European countries in the last two decades. The distinction, however, between cutaneous malignant melanoma (CMM) and non-melanomatous skin cancers on the basis of death certification is unreliable. METHODS: In order to assess the trends of CMM, analysis of the specific code for CMM (International Classification of Disease VIII and IX:172) was coupled with analysis of total skin cancer mortality rates, standardized on the 1981 Italian Census population, at all ages and in selected age groups (15-44, 45-64 and 65-84 years). The analyses were carried out for the whole of Italy and for Friuli-Venezia Giulia (FVG), a region in North-East Italy with a high proportion of fair-complexioned individuals, elevated frequency of sunbathing, and especially good diagnostic standards. RESULTS: In 1985-89 skin cancer mortality rates in men at all ages, as compared to 1970-74, were 33% higher in Italy and 46% higher in FVG. In women, there was a rise of 22% in Italy and 94% in FVG. More marked upward trends were observed in young and middle aged adults, especially among women in FVG (over 300% increase). In absolute terms, approximately 3000 more Italians died from skin cancers in 1985-89 as compared to 1970-74, about half of them prematurely (i.e., < 65 years). CMM was mentioned in death certifications for skin cancer increasingly often in all age groups, particularly in FVG. CONCLUSIONS: The analysis of mortality trends from skin cancer is consistent with a substantial rise of CMM-related deaths. The sensitivity of death certification with respect to CMM diagnosis is also increasing, especially in FVG. A public health strategy with the aim of reducing intermittent intense exposure to ultraviolet light, especially in children, is urgent in Italy as CMM represents one of the few causes of premature death with unfavorable trends.

Adolescent↗
PubMed2006

Shigella sonnei biotype G carrying class 2 integrons in southern Italy: a retrospective typing study by pulsed field gel electrophoresis.

BACKGROUND: Emergence and global dissemination of multiresistant strains of enteric pathogens is a very concerning problem from both epidemiological and Public Health points of view. Shigella sonnei is the serogroup of Shigella most frequently responsible for sporadic and epidemic enteritis in developed countries. The dissemination is associated most often to human to human transmission, but foodborne episodes have also been described. In recent years the circulation of multiresistant strains of S. sonnei biotype g carrying a class 2 integron has been reported in many countries worldwide. In southern Italy a strain with similar properties has been responsible for a large community outbreak occurred in 2003 in Palermo, Sicily. The objective of this study was to date the emergence of the biotype g strain carrying the class 2 integron in southern Italy and to evaluate the genetic heterogeneity of biotype g S. sonnei isolated throughout an extended interval of time. METHODS: A total of 31 clinical isolates of S. sonnei biotype g identified in southern Italy during the years 1971-2000 were studied. The strains were identified at the serogroup level, characterized by biochemical tests and submitted to antimicrobial susceptibility testing. Molecular typing was performed by pulsed field gel electrophoresis (PFGE) after digestion of DNA by XbaI. Carriage of class 2 integrons was investigated by polymerase chain reaction (PCR) with specific primers and confirmed by restriction endonuclease analysis of amplicons. RESULTS: The 15 isolates of S. sonnei biotype g identified in the decade 1971-1980 showed highly heterogeneous drug resistance profiles and pulsotypes. None of the isolates was simultaneous resistant to streptomycin and trimethoprim and none was class 2 integron positive. On the contrary, this resistance phenotype and class 2 integron carriage were very common among the 16 strains of biotype g identified in the following two decades. Moreover, all the more recent isolates, but one, showed closely related pulsotypes. CONCLUSION: Although our findings refer to a limited geographic area, they provide a snapshot of integron acquisition by an enteric pathogen responsible for several outbreaks in the years 2001-2003 in Italy. Molecular typing, indeed, suggests that the emergence of biotype g class 2 integron carrying S. sonnei in southern Italy should be backdated to at least the late 1980s. In the following decades, the circulation of biotype g appears to be sustained by multiresistant highly related strains. Similar trend are described in several countries, but the questions about mechanism of emergence and worldwide spread of this pathogen remain open.

Bacterial Typing Techniques↗
PubMed2005

Prevalence of Paget's disease of bone in Italy.

UNLABELLED: We examined the prevalence of PDB in Italy from radiological, scintigraphic, and biochemical surveys in two Italian towns. Prevalence rates varied from 0.7% to 2.4%, were higher in males than in females, and slightly differed between the two towns. Unlike previous studies in populations of British descent, no secular trend for a decreasing prevalence emerged. INTRODUCTION: Clinical, radiological, and necropsy data from different countries suggested pronounced geographical variations in the prevalence of Paget's disease of bone (PDB). Despite the impact of the disease on the population, there are limited data on the prevalence of PDB in Italy. MATERIALS AND METHODS: The objective of this study was to estimate the prevalence of PDB in the district of Siena (Central Italy) and Turin (Northern Italy) from radiological, biochemical, and scintigraphic surveys. We examined a sample of 1778 consecutive pelvic radiographs performed between 1999 and 2000 at the Hospital Radiology Unit in Siena and 6609 pelvic radiographs performed in 1986-1987, 1992-1993, and 1999-2002 from the Radiology Department of Molinette Hospital in Turin. In Siena, 7906 consecutive (99m)TC-MDP bone scans performed over a 4-year period (January 2000 to May 2004) were also screened for the presence of PDB, and the prevalence of elevated alkaline phosphatase (ALP) levels (>300 UI/liter) was estimated from 7449 computerized medical records over a 3-year period (January 2000 to February 2003). The finding of PDB on the pelvic radiograph and bone scan was based on standardized radiological criteria. RESULTS: At the end of the radiological surveys, 16/1778 pelvic PDB cases (8 males and 8 females) were observed in Siena and 41/6609 (27 males and 14 females) in Turin. The crude prevalence of the disease was 0.89% in Siena and 0.62% in Turin. Given that pelvic involvement is commonly described in 60-90% of PDB patients, the estimated overall prevalence of PDB ranged from 1.0% to 1.5% in Siena and from 0.7% to 1.0% in Turin. No decrease in the prevalence of PDB was evident after comparison of prevalence rates from different periods. Biochemical analyses showed 296/7449 subjects with elevated ALP levels and normal liver enzymes, 87 of whom had confirmed diagnosis of PDB. The estimated prevalence of biochemical PDB was 1.5%. The scintigraphic survey showed a PDB prevalence of 194/7906 (2.4%), which was significantly higher than the radiological and biochemical estimates. CONCLUSIONS: Our surveys suggest that PDB in Italy has an estimated prevalence of at least 1%, comparable with that observed in United States and other European countries, but lower than that described in Britain and New Zealand. No secular trend for a decreasing prevalence of PDB was observed.

Aged↗
PubMed2006

Paget's disease of bone in Italy.

Epidemiological studies of Paget's disease of bone (PDB) suggest a pronounced geographical variation in the prevalence of the disease and a decrease in prevalence and clinical severity over time. To analyze epidemiological and clinical features of PDB in Italy, we recently established a registry of Italian PDB cases and performed radiological, biochemical, and bone scan surveys in the towns of Siena and Turin. The overall prevalence of PDB in Italy varied between 0.7% and 2.4%. Prevalence rates increased with age and were higher in men than in women. We observed clinically confirmed familial aggregation in 15-26% of cases. Pedigree analysis indicated an autosomal dominant pattern of inheritance with variable penetrance. SQSTM1 gene analysis in two Italian studies revealed the presence of at least three different mutations accounting for both familial and sporadic cases. Interestingly, no decrease in the prevalence of PDB over time was observed, the opposite of what is described in populations of British descent. However, clinical severity of PDB cases included in the Registry in 2002-2004 seemed reduced with respect to that of PDB patients from the previous epidemiological studies, including a 1950-1956 Italian study. Of interest, a consistent association between PDB and animal-related factors and a significantly higher prevalence of the disease in rural than in urban districts were observed. These findings are in keeping with an important role of the environment in the pathogenesis of PDB, perhaps facilitating the expression of the disease in genetically susceptible subjects. Finally, there was also preliminary evidence indicating regional clustering of PDB in Italy, with a concentration of cases in rural districts of Campania and Tuscany. These districts may represent high prevalence areas of PDB in Italy, similar to what has been observed in other countries. Extrapolation estimates suggest that approximately 150,000-300,000 subjects may be affected with PDB in our country. These results confirm PDB to be the most common bone remodeling disorder in elderly people in Italy, excluding osteoporosis.

Cluster Analysis↗
PubMedDate not supplied

"Like a virgin": Absence of rheumatoid arthritis and treponematosis, good sanitation and only rare gout in Italy prior to the 15th century.

OBJECTIVES: This study was conducted to test several hypotheses: 1. That rheumatoid arthritis and syphilis were New World diseases, only transmitted to the Old World subsequent to the passages of Christopher Columbus; 2. To indirectly test the hypothesis that lead poisoning was prevalent in Roman Italy by looking for its byproduct, gout; 3. To test the hypothesis of compromised sanitation in ancient Italy, on the basis of spondyloarthropathy frequency; and 4. To assess variation of trauma frequencies in ancient Italy, by examining frequency of focal periosteal reaction. METHODS: Skeletons from sites ranging from the Bronze Age to the Black Plague epidemic of 1485-1486 were macroscopically evaluated for focal periosteal reaction and for the cardinal signs of rheumatoid arthritis, treponemal disease, gout and spondyloarthropathy. RESULTS: Examination of 688 individuals revealed low frequency of focally distributed periosteal reaction (bumps) in sites dated from the 3400-700 years before present, sharply increasing in the 15th century. Diffuse periosteal reaction was present only as isolated occurrences secondary to hypertrophic osteoarthropathy and sabre shin reaction was notably absent. Erosive disease was uncommon and always oligoarticular in distribution. No marginal erosions were present, with the exception of an isolated metatarsal with classic overhanging edge sign of gout. Subchondral erosions, peripheral joint fusion and axial skeletal involvement identified spondyloarthropathy frequencies of 1-3%, independent of the antiquity of the site. CONCLUSIONS: Italy, prior to Columbus was like a virgin. Rheumatoid arthritis and treponemal disease (specifically syphilis) were not present, further supporting the contention that they are New World-derived diseases. Periosteal signs of minor trauma were rare prior to fifteenth century plague times. This suggests a potential role of domestic (as opposed to outside environment activities) in is development. The hypothesis for a role of lead poisoning in the demise of the Roman Empire is falsified by the rarity of gout. The frequency of spondyloarthropathy was significantly below that found in sanitarily challenged populations, suggesting high standards of hygiene in ancient Italy.

Arthritis, Rheumatoid↗
PubMed1990

Reduction of births in Italy after the Chernobyl accident.

After the Chernobyl accident serious concern spread throughout Italy about the possible effects of the consequent exposure to radioactivity on fetuses. A reduction of births in the first three months of 1987, and particularly in February (7.2% reduction in the birth rate), was observed throughout Italy. In April-June 1987 a 4.8% increase in the number of births was observed. The magnitude of both phenomena varied in different areas of the country. The total number of births in the first six months of 1987 was very similar to the expected (264,241 versus 263,659). Induced abortions increased in Lombardia (northern Italy) in June (+1.6%) and July of 1986 (+3.4%) and in Campania (southern Italy) in June (+12.7%) and August (+4.3%). No increase in legal abortions was detected in Lazio (central Italy). Italian data suggest a voluntary decrease in the number of planned pregnancies and the termination of some of them in the first weeks after the accident as a consequence of postdisaster stress.

Abortion, Induced↗
PubMed2000

Geographic distribution of CDA-II: did a founder effect operate in Southern Italy?

BACKGROUND AND OBJECTIVE: Congenital dyserythropoietic anemia type II (CDA-II) is an autosomal recessive condition, whose manifestations range from mild to moderate. Its exact prevalence is unknown. Based on a recently established International Registry of CDA-II (64 unrelated kindreds), a high frequency of CDA II families living in South Italy became evident. DESIGN AND METHODS: The aim of this study was to define the haplotypes of the CDA II kindreds living in Southern Italy based on markers D20S884, D20S863, RPN, D20S841 and D20S908. These markers map to 20q11.2, within the interval of the CDAN2 gene that is responsible for CDA II. Next, we looked at these markers in kindreds from other regions of Italy and from other countries, with special attention to families having ancestors in Southern Italy. RESULTS: Evaluation of the geographic distribution of the ancestry of Italian CDA-II patients clearly demonstrated the unusually high incidence of this condition in Southern Italy. Our statistical calculations and linkage disequilibrium data also clearly demonstrate a strong association of the markers of chromosome 20 with the disease locus in our sample. Almost all the regions defined by the markers here used is in disequilibrium with the disease. Combining the data from the Italian sample together with those obtained from the non-Italian ones, we can restrict the area of highest disequilibrium to that defined by markers D20S863-D20S908. INTERPRETATION AND CONCLUSIONS: Despite the presence of this linkage disequilibrium the search for a common haplotype failed. This could suggest that the mutation was very old or that it occurred more than once on different genetic backgrounds.

Adolescent↗
PubMed2001

[Bright disease in Turin and Italy from the middle of the 19th century to the middle of the 20th century].

For many years the term nephritis was used to indicate renal diseases (in the sense of Bright s disease) in a larger sense. This review summarizes the history of the concept of glolomerulonephritis from Egyptian Medicine up to the Post-Biopsy Era, in particularly in Turin and in Italy. This study reports an epidemiology survey of Bright s disease in Italy from 1880 up to 1960. Towards the end of the 19th century Bright s disease accounted for 26 deaths/year/105 population (in comparison with more than 200 from tubercolosis) in Italy. At the beginning of the 20th century, Bright s disease was the seventh cause of death in Italy. Moreover, in Italy autopsy studies showed a higher percentage of deaths attributed to Bright s disease (5-7%) in comparison with those obtained from vital studies. In 1960, just before the beginning of renal replacement therapy, Bright s disease accounted for 15.7 deaths/year/105 population. Probably it was difficult to recognize in the real incidence of chronic renal diseases leading to death in the 1960s, and vital studies were able to furnish only approximate estimates. However, noteworthy is the fact that these values were very close to those estimated as being the annual need for renal replacement therapy (10-20/year/105 population).

Glomerulonephritis↗
PubMed1992

[Incidence and prevalence of respiratory tumors in Italy. Estimation from mortality data].

This study estimates the incidence and prevalence of larynx and lung cancers using a mathematical model based on available data on specific mortality and survival. In Italy, larynx and lung cancers account for more than 95% of respiratory cancers. In this paper, estimates of age/sex-specific and age-standardized incidence rates and prevalence are presented for the years 1970 and 1987. Age and birth-cohort effects on incidence are also presented by sex and broad geographical area. The procedure was firstly validated using data from four cancer registries: Varese (Northern Italy), Parma (North-Central Italy), Florence (Central Italy), and Ragusa (Southern Italy). Estimates were then carried out at the national level and for each major geographical area (i.e. North, Center and South). Larynx cancer age-standardized incidence rates increased for men by about 25% from 1970 to 1987. Age-specific rates increased for ages greater than 44 years, but decreased for younger ages. Cohort effects are low for older cohorts; they steeply increase and plateau for the 1900-1905 cohorts, and then peak for the 1930 cohort. The risk for cohorts born after 1930 systematically decreases. We estimated that the 1930 birth cohort has a risk five times higher than the 1890 cohort. For women, the incidence rates increased by about 30% from 1970 to 1987, for all age classes. Cohort effects steadily increase from the 1886 birth cohort to the 1960 cohort. The estimated prevalence between ages 30 and 84 increased from about 24,400 cases in 1970 (23,000 males and 1,400 females) to about 51,400 cases in 1987 (48,600 males and 2,800 females). For men, 42% of the increase can be attributed to an increase in the incidence of the disease; 45% can be attributed to population aging, and only 13% to an increase in the survival probability. Corresponding figures for women are 42%, 48%, and 10%. For lung cancer, we estimated 32,000 incident cases for 1987 (28,000 men and 4,000 women), two times the corresponding figures for 1970 (14,000 men and 2,000 women). Looking at age-adjusted rates, the overall risk of lung cancer increased by about 60% for men and 52% for women during a period of 17 years. Age-specific incidence rates increased proportionally with age for ages greater than 50 years. By contrast, there was a slight but systematic risk reduction in younger age classes.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Pollen-related allergy in Italy.

Pollen-related allergies are very common in Italy and pollinosis is the commonest allergic disease. The type of allergenic plants and the prevalence of hay fever varies among regions. In the Mediterranean area there are characteristic climatic conditions (mildness of winter, summer dryness) that facilitate the growth of a typical vegetation with its associated various types of allergenic pollen grains, some of them very different from those of central and northern Europe. Italy has a central position in the Mediterranean basin, but because of its geographic characteristics, there are different climatic aspects with different vegetation between northern, central, and southern areas. Gramineae are the most common allergenic plants in northern and central Italy, where more than 60% of patients with pollinosis are grass-pollen sensitive. Parietaria is the most important pollinating plant in southern Italy and Liguria. Olea europaea, the olive tree with cultivation widespread in the whole Mediterranean basin, is responsible for frequently severe pollinosis, particularly in some regions of the southern Italy.

Allergens↗
PubMedDate not supplied

Mammography screening in Italy: 2003-2004 survey.

GISMa performs a yearly survey to collect process indicators of mammography screening and compare them, using standard values agreed on a national and international basis. This survey is highly representative of the Italian situation, providing summary data stratified by region and by age group. Data come from several different programmes that may have changed over time, and may have different model of organisation and management. Eighty-eight programmes from 15 different regions (out of 21) provided data for 2003. In nine regions individual programmes are part of a comprehensive regional project. During this year about 1,480,000 women aged 50-69 years were invited to have a screening mammogram, and over 843,000 were screened. Theoretical coverage was 56.2%, while 41.4% of the target population received an invitation to screening. An imbalance in coverage can be seen when comparing Northern and Central Italy, where over 3/4 of the population is covered, to Southern Italy, with only a 10.6% coverage by organised screening. National crude attendance rate was 58.3%. A decreasing trend was evident from the North to the Centre to the South of Italy: 61.2%. 56.2%, and 38.1% respectively. Referral rates of 7.8% at first screening and 4.5% at repeat screening were recorded. Direct standardised detection rate was 6.9 x 1000 at first test and 4.8 at repeat test, while benign to malignant ratio for first and repeat screening was 0.33 and 0.23 respectively. Detection rate of "small" cancers (< or =10 mm in size) was 1.5 and 1.4 x 1000 for first and repeat test. Indicators by 5-year age groups confirm greater diagnostic problems at younger ages, with higher referral rates, higher frequency of surgical procedures with benign outcome (B/M ratio), and a substantially lower detection rate as compared to older age groups. The year 2004 was the first in which regions were required to provide data on screening activity to the ONS; data were provided by 120 programmes from 18 regions. Preliminary data showed a coverage rate of 69.4%, while 51.1% of the target population received an invitation to screening. Although a substantial increase in coverage was observed also in Southern Italy. a major imbalance in coverage still exists between Northern-Central and Southern Italy: 82.3%, 98.2% and 30.5% respectively. National crude attendance rate was 55.8%.

Aged↗
PubMedDate not supplied

[The experiences and outlook of occupational epidemiology in Italy].

Occupational epidemiology has been developed and established in Italy thanks mainly to cancer risk studies. From these studies contributions have been derived for the identification of occupational carcinogenic agents which have received wide international recognition. However, an opportunity was missed when the question of "subjectivity" was abandoned since this is still topical and important for the identification and evaluation of exposure and notification of risk. Significant investigations have estimated the proportion of tumours that could be ascribed to occupational exposure in Italy. Another area where epidemiology in Italy has made significant contributions is the retrospective conversion of jobs in exposures to specific substances. The situation in Italy is still favourable for "record linkage" studies using census data. The main challenges awaiting occupational epidemiology in Italy concern method (for example, the use of molecular dosimetry for the assessment of internal dose or the choice of the most appropriate reference populations), the interpretation of the effects of exogenous exposure in terms of biological mechanisms (including the role of individual susceptibility), evaluation of the predictability of cytogenetic alterations, comparison with bioethical aspects, the ever closer link between occupational and environmental problems in the study of effects on industrial activity and products.

Epidemiologic Methods↗
PubMed1995

Dietary intake in five ageing cohorts of men in Finland, Italy and The Netherlands.

OBJECTIVE: To obtain insight into dietary habits of elderly people and how these habits have evolved from middle to old age. DESIGN: Cross-sectional study of dietary patterns around 1990; retrospective cohort study of changes in dietary intake since middle age. SETTING: Five cohorts: East and West Finland, Zutphen (Netherlands), Crevalcore (Italy), and Montegiorgo (Italy). SUBJECTS: Men aged 70-90 years around 1990. METHODS: Food intake was estimated using a cross-check dietary history adjusted to the local situation. RESULTS: (i) Cross-sectional: Significant differences were observed between the countries for all food groups, energy and nutrients (P < 0.05). The Finnish diet was characterised by a high consumption of animal products and potatoes, the Italian diet by a high consumption of cereals, vegetables, fruits and alcohol. The Dutch diet was generally intermediate. (ii) Longitudinal: The decrease in energy intake since middle age varied from 4.2 MJ/day in the Finnish cohorts to 2.1 MJ/day in Italy. Also the consumption of most food groups decreased but the consumption of vegetables and fruits increased. Saturated fatty acid intake decreased by 3 E% in the Finnish cohorts and decreased by < 1 E% in Italy. Alcohol intake decreased by approximately 7 E% in Italy while it increased by 2.5 E% in the Netherlands. CONCLUSIONS: Although the general patterns of dietary intake of the different cultures still can be recognised at old age, the variation between them has become smaller. Compared to their dietary intake at middle age, however, the dietary pattern of the Finnish and Dutch cohorts has changed slightly in the direction of a healthy diet, while the diet of the Italian men remained Mediterranean, and thus more healthy, at old age.

Aged↗
PubMedDate not supplied

Trends in cancer mortality: perspectives from Italy and the United States.

Cancer continues to be a major public health problem in Italy, as it is throughout the world. We analyzed age-adjusted mortality rates for all cancers combined and for specific cancer sites in Italy for five year periods from 1950 to 1989. We compared trends in Italian cancer mortality to those observed in the United States during the same time period. We also considered some ancillary data including age-specific mortality rates, as well as incidence and five year relative survival data from the Modena Province. Age-adjusted cancer mortality rates in Italy are increasing in males and, to a lesser extent, females. This finding is in contrast to a recent plateau in age-adjusted cancer mortality rates in the United States. In Italy, stomach cancer mortality has declined substantially, counteracting marked increases in lung cancer mortality, particularly in males, and breast and lung cancer in females. Changes in cancer mortality in Italy, as in the US, have been driven primarily by changes in disease incidence rather than advances in therapeutics. These data suggest a need for realignment of cancer control resources toward prevention, particularly with regard to lung cancer and tobacco usage.

Adolescent↗
PubMed2005

The pre-vaccination regional epidemiological landscape of measles in Italy: contact patterns, effort needed for eradication, and comparison with other regions of Europe.

BACKGROUND: Strong regional heterogeneity and generally sub-optimal rates of measles vaccination in Italy have, to date, hampered attainment of WHO targets for measles elimination, and have generated the need for the new Italian National Measles Elimination Plan. Crucial to success of the plan is the identification of intervention priorities based upon a clear picture of the regional epidemiology of measles derived from the use of data to estimate basic parameters. Previous estimates of measles force of infection for Italy have appeared anomalously low. It has been argued elsewhere that this results from Italian selective under-reporting by age of cases and that the true measles force of infection in Italy is probably similar to that of other European countries. A deeper examination of the evidence for this conjecture is undertaken in the present paper. METHODS: Using monthly regional case notifications data from 1949 to the start of vaccination in 1976 and notifications by age from 1971-76, summary equilibrium parameters (force of infection (FOI), basic reproductive ratio (R0) and critical vaccination coverage (pc)) are calculated for each region and for each of 5 plausible contact patterns. An analysis of the spectra of incidence profiles is also carried out. Finally a transmission dynamics model is employed to explore the correspondence between projections using different estimates of force of infection and data on seroprevalence in Italy. RESULTS: FOI estimates are lower than comparable European FOIs and there is substantial regional heterogeneity in basic reproductive ratios; certain patterns of contact matrices are demonstrated to be unfeasible. Most regions show evidence of 3-year epidemic cycles or longer, and compared with England & Wales there appears to be little synchronisation between regions. Modelling results suggest that the lower FOI estimated from corrected aggregate national data matches serological data more closely than that estimated from typical European data. CONCLUSION: Results suggest forces of infection in Italy, though everywhere remaining below the typical European level, are historically higher in the South where currently vaccination coverage is lowest. There appears to be little evidence to support the suggestion that a higher true force of infection is masked by age bias in reporting.

Journal Article↗
PubMed2006

A rapid ethnographic study of breastfeeding in the North and South of Italy.

BACKGROUND: The past ten years have witnessed a rising trend in the prevalence and duration of breastfeeding in Italy, but breastfeeding rates increase in an unequal way; they are higher in the North of Italy than in the South. The purpose of this study was to describe the experiences, expectations and beliefs of a sample of mothers, and to identify differences, if any, between the North and the South of Italy. METHODS: The study was conducted in two regions of Italy, Friuli Venezia Giulia in the Northeast and Basilicata in the South. Two hundred and seventy-nine mothers of infants and children 6 to 23 months of age were interviewed using an 85-item questionnaire including closed and open questions on infant feeding experiences and beliefs, sources of information and support, reasons for intended and actual choices and practices, and some demographic and social variables. Face-to-face interviews were conducted between May 2001 and September 2002. Quantitative and qualitative methods were used for data analysis. RESULTS: The distribution of the mothers by age, education, employment and parity did not differ from that of the general population of the two regions. The reported rates of initiation and duration of breastfeeding were also similar: 95% started breastfeeding, exclusive breastfeeding was 32% at three and 9% at six months, with 64% and 35% of any breastfeeding, respectively. Some differences were reported in the rates of full breastfeeding, reflecting different ages of introduction of non-nutritive fluids. These, as well as nutritive fluids--including infant formula--and complementary foods, were introduced far too early. Advice on infant feeding was generally provided by health professionals and often was not based on up-to-date recommendations. Mothers were generally aware of the advantages of breastfeeding, but at the same time reported problems that they were not able to solve alone or through social and health system support. Most mothers would welcome the support of a peer counsellor. More mothers in Basilicata than in Friuli Venezia Giulia reported difficulties with breastfeeding related to returning to work and were not familiar with their rights on breastfeeding and maternity leave. CONCLUSION: Programmes for the protection, promotion and support of breastfeeding in these and similar regions of Italy should concentrate on better training of health professionals with regards to lactation management, communication, and counselling skills. The addition of trained peer counsellors could reinforce the work done by the health system and, through community involvement, could help change social prejudice in the mid- and long-term. The differences between regions should be taken into account in formulating these programmes to avoid increasing, and possibly to decrease, the current gaps.

Journal Article↗