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Bua A, Moirano G, Pizzi C, Rusconi F, Migliore E, Richiardi L, Popovic M. Maternal antenatal mental health and its associations with perinatal outcomes and the use of healthcare services in children from the NINFEA birth cohort study. Eur J Pediatr 2024:10.1007/s00431-024-05525-3. [PMID: 38564067 DOI: 10.1007/s00431-024-05525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
To investigate the associations between maternal mental health disorders before and during pregnancy and perinatal outcomes and child healthcare utilization between 6 and 18 months of age. Among the 6814 mother-child pairs from the Italian Internet-based NINFEA birth cohort, maternal depression, anxiety, and sleep disorders diagnosed by a physician before and during pregnancy were assessed through self-reported questionnaires completed during pregnancy and 6 months after delivery. Perinatal outcomes (preterm birth, birth weight, small for gestational age, congenital anomalies, and neonatal intensive care unit (NICU)) and children's healthcare utilization (emergency department (ED) visits, hospitalizations, and outpatient visits) were reported by mothers at 6 and 18 months postpartum. We used regression models adjusted for maternal age, education, parity, country of birth, region of delivery, and household income. Maternal mental health disorders were not associated with perinatal outcomes, except for depression, which increased the risk of offspring admission to NICU, and anxiety disorders during pregnancy, which were associated with preterm birth and lower birth weight. Children born to mothers with depression/anxiety disorders before pregnancy, compared to children of mothers without these disorders, had an increased odds of a visit to ED for any reason (odds ratio (ORadj) = 1.26, 95% confidence interval (CI): 1.02-1.54), of an ED visit resulting in hospitalization (ORadj = 1.75, 95%CI: 1.27-2.42), and of planned hospital admissions (ORadj = 1.55, 95%CI: 1.01-2.40). These associations with healthcare utilization were similar for mental disorders also during pregnancy. The association pattern of maternal sleep disorders with perinatal outcomes and child healthcare utilization resembled that of maternal depression and/or anxiety disorders with these outcomes. Conclusion: Antenatal maternal mental health is a potential risk factor for child-health outcomes and healthcare use. Early maternal mental health interventions may help to promote child health and reduce healthcare costs. What is Known: • Poor maternal mental health affects pregnancy outcomes and child health, and children of mothers with mental health conditions tend to have increased healtcare utilization. • Parents with poor mental health often face challenges in caring for their children and have less parenting self-efficacy, which could potentially lead to frequent medical consultations for minor health issues. What is New: • Maternal pre-pregnancy mental disorders were not associated with preterm birth, low birth weight, SGA, and congenital anomalies, except for depression, which increased the risk of offspring admission to NICU. Anxiety disorders during pregnancy were associated with lower birth weight and an increased odds of preterm birth. • Maternal depression and/or anxiety and sleep disorders, both before and during pregnancy, were associated with an increase in children's healthcare utilization between 6 and 18 months of life.
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Affiliation(s)
- Adriana Bua
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
| | - Costanza Pizzi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
| | - Franca Rusconi
- Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Enrica Migliore
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
| | - Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
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Maritano S, Moirano G, Isaevska E, Pizzi C, Ponzo V, Moccia C, Maule M, Lastrucci V, Alderotti G, Ronfani L, Brumatti LV, Rusconi F, Gagliardi L, Brescianini S, Nisticò L, De Sario M, Culasso M, Richiardi L. Examining the relationship between the environmental impact of diet and child growth from a co-benefit perspective. Environ Res 2024; 250:118496. [PMID: 38365051 DOI: 10.1016/j.envres.2024.118496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/29/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
The adoption of diets that minimize both their environmental impacts and weight excess in children would be a major co-benefit for climate change mitigation. We evaluated the relationship between child diet-related environmental impact and anthropometric characteristics in an Italian birth cohort. The study involved 2127 children of the Piccolipiù birth cohort. At 4 years, their diet in the previous two months was assessed through a questionnaire, from which we derived individual: (i) diet-related daily greenhouse gas emissions (GHGE), (ii) land use (LU), (iii) adherence to the Mediterranean Diet (MD) and (iv) red meat consumption. We related these variables with overweight and obesity, waist circumference, and height at 4 years using regression models adjusted for a priori selected confounders. Diet-related GHGE and LU had a positive weak association with overweight and obesity, with an odds ratio (OR) for the fourth vs. second quartile of 1.30 for both GHGE (95% confidence intervals -CI-: 0.96; 1.77) and LU (95% CI: 0.96-1.76). Both OR estimates increased after adjustment for energy intake. GHGE and LU were not associated with height, with the exception of shorter children in the first quartile. A high vs. low MD adherence was associated with an increase in height Z-score of 0.11 (95% CI 0.01; 0.21). No association was found for red meat consumption. These results suggest that lowering the impact of high environmental impact diets may have, if anything, beneficial effects on child obesity, overweight, and height, with pro-MD patterns playing an important role.
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Affiliation(s)
- Silvia Maritano
- Cancer Epidemiology Unit, Medical Science Department, University of Turin and CPO Piemonte, Via Santena 7, 10126, Turin, Italy; University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria, 27100, Pavia, PV, Italy.
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Medical Science Department, University of Turin and CPO Piemonte, Via Santena 7, 10126, Turin, Italy
| | - Elena Isaevska
- Cancer Epidemiology Unit, Medical Science Department, University of Turin and CPO Piemonte, Via Santena 7, 10126, Turin, Italy
| | - Costanza Pizzi
- Cancer Epidemiology Unit, Medical Science Department, University of Turin and CPO Piemonte, Via Santena 7, 10126, Turin, Italy
| | - Valentina Ponzo
- Human Nutrition Unit, Medical Science Department, University of Turin, c.so Dogliotti 14, 10126, Turin, Italy
| | - Chiara Moccia
- Cancer Epidemiology Unit, Medical Science Department, University of Turin and CPO Piemonte, Via Santena 7, 10126, Turin, Italy
| | - Milena Maule
- Cancer Epidemiology Unit, Medical Science Department, University of Turin and CPO Piemonte, Via Santena 7, 10126, Turin, Italy
| | - Vieri Lastrucci
- Epidemiology Unit, Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Giorgia Alderotti
- Epidemiology Unit, Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", via dell'Istria 65/1, 34137, Trieste, Italy
| | - Liza Vecchi Brumatti
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", via dell'Istria 65/1, 34137, Trieste, Italy
| | - Franca Rusconi
- Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Via Cocchi 7/9, 56121, Pisa, Italy
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, Azienda AUSL Toscana Nord Ovest, Pisa, Italy
| | - Sonia Brescianini
- Center for Behavioral Sciences and Mental Health, Italian National Health Institute, 00161, Rome, Italy
| | - Lorenza Nisticò
- Center for Behavioral Sciences and Mental Health, Italian National Health Institute, 00161, Rome, Italy
| | - Manuela De Sario
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit Roma 1, Rome, Italy
| | - Martina Culasso
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit Roma 1, Rome, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Medical Science Department, University of Turin and CPO Piemonte, Via Santena 7, 10126, Turin, Italy
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Moirano G, Botta A, Yang M, Mangeruga M, Murray K, Vineis P. Land-cover, land-use and human hantavirus infection risk: a systematic review. Pathog Glob Health 2023:1-15. [PMID: 37876214 DOI: 10.1080/20477724.2023.2272097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Previous studies suggest that the risk of human infection by hantavirus, a family of rodent-borne viruses, might be affected by different environmental determinants such as land cover, land use and land use change. This study examined the association between land-cover, land-use, land use change, and human hantavirus infection risk. PubMed and Scopus databases were interrogated using terms relative to land use (change) and human hantavirus disease. Screening and selection of the articles were completed by three independent reviewers. Classes of land use assessed by the different studies were categorized into three macro-categories of exposure ('Agriculture', 'Forest Cover', 'Urban Areas') to qualitatively synthesize the direction of the association between exposure variables and hantavirus infection risk in humans. A total of 25 articles were included, with 14 studies (56%) conducted in China, 4 studies (16%) conducted in South America and 7 studies (28%) conducted in Europe. Most of the studies (88%) evaluated land cover or land use, while 3 studies (12%) evaluated land use change, all in relation to hantavirus infection risk. We observed that land cover and land-use categories could affect hantavirus infection incidence. Overall, agricultural land use was positively associated with increased human hantavirus infection risk, particularly in China and Brazil. In Europe, a positive association between forest cover and hantavirus infection incidence was observed. Studies that assessed the relationship between built-up areas and hantavirus infection risk were more variable, with studies reporting positive, negative or no associations.
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Affiliation(s)
- Giovenale Moirano
- Department of Medical Sciences, University of Turin, Turin, Italy
- Postgraduate School of Biostatistics, Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Annarita Botta
- Department of Infectious Disease and Infectious Emergencies, AORN Monaldi-Cotugno-CTO, Naples, Italy
| | - Mingyou Yang
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Martina Mangeruga
- Environmental Technology, Centre for Environmental Policy, Imperial College, London, UK
| | - Kris Murray
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Paolo Vineis
- School of Public Health, Imperial College, Medical Research Council (MRC) Centre for Environment and Health, London, UK
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Cadman T, Elhakeem A, Vinther JL, Avraam D, Carrasco P, Calas L, Cardo M, Charles MA, Corpeleijn E, Crozier S, de Castro M, Estarlich M, Fernandes A, Fossatti S, Gruszfeld D, Gurlich K, Grote V, Haakma S, Harris JR, Heude B, Huang RC, Ibarluzea J, Inskip H, Jaddoe V, Koletzko B, Luque V, Manios Y, Moirano G, Moschonis G, Nader J, Nieuwenhuijsen M, Andersen AMN, McEachen R, de Moira AP, Popovic M, Roumeliotaki T, Salika T, Marina LS, Santos S, Serbert S, Tzorovili E, Vafeiadi M, Verduci E, Vrijheid M, Vrijkotte TGM, Welten M, Wright J, Yang TC, Zugna D, Lawlor D. Associations of Maternal Educational Level, Proximity to Greenspace During Pregnancy, and Gestational Diabetes With Body Mass Index From Infancy to Early Adulthood: A Proof-of-Concept Federated Analysis in 18 Birth Cohorts. Am J Epidemiol 2023:kwad206. [PMID: 37856700 DOI: 10.1093/aje/kwad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 04/06/2023] [Indexed: 10/21/2023] Open
Abstract
International sharing of cohort data for research is important and challenging. We explored the feasibility of multi-cohort federated analyses by examining associations between three pregnancy exposures (maternal education, exposure to green vegetation and gestational diabetes) with offspring BMI from infancy to 17 years. We used data from 18 cohorts (n=206,180 mother-child pairs) from the EU Child Cohort Network and derived BMI at ages 0-1, 2-3, 4-7, 8-13 and 14-17 years. Associations were estimated using linear regression via one-stage IPD meta-analysis using DataSHIELD. Associations between lower maternal education and higher child BMI emerged from age 4 and increased with age (difference in BMI z-score comparing low with high education age 2-3 years = 0.03 [95% CI 0.00, 0.05], 4-7 years = 0.16 [95% CI 0.14, 0.17], 8-13 years = 0.24 [95% CI 0.22, 0.26]). Gestational diabetes was positively associated with BMI from 8 years (BMI z-score difference = 0.18 [CI 0.12, 0.25]) but not at younger ages; however associations attenuated towards the null when restricted to cohorts which measured GDM via universal screening. Exposure to green vegetation was weakly associated with higher BMI up to age one but not at older ages. Opportunities of cross-cohort federated analyses are discussed.
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Moirano G, Pizzi C, Rusconi F, Maule M, Richiardi L, Popovic M. Family socioeconomic position and changes in planned health care for children with chronic diseases during the COVID-19 pandemic in Italy. Front Public Health 2023; 11:1174118. [PMID: 37521970 PMCID: PMC10372358 DOI: 10.3389/fpubh.2023.1174118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction In this study, we aimed at evaluating whether, during the COVID-19 pandemic, children affected by chronic diseases were impacted by the deferral of planned healthcare caused by the restriction measures. Design This study was conducted using data from the Italian NINFEA birth cohort, which include children born between 2005 and 2016. Women who completed the 4-year NINFEA follow-up questionnaire before November 2020 (N = 5,307) were invited to complete a questionnaire targeted at evaluating the impacts of the pandemic on their children's health. The questionnaire asked mothers to report whether their children had a chronic disease or condition that required one or more regular health checks by a doctor in 2019 (used as a reference period) and whether the children had problems getting routine health checks after March 2020. Results We obtained information on 3,721 children. Out of 353 children with a chronic disease that required at least one medical visit in 2019, 130 (36.8%) experienced problems during the pandemic. Lower family income was associated with a higher risk of experiencing health access problems. We observed that children living in families at lower income tertiles had more chance of experiencing healthcare access problems than children living in families at the highest income tertiles (prevalence rate ratio for a tertile decrease in family income: 1.22; 95% CIs: 1.02-1.49). Conclusion Our study underlines that the COVID-19 pandemic may have caused healthcare access problems for children with prevalent chronic diseases, especially among those living in households with a low socioeconomic position.
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Affiliation(s)
- Giovenale Moirano
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, Torino, Italy
- Department of Public Health and Paediatrics, Post Graduate School of Medical Statistics, University of Torino, Torino, Italy
| | - Costanza Pizzi
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Franca Rusconi
- Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Milena Maule
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Maja Popovic
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, Torino, Italy
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Ottone M, Petri D, Listorti E, Macciotta A, Moirano G, Murtas R, Renzi M, Asta F. [A national overview of the topics covered by young people in epidemiology: a comparison before and after the Covid-19.]. Recenti Prog Med 2023; 114:309-315. [PMID: 37229671 DOI: 10.1701/4042.40217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Epidemiology is increasingly involved on a wide variety of topics and to engage different professionals and disciplines in an increasingly active way. A fundamental role is played by young researchers active in Italian epidemiology who create opportunities for meeting and discussion, in the name of multidisciplinarity and integration of different skills. OBJECTIVE The aim of this paper is to provide a detailed description of the topics most frequently studied in epidemiology by young people and to highlight any changes in these topics in the pre- and post-Covid-19 workplaces. METHODS All abstracts submitted in the years 2019 and 2022 by young participants in the Maccacaro Prize, an annual award aimed at Italian association of epidemiology (Aie) conference addressed to people under 35 years of age, were considered. In addition to the comparison of the topics, a comparison of the related work structures and their geographical location was carried out by grouping the research centres into three Italian geographical regions: north, centre and south/islands. RESULTS Between 2019 and 2022, the number of abstracts participating in the Maccacaro Prize increased. The interest in topics related to infectious diseases, vaccines, and pharmaco-epidemiology has sharply increased, while in environmental and maternal and child epidemiology it has moderately increased. Social epidemiology, health promotion and prevention, as well as clinical and evaluative epidemiology, have experienced a decrease in interest. Finally, after analysing the geographical distribution of reference centres, it was discovered that certain regions, such as Piedmont, Lombardy, Veneto, Emilia-Romagna, Tuscany and Latium, have a strong and consistent presence of young people in the field of epidemiology. Conversely, there is a small number of young professionals working in this field in other Italian regions, especially in Southern regions. CONCLUSIONS The pandemic has changed our personal and working habits, but it has also played a fundamental role in making epidemiology known. The increase in young people joining an association such as the Aie is a clear sign of the growing interest in this discipline.
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Affiliation(s)
- Marta Ottone
- Servizio di Epidemiologia, Azienda Usl-Irccs di Reggio Emilia
| | - Davide Petri
- Dipartimento di Ricerca traslazionale e delle nuove tecnologie in medicina e chirurgia, Università di Pisa
| | - Elisabetta Listorti
- Centro di ricerche sulla gestione dell'assistenza sanitaria e sociale (Cergas), Sda Bocconi, Università Bocconi, Milano
| | | | | | - Rossella Murtas
- Uoc Epidemiologia, Agenzia per la tutela della salute della Città metropolitana di Milano
| | - Matteo Renzi
- Dipartimento di Epidemiologia, Ssr Lazio/Asl Roma 1
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D'Errico A, Maritano S, Moccia C, Isaevska E, Pizzi C, Moirano G, Popovic M. [Exposome: from definition to future challenges.]. Recenti Prog Med 2023; 114:349-354. [PMID: 37229681 DOI: 10.1701/4042.40227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The exposome concept arises from the need to integrate different disciplines of public health and environmental sciences, mainly including environmental epidemiology, exposure science, and toxicology. The role of the exposome is to understand how the totality of an individual's exposures throughout the lifetime can impact human health. The etiology of a health condition is rarely explained by a single exposure. Therefore, examining the human exposome as a whole becomes relevant to simultaneously consider multiple risk factors and more accurately estimate concurrent causes of different health outcomes. Generally, the exposome is explained through three domains: general external exposome, specific external exposome, and internal exposome. The general external exposome includes measurable population-level exposures such as air pollution or meteorological factors. The specific external exposome includes information on individual exposures, such as lifestyle factors, typically obtained from questionnaires. Meanwhile, the internal exposome encompasses multiple biological responses to external factors, detected through molecular and omics analyses. Additionally, in recent decades, the socio-exposome theory has emerged, where all exposures are studied as a phenomenon dependent on the interaction between socioeconomic factors that vary depending on the context, allowing the identification of mechanisms that lead to health inequalities. The considerable production of data in exposome studies has led researchers to face new methodological and statistical challenges, introducing various approaches to estimate the effect of the exposome on health. Among the most common are regression models (Exposome-Wide Association Study - ExWAS), dimensionality reduction and exposure grouping techniques, and machine learning methods. The significant conceptual and methodological innovation of the exposome for a more holistic evaluation of the risks associated with human health is continuously expanding and will require further investigations related to the application of information obtained from studies into prevention and public health policies.
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Affiliation(s)
| | | | - Chiara Moccia
- Dipartimento di Scienze mediche, Epidemiologia dei tumori, Università di Torino
| | - Elena Isaevska
- Dipartimento di Scienze mediche, Epidemiologia dei tumori, Università di Torino
| | - Costanza Pizzi
- Dipartimento di Scienze mediche, Epidemiologia dei tumori, Università di Torino
| | - Giovenale Moirano
- Dipartimento di Scienze mediche, Epidemiologia dei tumori, Università di Torino
| | - Maja Popovic
- Dipartimento di Scienze mediche, Epidemiologia dei tumori, Università di Torino
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Roccuzzo G, Moirano G, Fava P, Maule M, Ribero S, Quaglino P. Obesity and immune-checkpoint inhibitors in advanced melanoma: A meta-analysis of survival outcomes from clinical studies. Semin Cancer Biol 2023; 91:27-34. [PMID: 36871633 DOI: 10.1016/j.semcancer.2023.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
Obesity is a chronic inflammatory condition that has been associated with different types of cancer. However, its role in melanoma incidence, progression, and response to immune-checkpoint-inhibitors (ICI) is still controversial. On the one hand, increased levels of lipids and adipokines can promote tumor proliferation and several genes associated with fatty acid metabolism have been found to be upregulated in melanomas. On the other hand, immunotherapy seems to be more effective in obese animal models, presumably due to an increase in CD8 + and subsequent decrease in PD-1 + T-cells in the tumor microenvironment. In humans, several studies have investigated the role of BMI (body mass index) and other adiposity-related parameters as potential prognostic markers of survival in advanced melanoma patients treated with ICI. The aim of this research has been to systematically review the scientific literature on studies evaluating the relationship between overweight/obesity and survival outcomes in patients with advanced melanoma treated with ICI and to perform a meta-analysis on those sharing common characteristics. After screening 1070 records identified through a literature search, 18 articles assessing the role of BMI-related exposure in relation to survival outcomes in ICI-treated patients with advanced melanoma were included in our review. In the meta-analysis of the association between overweight (defined as BMI>25 or BMI 25-30), overall survival (OS), and progression free survival (PFS), 7 studies were included, yielding a summary HR of 0.87 (95% CI: 0.74-1.03) and 0.96 (95% CI: 0.86-1.08), respectively. Our results show that, despite few suggestive findings, the use of BMI as a valuable predictor of melanoma patients' survival in terms of PFS and OS should not be currently recommended, due to the limited evidence available.
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Affiliation(s)
- Gabriele Roccuzzo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin 10126, Torino, Italy.
| | - Giovenale Moirano
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, 10126 Torino, Italy; Postgraduate School in Biostatistics, Department of Public Health and Pediatrics, University of Turin, 10126 Torino, Italy
| | - Paolo Fava
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin 10126, Torino, Italy
| | - Milena Maule
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Simone Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin 10126, Torino, Italy
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin 10126, Torino, Italy
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Moccia C, Pizzi C, Moirano G, Popovic M, Zugna D, d'Errico A, Isaevska E, Fossati S, Nieuwenhuijsen MJ, Fariselli P, Sanavia T, Richiardi L, Maule M. Modelling socioeconomic position as a driver of the exposome in the first 18 months of life of the NINFEA birth cohort children. Environ Int 2023; 173:107864. [PMID: 36913779 DOI: 10.1016/j.envint.2023.107864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The exposome drivers are less studied than its consequences but may be crucial in identifying population subgroups with unfavourable exposures. OBJECTIVES We used three approaches to study the socioeconomic position (SEP) as a driver of the early-life exposome in Turin children of the NINFEA cohort (Italy). METHODS Forty-two environmental exposures, collected at 18 months of age (N = 1989), were classified in 5 groups (lifestyle, diet, meteoclimatic, traffic-related, built environment). We performed cluster analysis to identify subjects sharing similar exposures, and intra-exposome-group Principal Component Analysis (PCA) to reduce the dimensionality. SEP at childbirth was measured through the Equivalised Household Income Indicator. SEP-exposome association was evaluated using: 1) an Exposome Wide Association Study (ExWAS), a one-exposure (SEP) one-outcome (exposome) approach; 2) multinomial regression of cluster membership on SEP; 3) regressions of each intra-exposome-group PC on SEP. RESULTS In the ExWAS, medium/low SEP children were more exposed to greenness, pet ownership, passive smoking, TV screen and sugar; less exposed to NO2, NOX, PM25abs, humidity, built environment, traffic load, unhealthy food facilities, fruit, vegetables, eggs, grain products, and childcare than high SEP children. Medium/low SEP children were more likely to belong to a cluster with poor diet, less air pollution, and to live in the suburbs than high SEP children. Medium/low SEP children were more exposed to lifestyle PC1 (unhealthy lifestyle) and diet PC2 (unhealthy diet), and less exposed to PC1s of the built environment (urbanization factors), diet (mixed diet), and traffic (air pollution) than high SEP children. CONCLUSIONS The three approaches provided consistent and complementary results, suggesting that children with lower SEP are less exposed to urbanization factors and more exposed to unhealthy lifestyles and diet. The simplest method, the ExWAS, conveys most of the information and is more replicable in other populations. Clustering and PCA may facilitate results interpretation and communication.
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Affiliation(s)
- Chiara Moccia
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy.
| | - Costanza Pizzi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Daniela Zugna
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Antonio d'Errico
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Elena Isaevska
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Serena Fossati
- ISGlobal (Barcelona Institute for Global Health), Barcelona, Spain
| | | | - Piero Fariselli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Tiziana Sanavia
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Milena Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
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10
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Torres Toda M, Avraam D, James Cadman T, Fossati S, de Castro M, Dedele A, Donovan G, Elhakeem A, Estarlich M, Fernandes A, Gonçalves R, Grazuleviciene R, Harris JR, Harskamp-van Ginkel MW, Heude B, Ibarluzea J, Iñiguez C, Wv Jaddoe V, Lawlor D, Lertxundi A, Lepeule J, McEachan R, Moirano G, Lt Nader J, Nybo Andersen AM, Pedersen M, Pizzi C, Roumeliotaki T, Santos S, Sunyer J, Yang T, Vafeiadi M, Gm Vrijkotte T, Nieuwenhuijsen M, Vrijheid M, Foraster M, Dadvand P. Exposure to natural environments during pregnancy and birth outcomes in 11 European birth cohorts. Environ Int 2022; 170:107648. [PMID: 36436464 DOI: 10.1016/j.envint.2022.107648] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/25/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
Research suggests that maternal exposure to natural environments (i.e., green and blue spaces) promotes healthy fetal growth. However, the available evidence is heterogeneous across regions, with very few studies on the effects of blue spaces. This study evaluated associations between maternal exposure to natural environments and birth outcomes in 11 birth cohorts across nine European countries. This study, part of the LifeCycle project, was based on a total sample size of 69,683 newborns with harmonised data. For each participant, we calculated seven indicators of residential exposure to natural environments: surrounding greenspace in 100m, 300m, and 500m using Normalised Difference Vegetation Index (NDVI) buffers, distance to the nearest green space, accessibility to green space, distance to the nearest blue space, and accessibility to blue space. Measures of birth weight and small for gestational age (SGA) were extracted from hospital records. We used pooled linear and logistic regression models to estimate associations between exposure to the natural environment and birth outcomes, controlling for the relevant covariates. We evaluated the potential effect modification by socioeconomic status (SES) and region of Europe and the influence of ambient air pollution on the associations. In the pooled analyses, residential surrounding greenspace in 100m, 300m, and 500m buffer was associated with increased birth weight and lower odds for SGA. Higher residential distance to green space was associated with lower birth weight and higher odds for SGA. We observed close to null associations for accessibility to green space and exposure to blue space. We found stronger estimated magnitudes for those participants with lower educational levels, from more deprived areas, and living in the northern European region. Our associations did not change notably after adjustment for air pollution. These findings may support implementing policies to promote natural environments in our cities, starting in more deprived areas.
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Affiliation(s)
- Maria Torres Toda
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Demetris Avraam
- Population Health Sciences Institute, Newcastle University, Newcastle, UK; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Timothy James Cadman
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
| | - Serena Fossati
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Montserrat de Castro
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Audrius Dedele
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, 53361 Akademija, Lithuania.
| | - Geoffrey Donovan
- Center for Public Health Research, Massey University-Wellington Campus, PO Box 756, Wellington 6140, New Zealand; USDA Forest Service, PNW Research Station, 620 SW Main, Suite 502, Portland, OR 97205, USA.
| | - Ahmed Elhakeem
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Science, Bristol Medical School, University of Bristol, UK.
| | - Marisa Estarlich
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain; Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO-Public Health, FISABIO-Universitat Jaume I-Universitat de València, Av. Catalunya 21, 46020, Valencia, Spain; Nursing School, Universitat de València, C/Menendez y Pelayo, s/n, 46010, Valencia, Spain.
| | - Amanda Fernandes
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
| | - Romy Gonçalves
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
| | - Regina Grazuleviciene
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, 53361 Akademija, Lithuania.
| | - Jennifer R Harris
- Center for Fertility and Health, The Nowegian Institute of Public Health, Oslo, Norway.
| | - Margreet W Harskamp-van Ginkel
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, Netherlands.
| | - Barbara Heude
- Université de Paris Cité, Inserm, INRAE, Centre of Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France.
| | - Jesús Ibarluzea
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain; Biodonostia Health Research Institute, Environmental Epidemiology and Child Development Group, 20014, San Sebastian, Spain; Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013, San Sebastian, Spain; Faculty of Psychology of the University of the Basque Country, 20018, San Sebastian, Spain.
| | - Carmen Iñiguez
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain; Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO-Public Health, FISABIO-Universitat Jaume I-Universitat de València, Av. Catalunya 21, 46020, Valencia, Spain; Department of Statistics and Operational Research, Universitat de València, Dr. Moliner, 50 46100, Valencia, Spain.
| | - Vincent Wv Jaddoe
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Deborah Lawlor
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Science, Bristol Medical School, University of Bristol, UK.
| | - Aitana Lertxundi
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain; Biodonostia Health Research Institute, Environmental Epidemiology and Child Development Group, 20014, San Sebastian, Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), 48940, Leioa, Spain.
| | - Johanna Lepeule
- Université Grenoble Alpes, Institut Albert Bonniot, équipe d'épidémiologie environnementale appliquée à la reproduction et la santé respiratoire, F-38000 Grenoble, France; Inserm, Institut Albert Bonniot, équipe d'épidémiologie environnementale appliquée à la reproduction et la santé respiratoire, F-38000 Grenoble, France.
| | - Rosemary McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
| | - Giovenale Moirano
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy.
| | - Johanna Lt Nader
- Department of Genetics and Bioinformatics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway.
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Marie Pedersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Costanza Pizzi
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy.
| | - Theano Roumeliotaki
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Social Medicine, School of Medicine, University of Crete, Greece.
| | - Susana Santos
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Portugal.
| | - Jordi Sunyer
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Tiffany Yang
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
| | - Marina Vafeiadi
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Social Medicine, School of Medicine, University of Crete, Greece.
| | - Tanja Gm Vrijkotte
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, Netherlands.
| | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Martine Vrijheid
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Maria Foraster
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Payam Dadvand
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
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11
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Isaevska E, Fiano V, Asta F, Stafoggia M, Moirano G, Popovic M, Pizzi C, Trevisan M, De Marco L, Polidoro S, Gagliardi L, Rusconi F, Brescianini S, Nisticò L, Stazi MA, Ronfani L, Porta D, Richiardi L. Prenatal exposure to PM 10 and changes in DNA methylation and telomere length in cord blood. Environ Res 2022; 209:112717. [PMID: 35063426 DOI: 10.1016/j.envres.2022.112717] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/06/2021] [Accepted: 01/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Air pollution exposure in pregnancy can cause molecular level alterations that might influence later disease susceptibility. OBJECTIVES We investigated DNA methylation (DNAm) and telomere length (TL) in the cord blood in relation to gestational PM10 exposure and explored potential gestational windows of susceptibility. METHODS Cord blood epigenome-wide DNAm (N = 384) and TL (N = 500) were measured in children of the Italian birth cohort Piccolipiù, using the Infinium Methylation EPIC BeadChip and qPCR, respectively. PM10 daily exposure levels, based on maternal residential address, were estimated for different gestational periods using models based on satellite data. Epigenome-wide analysis to identify differentially methylated probes (DMPs) and regions (DMRs) was conducted, followed by a pathway analysis and replication analysis in an second Piccolipiù dataset. Distributed lag models (DLMs) using weekly exposures were used to study the association of PM10 exposure across pregnancy with telomere length, as well as with the DMPs that showed robust associations. RESULTS Gestational PM10 exposure was associated with the DNA methylation of more than 250 unique DMPs, most of them identified in early gestation, and 1 DMR. Out of 151 DMPs available in the replication dataset, ten DMPs showed robust associations: eight were associated with exposure during early gestation and 2 with exposure during the whole pregnancy. These exposure windows were supported by the DLM analysis. The PM10 exposure between 15th and 20th gestational week seem to be associated with shorter telomeres at birth, while exposure between 24th and 29th was associated with longer telomeres. DISCUSSION The early pregnancy period is a potential critical window during which PM10 exposure can influence cord blood DNA methylation. The results from the TL analysis were consistent with previous findings and merit further exploration in future studies. The study underlines the importance of considering gestational windows outside of the predefined trimesters that may not always overlap with biologically relevant windows of exposure.
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Affiliation(s)
- Elena Isaevska
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy.
| | - Valentina Fiano
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy.
| | - Federica Asta
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy.
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy.
| | - Giovenale Moirano
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy.
| | - Maja Popovic
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy.
| | - Costanza Pizzi
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy.
| | - Morena Trevisan
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy.
| | - Laura De Marco
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy.
| | - Silvia Polidoro
- Italian Institute for Genomic Medicine (IIGM), Candiolo, Italy; 5MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College, London, UK.
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, AUSL Toscana Nord Ovest, Pisa, Italy.
| | - Franca Rusconi
- Unit of Epidemiology, Meyer Children's University Hospital, Florence, Italy; Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Pisa, Italy.
| | - Sonia Brescianini
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy.
| | - Lorenza Nisticò
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy.
| | - Maria Antonietta Stazi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy.
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
| | - Daniela Porta
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy.
| | - Lorenzo Richiardi
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy.
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12
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Maritano S, Moirano G, Popovic M, D'Errico A, Rusconi F, Maule M, Richiardi L. Maternal pesticides exposure in pregnancy and the risk of wheezing in infancy: A prospective cohort study. Environ Int 2022; 163:107229. [PMID: 35405505 DOI: 10.1016/j.envint.2022.107229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/08/2022] [Accepted: 04/03/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Pesticide exposure in pregnancy may have health effects in the offspring. We studied whether maternal pesticides exposure during pregnancy is associated with infant wheezing. METHODS The study involved 5997 children from the Italian NINFEA birth cohort, whose mothers were recruited during pregnancy between 2005 and 2016. We used questionnaires completed during pregnancy and 6 months after delivery to derive the following indirect measures of exposure: i) Self-reported pesticide use during the first and the third trimester of pregnancy; (ii) Agricultural activities during the same trimesters. We also evaluated the exposure to agricultural pesticides applied near home using the Corine Land Cover inventory to derive the proportion of a 200-metre buffer area around maternal home address covered by agricultural crops and specific crop types (arable land, fruit trees, heterogeneous cultivations). Questionnaires completed when the child turned 18 months reported information on wheezing between 6 and 18 months of age. We estimated the odds ratios of wheezing adjusting for the following maternal characteristics: age, education, parity, asthma, atopy, smoking in pregnancy, region and area of residence, pet ownership during pregnancy. Crops proximity analyses were restricted to residents in rural areas (N = 1674). RESULTS Agricultural activities during pregnancy were not associated with infant wheezing. Compared to no pesticide use, there was a weak positive association for self-reported use in the third trimester (POR: 1.30; 95 %CI 0.95-1.78) and a stronger association for use in both trimesters (POR: 1.72; 95 %CI 1.11-2.65). The relationship between the proportion of crops around the home address and the risk of infant wheezing, was J-shaped, in particular for fruit trees with the lowest risk for mid values and elevated risk for higher values. CONCLUSION We found some evidence of association for maternal pesticide use in pregnancy and residential proximity to fruit trees cultivations with infant wheezing.
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Affiliation(s)
- Silvia Maritano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Via Santena 7, 10126 Turin, Italy.
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Via Santena 7, 10126 Turin, Italy.
| | - Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Via Santena 7, 10126 Turin, Italy.
| | - Antonio D'Errico
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Via Santena 7, 10126 Turin, Italy.
| | - Franca Rusconi
- Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Via Cocchi 7/9, 56121 Pisa, Italy.
| | - Milena Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Via Santena 7, 10126 Turin, Italy.
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Via Santena 7, 10126 Turin, Italy.
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13
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Bruno F, Moirano G, Budano C, Lalloni S, Ciccone G, Verardi R, Andreis A, Montabone A, De Filippo O, Gallone G, Gilardetti M, D'Ascenzo F, De Ferrari GM. Incidence trends and long-term outcomes of myocardial infarction in young adults: Does gender matter? Int J Cardiol 2022; 357:134-139. [PMID: 35301075 DOI: 10.1016/j.ijcard.2022.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/09/2022] [Accepted: 03/07/2022] [Indexed: 11/05/2022]
Abstract
AIMS Data about long-term clinical outcomes of young patients experiencing an acute myocardial infarction (MI) and about the potential impact of gender on juvenile MI incidence and prognosis are scant. METHODS AND RESULTS Hospital Discharge Register records of Piedmont region (Italy) from 2007 to 2018 were interrogated to identify incident juvenile MI cases and MI recurrences. Patients were considered young if the first MI occurred before or at 47 years of age (5th percentile). Incidence of first juvenile MI event and overall survival were the primary outcomes. Gender differences and survival rate after an MI recurrence were secondary outcomes. Out of 114.816 hospitalizations due to MI, 4482 (3.9%) occurred in people aged ≤47. Average incidence rate of juvenile MI over the study period was 24.5 (23.8-25.2) per 100.000 person-years, with a decline among men and a stable trend among women through the years. The risk of in hospital death was higher for women (1.9% vs. 0.9%, p = 0.02), while the survival rate at 10 years after the first MI was 94.8%, without gender differences (HR 1.05: 0.69-1.60). MI recurrence occurred in 348 (7.8%) and was less common in women (HR 0.72: 0.52-0.99). After multivariate adjustment, MI recurrence was associated with a significantly higher risk of death at follow-up as compared with a single MI episode (HR 3.05: 1.9-4.80, all CI 95%). CONCLUSION Among young patients with MI, women had a higher in-hospital mortality compared to men, but long-term prognosis after hospital discharge did not differ. MI recurrences were associated with increased mortality at follow up.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Giovenale Moirano
- Epidemiology Unit, Department of Medical Sciences, University of Turin, Italy
| | - Carlo Budano
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Stefania Lalloni
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Giovannino Ciccone
- Clinical Epidemiology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Roberto Verardi
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy; Division of Cardiology, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy
| | - Alessandro Andreis
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy.
| | - Andrea Montabone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Marco Gilardetti
- Clinical Epidemiology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
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14
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Popovic M, Fiano V, Moirano G, Chiusa L, Conway DI, Garzino Demo P, Gilardetti M, Iorio GC, Moccia C, Ostellino O, Pecorari G, Ramieri G, Ricardi U, Riva G, Virani S, Richiardi L. The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis. Front Public Health 2022; 10:809283. [PMID: 35265573 PMCID: PMC8899030 DOI: 10.3389/fpubh.2022.809283] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/24/2022] [Indexed: 12/16/2022] Open
Abstract
Background The COVID-19 pandemic has likely affected the most vulnerable groups of patients and those requiring time-critical access to healthcare services, such as patients with cancer. The aim of this study was to use time trend data to assess the impact of COVID-19 on timely diagnosis and treatment of head and neck cancer (HNC) in the Italian Piedmont region. Methods This study was based on two different data sources. First, regional hospital discharge register data were used to identify incident HNC in patients ≥18 years old during the period from January 1, 2015, to December 31, 2020. Interrupted time-series analysis was used to model the long-time trends in monthly incident HNC before COVID-19 while accounting for holiday-related seasonal fluctuations in the HNC admissions. Second, in a population of incident HNC patients eligible for recruitment in an ongoing clinical cohort study (HEADSpAcE) that started before the COVID-19 pandemic, we compared the distribution of early-stage and late-stage diagnoses between the pre-COVID-19 and the COVID-19 period. Results There were 4,811 incident HNC admissions in the 5-year period before the COVID-19 outbreak and 832 admissions in 2020, of which 689 occurred after the COVID-19 outbreak in Italy. An initial reduction of 28% in admissions during the first wave of the COVID-19 pandemic (RR 0.72, 95% CI 0.62-0.84) was largely addressed by the end of 2020 (RR 0.96, 95% CI 0.89-1.03) when considering the whole population, although there were some heterogeneities. The gap between observed and expected admissions was particularly evident and had not completely recovered by the end of the year in older (≥75 years) patients (RR: 0.88, 0.76-1.01), patients with a Romano-Charlson comorbidity index below 2 (RR 0.91, 95% CI: 0.84-1.00), and primary surgically treated patients (RR 0.88, 95% CI 0.80-0.97). In the subgroup of patients eligible for the ongoing active recruitment, we observed no evidence of a shift toward a more advanced stage at diagnosis in the periods following the first pandemic wave. Conclusions The COVID-19 pandemic has affected differentially the management of certain groups of incident HNC patients, with more pronounced impact on older patients, those treated primarily surgically, and those with less comorbidities. The missed and delayed diagnoses may translate into worser oncological outcomes in these patients.
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Affiliation(s)
- Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | - Valentina Fiano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | - Luigi Chiusa
- Pathology Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | - David I. Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Paolo Garzino Demo
- Maxillofacial Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | - Marco Gilardetti
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | | | - Chiara Moccia
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | - Oliviero Ostellino
- Oncology Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giancarlo Pecorari
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Guglielmo Ramieri
- Maxillofacial Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | | | - Giuseppe Riva
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Shama Virani
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
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Pelle MC, Zaffina I, Provenzano M, Moirano G, Arturi F. COVID-19 and diabetes-Two giants colliding: From pathophysiology to management. Front Endocrinol (Lausanne) 2022; 13:974540. [PMID: 36060943 PMCID: PMC9437522 DOI: 10.3389/fendo.2022.974540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/01/2022] [Indexed: 01/08/2023] Open
Abstract
Since December 2019, a new coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread around the world, causing the coronavirus 2019 (COVID-19) pandemic. From the beginning, SARS-CoV-2 has put a strain on the health system. In fact, many patients have had severe forms of the disease with the need for hospitalization due to respiratory failure. To contain the pandemic, the most widely used approach has been lockdowns. Social restrictions have been reduced thanks to the development of vaccines and targeted therapies. However, fatal events still occur among people at high risk of serious infection, such as patients with concomitant diabetes. Different mechanisms have been proposed to explain the poor prognosis of patients with diabetes and COVID-19, but the specific cause is unclear. It is now known that insulin resistance, inflammation, and cytokine storm are involved. Moreover, SARS-CoV-2 uses the angiotensin-converting enzyme 2 receptors to enter cells. This receptor is expressed on pancreatic beta cells and, during infection, it appears that receptor involvement may induce hyperglycemia in patients with or without diabetes. In this study, we discuss the mechanisms underlying the poor prognosis in people with COVID-19 and diabetes and what may improve the outcome in these patients.
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Affiliation(s)
- Maria Chiara Pelle
- Department of Medical and Surgical Sciences, University ‘Magna Graecia’ of Catanzaro, Catanzaro, Italy
| | - Isabella Zaffina
- Department of Medical and Surgical Sciences, University ‘Magna Graecia’ of Catanzaro, Catanzaro, Italy
| | - Michele Provenzano
- Nephrology, Dialysis and Transplantation Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giovenale Moirano
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy
| | - Franco Arturi
- Department of Medical and Surgical Sciences, University ‘Magna Graecia’ of Catanzaro, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University ‘Magna Graecia’ of Catanzaro, Catanzaro, Italy
- *Correspondence: Franco Arturi,
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Bruno F, Moirano G, Budano C, Lalloni S, Ciccone G, Verardi R, Andreis A, Montabone A, Gilardetti M, De Filippo O, D’Ascenzo F, De Ferrari GM. 294 Incidence trends and long-term outcomes of juvenile myocardial infarction: does gender matter? Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Data about long-term clinical outcomes of young patients experiencing an acute myocardial infarction (MI), along with the potential impact of gender on incidence and prognosis in such subset are scant and mostly including USA populations. Thus, there is a paucity of data about European patients suffering from a juvenile MI. Purpose. The purpose of the current study was to investigate temporal trends, survival, MI recurrence, and sex differences among subjects who experienced their first MI at young age in the Piedmont region (Italy) between 2007 and 2018.
Methods and results
Hospital Discharge Register records of Piedmont region (Italy) from 2007 to 2018 were interrogated to identify incident juvenile MI cases and MI recurrences (ICD-9-CM codes: ‘410’, ‘411’, and their subcodes). Patients were considered young if the first MI occurred before or at 47 years of age. Incidence of first Juvenile MI event and subsequent overall survival among patients who survived to hospital discharge were defined as primary outcomes of interest. Subgroup analysis were performed according to sex category, comorbidities and clinical intervention (obtained from the HDRs records). Incidence of MI recurrence among patients who survived to hospital discharge was defined as secondary outcome of interest. Lastly, we evaluated whether experiencing a MI recurrence was associated with a lower overall survival at follow-up. Out of 114 816 hospitalizations due to MI, 4482 occurred in people aged ≤47, with median age 44 years old. At baseline, men had more hypertension (13% vs. 9.4%, P < 0.006) and dyslipidaemia (18.2% vs. 9.9%, P < 0.001), while women more cardiac arrest at presentation (2.9% vs. 1.7%, P = 0.03), cardiogenic shock (2.1% vs. 1.3%, P = 0.06), and less likely to undergone PCI (53.9% vs. 74.3%, P < 0.001). More women (n = 14; 1.9%) than men (n = 33; 0.9%) died while in-hospital, adjusted OR: 2.12; 1.13–3.99. After a median follow-up was 7.2 years (IQR: 4.2–9.9), the survival rate after the first MI was 94.8%, without differences between men and women (HR: 1.05; 0.69–1.60). Age at first MI, year of hospitalization, hospitalization length, chronic kidney disease, cardiogenic shock, third degree atrio-ventricular block, and PCI were found independent predictors of long term survival. 348 (7.8%) experienced at least one MI recurrence and it was more common in men than women (adjusted HR: 0.72; 0.52–0.99). After multivariate adjustment, MI recurrence was associated with a significantly higher risk of death at follow-up as compared with a single MI episode (HR: 3.05; 1.9–4.80, all 95% CI).
Conclusions
In young patients with a MI, women had more in-hospital mortality compared to men, but among patients who survived to hospital discharge, overall long-term prognosis did not differ. MI recurrences were more common in men and were associated with lower long-term survival rate.
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Affiliation(s)
- Francesco Bruno
- A.O.U. Città della Salute e della Scienza, Cardiology, Torino, Italy
| | - Giovenale Moirano
- Center for Epidemiology and Prevention of Cancer (CPO-Piemonte), Turin, Italy
| | - Carlo Budano
- A.O.U. Città della Salute e della Scienza, Cardiology, Torino, Italy
| | - Stefania Lalloni
- A.O.U. Città della Salute e della Scienza, Cardiology, Torino, Italy
| | - Giovannino Ciccone
- Center for Epidemiology and Prevention of Cancer (CPO-Piemonte), Turin, Italy
| | | | | | - Andrea Montabone
- A.O.U. Città della Salute e della Scienza, Cardiology, Torino, Italy
| | - Marco Gilardetti
- Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ovidio De Filippo
- A.O.U. Città della Salute e della Scienza, Cardiology, Torino, Italy
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Popovic M, Moccia C, Isaevska E, Moirano G, Pizzi C, Zugna D, Rusconi F, Merletti F, Maule M, Richiardi L. COVID-19-like symptoms and their relation to the SARS-CoV-2 epidemic in children and adults of an Italian birth cohort. Epidemiol Prev 2021; 45:486-495. [PMID: 34545726 DOI: 10.19191/ep21.6.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to estimate the population prevalence of COVID-19-like symptoms in children and adults during the first SARS-CoV-2 epidemic wave hitting Italy in the spring 2020; to assess their geographical correlation with the cumulative number of COVID-19 cases by province; to analyse their clustering within families; to estimate their sensitivity, positive predictive value (PPV) and negative predictive value (NPV) for COVID-19 diagnosis in individuals tested for SARS-CoV-2. DESIGN cross-sectional study nested within a birth cohort. SETTING AND PARTICIPANTS mothers participating in an Italian birth cohort (NINFEA) were invited to complete an online questionnaire on COVID-19-like symptoms in their household. MAIN OUTCOME MEASURES population prevalence of COVID-19-like symptoms in children and adults, geographical correlation of COVID-19-like symptoms with the cumulative number of COVID-19 cases by province, clustering of COVID-19-like symptoms within families, and sensitivity, PPV and NPV of COVID-19-like symptoms for COVID-19 diagnosis in individuals tested for SARS-CoV-2. RESULTS information was collected on 3,184 households, 6,133 adults, and 5,751 children. In the period March-April 2020, 55.4% of the NINFEA families had at least one member with at least one COVID-19-like symptom. There was a strong geographical correlation between the population cumulative incidence of COVID-19 and the prevalence of muscle pain, fatigue, low-grade fever, and breathing difficulties in adults (Spearman's rho >=0.70). Having at least one family member with a COVID-19 diagnosis, compared with none tested for SARS-CoV-2, was associated with an increased prevalence ratio (PR) of almost all COVID-19-like symptoms in adults, and only of low-grade fever (37-37.5°C; PR 4.54; 95%CI 2.20-9.40) and anosmia/dysgeusia in children. Among adults with COVID-19 diagnosis, fatigue, muscle pain, and fever had a sensitivity >=70%. In individuals tested for SARS-CoV-2, with a 16.6% prevalence of COVID-19, breathing difficulties and nausea/vomiting had the highest PPVs, with point estimates close to 60%, and with NPVs close to 90%. CONCLUSIONS the geographical prevalence of COVID-19-like symptoms in adults may inform on local disease clusters, while certain symptoms in family members of confirmed COVID-19 cases could help identify the intra-familial spread of the virus and its further propagation in the community. Low-grade fever is frequent in children with at least one household member with COVID-19 and possibly indicates child infection.
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Affiliation(s)
- Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and Reference Centre for Epidemiology and Cancer Prevention in Piedmont (CPO Piemonte), Turin (Italy);
| | - Chiara Moccia
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and Reference Centre for Epidemiology and Cancer Prevention in Piedmont (CPO Piemonte), Turin (Italy)
| | - Elena Isaevska
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and Reference Centre for Epidemiology and Cancer Prevention in Piedmont (CPO Piemonte), Turin (Italy)
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and Reference Centre for Epidemiology and Cancer Prevention in Piedmont (CPO Piemonte), Turin (Italy)
| | - Costanza Pizzi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and Reference Centre for Epidemiology and Cancer Prevention in Piedmont (CPO Piemonte), Turin (Italy)
| | - Daniela Zugna
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and Reference Centre for Epidemiology and Cancer Prevention in Piedmont (CPO Piemonte), Turin (Italy)
| | - Franca Rusconi
- Unit of Epidemiology, Meyer Children's University Hospital, Florence (Italy)
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and Reference Centre for Epidemiology and Cancer Prevention in Piedmont (CPO Piemonte), Turin (Italy)
| | - Milena Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and Reference Centre for Epidemiology and Cancer Prevention in Piedmont (CPO Piemonte), Turin (Italy)
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and Reference Centre for Epidemiology and Cancer Prevention in Piedmont (CPO Piemonte), Turin (Italy)
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Pizzi C, Moccia C, Moirano G, d'Errico A, Maule M, Fossati S, Lioret S, Calas L, Richiardi L. 1459Socioeconomic position influence on the early-life individual exposome in the Italian NINFEA birth cohort. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Early exposure to unhealthy lifestyles and environmental risk factors is known to affect health throughout the life-course. There is also evidence that the exposure patterns are influenced by the socioeconomic position (SEP).
Methods
We use the data of the Turin participants of the Italian NINFEA birth cohort (n∼2500) to study how family SEP drives the early life exposome. SEP at birth is measured through the EHII (Equivalized Household Income Indicator), while the exposome includes urban environment, diet and lifestyle exposures measured during infancy. We use standard regression models to evaluate the effect of EHII on each exposome variable accounting for multiple comparison and potential confounders (Drivers-Exposome Wide Association Study – DExWAS) and the hierarchical clustering on the principal components approach to identify groups with similar exposure pattern.
Results
The DExWAS show that low EHII is associated with lower consumption of fruit and vegetables, lower levels of NO2, building and facilities densities, traffic, walkability and connectivity index, higher land-use diversity index, and higher exposure to pets. The hierarchical cluster analysis identifies three groups, with subjects belonging to the cluster characterized by higher level of urban environment risk factors and a healthier diet having a higher mean EHII.
Conclusions
These SEP-early life exposome analyses will be replicated in several European birth cohorts participating in the H2020 ATHLETE and LifeCycle projects.
Key messages
In the Italian city of Turin children from low SEP family are exposed to higher levels of environmental risk factors and unhealthy lifestyles during infancy.
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Affiliation(s)
- Costanza Pizzi
- Department of Medical Sciences, University Of Turin, Turin, Italy
| | - Chiara Moccia
- Department of Medical Sciences, University Of Turin, Turin, Italy
| | | | - Antonio d'Errico
- Department of Medical Sciences, University Of Turin, Turin, Italy
| | - Milena Maule
- Department of Medical Sciences, University Of Turin, Turin, Italy
| | - Serena Fossati
- ISGlobal, Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - Lucinda Calas
- Université de Paris, CRESS, INSERM, INRAE, Paris, France
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Pizzi C, Popovic M, Isaevska E, Rusconi F, Moirano G, Merletti F, Richiardi L. Socioeconomic inequalities in reproductive outcomes in the Italian NINFEA birth cohort and the Piedmont Birth Registry. Epidemiol Prev 2021; 44:136-141. [PMID: 33415956 DOI: 10.19191/ep20.5-6.s1.p136.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND socioeconomic inequalities in reproductive outcomes have been consistently reported in several countries. In a European collaborative study conducted in 2012 whose aim was to investigate the association between socioeconomic position (SEP), measured through maternal education, and preterm delivery inconsistent results were found for the NINFEA birth cohort. However, NINFEA contributed to that study with the first 2,500 pregnancies only, and estimates were not adjusted for any potential confounders assuming that SEP is a distal exposure, that could not be affected by other preterm risk factors. OBJECTIVES to investigate the relationship between SEP and the reproductive outcomes using the entire NINFEA cohort and compare the results with the population-based Piedmont Birth Registry (PBR), accounting for potential baseline collider bias both in the cohort and in the registry. DESIGN observational study. SETTING AND PARTICPANTS 5,323 NINFEA singletons, whose mothers registered into the study before the 36th week of gestation, were analysed. Analyses on maternal education were replicated in the 2011 PBR of 35,318 singletons live births. Factors affecting the likelihood of being a member of the NINFEA study or becoming pregnant in the general population were treated as potential confounders to adjust for baseline collider bias. MAIN OUTCOME MEASURES the association of maternal education and a recently developed household income indicator with both preterm delivery (<37th weeks of gestation) and low birth weight (<2,500 gr) were analysed. RESULTS in the NINFEA cohort, low SEP was positively associated with both preterm delivery and low birth weight, with slightly stronger associations for household income, especially on low birth weight. Results were consistent with those obtained in the PBR data, where an inverse relationship between maternal education and the two reproductive outcomes was found. In both populations, there was confounding due to maternal age and parity, showing that independently of the nature of the source population, baseline factors that affect the probability of being a member of such source population have to be accounted for to allow causal inference. CONCLUSIONS low SEP is associated with adverse reproductive outcomes in a contemporary Italian population.
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Affiliation(s)
- Costanza Pizzi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy);
| | - Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy)
| | - Elena Isaevska
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy)
| | - Franca Rusconi
- Unit of Epidemiology, "Anna Meyer" Children's University Hospital, Florence (Italy)
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy)
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy)
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy)
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Moirano G, Zanet S, Giorgi E, Battisti E, Falzoi S, Acquaotta F, Fratianni S, Richiardi L, Ferroglio E, Maule M. Integrating environmental, entomological, animal, and human data to model the Leishmania infantum transmission risk in a newly endemic area in Northern Italy. One Health 2020; 10:100159. [PMID: 33117874 PMCID: PMC7582207 DOI: 10.1016/j.onehlt.2020.100159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Historically, leishmaniasis in Italy was constrained to areas with Mediterranean climate. In the last 20 years, sand fly vectors (Phlebotomus perniciosus), cases of canine leishmaniasis (CanL) and cases of human visceral leishmaniasis (VL) have been observed in Northern Italian regions, traditionally classified as cold areas unsuitable for sand fly survival. AIM We aim to evaluate through a One-Health approach the risk of endemic transmission of Leishmania infantum in the Piedmont Region, Northern Italy. METHODS We collected environmental, entomological, animal, and human data. We applied a geostatistical binomial model to map the probability of P. perniciosus presence in the study area, using selected environmental parameters as predictors. We evaluated the spatial relationship between the probability of P. perniciosus presence and the geographical distribution of CanL and VL cases observed between 1999 and 2013. RESULTS Between 1999 and 2003, 142 sampling sets (17%) out of 839 resulted positive for P. perniciosus. Elevation, degree of slope, normalized difference vegetation index (NDVI) and summer temperatures were associated with positive sampling sets. During the study period, 164 (13.6%) of Piedmont municipalities reported at least one autochthonous case of CanL, while 89 VL cases were observed in 54 municipalities (4.5%). We observed an association between municipalities affected by autochthonous CanL cases and the estimated probability of P. perniciosus presence (Odds Ratio for 10% increase of probability: 2.66; 95% confidence intervals (CI): 2.16-3.37). We found that human VL incident cases were positively associated with the probability of the municipality of residence of being endemic for CanL (Incidence Rate Ratio for 10% increase of probability: 1.49; 95% CI 1.02-2.16). CONCLUSIONS Using a One-Health approach, we quantified the spatial association between the distribution of P. perniciosus, municipalities endemic for CanL and incident cases of human VL, suggesting that the disease has become endemic in the Piedmont region.
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Affiliation(s)
- G. Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Torino, Italy
| | - S. Zanet
- Dept. of Veterinary Sciences, University of Turin, Torino, Italy
| | - E. Giorgi
- CHICAS, Lancaster University Medical School, Lancaster, UK
| | - E. Battisti
- Dept. of Veterinary Sciences, University of Turin, Torino, Italy
| | - S. Falzoi
- Department of Earth Sciences, University of Turin, Torino, Italy
| | - F. Acquaotta
- Department of Earth Sciences, University of Turin, Torino, Italy
- Centro di Ricerca sui Rischi Naturali, Ambiente Montano e Collinare (NatRisk), Grugliasco, Italy
| | - S. Fratianni
- Department of Earth Sciences, University of Turin, Torino, Italy
- Centro di Ricerca sui Rischi Naturali, Ambiente Montano e Collinare (NatRisk), Grugliasco, Italy
| | - L. Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Torino, Italy
| | - E. Ferroglio
- Dept. of Veterinary Sciences, University of Turin, Torino, Italy
| | - M. Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Torino, Italy
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21
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Moccia C, Popovic M, Isaevska E, Moirano G, Pizzi C, Rusconi F, Merletti F, Maule MM, Richiardi L. Factors associated with self-perceived knowledge of COVID-19: a study among women from the NINFEA birth cohort. Epidemiol Prev 2020; 44:364-368. [PMID: 33412830 DOI: 10.19191/ep20.5-6.s2.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND health literacy may contribute to the strategies to control the Coronavirus disease 2019 (COVID-19), as individuals need to acquire promptly new health information, understand the reasons behind recommendations, and adapt their behaviour accordingly. OBJECTIVES to investigate sociodemographic and disease-related factors that can influence self-perceived knowledge (poor/medium vs high) about COVID-19 in women of the Italian NINFEA birth cohort. DESIGN cross-sectional study. SETTING AND PARTICIPANTS a web-based anonymous survey on COVID-19 was sent in April 2020 to women participating in the NINFEA cohort. A total of 3,129 women were included in the study. MAIN OUTCOME MEASURES using multiple weighted logistic regression models, self-perceived knowledge level was analysed in relation with the following variables: age, education level, family size, cumulative incidence of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) cases until 7 April 2020 by province, presence of COVID-19-like symptoms, SARS-CoV-2 testing, and COVID-19 diagnosis. RESULTS the prevalence of self-perceived poor/medium knowledge was 57%. In multivariable logistic regression analyses, the odds ratio (OR) of self-perceived poor/medium COVID-19 knowledge level was increased for low/medium compared with high education level (OR 1.57; 95%CI 1.34-1.84), and decreased for SARS-CoV-2 testing (OR 0.25; 95%CI 0.16-0.39) and COVID-19 diagnosis (OR 0.20; 95%CI 0.07-0.60). There was no evidence of association between the other analysed variables and self-perceived knowledge level. CONCLUSIONS the findings of this study suggest that low educational level is a determinant of low self-perceived knowledge on COVID-19 in middle-aged women.
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Affiliation(s)
- Chiara Moccia
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy);
| | - Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy)
| | - Elena Isaevska
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy)
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy)
| | - Costanza Pizzi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy)
| | - Franca Rusconi
- Unit of Epidemiology, "Anna Meyer" Children's University Hospital, Florence (Italy)
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy)
| | - Milena Maria Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy)
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin (Italy)
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Moirano G, Schmid M, Barone-Adesi F. Short-Term Effects of Mitigation Measures for the Containment of the COVID-19 Outbreak: An Experience From Northern Italy. Disaster Med Public Health Prep 2020; 14:e3-e4. [PMID: 32327001 PMCID: PMC7211796 DOI: 10.1017/dmp.2020.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 01/20/2023]
Abstract
We evaluated the short-term effects of mitigation measures imposed by the Italian government on the first 10 municipalities affected by Sars-Cov-2 spread. Our results suggest that the effects of containment measures can be appreciated in about approximately 2 wk.
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Affiliation(s)
- Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maurizio Schmid
- BioLab - Engineering Department - Roma Tre University, Rome, Italy
| | - Francesco Barone-Adesi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- CRIMEDIM – Research Center in Emergency and Disaster Medicine, University of Eastern Piedmont, Novara, Italy
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Schiara LAM, Moirano G, Grosso E, Richiardi L, Tibaldi M, Spertino E, Vezza C, Isaia GC, Massaia M, D'Amelio P. Hyponatremia, Hypokalemia, and Fragility Fractures in Old Patients: More than an Association? Calcif Tissue Int 2020; 106:599-607. [PMID: 32076748 DOI: 10.1007/s00223-020-00675-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/08/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Hyponatremia and hypokalemia are common among elderly and have been associated with osteoporosis, we evaluate the role of these electrolytes as risk for fragility fractures. METHODS This study is divided in two parts: one retrospective and one prospective. We retrospectively collected data on urgently admitted patients for femoral fragility fractures (Fx) or for acute myocardial infarction (AMI), and patients admitted for elective hip/knee replacement surgery for osteoarthrosis (OA). Age, sex, serum sodium, potassium, creatinine, and comorbidities were recorded. We enrolled prospectively in-patients from our unit: age, sex, comorbidities, drugs, and fragility fractures were recorded. Blood electrolytes were measured. Cognitive function, nutrition, muscular strength, and balance were evaluated by standard tests. The mortality rate was recorded with a follow-up after hospital discharge. RESULTS The retrospective study included 2166 subjects: 702 Fx and 1464 controls (907 AMI, 557 OA): the prevalence of hyponatremia was similar in Fx and AMI, whereas it was higher in Fx with respect to OA (p < 0.001) as well as hypokalemia (p < 0.001). Sodium decrease was associated with higher fracture risk. Among the 284 subjects included in the prospective study, 50 patients were hyponatremic, more likely malnourished, and presented a higher prevalence of fragility fractures (p = 0.008). They had a higher mortality after hospital discharge (HR = 1.80, p = 0.005), however, this association disappears after correction for confounding variables. CONCLUSIONS We suggest that hyponatremia and hypokalemia have to be considered as a marker of poor health more than an independent fracture risk.
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Affiliation(s)
- Laura Anna Maria Schiara
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Giovenale Moirano
- Cancer Epidemiology Unit-CERMS, Department of Medical Science, University of Torino and CPO-Piemonte, Via Santena 7, 10126, Torino, Italy
| | - Elena Grosso
- Department of Orthopedics, Traumatology, City of Health and Science Hospitals, Via Zuretti 29, 10126, Torino, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit-CERMS, Department of Medical Science, University of Torino and CPO-Piemonte, Via Santena 7, 10126, Torino, Italy
| | - Michela Tibaldi
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Elena Spertino
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Carlotta Vezza
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Giovanni Carlo Isaia
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Massimiliano Massaia
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Patrizia D'Amelio
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy.
- Centre Hospitalier Universitaire Vaudoise (CHUV) Service de Gériatrie, Mont Paisible 16 CH, 1011, Lausanne, Switzerland.
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24
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Moirano G, Richiardi L, Novara C, Maule M. Approaches to Daily Monitoring of the SARS-CoV-2 Outbreak in Northern Italy. Front Public Health 2020; 8:222. [PMID: 32574301 PMCID: PMC7256452 DOI: 10.3389/fpubh.2020.00222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022] Open
Abstract
Italy was the first European country affected by the Sars-Cov-2 pandemic, with the first autochthonous case identified on Feb 21st. Specific control measures restricting social contacts were introduced by the Italian government starting from the beginning of March. In the current study we analyzed public data from the four most affected Italian regions. We (i) estimated the time-varying reproduction number (Rt), the average number of secondary cases that each infected individual would infect at time t, to monitor the positive impact of restriction measures; (ii) applied the generalized logistic and the modified Richards models to describe the epidemic pattern and obtain short-term forecasts. We observed a monotonic decrease of Rt over time in all regions, and the peak of incident cases ~2 weeks after the implementation of the first strict containment measures. Our results show that phenomenological approaches may be useful to monitor the epidemic growth in its initial phases and suggest that costly and disruptive public health controls might have had a positive impact in limiting the Sars-Cov-2 spread in Northern Italy.
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Affiliation(s)
- Giovenale Moirano
- Department of Medical Sciences, University of Turin, and CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Lorenzo Richiardi
- Department of Medical Sciences, University of Turin, and CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Carlo Novara
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Milena Maule
- Department of Medical Sciences, University of Turin, and CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
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25
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Calzolari M, Angelini P, Bolzoni L, Bonilauri P, Cagarelli R, Canziani S, Cereda D, Cerioli MP, Chiari M, Galletti G, Moirano G, Tamba M, Torri D, Trogu T, Albieri A, Bellini R, Lelli D. Enhanced West Nile Virus Circulation in the Emilia-Romagna and Lombardy Regions (Northern Italy) in 2018 Detected by Entomological Surveillance. Front Vet Sci 2020; 7:243. [PMID: 32432132 PMCID: PMC7214930 DOI: 10.3389/fvets.2020.00243] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/09/2020] [Indexed: 02/02/2023] Open
Abstract
With several human cases reported annually since 2008 and the unapparent risk of infection of blood donors, the West Nile virus (WNV) is emerging as an important health issue in Europe. Italy, as well as other European countries, experienced a recrudescence of the virus circulation in 2018, which led to an increased number of human cases. An integrated surveillance plan was activated in the Emilia-Romagna and Lombardy regions (Northern Italy) since 2008 in order to monitor the intensity and timing of WNV circulation. A fundamental part of this plan consists in entomological surveillance. In 2018, the surveillance plan made it possible to collect 385,293 mosquitoes in 163 stations in the two Regions. In total 269,147 Culex mosquitoes were grouped into 2,337 pools and tested for WNV, which was detected in 232 pools. Circulation started in the central part of the Emilia-Romagna region in the middle of June, about one month before the previous seasons. Circulation suddenly expanded to the rest of the region and reached the Lombardy region in the middle of July. WNV circulated more intensively in the eastern part of the surveyed area, as confirmed by the highest number of human cases. A relationship between the number of mosquitoes collected and the virus incidence emerged, but the data obtained highlighted that the probability of detecting the virus in a given site was less than expected with a higher number of collected mosquitoes. A significant relationship was observed between the temperature recorded one week before the sampling and the number of collected mosquitoes, as well as between the estimated number of WNV-positive mosquitoes and the temperature recorded two weeks before the sampling. The two weeks delay in the influence of temperature on the positive mosquitoes is in line with the time of the virus extrinsic incubation in the mosquito. This finding confirms that temperature is one of the principal drivers in WNV mosquito infection. The surveillance system demonstrated the ability to detect the virus circulation early, particularly in areas where circulation was more intense. This allowed evaluating the effect of mosquito abundance and weather factors on virus circulation.
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Affiliation(s)
- Mattia Calzolari
- Istituto Zooprofilattico Sperimentale Della Lombardia e Dell'Emilia-Romagna, B. Ubertini, Brescia, Italy
| | - Paola Angelini
- Regional Health Authority of Emilia-Romagna, Bologna, Italy
| | - Luca Bolzoni
- Istituto Zooprofilattico Sperimentale Della Lombardia e Dell'Emilia-Romagna, B. Ubertini, Brescia, Italy
| | - Paolo Bonilauri
- Istituto Zooprofilattico Sperimentale Della Lombardia e Dell'Emilia-Romagna, B. Ubertini, Brescia, Italy
| | | | - Sabrina Canziani
- Istituto Zooprofilattico Sperimentale Della Lombardia e Dell'Emilia-Romagna, B. Ubertini, Brescia, Italy
| | | | - Monica Pierangela Cerioli
- Istituto Zooprofilattico Sperimentale Della Lombardia e Dell'Emilia-Romagna, B. Ubertini, Brescia, Italy
| | - Mario Chiari
- Regional Health Authority of Lombardy, Milan, Italy
| | - Giorgio Galletti
- Istituto Zooprofilattico Sperimentale Della Lombardia e Dell'Emilia-Romagna, B. Ubertini, Brescia, Italy
| | - Giovenale Moirano
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin, Italy
| | - Marco Tamba
- Istituto Zooprofilattico Sperimentale Della Lombardia e Dell'Emilia-Romagna, B. Ubertini, Brescia, Italy
| | - Deborah Torri
- Istituto Zooprofilattico Sperimentale Della Lombardia e Dell'Emilia-Romagna, B. Ubertini, Brescia, Italy
| | - Tiziana Trogu
- Istituto Zooprofilattico Sperimentale Della Lombardia e Dell'Emilia-Romagna, B. Ubertini, Brescia, Italy
| | | | - Romeo Bellini
- Centro Agricoltura Ambiente "G. Nicoli", Crevalcore, Italy
| | - Davide Lelli
- Istituto Zooprofilattico Sperimentale Della Lombardia e Dell'Emilia-Romagna, B. Ubertini, Brescia, Italy
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Moirano G, Richiardi L, Calzolari M, Merletti F, Maule M. Recent rapid changes in the spatio-temporal distribution of West Nile Neuro-invasive Disease in Italy. Zoonoses Public Health 2019; 67:54-61. [PMID: 31612606 DOI: 10.1111/zph.12654] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/12/2019] [Accepted: 09/13/2019] [Indexed: 12/01/2022]
Abstract
In Italy, the first human case of West Nile Virus (WNV) infection was reported in 2008 and, since then, the number of cases has been steadily increasing. In this study, we describe the temporal and spatial pattern of WNV infection risk among humans in Italy, focusing on the human cases of West Nile Neuro-invasive Disease (WNND) observed between 2008 and 2017. Incidence rates are estimated for each year and province under study. The incidence temporal trend is estimated using Poisson regression, and a spatio-temporal cluster detection analysis is performed to detect high-risk areas. In total, 231 WNND cases were notified in Italy between 2008 and 2017. The annual incidence rates increased during the study period (annual percentage change: 11.7%; 95%CI: -0.9%; 26.1%). A geographical spread of the disease was observed during the study period throughout Northern Italy, with an increasing number of affected provinces. Provinces close to the Po River (the main river in the north of Italy) and the Oristano province (in the Sardinia Island) experienced the highest incidence rates during the study period. Our study shows a gradual, but rapid spread of WNND across Northern Italy from east to west and suggests the hypothesis that provinces close to Po River might present ecological and climatic conditions favourable to the virus circulation.
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Affiliation(s)
- Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Mattia Calzolari
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia-Romagna 'B. Ubertini' (IZSLER), Brescia, Italy
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Milena Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
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27
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Moirano G, Gasparrini A, Acquaotta F, Fratianni S, Merletti F, Maule M, Richiardi L. West Nile Virus infection in Northern Italy: Case-crossover study on the short-term effect of climatic parameters. Environ Res 2018; 167:544-549. [PMID: 30145430 DOI: 10.1016/j.envres.2018.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/03/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Changes in climatic conditions are hypothesized to play a role in the increasing number of West Nile Virus (WNV) outbreaks observed in Europe in recent years. OBJECTIVES We aimed to investigate the association between WNV infection and climatic parameters recorded in the 8 weeks before the diagnosis in Northern Italy. METHODS We collected epidemiological data about new infected cases for the period 2010-2015 from the European Center for Disease Control and Prevention (ECDC) and meteorological data from 25 stations throughout the study area. Analyses were performed using a conditional Poisson regression with a time-stratified case-crossover design, specifically modified to account for seasonal variations. Exposures included weekly average of maximum temperatures, weekly average of mean temperatures, weekly average of minimum temperatures and weekly total precipitation. RESULTS We found an association between incidence of WNV infection and temperatures recorded 5-6 weeks before diagnosis (Incidence Rate Ratio (IRR) for 1 °C increase in maximum temperatures at lag 6: 1.11; 95% CI 1.01-1.20). Increased weekly total precipitation, recorded 1-4 weeks before diagnosis, were associated with higher incidence of WNV infection, particularly for precipitation recorded 2 weeks before diagnosis (IRR for 5 mm increase of cumulative precipitation at lag 2: 1.16; 95% CI 1.08-1.25). CONCLUSIONS Increased precipitation and temperatures might have a lagged direct effect on the incidence of WNV infection. Climatic parameters may be useful for detecting areas and periods of the year potentially characterized by a higher incidence of WNV infection.
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Affiliation(s)
- Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino Via Santena 7, 10126, Italy.
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiorella Acquaotta
- Department of Earth Sciences, University of Turin, via Valperga Caluso 35, 10125 Torino, Italy; Centro interdipartimentale sui rischi naturali in ambiente montano e collinare NatRisk, via Leonardo da Vinci 44, 10095 Grugliasco, TO, Italy
| | - Simona Fratianni
- Department of Earth Sciences, University of Turin, via Valperga Caluso 35, 10125 Torino, Italy; Centro interdipartimentale sui rischi naturali in ambiente montano e collinare NatRisk, via Leonardo da Vinci 44, 10095 Grugliasco, TO, Italy
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino Via Santena 7, 10126, Italy
| | - Milena Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino Via Santena 7, 10126, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino Via Santena 7, 10126, Italy
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28
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Moirano G, Zugna D, Grasso C, Mirabelli D, Lista P, Ciuffreda L, Segnan N, Merletti F, Richiardi L. Postnatal risk factors for testicular cancer: The EPSAM case-control study. Int J Cancer 2017; 141:1803-1810. [PMID: 28699204 DOI: 10.1002/ijc.30884] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 05/23/2017] [Accepted: 06/21/2017] [Indexed: 11/11/2022]
Abstract
Testicular cancer is considered to originate from an impaired differentiation of fetal germ cells, but puberty could represent another time window of susceptibility. Our study aimed at investigating the association between environmental exposures acting during puberty/adolescence (13-19 years of age) and the risk of testicular cancer. We used data of the EPSAM study, a case-control study on germ-cell testicular cancer conducted in the province of Turin, Italy, involving cases diagnosed between 1997 and 2008. Histologically confirmed cases (n = 255) and controls (n = 459) completed a postal questionnaire focusing in particular on the pubertal period (namely age 13 years) with questions on physical activity (competitive sports, gardening), lifestyle (alcohol consumption, smoking), occupational history and medical conditions. All analyses were adjusted for the matching variables, cryptorchidism and educational level. Having done at least one competitive sport during puberty (odds ratio [OR]: 0.72, 95% confidence interval: 0.52-1.00), gardening activities during puberty (OR: 0.62, 0.42-0.94) and having a lower weight than peers during puberty (OR: 0.64, 0.42-0.97) were all inversely associated with the risk of testicular cancer. No evidence of association between smoking or alcohol consumption during puberty and the risk of testicular cancer was observed. Regarding agriculture-related occupations, we found an association with the risk of testicular cancer both for occasional jobs during puberty (OR: 2.40, 95% CI: 1.08-5.29) and ever employment in adolescence (OR: 2.59, 95% CI: 0.83-8.10). Our results suggest that postnatal exposures could play a role in testicular cancer aetiology, at least when acting in puberty or adolescence.
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Affiliation(s)
- Giovenale Moirano
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Daniela Zugna
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Chiara Grasso
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Dario Mirabelli
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Patrizia Lista
- Medical Oncology Division 1, University Hospital "Citta' della Salute e della Scienza", Turin, Italy
| | - Libero Ciuffreda
- Medical Oncology Division 1, University Hospital "Citta' della Salute e della Scienza", Turin, Italy
| | - Nereo Segnan
- Department of Cancer Screening and Unit of Cancer Epidemiology, WHO Collaborative Center for Cancer Early Diagnosis and Screening, CPO Piedmont and University Hospital "Citta' della Salute e della Scienza", Turin, Italy
| | - Franco Merletti
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
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29
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Moirano G, Zugna D, Grasso C, Lista P, Ciuffreda L, Segnan N, Merletti F, Richiardi L. Baldness and testicular cancer: the EPSAM case-control study. Andrology 2016; 4:251-6. [PMID: 26941123 DOI: 10.1111/andr.12148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 10/28/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
Abstract
The etiology of testicular cancer is largely unexplained. Research has mainly focused on prenatal exposures, especially to sex hormones, while less attention has been paid to exposures that may act also postnatally. As baldness has been previously associated with testicular cancer risk we focused on baldness and body hairiness, which are both associated with androgen activity. We used data of the Postnatal Exposures and Male Health (EPSAM) study, a case-control study on testicular cancer conducted in the Province of Turin, Italy, involving cases diagnosed between 1997 and 2008. Information was collected using mailed questionnaires. Analyses included 255 cases and 459 controls. We calculated ORs and 95% CIs to estimate testicular cancer risk among those who developed baldness and among those with body hairiness. We found an inverse association between testicular cancer and baldness (OR: 0.67, 95% CI: 0.46-0.98) and body hairiness (OR: 0.78, 95% CI: 0.53-1.16), although the latter had wider CIs. The inverse association between baldness and testicular cancer is consistent with the results from previous studies. These results suggest that androgens activity may influence testicular cancer risk.
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Affiliation(s)
- G Moirano
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - D Zugna
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - C Grasso
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - P Lista
- Medical Oncology Division 1, University Hospital 'Citta' della Salute e delle Scienze', Turin, Italy
| | - L Ciuffreda
- Medical Oncology Division 1, University Hospital 'Citta' della Salute e delle Scienze', Turin, Italy
| | - N Segnan
- Department of Cancer Screening and Unit of Cancer Epidemiology, WHO Collaborative Center for Cancer Early Diagnosis and Screening, CPO Piedmont and University Hospital 'Citta' della Salute e della Scienza', Turin, Italy
| | - F Merletti
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - L Richiardi
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
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