OBJECTIVES:Occupational respiratory diseases represent a major public health concern worldwide. This study analyses the hospitalization costs and characteristics of four major occupational respiratory diseases: malignant mesothelioma (MM), sinonasal cancer (SNC), pneumoconiosis (PN), and hypersensitivity pneumonitis (HP). The findings are situated within the context of Italy's population trends and healthcare system, offering insights into the economic and clinical burden of these diseases. STUDY DESIGN:This retrospective, population-based study examines Italian hospitalizations for MM, SNC, PN, and HP during the period 2010-2021. The primary outcomes were the number of hospitalizations, length of stay, and associated cost. Costs were derived from charges linked to diagnosis-related groups (version 24) and major diagnostic category coding systems. RESULTS:Though the Italian population is rapidly aging, the annual number and rate of hospitalizations declined by 35% over the study period. SNC hospitalizations aligned with the overall trend, PN and MM experienced faster declines, whereas HP admissions remained steady. MM emerged as the most resource-intensive (EUR 25 million yearly, with 86% attributable to occupation), followed by PN (EUR 10 million, entirely occupational), SNC (EUR 5 million, with EUR 650,000 occupational), and HP (EUR 2 million, with EUR 370,000 occupational). All studied diseases had an average length of stay exceeding the national one. The SNC admissions were the shortest (6.5 days) and least expensive (EUR 3647). In contrast, MM, PN, and HP had a mean length of stay exceeding 10 days, with admission costs averaging EUR 4700 for MM and EUR 4000 for PN and HP. The median age was the highest for PN (78 years) and MM (71 years), while SNC and HP patients had a median age of approximately 65 years. CONCLUSIONS:Consistent with their anticipated benefits, Italian workplace health regulations over the last three decades, including the 1992 asbestos ban and D.lgs. 81/2008, are associated with significant reductions in the hospitalization burden and an increased median age at discharge for MM and PN. In contrast, fewer conclusions can be drawn for SNC and HP due to their lower occupational fractions (10-20%). This finding suggests adding an occupational exposure flag in hospital records for acknowledged occupational diseases to enhance surveillance. Finally, this study provides the first estimate of the occupational fraction of hospitalization costs for the studied diseases in Italy.

Background: The COVID-19 pandemic has emerged as the primary global health challenge of the new millennium. Understanding its impact on health systems and learning from these experiences are crucial for improving system resilience against future health crises. This paper examines hospitalizations related to COVID-19 in Italy from 2020 to 2021, with a specific focus on the costs associated with these admissions. Design and methods: This is a retrospective, population-based study of Italian hospitalizations of patients diagnosed with COVID-19 during the 2020–2021 period, using data extracted from the National Hospital Discharge Registry. The outcome variables considered include hospital admissions, costs, and length of stay. Results: In Italy, hospitalizations for COVID-19 totaled 357,354 in 2020 and 399,043 in 2021, with the transfer rate being three times higher than that of other patients. Hospitalizations were predominantly concentrated in the northern regions, especially during the first year. Mortality rates increased with age, while hospitalization rates peaked in the youngest and oldest age groups. The financial impact of COVID-19 hospitalizations was approximately €3.1 billion in 2020 and €3.6 billion in 2021. The cost per admission was around €8000 for standard care and €24,000 for intensive therapy in both years. Conclusion: Conducting a cost-benefit analysis of implementing a protective pad around the entire health system, which leverages networks of family doctors and nurses connected in real-time, could be an important step in strengthening health system resilience.

EDITORIAL article Front. Public Health, 09 October 2023Sec. Infectious Diseases: Epidemiology and Prevention Volume 11 - 2023 | https://doi.org/10.3389/fpubh.2023.1281493

Objective: This paper assesses hospital costs associated with sinonasal cancer (SNC) in Italy and evaluates related time trends.Methods: All Italian hospitalizations treating patients with a diagnosis of SNC (N = 29,355) were extracted from the National Hospital Discharge Registry. Data refer to patients discharged from public and private hospitals between 2001 and 2018. Hospitalization cost, admission rate, length of stay and other hospitalization-level variables were used as the main outcome variables. Information on the relative disease intensity per hospitalization was used to specifically allocate total hospitalization costs to SNC medical resources.Results: Over the 2001-2018 period, Italian hospitals have treated 1,631 admissions with SNC every year, on average. The mean annual hospitalization cost across all hospitals was 5,502,909 €, or 3,374 € per admission, and 60.0% of these costs were attributable to SNC only. Patient age at discharge (from 62 to 63 years), percentage of surgical procedures (from 29.3% to 46.8%) and of urgent cases (from 13.5% to 16.5%) increased over time. The percentage of costs attributable to SNC followed an inverted U-shaped pattern reaching the minimum level in 2006; conversely, mortality rose until 2007 then decreased steadily.Conclusions: Good progress has been made in SNC treatments. Endoscopic techniques represent one of the most important advances in this field, reducing morbidity and hospital length of stay while keeping similar survival rates. Policies aimed at monitoring workers most exposed to SNC risk and at standardizing hospital treatments could help Public Health Institutions to plan optimal prevention policies.

Background: The novel coronavirus disease is an ongoing pandemic that started in China in December 2019. This paper is aimed at estimating the first two infections waves in Italy in relation to adopted health policies. Design and methods: We moved deaths of the Italian COVID-19 registry from recorded to infection date by the weighted moving average. We considered two infection fatality ratios related to the effective or saturated health system, we estimated the likely incidence curve from the resulting deaths and evaluated the curve shape before and after the national health policies. Results: From the 24th of February 2020 to the 7th of February 2021, we estimated 6,664,655 (4,639,221-9,325,138) cases distributed on two waves. Suitable daily infection fatality rates were 2.53% within the first wave and 1.15% within the second one. The first wave (February-July 2020) had its peak on the 14th of March 2020 (26,575). The second wave (August 2020-February 2021) was fatter with the peak on the 12th of November (60,425) and a hump in December before decreasing to 26,288 at the end. Adopted health policies were followed by changes in the curve rate. Conclusions: Tracing infection contacts and quarantining asymptomatic people reduced virus lethality in the second wave. Restriction on population mobility is effective within a suppression strategy, distance learning reduces contacts among families. Removal of restrictions should be implemented by sequential steps for avoiding a quick rising of incident cases. A reasonable public health daily goal to control both virus spread and lethality could be to find at least 87 cases for each death.

BackgroundThe novel coronavirus disease 2019 (COVID-19) is an ongoing pandemic that was first recognized in China in December 2019. This paper aims to provide a detailed overview of the first 2 years of the pandemic in Italy.Design and methodsUsing the negative binomial distribution, the daily incidence of infections was estimated through the virus's lethality and the moving-averaged deaths. The lethality of the original strain (estimated through national sero-surveys) was adjusted daily for age of infections, hazard ratios of virus variants, and the cumulative distribution of vaccinated individuals.ResultsFrom February 24, 2020, to February 28, 2022, there were 20,833,018 (20,728,924–20,937,375) cases distributed over five waves. The overall lethality rate was 0.73%, but daily it ranged from 2.78% (in the first wave) to 0.15% (in the last wave). The first two waves had the highest number of daily deaths (about 710) and the last wave showed the highest peak of daily infections (220,487). Restriction measures of population mobility strongly slowed the viral spread. During the 2nd year of the pandemic, vaccines prevented 10,000,000 infections and 115,000 deaths.ConclusionAlmost 40% of COVID-19 infections have gone undetected and they were mostly concentrated in the first year of the pandemic. From the second year, a massive test campaign made it possible to detect more asymptomatic cases, especially among the youngest. Mobility restriction measures were an effective suppression strategy while distance learning and smart working were effective mitigation strategies. Despite the variants of concern, vaccines strongly reduced the pandemic impact on the healthcare system avoiding strong restriction measures.

Objectives This paper aims to establish hospitalisation costs of mesothelioma in Italy and to evaluate hospital-related trends associated with the 1992 asbestos ban. Design This is a retrospective population-based study of Italian hospitalisations treating pleura, peritoneum and pericardium mesothelioma in the period 2001–2018. Settings Public and private Italian hospitals reached by the Ministry of Health (coverage close to 100%). Participants 157 221 admissions with primary or contributing diagnosis of pleural, peritoneal or hearth cancer discharged from 2001 to 2018. Primary and secondary outcome measures: number, length and cost of hospitalisations with related percentages. Results Each year, Italian hospitals treated a mesothelioma in 6025 admissions on average. Mean annual costs by site were €20 293 733, €3183 632 and €40 443 for pleura, peritoneum and pericardium, respectively. Pericardial mesothelioma showed the highest cost per admission (€6117), followed by peritoneal (€4549) and pleural cases (€3809). Percentage of hospitalisation costs attributable to mesothelioma was higher when it is located in pleura (53.4%) and pericardium (51.8%) with respect to peritoneum (41.2%). Overall annual hospitalisation cost, percentages of number and length of admissions showed an inverted U-shape, with maxima (of €25 850 276, 0.064% and 0.096%, respectively) reached in 2011–2013. Mean age at discharge and percentages of surgery and of urgent cases increased over time. Conclusions The highest impact of mesothelioma on the National Health System was recorded 20 years after the asbestos ban (2011–2013). Hospitals should expect soon fewer but more severe patients needing more cares. To study the disease prevalence could help assistance planning of next decade.

Asbestosis and silicosis are preventable fibrotic forms of pneumoconiosis. Decades ago, the World Health Organization began prevention campaigns for eliminating these diseases worldwide. To establish Italian hospitalization costs of asbestosis and silicosis in relation to national adopted prevention policies. This is a retrospective population-based study of Italian hospitalizations treating asbestosis or silicosis in the period 2001–2018. We have extracted data from the National Hospital Discharge Registry and merged with national standard charges of hospitalizations through diagnosis-related group coding. We expressed costs in 2018 euros and evaluated data time-trends by linear normal and logistic regression models. During 2001–2018, hospitalization costs per year were 3,787,540 € for asbestosis and 10,103,215 € for silicosis. There were significant annual reductions in frequency (− 41 and − 266 hospitalizations per year for asbestosis and silicosis, respectively), length of stay (− 148 and − 2781 days per year for asbestosis and silicosis, respectively) and cost (− 43,881 and − 959,516 € per year for asbestosis and silicosis, respectively) of diseases. Length and cost of hospital stay per admission significantly increased over time for asbestosis (+ 0.2 days and + 100 €, respectively, per year). Overall hospitalizations costs were higher for silicosis than asbestosis. Over time hospitals treated fewer cases with greater severity. The decreased 2001–2018 consumption of hospital resources by patients with asbestosis or silicosis is associated with the occupational health policies instituted from the 1990s to reduce exposures to asbestos and silica. Extending existing epidemiological surveillance systems to pneumoconioses would help to control the social costs of work-related diseases.

Abstract Background The GBD study allows comparison of health conditions among different societies and cultures. This permits also to estimate health variations over a long time in a single nation, overcoming the difficulties deriving from social and economic changes. INAIL, the National Institute for Insurance against Accidents at Work, provides since 1884, detailed data about the number of events and their consequences, age and sex of injured workers, and the total number of insured workers. Such data allow us to estimate DALYs in terms of incidence and prevalence, and under different mortality models. Methods 1.8 mln. individual injury records occurred in 1990-2015 were transcoded into GBD injury categories. YLLs and YLDs were calculated considering life expectancy, DWs and duration, then distributed by compensation category. The YLLs and YLDs of permanent disabilities have been assessed with reference both to the life expectancy of the GBD 2017 and, in a competitive mortality model, to mean values at the time of the accident. Estimated DALYs were assessed both in terms of incidence and prevalence. Results Around 1900, an industrial worker suffered on average 0.087 incident DALY/year for occupational injuries, or 0.058 in a competitive mortality model. These values remained almost stationary until WWII when they showed a peak around 0.11, then declined to about a third in the 1970s, and to about a twentieth in 2017. The YLL / DALY ratio was 0.82 around 1900, then slowly decreased to less than 0.5 in the late 1930s, rose to a new peak around 0.8 in WWII, then diminished again to 0.32 in 2017. Considering prevalence, variations are much slower, due to the expected average durations of permanent disabilities, between 32.5 and 52 years. Risk breakdown by main industry sectors is ongoing. Conclusions DALY rate and YLL/DALY injuries declined largely along time. Nevertheless, such events continue to leave a very long-term legacy of disabilities. Key messages INAIL data permit to estimate burden for occupational injuries occurred in Italy along over a century. Injury burden declined over time, but continues to leave a legacy of long-term disabilities.

BACKGROUND:This work is aimed at evaluating the quality of Italian hospitalizations data about asbestosis and silicosis, assessing the impact of these diseases on the national health system and providing advice related to public health.METHODS:Italian hospital discharge data (2001-15) with diagnosis of asbestosis or silicosis were analysed by the multiple correspondence analysis and diseases epidemics were evaluated through hospitalization rates.RESULTS:Hospitalizations were concentrated in the northwestern area, referred mainly to males and oldest people, the most treated tumors were lung cancer and mesothelioma (for asbestosis) and cares were aimed at reducing symptoms and increasing blood oxygenation. Overall adjusted Italian hospitalization rates of asbestosis and silicosis were, respectively, 25.2 and 74.9 per 1 000 000 residents. With respect to asbestosis, hospitalizations treating silicosis reported doubled mortality (10.5 vs. 5.7%), longer stays (10.4 vs. 8.6 mean days) and older patients (77 vs. 72 years on average). Diseases rates reduced over time (with a steeper slope for silicosis) and in both fibroses increased hospital mortality (92.1% in asbestoses, 59.5% in silicoses) and percentage of urgent hospitalizations (116.0% in asbestoses, 56.6% in silicoses).CONCLUSION:Hospitalizations data regarding asbestosis and silicosis are consistent. Silicosis had a higher impact than asbestosis on the Italian health system. Although data show decreasing incidence of both fibroses, multiple correspondence analysis highlights that levels of illness severity were higher in silicosis and increased over time in both diseases. Further studies investigating the effectiveness of the current health surveillance programs concerning these diseases are suggested.

This paper is aimed at investigating the transient losses in the M / M /1/1 Erlang loss system. We evaluate the explicit form of the probability distribution of the number of losses in the time interval [0, t ) and provide two alternative representations: one based on the iterated derivatives of hyperbolic sinus and cosine and the other on the spherical modified Bessel function of the second kind. The mathematical structures of the transient loss rate and of the transient probability of losing all customers are described and several analytical properties are derived.

The fraction of female mesothelioma cases attributable to asbestos exposure is generally much lower than in men and significantly varying among published studies. The aim of this study is to analyze gender ratio for mesothelioma by mortality data and to test the relationship with the occurrence of the disease for country and income level. The numbers of mesothelioma deaths have been extracted from WHO mortality database (C45 or any subcategory of ICD 10 classification system). National population data have been obtained from the WHO health statistics and standardized mortality rates estimated using world reference population. Gender ratio has been estimated for each selected country and regression models with mortality rates have been tested. Only countries with more than 20 mesothelioma deaths in 2011 have been selected (N=34), accounting for 14,483 deaths (3,074 and 11,409 in women and men respectively). Gender ratio (females cases/males) is 0.27 with a significant inverse trend with mortality rates. A linear decrease in gender ratio for increasing mortality can be observed (b= -0.22; R2=0.35; p<0.001). Income level is strongly related with number of mesothelioma females cases. A gender ratio equal to 0.53 in upper medium income level countries (N=9) has been observed and equal to 0.25 in high income level countries (N=25). Italy presents a specific pattern with a high standardized mortality rates (1.1 *100,000) and a number of women involved (gender ratio = 0.41) significantly higher than expected according to the linear model. The historical pattern of industrial activities involved in asbestos exposure includes in Italy textile sector (with direct use of raw asbestos) with a relevant number of female workers. Furthermore non occupational exposures (environmental and familial) play a relevant role. Analyses of mesothelioma in women can support the efficiency of welfare system and the prevention of asbestos exposure.

Introduction The fraction of female mesothelioma cases attributable to asbestos exposure is generally much lower than in men and significantly varying among published studies. The aim of this study is to analyse gender ratio for mesothelioma by mortality data and to test the relationship with the occurrence of the disease for country and income level. Methods The numbers of mesothelioma deaths have been extracted from WHO mortality database (C45 or any subcategory of ICD 10 classification system). National population data have been obtained from the WHO health statistics and standardised mortality rates estimated using world reference population. Gender ratio has been estimated for each selected country and regression models with mortality rates have been tested. Results Only country with more than 20 mesothelioma deaths in 2011 have been selected (N = 34), accounting for 14,483 deaths (3,074 and 11,409 in women and men respectively). Gender ratio (females cases/males) is 0.27 with a significant inverse trend with mortality rates. A linear decrease in gender ratio for increasing mortality can be observed (b = −0.22; R2 = 0.35; p < 0.001). Income level is strongly related with number of mesothelioma females cases with a gender ratio equal to 0.53 in upper medium income level countries (N = 9) and 0.25 in high income level countries (N = 25). Italy presents a specific pattern with a high standardised mortality rates (1.1 *100,000) and a number of women involved (gender ratio = 0.41) significantly higher than expected according to the linear model. Conclusions The historical pattern of industrial activities involved in asbestos exposure includes in Italy textile sector (with direct use of raw asbestos) with a relevant number of female workers. Furthermore non occupational exposures (environmental and familial) play a relevant role. Analyses of mesothelioma in women can support the efficiency of welfare system and the prevention of asbestos exposure.

BACKGROUND:the large amount of asbestos used in many Countries (including Italy) is causing an epidemic of asbestos related diseases, which is still ongoing because of their long latency.OBJECTIVES:this study is aimed at reconstructing Italian time series of deaths for mesothelioma in the period 1970-2009 and comparing Italian incidence and mortality data.DESIGN, SETTING, AND PARTICIPANTS:deaths for pleural cancer (1970-2003,2006-2009) and mesothelioma (2003, 2006-2009) were recorded by the Italian Institute of Statistics (Istat) and provided by the Italian National Agency for New Technologies, Energy and the Environment (ENEA), incidence cases (1993-2008) were provided by the Italian mesotheliomas register (ReNaM) at the Italian National Workers' Compensation Authority (Inail). For the period before ICD-10 implementation (1970-2002) and when Istat data (2004-2005) are lacking, mesothelioma deaths were estimated through statistical models (logistic, Poisson). National incidence and mortality data were compared during the overlapping period (2003, 2006-2008).RESULTS:the mortality curve strongly rises from 1970 and seems to be smoothed in the last years. Mortality caused by mesothelioma and incident cases with certain diagnosis are overlapping, as are mortality due to pleural cancer other than mesothelioma and mesothelioma incidence with uncertain diagnosis (probable/possible).CONCLUSIONS:this epidemiological analysis of deaths encoded as pleural tumour suggests to carefully investigate space-temporal distribution before excluding they could be mesotheliomas. Some new lights have been thrown on the statistical behaviour of mesothelioma mortality.

INTRODUZIONE: sebbene la relazione causale tra esposizione ad amianto e malattie neoplastiche sia ben nota, in molti Paesi il consumo del materiale è ancora rilevante e crescente. A causa della lunga latenza, nei Paesi dove è stato bandito (come in Italia) è oggi in corso un'epidemia di malattie correlate ad amianto. OBIETTIVI: descrivere i sistemi di sorveglianza dei mesoteliomi attivi nel mondo mediante un'analisi comparativa.METODI:è stata condotta una revisione bibliografica della letteratura disponibile sui sistemi di sorveglianza epidemiologica dei mesoteliomi attivi nel mondo, comparando metodi e risultati disponibili. RISULTATI: sistemi di ricerca dei casi incidenti e di analisi anamnestica dei soggetti ammalati sono attivi solo in Italia, Francia e Corea del Sud. I Paesi presso i quali sono attivi sistemi di rilevazione e controllo dei casi incidenti di mesotelioma sono quelli in cui vige il bando dell'amianto e che hanno sperimentato consumi rilevanti in passato. Non sono stati istituiti sistemi epidemiologici di sorveglianza in molti Paesi dove il consumo di amianto è ancora importante (inclusi Russia, Cina, India e Brasile). CONCLUSIONI: si conferma l'importanza dei sistemi di sorveglianza epidemiologica dei mesoteliomi per la sanità pubblica, il sostegno alle politiche di welfare e la prevenzione dei rischi. Lo sviluppo di progetti per tendere a una maggiore uniformità nei metodi di ricerca dei casi, di classificazione delle diagnosi e dell'esposizione e nelle tecniche di analisi dei dati potrebbe consentire una maggiore fruibilità dei dati aggregati. La disponibilità di dati internazionali confrontabili può essere di stimolo all'adozione di provvedimenti di bando internazionale.

Background: Sinonasal cancer (SNC) has been related to occupational exposures, but the relative risk associated to specific jobs and/or carcinogen exposures other than wood and leather dust is generally based on small or inadequate sample sizes and the range of observed estimates is large. This paper is aimed at investigating such relationship through a systematic review of the literature followed by a meta-analysis of studies meeting specific inclusion criteria.Methods: Systematic search was made with PubMed, Google Scholar and Scopus engines using related keywords. Occupational exposures include wood and leather dust, formaldehyde, nickel and chromium compounds, textile industry, farming and construction. Meta-analysis of published studies after 1985 with a case-control or cohort design was performed, firstly using the fixed-effect model. Heterogeneity was assessed with the Q statistical test and quantified by the I-2 index. When the heterogeneity hypothesis appeared relevant, the random-effect model was chosen. Sources of heterogeneity were explored using subgroup analyses.Results: Out of 63 reviewed articles, 28 (11 cohort, 17 case-control) were used in the meta-analysis. Heterogeneity among studies was observed and random-effects models were used. Exposure to wood dust results associated with SNC (RRpooled = 5.91, 95% CI: 4.31-8.11 for the case-control studies and 1.61, 95% CI: 1.10-2.37 for the cohort studies), as well as to leather dust (11.89, 95% CI: 7.69-18.36). The strongest associations are with adenocarcinomas (29.43, 95% CI: 16.46-52.61 and 35.26, 95% CI: 20.62-60.28 respectively). An increased risk of SNC for exposures to formaldehyde (1.68, 95% CI: 1.37-2.06 for the case control and 1.09, 95% CI: 0.66-1.79 for the cohort studies), textile industry (2.03, 95% CI: 1.47-2.8), construction (1.62, 95% CI: 1.11-2.36) and nickel and chromium compounds (18.0, 95% CI: 14.55-22.27) was found. Subset analyses identified several sources of heterogeneity and an exposure-response relationship was suggested for wood dust (p = 0.001).Conclusions: By confirming the strength of association between occupational exposure to causal carcinogens and SNC risk, our results may provide indications to the occupational etiology of SNC (not only wood and leather dusts). Future studies could be focused on specific occupational groups to confirm causative agents and to define appropriate preventive measures.

Background: Size at birth is an important predictor of neonatal outcomes, but there are inconsistencies on the definitions and optimal cut-offs.Aims: The aim of this study is to compute birth size percentiles for Italian very preterm singleton infants and assess relationship with hospital mortality.Study design: Prospective area-based cohort study.Subjects: All singleton Italian infants with gestational age 22-31 weeks admitted to neonatal care in 6 Italian regions (Friuli Venezia-Giulia, Lombardia, Marche, Tuscany, Lazio and Calabria) (n. 1605).Outcome measure: Hospital mortality.Methods: Anthropometric reference charts were derived, separately for males and females, using the lambda (lambda) mu (mu) and sigma (sigma) method (LMS). Logistic regression analysis was used to estimate mortality rates by gestational age and birth weight centile class, adjusting for sex, congenital anomalies and region.Results: At any gestational age, mortality decreased as birth weight centile increased, with lowest values observed between the 50th and the 89th centiles interval. Using the 75th-89th centile class as reference, adjusted mortality odds ratios were 7.94 (95% CI 4.18-15.08) below 10th centile; 3.04 (95% CI 1.63-5.65) between the 10th and 24th; 1.96 (95% CI 1.07-3.62) between the 25th and the 49th; 1.25 (95% CI 0.68-2.30) between the 5011 and the 74th; and 2.07 (95% CI 1.01-425) at the 90th and above.Conclusions: Compared to the reference, we found significantly increasing adjusted risk of death up to the 49th centile, challenging the usual 10th centile criterion as risk indicator. Continuous measures such as the birthweight z-score may be more appropriate to explore the relationship between growth retardation and adverse perinatal outcomes. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Abstract This paper investigates the underlying structure of the n-th derivative of e s·x 1/2 with respect to x. For n ∈ ℤ+, (dn /d xn )e s·x 1/2 can be expressed in terms of spherical modified Bessel functions of second kind in the complex plane. The representation holds for n ∈ ℤ-, where it represents the particular n-th antiderivative of e s·x 1/2 with all n constants of integration equal to zero. Our results introduce new connections among mathematical applications and provide some Bessel properties.