BACKGROUND:The World Health Organization defined long coronavirus disease 2019 (COVID-19) as the continuation or development of new symptoms 3 months after the initial severe acute respiratory syndrome coronavirus 2 infection, with these symptoms lasting for at least 2 months with no other explanation. AIM:To evaluate the potential laboratory and instrumental findings (short-term and long-term) resulting from COVID-19. METHODS:This longitudinal observational COVID-19 cohort study (March 1, 2020-March 1, 2021) was carried out on patients ≥ 18 years old who were admitted to the University Hospitals of Pisa, Siena and Careggi and the Azienda USL Toscana Nord Ovest, Sud Est and USL Centro Toscana and were subjected to follow-up. Follow-up was conducted between 0 day and 89 days, 90 days and 179 days, 180 days and 269 days, 270 days and 359 days, and more than 360 days after hospitalization. RESULTS:Of 2887 patients (58.5% males, average age 66.2 years) hospitalized in the study period (March 1, 2020-March 1, 2021) carrying out at least one follow-up examination within 12 months of discharge, a total of 1739 patients (705 males, average age 66 years) underwent laboratory tests, of whom 714 patients (470 males, average age 63 years) underwent spirometry. Some laboratory test results remained above the threshold even at follow-up beyond 360 days (C-reactive protein: 36%, fibrin degradation fragment: 48.8%, gamma-glutamyl transferase: 16.8%), while others showed a return to normal range more quickly in almost all patients. Alterations in liver enzymes, hematocrit, hemoglobin, lymphocytes and neutrophils were associated with the risk of requiring oxygen therapy or forced expiratory volume in one second/forced vital capacity alterations at follow-up. CONCLUSION:Alterations in liver enzymes, hematocrit or hemoglobin, lymphocytes and neutrophils were associated with risk outcomes (need for oxygen therapy or spirometry alterations). These imbalanced conditions may contribute to pulmonary dysfunction.

Background: A few months after the COVID-19 pandemic onset, knowledge of SARS-CoV-2 infection and outcomes and treatments blew up. This paper aimed to evaluate the features of a Tuscany COVID-19 hospitalized cohort and to identify risk factors for COVID-19 severity. Methods: This retrospective observational COVID-19 cohort study (1 March 2020–1 March 2021) was conducted on patients ≥ 18 years old, admitted to Tuscany Hospital, and subjected to follow-up within 12 months after discharge. Patients were enrolled at Pisana, Senese and Careggi University Hospitals, and South East, North West, and Center Local Hospitals. Results: 2888 patients (M = 58.5%, mean age = 66.2 years) were enrolled, of whom 14.3% (N = 413) were admitted to an intensive care unit. Smokers were 25%, and overweight and obese 65%. The most used drugs were corticosteroids, antacids, antibiotics, and antithrombotics, all antiviral drugs, with slight differences between 2020 and 2021. A strong association was found between outcomes of evolution towards critical COVID-19 (non-invasive mechanical ventilation (NIV) and/or admission to intensive care) and smoking (RR = 4.91), ex-smoking (RR = 3.48), overweight (RR = 1.30), obese subjects (RR = 1.62), comorbidities (aRR = 1.38). The alteration of liver enzymes (aspartate aminotransferase, alanine aminotransferase, or gamma-glutamyl transpeptidase) was associated with NIV (aOR = 2.28). Conclusions: Our cohort, characterized by patients with a mean age of 66.2 years, showed 65% of patients were overweight and obese. Smoking/ex-smoking, overweight/obesity, and other comorbidities were associated with COVID-19 adverse outcomes. The findings also demonstrated that alterations in liver enzymes were associated with worse outcomes.

Background: During the coronavirus outbreak, a worldwide state of emergency and lockdown significantly affected the volunteer services for foreigners. The SARS-CoV-2 surveillance program was strengthened among migrants arriving in Italy. However, few screening measures for SARS-CoV2 infection have been conducted on the foreign population already present in Italy. In Tuscany, a great effort was made to know the epidemiological features of coronavirus outbreaks in the foreigners. Based on these premises, this study describes the prevalence and characteristics of SARS-CoV-2 infection in foreigners present in the Tuscan territory during the months of the highest incidence of this pandemic. Methods: Ministry of Health established the COVID-19 surveillance and predisposed the methods for reporting cases of SARS-CoV-2 infection in agreement with the Department of Infectious Diseases of the Istituto Superiore di Sanit`a. Data on SARS-CoV-2, updated daily, were collected based on the platform of the Istituto Superiore di Sanit`a. For each patient were available data on diagnosis, gender, age, nationality, exposure place, hospitalization and symptoms severity. Symptoms severity was classified using a 6-level scale (asymptomatic, paucisymptomatic, mild symptoms, severe symptoms, critic, and died). Results: By July 14, 2020, 10,090 SARS-CoV-2 cases were recorded. Out of 10,090 cases, 8,947 were Italians (88.7%), 608 foreigners (6%); in 535 patients (5.3%) citizenship was missing. The average age of foreigners was 44.1 years (range: 42.9???45.4), compared to 61.1 years (range: 60.7???61.5) of Italians. Chronic pathologies affected 16.8% of foreigners (14.0%-20.0%) and 36.4% of Italians (35.4%-37.4%). Foreigners with asymp-tomatic or mild symptoms of COVID-19 were 81.7% (78.4%-84.6%), while the Italians were 67% (66.6%-68.5%). Foreigners with severe COVID-19 were 15.2% (12.6%-18.4%) and Italians were 17.6% (16.8%-18.4%). Foreigners in critical conditions were 1.0% (0.5%-2.2%) and Italians were 2.6% (2.3%-3.0%). 38.6% (33.7%-43.7%) of foreigners were infected at the workplace as a health or social-health worker, compared to 24.2% (23.1%-25.4%) of Italians. Conclusion: The time between the onset of symptoms and the execution of the laboratory tests was similar be-tween foreigners and Italians. The foreigners infected by SARS-COV-2 were younger compared to the Italians. Foreigners showed few comorbidities, and asymptomatic or mild symptomatic COVID-19, and consequently, a low lethality index. National and Tuscany policy decisions are needed to create equity in the access to the health care system for immigrants and their families, regardless of their immigration status.

We read with great interest the study by Kinoshita and Tanaka in which the association of the BCG vaccine coverage with the prevalence of SARS-CoV-2 infection was analysed.1.Masako Kinoshita Masami Tanaka Impact of routine infant BCG vaccination on COVID-19.J Infect. 2020; 81: 625-633https://doi.org/10.1016/j.jinf.2020.08.013Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar In Italy, BCG vaccine was introduced mandatorily in 1975 for close contacts of Tuberculosis (Tb) cases, healthcare workers (HCWs), medical students and military forces. In 2001 these recommendations were reviewed and BCG became mandatory for children under 5 years of age, close contacts of Tb cases and medical, nursing students and HCWs employed in high-risk settings.2.Decree of the President of the Republic. November 7, 2001, n.465, 2001. n.d.Google Scholar In Tuscany, Central Italy, the COVID-19 epidemic broke out at the end of February 2020, and as of May 28th, 2020, the Region counted over 10,000 COVID-19 confirmed cases.3.Regional Health Agency of Tuscany. Data on COVID-19 in Tuscany and Italy. Available at https://www.ars.toscana.it/banche-dati/dati-sintesi-sintcovid-aggiornamenti-e-novita-sul-numero-dei-casi-deceduti-tamponi-per-provincia-e-per-asl-della-regione-toscana-e-confronto-con-italia-con-quanti-sono-i-decessi-per-comune?provenienza=home_ricerca&de. Accessed October 28, 2020, 2020.Google Scholar Thanks to the availability of the information on BCG vaccination status among COVID-19 cases occurred in the territory of Central Tuscany Health Unit, which covers over 1,6 million residents, we conducted a study aimed at assessing the correlation between BCG vaccination and the severity of COVID-19 in patients between 20 and 75 years, considering sex, age, comorbidities and being a healthcare worker (HCW) as confounders in a multivariate logistic regression model. The data source for SARS-CoV-2 infections was represented by a database developed within the national integrated COVID-19 surveillance system by the Italian National Institute of Health, comprising information on COVID-19 laboratory-confirmed cases, i.e. demographic characteristics; the date of symptoms onset; disease severity and outcome; risk factors such as obesity or being a healthcare worker. An anonymized database by replacing cases’ identifying variables with the universal anonymous identifier (IdUni) adopted within electronic health records of the Regional Health System of Tuscany was created. Through the IdUni, it was possible to assess previous vaccination with BCG, as well as the presence of chronic diseases, using the MaCro dataset of the Regional Health Agency,4Irene Bellini Valentina Barletta Francesco Profili Alessandro Bussotti Irene Severi Maddalena Isoldi et al.Identifying high-cost, high-risk patients using administrative databases in Tuscany.Biomed Res Int. 2017; 2017: 1-12https://doi.org/10.1155/2017/9569348Crossref Scopus (4) Google Scholar or active cancer by linking the IdUni with the hospital discharge record dataset to identify patients with at least one hospitalization for malignant cancer in the previous five years. As patient data were anonymized, approval from the local ethics committee was not required. COVID-19 outcomes were dichotomized as recovery without the need to access hospital treatment versus hospitalization or death. Among 2908 SARS-CoV-2 infections diagnosed between 02/24/2020 and 05/28/2020, 63 (2.2%) occurred in vaccinees, 40 of them HCWs. In Table 1, the demographic and clinical characteristics of SARS-CoV-2 infected individuals and their outcomes according to the BCG vaccination status are showed. Almost two out of three among vaccinees (N = 40) were HCWs.Table 1Characteristics of SARS-CoV-2 infected individuals according to the BCG vaccination status.BCG vaccineNo (N = 2845; 97.8%)Yes (N = 63; 2.2%)Total (N = 2908)p valueN (%)N (%)N (%)SexMale1310 (46.0)17 (27.0)1327 (45.6)0.003Female1535 (54.0)46 (73.0)1581 (54.4)AgeMean age (SD)53.3 (13.7)47,6 (12.0)53.2<0.001Body mass index (BMI)aThe info regarding BMI>30 was present for 1574 patients; the 1334 for whom the BMI was not indicated, were considered as having a BMI<30.<302790 (98.1)63 (100)2853 (98.1)0.265>3055 (1.9)0 (0.0)55 (1.9)Chronic diseasesNone1504 (52.9)32 (50.8)15360.745Heart failure56 (2.1)0 (0.0)56 (2.1)0.254Ischemic heart disease118 (4.5)1 (1.7)119 (4.4)0.296Myocardial infarction59 (2.2)0 (0.0)59 (2.2)0.242Peripheral obliterating arteriopathy50 (1.9)0 (0.0)50 (1.8)0.282Stroke58 (2.2)0 (0.0)58 (2.1)0.246Hypertension916 (34.7)20 (33.3)936 (34.6)0.828Diabetes244 (9.2)5 (8.3)249 (9.2)0.811Chronic obstructive pulmonary disease (COPD)53 (2.0)0 (0.0)53 (2.0)0.268Parkinson's disease30 (1.1)0 (0.0)30 (1.1)0.406Chronic kidney disease4 (0.1)0 (0.0)4 (0.1)0.763Multiple sclerosis8 (0.30)1 (1.7)9 (0.3)0.070Dementia65 (2.5)2 (3.3)67 (2.5)0.668Dyslipidaemia901 (34.1)18 (30.0)919 (34.0)0.506Epilepsy66 (2.5)2 (3.3)68 (2.5)0.683Inflammatory bowel disease21 (0.8)0 (0.0)21 (0.8)0.488Chronic rheumatic disease59 (2.2)1 (0.7)60 (2.2)0.768NeoplasiaNo active tumor2841 (99.9)63 (100)2904 (99.9)0.766Active tumor4 (0.1)0 (0.0)4 (0.1)ProfessionNot a HCW2142 (75.3)23 (36.5)2165 (74.5)HCW703 (24.7)40 (63.5)743 (25.5)<0.001SettingHome dwelling2772 (97.4)63 (100)2835 (97.5)0.198Nursing /residential care facility73 (2.6)0 (0.0)73 (2.5)OutcomeAt-home recovery1866 (65.6)54 (85.7)1920 (66.0)0.001Hospitalization or death979 (34.4)9 (14.3)988 (34.0)a The info regarding BMI>30 was present for 1574 patients; the 1334 for whom the BMI was not indicated, were considered as having a BMI<30. Open table in a new tab When each covariate was individually considered through logistic regression analyses adjusting only for age and gender (Table 2), consistently with the evidence emerging across the world, 5Wei-jie Guan Wen-hua Liang Yi Zhao Heng-rui Liang Zi-sheng Chen Yi-min Li et al.Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis.Eur Respir J. 2020; 552000547https://doi.org/10.1183/13993003.00547-2020Crossref PubMed Scopus (8) Google Scholar, 6Killerby Marie E. Ruth Link-Gelles Haight Sarah C. Schrodt Caroline A. Lucinda England Gomes Danica J. et al. Characteristics associated with hospitalization among patients with COVID-19 — Metropolitan Atlanta, Georgia, March–April 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 790-794https://doi.org/10.15585/mmwr.mm6925e1Crossref PubMed Google Scholar, 7Jennifer Lighter Michael Phillips Sarah Hochman Stephanie Sterling Diane Johnson Fritz Francois et al.Obesity in patients younger than 60 years is a risk factor for COVID-19 hospital admission.Clin Infect Dis. 2020; https://doi.org/10.1093/cid/ciaa415Crossref Scopus (842) Google Scholar gender, age, obesity and several chronic conditions were correlated with a bad COVID-19 outcome; furthermore, BCG and HCW status were protective against the risk of severe COVID-19: for BCG vaccine Odds Ratio (OR)= 0.47 (95% CI 0.22–0.98).Table 2Logistic regression analyses to assess the association of covariates with the outcome (hospitalization or death). A) Results of logistic regression analyses adjusting only for age and gender; B) Results of the multivariate logistic regression model.A) Logistic regression analyses to assess the association of each covariate with the outcome adjusting only for age and genderCovariatesOR (95% Conf. Int.)p-valueGenderaAdjusted for age.Males VS. females2.25 (1.90–2.65)<0.001AgebAdjusted for gender.Age1.06 (1.05–1.06)<0.001BMI>306.07 (3.06–12.07)<0.001VaccinationBCG vaccine0.47 (0.23–0.98)0.045Chronic diseasesHeart failure1.05 (0.60–1.83)0.871Ischemic heart disease1.54 (1.03–2.31)0.036Myocardial infarction1.80 (1.01–3.21)0.045Peripheral obliterative arteriopathy1.97 (1.06–3.65)0.031Stroke1.87 (1.06–3.30)0.029Hypertension1.61 (1.33–1.95)<0.001Diabetes1.70 (1.28–2.26)<0.001COPD2.74 (1.47–5.10)0.002Parkinson's disease0.51 (0.22–1.17)0.113Chronic kidney disease2.70 (0.27–26.6)0.395Multiple sclerosis0.30 (0.037–2.53)0.271Dementia0.68 (0.40–1.15)0.149Dyslipidaemia1.53 (1.27–1.83)<0.001Epilepsy1.22 (0.73–2.05)0.455Inflammatory bowel disease0.42 (0.15–1.19)0.103Chronic rheumatic disease1.45 (0.84–2.52)0.181NeoplasiaActive tumor2.74 (0.26–29.04)0.402ProfessionHCW0.29 (0.23–0.37)<0.001SettingLiving in a nursing /residential care facility0.77 (0.47–1.25)0.289B) Results of the multivariate logistic regression analysisCovariatesAdjusted OR (95% Conf. Int.)p-valueVaccinationBCG vaccine0.71 (0.33–1.51)0.369GenderMale VS female1.99 (1.68–2.37)<0.001AgeAge1.04 (1.03–1.05)<0.001BMIBMI>305.50 (2.72–11.11)<0.001Chronic diseasescAmong ischemic heart disease, myocardial infarction, peripheral obliterative arteriopathy, stroke, hypertension, diabetes mellitus, COPD and dyslipidaemia.Having at least 1 chronic disease1.56 (1.29–1.87)<0.001ProfessionBeing a HCW0.30 (0.23–0.39)<0.001a Adjusted for age.b Adjusted for gender.c Among ischemic heart disease, myocardial infarction, peripheral obliterative arteriopathy, stroke, hypertension, diabetes mellitus, COPD and dyslipidaemia. Open table in a new tab Variables with a significance level of p < 0.10 in such analyses were entered in a subsequent multivariate logistic regression model, in which they were considered statistically significant when the p-value was less than 0.05; chronic diseases with a significance level of p < 0.10 in the first analyses were assessed together as a binary category (having at least one chronic disease/having no comorbidity). Age, gender and obesity were shown to be independent determinants of a poorer outcome, as well as the presence of at least one comorbidity among those for which a significant association with the outcome in the univariate analysis was observed (i.e. ischemic heart disease, myocardial infarction, peripheral obliterative arteriopathy, stroke, hypertension, diabetes mellitus, COPD and dyslipidaemia) (p<0.001) (Table 2). On the contrary, being a HCW was inversely and independently correlated with a poorer outcome (OR=0.30, 95% CI 0.23–0.39). BCG was inversely correlated with the risk of being hospitalized or dying from COVID-19, although this association was not significant (OR=0.71, 95% CI 0.33–1.51). Since a strong interaction between being vaccinated with BCG in the past and being a healthcare worker was observed (p = 0.007), the multivariate analysis was repeated to consider separately i) the general population, i.e. all except healthcare workers and ii) healthcare workers only. In the general population, 23 were those vaccinated and 2142 those not vaccinated; BCG was strongly associated with a more favorable outcome (adjusted OR =0.09; 95% CI 0.01–0.74). If the risk among vaccinated individuals were the same as among non-vaccinated, we would have observed an unfavorable outcome in eight cases, whereas only one hospitalization was observed and no deaths occurred in the group of vaccinees. On the other hand, this supposed protective role of BCG against a poorer outcome was no longer evident among HCWs. For HCWs the adjusted OR was 1.87 (95% CI 0.81–4.33). Mass screening interventions for SARS-CoV-2 infections have been implemented among HCWs in Tuscany since April 2020.8Agenzia Regionale di Sanità della Toscana Screening for SARS-CoV-2 infection: first results on the validation of rapid tests in the field and on screening of health care workers [Screening per infezione da SARS-CoV-2: primi risultati sulla validazione dei test rapidi sul campo e sullo screening degli operatori sanitari]. Florence, Italy2020Google Scholar Such interventions allowed for asymptomatic infections in this group to emerge, which may at least partially explain the inverse association observed between being a HCW and the risk of developing a severe form of COVID-19. In Tuscany, the first epidemic wave in spring 2020 had less serious consequences than in the northern regions of Italy; the national lockdown imposed on account of the acceleration of the outbreak in the north of the country between February and March came into effect in Tuscany in an earlier epidemic phase, and granted HCWs time for preparation, training, and the adoption of protection measures. Hence, BCG probably could not confer any additional protection on top of that already provided by these prevention and control measures. Although definitive conclusions can only be drawn from the results of the ongoing RCTs, our findings provided suggestive evidence that BCG vaccination might provide protection against severe forms of COVID-19, and are in line with Kinoshita and Tanaka's observations. Nonetheless, we highlight the need to consider the HCW status as an effect modifier of the association between BCG vaccination and COVID-19 outcomes in observational studies that may be carried out in the near future on larger cohorts to confirm such findings. None This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

BACKGROUND:the COVID-19 pandemic represents a challenge for health systems around the world, with just under 10,000 cases in Tuscany Region (Central Italy) and about 4,500 in the Local Health Unit (LHU) 'Toscana Centro', updated on 11 May 2020. The risk factors reported are several, including age, being male, and some chronic diseases such as hypertension, diabetes, respiratory and cardiovascular diseases. However, the relative importance of chronic diseases is still to be explored.OBJECTIVES:to evaluate the role of chronic diseases on the risk to develop clinically evident (at least mild symptomatic) forms of SARS-CoV-2 infection in the population of the LHU Toscana Centro.DESIGN:case-population study.SETTING AND PARTICIPANTS:'case' is a subject with SARS-CoV-2 positive swab with at least mild clinical status, who lives in the LHU Toscana Centro area; 'controls' are all people residing in the LHU Toscana Centro area at 1 January 2020. People aged under 30 and patients living in nursing care homes are excluded from the analysis.MAIN OUTCOME MEASURES:the analysis assesses the effect of gender, age, neoplasm, and the main chronic diseases on the onset of an infection with at least mild symptoms by calculating odds ratios (OR) by multivariate logistic regression models (to produce adjusted OR by potential confounders).RESULTS:among the 1,840 cases, compared to the general population, the presence of males and over-60-year-old people is greater. Almost all the considered chronic diseases are more frequent among the cases, compared to the general population. A chronic patient has a 68% greater risk to be positive with at least mild symptoms. Many of the considered diseases show an effect on the risk of getting COVID-19 in a symptomatic form, which remains even adjusting by other comorbidities. The main ones include heart failure, psychiatric disorders, Parkinson's disease, and rheumatic diseases.CONCLUSIONS:these results confirm evidence already shown in other studies on COVID-19 patients and add information on the chronic diseases attributable risk in the population, referred to the symptomatic forms and adjusted by age, gender or the possible copresence of more diseases. These risk estimates should guide prevention interventions by health services in order to protect the chronic patients affected by the pathologies most at risk.

Background and aimsAim of the present study is to determine the role of obesity as a risk factor for COronaVirus Disease-19 (COVID-19) hospitalization.Methods and resultsThis observational study was performed using Istituto Superiore di Sanità (ISS) Tuscany COVID-19 database by the Agenzia Regionale Sanità (ARS), including all COVID-19 cases registered until April 30th, 2020, with reported information on chronic diseases. The principal outcome was hospitalization. An age and gender-adjusted logistic regression model was used to assess the association of clinical and demographic characteristics with hospitalization. Further multivariate models were applied. Of 4481 included subjects (36.9% aged over 70 years), 1907 (42.6%) were admitted to hospital. Obesity was associated with hospitalization after adjusting for age and gender. The association of obesity with hospitalization retained statistical significance in a fully adjusted model, including possible confounders (OR: 2.99 [IC 95% 2.04–4.37]). The effect of obesity was more evident in younger (<70 years) than in older (≥70 years) subjects.ConclusionsThe present data confirm that obesity is associated with an increased risk of hospitalization in patients with COVID-19. Interestingly, the association of obesity with hospitalization was greater in younger (<70 years) patients.

AIM:To evaluate this prevalence in Tuscan populations that was known and unknown to the Tuscan Regional Health Service in 2015.METHODS:Tuscan Health administrative data were used to evaluate hepatitis C virus (HCV) infected people known to the Regional Health Service. Residents in Tuscany with a HCV exemption code (070.54) were identified. Using the universal code attributed to each resident, these patients were matched with hospital admission codes identified by the International Classification of Diseases, Ninth Revision (ICD-9), Clinical Modification, and with codes for dispensing drugs to patients by local and hospital pharmacies. Individuals were considered only once. Capture-recapture analysis was used to evaluate the HCV-infected population unknown to the Regional Health Service.RESULTS:In total, 14526 individuals were living on 31/12/2015 with an exemption code for HCV. In total, 9524 patients were treated with pegylated interferon + ribavirin and/or direct-acting antiviral drugs during the last 10 years, and 13879 total hospital admissions were noted in the last 15 years. After data linkage, the total number was 25918. After applying the Capture-Recapture analysis, the number of unknown HCV-infected people was 23497. Therefore, the total number of chronic HCV-infected people was 38643, excluding those achieved sustained virological response to previous treatment.CONCLUSION:Our results show a prevalence of HCV infected people of 1%. Tuscan administrative data could be useful for calculating health care costs and health planning in the coming years.

Cecilia Scarinzi,1 Ester Rita Alessandrini,2 Monica Chiusolo,1 Claudia Galassi,3 Marco Baldini,4 Maria Serinelli,5 Paolo Pandolfi,6 Antonella Bruni,7 Annibale Biggeri,8 Aldo De Togni,9 Giulia Carreras,10 Claudia Casella,11 Cristina Canova,12 Giorgia Randi,13 Andrea Ranzi,14 Caterina Morassuto,12 Achille Cernigliaro,15 Simone Giannini,14 Paolo Lauriola,14 Fabrizio Minichilli,16 Bianca Gherardi,14 Stefano Zauli-Sajani,14 Massimo Stafoggia,2 Patrizia Casale,17 Emilio A.L. Gianicolo,18 Cinzia Piovesan,19 Riccardo Tominz,20 Loredana Porcaro,21 Ennio Cadum;1 Gruppo collaborativo EpiAir2* e&panno 37 (4-5) luglio-ottobre 2013 Rassegne e Articoli

Ester Rita Alessandrini,1 Annunziata Faustini,1 Monica Chiusolo,2 Massimo Stafoggia,1 Martina Gandini,2 Moreno Demaria,2 Antonello Antonelli,3 Pasquale Arena,4 Annibale Biggeri,5 Cristina Canova,6 Giovanna Casale,7 Achille Cernigliaro,8 Elsa Garrone,9 Bianca Gherardi,10 Emilio A.L. Gianicolo,11 Simone Giannini,10 Claudia Iuzzolino,12 Paolo Lauriola,10 Mauro Mariottini,13 Paolo Pasetti,14 Giorgia Randi,15 Andrea Ranzi,10 Michele Santoro,16 Vittorio Selle,17 Maria Serinelli,18 Elisa Stivanello,19 Riccardo Tominz,20 Mariangela Vigotti,16,21 Stefano Zauli-Sajani,10 Francesco Forastiere,1 Ennio Cadum;2 Gruppo collaborativo EpiAir2* e&panno 37 (4-5) luglio-ottobre 2013 Rassegne e Articoli

Background and Aims: in two areas of Tuscany 31 geothermal power plants have been operating since the eighties. Hydrogen sulphide (H2S) and mercury vapours in the air, inorganic arsenic in groundwater and in drinking water are the main pollutants. Communities' concern for health effects increased in the last decade. A descriptive epidemiological study commissioned by the Tuscany Region was carried out in 2010. Methods: sixteen municipalities, 43,400 inhabitants were considered; 60 causes of mortality 1980-2006 and of hospitalization 1998-2006 were compared with regional and local figures (80 municipalities around the study areas). For the total area, 2 subareas and 16 municipalities, standardized and Bayesian age-adjusted rates and clustering analysis were performed. Results: in the whole area total mortality was in excess for men (SMR=106) but not for women; significant excesses emerged for respiratory causes (SMR=125) and infective diseases (SMR=236) in men, for hepatic cirrhosis among women (SMR=142). No excesses of hospitalization for all causes, all cancers, all cardiovascular diseases resulted; SHR was in excess for stomach cancers in males and females (SHR=146;185), for leukaemia among women (SHR=167). In the northern subarea excesses of hospitalization for leukaemia in women (SHR=250), digestive diseases in both genders (SHR=113) were found. In the southern subarea mortality excesses of total causes, all cancers, respiratory diseases emerged for men (SMR=113;119;128), for acute respiratory and digestive diseases among women (SMR=141;132). Excesses of hospitalization for stomach cancers in males and females (SHR=160;208), kidney failure in both genders (SHR=136), respiratory diseases among women (SHR=113) emerged. Excesses of mortality and hospitalization prevailed in municipalities of southern subarea. Bayesian and clustering analysis confirmed the main results. Conclusions: although the mortality and hospitalization profiles did not show a critical situation and some excesses were likely to be associated with past occupational exposure or life-style determinants, a GIS assisted case-control study is in progress for some emerged signals, mainly regarding leukaemia, renal and respiratory diseases particularly to assess possible effects of H2S low doses exposure.

Background and aims: A Regional Registry for Alzheimer's Disease and Other Dementias is being tested in Tuscany (Italy) to provide a basis for epidemiological studies. Current results are presented and critically evaluated. Methods: The Registry extracts data on cases of dementia from Hospital Discharge Records, Outpatient Service Records, Regional Mortality Registry and Disease-Specific Co-payment Exemption Records, based on ICD-9 codes of dementias, and from Prescription Records based on registered anti-dementia drug codes. A list of cases of dementia prevalent at the end of 2005 was produced by cross-checking captured cases with the Regional Mortality Registry. Results: The Registry captured 47,889 cases, of which 27,796 were still alive at the end of 2005. Captured cases represent slightly less than half of all the cases of dementia estimated to be present in Tuscany among older residents (65+) according to recent prevalence studies. Conversely, of 87 subjects 65 years of age or older selected from the Registry and directly evaluated, 80 (92%) were truly cognitively impaired subjects. Conclusions: The Registry has low sensitivity, probably because not all demented individuals are diagnosed as such in current practice and/or use health services. Conversely, the Registry has high specificity, and the produced lists of prevalent dementia cases are the key to estimating health and quality-of-care indicators for the demented population, and may constitute a basis for epidemiological studies.

Background On a regional level, our aims were to describe rehabilitation patterns for elderly patients with stroke and hip fracture and to investigate mortality risk during the 6-month post acute period. Methods Data sources included administrative data relative to patients aged 65+ resident in Tuscany admitted in hospital for stroke or hip fracture between 2001 and 2003, traced up to 3 years before and 6 months following index admission. The study design involves computerized linkage of administrative data, and an exploratory analysis of the association between rehabilitation patterns and 6-month mortality, adjusting for clinical, demographic, and acute-related care characteristics using multivariate Cox regression. Results Rehabilitation patterns vary greatly across Tuscany with considerable cost implications. Six month mortality risk for stroke patients is significantly lower among residents of Local Health Authorities where patients are more frequently rehabilitated, specifically in extra-hospital settings. Conclusion Our study, targeting two crucial conditions for elderly patients, found a high variability of rehabilitation patterns across a region, albeit coherent between the two pathologies, associated with remarkable differences in average expenditure. Differences in hazard rates for 6-month mortality after stroke at population level were also found. These results need to be confirmed and further investigated through a more robust information framework.

OBJECTIVE To describe mortality of residents in the area of Massa-Carrara for the period 1995-2000 and to compare it with mortality for the years 1990-1994. DESIGN Geographical descriptive study. SETTING In the area of Massa-Carrara cause and gender specific standardized mortality ratios (SMR), adjusted for age and municipal deprivation index (reference: Tuscany Region), have been computed for the years 1995-2000 and compared with mortality in the period 1990-1994 calculating ratios between standardized rates by age classes with a direct method (CMF). For those causes showing a statistically significant increase a spatial analysis on a group of municipalities around Massa and Carrara has been carried out. MAIN OUTCOME Mortality for all causes, and for 30 specific causes. RESULTS The study results confirm, for the years 1995-2000, the previous observation (1990-1994) of statistically significant excesses for mortality from all causes (SMR 109), all cancers (SMR 112), respiratory diseases (SMR 126), cirrhosis (SMR 226), liver (SMR 161) and lung cancer (SMR 115) in males. A statistically significant excess for larynx (SMR 158) and pleural cancer (SMR 178) is observed in the years 1995-2000, which was not present in 1990-1994. A mortality excess for cirrhosis is confirmed in females (SMR 158) and a new one emerges for liver cancer (SMR 144). The comparison between mortality data for the periods 1995-2000 and 1990-1994 has shown a statistically significant decrease in mortality for all causes and for several specific causes, a significant increase in liver (CMF males 1.35; CMF females 1.78) and blood cancer mortality is also detected (CMF females 1.44). CONCLUSIONS This study confirms the negative health impact of environmental, occupational exposures in populations living in areas where high-risk factories are located. Adverse health effects are stronger in socially and economically deprived areas, and persist over many years after closing polluting industrial plants. The results of this study point out to the need of health promoting actions aiming at modifying lifestyle risk factors, ameliorating socio-economic conditions, and maintaining a constant control on environment, also through a specific environmental epidemiological surveillance to monitor the impact of reclamation procedures completed or in progress.