Explore the vast range of titles available.

Background Per- and polyfluoroalkyl substances (PFAS) are associated with many adverse health conditions. Among the main effects is carcinogenicity in humans, which deserves to be further clarified. An evident association has been reported for kidney cancer and testicular cancer. In 2013, a large episode of surface, ground and drinking water contamination with PFAS was uncovered in three provinces of the Veneto Region (northern Italy) involving 30 municipalities and a population of about 150,000. We report on the temporal evolution of all-cause mortality and selected cause-specific mortality by calendar period and birth cohort in the local population between 1980 and 2018. Methods The Italian National Institute of Health pre-processed and made available anonymous data from the Italian National Institute of Statistics death certificate archives for residents of the provinces of Vicenza, Padua and Verona (males, n  = 29,629; females, n  = 29,518) who died between 1980 and 2018. Calendar period analysis was done by calculating standardised mortality ratios using the total population of the three provinces in the same calendar period as reference. The birth cohort analysis was performed using 20–84 years cumulative standardised mortality ratios. Exposure was defined as being resident in one of the 30 municipalities of the Red area , where the aqueduct supplying drinking water was fed by the contaminated groundwater. Results During the 34 years between 1985 (assumed as beginning date of water contamination) and 2018 (last year of availability of cause-specific mortality data), in the resident population of the Red area we observed 51,621 deaths vs. 47,731 expected (age- and sex-SMR: 108; 90% CI: 107–109). We found evidence of raised mortality from cardiovascular disease (in particular, heart diseases and ischemic heart disease) and malignant neoplastic diseases, including kidney cancer and testicular cancer. Conclusions For the first time, an association of PFAS exposure with mortality from cardiovascular disease was formally demonstrated. The evidence regarding kidney cancer and testicular cancer is consistent with previously reported data.

Chronic pain (CP) is a global healthcare concern requiring careful monitoring. In Italy, the most recent CP prevalence estimates date back to 2003. In this work, we analyzed data from the 2019 European Health Interview Survey, based on a representative sample of the Italian population (n = 44,492), to update national CP prevalence estimates and evaluate its psychosocial burden. CP was detected using a validated questionnaire. Our results show that approximately 10.5 million adults (24.1%) suffer from CP; prevalence and intensity are higher among females and increase with age. In 54.3% of cases, CP was triggered by a diagnosed disease, while 13.6% remain undiagnosed and 14.8% do not seek treatment for CP. Severe CP accounts for 29.4% of cases. Individuals with severe CP are significantly more likely to experience difficulties in social participation (OR 4.82; CI 4.41–5.27), increased work absences (OR 4.18; CI 3.53–4.94), depression (OR 7.10; CI 6.22–8.11), and greater use of primary (OR 2.90; CI 2.64–3.18) and specialist healthcare (OR 2.63; CI 2.40–2.89) as well as diagnostic procedures (OR 2.27; CI 2.07–2.49). Among subjects diagnosed with depression or severe chronic anxiety, CP seems to reduce access to mental health care (OR 0.75; CI 0.61–0.92) and increase abandonment due to financial barriers (OR 1.57; CI 1.07–2.31). Unlike a few countries (e.g., Spain and Denmark) that have recorded a generally increasing trend in CP prevalence, our figures confirm a quite stable national epidemiological pattern. Our estimates underscore the need for careful management of CP and its psychosocial burden. Since data were collected just before the COVID-19 pandemic, they may represent a crucial baseline for monitoring post-pandemic trends.

Background Contaminated sites are among the main worldwide environmental health priorities. The health impact on population living in Italian contaminated sites of national concern for remediation (CSs) with petrochemical/refineries (P&R) and steel plants (S) was estimated. Since these CSs include the major Italian facilities located widespread on the territory are representative of the national reality. Furthermore, the population exposed in P&R and S is significant since it represents about 3% of the national population. Methods Two groups of CSs were defined: twelve CSs with P&R and eight with S. Cause-specific mortality (2013–2017) and hospitalization (2014–2018) in both groups were analysed. Pooled Standardized Mortality/Hospitalization Ratios (SMR pooled /SHR pooled ) were estimated through random-effect meta-regression of individual site SMR/SHR (reference: CS regional rate). The main groups of diseases and those for which the evidence of an association with the residential exposure to P&R and S was defined limited were analysed in adult while only the main groups of diseases were analysed in paediatric-adolescent and juvenile ages subgroups (0–1, 0–19, 20–29 years). All the analyses were performed separately for the two groups of CSs, and by sex. Results In the two CSs groups, the overall and the main causes mortality and hospitalization, including all cancers, exceeded in both sexes. Specifically, for lung cancer in the P&R group, among males SMR pooled =1.11 (CI90% 1.00-1.23) and SHR pooled =1.18 (0.99–1.40) and among females SMR pooled =1.13 (1.03–1.25) and SHR pooled =1.20 (1.05–1.38), while in the S group, SMR pooled =1.17 (1.02–1.34) and SHR pooled =1.27 (0.87–1.86) among males and SMR pooled =1.21 (0.93–1.59) and SHR pooled =1.19 (0.91–1.57) among females. The mortality and hospitalization exceeded also for breast cancer in the P&R group. Hospitalization for leukaemia and respiratory diseases increased in the S group. In both CSs groups, among 20–29 years old sub-population, mortality for all tumours and hospitalization for respiratory diseases was worthy of note and hospitalization for all tumours exceeded among 0–1-year age-subgroup. Conclusions The results suggest that living in petrochemical/refineries and steel plants CSs is associated with increased risk for specific diseases. The meta-analytical estimates could contribute to assess the order of magnitude of health impacts of contaminated sites and to perform integrated evaluation of health and environmental impact.

This study aimed to calculate Italy’s first national maternal mortality ratio (MMR) through an innovative record-linkage approach within the enhanced Italian Obstetric Surveillance System (ItOSS). A record-linkage retrospective cohort study was conducted nationwide, encompassing all women aged 11–59 years with one or more hospitalizations related to pregnancy or pregnancy outcomes from 2011 to 2019. Maternal deaths were identified by integrating data from the Death Registry and national and regional Hospital Discharge Databases supported by the integration of findings from confidential enquiries conducted through active surveillance. Maternal Mortality Ratio (MMR), direct MMR (DMMR), and causes of maternal death are the study main outcomes. The MMR was found to be 8.4 per 100,000 live births (95% CI 7.5–9.3), significantly higher than the 3.9 per 100,000 (95% CI 3.3–4.5) calculated solely from the Death Registry, with a notable declining trend over the study period. Causes of death have been classified according to the 10th International Classification of Diseases. Within 42 days from pregnancy outcome, leading causes were obstetric haemorrhage, sepsis, and cardiovascular diseases. Late maternal deaths were primarily attributed to suicide, malignancies, and cardiovascular diseases. This integrated methodology provides a comprehensive understanding of maternal mortality trends and causes in Italy, offering valuable insights for countries utilizing or planning enhanced surveillance systems.

Mosquitoes in the Culex pipiens complex are considered to be involved in the transmission of a range of pathogens, including West Nile virus (WNV). Although its taxonomic status is still debated, the complex includes species, both globally distributed or with a more limited distribution, morphologically similar and characterised by different physiological and behavioural traits, which affect their ability as vectors. In many European countries, Cx. pipiens and its sibling species Culex torrentium occur in sympatry, exhibiting similar bionomic and morphological characters, but only Cx. pipiens appears to play a vector role in WNV transmission. This species consists of two biotypes, pipiens and molestus, which can interbreed when in sympatry, and their hybrids can act as WNV-bridge vectors, due to intermediate ecological features. Considering the yearly WNV outbreaks since 2008 and given the morphological difficulties in recognising species and biotypes, our aim was to molecularly identify and characterised Cx. pipiens and Cx. torrentium in Italy, using recently developed molecular assays. Culex torrentium was not detected; as in other European countries, the pipiens and molestus biotypes were widely found in sympatry with hybrids in most environments. The UPGMA cluster analysis applied to CQ11 genotypic frequencies mainly revealed two groups of Cx. pipiens populations that differed in ecological features. The high propensity of the molestus biotype to exist in hypogean environments, where the habitat's physical characteristics hinder and preclude the gene flow, was shown. These results confirmed the CQ11 assay as a reliable diagnostic method, consistent with the ecological and physiological aspects of the populations analysed. Since the assessment of the actual role of three biotypes in the WNV circulation remains a crucial point to be elucidated, this extensive molecular screening of Cx. pipiens populations can provide new insights into the ecology of the species and may give useful indications to plan and implement WNV surveillance activities in Italy.

SARS-CoV-2 infection has been associated with the onset or persistence of symptoms in the long-term after the acute infection is resolved. This condition known as Post-COVID, might be particularly severe and potentially life-threatening. However, little is known on the impact of post-COVID condition on mortality. Aim of the present study is to assess and quantify Post-COVID deaths in Italy in years 2020 and 2021, based on an analysis of death certificates. Data from the Italian National Cause of Death Register were analyzed. ICD-10 code U09.9, released by the World Health Organization in September 2020, was used to identify the 'Post-COVID' condition. Numbers of post-COVID deaths from October 2020 to December 2021 were analyzed. Rates of post-COVID deaths were calculated for the year 2021. Between October 2020 and December 2021, 4,752 death certificates reporting post-COVID condition were identified. Of these, 14.9% (  = 706) occurred between October and December 2020 and 85.1% (  = 4,046) in 2021. In 46.0% of post-COVID-related deaths, the underlying cause of death was COVID-19. Other frequent underlying causes were heart disease (14.3% of cases), neoplasms (9.2%), cerebrovascular diseases (6.3%) and Alzheimer's disease and other dementias (5.5%). The mortality rate related to post-COVID conditions in year 2021 was 5.1 deaths per 100 thousand inhabitants and it increased with increasing age. Men showed a higher mortality rate than women (4.3 deaths per 100 thousand in women and 6.0 deaths per 100 thousand in men). Post-COVID conditions contributed to a substantial number of deaths in Italy. Strategies to identify the population at risk of severe long-term consequences of SARS-CoV-2 infection and interventions aimed at reducing this risk must be developed.

Chikungunya virus (CHIKV) is an emerging arbovirus, belonging to the Togaviridae family, Alphavirus genus, transmitted by Aedes spp. mosquitoes. Since 2007, two different CHIKV strains (E1-226A and E1-226V) have been responsible for outbreaks in European countries, including Italy, sustained by Ae. albopictus mosquitoes. In this study, we assessed the susceptibility to the CHIKV E1-226V, strain responsible for the Italian 2007 outbreak, of eight Ae. albopictus populations collected in Northern, Central, Southern, and Island Italy, by experimental infections. Vector competence was evaluated by estimating infection, dissemination, and transmission rates (IR, DR, TR), through detection of the virus in the bodies, legs plus wings, and saliva, respectively. Additionally, vertical transmission was evaluated by the detection of the virus in the offspring. The results of our study demonstrated that the Italian populations of Ae. albopictus tested were susceptible to CHIKV infection, and can disseminate the virus outside the midgut barrier with high values of IR and DR. Viral infectious RNA was detected in the saliva of three populations from Central, Southern, and Island Italy, also tested for TR and population transmission rate (PTR) values. No progeny of the first and second gonotrophic cycle were positive for CHIKV. This study strongly confirms the role of Ae. albopictus as a potential CHIKV vector in Italy. This may represent a threat, especially considering both the high density of this species, which is widespread throughout the country, and the increasing number of cases of imported arboviruses.

Background West Nile virus (WNV) is a vector-borne disease responsible for causing epidemics in many areas of the world. The virus is maintained in nature by an enzootic bird-mosquito-bird cycle and occasionally transmitted to other hosts, such as equines and humans. Culex species, in particular the ubiquitous species Culex pipiens is thought to play a major vector role both in enzootic and epizootic maintenance and transmission of WNV. Introduced in Europe in recent years, since 2008 WNV has been stably circulating mainly in the Northeastern regions of Italy, although sporadic equine and/or human cases, as well as WNV infected Cx. pipiens pools, have been recorded in other Italian areas. The scope of our study was to evaluate the potential competence of some Italian populations of Cx. pipiens to transmit WNV and to assess their ability for vertical transmission of the virus. For this purpose four Italian populations, from different areas, were experimentally infected. Methods After the infectious blood meal, fed females were monitored for 32 days to determine the length of viral extrinsic incubation period. WNV titre of infected mosquitoes was evaluated both by quantitative Real Time PCR and viral titration by Plaque Forming Units/ml (PFU/mL) in VERO cells. Potential Infection, Dissemination, Transmission rates (IR, DR, TR) were assessed by detection of the virus in body, legs plus wings and saliva of the fed females, respectively. Results All tested populations were susceptible to the WNV infection. The viral presence in legs and wings demonstrated the ability of WNV to disseminate in the mosquitoes. Viral RNA was detected in the saliva of tested populations. No significant differences in TR values were observed among the four studied populations. The offspring of the Cx. pipiens infected females were WNV negative. Conclusions Our study addressed an important issue in the knowledge on the complex WNV-vector relationships in Italy, indicating that all Italian Cx. pipiens populations tested exhibited vector competence for WNV. Further studies should be performed in order to better clarify the role of other factors (vector density, climatic conditions, reservoir presence etc.) in order to predict where and when WNV outbreaks could occur.

Epidemiological studies on primary biliary cholangitis (PBC) have been based primarily on tertiary referral case series. We aimed to estimate the incidence and prevalence and describe comorbidities in hospitalized patients with PBC in Italy using a national hospital‐based data source. Data were extracted from the National Hospital Discharge Database, which includes all Italian individuals discharged from any hospital in the country. All adults diagnosed with biliary cirrhosis (International Classification of Diseases, Ninth Revision, Clinical Modification, 571.6) as the primary or secondary diagnosis from 2011 to 2015 were included. To determine whether a comorbidity was either more or less frequent in PBC patients compared with the general hospitalized Italian population, the standardized hospitalization ratio (SHR) was calculated. A total of 5,533 incident cases were identified from 2011 to 2015, 3,790 of whom were females (68.5%; female to male [F:M] ratio, 2.2:1). Prevalent cases were 9,664, of whom 7,209 were females (74.6%; F:M ratio, 2.9:1). The incident rate was 1.03 × 100,000 in males and 1.92 × 100,000 in females; prevalence was 1.89 × 100,000 in males and 4.75 × 100,000 in females. Extrahepatic autoimmune diseases, malignant neoplasms of liver and intrahepatic biliary ducts, and malignant neoplasms of gallbladder and extrahepatic bile ducts were found more frequently in PBC patients than in the general hospitalized population (SHR > 100), whereas cerebrovascular diseases and ischemic heart diseases were less frequent in PBC individuals (SHR < 100). Conclusion: This national study provides a survey of comorbidities associated with PBC. Hospitalized patients with PBC are more likely to have extrahepatic autoimmune diseases, hepatocellular carcinoma, and biliary tract cancers and a low risk of cardiovascular events. This national, hospital‐based study derives from data of the Italian National Hospital Discharge Database. It reveals the incidence and prevalence of primary biliary cholangitis in hospitalized patients and offers a detailed picture of associated comorbidities.

The National Environmental Remediation programme in Italy includes sites with documented contamination and associated potential health impacts (National Priority Contaminated Sites—NPCSs). SENTIERI Project, an extensive investigation of mortality in 44 NPCSs, considered the area of Taranto, a NPCS where a number of polluting sources are present. Health indicators available at municipality level were analyzed, that is, mortality (2003–2009), mortality time trend (1980–2008), and cancer incidence (2006-2007). In addition, the cohort of individuals living in the area was followed up to evaluate mortality (1998–2008) and morbidity (1998–2010) by district of residence. The results of the study consistently showed excess risks for a number of causes of death in both genders, among them: all causes, all cancers, lung cancer, and cardiovascular and respiratory diseases, both acute and chronic. An increased infant mortality was also observed from the time trends analysis. Mortality/morbidity excesses were detected in residents living in districts near the industrial area, for several disorders including cancer, cardiovascular, and respiratory diseases. These coherent findings from different epidemiological approaches corroborate the need to promptly proceed with environmental cleanup interventions. Most diseases showing an increase in Taranto NPCS have a multifactorial etiology, and preventive measures of proven efficacy (e.g., smoking cessation and cardiovascular risk reduction programs, breast cancer screening) should be planned. The study results and public health actions are to be communicated objectively and transparently so that a climate of confidence and trust between citizens and public institutions is maintained.