Alessandra Lafranconi

Cardiorespiratory treatments as modifiers of the relationship between particulate matter and health: a case-only analysis on hospitalized patients in Italy.

BACKGROUND A few panel and toxicological studies suggest that health effects of particulate matter (PM) might be modified by medication intake, but whether this modification is confirmed in the general population or for more serious outcomes is still unknown. OBJECTIVES We carried out a population-based pilot study in order to assess how pre-hospitalization medical treatments modify the relationship between PM<10 μm in aerodynamic diameter (PM10) and the risk of cardiorespiratory admission. METHODS We gathered information on hospitalizations for cardiorespiratory causes, together with pre-admission pharmacological treatments, that occurred during 2005 in seven cities located in Lombardy (Northern Italy). City-specific PM10 concentrations were measured at fixed monitoring stations. Each treatment of interest was analyzed separately through a case-only approach, using generalized additive models accounting for sex, age, comorbidities, temperature and simultaneous intake of other drugs. Analyses were stratified by season and, if useful, by age and sex. RESULTS Our results showed a higher effect size for PM10 on respiratory admissions in subjects treated with theophylline (Odds Ratio (OR) of treatment for an increment of 10 μg/m(3) in PM10 concentration: 1.119; 95% Confidence Interval (CI): 1.013-1.237), while for cardiovascular admissions treatment with cardiac therapy (OR: 0.967, 95% CI: 0.940-0.995) and lipid modifying agents (OR: 0.962, 95% CI: 0.931-0.995) emerged as a protective factor, especially during the warm season. Evidence of a protective effect against the pollutant was found for glucocorticoids and respiratory admissions. CONCLUSIONS Our study showed that the treatment with cardiac therapy and lipid modifying agents might mitigate the effect of PM10 on cardiovascular health, while the use of theophylline seems to enhance the effect of the pollutant, possibly due to confounding by indication. It is desirable to extend the analyses to a larger population.

Coffee consumption is not associated with ovarian cancer risk: A dose-response meta-analysis of prospective cohort studies

Background Coffee consumption has been associated with numerous cancers, but evidence on ovarian cancer risk is controversial. Therefore, we performed a meta-analysis on prospective cohort studies in order to review the evidence on coffee consumption and risk of ovarian cancer. Methods Studies were identified through searching the PubMed and MEDLINE databases up to March 2017. Risk estimates were retrieved from the studies, and dose-response analysis was modelled by using restricted cubic splines. Additionally, a stratified analysis by menopausal status was performed. Results A total of 8 studies were eligible for the dose-response meta-analysis. Studies included in the analysis comprised 787,076 participants and 3,541 ovarian cancer cases. The results showed that coffee intake was not associated with ovarian cancer risk (RR = 1.06, 95% CI: 0.89, 1.26). Stratified and subgroup analysis showed consisted results. Conclusions This comprehensive meta-analysis did not find evidence of an association between the consumption of coffee and risk of ovarian cancer.

Caffeinated and decaffeinated coffee consumption and melanoma risk: a dose-response meta-analysis of prospective cohort studies

Abstract To determine the association between total, caffeinated and decaffeinated coffee consumption and melanoma risk a dose-response meta-analysis on prospective cohort studies were performed. Eligible studies were identified searching PubMed and EMBASE databases from the earliest available online indexing year to March 2017. The dose-response relationship was assessed by random-effects meta-analysis and the shape of the exposure-outcome curve was modelled linearly and using restricted cubic splines. A total of seven studies eligible for meta-analysis were identified that comprised 1,418,779 participants and 9211 melanoma cases. A linear dose-response meta-analysis showed a significant association between total coffee consumption and melanoma risk. An increase in coffee consumption of one cup per day was associated with a 3% reduction in melanoma risk (RR 0.97; 95% CI 0.95–0.99). Our findings suggest that coffee intake may be inversely associated with incidence of melanoma. Nevertheless, further studies exploring also the role of confounding factors are needed to explain the heterogeneity among studies.

Medical leadership—from inspiration to education

Medical leadership--from inspiration to education. Lafranconi A, Gomes B, Stankunas M, Babich SM, Rethmeier KA, Czabanowska K; EUPHA Working Group on Public Health Leadership. Lancet. 2015 Oct 17;386(10003):1531-2. doi: 10.1016/S0140-6736(15)00483-3. No abstract available. PMID: 26530615 [PubMed - indexed for MEDLINE]

The socioeconomic burden of patients affected by hemophilia with inhibitors

Hemophilia is associated with a high financial burden on individuals, healthcare systems, and society. The development of inhibitors significantly increases the socioeconomic burden of the diseases. This study aimed to review and describe the burden of hemophilia with inhibitors, providing a reference scenario to assess the impact of new products in the real word. Two systematic literature reviews were performed to collect data on (i) health economics and (ii) health‐related quality of life evidences in hemophilic patients with inhibitors. The costs associated with patients with hemophilia and inhibitors are more than 3 times greater than the costs incurred in those without inhibitors, with an annual cost per patient that can be higher than €1 000 000. The costs of bypassing agents account for the large majority of the total healthcare direct costs for hemophilia treatment. The quality of life is more compromised in patients with hemophilia and inhibitors compared to those without inhibitors, in particular the physical domains, whereas mental domains were comparable to that of the general population. The development of an inhibitor has a high impact on costs and quality of life. New treatments have the potential to change positively the management and socioeconomic burden of hemophilia with inhibitors.

The short-term effect of particulate matter on cardiorespiratory drug prescription, as a proxy of mild adverse events

Introduction and aims The association between particulate matter < 10 &mgr;m in aerodynamic diameter (PM10) and mild disease episodes, not leading to hospitalization or death, has been rarely investigated. We studied the short‐term effect of PM10 on purchases of specific cardiorespiratory medications, as proxies of mild episodes, in 7 small‐ and medium‐sized cities of Northern Italy, during 2005–2006. Materials and methods We extracted information on purchased prescriptions from healthcare administrative databases, and we obtained daily PM10 concentrations from fixed monitoring stations. We applied a time‐stratified case‐crossover design, using the time‐series of antidiabetic drugs purchases to control for confounding due to irregularities in daily purchase frequencies. Results During the warm season, we estimated a delayed (lags 2–6) increased risk of buying glucocorticoid (4.53%, 95% Confidence Interval (CI): 2.62, 6.48) and adrenergic inhalants (1.66%, 95% CI: 0.10, 3.24), following an increment (10 &mgr;g/m3) in PM10 concentration. During the cold season, we observed an immediate (lags 0–1) increased risk of purchasing antiarrhythmics (0.76%; 95% CI: 0.16, 1.36) and vasodilators (0.72%; 95% CI: 0.30, 1.13), followed by a risk reduction (lags 2–6), probably due to harvesting. Conclusions Focusing on drug purchases, we reached sufficient statistical power to study PM10 effect outside large urban areas and conclude that short‐term increments in PM10 concentrations might cause mild cardiorespiratory disease episodes. HighlightsCardiorespiratory prescriptions are stored in administrative databases.Such prescriptions can be used as tracers of mild disease episodes.We studied the relationship between PM10 and such prescriptions outside urban areas.PM10 is associated with a short‐term increase in cardiorespiratory drugs consumption.