orastiere F

Effect of the Italian Smoking Ban on Population Rates of Acute Coronary Events

Background— Several countries in the world have not yet prohibited smoking in public places. Few studies have been conducted on the effects of smoking bans on cardiac health. We evaluated changes in the frequency of acute coronary events in Rome, Italy, after the introduction of legislation that banned smoking in all indoor public places in January 2005. Methods and Results— We analyzed acute coronary events (out-of-hospital deaths and hospital admissions) between 2000 and 2005 in city residents 35 to 84 years of age. We computed annual standardized rates and estimated rate ratios by comparing the data from prelegislation (2000–2004) and postlegislation (2005) periods. We took into account several time-related potential confounders, including particulate matter (PM10) air pollution, temperature, influenza epidemics, time trends, and total hospitalization rates. The reduction in acute coronary events was statistically significant in 35- to 64-year-olds (11.2%, 95% CI 6.9% to 15.3%) and in 65- to 74-year-olds (7.9%, 95% CI 3.4% to 12.2%) after the smoking ban. No evidence was found of an effect among the very elderly. The reduction tended to be greater in men and among lower socioeconomic groups. Conclusions— We found a statistically significant reduction in acute coronary events in the adult population after the smoking ban. The size of the effect was consistent with the pollution reduction observed in indoor public places and with the known health effects of passive smoking. The results affirm that public interventions that prohibit smoking can have enormous public health implications.

Exposure to fine and ultrafine particles from secondhand smoke in public places before and after the smoking ban, Italy 2005

Background: A smoking ban in all indoor public places was enforced in Italy on 10 January 2005. Methods: We compared indoor air quality before and after the smoking ban by monitoring the indoor concentrations of fine (<2.5 μm diameter, PM2.5) and ultrafine particulate matter (<0.1 μm diameter, UFP). PM2.5 and ultrafine particles were measured in 40 public places (14 bars, six fast food restaurants, eight restaurants, six game rooms, six pubs) in Rome, before and after the introduction of the law banning smoking (after 3 and 12 months). Measurements were taken using real time particle monitors (DustTRAK Mod. 8520 TSI; Ultra-fine Particles Counter-TRAK Model 8525 TSI). The PM2.5 data were scaled using a correction equation derived from a comparison with the reference method (gravimetric measurement). The study was completed by measuring urinary cotinine, and pre-law and post-law enforcement among non-smoking employees at these establishments Results: In the post-law period, PM2.5 decreased significantly from a mean concentration of 119.3 μg/m3 to 38.2 μg/m3 after 3 months (p<0.005), and then to 43.3 μg/m3 a year later (p<0.01). The UFP concentrations also decreased significantly from 76 956 particles/cm3 to 38 079 particles/cm3 (p<0.0001) and then to 51 692 particles/cm3 (p<0.01). Similarly, the concentration of urinary cotinine among non-smoking workers decreased from 17.8 ng/ml to 5.5 ng/ml (p<0.0001) and then to 3.7 ng/ml (p<0.0001). Conclusion: The application of the smoking ban led to a considerable reduction in the exposure to indoor fine and ultrafine particles in hospitality venues, confirmed by a contemporaneous reduction of urinary cotinine.

Factors affecting in-hospital heat-related mortality: a multi-city case-crossover analysis

Background: Several studies have identified strong effects of high temperatures on mortality at population level; however, individual vulnerability factors associated with heat-related in-hospital mortality are largely unknown. The objective of the study was to evaluate heat-related in-hospital mortality using a multi-city case-crossover analysis. Methods: We studied residents of four Italian cities, aged 65+ years, who died during 1997–2004. For 94 944 individuals who died in hospital and were hospitalised two or more days before death, demographics, chronic conditions, primary diagnoses of last event and hospital wards were considered. A city-specific case-crossover analysis was performed to evaluate the association between apparent temperature and mortality. Pooled odds ratios (OR) of dying on a day with a temperature of 30°C compared to a day with a temperature of 20°C were estimated with a random-effects meta-analysis. Results: We estimated an overall OR of 1.32 (95% confidence interval: 1.25, 1.39). Age, marital status and hospital ward were important risk indicators. Patients in general medicine were at higher risk than those in high and intensive care units. A history of psychiatric disorders and cerebrovascular diseases gave a higher vulnerability. Mortality was greater among patients hospitalised for heart failure, stroke and chronic pulmonary diseases. Conclusions: In-hospital mortality is strongly associated with high temperatures. A comfortable temperature in hospitals and increased attention to vulnerable patients during heatwaves, especially in general medicine, are necessary preventive measures.

Mortality pattern of silicotic subjects in the Latium region, Italy.

A mortality study was carried out on 595 workers who were compensated for silicosis in the Latium region, Italy, during the period 1946-84 who died between 1 January 1969 and 31 December 1984. Respiratory disorders, tuberculosis, lung cancer, bone cancer, and cirrhosis of the liver showed significantly increased risk ratios (4.1, 3.7, 1.5, 4.1, and 1.9 respectively); excesses of brain cancer and leukaemia did not reach statistical significance. Lung cancer mortality was further analysed by age, period of compensation, final degree of disability, and occupational activity. The possible confounding role of smoking was assessed by comparing the lifetime smoking habits of a sample of silicotic subjects with those of the general male population as estimated by a national health survey; the prevalence of ever smokers among silicotic subjects (70.7%) was similar to that estimated for the general population (68.5%). The present study indicates that silicosis is associated with lung cancer even though it does not clarify the respective roles of exposure to silica and silicosis.

Environment and Health in Contaminated Sites: The Case of Taranto, Italy

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.

Health effects of air pollution in Rome in December 2015

BACKGROUND in December 2015 Rome has been interested by a peculiar meteorological situation, with atmospheric stability, no rain and little wind. These factors, coupled with the high pollutant emissions typical of the winter pre-Christmas period (increased use of private cars and domestic heating), caused extreme peaks in air pollution concentrations persisting several weeks. OBJECTIVES describing daily trends in PM10 over two months, November and December 2015, and their impact on the health of the population of Rome. DESIGN we analysed PM10 time series in Rome for November and December 2015. We estimated the association between daily PM10 concentrations and daily counts of deaths for natural and cardiorespiratory causes, and urgent hospitalizations/emergency-room visits for cardiorespiratory diseases, by use of Poisson regression models adjusted for time trends, influenza epidemics, and meteorology. These risk estimates have been used to quantify attributable deaths/admissions/visits due to exceedances of daily PM10 concentrations above EU-defined limit values in Rome for the period 29 November-30 December 2015. SETTING AND PARTICIPANTS Rome, November and December 2015; population resident in Rome and deceased or hospitalized/ admitted to emergency rooms in hospitals within the city. MAIN OUTCOME MEASURES daily mortality for natural (0+ years), respiratory (0+) or cardiac (35+) causes; urgent (non-scheduled) hospitalizations or admissions to emergency room visits for respiratory (0+) or cardiac (35+) diseases. RESULTS in December 2015, only three days (10th, 11th, and 26th December) had PM10 concentrations below the EU-limit value of 50 μg/m3. Over the 31 days under analysis (from 29 November to 29 December) we estimated 26 natural deaths attributable to PM10 concentrations above 50 μg/m3. Similarly, we estimated 20 and 30 attributable cases of cardiorespiratory hospitalizations and admissions to emergency room visits, respectively. CONCLUSIONS monitoring and control of anthropogenic emissions are mandatory in order to minimize the adverse health effects of air pollution, especially during air pollution peaks.