Monica Vichi

Differential impact of combined antiretroviral therapy on the survival of italian patients with specific AIDS-defining illnesses.

Background: A decrease in HIV‐related mortality and morbidity has been observed since 1996 in most developed countries as a consequence of the extensive use of combined antiretroviral therapies. The purpose of this study was to investigate whether combined antiretroviral therapies had a differential impact on the survival of patients with different AIDS‐defining illnesses (ADIs). Methods: In total, 35,318 persons representing all the adults with AIDS (PWAs) diagnosed in Italy from January 1, 1990 to August 31, 1998 were studied. Actuarial life tables and the Kaplan‐Meier method were used to estimate the cumulative probability of survival; the multivariate Cox proportional hazards model was used to estimate adjusted relative hazard of death (RH). Results: Among PWAs diagnosed after 1995, the proportion of survivors 24 months after diagnosis was more than doubled (66%) compared with that of PWAs diagnosed before the end of 1995 (31%). Significantly decreased RHs for some ADIs were observed as early as 1996 (i.e., esophageal candidiasis, Pneumocystis carinii pneumonia, brain toxoplasmosis, HIV‐wasting syndrome, and pulmonary tuberculosis). In the last period (1997‐1998), the decrease was marked and significant for almost all the ADIs, ranging from 55% to 80% compared with the RHs of the reference year (1995). Conversely, primary lymphoma of the brain and Burkitts lymphoma showed a low and not statistically significant decrease; these were the ADIs with the worst outcome. Conclusions: After 1995, there was a rather uniform increase in the survival of PWAs diagnosed with most specific ADIs but not for patients affected by primary brain lymphoma and Burkitts lymphoma. The determinants of this differential effect need to be investigated.

Relationship of suicide rates to economic variables in Europe: 2000-2011

BACKGROUND It is unclear whether there is a direct link between economic crises and changes in suicide rates. AIMS The Lopez-Ibor Foundation launched an initiative to study the possible impact of the economic crisis on European suicide rates. METHOD Data was gathered and analysed from 29 European countries and included the number of deaths by suicide in men and women, the unemployment rate, the gross domestic product (GDP) per capita, the annual economic growth rate and inflation. RESULTS There was a strong correlation between suicide rates and all economic indices except GPD per capita in men but only a correlation with unemployment in women. However, the increase in suicide rates occurred several months before the economic crisis emerged. CONCLUSIONS Overall, this study confirms a general relationship between the economic environment and suicide rates; however, it does not support there being a clear causal relationship between the current economic crisis and an increase in the suicide rate.

Mortality associated with neurofibromatosis type 1: A study based on Italian death certificates (1995-2006)

BackgroundPersons affected by neurofibromatosis type 1 (NF1) have a decreased survival, yet information on NF1-associated mortality is limited.Methods/AimThe National Mortality Database and individual Multiple-Causes-of-Death records were used to estimate NF1-associated mortality in Italy in the period 1995-2006, to compare the distribution of age at death (as a proxy of survival) to that of the general population and to evaluate the relation between NF1 and other medical conditions by determining whether the distribution of underlying causes of NF1-associated deaths differs from that of general population.ResultsOf the nearly 6.75 million deaths in the study period, 632 had a diagnosis of NF1, yet for nearly three-fourths of them the underlying cause was not coded as neurofibromatosis. The age distribution showed that NF1-associated deaths also occurred among the elderly, though mortality in early ages was high. The mean age for NF1-associated death was approximately 20 years lower than that for the general population. The gender differential may suggest that women are affected by more severe NF1-related complications, or they may simply reflect a greater tendency for NF1 to be reported on the death certificates of young women. Regarding the relation with other medical conditions, we found an excess, as the underlying cause of death, for malignant neoplasm of connective and other soft tissue and brain, but not for other sites. We also found an excess for obstructive chronic bronchitis and musculoskeletal system diseases among elderly persons.ConclusionThis is the first nationally representative population-based study on NF1-associated mortality in Italy. It stresses the importance of the Multiple-Causes-of-Death Database in providing a more complete picture of mortality for conditions that are frequently not recorded as the underlying cause of death, or to study complex chronic diseases or diseases that have no specific International Classification of Diseases code, such as NF1. It also highlights the usefulness of already available data when a surveillance system is not fully operational.

Suicide mortality in Italy from 1980 to 2002.

The aim of this study is to update age and sex mortality rates for suicide in Italy; to evaluate the methods of suicide; to consider the effect of under-reporting on mortality rate for suicide; to compare age-adjusted mortality rates for suicide; and to examine some possible causes for the misclassification of suicide. Temporal trends, from 1980 to 2002, were analyzed using joinpoint regression. Suicide rates decreased from 1980 to 2002 by 10.5% for men and by 44% for women. The change in suicide methods indicated an increasing use of highly lethal methods. The under-reporting of suicide seems to have no effect on temporal changes in mortality rates or on the geographical distribution. These data indicate that Italy is a country at low risk for suicide.

Does the level of education influence completed suicide? A nationwide register study

OBJECTIVE To evaluate whether education attainment was associated with completed suicide, a topic only marginally investigated in the literature. METHODS Data for the years between 2006 and 2008 were extracted from the Italian Mortality Database to include all deaths by suicide and natural causes and to obtain information on their education attainment. RESULTS We found significant differences in education attainment between suicide victims and individuals deceased by natural causes, stratified by sex and broken down by age bands. Of both males and females from 15 to 64 years old, suicide victims were significantly more often to have a higher education attainment compared with the same sex and age counterparts died from natural causes. Persons with higher school attainment, compared with those with a maximum primary school degree, had significantly increased odds ratios of dying from a suicide rather than a natural cause. For persons aged 65-74 years or above, however, the differences were not so much obvious. These observations remained almost the same after adjustment for marital status, region of residence and age. CONCLUSIONS Individual with higher educational achievement may be more prone to suicide risk when facing failures, public shame, and high premorbid functioning.

Relationships of local lithium concentrations in drinking water to regional suicide rates in Italy

Objectives. Higher natural concentrations of lithium in drinking water may be associated with lower local rates of suicide. Methods. Lithium concentrations in drinking water were assayed by mass spectrometry at 145 sites in Italy, and compared with reported local suicide rates for men and women between 1980 and 2011. Results. Lithium concentrations in drinking water averaged 5.28 [CI: 4.08–6.48] μg/L (0.761 [0.588–0.934] μEq/L) and ranged from 0.110 to 60.8 μg/L (1.58 to 8.76 μEq/L). Lithium concentrations and local suicide rates were not significantly inversely related, except in 1980–1989, particularly among women. Conclusions. A proposed association between trace lithium concentrations in drinking water and risk of suicide was only partially supported, and mechanisms for potential clinical effects of trace levels of lithium are unknown.

Inequalities and Impact of Socioeconomic-Cultural Factors in Suicide Rates Across Italy

BACKGROUND Suicide is a major cause of premature death in Italy and occurs at different rates in the various regions. AIMS The aim of the present study was to provide a comprehensive overview of suicide in the Italian population aged 15 years and older for the years 1980-2006. METHODS Mortality data were extracted from the Italian Mortality Database. RESULTS Mortality rates for suicide in Italy reached a peak in 1985 and declined thereafter. The different patterns observed by age and sex indicated that the decrease in the suicide rate in Italy was initially the result of declining rates in those aged 45+ while, from 1997 on, the decrease was attributable principally to a reduction in suicide rates among the younger age groups. It was found that socioeconomic factors underlined major differences in the suicide rate across regions. CONCLUSIONS The present study confirmed that suicide is a multifaceted phenomenon that may be determined by an array of factors. Suicide prevention should, therefore, be targeted to identifiable high-risk sociocultural groups in each country.

Suicide among Italian adolescents: 1970–2002

The purpose of the present study was to analyze sex and regional differences in the suicide rate of adolescents and the methods they used for suicide in Italy during the period 1970–2002. Temporal trends and regional variations in suicide for Italian adolescents were retrieved from the Italian database on mortality for the period 1970–2002, collected by the Italian Census Bureau and processed by the Italian National Institute of Health-Statistics Unit. In the period 1970–2002, 3,069 adolescent suicides were monitored in Italy. Analyses of these suicides identified significant differences by region of residence and sex. Males were 2.1 times more likely than females to kill themselves. Male and female suicides had inverse trends in the years analyzed, so that the sex difference at the present time is the result of a continuous increase in male suicides and a decrease in female suicides since 1970. The dramatic peaks observed over the time period studied cannot be attributed to a single cause, indicating that further studies are needed to better understand the phenomenon.

Epidemiologic Study of Mortality During Summer 2003 in Italian Regional Capitals: Results of a Rapid Survey

Following the unusually hot summer in 2003 and the dramatic news from neighbouring countries such as France, the Italian Minister of Health commissioned an epidemiologic mortality study to investigate whether there had been an excess of deaths in Italy, particularly for the elderly population. Communal offices, which provide vital statistics, were asked to provide data on the number of deaths among residents between June 1 and August 31, for the years 2003 and 2002, for the 21 capital cities of Italy’s regions. A mortality increase of 3,134 deaths was observed, most of which (92 %) occurred among persons aged 75 years and older. The highest increases were observed in northwestern cities (Turin, Milan, Genoa). A clear correlation was observed between mortality and climatic indexes (maximum temperature, Humidex).

Mortality from Human Transmissible Spongiform Encephalopathies: A Record Linkage Study

To evaluate the ability of the Italian Creutzfeldt-Jakob (CJD) register to detect human transmissible spongiform encephalopathy (TSE) cases we compared mortality data from the CJD register with those obtained from death certificates collected by the Italian National Census Bureau (ISTAT) between 1993 and 1999. We used the method of record linkage to compare and integrate data from these two sources. The integrated estimate of TSE deaths was 457: 183 deaths recorded by the CJD register and ISTAT, 210 cases only by the CJD register, and 64 cases only by ISTAT. The average integrated estimated mortality rate was 1.58 deaths per million people per year over the study period and peaked in 1999 at 2.13. This figure is similar to that obtained from data from the CJD register alone in the years 2000–2002. The increase in mortality rates is likely due to an improvement in case ascertainment. The misclassification of cases by ISTAT was above 50% from 1996 onward, suggesting that using only death certificates is not a reliable way to monitor TSE cases in Italy.