Adults In Italy Research Articles

Similarities and differences between two cohorts of young adults in Italy

This paper analyses the results of a CATI survey consisting of a representative national sample of 3083 young Italian people of two different generations: those aged 23-27 and 33-37 in the first half of 2004. The analysis is targeted particularly at the older cohort and examines the late transition to adulthood and its effect on fertility. Is the situation in Italy converging towards the European one? We also analyse transition processes to all life course events as interrelating mechanisms in which each process is the premise for the next step but in which they are all probably considered indispensable in choosing to have a child. The results suggest the spread of new family forms among youth but a persistent delay in family formation. (authors)

Prevalence of common mental disorders in Italy

To present 1-month, 12-month and lifetime prevalence estimates of mood, anxiety and alcohol disorders in Italy; and the socio-demographic correlates and comorbidity patterns of these estimated disorders. A representative random sample of non-institutionalised citizens of Italy aged 18 or older (N=4,712) was interviewed between January 2001 and July 2003, with a weighted response rate of 71.3%. DSM-IV disorders were assessed by lay interviewers using Version 3.0 of the Composite International Diagnostic Interview (CIDI). A total of 11% of respondents reported a lifetime history of any mood disorder, 10.3% any anxiety disorder and 1.3% any alcohol disorder. About 5% reported having an anxiety disorder in the past 12 months compared to 3.3% for any mood disorder and 0.2% for any alcohol disorder. Major depression and specific phobia were the most common mental disorders. Women were twice as likely as men to report a mood disorder and four times as likely as men to report an anxiety disorder, while men were twice as likely as women to report an alcohol disorder. High comorbidity of mood and anxiety disorders was observed. Prevalence estimates were generally lower than in parallel surveys carried out in other Western European countries. A high proportion of adults in Italy have a history of mood, anxiety or alcohol disorders. The lower than expected prevalence estimate of alcohol use disorder may be due to under-reporting or to low social harm from alcohol consumption.

Expert Consensus Conference: The screening for hepatitis C virus infection in adults in Italy, May 5–6, 2005

A Consensus Conference was convened by the Italian National Institute of Health on May 5–6, 2005, to address the issue of the screening for hepatitis C virus infection in adults in Italy. It was concluded that a mass screening for hepatitis C virus infection is inappropriate. It was recommended that the following high-risk groups be tested for hepatitis C virus infection, particularly if they are potentially eligible for antiviral treatment: subjects with history of intravenous drug use; haemodialysis patients; subjects who received blood coagulation factors before 1987; subjects who received blood transfusions or organ transplantation before 1992; households of hepatitis C virus-infected individuals; subjects with multiple sexual partners which have or have had a sexually transmitted disease. A screening for hepatitis C virus infection was considered unjustified for persons who are scheduled for an invasive procedure (e.g. surgery, endoscopy) and during pregnancy.

Host Immunogenetics and Control of Human Herpesvirus–8 Infection

Kaposi sarcoma (KS) is primarily caused by human herpesvirus (HHV)-8 infection, and the risk is increased with high HHV-8 lytic or latent antibody titers or the detection of HHV-8 DNA in peripheral blood mononuclear cells (PBMCs). Host genes important for control of HHV-8 infection are not well characterized. In 172 HHV-8 latent nuclear antigen (LANA)-seropositive adults in Italy without KS, we examined correlations of common variants in host immune genes with the detection of HHV-8 DNA in PBMCs and with high lytic and latent antibody titers. Twenty-eight single-nucleotide polymorphisms in 14 genes were analyzed. We detected HHV-8 DNA in PBMCs with real-time amplification of the K6 gene, anti-K8.1 (lytic) titers with enzyme-linked immunosorbent assay, and anti-LANA (latent) titers with immunofluorescence. Detection of HHV-8 DNA in PBMCs was not significantly related to any variant examined. In contrast, a 3-locus haplotype of IL4, which contains the -1098G allele (rs2243248), was overrepresented among subjects with high lytic titers (odds ratio [OR], 2.8 [95% confidence interval {CI}, 1.1-6.7]), compared with those with low titers, as was the functional promoter variant of IL6, C-236C (rs1800795) (OR, 3.7 [95% CI, 1.1-12.8]). Compared with subjects with low HHV-8 latent antibody titers, analysis of inferred haplotypes for IL12A revealed an overrepresentation of -798T/277A in subjects with high HHV-8 latent antibody titers (OR, 2.4 [95% CI, 1.1-5.2]). Our observations are the first to provide preliminary evidence suggesting that common variants in key host immune genes could influence the control of HHV-8 infection.

Comparison of digitalis-related adverse events in hospitalized men and women in Italy: An observational study

Background: A higher mortality rate in women thanin men treated with digitalis has been described. We hypothesized that this result could be due in part to an increased susceptibility of women to adverse events (AEs) from digitalis. Objective: The aim of this study was to compare theincidence of AEs related to digitalis in women and men. Methods: This was an observational study conducted in geriatrics and internal medicine acute-care wards located throughout Italy. We used the data of the Gruppo Italiano di Farmacoepidemiologia nell'Anziano (Italian Group of Pharmacoepidemiology in the Elderly), a collaborative study group on drug use and adverse drug reactions in hospitalized adults that performed 6 different surveys between 1988 and 1998. Adults who were taking digitalis at the time of admission or during the hospital stay were studied, with no other inclusion or exclusion criteria. The proportion of AEs to digitalis diagnosed at the time of admission or during the hospital stay was compared in men and women. Information on AEs was collected using a structured questionnaire at admission and during the hospital stay. A logistic regression model was used to evaluate the association between sex and AE(s) to digitalis, corrected for potential confounding variables. Results: The total sample size was 9626 patients.Women received a higher weight-adjusted dose of digitalis compared with men (0.0027 mg/kg per day vs 0.0025 mg/kg per day; P < 0.001). Overall, 199 AEs to digitalis were diagnosed. Women were more likely than men to suffer from an AE to digitalis (odds ratio, 1.51; 95% CI, 1.12–2.02). This finding was confirmed after correction for dose of digitalis, age, physical and cognitive impairment, atrial fibrillation, chronic obstructive pulmonary disease, glomerular filtration rate, and use of amiodarone, β-blockers, nondihydropyridine calcium channel blockers, and potassium-sparing diuretics (odds ratio, 1.58; 95% CI, 1.01–2.48). Conclusions: In this sample of hospitalized adults in Italy, we found a higher incidence of AEs to digitalis in women than in men.

Correlates of Human Herpesvirus-8 DNA detection among adults in Italy without Kaposi sarcoma

The presence of Human Herpesvirus-8 (HHV8) DNA is predictive of Kaposi sarcoma (KS) among patients with HIV-associated or iatrogenic immunosuppression. However, correlates of HHV8-DNA detection in the general population remain undefined. We assessed correlates of HHV8-DNA detection among Italian adults without KS who had antibodies against HHV8-latent nuclear antigen by immunofluorescence assay. HHV8-K6 DNA sequences were detected in peripheral blood mononuclear cells using TaqMan PCR. Of the 158 subjects 26 (16.5%) had detectable HHV8-DNA [median copies/million cells, 53; (13-2128)]. Adjusted for age, sex, and laboratory, HHV8-DNA was detected more frequently in participants with >7 total residents in the childhood home [OR = 3.7 (1.5-9.1)], >2 younger siblings [OR = 2.6 (1.1-6.5)], and current cardiovascular [OR = 3.6 (1.3-9.7)] or renal [OR = 3.1 (1.2-8.0)] disease. Excluding the participants using immune modulating drugs, HHV8-DNA was more frequent among those with low red blood cells (RBC) [<4.5 10(6)/microl; OR = 5.3 (1.7-16.2)], slightly elevated mean corpuscular volume [>92 microm3/red cell; OR = 2.8 (1.0-7.8)], and mild thrombocytopenia [<151 K/microl; OR = 5.6 (1.9-16.3)]. Presence of HHV8-DNA in elderly Italians is associated with childhood crowding, low RBCs, and platelets, perhaps indicating roles for early infection and chronic inflammation. These risk factors are the first to be reported for non-immunosuppressed HHV8-seropositive adults.

Allergic rhinitis and asthma comorbidity in a survey of young adults in Italy

Several studies have provided evidence of a strong association between asthma and allergic or nonallergic rhinitis, leading to the hypothesis that allergic rhinitis (AR) and asthma represent a continuum of the same disease. (i) to measure the comorbidity of AR and asthma and asthma-like symptoms and (ii) to assess whether asthma, AR, and their coexistence share a common pattern of individual risk factors. The subjects are participants from the Italian multicentre, cross-sectional survey on respiratory symptoms in the young adult general population (Italian Study of Asthma in Young Adults, ISAYA). The relationship between individual risk factors and asthma, AR and their coexistence, was studied by means of a multinomial logistic regression. About 60% of asthmatics reported AR. On the other hand, subjects with AR presented an eightfold risk of having asthma compared to subjects without AR. Age was negatively associated with asthma [OR = 0.89, 95% confidence interval (CI): 0.82-0.96], AR (OR = 0.92, 95% CI: 0.86-0.98), and asthma associated with AR (OR = 0.83, 95% CI: 0.79-0.88). The risk of AR without asthma was significantly higher in the upper social classes (OR = 1.23, 95% CI: 1.08-1.39). Active current smoking exposure was positively associated with asthma alone (OR = 1.24, 95% CI: 1.09-1.41) and negatively associated with AR with (OR = 0.69, 95% CI: 0.54-0.88) or without (OR = 0.76, 95% CI: 0.69-0.84) asthma. Asthma and AR coexist in a substantial percentage of patients; bronchial asthma and AR, when associated, seem to share the same risk factors as AR alone while asthma without AR seems to be a different condition, at least with respect to some relevant risk factors.

Direct cost of medical management of epilepsy among adults in Italy: a prospective cost-of-illness study (EPICOS).

To investigate the costs of epilepsy from a nationwide survey comparing adult patients included in different prognostic categories. A 12-month prospective observational study was conducted in 15 epilepsy centers from Northern, Central, and Southern Italy. The study population included a random sample of individuals aged 18 years and older with newly diagnosed (ND) epilepsy, seizure remission (R), occasional seizures (OS), active non-drug-resistant (NDR) seizures, drug-resistant (DR) seizures, or surgical candidates (SC). Estimates of the direct costs of care of epilepsy were based on the use of diagnostic examinations, laboratory tests, specialist consultations, hospital admissions, day-hospital days, and drugs, taking the Italian National Health Service perspective. The sample included 631 patients (ND 62, R 158, OS 155, NDR 114, DR 128, and SC 14). The SC group had the highest total cost per patient (3,619 euros) followed by DR (2,190 euros), ND (976 euros), NDR (894 euros), OS (830 euros), and R (561 euros). For each epilepsy group, the main components of the total cost were drugs and hospital admissions. Drug costs increased from the R group to the DR group. The new antiepileptic drugs (AEDs) were the largest part of the cost of treatment. The costs of epilepsy in referral patients vary significantly according to the time course of the disease and the response to treatment. Hospital admissions and drugs are the major sources of expenditure.

Prevalence of allergic rhinitis in young adults in Italy

Prevalence of allergic rhinitis in young adults in Italy

Inappropriate medication use among hospitalized older adults in Italy: results from the Italian Group of Pharmacoepidemiology in the Elderly.

To determine the prevalence of inappropriate medication use among hospitalized older adults and to identify predictors of this use. A total of 5734 patients (mean age 79 years) admitted to geriatric and internal medicine wards participating in the study in 1995 and 1997 were included in this analysis. Inappropriate medication use was defined on the basis of the criteria published by Beers in 1997. Only medications used during hospital stay were considered for the present study. During hospital stay, 837 (14.6%) patients received one or more medications classified as inappropriate based on Beers criteria. Ticlopidine ( n=346; 6.0% of the study sample) was the most frequently used medication among those in Beers' list, followed by digoxin ( n=174; 3.0%) and amytriptyline ( n=113; 2.0%). The multivariate analysis showed that age [75-84 years vs 65-74 years, odds ratio (OR) 0.85, 95% confidence interval (CI) 0.71-1.00; >or=85 years vs 65-74 years, OR 0.58, 95% CI 0.46-0.73], cognitive impairment (OR 0.77, 95% CI 0.64-0.94), Charlson co-morbidity index (>or=2 vs 0-1, OR 1.20, 95% CI 1.02-1.40) and overall number of medications used during hospital stay (5-8 medications vs <5 medications, OR 2.20, 95% CI 1.72-2.82; >or=9 medications vs <5 medications, OR 3.68, 95% CI 2.86-4.73) were significantly associated with use of inappropriate medications. Inappropriate medication use was common among hospitalized older adults. The most important determinant of risk of receiving an inappropriate medication was the number of drugs being taken. Older age and cognitive impairment were associated with a reduced likelihood of using an inappropriate medication.

Delayed infection, late tonsillectomy or adenoidectomy and adult leukaemia: a case-control study.

In a population-based case–control study among adults in Italy, of 261 lymphoid and 313 myeloid leukaemias and 1718 controls, a later age at adenoidectomy and tonsillectomy (after age 10 years) increased considerably the risk of lymphocytic (but not myeloid) leukaemia (odds ratio 4.2, 95% confidence interval 1.1–16.2). We propose that late infection is a proliferative stimulus for B-cells.

Asthma control and differences in management practices across seven European countries

Failure to follow asthma management guidelines may result in poor asthma control for many patients. The Asthma Insights and Reality in Europe (AIRE) survey, a multi-national survey assessing the level of asthma control from the patient's perspective in seven Western European countries, previously demonstrated that the Global Initiative for Asthma (GINA) guideline goals were not achieved in Western Europe and that both adults and children with asthma were poorly controlled. Using additional data on asthma management practices from each of the seven countries in the AIRE survey, we compared variations in asthma morbidity and asthma management practices across countries to provide insight into the reasons for poor asthma control. Asthma management practices and asthma control among adults and children with current asthma were suboptimal in each of seven countries surveyed. Among patients with symptoms of severe persistent asthma, over 40% reported their asthma was well or completely controlled. School absence due to asthma was reported by up to 52·7% of children and up to 27·6% of adult reported work absence due to asthma. Lung function testing in the past year was uncommon: ranging from 13·5% of children in the U.K. to 68·8% of adults in Germany. Written asthma management plans were used by less than 50% of adults and less than 61% of children in all seven countries. Most adults (49·5–73·0%) and a large proportion of children (38·4–70·6%) had follow-up visits for their asthma only when problems developed. The ratio of recent inhaled corticosteroid use to recent short-actingβ -agonist use was inappropriate (<1) among patients with symptoms of severe asthma in all countries. This disparity was greatest among adults in Italy and France, where recent inhaled corticosteroid use was reported by less than one in nine patients reporting recent use of short-acting bronchodialators (IS:SAB <0·11). Management practices differ between countries and additional public health interventions and resources may be necessary to reduce patient suffering. Further efforts to fully implement asthma management guidelines are required to improve asthma control in Europe.

Detection of genotypically drug-resistant HIV-1 variants and non-B subtypes in recently infected antiretroviral-naive adults in Italy.

Sezione di Microbiologia, Dipartimento di Biologia Molecolare, Universita di Siena, Siena, Italy; U.O. di Malattie Infettive, Azienda Ospedaliera di Careggi, Firenze, Firenze, Italy; U.O. di Malattie Infettive, Azienda Ospedaliera di Prato, Prato, Italy; U.O. di Malattie Infettive, Azienda Ospedaliera di Grosseto, Grosseto, Italy; and Servizio di Microbiologia e Virologia, Azienda Ospedaliera Senese, Siena, Italy.

Social Integration and Loneliness: A Comparative Study among Older Adults in the Netherlands and Tuscany, Italy

On the average, older adults in Italy are lonelier than those in the Netherlands. The results of a study by Jylha &amp; Jokela (1990) showed that loneliness was more prevalent in regions of Europe where living alone was rarest and where community bonds were strongest. This inverse macro-level association, an increasing proportion of lonely older people and a decreasing proportion of older people who live alone from northern to southern Europe, could not be explained by differences in individual social integration. The aim of the present study was to reinvestigate this association. The data were from surveys conducted in the Netherlands (N = 3750) and northwestern Tuscany, Italy (N = 1543). Fewer older adults lived alone in Tuscany than in the Netherlands, which indicates that the Dutch were less integrated. As regards their participation in social organizations and personal networks, the Tuscan older adults were less integrated. To a large extent, loneliness among the Dutch and Tuscans based on differences in social integration could be similarly explained, and regional loneliness differences could be attributed to individual situations and characteristics:

AIDS as a leading cause of death among young adults in Italy.

The objective of this study is to describe the impact of AIDS on the mortality of young adult (aged 25 to 44 years) in Italy, at both the national and regional level. We analyzed the official mortality data for Italy: the most recent data available being from 1990. General mortality trends show that while mortality among young women is still decreasing (i.e. from a standardized rate of 83.8 per 100,000 in 1980 to 68.4 in 1990), mortality among young men began to rise in the mid-1980s, after a steady decrease over many years. Among the 25-34 year olds, however, this reversal in trend is more marked, notwithstanding a decrease or stabilization in most major causes of death. In fact it coincides with the appearance and spread of AIDS in Italy, which has affected young men in particular. (The peak age group for AIDS deaths is the 25-34 year olds). Mortality data from 1990 reveal that AIDS is the fourth leading cause of death in Italy among men between the ages of 25 and 44 years. Among 25-34 year-old men, however, AIDS is the second leading cause of death, after road accidents. AIDS also contributes greatly to the general mortality in individual regions, both among 25-44 year-old men (Lombardy, Liguria, Lazio, Emilia-Romagna, Tuscany), and especially among 25-34 year-old men (Lombardy, Liguria, Lazio, Sardinia, where it is the number one cause of death, Emilia-Romagna, Tuscany, and Veneto, where it is the number two cause of death).

Changing epidemiology of hepatitis B in Italy: public health implications.

In Italy, a dramatic decline of hepatitis B infection occurred in recent years as a result of nonmedical and medical factors. The national type-specific surveillance system shows that the age of maximum incidence changed from early childhood, when the risk of becoming a chronic carrier after infection is very high, to late adolescence. Data of several seroepidemiologic studies are consistent with this picture, but could not be compared with previous data on similar age groups. In 1981, a seroepidemiologic study on a national sample of 5,005 recruits showed a high prevalence of serologic markers of hepatitis B infection among young adults in Italy. In 1990, the authors replicated that original study on a national sample of 4,993 recruits. The adjusted prevalence of hepatitis B core antibodies among Italian male recruits dropped from 16.8% to 5.8% in 9 years. The authors anticipate a substantial reduction in the rate of production of chronic carriers and the rates of liver cirrhosis and primary liver carcinoma in Italy in the next decades. Vaccination campaigns, especially if combined with nonimmunologic preventive measures, will further reduce the rate of hepatitis B infection in Italy.

AIDS cases in adolescents and young adults in Italy: Inferences from descriptive epidemiology

To assess the magnitude of the AIDS epidemic in the Italian adolescent (13-19 years) and young adult (20-24 years) age groups, data on AIDS cases notified to the AIDS Operational Centre as of 31 March 1990 were used. Of the 6068 reported AIDS cases, 0.7% occurred among adolescents and 15.7% among young adults. Among adolescents most cases were haemophiliacs (45.4%), while among young adults, drug use was the most frequently reported mode of transmission (87.5%). Females were more likely than males to contract the disease through the heterosexual contact in both the adolescent (20.0% vs 0%) and in young adult (15.1% vs 0.7%) age groups. Among young adults a geographical trend was present with a decrease in case rates from north to south, while for adolescents the rates were higher in northern and southern than in central Italy. If the incidence of AIDS is to be reduced in Italy, further efforts should be made to target the adolescent age group, since many of the young adult cases are likely to have resulted from HIV infection during adolescence.