General Population In Italy Research Articles

Wastewater analysis to monitor spatial and temporal patterns of use of two synthetic recreational drugs, ketamine and mephedrone, in Italy.

Wastewater analysis was applied in a four-year monitoring study to assess temporal and spatial patterns of ketamine and mephedrone use in the general population in Italy. Composite raw wastewater samples were collected from sewage treatment plants (STPs) in 17 cities. Target analytes were measured using a validated method based on solid phase extraction and liquid chromatography coupled to tandem mass spectrometry analysis. Mass loads were use to assess ketamine and mephedrone use and were normalized to the population served by the plants. Ketamine was detected in wastewater in all except one (Palermo) of the cities investigated, while mephedrone was detected only in Bologna and Florence. Ketamine mass loads progressively increased from 2010 to 2013, and in Milan rose from 1 to 1.5 g/day in 2008-2010 to 3.4-3.6 g/day in 2013-2014. Mass loads were higher in north and central Italy than in the south, and in larger rather than small cities. Wastewater analysis was suitable to provide objective and up-to-date information on the use of ketamine in Italy, to identify ketamine spatial and temporal changes, and to confirm the low use of mephedrone. These results can complement information from population surveys which often provide only scant and incomplete figures for these substances.

The impact of asthma, chronic bronchitis and allergic rhinitis on all-cause hospitalizations and limitations in daily activities: a population-based observational study.

BackgroundChronic respiratory diseases are a significant cause of morbidity and mortality worldwide. We sought to evaluate the impact of asthma, chronic bronchitis and allergic rhinitis on all-cause hospitalizations and limitations in daily activities in adults.MethodsIn the Gene Environment Interactions in Respiratory Diseases study (2007/2010), a screening questionnaire was mailed to 9,739 subjects aged 20–44 (response rate: 53.0%) and to 3,480 subjects aged 45–64 (response rate: 62.3%), who were randomly selected from the general population in Italy. The questionnaire was used to: identify the responders who had asthma, chronic bronchitis, allergic rhinitis or asthma-like symptoms/dyspnoea/other nasal problems; evaluate the total burden [use of hospital services (at least one ED visit and/or one hospital admission) and number of days with reduced activities (lost working days and days with limited, not work related activities) due to any health problems (apart from accidents and injuries) in the past three months]; evaluate the contribution of breathing problems to the total burden (hospitalizations and number of days with reduced activities specifically due to breathing problems).ResultsAt any age, the all-cause hospitalization risk was about 6% among the subjects without any respiratory conditions, it increased to about 9-12% among the individuals with allergic rhinitis or with asthma-like symptoms/dyspnoea/other nasal problems, and it peaked at about 15-18% among the asthmatics with chronic bronchitis aged 20–44 and 45–64, respectively. The expected number of days with reduced activities due to any health problems increased from 1.5 among the subjects with no respiratory conditions in both the age classes, to 6.3 and 4.6 among the asthmatics with chronic bronchitis aged 20–44 and 45–64, respectively. The contribution of breathing problems to the total burden was the highest among the asthmatics with chronic bronchitis (23-29% of the hospitalization risk and 39-50% of the days with reduced activities, according to age).ConclusionsThe impact of asthma, chronic bronchitis and allergic rhinitis on all-cause hospitalizations and limitations in daily activities is substantial, and it is markedly different among adults from the general population in Italy. The contribution of breathing problems to the total burden also varies according to the respiratory condition.

Cardiovascular diseases and women: knowledge, attitudes, and behavior in the general population in Italy.

Background. The objectives of the study were to document knowledge, attitudes, and behaviors of women regarding cardiovascular diseases (CVDs) and the determinants associated. Materials and Methods. The cross-sectional survey was conducted among a random sample of 830 women older than 18 years from the general population in Italy. Results. Almost all participants reported having heard about CVDs, and among them 89.4% and 74.7% identified smoking and high cholesterol level as risk factors. Only 26.5% identified the main CVDs risk factors. Women more knowledgeable were married and better educated and self-perceived a worse health status. Only 23% knew the main CVDs preventive measures and this knowledge was significantly higher in women who are unemployed, who are more educated, who have received information about CVDs from physicians, and who know the main risk factors. Respondents with lower education, those with at least three children, those who self-perceived a worse health status, and those who need information were most likely to have a positive attitude toward the perceived risk of developing CVDs. Women with two or three children or more were at high risk profiles 49% and 56% lower than women with one child. Conclusions. Educational programs are needed among women as support to improve knowledge and appropriate behavior about CVDs.

Public Knowledge, Attitudes, and Experience Regarding the Use of Antibiotics in Italy

BackgroundThe objectives of the study were to investigate the level of knowledge, attitudes, and behaviors regarding antibiotics of the general population in Italy, and to assess the correlates of these outcomes of interest.MethodsA cross-sectional survey was conducted on a random sample of 630 parents of students attending nine randomly selected public primary and secondary schools. A self-administered questionnaire included questions on demographic characteristics, knowledge about antibiotic use and resistance, attitudes and behaviors towards antibiotic use, and sources of information.ResultsA total of 419 parents participated. Only 9.8% knew the definition of antibiotic resistance and 21.2% knew when it was appropriate to use antibiotics. Respondents with higher education, employed, with a family member working in the health care sector, and with no need for additional information on antibiotics were more likely to know the definition of antibiotic resistance. One third (32.7%) self-classified them as users of self-medication with antibiotics and those with a lower self-rated health status, who did not use the physician as source of information on antibiotics, and who have attended a physician in the last year were more likely to use self-medication. One-fourth (22.7%) of those who had never been self-medicated would be willing to take an antibiotic without a prescription of a physician. Respondents were more likely to be willing to take antibiotics without a prescription if they were under 40 years of age, if they had a lower self-rated health status, if they did not know that antibiotics are not indicated for treating flu and sore throat, and if they knew that antibiotics are not indicated for treating colds.ConclusionsThe survey has generated information about knowledge, attitudes, and behaviors regarding antibiotics in the general population and effective public education initiative should provide practical and appropriate means to change their behavior.

Relation between pulmonary function and 10-year risk for cardiovascular disease among healthy men and women in Italy: the Moli-sani Project

Pulmonary dysfunction could influence the onset and the evolution of cardiovascular disorders. This study evaluated whether pulmonary dysfunction based on spirometry, plethysmography and carbon monoxide diffusion test is associated with the estimated risk of cardiovascular disease in 10 years. We performed a cross-sectional general population-based cohort study. The Moli-sani Project is a population-based cohort study of subjects aged ≥35 years, randomly recruited from the general population in Italy. Cardiovascular risk in 10 years was predicted by the CUORE score which provides an estimate of the probability of a first coronary or cerebrovascular event in the next 10 years, based on a risk equation derived from Italian cohorts. Out of 12,933 subjects with high-quality flow/volume manoeuvre, 8,132 subjects had suitable plethysmography and 3,422 carbon monoxide diffusion (carbon monoxide alveolar diffusion test [DLCO]). In multivariate analyses, reduced pulmonary function expressed by forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and total lung capacity (TLC) were inversely associated with CUORE score both in men and in women, independently of other risk factors such as age, height, smoking habits, total cigarettes exposure (pack-years), pulmonary disease, body mass index, social status and physical activity. In contrast, there was no association between FEV1/FVC ratio, residual volume, DLCO and CUORE risk score. In both genders from an adult general Italian population, pulmonary function decline is associated with increased cardiovascular risk. These results suggest that pulmonary monitoring could be useful to more accurately predict cardiovascular risk.

Knowledge, attitude, and behaviour of public health doctors towards pandemic influenza compared to the general population in Italy

To study differences between public health physicians' and general population's knowledge, attitude, and behaviours towards an influenza pandemic. During winter 2009, an anonymous questionnaire online (www.ijph.it) of 34 questions was available for participants, structured into three parts: socio-demographic information, people's knowledge, and behaviours about influenza H1N1. 836 persons were interviewed (335 physicians and 501 not physicians). Of these, 50.8% of physicians and 78.1% of not physicians were aged less than 50 years and 57.6% of physicians and 31.7% of not physicians were male. Physicians were more interested to be updated about the pandemic (90.6% versus 88.4% of not physicians; p = 0.003); not physicians were more inclined to avoid crowded places (29.7% versus 17.6% of physicians; p < 0.001); and physicians were more prone to get vaccinated (56.4% versus 23.6% of not physicians; p < 0.001). Broadly, physicians had a better ability to deal the pandemic, both for knowledge and behaviours. Particularly, a significant difference (p < 0.001) was found concerning the principle source of information on the pandemic, for physicians being the internet (41.5%), followed by the health facilities' internal communication (33.1%), while for not physicians being watching the national television news (34.1%) and surfing the internet (30.9%). During the spread of the pandemic flu, a lot of information was propagated chaotically. The information given were not always truthful and often they were interpreted incorrectly or sometimes only partially understood by the population, and this needs to be taken into account for future successful communication in cases of emergency.

Hepatitis C virus infection prevalence and liver dysfunction in a cohort of B-cell non-Hodgkin's lymphoma patients treated with immunochemotherapy

Several studies have reported a higher prevalence of hepatitis C virus (HCV) infection in patients with B-cell non-Hodgkin's lymphoma (NHL) than in the general population. Treatment for NHL includes the use of chemotherapeutic agents such as cytotoxic drugs, corticosteroids, and rituximab, which can be immunosuppressive and hepatotoxic. While reactivation of hepatitis B virus (HBV) when undergoing immunosuppressive therapy for haematological malignancies is a well-documented complication, data on HCV reactivation or liver function impairment after chemotherapy for NHL are controversial. From January 2006 to December 2009, 207 consecutive NHL patients treated with chemotherapy without rituximab (CHOP) or with rituximab (R-CHOP) were observed; screening for HCV infection and baseline liver function tests were performed in all patients. The prevalence of HCV infection was 9.2%. This prevalence is higher than that observed in the general population in Italy (3%). Among the HCV-infected subjects, the incidence of hepatitis flares was 26.3% vs 2.1% among the HCV-uninfected individuals. Although less frequent and less severe than in HBV-infected subjects, liver dysfunction can occur as a consequence of rituximab-containing regimens in HCV-infected patients with NHL. In the cases considered in this study, no patient treated with chemotherapy without rituximab developed hepatitis flares. The frequency and the severity of this complication vary in different reports. Therefore, we recommend the assessment of liver function and the screening of all patients with NHL for HCV infection before starting chemotherapy; we also recommend monitoring of liver function tests and HCV-RNA serum levels during treatment.

Prevalence of ‘Borderline’ Values of Cardiovascular Risk Factors in the Clinical Practice of General Medicine in Italy

The prevalence of patients with 'borderline' levels of cardiovascular risk factors has been rarely investigated, being often reported in studies evaluating abnormal values of these parameters. The BORDERLINE study represents a pilot experience to primarily identify the prevalence of 'high-normal' conditions, such as pre-hypertension, lipid and glucose levels in the upper range of normality in the setting of general practice in Italy. The aim of this study was to evaluate the prevalence of patients with 'borderline' values of cardiovascular risk factors in Italy. Involved physicians were asked to evaluate the first 20 outpatients, consecutively seen in June 2009. Data were collected in a study-designed case-report form, in which physicians identified thresholds rather than reported absolute values of several clinical parameters. High-normal values were defined as follows: blood pressure (BP) 130-140/85-90 mmHg; total cholesterol 180-200 mg/dL; low-density lipoprotein cholesterol (LDL-C) 130-150 mg/dL; high-density lipoprotein cholesterol (HDL-C) 30-40 mg/dL in males and 40-50 mg/dL in females; triglycerides 130-150 mg/dL and fasting glucose 100-110 mg/dL. Fifty-three Italian physicians provided valuable clinical data on 826 individual outpatients, among which 692 (83.7%, 377 women, mean age 60.9 ± 13.2 years, body mass index 26.6 ± 5.0 kg/m2) were included in the present analysis. Prevalence of borderline values of systolic BP and total cholesterol levels were at least comparable with those in the normal limits of the corresponding parameters, whereas prevalence of borderline diastolic BP, LDL-C, HDL-C, triglycerides and fasting glucose levels was significantly lower than that of normal values, but higher than that of abnormal values of the corresponding parameters. Using this sample of healthy subjects in the setting of general practice in Italy, our results demonstrated a relatively high prevalence of borderline values of cardiovascular risk factors, which was at least comparable with that of normal, but significantly higher than that of abnormal thresholds. These preliminary findings may prompt more extensive investigations in the area of 'borderline' cardiovascular risk. This information may, in fact, potentially enable the design of more effective prevention strategies in the future to limit the burden of cardiovascular disease in the general population in Italy. Received for publication 4 March 2011; accepted for publication 20 April 2011.

Mortality of HIV-Infected Patients with or without Cancer: Comparison with the General Population in Italy

HAART has reduced mortality in HIV-infected patients; however, the risk of non-AIDS-related events has increased, including cancer. We compared mortality in HIV-infected patients with or without cancer with the general population in Italy. Eligible patients were recorded in the San Raffaele Infectious Diseases Department database. The ratio of observed deaths to expected all-cause deaths (standardized mortality ratio [SMR]) was standardized for age and gender, and stratified by cancer occurrence or year of HIV infection (≤1998 or >1998). Expected all-cause deaths were obtained from the Istituto Superiore di Sanità (Rome, Italy; 2002 data). Among 6,495 HIV-infected patients, contributing 75,171 person-years, the SMR was 6.0 (95% CI 5.7, 6.4); SMRs decreased as age increased. Mortality rates were significantly higher than the general population for patients with or without cancer (SMR=15.1 [95% CI 13.6, 16.7] and 4.8 [95% CI 4.5, 5.1], respectively). For patients with or without cancer, SMRs were higher in those aged <45 years than older patients. SMRs for patients with cancer were almost stable in those infected with HIV ≤1998 (15.3; 95% CI 13.7, 17.0) or >1998 (13.5; 95% CI 9.2, 19.1). Among patients with cancer diagnosed with HIV >1998, age-adjusted SMRs ranged from 216.0 (95% CI 43.4, 631.3) to 6.8 (95% CI 4.7, 9.7) in patients <30 years or ≥70 years, respectively. Mortality in HIV-infected patients remains higher than the general population in Italy, with marked differences according to age, and cancer contributing to an increased excess of mortality.

Elevated risks of death for diabetes mellitus and cardiovascular diseases in Italian AIDS cases

After the introduction of highly active antiretroviral therapies (HAART), an increased incidence of insulin resistance, diabetes mellitus (DM), and cardiovascular diseases has been described. The impact of such conditions on mortality in the post-HAART era has been also assessed in various modes in the literature. In this paper, we report on the death risks for DM, myocardial infarction, and chronic ischemic heart diseases that were investigated among 9662 Italian AIDS cases diagnosed between 1999 and 2005. Death certificates reporting DM, myocardial infarction, and chronic ischemic heart diseases were reviewed to identify the underlying cause of death, and to compare the observed numbers of deaths with the expected ones from the sex- and age-matched, general population of Italy. Person-years at risk of death were computed from date of AIDS diagnosis up to date of death or to December 31, 2006. Standardized mortality ratios (SMR) and their 95% confidence intervals (CI) were computed. DM and cardiovascular diseases were the cause of death for 43 out of 3101 deceased AIDS cases (i.e., 1.4% of all deaths). In comparison with the general population, the risks of death were 6.4-fold higher for DM (95% CI:3.5-10.8), 2.3-fold higher for myocardial infarction (95% CI:1.4-3.7) and 3.0 for chronic ischemic heart diseases (95% CI: 1.5-5.2).

Clinical features of chronic C virus hepatitis in patients with celiac disease

The association between celiac disease (CD) and several liver disorders has long been documented. About 40% of adult celiac patients have been reported to have mild to moderate hypertransaminasemia (up to five times the upper limit of normal) at the time of diagnosis of CD [1, 2]. In addition, CD has been found in roughly 10% of patients with unexplained hypertransaminasemia, and the majority of them have had their liver enzyme levels normalized after one year of following a strict gluten-free diet [3, 4]. In addition, an increased prevalence of primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis among CD patients has been reported [5, 6]. CD might also be linked to very severe liver conditions such as end-stage liver failure and hepatocellular carcinoma [7]. There is also evidence, even contrasting reports, about the association of CD with nonalcoholic steatohepatitis and fatty liver disease [8]. In contrast, no definitive evidence is available about the association between chronic hepatitis C (hepatitis C virus [HCV]) and CD. Fine et al. described a three-fold increase of CD prevalence among HCV patients compared to noninfected celiac individuals [9]. It has also been reported the activation of silent CD during the antiviral treatment for HCV with interferon-α and ribavirin, both alone and in combination [10]. Consequently, a routine serological screening for CD has been proposed in HCV patients before starting antiviral therapy. In case of HCV positivity, the achievement of the histological normalization of the intestinal mucosa after following a gluten-free diet has been advised before starting the therapy [10]. On the contrary, some recent prospective studies have not shown increased prevalence of CD among HCV patients and reported that the link between these two conditions is biased by the route of transmission [11, 12]. Among the 3,725 celiac patients included in the Italian Registry of the Complication of Celiac Disease, we identified 34 individuals (0.91%) that had an HCV chronic hepatitis at the time of diagnosis of CD. For the diagnosis of HCV, we considered the serological positivity of antiHCV antibodies. Some of the patients had the diagnosis made in the early 1980s, when the molecular tests for the detection of the viral antigens were not yet available. The demographic and clinical features of the patients with both CD and HCV with respect to those of patients with CD only are listed in Table 1. The prevalence of HCV among our celiac series is lower than the overall prevalence of HCV among the general population in Italy, matched for age and gender, which is estimated to be around 2% [13]. This finding does not support the hypothesis of a potential correlation between these two disorders. It has been assumed that antiviral therapy with INF-α and ribavirin may precipitate the onset of CD in susceptible individuals, promoting a Th1-specific response in the small intestine [14]. However, in our series, only 12 of the 34 celiac patients with HCV had antiviral therapy before CD diagnosis. Looking at our series, it seems more likely that an overall increased risk of CD in HCV patients exists, due to the predisposition for autoimmune diseases related to Eur J Clin Microbiol Infect Dis (2009) 28:1267–1269 DOI 10.1007/s10096-009-0769-6

Serum levels of PCDDs, PCDFs and PCBs in non-occupationally exposed population groups living near two incineration plants in Tuscany, Italy

A pilot study was carried out in Tuscany, Italy, to provide preliminary information on the concentrations of polychlorinated dibenzodioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), dioxin-like polychlorobiphenyls (DL-PCBs), and selected non-dioxin-like PCBs (NDL-PCBs) in groups of subjects living in the vicinity of two incineration plants. Seventy-four volunteers were enrolled from areas identified as under a potential impact from incinerator emissions and from not exposed areas. No significant differences were observed between subjects living in the two types of areas. Total concentrations of PCDDs, PCDFs, and DL-PCBs resulted to be in the range 23–30 pg WHO–TEQ g −1, lipid base, for subjects in the 27–54 year age groups, while concentrations increased to 40–44 pgTEQ g −1 for the two 55–67 year age groups. The levels of PCDDs and PCDFs were in good agreement with those observed for unexposed population groups in Italy, while the contribution to total TEQ from DL-PCBs was appreciably higher than those currently observed in the general population in Italy and other countries. As to NDL-PCBs, serum levels of the six “indicator” congeners were in the range 240–300 ng g −1, lipid base, for subjects in the 27–54 year age groups. A raise in NDL-PCB body burden (430–470 ng g −1, lipid base) was observed for the two 55+ year age groups, in agreement with the expected age-dependent increase. The findings from this study do not show an incremental exposure to PCDDs and PCDFs in the samples from subjects living around the two incineration plants, whereas PCB congener profiles in all samples suggest a possible impact on the area of interest of industrial activities from near industrial settlements.

Prevalence of suicide ideation, plans, and attempts and related risk factors in Italy:: Results from the European Study on the Epidemiology of Mental Disorders-World Mental Health study

Background As in other Mediterranean countries, suicide mortality rates in Italy are generally lower than they are in Northern and Central European countries and on other continents (eg, North America, Australia). Yet, no studies to date have examined the prevalence of and risk factors for suicide ideation, plans, and attempts, in the general population in Italy. Methods Suicide ideation, plans, and attempts and potential risk factors were assessed in a community survey conducted with 4712 adult respondents (response rate, 71.2%). The participants had been selected from Italian municipality resident registries and made up a stratified, multistage, clustered probability sample. The project was part of the World Health Organization World Mental Health (WMH) Survey Initiative. Results The lifetime prevalence (SE) of suicide ideation, plans, and attempts was 3.0% (0.3), 0.7% (0.1), and 0.5% (0.1), respectively. Prevalence rates of these suicide-related phenomena did not differ by Italian geographic macro-area (Northern, Central, and Southern Italy, including the islands of Sicily and Sardinia). Among ideators, the probability of ever making a plan was 24.6% (4.0) and attempt was 18.2% (4.5). The probability of making an attempt for ideators having made a suicide plan was nearly 50%. Risk factors for lifetime suicide-related phenomena were female sex, younger cohort, fewer years of education, and earlier onset age of suicide ideation. The presence of a common mental disorder, especially if comorbid, was associated with a significantly increased risk for all suicide phenomena investigated (ideation, plans, and attempts suicide). There were no substantial differences in the frequency of these phenomena among the 3 main macro-areas examined, that is, Northern, Central, and Southern Italy (including Sicily and Sardinia), which conversely show marked climate, socioeconomic, and cultural differences. Conclusion As shown in previous studies examining suicide, suicide continuum phenomena (in terms of ideation, plans, and attempt) in Italy were lower than typically observed for other European countries and did not differ for different macro-areas presenting remarkably different socioeconomic conditions. Prevalence rates of common mental disorders were equally lower in Italy than in other European countries. Although the detection of mental disorders represents an important step in suicide prevention, the correlations observed between various suicidal continuum manifestations suggest that timely recognition of suicide ideation and plans is an equally crucial factor in the implementation of effective preventive policies.

Knowledge and perceptions of the health effects of environmental hazards in the general population in Italy

The purpose of the present study is to assess knowledge of and attitudes toward environmental risks as possible determinants of diseases in the general population in Italy. Parents of 900 children and adolescents received an anonymous self-administered questionnaire. Correct knowledge ranged from 98.4% of those who are aware that tobacco smoking is a risk factor for respiratory disease to 4.0% of those who know that there is no evidence of an increase of risk of childhood leukaemia in those living near mobile phones base stations. Those who are knowledgeable on the effect of an environmental risk factor are significantly more likely to know also about other risk factors. The findings of this survey provide valuable information to researchers and policy makers about public awareness of environmental risks that are to take into account in the implementation of risk communication and protective actions.

Tobacco dependence in the general population in Italy

Measures of tobacco dependence are mainly used in the clinical setting, but limited information is available on tobacco dependence on a population level. To obtain estimates of tobacco dependence on a population level, a six-item Fagerstrom questionnaire was used in two surveys, conducted in 2002-2003 on a sample of 6773 individuals aged 15 years or over, representative of the Italian adult population. Overall, 27.1% of Italian adults described themselves as current cigarette smokers (32.2% of men, 22.4% of women). Of all smokers, 42.8% were classified as very low dependent, 28.6% as low dependent, 11.0% as intermediate, 13.8% as high and only 3.8% as very high dependent. The proportions of very low/low dependent were 67.4% in men and 76.8% in women. Those of high/very high dependent smokers were 21.4% in men and 12.5% in women, but only 2.8% at age 15-17 years and 8.4% at age 18-24 years. Only 23% of smokers, moreover, found it difficult to avoid smoking in places where smoking was forbidden. The observation that over two-thirds of smokers on a population level in Italy report low or very low dependence has useful implication for intervention on stopping smoking, particularly in the young, who appear to be low dependent. However, in this age group cessation rates were comparatively low.

EMPIRICAL DATA AND MATHEMATICAL STRUCTURES IN THE EPIDEMIC MODELING OF PARENTERAL HEPATITIS IN ITALY

Viral liver infections with parenteral transmission in Western countries are mostly caused by hepatitis B and hepatitis C viruses (HBV and HCV). This paper presents a mathematical model that describes the history of the spread of HBV and HCV infections in the general population in Italy. The analysis of the model and the results also provide some new insight into the mechanisms of the epidemics. The model structure is based on an underlying analysis of the various effects of the infection progression in the host, in order to incorporate into its parameters most of the information available from the literature. Moreover, incidence and prevalence curves of both HBV and HCV infections and of HBV/HCV co-infections are generated and qualitative aspects of the epidemic, such as possible endemic steady states and the basic reproduction number, are also analyzed.

High prevalence of celiac disease in autoimmune hepatitis detected by anti-tissue tranglutaminase autoantibodies.

Celiac disease (CD) may be found in association with other autoimmune diseases. We investigated the relation between autoimmune hepatitis (AIH) and CD by assessing the prevalence of IgA and IgG anti-tissue transglutaminase (tTG) antibodies in AIH, and by verifying whether the findings were associated with clinical and histological features of CD. Forty-seven consecutive patients with AIH (type I: n = 39; type II: n = 8) were studied. One hundred patients with chronic hepatitis C, and 120 healthy blood donors were also studied as controls. We analyzed sera for the presence of IgA and IgG anti-tTG antibodies using a specific human recombinant tTG immunoenzymatic assay. Anti-tTG positive patients and controls were further tested for anti-endomysium antibodies (EMA) and HLA typing, and those found positive by either of these tests underwent duodenal biopsy to confirm a possible diagnosis of CD. Three of the 47 AIH patients (6.4%) were positive for IgA anti-tTG and EMA antibodies, and were subsequently confirmed to be affected with CD by small-bowel biopsy findings. No IgG anti-tTG positivity was found in the AIH patients. None of the controls were positive for IgA anti-tTG, and only one with chronic hepatitis C had a low positive reaction for IgG anti-tTG, which resulted as a false positive. The crude prevalence rate of CD in AIH was 63.8 per 1,000 (95% CI, 13.2-186.1), and it was significantly higher than that found in the general population in Italy (4.9 per 1,000; 95% CI, 2.8-7.8). The results of this study showed a high prevalence of CD in patients with AIH. For this reason, early serological screening testing for CD is strongly recommended for all AIH patients.

Current drug use as risk factor for erectile dysfunction: results from an Italian epidemiological study.

Several drugs have been associated with an increased risk of erectile dysfunction (ED). We analysed the role of pharmacological treatments on the risk of ED using data from a cross-sectional study on prevalence and risk factors for ED in the general population in Italy. A total of 2450 men aged more than 18 years were randomly identified by 143 general practioners (GP) among their registered patients and invited to a confidential interview by their GP. Patients were asked 'about their ability to achieve and maintain an erection sufficient for satisfactory sexual performance'. If they were dissatisfied, they were defined as having ED. Out of the 2450 men identified, 440 (18%) refused to participate. The present analysis therefore includes information on 2010 men. After adjustment for related pathologies, anxiolytics and antidepressants showed insignificantly higher odds ratio (ORs, respectively, 1.7 and 2.1); antipsychotic drug use significantly increased the risk of ED (OR 9.0, 95% confidence interval, CI 1.8-44.4). Diuretics (OR 3.1, 95% CI 1.4-6.9) and anticholinergic drugs (OR 12.8, 95% CI 2.7-60.1) were associated with ED risk. No association emerged between ED and H2 antagonists, anticholesterolemic or hypoglycemic drugs. In conclusion, after taking account of related pathologies, our results suggest that men treated with antipsychotic, diuretic and anticholinergic drugs are at greater risk of ED.

Cigarette smoking as risk factor for erectile dysfunction: results from an Italian epidemiological study.

We analysed the role of smoking on the risk of erectile dysfunction (ED) using data from a cross-sectional study on prevalence and risk factors for ED in the general population in Italy. A total of 2010 men aged more than 18 years were randomly identified and interviewed by 143 general practitioners among their registered patients. Patients were asked "about their ability to achieve and maintain an erection sufficient for satisfactory sexual performance." If they were dissatisfied, they were defined as having ED. In comparison with never smokers, current smokers had an odds ratio (OR) of ED of 1.7 (95% confidence interval (CI), 1.2-2.4) and ex-smokers of 1.6 (95% CI, 1.1-2.3). The association between smoking and ED risk was present in subjects without a history of any cardiovascular disease, cardiopathy, hypertension, diabetes and neuropathy, but not in those with a history of these conditions. For example, the ORs of ED in smokers, in comparison with never smokers, were respectively 2.4, 2.0 and 1.7 in men with no history of any cardiovascular disease, diabetes and neuropathy, but respectively 1.0, 1.0 and 1.2 in those with a history of the conditions. This study shows that the risk of ED is influenced by smoking and that the duration of the habit increases the risk. Further, it highlights the potential interaction of smoking with medical history on ED risk.

Prevalence and consequences of insomnia disorders in the general population of Italy

Objectives: To assess the prevalence of insomnia disorders using DSM-IV classification, and the consequences of insomnia in the Italian general population. Methods: A representative sample of the Italian general population composed of 3970 individuals aged 15 years or older were interviewed by telephone using the Sleep-EVAL system (participation rate: 89.4%). Participants were interviewed about their sleep habits and sleep disorders. DSM-IV classification was used by Sleep-EVAL to determine the sleep disorder diagnosis. Results: Insomnia symptoms were reported by 27.6% of the sample. Sleep dissatisfaction was found in 10.1% and insomnia disorder diagnoses in 7% of the sample. The use of sleep-enhancing medication was reported by 5.7% of the sample. Most of these subjects were using anxiolytics. Dissatisfaction with sleep was associated with daytime sleepiness. Middle-aged drivers dissatisfied with their sleep were three times more likely to have had a road accident in the previous year compared to other drivers. However, fewer than 30% of subjects dissatisfied with their sleep or with an insomnia disorder diagnosis had consulted a physician about their sleep problem. Conclusions: As in other European and non-European countries, insomnia is widespread in Italy. The consequences are important. Appropriate recognition and treatment of insomnia should be part of an educational program for general practitioners everywhere.