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1.  The Course of Asthma in Young Adults: A Population-Based Nine-Year Follow-Up on Asthma Remission and Control 
PLoS ONE  2014;9(1):e86956.
Only few longitudinal studies on the course of asthma among adults have been carried out.
The aim of the present prospective study, carried out between 2000 and 2009 in Italy, is to assess asthma remission and control in adults with asthma, as well as their determinants.
All the subjects with current asthma (21–47 years) identified in 2000 in the Italian Study on Asthma in Young Adults in 6 Italian centres were followed up. Asthma remission was assessed at follow-up in 2008–2009 (n = 214), asthma control at baseline and follow-up. Asthma remission and control were related to potential determinants by a binomial logistic and a multinomial logistic model. Separate models for remission were used for men and women.
The estimate of the proportion of subjects who were in remission was 29.7% (95%CI: 14.4%;44.9%). Men who were not under control at baseline had a very low probability of being in remission at follow-up (OR = 0.06; 95%CI:0.01;0.33) when compared to women (OR = 0.40; 95%CI:0.17;0.94). The estimates of the proportion of subjects who were under control, partial control or who were not under control in our sample were 26.3% (95%CI: 21.2;31.3%), 51.6% (95%CI: 44.6;58.7%) and 22.1% (95%CI: 16.6;27.6%), respectively. Female gender, increasing age, the presence of chronic cough and phlegm and partial or absent asthma control at baseline increased the risk of uncontrolled asthma at follow-up.
Asthma remission was achieved in nearly 1/3 of the subjects with active asthma in the Italian adult population, whereas the proportion of the subjects with controlled asthma among the remaining subjects was still low.
PMCID: PMC3906087  PMID: 24489813
2.  High Rates of Mycobacterium tuberculosis among Socially Marginalized Immigrants in Low-Incidence Area, 1991–2010, Italy 
Emerging Infectious Diseases  2013;19(9):1437-1445.
Migration from low- and middle-income countries to high-income countries increasingly determines the severity of tuberculosis (TB) cases in the adopted country. Socially marginalized groups, about whom little is known, may account for a reservoir of TB among the immigrant populations. We investigated the rates of and risk factors for Mycobacterium tuberculosis transmission, infection, and disease in a cohort of 27,358 socially marginalized immigrants who were systematically screened (1991–2010) in an area of Italy with low TB incidence. Overall TB and latent TB infection prevalence and annual tuberculin skin testing conversion rates (i.e., incidence of new infection) were 2.7%, 34.6%, and 1.7%, respectively. Prevalence of both TB and latent TB infection and incidence of infection increased as a function of the estimated TB incidence in the immigrants’ countries of origin. Annual infection incidence decreased with time elapsed since immigration. These findings have implications for control policy and immigrant screening in countries with a low prevalence of TB.
PMCID: PMC3810899  PMID: 23965807
tuberculosis; immigrants; latent tuberculosis; Mycobacterium tuberculosis; bacteria; Italy; tuberculosis and other mycobacteria; transmission; prevalence
3.  The Coexistence of Asthma and Chronic Obstructive Pulmonary Disease (COPD): Prevalence and Risk Factors in Young, Middle-aged and Elderly People from the General Population 
PLoS ONE  2013;8(5):e62985.
The joint distribution of asthma and chronic obstructive pulmonary disease (COPD) has not been well described. This study aims at determining the prevalence of self-reported physician diagnoses of asthma, COPD and of the asthma-COPD overlap syndrome and to assess whether these conditions share a common set of risk factors.
A screening questionnaire on respiratory symptoms, diagnoses and risk factors was administered by mail or phone to random samples of the general Italian population aged 20–44 (n = 5163) 45–64 (n = 2167) and 65–84 (n = 1030) in the frame of the multicentre Gene Environment Interactions in Respiratory Diseases (GEIRD) study.
A physician diagnosis of asthma or COPD (emphysema/chronic bronchitis/COPD) was reported by 13% and 21% of subjects aged <65 and 65–84 years respectively. Aging was associated with a marked decrease in the prevalence of diagnosed asthma (from 8.2% to 1.6%) and with a marked increase in the prevalence of diagnosed COPD (from 3.3% to 13.3%). The prevalence of the overlap of asthma and COPD was 1.6% (1.3%–2.0%), 2.1% (1.5%–2.8%) and 4.5% (3.2%–5.9%) in the 20–44, 45–64 and 65–84 age groups. Subjects with both asthma and COPD diagnoses were more likely to have respiratory symptoms, physical impairment, and to report hospital admissions compared to asthma or COPD alone (p<0.01). Age, sex, education and smoking showed different and sometimes opposite associations with the three conditions.
Asthma and COPD are common in the general population, and they coexist in a substantial proportion of subjects. The asthma-COPD overlap syndrome represents an important clinical phenotype that deserves more medical attention and further research.
PMCID: PMC3651288  PMID: 23675448
4.  Tuberculosis among Health Care Workers 
Emerging Infectious Diseases  2011;17(3):488-494.
PMCID: PMC3298382  PMID: 21392441
Tuberculosis and other mycobacteria; health care workers; systematic review; research
5.  Risk of tuberculin conversion among healthcare workers and the adoption of preventive measures 
In industrialised countries, occupational tuberculosis among healthcare workers (HCWs) is re‐emerging as an important public health issue. To prevent and control tuberculosis transmission, several institutions have issued and implemented recommendations and practice guidelines.
To estimate the annual rate of tuberculosis infection (ARTI; per 100 person‐years) among HCWs in Turin, the capital of the Piedmont region of Italy, to identify factors associated with variations in the ARTI and to evaluate the efficacy of the regional guidelines to prevent and control tuberculosis.
The study was conducted between 1997 and 2004 on a cohort of HCWs. The tuberculosis infection was diagnosed through tuberculin skin testing (TST) conversion and defined as an induration increase of at least 10 mm from a previous negative TST. The ARTI and the hazard ratio for each at‐risk subgroup, categorised according to working activities and settings, was estimated using exponential survival models. The efficacy of the regional guidelines was estimated by stratifying the analysis according to the moment of the implementation of the guidelines (before/after).
The 2182 study participants were drawn from the dynamic cohort. The overall adjusted ARTI was 1.6 (95% CI: 1.3 to 1.9)/100 person‐years. Different workplaces (eg, administrative and infectious diseases inpatient services) and occupations (eg, clerical and medical workers) were associated with significantly different ARTIs, ranging between 0.62 and 2.62 and between 0.61 and 1.71, respectively, whereas the TST conversion risk differed by about 16–68% and 30–60%, respectively. The implementation of the guidelines coincided with overall ARTI reductions of 1.3/100 person‐years, and concurrently the variations between ARTIs of different occupations and workplaces disappeared.
The occupational risk categories for targeting the surveillance and prevention of tuberculosis transmission among HCWs were identified, and the introduction of preventive measures was observed to be effective in decreasing the overall risk of tuberculosis infection among HCWs.
PMCID: PMC2092534  PMID: 16912085
6.  Respiratory symptoms in children living near busy roads and their relationship to vehicular traffic: results of an Italian multicenter study (SIDRIA 2) 
Environmental Health  2009;8:27.
Epidemiological studies have provided evidence that exposure to vehicular traffic increases the prevalence of respiratory symptoms and may exacerbate pre-existing asthma in children. Self-reported exposure to road traffic has been questioned as a reliable measurement of exposure to air pollutants. The aim of this study was to investigate whether there were specific effects of cars and trucks traffic on current asthma symptoms (i.e. wheezing) and cough or phlegm, and to examine the validity of self-reported traffic exposure.
The survey was conducted in 2002 in 12 centers in Northern, Center and Southern Italy, different in size, climate, latitude and level of urbanization. Standardized questionnaires filled in by parents were used to collect information on health outcomes and exposure to traffic among 33,632 6–7 and 13–14 years old children and adolescents. Three questions on traffic exposure were asked: the traffic in the zone of residence, the frequency of truck and of car traffic in the street of residence. The presence of a possible response bias for the self-reported traffic was evaluated using external validation (comparison with measurements of traffic flow in the city of Turin) and internal validations (matching by census block, in the cities of Turin, Milan and Rome).
Overall traffic density was weakly associated with asthma symptoms but there was a stronger association with cough or phlegm (high traffic density OR = 1.24; 95% CI: 1.04, 1.49). Car and truck traffic were independently associated with cough or phlegm. The results of the external validation did not support the existence of a reporting bias for the observed associations, for all the self-reported traffic indicators examined. The internal validations showed that the observed association between traffic density in the zone of residence and respiratory symptoms did not appear to be explained by an over reporting of traffic by parents of symptomatic subjects.
Children living in zones with intense traffic are at higher risk for respiratory effects. Since population characteristics are specific, the results of validation of studies on self-reported traffic exposure can not be generalized.
PMCID: PMC2708149  PMID: 19534827
7.  Reference values of Forced Expiratory Volumes and pulmonary flows in 3–6 year children: a cross-sectional study 
Respiratory Research  2007;8(1):14.
The aims of this study were to verify the feasibility of respiratory function tests and to assess their validity in the diagnosis of respiratory disorders in young children.
We performed spirometry and collected information on health and parents' lifestyle on a sample of 960 children aged 3–6.
The cooperation rate was 95.3%. Among the valid tests, 3 or more acceptable curves were present in 93% of cases. The variability was 5% within subjects in 90.8% of cases in all the parameters. We propose regression equations for FVC (Forced Vital Capacity), FEV1, FEV0.5, FEV0.75 (Forced Expiratory Volume in one second, in half a second and in 3/4 of a second), and for Maximum Expiratory Flows at different lung volume levels (MEF75, 50, 25). All parameters are consistent with the main reference values reported in literature. The discriminating ability of respiratory parameters versus symptoms always shows a high specificity (>95%) and a low sensitivity (<20%) with the highest OR (10.55; IC95% 4.42–25.19) for MEF75. The ability of FEV0.75 to predict FEV1 was higher than that of FEV0.50: FEV0.75 predicts FEV1 with a determination coefficient of 0.95.
Our study confirms the feasibility of spirometry in young children; however some of the current standards are not well suited to this age group. Moreover, in this restricted age group the various reference values have similar behaviour.
PMCID: PMC1810252  PMID: 17316433

Results 1-7 (7)