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1.  Risk of tuberculin conversion among healthcare workers and the adoption of preventive measures 
Background
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.
Objectives
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.
Methods
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).
Results
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.
Conclusions
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.
doi:10.1136/oem.2006.028068
PMCID: PMC2092534  PMID: 16912085
2.  Incidence of asthma and mortality in a cohort of young adults: a 7-year prospective study 
Respiratory Research  2005;6(1):95.
Background
Few longitudinal data exist on the incidence of asthma in young adults and on the overall mortality risk due to asthma. A 7-year follow-up prospective study was performed to assess the incidence of asthma and mortality from all causes in a cohort of young adults.
Methods
The life status of a cohort of 6031 subjects, aged 20–44 years, who replied to a respiratory screening questionnaire between 1991 and 1992, was ascertained in 1999. A new questionnaire investigating the history of asthma was subsequently sent to the 5236 subjects who were still alive and residents in the areas of the study. 3880 subjects (74%) replied to the second questionnaire.
Results
The incidence of adult-onset asthma was 15.3/10,000/year (95%CI:11.2–20.8). The presence of asthma-like symptoms (IRR:4.17; 95%CI:2.20–7.87) and allergic rhinitis (IRR:3.30; 95%CI:1.71–6.36) at baseline were independent predictors of the onset of asthma, which was more frequent in women (IRR:2.32; 95%CI:1.16–4.67) and increased in the younger generations.
The subjects who reported asthma attacks or nocturnal asthma symptoms at baseline had an excess mortality risk from all causes (SMR = 2.05; 95%CI:1.06–3.58) in the subsequent seven years. The excess mortality was mainly due to causes not related to respiratory diseases.
Conclusion
Asthma occurrence is a relevant public health problem even in young adults. The likelihood of developing adult onset asthma is significantly higher in people suffering from allergic rhinitis, in women and in more recent generations. The presence of asthma attacks and nocturnal symptoms seems to be associated with a potential excess risk of all causes mortality.
doi:10.1186/1465-9921-6-95
PMCID: PMC1201174  PMID: 16105170

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