Biomedical subjects

S Giampaoli

Publications and source records attributed to S Giampaoli.

At least 19 recordsLinked to original sources

PubMed2007

Decline in cognitive functioning is associated with a higher mortality risk.

OBJECTIVE: This study investigates the association between 5-year change in cognitive functioning and subsequent mortality. METHODS: Four hundred and ninety-three Dutch and Italian men from the Finland, Italy, and the Netherlands Elderly (FINE) Study, born between 1900 and 1920, participated in the present study between 1990 and 2000. Cognitive functioning was measured with the Mini-Mental State Examination in 1990 and 1995, and mortality data were obtained until the year 2000. A proportional hazard analysis was used to investigate the association between 5-year change in cognitive functioning and subsequent 5-year mortality. Adjustments were made for age, education, country, lifestyle factors, prevalence of chronic diseases and, additionally, for baseline cognitive functioning. RESULTS: Men whose cognition decreased (more than 1 standard deviation) between 1990 and 1995 had a 2-fold higher risk of dying in the following 5 years compared with men whose cognition was stable (adjusted hazard ratio=1.9; 95% confidence interval 1.3-2.7). Mortality risk of men whose cognition improved between 1995 and 2000 was not different from men whose cognition was stable (adjusted hazard ratio=1.1, 95% confidence interval 0.7-1.9). CONCLUSION: A decline in cognitive functioning is associated with a higher mortality risk.

Aged↗

PubMed2007

Survivin and Cyclooxygenase-2 are co-expressed in human and mouse colon carcinoma and in terminally differentiated colonocytes.

In the evolution of colon rectal cancer (CRC) the imbalance between cell proliferation and apoptosis is considered one of the prominent causes of tumor induction and/or progression. In order to establish the role of anti apoptotic proteins in colon cancer development, we studied with immunohistochemical techniques the expression of Survivin in a mouse model of colon carcinogenesis induced by 1,2-dimethyl-hydrazine treatment. In this mouse model Survivin was over-expressed during tumor development, showing a distribution mimicking that described in the correspondent human malignancies. We also correlated Survivin distribution with COX-2 and beta-Catenin expression patterns. The co-localization of COX-2/beta-Catenin/Survivin in the same epithelial cells in tumor samples lends credence to possible in vivo regulatory effects of COX-2 and beta-Catenin on the intracellular Survivin levels in mouse and human colon cancer.

1,2-Dimethylhydrazine↗

PubMed2006

Coffee consumption is inversely associated with cognitive decline in elderly European men: the FINE Study.

OBJECTIVE: To investigate whether coffee consumption is associated with 10-year cognitive decline in elderly men, as results of previous studies obtained hitherto have been controversial and prospective information on this association has been lacking. DESIGN, SUBJECTS AND SETTING: Six hundred and seventy six healthy men born between 1900 and 1920 from Finland, Italy and the Netherlands participated in a 10-year prospective cohort study. Cognitive functioning was assessed using the Mini-Mental State Examination (0-30 points, with a higher score indicating better cognitive performance). Coffee consumption was estimated in cups per day. A mixed longitudinal model was used to investigate the association between baseline coffee consumption and 10-year cognitive decline. Multiple adjustments were made. RESULTS: Men who consumed coffee had a 10-year cognitive decline of 1.2 points (4%). Non-consumers had an additional decline of 1.4 points (P<0.001). An inverse and J-shaped association was observed between the number of cups of coffee consumed and cognitive decline, with the least cognitive decline for three cups of coffee per day (0.6 points). This decline was 4.3 times smaller than the decline of non-consumers (P<0.001). CONCLUSIONS: Findings suggest that consuming coffee reduces cognitive decline in elderly men. An inverse and J-shaped association may exist between the number of cups of coffee consumed and cognitive decline, with the least cognitive decline for men consuming three cups of coffee per day.

Aged↗

PubMed2005

Regional variability in the prevalence of cerebral white matter lesions: an MRI study in 9 European countries (CASCADE).

White matter lesions (WML) on MRI of the brain are common in both demented and nondemented older persons. They may be due to ischemic events and are associated with cognitive and physical impairments. It is not known whether the prevalence of these WML in the general population differs across European countries in a pattern similar to that seen for coronary heart disease. Here we report the prevalence of WML in 1,805 men and women drawn from population-based samples of 65- to 75-year-olds in ten European cohorts. Data were collected using standardized methods as a part of the multicenter study CASCADE (Cardiovascular Determinants of Dementia). Centers were grouped by region: south (Italy, Spain, France), north (Netherlands, UK, Sweden), and central (Austria, Germany, Poland). In this 10-year age stratum, 92% of the sample had some lesions, and the prevalence increased with age. The prevalence of WML was highest in the southern region, even after adjusting for differences in demographic and selected cardiovascular risk factors. Brain aging leading to disabilities will increase in the future. As a means of hypothesis generation and for health planning, further research on the geographic distribution of WML may lead to the identification of new risk factors for these lesions.

Aged↗

PubMed2004

Physical activity in relation to cognitive decline in elderly men: the FINE Study.

BACKGROUND: Physical activity may be associated with better cognition. OBJECTIVE: To investigate whether change in duration and intensity of physical activity is associated with 10-year cognitive decline in elderly men. METHODS: Data of 295 healthy survivors, born between 1900 and 1920, from the Finland, Italy, and the Netherlands Elderly (FINE) Study were used. From 1990 onward, physical activity was measured with a validated questionnaire for retired men and cognitive functioning with the Mini-Mental State Examination (maximum score 30 points). RESULTS: The rates of cognitive decline did not differ among men with a high or low duration of activity at baseline. However, a decrease in activity duration of >60 min/day over 10 years resulted in a decline of 1.7 points (p < 0.0001). This decline was 2.6 times stronger than the decline of men who maintained their activity duration (p = 0.06). Men in the lowest intensity quartile at baseline had a 1.8 (p = 0.07) to 3.5 (p = 0.004) times stronger 10-year cognitive decline than those in the other quartiles. A decrease in intensity of physical activity of at least half a standard deviation was associated with a 3.6 times stronger decline than maintaining the level of intensity (p = 0.003). CONCLUSIONS: Even in old age, participation in activities with at least a medium-low intensity may postpone cognitive decline. Moreover, a decrease in duration or intensity of physical activity results in a stronger cognitive decline than maintaining duration or intensity.

Aged↗

PubMed2003

Expression of FGF2 in the limb blastema of two Salamandridae correlates with their regenerative capability.

Limb regenerative potential in urodeles seems to vary among different species. We observed that Triturus vulgaris meridionalis regenerate their limbs significantly faster than T. carnifex, where a long gap between the time of amputation and blastema formation occurs, and tried to identify cellular and molecular events that may underlie these differences in regenerative capability. Whereas wound healing is comparable in the two species, formation of an apical epidermal cap (AEC), which is required for blastema outgrowth, is delayed for approximately three weeks in T. carnifex. Furthermore, fewer nerve fibres are present distally early after amputation, consistent with the late onset of blastemal cell proliferation observed in T. carnifex. We investigated whether different expression of putative blastema mitogens, such as FGF1 and FGF2, in these species may underlie differences in the progression of regeneration. We found that whereas FGF1 is detected in the epidermis throughout the regenerative process, FGF2 onset of expression in the wound epidermis of both species coincides with AEC formation and initiation of blastemal cell proliferation, which is delayed in T. carnifex, and declines thereafter. In vitro studies showed that FGF2 activates MCM3, a factor essential for DNA replication licensing activity, and can be produced by blastemal cells themselves, indicating an autocrine action. These results suggest that FGF2 plays a key role in the initiation of blastema growth.

Amputation Stumps↗

PubMed2003

Serum cotinine as a marker of environmental tobacco smoke exposure in epidemiological studies: the experience of the MATISS project.

To describe serum cotinine levels in a rural Italian population and to examine its usefulness as an epidemiologic biomarker of nicotine exposure, cross-sectional data collected in 1993 for the MATISS Project (2098 men and 1352 women, aged 20-79 years) were used. The study population consisted of 977 current smokers, 882 nonsmokers reporting exposure to environmental tobacco smoke (ETS) and 1520 nonsmokers reporting no ETS exposure. Mean values of serum cotinine measured by radioimmunoassay for never smokers, ex-smokers and current smokers (including four categories of cigarette consumption), and for categories of ETS exposure in all nonsmokers were calculated. In univariate analysis, there was a positive association between self-reported nicotine exposure and serum cotinine levels in all groups. Using self-reported status as truth, sensitivity and specificity for various cotinine cutoff points were estimated to distinguish nonsmokers from smokers. The value of 15 ng/mL represented the best combined levels of sensitivity (95%) and specificity (96%). Using this cutoff point, the overall misclassification rate for self-reported nonsmokers was 2.1% and about two times greater for the more vs. the less educated. In multivariate analysis, reported ETS exposure among nonsmokers was significantly associated with serum cotinine even after adjusting for age, socio-demographic and behavioural factors, though the strength of the association was not strong. In conclusion, serum cotinine represents a reliable epidemiological marker of nicotine intake and may be helpful when studying ETS exposure. Improved information collection is needed to reduce misclassification among nonsmokers and enhance our understanding of the relationship between ETS and cotinine measures.

Adult↗

PubMed2002

Tight control of gene expression by a helper-dependent adenovirus vector carrying the rtTA2(s)-M2 tetracycline transactivator and repressor system.

Control of gene expression for gene therapy application requires the design of a sophisticated system embodying multiple properties. The ideal system should present the following features: (1) low or undetectable gene expression in the absence of inducer; (2) strong expression upon induction; and (3) fast kinetics of induction in the presence of inducers and rapid reversal of induction after its withdrawal. To evaluate these parameters, the features of the latest generation tetracycline-sensitive reverse-transactivator (rtTA2(s)-M2) alone or in combination with Tet-repressor (tTS-Kid) were explored in the context of helper-dependent adenovirus vector. Various genetic elements were assembled in a series of vectors and the ability to control secreted alkaline phosphatase expression evaluated in vitro in HeLa cells and in vivo by intramuscular injection in both C57/B6 and Balb/C nude mice. The results allow us to draw some general conclusions about the combination of transcription regulators and their relative orientation to the transgene to achieve maximal induction, while minimizing leakiness of expression.

Adenoviridae↗

PubMed2002

Predicting cardiovascular risk in the elderly in different European countries.

AIMS: The objective of this study was to develop risk functions for coronary heart disease and cardiovascular disease mortality for elderly men in different European countries. METHODS AND RESULTS: The FINE Study is a prospective follow-up study of 2170 elderly men aged 65-84 years in Finland, Italy and The Netherlands. During 10 years of follow-up 289 men died from coronary heart disease and 545 men from cardiovascular disease. Risk functions were estimated using logistic regression analysis, in order to take competing causes of death into account. The results of the present study show that total cholesterol and smoking were the most important predictors of coronary heart disease mortality, and HDL cholesterol, systolic blood pressure and smoking of cardiovascular disease mortality. Left ventricular hypertrophy, being subject to coronary heart disease or cardiovascular disease in Finland and The Netherlands and use of antihypertensive medication in Italy, were also important predictors. For estimating the absolute risk of coronary heart disease and cardiovascular disease mortality in the elderly it is necessary to take into account the European country in which they live. CONCLUSION: Total and HDL cholesterol, systolic blood pressure and smoking remain important predictors of coronary heart disease and/or cardiovascular disease mortality in elderly men, but also left ventricular hypertrophy, being subject to coronary heart disease, use of antihypertensive medication and country are predictive of coronary heart disease and cardiovascular disease risk.

Aged↗

PubMed2002

Infection rate and spontaneous seroreversion of anti-hepatitis C virus during the natural course of hepatitis C virus infection in the general population.

BACKGROUND: Hepatitis C virus (HCV) infection is common worldwide but there are different prevalence rates in different countries. Data on the incidence of HCV in the general population are scarce. Spontaneous viral clearance occurs in 10-25% of infected individuals after acute infection yet controversy exists regarding the frequency of spontaneous clearance during the natural course of HCV infection in the general population. AIMS: Anti-HCV prevalence, HCV infection rate, and the kinetics of anti-HCV were studied in a cross section of the general population of central Italy. STUDY POPULATION AND METHODS: Anti-HCV prevalence (EIA-3 Ortho, RIBA-3 Ortho Chiron) was estimated in 3884 randomly selected individuals. Infection rate and antibody kinetics were estimated in 2032 participants for whom a second blood sample was taken after a median follow up of seven years. HCV-RNA determination by polymerase chain reaction was performed on follow up sera. RESULTS: The overall confirmed anti-HCV prevalence was 2.4%. Two participants seroconverted for anti-HCV, giving an overall infection rate of 1.4 cases per 10 000 person years (95% confidence interval 0.2-5.2 per 10 000 person years). Of the 36 individuals confirmed as anti-HCV positive at enrollment, seven (19.4%) showed complete seroreversion. Seven (87%) of the eight individuals with indeterminate results at enrollment were serologically non-reactive at the end of follow up. Of the 25 participants confirmed to be anti-HCV positive at both enrollment and follow up, 23 (92.0%) with stable serological profiles tested positive for HCV-RNA at the end of follow up. CONCLUSIONS: There is still a permanent risk, although low, of HCV spread in the general population in an area of low level endemicity. In this setting, a wide spectrum of modifications of viral and antibody patterns can be observed in HCV infected patients.

Adult↗

PubMed2001

Prevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: The FINE study (Finland, Italy, Netherlands, Elderly).

Older males are known to carry, more likely than younger people, one or more chronic diseases with an expected impact on mortality. This study was aimed at identifying the relationship of prevalent chronic diseases in elderly populations of different countries with all-cause mortality. Men aged 65-84 from defined areas were enrolled in Finland (N=716), the Netherlands (N=887) and Italy (N=682). They were survivors of cohorts studied for 25 years within the Seven Countries Study. Major chronic diseases were diagnosed at entry. Ten-year follow-up for mortality was completed. Entry prevalence of selected chronic diseases was higher in Finland (56%) than in Italy (51%) and the Netherlands (44%). Ten-year age-adjusted death rates from all causes were higher in Finland (565 per 1000) and lower in the Netherlands (478 per 1000) and Italy (445 per 1000). The absolute risk of death related to chronic disease was high in the three countries, but was higher in Finland than in the Netherlands and Italy. The most lethal condition was stroke, with 10-year death rates of 806 per 1000 in Finland and 707 and 729 per 1000 in the Netherlands and Italy, respectively. The relative risk of all-cause mortality for a set of seven chronic diseases (coronary heart disease, heart failure, claudicatio intermittens, cerebrovascular accidents, diabetes, COPD and cancer) adjusted by age, other diseases and cohort was less than two for each condition, except cerebrovascular accidents in the Netherlands (RR 2.20). In general, relative risk was higher in Finland, intermediate in the Netherlands and lower in Italy, where only cerebrovascular accidents, intermittent claudication, diabetes and the presence of any chronic condition had a significant relative risk. About one third of men had one chronic disease, and between 10% and 15% had two diseases. The coexistence of any two or three chronic conditions was associated with a relative risk of 2 or more in Finland and the Netherlands and less than 2 in Italy. In these elderly men prevalent morbidity and comorbidity was relatively common and it explained a large proportion of excess in all-cause mortality in 10 years of follow-up.

Aged↗

PubMed2001

Socio-economic position and cardiovascular risk factors in an Italian rural population.

Cardiovascular disease (CVD) is the leading industrial world cause of mortality. Lower social class groups have higher incidence of CVD and also display less favourable risk factor profiles. To investigate the association and gradient between major cardiovascular risk factors (smoking habit, serum lipid profile, blood pressure, relative body weight) and socio-economic position (proxy measures selected: education and occupation) data on 2592 men and 2866 women were analysed. The effect of potential confounding factors and effect modifiers was estimated. Linear and logistic regression modelling was performed for continuous and dichotomous outcomes respectively. The lower the grade of employment or the level of education, the higher was the prevalence of obesity in the study population. The association was stronger in women than in men. Higher education was associated with a lower prevalence of smoking among men and a higher prevalence among women. Systolic blood pressure was negatively related to socio-economic position in both men and women in the age-adjusted models. Attention should be concentrated on socio-economic differences in obesity and blood pressure in this population.

Adult↗

PubMed2001

Cardiovascular risk factors and 10-year all-cause mortality in elderly European male populations; the FINE study. Finland, Italy, Netherlands, Elderly.

BACKGROUND: This study aims to examine cardiovascular risk factors in relation to all-cause mortality in elderly populations of different European countries. METHODS: Men aged 65--84 years from defined administrative areas were enrolled in Finland (rural areas of east and west Finland; n=716), in the Netherlands (the town of Zutphen; n=887), and in Italy (the rural areas of Crevalcore and Montegiorgio; n=682). Ten-year all-cause mortality was studied in relation to measurements taken at entry: age, systolic blood pressure, HDL- and non-HDL-cholesterol, body mass index, heart rate and smoking habits. Univariate and multivariate analyses were performed with all-cause mortality as the end-point. RESULTS: Ten-year death rates from all causes were higher in Finland (574 per 1000), lower in the Netherlands (475 per 1000), and Italy (466 per 1000). Age, heart rate and smoking in all three countries were independently associated with 10-year all-cause mortality. Non-HDL-cholesterol was not related with all-cause mortality. The observed associations between HDL-cholesterol, systolic blood pressure, body mass index and all-cause mortality were dependent on the in- or exclusions of early death. CONCLUSION: In these elderly men only age, smoking habits and heart rate were consistently associated with all-cause mortality.

Age Factors↗

PubMed2001

Surveillance of ischaemic heart disease: results from the Italian MONICA populations.

BACKGROUND: The major objectives are to report on coronary event mortality, incidence and attack rates and changes over time observed in the Italian MONICA populations and to assess if trends are consistent when different disease definitions are considered. An analysis of diagnostic agreement between clinical and MONICA categories is presented in the context of developing a model for estimating disease incidence in a population, based on currently available data. METHODS: Data were provided by the three Italian MONICA (MONItoring trends and determinants of CArdiovascular diseases) registers. The areas of Brianza and Friuli, both located in northern Italy, completed the 10-year period of registration. Data from the MONICA Latina area, located close to Rome, were limited to the first 3 years of registration. These data are used for assessing geographical differences in rates in the mid- 1980s and estimating the diagnostic agreement between International Classification of Diseases (ICD) codes and MONICA categories. Two diagnostic aggregates have been used: the standard MONICA diagnostic definition for myocardial infarction (MI), which includes non-fatal definite myocardial infarction and fatal coronary events, and the coronary event definition which includes, in addition, non-fatal possible myocardial infarctions. RESULTS: From the mid-1980s to the mid-1990s, a considerable reduction in all-cause, cardiovascular and coronary mortality rates occurred in the monitored populations. Data from the MONICA registers confirm the accuracy of official reports of death rates and changes in Italy. Comparisons of time differences in attack and incidence rates of myocardial infarction and all coronary events indicate that the impact of the more severe manifestations of coronary heart diseases (fatal coronary event and acute MI) reduced during the period of observation, but when less severe events (minor myocardial infarction and angina pectoris) are considered, the overall impact of the disease on the population remained stable. CONCLUSION: Epidemiological surveillance of coronary syndromes is relevant over this time period of impressive changes in prevention and treatment. Continuing restrictions in available resources necessitate the development of simplified registration systems.

Adult↗

PubMed2001

Estimating population-based incidence and prevalence of major coronary events.

BACKGROUND: Population-based data on coronary events are generally lacking for large areas, such as at the nation-wide level. While mortality data are currently and exhaustively collected in all developed countries and in a few developing countries, incidence and prevalence are often available only for certain subgroups of the population under study. METHODS: We propose to estimate population-based incidence and prevalence of coronary events through a mathematical method using mortality and survival data as input, and to forecast coronary event occurrence using an age, period and cohort approach. The method reconstructs incidence and prevalence of major coronary events in Italy from 1970 to 1997 and projects trends up to the year 2007 using survival data on coronary events from the Area Friuli-MONICA (MONItoring of CArdiovascular diseases) register. RESULTS: Major coronary event incidence has been decreasing since 1977 for men and since 1974, for women. Conversely, major coronary event prevalence increased up to the end of the 1980s for men and up to the early 1980s for women, and it has been declining thereafter. Major coronary event prevalence results from three main effects: increasing survival, population ageing, and incidence trend. CONCLUSIONS: Availability of national population data, collection of population-based survival data from the MONICA registers and appropriate statistical and mathematical methods help to estimate and project incidence and prevalence trends for major coronary events. This information is essential to plan and implement actions aimed at improving medical care services, and to evaluate the impact of public health interventions as well as spontaneously changing habits. Incidence, prevalence, mortality, projections, ischaemic heart disease, coronary events

Adult↗

PubMed2001

Heart rate as a predictor of mortality: the MATISS project.

OBJECTIVES: This study sought to verify the independent role of heart rate in the prediction of all-cause, cardiovascular, and noncardiovascular mortality in a low-risk male population. METHODS: In an Italian population-based observational study, heart rate was measured in 2533 men, aged 40 to 69 years, between 1984 and 1993. Data on cardiovascular risk factors were collected according to standardized procedures. Vital status was updated to December 1997. RESULTS: Of 2533 men followed up (representing 24,457 person-years), 393 men died. Age-adjusted death rates for 5 heart rate levels showed increasing trends. The adjusted hazard rate ratios for each heart rate increment were 1.52 (95% confidence interval [CI] = 1.29, 1.78) for all-cause mortality, 1.63 (95% CI = 1.26, 2.10) for cardiovascular mortality, and 1.47 (95% CI = 1.19, 1.80) for noncardiovascular mortality. Relative risks between extreme levels were more than 2-fold for all endpoints considered. CONCLUSIONS: Heart rate is an independent predictor of cardiovascular, noncardiovascular, and total mortality in this Italian middle-aged male population.

Adult↗

PubMed2001

The association of silent electrocardiographic findings with coronary deaths among elderly men in three European countries. The FINE study.

OBJECTIVES: Ten-year coronary heart disease (CHD) mortality in elderly male cohorts in three European countries was evaluated as a function of silent resting Minnesota Code electrocardiographic (ECG) findings found at baseline. METHODS AND RESULTS: Men aged 65-84 at entry were enrolled, examined and followed up for 10 years in 5 cohorts of three countries: Finland (N=716), the Netherlands (N= 887), and Italy (N = 682). Men with symptomatic angina pectoris, a documented history of myocardial infarction or heart failure were excluded from analysis, leaving 505 men in Finland, 713 in the Netherlands and 567 in Italy. ECG abnormalities were arranged in different groupings. Multivariate analyses adjusted ECG prediction of CHD mortality for cohort, and baseline age, systolic blood pressure, serum cholesterol, body mass index and cigarette smoking. RESULTS: Silent ECG abnormalities of presumed severity were found in more than half of these elderly men, with higher prevalence in Finland, compared to the other two countries. Adjusted hazards ratios for CHD deaths as a function of major single or combined ECG abnormalities, such as QQS and ST-T abnormalities, arrhythmia, definite and possible myocardial infarction and an operative definition of ischaemia, are generally similar across areas varying according to severity from around 1.5 to almost 4. Groupings of minor and major ECG abnormalities in the pooled countries gave significant relative risks of 1.79 and 3.12 respectively, compared to the group without or with marginal abnormalities. Sensitivity and positive predictive value were low, while specificity was high. CONCLUSIONS: Silent ECG abnormalities in elderly people are common and they carry a high risk of coronary death in the next 10 years, with relative risk ranging from around 1.5 to almost 4 or more depending upon severity and combination of findings.

Aged↗

PubMed2001

[Socioeconomic aspects and cardiovascular risk factors: experience at the Cardiovascular Epidemiologic Observatory].

BACKGROUND: Cardiovascular diseases are more frequent among the poorer social classes of the population. Studies including social and economic factors offer useful information when planning the strategy required in primary prevention. The aim of this investigation was to evaluate the association between socio-economic levels and cardiovascular risk factors in 3198 women and 3218 men aged 35-74 years enrolled for a cross sectional study within the Cardiovascular Epidemiologic Observatory, carried out in 1998 to evaluate the distribution of risk factors and the prevalence of cardiovascular risk conditions. METHODS: The level of education was used to determine the socio-economic status; the distribution of the risk factors and the prevalence of risk conditions were analyzed for the different levels of education. Models of logistic regression were used to evaluate the relation between the socio-economic status and obesity, cigarette smoking, hypertension, and hypercholesterolemia. RESULTS: A higher level of education is significantly protective against both obesity and cigarette smoking. With regard to obesity among males compared to those with a university degree the odds ratio increased to 1.6 for those with an upper secondary education diploma (95% confidence interval--CI 1.09-2.51) and to 3.5 for those without any qualification (95% CI 1.97-6.21). Among women the odds ratio increased to 3.2 (95% CI 1.81-5.81) and to 4.8 (95% CI 2.55-8.98) for the same levels of education. With regard to smoking among males compared to those with a university degree the odds ratio increased to 1.4 for those holding an upper secondary education diploma (95% CI 1.07-1.94) and to 2.3 for those without any qualification (95% CI 1.40-3.68). For men living in central or southern Italy, the odds ratio for cigarette smoking increased to 1.3 (95% CI 1.06-1.57) and to 1.5 (95% CI 1.24-1.82) and the odds ratio for hypercholesterolemia decreased to 0.8 (95% CI 0.62-0.95) and to 0.7 (95% CI 0.58-0.89); with regard to women, living in the same geographic areas the odds ratio for obesity increased to 1.3 (95% CI 1.03-1.65) and to 2.3 (95% CI 1.81-2.83). CONCLUSIONS: In primary prevention it is important to focus the attention on obesity and on smoking habits among the poorer social classes.

Adult↗