The underestimated burden of aspiration event and pneumonia within hospitals: what happens after dysphagia.

Study design: Prospective observational study. Background: Despite dysphagia large prevalence and the growing ageing phenomenon occurring in European countries, aspiration events among inpatients are often underestimated, given their frequent spontaneous resolution or silent contribution to aspiration syndromes. Our main objective was to evaluate the incidence of aspiration events among medical inpatients and to identify risk factors influencing the outcome of the event. Methods: Data about aspiration events - day, hour, type and outcome of the event occurred - along with underlying patient clinical conditions at the admission were collected. Between May 2015 and September 2016, data about aspiration event occurred among medical inpatients were collected in three large Italian hospitals. Results: Patients affected by aspiration events were 135 on 102,619 cumulative days of hospitalization; they were mostly females (53%) with an average age of 82. The total incidence of aspiration events was of 1.4 every 1,000 days of hospitalization (C.I. 95%: 1.2-1.7) and the most frequent manifestation was cough (61.6%). The addition of drugs or an infection diagnosis during the 24 hours preceding the event acted as risk factors for those events that needed additional interventions during the hospitalization (OR 3.1 e OR 1.9 respectively), while the elimination of one or more prescribed drugs seemed to lead to aspiration events without impact on the hospitalization. Conclusions: Results showed a large incidence of aspiration events within medical wards, many of them influencing patient outcomes. Healthcare professionals' attention concerning aspiration events should be fostered during the first hours and days of hospitalization.

The Prevalence of patients with panic attacks (PAs) and panic disorder (PD) visiting Emergency Departments of the Verona Hospital.

BACKGROUND: Panic Attacks (PAs) and Panic Disorder (PD) represent a heavy burden not only because of the difficulty in distinguishing them from other pathologies and in treating them appropriately but also because of their impact on public health worldwide. In Europe, PD constitutes one of the five most common mental disorders adversely affecting quality of life. STUDY DESIGN: The aim of this study is to evaluate the period prevalence of visits to the Emergency Departments of the University Hospital of Verona (North East of Italy) over the period between 2012-2016 because of symptoms of PAs or PD in order to quantify the burden of the disorder. METHODS: This study was carried out by retrospectively collecting data from the medical records of all the patients assessed at the Emergency Departments (EDs) of the Verona Hospital because of symptoms of PAs or PD over a 5-year period (1 January 2012 - 31 December 2016). The search words used in reviewing the medical records registered in the hospital discharge reports from the Gynecological, Pediatric and General Medicine Emergency Departments were: "Anxiety" and/or "Panic". A multiple logistic regression model was also created to evaluate the predictors of ED visits for PAs or PD over the period that was investigated. RESULTS: The study identified 3,771 cases of PAs or PD; 62.3% were females and 37.7% were males. The female-to-male ratio was 1.7:1. The mean age was 44 years (46 for the females and 41 for the males). The majority of the patients fell into two age categories: 30 to 39 (20.6%) and 40 to 49 (23.8%). The proportion of visits to the EDs for PAs or PD was approximately 20% per year, with an average of approximately 754 patients visiting the EDs every year. The period prevalence of accesses for PAs or PD over the five year period studied in the mean resident population (1.4%) and the mean visits to the EDs (2.5%) were calculated. Study results showed that the majority of the patients (80.9%) were referred to their general practitioner (GP) at the end of the assessment protocol at the EDs. According to the regression logistic model, the following variables were significant (p<0.05) risk factors for PAs or PD: being female vs. male (OR 1.899; 95% CI 1.785-2.020), being Italian vs. Foreigner (OR 1.292; 95% CI 1.174-1.421), having a white or green priority code at arrival (low urgency) vs. the other ones (OR 1.195; 95% CI 1.100-1.297), and being aged ≤42 years old (OR 1.091; 95% CI 1.024-1.161). CONCLUSION: The role of the GP is crucial in the management of PD and PAs. Given the difficulty of implementing primary and secondary prevention programs for these conditions, public health officials should make every effort to promote tertiary prevention in order to reduce the burden of the ailment and societal cost.