Analysis of survival in a sample of elderly patients from Ragusa, Italy on the basis of a primary care level multidimensional evaluation.

The detection of frail elderly people is a crucial point in planning health care services. The aim of this study is to assess the effectiveness of a multidimensional evaluation instrument in order to identify frail elderly people, in a primary care setting. In 1994, a 15-20-min multidimensional questionnaire, called Geriatric Functional Evaluation (GFE), was administered to 3060 over 65-year-old citizens of Ragusa (Italy), who live in their own home. The sample was subdivided in three groups (independent, moderately impaired, and severely impaired) on the basis of the Final Synthetic Score (FSS) originated by the answers to the questionnaire. A follow up was carried out in 1999 with survival and institutionalization as the end-point. The lost to follow-up rate was 1.2%. After 5 years, the Kaplan-Meyer survival analysis showed that the survival rate of the three groups was 42%, 68%, and 88%, respectively. The Cox Proportional Survival analysis showed that the risk of death was doubled in the moderately impaired group and tripled in the severely impaired group compared with higher FSS group. The multivariate analysis showed that the use of services was increased by 40% and therefore indirectly their need, shifting from the lowest to the highest score. The FGE questionnaire had a strong predictivity of both mortality and need of services. The use of FGE in a primary care setting could make it possible to detect the frail population in order to address the community based services.

[Social and health services needs in a sample of elderly people in Catanzaro]. / Domanda di assistenza socio-sanitaria in un campione di anziani a Catanzaro.

The aim of this study is to analyze the general health state conditions of older people living in Catanzaro, using a multidimensional assessment instrument to determine their social and health needs. To this purpose, a sample of 544 individuals (344 women and 210 men) older than 65 years of age (mean age = 75.3) was selected from the general population. All subjects were administered the OARS (Older Americans Resources and Services) questionnaire that evaluates five areas: physical health, mental health, social resources, economic resources and Activities of Daily Living (ADL). The percentage of subjects with score 3 or more in each area, and therefore identified as partially or totally dependent, is higher in the area of physical health (17.9%) and ADL (16.6%). About 65% of the sample is not disabled in any of the different areas, while 8% is dependent in 3 or more areas. These subjects are partially or totally dependent elderly people, who stay at their own house in precarious conditions, and are able to remain there only because they are helped by informal caregivers. Probably these people are those for whom any domiciliary help is necessary and more urgent in order to support the existing stability and to avoid institutionalization.

Family history of cardiovascular diseases and risk factors in children.

A sample of 861 Roman children, aged 7 to 14 years, was investigated in order to evaluate the association between some cardiovascular risk factors such as high systolic (SBP) and diastolic (DBP) blood pressure levels, body mass index (BMI), arm fat area (AFA) and a history of diabetes, stroke, angina pectoris, myocardial infarction, hypertension and overweight in their parents. The sample investigated was subdivided into three subgroups, based on whether the children had just one parent, both parents or no parent with a positive history. For all the variables considered, the highest values were found in the group of children with a positive history for both parents and the lowest ones in children with a negative history for both parents. The analysis of significance, based on the mean values for the three groups, revealed statistically significant differences for SBP, DBP, BMI and AFA between the group of children with a positive history for both parents and that of children with a negative history for both parents. Significant differences also emerged for DBP, BMI and AFA between the mean values of children positive for one parent and those negative for both parents and for BMI and AFA between the means of children positive for one parent and those positive for both parents. The odds ratio of high systolic and/or diastolic BP, BMI and AFA levels was consistently higher in children with one or two parents with a positive history compared to children with both parents with a negative history, and even higher considering only children with both parents with a positive history vs children with both parents with a negative history.

[Hepatitis C in Italy in 1992: analysis of individual reports]. / Epatite C in Italia nel 1992: analisi delle schede individuali.

The Authors examined the individual reporting forms of Hepatitis C infections received by the Communicable Diseases Reporting Centre of the Ministry of Health during the year 1992. Thanks to the adoption of a point estimator, 1448 cases of viral hepatitis C have been sorted out. The incidence rate of Hepatitis C has been, on the whole, 2.8 per 100,000, 3.9 for males and 1.9 for females. The highest incidence by age was observed at 20-29 y, and also among women aged 60-69 y. Moreover, the incidence was higher in the low socio-economic classes. Analyzing the data by geographical area, the highest incidence (11.8 per 100,000) was observed in the Basilicata Region, and the County of Potenza, in that Region, reached up 16.7 per 100,000.

Determinants of human papillomavirus types 16 and 18 infections in the lower female genital tract in an Italian population.

The prevalences of Human Papillomavirus (HPV) types 16 and 18 infection were determined by a non isotopic molecular hybridization assay on cervical scrapes from 738 women affected by gynaecological lesions different from malignancies. The correlation with known epidemiological risk factors for cervical neoplasia, such as sexual habits, smoking and pill use, was investigated. The overall HPV prevalence rate was 29.8% (220/738). Viral DNA sequences were detected in 26.9% (122/452) of morphologically normal cervices, in 75 of 224 HPV lesions (32.5%), in 1 case of 3 HSV2 lesions and in 22 of 59 dysplastic lesions (37.3%), and the frequency was increasing with the severity of CIN from 22.7% of CIN I to 57.1% of CIN III. The most relevant factor as relative risk for the presence of HPV 16/18 was the multiple lifetime sexual partners, whereas the other investigated factors were mainly associated with the clinically manifested HPV infection.