The Pattern and Progression of "Usual" Interstitial Pneumonia with Autoimmune Features: Comparison with Patients with Classic Interstitial Pneumonia with Autoimmune Features and Idiopathic Pulmonary Fibrosis.

BACKGROUND: We proposed the term "UIPAF" to define patients with Usual Interstitial Pneumonia (UIP) associated with only one domain of the classification called "Interstitial Pneumonia with Autoimmune Features" (IPAF). The objective of this study was to evaluate the clinical presentation and prognosis of UIPAF patients, compared with two cohorts, composed of IPAF and idiopathic pulmonary fibrosis (IPF) patients, respectively. METHODS: The patients were enrolled as IPAF, UIPAF, or IPF based on clinical, serological, and radiological data and evaluated by a multidisciplinary team. RESULTS: We enrolled 110 patients with IPF, 69 UIPAF, and 123 IPAF subjects. UIPAF patients were similar to IPAF regarding autoimmune features, except for the prevalence of Rheumatoid Factor in UIPAF and anti-SSA in IPAF. A similar proportion of the two cohorts progressed toward a specific autoimmune disease (SAD), with differences in the kind of SAD developed. The real-life management and prognosis of UIPAF patients proved to be almost identical to IPF. CONCLUSIONS: UIPAF shared with IPAF similar autoimmune features, suggesting the opportunity to be considered IPAF, excluding the morphological domain by the classification. However, the real-life management and prognosis of UIPAF are similar to IPF. These data suggest a possible modification in the therapeutic management of UIPAF.

Simulating the fate of indigenous antibiotic resistant bacteria in a mild slope wastewater polluted stream.

The fate of indigenous surface-water and wastewater antibiotic resistant bacteria in a mild slope stream simulated through a hydraulic channel was investigated in outdoor experiments. The effect of (i) natural (dark) decay, (ii) sunlight, (iii) cloudy cover, (iv) adsorption to the sediment, (v) hydraulic conditions, (vi) discharge of urban wastewater treatment plant (UWTP) effluent and (vii) bacterial species (presumptive Escherichia coli and enterococci) was evaluated. Half-life time (T1/2) of E. coli under sunlight was in the range 6.48-27.7min (initial bacterial concentration of 105CFU/mL) depending on hydraulic and sunlight conditions. E. coli inactivation was quite similar in sunny and cloudy day experiments in the early 2hr, despite of the light intensity gradient was in the range of 15-59W/m2; but subsequently the inactivation rate decreased in the cloudy day experiment (T1/2=23.0min) compared to sunny day (T1/2=17.4min). The adsorption of bacterial cells to the sediment (biofilm) increased in the first hour and then was quite stable for the remaining experimental time. Finally, when the discharge of an UWTP effluent in the stream was simulated, the proportion of indigenous antibiotic resistant E. coli and enterococci was found to increase as the exposure time increased, thus showing a higher resistance to solar inactivation compared to the respective total populations.

Effect of Socioeconomic Status on Surgery Waiting Times and Mortality After Hip Fractures in Italy.

BACKGROUND: Reducing inequities is a main goal of the Italian healthcare system. We evaluated socioeconomic differences in delayed surgery and postoperative mortality after a hip replacement after a fracture in Piedmont Region (Italy). METHODS: Cohort study including all people aged ≥65 years hospitalized for a hip fracture in 2007-2010 (n = 21,432). Study outcomes were the following: (1) surgery waiting times >2 days; (2) 30-day, 90-day, and 1-year mortality from admission. Log-binomial models were used to evaluate the effect of socioeconomic status on waiting time, adjusting for age, sex, comorbidities, biennium, and Local Health Unit. Logistic models were fitted for mortality, adjusting also for the type of intervention (prosthesis/reduction) and waiting time. RESULTS: Seventy percent of surgeries were performed beyond 2 days from admission; 30-day mortality was 4.1%, 90-day was 10.8%, and 1-year was 21.9%. Lower socioeconomic levels were associated with higher risk of waiting >2 days (Adjusted Relative Risk: 1.14) and higher odds for 90-day (Adjusted Odds Ratio: 1.18) and 1-year (Adjusted OR: 1.27) mortality. CONCLUSIONS: We found socioeconomic inequities in access to hip replacement and postoperative outcomes. Strengthening the connection between hospital, primary care and rehabilitation services, improving regional monitoring systems and taking into account quality of care in funding health system, may contribute to guarantee uniform levels of healthcare quality in Italy.

Geographic and socioeconomic differences in access to revascularization following acute myocardial infarction.

BACKGROUND: Geographic and socioeconomic barriers may hinder fair access to healthcare. This study assesses geographic and socioeconomic disparities in access to reperfusion procedures in acute myocardial infarction (AMI) patients residing in Piedmont (Italy). METHODS: Coronary Care Units (CCUs) were geocoded with a geographic information system (GIS) and the shortest drive time from CCUs to patients' residence was computed and categorized as 0 to <20, 20 to <40 and ≥40 min. Using data on AMI emergency hospitalizations in 2004-2012, we employed a log-binomial regression model to evaluate the relation between drive time and use of Percutaneous Transluminal Coronary Angioplasty (PTCA) occurring within 2 days after a hospitalization for an episode of AMI, and whether this relation varied depending on the period of hospitalization. RESULTS: A total of 29% of all cases with a diagnosis of AMI (n = 66 097), were revascularized within 2 days from the index admission. The further AMI patients lived from CCUs, the less likely they were to receive revascularization: compared with distance <20 min, RRs were respectively 0.84 [95% CI 0.80-0.88] and 0.78 [95% CI 0.71-0.86]. Findings also showed that less educated people had a lower relative risk of being revascularized compared to more educated people (RR = 0.78; 95% CI = 0.74-0.82). Both inequalities have reduced in recent years. CONCLUSION: This study provides evidence of reduced geographical and socioeconomic differences in revascularization use over time. Geography and socioeconomic status should not determine the type of treatment received for life-threatening conditions such as AMI.

Health care utilization by immigrants in Italy.

Healthcare utilization studies show how well documented disparities between migrants and non-migrants. Reducing such disparities is a major goal in European countries. However, healthcare utilization among Italian immigrants is under-studied. The objective of this study is to explore differences in healthcare use between immigrant and native Italians. Cross-sectional study using the latest available (2004/2005) Italian Health Conditions Survey. We estimated separate hurdle binomial negative regression models for GP, specialist, and telephone consultations and a logit model for emergency room (ER) use. We used logistic regression and zero-truncated negative binomial regression to model the zero (contact decision) and count processes (frequency decisions) respectively. Adjusting for risk factors, immigrants are significantly less likely to use healthcare services with 2.4 and 2.7 % lower utilization probability for specialist and telephone consultations, respectively. First- and second-generation immigrants' probability for specialist and telephone contact is significantly lower than natives'. Immigrants, ceteris paribus, have a much higher probability of using ERs than natives (0.7 %). First-generation immigrants show a higher probability of visiting ERs (1 %). GP visits show no significant difference. In conclusion Italian immigrants are much less likely to use specialist healthcare and medical telephone consultations than natives but more likely to use ERs. Hence, we report an over-use of ERs and under-utilization of preventive care among immigrants. We recommend improved health policies for immigrants: promotion of better information dissemination among them, simplification of organizational procedures, better communications between providers and immigrants, and an increased supply of health services for the most disadvantaged populations.

Socioeconomic differences in waiting times for elective surgery: a population-based retrospective study.

BACKGROUND: Widespread literature on inequity in healthcare access and utilization has been published, but research on socioeconomic differences in waiting times is sparse and the evidence is fragmentary and controversial. The objective of the present study is the analysis of the relationship between individual socioeconomic level and waiting times for in-hospital elective surgery. METHODS: We retrospectively studied the waiting times experienced by patients registered on hospital waiting lists for 6 important surgical procedures by using the Hospital Discharge Database (HDD) of the Piedmont Region (4,000,000 inhabitants in the North West of Italy) from 2006 to 2008. The surgical procedures analyzed were: coronary artery by-pass (CABG), angioplasty, coronarography, endarterectomy, hip replacement and cholecystectomy. Cox regression models were estimated to study the relationship between waiting times and educational level taking into account the confounding effect of the following factors: sex, age, comorbidity, registration period, and Local Health Authorities (LHA) as a proxy of supply. RESULTS: Median waiting times for low educational level were higher than for high educational level for all the selected procedures. Differences were particularly high for endarterectomy and hip replacement. For all considered procedures, except CABG, an inverse gradient between waiting times and educational level was observed: the conditional probabilities of undergoing surgery were lower among individuals with a low to middle level education than for individuals with a higher level of education after adjustment for sex, age, comorbidities, registration period, and LHAs. For most procedures the effect decreases over the follow up period. CONCLUSIONS: The results of the study show evidence of inequalities in access to elective surgery in Italy. Implementation of policies aimed to promote national information initiatives that guarantee wider access to those with low socio-economic status is strongly recommended.