[Thromboembolic vein disease (TVD): antithrombotic therapy choice in ASL TO3.] / Malattia tromboembolica venosa: scelta della terapia antitrombotica nei pazienti della ASL TO3.

BACKGROUND: Thromboembolic vein disease (TVD) comprises of deep vein thrombosis (DVT) and pulmonary embolism (PE). Standard therapy consists of the administration of low molecular weight heparin (LMWH) imbricated with antivitamin K agonists (AVK). Recently a new series of oral anticoagulants known as the direct oral anticoagulants (DOACs) has been introduced. CHEST 2016 guidelines recommend the use of DOACs rather then AVKs for the treatment of TVD. AIM: The aim of this study was to analise the choice of antithrombotic treatment and to see if CHEST 2016 guidelines were used in the ASL TO3 district for TVD therapy. METHODS: Data obtained from the SISR archives was used to perform a cohort retrospective study. Patients who had been recovered for TEVD were selected 6 months after dismissal. Based on Chest guidelines, the period that ranged from 01/01/2014 to 30/06/2017 was divided into two parts. The cohort was classified according to antithrombotic therapy administered to these patients. RESULTS: 475 patients that had been dismissed after recovery for TVD were identified and enrolled into this study. 1st period: from 275 patients, 247 had a prescription: 132 TAO, 73 DOACs, 42 eparine, 0 ASA. 2nd period: from 200 patients, 185 had a prescription: 55 TAO, 95 DOACs, 34 eparine, 1 ASA. DISCUSSION AND CONCLUSIONS: Our analysis shows a significant difference between the choice of antithrombotic therapy during both periods, this difference is greater among males. We can conclude that antithrombotic prescriptions carried out in the ASL TO3 area have been adherent to Chest guidelines.

Quit attempts and smoking cessation in Italian adults (25-64 years): factors associated with attempts and successes.

Background: Over the past 50 years there was a substantial decrease in the prevalence of smoking in Italy. The objective of this work is to describe attempts to quit and cessation success in Italian smokers. Methods: A surveillance on health-related behaviors (PASSI) was conducted in 2007-13 on a sample of 203 610 Italian adults 25-64 years of age. An analysis of smokers' characteristics and behaviors was performed, focusing on attempts to quit and quit success. Data from national surveys (ISTAT) from 1983 to 2013 (Italian adults, 25-64 years of age, 1983: 46 634; 1987: 40 915; 1990: 36 622; 2000: 77 531; 2005: 71 032; 2013: 64 205) were used to explore if a cessation trend in Italy exists. Results: Smokers who quit in the previous year and were still abstinent when interviewed increased from 1990 to 2013. In the years 2011-13, 38% of people who had smoked in the last 12 months reported at least a quit attempt during the same period and 7% were still abstinent when interviewed. An association of successful recent quit attempts with higher educational level, absence of economic difficulties and younger age was found. In the years 2007-13, the great majority tried to stop unaided. Having received assistance from a cessation program did not increase the probability of enduring abstinence. Conclusions: In Italy interventions to drive more smokers to quit should be focused in particular on disadvantaged groups. Initiatives have to be studied not only to incentive more smokers to try to quit, but also to maintain abstinence over time.

[Health inequalities and nutrition in Italy during crisis times]. / Disuguali a tavola, ma non troppo: le differenze sociali nell'alimentazione in Italia prima e durante la crisi.

OBJECTIVES: to describe systematically unhealthy patterns in nutrition behaviours, with a special focus on the impact of social, gender, geographical, and age inequalities on diet; to evaluate the potential impact of economic crisis on healthy nutrition choices and on health inequalities. DESIGN: cross sectional study within national surveys. SETTING AND PARTICIPANTS: population ≥20 years, from representative samples of the Italian population in official national multipurpose surveys, in the periods 2005-2007 and 2009-2012. MAIN OUTCOME MEASURES: prevalence, population attributable fraction (PAF), and relative time variation between periods. RESULTS: wide differences on the prevalence of nutrition healthy behaviour have been found according to social position (low educated have higher consumption of meat, carbohydrates, salty food, higher breakfast skipping rates as well as lower consumption of fish), geographical area (Northern regions have higher consumption of meat, carbohydrates and fats, whereas Southern ones have lower consumption of fruit and vegetables, higher obesity, and overweight rates). Economic crises seems to have had an impact on nutrition (reduction of meat, fruit and vegetable consumption, increase on snack and legumes frequencies, less fish, and meat presence on diet), but lower than expected. Besides, if long period trends seem to increase health inequalities on nutrition, crisis seems to have had an opposite effect. CONCLUSION: unhealthy patterns seem to be present in Italian food behaviour and long time trends appear to increase them, as illustrated by the spread of obesity and overweight. Nevertheless, Mediterranean diet does not seem to be too much at risk. Economic crisis has been frequently recognized as a determinant of nutrition patterns worsening, but it has had different impacts. Furthermore, health inequalities could be decreased in crisis times.

Cardiogenic shock complicating acute myocardial infarction in the elderly: predictors of long-term survival.

BACKGROUND: Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI), associated with a high mortality. A significant improvement in survival has been reported with immediate coronary revascularization. However, there is no clear evidence of such an improvement amongst older patients. The aim of our work was to evaluate in-hospital and long-term outcomes in the group of elderly AMI patients with CS (≥75 years old). METHODS: We collected data of 157 consecutive AMI patients with CS who underwent percutaneous coronary intervention (PCI) and compared clinical and procedural characteristics and in-hospital and long-term outcomes between patients <75 years and patients ≥75 years old. RESULTS: There were 58 patients (36.9%) with age ≥75 years and 99 patients (63.1%) with age <75 years. Patients were followed up for an average period of 34 months (range 5-69). In-hospital and long-term mortality was significantly higher in the older group (55 vs. 25%, P < 0.0001; and 62.1 vs. 37.3%, P = 0.005, respectively). Multivariate predictors of in-hospital mortality were age ≥75 years (hazard ratio 1.81, 95% CI 1.006-3.27, P = 0.04) and PCI failure (hazard ratio 2.67, 95% CI 1.34-5.307, P = 0.005), whereas, the only multivariate predictor of long-term mortality was PCI failure (hazard ratio 2.88, 95% CI 1.52-5.46, P = 0.001). Age ≥75 years showed only a trend toward statistical significance (hazard ratio 1.62, 95% CI 0.96-2.76, P = 0.07). CONCLUSIONS: In elderly AMI patients with CS, PCI can be performed with an acceptable risk that seems lower than that reported in most previous studies.

Risk factors for upper extremity musculoskeletal symptoms among call center employees.

OBJECTIVES: To investigate the prevalence of musculoskeletal symptoms in the upper extremity (UE) in a sample of Italian call center (CC) operators, and the relationship between the symptoms and potential workplace risk factors. METHODS: During 2005-2006, 775 workers from seven CCs in the Turin area participated in a questionnaire survey of exposure to ergonomic, organizational and psychosocial factors at work, socio-demographics, lifestyle, symptoms and diseases. Musculoskeletal symptoms were defined as self-reported musculoskeletal symptoms in the UE during the previous 28 days, for which a physician was consulted and/or drugs were taken. Relative risks were estimated through Poisson regression models with the Huber-White sandwich estimator of variance. RESULT: Overall, 45% of workers reported UE symptoms in the last four weeks. Symptoms in the neck were the most prevalent (39%), followed by the shoulder (22%), hand-wrist (10%) and elbow (4%). Among workplace risk factors, neck-shoulder symptoms were associated with low job control, elevated noise, poor desk lighting and impossibility to lean back while sitting; whereas elbow-hand/wrist symptoms were associated with short intervals between calls, insufficient working space, lack of forearm support, job insecurity and long seniority in the CC industry. CONCLUSIONS: The high prevalence of UE symptoms in this sample was similar to that reported by other studies conducted in this industry. Our results confirm previously reported associations, such as poor characteristics of the workstation and psychological stressors. The striking difference between the set of risk factors for neck-shoulder and elbow/wrist-hand symptoms indicates that the two regions should be investigated separately.

[MADEsmart: a web-based system for accessing data and healthcare indicators]. / MADEsmart: un sistema in ambiente web per l'accesso dinamico a dati e indicatori sanitari.

Methods for accessing information have evolved making thus possible the planning of a new generation of web applications. In the Piemonte region, tools for accessing demographic data and main health and epidemiologic indicators are available since several years. A new application named MADEsmart (from the Italian for "Engine for demographic and epidemiological analysis") provides various functions that allow the user to obtain information useful for creating health reports and health profiles at the subregional level.

Epidemiology and costs of herpes zoster: background data to estimate the impact of vaccination.

In 2004, we conducted a study in Piemonte (Italy), in order to describe incidence, treatment, hospitalizations and costs of herpes zoster (HZ), in population over 14 years of age. Twenty-four regional general practitioners, with 26,394 patients >14 years in charge (0.71% of the regional population), reported prospectively all diagnosed HZ cases. In addition, all regional hospital discharge records were reviewed. Forty-six HZ cases treated at home were reported, accounting for a total incidence of 1.74 cases/1000 population >14 years per year. HZ rate standardized by age on regional population 14 years older is 1.59/1000. The cost per observed home case was 136.06 euros. The incidence of hospital admissions was 0.12/1000 inhabitants. The mean cost of hospitalized cases was 4082.59 euros. These results contribute to depict the impact of HZ in the general population, and to provide background data for setting-up either mathematical models aimed to estimate the impact of vaccination on HZ, and the cost-benefit analyses of various preventive and therapeutic scenarios.

Relation of QRS duration to mortality in a community-based cohort with hypertrophic cardiomyopathy.

A prolonged QRS duration on the standard electrocardiogram is associated with an increased risk of cardiovascular death in cardiomyopathies of different origin. However, the relation between QRS duration and prognosis in hypertrophic cardiomyopathy (HC) remains undefined. We assessed the relation between QRS duration and cardiovascular death in 241 consecutive patients with HC. The study cohort was divided into 2 groups according to QRS duration: <120 and > or =120 ms. Of the 241 patients, 191 (79%) had a QRS duration <120 ms and 50 (21%) a QRS duration > or =120 ms. During a mean follow-up of 7.9 +/- 5.1 years, 35 patients died of cardiovascular causes related to HC. Of these 35 patients, 13 (6%) had a QRS duration <120 ms and 22 (43%) had a QRS duration > or =120 ms (p <0.01). Risk of cardiovascular death was significantly higher in patients with a QRS duration > or =120 ms than in those with a QRS duration <120 ms (relative risk 5.2, p <0.0001). At 8-year follow-up, cumulative risks of HC-related death were 7.1% in patients with a QRS duration <120 ms and 55% in those with a QRS duration > or =120 ms. Multivariate analysis confirmed that a QRS duration > or =120 ms was independently associated with an increased risk of cardiovascular death (hazard ratio 3.2, p = 0.007). New York Heart Association functional class III/IV was the only other clinical variable significantly and independently associated with an increased risk of cardiovascular death. In conclusion, in patients with HC, QRS duration on standard electrocardiogram is directly related to cardiovascular mortality, and a QRS duration > or =120 ms is a strong and independent predictor of prognosis.

Statins prescribing for the secondary prevention of ischaemic heart disease in Torino, Italy. A case of ageism and social inequalities.

BACKGROUND: Socio-demographic and clinical characteristics can influence statins prescribing for the secondary prevention of ischaemic heart disease (IHD). We studied the determinants of the prescription of statins in people with IHD in a population in Italy, the country with the lowest prescribing rate in Europe. METHODS: All 2001/2002 residents in Torino, aged 30-85 years, with a hospital discharge diagnosis of IHD were linked to the regional Database of Drug Prescriptions to identify those persons who, within 3 months after discharge, had been prescribed statins. Log-binomial models were used to test statins prescription associations with clinical and socio-demographic characteristics. RESULTS: Statins were prescribed to 31.0% of 7446 patients. Among persons >74 years of age, the prescription rate was 40% lower than that found for younger persons. A positive association was also found for: female gender, being married, a main discharge diagnosis of acute myocardial infarction, revascularization, diabetes and discharge from a cardiology ward. Age was an important effect modifier of the relationship between the prescribing rate and social, but not clinical, determinants. CONCLUSIONS: The prevention of IHD with statins is influenced by age, clinical and social factors. The prescribing rate is higher among population groups for whom statins are of proven efficacy. Among patients for whom the efficacy is uncertain, the decision to prescribe is influenced by non-clinical factors, suggesting that there exist both age-based and social-based mechanisms of rationing. Age and social determinants act in concert to further reduce the propensity of physicians to prescribe statins.

[Use of ISTAT mortality records for follow up study and local mortality data base]. / Archivi nominativi di mortalità ISTAT per studi di sopravvivenza e per registri nominativi delle cause di morte: valore d'uso e metodi di linkage.

The aim of the present study is to assess the quality of the variables "name" and "surname" recorded in the mortality records that the Italian Institute of Statistics (ISTAT) releases to its regional offices since 1999. These records could both constitute a regional mortality database in those regions that do not have one, and be a useful tool for ascertainment of vital status in follow-up studies. The study was conducted in Turin, North West Italy, through record linkage between ISTAT database and the local population register that records all deaths occurred among residents. This was considered as the gold standard. Firstly the concordance of name and surname was studied; this was 92% if the full length of name and surname was used raising to 97% using substrings of the two information. Secondly the cohort of 1999-2001 residents in Turin was linked to the ISTAT database using a four step record linkage with four different keys. 94,3% of subjects were correctly found. Within those not linked there was a higher proportion of subjects born abroad, women, young and unmarried. We conclude that the quality of ISTAT database should be further improved before implementing its use for follow-up studies.

New trends in the epidemiological and clinical features of infective endocarditis: results of a multicenter prospective study.

BACKGROUND: The clinical and epidemiological profiles of infective endocarditis (IE) are continuously evolving. We report the results of a 2-year multicenter prospective survey that investigated new trends in the epidemiology, microbiological and clinical features and the prognosis of IE. METHODS: From January 2000 through December 2001, a prospective multicenter survey on IE was conducted in the region of Piedmont, Italy (4.2 million inhabitants). RESULTS: A total of 267 patients with suspected IE were enrolled, of whom 147 received a definite diagnosis of IE, as confirmed by pathology or follow-up data. The annual estimated incidence of IE was 36 cases per 1 million inhabitants in urban Turin and 30 cases per 1 million inhabitants in the province of Turin. A predisposing heart disease was detected in 70.8% of cases, with prosthetic valve involvement in 27 (18%). The incidence of injection drug use was 10%. Twenty-two cases (15%) were related to invasive procedures. Causative microorganisms included: streptococci 37.4% (oral streptococci 17.7%, group D streptococci 9.5%, pyogenic streptococci 3.4%, enterococci 6.8%), staphylococci 34%, other pathogens 28.5%. Blood cultures were negative in 25% of cases. The mean time between symptom onset and hospital admission was 39.7 days; this interval was shorter and associated with a poorer prognosis in cases of IE due to Staphylococcus aureus infection (p < 0.001). The delay in carrying out echocardiographic and blood culture evaluation often led to a late diagnosis as defined by the Duke criteria (8.2 +/- 7.4 days after admission). Valve surgery was performed in 31% of patients. The in-hospital mortality was 14% and that at 3 months 18%. CONCLUSIONS: In Piedmont, the incidence of IE is similar to the rates reported in other recent series. Still, the diagnosis and management of IE remain a challenge. The variegated clinical manifestations of IE and its changing epidemiology require constant surveillance.

[Description of home accidents in Piedmont based on current information sources]. / Descrizione degli incidenti domestici in Piemonte a partire dalle fonti informative correnti.

OBJECTIVE: To analyse data from existing sources to assess the distribution over space and time of home accidents in Piedmont. DESIGN: Analysis of distribution of causes of hospitalisation and deaths following a home accident. SETTING: For non-fatal accidents, we reviewed the database of hospital discharge records (HDR), which includes data from all hospitals in the region. For fatal accidents, we reviewed the data on deaths provided by the Italian National Institute of Statistics (ISTAT). PARTICIPANTS: All patients hospitalised for "home accidents" for the period 1999-2001 and deaths due to "external causes of injury and poisoning" and from these excluded transport accidents, homicides, and suicides for the period 1982-1999. RESULTS: The most commonly reported reasons for hospitalisation following a home accident were: fracture for 15-64 year-old age-group and for persons aged 65 years or more (60.7% and 86% respectively) and intracranial transmatism for 0-14 year-old age group (33%). Regarding fatal accidents, the mortality rate per 100,000 was 3.6 among 0-14 year-olds, and 145.1 among the persons aged 65 years or more. The most common cause of death was chocking for 0-14 year-old age-group and falls for the person aged 65 years or more (32.2% and 86.3% respectively). There is an excess of mortality in the geographical areas of Western Alps of Piemonte. CONCLUSION: In Piedmont, existing sources can be used to estimate the distribution of the most serious home accidents i.e., those resulting in hospitalisation or death. The sources we reviewed in this study are, at the moment, the only ones available to quantify and describe the phenomenon over space and time.