[Incidence and risk factors for accidental falls among general practice elderly patients in Latina, Central Italy]. / Incidenza e fattori di rischio delle cadute accidentali in un campione di anziani assistiti da MMG nella provincia di Latina.

BACKGROUND: falls incidence in home resident elderly people varies from 30% to 40%. Falls induce loss of self-sufficiency and increase mortality and morbidity. OBJECTIVES: to evaluate falls incidence and risk factors in a group of general practice elderly patients. DESIGN: prospective cohort study with 1 year follow-up. METHODS: 18 practitioners visited their elderly patients (>75 years) for a baseline assessment. Information on current pathologies and previous falls in the last six months was collected. Functional status was evaluated using: Short Portable Mental State Questionnaire, Geriatric Depression Scale, Activities of Daily Living, Instrumental Activities of Daily Living. Total mobility Tinetti score was measured in a subgroup of elderly. Falls were monitored through 2 phone-interviews at 6 and 12 months. Data were analyzed through logistic regression. RESULTS: 1168 elderly were visited and 800 were enrolled in the study. Twenty-eight percent of the elderly fell in the whole period. Sixty percent of falls were not reported to the practitioner. Independent predictors for falls were ADL score (ADL<5: OR 1.90; 95% CI 1.05-3.45), falls occurred in the 6 months previous to the follow-up period (OR 1.62; 95% CI 1.03-2.54) and the interaction term among this factor and the follow-up period (OR 2.39; 95% CI 1.22-4.72). Tinetti score was significantly associated to falls only in univariate analysis. CONCLUSIONS: Practitioners can play a key-role in identifying at-risk subjects and managing prevention interventions. Falls monitoring and a continuous practice of comprehensive geriatric assessment should be encouraged.

Pressure ulcer risk in long-term units: prevalence and associated factors.

AIM: This paper is a report of a study to assess pressure ulcer prevalence in a group of long-term units and to describe the main factors associated both with risk for and presence of a pressure ulcer. BACKGROUND: Despite being potentially preventable, pressure ulcers are highly frequent among institutionalized patients and are associated with increased morbidity and mortality. METHOD: A cross-sectional study was carried out, involving 571 patients from 10 long-term units in Rome, Italy. Healthcare staff in each unit evaluated pressure ulcer risk and collected clinical data while a single Registered Nurse assessed all patients to identify pressure ulcers. Univariate and multivariate analyses were performed for the two outcomes: condition at risk for pressure ulcers (Braden score < or = 16) and pressure ulcer presence. The data were collected in February-March 2005. FINDINGS: The overall prevalence of pressure ulcers was 27%. Multivariate analysis showed a statistically significant positive association between high-risk condition of pressure ulcer and previous stroke (OR = 1.96; 95% CI 1.30-2.96), previous trauma (OR = 1.83; 95% CI 1.12-2.99) and cognitive decline (OR associated with a 1 point Short Portable Mental State Questionnaire increase = 1.26; 95% CI 1.05-1.50). The model for pressure ulcer presence confirmed a statistically significant excess in patients with cardiovascular diseases (OR = 1.79; 95% CI 1.13-2.85), with high Activity of Daily Living scores (OR associated with a 1 point increase 1.38; 95% CI 1.03-1.84) and low Braden Scale scores (OR associated with a 1 point increase = 0.80; 95% CI 0.70-0.87). The risk of pressure ulcers according to number of full-time nurses and auxiliary staff per 10 beds lower than five was marginally statistically significant (OR = 1.60; 95% CI 0.98-2.61). CONCLUSION: Further research is needed to validate our findings and further prospective research is needed to identify ways of preventing pressure ulcers. Our data on staffing suggest that organizational factors should be taken into account when exploring determinants of pressure ulcers.

[Epidemiology of HIV infection in Italy]. / Epidemiologia dell'infezione da HIV in Italia.

AIDS surveillance systems, which have provided for many years useful information on HIV epidemic dynamics, are no longer useful for estimating the evolution of the HIV epidemic due to the effect of anti-retroviral treatments that have strongly improved survival of HIV-infected persons. To obtain reliable data on the HIV epidemic, some Italian provinces and regions (Lazio, Veneto, Friuli Venezia-Giulia, Trento, Modena) have set up local surveillance systems of the new HIV diagnoses. Aggregated data collected by these systems since 1988, show that the rapid spread of the infection in the eighties has been followed by a progressive decrease in the number of new diagnoses during the nineties; in more recent years this trend has levelled-off. The composition of cases by exposure category has greatly changed over time: in 1988 75.2% of cases were injecting drug users, whereas in 2000 58.5% of cases acquired the infection through sexual contacts. HIV incidence for the considered areas decreased from 19.2 per 100.000 inhabitants in 1992, to 6.7 per 100.000 inhabitants in 2000. Median age at diagnosis increased over time, from 27 years in 1988 to 34 years in 2000. The changed pattern of the HIV epidemic in Italy stresses the need of a nation-wide surveillance system for HIV infections aimed at allocation of adequate economic resources and planning specific prevention programmes.