Total parenteral nutrition is associated with worse hospital outcomes among elderly diabetic patients: a propensity score matched analysis on discharge records.

Background: Recent trials and reviews have raised question about the safety of total parenteral nutrition (TPN), due to the increased rate of TPN related complications. Diabetic patients are vulnerable to hyperglycaemia, and poor studies have investigated hospital out-comes of diabetic patients requiring TPN. The aim of this study was to evaluate the association of in-hospital mortality, prolonged length of stay and transfer to long-term care facilities among diabetic patients with TPN. Methods: The study considered all hospital admissions of diabetic patients over 65 years of age performed between 2006 and 2015 in Abruzzo Region, Italy. To compare the outcomes of TPN and non-TPN patients, a propensity score matching procedure was performed. Results: A total of 140,556 admissions were analyzed. After matching, 1947 patients were included into the analyses: 649 patients with TPN and 1298 controls. TPN was significantly associated to in-hospital mortality (OR=7.15; 95%CI 5.54-9.22), prolonged LOS (OR=2.78; 95%CI 2.28-3.38) and transfer to LTCF (OR=2.16; 95%CI 1.64-2.85). Discussion: TPN is associated with poor outcomes among elderly diabetic patients in the Italian setting. Being aware of the risk factors among diabetic patients with TPN can be used to anticipate the patients' needs during the admission and the immediate post-discharge period.

Predictors of Prolonged Hospitalization and In-Hospital Mortality After Hip Fracture: A Retrospective Study on Discharge Registry.

Background: Hip fracture injury is one of the principal health problems affecting the elderly. Patients reporting hip fractures often show relevant comorbidities leading to prolonged hospital stay, significant complications and higher mortality rates. This study aims to assess the risk factors associated with prolonged hospitalization after hip fracture, in-hospital mortality and transfers to other facilities. Study design: Retrospective cross-sectional study. Methods: The study considered all admissions performed between 2006 and 2015 in Abruzzo region, Italy. Logistic regression analyses were performed to evaluate odds ratios for each risk factor as predictor of in-hospital mortality, length of stay, and transfer to other facilities. Results: Age over 85 (OR=5.38) and cancer (OR=3.62) were identified as the strongest risk predictors for in hospital mortality; diabetes (OR=2.24) and heart failure (OR=1.57) were identified as predictors of prolonged length of stay and age over 85 (OR=1.38) and atrial fibrillation (OR=1.69) were identified as predictors of transfer to other facilities. Conclusions: With the rising incidence of hip fractures, identification of modifiable factors may help to reduce morbidity and mortality.

Vitamin D Deficiency as a Predictive Factor of Transient Hypocalcemia after Total Thyroidectomy.

BACKGROUND: Total thyroidectomy (TT) is recommended in the treatment of malignant and benignant thyroid diseases, and, to date, transient hypocalcemia is the most frequent complication after the procedure. We prospectively evaluated the role of vitamin D deficiency as a predictor of postoperative hypocalcemia. METHODS: This is a prospective cohort study which was conducted between January 2016 and April 2019. A total of 177 consecutive patients (141 (79.7%) women and 36 (20.3%) men) who underwent TT were included in the current study. Hypocalcemia occurred when serum calcium levels were below 8.0 mg/dL or 1.10 mmol/L. Patients were divided into two groups (Group 1, normocalcemic; Group 2, hypocalcemic) and were assessed taking into consideration preoperative serum 25-hydroxy vitamin D (25-OHD) levels, preoperative serum calcium levels, thyroid hormone levels, sex, body mass index (BMI), and smoking habits. Vitamin D deficiency was defined as 25-OHD levels <25 ng/mL. RESULTS: The incidence of postoperative asymptomatic and symptomatic hypocalcemia in the two groups was 19.8% and 15.8%, respectively. Preoperative 25-OHD level was significantly different between Group 1 and Group 2 (31.5 ± 15.0 ng/mL vs 18.7 ± 9.8 ng/mL,p=0.017). Logistic regression analysis revealed that preoperative vitamin D deficiency was a significant predictive factor of postoperative hypocalcemia (p=0.012), and, specifically, the risk of hypocalcemia increased 15-fold in patients with a preoperative vitamin D level <25 ng/mL (odds ratio [OR], 14.8). CONCLUSIONS: Postoperative hypocalcemia is significantly associated with low preoperative levels of serum 25-OHD. Our studies demonstrate that vitamin D deficiency (<25 ng/mL) is an independent predictive factor of postoperative hypocalcemia.

The Revolving Door Phenomenon: Psychiatric Hospitalization and Risk of Readmission Among Drug-Addicted Patients.

BACKGROUND: Substance use may influence the onset and course of psychiatric diseases. The "Revolving door" (RD) phenomenon, which indicates repeated hospitalizations of the same patients, has become a public health. OBJECTIVES: The aim of this study was detecting the risk factors associated to hospital readmission to psychiatric wards of drug-addicted patients. METHODS: The study considered all the admissions performed between 2006 and 2015 in Abruzzo, Italy. Only the hospital discharge registry having code 304 (drug dependence) as diagnosis was taken into account. In addition, only the patients with a psychiatric DRG were included. RESULT: 325 patients performed 558 psychiatric admissions during the study period (1089 person-years). The analyses of the discharge registry showed "Psychoses" as the main DRG (73.2%). An amount of 119 patients experienced a second psychiatric admission. Psychiatric readmissions were independently predicted by Schizofrenia (HR=2.061) and Anxiety disorders (HR=0.326). CONCLUSION: Psychiatric hospitalization and readmission are frequent among drug-addicted patients. The subsequent RD phenomenon has become a public health issue, both for health and economic sides.

Trend in Hospital Admissions of Drug Addicts and Associated Factors from 2006 to 2015: an Observational Study on the Hospitals' Discharge Registries from a Region of Central Italy.

BACKGROUND: Several social, economic and political factors have contributed to the global spread of alcohol and other drugs. Drug addiction represents a huge expense for the society in terms of direct and indirect health and social consequences, as it is associated with numerous medical issues such as HIV, other infections and psychiatric disturbances. OBJECTIVES: The aim of this study was the assessment of the hospital admissions among drug addicted patients in Abruzzo Region, central Italy, from 2006 to 2015, in order to clarify the specific causes of hospitalization. METHODS: Data were collected from all hospital discharge records, taking into account only the hospital discharge registrations coded 304 (drug dependence). Multivariate logistic regression was performed to evaluate factors associated with main causes of the admission. RESULTS: Between 2006 and 2015, an amount of 2,159 drug-addicted subjects, aged 38.0±9.7 years, were admitted to hospital. Most of the admissions occurred in public hospitals (2,039, 94.4%), through the emergency room access (1,503, 69.6%) From an amount of 2,159 hospitalizations, 1,178 (54.6%) were first and 981 (45.4%) were subsequent admissions. The most frequent cause of hospitalization was "Psychosis" (419, 19.4%). The trend by range of age showed a progressive reduction in hospital admissions for patients aged < 45 y. Further, an increase in the hospitalization rate was estimated over recent years among drug addict subjects aged 25-45 years. Cannabis consumption was associated with mental disorder admissions (OR: 3.16, p<0.001), opioid consumption was associated with hepatic disorder admission (OR:2.16, p<0.001) and cardiovascular admissions (OR: 1,78, p<0.001), and cocaine was associated with cardiovascular admissions (OR:1,55, p:<0.001). CONCLUSIONS: Mental disorders result to be the leading cause of hospitalization among drug-addicts, principally associated with cannabis abuse. Opioid and cocaine abuse was associated with hepatic and cardiovascular disorders.

The Clean Care Contest: promoting hand hygiene among healthcare and medical students.

INTRODUCTION: Despite continuing efforts, compliance rates and knowledge of best practices in hand hygiene remain disappointing. Recognizing that conventional educational tools seem out of touch with young people and that the med and messages contents need refreshing, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health devised a novel approach to promote the creation of innovative educational tools for improving knowledge of, and compliance with, hand hygiene rules among healthcare and medical students. METHODS: A contest in creating educational material on hand hygiene practices involved university students of nursing and medicine, and of other healthcare degrees. Students from the universities of the GISIO network were invited to create educational material (e.g., videos, posters, presentations, leaflets, and screensavers) to be presented by May 5th 2019 during the World Hand Hygiene Day / Save Lives: Clean Your Hands Global Annual Initiative of the World Health Organization). A local and a national winners were awarded. RESULTS: Three different local and national contests were performed during 2016, 2017 and 2018. During the three-year period, more than 270 educational tools have been developed: 130 (48%) were judged useful for hand hygiene promotion campaigns. The most frequent projects participating in the contests were videos (39%), posters (29%), leaflets (14%), and others (18%) submitted by more than 1,500 students of nursing (40%), medicine (31%), dentistry (7%), and of other healthcare courses in 14 universities. Products were evaluated by a local committee and, subsequently, local winners represented their University in a national contest. CONCLUSIONS: The contest provided a framework for the creation of innovative and potentially effective educational tools via an engaging approach that leveraged student creativity. Given the need to improve compliance rates, this study suggests that new ways can be advantageously explored to teach hand hygiene procedures and increase awareness of the importance of their consistent use among healthcare and medical students.

Impact of reimbursement limits on patient access to direct-acting antivirals in Italy: analysis of data from national registries.

OBJECTIVE: Hepatitis C virus (HCV) infection is a global epidemic, still highly prevalent in Europe. Given efficacy and safety of HCV therapy by Direct Antiviral Agents (DAA), World Health Organization called for actions to eliminate HCV infection. A limit is represented by access to care, mostly due to the high costs of medicines. In Italy, in 2015, the access to DAA therapy was reimbursed for patients with advanced disease, whereas in 2017 universal access was granted. The aim of this study was to analyse changes in patient recruitment trends treated with DAA with or without limitations to access to therapy. PATIENTS AND METHODS: 165,105 patients treated with DAA in Italy from 2015 to December 2018 were analysed. Daily patient treatment rate was obtained by segmented regression of interrupted time series analysis. RESULTS: 74,199 patients with advanced disease (62% with cirrhosis) had access to the therapy during the time period from 2015 to 2017. Following the extension of reimbursement criteria, 90,906 additional patients were treated (43.2% with F0-F1 and 22.9% with F2), with an absolute reduction of 59.9% of patients with advanced disease (cirrhosis decreased to 18.5%). Segmented regression of interrupted time series analysis of daily patient treatment rate showed a progressive reduction of patients with advanced disease, offset by those with initial disease. Notably, elimination of restrictions to therapy did not change the overall treatment rate. CONCLUSIONS: This study showed that a no-limit reimbursement policy for DAAs prescriptions to HCV infected individuals in Italy widened the types of treated patients, but the process towards elimination of HCV infection was not significantly changed.

Predictors and Trend of Ketoacidosis Hospitalization Rate in Type 2 Diabetes Mellitus Patients from 2006 to 2015 in Abruzzo Region, Italy.

AIMS: This study aimed to assess the trend of hospitalizations for DKA in adult patients with type 2 diabetes mellitus and its associated factors. DESIGN: A retrospective cross-sectional study was performed. Data were collected from hospital discharge records (HDRs) of patients (age ≥18) with either primary or secondary discharge diagnosis for DKA and type 2 diabetes from 2006 to 2015 in Abruzzo region. Age-adjusted hospitalization rates were computed by gender and standardized on the regional population in 2006. A logistic regression model was implemented using presence of DKA as dependent variable. RESULTS: We identified 160,366 HDRs with type 2 diabetes. Out of them, 1611 (1.00%) were due to DKA. The hospitalization rates for DKA increased both for male +115.9 and female +142.8%, from 2006 to 2015. The most significant predictors of DKA were age 18-44 (aOR=4.17), uncontrolled diabetes (aOR=1.79), trauma (aOR=1.38), any infection (aOR=1.68), liver disease (aOR=1.29), fluid and electrolyte disorders (aOR=2.09), psychosis (aOR=1.69). CONCLUSIONS: Trends of DKA in adult patients with type 2 diabetes has been increasing in both male and female. Multimorbidity is an open challenge for public health, therefore better coordination is needed among different specialist consultants to reduce the occurrence of this preventable complication.

Risk of atrial fibrillation among bisphosphonate users: a multicenter, population-based, Italian study.

UNLABELLED: Bisphosphonate treatment is used to prevent bone fractures. A controversial association of bisphosphonate use and risk of atrial fibrillation has been reported. In our study, current alendronate users were associated with a higher risk of atrial fibrillation as compared with those who had stopped bisphosphonate (BP) therapy for more than 1 year. INTRODUCTION: Bisphosphonates are widely used to prevent bone fractures. Controversial findings regarding the association between bisphosphonate use and the risk of atrial fibrillation (AF) have been reported. The aim of this study was to evaluate the risk of AF in association with BP exposure. METHODS: We performed a nested case-control study using the databases of drug-dispensing and hospital discharge diagnoses from five Italian regions. The data cover a period ranging from July 1, 2003 to December 31, 2006. The study population comprised new users of bisphosphonates aged 55 years and older. Patients were followed from the first BP prescription until an occurrence of an AF diagnosis (index date, i.e., ID), cancer, death, or the end of the study period, whichever came first. For the risk estimation, any AF case was matched by age and sex to up to 10 controls from the same source population. A conditional logistic regression was performed to obtain the odds ratio with 95% confidence intervals (CI). The BP exposure was classified into current (<90 days prior to ID), recent (91-180), past (181-364), and distant past (≥365) use, with the latter category being used as a reference point. A subgroup analysis by individual BP was then carried out. RESULTS: In comparison with distant past users of BP, current users of BP showed an almost twofold increased risk of AF: odds ratio (OR) = 1.78 and 95% CI = 1.46-2.16. Specifically, alendronate users were mostly associated with AF as compared with distant past use of BP (OR, 1.97; 95% CI, 1.59-2.43). CONCLUSION: In our nested case-control study, current users of BP are associated with a higher risk of atrial fibrillation as compared with those who had stopped BP treatment for more than 1 year.

Deregulation of DNA-dependent protein kinase catalytic subunit contributes to human hepatocarcinogenesis development and has a putative prognostic value.

BACKGROUND: The DNA-repair gene DNA-dependent kinase catalytic subunit (DNA-PKcs) favours or inhibits carcinogenesis, depending on the cancer type. Its role in human hepatocellular carcinoma (HCC) is unknown. METHODS: DNA-dependent protein kinase catalytic subunit, H2A histone family member X (H2AFX) and heat shock transcription factor-1 (HSF1) levels were assessed by immunohistochemistry and/or immunoblotting and qRT-PCR in a collection of human HCC. Rates of proliferation, apoptosis, microvessel density and genomic instability were also determined. Heat shock factor-1 cDNA or DNA-PKcs-specific siRNA were used to explore the role of both genes in HCC. Activator protein 1 (AP-1) binding to DNA-PKcs promoter was evaluated by chromatin immunoprecipitation. Kaplan-Meier curves and multivariate Cox model were used to study the impact on clinical outcome. RESULTS: Total and phosphorylated DNA-PKcs and H2AFX were upregulated in HCC. Activated DNA-PKcs positively correlated with HCC proliferation, genomic instability and microvessel density, and negatively with apoptosis and patient's survival. Proliferation decline and massive apoptosis followed DNA-PKcs silencing in HCC cell lines. Total and phosphorylated HSF1 protein, mRNA and activity were upregulated in HCC. Mechanistically, we demonstrated that HSF1 induces DNA-PKcs upregulation through the activation of the MAPK/JNK/AP-1 axis. CONCLUSION: DNA-dependent protein kinase catalytic subunit transduces HSF1 effects in HCC cells, and might represent a novel target and prognostic factor in human HCC.

Changes in the carpal tunnel while wearing the Manu® soft hand brace: a sonographic study.

We studied the effect of the Manu(®) soft hand brace, which has been designed to relieve median nerve entrapment in carpal tunnel syndrome. An observational, controlled study was conducted in 10 participants, five with bilateral carpal tunnel syndrome and five controls, using sonography to study changes in the dimensions of the carpal tunnel before and while wearing the brace. An increase in transverse diameter, thinning of the flexor retinaculum, and displacement of the proximal insertion of the lumbrical muscle to the middle finger from the edge of the carpal tunnel were observed in patients while wearing the brace. The changes in the morphology of the carpal tunnel while wearing the Manu(®) support its use as an alternative to a night wrist splint.

Assessing the risk of osteonecrosis of the jaw due to bisphosphonate therapy in the secondary prevention of osteoporotic fractures.

SUMMARY: There is evidence that the use oral bisphosphonates can lead to osteronecrosis of the jaws (ONJ). Although the occurrence of ONJ appears rare among oral bisphosphonates (BPs) users, it is important to know that it exists and can be opportunely minimized. INTRODUCTION: The purpose of this study is to evaluate the association between BPs prescribed for the secondary prevention of osteoporotic fractures and the occurrence of ONJ. METHODS: An Italian record linkage claims database with a target population of around 18 million individuals (6 million over 55 years of age) constituted the data source. We conducted a nested case-control study within a cohort of individuals aged 55+ years old, who were discharged from hospitals with a primary diagnosis of incident osteoporotic fracture. The date related to the discharge diagnosis of ONJ was the index date. Conditional logistic regression for matched data was fitted to estimate the odds ratio (OR) along with 95 % confidence intervals (95 % CI) for the likely association between use of BPs and the risk of ONJ. RESULTS: Any one of the 61 ascertained cases of ONJ (incidence rate, 36.6 per 100,000 person-years) was matched to 20 controls for a total of 1120 controls. When the exposure to BPs was modeled according to recency (i.e., exposure time window prior to the index date) of use, the adjusted OR (95 % CI) for current users was 2.8 (1.3-5.9) against never users. The cumulative use of BPs has shown to increase the incidence of ONJ among patients with primary osteoporotic fractures, although not statistically significant risk has been observed. CONCLUSIONS: Although the risk of BP-related ONJ appears low in non-oncological indications, it is important to be aware that it exists and to know how it may be predicted and possibly minimized.

Origin, evolution and paleoepidemiology of brucellosis.

Brucellosis is a worldwide disease. Although it has been eradicated in some countries, it continues to be an important disease in many farming areas. Previous works have described the evolution and diffusion of brucellosis in antiquity through direct analysis of ancient human remains collected by the University Museum of Chieti, Italy, and by using paleopathological and historical data. The earliest published case was reported in a skeletal individual dated to the Middle Bronze Age. However, our research group has diagnosed vertebral brucellosis in the partial skeleton of the late Pliocene Australopithecus africanus, demonstrating that this infectious disease occasionally affected our direct ancestors 2·3-2·5 million years ago. The frequency of brucellosis increased during the Roman period, when the disease would almost certainly have been endemic in Roman society, and during the Middle Ages. Most paleopathological cases involve adult male skeletal individuals, and lumbar vertebrae and sacroiliac joints are most commonly involved.

Efficacy of a soft hand brace and a wrist splint for carpal tunnel syndrome: a randomized controlled study.

OBJECTIVE: To examine, in a randomized, controlled, single blinded trial, the efficacy of a soft hand brace and a wrist splint for carpal tunnel syndrome (CTS). METHODS: We randomized 120 patients with CTS into a group wearing the soft hand brace MANU and into another group wearing the wrist splint CAMP TIELLE at night for 3 months. We re-evaluated the patients after 3 (T1) and 9 months (T2). The primary efficacy measures were changes in scores of Boston Carpal Tunnel Questionnaire (BCTQ) and in Visual Analogical Scale (VAS) for pain and paresthesias. RESULTS: At T1, both groups showed a significant reduction in symptomatic and functional BCTQ (T0-T1 differences: MANU BCTQ sympt: 0.88 (0.68-1.08), funct: 0.45 (0.19-0.72); TIELLE BCTQ sympt: 0.78 (0.55-1.01), funct: 0.41 (0.22-0.59). At T2, a less evident benefit on symptoms persisted in both groups, except for pain VAS score that was significantly reduced only in the CAMP TIELLE group. No significant functional benefits persisted in either group. There were no differences in BCTQ and VAS scores between the two groups at T1 and T2 compared with that at baseline. CONCLUSIONS: A 3-month treatment with either the hand brace or the wrist splint induces a symptomatic and functional benefit in patients with CTS.

[Epidemiology of hospital loads in patients with multiple hospitalizations due to diabetes]. / Epidemiologia dei carichi assistenziali ospedalieri in pazienti con ricoveri ripetuti per diabete.

This study describes the results of a retrospective study carried out to evaluate the hospitalizations of patients with type 2 diabetes admitted from January to June 2001 in the teaching hospital "SS. Annunziata" of Chieti. This research evaluates the generic appropriateness using the PRUO manual and the specific appropriateness using the guidelines approved by Italian Diabetes Association, Italian Diabetes Society and Italian College of General Practitioners. A sample of 196 medical charts was examined. The percentage of inappropriate admission was 21.9%. The "critical" clinical conditions of patients were responsible for only 23.7% of inappropriate admissions. The first reason of the inappropriateness of the admission was the execution of diagnostic examinations (60.5%), followed by the execution of medical therapy (23.2%) and waiting for surgical intervention (16.3%). 46.5% of inappropriate hospitalization was prescribed by specialists. Concerning specific appropriateness, 42.3% of hospitalization was inappropriate. These findings suggest that a system for the assessment of disease management of diabetes should be started up in the Abruzzo region. Moreover, guidelines utilization should be implemented in order to get a more correct utilization of acute hospital by specialists and GPs.

[Prevalence of obesity, overweight and hypertension in children and adolescents from Abruzzo, Italy]. / Prevalenza di obesità, sovrapeso e ipertensione nei bambini e adolescenti della provincia di Pescara.

The present survey was aimed at determining the prevalence of overweight, obesity, hypertension, their correlation and the association with gender, age and provenience, in the pediatric population of Pescara province, Italy. During the academic year 2001-2002, the body mass index (BMI) and blood pressure of 15.612 scholars aged 6-14 years (mean age 9.9), coming from all province schools, have been measured. Two scales have been used to define obesity and overweight status (one developed by the National Center for Health Statistics--NCHS--the other by Cacciari et al.); while hypertension has been attributed using National Institute of Health curves. Several multiple logistic regression models have been fitted to analyze data. According to NCHS standards, the prevalence of childhood and adolescence overweight and obesity was, respectively, 40.6% and 19.5%. Using curves by Cacciari, the prevalence were 33.3% and 7.7%. Hypertensive subjects were 11.1%. With both scales, the prevalence of weight problems widely decreased after 12 years of age, and either obesity or overweight were significantly related with male sex, hypertension and rural area residence. A strong independent association was found between living inside the city and hypertension. Although the differences in the dimension of the problem "overweight" according to the used scale, and a potential overestimation of hypertension must be taken into account, the overall data suggest an urgent need, especially for primary school children, of preventive interventions aimed at reducing both overweight and blood pressure.

Risk of cancer onset in sub-Saharan Africans affected with chronic gastrointestinal parasitic diseases.

Gastrointestinal Schistosomiasis and Amebiasis are uncommon in the western world, while such infections are frequent in the African community. In addition to the problems associated with the clinical symptoms of these parasitic infections, it is important to stress the increase in cancer of the Gastro-Intestinal (GI) tract. In this study we evaluate the prevalence of cancer in patients affected by chronic inflammatory diseases caused by the above named parasites. In three years, from January 2000 to December 2003, we observed a total of 1199 subject. Of these, 950 presented with complaints of diarrhoea, vomiting, abdominal pain, melena, hematemesis, rectal discharges and alteration of bowel habits. A total of 818 patients were evaluated in Uganda (Mulago and Arua hospitals) and 381 at Luisa Guidotti Hospital in Zimbabwe. An exhaustive clinical history was collected for each patient and then physical and laboratory examinations were performed. The clinical files of all patients previously admitted to the respective hospitals were obtained and the information taken from these files was then integrated with our clinical findings. Subjects who were found free of gastro-intestinal disease after examinations and did not have a clinical history of infective GI disease but presented with other pathologies, were regarded as control group. The control group was composed of 249 subjects. The subjects who were positive on examination underwent further investigations. The number of patients affected by schistosomiasis and amebiasis were 221 and 224 respectively. The number of patients who suffered from aspecific enterocolitis was 454, intestinal tuberculosis was present in 21 patients and we found 30 patients with esophageal candidiasis. Patients who had the above mentioned GI diseases were then divided into 3 groups. First group was composed of patients who had a clinical history of infective GI diseases and were re-admitted for similar symptoms, and on examination were positive for the presence of the same infective GI diseases. Such patients were placed in the Chronic group. The second group was formed of patients who had previously undergone treatment for infective GI diseases but on readmission were found free of infective GI disease, and this group was described as the Cured group. They had symptoms associated with other pathologies. A third group, which we described as the Acute group was composed of patients who did not have any previous case of GI infection and were admitted for the first time. Such patients were found positive on examination for infective GI diseases. In the 950 patients, we found a total of 45 tumors. The tumors were prevalent (42 tumors) in the chronic group. In 34 patients the tumor was in the colo-rectal region, in 3 patients in the stomach, in 4 patients in the esophagus and 1 patient had cancer in the small bowel. Our results show a strong association between the chronic infection of the GI tract and the likelihood to develop tumors. However, it is not clear which biological mechanisms are implicated in such transformations. They may depend on the chronic inflammation of the GI mucous which permits the entrance of carcinogenic materials or on the effects of mutagenic products produced by the parasites or both.

Community acquired pneumonia in internal medicine: a one-year retrospective study based on pneumonia severity index.

Community acquired pneumonia (CAP) represents the sixth cause of death and the first cause of death for an infectious disease in the USA. The aim of the present study is to evaluate how CAP is managed in a hospital setting, with particular attention to the wards of internal medicine, compared to the recommendations based and validated PSI (Pneumonia Severity Index). 42 subjects were included in the study, 25 males and 17 females. According to the PSI, nine (21%) patients were classified in class I, two (5%) in class II, ten (24%) in class III, fifteen (36%) in class IV and six (14%) in class V. Three patients died during the stay in the hospital (2 males and 1 female), all in the highest PSI class (V). According to the criteria used to evaluate the adequacy of the admission to the hospital, twentyeight patients were classified in the HRG, with an appropriate admission, whilst fourteen (33%) were in the LRG, with an inappropriate admission to the hospital. The data of the study confirm the validity of a PSI based strategy for the management of CAP since admittance to the hospital. This approach is not yet widely implemented in Italy, and a better dialogue between hospital and health system representatives would be convenient, to reduce costs and ensure the safety of patients affected by CAP.

Smoking behaviour, cessation attempts and the influence of parental smoking in older adult women: a cross-sectional analysis from Italy.

OBJECTIVES: To investigate the association between parental smoking during infancy/adolescence and smoking prevalence in older adult women, and to provide a description of smoking and smoking cessation patterns in this subset of the population. STUDY DESIGN: Cross-sectional survey. METHODS: Between 1999 and 2001, trained physicians in 11 health agencies throughout the Abruzzo Region, Italy, conducted semi-structured interviews on 9708 women aged 50-70 years attending mammographic screening (overall response rate 89%). Information was collected on sociodemographic characteristics, smoking habits, parental smoking during their infancy and/or adolescence, and exposure to environmental tobacco smoke (ETS) inside or outside the family. RESULTS AND CONCLUSIONS: The overall prevalence of current smoking was 15.6% (n=1516), and that of former smoking was 13.2%. Women whose parent(s) smoked were more likely to be current smokers, especially if only the mother smoked (adjusted odds ratio 4.27; 95% confidence interval 2.24-8.12). Other factors significantly associated with current smoking in the multivariate analysis were younger age, lower body mass index, higher level of education, unmarried status, and exposure to ETS either inside or outside the family environment. Eighteen percent of all current smokers were non-inhalers, and more than 60% of ex-smokers quit smoking on their first attempt. Our findings expand the existing evidence suggesting that a strong effect of parental conduct on a daughter's smoking behaviour may persist throughout life. Although more research is needed, especially to clarify the role of genetic and environmental factors in determining the mother-child smoking association, our results suggest that intensifying smoking prevention efforts directed at women with children might considerably reduce the risk of ever smoking in future female generations.