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1.
BMC Public Health ; 24(1): 701, 2024 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-38443885

RESUMO

BACKGROUND: Population mortality is an important metric that sums information from different public health risk factors into a single indicator of health. However, the impact of COVID-19 on population mortality in low-income and crisis-affected countries like Sudan remains difficult to measure. Using a community-led approach, we estimated excess mortality during the COVID-19 epidemic in two Sudanese communities. METHODS: Three sets of key informants in two study locations, identified by community-based research teams, were administered a standardised questionnaire to list all known decedents from January 2017 to February 2021. Based on key variables, we linked the records before analysing the data using a capture-recapture statistical technique that models the overlap among lists to estimate the true number of deaths. RESULTS: We estimated that deaths per day were 5.5 times higher between March 2020 and February 2021 compared to the pre-pandemic period in East Gezira, while in El Obeid City, the rate was 1.6 times higher. CONCLUSION: This study suggests that using a community-led capture-recapture methodology to measure excess mortality is a feasible approach in Sudan and similar settings. Deploying similar community-led estimation methodologies should be considered wherever crises and weak health infrastructure prevent an accurate and timely real-time understanding of epidemics' mortality impact in real-time.


Assuntos
COVID-19 , Humanos , População Negra , Pandemias , Pobreza , Saúde Pública
2.
Cont Lens Anterior Eye ; 47(2): 102105, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38216392

RESUMO

PURPOSE: The current multi-study analysis combined data from three studies to quantify the relationship between the initial reaction to soft multifocal contact lens (MFCL) design types at dispensing and evaluate the predictability of overall vision satisfaction (OVS) and intention to purchase (ITP) after 1 week of wear. METHOD: Three prospective studies tested MFCLs over 1-week of wear following the same protocol, using a range of potentially predictive ratings at dispensing, and both OVS and ITP at 1-week as an indicator acceptance level. In each study, two of MyDay® multifocal, clariti® 1 day multifocal, Biofinity® multifocal (worn as a daily disposable lens) or 1 DAY ACUVUE® MOIST MULTIFOCAL were dispensed for 1-week of daily wear. OVS was recorded on a 100-point VAS and ITP on a 5-point LIKERT scale. Fourteen possible predictors were entered in the statistical model, and predictability was assessed using Chi-square Automatic Interaction Detector (CHAID) statistical test. RESULTS: A total of 210 participants (152 female & 58 male; 53.9 ± 6.5 years, range 41-71 years), representing 420 MFCL fits, equally distributed between emergent n = 65, established n = 70 and advanced n = 75 presbyopes, completed the studies. OVS on dispensing was the predictor of both OVS (p < 0.001) and ITP (p < 0.001) at 1-week. For OVS predictability, 70.8 % with OVS at dispensing > 91 points reported good OVS at 1-week and 73.4 % with OVS on dispensing ≤ 80 points reported poor OVS at 1-week. For ITP predictability, 74.6 % with OVS at dispensing > 94 points reported a positive ITP at 1-week and 65.9 % with OVS on dispensing ≤ 63 points reported negative ITP at 1-week. CONCLUSION: Overall vision satisfaction at the time of dispensing MFCLs is a powerful indicator of both OVS and ITP after 1-week of wear. Initial patient subjective assessments provide a clinically useful indicator of the likeliness of success.


Assuntos
Lentes de Contato Hidrofílicas , Presbiopia , Humanos , Masculino , Feminino , Acuidade Visual , Estudos Prospectivos , Visão Ocular
3.
Confl Health ; 16(1): 63, 2022 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-36510241

RESUMO

INTRODUCTION: Widespread armed conflict has affected Yemen since 2014. To date, the mortality toll of seven years of crisis, and any excess due to the COVID-19 pandemic, are not well quantified. We attempted to estimate population mortality during the pre-pandemic and pandemic periods in nine purposively selected urban and rural communities of southern and central Yemen (Aden and Ta'iz governorates), totalling > 100,000 people. METHODS: Within each study site, we collected lists of decedents between January 2014-March 2021 by interviewing different categories of key community informants, including community leaders, imams, healthcare workers, senior citizens and others. After linking records across lists based on key variables, we applied two-, three- or four-list capture-recapture analysis to estimate total death tolls. We also computed death rates by combining these estimates with population denominators, themselves subject to estimation. RESULTS: After interviewing 138 disproportionately (74.6%) male informants, we identified 2445 unique decedents. While informants recalled deaths throughout the study period, reported deaths among children were sparse: we thus restricted analysis to persons aged ≥ 15 years old. We noted a peak in reported deaths during May-July 2020, plausibly coinciding with the first COVID-19 wave. Death rate estimates featured uninformatively large confidence intervals, but appeared elevated compared to the non-crisis baseline, particularly in two sites where a large proportion of deaths were attributed to war injuries. There was no clear-cut evidence of excess mortality during the pandemic period. CONCLUSIONS: We found some evidence of a peak in mortality during the early phase of the pandemic, but death rate estimates were otherwise too imprecise to enable strong inference on trends. Estimates suggested substantial mortality elevations from baseline during the crisis period, but are subject to serious potential biases. The study highlighted challenges of data collection in this insecure, politically contested environment.

4.
Epidemiol Prev ; 46(4): 268-272, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36259343

RESUMO

OBJECTIVES: to assess the occurrence of potentially inappropriate prescribing (PIP) in residents of Tuscany nursing homes (NHs) and its variation before and after NH entry. DESIGN: retrospective observational study using data from the Regional Administrative Database of Tuscany. SETTING AND PARTICIPANTS: the study involved residents of 67 Tuscan NHs identified between 2011 and 2012. To estimate PIP prevalence before and after NH, a subset of 10 indicators of the Screening Tool of Older Person's Prescriptions (STOPP) criteria were selected. MAIN OUTCOME MEASURES: prevalence of PIP. RESULTS: considering 2,801 NH residents, the proportion of PIP ranged from 0.0% to 55.2% and from 0.0% to 33.9% before and after the NH admission, respectively. Overall, this study showed a decrease in the occurrence of PIP after the NH admission for most of the indicators, reaching statistical significance for indicator 3 (tricyclic antidepressants in combination with an opiate or calcium channel blockers), 7 (prescription of NSAIDs in heart failure patients), and 9 (warfarin in combination with NSAIDs). CONCLUSIONS: although the reduction of PIP after NH admission may suggest greater awareness about the appropriateness of drug use, more efforts still need to be made.


Assuntos
Prescrição Inadequada , Alcaloides Opiáceos , Humanos , Idoso , Prescrição Inadequada/prevenção & controle , Bloqueadores dos Canais de Cálcio , Antidepressivos Tricíclicos , Varfarina , Itália/epidemiologia , Casas de Saúde , Anti-Inflamatórios não Esteroides
5.
Alcohol Alcohol ; 57(6): 687-695, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-35596950

RESUMO

AIM: To examine whether in Europe perceptions of 'alcoholism' differ in a discrete manner according to geographical area. METHOD: Secondary analysis of a data set from a European project carried out in 2013-2014 among 1767 patients treated in alcohol addiction units of nine countries/regions across Europe. The experience of all 11 DSM-4 criteria used for diagnosing 'alcohol dependence' and 'alcohol abuse' were assessed in patient interviews. The analysis was performed through Multiple Correspondence Analysis. RESULTS: The symptoms of 'alcohol dependence' and 'alcohol abuse', posited by DSM-IV, were distributed according to three discrete geographical patterns: a macro-area mainly centered on drinking beer and spirit, a culture traditionally oriented toward wine and a mixed intermediate alcoholic beverage situation. CONCLUSION: These patterns of perception seem to parallel the diverse drinking cultures of Europe.


Assuntos
Alcoolismo , Humanos , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Cerveja , Manual Diagnóstico e Estatístico de Transtornos Mentais , Europa (Continente)/epidemiologia , Vinho
6.
Sci Total Environ ; 659: 973-982, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31096427

RESUMO

BACKGROUND: Geothermal power plants for the production of electricity are currently active in Mt. Amiata, Italy. The present study aimed to investigate the association between chronic low-level exposure to H2S and health outcomes, using a residential cohort study design. METHODS: Spatial variability of exposure to chronic levels of H2S was evaluated using dispersion modelling. Cohorts included people residing in six municipalities of the geothermal district from 01/01/1998 to 31/12/2016. Residence addresses were georeferenced and each subject was matched with H2S exposure metrics and socio-economic status available at census tract level. Mortality and hospital discharge data for neoplasms and diseases of the respiratory, central nervous and cardiovascular systems were taken from administrative health databases. Cox proportional hazard models were used to test the association between H2S exposure and outcomes, with age as the temporal axis and adjusting for gender, socio-economic status and calendar period. RESULTS: The residential cohort was composed of 33,804 subjects for a total of 391,002 person-years. Analyses reported risk increases associated with high exposure to H2S for respiratory diseases (HR = 1.12 95%CI: 1.00-1.25 for mortality data; HR = 1.02 95%CI: 0.98-1.06 for morbidity data), COPD and disorders of the peripheral nervous system. Neoplasms were negatively associated with increased H2S exposure. CONCLUSIONS: The most consistent findings were reported for respiratory diseases. Associations with increased H2S exposure were coherent in both mortality and hospitalization analyses, for both genders, with evidence of exposure-related trends. No positive associations were found for cancer or cardiovascular diseases.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Exposição Ambiental/análise , Sulfeto de Hidrogênio/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Doenças do Sistema Nervoso Central/induzido quimicamente , Doenças do Sistema Nervoso Central/epidemiologia , Doenças do Sistema Nervoso Central/mortalidade , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/induzido quimicamente , Neoplasias/epidemiologia , Neoplasias/mortalidade , Centrais Elétricas , Transtornos Respiratórios/induzido quimicamente , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/mortalidade , Adulto Jovem
7.
J Proteomics ; 190: 44-54, 2019 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-29654921

RESUMO

Fibromyalgia (FM) is a chronic pain disorder characterized by widespread pain and associated with unspecific symptoms. So far, no laboratory tests have been validated. The aim of the present study was to investigate the presence in saliva of potential diagnostic and/or prognostic biomarkers which could be useful for the management of FM patients. Specifically, the salivary profile of FM patients was compared with those of healthy subjects, subjects suffering migraine (model of non-inflammatory chronic pain), and patients affected by rheumatoid arthritis (model of inflammatory chronic pain). For proteomics analysis 2-DE and SELDI-TOF-MS were applied. From 2-DE serotransferrin and alpha-enolase were found differentially expressed in FM. Hence, their expression was validated by ELISA together with phosphoglycerate-mutase-I and transaldolase, which were found in a previous work. Moreover, ROC curve was calculated by comparing FM patients versus control subjects (healthy plus migraine) to investigate the discriminative power of biomarkers. The best performance was obtained by combining alpha-enolase, phosphoglycerate-mutase-I and serotransferrin. On the other hand, none of the candidate proteins showed a statistical correlation with clinical features. Finally, preliminary SELDI analysis highlighted two peaks whose identification need to be validated. Overall, these results could be useful in supporting the clinical diagnosis of FM. SIGNIFICANCE: FM is one of the most common chronic pain condition which is associated with significant disability. The fibromyalgic pain is a peculiar characteristic of this disease and FM patients suffer from reduced quality of life, daily functioning and productivity. Considering the deep complexity of FM, the discovery of more objective markers is crucial for supporting clinical diagnosis. Therefore, the aim of the present study was the selection of biomarkers effectively associated with fibromyalgic pain which will enable clinicians to achieve an unambiguous diagnosis, and to improve approaches to patients' management. We defined a panel of 3 salivary proteins which could be one of the criteria to be taken into account. Consequently, the identification of disease salivary biomarkers could be helpful in detecting FM clusters and targeted treatment. Actually, our future perspective foresees to develop a simple, rapid and not invasive point-of-care testing which will be of use during the diagnostic process. In addition, the present results can offer a clue for shedding light upon the complex entity of such a disease like FM.


Assuntos
Fibromialgia/diagnóstico , Proteômica/métodos , Proteínas e Peptídeos Salivares/análise , Adulto , Artrite Reumatoide/diagnóstico , Biomarcadores/análise , Estudos de Casos e Controles , Dor Crônica , Diagnóstico Diferencial , Feminino , Fibromialgia/patologia , Humanos , Masculino , Pessoa de Meia-Idade
8.
Neurol Sci ; 38(12): 2183-2187, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29019004

RESUMO

Tuscany (Central Italy) is a high-risk area for multiple sclerosis (MS) with a prevalence of 188 cases per 100,000 at 2011, and it is characterized by a heterogeneous geographic distribution of this disease. Our objective was to update prevalence at 2013 and to evaluate the presence of spatial clusters in Tuscany. The MS prevalence was evaluated on 31 December 2013 using a validated case-finding algorithm, based on administrative data. To identify spatial clusters, we calculated standardized morbidity ratios (SMRs) for each Tuscan administrative municipality. In addition to the classical approach, we applied the hierarchical Bayesian model to overcome random variability due to the presence of small number of cases per municipality. We identified 7330 MS patients (2251 males and 5079 females) with an overall prevalence of 195.4/100,000. The SMR for each Tuscan municipality ranged from 0 to 271.4, but this approach produced an extremely non-homogeneous map. On the contrary, the Bayesian map was much smoother than the classical one. The posterior probability (PP) map showed prevalence clusters in some areas in the province of Massa-Carrara, Pistoia, and Arezzo, and in the municipalities of Siena, Florence, and Barberino Val d'Elsa. Our prevalence data confirmed that Tuscany is a high-risk area, and we observed an increasing trend during the time. Using the Bayesian method, we estimated area-specific prevalence in each municipality reducing the random variation and the effect of extreme prevalence values in small areas that affected the classical approach.


Assuntos
Esclerose Múltipla/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Teorema de Bayes , Criança , Pré-Escolar , Análise por Conglomerados , Feminino , Geografia Médica , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
9.
Epidemiol Prev ; 41(1): 29-37, 2017.
Artigo em Italiano | MEDLINE | ID: mdl-28322526

RESUMO

"OBJECTIVES: to identify the differences among patients of general practictioners (GPs) in both Tuscany Region (Central Italy) and Friuli Venezia Giulia (FVG) Region (Northern Italy), which are different for drinking cultures, as to motivation of consultation, hazardous drinking and alcohol dependence, health problems, and use of health services. DESIGN: cross-sectional study by means of both a medical examination and a subsequent structured interview carried out with a questionnaire. Data were analysed using chi-square test, logistic regression and differences in prevalence. SETTING AND PARTICIPANTS: the study was implemented between July and November 2013 on a sample of 492 patients of 30 GPs in FVG, and 451 patients of 25 GPs in Tuscany. RESULTS: although patients in FVG were less likely to drink alcohol (66.7% vs. 70.9%), consumed lower amounts of alcohol on average per day per drinker (10.9 vs. 14.5 grams of alcohol), and were less likely to be hazardous drinkers (11.2% vs. 13.8%) compared to patients in Tuscany, they had a 3.6 to 4.7 times higher risk of alcohol dependence. In addition, the prevalence of diseases (in particular hepato-gastrointestinal diseases, hypertension, and psychiatric problems), smoking, and obesity/ overweighting was higher among clients of FVG, which exceed the Tuscan patients by 5-12 percentage points. Compared to Tuscany, FVG patients were more hospitalized and required more help to GPs or other people for their drinking problems. CONCLUSIONS: compared to Tuscan patients, GPs' patients in FVG has higher prevalence of alcohol addiction and other diseases, as well as of smoking and overweight/obesity, and higher need for health interventions as to their drinking problems."


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Medicina Geral/estatística & dados numéricos , Serviços de Saúde , Adulto , Alcoolismo/epidemiologia , Índice de Massa Corporal , Estudos Transversais , Feminino , Gastroenteropatias/epidemiologia , Serviços de Saúde/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Itália/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Fumar/epidemiologia , Inquéritos e Questionários
10.
World J Gastroenterol ; 22(44): 9829-9835, 2016 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-27956807

RESUMO

AIM: To evaluate this prevalence in Tuscan populations that was known and unknown to the Tuscan Regional Health Service in 2015. METHODS: Tuscan Health administrative data were used to evaluate hepatitis C virus (HCV) infected people known to the Regional Health Service. Residents in Tuscany with a HCV exemption code (070.54) were identified. Using the universal code attributed to each resident, these patients were matched with hospital admission codes identified by the International Classification of Diseases, Ninth Revision (ICD-9), Clinical Modification, and with codes for dispensing drugs to patients by local and hospital pharmacies. Individuals were considered only once. Capture-recapture analysis was used to evaluate the HCV-infected population unknown to the Regional Health Service. RESULTS: In total, 14526 individuals were living on 31/12/2015 with an exemption code for HCV. In total, 9524 patients were treated with pegylated interferon + ribavirin and/or direct-acting antiviral drugs during the last 10 years, and 13879 total hospital admissions were noted in the last 15 years. After data linkage, the total number was 25918. After applying the Capture-Recapture analysis, the number of unknown HCV-infected people was 23497. Therefore, the total number of chronic HCV-infected people was 38643, excluding those achieved sustained virological response to previous treatment. CONCLUSION: Our results show a prevalence of HCV infected people of 1%. Tuscan administrative data could be useful for calculating health care costs and health planning in the coming years.


Assuntos
Demandas Administrativas em Assistência à Saúde , Hepatite C Crônica/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Antivirais/uso terapêutico , Biomarcadores/sangue , Criança , Pré-Escolar , Bases de Dados Factuais , Quimioterapia Combinada , Feminino , Genótipo , Hepacivirus/genética , Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/sangue , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Prevalência , RNA Viral/sangue , Distribuição por Sexo , Fatores de Tempo , Carga Viral , Adulto Jovem
11.
Epidemiol Prev ; 40(1): 44-50, 2016.
Artigo em Italiano | MEDLINE | ID: mdl-26951701

RESUMO

OBJECTIVES: Geographical Information Systems (GIS) are widely used in environmental epidemiology studies to locate study population by geocoding addresses and to evaluate exposures and relationship with health outcomes. Despite this, Italian environmental epidemiologists poorly discuss quality of address geocoding results. DESIGN: two case-studies have been carried out in Tuscany Region (Central Italy): one in the mountain area in the Municipality of Piancastagnaio (Siena Province) and one in the urban area around the airport of Florence. Three geocoding systems have been compared: the geographical database produced by Tuscany Region and two commercial systems (Google and Bing-Microsoft); 1,549 addresses in Piancastagnaio and 2,946 addresses in Florence have been tested. RESULTS: Tuscan geographical database showed better performance than the two commercial systems, with bigger differences in Piancastagnaio. In this area, mean difference between regional system and Google service is more than 300 mt, with peaks of 7-8 km. Bing- Microsoft system does not provide any information on addresses in Piancastagnaio: all input addresses were geocoded in the centroid of the municipality or in the centre of a few principal streets. Lowest differences among the three methods were observed in the urban area of Florence: mean difference between Tuscany and Goggle systems was 150 mt, with less than 2 km peaks; between Tuscany and Bing-Microsoft mean difference was 100 mt with 3 km peaks. In both case-studies, but especially in Piancastagnaio area, these differences gave rise to great misclassification in the evaluation of individual exposure and health outcome. CONCLUSION: the study highlighted the impacts of address geocoding process in exposure assessment in environmental health research and pointed out the need of specifically evaluate the quality of cartographic data.


Assuntos
Cidades , Saúde Ambiental/normas , Sistemas de Informação Geográfica/normas , Mapeamento Geográfico , Bases de Dados Factuais , Humanos , Itália
12.
J Allergy Clin Immunol Pract ; 4(3): 512-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26883543

RESUMO

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic necrotizing vasculitis that occurs in patients with asthma, nasal disease, blood and tissue eosinophilia, and extrapulmonary manifestations. OBJECTIVE: The aim of our study was to assess the clinical, functional, and inflammatory status of upper and lower airways in 37 patients with EGPA, examined 6.4 ± 4.7 years after diagnosis, when they were in partial or complete remission from systemic involvement while on treatment with low-dose oral corticosteroids as maintenance therapy. METHODS: All patients performed spirometry and were assessed for bronchial hyperreactivity, sputum eosinophilia, and fractional exhaled nitric oxide; asthma control was evaluated according to the Global Initiative for Asthma (GINA) guidelines and the Asthma Control Test. Markers of systemic disease were compared with the data available at diagnosis. Nasal involvement was evaluated by using the Sino-Nasal Outcome Test, nasal endoscopy, and nasal cytology. The impact on the quality of life was evaluated by using generic (36-item short form health survey) and organ-specific questionnaires. RESULTS: At the time of the study visit, almost all patients were receiving low-dose oral corticosteroids and immunomodulating drugs, but only 50% were being treated with inhaled corticosteroids. Although low systemic disease activity was documented in the large majority of patients, poorly controlled asthma and rhinosinusitis with eosinophilic airway inflammation were demonstrated in almost all patients. A significant correlation was found between sputum and blood eosinophilia and between fractional exhaled nitric oxide and asthma control. The 36-item short form health survey questionnaire results significantly correlated with the Sino-Nasal Outcome Test but not with the Asthma Control Test. CONCLUSIONS: Systemic treatment controls systemic involvement in EGPA, but not asthma and nasal diseases, which negatively affects patients' quality of life.


Assuntos
Asma , Eosinofilia , Granulomatose com Poliangiite , Rinite , Corticosteroides/uso terapêutico , Adulto , Idoso , Asma/tratamento farmacológico , Asma/imunologia , Asma/metabolismo , Asma/fisiopatologia , Citocinas/sangue , Eosinofilia/tratamento farmacológico , Eosinofilia/imunologia , Eosinofilia/metabolismo , Eosinofilia/fisiopatologia , Feminino , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/imunologia , Granulomatose com Poliangiite/metabolismo , Granulomatose com Poliangiite/fisiopatologia , Humanos , Fatores Imunológicos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/metabolismo , Qualidade de Vida , Rinite/tratamento farmacológico , Rinite/imunologia , Rinite/metabolismo , Rinite/fisiopatologia , Espirometria , Escarro/citologia
13.
BMC Health Serv Res ; 15: 223, 2015 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-26047610

RESUMO

BACKGROUND: Previous studies have investigated process and structure indicators of nutritional care as well as their use in nursing homes (NHs), but the relative weight of these indicators in predicting the risk of malnutrition remains unclear. Aims of the present study are to describe the quality indicators of nutritional care in older residents in a sample of NHs in Tuscany, Italy, and to evaluate the predictors of protein-energy malnutrition risk. METHODS: A cross-sectional survey was conducted in 67 NHs. Information was collected to evaluate quality indicators of nutritional care and the individual risk factors for malnutrition, which was assessed using the Malnutrition Universal Screening Tool. A multilevel model was used to analyse the association between risk and predictors. RESULTS: Out of 2395 participants, 23.7 % were at high, 11 % at medium, and 65.3 % at low risk for malnutrition. Forty-two percent of the NHs had only a personal scale to weigh residents; 88 % did not routinely use a screening test/tool for malnutrition; 60 % used some standardized approach for weight measurement; 43 % did not assess the severity of dysphagia; 12 % were not staffed with dietitians. Patients living in NHs where a chair or platform scale was available had a significantly lower risk of malnutrition (OR = 0.73; 95 % CI = 0.56-0.94). None of the other structural or process quality indicators showed a statistically significant association with malnutrition risk. CONCLUSIONS: Of all the process and structural indicators considered, only the absence of an adequate scale to weigh residents predicted the risk of malnutrition, after adjusting for case mix. These findings prompt the conduction of further investigations on the effectiveness of structural and process indicators that are used to describe quality of nutritional care in NHs.


Assuntos
Casas de Saúde/normas , Avaliação Nutricional , Indicadores de Qualidade em Assistência à Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Itália , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Medicina Estatal , Inquéritos e Questionários
14.
Mod Rheumatol ; 25(4): 585-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25496408

RESUMO

AIMS: (i) To analyze the in vivo corneal structure and sub-basal plexus nerves in patients with primary Sjögren's syndrome (pSS) and no-SS dry eye by confocal scanning laser microscopy (CSLM) and (ii) to correlate CSLM findings with tear function tests and with patients' subjective dryness. METHODS: Seventeen patients with pSS, 16 no-SS dry eye, and 20 healthy volunteers were included. CSLM parameters taken into consideration included: basal epithelial integrity, corneal thickness, epithelial cellular density, keratocyte activation, and sub-basal plexus morphology. Statistical analysis was carried out using SPSS-13 (Chicago IL, USA). RESULTS: CSLM pachymetric data and the superficial epithelium cell density were significantly lower in pSS versus no-SS dry eye (p < 0.0001); keratocyte activation and sub-basal nerve abnormalities were also more frequent in pSS patients (p < 0.0001). CSLM findings well correlated with both the ocular test results and the patients' perception of ocular dryness at the baseline and over the follow-up. CONCLUSION: CSLM might be a useful novel tool in the assessment of the involvement of the lachrymal functional unit in pSS.


Assuntos
Córnea/patologia , Doenças da Córnea/patologia , Síndrome de Sjogren/patologia , Contagem de Células , Feminino , Humanos , Masculino , Microscopia Confocal/métodos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
15.
Subst Use Misuse ; 49(12): 1515-30, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25099313

RESUMO

This study confirms that during the decades following WW II there was a tendency towards closure of consumption of alcoholic beverages among the European countries. The Northern countries, which during the 1960s manifested the lowest rates of alcohol consumption, ended up with greater consumption rates than the Southern countries, manifested the opposite trend; greater amounts of consumptions in the 1960s and lower consumptions in the 2000s. During the same some period, social, demographic and economic indicators--urbanization, rate of elderly males, Income, female education, female employment and mother's age at their childbirths, tended to increase, while the alcoholic beverage control policy strategies showed differences according to the country. Liver disease-related mortality, decreased in most countries. Study limitations are noted.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Política de Saúde , Adulto , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/história , Consumo de Bebidas Alcoólicas/prevenção & controle , Bebidas Alcoólicas/economia , Custos e Análise de Custo , Europa (Continente)/epidemiologia , Feminino , Política de Saúde/história , História do Século XX , História do Século XXI , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos
16.
Subst Use Misuse ; 49(12): 1646-64, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25122545

RESUMO

This paper focuses on whether the on-going dramatic decrease in alcohol consumption in Italy, especially of wine, during 1961-2008, was associated with which parallel sociodemographic and economic changes and with alcohol control policies. The study, using both time series (TS) and artificial neural network (ANN)-based analyses documents that its selected sociodemographic and economic factors, and particularly urbanization, had a definite connection with wine consumption decrease, spirits decrease, and the increase in beer consumption over time. On the other hand, control policies showed no effect on the decline in alcohol consumption, since no alcohol control policy existed in Italy between 1960 and 1987. A few policies introduced since 1988 (BAC and sale restrictions during mass events) may have contributed to reducing or to maintaining the on-going reduction. Study limitations are noted and future needed research is suggested.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Cultura , Política de Saúde , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/prevenção & controle , Bebidas Alcoólicas , Cerveja , Comportamento Alimentar , Comportamentos Relacionados com a Saúde , Humanos , Itália/epidemiologia , Avaliação de Programas e Projetos de Saúde , Religião , Fatores Socioeconômicos , Vinho
17.
Nutrition ; 30(10): 1171-6, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24993751

RESUMO

OBJECTIVE: The aim of this study was to use the Malnutrition Universal Screening Tool (MUST) to assess the applicability of alternative versus direct anthropometric measurements for evaluating the risk for malnutrition in older individuals living in nursing homes (NHs). METHODS: We conducted a cross-sectional survey in 67 NHs in Tuscany, Italy. We measured the weight, standing height (SH), knee height (KH), ulna length (UL), and middle-upper-arm circumference of 641 NH residents. Correlations between the different methods for calculating body mass index (BMI; using direct or alternative measurements) were evaluated by the intraclass correlation coefficient and the Bland-Altman method; agreement in the allocation of participants to the same risk category was assessed by squared weighted kappa statistic and indicators of internal relative validity. RESULTS: The intraclass correlation coefficient for BMI calculated using KH was 0.839 (0.815-0.861), whereas those calculated by UL were 0.890 (0.872-0.905). The limits of agreement were ±6.13 kg/m(2) using KH and ±4.66 kg/m(2) using UL. For BMI calculated using SH, 79.9% of the patients were at low risk, 8.1% at medium risk, and 12.2% at high risk for malnutrition. The agreement between this classification and that obtained using BMI calculated by alternative measurements was "fair-good." CONCLUSION: When it is not possible to determine risk category by using SH, we suggest using the alternative measurements (primarily UL, due to its highest sensitivity) to predict the height and to compare these evaluations with those obtained by using middle-upper-arm-circumference to predict the BMI.


Assuntos
Antropometria/métodos , Índice de Massa Corporal , Tamanho Corporal , Avaliação Geriátrica/métodos , Desnutrição/diagnóstico , Avaliação Nutricional , Idoso , Idoso de 80 Anos ou mais , Braço , Estatura , Estudos Transversais , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Itália , Perna (Membro) , Masculino , Casas de Saúde , Fatores de Risco , Ulna
18.
Subst Use Misuse ; 49(12): 1692-715, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25004138

RESUMO

This AMPHORA study's aim was to investigate selected factors potentially affecting changes in consumption of alcoholic beverages in 12 European countries during the 1960s-2008 (an average increase in beer, decreases in wine and spirits, total alcohol drinking decrease). Both time series and artificial neural networks-based analyses were used. Results indicated that selected socio-demographic and economic factors showed an overall major impact on consumption changes; particularly urbanization, increased income, and older mothers' age at their childbirths were significantly associated with consumption increase or decrease, depending on the country. Alcoholic beverage control policies showed an overall minor impact on consumption changes: among them, permissive availability measures were significantly associated with consumption increases, while drinking and driving limits and availability restrictions were correlated with consumption decreases, and alcohol taxation and prices of the alcoholic beverages were not significantly correlated with consumption. Population ageing, older mother's age at childbirths, increased income and increases in female employment, as well as drink driving limitations were associated with the decrease of transport mortality. Study's limitations are noted.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Política de Saúde , Acidentes de Trânsito/mortalidade , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/prevenção & controle , Bebidas Alcoólicas , Cerveja , Europa (Continente)/epidemiologia , Feminino , Humanos , Hepatopatias/mortalidade , Masculino , Avaliação de Programas e Projetos de Saúde , Fatores Socioeconômicos , Vinho
20.
Subst Use Misuse ; 49(12): 1576-88, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24897127

RESUMO

In the United Kingdom, between 1960 and the 2000s, there were many sociodemographic and economic factors that played a part in the changing picture of alcohol consumption and its related harm. This paper describes some of these variables along with the political measures that were identified as correlated with changes in consumption and harm. The resulting picture is unclear. No consistent pattern was identified among the variables analyzed. Beverage choice changed over time with a reduction in beer consumption and an increase in wines and spirits. Nevertheless, the overall picture showed an increase in total alcohol consumption and resulting harm.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Bebidas Alcoólicas/provisão & distribuição , Política de Saúde , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Cerveja/provisão & distribuição , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Fatores Socioeconômicos , Reino Unido/epidemiologia , Vinho/provisão & distribuição
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