Annali dell'Istituto Superiore di Sanità
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Polypharmacy in the general population of a Northern Italian area: analysis of administrative data
Get PDFIntroduction: The aim of this study was to estimate the prevalence and assess patient-related determinants of polypharmacy in the general population of the Italian area around Udine.Materials and methods: A retrospective cohort study was conducted using administrative databases: drug prescriptions, hospital discharges, ambulatory care prescriptions, exemptions from medical charges. Various definitions of polypharmacy were adopted (co-prescription of multiple medications, use of multiple medications for overlapping time periods). The role of patient’s characteristics on polypharmacy was assessed through regression analyses.Results: In 2017, 63.7% of the general population received at least one drug prescription. 25,218 persons were co-prescribed ≥5 medications at least once. The prevalence of co-prescriptions among persons ≥65 years was 31.7%. 20,793 persons used ≥60 DDDs of ≥5 medications. The prevalence of all these phenomena was much higher in the elderly than in children and adults. The number of comorbidities significantly affected all types of polypharmacy.Conclusions: In this area, the prevalence of polypharmacy is alarming, particularly among the elderly. Age and comorbidities significantly affect the risk. Further research will aim at evaluating the health effects of polyphamacy.
An outbreak of cancer and asbestosis among former amosite-exposed subjects in Ledro Valley, Italy. From discovery to environmental cleanup
Get PDFHere are reviewed the studies conducted on asbestos-amosite pollution and its effects on the health of workers exposed from 1928 to 1973 at the Collotta-Cis factory of Ledro, Italy. The methods adopted to conduct the initial research, involving the population itself and the local administrations are described. The data summarized include: epidemiological studies of mortality carried out in 1977-85 and updated in 2009; results of the investigations carried out throughout the 1980s on the health consequences on workers, their families and residents near the factory; process of environmental cleanup from asbestos of the industrial area, completed in 1989, and the pollution risk assessment in the whole Ledro Valley. Although this was a small community of about 400 workers, these studies show that exposure to asbestos is responsible for the death of 81 people (22 mesotheliomas, 21 asbestosis, 38 malignant tumors of the lung, digestive system, ovary), for 1400 years of life lost, and for about 100 invalidity pensions, as recognized to former workers by INAIL
Training in pediatric palliative care in Italy: still much to do
Get PDF Aim. This survey investigated the availability of training programs in pediatric palliative care (PPC) for Italian postgraduates specializing in pediatric medicine. Methods. Two questionnaires were developed: (i) a questionnaire addressed to the Directors of Italian postgraduate pediatric medicine programs (n = 37); and (ii) a survey to the postgraduate students in pediatric medicine at the University Hospitals of Padua and Udine (n = 127). Results. 14 directors participated (response rate: 37.8%). In 85.7% of cases (n = 12), lectures on PPC were offered, for a supposed maximum of 90 minutes/year. 116 students responded (response rate: 91%): they stated that, pproximately 40 min/year of training on PPC was provided. In total, 37% of responders stated they attended a PPC Service during their training. The majority of responders (68.1%, n = 79) did not feel ready to care for a pediatric patient with life-limiting disease. Conclusions. Although PPC is well-recognized as part of a pediatrician’s training, it receives poor attention.
Ketamine abusers referring to Emergency Departments in Northern Italy: a cross- sectional study
Get PDFIntroduction. Ketamine is an essential medicine used as an anesthetic in low andmiddle-income countries and in veterinary medicine. Recreational use is widespreadthroughout the world, especially owing to its lower price compared to other substances.In Western countries its use has been mainly linked to subpopulations of young peoplewho use drugs recreationally. Ketamine misuse is associated with amnesia, dependence,dissociation, lower urinary tract dysfunction and poor impulse control. Regular ketamineuse is associated with abdominal pains.Aims. The aims of this study are to analyze characteristics and main symptoms of ketamineabusers attending emergency departments (EDs) in the metropolitan area of Bologna,Emilia-Romagna Region, northern Italy.Methods. We identified 74 records of ketamine-related visits: 30% female; 22% nonnatives;mean age 25.6 years. Forty-two percent reported ketamine use alone, 46% reportedthe use of other illegal substance (cocaine 19%, heroin 18%), 26% alcohol misuse.Results. The most common reported symptoms were neurological (soporous state 18%,agitation 14%, confusion 7%, panic attacks 7%, mydriasis 7%, tremors 7%), gastro-intestinal(abdominal pain 15%, vomiting 11%), urological (6.8%) and cardiac (palpitations5%, chest pain 5%). Complications secondary to falls and cuts (7%) were the mostfrequent trauma complications. We highlight a significant number of visits regardingsuicide attempts (10%) and overdose (4%).Conclusions. The results highlight a particular population of problematic ketamine usersidentified using the hospital’s ICT system. In particular, poly-drug users who consumeketamine in combination with heroin or cocaine presenting to the ED representa specific target for targeted prevention projects on non-lethal overdoses and suicideattempts
The way to move beyond the numbers: the lesson learnt from the Italian Obstetric Surveillance System
Get PDFObjective.To describe the Italian Obstetric Surveillance System (ItOSS) investigating maternal death through incident case reporting and confidential enquiries.Methods. All maternal deaths occurred in any public and private health facility in 8 Italian regions covering 73% of national births have been notified to the ItOSS. Every incident case is confidentially reviewed to assess quality of care and establish the cause and avoidability of the death.Findings. A total of 106 maternal deaths among 1.455.545 new-borns have been notified to the surveillance system in 2013-17. Haemorrhage, sepsis and hypertensive disorders of pregnancy are the leading causes of direct maternal deaths due to obstetric causes.Conclusions. A maternal mortality surveillance system, including incidence reporting and confidential enquiries along with a retrospective analysis of administrative data sources, emerged as the best option for case ascertainment and for promoting avoidable maternal deaths.
Primary prevention as an essential factor ensuring sustainability of health systems: the example of congenital anomalies
Get PDFProtection of early development contributes to health of next generations. Congenital anomalies (and other adverse reproductive outcomes) are an important public health issue and early indicator of public health risks, as early development is influenced by many risk factors (e.g., nutrition, lifestyles, pollution, infections, medications, etc). Effective primary prevention requires an integrated “One Health” approach, linking knowledge and action. This requires surveillance of health events and potential health-damaging factors, science-based risk analysis, citizens’ empowerment and education of health professionals. From the policy standpoint, joint budgeting mechanisms are needed to sustain with equity intersectoral actions (involving policy domains of health, social affairs, education, agriculture and environment). States should devote resources to strengthen registries and systematic data collection for surveillance of congenital anomalies, to better inform national prevention strategies. Investing in primary prevention based on scientific evidence is essential to support sustainable and resilient health systems and sustainable development of the society
Patient empowerment of people living with rare diseases. Its contribution to sustainable and resilient healthcare systems
Get PDFThe notion of empowerment is linked to patients’ everyday life and is the base allowing for the patient engagement through which individuals and communities are able to express their needs, are involved in decision-making, take action to meet those needs. In the field of rare diseases, empowerment strategies have greater value due to low prevalence, lack of expertise, poor quality of life. Avenues to patient empowerment are: health literacy and capacity-building; shared decision-making; support to self-management. Patient empowerment is recognised as key enabler in creating sustainability as addressing challenges faced by modern healthcare systems in terms of effectiveness, access and resilience. It is recommended to develop a comprehensive EU roadmap on patient empowerment including specific recommendations, taking stock of good practices. This holistic approach should lead to a society where all actors are fulfilled human beings and unmet needs are addressed in compliance with fundamental human rights
The usefulness of integrated strategy approaches in replacing animal experimentation
Get PDFIt is currently well accepted that in general, more than one method is necessary to allow the full replacement of an animal experimentation. These so called partial replacement methods can be used within integrated strategy approaches that combine different methods and information sources. A number of integrated strategy approaches were implemented within recent years in different areas of safety and regulatory toxicology.Moreover, latest advances in biomedical research and bioengineering provide a major opportunity to make use of in vitro human-based and/or three-dimensional complex models that can contribute to achieve more physiologically-relevant models. Examples herein describe currently existing integrated strategy frameworks aiming at full or partial replacement purposes and/or at gaining mechanistic insights. Furthermore, a general concept is provided on how 3R methods might be integrated in a strategy approach in order to ensure that animal experimentation is conducted only as a last resort
