Influenza vaccine effectiveness in an Italian elderly population during the 2016-2017 season

Interim analyses of the 2016-17 influenza vaccine effectiveness showed variable results depending on timing of the analysis and geographical setting. We conducted a population-based retrospective cohort study based on the analysis of health-related administrative data to assess the effectiveness of the 2016-17 influenza vaccine among the elderly population of a north-eastern Italian area. Data on 64854 subjects ≥65 years of age were analyzed up to April 30, 2017. The influenza vaccine was administered to 53% of the elderly population. No significant effect was observed on the likelihood of Emergency department visits, hospitalizations, or deaths from pneumonia and influenza.

Prenatal mercury exposure and child neurodevelopment outcomes at 18 months: Results from the Mediterranean PHIME cohort

INTRODUCTION

Neurotoxicity due to acute prenatal exposure to high-dose of mercury (Hg) is well documented. However, the effect of prenatal exposure to low Hg levels on child neurodevelopment and the question about "safety" of fish-eating during pregnancy remain controversial. International comparisons of Hg concentrations in mother-child biological samples and neurodevelopmental scores embedded in birth cohort studies may provide useful evidence to explore this issue.

MATERIALS AND METHODS

The Mediterranean (Italy, Slovenia, Croatia, and Greece) cohort study included 1308 mother-child pairs enrolled in the Public Health Impact of long-term, low-level, Mixed Element exposure in a susceptible population EU Sixth Framework Programme (PHIME). Maternal hair and venous blood, cord blood and breast milk samples were collected, and total Hg (THg) levels were measured. Demographic and socioeconomic information, lifestyles and nutritional habits were collected through questionnaires at different phases of follow-up. Children at 18 months of age underwent neurodevelopmental testing using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Multivariate linear and logistic regressions were performed, for each country, to assess the association between THg and BSID-III scores, obtaining adjusted β coefficients and odds ratios (ORs). These values were used to conduct a meta-analysis, to explore possible heterogeneity among countries and to obtain combined estimates of the association between THg exposure and BSID-III scores.

RESULTS

Median THg (ng/g) was: 704 in maternal hair, 2.4 in maternal blood, 3.6 in cord blood, and 0.6 in breast milk. THg concentrations were highest in Greece and lowest in Slovenia. BSID-III neurodevelopmental scores were higher in Croatia and Slovenia. The meta-analysis of multivariate linear models found an overall positive association between language composite score and receptive communication scaled score and increasing THg in maternal hair (n = 1086; β = 0.55; 95%CI: 0.05-1.05 and n = 1075; β = 0.12; 95%CI: 0.02-0.22, respectively). The meta-analysis of logistic regression models showed that the overall adjusted OR between THg in cord blood and suboptimal gross motor score was borderline significant (n = 882; OR = 1.03; 95%CI: 1.00-1.07). Heterogeneity was found across the four sub-cohorts for language composite score in maternal blood, and for fine motor scaled score in cord blood and breast milk. Language composite score and THg concentrations in maternal venous blood were positively related (n = 58; β = 4.29; CI95% (-0.02, 8.60)) in Croatia and an increase of 1 ng/g of THg in maternal venous blood was associated with a reduced risk for children to fall in the lowest quintile of language score by 31% (n = 58; OR = 0.69; CI 95%: 0.37, 1.01). The comparison of β coefficients obtained by multiple linear regression model showed an inverse association between fine motor score and THg concentrations in cord blood for Croatia (n = 54; β = -0.53; CI 95%: -1.10, 0.04) and Slovenia (n = 225; β = -0.25; CI 95%: -0.49, -0.01). In Slovenia THg level in breast milk was associated with suboptimal fine motor performance (n = 195; OR = 5.25; CI 95%: 1.36, 21.10).

CONCLUSIONS

This study showed an inverse relation between THg levels and developmental motor scores at 18 months, although the evidence was weak and partially internally and externally inconsistent. No evidence of detrimental effects of THg was found for cognitive and language outcomes at these concentrations and age.

The epidemiology of psoriasis in an Italian area: population-based analysis of administrative data

BACKGROUND

Data on the epidemiology of psoriasis are limited. The objective of this study was to estimate the prevalence and the incidence rate of psoriasis in a reproducible and efficient population-based assessment in a Northeastern Italian area around the city of Udine.

METHODS

A retrospective population-based analysis was conducted linking at the individual patient level, through a unique encrypted identifier, four electronic administrative health databases, with full coverage of the residing population: the hospital discharge database, the ambulatory care database, the pharmaceutical prescriptions database, and the database of exemptions from medical charges. Incident and prevalent cases of psoriasis were identified through predefined algorithms.

RESULTS

The estimated prevalence of psoriasis in the study area was 1.84%, while incidence rate was 0.96/1000 person-years; 13.6% of prevalent cases had arthritis. Prevalence turned out to increase with age and was higher in males. Arthritis was more common among females. Biological medications were prescribed to 2% of patients in 2015.

CONCLUSIONS

Our estimates of incidence and prevalence of psoriasis and description of patients characteristics in the North-East of Italy add knowledge to the existing body of scientific data on the epidemiology of this disease at the international level and provide useful information for health planners at the local level.

Cardiovascular prevention in 50-year-old adults: an Italian intervention study

AIMS

Cardio50 is a project of active risk identification and cardiovascular prevention implemented in an Italian cohort of healthy people aged 50.

METHODS

A total of 3127 individuals were invited for a screening visit with lifestyle interview and registration of BMI, blood pressure (BP), glucose, cholesterol and classified into groups: A (normal), B (abnormal lifestyle, normal parameters), C (at least one abnormal parameter). People in group C were offered a free blood test and a specialistic medical visit to investigate the suspect of hypertension, dyslipidemia or dysglycemia. Those in groups B and C were scheduled for a follow-up visit after 4-6 months and finally readdressed to the general practitioner.

RESULTS

A total of 2325 invited individuals attended the screening visit: 18% were classified in group A, 32% in B, 42% in C, 8% met exclusion criteria and were not classifiable. In group C, 86% attended to the cardiologist visit, 76% had dyslipidemia, 35% hypertension, 1% diabetes, 14% impaired fasting glycemia, 19% obesity, 21% metabolic syndrome; 21% were smokers, 11% at risk of alcoholism. At follow-up, we appreciated a decrease in BP in group C individuals. After lifestyle intervention, physical activity increased, whereas metabolic syndrome, impaired fasting glucose and risky drinking decreased.

CONCLUSION

The current project is coherent with modern strategies based on multifactorial actions. After the intervention, we observed an early reduction in BP and some improvements in lifestyle. This simple and low-technology program allowed us to detect and treat large numbers of individuals at high risk for cardiovascular events.

Does diabetes mellitus comorbidity affect in-hospital mortality and length of stay? Analysis of administrative data in an Italian Academic Hospital

AIMS

Hospitalized patients with comorbid diabetes mellitus may have worse outcomes than the others. We conducted a study to assess whether comorbid diabetes affects in-hospital mortality and length of stay.

METHODS

For this population-based study, we analyzed the administrative databases of the Regional Health Information System of the Region Friuli Venezia Giulia, where the Hospital of Udine is located. Hospital discharge data were linked at the individual patient level with the regional Diabetes Mellitus Registry to identify diabetic patients. For each 3-digit ICD-9-CM discharge diagnosis code, we assessed the difference in length of stay and in-hospital mortality between diabetic and non-diabetic patients. We conducted both univariate and multivariate analyses, adjusted for age, sex, Charlson's comorbidity score, and urgency of hospitalization, through linear and logistic regression models.

RESULTS

After adjusting for potential confounders, diabetes significantly increased the risk of in-hospital death among patients hospitalized for bacterial pneumonia (OR = 1.94) and intestinal obstruction (OR = 4.23) and length of stay among those admitted for several diagnoses, including acute myocardial infarction and acute renal failure. Admission glucose blood level was associated with in-hospital death in patients with pneumonia and intestinal obstruction, and increased length of stay for several conditions.

CONCLUSIONS

Patients with diabetes mellitus who are hospitalized for other health problems may have increased risk of in-hospital death and longer hospital stay. For this reason, diabetes should be promptly recognized upon admission and properly managed.

New oral anticoagulant prescription rate and risk of bleeding in an Italian region

PURPOSE

The purpose of this study was to measure the prescription rate of new oral anticoagulants (NOACs) and to investigate whether there is an increased risk of bleeding associated with these medications in the 1 220 000-inhabitant Italian region Friuli Venezia Giulia.

METHODS

The administrative data of the Regional Health Information System, linkable with each other at the individual patient level through an anonymous stochastic key, were used as the source of information. Prescription rates for rivaroxaban, dabigatran, and apixaban were calculated in the regional population in 2014 and 2015, also stratified by age class and gender. A case-crossover analysis with pair-matched interval approach and a case-time-control analysis were conducted to assess the risk of hospitalization with a diagnosis of bleeding and prescription of NOACs.

RESULTS

In the regional population ≥18 years of age, 1626 NOACs prescriptions per 100 000 population-years were filled in 2014 and 3370 in 2015. Prescription rate increased with age and was greater in males than in females. Overall, being a current NOACs user was not associated with the risk of hospitalization for bleeding compared to being a nonuser. A nonsignificant increase in risk was observed among patients with low prescription intensity.

CONCLUSIONS

This study showed an increasing time trend in NOACs prescriptions NOACs in Friuli Venezia Giulia. In this Italian population, NOACs users had no significantly increased risk of bleeding events as compared with nonusers.

Falls requiring visit to emergency room in a population-based cohort of diabetic patients in Italy

BACKGROUND

The aims were to assess the frequency of falls among the diabetic adult population of the Italian Northeastern region Friuli Venezia Giulia and to identify risk factors.

METHODS

This was a population-based retrospective cohort study using administrative data of the regional health information system as the source of information. In a cohort of diabetics 18 years of age or more, living in the region on December 31, 2014, the occurrence of falls requiring a visit to the regional Emergency Rooms was assessed. Multivariate logistic regression was used to identify factors associated with increased risk of falling.

RESULTS

Of 80,162 cohort subjects, 2967 (3.7%) had at least one fall requiring a visit to ER. Factors associated with increased risk of falling were female sex, older age, prescription of a thiazolidinedione as the last antidiabetic medication in 2014, increasing number of active principles prescribed in 2014, longer diabetes duration, and prescription of certain classes of medications other than antidiabetics in 2014.

CONCLUSIONS

In Friuli Venezia Giulia, injurious falls are a complication of diabetes relevant from the public health viewpoint. Efforts are needed to screen diabetic patients, review their prescriptions, provide appropriate care, and implement targeted interventions to minimize the individual risk of falls.

A population-based study of the years of life lost in the Friuli Venezia Giulia region, Italy

BACKGROUND

The number of years of life lost (YLL) in a population depends not only on the number of deaths but also on the age at which the deaths have occurred, and, as a measure of the burden of premature mortality, is an important piece of information for public health professionals.

METHODS

We calculated YLL in the population of Friuli Venezia Giulia, a 1 200 000 inhabitant Italian region, in 2013 and the trend in the past 14 years, through a population-based study using the regional mortality database as the source of information. The same projected life expectancy estimates for 2050 were used for calculating YLL both in males and females, for each calendar year.

RESULTS

In 2013, we counted 14 080 deaths and estimated 220 961 YLL. Malignant neoplasms and cardiovascular diseases accounted for the greatest number of YLL. Injuries had the highest number of YLL per death. Overall, YLL decreased from 2000 to 2013, but differences were observed for different causes of death. Cancers, cardiovascular diseases, and unintentional injuries showed a decreasing trend, whereas infectious diseases resulted increasing over time.

CONCLUSION

This study, estimating the relative impact of different conditions on the society though the YLL, is a relevant input for the regional public health agenda.

Inception and utility of a renal replacement registry using administrative health data in North-East Italy

BACKGROUND

Disease registries are useful tools for public health planning, evaluating clinical practice and providing information on cohorts of patients.

METHODS

The administrative databases of the regional health information system of Friuli Venezia Giulia, Italy were used to build a regional registry of the resident population in renal replacement therapy (including dialysis and renal transplantation), through an algorithm taking into account hospital discharge and outpatient ambulatory care data. The registry includes an anonymous univocal identifier, the start date for the replacement therapy and changes of status (haemodialysis, peritoneal dialysis, renal transplantation). Data from the registry were used to estimate incidence rate, prevalence and mortality of patients receiving renal replacement therapy in 2014. In addition, we described an example of how the registry can be used to assess the prevalence of selected comorbidities.

RESULTS

In Friuli Venezia Giulia in 2014, we estimated an incidence rate of renal replacement therapy of 166 per million inhabitants and a prevalence of 1,400 per million inhabitants. A total of 10% of the patients died in the study year. Hypertension, heart disease and diabetes mellitus were common co-morbidities.

CONCLUSION

The registry allows us to estimate the incidence rate and prevalence of renal replacement therapy and also to investigate specific issues regarding these patients through record linkage with other administrative health databases.

A case-crossover study of sleep, fatigue, and other transient exposures at workplace and the risk of non-fatal occupational injuries among the employees of an Italian academic hospital

OBJECTIVES

Transient exposure with acute effect has been shown to affect the risk of occupational injuries in various industrial settings and at the healthcare workplace. The objective of this study has been to identify transient exposures related to occupational injury risk in an Italian teaching hospital.

MATERIAL AND METHODS

A case-crossover study was conducted among the employees of the University Hospital of Udine who reported an occupational injury, commuting accident, or incident involving biological risk in a 15-month period in the years 2013 and 2014. The matched-pair interval approach was used to assess the role of acute sleep deprivation whereas the usual frequency approach was used for other 13 transient exposures.

RESULTS

Sleep hours were not associated with the risk of injuries whereas a significant risk increase was associated with fatigue, rush, distraction, emergency situations, teaching to or being taught by someone, non-compliant patients, bloody operative/work field, excess noise, complex procedures, and anger.

CONCLUSIONS

We identified transient exposures that increased the risk of occupational injuries in an Italian teaching hospital, providing indications for interventions to increase workers' safety at the healthcare workplace. Int J Occup Med Environ Health 2016;29(6):1001-1009.

The incidence rate and prevalence of pediatric type 1 diabetes mellitus (age 0-18) in the Italian region Friuli Venezia Giulia: population-based estimates through the analysis of health administrative databases

AIMS

The main objective of this study was to estimate the incidence rate and prevalence of pediatric type 1 diabetes mellitus (T1DM; population 0-18 years of age) in the northeastern Italian region Friuli Venezia Giulia and to characterize the subjects affected by the disease.

METHODS

This was a retrospective population-based study conducted through the individual-level linkage of several health administrative databases of the Friuli Venezia Giulia region. The incidence rate and prevalence were calculated in the population 0-18 years of age. Using the Mid-p exact method, 95 % confidence intervals for rates were calculated.

RESULTS

The incidence rate of pediatric T1DM in the years 2010-2013 was 15.8 new cases/100,000 person-years, peaking in the age class 10-14 years. The rate has increased substantially as compared with the previous regional estimate that dated back to 1993. We observed a seasonal pattern both in the date of birth of the incident cases and in the date of onset of the disease. In the region in 2013, there were 294 prevalent cases (15.1/10,000 inhabitants). Most of them had at least one glycated hemoglobin test in the year. More than 15 % had co-existing autoimmune comorbidities.

CONCLUSIONS

The incidence rate of pediatric T1DM in Friuli Venezia Giulia has increased in the last years, and the disease is a relevant public health issue in the region.

Efficacy, tolerability, impact on quality of life and sebostatic activity of three topical preparations for the treatment of mild to moderate facial acne vulgaris

BACKGROUND

Acne is treated according to the clinical observations and pathophysiologically relevant mechanisms, such as hyper-keratinization, seborrhea and bacterial proliferation. In mild and moderate forms of inflammatory acne, topical antimicrobials are recommended as a monotherapy or in combination with topical retinoids. The aim of this study was to compare the clinical effectiveness, tolerability, impact on quality of life and effect on sebum excretion of three antimicrobial preparations: clindamycin phosphate, benzoyl peroxide and a combination of clindamycin phosphate plus benzoyl peroxide.

METHODS

In total, 240 patients were randomized into treatment groups for an 8-week study. Every two weeks the patients were evaluated using the following methods: photography, the Global Acne Grading System, sebumetric evaluation, and the Acne-Specific Quality of Life questionnaire. In addition, 80 healthy controls were enrolled for the sebumetric evaluation.

RESULTS

A significant improvement in acne and the quality of life was observed for all three therapies at the end of the study. The sebum excretion results for the three treatment groups displayed significant and unpredictable variation, whereas the controls groups exhibited no significant variation. The three treatments were well tolerated.

CONCLUSIONS

The efficacy of the three antimicrobial preparations likely results from their anti-inflammatory and bacteriostatic activities. In contrast, seborrhoea seems to be minimally impacted.

Diabetes mellitus and cancer of the digestive organs: An Italian population-based cohort study

AIMS

The association between diabetes mellitus and the occurrence of digestive organs cancers was investigated in the Italian region Friuli Venezia Giulia. The risk of cancer associated with oral antidiabetic drugs among subjects with type 2 diabetes was also assessed.

METHODS

This was a retrospective population-based cohort study based on the 2002-2014 regional administrative health data. Incident digestive cancers were identified through the hospital discharge diagnoses. The incidence rates of cancer at different sites were calculated for type 1 and 2 diabetics and for non-diabetics. Proportional hazard models were built to assess the risk of cancer associated with diabetes and antidiabetic drugs.

RESULTS

Diabetes was associated with increased risk of digestive cancers. Liver and pancreatic cancers were associated with the highest hazard ratios. Among type 2 diabetics, total number of metformin prescriptions was associated with reduced risk of most types of digestive cancers; sulfonylureas with reduced risk of stomach and pancreatic cancer.

CONCLUSIONS

In this Italian population the excess risk of digestive cancers for diabetic patients was confirmed. Further research is needed to clarify the role of antidiabetic drugs.

Somatic disorders and antidepressant use in suicides: A population-based study from the Friuli Venezia Giulia region, Italy, 2003-2013

BACKGROUND

Many somatic disorders are complicated by depression and increase the risk of suicide. Little is known about whether antidepressants might reduce the suicidal risk in patients with somatic disorders.

METHODS

Data on diagnoses and antidepressant prescriptions were derived from the Social and Health Information System of the Friuli Venezia Giulia Region. Cases were all suicides that occurred in the region during the years 2003-2013 and were sex- and age-matched to controls from the general population. Conditional logistic regression analysis was used to assess the association between suicide and somatic disorders.

RESULTS

The suicide rate in Friuli Venezia Giulia decreased from 11.3 to 10.7 per 100,000 inhabitants during the years 2003-2013, however patients with somatic disorder had a three times increased risk of suicide. Elderly somatic patients' suicide risk was twice as high as younger patients. The risk increased from 2.6 to 9.8 times as the number of comorbid disorders increased from 1 to 4 and over. Although no significant risk of suicide in patients with somatic disorders was found when patients were adherent to antidepressants, only 11.5% of the suicides was adherent in the year prior to death.

CONCLUSIONS

Medical illnesses and underlying depressive symptoms may have a synergy effect on the risk of suicide, particularly in older patients and in patients with multiple morbidities. Since medically ill subjects adherent to antidepressants did not show a significant risk of suicide, early identification and adequate treatment of depression in somatic patients should be considered in order to prevent suicide.

Maintenance of Wakefulness and Occupational Injuries among Workers of an Italian Teaching Hospital

BACKGROUND

To assess in a laboratory setting the ability to stay awake in a sample of workers of an Italian hospital and to investigate the association between that ability and the risk of occupational injury.

METHODS

Nine workers at the University Hospital of Udine who reported an occupational injury in the study period (cases), and seven noninjured workers (controls) underwent a polysomnography and four 40-minute maintenance of wakefulness tests (MWT). Differences in sleep characteristics and in wakefulness maintenance were assessed using Wilcoxon's rank sums tests and Fisher's exact tests.

RESULTS

Controls had greater sleep latency, lower total sleep time, fewer leg movements, and a higher percentage ratio of cycling alternating pattern, were more likely not to fall asleep during the MWT and were less likely to have two or more sleep onsets. Although not all the differences reached statistical significance, cases had lower sleep onset times in Trials 1-3.

CONCLUSION

In the literature, the evidence of an association between MWT results and real life risk of accidents is weak. Our results suggest a relationship between the MWT results and the risk of injury among hospital workers.

An ecological study on the association between characteristics of hospital units and the risk of occupational injuries and adverse events on the example of an Italian teaching hospital

OBJECTIVES

We explored the association of workplace characteristics with occupational injuries and adverse events in an Italian teaching hospital.

MATERIAL AND METHODS

This ecological study was conducted using data routinely collected in the University Hospital of Udine, Northeastern Italy. Poisson regression models were used to investigate, at the hospital unit level, the association between 5 outcomes, including: occupational injuries, patient falls, medication errors, other adverse events and near-misses, and various characteristics of the units.

RESULTS

The proportion of female workers in a unit, the average number of sick-leave days and of overtime hours, the number of medical examinations requested by employees, and being a surgical unit were significantly associated with some of the outcomes.

CONCLUSIONS

Despite ecological nature of the study, which does not allow for inferences to be drawn at the individual level, the results of our study provide useful clues to support strategies and interventions directed towards healthier work environments and better patient care in hospitals.

The influence of patients' complexity and general practitioners' characteristics on referrals to outpatient health services in an Italian region

BACKGROUND

Patient referrals to outpatient health services may affect both health outcomes and health expenditures. General practitioners (GP) have a crucial role in driving the use of outpatient services and recognizing factors which affect referrals is important for health managers and planners.

OBJECTIVES

We investigated patient- and physician-related determinants of patient referrals in an Italian region.

METHODS

This was cross-sectional study based on the individual linkage of administrative databases from the health information system of the Friuli Venezia Giulia region. For each GP of the region, the association of the number of patient referrals to different types of outpatient services with the proportion of patients with chronic conditions, with the number of hospital admissions and drug prescriptions in 2012, and with GP's characteristics was investigated through multilevel multivariable Poisson regression models.

RESULTS

Some chronic conditions (e.g., cancer, autoimmune diseases, endocrine diseases, digestive system diseases) were positively associated with the number of referrals, as were hospital admissions and drug prescriptions. Time since GP's graduation was inversely related with referrals.

CONCLUSION

Patient complexity and GP's experience affect referral rates. These factors should be considered in case of a reorganization of the general practice structure in Friuli Venezia Giulia.