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Barbiellini Amidei C, Salmaso L, Fedeli U, Saia M. Traumatic brain injury incidence and mortality: a large population-based study. J Neurol 2024:10.1007/s00415-024-12386-1. [PMID: 38676724 DOI: 10.1007/s00415-024-12386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a severe condition that represents a major global public health concern. OBJECTIVES Provide a comprehensive epidemiological outlook encompassing TBI incidence, healthcare provision and mortality. METHODS Population-based study in Veneto (4.9 million inhabitants), Italy, from 2012 to 2021. Hospital discharge and mortality records were used to assess incidence and mortality. Kaplan-Meier survival estimator and Cox regression models were fitted to investigate determinants of mortality. RESULTS Between 2012 and 2021, there were 37,487 incident TBI cases, corresponding to an age-standardized rate of 77.30/100,000 people (95% CI 76.52-78.09), higher among males, with an exponential growth after age 70. Leading causes were domestic (33.1%) and traffic accidents (17.7%), the first predominating among the elderly and children, while the latter in males 15-24 and older people. After rates stably declined between 2012 and 2019, the study captured a sharp decrease especially for traffic and occupational accidents in males, due to COVID-19 lockdown in 2020. Overall, 48.9% TBI patients were hospitalized in a specialized trauma center, with 2.6% requiring a transfer after accessing a spoke hospital. Over a 3.7 years median follow-up, 16,145 deaths were recorded, with higher mortality for those undergoing neurosurgical interventions, regardless of their access point. Risks of death increased with age, male gender, and comorbidities. DISCUSSION TBI incidence is characterized by distinct patterns, affecting particularly older individuals and males. Minimal hospital transfers with comparable survival irrespective of access point suggests an effective patient management within the network. The study underscores the critical need for acute-phase support and prolonged care strategies for older TBI patients.
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Affiliation(s)
| | | | - Ugo Fedeli
- Azienda Zero, Padua, Veneto Region, Italy
| | - Mario Saia
- Azienda Zero, Padua, Veneto Region, Italy
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Manea S, Pinato M, Salmaso L, Vittorii S, Biasio M, Rigoni M, Manfrin V, Bertocco E, Zanatta M, Saia M. Home care models dedicated to COVID-19 patients: the experience of a Local Health District of Veneto Region (Italy). Ann Ig 2024. [PMID: 38647092 DOI: 10.7416/ai.2024.2623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Background During COVID-19 pandemic, health professionals have been working in an extreme uncertainty context. Affected patients needed to be cared at home as long as possible to avoid virus spreading and hospital resources saturation. The Veneto Regional Administration (North-east of Italy) released Regional guidelines about it. The Western Healthcare District of the Local Health Authority of the city of Vicenza (180,000 inhabitants) implemented a healthcare pathway following them. Aim of the study is to describe the results and outcomes of such implementation. Methods In the implemented health care pathway, a new service called "Special Unit of continuity of care" (USCA) with physicians and nurses has been dedicated to the prise en charge at home of patients suffering from Sars-CoV-2. They were referred to the USCA by general practitioners or by hospital specialists, and managed through a daily clinical monitoring by regular home visits and phone calls, specialist consultations and therapy management. In order to prevent hospital admission, an oxygen concentrator when possible has been employed and managed at home by the members of the USCA when the oxygen saturation was below 93%. An observational retrospective study has been conducted using anonymized data from different databases: the USCA activity database (from 12/01/20 to 21/31/21), the hospital and Emergency Department discharge databases, and the "healthcare co-payments exemptions database". The latter database refers to the people excluded - because of their chronicity - from the co-payment of a list of medical exams and services. Descriptive and multivariate logistic regression analyses have been implemented. Results 1,419 patients suffering from Sars-CoV-2 have been cared and managed by the USCA in the considered period of time (mean 11.4 days), of whom 787 (55.5%) with at least one chronic condition (described in the above quoted "healthcare co-payments exemption database") and 261 provided with oxygen concentrator. 275 (19.4%) needed a hospital admission, 39 (2.8%) in intensive unit; 53 died during hospitalization (3.8%). Out of the 261 patients utilizing oxygen concentrator, 103 have been admitted to hospital (39.5%), 7.3% in intensive unit and 8.0% died. In implemented multivariate analyses, the use of oxygen concentrator, proxy measure of the severity of the condition, is the major determinant for the risk of hospital admission (adj OR: 3.2, CI 2.3-4.3) and of dying within 30 days (adj OR: 2.8 CI 1.5-5.1). Among the 261 patients provided with oxygen concentrator, 158 (60,5%) have been managed at home without any admission to emergency department and/or hospitalization. Conclusions In an uncertain context such as COVID-19 pandemic, the already-implemented home care model has been modified by integrating the USCA physicians and nurses and specialist care networks to prevent hospitalization and the sense of isolation and abandonment of people as much as possible. Almost 1,500 patients suffering from COVID-19 have been cared for at home over 13 months by such new service with complex and multidisciplinary activities. The risk of hospitalization and death appears determined by the severity of the pathology with high and significant OR 60% of patients with oxygen concentrators who, despite an initial high hyposaturation were not hospitalized, represent, partly, the group of patients who would have been requiring hospital care in the absence of a home care pathway in a standard situation.
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Affiliation(s)
- Silvia Manea
- Primary Care Unit, Western Healthcare District, Local Health Authority "8 Berica", Vicenza, Italy
| | - Marco Pinato
- Public Health Department, Local Health Authority "8 Berica", Vicenza, Italy
| | - Laura Salmaso
- Clinical Governance Unit, Local Health Authority "Azienda Zero", Padua, Italy
| | - Silvia Vittorii
- Primary Care Unit, Western Healthcare District, Local Health Authority "8 Berica", Vicenza, Italy
| | - Michela Biasio
- Primary Care Unit, Western Healthcare District, Local Health Authority "8 Berica", Vicenza, Italy
| | - Matteo Rigoni
- Hospital Management Department, Local Health Authority "8 Berica", Vicenza, Italy
| | - Vinicio Manfrin
- Infectious Diseases Unit, Local Health Authority "8 Berica", Vicenza, Italy
| | | | - Mirko Zanatta
- Emergency Unit of Valdagno, Local Health Authority "8 Berica", Vicenza, Italy
| | - Mario Saia
- Clinical Governance Unit, Local Health Authority "Azienda Zero", Padua, Italy
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Casotto V, Amidei CB, Saia M, Gregori D, Zanetto A, Fedeli U, Russo FP. Mortality related to HCV and other chronic liver diseases in Veneto (Italy), 2008-2021: Changes in trends and age-period-cohort effects. Liver Int 2024; 44:559-565. [PMID: 38031995 DOI: 10.1111/liv.15798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/17/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND AIMS The objective of this study was to assess the impact of the COVID-19 pandemic and direct-acting antiviral (DAA) agents on mortality related to chronic liver diseases (CLD). METHODS Age-standardized mortality rates were computed based on CLD as the underlying cause of death (UCOD) and as any mention in death certificates (multiple causes of death-MCOD). Time trends in age-standardized mortality rates were investigated using generalized estimation equation models. Additionally, we conducted age, period, and birth cohort (APC) analyses on CLD-related mortality associated with alcohol and hepatitis C virus (HCV). RESULTS Between 2008 and 2021, among residents in the Veneto region (Northeastern Italy) aged ≥35 years, there were 20 409 deaths based on the UCOD and 30 069 deaths based on MCOD from all CLD. We observed a 4% annual decline in age-standardized MCOD-based mortality throughout 2008-2021, with minor peaks corresponding to COVID-19 epidemic waves. Starting in 2016, the decline in HCV-related mortality accelerated further (p < .001). A peak in HCV-related mortality in the 1963-1967 birth cohort was observed, which levelled off by the end of the study period. Mortality related to alcoholic liver disease declined at a slower pace, becoming the most common aetiology mentioned in death certificates. CONCLUSIONS The study demonstrates a significant decrease in HCV-related mortality at the population level in Italy with the introduction of DAAs. Continuous monitoring of MCOD data is warranted to determine if this favourable trend will continue. Further studies utilizing additional health records are needed to clarify the role of other CLD etiologies.
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Affiliation(s)
| | | | - Mario Saia
- Clinical Governance, Azienda Zero, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Alberto Zanetto
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Padova, Italy
| | - Francesco P Russo
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università di Padova, Padova, Italy
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De Gaspari M, Fedeli U, Saia M, Carturan E, Pilichou K, Corrado D, Thiene G, Rizzo S, Basso C. Rate and Cause of Sudden Cardiac Death in the Young During the COVID-19 Pandemic and Vaccination. Circulation 2023; 148:2069-2071. [PMID: 38109343 PMCID: PMC10752257 DOI: 10.1161/circulationaha.123.066270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Monica De Gaspari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy (U.F.)
| | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy (M.S.)
| | - Elisa Carturan
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
| | - Stefania Rizzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
- Epidemiological Department, Azienda Zero, Veneto Region, Italy (U.F.)
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy (M.S.)
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Censi S, Salmaso L, Ceccato F, Manso J, Fedeli U, Saia M, Mian C. Hyperthyroidism incidence in a large population-based study in northeastern Italy. Endocr Connect 2023; 12:e230292. [PMID: 37855396 PMCID: PMC10692690 DOI: 10.1530/ec-23-0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/18/2023] [Indexed: 10/20/2023]
Abstract
Objective An improvement in iodine status in Veneto Region has been documented in the last decade. We aimed at estimating the incidence of hyperthyroidism in the Veneto Region (Italy) over the period 2013-2022. Methods Retrospective population-based study conducted in Veneto (4.9 million people) using the population registry, an administrative health database. Between 2012 and 2022, hyperthyroidism incidence was defined thank to a health-care co-payment exemption for hyperthyroidism or any hospital diagnosis of hyperthyroidism. Incident hyperthyroidism was defined from 2013 to 2022 to exclude prevalent cases. Standardized incidence rates (IRs) were reported by age, sex, and etiology of thyroid hyperfunction too. Results We identified 26,602 incident cases (IR of 54.38 per 100,000 person-years, 2.47-fold higher in females than in males). IR decreased from 69.87 (95% CI: 67.49, 72.25) in 2013 to 42.83 (95% CI: 40.99, 44.66) in 2022. In 2020, an out-of-trend decrease in hyperthyroidism incidence was documented, corresponding to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic outbreak, with a realignment to the trend in the subsequent years. The annual percentage change according to the cause of hyperthyroidism was as follows: -6.62% (95% CI: 8.47, 4.73) (P < 0.0001) in toxic multinodular goiter, -7.56% in toxic uninodular goiter (95% CI: 10.54, 4.48) (P < 0.001) and -4.70% (95% CI: 6.33, 3.04) in toxic diffuse goiter (Graves' disease) (P < 0.001). Conclusions We documented a decline in the incidence of hyperthyroidism in Veneto Region, paralleling the improvement of the iodine status, thanks to a long and sustained iodine prophylaxis campaign. SARS-CoV-2 pandemic and vaccination campaign did not change the declining trend of hyperthyroidism incidence in our study region. Significance statement An improvement in iodine status in the population residing in the Veneto region has been documented in the last decade, thanks to a nationwide voluntary iodine prophylaxis program running since 2005, but its impact on the epidemiology of thyroid disease has never been documented. This is the largest study on the incidence rates of hyperthyroidism carried out in Italy and covers the longest observation period among all regionwide population-based studies of hyperthyroidism in our country. We documented a reduction in the incidence of hyperthyroidism, which was more pronounced in nodular goiter diagnosis but involved also toxic diffuse goiter. The decline in the incidence of hyperthyroidism in Veneto Region shows the efficacy and safety of the iodine prophylaxis campaign.
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Affiliation(s)
- Simona Censi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Laura Salmaso
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy
| | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Jacopo Manso
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Padua University Hospital, Padova, Italy
| | - Ugo Fedeli
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy
| | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy
| | - Caterina Mian
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
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Cappellari M, Bonetti B, Baracchini C, Corbetta M, De Boni A, Critelli A, Tonello S, Codemo V, Marcon M, Turinese E, Bombardi R, Basile AM, Ruzza G, Cadaldini M, Mampreso E, Marsala SZ, Padoan R, Marini B, Gaudenzi A, Tonon A, Masato M, Baldi A, Turazzini M, Zanette G, Adami A, Saia M, Bovi P. Correction to: Current territorial organization for access to revascularization therapies for acute ischemic stroke in the Veneto region (Italy) from 2017 to 2021. Neurol Sci 2023; 44:3769. [PMID: 37294391 DOI: 10.1007/s10072-023-06890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Manuel Cappellari
- Stroke Unit, DAI Di Neuroscienze, Azienda Ospedaliera, Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Bruno Bonetti
- Stroke Unit, DAI Di Neuroscienze, Azienda Ospedaliera, Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy
| | | | - Maurizio Corbetta
- Stroke Unit, Azienda Ospedaliera Università Di Padova, Padova, Italy
| | | | | | | | - Valentina Codemo
- Stroke Unit, Ospedale Santa Maria Della Misericordia, Rovigo, Italy
| | | | | | | | | | | | - Morena Cadaldini
- Stroke Unit, Ospedali Riuniti Padova Sud, Este, Schiavonia, Italy
| | | | | | - Roberta Padoan
- Stroke Unit, Ospedale Santa Maria del Prato, Feltre, Italy
| | - Bruno Marini
- Stroke Unit, Ospedale San Giacomo Apostolo, Castelfranco Veneto, Italy
| | - Anna Gaudenzi
- Stroke Unit, Ospedale Santa Maria Dei Battuti, Conegliano Veneto, Italy
| | - Agnese Tonon
- Stroke Unit, Ospedale Santi Giovanni E Paolo, Venezia, Italy
| | | | - Antonio Baldi
- Stroke Unit, Ospedale Di Portogruaro, Portogruaro, Italy
| | | | | | | | - Mario Saia
- UOC Governo Clinico Assistenziale, Regione Veneto, Azienda Zero, Padova, Italy
| | - Paolo Bovi
- Italian Stroke Association, Verona, Italy
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Guglielmi A, Tripepi M, Salmaso L, Fedeli U, Ruzzenente A, Saia M. Trends in hospital volume and operative mortality in hepato-biliary surgery in Veneto region, Italy. Updates Surg 2023; 75:1949-1959. [PMID: 37395932 PMCID: PMC10543584 DOI: 10.1007/s13304-023-01574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
Hepatobiliary resections are among the most complex and technically challenging surgical procedures. Even though robust evidence showed that complex surgical procedures such as hepatobiliary surgery have better short- and long-term outcomes and lower mortality rate when performed in high-volume centers, the minimal criteria of centers that can perform hepatobiliary activity are not clearly defined. We conducted a retrospective population study of patients who underwent hepatobiliary surgery for malignant disease in a single Italian administrative region (Veneto) from 2010 to 2021 with the aim to investigate the hospitals annual surgical volume for hepatobiliary malignant diseases and the effect of hospital volume on in-hospital, 30- and 90-day postoperative mortality. The centralization process of hepatobiliary surgery in Veneto is rapidly increasing over the past 10 years (rate of performed in highly specialized centers increased from 62% in 2010 to 78% in 2021) and actually it is really established. The crude and adjusted (for age, sex, Charlson Index) mortality rate after hepatobiliary surgery resulted significantly lower in centers with high-volume activity compared to them with low-volume activity. In the Veneto region, the "Hub and Spoke" model led to a progressive centralization of liver and biliary cancer treatment. High surgical volume has been confirmed to be related to better outcomes in terms of mortality rate after hepatobiliary surgical procedures. Further studies are necessary to clearly define the minimal criteria and associated numerical cutoffs that can help define the characteristics of centers that can perform hepatobiliary activities.
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Affiliation(s)
- Alfredo Guglielmi
- Department of Surgery, Division of General and Hepatobiliary Surgery, School of Medicine, University of Verona, Piazzale L. Scuro, 10, 37123, Verona, Italy
| | - Marzia Tripepi
- Department of Surgery, Division of General and Hepatobiliary Surgery, School of Medicine, University of Verona, Piazzale L. Scuro, 10, 37123, Verona, Italy
| | | | - Ugo Fedeli
- Azienda Zero, Veneto Region, Padua, Italy
| | - Andrea Ruzzenente
- Department of Surgery, Division of General and Hepatobiliary Surgery, School of Medicine, University of Verona, Piazzale L. Scuro, 10, 37123, Verona, Italy.
| | - Mario Saia
- Azienda Zero, Veneto Region, Padua, Italy
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Zen M, Salmaso L, Barbiellini Amidei C, Fedeli U, Bellio S, Iaccarino L, Giollo A, Doria A, Saia M. Systemic lupus erythematosus incidence and prevalence in a large population-based study in northeastern Italy. Rheumatology (Oxford) 2023; 62:2773-2779. [PMID: 36495204 DOI: 10.1093/rheumatology/keac685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/28/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES We aimed at estimating the incidence and prevalence of SLE in northeastern Italy over the period 2012-20. METHODS A retrospective population-based study was conducted in Veneto Region (4.9 million people) using the population registry, an administrative health database where all residents are recorded. Between 2012 and 2020, SLE prevalence was defined by a healthcare co-payment exemption for SLE (national registry code 028) or any hospital diagnosis of SLE (International Classification of Disease , Ninth Revision, Clinical Modification 710.0), whichever came first. Incident SLE was defined from 2013 to 2020 to exclude prevalent cases. Standardized incidence and prevalence rates were reported by age and sex. RESULTS During the study period, we identified 4283 SLE patients (85% female), with 1092 incident cases. Across the study period, SLE standardized point prevalence increased from 63.5 (95% CI 61.2, 65.8) to 70.6 (95% CI 68.3, 73.0) per 100 000 residents, corresponding to an annual increment of 1.14% (P < 0.0001). The highest prevalence was observed in females aged 60-69 years. SLE incidence corresponded to 2.8 per 100 000 person-years (95% CI 2.6, 2.9), with an annual decline of 7.3% (P < 0.0001). Incidence was 5-fold higher in females (female-to-male incidence rate ratio: 5.00, 95% CI 4.25, 5.87; P < 0.0001), with a peak among women aged 30-39 years. At diagnosis, women were significantly younger (45 years, IQR 33-58) than men (52 years, IQR 38-64). CONCLUSIONS Over the last decade, SLE prevalence has increased, while incidence has stably declined. In view of the introduction of new high-cost drugs, a clear definition of the epidemiology of SLE is crucial for all healthcare stakeholders.
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Affiliation(s)
- Margherita Zen
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Laura Salmaso
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy
| | | | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | - Stefania Bellio
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Alessandro Giollo
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy
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Fedeli U, Barbiellini Amidei C, Casotto V, Grande E, Saia M, Zanetto A, Russo FP. Mortality from chronic liver disease: Recent trends and impact of the COVID-19 pandemic. World J Gastroenterol 2023; 29:4166-4173. [PMID: 37475843 PMCID: PMC10354574 DOI: 10.3748/wjg.v29.i26.4166] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 07/10/2023] Open
Abstract
Prepandemic time trends in mortality from chronic liver disease (CLD) differed according to specific cause of death (decreasing for liver cirrhosis, stable or increasing for liver cancer), etiology (increasing for nonalcoholic fatty liver disease, generally decreasing for other etiologies), and world region (decreasing in areas with the highest burden of hepatitis B virus, increasing in Eastern Europe and other countries). The coronavirus disease 2019 (COVID-19) pandemic affected mortality of patients with CLD both directly, with a higher risk for severe illness and death depending on age, stage and etiology of the disease, and indirectly, through social isolation and loss of support, harmful drinking, and difficulties in access to care. Nevertheless, only sparse data are available on variations in CLD as a cause of death during the pandemic. In the USA, in 2020-2021 a growth in mortality was registered for all liver diseases, more marked for alcoholic liver disease, especially among young people aged 25-44 years and in selected ethnic groups. COVID-19 related deaths accounted only for a minor part of the excess. Further data from mortality registers of other countries are warranted, preferably adopting the so-called multiple cause-of-death approach, and extended to deaths attributed to viral hepatitis and liver cancer.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padova 35132, Italy
| | | | - Veronica Casotto
- Epidemiological Department, Azienda Zero, Veneto Region, Padova 35132, Italy
| | - Enrico Grande
- Integrated System for Health, Social Assistance and Welfare, National Institute of Statistics, Rome 00184, Italy
| | - Mario Saia
- Clinical Governance, Azienda Zero, Veneto Region, Padova 35132, Italy
| | - Alberto Zanetto
- Department of Surgery Oncology and Gastroenterology, University of Padua, Padova 35128, Italy
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università di Padova, Padova 25128, Italy
| | - Francesco Paolo Russo
- Department of Surgery Oncology and Gastroenterology, University of Padua, Padova 35128, Italy
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università di Padova, Padova 25128, Italy
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Zen M, Salmaso L, Barbiellini Amidei C, Fedeli U, Bellio S, Iaccarino L, Doria A, Saia M. Mortality and causes of death in systemic lupus erythematosus over the last decade: Data from a large population-based study. Eur J Intern Med 2023; 112:45-51. [PMID: 36774306 DOI: 10.1016/j.ejim.2023.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To assess mortality rates (MRs), standardized mortality ratios, and causes of death in systemic lupus erythematosus (SLE) in a population-based study. METHODS We analyzed linked administrative health databases of the Veneto Region (Italy, 4,900,000 residents). SLE was defined by any hospital diagnosis or healthcare copayment exemption for SLE. We analyzed mortality from January 1st, 2012, until December 31st, 2021. MRs per 1000 were stratified by year, sex, and age group. Standardized mortality ratios were derived by comparing MRs of the general regional population. Causes of death were coded using the ICD-10 coding system and they were grouped in: SLE, infectious diseases, cardiovascular diseases (CVD), cancer, or others. RESULTS Among 4283 SLE prevalent cases, 603 deaths occurred, corresponding to an average annual standardized MR of 18.6 per 1000 person/year (95% CI 17.0-20.2). Out of 1092 incident SLE patients, 90 died with a peak in the first year after diagnosis (MR 26.5 per 10,000 person/month). Standardized mortality ratio was 2.65 (95% CI 2.13-3.26) overall, and highest among younger patients (<45 years: 5.59, 95% CI 2.05-12.4). Five- and 8-year survival were 91% and 89%, respectively. About half of the deaths had CVD or cancer as underlying cause, whereas infections were less frequently reported. CONCLUSIONS Although the medium-term survival since diagnosis is good, SLE mortality is still higher than that of the general population, especially in youngest patients. Nowadays, CVD seems to be the major cause of deaths in SLE, whereas infections account for a low proportion of deaths, at least in Western countries.
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Affiliation(s)
- Margherita Zen
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Laura Salmaso
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy
| | | | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | - Stefania Bellio
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy.
| | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy
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11
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Saia M, Salmaso L, Bellio S, Miatton A, Cocchio S, Baldovin T, Baldo V, Buja A. Hospital readmissions and mortality following discharge against medical advice: a five-year retrospective, population-based cohort study in Veneto region, Northeast Italy. BMJ Open 2023; 13:e069775. [PMID: 37221033 DOI: 10.1136/bmjopen-2022-069775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVES The aim of this study was to examine the odds of readmission and mortality after discharge against medical advice (DAMA) in the Veneto region of Northeast Italy, drawing on data from the regional archives of emergency department records and hospital discharge records. DESIGN A retrospective cohort study. SETTING Hospital discharges, Veneto region, Italy. PARTICIPANTS All patients discharged after being admitted to a public or accredited private hospital between January 2016 and 31 January 2021 in the Veneto region were considered. A total of 3 574 124 index discharges were examined for inclusion in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES Readmission and overall mortality at 30 days after the index discharge against admission. RESULTS In our cohort, 7.6‰ of patients left hospital against their doctor's advice (n=19 272). These DAMA patients were more likely to be younger (mean age: 45.5 vs 55.0), foreign (22.1% vs 9.1%). The adjusted odds of readmission after DAMA was 2.76 (CI 95% 2.62-2.90) at 30 days (9.5% DAMA vs 4.6% not-DAMA), and the highest readmission rate was recorded in the first 24 hours after the index discharge. Mortality was higher for DAMA patients after adjusting for patient-level and hospital-level characteristics (with adjusted ORs of 1.40 for in-hospital mortality and 1.48 for overall mortality). CONCLUSIONS The present study shows that DAMA patients are more likely to die and to need hospital readmission than patients discharged by their doctors. DAMA patients should be more committed to a proactive and diligent postdischarge care.
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Affiliation(s)
- Mario Saia
- Clinical Governance Unit, Azienda Zero, Padua, Italy
| | - Laura Salmaso
- Clinical Governance Unit, Azienda Zero, Padua, Italy
| | | | - Andrea Miatton
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Silvia Cocchio
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Tatjana Baldovin
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Alessandra Buja
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua, Italy
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12
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Cocchio S, Prandi GM, Furlan P, Venturato G, Saia M, Marcon T, Tremolada G, Baldo V. Respiratory Syncytial Virus in Veneto Region: Analysis of Hospital Discharge Records from 2007 to 2021. Int J Environ Res Public Health 2023; 20:4565. [PMID: 36901576 PMCID: PMC10002215 DOI: 10.3390/ijerph20054565] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Respiratory Syncytial Virus (RSV) is a known cause of acute lower respiratory infections in infants and young children. The present study aims to analyze the temporal trends and characteristics of hospitalization related to RSV in the Veneto region (Italy) in the period between 2007 and 2021. The analysis is performed on all the hospital discharge records (HDRs) of public and accredited private hospitals corresponding to hospitalizations occurring in the Veneto region (Italy). HDRs are considered if they included at least one of the following ICD9-CM codes: 079.6-Respiratory Syncytial Virus (RSV); 466.11-acute bronchiolitis due to RSV; and 480.1-pneumonia due to RSV. Total annual cases, sex, and age-specific rates and trends are evaluated. Overall, an increasing trend in the number of hospitalizations due to RSV was observed between 2007 and 2019, with a slight drop in RSV seasons 2013-2014 and 2014-2015. From March 2020 to September 2021, almost no hospitalization was registered, but in the last quarter of 2021, the number of hospitalizations reached its highest value in the series. Our data confirm the preponderance of RSV hospitalizations in infants and young children, the seasonality of RSV hospitalizations, and acute bronchiolitis as the most frequent diagnosis. Interestingly, the data also show the existence of a significant burden of disease and a non-negligible number of deaths also in older adults. The present study confirms RSV is associated with high rates of hospitalization in infants and sheds light on the burden in the 70+ age group in which a considerable number of deaths was observed, as well as the parallelism with other countries, which is consistent with a wide underdiagnoses issue.
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Affiliation(s)
- Silvia Cocchio
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Gian Marco Prandi
- Department for Woman and Child Health, University of Padua, 35128 Padua, Italy
| | - Patrizia Furlan
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Giovanni Venturato
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Mario Saia
- “Azienda Zero” of Veneto Region, 35100 Padua, Italy
| | | | - Giulia Tremolada
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
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13
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Cappellari M, Bonetti B, Baracchini C, Corbetta M, De Boni A, Critelli A, Tonello S, Codemo V, Marcon M, Turinese E, Bombardi R, Basile AM, Ruzza G, Cadaldini M, Mampreso E, Marsala SZ, Padoan R, Marini B, Gaudenzi A, Tonon A, Masa M, Baldi A, Turazzini M, Zanette G, Adami A, Saia M, Bovi P. Current territorial organization for access to revascularization therapies for acute ischemic stroke in the Veneto region (Italy) from 2017 to 2021. Neurol Sci 2023; 44:2033-2039. [PMID: 36753010 PMCID: PMC9905755 DOI: 10.1007/s10072-023-06662-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION To evaluate the access to treatments with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) in acute ischemic stroke patients admitted to stroke units (SUs) of Veneto region (Italy) according to current "hub-and-spoke" model from 2017 to 2021. PATIENTS AND METHODS We retrospectively analyzed data on treatments with IVT and/or MT for stroke patients admitted to the 23 SUs (6 Hubs and 17 Spokes) of the 6 macro-areas including 9 local sanitary units (LSUs) and 2 hospitals. RESULTS We reported 6093 treatments with IVT alone, 1114 with IVT plus MT, and 921 with MT alone. Number of stroke unit (SU) beds/100,000 inhabitants ranges from 2.3 to 2.8, and no difference was found among different macro-areas. Number of treatments/100,000 inhabitants/year ranges from 19 to 34 for IVT alone, from 2 to 7 for IVT plus MT, and from 2 to 5 for MT alone. Number of IVT alone/SU bed/year ranges from 9 to 21 in the Hub and from 6 to 12 in the Spokes. Rate of IVT plus MT in patients directly arrived in the same LSU's Hub ranges from 50 to 81%, likewise the one of MT alone ranges from 49 to 84%. CONCLUSIONS Treatment target rates of IVT and MT set by Action Plan for Stroke in Europe 2018-2030 has been globally exceeded in the Veneto region. However, the target rate of MT and access revascularization treatments is heterogeneous among different macro-areas. Further efforts should be made to homogenize the current territorial organization.
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Affiliation(s)
- Manuel Cappellari
- Stroke Unit, DAI Di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Bruno Bonetti
- Stroke Unit, DAI Di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy
| | | | - Maurizio Corbetta
- Stroke Unit, Azienda Ospedaliera Università Di Padova, Padova, Italy
| | | | | | | | - Valentina Codemo
- Stroke Unit, Ospedale Santa Maria Della Misericordia, Rovigo, Italy
| | | | | | | | | | | | - Morena Cadaldini
- Stroke Unit, Ospedali Riuniti Padova Sud, Este, Schiavonia, Italy
| | | | | | - Roberta Padoan
- Stroke Unit, Ospedale Santa Maria del Prato, Feltre, Italy
| | - Bruno Marini
- Stroke Unit, Ospedale San Giacomo Apostolo, Castelfranco Veneto, Italy
| | - Anna Gaudenzi
- Stroke Unit, Ospedale Santa Maria Dei Battuti, Conegliano Veneto, Italy
| | - Agnese Tonon
- Stroke Unit, Ospedale Santi Giovanni E Paolo, Venezia, Italy
| | - Maela Masa
- Stroke Unit, Ospedale Di Mirano, Mirano, Italy
| | - Antonio Baldi
- Stroke Unit, Ospedale Di Portogruaro, Portogruaro, Italy
| | | | | | | | - Mario Saia
- UOC Governo Clinico Assistenziale, Regione Veneto, Azienda Zero, Padova, Italy
| | - Paolo Bovi
- Italian Stroke Association, Italy, Verona
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14
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Fedeli U, Casotto V, Barbiellini Amidei C, Saia M, Tiozzo SN, Basso C, Schievano E. Parkinson's disease related mortality: Long-term trends and impact of COVID-19 pandemic waves. Parkinsonism Relat Disord 2022; 98:75-77. [PMID: 35490543 PMCID: PMC9040425 DOI: 10.1016/j.parkreldis.2022.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
Introduction Parkinson's disease (PD) mortality burden is increasing worldwide, but accurate estimates on the magnitude of the impact of the COVID-19 pandemic are missing. Mortality rates vary largely when considering PD as underlying cause of death (UCOD), or as one among multiple causes reported in death certificates (MCOD). The aim of this study is to assess COVID-19 impact on PD-related mortality trends using the UCOD and MCOD approach. Methods Mortality records between 01/2008-12/2020 of residents aged ≥45 years in Veneto Region (Northeastern Italy) with any mention of PD were collected. Age-standardized sex-specific mortality rates were estimated for PD-related deaths as UCOD and MCOD to assess time trends. The average annual percentage change in age-standardized rates (AAPC) was estimated by linear regression models. Monthly mortality in 2020, the first year of the pandemic, was plotted against the 2018–2019 average. Results Overall, 13,746 PD-related deaths (2.3% of all deaths) were identified, 52% males, median age 84 years. Proportional mortality increased from 1.9% (2008) to 2.8% (2020). AAPC through 2008–2019 was +5.2% for males and +5.3% for females in analyses of the UCOD, and +1.4% in both genders based on MCOD. Excess in PD-related mortality during 2020 corresponded to 19% for UCOD and 28% for MCOD, with the latter showing two peaks corresponding to the first (28%) and second (59%) pandemic waves. Conclusion Age-standardized PD-related mortality rates have steeply increased during COVID-19 pandemic, amplifying a pre-existing long-term trend. Hence, surveillance of mortality associated to PD is warranted in the forthcoming pandemic and post-pandemic years.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | | | | | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy
| | | | - Cristina Basso
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Italy.
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15
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De Silvestro G, Marson P, La Raja M, Cattelan AM, Guarnieri G, Monticelli J, Tiberio I, Vianello A, Gandini G, Gessoni G, Fiorin F, Sardella C, Astolfi L, Saia M. Outcome of SARS CoV-2 inpatients treated with convalescent plasma: One-year of data from the Veneto region (Italy) Registry. Eur J Intern Med 2022; 97:42-49. [PMID: 34980505 PMCID: PMC8710400 DOI: 10.1016/j.ejim.2021.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/19/2021] [Accepted: 12/20/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES AND BACKGROUND Convalescent plasma (CP) has been used worldwide to contrast SARS-CoV-2 infection. Since April 2020, it has also been used in the treatment of patients with COVID-19 in the Veneto region (Italy), along with all the other available drugs and therapeutic tools. Here we report data analysis and clinical results in 1,517 COVID-19 inpatients treated with CP containing high-titre neutralizing anti-SARS-CoV-2 antibodies (CCP). Mortality after 30 days of hospitalization has been considered primary outcome, by comparing patients treated with CCP vs all COVID-19 patients admitted to hospitals of the Veneto region in a one-year period (from April 2020 to April 2021). PATIENTS AND METHODS Adult inpatients with a severe form of COVID-19 have been enrolled, with at least one of the following inclusion criteria: 1) tachypnea with respiratory rate (RR) ≥ 30 breaths/min; 2) oxygen saturation (SpO2) ≤ 93% at rest and in room air; 3) partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ≤ 200 mmHg, 4) radiological picture and/or chest CT scan showing signs of interstitial disease and/or rapid progression of lung involvement. Patients received a maximum of three therapeutic fractions (TFs) of CCP with a neutralizing antibody titre of ≥ 1:160, administered over a period of 3-5 days. If TFs of CCP with titre ≥ 1:160 were unavailable, 2 with antibody titre of ≥ 1:80 have been administered. RESULTS Of the 1,517 patients treated with CCP, 209 deceased at the 30-day follow-up (14%). Death was significantly associated with an older age (p<0.001), a longer time of hospitalization before CCP infusion (p<0.001), a greater number of inclusion criteria (p<0.001) and associated comorbidities (p<0.001). Conditions significantly associated with an increased frequency of death were PaO2/FiO2 ≤ 200 (p<0.001) and tachypnea with RR>30 (p<0.05) at entry, concurrent arterial hypertension (p<0.001), cardiovascular disease (p<0.001), chronic kidney disease (p<0.001), dyslipidemia (p<0.05) and cancer (p<0.05). Moreover, factors leading to an unfavorable prognosis were a life-threatening disease (p<0.001), admission to Intensive Care Unit (p<0.001), high flow oxygen therapy or mechanical ventilation (p<0.05) and a chest X-ray showing consolidation area (p<0.001). By analyzing the regional report of hospitalized patients, a comparison of mortality by age group, with respect to our series of patients treated with CCP, has been made. Mortality was altogether lower in patients treated with CCP (14% v. 25%), especially in the group of the elderly patients (23% vs 40%,), with a strong significance (p<0.001). As regards the safety of CCP administration, 16 adverse events were recorded out of a total of 3,937 transfused TFs (0,4%). CONCLUSIONS To overcome the difficulties of setting up a randomized controlled study in an emergency period, a data collection from a large series of patients with severe COVID-19 admitted to CCP therapy with well-defined inclusion criteria has been implemented in the Veneto region. Our results have shown that in patients with severe COVID-19 early treatment with CCP might contribute to a favourable outcome, with a reduced mortality, in absence of relevant adverse events.
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Affiliation(s)
| | - Piero Marson
- Department of Transfusion Medicine, Padua University Hospital, Padova, Italy.
| | - Massimo La Raja
- Department of Transfusion Medicine, Padua University Hospital, Padova, Italy.
| | | | - Gabriella Guarnieri
- Respiratory Pathophysiology Division, Padua University Hospital, Padova, Italy.
| | | | - Ivo Tiberio
- Intensive Care Central Unit, Department of Medicine, Padua University Hospital, Padova, Italy.
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Padua University Hospital, Padova, Italy.
| | - Giorgio Gandini
- Transfusion Medicine Department, Verona University Hospital, Verona, Italy.
| | - Gianluca Gessoni
- Transfusion Medicine Department of Venezia, Ospedale dell'Angelo-Mestre Venezia, Italy.
| | - Francesco Fiorin
- Transfusion Medicine Department of Vicenza, Ospedale San Bortolo, Vicenza, Italy.
| | | | - Laura Astolfi
- Bioacustics Research Laboratory, Department of Neurosciences, Padua University, Padova, Italy.
| | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Veneto, Italy.
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Cocchio S, Zabeo F, Facchin G, Piva N, Furlan P, Nicoletti M, Saia M, Tonon M, Mongillo M, Russo F, Baldo V. The Effectiveness of a Diverse COVID-19 Vaccine Portfolio and Its Impact on the Persistence of Positivity and Length of Hospital Stays: The Veneto Region's Experience. Vaccines (Basel) 2022; 10:vaccines10010107. [PMID: 35062767 PMCID: PMC8777781 DOI: 10.3390/vaccines10010107] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
The vaccination campaign for the Veneto region (northeastern Italy) started on 27 December 2020. As of early December 2021, 75.1% of the whole Veneto population has been fully vaccinated. Vaccine efficacy has been demonstrated in many clinical trials, but reports on real-world contexts are still necessary. We conducted a retrospective cohort study on 2,233,399 residents in the Veneto region to assess the reduction in the COVID-19 burden, taking different outcomes into consideration. First, we adopted a non-brand-specific approach borrowed from survival analysis to estimate the effectiveness of vaccination against SARS-CoV-2 in preventing infections, hospitalizations, and deaths. We used t-tests and multivariate regressions to examine vaccine impact on breakthrough infections, in terms of the persistence of positivity and the length of hospital stays. Evidence emerging from this study suggests that unvaccinated individuals are significantly more likely to become infected, need hospitalization, and are at a higher risk of death from COVID-19 than those given at least one dose of vaccine. Cox models indicate that the effectiveness of full vaccination is 88% against infection, 94% against hospitalization, and 95% against death. Multivariate regressions suggest that vaccination is significantly correlated with a shorter period of positivity and shorter hospital stays, with each step toward completion of the vaccination cycle coinciding with a reduction of 3.3 days in the persistence of positivity and 2.3 days in the length of hospital stay.
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Affiliation(s)
- Silvia Cocchio
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Federico Zabeo
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Giacomo Facchin
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Nicolò Piva
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Patrizia Furlan
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Michele Nicoletti
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Mario Saia
- Azienda Zero of Veneto Region, 35100 Padua, Italy;
| | - Michele Tonon
- Regional Directorate of Prevention, Food Safety, Veterinary, Public Health—Regione del Veneto, 30123 Venezia, Italy; (M.T.); (M.M.); (F.R.)
| | - Michele Mongillo
- Regional Directorate of Prevention, Food Safety, Veterinary, Public Health—Regione del Veneto, 30123 Venezia, Italy; (M.T.); (M.M.); (F.R.)
| | - Francesca Russo
- Regional Directorate of Prevention, Food Safety, Veterinary, Public Health—Regione del Veneto, 30123 Venezia, Italy; (M.T.); (M.M.); (F.R.)
| | - Vincenzo Baldo
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
- Correspondence: ; Tel.: +39-049-8275381
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17
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Paganini M, Barbiellini Amidei C, Valastro MF, Favaro A, Saia M, Buja A. Adult emergency department visits during the COVID-19 pandemic in Veneto region, Italy: a time-trend Analysis. Intern Emerg Med 2022; 17:285-289. [PMID: 34328625 PMCID: PMC8321884 DOI: 10.1007/s11739-021-02815-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 10/31/2022]
Affiliation(s)
- Matteo Paganini
- Department of Biomedical Sciences, University of Padova, Via Marzolo 3, 35131, Padova, Italy.
- Emergency Department and Emergency Medical Service, "San Bassiano" Hospital, ULSS 7 "Pedemontana", Via dei Lotti, 40, 36061, Bassano del Grappa, Italy.
| | - Claudio Barbiellini Amidei
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, Via Loredan 18, 35131, Padova, Italy
| | - Maria Francesca Valastro
- Emergency Department and Emergency Medical Service, "San Bassiano" Hospital, ULSS 7 "Pedemontana", Via dei Lotti, 40, 36061, Bassano del Grappa, Italy
| | - Andrea Favaro
- Emergency Department and Emergency Medical Service, "San Bassiano" Hospital, ULSS 7 "Pedemontana", Via dei Lotti, 40, 36061, Bassano del Grappa, Italy
| | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Veneto Region, Pass. Luigi Gaudenzio 1, 35131, Padova, Italy
| | - Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, Via Loredan 18, 35131, Padova, Italy
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18
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Buja A, De Luca G, Zorzi M, Carpin E, Pinato C, Vecchiato A, Del Fiore P, Bortolami A, Tognazzo S, Falasco F, Saia M, Baldo V, Rugge M, Rossi CR, Mocellin S. Quality management of cutaneous melanoma: impact on short-term outcomes and costs. Eur J Dermatol 2021; 31:730-735. [PMID: 34789442 DOI: 10.1684/ejd.2021.4149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Promoting standardization and quality assurance (QA) may guarantee better outcomes for patients and ensure a better allocation of healthcare system resources. The present study tested the association between process quality indicators of the clinical pathway for melanoma and both patient short-term mortality and budget utilization. Specific indicators were selected to assess quality of processes in different phases of the pathway as well as the pathway as a whole. Cox regression models were run for each phase to test the association between adherence to the quality indicator and overall mortality. A Tobit regression analysis was used to identify any association between adherence to the quality indicators and total costs over the two years after melanoma was diagnosed. This retrospective cohort study concerned 1,222 incident cases of melanoma in the Veneto Region (north-east of Italy). Adherence to the clinical pathway as a whole was associated with a significant decrease in risk of death (HR= 0.40; 95% CI: 0,19 -0,77). Adherence to quality processes in the diagnostic phase (HR= 0.55 95% CI: 0.31- 0.95) and surgical phase (HR= 0.33 95% CI: 0.16- 0.61) significantly reduced the hazard risk. Tobit regression revealed a significant increase in overall costs for patients who adhered to the whole pathway in comparison with those who did not (β= 2,393.24; p= 0.013). This study suggests that adherence to the quality of management of clinical pathways modifies short-term survival as well as mean cost of care for patients with cutaneous melanoma. Physicians should be encouraged to improve their compliance with clinical care pathways for their melanoma patients, and steadily growing associated costs emphasize the need for policy makers to invest exclusively in treatments of proven efficacy.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Giuseppe De Luca
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | - Eva Carpin
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | - Carlo Pinato
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology - IOV IRCCS, Padua, Italy
| | - Antonella Vecchiato
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology - IOV IRCCS, Padua, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology - IOV IRCCS, Padua, Italy
| | - Alberto Bortolami
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology - IOV IRCCS, Padua, Italy
| | - Sandro Tognazzo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology - IOV IRCCS, Padua, Italy
| | - Francesca Falasco
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology - IOV IRCCS, Padua, Italy
| | | | - Vincenzo Baldo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero, Padova, Italy, Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padova, Padova, Italy
| | - Carlo Riccardo Rossi
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology - IOV IRCCS, Padua, Italy, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology - IOV IRCCS, Padua, Italy
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Barbiellini Amidei C, Buja A, Bardin A, Bonaldi F, Paganini M, Manfredi M, Favaro A, Baldo V, Saia M, Da Dalt L. Pediatric emergency department visits during the COVID-19 pandemic: a large retrospective population-based study. Ital J Pediatr 2021; 47:218. [PMID: 34736514 PMCID: PMC8567132 DOI: 10.1186/s13052-021-01168-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has stretched healthcare system capacities worldwide and deterred people from seeking medical support at Emergency Departments (ED). Nevertheless, population-based studies examining the consequences on children are lacking. METHODS All ED visits from 2019 to 2020 in Veneto, Italy (4.9 million residents) were collected. Anonymized records of pediatric (≤14 years) ED visits included patient characteristics, arrival mode, triage code, clinical presentation, and discharge mode. Year-on-year variation of the main ED visit characteristics, and descriptive trends throughout the study period have been examined. RESULTS Overall, 425,875 ED presentations were collected, 279,481 in 2019, and 146,394 in 2020 (- 48%), with a peak (- 79%) in March-April (first pandemic wave), and a second peak (below - 60%) in November-December (second pandemic wave). Burn or trauma, and fever were the two most common clinical presentations. Visits for nonurgent conditions underwent the strongest reduction during both pandemic waves, while urgent conditions reduced less sharply. ED arrival by ambulance was more common in 2020 (4.5%) than 2019 (3.5%), with a higher proportion of red triage codes (0.5%, and 0.4% respectively), and hospitalizations following ED discharge (9.1%, and 5.9% respectively). CONCLUSION Since the beginning of the COVID-19 pandemic, pediatric ED presentations underwent a steeper reduction than that observed for adults. Lockdown and fear of contagion in hospital-based services likely deterred parents from seeking medical support for their children. Given COVID-19 could become endemic, it is imperative that public health experts guarantee unhindered access to medical support for urgent, and less urgent health conditions, while minimizing infectious disease risks, to prevent children from suffering direct and indirect consequences of the pandemic.
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Affiliation(s)
- Claudio Barbiellini Amidei
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padova, Italy
| | - Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padova, Italy.
| | - Andrea Bardin
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padova, Italy
| | - Filippo Bonaldi
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padova, Italy
| | - Matteo Paganini
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Mariagiovanna Manfredi
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padova, Italy
| | - Andrea Favaro
- Emergency Department and Emergency Medical Service, "San Bassiano" Hospital, ULSS 7 "Pedemontana", Bassano del Grappa, Italy
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padova, Italy
| | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Padova, Italy
| | - Liviana Da Dalt
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padova, Italy
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20
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Germana’ B, Bellio S, Barbiellini Amidei C, Capodaglio G, Avossa F, Narne E, Pitter G, Fedeli U, Zorzi M, Rosa–Rizzotto E, Pantalena M, Saia M. PC.01.11 IMPACT OF COVID-19 PANDEMIC ON COLONOSCOPY AND SURGICAL INTERVENTIONS FOR COLORECTAL CANCER IN VENETO REGION. Dig Liver Dis 2021. [PMCID: PMC8451198 DOI: 10.1016/s1590-8658(21)00471-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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21
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Bonora E, Fedeli U, Schievano E, Trombetta M, Saia M, Scroccaro G, Tacconelli E, Zoppini G. SARS-CoV-2 and COVID-19 in diabetes mellitus. Population-based study on ascertained infections, hospital admissions and mortality in an Italian region with ∼5 million inhabitants and ∼250,000 diabetic people. Nutr Metab Cardiovasc Dis 2021; 31:2612-2618. [PMID: 34348880 PMCID: PMC8239199 DOI: 10.1016/j.numecd.2021.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Diabetes conveys an increased risk of infectious diseases and related mortality. We investigated risk of ascertained SARS-CoV-2 infection in diabetes subjects from the Veneto Region, Northeastern Italy, as well as the risk of being admitted to hospital or intensive care unit (ICU), or mortality for COVID-19. METHODS AND RESULTS Diabetic subjects were identified by linkage of multiple health archives. The rest of the population served as reference. Information on ascertained infection by SARS-CoV-2, admission to hospital, admission to ICU and mortality in the period from February 21 to July 31, 2020 were retrieved from the regional registry of COVID-19. Subjects with ascertained diabetes were 269,830 (55.2% men; median age 72 years). Reference subjects were 4,681,239 (men 48.6%, median age 46 years). Ratios of age- and gender-standardized rates (RR) [95% CI] for ascertained infection, admission to hospital, admission to ICU and disease-related death in diabetic subjects were 1.31 [1.19-1.45], 2.11 [1.83-2.44], 2.45 [1.96-3.07], 1.87 [1.68-2.09], all p < 0.001. The highest RR of ascertained infection was observed in diabetic men aged 20-39 years: 1.90 [1.04-3.21]. The highest RR of ICU admission and death were observed in diabetic men aged 40-59 years: 3.47 [2.00-5.70] and 5.54 [2.23-12.1], respectively. CONCLUSIONS These data, observed in a large population of ∼5 million people of whom ∼250,000 with diabetes, show that diabetes not only conveys a poorer outcome in COVID-19 but also confers an increased risk of ascertained infection from SARS-CoV-2. Men of young or mature age have the highest relative risks.
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Affiliation(s)
- Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
| | - Ugo Fedeli
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | - Elena Schievano
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | - Maddalena Trombetta
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Mario Saia
- Azienda Zero, Veneto Region, Padua, Italy
| | | | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Giacomo Zoppini
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
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22
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Buja A, Fonzo M, Sperotto M, De Battisti E, Baldovin T, Cocchio S, Furlan P, Saia M, Scapellato ML, Viel G, Baldo V, Bertoncello C. Education level and hospitalization for ambulatory care sensitive conditions: an education approach is required. Eur J Public Health 2021; 30:207-212. [PMID: 31321416 DOI: 10.1093/eurpub/ckz122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies in several different countries and settings suggest that ambulatory care-sensitive conditions (ACSCs)-related hospitalizations could be associated more with socioeconomic variables than with the quality of primary healthcare services. The aim of the present study was to analyze the potential links between education levels or other social determinants and ACSC-related hospitalization rates. METHODS We analyzed a total of 467 504 records of ordinary discharges after acute hospitalization in 2015-16 for patients 20-74 years old residing in the Veneto Region. We calculated the prevention quality indicators (PQIs) developed by the Agency for Healthcare Research and Quality. Rate ratios (RRs) and 95% confidence intervals (95% CIs) were estimated with a set of Poisson regressions to measure the relative risk by sociodemographic level. RESULTS Hospitalizations for ACSCs accounted for 3.9% of all hospital admissions (18 436 discharges), and the crude hospitalization rate for ACSCs among 20- to 74-year-olds was 26.6 per 10 000 inhabitants (95% CI, 25.8-27.4). For all conditions, we found a significant association with formal education. In the case of the overall composite PQI#90, e.g. poorly educated people (primary school or no schooling) were at significantly higher risk of hospitalization for ACSCs than the better educated (RR, 4.50; 95% CI, 4.13-4.91). CONCLUSIONS Currently available administrative data regarding ACSCs may be used effectively for reveal equity issues in the provision of health care. Our results indicate that an educational approach inside Primary Health Care could address the extra risk for preventable healthcare demands associated with poorly educated patients.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Marco Fonzo
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Padova, Italy
| | - Milena Sperotto
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Elisa De Battisti
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Padova, Italy
| | - Tatjana Baldovin
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Silvia Cocchio
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Patrizia Furlan
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Mario Saia
- ULSS 6 Euganea, Veneto Region, Padova, Italy
| | - Maria Luisa Scapellato
- Department of Cardiological, Thoracic and Vascular Sciences, Occupational Medicine Unit, University of Padua, Padova, Italy
| | - Guido Viel
- Department of Cardiological, Thoracic and Vascular Sciences, Legal Medicine Unit, University of Padua, Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Chiara Bertoncello
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
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23
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Filippini T, Rothman KJ, Cocchio S, Narne E, Mantoan D, Saia M, Goffi A, Ferrari F, Maffeis G, Orsini N, Baldo V, Vinceti M. Associations between mortality from COVID-19 in two Italian regions and outdoor air pollution as assessed through tropospheric nitrogen dioxide. Sci Total Environ 2021; 760:143355. [PMID: 33187703 PMCID: PMC7609227 DOI: 10.1016/j.scitotenv.2020.143355] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/24/2020] [Accepted: 10/25/2020] [Indexed: 05/15/2023]
Abstract
After the appearance of COVID-19 in China last December 2019, Italy was the first European country to be severely affected by the outbreak. The first diagnosis in Italy was on February 20, 2020, followed by the establishment of a light and a tight lockdown on February 23 and on March 8, 2020, respectively. The virus spread rapidly, particularly in the North of the country in the 'Padan Plain' area, known as one of the most polluted regions in Europe. Air pollution has been recently hypothesized to enhance the clinical severity of SARS-CoV-2 infection, acting through adverse effects on immunity, induction of respiratory and other chronic disease, upregulation of viral receptor ACE-2, and possible pathogen transportation as a virus carrier. We investigated the association between air pollution and subsequent COVID-19 mortality rates within two Italian regions (Veneto and Emilia-Romagna). We estimated ground-level nitrogen dioxide through its tropospheric levels using data available from the Sentinel-5P satellites of the European Space Agency Copernicus Earth Observation Programme before the lockdown. We then examined COVID-19 mortality rates in relation to the nitrogen dioxide levels at three 14-day lag points after the lockdown, namely March 8, 22 and April 5, 2020. Using a multivariable negative binomial regression model, we found an association between nitrogen dioxide and COVID-19 mortality. Although ecological data provide only weak evidence, these findings indicate an association between air pollution levels and COVID-19 severity.
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Affiliation(s)
- Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Kenneth J Rothman
- RTI Health Solutions, Research Triangle Park, NC, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Silvia Cocchio
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Italy
| | | | - Domenico Mantoan
- Department for Health and Social Affairs of Veneto Region, Venice, Italy
| | - Mario Saia
- Azienda Zero of Veneto Region, Padua, Italy
| | | | | | | | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Vincenzo Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Italy
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
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24
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Russo F, Pitter G, Da Re F, Tonon M, Avossa F, Bellio S, Fedeli U, Gubian L, Monetti D, Saia M, Zanella F, Zorzi M, Narne E, Mantoan D. Epidemiology and public health response in early phase of COVID-19 pandemic, Veneto Region, Italy, 21 February to 2 April 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 33243356 PMCID: PMC7693165 DOI: 10.2807/1560-7917.es.2020.25.47.2000548] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Veneto was one of the Italian regions hit hardest by the early phase of the coronavirus disease (COVID-19) pandemic. Aim This paper describes the public health response and epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the Veneto Region from 21 February to 2 April 2020. Methods Information on the public health response was collected from regional health authorities’ official sources. Epidemiological data were extracted from a web-based regional surveillance system. The epidemic curve was represented by date of testing. Characteristics of hospitalised COVID-19 cases were described and compared to those never admitted to hospital. Age- and sex-stratified case-fatality ratios (CFRs) were calculated. Results Key elements of the regional public health response were thorough case-finding and contact tracing, home care for non-severe cases, creation of dedicated COVID-19 healthcare facilities and activation of sub-intensive care units for non-invasive ventilation. As at 2 April 2020, 91,345 individuals were tested for SARS-CoV-2 and 10,457 (11.4%) were positive. Testing and attack rates were 18.6 per 1,000 and 213.2 per 100,000 population, respectively. The epidemic peaked around 20 to 24 March, with case numbers declining thereafter. Hospitalised cases (n = 3,623; 34.6%) were older and more frequently male compared with never-hospitalised cases. The CFR was 5.6% overall, and was higher among males and people > 60 years of age. Conclusion In the Veneto Region, the strict social distancing measures imposed by the Italian government were supported by thorough case finding and contact tracing, as well as well-defined roles for different levels of care.
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Affiliation(s)
- Francesca Russo
- Regional Directorate of Prevention, Food Safety, Veterinary Public Health, Regione del Veneto, Padova, Italy
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Filippo Da Re
- These authors contributed equally.,Regional Directorate of Prevention, Food Safety, Veterinary Public Health, Regione del Veneto, Padova, Italy
| | - Michele Tonon
- These authors contributed equally.,Regional Directorate of Prevention, Food Safety, Veterinary Public Health, Regione del Veneto, Padova, Italy
| | - Francesco Avossa
- Regional Epidemiological Service Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Stefania Bellio
- Hygiene and Public Health Unit, Department of Cardiovascular Medicine and Public Health, University of Padova, Padova, Italy
| | - Ugo Fedeli
- Regional Epidemiological Service Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Lorenzo Gubian
- Informative Systems Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Daniele Monetti
- Regional Epidemiological Service Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Francesca Zanella
- Regional Directorate of Prevention, Food Safety, Veterinary Public Health, Regione del Veneto, Padova, Italy
| | - Manuel Zorzi
- Regional Epidemiological Service Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Elena Narne
- Screening and Health Impact Assessment Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Domenico Mantoan
- Director General, Health and Social Area, Regione del Veneto, Padova, Italy
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25
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Damiani G, Buja A, Grossi E, Rivera M, De Polo A, De Luca G, Zorzi M, Vecchiato A, Del Fiore P, Saia M, Baldo V, Rugge M, Rossi CR, Damiani G. Use of an Artificial Neural Network to Identify Patient Clusters in a Large Cohort of Patients with Melanoma by Simultaneous Analysis of Costs and Clinical Characteristics. Acta Derm Venereol 2020; 100:adv00323. [PMID: 33135769 PMCID: PMC9309838 DOI: 10.2340/00015555-3680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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26
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Cocchio S, Prandi GM, Furlan P, Bertoncello C, Fonzo M, Saia M, Baldovin T, Baldo V. Time-trend of hospitalizations for anogenital warts in Veneto region in the HPV vaccination era: a cross sectional study (2007-2018). BMC Infect Dis 2020; 20:857. [PMID: 33208109 PMCID: PMC7672898 DOI: 10.1186/s12879-020-05591-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 11/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is a common sexually transmitted pathogen and the cause of several cancers and of anogenital warts. With this study, we estimated the trend of hospitalizations for anogenital warts (AGWs) in the Veneto region (Italy) from 2007 to 2018. METHODS The analysis included all the hospital discharge records of public and accredited private hospitals occurred in Veneto residents in the timespan 2007-2018. The ICD9-CM code 078.11 considered were those associated with condyloma acuminatum and those associated with surgical interventions for vulval/vaginal warts, penile warts anal warts. Annual total and sex- and age-specific hospitalization rates and trends were calculated and correlated with the different HPV vaccine coverage over the study period. RESULTS We observed an overall reduction of hospitalization rates for AGWs: from 15.0 hospitalizations every 100,000 Veneto residents in years 2007-08 to 10.9 hospitalizations every 100,000 Veneto residents in year 2017-18 (- 37.4%; p < 0.05). Reduction has been caused by a drop in hospitalizations in females - from a rate of 20.4/100,000 in 2007-2008 to a rate of 10.8/100,000 in 2017-18 (AAPC: -7.1; 95%CI: - 10.6;-3.4); while in males, we observed a slight - but not statistically significant - increase in hospitalization rates. CONCLUSION The marked decline in hospitalization rates for AGWs in Veneto Region is probably attributable to the high coverage rates of HPV vaccination programs implemented since 2008.
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Affiliation(s)
- S Cocchio
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - G M Prandi
- Department for Woman and Child Health, University of Padua, Padua, Italy
| | - P Furlan
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - C Bertoncello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Fonzo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Saia
- "Azienda Zero" of Veneto region, Padua, Italy
| | - T Baldovin
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - V Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy.
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27
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Buja A, Rivera M, De Polo A, Zorzi M, Baracco M, Italiano I, Vecchiato A, Del Fiore P, Guzzinati S, Saia M, Baldo V, Rugge M, Rossi CR. Differences in direct costs of patients with stage I cutaneous melanoma: A real-world data analysis. Eur J Surg Oncol 2020; 46:976-981. [PMID: 32146052 DOI: 10.1016/j.ejso.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/21/2020] [Accepted: 02/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clinical factors, such as tumor thickness, ulceration and growth phase have a role as prognostic factors for stage I melanoma. However, it is still under debate whether these variables influence the related direct costs. We aimed to investigate which clinical factors represent direct health care "cost drivers" for stage I melanoma. MATERIALS AND METHOD Analyses were conducted on a cohort of patients diagnosed with stage I melanoma. Differences in the costs incurred by different groups of patients were examined using Mann-Whitney or Kruskal-Wallis non-parametric tests. Log linear multivariate analysis was used to identify the clinical drivers of the total direct costs one and two years after diagnosis. The study was conducted from the perspective of Italy's National Health care System. RESULTS One year after diagnosis, patients whose melanomas had a Breslow thickness ≥0.8 mmin (compared with those with lower thickness) and a vertical growth phase (compared with those with radial growth) incurred higher costs for hospitalization, as well as higher overall costs. One year after their diagnosis, treatment of patients with stage I melanoma in the vertical growth phase costs 50% more (95% CI: 22-85%) than their counterparts with a radial growth pattern, resulting in an estimated absolute increase of € 256.23. Having a tumor thicker than 0.8 mm prompted an increase of 91% (95% CI: 43-155%) in the costs (€955.24 in absolute terms). CONCLUSION Our data indicate a heterogeneity in the direct costs of stage I melanoma patients during the first year after diagnosis, which can be partly explained by clinical prognostic factors, like tumor thickness and growth pattern.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Michele Rivera
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy.
| | - Anna De Polo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | | | | | | | | | - Paolo Del Fiore
- Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Italy
| | | | - Mario Saia
- Veneto Regional Authority, Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Carlo Riccardo Rossi
- Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
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Pasin L, Sella N, Correale C, Boscolo A, Rosi P, Saia M, Mantoan D, Navalesi P. Regional COVID-19 Network for Coordination of SARS-CoV-2 outbreak in Veneto, Italy. J Cardiothorac Vasc Anesth 2020; 34:2341-2345. [PMID: 32425461 PMCID: PMC7228700 DOI: 10.1053/j.jvca.2020.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Laura Pasin
- Institute of Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria di Padova, Padova, Italy.
| | - Nicolò Sella
- Institute of Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
| | - Christelle Correale
- Institute of Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
| | - Annalisa Boscolo
- Institute of Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
| | - Paolo Rosi
- Medical Emergency Coordination Center - SUEM 118, Ca' Foncello Hospital, Treviso, Italy
| | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Veneto, Italy
| | | | - Paolo Navalesi
- Institute of Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria di Padova, Padova, Italy; University of Padova, Padova, Italy
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Buja A, Rivera M, De Polo A, Zorzi M, Carpin E, Vecchiato A, Del Fiore P, Martin G, Saia M, Baldo V, Rugge M, Rossi C. Real‐world data for direct stage‐specific costs of melanoma healthcare. Br J Dermatol 2020; 183:171-172. [DOI: 10.1111/bjd.18896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A. Buja
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health University of Padova Padova Italy
| | - M. Rivera
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health University of Padova Padova Italy
| | - A. De Polo
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health University of Padova Padova Italy
| | - M. Zorzi
- Surgical Oncology Unit Veneto Institute of Oncology IOV‐IRCCS Veneto Italy
| | - E. Carpin
- Surgical Oncology Unit Veneto Institute of Oncology IOV‐IRCCS Veneto Italy
| | - A. Vecchiato
- Department of Surgery, Oncology and Gastroenterology University of Padova Padova Italy
| | - P. Del Fiore
- Department of Surgery, Oncology and Gastroenterology University of Padova Padova Italy
| | - G. Martin
- Surgical Oncology Unit Veneto Institute of Oncology IOV‐IRCCS Veneto Italy
| | - M. Saia
- Clinical Governance Unit Azienda Zero Veneto Regional Authority Veneto Italy
| | - V. Baldo
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health University of Padova Padova Italy
| | - M. Rugge
- Surgical Oncology Unit Veneto Institute of Oncology IOV‐IRCCS Veneto Italy
| | - C.R. Rossi
- Veneto Tumor Registry Azienda Zero Veneto Regional Authority Veneto Italy
- Department of Surgery, Oncology and Gastroenterology University of Padova Padova Italy
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Buja A, Rivera M, Zorzi M, Sperotto M, Baracco S, Italiano I, Vecchiato A, Del Fiore P, Avossa F, Corti MC, Guzzinati S, Saia M, Baldo V, Rugge M, Rossi CR. Health Outcomes and Direct Healthcare Costs in Patients with Melanoma: Associations with Level of Education. Acta Derm Venereol 2020; 100:adv00003. [PMID: 31580466 PMCID: PMC9128928 DOI: 10.2340/00015555-3329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alessandra Buja
- Vascular and Thoracic Sciences, and Public Health, Laboratory of Health Care Services and Health Promotion Evaluation, Hygiene and Public Health Unit, University of Padova, Via Loredan 18, IT-35128 Padova, Italy.
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Caroli D, Rosa-Rizzotto E, Pilerci C, Lobello S, De Lazzari F, Saia M. Falling Rates of Hospital Admissions for Alcoholic Liver Disease in Northeast Italy: A Retrospective Study on a Large Database. Alcohol Alcohol 2019; 54:662-666. [PMID: 31566688 DOI: 10.1093/alcalc/agz070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/07/2019] [Accepted: 07/21/2019] [Indexed: 12/19/2022] Open
Abstract
AIM To describe recent trends in hospital admission rates for alcoholic liver disease (ALD) in the Veneto region of Italy. METHODS This retrospective cohort study is based on anonymous hospital discharge records (HDRs) for 2000-2017 from all public and accredited private hospitals operating within the context of the Regional (Veneto) Health Services that are conserved in National/Regional database. It examined the HDR's of all the hospitalizations of the residents of the Veneto region that were registered under an ALD diagnosis. These were classified under three subheadings: acute alcoholic hepatitis Alcoholic liver cirrhosis and 'other ALD'. RESULTS During 2000-2017, 30,089 hospital admissions (out of a total regional population of 4,900,000) were registered for ALD. Hospitalization stratified by age showed that the percentage attributable to acute alcoholic hepatitis is higher in younger age groups: 42% in 15-24-year-old (odds ratios (ORs): 14.74; CI95%: 7-30.86; P < 0.000) and 15% in the 25-44-year-old (OR: 3.51; CI95%: 3.12-3.94; P < 0.000). A longitudinal analysis of hospitalization patterns showed a 7% increase in average age in both sexes (from 58.8 ± 9.2 to 62.4 ± 9.7) and a substantial decrease (63.5%) in standardized hospitalization rates (HRs, χ2 trend: 4099.827; P < 0.000) and a smaller decrease (47%) in standardized mortality rates (χ2 trend: 89.563; P < 0.000). CONCLUSIONS The fall in the overall ALD-related HR in the Veneto region can be explained by a decrease in population alcohol consumption. Increase in the HRs for acute alcoholic hepatitis in the age group 15-44 suggests an ongoing need for strategies to prevent alcohol abuse by young people.
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Affiliation(s)
- Diego Caroli
- Gastroenterology Unit, St. Anthony Hospital, Local Health Unit 6, Padova, Italy
| | - Erik Rosa-Rizzotto
- Gastroenterology Unit, St. Anthony Hospital, Local Health Unit 6, Padova, Italy
| | | | | | - Franca De Lazzari
- Gastroenterology Unit, St. Anthony Hospital, Local Health Unit 6, Padova, Italy
| | - Mario Saia
- Medical Directorate, Local Health Unit 6, Padova, Italy
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Cocchio S, Bertoncello C, Napoletano G, Claus M, Furlan P, Fonzo M, Gagliani A, Saia M, Russo F, Baldovin T, Baldo V. Do We Know the True Burden of Tick-Borne Encephalitis? A Cross-Sectional Study. Neuroepidemiology 2019; 54:227-234. [PMID: 31536983 DOI: 10.1159/000503236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/06/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Tick-borne encephalitis (TBE) is an acute human arboviral infection of the central nervous system caused by a virus that is transmitted to humans mainly by tick bites. TBE is endemic in Europe and has become an increasingly important public health concern in recent years. Cases of TBE in Italy have occurred mainly in the north-east and central parts of the country. Vaccination is recommended for people who live in or visit areas at higher risk of tick bites. OBJECTIVE The aim of our study was to ascertain the burden of TBE in the Veneto Region (north-east Italy). METHODS Cases of TBE occurring in the region from January 1, 2007, to December 31, 2018, were extracted from the database of the mandatory notification system (MNS) and from hospital discharge records (HDRs) of admissions relating to a diagnostic code 063 according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Capture-recapture methods were used to estimate the completeness of each data source (as a percentage of cases). Records including diagnostic codes 322.9 (Meningitis, unspecified) and 323.9 (Unspecified cause of encephalitis, myelitis, and encephalomyelitis) were also extracted from the HDR database. Municipalities were grouped by location, based on their elevation above sea level, as "mountains," "hills," or "lowlands". After selecting only the municipalities where cases of TBE had occurred, the proportion of cases of TBE out of the total cases of encephalitis and meningitis identified was calculated and used to estimate the number of cases of TBE potentially occurring in the municipalities that reported none. Then the observed and adjusted TBE rates per 100,000 population were calculated. RESULTS During the 12 years considered, a total of 281 cases of TBE were identified; 155 emerged from the HDRs and the MNS, 89 only from the MNS database, and 37 only from the HDRs. The degree of completeness of the data was 93.0% for the MNS and HDRs combined, 80.8% for the MNS alone, and 63.6% for the HDRs alone. The observed annual rate of TBE in the Veneto in recent years was calculated at 0.48 per 100,000 population, with the highest standardized rate in the province of Belluno (5.95 per 100,000 population). A significant rising trend in the number of cases observed in the latest period (2015-2018) was apparent for the mountainous areas in the region (average annual percent changes: 43.7 [95% CI 19.0-73.5]). The number of cases peaked in the mountains in the month of June (0.89 per 100,000), in hilly areas in July (0.23 per 100,000) and in the lowlands in October (0.04 per 100,000). CONCLUSIONS Our findings seem to confirm an underreporting of the cases of TBE and inadequate TBE surveillance in the Veneto, despite the clinical severity of the disease and the fact that it is mandatory to report all cases. The routine integration of different databases is crucial to the successful implementation and assessment of targeted prevention strategies and fundamental to public health decision-making on this issue.
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Affiliation(s)
- Silvia Cocchio
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Padua, Italy
| | - Chiara Bertoncello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Padua, Italy
| | | | - Mirko Claus
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Padua, Italy
| | - Patrizia Furlan
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Padua, Italy
| | - Marco Fonzo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Padua, Italy
| | - Alberto Gagliani
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Padua, Italy
| | - Mario Saia
- Prevention Department, Veneto Regional Health Authority, Venice, Italy
| | - Francesca Russo
- Prevention Department, Veneto Regional Health Authority, Venice, Italy
| | - Tatjana Baldovin
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Padua, Italy,
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Cocchio S, Baldovin T, Furlan P, Bertoncello C, Buja A, Saia M, Fonzo M, Baldo V. Cross-sectional study on hospitalizations related to herpes zoster in an Italian region, 2008-2016. Aging Clin Exp Res 2019; 31:145-150. [PMID: 29766448 DOI: 10.1007/s40520-018-0968-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/04/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To assess the burden of herpes zoster (HZ) by analyzing HZ-related hospital admissions. METHODS We conducted a population-based descriptive cross-sectional study on all hospitalizations for HZ among the resident population admitted to all public and accredited private hospitals in the Veneto Region (north-east Italy) during the years 2008-2016. HZ hospitalizations were identified from the International Classification of Diseases codes in the hospital discharge records. RESULTS During the period considered, we identified 3566 HZ-associated admissions, 194 (5.4%) of which were readmissions within 30 days. A complicated HZ diagnosis was mentioned for 44.4% of the patients admitted once and for 65.9% of those admitted twice. In the sample as a whole, 27.0% of patients had at least one comorbidity. Overall, our analysis revealed a gradual increase in hospitalizations with age for both genders, reaching a hospitalization rate for the population over 80 years old of 51.2 × 100,000 for males and 52.8 × 100,000 for females. The average hospitalization rate for HZ-related conditions during the years 2008-2016 was 7.7 per 100,000 population. Postherpetic neuralgia was diagnosed in 8.2% of hospitalizations, with no difference between the genders. The estimated overall cost of HZ-related conditions was approximately €2.7 million a year. CONCLUSIONS This study suggests that the burden of HZ and its impact on quality of life are of critical relevance to public health decision-making.
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Affiliation(s)
- Silvia Cocchio
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan, 18, 35121, Padua, Italy
| | - Tatjana Baldovin
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan, 18, 35121, Padua, Italy
| | - Patrizia Furlan
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan, 18, 35121, Padua, Italy
| | - Chiara Bertoncello
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan, 18, 35121, Padua, Italy.
| | - Alessandra Buja
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan, 18, 35121, Padua, Italy
| | - Mario Saia
- EuroHealth Net, Veneto Region Health Directorate, Veneto, Italy
| | - Marco Fonzo
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan, 18, 35121, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan, 18, 35121, Padua, Italy
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Mennini FS, Fabiano G, Marcellusi A, Sciattella P, Saia M, Cocchio S, Baldo V. Burden of Disease of Human Papillomavirus (HPV): Hospitalizations in the Marche and Veneto Regions. An observational study. Clin Drug Investig 2018; 38:173-180. [PMID: 29081028 DOI: 10.1007/s40261-017-0597-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES HPV (human papillomavirus) is the virus most often responsible for sexually transmitted infections. The burden of HPV-related diseases on hospital resources represents a major public health problem. The aim of this study was to assess the economic burden of HPV-related diseases (anal cancer, genital cancer, genital warts, oropharyngeal cancer) on hospital resources in two Italian regions. METHODS A retrospective, non-randomized, observational study was developed in the Marche and Veneto Regions, based on patients receiving hospitalization between 2008 and 2011. All hospitalizations were identified through administrative archives, according to the International Classification of Diseases (ICD-9 CM) to which a defined tariff was assigned. RESULTS We identified 5299 hospitalized patients in Veneto and 1735 in the Marche Region. The mean annual hospitalization rate was 49.44 per 100,000 individuals in Veneto and 48.41 in Marche. The total mean annual cost attributable to HPV-related diseases was €5.78 (SD 0.80) million in Veneto and €2.24 (SD 0.17) million in Marche. Costs associated with genital cancer amounted to €1.61 million in Veneto and €1.06 million in Marche (28% and 47% of the total mean annual cost, respectively). Oropharyngeal cancer accounted for 36% in Veneto (€2.08 million) and 28% in Marche (€632,645). Hospitalization costs related to anal cancer were €882,567 in Veneto and €377,719 in Marche; genital warts accounted for €1.19 million in Veneto and €171,406 in Marche. Finally, the mean cost per patient was €4364 in Veneto and €5176 in Marche. CONCLUSIONS The present work estimated the cost of HPV-related diseases for hospitalized patients in two Italian regions. The considerable estimated annual economic burden is a powerful driver for the governance of the public health sector.
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Affiliation(s)
- Francesco Saverio Mennini
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome 'Tor Vergata', Via Columbia, 2, Roma, RM, Italy.,Institute of Leadership and Management in Health, Kingston University, London, UK
| | - Gianluca Fabiano
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome 'Tor Vergata', Via Columbia, 2, Roma, RM, Italy.,Institute of Leadership and Management in Health, Kingston University, London, UK
| | - Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome 'Tor Vergata', Via Columbia, 2, Roma, RM, Italy. .,Institute of Leadership and Management in Health, Kingston University, London, UK. .,Consiglio Nazionale delle Ricerche (CNR), Istituto di Richerche sulla Popolazione e le Politiche Sociali (IRPPS), Rome, Italy.
| | - Paolo Sciattella
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome 'Tor Vergata', Via Columbia, 2, Roma, RM, Italy
| | - Mario Saia
- Net, Veneto Region Health Directorate, Venezia, Italy
| | - Silvia Cocchio
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, Institute of Hygiene, University of Padua, Via Loredan, 18, 35121, Padova, Italy
| | - Vincenzo Baldo
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, Institute of Hygiene, University of Padua, Via Loredan, 18, 35121, Padova, Italy
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Tardivo S, Moretti F, Nobile M, Agodi A, Appignanesi R, Arrigoni C, Baldovin T, Brusaferro S, Canino R, Carli A, Chiesa R, D'Alessandro D, D'Errico MM, Giuliani G, Montagna MT, Moro M, Mura II, Novati R, Orsi GB, Pasquarella C, Privitera G, Ripabelli G, Rossini A, Saia M, Sodano L, Torregrossa MV, Torri E, Zarrilli R, Auxilia F, SItI G. Definition of criteria and indicators for the prevention of Healthcare-Associated Infections (HAIs) in hospitals for the purposes of Italian institutional accreditation and performance monitoring. Ann Ig 2018; 29:529-547. [PMID: 29048451 DOI: 10.7416/ai.2017.2183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are an important issue in terms of quality of care. HAIs impact patient safety by contributing to higher rates of preventable mortality and prolonged hospitalizations. In Italy, analysis of the currently available accreditation systems shows a substantial heterogeneity of approaches for the prevention and surveillance of HAIs in hospitals. The aim of the present study is to develop and propose the use of a synthetic assessment tool that could be implemented homogenously throughout the nation. METHODS An analysis of nine international and of the 21 Italian regional accreditation systems was conducted in order to identify requirements and indicators implemented for HAI prevention and control. Two relevant reviews on this topic were further analyzed to identify additional evidence-based criteria. The project team evaluated all the requirements and indicators with consensus meeting methodology, then those applicable to the Italian context were grouped into a set of "focus areas". RESULTS The analysis of international systems and Italian regional accreditation manuals led to the identification respectively of 19 and 14 main requirements, with relevant heterogeneity in their application. Additional evidence-based criteria were included from the reviews analysis. From the consensus among the project team members all the standards were compared and 20 different thematic areas were identified, with a total of 96 requirements and indicators for preventing and monitoring HAIs. CONCLUSIONS The study reveals a great heterogeneity in the definition of accreditation criteria between the Italian regions. The introduction of a uniform, synthetic assessment instrument, based on the review of national and international standards, may serve as a self-assessment tool to evaluate the achievement of a minimum standards set for HAIs prevention and control in healthcare facilities. This may be used as an assessment tool by the Italian institutional accreditation system, also useful to reduce regional disparities.
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Affiliation(s)
- S Tardivo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - F Moretti
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - M Nobile
- Management Department, G. Pini Orthopedic Institute, University of Milan, Milan, Italy
| | - A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy
| | - R Appignanesi
- Management Department, Asur Zt 12, San Benedetto del Tronto, Italy
| | - C Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - T Baldovin
- Department of Molecular Medicine, Section of Public Health, University of Padova, Padova, Italy
| | - S Brusaferro
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - R Canino
- Medical Direction Department, Oglio-Po Hospital, Vicomoscano - Casalmaggiore, Cremona, Italy
| | - A Carli
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - R Chiesa
- Programming Acquisition and Control Department, Asl Brescia, Brescia, Italy
| | - D D'Alessandro
- Department of Civil Building and Environmental Engineering, Sapienza University of Rome, Rome, Italy
| | - M M D'Errico
- Department of Biomedical Science and Public Health, Polytechnic University of Marche, Torrette di Ancona, Ancona, Italy
| | - G Giuliani
- Department of Medical Direction, Infections Control Committee, G. Salvini Hospital, Garbagnate Milanese, Milan, Italy
| | - M T Montagna
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - M Moro
- Department of Medical Direction, Infections Control Committee, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - I I Mura
- Department of Biomedical Sciences, Hygiene Unit, University of Sassari, Sassari, Italy
| | - R Novati
- Medical Direction, Aosta Regional Hospital, Aosta, Italy
| | - G B Orsi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - C Pasquarella
- Department of Hygiene and Public Health, University of Parma, Parma, Italy
| | - G Privitera
- Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy
| | - G Ripabelli
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - A Rossini
- Department of Medical Direction, IRCCS Santa Lucia Scientific Institute, Rome, Italy
| | - M Saia
- Veneto Region Health Directorate, Palazzo Molin San Polo Venice, Italy
| | - L Sodano
- Department of Medical Direction, San Camillo Forlanini Hospital, Rome, Italy
| | - M V Torregrossa
- Department of Sciences for Health Promotion "G. D'Alessandro" - Hygiene Section, University of Palermo, Palermo, Italy
| | - E Torri
- Department of Health and Social Policy, Trento, Italy
| | - R Zarrilli
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Gisio SItI
- Italian Study Group of Hospital Hygiene - Italian Society of Hygiene, Preventive Medicine and Public Health, Italy
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Bianchin C, Prevaldi C, Corradin M, Saia M. Medical malpractice claim risk in emergency departments. Emerg Care J 2018. [DOI: 10.4081/ecj.2018.6366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Medical malpractice claims are a major problem for emergency physicians and for the health system which must be addressed in a rational and effective fashion: claim analysis seems the best way to identify risk factors and risk areas and to elaborate risk management recommendations. The Emergency Department (ED) is one of the areas at higher risk. Medical diagnoses associated with the highest number of claims are acute myocardial infarction, fractures, appendicitis, abdominal/pelvic symptoms, aortic aneurism and open wounds to fingers. The present paper emphasizes the necessity for ED emergency physicians to pay special attention when facing these health conditions and seeks to provide indications in order to reduce litigation.
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Nardetto L, Giometto B, Moretto G, Mantoan D, Saia M. Hub-and-spoke stroke network in the Veneto region: a retrospective study investigating the effectiveness of the stroke pathway and trends over time. Neurol Sci 2017; 38:2117-2121. [PMID: 28905212 DOI: 10.1007/s10072-017-3118-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 09/07/2017] [Indexed: 01/03/2023]
Abstract
After recognizing the pivotal role played by stroke unit (SU) admission in reducing mortality and dependency in stroke patients, the need to organize and monitor stroke networks has become an increasingly essential aspect of stroke care. We conducted a retrospective study of stroke patients admitted to hospitals in the Veneto region from 2007 to 2015 in order to evaluate the effectiveness of the stroke pathway and trends over time. Between 2007 and 2015, 61,062 stroke patients were discharged from Veneto hospitals: they were more frequently female, females were older than males, and had higher intrahospital mortality and a lower probability of undergoing systemic thrombolysis. Patients admitted to facilities with a level 2 SU were twice as likely to undergo thrombolytic treatment compared to those admitted to facilities with a level 1 and had a lower intrahospital mortality rate. During the collection period, thrombolytic treatments increased in both level 1 and 2 SUs, as did the number of patients admitted to neurology wards and to facilities with an SU. Our study confirmed that thrombolytic treatment and admission to a facility with an SU are important determinants in improving stroke patient outcome. The increase in the proportion of both SU admissions and thrombolytic treatments demonstrates the effectiveness of the regional hub-and-spoke organization model, suggesting that implementation of highly specialized facilities is an efficient strategy in improving stroke care. The role of the observed sex bias in stroke treatment and outcome needs to be explored.
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Affiliation(s)
- L Nardetto
- Neurology, Ospedale San Antonio, Via Facciolati n° 71, 35127, Padua, Italy.
| | - B Giometto
- Neurology, Ospedale San Antonio, Via Facciolati n° 71, 35127, Padua, Italy
| | - G Moretto
- Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - D Mantoan
- Veneto Region Health Directorate, Venice, Italy
| | - M Saia
- Medical Directorate, Ospedale San Antonio, Padua, Italy
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Saia M, Buja A, Cosmi E, Mantoan D, Baldo V. Trend and variability in open and laparoscopic hysterectomies for patients with benign disease: a retrospective cohort study. Ann Ist Super Sanita 2017; 53:135-141. [PMID: 28617259 DOI: 10.4415/ann_17_02_09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The aim of the present analysis on a regional hospital database was to ascertain the variability and 5-year trends of hysterectomy rates and the different surgical approaches used. METHODS A retrospective cohort study was conducted in Veneto Region (North-East Italy), based on administrative data collected in 6 years, from 2009 to 2014. RESULTS Our study showed an overall decline in the hospitalization rates for hysterectomy from 197.5 to 165.8/100 000 and shorter overall hospital stays for this procedure (from 5.5 to 4.5 days). During the six years analyzed, there was an overall increase in the use of laparoscopic surgery (from 28% to 35% of cases). There was also a marked variability within the region considered in terms of the hysterectomy rates and the type of procedure performed. CONCLUSIONS The unwarranted variability in the rates of elective surgical procedures, and the techniques used to perform them, could be monitored by analyzing electronic hospital records.
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Affiliation(s)
- Mario Saia
- Direzione Salute, Regione Veneto,Venice, Italy
| | - Alessandra Buja
- Laboratorio di Sanità Pubblica, Dipartimento di Medicina Molecolare, Università degli Studi di Padova, Padua, Italy
| | - Erich Cosmi
- Dipartimento di Salute delle Donne e dei Bambini, Università degli Studi di Padova, Padua, Italy
| | | | - Vincenzo Baldo
- Laboratorio di Sanità Pubblica, Dipartimento di Medicina Molecolare, Università degli Studi di Padova, Padua, Italy
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Baldovin T, Lazzari R, Cocchio S, Furlan P, Bertoncello C, Saia M, Russo F, Baldo V. Invasive meningococcal disease in the Veneto region of Italy: a capture-recapture analysis for assessing the effectiveness of an integrated surveillance system. BMJ Open 2017; 7:e012478. [PMID: 28465304 PMCID: PMC5623379 DOI: 10.1136/bmjopen-2016-012478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 11/29/2016] [Accepted: 12/07/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Epidemiology of Neisseria meningitidis has been changing since the introduction of universal vaccination programmes against meningococcal serogroup C (MenC) and meningococcal serogroup B (MenB) has now become dominant. This study aimed to analyse the cases reported in institutional data recording systems to estimate the burden of invasive meningococcal diseases (IMDs) and assess the effectiveness of surveillance in Veneto region (Italy). METHODS Analysis was performed from 2007 to 2014 on data recorded in different systems: Mandatory Notification System, National Surveillance of Invasive Bacterial Diseases System and Laboratories Surveillance System (LSS), which were pooled into a combined surveillance system (CSS) and hospital discharge records (HDRs). A capture-recapture method was used and completeness of each source estimated. Number of cases with IMD by source of information and year, incidence of IMD by age group, case fatality rate (CFR) and distribution of meningococcal serogroups by year were also analysed. RESULTS Combining the four data systems enabled the identification of 179 confirmed cases with IMD, achieving an overall sensitivity of 94.7% (95% CI: 90.8% to 98.8%), while it was 76.7% (95% CI: 73.6% to 80.1%) for CSS and 77.2% (95% CI: 74.1% to 80.6%) for HDRs. Typing of isolates was done in 80% of cases, and 95.2% of the typed cases were provided by LSS. Serogroup B was confirmed in 50.3% of cases. The estimated IMD notification rate (cases with IMD diagnosed and reported to the surveillance systems) was 0.48/100 000 population, and incidence peaked at 6.2/100 000 in children aged <1 year old (60.9% due to MenB), and increased slightly in the age group between 15 and 19 years (1.1/100 000). A CFR of 14% was recorded (8.7% in paediatric age). CONCLUSIONS Quality of surveillance systems relies on case ascertainment based on serological characterisation of the circulating strains by microbiology laboratories. All available sources should be routinely combined to improve the epidemiology of IMD and the information used by public health departments to conduct timely preventive measures.
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Affiliation(s)
- Tatjana Baldovin
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padua, Italy
| | - Roberta Lazzari
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padua, Italy
| | - Silvia Cocchio
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padua, Italy
| | - Patrizia Furlan
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padua, Italy
| | - Chiara Bertoncello
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padua, Italy
| | - Mario Saia
- Area Sanità e Sociale, Veneto Regional Authority, Venice, Italy
| | - Francesca Russo
- Service of Hygiene Promotion and Development and Public Health, Veneto Region, Venice, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padua, Italy
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Saia M, Buja A, Mantoan D, Sartor G, Agresta F, Baldo V. Isolated rectal cancer surgery: a 2007-2014 population study based on a large administrative database. Updates Surg 2017; 69:367-373. [PMID: 28409441 DOI: 10.1007/s13304-017-0445-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/03/2017] [Indexed: 12/11/2022]
Abstract
Rectal resection is technically one of the most demanding laparoscopic procedures, requiring additional training and expertise of both surgeons and institutions. The literature has shown that laparoscopic procedures can be appropriate for the treatment of rectal cancer (RC), in terms of safety, outcome and efficiency, but results may not always be directly transferable to the general population. This study aimed to investigate the use of laparoscopic rectal cancer resections in a north-eastern Italian region (the Veneto) and to see how the characteristics of patients and hospitals are associated with the use of laparoscopy. This was a retrospective cohort study based on administrative data collected from 2007 to 2014 in the Veneto region (north-east Italy). In the period considered (2007-2014), 4953 rectal resections were performed for RC in Veneto hospitals, accounting for 35% of the total 14,243 surgical procedures involving the rectum, and resulting in 76,739 days in hospital [mean length of stay-post-operative (MLOS) 15.5 ± 11.1 days]. Patients were a mean 67.9 ± 11.7 years old (68 ± 12.7 for women, 67.9 ± 11 for men), while the subgroup of patients undergoing laparoscopic procedures was on average 2 years younger (66.5 ± 11.8 vs 68.8 ± 11.5; p < 0.05). The four main findings of this study are: (1) the increasing rates of laparoscopic procedures for RC resection at all the hospitals in our geographical area, rising up to 52% in 2014. This is probably related to not only to availability of better equipment but surely to a growing expertise of surgeons; (2) the esteem of proportion of laparoscopically treated RC; (3) the significant difference between the laparoscopic and open surgical approach in terms of mean length of hospital stay after RC resection, making the laparoscopic approach cost-effective generally speaking; and (4) the disparities in hospitals' use of laparoscopy by patients' age group: Laparoscopic surgery is safe also in the elderly population but it is not so widely offers in Veneto Region hospitals, and it's probably due to the lack of experience about this approach in frail/old patients.
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Affiliation(s)
- Mario Saia
- Veneto Region Health Directorate, Venice, Italy
| | - Alessandra Buja
- Department of Molecular Medicine, Laboratory of Public Health and Population StudiesUniversity of Padua, Padua, Italy
| | | | - Gino Sartor
- Department of Molecular Medicine, Laboratory of Public Health and Population StudiesUniversity of Padua, Padua, Italy
| | - Ferdinando Agresta
- Department of General Surgery, ULSS 5 Polesana del Veneto, Adria, RO, Italy.
| | - Vincenzo Baldo
- Department of Molecular Medicine, Laboratory of Public Health and Population StudiesUniversity of Padua, Padua, Italy
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Cocchio S, Baldovin T, Bertoncello C, Buja A, Furlan P, Saia M, Baldo V. Decline in hospitalization for genital warts in the Veneto region after an HPV vaccination program: an observational study. BMC Infect Dis 2017; 17:249. [PMID: 28381294 PMCID: PMC5382454 DOI: 10.1186/s12879-017-2361-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is one of the most common sexually transmitted pathogens. This observational study was conducted to estimate the trend of hospitalization for genital warts (GWs) in the Veneto region (Italy) from 2004 to 2015. METHODS All patients with GWs were identified in the hospital discharge records of all public and accredited private hospitals that related to Veneto residents and contained the ICD9-CM code 078.11 associated with a genital surgical procedure (vulval/vaginal warts, penile warts and anal warts). Annual total and sex- and age-specific hospitalization rates and trends were calculated and correlated with the different HPV vaccine coverage over the study period. RESULTS An annual rate of 11.8 per 100,000 population (8.6 per 100,000 males, and 14.8 per 100,000 females) was found, corresponding to 6076 hospitalizations for condyloma (53.3% vulval/vaginal, 35.8% anal, 8.3% penile, and 2.6% both penile or vulval/vaginal and anal). Among females, the rate of overall GWs remained stable to 2007 (19.1 per 100,000), then dropped significantly, reaching a rate of 11.3 per 100,000 in 2015 (average annual percent changes [AAPC]: -6.1%; 95% CI: -8.4; -3.7). For males, the overall rate increased over the study period (from 6.4 per 100,000 in 2004 to 10.8 per 100,000 in 2015; AAPC: 3.8%; 95% CI: 1.2; 6.4). Among the potentially vaccinated females (12- to 20-year-olds) there was a 62.1% decrease in the number of vulval/vaginal warts from the years 2010-2012 to the years 2013-2015 due to an increase in the HPV coverage rate. A similar reduction among males was observed in the same period and the same age group for penile warts (-68.2%). CONCLUSION GWs have an important impact on the health services and data suggest that GW-related hospitalization rates rapidly decline in a population with a high HPV vaccination coverage (about 75%). Further efforts should be made to better clarify the epidemiological picture regarding HPV-related diseases, with particular regard to sexual behavior.
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Affiliation(s)
- Silvia Cocchio
- Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Via Loredan 18, 35121, Padua, Italy
| | - Tatjana Baldovin
- Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Via Loredan 18, 35121, Padua, Italy
| | - Chiara Bertoncello
- Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Via Loredan 18, 35121, Padua, Italy
| | - Alessandra Buja
- Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Via Loredan 18, 35121, Padua, Italy
| | - Patrizia Furlan
- Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Via Loredan 18, 35121, Padua, Italy
| | - Mario Saia
- EuroHealth Net, Venice, Veneto Region Health Directorate, Venice, Italy
| | - Vincenzo Baldo
- Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Via Loredan 18, 35121, Padua, Italy.
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Saia M, Buja A, Mantoan D, Bertoncello C, Baldovin T, Callegaro G, Baldo V. Frequency and trends of hospital discharges against medical advice (DAMA) in a large administrative database. Ann Ist Super Sanita 2016; 50:357-62. [PMID: 25522077 DOI: 10.4415/ann_14_04_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this research was to characterize hospitalizations associated with discharges against medical advice (DAMA) in a large, population-based data system. MATERIALS AND METHODS This was a retrospective cohort study on 11 436 500 hospital admissions. The hospital discharge records for residents of the Veneto region (north-east Italy) discharged from 2001 to 2012, from both public and accredited private hospitals, were considered. The DAMA rate was calculated by type of hospital admission, excluding patients who died. The time trend of the DAMA rate was charted from the average annual percent changes. RESULTS During the period considered, 66 549 DAMA were recorded, amounting to an overall DAMA rate of 6.0‰ admissions. Analyzing the diagnostic categories, admissions for substance abuse (drugs or alcohol) and dependence coincided with the highest DAMA rate (83.5‰), followed by poisoning (40.2‰), psychiatric disorders (24.7 ‰), traumas (21.1‰), HIV-related diseases (19.9‰), burns (10.5‰), and - for women - issues relating to pregnancy, childbirth and the postnatal period (11.2‰). The DAMA rate dropped from 6.72 to 5.55 from 2000 to 2008, then remained stable. CONCLUSION The DAMA rate dropped slightly over the period considered. Several diagnostic categories are associated with a higher likelihood of patients leaving hospital against their doctor's advice.
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Affiliation(s)
- Mario Saia
- Area Sanità e Sociale, Regione Veneto, Italy
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Baldo V, Cocchio S, Gallo T, Furlan P, Clagnan E, Del Zotto S, Saia M, Bertoncello C, Buja A, Baldovin T. Impact of pneumococcal conjugate vaccination: a retrospective study of hospitalization for pneumonia in North-East Italy. J Prev Med Hyg 2016; 57:E61-8. [PMID: 27582630 PMCID: PMC4996041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Pneumonia remains a common reason for hospitalizing infants and the elderly worldwide, and streptococcal infection is often responsible. The aim of this study was to assess the burden of pneumonia in a large general population. METHODS All pneumonia-related hospitalizations from 2004 to 2013 in north-east Italy were identified from the hospital records with a first-listed diagnosis on discharge of bacterial pneumonia, or a first-listed diagnosis on discharge of meningitis, septicemia or empyema associated with a secondary diagnosis of bacterial pneumonia. We identified major comorbidities, calculated agespecific case-fatality rates (CFR), and estimated the related cost to the health care system. RESULTS Of the 125,722 hospitalizations identified, 96.9% were cases of pneumonia, 2.4% of septicemia, 0.4% of meningitis, and 0.3% of empyema; 75.3% of hospitalizations involved ≥ 65-yearolds. The overall CFR was 12.4%, and it increased with age, peaking in people over 80 (19.6%). The mean annual pneumonia-associated hospitalization rate was 204.6 per 100,000 population, and it peaked in 0- to 4-year-old children (325.6 per 100,000 in males, 288.9 per 100,000 in females), and adults over 65 (844.9 per 100,000 in males, 605.7 per 100,000 in females). Hospitalization rates dropped over the years for the 0-4 year-olds, and rose for people over 80. The estimated overall annual cost of these pneumonia-related hospitalizations was approximately € 41 million. CONCLUSIONS This study shows that the burden on resources for pneumonia-related hospitalization is an important public health issue. Prevention remains the most valuable tool for containing pneumonia, and vaccination strategies can help in the primary prevention of infection, possibly reducing the number of cases in all age groups.
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Affiliation(s)
- V. Baldo
- Institute of Hygiene, University of Padua, Italy;,Correspondence: Vincenzo Baldo, Institute of Hygiene, University of Padua, Istituto di Igiene, via Loredan 18, 35121 Padova, Italy - Tel. +39 0498275 - Fax +39 0498275392 - E-mail:
| | - S. Cocchio
- Institute of Hygiene, University of Padua, Italy
| | - T. Gallo
- EuroHealth Net, Friuli Venezia Giulia Region Health Directorate, Italy
| | - P. Furlan
- Institute of Hygiene, University of Padua, Italy
| | - E. Clagnan
- EuroHealth Net, Friuli Venezia Giulia Region Health Directorate, Italy
| | - S. Del Zotto
- EuroHealth Net, Friuli Venezia Giulia Region Health Directorate, Italy
| | - M. Saia
- EuroHealth Net, Veneto Region Health Directorate, Italy
| | | | - A. Buja
- Institute of Hygiene, University of Padua, Italy
| | - T. Baldovin
- Institute of Hygiene, University of Padua, Italy
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AdamI S, Ferrarese A, Tardivo S, Leone R, Conforti A, Saia M, Scroccaro G. PS-073 Regional project: risk management in hospital wards and nursing homes for elderly residents. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Buja A, Canavese D, Furlan P, Lago L, Saia M, Baldo V. Are hospital process quality indicators influenced by socio-demographic health determinants. Eur J Public Health 2015; 25:759-65. [PMID: 25667156 DOI: 10.1093/eurpub/cku253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This population-level health service study aimed to address whether hospitals assure the same quality of care to people in equal need, i.e. to see if any associations exist between social determinants and adherence to four hospital process indicators clearly identified as being linked to better health outcomes for patients. PARTICIPANTS This was a retrospective cohort study based on administrative data collected in the Veneto Region (northeast Italy). We included residents of the Veneto Region hospitalized for ST-segment elevation myocardial infarction (STEMI) or acute myocardial infarction (AMI), hip fracture, or cholecystitis, and women giving birth, who were discharged from any hospital operating under the Veneto Regional Health Service between January 2012 and December 2012. METHOD The following quality indicator rates were calculated: patients with STEMI-AMI treated with percutaneous coronary intervention, elderly patients with hip fractures who underwent surgery within 48 h of admission, laparoscopic cholecystectomies and women who underwent cesarean section. A multilevel, multivariable logistic regression analyses were conducted to test the association between age, gender, formal education or citizenship and the quality of hospital care processes. RESULTS All the inpatient hospital care process quality indicators measured were associated with an undesirable number of disparities concerning the social determinants. CONCLUSION Monitoring the evidence-based hospital health care process indicators reveals undesirable disparities. Administrative data sets are of considerable practical value in broad-based quality assessments and as a screening tool, also in the health disparities domain.
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Affiliation(s)
- Alessandra Buja
- 1 Department of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padova, Padova, Italy
| | - Daniel Canavese
- 2 Universida de Federal do Paraná, Setor Litoral Universidade Federal do Rio Grande do Sul, Curso de Saúde Coletiva, Brazil
| | - Patrizia Furlan
- 1 Department of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padova, Padova, Italy
| | - Laura Lago
- 3 Masters Course in Sciences of the Public Health and Prevention Professions, University of Padova, Padova, Italy
| | - Mario Saia
- 4 Heath Directorate, Veneto Region, Padova, Italy
| | - Vincenzo Baldo
- 1 Department of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padova, Padova, Italy
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Baldo V, Cocchio S, Baldovin T, Buja A, Furlan P, Bertoncello C, Russo F, Saia M. A population-based study on the impact of hospitalization for pneumonia in different age groups. BMC Infect Dis 2014; 14:485. [PMID: 25192701 PMCID: PMC4164793 DOI: 10.1186/1471-2334-14-485] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 09/03/2014] [Indexed: 01/08/2023] Open
Abstract
Background Pneumonia is an important cause of illness and death, particularly in elderly adults. This retrospective study was conducted to estimate the trend of hospitalization for pneumonia in the Veneto from the records of all hospitals in the region (serving a population of 4.81 million) during the years 2004 through 2012. Methods The cases of pneumonia identified in the hospital discharge records were all cases in which the first-listed diagnosis was pneumonia, or meningitis, septicemia or empyema associated with pneumonia. The annual total and age-specific hospitalization rates and trends were calculated and correlated with vaccine coverage. Total related costs were also calculated. Results There were 110,927 hospitalizations for pneumonia, meaning an annual rate of 256.3/100,000 population, with peaks in children and elderly people. The overall pneumonia-related hospitalization rate did not change significantly during the study period (AAPC: 1.3% [95% CI: −0.5, 3.1]). The rate dropped significantly among the 0- to 4-year-olds, however, from 617.3/100,000 in 2004 to 451.8/100,000 in 2012 (AAPC: −2.5% [95% CI: −4.5; −0.5]), while it increased slightly in adults aged 80+ (AAPC: 1.2% [95% CI: −0.9; 3.4]). The overall pneumonia-related mortality rate was 10.7%. The estimated cost per hospitalized patient was €3,090. Conclusion This study shows that hospitalization for pneumonia has a considerable impact on the health services, especially for children and the elderly. No decline in hospitalization rates was seen for the very elderly after the introduction of pneumococcal conjugate vaccination for children. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-485) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vincenzo Baldo
- Department of Molecular Medicine, Public Health Section, University of Padua, Istituto di Igiene, Via Loredan 18, 35130 Padova, Italy.
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Saia M, Buja A, Baldovin T, Callegaro G, Sandonà P, Mantoan D, Baldo V. Erratum to: Trend, variability, and outcome of open vs. laparoscopic appendectomy based on a large administrative database. Surg Endosc 2014. [DOI: 10.1007/s00464-014-3492-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cavallaro LG, Monica F, Germanà B, Marin R, Sturniolo GC, Saia M. Time trends and outcome of gastrointestinal bleeding in the Veneto region: a retrospective population based study from 2001 to 2010. Dig Liver Dis 2014; 46:313-7. [PMID: 24365335 DOI: 10.1016/j.dld.2013.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 11/03/2013] [Accepted: 11/12/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastrointestinal bleeding is the most frequent emergency for gastroenterologists. Despite advances in management, an improvement in mortality is still not evident. AIM Determining time trends of gastrointestinal bleeding hospitalization and outcomes from 2001 to 2010 in the Veneto Region (Italy). PATIENTS AND METHODS Data of patients admitted with gastrointestinal bleeding from Veneto regional discharge records were retrospectively evaluated. Chi-squared and multivariate logistic regression model were used. RESULTS Overall, 44,343 patients (mean age 64.2 ± 8.6 years) with gastrointestinal bleeding were analysed: 23,450 (52.9%) had upper, 13,800 (31.1%) lower, and 7093 (16%) undefined gastrointestinal bleeding. Admission rate decreased from 108.0 per 100,000 in 2001 to 80.7 in 2010, mainly owing to a decrease in upper gastrointestinal bleeding (64.4 to 35.9 per 100,000, p<0.05). Reductions in hospital fatality rate (from 5.3% to 3%, p<0.05), length of hospital stay (from 9.3 to 8.7 days, p<0.05), and need for surgery (from 5.6% to 5%, p<0.05) were observed. Surgery (OR: 2.97, 95% CI: 2.59-3.41) and undefined gastrointestinal bleeding (OR: 2.89, 95% CI: 2.62-3.19) were found to be risk factors for mortality. CONCLUSIONS Patient admissions for gastrointestinal bleeding decreased significantly over the years, owing to a decrease in upper gastrointestinal bleeding. Improved outcomes could be related to regional dedicated clinical gastroenterological management.
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Affiliation(s)
| | - Fabio Monica
- Gastroenterology Unit, S. Bassiano Hospital, Bassano del Grappa (VI), Italy
| | | | - Renato Marin
- Gastroenterology Unit, Hospital of Dolo (VE), Italy
| | | | - Mario Saia
- Health Directorate, Veneto Region, Venezia, Italy
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Baldo V, Cocchio S, Buja A, Baldovin T, Furlan P, Bertoncello C, Saia M. Hospitalization for diseases attributable to human papillomavirus in the Veneto Region (North-East Italy). BMC Infect Dis 2013; 13:462. [PMID: 24094080 PMCID: PMC3851564 DOI: 10.1186/1471-2334-13-462] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 09/27/2013] [Indexed: 01/30/2023] Open
Abstract
Background Human papillomavirus (HPV) is one of the most common sexually-transmitted pathogens. A number of studies in the literature have estimated the burden of HPV-related diseases by collecting data at primary care level, while a comprehensive assessment of the global burden of HPV-related diseases on hospital resources is still lacking. Methods This was a retrospective cohort study based on hospital discharge data collected from 2000 to 2010 in the Veneto Region (north-east Italy). All hospitalizations for diseases potentially associated with HPV were identified by searching the hospital discharge records, then the proportion of these hospitalizations relating to diseases attributable to the HPV infection was calculated. Results Overall, the annual hospitalization rate for HPV-related diseases was 21.3 per 100,000 individuals in the general population, 15.8 per 100,000 males, and 27.6 per 100,000 females. Hospitalizations were due mainly to genital warts, and peak among 15- to 44-year-olds in both genders. Taking both sexes together, the hospitalizations attributable to HPV dropped from 24.5/100,000 in 2000 to 17.5/100,000 in 2011, showing a significant decline during this period, with an average annual percent change (AAPC) of −1.9% (CI 95%: -2.8, -0.9;). On the other hand, the hospitalization rate for genital warts tended to increase significantly (AAPC 3.0% [CI 95%: 1.4;4.7]), whilst there was a significantly declining trend in the hospitalization rate for anal cancer (AAPC - 5.0% [CI 95%: -7.7;-2.2]), genital cancer (AAPC −6.2% [CI 95%: -7.8;-4.6]) and oropharyngeal cancer (AAPC −4.3% [CI 95%: -4.8;-3,8]). Conclusion Data derived from the hospital records indicate that HPV-related diseases are an important public health issue.
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Affiliation(s)
- Vincenzo Baldo
- Department of Molecular Medicine, Public Health Section, Istituto di Igiene, University of Padua, Via Loredan, 18, 35121 Padova, Italy.
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Saia M, Mantoan D, Buja A, Bertoncello C, Baldovin T, Zanardo C, Callegaro G, Baldo V. Increased rate of day surgery use for inguinal and femoral hernia repair in a decade of hospital admissions in the Veneto Region (north-east Italy): a record linkage study. BMC Health Serv Res 2013; 13:349. [PMID: 24028397 PMCID: PMC3847913 DOI: 10.1186/1472-6963-13-349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 08/05/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Worldwide, there has been a marked increase in the number of inguinal and femoral hernia repairs performed as day surgery procedures. This study aimed to outline the epidemiology of the procedures for repairing unilateral inguinal and femoral hernia in the Veneto Region, and to analyze the time trends and organizational appropriateness of these procedures. METHODS Drawing from the anonymous computerized database of hospital discharge records for the Veneto Region, we identified all unilateral groin hernia repair procedures completed in Veneto residents between 2000 and 2009 at both public and accredited private hospitals. RESULTS A total 141,329 hernias were repaired in the Veneto Region during the decade considered, with an annual rate of 291.2 per 100,000 population for inguinal hernia (IH) repairs and 11.2 per 100,000 population for femoral hernia (FH) repairs. Day surgery was used more for inguinal than for femoral hernia repairs, accounting for 76% and 43% (p< 0.05), respectively, of all hernia repair procedures completed during the period. The % of other than surgery hospital ordinary admissions (day surgery or ambulatory surgery) during the decade considered rose from 61.7% to 86.7% for IH and from 33.0% to 61.8% for FH. CONCLUSIONS In the last decade, the Veneto Region has reduced the rate of ordinary hospital admissions for groin hernia repair with a view to improving the efficiency of the hospital network.
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Affiliation(s)
- Mario Saia
- Veneto Region Health Directorate, Sanità Regione Veneto, Palazzo Molin San Polo, 2513 - 30125 Venezia, VE, Italy
| | - Domenico Mantoan
- Veneto Region Health Directorate, Sanità Regione Veneto, Palazzo Molin San Polo, 2513 - 30125 Venezia, VE, Italy
| | - Alessandra Buja
- Department of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padova, Padova, Via Loredan 18 35127 Italy
| | - Chiara Bertoncello
- Department of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padova, Padova, Via Loredan 18 35127 Italy
| | - Tatjana Baldovin
- Department of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padova, Padova, Via Loredan 18 35127 Italy
| | - Chiara Zanardo
- Department of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padova, Padova, Via Loredan 18 35127 Italy
| | - Giampietro Callegaro
- , Local Health Unit No. 8, Via dei Carpani 16/Z, 31033 Castelfranco Veneto, Veneto Region, Italy
| | - Vincenzo Baldo
- Department of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padova, Padova, Via Loredan 18 35127 Italy
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