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La Grotta R, Pellegrini V, Prattichizzo F, Amata O, Panella L, Frizziero A, Visconti M, Averame G, Brasesco PC, Calabrese I, Vaccaro O, Ceriello A. Feasibility of a Type 2 Diabetes Prevention Program at Nationwide Level in General Practice: A Pilot Study in Italy. J Clin Med 2024; 13:1127. [PMID: 38398440 PMCID: PMC10888610 DOI: 10.3390/jcm13041127] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Lifestyle interventions halt the progression of prediabetes to frank type 2 diabetes (T2D). However, the feasibility of a diabetes prevention program promoting tailored interventions on a national scale and conducted by primary care physicians is unclear. METHODS General practitioners located in ten different regions throughout Italy enrolled random subjects without known metabolic diseases to identify individuals with prediabetes and prescribe them an intervention based on physical activity. Using a simple stepwise approach, people referring to their primary care physician for any reason were screened for their diabetes risk with a web-based app of the Findrisc questionnaire. Those at risk for T2D, i.e., with a Findrisc score >9, were invited to come back after overnight fasting to measure fasting glycaemia (FG). Those with 100 ≤ FG < 126 mg/dL were considered as people with prediabetes and compiled the Physical Activity Readiness Questionnaire (PAR-Q) to then receive a personalised prescription of physical activity. RESULTS Overall, 5928 people were enrolled and compiled the questionnaire. Of these, 2895 (48.8%) were at risk for T2D. Among these, FG was measured in 2168 subjects (participation rate 75%). The numbers of individuals with undetected prediabetes and T2D according to FG were 755 and 79 (34.8% and 3.6% of those assessing FG), respectively. Of the 755 subjects in the prediabetes range, 739 compiled the PAR-Q and started a personalised program of physical activity (participation rate 97%). Physicians involved in the study reported a mean of 6 min to perform the screening. CONCLUSIONS Overall, these data suggest the feasibility of a national diabetes prevention program developed by general practitioners using a simple stepwise approach starting from a web app to intercept individuals with prediabetes.
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Affiliation(s)
- Rosalba La Grotta
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Via Fantoli 16/15, 20138 Milan, Italy
| | - Valeria Pellegrini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Via Fantoli 16/15, 20138 Milan, Italy
| | - Francesco Prattichizzo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Via Fantoli 16/15, 20138 Milan, Italy
| | - Oriana Amata
- Department of Rehabilitation, Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Lorenzo Panella
- Department of Rehabilitation, Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Antonio Frizziero
- Department of Rehabilitation, Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Marco Visconti
- Consorzio Sanità (Co.S.), Via Marconi 3, 26015 Soresina, Italy
| | - Gabriella Averame
- Consorzio Sanità (Co.S.), Via Marconi 3, 26015 Soresina, Italy
- Medicoopliguria, Via Peschiera 33, 16121 Genova, Italy
| | - Pier Claudio Brasesco
- Consorzio Sanità (Co.S.), Via Marconi 3, 26015 Soresina, Italy
- Medicoopliguria, Via Peschiera 33, 16121 Genova, Italy
| | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Antonio Ceriello
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Via Fantoli 16/15, 20138 Milan, Italy
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Pestarino L, Domnich A, Orsi A, Bianchi F, Cannavino E, Brasesco PC, Russo G, Valbonesi S, Vallini G, Ogliastro M, Icardi G. Rollout of the 2022/2023 Seasonal Influenza Vaccination and Correlates of the Use of Enhanced Vaccines among Italian Adults. Vaccines (Basel) 2023; 11:1748. [PMID: 38140153 PMCID: PMC10747154 DOI: 10.3390/vaccines11121748] [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: 11/06/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
In Italy, several types of seasonal influenza vaccines (SIVs) are available for older adults, but for the 2022/2023 season there were no guidelines on their specific use. This cross-sectional study assessed the frequency and determinants of the use of enhanced (adjuvanted and high-dose) SIVs in Italian older adults, as compared to standard-dose non-adjuvanted formulations. Of 1702 vaccines administered to a representative outpatient sample of adults aged ≥ 60 years and residing in Genoa, 69.5% were enhanced SIVs. Older age (adjusted odds ratio (aOR) for each 1-year increase 1.10; p < 0.001), and the presence of cardiovascular disease (aOR 1.40; p = 0.011) and diabetes (aOR 1.62; p = 0.005) were associated with the use of enhanced vaccines. Compared with the adjuvanted SIV, subjects immunized with the high-dose vaccine were older (aOR for each 1-year increase 1.05; p < 0.001) and had higher prevalence of respiratory diseases (aOR 1.85; p = 0.052). Moreover, usage of the enhanced SIVs was driven by the period of immunization campaign, place of vaccination and physician. Despite their superior immunogenicity and effectiveness, the adoption of enhanced SIVs in Italy is suboptimal, and should be increased. Enhanced formulations are mostly used in the oldest, and in subjects with some co-morbidities.
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Affiliation(s)
- Luca Pestarino
- Private General Practice, 16122 Genoa, Italy; (L.P.); (F.B.); (E.C.); (P.C.B.); (G.R.); (S.V.)
- Medicoop Liguria, 16122 Genoa, Italy;
| | - Alexander Domnich
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (A.O.); (G.I.)
| | - Andrea Orsi
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (A.O.); (G.I.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy;
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), 16132 Genoa, Italy
| | - Federico Bianchi
- Private General Practice, 16122 Genoa, Italy; (L.P.); (F.B.); (E.C.); (P.C.B.); (G.R.); (S.V.)
| | - Elisa Cannavino
- Private General Practice, 16122 Genoa, Italy; (L.P.); (F.B.); (E.C.); (P.C.B.); (G.R.); (S.V.)
| | - Pier Claudio Brasesco
- Private General Practice, 16122 Genoa, Italy; (L.P.); (F.B.); (E.C.); (P.C.B.); (G.R.); (S.V.)
- Medicoop Liguria, 16122 Genoa, Italy;
| | - Gianluca Russo
- Private General Practice, 16122 Genoa, Italy; (L.P.); (F.B.); (E.C.); (P.C.B.); (G.R.); (S.V.)
- Medicoop Liguria, 16122 Genoa, Italy;
| | - Simone Valbonesi
- Private General Practice, 16122 Genoa, Italy; (L.P.); (F.B.); (E.C.); (P.C.B.); (G.R.); (S.V.)
- Medicoop Liguria, 16122 Genoa, Italy;
| | | | - Matilde Ogliastro
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy;
| | - Giancarlo Icardi
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (A.O.); (G.I.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy;
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), 16132 Genoa, Italy
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Saccarello A, Montarsolo P, Massardo I, Picciotto R, Pedemonte A, Castagnaro R, Brasesco PC, Guida V, Picco P, Fioravanti P, Montisci R, Schiavetti I, Vanelli A. Oral Administration of S-Adenosylmethionine (SAMe) and Lactobacillus Plantarum HEAL9 Improves the Mild-To-Moderate Symptoms of Depression: A Randomized, Double-Blind, Placebo-Controlled Study. Prim Care Companion CNS Disord 2020; 22. [PMID: 32589828 DOI: 10.4088/pcc.19m02578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022] Open
Abstract
Objective To assess the effects of the combination of SAMe (S-adenosylmethionine) 200 mg and Lactobacillus plantarum (L. plantarum) HEAL9 1 × 10⁹ CFU for the overall symptomatology of mild-to-moderate depression. Methods This 6-week randomized, double-blind, placebo-controlled study included subjects aged 18-60 years with mild-to-moderate depression (according to ICD-10 diagnostic criteria) recruited from September 17, 2018, to October 5, 2018. Difference between groups in change from baseline to treatment week 6 on the Zung Self-Rating Depression Scale (Z-SDS) was the primary outcome. Comparisons between groups in change from baseline to treatment week 2 of the Z-SDS and from baseline to treatment weeks 2 and 6 of other scales (related to insomnia, anxiety, irritable bowel syndrome, and health status) were also analyzed. Results Ninety patients were randomized to SAMe plus L. plantarum HEAL9 (n = 46) or placebo (n = 44) groups. A greater reduction for the new combination compared to placebo was seen at treatment week 6 in the Z-SDS total score (P = .0165) and the core depression subdomain (P = .0247). A significant reduction in favor of the combination was shown at treatment week 2 for the Z-SDS total score (P = .0330), the cognitive and anxiety subdomains (P = .0133 and P = .0459, respectively), and the anxiety questionnaire (P = .0345). No treatment-related adverse events occurred. Conclusions Supplementation of SAMe and L. plantarum HEAL9 in adults with subthreshold or mild-to-moderate symptoms of depression resulted in fast and clinically relevant effects after 2 weeks. The combination was safe and significantly improved symptoms of depression, anxiety, and cognitive and somatic components. The effect of this novel product is independent from the severity of the symptoms unlike traditional antidepressants available on the market that have minimal benefits for subthreshold or mild-to-moderate symptoms. Trial Registration ClinicalTrials.gov identifier: NCT03932474.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Irene Schiavetti
- Hippocrates Research SRL, Via XX Settembre, 30/12, 16121 Genova, Italy. .,Hippocrates Research SRL, Genova, Italy
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Zuccoli ML, Milano G, Leone S, Fucile C, Brasesco PC, Martelli A, Mattioli F. A case report on escitalopram-induced hyperglycaemia in a diabetic patient. Int J Psychiatry Med 2014; 46:195-201. [PMID: 24552042 DOI: 10.2190/pm.46.2.f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The incidence of depression in diabetic patients is quite high; moreover, it has been suggested that the presence of depression itself may increase the risk of diabetes mellitus. Hence, it follows that the simultaneous use of antidiabetic and antidepressant drugs is common. Some clinical evidence indicates that selective serotonin re-uptake inhibitors (SSRIs) could be very useful in treating overweight patients, both with and without diabetes. However, recent deregulation of glucidic metabolism was tested in diabetic subjects treated with antidepressants. Several cases of hyperglycaemia and hypoglycaemia associated with other SSRIs have been published, whereas only one case of escitalopram inducing hyperglycaemia has been noted. The exact mechanism of glucose control impairment in patients taking SSRIs--escitalopram in particular--still remains unclear. We describe a diabetic 83-year-old woman with good glycaemic control (as evinced by glycaemic and glycosylated haemoglobin assay--HbA1c--values) before escitalopram initiation in response to therapy with glibenclamide. Escitalopram resulted in a significantly increased glycaemia values 5 days following administration. Glycaemia values returned to normality only after suspension of escitalopram, despite antidiabetic dosage increase. We report this case to draw attention to escitalopram as a possible cause of glycaemic control loss.
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Affiliation(s)
- M L Zuccoli
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
| | - G Milano
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
| | - S Leone
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
| | - C Fucile
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
| | - P C Brasesco
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
| | - A Martelli
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
| | - F Mattioli
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
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Palombo D, Lucertini G, Pane B, Mazzei R, Spinella G, Brasesco PC. District-based abdominal aortic aneurysm screening in population aged 65 years and older. J Cardiovasc Surg (Torino) 2010; 51:777-782. [PMID: 21124273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Screening for abdominal aortic aneurysms (AAAs) has been carried out in an area of Genoa (Italy) for subjects aged 65 years or more to evaluate prevalence of this disease. METHODS Between March 2007 and September 2009 8234 subjects were screened. Ultrasound examination of the abdominal aorta and the iliac arterial segments was carried out on each subject and all data related to risk factors were collected. RESULTS Five hundreds-twelve (6.2%) subjects were found to have an AAA: 469 (10.8%) males and 43 (1.1%) females (significant difference, P < 0.01). Based on the aortic diameter, 403 (4.9%), 80 (1.0%) and 29 (0.3%) had an AAA of 3.0-3.9 cm, 4.0-4.9 cm and ≥ 5.0 cm diameter, respectively. With regards to risk factors, family history of cardiovascular disease only resulted more frequent in subjects with AAA than in those without AAA. CONCLUSION The prevalence of patients with AAA (6.2%) was similar to previously published estimates. Nevertheless, AAA resulted very high in males. This observation is likely due to screening in a city with a very high percentage of elderly subjects. Family predisposition to cardiovascular disease resulted significant risk factor for AAA. Results of our epidemiological study provide evidence of the usefulness of AAA screening thanks to early diagnosis and appropriate treatment of AAA.
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Affiliation(s)
- D Palombo
- Vascular and Endovascular Surgery Unit, San Martino University Hospital, Genoa, Italy.
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