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Da Ros F, Di Gaspero L, Roitero K, La Barbera D, Mizzaro S, Della Mea V, Valent F, Deroma L. Supporting Fair and Efficient Emergency Medical Services in a Large Heterogeneous Region. J Healthc Inform Res 2024; 8:400-437. [PMID: 38681761 PMCID: PMC11052746 DOI: 10.1007/s41666-023-00154-1] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/24/2023] [Accepted: 11/07/2023] [Indexed: 05/01/2024]
Abstract
Emergency Medical Services (EMS) are crucial in delivering timely and effective medical care to patients in need. However, the complex and dynamic nature of operations poses challenges for decision-making processes at strategic, tactical, and operational levels. This paper proposes an action-driven strategy for EMS management, employing a multi-objective optimizer and a simulator to evaluate potential outcomes of decisions. The approach combines historical data with dynamic simulations and multi-objective optimization techniques to inform decision-makers and improve the overall performance of the system. The research focuses on the Friuli Venezia Giulia region in north-eastern Italy. The region encompasses various landscapes and demographic situations that challenge fairness and equity in service access. Similar challenges are faced in other regions with comparable characteristics. The Decision Support System developed in this work accurately models the real-world system and provides valuable feedback and suggestions to EMS professionals, enabling them to make informed decisions and enhance the efficiency and fairness of the system.
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Affiliation(s)
- Francesca Da Ros
- Intelligent Optimization Laboratory, Universitá degli Studi di Udine, Udine, Italy
- DMIF, Universitá degli Studi di Udine, via delle Scienze 206, Udine, I-33100 Italy
| | - Luca Di Gaspero
- Intelligent Optimization Laboratory, Universitá degli Studi di Udine, Udine, Italy
- DPIA, Universitá degli Studi di Udine, via delle Scienze 206, Udine, I-33100 Italy
| | - Kevin Roitero
- DMIF, Universitá degli Studi di Udine, via delle Scienze 206, Udine, I-33100 Italy
| | - David La Barbera
- DMIF, Universitá degli Studi di Udine, via delle Scienze 206, Udine, I-33100 Italy
| | - Stefano Mizzaro
- DMIF, Universitá degli Studi di Udine, via delle Scienze 206, Udine, I-33100 Italy
| | - Vincenzo Della Mea
- DMIF, Universitá degli Studi di Udine, via delle Scienze 206, Udine, I-33100 Italy
| | - Francesca Valent
- Public Health and Hygiene, Azienda Ospedaliera Universitaria del Friuli Centrale, via Chiusaforte 2, Udine, I-33100 Italy
| | - Laura Deroma
- Public Health and Hygiene, Azienda Ospedaliera Universitaria del Friuli Centrale, via Chiusaforte 2, Udine, I-33100 Italy
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Forgiarini A, Deroma L, Buttussi F, Zangrando N, Licata S, Valent F, Chittaro L, Di Chiara A. Introducing Virtual Reality in a STEMI Coronary Syndrome Course: Qualitative Evaluation with Nurses and Doctors. Cyberpsychol Behav Soc Netw 2024. [PMID: 38527251 DOI: 10.1089/cyber.2023.0414] [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] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
In the increasing number of medical education topics taught with virtual reality (VR), the prehospital management of ST-segment elevation myocardial infarction (STEMI) had not been considered. This article proposes an implemented VR system for STEMI training and introduces it in an institutional course addressed to emergency nurses and case manager (CM) doctors. The system comprises three different applications to, respectively, allow (a) the course instructor to control the conditions of the virtual patient, (b) the CM to communicate with the nurse in the virtual field and receive from him/her the patient's parameters and electrocardiogram, and (c) the nurse to interact with the patient in the immersive VR scenario. We enrolled 17 course participants to collect their perceptions and opinions through a semistructured interview. The thematic analysis showed the system was appreciated (n = 17) and described as engaging (n = 4), challenging (n = 5), useful to improve self-confidence (n = 4), innovative (n = 5), and promising for training courses (n = 10). Realism was also appreciated (n = 13), although with some drawbacks (e.g., oversimplification; n = 5). Overall, participants described the course as an opportunity to share opinions (n = 8) and highlight issues (n = 4) and found it useful for novices (n = 5) and, as a refresh, for experienced personnel (n = 6). Some participants suggested improvements in the scenarios' type (n = 5) and variability (n = 5). Although most participants did not report usage difficulties with the VR system (n = 13), many described the need to get familiar with it (n = 13) and the specific gestures it requires (n = 10). Three suffered from cybersickness.
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Affiliation(s)
- Alessandro Forgiarini
- Human-Computer Interaction Laboratory, Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
- Hygiene and Clinical Epidemiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Laura Deroma
- Hygiene and Public Health Unit, Department of Prevention, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Fabio Buttussi
- Human-Computer Interaction Laboratory, Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Nicola Zangrando
- Hygiene and Clinical Epidemiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Sabrina Licata
- Hygiene and Clinical Epidemiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Francesca Valent
- Hygiene and Clinical Epidemiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Luca Chittaro
- Human-Computer Interaction Laboratory, Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Antonio Di Chiara
- Cardiology Tolmezzo, San Daniele-Tolmezzo Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Gazzetta S, Valent F, Sala A, Driul L, Brunelli L. Sexually transmitted infections and the HPV-related burden: evolution of Italian epidemiology and policy. Front Public Health 2024; 12:1336250. [PMID: 38560434 PMCID: PMC10978588 DOI: 10.3389/fpubh.2024.1336250] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Sexually transmitted infections (STIs) are a major public health problem worldwide, with a high prevalence between the ages of 15 and 25 in most Western countries. High notification rates of chlamydia, gonorrhea, and syphilis are reported in the WHO European Region, with differences between countries. In Italy, the total number of STIs alerts increased by 18% from 2020 to 2021. HPV is the most common sexually transmitted infection; globally one in seven women is infected by this virus, and certain sexual behaviors are important risk factors for HPV-related cancers, particularly cervical cancer (CC), anogenital cancers and cancers of the head and neck. The burden of CC is relevant worldwide, in particular in Europe CC is the third leading cause of cancer-related deaths in women aged 15-44. This HPV-related tumor is preventable through a combined strategy of vaccination and screening for precursor lesions. In Italy, the coverage of organized screening varies from region to region and the average HPV vaccination rate is still far from the expected optimal threshold of 95% at the age of 12. To address the challenges of health promotion and HPV prevention, priority actions are needed such as: promoting education and information at every level, from schools to healthcare professionals. In Italy, education of adolescents on sexual and reproductive health, still remains critical, regionally inhomogeneous and much lower than in other European countries. Equitable measures need to be taken, and schools are an important place for health promotion activities.
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Affiliation(s)
| | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology, Friuli Centrale University Healthcare Trust, Udine, Italy
| | - Alessia Sala
- Departement of Medicine, University of Udine, Udine, Italy
| | - Lorenza Driul
- Departement of Medicine, University of Udine, Udine, Italy
- Department of Obstetrics and Gynaecology, ASUFC, Ospedale Santa Maria Della Misericordia, Udine, Italy
| | - Laura Brunelli
- Departement of Medicine, University of Udine, Udine, Italy
- Accreditation, Quality and Clinical Risk Unit, Friuli Centrale University Healthcare Trust, Udine, Italy
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Valent F, Degani G, Gri M, Donato R, Varadi G, Cardellino GG, Fasola G. A shared vaccination ambulatory for patients with cancer in Udine, Italy. Tumori 2024; 110:74-76. [PMID: 37904307 DOI: 10.1177/03008916231208622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Affiliation(s)
- Francesca Valent
- Vaccination Service, Unit of Hygiene and Public Health, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giulia Degani
- Vaccination Service, Unit of Hygiene and Public Health, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Monica Gri
- Vaccination Service, Unit of Hygiene and Public Health, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Raffaela Donato
- Oncology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giulia Varadi
- Vaccination Service, Unit of Hygiene and Public Health, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Gianpiero Fasola
- Oncology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Giovanazzi A, Gios L, Mastellaro M, Gentilini MA, Valent F, Condini S, Bincoletto G, Bacchiega A, Zorzi A, Malfatti G, Perini F, Eccher C, Marchesoni M, Dall'Alda M, Orrasch M, Conforti D, Inchiostro S. Organisational models supported by technology for the management of diabetic disease and its complications in a diabetic clinic setting: study protocol for a randomised controlled trial targeting type 2 diabetes individuals with non-ideal glycaemic values (Telemechron study). Trials 2023; 24:513. [PMID: 37563665 PMCID: PMC10413726 DOI: 10.1186/s13063-023-07515-6] [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: 12/11/2022] [Accepted: 07/16/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a non-communicable disease representing one of the most serious public health challenges of the twenty-first century. Its incidence continues to rise in both developed and developing countries, causing the death of 1.5 million people every year. The use of technology (e.g. smartphone application-App) in the health field has progressively increased as it has been proved to be effective in helping individuals manage their long-term diseases. Therefore, it has the potential to reduce the use of health service and its related costs. The objective of this study is to evaluate the impact of using a digital platform called "TreC Diabete" embedded into a novel organisational asset targeting poorly controlled T2DM individuals in the Autonomous Province of Trento (PAT), Italy. METHODS This trial was designed as a multi-centre, open-label, randomised, superiority study with two parallel groups and a 1:1 allocation ratio. Individuals regularly attending outpatient diabetes clinics, providing informed consent, are randomised to be prescribed TreC Diabete platform as part of their personalised care plan. Healthcare staff members will remotely assess the data shared by the participants through the App by using a dedicated online medical dashboard. The primary end-point is the evaluation of the Hb1Ac level at 12-month post-randomisation. Data will be analysed on an intention-to-treat (ITT) basis. DISCUSSION This trial is the first conducted in the PAT area for the use of an App specifically designed for individuals with poorly controlled T2DM. If the effects of introducing this specific App within a new organisational asset are positive, the digital platform will represent a possible way for people diagnosed with T2DM to better manage their health in the future. Results will be disseminated through conferences and peer-reviewed journals once the study is completed. TRIAL REGISTRATION ClinicalTrials.gov NCT05629221. Registered on November 29, 2022, prior start of inclusion.
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Affiliation(s)
- Alexia Giovanazzi
- Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma Di Trento, Trento, Italy
| | - Lorenzo Gios
- TrentinoSalute4.0, Competence Center for Digital Health, Trento, Italy
| | - Marina Mastellaro
- Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma Di Trento, Trento, Italy
| | | | - Francesca Valent
- Servizio di Igiene e Sanità Pubblica, Dipartimento di Prevenzione, Azienda sanitaria universitaria Friuli Centrale, Gemona del Friuli, Italy
| | - Sara Condini
- Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma Di Trento, Trento, Italy
| | - Giorgia Bincoletto
- Facoltà Di Giurisprudenza, Università Degli Studi Di Trento, Trento, Italy
| | | | | | - Giulia Malfatti
- TrentinoSalute4.0, Competence Center for Digital Health, Trento, Italy
| | - Francesca Perini
- TrentinoSalute4.0, Competence Center for Digital Health, Trento, Italy
| | | | | | - Marlene Dall'Alda
- Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma Di Trento, Trento, Italy
| | - Massimo Orrasch
- Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma Di Trento, Trento, Italy
| | | | - Sandro Inchiostro
- Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma Di Trento, Trento, Italy.
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Valent F, Deroma L, Degani G. Vaccination against human papilloma virus in a Northeastern Italian area. Ann Ist Super Sanita 2023; 59:223-230. [PMID: 37712241 DOI: 10.4415/ann_23_03_09] [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: 09/16/2023]
Abstract
OBJECTIVES Vaccination against human papilloma virus (HPV) in adolescents and persons at increased risk of infection and related consequences is an effective strategy to prevent genital cancers. The objective of this study was to assess vaccination activity and coverages in a Northeastern Italian area. METHODS Anonymous data from various health administrative databases of the Italian 530,000-inhabitant Health Authority "Azienda Sanitaria Universitaria Friuli Centrale" were deterministically linked at the individual level through an anonymous stochastic key. Doses of HPV vaccine administered by year and coverages in different birth cohorts were calculated. Vaccinations of women treated for a CIN2+ lesion were also identified. RESULTS The number of doses administered by year followed the evolution of national and regional laws. A steep drop was observed in 2020 and 2021 in both males and females (from 6,907 in 2019 to 5,027 in 2020 in males and from 6,989 in 2019 to 4,348 in 2020 in females). Coverages in adolescents were variable across Vaccination Services located in different sub-areas (complete cycle coverage in the 2008 cohort ranged from <40% in some Districts to >70% in others). Vaccination doses administered in adult women have increased almost steadily since 2018. One third of women treated for a CIN2+ were vaccinated. CONCLUSIONS In this area, efforts must be done to catch-up with doses missed during the pandemic and to overcome differences among different sub-areas.
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Affiliation(s)
- Francesca Valent
- SOC Igiene e Sanità Pubblica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Laura Deroma
- SOC Igiene e Sanità Pubblica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giulia Degani
- SOC Igiene e Sanità Pubblica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Garattini SK, Valent F, Minisini AM, Riosa C, Favaretti C, Regattin L, Fasola G. Analysis of workload generated in the two years following first consultation by each new cancer patient: studying the past to plan the future of cancer care. BMC Health Serv Res 2022; 22:1184. [PMID: 36131286 PMCID: PMC9494889 DOI: 10.1186/s12913-022-08573-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 09/14/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Prevalence of cancer patients is dramatically increasing. We aimed at quantifying the oncology workload generated by each new cancer patient in the two years following first consultation. Methods In this record-based retrospective study, we retrieved data of all newly diagnosed patients treated at the Oncology Department of Udine Academic Hospital between 01.01.2012 and 31.12.2017. We calculated mean number and standard deviation of the activity type generated by each new cancer patient during the following 2 years. Results Seven thousand four hundred fifty-two cancer patients generated a total of 85,338 clinical episodes. The two-years mean number of oncology episodes generated was 11.31 (i.e., for every 1,000 new cancer patients, 11,310 oncology activities are generated overall in the following two-year lapse). Patients with advanced disease generated the highest workload (24.3; SD 18.8) with a statistically significant difference compared to adjuvant and follow-up patients (p < 0.001). The workload generated in the period 0–6 and 0–12 months was significantly higher than in the following months (p < 0.001) and it was also higher for patients initially designated to treatment (p < 0.001). Conclusion This is the first study reporting on the mean oncology workload generated during the 2 years following first consultation. Workload is the highest for patient with advanced disease, especially in the first months and in patients in active treatment. A detailed analysis of workloads in oncology is feasible and could be crucial for planning a sustainable framework for cancer care in the next future.
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Affiliation(s)
- S K Garattini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy.
| | - F Valent
- Institute of Hygiene and Clinical Epidemiology, Academic Hospital of Udine ASUFC, 33100, Udine, UD, Italy
| | - A M Minisini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| | - C Riosa
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| | - C Favaretti
- Center for Leadership in Medicine, Catholic University of Sacred Heart, 000168, Rome, RO, Italy
| | - L Regattin
- Medical Director, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| | - G Fasola
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
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Werren M, Valent F, Di Chiara A. Effectiveness of home-rehabilitation in patients after an acute coronary syndrome and myocardial revascularization. Int J Cardiol Cardiovasc Risk Prev 2022; 14:200131. [PMID: 35663539 PMCID: PMC9160771 DOI: 10.1016/j.ijcrp.2022.200131] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022]
Abstract
Physical activity is a mainstay (class IA) of rehabilitation programme after an acute coronary syndrome, but less than 40% of patients is physically active at one year. Home-rehabilitation, initially designed to manage the increasing number of patients in rehabilitation programmes, could result in a better strategy to increase adherence and persistence to physical activity. Objectives To test such hypothesis, At Cardiac Rehabilitation Centre (Institute of Physical Medicine and Rehabilitation, Udine, Italy), physical activity adherence was compared between patients treated with a standard in-office rehabilitation programme and a cohort where home rehabilitation programme was added. Methods From February 2017 to February 2019, 372 patients after an acute coronary syndrome (72 were excluded according to study criteria) were included, 193 patients in standard rehabilitation and 179 in home rehabilitation. At the end of follow-up, patients of both groups were called on the telephone to collect physical activity items according to a standardized questionnaire. Results At a medium follow-up of 30.1 months, there are more physically active patients in home rehabilitation than in standard, respectively 139 vs 108 patients (77,1% vs. 56%, p < 0,0001).At multivariate analysis, including age, gender, and rehabilitation model, the probability to be fully physically active at the end of the rehabilitation programme, is 3 times higher (OR 3.0 CI 1,9-6,0 p < 0,0001) for home rehabilitation programme compared to standard one. Conclusions Home rehabilitation, when applied to selected populations, resulted in a feasible and effective strategy to promote long term physical activity in secondary prevention after an acute coronary syndrome.
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Affiliation(s)
- Marika Werren
- Cardiologia Riabilitativa, Istituto di Medicina Fisica e Riabilitazione, Azienda Sanitario-Universitaria Friuli Centrale, Udine, Italy
| | - Francesca Valent
- Servizio di Epidemiologia Clinica e Valutativa, Azienda Provinciale per i Servizi Sanitari della Provincia Autonoma di Trento, Trento, Italy
| | - Antonio Di Chiara
- Cardiologia Ospedale Tolmezzo-San Daniele, Azienda Sanitario-Universitaria Friuli Centrale, Udine, Italy
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Franceschi R, Scotton C, Leonardi L, Cauvin V, Maines E, Angriman M, Pertile R, Valent F, Soffiati M, Faraguna U. Impact of intermittently scanned continuous glucose monitoring with alarms on sleep and metabolic outcomes in children and adolescents with type 1 diabetes. Acta Diabetol 2022; 59:911-919. [PMID: 35397650 DOI: 10.1007/s00592-022-01882-3] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/13/2022] [Indexed: 11/01/2022]
Abstract
AIMS Data about sleep quality and quantity are not available in patients with type 1 diabetes (T1D) using intermittently scanned continuous glucose monitoring (isCGM). We questioned whether the isCGM with alarms could fragment sleep in patients and parents, compared to isCGM without alarms. METHODS A prospective, observational study including 47 child-adolescents with T1D who had experience with isCGM without alarms (Freestyle Libre 1-FSL1). They were asked to wear the isCGM with alarms (Freestyle Libre 2-FSL2) for 14 days. Patients enrolled and their caregiver (s), during a 14 day period with FSL1 and the following 14 days with FSL2, completed psychosocial and sleep-related questionnaires. Furthermore they wore an actigraph that was downloaded to a web platform and processed by the validated and certified algorithm "Dormi®." RESULTS By the switch to the alarmed FSL2 we found about a 5% increase in Time In Range (from 62.5 to 67.8%), a reduction in time spent in hypoglycemia, number of weekly hypoglycemic events, and coefficient of variation. We did not find significant differences in sleep parameters in patients and their parents; therefore, alarms did not worsen the duration and quality of sleep. A significant improvement in the Quality of Life was perceived by parents using FSL2. CONCLUSIONS Introduction of alarms in isCGM systems gives, in the short term, an improvement in metabolic control in terms of time in range and reduction in hypoglycemia, without worsening duration and quality of sleep, measured by actigraphy, in children-adolescent and their parents.
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Affiliation(s)
- Roberto Franceschi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy.
| | - Chiara Scotton
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Letizia Leonardi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Vittoria Cauvin
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Evelina Maines
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Marco Angriman
- Health Management, General Hospital of Bolzano, Bolzano, Italy
| | - Riccardo Pertile
- Clinical and Evaluative Epidemiology Unit, Department of Governance, APSS, Trento, Italy
| | - Francesca Valent
- Clinical and Evaluative Epidemiology Unit, Department of Governance, APSS, Trento, Italy
| | - Massimo Soffiati
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Ugo Faraguna
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Department of Developmental Neuroscience, IRCSS Stella Maris Foundation, Pisa, Italy
- SleepActa Srl, A spinoff company of the University of Pisa, Pisa, Italy
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Abstract
OBJECTIVE To assess changes in the number and severity of road traffic accidents in Italy in 2020, in particular after the beginning of COVID-19 and during the lockdown, as compared with 2019, with monthly details and geographical variations within the country. METHODS Official monthly data on road traffic accidents recorded by the Police in Italy in 2020 were compared with those in 2019. The comparison regarded number of accidents, percent change, non-fatal injuries, deaths, injury index (injuries/accidents ×100) and fatality index (deaths/accidents ×100). Monthly data were graphically presented separately for each of the 21 Italian Regions and autonomous Provinces. RESULTS A steep generalized decrease in the number of road traffic accidents was observed in March and April 2020 (Italian lockdown) as compared with the corresponding months of 2019 (more than 70% change), with a smaller change in the number of deaths, more variable among Regions. Smaller decreases were observed in the following part of 2020. CONCLUSIONS In Italy, lockdown and limitation of mobility due to COVID-19 determined a strong decrease in the number of road traffic accidents and their health consequences. Inter-regional variability in the decrease of deaths might be associated with the severity of the SARS-CoV-2 local outbreak, although specific causes need to be investigated. These data are useful to inform traffic and public health policy makers.
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Affiliation(s)
- Francesca Valent
- Servizio di Epidemiologia Clinica e Valutativa, Azienda Provinciale per i Servizi Sanitari di Trento, Trento, Italy
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Vetrugno L, Meroi F, Orso D, D’Andrea N, Marin M, Cammarota G, Mattuzzi L, Delrio S, Furlan D, Foschiani J, Valent F, Bove T. Can Lung Ultrasound Be the Ideal Monitoring Tool to Predict the Clinical Outcome of Mechanically Ventilated COVID-19 Patients? An Observational Study. Healthcare (Basel) 2022; 10:healthcare10030568. [PMID: 35327046 PMCID: PMC8955357 DOI: 10.3390/healthcare10030568] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 01/27/2023] Open
Abstract
Background: During the COVID-19 pandemic, lung ultrasound (LUS) has been widely used since it can be performed at the patient’s bedside, does not produce ionizing radiation, and is sufficiently accurate. The LUS score allows for quantifying lung involvement; however, its clinical prognostic role is still controversial. Methods: A retrospective observational study on 103 COVID-19 patients with respiratory failure that were assessed with an LUS score at intensive care unit (ICU) admission and discharge in a tertiary university COVID-19 referral center. Results: The deceased patients had a higher LUS score at admission than the survivors (25.7 vs. 23.5; p-value = 0.02; cut-off value of 25; Odds Ratio (OR) 1.1; Interquartile Range (IQR) 1.0−1.2). The predictive regression model shows that the value of LUSt0 (OR 1.1; IQR 1.0–1.3), age (OR 1.1; IQR 1.0−1.2), sex (OR 0.7; IQR 0.2−3.6), and days in spontaneous breathing (OR 0.2; IQR 0.1–0.5) predict the risk of death for COVID-19 patients (Area under the Curve (AUC) 0.92). Furthermore, the surviving patients showed a significantly lower difference between LUS scores at admission and discharge (mean difference of 1.75, p-value = 0.03). Conclusion: Upon entry into the ICU, the LUS score may play a prognostic role in COVID-19 patients with ARDS. Furthermore, employing the LUS score as a monitoring tool allows for evaluating the patients with a higher probability of survival.
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Affiliation(s)
- Luigi Vetrugno
- Dipartimento di Scienze, Orali e Biotecnologiche, Università degli Studi “G. d’Annunzio”, 66100 Chieti, Italy;
| | - Francesco Meroi
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
- Correspondence:
| | - Daniele Orso
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Natascia D’Andrea
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Matteo Marin
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Gianmaria Cammarota
- Division of Anesthesia, Analgesia and Intensive Care, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | - Lisa Mattuzzi
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Silvia Delrio
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Davide Furlan
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Jonathan Foschiani
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Francesca Valent
- Clinical and Evaluational Epidemiologic Service, Department of Governance, Local Health Authority, 38123 Trento, Italy;
| | - Tiziana Bove
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
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12
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Vetrugno L, Sala A, Orso D, Meroi F, Fabbro S, Boero E, Valent F, Cammarota G, Restaino S, Vizzielli G, Girometti R, Merelli M, Tascini C, Bove T, Driul L. Lung Ultrasound Signs and Their Correlation With Clinical Symptoms in COVID-19 Pregnant Women: The "PINK-CO" Observational Study. Front Med (Lausanne) 2022; 8:768261. [PMID: 35127744 PMCID: PMC8814327 DOI: 10.3389/fmed.2021.768261] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/10/2021] [Indexed: 12/21/2022] Open
Abstract
Objective To analyze the application of lung ultrasound (LUS) diagnostic approach in obstetric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and compare LUS score and symptoms of the patients. Design A single-center observational retrospective study from October 31, 2020 to March 31, 2021. Setting Department of Ob/Gyn at the University-Hospital of Udine, Italy. Participants Pregnant women with SARS-CoV-2 diagnosed with reverse transcription-PCR (RT-PCR) swab test were subdivided as symptomatic and asymptomatic patients with COVID-19. Exposure Lung ultrasound evaluation both through initial evaluation upon admission and through serial evaluations. Main Outcome Reporting LUS findings and LUS score characteristics. Results Symptomatic patients with COVID-19 showed a higher LUS (median 3.5 vs. 0, p < 0.001). LUS was significantly correlated with COVID-19 biomarkers as C-reactive protein (CPR; p = 0.011), interleukin-6 (p = 0.013), and pro-adrenomedullin (p = 0.02), and inversely related to arterial oxygen saturation (p = 0.004). The most frequent ultrasound findings were focal B lines (14 vs. 2) and the light beam (9 vs. 0). Conclusion Lung ultrasound can help to manage pregnant women with SARS-CoV-2 infection during a pandemic surge. Study Registration ClinicalTrials.gov, NCT04823234. Registered on March 29, 2021.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Alessia Sala
- Department of Medicine, University of Udine, Udine, Italy.,Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Francesco Meroi
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | | | - Enrico Boero
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Francesca Valent
- Department of Epidemiology and Public Health, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care Medicine, University of Perugia, Perugia, Italy
| | - Stefano Restaino
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Giuseppe Vizzielli
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Rossano Girometti
- Department of Medicine, University of Udine, Udine, Italy.,Department of Radiology, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Maria Merelli
- Department of Infectious Diseases, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy.,Department of Infectious Diseases, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Lorenza Driul
- Department of Medicine, University of Udine, Udine, Italy.,Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
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Garbo R, Valent F, Gigli GL, Valente M. Pre-Existing Lymphopenia Increases the Risk of Hospitalization and Death after SARS-CoV-2 Infection. Infect Dis Rep 2022; 14:20-25. [PMID: 35076526 PMCID: PMC8788278 DOI: 10.3390/idr14010003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/18/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 02/05/2023] Open
Abstract
There is limited information regarding the severity of COVID-19 in immunocompromized patients. We conducted a retrospective cohort study considering the period from 1 March 2020 to 31 December 2020 to determine whether previously existing lymphopenia increases the risk of hospitalization and death after SARS-CoV-2 infection in the general population. The laboratory and hospital discharge databases of the Azienda Sanitaria Universitaria Friuli Centrale were used, and 5415 subjects infected with SARS-CoV-2 and with at least one recent absolute lymphocyte count determination before SARS-CoV-2 positivity were included. In total, 817 (15.1%) patients had severe COVID-19. Patients developing severe COVID-19 were more frequently males (44.9% of the severe COVID-19 group vs. 41.5% in the non-severe COVID-19 group; p < 0.0001) and were older (73.2 ± 13.8 vs. 58.4 ± 20.3 years; p < 0.0001). Furthermore, 29.9% of the lymphopenic patients developed severe COVID-19 vs. 14.5% of the non-lymphopenic patients (p < 0.0001). In a logistic regression model, female sex remained a protective factor (OR = 0.514, 95%CI 0.438–0.602, p < 0.0001), while age and lymphopenia remained risk factors for severe COVID-19 (OR = 1.047, 95%CI 1.042–1.053, p < 0.0001 for each additional year of age; OR = 1.715, 95%CI 1.239–2.347, p = 0.0011 for lymphopenia). This provides further information to stratify the risk of COVID-19 severity, which may be an important element in the management of immunosuppressive therapies.
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Affiliation(s)
- Riccardo Garbo
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (G.L.G.); (M.V.)
- Correspondence:
| | - Francesca Valent
- Clinical and Evaluational Epidemiology Service, Department of Governance, Local Health Authority, 38123 Trento, Italy;
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (G.L.G.); (M.V.)
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (G.L.G.); (M.V.)
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy
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14
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García Rodríguez LA, Cea Soriano L, de Abajo FJ, Valent F, Hallas J, Gil M, Cattaruzzi C, Rodriguez-Martin S, Vora P, Soriano-Gabarró M, Gaist D. Trends in the use of oral anticoagulants, antiplatelets and statins in four European countries: a population-based study. Eur J Clin Pharmacol 2021; 78:497-504. [PMID: 34791521 PMCID: PMC8818635 DOI: 10.1007/s00228-021-03250-6] [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] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Abstract
Purpose To evaluate time trends in the prevalence of antithrombotic and statin use in four European countries. Methods Using population-based data from the United Kingdom, Denmark, Spain and Italy between 2010 and 2018, we calculated standardized annual prevalence proportions of antithrombotics and statin use, and changes in prevalence proportions (2018 vs. 2010). Results Prevalence proportion of statins increased from 24.8% to 24.6% (UK), 21.0% to 22.3% (Region of Southern Denmark [RSD]), 12.9% to 14.3% (Udine, Italy), and 20.3% to 23.2% (Spain). Prevalence proportions of antithrombotics declined in all four countries: 18.7% to 15.9% (UK; − 2.8% points), 18.9% to 18.1% (RSD; − 0.8% points), 17.7% to 16.6% (Udine; − 1.1% points) and 15.0% to 13.6% (Spain; − 1.4% points). These declines were driven by reductions in low-dose aspirin use: 15.3% to 8.9% (UK; − 6.4% points), 16.3% to 9.5% (RSD; − 6.8% points), 13.5% to 11.6% (Udine; − 1.9% points), and 10.2% to 8.8% (Spain; − 1.4% points). In the UK, low-dose aspirin use declined from 9.1% to 4.3% (− 4.8% points) for primary CVD prevention, and from 49.6% to 36.9% (− 12.7% points) for secondary prevention. Oral anticoagulant use gradually increased but did not fully account for the decrease in low-dose aspirin use. Conclusions Antithrombotic use in the UK, RSD, Udine and Spain declined between 2010 and 2018, driven by a reduction in use of low-dose aspirin that is not completely explained by a gradual increase in OAC use. Use of statins remained constant in the UK, and increased gradually in the RSD, Udine and Spain. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-021-03250-6.
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Affiliation(s)
| | - Lucía Cea Soriano
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid), Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, Department of Biomedical Sciences (Pharmacology Section), University Hospital Príncipe de Asturias, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain
| | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology, Udine Integrated University Health Unit, Udine, Italy
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Miguel Gil
- División de Farmacoepidemiología Y Farmacovigilancia, Agencia Española de Medicamentos Y Productos Sanitarios, Madrid, Spain
| | - Chiara Cattaruzzi
- Pharmaceutical Service, Udine Integrated University Health Unit, Udine, Italy
| | - Sara Rodriguez-Martin
- Clinical Pharmacology Unit, Department of Biomedical Sciences (Pharmacology Section), University Hospital Príncipe de Asturias, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain
| | | | | | - David Gaist
- Research Unit for Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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15
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Carrara A, Pertile R, Amabile D, Reich F, Nava FL, Moscatelli P, Pellecchia L, Motter M, Ferro A, Valent F, Benetollo PP, Tirone G. Impact of COVID-19 pandemic waves on changes in surgical urgency volumes and severity in the regional hospital network of Trento (Northern Italy): a descriptive epidemiological analysis. Epidemiol Prev 2021; 45:470-476. [PMID: 35001595 DOI: 10.19191/ep21.6.131] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES to analyse both direct and indirect impacts on surgical admissions, surgical rates, and clinical picture severity of the two COVID-19 pandemic waves in a hospital network covering an entire province (Trento, located in Trentino-Alto Adige Region, Northern Italy). DESIGN retrospective epidemiological study. SETTING AND PARTICIPANTS data regarding the patient load of the Surgical Urgencies/Emergencies flows (SUEs) of the Local Health Authority of the Autonomous Province of Trento derived from the Hospital Discharge Record (HDR) information flow. The population in study was that of patients hospitalized in the entire Province of Trento. This study compares the volume and characteristics of urgent/emergency surgery during the 2020 COVID-19 pandemic with the homologous period in 2019, subdividing the analysed pandemic period in 3 separated groups: • phase I (March-May 2020); • phase II (June-August 2020); • phase III (October-December 2020). The 3 groups represent, respectively: the 1st pandemic wave proclamation of national lockdown from 9 March to 18 May; the summer pandemic remission; the 2nd pandemic wave with partial restrictions on circulation and commercial activities. Clinical and surgical records of SUE population among these 3 periods (March-May; June-August; October-December) of both 2020 and 2019 were analyzed and compared. MAIN OUTCOME MEASURES the overall number of admissions and surgical rates for SUEs in the study periods were chosen as primary outcomes. The same outcomes were analysed for the most represented diagnoses in the SUEs population: diverticulitis, intestinal obstruction, appendicitis, cholecystitis, gastrointestinal (GI) perforations, pancreatitis, traumas. To assess the degree of clinical picture severity, variables coming from the hospital discharging charts, commonly associated to worst outcomes in term of mortality and morbidity, such as age, length of hospital stay, DRG weight, and patients not discharged at home were extrapolated from the electronic database. A numerical weight was then assigned to each variable, obtaining a scoring system from 0 to 15 (severity index). RESULTS the number of admissions for SUEs in the studied period showed a sinusoidal trend, with a dramatic decrease in phase I and III (-46.6% and -31.6%, respectively). This trend was also observed even by stratifying admissions for the most frequent pathologies, except for gastrointestinal perforations and pancreatitis. The surgical rate among hospitalised patients for SUEs was 35.2% in phase, significantly higher than that of 2019 (25.6%). Considering the most frequent diagnoses individually, some had a progressive increase in the surgical rate in phases I and II (diverticulitis, bowel obstructions, cholecystitis), others showed an initial decrease and then settled on values not far from those of 2019 (GI perforations and appendicitis), others again had an initial significant increase and then gradually returned to values similar to those of 2019 in phase III (traumas). The mean patients age was significantly higher in phase I than in 2019 (p-value <0.001) and in phase II (p-value <0.05). Consistently with the trend of the number of urgent admissions, even the severity index calculated on the SUEs population showed a sinusoidal trend with and evident increase during the two pandemic waves. CONCLUSIONS the effect of the COVID-19 pandemic on SUEs was mainly indirect, manifesting itself with a significant reduction in surgical admissions, particularly in phases I and III. Conversely, in the same phases, the surgical rate showed a significant increase compared to 2019. The stratified analysis confirmed these findings for the most frequent diagnoses except for GI perforations and pancreatitis. The clinical pictures were more severe in the two pandemic waves than in the reference period of 2019. Although with a slight numerical attenuation, in general, the second pandemic wave confirmed the first one findings.
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Affiliation(s)
- Alessandro Carrara
- UO of General Surgery, Rovereto and Arco, Health Service of Trento, Trento (Italy)
| | - Riccardo Pertile
- Department of Clinical and Evaluative Epidemiology, Health Service of Trento, Trento (Italy);
| | - Dalia Amabile
- 1st UO of General Surgery, St. Chiara Hospital, Trento, (Italy)
| | - Federico Reich
- 1st UO of General Surgery, St. Chiara Hospital, Trento, (Italy)
| | | | | | | | - Michele Motter
- 1st UO of General Surgery, St. Chiara Hospital, Trento, (Italy)
| | - Antonio Ferro
- General Direction of the Health Service of Trento, Trento (Italy)
| | - Francesca Valent
- Department of Clinical and Evaluative Epidemiology, Health Service of Trento, Trento (Italy)
| | | | - Giuseppe Tirone
- 1st UO of General Surgery, St. Chiara Hospital, Trento, (Italy)
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16
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Valent F, Gentilini MA, Fateh-Moghadam P. COVID-19 hospitalizations in children in the Autonomous Province of Trento (Northern Italy), year 2020. Epidemiol Prev 2021; 45:528-532. [PMID: 35001597 DOI: 10.19191/ep21.6.112] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND hospitalization rate of patients with SARS-CoV-2 infection can be considered as an indicator of severe COVID-19 burden. In children, however, hospital admissions may overestimate such burden. OBJECTIVES to describe the hospitalizations with COVID-19-related discharge diagnoses in the population <18 years of age in the 545,000 inhabitants of the Autonomous Province of Trento (Trentino-Alto Adige Region, North-Eastern Italy) in year 2020. DESIGN hospitalization characteristics and main and secondary discharge diagnosis codes were abstracted from anonymous hospital discharge records in all cases with at least one COVID-19-specific ICD-9-CM code. SETTING AND PARTICIPANTS: hospitalized patients 0-17 and >=18 years of age. MAIN OUTCOME MEASURES: in-hospital deaths, median length of stay and cost, frequency of main discharge diagnoses. RESULTS from March to December 2020, 61 admissions with COVID-19-specific codes regarded patients 0-17 years and 3,811 patients >=18 years. No in-hospital deaths were observed in the younger group. Median hospital stay was not significantly different in the two groups, but cost was higher among patients >=18 years. In adult patients, more than 70% had a pneumonia or other lung or respiratory disease main discharge diagnosis; in children, they were only 6.5%. Almost half of the children admitted with SARS-CoV-2 infection had a main discharge diagnosis of either trauma or encounter with the health system for procedures and aftercare (ICD-9-CM V-codes). CONCLUSIONS in the Province of Trento, a considerable proportion of hospitalizations of young patients with SARS-CoV-2 infection may be due to other underlying conditions requiring hospital care, supporting the hypothesis that hospitalization rate might overestimate the burden of serious COVID-19 in children.
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Affiliation(s)
- Francesca Valent
- Servizio di epidemiologia clinica e valutativa, Azienda provinciale per i servizi sanitari, Trento (Italy);
| | - Maria Adalgisa Gentilini
- Unità di Missione semplice statistica, Azienda provinciale per i servizi sanitari, Trento (Italy)
| | - Pirous Fateh-Moghadam
- Servizio osservatorio epidemiologico, Dipartimento di prevenzione, Azienda provinciale per i servizi sanitari, Trento (Italy)
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Agabiti N, Grilli R, Valent F, Ciccone G, Marchesini Reggiani G, Marenzi G, Di Carlo C, Bramanti P, Davoli M. Audit and feedback strategies: study protocol and preliminary results from the EASY-NET project. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Abstract
Background
In Italy there is evidence of a large variability in health care services and health outcomes. This multi-regional project is funded on Ministry of Health and Health Regional Authorities (code NET-2016-02364191). The aims are: 1) To test the effectiveness of Audit and Feedback (A&F) interventions in improving health professional practices and patients' outcomes in different settings using both a quantitative and a qualitative approach. 2) To examine factors that may explain variations in the effectiveness of A&F. 3) To evaluate the impact of A&F in reducing avoidable differences in access to effective health care interventions in socioeconomically disadvantaged populations.
Methods
In the 7 participating Regions (about 33 million inhabitants) experimental study designs have been implemented in different clinical areas (e.g. before-after controlled study, cluster randomized trial): in Lazio emergency care and chronic diseases care, in Friuli Venezia Giulia emergency care, in Piemonte oncology care, in Emilia Romagna chronic disease care, in Lombardia cardiovascular care, in Calabria deliveries and maternal health, in Sicilia emergency care. The effectiveness of different types of A&F are compared in term of outcomes using health information system databases.
Results
Preliminary results show large heterogeneity in developing and conducting A&F, in term of team project composition, type of intervention, clinicians' behavior to be changed, outcomes indicators, professionals involved, structure and timing of data reporting, actions to be implemented after the intervention. Limited awareness and interest of clinicians in A&F interventions was found.
Conclusions
The project represents a unique opportunity to explore how A&F interventions could be better designed. Different A&F strategies will be compared in term of clinical outcomes. The identification of barriers/facilitating factors will supply knowledge on mechanisms and tools to enhance A&F effectiveness.
Key messages
The project supports providers in reducing gap between knowledge and practice. The project promotes culture of interprofessional collaboration as a key point for high quality care.
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Affiliation(s)
- N Agabiti
- Epidemiology Unit, Regional Health Service Lazio ASL Roma 1, Rome, Italy
| | - R Grilli
- Clinical Governance, Local Health Authority of Reggio Emilia, Reggio Emilia, Italy
| | - F Valent
- Unit of Hygiene and Clinical Epidemiology, Health Authority Friuli Centrale, University Hospital, Udine, Italy
| | - G Ciccone
- CPO Piemonte Clinical Epidemiology and Evaluation Unit, Health Authority University Hospital Città della Salute e della Scienza, Turin, Italy
| | - G Marchesini Reggiani
- Unit of Metabolic Diseases and Clinical Dietetics, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - G Marenzi
- Intensive Cardiology Therapy Unit, Cardiology Center Monzino, Milan, Italy
| | - C Di Carlo
- Department of Integration and Protection of Motherhood and Childhood, Pugliese Ciaccio Hospital, University Magna Graecia, Catanzaro, Italy
| | - P Bramanti
- Centro Neurolesi Bonino Pulejo, Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - M Davoli
- Epidemiology Unit, Regional Health Service Lazio ASL Roma 1, Rome, Italy
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Mellace F, Scarpis E, Brunelli L, Tullio A, Cautero P, Londero C, Farneti F, Valent F, Cocconi R. Relationship between clinical record completeness and occurrence of adverse events within hospitals. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Abstract
Introduction
Clinical record (CR) is an appropriate source for adverse events (AEs) detection and Italian law requires its compilation. Its completeness is used as an indicator of the quality of care provided and offers guidance on system changes to improve professional practice. This study aimed at assessing the completeness of CRs, describing AEs' rate and triggers, and investigating the relationship between CR completeness and the occurrence of AEs.
Methods
A retrospective review of CRs was conducted, randomly selecting patients discharged from Internal Medicine (IM), General Surgery (GS) and Obstetrics (O) between June and September 2020 at the Academic Hospital of Udine (Italy). The completeness of CRs was assessed using a 65-items checklist developed by the hospital Quality Unit. Triggers and rate of AEs were detected by using Global Trigger Tool. Relationship between AEs and completeness of CR was analyzed using nonparametric tests.
Results
Among 93 reviewed CRs, 91.4% were from the GS, 5.4% from IM and 3.2% from O. Patient mean age was 64.6±18, women were 51.6%. The average completeness of CRs was 50.4% [30.4%-83.5%]. Identified triggers and AEs were 125 and 29 respectively, with at least one AE every 23.7% admissions, 31.2 AEs per 100 admissions and 40 AEs per 1000 patient-days. The most frequent AEs were surgical damage (51.7%; 15) and hospital-acquired infection (24.1%; 7). Hospitalization length for patients with at least one AE was 12.6 days, whereas it was 6.3 days without AEs. A significant positive correlation (R = 0.36; p < 0.001) was found between length of hospitalization and number of AEs. The increase in CR completeness is associated with the decrease of the total number of AEs (R=-0.18; p = 0.083).
Conclusions
These findings suggest a direct association between the number of AEs and the length of hospital stay. The correlation between CR completeness and AEs suggest that patient safety could benefit from the improvement of clinical record compilation.
Key messages
More studies are needed to understand if the occurrence of AEs to patients may cause a prolonged length of hospitalization. A better compilation of CRs should allow to reach a more effective communication between healthcare workers, creating a work environment less prone to errors and AEs.
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Affiliation(s)
- F Mellace
- Department of Medicine, University of Udine, Udine, Italy
| | - E Scarpis
- Department of Medicine, University of Udine, Udine, Italy
| | - L Brunelli
- Department of Medicine, University of Udine, Udine, Italy
- Quality and Risk Management, Friuli Centrale Healthcare and University Trust, Udine, Italy
| | - A Tullio
- Department of Medicine, University of Udine, Udine, Italy
| | - P Cautero
- Department of Medicine, University of Udine, Udine, Italy
| | - C Londero
- Quality and Risk Management, Friuli Centrale Healthcare and University Trust, Udine, Italy
| | - F Farneti
- Quality and Risk Management, Friuli Centrale Healthcare and University Trust, Udine, Italy
| | - F Valent
- Institute of Epidemiology, Friuli Centrale Healthcare and University Trust, Udine, Italy
| | - R Cocconi
- Quality and Risk Management, Friuli Centrale Healthcare and University Trust, Udine, Italy
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19
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Brunelli L, Romanese F, Tricarico P, Murati A, Benetollo PP, Iob A, Forgiarini M, Valent F, Brusaferro S. Parental thoughts after the Codroipo case: the other side of the story. Ann Ig 2021; 34:279-285. [PMID: 34623370 DOI: 10.7416/ai.2021.2481] [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: 11/03/2022]
Abstract
Background To address vaccine hesitancy and to build public trust, many factors need to be considered in the process of planning consistent public health interventions. After uncertain vaccinations of the Codroipo case, hesitant parents were surveyed about own beliefs and trusted sources of information. Methods A semi-structured phone survey was conducted between December 2017 and February 2018, collecting also age and educational level of respondents. Results The most trusted sources of information of the 258 surveyed parents were pediatricians (27.2%), general practitioners (25.4%) and institutional channels (12.1%). Highly educated parents trusted self-study of the scientific literature and expressed doubts about vaccine effectiveness more than others (p=0.0018). Conclusion Despite the underlying improper vaccination issue undermined public trust, healthcare professionals and institutional channels maintained their role as trusted sources of information. Educational patterns emerged among doubtful parents should be considered by public health policies to effectively tackle vaccine hesitancy.
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Affiliation(s)
- L Brunelli
- Department of Medicine, University of Udine, Udine, Italy.,Present address: Accreditation and Quality Unit, Friuli Centrale Healthcare University Trust, Via Colugna 50, Udine, Italy
| | - F Romanese
- Department of Medicine, University of Udine, Udine, Italy.,Present address: Health Prevention Department, Giulano Isontina Healthcare University Trust, Via Paolo De' Ralli, 3, Trieste, Italy
| | - P Tricarico
- Department of Medicine, University of Udine, Udine, Italy.,Present address: Medical Directorate, ULSS7 Pedemontana, Via dei Lotti 40, Bassano del Grappa, Vicenza, Italy
| | - A Murati
- Department of Medicine, University of Udine, Udine, Italy
| | - P P Benetollo
- Local Health Trust no.3 (AAS3, Azienda per l'Assistenza Sanitaria n.3) of Friuli Venezia Giulia, Gemona, Italy.,Present address: Healthcare Trust of the Autonomous Province of Trento, Via Alcide Degasperi 79, Trento, Italy
| | - A Iob
- Local Health Trust no.3 (AAS3, Azienda per l'Assistenza Sanitaria n.3) of Friuli Venezia Giulia, Gemona, Italy.,Present address: Health Prevention Department, Friuli Centrale Healthcare University Trust, Piazzetta Portuzza 2, Gemona, Italy
| | - M Forgiarini
- Local Health Trust no.3 (AAS3, Azienda per l'Assistenza Sanitaria n.3) of Friuli Venezia Giulia, Gemona, Italy.,Present address: Health Prevention Department, Friuli Centrale Healthcare University Trust, Piazzetta Portuzza 2, Gemona, Italy
| | - F Valent
- Institute of Hygiene and Clinical Epidemiology, Udine Healthcare and University Integrated Trust, Udine, Italy.,Present address: Healthcare Trust of the Autonomous Province of Trento, Via Alcide Degasperi 79, Trento, Italy
| | - S Brusaferro
- Department of Medicine, University of Udine, Udine, Italy
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20
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Quartuccio L, Valent F, Pasut E, Tascini C, De Vita S. [Not Available]. Rev Rhum Ed Fr 2021; 88:377-381. [PMID: 34007141 PMCID: PMC8120792 DOI: 10.1016/j.rhum.2021.05.004] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIF Cette étude a pour objectif de déterminer la prévalence du coronavirus 2 du syndrome respiratoire aigu sévère (SARS-CoV-2) 2019 (COVID-19) chez des patients adultes traités par biothérapies ou inhibiteurs des JAK pour des rhumatismes inflammatoires chroniques, en particulier des arthrites inflammatoires chroniques. MÉTHODES Pour cela, une étude basée sur la population, dans la province d'Udine (466 700 habitants d'âge > 15 ans, région du Frioul-Vénétie-Julienne, Italie) a été planifiée. Le critère principal de jugement était la prévalence du COVID-19 durant les deux premiers mois de l'épidémie. Tous les patients de notre province atteints de maladies rhumatismales et traités par biothérapies ou inhibiteurs des JAK au cours des 6 mois précédents ont été inclus (n = 1051). RÉSULTATS Du 29 février au 25 avril 2020, 4 patients adultes (4/1051, 3,8/1000, IC 95 % 1,5-9,7/1000) ont été testés positifs au COVID-19 par RT-PCR et écouvillon. Au total, 47/1051 patients (4,5 %) ont été soumis au test COVID-19 par RT-PCR durant la même période, en raison de symptômes compatibles avec le COVID-19 pour 15 d'entre eux. Dans la population générale, la prévalence était de 937 cas/466700 (2/1000, IC 95 % 1,9-2,1/1000, valeur p = 0,33, test du Chi2), et 20 179/466 700 (4,3 %) prélèvements COVID-19 sur écouvillon ont été effectués. CONCLUSION Le risque de COVID-19 chez les patients atteints de maladies rhumatismales et traités par biothérapies ou inhibiteurs des JAK n'apparaît pas différent de celui observé dans la population générale. Les patients doivent être encouragés à poursuivre en toute sécurité leur traitement et à respecter les mesures de prévention et de protection contre le COVID-19.
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Affiliation(s)
- Luca Quartuccio
- Clinique de Rhumatologie, Service de Médecine (DAME), ASUFC, Université d'Udine, Udine, Italie
| | | | | | - Carlo Tascini
- Unité des Maladies Infectieuses, ASUFC, Udine, Italie
| | - Salvatore De Vita
- Clinique de Rhumatologie, Service de Médecine (DAME), ASUFC, Université d'Udine, Udine, Italie
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21
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Thompson HA, Mousa A, Dighe A, Fu H, Arnedo-Pena A, Barrett P, Bellido-Blasco J, Bi Q, Caputi A, Chaw L, De Maria L, Hoffmann M, Mahapure K, Ng K, Raghuram J, Singh G, Soman B, Soriano V, Valent F, Vimercati L, Wee LE, Wong J, Ghani AC, Ferguson NM. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Setting-specific Transmission Rates: A Systematic Review and Meta-analysis. Clin Infect Dis 2021; 73:e754-e764. [PMID: 33560412 PMCID: PMC7929012 DOI: 10.1093/cid/ciab100] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [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] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Understanding the drivers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is crucial for control policies, but evidence of transmission rates in different settings remains limited. METHODS We conducted a systematic review to estimate secondary attack rates (SARs) and observed reproduction numbers (Robs) in different settings exploring differences by age, symptom status, and duration of exposure. To account for additional study heterogeneity, we employed a beta-binomial model to pool SARs across studies and a negative-binomial model to estimate Robs. RESULTS Households showed the highest transmission rates, with a pooled SAR of 21.1% (95% confidence interval [CI]:17.4-24.8). SARs were significantly higher where the duration of household exposure exceeded 5 days compared with exposure of ≤5 days. SARs related to contacts at social events with family and friends were higher than those for low-risk casual contacts (5.9% vs 1.2%). Estimates of SARs and Robs for asymptomatic index cases were approximately one-seventh, and for presymptomatic two-thirds of those for symptomatic index cases. We found some evidence for reduced transmission potential both from and to individuals younger than 20 years of age in the household context, which is more limited when examining all settings. CONCLUSIONS Our results suggest that exposure in settings with familiar contacts increases SARS-CoV-2 transmission potential. Additionally, the differences observed in transmissibility by index case symptom status and duration of exposure have important implications for control strategies, such as contact tracing, testing, and rapid isolation of cases. There were limited data to explore transmission patterns in workplaces, schools, and care homes, highlighting the need for further research in such settings.
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Affiliation(s)
- Hayley A Thompson
- MRC Centre for Global Infectious Disease Analysis & World Health Organization Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Andria Mousa
- MRC Centre for Global Infectious Disease Analysis & World Health Organization Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Amy Dighe
- MRC Centre for Global Infectious Disease Analysis & World Health Organization Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Han Fu
- MRC Centre for Global Infectious Disease Analysis & World Health Organization Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Alberto Arnedo-Pena
- Sección de Epidemiología, Centro de Salud Pública de Castellón, Valencia, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Valencia, Spain
| | - Peter Barrett
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
| | - Juan Bellido-Blasco
- Sección de Epidemiología, Centro de Salud Pública de Castellón, Valencia, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Valencia, Spain
- Facultad de Ciencias de la Salud, Universitat Jaime I (UJI), Castelló, Spain
| | - Qifang Bi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Antonio Caputi
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy
| | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Brunei
| | - Luigi De Maria
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy
| | - Matthias Hoffmann
- Division of General Internal Medicine, Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Olten, Olten, Switzerland
| | - Kiran Mahapure
- Department of Plastic Surgery, Dr Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India
| | | | | | - Gurpreet Singh
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Biju Soman
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - Francesca Valent
- SOC Istituto di Igiene ed Epidemiologia Clinica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Luigi Vimercati
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy
| | - Liang En Wee
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Justin Wong
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Brunei
- Disease Control Division, Ministry of Health, Brunei
| | - Azra C Ghani
- MRC Centre for Global Infectious Disease Analysis & World Health Organization Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Neil M Ferguson
- MRC Centre for Global Infectious Disease Analysis & World Health Organization Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
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22
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Cattani G, Madia A, Arnoldo L, Brunelli L, Celotto D, Grillone L, Valent F, Castriotta L, Pea F, Bassetti M, Brusaferro S. Assessment of the impact of clinical recommendations on antibiotic use for CAP and HCAP: results from an implementation program in an Academic Hospital. Ann Ig 2021; 32:344-356. [PMID: 32744293 DOI: 10.7416/ai.2020.2358] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Local guidelines and recommendations to treat common infectious diseases are a cornerstone of most Antimicrobial Stewardship programs. The evaluation of the adherence to guidelines is an effective quality measure of the programs themselves; the proposed evaluation model aimed at examining antibiotic treatment for pneumonia. STUDY DESIGN A retrospective pre-post intervention study was conducted in a North-Eastern Italian Academic Hospital. METHODS 231 patients with Community-Acquired Pneumonia and 95 with Healthcare-Associated Pneumonia were divided into pre- and post-intervention groups (188 and 138, respectively). A course and a pocket summary of Pneumonia Regional Recommendations were the stewardship activities adopted. The compliance degree of prescriptions with Regional Recommendations was tested for drug(s), dosage and duration of treatment in both groups for Community-Acquired and Healthcare-Associated Pneumonia and a comparison with International guidelines was performed. RESULTS A significant improvement in the compliance with Regional Recommendations for the variable drug emerged for Community-Acquired (38.8% vs 52.2%), but not for Healthcare-Associated Pneumonia; no significant variation in compliance was registered for dosage and duration of treatment. The significant decrease in consumption of levofloxacin showed the positive impact of the Regional Antimicrobial Stewardship programs. A high level of adherence to International Guidelines for the variable drug for Community-Acquired Pneumonia was found in both groups (75.5% and 77.2%, respectively). CONCLUSIONS Our study highlighted that room for improvement in antibiotic prescription in Community-Acquired and Healthcare-Associated Pneumonia currently remains. New strategies for a better use of the adopted tools and definition of new antimicrobial stewardship initiatives are needed to improve compliance to Regional Recommendations.
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Affiliation(s)
- G Cattani
- Udine Healthcare and University Integrated Trust, Udine, Italy - Department of Medicine, University of Udine, Italy - Present affiliation: Codroipo District, Local Health Trust no. 3, Gemona, Italy
| | - A Madia
- Department of Medicine, University of Udine, Italy
| | - L Arnoldo
- Udine Healthcare and University Integrated Trust, Udine, Italy - Department of Medicine, University of Udine, Italy
| | - L Brunelli
- Udine Healthcare and University Integrated Trust, Udine, Italy - Department of Medicine, University of Udine, Italy
| | - D Celotto
- Department of Medicine, University of Udine, Italy
| | - L Grillone
- Udine Healthcare and University Integrated Trust, Udine, Italy - Department of Medicine, University of Udine, Italy
| | - F Valent
- Udine Healthcare and University Integrated Trust, Udine, Italy
| | - L Castriotta
- Udine Healthcare and University Integrated Trust, Udine, Italy
| | - F Pea
- Udine Healthcare and University Integrated Trust, Udine, Italy - Department of Medicine, University of Udine, Italy
| | - M Bassetti
- Udine Healthcare and University Integrated Trust, Udine, Italy - Department of Medicine, University of Udine, Italy
| | - S Brusaferro
- Udine Healthcare and University Integrated Trust, Udine, Italy - Department of Medicine, University of Udine, Italy
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23
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Quartuccio L, Zabotti A, Gallo T, De Vita S, Valent F. Influenza vaccination in chronic inflammatory arthritis undergoing immunosuppressive treatments: temporal trend and factors of adherence. Rheumatology (Oxford) 2021; 60:2456-2460. [PMID: 33083815 DOI: 10.1093/rheumatology/keaa454] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To verify the level of adherence to the influenza vaccination program in a population of patients suffering from RA, PsA or AS undergoing immunosuppressive treatment. METHODS Administrative databases from the Regional Health Information System of Friuli Venezia Giulia (FVG), Italy, were used. Subjects were residents in FVG, suffered from chronic inflammatory arthritis and had at least one prescription for a DMARD in the 9 months before the start of the vaccination season (from 1 October to 31 December). The observation ranged from 2006 to 2018. Logistic regression was used to assess the association between vaccination and the patient's characteristics in the 2018-2019 influenza season. RESULTS Overall, vaccination adherence decreased from the highest value of 35.7% (662/1853) in 2006 to the lowest value of 25.3% (926/3663) in 2014; in people ≥65 years of age it also decreased over time from 61.6% (577/936) in 2008 to 43.9% (701/1595) in the 2014. By logistic analysis on the 2018-2019 season, which included 4460 patients, older subjects were more likely to be vaccinated [people 65-74 years, odds ratio (OR) 4.58 (95% CI 3.72, 5.64); people 75-84 years, OR 6.47 (95% CI 5.04, 8.32); both vs <65] as were those with diabetes [OR 1.66 (95% CI 1.05, 2.64)]. Treatment with a biologic agent alone [OR 0.64 (95% CI 0.52, 0.80)] and RA diagnosis [OR 0.69 (95% CI 0.51, 0.93)] were associated with lower adherence. CONCLUSION Influenza vaccination adherence is alarmingly low in a population at higher risk of infectious complications, in particular in elderly patients.
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Affiliation(s)
- Luca Quartuccio
- Clinic of Rheumatology, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, University of Udine
| | - Alen Zabotti
- Clinic of Rheumatology, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, University of Udine
| | - Tolinda Gallo
- Department of Prevention, Azienda sanitaria universitaria Friuli Centrale
| | - Salvatore De Vita
- Clinic of Rheumatology, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, University of Udine
| | - Francesca Valent
- Institute of Epidemiology, Academic Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
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24
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Quartuccio L, Treppo E, Valent F, De Vita S. Healthcare and economic burden of ANCA-associated vasculitis in Italy: an integrated analysis from clinical and administrative databases. Intern Emerg Med 2021; 16:581-589. [PMID: 32666174 PMCID: PMC8049888 DOI: 10.1007/s11739-020-02431-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/13/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022]
Abstract
ANCA-associated vasculitides (AAV) comprise a group of systemic vasculitides characterized by inflammation of small-sized blood vessels leading to multi-organ involvement. The worldwide annual incidence of AAV ranges from 1.2 to 3.3 cases per 100 000 individuals with a prevalence of 4.6-42.1 cases per 100 000 individuals. The prevalence of AAV is geographically heterogeneous; therefore, regional epidemiological studies can be more informative to improve health care systems. Even though clinicians are aware that the healthcare burden and the risk of hospitalization of AAV appear high, data on hospitalization and cost of illness due to AAV are still scarce or even lacking. This study aims to characterize the economic burden of AAV in Friuli Venezia Giulia (FVG), Italy. Thus, a retrospective study was conducted through the integration of many administrative health databases of the FVG as the source of information. From data integration, we estimated that more than two-thirds of AAV patients showed at least one hospitalization in their medical history, most frequently caused by the disease itself or superimposed infections. Around 10% of patients developed end-stage renal disease. In an 8-year follow-up, the overall healthcare cost was € 1,215,078, corresponding to € 6,168 patient-year. ANCA-positive patients showed much higher costs than ANCA-negative patients did. Overall, AAV are rare diseases, but imply very high healthcare costs. Early diagnosis and optimal treatment probably still remain unmet needs for AAV.
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Affiliation(s)
- Luca Quartuccio
- Department of Medicine (DAME), Clinic of Rheumatology, Department of Medicine (DAME), ASU FC, University of Udine, Udine, Italy.
| | - Elena Treppo
- Department of Medicine (DAME), Clinic of Rheumatology, Department of Medicine (DAME), ASU FC, University of Udine, Udine, Italy
| | | | - Salvatore De Vita
- Department of Medicine (DAME), Clinic of Rheumatology, Department of Medicine (DAME), ASU FC, University of Udine, Udine, Italy
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25
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Valent F, Tullio A, Kara E, Cipri C, Sciannimanico SM, Vescini F, Grimaldi F. A Retrospective Cohort Study of Histology-Proven Neuroendocrine Neoplasms in the Italian Area of Udine. Endocr Metab Immune Disord Drug Targets 2021; 21:448-457. [PMID: 32660412 DOI: 10.2174/1871530320666200713093533] [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: 12/16/2019] [Revised: 03/12/2020] [Accepted: 05/15/2020] [Indexed: 11/22/2022]
Abstract
AIMS The aim of this study was to investigate the epidemiology of histology-proven Neuroendocrine neoplasms (NENs) in an Italian area. BACKGROUND NENs are a rare and poorly known disease and the global incidence and prevalence appear to be increasing over the past decades. OBJECTIVE The objectives of this study were to estimate the incidence and trends of NENs in a 250,000-inhabitant area in the North-East of Italy in the 1998-2018 period and to compare them with international data. METHODS This retrospective cohort study was based on the analysis of anonymous health administrative databases, linked with each other at individual patient level through an anonymous stochastic key. NENs were identified from the anatomical pathology database. The standardized incidence rate (2010ESP and US2000) ± 95% CI per 100,000 were calculated, both annually and globally, for the whole period. Incidence was also calculated for specific anatomical sites and by gender. Trends for the considered periods and sites were summarized through the annual percent change (APC) and average increase (cases per 100,000 per year). RESULTS In the 1998-2018 period, the standardized incidence rate of NENs in the area of Udine was 2.49 (APC 3.33). A total of 162 cases were observed (51.2% males). Differences in incidence and trend were observed between sexes. The obtained results were consistent with those reported in other countries, confirming a significant and steady increase in NENs incidence in the last twenty years. CONCLUSION This study provides new epidemiological data on NENs in Italy. The observed sex differences deserve further investigations.
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Affiliation(s)
- Francesca Valent
- Hygiene and Clinical Epidemiology Unit, University Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
| | - Annarita Tullio
- Hygiene and Clinical Epidemiology Unit, University Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
| | - Elda Kara
- Endocrinology and Metabolism Unit, University Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
| | - Claudia Cipri
- Endocrinology and Metabolism Unit, University Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
| | - Silvia M Sciannimanico
- Endocrinology and Metabolism Unit, University Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
| | - Fabio Vescini
- Endocrinology and Metabolism Unit, University Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
| | - Franco Grimaldi
- Endocrinology and Metabolism Unit, University Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
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27
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Lesa L, Brunelli L, Valent F, Aprili I, Cametti E, Ferrari S, Camussi E, Degan S, De Corti D, Bellomo F, Tardivo S, Siliquini R, Brusaferro S. The underestimated burden of aspiration event and pneumonia within hospitals: what happens after dysphagia. Ann Ig 2021; 33:555-563. [PMID: 33565565 DOI: 10.7416/ai.2021.2436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Study design Prospective observational study. Background Despite dysphagia large prevalence and the growing ageing phenomenon occurring in European countries, aspiration events among inpatients are often underestimated, given their frequent spontaneous resolution or silent contribution to aspiration syndromes. Our main objective was to evaluate the incidence of aspiration events among medical inpatients and to identify risk factors influencing the outcome of the event. Methods Data about aspiration events - day, hour, type and outcome of the event occurred - along with underlying patient clinical conditions at the admission were collected. Between May 2015 and September 2016, data about aspiration event occurred among medical inpatients were collected in three large Italian hospitals. Results Patients affected by aspiration events were 135 on 102,619 cumulative days of hospitalization; they were mostly females (53%) with an average age of 82. The total incidence of aspiration events was of 1.4 every 1,000 days of hospitalization (C.I. 95%: 1.2-1.7) and the most frequent manifestation was cough (61.6%). The addition of drugs or an infection diagnosis during the 24 hours preceding the event acted as risk factors for those events that needed additional interventions during the hospitalization (OR 3.1 e OR 1.9 respectively), while the elimination of one or more prescribed drugs seemed to lead to aspiration events without impact on the hospitalization. Conclusions Results showed a large incidence of aspiration events within medical wards, many of them influencing patient outcomes. Healthcare professionals' attention concerning aspiration events should be fostered during the first hours and days of hospitalization.
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Affiliation(s)
- L Lesa
- Department of Medicine, University of Udine, Italy.,Medical Directorate, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - L Brunelli
- Department of Medicine, University of Udine, Italy.,Quality Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - F Valent
- Hygiene and Clinical Epidemiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - I Aprili
- Diagnostic and Public Health Department, University of Verona, Italy
| | - E Cametti
- Diagnostic and Public Health Department, University of Verona, Italy
| | - S Ferrari
- Diagnostic and Public Health Department, University of Verona, Italy
| | - E Camussi
- Public Health and Pediatric Science Department, University of Torino, Italy
| | - S Degan
- Quality Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - D De Corti
- Quality Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - F Bellomo
- Quality Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - S Tardivo
- Diagnostic and Public Health Department, University of Verona, Italy
| | - R Siliquini
- Public Health and Pediatric Science Department, University of Torino, Italy
| | - S Brusaferro
- Department of Medicine, University of Udine, Italy
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Brunelli L, Valent F, Romanese F, Tricarico P, Pellizzaro A, d'Angelo M, Benetollo PP, Iob A, Forgiarini M, Brusaferro S. Parental trust and beliefs after the discovery of a six-year-long failure to vaccinate. Hum Vaccin Immunother 2021; 17:583-587. [PMID: 32750274 PMCID: PMC7899632 DOI: 10.1080/21645515.2020.1777820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND In Italy vaccine hesitancy worsened after a failure to vaccinate episode that took place in Friuli Venezia-Giulia Region until early 2017 which undermined herd immunity by leaving unprotected more than 5,444 children. METHODS Between May and June 2017, 2,557 parents were surveyed at the local vaccination clinic where they were invited within the subsequent extraordinary vaccination campaign. The aim of the survey was to evaluate whether the multi-channel extraordinary vaccination campaign had reached the target population and to know parental beliefs and trusted sources of information after the failure to vaccinate event. RESULTS While 279 parents were non-hesitant (10.9%) and 1,491 hesitant acceptors (58.3%), just 38 (1.5%) refused to have their children revaccinated. Overall, the most consulted sources of information were print media (18.8%), physicians (16.0%), relatives and friends (12.1%). The majority of parents considered vaccination as a fundamental practice (73.9%), but many were worried about potential side effects (38.8%) or doubtful about the effectiveness of some vaccines (11.0%). According to parents, 19.7% of them (57) changed their opinion about vaccines after the Codroipo case. CONCLUSIONS After the Codroipo case, most parents chose to have their children re-vaccinated and just a little proportion refused the re-administration of vaccines. More studies are needed to confirm the importance of a coherent multi-channel communication strategy using both traditional and new media in order to counteract vaccine hesitancy.
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Affiliation(s)
- Laura Brunelli
- Dipartimento di Area Medica, Università Degli Studi di Udine , Udine, Italy
| | - Francesca Valent
- Istituto di Igiene Ed Epidemiologia Clinica, Azienda Sanitaria Universitaria Integrata di Udine , Udine, Italy
| | - Federico Romanese
- Dipartimento di Area Medica, Università Degli Studi di Udine , Udine, Italy
| | | | - Alice Pellizzaro
- Dipartimento di Area Medica, Università Degli Studi di Udine , Udine, Italy
| | - Matteo d'Angelo
- Dipartimento di Area Medica, Università Degli Studi di Udine , Udine, Italy
| | - Pier Paolo Benetollo
- Azienda per l'Assistenza Sanitaria No.3 Del Friuli Venezia Giulia , Gemona, Italy
| | - Andrea Iob
- Azienda per l'Assistenza Sanitaria No.3 Del Friuli Venezia Giulia , Gemona, Italy
| | - Mariarita Forgiarini
- Azienda per l'Assistenza Sanitaria No.3 Del Friuli Venezia Giulia , Gemona, Italy
| | - Silvio Brusaferro
- Dipartimento di Area Medica, Università Degli Studi di Udine , Udine, Italy
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Agabiti N, Acampora A, Angelici L, Di Blasio N, Ciccone G, Pagano E, Grilli R, Di Martino M, Marinacci C, Valent F, Davoli M. [A&F to monitor and promote quality in healthcare during the COVID-19 emergency: the EASY-NET work]. Epidemiol Prev 2021; 44:88-94. [PMID: 33412798 DOI: 10.19191/ep20.5-6.s2.106] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We are presenting here the findings of the reaction to the COVID-19 epidemic during the period March to June 2020 of those centres participating in the research EASY-NET which is on-going in Italy, funded by the Ministry of Health and co-founded by the Regional Health Authorities. The objective of EASY-NET is to evaluate the effectiveness of the audit and feedback (A&F) strategies in different clinical and organizational settings in seven regions. As a negative consequence of the COVID-19 epidemic, the activities of the project have suddenly slowed down; nevertheless, the COVID-19 epidemic represented an opportunity to apply the A&F methodology and support the healthcare within the regional authorities in order to manage and monitor the impact of this new disease. The reaction to the crisis on behalf of EASY-NET was inconsistent across the participating regions for various reasons. Factors which influenced the reaction levels in relation to the rapidity and efficiency of the implementation of the A&F strategies were as follows: the varying epidemiological impact of the COVID-19 epidemic in the various territories, the different clinical and organizational context and availability of expert research teams together with A&F procedures which had already been tested before the start of the epidemic.
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Affiliation(s)
- Nera Agabiti
- Dipartimento di epidemiologia del servizio sanitario regionale del Lazio, Azienda sanitaria locale Roma 1, Roma
| | - Anna Acampora
- Dipartimento di epidemiologia del servizio sanitario regionale del Lazio, Azienda sanitaria locale Roma 1, Roma;
| | - Laura Angelici
- Dipartimento di epidemiologia del servizio sanitario regionale del Lazio, Azienda sanitaria locale Roma 1, Roma
| | | | - Giovannino Ciccone
- SSD epidemiologia clinica e valutativa, Azienda ospedaliera universitaria Città della salute e della scienza di Torino e Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte, Torino
| | - Eva Pagano
- SSD epidemiologia clinica e valutativa, Azienda ospedaliera universitaria Città della salute e della scienza di Torino e Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte, Torino
| | - Roberto Grilli
- Azienda unità sanitaria locale, Istituto di ricovero e cura a carattere scientifico di Reggio Emilia
| | - Mirko Di Martino
- Dipartimento di epidemiologia del servizio sanitario regionale del Lazio, Azienda sanitaria locale Roma 1, Roma
| | - Chiara Marinacci
- Dipartimento di epidemiologia del servizio sanitario regionale del Lazio, Azienda sanitaria locale Roma 1, Roma
| | - Francesca Valent
- Istituto di igiene ed epidemiologia clinica, Azienda sanitaria universitaria Friuli Centrale, Udine
| | - Marina Davoli
- Dipartimento di epidemiologia del servizio sanitario regionale del Lazio, Azienda sanitaria locale Roma 1, Roma
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Licata S, Tullio A, Valent F. Audit and Feedback in emergency: a systematic review and an Italian project to investigate and improve quality of care. Emerg Care J 2020. [DOI: 10.4081/ecj.2020.9201] [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
The Audit and Feedback process (AandF) is commonly accepted as a good way to improve quality in health care, also in Emergency Departments (ED), where health aspects and pathologies are very different, usually acute and highly complex. Within an Italian Ministry of Health research project called EASY-NET, we conducted a systematic review of literature on AandF in EDs from 2014 to December 2019 to evaluate the impact of this approach in a particular setting where time-dependent indicators are fundamental. We selected 24 articles: 9 about infective pathologies (i.e. antibiotic stewardship), 6 about cardiovascular acute emergencies (i.e. cardiac arrest), 2 about stroke, 3 about laboratory tests, and 4 about other fields (i.e. diabetic ketoacidosis or use of prothrombin complex). Most of articles proposed a multimodal approach: only 7 concerned AandF alone. Despite the wide range on interventions modality and the poor comparability of the considered studies, the results are encouraging and confirm the importance to implement AandF both in emergency and in other clinical settings.
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Valent F, Mazzilis G, Doimo A, Pipan C. Frequency of nasopharyngeal swab collection and positivity for SARS-CoV-2 infection in the population of the Italian province of Udine with and without chronic conditions. Health Policy 2020; 125:155-159. [PMID: 33384183 PMCID: PMC7752027 DOI: 10.1016/j.healthpol.2020.12.009] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022]
Abstract
This is a prevalence study in the Italian province of Udine. We study SARS-CoV-2 tests in persons with and without comorbidities. Patients with comorbidities are tested more than the others. Prevalence of positive test is not increased in patients with most chronic conditions.
Severity of SARS-CoV-2 infection is associated with comorbidities. However, no information is available on the frequency of nasopharyngeal swab collection and positivity depending on comorbidities. Using a cross-sectional design, we assessed the prevalence of SARS-CoV-2 tests and of positivity in the general population of the 530,000-inhabitant Italian province of Udine and in subgroups affected by chronic conditions in the first weeks of SARS-CoV-2 epidemic. Anonymous health databases were used as source of information to identify persons with 14 chronic conditions. From laboratory records we assessed the likelihood of real‐time reverse‐transcriptase polymerase chain reaction for SARS-CoV-2 and the frequency of positivity from February 29 to April 19, 2020, i.e., 7 weeks from the first case detected in the study area. Sex and age-stratified proportions were calculated in comorbidity subgroups. Multivariate regression was used to adjust for confounders. In the province, 236,623 persons had ≥1 chronic condition; 869 had positive tests. Persons with comorbidities were tested more than the others. However, most chronic conditions were not significantly associated with the prevalence of positivity, except psychiatric and neurological diseases and diabetes. In conclusion, despite more frequent testing, patients with most chronic diseases where equally likely to be diagnosed with SARS-CoV-2 as the general population. Chronic patients should adhere to general recommendations for preventing SARS-CoV-2 infection, but ad hoc restrictions do not seem necessary.
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Affiliation(s)
- Francesca Valent
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Italy.
| | - Giada Mazzilis
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Italy
| | - Anna Doimo
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Italy
| | - Corrado Pipan
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Italy
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Deana C, Vetrugno L, Stefani F, Basso A, Matellon C, Barbariol F, Vecchiato M, Ziccarelli A, Valent F, Bove T, Bassi F, Petri R, De Monte A. Postoperative complications after minimally invasive esophagectomy in the prone position: any anesthesia-related factor? Tumori 2020; 107:525-535. [PMID: 33323061 DOI: 10.1177/0300891620979358] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the incidence of postoperative complications arising within 30 days of minimally invasive esophagectomy in the prone position with total lung ventilation and their relationship with 30-day and 1-year mortality. Secondary outcomes included possible anesthesia-related factors linked to the development of complications. METHODS The study is a retrospective single-center observational study at the Anesthesia and Surgical Department of a tertiary care center in the northeast of Italy. Patients underwent cancer resection through esophagectomy in the prone position without one-lung ventilation. RESULTS We included 110 patients from January 2010 to December 2017. A total of 54% of patients developed postoperative complications that increased mortality risk at 1 year of follow-up. Complications postponed first oral intake and delayed patient discharge to home. Positive intraoperative fluid balance was related to increased mortality and the risk to develop postoperative complications. C-reactive protein at third postoperative day may help detect complication onset. CONCLUSIONS Complication onset has a great impact on mortality after esophagectomy. Some anesthesia-related factors, mainly fluid balance, may be associated with postoperative mortality and morbidity. These factors should be carefully taken into account to obtain better outcomes after esophagectomy in the prone position without one-lung ventilation.
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Affiliation(s)
- Cristian Deana
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Luigi Vetrugno
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Francesca Stefani
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Andrea Basso
- Department of Medicine, University of Udine, Udine, Italy
| | - Carola Matellon
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Federico Barbariol
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Massimo Vecchiato
- General Surgery, Department of Surgery, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Antonio Ziccarelli
- General Surgery, Department of Surgery, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Francesca Valent
- Institute of Epidemiology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Tiziana Bove
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Flavio Bassi
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Roberto Petri
- General Surgery, Department of Surgery, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Amato De Monte
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Smaniotto C, Battistella C, Brunelli L, Ruscio E, Agodi A, Auxilia F, Baccolini V, Gelatti U, Odone A, Prato R, Tardivo S, Voglino G, Valent F, Brusaferro S, Balzarini F, Barchitta M, Carli A, Castelli F, Coppola C, Iannelli G, Milazzo M, Rosina B, Salerno C, Siliquini R, Sisi S. Sustainable Development Goals and 2030 Agenda: Awareness, Knowledge and Attitudes in Nine Italian Universities, 2019. Int J Environ Res Public Health 2020; 17:ijerph17238968. [PMID: 33276530 PMCID: PMC7730411 DOI: 10.3390/ijerph17238968] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022]
Abstract
Sustainable Development Goals (SDGs) and 2030 Agenda represent global development programs. Education can widen the acknowledgement of their relevance and their applications. This survey aims to assess awareness, knowledge and attitudes towards SDGs and sustainability among first-year students in nine Italian Universities. A Likert scale-based online questionnaire of 70 items was compiled by students from March to July 2019. It examined knowledge and expectations referred to sustainable development concepts, indicators and documents/models accounting for sociodemographic variables. Statistical analyses performed were Chi-square test, Fisher’s Exact test, Kendall’s W correlation coefficient, univariate and multivariate analysis. The questionnaire was completed by 1676 students. A low percentage referred a good knowledge of SDGs and 2030 Agenda, most of them had never attended related educational activities previously. Better knowledge of SDGs and 2030 Agenda was observed in case of previous specific educational activities (p < 0.001). The expectation towards university guaranteeing an education on SDGs was high, both for personal wisdom and for usefulness in future professional context. A significant difference (p < 0.001) in such expectations was found, as healthcare students were less interested than colleagues of other areas. The results showed low knowledge but interest towards sustainable development. A scheduled implementation of academic initiatives should be considered.
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Affiliation(s)
- Cecilia Smaniotto
- Department of Medicine, University of Udine, 33100 Udine, Friuli Venezia Giulia, Italy; (C.B.); (L.B.); (E.R.); (S.B.)
- Correspondence: ; Tel.: +39-0432-554767
| | - Claudio Battistella
- Department of Medicine, University of Udine, 33100 Udine, Friuli Venezia Giulia, Italy; (C.B.); (L.B.); (E.R.); (S.B.)
| | - Laura Brunelli
- Department of Medicine, University of Udine, 33100 Udine, Friuli Venezia Giulia, Italy; (C.B.); (L.B.); (E.R.); (S.B.)
- Friuli Centrale Healthcare and University Integrated Trust, 33100 Udine, Friuli Venezia Giulia, Italy;
| | - Edoardo Ruscio
- Department of Medicine, University of Udine, 33100 Udine, Friuli Venezia Giulia, Italy; (C.B.); (L.B.); (E.R.); (S.B.)
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Sicilia, Italy; (A.A.); (M.B.)
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Lombardia, Italy;
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Lazio, Italy; (V.B.); (C.S.)
| | - Umberto Gelatti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Lombardia, Italy;
| | - Anna Odone
- Faculty of Medicine and Surgery, University Vita-Salute San Raffaele, 20132 Milan, Lombardia, Italy; (A.O.); (F.B.)
| | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Puglia, Italy; (R.P.); (C.C.); (G.I.); (M.M.); (S.S.)
| | - Stefano Tardivo
- Department of Diagnostic and Public Health, University of Verona, 37134 Verona, Veneto, Italy; (S.T.); (A.C.)
| | - Gianluca Voglino
- Department of Public Health Sciences and Pediatrics, University of Turin, 10124 Turin, Piemonte, Italy; (G.V.); (R.S.)
| | - Francesca Valent
- Friuli Centrale Healthcare and University Integrated Trust, 33100 Udine, Friuli Venezia Giulia, Italy;
| | - Silvio Brusaferro
- Department of Medicine, University of Udine, 33100 Udine, Friuli Venezia Giulia, Italy; (C.B.); (L.B.); (E.R.); (S.B.)
| | - Federica Balzarini
- Faculty of Medicine and Surgery, University Vita-Salute San Raffaele, 20132 Milan, Lombardia, Italy; (A.O.); (F.B.)
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Sicilia, Italy; (A.A.); (M.B.)
| | - Alberto Carli
- Department of Diagnostic and Public Health, University of Verona, 37134 Verona, Veneto, Italy; (S.T.); (A.C.)
| | - Francesco Castelli
- University Research and Documentation Center for the 2030 Sustainable Development Agenda, Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, 25123 Brescia, Lombardia, Italy;
| | - Cristina Coppola
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Puglia, Italy; (R.P.); (C.C.); (G.I.); (M.M.); (S.S.)
| | - Giuseppina Iannelli
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Puglia, Italy; (R.P.); (C.C.); (G.I.); (M.M.); (S.S.)
| | - Marica Milazzo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Puglia, Italy; (R.P.); (C.C.); (G.I.); (M.M.); (S.S.)
| | - Barbara Rosina
- Advisory and Career Service, University of Milan, 20122 Milan, Lombardia, Italy;
| | - Carla Salerno
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Lazio, Italy; (V.B.); (C.S.)
| | - Roberta Siliquini
- Department of Public Health Sciences and Pediatrics, University of Turin, 10124 Turin, Piemonte, Italy; (G.V.); (R.S.)
| | - Sauro Sisi
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Puglia, Italy; (R.P.); (C.C.); (G.I.); (M.M.); (S.S.)
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Andreotti V, Cinausero M, Garattini S, Bortot L, Palmero L, Valent F, Riosa C, Iacono D, Casagrande M, Rihawi K, Macerelli M, Minisini A, Fasola G. 48P Impact of 12 months of immunotherapy for metastatic cancer patients on oncology workload. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.535] [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: 11/30/2022] Open
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Valent F, Di Chiara A. Detection of severe acute respiratory syndrome coronavirus 2 in nasopharynx according to clinical phenotype of affected patients. Clin Microbiol Infect 2020; 26:1686.e1-1686.e4. [PMID: 32905833 PMCID: PMC7474912 DOI: 10.1016/j.cmi.2020.08.041] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the upper respiratory tract is extremely variable, but its relation to disease severity is unknown. We investigated this relation in the 530 000 inhabitants of the northeastern Italian province of Udine. METHODS We analysed real-time RT-PCR tests for SARS-CoV-2 in upper respiratory specimens conducted at the Virology Laboratory of the University Hospital of Udine, Italy (which serves the whole province) from 1 March to 30 April 2020 Specimens were from positive individuals in four groups characterized by different disease severity (critically ill patients admitted to intensive care units, patients admitted to infectious disease units, symptomatic patients visiting the emergency department and not hospitalized, and asymptomatic individuals tested during contact tracing or screening activities). Duration of viral positivity was assessed from the first positive test to the day of the first of two consecutive negative tests. Univariate and multivariate analyses were conducted to investigate differences in the four groups. RESULTS From 1 March to 30 April, 39 483 RT-PCR tests for SARS-CoV-2 were conducted on 23 778 individuals, and 974 individuals had a positive test result. Among those with multiple tests (n = 878), mean time to negativity was 23.7 days (standard error 0.3639; median 23, interquartile range 16-30 days). Mean time to negativity was longer in the group admitted to the intensive care unit than in the others, whereas no difference was observed between asymptomatic patients and those with mild disease. CONCLUSIONS Disease control measures should not be adjusted to account for differences in viral shedding according to symptomatic status.
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Affiliation(s)
- Francesca Valent
- SOC Istituto di Igiene ed Epidemiologia Clinica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Antonio Di Chiara
- SOC Cardiologia e riabilitazione cardiologica, Azienda Sanitaria Universitaria Friuli Centrale, San Daniele del Friuli, Italy
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36
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Barbone F, Valent F, Pisa F, Daris F, Fajon V, Gibicar D, Logar M, Horvat M. Prenatal low-level methyl mercury exposure and child development in an Italian coastal area. Neurotoxicology 2020; 81:376-381. [PMID: 35623359 DOI: 10.1016/j.neuro.2020.09.033] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Environmental studies have identified mercury pollution in the Northern Adriatic Sea (Italy). High- level methyl mercury exposure is a known cause of neurodevelopmental disorders. However, the exposure-effect relation at levels <10ppm is controversial. To assess the possible health effects of prenatal methyl mercury exposure through maternal fish consumption, we conducted an epidemiologic cohort study in a mercury polluted area of the Adriatic Sea. We identified all the children born between 1999 and 2001 to women who were resident in two coastal fishing towns. A comparison group was identified inland. A total of 243 children were enrolled. Their mothers were interviewed approximately two months after delivery to determine a variety of covariates and the type, quantity and origin of fish consumed during pregnancy. Total mercury (THg) and methyl mercury (MeHg) were assessed in maternal hair and breast milk and in the child's hair. The children were evaluated after age 18 months with a physical examination and the Denver Developmental Screening Test II (DDST II). Statistical analyses matched by residential area are not presented since they were not associated with fresh fish consumption, THg or MeHg exposure level or neurodevelopmental outcomes. To date 52 children have been evaluated. After adjustment for a number of potential confounders, preliminary results indicate that the fine motor adaptive score on the Denver Developmental test is inversely related to maternal hair THg. These pilot findings are suggestive of an association between children's fine motor skills and their prenatal methyl mercury exposure from maternal fish consumption. However, only a small number of the cohort have been tested and more extensive testing with more sensitive and specific tests is needed to determine if these findings persist.
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Affiliation(s)
- Fabio Barbone
- Division of Hygiene and Epidemiology, Department of Experimental and Clinical Pathology and Medicine (DPMSC), University and University Hospital of Udine, Italy.
| | - Francesca Valent
- Division of Hygiene and Epidemiology, Department of Experimental and Clinical Pathology and Medicine (DPMSC), University and University Hospital of Udine, Italy
| | - Federica Pisa
- Division of Hygiene and Epidemiology, Department of Experimental and Clinical Pathology and Medicine (DPMSC), University and University Hospital of Udine, Italy
| | - Fulvio Daris
- Environmental Protection Agency (ARPA), Friuli-Venezia Giulia Region, Italy
| | - Vesna Fajon
- Department of Environmental Sciences, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Darija Gibicar
- Department of Environmental Sciences, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Martina Logar
- Department of Environmental Sciences, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Milena Horvat
- Department of Environmental Sciences, Jozef Stefan Institute, Ljubljana, Slovenia
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Affiliation(s)
- Francesca Valent
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Sabrina Licata
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
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Zabotti A, Zandonella Callegher S, Tullio A, Vukicevic A, Hocevar A, Milic V, Cafaro G, Carotti M, Delli K, De Lucia O, Ernst D, Ferro F, Gattamelata A, Germanò G, Giovannini I, Hammenfors D, Jonsson MV, Jousse-Joulin S, Macchioni P, Parisi S, Perricone C, Stradner MH, Filipovic N, Tzioufas AG, Valent F, De Vita S. Salivary Gland Ultrasonography in Sjögren's Syndrome: A European Multicenter Reliability Exercise for the HarmonicSS Project. Front Med (Lausanne) 2020; 7:581248. [PMID: 33330537 PMCID: PMC7719819 DOI: 10.3389/fmed.2020.581248] [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] [Received: 07/08/2020] [Accepted: 10/21/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives: Salivary gland ultrasonography (SGUS) is increasingly applied for the management of primary Sjögren's syndrome (pSS). This study aims to: (i) compare the reliability between two SGUS scores; (ii) test the reliability among sonographers with different levels of experience. Methods: In the reliability exercise, two four-grade semi-quantitative SGUS scoring systems, namely De Vita et al. and OMERACT, were tested. The sonographers involved in work-package 7 of the HarmonicSS project from nine countries in Europe were invited to participate. Different levels of sonographers were identified on the basis of their SGUS experience and of the knowledge of the tested scores. A dedicated atlas was used as support for SGUS scoring. Results: Twenty sonographers participated in the two rounds of the reliability exercise. The intra-rater reliability for both scores was almost perfect, with a Light's kappa of 0.86 for the De Vita et al. score and 0.87 for the OMERACT score. The inter-rater reliability for the De Vita et al. and the OMERACT score was substantial with Light's Kappa of 0.75 and 0.77, respectively. Furthermore, no significant difference was noticed among sonographers with different levels of experience. Conclusion: The two tested SGUS scores are reliable for the evaluation of major salivary glands in pSS, and even less-expert sonographers could be reliable if adequately instructed.
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Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Sara Zandonella Callegher
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Annarita Tullio
- Institute of Epidemiology, Academic Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Arso Vukicevic
- Faculty of Engineering Science, University of Kragujevac, Kragujevac, Serbia.,Bioengineering Research and Development Center (BioIRC), Kragujevac, Serbia
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vera Milic
- Institute of Rheumatology, Belgrade, Serbia
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Marina Carotti
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Orazio De Lucia
- Unit of Clinical Rheumatology, Department of Rheumatology and Medical Sciences, Aziende Socio Sanitarie Territoriali (ASST) Centro Traumatologico Ortopedico G. Pini-Centri Traumatologici Ortopedici (CTO), Milan, Italy
| | - Diana Ernst
- Clinic for Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angelica Gattamelata
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Germanò
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Daniel Hammenfors
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Malin V Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Section for Oral and Maxillofacial Radiology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Sandrine Jousse-Joulin
- Rheumatology Department, Centre Hospitalier Universitaire (CHU) de Brest, Univ Brest, Brest, France.,UMR 1227, Lymphocytes B et Autoimmunité (LBAI), Inserm, Univ Brest, Brest, France
| | - Pierluigi Macchioni
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Simone Parisi
- Unit of Rheumatology, Department of General and Specialty Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Nenad Filipovic
- Faculty of Engineering Science, University of Kragujevac, Kragujevac, Serbia.,Bioengineering Research and Development Center (BioIRC), Kragujevac, Serbia
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesca Valent
- Institute of Epidemiology, Academic Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
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Buttussi F, Chittaro L, Valent F. A virtual reality methodology for cardiopulmonary resuscitation training with and without a physical mannequin. J Biomed Inform 2020; 111:103590. [PMID: 33039589 DOI: 10.1016/j.jbi.2020.103590] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/19/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) is an emergency procedure that can increase survival after a cardiac arrest. Performing CPR effectively requires both procedural knowledge and manual skills. Traditional CPR training methodology includes lessons led by instructors and supervised practice on mannequins, thus requiring considerable resources. OBJECTIVE This paper proposes a new methodology for low-cost CPR training based on virtual reality (VR) with and without the addition of a physical mannequin. Moreover, it describes an experimental evaluation of the methodology that assessed gain in manual skills during training, transfer of procedural knowledge and manual skills in a final assessment, and changes in self-efficacy with three measurements over time (pre-training, post-training, and post-assessment). METHODS We implemented a VR application that supports the proposed methodology, and can thus be used with or without a mannequin. The experimental evaluation involved 30 participants who tried CPR in VR twice, performing two repetitions of 30 chest compressions per trial. Half participants tried the VR application with the mannequin and half without it. Final assessment required all participants to perform CPR on the mannequin without the assistance of VR. To assess self-efficacy, participants filled in a questionnaire at the three times of measurement. RESULTS Mixed-design ANOVAs showed effects of repetition, effects of group, or interaction between the two variables on manual skills assessed during training. In the final assessment, participants in both groups correctly remembered most of the steps of the procedure. ANOVAs revealed differences between the two groups only in pressure-related skills (better with mannequin) and in the number of wrong steps added to the procedure (better without mannequin). Mixed-design ANOVA showed a self-efficacy increase in both groups after training, which was maintained after final assessment. CONCLUSIONS The proposed VR methodology for CPR training has a positive effect on procedural knowledge, manual skills, and self-efficacy, with as well as without the physical mannequin. Trials on a mannequin are required to understand the correct pressure for chest compression. This supports the adoption of the proposed VR methodology to reduce instructor and mannequin time required to teach CPR to trainees.
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Affiliation(s)
- Fabio Buttussi
- Human-Computer Interaction Lab, Department of Mathematics, Computer Science, and Physics, University of Udine, Udine, Italy; SOC Istituto di Igiene ed Epidemiologia Clinica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Luca Chittaro
- Human-Computer Interaction Lab, Department of Mathematics, Computer Science, and Physics, University of Udine, Udine, Italy
| | - Francesca Valent
- SOC Istituto di Igiene ed Epidemiologia Clinica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Andreotti V, Cinausero M, Garattini SK, Bortot L, Palmero L, Valent F, Riosa C, Iacono D, Casagrande M, Rihawi K, Macerelli M, Minisini AM, Fasola G. Impact of 12 months of immunotherapy for metastatic cancer patients on oncology workload. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
279 Background: In the last years, the introduction of immune checkpoint inhibitors (ICI) in clinical practice translated into major changes in oncology workload. We conducted a study aimed to estimate the shift in workload generated, within 1 year of first consultation, by any new metastatic cancer patient receiving ICI at the Oncology Department of the Academic Hospital of Udine, Italy. Methods: We collected from our electronic accountability system data all new cases of metastatic cancer between 01.01.2017 and 31.12.2018, leading to at least a second clinical episode (treatment sessions, unplanned presentations, hospitalizations, re-evaluations, follow-up, and inpatient oncology advices) during the following year. Patients (pts) were divided into those receiving ICI (anti-CTLA4/PD1/PDL1) versus pts receiving other treatments. Mean number per patient and standard deviation were calculated for clinical episodes, and the mean numbers in each group were compared using Student’s t-test (significance p<0.05). Follow-up continued until 31.12.2019. Results: 969 pts were included: 115 were treated with ICI, 854 received other treatments. In the first group a greater number of treatment sessions, re-evaluations and unplanned presentations was generated, with a statistically significant increased workload. On the other hand, pts receiving other treatments generated a greater workload in terms of follow-up. In detail, data are reported in Table. Conclusions: ICI have transformed the oncology landscape, leading to longer lasting treatment period with emerging toxicities. Estimating the workload generated by ICI is crucial for the implementation of more sustainable systems and for planning clinical activities. Mean number of clinical episodes in the first year of treatment with ICI for metastatic disease. Mean number per patient is represented by mean value and standard deviation (SD). Total number of clinical episodes is shown (N=). Data are reported for ICI versus other treatments group. [Table: see text]
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Affiliation(s)
- Victoria Andreotti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Marika Cinausero
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Lucia Bortot
- Department of Medicine (DAME), University of Udine; Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Udine, Italy
| | | | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology,University Hospital of Udine, Udine, Italy
| | - Chiara Riosa
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Donatella Iacono
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Karim Rihawi
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | | | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, Udine, Italy
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Valent F, Di Chiara A, Di Bartolomeo S. Emergency Key Performance Indicators in the Italian region Friuli Venezia Giulia. Emerg Care J 2020. [DOI: 10.4081/ecj.2020.8910] [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
Key Performance Indicators (KPI) regard key areas of a particular service which needs to be evaluated. Within the health system, they represent specific and measurable elements and are based on standards generally set by the scientific literature. KPI can be used to assess performances in different areas and achievement of goals. To develop and calculate a set of KPI in the Italian Region Friuli Venezia Giulia (1 million inhabitants) as an audit tool for the regional Emergency healthcare system, with a focus on three timedependent conditions: trauma, acute myocardial infarction, and stroke. To develop the set, a modified Delphi process was applied among Emergency care experts in Friuli Venezia Giulia. Then, the indicators were calculated from anonymous administrative health databases (Emergency Medical System, Emergency Department, hospital discharge, cardiac catheterization laboratory). Databases could be linked with each other at the individual level through a univocal stochastic key. Sensitivity analyses were conducted where different results were expected using different databases. Sixty-one indicators were calculated for the year 2018. Five indicators were summary descriptive measures, 10 were outcome measures, the others were process indicators; 20 were specific on acute myocardial infarction, 12 on trauma, 4 on stroke. Values for some indicators varied depending on the data source. These KPI provided new and interesting information and are used for periodic audit purposes in Friuli Venezia Giulia. Higher quality, completeness and richness of the administrative databases should be promoted to further increase the value of the indicators.
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Garattini S, Minisini A, Valent F, Riosa C, Zara D, Giavarra M, Corvaja C, Palmero L, Noto C, Fasola G. 1613P_PR An estimate of the 2-year oncology workload generated by each new patient: A real-world study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2302] [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: 11/24/2022] Open
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Bordin P, Dotto L, Battistella L, Rosso E, Pecci L, Valent F, Collarile P, Vanin M. Gestational diabetes mellitus yesterday, today and tomorrow: A 13 year italian cohort study. Diabetes Res Clin Pract 2020; 167:108360. [PMID: 32758619 DOI: 10.1016/j.diabres.2020.108360] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 12/14/2022]
Abstract
AIMS To describe all cases of gestational diabetes mellitus (GDM) managed at the Italian Hospital of San Daniele del Friuli from 2006 to 2018, after the establishment of a dedicated multidisciplinary team. METHODS Data on mothers, pregnancies, and newborns have been recorded since the team establishment. The associations of maternal, pregnancy, and delivery characteristics with complications of pregnancy and delivery and adverse birth outcomes were assessed. RESULTS 894 cases of GDM were observed, representing 6.8% of all deliveries. More than 20% of women were non-Italian, 5.3% had a previous macrosomic child, 12.5% previous diabetes or GDM, 27.3% family history of diabetes. On average, women had 4 visits at the clinic; mean glycated hemoglobin was 5.3%; starting body mass index (BMI) 26.2 and weight gain 10.3 kg. Cesarean sections were 21.8%. Pre-eclampsia was the most common pregnancy complication (4.7%). 6.0% of newborns were macrosomic and there were 3 fetal deaths. Only 26.3% of women had a post-partum oral glucose tolerance test. Initial BMI, weight gain, nationality, family history of diabetes or previous diabetes-related pregnancy complications were associated with pregnancy complications or adverse outcomes. CONCLUSIONS We identified factors to be targeted for preventing GDM complications. Further efforts should be directed at post-partum.
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Affiliation(s)
- Paolo Bordin
- Department of Prevention, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, Italy
| | - Luciana Dotto
- Diabetes Clinic, Department of Internal Medicine, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, San Antonio Hospital, San Daniele del Friuli, Italy
| | - Liliana Battistella
- Unit of Obstetrics and Gynechology, AAS3 "Alto Friuli-Collinare-Medio Friuli" San Antonio Hospital, San Daniele del Friuli, Italy
| | - Elena Rosso
- Diabetes Clinic, Department of Internal Medicine, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, San Antonio Hospital, San Daniele del Friuli, Italy
| | - Lucia Pecci
- Unit of Obstetrics and Gynechology, AAS3 "Alto Friuli-Collinare-Medio Friuli" San Antonio Hospital, San Daniele del Friuli, Italy
| | - Francesca Valent
- Unit of Hygiene and Clinical Epidemiology, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Paolo Collarile
- Department of Prevention, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, Italy
| | - Michele Vanin
- Unit of Obstetrics and Gynechology, AAS3 "Alto Friuli-Collinare-Medio Friuli" San Antonio Hospital, San Daniele del Friuli, Italy
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Valent F, Gongolo F. Hospital discharge diagnoses in patients with SARS-CoV-2 infection in the first months of COVID-19 outbreak in the Italian province of Udine. HEALTH INF MANAG J 2020; 50:101-102. [PMID: 32840401 DOI: 10.1177/1833358320948741] [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: 11/17/2022]
Affiliation(s)
| | - Francesco Gongolo
- 161161Central Health Directorate, Autonomous Region Friuli Venezia Giulia, Italy
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Di Chiara A, Clagnan E, Valent F. Epidemiology and mortality in an Italian region after the adoption of the universal definition of myocardial infarction. J Cardiovasc Med (Hagerstown) 2020; 21:34-39. [PMID: 31834103 DOI: 10.2459/jcm.0000000000000893] [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] [Indexed: 11/05/2022]
Abstract
AIMS The aim of the study is to validate at the biochemical level (presence of myocardial damage) the discharge diagnosis code ICD-9-CM 410.x1, and to compare the acute myocardial infarction (AMI) epidemiology based on pure administrative data with the epidemiology based on troponin and clinical data. METHODS The health-related administrative databases of the Italian Region Friuli Venezia Giulia were used as the source of information. All the databases are anonymous and can be linked with each other at the individual patient level through a univocal stochastic key. Two methods were used to assess incidence in 2017: the first used the main hospital discharge diagnosis, validated by biochemical myocardial necrosis; the second identified from the cohort of all patients with any myocardial injury those with ischemic origin. RESULTS The positive-predictive value of the clinical diagnosis of AMI (410.x1), validated at the biochemical level, was 96.2%.About 40% of patients with a not trivial biochemical myocardial injury and an ischemic heart disease diagnosis (e.g. 411) were discharged without either ST-elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI) diagnosis, leading to a sensitivity of clinical discharge diagnosis of 47.6%.Thirty-day and 90-day mortality at multivariate analysis resulted respectively, 1.8 and 4.0% in NSTEMI, 6.6 and 9.8% in STEMI, 8.8 and 12.2% in patients with biochemical AMI and discharge diagnosis other than 410.x1. CONCLUSION Pure administrative data (clinical discharge diagnosis) are today insufficient to catch the whole hospital epidemiology of myocardial infarction missing an important proportion of AMI with an adverse prognosis comparable with STEMI.
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Affiliation(s)
- Antonio Di Chiara
- Cardiology Department, Azienda per l'Assistenza Sanitaria n°3, Gemona del Friuli, Italy
| | - Elena Clagnan
- Servizio Epidemiologico e Flussi Informativi, Azienda regionale di coordinamento per la salute (ARCS), Udine, Friuli Venezia Giulia Italy
| | - Francesca Valent
- Istituto di Igiene ed Epidemiologia, Clinica Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
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Valent F, Del Pin M, Mattiussi E, Palese A. [Prevalence of mobile phone use among drivers: direct observation in Udine (Northern Italy)]. Epidemiol Prev 2020; 44:171-178. [PMID: 32631017 DOI: 10.19191/ep20.2-3.p171.040] [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: 11/15/2022]
Abstract
OBJECTIVES to measure the prevalence of hand-held mobile phone use among drivers in Udine, Italy. Such behaviour is prohibited by law. DESIGN direct roadside observation of car drivers. SETTING AND PARTICIPANTS groups of nursing students on the roadside observed car drivers either waiting at red traffic lights or driving in selected major urban streets of the city of Udine and of two smaller neighboring towns, in one-hour time slots in different days in November and December 2018, for a total of 24 hours of observation. MAIN OUTCOME MEASURES prevalence of use of handheld mobile phone either for calling or for activities implying visuo-manual interaction (texting or social media browsing), both among drivers waiting at red traffic lights and among those driving along the streets. RESULTS overall, 8,240 observations of vehicles were carried out. The prevalence of mobile phone use was 9.9% among drivers waiting at red traffic lights and 6.5% among those moving along the streets in Udine; the prevalence was higher in the smaller neighboring towns. Among 6,116 drivers, the type of use has also been recorded: prevalence of texting was 7.2% at traffic lights and 5.0% in moving vehicles; prevalence of phone calls was 3.3% and 3.6%, respectively. Texting represented 68.4% of mobile phone use among drivers waiting at traffic lights and 57.8% among moving drivers. Behaviors of female and male drivers were similar. CONCLUSION the use of mobile phones among drivers is very common in Udine, particularly for activities involving both the hands and the eyes. Since the increased risk of road accidents caused by this type of distraction from driving activities is well known, interventions discouraging the use of mobile phones among drivers are needed.
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Affiliation(s)
- Francesca Valent
- Istituto di igiene ed epidemiologia clinica, Azienda sanitaria universitaria integrata di Udine;
| | - Massimo Del Pin
- Dipartimento di area medica, Università degli Studi di Udine
| | - Elisa Mattiussi
- Dipartimento di area medica, Università degli Studi di Udine
| | - Alvisa Palese
- Dipartimento di area medica, Università degli Studi di Udine
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Sechi A, Macor D, Valent S, Da Riol RM, Zanatta M, Spinelli A, Bianchi K, Bertossi N, Dardis A, Valent F, Scarpa M. Impact of COVID-19 related healthcare crisis on treatments for patients with lysosomal storage disorders, the first Italian experience. Mol Genet Metab 2020; 130:170-171. [PMID: 32386848 PMCID: PMC7189198 DOI: 10.1016/j.ymgme.2020.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 04/24/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
Abstract
The direct and indirect effects of Coronavirus Disease-19 (COVID-19) pandemic, on Italian patients with lysosomal storage disorders receiving therapy, were analyzed by a phone questionnaire. No proved COVID-19 emerged among 102 interviewed. No problems were reported by patients receiving oral treatments. Forty-nine% of patients receiving enzyme replacement therapy in hospitals experienced disruptions, versus 6% of those home-treated. The main reasons of missed infusions were fear of infection (62.9%) and re-organization of the infusion centers (37%).
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Affiliation(s)
- Annalisa Sechi
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy.
| | - Daniela Macor
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Serena Valent
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Rosalia Maria Da Riol
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Manuela Zanatta
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Alessandro Spinelli
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Katja Bianchi
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Nadia Bertossi
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Andrea Dardis
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Maurizio Scarpa
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
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De Lucia O, Zandonella Callegher S, De Souza MV, Battafarano N, Del Papa N, Gerosa M, Giovannini I, Tullio A, Valent F, Zabotti A, Caporali R, De Vita S. Ultrasound assessment of lacrimal glands: a cross-sectional study in healthy subjects and a preliminary study in primary Sjögren's syndrome patients. Clin Exp Rheumatol 2020; 38 Suppl 126:203-209. [PMID: 33095143] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This study aimed to: i) perform an ultrasonographic (US) evaluation of the lacrimal glands (LGs) in healthy subjects in order to define the sonographic elementary lesions which could be identified in the LGs and describe their frequencies in healthy subjects; ii) test the intra and inter-rater agreement between four rheumatologists; iii) preliminary assess whether the elementary lesions of the LGs let us differentiate healthy subjects from primary Sjögren's syndrome (pSS) patients. METHODS A consensus meeting was held to define the sonographic lesions to be evaluated. Healthy subjects and pSS patients underwent lacrimal glands ultrasound (LGUS) examinations in two Italian Rheumatology Clinics. A web-based reliability exercise was performed on healthy subjects' images by four rheumatologists. Afterward, images of pSS patients were evaluated for the presence of the sonographic lesions previously defined and compared to the US findings in healthy subjects. RESULTS Fifty-seven healthy subjects and 17 pSS patients were evaluated. The intra and inter-rater reliability score was good-excellent for almost all the agreed US features assessed (glandular parenchyma visibility, size, homogeneity, hypoechoic areas, hyperechoic spots, fibrous gland appearance, fatty deposition). Among the LGUS elementary lesions in pSS patients compared with healthy subjects, we detected a significantly difference in glandular inhomogeneity [13/33 (39.4%) vs. 9/63 (14.3%), p=0.01], and in fibrous gland appearance [3/33 (9.1%) vs. 0/63 (0%), p=0.04]. CONCLUSIONS In this preliminary study, LGUS proved to have a good-excellent intra and inter-rater reliability. The glandular parenchyma inhomogeneity and the fibrous gland appearance could help differentiate pSS patients from healthy subjects.
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Affiliation(s)
- Orazio De Lucia
- Clinical Rheumatology Unit, Department of Rheumatology and Medical Sciences, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milan, Italy.
| | - Sara Zandonella Callegher
- Rheumatology Clinic, Department of Medical Area, University of Udine, Academic Hospital Santa Maria della Misericordia, Udine, Italy
| | - Mirian Veronica De Souza
- Clinical Rheumatology Unit, Department of Rheumatology and Medical Sciences, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milan, and Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Norma Battafarano
- Rheumatology DH Unit, Department of Rheumatology and Medical Sciences, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milan, Italy
| | - Nicoletta Del Papa
- Rheumatology DH Unit, Department of Rheumatology and Medical Sciences, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milan, Italy
| | - Maria Gerosa
- Clinical Rheumatology Unit, Department of Rheumatology and Medical Sciences, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milan, and Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medical Area, University of Udine, Academic Hospital Santa Maria della Misericordia, Udine, Italy
| | - Annarita Tullio
- Institute of Epidemiology, Academic Hospital Santa Maria della Misericordia, Udine, Italy
| | - Francesca Valent
- Institute of Epidemiology, Academic Hospital Santa Maria della Misericordia, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical Area, University of Udine, Academic Hospital Santa Maria della Misericordia, Udine, Italy
| | - Roberto Caporali
- Clinical Rheumatology Unit, Department of Rheumatology and Medical Sciences, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milan, and Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical Area, University of Udine, Academic Hospital Santa Maria della Misericordia, Udine, Italy
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Quartuccio L, Zabotti A, De Marchi G, Gallo T, De Vita S, Valent F. AB1188 INFLUENZA VACCINATION TREND IN THE LAST DECADE AND FACTORS INFLUENCING THE RATE OF INFLUENZA VACCINATION IN CHRONIC INFLAMMATORY ARTHRITIS IN THE ITALIAN REGION OF FRIULI VENEZIA GIULIA (2006-2018). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2555] [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: 11/03/2022]
Abstract
Background:vaccination is one of the most important medical intervention to prevent infectious complications in population at risk. EULAR recommendations for vaccination of patients suffering from autoimmune inflammatory rheumatic diseases (AIIRD) have been recently updated (1).Objectives:to verify the level of coverage of the influenza vaccination in a local population of patients suffering from rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS).Methods:integration of the information coming from many administrative databases were used to this end. The Regional Health Information System of Friuli Venezia Giulia was used as the source of information for this retrospective cohort study. Patients were residents in Friuli Venezia Giulia and they had to carry the exemption code for RA, or PsA, or AS and at least one prescription of a tsDMARD or a bDMARD in the 9 months before the start of the vaccination season (from October 1 to December 31). The observation period comprises all the years from 2006 to 2018. Multivariate logistic regression was used to assess the association between the probability of vaccination and demographic and clinical patient’s characteristics in the influenza season 2018-2019.Results:table 1 summarizes the results. During the whole period of observation, the coverage is always under the minimum desirable threshold of 75% and far from the optimum target of 95%, according to the National Italian Plan for Vaccination in the population at risk, even in the subgroup of older patients (age ≥ 65 years). In the logistic model including sex, age category, number and type of chronic conditions, socioeconomic status, rheumatic disease affecting the patient, area of residency, and treatment with tsDMARD or bDMARD, in 2018, older subjects were more likely to be vaccinated (people 65-74 vs 44-64, OR 4.63, 95%CI 3.76-5.70; people 75-84, OR 6.61, 95%CI 5.14-8.50) as were those with diabetes comorbidity (OR 1.64, 95%CI 1.03- 2.59); a lower borderline-significant probability of being vaccinated was observed among patients with low socioeconomic status (OR 0.83, 95%CI 0.68-1.00), and those treated by a biologic agent (OR 0.85, 95% CI 0.73-1.00)Table 1.2006-2018 vaccination coverage in RA, PsA and AS population.2006200720082009201020112012201320142015201620172018GlobalNumber censored1853203124492684291030923295347136633883417543344426Total vaccinated (%)662 (35.7)664 (32.7)848 (34.6)946 (35.2)892 (30.6)942 (30.5)886 (26.9)994 (28.6)926 (25.3)1027 (26.4)1232 (29.5)1344 (31.1)1550(35)Vaccinated ≥ 65 yrs (%)61.457.961.660.555.754.547.749.943.946.151.952.657.0RAvaccinated (%)38.535.037.137.733.733.829.731.328.329.632.333.537.3Vaccinated ≥ 65 yrs (%)61.956.961.159.655.254.647.449.244.346.251.551.356.0PsAvaccinated (%)28.026.629.630.824.624.623.226.021.022.326.128.832.6Vaccinated ≥ 65 yrs (%)59.565.566.467.558.054.650.955.244.946.454.757.860.3ASvaccinated (%)19.519.619.219.916.714.410.110.711.112.918.119.125.1Vaccinated ≥ 65 yrs (%)42.957.150.057.166.750.034.632.423.543.547.349.258.8Legend: RA, rheumatoid arthritis; PsA, psoriatic arthritis; AS, ankylosing spondylitis.Conclusion:influenza vaccination coverage is low in a population at high risk of infectious complications, even in the subgroup of elderly patients. Local guidelines are needed to improve the vaccination policies in AIIRD in order to increase the protection among patients who really need it.References:[1]Furer V, et al. Ann Rheum Dis 2019. Ann Rheum Dis. 2019 Aug 14. pii: annrheumdis-2019-215882Disclosure of Interests:Luca Quartuccio Consultant of: Abbvie, Bristol, Speakers bureau: Abbvie, Pfizer, Alen Zabotti Speakers bureau: Celgene, Novartis, Janssen, Ginevra De Marchi: None declared, Tolinda Gallo: None declared, Salvatore De Vita Consultant of: Roche, GSK, Speakers bureau: Roche, GSK, Novartis, Francesca Valent: None declared
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Quartuccio L, Treppo E, De Vita S, Valent F. AB0521 COST OF ILLNESS OF ANCA-ASSOCIATED VASCULITIS IN ITALY: DATA LINKAGE ANALYSIS OF MULTIPLE CLINICAL AND ADMINISTRATIVE DATABASES IN THE PROVINCE OF UDINE, ITALY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2585] [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: 11/04/2022]
Abstract
Background:ANCA-associated vasculitides (AAV) are a group of systemic vasculitis carrying a high risk of hospitalization because the multiorgan involvement, the acute nature of some clinical manifestations, the chronic but very disabling course of some other manifestations and finally the risk of severe infections due to chronic glucocorticoid and immunosuppressor administration. However, data on cost of illness due to AAV are lacking.Objectives:to estimate the cost of illness in patients suffering from AAV in the province of Udine (about 500,000 inhabitants), Friuli Venezia Giulia (FVG), Italy, from year 2010 to 2018.Methods:integration of the information coming from many administrative databases were used to this end. The Regional Health Information System of FVG was used as the source of information for this retrospective cohort study. The system covers the entire regional population and includes various electronic health administrative databases that can be linked with one another on an individual basis through a unique encrypted identifier. In particular, the following databases were matched: the database of the health care beneficiaries (including demographic information and the residential history of all of the subjects living in FVG), the hospital discharge database, the database of exemptions from medical charges, the database of the laboratories. The population under study was selected based on the following inclusion criteria: patients were residents in the province of Udine and they had to carry the exemption code for AAV, including GPA, or EGPA, or MPA. This population was observed from 2010 to 2018.Results:57 patients (201 patient-years) with AAV were identified. They were ANCA-positive in 44/57 (77%). GPA, EGPA and MPA was diagnosed in 18 (31,6%), 15 (26,3%), 11 (19,3%) patients, respectively. The mean age at diagnosis was 54,5 (17,5) years. The disease itself was the main cause of hospitalization in almost half of the hospital discharges (60/126, 47,6%). Four patients died during the observation period due to vasculitis itself (1), pneumonia (2), or haematological malignancy (1). Time to the first event (death or hospitalization) was significantly higher in ANCA-negative AAV patients than in ANCA-positive AAV patients (p=0,03, Log-Rank test), ANCA-positive AAV patients having a three-times higher risk (HR 3,38 95%CI 1,13-10,08, p=0,03). Total estimated cost was € 1,215,078, corresponding to € 6,168 patient-year. Costs for ANCA-positive AAV patients were much higher than those for ANCA-negative AAV patients (€ 1,115,253 vs € 99,825, and € 7058 per person-year vs € 2,559 per person-year, respectively). GPA and MPA showed the highest costs if compared to EGPA [GPA: € 239,168 (€ 5199 per person-year) vs MPA: € 281,502 (€ 4771 per person-year) vs EGPA: € 214,287 (2329 per person-year), respectively]. Costs for hospitalization were the highest [€ 734,957 (€ 3731 per person-year) vs other costs € 480,121 (€ 2437 per person-year)].Conclusion:costs for AAV are very high, confirming the high health care burden of this illness. Management of ANCA-positive patients rather than ANCA-negative patients was burdened by the highest costs. GPA and MPA showed the highest direct costs for hospitalization, which very frequently occurred due to the vasculitis itself.Disclosure of Interests:Luca Quartuccio Consultant of: Abbvie, Bristol, Speakers bureau: Abbvie, Pfizer, Elena Treppo: None declared, Salvatore De Vita Consultant of: Roche, GSK, Speakers bureau: Roche, GSK, Novartis, Francesca Valent: None declared
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