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Barbato A, D'Avanzo B, Corrao G, Di Fiandra T, Ferrara L, Gaddini A, Jarach CM, Monzio Compagnoni M, Saponaro A, Scondotto S, Tozzi VD, Lora A. Allocation of Users of Mental Health Services to Needs-Based Care Clusters: An Italian Pilot Study. Community Ment Health J 2024; 60:494-503. [PMID: 37882894 PMCID: PMC10912259 DOI: 10.1007/s10597-023-01200-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
In Italy, despite strong community-based mental health services, needs assessment is unsatisfactory. Using the Mental Health Clustering Tool (MHCT) we adopted a multidimensional and non-diagnosis dependent approach to assign mental health services users with similar needs to groups corresponding to resources required for effective care. We tested the MHCT in nine Departments of Mental Health in four Italian regions. After a brief training, 318 professionals assessed 12,938 cases with a diagnosis of schizophrenia, depression, bipolar disorder and personality disorder through the MHCT. 53% of cases were 40-59 years, half were females, 51% had a diagnosis of schizophrenia, 48% of cases were clinically severe. Clusters included different levels of clinical severity and diagnostic groups. The largest cluster was 11 (ongoing recurrent psychosis), with 18.9% of the sample, followed by cluster 3 (non-psychotic disorders of moderate severity). The MHCT could capture a variety of problems of people with mental disorders beyond the traditional psychiatric assessment, therefore depicting service population from a different standpoint. Following a brief training, MHCT assessment proved to be feasible. The automatic allocation of cases made the attribution to clusters easy and acceptable by professionals. To what extent clustering provide a sound base for care planning will be the matter of further research.
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Affiliation(s)
- Angelo Barbato
- Laboratory of Quality Assessment of Care and Services, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Barbara D'Avanzo
- Laboratory of Quality Assessment of Care and Services, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, 20126, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Teresa Di Fiandra
- Psychologist, previously General Directorate for Health Prevention, Italian Ministry of Health, Rome, Italy
| | - Lucia Ferrara
- Centre of Research on Health and Social Care Management, CERGAS SDA Bocconi School of Management (Bocconi University), Milan, Italy
| | | | - Carlotta Micaela Jarach
- Laboratory of Lifestyle Epidemiology, Department of Environment and Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Matteo Monzio Compagnoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, 20126, Milan, Italy.
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Valeria D Tozzi
- Psychologist, previously General Directorate for Health Prevention, Italian Ministry of Health, Rome, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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Maio S, Gariazzo C, Stafoggia M, Ancona C, Bisceglia L, Caranci N, Cernigliaro A, Cesaroni G, Costa G, Marcon A, Massari S, Nobile F, Ranzi A, Renzi M, Scondotto S, Zengarini N, Verlato G, Viegi G. [BIGEPI project: environmental and health data]. Epidemiol Prev 2023; 47:8-18. [PMID: 38639296 DOI: 10.19191/ep23.6.s3.003] [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: 04/20/2024]
Abstract
OBJECTIVES the BIGEPI project, co-funded by INAIL, has used big data to identify the health risks associated with short and long-term exposure to air pollution, extreme temperatures and occupational exposures. DESIGN the project consists of 5 specific work packages (WP) aimed at assessing: 1. the acute effects of environmental exposures over the national territory; 2. the acute effects of environmental exposures in contaminated areas, such as Sites of National Interest (SIN) and industrial sites; 3. the chronic effects of environmental exposures in 6 Italian longitudinal metropolitan studies; 4. the acute and chronic effects of environmental exposures in 7 epidemiological surveys on population samples; 5. the chronic effects of occupational exposures in the longitudinal metropolitan studies of Rome and Turin. SETTING AND PARTICIPANTS BIGEPI analyzed environmental and health data at different levels of detail: the whole Italian population (WP1); populations living in areas contaminated by pollutants of industrial origin (WP2); the entire longitudinal cohorts of the metropolitan areas of Bologna, Brindisi, Rome, Syracuse, Taranto and Turin (WP3 and WP5); population samples participating in the epidemiological surveys of Ancona, Palermo, Pavia, Pisa, Sassari, Turin and Verona (WP4). MAIN OUTCOME MEASURES environmental exposure: PM10, PM2,5, NO2 and O3 concentrations and air temperature at 1 Km2 resolution at national level. Occupational exposures: employment history of subjects working in at least one of 25 sectors with similar occupational exposures to chemicals/carcinogens; self-reported exposure to dust/fumes/gas in the workplace. Health data: cause-specific mortality/hospitalisation; symptoms/diagnosis of respiratory/allergic diseases; respiratory function and bronchial inflammation. RESULTS BIGEPI analyzed data at the level of the entire Italian population, data on 2.8 million adults (>=30 yrs) in longitudinal metropolitan studies and on about 14,500 individuals (>=18 yrs) in epidemiological surveys on population samples. The population investigated in the longitudinal metropolitan studies had an average age of approximately 55 years and that of the epidemiological surveys was about 48 years; in both cases, 53% of the population was female. As regards environmental exposure, in the period 2013-2015, at national level average values for PM10, PM2.5, NO2 and summer O3 were: 21.1±13.6, 15.1±10.9, 14.7±9.1 and 80.3±17.3 µg/m3, for the temperature the average value was 13.9±7.2 °C. Data were analyzed for a total of 1,769,660 deaths from non-accidental causes as well as 74,392 incident cases of acute coronary event and 45,513 of stroke. Epidemiological investigations showed a high prevalence of symptoms/diagnoses of rhinitis (range: 14.2-40.5%), COPD (range: 4.7-19.3%) and asthma (range: 3.2-13.2%). The availability of these large datasets has made it possible to implement advanced statistical models for estimating the health effects of short- and long-term exposures to pollutants. The details are reported in the BIGEPI papers already published in other international journals and in those published in this volume of E&P. CONCLUSIONS BIGEPI has confirmed the great potential of using big data in studies of the health effects of environmental and occupational factors, stimulating new directions of scientific research and confirming the need for preventive action on air quality and climate change for the health of the general population and the workers.
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Affiliation(s)
- Sara Maio
- Istituto di fisiologia clinica del Consiglio nazionale delle ricerche, Pisa;
| | - Claudio Gariazzo
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale di INAIL, Roma
| | - Massimo Stafoggia
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Carla Ancona
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Lucia Bisceglia
- Agenzia regionale per la salute e il sociale della Puglia, Bari
| | - Nicola Caranci
- Settore innovazione nei Servizi sanitari e sociali, Direzione generale cura della persona, salute e welfare, Regione Emilia-Romagna, Bologna
| | - Achille Cernigliaro
- Dipartimento attività sanitarie e Osservatorio epidemiologico, Assessorato salute, Regione Sicilia, Palermo
| | - Giulia Cesaroni
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Giuseppe Costa
- Servizio sovrazonale di epidemiologia ASL TO3, Grugliasco, Torino
| | - Alessandro Marcon
- Sezione di epidemiologia e statistica medica, Dipartimento di diagnostica e sanità pubblica, Università di Verona
| | - Stefania Massari
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale di INAIL, Roma
| | - Federica Nobile
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Andrea Ranzi
- ARPAE Emilia-Romagna - Dir. Tecnica, struttura ambiente, prevenzione e salute, Bologna
| | - Matteo Renzi
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Salvatore Scondotto
- Dipartimento attività sanitarie e osservatorio epidemiologico, Assessorato salute, Regione Sicilia, Palermo
| | | | - Giuseppe Verlato
- Sezione di epidemiologia e statistica medica, Dipartimento di diagnostica e sanità pubblica, Università di Verona
| | - Giovanni Viegi
- Istituto di fisiologia clinica del Consiglio nazionale delle ricerche, Pisa
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Sanza M, Monzio Compagnoni M, Caggiu G, Allevi L, Barbato A, Campa J, Carle F, D'avanzo B, Di Fiandra T, Ferrara L, Gaddini A, Saponaro A, Scondotto S, Tozzi VD, Lorusso S, Giordani C, Corrao G, Lora A. Assessing the quality of the care offer for people with personality disorders in Italy: the QUADIM project. A multicentre research based on the database of use of Mental Health services. Int J Ment Health Syst 2023; 17:31. [PMID: 37833745 PMCID: PMC10571410 DOI: 10.1186/s13033-023-00603-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Italy can be viewed as a laboratory to assess the quality of mental healthcare delivered in a community-oriented system, especially for severe mental disorders, such as personality disorders. Although initiatives based on clinical indicators for assessing the quality of mental healthcare have been developed by transnational-organisations, there is still no widespread practice of measuring the quality of care pathways delivered to patients with severe mental disorders in a community-oriented system, especially using administrative healthcare databases. The aim of the study is to evaluate the quality of care delivered to patients with personality disorders taken-in-care by mental health services of four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily). METHODS A set of thirty-three clinical indicators, concerning accessibility, appropriateness, continuity, and safety of care, was implemented using regional healthcare utilization databases, containing data on mental health treatments and diagnosis, hospital admissions, outpatient interventions and exams and drug prescriptions. RESULTS 31,688 prevalent patients with personality disorders treated in 2015 were identified, of whom 2,331 newly taken-in-care. One-in-10 patients received a standardized assessment, the treatment discontinuity affected half of the cases. 12.7% of prevalent patients received at least one hospitalization, 10.6% in the newly taken-in-care cohort. 6-out-of-10 patients had contact with community-services within 14 days from hospital discharge. Access to psychotherapy and psychoeducational treatments was low and delivered with a low intensity. The median of psychosocial interventions per person-year was 19.1 and 9.4, respectively, in prevalent and newly taken-in-care cases. Nearly 50% of patients received pharmacological treatments. CONCLUSIONS Healthcare utilization databases were used to systematically evaluate and assess service delivery across regional mental health systems; suggesting that in Italy the public mental health services provide to individuals with personality disorders suboptimal treatment paths.
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Affiliation(s)
- Michele Sanza
- Department of Mental Health and Addiction Disorders Forlì-Cesena, AUSL Romagna, Cesena, Italy
| | - Matteo Monzio Compagnoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
| | - Giulia Caggiu
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Liliana Allevi
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Angelo Barbato
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | | | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Barbara D'avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Teresa Di Fiandra
- Psychologist, previously General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | - Lucia Ferrara
- Centre of Research on Health and Social Care Management, CERGAS SDA Bocconi School of Management (Bocconi University, Milan, Italy
| | | | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Valeria D Tozzi
- Centre of Research on Health and Social Care Management, CERGAS SDA Bocconi School of Management (Bocconi University, Milan, Italy
| | - Stefano Lorusso
- Department of Health Planning, Italian Health Ministry, Rome, Italy
| | | | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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Tozzi VD, Banks H, Ferrara L, Barbato A, Corrao G, D'avanzo B, Di Fiandra T, Gaddini A, Compagnoni MM, Sanza M, Saponaro A, Scondotto S, Lora A. Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment system. BMC Health Serv Res 2023; 23:960. [PMID: 37679722 PMCID: PMC10483754 DOI: 10.1186/s12913-023-09655-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/06/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Mental health (MH) care often exhibits uneven quality and poor coordination of physical and MH needs, especially for patients with severe mental disorders. This study tests a Population Health Management (PHM) approach to identify patients with severe mental disorders using administrative health databases in Italy and evaluate, manage and monitor care pathways and costs. A second objective explores the feasibility of changing the payment system from fee-for-service to a value-based system (e.g., increased care integration, bundled payments) to introduce performance measures and guide improvement in outcomes. METHODS Since diagnosis alone may poorly predict condition severity and needs, we conducted a retrospective observational study on a 9,019-patient cohort assessed in 2018 (30.5% of 29,570 patients with SMDs from three Italian regions) using the Mental Health Clustering Tool (MHCT), developed in the United Kingdom, to stratify patients according to severity and needs, providing a basis for payment for episode of care. Patients were linked (blinded) with retrospective (2014-2017) physical and MH databases to map resource use, care pathways, and assess costs globally and by cluster. Two regions (3,525 patients) provided data for generalized linear model regression to explore determinants of cost variation among clusters and regions. RESULTS Substantial heterogeneity was observed in care organization, resource use and costs across and within 3 Italian regions and 20 clusters. Annual mean costs per patient across regions was €3,925, ranging from €3,101 to €6,501 in the three regions. Some 70% of total costs were for MH services and medications, 37% incurred in dedicated mental health facilities, 33% for MH services and medications noted in physical healthcare databases, and 30% for other conditions. Regression analysis showed comorbidities, resident psychiatric services, and consumption noted in physical health databases have considerable impact on total costs. CONCLUSIONS The current MH care system in Italy lacks evidence of coordination of physical and mental health and matching services to patient needs, with high variation between regions. Using available assessment tools and administrative data, implementation of an episodic approach to funding MH could account for differences in disease phase and physical health for patients with SMDs and introduce performance measurement to improve outcomes and provide oversight.
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Affiliation(s)
- Valeria D Tozzi
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management - Bocconi University, Via Sarfatti, 10, Milan, 20136, Italy
| | - Helen Banks
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management - Bocconi University, Via Sarfatti, 10, Milan, 20136, Italy
| | - Lucia Ferrara
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management - Bocconi University, Via Sarfatti, 10, Milan, 20136, Italy.
| | - Angelo Barbato
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano- Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Barbara D'avanzo
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Teresa Di Fiandra
- General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | | | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano- Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Michele Sanza
- Department of Mental Health and Addiction Services, AUSL Romagna, Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Antonio Lora
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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De Cola MC, Ielo A, Corallo F, Pollina Addario S, Scondotto S, Allotta A, Fantaci G, Bramanti P, Ciurleo R. Development of a Set of Indicators for Measuring and Improving Quality of Rehabilitation Care after Ischemic Stroke. Healthcare (Basel) 2023; 11:2065. [PMID: 37510506 PMCID: PMC10378746 DOI: 10.3390/healthcare11142065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Stroke is the leading global cause of permanent disability and the second leading cause of dementia within the first year of the event. Systematic quality improvement interventions such as Audit & Feedback (A&F) can monitor and improve the performance of post-stroke care in conjunction with the use of quality indicators (QIs). The scientific literature shows limited studies on quality improvement and QIs design for poststroke rehabilitation. In Italy, the National Outcomes Evaluation Programme (PNE) annually provides several QIs concerning the acute wards. On the contrary, indicators for quality assessment of post-acute stroke rehabilitation are not available nationwide. In recent years, the Italian Ministry of Health has funded a national network project, the aim of which is to provide and evaluate the effectiveness of A&F strategies in healthcare improvement. Part of this project is the development of a set of IQs for ischemic stroke rehabilitation used to conduct an A&F. In this study, we describe the design and development process of these QIs from administrative databases and report the results of the pilot test conducted on a small sample of Sicilian rehabilitation facilities, comparing them from 2019 to 2021. Feedback from the participating centers was mainly positive, and the quality indicators were found to be comprehensible and appreciated. However, the study highlighted the need for better adherence to indicators measuring processes of rehabilitation care. The set of quality indicators presented in this study, relevant to inpatient settings, could be considered a starting point on which to base quality improvement initiatives both nationally and internationally.
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Affiliation(s)
| | - Augusto Ielo
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy
| | | | - Sebastiano Pollina Addario
- Assessorato della Salute, Dipartimento Attività Sanitarie e Osservatorio Epidemiologico, 90145 Palermo, Italy
| | - Salvatore Scondotto
- Assessorato della Salute, Dipartimento Attività Sanitarie e Osservatorio Epidemiologico, 90145 Palermo, Italy
| | - Alessandra Allotta
- Assessorato della Salute, Dipartimento Attività Sanitarie e Osservatorio Epidemiologico, 90145 Palermo, Italy
| | - Giovanna Fantaci
- Assessorato della Salute, Dipartimento Attività Sanitarie e Osservatorio Epidemiologico, 90145 Palermo, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy
- Faculty of Psychology, Università Degli Studi eCampus, Via Isimbardi 10, 22060 Novedrate, Italy
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Bruno C, Di Stefano R, Ricceri V, La Rosa M, Cernigliaro A, Ciranni P, Di Maria G, Mandrioli D, Zona A, Comba P, Scondotto S. Fluoro-edenite non-neoplastic diseases in Biancavilla (Sicily, Italy): pleural plaques and/or pneumoconiosis? Ann Ist Super Sanita 2023; 59:187-193. [PMID: 37712235 DOI: 10.4415/ann_23_03_03] [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
BACKGROUND A mesothelioma cluster in Biancavilla (Sicily, Italy), drew attention to fluoro-edenite, a fibre classified by International Agency for Research on Cancer as carcinogenic to humans. Significant excesses in mortality and morbidity were observed for respiratory diseases and a significant excess of pneumoconiosis hospitalizations was reported. OBJECTIVE Aim of this study is to assess the characters of the lung damage in Biancavilla residents hospitalized with pneumoconiosis or asbestosis diagnoses. METHODOLOGY Medical records, available radiographs and computed tomography scans were collected. The obtained imaging was reviewed by a panel of three specialists and focused on pleural and parenchymal abnormalities. Cases with an ILO-BIT or ICOERD score equal or greater than 2 were considered positive for a pneumoconiosis-like damage, cases with a score lower than 2 or insufficient quality of imaging were considered inconclusive. If no pneumoconiotic aspects were present the cases were classified as negative. RESULTS Out of 38 cases, diagnostic imaging for 25 cases were found. Ten cases out of 25 showed asbestosis-like features, nine subjects were considered negative. In six patients' results were inconclusive. CONCLUSIONS Asbestosis-like features were substantiated in Biancavilla residents without known occupational exposure to asbestos. Further studies to estimate population respiratory health are required. Experimental studies on the fibrogenic potential of fluoro-edenite are needed.
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Affiliation(s)
- Caterina Bruno
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | | | - Vincenzo Ricceri
- Divisione di Radiologia, Ospedale Maria Santissima Addolorata di Biancavilla, Azienda Provinciale Sanitaria, Catania, Italy
| | - Mauro La Rosa
- Divisione di Radiologia, Ospedale Maria Santissima Addolorata di Biancavilla, Azienda Provinciale Sanitaria, Catania, Italy
| | - Achille Cernigliaro
- Unità Operativa Complessa di Patologia Clinica, Dipartimento di Scienze Radiologiche e Servizi, Ospedale Sant'Antonio Abate, Azienda Sanitaria Provinciale, Trapani, Italy
| | - Paolo Ciranni
- Dipartimento per le Attività Sanitarie e Osservatorio Epidemiologico, Assessorato della Salute, Regione Siciliana, Palermo, Italy
| | - Giuseppe Di Maria
- Dipartimento di Medicina Interna, Università di Catania, Catania, Italy
| | | | - Amerigo Zona
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Salvatore Scondotto
- Dipartimento per le Attività Sanitarie e Osservatorio Epidemiologico, Assessorato della Salute, Regione Siciliana, Palermo, Italy
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D'Avanzo B, Barbato A, Monzio Compagnoni M, Caggiu G, Allevi L, Carle F, Di Fiandra T, Ferrara L, Gaddini A, Sanza M, Saponaro A, Scondotto S, Tozzi VD, Giordani C, Corrao G, Lora A. The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project. BMC Psychiatry 2023; 23:424. [PMID: 37312076 PMCID: PMC10261835 DOI: 10.1186/s12888-023-04921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The assessment of the quality of care pathways delivered to people with severe mental disorders in a community-based system remains uncommon, especially using healthcare utilization databases. The aim of the study was to evaluate the quality of care provided to people with bipolar disorders taken-in-care by mental health services of four Italian areas (Lombardy, Emilia-Romagna, Lazio, province of Palermo). METHODS Thirty-six quality indicators were implemented to assess quality of mental health care for patients with bipolar disorders, according to three dimensions (accessibility and appropriateness, continuity, and safety). Data were retrieved from healthcare utilization (HCU) databases, which contain data on mental health treatments, hospital admissions, outpatient interventions, laboratory tests and drug prescriptions. RESULTS 29,242 prevalent and 752 incident cases taken-in-care by regional mental health services with a diagnosis of bipolar disorder in 2015 were identified. Age-standardized treated prevalence rate was 16.2 (per 10,000 adult residents) and treated incidence rate 1.3. In the year of evaluation, 97% of prevalent cases had ≥ 1 outpatient/day-care contacts and 88% had ≥ 1 psychiatric visits. The median of outpatient/day-care contacts was 9.3 interventions per-year. Psychoeducation was provided to 3.5% of patients and psychotherapy to 11.5%, with low intensity. 63% prevalent cases were treated with antipsychotics, 71.5% with mood stabilizers, 46.6% with antidepressants. Appropriate laboratory tests were conducted in less than one-third of prevalent patients with a prescription of antipsychotics; three quarters of those with a prescription of lithium. Lower proportions were observed for incident patients. In prevalent patients, the Standardized Mortality Ratio was 1.35 (95% CI: 1.26-1.44): 1.18 (1.07-1.29) in females, 1.60 (1.45-1.77) in males. Heterogeneity across areas was considerable in both cohorts. CONCLUSIONS We found a meaningful treatment gap in bipolar disorders in Italian mental health services, suggesting that the fact they are entirely community-based does not assure sufficient coverage by itself. Continuity of contacts was sufficient, but intensity of care was low, suggesting the risk of suboptimal treatment and low effectiveness. Care pathways were monitored and evaluated using administrative healthcare databases, adding evidence that such data may contribute to assess the quality of clinical pathways in mental health.
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Affiliation(s)
- Barbara D'Avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Angelo Barbato
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy.
| | - Giulia Caggiu
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Liliana Allevi
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | | | - Lucia Ferrara
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University, Milan, Italy
| | | | - Michele Sanza
- Department of Mental Health and Substance Abuse, Local Health Trust of Romagna, Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Valeria D Tozzi
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University, Milan, Italy
| | | | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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8
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Conti S, Fornari C, Ferrara P, Antonazzo IC, Madotto F, Traini E, Levi M, Cernigliaro A, Armocida B, Bragazzi NL, Cadum E, Carugno M, Crotti G, Deandrea S, Cortesi PA, Guido D, Iavicoli I, Iavicoli S, La Vecchia C, Lauriola P, Michelozzi P, Scondotto S, Stafoggia M, Violante FS, Abbafati C, Albano L, Barone-Adesi F, Biondi A, Bosetti C, Buonsenso D, Carreras G, Castelpietra G, Catapano A, Cattaruzza MS, Corso B, Damiani G, Esposito F, Gallus S, Golinelli D, Hay SI, Isola G, Ledda C, Mondello S, Pedersini P, Pensato U, Perico N, Remuzzi G, Sanmarchi F, Santoro R, Simonetti B, Unim B, Vacante M, Veroux M, Villafañe JH, Monasta L, Mantovani LG. Time-Trends in Air Pollution Impact on Health in Italy, 1990-2019: An Analysis From the Global Burden of Disease Study 2019. Int J Public Health 2023; 68:1605959. [PMID: 37347013 PMCID: PMC10280378 DOI: 10.3389/ijph.2023.1605959] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives: We explored temporal variations in disease burden of ambient particulate matter 2.5 μm or less in diameter (PM2.5) and ozone in Italy using estimates from the Global Burden of Disease Study 2019. Methods: We compared temporal changes and percent variations (95% Uncertainty Intervals [95% UI]) in rates of disability adjusted life years (DALYs), years of life lost, years lived with disability and mortality from 1990 to 2019, and variations in pollutant-attributable burden with those in the overall burden of each PM2.5- and ozone-related disease. Results: In 2019, 467,000 DALYs (95% UI: 371,000, 570,000) were attributable to PM2.5 and 39,600 (95% UI: 18,300, 61,500) to ozone. The crude DALY rate attributable to PM2.5 decreased by 47.9% (95% UI: 10.3, 65.4) from 1990 to 2019. For ozone, it declined by 37.0% (95% UI: 28.9, 44.5) during 1990-2010, but it increased by 44.8% (95% UI: 35.5, 56.3) during 2010-2019. Age-standardized rates declined more than crude ones. Conclusion: In Italy, the burden of ambient PM2.5 (but not of ozone) significantly decreased, even in concurrence with population ageing. Results suggest a positive impact of air quality regulations, fostering further regulatory efforts.
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Affiliation(s)
- Sara Conti
- Research Center on Public Health, University of Milan Bicocca, Monza, Italy
| | - Carla Fornari
- Research Center on Public Health, University of Milan Bicocca, Monza, Italy
| | - Pietro Ferrara
- Research Center on Public Health, University of Milan Bicocca, Monza, Italy
- Laboratory of Public Health, Auxologico Research Hospital—IRCCS, Milan, Italy
| | | | - Fabiana Madotto
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Eugenio Traini
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Miriam Levi
- Epidemiology Unit, Department of Prevention, Central Tuscany Local Health Authority, Florence, Italy
| | - Achille Cernigliaro
- Health Activities and Epidemiological Observatory Department, Health Authority Sicily Region, Parlemo, Italy
- Clinical Pathology Complex Hospital Unit, Health Authority Trapani Province, Trapani, Italy
| | - Benedetta Armocida
- Department of Cardiovascular, Endocrine-Metabolic Disease and Aging, National Institute of Health (ISS), Rome, Italy
| | - Nicola L. Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, Faculty of Science, York University, Toronto, ON, Canada
| | - Ennio Cadum
- Department of Hygiene and Health Prevention and Complex Operative Unit Environmental Health and Innovative Projects, Health Protection Agency, Pavia, Italy
| | - Michele Carugno
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Crotti
- Servizio Epidemiologico Aziendale, Agenzia di Tutela della Salute di Bergamo, Bergamo, Italy
| | - Silvia Deandrea
- Department of Hygiene and Health Prevention and Complex Operative Unit Environmental Health and Innovative Projects, Health Protection Agency, Pavia, Italy
| | - Paolo A. Cortesi
- Research Center on Public Health, University of Milan Bicocca, Monza, Italy
| | - Davide Guido
- Neurology, Public Health and Disability Unit, Carlo Besta Neurological Institute, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ivo Iavicoli
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine Epidemiology and Hygiene, Italian National Workers Compensation Authority (IIL), Monteporzio Catone, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Lauriola
- International Society Doctors for the Environment, Milan, Italy
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Region Health Authority (ASL RM1), Rome, Italy
| | - Salvatore Scondotto
- Health Activities and Epidemiological Observatory Department, Health Authority Sicily Region, Parlemo, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Authority (ASL RM1), Rome, Italy
| | - Francesco S. Violante
- Occupational Health Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Cristiana Abbafati
- Department of Juridical and Economic Studies, Faculty of Law, Sapienza University of Rome, Rome, Italy
| | - Luciana Albano
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Antonio Biondi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Cristina Bosetti
- Department of Oncology, Mario Negri Pharmacological Research Institute (IRCCS), Milano, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS (Agostino Gemelli University Polyclinic IRCCS), Rome, Italy
- Global Health Research Institute, Università Cattolica del Sacro Cuore (Catholic University of Sacred Heart), Rome, Italy
| | - Giulia Carreras
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Giulio Castelpietra
- Department of Medicine, University of Udine, Udine, Italy
- Department of Mental Health, Healthcare Agency “Friuli Occidentale”, Pordenone, Italy
| | - Alberico Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- MultiMedica, IRCCS, Sesto San Giovanni, Italy
| | - Maria S. Cattaruzza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Barbara Corso
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - Giovanni Damiani
- IRCCS Istituto Ortopedico Galeazzi (Galeazzi Orthopedic Institute IRCCS), University of Milan, Milan, Italy
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States
| | - Francesco Esposito
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Gaetano Isola
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Caterina Ledda
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Messina University, Messina, Italy
| | - Paolo Pedersini
- Clinical Research Department, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Umberto Pensato
- Department of Neurology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Biagio Simonetti
- Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy
- WSB University in Gdańsk, Gdańsk, Poland
| | - Brigid Unim
- Department of Cardiovascular, Endocrine-Metabolic Disease and Aging, National Institute of Health (ISS), Rome, Italy
| | - Marco Vacante
- Department of Oncology, Mario Negri Pharmacological Research Institute (IRCCS), Milano, Italy
| | - Massimiliano Veroux
- Department of Medical, Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Jorge H. Villafañe
- Clinical Research Department, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Lorenzo G. Mantovani
- Research Center on Public Health, University of Milan Bicocca, Monza, Italy
- Laboratory of Public Health, Auxologico Research Hospital—IRCCS, Milan, Italy
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9
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Rea F, Ferrante M, Scondotto S, Corrao G. Small-area deprivation index does not improve the capability of multisource comorbidity score in mortality prediction. Front Public Health 2023; 11:1128377. [PMID: 37261238 PMCID: PMC10228715 DOI: 10.3389/fpubh.2023.1128377] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
Background The stratification of the general population according to health needs allows to provide better-tailored services. A simple score called Multisource Comorbidity Score (MCS) has been developed and validated for predicting several outcomes. The aim of this study was to evaluate whether the ability of MCS in predicting 1-year mortality improves by incorporating socioeconomic data (as measured by a deprivation index). Methods Beneficiaries of the Italian National Health Service who in the index year (2018) were aged 50-85 years and were resident in the Sicily region for at least 2 years were identified. For each individual, the MCS was calculated according to his/her clinical profile, and the deprivation index of the census unit level of the individual's residence was collected. Frailty models were fitted to assess the relationship between the indexes (MCS and deprivation index) and 1-year mortality. Akaike information criterion and Bayesian information criterion statistics were used to compare the goodness of fit of the model that included only MCS and the model that also contained the deprivation index. The models were further compared by means of the area under the receiver operating characteristic curve (AUC). Results The final cohort included 1,062,221 individuals, with a mortality rate of 15.6 deaths per 1,000 person-years. Both MCS and deprivation index were positively associated with mortality.The goodness of fit statistics of the two models were very similar. For MCS only and MCS plus deprivation index models, Akaike information criterion were 17,013 and 17,038, respectively, whereas Bayesian information criterion were 16,997 and 17,000, respectively. The AUC values were 0.78 for both models. Conclusion The present study shows that socioeconomic features as measured by the deprivation index did not improve the capability of MCS in predicting 1-year risk of death. Future studies are needed to investigate other sources of data to enhance the risk stratification of populations.
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Affiliation(s)
- Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Mauro Ferrante
- Department of Culture and Society, University of Palermo, Palermo, Italy
| | | | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- Directorate General for Health, Lombardy Region, Milan, Italy
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10
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Monzio Compagnoni M, Caggiu G, Allevi L, Barbato A, Carle F, D'Avanzo B, Di Fiandra T, Ferrara L, Gaddini A, Giordani C, Sanza M, Saponaro A, Scondotto S, Tozzi VD, Corrao G, Lora A. Assessment and Monitoring of the Quality of Clinical Pathways in Patients with Depressive Disorders: Results from a Multiregional Italian Investigation on Mental Health Care Quality (the QUADIM Project). J Clin Med 2023; 12:jcm12093297. [PMID: 37176737 PMCID: PMC10179491 DOI: 10.3390/jcm12093297] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Ensuring adequate quality of care to patients with severe mental disorders remains a challenge. The implementation of clinical indicators aimed at assessing the quality of health care pathways delivered is crucial for the improvement of mental health services (MHS). This study aims to evaluate the quality of care delivered to patients who are taken-into-care with depressive disorders by MHS. Thirty-four clinical indicators concerning accessibility, appropriateness, continuity, and safety were estimated using health care utilization databases from four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily). A total of 78,924 prevalent patients treated for depressive disorders in 2015 were identified, of whom 15,234 were newly engaged by MHS. During the year of follow-up, access to psychotherapeutic interventions was low, while the intensity was adequate; 5.1% of prevalent patients received at least one hospitalization in a psychiatric ward (GHPW), and 3.3% in the cohort of newly engaged in services. Five-out-of-10 patients had contact with community services within 14 days after GHPW discharge, but less than half of patients were persistent to antidepressant drug therapy. Furthermore, prevalent patients showed an excess of mortality compared to the general population (SMR = 1.35; IC 95%: 1.26-1.44). In conclusion, the quality of health care is not delivered in accordance with evidence-based mental health standards. Evaluation of health interventions are fundamental strategies for improving the quality and equity of health care.
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Affiliation(s)
- Matteo Monzio Compagnoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Giulia Caggiu
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, 23900 Lecco, Italy
| | - Liliana Allevi
- Department of Mental Health and Addiction Services, ASST Lecco, 23900 Lecco, Italy
| | - Angelo Barbato
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Barbara D'Avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Teresa Di Fiandra
- Psychologist, Previously General Directorate for Health Prevention, Ministry of Health, 00144 Rome, Italy
| | - Lucia Ferrara
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, 20100 Milan, Italy
| | | | - Cristina Giordani
- Department of Health Planning, Italian Health Ministry, 00144 Rome, Italy
| | - Michele Sanza
- Department of Mental Health and Addiction Disorders Forlì-Cesena, AUSL Romagna, 48121 Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, 40127 Bologna, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, 90145 Palermo, Italy
| | - Valeria D Tozzi
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, 20100 Milan, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, 23900 Lecco, Italy
- Consultant for General Directorate for Welfare, 20124 Milan, Italy
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11
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Vitrano A, Musallam KM, Meloni A, Karimi M, Daar S, Ricchi P, Costantini S, Vlachaki E, Di Marco V, El-Beshlawy A, Hajipour M, Ansari SH, Filosa A, Ceci A, Singer ST, Naserullah ZA, Pepe A, Cademartiri F, Pollina SA, Scondotto S, Dardanoni G, Bonifazi F, Sankaran VG, Vichinsky E, Taher AT, Maggio A. Development of a Thalassemia International Prognostic Scoring System (TIPSS). Blood Cells Mol Dis 2023; 99:102710. [PMID: 36463683 DOI: 10.1016/j.bcmd.2022.102710] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
A prognostic scoring system that can differentiate β-thalassemia patients based on mortality risk is lacking. We analysed data from 3145 β-thalassemia patients followed through a retrospective cohort design for the outcome of death. An a priori list of prognostic variables was collected. β Coefficients from a multivariate cox regression model were used from a development dataset (n = 2516) to construct a formula for a Thalassemia International Prognostic Scoring System (TIPSS) which was subsequently applied to a validation dataset (n = 629). The median duration of observation was 10.0 years. The TIPSS score formula was constructed as exp (1.4 × heart disease + 0.9 × liver disease + 0.9 × diabetes + 0.9 × sepsis + 0.6 × alanine aminotransferase ≥42 IU/L + 0.6 × hemoglobin ≤9 g/dL + 0.4 × serum ferritin ≥1850 ng/mL). TIPSS score thresholds of greatest differentiation were assigned as <2.0 (low-risk), 2.0 to <5.0 (intermediate-risk), and ≥5.0 (high-risk). The TIPSS score was a good predictor for the outcome of death in the validation dataset (AUC: 0.722, 95%CI: 0.641-0.804) and survival was significantly different between patients in the three risk categories (P < 0.001). Compared to low-risk patients, the hazard ratio for death was 2.778 (95%CI: 1.335-5.780) in patients with intermediate-risk and 6.431 (95%CI: 3.151-13.128) in patients with high-risk. This study provides a novel tool to support mortality risk categorization for patients with β-thalassemia that could help management and research decisions.
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Affiliation(s)
- Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Khaled M Musallam
- Thalassemia Center, Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Oman; Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | | | - Efthymia Vlachaki
- Thalassaemia Unit, Ippokratio University Hospital, Thessaloniki, Greece
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Sylvia Titi Singer
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | | | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Harvard Stem Cell Institute, Cambridge, MA, USA
| | - Elliott Vichinsky
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy.
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12
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Zona A, Fazzo L, Benedetti M, Bruno C, Vecchi S, Pasetto R, Minichilli F, De Santis M, Nannavecchia AM, Di Fonzo D, Contiero P, Ricci P, Bisceglia L, Manno V, Minelli G, Santoro M, Gorini F, Ancona C, Scondotto S, Soggiu ME, Scaini F, Beccaloni E, Marsili D, Villa MF, Maifredi G, Magoni M, Iavarone I. [SENTIERI - Epidemiological Study of Residents in National Priority Contaminated Sites. Sixth Report]. Epidemiol Prev 2023; 47:1-286. [PMID: 36825373 DOI: 10.19191/ep23.1-2-s1.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION ADN OBJECTIVES The Sixth Report presents the results of the "SENTIERI Project: implementation of the permanent epidemiological surveillance system of populations residing in Italian Sites of Remediation Interest", promoted and financed by the Italian Ministry of Health (Centre for Disease Control and Prevention - CCM Project 2018). The aim of this study is to update the mortality and hospitalization analyses concerning the 6,227,531 inhabitants (10.4% of the Italian population) residing in 46 contaminated sites (39 of national interest and 7 of regional interest). The sites include 316 municipalities distributed as follows: 15 in the North-East (20.3% of the investigated population); 104 in the North-West (12% of the investigated population), 32 in the Centre (12.6% of the investigated population), 165 in the South and Islands (55.5% of the investigated population). Analyses were carried out on the paediatric-adolescent (1,128,396 residents) and youth (665,284 residents) population, and a study on congenital anomalies (CA) was carried out at sites covered by congenital malformation registers. Accompanying the epidemiological assessments, site-specific socioeconomic conditions were examined and an overall estimate of excess risk for populations residing at contaminated sites was drawn up. By means of a systematic review of the scientific literature, the epidemiological evidence on causal links between sources of environmental exposure and health effects was updated to identify pathologies of a priori interest. METHODOLOGY In the 46 sites included in the SENTIERI Project, mortality (time window: 2013-2017) and hospital admissions (time window: 2014-2018) of the general population of all ages, divided by gender, and of the paediatric-adolescent (0-1 year, 0-14 years, 0-19 years), youth (20-29 years), and overall (0-29 years) age groups, divided by gender, were analysed. In 21 sites, CA diagnosed within the first year of life were studied. Standardised mortality ratios (SMR) and hospitalization ratios (SHR) were calculated with reference to the rates in the regions to which the sites belong. The reference population was calculated net of residents in the sites. CA were studied by calculating the prevalence per 10,000 births and the ratio, multiplied by 100, between the cases observed at the site and those expected on the basis of the prevalences observed in the reference area (region or sub-regional area of belonging, according to the geographical coverage of the registry). The socioeconomic condition studied in the 46 sites is based on the convergence of three deprivation indicators with respect to the reference region: deprivation index at municipal level, deprivation index at census section level, premature mortality indicator (age range 30-69 years) for chronic non-communicable diseases. For the estimation of excess risk for the entire study population, meta-analysis of the mortality and hospitalization risk estimates for each site was carried out and the number of excess deaths estimated for the sites as a whole. The epidemiological evidence was updated through a systematic literature review (January 2009-May 2020), following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was carried out on the search engines MEDLINE, EMBASE and Web of Science; the quality of the studies included in the review was assessed using the AMSTAR 2 checklist for systematic reviews and the NewCastle-Ottawa Scale for observational studies in the case of cohort and case-control studies and a modified version thereof for ecological and cross-sectional studies. The update was based on the selection of 14 systematic reviews, 15 primary studies, 6 monographs/reports from international scientific organisations on health effects due to the presence of environmental exposure sources. RESULTS Mortality. The a priori causes of interest that occur most frequently in excess are, in descending order: malignant lung cancer, malignant mesothelioma of the pleura, malignant bladder cancer, respiratory diseases, non-Hodgkin lymphomas, malignant liver cancer, all malignant tumours, malignant colorectal cancer, malignant stomach cancer, total mesotheliomas, malignant breast cancer, and asbestosis. Hospitalization. The a priori causes of interest that occur most frequently in excess are represented in descending order by: respiratory diseases, malignant lung cancer, malignant tumours of the pleura, malignant bladder cancer, malignant breast cancer, malignant liver cancer, asthma, malignant colorectal cancer, all malignant tumours, malignant stomach cancer, non-Hodgkin's lymphomas, acute respiratory diseases, leukaemias. The differences observed between mortality and hospitalization can be attributed to the intrinsic characteristics of the diseases (higher or lower lethality, gender differences in incidence), lifestyles, and occupational phenomena. Age classes. Excesses of general mortality were observed in the first year of life at the Manfredonia, Basso Bacino Fiume Chienti, Litorale Domizio Flegreo and Agro Aversano sites; in the 0-1 year and 0-19 year age groups at Casale Monferrato; in the paediatric age group at Serravalle Scrivia and at the Trento Nord site; in the 0-19 year age group at Sassuolo Scandiano; in the young age group (0-29 years) at the two municipalities of Cerchiara and Cassano (Crotone-Cassano-Cerchiara site). With regard to hospitalization due to natural causes, risk excesses in both genders are found in the first year of life in 35% of the sites (Porto Torres industrial areas, Bari-Fibronit, Basso bacino fiume Chienti, Bolzano, Crotone-Cassano-Cerchiara, Cerro al Lambro, Bologna ETR large repair workshop, Gela, Manfredonia, Massa Carrara, Pioltello Rodano, Pitelli, Priolo, Sesto San Giovanni, Trento Nord, and Trieste). These same sites, with the addition of Casale Monferrato, Cengio e Saliceto, Serravalle Scrivia, and Sulcis-Iglesiente-Guspinese (total: 43% of sites), show excesses for all natural causes, in both genders, even in the paediatric-adolescent age group (0-19 years). Among young adults (20-29 years), the analyses show excesses of hospitalization for all natural causes in both genders in the Bolzano, Crotone-Cassano-Cerchiara, Gela, Manfredonia, Pitelli, Priolo, and Sulcis-Iglesiente-Guspinese sites. Among young women only, excesses for all natural causes are also found in Brescia Caffaro, Brindisi, Broni, Casale Monferrato, Crotone-Cassano-Cerchiara, Falconara Marittima, Fidenza, and Massa Carrara. Congenital anomalies. In the 21 sites investigated for CA, 10,126 cases of CA, validated by participating registers, were analysed out of 304,620 resident births. Genital CA is the subgroup for which the greatest number of excesses was observed (in 6 out of 21 sites). The available evidence does not allow a causal link to be established between the excesses observed for specific subgroups of ACs and exposure to industrial sources, but the results suggest further action. The interpretation of the results appears, in fact, particularly complex as the scientific literature on the association between exposure to industrial sources and AC is very limited. Socioeconomic status. The sites in which the indicators converge to show the presence of fragility are: Litorale Vesuviano area, Val Basento industrial areas, Basso Bacino fiume Chienti, Biancavilla, Crotone-Cassano-Cerchiara, Litorale Domizio Flegreo and Agro Aversano, Livorno, Massa Carrara, Trieste. Global impact. Over the period 2013-2017, an estimated 8,342 excess deaths (CI90% 1,875-14,809) or approximately 1,668 excess cases/year, 4,353 excess deaths among males (CI90% 334-8,372) and 3,989 among females (CI90% -1,122;9,101). The pooled excess risk of general mortality is 2% in both genders (pooled SMR 1.02; CI90% 1.00-1.04). The proportion of excess deaths to total observed deaths is almost constant over time, rising from 2.5% in 1995-2002 to 2.6% in 2013-2017. The number of deaths in absolute value is also very similar between the periods analysed. Deaths from all malignant tumours contribute the most by accounting for 56% of the observed excesses, the excess risk of mortality from malignant tumours across all sites, compared to the reference populations, is 4% in the male population (pooled SMR 1.04; CI90% 1.01-1.06) and 3% among the female population (pooled SMR 1.03; CI90% 1.01-1.05). Hospitalization (2014-2018) in the 46 sites as a whole was in excess of 3% for all causes, in both genders, for all major disease groups (males: SHR pooled 1.03; CI90% 1.01-1.04 - females: SHR pooled 1.03; CI90% 1.01-1.05). The results for the pooled estimates at the 46 sites on the general population, both with regard to mortality and hospitalization, are consistent in indicating excess risk in both genders for all the diseases considered and, in particular, for all malignancies. A total of 1,409 paediatric-adolescent deaths and 999 young adult deaths were observed, and the pooled analysis of mortality across the 46 sites showed no critical issues, with pooled estimates for all causes, perinatal morbid conditions and all malignancies falling short of expectations. The analysis of hospitalizations, on the other hand, showed an excess risk of 8% (males: SHR pooled 1.08; CI90% 1.03-1.13 - females: SHR pooled 1.08; CI90% 1.03-1.14) for all causes in the first year of life, and in paediatric-adolescent and juvenile age of 3-4% among males (age 0-19 years: SHR pooled 1.04; CI90% 1.02-1.06 - age 20-29 years: SHR pooled 1.03; CI90% 1.00-1.05) and 5% among females (in both age groups; SHR pooled 1.05; CI90% 1.02-1.08). The pooled analysis of mortality for the a priori identified diseases reported excesses for specific diseases in the group of sites with sources of exposure associated with them. Mortality from total mesotheliomas is three times higher at sites with asbestos present (males: pooled SMR 3.02; CI90% 2.18-3.87 - females: pooled SMR 3.61; CI90% 2.33-4.88) and that from pleural mesotheliomas more than two times higher at the group of sites with asbestos and port areas (males: pooled SMR 2.47; CI90% 1.94-3.00 - females: pooled SMR 2.43; CI90% 1.67-3.19). Lung cancer was in excess by 6% among males (pooled SMR 1.06; CI90% 1.03-1.10) and 7% among females (pooled SMR 1.07; CI90% 1.00-1.13). In addition, there are excess mortalities for colorectal cancer at sites with chemical plants, by 4 % among males (SMR pooled 1.04; CI90% 1.01-1.08) and 3 % among females (SMR pooled 1.03; CI90% 1.00-1.07) and for bladder cancer among the male population of sites with landfills (+6 %: SMR pooled 1.06; CI90% 1.02-1.11). Among the diseases of a priori interest, stomach and soft tissue cancers are at fault as a cause of death among all the sites considered. LITERATURE REVIEW The update of the epidemiological evidence underlying the Sixth SENTIERI Report has highlighted in the general population a possible association, previously undiscovered, between certain diseases and residence near petrochemical and steel plants, landfills, coal mines and asbestos sources. CONCLUSIONS AND PERSPECTIVES Despite the fact that this is an ecological study, and the excesses of pathologies with multifactorial aetiology can never be mechanically attributed solely to the environmental pressure factors that exist or existed in the areas studied, the ability to identify the excesses found in the contaminated sites investigated by the SENTIERI Project confirms the validity of this method of assessing the site-specific health profile, based on the use of epidemiological evidence to identify pathologies of interest a priori. In interpreting the data and lending robustness to what has been observed, comparison with the results obtained in previous Reports is essential. The global estimates give an overall picture that shows excess mortality and hospitalization in these populations compared to the rest of the population, and show how, for specific pathologies, comparable effects are produced at sites with similar contamination characteristics. The themes developed in the in-depth chapters broaden the vision and understanding of the complex interactions between environment and health, describe the possibilities offered by new ways of communicating the results, and confirm the modernity of a Project that began way back in 2006, and that could be grafted onto the objectives of the National Recovery and Resilience Plan within the framework of the Operational Programme Health, Environment, Biodiversity and Climate.
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Affiliation(s)
- Amerigo Zona
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma; .,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Marta Benedetti
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Caterina Bruno
- già Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,già WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Simona Vecchi
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Roberto Pasetto
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Fabrizio Minichilli
- Unità di ricerca di epidemiologia ambientale e registri di patologia, Istituto di fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
| | - Marco De Santis
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Anna Maria Nannavecchia
- Agenzia regionale strategica per la salute e il sociale della Puglia (AReSS Puglia), Bari.,Registro delle malformazioni congenite della Regione Puglia
| | | | - Paolo Contiero
- SS Epidemiologia ambientale, Fondazione IRCCS Istituto nazionale dei tumori, Milano
| | - Paolo Ricci
- già UOC Osservatorio epidemiologico, ATS Val Padana, Mantova
| | - Lucia Bisceglia
- Agenzia regionale strategica per la salute e il sociale della Puglia (AReSS Puglia), Bari.,Registro delle malformazioni congenite della Regione Puglia
| | - Valerio Manno
- Servizio tecnico-scientifico di statistica, Istituto superiore di sanità, Roma
| | - Giada Minelli
- Servizio tecnico-scientifico di statistica, Istituto superiore di sanità, Roma
| | - Michele Santoro
- Unità di epidemiologia delle malattie rare e delle anomalie congenite, Istituto di fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
| | - Francesca Gorini
- Unità di epidemiologia delle malattie rare e delle anomalie congenite, Istituto di fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
| | - Carla Ancona
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Salvatore Scondotto
- già Dipartimento per le attività sanitarie e osservatorio epidemiologico, Assessorato della salute, Regione Siciliana.,già Sistema di sorveglianza sulle malformazioni congenite, Regione Sicilia
| | | | - Federica Scaini
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
| | | | - Daniela Marsili
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Marco Francesco Villa
- UOC Osservatorio epidemiologico, ATS Val Padana, Mantova.,Registro malformazioni congenite della Provincia di Mantova
| | | | - Michele Magoni
- già UO Osservatorio epidemiologico, ATS Brescia, Brescia
| | - Ivano Iavarone
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
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Merlo I, Cantarutti A, Allotta A, Tavormina EE, Iommi M, Pompili M, Rea F, Agodi A, Locatelli A, Zanini R, Carle F, Addario SP, Scondotto S, Corrao G. Development and Validation of a Novel Pre-Pregnancy Score Predictive of Preterm Birth in Nulliparous Women Using Data from Italian Healthcare Utilization Databases. Healthcare (Basel) 2022; 10:healthcare10081443. [PMID: 36011100 PMCID: PMC9407812 DOI: 10.3390/healthcare10081443] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Preterm birth is a major worldwide public health concern, being the leading cause of infant mortality. Understanding of risk factors remains limited, and early identification of women at high risk of preterm birth is an open challenge. Objective: The aim of the study was to develop and validate a novel pre-pregnancy score for preterm delivery in nulliparous women using information from Italian healthcare utilization databases. Study Design: Twenty-six variables independently able to predict preterm delivery were selected, using a LASSO logistic regression, from a large number of features collected in the 4 years prior to conception, related to clinical history and socio-demographic characteristics of 126,839 nulliparous women from Lombardy region who gave birth between 2012 and 2017. A weight proportional to the coefficient estimated by the model was assigned to each of the selected variables, which contributed to the Preterm Birth Score. Discrimination and calibration of the Preterm Birth Score were assessed using an internal validation set (i.e., other 54,359 deliveries from Lombardy) and two external validation sets (i.e., 14,703 and 62,131 deliveries from Marche and Sicily, respectively). Results: The occurrence of preterm delivery increased with increasing the Preterm Birth Score value in all regions in the study. Almost ideal calibration plots were obtained for the internal validation set and Marche, while expected and observed probabilities differed slightly in Sicily for high Preterm Birth Score values. The area under the receiver operating characteristic curve was 60%, 61% and 56% for the internal validation set, Marche and Sicily, respectively. Conclusions: Despite the limited discriminatory power, the Preterm Birth Score is able to stratify women according to their risk of preterm birth, allowing the early identification of mothers who are more likely to have a preterm delivery.
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Affiliation(s)
- Ivan Merlo
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy; (I.M.); (F.R.); (G.C.)
| | - Anna Cantarutti
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy; (I.M.); (F.R.); (G.C.)
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (S.P.A.); (S.S.)
- Correspondence: ; Tel.: +39-02-6448-5828; Fax: +39-02-6448-5899
| | - Alessandra Allotta
- Department of Health Activities and Epidemiological Observatory, Regional Health Authority, Sicily Region, 90145 Palermo, Italy; (A.A.); (E.E.T.)
| | - Elisa Eleonora Tavormina
- Department of Health Activities and Epidemiological Observatory, Regional Health Authority, Sicily Region, 90145 Palermo, Italy; (A.A.); (E.E.T.)
- National Research Council of Italy, Institute for Biomedical Research and Innovation, 90146 Palermo, Italy
| | - Marica Iommi
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60020 Ancona, Italy;
| | - Marco Pompili
- Regional Epidemiological Observatory, Regional Health Agency of Marche, 60125 Ancona, Italy;
| | - Federico Rea
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy; (I.M.); (F.R.); (G.C.)
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (S.P.A.); (S.S.)
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy;
| | - Anna Locatelli
- Department of Mother and Child, ASST Vimercate, 20871 Vimercate, Italy;
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Rinaldo Zanini
- Past Director of Woman and Child Health Department, Azienda Ospedaliera della Provincia di Lecco, 23900 Lecco, Italy;
| | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (S.P.A.); (S.S.)
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60020 Ancona, Italy;
| | - Sebastiano Pollina Addario
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (S.P.A.); (S.S.)
- Department of Health Activities and Epidemiological Observatory, Regional Health Authority, Sicily Region, 90145 Palermo, Italy; (A.A.); (E.E.T.)
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (S.P.A.); (S.S.)
- Department of Health Activities and Epidemiological Observatory, Regional Health Authority, Sicily Region, 90145 Palermo, Italy; (A.A.); (E.E.T.)
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy; (I.M.); (F.R.); (G.C.)
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (S.P.A.); (S.S.)
- Directorate General for Health, Lombardy Region, 20124 Milan, Italy
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14
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Renzi M, Scortichini M, Forastiere F, De' Donato F, Michelozzi P, Davoli M, Gariazzo C, Viegi G, Stafoggia M, Ancona C, Bucci S, De' Donato F, Michelozzi P, Renzi M, Scortichini M, Stafoggia M, Bonafede M, Gariazzo C, Marinaccio A, Argentini S, Sozzi R, Bonomo S, Fasola S, Forastiere F, La Grutta S, Viegi G, Cernigliaro A, Scondotto S, Baldacci S, Maio S, Licitra G, Moro A, Angelini P, Bonvicini L, Broccoli S, Ottone M, Rossi PG, Colacci A, Parmagnani F, Ranzi A, Galassi C, Migliore E, Bisceglia L, Chieti A, Brusasca G, Calori G, Finardi S, Nanni A, Pepe N, Radice P, Silibello C, Tinarelli G, Uboldi F, Carlino G. A nationwide study of air pollution from particulate matter and daily hospitalizations for respiratory diseases in Italy. Sci Total Environ 2022; 807:151034. [PMID: 34666080 DOI: 10.1016/j.scitotenv.2021.151034] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND/AIM The relationship between air pollution and respiratory morbidity has been widely addressed in urban and metropolitan areas but little is known about the effects in non-urban settings. Our aim was to assess the short-term effects of PM10 and PM2.5 on respiratory admissions in the whole country of Italy during 2006-2015. METHODS We estimated daily PM concentrations at the municipality level using satellite data and spatiotemporal predictors. We collected daily counts of respiratory hospital admissions for each Italian municipality. We considered five different outcomes: all respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), lower and upper respiratory tract infections (LRTI and URTI). Meta-analysis of province-specific estimates obtained by time-series models, adjusting for temperature, humidity and other confounders, was applied to extrapolate national estimates for each outcome. At last, we tested for effect modification by sex, age, period, and urbanization score. Analyses for PM2.5 were restricted to 2013-2015 cause the goodness of fit of exposure estimation. RESULTS A total of 4,154,887 respiratory admission were registered during 2006-2015, of which 29% for LRTI, 12% for COPD, 6% for URTI, and 3% for asthma. Daily mean PM10 and PM2.5 concentrations over the study period were 23.3 and 17 μg/m3, respectively. For each 10 μg/m3 increases in PM10 and PM2.5 at lag 0-5 days, we found excess risks of total respiratory diseases equal to 1.20% (95% confidence intervals, 0.92, 1.49) and 1.22% (0.76, 1.68), respectively. The effects for the specific diseases were similar, with the strongest ones for asthma and COPD. Higher effects were found in the elderly and in less urbanized areas. CONCLUSIONS Short-term exposure to PM is harmful for the respiratory system throughout an entire country, especially in elderly patients. Strong effects can be found also in less urbanized areas.
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Affiliation(s)
- Matteo Renzi
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy.
| | - Matteo Scortichini
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
| | - Francesco Forastiere
- CNR Institute of Biomedical Research and Innovation (IRIB), Palermo, Italy; Environmental Research Group, School of Public Health, Imperial College, London, UK
| | - Francesca De' Donato
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
| | - Paola Michelozzi
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
| | - Marina Davoli
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
| | - Claudio Gariazzo
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Monteporzio Catone (RM), Italy
| | - Giovanni Viegi
- CNR Institute of Biomedical Research and Innovation (IRIB), Palermo, Italy; CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
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15
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Musallam KM, Vitrano A, Meloni A, Pollina SA, Karimi M, El‐Beshlawy A, Hajipour M, Di Marco V, Ansari SH, Filosa A, Ricchi P, Ceci A, Daar S, Vlachaki E, Singer ST, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Sankaran VG, Vichinsky E, Taher AT, Maggio A. Risk of mortality from anemia and iron overload in nontransfusion-dependent β-thalassemia. Am J Hematol 2022; 97:E78-E80. [PMID: 34862982 DOI: 10.1002/ajh.26428] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/17/2022]
Affiliation(s)
| | - Angela Vitrano
- Campus of Haematology Franco and Piera Cutino AOOR Villa Sofia‐V, Cervello Palermo Italy
| | - Antonella Meloni
- MRI Unit, Fondazione G. Monasterio CNR‐Regione Toscana Pisa Italy
| | | | - Mehran Karimi
- Haematology Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Amal El‐Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine Cairo University Cairo Egypt
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica University of Palermo Palermo Italy
| | | | - Aldo Filosa
- Rare Blood Cell Disease Unit "Cardarelli" Hospital Naples Italy
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit "Cardarelli" Hospital Naples Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Valenzano (BA) Italy
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman; Wallenberg Research Centre, Stellenbosch Institute for Advanced Study Stellenbosch University Stellenbosch South Africa
| | - Efthymia Vlachaki
- Thalassaemia Unit Ippokratio University Hospital Thessaloniki Greece
| | - Sylvia Titi Singer
- Division of Hematology‐Oncology, Department of Pediatrics University of California San Francisco, UCSF Benioff Children's Hospital Oakland Oakland California USA
| | | | - Alessia Pepe
- MRI Unit, Fondazione G. Monasterio CNR‐Regione Toscana Pisa Italy
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Valenzano (BA) Italy
| | - Vijay G. Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana‐Farber Cancer Institute Harvard Medical School Boston Massachusetts USA
- Broad Institute of MIT and Harvard Cambridge Massachusetts USA
- Harvard Stem Cell Institute Cambridge Massachusetts USA
| | - Elliott Vichinsky
- Division of Hematology‐Oncology, Department of Pediatrics University of California San Francisco, UCSF Benioff Children's Hospital Oakland Oakland California USA
| | - Ali T. Taher
- Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino AOOR Villa Sofia‐V, Cervello Palermo Italy
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Drago G, Tavormina E, Ruggieri S, Cibella F, Allotta A, Pollina Addario S, Dardanoni G, Scondotto S. [Application of an algorithm for the validation of congenital anomaly cases using hospital discharge records]. Epidemiol Prev 2022; 46:84-91. [PMID: 35354271 DOI: 10.19191/ep22.1-2.p084.016] [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 evaluate and validate the adoption of an algorithm for the identification of cases of congenital anomalies (CAs) to improve the performance of the Congenital Malformations Registry of Sicily Region (Southern Italy). DESIGN an algorithm was used to identify congenital anomalies on a sample of hospital discharge records (SDO) with ICD-9-CM code between 740-759 on any of the diagnoses within the first year of life, together with a sample of healthy births equal to 5% of total births for the same period. The identified cases were evaluated through the clinical record analysis. SETTING AND PARTICIPANTS the analysed sample was composed of 4,271 cases identified between June 2013 and December 2014 along with 3,993 SDO without any code of MC (5% of the total volume of births in the same period). MAIN OUTCOME MEASURES positive predictive value (VPP) and negative predictive value (VPN) were computed by means of the comparison between the algorithm outcomes and the clinical record verification. RESULTS 4,271 potentially malformed records involving 3,381 subjects born in the Sicilian territory have been identified. Among the hospital discharge records that it was possible to verify, the application of the algorithm led to the exclusion of 924 cases: of these, 62 proved to be false negatives (VPN: 93.3). The valid cases were 1,179, while the cases to be evaluated 617: the comparison between algorithm and clinical record analysis led to a VPP of 91.7 and 72.1, respectively, for valid and to be evaluated. CONCLUSIONS the tested algorithm proved to be a useful tool for identifying SDO potentially related to congenital anomalies. In the overall sample, the algorithm provided an outcome consistent with the clinical record assessment in 87.4% (2,379) of cases.
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Affiliation(s)
- Gaspare Drago
- Consiglio nazionale delle ricerche, Istituto per la ricerca e l'innovazione biomedica (IRIB), Palermo
| | - Elisa Tavormina
- Consiglio nazionale delle ricerche, Istituto per la ricerca e l'innovazione biomedica (IRIB), Palermo
| | - Silvia Ruggieri
- Consiglio nazionale delle ricerche, Istituto per la ricerca e l'innovazione biomedica (IRIB), Palermo;
| | - Fabio Cibella
- Consiglio nazionale delle ricerche, Istituto per la ricerca e l'innovazione biomedica (IRIB), Palermo
| | - Alessandra Allotta
- Regione siciliana, Assessorato della salute, Dipartimento per le attività sanitarie e Osservatorio epidemiologico (DASOE), Palermo
| | - Sebastiano Pollina Addario
- Regione siciliana, Assessorato della salute, Dipartimento per le attività sanitarie e Osservatorio epidemiologico (DASOE), Palermo
| | - Gabriella Dardanoni
- Regione siciliana, Assessorato della salute, Dipartimento per le attività sanitarie e Osservatorio epidemiologico (DASOE), Palermo
| | - Salvatore Scondotto
- Regione siciliana, Assessorato della salute, Dipartimento per le attività sanitarie e Osservatorio epidemiologico (DASOE), Palermo
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Corrao G, Barbato A, D’Avanzo B, Di Fiandra T, Ferrara L, Gaddini A, Monzio Compagnoni M, Saponaro A, Scondotto S, Tozzi VD, Carle F, Lora A. Does the mental health system provide effective coverage to people with schizophrenic disorder? A self-controlled case series study in Italy. Soc Psychiatry Psychiatr Epidemiol 2022; 57:519-529. [PMID: 34132836 PMCID: PMC8934324 DOI: 10.1007/s00127-021-02114-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To measure indicators of timeliness and continuity of treatments on patients with schizophrenic disorder in 'real-life' practice, and to validate them through their relationship with relapse occurrences. METHODS The target population was from four Italian regions overall covering 22 million beneficiaries of the NHS (37% of the entire Italian population). The cohort included 12,054 patients newly taken into care for schizophrenic disorder between January 2015 and June 2016. The self-controlled case series (SCCS) design was used to estimate the incidence rate ratio of relapse occurrences according to mental healthcare coverage. RESULTS Poor timeliness (82% and 33% of cohort members had not yet started treatment with psychosocial interventions and antipsychotic drug therapy within the first year after they were taken into care) and continuity (27% and 23% of patients were persistent with psychosocial interventions, and antipsychotic drug therapy within the first 2 years after starting the specific treatment) were observed. According to SCCS design, 4794 relapses occurred during 9430 PY (with incidence rate of 50.8 every 100 PY). Compared with periods not covered by mental healthcare, those covered by psychosocial intervention alone, antipsychotic drugs alone and by psychosocial intervention and antipsychotic drugs together were, respectively, associated with relapse rate reductions of 28% (95% CI 4-46%), 24% (17-30%) and 44% (32-53%). CONCLUSION Healthcare administrative data may contribute to monitor and to assess the effectiveness of a mental health system. Persistent use of both psychosocial intervention and antipsychotic drugs reduces risk of severe relapse.
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Affiliation(s)
- Giovanni Corrao
- grid.7563.70000 0001 2174 1754National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy ,grid.7563.70000 0001 2174 1754Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, 20126 Milan, Italy
| | - Angelo Barbato
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Barbara D’Avanzo
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Teresa Di Fiandra
- grid.415788.70000 0004 1756 9674General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | - Lucia Ferrara
- grid.7945.f0000 0001 2165 6939Centre of Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | | | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy. .,Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, 20126, Milan, Italy.
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- grid.7563.70000 0001 2174 1754National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy ,Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Valeria D. Tozzi
- grid.7945.f0000 0001 2165 6939Centre of Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Flavia Carle
- grid.7563.70000 0001 2174 1754National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy ,grid.7010.60000 0001 1017 3210Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Antonio Lora
- grid.7563.70000 0001 2174 1754National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy ,Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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18
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Corrao G, Monzio Compagnoni M, Barbato A, D'Avanzo B, Di Fiandra T, Ferrara L, Gaddini A, Saponaro A, Scondotto S, Tozzi VD, Carle F, Carbone S, Chisholm DH, Lora A. From contact coverage to effective coverage of community care for patients with severe mental disorders: A real-world investigation from Italy. Front Psychiatry 2022; 13:1014193. [PMID: 36523868 PMCID: PMC9744794 DOI: 10.3389/fpsyt.2022.1014193] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To measure the gap between contact and effective coverage of mental healthcare (MHC). MATERIALS AND METHODS 45,761 newly referred cases of depression, schizophrenia, bipolar disorder, and personality disorder from four Italian regions were included. A variant of the self-controlled case series method was adopted to estimate the incidence rate ratio (IRR) for the relationship between exposure (i.e., use of different types of MHC such as pharmacotherapy, generic contact with the outpatient services, psychosocial intervention, and psychotherapy) and relapse (emergency hospital admissions for mental illness). RESULTS 11,500 relapses occurred. Relapse risk was reduced during periods covered by (i) psychotherapy for patients with depression (IRR 0.67; 95% CI: 0.49 to 0.91) and bipolar disorder (0.64; 0.29 to 0.99); (ii) psychosocial interventions for those with depression (0.74; 0.56 to 0.98), schizophrenia (0.83; 0.68 to 0.99), and bipolar disorder (0.55; 0.36 to 0.84), (iii) pharmacotherapy for patients with schizophrenia (0.58; 0.49 to 0.69), and bipolar disorder (0.59; 0.44 to 0.78). Coverage with generic care, in absence of psychosocial/psychotherapeutic interventions, did not affect risk of relapse. CONCLUSION This study ascertained the gap between contact and effective coverage of MHC and showed that administrative data can usefully contribute to assess the effectiveness of a mental health system.
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Affiliation(s)
- Giovanni Corrao
- National Center for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Matteo Monzio Compagnoni
- National Center for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Angelo Barbato
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Barbara D'Avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Teresa Di Fiandra
- Previously General Directorate for Health Prevention, Italian Health Ministry, Rome, Italy
| | - Lucia Ferrara
- Center of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University), Milan, Italy
| | | | - Alessio Saponaro
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Salvatore Scondotto
- National Center for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Department of Health Services and Epidemiological Observatory, Regional Health Authority, Palermo, Italy
| | - Valeria D Tozzi
- Center of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University), Milan, Italy
| | - Flavia Carle
- National Center for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Simona Carbone
- Department of Health Planning, Italian Health Ministry, Rome, Italy
| | - Daniel H Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Antonio Lora
- National Center for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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Mondello S, Visalli C, Kobeissy F, Cacciani L, Cruciani F, D'Amato S, Di Napoli A, Giorgi Rossi P, Milli C, Petrelli A, Silvestri C, Cernigliaro A, Scondotto S. Exploring the evidence for the effectiveness of health interventions for COVID-19 targeting migrants: a systematic review protocol. BMJ Open 2021; 11:e057985. [PMID: 34937727 PMCID: PMC8704024 DOI: 10.1136/bmjopen-2021-057985] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Owing to their inherent vulnerabilities, the burden of COVID-19 and particularly of its control measures on migrants has been magnified. A thorough assessment of the value of the interventions for COVID-19 tailored to migrants is essential for improving their health outcomes as well as promoting an effective control of the pandemic. In this study, based on evidence from primary biomedical research, we aimed to systematically identify health interventions for COVID-19 targeting migrants and to assess and compare their effectiveness. The review will be conducted within a programme aimed at defining and implementing interventions to control the COVID-19 pandemic in Italy, funded by the Italian Ministry of Health and conducted by a consortium of Italian regional health authorities. METHODS AND ANALYSES Data sources will include the bibliographic databases MEDLINE, Embase, LOVE Platform COVID-19 Evidence, and Cochrane Central Register of Controlled Trials. Eligible studies must evaluate health interventions for COVID-19 in migrants. Two independent reviewers will screen articles for inclusion using predefined eligibility criteria, extract data of retained articles and assess methodological quality by applying the Cochrane Risk of Bias tool. Disagreements will be resolved through consensus or arbitrated by a third reviewer if necessary. In synthesising the evidence, we will structure results by interventions, outcomes and quality. Where studies are sufficiently homogenous, trial data will be pooled and meta-analyses will be performed. Data will be reported according to methodological guidelines for systematic review provided by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. ETHICS AND DISSEMINATION This is a review of existing literature, and ethics approval is not required. We will submit results for peer-review publication and present at relevant conferences. The review findings will be included in future efforts to develop evidence-informed recommendations, policies or programmatic actions at the national and regional levels and address future high-quality research in public health.
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Affiliation(s)
- Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Carmela Visalli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Firas Kobeissy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
- Department of Biochemistry and Molecular Genetics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Laura Cacciani
- Dipartimento di Epidemiologia, SSR Lazio, Azienda Sanitaria Locale Roma 1, Roma, Italy
| | - Fabio Cruciani
- Dipartimento di Epidemiologia, SSR Lazio, Azienda Sanitaria Locale Roma 1, Roma, Italy
| | | | | | - Paolo Giorgi Rossi
- Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Caterina Milli
- 'Agenzia Regionale di Sanità della Toscana, Firenze, Toscana, Italy
| | | | | | - Achille Cernigliaro
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Palermo, Italy
| | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Palermo, Italy
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20
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Guarnotta V, Radellini S, Vigneri E, Cernigliaro A, Pantò F, Scondotto S, Almasio PL, Guercio G, Giordano C. Diabetic foot ulcers: Retrospective comparative analysis from Sicily between two eras. PLoS One 2021; 16:e0259405. [PMID: 34874944 PMCID: PMC8651101 DOI: 10.1371/journal.pone.0259405] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/18/2021] [Indexed: 12/28/2022] Open
Abstract
Aim The aim of this study was to analyze changes in the incidence, management and mortality of DFU in Sicilian Type 2 diabetic patients hospitalized between two eras, i.e. 2008–2013 and 2014–2019. Methods We compared the two eras, era1: 2008–13, era2: 2014–19. In era 1, n = 149, and in era 2, n = 181 patients were retrospectively enrolled. Results In the population hospitalized for DFU in 2008–2013, 59.1% of males and 40.9% of females died, whilst in 2014–2019 65.9% of males and 34.1% of females died. Moderate chronic kidney disease (CKD) was significantly higher in patients that had died than in ones that were alive (33% vs. 43%, p < 0.001), just as CKD was severe (14.5% vs. 4%, p < 0.001). Considering all together the risk factors associated with mortality, at Cox regression multivariate analysis only moderate-severe CKD (OR 1.61, 95% CI 1.07–2.42, p 0.021), age of onset greater than 69 years (OR 2.01, 95% CI 1.37–2.95, p <0.001) and eGFR less than 92 ml/min (OR 2.84, 95% CI 1.51–5.34, p 0.001) were independently associated with risk of death. Conclusions Patients with DFU have high mortality and reduced life expectancy. Age at onset of diabetic foot ulcer, eGFR values and CKD are the principal risk factors for mortality.
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Affiliation(s)
- Valentina Guarnotta
- Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Università di Palermo, Palermo, Italy
- * E-mail: (CG); (VG)
| | - Stefano Radellini
- Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Università di Palermo, Palermo, Italy
| | - Enrica Vigneri
- Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Università di Palermo, Palermo, Italy
| | | | - Felicia Pantò
- Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Università di Palermo, Palermo, Italy
| | | | - Piero Luigi Almasio
- Sezione di Gastroenterologia ed Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, PROMISE, Università degli Studi di Palermo, Palermo, Italy
| | - Giovanni Guercio
- Sezione di Chirurgia d’Urgenza, Dipartimento di Chirurgia, Oncologia e Scienza Orale, DICHIRONS, Università degli Studi di Palermo, Palermo, Italy
| | - Carla Giordano
- Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Università di Palermo, Palermo, Italy
- * E-mail: (CG); (VG)
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21
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Corrao G, Rea F, Carle F, Scondotto S, Allotta A, Lepore V, D'Ettorre A, Tanzarella C, Vittori P, Abena S, Iommi M, Spazzafumo L, Ercolanoni M, Blaco R, Carbone S, Giordani C, Manfellotto D, Galli M, Mancia G. Stratification of the risk of developing severe or lethal Covid-19 using a new score from a large Italian population: a population-based cohort study. BMJ Open 2021; 11:e053281. [PMID: 34794995 PMCID: PMC8602929 DOI: 10.1136/bmjopen-2021-053281] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To develop a population-based risk stratification model (COVID-19 Vulnerability Score) for predicting severe/fatal clinical manifestations of SARS-CoV-2 infection, using the multiple source information provided by the healthcare utilisation databases of the Italian National Health Service. DESIGN Retrospective observational cohort study. SETTING Population-based study using the healthcare utilisation database from five Italian regions. PARTICIPANTS Beneficiaries of the National Health Service, aged 18-79 years, who had the residentship in the five participating regions. Residents in a nursing home were not included. The model was built from the 7 655 502 residents of Lombardy region. MAIN OUTCOME MEASURE The score included gender, age and 29 conditions/diseases selected from a list of 61 conditions which independently predicted the primary outcome, that is, severe (intensive care unit admission) or fatal manifestation of COVID-19 experienced during the first epidemic wave (until June 2020). The score performance was validated by applying the model to several validation sets, that is, Lombardy population (second epidemic wave), and the other four Italian regions (entire 2020) for a total of about 15.4 million individuals and 7031 outcomes. Predictive performance was assessed by discrimination (areas under the receiver operating characteristic curve) and calibration (plot of observed vs predicted outcomes). RESULTS We observed a clear positive trend towards increasing outcome incidence as the score increased. The areas under the receiver operating characteristic curve of the COVID-19 Vulnerability Score ranged from 0.85 to 0.88, which compared favourably with the areas of generic scores such as the Charlson Comorbidity Score (0.60). A remarkable performance of the score on the calibration of observed and predicted outcome probability was also observed. CONCLUSIONS A score based on data used for public health management accurately predicted the occurrence of severe/fatal manifestations of COVID-19. Use of this score may help health decision-makers to more accurately identify high-risk citizens who need early preventive or treatment interventions.
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Affiliation(s)
- Giovanni Corrao
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Federico Rea
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority of Sicily, Palermo, Italy
| | - Alessandra Allotta
- Department of Health Services and Epidemiological Observatory, Regional Health Authority of Sicily, Palermo, Italy
| | - Vito Lepore
- Regional Health Agency of Puglia, Bari, Italy
| | | | | | | | | | - Marica Iommi
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Liana Spazzafumo
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Regional Health Agency of Marche, Ancona, Italy
| | | | | | - Simona Carbone
- Department of Health Planning, Italian Health Ministry, Rome, Italy
| | | | - Dario Manfellotto
- Department of Internal Medicine, Hospital Fatebenefratelli, Rome, Italy
| | - Massimo Galli
- Institute of Tropical and Infectious Diseases, University of Milan L Sacco Hospital, Milan, Italy
| | - Giuseppe Mancia
- University of Milano-Bicocca, Milan, Italy
- Policlinico di Monza, Monza, Italy
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22
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Musallam KM, Vitrano A, Meloni A, Addario Pollina S, Di Marco V, Hussain Ansari S, Filosa A, Ricchi P, Ceci A, Daar S, Vlachaki E, Singer ST, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Karimi M, El-Beshlawy A, Hajipour M, Bonifazi F, Vichinsky E, Taher AT, Sankaran VG, Maggio A. Primary HBB gene mutation severity and long-term outcomes in a global cohort of β-thalassaemia. Br J Haematol 2021; 196:414-423. [PMID: 34697800 DOI: 10.1111/bjh.17897] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 01/19/2023]
Abstract
In β-thalassaemia, the severity of inherited β-globin gene mutations determines the severity of the clinical phenotype at presentation and subsequent transfusion requirements. However, data on associated long-term outcomes remain limited. We analysed data from 2109 β-thalassaemia patients with available genotypes in a global database. Genotype severity was grouped as β0 /β0 , β0 /β+ , β+ /β+ , β0 /β++ , β+ /β++ , and β++ /β++ . Patients were followed from birth until death or loss to follow-up. The median follow-up time was 34·1 years. Mortality and multiple morbidity outcomes were analyzed through five different stratification models of genotype severity groups. Interestingly, β0 and β+ mutations showed similar risk profiles. Upon adjustment for demographics and receipt of conventional therapy, patients with β0 /β0 , β0 /β+ , or β+ /β+ had a 2·104-increased risk of death [95% confidence interval (CI): 1·176-3·763, P = 0·011] and 2·956-increased odds of multiple morbidity (95% CI: 2·310-3·784, P < 0·001) compared to patients in lower genotype severity groups. Cumulative survival estimates by age 65 years were 36·8% for this subgroup compared with 90·2% for patients in lower genotype severity groups (P < 0·001). Our study identified mortality and morbidity risk estimates across various genotype severity groups in patients with β-thalassaemia and suggests inclusion of both β+ and β0 mutations in strata of greatest severity.
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Affiliation(s)
- Khaled M Musallam
- Thalassemia Center, Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Antonella Meloni
- MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | | | - Vito Di Marco
- Department of Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Saqib Hussain Ansari
- Department of Pediatric Haematology & Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.,Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
| | - Efthymia Vlachaki
- Thalassaemia Unit, Ippokratio University Hospital, Thessaloniki, Greece
| | - Sylvia T Singer
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | - Alessia Pepe
- MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Elliott Vichinsky
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Harvard Stem Cell Institute, Cambridge, MA, USA
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
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Trifirò G, Isgrò V, Ingrasciotta Y, Ientile V, L'Abbate L, Foti SS, Belleudi V, Poggi F, Fontana A, Moretti U, Lora R, Sabaini A, Senesi I, Sorrentino C, Puzo MR, Padula A, Fusco M, Giordana R, Solfrini V, Puccini A, Rossi P, Del Zotto S, Leoni O, Zanforlini M, Ancona D, Bavaro V, Garau D, Ledda S, Scondotto S, Allotta A, Tuccori M, Gini R, Bucaneve G, Franchini D, Cavazzana A, Biasi V, Spila Alegiani S, Massari M. Large-Scale Postmarketing Surveillance of Biological Drugs for Immune-Mediated Inflammatory Diseases Through an Italian Distributed Multi-Database Healthcare Network: The VALORE Project. BioDrugs 2021; 35:749-764. [PMID: 34637126 PMCID: PMC8507511 DOI: 10.1007/s40259-021-00498-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Biological drugs have improved the management of immune-mediated inflammatory diseases (IMIDs) despite being associated with important safety issues such as immunogenicity, infections, and malignancies in real-world settings. OBJECTIVE The aim of this study was to explore the potential of a large Italian multi-database distributed network for use in the postmarketing surveillance of biological drugs, including biosimilars, in patients with IMID. METHODS A retrospective cohort study was conducted using 13 Italian regional claims databases during 2010-2019. A tailor-made R-based tool developed for distributed analysis of claims data using a study-specific common data model was customized for this study. We measured the yearly prevalence of biological drug users and the frequency of switches between originator and biosimilars for infliximab, etanercept, and adalimumab separately and stratified them by calendar year and region. We then calculated the cumulative number of users and person-years (PYs) of exposure to individual biological drugs approved for IMIDs. For a number of safety outcomes (e.g., severe acute respiratory syndrome coronavirus 2 [SARS-COV-2] infection), we conducted a sample power calculation to estimate the PYs of exposure required to investigate their association with individual biological drugs approved for IMIDs, considering different strengths of association. RESULTS From a total underlying population of almost 50 million inhabitants from 13 Italian regions, we identified 143,602 (0.3%) biological drug users, with a cumulative exposure of 507,745 PYs during the entire follow-up. The mean age ± standard deviation of biological drug users was 49.3 ± 16.3, with a female-to-male ratio of 1.2. The age-adjusted yearly prevalence of biological drug users increased threefold from 0.7 per 1000 in 2010 to 2.1 per 1000 in 2019. Overall, we identified 40,996 users of biosimilars of tumor necrosis factor (TNF)-α inhibitors (i.e., etanercept, adalimumab, and infliximab) in the years 2015-2019. Of these, 46% (N = 18,845) switched at any time between originator and biosimilars or vice versa. To investigate a moderate association (incidence rate ratio 2) between biological drugs approved for IMIDs and safety events of interest, such as optic neuritis (lowest background incidence rate 10.4/100,000 PYs) or severe infection (highest background incidence rate 4312/100,000 PYs), a total of 43,311 PYs and 104 PYs of exposure to individual biological drugs, respectively, would be required. As such, using this network, of 15 individual biological drugs approved for IMIDs, the association with those adverse events could be investigated for four (27%) and 14 (93%), respectively. CONCLUSION The VALORE project multi-database network has access to data on more than 140,000 biological drug users (and > 0.5 million PYs) from 13 Italian regions during the years 2010-2019, which will be further expanded with the inclusion of data from other regions and more recent calendar years. Overall, the cumulated amount of person-time of exposure to biological drugs approved for IMIDs provides enough statistical power to investigate weak/moderate associations of almost all individual compounds and the most relevant safety outcomes. Moreover, this network may offer the opportunity to investigate the interchangeability of originator and biosimilars of several TNFα inhibitors in different therapeutic areas in real-world settings.
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Affiliation(s)
- Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, 37129, Verona, Italy.
| | - Valentina Isgrò
- Department of Diagnostics and Public Health, University of Verona, 37129, Verona, Italy
| | - Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Valentina Ientile
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Luca L'Abbate
- Department of Diagnostics and Public Health, University of Verona, 37129, Verona, Italy
| | - Saveria S Foti
- Academic spin-off "INSPIRE, Innovative Solutions for Medical Prediction and Big Data Integration in Real World Setting", Azienda Ospedaliera Universitaria "G. Martino", Messina, Italy
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Francesca Poggi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Ugo Moretti
- Department of Diagnostics and Public Health, University of Verona, 37129, Verona, Italy
| | - Riccardo Lora
- Department of Diagnostics and Public Health, University of Verona, 37129, Verona, Italy
| | - Alberto Sabaini
- Dipartimento di Informatica, Università degli Studi di Verona, Verona, Italy
| | - Ilenia Senesi
- Territorial Assistance Service, ASL Teramo, Abruzzo, Italy
| | | | - Maria R Puzo
- Assistance and Pharmaceutical Services Office, Personal Policies Department, Basilicata Region, Potenza, Italy
| | - Angela Padula
- Rheumatology Institute of Lucania (IReL), San Carlo Hospital of Potenza, Via Potito Petrone, 85100, Potenza, Italy
| | - Mariano Fusco
- Dipartimento delle Attività Farmaceutiche Territoriali e Ospedaliere, Naples 2 Nord LHU, Naples, Italy
| | | | - Valentina Solfrini
- Territorial Assistance Service, Drug and Medical Device Area, Emilia Romagna Health Department, Bologna, Italy
| | - Aurora Puccini
- Territorial Assistance Service, Drug and Medical Device Area, Emilia Romagna Health Department, Bologna, Italy
| | - Paola Rossi
- Direzione Centrale Salute Regione Friuli Venezia Giulia, Trieste, Italy
| | | | - Olivia Leoni
- Lombardy Regional Centre of Pharmacovigilance, Milan, Italy
| | | | | | - Vito Bavaro
- Apulian Regional Health Department, Bari, Italy
| | | | - Stefano Ledda
- Sardinia Regional Health Department, Cagliari, Italy
| | - Salvatore Scondotto
- Epidemiologic Observatory of the Sicily Regional Health Service, Palermo, Italy
| | - Alessandra Allotta
- Epidemiologic Observatory of the Sicily Regional Health Service, Palermo, Italy
| | - Marco Tuccori
- Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy
| | - Rosa Gini
- Agenzia Regionale di Sanità Toscana, Florence, Italy
| | | | - David Franchini
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | | | - Stefania Spila Alegiani
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Massari
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
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Musallam KM, Vitrano A, Meloni A, Pollina SA, Karimi M, El-Beshlawy A, Hajipour M, Di Marco V, Ansari SH, Filosa A, Ricchi P, Ceci A, Daar S, Vlachaki E, Singer ST, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Sankaran VG, Vichinsky E, Taher AT, Maggio A. Survival and causes of death in 2,033 patients with non-transfusion-dependent β-thalassemia. Haematologica 2021. [PMID: 33882642 DOI: 10.3324/haematol.2021.278684.pmid:33882642;pmcid:pmc8409024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Affiliation(s)
| | - Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz
| | - Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran
| | - Vito Di Marco
- Department of Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Saqib Hussain Ansari
- Department of Pediatric Haematology and Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA)
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman; Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch
| | | | - Sylvia Titi Singer
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | | | - Alessia Pepe
- MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA)
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Harvard Stem Cell Institute, Cambridge, MA
| | - Elliott Vichinsky
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo
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Musallam KM, Vitrano A, Meloni A, Pollina WA, Karimi M, El-Beshlawy A, Hajipour M, Di Marco V, Ansari SH, Filosa A, Ricchi P, Ceci A, Daar S, Vlachaki E, Singer ST, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Sankaran VG, Vichinsky E, Taher AT, Maggio A. Survival and causes of death in 2,033 patients with non-transfusion-dependent β-thalassemia. Haematologica 2021; 106:2489-2492. [PMID: 33882642 PMCID: PMC8409024 DOI: 10.3324/haematol.2021.278684] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz
| | - Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo
| | - Saqib Hussain Ansari
- Department of Pediatric Haematology and Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA)
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman; Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch
| | | | - Sylvia Titi Singer
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | | | - Alessia Pepe
- MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA)
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Harvard Stem Cell Institute, Cambridge, MA
| | - Elliott Vichinsky
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo.
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Cicero CE, Scondotto S, Allotta AV, De Luca G, Murolo G, Nicoletti A, Zappia M. Burden of Parkinson's disease in Sicily: a health administrative database study. Neurol Sci 2021; 43:1043-1046. [PMID: 34259973 DOI: 10.1007/s10072-021-05460-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/03/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Prevalence of Parkinson's disease (PD) increases with the advanced ages, representing a relevant health burden. Accurate prevalence estimates are of fundamental need in order to adjust the supply of health services for these patients. The availability of administrative health data from the National Health System provides a useful resource to assess the burden of diseases. Our aim was to evaluate the prevalence of PD through the use of administrative data in the Sicily region. METHODS We have identified all the subjects affected by PD in Sicily in 2017 by gathering data from three regional health administrative databases: the hospital discharge records, the medical exemption databases, and the pharmacological prescription database. Prevalence rates and 95% confidence intervals (CI) have been calculated across 5-year age classes. RESULTS PD patients identified through database searching were 24,674, giving a prevalence of 488/100,000 (95%CI 481.9-494.1) inhabitants. Prevalence was higher among men (514.5/100,000; 95%CI 505.6-523.6) and reached a peak in the 85-89 age class (3203.8/100,000; 95%CI 3095.2-3315.1). DISCUSSION Our prevalence estimates of PD were higher when compared to previous epidemiological surveys conducted in Sicily. These findings are, however, comparable to other studies conducted in Italy that identified cases through administrative databases. Using health databases is a feasible strategy to assess the burden of PD.
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Affiliation(s)
- Calogero Edoardo Cicero
- Department of Medical, Surgical and Advanced Technologies, G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Salvatore Scondotto
- Health Activities and Epidemiologic Observatory Division, Health Department, Sicily Region, Palermo, Italy
| | | | - Giovanni De Luca
- Health Activities and Epidemiologic Observatory Division, Health Department, Sicily Region, Palermo, Italy
| | - Giuseppe Murolo
- Health Activities and Epidemiologic Observatory Division, Health Department, Sicily Region, Palermo, Italy
| | - Alessandra Nicoletti
- Department of Medical, Surgical and Advanced Technologies, G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Mario Zappia
- Department of Medical, Surgical and Advanced Technologies, G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
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27
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Di Napoli A, Rossi A, Battisti L, Cacciani L, Caranci N, Cernigliaro A, De Giorgi M, Fanolla A, Fateh-Moghadam P, Franchini D, Lazzeretti M, Melani C, Mininni M, Mondo L, Recine M, Rosaia EM, Rusciani R, Scondotto S, Silvestri C, Trappolini E, Petrelli A. [Evaluating health care of the immigrant population in Italy through indicators of a national monitoring system]. Epidemiol Prev 2021; 44:85-93. [PMID: 33415950 DOI: 10.19191/ep20.5-6.s1.p085.077] [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: 11/15/2022]
Abstract
OBJECTIVES to evaluate maternal and child healthcare, avoidable hospitalisation, access to emergency services among immigrants in Italy. DESIGN cross sectional study of some health and health care indicators among Italian and foreign population residing in Italy in 2016-2017. SETTING AND PARTICIPANTS indicators based on the national monitoring system coordinated by the Italian National Institute for Health, Migration and Poverty (INMP) of Rome, calculated on perinatal care (CedAP), hospital discharge (SDO), emergency services (EMUR) archives for the years 2016-2017, by of the following regions: Piedmont, Trento, Bolzano, Emilia-Romagna, Tuscany, Umbria, Lazio, Basilicata, Sicily. MAIN OUTCOME MEASURES number and timeliness of pregnancy visits, number of ultrasounds, invasive prenatal investigations; perinatal mortality rates, birth weight, Apgar score at 5 minutes, need for neonatal resuscitation; standardized rates of avoidable hospitalisation and access to emergency services by triage code. RESULTS more often than Italians, immigrant women have during pregnancy: less than 5 gynaecological examination (16.3% vs 8.5%), first examination after the 12th week of gestational age (12.5% vs 3.8%), less than 2 ultrasounds (3.8% vs 1.0%). Higher perinatal mortality rates among immigrants compared to Italians (3.6 vs 2.3 x1,000). Higher standardized rates (x1,000) among immigrants compared to Italians of avoidable hospitalisation (men: 2.1 vs 1.4; women: 0.9 vs 0.7) and of white triage codes in emergency (men: 62.0 vs 32.7; women: 52.9 vs 31.4). CONCLUSIONS study findings show differences in access and outcomes of healthcare between Italians and immigrants. National monitoring system of indicators, coordinated by INMP, represents a useful tool for healthcare intervention policies aimed to health equity.
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Affiliation(s)
- Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma;
| | - Alessandra Rossi
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Laura Battisti
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Laura Cacciani
- Dipartimento di epidemiologia del SSR del Lazio, ASL Roma 1, Roma
| | - Nicola Caranci
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
| | - Achille Cernigliaro
- Dipartimento attività sanitarie e osservatorio epidemiologico, Assessorato alla sanità, Regione Siciliana, Palermo
| | - Marcello De Giorgi
- Servizio mobilità sanitaria, gestione del sistema informativo sanitario e sociale, Osservatorio epidemiologico regionale, Regione Umbria, Perugia
| | - Antonio Fanolla
- Osservatorio per la salute, Ufficio governo sanitario, Provincia autonoma di Bolzano, Bolzano
| | | | - David Franchini
- Servizio mobilità sanitaria, gestione del sistema informativo sanitario e sociale, Osservatorio epidemiologico regionale, Regione Umbria, Perugia
| | - Marco Lazzeretti
- Osservatorio di epidemiologia, Agenzia regionale di sanità della Toscana, Firenze
| | - Carla Melani
- Osservatorio per la salute, Ufficio governo sanitario, Provincia autonoma di Bolzano, Bolzano
| | - Mariangela Mininni
- Ufficio prevenzione primaria, Dipartimento politiche della persona, Regione Basilicata, Potenza
| | - Luisa Mondo
- SC a DU servizio sovrazonale di epidemiologia ASL TO3, Regione Piemonte, Grugliasco (TO)
| | - Michele Recine
- Sistema informativo sociosanitario, Dipartimento politiche della persona, Regione Basilicata, Potenza
| | - Eva Miriam Rosaia
- Dipartimento di scienze statistiche, Alma Mater Studiorum, Università di Bologna, Bologna
| | - Raffaella Rusciani
- SC a DU servizio sovrazonale di epidemiologia ASL TO3, Regione Piemonte, Grugliasco (TO)
| | - Salvatore Scondotto
- Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo
| | - Caterina Silvestri
- Osservatorio di epidemiologia, Agenzia regionale di sanità della Toscana, Firenze
| | | | - Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
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Smits E, Spentzouris G, Ingrasciotta Y, Foti SS, Ferrajolo C, Pastorello M, Scondotto S, Tari M, Trifiro G. Bleeding risk and healthcare resource utilisation in elderly patients treated with edoxaban or vitamin K antagonists for atrial fibrillation in Italy. Europace 2021. [DOI: 10.1093/europace/euab116.170] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Daiichi Sankyo Europe GmbH
Background
Direct oral anticoagulants (DOACs) have been shown to be non-inferior to vitamin K antagonists (VKA) regarding both efficacy and safety outcomes in patients with atrial fibrillation (AF). However, elderly are underrepresented in the underlying clinical trials.
Purpose
The aim of this study was to compare risks of major bleeding events and compare healthcare resource utilization (HRU) between AF patients treated with edoxaban or VKA in elderly.
Methods
A cohort study was conducted using claims databases of Caserta and Palermo Local Heath Units in Italy. AF patients starting use of edoxaban or VKA between August 1st, 2016 and December 31st, 2018 were included. Date of the first dispensing was defined as the index date. The study population was matched based on a propensity score based on factors associated with the outcome. We restricted to patients aged ≥65, ≥1 year database history, and no use of the index drug in the year before index date. Incidence rates of bleeding outcomes and rates of HRU were assessed per 1,000 and 100 person-years follow-up (PY), respectively. Cox regression analyses to adjust for baseline covariates were used for comparisons of incidence rates of bleeding outcomes among all edoxaban and VKA users. Poisson regression analyses were used for comparisons of rates of HRU among all edoxaban and VKA users. Both analyses were adjusted for age. Sex, region and year of index date were considered for the adjusted models as well, using a backward stepwise approach to select eligible variables.
Results
1,317 edoxaban users and 2,924 VKA users were included in the matched population. Mean age was 79 in both treatments groups, and 43% of the edoxaban users and 45% of the VKA users was male. Bleeding risks were significantly lower among edoxaban users compared to VKA users aged ≥65 (adjusted HR 0.39 (95% CI 0.19-0.83)) and among patients aged ≥75 (adjusted HR 0.37 (95% CI 0.16-0.86)). Among patients aged ≥65, edoxaban users were significantly less often hospitalised (RR 0.56 (95% CI 0.46-0.68)) and the total number of hospitalised days were also significant lower (RR 0.58 (95% CI 0.42-0.80)) compared to VKA users. Among patients aged ≥75, similar results were observed for the number of hospitalisations. Edoxaban users had significant less out-patient visits compared to VKA users (among patients aged ≥65 the RR was 0.44 (95% CI 0.39-0.50) and among patients ≥75 this was 0.40 (95% CI 0.35-0.47). Use of out-patient medication use was significantly lower among edoxaban users compared to VKA users among patients aged ≥65 (adjusted RR 0.91 (95% CI 0.88-0.95)) as well as among patients aged ≥75 (adjusted RR 0.91 (95% CI 0.87-0.95)).
Conclusion
Study results show a decreased bleeding risk of edoxaban compared to VKA in both age groups of patients with AF. Hospital based HRU has shown to be lower among edoxaban users compared to VKA users in both age groups. Out-patient HRU was also lower among edoxaban users.
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Affiliation(s)
- E Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands (The)
| | | | - Y Ingrasciotta
- University of Messina, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Messina, Italy
| | - SS Foti
- University of Messina, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Messina, Italy
| | - C Ferrajolo
- university of Campania Luigi Vanvitelli, Department of Experimental Medicine, Naples, Italy
| | - M Pastorello
- Palermo Local Health Unit, Department of Pharmacy, Palermo, Italy
| | - S Scondotto
- Health Department of Sicily, Department of Epidemiologic Observatory, Palermo, Italy
| | - M Tari
- Caserta Local Health Unit, Caserta, Italy
| | - G Trifiro
- University of Verona, Department of Diagnostic and Public Health, Verona, Italy
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Di Martino M, Alagna M, Lallo A, Gilmore KJ, Francesconi P, Profili F, Scondotto S, Fantaci G, Trifirò G, Isgrò V, Davoli M, Fusco D. Chronic polytherapy after myocardial infarction: the trade-off between hospital and community-based providers in determining adherence to medication. BMC Cardiovasc Disord 2021; 21:180. [PMID: 33853534 PMCID: PMC8048349 DOI: 10.1186/s12872-021-01969-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 03/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background The benefits of chronic polytherapy in reducing readmissions and death after myocardial infarction (MI) have been clearly shown. However, real-world evidence shows poor medication adherence and large geographic variation, suggesting critical issues in access to optimal care. Our objectives were to measure adherence to polytherapy, to compare the amount of variation attributable to hospitals of discharge and to community-based providers, and to identify determinants of adherence to medications. Methods This is a population-based study. Data were obtained from the information systems of the Lazio and Tuscany Regions, Italy (9.5 million inhabitants). Patients hospitalized with incident MI in 2010–2014 were analyzed. The outcome measure was medication adherence, defined as a Medication Possession Ratio (MPR) ≥ 0.75 for at least 3 of the following drugs: antiplatelets, β-blockers, ACEI/ARBs, statins. A 2-year cohort-study was performed. Cross-classified multilevel models were applied to analyze geographic variation. The variance components attributable to hospitals of discharge and community-based providers were expressed as Median Odds Ratio (MOR). Results A total of 32,962 patients were enrolled. About 63% of patients in the Lazio cohort and 59% of the Tuscan cohort were adherent to chronic polytherapy. Women and patients aged 85 years and over were most at risk of non-adherence. In both regions, adherence was higher for patients discharged from cardiology wards (Lazio: OR = 1.58, p < 0.001, Tuscany: OR = 1.59, p < 0.001) and for patients with a percutaneous coronary intervention during the index admission. Relevant variation between community-based providers was observed, though when the hospital of discharge was included as a cross-classified level, in both Lazio and Tuscany regions the variation attributable to hospitals of discharge was the only significant component (Lazio: MOR = 1.30, p = 0.001; Tuscany: MOR = 1.31, p = 0.001). Conclusion Adherence to best practice treatments after MI is not consistent with clinical guidelines, and varies between patient groups as well as within and between regions. The variation attributable to providers is affected by the hospital of discharge, up to two years from the acute episode. This variation is likely to be attributable to hospital discharge processes, and could be reduced through appropriate policy levers. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01969-9.
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Affiliation(s)
- Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy.
| | - Michela Alagna
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Adele Lallo
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | | | - Paolo Francesconi
- Epidemiology Unit, Regional Health Agency (ARS) of Tuscany, Florence, Italy
| | - Francesco Profili
- Epidemiology Unit, Regional Health Agency (ARS) of Tuscany, Florence, Italy
| | - Salvatore Scondotto
- Department of Epidemiologic Observatory, Health Department of Sicily, Palermo, Italy
| | - Giovanna Fantaci
- Department of Epidemiologic Observatory, Health Department of Sicily, Palermo, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Valentina Isgrò
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy
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Franchi M, Vener C, Garau D, Kirchmayer U, Di Martino M, Romero M, De Carlo I, Scondotto S, Stival C, Della Porta MG, Passamonti F, Corrao G. Bortezomib-based therapy in non-transplant multiple myeloma patients: a retrospective cohort study from the FABIO project. Ther Adv Hematol 2021; 12:2040620721996488. [PMID: 33747423 PMCID: PMC7905486 DOI: 10.1177/2040620721996488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: Randomized clinical trials showed that bortezomib, in addition to
conventional chemotherapy, improves survival and disease progression in
multiple myeloma (MM) patients not eligible for stem cell transplantation.
The aim of this retrospective population-based cohort study is the
evaluation of both clinical and economic profile of bortezomib-based
versus conventional chemotherapy in daily clinical
practice. Methods: Healthcare utilization databases of six Italian regions were used to identify
adult patients with non-transplant MM, who started a first-line therapy with
bortezomib-based or conventional chemotherapy. Patients were matched by
propensity score and were followed from treatment start until death, lost to
follow-up or study end-point. Overall survival (OS) and restricted mean
survival time (RMST) were estimated using the Kaplan–Meier method.
Association between first-line treatment and risk of death was estimated by
a conditional Cox proportional regression model. Average mean cumulative
costs were estimated and compared between groups. Results: In the period 2010–2016, 3509 non-transplant MM patients met the inclusion
criteria, of which 1157 treated with bortezomib-based therapy were matched
to 1826 treated with conventional chemotherapy. Median OS and RMST were 33.9
and 27.9 months, and 42.9 and 38.4 months, respectively, in the two
treatment arms. Overall, these values corresponded to a HR of death of 0.79
(95% CI 0.71–0.89) over a time horizon of 84 months. Average cumulative cost
were 83,839 € and 54,499 €, respectively, corresponding to an incremental
cost-effectiveness ratio of 54,333 € per year of life gained, a cost
coherent with the willingness-to-pay thresholds frequently adopted from
Western countries. Conclusions: These data suggested that, in a large cohort of non-transplant MM patients
treated outside the experimental setting, first-line treatment with
bortezomib-based therapy was associated with a favourable effectiveness and
cost-effectiveness profile.
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Affiliation(s)
- Matteo Franchi
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Building U7, Via Bicocca degli Arcimboldi 8, Milan, 20126, Italy
| | - Claudia Vener
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Ursula Kirchmayer
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Rome, Lazio, Italy
| | - Mirko Di Martino
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Rome, Lazio, Italy
| | - Marilena Romero
- Department of Medical, Oral and Biotechnological Sciences - Section of Pharmacology and Toxicology, University of Chieti, Italy
| | - Ilenia De Carlo
- Regional Centre of Pharmacovigilance, Regional Health Authority, Marche Region, Ancona, Italy
| | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Palermo, Sicily Region, Palermo, Italy
| | - Chiara Stival
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, ItalyLaboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Lombardia, Italy
| | - Matteo Giovanni Della Porta
- Humanitas Clinical and Research Hospital - IRCCS and Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Lombardia, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
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Silverii GA, Monami M, Cernigliaro A, Vigneri E, Guarnotta V, Scondotto S, Allotta VA, Conti M, Giordano C, Mannucci E. Are diabetes and its medications risk factors for the development of COVID-19? Data from a population-based study in Sicily. Nutr Metab Cardiovasc Dis 2021; 31:396-398. [PMID: 33223405 PMCID: PMC7528967 DOI: 10.1016/j.numecd.2020.09.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Diabetes mellitus (DM) has been associated with higher incidence of severe cases of COVID-19 in hospitalized patients, but it is unknown whether DM is a risk factor for the overall COVID-19 incidence. The aim of present study was to investigate whether there is an association of DM with COVID-19 prevalence and case fatality, and between different DM medications and risk for COVID-19 infection and death. METHODS AND RESULTS retrospective observational study on all SARS-CoV-2 positive (SARS-CoV-2+) cases and deaths in Sicily up to 2020, May 14th. No difference in COVID-19 prevalence was found between people with and without DM (RR 0.92 [0.79-1.09]). Case fatality was significantly higher in SARS-CoV-2+ with DM (RR 4.5 [3.55-5.71]). No diabetes medication was associated with differences in risk for SARS-Cov2 infection. CONCLUSIONS in Sicily, DM was not a risk factor for COVID-19 infection, whereas it was associated with a higher case fatality.
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Affiliation(s)
- G Antonio Silverii
- Experimental and Clinical Biomedical Sciences "Mario Serio" Department, University of Florence, Italy.
| | - Matteo Monami
- Experimental and Clinical Biomedical Sciences "Mario Serio" Department, University of Florence, Italy
| | - Achille Cernigliaro
- Health Activities and Epidemiologic Observatory Division, Health Department, Sicily Region, Italy
| | - Enrica Vigneri
- Health Promotion, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, Italy
| | - Valentina Guarnotta
- Health Promotion, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, Italy
| | - Salvatore Scondotto
- Health Activities and Epidemiologic Observatory Division, Health Department, Sicily Region, Italy
| | - Vincenza A Allotta
- Health Activities and Epidemiologic Observatory Division, Health Department, Sicily Region, Italy
| | - Michela Conti
- Health Promotion, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, Italy
| | - Carla Giordano
- Health Promotion, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, Italy
| | - Edoardo Mannucci
- Experimental and Clinical Biomedical Sciences "Mario Serio" Department, University of Florence, Italy
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Vitrano A, Meloni A, Addario Pollina W, Karimi M, El-Beshlawy A, Hajipour M, Di Marco V, Hussain Ansari S, Filosa A, Ricchi P, Ceci A, Daar S, Titi Singer S, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Vichinsky E, Maggio A. A complication risk score to evaluate clinical severity of thalassaemia syndromes. Br J Haematol 2021; 192:626-633. [PMID: 33216983 DOI: 10.1111/bjh.17203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/28/2020] [Indexed: 01/16/2023]
Abstract
The thalassaemia syndromes (TS) show different phenotype severity. Developing a reliable, practical and global tool to determine disease severity and tailor treatment would be of great value. Overall, 7910 patients were analysed with the aim of constructing a complication risk score (CoRS) to evaluate the probability of developing one or more complications. Nine independent variables were included in the investigation as predictors. Logistic regression models were used for Group A [transfusion-dependent thalassaemia (TDT)], Group B [transfused non-TDT (NTDT)] and Group C (non-transfused NTDT). Statistically significant predictors included age (years), haemoglobin levels, hepatic transaminases [alanine aminotransferase (ALT) and aspartate aminotransferase] and left-ventricular ejection fraction (LVEF) for Group A; age (years), age at first chelation (months), ALT and LVEF for Group B; and age (years), mean serum ferritin (SF) levels and LVEF for Group C. The area under the receiver operating characteristic curve was 84·5%, 82·1% and 80·0% for Groups A, Group B and Group C respectively, suggesting the models had good discrimination. Finally, the CoRS for each group was categorised into four risk classes (low, intermediate, high, and very high) using the centiles of its distribution. In conclusion, we have developed a CoRS for TS that can assist physicians in prospectively tailoring patients' treatment.
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Affiliation(s)
- Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahmoud Hajipour
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Saqib Hussain Ansari
- Department of Paediatric Haematology and Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano, BA, Italy
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
- Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Alessia Pepe
- U.O.C. MRI, Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano, BA, Italy
| | | | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
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Cernigliaro A, Allotta AV, Scondotto S. [Can diabetes and its related hypoglycemic drug treatment be considered risk factors for health outcomes in COVID-19 patients? The results of a study in the population residing in Sicily Region (Southern Italy)]. Epidemiol Prev 2021; 44:315-322. [PMID: 33412824 DOI: 10.19191/ep20.5-6.s2.132] [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: 11/15/2022]
Abstract
OBJECTIVES to evaluate the effects of a pre-existing condition of diabetes and of the use of antidiabetic drugs in the Sicilian population on different outcomes of the COVID-19 disease. DESIGN a retrospective observational study based was used. Data deriving from the COVID-19 epidemic surveillance and from the collection of information on drugs consume by Sicilian residents. SETTING AND PARTICIPANTS due to the data availability, the study was calibrated on the Region and included all population distinguishing by gender and age groups. MAIN OUTCOME MEASURES the risks of cumulative incidence for COVID-19 were investigated in people who had diabetes comorbidities to incur a hospitalization for COVID-19, to be treated within an intensive care unit, and lethality. The role of previous antidiabetic drug treatments with respect to each study outcome was also investigated. RESULTS in Sicily, from 01.03.2020 to 26.06.2020, a number of 172 cases of COVID-19 disease with diabetes comorbidity were diagnosed. The data did not show any difference in the cumulative incidence for COVID-19 between diabetics (64.2/100,000 inhabitants) and non-diabetics (56.9/100,000 inhabitants) patients. Diabetes increases the risk of hospitalization in the under 80 in both men and women (men: OR 2.62; women OR 4.31), for treatment in intensive care (men: OR 4,41; women: OR 7.74), and for death (men: OR 5.21; women OR 5.92). The analysis of drug using showed risks effect of insulin (OR 2.13) on hospitalization, sulfonylureas/glinides (OR 2.58) on intensive care and protective of metformin on death both in single component (OR 0.44) and in multicomponent (OR 0.43). CONCLUSIONS data availability made it possible to monitor the occurrence and explore some of the characteristics of the cases with COVID-19 in Sicily. Diabetes does not seem to represent a risk factor for SARS-CoV-2 infection in Sicily, while previous diabetes condition seems to determine greater risk of hospitalization, treatment in intensive care, and lethality among over 80. There are also gender differences with almost double risks in women for hospitalization and intensive care only. Among the antidiabetic drugs investigated, there was a risk for hospitalization and intensive care while protective for deaths. This study represents an important tool for the activation of intervention programmes in the area aimed at populations with greater health risk deriving from the effects of this new pandemic.
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Affiliation(s)
- Achille Cernigliaro
- Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo;
| | - Alessandra Vincenza Allotta
- Dipartimento per le attività sanitarie e osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo
| | - Salvatore Scondotto
- Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo
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Giraudo MT, Falcone M, Cadum E, Deandrea S, Scondotto S, Mattaliano A, Di Pietrantonj C, Bisceglia L, Duca P, Cislaghi C. [Rt or RDt, that is the question!]. Epidemiol Prev 2021; 44:42-50. [PMID: 33412793 DOI: 10.19191/ep20.5-6.s2.102] [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
The article compares two of the most followed indices in the monitoring of COVID-19 epidemic cases: the Rt and the RDt indices. The first was disseminated by the Italian National Institute of Health (ISS) and the second, which is more usable due to the lower difficulty of calculation and the availability of data, was adopted by various regional and local institutions.The rationale for the Rt index refers to that for the R0 index, the basic reproduction number, which is used by infectivologists as a measure of contagiousness of a given infectious agent in a completely susceptible population. The RDt index, on the other hand, is borrowed from the techniques of time series analysis for the trend of an event measurement that develops as a function of time. The RDt index does not take into account the time of infection, but the date of the diagnosis of positivity and for this reason it is defined as diagnostic replication index, as it aims to describe the intensity of the development of frequency for cases recognized as positive in the population.The comparison between different possible applications of the methods and the use of different types of monitoring data was limited to four areas for which complete individual data were available in March and April 2020. The main problems in the use of Rt, which is based on the date of symptoms onset, arise from the lack of completeness of this information due both to the difficulty in the recording and to the absence in asymptomatic subjects.The general trend of RDt, at least at an intermediate lag of 6 or 7 days, is very similar to that of Rt, as confirmed by the very high value of the correlation index between the two indices. The maximum correlation between Rt and RDt is reached at lag 7 with a value of R exceeding 0.97 (R2=0.944).The two indices, albeit formally distinct, are both valid; they show specific aspects of the phenomenon, but provide basically similar information to the public health decision-maker. Their distinction lies not so much in the method of calculation, rather in the use of different information, i.e., the beginning of symptoms and the swabs outcome.Therefore, it is not appropriate to make a judgment of preference for one of the two indices, but only to invite people to understand their different potentials so that they can choose the one they consider the most appropriate for the purpose they want to use it for.
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Affiliation(s)
| | | | | | - Silvia Deandrea
- Unità operativa complessa salute e ambiente e progetti innovativi
| | - Salvatore Scondotto
- Dipartimento per le attività sanitarie e osservatorio epidemiologico, Regione Siciliana, Palermo
| | | | - Carlo Di Pietrantonj
- Servizio di riferimento regionale di epidemiologia per la sorveglianza, la prevenzione e il controllo delle malattie infettive, Azienda sanitaria locale, Alessandria
| | - Lucia Bisceglia
- Area epidemiologia e care intelligence, Agenzia regionale strategica per la salute e il sociale Puglia, Bari
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Cernigliaro A, Usticano A, Miceli P, Marras A, Tavormina EE, Ferro MP, Scondotto S. [A regional equity profile to assess the impact of social inequalities on determinants and health outcomes in the population residing in Sicily Region (Southern Italy)]. Epidemiol Prev 2021; 44:54-63. [PMID: 33415947 DOI: 10.19191/ep20.5-6.s1.p054.074] [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 build an equity profile for assessing the impact of socioeconomic inequalities on the determinants and health outcome in Sicily (Southern Italy). DESIGN descriptive study aimed to define an equity profile in Sicily by using a rich list of indicators of structure of the resident population and of distribution of determinants and health outcome, derived from the integration of available information and scientific evidence at regional level with high local detail. SETTING AND PARTICIPANTS the equity profile collects available information on the health status of the population in Sicily, on the determinants, and on the use of health and social services. The characteristics of people or population groups have been explored and can produce inequalities on health which included individual and context socioeconomic status. MAIN OUTCOME MEASURES using available information sources and study results have explored the effects of the disadvantage on health in the region: mortality, morbidity, oncological incidence, reproductive health, and some of their determinants. RESULTS the Sicilian population tends to aging. Migration flows tend to compensate the reduction in births in Sicily and it increases the proportion of younger people and women in childbearing age. The proportion of large families tends to get smaller, whereas the proportion of single-component ones increases; the population groups with low education, unemployment, poverty, and income increases. Starting from the first thousand days of life, to continue in the other classes of the population, the different distribution of risk factors on health was identified according to different levels of deprivation. CONCLUSIONS the Sicilian equity profile has systematized and consolidated previous experiences on the effects of disadvantage on health. Prevention interventions, oriented towards equity, should be based on the results of this study and should take care of the general aspects of actions and, at the same time, focus on vulnerable population groups.
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Affiliation(s)
- Achille Cernigliaro
- Dipartimento attività sanitarie e osservatorio epidemiologico, Assessorato alla sanità, Regione Siciliana, Palermo;
| | - Antonella Usticano
- Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo.,Registro tumori, Azienda sanitaria provinciale, Ragusa
| | - Patrizia Miceli
- Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo
| | - Antonello Marras
- Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo
| | - Elisa Eleonora Tavormina
- Istituto per la ricerca e l'innovazione biomedica, Consiglio nazionale delle ricerche, Palermo.,Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo
| | - Maria Paola Ferro
- Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo
| | - Salvatore Scondotto
- Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo
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Ingrasciotta Y, Bertuccio MP, Crisafulli S, Ientile V, Muscianisi M, L’Abbate L, Pastorello M, Provenzano V, Scorsone A, Scondotto S, Trifirò G. Real World Use of Antidiabetic Drugs in the Years 2011-2017: A Population-Based Study from Southern Italy. Int J Environ Res Public Health 2020; 17:ijerph17249514. [PMID: 33353081 PMCID: PMC7765957 DOI: 10.3390/ijerph17249514] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022]
Abstract
Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia. The availability of new antidiabetic drugs (ADs) has led to complex treatment patterns and to changes in the patterns of specific drug utilization. The aim of this population-based study was to describe the pattern of antidiabetic drugs (ADs) use in Southern Italy in the years 2011–2017, in relation to the updated type 2 diabetes mellitus (T2DM) therapy guidelines. A retrospective cohort study was conducted on T2DM patients using data from the Palermo Local Health Unit (LHU) claims database and diabetologist registry. The first-line treatment was investigated and incident treatments were identified and characterized at baseline in terms of demographics, complications, comorbidities, concomitant drugs and clinical parameters. Persistence to AD treatment was also evaluated. During the study period, one-third of first ever ADs users started the treatment with ADs other than metformin, in contrast to guideline recommendations. Among 151,711 incident AD treatments, the male to female ratio was 1.0 and the median age was 66 (57–75) years. More than half (55.0%) of incident treatments discontinued the therapy during the first year of treatment. In Italy, general practitioners (GPs) can only prescribe first-generation ADs, while the prescription of more recently marketed ADs, such as GLP-1RA, DPP4i and SGLT2i, is restricted to diabetologists only, based on a therapeutic plan. The role of GPs in the management of T2DM in Italy should be re-evaluated.
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Affiliation(s)
- Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (M.P.B.); (S.C.); (V.I.); (L.L.)
- Correspondence: ; Tel.: +39-090-2213877
| | - Maria Paola Bertuccio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (M.P.B.); (S.C.); (V.I.); (L.L.)
| | - Salvatore Crisafulli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (M.P.B.); (S.C.); (V.I.); (L.L.)
| | - Valentina Ientile
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (M.P.B.); (S.C.); (V.I.); (L.L.)
| | - Marco Muscianisi
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy;
| | - Luca L’Abbate
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (M.P.B.); (S.C.); (V.I.); (L.L.)
| | | | - Vincenzo Provenzano
- Regional Referral Centre for Insulin Pump Implantation and Diabetes, Civic Hospital, Partinico, 90047 Palermo, Italy; (V.P.); (A.S.)
| | - Alessandro Scorsone
- Regional Referral Centre for Insulin Pump Implantation and Diabetes, Civic Hospital, Partinico, 90047 Palermo, Italy; (V.P.); (A.S.)
| | - Salvatore Scondotto
- Department of Epidemiologic Observatory, Health Department of Sicily, 90127 Palermo, Italy;
| | - Gianluca Trifirò
- Department of Diagnostic and Public Health, University of Verona, 37134 Verona, Italy;
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Ingrasciotta Y, Sultana J, Formica D, Ientile V, Aiello A, Chinellato A, Tari DU, Gini R, Pastorello M, Scondotto S, Cananzi P, Traversa G, Rossi M, Santoro D, Trifirò G. Direct healthcare costs of chronic kidney disease management in Italy: What cost-savings can be achieved with higher biosimilar uptake and more appropriate use of erythropoiesis-stimulating agents? Pharmacoepidemiol Drug Saf 2020; 30:65-77. [PMID: 33067914 DOI: 10.1002/pds.5152] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 07/24/2020] [Accepted: 10/07/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Erythropoiesis-stimulating agents (ESAs), are used for treating chronic kidney disease (CKD)-related anemia, contributing to CKD costs. The study was aimed at investigating direct healthcare costs of CKD patients treated with ESAs and the potential savings achievable by increasing the use of biosimilars and preventing inappropriate ESA use. METHODS A multi-center, cohort study was conducted using claims databases of five large Italian geographic areas. Yearly mean direct healthcare costs per patient were estimated, stratifying by CKD stage. The total yearly cost and potential savings related to ESA use were estimated: (a) considering 25/50/75% of originator ESA substitution with biosimilars; (b) eliminating inappropriate ESA dispensing. RESULTS During the study period, the ESA-related yearly mean cost represented 17% of total yearly costs in stage I-III, decreasing to 13% in stage IV-V and 6% in dialysis. Among originator users, assuming a 25% of biosimilar uptake, the annual cost-savings of ESA treatment would represent 10.5% of total ESA costs in CKD stage I-V and 7.7% in dialysis. Among incident ESA users for which hemoglobin levels were available, 9% started inappropriately ESA treatment, increasing to 62.0% during the first year of maintenance therapy. Hypothesizing prevention of the first inappropriate ESA dispensing, the total yearly cost-savings would amount to €35 772, increasing to €167 641 eliminating the inappropriate dispensing during maintenance therapy. CONCLUSIONS Higher use of lowest cost ESA, prevention of inappropriate ESA use as well as other strategies aimed at slowing down the progressive renal impairment are essential for minimizing clinical and economic burden of CKD.
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Affiliation(s)
- Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Janet Sultana
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Dario Formica
- Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Valentina Ientile
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | | | | | | | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | | | - Salvatore Scondotto
- Department of Epidemiologic Observatory, Health Department of Sicily, Palermo, Italy
| | - Pasquale Cananzi
- Sicilian Regional Centre of Pharmacovigilance, Servizio 7-Farmaceutica, Health Department of Sicily, Palermo, Italy
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Mariangela Rossi
- Health-Unit for Pharmaceutical Governance, Umbria Region, Perugia, Italy
| | - Domenico Santoro
- UOC Nefrologia e Dialisi, Department of Clinical and Experimental Medicine, University Messina, Messina, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy
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Arnao V, Salemi G, Scondotto S, Casuccio N, Riolo M, D'Amelio M, Ragonese P, Aridon P. Stroke incidence and case fatality: a 9-year prospective population-based study in an elderly population of Bagheria, Italy. Neurol Sci 2020; 42:2447-2452. [PMID: 33078249 PMCID: PMC8159798 DOI: 10.1007/s10072-020-04830-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
Background The incidence of stroke in high-income countries has been on the decline; however, few epidemiological surveys have been conducted in recent years to specifically estimate the incidence along with outcome of stroke, in Italy. This study aimed to examine the incidence and case fatality rates of stroke in an elderly Italian population. Methods A cohort of 2200 people > 65 years was randomly stratified from the total elderly population of Bagheria, Italy. A 9-year prospective population-based study was performed (19,800 person/years). Results We identified 112 first-ever strokes, 53 females and 59 males: 82 (73.1%) ischemic, 13(11.6%) intracerebral haemorrhages, 6 (5.35%) subarachnoid haemorrhages, while 11(9.8%) were classified as undetermined strokes. The crude overall annual incidence was 5.65 per 1000 (95%CI: 4.61 to 6.70) for first-ever stroke. The overall crude incidence rates were 4.74 per 1000 (5.08 for males and 4.46 for females) for ischemic stroke, 0.65 (0.99 for males and 0.37 for females) for intracerebral haemorrhage, and 0.03 for subarachnoid haemorrhage. The incidence rate for first-ever stroke was 5.4 per 1000 (95% CI: 5.36 to 5.45) after adjustment for the 2015 World population and 5.56 (95% CI: 5.52 to 5.61), compared to the 2015 European population. Overall case fatality rates for first-ever stroke was 8.19% at 28 days and 24.1% at 1 year. Conclusion Our study shows that in the elderly population investigated, stroke incidence and case fatality rates resulted being lower, compared to those from Italian and most European populations. Similar to previous studies, these rates increased linearly with age and were higher in males.
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Affiliation(s)
- Valentina Arnao
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via Gaetano la Loggia n.1, 90129, Palermo, Italy
- UO Neurologia e Stroke Unit, A. R. N. A. S. Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via Gaetano la Loggia n.1, 90129, Palermo, Italy
| | | | - Nicola Casuccio
- Azienda sanitaria Provinciale di Palermo -UOC di sanità pubblica, epidemiologia e medicina preventiva, Palermo, Italy
| | - Marianna Riolo
- Ospedale Santa Croce di Moncalieri - Asl TO5, Moncalieri, Torino, Italy
| | - Marco D'Amelio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via Gaetano la Loggia n.1, 90129, Palermo, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via Gaetano la Loggia n.1, 90129, Palermo, Italy
| | - Paolo Aridon
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via Gaetano la Loggia n.1, 90129, Palermo, Italy.
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Mazzucco W, Costantino C, Restivo V, Alba D, Marotta C, Tavormina E, Cernigliaro A, Macaluso M, Cusimano R, Grammauta R, Tramuto F, Scondotto S, Vitale F. The Management of Health Hazards Related to Municipal Solid Waste on Fire in Europe: An Environmental Justice Issue? Int J Environ Res Public Health 2020; 17:E6617. [PMID: 32932886 PMCID: PMC7558387 DOI: 10.3390/ijerph17186617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/01/2022]
Abstract
Landfilling should be the last option in an integrated Municipal Solid Waste (MSW) management approach. In the European Union (EU), the policy framework to protect the environment and the public health against the impact of health hazards related to urban solid waste management has been consistently implemented in recent decades. A growing interest in the negative impact of fires in waste landfills on the environment and people's health was reported in some European countries. In Italy, an increasing occurrence of arsons in MSW and landfills has been reported in recent years. During the summer of 2012, a multi-site arson occurred in the Palermo Municipal solid waste landfill of Bellolampo (western Sicily), giving rise to an environmental emergency of public health concern. Local health authorities reacted by creating an inter-institutional multidisciplinary task force with the aim to implement measures to prevent and control the risk of exposure by delimiting a protection area to be taken under strict monitoring. Environmental and epidemiological investigations were put in place by air, soil, and farm product sampling. A syndromic surveillance of the exposed population was conducted as well. The air monitoring stations system in place detected an increase in the concentrations of dioxins and dioxin-like substances with the PM10 highest emission pick documented within the first 24 h and estimated at about 60 μg/m3. Levels of heavy metals above the limits permitted by law were detected in the top- and sub-soil samples collected within the two landfill sampling sites and also in other nearby sites. Non-conforming concentration values of dioxins and dioxin-like substances were detected in samples taken from farms, milk, and water. The health syndromic surveillance did not document any daily increase in the notification of emergency admissions related to acute respiratory diseases or any other health effect potentially related to the waste arson, but these findings were limited by the non-systematic collection of data. The experience reported in the present case report, as declined within the European Union policy framework and in the view of environmental justice, documented the need to structure a permanent collaboration between the different institutional actors involved in environmental and public health protection activities in order to develop specific protocols to manage events related to the occurrence of waste-related environmental emergencies or disasters.
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Affiliation(s)
- Walter Mazzucco
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital “P. Giaccone”, 90127 Palermo, Italy
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - Claudio Costantino
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
| | - Vincenzo Restivo
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
| | - Davide Alba
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
| | - Claudia Marotta
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
| | - Elisa Tavormina
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, 90145 Palermo, Italy; (E.T.); (A.C.); (S.S.)
| | - Achille Cernigliaro
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, 90145 Palermo, Italy; (E.T.); (A.C.); (S.S.)
| | - Maurizio Macaluso
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA;
| | | | - Rosario Grammauta
- Institute for the Study of Anthropogenic Impacts and Sustainability in the Marine Environment (IAS), National Research Council, 91021 Torretta Granitola (Trapani), Italy;
| | - Fabio Tramuto
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
| | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, 90145 Palermo, Italy; (E.T.); (A.C.); (S.S.)
| | - Francesco Vitale
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
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Miligi L, Massari S, Paredes Alpaca RI, Piro S, Airoldi C, Ranucci A, Romeo E, Scondotto S, Cenni A, Aprea MC. Risk of nasopharyngeal cancer in productive sectors and formaldehyde exposure in bakeries industry. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1376] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The International Agency for Research on Cancer evaluated formaldehyde (F) as carcinogenic for human in association with Nasopharyngeal Cancer (NPC). Occupational exposure to F occurs in many industrial sectors also in those non-traditional. For example in Tuscany F was detected in a bakery where a NPC case had ever worked.
Methods
In this study a) A case control approach (OCCAM) was used for monitoring occupational risks based on current information sources. Three Italian Regional Operating Centres, collected NPC cases from cancer registries and/or hospital discharge records. Controls were randomly sampled from the regional health service population data. Occupational histories were available through record linkage with the social security pension database (INPS). Study results were reported by industrial sectors, area and gender. b) A specific study on F exposure was conducted in bakeries and pastry industry carrying out measurements to determine the concentration of F in specific tasks and positions.
Results
717 cases linked with INPS database. Increased ORs for several industrial sectors such as iron and steel, wood and plastic were observed. In two regions also health and veterinary services and hairdressers were at increased risk, but based on few cases of exposed workers. In the non traditional sector of bakeries and pastry industries, where workplaces were monitored, high levels of F in personal air samplings were found, in particular in processes that involve a strong leavening.
Conclusions
Many productive sectors, in which F exposure could occurred, were observed to be at higher risk. The measurements performed in the non traditional sector monitored, confirmed the F exposure in some phases of the work process. With this study we contributed to increased knowledge on the risk of NPC within the monitoring system of occupational risks, and to deepen exposure to F in a non traditional productive sector such as bakeries and pastry industries.
Key messages
The epidemiological method used (OCCAM) in this study provides further information on the role of occupational exposure in the development of nasopharyngeal cancer. The measurements performed in the bakeries and pastry industries provide new additional information on the exposure to formaldehyde in some work process phases of a non-traditional productive sector.
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Affiliation(s)
- L Miligi
- Occupational and Environmental Epidemiology Branch, Institute for Cancer, Research, Prevention and Clinical network-ISPRO, Firenze, Italy
| | - S Massari
- Department of Occupational and Environmental Medicine, Italian Workers' Compensation Authority- INAIL, Rome, Italy
| | - R I Paredes Alpaca
- Department of Public Health SPSAL, Local Health Unit AUSL Modena, Modena, Italy
| | - S Piro
- Occupational and Environmental Epidemiology Branch, Institute for Cancer, Research, Prevention and Clinical network-ISPRO, Firenze, Italy
| | - C Airoldi
- Occupational and Environmental Epidemiology Branch, Institute for Cancer, Research, Prevention and Clinical network-ISPRO, Firenze, Italy
| | - A Ranucci
- Occupational and Environmental Epidemiology Branch, Institute for Cancer, Research, Prevention and Clinical network-ISPRO, Firenze, Italy
| | - E Romeo
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - S Scondotto
- Department of Epidemiological Observatory, Sicily Region, Palermo, Italy
| | - A Cenni
- Public Health Laboratory, Local Health Unit South East Tuscany, Siena, Italy
| | - M C Aprea
- Public Health Laboratory, Local Health Unit South East Tuscany, Siena, Italy
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Franchi M, Trama A, Merlo I, Minicozzi P, Tarantini L, Garau D, Kirchmayer U, Di Martino M, Romero M, De Carlo I, Scondotto S, Apolone G, Corrao G. Cardiovascular Risk After Adjuvant Trastuzumab in Early Breast Cancer: An Italian Population-Based Cohort Study. Oncologist 2020; 25:e1492-e1499. [PMID: 32770690 PMCID: PMC7543336 DOI: 10.1634/theoncologist.2020-0216] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Although trastuzumab (T) represents the standard of care for the adjuvant treatment of HER2‐positive early‐stage breast cancer, contrasting results are available about the cardiac toxicity associated to its use. We conducted a multiregional population‐based cohort investigation aimed to assess both the short‐ and long‐term cardiovascular (CV) outcomes in women with early breast cancer treated with T‐based or standard adjuvant chemotherapy (CT). Materials and Methods We used health care use databases of six Italian regions, overall accounting for 42% of the Italian population. The study cohort was made by all women surgically treated for breast cancer who started a first‐line adjuvant T‐based or CT treatment. Patients treated with T were 1:2 matched to those treated with CT based on date of treatment start, age, and presence of CV risk factors. Short‐ and long‐term CV outcomes (heart failure and cardiomyopathy) were measured, respectively, after 1 year and at the end of follow‐up. Results Among 28,599 women who met the inclusion criteria, 6,208 T users were matched to 12,416 CT users. After a mean follow‐up of 5.88 years, short‐ and long‐term cumulative CV risk were 0.8% and 2.6% in patients treated with T and 0.2% and 2.8% in those treated with CT, respectively. Adjusted hazard ratios were 4.6 (95% confidence interval [CI], 2.6–8.0) for short‐term and 1.2 (95% CI, 0.9–1.6) for long‐term CV risk. Discussion In our large real‐world investigation, T‐associated cardiotoxicity was limited to the treatment period. The addition of T to adjuvant CT did not result in long‐term worsening of CV events. Implications for Practice Adjuvant trastuzumab‐based chemotherapy represents the backbone therapy in patients with HER2‐positive early breast cancer. Although well tolerated, cardiovascular events can manifest during or after therapy because of treatment‐related toxicities. In this wide multicenter and unselected cohort, long‐term symptomatic cardiotoxicity was low and limited to the treatment period. The findings suggest that developing tools that would be adequately able to predict cardiac toxicity at an early stage remains an important area in which additional research efforts are needed. With breast cancer patients experiencing longer survival, emphasizing their overall health through management of late and long‐term treatment effects is becoming increasingly important. This article reports a multiregional real‐world population‐based cohort investigation carried out to compare short‐term and long‐term cardiovascular risk of symptomatic cardiovascular events in women with localized breast cancer treated with trastuzumab‐based or standard adjuvant therapy in clinical practice.
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Affiliation(s)
- Matteo Franchi
- National Centre for Healthcare Research and PharmacoepidemiologyMilanItaly
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano‐BicoccaMilanItaly
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Ivan Merlo
- National Centre for Healthcare Research and PharmacoepidemiologyMilanItaly
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano‐BicoccaMilanItaly
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
- Cancer Survival Group, Department of Non‐Communicable Disease Epidemiology, London School of Hygiene and Tropical MedicineLondon
| | - Luigi Tarantini
- Department of Cardiology, Azienda Ospedale San Martino, ASL n. 1BellunoItaly
| | | | - Ursula Kirchmayer
- Department of Epidemiology ASL Roma 1, Lazio Regional Health ServiceRomeItaly
| | - Mirko Di Martino
- Department of Epidemiology ASL Roma 1, Lazio Regional Health ServiceRomeItaly
| | - Marilena Romero
- Department of Medical, Oral and Biotechnological Sciences, Section of Pharmacology and Toxicology, University of ChietiItaly
| | - Ilenia De Carlo
- Regional Centre of Pharmacovigilance, Regional Health Authority, Marche RegionItaly
| | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily RegionPalermoItaly
| | - Giovanni Apolone
- Scientific Director, Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Giovanni Corrao
- National Centre for Healthcare Research and PharmacoepidemiologyMilanItaly
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano‐BicoccaMilanItaly
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Isgrò V, Sultana J, Fontana A, Ientile V, Alecci U, Scoglio R, Magliozzo F, Scondotto S, Caramori G, Cazzola M, Trifirò G. Gender differences in COPD management in a Sicilian general practice setting: a cohort study evaluating the impact of educational interventions. ERJ Open Res 2020; 6:00279-2020. [PMID: 32832528 PMCID: PMC7430144 DOI: 10.1183/23120541.00279-2020] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/21/2020] [Indexed: 01/30/2023] Open
Abstract
Aim The aim of this study was to measure gender differences among COPD patients' quality of care (QOC) before and after two educational interventions in Southern Italy. Methods In this prospective cohort study, COPD patients were identified from primary care electronic medical records (EMRs). Twelve process indicators concerning diagnosis, preventative measures and therapeutic processes were developed as a measure of QOC. Educational interventions consisted of clinical seminars and audits on COPD QOC at baseline, and at 12 and 24 months. QOC indicators were stratified by gender: odds ratios (ORs) (males as reference group) of having a good QOC indicator were calculated at baseline, 12 and 24 months, with 95% confidence intervals (CIs) using hierarchical generalised linear models. Results Of 46 326 people registered in the EMRs, 1463 COPD patients (3.1%) were identified, of which 37% were women. QOC indicators reflecting best practice 24 months after the educational programme were generally not different to baseline, often favouring men. On the other hand, the composite global QOC indicator suggested that while a good overall QOC at baseline was significantly higher in men than women (OR: 0.74; 95% CI: 0.57–0.96), it became nonsignificant at 24 months (OR: 0.96; 95% CI: 0.72–1.29). Conclusions Specific QOC indicators among COPD patients often favoured men. However, several gender disparities seen at baseline disappeared at 24 months, suggesting that even general educational interventions which do not target gender can improve the gender disparity in QOC. This observational study shows that quality of care (QOC) is better among male COPD patients in primary care. Planned educational interventions over 24 months abolished gender difference in global QOC, although not in all QOC items.https://bit.ly/3cfwPST
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Affiliation(s)
- Valentina Isgrò
- Dept of Biomedical Sciences, Dentistry and Functional and Morphologic Imaging, University of Messina, Messina, Italy.,These authors contributed equally
| | - Janet Sultana
- Dept of Biomedical Sciences, Dentistry and Functional and Morphologic Imaging, University of Messina, Messina, Italy.,These authors contributed equally
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Valentina Ientile
- Dept of Biomedical Sciences, Dentistry and Functional and Morphologic Imaging, University of Messina, Messina, Italy
| | - Umberto Alecci
- Italian Society of General Practice (SIMG), Florence, Italy
| | | | | | | | - Gaetano Caramori
- Dept of Biomedical Sciences, Dentistry and Functional and Morphologic Imaging, University of Messina, Messina, Italy
| | - Mario Cazzola
- Dept of Experimental Medicine, Tor Vergata University, Rome, Italy
| | - Gianluca Trifirò
- Dept of Biomedical Sciences, Dentistry and Functional and Morphologic Imaging, University of Messina, Messina, Italy.,Unit of Clinical Pharmacology, G. Martino Academic Hospital, Messina, Italy
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Fazzo L, Cernigliaro A, De Santis M, Quattrone G, Bruno C, Zona A, Tumino R, Cascone G, Scondotto S, Comba P. Occupational cohort study of asbestos-cement workers in a contaminated site in Sicily (Italy). Epidemiol Prev 2020; 44:137-144. [PMID: 32631013 DOI: 10.19191/ep20.2-3.p137.036] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to analyse the asbestos-related diseases risk among the former workers of Sacelit asbestos-cement plant, operating in San Filippo del Mela (Sicily: 1958- 1993). DESIGN cohort study. SETTING AND PARTICIPANTS 228 subjects were employed in Sacelit from 1958 to 1993. Due to the available observation periods, the analyses of the different outcomes were performed for the subjects alive at the beginning of the respective follow up periods: mortality (1986-2018) was analysed for 204 subjects (177 men, 27 women), hospitalization (2001-2016) for 164 workers (139 men, 25 women) and the incidence of mesothelioma (1998-2016) was estimated for 178 subjects (153 men, 25 women). MAIN OUTCOMES MEASURES mortality (Standardized Mortality Ratio: SMR) and hospitalization (Standardized Hospitalization Ratio: SHR) from specific diseases were analysed. Incidence (Standardized Incidence Ratio: SIR) of mesothelioma cases was detected, also. SMR (1986-2014), SHR (2001-2016) and SIR (1998-2016), with 95% Confidence Intervals, were computed with respect to the regional rates, with STATA11. RESULTS in the men cohort, mortality from lung (17 cases, SMR 2.83) and pleural cancers (5 cases, SMR 30) and from asbestosis (15 cases, SMR 1,930) was in excess. The risk of hospitalization was in excess, in both genders, from lung cancer (men: 6 cases, SHR 4.1; women: 2 cases, SHR 8.6) and asbestosis (men: 17 cases, SHR 1,304; women: 6 cases, SHR 2,455). The incidence of mesothelioma was in excess in men (5 cases, SIR 23.9); no female cases of mesothelioma were observed. CONCLUSIONS a high occurrence of asbestos-related diseases in the cohort, particularly among men, was observed. The excess of hospitalization from asbestosis and lung cancer was highlighted also in women. The prosecution of the on-going health surveillance plan is particularly appropriated.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy);
| | - Achille Cernigliaro
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, Palermo (Italy)
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy)
| | | | - Caterina Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy)
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy)
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, Provincial Health Unit, Ragusa (Italy)
| | | | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, Palermo (Italy)
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy)
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Vineis P, Bisceglia L, Forastiere F, Salmaso S, Scondotto S. [Covid-19: how to get prepared for Autumn]. Epidemiol Prev 2020; 44:201-203. [PMID: 32921024 DOI: 10.19191/ep20.4.a001.048] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Lucia Bisceglia
- Agenzia strategica regionale per la salute e il sociale (AReSS), Puglia
| | | | - Stefania Salmaso
- Ex direttrice del Centro nazionale di epidemiologia, sorveglianza e promozione della salute dell'Istituto superiore di sanità, Roma
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Usticano A, Tumino R, Dardanoni G, Cascone G, Scondotto S, Spata E, Capocaccia R. Trends and projections of pleural mesothelioma incidence and mortality in the national priority contaminated sites of Sicily (Southern Italy). Epidemiol Prev 2020; 44:218-227. [PMID: 32921027 DOI: 10.19191/ep20.4.046] [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: 06/11/2023]
Abstract
OBJECTIVES to evaluate short-medium term incidence and mortality projections of pleural malignant mesothelioma (PMM) in Sicily Region (Southern Italy) and in its four National Priority Contaminated Sites (NPCSs). DESIGN population-based prediction study. SETTING AND PARTICIPANTS PMM cases from 1998 to 2016 registered by the Regional Operations Centre of the Sicilian Region. MAIN OUTCOME MEASURES incidence and mortality trends of PMM were estimated for the period 1998-2016 from the relationships among mortality, incidence, and survival. Projections of incidence and mortality rates were obtained up to 2026. RESULTS age-standardized incidence rates of PMM in Sicily were estimated to increase in men from 1.4 (x100,000) in 1998 to 2.29 in 2021 and to slightly decrease down to 2.2 in 2026. Women age-standardized rates in the same period are estimated to decrease from 0.52 to 0.27. In Biancavilla, age-standardized incidence rates were estimated to remain stable between 8.1 and 8.0 in men, while crude rates increased from 8.3 in 1998 to 10.7 in 2026. For women, the estimated age-standardized incidence rates are increasing from 3.08 to 6.75. In the three pooled NPCSs of Augusta-Priolo, Gela, and Milazzo, the estimates of age-standardized incidence rates show an initial trend to growth followed by a decreasing trend, both in men and women, down to predicted values in 2016 of 3.0 in men and 0.77 in women. Estimated age-standardized and crude mortality rates show, for both sexes and all areas, similar patterns as those estimated for incidence. CONCLUSIONS in Sicily and in the three NPCSs of Gela, Milazzo, and Priolo, incidence and mortality projections are downward in both sexes. In Biancavilla, mesothelioma occurrence is estimated to increase up to 2026, slightly in males and more significantly in females.
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Affiliation(s)
- Antonella Usticano
- Cancer register, Provincial Health Department, Ragusa (Italy);
- Department of health activities and epidemiological observatory of Sicily Region, Palermo (Italy)
| | - Rosario Tumino
- Cancer register, Provincial Health Department, Ragusa (Italy)
- Department of pathological anatomy, Provincial Health Department, Ragusa (Italy)
| | - Gabriella Dardanoni
- Department of health activities and epidemiological observatory of Sicily Region, Palermo (Italy)
| | | | - Salvatore Scondotto
- Department of health activities and epidemiological observatory of Sicily Region, Palermo (Italy)
| | - Eugenia Spata
- Cancer register, Provincial Health Department, Ragusa (Italy)
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Corrao G, Rea F, Carle F, Di Martino M, De Palma R, Francesconi P, Lepore V, Merlino L, Scondotto S, Garau D, Spazzafumo L, Montagano G, Clagnan E, Martini N, Bucci A, Carle F, Dajko M, Arcà S, Bellentani D, Bruno V, Carbone S, Ceccolini C, De Feo A, Lispi L, Mariniello R, Masullo M, Medici F, Pisanti P, Visca M, Zanini R, Di Fiandra T, Magliocchetti N, Romano G, Cantarutti A, Corrao G, Pugni P, Rea F, Davoli M, Fusco D, Di Martino M, Lallo A, Marinacci C, Maggioni A, Vittori P, Belotti L, De Palma R, Di Felice E, Chiandetti R, Clagnan E, Del Zotto S, Di Lenarda A, Mariotto A, Zanier L, Agnello M, Lora A, Merlino L, Scirè CA, Sechi G, Spazzafumo L, Massaro G, Simiele M, Cosentino M, Marvulli MG, Attolini E, Bisceglia L, Lepore V, Petrarolo V, Dondi L, Martini N, Pedrini A, Piccinni C, Fantaci G, Addario SP, Scondotto S, Bellomo F, Braga M, Di Fabrizio V, Forni S, Francesconi P, Profili F, Avossa F, Corradin M, Bucci A, Carle F, Dajko M, Arcà S, Bellentani D, Bruno V, Carbone S, Ceccolini C, De Feo A, Lispi L, Mariniello R, Masullo M, Medici F, Pisanti P, Visca M, Zanini R, Di Fiandra T, Magliocchetti N, Romano G, Cantarutti A, Corrao G, Pugni P, Rea F, Davoli M, Fusco D, Di Martino M, Lallo A, Marinacci C, Maggioni A, Vittori P, Belotti L, De Palma R, Di Felice E, Chiandetti R, Clagnan E, Del Zotto S, Di Lenarda A, Mariotto A, Zanier L, Agnello M, Lora A, Merlino L, Scirè CA, Sechi G, Spazzafumo L, Massaro G, Simiele M, Cosentino M, Marvulli MG, Attolini E, Bisceglia L, Lepore V, Petrarolo V, Dondi L, Martini N, Pedrini A, Piccinni C, Fantaci G, Addario SP, Scondotto S, Bellomo F, Braga M, Di Fabrizio V, Forni S, Francesconi P, Profili F, Avossa F, Corradin M. Measuring multimorbidity inequality across Italy through the multisource comorbidity score: a nationwide study. Eur J Public Health 2020; 30:916-921. [DOI: 10.1093/eurpub/ckaa063] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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
Multimorbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. A simple multisource comorbidity score (MCS) has been recently developed and validated. A very large real-world investigation was conducted with the aim of measuring inequalities in the MCS distribution across Italy.
Methods
Beneficiaries of the Italian National Health Service aged 50–85 years who in 2018 were resident in one of the 10 participant regions formed the study population (15.7 million of the 24.9 million overall resident in Italy). MCS was assigned to each beneficiary by categorizing the individual sum of the comorbid values (i.e. the weights corresponding to the comorbid conditions of which the individual suffered) into one of the six categories denoting a progressive worsening comorbidity status. MCS distributions in women and men across geographic partitions were compared.
Results
Compared with beneficiaries from northern Italy, those from centre and south showed worse comorbidity profile for both women and men. MCS median age (i.e. the age above which half of the beneficiaries suffered at least one comorbidity) ranged from 60 (centre and south) to 68 years (north) in women and from 63 (centre and south) to 68 years (north) in men. The percentage of comorbid population was lower than 50% for northern population, whereas it was around 60% for central and southern ones.
Conclusion
MCS allowed of capturing geographic variability of multimorbidity prevalence, thus showing up its value for addressing health policy in order to guide national health planning.
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Affiliation(s)
- Giovanni Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Federico Rea
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Flavia Carle
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Rossana De Palma
- Authority for Healthcare and Welfare, Emilia Romagna Regional Health Service, Bologna, Italy
| | - Paolo Francesconi
- Regional Health Agency of Tuscany (Agenzia regionale di sanità), Florence, Italy
| | - Vito Lepore
- Regional Health Agency of Puglia (Agenzia regionale socio-sanitaria), Bari, Italy
| | - Luca Merlino
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy
| | | | - Donatella Garau
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Regional Councillorship of Health ‘Regione Autonoma della Sardegna’, Cagliari, Italy
| | - Liana Spazzafumo
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Biostatistics Centre, INRCA-IRCCS National Institute, Ancona, Italy
| | | | - Elena Clagnan
- Regional Health Agency of Friuli-Venezia-Giulia (Azienda Regionale di Coordinamento per la Salute), Udine, Italy
| | - Nello Martini
- Research and Health Foundation (Fondazione ReS-Ricerca e Salute), Bologna, Italy
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Belleudi V, Trotta F, Addis A, Ingrasciotta Y, Ientile V, Tari M, Gini R, Pastorello M, Scondotto S, Cananzi P, Traversa G, Davoli M, Trifirò G. Effectiveness and Safety of Switching Originator and Biosimilar Epoetins in Patients with Chronic Kidney Disease in a Large-Scale Italian Cohort Study. Drug Saf 2020; 42:1437-1447. [PMID: 31228010 PMCID: PMC6858470 DOI: 10.1007/s40264-019-00845-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction Real-world data on the comparative effectiveness and safety of switching among different epoetins (including originators and biosimilars) are limited. In light of current debate about interchangeability, prescribers, some patient groups and decision makers are calling for additional post-marketing evidence on the clinical effects of switching between originator and biosimilar epoetins in chronic kidney disease (CKD) patients. Objective The objective of this study was to evaluate the effectiveness and safety of switching versus non-switching and of switching from originator/biosimilar epoetin alpha (ESA α) to any other epoetin in CKD patients. Methods An observational, record-linkage, multi-database, retrospective cohort study was carried out in four Italian geographical areas. All subjects with at least one ESA α dispensing between 1 January 2009 and 31 December 2015 were retrieved. Switching was defined as any transition between originator/biosimilar ESA α to any other epoetin in a series of two consecutive prescriptions up to 2 years. Switchers were matched 1:1 with non-switchers by baseline propensity score and by duration of ESA α treatment. Switchers and non-switchers were followed up from switching date to a maximum of 1 year. Lack of effectiveness and safety of switching versus non-switching were evaluated through Cox regression models (hazard ratio [HR], 95% confidence interval [CI]). A direct comparison between the two switcher categories (switchers from originator/biosimilar ESA α to any other epoetin) was also performed. Results Overall, 14,400 incident users of ESA α for anaemia due to CKD (61.4% originator, 38.6% biosimilar) were available for analysis. During the follow-up, we found no differences on effectiveness (HR 1.02, 95% CI 0.79–1.31 originators; HR 1.16, 95% CI 0.75–1.79 biosimilars) and safety outcomes (HR 1.08, 95% CI 0.77–1.50 originators; HR 1.20, 95% CI 0.66–2.21 biosimilars) between switchers and non-switchers of ESA α. Cumulative probabilities of recording an adverse event, either in terms of lack of effectiveness or safety issue, were the same for two switching categories Conclusions In this large-scale Italian observational multi-database study, switching versus non-switching as well as switching from biosimilar/originator ESA α to any other epoetin in CKD patients is not associated with any effectiveness and safety outcomes. Electronic supplementary material The online version of this article (10.1007/s40264-019-00845-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Rome, Italy.
| | | | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Valentina Ientile
- Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy
| | | | - Rosa Gini
- Toscana Regional Healthcare Agency, Florence, Italy
| | | | - Salvatore Scondotto
- Department of Epidemiologic Observatory, Health Department of Sicily, Palermo, Italy
| | - Pasquale Cananzi
- Sicilian Regional Centre of Pharmacovigilance, Servizio 7-Farmaceutica, Health Department of Sicily, Palermo, Italy
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy
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Zona A, Iavarone I, Buzzoni C, Conti S, Santoro M, Fazzo L, Pasetto R, Pirastu R, Bruno C, Ancona C, Bianchi F, Forastiere F, Manno V, Minelli G, Minerba A, Minichilli F, Stoppa G, Pierini A, Ricci P, Scondotto S, Bisceglia L, Cernigliaro A, Ranzi A, Comba P. [SENTIERI: Epidemiological Study of Residents in National Priority Contaminated Sites. Fifth Report]. Epidemiol Prev 2020; 43:1-208. [PMID: 31295974 DOI: 10.19191/ep19.2-3.s1.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES This volume provides an update of the health status of the populations living in the National Priority Contaminated Sites (NPCSs) included in the SENTIERI Project. This update is part of an epidemiological surveillance programme carried out in NPCSs, promoted by the Italian Ministry of Health as a further step of a project started in 2006, when the health status of residents in contaminated sites was first addressed within the National Strategic Program "Environment and Health". The Report focuses on five health outcomes: mortality, cancer incidence, hospital discharges, congenital anomalies, and children, adolescents and young adults' health. A key element of SENTIERI project is the a priori evaluation of the epidemiological evidence of a causal association between the considered cause of disease and the exposure. When an a priori evidence is identified, it is given a greater importance in the comment of the study findings. METHODS The present update of the SENTIERI Project concerns 45 NPCSs including in all 319 Italian Municipalities (out of over 8,000 Municipalities), with an overall population of 5,900,000 inhabitants at the 2011 Italian Census. Standardized Mortality Ratios (SMRs) and Standardized Hospitalization Ratios (SHRs), referring to a time window of 2006-2013, were computed for all the 45 NPCSs, using as a reference the corresponding mortality and hospitalization rates of the Regions where each NCPS is located. Standardized Incidence Ratios (SIRs) were computed by the Italian Association of Cancer Registries (AIRTUM) for the 22 NPCSs served by a Cancer Registry. AIRTUM covers about 56% of Italy, with partly different time-windows. SIRs have been estimated using as reference population the 4 macroareas in which Italy is divided (North-West, North-East, Centre, South). Prevalence of congenital anomalies was computed for 15 NPCSs. RESULTS An all-cause excess of 5,267 and 6,725 deaths was observed, respectively, in men and women; the cancer death excess was of 3,375 in men and 1,910 in women. It was estimated an excess of cancer incidence of 1,220 case in men and 1,425 in women over a five-year time window. With regard to the diseases with an a priori environmental aetiological validity, an excess for malignant mesothelioma, lung, colon, and gastric cancer, and for non-malignant respiratory diseases was observed. Cancer excess mainly affected NPCSs with presence of chemical and petrochemical plants, oil refineries, and dumping hazardous wastes. An excess of non-malignant respiratory disease was also detected in NPCSs in which steel industries and thermoelectric plants were present. An excess of mesothelioma was observed in NPCSs characterized by presence of asbestos and fluoro-edenite; it was also observed where the presence of asbestos was not reported in the legislative national decrees which define the NPCS areas. It is worth noting that, even if the presence of asbestos is not reported in many NPCSs legislative decrees, petrochemical plants and steel industries, for instance, are often characterized by the presence of a large amount of this mineral that, in the past, was extensively used as an insulating material. For the first time, the present Report includes a focus on the health status of children and adolescents (1,160,000 subjects, aged 0-19 years), and young adults (660,000 subjects, aged 20-29 years). Among infants (0-1 year), an excess of 7,000 hospitalizations was observed, 2,000 of which due to conditions of perinatal origin. In the age class 0-14, an excess of 22,000 hospitalizations for all causes was observed; 4,000 of them were due to acute respiratory diseases, and 2,000 to asthma. Data on cancer incidence for subjects aged 0-24 years were derived from general population cancer registries for twenty NPCSs, and from children cancer registries (age group: 0-19 years) for six NPCSs; 666 cases where diagnosed in the age group 0-24 years, corresponding to an excess of 9%. The main contributions to this excess are from soft tissue sarcomas in children (aged 0-14 years), acute myeloid leukaemia in children (aged 0-14 years) and in the age group 0-29 years, non-Hodgkin lymphoma and testicular cancer in young adults (aged 20-29 years). In seven out of 15 NPCSs, an excess prevalence rate of overall congenital anomalies at birth was observed. Congenital anomalies excesses included the following sites: genital organs, heart, limbs, nervous system, digestive system, and urinary system. CONCLUSIONS The main findings of SENTIERI Project have been the detection of excesses for the diseases which showed an a priori epidemiological evidence of a causal association with the environmental exposures specific for each considered NPCS. These observations are valuable within public health, because they contribute to priority health promotion activities. Looking ahead, the health benefits of an improved environmental quality might be appreciated in terms of reduction of the occurrence of adverse health effects attributable to each Site major pollutant agents. Due to the methodological approach of the present study, it was not possible to adjust for several confounding factors reported to be risk factors for the studied diseases (e.g., smoking, alcohol consumption, obesity). Even if excesses of mortality, hospitalization, cancer incidence, and prevalence of congenital anomalies were found in several NPCSs, the study design and the multifactorial aetiology of the considered diseases do not permit, for all of them, to draw conclusions in terms of causal links with environmental contamination. Moreover, it must be taken into consideration that economic factors and the availability of health services may also play a relevant role in a diseases outcome. A few observations regarding some methodological limitations of SENTIERI Project should be made. There is not a uniform environmental characterisation of the studied NPCSs in term of quality and detection of the pollutants, because this information is present in different databases which at present are not adequately connected. Moreover, the recognition of a contaminated site as a National Priority Site is based on soil and groundwater pollution, and the available information on air quality is currently sparse and not homogenous. Another limitation, in term of statistical power, is the small population size of many NPCSs and the low frequency of several health outcomes. A special caution must be paid in data interpretation when considering the correspondence between the contaminated areas and the municipality boundaries, as they do not always coincide perfectly: in some cases, a small municipality with a large industrial site, while in other settings only a part of the municipality is exposed to the sources of pollution. Furthermore, all available health information systems are currently accessible at municipality level. The real breakthrough is essentially comprised of the development and fostering of a networking system involving all local health authorities and regional environmental protection agencies operating in the areas under study. The possibility to integrate the geographic approach of SENTIERI Project with a set of ad hoc analytic epidemiological investigations, such as residential cohort studies, case control studies, children health surveys, biomonitoring surveys, and with socioepidemiological studies, might greatly contribute to the identification of health priorities for environmental remediation activities. Finally, as discussed in the last section of the report, there is a need to adopt, in each NPCS, a two-way oriented communication plan involving public health authorities, scientific community, and resident population, taking into account that the history, the cultural frame and the network of relationships specific of each local context play a major role in the risk perception perspective.
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Affiliation(s)
- Amerigo Zona
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma;
| | - Ivano Iavarone
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
| | - Carlotta Buzzoni
- Registro Tumori Toscano, Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Firenze
| | - Susanna Conti
- Servizio Tecnico Scientifico di Statistica, Istituto Superiore di Sanità, Roma
| | - Michele Santoro
- Unità di Epidemiologia Ambientale e Registri di Patologia, Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa
| | - Lucia Fazzo
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
| | - Roberto Pasetto
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
| | - Roberta Pirastu
- Dipartimento di Biologia e Biotecnologie Charles Darwin, Sapienza Università di Roma
| | - Caterina Bruno
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
| | - Carla Ancona
- Dipartimento di Epidemiologia del Servizio Sanitario Regionale, Regione Lazio, Roma
| | - Fabrizio Bianchi
- Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa
| | - Francesco Forastiere
- Dipartimento di Epidemiologia del Servizio Sanitario Regionale, Regione Lazio, Roma
| | - Valerio Manno
- Servizio Tecnico Scientifico di Statistica, Istituto Superiore di Sanità, Roma
| | - Giada Minelli
- Servizio Tecnico Scientifico di Statistica, Istituto Superiore di Sanità, Roma
| | - Aldo Minerba
- Struttura Complessa Statistica ed Epidemiologia, ASL Taranto
| | - Fabrizio Minichilli
- Unità di Epidemiologia Ambientale e Registri di Patologia, Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa
| | - Giorgia Stoppa
- Registro Tumori Toscano, Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Firenze
| | - Anna Pierini
- Unità di Epidemiologia Ambientale e Registri di Patologia, Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa
| | - Paolo Ricci
- UOC Osservatorio Epidemiologico, ATS Val Padana, Mantova
| | - Salvatore Scondotto
- Dipartimento Attività sanitarie e Osservatorio epidemiologico, Assessorato Salute Regione Siciliana, Palermo
| | - Lucia Bisceglia
- Agenzia Regionale Strategica per la Salute e il Sociale, Regione Puglia, Bari
| | - Achille Cernigliaro
- Dipartimento Attività sanitarie e Osservatorio epidemiologico, Assessorato Salute Regione Siciliana, Palermo
| | - Andrea Ranzi
- Direzione Tecnica, Centro Tematico Regionale Ambiente Salute, ARPAE Emilia-Romagna, Modena
| | - Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
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Cernigliaro A, Stafoggia M, Gariazzo C, Viegi G, de’ Donato F, Scondotto S. High resolution data to estimate effects of pollution and temperatures in Italy: The BEEP project. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.244] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
The BEEP (Big data in Environmental and occupational Epidemiology) project aims to estimate the health effects of several environmental risk factors on the Italian population at municipal level. Specific focus is being devoted to the risk of hospitalizations and mortality at the national level and within the major metropolitan areas and the risk of occupational injuries.
Results
Particulate matter concentrations and mean air temperatures (1x1km) were estimated using satellite data, land use data and observed data from monitoring networks for the Italian domain for 5 yrs. The short-term effects of PM and air temperature on morbidity and mortality only in Sicily, Lazio, Puglia, Emilia Romagna and Piedmont, were assessed. The preliminary results show: an increased risk of natural mortality, cardiovascular and respiratory hospitalizations in subjects exposed to PM, as well as higher effects in the older age on respiratory admissions in males. Associations were found also in the municipalities of medium and low level of urbanization; a non-linear relationship was found with increased risk of hospitalizations and mortality for high and low temperatures. Effects of heat were observed on respiratory hospital admissions, and effects of cold temperature were found on both cardiovascular and respiratory admissions. Larger effects of heat and cold were estimated in the elderly and in municipalities at a higher urbanization; a larger risk of occupational accidents in the construction industry for hot temperatures and in the transport sector for cold temperatures were evidenced.
Conclusions
Results of the BEEP project provide innovative findings on the health risks of environmental exposures in both urban and rural settings and provide decision makers with important information for the definition of prevention measures.
Acknowledgement: The BEEP project is supported by INAIL and is described in the website: www.progettobeep.it.
Key messages
Using Big Data (environmental and Health) is possible estimate the effect of pollution and temperature on mortality and morbidity among the residents in cities or rural areas. Pollutant increase the risk on natural mortality and cardiovascular and respiratory hospitalizations.
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Affiliation(s)
- A Cernigliaro
- Department of Health Activities and Epidemiological Observatory, Health Autority Sicily Region, Palermo, Italy
| | - M Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - C Gariazzo
- Department of Occupational & Environmental Medicine, INAIL, Monteporzio Catone, Italy
| | - G Viegi
- Institute of Biomedicine and Molecular Immunology, CNR - IBIM, Palermo, Italy
| | - F de’ Donato
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - S Scondotto
- Department of Health Activities and Epidemiological Observatory, Health Autority Sicily Region, Palermo, Italy
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Cernigliaro A, Palmeri S, Casuccio A, Scondotto S, Restivo V. Association of the Individual and Context Inequalities on the Breastfeeding: A Study from the Sicily Region. Int J Environ Res Public Health 2019; 16:E3514. [PMID: 31547173 PMCID: PMC6801793 DOI: 10.3390/ijerph16193514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/21/2019] [Revised: 09/12/2019] [Accepted: 09/18/2019] [Indexed: 12/29/2022]
Abstract
Despite the advantages of breastfeeding being widely recognized, the economic level can have an influence on breastfeeding rates, with rich women breastfeeding longer than poor in high-income countries. In Italy, socio-economic differences affect breastfeeding start and continuation among most deprived people, such as in Southern Italy. The objective of the study was to evaluate the prevalence of the initiation and continuation of exclusive breastfeeding and its association with the levels of socio-economic deprivation in Sicily. A prospective cohort study with a two-phase survey in three breastfeeding detection times was conducted. Overall, 1,055 mothers were recruited with a mean age of 31 years. Breastfeeding decreased from 86% during hospitalization to 69% at the first month and 42% at the sixth month, yet at the same time, exclusive breastfeeding increased from 34% to 38% during hospitalization to the first month and went down to 20.2% at the sixth month. The adjusted multivariate analysis showed no association with individual inequalities. On the other hand, the context inequalities had a significant association with the risk of not following exclusive breastfeeding in the deprived class (odds ratio (OR): 2.08, confidence interval (CI) 95% 1.01-4.27) and in the very deprived class (OR: 1.83, CI 95% 1.00-3.38) at the six-month survey. These results indicate that the context inequalities begin to emerge from the return home of the mother and the child.
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Affiliation(s)
- Achille Cernigliaro
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, 90145 Palermo, Italy (S.S.)
| | - Sara Palmeri
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (S.P.); (V.R.);
| | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (S.P.); (V.R.);
| | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, 90145 Palermo, Italy (S.S.)
| | - Vincenzo Restivo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (S.P.); (V.R.);
| | - In Primis Working Group
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (S.P.); (V.R.);
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