A multicenter survey on profile of care for hip fracture: predictors of mortality and disability

Because delay in time to surgery beyond 24-48 h has been observed in many studies to be associated with adverse outcomes, a survey in nine centers in Italy was undertaken to examine the impact of time to surgery on mortality and disability at 6 months after hospitalization.

INTRODUCTION

Delays in surgery for hip fracture have been reported to be associated with negative outcomes. However, most studies are based on retrospective analysis of hospital discharge data, which cannot determine functional status or general health status of patients prior to the fracture.

METHODS

Using a prospective cohort design, data were collected on 3,707 patients aged >50 years during hospitalization for hip fracture and in a 6-month postdischarge follow-up. Baseline information included age, gender, living arrangement, prefracture walking ability, walking aid, ASA grade, type and reason of fracture, time to surgery, type of surgery, date and destination at discharge, and osteoporosis treatment. Follow-up data included living arrangement, walking ability, and mortality.

RESULTS

Six-month mortality was positively associated with increasing age, comorbidity, prefracture functional disability, and having surgery more than 48 h after admission. Higher levels of functional status at 6 months were independently associated with surgery occurring within 24 h of the fracture and with osteoporosis therapy at discharge. Walking disability was associated with older age, comorbidity, disability before fracture, and time to surgery after 24 h.

CONCLUSIONS

Delay in surgery is a major cause of mortality and disability at 6 months, and interventions to modify this pattern of care are urgently needed.

Impact of intensity and timing of integrated home palliative cancer care on end-of-life hospitalization in Northern Italy

PURPOSE

The Veneto Region implemented a novel integrated home-based palliative cancer care (HPCC) program embedded in primary care. We examined the impact of timing and intensity of this program on the quality of end-of-life (EOL) care.

METHODS

We selected adult cancer patients died in the Veneto Region between March and December 2013, excluding those died from haematological malignancies as well as the very elderly (85+ years). We retrieved the claim-based data on hospitalization and homecare visits, and defined two observation windows: 90 to 16 days before death to examine intensity of HPCC exposure, and the last 15 days of life to examine EOL outcomes, including hospital death, any hospital stay for medical reasons and hospital stay ≥7 days for medical reasons. Multivariate analysis was conducted using a Poisson model.

RESULTS

Among the 2211 adults who died of solid tumours and received 1+ homecare visits during the exposure period, 1077 (48.7%), 552 (25.0%) and 582 (26.3%) had 0.1-1.9, 2-3.9 and 4+ homecare visits/week, respectively. The median duration between an HPCC home visit and death was 92 days (IQR 42-257 days). Hospital death occurred in 856 (38.7%) patients, while 1087 (49.2%) and 556 (25.1%) had a hospital stay and a hospital stay ≥7 days during the exposure period, respectively. In the multivariate analysis, a greater intensity of integrated HPCC (4+ visits/week) was significantly associated with a lower risk of hospital death (relative risk [RR] = 0.67, 0.59-0.76), any hospital stay (RR = 0.69, 0.62-0.77) and hospital stay ≥7 days for medical reasons (RR = 0.59, 0.49-0.71). A late activation (≤30 days before death) of HPCC was also associated with increased both hospital stay (RR = 1.26, 0.11-1.42) and hospital stay ≥7 days (RR = 1.25, 1.01-1.54).

CONCLUSIONS

A greater HPCC program intensity reduces the risk of hospital death and hospital stay in the end-of-life. An early activation of this program can contribute to improve these EOL outcomes.

Immobilization of antibacterial metallic cations (Ga3+, Zn2+ and Co2+) in a polypyrrole coating formed on Nitinol

Gallium, zinc and cobalt species were immobilized in hollow rectangular-sectioned microtubes of polypyrrole (PPy) electrosynthesized on Nitinol (NiTi) alloy by means of two different methods. One of them involved the immobilization after the PPy electropolymerization and the other one during the electrosynthesis process. The antibacterial activity of the coating against Escherichia coli (E. coli) was evaluated and the best results were obtained with gallium species. Characterization results demonstrated that gallium is incorporated into the PPy matrix as Ga³⁺ ions. The PPy film with gallium species incorporated during the electropolymerization exhibited a good corrosion protection performance.

Prevalence of diabetes across different immigrant groups in North-eastern Italy

BACKGROUND AND AIMS

Type 2 diabetes, one of the most important non-communicable diseases, represents a major health problem worldwide. Immigrants may contribute relevantly to the increase in diabetes. The aim of the study was to investigate variability in diabetes prevalence across different immigrant groups in the Veneto Region (northeastern Italy).

METHODS AND RESULTS

Diabetic subjects on January 2013 were identified by record linkage of hospital discharge records, drug prescriptions, and exemptions from medical charges for diabetes. Immigrant groups were identified based on citizenship. Age-standardized prevalence rates were obtained for residents aged 20-59 years by the direct method, taking the whole regional population as reference. Prevalence rate ratios (RR) with 95% Confidence Intervals (CI) were computed with respect to Italian citizens. Among residents aged 20-59 years, 45280 Italian and 7782 foreign subjects affected by diabetes were identified. Prevalence rates were highest among immigrants from South-East Asia, RR 4.9 (CI 4.7-5.1) among males, and 7.6 (7.2-8.1) among females, followed by residents from both North and Sub-Saharan Africa. Citizens from Eastern Europe (the largest immigrant group) showed rates similar to Italians. Most South-Asian patients aged 20-39 years were not insulin-treated, suggesting a very high risk of early onset type 2 diabetes in this ethnic group.

CONCLUSION

Large variations in diabetes prevalence by ethnicity should prompt tailored strategies for primary prevention, diabetes screening, and disease control. An increased demand for prevention and health care in selected population groups should guide appropriate resource allocation.

The C825T GNB3 polymorphism, independent of blood pressure, predicts cerebrovascular risk at a population level

BACKGROUND

The role of C825T polymorphism of the candidate GNB3 gene in predicting cerebrovascular outcome has been poorly explored in longitudinal setting at a population level.

METHODS

In an epidemiological setting, 1,678 men and women from general population were genotyped for C825T polymorphism of GNB3 gene and follow-up for 10 years to detect nonfatal and fatal cerebrovascular events (CE). Established cerebrovascular risk factors were used to adjust the multivariate Cox analysis for confounders.

RESULTS

Seventy-three nonfatal and 30 fatal CE were recorded. Incidence of CE was higher in TT than in C-carriers (fatal: 2.6 vs. 1.7%, P < 0.03; nonfatal: 7.8 vs. 3.9%, P < 0.03; fatal recurrences: 1.6 vs. 0.6%, P < 0.03). In Cox analysis, the TT genotype predicted nonfatal (hazard ratio 1.99, 95% confidence interval 1.05-3.79, P = 0.03), fatal (2.91, 1.05-8.12, P = 0.04), and fatal recurrent CE (6.82, 1.50-31.1, P = 0.02) also after adjustment for age, gender, systolic and diastolic blood pressure, body adiposity, atherogenetic blood lipids, serum uric acid, diabetes, calories, caffeine and ethanol intake, and coronary events at baseline. Further adjustment for historical CE made the association between TT genotype and incident fatal CE nonsignificant (hazard ratio 2.72, 95% confidence interval 0.96-7.22, P = 0.06).

CONCLUSIONS

The TT genotype of GNB3 gene predicts incident CE independent of blood pressure and other established risk factors at a population level. Further studies are needed to clarify the nature and pathways of this association.

Glycaemic fall after a glucose load. A population-based study

BACKGROUND AND AIMS

A blood glucose (BG) fall after an oral glucose load has never been described previously at a population level. This study was aimed at looking for a plasma glucose trend after an oral glucose load for possible blood glucose fall if any, and for its impact on coronary mortality at a population level.

METHODS AND RESULTS

In subjects from an unselected general population, BG and insulin were detected before and 1 and 2h after a 75-g oral glucose load for insulin sensitivity and β-cell function determination. Blood pressure, blood examinations and left ventricular mass were measured, and mortality was monitored for 18.8±7.7 years. According to discriminant analysis, the population was stratified into cluster 0 (1-h BG < fasting BG; n=497) and cluster 1 (1-h BG ≥ fasting BG; n=1733). To avoid any interference of age and sex, statistical analysis was limited to two age-gender-matched cohorts of 490 subjects from each cluster (n=940). Subjects in cluster 0 showed significantly higher insulin sensitivity and β-cell function, lower visceral adiposity and lower blood pressure values. Adjusted coronary mortality was 8 times lower in cluster 0 than 1 (p<0.001). The relative risk of belonging to cluster 1 was 5.40 (95% CI 2.22-13.1).

CONCLUSION

It seems that two clusters exist in the general population with respect to their response to an oral glucose load, independent of age and gender. Subjects who respond with a BG decrease could represent a privileged sub-population, where insulin sensitivity and β-cell function are better, some risk factors are less prevalent, and coronary mortality is lower.

Technical note: Repeatability and reproducibility of curd yield and composition in a miniaturized coagulation model

Miniaturized coagulation (MC) models have been proposed for the evaluation of curd yield (CY) in individual milk samples of different dairy species and breeds, and for the analysis of cheese microstructure and texture. It is still unclear if MC using less than 50 mL of milk is suitable to evaluate CY and chemical composition, and if preservative added to raw milk may interfere with MC process. Therefore, this study aimed at evaluating repeatability and reproducibility of CY, curd moisture, and fat and protein content on curd dry matter (DM) from MC trials using 40 g of milk. Miniaturized coagulations were performed by 3 different operators on 3 consecutive days, using raw milk (RM) and raw milk added with preservative (RMP). Repeatability of CY, calculated as relative standard deviation on 6 miniaturized curds obtained within a day by the same operator, was below 5% for MC carried out with both RM and RMP. The Horwitz ratio, which is the ratio between measured and expected reproducibility, highlighted good reproducibility for CY from RM and fair reproducibility for CY from RMP. The same ratio highlighted lower accuracies for curd moisture and fat and protein content on curd DM, especially for MC trials carried out with RMP. The z-test was performed to evaluate the similarity between curds manufactured with RM and RMP in terms of average yield and chemical composition; z-scores did not highlight significant differences between values obtained from MC carried out with RM and RMP. It can be concluded that preservative had negligible effects on MC, giving the opportunity to extend milk physical and chemical stability, to schedule laboratory trials on longer time span, and to broaden the sample size within a batch of analyses.

Mineral equilibrium in commercial curd and predictive ability of near-infrared spectroscopy

Curd samples (n = 83) from 3 European dairy companies were analyzed for micellar and soluble mineral fractions content using inductively coupled plasma optical emission spectrometry as a gold standard method. The same curd samples were analyzed through 3 different near-infrared (NIR) instruments, and NIR spectra were merged with reference data. Prediction equations were developed using modified partial least squares analysis, and the accuracy of prediction was evaluated through leave-one-out cross validation. Overall, NIR spectroscopy was capable of predicting micellar and soluble mineral fractions in curd, but with differences among instruments. Fitting statistics showed that the visible NIR instrument in reflectance mode outperformed the NIR instrument in transmittance mode as well as the portable NIR instrument in reflectance mode. Prediction accuracies for most of the analyzed mineral fractions can be used for curd quality control in dairy companies and to aid in decision-making during the cheesemaking process.

Prognostic significance of nuclear DNA analysis by flow cytometry in the progression of superficial bladder cancer

The authors used nuclear DNA analysis to evaluate 142 patients with bladder tumours in stage Ta, T1. During follow-up, only the T1G2-G3 forms progressed. Tumour stage and DNA Index (DI) > 1.25 were strongly correlated to tumour invasiveness. According to these data, patients with tumours in the T1 stage and Dl>1.25 should undergo closer follow-up.