Monitoring Appropriate Monoclonal Antibodies Prescribing via Administrative Data: An Application to Psoriasis

: The Italian Medicines Agency (AIFA) and the Italian Regional Health Systems have implemented measures together with data collection and analysis to improve medicines' appropriate prescription. Administrative databases represent rich Real-World Evidence (RWE) sources that may be leveraged for research purposes. Thus, such heritage may allow for appropriate prescription studies to be carried out on complex pharmaceutical molecules, as the appropriateness of prescriptions is essential both for patients' treatment and to ensure healthcare systems' sustainability. This study analyzed the appropriate monoclonal antibodies (mAbs) prescribed in psoriasis treatment across Tuscany, Italy. Data were extracted from several large administrative databases collected by the Tuscan Regional Healthcare System through record linkages. The analysis showed that over 30% of the 2020 cohort of psoriatic patients could be regarded as potentially inappropriate treated, signaling that mAbs are often prescribed as first-line treatment contrary to guidelines. Variation was observed in the appropriate prescription of mAbs, across different types of mAbs and areas. The study revealed potential inappropriate prescription, and its geographic variation should raise awareness among managers about the appropriate use of resources. Despite limitations, this could represent a pilot for future studies to evaluate the appropriate prescription of mAbs in other clinic conditions and across time

Desde microorganismos a la macrofauna: un estudio comparativo de las comunidades bentónicas profundas y su respuesta a las variables ambientales a lo largo del talud de Malta (mar Jónico)

A comparative study for abundance, biomass and diversity was carried out for the prokaryote, meiofauna and macrofauna communities at three depth stations (1200, 1800 and 2100 m) along the Malta Escarpment (Mediterranean Sea). Our investigation showed a two-fold increase with depth in prokaryote abundance; the contribution of prokaryote biomass to the total benthic biomass was predominant at all depths. Bacteria were the dominant prokaryote component and Archaea formed a considerable fraction (20%-30%) of the prokaryote assemblages. The meio- and macrofauna abundances and meiofauna biomass did not decrease significantly with depth but macrofauna biomass did. The α diversity did not follow a clear bathymetric trend for both nematode and macrofauna species. Probably because of the large number of eurybathic nematode genera, nor did the turnover diversity in nematode composition change down the depth gradient. Conversely, for the macrofauna there was a perceptible change in community composition between the shallowest station and the two deeper stations. Food availability affected only the macrobenthic component. The increase in the prokaryote organisms with depth and the dominance of nematodes and macrofauna deposit feeders suggest active grazing by the two benthic components on microbes. This would transfer energy to the higher trophic levels through the microbial compartment.Se llevó a cabo un estudio comparativo de las comunidades de procariotas, meiofauna y macrofauna sobre la abundancia, biomasa y diversidad. Fue realizado en tres estaciones en varias profundidades (1200, 1800 y 2100 m) a lo largo del talud de Malta (mar Mediterráneo). Nuestra investigación muestra que, aumentando la profundidad, la abundancia de procariotas se duplica. La contribución de la biomasa procariota al total de la biomasa bentónica predominó en todas las profundidades. Las bacterias eran la fracción procariota dominante y junto con los Archaea representaban al 20-30% del total de procariotas. Por otra parte la abundancia de la meiofauna y macrofauna y la biomasa de la meiofauna no disminuían significativamente con la profundidad, mientras que la biomasa de la macrofauna sí lo hacía. La diversidad α no siguió una tendencia batimétrica muy clara para las especies de los nematodos y macrofauna. Probablemente debido a la gran abundancia de géneros de nematodos eurybatiales, la tasa derenovación de la diversidad en la composición de nematodos tampoco cambió por el gradiente de profundidad. En cambio, para la macrofauna hubo un cambio apreciable en la composición de la comunidad entre la estación más superficial y las dos estaciones más profundas. La disponibilidad de alimentos afectó sólo al componente macrobentónico. El aumento con la profundidad de los organismos procariotas, el dominio de los nematodos y la macrofauna que se alimenta de los materiales depositados sugieren un medio activo para los dos componentes bentónicos microbianos. Esto daría lugar a una transferencia de energía a niveles tróficos superiores a través del compartimento microbiano

Healthcare costs of diabetic foot disease in Italy: estimates for event and state costs

Objective This study aimed to estimate healthcare costs of diabetic foot disease (DFD) in a large population-based cohort of people with type-2 diabetes (T2D) in the Tuscany region (Italy). Data sources/study setting Administrative healthcare data of Tuscany region, with 2018 as the base year. Study design Retrospective study assessing a longitudinal cohort of patients with T2D. Data collection/extraction methods Using administrative healthcare data, DFD were identifed using the International Classifcation of Diseases, Ninth Revision, Clinical Modifcation codes. Methods We examined the annual healthcare costs of these clinical problems in patients with T2D between 2015 and 2018; moreover, we used a generalized linear model to estimate the total healthcare costs. Principal fndings Between 2015 and 2018, patients with T2D experiencing DFD showed signifcantly higher average direct costs than patients with T2D without DFD (p<0.0001). Among patients with T2D experiencing DFD, those who experienced complications either in 2015–2017 and in 2018 incurred the highest incremental costs (incremental cost of € 16,702) followed by those with complications in 2018 only (incremental cost of € 9,536) and from 2015 to 2017 (incremental cost of € 800). Conclusions DFD signifcantly increase healthcare utilization and costs among patients with TD2. Healthcare costs of DFD among patients with T2D are associated with the timing and frequency of DFD. These fndings should increase awareness among policymakers regarding resource reallocation toward preventive strategies among patients with T2

Internet Addiction Disorder in a Sample of 402 High School Students [Zespół uzależnienia od internetu w grupie 402 uczniów szkoły ̈redniej]

Internet Addiction Disorder can be defined as “the inability of individuals to control their internet use, resulting in marked distress and/or functional impairment in daily life.” It carries the same social aftermath of impulse control and substance misuse disorders such as loss of control, craving and withdrawal symptoms. Aim: In this paper, we aimed to assess the prevalence of IAD in an Italian sample of high-school students. We also explored the relationship between Social Phobia and IAD diagnosis; lastly, we investigated the association between IAD and substance misuse. Methods: The research was conducted in accordance with the Helsinki Declaration. Assessments administered in this study consisted of three parts: 1) collecting information about general and personal data of the subjects; 2) the Internet Addiction questionnaire proposed by Ko, composed by 9 different areas; 3) the Social Anxiety Spectrum Self-Report (SHY-SR) Lifetime Questionnaire. Results: 19 of 402 subjects (i.e. 4.7% of the sample) fulfilled the diagnostic criteria for IAD, showing a slight predominance of males. 10.9% of subjects met diagnostic criteria for a Social Phobia Spectrum disorder. Six IAD subjects (31.8%) were also diagnosed with a social phobia spectrum condition. Within the group of students diagnosed with IAD, 4 (21.05%) subjects reported current or past use of drugs. Conclusion: Our results suggest that there is a sizable population of youth already showing or at risk of developing some kind of problematic relationship with the web. Social Anxiety Disorder seems to be both a risk factor and a frequent co-morbid disorder of internet misuse. Further studies along with shared diagnostic criteria and tools will facilitate research on treatments for these rapidly expanding and disabling conditions