Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Method for analysis and identification of adhesion coefficient through on-board sensors

The digitalization of data and the technolog-ical development of systems in the railway field offer count-less advantages, including the ease of reading, processing and transmission of the acquired data in order to increase the safety of the path. The following work aims to provide a method of investigation for the analysis of the coefficient of adhesion through the use of on-board sensors of a railway vehicle. The investigation is articulated with the theoretical and analytical knowledge of the wheel-rail contact and experimental results from bench tests, proposing a method of analysis that examines the running data digitized and acquired from real cases using the on-board train sensors pro-vided

Linee guida volontarie per l’uso sostenibile del suolo per i professionisti dell'area tecnica. Indirizzi per la tutela del suolo dai processi di impermeabilizzazione e dalla perdita di materia organica

The voluntary guidelines aim to collect and analyses tools, strategies and methods for soil protection and its sustainable management with specific regard on two threats: the increase of Soil sealing and Land take process, and the decline and loss of soil organic matter. The main purpose of the document is to spread awareness on Soil value among professionals respectively to agronomists, architects, geologists, geometers, and engineers sharing knowledge and experiences on best practices and innovative solutions for soil protection. The Voluntary guidelines are articulated in 8 main strategic actions concerning: Spread the awareness of the soil value through a participation, communication and training activities; • Reduce the Land take process in territorial planning adopting an Ecosystem Services-based approach for setting qualitative and quantitative limits and ecological mitigation and compensation measures; • Increase the ecosystem services provision through the design of green and blue infrastructures; • Prioritise the regeneration of brownfields and underutilised areas restoring the contaminated soils; • Monitor and optimise the soil organic matter; • Increase and restore the soil organic matter for enhancing the ecosystem services provision through the adoption of conservative soil management practices; • Enhance soil resilience to climate change; • Promote agro-biodiversity conservation strategies to increase the soil organic matter and the provision of ecosystem services. The 8 actions are presented through a summary sheet articulated in objectives, stakeholders involved in the action, techniques and methods of action implementation, leading best practices, references and manuals useful for the practical operationalisation of the action. The document includes a glossary section, aiming to set common definitions and terminologies among professionals, a focus on available regional soil database, and a framework on existing regulations on soil protection useful for professional activities

Evidence of inadequate docosahexaenoic acid status in Brazilian pregnant and lactating women Evidencia de estado inadecuado del ácido docosahexaenóico en gestantes y nutrices brasileras Evidência de estado inadequado do ácido docosahexaenóico em gestantes e nutrizes brasileiras

Recently published data concerning dietary intake of fat and food sources of (n-3) long-chain polyunsaturated fatty acids (LCPUFA) in Brazil are reviewed together with data on biochemical indices of PUFA status during pregnancy and lactation and PUFA composition of breast milk in Brazilian adolescents and adults. Potential inadequacies of docosahexaenoic acid (DHA) status among Brazilian pregnant and lactating women have not yet been thoroughly evaluated. The data reviewed show that dietary intake of food sources of n-3 LCPUFA is low and possibly deficient in Brazil, and that biochemical indices of maternal DHA status and breast milk DHA content are low compared to the international literature. These data indicate inadequate DHA status among Brazilian women during pregnancy and lactation, but this evidence needs confirmation through comprehensive and specific population-based studies.<br>Son revisadas informaciones publicadas recientemente sobre la ingestión de tipos de grasas alimenticias y fuentes de alimentos de ácidos grasos poli-insaturados de cadena larga (AGPI-CL) n-3 en Brasil, junto con índices bioquímicos del estado nutricional para AGPI en gestantes y nutrices y la composición en AGPI en la leche de mujeres brasileras adultas y adolescentes. Posibles inadecuaciones del estado nutricional del ácido docosahexaenóico (DHA) en las gestantes y nutrices brasileras aún no fueron investigadas con amplitud y profundidad suficientes en Brasil. Los datos considerados muestran que la ingestión dietética de fuentes de alimentos de AGPI-CL n-3 en Brasil y baja e insuficiente. Así mismo, los índices bioquímicos del estado nutricional materno para el DHA y la proporción de DHA en la leche de mujeres brasileras adultas y adolescentes son bajos, cuando se comparan con datos internacionales. Estos datos indican posible estado inadecuado para el DHA en gestantes y nutrices brasileras, pero estas evidencias merecen confirmación por medio de estudios poblacionales amplios y específicos.<br>São revistas informações publicadas recentemente sobre a ingestão de tipos de gorduras alimentícias e fontes alimentares de ácidos graxos poli-insaturados de cadeia longa (AGPI-CL) n-3 no Brasil, juntamente com índices bioquímicos do estado nutricional para AGPI em gestantes e nutrizes e a composição em AGPI no leite de mulheres brasileiras adultas e adolescentes. Possíveis inadequações do estado nutricional do ácido docosahexaenóico (DHA) nas gestantes e nutrizes brasileiras ainda não foram investigadas com abrangência e profundidade suficientes no Brasil. Os dados considerados mostram que a ingestão dietética de fontes alimentares de AGPI-CL n-3 no Brasil é baixa e insuficiente. Além disso, os índices bioquímicos do estado nutricional materno para o DHA e o teor de DHA no leite de mulheres brasileiras adultas e adolescentes são baixos, quando comparados com dados internacionais. Estes dados indicam possível estado inadequado para o DHA em gestantes e nutrizes brasileiras, mas estas evidências merecem confirmação por meio de estudos populacionais abrangentes e específicos