Mediterranean diet adherence and synergy with acute myocardial infarction and its determinants. a multicenter case-control study in Italy.

Cardiovascular diseases are the leading causes of mortality and morbidity in Western countries. The possible synergistic effect of poor adherence to a Mediterranean diet (MD) and other risk factors for acute myocardial infarction (AMI) such as hypertension, cholesterol, ever smoker, BMI> 25, diabetes, has not been deeply studied. Design Case-control study. Methods Patients with first AMI and controls from four tertiary referral Italian centers were screened for enrolment. Dietary information was collected through a questionnaire and a MD adherence score was calculated. Physical activity and smoking habits were also registered. The Synergy Index was calculated according to Rothman. Results 127 cases and 173 controls were enrolled. The analysis was conducted using a dichotomous variable for the MD score with values 7 representing good adherence. Multivariate analysis showed the following variables associated to AMI: ever smoker (OR = 2.08), diabetes (OR = 1.42), hypertension (OR = 2.08), hypercholesterolemia (OR = 2.47), BMI> 25 (OR = 1.99), while a protective effect emerged both in subjects scoring > 7 on the MD score(OR = 0.55) and in subjects resident of Southern Italy (OR = 0.38). A synergistic effect does exist between poor adherence to the MD and the following risk factors: hypertension, hypercholesterolemia, BMI >25, diabetes and being a resident in central and northern Italy. Conclusion Synergy between heart disease risk factors and MD underlines the need to enlarge the list of known modifiable cardiovascular risk factors to include and promote adherence to Mediterranean dietary habits

Appropriateness of frequent use of emergency departments: A retrospective analysis in Rome, Italy

Background: Frequent users (FUs) are patients who repeatedly and inappropriately visit the emergency department (ED) for low-grade symptoms that could be treated outside the hospital setting. This study aimed to investigate the phenomenon of the FU in Rome by profiling such users and analyzing ED attendance by FUs. Methods: The analysis was carried out for attendance in 2021 at 15 EDs in the Local Health Authority Roma 1 geographical area. A digital app collected data, including information on the following variables: number of attendance, demographic characteristics, emergency medical service (EMS) usage, triage code, and appropriateness of attendance. COVID-19 diagnosis was also studied to analyze any possible influence on ED attendance. Differences between FUs and non-FUs were investigated statistically by t-test and chi-square test. Univariate analysis and multivariable logistic regression were performed to analyze the associated factors. Results: A total of 122,762 ED attendance and 89,036 users were registered. The FU category represented 2.9% of all users, comprising 11.9% of total ED attendance. There was a three times higher frequency of non-urgent codes in attendance of FU patients (FU: 9.7%; non-FU: 3.2%). FUs were slightly more likely to have used the EMS (13.6% vs. 11.4%) and had a lower frequency of appropriate ED attendance (23.8% vs. 27.0%). Multivariate logistic analysis confirmed a significant effect of triage code, gender, age, EMS usage, and COVID-19 diagnosis for the appropriateness of attendance. The results were statistically significant (p < 0.001). Conclusion: The FU profile describes mostly non-urgent and inappropriate attendance at the ED, including during the COVID-19 pandemic. This study represents an important tool for strengthening preventive policies outside the hospital setting. The Italian National Recovery and Resilience Plan represents an excellent opportunity for the development of new strategies to mitigate the phenomenon of FUs

Increasing HPV vaccination uptake among adolescents: A systematic review

Human Papillomavirus (HPV) vaccination is a well-known fundamental strategy in the prevention of cervical cancer, as it is always caused by HPV infection. In fact, primary prevention of the infection corresponds to primary prevention of HPV-related cancers and other diseases. Since an effective prevention at the population level is the final goal, it is mandatory for healthcare systems to achieve a high HPV vaccination coverage among the adolescents to reduce the circulation of the virus and the burden of HPV-related diseases. This research identified, through a systematic literature review, 38 papers on strategies adopted to increase HPV vaccination coverage among adolescents. The evaluated strategies targeted adolescents/parents and/or healthcare providers and could be grouped in three main types: (1) reminder-based, (2) education, information, and communication activities, and (3) multicomponent strategies. Several types of strategy, such as those relied only on reminders and integrating different interventions, showed a positive impact on vaccination coverage. Nonetheless, the heterogeneity of the interventions suggests the importance to adapt such strategies to the specific national/local contexts to maximize vaccination coverage

PGI12 Organizational and Economic Issues Related to the Introduction of Boceprevir in the Treatment of Patients with Genotype 1 Chronic Hepatitis C in Italy

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Developing an Evidence-Based Tool for Planning and Evaluating Vaccination Strategies Aimed at Improving Coverage in Elderly and At-Risk Adult Population

Background: Vaccination coverages need to be constantly maintained and improved with the implementation of vaccination strategies. This paper describes the development of an evidence-based tool to guide their planning and evaluation. Methods: A scoping review was performed in MEDLINE and institutional websites to search for similar available tools. A first version of the tool was developed considering review results and a four-step method used for the control and continuous improvement of processes and products, namely the Deming cycle. A panel of eight experts was then involved in a Delphi study for the finalization of the tool that was eventually discussed in a face-to-face meeting. Results: The scoping review found only one document and the first version of the tool was composed of 30 items. After the Delphi first round, 11 additional items were suggested and 5 original items amended. After the Delphi second round 41 items were eventually included. During the face-to-face meeting, 7 items were recognized as requisites for setting vaccination strategies, whereas 17 as relevant ones. Conclusions: Current public health challenges impose the need for evidence-based tools to organize effective vaccination strategies. Our tool is a first proposal which aims to reflect this focus

[Changes in tobacco addiction and spirometric variations in workers exposed to chemical risk in biochemical research laboratories of a large Italian University--a retrospective cohort study]

To describe smoking cessation in a group of workers exposed to chemical risk and factors associated; to assess the changes of respiratory function over the years also in relation to risks to which they were exposed

Is the adjuvanted influenza vaccine more effective than the trivalent inactivated vaccine in the elderly population? Results of a case-control study<subtitle>Vittoria Colamesta</subtitle>

Background Influenza illness is an important public health problem and annual vaccination is globally recommended for high risk populations. In the elderly the vaccine effectiveness is lower, compared with younger adults, due to the diminished immune response. The aim of the present study is to compare the effectiveness of two influenza vaccines in reducing hospitalizations for influenza or pneumonia in the elderly and to determine which formulation is more appropriate. Methods A case-control study was performed by selecting subjects at least 65 years old from the administrative database of a Local Health Unit in Rome. The cases were hospitalized for influenza or pneumonia during influenza season in the years 2010-2011 and 2011-2012. The controls were hospitalized in the same period for different pathologies. The sample was immunized with the trivalent inactivated vaccine (TIV) in the first flu season (2010-2011) and with the adjuvanted vaccine MF59 (ATIV) in the second season (2011-2012). Results A total of 269 cases and 1247 controls were included for the 2010-2011 flu season, and 365 cases and 1227 controls for the year 2011-2012. Up to 171 (63.6%) cases and 667 (53.5%) controls in the 2010-2011 season and 287 (78.6%) cases and 786 (64.1%) controls in the 2011-2012 season have not been vaccinated. Females are less likely to be hospitalized than males especially in 2010-2011: adjusted OR (AOR) = 0.36, 95% CI = 0.21-0.64. High educational level is also a protective factor for hospitalization, especially in 2011-2012 (AOR = 0.54, 95% CI = 0.41-0.70). Subjects over 75 years were at high risk of hospitalization compared to 65-74 year olds, mostly in the second season (AOR = 1.93, 95% CI = 1.45-2.58). In subjects with 65-74 years, TIV reduces more hospitalizations (AOR = 0.49, 95% CI = 0.24-0.97) than ATIV (AOR = 0.70, 95% CI = 0.40-1.23). In those over 75 years old, ATIV is more effective (AOR = 0.43, 95% CI = 0.31-0.59) compared to TIV (AOR = 0.64, 95% CI = 0.47-0.88). Conclusions TIV and ATIV reduce hospitalization for influenza or pneumonia with a variable degree of protection in different age groups: ATIV is more effective in individuals over-75 years old. The use of ATIV in the very elderly persons would provide important clinical benefit compared to nonadjuvanted vaccines

Chronic obstructive pulmonary disease (COPD) exacerbation: impact of comorbidities on length and costs during hospitalization

A retrospective cohort study was performed, using administrative database of the Local Health Unit Roma-A (LHU RM-A). The included subjects were residing in one of the four districts and were hospitalized for COPD exacerbation in healthcare facilities of the LHU during years 2010-2012