Impact of COVID-19 on Timing of Hip-Fracture Surgeries: An Interrupted Time-Series Analysis of the Pre/Post-Quarantine Period in Northern Italy

To assess whether the imposition of the coronavirus disease 2019 (COVID-19) national quarantine (March 10, 2020) resulted in a shift in the proportion of patients operated for hip fracture on the day of admission, the following day and two days after admission in the region of Piedmont, northern Italy

Burden of multimorbidity in relation to age, gender and immigrant status: A cross-sectional study based on administrative data

Objectives Many studies have investigated multimorbidity, whose prevalence varies according to settings and data sources. However, few studies on this topic have been conducted in Italy, a country with universal healthcare and one of the most aged populations in the world. The aim of this study was to estimate the prevalence of multimorbidity in a Northern Italian region, to investigate its distribution by age, gender and citizenship and to analyse the correlations of diseases. Design Cross-sectional study based on administrative data. Setting Emilia-Romagna, an Italian region with-1/44.4 million inhabitants, of which almost one-fourth are aged 6565 years. Participants All adults residing in Emilia-Romagna on 31 December 2012. Hospitalisations, drug prescriptions and contacts with community mental health services from 2003 to 2012 were traced to identify the presence of 17 physical and 9 mental health disorders. Primary and secondary outcome measures Descriptive analysis of differences in the prevalence of multimorbidity in relation to age, gender and citizenship. The correlations of diseases were analysed using exploratory factor analysis. Results The study population included 622 026 men and 751 011women, with a mean age of 66.4 years. Patients with multimorbidity were 33.5% in 75 years and >60% among patients aged 6590 years; among patients aged 6565 years, the proportion of multimorbidity was 39.9%. After standardisation by age and gender, multimorbidity was significantly more frequent among Italian citizens than among immigrants. Factor analysis identified 5 multimorbidity patterns: (1) psychiatric disorders, (2) cardiovascular, renal, pulmonary and cerebrovascular diseases, (3) neurological diseases, (4) liver diseases, AIDS/HIV and substance abuse and (5) tumours. Conclusions Multimorbidity was highly prevalent in Emilia-Romagna and strongly associated with age. This finding highlights the need for healthcare providers to adopt individualised care plans and ensure continuity of care

Determinants of cesarean delivery: a classification tree analysis.

open4noBackground Cesarean delivery (CD) rates are rising in many parts of the world. To define strategies to reduce them, it is important to identify their clinical and organizational determinants. The objective of this cross-sectional study is to identify sub-types of women at higher risk of CD using demographic, clinical and organizational variables. Methods All hospital discharge records of women who delivered between 2005 and mid-2010 in the Emilia-Romagna Region of Italy were retrieved and linked with birth certificates. Sociodemographic and clinical information was retrieved from the two data sources. Organizational variables included activity volume (number of births per year), hospital type, and hour and day of delivery. A classification tree analysis was used to identify the variables and the combinations of variables that best discriminated cesarean from vaginal delivery. Results The classification tree analysis indicated that the most important variables discriminating the sub-groups of women at different risk of cesarean section were: previous cesarean, mal-position/mal-presentation, fetal distress, and abruptio placentae or placenta previa or ante-partum hemorrhage. These variables account for more than 60% of all cesarean deliveries. A sensitivity analysis identified multiparity and fetal weight as additional discriminatory variables. Conclusions Clinical variables are important predictors of CD. To reduce the CD rate, audit activities should examine in more detail the clinical conditions for which the need of CD is questionable or inappropriate.openStivanello E;Rucci P;Lenzi J;Fantini MPStivanello E;Rucci P;Lenzi J;Fantini M

COVID-19 and regional differences in the timeliness of hip-fracture surgery: an interrupted time-series analysis

Background. It is of great importance to examine the impact of the healthcare reorganization adopted to confront the COVID-19 pandemic on the quality of care provided to non-COVID-19 patients. The aim of this study is to assess the impact of the COVID-19 national lockdown (March 9, 2020) on the quality of care provided to patients with hip fracture (HF) in Piedmont and Emilia-Romagna, two large regions of northern Italy severely hit by the pandemic.Methods. We calculated the percentage of HF patients undergoing surgery within 2 days of hospital admission. An interrupted time-series analysis was performed on weekly data from December 11, 2019 to June 9, 2020 (approximate to 6 months), interrupting the series in the 2nd week of March. The same data observed the year before were included as a control time series with no "intervention"(lockdown) in the middle of the observation period.Results. Before the lockdown, 2-day surgery was 69.9% in Piedmont and 79.2% in Emilia-Romagna; after the lockdown, these proportions were equal to 69.8% (-0.1%) and 69.3% (-9.9%), respectively. While Piedmont did not experience any drop in the amount of surgery, Emilia-Romagna exhibited a significant decline at a weekly rate of -1.29% (95% CI [-1.71 to -0.88]). Divergent trend patterns in the two study regions reflect local differences in pandemic timing as well as in healthcare services capacity, management, and emergency preparedness

Factors Influencing Consumers’ Attitude Towards Biopreservatives

Biopreservatives have received considerable attention in recent years as natural alternatives to synthetic preservatives. This seems to be a response to an increased demand for natural and organic foods. This study investigates the potential market for products enriched with biopreservatives in Italy. Data were collected from a sample of Italian consumers (N = 479) using a web‐based survey. The main results indicate that 64% of respondents declared themselves to be willing to consume biopreservatives only if they replaced synthetic preservatives. Principal component analysis (PCA) was applied to reduce the number of variables. The factorial scores of the components obtained from PCA were used for a Cluster Analysis related to consumers’ perceptions about biopreservatives. Moreover, the survey highlights that the respondents had positive opinions about biopreservatives, although they showed difficulty in perceiving the exact meaning of the term. The study could provide useful implications for food manufacturers and facilitate the design of marketing strategies for foods enriched with biopreservative

Medical Costs of Patients with Type 2 Diabetes in a Single Payer System: A Classification and Regression Tree Analysis

Background and objectives Many studies and systematic reviews have estimated the healthcare costs of diabetes using a cost-of-illness approach. However, in the studies based on this approach patients\u2019 heterogeneity is rarely taken into account. The aim of this study is to stratify patients with type-2 diabetes into homogeneous cost groups based on demographic and clinical characteristics. Methods We conducted a retrospective cost of illness study by linking individual data on health services utilization retrieved from the administrative databases of Emilia-Romagna Region (Italy). Direct medical costs (either all-cause or diabetes-related) were calculated from the perspective of regional health service, using tariffs for hospitalizations and outpatient services and the unit costs of prescriptions for drugs. The determinants of costs identified in a generalized linear regression model were used to characterize subgroups of patients with homogeneous costs in a classification and regression tree analysis. Results The study population consists of a cohort of 101,334 patients with type 2 diabetes, followed up for 1 year, with a mean age of 70.9 years. Age, gender, complications, comorbidities and living area accounted significantly for cost variability. The classification tree identified 10 patient subgroups with different costs, ranging from a median of \u20ac 483 to \u20ac 39,578. The 2 subgroups with highest costs comprised dialysis patients and the largest subgroup (57.9%) comprised patients aged 6565 years without renal, cardiovascular and cerebrovascular complications. Conclusions Patients\u2019 classification into homogeneous cost subgroups can be used to improve the management and budget allocation for patients with type 2 diabetes

Spatial distribution of vastus lateralis blood flow and oxyhemoglobin saturation measured at the end of isometric quadriceps contraction by multichannel near-infrared spectroscopy.

Muscle blood flow (MBF) and muscle oxygen saturation (SmO(2)) were measured at eight locations (four proximal, four distal) over a 4 x 8 cm(2) area of the vastus lateralis at rest and immediately after isometric, maximal quadriceps contraction using multichannel, frequency-domain, near-infrared spectroscopy. A venous occlusion was applied 20 s before the end of the exercise, so that the venous-occlusion-induced increase in total hemoglobin was recorded without any delay after the end of the exercise. Therefore, we were able to investigate the relationship between the exercise-induced changes in vastus lateralis MBF and SmO(2). After exercise, MBF increased significantly at each measured location. Comparing the MBF values measured at the end of exercise in the proximal and distal regions, we observed that only one proximal region had a significantly higher MBF than the corresponding distal one. The maximum desaturation measured during exercise was positively correlated with the postexercise to pre-exercise MBF ratio in both the proximal (P=0.016) and distal (P=0.0065) regions. These data confirm that frequency-domain tissue oximeters are noninvasive, powerful tools to investigate the spatial and temporal features of muscle blood flow and oxygenation, with potential applications in areas of pathophysiology