EFFECTS OF ANTICOAGULATION THERAPY WITH VITAMIN K ANTAGONISTS ON HOSPITALIZATIONS AND EMERGENCY ROOM ACCESSES IN GROSSETO (ITALY)

Background A lot of drug groups are associated with preventable drug-related admissions. Coumarin derivatives, prescribed for the treatment and prevention of deep vein thrombosis or pulmonary embolism or prevention of systemic embolism or stroke in patients with prosthetic heart valves or atrial fibrillation, are often associated  with bleeding. The aim of our study was to estimate the impact of the anticoagulant therapy in the elderly population (over 65 years old) living in Grosseto province, through the hospitalizations and the visits to emergency room, using only current data flows.Methods In 2013 we conducted a cross sectional study analyzing the database of all pharmaceutical prescriptions, selecting patients living in Grosseto (Italy), which received at least two prescriptions of coumarin derivatives in 2012.  We analyzed the admissions to hospital and the accesses to the emergency rooms (ER) made by each patient, focusing especially on those related to bleeding. For each access to ER we recorded the date, time of stay, diagnosis and outcome. For each hospitalization the information we recorded were the date of admission and discharge diagnosis.Results 3684 patients were included in our study. 261 (7.1%) patients visited the emergency room for bleeding; 37 (1%) for intracranial bleeding. The accesses made by men were higher than those made by women. The average time of stay in ER was 349 minutes. The admissions to hospital were 96 (2.6%); 42 (1.1%) were admitted to hospital with a diagnosis of major vascular event. 53 patients (20.3 %), accessed to the ER more than one time. The 11.5% was admitted to the hospital more than one time.  Conclusions Our study tried to estimate the impact of the anticoagulant therapy in the elderly population, living in Grosseto province, showing an important impact of this therapy on the accesses at ER and on admissions at hospital

Master athletes and “1001 miles”, the longest and most extreme European randonneè: Ultra-endurance road cycling in master athletes

NO ABSTRACT AVAILABLE - LETTER TO THE EDITO

HUMAN TRICHINELLOSIS IN ITALY: AN EPIDEMIOLOGICAL REVIEW SINCE 1989

Objectives Trichinellosis is a worldwide zooantroponosis caused by a nematode of the genus Trichinella. The main source of human infection is the consumption of raw or undercooked meat (especially from pigs, wild boars and horses). Infection with Trichinella was one of the most frequent parasitic diseases inItaly until 1959 when obligatory screening for these parasites in slaughtered swine was introduced. The aim of our review was to describe the epidemiology of Trichinellosis inItaly, because the last review on this topic was performed in 1989.Study Design We performed a systematic research in MEDLINEMethods We included in our review studies that were published in the peer reviewed literature using the MESH terms “Trichinellosis” and “Italy”. The only restrictions were the language (articles should be in English, Italian, Spanish or French) and the date of publication: from 1989 to March 2017. We excluded all the articles which referred to trichinellosis in the animals or which focused only on molecular biology of trichinella or on diagnostic techniques.Results We found 56 studies, but only 8 studies were considered. A total of 764 cases of Trichinellosis occurred inItaly since the 1990:13.75%caused by T. Britovi and 84.42% by T. spiralis; in 14 cases the identification of the parasite was not performed. The outbreaks occurred inUmbria, Piedmont, Apulia (500 cases in 1990, by T. spiralis),Basilicata,Tuscany, Abruzzo, Emilia Romagna,Sardinia. In 2001 and in 2008 two outbreaks occurred in Lazio andVeneto respectively, but imported from abroad. The most important sources of infections were: horse meat (82.19%); wild boar (11.91%); pig (5.89%).Conclusion Trichinellosis is an old disease, still present in our country, but often forgotten by general practitioners and infectious diseases specialists. Our review shows how it is impossible to define a region with a negligible risk, and how physicians and veterinarians should be regularly trained about this parasitic disease. A strict surveillance, especially on meat products from endemic countries or from wild animals is necessary to considerably reduce the risk of acquiring the infection

guerra batteriologica e bioterrorismo ancora una sfida per la sanita pubblica

Introduzione: Secondo i CDC americani il bioterrorismo viene definito come "rilascio di virus, batteri e altri agenti allo scopo di causare malattie o morte nella popolazione, ma anche animali e piante". Fin dall'antichità si riconobbe il potenziale degli agenti biologici come arma, ma solo con le scoperte di Kock e Pasteur del XIX secolo si poté parlare più propriamente di "guerra batteriologica". Lo scopo del presente lavoro è stato quello di studiare e confrontare tutte le più moderne evidenze scientifiche in materia di bioterrorismo, per valutare lo stato dell'arte in materia e fornire uno strumento utile per la prevenzione e gestione di una possibile minaccia biologica. Metodologia: Lo studio è stato condotto ricercando la letteratura scientifica attraverso la banca dati PUBMED. Si è basata sull'utilizzo di differenti stringhe di ricerca utilizzando keywords che potessero ben centrare l'argomento di interesse. A ciò è stata aggiunta anche la consultazione dei database dei Centers For Disease Control and Prevention che si focalizzassero sull'argomento. Risultati: Il caso delle "lettere all'antrace" ha dimostrato come il bioterrorismo rimane ancora un pericolo per tutta la comunità, e deve essere preso seriamente in considerazione a livello individuale e politico. Il requisito fondamentale per un attacco biologico è innanzitutto la disponibilità dell'agente patogeno o di tossine, in quantità sufficiente a colpire l'organismo umano e causare malattia. I terroristi tuttavia non necessitano, per i loro scopi, di agenti di distruzione di massa e ciò apre loro un più ampio schieramento di possibilità, preferendo agenti prontamente disponibili, prima fra tutte la tossina del ricino. Necessaria è pertanto una preparazione adeguata per microbiologi clinici e personale sanitario volta a identificare e trattare tempestivamente gli agenti biologici implicati, e il mantenimento di scorte di emergenza di farmaci. Conclusioni: Sebbene il bioterrorismo rappresenti una forma marginale, se confrontato con forme tradizionali di terrorismo con armi ed esplosivi, è fondamentale che la Sanità Pubblica risponda in modo adeguato a questa potenziale minaccia: un pronto riconoscimento dell'evento è il passo fondamentale per assicurare il contenimento dell'infezione del numero delle vittime

BACTERIAL LYSATES (OM-85 BV): a cost-effective proposal in order to contrast antibiotic resistance

Background Chronic Obstructive Pulmonary Disease (COPD) is one of the most frequent pathologies in which antibiotics are used because 50% of the exacerbations are attributable to a bacterial infection. The aims of our study were: i)to perform a meta-analysis on the efficacy of the bacterial lysate OM-85 BV in preventing acute exacerbations in patients with COPD; ii) to evaluate whether this preventive treatment can lead to significant savings for the National Health Service (NHS).   Methods A systematic research was conducted in the electronic database MEDLINE (PubMed) in June 2017-July 2020, collecting evidences without time restrictions. Only randomized controlled trials (RCTs) were included. The keywords used were "OM 85 BV AND chronic bronchitis" and "OM 85 BV AND COPD". We realized the cost-effectiveness analysis (CEA) considering the costs for a treatment with OM-8BV, the costs for the treatment of an acute exacerbation and the number of prevented exacerbations.   Results 59 publications were found, but the meta-analysis was conducted on 13 studies conducted between 1981 and 2015.OM-85 BV is responsible of a statistically significant reduction in the mean number of COPD exacerbations (p <0.01; WMD -0.86;CI 95% -1.38, -0.34) and in the days of antibiotic therapy (p <0.01; WMD -9.49;CI 95% -11.93, -7.05). The cost-effectiveness ratio with a negative value is in favor to treatment.      Conclusions OM-85 BV is effective in reducing exacerbations, and could lead to significant savings for the NHS. Moreover, reducing the number of exacerbations it avoids an over-use of antibiotics and the consequent antibiotic resistance

Vaccine hesitancy among Ukrainian refugees

Background On February 2022, Russia invaded Ukraine so several refugees went to Poland, Romania, Russia, but also to Italy. Several factors contributed to low vaccination coverage in Ukraine and the occurrence of epidemic outbreaks. The purpose of our study was to analyze the main characteristics of refugees who accessed the Rozzano Vaccination Center (Italy), and the attitude towards proposed vaccinations. Methods In March-July 2022, we conducted a cross sectional study on Ukrainian refugees under the age of 18. On the basis of their vaccination certificates or antibody dosages, the doctor proposed to the parents (or legal guardians) any vaccinations to be carried out on the basis of the Italian Vaccinal Calendar. Refused or accepted vaccinations were registered and the data exported for statistical analysis. COVID-19 vaccination was excluded from our analysis. Results 27 refugees missed the appointment, so 79 Ukrainian refugees have been included in the study. Females represented the 51.90% of patients; the average age was 7.11 (sd 4.92) years. The most refused vaccinations were: HPV, MMR and men C. Significant differences due to age were found for Men C and Chickenpox. Conclusions The efforts made to ensure complete care and promote vaccination among refugees, offering them a complete evaluation of the vaccination status and the possibility of being vaccinated for free, seem to be insufficient to convince most refugees to get vaccinated

Food related risks during pregnancy: how much do women know about it?

Aim Infection with Toxoplasma gondii and Listeria monocytogenes during pregnancy can lead to severe illness in the foetus but it can be prevented by simple hygienic measures. This study evaluated the knowledge that women have about food related risk and the information sources used. Methods We surveyed pregnant women and new mothers in[Removed for blind peer review], using a questionnaire approved by health direction, processed by an optical reader and analyzed using χ² test and Odds Ratio. Results 149 women responded to the survey, 78.5% of them received information from the gynaecologist, 45% from internet and then books/pamphlets. 67.8% felt well informed about food-related risks connected. 94% of them knows Toxoplasma; 39.5% ignore Listeria instead. From our results it’s evident  that graduated women tend to identify all foods as less secure and had better attitudes on cleaning refrigerator, on respecting temperatures, on avoiding consumption of undercooked foods, on protecting food before consumption. Conclusions Pregnant women have good awareness of food-related risks. However there’s a high confusion, due to the use of internet and other not reliable sources. This study demonstrates that it’s necessary to improve the organization of nutritional education by adequately trained health personnel

Pes planus and pes cavus in Southern

Introduction. Baropodometrical digital techniques map the pressures exerted on the foot plant during both static and dynamic loadings. The study of the distribution of such pressures makes it possible to evaluate the postural and locomotory biomechanics together with its pathological variations.Methods. From January 2011 to August 2016 we conducted a cross sectional study in order to diagnose flatfoot and hollowfoot through the baropodometric analysis, and collecting additional information such as gender and the age. 7816 static and dynamic baropodometric tests and radiological exams of the spine in different positions were performed in order to detect, evaluate and verify the presence of spine pathologies or postural disorders. 978 patients were screened for suspected foot deformities: 668 cases of hollow feet and 310 of flat feet were diagnosed.Results. Dividing patients in “younger” and “older” (> 60 years) according to WHO, there is a statistically significant difference in the prevalence of hollow feet and flat feet (p < 0.01): the young age is a risk factor for flat feet (OR = 1.61 CI 95% 1.22-2.11) but protective for hollow feet (OR = 0.62 CI 95% 0.47-0.81). There is a statistically significant difference (p < 0.01) due to sex in the prevalence of hollow feet (OR = 0.44 CI 95% 0.33-0.59) and flat feet (OR = 2.23 CI 95% 1.68-2.98): to be a man is a preventive factor for hollow feet, but a risk factor for flat feet.Conclusions. Flatfoot and hollowfoot represent a serious public health problem which is related to working life because these deformities negatively influence the productivity of employees and the quality of life of affected patients.

Evaluation of maternal perception of children's weight and Body Mass Index in Tuscany, Italy

Background: The prevention of overweight is a high-priority public health task. The perception that parents have of their children’s nutritional status is a well recognized risk factor for obesity in children, so the aim of our study was to evaluate mothers’ perceptions of their children’s nutritional status. Methods: We conducted, in 2016, a cross-sectional study enrolling1710 children (third grade of all primary schools ) in Tuscany, as well as their mothers. Mothers’ information were collected through a self-administered questionnaire, while children (weighed and measured) filled a questionnaire under the supervision of qualified personnel. Results: 1449 children completed the questionnaire. 74.12% of mothers were able to correctly identify children BMI. The non correct classification tends to significantly decrease in presence of a high educational level compared to low educational level. Mothers’ BMI seems to not be associated with misclassification. The non correct classification was significantly associated with mothers’ opinion about their children’s eating habit. Conclusion: Our data confirmed that, in Tuscany, a limited percentage of mothers tend to misclassify the nutritional state of their children, but in order to maintain these encouraging results, further efforts should be done in order to make all mothers able to correctly evaluate their children. Statements:Authors declare no conflict of interest. The study was conducted according to the criteria set by the declaration of Helsinki and each subject signed an informed consent before participating to the study. Approval of the protocol was obtained from the institutional review board of the National Institute of Health, including the use of opt-out consent; that is, parents could refuse participation but the lack of a returned form was taken to imply consent to their child’s participation