Diabetes mellitus and colorectal cancer screening in the population of the Italian region Friuli Venezia Giulia

Aims: Colorectal cancer is the most common cancer in Italy, where screening programs are now in place all over the country. We conducted a research to assess whether the use and outcomes of colorectal cancer screening are different between diabetics, who are at increased risk of developing colorectal cancer, and non-diabetics in the Italian Northeastern region Friuli Venezia Giulia. Methods: This was a retrospective population-based study which used the administrative databases of the regional health information system as the sources of information. For the two screening rounds 2010-2011 and 2012-2013, we compared adherence to the program and the results of the fecal occult blood tests and of the colonoscopy among diabetic and non-diabetic residents. Results: Overall, more than 300,000 persons were invited for the colorectal cancer screening in each round. Of them, approximately 8.8% were diabetic. In the regional population, adherence to the screening program was significantly lower among diabetics than among non-diabetics. The proportion of positive fecal occult blood tests was higher among diabetics than among non-diabetics. Among diabetics, the detection rate for initial and advanced adenomas was higher than among non-diabetics, whereas no clear pattern was observed for the detection of cancers. Conclusion: In Friuli Venezia Giulia, efforts should be directed at improving the management of diabetic patients and at reducing the inequalities in access to care due to this comorbidity

The influence of patients’ complexity and general practitioners’ characteristics on referrals to outpatient health services in an Italian region

Background. Patient referrals to outpatient health services may affect both health outcomes and health expenditures. General practitioners (GP) have a crucial role in driving the use of outpatient services and recognizing factors which affect referrals is important for health managers and planners. Objectives. We investigated patient- and physician-related determinants of patient referrals in an Italian region. Methods. This was cross-sectional study based on the individual linkage of administrative databases from the health information system of the Friuli Venezia Giulia region. For each GP of the region, the association of the number of patient referrals to different types of outpatient services with the proportion of patients with chronic conditions, with the number of hospital admissions and drug prescriptions in 2012, and with GP’s characteristics was investigated through multilevel multivariable Poisson regression models. Results. Some chronic conditions (e.g., cancer, autoimmune diseases, endocrine diseases, digestive system diseases) were positively associated with the number of referrals, as were hospital admissions and drug prescriptions. Time since GP’s graduation was inversely related with referrals. Conclusion. Patient complexity and GP’s experience affect referral rates. These factors should be considered in case of a reorganization of the general practice structure in Friuli Venezia Giulia

Discontinuation of antidepressants in suicides findings from the Friuli Venezia Giulia Region, Italy, 2005-2014

6siAlthough continued use of antidepressants (AD) has been found to be associated with a lower risk of suicide, AD discontinuation is reported repeatedly. The aim of this case-control study, thus, was to assess whether discontinuation to AD was associated with an increased risk of suicide, according to different genders and age groups. The Social and Health Information System of Friuli Venezia Giulia Region, Italy, was used to collect data on suicides, diagnoses and AD use from 2005 to 2014. We selected, as cases, all suicides that had at least one prescription of AD in the 730 days before death (N = 876), and we matched with regard to age and sex each case with five controls from the general population. Conditional logistic regression analyses were used to assess the association between suicide and modifications of AD treatment. We found that 70% of suicides and controls from the general population discontinued AD in the 2 years before the index date. In two-thirds of them, discontinuations were two or more. Discontinuation of AD, however, did not represent a significant risk factor for suicide. More appropriate care of depression, particularly by primary care physicians who widely prescribe AD, should be fostered in order to prevent suicide. However, more research is needed to assess to which extent AD discontinuation can affect suicidal risk. © 2018 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society)partially_openembargoed_20200331Castelpietra, Giulio; Bortolussi, Luca; Gobbato, Michele; Arnoldo, Luca; Balestrieri, Matteo; Wettermark, BjornCastelpietra, Giulio; Bortolussi, Luca; Gobbato, Michele; Arnoldo, Luca; Balestrieri, Matteo; Wettermark, Bjor

Observed expenditures vs estimated burden of health care: a comparative evaluation based on spatial analysis

In the context of increasing life expectancy and growth of the elderly population, the assessment of time and spatial patterns of over 65 population health care need is a key step in order to better manage public resources (Gray, 2005). The aim of this study is to highlight the existence of spatial heterogeneity in the elderly healthcare burden, comparing alternative modelling approaches, in the context of Regione Friuli Venezia Giulia (FVG). Data on estimated health burden in 2017 and 2018 were aggregated on age classes within each municipality. The population size, the ratio between males and females, and the death rate, the counts of 21 chronic conditions, the Resource Utilization Band (RUB) indicator, and the expenditures for healthcare services (Pharmaceutical, Hospital, and Outpatient types) in years from 2002 to 2017 were also collected. A descriptive analysis both of ageing phenomenon and of health care expenditures trends has been performed. The availability of the RUB indicator, provided in the John Hopkins ACG System (version11.1.2), allows comparing observed healthcare expenditures (HCE) with the estimated healthcare burdens. In particular, different spatial econometrics models (such as those discussed in Elhorst, 2014; Moscone and Tosetti,2014; Le Sage and Pace, 2009) have been compared to explore spatial heterogeneity of the differences between demand and health need. The analyses are developed on the full population and also focusing on the elderly population only. The empirical evidence shows that while HCE does not present any spatial pattern, the RUB indicator is characterized by some strong geographical clusterization even after controlling for the demographical structure of municipalities. In order to model the spatial heterogeneity, an SDM speci\ufb01cation is chosen after an appropriate set of tests. The spatial patterns of morbidities play an important role in the explanation of the healthcare burden, together with the economic characteristic of the municipality. The model estimation, based on the elderly subpopulation, provides further insights on the diseases mostly in\ufb02uencing the healthcare burden, namely age macular degeneration, human immunode\ufb01ciency virus and low back pain. Surprisingly, the focus on the subpopulation points out that elderlies living in areas with higher shares of elderly population are healthier and needs fewer resources than their peers in other areas

Determinants of Heterogeneity in Management of Patients with AMI Diagnosis: A Retrospective Population Study

Background: In Italy cardiovascular diseases are the leading cause of death. Percutaneous Transluminal Coronary Angioplasty (PTCA) reduces short-term deaths in patients with Acute Myocardial Infarction (AMI). We evaluated inequalities in accessing PTCA among AMI patients. Methods: This is a retrospective cohort study on 9894 Italian patients hospitalized for AMI in 2003-2007. Generalized linear models were estimated for the probability of PTCA and for time between hospital admission and intervention. Result: Gender was the most relevant factor in the probability of intervention. Patients 6575 years and those with higher Charlson index had lower probability. The presence of a coronary unit was associated with greater probability. Surgical intervention within 24 hours from admission was more likely with increasing age and Charlson index and less likely for patients living near a coronary unit. Days between admission and intervention resulted affected by all covariates and deprivation index. Conclusion: Consistently with literature, we pointed out the role of gender and age on the likelihood of PTCA. Additional factors affecting time to intervention (coronary units and deprivation index) were also identified

Pulsed electromagnetic fields for postoperative pain: A randomized controlled clinical trial in patients undergoing mandibular third molar extraction

The clinical efficacy of a wearable pulsed electromagnetic field (PEMF) therapy device was assessed in terms of pain and quality of healing after tooth extraction. STUDY DESIGN: This randomized, parallel design, placebo-controlled study involved 120 patients undergoing unilateral mandibular third molar extraction and assigned to three groups after surgery. Test and placebo patients wore enabled or disabled PEMF devices, respectively, and controls wore no device. Patients recorded pain (on the visual analog scale) and analgesic use for a week, after which healing complications were assessed. RESULTS: Test patients had only slightly lower visual analog scale scores and analgesic use, but significantly fewer cases of dehiscence than placebo patients. CONCLUSIONS: PEMF therapy delivered by a wearable device improved soft tissue healing and may be a useful adjunct for pain management after oral surgery