CONTINUITA' OSPEDALE TERRITORIO

L’Italia ha una percentuale di popolazione ultrasessantacinquenne che supera il 20%, e che dovrebbe salire a oltre il 35% nel 2050. Circa 2 milioni di persone anziane non sono autonome. La prevalenza di disabilità è più alta nelle regioni meridionali del paese. L'età avanzata è un fattore di rischio indipendente per le fratture da fragilità che a lungo termine comportano un maggiore e considerevole rischio di disabilità. L’impatto delle fratture di femore è particolarmente grave negli anziani fragili. I casi più gravi di disabilità (più concentrati negli ultraottantenni) sono aumentati drammaticamente nelle ultime decade. Di conseguenza, il bisogno dei servizi di cure continuative territoriali in grado di gestire questa crescente fetta della popolazione, cioè, anziani con patologie multiple e/o con disabilità grave, spesso come conseguenza delle fratture da fragilità, è in continuo aumento. La cura a lungo termine di queste persone, con un carico sociale complesso e oneri di assistenza gravosi pongono seri problemi sia agli operatori sanitari che all'intero sistema di welfare. Da sottolineare che nei pazienti istituzionalizzati la incidenza di fratture di femore è circa 2-3 volte maggiore rispetto alle persone che vivono in comunità, comportando ancora un ulteriore rischio di disabilità, costi sociali e finanziari. Pertanto, negli anziani istituzionalizzati è di fondamentale importanza l’attuazione di programmi di prevenzione delle fratture da fragilità e soprattutto del rischio di ulteriori fratture. Le cure continuative territoriali in Italia sono contraddistinte da una bassa quota di finanziamenti pubblici e di un basso numero di prestazione se paragonate con la situazione in altri paesi del centro-nord europeo. Ad esempio, nell’anno 2007 la spesa pubblica per le cure domiciliari e residenziali (long term care – LTC) è stata del 1,13% del PIL e gli utenti di questi servizi erano soltanto circa il 5% del totale della popolazione ultrasessantacinquenne. Il sistema pubblico di cure continuative italiano si basa su due forme parallele di intervento: il primo, e più rilevante (50% del totale delle spese pubbliche per le cure continuative), consiste in programmi di erogazioni monetarie ("indennità di accompagnamento"), il secondo è dato dai programmi sociali e sanitari, compresa la erogazione di assistenza residenziale e domiciliare. La responsabilità delle cure è in gran parte delegata alle famiglie anche se la tradizionale capacità assistenziale delle famiglie italiane si è ridotta notevolmente nell'ultimo decennio a causa, al meno in parte, del continuo aumento del tasso di occupazione femminile. Le tendenze demografiche minacciano la sostenibilità del sistema di welfare italiano esistente, in particolare nei servizi di cure croniche territoriali, per i quali la domanda è in gran parte aumentata e si prevede che continuerà ad aumentare nei prossimi decenni

Celiac disease in older persons: A case of seronegative disease

A 68-year-old man with a history of smoking (former smoker of 40 cigarettes per day), euthyroid goiter, deep vein thrombosis and depression, came to our attention for weakness, cachexia, abdominal bloating and diarrhea lasting for almost six months. Furthermore, he had lost about 25 kilograms of weight in the last year and was bedridden for three months. Combining the results of serological, histopathological and genetic tests, he was diagnosed with a seronegative celiac disease. Gluten-free diet, combined with nutritional supplements and physical therapy, improved his clinical condition and allowed the recovery of weight and the walking ability. Celiac disease might be suspected in elderly patients with diarrhea, malabsorption, malnutrition and cachexia, but also with other symptoms such as anemia, micronutrients' deiciency, fragility fractures and neurological symptoms

Rapid Tooling Method for Soft Customized Removable Oral Appliances

Traditionally oral appliances i.e. removable orthodontic appliances, bite splints and snoring / sleep apnea appliances are made with alginate impressions and wax registrations. Our aim was to describe the process of manufacturing customized oral appliances with a new technique i.e. rapid tooling method. The appliance should ideally be custom made to match the teeth. An orthodontic patient, scheduled for conventional orthodontic treatment, served as a study subject. After a precise clinical and radiographic examination, the approach was to digitize the patient’s dental arches and then to correct them virtually by computer. Additive manufacturing was then used to fabricate a mould for a soft customized appliance. The mould was manufactured using stereolithography from Somos ProtoGen O-XT 18420 material. Casting material for the mould to obtain the final appliance was silicone. As a result we managed to create a customized soft orthodontic appliance. Also, the accuracy of the method was found to be adequate. Two versions of the described device were manufactured: one with small and one with moderate orthodontic force. The study person also gave information on the subjective patient adaptation aspects of the oral appliance

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment

Background High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods We used data for exposure to risk factors by country, age group, and sex from pooled analyses of populationbased health surveys. We obtained relative risks for the eff ects of risk factors on cause-specifi c mortality from metaanalyses of large prospective studies. We calculated the population attributable fractions for- each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the eff ects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specifi c population attributable fractions by the number of disease-specifi c deaths. We obtained cause-specifi c mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the fi nal estimates. Findings In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10\ub78 million deaths, 95% CI 10\ub71\u201311\ub75) of deaths from these diseases in 2010 were attributable to the combined eff ect of these four metabolic risk factors, compared with 67% (7\ub71 million deaths, 6\ub76\u20137\ub76) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined eff ects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing eff ect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the globalresponse to non-communicable diseases

Diminishing benefits of urban living for children and adolescents’ growth and development

AbstractOptimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was &lt;1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.</jats:p

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity