Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Carbon fluxes of an alpine peatland in Northern Italy

It is widely known that peatlands are a significant carbon (C) stock. Most peatlands are located in boreal and subarctic regions of the northern hemisphere but some occur also at high altitude and, contrary to the first; their contribution in terms of carbon sequestration is far less studied. In the Alps, there are numerous small peatlands, which are threatened by increasing temperatures and an alteration of their water balance. The aim of this study was to investigate the carbon fluxes of a small-scale fen in the Alps over three years (2012–2014). During the study period, the peatland experienced a high interannual variation in weather conditions while it acted as a carbon source based on CO2 emissions (NEE: 180.7 ± 65.2 g C CO2m−2 yr−1) for all three years. This was mainly due to the short net C uptake period (73 ± 7 days) and high respiration. Ecosystem respiration and summer gross primary production were both very high compared to other peatlands around the world and compared to a nearby low productive grassland. In wintertime, the soil did not freeze, resulting in a slow decomposition of the organic matter. Low methane fluxes were recorded during a 10-month measurement campaign, for a total of 3.2 g C CH4m−2 over the December 2013–September 2014 period. Our findings suggest that the interannual variability of temperature and soil water content exert a strong influence on the carbon balance of peatlands of the Alps and that could further worsen depending upon the magnitude of climate change

Endoscopic Pilonidal Sinus Treatment: Long-Term Results of a Prospective Series

BACKGROUND AND OBJECTIVES: Pilonidal sinus is a common problem in the sacrococcygeal region, especially in obese, sedentary young men. The ideal surgical solution is still under debate, and there is a high rate of recurrence. In the present study, we analyzed the long-term results of a video-assisted minimally invasive technique for the treatment of sacrococcygeal pilonidal disease: endoscopic pilonidal sinus treatment (EPSiT)

Costruzione di un modello di valutazione del processo di presa in carico dei lavoratori ex esposti ad amianto nella Regione Toscana

SUMMARY (Definition of a performance assessment plan of the health surveillance programme for former asbestos workers in Tuscany Region, Italy) - In Tuscany Region (Italy), a public programme aimed at providing health surveillance for former asbestos workers recently started, following a common approach to asbestos-related diseases as defined by a regional group of experts. A performance assessment plan of the post occupational surveillance programme was drafted by the Institute for Study, Prevention and Cancer Network, and discussed within the Regional Committee, in order to monitor its equity, accessibility and to improve its effectiveness.The performance evaluation plan, partly designed with the PRECEDE-PROCEED model, provides for the periodic assessment of: structure, process and outcome indicators, obtained by the programme database; health care workers’ and patients’ perspectives, obtained by two specific questionnaires. Site visits over the regional facilities will also be performed as a tool for peer training. Expected benefits of the performance evaluation of this programme are multidisciplinary interactions between professionals, the development of audit techniques during site visits, the adequate and fair management of health needs and continuous training of involved healthcare personnel