The Role of Attitudes Toward Medication and Treatment Adherence in the Clinical Response to LAIs: Findings From the STAR Network Depot Study

Background: Long-acting injectable (LAI) antipsychotics are efficacious in managing psychotic symptoms in people affected by severe mental disorders, such as schizophrenia and bipolar disorder. The present study aimed to investigate whether attitude toward treatment and treatment adherence represent predictors of symptoms changes over time. Methods: The STAR Network \u201cDepot Study\u201d was a naturalistic, multicenter, observational, prospective study that enrolled people initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centers were assessed at three time points: baseline, 6-month, and 12-month follow-up. Psychopathological symptoms, attitude toward medication and treatment adherence were measured using the Brief Psychiatric Rating Scale (BPRS), the Drug Attitude Inventory (DAI-10) and the Kemp's 7-point scale, respectively. Linear mixed-effects models were used to evaluate whether attitude toward medication and treatment adherence independently predicted symptoms changes over time. Analyses were conducted on the overall sample and then stratified according to the baseline severity (BPRS < 41 or BPRS 65 41). Results: We included 461 participants of which 276 were males. The majority of participants had received a primary diagnosis of a schizophrenia spectrum disorder (71.80%) and initiated a treatment with a second-generation LAI (69.63%). BPRS, DAI-10, and Kemp's scale scores improved over time. Six linear regressions\u2014conducted considering the outcome and predictors at baseline, 6-month, and 12-month follow-up independently\u2014showed that both DAI-10 and Kemp's scale negatively associated with BPRS scores at the three considered time points. Linear mixed-effects models conducted on the overall sample did not show any significant association between attitude toward medication or treatment adherence and changes in psychiatric symptoms over time. However, after stratification according to baseline severity, we found that both DAI-10 and Kemp's scale negatively predicted changes in BPRS scores at 12-month follow-up regardless of baseline severity. The association at 6-month follow-up was confirmed only in the group with moderate or severe symptoms at baseline. Conclusion: Our findings corroborate the importance of improving the quality of relationship between clinicians and patients. Shared decision making and thorough discussions about benefits and side effects may improve the outcome in patients with severe mental disorders

L'Italia come modello per l'Europa e per il mondo nelle politiche sanitarie per il trattamento dell'epatite cronica da HCV

The World Health Organization foresees the elimination of HCV infection by 2030. In light of this and the curre nt, nearly worldwide, restriction in direct-acting agents (DAA) accessibility due to their high price, we aimed to evaluate the cost-effectiveness of two alternative DAA treatment policies: Policy 1 (universal): treat all patients, regardless of the fibrosis stage; Policy 2 (prioritized): treat only priori tized patients and delay treatment of the remaining patients until reaching stage F3. T he model was based on patient’s data from the PITER cohort. We demonstrated that extending HC V treatment of patients in any fibrosis stage improves health outcomes and is cost-effective

Arthrosis and osteoporosis

The relationships between osteoarthritis and osteoporosis are very intriguing and debated. In the Western populations there is evidence of osteoarthritis in about 80% of individual above 70 years of age, while osteoporosis affects one third of postmenopausal women. Studies on bone mineral density measured by absorptiometry in subjects with osteoarthritis have yielded conflicting results. Recently it has been described the presence of remarkable anthropometric differences between women with postmenopausal osteoporosis and women with generalized osteoarthritis. Other authors have also analyzed bone biopsies from the iliac crest showing a significant increase of bone mass in the osteoarthritic subjects. These and other results suggest that caution is needed when interpreting the values of bone mineral density in the lumbar area of patients with osteophytosis, due to the possibillity of false negative results. Data showing a generalized increase in bone mineral density in individuals with osteoarthritis stimulate further research on the hypothesis that primitive osteoarthritis can represent a generalized bone disorde

RILIEVO DI UN'INCIDENZA ESTREMAMENTE BASSA DI FRATTURE DEL FEMORE PROSSIMALE DA OSTEOPOROSI NELLA POPOLAZIONE DELL'ISOLA DI ISCHIA

We present the raw data from a study done on the incidence of osteoporotic hip fractures on Ischia, an island facing the Bay of Naples. Its 43,975 inhabitants form a well-defined, stable and homogeneous population. Since no air transportation to the mainland is available for residents, acute health care is provided by the sole local hospital. We carried out a discharge data survey by reviewing the hospital medical records from 1980-1989. During that decade, 148 residents (111 women, 37 men) had new hip fractures. The age-sex adjusted incidence for the population aged 50 years or more was 170.3 cases/100,000/year [95% confidence interval (CI) = 144.8-195.9] (women = 241.4 with 95% CI = 211.0-271.9; men = 79.4 with 95% CI = 62.0-96.9). Age-specific rates increased with age and were higher among women only over 60 years old. On the basis of the 1981 census and comparison of age-adjusted rates, we determined that incidence rates of these fractures for men and women on Ischia are among the lowest in the world: Ischian men have a hip fracture incidence second only to that of South African Bantu males. The female/male ratio on the island, one of the highest reported, is 3.05:1. Our data suggest that further studies on Ischia may provide important clues regarding risk and/or protective factors for hip fracture