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 population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses 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 effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final 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% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) 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 effects 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 effect 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 global response to non-communicable diseases. Funding: UK Medical Research Council, US National Institutes of Health. © 2014 Elsevier Ltd

Consequences of the COVID-19 pandemic on admissions to general hospital psychiatric wards in Italy: Reduced psychiatric hospitalizations and increased suicidality

Aims: The present investigation aimed at evaluating differences in psychiatric hospitalizations in Italy during and after the lockdown due to the novel coronavirus disease 2019 (COVID-19), compared to the same periods in 2018 and 2019. Methods: We obtained and analyzed anonymized data on psychiatric admissions (n = 4550) from 12 general hospital psychiatric wards (GHPWs) in different Italian regions (catchment area = 3.71 millions of inhabitants). Using a mixed-effects Poisson regression model, we compared admission characteristics across three periods: (a) March 1-June 30, 2018 and 2019; (b) March 1-April 30, 2020 (i.e., lockdown); and (c) May 1-June 30, 2020 (i. e., post-lockdown). Results: During the COVID-19 lockdown, there was a 41% reduction (IRR = 0.59; p 0.001, CI: 0.45-0.79) in psychiatric admissions in the enrolled GHPWs with respect to the 2018 and 2019 control period. Conversely, admission rates in the post-lockdown period were similar to those observed in the control period. Notably, a consistent and significant reduction in psychiatric hospitalizations of older patients (aged 65 years) was observed in the lockdown (40%; IRR = 0.60; 95% CI: 0.44-0.82) and post-lockdown (28%; IRR = 0.72; 95% CI: 0.54-0.96) periods. Long-stay admissions (>14 days) increased (63%; IRR = 1.63; 95% CI: 1.32-2.02) during the lockdown and decreased by 39% thereafter (IRR = 0.61; 95% CI: 0.49-0.75). A significant 35% increase in patients reporting suicidal ideation was observed in the post-lockdown period, compared to the rate observed in the 2018 and 2019 control period (IRR = 1.35; 95% CI: 1.01-1.79). Conclusion: The COVID-19 lockdown was associated with changes in the number of psychiatric admissions, particularly for older patients and long-stay hospitalizations. Increased admission of patients reporting suicida

Consequences of the COVID-19 pandemic on admissions to general hospital psychiatric wards in Italy: Reduced psychiatric hospitalizations and increased suicidality

Aims: The present investigation aimed at evaluating differences in psychiatric hospitalizations in Italy during and after the lockdown due to the novel coronavirus disease 2019 (COVID-19), compared to the same periods in 2018 and 2019. Methods: We obtained and analyzed anonymized data on psychiatric admissions (n = 4550) from 12 general hospital psychiatric wards (GHPWs) in different Italian regions (catchment area = 3.71 millions of inhabitants). Using a mixed-effects Poisson regression model, we compared admission characteristics across three periods: (a) March 1-June 30, 2018 and 2019; (b) March 1-April 30, 2020 (i.e., lockdown); and (c) May 1-June 30, 2020 (i.e., post-lockdown). Results: During the COVID-19 lockdown, there was a 41% reduction (IRR = 0.59; p 65 years) was observed in the lockdown (40%; IRR = 0.60; 95% CI: 0.44-0.82) and post-lockdown (28%; IRR = 0.72; 95% CI: 0.54-0.96) periods. Long-stay admissions (>14 days) increased (63%; IRR = 1.63; 95% CI: 1.32-2.02) during the lockdown and decreased by 39% thereafter (IRR = 0.61; 95% CI: 0.49-0.75). A significant 35% increase in patients reporting suicidal ideation was observed in the post-lockdown period, compared to the rate observed in the 2018 and 2019 control period (IRR = 1.35; 95% CI: 1.01-1.79). Conclusion: The COVID-19 lockdown was associated with changes in the number of psychiatric admissions, particularly for older patients and long-stay hospitalizations. Increased admission of patients reporting suicidal ideation in the post-lockdown period merits special attention. Further studies are required to gain insight into the observed phenomena

"Malattie dell’apparato respiratorio. Pneumologia e chirurgia toracica"

La tecnica tomografica permette di riconoscere con accuratezza la sede, le dimensioni, le porzioni anatomiche del polmone e le caratteristiche dei processi patologici. Esistono due tecniche di tomografia a emissione, quella a emissione di singolo fotone, la SPET, e quella a emissione di positroni, la PET (Tab. 7-11). Al fine di ottenere un'accurata diagnosi e una corretta interpretazione delle immagini scintigrafiche è diventato fondamentale disporre affianco alle immagini funzionali (SPET o PET) immagini di tipo morfologico (Rx, TC e RM). Inizialmente si è provveduto a effettuare fusioni di immagini provenienti da apparecchiature differenti e acquisite in tempi diversi mediante l'utilizzo di opportuni sistemi software. Attualmente si dispone però di sistemi hardware ibridi, ovvero un unico sistema con integrati SPET o PET e CT o più di recente SPET o PET e RM, in uno stesso gantry, con cui le immagini di due modalità vengono acquisite in un'unica sessione e co-registrate, senza che il paziente si muova dal lettino. Si ottengono così immagini multimodali, funzionali e morfologiche contemporaneamente. La utilizzazione di macchine SPECT/CT per ottenere contemporaneamente e durante un singolo esame sia le immagini di medicina nucleare (scintigrafie polmonari perfusive /ventilatorie) che la TC, rappresentano la migliore scelta tecnica per lo studio delle patologie polmonari. L'indagine che visualizza la distribuzione e la concentrazione del radiofarmaco nei due polmoni o nel torace viene definita scintigrafia statica. Le proiezioni possibili sono: anteriore, posteriore, laterali e oblique a 45° anteriore e posteriore. Se l'esame viene esteso all'intero corpo nelle due proiezioni, anteriore e posteriore, viene detto total body (IB) o whole body (WB). Le immagini WB sono utili nella stadiazione e ristadiazione di pazienti con patologie neoplastiche o infiammatorie con possibile disseminazione in varie sedi come anche nel ricercare patologie la cui sede di origine non è nota. Tale indagine WB rappresenta il primo step per guidare indagini su specifici distretti anatomici sede di patologie. Quando si acquisiscono immagini in sequenza sul torace è possibile ottenere la visualizzazione delle modificazioni spaziali della concentrazione del radiofarmaco nel tempo. Queste vengono definite scintigrafie dinamiche. Queste ultime sono caratterizzate dalla frequenza temporale, con cui vengono ottenute le immagini, e dal tempo di durata dell'esame (per esempio: 1 immagine ogni minuto per 60 minuti). Si può dire che nella maggioranza dei casi i radiofarmaci impiegati in pneumologia si distribuiscono nelle porzioni integre e normo-funzionanti del polmone, mentre nei processi patologici la loro concentrazione appare ridotta o assente. La lesione viene definita ipofissante, non fissante, fredda. Quando si utilizzano radiofarmaci con specifico tropismo per il tessuto patologico, la lesione accumula il radiofarmaco e si mette in evidenza come area Iperattiva o positiva. I radiofarmaci che permettono questo tipo di immagine sono detti indicatori positivi di lesione