Osteoarthritis increases the risk of cardiovascular disease: Data from the osteoarthritis initiative

Objective: Although osteoarthritis (OA) is a common condition in older adults, the role of OA in increasing cardiovascular disease (CVD) incidence is still debated. The aim of this study was to investigate the association between OA and the onset of CVD in a large database of American adults. Design: Longitudinal. Setting: Community-dwelling. Participants: People with OA or at high risk of OA. Measurements:. Osteoarthritis was defined as the presence of OA of the hand, knee, hip, back/neck or of other sites. CVD was defined as self-reported presence of heart attack, heart failure, stroke and other cerebral atherosclerotic conditions, and peripheral artery disease. Results: A total 4,265 persons without CVD (mean age=60.8 years, females=59.2%) at baseline were analyzed (1,775 with OA versus 2,490 without). Over a mean of 8.2 years, according to an adjusted Cox’s regression analysis for 11 potential baseline confounders, study participants with OA of any joint had a significantly higher risk of developing CVD compared to those without OA (Hazard ratio (HR): =1.27; 95% CI: 1.03-1.56). The presence of hand OA was associated with a higher risk of developing CVD (HR=1.31; 95%CI: 1.01-1.68) with respect to those who had no OA. Knee, hip and back/neck OA did not, instead, increase the risk of developing CVD. The association between OA and CVD was significant in the women, but not in the men. Conclusions: OA, in particular, when it affects the hand and is found in women, was associated with a higher risk of developing CVD

Mitochondrial genetic haplogroups and depressive symptoms: A large study among people in North America

Background: A possible relationship between mitochondrial haplogroups and psychiatric diseases (e.g. schizophrenia and bipolar disorder) has been postulated, but data regarding depression is still limited. We investigated whether any mitochondrial haplogroup carried a significant higher risk of depressive symptoms in a large prospective cohort of North American people included in the Osteoarthritis Initiative. Methods: Cross sectional data was derived from the Osteoarthritis Initiative. The haplogroup was assigned through a combination of sequencing and PCR-RFLP techniques. All the mitochondrial haplogroups were named following this nomenclature: H, U, K, J, T, V, SuperHV, I, W, X or Others. Depression was ascertained through the 20-item Center for Epidemiologic Studies- Depression (CES-D), with >16 indicating depressive symptoms. Results: Overall, 3,601 Caucasian participants (55.9% women), mean age of 61.7±9.3 years were included. No difference was observed in mitochondrial haplogroups frequency among those with depressive symptoms (n=285, =7.9% of the baseline population) compared to participants with no depressive symptoms (N=3,316) (chi-square test=0.53). Using a logistic regression analysis, adjusted for eight potential confounders, with those having the haplogroup H as the reference group (the most common haplogroup), no significant mitochondrial haplogroup was associated with prevalent depressive symptoms. The same results were evident in secondary analysis in which we matched depressed and non-depressed participants for age and sex. Limitations: cross-sectional design; only CES-D for evaluating mood; participants not totally representative of general population. Conclusions: We found no evidence of any relationship between specific mitochondrial haplogroups and depressive symptoms. Future longitudinal research is required to confirm/ refute these findings

Low vitamin D levels increase the risk of type 2 diabetes in older adults: A systematic review and meta-analysis

Low serum levels of 25 hydroxyvitamin D (25OHD) (hypovitaminosis D) is common in older adults and associated with several negative outcomes. The association between hypovitaminosis D and diabetes in older adults is equivocal, however. We conducted a meta-analysis investigating if hypovitaminosis D is associated with diabetes in prospective studies among older participants. Two investigators systematically searched major electronic databases, from inception until 10/07/2016. The cumulative incidence of diabetes among groups was estimated according to serum 25OHD levels. Random effect models were used to assess the association between hypovitaminosis D and diabetes at follow-up. From 4,268 non-duplicate hits, 9 studies were included; these followed 28,258 participants with a mean age of 67.7 years for a median of 7.7 years. Compared with higher levels of 25OHD, lower levels of 25OHD were associated with a higher risk of developing diabetes (6 studies; n = 13,563; RR = 1.31; 95% CI: 1.11–1.54; I2 = 37%). The findings remained significant after adjusting for a median of 11 potential confounders in all the studies available (9 studies; n = 28,258; RR = 1.17; 95% CI: 1.03–1.33; p = 0.02; I2 = 0%). In conclusion, our data suggest that hypovitaminosis D is associated with an elevated risk of future diabetes in older people. Future longitudinal studies are required and should seek to confirm these findings and explore potential pathophysiological underpinnings

The association between smoking prevalence and eating disorders: a systematic review and meta-analysis

Background and Aims: Cigarette smoking is associated with severe mental illness, including schizophrenia and bipolar disorder, and with morbidity and mortality, but the association with anorexia (AN), bulimia nervosa (BN) and binge eating disorder (BED) is unclear. This meta-analysis compared the odds of smoking in eating disorders (ED) (ED = AN or BN or BED) versus healthy controls (HC) and calculated the prevalence of smokers in people with ED.  Methods: Three independent authors searched PubMed, MEDLINE and Scopus from database inception until 31 December 2015 for studies reporting data on life-time or current smoking prevalence in BED, BN and AN with or without control group. Meta-analyses were undertaken, calculating odds ratios (ORs) of life-time smoking in BED, BN, AN versus healthy controls (HCs) or prevalence of smoking in BED, BN and AN with 95% confidence intervals (CI).  Results: Thirty-one studies (ED = 8517, controls = 68 335) were meta-analysed. Compared with HCs, there were significantly more smokers among people with BN (life-time OR = 2.165) and BED (life-time OR = 1.792) but not AN (life-time OR = 0.927). BED was associated with smoking the most (life-time prevalence = 47.73%) followed by BN (life-time prevalence = 39.4%) and AN (life-time prevalence = 30.8%). In BN, life-time smoking prevalence was highest in Europe. In AN, higher age moderated both life-time and current smoking prevalence, and body mass index moderated higher life-time smoking prevalence. In BN, female sex moderated higher life-time smoking prevalence.  Conclusions: People with binge eating disorder and bulimia nervosa are significantly more likely to be life-time smokers than healthy controls, which is not the case for anorexia nervosa

Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults : Results from a meta-analysis and exploratory meta-regression analysis

Frailty is common and associated with poorer outcomes in the elderly, but its role as potential cardiovascular disease (CVD) risk factor requires clarification. We thus aimed to meta-analytically evaluate the evidence of frailty and pre-frailty as risk factors for CVD. Two reviewers selected all studies comparing data about CVD prevalence or incidence rates between frail/pre-frail vs. robust. The association between frailty status and CVD in cross-sectional studies was explored by calculating and pooling crude and adjusted odds ratios (ORs)+/- 95% confidence intervals (CIs); the data from longitudinal studies were pooled using the adjusted hazard ratios (HRs). Eighteen cohorts with a total of 31,343 participants were meta-analyzed. Using estimates from 10 cross-sectional cohorts, both frailty and pre-frailty were associated with higher odds of CVD than robust participants. Longitudinal data were obtained from 6 prospective cohort studies. After a median follow-up of 4.4 years, we identified an increased risk for faster onset of any type CVD in the frail (HR= 1.70 [95%CI, 1.18-2.45]; I-2 = 66%) and pre-frail (HR= 1.23 [95%CI, 1.07-1.36]; I-2 = 67%) vs. robust groups. Similar results were apparent for time to CVD mortality in the frail and pre-frail groups. In conclusion, frailty and pre-frailty constitute addressable and independent risk factors for CVD in older adults. (C) 2017 Elsevier B.V. All rights reserved.Peer reviewe

Utilizzo dei dispositivi digitali e cyberbullismo. Dati a partire da una ricerca nel comune di Chioggia

La presente tesi si propone l'obiettivo di indagare il fenomeno del cyberbullismo e l'utilizzo dei dispositivi digitali anche alla luce dei risultati di una ricerca condotta negli istituti scolastici superiori di secondo grado a Chioggia privilegiando il questionario. La scelta di affrontare tale tematica è motivata dal fatto che internet è alla portata di tutti. Al fine di governare il cyberbullismo e l'utilizzo elevato dei dispositivi elettronici è importante ragionare in termini di prevenzione e sensibilizzazione

SERUM 25-HYDROXYVITAMIN D, FRAILTY SYNDROME AND RISK OF DEMENTIA IN ELDERLY MEN AND WOMEN: Pro.V.A. STUDY

Background: Frailty is one of the most problematic expression of population ageing. It is a state of vulnerability and is associated with a greater risk for adverse outcomes such as falls, disability and death. Identifying early markers for the onset of this clinical syndrome is more than just a scientific challenge. One of the most important component of frailty is the sarcopenia, a progressive loss of skeletal muscle mass, strength, and power. Recent insight suggests that vitamin D may be important in preserving from muscle mass and, strength which are key components of frailty. Cognition and dementia have already been considered as components of frailty, but the role of frailty as a possible determinant of dementia has been poorly investigated. We examined the relationship between serum 25-hydroxyvitamin D (25OHD) levels and the presence of frailty syndrome, and the association between vitamin D deficiency and the onset of frailty in a sample of older male and female adults. We also estimated the predictive role of frailty syndrome on incident dementia in the same population. Methods: This research is part of the Progetto Veneto Anziani (Pro.V.A), an Italian prospective population-based cohort study conduct in Italy between 1995 and 2001 with follow up assessment at 4.4 years. A total of 1577 subjects (978 women and 599 men) aged ≥ 65 years completed interviews, medical examinations and functional assessments, and provided blood samples. For the purpose of the second part of this study, 1181 partecipans (712 women and 469 men) were studied, excluding subjects with alterations of MMSE. Serum 25OHD levels were measured at the baseline and categorized into clinical groups: 25OHD deficient (<50 nmol/L), insufficient (≥50 to <75 nmol/L) and sufficient (≥75 nmol/L). Frailty syndrome was defined using a modified measurement of Cardiovascular Health study criteria. Analyses were adjusted for relevant confounders including health status and physical performance. Results: Frailty was present at baseline in 457 (29%) subjects. The prevalence of frail syndrome was significantly higher among 25OHD-deficient participants compared to 25OHD-sufficient ones (43.4% vs 20.7%, p<.0001). Compered to normal Vitamin D status, Vitamin D deficiency and vitamin D insufficient were independently associated to the likelihood of being frail, even adjusting for multiple potential confounders (OR: 1.657, 95% CI: 1.232-2.228; p<0.001 for the deficient group and OR: 1.392, 95% CI: 1.024-1.891; p<0.05). In a subsample of 1129 non-frail participants, the 27% became frail at 4.4 years; nevertheless after adjusting for health and functional confounders, Vitamin D deficiency was no longer associated to the risk of the onset of frailty. Participants who developed dementia in follow-up were about 19% (228) of the sample. The subjects with frailty status were more likely to be dementia (OR: 1.87, 95% CI 1.02-3.30). Frailty syndrome was also associated with a greater risk of developing dementia (RR: 1.94, 95% CI: 1.42-2.64). Conclusion: Vitamin D deficiency is associated to frailty syndrome in elderly men and women, regardless of several confounding factors. By the way, vitamin D deficiency does not predict the onset of frailty, as well as other health condition. Frailty is a risk factor of dementia

Relationship between sedentary behavior and depression: a mediation analysis of influential factors across the lifespan among 42,469 people in low- and middle-income countries

Background: Sedentary behavior (SB) is associated with diabetes, cardiovascular disease and low mood. There is a paucity of multi-national research investigating SB and depression, particularly among low- and middle-income countries. This study investigated the association between SB and depression, and factors which influence this. Methods: Cross-sectional data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. Depression was based on the Composite International Diagnostic Interview. The association between depression and SB (self-report) was estimated by multivariable linear and logistic regression analyses. Mediation analysis was used to identify influential factors. Results: A total of 42,469 individuals (50.1% female, mean 43.8 years) were included. People with depression spent 25.6 (95%CI8.5-42.7) more daily minutes in SB than non-depressed participants. This discrepancy was most notable in adults aged ≥65 y (35.6 minutes in those with depression). Overall, adjusting for socio-demographics and country, depression was associated with a 1.94 (95%CI1.31-2.85) times higher odds for high SB (i.e., ≥8 h/day). The largest proportion of the SB-depression relationship was explained by mobility limitations (49.9%), followed by impairments in sleep/energy (43.4%), pain/discomfort (31.1%), anxiety (30.0%), disability (25.6%), cognition (16.1%), and problems with vision (11.0%). Other health behaviors (physical activity, alcohol consumption, smoking), body mass index, and social cohesion did not influence the SB-depression relationship. Conclusion: People with depression are at increased risk of engaging in high levels of SB. This first multi-national study offers potentially valuable insight for a number of hypotheses which may influence this relationship, although testing with longitudinal studies is needed

Textbook of Patient Safety and Clinical Risk Management

Implementing safety practices in healthcare saves lives and improves the quality of care: it is therefore vital to apply good clinical practices, such as the WHO surgical checklist, to adopt the most appropriate measures for the prevention of assistance-related risks, and to identify the potential ones using tools such as reporting & learning systems. The culture of safety in the care environment and of human factors influencing it should be developed from the beginning of medical studies and in the first years of professional practice, in order to have the maximum impact on clinicians' and nurses' behavior. Medical errors tend to vary with the level of proficiency and experience, and this must be taken into account in adverse events prevention. Human factors assume a decisive importance in resilient organizations, and an understanding of risk control and containment is fundamental for all medical and surgical specialties. This open access book offers recommendations and examples of how to improve patient safety by changing practices, introducing organizational and technological innovations, and creating effective, patient-centered, timely, efficient, and equitable care systems, in order to spread the quality and patient safety culture among the new generation of healthcare professionals, and is intended for residents and young professionals in different clinical specialties

L’attività dei Centri Antifumo italiani tra problematiche e aree da potenziare: i risultati di un’indagine svolta attraverso un questionario on-line

Introduzione. In Italia sono 295 i Servizi per la cessazione dal fumo di tabacco (Centri Antifumo - CA) afferenti al Servizio Sanitario Nazionale (SSN) censiti nel 2011 dall’Osservatorio Fumo, Alcol e Droga (OssFAD) dell’Istituto Superiore di Sanità. La presente indagine, condotta dall’OssFAD in collaborazione con i CA, è stata volta a rilevare alcune delle problematiche con le quali il personale dei CA si confronta per portare avanti la propria attività e le iniziative ritenute utili per migliorarla. Materiali e metodi. L’indagine è stata condotta dal 7 al 21 maggio 2012, mediante un questionario compilabile on-line composto da 5 brevi sezioni di domande con un totale di 38 items da completare. Il link al questionario on-line è stato inviato per e-mail a 322 indirizzi dei CA censiti nel 2011 dall’OssFAD. I dati raccolti sono stati elaborati statisticamente con il programma SPSS 20. Risultati. All’indagine hanno risposto 146 operatori dei CA (45,3%). Sebbene ci siano aspetti ormai consolidati dell’attività dei CA, sono ancora molte le criticità che gli operatori riscontrano nella loro attività. Le principali problematiche che influiscono in modo fondamentale/rilevante per la buona attività del centro sono le “Scarse o nulle risorse economiche” per il 60,7% del personale, “la mancanza di personale dedicato” per il 52,4% del personale; il “riconoscimento/mandato istituzionale del CA” per il 40,9% del personale. Tra le azioni ritenute più efficaci per facilitare l’accesso ai CA sono risultate la sensibilizzazione del personale sanitario (91%), in particolare dei medici di famiglia e l’inserimento delle prestazioni antitabagiche nei LEA (76,8%). Conclusioni. È auspicabile che l’attività dei CA riceva una maggiore attenzione, attraverso la dotazione di strutture, personale e finanziamenti adeguati a svolgere un importante ruolo nella tutela e promozione della salute