An Overview of US-Italian Relations: The Legacy of the Past

At the end of World War II the United States became Italy’s indispensable ally, and throughout the Cold War, US-Italian relations remained consistently strong, even accounting for some inevitable ups and downs. In the post-Cold War era, the relationship has remained strong in spite of a number of dramatic changes in both the international system and Italian domestic politics. The rise of populist movements on both sides of the Atlantic in recent years, however, might challenge the centrality of the United States in Italy’s foreign policy

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

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

The making of the global nuclear order in the 1970s. Issues and controversies

This collection of essays offers a fresh look at the 1970s, the crucial decade when the nuclear non-proliferation regime took shape. Exploring a broad array of newly declassified archival sources from different countries across the globe, and moving freely across methodological and national barriers, historians from Europe, North and South America, Asia and Africa discuss the making of the global nuclear order from truly international and transnational perspectives. The result is a fascinating and innovative volume which will remain an essential reference for historians of the nuclear age, of the cold war, and more generally of the evolution of the international system in the second half of the twentieth century

La politica estera italiana negli anni della distensione: una riflessione

"Il capitolo è diviso in tre parti ineguali, una prima, molto sintetica, in cui si propone appunto una interpretazione dell’era della distensione; una seconda, più ampia e articolata, nella quale si discute il complesso rapporto che si sviluppò tra la politica estera italiana e l’evoluzione del sistema internazionale, e una terza, in cui si analizza la relazione tra Moro e alcune delle principali figure della diplomazia italiana del periodo in cui egli fu Presidente del Consiglio e Ministro degli Esteri. In particolare, nella seconda e nella terza parte si cercherà di mettere in luce soprattutto il modo in cui la diplomazia e buona parte della classe politica italiana concepirono la distensione, vale a dire non solo come un’opportunità per superare le asprezze e le contrapposizioni del periodo della guerra fredda ma anche, per le caratteristiche che assunse e per le circostanze che la accompagnarono, come una messa in discussione delle linee di fondo lungo le quali la politica estera italiana si era sviluppata a partire dai primi anni del dopoguerra, anche per le ripercussioni sul piano politico interno -

Fanfani e la proliferazione nucleare

All'interno del capitolo le scelte nucleari di Fanfani sono state suddivise in tre periodi distinti. Nel primo si analizza il momento in cui Fanfani arriva alla presidenza del Consiglio nel 1958, quando l’alleanza occidentale si trovava nel pieno del dibattito relativo alla diffusione delle armi atomiche tra gli stati membri; la seconda parte riguarda invece il periodo 1958-1963, che costituisce sia il culmine dell’importanza delle armi nucleari all’interno del sistema internazionale e dell’alleanza atlantica, sia l’inizio della fine di questa loro crescente diffusione; mentre il terzo periodo è quello della vera e propria inversione di tendenza, tra il 1963 e il 1968, quando si avvia il dialogo tra le superpotenze per tenerne sotto controllo la proliferazione. Attraverso l’analisi dell’apporto di Fanfani alle scelte che la politica estera italiana è chiamata a fare in questo quindicennio, il capitolo si prefigge l’obiettivo di indagare come uno dei massimi esponenti della classe dirigente democristiana abbia affrontato il nodo cruciale del rapporto tra politica estera italiana e politica di potenza.