Cardiovascular health of the elderly.

Within the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 426 men and 376 women, ages 75-79 years, randomly selected from the general population were examined. Participation rate was 50%; within men 78% were hypertensives, 36% had high serum cholesterol, 28% were diabetics, 25% were obese; within women 81% were hypertensives, 55% had high cholesterol, 19% were diabetics, 37% were obese. Preventive actions at individual and community level are urgent, also at this age range.RiassuntoNell'ambito dell'Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey sono stati esaminati 426 uomini e 376 donne di età compresa fra 75-79 anni, estratti casualmente dalla popolazione generale. Il tasso di partecipazione è stato del 50%; fra gli uomini il 78% era iperteso, il 36% ipercolesterolemico, il 28% diabetico e il 25% obeso; fra le donne l'81% era ipertesa, il 55% ipercolesterolemica, il 19% diabetica, il 37% obesa. Azioni di prevenzione a livello individuale e collettivo sono urgenti sulla popolazione generale, anche in questa fascia di età.</p

We all want to live longer, but not grow old

Population ageing represents a “triumph” and a “challenge” for society. The increase in life expectancy corresponds to an increase of risk factors and age-associated non communicable diseases, with consequent rise in health care costs and the burden of healthcare sustainability. Aim of this analysis is to describe the prevalence of non communicable diseases, comorbidity and disability in non-institutionalized elderly population, aged 75-79 years, examined within the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey. Cardiovascular disease is the most frequent occurring in 27% of the examined population, followed by diabetes (24%) and chronic kidney disease (21%); 60% of examined elderly population suffers of one or more chronic diseases, while 40% is in a good health. Ninety-three per cent of the examined population is free of disability; cognitive function disorders, assessed by the Folstein’s Mini Mental State Examination, are recorded in 21% men and 29% women. In the context of prevention, there is still much that needs to be done. It is important to initiate or maintain preventive actions concerning also this age-group at both community and individual level, to promote the cultural notion that a good quality of life in advanced age is built day by day starting from one’s youth through a healthy diet, regular physical activity and non-smoking habit

Challenges and opportunities in establishing an Health Examination Survey

In Italy, the last 30 years witnessed the implementation of cross-sectional surveys providing baseline data on numerous risk factors collected from random samples of the adult general population. In order to support those groups who would like to implement an health examination survey (HES), according to the experience of&nbsp; the CUORE Project surveys, the objective of this paper is to describe some information related to the organization of a survey (examination sites and sampling, selection of analytic laboratory, coordination and personnel involved, sample selection, recruitment and appointment scheduling, informative notice and informed consent, participation rate, non-participation bias, quality assurance, survey data, long term storage of the samples, internal quality control, external quality assessment, feedback to participants, error checking, correction and documentation of the data, transfer and storage of the data, statistical analyses and interpretation of results, dissemination of results), usually shortly described&nbsp; in scientific papers but relevant when an HES is planned

Real-world assessment of healthcare provided by the National Health Service: The network of regional Beaver research platforms

Real-world evidence can provide answers on healthcare utilization and appropriateness, post-marketing drugs safety and comparative effectiveness, and cost-effectiveness profiles of healthcare pathways. Healthcare utilization databases, possibly integrated with drug and disease registries, electronic medical records, survey and cohort data (i.e. real-world data), allow to trace healthcare ‘footprints’ left from beneficiaries of National Health Service. Beaver is a research platform available on demand to Italian regions which we developed for computing indicators of healthcare utilization and clinical outcomes, as well as for generating evidence on effectiveness and cost-effectiveness profile. Two distinct solutions may be adopted. One, the so-called Beaver Light front-end allows to automatically compute health indicators of adherence to official guidelines. Two, the so-called Beaver Full front-end involves an eight-step procedure entirely driven by the study protocol. In order to fulfil the directives recently issued by the European Parliament and Council and the Italian Authority for the protection of individual data, the platform resides in each region’s infrastructure, so limiting the free movement of electronic health data. Indeed, regional authorities should be responsible for data safety and for allowing data accessibility. The use of standardized and validated algorithms enables to obtain regional estimates that, being obtained by employing regional platforms containing data extracted with standardized procedure, may be compared and possibly summarized by using common meta-analytic techniques. In conclusion, the Beaver regional platform is a promising tool which may contribute to stimulate healthcare research in Italy

Acute myocardial infarction and stroke registries. The Italian experience

Cardiovascular diseases (CVD) are the leading causes of death and hospitalisation in nearly all European countries and accounted for almost 40% of all deaths in 2013. With the exception of few rigorous but limited studies carried out in some geographical areas, data available on CVD incidence and prevalence is generally limited and of poor quality, despite the magnitude of the CVD phenomenon. The EUROCISS Project, supported by the Health Monitoring Programme of the DG SANCO from 2000 to 2007, provided general guidance and updated methods for the surveillance of Acute Myocardial Infarction and Stroke. The Italian population-based registry of major coronary and cerebrovascular events was set up following EUROCISS recommendations; it also took into account the experience acquired by Italy in the MONICA project since the mid-1980s and continued with the coordination of the EUROCISS The project: “A population-based AMI register: assessing the feasibility for a pilot study to implement a surveillance system of acute myocardial infarction (AMI) in Mediterranean countries according to EUROCISS recommendations” in the framework of the EuroMed Programme, followed major practical and operative issues for the implementation of a population-based registry for coronary and cerebrovascular events, which are here described. This paper includes the definition of target population, data sources, events, indicators, quality methods, and the description of a software used to implement the registry

World Health Organization definition of myocardial infarction: 2008-09 revision

Background WHO has played a leading role in the formulation and promulgation of standard criteria for the diagnosis of coronary heart disease and myocardial infarction since early 1970s. Methods The revised definition takes into consideration the following: well-resourced settings can use the ESC/ACC/AHA/WHF definition, which has new biomarkers as a compulsory feature; in resource-constrained settings, a typical biomarker pattern cannot be made a compulsory feature as the necessary assays may not be available; the definition must also have provision for diagnosing non-fatal events with incomplete information on cardiac biomarkers and the ECG; to facilitate epidemiologic monitoring definition must recognize fatal events with incomplete or no information on cardiac biomarkers and/or ECG and/or autopsy and/or coronary angiography. Results Category A definition is the same as ESC/ACC/AHA/WHF definition of MI, and can be applied to settings with no resource constraints. Category B definition of MI is to be applied whenever there is incomplete information on cardiac bio-markers together with symptoms of ischaemia and the development of unequivocal pathological Q waves. Category C definition (probable MI) is to be applied when individuals with MI may not satisfy Category A or B definitions because of delayed access to medical services and/or unavailability of electrocardiography and/or laboratory assay of cardiac biomarkers. In these situations, the term probable MI should be used when there is either ECG changes suggestive of MI or incomplete information on cardiac biomarkers in a person with symptoms of ischaemia with no evidence of a non-coronary reason. Conclusions This article presents the 2008-09 revision of the World Health Organization (WHO) definition of myocardial infarction (MI) developed at a WHO expert consultatio

Quality Assessment of Healthcare Databases

The assessment of data quality and suitability plays an important role in improving the validity and generalisability of the results of studies based on secondary use of health databases. The availability of more and more updated and valid information on data quality and suitability provides data users and researchers an useful tool to optimize their activities. In this paper, we have summarized and synthesized the main aspects of Data Quality Assessment (DQA) applied in the field of secondary use of healthcare databases, with the aim of drawing attention to the critical aspects having to be considered and developed for improving the correct and effective use of secondary sources. Four developing features are identified: standardizing DQA methods, reporting DQA methods and results, synergy between data managers and data users, role of Institutions. Interdisciplinarity, multi-professionality and connection between government institutions, regulatory bodies, universities and the scientific community will provide the "toolbox" for i) developing standardized and shared DQA methods for health databases, ii) defining the best strategies for disseminating DQA information and results

AD HOC SURVEYS: HOW TO MEASURE AND REPORT QUALITY METHODS

Surveys need a clear report on adopted quality methods to support surveillance, research and to implement evidence-based health policies. Aim of this report is to provide a simple and practical tool to those interested in survey, like HIS or HES , suggesting the different aspects of the quality to be controlled. These are crucial to generate useful and reliable results that can help the monitoring of health policy in Europe. Starting from the wide literature available in the field, the various quality dimensions that should be documented in a quality report and support the published results are briefly presented. In this paper, the six dimensions of the quality are analysed, as well as the different steps necessary to implement a survey, with particular attention to the quality and taking account of the remarkable expertise in the field. Before starting the survey, as known, the planning of specific steps is required. Moreover, to improve quality, training and testing of personnel involved in the different sets (organization, data collection, data processing, and statistical analysis) are fundamental. The methods used and the results obtained need to be published

Geographic and socioeconomic variation of sodium and potassium intake in Italy : results from the MINISAL-GIRCSI programme

Objectives To assess geographic and socioeconomic gradients in sodium and potassium intake in Italy. Setting Cross-sectional survey in Italy. Participants 3857 men and women, aged 39–79 years, randomly sampled in 20 regions (as part of a National cardiovascular survey of 8714 men and women). Primary outcome measures Participants’ dietary sodium and potassium intakes were measured by 24 h urinary sodium and potassium excretions. 2 indicators measured socioeconomic status: education and occupation. Bayesian geoadditive models were used to assess spatial and socioeconomic patterns of sodium and potassium intakes accounting for sociodemographic, anthropometric and behavioural confounders. Results There was a significant north-south pattern of sodium excretion in Italy. Participants living in southern Italy (eg, Calabria, Basilicata and Puglia >180 mmol/24 h) had a significantly higher sodium excretion than elsewhere (eg, Val d'Aosta and Trentino-Alto Adige <140 mmol/24 h; p<0.001). There was a linear association between occupation and sodium excretion (p<0.001). When compared with occupation I (top managerial), occupations III and IV had a 6.5% higher sodium excretion (coefficients: 0.054 (90% credible levels 0.014, 0.093) and 0.064 (0.024, 0.104), respectively). A similar relationship was found between educational attainment and sodium excretion (p<0.0001). When compared with those with a university degree, participants with primary and junior school education had a 5.9% higher urinary sodium (coefficients: 0.074 (0.031, 0.116) and 0.038 (0.001, 0.075), respectively). The socioeconomic gradient explained the spatial variation. Potassium excretion was higher in central regions and in some southern regions. Those in occupation V (low-skill workers) showed a 3% lower potassium excretion compared with those in occupation I. However, the socioeconomic gradient only partially explained the spatial variation. Conclusions Salt intake in Italy is significantly higher in less advantaged social groups. This gradient is independent of confounders and explains the geographical variation

Acute myocardial infarction and stroke registries. The italian experience

Cardiovascular diseases (CVD) are the leading causes of death and hospitalisation in nearly all European countries and accounted for almost 40% of all deaths in 2013. With the exception of few rigorous but limited studies carried out in some geographical areas, available data on CVD incidence and prevalence are generally limited and of poor quality, despite the magnitude of the CVD phenomenon. The EUROCISS Project, supported by the Health Monitoring Programme of the DG SANCO from 2000 to 2007, provided general guidance and updated methods for the surveillance of Acute Myocardial Infarction (AMI) and Stroke. The Italian population-based registry of major coronary and cerebrovascular events was set up following EUROCISS Project recommendations; it also took into account the experience acquired by Italy in the WHO-MONICA project since the mid-1980s and continued with the coordination of the EUROCISS Project. The project: “A population-based AMI register: assessing the feasibility for a pilot study to implement a surveillance system of AMI in Mediterranean countries according to EUROCISS recommendations”, in the framework of the EuroMed Programme, followed major practical and operative issues for the implementation of a population-based registry for coronary and cerebrovascular events, which are here described. This paper includes the definition of target population, data sources, events, indicators, quality methods, and the description of a software used to implement the registry