Il ruolo delle infezioni da Chlamydia nel determinismo delle malattie cronico-degenerative: una nuova sfida per i sistemi sanitari

Le infezioni da Chlamydia stanno riscuotendo una rinnovata attenzione da quando è stato postulato che proteine rilasciate da questi batteri intracellulari possono generare fenomeni di autoimmunità e l’insorgenza di diverse malattie, come l’Alzheimer, l’aterosclerosi, l’arterite reumatoide, la sclerosi multipla e numerose altre ancora. Questo breve articolo ha lo scopo di stressare il problema che, negli Stati Uniti, rappresenta già una emergenza sanitari

Cost effectiveness of aortic valve therapies: a systematic review of the literature

Background: we performed a systematic review on the cost effectiveness of transcatheter aortic valve implantation (TAVI) to standard aortic valve replacement and medical management in high-risk elderly patients with severe aortic stenosis. Methods: in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses, a systematic review on current literature for cost-effectiveness of TAVI, standard aortic valve replacement, and medical management for elderly patients with high-risk severe aortic stenosis was performed. Incremental cost effectiveness ratio is used to measure effectiveness through life years gained or quality adjusted life years. Drummond checklist was used to further assess the quality of the included studies. Results: the systematic literature search identified 4 primary publications (derived from 52 citations) that fulfilled the inclusion criteria. Tremendous discrepancy in incremental cost effectiveness ratio is demonstrated with operable patients similar to Cohort A of the PARTNER trial (€ 749 416 and € 39 577). Inoperable patients similar to Cohort B of the PARTNER trial suggest notable differences in favour for transcatheter aortic valve implantation with an increase in quality adjusted life years (0.06 versus 1.6, respectively). With lifetime horizon to transcatheter aortic valve implantation there is a more comparable incremental cost effectiveness ratio in the literature (€ 38 260 and € 37 432). Lowest incremental cost effectiveness ratio witnessed in the technical inoperable group at € 26 482. Lifetime horizon of 10 years with transcatheter aortic valve implantation differ (€ 39 388 versus € 19 947). Overall, a review of the literature suggests TAVI usage in patients for severe aortic stenosis whom are not eligible for surgery. All the studies were overall judged of medium-high quality. Conclusions: transcatheter aortic valve replacement is more cost effective with a lifetime horizon for the treatment of patients with high-risk aortic stenosis compared with medical management considering those ineligible for standard aortic valve replacement. Further cost effectiveness research is needed in the stratifications of patient risk and patient co-morbidities for those candidates eligible for surgery. &nbsp

Cost effectiveness analysis of childhood obesity primary prevention programmes: a systematic review

Background. Childhood obesity is associated with enormous health consequences and costs to society. This study aims to systematically review the studies on Cost Effectiveness Analysis (CEA) of primary prevention programmes of childhood obesity, discussing the gaps and providing recommendations for future research.                                               Methods. All the studies on the cost effectiveness evaluation of  primary prevention of obesity among children were included. Studies were retrieved from MEDLINE and Google Scholar, up to 31st March 2012, with only English language papers being eligible. The quality of the retrieved studies was evaluated by using the Drummond scale. Results. Eight studies were included, five of which concerning community-based intervention programmes, while three school-based programmes. Fifty-percent of the studies, 3 school-based and 1 community-based primary prevention programme reported the intervention being cost effective. The studies were heterogeneous in terms of study design, quality, target population and outcome measures. Use of the Drummond scale showed that the eight studies were of low-medium quality.                                                                                            Conclusion. Although model-based studies may be considered as practical measures applicable to different type of programmes and settings, we auspicate for a convergence towards the use of homogenous clinical and outcome measures in order to properly evaluate the added value of obesity primary prevention programmes in childhoo

Distance learning training in genetics and genomics testing for Italian health professionals: results of a pre and post-test evaluation

BACKGROUND: Progressive advances in technologies for DNA sequencing and decreasing costs are allowing an easier diffusion of genetic and genomic tests. Physicians' knowledge and confidence on the topic is often low and not suitable for manage this challenge. Tailored educational programs are required to reach a more and more appropriate use of genetic technologies. METHODS: A distance learning course has been created by experts from different Italian medical associations with the support of the Italian Ministry of Health. The course was directed to professional figures involved in prescription and interpretation of genetic tests. A pretest-post-test study design was used to assess knowledge improvement. We analyzed the proportion of correct answers for each question pre and post-test, as well as the mean score difference stratified by gender, age, professional status and medical specialty. RESULTS: We reported an improvement in the proportion of correct answers for 12 over 15 questions of the test. The overall mean score to the questions significantly increased in the post-test, from 9.44 to 12.49 (p-value < 0.0001). In the stratified analysis we reported an improvement in the knowledge of all the groups except for geneticists; the pre-course mean score of this group was already very high and did not improve significantly. CONCLUSION: Distance learning is effective in improving the level of genetic knowledge. In the future, it will be useful to analyze which specialists have more advantage from genetic education, in order to plan more tailored education for medical professionals

Management of labyrinthine fistula in chronic otitis with cholesteatoma: case series.

Labyrinthine fistula is a complication of ear cholesteatoma that increase the risk of sensorineural hearing loss. The management of the fistula must be done contextually with mastoidectomy by: leaving cholesteatoma matrix over the fistula, or remove the matrix reconstructing the defect. Objective: analysis of the two techniques to treat labyrinthine fistula. Methods: retrospective review with case series analysis. Results: a labyrinthine fistula was present in 14% of cholesteatoma patients; CT scan was pre-dictive in all cases; the hearing preservation was obtained with both techniques; a re-currence was detected only in one case; postoperative nystagmus incidence was higher in those cases with matrix left in situ and when the size of the fistula was lar-ger than 2 mm. Conclusions: the labyrinthine fistula have to be treated contextually with cholesteatoma removal, both techniques had good postoperative hearing preser-vation rate. The postoperative vertigo with nystagmus is more frequent in larger fistu-las

Distance learning training in genetics and genomics testing for Italian health professionals: results of a pre and post-test evaluation

Background Progressive advances in technologies for DNA sequencing and decreasing costs are allowing an easier diffusion of genetic and genomic tests. Physicians’ knowledge and confidence on the topic is often low and not suitable for manage this challenge. Tailored educational programs are required to reach a more and more appropriate use of genetic technologies. Methods A distance learning course has been created by experts from different Italian medical associations with the support of the Italian Ministry of Health. The course was directed to professional figures involved in prescription and interpretation of genetic tests. A pretest-post-test study design was used to assess knowledge improvement. We analyzed the proportion of correct answers for each question pre and post-test, as well as the mean score difference stratified by gender, age, professional status and medical specialty. Results We reported an improvement in the proportion of correct answers for 12 over 15 questions of the test. The overall mean score to the questions significantly increased in the post-test, from 9.44 to 12.49 (p-value &lt; 0.0001). In the stratified analysis we reported an improvement in the knowledge of all the groups except for geneticists; the pre-course mean score of this group was already very high and did not improve significantly. Conclusion Distance learning is effective in improving the level of genetic knowledge. In the future, it will be useful to analyze which specialists have more advantage from genetic education, in order to plan more tailored education for medical professionals