Adherence issues related to sublingual immunotherapy as perceived by allergists

Objectives: Sublingual immunotherapy (SLIT) is a viable alternative to subcutaneous immunotherapy to treat allergic rhinitis and asthma, and is widely used in clinical practice in many European countries. The clinical efficacy of SLIT has been established in a number of clinical trials and meta-analyses. However, because SLIT is self-administered by patients without medical supervision, the degree of patient adherence with treatment is still a concern. The objective of this study was to evaluate the perception by allergists of issues related to SLIT adherence. Methods: We performed a questionnaire-based survey of 296 Italian allergists, based on the adherence issues known from previous studies. The perception of importance of each item was assessed by a VAS scale ranging from 0 to 10. Results: Patient perception of clinical efficacy was considered the most important factor (ranked 1 by 54% of allergists), followed by the possibility of reimbursement (ranked 1 by 34%), and by the absence of side effects (ranked 1 by 21%). Patient education, regular follow-up, and ease of use of SLIT were ranked first by less than 20% of allergists. Conclusion: These findings indicate that clinical efficacy, cost, and side effects are perceived as the major issues influencing patient adherence to SLIT, and that further improvement of adherence is likely to be achieved by improving the patient information provided by prescribers. © 2010 Scurati et al, publisher and licensee Dove Medical Press Ltd

A survey of clinical features of allergic rhinitis in adults

Background: Allergic rhinitis (AR) has high prevalence and substantial socio-economic burden. Material/Methods: The study included 35 Italian Centers recruiting an overall number of 3383 adult patients with rhinitis (48% males, 52% females, mean age 29.1, range 18\u201345 years). For each patient, the attending physician had to fill in a standardized questionnaire, covering, in particular, some issues such as the ARIA classification of allergic rhinitis (AR), the results of skin prick test (SPT), the kind of treatment, the response to treatment, and the satisfaction with treatment. Results: Out of the 3383 patients with rhinitis, 2788 (82.4%) had AR: 311 (11.5%) had a mild intermittent, 229 (8.8%) a mild persistent, 636 (23.5%) a moderate-severe intermittent, and 1518 (56.1%) a moderate-severe persistent form. The most frequently used drugs were oral antihistamines (77.1%) and topical corticosteroids (60.8%). The response to treatment was judged as excellent in 12.2%, good in 41.3%, fair in 31.2%, poor in 14.5%, and very bad in 0.8% of subjects. The rate of treatment dissatisfaction was significantly higher in patients with moderate-to-severe AR than in patients with mild AR (p<0.0001). Indication to allergen immunotherapy (AIT) was significantly more frequent (p<0.01) in patients with severe AR than with mild AR. . Conclusions: These fndings confirm the appropriateness of ARIA guidelines in classifying the AR patients and the association of severe symptoms with unsuccessful drug treatment. The optimal targeting of patients to be treated with AIT needs to be reassessed

Impact of anastomotic leakage on overall and disease-free survival after surgery for gastric carcinoma. a systematic review

BACKGROUND/AIM: Gastric cancer is the fifth most frequently diagnosed cancer and the second most common cause of cancer-related death. The only potentially curative treatment is surgical resection, which is associated with potentially severe complications, such as anastomotic leakage. The aim of this systematic review was to evaluate the relationship between anastomotic leakage and overall and disease-free survival after surgery for gastric cancer. MATERIALS AND METHODS: A systematic literature search was performed and 7 articles published between 2010 and 2019 were included, including a total of 7,167 patients. RESULTS: Among the included studies the frequency of anastomotic leakage ranged from 6 to 41%. Patients affected by anastomotic leakage had an overall survival ranging between 4.1 and 97.6 months, whereas patients who did not experience anastomotic leakage had an overall survival between 23 and 109.5 months. CONCLUSION: Closer follow-up or even more aggressive oncological therapy may be considered for patients affected by anastomotic leakage after surgery for gastric cancer

La strategia nazionale per la biodiversità in Italia

La conservazione della biodiversità e l’uso sostenibile delle risorse garantiscono il corretto funzionamento degli ecosistemi così come la fornitura dei loro servizi, che sono le basi essenziali della vita e dell’economia umane. La società moderna e l’economia sono, infatti, legate in modo sistemico all'uso delle risorse naturali e dei sistemi produttivi. In particolare, questa stretta dipendenza si manifesta con le attività agricole e forestali, oltre che con le attività collegate ai trasporti, al turismo e alla crescita urbana.I benefici diretti e indiretti della biodiversità si riflettono in servizi riguardanti i prodotti (cibo, principi farmaceutici, materie prime, acqua), la regolazione (controllo climatico, protezione dagli eventi estremi), il supporto (produzione di ossigeno, formazione del suolo) e gli interessi culturali (aumento delle conoscenze, valore estetico, relazioni sociali). Realizzare un bilancio ottimale tra tutela della biodiversità, valorizzazione delle risorse naturali e sviluppo economico significa perseguire l’obiettivo dello sviluppo sostenibile. Inoltre, la perdita di biodiversità e la riduzione dell’efficienza dei servizi ecosistemici hanno costi economici e sociali rilevanti non solo in relazione alla sostenibilità ambientale, ma anche ai tentativi in atto per ridurre la povertà, la fame e la malattia nel mondo. Grazie alle sue caratteristiche ambientali e storiche, l’Italia è un paese che contiene, a tutti i livelli di organizzazione biologica e territoriale, un elevato valore di biodiversità. In questo contesto, studi e attività di ricerca rappresentano il presupposto irrinunciabile per la sostenibilità ambientale di scelte e azioni future

National Biodiversity Strategy in Italy

Biodiversity conservation and sustainable use guarantee the correct functioning of ecosystems as well as the provision of their services, which constituite the essential basis for human economy and life. The loss of biodiversity and the reduced efficiency of ecosystem-related services have high social and economic costs as regards not only environmental sustainability, but also attempts made to reduce poverty, hunger and disease throughout the world. Indeed, the direct and indirect benefits of biodiversity are reflected in services regarding supplies (food, pharmaceutical drugs, raw materials, water), regulation (climate control, protection against extreme events), support (oxygen production, soil formation) and cultural interest (increased knowledge, aesthetic value, social relations). Modern society and economy are strongly linked to natural resources and productive ecosystems use. In particular, this dependence is expressed through agriculture and forest activities. It is evident that this dependency is also linked to other human activities related to transports, tourism and urban growth. The achievement of the optimum balance between biodiversity conservation, natural resources valorization and economic development mean the pursuing of sustainable development