Survival of Persons with Down Syndrome in Italy

Down syndrome (DS) is a major cause of congenital malformation and disability. No updated data are available on life expectancy of persons with DS in Europe. We collected information on age, sex and area of birth of 3,217 persons with DS died from 1997 to 2009 in Italy. Survivals rates and mean survival time was calculated using a life tables calculated from cross sectional data. Some factors influencing the survival were also analysed using a semi-proportional hazard model. Survival rates of 91.4% at one year and 88.3% at ten years were found. Mean survival time at birth was 47.1 years (C.I. 95%: 46.5-47.7). There was 8-year significant difference in survival between north-central regions and southern regions. Male life expectancy was 46.9 years (C.I. 95%: 46.1-47.8), lower than females 47.3 years (C.I. 95%: 46.5-48.2) even though not statistically significant (p=0.23). Almost nine out ten children with DS now survive at least 10 years. Adequate educational and health service provisions needs to be made for them. The disadvantage of Down persons born in the Southern regions in terms of life expectancy is impressive. Quality of medical care provided in the South of Italy in the first months of life is the most likely determinant of the high mortality observed among persons with DS born in that area

A New Computer-aided Technique for Planning the Aesthetic Outcome of Plastic Surgery

Plastic surgery plays a major role in today health care. Planning plastic face surgery requires dealing with the elusive concept of attractiveness for evaluating feasible beautification of a particular face. The existing computer tools essentially allow to manually warp 2D images or 3D face scans, in order to produce images simulating possible surgery outcomes. How to manipulate faces, as well as the evaluation of the results, are left to the surgeon's judgement. We propose a new quantitative approach able to automatically suggest effective patient-specific improvements of facial attractiveness. The general idea is to compare the face of the patient with a large database of attractive faces, excluding the facial feature to be improved. Then, the feature of the faces more similar is applied, with a suitable morphing, to the face of the patient. In this paper we present a first application of the general idea in the field of nose surgery. Aesthetically effective rhinoplasty is suggested on the base of the entire face profile, a very important 2D feature for rating face attractivenes

Access to Preventive Health Services of People with Intellectual Disability in Italy

People with intellectual disabilities today have an high life expectancy, routine screening and preventive services are essential to their overall quality of care. We used the 2012-2013 Italian National Health Interview Survey (NHIS) to examine screening and preventive service use for persons with intellectual disability. We estimated about 953 thousand people with intellectual disability, 58% of which are female and the 59% are over 65 years. Their quality of life, in terms of physical and mental status, was significant lower than general population. Intellectually disabled women generally reported screening and preventive services at lower as compared to women without intellectual disability: the risk of not attending a Pap smear test in a due time, in terms of odds ratio, was 4.5 (95% confidence interval, 3.6-5.7), as for mammography was 2.4 (95% confidence interval, 1.8-3.2). The risk of not attending colorectal screening was also significant, even if lower than female screening, (OR: 1.5; 95% confidence interval, 1.2-2.0). Various approaches can be adopted to improve access for intellectually disabled persons to preventive health care services

Analysis of the role of General Practice in preventing Avoidable Hospitalisation through a multilevel approach

Objective. To examine the relationship between Avoidable Hospitalisation (AH) and the activities of General Practitioners (GPs). The study was carried out in the Lazio Region (Italy) within different organizational models of primary care (PC) delivery. Methods: Secondary data of a set of GP activities delivered to the Lazio population as listed in the Lazio GPs in 2008, were used. For each GP a set of health services delivered to the patients on their practice lists were measured. The relation between the rates of AH, acute and chronic conditions separately, and the rates of such health services were analyzed through the use of a multilevel Poisson regression model, adjusted according to patients’ health status. Results: The study included data from all the active GPs (4,837) in the Lazio Region and their 4,666,037 registered patients. The overall AH rate of the registered patients was 7.7 per 1,000, 2.2 for acute and 5.5 for chronic conditions. The diagnostics prescription by GPs is associated with a 7% (IRR=0.93;95% C.I.:0.89-0.97) reduction of the chronic AH rate. Patients registered at GPs working within a team practice resulted in a hospitalisation rate decrease of 5% (IRR= 0.95; 95% C.I.:0.91-0.99)  for avoidable acute conditions. Conclusion: The study showed that the role of GPs in preventing AH is substantial, particularly when team practice is performed and specifically when additional diagnostics are prescribed. The study is further evidence in favor of the validity of AH as an outcome measure of quality and accessibility of primary care

Regioselective Synthesis, Structural Characterization, and Antiproliferative Activity of Novel Tetra-Substituted Phenylaminopyrazole Derivatives

A small library of highly functionalized phenylaminopyrazoles, bearing different substituents at position 1, 3 and 4 of the pyrazole ring, was prepared by the one pot condensation of active methylene reagents, phenylisothiocyanate and substituted hydrazine (namely, methyl- and benzyl-hydrazine). The identified reaction conditions proved to be versatile and efficient. Fur-thermore, the evaluation of alternative stepwise protocols affected the chemo- and re-gio-selectivity outcome of the one-pot procedure. The chemical identity of two N-methyl pyrazole isomers, selected as prototypes of the whole series, was unambiguously identified by means of NMR and mass spectrometry studies. Additionally, semiempirical calculations provided a structural rationale for the different chromatographic behaviour of the two isomers. The prepared tetra-substituted phenylaminopyrazoles were tested in cell-based assays on a panel of cancer and normal cell lines. The tested compounds did not show any cytotoxic effect on the selected cell lines, thus supporting their pharmaceutical potentials

Trends in avoidable hospitalization rates in Italy, 2001-2008

Background: hospitalization for Ambulatory Care Sensitive Conditions (AC SC), also known as avoidable hospitalization (AH) has been proposed as effect measure of the accessibility and effectiveness of primary care. In the last years in developed countries, including Italy, hospitalization rates have decreased as well as the rates of AH. The decline of AH-rates could be just an effect of the general trend of hospitalization. The objective of our study was to examine the adjusted trend of AH rates and to test possible associations with measures of primary care (re)organization. Methods: hospital discharges from 2001 to 2008 were analyzed. Main outcome measures were hospitalization rates, both as inpatient and day hospital. ACSCs were grouped in acute conditions, preventable through early diagnoses and treatment and chronic conditions, preventable through good ongoing control and management. Expected time-series rates of AH, estimated on the hypothesis of same time trends of Total Hospitalization (TH), were compared with observed ones using a Chi Square test. Adjusted hospitalization rates were analyzed in conjunction with indicators of primary care. Results: in the studied period, in Italy, the TH rates declined with an average decrease of 19.6%, while the decrease for AH was 16.4%. The rates of AH adjusted for the trend of TH significantly decreased only for chronic conditions. Decreasing trend of AH was correlated with the impact of reorganization of primary care in associative forms. Conclusions: the presented methodology can be used to evaluate the real effectiveness of policies aimed at reducing hospitalization for ACSCs

Investigating the impact of influenza on excess mortality in all ages in Italy during recent seasons (2013/14 - 2016/17 seasons)

Objectives: In recent years, Italy has been registering peaks in death rates, particularly among the elderly during the winter season. Influenza epidemics have been indicated as one of the potential determinants of such an excess. The objective of our study was to estimate the influenza-attributable contribution to excess mortality during the influenza seasons from 2013/14 to 2016/17 in Italy. Methods: We used the EuroMomo and the FluMomo methods to estimate the annual trend of influenza-attributable excess death rate by age group. Population data were provided by the National Institute of Statistics, data on influenza like illness and confirmed influenza cases were provided by the National Institutes of Health. As an indicator of weekly influenza activity (IA) we adopted the Goldstein index, which is the product of the percentage of patients seen with influenza-like illness (ILI) and percentage of influenza-positive specimens, in a given week. Results: We estimated excess deaths of 7,027, 20,259, 15,801 and 24,981 attributable to influenza epidemics in the 2013/14, 2014/15, 2015/16 and 2016/17, respectively, using the Goldstein index. The average annual mortality excess rate per 100,000 ranged from 11.6 to 41.2 with most of the influenza-associated deaths per year registered among the elderly. However children less than 5 years old also reported a relevant influenza attributable excess death rate in the 2014/15 and 2016/17 seasons (1.05/100,000 and 1.54/100,000 respectively). Conclusions: Over 68,000 deaths were attributable to influenza epidemics in the study period. The observed excess of deaths is not completely unexpected, given the high number of fragile very old subjects living in Italy. In conclusion, the unpredictability of the influenza virus continues to present a major challenge to health professionals and policy makers. Nonetheless, vaccination remains the most effective means for reducing the burden of influenza, and efforts to increase vaccine coverage and the introduction of new vaccine strategies (such as vaccinating healthy children) should be considered to reduce the influenza attributable excess mortality experienced in Italy and in Europe in the last seasons. Keywords: Flu, Mortality, Italy, Vaccinatio

Social relationships and HRQL: A cross-sectional survey among older Italian adults

BACKGROUND: The aim of this study is to investigate the association between social relationships and Health Related Quality of Life (HRQL) among the elderly in Italy. METHODS: A sample of 33,744 Italian residents, representing the non-institutionalised population aged 60 years and over was extracted from the national ISTAT cross-sectional survey during 1999-2000. HRQL was measured with the SF-12, from which the Physical Component Score (PCS) and Mental Component Score (MCS) were obtained. Data were subjected to descriptive analysis and multiple logistic regression models with adjustment for the main confounders. RESULTS: Our analysis shows a gradient in PCS and MCS among the terziles in seeing/meeting "friends" and "family" and, for PCS, a North-South gradient among the Italian regions. Females, the elderly who reported a lower household income, those who spent less time in recreational and religious activities, who lived too far from their relatives and had few relationships with friends and relatives, were significantly less likely to have an MCS above the median value. For PCS, an increase in HRQL was likely to be associated with a higher educational level, while lower PCS scores were associated with: age 75+, inadequate household income, unmarried status, infrequency of seeing/meeting friends, too high a mean distance from own home to relatives' homes, lack of leisure time spent in recreational activities, living in the Centre-South of Italy, chronic diseases, reduced autonomy, and use of drugs during the previous two days. Significant interactions between suffering from one chronic disease and the use of drugs were also found for both MCS and PCS. CONCLUSION: Some dimensions of social relationships were significantly associated with HRQL. These findings are crucial for devising welfare strategies at both the regional and the European level, i.e. in countries such as Italy where the primacy of family support of the elderly has declined in recent year