Limitations and consequences of public health models centred on hospitals and lacking connections with territorial and home-based social and health services.

BACKGROUND: Delayed discharge from hospital to home or other care institutions is a significant problem and has been investigated in the international scientific literature for many years. Behind this condition is a health care system based on a hospital-centered concept characterized by a lack of territorial health and social welfare services. This phenomenon causes two different problems: an excessive length of hospital stay, resulting in slow turnover of bed utilization; and overcrowding in emergency rooms (ERs). The phenomenon of frequent users assumes particular importance in this context. These patients repeatedly visit the emergency department (ED) in the same year because care needs are not met by primary care services. The authors in this study tried to describe the Frequent users (FUs) population and the variables associated with this condition. MATERIALS AND METHODS: A retrospective "single-arm" descriptive study was conducted by analysing all accesses made to the ED of Policlinico Tor Vergata (PTV) from January 1, 2022, to December 31, 2022. FUs were defined as patients who had 4 or more accesses to PTV ER during the year. RESULTS: A total of 37,800 accesses occurred during the study period. A total of 31,691 users accessed the PS, with a mean age of 55.8 ± 22.2 years. There were 359 FU patients (approximately 1%) who had a total of 1984 accesses, corresponding to 5.2% of the total accesses. The triage codes for the FU patients were red, 2%; orange, 21%; blue, 45%; green, 26%; white, 5%; and not performed, 1%. Considering the 1984 FU accesses, the most frequently attributed "main problems" in the ED were "other symptoms or disorders" (54%), "psychomotor agitation" (12%), "trauma or burn" (8%), "abdominal pain" (6%), "chest pain" (4%), "dyspnea" (4%) and "urological symptoms or disorders" (4%). Multivariate analysis revealed that the main determinants of FUs were psychomotor agitation (HR = 7,23; CL95%:6,194-8,443), urological disorders (HR = 2,16; CL95%:1,68-2,76) and poor socioeconomic status (HR = 2,40; CL95%:2,213-2,663). CONCLUSIONS: The FUs phenomenon expresses an area of health and social distress where poverty and lack of territorial services oblige people to refer to the ED. Primary care interventions integrated with social support are crucial for managing access to the ED.

Unemployment Status Subsequent to Cancer Diagnosis and Therapies: A Systematic Review and Meta-Analysis.

The purpose of our study is to examine whether cancer and treatments are associated with job loss or changes in employment status. Eight prospective studies were included in the systematic review and meta-analysis, with a population aged 18-65 years, analyzing treatment regimen and psychophysical and social status in post-cancer follow-up of at least 2 years. In the meta-analysis, a comparison was made between recovered unemployed cases and cases from a standard reference population. Results are summarized graphically using a forest plot. We showed that cancer and subsequent treatment are risk factors for unemployment with an overall relative risk of 7.24 (lnRR: 1.98, 95% CI: 1.32-2.63) or for change in employment status. Individuals undergoing chemotherapy and/or radiation treatment and those with brain and colorectal cancers are more likely to develop disabilities that negatively affect the risk of unemployment. Finally, variables such as low level education, female sex, older age, and being overweight before starting therapy are associated with higher risk of unemployment. In the future, it will be necessary for people with cancer to have access to specific health, social welfare, and employment support programs. In addition, it is desirable that they become more involved in their choice of therapeutic treatment.

Long-term treatment of psoriatic patients with adalimumab reduces disease severity and maintains a favorable lipid pattern and a low Atherogenic Index.

BACKGROUND: This retrospective study aimed to evaluate the long-term efficacy and effects on lipid profile and Atherogenic Index of antitumor necrosis factor (TNF)α therapy with adalimumab in patients with moderate-to-severe psoriasis or psoriatic arthritis. METHODS: Sixty-nine psoriatic patients treated with adalimumab 40 mg every other week were included. Patients were treated continuously for four years; study visits took place every 24 weeks. Disease severity (Psoriasis Area Severity Index [PASI], Nail Psoriasis Severity Index [NAPSI], articular pain intensity), disease burden (PSOdisk), serum lipid concentrations, Atherogenic Index, and inflammatory markers were assessed at each visit. RESULTS: Disease severity improved significantly during treatment. After 24 weeks, 89.9% of patients achieved a PAS I75 response; 79.7% and 46.4% had PASI 90 and PASI 100 responses, respectively. Response was sustained over four years. NAPSI Score, articular pain and disease burden improved significantly. Lipid serum concentrations and inflammatory markers were overall stable and within the range of normality. High-density lipoprotein cholesterol concentrations increased significantly and Atherogenic Index improved. The four years of uninterrupted treatment with adalimumab was well tolerated. CONCLUSIONS: Long-term treatment of moderate-to-severe psoriatic disease with adalimumab is effective, well tolerated, and potentially beneficial also in terms of lipid pattern and atherogenic risk.