Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status.

BACKGROUND: Carpal tunnel syndrome (CTS) is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status. METHODS: Seven regions were considered (overall population, 14.9 million) over 3-6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare). Incidence rates of in-hospital cases of CTS were estimated based on 1) codified demographic, diagnostic and intervention data in obligatory discharge records from all Italian public/private hospitals, archived (according to residence) on regional databases; 2) demographic general population data for each region. We compared (using the chiscore test) age-sex-specific rates between married, unmarried, divorced and widowed subsets of the general population. We calculated standardized incidence ratios (SIRs) for married/unmarried men and women. RESULTS: Age-standardized incidence rates (per 100,000 person-years) of in-hospital cases of CTS were 166 in women and 44 in men (106 overall). Married subjects of both sexes showed higher age-specific rates with respect to unmarried men/women. SIRs were calculated comparing married vs unmarried rates of both sexes: 1.59 (95% confidence interval [95% CI], 1.57-1.60) in women, and 1.42 (95% CI, 1.40-1.45) in men. As compared with married women/men, widows/widowers both showed 2-3-fold higher incidence peaks during the fourth decade of life (beyond 50 years of age, widowed subjects showed similar trends to unmarried counterparts). CONCLUSION: This large population-based study illustrates distinct age-related trends in men and women, and also raises the question whether marital status could be associated with CTS in the general population.

[Socio-economic status and family profile indicators: methodological issues in studying the burden of caregiving for terminally ill cancer patients]. / Indicatori di stato socio-economico e profili familiari: problemi metodologici nello studio dell'impatto sulle famiglie della fase terminale della malattia oncologica.

INTRODUCTION: The quality of care received by terminally ill cancer patients depends heavily on socio-economic conditions and family resources, especially because of the current increase in home care assistance. OBJECTIVE: To validate the demographic information on educational level which is recorded in the registries of residents in Italian towns; to compare simple indicators of socio-economic status and family profiles with composite indicators in their ability to predict the economic and social impact of the disease. DESIGN: A two-level probabilistic sample of cancer deaths from the Italian Survey on Dying Of Cancer. PARTICIPANTS: 2000 deaths were sampled; caregivers were identified and interviewed between 4 and 12 months after the patient's death. METHODS: We calculated Cohens kappa for educational level as reported in the registry, and in the questionnaire. We constructed a composite indicator of socio-economic status and family profile using a cluster analysis; its association with the impact on finances and quality of daily life was compared with that from the educational level reported in the questionnaire and with a previously derived indicator of family profile. RESULTS: The weighted kappa of the two sources used for educational level was 0.60 (CI 95% 0.55-0.64). Of the two indicators, educational level and socio-economic status (6 groups), only the later showed a significant association with the outcomes "difficulties" in sustaining the costs of treatment" and "use of entire savings for the illness". The composite indicator of family profile (7 groups) was significantly associated with all outcomes considered. Log-likelihood was significantly better with model using the composite and the prior indicators of family profile than in models without them. Models that included educational level and prior indicator of family profile (7 groups) were more adaptable than models with the composite indicators. CONCLUSIONS: The good level of agreement between the two sources regarding educational level suggests that the registry is an adequate data source, when other information is lacking. Our study did not reveal which of the indicators we used is the best, at least with regard to the outcomes we considered.

Dying of cancer in Italy: impact on family and caregiver. The Italian Survey of Dying of Cancer.

OBJECTIVE: To describe the effect of terminal cancer on the patient's family, finances and daily life. METHODS: A cluster sample of 2000 adults (> or = 18 years old) who had died from cancer, and who were representative of Italy, was studied. 1900 caregivers were identified and 68% responded to a post-bereavement survey. Caregivers included the patient's child (46%), his/her spouse (31%), other relatives or friends (20%) or a health professional (3%). The median age of a caregiver was 54 years and 69% were females. During the last 3 months of the patient's life, 44% of caregivers reported difficulties in their regular employment. RESULTS: Of the 68% of families who had to pay for some of the care, 37% had to pay for drugs, 36% for nursing and assistance and 22% for physicians. Paying for care was more frequent in the south of Italy (OR 2.5; 95% CI 1.0 to 6.3) and when the patient was a housewife (OR for unit increase 2.7; 95% CI 1.6 to 6.1). To cover the costs of patient care, 26% of families used all or most of their savings. Economic difficulties were greater in the south of Italy (OR 3; 95% CI 1.8 to 5.1), for female caregivers (OR 1.4; 95% CI 1.0 to 1.9) and for disadvantaged patients. The duration of time the patient was completely dependent strongly determined the effect caregiving had on their regular employment and on the family's financial situation. CONCLUSIONS: Although in Italy families are responsible for a small percentage of the overall costs of patient care, the effect of cancer on savings and daily life can be substantial. Strong geographical and gender differences emerged from this study.

[Epidemiology of falls among the elderly]. / Indagine sulle cadute nella popolazione anziana di undici regioni italiane: Studio Argento 2001-2002.

INTRODUCTION: Falls among the elderly have important physical and psychological consequences. Interventions of proven effectiveness exist at individual and population level for their prevention. Studies conducted in other countries have estimated the prevalence and identified the health and environmental risk factors associated with falls, while in Italy, the information available is limited to elderly living in protected residences. To estimate therefore the prevalence of falls and to estimate the association between these events and different risk factors, a series of questions on falls and their possible determinants were included in Studio Argento, a cross-sectional survey of the state of health of the non-institutionalized population > or = 65 years of age that was conducted in 2002 in 11 Italian Regions. METHODS: In each region, two-stage cluster sampling was used to sample 210 individuals. In the first phase, 30 communes were selected, with the probability of selection proportionate to their population; in the second phase, simple random sampling using the communal population register to select the persons to be interviewed. Interviews were conducted in the homes of the study subjects using a standardized questionnaire. Data from the 11 regions were merged for purposes of the analysis, and the C-sample routine of Epi-Info version 2002 was used to conduct the analysis, taking into account of the survey design and the size of the total population > or = 65 years in the various Regions. SUDAAN, an application of SAS was used for the calculation of the rate ratios (R.R.) and 95% confidence intervals (95% CI) and the population-attributable fractions, taking into account potentially confounding variables. RESULTS: A total of 2,273 persons were included in the study. During the previous 12 months, 651 (28.6%; 95% CI = 26.4%-30.7%) had fallen; of these 43.1% (95% IC = 38.6%-47.7%) had fallen 2 or more times. Sixty percent (95% CI = 55,6%-64,2%) of those who had fallen reported having fallen at home. Risk factors for falls included stroke (adjusted RR = 1.4 (95% CI = 1.03-1.8)). diabetes (adjusted RR = 1.7 (95% CI = 1.2-2.1)). visual difficulties (adjusted RR = 1.3 (95% CI = 1.02-1.6)). urinary incontinence (adjusted RR = 1.3 (95%CI= 1.1-1.5) and physical inactivity (adjusted RR = 1.3 (95% CI = 1.03-1.5)). In addition, the consumption of anti-anxiety drugs was also associated with a greater risk of falls. The highest population-attributable fractions were seen for urinary incontinence (9.4%) and lack of physical activity (10.0%). CONCLUSIONS: Falls are common in Italian elderly and are linked with the fragility of aging. To prevent falls, it is necessary to intervene on factors associated with fragility. Methods include encouraging regular physical activity to improve equilibrium and muscle strength and the continuous monitoring of health status to prevent further deterioration. Moreover studies carried out in other countries have demonstrated that the multidisciplinary interventions targeted at persons who have already experienced a fall reduces their risk of further falls. These interventions consist of evaluations of visual acuity, balance, and gait and a review of clinical history with eventual modifications of drug therapy and the environmental risks in the home.