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1.
Ann Hematol ; 98(7): 1573-1582, 2019 Jul.
Article in English | MEDLINE | ID: mdl-31073646

ABSTRACT

Iron-deficiency anemia (IDA) was the main condition contributing to higher rates of years lived with disabilities in women in 2016. To date, few studies have investigated gender differences in determinants of IDA in Europe. The aim of the present study was to evaluate the determinants of IDA among females and males in four European countries. IDA determinants were estimated using multivariable Cox regression based on information gathered from national primary care databases, namely Italy (for years 2002-2013), Belgium, Germany, and Spain (for years 2007-2012). Adjusted hazard ratios (aHR) with 95% confidence intervals (CIs) were estimated. Age was significantly associated with IDA in females of childbearing age in all four countries, as well as pregnancy, for which the aHR ranged from 1.20 (95% CI 1.15-1.25) in Italy to 1.88 (95% CI 1.53-2.31) in Germany. In males, the aHR increased with age starting from the 65-69 age group. Menometrorrhagia was associated with IDA in Germany (aHR 2.71, 95% CI 1.96-3.73), Italy (aHR 1.80, 95% CI 1.60-2.03), and Spain (aHR 1.52, 95% CI 1.31-1.76). A greater risk for women with alopecia was also observed. Weakness and headache indicated a higher risk in both men and women. Patients with diseases characterized by blood loss or gastrointestinal malabsorption were also at significantly increased risk. Physicians should encourage women of childbearing age to adhere to dietary recommendations regarding iron intake and regularly prescribe screening of iron status. Upper and lower gastrointestinal investigations should be recommended for patients with a confirmed diagnosis of IDA.


Subject(s)
Anemia, Iron-Deficiency/epidemiology , Databases, Factual , Sex Characteristics , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Anemia, Iron-Deficiency/diet therapy , Anemia, Iron-Deficiency/physiopathology , Child , Child, Preschool , Europe , Female , Humans , Male , Middle Aged , Pregnancy , Pregnancy Complications, Hematologic/drug therapy , Pregnancy Complications, Hematologic/epidemiology , Pregnancy Complications, Hematologic/physiopathology
2.
Ann Ist Super Sanita ; 53(1): 70-76, 2017.
Article in English | MEDLINE | ID: mdl-28361808

ABSTRACT

OBJECTIVE: The aim of the study was to identify the main aspects concerning appropriateness and efficacy of Spa therapy for musculoskeletal pathologies. METHODS: A committee of 8 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Clinicians from Italian medical centers specialized in rheumatology, rehabilitation and thermal medicine took part in a Delphi process aimed at obtaining consensus statements among the participants. RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; choice of treatment modality and treatment efficacy. CONCLUSIONS: The experts developed a number of consensus statements which may be used as a practical reference to guide the choice of physicians to treat musculoskeletal diseases with Spa therapy.


Subject(s)
Balneology , Musculoskeletal Diseases/therapy , Consensus , Delphi Technique , Humans , Italy
4.
Int J Food Sci Nutr ; 68(6): 643-655, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28142298

ABSTRACT

The use of palm oil by the food industry is increasingly criticized, especially in Italy, for its purported negative effects on human health and environment. This paper summarizes the conclusions of a Symposium on this topic, gathered by the Nutrition Foundation of Italy, among experts representing a number of Italian Medical and Nutritional Scientific Societies. Toxicological and environmental issues were not considered. Participants agreed that: no evidence does exist on the specific health effects of palm oil consumption as compared to other saturated fatty acids-rich fats; the stereospecific distribution of saturated fatty acids in the triacylglycerol molecule of palm oil limits their absorption rate and metabolic effects; in agreement with International guidelines, saturated fatty acids intake should be kept <10% of total energy, within a balanced diet; within these limits, no effect of palm oil consumption on human health (and specifically on CVD or cancer risk) can be foreseen.


Subject(s)
Palm Oil/administration & dosage , Palm Oil/adverse effects , Cardiovascular Diseases/epidemiology , Congresses as Topic , Fatty Acids/administration & dosage , Fatty Acids/adverse effects , Humans , Italy , Meta-Analysis as Topic , Neoplasms/epidemiology , Nutrition Policy , Nutritional Status , Randomized Controlled Trials as Topic , Risk Factors , Societies, Scientific , Triglycerides/administration & dosage , Triglycerides/adverse effects
5.
Eur J Nutr ; 56(4): 1685-1691, 2017 Jun.
Article in English | MEDLINE | ID: mdl-27154309

ABSTRACT

PURPOSE: In order to collect information on food intake, lifestyle and health status of the Italian population, a random cohort of about 2000 adults was selected in collaboration with the Italian society of general practitioners' network (SIMG). METHODS: Cohort subjects underwent a full clinical evaluation, by their family doctor, who also collected anthropometric data and information on the prevalence of cardiovascular disease risk factors; they were also administered diary forms developed to assess dietary use of simple sugars, of sugar-containing food and of selected food items. RESULTS: Data obtained indicate that the consumption of simple sugars (either added or as natural part of food) by the Italian adult population is, on average, not high (65 and 67 g/day, among women and men, respectively) and mostly derived from food items such as fruit, milk and yogurt. In addition, no correlations were found, in this low-sugar-consuming cohort, between sugar intake and weight, body mass index and waist circumference. CONCLUSIONS: Intakes of simple sugars in the LIZ cohort are not associated with weight, BMI and waist circumference. Prospective data, from cohorts like the LIZ one, might shed further light on the contribution of simple sugar intake to health in countries like Italy.


Subject(s)
Diet , Dietary Sugars/administration & dosage , Life Style , Nutrition Assessment , White People , Adult , Aged , Anthropometry , Choice Behavior , Cohort Studies , Cross-Sectional Studies , Female , Food Preferences , Humans , Italy , Male , Middle Aged , Nutrition Surveys
6.
Eur J Haematol ; 97(6): 583-593, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27155295

ABSTRACT

OBJECTIVES: Iron deficiency anaemia (IDA) is a global public health concern, being responsible for about 800 000 deaths per year worldwide. To date, few studies have investigated the epidemiology of IDA in Europe. This study therefore aimed to assess the incidence rate and determinants of IDA in four European countries. METHODS: Demographic and clinical information was obtained from four national primary care databases, respectively, for Italy, Belgium, Germany and Spain. IDA-related determinants were estimated using multivariable Cox regression. RESULTS: The annual incidence rates of IDA ranged between 7.2 and 13.96 per 1000 person-years. The estimates were higher in Spain and Germany. Females, younger and older patients were at greater risk of IDA, as well as those suffering from gastrointestinal diseases, pregnant women and those with history of menometrorrhagia, and aspirin and/or antacids users. A Charlson Index >0 was a significant determinant of IDA in all countries. CONCLUSIONS: The use of primary care databases allowed us to assess the incidence rate and determinants of IDA in four European countries. Given the crucial role of general practitioners in the diagnosis and management of this condition, our findings may contribute to increase the awareness of IDA among physicians as well as to reduce its occurrence among at-risk patients.


Subject(s)
Anemia, Iron-Deficiency/epidemiology , Population Surveillance , Adolescent , Adult , Aged , Aged, 80 and over , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/etiology , Child , Child, Preschool , Comorbidity , Databases, Factual , Electronic Health Records , Europe/epidemiology , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Middle Aged , Pregnancy , Prevalence , Primary Health Care , Risk Factors , Young Adult
7.
J Cardiovasc Med (Hagerstown) ; 17(8): 581-6, 2016 Aug.
Article in English | MEDLINE | ID: mdl-25347357

ABSTRACT

AIMS: Although calculation of the global cardiovascular risk is strongly recommended, limited data are available regarding the use and the utility of this tool in clinical practice. We aimed at answering the following questions in the setting of Italian general practice: how many patients are evaluated via the cardiovascular risk algorithm; what are their characteristics; and what happens after their evaluation. METHODS: We used the Health Search/CSD Longitudinal Patient Database. The software used by about 800 participating GPs allows the calculation of the global cardiovascular risk in automatic. The following data were yearly extracted from the database within 2004-2008: age, sex, and recorded diagnosis of the main cardiovascular and other information encompassing smoking habits, blood pressure, total cholesterol, high density lipoprotein cholesterol (i.e., variables used to calculate cardiovascular risk), BMI, physical activity, triglycerides, glucose and creatinine; wherever available, current cardiovascular therapy and the automatically computed global cardiovascular risk were also extracted. RESULTS: In 2008, the observed population, aged 35-69 years, numbered 438 922 individuals; 78 617 (17.9%) had at least one calculation of cardiovascular risk; 20 181 patients were re-evaluated at least once: 61.1% among high-risk patients, 43.8% among moderate-risk patients, and 27.2% among low-risk patients. The level of cardiovascular risk measured at baseline increased in 6863 (34%), decreased in 11 791 (58.4%), and did not change in 1527 (7.6%) individuals. Overall, mean cardiovascular risk decreased over 4 years in 2.25% (SD 6.41%; P < 0.01) of patients. CONCLUSION: The calculation of global cardiovascular risk is underused by GPs, who generally assign a higher priority to high-risk individuals. In addition, the use of this algorithm seems to favor a reduction of risk in moderate-risk and high-risk patients.


Subject(s)
Algorithms , Cardiovascular Diseases/epidemiology , Risk Assessment/methods , Adult , Aged , Blood Pressure , Cardiovascular Diseases/blood , Cholesterol, HDL/blood , Databases, Factual , Exercise , Female , Humans , Italy , Male , Middle Aged , Risk Factors , Triglycerides/blood
8.
Ann Ist Super Sanita ; 51(2): 131-8, 2015.
Article in English | MEDLINE | ID: mdl-26156184

ABSTRACT

OBJECTIVE: The aim of the study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile, as well as the medico-legal and organizational aspects of intra-articular injection therapies for osteoarthritis. METHODS: A committee of 10 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Fifty-two clinicians from a large number of Italian medical centers specialized in intra-articular injection therapy took part in a Delphi process aimed at obtaining consensus statements among the participants. RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical device choice; treatment efficacy; and appropriate setting. CONCLUSIONS: The consensus statements developed by a large number of experts may be used as a practical reference tool to help physicians treat osteoarthritis patients by means of intra-articular injection therapies.


Subject(s)
Antirheumatic Agents/administration & dosage , Antirheumatic Agents/therapeutic use , Injections, Intra-Articular , Osteoarthritis/drug therapy , Consensus , Delphi Technique , Disease Management , Health Care Surveys , Humans , Italy , Surveys and Questionnaires , Treatment Outcome
9.
Catheter Cardiovasc Interv ; 85(5): E129-39, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25380511

ABSTRACT

The number of percutaneous coronary interventions (PCI) is increasing worldwide. Follow-up strategies after PCI are extremely heterogeneous and can greatly affect the cost of medical care. Of note, clinical evaluations and non-invasive exams are often performed to low risk patients. In the present consensus document, practical advises are provided with respect to a tailored follow-up strategy on the basis of patients' risk profile. Three strategies follow-up have been defined and types and timing of clinical and instrumental evaluations are reported. Clinical and interventional cardiologists, cardiac rehabilitators, and general practitioners, who are in charge to manage post-PCI patients, equally contributed to the creation of the present document.


Subject(s)
Cardiology , Consensus , Coronary Artery Disease/surgery , Percutaneous Coronary Intervention/standards , Postoperative Care/standards , Practice Guidelines as Topic/standards , Societies, Medical , Follow-Up Studies , Humans , Italy
10.
J Hypertens ; 32(6): 1245-54, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24751593

ABSTRACT

OBJECTIVE: The aim of this study was to assess the accuracy of a risk calculator that includes renal function as compared with that of the traditional Framingham Risk Score (FRS) in predicting the risk of mortality of hypertensive individuals managed in primary care. METHODS: From the databases of British and Italian General Practitioners, we retrieved demographic and clinical data for 35 101 UK and 27 818 Italian individuals aged 35-74 years with a diagnosis of hypertension. Then, the 5-year incidence of cardiovascular events as well as all-cause and cardiovascular mortality were recorded for both samples. A comparison analysis of the performance of the Individual Data Analysis of Antihypertensive Intervention Trials (INDANA) calculator with that of FRS in predicting 5-year all-cause and cardiovascular mortality risk was made. RESULTS: The INDANA calculator was more accurate than the FRS in predicting all-cause [Δc 0.038, 95% confidence interval (CI) 0.026-0.051 for United Kingdom, and 0.018, 95% CI 0.010-0.027 for Italy, both P < 0.0001] and cardiovascular mortality (Δc 0.050, 95% CI 0.027-0.074 for United Kingdom, and 0.080, 95% CI 0.059-0.101 for Italy, both P < 0.0001). By using the INDANA calculator, 20% of the UK and 10% of the Italian patients were reclassified to higher risk classes for all-cause mortality, and 25 and 28%, respectively were reclassified when cardiovascular mortality was assessed (P < 0.0001 for all). CONCLUSION: The INDANA calculator proved to be more accurate than the FRS in predicting the risk of mortality in hypertensive patients and should be considered for systematic adoption for risk stratification of hypertensive individuals managed in primary care.


Subject(s)
Antihypertensive Agents/therapeutic use , Hypertension/physiopathology , Kidney/physiopathology , Risk Assessment/methods , Adult , Aged , Algorithms , Clinical Trials as Topic , Databases, Factual , Electrocardiography , Female , Humans , Hypertension/mortality , Italy , Male , Middle Aged , Primary Health Care/organization & administration , Probability , ROC Curve , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , United Kingdom
11.
Eur J Intern Med ; 24(4): 314-7, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23474251

ABSTRACT

PURPOSE: "Rhythm" and "Rate" control strategies require partially different organization, and a different involvement of Specialists and General Practitioners; we verified whether the strategy assignment modified the approach to stroke prophylaxis. METHODS: Survey in general practice: 233 GPs identified all patients with codified atrial fibrillation (AF) diagnosis, checked the diagnosis (ECG/hospital discharge document), and filled a structured questionnaire on stroke risk-factors, prophylactic therapy, and reasons for warfarin non prescription in CHADS ≥2 patients. Data were collected as an "aggregate." RESULTS: Population observed: 295,906 patients aged >14; 6,036 with confirmed AF; 5,888 with complete data about anti-thrombotic prophylaxis are analyzed here. In the "rhythm strategy" group 45.6% of the CHADS score ≥2 patients (594) were on warfarin, vs. 73.2% (1,741) in the "rate strategy" group (p<0.0001). Overall reasons for warfarin non-use were significantly different in the two groups: clinical contraindications (12.3% vs. 19.7%), side effects (5.5% vs. 8.5%), patients' refusal (12.2% vs. 15.2%), unreliable patient/care-giver (14.4% vs. 25.9%); reasons were unknown to the GP in 55.6% in rhythm control vs. 30.9% in rate control group. CONCLUSIONS: Anti-thrombotic prophylaxis in CHADS ≥2 patients is different in subjects assigned to the Rhythm vs. the Rate control strategy, as well as reported reasons for warfarin non use. GPs do not know why warfarin is not used in a large percentage of cases, mainly in the rhythm control strategy group. Improving efforts should probably be differently tailored for patients assigned to the "rhythm" or the "rate" control strategy.


Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Stroke/prevention & control , Warfarin/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Atrial Fibrillation/complications , Atrial Fibrillation/physiopathology , Female , Heart Rate , Humans , Male , Middle Aged , Practice Guidelines as Topic , Practice Patterns, Physicians'/statistics & numerical data , Stroke/etiology , Surveys and Questionnaires
12.
Am J Cardiol ; 111(5): 705-11, 2013 Mar 01.
Article in English | MEDLINE | ID: mdl-23273528

ABSTRACT

Atrial fibrillation (AF) is 1 of the most important healthcare issues and an important cause of healthcare expenditure. AF care requires specific arrhythmologic skills and complex treatment. Therefore, it is crucial to know its real affect on healthcare systems to allocate resources and detect areas for improving the standards of care. The present nationwide, retrospective, observational study involved 233 general practitioners. Each general practitioner completed an electronic questionnaire to provide information on the clinical profile, treatment strategies, and resources consumed to care for their patients with AF. Of the 295,906 patients screened, representative of the Italian population, 6,036 (2.04%) had AF: 20.2% paroxysmal, 24.3% persistent, and 55.5% permanent AF. AF occurred in 0.16% of patients aged 16 to 50 years, 9.0% of those aged 76 to 85 years, and 10.7% of those aged ≥85 years. AF was symptomatic despite therapy in 74.6% of patients and was associated with heart disease in 75%. Among the patients with AF, 24.8% had heart failure, 26.8% renal failure, 18% stroke/transient ischemic attack, and 29.3% had ≥3 co-morbidities. The rate control treatment strategy was pursued in 55%. Of the 6,036 patients with AF, 46% received anticoagulants. The success rate of catheter ablation of the AF substrate was 50%. In conclusion, in our study, the frequency of AF was 2 times greater than previously reported (approximately 0.90%), rate control was the most pursued treatment strategy, anticoagulants were still underused, and the success rate of AF ablation was lower than reported by referral centers.


Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/epidemiology , Catheter Ablation , Health Resources/statistics & numerical data , Physicians/statistics & numerical data , Practice Guidelines as Topic , Adolescent , Adult , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , Atrial Fibrillation/physiopathology , Atrial Fibrillation/therapy , Electrocardiography , Female , Humans , Italy/epidemiology , Male , Middle Aged , Morbidity , Registries , Retrospective Studies , Stroke/epidemiology , Stroke/etiology , Stroke/prevention & control , Surveys and Questionnaires , Young Adult
13.
Eur J Intern Med ; 24(2): 161-6, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23040261

ABSTRACT

BACKGROUND: C-reactive protein (CRP) increases during an inflammatory response; its plasma levels are believed to be an independent predictor of future atherosclerotic disease. We report the distribution of plasma levels of CRP and its possible relationship with other cardiovascular risk factors in an Italian cohort. METHODS: CRP was assessed in frozen plasma samples of 1949 participants in the CHECK study (2001-2005), which collected clinical and biochemical data from randomly selected subjects (40-79 years) in the setting of Italian general practice. RESULTS: Median CRP (interquartile range) was higher in women (1.42 [0.58-2.86] vs 1.28 [0.58-2.50]; p=.163), in people aged ≥ 65 years (1.74 [0.89-3.34] vs 1.11 [0.52-2.45]; p<.001), in patients with obesity (2.37 [1.27-4.15] vs 1.16 [0.52-2.41]; p<.001), metabolic syndrome (2.12 [1.16-3.72] vs 1.10 [0.50-2.38]; p<.001), or higher cardiovascular risk (2.03 [1.01-3.42] vs 1.19 [0.53-2.50]; p<.001). Stepwise regression analysis showed significant associations (R(2)=.264) of circulating log(e)CRP with body mass index, fibrinogen, apoB, age, gender, smoking habits, physical inactivity, creatinine levels, and systolic blood pressure. CONCLUSION: This study provides epidemiological data of CRP in the Italian population and reinforces the existing evidences about the close correlation between CRP and markers of inflammation and adiposity.


Subject(s)
C-Reactive Protein/metabolism , Cardiovascular Diseases/blood , Cardiovascular Diseases/epidemiology , Risk Assessment/methods , Adult , Aged , Biomarkers/blood , Female , Follow-Up Studies , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors
14.
Pharmacol Res ; 64(4): 393-6, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21740971

ABSTRACT

We estimated the need to use low-efficacy statins or high-efficacy statins or drug combinations to bring high- or very-high cardiovascular risk subjects to their LDL-c target, in a sample representative of the Italian adult population and according to the principles of reimbursement of hypercholesterolemic drugs currently used in Italy. The results allow us concluding that among high or very high cardiovascular risk patients about three patients out of five should be prescribed high-efficacy statins or drug combinations. The other two prescriptions might take into account lower-efficacy statins. If we also compute the values of HDL-c in these subjects--the large majority of which stands below the optimal values as suggested by International guidelines--we bring forward the need either to select specific statins able to increase the levels of these protective lipoproteins or to consider combination therapies of statins with fibrates or nicotinic acid. Our data might conceivably be applied to other low-cardiovascular risk countries and should be taken into account when defining the proportion of drugs with different efficacy and cost in the everyday clinical practice.


Subject(s)
Cardiovascular Diseases/prevention & control , Cholesterol, LDL/metabolism , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Adult , Aged , Cardiovascular Diseases/epidemiology , Cholesterol, HDL/metabolism , Cohort Studies , Humans , Italy/epidemiology , Middle Aged
15.
Eur J Cardiovasc Prev Rehabil ; 18(4): 642-9, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21450625

ABSTRACT

PURPOSE: The Italian national prevention plan 2005-2008 included 10-year cardiovascular risk (10-CR) assessment of the general population aged 35-69 years using the CUORE project risk score. General practitioners (GPs) were encouraged to collect data on risk factors and 10-CR and to contribute to the Cardiovascular Risk Observatory (CRO). The aim is to demonstrate feasibility and effectiveness of 10-CR assessment as a first step to implement primary preventive actions at the individual level. METHODS: Data were collected using CUORE.EXE software, easily and freely downloadable by GPs from the CUORE project website (www.cuore.iss.it). CRO provides a web platform to analyse and compare data on 10-CR and risk factors at regional and national levels with the aim of supporting health policy decision processes. RESULTS: From January 2007 to May 2010, 2,858 GPs downloaded cuore.exe; 139,269 CR assessments on 117,345 persons were sent to CRO. CR mean was 3.0% in women, 8.3% in men; 30% of men and 65% of women were at lower risk (CR < 3%), 9.2% of men and 0.4% of women were at high risk (CR ≥ 20%). Among those with at least two risk assessments (n = 5,948), 8% (95% CI 7-9%) shifted to a lower risk class after 1 year. Systolic blood pressure mean levels decreased by 1.6 mmHg (95% CI 1.2-2.1 mmHg), diastolic blood pressure by 0.9 mmHg (95% CI 0.5-1.3 mmHg), total cholesterol by 5.6 mg/dl (95% CI 4.3-6.8 mg/dl), and smokers prevalence by 3.5% (95% CI 2.5-4.6%); high-density lipoprotein cholesterol increased in women by 1 mg/dl (95% CI 0.5-1.4 mg/dl). CONCLUSIONS: Data demonstrate that 10-CR assessment can be the first step to implement preventive actions in primary care.


Subject(s)
Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Dyslipidemias/complications , Dyslipidemias/therapy , Hypertension/complications , Hypertension/therapy , Primary Prevention , Smoking/adverse effects , Adult , Aged , Cardiovascular Diseases/epidemiology , Decision Support Techniques , Dyslipidemias/epidemiology , Feasibility Studies , Female , General Practice , Humans , Hypertension/epidemiology , Internet , Italy/epidemiology , Male , Middle Aged , Prevalence , Primary Prevention/statistics & numerical data , Prognosis , Risk Assessment , Risk Factors , Smoking/epidemiology , Software , Time Factors
17.
G Ital Cardiol (Rome) ; 11(2): 154-61, 2010 Feb.
Article in Italian | MEDLINE | ID: mdl-20408480

ABSTRACT

BACKGROUND: The Italian National Prevention plan includes 10-year cardiovascular risk (CR) assessment of the Italian general population aged 35-69 years using the CUORE Project risk score. A national training program for general practitioners (GPs) was launched by the Ministry of Health in 2003. GPs were encouraged to collect data on risk factors and risk assessment and to contribute to the CUORE Project Cardiovascular Risk Observatory (CRO). The aim of this analysis is to demonstrate the feasibility and effectiveness of risk assessment in primary care. METHODS: The cuore.exe software, free of charge for GPs and easily downloadable from the CUORE Project web site (www.cuore.iss.it), is the frame for the GP data collection. The CRO provides a platform to analyze data collected on risk assessment and risk factors, and compare results at regional and national level in order to support health policy makers in their decision process. RESULTS: From January 2007 to April 2009, 2858 GPs have downloaded the cuore.exe software; 102,113 risk assessments were sent to the CRO based on risk factors profile of 87,556 persons (3617 persons had more than 1 risk assessment). Mean level of CR was 3.1% in women and 8.4% in men; 30% of men and 65% of women were at low risk (CR < 3%), 9% of men and 0.4% of women were found at high risk (CR > or = 20%). Among those with at least 2 risk assessments, 8% shifted to a lower class of risk after 1 year. Mean level of systolic and diastolic blood pressure decreased by about 1% in 1 year; total cholesterol more than 2%, and prevalence of smokers decreased by about 3% in the second risk assessment. CONCLUSIONS: These data demonstrate that risk assessment can be included as a first step of prevention in primary care. The CUORE Project individual score is expected to become an important tool for GPs to assess their patients' CR, to promote primary prevention, and to focus attention to healthy lifestyle adoption.


Subject(s)
Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Family Practice , Primary Health Care , Risk Assessment/methods , Adult , Age Distribution , Age Factors , Aged , Blood Pressure Determination , Cardiovascular Diseases/etiology , Family Practice/methods , Family Practice/trends , Feasibility Studies , Female , Health Behavior , Humans , Italy/epidemiology , Life Style , Male , Middle Aged , Primary Health Care/methods , Primary Health Care/trends , Prognosis , Retrospective Studies , Risk Factors , Sex Distribution , Sex Factors , Smoking/adverse effects , Time Factors
18.
Eur J Cardiovasc Prev Rehabil ; 17(5): 562-8, 2010 Oct.
Article in English | MEDLINE | ID: mdl-20308908

ABSTRACT

BACKGROUND: Elevated blood pressure (BP) is one of the most important modifiable risk factors for cardiovascular diseases. In this study we assessed the excess of cardiovascular risk attributable to high BP and antihypertensive treatment in a sample of Italian patients enrolled by the 'Cholesterol and Health: Education, Control and Knowledge' (CHECK) study. METHODS: CHECK is a large, cross-sectional epidemiological study, which randomly enrolled patients aged 40-79 years from 425 Italian General Practices from March 2002 to April 2004. Among 5731 patients enrolled in the study [49.6% men, mean age (standard deviation) 57.7 (10.3) years], 723 (12.6%) had 'optimal' BP, 1496 (26.1%) had 'high normal' BP, and 1942 (33.9%) were hypertensive. RESULTS: According to the European Guidelines stratification of the cardiovascular risk-excess attributable to high BP, 34.7% of the sample had a low added risk and 53.2% had a moderate-to-very high added risk. The pharmacological therapy was prescribed in 22.3, 43.9, 61.4, and 76.9% of the patients with low, moderate, high, and very high added risk, respectively. CONCLUSION: Overall dietary and drug therapies are under prescribed, as most of the treated patients would require two additional antihypertensive drugs to meet the recommended BP target. This effort could provide significant individual benefit to moderate/high-risk patients.


Subject(s)
Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Cardiovascular Diseases/prevention & control , Hypertension/drug therapy , Practice Patterns, Physicians' , Adult , Aged , Cardiovascular Diseases/etiology , Cardiovascular Diseases/physiopathology , Cross-Sectional Studies , Drug Prescriptions , Drug Utilization , Female , General Practice , Guideline Adherence , Humans , Hypertension/complications , Hypertension/physiopathology , Italy , Male , Middle Aged , Odds Ratio , Practice Guidelines as Topic , Risk Assessment , Risk Factors , Treatment Outcome
19.
Int Clin Psychopharmacol ; 25(1): 22-8, 2010 Jan.
Article in English | MEDLINE | ID: mdl-19898244

ABSTRACT

The objective of this study was to evaluate the antipsychotic drug prescribing pattern in the Italian general population, elderly, and especially elderly with dementia, in relation to the safety warnings issued by international regulatory agencies about the risk of cerebrovascular adverse events and mortality in 2004 and 2005. A cohort study was conducted using the electronic medical records of the Italian general practice database 'Health Search/Thales'. On the basis of prescription data, 1-year and monthly prevalence estimates were calculated for atypical and typical antipsychotic use in general population, elderly, and elderly demented outpatients. One-year prevalence of individual medication use in elderly demented patients was calculated as well. The prevalence of use of atypical agents in demented patients progressively increased from 2000 [0.2 (0.05-0.7) per 10 000] until the beginning of 2004 [9.7 (8.1-11.6) per 10 000], after which a slight decrease started, whereas the prevalence of use of typical antipsychotics decreased from 2001 [15.7 (13.5-18.2) per 10 000] until 2004 [10.7 (9.0-12.7) per 10 000], then slightly increased in December 2005 [12.1 (10.4-14.2) per 10 000]. Monthly trends in general population and elderly were quite similar and differed significantly from the trend in elderly with dementia: stable use of atypicals from 2002 to 2005 and strong reduction of typicals from 2001 to the end of 2004. The recent safety warnings led to an increasing trend in the use of typical agents and decreasing trend in the use of atypical agents in elderly demented outpatients in Italy. Similar trends were not observed in general population and elderly as a whole.


Subject(s)
Antipsychotic Agents/therapeutic use , Dementia/drug therapy , Drug Utilization/trends , Practice Patterns, Physicians'/trends , Adolescent , Adult , Age Factors , Aged , Electronic Health Records , Humans , Italy , Middle Aged
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