Improving the quality of care for people with chronic diseases: translating recommendations to practice.

INTRODUCTION: Aim of this paper is to present a guide for translating to practice an evidence-based set of Quality Criteria and Recommendations (QCR) to promote the implementation of policies and practices in the field of health promotion, disease prevention and care for people with chronic diseases. METHODS: The guide is based on real-world experiences of eight European pilot actions using QCR as a framework for practice design, development, implementation, monitoring and evaluation. All partners implemented their respective practices by following the same agreed process. RESULTS: The implementation method was summarized in seven steps where each of one outline a particular phase of the process. The guide provides a step-by-step tutorial for the implementation of QCR. CONCLUSIONS: Practical experiences from the pilot actions show the potential value of using the QCR in designing and implementing practices to improve the quality of care for people with chronic diseases.

Amyotrophic Lateral Sclerosis and soccer: an internet survey of 29 Italian players.

OBJECTIVES: Previous epidemiological studies reported a significantly higher risk of Amyotrophic Lateral Sclerosis (ALS) in Italian male soccer players. As a consequence, sports newspapers and news agencies focused on this issue and spread the news of 51 male soccer players with a reported diagnosis of ALS. DESIGN: We searched news on male Italian national soccer players with a reported diagnosis of ALS quoted from January 1, 1950 to July 31, 2016 in at least two Internet web sites or in books by journalists. RESULTS: A total of 39 male soccer players with a reported diagnosis of ALS were identified. Subjects were born from 1905 to 1973, 32 were currently deceased, 6 were still living, while the status of 1 player was unknown. All gathered information was available for 29 soccer players. The group had a mean age at diagnosis of 45.3 ± 12.2 years, a mean age at onset of symptoms of 46.4 ± 12.1 years, and a mean age at death of 50.9 ± 12.3 years. A significant inverse correlation between year of birth and age at onset of symptoms was observed, with a younger age at onset of symptoms in soccer players born in more recent years (r = -0.65, p < 0.01). CONCLUSIONS: Italian male soccer players with a reported diagnosis of ALS have a significantly younger age at diagnosis when compared to other European patients with ALS. Results support a possible relationship between soccer and the risk of ALS. We believe that further research is urgently needed in this field.

An update on the Italian Twin Register: advances in cohort recruitment, project building and network development.

The Italian Twin Register has been in place for more than 10 years. Since its establishment, it has been focusing, on the one hand, on a continuous update of the existing information, and on the other hand, on new phenotypes and sample collection. Demographic data on about 140,000 twins have been updated using the municipality registries. The Italian Twin Register has been carrying out several new studies during the last few years. A birth cohort of twins, Multiple Births Cohort Study, has been started and the enrollment is ongoing. For this cohort, data on pregnancy and birth are collected, and periodical follow-ups are made. DNA is being collected for the twins and their parents. In the area of behavioral genetics, most efforts have been directed to psychological well being assessed with self-reported tools. Research on age-related traits continues with studies on arteriosclerosis development, early biomarkers in mild cognitive impairment, and the relation between lifestyle habits and mutagen sensitivity. The Italian Twin Register biobanking has grown in its size and in its know-how in terms of both technical issues and ethical procedures implementation. Furthermore, attitudes toward biobank-based research, together with willingness and motivation for donation, are being investigated. A valuable key resource for the Italian Twin Register is the possibility of linking twin data with disease registries. This approach has been yielding several important results, such as the recent study on the heritability of type 1 diabetes.

[Prescription drugs and the elderly: results of the Argento study]. / La prescrizione di farmaci nell'anziano: risultati dello studio Argento.

OBJECTIVE: To evaluate prescription drug use in the elderly and in particular, to determine the number and types of medications taken, whether and to what extent drugs that are contraindicated in this age group are being used, and what type of prescription check may be performed by primary care physicians. DESIGN: A survey was performed in a sample of non-institutionalised elderly subjects (= 65 years). These were selected by cluster sampling in 11 of 20 Italian regions and were interviewed in the home by trained interviewers using a standardised questionnaire. RESULTS: Eighty-seven percent of interviewed subjects reported that they had taken at least one medication in the previous year; higher frequencies were found in age groups= 75 years. The most common therapeutic classes of drugs used in all participating regions, in the previous week, were cardiovascular, gastrointestinal, metabolic (including drugs to treat diabetes) and nervous system. Among interviewed subjects, 45.3% reported using 4 or more different drugs, though wide regional differences were observed (Campania 60.5%, Bolzano 35.6%); 7.2 % were taking potentially inappropriate drugs while 2.3% were taking medications that may lead to potentially harmful interactions. In addition, 84.9% of subjects reported that their primary care physician regularly checked their drug prescriptions. CONCLUSIONS: The high frequency of prescription drug use observed in the elderly is a diffuse phenomenon, related to the worsening health conditions that inevitably accompany aging. Considering the extent of this phenomenon, care should be taken to improve qualitative (i.e. contraindications in the elderly, potential drug-interactions) and quantitative (high number of medications taken by the elderly) appropriateness in physician prescribing. In addition, special attention must be placed on regularly checking drug therapies in the elderly.

[The characteristics of Alzheimer's Disease Units in relation to neuropsychological tests]. / Le caratteristiche delle Unita di Valutazione Alzheimer (UVA) in relazione all'uso degli strumenti neuropsicologici.

The Cronos Project is a post-marketing surveillance study implemented by the Italian Ministry of Health and the National Institute of Health whose main objectives are to characterise the population of Alzheimer's disease patients treated with acetylcholinesterase inhibitors and monitor effectiveness and drug safety in the field practice. In this project 503 Alzheimer's disease units were activated located throughout the country. The characteristics of these Alzheimer's disease units are presented for setting (territorial, university, hospital, extra-hospital), health personnel employed, examinations offered (CT and MRI scans and laboratory tests), counselling activities and relationship with caregiver associations in relation to neuropsychological tests.

[Use of neuropsychological tests in the Cronos Project]. / L'uso degli strumenti neuropsicologici nell'ambito del Progetto Cronos.

Within the Cronos Project, 503 Alzheimer's disease units were activated throughout the country. In June/July 2002 a questionnaire was sent to all Alzheimer's disease units to collect data on neuropsychological tests utilised in the diagnostic process of dementias. Only 196 of Alzheimer's disease units that have responded to the questionnaire (196/392) declare to utilize neuropsychological test while 97.8% use the mini mental state examination. This paper aims to collect, for the first time in Italy, data on use of the neuropsychological tests in the specialist units on dementia and to propose a discussion on the reliability of neuropsychological instruments.

A cohort study of effectiveness of acetylcholinesterase inhibitors in Alzheimer's disease.

OBJECTIVES: To characterise the population of Alzheimer's disease patients treated with acetylcholinesterase inhibitors, to analyse effectiveness and drug safety in the clinical practice, and to identify variables that may predict the response to therapy. METHODS: From September 2000 to December 2001, a total of 5,462 patients diagnosed with mild to moderate Alzheimer's disease were enrolled at the time of their first prescription of the study drugs and followed up for an average of 10.5 months. Responders were defined as patients with a mini-mental state examination (MMSE) score improvement of 2 or more points from baseline after 9 months of therapy. RESULTS: At 9 months, 2,853 patients (52.2%) completed the study. The mean change from baseline in MMSE scores was an improvement of 0.5 points (+/-3.0). The proportion of responders to the therapy was 15.7% at 9 months. A greater probability of response at 9 months was observed among patients without concomitant diseases at baseline [odds ratio (OR)=2.1, 95% confidence interval (CI) 1.5-2.9] and among those with a response at 3 months (OR=20.6, 95% CI 17.2-24.6). During the study period, 285 patients (5.2%) discontinued the treatment because of an adverse drug reaction. CONCLUSIONS: Effectiveness of acetylcholinesterase inhibitors on cognitive symptoms of patients with mild to moderate Alzheimer's disease is modest. At 9 months, improvement was evident only in a subgroup of patients without concomitant diseases and who had demonstrated a response at 3 months.

The cerivastatin withdrawal crisis: a "post-mortem" analysis.

In August 2001, cerivastatin was removed from European and USA markets because of a higher risk of rhabdomyolysis associated with its use in comparison with other statins. The objective of this study was to compare cholesterol-lowering drug use in Italy before and after the withdrawal of cerivastatin from the market, and to evaluate if the withdrawal influenced patients compliance and physicians prescribing habits. After August 2001, 48% of cerivastatin users discontinued any statin treatment. The major risk factor for discontinuation was a concomitant use of fibrate during the first 7 months of 2001 (OR = 2.3; 95% CI = -2.9). Comparing the discontinuation of statin therapy between 2001 and 2000 we can estimate that there was a 5% increase, corresponding to about 200,000 patients, who discontinued statin therapy during autumn 2001 because of cerivastatin emergency.