[Prevention of diabetes mellitus complications and improvement of early diagnosis at a population level, through the implementation of integrated disease management in the Modena region]. / Prevenzione delle complicanze del diabete mellito e miglioramento della capacità di diagnosi precoce a livello di popolazione attraverso l'implementazione della gestione integrata nella provincia di Modena.

We evaluated the effectiveness of diabetes mellitus disease management, implemented in Modena province since ten years, on the prevention of complications and early diagnoses at a population level. Time trends show that diabetic patients had significantly decreasing values over time of age, diabetes duration, and glycated haemoglobin; and increasing percentage over time of new-onset diabetes and optimal glycaemic control. That indicates an improved ability of early diagnosis and care of diabetes mellitus. It indicates at a population level that the Local Health Unit, as health system, promoted diabetes prevention and its complications.

A retrospective study on heat-related mortality in an elderly population during the 2003 heat wave in Modena, Italy: the Argento Project.

BACKGROUND: Summer 2003 witnessed an excess in heat-related mortality in the elderly population. The Argento Project was planned to define risk factors for heat-related death in Modena, Italy, during the hottest month of 2003 (August). METHODS: We performed a retrospective, case-control study of a cohort of 394 older persons living in Modena, 197 dead (cases) and 197 survivors (controls). A questionnaire to collect information about demographic, social, environmental, and clinical characteristics and about causes of death was completed. RESULTS: Cases were more likely to be living in a nursing home and needing assistance (p =.024, and p <.001, respectively). Survivors were living on higher level floors (p =.046). Spending the summer in Modena was significantly related to poor outcomes (p <.01). A higher number of cases were using public health services (p <.001). Individuals who died had a greater degree of comorbidity and dependence (p <.001); they were cognitively impaired (p <.001), took a larger number of drugs (p <.001), and had a greater number of hospital admissions (p <.001). Multivariate analysis showed that patients who spent the summer in Modena had a higher mortality. Other predictors of death were the use of home public-integrated assistance, a higher comorbidity and a higher degree of disability; the loss of at least 1 Activity of Daily Living (ADL) represents the strongest risk factor of heat-related death. CONCLUSIONS: Our study identifies the major risk factors of heat-related death in the elderly population. With the creation of an up-to-date database, when a new heat wave will come, it will be possible to identify frail persons for preventive targeted strategies.

[Implementing simple tools for clinical practice in primary care: reports from the Project Diabetes registry addressed to primary care groups in Modena]. / Messa a punto di strumenti semplici per il governo clinico nella medicina territoriale: la reportistica per nucleo di cure primarie dal registro del Progetto Diabete di Modena.

We implemented simple tools for Clinical Practice in Primary Care, i.e. reports of Diabetes Project's Registry addressed to Primary Care Groups in Modena in order to promote the clinical practice through a detailed peer-review of program indicators. The efforts of health organisations to involve the general practitioners in clinical practice should be improved by implementing audit-and-feedback tools of simple interpretation for clinical practice.