Association of Antipsychotic Polypharmacy and Two-Year All-Cause Mortality: A Population-Based Cohort Study of 33,221 Italian Continuous Users.

Background: Differences in survival between patients treated with antipsychotic monotherapy vs. polytherapy are debated. This study aimed to examine the association of antipsychotic polytherapy with 2-year all-cause mortality in a population-based cohort. Methods: Data were retrieved from healthcare databases of four local health units of Lombardy, Italy. Subjects aged 18-79 years who received continuous antipsychotic prescriptions in 2018 were identified. Overall survival among patients with antipsychotic monotherapy vs. polytherapy was compared. A multivariate Cox PH model was used to estimate the association between antipsychotic therapy, or antipsychotic use (continuous vs. non-continuous), and all-cause mortality. Adjustments were made for the presence of metabolic disturbances, total antipsychotic dosage amount (olanzapine equivalent doses), age, and sex. Results: A total of 49,875 subjects receiving at least one prescription of antipsychotics during 2018 were identified. Among the 33,221 patients receiving continuative antipsychotic prescriptions, 1958 (5.9%) experienced death from any cause at two years. Patients with continuous antipsychotic use had a 1.13-point increased mortality risk compared with non-continuous users. Patients treated with antipsychotic polytherapy showed an adjusted mortality risk increased by 17% (95% CI: 2%, 33%) compared to monotherapy. Conclusions: The study highlights the potential risks associated with antipsychotic polypharmacy, emphasizing the importance of optimizing drug prescriptions to improve patient safety and reduce mortality rates in individuals receiving antipsychotic therapy.

Is the long-term poor prognosis of acute myocardial infarction in patients with mental illness mediated through their poor adherence with recommended healthcare?

BACKGROUND: Compared with patients without evidence of psychiatric symptoms, those with mental disorders experience reduced adherence with recommended healthcare and poorer clinical outcomes. This study aimed to evaluate whether the worse prognosis of patients with mental disorders after experiencing acute myocardial infarction could be fully or partially mediated by their reduced adherence to recommended healthcare. METHODS: In this retrospective cohort population-based study, 103 389 residents in the Italian Lombardy Region who experienced acute myocardial infarction in 2007-19 were identified. Among them, 1549 patients with severe mental illness (SMI) were matched with five cohort members without evidence of mental disorders (references). Recommended healthcare (cardiac medicaments and selected outpatient services) was evaluated in the year after the date of index hospital discharge. The first occurrences of cardiovascular (CV) hospital admissions and any-cause-death were considered as endpoints. Mediation analysis was performed to investigate whether post-discharge use of recommended healthcare may be considered a mediator of the relationship between healthcare exposure and endpoints occurrence. RESULTS: Compared with references, patients with SMI had lower adherence with recommended healthcare and adjusted risk excesses of 39% and 73% for CV hospitalizations and all-cause mortality. Mediation analysis showed that 4.1% and 11.3% of, respectively, CV hospitalizations and deaths occurred among psychiatric patients was mediated by their worse adherence to specific healthcare. CONCLUSION: The reduced use of recommended outpatient healthcare by patients with SMI had only a marginal effect on their worse prognosis. Other key factors mediating the prognostic gap between patients with and without mental disorders should be investigated.

Shifting the Paradigm of Nursing Home Care for People with Dementia: The Italian Experience of Il Paese Ritrovato and the Impact of SARS-CoV-2.

BACKGROUND: Il Paese Ritrovato is an Italian nursing home founded in 2018, it is based on the Alzheimer village model and admits people with mild-to-moderate dementia. OBJECTIVE: Describe the impact of the SARS-CoV-2 pandemic on people living at Il Paese Ritrovato through a Comprehensive Geriatric Assessment (CGA) regularly administered prior to and during the pandemic. METHODS: We explored the effects of a person-centered approach. We assessed 64 subjects (enrolled and followed between June 2018 and December 2020), who underwent at least 18 months of observation prior to the pandemic. Each subject was evaluated using a CGA on admission time (T0) and at defined time-points: T6, T12, T18. One last CGA evaluation was performed during the SARS-CoV-2 pandemic (TCovid-19). Temporal trends during T0-T18, and differences between T18 and TCovid-19 were calculated. RESULTS: The mean age was 82 years with a prevalence for females (77.0%) and Alzheimer's disease diagnosis (60%). Psychiatric and behavioral disorders were the most common conditions (80%). We utilized a nonpharmacological approach aimed at promoting the residents' overall wellbeing and observed satisfactory performance during the first 18 months. In comparison with the pre-pandemic period, TCovid-19 enlightened +11.7% use of antidepressants and a decline of Mini-Mental State Examination mean values (not statistically significant), while engagement in activities dropped. CONCLUSIONS: The pandemic may have disrupted the existing model of care, but at the same time, it confirmed that the Il Paese Ritrovato approach, which encompasses symptoms improvement and multicomponent support, is in fact beneficial.

The effects of two longpass filters on visual performance / Efectos sobre el desempeño visual de dos filtros Longpass

PURPOSE: This study compared visual performance and optical properties of three filters. METHOD: Two groups of twenty adults were recruited: wearers of progressive addition lenses (PAL, 46-73 years) and wearers of single vision lenses (SVL, 26-55 years). Three spectacle filters (Hoya, Japan) were compared: clear control, Standard Drive (STD), and Professional Drive (PRO) lenses. Optical transmittance was measured by a Jasco V-650 spectrophotometer. Best corrected visual acuity (BCVA) was measured in photopic (BCVAphotopic) and mesopic (BCVAmesopic) conditions and under glare (BCVAglare). Photopic contrast sensitivity (CS) was also measured. RESULTS: The three longpass filters show cutoff at 426 ± 2 nm (STD/PRO) and 405 ± 2 nm (clear lens). BCVAglare improved with Drive filters compared to the clear one (p < 0.05) from 0.03 to -0.02 (STD) and to -0.01 (PRO) for PAL and from -0.08 to -0.12 (STD and PRO) for SVL. For PAL, BCVAmesopic improved from 0.15 to 0.12 (STD, p < 0.05) and 0.13 (PRO), while no substantial difference was observed for SVL. CS showed some improvements with Drive lenses at some angular frequencies between 6 and 18 cycles/deg, mainly for the PAL group. No BCVAphotopic differences were found. After testing all filters, each for two weeks, 79% (PAL) and 60% (SVL) of participants preferred Drive lenses. CONCLUSIONS: Drive lenses are found to maintain or improve some visual functions compared to the clear lens. The improvement of mesopic visual acuity, visual acuity under glare, and contrast sensitivity is mainly attributed to the reduction of intraocular light scattering as a consequence of the total light attenuation in the spectral range below the cutoff

OBJETIVO: Este estudio comparó el desempeño visual y las propiedades ópticas de tres filtros. MÉTODO: Se reclutaron dos grupos de veinte adultos: los que utilizaban lentes de adición progresiva (PAL,de 46 a 73 años), y los que utilizaban lentes monofocales (SVL, de 26 a 55 años). Se compararon tres filtros de gafas (Hoya, Japón): control claro, Standard Drive (STD), y Professional Drive (PRO). La transmitancia óptica se midió con un espectrofotómetro Jasco V-650. Se midió la agudeza visual mejor corregida (BCVA) en condiciones fotópicas (BCVAphotopic) y mesópicas (BCVAmesopic) y con deslumbramiento (BCVAglare). También se midió la sensibilidad al contraste fotópico (CS). RESULTADOS: Los tres filtros de amplio espectro reflejaron un punto de corte de 426 ± 2 nm (STD/PRO) y 405 ± 2 nm (lentes claras). BCVAglare mejoró con los filtros Drive en comparación con los filtros claros (p < 0,05) de 0,03 a -0,02 (STD) y -0,01 (PRO) para PAL, y de -0,08 a -0,12 (STD y PRO) para SVL. Para PAL, BCVAmesopic mejoró de 0,15 a 0,12 (STD, p < 0,05) y 0,13 (PRO), no encontrándose diferencia sustancial para SVL. CS reflejó algunas mejoras con las lentes Drive a ciertas frecuencias angulares entre 6 y 18 ciclos/deg, principalmente para el grupo PAL. No se encontraron diferencias para BCVAphotopic. Tras probar todos los filtros, cada uno de ellos durante dos semanas, el 79% (PAL) y el 60% (SVL) de los participantes prefirieron las lentes Drive. CONCLUSIONES: Se ha encontrado que las lentes Drive mantienen o mejoran ciertas funciones visuales en comparación con otras lentes claras. La mejora de la agudeza visual mesópica, la agudeza visual con sensibilidad de deslumbramiento y contraste se atribuye principalmente a la reducción de la dispersión de la luz intraocular, como consecuencia de la atenuación total de la luz en el rango espectral inferior al punto de corte