Predictors of mortality in nursing-home residents with pneumonia: a multicentre study.

OBJECTIVES: To evaluate predictors of mortality in patients residing in nursing-homes (NHs) or long-term care facilities (LTCFs) with diagnosis of NH-acquired pneumonia (NHAP). METHODS: We conducted an observational, prospective study (December 2013-December 2015) of patients residing in nine NHs/LTCFs of Central and Northern Italy with diagnosis of NHAP. Data on demographics, comorbidities, microbiology, and therapies were entered into an electronic database. To identify risk factors associated with 30-day mortality, we performed univariable and multivariable analyses, and predictors were internally validated using a bootstrap resampling procedure. We derived a prediction rule using the coefficients obtained from the multivariable logistic regression. The model obtained was assessed using the area under the receiver operating characteristic curve (AUROC). RESULTS: Overall, 446 patients with NHAP were included in the final cohort. The median age was 80 (IQR 75-87) years. A definite aetiology was obtained in 120 (26.9%) patients; of these, 66 (55%) had a culture positive for a multidrug-resistant pathogen. The 30-day mortality was 28.7%. On multivariate analysis, malnutrition (OR 7.8; 95% CI 3-20.2, 2 points), bilateral pneumonia (OR 3.7; 95% CI 1.4-9.8, 1 point), acute mental status deterioration (OR 6.2; 95% CI 2.2-17.6, 2 points), hypotension (OR 7.7; 95% CI 2.3-24.9, 2 points), and PaO2/FiO2 ratio ≤250 (OR 7.4; 95% CI 2.2-24.2, 2 points) were independently associated with 30-day mortality. The derived prediction rule showed an AUROC of 0.83 (95% CI 0.78-0.87, p <0.001). CONCLUSIONS: NH residents with pneumonia have specific risk factors associated with 30-day mortality. Malnutrition and acute mental change appear as major determinants of death in this population.

The independent effect of habitual cigarette and coffee consumption on blood pressure.

The authors investigated the possible relation between habitual cigarette and coffee consumption and blood pressure (BP) levels in 7506 men and 2095 women. The study population were managers and employees examined in northern Italy between 1986-1988. In particular, the hypothesis of a substantial independence between smoking-BP and coffee-BP was tested. BP levels were corrected for age, body mass index, physical activity, and alcohol consumption by analysis of covariance. Significantly, smoking was inversely related to BP, both in men (SBP, P < 0.001, DBP, P < 0.001) and women (SBP, P = 0.001, DBP, P = 0.012). In particular, the BP of non-smoking men, SBP/DBP, was 131.0/83.5, whereas in male smokers up to and over 20 cigarette/day, BP was 128.1/82.0 and 128.1/82.1 respectively. Coffee consumption was related to BP levels in men (SBP, P < 0.001; DBP, P = 0.009), but not in women (SBP, P = 0.320; DBP, P = 0.982). BP in male subjects was 131.3/83.5 in non-drinkers, 130.7/83.3 in those drinking 1-3 cups/day, 128.4/82.6 and 127.2/81.8 in drinkers of 4-5 and over 5 cups/day, respectively. No significant interactions were demonstrated, thus the relationship between habitual smoking and coffee consumption with BP appears to agree with an additive model.

Iron and ferritin in Italian subjects.

We studied the iron status of 400 Italian subjects, 200 men and 200 women, equally distributed in four 10-year age groups between 20 and 60 years. The frequency of iron deficiency was elevated in women of childbearing age. On average 13% of the women in the three younger age groups showed low serum ferritin levels and 16-18% a low transferrin saturation index. Only 6% of the women over 50 were iron deficient. Signs of iron deficiency were never observed in more than 2% of the men in the age groups under 50, with the percentage rising slightly in the men over 50. In the women an inverse correlation was found between serum ferritin levels and number of births [log ferritin (ng/ml) vs number of births, b +/- SE (b): -0.252 +/- 0.088] and between serum ferritin and duration of menstruation [log ferritin (ng/ml) vs duration of menstruation (days), b +/- SE (b): -0.160 +/- 0.065]. Furthermore, hemoglobin levels were 0.700 (+/- 0.248, SE) g/dl lower in the women with 'abundant menstrual flow', and hemoglobin levels correlated inversely with number of births [hemoglobin (g/dl) vs number of births, b +/- SE (b): -0.354 +/- 0.115]. Our study showed an elevated frequency of iron deficiency in women of reproductive age. The number of births and abundance of menstrual flow were both important factors in predisposing younger women to developing iron deficiency.

Coffee and cholesterol, an Italian study.

In the present study, conducted in northern Italy between 1986 and 1989, the authors investigated the possible association between coffee consumption and serum cholesterol levels in 8,983 subjects, 7,432 men and 1,551 women, managers and employees aged 18-65 years, who were examined during a program of preventive medicine upon an agreement between various companies and the Centro Diagnostico Italiano. Analysis of covariance was used to compare the serum cholesterol levels of the subjects subdivided according to coffee consumption, along with age, body mass index, alcohol consumption, cigarette smoking, and physical activity. An important relation was demonstrated between coffee intake and cholesterol, particularly in the men, the differences in serum cholesterol in the coffee users compared with the nonusers being 6.1 +/- 1.4 (standard error) mg/dl for consumers of 1-3 cups/day (3.4 +/- 1.4 mg/dl after adjustment for age, body mass index, alcohol and cigarette consumption, and physical activity), 9.9 +/- 1.6 mg/dl for those drinking 4-5 cups/day (5.8 +/- 1.6 mg/dl after adjustment), and 14.8 +/- 2.0 mg/dl for those drinking over 5 cups/day (9.6 +/- 2.0 mg/dl after adjustment). This relation remained substantially unvaried when nonsmokers and smokers were analyzed separately. It has been suggested that it is coffee prepared by boiling rather than other methods that has a hypercholesterolemic effect. Our observations demonstrate an interesting relation between coffee and cholesterol, even though the coffee drunk in Italy is mainly filtered and nonboiled. However, our finding is not necessarily in disagreement with the above hypothesis since, when coffee is prepared in the Italian way (with the mocha method), ground coffee is preheated by steam and more importantly, the water passes through the ground coffee at a higher temperature than with the other brewing methods.

Body mass index and liver enzyme activity in serum.

The association between body mass index (BMI) and serum liver enzyme activity [gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST)] was studied in 3167 subjects, 2373 men and 794 women. The subjects were managers and employees, ages 18-64 years, who were examined during a program of preventive medicine. Analysis of covariance was used to compare the serum liver enzyme activities (expressed as natural logarithms) of the subjects, who were subdivided according to BMI, while also considering age, alcohol and cigarette consumption, and physical activity. In men, the percentage increase in the geometric mean of liver enzyme activity of the obese subjects (BMI greater than 30 kg/m2) compared with that of the normal subjects (BMI less than or equal to 25 kg/m2) was 47.7% (P less than 0.001) for GGT, 55.3% (P less than 0.001) for ALT, and 19.7% (P less than 0.001) for AST; in women, the increase was 63.2% (P less than 0.01) for GGT, 58.4% (P less than 0.001) for ALT, and 7.3% (P greater than 0.05) for AST. Thus, our observations demonstrate a relation between BMI and serum liver enzyme activity.

Renal tubular acidosis in a case of Shwachman's syndrome.

We describe metabolic acidosis in a 15-month-old girl with clinical features of Shwachman's syndrome. Renal function tests indicated that the patient had type 1 renal tubular acidosis. Based on our findings and other reports of renal tubular dysfunction in patients with Shwachman's syndrome, we conclude that it is important to look for a possible renal tubular defect in this syndrome.

HLA-ABC and DR antigens in celiac disease. A study in a pediatric Italian population.

HLA phenotypes of 64 Italian pediatric patients with celiac disease (CD) were compared with those of a group of healthy controls. DR3 and DR7 are significantly increased as reported in other populations. In addition an increase of heterozygotes DR5/DR7 was observed in our patients. The Hardy-Weinberg distribution in the patients group shows a disequilibrium due to the genotype DR5/DR7. Our data confirm that more than one HLA gene product is associated with CD: one with DR3 and the other with DR7.

Does breast feeding protect against the development of clinical symptoms of celiac disease in children?

A retrospective approach has been adopted to investigate the frequency and duration of breast feeding and the time of gluten introduction in the diet in 216 celiac children and their healthy siblings of three different centers--Naples, Milan, and Turin. In this matched case-control study, the selected controls were healthy siblings of the cases. Children formula-fed from birth, or breast-fed for less than 30 days, were found to have a relative risk of developing symptoms of celiac disease four times higher than children breast-fed for more than 30 days (p less than 0.0001). To investigate more deeply the effect of the duration of breast feeding as a possible protecting factor, the linear trend for different periods of breast feeding was tested and found to be highly significant (G1: 18.3 with 1 df). Therefore, increased duration of breast feeding is associated with decreased risk of developing celiac symptoms. On the contrary, there was no apparent relationship between early introduction of gluten into the diet and frequency of celiac disease. Our findings are consistent with the hypothesis that a wider diffusion of breast feeding is a factor underlying the recently reported decrease of the incidence of celiac disease in children.