Protocol for the evaluation of a chronic care model experience in Rome.

INTRODUCTION: Chronic diseases are the leading cause of death and disability in almost all over the world; in Europe causing over 9 million deaths per year according to WHO estimates. A promising health organization model for chronic disease management is represented by the Chronic Care Model (CCM). In the 12th district of the ASL Roma 2 since 4 years was implemented a CCM for the management of patients affected by diabetes and/or at high cardiovascular risk. OBJECTIVE: Aim of this study is to evaluate the effectiveness of the Chronic Care Model (CCM) for the management of chronic disease in terms of mortality reduction, avoidable hospitalizations reduction and improvement of clinical parameters. MATERIALS AND METHODS: A retrospective cohort study will involve patients of 12th district of the ASL Roma 2 affected by diabetes and at high cardiovascular risk assisted through the CCM. Their health outcomes will be compared with those of patients in the same clinical conditions, residents in the same district but not assisted with CCM. The sample will be composed by adults (> 18 years) with a diagnosis of diabetes mellitus type 2 (DM2) or metabolic syndrome and / or arterial hypertension (IT) and two or more risk factors. Outcomes will be mortality from all causes and from causes related to DM and IT, preventable hospitalizations as defined in the Prevention Quality Indicators (PQI) by the Agency for Healthcare Research and Quality, and 10 clinical parameters. The data sources will be the records of causes of death (RENCAM), the hospital discharge records (SDO) and information systems for primary healthcare. CONCLUSION: Data from the experience of CCM in Tuscany seem promising especially in the evaluation of patient satisfaction and clinical outcomes particularly on cardiovascular and neurological complications and long-term mortality.

Association of colon adenomas and skin tags: coincidence or coexistence?

OBJECTIVES: Skin tag (STs) are benign connective tissue tumors of the dermis. Some researchers have argued that there is a relationship between skin tag and colon polyps, although the physiopathological mechanisms underlying this relation were not well elucidated. In this study we aimed to investigate the co-existence of colonic adenomatous polyps and ST, additionally to shed light on the physiopathological mechanisms underlying this coincidence. PATIENTS AND METHODS: A total of 45 patients aged between 18 and 60 diagnosed with adenomatous colonic polyps and 45 sex, age, and socio-demographically matched subjects, had no polyps, were enrolled as the control group. Routine blood analysis of all participants, including serum glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-C), (high-density lipoprotein cholesterol (HDL-C), triglyceride, insulin, IGF-1, and EGF, were performed. The chi-square and independent sample t or Mann Whitney U test were used to determine differences between groups. RESULTS: The number of participants with ST was significantly higher in the patient group (OR 7.067, p < 0.01). Serum levels of IGF-1 and EGF were statistically similar between the groups. In the subgroup analyses, no difference was found in serum levels of insulin, IGF-1, or EGF between patients with and without ST. However, higher serum levels of insulin and EGF were found in control subjects with ST (p < 0.01 and p < 0.01, respectively). For the entire study group, 67 participants had ST and 23 patients did not. Serum insulin, and IGF-1 were similar, while serum EGF levels were higher in patients with ST (p < 0.01). CONCLUSIONS: Findings of the present study may show a co-existence of colonic polyps and ST. Although previous studies have indicated that insulin resistance may play a role in the pathogenesis of both lesions in diabetic and obese patients, we found no indication of a relationship in nondiabetic and nonobese patients with increased levels of EGF in patients with ST, suggesting an alternative pathogenesis in this patient group.

Carotid intima-media thickness and serum paraoxonase-1 activity in patients with Helicobacter pylori.

AIM: To evaluate serum paraoxonase(PON)-1 activity and carotid intima-media thickness (CIMT) in patients with Cytotoxin-associated antigen(CagA)-positive and negative Helicobacter pylori strains. PATIENTS AND METHODS: The study group included a total of 134 individuals, of whom 103 were H. pylori positive, and 31 were H. pylori negative. Five biopsies were collected from each patient for histological examination: two from the antrum, two from the corpus, and one from the incisura angularis. The presence of H. pylori was determined using a modified Gram staining protocol. Peripheral blood was collected from each patient to determine levels of triglyceride, TC, HDL-cholesterol and LDL-cholesterol. IgG antibodies against CagA protein were analyzed by enzyme immunoassays. PON-1 activity was measured by colorimetric method. Carotid intima-media thickness and atherogenic plaques were measured using a grey scale color Doppler ultrasound. Data were analyzed by descriptive and inferential statistics. RESULTS: The right, the left and the mean CIMT were significantly higher in H. pylori (+) group versus H. pylori (-) group (p < 0.001 for all). However, the mean PON-1 concentration was significantly lower in H. pylori (+) group versus H. pylori (-) group (p < 0.001). The right, the left and the mean CIMT of CagA (+) group were significantly higher than that of CagA (-) group and controls, while PON-1 concentrations of CagA (+) group were significantly lower than that of CagA (-) group and controls (for all p = 0.0001). The right, the left and the mean CIMT of CagA (-) group were significantly higher than that of the control group, while the mean PON-1 concentration were significantly lower (for all p = 0.0001). CONCLUSIONS: Decreased PON-1 activity may be an etiopathogenetic factor in increased atherosclerosis in patients with H. pylori infection, especially in those infected with the CagA positive strain.

Relationship Between Leptin Levels and Body Indexes in Patients with Haematologic Malignancy.

Leptin is a recently found hormone regulating body weight. In human obesity, this weight-regulating hormone level is in a positive correlation with FMI (fat mass index) and BMI (body mass index). In this study, we aimed to investigate the relation between serum leptin levels and BMI, PF (percentage fat), LMI (lean mass index), FMI and some other parameters of patients with haematologic malignant diseases. Fourty-four patients with haematologic malignant diseases and 25 healthy control group were taken into the study. In the comparison, there were no significant difference between the PF and FMI values of both groups, while the mean BMI and LMI values of the control group were significantly higher than that of the patient group. There was a positive correlation between leptin levels and BMI and FMI among parameters studied in our control group, whereas we couldn't demostrate any such correlation in patient group. We estimate that the alteration may be due to disturbances in the feed back mechanism developing in patient with haematologic malignancy.

[Research on accidents in a tire-producing plant]. / Indagine infortunistica in una azienda produttrice di pneumatici.

In the autumn of 1987 the U.S.L. health service (prevention, hygiene and occupational safety section) began a study about the accidents in a firm manufacturing tyres, placed in its own area. The retrospective enquiry starts from the analysis of typology, diffusion and seriousness of occupational accidents. The firm's accident register has been analyzed and integrated with other necessary information provided by the firm, by I.N.A.I.L. and by the air force metereological service. The study has been carried out on data concerning the following years: 1984-1985-1986. The accidents considered, implied absence from work and were divided as follows: for absence up till 3 days (in franchise), and more than 3 days (indemnified), applying the average value calculated on one year of the three analyzed. Every accident has been analyzed per year, month, day, hour of event. According to the classes: circumstances, kind of lesion, site of lesion, period of absence from work. The indices of: frequency, seriousness, incidence, mean duration have been calculated. The average monthly values of temperature: max and min. of the area and to the average monthly amount of processed elastomer (rate of production). The statistics we obtained, justified the study and showed the operative solution. The aspect of sanitary education and the general psychological aspect regarding the accident have been considered. Moreover the general operative solutions for the firm and specific ones for every department and for every position have been shown and faced up to. In this way, according to the risks that have emerged from the enquiries on previous accidents and thanks to direct inspection. it was possible to prevent accidents.

[A case of leptospirosis in an agrarian community]. / Caso di leptospirosi in comunità agricola.

A mortal case of leptosprosis happened in a little agricultural community situated in a country town in the south Lazio Region, and in consequence of that the Local Health Unit originated a series of epidemiological investigation and preventive treatments. Serological tests were effectuated both on the residents of the interested area and on animals of the farm. These serological tests gave positive results for four inhabitants and eight animals. The agricultural community were subjected to a chemoprophylaxis. No new cases of disease have been found. The drinking water was analyzed because the water supplied came from unprotected wells. The tests gave unfavorable results for the presence of fecal streptococci. It wasn't possible to effect specific tests for the research of leptospira, because it was difficult to find suitably equipped laboratory. As a result of these tests it was decided to apply preventive treatments on a permanent basis on the farm in question. The fact that the serodiagnosis showed the same kind of leptospira in both men and animal, suggested once again the problem of transmission between animals and men and the need for adequate measures of profilaxis. Also the need to cover exposed agricultural work men with an adequate insurance. Great interest was shown in the correct intervention of the operators of Public Hygiene Service and Veterinary Services. It's essential to coordinate the activity of the two services for an effective intervention in these si milar cases, both during the phases of epidemiological research and prevention. Intention of this work is to furnish a possible operative procedure for situations of this kind.

Hereditary macrothrombocytopathia, deafness and nephritis (Epstein's triad).

Epstein's triad is a syndrome with a combination of hereditary macrothrombocytopathia and progressive sensorineural hearing loss and nephritis. This syndrome is rare and may be inherited as dominant trait or sex-linked or new mutation. But the true mode of this syndrome is still questionable. Bilateral sensorineural hearing loss is progressive and seems not to be related to the severity of bleeding episodes and renal failure. An 8-year-old boy with these findings is presented and discussed in this article.