Effects of a community-based exercise and motivational intervention on physical fitness of subjects with type 2 diabetes.

BACKGROUND: This study aimed to analyze the effects of a long-term community-based combined exercise program consisting of aerobic, resistance, flexibility and agility/balance training associated with motivational interviewing on physical fitness, physiological parameters and Physical Activity (PA) levels in middle-aged and older patients with Type 2 Diabetes (T2D). METHODS: Sixty-nine diabetic subjects (mean age 63 ± 5.2 y, 62.3% M) underwent a 9-month exercise program and 12 motivational group meetings focused on PA, while 90 diabetic controls (mean age 64 ± 6.4 y, 58% M) underwent usual PA recommendations. Changes in physical fitness measured by Senior Fitness Tests, BMI, HbA1c, waist circumference (WC) and habitual PA expressed in Metabolic Equivalent of Tasks (METs)-min/week were evaluated in each group through the International PA Questionnaire and compared between groups. RESULTS: At the end of the intervention participants showed significant improvements in BMI (29.3 to 27.6 kg/m2, P < 0.03), HbA1c (6.5 to 6.1%, P < 0.01), WC (104.2 to 95.6 cm, P < 0.01) and all the physical fitness parameters (P < 0.01) but lower body flexibility (P = 0.82), while only upper body strength (P = 0.04) and agility (P ≤ 0.01) improved significantly in controls. Habitual PA increased in participants and controls (+67 and +19 METs-min/week, respectively, P ≤ 0.01). Changes in physical fitness and PA levels registered in the two groups differed significantly (P < 0.01), while improvements in BMI, HbA1c and WC did not (P = 0.40, P = 0.52, P = 0.05, respectively). CONCLUSIONS: A long-term motivational exercise-based intervention may be more effective than PA recommendations only in improving physical fitness and PA levels in individuals with T2D and produce similar health improvements.

Effects of nutrition motivational intervention in patients affected by type 2 diabetes mellitus: a longitudinal study in Naples, South Italy.

BACKGROUND: Type 2 diabetes (T2D) is associated with a prion diminished quality of life, especially due to the severe complications that it implicates. Changing dietary habits is an absolute priority, as well as implementing nutritional motivational programs. The aim of this study was to verify the effectiveness of a nutritional intervention in improving the health of patients affected by T2D. METHODS: A total of 69 patients participated in a nine-months motivational program focused on the principles of the Mediterranean diet, the classes of nutrients, the distribution of the meals during the day and the dietary choices. During regular meetings, the patients were requested to fill out a questionnaire about their dietary habits and behaviours. Clinical and metabolic parameters were also analysed. RESULTS: At the end of the intervention the number of people who declared that they ate five meals a day (p = 0.006) and preferred to have fruit for snack (p = 0.004) increased, while there was a reduction in the use of sweeteners and an elimination of the use of fructose (p = 0.05). The total daily consumption of kilocalories (kcal) had been reduced and the percentages of carbohydrates, proteins and lipids, after the intervention, follow the guidelines. In relation to this, a significant improvement (p < 0.05) was registered in systolic and diastolic pressure, BMI and waist circumference, as well as in glycaemic values (p = 0.018). CONCLUSIONS: A nutritional motivational intervention may be useful in improving dietary habits and health status of patients with T2D. We hope that a similar intervention will be applied in Campania and in other Italian regions. TRIAL REGISTRATION: Registration number is ISRCTN11067689 ; date of registration: 10/09/2018. Retrospectively registered.

The principles of Health Technology Assessment in laboratory medicine.

The Health Technology Assessment (HTA) is a multi-professional and multidisciplinary evaluation approach designed to assess health technology in the broadest sense of the term, from its instruments to the rearranging of its organizational structures. It is by now an established methodology at national and international levels that involves several medical disciplines thanks to its versatility. Laboratory medicine is one of these disciplines. Such specialization was subjected, in recent years, to deep changes even from an organizational standpoint, in order to meet the health needs of the population, making them as effective and cost-effective as possible. In this regard, HTA was the tool used to assess implications in different areas.

[Adapted Exercise in the management of Type II diabetes: a Budget Impact Analysis]. / L'Esercizio Fisico Adattato nel management del paziente con diabete di tipo 2: una Budget Impact Analysis.

Type II diabetes has a high prevalence rate worldwide, especially in industrialized countries. By requiring increasing health expenditures and resources, the disease and its complications generate a considerable economic burden. Since many years several institutions promote awareness and information programs regarding the most effective strategies to prevent and control diabetes. By reducing the severity of the disease and its complications, Adapted Exercise therapy (AE) represents an ideal instrument to remodulate the Therapeutic Healthcare Management Protocol (THMP) of patients with type II diabetes and may be defined as a new health technology. On the basis of these considerations, a Budget Impact Analysis (BIA) was carried out from the healthcare management perspective to evaluate advantages deriving from the introduction of a structured program of AE for diabetics in Campania, one of the Italian regions with the highest prevalence of diabetes. The analysis has examined two scenarios: the basic one, in which is not provided a program of AE and alternative that, instead, contemplated it. In a horizon of 5 years, the implementation of integrated THMP would entail, as demonstrated by the present analysis, a decrease in the estimation of the number of diabetic subjects complicated and related costs. The sensitivity analysis, adapted to check the soundness of this result, has supported the basic assumptions.

[Economic evaluation of the stroke units in Campania]. / Impatto economico delle Stroke Unit in Campania.

The Stroke Units (SU) delivers high quality care and treatment in patients affected by strokes. In Italy stroke is the second leading cause of death and the first of disability in adult people. There is significant evidence in literature indicating the better quality assistance SU provide in the treatment of neurological acute disease, with significant improvements in mortality and disability, when the therapeutic intervention (thrombolysis) is carried out within 3 hours after the onset of symptoms. Two are the aims of the present study: to evaluate the economic impact of both the start-up of Stroke Units in the Campania Region and the use of thrombolytic therapy for all treatable population. In the first case, the authors assume charges and costs on the national health service in absence of SU, rather than in the presence of these: the analysis compares the two alternatives to identify the most affordable one. Moreover, the authors try to estimate the potential savings achievable through the use of thrombolytic therapy: savings resulting from the difference between the number of cases treated in 2009 against the targeted population. By the results of the anticipate analysis, the global economic advantage for the Regional Banks is constituted by the sum of the savings hypothesized in two considered hypothesis. In the synthesis, the activation of SU and trombolytic treatment for all people whit eligibility criteria, may be considered health policy strategies extremely convenient for economic and social impact without causing high sacrifices for the Regional Banks.

[Health Technology Assessment to evaluate the economic advantage of offering of low-protein diet to pre-dialysis patients in Campania (Italy)]. / Un modello HTA a sostegno dell'offerta della dieta ipoproteica ai nefropatici della Campania.

A low-protein diet is well known to slow the progression of chronic renal failure, delay initiation of dialysis, while achieving significant economic benefits. In the context of a Health Technology Assessment (HTA), a budget impact analysis model was implemented to evaluate the economic advantage of offering of low-protein diet to nephropathic patients in Campania (Italy). The implemented model takes into account only the direct costs to the national healthcare system. In particular, costs related to supplying low-protein foods are compared to dialysis costs avoided, in a scenario that evaluates different indices of Numbers Needed to Treat and compliance to treatment. Results indicate that when compliance to treatment is at least 50% and NNT is £ 50, supplying a low-protein diet to all kidney disease patients in the pre-dialysis phase, namely with an estimated Glomerular filtration rate > 45, in Campania (which in the year 2009 were equal to 25,000 subjects), is economically advantageous. In this perspective, the authors argue that distribution of low-protein foods by local pharmacies could be an appropriate choice as it would allow the products to be offered at a discounted price and create a favorable setting for increasing adherence to treatment.

Exploring the Social Networks' Use in the Health-Care Industry: A Multi-Level Analysis.

The application of social networks in the health domain has become increasingly prevalent. They are web-based technologies which bring together a group of people and health-care providers having in common health-related interests, who share text, image, video and audio contents and interact with each other. This explains the increasing amount of attention paid to this topic by researchers who have investigated a variety of issues dealing with the specific applications in the health-care industry. The aim of this study is to systematize this fragmented body of literature, and provide a comprehensive and multi-level overview of the studies that has been carried out to date on social network uses in healthcare, taking into account the great level of diversity that characterizes this industry. To this end, we conduct a scoping review enabling to identify the major research streams, whose aggregate knowledge are discussed according to three levels of analysis that reflect the viewpoints of the major actors using social networks for health-care purposes, i.e., governments, health-care providers (including health-care organizations and professionals) and social networks' users (including ill patients and general public). We conclude by proposing directions for future research.

Impact of 13Valent Vaccine for Prevention of Pneumococcal Diseases in Children and Adults at Risk: Possible Scenarios in Campania Region.

BACKGROUND: Pneumonias are the most frequent infectious diseases, characterized by a high prevalence especially among children and adults at risk. The socio-economic impact caused by Streptococcus pneumoniae is evaluated in terms of morbidity, death rate and hospitalizations. OBJECTIVE: The aim of the study was to demonstrate the potential economic advantages by implementation of an active anti-pneumococcal 13-valent vaccine strategy in Campania region (Southern Italy) in two different categories of subjects, children (aged 0-12), and adults (aged 50- 79) at risk (hypertension, nephropathies, COPD and heart diseases). METHODS: Vaccination costs were compared with costs necessary to treat avoidable diseases in the presence and absence of a vaccination program. RESULTS: Offering anti-pneumococcal 13-valent vaccine to the paediatric population was quantified as saving one million euros for Italian national health service in two years. In addition, offering anti-pneumococcal vaccine to adults at risk would generate a return of around 29 million euros. CONCLUSION: In both cases, offering anti-pneumococcal 13-valent vaccine was proven to be a helpful political health strategy, not only in consideration of a reduction of cases but also in view of the favourable economic impacts.

Adapted physical activity and stroke: a systematic review.

INTRODUCTION: Stroke is one of the most significant social and health issues at the global level. The integration of adapted physical activity and exercise into the rehabilitation process and in the postrehabilitation stage could represent a successful action aimed at the functional and cognitive recovery of brain-injured individuals following a stroke. The objective of this systematic review was to analyze the role of physical activity in the post-stroke period referring not only to the rehabilitation stage but also to the postrehabilitation one. EVIDENCE ACQUISITION: The systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses methodology. We systematically reviewed studies published since 2005. The databases used were PubMed and Scopus. EVIDENCE SYNTHESIS: Fourteen articles were included in our review. The evidence supporting the use of physical activity and exercise in stroke survivors in order to maintain adequate levels of their motor autonomy and to improve their physical and psychological health increased over time. CONCLUSIONS: Physical activity and exercise contribute to the improvement of health and quality of life in stroke survivors. Moreover, it contributes to maintain functional autonomy, reduces the risk of new cerebrovascular events and encourages socialization if practiced in a group.

Economic aspects and managerial implications of the new technology in the treatment of low back pain.

BACKGROUND: The Human Body Posturizer (HPB), an innovative therapeutic tool able to correct postural changes dynamically, fits perfectly in this framework. OBJECTIVE: The aim of this paper is to consider the potential economic benefits of using the Human Body Posturizer both in terms of direct and indirect cost reduction in one year. METHODS: This study was carried out using an estimation method in order to investigate the possible economic impact related to the adoption of the HBP in subjects with low back pain as an attempt to quantify the costs (direct and indirect) generated at different levels of the path therapeutic. RESULTS: The use of therapy with HBP would generate a saving of € 971.40/year in case of sub-acute LBP and amounted to € 2,922.90/year in case of chronic low back pain. CONCLUSION: This paper provides guidance on the potential economic benefits resulting from the adoption of the Human Body Posturizer as an innovative therapeutic approach by the Italian Health System.

Does Post-operative Psychotherapy Contribute to Improved Comorbidities in Bariatric Patients with Borderline Personality Disorder Traits and Bulimia Tendencies? A Prospective Study.

BACKGROUND: Borderline personality disorder (BPD) and eating disorders may affect the outcomes of bariatric surgery. This study was aimed to evaluate the influence of a post-operative dialectical behavioral therapy (DBT) intervention on weight loss and comorbidities in a sample of comorbid obese Italian patients with BPD traits and bulimia tendencies who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB). METHODS: One hundred fifty-four LRYGB or LAGB patients showing BPD and bulimia traits and type II diabetes, hypertension, and/or sleep apnea (OSAS) voluntarily adhered to DBT (n = 72) or treatment as usual (n = 82) for 12 months after surgery. Total weight loss (%TWL) and remission/improvement of comorbidities were considered as outcomes. Differences between treatment groups and between LRYGB and LAGB subgroups were evaluated through Student's t test for TWL and chi-square test for comorbidities. RESULTS: DBT was more effective than treatment as usual (TAU) in reducing weight loss (p < .001). Reduction of comorbidities was higher in patients treated with DBT, as for diabetes (p = .68), hypertension (p = .02), and OSAS (p = .03). LRYGB outcomes seem to be significantly better than those of LAGB, mainly in TAU group. CONCLUSION: Our findings confirm the effectiveness of DBT in enhancing post-bariatric weight loss and reduction of comorbidities in patients showing BPD traits and bulimia tendencies. Further in-depth investigations and a longer follow-up are needed to strengthen these results.

Improving physical fitness and health status perception in community-dwelling older adults through a structured program for physical activity promotion in the city of Naples, Italy: A randomized controlled trial.

AIM: To evaluate the efficacy and feasibility of a physical activity promotion intervention in community-dwelling older adults based on a free program of exercise adapted for older adults aged ≥60 years managed by trainees from the Movement Sciences degree course. METHODS: A total of 160 adults aged 60-82 years were randomly allocated into the intervention and control group. The exercise program consisted of 1-h sessions carried out twice a week for a year. Control participants received recommendations about an active lifestyle from their physicians. Senior Fitness Tests and the 12-item Short Form Health Survey were used to assess six functional fitness domains of participants and perception of their health status, respectively. Body mass index was also evaluated. RESULTS: A total of 62 participants completed the exercise path. At the end of the intervention, they showed a significant body mass index decrease (from 27.9 ± 1.6 to 25.1 ± 1.8 kg/m2 , P < 0.01), and a significant improvement in functional domains, mainly aerobic fitness (+33.9%, P < 0.01) and agility (+24.2%, P < 0.01), and in good health status perception (+38.7%, P < 0.05). Similar variations were not observed in the control group (P > 0.05). A high acceptance of the intervention was registered among participants (>88.7%); staff competence and gratuitousness were the most appreciated features (>85.5%). CONCLUSIONS: The structured program represented a useful opportunity to promote physical activity among participants, and it was effective in improving their physical fitness and health status perception. Similar interventions are required to sensitize the whole older population, and experts in Movement Sciences might represent a key figure in this context. Geriatr Gerontol Int 2017; 17: 1421-1428.

Adult immunization with 13-valent pneumococcal vaccine in Campania region, South Italy: an economic evaluation.

Pneumococcal pneumonia has a high clinical burden in terms of morbidity, mortality and hospitalization rate, with heavy implications for worldwide health systems. In particular, higher incidence and mortality rates of community-acquired pneumonia (CAP) cases, with related costs, are registered among elderly. This study aimed to an economic evaluation about the immunization with PCV13 in the adult population in Campania region, South Italy. For this purpose we performed, considering a period of 5 y, a budget impact analysis (BIA) and a cost-effectiveness analysis which considered 2 scenarios of immunization compared with lack of immunization for 2 targeted cohorts: first, the high risk subjects aged 50-79 y, and second the high risk individuals aged 50-64 y, together with all those aged 65 y. Regarding the first group, the decrease of pneumonia could give savings equal to €29,005,660, while the immunization of the second cohort could allow savings equal to €10,006,017. The economic evaluation of pneumococcal vaccine for adult groups represents an essential instrument to support health policies. This study showed that both hypothesized immunization strategies could produce savings. Obtained results support the use of pneumococcal conjugate vaccine for adults. This strategy could represent a sustainable and savings-producer health policy.