Agenzia Regionale Sanita Toscana

Firenze, Italy

Agenzia Regionale Sanita Toscana

Firenze, Italy
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Policardo L.,Agenzia Regionale Sanita Toscana | Seghieri G.,Agenzia Regionale Sanita Toscana | Francesconi P.,Agenzia Regionale Sanita Toscana | Anichini R.,Diabetes Unit S Jacopo Hospital | And 2 more authors.
Journal of Diabetes and its Complications | Year: 2016

Objective: Women with diabetes have a greater excess risk for cardiovascular diseases (CVD) than men. This study was aimed at clarifying whether this effect is lifelong or more evident in some life-periods. Methods: The effect of diabetes and gender on the risk of first ever hospitalization for acute myocardial infarction (AMI), ischemic stroke (IS), congestive heart failure (CHF), lower extremity amputations (LEA) or any of these major cardiovascular events (MACE) have been evaluated by a Cox-hazard model, over years 2008-2012 querying administrative databases of a cohort living in Tuscany, Italy. Results: Comparing subjects with diabetes to those without it the overall age-adjusted excess risk was higher in women than in men for AMI and MACE and higher in men for LEA, with no difference for IS or CHF. In women the excess risk for AMI and MACE started earlier (46. yr) and lasted until age of more than 85. yr, while 'risk-windows' opened later and had a shorter duration for CHF (56-65. yr) and IS (66-75. yr). Conclusion: Diabetic women have a significant diabetes-associated excess of CVD risk, except for LEA, with a 'risk window' opening earlier and lasting longer for AMI and MACE, later and with a shorter duration for IS and CHF. © 2016 Elsevier Inc.


Policardo L.,Agenzia Regionale Sanita Toscana | Seghieri G.,Agenzia Regionale Sanita Toscana | Francesconi P.,Agenzia Regionale Sanita Toscana | Franconi F.,University of Sassari | And 3 more authors.
Journal of Diabetes and its Complications | Year: 2015

Objective To evaluate the effect of diabetes by gender on the peak-risk of first-ever-ischemic stroke and its recurrence. Methods Administrative datasets including all hospital discharges for ischemic stroke (N = 43,332) in the diabetic (N = 207,568) and non-diabetic (N = 2,808,554) population of the Tuscany region, Italy were used to calculate Hazard ratios (HR) after Cox-regression, of first-ever and recurrent ischemic strokes, between 2005 and 2011. Results Overall, diabetes increased the HR of first-ever ischemic stroke by about 50% in both genders. However, this risk significantly declined with age and was higher in women aged 55-74 yr than in men of the same age (HR; 95% CI: 1.392; 1.228-1.579 in age-class 55-64 yr and 1.203; 1.110-1.304 in age class 65-74 yr; p < 0.001). Diabetes also increased the adjusted risk of three-year-stroke recurrence (N = 5,998) in women, independently of age, whereas this was the case in men < 70 yr. Conclusions Diabetes is associated with increased risk of ischemic stroke although it declines with age though at lower rate among women than men. Moreover, diabetic women have greater risk of recurrence than in men > 70 yrs old, supporting a high-risk "time-window" in postmenopausal-elderly diabetic women. © 2015 Elsevier Inc.


PubMed | University of Pisa, Sant'Anna School of Advanced Studies, Agenzia Regionale Sanita Toscana and University of Sassari
Type: Journal Article | Journal: Journal of diabetes and its complications | Year: 2015

To evaluate the effect of diabetes by gender on the peak-risk of first-ever-ischemic stroke and its recurrence.Administrative datasets including all hospital discharges for ischemic stroke (N = 43,332) in the diabetic (N = 207,568) and non-diabetic (N = 2,808,554) population of the Tuscany region, Italy were used to calculate Hazard ratios (HR) after Cox-regression, of first-ever and recurrent ischemic strokes, between 2005 and 2011.Overall, diabetes increased the HR of first-ever ischemic stroke by about 50% in both genders. However, this risk significantly declined with age and was higher in women aged 55-74 yr than in men of the same age (HR; 95% CI: 1.392; 1.228-1.579 in age-class 55-64 yr and 1.203; 1.110-1.304 in age class 65-74 yr; p < 0.001). Diabetes also increased the adjusted risk of three-year-stroke recurrence (N = 5,998) in women, independently of age, whereas this was the case in men < 70 yr.Diabetes is associated with increased risk of ischemic stroke although it declines with age though at lower rate among women than men. Moreover, diabetic women have greater risk of recurrence than in men > 70 yrs old, supporting a high-risk time-window in postmenopausal-elderly diabetic women.


PubMed | University of Pisa, Agenzia Regionale Sanita Toscana, Diabetes Unit S Jacopo Hospital and University of Sassari
Type: Journal Article | Journal: Journal of diabetes and its complications | Year: 2016

Women with diabetes have a greater excess risk for cardiovascular diseases (CVD) than men. This study was aimed at clarifying whether this effect is lifelong or more evident in some life-periods.The effect of diabetes and gender on the risk of first ever hospitalization for acute myocardial infarction (AMI), ischemic stroke (IS), congestive heart failure (CHF), lower extremity amputations (LEA) or any of these major cardiovascular events (MACE) have been evaluated by a Cox-hazard model, over years 2008-2012 querying administrative databases of a cohort living in Tuscany, Italy.Comparing subjects with diabetes to those without it the overall age-adjusted excess risk was higher in women than in men for AMI and MACE and higher in men for LEA, with no difference for IS or CHF. In women the excess risk for AMI and MACE started earlier (46yr) and lasted until age of more than 85yr, while risk-windows opened later and had a shorter duration for CHF (56-65yr) and IS (66-75yr).Diabetic women have a significant diabetes-associated excess of CVD risk, except for LEA, with a risk window opening earlier and lasting longer for AMI and MACE, later and with a shorter duration for IS and CHF.


Samavat J.,University of Florence | Natali I.,Seminology Laboratory | Degl'Innocenti S.,University of Florence | Filimberti E.,University of Florence | And 8 more authors.
Fertility and Sterility | Year: 2014

Objective: To compare spontaneous (Sp-AR) and P-induced acrosome reaction (AR) in spermatozoa of obese and lean subjects. Setting: Bariatric unit at a university hospital. Design: Prospective, observational study. Patient(s): Twenty-three obese (mean ± SD body mass index [BMI], 44.3 ± 5.9 kg/m2) and 25 age-matched lean (BMI, 24.2 ± 3.0 kg/m2) subjects. Intervention(s): None. Main Outcome Measure(s): Spontaneous and P-induced AR in spermatozoa of obese and lean subjects. Result(s): A statistically significant difference was found between obese and lean cohorts in total T and calculated free T, E2, glycated hemoglobin, and high-density lipoproteins, whereas among the routine semen parameters analyzed, only immotile sperm percentage and ejaculate volume differed significantly. Spermatozoa of obese (n = 13) vs. lean men (n = 19) showed a higher Sp-AR (17.9% ± 7.2% vs. 8.3% ± 4.2%), which resulted in a reduced ability to respond to P evaluated as the AR-after-P-challenge parameter (3.5% ± 3.2% vs. 17.6% ± 9.2%). Multivariate analysis adjusted for age revealed a significant correlation between BMI, waist, E2, and glycated hemoglobin with both Sp-AR (age-adjusted r = 0.654, r = 0.711, r = 0.369, and r = 0.644, respectively) and AR-after-P-challenge (age-adjusted r = -0.570, r = -0.635, r = -0.507, and r = -0.563, respectively). A significant difference in sperm cholesterol content was reported between obese and lean men (29.8 ± 19.5 vs. 19.1 ± 14.6 ng/μg of proteins). content was reported between obese and lean men (29.8 ± 19.5 vs. 19.1 ± 14.6 ng/μg of proteins). Conclusion(s): Sperm AR is impaired in obese men, showing reduced response to P and elevated Sp-AR, associated with altered circulating levels of E2 and sperm cholesterol content. ©2014 by American Society for Reproductive Medicine.


Patadia V.K.,Erasmus Medical Center | Patadia V.K.,Astellas Pharma Inc. | Coloma P.,Erasmus Medical Center | Schuemie M.J.,Erasmus Medical Center | And 10 more authors.
Expert Review of Clinical Pharmacology | Year: 2014

A prospective pharmacovigilance signal detection study, comparing the real-world healthcare data (EU-ADR) and two spontaneous reporting system (SRS) databases, US FDA's Adverse Event Reporting System and WHO's Vigibase is reported. The study compared drug safety signals found in the EU-ADR and SRS databases. The potential for signal detection in the EU-ADR system was found to be dependent on frequency of the event and utilization of drugs in the general population. The EU-ADR system may have a greater potential for detecting signals for events occurring at higher frequency in general population and those that are commonly not considered as potentially a drug-induced event. Factors influencing various differences between the datasets are discussed along with potential limitations and applications to pharmacovigilance practice. © 2015 Informa UK, Ltd.


Seghieri G.,Agenzia Regionale Sanita Toscana | Policardo L.,Agenzia Regionale Sanita Toscana | Profili F.,Agenzia Regionale Sanita Toscana | Francesconi P.,Agenzia Regionale Sanita Toscana | And 2 more authors.
Journal of Diabetes and its Complications | Year: 2015

Aims: To identify incidental previously unrecognized diabetes (IPUD) among hospitalized patients and corresponding mortality risk in comparison with individuals with known diabetes (KDM). Methods: Out of 214,991 individuals discharged in year 2011 from all hospitals of Tuscany, Italy we retrospectively identified IPUD as individuals with no known diabetes and/or previous antidiabetic medication, receiving at least two prescriptions of glucose-lowering-drugs over the next 6. months after discharge. Two-year (2012-2013) adjusted mortality risk was tested by a Cox-regression-analysis, comparing IPUD and KDM patients with at least one hospital admission in 2011. Results: 974 patients with IPUD (375.6. ×. 100,000 hospitalized people) have been identified. IPUD risk was associated with aging, male gender and greater burden of co-morbidities, was higher in migrants of non-Italian ancestry and was reduced among patients of family physicians adhering to guidelines resulting in a proactive model of care delivery. In IPUD patients alive at 1st January 2012, (n = 865) the adjusted risk of two-year mortality was similar to that of KDM subjects (HR = 1.08; 95% CI: 0.92-1.26; p = NS). Conclusions: IPUD occurs more commonly in older male subjects, migrants of non-Italian ancestry, and among patients of physicians non-adhering to a shared diabetes care model. People with IPUD have similar two-year-mortality risk compared with KDM individuals. © 2015 Elsevier Inc.


PubMed | University of Pisa, Agenzia Regionale Sanita Toscana and Diabetes Unit
Type: Journal Article | Journal: Journal of diabetes and its complications | Year: 2016

To identify incidental previously unrecognized diabetes (IPUD) among hospitalized patients and corresponding mortality risk in comparison with individuals with known diabetes (KDM).Out of 214,991 individuals discharged in year 2011 from all hospitals of Tuscany, Italy we retrospectively identified IPUD as individuals with no known diabetes and/or previous antidiabetic medication, receiving at least two prescriptions of glucose-lowering-drugs over the next 6months after discharge. Two-year (2012-2013) adjusted mortality risk was tested by a Cox-regression-analysis, comparing IPUD and KDM patients with at least one hospital admission in 2011.974 patients with IPUD (375.6100,000 hospitalized people) have been identified. IPUD risk was associated with aging, male gender and greater burden of co-morbidities, was higher in migrants of non-Italian ancestry and was reduced among patients of family physicians adhering to guidelines resulting in a proactive model of care delivery. In IPUD patients alive at 1st January 2012, (n=865) the adjusted risk of two-year mortality was similar to that of KDM subjects (HR=1.08; 95% CI: 0.92-1.26; p=NS).IPUD occurs more commonly in older male subjects, migrants of non-Italian ancestry, and among patients of physicians non-adhering to a shared diabetes care model. People with IPUD have similar two-year-mortality risk compared with KDM individuals.


Policardo L.,Agenzia Regionale Sanita Toscana | Barchielli A.,Instituto per lo Studio e la Prevenzione Oncologica ISPO | Seghieri G.,Agenzia Regionale Sanita Toscana | Francesconi P.,Agenzia Regionale Sanita Toscana
Acta Diabetologica | Year: 2016

Aims: This study was designed to answer the question whether surgery due to newly diagnosed cancer may modify quality of diabetes’ management, as suggested by current guidelines. Methods: Adherence to guideline composite indicator (GCI), a process indicator including one annual assessment of HbA1c and at least two among eye examination, serum lipids measurement and microalbuminuria, was evaluated between years 2011–2012 and 2014–2015 in 158,069 diabetic patients living in Tuscany, Italy, on 1 January 2011 and surviving on 31 December 2015, of whom 661 were hospitalized in index year 2013 for a surgery procedure due to a newly incident cancer. Difference in GCI modification (DELTA_GCI) of these patients was compared with that of diabetic people without cancer, strictly matched for main confounders by means of a propensity score. Results: In diabetic patients with cancer, GCI adherence increased by about 8 % between years 2011–2012 and 2014–2015. When compared with controls, DELTA_GCI increased by 6 % in cancer group compared with controls (p < 0.05), but any significance was lost after matching the groups by propensity score (3 %; p = NS). Conclusions: Our study suggests that a hospitalization for a surgical procedure due to a newly diagnosed cancer does not influence the compliance to a quality process indicator of diabetes care such as GCI. © 2016 Springer-Verlag Italia


PubMed | Agenzia Regionale Sanita Toscana and Instituto per lo Studio e la Prevenzione Oncologica ISPO
Type: Journal Article | Journal: Acta diabetologica | Year: 2016

This study was designed to answer the question whether surgery due to newly diagnosed cancer may modify quality of diabetes management, as suggested by current guidelines.Adherence to guideline composite indicator (GCI), a process indicator including one annual assessment of HbA1c and at least two among eye examination, serum lipids measurement and microalbuminuria, was evaluated between years 2011-2012 and 2014-2015 in 158,069 diabetic patients living in Tuscany, Italy, on 1 January 2011 and surviving on 31 December 2015, of whom 661 were hospitalized in index year 2013 for a surgery procedure due to a newly incident cancer. Difference in GCI modification (DELTA_GCI) of these patients was compared with that of diabetic people without cancer, strictly matched for main confounders by means of a propensity score.In diabetic patients with cancer, GCI adherence increased by about 8% between years 2011-2012 and 2014-2015. When compared with controls, DELTA_GCI increased by 6% in cancer group compared with controls (p<0.05), but any significance was lost after matching the groups by propensity score (3%; p=NS).Our study suggests that a hospitalization for a surgical procedure due to a newly diagnosed cancer does not influence the compliance to a quality process indicator of diabetes care such as GCI.

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