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Franchi C.,Laboratory for Quality Assessment of Geriatric Therapies and Services | Tettamanti M.,Laboratory of Geriatric Neuropsychiatry | Pasina L.,Laboratory for Quality Assessment of Geriatric Therapies and Services | Djignefa C.D.,Laboratory for Quality Assessment of Geriatric Therapies and Services | And 4 more authors.
European Journal of Clinical Pharmacology

Purpose: To investigate the changes in the last decade (2000-2010) in drug prescribing among community-dwelling elderly people aged 65-94 years, in relation to age and sex. Methods: We analyzed the data of nearly two million subjects ranging in age from 65 to 94 years recorded in the Drug Administrative Database of the Lombardy Region (Italy) from 2000 to 2010. Associations between drug use (at least one drug, one chronic drug, polypharmacy or chronic polypharmacy) and age, sex, and year of prescription were analyzed by logistic regression analysis. We also analyzed differences in changes linked to sex and age. Results: Between 2000 and 2010, the prescriptions of at least one drug or one chronic drug increased by 2 % (from 88.0 to 90.3 %; p<0.0001) and 8 % (from 73.8 to 82.0 %; p<0.0001), respectively, while the mean number of packages/person/year rose from 34.6 [standard deviation (SD) 32.4] to 48.5 (SD 42.2). During this same period, there was a 10 % increase in the prevalence of elderly people exposed to polypharmacy (≥5 different active substances) (from 42.8 to 52.7 %; p<0.0001), and the prevalence of those exposed to chronic polypharmacy (≥5 different chronic drugs) doubled (from 14.9 to 28.5 %; p<0.0001). Males were less frequently treated than females, except for chronic polypharmacy. People aged ≥80 years showed the largest increase in all prescribing patterns. Drug consumption in ATC groups A, H, and N (women) and in B and C (men) increased most, with the greatest absolute differences occurring in the consumption of proton pump inhibitors (31.1 %), platelet aggregation inhibitors (30.1 %), and statins (23.8 %). Conclusion: Prescriptions to community-dwelling elderly people have increased substantially during the last 10 years. Although this might indicate an improvement in care, the large increase in the number of elderly people exposed to polypharmacy and chronic polypharmacy should be carefully analyzed in terms of quality of care, patient safety, and costs. © 2014 Springer-Verlag. Source

Franchi C.,Laboratory for Quality Assessment | Sequi M.,Laboratory for Mother and Child Health | Tettamanti M.,Laboratory of Geriatric Neuropsychiatry | Bonometti F.,University of Brescia | And 7 more authors.
Journal of Clinical Psychopharmacology

Meta-analyses have found conflicting evidence on the link between antipsychotics and cerebrovascular events (CVEs). The primary aim of this study was to evaluate the association between any antipsychotic prescription and CVEs in Italian elderly; second, to compare the effect of typical and atypical antipsychotics on CVEs; and third, to investigate the effect of antipsychotics on CVEs in the subgroup of persons coprescribed with acetylcholinesterase inhibitors (AChEIs). Administrative claims from community-dwelling people aged 65 to 94 years living in Northern Italy were analyzed using a retrospective case-control design, from 2003 to 2005. The primary outcome measure was a hospital discharge diagnosis of CVEs during 2005. Four age-, sex-, and local health unit-matched control subjects were identified for each case. Antihypertensive drugs, anticoagulants, platelet inhibitors, antidiabetic drugs, lipid-lowering drugs, and AChEI were used as covariates in conditional logistic regression models testing the odds ratio (OR) for CVEs due to antipsychotics use. Three thousand eight hundred fifty-five cases of CVEs were identified and matched with 15,420 control subjects. In multiadjusted models, the association of any antipsychotics, typical or atypical with CVEs, was not significant. When antipsychotics were categorized according to the number of boxes prescribed during the observational period, being prescribed with at least 19 boxes of typical antipsychotics was significantly associated with CVEs (OR, 2.4; 95% confidence interval, 1.08-5.5). An interaction was found between any antipsychotic and AChEI coprescription on CVEs (OR, 0.46; 95% confidence interval, 0.23-0.92). In conclusion, only typical antipsychotics were associated with an increased odd of CVEs, but the association was duration dependent. Persons prescribed simultaneously with AChEI and antipsychotics may be at a lower risk of CVEs. Copyright © 2013 by Lippincott Williams & Wilkins. Source

Bombeccari G.P.,University of Milan | Guzzi G.,Italian Association for Metals and Biocompatibility Research | Tettamanti M.,Laboratory of Geriatric Neuropsychiatry | Giann A.B.,University of Milan | And 3 more authors.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology

Objective: Oral lichen planus (OLP) is associated with risk for developing oral squamous cell carcinoma (OSCC). We performed a 7-year prospective study to assess the incidence of malignant transformation of OLP among adults. Study design: Three hundred twenty-seven OLP patients, 229 women (70.0%) and 98 men (30.0%), were observed during the follow-up period. Results: During a mean follow-up of 81.7 months, 8 of 327 patients developed an OSCC in OLP areas (0.36%/y), yielding the high overall standardized incidence ratio of 17.7 (95% confidence interval [CI] 8.8-35.3). The standardized incidence ratio for OSCC was significantly higher in women [27.0 (95% CI 11.2-64.8)] than in men [11.2 (95% CI 3.6-34.9)]. Six OSCCs were well differentiated (75%) and 2 moderately differentiated (25%). Three subjects (37.5%) developed recurrences within 2 years (mean 16.1 ± 3.5 months). Disease-free survival rate after 69.8 months was 97.3%. Conclusions: OLP was associated with a significant increase in the risk for OSCC. Close surveillance may help to reduce the morbidity of OSCC arising from OLP at 24 months. © 2011 Mosby, Inc. Source

Monesi L.,Laboratory of General Practice Research | Tettamanti M.,Laboratory of Geriatric Neuropsychiatry | Cortesi L.,Laboratory of General Practice Research | Baviera M.,Laboratory of General Practice Research | And 11 more authors.
Nutrition, Metabolism and Cardiovascular Diseases

Aims: To investigate the incidence of major cardiovascular complications and mortality in the first years of follow-up in patients with newly diagnosed diabetes. Methods and results: We examined incidence rates of hospitalization for cardiovascular reasons and death among new patients with diabetes using the administrative health database of the nine million inhabitants of Lombardy followed from 2002 to 2007. Age and sex-adjusted rates were calculated and hazard ratios (HR) were estimated with a matched population without diabetes of the same sex, age (±1 year) and general practitioner.There were 158,426 patients with newly diagnosed diabetes and 314,115 subjects without diabetes. Mean follow-up was 33.0 months (SD ± 17.5). 9.7% of patients with diabetes were hospitalized for cardiovascular events vs. 5.4% of subjects without diabetes; mortality rate was higher in patients with diabetes (7.7% vs. 4.4%). The estimated probability of hospitalization during the follow up was higher in patients with diabetes than in subjects without for coronary heart disease (HR 1.4, 95% CI 1.3-1.4), cerebrovascular disease (HR 1.3.95% CI 1.2-1.3), heart failure (HR 1.4, 95% CI 1.3-1.4) as was mortality (HR 1.4, 95% CI 1.4-1.4).Younger patients with diabetes had a risk of death or hospital admission for cardio-cerebrovascular events similar to subjects without diabetes ten years older. Conclusions: The elevated morbidity and mortality risks were clear since the onset of diabetes and rose over time. These data highlight the importance of prompt and comprehensive patients care in addition to anti-diabetic therapy in patients with newly diagnosed diabetes. © 2013 Elsevier B.V. Source

Franchi C.,Laboratory for Quality Assessment of Geriatric Therapies and Services | Cartabia M.,Laboratory of Mother and Child Health | Risso P.,Laboratory of Epidemiology and Social Psychiatry | Mari D.,University of Milan | And 8 more authors.
European Journal of Clinical Pharmacology

Purpose: To compare the geographical differences in the prevalence of chronic polypharmacy in community-dwelling older people over 11 years. Methods: This study analyzed nearly two million patients aged 65-94 years recorded in the Drug Administrative Database of the Lombardy Region (Northern Italy) from 2000 to 2010. Chronic polypharmacy was defined as taking five or more drugs in 1 month for at least 6 months (consecutive or not) in a year. Results: There was a significant spatial autocorrelation that increased at the municipality level from 2000 (Moran's I Index = 0.26, z score = 16.91, p < 0.0001) to 2010 (Moran's I Index = 0.36, z score = 23.78, p < 0.0001). Clusters of high (Z(G) > 1.96) and low (Z(G) < -1.96) prevalence rates of chronic polypharmacy were found and were not influenced by age. Chronic polypharmacy weakly correlated with hospital admission (2000: ρ = 0.08, p = 0.0032; 2005: ρ = 0.11, p < 0.0001; 2010: ρ = 0.18, p < 0.0001), but not with mortality. Conclusions: There were geographical differences in the prevalence of older people with chronic polypharmacy that were only partly explained by health indicators. Targeted activities on prescription practice to ensure that the prescribing of chronic polypharmacy is appropriate are required. © 2013 Springer-Verlag Berlin Heidelberg. Source

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