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Di Bari M.,University of Florence | Profili F.,Osservatorio di Epidemiologia | Bandinelli S.,Geriatric Unit | Salvioni A.,Fiorentina Sud Est Health District | And 5 more authors.
Journal of the American Geriatrics Society | Year: 2014

Objectives To develop and test a postal screening questionnaire to intercept frailty in older community-dwelling individuals.Design A questionnaire was developed on the basis of expert consensus and preliminarily tested against the occurrence of incident disability, in secondary analyses of previous epidemiological studies. The questionnaire was then mailed and its concurrent validity, defined from the association between its individual items and summary score and the presence of the Fried frailty phenotype (FFP), was subsequently evaluated cross-sectionally with in-person examination of initial participants.Setting Community-based.Participants Individuals aged 70 and older living in two communities near Florence, Italy.Measurements A home comprehensive geriatric assessment including the FFP was conducted in participants who screened positive for frailty and in a limited sample of negative responders.Results A 10-item questionnaire, developed based on expert consensus, was preliminarily tested on preexisting epidemiological data and showed an area under the receiver operating characteristic curve (AUC) of 0.716 versus incident disability. The questionnaire was then mailed to 15,774 subjects, whose response rate was 53.6%. Of the first 1,037 participants included in the concurrent validation study, 833 (80.3%) screened positive, and 380 (36.6%) were frail on assessment. The ability of the questionnaire summary score to predict frailty was adequate, with an AUC of 0.695, a sensitivity of 71%, and a specificity of 58%.Conclusion A simple questionnaire delivered by mail was able to identify FFP in the community. This would facilitate large-scale screening for frailty in older persons. © 2014, The American Geriatrics Society.


Buja A.,University of Padua | Damiani G.,University Cattolica Sacro Cuore Of Rome | Gini R.,Osservatorio di Epidemiologia | Visca M.,Sezione OSS Organizzazione Servizi Sanitari | And 8 more authors.
PLoS ONE | Year: 2014

Background: Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF) and coronary heart disease (CHD), by age group. Methods: This population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ≥16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level. Results: The quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16-44 year-olds), adults (45-64), and oldest old (+85) than for patients aged 65-74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16-44 y), adults (45-64 y), the very old (75-84 y) and the oldest old (+85 y) patients with CHD, CHF and diabetes are less likely than 65-74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old. Conclusion: Our study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly. © 2014 Buja et al.


Morabito M.,University of Florence | Crisci A.,National Research Council Italy | Moriondo M.,National Research Council Italy | Profili F.,Osservatorio di Epidemiologia | And 6 more authors.
Science of the Total Environment | Year: 2012

The association between air temperature and human health is described in detail in a large amount of literature. However, scientific publications estimating how climate change will affect the population's health are much less extensive. In this study current evaluations and future predictions of the impact of temperature on human health in different geographical areas have been carried out. Non-accidental mortality and hospitalizations, and daily average air temperatures have been obtained for the 1999-2008 period for the ten main cities in Tuscany (Central Italy). High-resolution city-specific climatologic A1B scenarios centered on 2020 and 2040 have been assessed. Generalized additive and distributed lag models have been used to identify the relationships between temperature and health outcomes stratified by age: general adults (< 65), elderly (aged 65-74) and very elderly (≥ 75). The cumulative impact (over a lag-period of 30. days) of the effects of cold and especially heat, was mainly significant for mortality in the very elderly, with a higher impact on coastal plain than inland cities: 1 °C decrease/increase in temperature below/above the threshold was associated with a 2.27% (95% CI: 0.17-4.93) and 15.97% (95% CI: 7.43-24.51) change in mortality respectively in the coastal plain cities. A slight unexpected increase in short-term cold-related mortality in the very elderly, with respect to the baseline period, is predicted for the following years in half of the cities considered. Most cities also showed an extensive predicted increase in short-term heat-related mortality and a general increase in the annual temperature-related elderly mortality rate. These findings should encourage efforts to implement adaptation actions conducive to policy-making decisions, especially for planning short- and long-term health intervention strategies and mitigation aimed at preventing and minimizing the consequences of climate change on human health. © 2012 Elsevier B.V.

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