Regional Health Agency of Tuscany

Firenze, Italy

Regional Health Agency of Tuscany

Firenze, Italy
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Rusconi F.,University of Florence | Da Fre M.,Regional Health Agency of Tuscany | Mello G.,University of Florence | Carnielli V.,Marche University and Salesi Hospital | And 5 more authors.
Pediatric Research | Year: 2013

Background:We examined the relationships between pregnancy disorders leading to very preterm birth (spontaneous preterm labor, prelabor premature rupture of membranes (PPROM), hypertension/preeclampsia, intrauterine growth restriction (IUGR), antenatal hemorrhage, and maternal infection), both in isolation and grouped together as "disorders of placentation" (hypertensive disorders and IUGR) vs. "presumed infection/ inflammation" (all the others), and several unfavorable neonatal outcomes.Methods:We examined a population-based prospective cohort of 2,085 singleton infants of 23-31 wk gestational age (GA) born in six Italian regions (the Accesso alle Cure e Terapie Intensive Ostetriche e Neonatali (ACTION) study).Results:Neonates born following disorders of placentation had a higher GA and better overall outcomes than those born following infection/inflammation. After adjustment for GA, however, they showed higher risk of mortality (odds ratio, OR: 1.4; 95% confidence interval, CI: 1.0-2.0), bronchopulmonary dysplasia (BPD) (OR: 2.5; CI: 1.8-3.6), and retinopathy of prematurity (ROP) (OR: 2.0; CI: 1.1-3.5), especially in growth-restricted infants, and a lower risk of intraventricular hemorrhage (IVH) (OR: 0.5; CI: 0.3-0.8) and periventricular leukomalacia (PVL) (OR: 0.6; CI: 0.4-1.1) as compared with infants born following infection/inflammation disorders.Conclusion:Our data confirm the hypothesis that, in very preterm infants, adverse outcomes are both a function of immaturity (low GA) and of complications leading to preterm birth. The profile of risk is different in different pregnancy disorders. Copyright © 2013 International Pediatric Research Foundation, Inc.

Corchia C.,International Center on Birth Defects and Prematurity | Ferrante P.,Bambino Gesu Childrens Hospital | Da Fre M.,Regional Health Agency of Tuscany | Di Lallo D.,Regional Health Agency of Lazio | And 5 more authors.
Journal of Pediatrics | Year: 2013

Objective To assess the relationship between antenatal factors and cause-specific risk of death in a large area-based cohort of very preterm infants. Study design The ACTION (Accesso alle Cure e Terapie Intensive Ostetriche e Neonatali) study recruited during an 18-month period all infants 22-31 weeks' gestational age admitted to neonatal care in 6 Italian regions (n = 3040). We analyzed the data of 2974 babies without lethal or acutely life-threatening malformations. Cause-specific risks of death adjusted for competing causes were calculated, and region-stratified multiple Cox regression analyses were used to study the association between cause-specific mortality and infants' characteristics, pregnancy complications, antenatal steroids, and place of birth. Results Deaths attributable to respiratory problems and intraventricular hemorrhage prevailed in the first 2 weeks of life, and those attributable to infections and gastrointestinal diseases afterwards. Antepartum hemorrhage was associated with respiratory deaths (hazard ratio [HR] 1.6, 95% CI 1.1-2.4), and maternal infection with deaths attributable to asphyxia (HR 32.5, 95% CI 4.1-259.4) and to respiratory problems (HR 2.8, 95% CI 1.6-5.2). Preterm premature rupture of membranes increased the likelihood of deaths due to neonatal infection (HR 1.8, 95% CI 1.0- 3.1), and preterm labor/contractions of those due to respiratory (HR 1.5, 95% CI 1.1-2.0) and gastrointestinal diseases (HR 5.8, 95% CI 2.1-16.3). In addition, a birth weight z-score < 1 was associated with increasing hazards of death resulting from asphyxia, late infections, respiratory, and gastrointestinal diseases. Conclusions Different complications of pregnancy lead to different cause-specific mortality patterns in very preterm infants. Copyright © 2013 Mosby Inc.

Nuvolone D.,Regional Health Agency of Tuscany | Petri D.,Regional Health Agency of Tuscany | Voller F.,Regional Health Agency of Tuscany
Environmental Science and Pollution Research | Year: 2017

Ozone is a highly reactive, oxidative gas associated with adverse health outcome, including mortality and morbidity. Data from monitoring sites worldwide show levels of ozone often exceeding EU legislation threshold and the more restrictive WHO guidelines for the protection of human health. Well-established evidence has been produced for short-term effects, especially on respiratory and cardiovascular systems, associated to ozone exposure. Less conclusive is the evidence for long-term effects, reporting suggestive associations with respiratory mortality, new-onset asthma in children and increased respiratory symptom effects in asthmatics. The growing epidemiological evidence and the increasing availability of routinely collected data on air pollutant concentrations and health statistics allow to produce robust estimates in health impact assessment routine. Most recent estimates indicate that in 2013 in EU-28, 16,000 premature deaths, equivalent to 192,000 years of life lost, are attributable to ozone exposure. Italy shows very high health impact estimates among EU countries, reporting 3380 premature deaths and 61 years of life lost (per 100,000 inhabitants) attributable to ozone exposure. © 2017 Springer-Verlag Berlin Heidelberg

PubMed | Nuovo S Giovanni Of Dio Hospital, University of Ferrara, S Maria Annunziata Hospital, The Second University of Naples and 8 more.
Type: | Journal: European heart journal cardiovascular Imaging | Year: 2016

The determinants of discrepancies among two-dimensional echocardiographic (2D-E) methods for left atrial volume (LAV) assessment are poorly investigated.Maximal LAV was measured in 613 individuals (282 healthy subjects,180 athletes, and 151 hypertensives; age 45 20 years, 62% male) using the ellipsoid model (LAVLA geometry is the main determinant of inconsistencies between 2D-E methods for measuring maximal LAV. Body mass index is the strongest determinant of differences between single-plane and biplane approaches. Different 2D-E methods cannot be used interchangeably for diagnosis and follow-up. The biplane area-length method should be preferred, particularly in overweight-obese subjects.

PubMed | Medical House Unit in prison and the third House of Rebibbia, General Directorate for Health Prevention, Unit for the Overcoming of the Judicial Psychiatric Hospitals and for Mental Health in Prisons, National Healthcare Company and 4 more.
Type: Journal Article | Journal: BMC public health | Year: 2016

Several studies have shown that prison is characterized by a higher prevalence of chronic diseases than unconfined settings. The aim of this study was to describe the characteristics and health of inmates, focusing on internal diseases.We designed a specific clinical record using the Python programming language. We considered all of the diagnoses according to the ICD-9-CM.Of a total of 17,086 inmates, 15,751 were enrolled in our study (M=14,835; F=869), corresponding to 92.2% of the entire inmate population (mean age of 39.6years). The project involved a total of 57 detention facilities in six Italian regions (for a total of 28% of all detainees in Italy), as counted in a census taken on February 3, 2014. From the entire study sample, 32.5% of prisoners did not present any disorders, while 67.5% suffered from at least one disease. The most frequent pathologies were psychiatric (41.3%), digestive (14.5%), infectious (11.5%), cardiovascular (11.4%), endocrine, metabolic, and immune (8.6%), and respiratory (5.4%).The findings showed that a large number of detainees were affected by several chronic conditions such as hypertension, dyslipidemia and type 2 diabetes mellitus, with an unusually high prevalence for such a young population. Therefore, a series of preventive measures is recommended to strengthen the entire care process and improve the health and living conditions of prisoners.

Rossi E.,Local Health Unit N 2 | Bartoli P.,Local Health Unit N 2 | Bianchi A.,Local Health Unit N 2 | Da Fre M.,Regional Health Agency of Tuscany
Homeopathy | Year: 2012

Aim: To study the socio-demographic features, the prescribed remedies and the outcome of atopic diseases in children treated with homeopathy at the Homeopathic Clinic of Lucca (Italy), and the long-term outcome of children suffering from atopic dermatitis (AD) after an approximate 8-year period (range 5-10. years). Methods: Our data derive from an observational longitudinal study carried out on 213 children (38.6%) with atopic diseases out of 551 children consecutively examined from September 1998 to December 2008. We used the Glasgow Homeopathic Hospital Outcome Score to evaluate the results that were classified on the basis of a Likert scale. Results: Eighty-three (39%) children were affected by asthma, 51 (24%) by allergic rhinoconjunctivitis, 76 (36%) by AD and 3 (1%) by food intolerance. Follow-up patients were 104 (48.8%), and 65 (62.5%) of them reported a major improvement or resolution. The parents of paediatric patients suffering from AD, who had started homeopathic treatment at <4.9. years of age were invited to follow-up assessment 8. years later and 40 children (mean age 12.9) were examined; 28/40 (70%) had a complete disappearance of AD, 12/40 children (30.0%) were still affected by AD; 8/40 (20%) had asthma and 8/40 patients had, or developed, allergic rhinitis. Conclusion: These preliminary results seem to confirm a positive therapeutic effect of homeopathy in atopic children. Furthermore, according to the data from the literature paediatric patients treated with homeopathy seem to show a reduced tendency to maintain AD and develop asthma (and allergic rhinitis) in adult age. © 2011 The Faculty of Homeopathy.

Bonaccorsi G.,University of Florence | Lorini C.,University of Florence | Bani Assad G.,University of Florence | Pepe P.,Regional Health Agency of Tuscany | Santomauro F.,University of Florence
European Journal of Clinical Nutrition | Year: 2013

Objective:The objective of this work is to evaluate the association between Selenium (Se)-, Copper (Cu)- and Zinc (Zn)-circulating concentrations and indicators of nutritional status.Subjects/Methods:This study enroled 428 institutionalised elderly. The diagnostic tools used are a form to collect data regarding gender, age, duration of stay in nursing home, number of prescribed drugs, chronic diseases, Mini Nutritional Assessment (MNA), anthropometric measurements, albumin, transferrin and serum concentrations of Se, Cu and Zn. The collected data were analysed with descriptive assessments of the differences χ 2, Student's t-test and analysis of variance. Multivariate linear regression were performed to evaluate the association between the concentrations of each trace elements and the other variables.Results:The study population was represented by 327 women and 101 men, of whom 13.8% were 65-75 years old and 47.4% were older than 85 years. According to the MNA score, 58.4% were at risk of malnutrition and 21.3% were malnourished. The results show a significant reduction in the average concentrations of Se and Zn in women when the nutritional status gets worse. The same trend, although not statistically significant, is also observed in men. In both genders, the Cu concentration does not show a statistically significant association with nutritional status. Multivariate linear regression show some positive or negative associations.Conclusions:Our study seems to confirm the association between Se and nutritional status, as well as with some blood chemistry parameters. The length of institutionalisation seems to be an independent predictor of Se concentration. © 2013 Macmillan Publishers Limited All rights reserved.

Eisenbach-Stangl I.,European Center for Social Welfare Policy and Research | Allamani A.,Regional Health Agency of Tuscany
Substance Use and Misuse | Year: 2014

The study identifies changes in selected ("unplanned") socio-demographic and economic factors as well as in (planned) political measures that are most strongly correlated with changes in alcohol consumption and alcohol consumption-related harm between 1961 and 2006 in Austria. During the period of investigation consumption increased until the early 1970s, dropped during the next decade and have leveled off since. Increasing urbanization, female employment and average age of mothers at their child births are associated with the best time series model for the interpretation of consumption changes. The results regarding alcohol control policies and their impact on consumption were paradoxical. Study limitations were noted pointing up the necessity to improve indicators and concepts. © 2014 Informa Healthcare USA, Inc.

Rossi E.,Local Health Unit N 2 Lucca | Bartoli P.,Local Health Unit N 2 Lucca | Bianchi A.,Local Health Unit N 2 Lucca | Endrizzi C.,Hospice Il Gelso | Da Fre M.,Regional Health Agency of Tuscany
Homeopathy | Year: 2012

Introduction: Homeopathic aggravation is the exacerbation of some symptoms or the whole pathological situation, followed by improvement of the patient's conditions. Aim: To evaluate the typology, intensity and frequency of homeopathic aggravation, especially with Quinquagintamillesimal (Q, LM) potencies and its prognostic value. Methods: The homeopathic prescription strategy evaluated consists in the administration of a single homeopathic medicine in Q dilutions, starting with 6Q, then a progressive scale of Q potencies. Patients whose symptoms could be attributed to a wrong and inappropriate prescription, according to the criteria previously described, were excluded. Results: Data was collected on 1108 patients consecutively visited from 3rd October 2002 to 31st December 2007, and 441 cases followed for at least 2 months (40% of total cases). 63 of these cases (14%) reported homeopathic aggravation: 7% reported 'slight', 5% 'medium', 2% 'intense' and 0.4% 'very intense' aggravation. Homeopathic aggravation was present in 21% of paediatric patients (≤14 years). About 50% of the cases manifested homeopathic aggravation 1 or 2 days after the prescription and for 67% of patients the symptoms lasted 1 week or less. Patients with aggravation of the original disease had significantly greater improvement than those patients showing the aggravation of other, new or different, symptoms or conditions, or no aggravation. Conclusions: These data show that homeopathic aggravation with Q potencies is quite frequent in homeopathic clinical practice and seems to be associated with better treatment outcome. © 2012 The Faculty of Homeopathy.

PubMed | Cardiology Unit S Maria Annunziata Hospital, Epidemiology Unit Local Health Unit, Regional Health Agency of Tuscany, University of Sassari and 2 more.
Type: Journal Article | Journal: European journal of clinical pharmacology | Year: 2016

The existence of gender differences in the management of statin therapy among patients with chronic heart failure (HF) is still poorly investigated. We aimed at exploring the effect of gender on statin prescription rates and adequacy of dosing and on the association between statin therapy and all-cause 1-year mortality, after HF hospitalization in a community setting.Statin prescription rates, adequacy of dosing (estimated as a PDD/DDD ratio >0.80), and 1-year mortality were retrospectively assessed in 2088 consecutive patients discharged from 5 local community hospitals with a definite diagnosis of HF after a mean length of stay of 7.6 days. The effect of gender was explored using multivariable logistic and Cox analyses adjusting to confounders.Women showed a lower statin prescription rate (25.7 vs 35.3%, P<0.0001) and a lower prevalence of adequate statin dose (32.6 vs 42.3%, P<0.0001) than men. Female gender was independently associated with a 24% lower probability of statin prescription and a 48% higher probability of inadequate statin dose. Statin prescription and adequacy of dosing were associated with 35 and 44% decreases in the risk of 1-year mortality, respectively, irrespective of gender. A nested case/control analysis confirmed that adequate statin dose was associated with 48% lower 1-year mortality, again without interaction with gender.In patients with chronic HF, female gender is independently associated with lower statin prescription rates and higher probability of inadequate dose. Statin therapy in these subjects is associated with improved 1-year survival in both men and women. This prognostic benefit is not affected by gender.

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