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1. The Prevalence of Diarrhea and Its Association With Drug Use in Elderly Outpatients: A Multicenter Study

Author

Pilotto, A, Franceschi, M, Vitale, D, Zaninelli, A, Di Mario, F, Seripa, D, Rengo, F, FIRI e. SOFIA Project Investigators, Barbagallo, M, Bavazzano, A, Bernabei, R, Biagini, C, Cucinotta, D, Guizzardi, G, Granchi, F, Laguzzi, E, Masotti, G, Maugeri, D, Mazzei, B, Nicìta, MV, Nieddu, A, Noro, G, Olivari, G, Palummeri, E, Policicchio, D, Postacchini, D, Putzu, P, Tardi, S, Abbiati, C, Alpa, A, Antiga, I, Antonina, MR, Arnaboldi, L, Ballotti, E, Bargellini, N, Barisone, G, Battelli, M, Beccari, G, Bitetti, E, Bologni, A, Bongera, P, Bortot, M, Bracalenti, L, Buonono, G, Busolo, M, Campanini, MC, Caputo, L, Cartei, A, Cascavilla, P, Casciaro, L, Casula, E, Cesarone, L, Chiesa, D, Chiumeo, F, Ciciarello, A, Cincotta, G, Corò, G, Corona, S, Corsini, M, Cosola, C, Dainese, A, Danza, M, De Bastiani, R, De Cesare, P, De Facci, G, De Lorenzo, R, De Vuono, AD, Della Piccola, P, D'Errico, G, Di Benedetto, G, Dodaro, M, Ercolino, M, Fatarella, P, Fazzari, F, Fiorese, G, Foco, G, Formicola, G, Franchi, F, Fronges, D, Gaetano, MA, Giordano, G, Guarino, M, Guasti, D, Kuel, AM, Kusanovic, M, Lanzavecchia, D, Lofiego, MC, Lorenzano, E, Losi, C, Magrini, F, Mancini, NM, Mander, A, Manneschi, M, Marchi, R, Maronato, G, Marsala, V, Mascia, R, Matuonto, V, Mauceri, ML, Mazzi, PA, Mezzapica, A, Mochi, F, Molenda, G, Morelli, F, Morsia, D, Mosna, MC, Muglia, A, Murgia, P, Muscetta, M, Muscetta, S, Nucci, P, Olimpi, G, Orro, W, Poletto, C, Palmieri, IP, Pastacaldi, G, Pastori, C, Pieresca, G, Pietragalla, M, Pilo, S, Poggesi, S, Poli, L, Ricciardi, A, Riggi, V, Romano, V, Rossi, T, Saccarello, A, Salatino, A, Salvati, R, Sannino, A, Santelli, M, Santucci, A, Saponaro, GM, Schergna, A, Schiavone, C, Sammarco, R, Scornavacca, G, Serena, D, Silvino, G, Sistilli, L, Soldan, S, Soro, A, Tatti, R, Tempestini, L, Testini, D, Tibeloli Carnevali, A, Toniolo, B, Torselli, R, Tremul, L, Trevisan, F, Trifilò, P, Cimenti, T, Valente, S, Vannucchi, CE, Vencato, PG, Vigotti, G, Virdis, G, Zaccaro, F, Zanzot, S, Zingone, FM, Zirillo, AM, ANNONI, GIORGIO, Pilotto, A, Franceschi, M, Vitale, D, Zaninelli, A, Di Mario, F, Seripa, D, Rengo, F, FIRI e., S, Annoni, G, Barbagallo, M, Bavazzano, A, Bernabei, R, Biagini, C, Cucinotta, D, Guizzardi, G, Granchi, F, Laguzzi, E, Masotti, G, Maugeri, D, Mazzei, B, Nicìta, M, Nieddu, A, Noro, G, Olivari, G, Palummeri, E, Policicchio, D, Postacchini, D, Putzu, P, Tardi, S, Abbiati, C, Alpa, A, Antiga, I, Antonina, M, Arnaboldi, L, Ballotti, E, Bargellini, N, Barisone, G, Battelli, M, Beccari, G, Bitetti, E, Bologni, A, Bongera, P, Bortot, M, Bracalenti, L, Buonono, G, Busolo, M, Campanini, M, Caputo, L, Cartei, A, Cascavilla, P, Casciaro, L, Casula, E, Cesarone, L, Chiesa, D, Chiumeo, F, Ciciarello, A, Cincotta, G, Corò, G, Corona, S, Corsini, M, Cosola, C, Dainese, A, Danza, M, De Bastiani, R, De Cesare, P, De Facci, G, De Lorenzo, R, De Vuono, A, Della Piccola, P, D'Errico, G, Di Benedetto, G, Dodaro, M, Ercolino, M, Fatarella, P, Fazzari, F, Fiorese, G, Foco, G, Formicola, G, Franchi, F, Fronges, D, Gaetano, M, Giordano, G, Guarino, M, Guasti, D, Kuel, A, Kusanovic, M, Lanzavecchia, D, Lofiego, M, Lorenzano, E, Losi, C, Magrini, F, Mancini, N, Mander, A, Manneschi, M, Marchi, R, Maronato, G, Marsala, V, Mascia, R, Matuonto, V, Mauceri, M, Mazzi, P, Mezzapica, A, Mochi, F, Molenda, G, Morelli, F, Morsia, D, Mosna, M, Muglia, A, Murgia, P, Muscetta, M, Muscetta, S, Nucci, P, Olimpi, G, Orro, W, Poletto, C, Palmieri, I, Pastacaldi, G, Pastori, C, Pieresca, G, Pietragalla, M, Pilo, S, Poggesi, S, Poli, L, Ricciardi, A, Riggi, V, Romano, V, Rossi, T, Saccarello, A, Salatino, A, Salvati, R, Sannino, A, Santelli, M, Santucci, A, Saponaro, G, Schergna, A, Schiavone, C, Sammarco, R, Scornavacca, G, Serena, D, Silvino, G, Sistilli, L, Soldan, S, Soro, A, Tatti, R, Tempestini, L, Testini, D, Tibeloli Carnevali, A, Toniolo, B, Torselli, R, Tremul, L, Trevisan, F, Trifilò, P, Cimenti, T, Valente, S, Vannucchi, C, Vencato, P, Vigotti, G, Virdis, G, Zaccaro, F, Zanzot, S, Zingone, F, and Zirillo, A

Subjects
Diarrhea, Drug, medicine.medical_specialty, Drug-Related Side Effects and Adverse Reactions, health care facilities, manpower, and services, media_common.quotation_subject, MEDLINE, Internal medicine, Outpatients, Prevalence, medicine, Humans, Psychiatry, Aged, media_common, Polypharmacy, Hepatology, business.industry, Gastroenterology, social sciences, humanities, Multicenter study, elderly outpatients, drug use, Diarrhea, MED/09 - MEDICINA INTERNA, medicine.symptom, business
Abstract

OBJECTIVES: To evaluate the prevalence of diarrhea and its association with drug use in elderly outpatients. METHODS: The study was carried out by 133 general practitioners (GPs) who referred to 24 geriatric units in Italy. The demographic data, disability, gastrointestinal symptoms, and current medications were evaluated using a structured interview, including the evaluation of the activities of daily living (ADL), the instrumental activities of daily living (IADL), and the gastrointestinal symptoms rating scale (GSRS). RESULTS: The study included 5,387 elderly subjects who regularly completed the structured interview. In total, 488 patients (9.1% of the whole population, 210 men and 278 women, mean age 75.6 6.2 yr, range 65–100 yr) reported diarrhea, that is, items 11 and 12 of the GSRS, during the 7-day period before the interview. The prevalence of diarrhea significantly increased with older age (P= 0.025), the severity of ADL (P < 0.0001) and IADL disability (P < 0.0001), and the number of drugs taken (P= 0.0002). A multivariate analysis demonstrated that the presence of diarrhea was significantly associated with the use of antibiotics (odds ratio [OR] 4.58, 95% confidence interval [CI] 1.95–10.73), proton pump inhibitors (OR 2.97, 95% CI 2.03–4.35), allopurinol (OR 2.19, 95% CI 1.26–3.81), psycholeptics (OR 1.82, 95% CI 1.26–2.61), selective serotonin reuptake inhibitors (OR 1.71, 95% CI 1.01–2.89), and angiotensin II receptor blockers (OR 1.46, 95% CI 1.08–1.99), also accounting for sex, age, and the use of antidiarrheal agents and drugs for functional gastrointestinal disorders. CONCLUSION: Diarrhea is a common problem in elderly outpatients. Its prevalence increases with old age, the severity of disability, and the number of drugs. Monitoring the presence of diarrhea and its complications in elderly patients who need treatments with drugs significantly associated with diarrhea may be clinically useful.

Published
2008
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2. Drug use by the elderly in general practice: effects on upper gastrointestinal symptoms

Author

Pilotto, A, Franceschi, M, Vitale, D, Zaninelli, A, Masotti, G, Rengo, F, Barbagallo, M, Bavazzano, A, Bernabei, R, Biagini, C, Cucinotta, D, Guizzardi, G, Granchi, F, Laguzzi, E, Maugeri, D, Mazzei, B, Nicita, MV, Nieddu, A, Noro, G, Olivari, G, Palummeri, E, Policicchio, D, Postacchini, D, Putzu, P, Tardi, S., ANNONI, GIORGIO, Pilotto, A, Franceschi, M, Vitale, D, Zaninelli, A, Masotti, G, Rengo, F, Annoni, G, Barbagallo, M, Bavazzano, A, Bernabei, R, Biagini, C, Cucinotta, D, Guizzardi, G, Granchi, F, Laguzzi, E, Maugeri, D, Mazzei, B, Nicita, M, Nieddu, A, Noro, G, Olivari, G, Palummeri, E, Policicchio, D, Postacchini, D, Putzu, P, and Tardi, S

Subjects
Male, Drug Utilization, Drug, medicine.medical_specialty, Drug use, Elderly, Gastrointestinal symptoms, Pharmacoepidemiology, Activities of daily living, Drug-Related Side Effects and Adverse Reactions, Gastrointestinal Diseases, media_common.quotation_subject, Upper Gastrointestinal Tract, Sex Factors, Internal medicine, Activities of Daily Living, Epidemiology, Humans, Medicine, Upper gastrointestinal, Pharmacology (medical), Aged, media_common, Aged, 80 and over, Pharmacology, Polypharmacy, business.industry, Age Factors, social sciences, General Medicine, Pharmacoepidemiology, humanities, Surgery, Italy, General practice, Female, Family Practice, business
Abstract

Objective To evaluate the prevalence of drug use by elderly outpatients in Italy and to identify the association between drug use and gastrointestinal symptoms. Study design and setting The study was carried out by 133 general practitioners (GPs) who referred to 24 geriatric units in Italy. All consenting elderly patients seen at the GPs’ offices were evaluated for gender, age, disability, current medications, and upper gastrointestinal symptoms. Results The study included 5,515 elderly subjects. The prevalence of drug use was 91.6%, and the mean number of drugs taken was 2.86 per person. Both the prevalence and the mean number of drugs significantly increased with advancing age. Regarding gastrointestinal symptoms, 32.7% of patients reported at least one upper gastrointestinal symptom: 25% with indigestion syndrome, 16.2% with abdominal pain, and 14.2% with reflux symptoms. A significantly higher prevalence of symptoms was observed in females, patients who were taking a higher number of drugs, and those who had higher disability. Adjusted multivariate analysis demonstrated that the use of nonsteroidal antiinflammatory drugs, steroids, psycholeptics, diuretics, selective β2 adrenoreceptor agonists or adrenergics, and antiplatelet drugs was significantly associated with upper gastrointestinal symptoms. Conclusion The prevalence of drug use is very high in this elderly outpatient population. The number of drugs and the use of some specific drug classes are significantly associated with the presence of upper gastrointestinal symptoms.

Published
2005
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3. Upper gastrointestinal symptoms and therapies in elderly out-patients, users of non-selective NSAIDs or coxibs

Author

Pilotto, A, Franceschi, M, Vitale, DF, Zaninelli, A, Masotti, G, Rengo, F, Barbagallo, M, Bavazzano, A, Bernabei, R, Biagini, C, Cucinotta, D, Guizzardi, G, Granchi, F, Laguzzi, E, Maugeri, D, Mazzei, B, Nicita, MV, Nieddu, A, Noro, G, Olivari, G, Palummeri, E, Policicchio, D, Postacchini, D, Putzu, P, Tardi, S., ANNONI, GIORGIO, Pilotto, A, Franceschi, M, Vitale, D, Zaninelli, A, Masotti, G, Rengo, F, Annoni, G, Barbagallo, M, Bavazzano, A, Bernabei, R, Biagini, C, Cucinotta, D, Guizzardi, G, Granchi, F, Laguzzi, E, Maugeri, D, Mazzei, B, Nicita, M, Nieddu, A, Noro, G, Olivari, G, Palummeri, E, Policicchio, D, Postacchini, D, Putzu, P, and Tardi, S

Subjects
Male, Drug, medicine.medical_specialty, Gastrointestinal bleeding, Gastrointestinal Diseases, media_common.quotation_subject, Drug Prescriptions, Gastroenterology, Random Allocation, Gastrointestinal Agents, Ambulatory care, Internal medicine, Ambulatory Care, Humans, Medicine, Upper gastrointestinal, Cyclooxygenase Inhibitors, Pharmacology (medical), Medical prescription, Aged, media_common, Gastrointestinal agent, Hepatology, business.industry, Stomach, Anti-Inflammatory Agents, Non-Steroidal, medicine.disease, ADR, Elderly Patients, NSAID, medicine.anatomical_structure, Ambulatory, Female, Family Practice, business
Abstract

Summary Background: The association between coxib or non-steroidal anti-inflammatory drug use with gastrointestinal symptoms and drug prescriptions in ambulatory elderly patients is not well defined. Aim: To evaluate the association between non-steroidal anti-inflammatory drug NSAID and coxib use with gastrointestinal symptoms and therapies in elderly subjects managed by their general practitioner. Materials: The study was carried out by 133 general practitioners in Italy. By using a structured interview, sex, age, physical function, current medications, new drug prescriptions and upper gastrointestinal symptoms were registered from all elderly subjects who were referred to their general practitioners during a 2-week period. The numbers of hospitalizations, gastrointestinal bleeding events and gastrointestinal diagnostic procedures occurring during the last 6-month period were recorded. Results: Included in this study were 5515 elderly subjects. The overall prevalence of drug use was 92%. Musculo-skeletal drugs were taken by 15% of patients; NSAIDs were taken by 6%, and coxibs by 3% of patients. A significantly higher prevalence of upper gastrointestinal symptoms was observed in elderly NSAID users compared with coxib users and non-users of musculo-skeletal drugs (44% vs. 33% vs. 32% respectively, P = 0.001). The prescriptions of drugs for acid-related disorders were significantly higher in patients who were concomitantly taking NSAID rather than coxibs (13% vs. 6%, P

Published
2005
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4. Comparing the prognostic accuracy for all-cause mortality of frailty instruments: a multicentre 1-year follow-up in hospitalized older patients

Author

Pilotto A, Rengo F, Marchionni N, Sancarlo D, Fontana A, Panza F, Ferrucci L, Branca S, Gregorio TD, Manmano M, Spallina G, Laguzzi E, Estienne G, Massone A, Moscato M, Ravera C, Ferrara L, Tommaso GD, Serenella D, Rozzini R, Barbisoni P, Sleiman I, Carrieri V, Devicienti C, Cristofalo R, Argentieri G, Salsi A, Bellotti L, Bernardi R, Nicolino F, Putzu PF, Caddeo G, Coghe F, Riccio D, Mazzei B, Corsonello A, Bari MD, Caldi F, Lopilato E, Tassinari I, Tardi S, Mascolo EP, Abete P, Simione I, Centomo R, Cester A, Scevola M, Lunardelli P, Giordano A, Martini E, Nardelli A, Visioli S, Cherubini A, Dell'Aquila G, Gasperini B, Senin U, Costanza AM, Bavazzano A, Gambardella L, Malin N, Bernabei R, D'Arco C, Gambassi G, Mammarella F, Cascavilla L, Paris F, Scarcelli C, Grasselli C, Brunello P, Cortiana C, Pavin D, Cabodi S, Carlucci R, Grassone D, Colle PD, Lattuada L, Tulliani A., TOIGO, GABRIELE, Pilotto, A, Rengo, F, Marchionni, N, Sancarlo, D, Fontana, A, Panza, F, Ferrucci, L, Branca, S, Gregorio, Td, Manmano, M, Spallina, G, Laguzzi, E, Estienne, G, Massone, A, Moscato, M, Ravera, C, Ferrara, L, Tommaso, Gd, Serenella, D, Rozzini, R, Barbisoni, P, Sleiman, I, Carrieri, V, Devicienti, C, Cristofalo, R, Argentieri, G, Salsi, A, Bellotti, L, Bernardi, R, Nicolino, F, Putzu, Pf, Caddeo, G, Coghe, F, Riccio, D, Mazzei, B, Corsonello, A, Bari, Md, Caldi, F, Lopilato, E, Tassinari, I, Tardi, S, Mascolo, Ep, Abete, P, Simione, I, Centomo, R, Cester, A, Scevola, M, Lunardelli, P, Giordano, A, Martini, E, Nardelli, A, Visioli, S, Cherubini, A, Dell'Aquila, G, Gasperini, B, Senin, U, Costanza, Am, Bavazzano, A, Gambardella, L, Malin, N, Bernabei, R, D'Arco, C, Gambassi, G, Mammarella, F, Cascavilla, L, Paris, F, Scarcelli, C, Grasselli, C, Brunello, P, Cortiana, C, Pavin, D, Cabodi, S, Carlucci, R, Grassone, D, Toigo, Gabriele, Colle, Pd, Lattuada, L, and Tulliani, A.

Subjects
prognostic accuracy, multicentric study, frailty, MPI
Abstract

Background: Frailty is a dynamic age-related condition of increased vulnerability characterized by declines across multiple physiologic systems and associated with an increased risk of death. We compared the predictive accuracy for one-month and one-year all-cause mortality of four frailty instruments in a large population of hospitalized older patients in a prospective multicentre cohort study. Methods and Findings: On 2033 hospitalized patients aged $65 years from twenty Italian geriatric units, we calculated the frailty indexes derived from the Study of Osteoporotic Fractures (FI-SOF), based on the cumulative deficits model (FI-CD), based on a comprehensive geriatric assessment (FI-CGA), and the Multidimensional Prognostic Index (MPI). The overall mortality rates were 8.6% after one-month and 24.9% after one-year follow-up. All frailty instruments were significantly associated with one-month and one-year all-cause mortality. The areas under the receiver operating characteristic (ROC) curves estimated from age- and sex-adjusted logistic regression models, accounting for clustering due to centre effect, showed that the MPI had a significant higher discriminatory accuracy than FI-SOF, FI-CD, and FI-CGA after one month (areas under the ROC curves: FI-SOF = 0.685 vs. FI-CD = 0.738 vs. FI-CGA = 0.724 vs. MPI = 0.765, p,0.0001) and one year of followup (areas under the ROC curves: FI-SOF = 0.694 vs. FI-CD = 0.729 vs. FI-CGA = 0.727 vs. MPI = 0.750, p,0.0001). The MPI showed a significant higher discriminatory power for predicting one-year mortality also in hospitalized older patients without functional limitations, without cognitive impairment, malnourished, with increased comorbidity, and with a high number of drugs. Conclusions: All frailty instruments were significantly associated with short- and long-term all-cause mortality, but MPI demonstrated a significant higher predictive power than other frailty instruments in hospitalized older patients.

Published
2012

5. Health care for older people in Italy: The U.L.I.S.S.E. Project (Un link informatico sui servizi sanitari esistenti per l'anziano - a computerized network on health care services for older people)

Author

Lattanzio F, Mussi C, Scafato E, Ruggiero C, Dell'Aquila G, Pedone C, Mammarella F, Galluzzo L, Salvioli G, Senin U, Carbonin PU, Bernabei R, Cherubini A, Laguzzi E, Cucinotta D, Arnone G, Rozzini R, Cassinadri A, Putzu P, Porceddu C, Zaru C, Abate G, Di Iorio A, Abate M, Guglielmi M, Foschini N, Battaglini C, Fellin R, Volpato S, Cavalieri M, Fotini S, Guerra G, Rossi L, Masotti G, Fumagalli S, Odetti P, Cataldi A, Monacelli F, Nicita Mauro V, Basile G, Maltese G, Nicita Mauro C, Pellicciotti F, Scotto R, Vaccina A, Minnucci A, Forte L, Lo Storoto MR, Licata G, Tuttolomondo A, Barbagallo M, Dominguez LJ, De Leo M, Belvedere M, Putignano E, Longo A, Mancioli G, Patacchini F, Palmari N, Ierardi BA, Marino P, Soldato M, Pilotto A, Paris F, Forconi S, Guerrini M, De Paduanis GA, De Palma A, Boschi S, Molaschi M, Poli L, De Colle P, Bonoldi G, Puricelli S, Pellegrini R, Consolaro E, Bosello O, Zivelonghi A, Gravic G, Guariento S, Di Francesco V, Tua E, Pisaturo A, Lacava R, Gareri P, Borgia R, Cristiano VN, Palummeri, Pescetelli, Galdi M, Bochicchio GB, Solimano A, Brugaletta S, Carnazza L, Gallitto E, Albano G, Schipani G, Conte, Pagella A, Perrero L, Sabato V, Marella L, Schiavina, Zacco B, Scaglia L, Virgilio A, Iera M, Doria, Pansini L, Boni N, Inzitari M, Aramini I, Musante S, Cavagnaro P, Riello F, De Alfieri W, Pescetelli P, Trecca R, Di Iusto, Zamboni V, Cuppone R, Foschi, Marino S, Simone M, Scarlata A, Battegazzore C, Morucci R, Luchetti M, Menculini G, Cichetti G, Orlando I, Fantoni B, Ognibene G, Gobbi C, Cascone A, Avanzi GL, Casu A, Zeni S, Santin S, Scotti G, Cappella C, Penzo P., TOIGO, GABRIELE, Lattanzio, F, Mussi, C, Scafato, E, Ruggiero, C, Dell'Aquila, G, Pedone, C, Mammarella, F, Galluzzo, L, Salvioli, G, Senin, U, Carbonin, Pu, Bernabei, R, Cherubini, A, Laguzzi, E, Cucinotta, D, Arnone, G, Rozzini, R, Cassinadri, A, Putzu, P, Porceddu, C, Zaru, C, Abate, G, Di Iorio, A, Abate, M, Guglielmi, M, Foschini, N, Battaglini, C, Fellin, R, Volpato, S, Cavalieri, M, Fotini, S, Guerra, G, Rossi, L, Masotti, G, Fumagalli, S, Odetti, P, Cataldi, A, Monacelli, F, Nicita Mauro, V, Basile, G, Maltese, G, Nicita Mauro, C, Pellicciotti, F, Scotto, R, Vaccina, A, Minnucci, A, Forte, L, Lo Storoto, Mr, Licata, G, Tuttolomondo, A, Barbagallo, M, Dominguez, Lj, De Leo, M, Belvedere, M, Putignano, E, Longo, A, Mancioli, G, Patacchini, F, Palmari, N, Ierardi, Ba, Marino, P, Soldato, M, Pilotto, A, Paris, F, Forconi, S, Guerrini, M, De Paduanis, Ga, De Palma, A, Boschi, S, Molaschi, M, Poli, L, Toigo, Gabriele, De Colle, P, Bonoldi, G, Puricelli, S, Pellegrini, R, Consolaro, E, Bosello, O, Zivelonghi, A, Gravic, G, Guariento, S, Di Francesco, V, Tua, E, Pisaturo, A, Lacava, R, Gareri, P, Borgia, R, Cristiano, Vn, Palummeri, Pescetelli, Galdi, M, Bochicchio, Gb, Solimano, A, Brugaletta, S, Carnazza, L, Gallitto, E, Albano, G, Schipani, G, Conte, Pagella, A, Perrero, L, Sabato, V, Marella, L, Schiavina, Zacco, B, Scaglia, L, Virgilio, A, Iera, M, Doria, Pansini, L, Boni, N, Inzitari, M, Aramini, I, Musante, S, Cavagnaro, P, Riello, F, De Alfieri, W, Pescetelli, P, Trecca, R, Di, Iusto, Zamboni, V, Cuppone, R, Foschi, Marino, S, Simone, M, Scarlata, A, Battegazzore, C, Morucci, R, Luchetti, M, Menculini, G, Cichetti, G, Orlando, I, Fantoni, B, Ognibene, G, Gobbi, C, Cascone, A, Avanzi, Gl, Casu, A, Zeni, S, Santin, S, Scotti, G, Cappella, C, and Penzo, P.

Subjects
computerized network, Health care, service, elderly
Abstract

Objectives: The U.L.I.S.S.E. study is aimed at describing older patients who are cared for in hospitals, home care or nursing homes in Italy. Design: The U.L.I.S.S.E. study is an observational multicenter prospective 1-year study. Setting: Overall, 23 acute geriatric or internal medicine hospital units, 11 home care services and 31 nursing homes participated in the study. Measurements: The patient’s evaluation was performed using comprehensive geriatric assessment instruments, i.e. the interRAI Minimum Data Set, while data on service characteristics were recorded using ad-hoc designed questionnaires. Results: The older subjects who are in need of acute and long term care in Italy have similar characteristics: their mean age is higher than 80 years, they have a high level of disability in ADL, an important multimorbidity, and are treated with several drugs. The prevalence of cognitive impairment is particularly high in nursing homes, where almost 70% of residents suffer from it and 40% have severe cognitive impairment. On the other hand, there is a shortage of health care services, which are heterogeneous and fragmented. Conclusions: Health care services for older people in Italy are currently inadequate to manage the complexity of the older patients. An important effort should be undertaken to create a more integrated health care system.

Published
2010

6. Health care for older people in Italy: The U.L.I.S.S.E. Project (Un link informatico sui servizi sanitari esistenti per l'anziano - a computerized network on health care services for older people)

Author

Lattanzio, F, Mussi, C, Scafato, E, Ruggiero, C, Dell'Aquila, G, Pedone, C, Mammarella, F, Galluzzo, L, Salvioli, G, Senin, U, Carbonin, Pu, Bernabei, R, Cherubini, A, STUDY GROUP LAGUZZI E, U. L. I. S. S. E., Cucinotta, D, Arnone, G, Rozzini, R, Cassinadri, A, Putzu, P, Porceddu, C, Zaru, C, Abate, G, DI IORIO, A, Abate, M, Guglielmi, M, Foschini, N, Battaglini, C, Fellin, R, Volpato, S, Cavalieri, M, Fotini, S, Guerra, G, Rossi, L, Masotti, G, Fumagalli, S, Odetti, Patrizio, Cataldi, A, Monacelli, Fiammetta, NICITA MAURO, V, Basile, G, Maltese, G, NICITA MAURO, C, Pellicciotti, F, Scotto, R, Vaccina, A, Minnucci, A, Forte, L, LO STOROTO MR, Licata, G, Tuttolomondo, A, Barbagallo, M, Dominguez, Lj, DE LEO, M, Belvedere, M, Putignano, E, Longo, A, Mancioli, G, Patacchini, F, Palmari, N, Ierardi, Ba, Marino, P, Soldato, M, Pilotto, A, Paris, F, Forconi, S, Guerrini, M, DE PADUANIS GA, DE PALMA, A, Boschi, S, Molaschi, M, Poli, L, Toigo, G, DE COLLE, P, Bonoldi, G, Puricelli, S, Pellegrini, R, Consolaro, E, Bosello, O, Zivelonghi, A, Gravic, G, Guariento, S, DI FRANCESCO, V, Tua, E, Pisaturo, A, Lacava, R, Gareri, P, Borgia, R, Cristiano, Vn, Palummeri, Pescetelli, Galdi, M, Bochicchio, Gb, Solimano, A, Brugaletta, S, Carnazza, L, Gallitto, E, Albano, G, Schipani, G, Conte, Pagella, A, Perrero, L, Sabato, V, Marella, L, Schiavina, Zacco, B, Scaglia, L, Virgilio, A, Iera, M, Doria, Pansini, L, Boni, N, Inzitari, M, Aramini, I, Musante, S, Cavagnaro, P, Riello, F, DE ALFIERI, W, Pescetelli, P, Trecca, R, Iusto, Di, Zamboni, V, Cuppone, R, Foschi, Marino, S, Simone, M, Scarlata, A, Battegazzore, C, Morucci, R, Luchetti, M, Menculini, G, Cichetti, G, Orlando, I, Fantoni, B, Ognibene, G, Gobbi, C, Cascone, A, Avanzi, Gl, Casu, A, Zeni, S, Santin, S, Scotti, G, Cappella, C, and Penzo, P.

Subjects
residenzialità, non autosufficienza, cura anziani, servizio sanitario
Published
2010

8. Chemotherapy

Author

Soffietti, Riccardo, Rudà, R., Leoncini, B., Laguzzi, E., and Trevisan, Elisa

Published
2007

9. Natural history and management of brainstem gliomas in adults. A retrospective Italian study

Author

Salmaggi, A., Fariselli, L., Milanesi, I., Lamperti, E., Silvani, A., Bizzi, A., Maccagnano, E., Trevisan, E., Laguzzi, E., Rudà, R., Boiardi, A., Soffietti, Riccardo, and Associazione Italiana di Neuro Oncologia

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Context (language use), Antineoplastic Agents, Fluorodeoxyglucose F18, Glioma, medicine, Brainstem glioma, Image Processing, Computer-Assisted, Brain Stem Neoplasms, Humans, Aged, Retrospective Studies, Temozolomide, Pilocytic astrocytoma, business.industry, Astrocytoma, Brain, Retrospective cohort study, Middle Aged, medicine.disease, Prognosis, Magnetic Resonance Imaging, Survival Analysis, Surgery, Treatment Outcome, Neurology, Italy, Spinal Cord, Positron-Emission Tomography, Disease Progression, Female, Neurology (clinical), Radiology, Radiopharmaceuticals, business, Anaplastic astrocytoma, medicine.drug
Abstract

Brainstem gliomas in adults are rare tumors, with heterogeneous clinical course; only a few studies in the MRI era describe the features in consistent groups of patients. In this retrospective study, we report clinical features at onset, imaging characteristics and subsequent course in a group of 34 adult patients with either histologically proven or clinico-radiologically diagnosed brainstem gliomas followed at two centers in Northern Italy. Of the patients 18 were male, 14 female, with a median age of 31. In 21 of the patients histology was obtained and in 20 it was informative (2 pilocytic astrocytoma, 9 low-grade astrocytoma, 8 anaplastic astrocytoma and 1 glioblastoma). Contrast enhancement at MRI was present in 14 patients. In all of the 9 patients who were investigated with MR spectroscopy, the Cho/NAA ratio was elevated at diagnosis. In 8 of the patients, an initial watch and wait policy was adopted, while 24 were treated shortly after diagnosis with either radiotherapy alone [4] or radiotherapy and chemotherapy [20] (mostly temozolomide). Only minor radiological responses were observed after treatments; in a significant proportion of patients (9 out of 15) clinical improvement during therapy occurred in the context of radiologically (MRI) stable disease. Grade III or IV myelotoxicity was observed in 6 patients. After a follow-up ranging from 9 to 180 months, all but 2 patients have progressed and 14 have died (12 for disease progression, 2 for pulmonary embolism). Median overall survival time was of 59 months. Investigation of putative prognostically relevant parameters showed that a short time between disease onset and diagnosis was related to a shorter survival. Compared with literature data, our study confirms the clinical and radiological heterogeneity of adult brainstem gliomas and underscores the need for multicenter trials in order to assess the efficacy of treatments in these tumors.

Published
2006

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