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• The sensibility of the method in diagnosis of sarcopenia was 100%. • ROC analysis showed high accuracy of the method (AUC resulted 0.9). • This method is useful in elderly patients with functional or cognitive impairment. Sarcopenia is a geriatric syndrome related to loss of muscle mass and function, leading to disability, frailty and higher mortality. According to European Working Group on Sarcopenia in Older People (EWGSOP) the diagnosis of sarcopenia requires the assessment of muscle mass, muscle force and function, that is time-consuming and not easily at hand in everyday clinical practice. We propose the B-mode ultrasound measurement of muscle thickness as a quick screening test to assess the presence of sarcopenia. A cross-sectional study was realized, 119 patients (average age 82 years, 50.4% females) from the Department of Internal Medicine of the University Hospital of Siena (Italy) were enrolled. The diagnosis of sarcopenia was assessed according to EWGSOP criteria. Rectus femoris muscle (RFM) thickness (in cm) was measured by ultrasound B-mode scanning. Sensibility and specificity of the test was evaluated and Receiver Operating Analysis (ROC) was performed to assess the accuracy of the test. Average RFM thickness was 0.78 ± 0.26, significantly lower in sarcopenic patients (0.55 ± 0.2 vs. 0.9 ± 0.3; Mann-Whitney; p < 0.001) and females (0.7 ± 0.3 vs 0.86 ± 0.3; Mann-Whitney; p < 0.001). The cut-off point of 0.7 cm for females and 0.9 cm for males was established as a threshold to assess the presence of sarcopenia by ultrasound. Sensibility of ultrasound measurement of RFM thickness was 100%, specificity 64%, positive predictive value (PPV) 64.3% and negative predictive value (NPV) 100%. ROC analysis was performed in order to quantify how accurately RFM thickness can discriminate between sarcopenia and non-sarcopenia state. AUC for all patients was 0.9 and after a comparative analysis for gender higher values for males (0.94 vs. 0.92) were observed. We suggest a screening test for sarcopenia based on the ultrasound measurement of RFM thickness, as a not invasive and easy to perform method even in elderly patients with functional or cognitive impairment. [ABSTRACT FROM AUTHOR]

• An increase in mortality for MS was observed especially for females. • Differences in mortality were observed between Italian geographical areas. • Mortality reflects prevalence and incidence trend. The epidemiology of Multiple Sclerosis (MS) is relevant for health-services planning. Most of MS prevalence and incidence studies in Italy referred to specific geographical areas and periods, whereas mortality data are routinely collected at the national level. The aim was to assess MS mortality trend and geographical differences in Italy from 1980 to 2015. Mortality data were provided by the Italian Institute of Statistics. Due to a low number of annual deaths, mortality data were analysed for both the entire period under study and for sub-periods. Temporal trends were first evaluated using age-adjusted mortality rates (AMRs) comparing each sub-period with the initial one. Then, the annual percent change in mortality was estimated through the joinpoint regression model. Spatial differences between 5 main geographical areas were evaluated using standardized mortality ratios (SMRs). During the study period, 4,959 deaths for males and 7,434 for females were observed. The higher overall AMR was observed for females (F:0.71 vs. M: 0.56 per 100,000 persons per year). Analysing mortality by gender and geographical area, SMRs 〈 100 were observed in South Italy for both sexes, and in Central Italy for males only, whereas SMRs 〉 100 for Islands for both sexes, and in North-East and North-West for females only. The analysis of the mortality trend through AMRs calculated for sub-periods revealed no difference between the first and the last period for males, whereas a significant increase in mortality was observed for females. The joinpoint regression analysis showed a significant decrease in mortality up to 1995 for males (APC -3.23%) and up to 1999 for females, (APC -1.01%), followed by a significant increase for both sexes, but more marked for females (APC +1.9% M, +2.34% F). The increasing trend of mortality for MS, especially for females, may reflect the increase in the prevalence of MS and the improvement in the quality of diagnosis or coding of the cause of death. [ABSTRACT FROM AUTHOR]

Objectives: to define the most frequent health pathways of cases affected by malignant pleural mesothelioma according to those suggested and evaluated by the most recent specific guidelines., Design: epidemiological descriptive study., Setting and Participants: 100 cases histologically or cytologically well defined during 2015-2017 are extracted from the archive of two Regional Mesothelioma Registries: in Tuscany Region (Central Italy) they are randomly extracted, while in Lombardy Region (Northern Italy) cases treated by a highly-specialized health centre are collected., Main Outcome Measures: frequency of the diagnostic and therapeutic procedures; development and application of the checklist with evaluation of the duration of some phases of the predefined pathway., Results: all hospital medical records were collected only for 34 cases in Tuscany and 20 cases in Lombardy. The health examinations were supplied according to each case's health condition and it was not possible to define one or more structured and standardized pathways. The pre-diagnostic phase has a variable duration according to the initial health condition of the patient, also for his/her comorbidity, and to the hospital where he/she was hospitalized at first. The examinations in outpatient services (medical examinations, blood chemistry tests and radiological examinations) are several, but they are specially requested during the pre-diagnostic phase and during the period of chemotherapy. The checklist applied to a subset of Tuscan cases shows a large variation of the length of the pre-diagnostic phase (6-330 days), of the time interval between diagnosis and reporting to mesothelioma registry (1-200 days), and of the survival time (8 days - alive at 31.12.2019)., Conclusions: to obtain the best health pathways for malignant pleural mesotheliomas, it is necessary a strong network among the health regional services with a clinical multiprofessional coordination located in hospitals characterized by a long experience on these cases, and with an active regional monitoring on all clinical, psychological, epidemiological, and legal aspects of the pathway. The regional mesothelioma registries could give a high contribution thanks to their epidemiological skills which are necessary for the monitoring., Competing Interests: None declared

Background: changing of life expectancy at birth (LE) over time is an important indicator of welfare and healthcare infrastructure of a Country., Objectives: to evaluate the impact of age and cause-specific mortality on the change in LE in the Tuscany Region (Central Italy)., Design: the decomposition of LE gain was realized with Pollard's method, using Epidat software., Setting and Participants: mortality data relative to residents that died during the period 1987-2015 were provided by the Tuscan Regional Mortality Registry. The analyzed causes of death were cardiovascular (CVS), respiratory (RESP), infective (INF) diseases and cancer (TUM)., Main Outcome Measures: changing of LE expressed in years in relation to cause and age-specific mortality., Results: the overall LE gain was 6.5 years for males and 4.3 years for females, the major gain was observed in the age groups 65-89 years (for females 75-89 years) and <1 year. The highest gain (2.6 years) was attributable to the reduction of mortality for CVS, followed by TUM (males: 1.42 vs females: 0.83) and RESP (males: 0.4 vs females: 0.1). The causes responsible for the loss of LE were INF (females: -0.16 vs males: -0.07) and lung cancer in females (-0.13)., Conclusions: the prompt treatment of acute CVS events and prevention (both primary and secondary) are responsible for the gain in LE. The reduction of mortality for TUM can be attributed to the evolution of diagnostic-therapeutic possibilities, but also to the implementation of the cancer screening programmes. Lung cancer was responsible for the loss of LE in Tuscan females; the targeted anti-smoke campaigns should, therefore, be intensified. The INF comported the loss of LE; explainable by diffusion of multi-drug resistant bacteria. The programmes of Hospital Infection Control and Antimicrobial Stewardship should be potentiated to contain the phenomenon.