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Starting with a collection of traces generated by process executions, process discovery is the task of constructing a simple model that describes the process, where simplicity is often measured in terms of model size. The challenge of process discovery is that the process of interest is unknown, and that while the input traces constitute positive examples of process executions, no negative examples are available. Many commercial tools discover Directly-Follows Graphs, in which nodes represent the observable actions of the process, and directed arcs indicate execution order possibilities over the actions. We propose a new approach for discovering sound Directly-Follows Graphs that is grounded in grammatical inference over the input traces. To promote the discovery of small graphs that also describe the process accurately we design and evaluate a genetic algorithm that supports the convergence of the inference parameters to the areas that lead to the discovery of interesting models. Experiments over real-world datasets confirm that our new approach can construct smaller models that represent the input traces and their frequencies more accurately than the state-of-the-art technique. Reasoning over the frequencies of encoded traces also becomes possible, due to the stochastic semantics of the action graphs we propose, which, for the first time, are interpreted as models that describe the stochastic languages of action traces.

SAFECOMP 2023, Contains fulltext : 297189.pdf (Publisher’s version ) (Open Access), Safety-critical infrastructures must operate safely and securely. Fault tree and attack tree analysis are widespread methods used to assess risks in these systems: fault trees (FTs) are requiredamong others-by the Federal Aviation Administration, the Nuclear Regulatory Commission, in the ISO26262 standard for autonomous driving and for software development in aerospace systems. Attack trees (ATs) are hierarchical diagrams that offer a flexible modelling language used to assess how systems can be attacked. ATs are widely employed both in industry and academia: they are referred to by many system engineering frameworks, e.g. UMLsec and SysMLsec, and are supported by industrial tools such as Isograph's AttackTree. In this paper we will briefly present advancements on logics for property specification on FTs and ATs and pitch the idea of an extended model that combines FTs and ATs: risk propagation graphs.

No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from “TBI Section” of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the “T

South Tyrol (northern Italy) produces around one million metric tons of apple fruit annually and contributes to almost 10% of the European apple harvest. Despite the availability of advanced storage technologies, postharvest diseases of apple may lead to the deterioration of quality and losses of fruit not only during the storage process but also in the course of packing, shipment and shelf-life. In order to decide on a strategy for damage control or to implement plant protection programs, it is crucially important to reliably determine the nature of plant diseases. Apart from the observation of macroscopic symptoms and the application of laboratory-dependent microscopic, microbiological and molecular methods, a variety of novel approaches for the detection of plant diseases and pathogens is being developed. The present study focuses on the potential of information technology to bring the diagnosis process closer to practitioners. Particular attention is paid to the application of computer vision techniques and use of decision support systems. We provide a review of existing implementations of computer-based tools to diagnose plant diseases and present an outline of the “DSSApple” research project, which focuses on the development of a decision support system for the determination of postharvest diseases of apples.

In recent years, there has been a growing interest in the application of foundational ontologies, i.e., formal ontological theories in the philosophical sense, to provide a theoretically sound foundation for improving the theory and practice of conceptual modeling and knowledge representation. This paper addresses one particular foundational theory of events termed UFO-B, which has been successfully employed as a reference model for addressing problems from complex media management, enterprise architecture, software engineering, and modeling of events in petroleum exploration. Despite its success, there is still no formalization of UFO-B in a decidable knowledge representation language that could support reasoning about complex events and event relations. We address this gap by proposing a number of alternative translations from UFO-B's original axiomatization (in first-order logic and in the Alloy formal language) to the description logic SROIQ, which is the formal underpinning of OWL 2 DL. Additionally, to support practical applications, we translated these SROIQ theories to OWL 2 DL TBoxes, which were validated by showing that all the intended models of UFO-B (the logical models of the UFO-B specification in Alloy) that we generated are consistent with these UFO-B TBoxes. In a sense, the specification in Alloy implements the specification in first-order logic, while the OWL 2 TBoxes implement the SROIQ specifications. Incidentally, the methodology that we designed for the translation from UFO-B's original axiomatization in FOL and Alloy to SROIQ came to be a key contribution of this work by providing us evidence of the inadequacy of DLs for the specification of comprehensive foundational ontologies.

Context: The outbreak of the SARS-CoV-2 pandemic of the new COVID-19 disease (COVID-19 for short) demands empowering existing medical, economic, and social emergency backend systems with data analytics capabilities. An impediment in taking advantages of data analytics in these systems is the lack of a unified framework or reference model. Ontologies are highlighted as a promising solution to bridge this gap by providing a formal representation of COVID-19 concepts such as symptoms, infections rate, contact tracing, and drug modelling. Ontology-based solutions enable the integration of diverse data sources that leads to a better understanding of pandemic data, management of smart lockdowns by identifying pandemic hotspots, and knowledge-driven inference, reasoning, and recommendations to tackle surrounding issues.Objective: This study aims to investigate COVID-19 related challenges that can benefit from ontology-based solutions, analyse available tool support, and identify emerging challenges that impact research and development of ontologies for COVID-19. Moreover, reference architecture models are presented to facilitate the design and development of innovative solutions that rely on ontology-based solutions and relevant tool support to address a multitude of challenges related to COVID-19.Method: We followed the formal guidelines of systematic mapping studies and systematic reviews to identify a total of 56 solutions – published research on ontology models for COVID-19 – and qualitatively selected 10 of them for the review.Results: Thematic analysis of the investigated solutions pinpoints five research themes including telehealth, health monitoring, disease modelling, data intelligence, and drug modelling. Each theme is supported by tool(s) enabling automation and user-decision support. Furthermore, we present four reference architectures that can address recurring challenges towards the development of the next generation of ontology-based solutions for COVID-19 a

Context: The outbreak of the SARS-CoV-2 pandemic of the new COVID-19 disease (COVID-19 for short) demands empowering existing medical, economic, and social emergency backend systems with data analytics capabilities. An impediment in taking advantages of data analytics in these systems is the lack of a unified framework or reference model. Ontologies are highlighted as a promising solution to bridge this gap by providing a formal representation of COVID-19 concepts such as symptoms, infections rate, contact tracing, and drug modelling. Ontology-based solutions enable the integration of diverse data sources that leads to a better understanding of pandemic data, management of smart lockdowns by identifying pandemic hotspots, and knowledge-driven inference, reasoning, and recommendations to tackle surrounding issues.Objective: This study aims to investigate COVID-19 related challenges that can benefit from ontology-based solutions, analyse available tool support, and identify emerging challenges that impact research and development of ontologies for COVID-19. Moreover, reference architecture models are presented to facilitate the design and development of innovative solutions that rely on ontology-based solutions and relevant tool support to address a multitude of challenges related to COVID-19.Method: We followed the formal guidelines of systematic mapping studies and systematic reviews to identify a total of 56 solutions – published research on ontology models for COVID-19 – and qualitatively selected 10 of them for the review.Results: Thematic analysis of the investigated solutions pinpoints five research themes including telehealth, health monitoring, disease modelling, data intelligence, and drug modelling. Each theme is supported by tool(s) enabling automation and user-decision support. Furthermore, we present four reference architectures that can address recurring challenges towards the development of the next generation of ontology-based solutions for COVID-19 a

Context: The outbreak of the SARS-CoV-2 pandemic of the new COVID-19 disease (COVID-19 for short) demands empowering existing medical, economic, and social emergency backend systems with data analytics capabilities. An impediment in taking advantages of data analytics in these systems is the lack of a unified framework or reference model. Ontologies are highlighted as a promising solution to bridge this gap by providing a formal representation of COVID-19 concepts such as symptoms, infections rate, contact tracing, and drug modelling. Ontology-based solutions enable the integration of diverse data sources that leads to a better understanding of pandemic data, management of smart lockdowns by identifying pandemic hotspots, and knowledge-driven inference, reasoning, and recommendations to tackle surrounding issues.Objective: This study aims to investigate COVID-19 related challenges that can benefit from ontology-based solutions, analyse available tool support, and identify emerging challenges that impact research and development of ontologies for COVID-19. Moreover, reference architecture models are presented to facilitate the design and development of innovative solutions that rely on ontology-based solutions and relevant tool support to address a multitude of challenges related to COVID-19.Method: We followed the formal guidelines of systematic mapping studies and systematic reviews to identify a total of 56 solutions - published research on ontology models for COVID-19 - and qualitatively selected 10 of them for the review.Results: Thematic analysis of the investigated solutions pinpoints five research themes including telehealth, health monitoring, disease modelling, data intelligence, and drug modelling. Each theme is supported by tool(s) enabling automation and user-decision support. Furthermore, we present four reference architectures that can address recurring challenges towards the development of the next generation of ontology-based solutions for COVID-19 a

In the modern era evidence-based medicine, guidelines and recommendations represent a key-point of daily activity. The Spinal Section of the Italian Society of Neurosurgery introduced some recommendations regarding Degenerative Lumbar Spine Stenosis based on those of the Spine Committee of World Federation of Neurosurgical Societies, revising them on the basis of Italian common practice. In June 2019, a Committee of 21 spine surgeons met in Rome to validate the recommendations of the WFNS. Furthermore, they decided to review the ones that did not reach a consensus to create Italian Recommendations on Degenerative Lumbar Spine Stenosis. A literature review of the last ten years was performed and the statements were voted using the Delphi method. Forty-one statements were discussed, and 7 statements were voted again to reach a consensus with respect to those of the WFNS. A total of 40 statements reached a consensus, of which 36 reached a positive consensus and 4 a negative consensus, while no consensus was reached in 1 case. Conservative multimodal therapy, tailored on the patient, is a reasonable and effective first option choice for the treatment of LSS patients with tolerable moderate symptoms. Surgical treatment is reserved for symptomatic patients non-responding to conservative treatment or with neurological deficits. The best surgical technique to use depends on personal experience; modern MISS techniques are equivalent to open decompressive surgery with some advantages and higher cost-effectiveness. Fusion surgery and mobility preserving surgery only have a marginal role in the treatment of DLSS without instability.

No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from “TBI Section” of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the “T

In recent years, there has been a growing interest in the application of foundational ontologies, i.e., formal ontological theories in the philosophical sense, to provide a theoretically sound foundation for improving the theory and practice of conceptual modeling and knowledge representation. This paper addresses one particular foundational theory of events termed UFO-B, which has been successfully employed as a reference model for addressing problems from complex media management, enterprise architecture, software engineering, and modeling of events in petroleum exploration. Despite that, there is still no formalization of UFO-B in a decidable knowledge representation language that could support reasoning about complex events and event relations. We address this gap by proposing a number of alternative translations from UFO-B's original axiomatization (in first-order logic and in the Alloy formal language) to the description logic SROIQ, which is the formal underpinning of OWL 2 DL. Additionally, to support practical applications, we translated these SROIQ theories to OWL 2 DL TBoxes, which were validated by showing that all the intended models of UFO-B (the logical models of the UFO-B specification in Alloy) that we generated are consistent with these UFO-B TBoxes.

[EN] This paper conducts an empirical study that explores the differences between adopting a traditional conceptual modeling (TCM) technique and an ontology-driven conceptual modeling (ODCM) technique with the objective to understand and identify in which modeling situations an ODCM technique can prove beneficial compared to a TCM technique. More specifically, we asked ourselves if there exist any meaningful differences in the resulting conceptual model and the effort spent to create such model between novice modelers trained in an ontology-driven conceptual modeling technique and novice modelers trained in a traditional conceptual modeling technique. To answer this question, we discuss previous empirical research efforts and distill these efforts into two hypotheses. Next, these hypotheses are tested in a rigorously developed experiment, where a total of 100 students from two different Universities participated. The findings of our empirical study confirm that there do exist meaningful differences between adopting the two techniques. We observed that novice modelers applying the ODCM technique arrived at higher quality models compared to novice modelers applying the TCM technique. More specifically, the results of the empirical study demonstrated that it is advantageous to apply an ODCM technique over an TCM when having to model the more challenging and advanced facets of a certain domain or scenario. Moreover, we also did not find any significant difference in effort between applying these two techniques. Finally, we specified our results in three findings that aim to clarify the obtained results. (C) 2018 Elsevier Ltd. All rights reserved.

Image schema profiles are described as clusters of spatiotemporal relationships learned from embodied experiences and function as the gathered conceptual information for event concepts. Looking at such profiles allows not only to model aspects of human conceptualisation but also offers a method to approach event conceptualisation for more formal purposes. This article investigates this research program by looking closer at how humans conceptualise events and specifies three combination methods of image schema profiles that each offer different aspects for concept construction. As a proof of concept, we present an in-depth analysis of the classic commonsense reasoning problem of ‘Cracking an Egg’ as a demonstration of how these profiles can be used in formal knowledge representation. This is formalised using the Image Schema Logic, ISLM, a combined logic targeted at the spatiotemporal relationships present in image schemas.

Formal knowledge representation struggles to represent the dynamic changes within complex events in a cognitively plausible way. Image schemas, on the other hand, are spatiotemporal relationships used in cognitive science as building blocks to conceptualise objects and events on a high level of abstraction. In this paper, we explore this modelling gap by looking at how image schemas can capture the skeletal information of events and describe segmentation cuts essential for conceptualising dynamic changes. The main contribution of the paper is the introduction of a more systematic approach for the combination of image schemas with one another in order to capture the conceptual representation of complex concepts and events. To reach this goal we use the image schema logic ISL, and, based on foundational research in cognitive linguistics and developmental psychology, we motivate three different methods for the formal combination of image schemas: merge, collection, and structured combination. These methods are then used for formal event segmentation where the changes in image-schematic state generate the points of separation into individual scenes. The paper concludes with a demonstration of our methodology and an ontological analysis of the classic commonsense reasoning problem of ‘cracking an egg’.

Image schema profiles are described as clusters of spatiotemporal relationships learned from embodied experiences and function as the gathered conceptual information for event concepts. Looking at such profiles allows not only to model aspects of human conceptualisation but also offers a method to approach event conceptualisation for more formal purposes. This article investigates this research program by looking closer at how humans conceptualise events and specifies three combination methods of image schema profiles that each offer different aspects for concept construction. As a proof of concept, we present an in-depth analysis of the classic commonsense reasoning problem of ‘Cracking an Egg’ as a demonstration of how these profiles can be used in formal knowledge representation. This is formalised using the Image Schema Logic, ISLM, a combined logic targeted at the spatiotemporal relationships present in image schemas.

Formal knowledge representation struggles to represent the dynamic changes within complex events in a cognitively plausible way. Image schemas, on the other hand, are spatiotemporal relationships used in cognitive science as building blocks to conceptualise objects and events on a high level of abstraction. In this paper, we explore this modelling gap by looking at how image schemas can capture the skeletal information of events and describe segmentation cuts essential for conceptualising dynamic changes. The main contribution of the paper is the introduction of a more systematic approach for the combination of image schemas with one another in order to capture the conceptual representation of complex concepts and events. To reach this goal we use the image schema logic ISL, and, based on foundational research in cognitive linguistics and developmental psychology, we motivate three different methods for the formal combination of image schemas: merge, collection, and structured combination. These methods are then used for formal event segmentation where the changes in image-schematic state generate the points of separation into individual scenes. The paper concludes with a demonstration of our methodology and an ontological analysis of the classic commonsense reasoning problem of ‘cracking an egg’.

Conceptual blending has been proposed as the cognitive machinery for concept generation. While computational approaches to conceptual blending have been implemented with some success, the automatic approaches still struggle to consistently produce concepts and blends that ‘make sense’ and have value. Mechanisms and optimality principles for blending have been introduced, yet their formal integration remains sparse. In this paper, we suggest to partly bypass this problem by identifying some conceptual heuristics for blending. This is done through a top-down analysis of three prototypical superheroes, an exemplary domain for conceptual blends and human imagination. We formalise the superheroes and backtrace their properties into their respective input spaces and from there map the inherited properties to cognitive theories for conceptualisation. It is our belief that computational blending systems could greatly benefit from conceptual heuristics for blending, identified in this top-down fashion. As a proof of concept of the identified superhero-blending heuristics, we blend the superhero ‘Flowerman’.

Conceptual blending has been proposed as the cognitive machinery for concept generation. While computational approaches to conceptual blending have been implemented with some success, the automatic approaches still struggle to consistently produce concepts and blends that ‘make sense’ and have value. Mechanisms and optimality principles for blending have been introduced, yet their formal integration remains sparse. In this paper, we suggest to partly bypass this problem by identifying some conceptual heuristics for blending. This is done through a top-down analysis of three prototypical superheroes, an exemplary domain for conceptual blends and human imagination. We formalise the superheroes and backtrace their properties into their respective input spaces and from there map the inherited properties to cognitive theories for conceptualisation. It is our belief that computational blending systems could greatly benefit from conceptual heuristics for blending, identified in this top-down fashion. As a proof of concept of the identified superhero-blending heuristics, we blend the superhero ‘Flowerman’.

Advances in Enterprise Engineering XI: 7th Enterprise Engineering Working Conference, Antwerp, Belgium, Contains fulltext : 201381.pdf (publisher's version ) (Closed access)

7th Enterprise Engineering Working Conference, EEWC 2017, Antwerp, Belgium, May 8-12, 2017, Proceedings, Contains fulltext : 181816.pdf (publisher's version ) (Closed access), This book constitutes the proceedings of the 7th Enterprise Engineering Working Conference, EEWC 2017, held in Antwerp, Belgium, in May 2017. EEWC aims at addressing the challenges that modern and complex enterprises are facing in a rapidly changing world. The participants of the working conference share a belief that dealing with these challenges requires rigorous and scientific solutions, focusing on the design and engineering of enterprises. The goal of EEWC is to stimulate interaction between the different stakeholders, scientists as well as practitioners, interested in making Enterprise Engineering a reality. The 12 full papers and 4 short papers presented in this volume were carefully reviewed and selected from 40 submissions. They were organized in topical sections named: formalisms; standards and laws; business processes; normalized systems and evolvability; ontologies; and organization design.

Advances in Enterprise Engineering XI: 7th Enterprise Engineering Working Conference, Antwerp, Belgium, Contains fulltext : 201381.pdf (publisher's version ) (Closed access)

Contains fulltext : 181816.pdf (publisher's version ) (Closed access), This book constitutes the proceedings of the 7th Enterprise Engineering Working Conference, EEWC 2017, held in Antwerp, Belgium, in May 2017. EEWC aims at addressing the challenges that modern and complex enterprises are facing in a rapidly changing world. The participants of the working conference share a belief that dealing with these challenges requires rigorous and scientific solutions, focusing on the design and engineering of enterprises. The goal of EEWC is to stimulate interaction between the different stakeholders, scientists as well as practitioners, interested in making Enterprise Engineering a reality. The 12 full papers and 4 short papers presented in this volume were carefully reviewed and selected from 40 submissions. They were organized in topical sections named: formalisms; standards and laws; business processes; normalized systems and evolvability; ontologies; and organization design.

Advances in Enterprise Engineering XI: 7th Enterprise Engineering Working Conference, Antwerp, Belgium, Contains fulltext : 201381.pdf (Publisher’s version ) (Closed access)

SUMMARY BACKGROUND: Thromboembolism is a relatively common complication of chronic heart failure (HF) and the place of antiplatelet therapy is uncertain. OBJECTIVES: We characterized the rate of thromboxane and prostacyclin biosynthesis in chronic HF of ischemic origin, with the aim of separating the influence of HF on platelet activation from that of the underlying ischemic heart disease (IHD). PATIENTS AND METHODS: We compared urinary 11-dehydro-thromboxane (TX)B(2), 2,3 dinor 6-keto-PGF(1alpha,) 8-iso-prostaglandin (PG)F(2alpha), and plasma N-terminal pro-brain natriuretic peptide (NT-pro-BNP), asymmetric dimethylarginine (ADMA), and soluble CD40 ligand (sCD40L), in 84 patients with HF secondary to IHD, 61 patients with IHD without HF and 42 healthy subjects. RESULTS: HF patients not on aspirin had significantly higher urinary 11-dehydro-TXB(2) as compared with healthy subjects (P < 0.0001) and IHD patients not on aspirin (P = 0.028). They also showed significantly higher 8-iso-PGF(2alpha) (P = 0.018), NT-pro-BNP (P = 0.021) and ADMA (P < 0.0001) than IHD patients not on aspirin. HF patients on low-dose aspirin had significantly lower 11-dehydro-TXB(2) (P < 0.0001), sCD40L (P = 0.007) and 2,3-dinor-6-keto-PGF(1alpha) (P = 0.005) than HF patients not treated with aspirin. HF patients in NYHA classes III and IV had significantly higher urinary 11-dehydro-TXB(2) than patients in classes I and II, independently of aspirin treatment (P < 0.05). On multiple linear regression analysis, higher NT-pro-BNP levels, lack of aspirin therapy and sCD40L, predicted 11-dehydro-TXB(2) excretion rate in HF patients (R(2) = 0.771). CONCLUSIONS: Persistent platelet activation characterizes HF patients. This phenomenon is related to disease severity and is largely suppressable by low-dose aspirin. The homeostatic increase in prostacyclin biosynthesis is impaired, possibly contributing to enhanced thrombotic risk in this setting.

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.

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.

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 < 0.01). The prescriptions of drugs for acid-related disorders were significantly associated with the presence of upper gastrointestinal symptoms (OR = 1.7, 95% CI = 1.6–1.9), previous gastrointestinal disorders (OR = 1.1, 95% CI = 1.0–1.3) and NSAID use (OR = 1.5, 95% CI = 1.0–2.2), but no coxib use. Conclusion: In this elderly population, upper gastrointestinal symptoms and prescriptions for gastroenterological drugs were higher in non-steroidal anti-inflammatory drug users than coxib users and non-users of

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 < 0.01). The prescriptions of drugs for acid-related disorders were significantly associated with the presence of upper gastrointestinal symptoms (OR = 1.7, 95% CI = 1.6–1.9), previous gastrointestinal disorders (OR = 1.1, 95% CI = 1.0–1.3) and NSAID use (OR = 1.5, 95% CI = 1.0–2.2), but no coxib use. Conclusion: In this elderly population, upper gastrointestinal symptoms and prescriptions for gastroenterological drugs were higher in non-steroidal anti-inflammatory drug users than coxib users and non-users of