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Background. Hip fracture injury is one of the principal health problems affecting the elderly. Patients reporting hip fractures often show relevant comorbidities leading to prolonged hospital stay, significant complications and higher mortality rates. This study aims to assess the risk factors associated with prolonged hospitalization after hip fracture, in-hospital mortality and transfers to other facilities. Study design. Retrospective cross-sectional study. Methods. The study considered all admissions performed between 2006 and 2015 in Abruzzo region, Italy. Logistic regression analyses were performed to evaluate odds ratios for each risk factor as predictor of in-hospital mortality, length of stay, and transfer to other facilities. Results. Age over 85 (OR=5.38) and cancer (OR=3.62) were identified as the strongest risk predictors for in hospital mortality; diabetes (OR=2.24) and heart failure (OR=1.57) were identified as predictors of prolonged length of stay and age over 85 (OR=1.38) and atrial fibrillation (OR=1.69) were identified as predictors of transfer to other facilities. Conclusions. With the rising incidence of hip fractures, identification of modifiable factors may help to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background. Recent trials and reviews have raised question about the safety of total parenteral nutrition (TPN), due to the increased rate of TPN related complications. Diabetic patients are vulnerable to hyperglycaemia, and poor studies have investigated hospital outcomes of diabetic patients requiring TPN. The aim of this study was to evaluate the association of in-hospital mortality, prolonged length of stay and transfer to long-term care facilities among diabetic patients with TPN. Methods. The study considered all hospital admissions of diabetic patients over 65 years of age performed between 2006 and 2015 in Abruzzo Region, Italy. To compare the outcomes of TPN and non-TPN patients, a propensity score matching procedure was performed. Results. A total of 140,556 admissions were analyzed. After matching, 1947 patients were included into the analyses: 649 patients with TPN and 1298 controls. TPN was significantly associated to in-hospital mortality (OR=7.15; 95%CI 5.54-9.22), prolonged LOS (OR=2.78; 95%CI 2.28-3.38) and transfer to LTCF (OR=2.16; 95%CI 1.64-2.85). Discussion. TPN is associated with poor outcomes among elderly diabetic patients in the Italian setting. Being aware of the risk factors among diabetic patients with TPN can be used to anticipate the patients' needs during the admission and the immediate post-discharge period. [ABSTRACT FROM AUTHOR]

Background. Substance use may influence the onset and course of psychiatric diseases. The “Revolving door” (RD) phenomenon, which indicates repeated hospitalizations of the same patients, has become a public health. Objectives. The aim of this study was detecting the risk factors associated to hospital readmission to psychiatric wards of drug-addicted patients. Methods. The study considered all the admissions performed between 2006 and 2015 in Abruzzo, Italy. Only the hospital discharge registry having code 304 (drug dependence) as diagnosis was taken into account. In addition, only the patients with a psychiatric DRG were included. Results. 325 patients performed 558 psychiatric admissions during the study period (1089 person-years). The analyses of the discharge registry showed “Psychoses” as the main DRG (73.2%). An amount of 119 patients experienced a second psychiatric admission. Psychiatric readmissions were independently predicted by Schizofrenia (HR=2.061) and Anxiety disorders (HR=0.326). Conclusions. Psychiatric hospitalization and readmission are frequent among drug-addicted patients. The subsequent RD phenomenon has become a public health issue, both for health and economic sides. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Hepatitis C virus (HCV) infection is a global epidemic, still highly prevalent in Europe. Given efficacy and safety of HCV therapy by Direct Antiviral Agents (DAA), World Health Organization called for actions to eliminate HCV infection. A limit is represented by access to care, mostly due to the high costs of medicines. In Italy, in 2015, the access to DAA therapy was reimbursed for patients with advanced disease, whereas in 2017 universal access was granted. The aim of this study was to analyse changes in patient recruitment trends treated with DAA with or without limitations to access to therapy. PATIENTS AND METHODS: 165,105 patients treated with DAA in Italy from 2015 to December 2018 were analysed. Daily patient treatment rate was obtained by segmented regression of interrupted time series analysis. RESULTS: 74,199 patients with advanced disease (62% with cirrhosis) had access to the therapy during the time period from 2015 to 2017. Following the extension of reimbursement criteria, 90,906 additional patients were treated (43.2% with F0-F1 and 22.9% with F2), with an absolute reduction of 59.9% of patients with advanced disease (cirrhosis decreased to 18.5%). Segmented regression of interrupted time series analysis of daily patient treatment rate showed a progressive reduction of patients with advanced disease, offset by those with initial disease. Notably, elimination of restrictions to therapy did not change the overall treatment rate. CONCLUSIONS: This study showed that a no-limit reimbursement policy for DAAs prescriptions to HCV infected individuals in Italy widened the types of treated patients, but the process towards elimination of HCV infection was not significantly changed. [ABSTRACT FROM AUTHOR]

Aims. This study aimed to assess the trend of hospitalizations for DKA in adult patients with type 2 diabetes mellitus and its associated factors. Design. A retrospective cross-sectional study was performed. Data were collected from hospital discharge records (HDRs) of patients (age =18) with either primary or secondary discharge diagnosis for DKA and type 2 diabetes from 2006 to 2015 in Abruzzo region. Age-adjusted hospitalization rates were computed by gender and standardized on the regional population in 2006. A logistic regression model was implemented using presence of DKA as dependent variable. Results. We identified 160,366 HDRs with type 2 diabetes. Out of them, 1611 (1.00%) were due to DKA. The hospitalization rates for DKA increased both for male +115.9 and female +142.8%, from 2006 to 2015. The most significant predictors of DKA were age 18-44 (aOR=4.17), uncontrolled diabetes (aOR=1.79), trauma (aOR=1.38), any infection (aOR=1.68), liver disease (aOR=1.29), fluid and electrolyte disorders (aOR=2.09), psychosis (aOR=1.69). Conclusions. Trends of DKA in adult patients with type 2 diabetes has been increasing in both male and female. Multimorbidity is an open challenge for public health, therefore better coordination is needed among different specialist consultants to reduce the occurrence of this preventable complication. [ABSTRACT FROM AUTHOR]

Background: In 2020 the Covid-19 pandemic influenced the organization of all health systems, imposing new rules for accessing the hospitals and delaying or reducing the ability to cope with all the population needs. In addition, people with life-threatening conditions deferred care for their fear of contagion. The study aimed to evaluate the indirect impact of Covid-19 on hospitalization rates for cardiovascular diseases in 2020 in Abruzzo. Methods: Data were obtained from the hospital discharge records of all Abruzzo. We analyzed all the hospitalizations included in Major Diagnostic Categories 5 (cardiovascular diseases). First, we distinguished both between public or private hospitalizations and ordinary or day-hospital admissions. Second, we compared the first nine months of 2020 with a mean of the same months in the two previous years. Finally, we calculated the variable percentage. Results: A huge reduction in hospitalization in MCD 5 contest was observed in each subgroup. Specifically, ordinary regimen had a peak of -56,4% in April. Day-hospital admissions were the most affected by Covid-19 with a peak of -84% in April. The largest reduction in hospitalizations occurred in private hospitals, in both ordinary (-81% in April) and DH admissions (-100% in April). A rebound in admissions was reported only for ordinary private regime between June and September, with a peak of + 24% in August. Conclusions: Covid-19 had a severe impact on Abruzzo hospitalizations. The medical conditions that we examined needed effective hospital treatment to avoid adverse outcomes or death. Subsequently, fewer hospitalizations for such medical conditions were almost certainly associated with patient harm. Despite the pandemic, health system leaders should manage to provide subjects with hospital care, when necessary. Key messages: Covid-19 had a significant indirect impact on the rate of hospitalizations for cardiovascular disease in Abruzzo. Despite the pandemic, regional health systems should manage to provide effective hospital care for patients with cardiovascular conditions that require hospitalization. [ABSTRACT FROM AUTHOR]

Background: As a consequence of the Covid-19 outbreak, Italy has adopted unprecedented preventive measures such as large-scale application of social isolation and hospital rearrangements. These measures have led to difficulty in managing diseases and hospitalizations, particularly acute and severe conditions such as neurological morbidities. The aim of the present analysis is to investigate the change in hospital admissions for neurological diseases over the first nine months of 2020 in Abruzzo region. Methods: Data were obtained from the Hospital Discharge Records of all Abruzzo. We analyzed all the hospitalizations included in Major Diagnostic Categories 1 (neurological diseases). First, we distinguished both between public or private hospitalizations and ordinary or day-hospital admissions. Second, we compared the first nine months of 2020 with a mean of the same months in the two previous years. Finally, we calculated the variable percentage. Results: A huge reduction in MCD 1 series hospitalizations was observed in each subgroup. Specifically, ordinary regimen had a peak of -47,3% in April. Day-hospital admissions were the most affected by Covid-19 with a peak of more than 90% in April both in public and private hospitals. The largest reduction occurred in private hospitals, both in ordinary (- 75% in April) and DH admissions (-93,8% in March). Conclusions: Despite the severity of the diseases included in MDC 1 (i.e. ischemic stroke, intracranial hemorrhage), a significant decline was detected in hospital admissions in Abruzzo. Subsequently, a high number of subjects might have not received the necessary health assistance leading to an increase in mortality and morbidity for these severe pathologies. Additionally, patients might have avoided seeking hospital care in response to the fear of contagion triggered either by media or as a result of the stay-at-home government recommendations. Key messages: An alarming reduction in all types of hospitalizations for neurological diseases occurred over the first months of pandemic in Abruzzo. Greater management efforts are needed to reduce the morbidity and mortality rates associated with the reduced hospital admissions during the pandemic. [ABSTRACT FROM AUTHOR]

(1) Background: Herpes zoster (HZ) is a disease caused by the reactivation of the Varicella Zoster Virus (VZV). Clinical reactivation, herpes zoster, takes place in 10-20% of subjects who contracted the primary infection, with a higher risk of developing zoster increasing proportionally with age, especially after 50 years of age. HZ is a common clinical problem, particularly among patients aged over 50 years and immunocompromised patients. Immunocompromised patients and adults could present an atypical and more severe course. In addition, they are at greater risk of complications. For this reason, it is important to understand the real burden of the disease and to identify the subjects who are at higher risk of HZ and its complications, also to direct preventive strategies at the right targets. The aim of the present study is to analyze HZ-related hospitalization trends in Abruzzo in the period of 2015-2021. (2) Methods: Data related to hospital admissions were extracted from the hospital discharge records (HDRs) of the whole region, considering all admissions during the years of 2015-2021. The trends in hospital admissions and length of stay were evaluated and analyzed. (3) Results: A total of 768 hospital discharges with a diagnosis of herpes zoster were registered in Abruzzo during the 7-year study period. During the study period, an increasing trend was observed from the year 2015 to the year 2017, ranging from 8.19 cases/100,000 to 11.5 cases/100,000 (APC (Annual percentage change) +20.8%; 95%CI -2.3; 47.6). After the year 2017, a significantly decreasing trend was observed, reaching 5.46 cases/100,000 in the year 2021 (APC -18.4%; 95%CI -31.5; -12.0). Across the entire study period, an average annual percentage change (AAPC) of -7.0% (95%CI -13.0; -1.3) was observed. (4) Conclusions: Despite the trend of a reduction in hospitalizations, this study highlights that HZ continues to have a great impact on public health. So, it is important to update recommendations for the use of the already available HZ vaccine and to implement new strategies to increase awareness of the prevention of the disease.

(1) Background: The lockdown, imposed to limit the pandemic evolution, impacted the social habits and lifestyle of inhabitants also from many countries other than Italy. Caffeine consumption could be a useful option to improve mood, as the lockdown strongly affected mental health, particularly increasing anxiety and sleep disorders. (2) Methods: It was a cross-sectional study aimed to evaluate the change in caffeine consumption after the pandemic period in a sample of Italian University students. It investigated coffee and products containing caffeine consumption, the anxiety level by State Trait Anxiety Inventory (STAI) and sleep quality with the Insomnia Severity Index (ISS). (3) Results: A total of 404 participants were enrolled in the study. During the lockdown period, 23% of subjects consumed more coffee compared to the pre-pandemic period. Daily coffee consumption also changed after the lockdown period compared to the pre-pandemic period, with 36.1% of subjects that increased their consumption. Comparing other caffeine-based products, energizing supplement consumption showed a greater increase after the lockdown period than energy drinks. Regarding anxiety, subjects who reported increased coffee consumption reported higher STAI scores and ISS. (4) Conclusions: About a quarter of university students increased their consumption of caffeine-based products after the pandemic, reporting higher levels of anxiety and poor sleep quality., Competing Interests: The authors declare no conflict of interest.

(1) Background: Rotavirus is one of the leading causes of severe diarrhea and dehydration in infants and young children worldwide. The economic and social burden of rotavirus-related hospitalizations, particularly among children, remains a pressing concern for healthcare systems across the globe. Healthcare infrastructure and access to medical care can vary significantly within the region. Differences in the availability of healthcare facilities and the quality of care may influence the management and outcomes of rotavirus cases. (2) Methods: This was a retrospective study performed in the Abruzzo region, Italy. The study considered all hospitalization due to rotavirus gastroenteritis that occurred in the Abruzzo region from the year 2015 to 2021. Data were extracted from the hospital discharge records. The trend in hospital admissions, hospitalization costs and length of stay were evaluated and analyzed. (3) Results: A total of 664 admissions were reported during the study period. The incident rate grew till year 2019 with an annual percentage change of +13.9% (95%CI 12.6-15.2, p < 0.001). During the pandemic years, the incident rate showed a significant decrease with an annual percentage change of 12.5% (95%CI 15.5-9.3, p = 0.004). The length of stay of admissions was significantly higher among patients aged less than 1 year. (4) Conclusions: Rotavirus admission represents a heavy burden even in a high-income country such as Italy. These findings have the potential to inform targeted public health interventions, including vaccination strategies, and improve the overall well-being of children.

Introduction: The epidemiological surveillance of mesothelioma incidence is a crucial key for investigating the occupational and environmental sources of asbestos exposure. The median age at diagnosis is generally high, according to the long latency of the disease. The purposes of this study are to analyse the incidence of mesothelioma in young people and to evaluate the modalities of asbestos exposure., Methods: Incident malignant mesothelioma (MM) cases in the period 1993-2018 were retrieved from Italian national mesothelioma registry and analysed for gender, incidence period, morphology and exposure. Age-standardised rates have been calculated and the multiple correspondence analysis has been performed. The association between age and asbestos exposure has been tested by χ 2 test., Results: From 1993 to 2018, 30 828 incident MM cases have been collected and 1278 (4.1%) presented diagnosis at early age (≤50 years). There is a substantial association between age at diagnosis and the type of asbestos exposure and a significantly lower frequency of cases with occupational exposure to asbestos (497 cases vs 701 expected) in young people has been documented. Paraoccupational and environmental exposure to asbestos have been found more frequent in young MM cases (85 and 93 observed cases vs 52 and 44 expected cases, respectively)., Conclusions: Mesothelioma incidence surveillance at population level and the anamnestic individual research of asbestos exposure is a fundamental tool for monitoring asbestos exposure health effects, supporting the exposure risks prevention policies. Clusters of mesothelioma incident cases in young people are a significant signal of a potential non-occupational exposure to asbestos., Competing Interests: Competing interests: CM and DCo reported that they have served as expert witnesses in court trials on asbestos-related diseases., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

The study describes the 466 cases of malignant mesotheliomas (MM) collected by the National Mesothelioma Register (ReNaM) in Italy in the period 1993-2018 relating to subjects with exclusive asbestos exposure in merchant or military navy. The cases among maritime workers represent 1.8% of the total cases with defined exposure registred in the ReNaM, of which 212 cases (45.4%) among merchant maritime workers and 254 cases (54.5%) among navy. The distribution by site of mesothelioma showed 453 (97.2%) MM cases of the pleura, 11 (2.3%) of the peritoneum and 2 (0.4%) of the tunica vaginalis of the testis. With regard to occupational exposure, it was classified as certain in 318 (68.2%) cases, probable in 69 (14.8%) cases and possible in 79 (16.9%) cases. Among the 23 classified jobs, the highest percentages of certain exposures are among naval engineers, motor mechanics, machine captains and sailors. Machine crew accounted for 49.3% of the cases, deck crew for 27.6%. All cases began exposure on board between 1926 and 1988. Seamen were exposed to asbestos while at sea by virtue of living onboard ships and from continual release of asbestos fibers due to the motion of a vessel. Epidemiological surveillance through the ReNaM has allowed us to verify among cases in the maritime, navy and merchant marine sectors, that in the past, subjects were exposed regardless of the ship's department where have provided service therefore all these cases must be considered as occupational diseases.

Background: An increased risk of mesothelioma has been reported in various countries for construction workers. The Italian National Mesothelioma Registry, from 1993 to 2018, reported exposure exclusively in the construction sector in 2310 cases. We describe the characteristics of these cases according to job title., Methods: We converted into 18 groups the original jobs (N=338) as reported by ISTAT codes ('ATECO 91'). The exposure level was attributed at certain, probable and possible in accordance with the qualitative classification of exposure as reported in the Registry guidelines. Descriptive analysis by jobs highlights the total number of subjects for each single job and certain exposure, in descending order, insulator, plumbing, carpenter, mechanic, bricklayer, electrician, machine operator, plasterer, building contractor, painter and labourer., Results: The cases grow for plumbing in the incidence periods 1993-2018, while, as expected, it decreases for insulator. Within each period considered the most numerous cases are always among bricklayers and labourers, these data confirm the prevalence of non-specialised "interchangeable" jobs in Italian construction sector in the past., Conclusions: Despite the 1992 ban, the construction sector still presents an occupational health prevention challenge, circumstances of exposure to asbestos may still occur due to incomplete compliance with prevention and protection measures.

(1) Background: Rotavirus is the leading cause of severe diarrhea and dehydration in infants and young children worldwide. Despite the proven benefits of vaccination, vaccine hesitancy and refusal remains a significant barrier to achieving high vaccination coverage in many countries, such as Italy. (2) Methods: An online survey was conducted among women aged between 18 and 50 years from Abruzzo Region, Italy. The survey was composed of two main sections: demographic characteristics and attitudes and knowledge about rotavirus vaccination, based on a five-point Likert scale. Logistic regression analysis was performed to evaluate factors associated with willingness to get the rotavirus vaccination. (3) Results: A total of 414 women were enrolled in the study. Women who were unaware of rotavirus more frequently had a lower education level (university degree 62.5% vs. 78.7%, p = 0.004) and reported having no children ( p < 0.001). About half of the enrolled women thought that rotavirus infection is dangerous (190, 55.6%) and that rotavirus can cause a serious illness (201, 58.8%). Regarding associated factors, women informed by a physician were more likely get a vaccination compared to women informed by friends or relatives (OR 34.35, 95% CI 7.12-98.98, p < 0.001). (4) Conclusions: The present study showed low levels of knowledge and attitudes towards rotavirus vaccination. These results highlight the need for developing and improving additional public education programs for parents.

(1) Background: The human papillomavirus (HPV) is the most common agent related to sexually transmitted infections in the general population. Its genotypes are classified into two main classes, high-risk genotypes and low-risk genotypes, according to their capacity to induce cancers. The low-risk class (types 6 and 11) is associated with anogenital and genital lesions. The high-risk class is responsible for up to 4.5% of all new cancer cases yearly. The aim of this study was to evaluate the incidence of HPV-related hospitalizations and its trend in a southern Italian region for the years 2015-2021. (2) Methods: This was a retrospective study performed in the Abruzzo region, Italy. All admissions for the period 2015-2021 were extracted from the hospital discharge record (HDR). (3) Results: During the study period (2015-2021), a total of 5492 hospitalizations attributable to HPV infection occurred in the Abruzzo region, Italy. A significant number of admissions were related to cervical cancer (3386 cases) and genital warts (638 cases). The trend declined for all diagnoses except for penile cancer admissions. Considering the first year of the pandemic (year 2020), a decrease in the standardized incidence of the majority of the diseases considered was reported, particularly among cases of cervical cancer. (4) Conclusions: HPV-related hospitalizations decreased in Abruzzo during study period. These results could be useful to LHAs and policy-makers in improving vaccination coverage and screening adherence.

(1) Background: The pandemic had a strong impact on healthcare for other diseases, the so-called collateral damage. This situation heavily impacted the health care system, causing a deferment of surgical admissions. This situation had an immediate and long-term impact on millions of patients with surgical diseases all over the world. The objective of this study was to evaluate the incidence of hospitalizations for colorectal and breast cancers in an Italian region in the year 2020 and compare it with the years 2018−2019. (2) Methods: This retrospective study was performed in the region of Abruzzo, Italy. Monthly number of hospitalizations in the year 2020 was compared with a control period consisting of the average of admissions that occurred in the years 2018−2019 using Poisson regression. (3) Results: A reduction in hospital admissions for all diseases considered was found. In particular, compared with years 2018−2019, admissions for colorectal cancer were 35.71% lower (HRR 0.915; p < 0.001), and admissions for breast cancer were 10.36% lower (HRR 0.895; p < 0.001) (4) Conclusions: The results of this study showed the decrease of admissions for elective oncological surgery during pandemic, suggesting the need of strategic measures to face the burden of future years’ hospitalizations.

Background: Hip fracture injury is one of the principal health problems affecting the elderly. Patients reporting hip fractures often show relevant comorbidities leading to prolonged hospital stay, significant complications and higher mortality rates. This study aims to assess the risk factors associated with prolonged hospitalization after hip fracture, in-hospital mortality and transfers to other facilities., Study Design: Retrospective cross-sectional study., Methods: The study considered all admissions performed between 2006 and 2015 in Abruzzo region, Italy. Logistic regression analyses were performed to evaluate odds ratios for each risk factor as predictor of in-hospital mortality, length of stay, and transfer to other facilities., Results: Age over 85 (OR=5.38) and cancer (OR=3.62) were identified as the strongest risk predictors for in hospital mortality; diabetes (OR=2.24) and heart failure (OR=1.57) were identified as predictors of prolonged length of stay and age over 85 (OR=1.38) and atrial fibrillation (OR=1.69) were identified as predictors of transfer to other facilities., Conclusions: With the rising incidence of hip fractures, identification of modifiable factors may help to reduce morbidity and mortality.

Background and Objectives : The improved life expectancy was associated to the increased in the incidence of hip fractures among elderly people. Subjects suffering hip fractures frequently show concomitant conditions causing prolonged lengths of stay and higher in-hospital mortality. The knowledge of factors associated to in-hospital mortality or adverse events can help healthcare providers improve patients' outcomes and management. The aim of this study was to develop a score to predict in-hospital mortality among hip fractured patients. Materials and Methods : Cases were selected from hospital admissions that occurred during the period 2006-2015 in Abruzzo region, Italy. The study population was split into two random samples in order to evaluate the accuracy of prediction models. A multivariate logistic regression was performed in order to identify factors associated to in-hospital mortality. All diagnoses significantly associated to in-hospital mortality were included in the final model. Results : The PRIMOF ranged between 0 and 27 and was divided into four risk categories to allow the score interpretation. An increase in odds ratio values with the increase in PRIMOF score was reported in both study groups. Conclusions : This study showed that a simple score based on the patient' clinical comorbidities was able to stratify the risk of hip-fractured patients in terms of in-hospital mortality.

(1) Background: Type 2 diabetes is a common comorbidity of chronic obstructive pulmonary disease. Despite the lack of knowledge of the pathophysiological link between diabetes and chronic obstructive pulmonary disease, the presence of diabetes among those with chronic obstructive pulmonary disease is associated with worse outcomes, such as mortality and hospitalization. The aim of this study was to evaluate the impact of chronic obstructive pulmonary disease on in-hospital mortality and prolonged length of stay (PLOS) among patients with diabetes. (2) Methods: The study considered all hospital admissions of patients with diabetes aged over 65 years performed from 2006 to 2015 in Abruzzo, Italy. To compare outcomes between patients with and without chronic obstructive pulmonary disease, a propensity score matching procedure was performed. (3) Results: During the study period, 140,556 admissions of patients with diabetes were performed. After matching, 18,379 patients with chronic obstructive pulmonary disease and 18,379 controls were included in the analyses. Logistic regression analyses showed as chronic obstructive pulmonary disease was associated with in-hospital mortality (OR: 1.10; p = 0.036) and PLOS (OR: 1.18; p = 0.002). (4) Conclusions: In a cohort of Italian patients, diabetic patients with chronic obstructive pulmonary disease were associated with in-hospital mortality and PLOS. The definition of the causes of these differences aims to implement public health surveillance and policies.