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Background: Bio-psycho-social frailty can negatively affect the health status of an ageing population. The integration between community nurses and social services can emphasize community care and prevent the onset of both health and social negative outcomes in the older population. The aim of the paper is to explore the causal association through the analysis of the hospitalization and mortality rate after a pro-active social service integrated by the community nurse., Study Design: A nested case-control study comparing groups of older adults has been carried out. Methods. The paper compares data stem from a cohort followed up by the University of Rome "Tor Vergata" with data from the "Long Live the Elderly!" program (LLE) cohort., Results: One-year standardized mortality rate was 6.5%, 4.7% and 7.5% in the control group, the LLE group and the LLE group integrated by the community nurse (LLE-CN), respectively. One-year hospitalization rate was 15.4%, 15.5% and 10.8% in the control group, the LLE group and the LLE-CN group, respectively., Conclusions: According to our results a social service with a pro-active approach, integrated by the community nurse, appears to be able to reduce mortality and hospitalization in a group of older adults aged>75. The multidimensional assessment of frailty stands for the first step of a new organization of community services.

Introduction: The paper describes the impact on Hospital Admissions of a program targeting the community-dwelling older citizens with social interventions aimed at managing frailty and reducing social isolation., Study Design: The study is quasi-experimental intervention program., Methods: A randomized sample made up by 207 participants (cases) to the Long Live the Elderly program is compared with a cohort of 308 older adults (controls) followed up since 2014 by the University of Tor Vergata. At the enrolment all the participants have been administered a multidimensional questionnaire to assess frailty. After six months, the two groups are compared for the inpatient's admission rate., Results: The percentage of patients who was admitted to the hospital during the first six month of follow up was 9.1% and 8.3% among the controls and the cases respectively. The inpatient's admission rate was higher among the controls (251.6 per 1000 observation/year) than for the cases (167.3). Despite the cases were older than the controls (mean age 83.5, SD±8.1 vs 76.7, SD±7.1; p=0.001), showed a lower percentage of frail/very frail individuals (29.5% vs 33.4%). The multivariate linear regression adjusted for gender, age and frailty showed a reduction of the hospital admission rate associated to the Long Live the Elderly program (p=0.013)., Conclusions: The study suggests the impact on the reduction of acute hospital admission in the first six months of follow up, of a Community-based Program aimed at increasing the social capital of older adults. Further studies with longer follow up are needed to confirm the study results in order to support the hypothesis that the future sustainability of health systems is partially linked to the increase of the social component of community care service.

Introduction: Frailty screening and assessment are a fundamental issue in Public Health in order to plan prevention programs and services., Methodology: By a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aims to develop an updated framework for the main procedures and measurement tools to assess frailty in older adults, paying attention to the use in the primary care setting., Results: The study selected 10 reviews published between January 2010 and December 2016 that define some characteristics of the main tools used to measure the frailty. Within the selected reviews only one of the described tools met all the criteria (multidimensionality, quick and easy administration, accurate risk prediction of negative outcomes and high sensitivity and specificity) necessary for a screening tool., Conclusion: Accurate risk prediction of negative outcomes could be the appropriate and sufficient criteria to assess a tool aimed to detect frailty in the community-dwelling elderly population. A two-step process (a first short questionnaire to detect frailty and a second longer questionnaire to define the care demand at individual level) could represent the appropriate pathway for planning care services at community level.

Background: The population over 64 years of age is the main user of acute hospital care services. The elderly admission rates represent a marker for the appropriateness of the model of care. The aim of this study was to assess trends and determinants of acute in-patient care among the elderly in Italy between 2001 and 2011., Study Design: Retrospective analysis of data included in the Italian Hospital Discharge Form Database., Methods: Data from the Italian Hospital Discharge Form Database, Italian Ministry of Health, for the years 2001, 2006 and 2011 were analyzed for individuals over 64 years of age. Inpatient admission (> 1 day) rates across Italian Regions were calculated and compared with demographic variables and out-of-hospital care indicators. Univariate and multivariate analysis were used to determine independent relationship among variables., Results: From 2001 to 2011 the elderly hospital admission rate decreased from 302.1/1,000 in 2001, to 222.4 in 2011, accounting for an overall decrease of about 28%. The decline in admission rates was less pronounced among individuals > 74 y (26.4%) than among those 65-74 y (32.1%). Hospitalization rates decreased in all Italian administrative regions between 2001 and 2011, even if the hospitalization rates in 2011 were still very different through the different Italian regions, ranging from 180.3/1,000 in Piedmont to 278.1/1,000 in Molise for people > 64 y. The multivariate linear regression was statistically significant in explaining the variations in hospitalization rates among the different Italian administrative regions (F: 3.637; p = 0.024; adjusted R2 = 0.57) and pointed to the role played by the proportion of the elderly (as percentage of the total population, p=0.043) and the rate of variation of acute care beds from 2004 to 2011 (p=0.001). Variables related to community-based care did not show any association with the hospital admissions rate among the elderly., Conclusions: The trend toward decline in elderly inpatient admissions is still present in 2011 as it was in 2001. Determinants of elderly hospital care in Italy are related to the increased number of elderly individuals and the reduction of hospital beds. Out-of-hospital care does not correlate with the variation of in-patient care so the overall care appropriateness could be negatively affected.

Kaposi Sarcoma shows several different clinical and epidemiological patterns. In Sub-Saharan Africa, where the HIV achieves an high prevalence of infection, the KS can be found both in HIV positive than in HIV negative patients, and the diffusion of the HHV8 virus is endemic. The aim of the work is to evaluate the HHV8 seroprevalence in Mozambique. Moreover the relationship of some main indicators, as CD4 and CD8 cells count, HIV viral load, Body Mass Index and haemoglobin values have been calculated in a part of the DREAM Cohort, (HIV positive patients enrolled in the Community of Sant'Egidio program to fight AIDS in the Sub-Saharan Africa). In the HIV positive cohort HHV8 negative and HHV8 positive groups show statistical significance (p < 0.05) in CD4 cells count, a strong significance (p = 0.01) in CD8 cells count and a significance also in Haemoglobin levels (p = 0.35). The difference in Haemoglobin levels (0.5 g/dl) is related more to a statistical than a clinical significance. The study confirms the free circulation of the HHV8 virus in the Mozambican population, with a prevalence rate of 51.1%, similar than that measured in bordering countries. Considering the CD8 value within the HIV positive sub-cohort a strong correlation with the positivity for HHV8 and the immunological status is suggested.

The evaluation of the demand for assistance requires instruments and procedures scientifically validated as being effective. The aim of this paper is to present the results of a survey on the demand for assistance by a sector of the population, with an approach based on validated instruments and standardised procedures. The survey was carried out on a sample of 1,245 elderly persons (610 in Rome and 635 in Viterbo), who represent the over sixty-five year olds, resident in the Local Health Authority Roma D area and in the Local Health Authority of Viterbo. All the subjects were given the questionnaire for the Geriatric Functional Evaluation (GFE). Around 30% of over sixty-five year olds needs assistance. The Final Brief Evaluation indicates that 8% (CL 95%: 7.2-8.8) of the people interviewed need health and social services at the time of the study, and 20.6% more (CL95%: 19.5-21.7), should be carefully monitored in order to provide supportive, even if only social, services. Around 20.7% (CL95% 19.6-21.8) suffers from neurological pathologies and is characterised by a reduced functional capacity, as pointed out by the Multiple Correspondence Analysis. The combination of neuropathy and need of physical rehabilitation service is relevant part of the need for assistance. The approach used makes it possible to find out about situations of frailty in advance, so that a suitable plan of assistance in the area surveyed is possible.

Iron deficiency is the most prevalent nutritional problem of humans. In northern Albania, nutritional deficiencies are widespread among children but there is a lack of biochemical data. The aim of this study was to assess the prevalence rate of the iron deficiency anemia in a sample of northern Albanian children. A group of 112 children aged 6-60 months, recruited during the routine vaccinations, was enrolled in a cross-sectional health examination survey that included venou blood measurements of iron status. The survey was conducted during 2000 in Lezha District. The mean age was 17.1 +/- 10 months, the majority of the children were living in rural areas (61%), 47.8% were female. The mean level of hemoglobin was lower than the reference value (10.3 +/- 1.1). Iron deficiency Anemia occurred in 47 children (47%) and more likely during the first year of the life (51%). Fifty seven children were fed with whole cow's milk, among them 44 were IDA. The risk value to be anemic or iron deficient for infants aged 6 to 12 months that were fed with whole cow's milk before the fourth months of life was high (OR = 6.2 (C.L.1.0-38)). In conclusion, the high prevalence of IDA and the relationship with early feeding of whole cow's milk suggest to consider iron deficiency in infancy and childhood in Albania as an important nutritional public health problem and to implement strategies for his detection, treatment and prevention.

The aim of this study is to analyse the condition of the elderly of Rome through a multidimensional instrument to determine their assistance needs. To this purpose a sample composed by 693 over 65 subjects was selected (430 women and 263 men). The Geriatric Functional Rating Scale of Grauer was administered to them. The questionnaire is divided into 7 sections (physical health, mental health, functional skills, support to the collectivity, type of housing, social relationships and economic situation); they enable to evaluate the dependency level of each subject. On the base of each area score a total score is obtained which divides the elderly into three categories according to their assistance need. The whole information collected in the single areas led to a definition of non self-sufficiency for 4.9% of the interviewed people and of partial self-sufficiency for 5.3%, the rest of the sample turned out composed by subjects able to live in an autonomous way. This sample of elderly (about 10%) is that on which it is possible to intervene with social and/or health home care plans in order to limit institutionalization.

The aim of this study is to analyze the general health state conditions of older people living in Catanzaro, using a multidimensional assessment instrument to determine their social and health needs. To this purpose, a sample of 544 individuals (344 women and 210 men) older than 65 years of age (mean age = 75.3) was selected from the general population. All subjects were administered the OARS (Older Americans Resources and Services) questionnaire that evaluates five areas: physical health, mental health, social resources, economic resources and Activities of Daily Living (ADL). The percentage of subjects with score 3 or more in each area, and therefore identified as partially or totally dependent, is higher in the area of physical health (17.9%) and ADL (16.6%). About 65% of the sample is not disabled in any of the different areas, while 8% is dependent in 3 or more areas. These subjects are partially or totally dependent elderly people, who stay at their own house in precarious conditions, and are able to remain there only because they are helped by informal caregivers. Probably these people are those for whom any domiciliary help is necessary and more urgent in order to support the existing stability and to avoid institutionalization.

In order to assess child malnutrition, an anthropometric cross-sectional survey of children aged 0-36 months was conducted in selected rural, urban and mountainous areas of Northern Albania in May 1997. The results showed a high prevalence of low anthropometric indices in rural and mountainous areas with a trend of similar magnitude in northern rural areas. In Northern Albania child malnutrition is a public health priority. As the main risk factor for underweight we found a recent history of diarrhoea (OR = 2.45) together with female gender (OR = 2.28), rural (OR = 2.09) or mountain (OR = 1.61) residency. Absence of sanitation, marker of poor housing conditions, also showed a significant association (OR = 1.55) with underweight. Low birthweight (OR = 1.12) was confirmed as an important risk factor for underweight condition. In conclusion these findings underline the importance of support appropriate mother and child health and nutritional programmes in rural areas of Northern Albania.

The purpose of this study was to investigate dental conditions and oral hygiene in a population of 369 elderly people residing in Rome--293 females and 76 males--aged between 60 and 99 years (mean 81.9 +/- 8.1). The sample was interviewed following a dental examination. Clinical tests revealed that 40% were totally edentulous, whereas subjects with natural teeth had a mean of 11.4, teeth, of which 1.5 were decayed. Oral hygiene habits were investigated by means of questions on use of dental tools (toothbrush, mouth-wash, dental floss), which were not much used. Moreover, many elderly people reported they had not been to the dentist's recently (86.2% during the last year) because they did not feel it necessary. From this study a rather low level of oral health has emerged, along with a limited knowledge of prevention for dental and periodontal diseases. These results show the need of dental treatment and prevention for the elderly population.