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The objective of this study was to assess complexity of patients discharged from hospital to intermediate care facility in an Italian setting. Multiple anonymous health-related databases were linked through a stochastic key at individual patient level, in order to study patients discharged from the University Hospital of Udine, Italy, between 2010 and 2019. Patient complexity was measured through diagnosis-related group (DRG) relative weight of each hospitalization, number of chronic conditions and annual use of health resources. 12,674 intermediate care facility admissions were recorded in the study period. Mean DRG weight was 1.54±1.05 with variations depending on the discharging hospital ward. Patients discharged to intermediate facilities had higher DRG weight, had more comorbidities and consumed more health resources than the others, particularly in case of patients discharged from surgical wards. Patients discharged to intermediate care facilities are particularly complex, make extensive use of health resources, and may be difficult to manage. [ABSTRACT FROM AUTHOR]

Background: The lack of epidemiological and clinical data is a major obstacle in health service planning for rare diseases. Patient registries are examples of real-world data that may fill the information gap.Objective: We describe the Rare Disease Registry of the Friuli Venezia Giulia region of Italy and its potential for research and health planning.Methods: The Rare Disease Registry data were linked with information on mortality, hospital discharges, ambulatory care, and drug prescriptions contained in administrative databases. All information is anonymous, and data linkage was based on a stochastic key univocal for each patient. Average annual costs owing to hospitalizations, outpatient care, and medications were estimated.Results: Implementation of the Registry started in 2010, and 4250 participants were registered up to 2017. A total of 2696 patients were living in the region as of January 1, 2017. The overall raw prevalence of rare diseases was 22 per 10,000 inhabitants, with higher prevalence in the pediatric population. The most common disease groups were congenital malformations, chromosomal and genetic syndromes, and circulatory and nervous diseases. In 2017, 30 patients died, 648 were hospitalized, and 2355 received some type of ambulatory care. The total annual estimated cost was approximately €6.5 million, with great variability in the average patient cost across diseases.Conclusions: The possibility of following the detailed real-world care experience of patients with each specific rare disease and assessing the costs related to each step in their care path represents a unique opportunity to identify inefficiencies, optimize care, and reduce waste of resources. [ABSTRACT FROM AUTHOR]

Background: The aims were to assess the frequency of falls among the diabetic adult population of the Italian Northeastern region Friuli Venezia Giulia and to identify risk factors. Methods: This was a population-based retrospective cohort study using administrative data of the regional health information system as the source of information. In a cohort of diabetics 1 8 years of age or more, living in the region on December 31, 2014, the occurrence of falls requiring a visit to the regional Emergency Rooms was assessed. Multivariate logistic regression was used to identify factors associated with increased risk of falling. Results: Of 80,162 cohort subjects, 2967 (3.7%) had at least one fall requiring a visit to ER. Factors associated with increased risk of falling were female sex, older age, prescription of a thiazolidinedione as the last antidiabetic medication in 2014, increasing number of active principles prescribed in 2014, longer diabetes duration, and prescription of certain classes of medications other than antidiabetics in 2014. Conclusions: In Friuli Venezia Giulia, injurious falls are a complication of diabetes relevant from the public health viewpoint. Efforts are needed to screen diabetic patients, review their prescriptions, provide appropriate care, and implement targeted interventions to minimize the individual risk of falls. [ABSTRACT FROM AUTHOR]

SUMMARY Background Disease registries are useful tools for public health planning, evaluating clinical practice and providing information on cohorts of patients. Methods The administrative databases of the regional health information system of Friuli Venezia Giulia, Italy were used to build a regional registry of the resident population in renal replacement therapy (including dialysis and renal transplantation), through an algorithm taking into account hospital discharge and outpatient ambulatory care data. The registry includes an anonymous univocal identifier, the start date for the replacement therapy and changes of status (haemodialysis, peritoneal dialysis, renal transplantation). Data from the registry were used to estimate incidence rate, prevalence and mortality of patients receiving renal replacement therapy in 2014. In addition, we described an example of how the registry can be used to assess the prevalence of selected comorbidities. Results In Friuli Venezia Giulia in 2014, we estimated an incidence rate of renal replacement therapy of 166 per million inhabitants and a prevalence of 1,400 per million inhabitants. A total of 10% of the patients died in the study year. Hypertension, heart disease and diabetes mellitus were common co-morbidities. Conclusion The registry allows us to estimate the incidence rate and prevalence of renal replacement therapy and also to investigate specific issues regarding these patients through record linkage with other administrative health databases. [ABSTRACT FROM AUTHOR]

Objectives: Transient exposure with acute effect has been shown to affect the risk of occupational injuries in various industrial settings and at the healthcare workplace. The objective of this study has been to identify transient exposures related to occupational injury risk in an Italian teaching hospital.Material and Methods: A case-crossover study was conducted among the employees of the University Hospital of Udine who reported an occupational injury, commuting accident, or incident involving biological risk in a 15-month period in the years 2013 and 2014. The matched-pair interval approach was used to assess the role of acute sleep deprivation whereas the usual frequency approach was used for other 13 transient exposures.Results: Sleep hours were not associated with the risk of injuries whereas a significant risk increase was associated with fatigue, rush, distraction, emergency situations, teaching to or being taught by someone, non-compliant patients, bloody operative/work field, excess noise, complex procedures, and anger.Conclusions: We identified transient exposures that increased the risk of occupational injuries in an Italian teaching hospital, providing indications for interventions to increase workers' safety at the healthcare workplace. Int J Occup Med Environ Health 2016;29(6):1001-1009. [ABSTRACT FROM AUTHOR]

Seafood is an important component of healthful human diets. Intake of seafood is recommended both for young women and children. In fact, it is a good source of high-quality protein, low in saturated fats, and rich in essential nutrients (e.g. iodine, iron, choline, and selenium) and long-chain polyunsaturated fatty acids (LCPUFAs), especially omega-3. However, the relationship between maternal diet and the children's dietary habits is controversial. This study investigated the possible association between the seafood consumption by mothers and that by their 8-11 years old children and compared maternal seafood intakes during pregnancy and about 10 years later. The seafood consumption by 37 pregnant women was assessed in 1999-2001. In 2009, mothers were asked to report their weekly intake and their children's. Mother-child pairs showed a similar consumption pattern: the overall intake was 1.28±0.77 vs 1.19±0.64 (p=0.49) while the sum of specific items was 3.71±3.01 vs 3.18±2.90 (p=0.049). However, it cannot be discerned whether maternal diet affected the children's nutritional habits or vice-versa. In fact, mothers showed to have a higher seafood intake about 10 years after pregnancy (3.71 vs 1.83; p<0.001), suggesting that a progressive modification of dietary habits occurred after delivery, possibly due to the influence of maternal diet on the nutritional habits of offspring or due to the presence of children in the family unit, that could have influenced maternal dietary habits. This dietary improvement could be brought forward through educational interventions addressed to young women, that could also allow a more informed choice of the healthier species of fish both for them and their children. [ABSTRACT FROM AUTHOR]

Purpose: We validated the Italian version of the Ureteral Stent Symptoms Questionnaire in male and female patients with an indwelling ureteral stent. Materials and Methods: A double-back translation of the original Ureteral Stent Symptoms Questionnaire was performed by 3 urologists and 4 professional translators. A total of 78 patients (cases) with and 35 healthy subjects without (controls) an indwelling ureteral stent were asked to complete the Italian version of the Ureteral Stent Symptoms Questionnaire and a visual analog scale for pain as well as the International Prostate Symptom Score (men) and Urogenital Distress Inventory-6 plus Incontinence Impact Questionnaire-7 (women). Cases were evaluated at weeks 1 and 4 after stent placement, and at week 4 after removal, while controls were evaluated once. The psychometric properties of the questionnaire were analyzed. Results: A total of 66 cases and 30 controls were suitable for analysis. The questionnaire showed good internal consistency in all domains except global quality of life compared with that of the International Prostate Symptom Score (Cronbach''s α >0.75). Test-retest reliability was good except for the sexual matters domain (Pearson''s coefficient >0.7). Relatively high correlation coefficients (greater than 0.65) were found for the visual analog scale for pain, the International Prostate Symptom Score, the Urogenital Distress Inventory-6 and the Incontinence Impact Questionnaire-7 with the corresponding Ureteral Stent Symptoms Questionnaire domains, suggesting good convergent validity. Sensitivity to change and discriminant validity were also good (p <0.001). Conclusions: The Italian version of the Ureteral Stent Symptoms Questionnaire is a reliable and robust instrument that can be self-administered to male and female Italian patients with an indwelling ureteral stent in the clinical and research settings. [Copyright &y& Elsevier]

Clostridium difficile infections (CDI) are a frequent cause of healthcare-associated infection and are also increasingly described in the outpatient setting. Epidemiological data in Italy have been collected through hospital-based study designs. We aimed at studying the epidemiology of laboratory-confirmed CDI through a population-based analysis in the Italian 500,000-inhabitant province of Udine. Various health administrative databases were linked at the individual patient level through an anonymous stochastic key: laboratory tests, hospital discharges, nursing homes, drug prescriptions. The incidence of CDI in 2018 was calculated as new cases per 100,000 inhabitants and, for cases diagnosed during a hospital or nursing home stay, per 1000 patient admissions and per 10,000 patient-days. The frequency of recurrent infections was also estimated. In the population of Udine, 240 positive tests were observed, corresponding to 225 infection episodes and 185 persons (35 new cases/100,000 population-year). 75.1% of CDI episodes were diagnosed during hospital stays, 8.9% during nursing home stays, and 16.0% in non-institutionalized persons. Among hospital inpatients, the incidence was 2.03/1000 admissions and 2.85/10,000 patient-days; in nursing homes, there were 3.22 cases/1000 admissions and 1.42/10,000 patient-days. 15% of patients had at least one recurrence. Our results are consistent with international incidence estimates and show higher incidence and frequency of recurrence than those reported in a previous hospital-based study conducted in the Hospital of Udine providing insights for diagnosis and prevention of CDIs. • This is a population-based study of C. difficile infections in an Italian area. • Linkage of anonymous administrative databases was performed. • Infections analyzed were laboratory-confirmed. • In-hospital incidence was higher than previously reported in this area. • In-hospital incidence was consistent with international literature. [ABSTRACT FROM AUTHOR]

Background Infant vaccination rates have been declining in Italy over the past 5–7 years. The aims of this study were to assess the trend in the proportions of children unvaccinated at 24 months old, to identify sociodemographic factors associated with non-vaccination; and to examine changes in parental attitudes to vaccination over time. Methods We conducted a population-based birth cohort study by combining existing electronic data sets. The study population consisted of children born from 1995 to 2010 in the Friuli-Venezia Giulia (FVG) region, and from 2007 to 2011 in part of the Emilia Romagna (ER) region, in north-eastern Italy. The immunization registers were linked with the medical birth registers, which contain sociodemographic data on both parents and the newborn. Unconditional logistic regressions were used to identify associations between vaccine uptake at 24 months and maternal sociodemographic variables. Results Of 145,571 babies born in FVG and 75,308 in ER, there were 4222 (1.9%) who had not been vaccinated at all, and 23,948 (11.0%) without the optional measles, mumps and rubella (MMR) vaccination. The number of unvaccinated infants increased over time. Mothers who were over 35 or under 25 years old, unmarried, with a higher formal education, and citizens of highly-developed countries were less compliant with vaccination recommendations in both the regions. A cohort effect was observed in FVG, for both educational level and citizenship: babies born between 1995 and 2000 to mothers without an Italian citizenship and with a lower formal education were more likely to refuse vaccination for their offspring, while this association was reversed between 2006 and 2010. Conclusions Mothers who are Italian citizens and have a good formal education have begun to refuse vaccination for their children in recent years. Future public health action in this setting should target highly educated parents. [ABSTRACT FROM AUTHOR]

Aims: To describe all cases of gestational diabetes mellitus (GDM) managed at the Italian Hospital of San Daniele del Friuli from 2006 to 2018, after the establishment of a dedicated multidisciplinary team.Methods: Data on mothers, pregnancies, and newborns have been recorded since the team establishment. The associations of maternal, pregnancy, and delivery characteristics with complications of pregnancy and delivery and adverse birth outcomes were assessed.Results: 894 cases of GDM were observed, representing 6.8% of all deliveries. More than 20% of women were non-Italian, 5.3% had a previous macrosomic child, 12.5% previous diabetes or GDM, 27.3% family history of diabetes. On average, women had 4 visits at the clinic; mean glycated hemoglobin was 5.3%; starting body mass index (BMI) 26.2 and weight gain 10.3 kg. Cesarean sections were 21.8%. Pre-eclampsia was the most common pregnancy complication (4.7%). 6.0% of newborns were macrosomic and there were 3 fetal deaths. Only 26.3% of women had a post-partum oral glucose tolerance test. Initial BMI, weight gain, nationality, family history of diabetes or previous diabetes-related pregnancy complications were associated with pregnancy complications or adverse outcomes.Conclusions: We identified factors to be targeted for preventing GDM complications. Further efforts should be directed at post-partum. [ABSTRACT FROM AUTHOR]