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Background: Falls in older adults significantly impact overall health and healthcare costs. Intrinsic capacity (IC) reflects functional reserve and is an indicator of healthy aging. Aims: To explore the association between IC and recent falls (≤ 90 days) in community-dwelling octogenarians from the Aging and Longevity in the Sirente geographic area (IlSIRENTE) study. Methods: The Minimum Data Set for Home Care (MDS−HC) and supplementary questionnaires and tests were used to assess the five IC domains: locomotion, cognition, vitality, psychology, and sensory. Scores in each domain were rescaled using the percent of maximum possible score method and averaged to obtain an overall IC score (range 0−100). Results: The study included 319 participants (mean age 85.5 ± 4.8 years, 67.1% women). Mean IC score was 80.5 ± 14.2. The optimal IC score cut-off for predicting the two-year risk of incident loss of at least one activity of daily living (ADL) was determined and validated in a subset of 240 individuals without ADL disability at baseline (mean age 84.7 ± 4.4 years, 67.1% women). Participants were then stratified into low (< 77.6) and high (≥ 77.6) IC categories. Those with high IC (63.9%) were younger, more often males, and had lower prevalence of recent falls, disability, multimorbidity, and polypharmacy. Logistic regression models including IC as a continuous variable revealed a significant association between higher IC and lower odds of falls. This association was significant in the unadjusted (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94–0.98, p < 0.001), age- and sex-adjusted (OR 0.96, 95% CI 0.94–0.98, p < 0.001), and fully adjusted models (OR 0.96, 95% CI 0.93–0.99, p = 0.003). When considering IC as a categorical variable, unadjusted logistic regression showed a strong association between high IC and lower odds of falls (OR 0.31, 95% CI 0.16–0.60, p < 0.001). This association remained significant in both the age- and sex-adjusted (OR 0.30, 95% CI 0.15–0.59, p < 0.001) and fully adjusted models (OR 0.33, 95% CI 0.16–0.82, p = 0.007). The locomotion domain was independently associated with falls in the unadjusted (OR 0.98, 95% CI 0.97–0.99, p < 0.001), age- and sex-adjusted (OR 0.97, 95% CI 0.96–0.99, p < 0.001), and fully adjusted model (OR 0.98, 95% CI 0.96–0.99, p < 0.001). Discussion: This is the first study using an MDS−HC-derived instrument to assess IC. Individuals with higher IC were less likely to report recent falls, with locomotion being an independently associated domain. Conclusions: Lower IC is linked to increased odds of falls. Interventions to maintain and improve IC, especially the locomotion domain, may reduce fall risk in community-dwelling octogenarians. [ABSTRACT FROM AUTHOR]

The article presents a research paper on the link between physical performance and long-term survival in a cohort of community-dwelling older people from the "Aging and Longevity in the Sirente Geographic Area" study. Topics discussed include the methods used in the study, the definition of long-term survival, and the implications of the study for assessing mortality risk in octogenarians.

One of the main goals of the Italian National Resilience and Recovery Plan (NRRP) is to modernize the economy and the public sector, including the digitalization of public services. Among the many interventions aimed at achieving this goal, the implementation of a national system of Electronic Health Records (EHRs) is both an ambitious and yet overdue objective, having been envisioned for over a decade. Despite the existence of broad agreement on this policy measure, its implementation has turned out to be more challenging than expected, this for constitutional, political and technical reasons. Adopting an interest groups perspective, the aim of this article is to map the positions of the various actors involved in the realization of EHRs in Italy, focusing on the implementation phase of the NRRP, and comparing the two sub-phases corresponding to the different governments in office, namely, the Draghi government (May 2021 – September 2022) and the Meloni government (since October 2022). Having developed a process-tracing analysis, we find that political claims and factors became more salient in the second phase, especially as regards the role of ICT companies in charge of implementing EHRs, despite substantial continuity in terms of policy content. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the psychological impact of the COVID-19 pandemic on healthcare workers (HCWs) in geriatric settings. Design: Online cross-sectional survey. Settings and Participants: 394 geriatric HCWs in Italy. Measurements: The survey was developed by a multidisciplinary team and disseminated in April 2022 to the members of two geriatric scientific societies (Italian Society of Geriatrics and Gerontology and Italian Association of Psychogeriatrics). The survey examined the experiences related to the COVID-19 pandemic, as well as psychological burden and support. Work-related anxiety and distress related to the pandemic were studied using the SAVE-9 scale (Stress and Anxiety to Viral Epidemics). Results: Three hundred sixty-four participants (92.4%) changed their job activity during the pandemic and about half (50.9%) failed to cope with this change, 58 (14.7%) had increased work-related anxiety, and 39 (9.9%) work-related stress levels. Three hundred forty (86.3%) participants reported acute stress reaction symptoms, including irritability, depressed mood, headache, anxiety, and insomnia, and 262 (66.5%) required psychological support, mainly from friends/relatives (57.9%) and/or colleagues (32.5%). Furthermore, 342 participants (86.8%) recognized they would benefit from informal and formal psychological support in case of future similar emergencies. Conclusions: This study highlights the high psychological burden experienced by geriatric HCWs in Italy during the COVID-19 pandemic and emphasizes the need for supportive interventions. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases are the leading cause of mortality, morbidity, and disability in the world, especially in the older adults. A relevant proportion of patients admitted to Cardiac Rehabilitation (CR) may suffer from frailty, a complex geriatric syndrome with multifactorial aetiology. Aims: The hypothesis underlying the study is that frailty complicates the management of older patients undergoing CR. The main objective is, therefore, to determine the relationship between frailty and CR outcomes in hospitalized older adults. Methods: The participants have been recruited among patients aged ≥ 65 years admitted at the hospital for CR. A Comprehensive Geriatric Assessment (CGA)-based Frailty Index (FI) was created following a standard procedure. The outcome was measured as the ratio between 6-min walk test (6MWT) distance at the end of CR and normal predicted values for a healthy adult of same age and gender, according to reference equations. Results: The study population consisted of 559 elderly patients, 387 males (69.2%), with age of 72 (69–76) years. The most frequent diagnosis at admission was ischaemic heart disease (231, 41.5%) and overall 6MWT ratio was 0.62 ± 0.21. At the multivariable regression analysis, gender, diagnosis and FI were significantly and independently associated with 6MWT ratio (p ≤ 0.0001, p ≤ 0.001 and p ≤ 0.0001, respectively), while no significant association emerged for age. Conclusion: FI resulted independently correlated to 6MWT ratio in a population of older patients undergoing in-hospital CR programs. Frailty is a multifactorial geriatric syndrome whose assessment is essential for prognostic evaluation of older patients, also in CR clinical setting. [ABSTRACT FROM AUTHOR]

This paper explores the effects of the pandemic on corruption and mismanagement in Italy, a country where the Covid-19 crisis is supposed to have significantly increased the risk of corruption. It proposes a novel operationalization of safeguards for accountability that are attached to the disbursement of recovery funds. Emergency law decrees and their implementing acts have been coded to assess whether the discretion in the allocation of recovery funds has been constrained by transparency requirements and enforcement provisions. Findings reveal that safeguards for accountability have been strengthened over time but that they have followed various patterns across recovery measures targeting businesses and people. [ABSTRACT FROM AUTHOR]

Aims: The study assesses the reliability of fr-AGILE, a validated rapid tool used for the evaluation of multidimensional frailty in older adults hospitalized with COVID-19. Methods: Two different staff members independently assessed the presence of frailty in 144 patients aged ≥ 65 years affected by COVID-19 using the fr-AGILE tool. The internal consistency of fr-AGILE was evaluated by examining the item-total correlations and the Kuder–Richardson (KR) formula. The inter-rater reliability was evaluated using linear weighted kappa. Results: Multidimensional frailty severity increases with age and is associated to higher use of non-invasive ventilation (p = 0.025), total severity score on chest tomography (p = 0.001) and in-hospital mortality (p = 0.032). Fr-AGILE showed good internal consistency (KR-20 = 0.742) and excellent inter-rater reliability (weighted kappa = 0.752 and 0.878 for frailty score and frailty degree, respectively). Conclusions: fr-AGILE tool can quickly identify and quantify multidimensional frailty in hospital settings for older patient affected by COVID-19. [ABSTRACT FROM AUTHOR]

This article presents a study on the Italian stay-behind network 'Gladio' based on documentary evidence from the Italian secret services made available in recent years. The aim is to re-contextualize the Italian experience with stay-behind networks and use it as a tool to analyse American covert intervention in the country, as well as broader issues of policymaking and strategy. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has demonstrated that a new and unforeseen threat easily outmatched political-administrative systems currently in place. Our commentary on the Italian case contributes to the call for public administration scholars to incorporate crisis management into the main research agendas of the field. We focus on regulatory capacity that is needed to tackle the effects of COVID-19. Under crisis conditions of radical urgency and uncertainty, the Italian regulatory policy has been based on temporary, fast-track procedures. The latter have been regularly applied when Italian governments confront with natural disasters and prompt action is ensured by a repertoire of extraordinary measures running in parallel to burdensome ordinary procedures. We discuss the implications of this "two-track" approach for governance capacity and legitimacy. We also extrapolate existing trends and engage with projection of future developments. [ABSTRACT FROM AUTHOR]

Tectonic processes are widely considered as a mechanism causing carbonate platform margin instabilities leading to the emplacement of mass transport deposits and calciturbidites. However, only few examples establishing a clear link between tectonics and re‐sedimentation processes are known from the literature. The two‐dimensional and three‐dimensional wire‐cut walls of hundreds of quarries extracting ornamental limestones (for example, Perlato di Sicilia) from the Western Sicily Cretaceous Escarpment in Italy expose a series of mass transport deposits. The depositional architecture, spatial facies distribution and sedimentary features of these deposits were studied in detail. Thin section analysis was used to define the microfacies characteristics and to determine the age of the re‐sedimented limestones. Eleven facies types grouped into four facies associations were recognized that defined specific depositional processes and environments. The stratigraphic architecture of the slope was reconstructed using four composite facies successions based on the detailed analysis and correlation of the field sections. The palaeoslope orientation was reconstructed based on the analysis of synsedimentary faults, slump scars and pinch‐out geometries. The Western Sicily Cretaceous Escarpment was strongly influenced by synsedimentary transtensional tectonics in combination with magmatic processes, as suggested by the presence of tuffites and pillow lava intercalations within the re‐sedimented carbonate series. These volcanics point to a major role of crustal shear as a trigger for mass transport deposit emplacement. The facies distribution along the Western Sicily Cretaceous Escarpment delivers new insights into the deformation processes accompanying the crustal extension of the Cretaceous western Tethys realm. [ABSTRACT FROM AUTHOR]

Background The elderly, defined here as subjects aged ≥ 65 years, are among at-risk subjects for whom annual influenza vaccination is recommended. For the 2018/19 season, three vaccine types are available for the elderly in Italy: trivalent inactivated vaccine (TIV), adjuvanted TIV (aTIV) and quadrivalent inactivated vaccines (QIV). No health technology assessment (HTA) of seasonal influenza vaccination in the elderly has previously been conducted in Italy. Methods An HTA was conducted in 2017 to analyze the burden of influenza illness, the characteristics, efficacy, safety and cost-effectiveness of available vaccines and the related organizational and ethical implications. This was then contextualized to the 2018/19 influenza season. Comprehensive literature reviews/analyses were performed and a static mathematical model developed in order to address the above issues. Results In Italy, influenza is usually less common in the elderly than in other age-classes, but the burden of disease is the highest; >10% of infected elderly subjects develop complications, and about 90% of all influenza-related deaths occur in this age-class. All available vaccines are effective, safe and acceptable from an ethical standpoint. However, aTIV has proved more immunogenic and effective in the elderly. Furthermore, from the third payer's perspective, aTIV is highly cost-effective and cost-saving in comparison with TIV and QIV, respectively. Nevertheless, vaccination coverage needs to be improved. Conclusions According to this HTA, aTIV appeared the vaccine of choice in the elderly. HTA should be reapplied whenever new relevant data become available. [ABSTRACT FROM AUTHOR]

Recent evidence supports the concept that progression of chronic heart failure (CHF) depends upon an imbalance of catabolic forces over the anabolic drive. In this regard, multiple hormonal deficiency syndrome (MHDS) significantly has impacts upon CHF progression, and is associated with a worse clinical status and increased mortality. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone Therapy in Heart Failure) Registry (clinicaltrial.gov = NCT02335801) tests the hypothesis that anabolic deficiencies reduce survival in a large population of mild-to-moderate CHF patients. The T.O.S.CA. Registry is a prospective multicenter observational study coordinated by "Federico II" University of Naples, and involves 19 centers situated throughout Italy. Thyroid hormones, insulin-like growth factor-1, total testosterone, dehydroepiandrosterone , and insulin are measured at baseline and every year for a patient-average follow-up of 3 years. Subjects with CHF are divided into two groups: patients with one or no anabolic deficiency, and patients with two or more anabolic deficiencies at baseline. The primary endpoint is the composite of all-cause mortality and cardiovascular hospitalization. Secondary endpoints include the composite of all-cause mortality and hospitalization, the composite of cardiovascular mortality and cardiovascular hospitalization, and change of VO2 peak. Patient enrollment started in April 2013, and was completed in July 2017. Demographics and main clinical characteristics of enrolled patients are provided in this article. Detailed cross-sectional results will be available in late 2018. The T.O.S.CA. Registry represents the most robust prospective observational trial on MHDS in the field of CHF. The study findings will advance our knowledge with regard to the intimate mechanisms of CHF progression and hopefully pave the way for future randomized clinical trials of single or multiple hormonal replacement therapies in CHF. [ABSTRACT FROM AUTHOR]

Background and Aim: Several measurements were taken for frailty classification in geriatric population. 'Frailty index' is based on 'deficits in health,' but it is still not available in Italian version. Thus, the aim of the present work was to validate a version of 'frailty index' for the Italian geriatric community. Methods: The validation of Italian frailty index (IFi) is based on a cohort study that enrolled 1077 non-disabled outpatients aged 65 years or older (81.3 ± 6.5 years) in Naples (Italy). IFi has been expressed as a ratio of deficits present/deficits considered after a comprehensive geriatric assessment. IFi was stratified in light, moderate and severe frailty. Mortality, disability (considering an increase in ADL lost ≥1 from the baseline) and hospitalization were considered at 3, 6, 12, 18 and 24 months of follow-up. Area under curve (AUC) was evaluated for both Fried's and IFi frailty index. Result: At the end of follow-up, mortality increased from 1.0 to 30.3%, disability from 40.9 to 92.3% and hospitalization from 0.0 to 59.0% ( p < 0.001 for trend). Multivariate analysis shows that the relative risk for unit increase in IFi is 1.09 (95% CI = 1.01-1.17, p = 0.013) for mortality, 1.04 (95% CI = 1.01-1.06, p = 0.024) for disability and 1.03 (95% CI = 1.01-1.07, p = 0.041) for hospitalization. AUC is higher in IFi with respect to Fried's frailty index when considering mortality (0.809 vs. 0.658, respectively), disability (0.800 vs. 0.729, respectively) and hospitalization (0.707 vs. 0.646, respectively). Conclusions: IFi is a valid measure of frailty after the comprehensive geriatric assessment in an Italian cohort of non-institutionalized patients. [ABSTRACT FROM AUTHOR]

Objective. Elderly subjects are characterized by a high prevalence of OA and clinical frailty. This study aimed to examine the predictive role of clinical frailty on long-term mortality in elderly subjects with and without OA.Methods. Mortality was evaluated after a 12-year follow-up in 698 subjects with and 590 subjects without OA recruited in 1992. Clinical frailty was assessed according to the Frailty Staging System and stratified in tertiles.Results. After a 12-year follow-up, mortality was 42.2% in subjects without and 55.8% in subjects with OA (P = 0.256). With increasing frailty, mortality increased by 30.5% (P for trend < 0.001) in subjects without and by 45.6% in subjects with OA (P for trend < 0.001). Multivariate analysis showed that frailty [hazard ratio (HR) = 1.49 for each unit of increase, 95% CI 1.32, 1.94, P < 0.001) but not OA (HR = 1.28, 95% CI 0.987, 1.39, P = 0.412) was predictive of long-term mortality. Moreover, when Cox regression analysis was performed, frailty enhanced the risk of long-term mortality for each unit of increase by 32% (HR = 1.32, 95% CI 1.06, 1.65, P = 0.03) in the absence of OA and by 98% in the presence (HR = 1.98, 95% CI 1.63, 2.95, P < 0.01) of OA.Conclusion. Clinical frailty significantly predicts mortality in subjects without OA and even more in those with OA. Thus clinical frailty may be considered a new prognostic factor to identify subjects with OA at high risk of mortality. [ABSTRACT FROM PUBLISHER]

Aim The role of atenolol, a non-vasodilating beta-blocker drug, on long-term mortality in hypertensive older adults is still unclear. The aim of the present study was to evaluate long-term mortality in community-dwelling hypertensive older adults taking atenolol. Methods Long-term mortality after 12-year follow up in isolated hypertensive older adults ( n = 972) was analyzed. The patients were stratified in the presence and absence of atenolol use. Systolic, diastolic and pulse arterial pressure were measured. Results Older adults taking atenolol showed a greater mortality and higher pulse arterial pressure values than those not taking atenolol (73.9% vs 55.0%; P = 0.047 and 74.7 ± 14.1 vs 63.0 ± 14.2 mmHg, P < 0.001, respectively). Cox regression analysis showed that atenolol use (hazard risk 1.91; 95% confidence interval 1.04-4.31; P = 0.04) and pulse arterial pressure (hazard risk 1.02; 95% confidence interval 1.01-1.03; P = 0.032) were predictive of long-term mortality. Conclusions Atenolol use was related to increased mortality in community-dwelling hypertensive Older adults. This increase in mortality risk seems to be related to an increase of pulse arterial pressure. Geriatr Gerontol Int 2014; 14: 153-158. [ABSTRACT FROM AUTHOR]

Objective: Moderate alcohol consumption is related to a reduction of mortality. However, this phenomenon is not well established in the elderly, especially in the presence of chronic heart failure (CHF). The aim of the study was to verify the effect of moderate alcohol consumption on 12-year mortality in elderly community-dwelling with and without CHF. Settings: community-dwelling from 5 regions of Italy. Participants: A cohort of 1332 subjects aged 65 and older. Measurement: Mortality after 12-year follow-up in elderly subjects (≥65 years old) with and without CHF was studied. Moderate alcohol consumption was considered ≤250 ml/day (drinkers). Results: In the absence of CHF (n=947), mortality was 42.2% in drinkers vs. 53.7% in non-drinker elderly subjects (p=0.021). In contrast, in the presence of CHF (n=117), mortality was 86.5% in drinkers vs. 69.7% in non-drinker elderly subjects (p=0.004). Accordingly, Cox regression analysis shows that a moderate alcohol consumption is protective of mortality in the absence (HR=0.79; CI 95% 0.66-0.95; p<0.01) but it is predictive of mortality in the presence of CHF (HR=1.29; CI 95% 1.05-1.97; p<0.05). Conclusions: Our data demonstrates that moderate alcohol consumption is associated with an increased long-term mortality risk in the elderly in the presence of CHF. [ABSTRACT FROM AUTHOR]

The Venice lagoon is the main Manila clam (Venerupis philippinarum) production site in Europe. Following the unsustainable exploitation of this site (free-access fishery) local authorities have been striving to regulate fishing activities and most clams are produced using mollusc culture techniques based on wild spat harvesting and on its seeding in appropriate, designated culture areas. Therefore, the quality and abundance of wild clam stocks are critical factors that could limit the full development of this activity. The present study aims at assessing Manila clam stocks (spat, adults per square meter) using ordinary kriging, in an area of the Venice lagoon located near the Porto Marghera industrial zone. Previous studies have identified this area as one of the most important natural clam settlement sites in the Venice lagoon. The study area was approximately 1085 ha; 46 sampling stations were examined. Stock assessment (animals were grouped by size and age group), biomass and correlation with sediment texture were evaluated. The results obtained and comparisons with studies from the literature enabled an estimation of clam recruitment potential and an analysis of the conservation status of clam stocks. Thereafter, in view of a full reclamation and an ecological restoration of the study area, different measures are proposed for the sustainable use of this area that include the establishment of a biological protection area and a shared and rational management of the nursery area; these measures could potentially increase the sustainability of clam culture in the Venice lagoon. [ABSTRACT FROM AUTHOR]

Objectives: In the last decade, there has been a rapid increase in the number of elderly patients referred for cardiac surgery. Recent studies have identified risk factors for prolonged intensive care unit (ICU) stay in cardiac surgery patients. The aims of this study was to evaluate pre-operative risk factors for ICU stay longer than 3 days in a cardiac surgery elderly population, and whether prolonged ICU stay may influence disability, functional recovery and length of rehabilitation. Methods: Two hundred and fifty elderly (>65 years) cardiac surgery patients were consecutively evaluated at enter in cardiac rehabilitation after ICU dismissal from January 2008 to July 2009. Univariate and multivariate analyses for risk factors were performed for ICU stay longer than 3 days. Thereafter, 6-minute walking test (6MWT), Barthel Index (BI), BIpercent recovery and length of stay (LOS) in rehabilitation were evaluated. Results: Mean age was 72.9±4.8 yrs, 170 (68%) patients underwent cardiac surgery for coronary artery by-pass grafting (CABG), 56 (22A%) for valve replacement and 24 (9.6%) for both CABG and valve replacement. Mean ICU stay was 1.9±1.5 days and 72 patients (28.8%) spent more than 3 days in ICU. Age, New York Heart Association class ≥3, Cumulative Illness Rating Scale (CIRS) score, prevalence of stroke and renal failure were significantly higher in patients with than in those without ICU stay ≥3 days. Off-pump CABG, Physical Activity Scale for the Elderly (PASE), BI and 6MWT were significantly lower in patients with than in those without ICU stay ≥3 days. Multivariate analysis shows that female sex, a NYHA class ≥3, CIRS and PASE score are predictors of ICU stay ≥3 days independently of age, off-pump CABG, stroke and renal failure. Multiple linear regression shows that ICU stay ≥3 days is negatively associated with 6MWT, BI at entry and BI percent recovery, whereas it is positively associated with a longer rehabilitation LOS. Conclusions: Pre-operative comprehensive assessment in the elderly could help to identify predictors of long ICU stay after cardiac surgery. This approach could help to better define the elderly cardiac surgery patients and their needs throughout the cardiac rehabilitation program in order to maximize functional capacity recovery, reducing disability and rehabilitation LOS. [ABSTRACT FROM AUTHOR]

Background: The role of ventricular rate response (VRr) on the incidence of dementia in elderly subjects with cognitive impairment and atrial fibrillation (AF) is not known. Thus, we examined the ability of VRr to predict dementia in cognitively impaired elderly subjects with and without AF. Methods: A total of 358 cognitively impaired elderly subjects (MMSE <24) with and without AF were stratified in low/high (<50/>90) and moderate (>50/<90 bpm) VRr. A 10-year follow-up was performed. Results: Cognitively impaired subjects with dementia at the end of the follow-up were 135 (37.7%): 33 in the presence (75.0%) and 102 (32.5%) in the absence of AF (p < 0.001). Multivariate analysis shows that AF is a strong predictor of dementia (hazard ratio, HR = 4.10; 95% confidence interval, CI = 1.80-9.30, p < 0.001). More importantly, low/high VRr (<50/>90 bpm) is predictive of dementia in the presence (HR = 7.70, 95% CI = 1.10-14.20, p = 0.03) but not in the absence (HR = 1.85; 95% CI = 0.78-4.47; p = 0.152) of AF. Conclusions: This study demonstrates that AF predicts dementia in elderly subjects with cognitive impairment. Moreover, VRr seems to play a key role in the incidence of dementia in cognitively impaired elderly subjects with AF. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Permanent AF is characterized by an increased mortality in elderly subjects with CHF. Moreover, AF increased the risk of mortality also in elderly subjects without CHF. Thus, we examined long-term mortality in community-dwelling elderly people with and without CHF. A total of 1332 subjects aged 65 and older were selected from the electoral rolls of Campania, a region of southern Italy. The relationship between AF and mortality during a 12-year follow-up in 125 subjects with CHF and in 1.143 subjects without CHF were studied. Elderly subjects showed a higher mortality in those with respect to those without AF (72.1% vs. 51.8%; p <0.01). Similarly, elderly subjects without CHF showed a higher mortality in those with respect to those without AF (61.8% vs. 49.8%; p <0.05). In contrast, elderly subjects with CHF showed a similar mortality in those with respect to those without AF (74.7% vs. 82.4%; p =0.234). Multivariate analysis shows that AF was predictive of mortality in all elderly subjects (Hazard Risk=HR=1.39, 95% confidence interval (CI)=1.25–2.82; p <0.001). When the analysis was conducted considering the presence and the absence of CHF, AF was strongly predictive of mortality in elderly subjects without CHF (HR=1.95, 95%CI=1.25–4.51; p <0.001) but not in those with CHF (HR=1.12, 95%CI=0.97–3.69; p =0.321). We concluded that AF is able to predict long-term mortality in elderly subjects. Moreover, AF is strongly predictive of long-term mortality in the absence but not in the presence of CHF. [Copyright &y& Elsevier]

Aims We conducted a population-based cross-sectional study to assess the prevalence of both preclinical and clinical heart failure (HF) in the elderly. Methods and results A sample of 2001 subjects, 65- to 84-year-old residents in the Lazio Region (Italy), underwent physical examination, biochemistry/N-terminal pro brain natriuretic peptide (NT-proBNP) assessment, electrocardiography, and echocardiography. Systolic left ventricular dysfunction (LVD) was defined as left ventricular ejection fraction (LVEF) <50%. Diastolic LVD was defined by a Doppler-derived multiparametric algorithm. The overall prevalence of HF was 6.7% [95% confidence interval (CI) 5.6–7.9], mainly due to HF with preserved LVEF (HFpEF) (4.9%; 95% CI 4.0–5.9), and did not differ by gender. A systolic asymptomatic LVD (ALVD) was detected more frequently in men (1.8%; 95% CI 1.0–2.7) than in women (0.5%; 95% CI 0.1–1.0; P = 0.005), whereas the prevalence of diastolic ALVD was comparable between genders (men: 35.8%; 95% CI = 32.7–38.9; women: 35.0%; 95% CI = 31.9–38.2). The NT-proBNP levels and severity of LVD increased with age. Overall, 1623 subjects (81.1% of the entire studied population) had preclinical HF (Stage A: 22.2% and stage B: 59.1% respectively). A large number of subjects in stage B of HF showed risk factor levels not at target. Conclusions In a population-based study, the prevalence of preclinical HF in the elderly is high. The prevalence of clinical HF is mainly due to HFpEF and is similar between genders. [ABSTRACT FROM AUTHOR]

Background and aims: Elderly subjects are characterized by a high prevalence of chronic obstructive pulmonary disease (COPD) and frailty. This study examined the predictive role of frailty on long-term mortality in elderly subjects with and without COPD. Methods: The study assessed mortality after a 12-year follow-up in 489 subjects with COPD and 799 subjects without COPD, selected in 1992. Frailty was assessed according to the Frailty Staging System scores ranging from 1 to 7. Results: After 12 years' follow-up, mortality was 48.1% in subjects without and 60.7% in subjects with COPD (p<0.001). With increasing frailty, mortality increased from 41.7% to 75.1% (p for trend <0.01) in subjects without and from 54.3% to 97.0% in subjects with COPD (p for trend <0.001). Multivariate analysis showed that both COPD [hazard ratio (HR)=1.34; 95% confidence interval (95% CI)=1.02-1.81; p=0.042] and frailty score (HR=1.69 for each unit of increase; 95% CI=1.42- 2.00; p<0.001) were predictive of long-term mortality. The frailty score also increased the risk of long-term mortality by 34% in the absence of COPD (HR=1.34 for each unit of increase; 95% CI=1.02-1.81; p<0.05) and by 80% in its presence (HR=1.80 for each unit of increase; 95% CI=28-2.53; p<0.001). Conclusions: Long-term mortality was higher in elderly subjects with than in those without COPD. The clinical frailty score also significantly predicted mortality in subjects without and, even more, in those with COPD. Thus, clinical frailty may be considered a new prognostic factor to identify COPD subjects at high risk of mortality. [ABSTRACT FROM AUTHOR]

Several studies have demonstrated a global increase in morbidity and mortality in elderly subjects with low social support or high comorbidity. However, the relationship between social support and comorbidity on long-term mortality in elderly people is not yet known. Thus, the present study was performed to evaluate the relationship between social support and comorbidity on 12-year mortality of elderly people. A random sample of 1288 subjects aged 65–95 years interviewed in 1992 was studied. Comorbidity by Charlson Comorbidity Index (CCI) score and Social Support by a scale in which total score ranges from 0 to 17, assigning to lowest social support the highest score, were evaluated. At 12-year follow-up, mortality progressively increase with low social support and comorbidity increasing (from 41.5% to 66.7% and from 41.2% to 68.3%, respectively; p <0.001). Moreover, low social support progressively increases with comorbidity increasing (and 12.4±2.5 to 14.3±2.6; p <0.001). Accordingly, multivariate analysis shows an increased mortality risk of 23% for each increase of tertile of social support scale (Hazard ratio=HR=1.23; 95% CI=1.01–1.51; p =0.045). Moreover, when the analysis was performed considering different degrees of comorbidity we found that social support level was predictive of mortality only in subjects with the highest comorbidity (HR=1.39; 95% CI=1.082–1.78; p =0.01). Thus, low social support is predictive of long-term mortality in the elderly. Moreover, the effect of social support on mortality increases in subjects with the highest comorbidity. [Copyright &y& Elsevier]

Background and aims: The prevalence of the preclinical phase of dementia varies greatly, according to the diagnostic criteria and assessment procedures applied. The purpose of this study was to estimate the prevalence of cognitive impairment according to the Aging-Associated Cognitive Decline (AACD) diagnostic criteria in an Italian elderly population. Methods: In a multicenter community-based prospective study, 4785 Italian subjects aged 65-84 years, randomly selected from the registries of 12 Italian municipalities, were assessed by personal and informant interviews, physical and neurological examinations and an extensive neuropsychological battery. Results: Of these older subjects, 274 (9.2%) fulfilled all the AACD criteria, whereas 561 (18.8%) fulfilled only 3 of them (AACD-3). When the two groups diagnosed according to AACD criteria (AACD and AACD- 3) were merged, the prevalence was 28.0% (28.3% for men, 27.6% for women). Two other groups of subjects were also identified: a) Subjects with Objective evidence of Cognitive Decline without cognitive complaints (OCD), 508 (17.0%), i.e., subjects with documented neuropsychological deficits, although neither subjects nor informants reported cognitive complaints; and b) Subjects with Cognitive Complaints without objective demonstrable cognitive deficits (CC), 44 (1.5%), i.e., subjects and/or informants reported cognitive complaints without evidence of neuropsychological deficits. Thus, taking into account the additional OCD group, a total of 1343 persons with cognitive impairment without dementia (45.0%) was identified. Conclusions: On the basis of our results, we estimate that 45% of our population-based Italian sample aged 65-84 years had some kind of cognitive deficits without dementia. [ABSTRACT FROM AUTHOR]

Ustica is an island relatively far from continental, industrial and urban settlements and it has been designated as a marine protected area with the aim of preserving the natural diversity of flora and fauna of the surrounding sea. In such an environment, the assessment of the levels and origin of persistent organic pollutants such as polycyclic aromatic hydrocarbons (PAHs) can shed light on the mechanisms and effects of pollutant long-distance transport in the western Mediterranean Sea. PAHs concentrations resulted relatively low when compared with those of other coastal areas of the Mediterranean Sea. The low values of the ratio between low- and high-molecular-weight (LMW and HMW, respectively) PAHs and the fluoranthene and pyrene ratios underlined a pyrolytic origin of these contaminants. The prevalence of HMW-PAHs, however, may also be due to the effect of LMW-PAH preferential degradation during transport and burial into sediments. On the other hand, petrogenic sources prevailed in the past. Whilst PAHs concentrations showed a recent increase, especially at the site close to the port, the estimated sedimentary fluxes of PAHs ranged from 0.5 to 25 μg m−2 year−1. [ABSTRACT FROM AUTHOR]

Variation of polycyclic aromatic hydrocarbons (PAHs) levels was assessed in Tapes philippinarum from the Lagoon of Venice. Clams were transplanted from a polluted area next to Porto Marghera to two rearing areas of the Southern Lagoon. Analyses of PAHs were made in sediments and clams by GC/MS at first sampling and after 30, 60 and 180 days. Principal component analysis was performed to elucidate bioaccumulation and depuration pattern and input sources. Biota-Sediment-Accumulation-Factor (BSAF) was applied to evaluate the PAHs input sources from sediment. Condition index was calculated to compare the seasonal variation of clam tissue to PAHs levels. To propose results not affected by seasonal changes in flesh weight of clams, the approach based on the calculation of PAHs/SW index was applied. From the results, it was concluded that PAHs/SW index is more recommendable to asses temporal variation of PAHs levels in Manila clams. [Copyright &y& Elsevier]

In 2009, the first Italian offshore LNG terminal, located approximately 12 km from the coast of Italy in the Northern Adriatic Sea, started its operation phase. Even if the active chlorine concentration in the discharged seawater is within limits set by Italian regulations (0.2 mg/L), to verify the environmental impact of disinfection by-products (DBPs) on the ecosystem, a specific monitoring program was scheduled from 2010 to 2015. The present study is the first displaying results of DBPs in marine waters of the Adriatic Sea. During the first two years of monitoring activities, DBPs were slightly above limit of quantifications (LOQs) in all investigated matrices and limited to the nearest area around the terminal. In these surveys, bromoform was the most frequently detected compound in seawaters, while haloacetic acid presence, as well as transplanted mussels and fish fauna, mostly characterized sediments. In the following surveys, levels were mostly negligible in all matrices investigated, with values mostly below the specific LOQs of the different compounds. [ABSTRACT FROM AUTHOR]

The article discusses a cross-sectional study at the Department of Public Health in the University of Naples on worksite energy cost assessment in non-surgical versus surgical medical residency programs. Highlights include exclusion of residents with medical conditions with potential impact on energy expenditure from the study, the use of SenseWear Armband to assess the energy cost of each participant during a 12-hour working time, and attributes of the study sample and groups comparisons.

Background: Several tools have been proposed and validated to operationally define frailty. Recently, the Italian Frailty index (IFi), an Italian modified version of Frailty index, has been validated but its use in clinical practice is limited by long time of administration. Therefore, the aim of this study was to create and validate a quick version of the IFi (AGILE).Methods: Validation study was performed by administering IFi and AGILE, after a Comprehensive Geriatric Assessment (CGA) in 401 subjects aged 65 or over (77 ± 7 years). AGILE was a 10-items tool created starting from the more predictive items of the four domains of frailty investigated by IFi (mental, physical, socioeconomic and nutritional). AGILE scores were stratified in light, moderate and severe frailty. At 24 months of follow-up, death, disability (taking into account an increase in ADL lost ≥1 from the baseline) and hospitalization were considered. Area under curve (AUC) was evaluated for both IFi and AGILE.Results: Administration time was 9.5 ± 3.8 min for IFi administered after a CGA, and 2.4 ± 1.2 min for AGILE, regardless of CGA (p < 0.001). With increasing degree of frailty, prevalence of mortality increased progressively from 6.5 to 41.8% and from 9.0 to 33.3%, disability from 16.1 to 64.2% and from 22.1 to 59.8% and hospitalization from 17.2 to 58.7% and from 27.0 to 52.2% with AGILE and IFi, respectively (p = NS). Relative Risk for each unit of increase in AGILE was 56, 44 and 24% for mortality, disability and hospitalization, respectively and was lower for IFi (8, 7 and 4% for mortality, disability and hospitalization, respectively). The AUC was higher in AGILE vs. IFi for mortality (0.729 vs. 0.698), disability (0.715 vs. 0.682) and hospitalization (0.645 vs. 0.630).Conclusions: Our study shows that AGILE is a rapid and effective tool for screening multidimensional frailty, able to predict mortality, disability and hospitalization, especially useful in care settings that require reliable assessment instruments with short administration time. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with research which investigated the precipitating factors in younger and older adults with decompensated chronic heart failure.

Abstract: Objectives: A high falls-related mortality rate in the elderly is not exclusively related to injuries. Moreover, the risk of falls increases with urinary disorders such as nocturia. The aim of this study was to investigate the role of nocturia in falls-related long-term mortality in elderly subjects. Design: Longitudinal study. Setting and Participants: The "Osservatorio Geriatrico Regione Campania" was a cross-sectional study performed in 1992 in Campania, a region of Southern Italy. Main Measurements: Long-term mortality (12 years’ follow-up) in 178 elderly subjects (mean age 74.0 ± 6.3 years) with falls and 1110 elderly subjects (mean age 75.2 ± 6.4 years) without falls at baseline was measured. Subjects were then stratified for the presence/absence of nocturia. Key Results: In our sample, the prevalence of falls was 13.8% and the prevalence of nocturia was 45.7%. Long-term mortality was 51.3% in nonfallers and 62.9% in fallers (P < .05). In the absence of nocturia, long-term mortality was similar in nonfallers and fallers (49.0% vs 46.7%; P = .514, NS). In contrast, in the presence of nocturia, long-term mortality was higher in fallers than in nonfallers (74.5% vs 53.6%; P < .05). Cox regression analysis confirmed the predictive role of falls on long-term mortality in the presence of nocturia (hazard ratio 60; 95% confidence interval 1.01–2.57; P < .05) but not in the absence of nocturia (hazard ratio = 1.27; 95% confidence interval 0.81–1.99; P = .28). Conclusions: Our data suggest that falls are related to an increased risk of long-term mortality in the elderly much more in the presence of nocturia. This phenomenon is probably related to the high comorbidity that usually affects elderly subjects with nocturia. [Copyright &y& Elsevier]

Objectives: Sinonasal inverted papilloma (IP) is an uncommon benign tumour characterised by frequent recurrence and, in approximately 10% of cases, by neoplastic transformation. IP aetiology is unknown but human papillomavirus is detectable in about one quarter of tumours. As some occupational hazards have been reported to be possible risk factors for IP, the aim of this study was to assess risk for sinonasal IP associated with prior exposure to suspected occupational risk factors for sinonasal malignancies., Methods: Between 1996 and 2007, data on incident cases were collected from hospitals throughout the Piedmont region of Italy by the regional sinonasal cancer registry. A questionnaire on occupational history, completed by 127 cases and 337 hospital controls, was used to assign previous exposure to a list of 17 occupational hazards. The relationship between IP and cumulative exposure to these hazards was explored using unconditional logistic regression to statistically adjust for age, sex, area of residence, smoking and co-exposures., Results: The risk of IP was significantly increased for ever exposure to welding fumes (OR 2.14) and organic solvents (OR 2.11) after controlling for potential confounders. For organic solvents only, a significant association with continuous cumulative exposure and a significant trend in risk across ordered cumulative exposure categories was found., Conclusions: The present study revealed a significant association and a significant dose-response relationship between occupational exposure to organic solvents and IP. The lack of a dose-response relationship for welding fumes suggests that the observed association with ever exposure should be interpreted with caution.

Background: Familial Adenomatous Polyposis in an autosomal dominant disease in which the large bowel is carpeted by polyps of various dimensions appearing during the second or third decade of life. Several extracolonic manifestations complete the clinical spectrum of Familial Adenomatous Polyposis. If untreated, the disease leads invariably to colorectal cancer. The gene responsible for the disease, adenomatous Polyposis Coli, has been localized at chromosome 5q21., Aims: To describe the clinical features of 156 Familial Adenomatous Polyposis patients (from 41 families) and to analyze possible correlations between genotype and phenotype., Patients and Methods: Familial Adenomatous Polyposis was defined as the presence of 100 or more polyps in the large bowel. In 17 families (41%), the proband was the only affected individual (single cases). Adenomatous Polyposis Coli gene mutations were studied on DNA extracted from peripheral white blood cells and evaluated by polymerase chain reaction single strand conformation polymorphism, followed by direct sequencing of samples showing abnormal banding at single strand conformation polymorphism., Results: The large majority of Familial Adenomatous Polyposis patients underwent surgery; colectomy with ileorectal anastomosis was the most frequent approach, however, cancer of the rectal stump developed in 11.6% of patients submitted to colectomy and ileorectal anastomosis. Adenomas were rare in the stomach (8.8%), but their frequency increased in the duodenum (33.8%) and jejunum (55.0%, chi 2 for trend 23.7, p < 0.001). Desmoid tumours were diagnosed in 17 patients (10.9% of the total) and in 6 families. Mutations of the Adenomatous Polyposis Coli gene were studied in 20 out of 25 families (80%) and on a total of 75 individuals. The most frequent alterations were 1 to 5 bp deletions leading to stop codons and truncated proteins. Desmoid tumours, presence of duodenal or jejunal adenomas were associated with an ample range of mutations, from codon 215 to codon 1464. In contrast, particularly severe polyposis (mean age at appearance of polyps 11-16 years, and of cancer development 27-32 years) was associated with a "hotspot" mutation site at codons 1303-1309., Conclusions: In patients with Familial Adenomatous Polyposis, subtotal colectomy with ileorectal anastomosis is still the treatment of choice. Adenomatous lesions seem to show a "gradient" distribution from the stomach to the large bowel. Desmoid tumours are relatively common, though their incidence is limited to some of the families. Constitutional mutations can be detected in 80% of the investigated families. Genotype-phenotype correlations showed a hot-spot at codons 1303-1309, frequently associated with severe polyposis.