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Guideline recommendations for COPD management are only partially applied within primary care clinical practice.To compare the COPD management by Italian general practitioners (GPs) according to either the old GOLD (oGOLD) or the new GOLD (nGOLD) guidelines.Observational study in different Italian areas. A total of 176 GPs enrolled their patients with a COPD diagnosis. Questionnaires were used to collect data on: COPD symptoms, disease severity, exacerbations, prescribed pharmacological and non-pharmacological treatments. COPD severity was estimated according to oGOLD and nGOLD guidelines.A total of 526 subjects had complete information to assess COPD severity level according to guidelines (symptoms level, spirometry, history of exacerbations). The investigated subjects were more frequently males (71.2%) with a mean age of 72.5 years, and ex-smokers (44.4%). GPs reported sufficient control of the disease in 47.2% of the subjects with over two exacerbations in the last 12 months. Most patients have moderate COPD (51.5%), according to oGOLD, and belong to D groups (high risk, more symptoms) (45.6%), according to nGOLD. Overall, a low use of post-bronchodilator spirometry (65.1%) and of pulmonary rehabilitation (13.4%) was shown. The results highlighted a low prescriptive appropriateness but with higher value according to nGOLD than oGOLD: 61.4% vs 35.6%.Prescription data only provide limited information to judge prescribing quality, thus the results have to be evaluated with caution; moreover, this study was not designed to assess the difference between oGOLD and nGOLD.Guideline recommendations are applied only partially within clinical practice. A higher prescriptive appropriateness is shown by GPs using nGOLD classification. This might be due to the fact that nGOLD, with respect to oGOLD, takes into account anamnestic usual features considered by GPs in their clinical practice.

Aim: To evaluate the impact of a medical education course (MEC) on the behaviour of general practitioners (GPs) to treat asthma and allergic rhinitis (AR). Methods: Data on 1820 patients (mean age 41yrs ± 17yrs) with asthma or AR were collected by 107 Italian GPs: 50% attended a MEC and 50% didn't (group B). The adherence for AR and asthma treatment was evaluated according to ARIA and GINA guidelines (GL). Results: AR and asthma were diagnosed in 78% and 56% of patients; 34% had concomitant AR and asthma. Regardless of the MEC, the adherence to GL was significantly higher for AR than for asthma treatment (52 versus 19%). Group B GPs were more compliant to ARIA guidelines in the treatment of mild AR, whereas group A were more compliant in the treatment of moderate-severe AR; the adherence didn't differ between the groups for AR patients with comorbid asthma. Adherence to GINA GL for asthma treatment did not differ between GPs of groups A and B, independently from concomitant AR. Though insignificantly, group A were more compliant to GINA GL in the treatment of patients with only severe persistent asthma (63 versus 46%) as group B were for patients with severe persistent asthma and concomitant AR. Conclusions: GPs often tend to treat patients independently from GL. The impact of a single MEC did not improve adherence to GL in treating less severe AR and asthma patients, while there was a trend towards the opposite attitude in more severe AR patients without concomitant asthma. © 2012 Elsevier Ltd. All rights reserved.

The DOREMI Project context and Scientific and Technological objectives are: ? Development of an unobtrusive monitoring environment keeping track of the daily activities of the elderly people at risk of malnutrition, sedentariness and cognitive decline according to the "active ageing lifestyle protocol"(MS1, M8) established by the specialist. ? Development of a smart environment for context awareness and service orientation (MS6, M33) for the dynamic analysis of elderly behaviour and compliance to the active ageing lifestyle protocol. ? Development of a gamified environment to engage the elderly and stimulate social interaction and physical activity (MS7, M24). ? Proof the concept and validate (MS8, M28 and MS9, M36) the effectiveness and impact of the proposed solution in a pilot study carried out in Italy (SI4LIFE) and UK (Extra and Accord), involving both elderly users and care providers.

Most health care systems consider continuing medical education a potential tool to improve quality of care and reduce disease management costs. Its efficacy in general practitioners needs to be further explored.This study assesses the effectiveness of a one-year continuing medical education/continuing professional development course for general practitioners, regarding the improvement in knowledge of ARIA and GINA guidelines and compliance with them in asthma management.Sixty general practitioners, covering 68,146 inhabitants, were randomly allocated to continuing medical education/continuing professional development (five residential events +four short distance-learning refresher courses over one year) or no training. Participants completed a questionnaire after each continuing medical education event; key questions were repeated at least twice. The Local Health Unit prescription database was used to verify prescription habits (diagnostic investigations and pharmacological therapy) and hospitalizations over one year before and after training.Fourteen general practitioners (46.7%) reached the cut-off of 50% attendance of the training courses. Knowledge improved significantly after training (p0.001, correct answers to key questions +13%). Training resulted in pharmaceutical cost containment (trained general practitioners +0.5% vs. controls +18.8%) and greater attention to diagnosis and monitoring (increase in spirometry +63.4%, p0.01).This study revealed an encouraging impact of educational events on improvement in general practitioner knowledge of guidelines and daily practice behavioral changes. Long-term studies of large populations are required to assess the effectiveness of education on the behavior of physicians in asthma management, and to establish the best format for educational events.

AIM: To evaluate the impact of a medical education course (MEC) on the behaviour of general practitioners (GPs) to treat asthma and allergic rhinitis (AR). METHODS: Data on 1820 patients (mean age 41 yrs ± 17 yrs) with asthma or AR were collected by 107 Italian GPs: 50% attended a MEC and 50% didn't (group B). The adherence for AR and asthma treatment was evaluated according to ARIA and GINA guidelines (GL). RESULTS: AR and asthma were diagnosed in 78% and 56% of patients; 34% had concomitant AR and asthma. Regardless of the MEC, the adherence to GL was significantly higher for AR than for asthma treatment (52 versus 19%). Group B GPs were more compliant to ARIA guidelines in the treatment of mild AR, whereas group A were more compliant in the treatment of moderate-severe AR; the adherence didn't differ between the groups for AR patients with comorbid asthma. Adherence to GINA GL for asthma treatment did not differ between GPs of groups A and B, independently from concomitant AR. Though insignificantly, group A were more compliant to GINA GL in the treatment of patients with only severe persistent asthma (63 versus 46%) as group B were for patients with severe persistent asthma and concomitant AR. CONCLUSIONS: GPs often tend to treat patients independently from GL. The impact of a single MEC did not improve adherence to GL in treating less severe AR and asthma patients, while there was a trend towards the opposite attitude in more severe AR patients without concomitant asthma.

Objective. Asthma is a disease with elevated prevalence within the general population. Although general practitioners (GPs) are among the first health-care professionals to whom patients refer for their symptoms, there are few evaluations of this disease based on data provided by the GPs. The aim of this observational study is to assess the impact of asthma and comorbid allergic rhinitis on individual/social burden, quality of life, and disease control in asthmatic patients of Italian GPs. Methods. Throughout Italy, 107 GPs enrolled 995 patients diagnosed with asthma and using anti-asthmatic drug prescriptions, or with asthma-like symptoms during the previous 12 months. Data were collected through questionnaires filled out by GPs and patients. Results. Of the 995 asthmatic patients, 60.6 had concomitant allergic rhinitis (RA), 39.4 had asthma alone. The latter, compared to those with RA, showed significantly lower prevalence of intermittent asthma (37.5 vs. 55.6) and higher prevalence of mild, moderate, and severe persistent asthma (28.4 vs. 23.2, 28.7 vs. 18.8, and 5.4 vs 2.4, respectively). Individual/social burden due to asthma was frequent and increased with disease severity: 87.5 of severe persistent asthma patients reported at least one medical consultation in the last 12 months, 37.5 emergency department visits, 26.7 hospitalization, and 62.5 limitations in daily activities. Control and quality of life were inversely associated with disease severity and were worse in patients with RA than in those with asthma alone. Conclusions. This study showed the negative impact of high severity levels and comorbid allergic rhinitis on quality of life of asthmatic patients and on individual/social burden due to asthma in an Italian GPs setting. © 2012 Informa Healthcare USA, Inc.

Obiettivo. Valutare, in un campione di popolazione residente a Pisa (Toscana), la relazione fra cambiamenti temporali dello stato di salute, fattori di rischio ed esposizione a lungo termine a sorgenti di inquinamento atmosferico, usando la tecnologia GIS (Geographic lnformation System). Metodi. Studio longitudinale su un sotto-campione della popolazione generale (consumatori abituali dì farmaci, durante un'indagine svolta nel l99l-1993. appaiati con metodo random, per sesso e decadi di età, ad un gruppo di non consumatori).Questo soffo-campione è stato nuovamente indagato,nel 2005, mediante un'intervista telefonica riguardante le caratteristiche demografiche, i sintomi/malattie respiratori, la comorbosità e l'uso abituale di farmaci. In particolare, per queste analisi, sono state indagate tutte le persone con età maggiore di 65 anni (età media 73 anni; n=462) che non avevano cambiato residenza nell'arco dei l3 anni trascorsi dall'indagine condotta nel 1991-1993. Per valutare la relazione fra lo stato di salute e l'esposizione ad inquinamento atmosferico, i soggeffi sono stati classificati in base alla distanza dell'abitazione di residenza dalle strade principali e dalle indusfie. In particolare, con l'utrlizzo della tecnologia GIS, è stata scelta una distanza di 150 metri dalle strade principali ed una distanza di 1100 metri dalle sorgenti di inquinamento industriale. Le analisi statistiche sono state eseguite con il Paccheffo Statistico per le Scienze Sociali( SPSS 13.0 per Windows). Risultati. I risultati della analisi logistica multivariata, aggiustata per sesso, abitudini di fumo, scolarità, posizione lavorativa, fumo passivo, esposizione lavorativa e residenza, hanno mostrato un'associazione significativa con l'incidenza di BPCO (OR 2.37,IC95% 1.15-4.87) nelle persone residenti entro l50m da strade principali e con l'incidenza di espettorato(OR 8.62,IC 95o/o 1.87-39.70)in quelle esposte ad inquinamento veicolare ed industriale. E' emersa inoltre un'associazione border-line fra l'incidenza di espettorato(OR 2.24,IC95% 0.98-5.13) e vivere a 150m da strade trafficate. Conclusioni.Questo studio mostra che l'esposizione a lungo termine ad inquinamento atmosferico è associata allo sviluppo di sintomi e patologie respiratorie croniche negli anziani

This study aims to assess the effetcs of long term exposure to air pollution on human respiratory health status. We selected a general population sub-sample (those who were medicine users in the 1991-93 survey and a matched randomly selected control group). These subjects, in 2005, participated in a telephone interview about demographic characteristics, respiratory symptoms/diseases, comorbidity, and medicines consumption. People were classified on the basis of the distance of their house from atmospheric pollution sources, using GIS technology. Buffers of 100 metres from the main roads and buffer of 1100 metres from an industrial pollution source were considered. Living close to air pollution sources was associated with incidence of respiratory symptoms/diseases.

Objective: to assess, in a population sample living in Pisa (Tuscany, Italy), the relation between the temporal change of health status, risk factors, drugs consumption and long-term exposure to atmospheric pollution sources, using GIS (Geographical Information System) technology. Design: we selected a general population sub-sample (those who were medicine users in the 1991-93 survey and a matched randomly selected control group). These subjects, in 2005, participated in a telephone interview about demographic characteristics, respiratory symptoms/diseases, comorbidity, and medicines consumption. People were classified on the basis of the distance of their house from atmospheric pollution sources, using GIS technology. Buffers of 100 metres from the main roads and buffer of 1100 metres from an industrial pollution source were considered. Results: living close to air pollution sources was associated with incidence of respiratory symptoms/diseases. In particular, there were significant associations: with COPD (OR 2.95, IC 95% 1.07-8.17) and with phlegm (OR 5.25, IC 95% 1.47-18.77) in those exposed to industrial and traffic pollution; with COPD (OR 2,10 IC 95% 1.20-3.69) in those exposed only to traffic pollution. Conclusions: this study has allowed to estimate that the chronic exposure (approximately 13 years) to atmospheric pollution is associated to the development of chronic respiratory conditions, such as COPD and phlegm.

Background: Pisa has an old tradition of horse racing: workers, mainly grooms, have a high risk of accidents during their activities. Aim: to investigate the prevalence of accidents in a group of grooms in Pisa area.

To examine whether distance from main roads has an effect on the incidence of respiratory symptoms/diseases, an approach based on Geographical Information System (GIS) was applied to the epidemiological survey conducted in Pisa-Cascina area (Tuscany) in 1991-93 (2062 subjects, aged 8-97 years). By using GIS, subjects living within 800 m of the major road were geocoded using home address method. Subjects were classified according to the distance of each home from the main road. Different spatial classifications are attempted at by using buffering techniques. Results indicate statistically significant associations among some respiratory symptoms/diseases and living in the close proximity of the road. The study points out the added value of GIS in Public and Environmental Health Research.

This study aims to assess the effetcs of long term exposure to air pollution on human respiratory health status. We selected a general population sub-sample (those who were medicine users in the 1991-93 survey and a matched randomly selected control group). These subjects, in 2005, participated in a telephone interview about demographic characteristics, respiratory symptoms/diseases, comorbidity, and medicines consumption. People were classified on the basis of the distance of their house from atmospheric pollution sources, using GIS technology. Buffers of 100 metres from the main roads and buffer of 1100 metres from an industrial pollution source were considered. Living close to air pollution sources was associated with incidence of respiratory symptoms/diseases.

Objective: to assess, in a population sample living in Pisa (Tuscany, Italy), the relation between the temporal change of health status, risk factors, drugs consumption and long-term exposure to atmospheric pollution sources, using GIS (Geographical Information System) technology. Design: we selected a general population sub-sample (those who were medicine users in the 1991-93 survey and a matched randomly selected control group). These subjects, in 2005, participated in a telephone interview about demographic characteristics, respiratory symptoms/diseases, comorbidity, and medicines consumption. People were classified on the basis of the distance of their house from atmospheric pollution sources, using GIS technology. Buffers of 100 metres from the main roads and buffer of 1100 metres from an industrial pollution source were considered. Results: living close to air pollution sources was associated with incidence of respiratory symptoms/diseases. In particular, there were significant associations: with COPD (OR 2.95, IC 95% 1.07-8.17) and with phlegm (OR 5.25, IC 95% 1.47-18.77) in those exposed to industrial and traffic pollution; with COPD (OR 2,10 IC 95% 1.20-3.69) in those exposed only to traffic pollution. Conclusions: this study has allowed to estimate that the chronic exposure (approximately 13 years) to atmospheric pollution is associated to the development of chronic respiratory conditions, such as COPD and phlegm.

The present study deals with the application of GIS technology to examine the effect of living near major roads on human respiratory health status. Distance from main roads is used as a proxy of exposure to air pollution. Through GIS, subjects living within 800 m of the major road were georeferenced using home address method. Subjects were classified according to the distance of each home from the street. Different spatial classifications are attempted using buffers techniques. Results indicate statistically significant associations between some symptoms/diseases (bronchial asthma, dyspnea, attacks of shortness of breath, chronic bronchitis, emphysema) and living in the proximity of the road. Subjects living within 75m of the road report the highest risk level.

Pisa has an old tradition of horse racing: workers, mainly grooms, are exposed to inorganic and organic dusts and allergens. Such exposures were reported to be related to asthma, allergic and chronic respiratory symptoms and to lung function impairment. Aim: to investigate the prevalence of respiratory symptoms and diseases in a group of grooms in Pisa area.

The present work focuses on the spatial analysis of the association between human respiratory health and road traffic-related air pollution. We studied a general population sample living in Pisa. Two different spatial approaches are applied using GIS functionality. The first one deals with the use of distance of subjects' residences from main roads as a proxy for exposure. We used a 50m distance class for urban streets and 150m distance class for extra-urban streets. In the second model population is classified according to the houses' location: along a very busy street or near an industrial area. Statistical analyses (chi square test and multiple logistic regression model) were performed. Results showed a significant association between living near busy roads and manifesting phlegm in females. In the second spatial model living near the Tosco-Romagnola road is associated to BPCO and bronchial obstruction in both sexes. Then living near the industrial area is statistically related to cough and eye-redness.

talian National Council of Research (CNR) uses GIS technology for the management of epidemiological and environmental data. This work deals with data from epidemiological survey based on a standardized intervieweradministered questionnaire referring to respiratory symptoms and diseases. Through geostatistical methods a respiratory health risk map was obtained. For this purpose a new continuous variable representing population respiratory health status was created. Inverse Distance Weighted interpolation technique was used to fit a continuous surface across sample points. Then the study area was classified to get homogeneous zones by respiratory risk. To assess the classification, tests of statistical significance were applied to population living in such areas. Results indicated that the interpolated map is a good representation of the distribution of respiratory symptoms/diseases over land.

The Information Systems Technology Centre of ISTI-CNR uses GIS technology for the management of epidemiological and environmental data, mainly about air quality topics. This work uses data from epidemiological surveys based on a standardized interviewer-administered questionnaire referring to respiratory symptoms and diseases, life style and personal habits. This study aims to apply geostatistical methods in order to obtain a respiratory health risk map. A variable representing population respiratory health status was created from information about presence/absence of respiratory symptoms/diseases derived from the epidemiological questionnaire. Exploratory Spatial Data Analysis (ESDA) tools assured a deep understanding of spatial and structural properties of dataset. Inverse Distance Weighted interpolation technique was used to create continuous surfaces from sample points. To assess the resulting map population was classified according to it. Classical statistical analyses were performed. Results show that interpolation gives a good representation of the distribution of symptoms/diseases over land.

In the year 2001 Italian National Research Council (CNR) performed "Ospedaletto project" with the aim to assess the environmental and people health status in south-east area of Pisa (Tuscany, Italy), near a waste incinerator. An epidemiological survey was performed, asking a general sample of people (1408 subjects) for respiratory symptoms and diseases. We classified the subjects on the basis of the houses distance from the waste incinerator, but the health status resulted not certainly linked with the past activity of incinerator; so the subjects were classified again with the aim to analyse a possible joint between their health conditions and traffic pollution. We obtained a new classification of the subjects on the basis of the houses distance from the streets. Buffers of 100 metres from the secondary roads and 75 and 150 metres from the main roads were considered. The statistical analyses suggest significant relations between living near main roads and the increase of respiratory diseases.

Background: In Pisa area there is an old tradition of horse racing, and workers, especially grooms, are exposed to inorganic and organic dusts and allergens derived from ground, feeding, horse skin and hair. In literature is described that such exposures induces asthma, allergic symptoms and chronic respiratory symptoms and impairs lung function. Aim: to investigate the prevalence of respiratory symptoms and diseases in a group of grooms in Pisa area. Methods: information on respiratory symptoms and diseases were collected by CNR standardized questionnaire. 242 grooms, 186 males and 56 females (mean age = 37,72 + 12.47; mean years spent as grooms = 15 + 11, 47.1 % smokers, 19.4 % ex smokers, 33.5 % non smokers) were compared with a control group of 242 subjects, 186 males and 56 females, not occupationally exposed to respiratory hazards, derived from a general population survey conducted in Pisa and Po river delta (mean age = 35,90 + 15.65, 30.2 % smokers, 28.9 % ex smokers, 40.9 % non smokers). Statistical analyses were performed through the SPSS 10.0 package. Results : Multiple logistic regression analysis adjusting for gender, smoking, child respiratory trouble, education and occupation as grooms showed that any abitual cough was significantly associated with been groom (odds ratio 2.08 C.I. 1.22- 3.54 ). Also the diagnosis of sinusitis was significantly associated to the job (odds ratio 6.33 C.I. 3.24-12.39). Conclusions: our data suggest a strong association between exposure to equestrian work environment and the diagnosis of sinusitis and also with the prevalence of any abitual cough. A possible causative role of organic and inorganic dust exposure need to be investigated.

Traffic-related air pollution is considered to be a potential risk factor for respiratory human health. To examine whether distance from main roads has an effect on population respiratory health, a GIS-based approach is applied to data gathered during the epidemiological survey conducted in Pisa-Cascina area (central Italy) in 1991-93. Subjects are classified according to the distance of their residences from a major road, the Tosco-Romagnola street. Different spatial classifications are attempted using buffers techniques. Results indicate statistically significant associations between some symptoms/diseases (bronchial asthma, dyspnea, attacks of shortness of breath, chronic bronchitis, emphysema) and living in proximity of the road. Subjects living within 75m of the road report the highest risk level. These relationships are more pronounced in females than in males.

L'indagine campionaria condotta nell'area sud-est di Pisa (2001) aveva come obiettivo la valutazione dello stato dell'ambiente e della salute della comunità residente nell'area intorno ad un inceneritore di rifiuti solidi urbani.

In the year 2001 CNR has worked 'Ospedaletto project' with the aim to asses the environmental and health status of the people living in south-est area of Pisa, near a waste incinerator. During the epidemiological investigation, the subjects were classified on the basis of the houses distance from the waste incinerator. The health status wasn't certainly linked with the past activity of the waste incinerator, so we classified again the subjects with the aim to analyze a possible joint between health status and traffic air pollution. The new classification of the 1408 subjects is based on the houses distances from the streets and we choosed buffer of 100 metres from the secondary roads and 75 and 150 metres from the major roads. The statistical analyses suggest significant relations between living near major roads and the increase of respiratory symptoms.

Associazione significativa inversa tra la distanza della residenza da un inceneritore di rifiuti solidi urbani e sintomi/malattie respiratori nei maschi ma non nelle femmine (2001).

An abstract is not available

An abstract is not available.