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1. Cost-effectiveness of the adherence with recommendations for clinical monitoring of patients with diabetes

Author

Corrao, G, Rea, F, Mancia, G, Perseghin, G, Merlino, L, Martini, N, Carbone, S, Carle, F, Bucci, A, Dajko, M, Arca, S, Bellentani, D, Bruno, V, Ceccolini, C, De Feo, A, Lispi, L, Mariniello, R, Masullo, M, Medici, F, Pisanti, P, Visca, M, Zanini, R, Di Fiandra, T, Magliocchetti, N, Romano, G, Cantarutti, A, Pugni, P, Davoli, M, Di Martino, M, Lallo, A, Vittori, P, Vuillermin, G, Bernardo, A, Fusciante, A, Belotti, L, De Palma, R, Di Felice, E, Chiandetti, R, Clagnan, E, Del Zotto, S, Di Lenarda, A, Mariotto, A, Prezza, M, Zanier, L, Fusco, D, Marinacci, C, Lora, A, Spazzafumo, L, Pizzi, S, Simiele, M, Massaro, G, Attolini, E, Lepore, V, Petrarolo, V, De Luca, G, Fantaci, G, Pollina Addario, S, Scondotto, S, Bellomo, F, Braga, M, Di Fabrizio, V, Forni, S, Francesconi, P, Profili, F, Avossa, F, Corradin, M, Vigna, S, Dondi, L, Pedrini, A, Piccinni, C, Cosentino, M, Marvulli, M, Maggioni, A, Corrao G., Rea F., Mancia G., Perseghin G., Merlino L., Martini N., Carbone S., Carle F., Bucci A., Dajko M., Arca S., Bellentani D., Bruno V., Ceccolini C., De Feo A., Lispi L., Mariniello R., Masullo M., Medici F., Pisanti P., Visca M., Zanini R., Di Fiandra T., Magliocchetti N., Romano G., Cantarutti A., Pugni P., Davoli M., Di Martino M., Lallo A., Vittori P., Vuillermin G., Bernardo A., Fusciante A., Belotti L., De Palma R., Di Felice E., Chiandetti R., Clagnan E., Del Zotto S., Di Lenarda A., Mariotto A., Prezza M., Zanier L., Fusco D., Marinacci C., Lora A., Spazzafumo L., Pizzi S., Simiele M., Massaro G., Attolini E., Lepore V., Petrarolo V., De Luca G., Fantaci G., Pollina Addario S., Scondotto S., Bellomo F., Braga M., Di Fabrizio V., Forni S., Francesconi P., Profili F., Avossa F., Corradin M., Vigna S., Dondi L., Pedrini A., Piccinni C., Cosentino M., Marvulli M. G., Maggioni A., Corrao, G, Rea, F, Mancia, G, Perseghin, G, Merlino, L, Martini, N, Carbone, S, Carle, F, Bucci, A, Dajko, M, Arca, S, Bellentani, D, Bruno, V, Ceccolini, C, De Feo, A, Lispi, L, Mariniello, R, Masullo, M, Medici, F, Pisanti, P, Visca, M, Zanini, R, Di Fiandra, T, Magliocchetti, N, Romano, G, Cantarutti, A, Pugni, P, Davoli, M, Di Martino, M, Lallo, A, Vittori, P, Vuillermin, G, Bernardo, A, Fusciante, A, Belotti, L, De Palma, R, Di Felice, E, Chiandetti, R, Clagnan, E, Del Zotto, S, Di Lenarda, A, Mariotto, A, Prezza, M, Zanier, L, Fusco, D, Marinacci, C, Lora, A, Spazzafumo, L, Pizzi, S, Simiele, M, Massaro, G, Attolini, E, Lepore, V, Petrarolo, V, De Luca, G, Fantaci, G, Pollina Addario, S, Scondotto, S, Bellomo, F, Braga, M, Di Fabrizio, V, Forni, S, Francesconi, P, Profili, F, Avossa, F, Corradin, M, Vigna, S, Dondi, L, Pedrini, A, Piccinni, C, Cosentino, M, Marvulli, M, Maggioni, A, Corrao G., Rea F., Mancia G., Perseghin G., Merlino L., Martini N., Carbone S., Carle F., Bucci A., Dajko M., Arca S., Bellentani D., Bruno V., Ceccolini C., De Feo A., Lispi L., Mariniello R., Masullo M., Medici F., Pisanti P., Visca M., Zanini R., Di Fiandra T., Magliocchetti N., Romano G., Cantarutti A., Pugni P., Davoli M., Di Martino M., Lallo A., Vittori P., Vuillermin G., Bernardo A., Fusciante A., Belotti L., De Palma R., Di Felice E., Chiandetti R., Clagnan E., Del Zotto S., Di Lenarda A., Mariotto A., Prezza M., Zanier L., Fusco D., Marinacci C., Lora A., Spazzafumo L., Pizzi S., Simiele M., Massaro G., Attolini E., Lepore V., Petrarolo V., De Luca G., Fantaci G., Pollina Addario S., Scondotto S., Bellomo F., Braga M., Di Fabrizio V., Forni S., Francesconi P., Profili F., Avossa F., Corradin M., Vigna S., Dondi L., Pedrini A., Piccinni C., Cosentino M., Marvulli M. G., and Maggioni A.

Abstract

Background and aims: To validate a set of indicators for monitoring the quality of care of patients with diabetes in ‘real-life’ practice through its relationship with measurable clinical outcomes and healthcare costs. Methods and results: A population-based cohort study was carried out by including the 20,635 patients, residents in the Lombardy Region (Italy), who in the year 2012 were newly taken-in-care for diabetes. Adherence with clinical recommendations (i.e., controls for glycated haemoglobin, lipid profile, urine albumin excretion and serum creatinine) was recorded during the first year after the patient was taken-in-care, and categorized according whether he/she complied with none or almost none (0 or 1), just some (2) or all or almost all (3 or 4) the recommendations, respectively denoted as poor, intermediate and high adherence. Short- and long-term complications of diabetes, and healthcare cost incurred by the National Health Service, were assessed during follow-up. Compared with patients with poor adherence, those with intermediate and high adherence respectively showed (i) a delay in outcome occurrence of 13 days (95% CI, −2 to 27) and 23 days (9–38), and (ii) a lower healthcare cost of 54 € and 77 €. In average, a gain of 18 Euros and 15 Euros for each day free from diabetic complication by increasing adherence respectively from poor to intermediate and from poor to high were observed. Conclusion: Close control of patients with diabetes through regular clinical examinations must be considered the cornerstone of national guidance, national audits, and quality improvement incentive schemes.

Published
2021

2. Hospitalization and mortality among the elderly exposed to polytherapy and at risk of adverse drug reactions

Author

Scondotto, G, Pollina Addario, S, FERRANTE, Mauro, Pastorello, M, Visconti, M, CASUCCIO, Alessandra, Scondotto, G., Pollina Addario, S., Ferrante, M., Pastorello, M., Visconti, M., and Casuccio, A.

Subjects
polypharmacy, pharmaceutical prescription, Settore BIO/14 - Farmacologia, Settore SECS-S/05 - Statistica Sociale, Settore MED/42 - Igiene Generale E Applicata, elderly, Drug-drug interaction
Abstract

The increase in comorbidities due to an aging population determines a marked increase in the use of drugs (polypharmacy), which in turn carries a high risk of drug-drug interactions. This Paper will analyze the relationship between exposure to adverse drug interactions, and hospitalization and mortality in a cohort of elderly patients, living in a local Health Unit in Palermo, Italy. These patients were exposed to drugs whose concurrent use is contraindicated during the period 1.1.2014 - 30.12.2014. After a description of the most common drugs involved in adverse reactions, an evaluation of the extent of hospitalization and mortality will be performed. The results will demonstrate that there is an increasing risk of hospitalization and mortality as the degree of polypharmacy increases. Moreover, of the different classes of drug-drug interactions, those associated with the causation of QT prolongation present significantly higher risks for hospitalization and mortality, when compared to other classes of interactions. The implementation of appropriate tools, able to monitor drug prescriptions, could lower the number of hospitalizations and deaths, thus obviating the phenomenon of a prescriptions cascade.

Published
2017

3. SOLUZIONI OPERATIVE ED ASPETTI QUALITATIVI PER LA GEOCODIFICA DI POPOLAZIONI IN AMBITO SANITARIO

Author

FERRANTE, Mauro, Carnà, P., Pontillo, A, Pollina Addario, S, Migliardi, A., Scondotto, S., Ferrante, M, Carnà, P., Pontillo, A, Pollina Addario, S, Migliardi, A., and Scondotto, S.

Subjects
Geocoding, Geographic Information system, Healthcare management, Settore SECS-S/05 - Statistica Sociale, Healthcare evaluation
Abstract

IntroduzioneL'utilizzo dei Geographic Information Systems (GIS) in ambito sanitario, continua a ricevere grande attenzione. La disponibilità di informazioni sulla localizzazione degli individui, consente di effettuare associazioni territoriali sulle cause delle patologie, nonché di indagare aspetti legati alla distribuzione dei servizi sanitari ed all'equità di accesso alle cure. ObiettiviAnalizzare le principali problematiche e le soluzioni operative per la geocodifica di popolazioni e proporre un indice di qualità della geocodifica di cui poter tenere conto in sede di analisi. MetodiCome caso studio vengono illustrate le fasi che hanno portato alla georeferenziazione di indirizzi residenziali di 12 Comuni Siciliani, attraverso l'utilizzo di due procedure di georeferenziazione. Un primo metodo ha utilizzato un record linkage probabilistico tramite un indice basato sulla similarità di Jaccard con tabelle ufficiali degli indirizzi Istat e l'impiego di software per la fase di georeferenziazione degli indirizzi. Il secondo metodo si è basato su un record linkage tramite ricerca fulltext (in Sql) ed ha utilizzato servizi web-based per la georeferenziazione. Dopo aver proposto un indice sintetico di qualità del processo di georeferenziazione, vengono confrontati i risultati derivanti dalle due procedure in termini di copertura e qualità. RisultatiConsiderando livelli alti dell'indice di qualità di georeferenziazione, e grazie all’integrazione dei risultati derivati dalle due procedure, la percentuale di indirizzi geocodificati è risultata circa l’80%. Guardando ai risultati di elevata qualità per entrambe le procedure utilizzate non si rilevano differenze rilevanti in termini di distanza tra le coordinate derivanti dalle due procedure. Tuttavia, i risultati evidenziano migliori performance della procedura che ha fatto ricorso al servizio web-based in termini di copertura (+40% circa di indirizzi geocodificati, rispetto alla procedura software-based), mentre il 9.2% di indirizzi che non sono stati ben georeferenziati con il servizio webbased hanno trovato una corrispondenza tramite procedura software. ConclusioniLa geocodifica di popolazioni può assistere il management sanitario in diversi modi: può aiutare a meglio comprendere la relazione tra esposizioni ambientali e stato di salute, consente di identificare comunità a maggiore rischio di salute, nonché a comprendere le ragioni di natura territoriale che possono avere un'influenza sullo stato di salute degli individui. Dati i limiti insiti in ciascuno dei metodi utilizzati, l'impiego di un indice di qualità di georeferenziazione assieme all'integrazione dei risultati dei due metodi, consente di ottenere un notevole miglioramento dei risultati, e di valutare l'attendibilità del processo di geocodifica in sede di analisi.

Published
2015

4. INDICATORI PER LA VALUTAZIONE DELL'APPROPRIATEZZA DEL PERCORSO NASCITA

Author

Fantaci, G, FERRANTE, Mauro, Pollina Addario, S, Tavormina, E, Marras, A, Scondotto, S., Fantaci, G, Ferrante, M, Pollina Addario, S, Tavormina, E, Marras, A, and Scondotto, S.

Subjects
Hospital outcome, Sicily, Healthcare evaluation, Settore SECS-S/05 - Statistica Sociale, Neonatal mortality
Abstract

Introduzione:La gravidanza, il parto ed il puerperio sono eventi fisiologici che possono talvolta complicarsi in modo non prevedibile e con conseguenze gravi per la donna, per il nascituro e per il neonato. Gli standard nazionali prevedono la razionalizzazione/riduzione progressiva dei punti nascita con numero di parti inferiore a 1000/anno, e l'abbinamento per pari complessità di attività delle UU.OO. ostetrico-ginecologiche con quelle neonatologiche/pediatriche, riconducendo a due i precedenti tre livelli assistenziali. I punti nascita privi di una copertura di guardia medico-ostetrica, anestesiologica e medico pediatrica attiva h 24, o di risorse umane e di attrezzature adeguate non dovrebbero prendere in carico nascite a rischio. Anche il trasferimento del neonato subito dopo la nascita, in presenza di condizioni predittive di rischio per il neonato al momento del parto, rappresenta un indicatore di cattiva gestione del percorso clinico. Obiettivi: Valutare l’appropriatezza del percorso nascita e la gestione delle fasi assistenziali nelle prime ore dalla nascita con riferimento ai “neonati a rischio”. Metodi: Come caso studio vengono analizzati i dati desunti dal Certificato di Assistenza al Parto (CedAP) e dalle Schede di Dimissione Ospedaliera (SDO). E' stata condotta quindi un'analisi di tipo descrittivo sui volumi dei nati a rischio e trasferiti entro tre giorni dalla nascita per livello di complessità di struttura. La definizione di neonato a rischio viene determinata sulla base di alcuni criteri, basati su: età gestazionale, peso alla nascita, SGA (Small for Gestational Age), età della madre e gravidanza plurima, con valori del rischio definiti da 0 a 3 (nessun fattore di rischio tra quelli selezionati, un fattore, due fattori, oltre due). Tramite processi di record linkage deterministico e probabilistico tra dati desunti da fonte CedAP e SDO, vengono analizzati alcuni aspetti legati alla gestione del neonato a rischio in termini di trasferimenti tra tipologie di strutture ospedaliere, anche alla luce della recente normativa regionale. Risultati: Nel 2013 nella Regione Sicilia sono stati osservati 8.871 (20,3%) parti di neonati con almeno un fattore di rischio tra quelli selezionati. La percentuale di linkage tra CedAP ed almeno una delle due SDO (madre o bambino) è risultata pari al 97.2%. Degli 8.324 neonati a rischio linkati con il flusso SDO, ben il 34,6% è risultato ancora assistito in un punto nascita non di II livello. La percentuale di nati trattati in centri di II livello aumenta all’aumentare del livello di rischio, con valori pari al 75% per neonati con due fattori di rischio e del 78% per neonati con almeno tre fattori di rischio. Con riferimento ai trasferimenti entro tre giorni dalla nascita, dei 568 trasferimenti, il 14.9 % è stato trasferito da punti nascita di II livello, ed il 73.9% da strutture di I livello, mentre l’11% di trasferimenti ha interessato le altre strutture. Conclusioni: L'analisi condotta consente di valutare l'appropriatezza del percorso nascita attraverso alcuni indicatori riguardanti la gestione dei neonati a rischio all'interno della rete assistenziale regionale. Gli indicatori analizzati costituiscono pertanto un utile strumento da impiegare all'interno di programmi di valutazione della qualità dell'assistenza alla gravidanza e al parto.

Published
2015

5. Developing and validating a novel multisource comorbidity score from administrative data: A large population-based cohort study from Italy

Author

Corrao, G, Rea, F, Di Martino, M, De Palma, R, Scondotto, S, Fusco, D, Lallo, A, Belotti, L, Ferrante, M, Pollina Addario, S, Merlino, L, Mancia, G, Carle, F, Belotti, LMB, Corrao, G, Rea, F, Di Martino, M, De Palma, R, Scondotto, S, Fusco, D, Lallo, A, Belotti, L, Ferrante, M, Pollina Addario, S, Merlino, L, Mancia, G, Carle, F, and Belotti, LMB

Abstract

Objective To develop and validate a novel comorbidity score (multisource comorbidity score (MCS)) predictive of mortality, hospital admissions and healthcare costs using multiple source information from the administrative Italian National Health System (NHS) databases. Methods An index of 34 variables (measured from inpatient diagnoses and outpatient drug prescriptions within 2 years before baseline) independently predicting 1-year mortality in a sample of 500 000 individuals aged 50 years or older randomly selected from the NHS beneficiaries of the Italian region of Lombardy (training set) was developed. The corresponding weights were assigned from the regression coefficients of a Weibull survival model. MCS performance was evaluated by using an internal (ie, another sample of 500 000 NHS beneficiaries from Lombardy) and three external (each consisting of 500 000 NHS beneficiaries from Emilia-Romagna, Lazio and Sicily) validation sets. Discriminant power and net reclassification improvement were used to compare MCS performance with that of other comorbidity scores. MCS ability to predict secondary health outcomes (ie, hospital admissions and costs) was also investigated. results Primary and secondary outcomes progressively increased with increasing MCS value. MCS improved the net 1-year mortality reclassification from 27% (with respect to the Chronic Disease Score) to 69% (with respect to the Elixhauser Index). MCS discrimination performance was similar in the four regions of Italy we tested, the area under the receiver operating characteristic curves (95% CI) being 0.78 (0.77 to 0.79) in Lombardy, 0.78 (0.77 to 0.79) in Emilia-Romagna, 0.77 (0.76 to 0.78) in Lazio and 0.78 (0.77 to 0.79) in Sicily. conclusion MCS seems better than conventional scores for predicting health outcomes, at least in the general population from Italy. This May offer an improved tool for risk adjustment, policy planning and identifying patients in need of a focused treatment approach in t

Published
2017

8. Trends in Lung Cancer and Smoking Behavior in Italy: An Alarm Bell for Women

Author

Trama, Annalisa, Boffi, Roberto, Contiero, Paolo, Buzzoni, Carlotta, Pacifici, Roberta, Mangone, Lucia, Coviello, V, Buzzoni, C, Fusco, M, Barchielli, A, Cuccaro, F, De Angelis, R, Giacomin, A, Luminari, S, Randi, G, Mangone, L, Mazzoleni, G, Bulatko, A, Devigili, E, Tschugguel, B, De Valiere, E, Facchinelli, G, Falk, M, Vittadello, F, Coviello, V, Cuccaro, F, Calabrese, A, Pinto, A, Cannone, G, Vitali, ME, Galasso, R, Del Riccio, L, Napolitano, D, Sampietro, G, Ghisleni, S, Giavazzi, L, Zanchi, A, Zucchi, A, Giacomin, A, Vercellino, PC, Andreone, S, Fedele, M, Barale, A, Germinetti, F, Magoni, M, Salvi, O, Puleio, M, Gerevini, C, Chiesa, R, Lonati, F, Cavalieri d'Oro, L, Rognoni, M, Le Rose, L, Merlo, E, Bracchi, A, Negrino, L, Pezzuto, L, Ardizzone, A, Spagnolo, G, Cozzi, E, De Lorenzism, L, Lotti, F, Pagliara, MC, D'Argenzio, A, D'Abronzo, M, De Francesco, D, Pereira da Silva, MCM, Menditto, V, Perrotta, E, Pesce, MT, Sessa, A, Sciacca, S, Sciacchitano, S, Fidelbo, M, Benedetto, G, Benedetto, A, Calabretta, LMR, Caruso, AM, Castaing, M, Di Prima, AA, Dinaro, YM, Fidelbo, P, Grosso, G, Ippolito, A, Irato, E, Leone, A, Paderni, F, Pesce, PNR, Pollina Addario, S, Savasta, A, Sciacchitano, CG, Torrisi, AAM, Torrisi, A, Varvarà, M, Viscosi, C, Sutera Sardo, A, Sia, A, Scalzi, S, Lavecchia, AM, Mancuso, P, Nocera, V, Mancusi, F, Del Duca, S, Gola, G, Corti, M, Caparelli, M, Ferretti, S, Marzola, L, Migliari, E, Carletti, N, Biavati, P, Petrucci, C, Serraino, D, Angelin, T, Bidoli, E, Birri, S, Dal Maso, L, De Dottori, M, De Santis, E, Forgiarini, O, Zucchetto, A, Zanier, L, Pannozzo, F, Busco, S, Rossi, M, Curatella, S, Bugliarello, E, Macci, L, Bernazza, E, Calabretta, F, Tamburrino, S, Sperduti, I, Tamburo, L, Serafini, G, Quarta, F, Melcarne, A, Golizia, MG, Arciprete, C, De Maria, V, Filiberti, RA, Casella, C, Marani, E, Puppo, A, Celesia, MV, Cogno, R, Vitarelli, S, Ricci, P, Autelitano, M, Ghilardi, S, Leone, R, Filipazzi, L, Bonini, A, Giubelli, C, Russo, AG, Quattrocchi, M, Distefano, R, Panciroli, E, Bellini, A, Pinon, M, Spinosa, S, Spagnoli, G, Carrozzi, G, Cirilli, C, Valla, K, Amendola, V, Fusco, M, Bellatalla, C, Ciullo, V, Di Buono, M, Fusco, M, Panico, M, Perrotta, C, Vitale, MF, Usala, M, Pala, F, Sini, GM, Pintori, N, Canu, L, Demurtas, G, Doa, N, Vitale, F, Cusimano, R, Traina, A, Guttadauro, A, Cascio, MA, Mannino, R, Ravazzolo, B, Brucculeri, MA, Rudisi, G, Adamo, MS, Amodio, R, Costa, A, Zarcone, M, Sunseri, R, Bucalo, G, Trapani, C, Staiti, R, Michiara, M, Bozzani, F, Sgargi, P, Boschetti, L, Migliazza, S, Reggiani, E, Incardona, N, Borciani, E, Seghini, P, Prazzoli, R, Zanetti, R, Rosso, S, Patriarca, S, Prandi, R, Sobrato, I, Gilardi, F, Busso, P, Sacchetto, L, Tumino, R, Cascone, G, Frasca, G, Giurdanella, MC, Martorana, C, Morana, G, Nicita, C, Rollo, PC, Ruggeri, MG, Spata, E, Vacirca, S, Mangone, L, Vicentini, M, Di Felice, E, Pezzarossi, A, Ferrari, F, Roncaglia, F, Sacchettini, C, Caroli, S, Falcini, F, Colamartini, A, Bucchi, L, Balducci, C, Ravegnani, M, Vitali, B, Cordaro, C, Caprara, L, Giuliani, O, Giorgetti, S, Palumbo, M, Vattiato, R, Ravaioli, A, Mancini, S, Caiazzo, AL, Cavallo, R, Colavolpe, AFG, D'Alessandro, A, Iannelli, A, Lombardo, C, Senatore, G, Sensi, F, Cesaraccio, R, Pirino, D, Mura, F, Contrino, ML, Madeddu, A, Tisano, F, Dinaro, Y, Muni, A, Mizzi, M, Bella, F, Rossitto, L, Sacco, G, Aletta, P, Colanino Ziino, A, Maspero, S, Fanetti, AC, Cometti, I, Cecconami, L, Minerba, S, Mincuzzi, A, Carone, S, Tanzarella, M, Galluzzo, C, Barchielli, A, Buzzoni, C, Caldarella, A, Corbinelli, A, Intrieri, T, Di Dia, PP, Manneschi, G, Nemcova, L, Visioli, C, Zappa, M, Candela, G, Scuderi, T, Crapanzano, G, Taranto, V, Piffer, S, Gentilini, M, Rizzello, R, Bombarda, L, Pedron, M, Clivati, E, Stracci, F, D'Alò, D, Scheibel, M, Costarelli, D, Spano, F, Rossini, S, Santucci, C, Petrinelli, AM, Solimene, C, Bianconi, F, Brunori, V, Tagliabue, G, Contiero, P, Tittarelli, A, Fabiano, S, Maghini, A, Codazzi, T, Barigelletti, G, D'Agostino, A, Modonesi, C, Rugge, M, Baracco, M, Baracco, S, Bovo, E, Dal Cin, A, Fiore, AR, Greco, A, Guzzinati, S, Martin, G, Memo, L, Monetti, D, Rizzato, S, Rosano, A, Stocco, C, Tognazzo, S, Zorzi, M, Brustolin, A, Beggiato, S, Aniceti, S, Fiocchetti, L, Schirra, G, Galeotti, P, Capati, A, Nami, A, Montanaro, M, Verrico, G, Poleggi, F, Rashid, I, Grappasonni, I, Pascucci, C, Merletti, F, Magnani, C, Pastore, G, Terracini, B, Alessi, D, Cena, T, Lazzarato, F, Macerata, V, Maule, M, Mosso, ML, Sacerdote, C, Romanelli, A, Mangone, L, Storchi, C, Sala, O, Gabbi, C, Gennaro, V, Benfatto, L, Malacarne, D, Lando, C, Campi, MG, Mazzucco, G, Ponz de Leon, M, Domati, F, Rossi, G, Goldoni, CA, Kaleci, S, Rossi, F, Benatti, P, Roncucci, L, Di Gregorio, C, Magnani, G, Pedroni, M, Maffei, S, Mariani, F, Reggiani-Bonetti, L, Sassatelli, R, Cassetti, T, Giorgi Rossi, P, and Vicentini, M

Abstract

Introduction The epidemiology of lung cancer is changing worldwide, with smoking being the key driver of lung cancer incidence and mortality. Our aim is to analyze the incidence, survival and mortality trends in Italy in the framework of the 2017 survey on smoking behavior in Italy.Methods AIRTUM 2017 reports on cancer survival and incidence; 2017 survey on smoking behavior in Italy.Results Men achieved progress in lung cancer control characterized by a decrease in incidence and mortality and an increase in survival. The decreasing use of tobacco in men (from 60% in the 1960s to 24% in 2017) was most likely responsible for the decreasing incidence and mortality. Women showed no progress: although survival improved slightly, the incidence and mortality were both on the rise. This was most likely due to the increasing smoking rates in women in the 1970s and 80s. Of major concern is the accelerated rise in the number of smoking women from 4.6 million in 2016 to 5.7 million in 2017 compared to the decrease observed in men (from 6.9 to 6 million).Conclusions The incidence and mortality trends in males clearly demonstrate that primary prevention is the most effective way to reduce lung cancer mortality. By contrast, a 24% increase in the prevalence of smoking among women in just 1 year is extremely worrying for the future, and calls for immediate action by targeted strategies to reduce tobacco consumption in women and avert the dreadful prospect of a lung cancer epidemic in Italy.

Published
2017
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9. Developing and validating a novel multisource comorbidity score from administrative data: a large population-based cohort study from Italy

Author

Danilo Fusco, Giovanni Corrao, Luca Merlino, Mauro Ferrante, Rossana De Palma, Mirko Di Martino, Sebastiano Pollina Addario, Laura Maria Beatrice Belotti, Salvatore Scondotto, Adele Lallo, Flavia Carle, Giuseppe Mancia, Federico Rea, Corrao, G., Rea, F., Di Martino, M., De Palma, R., Scondotto, S., Fusco, D., Lallo, A., Belotti, L., Ferrante, M., Pollina Addario, S., Merlino, L., Mancia, G., Carle, F., Corrao, G, Rea, F, Di Martino, M, De Palma, R, Scondotto, S, Fusco, D, Lallo, A, Belotti, L, Ferrante, M, Pollina Addario, S, Merlino, L, Mancia, G, and Carle, F

Subjects
Male, Databases, Factual, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Settore MED/42 - Igiene Generale E Applicata, Severity of Illness Index, State Medicine, Cohort Studies, 0302 clinical medicine, Health care, Medicine, Hospital Mortality, Settore SECS-S/05 - Statistica Sociale, 030212 general & internal medicine, Medical diagnosis, Aged, 80 and over, education.field_of_study, Health Care Costs, General Medicine, Middle Aged, prognostic score, Hospitalization, comorbidity, Italy, administrative database, Regression Analysis, Female, Risk Adjustment, Public Health, Cohort study, Population, Drug Prescriptions, Settore MED/01 - Statistica Medica, 03 medical and health sciences, Humans, Medical prescription, education, Survival analysis, Aged, Receiver operating characteristic, business.industry, Research, medicine.disease, Comorbidity, ROC Curve, record linkage, business, Demography
Abstract

ObjectiveTo develop and validate a novel comorbidity score (multisource comorbidity score (MCS)) predictive of mortality, hospital admissions and healthcare costs using multiple source information from the administrative Italian National Health System (NHS) databases.MethodsAn index of 34 variables (measured from inpatient diagnoses and outpatient drug prescriptions within 2 years before baseline) independently predicting 1-year mortality in a sample of 500 000 individuals aged 50 years or older randomly selected from the NHS beneficiaries of the Italian region of Lombardy (training set) was developed. The corresponding weights were assigned from the regression coefficients of a Weibull survival model. MCS performance was evaluated by using an internal (ie, another sample of 500 000 NHS beneficiaries from Lombardy) and three external (each consisting of 500 000 NHS beneficiaries from Emilia-Romagna, Lazio and Sicily) validation sets. Discriminant power and net reclassification improvement were used to compare MCS performance with that of other comorbidity scores. MCS ability to predict secondary health outcomes (ie, hospital admissions and costs) was also investigated.ResultsPrimary and secondary outcomes progressively increased with increasing MCS value. MCS improved the net 1-year mortality reclassification from 27% (with respect to the Chronic Disease Score) to 69% (with respect to the Elixhauser Index). MCS discrimination performance was similar in the four regions of Italy we tested, the area under the receiver operating characteristic curves (95% CI) being 0.78 (0.77 to 0.79) in Lombardy, 0.78 (0.77 to 0.79) in Emilia-Romagna, 0.77 (0.76 to 0.78) in Lazio and 0.78 (0.77 to 0.79) in Sicily.ConclusionMCS seems better than conventional scores for predicting health outcomes, at least in the general population from Italy. This may offer an improved tool for risk adjustment, policy planning and identifying patients in need of a focused treatment approach in the everyday medical practice.

Published
2017

10. Cost-effectiveness of the adherence with recommendations for clinical monitoring of patients with diabetes

Author

Giovanni Corrao, Federico Rea, Giuseppe Mancia, Gianluca Perseghin, Luca Merlino, Nello Martini, Simona Carbone, Flavia Carle, Andrea Bucci, Marianxhela Dajko, Silvia Arcà, Donata Bellentani, Velia Bruno, Carla Ceccolini, Angela De Feo, Lucia Lispi, Rosanna Mariniello, Maurizio Masullo, Federica Medici, Paola Pisanti, Modesta Visca, Rinaldo Zanini, Teresa Di Fiandra, Natalia Magliocchetti, Giovanna Romano, Anna Cantarutti, Pietro Pugni, Marina Davoli, Mirko Di Martino, Adele Lallo, Patrizia Vittori, Giuliana Vuillermin, Alfonso Bernardo, Anna Fusciante, Laura Belotti, Rossana De Palma, Enza Di Felice, Roberta Chiandetti, Elena Clagnan, Stefania Del Zotto, Andrea Di Lenarda, Aldo Mariotto, Marisa Prezza, Loris Zanier, Danilo Fusco, Chiara Marinacci, Antonio Lora, Liana Spazzafumo, Simone Pizzi, Maria Simiele, Giuseppe Massaro, Ettore Attolini, Vito Lepore, Vito Petrarolo, Giovanni De Luca, Giovanna Fantaci, Sebastiano Pollina Addario, Salvatore Scondotto, Francesco Bellomo, Mario Braga, Valeria Di Fabrizio, Silvia Forni, Paolo Francesconi, Francesco Profili, Francesco Avossa, Matteo Corradin, Silvia Vigna, Letizia Dondi, Antonella Pedrini, Carlo Piccinni, Mimma Cosentino, Maria G. Marvulli, Aldo Maggioni, Corrao, G, Rea, F, Mancia, G, Perseghin, G, Merlino, L, Martini, N, Carbone, S, Carle, F, Bucci, A, Dajko, M, Arca, S, Bellentani, D, Bruno, V, Ceccolini, C, De Feo, A, Lispi, L, Mariniello, R, Masullo, M, Medici, F, Pisanti, P, Visca, M, Zanini, R, Di Fiandra, T, Magliocchetti, N, Romano, G, Cantarutti, A, Pugni, P, Davoli, M, Di Martino, M, Lallo, A, Vittori, P, Vuillermin, G, Bernardo, A, Fusciante, A, Belotti, L, De Palma, R, Di Felice, E, Chiandetti, R, Clagnan, E, Del Zotto, S, Di Lenarda, A, Mariotto, A, Prezza, M, Zanier, L, Fusco, D, Marinacci, C, Lora, A, Spazzafumo, L, Pizzi, S, Simiele, M, Massaro, G, Attolini, E, Lepore, V, Petrarolo, V, De Luca, G, Fantaci, G, Pollina Addario, S, Scondotto, S, Bellomo, F, Braga, M, Di Fabrizio, V, Forni, S, Francesconi, P, Profili, F, Avossa, F, Corradin, M, Vigna, S, Dondi, L, Pedrini, A, Piccinni, C, Cosentino, M, Marvulli, M, and Maggioni, A

Subjects
Diagnostic Screening Programs, Male, medicine.medical_specialty, Time Factors, Databases, Factual, National Health Programs, Cost effectiveness, Endocrinology, Diabetes and Metabolism, Cost-Benefit Analysis, Population, Medicine (miscellaneous), Audit, Diagnostic Techniques, Ophthalmological, Diabete, Kidney Function Tests, Cost Savings, Predictive Value of Tests, Diabetes mellitus, Health care, medicine, Diabetes Mellitus, Healthcare cost, Humans, education, Aged, Incremental cost-effectiveness ratio, education.field_of_study, Nutrition and Dietetics, medicine.diagnostic_test, business.industry, Periodic examination, Health Care Costs, Middle Aged, medicine.disease, Prognosis, Population-based cohort study, Real-world, Italy, Cost-effectivene, Emergency medicine, Patient Compliance, Female, Cardiology and Cardiovascular Medicine, business, Lipid profile, Complication, Blood Chemical Analysis, Cohort study
Abstract

Background and aims To validate a set of indicators for monitoring the quality of care of patients with diabetes in ‘real-life’ practice through its relationship with measurable clinical outcomes and healthcare costs. Methods and results A population-based cohort study was carried out by including the 20,635 patients, residents in the Lombardy Region (Italy), who in the year 2012 were newly taken-in-care for diabetes. Adherence with clinical recommendations (i.e., controls for glycated haemoglobin, lipid profile, urine albumin excretion and serum creatinine) was recorded during the first year after the patient was taken-in-care, and categorized according whether he/she complied with none or almost none (0 or 1), just some (2) or all or almost all (3 or 4) the recommendations, respectively denoted as poor, intermediate and high adherence. Short- and long-term complications of diabetes, and healthcare cost incurred by the National Health Service, were assessed during follow-up. Compared with patients with poor adherence, those with intermediate and high adherence respectively showed (i) a delay in outcome occurrence of 13 days (95% CI, -2 to 27) and 23 days (9 to 38), and (ii) a lower healthcare cost of 54 € and 77 €. In average, a gain of 18 Euros and 15 Euros for each day free from diabetic complication by increasing adherence respectively from poor to intermediate and from poor to high were observed. Conclusion Close control of patients with diabetes through regular clinical examinations must be considered the cornerstone of national guidance, national audits, and quality improvement incentive schemes.

Published
2021

11. Nutritional predictors of mortality after discharge in elderly patients on a medical ward

Author

Sebastiano Pollina Addario, Vincenza Maniaci, Giuseppe Rosafio, Anna Maria Barile, Vittoria Sciascia, Silvio Buscemi, Nadia Rini, Gregorio Caimi, Fatima Maria Massenti, John A. Batsis, Flavia Costa, Serena Mendola, Gaspare Parrinello, Buscemi, S., Batsis, J., Parrinello, G., Massenti, F., Rosafio, G., Sciascia, V., Costa, F., Pollina Addario, S., Mendola, S., Barile, A., Maniaci, V., Rini, N., and Caimi, G.

Subjects
Male, 0301 basic medicine, Pediatrics, mini-nutritional assessment, Clinical Biochemistry, Coronary Disease, Comorbidity, Biochemistry, Cohort Studies, Grip strength, 0302 clinical medicine, Risk Factors, Electric Impedance, Medicine, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Aged, 80 and over, Anthropometry, Hand Strength, Bioimpedance, Medicine (all), Hazard ratio, Age Factors, General Medicine, Middle Aged, Prognosis, Patient Discharge, phase angle, Italy, Hypertension, Female, hospitalization, Cohort study, medicine.medical_specialty, Nutritional Status, malnutrition, 03 medical and health sciences, Patients' Rooms, Humans, Aged, Proportional Hazards Models, 030109 nutrition & dietetics, business.industry, Proportional hazards model, medicine.disease, mortality, Confidence interval, Nutrition Assessment, Diabetes Mellitus, Type 2, Kidney Failure, Chronic, business, Follow-Up Studies
Abstract

Background: Malnutrition in elderly inpatients hospitalized on medical wards is a significant public health concern. The aim of this study was to investigate nutritional markers as mortality predictors following discharge in hospitalized medical elderly patients. Materials and methods: This is a prospective observational cohort study with follow-up of 48 months. Two hundred and twenty-five individuals aged 60 and older admitted from the hospital emergency room in the past 48 h were investigated at the medical ward in the University hospital in Palermo (Italy). Anthropometric and clinical measurements, Mini-nutritional Assessment (MNA) questionnaire, bioelectrical (BIA) phase angle (PA), grip strength were obtained all within 48 h of admission. Mortality data were verified by means of mortality registry and analysed using Cox-proportional hazard models. Results: Ninety (40%) participants died at the end of follow-up. There were significant relationships between PA, MNA score, age and gender on mortality. Patients in the lowest tertile of PA (< 4·6°) had higher mortality estimates [I vs II tertile: hazard ratio (HR) = 3·40; 95% confidence interval (CI): 2·01–5·77; II vs III tertile: HR = 3·83; 95% CI: 2·21–6·64; log-rank test: χ2 = 43·6; P < 0·001]. Similarly, the survival curves demonstrated low MNA scores (< 22) were associated with higher mortality estimates (HR = 1·85; 95% CI: 1·22–2·81 χ2 = 8·2; P = 0·004). Conclusions: The MNA and BIA-derived phase angle are reasonable tools to identify malnourished patients at high mortality risk and may represent useful markers in intervention trials in this high-risk subgroup.

Published
2016

12. The impact of polypharmacy and drug interactions among the elderly population in Western Sicily, Italy

Author

Maurizio Pastorello, Salvatore Scondotto, Sebastiano Pollina Addario, Giulia Scondotto, Fanny Pojero, Michele Visconti, Alessandra Casuccio, Mauro Ferrante, Scondotto, G., Pojero, F., Pollina Addario, S., Ferrante, M., Pastorello, M., Visconti, M., Scondotto, S., and Casuccio, A.

Subjects
Drug, Male, Aging, Pediatrics, medicine.medical_specialty, Databases, Factual, media_common.quotation_subject, Drug interaction, Population, Drug prescription, 030204 cardiovascular system & hematology, Settore MED/42 - Igiene Generale E Applicata, 03 medical and health sciences, 0302 clinical medicine, Drug Utilization Review, Age groups, Elderly population, Internal medicine, medicine, Clinical endpoint, Humans, Drug Interactions, 030212 general & internal medicine, Settore SECS-S/05 - Statistica Sociale, Medical prescription, education, Sicily, media_common, Aged, Polypharmacy, education.field_of_study, business.industry, Significant difference, Age Factors, Middle Aged, Contraindicated drug-drug interactions, Population Surveillance, Chronic Disease, Settore BIO/14 - Farmacologia, Female, Geriatrics and Gerontology, business
Abstract

Aim: Primary endpoint was to report polypharmacy distribution in the general population vs ≥65 years old people and to examine the frequency of drug–drug interactions (DDIs) in the Health Local Unit of Palermo, Italy, in relationship with patients’ age. Methods: Drug prescription data for the year 2014 were extracted from the database of the Local Health Unit of Palermo Province, Italy. Patients were divided into five age groups (0–13, 14–64, 65–69, 70–74, and ≥75 year old). The detection of potential DDIs in polypharmacy profiles was performed with NavFarma software (Infologic srl, Padova, Italia), with DDI classification provided by tool Micromedex Drug Reax (Truven Health Analitics, Michigan, USA). Results: We analyzed data of 1,324,641 patients, and 15,801,191 medical prescription were recorded; of these, 11,337,796 regarded chronic conditions. The drug prescriptions reached the highest values in the 65–69 and 70–74 age groups (p = 0.005 and p = 0.008 vs age 14–64 respectively). An overall amount of 6,094,373 DDIs were detected, of which 47,173 were contraindicated. Median number of DDIs was higher in 65–69 and 70–74 age groups (p = 0.008 and p = 0.012 vs age 14–64, respectively). Regarding contraindicated DDIs a significant difference was detected comparing 14–64 vs ≥65 age groups (p = 0.010 vs 65–69 group, p= 0.005 vs 70–74 group and ≥75 group). Conclusions: Polypharmacy is a phenomenon acquiring increasing dimensions also in our province. It interests particularly the older subjects, and assumes a dramatic accent when it is put in relationship with the frequency of DDIs. A proactive vigilance about potential life threatening drug interactions is mandatory.

Published
2017

13. North-south differences in incidence and surveillance of cutaneous malignant melanoma in Italy.

Author

Bucchi L, Mancini S, Zamagni F, Crocetti E, Dal Maso L, Ferretti S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Bella F, Carrozzi G, Cascone G, Ferrante M, Michiara M, Musolino A, Tumino R, Usticano A, Allotta A, Pollina Addario S, Lacarrubba F, Stanganelli I, and Falcini F

Subjects
Humans, Incidence, Female, Italy epidemiology, Male, Middle Aged, Aged, Adult, Registries, Aged, 80 and over, Melanoma epidemiology, Melanoma pathology, Skin Neoplasms epidemiology, Skin Neoplasms pathology, Melanoma, Cutaneous Malignant
Abstract

Background: In Italy, the incidence of cutaneous malignant melanoma is two-fold higher in the north than in the south. This gradient might be associated with differences in incidence trends and disease surveillance. We compared the time trends in incidence rates, mortality rates, dermatologic office visit rates and skin biopsy rates between the Emilia-Romagna Region (northern Italy) and the Sicily Region (southern Italy)., Methods: The cancer registries of Parma, Modena, Ferrara and Romagna (current population, 2,606,465) and Catania-Messina-Enna, Siracusa and Ragusa (2,775,019) provided incidence and mortality records for the years 2008-2017. The records of outpatient services delivered in public health facilities were obtained from the two Regional Administrations. Trends in rates were assessed with the estimated average annual percent change. North-south differences were expressed as age-standardised rate ratios., Results: In the context of a generalised increasing incidence trend, which was more moderate in the female population of the Sicily Region, the standardised rate ratios were: 5.31 (males) and 5.20 (females) for in situ cutaneous malignant melanoma; 2.10 and 2.07 for invasive cutaneous malignant melanoma, with an excess incidence concentrated in lesions ⩽1.00 mm thick (3.58 and 3.05); 3.00 and 2.44 for dermatologic office visits; and 5.25 and 5.02 for skin biopsies. Mortality was stable in both Regions., Conclusions: In the Emilia-Romagna Region, as compared with the Sicily Region, a higher incidence of cutaneous malignant melanoma -especially of in situ and early invasive cutaneous malignant melanoma- coexisted with a higher level of clinical surveillance. The question of the direction of the cause-effect relationship between increased incidence and increased diagnostic scrutiny remains open., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Published
2024
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14. [Temporal analysis of the prevalence of congenital hypospadias in the municipality of Gela].

Author

Tavormina EE, Bianchi F, Drago G, Ruggieri S, Usticano A, Cernigliaro A, Scondotto S, Pollina Addario S, Cosentini I, and Cibella F

Subjects
Humans, Prevalence, Male, Sicily epidemiology, Infant, Infant, Newborn, Italy epidemiology, Oil and Gas Industry, Environmental Exposure adverse effects, Risk Factors, Odds Ratio, Hypospadias epidemiology
Abstract

Objectives: to evaluate the risk profile of hypospadias in Gela, an Italian National Priority Contaminated Site (NPCS) located in Sicily Region (Southern Italy), characterized by a significant excess of hypospadias in newborn residents compared to data from reference on regional, national, and international basis and, until 2014, by the presence of a petrochemical plant., Design: geographical analyses were conducted by comparing the prevalence of the Gela municipality to prevalence found in Sicily, in a territorial area bordering Gela (ALG), and in the NPCSs of Milazzo and Priolo. The geographical comparisons were conducted for the period 2010-2020, the trend within the Gela NPCS was evaluated by comparing two subperiods (2010-2014 and 2015-2020)., Setting and Participants: children up to 1 year of age with hypospadias resident in the municipality of Gela in the period 2010-2020., Main Outcomes Measures: crude odds ratios (OR) and respective 95% confidence intervals (95%CI) were used to compare the prevalence observed in Gela and that detected in the comparison areas., Results: excess risk for hypospadias was highlighted in 2010-2020 in Gela vs Sicily (OR 4.45; 95%CI 3.45-5.75), vs ALG (OR 4.29; 95%CI 3.02-6.10), and vs the NPCSs of Milazzo (OR 2.32; 95%CI 1.32-4.07) and Priolo (OR 2.37; 95%CI 1.55-3.62). The between-period comparisons in Gela did not show an important difference between 2010-2014 and 2015-2020 (OR 1.37; 95%CI 0.83-2.24), with a prevalence of 98.9 and 72.4 per 10,000, respectively., Conclusions: the prevalence of hypospadias in 2015-2020 remains very high, although decreasing when compared to 2010-2014 period. The Gela data, despite the refinery being closed after 2014, suggest a complex situation in which multiple risk factors may play a role.

Published
2024
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15. Comparing clinical trial population representativeness to real-world users of 17 biologics approved for immune-mediated inflammatory diseases: An external validity analysis of 66,639 biologic users from the Italian VALORE project.

Author

Ingrasciotta Y, Spini A, L'Abbate L, Fiore ES, Carollo M, Ientile V, Isgrò V, Cavazzana A, Biasi V, Rossi P, Ejlli L, Belleudi V, Poggi F, Sapigni E, Puccini A, Ancona D, Stella P, Pollina Addario S, Allotta A, Leoni O, Zanforlini M, Tuccori M, Gini R, and Trifirò G

Subjects
Adult, Female, Humans, Immunomodulating Agents, Italy, Biological Products adverse effects, Psoriasis drug therapy
Abstract

To date, no population-based studies have specifically explored the external validity of pivotal randomized clinical trials (RCTs) of biologics simultaneously for a broad spectrum of immuno-mediated inflammatory diseases (IMIDs). The aims of this study were, firstly, to compare the patients' characteristics and median treatment duration of biologics approved for IMIDs between RCTs' and real-world setting (RW); secondly, to assess the extent of biologic users treated for IMIDs in the real-world setting that would not have been eligible for inclusion into pivotal RCT for each indication of use. Using the Italian VALORE distributed database (66,639 incident biologic users), adult patients with IMIDs treated with biologics in the Italian real-world setting were substantially older (mean age ± SD: 50 ± 15 years) compared to those enrolled in pivotal RCTs (45 ± 15 years). In the real-world setting, certolizumab pegol was more commonly used by adult women with psoriasis/ankylosing spondylitis (F/M ratio: 1.8-1.9) compared to RCTs (F/M ratio: 0.5-0.6). The median treatment duration (weeks) of incident biologic users in RW was significantly higher than the duration of pivotal RCTs in almost all indications for use and most biologics (4-100 vs. 6-167). Furthermore, almost half (46.4%) of biologic users from RW settings would have been ineligible for inclusion in the respective indication-specific pivotal RCTs. The main reasons were: advanced age, recent history of cancer and presence of other concomitant IMIDs. These findings suggest that post-marketing surveillance of biologics should be prioritized for those patients., Competing Interests: Declaration of Competing Interest G.T. participated to advisory boards and seminars as lecturer on topics not related to the paper and sponsored by the following pharmaceutical companies in the last two years: Eli Lilly; Sanofi; Amgen; Novo Nordisk; Sobi; Gilead; Celgene; Daiichi Sankyo, Takeda and MSD. He is also scientific coordinator of the pharmacoepidemiology team at the University of Verona and of the academic spin-off “INSPIRE srl” that carried out in the last two years observational studies/systematic reviews on topics not related to the content of this article and which were funded by PTC Pharmaceutics, Kyowa Kirin, Shionogi, Shire, Chiesi and Daiichi Sankyo. Y.I. is the CEO of the academic spin-off “INSPIRE srl”, which has received funding for conducting observational studies from contract research organizations (RTI Health Solutions, Pharmo Institute N.V.) and from pharmaceutical Companies (Chiesi Italia, Kyowa Kirin s.r.l., Daiichi Sankyo Italia S.p.A.)., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2024
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16. Development of a Set of Indicators for Measuring and Improving Quality of Rehabilitation Care after Ischemic Stroke.

Author

De Cola MC, Ielo A, Corallo F, Pollina Addario S, Scondotto S, Allotta A, Fantaci G, Bramanti P, and Ciurleo R

Abstract

Stroke is the leading global cause of permanent disability and the second leading cause of dementia within the first year of the event. Systematic quality improvement interventions such as Audit & Feedback (A&F) can monitor and improve the performance of post-stroke care in conjunction with the use of quality indicators (QIs). The scientific literature shows limited studies on quality improvement and QIs design for poststroke rehabilitation. In Italy, the National Outcomes Evaluation Programme (PNE) annually provides several QIs concerning the acute wards. On the contrary, indicators for quality assessment of post-acute stroke rehabilitation are not available nationwide. In recent years, the Italian Ministry of Health has funded a national network project, the aim of which is to provide and evaluate the effectiveness of A&F strategies in healthcare improvement. Part of this project is the development of a set of IQs for ischemic stroke rehabilitation used to conduct an A&F. In this study, we describe the design and development process of these QIs from administrative databases and report the results of the pilot test conducted on a small sample of Sicilian rehabilitation facilities, comparing them from 2019 to 2021. Feedback from the participating centers was mainly positive, and the quality indicators were found to be comprehensible and appreciated. However, the study highlighted the need for better adherence to indicators measuring processes of rehabilitation care. The set of quality indicators presented in this study, relevant to inpatient settings, could be considered a starting point on which to base quality improvement initiatives both nationally and internationally.

Published
2023
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17. [Application of an algorithm for the validation of congenital anomaly cases using hospital discharge records].

Author

Drago G, Tavormina E, Ruggieri S, Cibella F, Allotta A, Pollina Addario S, Dardanoni G, and Scondotto S

Subjects
Algorithms, Hospitals, Humans, Sicily epidemiology, Hospital Records, Patient Discharge
Abstract

Objectives: to evaluate and validate the adoption of an algorithm for the identification of cases of congenital anomalies (CAs) to improve the performance of the Congenital Malformations Registry of Sicily Region (Southern Italy)., Design: an algorithm was used to identify congenital anomalies on a sample of hospital discharge records (SDO) with ICD-9-CM code between 740-759 on any of the diagnoses within the first year of life, together with a sample of healthy births equal to 5% of total births for the same period. The identified cases were evaluated through the clinical record analysis., Setting and Participants: the analysed sample was composed of 4,271 cases identified between June 2013 and December 2014 along with 3,993 SDO without any code of MC (5% of the total volume of births in the same period)., Main Outcome Measures: positive predictive value (VPP) and negative predictive value (VPN) were computed by means of the comparison between the algorithm outcomes and the clinical record verification., Results: 4,271 potentially malformed records involving 3,381 subjects born in the Sicilian territory have been identified. Among the hospital discharge records that it was possible to verify, the application of the algorithm led to the exclusion of 924 cases: of these, 62 proved to be false negatives (VPN: 93.3). The valid cases were 1,179, while the cases to be evaluated 617: the comparison between algorithm and clinical record analysis led to a VPP of 91.7 and 72.1, respectively, for valid and to be evaluated., Conclusions: the tested algorithm proved to be a useful tool for identifying SDO potentially related to congenital anomalies. In the overall sample, the algorithm provided an outcome consistent with the clinical record assessment in 87.4% (2,379) of cases.

Published
2022
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18. [The epidemiological surveillance in the programme of public health intervention in the national priority contaminated sites of Sicily Region (Southern Italy): update of mortality, hospitalization, and cancer incidence].

Author

Cernigliaro A, Santangelo OE, Maniglia M, Pollina Addario S, Usticano A, Marras A, Ciranni P, Dardanoni G, Saporito L, Tavormina E, Fantaci G, and Scondotto S

Subjects
Cause of Death, Female, Hospitalization statistics & numerical data, Humans, Incidence, Male, Mortality, Sicily epidemiology, Chronic Disease epidemiology, Environmental Monitoring, Environmental Pollution, Health Priorities, Neoplasms epidemiology
Abstract

Objectives: to update the health profile of populations residing in the national priority contaminated sites (NPCSs) in Sicily Region (Southern Italy) through a description of mortality and hospitalization for causes and through cancer incidence. This new profile is part of the implementation of the epidemiological surveillance system within the new Programme of care intervention for health protection in these populations and in the new Regional Prevention Plan., Design: geographic population survey providing, for each NPCS considered in this study, a comparison between the local population and the populations of the neighbouring areas., Setting and Participants: the study population included the residents in the municipalities residing in the NPCSs of Augusta-Priolo, Gela, Milazzo, and Biancavilla., Main Outcome Measures: the standardized mortality ratio (SMR), morbidity (SHR), and tumour incidence (SIR), with the respective 95% confidence intervals, were estimated using the Mortality Registry as source for the mortality index, the database of the hospital discharged as source for the morbidity index, and the data from the Regional Network of Tumour Registers as source for the incidence index., Results: in the local comparison, excess of hospitalization in both sexes was reported in Augusta-Priolo for liver cirrhosis, mental disorders, and digestive tract disease, and an excess of incidence and mortality for leukaemia in women and prostate cancer in men. In the NPCS of Gela, there was an excess of hospitalization in both sexes for blood and hematopoietic diseases, circulatory and nervous system diseases, coupled with the same excess of mortality. Excess of incidence and mortality of stomach tumours in men and incidence of lung cancer in women were observed. The area of ​​Milazzo was characterized by an excess of incidence and mortality for melanoma in men. In the municipality of Biancavilla, there is evidence of excess of hospitalization for respiratory diseases and endocrine glands diseases in both sexes, while a mortality excess for circulatory system diseases was highlighted. The excess of incidence of mesothelioma in both men and women was confirmed., Conclusion: data from the new surveillance system help to define the health profile in the NPCSs of Sicily. Even using the local level of comparison, that was added to the traditional approach in geographic studies for the NPCSs available to date, the particular impact of some chronic diseases in these populations has been confirmed also in recent years.

Published
2019
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19. The impact of polypharmacy and drug interactions among the elderly population in Western Sicily, Italy.

Author

Scondotto G, Pojero F, Pollina Addario S, Ferrante M, Pastorello M, Visconti M, Scondotto S, and Casuccio A

Subjects
Age Factors, Aged, Chronic Disease drug therapy, Databases, Factual, Female, Humans, Male, Middle Aged, Population Surveillance, Sicily, Drug Interactions, Drug Utilization Review statistics & numerical data, Polypharmacy
Abstract

Aim: Primary endpoint was to report polypharmacy distribution in the general population vs ≥65 years old people and to examine the frequency of drug-drug interactions (DDIs) in the Health Local Unit of Palermo, Italy, in relationship with patients' age., Methods: Drug prescription data for the year 2014 were extracted from the database of the Local Health Unit of Palermo Province, Italy. Patients were divided into five age groups (0-13, 14-64, 65-69, 70-74, and ≥75 year old). The detection of potential DDIs in polypharmacy profiles was performed with NavFarma software (Infologic srl, Padova, Italia), with DDI classification provided by tool Micromedex Drug Reax (Truven Health Analitics, Michigan, USA)., Results: We analyzed data of 1,324,641 patients, and 15,801,191 medical prescription were recorded; of these, 11,337,796 regarded chronic conditions. The drug prescriptions reached the highest values in the 65-69 and 70-74 age groups (p = 0.005 and p = 0.008 vs age 14-64 respectively). An overall amount of 6,094,373 DDIs were detected, of which 47,173 were contraindicated. Median number of DDIs was higher in 65-69 and 70-74 age groups (p = 0.008 and p = 0.012 vs age 14-64, respectively). Regarding contraindicated DDIs a significant difference was detected comparing 14-64 vs ≥65 age groups (p = 0.010 vs 65-69 group, p = 0.005 vs 70-74 group and ≥75 group)., Conclusions: Polypharmacy is a phenomenon acquiring increasing dimensions also in our province. It interests particularly the older subjects, and assumes a dramatic accent when it is put in relationship with the frequency of DDIs. A proactive vigilance about potential life threatening drug interactions is mandatory.

Published
2018
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20. Developing and validating a novel multisource comorbidity score from administrative data: a large population-based cohort study from Italy.

Author

Corrao G, Rea F, Di Martino M, De Palma R, Scondotto S, Fusco D, Lallo A, Belotti LMB, Ferrante M, Pollina Addario S, Merlino L, Mancia G, and Carle F

Subjects
Aged, Aged, 80 and over, Cohort Studies, Databases, Factual, Drug Prescriptions economics, Female, Hospitalization economics, Humans, Italy, Kaplan-Meier Estimate, Male, Middle Aged, ROC Curve, Regression Analysis, Severity of Illness Index, State Medicine economics, Comorbidity trends, Health Care Costs trends, Hospital Mortality trends, Hospitalization statistics & numerical data, Risk Adjustment methods
Abstract

Objective: To develop and validate a novel comorbidity score (multisource comorbidity score (MCS)) predictive of mortality, hospital admissions and healthcare costs using multiple source information from the administrative Italian National Health System (NHS) databases., Methods: An index of 34 variables (measured from inpatient diagnoses and outpatient drug prescriptions within 2 years before baseline) independently predicting 1-year mortality in a sample of 500 000 individuals aged 50 years or older randomly selected from the NHS beneficiaries of the Italian region of Lombardy (training set) was developed. The corresponding weights were assigned from the regression coefficients of a Weibull survival model. MCS performance was evaluated by using an internal (ie, another sample of 500 000 NHS beneficiaries from Lombardy) and three external (each consisting of 500 000 NHS beneficiaries from Emilia-Romagna, Lazio and Sicily) validation sets. Discriminant power and net reclassification improvement were used to compare MCS performance with that of other comorbidity scores. MCS ability to predict secondary health outcomes (ie, hospital admissions and costs) was also investigated., Results: Primary and secondary outcomes progressively increased with increasing MCS value. MCS improved the net 1-year mortality reclassification from 27% (with respect to the Chronic Disease Score) to 69% (with respect to the Elixhauser Index). MCS discrimination performance was similar in the four regions of Italy we tested, the area under the receiver operating characteristic curves (95% CI) being 0.78 (0.77 to 0.79) in Lombardy, 0.78 (0.77 to 0.79) in Emilia-Romagna, 0.77 (0.76 to 0.78) in Lazio and 0.78 (0.77 to 0.79) in Sicily., Conclusion: MCS seems better than conventional scores for predicting health outcomes, at least in the general population from Italy. This may offer an improved tool for risk adjustment, policy planning and identifying patients in need of a focused treatment approach in the everyday medical practice., Competing Interests: Competing interests: GC received research support from the European Community (EC), the Italian Agency of Drug (AIFA) and the Italian Ministry of Education, University and Research (MIUR). GC took part in a variety of projects that were funded by pharmaceutical companies (ie, Novartis, GSK, Roche, AMGEN, BMS). GC also received honoraria as member of Advisory Board from Roche., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Published
2017
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21. Nutritional predictors of mortality after discharge in elderly patients on a medical ward.

Author

Buscemi S, Batsis JA, Parrinello G, Massenti FM, Rosafio G, Sciascia V, Costa F, Pollina Addario S, Mendola S, Barile AM, Maniaci V, Rini N, and Caimi G

Subjects
Age Factors, Aged, Aged, 80 and over, Anthropometry, Cohort Studies, Comorbidity, Coronary Disease epidemiology, Diabetes Mellitus, Type 2 epidemiology, Electric Impedance, Female, Follow-Up Studies, Hand Strength, Hospitalization, Humans, Hypertension epidemiology, Italy epidemiology, Kidney Failure, Chronic epidemiology, Male, Middle Aged, Nutritional Status, Patient Discharge, Patients' Rooms, Prognosis, Proportional Hazards Models, Prospective Studies, Risk Factors, Malnutrition epidemiology, Mortality, Nutrition Assessment
Abstract

Background: Malnutrition in elderly inpatients hospitalized on medical wards is a significant public health concern. The aim of this study was to investigate nutritional markers as mortality predictors following discharge in hospitalized medical elderly patients., Materials and Methods: This is a prospective observational cohort study with follow-up of 48 months. Two hundred and twenty-five individuals aged 60 and older admitted from the hospital emergency room in the past 48 h were investigated at the medical ward in the University hospital in Palermo (Italy). Anthropometric and clinical measurements, Mini-nutritional Assessment (MNA) questionnaire, bioelectrical (BIA) phase angle (PA), grip strength were obtained all within 48 h of admission. Mortality data were verified by means of mortality registry and analysed using Cox-proportional hazard models., Results: Ninety (40%) participants died at the end of follow-up. There were significant relationships between PA, MNA score, age and gender on mortality. Patients in the lowest tertile of PA (< 4·6°) had higher mortality estimates [I vs II tertile: hazard ratio (HR) = 3·40; 95% confidence interval (CI): 2·01-5·77; II vs III tertile: HR = 3·83; 95% CI: 2·21-6·64; log-rank test: χ(2) = 43·6; P < 0·001]. Similarly, the survival curves demonstrated low MNA scores (< 22) were associated with higher mortality estimates (HR = 1·85; 95% CI: 1·22-2·81 χ(2) = 8·2; P = 0·004)., Conclusions: The MNA and BIA-derived phase angle are reasonable tools to identify malnourished patients at high mortality risk and may represent useful markers in intervention trials in this high-risk subgroup., (© 2016 Stichting European Society for Clinical Investigation Journal Foundation.)

Published
2016
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22. [Distance from the nearest hospital and mortality for acute miocardial infarction (AMI) in Sicily Region (Southern Italy)].

Author

Ferrante M, De Luca G, Fantaci G, Pollina Addario S, and Scondotto S

Subjects
Female, Health Services Accessibility economics, Hospitals, Humans, Male, Myocardial Infarction economics, Sicily epidemiology, Social Class, Time-to-Treatment, Health Services Accessibility statistics & numerical data, Myocardial Infarction mortality
Abstract

Objectives: to analyse the effect of distance between the Municipality of residence and the nearest hospital on out-of-hospital mortality rate of patients died for acute myocardial infarction (AMI)., Design: analysis of out-of-hospital mortality using a record linkage database., Setting and Participants: Sicilian Municipalities; 4,999 deaths with acute myocardial infarction as primary cause of death, by excluding patients hospitalised within the 15 days before the death event., Main Outcome Measures: acute myocardial infarction out-of-hospital mortality in Sicilian Municipalities, with the exclusion of patients hospitalised within 15 days before the death event., Results: during the years 2009-2011, 7,473 subjects died for acute myocardial infarction in Sicily. 4,999 (66.92%) patients were not hospitalised in the 15 days before the death event; 2,001 of these (40.01%) lived quite far from the nearest hospital (more than 17 minutes of traveling time). After adjustment for age, gender and socioeconomic status, the distance between the residential Municipality and the nearest hospital was significantly associated with increased mortality (27% higher risk of out-of-hospital mortality for patients living far from the nearest hospital, compared to those living in municipalities with at least one hospital)., Conclusions: the distance between the residential Municipality and the nearest Municipality with at least one hospital is associated with an increase in out-of-hospital mortality rate after acute myocardial infarction. However, besides the limitations of using a distance metric (at a municipality level), the clinical history of the subjects under study is not explicitly taken into account. Further studies are needed in order to explore the reasons for this correlation and to further analyse the relationship between distance and mortality (in- and out-of-hospital). Nevertheless, the results presented provide useful information for healthcare service management policies.

Published
2014

23. [Socioeconomic disparities in mortality among older people in Sicily].

Author

Cernigliaro A, Cesaroni G, Pollina Addario S, Dardanoni G, Forastiere F, Scondotto S, and Perucci CA

Subjects
Age Distribution, Aged, Aged, 80 and over, Female, Humans, Male, Sicily epidemiology, Social Class, Mortality trends, Socioeconomic Factors
Abstract

Objective: to construct a composite municipal index of socioeconomic position (SEP) and to describe socioeconomic disparities in mortality within Sicilian elderly inhabitants (age 65+)., Design: 2001 Sicily Census data were used to develop a 5-level SEP index for the 390 municipalities of the Region. Education, occupation, housing tenure, family composition and immigration were considered in order to perform a factor analysis. We used Sicilian Mortality Registry data to compute standardized mortality rates by gender. The SEP index was used for mortality from all causes and for most common causes of death in elderly population. Rates, with 95% confidence intervals, were computed to compare mortality in each level of SEP to the highest level., Results: there were socioeconomic disparities both in overall and in cause-specific mortality. Progressively higher mortality rates with lower SEP were observed for overall mortality (ratio between extreme categories: 1.16 in men, 1.14 in women), as well for mortality from cardiovascular diseases in both genders (ratio between extreme categories: 1.12 in men, 1.09 in women), from respiratory disease in men (ratio between extreme categories: 1.20), and from endocrine glands diseases in women (ratio between extreme categories: 1.35). For deaths from cancer and from diseases of the digestive system mortalities, in both genders, we found higher risks within the lowest SEP level as compared to the highest. Cardiovascular diseases contributed the most to the socioeconomic differences in overall mortality., Conclusion: Within the Sicilian elderly population, socioeconomic position is associated with mortality. The highest mortality rates were observed in the most disadvantaged municipalities. Moreover, mortality rates were oddly distributed by gender.

Published
2009

24. [The experience of the Sicilian epidemiology observatory in studying health status of population resident in Gela risk area].

Author

Cernigliaro A, Pollina Addario S, Fantaci G, Tavormina E, Dardanoni G, and Scondotto S

Subjects
Adolescent, Age Factors, Child, Child, Preschool, Cohort Studies, Female, Hospitalization, Humans, Infant, Infant, Newborn, Male, Neoplasms epidemiology, Neoplasms mortality, Occupational Diseases epidemiology, Occupational Exposure adverse effects, Risk Factors, Sex Factors, Sicily, Cause of Death, Chemical Industry, Epidemiologic Studies, Health Status, Morbidity trends, Mortality trends, Petroleum
Published
2009

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