Search Results for: I numeri del cancro in Italia 2019

Regione: ‘Lo certifica Agenas, orgogliosi del risultato’

Background
The COVID-19 outbreak at the end of 2019 severely impacted global healthcare systems, especially primary healthcare services. This paper aimed to identify the implications derived from the strengths and weaknesses observed in Iran’s primary healthcare (PHC) programmes during the pandemic.

Methods
This was a qualitative study conducted in 2021. 13 semistructured interviews were held with Iranian healthcare policymakers and executive managers, selected via snowball sampling, using the World Health Organization’s analytical framework. Finally, a thematic analysis was conducted on the interview data.

Results
The thematic analysis of the findings yielded five major themes: revision of healthcare financing, redefining education and research in primary healthcare, redefinition of primary healthcare, development of a new model for family medicine, and community engagement.

Conclusion
Addressing vertical inequality in Iran’s healthcare system was delineated to be crucial. Meanwhile, multiple strategies including enhancing family physicians’ knowledge and skills, decentralising decision-making, empowering them and involving communities in healthcare planning were presented to improve PHC and family medicine. Further empirical research is needed.

Purpose
The AMBulatoRy blOod preSsure In older Adults (AMBROSIA) study cohort was designed to determine whether ambulatory blood pressure (BP) monitoring (ABPM) is useful for identifying older adults with hypertension taking antihypertensive medication who are at increased risk for falls. The association of home BP monitoring (HBPM) with falls was assessed in an ancillary study (AMBROSIA-HOME).

Participants
AMBROSIA was a prospective observational study of adults aged 65 years and older taking antihypertensive medication for hypertension. Participants were recruited from Kaiser Permanente Southern California (KPSC), an integrated healthcare delivery system, and enrolled from May 2019 to November 2022. Demographic and clinical characteristics and geriatric assessments were collected over the course of two consecutive study visits. Participants completed a 24-hour ABPM and 1 week of HBPM. Over the following year, falls were assessed using a monthly falls calendar, and serious fall injuries were assessed from the KPSC electronic health record (EHR).

Findings to date
We enrolled 670 participants; 656 completed 24-hour ABPM and 536 also completed HBPM. The mean (SD) age of the AMBROSIA cohort was 75 (6) years, 16% were over 80 years of age and 56% were female. There were 13% non-Hispanic Asian or Pacific Islander, 22% non-Hispanic Black, 18% Hispanic and 44% non-Hispanic White participants. Nearly 72% had mild cognitive impairment, 50% were pre-frail and 4% were frail. Overall, 87% of participants returned all monthly calendars during follow-up.

Future plans
The AMBROSIA cohort can be updated with longitudinal data from the EHR including antihypertensive medication to explore the relationship of fall risk and white coat effect, defined as the difference between clinic BP and out-of-clinic BP, BP variability over 24 hours and postprandial BP decline with antihypertensive medication intensification during follow-up. Additionally, the cohort can be updated to include outcomes data from the EHR such as cardiovascular events to examine BP phenotypes as potential predictors of cardiovascular events.

Mazzucchelli, ‘dai numeri quadro assolutamente insoddisfacente’

Intervento eseguito in Abruzzo dall’équipe di Mastropasqua

Di cui 30mila minori. ‘Gli infermieri centrali ma troppo pochi’

Ostacoli anche dai prontuari terapeutici. Ritardi territoriali per la cura innovativa nel cancro della prostata

Stroke, Ahead of Print. BACKGROUND:Dual antiplatelet drug administration is recommended after percutaneous coronary intervention (PCI) stent placement. Although prasugrel, a newer P2Y12 inhibitor, reportedly suppresses cardiovascular events more effectively than the traditional agent clopidogrel, its preventive effects on cerebrovascular disorders remain a topic of ongoing debate. This study aimed to examine the cerebrovascular efficacy and safety of post-PCI prasugrel and clopidogrel using extensive real-world data in Japan.METHODS:Using the CLIDAS (Clinical Deep Data Accumulation System) database, 7412 post-PCI patients who received dual antiplatelet therapy between April 2013 and March 2019 were identified. The primary end point was defined as the incidence of any stroke, while secondary end points included individual ischemic and hemorrhagic cerebrovascular events. The incidence of cerebrovascular events was compared between the prasugrel (2.5–3.75 mg daily; n=2219) and clopidogrel (75 mg daily; n=5193) groups using propensity-score inverse probability of treatment weighting and Fine and Gray models to account for competing risks.RESULTS:Within 1 year after PCI, the prasugrel group had a significantly lower incidence of cerebrovascular events (subdistribution hazard ratio, 0.46 [95% CI, 0.24–0.91];P=0.027) than the clopidogrel group. The subgroup analyses did not show significant differences in the incidence of ischemic (subdistribution hazard ratio, 0.54 [95% CI, 0.25–1.14];P=0.11) and hemorrhagic cerebrovascular events (subdistribution hazard ratio, 0.30 [95% CI, 0.084–1.10];P=0.070) between the use of prasugrel and clopidogrel. One-year health care costs between patients treated with prasugrel and those treated with clopidogrel showed no significant differences.CONCLUSIONS:Our data suggest that post-PCI prasugrel use was associated with lower cerebrovascular events compared with the use of clopidogrel in combination with aspirin. Further research is necessary to substantiate the potential of prasugrel in lowering cerebrovascular risks after post-PCI while upholding a satisfactory safety profile.

Objective
To determine wealth-based inequality and the dropout rate in the completion of the maternal continuum of care (CoC) in Ethiopia.

Setting
Ethiopian Demographic and Health Survey-2019.

Participants
Reproductive-age women (15–49 years) in Ethiopia.

Primary outcome
Completion of the maternal CoC services is the primary outcome. Maternal CoC is defined as a situation where women have at least four antenatal care (ANC) visits, deliver their babies at a health facility and receive at least one postnatal care service for both mother and newborn baby.

Methods
We analysed the 2019 Mini demographic and health survey data using STATA V.17. Multilevel logistic regression analysis was employed for the factors associated with the maternal CoC. The concentration index was used to measure equity.

Result
Overall, 24% (95% CI: 21.6 to 26.5) of women completed the maternal CoC. There was wealth-based inequality in the completion of maternal CoC in Ethiopia (concentration index: 0.25 (95% CI: 0.18 to 0.31, p≤0.001)), rural residents (concentration index: 0.15 (95% CI: 0.09 to 0.21, p≤0.001)) and urban residents (concentration index: 0.15 (95% CI: 0.05 to 0.26, p≤0.01)). Being an urban resident (adjusted OR (AOR)=1.59, 95% CI: 1.09 to 2.33), attaining secondary (AOR=1.67, 95% CI: 1.19 to 2.33) or higher education (AOR=1.93, 95% CI: 1.30 to 2.87) and early initiation of ANC (AOR=1.97, 95% CI: 1.61 to 2.41) were positively associated with the completion of maternal CoC. However, belonging to a pastoral region (Afar or Somali) (AOR=0.46, 95% CI: 0.28 to 0.77), belonging to the poorest (AOR=0.58, 95% CI: 0.37 to 0.92) or middle (AOR=0.62, 95% CI: 0.40 to 0.96) wealth quintile, not being informed about obstetric danger signs (AOR=0.54, 95% CI: 0.43 to 0.66) and blood pressure not being measured (AOR=0.53, 95% CI: 0.32 to 0.85) were negatively associated with maternal CoC.

Conclusion
We concluded that completion of the maternal CoC was low in Ethiopia. There was significant inequality in the completion of maternal CoC across wealth status, place of residence and educational status. Strategies and interventions that target the disadvantaged group of women are needed to improve the utilisation of maternal healthcare services. Tailored and multisectoral intervention considering women with poor or middle wealth, women in pastoralist regions and women with no information on obstetric danger signs improves the CoC practice in the country.

Stroke, Ahead of Print. INTRODUCTION:Patients with chronic kidney disease (CKD) are at increased risk of ischemic stroke (IS) and intracerebral hemorrhage, so the safety and efficacy of early direct oral anticoagulant (DOAC) initiation in those with CKD are of interest.METHODS:OPTIMAS was a multicenter, randomized, parallel-group, open-label trial with blinded outcome assessment, recruiting patients with IS and atrial fibrillation from 100 UK hospitals between 2019 and 2024. Participants were randomized 1:1, stratified by stroke severity, to early (within 4 days of onset) or delayed (at days 7–14) DOAC initiation. CKD was defined as a past medical history of known CKD, collected according to trial protocol as part of the case report form. For this prespecified subgroup analysis, the trial cohorts were classified according to the presence or absence of CKD. Whether CKD modified the treatment effect of early DOAC initiation was determined by fitting mixed effects logistic regression models with interaction terms between CKD and treatment group. The primary outcome was a composite outcome of recurrent IS, symptomatic intracranial hemorrhage, and systemic arterial embolism. Key secondary outcomes included the individual components of the primary outcome and all-cause mortality.RESULTS:We included 3601 patients (mean age, 78±10 years; 45% female), 543 with CKD. There were 116 primary outcome events: 97 (3.2%) in the normal kidney function group and 19 (3.5%) in the CKD group. There was no difference between early and delayed DOAC initiation for the primary outcome in either the normal kidney function group (odds ratio, 1.01 [95% CI, 0.67–1.51]) or the CKD group (odds ratio, 0.90 [95% CI, 0.36–2.25];Pinteraction=0.822). Similarly, for the secondary outcomes, we detected no modification of the treatment effect according to CKD (Pinteractionvalues of 0.637, 0.386, and 0.107 for IS, symptomatic intracranial hemorrhage, and all-cause mortality, respectively).CONCLUSIONS:Our findings suggest that CKD does not modify the effects of early versus delayed DOAC initiation after acute IS. Based on these results, early DOAC initiation should not be withheld in patients with CKD.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT03759938.

Stroke, Ahead of Print. BACKGROUND:For patients with acute ischemic stroke due to a large vessel occlusion admitted in primary stroke centers, helicopter transfer to comprehensive stroke centers is often used to expedite access to mechanical thrombectomy. Some studies have suggested that vibrations generated during helicopter transport might enhance intravenous thrombolysis (IVT) efficacy. We aimed to evaluate the impact of helicopter transfer, compared with ground transportation, on interhospital recanalization and functional outcomes.METHODS:We conducted a retrospective analysis of 2 prospectively collected cohorts of anterior circulation acute ischemic stroke due to a large vessel occlusion patients transferred to 2 comprehensive stroke centers (Stanford, CA, November 2019 to January 2023, and Montpellier, France, January 2015 to January 2017) for mechanical thrombectomy consideration with arterial imaging both at the primary stroke center and on comprehensive stroke center arrival. The primary outcome was interhospital recanalization, determined by comparison of the baseline and posttransfer arterial imaging and defined as revised arterial occlusive lesion scores of 2b to 3. The association between transportation mode (helicopter versus ground) and interhospital recanalization was studied in logistic regression analysis, adjusting for pretransfer IVT use, occlusion site, and transfer duration.RESULTS:Among 520 included patients, 315 (61%) were transferred by helicopter and 259 (50%) received IVT before transfer. Interhospital recanalization rates were similar between helicopter and ground transfers in both the overall cohort (23% versus 19%;P=0.30) and the IVT subgroup (36% versus 33%;P=0.61). Adjusted analyses confirmed no association between helicopter transport and interhospital recanalization (adjusted odds ratio, 1.23 [95% CI, 0.72–2.11];P=0.44). Favorable 3-month functional outcome (modified Rankin Scale score, 0–2) rates were also similar between helicopter and ground transfers in both unadjusted (35% versus 40%;P=0.29) and adjusted analyses (adjusted odds ratio, 1.12 [95% CI, 0.67–1.88];P=0.67).CONCLUSIONS:In this multicenter observational cohort study, helicopter transfer was not associated with improved interhospital recanalization or favorable functional outcomes compared with ground transport. These findings do not support the hypothesis that vibrations during helicopter transport enhance IVT efficacy.

Objectives
Suicide rates in India are among the highest in the world, with the most recent suicide death rate estimates ranging between 18 and 21 deaths per 100 000 population (compared with the global average of 11/100 000). Responsible media reporting of suicide is one of the few evidence-based population-level suicide prevention interventions. Reports of recent suicides are a routine daily feature in major newspapers in India, and the reporting style carries many concerning features. In 2019, the Press Council of India adopted the WHO media guidelines, yet there has been no investigation as to whether this guidance is being followed. The aim of this paper was to systematically investigate whether the quality of print media reports of suicides has changed since the adoption of media guidelines for suicide reporting in India.

Design
We used content analysis to assess the quality of suicide reporting against WHO guidelines in nine of the most highly read daily newspapers in the southern state of Tamil Nadu between June and December 2016 and June and December 2023. Our analyses of changes in reporting were based on a sample of 1681 print newspaper articles from 2016 and 512 print newspaper articles from 2023. Two-tailed t-tests and proportion tests on aggregate means and frequencies assessed whether the reporting characteristics had changed between 2016 and 2023.

Results
There were small yet statistically discernible reductions in the proportion of articles containing various potentially harmful reporting characteristics, such as articles placed on the front page (4.9–1.8%, p=0.002) and articles mentioning the suicide method (92.7–86.5%, p

Objectives
We hypothesised that there is substantial variation in acute myocardial infarction (AMI) treatment across English hospitals, particularly for people hospitalised for non-ST-elevation myocardial infarction (NSTEMI) and with reduced kidney function. This study aimed to describe this variation at the hospital and the individual level to understand treatment variation and potential disparities in AMI management among people with reduced kidney function.

Design
Cross-sectional study.

Setting
Secondary care in England.

Participants
People hospitalised for AMI (ST-elevation myocardial infarction (STEMI) or NSTEMI) in English hospitals and captured in the Myocardial Ischaemia National Audit Project, 2014 to 2019. Kidney function was defined using estimated glomerular filtration rate (eGFR) derived from the serum creatinine recorded within 24 hours of AMI admission.

Outcome measure
The primary outcome was recorded invasive cardiac intervention (at least one of angiography, percutaneous coronary intervention and coronary artery bypass graft) compared with conservative management.

Results
We included 361 259 people with a first hospitalisation for AMI (STEMI or NSTEMI) at 209 hospitals for hospital-level analyses and 292 572 people with complete covariable data at 207 hospitals for individual-level analyses. We found substantial variation in the mean proportion of people with NSTEMI managed invasively across hospitals in England. At the individual level, using multivariable logistic regression to derive adjusted predicted probabilities to describe the association between kidney function and AMI management (invasive vs conservative management), we found that people had a lower adjusted predicted probability of being treated with invasive cardiac management with worsening eGFR range, particularly for NSTEMI cases (eGFR range 2: 76.6% (95% CI 76.3 to 76.8) vs eGFR range 5: 44.5% (95% CI 41.2 to 47.5)).

Conclusions
There is substantial AMI treatment variation across hospitals in England, particularly among people hospitalised for NSTEMI with reduced kidney function. Further research is needed to evaluate the comparative effectiveness of NSTEMI management strategies for complex patients.

“Abbiamo capito che non esistono cure miracolose”

Objectives
The influence of short-term variations in blood pressure (BP) in acute stroke on clinical outcomes remains uncertain. Our study explores the relationship between BP variability (BPV) from stroke admission up to 72 hours and in-hospital and 1-year mortality.

Design
Retrospective observational cohort study.

Setting
Hamad General Hospital (HGH) a tertiary care stroke centre in Qatar.

Participants
2820 participants were initially included. After the exclusion of ineligible subjects, 2554 patients (82.5% male, median age 53±9 years) were included. 893 (34.96%) were from the Middle East and North Africa, 1302 (50.98%) were from South Asia, 258 (10.10%) from Southeast Asia, 9 (0.35%) were from East Asia and 92 (3.60%) were from other regions. Eligible participants were adult patients above 18 years of age who presented with acute ischaemic or haemorrhagic stroke. Excluded individuals were those younger than 18 years, had incomplete data, had transient ischaemic attack (TIA), had severe hypoglycaemia on admission (