scholarly journals Subclinical hypothyroidism in paediatric population treated with levothyroxine: a real-world study on 2001–2014 Italian administrative data

2017 ◽  
Vol 6 (6) ◽  
pp. 367-374 ◽  
Author(s):  
Nella Augusta Greggio ◽  
Elisa Rossi ◽  
Silvia Calabria ◽  
Alice Meneghin ◽  
Joaquin Gutierrez de Rubalcava ◽  
...  
Keyword(s):  
Real World ◽  
Subclinical Hypothyroidism ◽  
Paediatric Population ◽  
Mean Value ◽  
Administrative Databases ◽  
Slight Reduction ◽  
Local Health ◽  
Annual Dose ◽  
Historical Cohort ◽  
Low Dosage

Objective To estimate the prevalence of subclinical hypothyroidism (SH) among children, by using levothyroxine low dosage as disease proxy, and to describe prescription pattern. Design An historical cohort study was performed through administrative databases of 12 Italian Local Health Units covering 3,079,141 inhabitants. A cohort of children (aged 0–13 years) was selected in the period 2001–2014. A subgroup of new users (aged 0–9 years) was identified and followed up for 5 years. Methods The prevalence was provided as mean value of the whole period, as annual trend, by patient gender and age. Demographic details, information on levothyroxine dosage, comorbidities and co-medications were provided. Therapy duration and medication persistence were evaluated among new users. Results 644 children treated with levothyroxine low dosage was selected, with a mean annual prevalence of 0.20 per 1000 children. The temporal trend of prevalence was stable, with a slight reduction in the 2005–2008. Prevalence by age showed an increase after 10 years. Patients were treated with an average annual dose of 4290 µg/year and 66.9% of children were affected by comorbidities. Among 197 new users, 62.9% received therapy only for one year, whereas out of those treated two or more years, 89.0% resulted persistent to the therapy. Conclusions This study provides real-world epidemiology of SH among children, and it depicts the clinical and therapeutic characteristics of these subjects. Its findings showed that the SH treatment of this disorder was widely variable, also due to lack of evidence concerning paediatric population.

scholarly journals Association of Hypertriglyceridemia with All‐Cause Mortality and Atherosclerotic Cardiovascular Events in a Low‐Risk Italian Population: The TG‐REAL Retrospective Cohort Analysis

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Marcello Arca ◽  
Chiara Veronesi ◽  
Laura D’Erasmo ◽  
Claudio Borghi ◽  
Furio Colivicchi ◽  
...  
Keyword(s):  
Real World ◽  
Clinical Setting ◽  
Cohort Analysis ◽  
Administrative Databases ◽  
Local Health ◽  
Atherosclerotic Cardiovascular Disease ◽  
Italian Population ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Very High

Background Evidence regarding the relationships among high plasma triglycerides (TG), all‐cause mortality, and atherosclerotic cardiovascular disease (ASCVD) events in low‐to‐moderate risk individuals is limited. The aim of this study was to determine whether the presence of high TG levels influences the risk of all‐cause mortality and ASCVD events in a population cohort followed in the real‐world clinical setting. Methods and Results A retrospective longitudinal cohort analysis using administrative databases of 3 Italian Local Health Units was performed. All individuals with at least one TG measurement between January 1, 2010 and December 31, 2015 were followed through December 2016. Outcome measures included incident ASCVD events and all‐cause mortality. Individuals with normal TG levels (<150 mg/dL) were compared with those with high (150–500 mg/dL) and very high TG (>500 mg/dL). 158 042 individuals (142 289 with normal, 15 558 with high, and 195 with very high TG) were considered. In the whole cohort, the overall incidence rates of ASCVD and all‐cause mortality were 7.2 and 17.1 per 1000 person‐years, respectively. After multivariate adjustment for potential confounders, individuals with high and very high TG showed a significantly increased risk of all‐cause mortality (hazard ratio [HR]=1.49 [95% confidence interval (CI) 1.36–1.63], P <0.001, and HR=3.08 [95% CI 1.46–6.50], P <0.01, respectively) and incident ASCVD events (HR=1.61 [95% CI 1.43–1.82], P <0.001, and HR=2.30 [95% CI 1.02–5.18], P <0.05, respectively) as compared to those with normal TG. Conclusions Moderate‐to‐severe elevation of TG is associated with a significantly increased risk of all‐cause mortality and ASCVD events in a large cohort of low‐to‐moderate cardiovascular risk individuals in a real‐world clinical setting.

scholarly journals Long-Term Use of Antiplatelet Therapy in Real-World Patients with Acute Myocardial Infarction: Insights from the PIPER Study

TH Open ◽  
2018 ◽  
Vol 02 (04) ◽  
pp. e437-e444
Author(s):  
Luca Degli Esposti ◽  
Valentina Perrone ◽  
Chiara Veronesi ◽  
Stefano Buda ◽  
Roberta Rossini ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
Real World ◽  
Cohort Analysis ◽  
Administrative Databases ◽  
Local Health ◽  
Number Of Patients ◽  
All Cause Mortality

AbstractThe aim of this study was to assess long-term drug adherence and prognosis in real-world patients discharged on dual-antiplatelet therapy (DAPT) after acute myocardial infarction (AMI). A retrospective cohort analysis using administrative databases kept by eight local health units was performed. DAPT exposure (defined as ≥ 2 prescriptions), adherence, and the occurrence of major adverse events (MACE) were analyzed during a 36-month follow-up. The analysis included 11,101 patients who were discharged alive with a primary diagnosis of AMI. Of these, 5,919 patients (53.31%) were discharged on DAPT without a diagnosis of cancer or anemia, without transient DAPT discontinuation, and represented the study population. DAPT discontinuation occurred in 2,200 patients (37.2%) and in 1,995 (33.7%) after the first 6 and 12 months, respectively, whereas 423 patients (7.1%) were still on DAPT after 36 months. Patients who maintained DAPT up to 12 months had a significantly lower overall mortality, compared with patients who discontinued DAPT after 6 months. Exposure to DAPT at 3 years was associated with reduced all-cause mortality (hazard ratio [HR]: 0.067, 95% confidence interval [CI]: 0.027–0.162, p < 0.001) and reduced recurrent AMI (HR: 0.02, 95% CI: 0.003–0.173, p < 0.001). In conclusion, this study shows that prolonged DAPT over 12 months is maintained in a relevant number of patients after AMI. However, adherence to antiplatelet therapy in first 12 months after AMI is still unsatisfactory and efforts to enhance patients' compliance are warranted. Exposure to prolonged DAPT at 3 years seems to be associated with a significant reduction in all-cause mortality and AMI.

scholarly journals The Advantages of Clinical Nutrition Use in Oncologic Patients in Italy: Real World Insights

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 125 ◽  
Author(s):  
Paolo Pedrazzoli ◽  
Riccardo Caccialanza ◽  
Paolo Cotogni ◽  
Luca Degli Esposti ◽  
Valentina Perrone ◽  
...  
Keyword(s):  
Real World ◽  
Clinical Nutrition ◽  
Administrative Databases ◽  
P Value ◽  
Malignant Neoplasms ◽  
Local Health ◽  
Genitourinary Cancer ◽  
Oncologic Patients ◽  
Data Source ◽  
Improvement In Survival

This retrospective observational study aimed to provide insights on the use of clinical nutrition (CN) (enteral and parenteral feeding) and outcomes in an Italian real-world setting. The data source comes from administrative databases of 10 Italian Local Health Units. Patients diagnosed with malignant neoplasms from 1 January 2010 to 31 December 2015 were included. Metastasis presence was ascertained by discharge diagnosis in the hospitalization database. CN was identified by specific codes from pharmaceutical and hospitalization databases. Two cohorts were created—one for metastatic patients (N = 53,042), and one for non-metastatic patients (N = 4379) receiving CN. Two survival analyses were set for the cohort of metastatic patients—one included patients receiving CN and the second included malnourished patients. Our findings show that (1) administration of CN is associated with positive survival outcomes in metastatic patients with gastrointestinal, respiratory, and genitourinary cancer; (2) CN in malnourished metastatic patients with gastrointestinal and genitourinary cancer was associated with significant improvement in survival; (3) early administration of CN was associated with improvement in survival in non-metastatic patients with gastrointestinal cancer (HR 95%CI: 0.5 (0.4–0.6), p-value < 0.05). This study highlights the need to improve the assessment of nutritional status in oncologic patients and suggests a potential survival benefit of CN treatment in metastatic disease.

scholarly journals Universal varicella vaccination in the Sicilian paediatric population: rapid uptake of the vaccination programme and morbidity trends over five years

2009 ◽  
Vol 14 (35) ◽  
Author(s):  
G Giammanco ◽  
S Ciriminna ◽  
I Barberi ◽  
L Titone ◽  
M Lo Giudice ◽  
...  
Keyword(s):  
Vaccination Programme ◽  
Vaccine Coverage ◽  
Varicella Vaccine ◽  
Age Groups ◽  
Vaccination Strategy ◽  
Paediatric Population ◽  
Incidence Rates ◽  
Universal Vaccination ◽  
Varicella Vaccination ◽  
Local Health

Following the licensure of the Oka/Merck varicella vaccine in Italy in January 2003, the Sicilian health authorities launched a universal vaccination programme in all nine Local Health Units. A two-cohort vaccination strategy was adopted to minimise the shift of the mean age of varicella occurrence to older age groups, with the goal of vaccinating with one dose at least 80% of children in their second year of life and 50% of susceptible adolescents in their 12th year of life. Two studies were implemented in parallel to closely monitor vaccination coverage as well as varicella incidence. Overall, the programme achieved its target, with 87.5% vaccine coverage for the birth cohort 2005 and 90.2% for adolescents born in 1995 and 1996. Varicella surveillance data obtained from a total of 28,188 children (0-14 years-old) monitored by family paediatricians showed a decline in incidence rates from 95.7 (95% confidence interval (CI): 72.2-126.8) for 1,000 person-years (PY) in 2004 to 9.0 (95% CI: 6.4-12.6) for 1,000 PY in 2007. In Europe, the only similar experience is the routine childhood varicella vaccination programme in Germany that started in 2004 with a single dose at the age of 11-14 months. The two-cohort universal vaccination programme implemented in Sicily, as well as the network for the surveillance study, can offer a model to other European countries that are considering introducing universal childhood varicella vaccination.

Modeling and Simulation Analyses of Healthcare Delivery Operations for Inter-Hospital Patient Transfers

2014 ◽  
Vol 5 (1) ◽  
pp. 76-94 ◽  
Author(s):  
Chialin Chen ◽  
Samson X. Zhao
Keyword(s):  
Real World ◽  
Healthcare Delivery ◽  
Limited Resources ◽  
Local Health ◽  
Hospital Patient ◽  
Patient Transfers ◽  
Fleet Sizing ◽  
Common Strategy ◽  
Hospital Transfer ◽  
Transfer Services

Inter-hospital transfers of patients for different elements of care have been increasingly used as a common strategy for providing quality healthcares through sharing limited resources worldwide. In this paper, the authors study the problem of healthcare delivery operations for inter-hospital patient transfers motivated by a real-world case within the South East Local Health Integration Network of Ontario. The authors use a directed graph to develop a general model for obtaining the solution that minimizes the overall transportation time while satisfying all the inter-hospital transfer requests with identical or different start and end points. The authors also perform simulation analyses to study the fleet sizing problem through evaluating different service performances with different fleet sizes. A number of implementation issues for managing inter-hospital patient transfer services are also discussed.

scholarly journals Spirometry monitoring in asthmatic children in Lombardy Region, Italy

2018 ◽  
Vol 2 (1) ◽  
pp. e000334
Author(s):  
Pietro Casartelli ◽  
Antonio Clavenna ◽  
Massimo Cartabia ◽  
Angela Bortolotti ◽  
Ida Fortino ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Inhaled Corticosteroids ◽  
Drug Prescription ◽  
Administrative Databases ◽  
Function Evaluation ◽  
Local Health ◽  
Local Health Unit ◽  
Lombardy Region ◽  
Asthmatic Children ◽  
Antiasthmatic Drug

ObjectivesTo evaluate the diagnostic and therapeutic approaches in a cohort of asthmatic children before and after starting drug therapy.MethodsData were retrieved from administrative databases of the Lombardy Region. The study population was composed of 78 184 children born in the Lombardy Region in 2002 and followed until their 10th birthday.Children with at least one antiasthmatic drug prescription per year (with the exclusion of nebulised suspension/solution formulations) in 2 consecutive years and at least one antiasthmatic drug prescription after the fifth birthday were identified as potential asthmatics (PA).Each PA was monitored for a period starting from 12 months before and ending 24 months after the first prescription (index prescription, IP). During the monitoring period antiasthmatic drug prescriptions were analysed, as well as spirometry and/or specialist visits.ResultsA total of 59 975 children (76.7%) received ≥1 prescription of antiasthmatic drugs in their first 10 years of life, and 4475 (5.7%) were identified as PAs. In all, 24% of PAs started with short-acting β2-agonists (SABA), 23% with inhaled corticosteroids (ICS) and 20% with SABA+ICS.A total of 33% of PAs had at least one prescription for specialist visit/spirometry: 11% before and 28% after the IP. The factors associated with a greater likelihood of receiving visit/spirometry prescriptions were local health unit of residence, age and high use of asthma drugs.ConclusionsDespite international guideline recommendations, spirometry monitoring is still underused in asthmatic children, even in subjects who initiated pharmacological treatment and therefore need an airway function evaluation. Moreover, the choice of drug therapy appears not always rational, since one out of four children were commenced on ICS as monotherapy.

scholarly journals 16-09: Real-world impact of ablation in patients with atrial fibrillation and flutter: an observational study based on healthcare administrative databases

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i3-i3
Author(s):  
Gianluca Botto ◽  
Sara Conti ◽  
Claudio Tondo ◽  
Giuseppe Inama ◽  
Virginio Chiodini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Observational Study ◽  
Real World ◽  
Administrative Databases ◽  
Atrial Fibrillation And Flutter

scholarly journals Influence of weight status in the response to Step-2 maintenance therapies in children with asthma

2019 ◽  
Vol 6 (1) ◽  
pp. e000401 ◽  
Author(s):  
Cristina Longo ◽  
Gillian Bartlett ◽  
Tibor Schuster ◽  
Francine M. Ducharme ◽  
Brenda MacGibbon ◽  
...  
Keyword(s):  
Weight Status ◽  
Low Dose ◽  
Inhaled Corticosteroids ◽  
Administrative Databases ◽  
Ratio Test ◽  
Historical Cohort ◽  
Cox Models ◽  
Early Management ◽  
Unit Increase ◽  
Children With Asthma

IntroductionOverweight children with asthma may display impaired response to inhaled corticosteroids (ICS), possibly due to non-eosinophilic inflammation or weight-related lung compression; these mechanisms may differentially affect response to ICS and leukotriene receptor antagonists (LTRAs). We assessed whether weight status modified the response to low-dose ICS and LTRA Step-2 monotherapy.MethodsA historical cohort study from clinical data linked to administrative databases was conducted among children aged 2–18 years with specialist-diagnosed asthma who were initiating or continuing a Step-2 monotherapy from 2000 to 2007 at the Montreal Children’s Hospital Asthma Centre. The outcome was time-to-management failure defined as any step-up in therapy, acute care visit, hospitalisation or oral corticosteroids for asthma, whichever occurred first. The independent and joint effects of weight status (body mass index [BMI] percentile) and time-varying treatment on time-to-management failure were estimated with marginal structural Cox models. The likelihood ratio test (LRT) and relative excess risk due to interaction (RERI) were computed to assess treatment effect modification by weight status on the multiplicative and additive scales.ResultsOf the 433 and 85 visits with a low-dose ICS and LTRA prescription, respectively, 388 management failures occurred over 14 529 visit-weeks of follow-up. Children using LTRA compared with low-dose ICS tended to have an overall higher risk of early management failure (HR 1.52; 95% CI 0.72 to 3.22). Irrespective of treatment, the hazard of management failure increased by 5% (HR 1.05; 95% CI 1.01 to 1.10) for every 10-unit increase in BMI percentile. An additional hazard reduction of 17% (HR 0.83; 95% CI 0.70 to 0.99) was observed for every 10-unit increase in BMI percentile among LTRA users, but not for ICS (HR 0.95; 95% CI 0.86 to 1.04). The LRT indicated a departure from exact multiplicativity (p<0.0001), and the RERIs for ICS and LTRA were −0.05 (95% CI −0.14 to 0.05) and −0.52 (95% CI −1.76 to 0.71).ConclusionsWeight status was associated with earlier time-to-management failure in children prescribed Step-2 therapy. This hypothesis-generating study suggests that LTRA response increases in children with higher BMI percentiles, although further research is warranted to confirm findings.

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