IntroductionEfficacy of preventive therapy with statins in reducing mortality and cardiovascular morbidity in patients with and without cardiovascular disease has been shown in clinical settings, but ...effectiveness results were not reported.ObjectivesTo evaluate whether chronic statin therapy before infarction reduces mortality within 30 days after acute myocardial infarction (AMI) and investigate potential confounders/effect modifiers (gender, age and comorbidities).MethodsHospital discharges of AMI patients (≥35 years) resident in the Lazio region in 2007–2008, were selected, excluding patients with AMI or revascularisation procedures (aortocoronary bypass, PTCA) in the preceding 9 years. Statin use (ATC: C10AA, C10B) during 1 year preceding the index admission was assessed through the drug claims information system; patients were defined “partially adherent” with 20%–80% days covered by statin doses and “adherent” with 80% and more coverage. Crude and adjusted 30-day mortality risks of statin users vs nonusers were estimated using logistic regression models. The role of gender and age as effect modifiers, interaction terms were included in the model.ResultsAmong 6790 AMI patients statin users showed reduced mortality risk compared to nonusers (OR=0.75, 95% CI 0.58 to 0.98 for partially adherent, OR=0.85 95% CI 0.66 to 1.09 for adherent). The protective effect was more evident in females (OR=0.74, 95% CI 0.52 to 1.05 for partially adherent, OR=0.67 95% CI 0.46 to 0.97 for adherent) and in older people (>85 years) (OR=0.84, 95% CI 0.50 to 1.40 for partially adherent, OR=0.51 95% CI 0.29 to 0.91 for adherent).ConclusionsChronic statin therapy before infarction reduced 30 days mortality in patients with AMI, especially in females and elderly.
IntroductionAdministrative databases are increasingly used to identify patients with chronic conditions, however the optimal methodology for Chronic Obstructive Pulmonary Disease (COPD) is still ...debated.ObjectiveTo develop and validate an algorithm to identify patients with COPD in Lazio (2 625 102 residents over 45) linking clinical and administrative data.MethodsFrom the regional hospitalisation, drug prescription and outpatient registries, through record linkage, we identified patterns of specific drug use (minimum 2 prescription during 12 months) and COPD hospitalisations during a 9-year period in 428 patients with COPD, who attended an outpatient clinic in 2006, and in 2140 people without COPD. Through a Bootstrap-Stepwise procedure we selected COPD associated factors. We validated the algorithm through internal (cross-validation-bootstrap, jack-knife) and external validation (comparison with external COPD patients with confirmed diagnosis).ResultsA total of 205 611 (7.8%) COPD patients were identified. Factors associated with COPD were: prescription of β2-agonists, anticholinergics, corticosteroids, oxygen, and previous hospitalisation for COPD and respiratory failure. For each patient we estimated an expected probability to suffer from COPD. Depending on the cut-point of expected probability, sensibility (SE) ranged from 0.15 to 0.87 and specificity (SP) from 0.79 to 0.99. We defined a cut-point of 0.30 (SE=64%; SP=97%) to identify the COPD patients. Applying our algorithm on external COPD patients we succeeded to identify 86%.ConclusionThe algorithm showed good performance to identify COPD patients among those individuals registered in the regional healthcare system confirming the strength of administrative data for monitoring chronic diseases.
IntroductionThe Italian health system guarantees care to all citizens. Previous research reported socio-demographic differences in access to evidence-based therapies, whereas studies evaluating ...differences in healthcare related outcomes are scarce.ObjectivesAnalysing socio-demographic and geographical differences in healthcare related outcomes in patients with diabetes mellitus (DM).MethodsAmong all residents registered with the regional healthcare service in 2008, adult patients with DM were identified through a validated predictive model from the regional administrative health information systems (hospital discharges, drug claims, exemptions for DM). Healthcare related outcomes were hospitalisation for uncontrolled DM, short-term complications, long-term complications, and amputation of lower limb (excluding traumatic amputations). Age standardised rates were calculated by gender, geographic area and socio-economic position (SEP) of residence (only for the city of Rome, 5 levels), and RRs were calculated.ResultsIn 2008, 2569 cases of complications were registered among the 303.016 DM patients, with higher prevalence among males. Incidence rates varied between 0.8/1000 for short-term and 4.2/1000 for long-term complications. Geographic variations were not statistically significant. Incidence of admissions for uncontrolled DM and short-term complications increased with decreasing socio-economic position in both genders. A significant risk increase was observed among males with lowest respect to highest SEP for amputations (RR=5.88, 95% CI 1.69 to 20.51) and for short-term complications (RR=12.58, 95% CI 2.83 to 55.91).ConclusionsIn the Lazio region, complications of DM are more frequent among males. In Rome, the risk of complications is higher in DM patients belonging to lower SEP.
To evaluate the effects of infection in multiple types of high-risk human papilloma virus (HPV) in cervical preneoplastic lesions in patients undergoing colposcopy following a diagnosis of atypical ...squamous cells of unknown significance (ASCUS) and low-grade squamous intraepithelial (LSIL) cytology.
Between 2009 and 2010, 2,500 patients were recruited with a mean age of 35 +/- 5 years. Screening for cervical cancer was performed and in case of ASCUS and LSIL the patients underwent colposcopy. The tests for the detection and typing of viral DNA (HPV - DNA test) were performed on cervical swab with real-time PCR amplification.
The prevalence of infection was 70% (1579/2256) in the patients recruited. In relation to the degree of preneoplastic lesions some high-risk HPV viral genotypes were identified: HPV 16 (319/1466), HPV 18 (164/1466), HPV 45 (76/1466), HPV 31 (215/1466), HPV 52 (145/1466), HPV 58 (55/1466) HPV 56 (79/1466), HPV 51 (110/1466), HPV 6(138/1466), HPV 11 (88/1466), HPV 42 (34/1466), HPV 53 (43/1466). In case of high-grade lesions of CIN (CIN2 and CIN3) a greater HPV co-infection was detected and in particular the association from 16 to 18 (70%), 16-33 (18%) and 16 to 52 (12%).
Infection caused by the simultaneous presence of multiple HPV genotypes appears to be associated with a significantly increased risk of high-grade lesions of CIN or invasive cancer than the presence of single viral infections. The infection with multiple HPV types is a significant risk factor for high-grade lesions of CIN in women undergoing colposcopy for ASCUS cytology/LSIL. The use of real-time PCR has shown the ability not only to identify the different types of HPV, but also to monitor quantitatively the same over time, and during the study phase, to evaluate the sensitivity and specificity of the method in comparison with other techniques.
Motivation: Transcription networks, and other directed networks can be characterized by some topological observables (e.g. network motifs), that require a suitable randomized network ensemble, ...typically with the same degree sequences of the original ones. The commonly used algorithms sometimes have long convergence times, and sampling problems. We present here an alternative, based on a variant of the importance sampling Monte Carlo developed by (Chen et al.). Availability: The algorithm is available at http://wwwteor.mi.infn.it/~bassetti/downloads.html Contact: diana.fusco@studenti.unimi.it and marco.cosentino@unimi.it Supplementary information: Supplementary data are available at Bioinformatics online.
An asymptotic analysis is developed to deduce the evolution equations compatible with the nonlinear shallow-water equations involving forcing terms. The Burgers-like equation obtained is integrated ...numerically and the propagation of an initial datum simulating a seismic impulse is investigated.
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