The issue of subjects with mild cognitive impairment (MCI) reverting to normal cognition (NC) has to date been taken in limited consideration, and no conclusive data are available on the rate of ...reversion. We aimed at systematically reviewing available longitudinal studies on MCI and meta-analyzing data with the purpose of estimating the proportion of subjects reverting to NC.
We performed a systematic bibliographic search on PubMed, the Cochrane Library, and the ISI Web of Science databases. We included in the review all longitudinal studies on MCI published from 1999 up to November 2015. Only studies with a longitudinal design, a follow-up ≥2 years, enrolling subjects with MCI, and reporting the number or the percentage of subjects reverting to NC were included. Data extraction was performed independently by 2 authors. The methodological quality of studies was also assessed by 2 independent authors using the QUIPS tool.
Twenty-five studies were included. The quality of evidence was found to be moderate. We observed an overall 18% (95% CI 14-22) reversion rate from MCI to NC. Results from the metaregression showed a significant association between effect size and study setting. In particular, estimates significantly varied according to study setting, with an 8% (95% CI 4-11) reversion rate in clinical-based studies and a 25% (95% CI 19-30) rate in population-based studies. The frequency of reversion from MCI to NC further increased to 26% when considering only studies of better quality. Only a few studies were designed to specifically investigate the reversion from MCI to NC, thus relevant information on this topic was frequently missing.
Our data confirm that reversion to normality is a common outcome in subjects with MCI, thus leading to recommend a more balanced view when approaching the construct of MCI both in a clinical and in a research setting.
Abstract Purpose Field substitution of nonrespondents can be used to maintain the planned sample size and structure in surveys but may introduce additional bias. Sample weighting is suggested as the ...preferable alternative; however, limited empirical evidence exists comparing the two methods. We wanted to assess the impact of substitution on surveillance results using data from Progressi delle Aziende Sanitarie per la Salute in Italia—Progress by Local Health Units towards a Healthier Italy (PASSI). Methods PASSI is conducted by Local Health Units (LHUs) through telephone interviews of stratified random samples of residents. Nonrespondents are replaced with substitutes randomly preselected in the same LHU stratum. We compared the weighted estimates obtained in the original PASSI sample (used as a reference) and in the substitutes' sample. The differences were evaluated using a Wald test. Results In 2011, 50,697 units were selected: 37,252 were from the original sample and 13,445 were substitutes; 37,162 persons were interviewed. The initially planned size and demographic composition were restored. No significant differences in the estimates between the original and the substitutes' sample were found. Conclusions In our experience, field substitution is an acceptable method for dealing with nonresponse, maintaining the characteristics of the original sample without affecting the results. This evidence can support appropriate decisions about planning and implementing a surveillance system.
Abstract Background Influenza is an important public health problem, with potential severe consequences among people with chronic diseases. The aim of this study was to obtain reliable measures of ...seasonal influenza vaccine uptake in this population, otherwise not available in Italy. Methods Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI) is a nationwide surveillance system of health-related behaviours and acceptance of preventive interventions (including influenza immunisation) offered by the Italian National Health Service. Data are collected with telephone interviews at local health unit level for supporting local activities. The survey sample is randomly selected from local health unit lists of adult residents. The trend of annual vaccine coverage since 2008 was estimated for people aged 18–64 years who reported having at least one chronic disease. To obtain a sufficient sample size in subgroups, we analysed the characteristics of vaccinated people in the 2010–13 cumulative dataset. Univariate, multivariate, and logistic regression analyses were undertaken. Findings In 2008–13, 13 659 individuals with at least one chronic disease were interviewed. Vaccination coverage fell significantly from 29·7% (95% CI 27·2–32·4) in 2007–08 to 19·9% (18·0–22·1) in 2012–13. During 2010–13, the overall proportion of vaccinated people with a chronic disease was 25·6% (24·5–26·7). Vaccine coverage of people with diabetes (34·3%, 31·7–36·9) or cardiovascular diseases (31·8%, 29·6–34·2) was greater than that of people affected by renal failure, respiratory diseases, tumours, or chronic liver diseases (26·5% 22·5–30·7, 24·9% 23·2–26·7, 22·2% 20·0–24·6, and 20·6% 17·5–24·6, respectively). Vaccination coverage increased with age (from 13·1% 11·0–15·5 in the 18–34 year age group to 33·4% 31·9–35·1 in people aged 50–64 years); it was higher among people with a low educational level than among those with a high educational level, higher in those having economic difficulties than in those with no economic difficulties, and higher among Italian citizens than among non-citizens. Interpretation In the past few years, prevalence of influenza vaccination in Italian adults with at least one chronic disease was well below the Ministry of Health's goal (75% minimum) and showed a downward trend. A major reason of this evolution is probably the changing public perception of the benefits and risks of vaccines. PASSI is a source of useful data not otherwise available for public health intervention. Funding Italian Ministry of Health.
This study represents a preliminary inquiry on tick fauna composition carried out in Maremma, Central Italy, where very few data are available.
The study area was selected in the limestone hills ...surrounding Tarquinia town, on the base of suitable elements directly affecting the tick occurrence and the possible circulation of tick-borne pathogens, such as wild cattle rearing, kind of vegetation and human activities. Since a proper understanding of tick ecology is critical in predicting the risk of tick-borne pathogen transmission in a given area, a series of surveys was planned in such area in 2011.
One hundred fifty-four ticks belonging to 4 genera and 6 species, namely Ixodes ricinus (n. = 109; 70%), Rhipicephalus bursa (n. = 18; 12%), Rhipicephalus turanicus (n. = 14; 9%), Rhipicephalus sanguineus (n. = 6; 4%), Hyalomma marginatum (n. = 4; 3%) and Dermacentor marginatus (n. = 3; 2%) were identified and reported for the area.
The results of this acarological research represent a significant contribution to the knowledge of the tick fauna of rural areas in Northern Lazio Region, as first step toward a future molecular investigation on pathogen circulation.
This study explored electronic cigarette (e-cigarette) use as an aid to quit smoking and compared abstinence rates for different quitting methods in a representative sample of the Italian population.
...In the 2014–2015 PASSI survey, the ongoing Italian behavioural risk factor surveillance system, 6112 adults who smoked and made at least one quit attempt in the previous 12months, were categorized into three groups according to the method used in their most recent quit attempt: e-cigarette only, no aid, other quitting methods (medications; programmes delivered in smoking cessation services; other unspecified methods). The primary outcome was self-reported abstinence for a period ≥6months, adjusted for potential confounders.
Eleven percent used e-cigarettes only, 86% no aid, 3% other quitting methods. Smoking abstinence was reported among 9% of those using no aid; 8% of e-cigarette users; 15% of those using other methods. No significant differences in abstinence were observed for e-cigarette users compared with those reporting no aid (adjusted Prevalence Ratio aPR=0.81; 95%Confidence Interval (CI)=0.58–1.14). Changing the reference group to e-cigarette users, those using other quitting methods were significantly more likely to report abstinence than e-cigarette users (aPR=1.76; 95%CI=1.07–2.88).
One out of ten smokers who attempted to quit in 2014–2015 in Italy used e-cigarettes. E-cigarettes users were as likely to report abstinence as those using no aid, but were less likely to report abstinence than users of established quitting methods. Further studies are needed to understand the relationship between e-cigarette types used to quit and abstinence rates.
•In Italy, one out of ten smokers attempting to quit use e-cigarettes (EC) as an aid.•The use of EC to quit smoking is three times higher than other traditional methods.•Smokers using EC are less likely to report abstinence than those using other methods.
Foods for Special Medical Purposes (FSMPs) are formulated to support the nutritional needs of subjects with impaired capacity to ingest, digest or absorb ordinary food or nutrients. Polglumyt® is a ...proprietary highly purified, high quality glycogen obtained from mussels. Here we report the results of a single-center, single dose, open label, single arm study carried out to investigate acceptance (i.e. gastrointestinal tolerance and palatability), metabolic profile and safety of a low osmolarity, high-density energy Polglumyt®-based drink (the investigational product, IP) as a novel FSMP.
Twelve healthy subjects received a single oral administration of the IP under fasting conditions. The study endpoints were: changes in gastrointestinal system tolerability at 3 h, 6 h and 24 h after IP intake; IP palatability evaluation; metabolic evaluation through the kinetic profile of circulating glucose, insulin and C-peptide from 0 h to 6 h after IP intake and changes from baseline in circulating triglycerides at 3 h and 6 h after IP intake.
The IP showed a good gastrointestinal tolerability and an acceptable palatability. The IP did not affect the physiological glycemic profile and the triglycerides levels 6 h after the intake. The IP was well tolerated by study subjects, with no or minor adverse events.
The study results encourage additional clinical investigations on the IP as a novel FSMP in patients with impaired digestion or gastrointestinal absorption, unable to assume an ordinary diet, e.g. patients undergoing invasive gastrointestinal surgery, elderly or oncological patients, even with certain metabolic disorders.
Tick species characterization and molecular studies were performed within ornithological surveys conducted during 2010 and 2011 in the Lazio Region of central Italy. A total of 137 ticks were ...collected from 41 migratory birds belonging to 17 species (four partial migrants and 13 long-distance migrants). Most ticks were nymphs, with a predominance of Hyalomma marginatum marginatum and H. m. rufipes, and a small portion of Ixodes and Amblyomma species. All tick species analyzed were infected, and the molecular pathogen recognition revealed the presence of Rickettsia aeschlimannii, Rickettsia africae, Erlichia spp., Coxiella burnetii, Borrelia burgdorferi sensu lato group, and Babesia microti, whereas no genomic DNA of Bartonella spp. or Francisella tularensis was detected. The results of the survey show that H. marginatum ticks appear to be a vector of microbial agents that may affect human and animal health and that migratory birds may be an important carrier of these ticks. Additional studies are needed to better investigate the role of migratory birds in the epidemiology of these pathogens.
Over the past 50 years there was a substantial decrease in the prevalence of smoking in Italy. The objective of this work is to describe attempts to quit and cessation success in Italian smokers.
A ...surveillance on health-related behaviors (PASSI) was conducted in 2007-13 on a sample of 203 610 Italian adults 25-64 years of age. An analysis of smokers' characteristics and behaviors was performed, focusing on attempts to quit and quit success. Data from national surveys (ISTAT) from 1983 to 2013 (Italian adults, 25-64 years of age, 1983: 46 634; 1987: 40 915; 1990: 36 622; 2000: 77 531; 2005: 71 032; 2013: 64 205) were used to explore if a cessation trend in Italy exists.
Smokers who quit in the previous year and were still abstinent when interviewed increased from 1990 to 2013. In the years 2011-13, 38% of people who had smoked in the last 12 months reported at least a quit attempt during the same period and 7% were still abstinent when interviewed. An association of successful recent quit attempts with higher educational level, absence of economic difficulties and younger age was found. In the years 2007-13, the great majority tried to stop unaided. Having received assistance from a cessation program did not increase the probability of enduring abstinence.
In Italy interventions to drive more smokers to quit should be focused in particular on disadvantaged groups. Initiatives have to be studied not only to incentive more smokers to try to quit, but also to maintain abstinence over time.
Aim
The effect of switching from lithium immediate release (Li‐IR) to lithium prolonged release (Li‐PR) on lithium‐induced tremor after 1 and 12 weeks of treatment was evaluated in a randomized, ...multicenter, open trial, in bipolar patients from the participating sites with a tremor severity ≥2 (Udvalg for Kliniske Undersøgelser UKU rating scale) despite optimal lithium titration.
Methods
The primary endpoint was the evaluation of tremor by means of the UKU scale after 1 week of treatment. Secondary endpoints included manic Young Mania Rating Scale (YMRS) and depressive symptoms (Montgomery–Asberg Depression Rating Scale), a global assessment of the patient's status (Clinical Global Impression), polyuria/polydipsia (UKU item 3.8) and patient‐reported outcomes.
Results
Owing to difficulties in including suitable patients the enrollment phase was closed when 73 patients were randomized. Notwithstanding the lower number of patients, in the modified intention‐to‐treat population (n = 70) the primary endpoint was statistically significant: tremor improved after 1 week in 62.9% in Li‐PR group against 20.0% of patients in Li‐IR group (p = .0006; two‐tailed Fisher's exact test). The difference remained statistically significant after 4 (p = .0031) and 12 weeks (p = .0128). The same analysis performed in the PP population confirmed these results. Among the secondary endpoints, only the factor convenience of the treatment satisfaction questionnaire showed a statistically significant difference between groups. There were no apparent differences in the safety profile of the two formulations.
Conclusions
This study is the first comparative documentation of a potential benefit of the prolonged‐release formulation in reducing the symptom tremor, a well‐known adverse effect of lithium therapy. Indeed, the study results should be interpreted taking into account the sample size lower than planned.
The effect of switching from lithium immediate release (Li‐IR) to lithium prolonged release (Li‐PR) on lithium‐induced tremor after 1 and 12 weeks of treatment was evaluated in a randomized, multicenter, open trial, in 70 bipolar patients with a tremor severity ≥2 (UKU rating scale) despite optimal lithium titration. After 1 week, switching tremor improved in 62.9% in Li‐PR group against 20.0% of patients in Li‐IR group (p = .0006; two‐tailed Fisher's exact test). The difference remained statistically significant after 4 (p = .0031) and 12 weeks (p = .0128).
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