IntroductionThe 1978 Italian reform of psychiatric services initiated the closure of psychiatric hospitals encouraging the development of community mental health. However, there is wide variability ...across regions in the amount of resources devoted to community-based psychiatric care, and the range of services provided still is cause of concern.ObjectivesTo evaluate the quality of mental health care delivered to patients with schizophrenia and related disorders taken-in-care by mental health services in four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily).MethodsThirty-one clinical indicators concerning accessibility, appropriateness, continuity, and safety were defined and estimated using healthcare utilization (HCU) databases, containing data on mental health treatments, hospital admissions, outpatient interventions, lab tests and drug prescriptions.ResultsA total of 70,586 prevalent patients with schizophrenia treated in 2015 were identified, of whom 1,752 were newly taken-in-care. For most patients community care was accessible and moderately intensive. However, care pathways were not implemented based on a structured assessment and only half of the patients received psychosocial treatments. One patient out of ten had access to psychological interventions and psychoeducation. Activities specifically addressed to families involved a third of prevalent patients and less than half of new patients. One patient out of six was admitted to a community residential facility, and one out of ten to a general hospital psychiatric ward (GHPW); higher values were identified in new cases. In general hospitals, one-fifth of the admissions were followed by readmission within 30 days of discharge. For two- thirds of patients continuity of community care was met, and six times out of ten a discharge from a GHPW was followed by an outpatient contact within two weeks. For cases newly taken-in-care the continuity of community care was uncommon, while the readiness of outpatient contacts after discharge was slightly more frequent. Most of the patients received antipsychotic medication, but their adherence to long-term treatment was low. Antipsychotic polytherapy was frequent and the control of metabolic side effects was poor. The variability between regions was high and consistent.ConclusionsThe Italian mental health system could be improved by increasing the accessibility to psychosocial interventions, improving the quality of care for newly taken-in-care patients, focusing on somatic health and mortality, and reducing regional variability. Clinical indicators demonstrate the strengths and weaknesses of the mental health system in these regions, and, as HCU databases, they could be useful tools in the routine assessment of mental healthcare quality at regional and national levels.Disclosure of InterestNone Declared
Introduction
The evaluation of healthcare pathways must be considered of fundamental importance. The quality of care provided to patients with severe mental disorders (SMD) does not correspond to the ...standards set by the recommendations. Therefore, measures such as the real coverage rate of psychiatric patients’ needs (
contact coverage
), by comparing epidemiological prevalence rates and the number of patients receiving adequate care, could be a valuable resource for implementing the transition to community mental health. However, simple assessment and reporting of rates of contact with mental healthcare potentially overestimate the full expected health benefits of services. Therefore, in addition to monitor the coverage rate achieved by the services, the evaluation of the
effectiveness
of the care provided (
effective coverage
) De Silva
et al
. Int J Epidemiol 2014;43(2):341–53 is also of relevant importance.
Objectives
To measure the gap between contact and
effective coverage
of mental healthcare, i.e., the
effectiveness
of interventions provided by services for the treatment of SMD in preventing an exacerbation of psychiatric symptoms.
Methods
Data were retrieved from Healthcare Utilization databases of four Italian Regions (Lombardy, Emilia-Romagna, Lazio, Sicily). 45,761 newly taken-in-care cases of depression, schizophrenia, bipolar, and personality disorder were included. A variant of the self-controlled case series method was used to estimate the incidence rate ratio (IRR) for the relationship between exposure (use of different types of mental healthcare such as pharmacotherapy, generic contacts with the outpatient service, psychosocial interventions, and psychotherapies) and relapse episodes (mental illness emergency hospital admissions).
Results
11,500 relapses occurred. Relapse risk was reduced (
Figure
) during periods covered by (i)
psychotherapy
for patients with depression (IRR 0.67; 95% CI, 0.49 to 0.91) and bipolar disorder (0.64; 0.29 to 0.99); (ii)
psychosocial interventions
for those with depression (0.74; 0.56 to 0.98), schizophrenia (0.83; 0.68 to 0.99) and bipolar disorder (0.55; 0.36 to 0.84), (iii)
pharmacotherapy
for those with schizophrenia (0.58; 0.49 to 0.69), and bipolar disorder (0.59; 0.44 to 0.78). Coverage with generic mental healthcare, in the absence of psychosocial/psychotherapeutic interventions, did not affect the risk of relapse.
Image:
Conclusions
Psychosocial interventions, psychotherapies and specific pharmacotherapies can be considered particularly effective in treating patients with bipolar, depressive, and schizophrenic disorders. This study ascertained the gap between utilization of mental healthcare and
effective coverage
, showing that
real-world
data can represent a useful resource to monitor mental healthcare paths and to assess the effectiveness of a mental health system.
Disclosure of Interest
None Declared
Italy implemented a law in January 2005 banning smoking in all enclosed public spaces.
To document perceived obstacles and effects of the law and observed client smoking behaviours in bars and ...restaurants.
Four surveys were conducted between December 2004 and February 2006. Protocols and questionnaires were posted on a public health website to solicit participation among local health units (LHUs). Participating LHUs randomly selected 50 bars and restaurants using the electronic Yellow Pages. Self-administered questionnaires were delivered to owners or managers of selected locales; all of them were revisited during peak hours to collect questionnaires and observe client smoking.
Before the ban, smokers were observed in 31% of locales; 24% of owners predicted major financial losses. One year later, no smokers were observed and only 7% reported major financial losses. Only 30% had received law enforcement visits. Most owners/managers (88%) reported positive attitudes about the law and 79% reported such attitudes among clients.
The Italian smoking law has drastically reduced smoking in bars and restaurants despite minimal enforcement visits. Perceived negative effects on profits appear limited, and the owners and managers and their clients are satisfied.
Increased PM10 concentrations are commonly observed during Saharan dust advections. Limited epidemiological evidence suggests that PM10 from anthropogenic and desert sources increase mortality. We ...aimed to evaluate the association between source-specific PM10 (non-desert and desert) and cause-specific mortality in Sicily during 2006–2012 period.
Daily PM10 concentrations at 1-km2 were estimated in Sicily using satellite-based data, fixed monitors and land use variables. We identified Saharan dust episodes using meteorological models, back-trajectories, aerosol maps, and satellite images. For each dust day, we estimated desert and non-desert PM10 concentrations. We applied a time-series approach on 390 municipalities of Sicily to estimate the association between PM10 (non-desert and desert) and daily cause-specific mortality.
33% of all days were affected by Saharan dust advections. PM10 concentrations were 8 μg/m3 higher during dust days compared to other days. We found positive associations of both non-desert and desert PM10 with cause-specific mortality. We estimated percent increases of risk (IR%) of non-accidental mortality equal to 2.3% (95% Confidence Interval CI: 1.4, 3.1) and 3.8% (3.2, 4.4), per 10 μg/m3 increases in non-desert and desert PM10 at lag 0–5, respectively. We also observed significant associations with cardiovascular (2.4% 1.3, 3.4 and 4.5% 3.8, 5.3) and respiratory mortality (8.1% 6.8, 9.5, and 6.3% 5.4, 7.2). We estimated higher effects during April–September, with IR% = 4.4% (3.2, 5.7) and 6.3% (5.4, 7.2) for non-desert and desert PM10, respectively.
Our results confirm previous evidence of harmful effects of desert PM10 on non-accidental and cardio-respiratory mortality, especially during the warm season.
•Dust advections affects >30% of days in Sicily.•Desert PM10 displays similar health effects to non-desert PM10.•Non-desert PM10 exerts higher effects on respiratory mortality.•Desert and non-desert PM10 show higher health effects during warm season.
Abstract
Background
The quality of care provided to patients with severe mental disorders (SMD) often does not correspond to the standards set by the recommendations. In addition to monitoring the ...coverage rate achieved by services, the evaluation of the effectiveness of interventions provided by mental health services for the treatment of SMD, in preventing an exacerbation of psychiatric symptoms, becomes of relevant importance.
Methods
Data were retrieved from Healthcare Utilization databases of four Italian Regions (Lombardy, Emilia-Romagna, Lazio, Sicily). 45,761 newly referred cases of depression, schizophrenia, bipolar and personality disorder were included. A variant of the self-controlled case series method was adopted to estimate the incidence rate ratio (IRR) for the relationship between exposure (use of different types of mental healthcare such as pharmacotherapy, generic contact with outpatient services, psychosocial intervention, psychotherapy) and relapse (emergency hospital admissions for mental illness).
Results
11,500 relapses occurred. Relapse risk was reduced during periods covered by (i) psychotherapy for patients with depression (IRR 0.67; 95% CI: 0.49-0.91) and bipolar disorder (0.64; 0.29-0.99); (ii) psychosocial interventions for those with depression (0.74; 0.56 to 0.98), schizophrenia (0.83; 0.68-0.99) and bipolar disorder (0.55; 0.36-0.84), (iii) pharmacotherapy for patients with schizophrenia (0.58; 0.49-0.69) and bipolar disorder (0.59; 0.44-0.78). Coverage with generic care, in absence of psychosocial/psychotherapeutic interventions, did not affect relapse risk.
Conclusions
Psychosocial interventions, psychotherapies and specific pharmacotherapies can be considered particularly effective in treating patients with bipolar, depressive, and schizophrenic disorders. This study showed that real-world data can represent a useful resource to monitor mental healthcare paths and to assess the effectiveness of a mental health system.
Key messages
• Real-world data can represent a useful resource to monitor mental healthcare paths and to assess the effectiveness of a mental health system.
• To evaluate the effectiveness of interventions provided by mental health services in preventing an exacerbation of psychiatric symptoms becomes important in the transition to community mental health.
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Daiichi Sankyo Europe GmbH
Background
Direct oral anticoagulants (DOACs) have been shown to be non-inferior ...to vitamin K antagonists (VKA) regarding both efficacy and safety outcomes in patients with atrial fibrillation (AF). However, elderly are underrepresented in the underlying clinical trials.
Purpose
The aim of this study was to compare risks of major bleeding events and compare healthcare resource utilization (HRU) between AF patients treated with edoxaban or VKA in elderly.
Methods
A cohort study was conducted using claims databases of Caserta and Palermo Local Heath Units in Italy. AF patients starting use of edoxaban or VKA between August 1st, 2016 and December 31st, 2018 were included. Date of the first dispensing was defined as the index date. The study population was matched based on a propensity score based on factors associated with the outcome. We restricted to patients aged ≥65, ≥1 year database history, and no use of the index drug in the year before index date. Incidence rates of bleeding outcomes and rates of HRU were assessed per 1,000 and 100 person-years follow-up (PY), respectively. Cox regression analyses to adjust for baseline covariates were used for comparisons of incidence rates of bleeding outcomes among all edoxaban and VKA users. Poisson regression analyses were used for comparisons of rates of HRU among all edoxaban and VKA users. Both analyses were adjusted for age. Sex, region and year of index date were considered for the adjusted models as well, using a backward stepwise approach to select eligible variables.
Results
1,317 edoxaban users and 2,924 VKA users were included in the matched population. Mean age was 79 in both treatments groups, and 43% of the edoxaban users and 45% of the VKA users was male. Bleeding risks were significantly lower among edoxaban users compared to VKA users aged ≥65 (adjusted HR 0.39 (95% CI 0.19-0.83)) and among patients aged ≥75 (adjusted HR 0.37 (95% CI 0.16-0.86)). Among patients aged ≥65, edoxaban users were significantly less often hospitalised (RR 0.56 (95% CI 0.46-0.68)) and the total number of hospitalised days were also significant lower (RR 0.58 (95% CI 0.42-0.80)) compared to VKA users. Among patients aged ≥75, similar results were observed for the number of hospitalisations. Edoxaban users had significant less out-patient visits compared to VKA users (among patients aged ≥65 the RR was 0.44 (95% CI 0.39-0.50) and among patients ≥75 this was 0.40 (95% CI 0.35-0.47). Use of out-patient medication use was significantly lower among edoxaban users compared to VKA users among patients aged ≥65 (adjusted RR 0.91 (95% CI 0.88-0.95)) as well as among patients aged ≥75 (adjusted RR 0.91 (95% CI 0.87-0.95)).
Conclusion
Study results show a decreased bleeding risk of edoxaban compared to VKA in both age groups of patients with AF. Hospital based HRU has shown to be lower among edoxaban users compared to VKA users in both age groups. Out-patient HRU was also lower among edoxaban users.
Abstract
Introduction
The BEEP (Big data in Environmental and occupational Epidemiology) project aims to estimate the health effects of several environmental risk factors on the Italian population at ...municipal level. Specific focus is being devoted to the risk of hospitalizations and mortality at the national level and within the major metropolitan areas and the risk of occupational injuries.
Results
Particulate matter concentrations and mean air temperatures (1x1km) were estimated using satellite data, land use data and observed data from monitoring networks for the Italian domain for 5 yrs. The short-term effects of PM and air temperature on morbidity and mortality only in Sicily, Lazio, Puglia, Emilia Romagna and Piedmont, were assessed. The preliminary results show: an increased risk of natural mortality, cardiovascular and respiratory hospitalizations in subjects exposed to PM, as well as higher effects in the older age on respiratory admissions in males. Associations were found also in the municipalities of medium and low level of urbanization; a non-linear relationship was found with increased risk of hospitalizations and mortality for high and low temperatures. Effects of heat were observed on respiratory hospital admissions, and effects of cold temperature were found on both cardiovascular and respiratory admissions. Larger effects of heat and cold were estimated in the elderly and in municipalities at a higher urbanization; a larger risk of occupational accidents in the construction industry for hot temperatures and in the transport sector for cold temperatures were evidenced.
Conclusions
Results of the BEEP project provide innovative findings on the health risks of environmental exposures in both urban and rural settings and provide decision makers with important information for the definition of prevention measures.
Acknowledgement: The BEEP project is supported by INAIL and is described in the website: www.progettobeep.it.
Key messages
Using Big Data (environmental and Health) is possible estimate the effect of pollution and temperature on mortality and morbidity among the residents in cities or rural areas.
Pollutant increase the risk on natural mortality and cardiovascular and respiratory hospitalizations.
Abstract
Background
The International Agency for Research on Cancer evaluated formaldehyde (F) as carcinogenic for human in association with Nasopharyngeal Cancer (NPC). Occupational exposure to F ...occurs in many industrial sectors also in those non-traditional. For example in Tuscany F was detected in a bakery where a NPC case had ever worked.
Methods
In this study a) A case control approach (OCCAM) was used for monitoring occupational risks based on current information sources. Three Italian Regional Operating Centres, collected NPC cases from cancer registries and/or hospital discharge records. Controls were randomly sampled from the regional health service population data. Occupational histories were available through record linkage with the social security pension database (INPS). Study results were reported by industrial sectors, area and gender. b) A specific study on F exposure was conducted in bakeries and pastry industry carrying out measurements to determine the concentration of F in specific tasks and positions.
Results
717 cases linked with INPS database. Increased ORs for several industrial sectors such as iron and steel, wood and plastic were observed. In two regions also health and veterinary services and hairdressers were at increased risk, but based on few cases of exposed workers. In the non traditional sector of bakeries and pastry industries, where workplaces were monitored, high levels of F in personal air samplings were found, in particular in processes that involve a strong leavening.
Conclusions
Many productive sectors, in which F exposure could occurred, were observed to be at higher risk. The measurements performed in the non traditional sector monitored, confirmed the F exposure in some phases of the work process. With this study we contributed to increased knowledge on the risk of NPC within the monitoring system of occupational risks, and to deepen exposure to F in a non traditional productive sector such as bakeries and pastry industries.
Key messages
The epidemiological method used (OCCAM) in this study provides further information on the role of occupational exposure in the development of nasopharyngeal cancer. The measurements performed in the bakeries and pastry industries provide new additional information on the exposure to formaldehyde in some work process phases of a non-traditional productive sector.
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