Ovidio Brignoli - Academia.edu (original) (raw)
Papers by Ovidio Brignoli
Open Journal of Epidemiology, Nov 27, 2012
Objective: To evaluate the distribution of cardiovascular risk factors and the prevalence of card... more Objective: To evaluate the distribution of cardiovascular risk factors and the prevalence of cardiovascular disease in a sample of the Italian population. Methods: CHECK (Cholesterol and Health: Education, Control and Knowledge) is a cross-sectional observational study in a randomised sample of the Italian adult population aged 40 -79 years, in the setting of general practice. Results: 5846 subjects (50.3% male) were included in the analysis. The mean age [±SD] of the observed cohort was 57.8 (±10.3) years. One out of five subjects smoked cigarettes and almost 80% didn't engage in regular leisure-time physical activity. The mean blood pressure was 132.0 [±14.7]/81.2 [±7.9] mmHg. The total and LDL-cholesterol levels were respectively 205.3 [±35.9] mg/dL and 124.9 [±29.9] mg/dL. The mean glucose concentration was 98.3 [±28.
Farmeconomia. Health economics and therapeutic pathways, 2011
Farmeconomia. Health economics and therapeutic pathways, 2011
Italian Heart Journal Official Journal of the Italian Federation of Cardiology, Feb 1, 2005
The aim of this study was to compare the prevalence of angina pectoris (AP) using self-reported i... more The aim of this study was to compare the prevalence of angina pectoris (AP) using self-reported information and primary care databases. A comparison between the prevalence of AP in 730,586 subjects from the Health Search Database (HSD) and 119,799 individuals from a Health Interview Survey (HIS) was performed. The age-specific prevalence was calculated by dividing the detected cases by the total number of individuals in each age group. The age-standardized prevalence was estimated by direct standardization performed using the Italian standard population. The HSD reported a higher crude prevalence of AP than the HIS, both in males (1374/100,000 vs 1006/100,000) and females (1449/100,000 vs 1007/100,000). In the HSD the age-specific prevalence was lower for patients aged <65 years, whilst higher estimates were reported for older patients. Age standardization slightly reduced the prevalence in both samples, although the HSD always reported higher estimates. Prescription data from general practice databases may be a valid, simple, and cost-effective method to evaluate and serially monitor the prevalence of AP.
The Primary Care Companion to the Journal of Clinical Psychiatry, Feb 1, 2008
To test the efficacy of a training course on the diagnosis and treatment of schizophrenia, tailor... more To test the efficacy of a training course on the diagnosis and treatment of schizophrenia, tailored for the general practitioner. A course, in a 3-session format, was given to 215 primary care doctors from the city of Brescia and its province, in Italy. All 706 doctors working in primary care were asked to participate. Of these doctors, 30.5% took part in the study. The first session (215 doctors) assessed baseline knowledge of schizophrenia (June 2002), the second (173 doctors) gave formal teaching and assessed post-lesson knowledge (October 2002), and the third (130 doctors) evaluated the retention of knowledge after 8 months (July 2003). The main outcome measures were total number of schizophrenia symptoms identified, total number of antipsychotics identified, and knowledge about antipsychotic-related adverse events. Post-lesson, general practitioners could identify 6.5 more symptoms (p < .001) and 4.9 more antipsychotics (p < .001). Compared to baseline, 71.5% vs. 15.4% of doctors had a good knowledge of antipsychotic-related adverse events. Although a loss of knowledge was found after the 8-month follow-up, knowledge at the endpoint was significantly higher than at baseline for the 3 main outcome variables (p < .001). The teaching course on schizophrenia for general practitioners was effective, and the knowledge gained after teaching was stable across time.
European journal of nutrition, Jan 6, 2016
In order to collect information on food intake, lifestyle and health status of the Italian popula... more In order to collect information on food intake, lifestyle and health status of the Italian population, a random cohort of about 2000 adults was selected in collaboration with the Italian society of general practitioners' network (SIMG). Cohort subjects underwent a full clinical evaluation, by their family doctor, who also collected anthropometric data and information on the prevalence of cardiovascular disease risk factors; they were also administered diary forms developed to assess dietary use of simple sugars, of sugar-containing food and of selected food items. Data obtained indicate that the consumption of simple sugars (either added or as natural part of food) by the Italian adult population is, on average, not high (65 and 67 g/day, among women and men, respectively) and mostly derived from food items such as fruit, milk and yogurt. In addition, no correlations were found, in this low-sugar-consuming cohort, between sugar intake and weight, body mass index and waist circum...
European Journal of Haematology, 2016
Iron deficiency anaemia (IDA) is a global public health concern, being responsible for about 800,... more Iron deficiency anaemia (IDA) is a global public health concern, being responsible for about 800,000 deaths per year worldwide. To date, few studies have investigated the epidemiology of IDA in Europe. This study therefore aims to assess the incidence rate and determinants of IDA in four European countries. Demographic and clinical information was obtained from four national primary care databases, respectively for Italy, Belgium, Germany and Spain. IDA-related determinants were estimated using multivariable Cox regression. The annual incidence rates of IDA ranged between 7.2 and 13.96 per 1,000 person-years. The estimates were higher in Spain and Germany. Females, younger and older patients were at greater risk of IDA, as well as those suffering from gastrointestinal diseases, pregnant women and those with history of menometrorrhagia, and aspirin and/or antacids users. A Charlson Index >0 was a significant determinant of IDA in all countries. The use of primary care databases allowed us to assess the incidence rate and determinants of IDA in four European countries. Given the crucial role of general practitioners in the diagnosis and management of this condition, our findings may contribute to increase the awareness of IDA among physicians as well as to reduce its occurrence among at-risk patients. This article is protected by copyright. All rights reserved.
... Claudio Cricelli 3 Giampiero Favato 1,4 Alessandro Filippi 3 Andrea Poli 1 , Elena Tragni 1,2... more ... Claudio Cricelli 3 Giampiero Favato 1,4 Alessandro Filippi 3 Andrea Poli 1 , Elena Tragni 1,2 ... Without exception, all risk prediction charts and risk scores are based on evidences obtained from prospective observational studies (Hense, 2004; Chobanian, 2003; ATP III, 2001). ...
In Italia sono state recentemente introdotte le carte per la valutazione del rischio cardiovascol... more In Italia sono state recentemente introdotte le carte per la valutazione del rischio cardiovascolare globale assoluto ed il punteggio individuale costruiti attraverso funzioni messe a punto con gli studi longitudinali del Progetto CUORE 1 2 . Carte e punteggio differiscono per l'età coperta e per alcuni fattori considerati; pertanto abbiamo valutato le differenze di classificazione tra la carta e punteggio individuale del Progetto CUORE utilizzando le stesse classi di rischio cardiovascolare della carta e prestando particolare attenzione alla soglia del 20% a 10 anni, utile per la rimborsabilità di alcune tipologie di farmaci in prevenzione primaria (atorvastatina, fluvastatina, pravastatina, rosuvastatina, simvastatina) secondo la Nota 13 dell'Agenzia Italiana del Farmaco (AIFA).
Journal of Psychopharmacology, 2008
European Journal of Clinical Pharmacology, Sep 12, 2003
Objective: To assess patient-and doctor-related variables leading physicians to prescribe antibio... more Objective: To assess patient-and doctor-related variables leading physicians to prescribe antibiotics or parenteral antibiotics for acute respiratory infections (ARIs) and to describe the variability as well as the appropriateness of antibiotic use and its predictive factors in general practice. Methods: We conducted a cross-sectional study among patients aged 15-85 years with a diagnosis of ARIs, using information from 469 GPs from the Health Search Database. Diagnoses were linked with antibiotic prescriptions and other patients and doctor-related variables. Available scientific evidence was used to establish the appropriateness of first-choice antibiotic treatment. Frequency analyses and logistic regressions were used to identify variables associated with antibiotic use and appropriateness. Results: On 67,761 cases of ARIs, antibiotics were prescribed in 63.2%, varying from 80.9% for acute bronchitis to 43.9% for croup, influenza and common cold. Significant associations with antibiotic use were found for geographic location and number of patients under care. The use of diagnostic tests significantly lowered the risk. Geographic location and living in an urban area were associated with parenteral antibiotic use. Amoxicillin (16.7%) and amoxicillin-clavulanate (17.9%) were the most common antibiotics prescribed. Appropriateness was reported in 39.0% of cases, with geographic location, physician's gender and diagnostic tests being the factors more predictive of appropriate antibiotic use. Conclusions: There is still excessive antibiotic use for ARIs. Its overuse is influenced by the physicians' characteristics and by the environment in which they practice, whilst diagnostic tests might reduce inappropriateness. Therefore, effective strategies for changing diagnostic and therapeutic behaviour are needed.
BACKGROUND: The new European guidelines for the management of dyslipidaemias indicate that interv... more BACKGROUND: The new European guidelines for the management of dyslipidaemias indicate that interventions to reduce LDL-cholesterol should be based on the assessment of global cardiovascular risk of the patient. The distributions of risk and lipid values are therefore key factors in the definition of lipid-lowering therapy. Our aim was to estimate assess the therapeutic target achievement in a representative sample of Italian population. METHODS: Cross-sectional, population-based study of a representative sample of the Italian adult population, comprising 5618 individuals (from 40 to 79 years of age, both sexes) from general practices in Italy. RESULTS: According to Guidelines stratification, 33.5% of the subjects were at low risk, while 31.6%, 9.8% and 25.1% were at intermediate, high and very high risk, respectively. Overall, 72.9% of subjects were not at target for LDL-c, ranging from 56.5% in the low-risk class to 95.5% in the very-high-risk class. Among diabetic patients (13.0% ...
Giornale italiano di cardiologia (2006), 2010
The Italian National Prevention plan includes 10-year cardiovascular risk (CR) assessment of the ... more The Italian National Prevention plan includes 10-year cardiovascular risk (CR) assessment of the Italian general population aged 35-69 years using the CUORE Project risk score. A national training program for general practitioners (GPs) was launched by the Ministry of Health in 2003. GPs were encouraged to collect data on risk factors and risk assessment and to contribute to the CUORE Project Cardiovascular Risk Observatory (CRO). The aim of this analysis is to demonstrate the feasibility and effectiveness of risk assessment in primary care. The cuore.exe software, free of charge for GPs and easily downloadable from the CUORE Project web site (www.cuore.iss.it), is the frame for the GP data collection. The CRO provides a platform to analyze data collected on risk assessment and risk factors, and compare results at regional and national level in order to support health policy makers in their decision process. From January 2007 to April 2009, 2858 GPs have downloaded the cuore.exe sof...
Primary care companion to the Journal of clinical psychiatry, 2008
To test the efficacy of a training course on the diagnosis and treatment of schizophrenia, tailor... more To test the efficacy of a training course on the diagnosis and treatment of schizophrenia, tailored for the general practitioner. A course, in a 3-session format, was given to 215 primary care doctors from the city of Brescia and its province, in Italy. All 706 doctors working in primary care were asked to participate. Of these doctors, 30.5% took part in the study. The first session (215 doctors) assessed baseline knowledge of schizophrenia (June 2002), the second (173 doctors) gave formal teaching and assessed post-lesson knowledge (October 2002), and the third (130 doctors) evaluated the retention of knowledge after 8 months (July 2003). The main outcome measures were total number of schizophrenia symptoms identified, total number of antipsychotics identified, and knowledge about antipsychotic-related adverse events. Post-lesson, general practitioners could identify 6.5 more symptoms (p < .001) and 4.9 more antipsychotics (p < .001). Compared to baseline, 71.5% vs. 15.4% of...
Giornale italiano di cardiologia (2006), 2006
To evaluate 10-year cardiovascular risk, the risk chart and the individual risk score from the CU... more To evaluate 10-year cardiovascular risk, the risk chart and the individual risk score from the CUORE Project were recently introduced in Italy. These tools differ as for age range and some risk factors. Therefore, the aim of this study is to evaluate the difference between the global absolute risk assessed by the risk chart and the individual risk score using the data collected through the Osservatorio Epidemiologico Cardiovascolare (OEC). From the Osservatorio Epidemiologico Cardiovascolare sample, 6508 people aged 40-69 years without clinical manifestations of atherosclerosis were selected. Cardiovascular risk was assessed using risk chart and individual risk score and the 10-year risk was categorized in six classes (< 5%, 5-9%, 10-14%, 15-19%, 20-29%, > or = 30%). As coefficient of agreement between risk chart and individual risk score, Cohen kappa statistic was computed using the Cicchetti-Allison weights (k(w)). From contingency tables of the two methods distribution, k(w...
Italian heart journal : official journal of the Italian Federation of Cardiology, 2004
Italian heart journal : official journal of the Italian Federation of Cardiology, 2004
The aim of our work was to evaluate, in a general practice setting, the attitude of general pract... more The aim of our work was to evaluate, in a general practice setting, the attitude of general practitioners in determining the individual coronary risk. The coronary risk was determined among patients aged 30 to 74 years using the following parameters: gender, age, smoking habits, diagnosis of diabetes mellitus, systolic blood pressure, and total cholesterol. We evaluated the records of 446,331 subjects collected by 481 general practitioners working throughout Italy. Except for age, gender and diabetes mellitus, risk factors were largely under-recorded: blood pressure in 37.0% of the total patients, total cholesterol in 34.3%, smoking habits in 21.9%. Recording was substantially low even in patients who were prescribed with antihypertensive drugs and/or lipid-lowering drugs: blood pressure in 80.6% of the patients, total cholesterol in 69.1%, smoking habits in 46.1%. Cardiovascular risk factors were more frequently recorded as age increased and slightly more among women as compared to...
Journal of Cardiovascular Medicine, 2006
To collect information on the major risk factors and secondary prevention among patients with myo... more To collect information on the major risk factors and secondary prevention among patients with myocardial infarction in Italy. Data were obtained from the database of the Italian College of General Practitioners; 3588 patients (mean age 68.7 +/- 11.3 years; 2698 men, 888 women; two unrecorded gender), with an average time from event of 6 +/- 5.7 years, were identified. Among the major risk factors, data entry ranged from 50.3% for physical activity to 74.9% for blood pressure. Inadequate blood pressure control was present in 49.2% and elevated plasma cholesterol levels (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 5.2 mmol/l) in 57.3%; among the latter group, 65% were on lipid-lowering therapy. Only 47.2% of the treated patients achieved a total cholesterol level of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 5.2 mmol/l. Antiplatelet or anticoagulant drugs, beta-blockers, and angiotensin-converting enzyme inhibitors were prescribed to 43%, 10.3%, and 57.9% of patients, respectively. The preventive attitude of Italian general practitioners is similar to that reported in other European countries with two noticeable exceptions: under-prescription of beta-blockers and of antiplatelet drugs. Clearly, secondary prevention requires major improvement.
Healthcare utilisation databases, and other secondary data sources, have been used with growing f... more Healthcare utilisation databases, and other secondary data sources, have been used with growing frequency to assess health outcomes and healthcare interventions worldwide. Their increased popularity as a research tool is due to their timely availability, the large patient populations covered, low cost, and applicability for studying real-world clinical practice. Despite the need to measure Italian National Health Service performance both at regional and national levels, the wealth of good quality electronic data and the high standards of scientific research in this field, healthcare research and public health policies seem to progress along orthogonal dimensions in Italy. The main barriers to the development of evidence-based public health include the lack of understanding of evidence-based methodologies by policy makers, and of involvement of researchers in the policy process. The CRACK programme was launched by some academics from the Lombardy Region. By extensively using electronically stored data, epidemiologists, biostatisticians, pharmacologists and clinicians applied methods and evidence to several issues of healthcare research. The CRACK programme was based on their intention to remove barriers that thwart the process of bridging methods and findings from scientific journals to public health practice. This paper briefly describes aim, articulation and management of the CRACK programme, and discusses why it might find articulated application in Italy.
Open Journal of Epidemiology, Nov 27, 2012
Objective: To evaluate the distribution of cardiovascular risk factors and the prevalence of card... more Objective: To evaluate the distribution of cardiovascular risk factors and the prevalence of cardiovascular disease in a sample of the Italian population. Methods: CHECK (Cholesterol and Health: Education, Control and Knowledge) is a cross-sectional observational study in a randomised sample of the Italian adult population aged 40 -79 years, in the setting of general practice. Results: 5846 subjects (50.3% male) were included in the analysis. The mean age [±SD] of the observed cohort was 57.8 (±10.3) years. One out of five subjects smoked cigarettes and almost 80% didn't engage in regular leisure-time physical activity. The mean blood pressure was 132.0 [±14.7]/81.2 [±7.9] mmHg. The total and LDL-cholesterol levels were respectively 205.3 [±35.9] mg/dL and 124.9 [±29.9] mg/dL. The mean glucose concentration was 98.3 [±28.
Farmeconomia. Health economics and therapeutic pathways, 2011
Farmeconomia. Health economics and therapeutic pathways, 2011
Italian Heart Journal Official Journal of the Italian Federation of Cardiology, Feb 1, 2005
The aim of this study was to compare the prevalence of angina pectoris (AP) using self-reported i... more The aim of this study was to compare the prevalence of angina pectoris (AP) using self-reported information and primary care databases. A comparison between the prevalence of AP in 730,586 subjects from the Health Search Database (HSD) and 119,799 individuals from a Health Interview Survey (HIS) was performed. The age-specific prevalence was calculated by dividing the detected cases by the total number of individuals in each age group. The age-standardized prevalence was estimated by direct standardization performed using the Italian standard population. The HSD reported a higher crude prevalence of AP than the HIS, both in males (1374/100,000 vs 1006/100,000) and females (1449/100,000 vs 1007/100,000). In the HSD the age-specific prevalence was lower for patients aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;65 years, whilst higher estimates were reported for older patients. Age standardization slightly reduced the prevalence in both samples, although the HSD always reported higher estimates. Prescription data from general practice databases may be a valid, simple, and cost-effective method to evaluate and serially monitor the prevalence of AP.
The Primary Care Companion to the Journal of Clinical Psychiatry, Feb 1, 2008
To test the efficacy of a training course on the diagnosis and treatment of schizophrenia, tailor... more To test the efficacy of a training course on the diagnosis and treatment of schizophrenia, tailored for the general practitioner. A course, in a 3-session format, was given to 215 primary care doctors from the city of Brescia and its province, in Italy. All 706 doctors working in primary care were asked to participate. Of these doctors, 30.5% took part in the study. The first session (215 doctors) assessed baseline knowledge of schizophrenia (June 2002), the second (173 doctors) gave formal teaching and assessed post-lesson knowledge (October 2002), and the third (130 doctors) evaluated the retention of knowledge after 8 months (July 2003). The main outcome measures were total number of schizophrenia symptoms identified, total number of antipsychotics identified, and knowledge about antipsychotic-related adverse events. Post-lesson, general practitioners could identify 6.5 more symptoms (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) and 4.9 more antipsychotics (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Compared to baseline, 71.5% vs. 15.4% of doctors had a good knowledge of antipsychotic-related adverse events. Although a loss of knowledge was found after the 8-month follow-up, knowledge at the endpoint was significantly higher than at baseline for the 3 main outcome variables (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The teaching course on schizophrenia for general practitioners was effective, and the knowledge gained after teaching was stable across time.
European journal of nutrition, Jan 6, 2016
In order to collect information on food intake, lifestyle and health status of the Italian popula... more In order to collect information on food intake, lifestyle and health status of the Italian population, a random cohort of about 2000 adults was selected in collaboration with the Italian society of general practitioners' network (SIMG). Cohort subjects underwent a full clinical evaluation, by their family doctor, who also collected anthropometric data and information on the prevalence of cardiovascular disease risk factors; they were also administered diary forms developed to assess dietary use of simple sugars, of sugar-containing food and of selected food items. Data obtained indicate that the consumption of simple sugars (either added or as natural part of food) by the Italian adult population is, on average, not high (65 and 67 g/day, among women and men, respectively) and mostly derived from food items such as fruit, milk and yogurt. In addition, no correlations were found, in this low-sugar-consuming cohort, between sugar intake and weight, body mass index and waist circum...
European Journal of Haematology, 2016
Iron deficiency anaemia (IDA) is a global public health concern, being responsible for about 800,... more Iron deficiency anaemia (IDA) is a global public health concern, being responsible for about 800,000 deaths per year worldwide. To date, few studies have investigated the epidemiology of IDA in Europe. This study therefore aims to assess the incidence rate and determinants of IDA in four European countries. Demographic and clinical information was obtained from four national primary care databases, respectively for Italy, Belgium, Germany and Spain. IDA-related determinants were estimated using multivariable Cox regression. The annual incidence rates of IDA ranged between 7.2 and 13.96 per 1,000 person-years. The estimates were higher in Spain and Germany. Females, younger and older patients were at greater risk of IDA, as well as those suffering from gastrointestinal diseases, pregnant women and those with history of menometrorrhagia, and aspirin and/or antacids users. A Charlson Index &amp;gt;0 was a significant determinant of IDA in all countries. The use of primary care databases allowed us to assess the incidence rate and determinants of IDA in four European countries. Given the crucial role of general practitioners in the diagnosis and management of this condition, our findings may contribute to increase the awareness of IDA among physicians as well as to reduce its occurrence among at-risk patients. This article is protected by copyright. All rights reserved.
... Claudio Cricelli 3 Giampiero Favato 1,4 Alessandro Filippi 3 Andrea Poli 1 , Elena Tragni 1,2... more ... Claudio Cricelli 3 Giampiero Favato 1,4 Alessandro Filippi 3 Andrea Poli 1 , Elena Tragni 1,2 ... Without exception, all risk prediction charts and risk scores are based on evidences obtained from prospective observational studies (Hense, 2004; Chobanian, 2003; ATP III, 2001). ...
In Italia sono state recentemente introdotte le carte per la valutazione del rischio cardiovascol... more In Italia sono state recentemente introdotte le carte per la valutazione del rischio cardiovascolare globale assoluto ed il punteggio individuale costruiti attraverso funzioni messe a punto con gli studi longitudinali del Progetto CUORE 1 2 . Carte e punteggio differiscono per l'età coperta e per alcuni fattori considerati; pertanto abbiamo valutato le differenze di classificazione tra la carta e punteggio individuale del Progetto CUORE utilizzando le stesse classi di rischio cardiovascolare della carta e prestando particolare attenzione alla soglia del 20% a 10 anni, utile per la rimborsabilità di alcune tipologie di farmaci in prevenzione primaria (atorvastatina, fluvastatina, pravastatina, rosuvastatina, simvastatina) secondo la Nota 13 dell'Agenzia Italiana del Farmaco (AIFA).
Journal of Psychopharmacology, 2008
European Journal of Clinical Pharmacology, Sep 12, 2003
Objective: To assess patient-and doctor-related variables leading physicians to prescribe antibio... more Objective: To assess patient-and doctor-related variables leading physicians to prescribe antibiotics or parenteral antibiotics for acute respiratory infections (ARIs) and to describe the variability as well as the appropriateness of antibiotic use and its predictive factors in general practice. Methods: We conducted a cross-sectional study among patients aged 15-85 years with a diagnosis of ARIs, using information from 469 GPs from the Health Search Database. Diagnoses were linked with antibiotic prescriptions and other patients and doctor-related variables. Available scientific evidence was used to establish the appropriateness of first-choice antibiotic treatment. Frequency analyses and logistic regressions were used to identify variables associated with antibiotic use and appropriateness. Results: On 67,761 cases of ARIs, antibiotics were prescribed in 63.2%, varying from 80.9% for acute bronchitis to 43.9% for croup, influenza and common cold. Significant associations with antibiotic use were found for geographic location and number of patients under care. The use of diagnostic tests significantly lowered the risk. Geographic location and living in an urban area were associated with parenteral antibiotic use. Amoxicillin (16.7%) and amoxicillin-clavulanate (17.9%) were the most common antibiotics prescribed. Appropriateness was reported in 39.0% of cases, with geographic location, physician's gender and diagnostic tests being the factors more predictive of appropriate antibiotic use. Conclusions: There is still excessive antibiotic use for ARIs. Its overuse is influenced by the physicians' characteristics and by the environment in which they practice, whilst diagnostic tests might reduce inappropriateness. Therefore, effective strategies for changing diagnostic and therapeutic behaviour are needed.
BACKGROUND: The new European guidelines for the management of dyslipidaemias indicate that interv... more BACKGROUND: The new European guidelines for the management of dyslipidaemias indicate that interventions to reduce LDL-cholesterol should be based on the assessment of global cardiovascular risk of the patient. The distributions of risk and lipid values are therefore key factors in the definition of lipid-lowering therapy. Our aim was to estimate assess the therapeutic target achievement in a representative sample of Italian population. METHODS: Cross-sectional, population-based study of a representative sample of the Italian adult population, comprising 5618 individuals (from 40 to 79 years of age, both sexes) from general practices in Italy. RESULTS: According to Guidelines stratification, 33.5% of the subjects were at low risk, while 31.6%, 9.8% and 25.1% were at intermediate, high and very high risk, respectively. Overall, 72.9% of subjects were not at target for LDL-c, ranging from 56.5% in the low-risk class to 95.5% in the very-high-risk class. Among diabetic patients (13.0% ...
Giornale italiano di cardiologia (2006), 2010
The Italian National Prevention plan includes 10-year cardiovascular risk (CR) assessment of the ... more The Italian National Prevention plan includes 10-year cardiovascular risk (CR) assessment of the Italian general population aged 35-69 years using the CUORE Project risk score. A national training program for general practitioners (GPs) was launched by the Ministry of Health in 2003. GPs were encouraged to collect data on risk factors and risk assessment and to contribute to the CUORE Project Cardiovascular Risk Observatory (CRO). The aim of this analysis is to demonstrate the feasibility and effectiveness of risk assessment in primary care. The cuore.exe software, free of charge for GPs and easily downloadable from the CUORE Project web site (www.cuore.iss.it), is the frame for the GP data collection. The CRO provides a platform to analyze data collected on risk assessment and risk factors, and compare results at regional and national level in order to support health policy makers in their decision process. From January 2007 to April 2009, 2858 GPs have downloaded the cuore.exe sof...
Primary care companion to the Journal of clinical psychiatry, 2008
To test the efficacy of a training course on the diagnosis and treatment of schizophrenia, tailor... more To test the efficacy of a training course on the diagnosis and treatment of schizophrenia, tailored for the general practitioner. A course, in a 3-session format, was given to 215 primary care doctors from the city of Brescia and its province, in Italy. All 706 doctors working in primary care were asked to participate. Of these doctors, 30.5% took part in the study. The first session (215 doctors) assessed baseline knowledge of schizophrenia (June 2002), the second (173 doctors) gave formal teaching and assessed post-lesson knowledge (October 2002), and the third (130 doctors) evaluated the retention of knowledge after 8 months (July 2003). The main outcome measures were total number of schizophrenia symptoms identified, total number of antipsychotics identified, and knowledge about antipsychotic-related adverse events. Post-lesson, general practitioners could identify 6.5 more symptoms (p < .001) and 4.9 more antipsychotics (p < .001). Compared to baseline, 71.5% vs. 15.4% of...
Giornale italiano di cardiologia (2006), 2006
To evaluate 10-year cardiovascular risk, the risk chart and the individual risk score from the CU... more To evaluate 10-year cardiovascular risk, the risk chart and the individual risk score from the CUORE Project were recently introduced in Italy. These tools differ as for age range and some risk factors. Therefore, the aim of this study is to evaluate the difference between the global absolute risk assessed by the risk chart and the individual risk score using the data collected through the Osservatorio Epidemiologico Cardiovascolare (OEC). From the Osservatorio Epidemiologico Cardiovascolare sample, 6508 people aged 40-69 years without clinical manifestations of atherosclerosis were selected. Cardiovascular risk was assessed using risk chart and individual risk score and the 10-year risk was categorized in six classes (< 5%, 5-9%, 10-14%, 15-19%, 20-29%, > or = 30%). As coefficient of agreement between risk chart and individual risk score, Cohen kappa statistic was computed using the Cicchetti-Allison weights (k(w)). From contingency tables of the two methods distribution, k(w...
Italian heart journal : official journal of the Italian Federation of Cardiology, 2004
Italian heart journal : official journal of the Italian Federation of Cardiology, 2004
The aim of our work was to evaluate, in a general practice setting, the attitude of general pract... more The aim of our work was to evaluate, in a general practice setting, the attitude of general practitioners in determining the individual coronary risk. The coronary risk was determined among patients aged 30 to 74 years using the following parameters: gender, age, smoking habits, diagnosis of diabetes mellitus, systolic blood pressure, and total cholesterol. We evaluated the records of 446,331 subjects collected by 481 general practitioners working throughout Italy. Except for age, gender and diabetes mellitus, risk factors were largely under-recorded: blood pressure in 37.0% of the total patients, total cholesterol in 34.3%, smoking habits in 21.9%. Recording was substantially low even in patients who were prescribed with antihypertensive drugs and/or lipid-lowering drugs: blood pressure in 80.6% of the patients, total cholesterol in 69.1%, smoking habits in 46.1%. Cardiovascular risk factors were more frequently recorded as age increased and slightly more among women as compared to...
Journal of Cardiovascular Medicine, 2006
To collect information on the major risk factors and secondary prevention among patients with myo... more To collect information on the major risk factors and secondary prevention among patients with myocardial infarction in Italy. Data were obtained from the database of the Italian College of General Practitioners; 3588 patients (mean age 68.7 +/- 11.3 years; 2698 men, 888 women; two unrecorded gender), with an average time from event of 6 +/- 5.7 years, were identified. Among the major risk factors, data entry ranged from 50.3% for physical activity to 74.9% for blood pressure. Inadequate blood pressure control was present in 49.2% and elevated plasma cholesterol levels (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 5.2 mmol/l) in 57.3%; among the latter group, 65% were on lipid-lowering therapy. Only 47.2% of the treated patients achieved a total cholesterol level of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 5.2 mmol/l. Antiplatelet or anticoagulant drugs, beta-blockers, and angiotensin-converting enzyme inhibitors were prescribed to 43%, 10.3%, and 57.9% of patients, respectively. The preventive attitude of Italian general practitioners is similar to that reported in other European countries with two noticeable exceptions: under-prescription of beta-blockers and of antiplatelet drugs. Clearly, secondary prevention requires major improvement.
Healthcare utilisation databases, and other secondary data sources, have been used with growing f... more Healthcare utilisation databases, and other secondary data sources, have been used with growing frequency to assess health outcomes and healthcare interventions worldwide. Their increased popularity as a research tool is due to their timely availability, the large patient populations covered, low cost, and applicability for studying real-world clinical practice. Despite the need to measure Italian National Health Service performance both at regional and national levels, the wealth of good quality electronic data and the high standards of scientific research in this field, healthcare research and public health policies seem to progress along orthogonal dimensions in Italy. The main barriers to the development of evidence-based public health include the lack of understanding of evidence-based methodologies by policy makers, and of involvement of researchers in the policy process. The CRACK programme was launched by some academics from the Lombardy Region. By extensively using electronically stored data, epidemiologists, biostatisticians, pharmacologists and clinicians applied methods and evidence to several issues of healthcare research. The CRACK programme was based on their intention to remove barriers that thwart the process of bridging methods and findings from scientific journals to public health practice. This paper briefly describes aim, articulation and management of the CRACK programme, and discusses why it might find articulated application in Italy.