Giulia Lorenzoni

Cost-effectiveness of early detection of atrial fibrillation via remote control of implanted devices

RATIONALE, AIMS AND OBJECTIVES Atrial fibrillation (AF) is an independent risk factor for stroke, and its incidence is high in patients implanted with pacemakers (PMs) and implantable cardioverter defibrillators (ICDs). The aim of our study is to evaluate the potential benefit of remote control (RC) on the incidence of stroke related to AF in patients with new-onset AF implanted with PMs and ICDs and to evaluate the impact of RC on the consumption of medical resources. METHOD The study consisted of two cohorts of patients: group AMB (patients attending ambulatory care clinics from August to October 2013) and group RC (patients followed remotely). All detected cases of new-onset AF were confirmed by the electrogram stored in the devices memory or by standard electrocardiogram recording. Monte Carlo simulations were performed in order to evaluate the potential risk reduction of stroke related to AF. The costs were estimated from the perspectives of the hospital, the patients and the National Health Service. RESULT We enrolled 223 patients in group RC and 359 in group AMB. We detected 20 new-onset cases of AF, and the median time to AF detection was 2 days in the RC and 78 days in the ambulatory care clinic control. Management of patients was more efficient with RC, with an average savings in direct costs of €40.88 per year per patient. Through the use of Monte Carlo simulations, we showed that the early detection of new-onset AF may provide a relative risk reduction of 94.3% for stroke in PM-implanted patients older than 55 years. CONCLUSION RC potentially provides a risk reduction for stroke because it allows an early detection of new-onset AF. Moreover, it is also a cost-saving means of follow-up.Rationale, aims and objectives Atrial fibrillation (AF) is an independent risk factor for stroke, and its incidence is high in patients implanted with pacemakers (PMs) and implantable cardioverter defibrillators (ICDs). The aim of our study is to evaluate the potential benefit of remote control (RC) on the incidence of stroke related to AF in patients with new-onset AF implanted with PMs and ICDs and to evaluate the impact of RC on the consumption of medical resources. Method The study consisted of two cohorts of patients: group AMB (patients attending ambulatory care clinics from August to October 2013) and group RC (patients followed remotely). All detected cases of new-onset AF were confirmed by the electrogram stored in the devices memory or by standard electrocardiogram recording. Monte Carlo simulations were performed in order to evaluate the potential risk reduction of stroke related to AF. The costs were estimated from the perspectives of the hospital, the patients and the National Health Service. Result We enrolled 223 patients in group RC and 359 in group AMB. We detected 20 new-onset cases of AF, and the median time to AF detection was 2 days in the RC and 78 days in the ambulatory care clinic control. Management of patients was more efficient with RC, with an average savings in direct costs of €40.88 per year per patient. Through the use of Monte Carlo simulations, we showed that the early detection of new-onset AF may provide a relative risk reduction of 94.3% for stroke in PM-implanted patients older than 55 years. Conclusion RC potentially provides a risk reduction for stroke because it allows an early detection of new-onset AF. Moreover, it is also a cost-saving means of follow-up.

Public Health Implications of Obstructive Sleep Apnea Burden

ObjectiveTo assess the implications of obstructive sleep apnea (OSA) burden among Indian children.MethodsMonteCarlo simulations were performed in order to estimate the number of OSA related obesity cases among Indian children (1–14 y of age) and the number of cases of stroke, coronary heart disease (CHD) and type 2 diabetes, considered as main adverse outcomes of OSA related childhood obesity, according to untreated and treated [adenotonsillectomy (AT) alone and AT associated to continuous positive airway pressure (CPAP)] pediatric OSA. Data used to perform MonteCarlo simulations were derived from a review about current literature exploring OSA related obesity.ResultsThe analysis on the number of adverse outcomes according to treated and untreated obesity related to OSA showed that treatments reduce the number of obesity cases, resulting in a great reduction of the amount of stroke, CHD and type 2 diabetes cases. However, the cost for treating adverse outcome was higher in patients treated for obesity related to OSA compared to those not receiving any treatment.ConclusionsThe reduction in the number of adverse outcomes due to treatment of obesity related OSA implicates the urgent need for public health policies in providing screening for OSA among children population: an early detection and a consequently prompt reaction to pediatric OSA could improve the burden of OSA related obesity.

Does Love Really Make Mothers Blind? A Large Transcontinental Study on Mothers' Awareness About Their Children's Weight

The aim of this study was to assess maternal misperception rates (perception as normal or underweight of a child with overweight or obesity) and their role in affecting the chance of implementing actions to change childrens weight.

A novel approach for comparing patterns of foreign body injuries across countries: A case study comparing European Countries and Bosnia and Herzegovina

OBJECTIVES The present study aimed at analyzing the characteristics of FB injuries from Bosnia and Herzegovina (B&H), a rapidly growing newly industrialized country, and to compare them with cases from European countries. METHODS The analysis is based on FB injury cases included in the Susy Safe registry. Cases from the Ear-Nose-Throat (ENT) Clinic, University Clinical Center of Tuzla (B&H) were compared with cases from European countries participating in the Susy Safe project. Multiple Correspondence Analysis (MCA) was performed to elucidate differences within a large data set regarding mechanisms and objects causing injuries. RESULTS The results of the MCA showed that the first three dimensions explained 43% of the variability. The first dimension was identified by children hospitalized for FB ingestion, the second one by children hospitalized for FB aspiration (lower airways), and the third one by children with an FB in the ear or in the upper airways. The analysis of the median of coordinates of factors contributing to each dimension showed that the greatest difference between B&H and European countries regarded the third one. Looking at the profile of these patients, it might be suggested that the proportion of males and females and the type of activity in which they were involved at time of injury occurrence are different among the countries considered CONCLUSIONS: This study proposes a simple tool for assessing differences among countries in the distribution of FB injuries. This case study shows that B&H has different patterns of FB injuries in the upper respiratory tract.

PW 2281 A massive open online course for food choking prevention in children: the malaysian safefood4children experience as a working model

Background Food choking injuries represent one of the leading cause of death, among unintentional injuries, in children. However, data from the Susy Safe registry have shown that adult supervisors are not aware of food choking hazard, highlighting the need to implement specific educational campaigns in the field. Objective To try to respond to this need, an international MOOC (massive open online course) has been realized. Methods The SafeFood4Children (https://www.safefood4children.org/) initiative consists of a series of videos freely available on a dedicated website (MOOC learning modality) that addresses specific topics (obstruction mechanism, hazardous food items and their preparation, pediatric unblocking maneuvers) closely related to the problem of food choking in children. Once the course has been completed, a certificate of participation is obtained. Dedicated sections have been implemented for each country collaborating to such initiative. Course contents are based on the country’s intrinsic characteristics (taking into account families’ eating habits, which are known to affect the type of food on which children choke). Findings A positive cooperation with the National University of Malaysia has been undertaken, drawing the attention of local government authorities, instituting Malaysia as a role model. As results, the SafeFood4children initiative has been implemented in Malaysia (https://www.safefood4children.org/#may) and a dedicate section has been developed, in both English and Malay, involving Malaysian experts (https://vimeo.com/223429785/c9ad8a0c50 for a video clip). Conclusion The SafeFood4Children initiative in Malaysia would be a working model to be implemented to other AESAN countries, to further reduce the burden of food choking injuries in children. Policy implications This prevention initiative has been designed to be freely accessible to everyone. One of the goals of the project is to be adopted by a national prevention program that promotes participation in the online course among public school teachers and families.

Optimizing Protein Intake and Nitrogen Balance (OPINiB) in Adult Critically Ill Patients: A Study Protocol for a Randomized Controlled Trial

Background Adequate nutrition of critically ill patients plays a key role in the modulation of metabolic response to stress. Objective This paper presents the development of a protocol for a randomized controlled trial (RCT) aimed at comparing clinical outcomes of patients in the intensive care unit (ICU) administered with standard and protein-fortified diet. Together with the RCT study protocol, the results of the observational analysis conducted to assess the feasibility of the RCT are presented. Methods An RCT on adult patients admitted to ICU and undergoing mechanical ventilation in the absence of renal or hepatic failure will be conducted. Patients enrolled will be randomized with an allocation rate of 1:1 at standard diet versus protein-fortified diet. The estimated sample size is 19 per arm, for a total of 38 patients to be randomized. Results Enrollment began in January 2017. In the feasibility study, 14 patients were enrolled. Protein administration increased significantly (P<.001) over time but was significantly lower compared to that recommended (P<.001). Blood urea nitrogen significantly increased (P<.03) over the period of observation. Such increased catabolism resulted in negative cumulative nitrogen balance (NB) in all patients, and some patients presented with a more negative NB compared to the others. Conclusions Results of the feasibility study clearly confirmed that protein provision in ICU patients is below that recommended and that this results in impaired NB. The emerging of an interindividual variability in NB will be further analyzed in the RCT. Trial Registration ClinicalTrials.gov NCT02990065; https://clinicaltrials.gov/ct2/show/NCT02990065 (Archived by WebCite at http://www.webcitation.org/6prsqZdRM).

Research in nursing and nutrition: Is randomized clinical trial the actual gold standard?

The aim of this study was to assess the quality of reporting of nurse-driven randomized controlled trials involving a direct nutritional intervention. A bibliometric search for randomized controlled trials involving a direct nutritional intervention from 1991 to 2011 in nursing research was conducted. Both quality of the study and design aspects were evaluated. The prevalent randomized controlled trial design used is 2-arm parallel, individual, and randomized with a continuous primary endpoint. Global numbers of randomized controlled trials and the proportion of good-quality randomized controlled trials began a steady and marked rise, more than doubling, from the 1990s to about 2001 and increased slowly thereafter. Studies are overall sufficiently well designed, although there is still room for quality improvement. Additionally, implementation of new randomized controlled trial designs exists and should be advocated.

Recomendaciones sobre la prevención de la aspiración de cuerpos extraños orgánicos

Foreign body aspiration remains a common and potentially serious pediatric problem. Most aspirated foreign bodies are food. The education of parents and caregivers about choking hazards and how to avoid them is critical to reduce the incidence of these events. The pediatricians play a key role in promoting injury prevention. We indicate the main characteristics of hazardous food and we present recommendations on age-appropriate meals, adequate forms of food preparation and behavioral rules at mealtimes in order to reduce food choking.

Pimpinella Anisum and Illicium Verum: The Multifaceted Role of Anise Plants

The role of dietary active compounds in human nutrition is an important area of investigation in the field of nutritional science. In this perspective, functional foods play a relevant role, offering a new kind of health tool that promises specific effects related to particular food components. Anise plant has a long cultural tradition in various countries all over the world, both as food and as drug. The essential oil of anise, extracted from the dry ripe fruits of Illicium verum and Pimpinella anisum, contains anethole, an active chemical compound that showed several functional properties including antimicrobial, antioxidant, hypoglycemic, hypolipidemic and oestrogenic properties. To date, studies conducted on the properties of anise, demonstrated the efficacy of the plant in the improvement of physiological condition in human and the possibility to exploit the active compounds of anise for the treatment of several chronic diseases. The aim of this review is to collect data on anise in order to evaluate its pharmacological properties.

Integration of Functional and Traditional Food in Emerging Markets: Regulatory and Substantive Aspects of Yerba Mate and Quinoa

Given the rising cost of healthcare, the increase in life expectancy and the wish for a better quality of life, the request for foods and beverages producing a beneficial effect on health has increased worldwide. “Functional food” is a new concept and may play a key role in diseases’ prevention and management. Although its meaning is currently under definition, its role in global health improvement is growing constantly. This article aims at giving a description of existing legislation on functional food in South America, identifying future directions for health and marketing policies. Furthermore, authors provide a literature revision on two products widely consumed in Latin American countries: Yerba Mate and Quinoa. Thanks to their beneficial health effects in terms of disease prevention and promotion of well-being, they may be considered as functional foods with a potential key role in health care.