Raffaele Gimigliano

Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records

Objectives As osteoporotic fractures are becoming a major health care problem in countries characterized by an increasing number of older adults, in this study we aimed to compare the incidence and costs of hip fragility fractures in Italian elderly people versus those of major cardiovascular diseases (strokes and acute myocardial infarctions [AMI]) occurring in the whole adult population. Methods We analyzed hospitalization records maintained at the national level by the Italian Ministry of Health for the diagnosis of hip fractures (ICD-9-CM codes 820–821), AMI (code 410), hemorrhagic (codes 430, 431, 432) and ischemic strokes (codes 433–434), and TIA (code 435) between 2001–2005. Cost analyses were based on diagnosis-related groups. Results The incidence of hip fractures in elderly people has increased (+12.9% between 2001 and 2005), as well as that of AMI (+20.2%) and strokes (hemorrhagic: +9.6%; ischemic: +14.7) occurring in the whole adult population; conversely, hospitalization due to TIA decreased by a rate of 13.6% between 2001 and 2005. In 2005, the hospital costs across the national health care system that were associated with hip fragility fractures in the elderly were comparable to those of strokes (both hemorrhagic and ischemic), which occurred in the whole Italian adult population. Moreover, these costs were higher than those generated by AMI and TIA. Rehabilitation costs following strokes reached about 3 billion Euros in 2005, but rehabilitative costs of hip fractures and AMI were comparable (about 530 million Euros in 2005). Conclusion The burden of hip fragility fractures in Italy is comparable to that of AMI and strokes.

Socioeconomic burden of total joint arthroplasty for symptomatic hip and knee osteoarthritis in the Italian population: a 5-year analysis based on hospitalization records

To assess the burden of total joint arthroplasties (TJAs) performed for symptomatic hip and knee osteoarthritis (OA) in the Italian population.

Is Spastic Muscle Echo Intensity Related to the Response to Botulinum Toxin Type A in Patients With Stroke? A Cohort Study

OBJECTIVE To investigate the relationship between gastrocnemius muscle echo intensity and response to botulinum toxin type A (BoNT-A) in patients with spastic equinus foot resulting from stroke. DESIGN Cohort study. SETTING University hospital. PARTICIPANTS Adult patients (N=56) with spastic equinus foot resulting from stroke scheduled to receive BoNT-A injection into the gastrocnemius muscle. INTERVENTIONS All patients were injected with BoNT-A (abobotulinumtoxinA) into the gastrocnemius muscle with an ultrasonography-guided, multisite injection technique. The toxin dose was 250U for the gastrocnemius medialis and 250U for the gastrocnemius lateralis (dilution 500U/2mL) in each patient. All patients were evaluated before and 4 weeks after BoNT-A injection. MAIN OUTCOME MEASURES Spastic gastrocnemius muscle echo intensity visually graded with the Heckmatt scale. Clinical assessment of the spastic gastrocnemius with the Modified Ashworth Scale, Tardieu Scale, and ankle passive range of motion. RESULTS Postintervention testing at 4 weeks showed overall significant improvements in the clinical assessment of the spastic gastrocnemius muscle. No significant change was observed in the echo muscle intensity of the spastic gastrocnemius after BoNT-A injection. Post hoc comparisons showed that all clinical outcomes were significantly better in those patients with echo muscle intensity of the spastic gastrocnemius graded II on the Heckmatt scale than those with grades III (P<.001) and IV (P<.001) after botulinum toxin injection. CONCLUSIONS These findings support the hypothesis that patients with higher spastic muscle echo intensity have a reduced response to BoNT-A.

Accuracy of botulinum toxin type A injection into the gastrocnemius muscle of adults with spastic equinus: manual needle placement and electrical stimulation guidance compared using ultrasonography.

OBJECTIVE To investigate the accuracy of manual needle placement and electrical stimulation guidance, compared using ultrasonography, for injection of botulinum toxin type A into the gastrocnemius muscle of adults with spastic equinus. DESIGN Prospective clinical study. SUBJECTS A total of 81 adults with stroke who were scheduled to receive botulinum toxin type A injection into the gastrocnemius muscle. METHODS After randomization into two groups, each patient was injected into two sites at each head of the gastrocnemius muscle. The manual needle placement group (n = 42) underwent injections using anatomical landmarks and palpation. The electrical stimulation guidance group (n = 39) underwent injections under electrical stimulation guidance. The accuracy of needle placement and muscle thickness at each injection site were compared by means of ultrasonography. RESULTS The overall accuracy of manual needle placement and electrical stimulation guidance, measured using ultrasonography, was significantly higher for the gastrocnemius medialis than for the lateralis (92.0% vs 79.0%). The gastrocnemius medialis was significantly thicker than the lateralis (mean 13.25 mm (standard deviation (SD) 1.86 mm) vs 10.84 mm (SD 1.52 mm). CONCLUSION Electrical stimulation guidance may be useful for injections into the gastrocnemius lateralis of adults with spastic equinus. However, neither manual needle placement nor electrical stimulation guidance showed complete accuracy, when measured using ultrasonography.

Incidence of breast cancer in Italy: mastectomies and quadrantectomies performed between 2000 and 2005.

ObjectivesWe aimed to determine the incidence of womens breast cancer in Italy without using statistical approximations.MethodsWe analyzed the national hospitalizations database at the Ministry of Health to calculate the number of major surgeries in Italian women (mastectomies and quadrantectomies) due to breast cancer between 2000 and 2005, overall and by age groups (<44, 45–64, 65–74 and ≥ 75 years old).ResultsOver the six years examined, an overall number of 100,745 mastectomies and 168,147 quadrantectomies were performed. A total of 41,608 major surgeries due to breast cancer were performed in the year 2000 and this number rose to 47,200 in 2005, with a 13.4% increase over six years.Conclusionby analyzing the hospitalizations database concerning major breast surgery, incidence of breast cancer in Italy was found to be 26.5% higher than the official estimations which have been computed using statistical models (namely 47,200 vs. 37,300 cases in year 2005).

Are dietary supplements and nutraceuticals effective for musculoskeletal health and cognitive function? A scoping review

ObjectiveThe aim of our scoping review was to summarize the state of the art regarding micronutrients in order to identify which of them might effectively improve health status in the areas typically impaired in older people: bone, skeletal muscle, and cognitive function.DesignScoping review.MethodsThe Italian Study Group on Healthy Aging by Nutraceuticals and Dietary Supplements (HANDS) performed this scoping review, based on the following steps: doing a list of micronutrients related with musculoskeletal or cognitive functions, included in dietary supplements and nutraceuticals commercialized in Italy; planning a research on PubMed, according to an evidence-based approach, in order to the most relevant positive study for each micronutrient into each of the three areas involved (bone, skeletal muscle and cognitive function); identifying the micronutrients effective in maintaining or achieving an adequate health status in older people, specifying the effective and safe daily doses, according to the selected studies.ResultsIn literature we found 12 relevant positive studies (1 international society guidelines/recommendations, 1 systematic review, 7 randomized controlled trials, and 3 prospective cohort studies). We showed that only 16 micronutrients resulted to have appropriate scientific evidences in terms of improving musculoskeletal health and/or cognitive function in older people: beta-alanine, calcium, creatine, fluorides, leucine, magnesium, omega-3 fatty acids, potassium, vitamin B6, vitamin B9, vitamin B12, vitamin C, vitamin D, vitamin E, vitamin K2, and zinc.ConclusionThis scoping review showed that selected micronutrients in adequate doses might have an ancillary role in musculoskeletal health and cognitive functions in older people.

The occurrence of acute myocardial infarction in Italy: a five-year analysis of hospital discharge records.

Background: The incidence and costs of acute myocardial infarction (AMI) in Europe represent a substantial problem due to population aging. Methods: Between 2001 and 2005, Italian hospitalization records were examined to evaluate hospital admissions and costs of AMI in adults aged ≥45 and in elderly people ≥65 or ≥75. Hospital costs were calculated on the basis of Diagnosis Related Groups (DRGs). Results: 75,586 men and 43,164 women were hospitalized because of AMI in 2005, showing respectively increases of 17.2% and 29.2% across five years. In the youngest age group (45–64), 29,925 hospitalizations in men and 6443 in women due to AMI were registered during 2005. In the subgroup of patients aged 65–74, 21,621 men and 10,145 women were hospitalized for AMI; in the oldest group (≥75) 24,040 and 26,576 hospitalizations were recorded. The increasing rates across the five examined years were 8.3% and 22.0% in the first age group, 14.3% and 17.4% in people aged 65–74, and 31.8% and 36.3% in the oldest subgroup, respectively in men and women. Among AMI patients aged ≥75, the number of women was always higher than that of men. Overall hospitalization costs due to AMI in Italy were 305 million Euros in 2001 and 370 million in 2005, with an average cost of 3115 Euros per patient in the latter year. Conclusion: Our findings confirm AMI as a leading health problem and a leading cause of health care costs.

Rehabilitative approach in patients with vertebral fragility fracture

Osteoporosis is a skeleton disease characterized by low bone mineral density and deterioration of bone tissue, resulting in an increased risk of fragility fracture. Osteoporotic vertebral fractures are recognized as a significant health problem particularly in older people with an impact on the quality of life, mobility and mortality. A well-timed diagnosis and treatment is necessary in preventing further vertebral fracture and their consequences. Exercise alone or as part of physical therapy management is often recommended as a non-pharmacological intervention. The exercise protocols, designed specifically for individuals with vertebral fracture, should include postural correction, trunk and lower extremity muscle strengthening, balance exercises and falls prevention program. The aim of this short communication is to examine the rationale of a rehabilitation protocol after a vertebral fracture.

Post-surgical rehabilitative approach to fragility fractures

Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. The most frequent sites of fragility fractures are the hip, the distal radius, the spine, the proximal humerus, and the ankle. In most cases, a surgical approach with subsequent rehabilitative treatment is required. The general aims of rehabilitation are to increase functioning and improve patients’ activities, participation level, and quality of life.

NSAIDs and opioids in management of fragility fractures

Fragility fractures and their care are a major burden on individuals, health systems, and social care systems in industrialized countries. Fragility fracture can lead to long lasting painful and disabling condition. The level of pain is a major determinant for the outcome of any treatment of these fractures regardless of its location. The treatment of pain in patient with fragility fracture is rarely considered a priority in the care pathway.