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Sistemi di sorveglianza

  • Antonia Stazi1

  1. Istituto superiore di sanità, Roma

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Ricerca bibliografica periodo dal 1 gennaio 2012 al 15 marzo 2012

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Stringa: (((("sentinel surveillance"[MeSH Terms] OR "behavioral risk factor surveillance system"[MeSH Terms]) OR "population surveillance"[MeSH Terms]) OR "surveillance system*"[All Fields]) OR "surveillance program*"[All Fields]) AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2012/01/01"[PDAT] : "2012/03/15"[PDAT])
1. Gigantesco A, Lega I, Picardi A; the SEME Collaborative Group# The Italian SEME Surveillance System of Severe Mental Disorders Presenting to Community Mental Health Services. Clin Pract Epidemiol Ment Health. 2012;8:7-11. Epub 2012 Feb 24.
Mental Health Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy.

Abstract
Mental health is recognized worldwide as a major public health priority for the twenty-first century. Different actions are needed, including developing or strengthening national mental health information systems, based on standardized indicators that allow national and international monitoring. In 2008, the national Centre for Disease prevention and Control of the Italian Ministry of Health and the Mental Health Unit of the Italian National Institute of Health (INIH) jointly launched a mental health information system named SEME (an Italian acronym meaning 'mental health epidemiological surveillance') based upon data collected from trained psychiatrists working in 22 selected sentinel community mental health centers distributed across Italy and covering a total population of 1,941,853 inhabitants, in order to collect and report site-level information on first -contact patients suffering from specific severe mental disorders (schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, bipolar I disorder, anorexia nervosa, major depressive episode with psychotic symptoms or suicide attempt). Strengths of the system are the high reliability of diagnoses and the use of a web-based technique for data collection with data entry forms designed for ease of completion. During the first year of implementation of this system, a total of 343 first-contact patients met criteria for one of the severe mental disorders under surveillance. As the system includes standardized instruments to measure psychiatric symptoms and psychosocial functioning, it may facilitate health services research based on longitudinal measurements aimed at evaluating the continuity of psychiatric care and the effectiveness of innovative therapeutic and rehabilitative programs.

Breve commento a cura di A. Stazi
I primi risultati del progetto SEME (Sorveglianza Epidemiologica integrata in salute MEntale) sono stati pubblicati in Clinical Practice Epidemiology and Mental Health. Si tratta di un sistema di sorveglianza sperimentale su disturbi mentali gravi basato su 22 centri clinici sentinella, con una copertura del 3% della popolazione adulta residente in Italia. La comprensione a livello nazionale dell’epidemiologia dei disturbi mentali e dei fattori psicosociali ad essi associati è tra gli obiettivi prioritari dell’Organizzazione Mondiale della Sanità. Per il nostro Paese questa è la prima esperienza di sorveglianza nazionale che, con una procedura diagnostica standardizzata, raccoglie e processa informazioni relative a pazienti affetti da disturbi gravi (principali disturbi psicotici, disturbo bipolare I, depressione maggiore con sintomi psicotici, anoressia nervosa), che giungono per la prima volta all’osservazione di un servizio di salute mentale pubblico. Il sistema rileva informazioni che riguardano numerosi aspetti della storia del paziente, con particolare riferimento alla sua dimensione sociale. Tra i dati emersi nel primo anno di sorveglianza, oltre alla condizione di generale disagio sociale dei pazienti (il 40% è disoccupato, l’87% vive in difficoltà economiche moderatamente gravi o gravi )che potrebbero indicare una selezione degli utilizzatori del servizio pubblico in questo tipo di patologie, desta particolare interesse il gap temporale tra la comparsa dei primi sintomi dei disturbi e il ricorso ai servizi da parte dei pazienti ai servizi di salute mentale (4 anni in mediana). Siamo d’accordo con gli autori che osservano che una presa in carico precoce dei disturbi mentali gravi potrebbe con buona probabilità migliorare la prognosi e l’adattamento sociale. SEME nasce dal CCM. Ci si augura che da seme diventi un frutto del sistema sanitario.

2.Longo UG, Loppini M, Berton A, Marinozzi A, Maffulli N, Denaro V. The FIFA 11+ Program Is Effective in Preventing Injuries in Elite Male Basketball Players: A Cluster Randomized Controlled Trial. Am J Sports Med. 2012 Mar 13. [Epub ahead of print]
Dipartimento di Ortopedia e Traumatologia, Università Campus Bio-Medico di Roma, Rome, Italy.

Abstract
BACKGROUND: Recently, structured training programs for sports injury prevention ("The 11" and "The 11+") have been validated in soccer. The FIFA 11+ program has not been evaluated in basketball. HYPOTHESIS: The FIFA 11+ program is effective in reducing the rates of injury in male basketball players. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: The authors randomized 11 teams of the same club. Seven teams were allocated to the intervention group (80 players; mean [SD] age 13.5 [2.3] years), and 4 teams were allocated to the control group (41 players; mean [SD] age 15.2 [4.6] years). The authors conducted an injury surveillance program during a 9-month season. The primary outcome was any injury to the athletes. The secondary outcome was any injury to the lower extremity (foot, ankle, lower leg, knee, thigh, groin, and hip). They included an analysis of the type of exposure (match or training), injury location in the body, and type of injury (acute or overuse). RESULTS: During the 9-month season, 23 (19%) of the 121 players included in the study sustained a total of 31 injuries (14 in the intervention group and 17 in the control group). In the intervention group, injury rates per 1000 athlete-exposures were lower than those in the control group, with statistical significance, for overall injuries (0.95 vs 2.16; P = .0004), training injuries (0.14 vs 0.76; P = .007), lower extremity injuries (0.68 vs 1.4; P = .022), acute injuries (0.61 vs 1.91; P < .0001), and severe injuries (0 vs 0.51; P = .004). The intervention group also had statistically significant lower injury rates for trunk (0.07 vs 0.51; P = .013), leg (0 vs 0.38; P = .007), and hip and groin (0 vs 0.25; P = .023) compared with the control group. There was no statistically significant difference in match injuries, knee injuries, ankle injuries, and overuse injuries between 2 groups. The most frequent acute injury diagnoses were ligament sprains (0.41 and 0.38 in the intervention and control groups, respectively; P < .006) and contractures (0.76 and 0.07 in the control and intervention groups, respectively; P < .003). CONCLUSION: The FIFA 11+ warm-up program is effective in reducing the rates of injuries in elite male basketball players.

3. Curzio O, Tilli A, Mezzasalma L, Scalese M, Fortunato L, Potente R, Guidoni G, Molinaro S. Characteristics of Alcoholics Attending 'Clubs of Alcoholics in Treatment' in Italy: A National Survey. Alcohol Alcohol. 2012 Feb 23. [Epub ahead of print]
Institute of Clinical Physiology, Italian National Research Council (IFC-CNR), Via Moruzzi 1, Pisa 56124, Italy.

Abstract
AIMS: To provide an overview of alcoholics attending a socio-ecological treatment programme [Clubs of Alcoholics in Treatment (CATs)] and to identify factors associated with abstinence and self- perceived improvement in lifestyle. METHODS: A national sample of 7522 subjects (76% males and 24% females, mean age 53.2 ± 11.3 years ± SD) attending CATs was evaluated using a self-administered questionnaire completed at a weekly meeting in 2006. RESULTS: Of participants, >70% reported no alcohol use in the last year and around 90% indicated no use in the previous month, whereas 4% of them declared no alcohol use before club attendance. Abstinence and lifestyle improvement were related positively to the number of years of club attendance but negatively to the presence of other problems in addition to the alcohol-related one. Moreover, being older or female was associated with more likely achievement of abstinence as well as with the perception of a better lifestyle. Finally, attending the club with one or more family members was associated with achievement of better lifestyle. Conclusion: These data provide an overview of alcoholics attending the CAT programme and are a first step toward developing a surveillance system. In addition, on the basis of this preliminary picture further research (notably longitudinal studies) can be planned considering this method and its effectiveness.

4. Bena A, Leombruni R, Giraudo M, Costa G. A new Italian surveillance system for occupational injuries: Characteristics and initial results. Am J Ind Med. 2012 Feb 21. doi: 10.1002/ajim.22025. [Epub ahead of print]
Department of Epidemiology, ASL TO3 Grugliasco, Turin, Italy. antonella.bena@epi.piemonte.it.

Abstract
BACKGROUND: Occupational injuries research and surveillance is important for prevention and public health protection. A new occupational surveillance system based on linkage of work histories calculated from the Italian National Social Security Institute (INPS) and occupational injuries provided by the National Insurance Institute for Occupational Injuries (INAIL) was created and assessed. METHODS: It has been extracted a 1% sample of individuals from INPS. For each subject, a detailed description of the career has been compiled between 1985 and 2004, and matched on an individual basis to work injuries between 1994 and 2003. It has been calculated injury rates and risks by economic activity, gender, age, job tenure, country of birth, and firm size. RESULTS: The linkage success is very high both in engineering than in the construction sector. The comparison with Eurostat statistics is very positive. The injury risks calculated by job tenure, country of birth, and firm size are consistent with literature. The high injury rate for short work contracts remain unvaried also after controlling by age. CONCLUSIONS: It is finally possible to describe injuries based on some main characteristics of the recent changes in the labor market, such as precarization, ageing of workers, migration, that databases currently available in Italy do not allow. The sample is longitudinal and can contribute to describing the development of the phenomena over time. The Ministry of Health is completing procedures to extend the sample and to increase the health outcomes for which a follow-up is available.

5. Cattaneo C, Antoniazzi F, Casari S, Ravizzola G, Gelmi M, Pagani C, D'Adda M, Morello E, Re A, Borlenghi E, Manca N, Rossi G. P. aeruginosa bloodstream infections among hematological patients: an old or new question? Ann Hematol. 2012 Feb 15. [Epub ahead of print]
Dept. of Haematology, Spedali Civili, Piazza Spedali Civili, 25100, Brescia, Italy, chiara.cattaneo@libero.it.

Abstract
Pseudomonas aeruginosa is a well-known cause of severe and potentially life-threatening infections among hematological patients. A prospective epidemiological surveillance program ongoing at our Hematology Unit revealed an increase over time of P. aeruginosa bloodstream infections (BSI). Their impact on outcome and antibiotic susceptibility was analyzed. BSI which consecutively occurred at our institution during a 70-month period were evaluated and correlated with type of pathogen, status of underlying disease, neutropenia, previous antibiotic therapy, resistance to antibiotics, and outcome. During the observation period, 441 BSI were recorded. Frequency of Gram-negative BSI was higher than that of other pathogens (57.3%). Overall, 66 P. aeruginosa BSI were recorded; 22 out of 66 were multiresistant (MR P. aeruginosa). Thirty-day mortality for all BSI was 11.3%; it was 27.3% for P. aeruginosa BSI and 36.4% for MR P. aeruginosa. At multivariate analysis, only active hematological disease and P. aeruginosa BSI were associated to an increased risk of death. For MR P. aeruginosa, BSI mortality was 83.3% vs. 18.8% when empiric therapy included or not an antibiotic with in vitro activity against P. aeruginosa (p = 0.011). Together with active disease, the emergence of P. aeruginosa BSI, particularly if multiresistant, was responsible for an increased risk of death among hematological patients at our institution. In this scenario, reconsidering the type of combination antibiotic therapy to be used as empiric treatment of neutropenic fever was worthwhile.

6. Pulli R, Dorigo W, Fargion A, Pratesi G, Innocenti AA, Angiletta D, Pratesi C. Comparison of Early and Midterm Results of Open and Endovascular Treatment of Popliteal Artery Aneurysms. Ann Vasc Surg. 2012 Feb 8. [Epub ahead of print]
Department of Vascular Surgery, University of Florence, Florence, Italy.

Abstract
BACKGROUND: Aim of this study was to retrospectively compare perioperative (<30 days) and 2-year results of open and endovascular management of popliteal artery aneurysms (PAAs) in a single-center experience. METHODS: From January 2005 to December 2010, 64 PAAs in 59 consecutive patients were operated on at our institution; in 43 cases, open repair was performed (group 1), whereas the remaining 21 cases had an endovascular procedure (group 2). Data from all the interventions were prospectively collected in a dedicated database, which included main preoperative, intraoperative, and postoperative parameters. Early results in terms of mortality, graft thrombosis, and amputation rates were analyzed and compared by χ(2) text or Fisher exact text. The surveillance program consisted of clinical and ultrasonographic examinations at 1, 6, and 12 months and yearly thereafter. Follow-up results (survival, primary and secondary patency, limb salvage) were analyzed by Kaplan-Meier curves, and differences in the two groups were assessed by log-rank test. RESULTS: There were no differences between the two groups in terms of sex, age, risk factors for atherosclerosis, and comorbidities; PAAs were symptomatic in 48% of cases in group 1 and in 29% in group 2 (P = 0.1). Fifteen patients with mild-to-moderate acute ischemia due to PAA thrombosis underwent preoperative intra-arterial thrombolysis, 13 in group 1 and 2 in group 2. In open surgery group, nine cases were treated with aneurysmectomy and prosthetic graft interposition, and in seven cases, the aneurysm was opened and a prosthetic graft was placed inside the aneurysm. In 27 cases, ligation of the aneurysm with bypass grafting (21 prosthetic grafts and 6 autologous veins) was carried out. In group 2, 20 patients had endoprosthesis placement, whereas in the remaining patient, a multilayer nitinol stent was used. There was one perioperative death in a patient of group 2 who underwent concomitant endovascular aneurysm repair and PAA endografting. Cumulative 30-day death and amputation rate was 4.5% in group 1 and 4.7% in group 2 (P = 0.9). Follow-up was available in 61 interventions (96%) with a mean follow-up period of 22.5 months (range: 1-60). Estimated primary patency rates at 24 months were 78.1% in group 1 and 59.4% in group 2 (P = 0.1). Freedom from reintervention rates at 24 months were 79% in group 1 and 61.5% in group 2 (P = 0.2); estimated 24-month secondary patency rates were 81.6% in group 1 and 78.4% in group 2 (P = 0.9), and freedom from amputation rates were 92.7% and 95%, respectively (P = 0.7). CONCLUSIONS: Endovascular treatment of PAAs provided, in our initial experience, satisfactory perioperative and 1-year results, not significantly different from those obtained with prosthetic open repair in patients with similar clinical and anatomical status. There is, however, a trend toward poorer primary patency rates among patients endovascularly treated, who also seem to require more frequently a reintervention.

7.[No authors listed] Abstracts presented at the 7th World Alliance for Risk Factor Surveillance (WARFS) Global Conference. October 16-19, 2011. Toronto, Ontario, Canada. Chronic Dis Inj Can. 2012;32 Suppl 1. pii: 1.

Abstract
The 7th World Alliance for Risk Factor Surveillance (WARFS) Global Conference, hosted by the Public Health Agency of Canada, was held in Toronto, Ontario, Canada, from October 16 to 19, 2011. Previous WARFS conferences were held in USA (1999), Finland (2001), Australia (2003), Uruguay (2005) and Italy (2007, 2009). WARFS is a global working group on surveillance under the International Union for Health Promotion and Education (IUHPE) It supports the development of risk factor surveillance as a tool for evidence-based public health, acknowledging the importance of this source of information to inform, monitor and evaluate disease prevention and health promotion policies and programs. The theme of the 2011 Global Conference was the role of surveillance in the promotion of health. The Global Conference had 146 registered participants, making it the second most attended WARFS conference in its history. Over the three days, participants attended oral and poster presentations from 30 countries. The conference would not have been possible without the hard work of the International Scientific Committee and the Local Organizing Committee. To highlight the importance and the significance of this conference at an international level, Chronic Diseases and Injuries in Canada (CDIC) is pleased to publish this supplementary issue, which contains 70 abstracts presented at the 7th WARFS Global Conference. In the spirit the Global Conference, this collection of abstracts brings together surveillance material on risk factors, chronic diseases, infectious diseases and injuries from around the world. By making these abstracts widely available, CDIC hopes to further the conference objectives through a continued dialogue between those interested in linking risk factor surveillance to health promotion.

8. Leonardi G, Marchi S, Falconi M, Zerbi A, Ussia V, de Bortoli N, Mosca F, Presciuttini S, Del Chiaro M. "PancPro" as a tool for selecting families eligible for pancreatic cancer screening: An Italian study of incident cases. Dig Liver Dis. 2012 Jan 24. [Epub ahead of print]
Gastroenterology Unit, Pisa University Hospital, Italy.

Abstract
BACKGROUND: PancPRO is a computer program that estimates the risk of pancreatic cancer for asymptomatic individuals based on a genetic model of susceptibility and the familial incidence of cancer. AIM: To evaluate the distribution of the familial risk in a series of incident cases of pancreatic adenocarcinoma. MATERIALS AND METHODS: The lifetime risk of pancreatic cancer was calculated by PancPro for a hypothetical 40-year-old son of 570 consecutive probands with pancreatic cancer. RESULTS: The 570 risk values were included between 1% and 13%. The distribution was bimodal, with the antimode located at risk=7.5%. Considering a 10-fold risk over the general population as a threshold for including a subject in a surveillance program, 19 families (3.3%) would be selected, totalling 92 first-degree relatives with age >40 years. CONCLUSIONS: PancPro is a valid instrument to rank families based on risk of pancreatic cancer.

9. Renault P, Balleydier E, D'Ortenzio E, Bâville M, Filleul L. Epidemiology of chikungunya infection on Reunion Island, Mayotte, and neighboring countries. Med Mal Infect. 2012 Jan 24. [Epub ahead of print]
Cellule de l'Institut de veille sanitaire en région (Cire Océan Indien, InVS), 2 bis, avenue G.- Brassens, CS 60050, 97408 Saint-Denis cedex 9, Reunion.

Abstract
Since 2004, the frequency of chikungunya virus infections has been increasing in Africa, Indian Ocean islands, and Asia. The epidemic began on the Kenyan coast, and reached the Comoros at the end of 2004 before spreading to the South-western Indian Ocean islands (SWIOI) in 2005 and especially in 2006. The epidemic then spread to Asia where epidemic foci are still active today. This increase also affected temperate zone countries where imported cases were reported, and indigenous transmission was reported in Italy in 2007, and in France (Var) in 2010. This review provides an update on the knowledge gained from monitoring chikungunya infections in SWIOI. Despite significant differences in design and performance, the implementation of surveillance systems has allowed describing the evolution of epidemic waves in the affected areas. Synchronous epidemic waves were observed in SWIOI, despite the differences between the preventive measures locally implemented. Between 2005 and 2007, all SWIOI were in inter-epidemic situation, except for Madagascar where a persistent virus circulation in an endemic-epidemic pattern was observed. In 2009, and in 2010, two moderate indigenous outbreaks were identified on the Reunion Island by the inter-epidemic surveillance system. Strains analyses demonstrated a reintroduction of the virus from Madagascar. These limited outbreaks should be a reminder of the vulnerability of SWIOI to arbovirosis, since the entomological indexes for competent vectors are high and the virus keeps on circulating more or less actively in the area.

10. Franchini M, Makris M, Santagostino E, Coppola A, Mannucci PM. Non-thrombotic-, non-inhibitor-associated adverse reactions to coagulation factor concentrates for treatment of patients with hemophilia and von Willebrand's disease: a systematic review of prospective studies. Haemophilia. 2012 Jan 18. doi: 10.1111/j.1365-2516.2011.02745.x. [Epub ahead of print]
Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy Department of Cardiovascular Science, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK A. Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Cà Granda Foundation Maggiore Hospital, Milan Regional Reference Center for Coagulation Disorders, Federico II University Hospital, Naples Scientific Direction, IRCCS Cà Granda Foundation Maggiore Hospital, Milan, Italy.

Abstract
In the last three decades there have been dramatic improvements in the availability and quality of treatment for people with inherited coagulation disorders. Indeed, the improvement of methods of purification and viral inactivation for plasma-derived coagulation factor concentrates first and then the development of products utilizing recombinant DNA technology have greatly improved the life expectancy of hemophiliacs, which has progressively become similar to that of males in the general population. Nowadays, the most frequent complication of factor replacement therapy for hemophilia is the development of inhibitors. However, no studies so far have systematically analysed the type and incidence of other adverse reactions following the administration of coagulation factor concentrates. The aim of this systematic review was to screen the published literature data to evaluate the types and frequencies of non-thrombotic-, non-inhibitor-associated adverse reactions to coagulation factor concentrates in patients with hemophilia A, hemophilia B and von Willebrand's disease. On behalf the European Haemophilia Safety Surveillance System (EUHASS), a systematic review of the prospective studies published in the last 20 years was performed using electronic databases and article references. Both severe and mild adverse events following infusion of coagulation factor concentrates are relatively rare in patients with inherited coagulation disorders; the most common events are of an allergic type. There are no differences in the rate of adverse events caused by plasma-derived or recombinant products. On the whole, these data confirm the high degree of safety of the products currently used for replacement therapy.

11. Andronache AS, Alvarez AS, Ajovalasit D, Cerniauskaite M, Koutsogeorgou E, Quintas R, Leonardi M. Analysis of general population surveys with regard to comparable estimates of disability and its correlates across selected European surveys. Am J Phys Med Rehabil. 2012 Feb;91(13 Suppl 1):S141-5.
Neuroradiology Unit, Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy.

Abstract
This article presents a methodology developed by the Multidisciplinary Research on Health and Disability in Europe project researchers for the retrieval of information about disability using the conceptual framework of the International Classification of Functioning, Disability and Health. A comprehensive review and analysis of European surveys was performed and it is presented here briefly. Recommendations and guidelines for future statistical studies and development of disability surveys are provided. The methodology proposed shows the utility and feasibility of the ICF in research.

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