Ida Fortino

Ministry of Health, Italy, Roma, Latium, Italy

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Publications (40)118.19 Total impact

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    ABSTRACT: The aim of this study was to investigate the rate of recurrent prescriptions and hospital admissions in children receiving a brand name or generic antibiotic prescription.
    Pharmacoepidemiology and Drug Safety 06/2014; · 2.90 Impact Factor
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    ABSTRACT: To describe prescribing patterns in elderly Italian diabetic patients of the Lombardy Region in 2000 and 2010 using an administrative database. Hospital admissions and mortality were also recorded and compared in the two index years. Analyses were performed on the whole cohort of elderly diabetic patients and across age groups. Direct age standardization was done, with data from the Lombardy Region database for 2005 used as reference to compare diabetic populations in the two index years. Logistic regression models were used to analyze changes in hospital admissions and mortality and to calculate odds ratios. Using data retrieved from the Lombardy Region database we identified 176,384 and 283,982 elderly diabetic patients in 2000 and 2010, respectively. The overall rates of patients treated with antidiabetic drugs were 92.5 % in 2000 and 97.0 % in 2010. Between 2000 and 2010 the prescribing of glibenclamide declined by 30.0 % (from 52.9 to 22.9 %, p < 0.001) and that of biguanides rose by 17.4 % (from 47.5 to 64.8 %, p < 0.001). In 2010 thiazolidinediones, dipeptidyl peptidase-4 inhibitors and incretin mimetic drugs were seldom prescribed. Drugs for cardiovascular prevention rose in all age classes from 2000 to 2010, and the rates of hospital admission overall fell from 32.0 to 26.8 % (p < 0.001) during the same period, with the exception of those aged ≥85 years. Between 2000 and 2010 the mortality rate decreased in patients aged 65-74 years (from 3.4 to 2.9 %, p < 0.0001) and rose significantly in those aged ≥85 years. The drug prescription profile of elderly diabetic patients changed from 2000 to 2010, with a tendency toward recommended drugs. These changes may possibly be linked to the decrease in both hospital admissions and mortality in the diabetic group aged 65-74 years.
    European Journal of Clinical Pharmacology 05/2014; · 2.74 Impact Factor
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    ABSTRACT: To investigate the changes in the last decade (2000-2010) in drug prescribing among community-dwelling elderly people aged 65-94 years, in relation to age and sex. We analyzed the data of nearly two million subjects ranging in age from 65 to 94 years recorded in the Drug Administrative Database of the Lombardy Region (Italy) from 2000 to 2010. Associations between drug use (at least one drug, one chronic drug, polypharmacy or chronic polypharmacy) and age, sex, and year of prescription were analyzed by logistic regression analysis. We also analyzed differences in changes linked to sex and age. Between 2000 and 2010, the prescriptions of at least one drug or one chronic drug increased by 2 % (from 88.0 to 90.3 %; p < 0.0001) and 8 % (from 73.8 to 82.0 %; p < 0.0001), respectively, while the mean number of packages/person/year rose from 34.6 [standard deviation (SD) 32.4] to 48.5 (SD 42.2). During this same period, there was a 10 % increase in the prevalence of elderly people exposed to polypharmacy (≥5 different active substances) (from 42.8 to 52.7 %; p < 0.0001), and the prevalence of those exposed to chronic polypharmacy (≥5 different chronic drugs) doubled (from 14.9 to 28.5 %; p < 0.0001). Males were less frequently treated than females, except for chronic polypharmacy. People aged ≥80 years showed the largest increase in all prescribing patterns. Drug consumption in ATC groups A, H, and N (women) and in B and C (men) increased most, with the greatest absolute differences occurring in the consumption of proton pump inhibitors (31.1 %), platelet aggregation inhibitors (30.1 %), and statins (23.8 %). Prescriptions to community-dwelling elderly people have increased substantially during the last 10 years. Although this might indicate an improvement in care, the large increase in the number of elderly people exposed to polypharmacy and chronic polypharmacy should be carefully analyzed in terms of quality of care, patient safety, and costs.
    European Journal of Clinical Pharmacology 01/2014; · 2.74 Impact Factor
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    ABSTRACT: Background The impact of diabetes on cardiovascular disease in both sexes is known, but the specifics have not been fully clarified. We investigated whether sex-related differences exist in terms of management and hospitalization in patients with newly diagnosed diabetes. Methods We examined the rates of hospitalization for cardiovascular causes, mortality, treatments and management of patients with diabetes compared to subjects without, from administrative database. Interaction between sex and diabetes on clinical outcomes were calculated using a Cox regression model. Pharmacological treatments and recommended examinations by sex were calculated using logistic regression. Results From 2002 to 2006, 158,426 patients with diabetes and 314,115 subjects without were identified and followed up for a mean of 33 months (± 17.5). Diabetes confers a higher risk for all clinical outcomes. Females with diabetes have a risk profile for hospitalization for coronary heart disease comparable to males without (4.6% and 5.3%). Interaction between sex and diabetes shows that females with diabetes had an added 19% higher risk of total death (95% CI 1.13–1.24). No differences were observed in hospitalizations, although females with diabetes were less likely to undergo revascularization after myocardial infarction. Females received cardiovascular prevention drugs less frequently than males and had a slight tendency to get fewer examinations. Conclusion Diabetes is linked to a higher increase of mortality in females relative to males. This might reflect sex differences in the use of revascularization procedures or therapeutic regimens. Closer attention and implementation of standard care for females are necessary from the onset of diabetes.
    European Journal of Internal Medicine 01/2014; · 2.05 Impact Factor
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    ABSTRACT: To investigate the incidence of major cardiovascular complications and mortality in the first years of follow-up in patients with newly diagnosed diabetes. We examined incidence rates of hospitalization for cardiovascular reasons and death among new patients with diabetes using the administrative health database of the nine million inhabitants of Lombardy followed from 2002 to 2007. Age and sex-adjusted rates were calculated and hazard ratios (HR) were estimated with a matched population without diabetes of the same sex, age (±1 year) and general practitioner. There were 158,426 patients with newly diagnosed diabetes and 314,115 subjects without diabetes. Mean follow-up was 33.0 months (SD ± 17.5). 9.7% of patients with diabetes were hospitalized for cardiovascular events vs. 5.4% of subjects without diabetes; mortality rate was higher in patients with diabetes (7.7% vs. 4.4%). The estimated probability of hospitalization during the follow up was higher in patients with diabetes than in subjects without for coronary heart disease (HR 1.4, 95% CI 1.3-1.4), cerebrovascular disease (HR 1.3.95% CI 1.2-1.3), heart failure (HR 1.4, 95% CI 1.3-1.4) as was mortality (HR 1.4, 95% CI 1.4-1.4). Younger patients with diabetes had a risk of death or hospital admission for cardio-cerebrovascular events similar to subjects without diabetes ten years older. The elevated morbidity and mortality risks were clear since the onset of diabetes and rose over time. These data highlight the importance of prompt and comprehensive patients care in addition to anti-diabetic therapy in patients with newly diagnosed diabetes.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 10/2013; · 3.52 Impact Factor
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    ABSTRACT: Administrative databases have become an important tool to monitor diseases. Patients with epilepsy could be traced using disease-specific codes and prescriptions, but formal validation is required to obtain an accurate case definition. The aim of the study was to correlate administrative data on epilepsy with an independent source of patients with epilepsy in a district of Lombardy, Northern Italy, from 2000 to 2008. Data of nearly 320 600 inhabitants in the district of Lecco collected from the Drug Administrative Database of the Lombardy Region were analysed. Among them were included patients who fulfilled the International Classification of Diseases 9 (ICD-9) codes and/or the disease-specific exemption code for epilepsy and those who had at least one EEG record and took antiepileptic drugs (AEDs) as monotherapy or in variable combinations. To ascertain epilepsy cases, 11 general practitioners (GPs) with 15 728 affiliates were contacted. Multiple versions of the diagnostic algorithm were developed using different logistic regression models and all combinations of the four independent variables. Among the GP affiliates, 71 (4.5/1000) had a gold standard diagnosis of epilepsy. The best and most conservative algorithm included EEG and selected treatment schedules and identified 61/71 patients with epilepsy (sensitivity 85.9%, CI 76.0% to 92.2%) and 15 623/15 657 patients without epilepsy (specificity 99.8%,CI 99.7% to 99.8%). The positive and negative predictive values were 64.2% and 99.9%. Sensitivity (86.7%) and the positive predictive value (68.4%) increased only slightly when patients with single seizures were included. A diagnostic algorithm including EEG and selected treatment schedules is only moderately sensitive for the detection of epilepsy and seizures. These findings apply only to the Northern Italian scenario.
    Journal of epidemiology and community health 09/2013;
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    ABSTRACT: Meta-analyses have found conflicting evidence on the link between antipsychotics and cerebrovascular events (CVEs). The primary aim of this study was to evaluate the association between any antipsychotic prescription and CVEs in Italian elderly; second, to compare the effect of typical and atypical antipsychotics on CVEs; and third, to investigate the effect of antipsychotics on CVEs in the subgroup of persons coprescribed with acetylcholinesterase inhibitors (AChEIs). Administrative claims from community-dwelling people aged 65 to 94 years living in Northern Italy were analyzed using a retrospective case-control design, from 2003 to 2005. The primary outcome measure was a hospital discharge diagnosis of CVEs during 2005. Four age-, sex-, and local health unit-matched control subjects were identified for each case. Antihypertensive drugs, anticoagulants, platelet inhibitors, antidiabetic drugs, lipid-lowering drugs, and AChEI were used as covariates in conditional logistic regression models testing the odds ratio (OR) for CVEs due to antipsychotics use. Three thousand eight hundred fifty-five cases of CVEs were identified and matched with 15,420 control subjects. In multiadjusted models, the association of any antipsychotics, typical or atypical with CVEs, was not significant. When antipsychotics were categorized according to the number of boxes prescribed during the observational period, being prescribed with at least 19 boxes of typical antipsychotics was significantly associated with CVEs (OR, 2.4; 95% confidence interval, 1.08-5.5). An interaction was found between any antipsychotic and AChEI coprescription on CVEs (OR, 0.46; 95% confidence interval, 0.23-0.92). In conclusion, only typical antipsychotics were associated with an increased odd of CVEs, but the association was duration dependent. Persons prescribed simultaneously with AChEI and antipsychotics may be at a lower risk of CVEs.
    Journal of clinical psychopharmacology 06/2013; · 5.09 Impact Factor
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    ABSTRACT: PURPOSE: To compare the geographical differences in the prevalence of chronic polypharmacy in community-dwelling older people over 11 years. METHODS: This study analyzed nearly two million patients aged 65-94 years recorded in the Drug Administrative Database of the Lombardy Region (Northern Italy) from 2000 to 2010. Chronic polypharmacy was defined as taking five or more drugs in 1 month for at least 6 months (consecutive or not) in a year. RESULTS: There was a significant spatial autocorrelation that increased at the municipality level from 2000 (Moran's I Index = 0.26, z score = 16.91, p < 0.0001) to 2010 (Moran's I Index = 0.36, z score = 23.78, p < 0.0001). Clusters of high (Z(G) > 1.96) and low (Z(G) < -1.96) prevalence rates of chronic polypharmacy were found and were not influenced by age. Chronic polypharmacy weakly correlated with hospital admission (2000: ρ = 0.08, p = 0.0032; 2005: ρ = 0.11, p < 0.0001; 2010: ρ = 0.18, p < 0.0001), but not with mortality. CONCLUSIONS: There were geographical differences in the prevalence of older people with chronic polypharmacy that were only partly explained by health indicators. Targeted activities on prescription practice to ensure that the prescribing of chronic polypharmacy is appropriate are required.
    European Journal of Clinical Pharmacology 03/2013; · 2.74 Impact Factor
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    ABSTRACT: Aims. To determine the prevalence of women of childbearing age with schizophrenia and bipolar disorder exposed to antipsychotic (AP) drugs and mood stabilizers (MS) in Lombardy, a European region of 10 million inhabitants and 1 752 285 women of childbearing age. Methods. The data concerning psychiatric care, drug treatments and pregnancy outcomes were retrieved from local administrative databases during a 12-month census period. Results. During a 12-month census period, 2893 women of childbearing age with schizophrenia (74.8% of all women of childbearing age with schizophrenia) and 918 with bipolar disorder (80.1% of all women of childbearing age with bipolar disorder) were exposed to AP drugs or MS, yielding a prevalence of exposure for women with schizophrenia of 1.65 (95% confidence interval (CI) 1.59-1.71) per 1000 female inhabitants, and for women with bipolar disorder of 0.52 (95% CI 0.49-0.55) per 1000 female inhabitants. Persistent exposure to potentially teratogenic medications accounted for one in every 1000 women of childbearing age. Of the 57 pregnancies in women with schizophrenia, normal delivery was recorded in 23 (40%) cases; of the 26 pregnancies in women with bipolar disorder, normal delivery was recorded in 10 (38%) cases. Conclusions. In women of childbearing age with severe mental disorders, exposure to psychotropic drugs is substantial, which suggests that the issue of reproductive health is epidemiologically relevant and a major public health concern.
    Epidemiology and Psychiatric Sciences 02/2013; · 2.94 Impact Factor
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    ABSTRACT: Many hospitalizations for asthma could potentially be avoided with appropriate management. The aim of this study was to analyze data on disease management of a paediatric population with a hospitalization for asthma. The study population comprised 6-17 year old subjects belonging to three local health units of the Lombardy Region, northern Italy. Regional administrative databases were used to collect data on: the number of children with an incident hospitalization for asthma during the 2004-2006 period, anti-asthma therapy, specialist visit referrals, and claims for spirometry, released in the 12 months before and after hospitalization. Each patient's asthma management profile was compared with GINA guideline recommendations. Among the 183 hospitalized subjects, 101 (55%) received therapy before hospitalization and 82 (45%) did not. 10% did not receive any therapy either before or after hospital admission and in 13% the therapy was discontinued afterward. Based on GINA guidelines, asthma management adhered to recommendations only for 55% of subjects. Results may suggest that for half of hospitalized subjects, inaccurate diagnosis, under-treatment/scarce compliance with asthma guidelines by physicians, and/or scarce compliance to therapy by patients/their parents occurred. In all these cases, hospitalization would be a proxy indicator of preventable poor control of disease, rather than a proxy indicator of severity.
    PLoS ONE 01/2013; 8(10):e76439. · 3.73 Impact Factor
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    ABSTRACT: BACKGROUND: Thematic maps allow a more rapid and immediate reading of the geographical differences in the distribution of data referred to a specific territory. The aim of this study was to show, for the first time, the application of some statistical and cartographic tools in the analysis of drug utilization in the pediatric population of an Italian region, and to assess the intra-regional difference in the antibiotic prescriptions. METHODS: To assess the type of geographic distribution of the prescriptions, the analyses were based on the standardized prevalence rate (z-score) calculated at the local health unit, health district, and municipality levels. Pearson's coefficient of correlation was used to evaluate the correlation with hospitalization and the Moran's I index was used to evaluate the existence of spatial autocorrelation. With the use of Getis-Ord's G statistic, clusters of areas with high and low levels of prevalence were identified and mapped. The probability of receiving at least one prescription of antibacterials during the year for all the children included in the study was evaluated with a logistic regression model. RESULTS: With the use of the maps it was possible to see that the prescriptions were not correlated with the health status of the population, but with the tendency of the pediatrician to prescribe drugs. This was also confirmed by the logistic regression model constructed to estimate the probability of receiving at least one prescription of antibacterials considering, as independent variables: age, sex, prevalence of hospitalizations in the district of residence, prescriptive attitude of the pediatrician, sex of the pediatrician, pediatrician's age group, and duration of the pediatrician's contract with the local health unit (LHU). CONCLUSIONS: The priority actions to rationalize the use of antibacterials in the preschool age should concentrate on the active participation of the pediatricians in permanent education activities. Moreover, the competent authorities should increasing their efforts to limit unnecessary prescriptions and increase appropriateness of prescribing.
    International Journal of Health Geographics 12/2012; 11(1):52. · 2.62 Impact Factor
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    ABSTRACT: PURPOSE: To analyse, in older community-dwelling people living in Italy's Lombardy region, 8-year trends in new users of spironolactone co-prescribed with angiotensin-converting-enzyme inhibitors (ACE-Is) and/or angiotensin receptor blockers (ARBs); blood test monitoring; and independent predictors of appropriate blood test monitoring. METHODS: The region's administrative health database from 2001 to 2008 was used to retrieve yearly frequencies of subjects aged 65+ who started this co-prescription. Multivariate analyses were adjusted for age, sex, local health unit, treatment with beta-blockers, drugs for diabetes, and polypharmacy (i.e., exposure to five or more different drugs). RESULTS: Only new users of spironolactone co-prescribed with ARBs increased from 2001 to 2008 (P < 0.001). In the 6 months before starting the co-prescriptions 96 to 100% of patients measured serum creatinine (mean 99.3%), sodium (97.3%) and potassium (98.6%). Within 3 months of starting the co-prescriptions 96 to 99% of patients measured serum sodium (mean 97.3%) and potassium (98.6%), but on average only 48% of them (range 43 to 53%) measured serum creatinine, with an increase over time (odds ratio [change in regression per year] = 1.03, 95% CI 1.02-1.05, P < 0.001). At multivariate analysis polypharmacy was found to be the only independent predictor of such creatinine monitoring (P < 0.001). CONCLUSIONS: Our results support the need for greater awareness within the medical community of the potential renal toxicity of the association of spironolactone with ACE-Is and/or ARBs. Adequate short-term monitoring of serum creatinine in all older community-dwelling people who receive such co-prescription is necessary in order to ensure safe usage of these medications.
    European Journal of Clinical Pharmacology 09/2012; · 2.74 Impact Factor
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    ABSTRACT: To estimate how many asthmatic children underwent spirometry testing in one year in a large Italian region, and evaluate sociodemographic determinants. Data were retrieved from the administrative databases that store all pharmacological and diagnostic prescriptions issued to individuals living in the Lombardy Region. The analysis involved prescriptions dispensed to all 6-17 year olds (1,047,241 subjects) during 2008. Youths were identified as asthmatics by a previously validated strategy. Number of subjects having ≥1 spirometry claims was calculated, and factors associated with the probability of undergoing spirometry were evaluated by multivariate analysis. A total of 40,528 (3.9%) asthmatic subjects were identified. Only 30% of them underwent ≥1 spirometry during 2008, with differences between local health units (range 22-45%) and degree of anti-asthmatic use (26-35%). Moreover, in a multivariate analysis, the chance of undergoing spirometry was greater in boys than in girls (OR=2.3). A low percentage of asthmatic children, especially girls (who are more at risk of developing severe disease in adulthood), underwent spirometry during 1-year period. This highlights a low compliance with guidelines in the monitoring of childhood asthma. Educational intervention is needed in order to encourage use of spirometry in primary care settings.
    Respiratory medicine 06/2012; 106(10):1383-8. · 2.33 Impact Factor
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    ABSTRACT: PURPOSE: The aim of this study was to measure persistence with pharmacological treatment in the specialist mental healthcare of patients with schizophrenia, bipolar disorder, and unipolar depression in Lombardy, a region of 10 million inhabitants located in the northernmost part of Italy. METHODS: The data concerning psychiatric care used in this study were retrieved from the regional Psychiatric Information System, while information on drug treatment was retrieved from the regional administrative database. Time to lack of persistence with initial pharmacological treatment was the outcome measure. RESULTS: A total of 11,797 patients, followed in the specialist mental healthcare system, started a new pharmacological treatment for depression, schizophrenia, or bipolar disorder during 2007. Overall, 8,500 patients (72.1%) discontinued treatment during the 12 month follow-up, with a median duration of 101 days. Very similar discontinuation rates were observed in patients with unipolar depression, schizophrenia, and bipolar disorder. In the multivariate analysis, operational definitions of continuity and intensity of care were the most robust determinants of persistence with drug treatment in each of the three cohorts of psychiatric diagnoses. CONCLUSIONS: High rates of treatment discontinuation were found in a population of patients with severe mental disorders followed in the specialist mental healthcare system of an Italian region, with no differences among patients with unipolar major depression, schizophrenia, and bipolar disorder. These findings corroborate the notion that the problem of treatment discontinuation in psychiatric disorders is a factor related to the capacity of the mental health system to assure and maintain continuity and intensity of care.
    European Journal of Clinical Pharmacology 05/2012; · 2.74 Impact Factor
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    ABSTRACT: In order to estimate the burden of mental disorders in a representative Italian pediatric population, an epidemiological study was performed using three administrative databases: a drug prescription, a hospital discharge form, and an outpatient ambulatory visit database. The population target was 1,616,268 children and adolescents under 18 years living in the Lombardy Region, Italy. A youth was defined as a case if during 2008 he/she received at least one psychotropic drug prescription or was hospitalized for a psychiatric disorder (International Classification of Disease codes 290-319), or attended a child neuropsychiatric outpatient unit for a visit and/or a psychological intervention or rehabilitation at least once. Epileptic children were excluded. In all, 63,550 youths (39.3 per 1000; 95%CI 39.1-39.7‰) were identified as users of health care resources for a putative mental disorder. The prevalence was higher in boys than in girls (47.0‰ versus 31.3‰) and the highest value was recorded in children 8 years old (60.2‰). A total of 59,987 youths (37.1‰) attended a child and adolescent neuropsychiatry service at least once, 3605 (2.2‰) were admitted to hospital, and 2761 (1.7‰) received at least one psychotropic drug prescription, 57% of which did not attend a child neuropsychiatry service. In all, 14,741 youths (23.1% of users) had a disorder that required a high intensity of care (e.g. recurrent prescriptions for drugs and/or ambulatory care). The proportion of youths who received care for mental disorders in the Lombardy Region seems lower than in other countries. However, the fact that many children were prescribed psychotropic drugs without the supervision of a child psychiatrist is a reason for concern.
    European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 05/2012; · 3.68 Impact Factor
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    ABSTRACT: OBJECTIVE To compare the use of reboxetine with that of fluoxetine and paroxetine in terms of prescription trends and rates of prolonged and persistent use from 2000 to 2006. Secondarily, to compare the prescription trends of reboxetine with those of mirtazapine, another newer antidepressant with a similar approval background. DESIGN Retrospective analysis of population-based prescription data. All data were drawn from the regional drug administrative Lombardy database (Italy). After obtaining the authorization by the Regional Health Ministry, data were managed and analyzed using an anonymous patient code. The dataset contained all prescription records for 1 704 923 inhabitants of three administrative provinces from January 1, 2000 to December 31, 2007. Mai outcome measures: prevalent and incident use of the study antidepressants were analysed. The proportion of prolonged to occasional use and of persistence to non-persistence among reboxetine, fluoxetine and paroxetine users were compared. RESULTS A mean of 211 883 subjects per year were prescribed and dispensed one of the study drugs across the study period. The rise in the prescriptions of paroxetine and fluoxetine from 2000 to 2006 was dramatic: from 0.42% to 1.16% and from 0.18% to 0.39%, respectively. The prescripition rates of mirtazapine gradually increased all through the study period: from 0.07% in 2000 to 0.13% in 2006. On the contrary, the prescription rates of reboxetine progressively decreased from 0.20% in 2000 to 0.04% in 2006. The overall proportion of prolonged to occasional use was significantly lower for reboxetine (42%) than for paroxetine (57%; OR 0.55, 95% IC 0.53-0.57, p<0.001) and fluoxetine (58%; OR 0.53, 95% IC 0.51-0.55, p<0.001). Similarly, the overall proportion of persistence to non-persistence was significantly lower for reboxetine (23%) than for paroxetine (34%; OR 1.67, 95% IC 1.56-1.79, p<0.001) and fluoxetine (36%; OR 1.89, 95% IC 1.76-2.03). CONCLUSIONS In years 2000-2006 reboxetine showed a progressive decrease in prescription rates and was associated with worse treatment retention than paroxetine and fluoxetine. We can hypothesize that the higher discontinuation rates of reboxetine have affected its perception as a poorly effective antidepressant and that this resulted in the decline of its prescriptions. WHAT IS ALREADY KNOWN ON THIS TOPIC - In a recent meta-analysis, the previously favourable evidence on the risk-benefit profile of reboxetine was overturned by the addition of unpublished data. This typical effect of publication bias was highlighted in other research on antidepressants and could have prompted unwitting clinicians to prescribe those drugs too easily in recent past. - Antidepressant prescribing doubled in Europe over the last two decades, and within this rise SSRI utilisation increased tenfold. - With its small share of the overall amount of antidepressants prescribed, reboxetine seems to be an exception. WHAT THIS STUDY ADDS - While the prescribing of paroxetine, fluoxetine, and mirtazapine increased in years 2000-2006, the prescribing of reboxetine decreased. - The declining use of reboxetine was evident both in terms of prevalence and incidence. Reboxetine was associated with lower rates of prolonged and persistent use than fluoxetine and paroxetine. Those differences could be explained by clinicians’ perception of reboxetine ineffectiveness.
    Journal of clinical psychopharmacology 04/2012; 32(2):303-5. · 5.09 Impact Factor
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    ABSTRACT: The objective of the study was to assess the trend of antipsychotic prescription in elderly patients taking cholinesterase inhibitors (ChEIs) from 2002 to 2008 and the changes subsequent to two main official warnings issued by the Italian Medicines Agency to restrict their use. Elderly patients aged 65-94years who received at least one prescription of ChEIs between 1 January 2002 and 31 December 2008 were selected. We used data on prescriptions from the Lombardy Region Drug Administrative Database (Italy). The first prescription of one ChEI was used as the index day to calculate the prescription of an antipsychotic. The prescription of atypical antipsychotics in patients exposed to ChEIs declined from 21.0% in 2002 to 14.6% in 2008 (OR 0.92; 95%CI:0.90, 0.94; p<0.001), while the prescribing prevalence of typicals slightly increased (OR 1.08; 95%CI:1.03, 1.13; p=0.001). In relation to the two warnings, the prevalence of patients who received a prescription of antipsychotics was significantly lower in 2005 than 2004 (23.1% vs. 28.0%; OR 0.79; 95%CI:0.73-0.86; p<0.001) and in 2007 than 2006 (19.4% vs. 23.0%; OR 0.79; 95%CI:0.73-0.86; p<0.001). After the first safety warning the prevalence of prescriptions for risperidone and olanzapine dropped significantly, and there was a significant increase for quetiapine. Haloperidol prescriptions increased, especially after the second warning. Despite regulatory warnings issued to discourage the use of antipsychotics, they are still frequently prescribed to patients taking ChEIs. Awaiting further studies to clarify their therapeutic role, physicians should prescribe antipsychotics very cautiously and only after careful risk-benefit assessment.
    European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 01/2012; 22(8):569-77. · 3.68 Impact Factor
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    ABSTRACT: To describe trends in diagnosed diabetes prevalence, incidence and mortality from 2000 to 2007 in the most heavily populated Italian region. We examined the prevalence and incidence rates of Type 1 and Type 2 diabetes and yearly mortality rates among individuals with diabetes from 2000 to 2007 using an administrative health database of prescription, disease-specific exemption and hospitalization records of more than 9 million inhabitants of Lombardy. Age- and sex-specific rates were calculated and temporal trends for subjects aged ≥ 30 years were analysed. The crude point diabetes prevalence rose from 3.0% in 2000 to 4.2% in 2007, a 40% increase. The incidence remained stable during the study period with a rate of 4/1000 per year. Overall mortality declined from 43.2/1000 in 2001 to 40.3/1000 in 2007 (6.7% decrease) at a rate slightly higher than that of the general population (4.8% decrease). Our projection in subjects aged ≥ 30 years indicates that the prevalence will rise continuously over the next years, reaching 11.1% in 2030. The prevalence of diabetes increased substantially between 2000 and 2007, mainly because there are more patients with a new diagnosis each year than those who die. The increase observed by 2007 almost reached the World Health Organization prediction for 2030. Our analyses suggest that the increase will continue over the next few decades. These data are important for defining the burden of diabetes in the near future, to help in planning health services and ensure proper allocation of resources.
    Diabetic Medicine 09/2011; 29(3):385-92. · 3.24 Impact Factor

Publication Stats

244 Citations
118.19 Total Impact Points

Institutions

  • 2009–2014
    • Ministry of Health, Italy
      Roma, Latium, Italy
  • 2008–2013
    • Mario Negri Institute for Pharmacological Research
      • • Laboratory of Quality Assessment of Geriatric Therapies and Services
      • • Department of Public Health
      • • Laboratory of Mother and Child Health
      Milano, Lombardy, Italy
  • 2005
    • University of Verona
      • Department of Public Health and Community Medicine
      Verona, Veneto, Italy