Valorisation of residues from municipal wastewater sieving through anaerobic (co-)digestion with biological sludge.

The Circular and Green Economy principles is inspiring new approaches to municipal wastewater treatment plants (MWWTPs) design and operation. Recently, an ever-growing interest is devoted to exploring the alternatives for switching the WWTPs from being able to 'simply' removing contaminants from water to biorefinery-like plants where energy and material can be recovered. In this perspective, both wastewater and residues from process can be valorised for recovering nutrients (N and P), producing value added products (i.

A simple informative intervention in primary care increases statin adherence.

Purpose: To assess the effectiveness of an informative intervention on general practitioners aimed at improving patients' adherence to statin therapy.

Methods: In the local health unit (LHU) of Bergamo, Lombardy (Italy), each general practitioner received a synthetic scientific document on dyslipidaemia and statins and aggregated data on adherence in 2006 for his/her patients compared to the means in the LHU and in his/her working district. Furthermore, a sample of seven districts received also a table of adherence levels for single patients.

[Patients with heart failure in the last year of their life: the primary care perspective].

Background: The care of end-stage patients with heart failure (HF) represents a substantial cost and a relevant workload for health professionals and caregivers. Studies performed in out-of-hospital settings are limited. We aimed to provide data about management in primary care and professional needs of general practitioners (GPs).

Why is my hypertensive patient still not controlled?

Unlabelled: Despite the well-known obstacles to blood pressure (BP) control, significant improvement can be obtained. Unfortunately more than a third of hypertensive patients remain non-controlled even after improving initiatives. We asked a group of General Practitioners (GPs) why their patients failed to reach the target despite their efforts.

A multidisciplinary consensus document on follow-up strategies for patients treated with percutaneous coronary intervention.

The number of percutaneous coronary interventions (PCI) is increasing worldwide. Follow-up strategies after PCI are extremely heterogeneous and can greatly affect the cost of medical care. Of note, clinical evaluations and non-invasive exams are often performed to low risk patients.

Global cardiovascular risk evaluation: pattern of algorithm use and risk modification in 'real life'.

Aims: Although calculation of the global cardiovascular risk is strongly recommended, limited data are available regarding the use and the utility of this tool in clinical practice. We aimed at answering the following questions in the setting of Italian general practice: how many patients are evaluated via the cardiovascular risk algorithm; what are their characteristics; and what happens after their evaluation.

Methods: We used the Health Search/CSD Longitudinal Patient Database.

Assessment and potential determinants of compliance and persistence to antiosteoporosis therapy in Italy.

Objectives: To analyze adherence to antiosteoporosis drugs (AODs) and to assess the influence of patient-related and drug-related factors.

Study Design: Observational, retrospective study.

Methods: Data on prescriptions for AODs from 2007 through 2008 were retrieved from administrative databases of 10 Italian local health units.

Effects of a computerized decision support system in improving pharmacological management in high-risk cardiovascular patients: A cluster-randomized open-label controlled trial.

Unlabelled: This study was aimed to investigate the effects of computerized decision support system in improving the prescription of drugs for cardiovascular prevention. A total of 197 Italian general practitioners were randomly allocated to receive either the alerting computerized decision support system integrated into standard software (intervention arm) or the standard software alone (control arm). Data on 21230 patients with diabetes, 3956 with acute myocardial infarction, and 2158 with stroke were analysed.

[Screening of asymptomatic left ventricular systolic dysfunction in a population sample at high cardiovascular risk in Lombardy (Italy): the DAVID-Berg study].

Background: Prevalence of asymptomatic left ventricular systolic dysfunction (ALVSD) increases with age and cardiovascular (CV) risk exposure. Early diagnosis and treatment allow reducing heart failure and fatal and non-fatal event rates. Data on ALVSD prevalence in Italy are still scarce and ALVSD remains commonly under-diagnosed in primary care, where diagnostic facilities are limited.

How many hypertensive patients can be controlled in "real life": an improvement strategy in primary care.

Background: It is well known that hypertension control is non-satisfactory, but it is not clear how many hypertensive patients can be controlled in real life. We addressed this question implementing a simple, multifaceted improvement strategy in family practice.

Methods: Eighteen General Practitioner (GPs) agreed upon a simple improvement strategy including: 1) the use of occasional direct/indirect contacts (prescription refilling) to decrease missing blood pressure (BP) recording, and to increase therapeutic adherence, 2) the use of home BP measurements in non-controlled patients, 3) the addition of a new drug in non-controlled, but adequately adherent patients.

2012 consensus document of the Italian Society of Hypertension (SIIA): strategies to improve blood pressure control in Italy: from global cardiovascular risk stratification to combination therapy.

Observational clinical studies have demonstrated that only 30-40% of patients with arterial hypertension achieve the recommended blood pressure goals (below 140/90 mmHg). In contrast, interventional trials consistently showed that it is possible to achieve effective blood pressure targets in about 70% of treated hypertensive patients with different cardiovascular risk profiles, especially through the use of rational, effective and well tolerated combination therapies. In order to bridge the gap between current and desired blood pressure control and to achieve more effective prevention of cardiovascular diseases, the Italian Society of Hypertension (SIIA) has developed an interventional strategy aimed at reaching nearly 70% of treated controlled hypertensive patients by 2015.

Stroke prophylaxis in high-risk patients with atrial fibrillation: rhythm vs. rate control strategy.

Purpose: "Rhythm" and "Rate" control strategies require partially different organization, and a different involvement of Specialists and General Practitioners; we verified whether the strategy assignment modified the approach to stroke prophylaxis.

Methods: Survey in general practice: 233 GPs identified all patients with codified atrial fibrillation (AF) diagnosis, checked the diagnosis (ECG/hospital discharge document), and filled a structured questionnaire on stroke risk-factors, prophylactic therapy, and reasons for warfarin non prescription in CHADS ≥2 patients. Data were collected as an "aggregate.

Clinical management of rivaroxaban-treated patients.

Introduction: Until recently, only vitamin K antagonists (VKAs) were used for long-term anticoagulation. New oral anticoagulants, with pharmacokinetic and pharmacodynamic characteristics different to VKAs, are now available for some indications. Rivaroxaban (Xarelto®) is an oral Factor Xa inhibitor approved in many countries for long-term treatment of patients with atrial fibrillation or venous thromboembolism.

Left-ventricular hypertrophy and renal outcome in hypertensive patients in primary-care.

Background: Subclinical cardiac damage has recently emerged as a potential predictor of adverse renal outcome. We therefore retrospectively evaluated the effect of left-ventricular hypertrophy (LVH), diagnosed electrocardiographically, on the renal outcome of hypertensive patients managed in primary care.

Methods: From a historical cohort of 39,525 hypertensive individuals evaluated in 2005, we retrieved 5-year data of the 18,510 surviving subjects for whom renal follow-up was available.

Frequency, patient characteristics, treatment strategies, and resource usage of atrial fibrillation (from the Italian Survey of Atrial Fibrillation Management [ISAF] study).

Atrial fibrillation (AF) is 1 of the most important healthcare issues and an important cause of healthcare expenditure. AF care requires specific arrhythmologic skills and complex treatment. Therefore, it is crucial to know its real affect on healthcare systems to allocate resources and detect areas for improving the standards of care.

[Strategies for improving blood pressure control in Italy: from global cardiovascular risk stratification to combination therapy. 2012 Position paper of the Italian Society of Hypertension].

Observational studies demonstrate that the proportion of treated hypertensive patients who attain the recommended blood pressure goals (140/90 mmHg) does not exceed 30-40%. Conversely, clinical trials have consistently shown that effective blood pressure control within the recommended targets can be achieved in 70-80% of treated hypertensive patients with different cardiovascular risk profile, especially when appropriate, effective and well tolerated combination therapies are used. In order to bridge the gap between current and optimal blood pressure control rates and to achieve a more effective cardiovascular prevention, the Italian Society of Hypertension has recently developed an interventional strategy that aims to approximate 70% of treated controlled patients by 2015.

C-reactive protein distribution and correlation with traditional cardiovascular risk factors in the Italian population.

Background: C-reactive protein (CRP) increases during an inflammatory response; its plasma levels are believed to be an independent predictor of future atherosclerotic disease. We report the distribution of plasma levels of CRP and its possible relationship with other cardiovascular risk factors in an Italian cohort.

Methods: CRP was assessed in frozen plasma samples of 1949 participants in the CHECK study (2001-2005), which collected clinical and biochemical data from randomly selected subjects (40-79 years) in the setting of Italian general practice.

Reaching LDL-c targets in high-risk patients requires high-efficacy cholesterol-lowering drugs in more than 50% of cases. The results of the CHECK study.

We estimated the need to use low-efficacy statins or high-efficacy statins or drug combinations to bring high- or very-high cardiovascular risk subjects to their LDL-c target, in a sample representative of the Italian adult population and according to the principles of reimbursement of hypercholesterolemic drugs currently used in Italy. The results allow us concluding that among high or very high cardiovascular risk patients about three patients out of five should be prescribed high-efficacy statins or drug combinations. The other two prescriptions might take into account lower-efficacy statins.

A national survey on aspirin patterns of use and persistence in community outpatients in Italy.

Background: Aspirin is recommended as preventive therapy in patients with cardiovascular diseases (CVD), diabetes mellitus, and high cardiovascular risk due to multiple risk factors. However, the benefits of aspirin might be affected by its inappropriate use. Real-life information on aspirin use is therefore needed as an audit tool aimed to maximize the benefits and minimize the risks.

CKD awareness and blood pressure control in the primary care hypertensive population.

Background: Chronic kidney disease (CKD) is associated with poor renal and cardiovascular outcomes, and early identification largely depends on general practitioners' (GPs') awareness of it. To date, no study has evaluated CKD prevalence in patients with hypertension in primary care.

Study Design: Cross-sectional evaluation of the Italian GPs' database.

[Role of outpatient heart failure clinics and primary care physicians in the tailored follow-up of heart failure patients].

Continuity of care is pivotal to appropriately manage patients affected by heart failure (HF). HF is a chronic disease with frequent exacerbations that requires long-term care at different complexity levels. The lack of adequate communication between hospital cardiologists and primary care physicians (PCPs) is the main pitfall in continuity of care for HF patients.

[Tailored follow-up for chronic heart failure patients: time for discussion].

Decreasing hospital readmissions in heart failure (HF) patients represents the primary goal of HF management to improve patient survival and quality of life and resource use. The wide Italian network of outpatient HF clinics may play a pivotal role in achieving this aim through the appropriate implementation of tailored patient follow-up. This tool rests on accurate risk stratification to identify complex unstable patients who should be referred to an HF clinic.