Chapters authored
Cardiovascular Risk Assessment in People Affected with Diabetes in Primary Care By Lucia Borsari, Monica Lorenzini, Silvia Riccomi, Valentina Solfrini,
Marco Vinceti and Oreste Capelli
Several studies suggest that the cardiovascular disease (CVD) mortality rates of persons with type 2 diabetes are about two to four times higher than those of the general population. It is therefore considered necessary to develop specific tools to evaluate and reduce CVD risk in this population. In the present chapter, main CVD risk scores were explored: from the Framingham study developed in the 1960s to the last diabetes-specific models, passing through the concept of diabetes as a “CVD risk equivalent”. The scores developed in Italian population were specifically explored. The Italian experience, according to other countries, emphasizes that it may be appropriate for each country to validate existing models and eventually to adapt them to the different settings to improve targeted risk management.
Part of the book: Primary Care in Practice
Allergic Sensitization in Rhinitis and Asthma By Eleonora Savi, Silvia Peveri and Oreste Capelli
Allergic rhinitis (AR) is usually defined as an inflammatory disease of the nasal mucosa induced by an interaction of environmental allergens and IgE in sensitized patients. Its symptoms are sneezing, nasal itching, rhinorrhoea and nasal obstruction. Allergic rhinitis affects approximately 20- 30% of the population worldwide and its prevalence is increasing. Isolated AR is rare and it actually has to be considered as a systemic allergic disease, associated to comorbidities, such as conjunctivitis, chronic middle ear effusions, irregular sleep, sinusitis, lymphoid hypertrophy with obstructive sleep apnoea. The most relevant comorbidity is asthma, a heterogeneous disease, usually characterized by chronic airway inflammation in which many cells and cellular elements play an important role. Bronchial asthma is characterized by bronchial hyper-reactivity and symptoms may be triggered or worsened by factors such as viral infections, allergens, tobacco smoke, exercise and stress. A state of "minimal persistent inflammation" is permanently maintained in the lower respiratory tract of asthmatic individuals. The diagnosis of asthma is based on evidence of variable airflow limitation tested with spirometry and a positive bronchodilation reversibility test. Skin prick tests (SPTs) are widely used to demonstrate an immediate IgE-mediated allergic reaction. They represent a major diagnostic tool in the field of allergy. Skin prick tests have a high specificity and sensitivity for the diagnosis of inhalant allergens. Immunotherapy (AIT) for allergic diseases has entered in a new age characterized by the development of a few innovative therapeutic classes of standardized allergen formulations registered. Clinical randomized trials have demonstrated the efficacy of AIT in allergic rhinitis in children and in adults, expressed in terms of reduction of symptom score and use of rescue medication. The efficacy is confirmed both for subcutaneous (SCIT) and sublingual (SLIT) immunotherapy in adults and in pediatric patients. The long lasting effect of AIT after its discontinuation is an important added value of this therapy. Controlled studies are available, where the carry-over effect of AIT is demonstrated for two years after discontinuance. The capacity to prevent new sensitizations, and to modify the evolution of the disease from the rhinitis to asthma are two important features of AIT. Allergen immunotherapy showed preventive capacity and also a carryover effect once treatment is discontinued.
Part of the book: Primary Care in Practice
Integrated Care for Chronic Diseases – State of the Art By O. Capelli, B. Quattrini, F. Abate, B. Casalgrandi and I. Cacciapuoti
Chronic diseases represent a high cost for healthcare systems, for individuals, families, businesses and governments. The World Health Organization (WHO) estimates that an increase of 10% of chronic diseases is associated with a reduction of 0.5% of annual economic growth. Primary care has proven to ensure high levels of efficiency, effectiveness, equity, safety, timely and centrality of the patient achieving better health outcomes and lower costs. The Chronic Care Model (CCM) proposes a proactive approach in assisting the empowerment of patients and their community. The CCM contributes to improving the quality of care and health outcomes and the reduction of inequalities (e.g., ethnicity, social status) too.
Part of the book: Primary Care in Practice
Integrated Care for Heart Failure in Primary Care By Monica Lorenzini, Caterina Ricci, Silvia Riccomi, Federica Abate,
Barbara Casalgrandi, Benedetta Quattrini, Gianbattista Spagnoli,
Letizia Reggianini and Oreste Capelli
Chronic heart failure (CHF or simply HF) is a complex clinical syndrome that involves more than 2% of the general population and over 10% of the older people. For people with reduced ventricular function (the classical HFrEF phenotype), the guideline-directed medical therapy (GDMT) (e.g., Ace-inhibitors, beta-blockers, diuretics, rehabilitation or implantable ventricular devices) demonstrated to be efficacious in reducing hospitalisations and prolonging survival. Vice-versa, the HF with preserved ejection fraction (diastolic HF or HFpEF phenotype) is a much more complex syndrome, in which co-morbidities (such as COPD, depression, anemia, and diabetes, CAD) play a significant role in the decompensation episodes.
Part of the book: Primary Care in Practice
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