Use Of Databases Research Articles

Multi-Platform Collaboration in Integrated Surveying: Ensuring Completeness and Reliability of Geospatial Data—A Case Study

Multi-platform geospatial data synergy is critical for complete and reliable surveys. This study investigates various methods for combining data from terrestrial laser scanning (TLS), orthophotos, databases of topographic objects, utility databases, tacheometry, and GNSS to assess and improve positioning accuracy and consistency of data in spatial databases. The study highlights the challenges and solutions regarding integrating various datasets to yield a complete and reliable geospatial database for building surveys and the construction and keeping of spatial databases. Input from diversified surveying technologies, such as TLS, GNSS, and orthophotos, offers detailed and precise data necessary to create and update accurate base maps and databases of topographic objects. A complete survey of a structure and its surroundings demonstrates how the synergistic application of diverse data sources helps improve the positioning accuracy and consistency of spatial databases. The results indicate the importance of multi-platform collaboration for high data quality standards in surveying, which is critical for effective planning and implementation of surveying projects.

Survival, treatment duration and costs of patients with prostate cancer treated with triptorelin in Italy: a study of administrative databases.

Several data support the efficacy/effectiveness, safety and favorable impact on quality of life of triptorelin treatment in patients with prostate cancer. However, little evidence is available concerning triptorelin use in the long term. We analyzed data on triptorelin treatment in patients with prostate cancer in an integrated Italian administrative database, covering around 6 million health-assisted subjects throughout the country. Patients with at least one prescription for triptorelin in the period 2010-2020 and with no evidence of metastasis were included and followed up until 2021. Overall survival (OS) and duration of treatment were analyzed using Kaplan-Meier curves, starting from the date of first prescription. The cohort included a total of 3,411 patients (mean age: 76.8 ± 8.7 years), of whom 1,326 (38.9%) were treated with triptorelin only and 2,085 (61.1%) with triptorelin combined with an anti-androgen. Overall, 847 (24.8%) patients with prostate cancer died and 1,037 (30.4%) had a treatment switch during the follow-up period, and both the median OS and median duration of treatment were not reached in both groups. The mean annual total cost per patient was estimated as 5,574 €, with almost half of the costs related to medication expenses (2,737 €). We found a long survival and duration of triptorelin treatment in this population of Italian patients with prostate cancer. This study with a long follow-up period further highlights the usefulness of healthcare utilization databases to integrate results obtained from clinical studies with those from everyday clinical practice.

2001-2021 Comparative Persistence of Oral Antipsychotics in Patients Initiating Treatment: Superiority of Clozapine in Time-to-Treatment Discontinuation.

Continuous antipsychotic (AP) therapy is crucial for managing psychotic disorders, and its early interruption reflects the drug's failure. Real-world epidemiological research is essential for confirming experimental data and generating new research hypotheses. The persistence of oral APs in a large population sample from 2000 to 2021 was analyzed by comparing AP prescriptions over this period across four Italian provinces, using dispensing data linked via a record-linkage procedure among regional healthcare utilization databases. We calculated personalized daily dosages and assessed time-to-treatment discontinuation over a 3-month period for patients initiating AP treatment. Treatment persistence was evaluated using Kaplan-Meier curves and Cox regression, with adjustments for age and sex. Second-generation antipsychotics (SGAs) were favored over first-generation antipsychotics (FGAs), with olanzapine as the most prescribed. Within the study time frame, 42,434 individuals were prescribed a new continuous AP regimen. The analysis revealed 24 significant differences within 28 comparisons. As a class, SGAs demonstrated better treatment persistence than FGAs (HR: 0.76; 95%CI: 0.73, 0.79). Clozapine stood out for its superior persistence, surpassing all other SGAs, notably olanzapine (HR: 0.85; 95%CI: 0.79-0.91) and risperidone (HR: 0.80; 95%CI: 0.74-0.87). Olanzapine and aripiprazole showed better results than both risperidone and quetiapine. Quetiapine showed inferior 3-month persistence in all pairwise comparisons. The study results provide insight into the performance dynamics among SGAs: clozapine, despite being one of the less frequently dispensed APs in our sample, emerged as a significant prescription choice. The significance of pharmacoepidemiological studies in complementing experimental findings is also underscored.

Respiratory phenotype and health care utilization patterns by adults with sickle cell disease

AbstractAdults with sickle cell disease (SCD) and asthma have increased mortality and health care utilization; however, there are individuals with respiratory symptoms (including cough and wheeze) without asthma. These individuals may have similar patterns of increased mortality and health care utilization. To characterize the association between respiratory phenotype and health care utilization by adults with SCD. Cross-sectional study of adults with SCD presenting for emergency and inpatient hospital care from 2012 to 2014 in Florida, Iowa, and New York using state-level health care utilization databases. Outcomes of interest include all-cause, SCD-related, painful episode, and acute chest syndrome–related care. Respiratory phenotype was defined as SCD + asthma, SCD + respiratory symptoms, and SCD + none. We built multivariable logistic regression and negative binomial regression models to evaluate the association adjusting for demographics, social determinant of health proxies, year of care, and state. Of 29 952 identified individuals, 3.4% had intermittent respiratory symptoms, and a larger proportion (15.6%) had asthma. There was a high rate of inpatient hospitalizations (43%) and ED visits (60%). Individuals with asthma had a higher annual risk of inpatient hospitalizations (48% vs 37%) but lower annual risk of an ED visit (62% vs 86%) than individuals with intermittent respiratory symptoms. The pattern of increased health care utilization among individuals with intermittent respiratory symptoms was consistent across each utilization type. In this large cohort of adults with SCD, we identified some with intermittent respiratory symptoms who had significantly increased health care utilization. This warrants further evaluation to understand potential etiologies and interventions.

P53motifDB: integration of genomic information and tumor suppressor p53 binding motifs.

The tumor suppressor gene TP53 encodes the DNA binding transcription factor p53 and is one of the most commonly mutated genes in human cancer. Tumor suppressor activity requires binding of p53 to its DNA response elements and subsequent transcriptional activation of a diverse set of target genes. Despite decades of close study, the logic underlying p53 interactions with its numerous potential genomic binding sites and target genes is not yet fully understood. Here, we present a database of DNA and chromatin-based information focused on putative p53 binding sites in the human genome to allow users to generate and test new hypotheses related to p53 activity in the genome. Users can query genomic locations based on experimentally observed p53 binding, regulatory element activity, genetic variation, evolutionary conservation, chromatin modification state, and chromatin structure. We present multiple use cases demonstrating the utility of this database for generating novel biological hypotheses, such as chromatin-based determinants of p53 binding and potential cell type-specific p53 activity. All database information is also available as a precompiled sqlite database for use in local analysis or as a Shiny web application.

Development and validation of claims-based algorithms for estimating gestational age of spontaneous abortion and termination.

To study the risk of spontaneous abortion (SAB) or termination using healthcare utilization databases, algorithms to estimate the gestational age (GA) are needed. Using Medicaid data, we developed a hierarchical algorithm to classify pregnancy outcomes. We identified the subset of potential SAB and termination cases, and abstracted the GA from linked electronic medical records (gold standard). We developed three approaches: (1) assign median GA for SAB and termination cases in the US; (2) draw a random GA from the population distributions; (3) estimate GA based on regression models. Algorithm performance was assessed based on the proportion of pregnancies with estimated GA within 1-4 weeks of the gold standard, the mean squared error (MSE) and the R-squared. Approach 1 and Approach 3 had similar performance, though approach 3 using random forest models with variables selected via the Boruta algorithm had better MSE and R-squared. For SAB, 58.0% of pregnancies were correctly classified within 2 weeks of the gold standard (MSE: 8.7, R-squared: 0.09). For termination, the proportions were 66.3% (MSE: 11.7; R-squared: 0.35). SABs and terminations can be studied in healthcare utilization data with careful implementation of validated algorithms though higher level of GA misclassification is expected compared to live births.

Predicting the risk of nursing home placement of elderly persons using a population-based stratification score

ObjectiveTo develop and validate a novel score predictive of nursing home placement in elderly. Study designPopulation-based case-control study based on healthcare utilization databases of Lombardy, a region of Northern Italy. MethodsThe 2.4 million citizens aged ≥65 years who on January 1, 2018 lived outside nursing home formed the target population. Cases were citizens who experienced nursing home admission (the outcome of interest) until December 31, 2019. Cases were matched 1:1 by gender, age, and municipality of residence to one control. Conditional logistic regression was fitted to select candidate predictors (the exposure to 69 clinical conditions and 11 social and healthcare services) independently associated with the outcome. The model was built from the 26,156 cases, and as many controls (training set), and applied to a validation set (15,807 case-control couples). Predictive performance was assessed by discrimination and calibration. ResultsTwenty-one factors were identified as predictive of nursing home admission and were included in the “Elderly Nursing Home Placement” (ENHP) score. Mental health disorders and chronic neurological illnesses contributed most to prediction of nursing home admission. ENHP performance showed an area under the receiver operating characteristic curve of 0.77 and a remarkable calibration of observed and predicted outcome risk. ConclusionsA simple score derived from data used for public health management may reliably predict the risk of nursing home placement in elderly. Its use by healthcare decision makers allows to accurately identify high-risk individuals who need home services, thereby avoiding admission to nursing homes.

Long-term exposure to antihypertensive drugs and the risk of cancer occurrence: evidence from a large population-based study.

Available data on the association between antihypertensive drugs and cancer are characterized by a few years follow-up. Our aim has been to evaluate the association between long-term exposure to antihypertensive drugs and the risk of cancer occurrence. Using the healthcare utilization databases of the Lombardy region (Italy), individuals aged 40-85 years who had no previous history of cancer and were newly dispensed with at least one antihypertensive drug from the major drug classes between 2009 and 2011 were followed from the first drug dispensation to December 31, 2020. Data were analyzed according to the first drug used and the intention to treat principle, but also via an "as treated" approach, that is, by considering changes of and exposure to drugs during follow-up. The association between the duration of exposure to each drug class and the risk of cancer occurrence was evaluated using the adjusted Cox regression models. The study cohort included 338 910 new drug users (median age, 59 years; 49.5% males). During a median follow-up of 10.2 years, 36 556 cancers occurred. There was no consistent significant association between the risk of cancer occurrence and angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, or thiazides. A progressive, weak increase in cancer occurrence was associated with progressive exposure to calcium channel blockers and, limited to long-term exposure, to beta-blockers. A modest progressive increase in risk was observed also for thiazide-like and loop diuretics in the as treated, although not in the intention to treat approach. Long-term evaluation of exposure to antihypertensive drugs did not show consistent associations between thiazides, angiotensin-receptor blockers, or angiotensin-converting-enzyme inhibitors and the risk of cancer occurrence. A weak association was observed between cancer and the duration of exposure to calcium channel blockers and beta-blockers.

Life cycle environmental impacts of urban water systems in China

Urban water systems in China are facing multiple challenges, including rapid urbanisation, climate change and infrastructure ageing. It is crucial to evaluate their environmental performance from a holistic perspective in planning and management processes. To the best of our knowledge, there is a lack of nationwide life cycle assessment (LCA) studies on China's urban water systems that cover all system stages. Therefore, this study aims to present a comprehensive and nationwide LCA analysis that pinpoints the environmental hotspots and their major sources across China. This study was conducted based on water utility databases at the province level, covering water abstraction and treatment, waterwork sludge treatment, water distribution, sewage collection, stormwater drainage, wastewater treatment and sewage sludge treatment. Nine environmental impact categories were calculated and analysed. The results reveal the inequity of environmental impacts across provinces, with overall impacts geographically higher in the east and south, lower in the west and north. However, at the functional unit level, the impacts in the northern and northeastern provinces are higher than other regions. Most environmental categories are dominated by multiple water system stages. The analyses of underlying drivers found that purchased electricity is the primary source of several environmental impacts. This study provides a holistic understanding of the environmental performance of China's urban water systems, offers some insights for comprehensive decision-making support on sustainable water system management, and can also serve as a benchmark for future scenario analysis to explore options for reducing environmental impact.

Benchmarking building energy consumption for space heating using an empirical Bayesian approach with urban-scale energy model

Calibration of an urban-scale building energy model is crucial for advancing building energy efficiency codes and policies to reduce carbon dioxide emissions whereas the accuracy of the model is challenged by performance gaps resulting from sparse data and uncertainties in modeling. An empirical Bayesian (EB) approach, incorporated a probability-based mixed-effects energy model and Monte Carlo Markov chain simulation, was developed to predict and benchmark building energy use intensity (EUI) for space heating, using the metering data of 2020 stochastically sampled district heating substations from a municipal utility database. The limitations, implementations and performances of different modeling strategy, including EB as well as Maximum Likelihood Estimation (MLE), Maximum A Posteriori (MAP) and Fully Bayes (FB) were compared. The results show that EB strategy achieved superior prediction performance than other strategies on the novel test dataset. The preparation, calibration, and validation efforts for implementing the EB approach were demonstrated. The proposed methodology is recommended as a robust approach for benchmarking urban-scale building EUI, distinguished from other machine learning approaches by requiring fewer training samples, better interpreting uncertainties in the data used, and exhibiting superior generalization capabilities. The proposed methodology was successfully demonstrated through the urban-scale benchmarking of space heating EUI in Beijing.

Cost-effectiveness of single-pill and separate-pill administration of antihypertensive triple combination therapy: a population-based microsimulation study

BackgroundSingle-pill combination (SPC) of three antihypertensive drugs has been shown to improve adherence to therapy compared with free combinations, but little is known about its long-term costs and health consequences. This study aimed to evaluate the lifetime cost-effectiveness profile of a three-drug SPC of an angiotensin-converting enzyme inhibitor, a calcium-channel blocker, and a diuretic vs the corresponding two-pill administration (a two-drug SPC plus a third drug separately) from the Italian payer perspective.MethodsA cost-effectiveness analysis was conducted using multi-state semi-Markov modeling and microsimulation. Using the healthcare utilization database of the Lombardy Region (Italy), 30,172 and 65,817 patients aged ≥ 40 years who initiated SPC and two-pill combination, respectively, between 2015 and 2018 were identified. The observation period extended from the date of the first drug dispensation until death, emigration, or December 31, 2019. Disease and cost models were parametrized using the study cohort, and a lifetime microsimulation was applied to project costs and life expectancy for the compared strategies, assigning each of them to each cohort member. Costs and life-years gained were discounted by 3%. Probabilistic sensitivity analysis with 1,000 samples was performed to address parameter uncertainty.ResultsCompared with the two-pill combination, the SPC increased life expectancy by 0.86 years (95% confidence interval [CI] 0.61–1.14), with a mean cost differential of -€12 (95% CI -9,719–8,131), making it the dominant strategy (ICER = -14, 95% CI -€15,871–€7,113). The cost reduction associated with the SPC was primarily driven by savings in hospitalization costs, amounting to €1,850 (95% CI 17–7,813) and €2,027 (95% CI 19–8,603) for patients treated with the SPC and two-pill combination, respectively. Conversely, drug costs were higher for the SPC (€3,848, 95% CI 574–10,640 vs. €3,710, 95% CI 263–11,955). The cost-effectiveness profile did not significantly change according to age, sex, and clinical status.ConclusionsThe SPC was projected to be cost-effective compared with the two-pill combination at almost all reasonable willingness-to-pay thresholds. As it is currently prescribed to only a few patients, the widespread use of this strategy could result in benefits for both patients and the healthcare system.

Assessing competitiveness through intellectual capital research: a systematic literature review and agenda for future research

Purpose The purpose of this study is to undertake a systematic literature review (SLR) on intellectual capital disclosure (ICD), focusing on its role in fostering competitive advantage. Design/methodology/approach Following the SLR process, the study identified 84 papers published in high-ranking journals over a 19-year span, providing insights into descriptive outcomes, research limitations and future research directions. Findings The results show that ICD research peaked in 2022, with the Journal of Intellectual Capital leading with the highest number of ICD publications. Resource-based theory was found to be the most applied theoretical framework, with developed country-specific research receiving the most attention. The use of small sample size, a lack of longitudinal studies, reliance on a single source of data, unsuitability of control variables and a lack of comparative studies with firms operating in developing countries are the main limitations that have been noted. Research limitations/implications This study faces constraints, primarily stemming from the selective keyword utilization and exclusive Scopus database reliance. It omits non-English papers, conference proceedings and books, potentially overlooking relevant insights. Practical implications The findings offer valuable insight for researchers, emphasizing the need for research on intellectual capital (IC) across diverse industries. Furthermore, our findings urge regulators to mandate global IC reporting to mitigate information asymmetry, while also prompting managers to enhance IC-related practices and reporting for more stakeholders’ trust. Originality/value This study provides a comprehensive overview of over two decades of ICD literature, synthesizing previous studies, identifying gaps and outlining potential directions for scholars and industry professionals in the context of competitiveness.

Multiple births from medically assisted reproduction: contribution of different types of procedures and trends over time

ObjectiveTo evaluate the relative impact of different strategies of medically assisted reproduction (MAR), i.e. first line treatment (ovarian stimulation with or without intrauterine insemination) and in vitro fertilization (IVF) procedures (conventional IVF or intracytoplasmic sperm injection), on the risk of multiple births. Study designWe utilized the health care utilization databases of the Lombardy region to identify births resulting from MAR between 2007 and 2022. We gathered data on the total number of multiple births and calculated the prevalence rate by dividing the number of multiples by the total number of births. To examine the temporal trend in the proportion of multiple births after MAR over time, a linear regression model was employed separately for different types of techniques and in strata of maternal age. ResultsA total of 30,900 births after MAR were included; 4485 (14.5 %) first line treatments and 26,415 (85.5 %) IVF techniques. Overall, 4823 (15.6 %) multiple births were identified. The frequency of multiple births over the study period decreased from 22.0 % in 2007 to 8.7 % in 2022 (p < 0.01). Multiple births from first line treatments were stable ranging from 13.5 % in 2007–2008 to 12.0 % in 2021–2022 (p = 0.29). Multiple births from IVF procedures decreased from 23.8 % in 2007–2008 to 8.4 % in 2021–2022 (p < 0.01). Stratifying for maternal age (i.e. < 35 and ≥ 35 years), the trends remained consistent. ConclusionsThe reduction in multiple births has been influenced by changes in IVF strategy and procedures. The decline has been gradual but steady since 2009, when a law restricting embryo freezing was repealed in Italy. In contrast, the proportion of multiple births resulting from first line treatments has remained constant over time. Despite declining, multiple births from MAR remained about one order of magnitude higher than those from spontaneous pregnancies.

Linking the mothers and index children in the Avon Longitudinal Study of Parents and Children (ALSPAC) with the Avon and Wiltshire Mental Health Partnership NHS Trust (AWP)

This data note describes electronic mental-health records of a portion of the Avon Longitudinal Study of Parents and Children cohort. The records were obtained by the linking of identifiers of the participants of the Avon Longitudinal Study of Parents and Children (ALSPAC – also known as ‘Children of the 90s’) with those of the clients of the Avon and Wiltshire Mental Health Partnership NHS Trust (AWP). The patient records from AWP includes data about some of the original mothers as well as some of the study’s index children. There was insufficient linkage data to include the original fathers/partners in this exercise. There are a smaller number of families with AWP records on both mother and child. Software syntax was written using STATA (StataCorp LLC, version 17) to convert the original ‘comma separated values’ (.csv) files into a de-identified, but consistent, format for use in research. The cleaned AWP records provide a contemporaneous record of a subset of the ALSPAC cohort over a period of the ALSPAC study in an easily accessible format, in a data base for use in future research.

Hip fracture rate and osteoporosis treatment in Ontario: A population-based retrospective cohort study

SummaryThis population-based study analyzes hip fracture and osteoporosis treatment rates among older adults, stratified by place of residence prior to fracture. Hip fracture rates were higher among older adults living in the community and discharged to long-term care (LTC) after fracture, compared to LTC residents and older adults living in the community. Only 23% of LTC residents at high fracture risk received osteoporosis treatment.PurposeThis population-based study examines hip fracture rate and osteoporosis management among long-term care (LTC) residents > 65 years of age compared to community-dwelling older adults at the time of fracture and admitted to LTC after fracture, in Ontario, Canada.MethodsHealthcare utilization and administrative databases were linked using unique, encoded identifiers from the ICES Data Repository to estimate hip fractures (identified using the Public Health Agency of Canada algorithm and International Classification of Diseases (ICD)-10 codes) and osteoporosis management (pharmacotherapy) among adults > 66 years from April 1, 2014 to March 31, 2018. Sex-specific and age-standardized rates were compared by pre-fracture residency and discharge location (i.e., LTC to LTC, community to LTC, or community to community). Fracture risk was determined using the Fracture Risk Scale (FRS).ResultsAt baseline (2014/15), the overall age-standardized hip fracture rate among LTC residents was 223 per 10,000 person-years (173 per 10,000 females and 157 per 10,000 males), 509 per 10,000 person-years (468 per 10,000 females and 320 per 10,000 males) among the community to LTC cohort, and 31.5 per 10,000 person-years (43.1 per 10,000 females and 25.6 per 10,000 males). During the 5-year observation period, the overall annual average percent change (APC) for hip fracture increased significantly in LTC (AAPC = + 8.6 (95% CI 5.0 to 12.3; p = 0.004) compared to the community to LTC group (AAPC = + 2.5 (95% CI − 3.0 to 8.2; p = 0.248)) and the community-to-community cohort (AAPC − 3.8 (95% CI − 6.7 to − 0.7; p = 030)). However, hip fracture rate remained higher in the community to LTC group over the study period. There were 33,594 LTC residents identified as high risk of fracture (FRS score 4 +), of which 7777 were on treatment (23.3%).ConclusionOverall, hip fracture rates have increased in LTC and among community-dwelling adults admitted to LTC after fracture. However, hip fracture rates among community-dwelling adults have decreased over time. A non-significant increase in osteoporosis treatment rates was observed among LTC residents at high risk of fracture (FRS4 +). Residents in LTC are at very high risk for fracture and require individualized based on goals of care and life expectancy.

Sirt1 in focus: unveiling molecular insights and therapeutic prospects in calcific aortic stenosis with sglt2i inhibitors

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Fondazione Gigi &amp; Pupa Ferrari ONLUS Background Calcific aortic stenosis (AS) affects 3% of older adults and lacks medical treatment. The well-known deacetylase Sirtuin1 (SIRT1) could be involved in many pathways linked to AS progression. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), a class of antihyperglycemic agents, have been shown to reduce cardiovascular events and hospitalization for heart failure (possibly via SIRT1), but their possible benefits in AS are not yet known. Purpose Our study aims to uncover if SIRT1 plays a key role in AS progression and if SGLT2i can potentially slow the valve fibro-calcification processes, potentially via SIRT1 modulation. Methods RNA sequencing of control (n=27) and AS (n=39) aortic valves was performed. SIRT1 knockdown (SIRT1-) and overexpressing (SIRT1+) valve interstitial cells (VIC) were generated by CRISPR/Cas9. A calcification assay with or without dapagliflozin (dapa 1uM as SGLT2i) was employed to evaluate valve endothelial cells (VEC) and VIC crass-talk on calcification potential. Patient data were collected from the Lombardy regional healthcare utilization database and diabetic patients who were taking sulphonylureas (sul; not affecting SIRT1) and SGLT2i (acting on SIRT1) were selected. Patients were matched 1:1 by age, sex, and multisource comorbidity score. Kaplan-Maier analysis was used to generate time-to-event curves for aortic valve replacement (AVR) cumulative incidence at 2 years and Cox regression analysis was used to account for confounding effects. Results Whole tissue RNA-seq showed that SIRT1 could be a master regulator of multiple pathways linked to AS. Functional analysis and validations on mutant VIC revealed that inflammation, extracellular-matrix remodeling, and calcification mechanisms are directly regulated by SIRT1. Calcium assays unveiled an increment of calcification in SIRT1- VICs (+50.8%, p&amp;lt;0.01), while SIRT1+ VICs deposited less calcium (-23.6%; p&amp;lt;0.01) compared to wild-type ones. VIC exposed to dapa-treated VEC medium showed reduced calcification (-35.2%, p&amp;lt;0.01). In the dapa-treated VEC medium, we found an increase in NO levels (+19.9%, p&amp;lt;0.01) and VIC treated with an NO donor (detanonate 50uM) showed reduced calcification (-23.2%, p&amp;lt;0.05), while VIC treated with a SIRT1 inhibitor (EX527 25uM) showed an increased calcification (+68.1%, p&amp;lt;0.01). To corroborate these findings, we retrospectively enrolled 233,546 diabetic patients, and after matching, we obtained two groups (sul and SGLT2i) with 37,081 patients each. Adjusted Cox regression analysis revealed that patients taking SGLT2i had a lower AVR incidence than patients taking sulp with a hazard ratio of 0.65 (95%CI 0.47-0.89) resulting in a 35% risk reduction. Conclusion Our data highlights SIRT1 as a key regulator of fibro-calcific processes involved in AS and SGLT2i exhibit potential in slowing AS progression, via SIRT1 modulation. This study unveils promising molecular insights and suggests SGLT2i as a potential therapeutic avenue for AS.

Understanding Patterns of Adherence to Antifibrotic Treatment in Idiopathic Pulmonary Fibrosis: Insights from an Italian Prospective Cohort Study.

Background: Pirfenidone and Nintedanib have significantly improved the prognosis of patients with idiopathic pulmonary fibrosis (IPF), reducing mortality risk and exacerbations. This study aimed to analyze antifibrotic treatment utilization and its association with clinical outcomes (i.e., acute exacerbation or death) during 2014-2021 in newly diagnosed IPF patients, using Healthcare Utilization Databases of the Marche Region, Italy. Methods: The first 12-month adherence to antifibrotic was estimated using the Proportion of Days Covered (PDC), defining adherence as PDC ≥ 75%. State Sequence Analysis over the initial 52 weeks of treatment was used to identify adherence patterns. The role of adherence patterns on acute exacerbations/death, adjusted by demographic, clinical features, and monthly adherence after the 52-week period (time-dependent variable), was assessed with Cox regression. Results: Among 667 new IPF cases, 296 received antifibrotic prescriptions, with 62.8% being adherent in the first year. Three antifibrotic utilization patterns emerged-high adherence (37.2%), medium adherence (42.5%), and low adherence (20.3%)-with median PDCs of 95.3%, 79.5%, and 18.6%, respectively. These patterns did not directly influence three-year mortality/exacerbation probability, but sustained adherence reduced risk over time. Conclusions: Good adherence was observed in in this population-based study, emphasizing the importance of continuous antifibrotics therapy over time to mitigate adverse outcomes.

COST-EFFECTIVENESS OF SINGLE-PILL AND SEPARATE-PILL ADMINISTRATION OF ANTIHYPERTENSIVE TRIPLE-COMBINATION THERAPY: A POPULATION-BASED MICROSIMULATION STUDY

Objective: To evaluate the lifetime cost-effectiveness profile of the perindopril/amlodipine/indapamide single-pill combination (SPC) compared with the combination of an angiotensin-converting enzyme inhibitor, a calcium-channel blocker, and a diuretic as a SPC of two drugs plus the third drug separately from the Italian payer perspective. Design and method: A cost-effectiveness analysis was conducted employing multi-state semi-Markov modeling and microsimulation. Using the healthcare utilization database of the Lombardy Region (Italy), 30,172 and 65,817 patients aged &gt;=40 years who initiated SPC and two-pill combination, respectively, between 2015 and 2018 were identified. The observation period extended from the date of the first drug prescription until death, emigration, or December 31, 2019. Disease and cost models were parametrized using the study cohort, and a lifetime microsimulation was applied to project costs and life expectancy for the compared strategies Probabilistic sensitivity analysis with 1,000 samples was performed to address parameter uncertainty. Results: Compared with the two-pill combination, the SPC increased life expectancy by 0.86 years (95% confidence interval [CI] 0.61–1.14), with a reduction in total cost of –€12 (95% CI –9,719 to 8,131), making it the dominant strategy (ICER of –14, 95% CI –€15,871 to €7,113). The cost reduction associated with the SPC was primarily driven by savings in hospitalization costs, amounting to €1,850 (95% CI 17 to 7,813) and €2,027 (95% CI 19 to 8,603) for patients treated with the SPC and two-pill combination, respectively. Conversely, drug costs were higher for the SPC (€3,848, 95% CI 574 to 10,640 vs. €3,710, 95% CI 263 to 11,955). This was the case for all strata of age, sex, and clinical status. Conclusions: The SPC was projected to increase survival and reduce costs compared with the two-pill combination. This is likely explained by an improvement in drug compliance. As three-drug SPC is currently prescribed to only a few patients, the widespread use of this strategy could result in benefits for both patients and the healthcare system.

Comparing the effectiveness and cost-effectiveness of sulfonylureas and newer diabetes drugs as second-line therapy for patients with type 2 diabetes

IntroductionWe aimed to compare the effectiveness and cost-effectiveness profiles of glucagon-like peptide-1 receptor agonist (GLP-1-RA), sodium-glucose cotransporter 2 inhibitor (SGLT2i), and dipeptidyl peptidase-4 inhibitor (DPP-4i) compared with sulfonylureas and glinides...

The COVID-19 Pandemic Was Associated with a Change in Therapeutic Management and Mortality in Heart Failure Patients.

Background: Heart failure (HF)-related mortality has been exacerbated by the COVID-19 pandemic; however, it is unclear how healthcare reassessment has contributed to the excess mortality versus SARS-CoV-2 infection itself. We aimed to assess how the pandemic affected the therapeutic management and prognosis of HF patients. Methods: We retrospectively reviewed the healthcare utilization databases of the Lombardy region (Italy) to identify all newly-diagnosed HF patients from January 2018 to December 2021. Outcomes were the utilization of HF therapies (Sacubitril/Valsartan; cardiac resynchronization therapy [CRT] and/or implantable cardioverter-defibrillator [ICD]; mechanical circulatory support [MCS]; heart transplantation [HTX]) and mortality. Cox regression models were fitted to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for outcomes associated with the pandemic. Results: 36,130 and 17,263 patients were identified in the pre-pandemic and pandemic eras, respectively. The pandemic reduced Sacubitril/Valsartan utilization (HR = 0.77, 95% CI: 0.65-0.91) and CRT/ICD implantation (HR = 0.85, 95% CI: 0.78-0.92), but not MCS (HR = 1.11, 95% CI: 0.86-1.43) and HTX (HR = 0.88, 95% CI: 0.70-1.09). An increased mortality risk was observed during the pandemic (HR = 1.19, 95% CI: 1.15-1.23), which was attributable to SARS-CoV-2 infection (HR for non-COVID-19-related mortality = 1.01, 95% CI: 0.97-1.04). Conclusions: The COVID-19 pandemic was associated with a reduction in medical and interventional therapies for HF and an increase in mortality for HF patients.