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Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie–Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria.

Specific immune suppression types have been associated with a greater risk of severe COVID-19 disease and death. We analyzed data from patients >17 years that were hospitalized for COVID-19 at the “Fondazione IRCCS Ca′ Granda Ospedale Maggiore Policlinico” in Milan (Lombardy, Northern Italy). The study included 1727 SARS-CoV-2-positive patients (1,131 males, median age of 65 years) hospitalized between February 2020 and November 2022. Of these, 321 (18.6%, CI: 16.8–20.4%) had at least one condition defining immune suppression. Immune suppressed subjects were more likely to have other co-morbidities (80.4% vs. 69.8%, p  < 0.001) and be vaccinated (37% vs. 12.7%, p  < 0.001). We evaluated the contribution of immune suppression to hospitalization during the various stages of the epidemic and investigated whether immune suppression contributed to severe outcomes and death, also considering the vaccination status of the patients. The proportion of immune suppressed patients among all hospitalizations (initially stable at <20%) started to increase around December 2021, and remained high (30–50%). This change coincided with an increase in the proportions of older patients and patients with co-morbidities and with a decrease in the proportion of patients with severe outcomes. Vaccinated patients showed a lower proportion of severe outcomes; among non-vaccinated patients, severe outcomes were more common in immune suppressed individuals. Immune suppression was a significant predictor of severe outcomes, after adjusting for age, sex, co-morbidities, period of hospitalization, and vaccination status (OR: 1.64; 95% CI: 1.23–2.19), while vaccination was a protective factor (OR: 0.31; 95% IC: 0.20–0.47). However, after November 2021, differences in disease outcomes between vaccinated and non-vaccinated groups (for both immune suppressed and immune competent subjects) disappeared. Since December 2021, the spread of the less virulent Omicron variant and an overall higher level of induced and/or natural immunity likely contributed to the observed shift in hospitalized patient characteristics. Nonetheless, vaccination against SARS-CoV-2, likely in combination with naturally acquired immunity, effectively reduced severe outcomes in both immune competent (73.9% vs. 48.2%, p  < 0.001) and immune suppressed (66.4% vs. 35.2%, p  < 0.001) patients, confirming previous observations about the value of the vaccine in preventing serious disease.

Objective: To know the profile of sexual and reproductive health and sociocultural aspects of indigenous women Methods: Observational and descriptive cross-sectional study conducted in an outpatient reference center for indigenous health in the period from 2010 to 2013. A semi-structured questionnaire containing socio-cultural data and history of sexual and reproductive life was applied. Cervicovaginal smear was collected. Descriptive analysis was conducted using mean and standard deviation (SD) for quantitative variables and absolute and relative numbers for qualitative variables. Results: The sample included 90 indigenous women with mean age of 36 years (±SD13.41), belonging to 35 ethnicities. A total of 75 women (83.4%) experienced the first sexual intercourse at age 12-19 years, 74 (82.2%) were at reproductive age, 36 (48.6%) used contraceptive methods such as hormonal contraceptives and tubal sterilization. There was a mean of 4.6 births per woman; average age at first childbirth was 17.3 years (±SD 3.23); 23 of the women (26.8%) had 1-3 abortions and 26 (31. 2%) had one or more cesarean deliveries. In all, eight women (8.9%) presented alterations for cytologic atypia and sexually transmitted diseases ( Trichomonas vaginalis and Human Papillomavirus) in the Pap test. Conclusion: Vulnerable conditions for indigenous women were observed based on their sexual and reproductive profile, with exposure to sexually transmitted diseases, cervical cancer, early initiation of sexual activity and poor access to information and prevention. Objetivo:Conhecer o perfil da saúde sexual, reprodutiva e aspectos socioculturais de mulheres indígenas. Métodos:Estudo observacional, transversal e descritivo, realizado em ambulatório de referência em saúde indígena, durante o período de 2010 a 2013. Aplicouse um formulário semiestruturado contendo dados socioculturais, histórico de vida sexual e reprodutiva. Coletou-se o esfregaço cervicovaginal. Utilizou-se a análise descritiva, com apresentação de média e desvio padrão (DP) para variáveis quantitativas, e números absolutos e relativos para variáveis qualitativas.Resultados: A amostra constituiu-se de 90 indígenas, com idade média de 36 anos (± DP 13,41), pertencentes a 35 etnias. Para 75 mulheres (83,4%), a coitarca ocorreu na faixa etária de 12 a 19 anos, 74 (82,2 %) estavam em período reprodutivo e 36 (48,6%) usavam método contraceptivo, como o anticoncepcional hormonal e a laqueadura tubária. A média de partos foi de 4,6 por mulher; a idade média no primeiro parto foi de 17,3 anos (± DP 3,23); 23 delas (26,8%) tiveram de 1 a 3 abortamentos e 26 (31,2%) tiveram um ou mais partos cesáreas. Em oito mulheres (8,9%), identificaram-se alterações para atipias citológicas e doenças sexualmente transmissíveis ( Trichomonas vaginalis e Papilomavírus humano) no exame colpocitológico.Conclusão: Foram observadas condições de vulnerabilidade das mulheres indígenas a partir do seu perfil sexual e reprodutivo, com exposição às doenças sexualmente transmissíveis, câncer do colo do útero, início precoce da vida sexual e pouco acesso à informação e prevenção. Objetivo: Conocer el perfil de la salud sexual, reproductiva y los aspectos socioculturales de mujeres indígenas. Métodos: Estudio observacional, transversal y descriptivo realizado en ambulatorio de referencia en salud indígena entre 2010 y 2013. Se aplicó un formulario semi-estructurado con datos socioculturales, el histórico de la vida sexual y reproductiva. Se realizó el frotis cérvicovaginal. Se utilizó un análisis descriptivo con presentación de la media y desviación típica (SD) para las variables cuantitativas y números absolutos y relativos para las variables cualitativas. Resultados: La muestra fue de 90 indígenas con media de edad de 36 años (± SD 13,41) y pertenecientes de 35 etnias distintas. Para 75 mujeres (83,4%), la primera relación sexual se dio entre los 12 y 19 años, 74 (82,2 %) estaban en el periodo reproductivo y 36 (48,6%) usaban método anticonceptivo como el anticonceptivo hormonal y la ligadura de trompas. La media de partos fue de 4,6 para cada mujer; la media de edad del primer parto fue de 17,3 años (± SD 3,23); 23 de ellas (26,8%) tuvieron entre 1 y 3 abortos y 26 (31,2%) tuvieron una o más cesáreas. Se identificó alteraciones para atipias citológicas y enfermedades transmitidas sexualmente ( Trichomonas vaginalis e Papilomavirus humano) en la copocitología de ocho mujeres (8,9%). Conclusión: Se observó condiciones de vulnerabilidad de las mujeres indígenas a partir de su perfil sexual y reproductivo con exposición para las enfermedades transmitidas sexualmente, el cáncer de cuello uterino, el inicio temprano de la vida sexual y poca accesibilidad a la información y la prevención.

Objective: To know the profile of sexual and reproductive health and sociocultural aspects of indigenous women Methods: Observational and descriptive cross-sectional study conducted in an outpatient reference center for indigenous health in the period from 2010 to 2013. A semi-structured questionnaire containing socio-cultural data and history of sexual and reproductive life was applied. Cervicovaginal smear was collected. Descriptive analysis was conducted using mean and standard deviation (SD) for quantitative variables and absolute and relative numbers for qualitative variables. Results: The sample included 90 indigenous women with mean age of 36 years (±SD13.41), belonging to 35 ethnicities. A total of 75 women (83.4%) experienced the first sexual intercourse at age 12-19 years, 74 (82.2%) were at reproductive age, 36 (48.6%) used contraceptive methods such as hormonal contraceptives and tubal sterilization. There was a mean of 4.6 births per woman; average age at first childbirth was 17.3 years (±SD 3.23); 23 of the women (26.8%) had 1-3 abortions and 26 (31. 2%) had one or more cesarean deliveries. In all, eight women (8.9%) presented alterations for cytologic atypia and sexually transmitted diseases (Trichomonas vaginalis and Human Papillomavirus) in the Pap test. Conclusion: Vulnerable conditions for indigenous women were observed based on their sexual and reproductive profile, with exposure to sexually transmitted diseases, cervical cancer, early initiation of sexual activity and poor access to information and prevention.

Objetivo: Conhecer o perfil da saúde sexual, reprodutiva e aspectos socioculturais de mulheres indígenas. Métodos: Estudo observacional, transversal e descritivo, realizado em ambulatório de referência em saúde indígena, durante o período de 2010 a 2013. Aplicou- se um formulário semiestruturado contendo dados socioculturais, histórico de vida sexual e reprodutiva. Coletou-se o esfregaço cervicovaginal. Utilizou-se a análise descritiva, com apresentação de média e desvio padrão (DP) para variáveis quantitativas, e números absolutos e relativos para variáveis qualitativas. Resultados: A amostra constituiu-se de 90 indígenas, com idade média de 36 anos (± DP 13,41), pertencentes a 35 etnias. Para 75 mulheres (83,4%), a coitarca ocorreu na faixa etária de 12 a 19 anos, 74 (82,2 %) estavam em período reprodutivo e 36 (48,6%) usavam método contraceptivo, como o anticoncepcional hormonal e a laqueadura tubária. A média de partos foi de 4,6 por mulher; a idade média no primeiro parto foi de 17,3 anos (± DP 3,23); 23 delas (26,8%) tiveram de 1 a 3 abortamentos e 26 (31,2%) tiveram um ou mais partos cesáreas. Em oito mulheres (8,9%), identificaram- se alterações para atipias citológicas e doenças sexualmente transmissíveis ( Trichomonas vaginalis e Papilomavírus humano) no exame colpocitológico. Conclusão: Foram observadas condições de vulnerabilidade das mulheres indígenas a partir do seu perfil sexual e reprodutivo, com exposição às doenças sexualmente transmissíveis, câncer do colo do útero, início precoce da vida sexual e pouco acesso à informação e prevenção. Objective: To know the profile of sexual and reproductive health and sociocultural aspects of indigenous women. Methods: Observational and descriptive cross-sectional study conducted in an outpatient reference center for indigenous health in the period from 2010 to 2013. A semi-structured questionnaire containing socio-cultural data and history of sexual and reproductive life was applied. Cervicovaginal smear was collected. Descriptive analysis was conducted using mean and standard deviation (SD) for quantitative variables and absolute and relative numbers for qualitative variables. Results:The sample included 90 indigenous women with mean age of 36 years (±SD13.41), belonging to 35 ethnicities. A total of 75 women (83.4%) experienced the first sexual intercourse at age 12-19 years, 74 (82.2%) were at reproductive age, 36 (48.6%) used contraceptive methods such as hormonal contraceptives and tubal sterilization. There was a mean of 4.6 births per woman; average age at first childbirth was 17.3 years (±SD 3.23); 23 of the women (26.8%) had 1-3 abortions and 26 (31. 2%) had one or more cesarean deliveries. In all, eight women (8.9%) presented alterations for cytologic atypia and sexually transmitted diseases (Trichomonas vaginalis and Human Papillomavirus) in the Pap test.Conclusion: Vulnerable conditions for indigenous women were observed based on their sexual and reproductive profile, with exposure to sexually transmitted diseases, cervical cancer, early initiation of sexual activity and poor access to information and prevention. Objetivo: Conocer el perfil de la salud sexual, reproductiva y los aspectos socioculturales de mujeres indígenas. Métodos:Estudio observacional, transversal y descriptivo realizado en ambulatorio de referencia en salud indígena entre 2010 y 2013. Se aplicó un formulario semi-estructurado con datos socioculturales, el histórico de la vida sexual y reproductiva. Se realizó el frotis cérvico- vaginal. Se utilizó un análisis descriptivo con presentación de la media y desviación típica (SD) para las variables cuantitativas y números absolutos y relativos para las variables cualitativas. Resultados: La muestra fue de 90 indígenas con media de edad de 36 años (± SD 13,41) y pertenecientes de 35 etnias distintas. Para 75 mujeres (83,4%), la primera relación sexual se dio entre los 12 y 19 años, 74 (82,2 %) estaban en el periodo reproductivo y 36 (48,6%) usaban método anticonceptivo como el anticonceptivo hormonal y la ligadura de trompas. La media de partos fue de 4,6 para cada mujer; la media de edad del primer parto fue de 17,3 años (± SD 3,23); 23 de ellas (26,8%) tuvieron entre 1 y 3 abortos y 26 (31,2%) tuvieron una o más cesáreas. Se identificó alteraciones para atipias citológicas y enfermedades transmitidas sexualmente (Trichomonas vaginalis e Papilomavirus humano) en la copocitología de ocho mujeres (8,9%). Conclusión:Se observó condiciones de vulnerabilidad de las mujeres indígenas a partir de su perfil sexual y reproductivo con exposición para las enfermedades transmitidas sexualmente, el cáncer de cuello uterino, el inicio temprano de la vida sexual y poca accesibilidad a la información y la prevención.

Objetivo: Conhecer o perfil da saúde sexual, reprodutiva e aspectos socioculturais de mulheres indígenas. Métodos: Estudo observacional, transversal e descritivo, realizado em ambulatório de referência em saúde indígena, durante o período de 2010 a 2013. Aplicou-se um formulário semiestruturado contendo dados socioculturais, histórico de vida sexual e reprodutiva. Coletou-se o esfregaço cervicovaginal. Utilizou-se a análise descritiva, com apresentação de média e desvio padrão (DP) para variáveis quantitativas, e números absolutos e relativos para variáveis qualitativas. Resultados: A amostra constituiu-se de 90 indígenas, com idade média de 36 anos (± DP 13,41), pertencentes a 35 etnias. Para 75 mulheres (83,4%), a coitarca ocorreu na faixa etária de 12 a 19 anos, 74 (82,2 %) estavam em período reprodutivo e 36 (48,6%) usavam método contraceptivo, como o anticoncepcional hormonal e a laqueadura tubária. A média de partos foi de 4,6 por mulher; a idade média no primeiro parto foi de 17,3 anos (± DP 3,23); 23 delas (26,8%) tiveram de 1 a 3 abortamentos e 26 (31,2%) tiveram um ou mais partos cesáreas. Em oito mulheres (8,9%), identificaramse alterações para atipias citológicas e doenças sexualmente transmissíveis (Trichomonas vaginalis e Papilomavírus humano) no exame colpocitológico. Conclusão: Foram observadas condições de vulnerabilidade das mulheres indígenas a partir do seu perfil sexual e reprodutivo, com exposição às doenças sexualmente transmissíveis, câncer do colo do útero, início precoce da vida sexual e pouco acesso à informação e prevenção. doi: 10.5020/18061230.2014.p445 Objective: To know the profile of sexual and reproductive health and sociocultural aspects of indigenous women Methods: Observational and descriptive cross-sectional study conducted in an outpatient reference center for indigenous health in the period from 2010 to 2013. A semi-structured questionnaire containing socio-cultural data and history of sexual and reproductive life was applied. Cervicovaginal smear was collected. Descriptive analysis was conducted using mean and standard deviation (SD) for quantitative variables and absolute and relative numbers for qualitative variables. Results: The sample included 90 indigenous women with mean age of 36 years (±SD13.41), belonging to 35 ethnicities. A total of 75 women (83.4%) experienced the first sexual intercourse at age 12-19 years, 74 (82.2%) were at reproductive age, 36 (48.6%) used contraceptive methods such as hormonal contraceptives and tubal sterilization. There was a mean of 4.6 births per woman; average age at first childbirth was 17.3 years (±SD 3.23); 23 of the women (26.8%) had 1-3 abortions and 26 (31. 2%) had one or more cesarean deliveries. In all, eight women (8.9%) presented alterations for cytologic atypia and sexually transmitted diseases (Trichomonas vaginalis and Human Papillomavirus) in the Pap test. Conclusion: Vulnerable conditions for indigenous women were observed based on their sexual and reproductive profile, with exposure to sexually transmitted diseases, cervical cancer, early initiation of sexual activity and poor access to information and prevention. doi: 10.5020/18061230.2014.p445 Objetivo: Conocer el perfil de la salud sexual, reproductiva y los aspectos socioculturales de mujeres indígenas. Métodos: Estudio observacional, transversal y descriptivo realizado en ambulatório de referencia en salud indígena entre 2010 y 2013. Se aplico un formulario semi-estructurado con datos socioculturales, El histórico de la vida sexual y reproductiva. Se realizó el frotis cérvicovaginal. Se utilizó un análisis descriptivo con presentación de La media y desviación típica (SD) para las variables cuantitativas y números absolutos y relativos para las variables cualitativas. Resultados: La muestra fue de 90 indígenas con media de edad de 36 años (± SD 13,41) y pertenecientes de 35 etnias distintas. Para 75 mujeres (83,4%), la primera relación sexual se dio entre los 12 y 19 años, 74 (82,2 %) estaban en el periodo reproductivo y 36 (48,6%) usaban método anticonceptivo como el anticonceptivo hormonal y la ligadura de trompas. La media de partos fue de 4,6 para cada mujer; la media de edad del primer parto fue de 17,3 años (± SD 3,23); 23 de ellas (26,8%) tuvieron entre 1 y 3 abortos y 26 (31,2%) tuvieron una o más cesáreas. Se identifico alteraciones para atipias citológicas y enfermedades transmitidas sexualmente (Trichomonas vaginalis e Papilomavirus humano) en la copocitología de ocho mujeres (8,9%). Conclusión: Se observó condiciones de vulnerabilidad de las mujeres indígenas a partir de su perfil sexual y reproductivo con exposición para las enfermedades transmitidas sexualmente, el cáncer de cuello uterino, el inicio temprano de la vida sexual y poca accesibilidad a la información y la prevención. doi: 10.5020/18061230.2014.p445