Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App

BACKGROUND

In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently.

METHODS

All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated.

RESULTS

A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.

CONCLUSIONS

VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

The Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Ageing

Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, and the development of sustainable economic growth and the creation of jobs.

Transfer of innovation on allergic rhinitis and asthma multimorbidity in the elderly (MACVIA-ARIA) - EIP on AHA Twinning Reference Site (GARD research demonstration project)

The overarching goals of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) are to enable European citizens to lead healthy, active and independent lives whilst ageing. The EIP on AHA includes 74 Reference Sites. The aim of this study was to transfer innovation from an app developed by the MACVIA-France EIP on AHA reference site (Allergy Diary) to other reference sites. The phenotypic characteristics of rhinitis and asthma multimorbidity in adults and the elderly will be compared using validated information and communication technology (ICT) tools (i.e. the Allergy Diary and CARAT: Control of Allergic Rhinitis and Asthma Test) in 22 Reference Sites or regions across Europe. This will improve the understanding, assessment of burden, diagnosis and management of rhinitis in the elderly by comparison with an adult population. Specific objectives will be: (i) to assess the percentage of adults and elderly who are able to use the Allergy Diary, (ii) to study the phenotypic characteristics and treatment over a 1-year period of rhinitis and asthma multimorbidity at baseline (cross-sectional study) and (iii) to follow-up using visual analogue scale (VAS). This part of the study may provide some insight into the differences between the elderly and adults in terms of response to treatment and practice. Finally (iv) work productivity will be examined in adults.

HeartDrive: A Broader Concept of Interoperability to Implement Care Processes for Heart Failure

This paper originates from the HeartDrive project, a platform of services for a more effective, efficient and integrated management of heart failure and comorbidities. HeartDrive establishes a cooperative approach based on the concepts of continuity of care and extreme, patient oriented, customization of diagnostic, therapeutic and follow-up procedures. Definition and development of evidence based processes, migration from parceled and episode based healthcare provisioning to a workflow oriented model and increased awareness and responsibility of citizens towards their own health and wellness are key objectives of HeartDrive. In two scenarios for rehabilitation and home monitoring we show how the results are achieved by providing a solution that highlights a broader concept of cooperation that goes beyond technical interoperability towards semantic interoperability explicitly sharing process definitions, decision support strategies and information semantics.

Genetic markers to discriminate benign and malignant thyroid nodules with undetermined cytology in an area of borderline iodine deficiency

BACKGROUND

Fine needle aspiration (FNA) with cytologic evaluation is the most reliable tool for malignancy prediction in thyroid nodules, but cytologic diagnosis remains undetermined for 20% of nodules.

AIM

We investigated the diagnostic potential of a set of 6 marker genes to distinguish benign and malignant thyroid nodules.

SUBJECTS AND METHODS

The prospective study included 153 thyroid samples obtained by FNA of thyroid nodules from 151 patients (56 benign, 43 malignant, and 54 nodules with undetermined cytology). Gene expression was evaluated by quantitative realtime PCR and statistical analysis of data was performed. All samples were analyzed for V600E BRAF mutation.

RESULTS

A decrease in TTF3 and HGD1 expression was observed in malignant nodules with respect to benign ones, while an increase in PLAB expression was demonstrated in these nodules. The decision model was valid for 88 of 99 cases of benign and malignant nodules, with a total of 11 false positive or negative predictions. The obtained malignant/benign phenotype prediction was also valid for 37 of 54 cases of nodules with undetermined cytology with a total of 8 false positive and 9 false negative predictions. V600E BRAF gene mutation was demonstrated in 19/43 malignant nodules, in 0/56 benign nodules, and in 1/54 undetermined nodules.

CONCLUSIONS

The expression profiles of genes (TFF3, HGD1, and PLAB) allowed a good prediction for the differentiation of benign thyroid lesions and thyroid cancer starting from cells of FNA; however, this assay showed limitations when applied to discriminate thyroid nodules with undetermined cytology.

Prediction of chronic allograft nephropathy using classification trees

INTRODUCTION

For its intrinsic potential to mine causal relations, machine learning techniques are useful to identify new risk indicators. In this work, we have shown two classification trees to predict chronic allograft nephropathy (CAN), through an evaluation of routine blood and urine tests.

METHODS

We retrospectively analyzed 80 renal transplant patients with 60-month follow-up (mean = 55.20 +/- 12.74) including 52 males and 28 females of overall average age of 41.65 +/- 12.52 years. The primary endpoint was biopsy-proven CAN within 5 years from transplantation (n = 16). Exclusion criteria were multiorgan transplantations, patients aged less than 18 years, graft failure, or patient death in the first 6 months posttransplantation. Classification trees based on the C 4.8 algorithm were used to predict CAN development starting from patient features at transplantation and biochemical test at 6-month follow-up. Model performance was showed as sensitivity (S), false-positive rate (FPR), and area under the receiver operating characteristic curve (AUC).

RESULTS

The two class of patients (no CAN versus CAN) showed significant differences in serum creatinine, estimated Glomerular Filtration Rate with Modification of Diet in Renal Disease study formula (MDRD), serum hemoglobin, hematocrit, blood urea nitrogen, and 24-hour urine protein excretion. Among the 23 evaluated variables, the first model selected six predictors of CAN, showing S = 62.5%, TFP = 7.2%, and AUC = 0.847 (confidence interval [CI] 0.749-0.945). The second model selected four variables, showing S = 81.3%, TFP = 25%, and AUC = 0.824 (CI 0.713-0.934).

CONCLUSIONS

Identification models have predicted the onset of multifactorial, complex pathology, like CAN. The use of classification trees represent a valid alternative to traditional statistical models, especially for the evaluation of interactions of risk factors.

Personal Interaction in the Vegetative State

Background and purpose: Brain processing at varying levels of functional complexity and emotional reactions to relatives are anecdotally reported by the caregivers of patients in a vegetative state. In this study, computer-assisted machine-learning procedures were applied to identify heart rate variability changes or galvanic skin responses to a relative’s presence. Methods: The skin conductance (galvanic skin response) and heart beats were continuously recorded in 12 patients in a vegetative state, at rest (baseline) and while approached by a relative (usually the mother; test condition) or by a nonfamiliar person (control condition). The cardiotachogram (the series of consecutive intervals between heart beats) was analyzed in the time and frequency domains by computing the parametric and nonparametric frequency spectra. A machine-learning algorithm was applied to sort out the significant spectral parameter(s). For all patients, each condition (baseline, test, control) was characterized by the values of its spectral parameters, and the association between spectral parameters values and experimental condition was tested (WEKA machine-learning software). Results and comments: A galvanic skin response was obtained in two patients. The machine-learning procedure independently selected the nu_LF spectral parameter and attributed each nu_LF measure to any of the three experimental conditions. 69.4% of attributions were correct (baseline: 58%; test condition: 75%; control. 75%). In seven patients, attribution changed when the subject was approached by the test person; specifically, sequential shifts from baseline to test condition (“the Mom effect”) to control condition were identified in four patients (30.0%); the change from test to control was attributed correctly in seven patients (58%). The observation of heart rate changes tentatively attributable to emotional reaction in a vegetative state suggest residual rudimentary personal interaction, consistent with functioning limbic and paralimbic systems after massive brain damage. Machine-learning proved applicable to sort significant measure(s) out of large samples and to control for statistical alpha inflation.

Heart Rate Response to Music

Background and rationale: Investigation of the brain’s emotional response to music is limited by methodological problems mainly related to the characterization of the emotions and concomitant brain conditions. In this study, artificial intelligence procedures were applied to identify significant music-induced changes in heart rate variability and to classify autonomic reactions to stimuli requiring complex brain operations. Both healthy subjects and traumatic brain-injury (TBI) patients were studied in order to test the method’s validity. Methods: 16 TBI patents and 26 healthy subjects were requested to listen to selected music samples while the heart beat was continuously recorded. The parametric and nonparametric frequency spectra were computed on the heart rate and the spectra descriptors were entered into a 1-R rules (very simple classification rules) data-mining procedure. Data-mining procedures independently classified the heart-rate spectral patterns and the emotions reported by subjects as positive, indifferent, or negative. Results and conclusions: The data-mining procedures sorted the nu_LF descriptor as the spectral parameter that allowed clustering the emotions reported by the subjects as positive and negative. Classification by nu_LF was comparable to that by self-reported emotions, with an overall correct classification by author in 76.0% of controls and 70% of patients. The identification of negative and positive emotions was correct in 81.3% and 68.9% of controls and in 65% and 74% of TBI patients, without significant differences between healthy subjects and TBI patients. This observation suggests that autonomic concomitants of emotions are detectable in response to complex emotional stimuli.

Serum cholesterol and psychological distress in hospitalized depressed patients

OBJECTIVE

To assess the relationship between total serum cholesterol and various psychosocial variables in depressed in-patients.

METHOD

One hundred and eighty-six patients had their total fasting serum cholesterol assessed following admission; psychiatric diagnoses were obtained with the structured clinical interview for DSM-IV (SCID) interview. Psychopathology was measured with a clinician rated scale [Montgomery and Asberg Depressive Rating Scale (MADRS)] and a self-rating scale [Symptom checklist-90 (SCL-90)].

RESULTS

Univariate analyses showed lower total serum cholesterol levels being correlated with higher scores in several psychopathological areas. Multivariate analyses indicated that male gender, lower age and higher MADRS scores were the most predictive variables for lower cholesterol levels.

CONCLUSION

The data suggest, in this depressed population, an association between serum cholesterol and depressive symptoms. What is the cause and what is its effect is not possible to say from this cross-sectional study.

Social adjustment in bipolar and unipolar single-episode and recurrently depressed inpatients

Social adjustment scores were compared using the Social Adjustment Scale for 24 inpatients with single-episode major depression, 72 with recurrent major depression, and 28 with bipolar disorder. There were no differences between the three groups either in overall score or on single scales.

Extrapyramidal symptoms associated with the adjunct of nortriptyline to a venlafaxine-valproic acid combination

The onset of extrapyramidal symptoms has been traditionally linked to the prescription of neuroleptic treatment: there are some reports in the international literature describing extrapyramidal effects related to antidepressant. In this paper we present a case under multiple pharmacologic treatment in whom extrapyramidal symptoms developed shortly after the adjunct of nortriptyline to a combination of venlafaxine and valproic acid administered for several months. We describe here the clinical history of this patient, affected by Bipolar Disorder, type II, and the progressive pharmacologic path in his treatment. Possible hypothesis to explain this evidence are discussed.

A century of suicide in Italy: a comparison between the old and the young

This study analyzes suicide rates from 1887 to 1993 in the Italian population between the ages of 15 and 24 years old and over 65 years of age, based on official data published in the Health Statistics Year Book. The rates of death by suicide (per 100,000) subjects) are calculated for each year and for 10-year periods, as are the mortality rates relative to each method of suicide, standardized by gender. The latter analysis was possible starting from 1951 only, when it became customary to record method. The findings indicate an increase in the suicide phenomenon in the elderly population in Italy over the test period. Rates are at least 3 times higher for men than for women. The highest rates are reported for elderly men, but there appears to have been a greater proportional increase in the number of suicides committed by elderly women. The rise was statistically significant in both males and females. By contrast, a rather constant decrease in suicide rates in young people emerges from the beginning of the century through to the present date. This decrease is more marked in females, although suicide rates are lower for females than for males. Over the study period, substantial changes have come about in the suicide methods used by both young and old people. There was an increase in poisoning by care exhaust fumes, jumping from heights, hanging, and firearms.

Elderly care. A pilot project on opportunistic geriatric assessments in general practice

OBJECTIVES

To develop a pilot program for systematic assessment of functional status of the elderly in general practice.

METHOD

The program was developed in consultation with local GPs and aged care services and introduced to GPs at a workshop. The program was piloted for seven general practitioners with 41 patients, 70 years or older.

RESULTS

While many problems had been previously identified by GPs additional problems with: home and social life; activities of daily living and mobility; cognition and depression; general health and medication problems were found in up to 2.5% of patients.

CONCLUSION

Opportunistic health assessment of the elderly in general practice is practical and useful in detecting health problems.