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Barbieri G, Garcia-Larsen V, Lundin R, Fujii R, Melotti R, Gögele M, Christopher KB, Cazzoletti L, Pramstaller PP, Zanolin ME, Pattaro C, Hantikainen E. Associations Between Dietary Patterns and Kidney Health Assessed in the Population-Based CHRIS Study Using Reduced Rank Regression. J Ren Nutr 2024:S1051-2276(24)00051-7. [PMID: 38521380 DOI: 10.1053/j.jrn.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/22/2023] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE While diet plays a key role in chronic kidney disease (CKD) management, the potential for diet to impact CKD prevention in the general population is less clear. Using a priori knowledge, we derived disease-related dietary patterns (DPs) through reduced rank regression (RRR) and investigated associations with kidney function, separately focusing on generally healthy individuals and those with self-reported kidney diseases, hypertension, or diabetes mellitus. METHODS Eight thousand six hundred eighty-six participants from the population-based Cooperative Health Research in South Tyrol study were split into a group free of kidney disease, hypertension and diabetes (n = 6,133) and a group with any of the 3 conditions (n = 2,553). Diet was assessed through the self-administered Global Allergy and Asthma Network of Excellence food frequency questionnaire and DPs were derived through RRR selecting food frequency questionnaire-derived sodium, potassium, phosphorus, and protein intake as mediators. Outcomes were creatinine-based estimated glomerular filtration rate, urinary albumin-to-creatinine ratio, CKD and microalbuminuria. Multiple linear and logistic models were used to assess associations between RRR-based DPs and kidney outcomes separately in the 2 analytic groups. RESULTS We identified 3 DPs, where high adherence reflected high levels of all nutrients (DP1), high potassium-phosphorus and low protein-sodium levels (DP2), and low potassium-sodium and high protein-phosphorus levels (DP3), respectively. We observed heterogeneous associations with kidney outcomes, varying by analytic group and sex. Kidney outcomes were much more strongly associated with DPs than with single nutrients. CONCLUSION RRR is a feasible approach to estimate disease-related DPs and explore the combined effects of nutrients on kidney health. Heterogeneous associations across kidney outcomes suggest possible specificity to kidney function or damage. In individuals reporting kidney disease, hypertension or diabetes, specific dietary habits were associated with better kidney health, indicating that disease-specific dietary interventions can be effective for disease control.
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Affiliation(s)
- Giulia Barbieri
- Institute for Biomedicine, Eurac Research, Bolzano, Bozen, Italy; Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Vanessa Garcia-Larsen
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rebecca Lundin
- Institute for Biomedicine, Eurac Research, Bolzano, Bozen, Italy
| | - Ryosuke Fujii
- Institute for Biomedicine, Eurac Research, Bolzano, Bozen, Italy; Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, Toyoake, Japan
| | - Roberto Melotti
- Institute for Biomedicine, Eurac Research, Bolzano, Bozen, Italy
| | - Martin Gögele
- Institute for Biomedicine, Eurac Research, Bolzano, Bozen, Italy
| | - Kenneth B Christopher
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Maria Elisabetta Zanolin
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Cristian Pattaro
- Institute for Biomedicine, Eurac Research, Bolzano, Bozen, Italy
| | - Essi Hantikainen
- Institute for Biomedicine, Eurac Research, Bolzano, Bozen, Italy.
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Brogna C, Montano L, Zanolin ME, Bisaccia DR, Ciammetti G, Viduto V, Fabrowski M, Baig AM, Gerlach J, Gennaro I, Bignardi E, Brogna B, Frongillo A, Cristoni S, Piscopo M. A retrospective cohort study on early antibiotic use in vaccinated and unvaccinated COVID-19 patients. J Med Virol 2024; 96:e29507. [PMID: 38504586 DOI: 10.1002/jmv.29507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/21/2024]
Abstract
The bacteriophage behavior of SARS-CoV-2 during the acute and post-COVID-19 phases appears to be an important factor in the development of the disease. The early use of antibiotics seems to be crucial to inhibit disease progression-to prevent viral replication in the gut microbiome, and control toxicological production from the human microbiome. To study the impact of specific antibiotics on recovery from COVID-19 and long COVID (LC) taking into account: vaccination status, comorbidities, SARS-CoV-2 wave, time of initiation of antibiotic therapy and concomitant use of corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs). A total of 211 COVID-19 patients were included in the study: of which 59 were vaccinated with mRNA vaccines against SARS-CoV-2 while 152 were unvaccinated. Patients were enrolled in three waves: from September 2020 to October 2022, corresponding to the emergence of the pre-Delta, Delta, and Omicron variants of the SARS-CoV-2 virus. The three criteria for enrolling patients were: oropharyngeal swab positivity or fecal findings; moderate symptoms with antibiotic intake; and measurement of blood oxygen saturation during the period of illness. The use of antibiotic combinations, such as amoxicillin with clavulanic acid (875 + 125 mg tablets, every 12 h) plus rifaximin (400 mg tablets every 12 h), as first choice, as suggested from the previous data, or azithromycin (500 mg tablets every 24 h), plus rifaximin as above, allows healthcare professionals to focus on the gut microbiome and its implications in COVID-19 disease during patient care. The primary outcome measured in this study was the estimated average treatment effect, which quantified the difference in mean recovery between patients receiving antibiotics and those not receiving antibiotics at 3 and 9 days after the start of treatment. In the analysis, both vaccinated and unvaccinated groups had a median illness duration of 7 days (interquartile range [IQR] 6-9 days for each; recovery crude hazard ratio [HR] = 0.94, p = 0.700). The median illness duration for the pre-Delta and Delta waves was 8 days (IQR 7-10 days), while it was shorter, 6.5 days, for Omicron (IQR 6-8 days; recovery crude HR = 1.71, p < 0.001). These results were confirmed by multivariate analysis. Patients with comorbidities had a significantly longer disease duration: median 8 days (IQR 7-10 days) compared to 7 days (IQR 6-8 days) for those without comorbidities (crude HR = 0.75, p = 0.038), but this result was not confirmed in multivariate analysis as statistical significance was lost. Early initiation of antibiotic therapy resulted in a significantly shorter recovery time (crude HR = 4.74, p < 0.001). Concomitant use of NSAIDs did not reduce disease duration and in multivariate analysis prolonged the disease (p = 0.041). A subgroup of 42 patients receiving corticosteroids for a median of 3 days (IQR 3-6 days) had a longer recovery time (median 9 days, IQR 8-10 days) compared to others (median 7 days, IQR 6-8 days; crude HR = 0.542, p < 0.001), as confirmed also by the adjusted HR. In this study, a statistically significant reduction in recovery time was observed among patients who received early antibiotic treatment. Early initiation of antibiotics played a crucial role in maintaining higher levels of blood oxygen saturation. In addition, it is worth noting that a significant number of patients who received antibiotics in the first 3 days and for a duration of 7 days, during the acute phase did not develop LC.
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Affiliation(s)
- Carlo Brogna
- Craniomed Group Srl. Research Facility, Bresso, Italy
| | - Luigi Montano
- Andrology Unit and Service of Lifestyle Medicine in Uro-Andrology, Local Health Authority (ASL), Salerno, Italy
| | | | | | - Gianluca Ciammetti
- Otorhinolaryngology Unit, Hospital Ferdinando Veneziale Isernia, Regional Health Authority of Molise, Italy
| | | | - Mark Fabrowski
- Department of Emergency Medicine, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Abdul M Baig
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Iapicca Gennaro
- Pineta Grande Hospital Group, Department of Urology, Santa Rita Clinic, Atripalda, Italy
| | | | - Barbara Brogna
- Department of Radiology, Moscati Hospital, Avellino, Italy
| | | | | | - Marina Piscopo
- Department of Biology, University of Naples Federico II, Naples, Italy
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Di Gennaro G, Chamitava L, Pertile P, Ambrosi E, Mosci D, Fila A, Alemayohu MA, Cazzoletti L, Tardivo S, Zanolin ME. A stepped-wedge randomised controlled trial to assess efficacy and cost-effectiveness of a care-bundle to prevent falls in older hospitalised patients. Age Ageing 2024; 53:afad244. [PMID: 38251740 PMCID: PMC10801830 DOI: 10.1093/ageing/afad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Patient accidental falls in a hospital environment are a serious problem for patient safety, and for the additional costs due to associated medical interventions. OBJECTIVE The endpoints of this study were the assessment of the fall incidence in the hospital before and after the implementation of a multidisciplinary care-bundle, along with a cost-effectiveness evaluation. DESIGN A stepped-wedge trial was conducted between April 2015 and December 2016 in Bologna University Hospital. METHODS Incidence rates (IRs) of falls in both the control and intervention periods were calculated. A multilevel mixed-effects generalised linear model with logit link function, adjusted for age, sex, cluster cross-over timing and patients' clinical severity was used to estimate odds ratios (OR) of fall risk of patients of the intervention group respect to the controls.Intervention costs associated with the introduction of the care-bundle intervention were spread between patients per cluster-period-group of exposure. Incremental cost-effectiveness ratio was evaluated using total costs in the intervention and control groups. RESULTS IRs of falls in control and intervention periods were respectively 3.15 and 2.58 for 1,000 bed-days. After adjustment, the subjects receiving the intervention had a statistically significant reduced risk of falling with respect to those who did not (OR = 0.71, 95% confidence interval: 0.60-0.84). According to the cost-effectiveness analysis, the incremental cost per fall prevented was €873.92 considering all costs, and €1644.45 excluding costs related falls. CONCLUSIONS Care-bundle had a protective effect on patients, with a statistically significant reduction of the fall risk. This type of intervention appears cost-effective compared to routine practices.
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Affiliation(s)
- Gianfranco Di Gennaro
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Liliya Chamitava
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Paolo Pertile
- Department of Economics, University of Verona, Verona, Italy
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Daniela Mosci
- Hospital Hygiene and Prevention, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alice Fila
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Lucia Cazzoletti
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Stefano Tardivo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Alemayohu MA, Zanolin ME, Cazzoletti L, Nyasulu P, Garcia-Larsen V. Burden and risk factors of chronic obstructive pulmonary disease in Sub-Saharan African countries, 1990-2019: a systematic analysis for the Global Burden of disease study 2019. EClinicalMedicine 2023; 64:102215. [PMID: 37799614 PMCID: PMC10550520 DOI: 10.1016/j.eclinm.2023.102215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Abstract
Background Sub-Saharan Africa (SSA) has experienced a surge of non-communicable diseases (NCDs) including chronic obstructive pulmonary disease (COPD) over the past two decades. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), in this study we have estimated the burden and attributable risk factors of COPD across SSA countries between 1990 and 2019. Methods COPD burden and its attributable risk factors were estimated using data from the 2019 GBD. Percentage change was estimated to show the trend of COPD estimates from 1990 to 2019. COPD estimates attributable by risk factors were also reported to ascertain the risk factor that brings the greatest burden by sex and locations (at country and regions level). Findings In 2019, all-age prevalent cases of COPD in SSA were estimated to be 10.3 million (95% Uncertainty Intervals (UI) 9.7 million to 10.9 million) showing an increase of 117% compared with the number of all-age COPD cases in 1990. From 1990 to 2019, SSA underwent an increased percentage change in all-age YLDs due to COPD ranging from 41% in Lesotho to 203% in Equatorial Guinea. The largest premature mortality due to COPD was reported from Central SSA accounting for 729 subjects (95% UI, 509-1078). The highest rate of DALYs attributable to COPD was observed in Lesotho. Household air pollution from solid fuel was the primary contributor of the age standardized YLDs, death rate, and DALYs rate per 100,000 population. Interpretation The prevalence of COPD in SSA has had a steady increase over the past three decades and has progressively become a major public health burden across the region. Household air pollution from solid fuel is the primary contributor to COPD related burden, and its percentage contribution showed a similar trend to the reduction of COPD attributed age-standardized DALY rate. The methodological limitations of surveys and datapoints included in the GBD need to be considered when interpreting these associations. Funding There are no specific fundings received for this study. The Global Burden of Disease study was supported by funding from the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Mulubirhan Assefa Alemayohu
- Unit of Epidemiology and Medical Statistics, University of Verona, Italy
- School Public Health, Mekelle University, Ethiopia
- Biostatistics and Clinical Epidemiology Unit, Department of Public Health, Experimental and Forensic Medicin, University of Pavia, 27100, Pavia, Italy
| | | | - Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, University of Verona, Italy
| | - Peter Nyasulu
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Vanessa Garcia-Larsen
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Tocco Tussardi I, Cazzoletti L, Zanolin ME, Comini A, Visentin D, Torri E, Tardivo S, Moretti F. Patient Safety Subcultures among Nursing Home Staff in Italy: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:1962. [PMID: 37444796 DOI: 10.3390/healthcare11131962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Nursing home (NH) residents are vulnerable subjects and highly susceptible to adverse events. Knowledge of patient safety culture (PSC) is essential for an organization to ensure patient safety. However, research on PSC in NHs, and its variability among staff, is still scarce. This study aimed to explore whether and how PSC differed among NH staff (Managers, Nurses, Direct Care Staff, Support Staff, Administrative Staff and Other Providers) in the Autonomous Province of Trento, Italy. This study employed a cross-sectional design and collected data from 1145 NH providers using the Nursing Home Survey on Patient Safety Culture (NHSPSC). Data were analyzed using linear mixed models, with each of the 12 NHSPSC domains as a response variable. The majority of the respondents (61.6%) were Direct Care Staff members. 'Feedback and Communication about Incidents' and 'Overall Perceptions of Resident Safety' were the domains with the highest proportions of positive answers (PPAs). For most staff categories, 'Staffing' was the domain with the lowest PPA. Support Staff showed significantly lower scores in the majority of domains (8/12). Shorter job tenure, fewer weekly working hours, working mostly during the day and working in highly specialized areas were associated with higher scores in several domains. Interventions to improve PSC must consider the differences between professional groups. Further research is needed to explore the relationship between job-related features and perceptions of patient safety among NH workers.
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Affiliation(s)
- Ilaria Tocco Tussardi
- Department of Diagnostics and Public Health, Section of Hygiene, University of Verona, 37134 Verona, Italy
| | - Lucia Cazzoletti
- Department of Diagnostics and Public Health, Section of Epidemiology and Medical Statistics, University of Verona, 37134 Verona, Italy
| | - Maria Elisabetta Zanolin
- Department of Diagnostics and Public Health, Section of Epidemiology and Medical Statistics, University of Verona, 37134 Verona, Italy
| | - Annarita Comini
- Department of Diagnostics and Public Health, Section of Hygiene, University of Verona, 37134 Verona, Italy
| | - Donatella Visentin
- Department of Prevention, Healthcare Trust of the Autonomous Province of Trento, 38123 Trento, Italy
| | - Emanuele Torri
- Clinical Governance Service, Healthcare Trust of the Autonomous Province of Trento, 38123 Trento, Italy
| | - Stefano Tardivo
- Department of Diagnostics and Public Health, Section of Hygiene, University of Verona, 37134 Verona, Italy
| | - Francesca Moretti
- Department of Neurosciences, Biomedicine and Movement, University of Verona, 37134 Verona, Italy
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Di Vico IA, Stone J, Mcwhirter L, Riello M, Zanolin ME, Colombari M, Fiorio M, Tinazzi M. Performance validity tests in nonlitigant patients with functional motor disorder. Eur J Neurol 2023; 30:806-812. [PMID: 36692870 DOI: 10.1111/ene.15703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/09/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Performance validity tests (PVTs) are used in neuropsychological assessments to detect patterns of performance suggesting that the broader evaluation may be an invalid reflection of an individual's abilities. Data on functional motor disorder (FMD) are currently poor and conflicting. We aimed to examine the rate of failure on three different PVTs of nonlitigant, non-compensation-seeking FMD patients, and we compared their performance to that of healthy controls and controls asked to simulate malingering (healthy simulators). METHODS We enrolled 29 nonlitigant, non-compensation-seeking patients with a clinical diagnosis of FMD, 29 healthy controls, and 29 healthy simulators. Three PVTs, the Coin in the Hand Test (CIH), the Rey 15-Item Test (REY), and the Finger Tapping Test (FTT), were employed. RESULTS Functional motor disorder patients showed low rates of failure on the CIH and REY (7% and 10%, respectively) and slightly higher rates on the FTT (15%, n = 26), which implies a motor task. Their performance was statistically comparable to that of healthy controls but statistically different from that of healthy simulators (p < 0.001). Ninety-three percent of FMD patients, 7% of healthy simulators, and 100% of healthy controls passed at least two of the three tests. CONCLUSIONS Performance validity test performance of nonlitigant, non-compensation-seeking patients with FMD ranged from 7% to 15%. Patients' performance was comparable to that of controls and significantly differed from that of simulators. This simple battery of three PVTs could be of practical utility and routinely used in clinical practice.
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Affiliation(s)
- Ilaria A Di Vico
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
- Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, New York, New York, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Laura Mcwhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Marianna Riello
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Elisabetta Zanolin
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Michela Colombari
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
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Cazzoletti L, Zanolin ME, Dorelli G, Ferrari P, Dalle Carbonare LG, Crisafulli E, Alemayohu MA, Olivieri M, Verlato G, Ferrari M. Six-minute walk distance in healthy subjects: reference standards from a general population sample. Respir Res 2022; 23:83. [PMID: 35382813 PMCID: PMC8985335 DOI: 10.1186/s12931-022-02003-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/23/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The 6-min walking distance (6MWD) test is a useful tool to obtain a measure of functional exercise capacity. However, reference equations have been mainly based on selected populations or small samples. The purpose of this study was to determine the reference equations to predict the 6MWD in a large Italian population sample of healthy adults of a wide age range. Methods In the frame of the multi case–control population-based study Gene Environment Interaction in Respiratory Diseases (GEIRD), we studied 530 healthy subjects: 287 females ranging 21–76 and 243 males ranging 21–78 years of age. We measured 6MWD, demographic and anthropometric data and collected the reported physical activity. A multiple linear regression model for the 6MWD included age, age2, height, weight and physical activity for both sex equations. The two-way interaction age-height and age-weight and the quadratic terms of weight and height were also tested for inclusion separately in each model. Results The mean ± SD for 6MWD was 581.4 ± 66.5 m (range 383–800 m) for females and 608.7 ± 80.1 m (range 410–875 m) for males. The reference equations were 6MWD = 8.10*age + 1.61*heightcm−0.99*weightkg + 22.58*active−0.10*age2 + 222.55 for females (R squared = 0.238) and 6MWD = 26.80*age + 8.46*heightcm−0.45*weightkg−2.54*active−0.06*age2−0.13*age*heightcm−890.18 for males (R squared = 0.159), where “active” is 1 when the subject is physically active, 0 otherwise. Conclusion This study is the first to describe the 6MWD in a large population sample of young, middle aged and elderly healthy Caucasian subjects, and to determine reference equations. These findings will help to improve the evaluation of Italian and European patients with diseases influencing their functional capacity.
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Affiliation(s)
- Lucia Cazzoletti
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie, 8, 37134, Verona, Italy.
| | - Maria Elisabetta Zanolin
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie, 8, 37134, Verona, Italy
| | - Gianluigi Dorelli
- School of Medicine in Sports and Exercise, Department of Medicine, University of Verona, Verona, Italy
| | - Pietro Ferrari
- School of Medicine in Sports and Exercise, Department of Medicine, University of Verona, Verona, Italy
| | | | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Mulubirhan Assefa Alemayohu
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie, 8, 37134, Verona, Italy.,Department of Epidemiology, School of Public Health, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mario Olivieri
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie, 8, 37134, Verona, Italy
| | - Marcello Ferrari
- School of Medicine in Sports and Exercise, Department of Medicine, University of Verona, Verona, Italy.,Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Cazzoletti L, Zanolin ME, Tocco Tussardi I, Alemayohu MA, Zanetel E, Visentin D, Fabbri L, Giordani M, Ruscitti G, Benetollo PP, Tardivo S, Torri E. Correction: Cazzoletti et al. Risk Factors Associated with Nursing Home COVID-19 Outbreaks: A Retrospective Cohort Study. Int. J. Environ. Res. Public Health 2021, 18, 8434. Int J Environ Res Public Health 2021; 18:ijerph182413175. [PMID: 34949038 PMCID: PMC8701741 DOI: 10.3390/ijerph182413175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Lucia Cazzoletti
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (M.E.Z.); (I.T.T.); (M.A.A.); (E.Z.); (D.V.)
| | - Maria Elisabetta Zanolin
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (M.E.Z.); (I.T.T.); (M.A.A.); (E.Z.); (D.V.)
| | - Ilaria Tocco Tussardi
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (M.E.Z.); (I.T.T.); (M.A.A.); (E.Z.); (D.V.)
| | - Mulubirhan Assefa Alemayohu
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (M.E.Z.); (I.T.T.); (M.A.A.); (E.Z.); (D.V.)
| | - Ernesto Zanetel
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (M.E.Z.); (I.T.T.); (M.A.A.); (E.Z.); (D.V.)
| | - Donatella Visentin
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (M.E.Z.); (I.T.T.); (M.A.A.); (E.Z.); (D.V.)
| | - Luca Fabbri
- Azienda Provinciale per i Servizi Sanitari, Autonomous Province of Trento, 38123 Trento, Italy; (L.F.); (P.P.B.)
| | - Massimo Giordani
- Unione Provinciale Istituzioni per l’Assistenza, Autonomous Province of Trento, 38122 Trento, Italy;
| | - Giancarlo Ruscitti
- Department of Health and Social Policies, Autonomous Province of Trento, 38123 Trento, Italy; (G.R.); (E.T.)
| | - Pier Paolo Benetollo
- Azienda Provinciale per i Servizi Sanitari, Autonomous Province of Trento, 38123 Trento, Italy; (L.F.); (P.P.B.)
| | - Stefano Tardivo
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (M.E.Z.); (I.T.T.); (M.A.A.); (E.Z.); (D.V.)
- Correspondence: ; Tel.: +39-045-802-7660
| | - Emanuele Torri
- Department of Health and Social Policies, Autonomous Province of Trento, 38123 Trento, Italy; (G.R.); (E.T.)
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Di Vico IA, Riello M, Marotta A, Colombari M, Sandri A, Tinazzi M, Zanolin ME. The impact of lockdown on Functional Motor Disorders patients during the first COVID-19 outbreak: acase-control study. Parkinsonism Relat Disord 2021; 93:40-42. [PMID: 34784525 PMCID: PMC8590517 DOI: 10.1016/j.parkreldis.2021.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/04/2021] [Accepted: 11/07/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Ilaria A Di Vico
- Neurology Unit, Movement Disorders Division, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy.
| | - Marianna Riello
- Neurology Unit, Movement Disorders Division, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Angela Marotta
- Neurology Unit, Movement Disorders Division, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Michela Colombari
- Neurology Unit, Movement Disorders Division, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Angela Sandri
- Neurology Unit, Movement Disorders Division, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy.
| | - Maria Elisabetta Zanolin
- Neurology Unit, Movement Disorders Division, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Public Health and Community Medicine, University and Hospital Trust of Verona, 37134, Verona, Italy
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Cazzoletti L, Zanolin ME, Antonicelli L, Battaglia S, Bono R, Corsico A, Murgia N, Olivieri M, Pirina P, Verlato G, Ferrari M. Relationship status and respiratory diseases: an analysis on a general population sample. Epidemiology 2021. [DOI: 10.1183/13993003.congress-2021.pa3514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Zoccante L, Ciceri ML, Chamitava L, Di Gennaro G, Cazzoletti L, Zanolin ME, Darra F, Colizzi M. Postural Control in Childhood: Investigating the Neurodevelopmental Gradient Hypothesis. Int J Environ Res Public Health 2021; 18:ijerph18041693. [PMID: 33578752 PMCID: PMC7916459 DOI: 10.3390/ijerph18041693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 01/26/2023]
Abstract
Neurodevelopmental disorders (NDDs) have been suggested to lie on a gradient continuum, all resulting from common brain disturbances, but with different degrees of impairment severity. This case-control study aimed to assess postural stability against such hypothesis in 104 children/adolescents aged 5–17, of whom 81 had NDDs and 23 were healthy controls. Compared to healthy controls, Autism Spectrum Disorder (ASD) resulted in the most severely impaired neurodevelopmental condition, followed by Attention Deficit Hyperactive Disorder (ADHD) and Tourette Syndrome (TS). In particular, while ASD children/adolescents performed worse than healthy controls in a number of sensory conditions across all parameters, ADHD children/adolescents performed worse than healthy controls only in the sway area for the most complex sensory conditions, when their vision and somatosensory functions were both compromised, and performance in Tourette Syndrome (TS) was roughly indistinguishable from that of healthy controls. Finally, differences were also observed between clinical groups, with ASD children/adolescents, and to a much lesser extent ADHD children/adolescents, performing worse than TS children/adolescents, especially when sensory systems were not operationally accurate. Evidence from this study indicates that poor postural control may be a useful biomarker for risk assessment during neurodevelopment, in line with predictions from the gradient hypothesis.
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Affiliation(s)
- Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (L.Z.); (M.L.C.); (F.D.)
| | - Marco Luigi Ciceri
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (L.Z.); (M.L.C.); (F.D.)
| | - Liliya Chamitava
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (L.C.); (M.E.Z.)
| | - Gianfranco Di Gennaro
- Department of Pathology and Diagnostics, Integrated University Hospital of Verona, 37126 Verona, Italy;
| | - Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (L.C.); (M.E.Z.)
| | - Maria Elisabetta Zanolin
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (L.C.); (M.E.Z.)
| | - Francesca Darra
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (L.Z.); (M.L.C.); (F.D.)
| | - Marco Colizzi
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (L.Z.); (M.L.C.); (F.D.)
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- Correspondence: ; Tel.: +39-045-812-6832
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12
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Variola A, Zanolin ME, Cipriano G, Macchioni P, Martinis F, Pasetti A, Grassi M, Geccherle A, Marchetta A, McGonagle D, Tinazzi I. The IBIS-Q [IBd Identification of Spondyloarthritis Questionnaire]: A Novel Tool to Detect Both Axial and Peripheral Arthritis in Inflammatory Bowel Disease Patients. J Crohns Colitis 2020; 14:1680-1686. [PMID: 32413102 DOI: 10.1093/ecco-jcc/jjaa096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Both peripheral and axial spondyloarthritis [SpA] occur in inflammatory bowel disease [IBD] and represent the commonest extra-intestinal manifestation. We aimed to develop an easy and quick questionnaire through psychometric analysis, to identify peripheral and axial SpA in IBD patients within an integrated combined multidisciplinary rheumatological-gastroenterology clinic. METHODS Initially, SpA-IBD experts generated a 42-item list covering SpA manifestations including spinal, articular, and entheseal involvement. The new questionnaire was administered before routine clinical IBD assessment. On the same day, rheumatological assessment, blinded to both history and questionnaire results, was performed to explore the presence of the Assessment of SpondyloArthritis International Society [ASAS] criteria for SpA, diagnostic criteria for fibromyalgia [FM], and non-specific low back pain [NSLB]. Factorial analysis of questionnaire items to identify the main factors-receiver operating characteristic [ROC] curves for sensitivity/specificity and Youden index for cut-off-were performed. RESULTS Of the 181 consecutive patients, 56 met the ASAS SpA criteria [prevalence of 30%] with 10 new cases detected [5.5%: seven peripheral and three axial]. Through the psychometric and factorial analysis, we selected 14 items for the final questionnaire [named IBIS-Q]. The IBIS-Q was quick and performed well for detection of axial SpA and peripheral SpA (area under the curve [AUC] 0.88 with 95% confidence interval [CI] 0.830.93). A cut-off of three positive questions had a sensitivity 93% and specificity 77% for SpA patient identification. CONCLUSIONS The IBIS-Q is a useful and simple tool to use in IBD clinics for SpA detection, with a good statistical performance. Further studies are needed to validate it.
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Affiliation(s)
| | - Maria Elisabetta Zanolin
- Department of Diagnostics and Public Health, Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Giovanni Cipriano
- Clinical Research Unit, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | | | - Federica Martinis
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Annalisa Pasetti
- Unit of Gastroenterology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Mario Grassi
- Medical and Genomic Statistics Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | - Dennis McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust & University of Leeds, Leeds, UK
| | - Ilaria Tinazzi
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
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Grosso A, Piloni D, Zanolin ME, Cazzoletti L, Mattioli V, Gini E, Albicini F, Ronzoni V, Cerveri I, Corsico AG, Jarvis D, Janson C. Inhaled Corticosteroids and Risk of Osteoporosis in Late-Middle Age Subjects: A Multicenter European Cohort Study. Epidemiology 2020. [DOI: 10.1183/13993003.congress-2020.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Gandolfi M, Valè N, Dimitrova E, Zanolin ME, Mattiuz N, Battistuzzi E, Beccari M, Geroin C, Picelli A, Waldner A, Smania N. Robot-Assisted Stair Climbing Training on Postural Control and Sensory Integration Processes in Chronic Post-stroke Patients: A Randomized Controlled Clinical Trial. Front Neurosci 2019; 13:1143. [PMID: 31708735 PMCID: PMC6821720 DOI: 10.3389/fnins.2019.01143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/10/2019] [Indexed: 12/20/2022] Open
Abstract
Background Postural control disturbances are one of the important causes of disability in stroke patients affecting balance and mobility. The impairment of sensory input integration from visual, somatosensory and vestibular systems contributes to postural control disorders in post-stroke patients. Robot-assisted gait training may be considered a valuable tool in improving gait and postural control abnormalities. Objective The primary aim of the study was to compare the effects of robot-assisted stair climbing training against sensory integration balance training on static and dynamic balance in chronic stroke patients. The secondary aims were to compare the training effects on sensory integration processes and mobility. Methods This single-blind, randomized, controlled trial involved 32 chronic stroke outpatients with postural instability. The experimental group (EG, n = 16) received robot-assisted stair climbing training. The control group (n = 16) received sensory integration balance training. Training protocols lasted for 5 weeks (50 min/session, two sessions/week). Before, after, and at 1-month follow-up, a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Berg Balance Scale (BBS). Secondary outcomes:10-meter walking test, 6-min walking test, Dynamic gait index (DGI), stair climbing test (SCT) up and down, the Time Up and Go, and length of sway and sway area of the Center of Pressure (CoP) assessed using the stabilometric assessment. Results There was a non-significant main effect of group on primary and secondary outcomes. A significant Time × Group interaction was measured on 6-min walking test (p = 0.013) and on posturographic outcomes (p = 0.005). Post hoc within-group analysis showed only in the EG a significant reduction of sway area and the CoP length on compliant surface in the eyes-closed and dome conditions. Conclusion Postural control disorders in patients with chronic stroke may be ameliorated by robot-assisted stair climbing training and sensory integration balance training. The robot-assisted stair climbing training contributed to improving sensorimotor integration processes on compliant surfaces. Clinical trial registration (NCT03566901).
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Nicola Valè
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Eleonora Dimitrova
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | | | - Nicola Mattiuz
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Elisa Battistuzzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Marcello Beccari
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Christian Geroin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Andreas Waldner
- Department of Neurological Rehabilitation, Private Hospital Villa Melitta, Bolzano, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
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Chamitava L, Zanolin ME, Garcia-Larsen V, Ferrari M, Cerveri I, Pirina P, Verlato G, Cazzoletti L. Late Breaking Abstract - Dietary patterns and lung function in a case-control study of asthma in Italian adults. Epidemiology 2019. [DOI: 10.1183/13993003.congress-2019.pa4437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Cazzoletti L, Zanolin ME, Spelta F, Bono R, Chamitava L, Cerveri I, Garcia-Larsen V, Grosso A, Mattioli V, Pirina P, Ferrari M. Dietary fats, olive oil and respiratory diseases in Italian adults: A population-based study. Clin Exp Allergy 2019; 49:799-807. [PMID: 30689281 DOI: 10.1111/cea.13352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fat intake has been associated with respiratory diseases, with conflicting results. OBJECTIVE We studied the association between asthma and rhinitis with dietary fats, and their food sources in an Italian population. METHODS Clinical and nutritional information was collected for 871 subjects (aged 20-84) from the population-based multi-case-control study Genes Environment Interaction in Respiratory Diseases (GEIRD): 145 with current asthma (CA), 77 with past asthma (PA), 305 with rhinitis and 344 controls. Food intake was collected using the EPIC (European Investigation into Cancer and Nutrition) Food Frequency Questionnaire. The associations between fats and respiratory diseases were estimated by multinomial models. Fats and their dietary sources were analysed both as continuous variables and as quartiles. RESULTS Monounsaturated fatty acids and oleic acid were associated with a reduced risk of CA in both continuous (RRR = 0.68, 95%CI: 0.48; 0.96; RRR = 0.69; 95%CI: 0.49; 0.97, per 10 g, respectively) and per-quartile analyses (p for trend = 0.028 and 0.024, respectively). Olive oil was associated with a decreased risk of CA (RRR = 0.80; 95%CI: 0.65; 0.98 per 10 g). An increased risk of rhinitis was associated with moderate total fat and SFA intake. CONCLUSIONS High dietary intakes of oleic acid and of olive oil are associated with a lower risk of asthma but not of rhinitis.
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Affiliation(s)
- Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Maria Elisabetta Zanolin
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Francesco Spelta
- Unit of Respiratory Diseases, Department of Internal Medicine, University of Verona, Verona, Italy.,Long-term care Unit, Fracastoro Hospital - ULSS 9, Verona, Italy
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Liliya Chamitava
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Isa Cerveri
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - Vanessa Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amelia Grosso
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - Veronica Mattioli
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Pietro Pirina
- Institute of Respiratory Diseases, University of Sassari, Sassari, Italy
| | - Marcello Ferrari
- Unit of Respiratory Diseases, Department of Internal Medicine, University of Verona, Verona, Italy
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Cappa V, Marcon A, Di Gennaro G, Chamitava L, Cazzoletti L, Bombieri C, Nicolis M, Perbellini L, Sembeni S, de Marco R, Spelta F, Ferrari M, Zanolin ME. Health-related quality of life varies in different respiratory disorders: a multi-case control population based study. BMC Pulm Med 2019; 19:32. [PMID: 30732605 PMCID: PMC6367788 DOI: 10.1186/s12890-019-0796-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Health-related quality of life (HRQL) in respiratory diseases has been generally investigated in clinical settings, focusing on a single disorder. In this study on a general population sample, we assessed the relationship between HRQL and several respiratory diseases studied simultaneously (COPD, current (CA) and past (PA) asthma, allergic (AR) and non-allergic (NAR) rhinitis and chronic bronchitis (CB). METHODS Controls (n = 328) and cases of NAR (n = 95), AR (n = 163), CB (n = 48), CA (n = 224), PA (n = 126) and COPD (n = 28) were recruited in the centre of Verona in the frame of the Italian multi-case control GEIRD (Gene Environment Interactions in Respiratory Diseases) study; HRQL was measured through the SF-36 questionnaire. The relationships between HRQL (in terms of Physical (PCS) and Mental Component Scores (MCS)), respiratory diseases, and covariates were evaluated. RESULTS With respect to controls, the adjusted PCS median score was worse in subjects suffering from current asthma (- 1.7; 95%CI:-2.8;-0.6), CB (- 3.8; 95%CI:-5.7;-1.9), and COPD (- 5.6; 95%CI:-8.1;-3.1). MCS was worse in current asthmatics (- 2.2; 95%CI:-4.1;-0.3), CB (- 5.5; 95%CI:-8.7;-2.2), and COPD cases (- 4.6; 95%CI:-8.8;-0.5) as well. CONCLUSIONS To our knowledge, this is the first study in the general population that analyzed HRQL performing a simultaneous comparison of HRLQ in several respiratory disorders. We found that subjects suffering from COPD, CA, and CB had the poorest HRQL. Clinicians should carefully consider the possible impact of respiratory disorders as CB and not only that of CA and COPD.
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Affiliation(s)
- Veronica Cappa
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy
| | - Gianfranco Di Gennaro
- Department of Pathology and Diagnostics, University Hospital of Verona, Verona, Italy
| | - Liliya Chamitava
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy
| | - Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy
| | - Cristina Bombieri
- Unit of Biology and Genetics, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Morena Nicolis
- Unit of Hygiene and Preventive, Environmental and Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Luigi Perbellini
- Unit of Occupational Medicine, Azienda Ospedaliero Universitaria di Verona, Verona, Italy
| | - Silvia Sembeni
- Unit of Hygiene and Preventive, Environmental and Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Roberto de Marco
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy
| | - Francesco Spelta
- Department of Medicine, Unit of Respiratory Medicine, University of Verona, Verona, Italy
| | - Marcello Ferrari
- Department of Medicine, Unit of Respiratory Medicine, University of Verona, Verona, Italy
| | - Maria Elisabetta Zanolin
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy
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Calciano L, Portas L, Corsico AG, Olivieri M, Degan P, Ferrari M, Fois A, Pasini AMF, Pasini A, Zanolin ME, de Marco R, Accordini S. Biomarkers related to respiratory symptoms and lung function in adults with asthma. J Breath Res 2018; 12:026012. [PMID: 29167414 DOI: 10.1088/1752-7163/aa9c86] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a need for easily measurable biomarkers that are able to identify different levels of asthma severity. AIM To assess the association between peripheral blood cell counts, fractional nitric oxide in exhaled air (FeNO), urinary biomarkers of oxidative stress (8-hydroxy-2'-deoxyguanosine and 8-isoprostane), and asthma severity in adult patients from the general population. METHODS In the Gene Environment Interactions in Respiratory Diseases study, 287 subjects with asthma (aged 20-64) were identified from the general population in Verona (Italy) (2008-2010). Self-reported asthma attacks, asthma-like symptoms and the use of hospital services in the past year were synthesized in a score of respiratory symptoms (SRS). The association of biomarkers with SRS and lung function measures (pre-bronchodilator FEV1% predicted and FEV1/FVC) was assessed using quasi-Poisson and Gaussian regression models, respectively. RESULTS Eosinophils (ratio of expected scores: RES[95%CI] = 1.19[1.09,1.30]), basophils (RES[95%CI] = 1.24[1.10,1.40]), lymphocytes (RES[95%CI] = 1.27[1.12,1.45]) and FeNO (RES[95%CI] = 1.18[1.02,1.37]) were positively associated with SRS. However, only eosinophils (RES[95%CI] = 1.15[1.02,1.30]) and lymphocytes (RES[95%CI] = 1.25[1.06,1.47]) showed an independent association. Furthermore, eosinophils (change in the expected outcome for 1-SD increase: CEO[95%CI] = -1.18[-2.09, -0.27]%), basophils (CEO[95%CI] = -1.24[-2.16, -0.33]%) and lymphocytes (CEO[95%CI] = -1.07[-1.99, -0.14]%) were individually, but not independently, associated with FEV1/FVC. Finally, neutrophils were negatively associated with FEV1% predicted (CEO[95%CI] = -2.22[-4.00, -0.44]%). CONCLUSIONS We identified a pattern of association between a set of biomarkers and asthma endotypes in adult patients from the general population, which could improve understanding of the heterogeneity and severity of the disease and could be useful in defining targeted therapeutic approaches.
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Affiliation(s)
- Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Pesce G, Locatelli F, Cerveri I, Bugiani M, Pirina P, Johannessen A, Accordini S, Zanolin ME, Verlato G, de Marco R. Correction: Seventy Years of Asthma in Italy: Age, Period and Cohort Effects on Incidence and Remission of Self-Reported Asthma from 1940 to 2010. PLoS One 2018; 13:e0191589. [PMID: 29342215 PMCID: PMC5771631 DOI: 10.1371/journal.pone.0191589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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mattioli V, Cazzoletti L, Zanolin ME, Garcia-Larsen V, Bono R, Cerveri I, Pirina P. Late Breaking Abstract - Dietary flavonoids and respiratory diseases: a population-based multi-case control study in Italian adults. Epidemiology 2017. [DOI: 10.1183/1393003.congress-2017.pa2608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Pesce G, Locatelli F, Cerveri I, Bugiani M, Pirina P, Johannessen A, Accordini S, Zanolin ME, Verlato G, de Marco R. Seventy Years of Asthma in Italy: Age, Period and Cohort Effects on Incidence and Remission of Self-Reported Asthma from 1940 to 2010. PLoS One 2015; 10:e0138570. [PMID: 26439263 PMCID: PMC4595078 DOI: 10.1371/journal.pone.0138570] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/01/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is well known that asthma prevalence has been increasing all over the world in the last decades. However, few data are available on temporal trends of incidence and remission of asthma. OBJECTIVE To evaluate the rates of asthma incidence and remission in Italy from 1940 to 2010. METHODS The subjects were randomly sampled from the general Italian population between 1991 and 2010 in the three population-based multicentre studies: ECRHS, ISAYA, and GEIRD. Individual information on the history of asthma (age at onset, age at the last attack, use of drugs for asthma control, co-presence of hay-fever) was collected on 35,495 subjects aged 20-84 and born between 1925-1989. Temporal changes in rates of asthma incidence and remission in relation to age, birth cohort and calendar period (APC) were modelled using Poisson regression and APC models. RESULTS The average yearly rate of asthma incidence was 2.6/1000 (3,297 new cases among 1,263,885 person-years). The incidence rates have been linearly increasing, with a percentage increase of +3.9% (95%CI: 3.1-4.5), from 1940 up to the year 1995, when the rates begun to level off. The stabilization of asthma incidence was mainly due to a decrease in the rates of atopic asthma after 1995, while non-atopic asthma has continued to increase. The overall rate of remission was 43.2/1000person-years, and it did not vary significantly across generations, but was associated with atopy, age at asthma onset and duration of the disease. CONCLUSIONS After 50 years of a continuous upward trend, the rates of asthma incidence underwent a substantial stabilization in the late 90s. Despite remarkable improvements in the treatment of asthma, the rate of remission did not change significantly in the last seventy years. Some caveats are required in interpreting our results, given that our estimates are based on self-reported events that could be affected by the recall bias.
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Affiliation(s)
- Giancarlo Pesce
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
| | - Francesca Locatelli
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
| | - Isa Cerveri
- Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Pietro Pirina
- Institute for Respiratory Diseases, University of Sassari, Sassari, Italy
| | - Ane Johannessen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Simone Accordini
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
| | - Maria Elisabetta Zanolin
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
| | - Roberto de Marco
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
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Marcon A, Nguyen G, Rava M, Braggion M, Grassi M, Zanolin ME. A score for measuring health risk perception in environmental surveys. Sci Total Environ 2015; 527-528:270-278. [PMID: 25965040 DOI: 10.1016/j.scitotenv.2015.04.110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 04/10/2015] [Accepted: 04/28/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND In environmental surveys, risk perception may be a source of bias when information on health outcomes is reported using questionnaires. Using the data from a survey carried out in the largest chipboard industrial district in Italy (Viadana, Mantova), we devised a score of health risk perception and described its determinants in an adult population. METHODS In 2006, 3697 parents of children were administered a questionnaire that included ratings on 7 environmental issues. Items dimensionality was studied by factor analysis. After testing equidistance across response options by homogeneity analysis, a risk perception score was devised by summing up item ratings. RESULTS Factor analysis identified one latent factor, which we interpreted as health risk perception, that explained 65.4% of the variance of five items retained after scaling. The scale (range 0-10, mean ± SD 9.3 ± 1.9) had a good internal consistency (Cronbach's alpha 0.87). Most subjects (80.6%) expressed maximum risk perception (score = 10). Italian mothers showed significantly higher risk perception than foreign fathers. Risk perception was higher for parents of young children, and for older parents with a higher education, than for their counterparts. Actual distance to major roads was not associated with the score, while self-reported intense traffic and frequent air refreshing at home predicted higher risk perception. CONCLUSIONS When investigating health effects of environmental hazards using questionnaires, care should be taken to reduce the possibility of awareness bias at the stage of study planning and data analysis. Including appropriate items in study questionnaires can be useful to derive a measure of health risk perception, which can help to identify confounding of association estimates by risk perception.
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Affiliation(s)
- Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
| | - Giang Nguyen
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
| | - Marta Rava
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
| | - Marco Braggion
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
| | - Mario Grassi
- Medical and Genomic Statistics Unit, Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
| | - Maria Elisabetta Zanolin
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
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23
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Caliò A, Zamò A, Ponzoni M, Zanolin ME, Ferreri AJM, Pedron S, Montagna L, Parolini C, Fraifeld VE, Wolfson M, Yanai H, Pizzolo G, Doglioni C, Vinante F, Chilosi M. Cellular Senescence Markers p16INK4a and p21CIP1/WAF Are Predictors of Hodgkin Lymphoma Outcome. Clin Cancer Res 2015. [PMID: 26199387 DOI: 10.1158/1078-0432.ccr-15-0508] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE There is evidence that Hodgkin Reed-Sternberg (HRS) cells in classical Hodgkin lymphoma (cHL) could display some molecular and morphologic markers of cellular senescence (CS). We hypothesized that CS mechanisms may have potential prognostic relevance in cHL and investigated whether the expression of the well-established CS biomarkers p21(CIP1/WAF1) and p16(INK4a) by HRS cells might be predictive of the probability of event-free survival (EFS). EXPERIMENTAL DESIGN The study analyzed a retrospective cohort of 147 patients and the results were validated on a cohort of 91 patients independently diagnosed and treated in a different institution. p16(INK4a) and p21(CIP1/WAF1) were categorized as dichotomous variables (< or ≥ 30% of HRS cells at diagnosis) and evaluated in univariate and multivariate analysis. RESULTS Both molecules were independent prognostic factors. A positive staining of one of the two molecules in more than 30% HRS cells predicted a better EFS (P < 0.01). p16(INK4a)/p21(CIP1/WAF1) together as a unique categorical variable (both <30%, either <30%, both ≥ 30%) sorted out three prognostic groups with better, intermediate, or worse outcome either overall or within I-II, bulky and advanced stages. The presence or the lack of the robust expression of p21(CIP1/WAF1) and/or p16(INK4a) defined the prognosis in our series. CONCLUSIONS These findings point to (i) the relevance of CS-related mechanisms in cHL, and to (ii) the prognostic value of a simple, reproducible, and low-cost immunohistochemical evaluation of p16(INK4a) and p21(CIP1/WAF1) expression.
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Affiliation(s)
- Anna Caliò
- Department of Pathology and Diagnostic, Anatomic Pathology Section, University of Verona, Verona, Italy
| | - Alberto Zamò
- Department of Pathology and Diagnostic, Anatomic Pathology Section, University of Verona, Verona, Italy
| | - Maurilio Ponzoni
- Vita-Salute San Raffaele University, Pathology and Lymphoid Malignancies Units, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Elisabetta Zanolin
- Department of Public Health and Community Medicine, Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Division of Onco-Hematological Medicine, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Pedron
- Department of Pathology and Diagnostic, Anatomic Pathology Section, University of Verona, Verona, Italy
| | - Licia Montagna
- Department of Pathology and Diagnostic, Anatomic Pathology Section, University of Verona, Verona, Italy
| | - Claudia Parolini
- Department of Pathology and Diagnostic, Anatomic Pathology Section, University of Verona, Verona, Italy
| | - Vadim E Fraifeld
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Center for Multidisciplinary Research on Aging, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Marina Wolfson
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Center for Multidisciplinary Research on Aging, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Hagai Yanai
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Center for Multidisciplinary Research on Aging, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Giovanni Pizzolo
- Department of Medicine, Hematology Section, University of Verona, Verona, Italy
| | - Claudio Doglioni
- Vita-Salute San Raffaele University, Pathology and Lymphoid Malignancies Units, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Vinante
- Department of Medicine, Hematology Section, University of Verona, Verona, Italy.
| | - Marco Chilosi
- Department of Pathology and Diagnostic, Anatomic Pathology Section, University of Verona, Verona, Italy
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Tosi F, Di Sarra D, Bonin C, Zambotti F, Dall'Alda M, Fiers T, Kaufman JM, Donati M, Franchi M, Zanolin ME, Bonora E, Moghetti P. Plasma levels of pentraxin-3, an inflammatory protein involved in fertility, are reduced in women with polycystic ovary syndrome. Eur J Endocrinol 2014; 170:401-9. [PMID: 24347428 DOI: 10.1530/eje-13-0761] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Pentraxin-3 (PTX3), like C-reactive protein (CRP), is an acute-phase protein that belongs to the pentraxin superfamily. Moreover, it is expressed in the cumulus oophorus and appears to be involved in female fertility. The aim of the present study was to assess whether PTX3 levels are altered in polycystic ovary syndrome (PCOS) women and whether they show any relationship with the main features of these subjects. DESIGN A cross-sectional study was conducted at the outpatient clinic of an academic centre. METHODS A total of 66 women affected with PCOS and 51 healthy controls were studied. Plasma PTX3 and serum CRP were measured by ELISA. Androgens were measured by liquid chromatography-mass spectrometry and free testosterone was measured by equilibrium dialysis. In PCOS women, insulin sensitivity was assessed by the glucose clamp technique. RESULTS Adjusting for age and BMI, plasma PTX3 was reduced in PCOS women (P=0.036), in contrast with serum CRP, which was increased (P=0.004). In multiple regression analysis, serum androgens and other endocrine and ovarian features of PCOS were predictors of PTX3 levels, whereas body fat was the main independent predictor of CRP concentrations. CONCLUSIONS Plasma PTX3 levels were reduced in PCOS women and independently associated with hyperandrogenism and other endocrine and ovarian features of PCOS.
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Affiliation(s)
- Flavia Tosi
- Section of Endocrinology, Diabetes and Metabolism
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25
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Bacchi E, Negri C, Tarperi C, Baraldo A, Faccioli N, Milanese C, Zanolin ME, Lanza M, Cevese A, Bonora E, Schena F, Moghetti P. Relationships between cardiorespiratory fitness, metabolic control, and fat distribution in type 2 diabetes subjects. Acta Diabetol 2014; 51:369-75. [PMID: 24129948 DOI: 10.1007/s00592-013-0519-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
Factors contributing to the reduced cardiorespiratory fitness typical of sedentary subjects with type 2 diabetes are still largely unknown. In this study, we assessed the relationships between cardiorespiratory fitness and abdominal and skeletal muscle fat content in 39 untrained type 2 diabetes subjects, 27 males and 12 females (mean ± SD age 56.5 ± 7.3 year, BMI 29.4 ± 4.7 kg/m(2)). Peak oxygen uptake (VO2peak) and ventilatory threshold (VO2VT) were assessed by maximal cycle ergometer exercise test, insulin sensitivity by euglycemic-hyperinsulinemic clamp, and body composition by dual-energy X-ray absorptiometry. Magnetic resonance imaging was used to evaluate visceral, total subcutaneous (SAT), superficial (SSAT) and deep sub-depots of subcutaneous abdominal adipose tissue, and sagittal abdominal diameter (SAD), as well as femoral quadriceps skeletal muscle fat content. In univariate analysis, both VO2peak and VO2VT were inversely associated with BMI, total fat mass, SAT, SSAT, and sagittal abdominal diameter. VO2peak was also inversely associated with skeletal muscle fat content. A significant direct association was observed between VO2VT and insulin sensitivity. No associations between cardiorespiratory fitness parameters and metabolic profile data were found. In multivariable regression analysis, after adjusting for age and gender, VO2peak was independently predicted by higher HDL cholesterol, and lower SAD and skeletal muscle fat content (R (2) = 0.64, p < 0.001), whereas VO2VT was predicted only by sagittal abdominal diameter (R (2) = 0.48, p = 0.025). In conclusion, in untrained type 2 diabetes subjects, peak oxygen uptake is associated with sagittal abdominal diameter, skeletal muscle fat content, and HDL cholesterol levels. Future research should target these features in prospective intervention studies.
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Affiliation(s)
- Elisabetta Bacchi
- Unit of Endocrinology and Metabolism, Department of Medicine, University of Verona, P.le Stefani 1, 37126, Verona, Italy
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26
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Di Sarra D, Tosi F, Bonin C, Fiers T, Kaufman JM, Signori C, Zambotti F, Dall'Alda M, Caruso B, Zanolin ME, Bonora E, Moghetti P. Metabolic inflexibility is a feature of women with polycystic ovary syndrome and is associated with both insulin resistance and hyperandrogenism. J Clin Endocrinol Metab 2013; 98:2581-8. [PMID: 23596136 DOI: 10.1210/jc.2013-1161] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONTEXT Metabolic inflexibility, ie, the impaired ability of the body to switch from fat to carbohydrate oxidation under insulin-stimulated conditions, is associated with insulin resistance. This alteration in metabolic plasticity can lead to organ dysfunction and is considered a key issue among the abnormalities of the metabolic syndrome. It is still unknown whether this phenomenon occurs in women with polycystic ovary syndrome (PCOS). OBJECTIVE Our objective was to examine whether metabolic inflexibility is a feature of PCOS women and whether hyperandrogenism may contribute to this phenomenon. DESIGN AND PATIENTS Eighty-nine Caucasian women with PCOS were submitted to hyperinsulinemic-euglycemic clamp. Respiratory exchange ratios were evaluated at baseline and during hyperinsulinemia by indirect calorimetry to quantify substrate oxidative metabolism. Total testosterone was measured by liquid chromatography mass spectrometry and free testosterone by equilibrium dialysis. SETTING Outpatients were seen in a tertiary care academic center. MAIN OUTCOME MEASURE Metabolic flexibility was assessed by the change in respiratory quotient upon insulin stimulation. RESULTS Sixty-five of the 89 PCOS women (73%) had increased serum free testosterone, 68 (76%) were insulin resistant, and 62 (70%) had an impaired metabolic flexibility. Comparison of hyperandrogenemic and normoandrogenemic women showed that the 2 subgroups were of similar age but differed in terms of several anthropometric and metabolic features. In particular, hyperandrogenemic women had greater body mass index (32.9 ± 1.0 vs 24.7 ± 0.9 kg/m(2), P < .001) and lower glucose utilization during the clamp (9.2 ± 0.4 vs 10.9 ± 0.7 mg/kg fat-free mass · min, P = .023) and metabolic flexibility (0.09 ± 0.06 vs 0.12 ± 0.01, P = .014). In univariate analysis, metabolic flexibility was associated with several anthropometric, endocrine, and metabolic features. In multivariate analysis, this feature was directly associated with baseline respiratory quotient and insulin sensitivity and inversely with free testosterone and free fatty acids concentrations under insulin suppression (R(2) = 0.634, P < .001). CONCLUSIONS Metabolic inflexibility is a feature of PCOS women. Both insulin resistance and androgen excess might contribute to this abnormality.
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Affiliation(s)
- Daniela Di Sarra
- Department of Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, I-37126 Verona, Italy
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de Marco R, Pesce G, Marcon A, Accordini S, Antonicelli L, Bugiani M, Casali L, Ferrari M, Nicolini G, Panico MG, Pirina P, Zanolin ME, Cerveri I, Verlato G. The coexistence of asthma and chronic obstructive pulmonary disease (COPD): prevalence and risk factors in young, middle-aged and elderly people from the general population. PLoS One 2013; 8:e62985. [PMID: 23675448 PMCID: PMC3651288 DOI: 10.1371/journal.pone.0062985] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/26/2013] [Indexed: 11/21/2022] Open
Abstract
Background The joint distribution of asthma and chronic obstructive pulmonary disease (COPD) has not been well described. This study aims at determining the prevalence of self-reported physician diagnoses of asthma, COPD and of the asthma-COPD overlap syndrome and to assess whether these conditions share a common set of risk factors. Methods A screening questionnaire on respiratory symptoms, diagnoses and risk factors was administered by mail or phone to random samples of the general Italian population aged 20–44 (n = 5163) 45–64 (n = 2167) and 65–84 (n = 1030) in the frame of the multicentre Gene Environment Interactions in Respiratory Diseases (GEIRD) study. Results A physician diagnosis of asthma or COPD (emphysema/chronic bronchitis/COPD) was reported by 13% and 21% of subjects aged <65 and 65–84 years respectively. Aging was associated with a marked decrease in the prevalence of diagnosed asthma (from 8.2% to 1.6%) and with a marked increase in the prevalence of diagnosed COPD (from 3.3% to 13.3%). The prevalence of the overlap of asthma and COPD was 1.6% (1.3%–2.0%), 2.1% (1.5%–2.8%) and 4.5% (3.2%–5.9%) in the 20–44, 45–64 and 65–84 age groups. Subjects with both asthma and COPD diagnoses were more likely to have respiratory symptoms, physical impairment, and to report hospital admissions compared to asthma or COPD alone (p<0.01). Age, sex, education and smoking showed different and sometimes opposite associations with the three conditions. Conclusion Asthma and COPD are common in the general population, and they coexist in a substantial proportion of subjects. The asthma-COPD overlap syndrome represents an important clinical phenotype that deserves more medical attention and further research.
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Affiliation(s)
- Roberto de Marco
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy.
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28
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Moghetti P, Tosi F, Bonin C, Di Sarra D, Fiers T, Kaufman JM, Giagulli VA, Signori C, Zambotti F, Dall'Alda M, Spiazzi G, Zanolin ME, Bonora E. Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. J Clin Endocrinol Metab 2013; 98:E628-37. [PMID: 23476073 DOI: 10.1210/jc.2012-3908] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT/OBJECTIVE Current diagnostic criteria for polycystic ovary syndrome (PCOS) have generated distinct PCOS phenotypes, based on the different combinations of diagnostic features found in each patient. Our aim was to assess whether either each single diagnostic feature or their combinations into the PCOS phenotypes may predict insulin resistance in these women. PATIENTS/DESIGN A total of 137 consecutive Caucasian women with PCOS, diagnosed by the Rotterdam criteria, underwent accurate assessment of diagnostic and metabolic features. Insulin sensitivity was measured by the glucose clamp technique. RESULTS Among women with PCOS, 84.7% had hyperandrogenism, 84.7% had chronic oligoanovulation, and 89% had polycystic ovaries. According to the individual combinations of these features, 69.4% of women had the classic phenotype, 15.3% had the ovulatory phenotype, and 15.3% had the normoandrogenic phenotype. Most subjects (71.4%) were insulin resistant. However, insulin resistance frequency differed among phenotypes, being 80.4%, 65.0%, and 38.1%, respectively, in the 3 subgroups (P < .001). Although none of the PCOS diagnostic features per se was associated with the impairment in insulin action, after adjustment for covariates, the classic phenotype and, to a lesser extent, the ovulatory phenotype were independently associated with insulin resistance, whereas the normoandrogenic phenotype was not. Metabolic syndrome frequency was also different among phenotypes (P = .030). CONCLUSIONS There is a scale of metabolic risk among women with PCOS. Although no single diagnostic features of PCOS are independently associated with insulin resistance, their combinations, which define PCOS phenotypes, may allow physicians to establish which women should undergo metabolic screening. In metabolic terms, women belonging to the normoandrogenic phenotype behave as a separate group.
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Affiliation(s)
- Paolo Moghetti
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Piazzale Stefani, Verona, Italy.
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Marcon A, Girardi P, Ferrari M, Olivieri M, Accordini S, Bombieri C, Bortolami O, Braggion M, Cappa V, Cazzoletti L, Locatelli F, Nicolis M, Perbellini L, Sembeni S, Verlato G, Zanolin ME, de Marco R. Mild asthma and chronic bronchitis seem to influence functional exercise capacity: a multi-case control study. Int Arch Allergy Immunol 2013; 161:181-8. [PMID: 23363736 DOI: 10.1159/000345137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 10/15/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the Genes Environment Interaction in Respiratory Diseases population-based multi-case control study, we investigated whether asthma, chronic bronchitis (CB) and rhinitis were associated with a reduced 6-minute walk distance (6MWD), and whether the 6MWD determinants were similar for subjects with/without respiratory diseases. METHODS Cases of asthma (n = 360), CB (n = 120), rhinitis (n = 203) and controls (no respiratory diseases: n = 302) were recruited. The variation in the 6MWD across the groups was analyzed by ANCOVA, adjusting for gender, age, height, weight and comorbidity. The 6MWD determinants were studied by linear regression, and heterogeneity across the cases and controls was investigated. RESULTS The 6MWD differed across cases and controls (p = 0.01). It was shorter for cases of asthma (-17.1, 95% CI -28.3 to -5.8 m) and CB (-20.7, 95% CI: -36.6 to -4.8 m) than for controls (604 ± 68 m on average), but not for cases of rhinitis. The negative association between age and the 6MWD was significant for cases of CB, but not for the other groups (p = 0.001). CONCLUSIONS Even at the level of severity found in the general population, asthma and CB could influence the 6MWD, which seems to reflect the functional exercise level for daily physical activities. The negative association between ageing and the 6MWD was particularly strong in subjects with CB. Our report adds to the mounting evidence that CB is not a trivial condition, especially in the ageing adult population, and it supports the importance of monitoring functional capacity and of physical reconditioning in mild asthma.
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Affiliation(s)
- Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
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Bacchi E, Negri C, Trombetta M, Zanolin ME, Lanza M, Bonora E, Moghetti P. Differences in the acute effects of aerobic and resistance exercise in subjects with type 2 diabetes: results from the RAED2 Randomized Trial. PLoS One 2012; 7:e49937. [PMID: 23227155 PMCID: PMC3515569 DOI: 10.1371/journal.pone.0049937] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 10/15/2012] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Both aerobic (AER) and resistance (RES) training, if maintained over a period of several months, reduce HbA1c levels in type 2 diabetes subjects. However, it is still unknown whether the short-term effects of these types of exercise on blood glucose are similar. Our objective was to assess whether there may be a difference in acute blood glucose changes after a single bout of AER or RES exercise. STUDY DESIGN Twenty-five patients participating in the RAED2 Study, a RCT comparing AER and RES training in diabetic subjects, were submitted to continuous glucose monitoring during a 60-min exercise session and over the following 47 h. These measurements were performed after 10.9+0.4 weeks of training. Glucose concentration areas under the curve (AUC) during exercise, the subsequent night, and the 24-h period following exercise, as well as the corresponding periods of the non-exercise day, were assessed. Moreover, the low (LBGI) and high (HBGI) blood glucose indices, which summarize the duration and extent of hypoglycaemia or hyperglycaemia, respectively, were measured. RESULTS AER and RES training similarly reduced HbA1c. Forty-eight hour glucose AUC was similar in both groups. However, a comparison of glucose AUC during the 60-min exercise period and the corresponding period of the non-exercise day showed that glucose levels were lower during exercise in the AER but not in the RES group (time-by-group interaction p = 0.04). Similar differences were observed in the nocturnal periods (time-by-group interaction p = 0.02). Accordingly, nocturnal LBGI was higher in the exercise day than in the non-exercise day in the AER (p = 0.012) but not in the RES group (p = 0.62). CONCLUSIONS Although AER and RES training have similar long-term metabolic effects in diabetic subjects, the acute effects of single bouts of these exercise types differ, with a potential increase in late-onset hypoglycaemia risk after AER exercise. TRIAL REGISTRATION ClinicalTrials.gov NCT01182948.
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Affiliation(s)
- Elisabetta Bacchi
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Carlo Negri
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Maddalena Trombetta
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Maria Elisabetta Zanolin
- Section of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Massimo Lanza
- Section of Motor Sciences, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Paolo Moghetti
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Bacchi E, Negri C, Zanolin ME, Milanese C, Faccioli N, Trombetta M, Zoppini G, Cevese A, Bonadonna RC, Schena F, Bonora E, Lanza M, Moghetti P. Metabolic effects of aerobic training and resistance training in type 2 diabetic subjects: a randomized controlled trial (the RAED2 study). Diabetes Care 2012; 35:676-82. [PMID: 22344613 PMCID: PMC3308269 DOI: 10.2337/dc11-1655] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess differences between the effects of aerobic and resistance training on HbA(1c) (primary outcome) and several metabolic risk factors in subjects with type 2 diabetes, and to identify predictors of exercise-induced metabolic improvement. RESEARCH DESIGN AND METHODS Type 2 diabetic patients (n = 40) were randomly assigned to aerobic training or resistance training. Before and after 4 months of intervention, metabolic phenotypes (including HbA(1c), glucose clamp-measured insulin sensitivity, and oral glucose tolerance test-assessed β-cell function), body composition by dual-energy X-ray absorptiometry, visceral (VAT) and subcutaneous (SAT) adipose tissue by magnetic resonance imaging, cardiorespiratory fitness, and muscular strength were measured. RESULTS After training, increase in peak oxygen consumption (V(O(2peak))) was greater in the aerobic group (time-by-group interaction P = 0.045), whereas increase in strength was greater in the resistance group (time-by-group interaction P < 0.0001). HbA(1c) was similarly reduced in both groups (-0.40% [95% CI -0.61 to -0.18] vs. -0.35% [-0.59 to -0.10], respectively). Total and truncal fat, VAT, and SAT were also similarly reduced in both groups, whereas insulin sensitivity and lean limb mass were similarly increased. β-Cell function showed no significant changes. In multivariate analyses, improvement in HbA(1c) after training was independently predicted by baseline HbA(1c) and by changes in V(O(2peak)) and truncal fat. CONCLUSIONS Resistance training, similarly to aerobic training, improves metabolic features and insulin sensitivity and reduces abdominal fat in type 2 diabetic patients. Changes after training in V(O(2peak)) and truncal fat may be primary determinants of exercise-induced metabolic improvement.
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Storti M, Braggion M, Dal Santo P, Fanchin G, Zanolin ME. [Institutionalized elderly and depression: a multicenter observational study]. Recenti Prog Med 2012; 103:154-157. [PMID: 22561994 DOI: 10.1701/1068.11705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Scientific literature recommends nurses to use the Geriatric Depression Scale (GDS) in the assessment of symptoms of depression among elderly with no cognitive deficits. The first purpose of this observational study was to determine the prevalence of depressive symptoms and the related antidepressant therapy in a sample of institutionalized elderly people administering the 30 questions GDS (GDS 30). The second aim was to estimate the time to complete the test. The survey is a cross-sectional multicenter study. 115 cognitively intact elderly residents in 5 retirement houses in the province of Vicenza (Italy) were administered the 30 items GDS by nursing staff: 80 females with a median age of 83 years (Inter Quartile Range RIQ: 80-85) and 35 males with a median age of 79 years (RIQ: 73-85). The prevalence of depression was 46% (95% Confidence Interval: 37-55%). The difference in depression between males and females was not significant (p=0.646). The median of the total answering time was equal to 306 seconds (RIQ: 257-315). The answering time of the GDS in people taking antidepressants is higher with respect to those who do not take them. The GDS 30 is an useful tool for nurses to identify in a fairly short amount of time institutionalised individuals with no cognitive deficit and risk of depression.
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de Marco R, Cappa V, Accordini S, Rava M, Antonicelli L, Bortolami O, Braggion M, Bugiani M, Casali L, Cazzoletti L, Cerveri I, Fois AG, Girardi P, Locatelli F, Marcon A, Marinoni A, Panico MG, Pirina P, Villani S, Zanolin ME, Verlato G. Trends in the prevalence of asthma and allergic rhinitis in Italy between 1991 and 2010. Eur Respir J 2011; 39:883-92. [PMID: 22005911 DOI: 10.1183/09031936.00061611] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The prevalence of asthma increased worldwide until the 1990s, but since then there has been no clear temporal pattern. The present study aimed to assess time trends in the prevalence of current asthma, asthma-like symptoms and allergic rhinitis in Italian adults from 1990 to 2010. The same screening questionnaire was administered by mail or phone to random samples of the general population (age 20-44 yrs) in Italy, in the frame of three multicentre studies: the European Community Respiratory Health Survey (ECRHS) (1991-1993; n = 6,031); the Italian Study on Asthma in Young Adults (ISAYA) (1998-2000; n = 18,873); and the Gene Environment Interactions in Respiratory Diseases (GEIRD) study (2007-2010; n = 10,494). Time trends in prevalence were estimated using Poisson regression models in the centres that repeated the survey at different points in time. From 1991 to 2010, the median prevalence of current asthma, wheezing and allergic rhinitis increased from 4.1% to 6.6%, from 10.1% to 13.9% and from 16.8% to 25.8%, respectively. The prevalence of current asthma was stable during the 1990s and increased (relative risk 1.38, 95% CI 1.19-1.59) from 1998-2000 to 2007-2010, mainly in subjects who did not report allergic rhinitis. The prevalence of allergic rhinitis has increased continuously since 1991. The asthma epidemic is not over in Italy. During the past 20 yrs, asthma prevalence has increased by 38%, in parallel with a similar increase in asthma-like symptoms and allergic rhinitis.
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Affiliation(s)
- R de Marco
- Unit of Epidemiology and Medical Statistics, Dept of Public Health and Community Health, University of Verona, 37134 Verona, Italy.
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de Marco R, Accordini S, Antonicelli L, Bellia V, Bettin MD, Bombieri C, Bonifazi F, Bugiani M, Carosso A, Casali L, Cazzoletti L, Cerveri I, Corsico AG, Ferrari M, Fois AG, Lo Cascio V, Marcon A, Marinoni A, Olivieri M, Perbellini L, Pignatti P, Pirina P, Poli A, Rolla G, Trabetti E, Verlato G, Villani S, Zanolin ME. The Gene-Environment Interactions in Respiratory Diseases (GEIRD) Project. Int Arch Allergy Immunol 2010; 152:255-63. [PMID: 20150743 DOI: 10.1159/000283034] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 09/22/2009] [Indexed: 11/19/2022] Open
Abstract
The role of genetic and environmental factors, as well as their interaction, in the natural history of asthma, allergic rhinitis and chronic obstructive pulmonary disease (COPD) is largely unknown. This is mainly due to the lack of large-scale analytical epidemiological/genetic studies aimed at investigating these 3 respiratory conditions simultaneously. The GEIRD project is a collaborative initiative designed to collect information on biomarkers of inflammation and oxidative stress, individual and ecological exposures, diet, early-life factors, smoking habits, genetic traits and medication use in large and accurately defined series of asthma, allergic rhinitis and COPD phenotypes. It is a population-based multicase-control design, where cases and controls are identified through a 2-stage screening process (postal questionnaire and clinical examination) in pre-existing cohorts or new samples of subjects. It is aimed at elucidating the role that modifiable and genetic factors play in the occurrence, persistence, severity and control of inflammatory airway diseases, by way of the establishment of a historical multicentre standardized databank of phenotypes, contributed by and openly available to international epidemiologists. Researchers conducting population-based surveys with standardized methods may contribute to the public-domain case-control database, and use the resulting increased power to answer their own scientific questions.
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Pomposelli R, Piasere V, Andreoni C, Costini G, Tonini E, Spalluzzi A, Rossi D, Quarenghi C, Zanolin ME, Bellavite P. Observational study of homeopathic and conventional therapies in patients with diabetic polyneuropathy. HOMEOPATHY 2009; 98:17-25. [PMID: 19135955 DOI: 10.1016/j.homp.2008.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 10/27/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022]
Abstract
METHODS The feasibility and outcomes of homeopathic therapy in a group of type-2 diabetes mellitus patients with diabetic neuropathy were studied in a prospective observational study. Patients were followed from baseline (T0) for 6 months (T1) and for 12 months (T2), treatment was adjusted as necessary. Primary outcome was diabetic neuropathy symptom (DNS) score, secondary outcomes were clinical evolution and short-form-36 (SF-36)-evaluated quality of life (QOL). RESULTS Homeopathy was used in 45 patients, 32 of whom completed the observation study, and in parallel the conventional therapy outcomes were observed in 32 patients, 29 of whom completed the study. DNS improved in both groups during the observation period, but the change with respect to baseline was statistically significant only in Homeopathic group at T1 (P=0.016). Over the course of the observation there was a substantial stability of the electroneurophysiological values, blood pressure and body weight in both groups, a slight decrease of fasting blood glucose and glycated haemoglobin in Homeopathic group. QOL scores showed an improvement in Homeopathic group only. The cost of conventional drugs decreased in Homeopathic group from 114 euro/month to 94 euro/month at T1. CONCLUSION Complementary homeopathic therapy of diabetic neuropathy was feasible and promising effects in symptom scores and cost savings were observed.
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Saiani L, Zanolin ME, Dalponte A, Palese A, Viviani D. [Sensibility and specificity of a screening instrument for patients at risk of difficult discharge]. Assist Inferm Ric 2008; 27:184-193. [PMID: 19260366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Planned discharge guarantees continuity of care. The process starts with the identification of patients at risk of post-discharge problems. In Italy no validated screening instruments are available. One of the UK discharge screening instruments is the Blaylock Risk Assessment Screening Score (BRASS), applicable from admission, for the identification of patients that need a discharge plan. AIMS To assess the validity (sensitivity and specificity) of the BRASS scale on a sample of adult patients admitted to medical wards. METHODS Patients admitted to medical wards of Trento Hospital from January to March 2006 were screened at admission and discharge and interviewed by phone 45 days after discharge to assess where they had been discharged. RESULTS One hundred eighty nine patients were assessed at admission and discharge and 145 were available at follow-up after 3 months; 7.5% were at risk for difficult discharge. Sensibility and specificity of the scale were respectively 73.1 and 83.2%. No major differences were observed for risk scores obtained at admission and discharge. CONCLUSIONS The BRASS scale collects a limited number of information, predictive on the need to organize discharge services. It can therefore be an useful instrument to help health care workers to plan appropriate and timely interventions for guaranteeing continuity of care.
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Storti M, Dal Santo P, Zanolin ME. [A comparison study between two pain assessment scales for hospitalized and cognitively impaired patients with advanced dementia]. Prof Inferm 2008; 61:210-215. [PMID: 19250617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The management of pain in a elderly patients with advanced dementia is a very frequently problem in geriatric wards. The pain in patients with advanced dementia whose verbal fluency is declining is underestimated and poorly treated and this is mainly due to the lack of availability of proper tools able to recognise and to assess this disease symptom in those patients. During recent years major progress has taken place, and valid scales that allow for the assessment of the pain also in those kind of patients have been developed. The objective of this research is to verify the pertinence of the PAINAD and ABBEY scales throughout the assessment of pain in a 30 resident patients in care of a geriatric setting. The thirty elderly were average age 86 years (18 female and 12 male) with vascular dementia or late stage Alzheimer's disease, completely dependant on ADLs and with global aphasia. After 48 hours from the acceptance to hospital the pain has been identified. The pain assessment was carried out by administering the PAINAD (already validate in italian) and ABBEY scales by the nurse responsible for the patient and by a second nurse, for an amount of four surveys for each patients. Results show that both scales give equivalent results for the pain assessment (K=0.68), with concordance asset moderately good between the exams taken by the two nurses (Cohen K rate between 0.49 and 0.58). The PAINAD scale requires an administering time far lower than the ABBEY scale (p 0.001) and both can be used for the assessment of pain in those patients, also in the hospital.
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Affiliation(s)
- Matteo Storti
- Formatore EBN, Gruppo di Ricerca del Collegio IPASVI di Vicenza
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38
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Zanolin ME, Pattaro C, Corsico A, Bugiani M, Carrozzi L, Casali L, Dallari R, Ferrari M, Marinoni A, Migliore E, Olivieri M, Pirina P, Verlato G, Villani S, Marco R. The role of climate on the geographic variability of asthma, allergic rhinitis and respiratory symptoms: results from the Italian study of asthma in young adults. Allergy 2004; 59:306-14. [PMID: 14982513 DOI: 10.1046/j.1398-9995.2003.00391.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Variations in the prevalence of respiratory symptoms according to geo-climatic factors could provide important clues to the knowledge of the aetiology of asthma. METHODS Geo-climatic variations in the prevalence of current asthma, allergic rhinitis and chronic cough, and phlegm were assessed on a random sample of 18 873 subjects (response rate = 72.7%) from different climatic regions of Italy. An ecological analysis, supported by robust statistical methods, was employed to investigate potential trends. RESULTS The prevalence of all symptoms was significantly heterogeneous throughout the peninsula. Only asthma-like symptoms showed a north-south trend: the prevalence increased at a decreasing latitude [odds ratio (OR) varies from 0.92 to 0.96, P < 0.05], at a decreasing distance from the sea (OR: 0.90-0.93 for 30 km distance, P < 0.05), at higher annual mean temperatures (OR: 1.11-1.14, P < 0.05) and at smaller annual temperature ranges (OR: 0.94-0.95, P < 0.05). Of the geo-climatic variables considered, temperature range had the greatest influence on most asthma-like symptoms. No association was found between geo-climatic variables and allergic rhinitis or chronic cough and phlegm. CONCLUSIONS Asthma prevalence seems to be significantly affected by climate as asthma-like symptoms were more common in central-southern Italy, with a Mediterranean climate, than in areas with a continental climate (northern Italy).
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Affiliation(s)
- M E Zanolin
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
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de Marco R, Zanolin ME, Accordini S, Signorelli D, Marinoni A, Bugiani M, Lo Cascio V, Woods R, Burney P. A new questionnaire for the repeat of the first stage of the European Community Respiratory Health Survey: a pilot study. Eur Respir J 1999; 14:1044-8. [PMID: 10596688 DOI: 10.1183/09031936.99.14510449] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the early 1990s a multicentre survey on asthma was performed on the young adult population (European Community Respiratory Health Survey - ECRHS). This study is to be repeated in order to estimate changes in the prevalence of asthma-like symptoms during the last decade and to assess the social and economic costs of the disease and their variations among countries. The self-administered questionnaire devised for this purpose is a two-page questionnaire. The first page contains the same items as those used in the first survey with four additional questions related to: 1) the frequency and severity of asthma attacks; 2) the presence of chronic bronchitis; 3) smoking habits; and 4) a visual analogue scale assessing perception of outdoor pollution. The second page aims to collect information regarding the direct and indirect costs of asthma. The influence of the length of the questionnaire on the response rate was assessed in a pilot study in Italy. Two random samples of 150 subjects received either the one-page questionnaire (first page) or the two-page questionnaire. The response rate was compared with that obtained from the first postal wave in the 1991-1992 survey. Although the response rate was unchanged when using the one-page questionnaire (45% versus 45%), it decreased by 7% when the two-page questionnaire was used (38% versus 45%). On the basis of these results, no problem should arise if four more questions are added to the one-page questionnaire. The slight reduction in the response rate of the two-page questionnaire is worrying but could be corrected by the use of telephone interviews.
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Affiliation(s)
- R de Marco
- Cattedra di Statistica Medica, Università di Verona, Italy
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Ferrari M, Tardivo S, Zanolin ME, Olivieri M, Lampronti G, Biasin C, Poli A, Balestreri F, de Marco R, Lo Cascio V. Serious childhood respiratory infections and asthma in adult life. A population based study. ECRHS Italy. European Community Respiratory Health Survey. Ann Allergy Asthma Immunol 1999; 83:391-6. [PMID: 10582719 DOI: 10.1016/s1081-1206(10)62836-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A number of epidemiologic studies have tried to establish whether respiratory tract infections in early childhood cause obstructive pulmonary disease in adult life. OBJECTIVE To determine whether reported serious respiratory infection before the age of 5 years (SRI) is a significant risk factor for subsequent development of bronchial asthma and/or bronchial hyperresponsiveness in adults. METHODS We investigated a random population sample of 1,104 subjects (aged 20 to 40 years), participating in the European Respiratory Health Survey in Italy. Bronchial response to methacholine and answers to a standardized questionnaire were analyzed. RESULTS The prevalence of SRI (ie, a positive response to the question "Have you ever had a serious respiratory infection before the age of 5 years?") was significantly higher in the subjects with a positive family history of allergic diseases than in those with a negative one (O.R. 1.89; 95% C.I. 1.24 to 2.87, P < .01). No relationship was found between SRI and current adult asthma; however, asthma in the past was found in 20.5% of the SRI positive subjects and in 9.1% of SRI negative subjects (O.R. 2.47; 95% C.I. 1.47 to 4.15, P < .05). No difference in the response to methacholine and in FEV1, FEV1/FVC values was found between SRI positive and SRI negative subjects. CONCLUSIONS We suggest that a positive family history of atopy is associated with a significantly higher prevalence of SRI. Furthermore our results indicate that exposure to SRI is a risk factor for asthma in the past (ie, asthma in childhood and adolescence) but not for adult asthma or for the development of bronchial impairment in adult life.
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Affiliation(s)
- M Ferrari
- Istituto di Semeiotica Medica, University of Verona, Italy
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Krampera M, Vinante F, Tavecchia L, Morosato L, Chilosi M, Romagnani S, Zanolin ME, Pizzolo G. Progressive polarization towards a T helper/cytotoxic type-1 cytokine pattern during age-dependent maturation of the immune response inversely correlates with CD30 cell expression and serum concentration. Clin Exp Immunol 1999; 117:291-7. [PMID: 10444260 PMCID: PMC1905340 DOI: 10.1046/j.1365-2249.1999.00977.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In order to investigate the T cell cytokine profile during age-dependent maturation of the immune response, we evaluated the cytokine expression of CD4+ and CD8+ circulating cells by flow cytometric single-cell analysis after non-specific stimulation in vitro in different age groups of normal individuals, from cord blood to adulthood. Moreover, we correlated these lymphocyte cytokine patterns with the expression/release of CD30, a member of the tumour necrosis factor (TNF) receptor superfamily, which has been suggested to be related to the T helper/cytotoxic (Th(c))2-type immune responses, in order to verify this association in vivo, in non-pathological conditions. The results showed a progressive increase of circulating Th(c)1-type, interferon-gamma (IFN-gamma)- and/or IL-2-producing T cells along with ageing and, conversely, a stable number, although higher than in cord blood samples, of CD4+/IL-4+ T cells in the post-natal groups. In addition, serum levels of soluble CD30 (sCD30) and numbers of circulating CD4+/CD30+ and CD8+/CD30+ T cells were significantly higher in children aged < 5 years in comparison with those found either in cord blood or in blood from both older children and adults. These data support the concept of a progressive polarization of the Th(c) cell cytokine profile towards the Th(c)1 pattern during age-dependent maturation of the immune response. Moreover, the peak of CD30 expression/release in early infancy before the Th(c)1 shifting occurs, although not associated with a significant increase of circulating IL-4+ T cells, raises the question of the possible relationship in vivo between CD30 and Th(c)2-type immune responses.
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Affiliation(s)
- M Krampera
- Department of Haematology, University of Verona, Italy
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Lo Cascio V, Kanis JA, Beneton MN, Bertoldo F, Adami S, Poggi G, Zanolin ME. Acute effects of deflazacort and prednisone on rates of mineralization and bone formation. Calcif Tissue Int 1995; 56:109-12. [PMID: 7736317 DOI: 10.1007/bf00296340] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aims of this study were to determine (1) whether acute suppression of bone formation could be evaluated after the administration of corticosteroids in man by quantitative bone histomorphometry; and (2) whether there were significant differences between the effects of prednisone and its analog deflazacort. Thirteen patients who needed high-dose corticosteroid therapy were randomly allocated to two groups of treatment (prednisone or deflazacort). Quantitative bone histomorphometry, using the technique of triple labeling, and biochemical measurements of bone turnover were studied. There were no differences in biochemical indices of bone turnover between prednisone and deflazacort at the beginning and end of the 15 days of treatment course. During corticosteroid treatment, there were no significant changes in biochemical indices of bone turnover but a significant decline in total alkaline phosphatase (P < 0.01). Histomorphometric indices, as revealed by measurements of tetracycline interval and extent of labeling, showed no significant differences in either mineral apposition rate or bone formation rate in the two groups. We conclude that the acute glucocorticoid suppression of bone turnover by glucocorticoids is not detectable within the first 2 weeks of treatment by histomorphometric techniques. No differences in bone effects of prednisone and deflazacort were detected in this short-term study.
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Affiliation(s)
- V Lo Cascio
- Istituto di Semeiotica e Nefrologia Medica, Ospedale Policlinico, Verona, Italy
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de Marco R, Zanolin ME. [Mortality from causes amenable to medical intervention in Lombardy (1980-1985)]. Epidemiol Prev 1990; 12:24-32. [PMID: 2151324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
From Rutstein's sentinel events list, causes were selected which are regarded as most amenable to medical intervention. Considerable variation in mortality between Health Districts (in Northern Italy) was found in most of these diseases. This substantial variation should be examined further in order to discover the true causes of unnecessary deaths. Using such indexes as an alarm indicator could be very useful in monitoring the quality of care and in allocating resources.
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Affiliation(s)
- R de Marco
- Istituto di Scienze Sanitarie Applicate, Università di Pavia
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