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Lenzi J, Messina R, Rosa S, Iommi M, Rucci P, Pia Fantini M, Di Bartolo P. A multi-state analysis of disease trajectories and mental health transitions in patients with type 2 diabetes: A population-based retrospective cohort study utilizing health administrative data. Diabetes Res Clin Pract 2024; 209:111561. [PMID: 38325659 DOI: 10.1016/j.diabres.2024.111561] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
AIMS To investigate the risk of major depression and dementia in patients with type 2 diabetes, including dementia resulting from depression, and their impact on diabetes-related complications and mortality. METHODS We conducted a population-based retrospective cohort study including 11,441 incident cases of diabetes in 2015-2017, with follow-up until 2022. A multi-state survival analysis was performed on a seven-state model with 15 transitions to capture disease progression and onset of mental disorders. RESULTS Eight-year probabilities of depression, dementia, diabetes-related complications, and death were 9.7% (95% CI 8.7-10.7), 0.9% (95% CI 0.5-1.3), 10.4% (95% CI 9.5-11.4), and 14.8% (95% CI 13.9-15.7), respectively. Depression increased the risk of dementia up to 3.7% (95% CI 2.0-5.4), and up to 10.3% (95% CI 0.3-20.4) if coupled with diabetes complications. Eight-year mortality was 37.5% (95% CI 33.1-42.0) after depression, 74.1% (95% CI 63.7-84.5) after depression plus complications, 76.4% (95% CI 68.8-83.9) after dementia, and 98.6% (95% CI 96.1-100.0) after dementia plus complications. CONCLUSIONS The interconnections observed across depression, dementia, complications, and mortality underscore the necessity for comprehensive and integrated approaches in managing diabetes. Early screening for depression, followed by timely and targeted interventions, may mitigate the risk of dementia and improve diabetes prognosis.
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Affiliation(s)
- Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Rossella Messina
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Di Bartolo
- Diabetes Unit, Local Healthcare Authority of Romagna, Ravenna, Italy
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Agostinelli C, Morandi L, Righi S, Cirillo L, Iommi M, Tonon C, Mazzatenta D, Zoli M, Rossi M, Bagnato G, Broccoli A, Lodi R, Zinzani PL, Sabattini E, Giannini C, Asioli S. Genomic Profiling of Primary Diffuse Large B-Cell Lymphoma of the Central Nervous System Suggests Novel Potential Therapeutic Targets. Mod Pathol 2023; 36:100323. [PMID: 37678673 DOI: 10.1016/j.modpat.2023.100323] [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: 03/31/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
Primary diffuse large B-cell lymphoma of the primary central nervous system (CNS-DLBCL) is an aggressive disease, with dismal prognosis despite the use of high-dose methotrexate-based polychemotherapy. Our study aimed to expand the biologic profiles of CNS-DLBCL and to correlate them with clinical/imaging findings to gain diagnostic insight and possibly identify new therapeutic targets. We selected 61 CNS-DLBCL whose formalin-fixed paraffin-embedded samples were available at first diagnosis. These were investigated by immunohistochemistry, cMYC rearrangements were explored by fluorescence in situ hybridization, and CNS-DLBCL mutated genes were evaluated by next-generation sequencing. CD10, BCL6, and IRF4 were observed in 16%, 83.6%, and 93% of cases, respectively. As typical of CNS lymphoma, 10 (16.4%) of 61 cases were classified as germinal center (GCB) type and 51 (83.6%) of 61 as non-germinal center (non-GCB) type according to the Hans algorithm. Double-expression status for BCL2 and cMYC was detected in 36 (59%) of 61 cases whereas 25 (41%) of 61 were non-DE. Rearrangement of the cMYC gene was detected in 2 cases, associated with BCL6 translocation only in 1 case MYD88, PIM1, CD79B, and TP53 were mutated in 54.5%, 53.5%, 30.2%, and 18.4% cases, respectively. Novel mutations not previously reported in CNS-DLBCL were found: AIP in 23.1%, PI3KCA in 15%, NOTCH1 in 11.4%, GNAS in 8.1%, CASP8 in 7.9%, EGFR in 6.4%, PTEN in 5.1, and KRAS in 2.6% of cases. Survival was significantly longer for patients with mutated MYD88 (8.7 months vs 1.7 months; log-rank test = 5.43; P = .020) and for patients with mutated CD79B (10.8 months vs 2.5 months; log-rank test = 4.64; P = .031). MYD88 and CD79B predicted a longer survival in patients affected by CNS-DLBCL. Notably, we identified novel mutations that enrich the mutational landscape of CNS-DLBCL, suggest a role of PTEN-PI3K-AKT and receptor tyrosine kinase-RAS-mitogen-activated protein kinase signaling in a subset of CNS-DLBCL, and provide new potential therapeutic targets.
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Affiliation(s)
- Claudio Agostinelli
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luca Morandi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Simona Righi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luigi Cirillo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Diego Mazzatenta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, Pituitary Unit
| | - Matteo Zoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Maura Rossi
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Gianmarco Bagnato
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" Bologna Italy
| | - Alessandro Broccoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" Bologna Italy
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Pier Luigi Zinzani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" Bologna Italy
| | - Elena Sabattini
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Caterina Giannini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, Pituitary Unit.
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Messina R, Liliana I, Iommi M, Trombetta M, Roos T, Hermanns N, Di Sipio A, Fantini MP, Calvo V. Assessing attitudes towards insulin pump therapy in adults with type 1 diabetes: Italian validation of the Insulin Pump Attitudes Questionnaire (IT-IPA questionnaire). Acta Diabetol 2023; 60:687-695. [PMID: 36801976 PMCID: PMC10063466 DOI: 10.1007/s00592-023-02046-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
AIMS The aim of the study was to adapt the German version of the insulin pump therapy (IPA) questionnaire to Italian (IT-IPA) and to evaluate its psychometric properties in adults with type 1 diabetes. METHODS We conducted a cross-sectional study, data were collected through an online survey. In addition to IT-IPA, questionnaires evaluating depression, anxiety, diabetes distress, self-efficacy, and treatment satisfaction were administered. The six factors identified in the IPA German version were assessed using confirmatory factor analysis; psychometric testing included construct validity and internal consistency. RESULTS The online survey was compiled by 182 individuals with type 1 diabetes: 45.6% continuous subcutaneous insulin infusion (CSII) users and 54.4% multiple daily insulin injection users. The six-factor model had a very good fit in our sample. The internal consistency was acceptable (Cronbach's α = 0.75; 95% IC [0.65-0.81]). Diabetes treatment satisfaction was positively correlated with a positive attitude towards CSII therapy (Spearman's rho = 0.31; p < 0.01), less Technology Dependency, higher Ease of Use, and less Impaired Body Image. Furthermore, less Technology Dependency was associated with lower diabetes distress and depressive symptoms. CONCLUSIONS The IT-IPA is a valid and reliable questionnaire evaluating attitudes towards insulin pump therapy. The questionnaire can be used for clinical practice during consultations for shared decision-making to CSII therapy.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy.
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy.
| | - Indelicato Liliana
- University of Verona, Verona, Italy
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
| | - Maddalena Trombetta
- University of Verona, Verona, Italy
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
| | - Timm Roos
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - Norbert Hermanns
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - Annamaria Di Sipio
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
- Department of Philosophy, Sociology, Pedagogy, and Applied Psychology, University of Padova, Padua, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
| | - Vincenzo Calvo
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
- Department of Philosophy, Sociology, Pedagogy, and Applied Psychology, University of Padova, Padua, Italy
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Messina R, Indelicato L, Iommi M, Trombetta M, Roos T, Hermanns N, Di Sipio A, Fantini MP, Calvo V. Correction to: Assessing attitudes towards insulin pump therapy in adults with type 1 diabetes: Italian validation of the Insulin Pump Attitudes Questionnaire (IT‑IPA questionnaire). Acta Diabetol 2023; 60:1005. [PMID: 37083963 DOI: 10.1007/s00592-023-02090-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy.
| | | | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
| | - Maddalena Trombetta
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
| | - Timm Roos
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - Annamaria Di Sipio
- Department of Philosophy, Sociology, Pedagogy, and Applied Psychology, University of Padova, Padua, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
| | - Vincenzo Calvo
- Department of Philosophy, Sociology, Pedagogy, and Applied Psychology, University of Padova, Padua, Italy
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Tundo A, Betro' S, de Filippis R, Marchetti F, Nacca D, Necci R, Iommi M. Pramipexole Augmentation for Treatment-Resistant Unipolar and Bipolar Depression in the Real World: A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:life13041043. [PMID: 37109571 PMCID: PMC10141126 DOI: 10.3390/life13041043] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/12/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Pramipexole is a dopamine full agonist approved for the treatment of Parkinson's disease and restless legs syndrome. Its high affinity for the D3 receptor and neuroprotective, antioxidant, and anti-inflammatory activity provides a rationale for the treatment of depression. In this paper, we review studies on the effectiveness and safety of antidepressant pramipexole augmentation in treatment-resistant depression. METHODS This comprehensive systematic review and meta-analysis of observational studies on pramipexole-antidepressant augmentation included patients with resistant unipolar and bipolar depression. The primary outcome measure was the treatment response, measured at the study endpoint. RESULTS We identified 8 studies including 281 patients overall, 57% women and 39.5% with bipolar disorder and 60.5% with major depressive disorder. The mean follow-up duration was 27.3 weeks (range 8-69). The pooled estimate of treatment response was 62.5%, without significant differences between unipolar and bipolar depression. Safety was good, with nausea and somnolence the most frequent side effects. CONCLUSIONS The findings of this systematic review, needing further confirmation, show that off-label use of pramipexole as augmentation of antidepressant treatment could be a useful and safe strategy for unipolar and bipolar treatment-resistant depression.
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Affiliation(s)
- Antonio Tundo
- Istituto di Psicopatologia, Via Girolamo da Carpi, 1, 00196 Rome, Italy
| | - Sophia Betro'
- Istituto di Psicopatologia, Via Girolamo da Carpi, 1, 00196 Rome, Italy
| | - Rocco de Filippis
- Istituto di Psicopatologia, Via Girolamo da Carpi, 1, 00196 Rome, Italy
| | - Fulvia Marchetti
- Istituto di Psicopatologia, Via Girolamo da Carpi, 1, 00196 Rome, Italy
| | - Daniele Nacca
- Istituto di Psicopatologia, Via Girolamo da Carpi, 1, 00196 Rome, Italy
| | - Roberta Necci
- Istituto di Psicopatologia, Via Girolamo da Carpi, 1, 00196 Rome, Italy
| | - Marica Iommi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, 40126 Bologna, Italy
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Iommi M, Faragalli A, Bonifazi M, Mei F, Latini LL, Pompili M, Carle F, Gesuita R. Prognosis and Survival in Idiopathic Pulmonary Fibrosis in the Era of Antifibrotic Therapy in Italy: Evidence from a Longitudinal Population Study Based on Healthcare Utilization Databases. Int J Environ Res Public Health 2022; 19:16689. [PMID: 36554568 PMCID: PMC9779053 DOI: 10.3390/ijerph192416689] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/30/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
The aim was to evaluate the determinants of acute exacerbation (AE) and death in new cases of idiopathic pulmonary fibrosis (IPF) using administrative databases in the Marche Region. Adults at their first prescription of antifibrotics or hospitalization with a diagnosis of IPF occurring in 2014-2019 were considered as new cases. Multiple Cox regression was used to estimate the risk of AE and of all-cause mortality adjusted by demographic and clinical characteristics, stratifying patients according to antifibrotic treatment. Overall, 676 new cases of IPF were identified and 276 deaths and 248 AE events occurred. In never-treated patients, the risk of AE was higher in patients with poor health conditions at diagnosis; the risk of death was higher in males, in patients aged ≥75 and in those with poor health conditions at baseline. The increasing number of AEs increased the risk of death in treated and never-treated patients. Within the limits of an observational study based on secondary data, the combined use of healthcare administrative databases allows the accurate analysis of progression and survival of IPF from the beginning of the antifibrotic therapy era, suggesting that timely and early diagnosis is critical to prescribing the most suitable treatment to increase survival and maintain a healthy life expectancy.
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Affiliation(s)
- Marica Iommi
- Center of Epidemiology Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Andrea Faragalli
- Center of Epidemiology Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60166 Ancona, Italy
| | - Federico Mei
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60166 Ancona, Italy
| | - Lara Letizia Latini
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60166 Ancona, Italy
| | - Marco Pompili
- Regional Health Agency of Marche, 60121 Ancona, Italy
| | - Flavia Carle
- Center of Epidemiology Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milano, Italy
| | - Rosaria Gesuita
- Center of Epidemiology Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milano, Italy
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Bardazzi F, Bonci C, Sacchelli L, DI Altobrando A, Iommi M, Rucci P, Sacchelli P, Berardi D, Patrizi A, Tengattini V. Suicide risk and depression in patients with psoriasis. Ital J Dermatol Venerol 2022; 157:497-501. [PMID: 36651203 DOI: 10.23736/s2784-8671.22.07184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Psoriasis is associated with comorbid psychiatric conditions. However, its relationship with suicidality is not completely understood. The aim of this study was to analyze the prevalence and the correlates of depressive symptoms and suicide risk in patients with psoriasis. METHODS Adult psoriatic patients referring to the Outpatient Service of the Sant'Orsola-Malpighi Polyclinic were enrolled. Depressive symptoms and suicidality were assessed using the Patient Health Questionnaire (PHQ-9) and section C of Mini-International Neuropsychiatric Interview (M.I.N.I. 5.0.0). Psoriasis was evaluated using the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA) and the Dermatology Life Quality Index (DLQI). RESULTS The prevalence of depressive symptoms was 14.9% and that of suicidality 6.3%. PHQ-9 scores were higher in patients with moderate-to-severe psoriasis (PASI≥10, Mann-Whitney U Test=4014.5; P<0.001; BSA≥10, Mann-Whitney Test=3930.5; P<0.001) and poorer quality of life (Mann-Whitney Test=805.5; P=0.024). Moreover, PHQ-9 scores were higher in females (Mann-Whitney Test U=3612.5; P=0.008) and were unrelated to age (r<inf>s</inf>=-0.056, P=0.423). Conversely, suicide risk was significantly higher in younger patients (Mann-Whitney=744, P=0.013) and females (χ2=5.69, P=0.028), and was unrelated to psoriasis severity. CONCLUSIONS Patients with moderate-to-severe psoriasis, especially females, should be screened for depression and suicidal ideation to support them with effective strategies to treat depressive symptoms.
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Affiliation(s)
- Federico Bardazzi
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Camilla Bonci
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Lidia Sacchelli
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy -
| | - Ambra DI Altobrando
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | - Paola Sacchelli
- School of Specialization in Psychotherapy with "Relationship Psychoanalysis, " Area 25 Clinical Center, Società Italiana di Psicoanalisi della Relazione (SIPRe), Milan, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy.,Departiment of Dermatology, IRCCS Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Vera Tengattini
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
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Tundo A, Salvati L, Cieri L, Balestrini V, Di Spigno D, Orazi F, Iommi M, Necci R. Serotonin reuptake inhibitor-cognitive behavioural therapy-second generation antipsychotic combination for severe treatment-resistant obsessive-compulsive disorder. A prospective observational study. Int J Psychiatry Clin Pract 2022; 26:395-400. [PMID: 35323098 DOI: 10.1080/13651501.2022.2054351] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Six in ten patients with obsessive-compulsive disorder (OCD) do not respond to the first-line treatments with serotonin reuptake inhibitor (SRI) or cognitive behavioural therapy including exposure and response prevention (CBT/ERP), and several do not respond to second-line treatments, i.e., SRI-second generation antipsychotic (SGA) or SRI-CBT/ERP augmentation. Evidence on third-line treatments is inconsistent. OBJECTIVE We investigated the 1-year response to SRI-CBT/ERP-SGA combination in patients with severe treatment-resistant OCD, who failed to respond to SRI and to SRI-SGA or SRI-CBT/ERP augmentation. METHODS Twenty-eight patients were consecutively recruited and treated with SRI (drug(s) and doses previously administered), SGA (risperidone median dosage 1 mg/day in 14 cases, aripiprazole median dosage 3 mg/day in 14 cases) and CBT/ERP (median hours 32.5). Exclusion criteria: mental retardation and organic brain syndrome. RESULTS The mean Y-BOCS total score reduction at 12 months was 28.2%, 60.7% of patients improved, 46.4% partially responded, 32.1% responded, and 28.6% remitted. Patients previously resistant to SRI-SGA and SRI-CBT/ERP did not significantly differ in the rates of improvement, partial response, response and remission. CONCLUSIONS This study suggests that SRI-SGA-CBT/ERP combination could be useful for severe treatment-resistant OCD. Small sample size is a limitation.Key pointsUp to 6 in 10 patients with OCD do not respond to first line treatments (CBT/ERP or SRIs) and several to second-line treatments (SRI-SGA or SRI CBT/ERP augmentation).In our study, patients with OCD resistant to the first and the second line treatment improved (61%), partially responded (46%), responded (32%), or remitted (29%) combining SRI, SGA and CBT/ERP.In our patients the SRI-SGA-CBT/ERP augmentation improved working/school, social and family impairment.SRI-SGA-CBT/ERP augmentation is easier to use than other treatments for severe treatment-resistant OCD.
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Affiliation(s)
| | | | | | | | | | | | - Marica Iommi
- Dipertimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
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Casula M, Galimberti F, Iommi M, Olmastroni E, Rosa S, Altini M, Catapano AL, Tragni E, Poluzzi E. Impact of the COVID-19 Pandemic on the Therapeutic Continuity among Outpatients with Chronic Cardiovascular Therapies. Int J Environ Res Public Health 2022; 19:ijerph191912101. [PMID: 36231403 PMCID: PMC9566639 DOI: 10.3390/ijerph191912101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/25/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 05/13/2023]
Abstract
The COVID-19 pandemic poses major challenges to healthcare systems. We aimed to investigate the impact of the pandemic on prescription and adherence patterns of chronic cardiovascular therapies (lipid-lowering [LL], oral antidiabetic drugs [AD], and antihypertensives [AH]) using administrative pharmaceutical databases. For each treatment, two cohorts of prevalent cases in 2019 and 2020 were compared. We evaluated the percentage change in dispensed packages and treatment adherence as a proportion of days covered (PDC). For all therapies, an increase was observed during March-April 2020 (LL: +4.52%; AD: +2.72%; AH: +1.09%), with a sharp decrease in May-June 2020 (LL: -8.40%; AD: -12.09%; AH: -10.54%) compared to 2019. The impact of the COVID-19 pandemic on chronic cardiovascular treatments appears negligible on adherence: 533,414 patients showed high adherence to LL (PDC ≥ 80%) in January-February 2020, and 2.29% became poorly adherent (PDC < 20%) in the following four-month period (vs. 1.98% in 2019). A similar increase was also observed for AH (1.25% with poor adherence in 2020 vs. 0.93% in 2019). For AD, the increase was restrained (1.55% with poor adherence in 2020 vs. 1.37% in 2019). The rush to supply drugs at the beginning of lockdown preserved the continuity of chronic cardiovascular therapies.
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Affiliation(s)
- Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133 Milan, Italy
- IRCCS MultiMedica, Via Milanese 300, Sesto S. Giovanni, 20099 Milan, Italy
| | | | - Marica Iommi
- Department of Medical and Surgical Sciences-Pharmacology Unit, University of Bologna, Via Irnerio 48, 40126 Bologna, Italy
| | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133 Milan, Italy
- Correspondence:
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences-Hygiene and Biostatistics Unit, University of Bologna, Via San Giacomo, 40126 Bologna, Italy
| | - Mattia Altini
- Romagna Local Health Authority, Emilia-Romagna Region, Via A. De Gasperi 8, 48121 Ravenna, Italy
| | - Alberico L. Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133 Milan, Italy
- IRCCS MultiMedica, Via Milanese 300, Sesto S. Giovanni, 20099 Milan, Italy
| | - Elena Tragni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133 Milan, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences-Pharmacology Unit, University of Bologna, Via Irnerio 48, 40126 Bologna, Italy
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10
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Marconi V, Iommi M, Monachesi C, Faragalli A, Skrami E, Gesuita R, Ferrante L, Carle F. Validity of age estimation methods and reproducibility of bone/dental maturity indices for chronological age estimation: a systematic review and meta-analysis of validation studies. Sci Rep 2022; 12:15607. [PMID: 36114349 PMCID: PMC9481543 DOI: 10.1038/s41598-022-19944-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Several approaches have been developed to estimate age, an important aspect of forensics and orthodontics, using different measures and radiological examinations. Here, through meta-analysis, we determined the validity of age estimation methods and reproducibility of bone/dental maturity indices used for age estimation. The PubMed and Google Scholar databases were searched to December 31, 2021 for human cross-sectional studies meeting pre-defined PICOS criteria that simultaneously assessed the reproducibility and validity. Meta-estimates of validity (mean error: estimated age-chronological age) and intra- and inter-observer reproducibility (Cohen’s kappa, intraclass correlation coefficient) and their predictive intervals (PI) were calculated using mixed-effect models when heterogeneity was high (I2 > 50%). The literature search identified 433 studies, and 23 met the inclusion criteria. The mean error meta-estimate (mixed effects model) was 0.08 years (95% CI − 0.12; 0.29) in males and 0.09 (95% CI − 0.12; 0.30) in females. The PI of each method spanned zero; of nine reported estimation methods, Cameriere’s had the smallest (− 0.82; 0.47) and Haavikko’s the largest (− 7.24; 4.57) PI. The reproducibility meta-estimate (fixed effects model) was 0.98 (95% CI 0.97; 1.00) for intra- and 0.99 (95% CI 0.98; 1.00) for inter-observer agreement. All methods were valid but with different levels of precision. The intra- and inter-observer reproducibility was high and homogeneous across studies.
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11
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Messina R, Iommi M, Rucci P, Reno C, Mazzotti A, Caletti MT, Altini M, Bravi F, Fantini MP, Di Bartolo P. Emergency department accesses for diabetes-related complications during COVID-19 pandemic in people with type 2 diabetes and depression. Acta Diabetol 2022; 59:1247-1249. [PMID: 35525884 PMCID: PMC9078373 DOI: 10.1007/s00592-022-01894-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo 12, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo 12, Bologna, Italy.
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo 12, Bologna, Italy
| | - Chiara Reno
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo 12, Bologna, Italy
| | - Arianna Mazzotti
- Diabetes Unit, Romagna Local Health Authority, Via De Gasperi 8, Ravenna, Italy
| | | | - Mattia Altini
- Romagna Local Health Authority, Emilia-Romagna Region, Via De Gasperi 8, Ravenna, Italy
| | - Francesca Bravi
- Romagna Local Health Authority, Emilia-Romagna Region, Via De Gasperi 8, Ravenna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo 12, Bologna, Italy
| | - Paolo Di Bartolo
- Diabetes Unit, Romagna Local Health Authority, Via De Gasperi 8, Ravenna, Italy
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12
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Connelly L, Fiorentini G, Iommi M. Supply-side solutions targeting demand-side characteristics: causal effects of a chronic disease management program on adherence and health outcomes. Eur J Health Econ 2022; 23:1203-1220. [PMID: 35091855 DOI: 10.1007/s10198-021-01421-x] [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] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
We estimate the effects of a chronic disease management program (CDMP) which adapts various supply-side interventions to specific demand-side conditions (disease-staging) for patients with chronic kidney disease (CKD). Using a unique dataset on the entire population of the Emilia-Romagna region of Italy with hospital-diagnosed CKD, we estimate the causal effects of the CDMP on adherence indicators and health outcomes. As CKD is a progressive disease with clearly-defined disease stages and a treatment regimen that can be titrated by disease severity, we calculate dynamic, severity-specific, indicators of adherence as well as several long-term health outcomes. Our empirical work produces statistically significant and sizeable causal effects on many adherence and health outcome indicators across all CKD patients. More interestingly, we show that the CDMP produces larger effects on patients with early-stage CKD, which is at odds with some of the literature on CDMP that advocates intensifying interventions for high-cost (or late-stage) patients. Our results suggest that it may be more efficient to target early-stage patients to slow the deterioration of their health capital. The results contribute to a small, recent literature in health economics that focuses on the marginal effectiveness of CDMPs after controlling either for supply- or demand-side sources of heterogeneity.
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Affiliation(s)
- Luke Connelly
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia.
- Dipartimento di Sociologia e Diritto dell'Economia, Università di Bologna, Bologna, Italy.
| | | | - Marica Iommi
- Scuola Superiore di Politiche per la Salute, Università di Bologna, Bologna, Italy
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13
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Iozzino L, Canessa N, Rucci P, Iommi M, Dvorak A, Heitzman J, Markiewicz I, Picchioni M, Pilszyk A, Wancata J, de Girolamo G. Decision-making and risk-taking in forensic and non-forensic patients with schizophrenia spectrum disorders: A multicenter European study. Schizophr Res Cogn 2022; 29:100257. [PMID: 35620384 PMCID: PMC9127676 DOI: 10.1016/j.scog.2022.100257] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Studies of patients with schizophrenia and offenders with severe mental disorders decision-making performance have produced mixed findings. In addition, most earlier studies have assessed decision-making skills in offenders or people with mental disorders, separately, thus neglecting the possible additional contribution of a mental disorder on choice patterns in people who offend. This study aimed to fill this gap by comparing risk-taking in patients with schizophrenia spectrum disorders (SSD), with and without a history of serious violent offending assessing whether, and to what extent, risk-taking represents a significant predictor of group membership, controlling for their executive skills, as well as for socio-demographic and clinical characteristics. Overall, 115 patients with a primary diagnosis of SSD were recruited: 74 were forensic patients with a lifetime history of severe interpersonal violence and 41 were patients with SSD without such a history. No significant group differences were observed on psychopathological symptoms severity. Forensic generally displayed lower scores than non-forensic patients in all cognitive subtests of the Brief Assessment of Cognition in Schizophrenia (except for the “token motor” and the “digit sequencing” tasks) and on all the six dimensions of the Cambridge Gambling Task, except for “Deliberation time”, in which forensic scored higher than non-forensic patients. “Deliberation time” was also positively, although weakly correlated with “poor impulse control”. Identifying those facets of impaired decision-making mostly predicting offenders' behaviour among individuals with mental disorder might inform risk assessment and be targeted in treatment and rehabilitation protocols.
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Affiliation(s)
- Laura Iozzino
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Unit of Epidemiological Psychiatry and Evaluation, via Pilastroni 4, 25125 Brescia, Italy
| | - Nicola Canessa
- Scuola Universitaria Superiore IUSS, IUSS Cognitive Neuroscience (ICoN) Center, Piazza della Vittoria 15, 27100 Pavia, Italy.,Istituti Clinici Scientifici Maugeri IRCCS, Cognitive Neuroscience Laboratory of Pavia Institute, via S. Maugeri 10, 27100 Pavia, Italy
| | - Paola Rucci
- University of Bologna, Department of Biomedical and Neuromotor Sciences, Piazza di Porta S. Donato 2, 40127 Bologna, Italy
| | - Marica Iommi
- University of Bologna, Department of Biomedical and Neuromotor Sciences, Piazza di Porta S. Donato 2, 40127 Bologna, Italy
| | - Alexander Dvorak
- Ministry of Justice, Medical Director of the Justizanstalt Göllersdorf, Museumstraße 7, 1070 Vienna, Austria
| | - Janusz Heitzman
- Institute of Psychiatry and Neurology, Department of Forensic Psychiatry, Jana III Sobieskiego 9, 02-957 Warsaw, Poland
| | - Inga Markiewicz
- Institute of Psychiatry and Neurology, Department of Forensic Psychiatry, Jana III Sobieskiego 9, 02-957 Warsaw, Poland
| | - Marco Picchioni
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Forensic and Neurodevelopmental Science, 16 De Crespigny Park, SE5 8AF London, UK.,St Magnus Hospital, Haslemere, GU27 3PX Surrey, UK
| | - Anna Pilszyk
- Institute of Psychiatry and Neurology, Department of Forensic Psychiatry, Jana III Sobieskiego 9, 02-957 Warsaw, Poland
| | - Johannes Wancata
- Medical University of Vienna, Clinical Division of Social Psychiatry, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Giovanni de Girolamo
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Unit of Epidemiological Psychiatry and Evaluation, via Pilastroni 4, 25125 Brescia, Italy
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14
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Merlo I, Cantarutti A, Allotta A, Tavormina EE, Iommi M, Pompili M, Rea F, Agodi A, Locatelli A, Zanini R, Carle F, Addario SP, Scondotto S, Corrao G. Development and Validation of a Novel Pre-Pregnancy Score Predictive of Preterm Birth in Nulliparous Women Using Data from Italian Healthcare Utilization Databases. Healthcare (Basel) 2022; 10:healthcare10081443. [PMID: 36011100 PMCID: PMC9407812 DOI: 10.3390/healthcare10081443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Preterm birth is a major worldwide public health concern, being the leading cause of infant mortality. Understanding of risk factors remains limited, and early identification of women at high risk of preterm birth is an open challenge. Objective: The aim of the study was to develop and validate a novel pre-pregnancy score for preterm delivery in nulliparous women using information from Italian healthcare utilization databases. Study Design: Twenty-six variables independently able to predict preterm delivery were selected, using a LASSO logistic regression, from a large number of features collected in the 4 years prior to conception, related to clinical history and socio-demographic characteristics of 126,839 nulliparous women from Lombardy region who gave birth between 2012 and 2017. A weight proportional to the coefficient estimated by the model was assigned to each of the selected variables, which contributed to the Preterm Birth Score. Discrimination and calibration of the Preterm Birth Score were assessed using an internal validation set (i.e., other 54,359 deliveries from Lombardy) and two external validation sets (i.e., 14,703 and 62,131 deliveries from Marche and Sicily, respectively). Results: The occurrence of preterm delivery increased with increasing the Preterm Birth Score value in all regions in the study. Almost ideal calibration plots were obtained for the internal validation set and Marche, while expected and observed probabilities differed slightly in Sicily for high Preterm Birth Score values. The area under the receiver operating characteristic curve was 60%, 61% and 56% for the internal validation set, Marche and Sicily, respectively. Conclusions: Despite the limited discriminatory power, the Preterm Birth Score is able to stratify women according to their risk of preterm birth, allowing the early identification of mothers who are more likely to have a preterm delivery.
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Affiliation(s)
- Ivan Merlo
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy; (I.M.); (F.R.); (G.C.)
| | - Anna Cantarutti
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy; (I.M.); (F.R.); (G.C.)
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (S.P.A.); (S.S.)
- Correspondence: ; Tel.: +39-02-6448-5828; Fax: +39-02-6448-5899
| | - Alessandra Allotta
- Department of Health Activities and Epidemiological Observatory, Regional Health Authority, Sicily Region, 90145 Palermo, Italy; (A.A.); (E.E.T.)
| | - Elisa Eleonora Tavormina
- Department of Health Activities and Epidemiological Observatory, Regional Health Authority, Sicily Region, 90145 Palermo, Italy; (A.A.); (E.E.T.)
- National Research Council of Italy, Institute for Biomedical Research and Innovation, 90146 Palermo, Italy
| | - Marica Iommi
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60020 Ancona, Italy;
| | - Marco Pompili
- Regional Epidemiological Observatory, Regional Health Agency of Marche, 60125 Ancona, Italy;
| | - Federico Rea
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy; (I.M.); (F.R.); (G.C.)
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (S.P.A.); (S.S.)
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy;
| | - Anna Locatelli
- Department of Mother and Child, ASST Vimercate, 20871 Vimercate, Italy;
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Rinaldo Zanini
- Past Director of Woman and Child Health Department, Azienda Ospedaliera della Provincia di Lecco, 23900 Lecco, Italy;
| | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (S.P.A.); (S.S.)
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60020 Ancona, Italy;
| | - Sebastiano Pollina Addario
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (S.P.A.); (S.S.)
- Department of Health Activities and Epidemiological Observatory, Regional Health Authority, Sicily Region, 90145 Palermo, Italy; (A.A.); (E.E.T.)
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (S.P.A.); (S.S.)
- Department of Health Activities and Epidemiological Observatory, Regional Health Authority, Sicily Region, 90145 Palermo, Italy; (A.A.); (E.E.T.)
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy; (I.M.); (F.R.); (G.C.)
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (S.P.A.); (S.S.)
- Directorate General for Health, Lombardy Region, 20124 Milan, Italy
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15
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Bardazzi F, Filippi F, Chessa MA, Iommi M, Loi C, Campanati A, Rizzetto G, Tagliati C, Atzori L, Muratori S, Genovese G, Gisondi P, Schena D, Balestri R, Rech G, Feliciani C, Lasagni C, Bigi L, De Simone C, Di Zenzo G, Moro F, Borghi A, Di Lernia V, D'Arrigo G, Tripepi G, Gori M, Pitino A. Mortality and prognostic factors in patients with bullous pemphigoid: a retrospective multicenter Italian study. J Eur Acad Dermatol Venereol 2022; 36:2473-2481. [PMID: 35857348 DOI: 10.1111/jdv.18441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Bullous pemphigoid is the most common autoimmune bullous dermatosis. In recent years several studies have tried to identify the main factors of the disease related with an increased risk of death. The aim of this multicenter Italian study was to assess the risk score of death considering epidemiologic, clinical, immunological, and therapeutic factors in a cohort of patients affected by bullous pemphigoid and try to identify the cumulative survival up to 120 months. METHODS We retrospectively reviewed the medical records of patients with bullous pemphigoid who were diagnosed between 2005 and 2020 in the 12 Italian centers. Data collected included sex, age at the time of diagnosis, laboratory findings, severity of disease, time at death/censoring, treatment, and multimorbidity. RESULTS A total of 572 patients were included in the study. The crude mortality rate was of 20.6%, with an incidence mortality rate of 5.9x100 person/year. The mortality rate at 1,3,5 and 10 years was 3,2%, 18,2%, 27,4% and 51,9%, respectively. Multivariate model results showed that the risk of death was significantly higher in patients older than 78 years, in presence of multimorbidity, anti-BP180 autoantibodies>72 U/ml or anti-BP230>3 U/ml at diagnosis. The variables jointly included provided an accuracy (Harrel's Index) of 77% for predicting mortality. CONCLUSION This study represents the first nationwide Italian study to have retrospectively investigated the mortality rates and prognostic factors in patients with bullous pemphigoid. A novel finding emerged in our study is that a risk prediction rule based on simple risk factors (age, multimorbidity, steroid-sparing drugs, prednisone use and disease severity) jointly considered with two biomarkers routinely measured in clinical practice (anti-BP230 and anti-BP180 autoantibodies) provided about 80% accuracy for predicting mortality in large series of patients with this disease.
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Affiliation(s)
- Federico Bardazzi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Division of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federica Filippi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Division of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Adriano Chessa
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Division of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, University of Bologna
| | - Camilla Loi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Division of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Anna Campanati
- Dermatology Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Giulio Rizzetto
- Dermatology Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Corrado Tagliati
- Dermatology Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Laura Atzori
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari
| | - Simona Muratori
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Paolo Gisondi
- Section of Dermatology, Department of Medicine, University of Verona, 37126, Verona, Italy
| | - Donatella Schena
- Section of Dermatology, Department of Medicine, University of Verona, 37126, Verona, Italy
| | | | - Giulia Rech
- Division of Dermatology, Santa Chiara Hospital, Trento, Italy
| | - Claudio Feliciani
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Italy
| | - Claudia Lasagni
- Dermatology Unit, Surgical, Medical, and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Bigi
- Dermatology Unit, Surgical, Medical, and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Clara De Simone
- Institute of Dermatology, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Di Zenzo
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy
| | - Francesco Moro
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy
| | - Alessandro Borghi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases University of Ferrara, Ferrara, Italy
| | - Vito Di Lernia
- Dermatology Unit, Department of Medical Specialities, Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giovanni Tripepi
- IFC CNR Institute of clinical physiology of Reggio Calabria, Italy
| | - Mercedes Gori
- IFC CNR Institute of clinical physiology of Rome, Italy
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16
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Martini S, Czosnyka M, Smielewski P, Iommi M, Galletti S, Vitali F, Paoletti V, Camela F, Austin T, Corvaglia L. Clinical determinants of cerebrovascular reactivity in very preterm infants during the transitional period. Pediatr Res 2022; 92:135-141. [PMID: 35513715 DOI: 10.1038/s41390-022-02090-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/29/2022] [Accepted: 04/10/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Preterm infants are at enhanced risk of brain injury due to altered cerebral haemodynamics during postnatal transition. This observational study aimed to assess the clinical determinants of transitional cerebrovascular reactivity and its association with intraventricular haemorrhage (IVH). METHODS Preterm infants <32 weeks underwent continuous monitoring of cerebral oxygenation and heart rate over the first 72 h after birth. Serial cranial and cardiac ultrasound assessments were performed to evaluate the ductal status and to diagnose IVH onset. The moving correlation coefficient between cerebral oxygenation and heart rate (TOHRx) was calculated. Linear mixed-effect models were used to analyse the impact of relevant clinical variables on TOHRx. The association between TOHRx and IVH development was also assessed. RESULTS Seventy-seven infants were included. A haemodynamically significant patent ductus arteriosus (hsPDA) (β = 0.044, 95% CI: 0.007-0.081) and ongoing dopamine treatment (β = 0.096, 95% CI: 0.032-0.159) were associated with increasing TOHRx, indicating impaired cerebrovascular reactivity. A significant association between TOHRx, mean arterial blood pressure (β = -0.004, 95% CI: -0.007, -0.001) and CRIB-II score (β = 0.007, 95% CI: 0.001-0.015) was also observed. TOHRx was significantly higher in infants developing high-grade IVH compared to those without IVH. CONCLUSIONS Dopamine treatment, low blood pressure, hsPDA and high CRIB-II are associated with impaired cerebrovascular reactivity during postnatal transition, with potential implications on IVH development. IMPACT The correlation coefficient between cerebral oxygenation and heart rate (TOHRx) provides a non-invasive estimation of cerebrovascular reactivity, whose failure has a potential pathogenic role in the development of IVH in preterm infants. This study shows that cerebrovascular reactivity during the transitional period improves over time and is affected by specific clinical and therapeutic factors, whose knowledge could support the development of individualized neuroprotective strategies in at-risk preterm infants. The evidence of increased TOHRx in infants developing high-grade compared to low-grade or no IVH during the transitional period further supports the role of impaired cerebrovascular reactivity in IVH pathophysiology.
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Affiliation(s)
- Silvia Martini
- Neonatal Intensive Care Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy. .,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | - Silvia Galletti
- Neonatal Intensive Care Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesca Vitali
- Neonatal Intensive Care Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vittoria Paoletti
- Neonatal Intensive Care Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Federica Camela
- Neonatal Intensive Care Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Topun Austin
- Neonatal Intensive Care Unit, The Rosie Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Iommi M, Bergquist S, Fiorentini G, Paolucci F. Comparing risk adjustment estimation methods under data availability constraints. Health Econ 2022; 31:1368-1380. [PMID: 35384134 PMCID: PMC9320950 DOI: 10.1002/hec.4512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 01/24/2022] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
The Italian National Healthcare Service relies on per capita allocation for healthcare funds, despite having a highly detailed and wide range of data to potentially build a complex risk-adjustment formula. However, heterogeneity in data availability limits the development of a national model. This paper implements and ealuates machine learning (ML) and standard risk-adjustment models on different data scenarios that a Region or Country may face, to optimize information with the most predictive model. We show that ML achieves a small but generally statistically insignificant improvement of adjusted R2 and mean squared error with fine data granularity compared to linear regression, while in coarse granularity and poor range of variables scenario no differences were observed. The advantage of ML algorithms is greater in the coarse granularity and fair/rich range of variables set and limited with fine granularity scenarios. The inclusion of detailed morbidity- and pharmacy-based adjustors generally increases fit, although the trade-off of creating adverse economic incentives must be considered.
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Affiliation(s)
- Marica Iommi
- Advanced School for Health PolicyUniversity of BolognaBolognaItaly
| | | | | | - Francesco Paolucci
- Newcastle Business SchoolUniversity of NewcastleNewcastleAustralia
- School of Economics and ManagementUniversity of BolognaBolognaItaly
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18
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Iommi M, Bonifazi M, Faragalli A, Latini LL, Mei F, Spazzafumo L, Skrami E, Ferrante L, Carle F, Gesuita R. Occurrence of Idiopathic Pulmonary Fibrosis in Italy: Latest Evidence from Real-World Data. Int J Environ Res Public Health 2022; 19:ijerph19052510. [PMID: 35270205 PMCID: PMC8909740 DOI: 10.3390/ijerph19052510] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/04/2022] [Accepted: 02/20/2022] [Indexed: 12/04/2022]
Abstract
The aim of the study was to evaluate the trend in the incidence of idiopathic pulmonary fibrosis (IPF) in a real-world setting of the Marche region, a region of Central Italy, between 2014 and 2019. This observational prospective study was based on administrative databases of hospital discharges and drug prescriptions. All adult residents in the Marche Region with a first prescription of antifibrotic drugs, or a first hospitalization with a diagnosis of IPF during the study period, were identified as incident cases of IPF. A multiple Poisson regression analysis was used to estimate the IPF incidence trend, adjusted for age, sex, and health conditions. The mean incidence rate was 9.8 cases per 100,000 person-years. A significant increasing trend of 6% per year was observed. The incidence rates were significantly higher in males than females, older subjects, and those with poorer health conditions. To our knowledge, this is the first study evaluating incidences of IPF over a 6-year period in Italy, combining hospital discharge and drug prescription databases. The study highlights that the combined use of two secondary sources is a reliable strategy to accurately identify new cases of IPF when the appropriate disease registry is lacking.
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Affiliation(s)
- Marica Iommi
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.I.); (A.F.); (E.S.); (L.F.); (R.G.)
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.B.); (L.L.L.); (F.M.)
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60126 Ancona, Italy
| | - Andrea Faragalli
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.I.); (A.F.); (E.S.); (L.F.); (R.G.)
| | - Lara Letizia Latini
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.B.); (L.L.L.); (F.M.)
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60126 Ancona, Italy
| | - Federico Mei
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.B.); (L.L.L.); (F.M.)
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60126 Ancona, Italy
| | | | - Edlira Skrami
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.I.); (A.F.); (E.S.); (L.F.); (R.G.)
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milano, Italy
| | - Luigi Ferrante
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.I.); (A.F.); (E.S.); (L.F.); (R.G.)
| | - Flavia Carle
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.I.); (A.F.); (E.S.); (L.F.); (R.G.)
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milano, Italy
- Correspondence: ; Tel.: +39-071-2206020
| | - Rosaria Gesuita
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.I.); (A.F.); (E.S.); (L.F.); (R.G.)
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milano, Italy
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Messina R, Iommi M, Rucci P, Reno C, Fantini MP, Lunghi C, Altini M, Bravi F, Rosa S, Nicolucci A, Di Bartolo P. Is it time to consider depression as a major complication of type 2 diabetes? Evidence from a large population-based cohort study. Acta Diabetol 2022; 59:95-104. [PMID: 34495396 PMCID: PMC8758621 DOI: 10.1007/s00592-021-01791-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/19/2021] [Indexed: 12/26/2022]
Abstract
AIMS Depression in type 2 diabetes may heavily affect the course of the disease. In this study, we investigated, among new cases with type 2 diabetes, the incidence and clinical predictors of depression and determined the extent to which depression constitutes a risk factor for acute and long-term diabetes complications and mortality. METHODS In this population-based retrospective cohort study, incident cases of type 2 diabetes without a prior history of depression were identified from the administrative databases of the Emilia-Romagna Region, Italy, between 2008 and 2017 and followed up until 2020. Logistic regression models were used to identify the predictors of depression. Cox regression models were used to estimate the risk of acute complications over three years, and the risk of long-term complications and mortality over ten years. RESULTS Incident cases with type 2 diabetes were 30,815, of whom 5146 (16.7%) developed depression. The predictors of depression onset were as follows: female sex, age > 65 years, living in rural areas and comorbid diseases. Depression in type 2 diabetes was associated with a 2.3-fold risk of developing acute complications, 1.6-fold risk of developing long-term complications and 2.8-fold mortality risk. CONCLUSIONS Our findings highlight that depression is associated with an increased risk for complications in type 2 diabetes and mortality and should not be neglected. Therefore, it is important to promote screening activities and introduce targeted and personalized treatment for depression in order to reduce the risk of poor short- and long-term outcomes of diabetes.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, BO, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, BO, Italy.
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, BO, Italy
| | - Chiara Reno
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, BO, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, BO, Italy
| | - Carlotta Lunghi
- Department of Health Sciences, Université du Québec À Rimouski, Rimouski, Canada
- Santé Des Populations Et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec, Québec, Canada
| | - Mattia Altini
- Health Directorate, Romagna Local Health Authority, Bologna, Emilia-Romagna Region, Italy
| | - Francesca Bravi
- Health Directorate, Romagna Local Health Authority, Bologna, Emilia-Romagna Region, Italy
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, BO, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
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Bardazzi F, Rucci P, Rosa S, Loi C, Iommi M, Altobrando AD. Komorbidität bei Pemphigus: eine Fall-Kontroll-Studie. J Dtsch Dermatol Ges 2021; 19:1613-1620. [PMID: 34811909 DOI: 10.1111/ddg.14595_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
HINTERGRUND UND ZIELE Pemphigus ist mit physischen und psychischen Erkrankungen assoziiert. Diese Studie soll derartige Zusammenhänge bei Patienten mit Pemphigus näher untersuchen sowie die Komorbidität nach Geschlecht, Alter, dem Pemphigus Disease Area Index, der Diagnoseverzögerung und der Beteiligung von Haut/Schleimhaut analysieren. PATIENTEN UND METHODEN Jedem Pemphigus-Patienten wurden acht Kontrollen mit ähnlichem Alter, Geschlecht und Wohnsitz zugeordnet. Die Wahrscheinlichkeit für Begleiterkrankungen bei Patienten und Kontrollpersonen wurde anhand univariater konditionaler Regressionsmodelle bestimmt. Begleiterkrankungen, die in den univariaten Modellen mit P < 0,05 mit der Diagnose Pemphigus assoziiert waren, wurden dann in einem Vorwärtsverfahren in ein multivariates konditionales Regressionsmodell eingefügt. ERGEBNISSE Die Studie umfasste 163 Patienten mit Pemphigus. Die hauptsächlichen Erkrankungen zum Diagnosezeitpunkt waren kardiovaskuläre Erkrankungen, Hyperlipidämie, Autoimmunerkrankungen der Schilddrüse, autoimmune/entzündliche Dermatosen und Krebs. In der multivariaten konditionalen Regressionsanalyse waren Krebs und autoimmune/entzündliche Dermatosen unabhängig mit Pemphigus assoziiert. In Sensitivitätsanalysen, in denen vier Patienten mit paraneoplastischem Pemphigus ausgeschlossen wurden, waren diese Assoziationen ebenfalls signifikant. SCHLUSSFOLGERUNGEN Krebs und autoimmune/entzündliche Dermatosen sind möglicherweise auslösende Faktoren für Pemphigus dar und sollten als frühe Warnsignale für diese Erkrankung angesehen werden.
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Affiliation(s)
- Federico Bardazzi
- Department of Experimental, Diagnostic and Specialty Medicine - Dermatology - IRCCS Policlinico di Sant'Orsola, Bologna, Italien
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italien
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italien
| | - Camilla Loi
- Department of Experimental, Diagnostic and Specialty Medicine - Dermatology - IRCCS Policlinico di Sant'Orsola, Bologna, Italien
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italien
| | - Ambra Di Altobrando
- Department of Experimental, Diagnostic and Specialty Medicine - Dermatology - IRCCS Policlinico di Sant'Orsola, Bologna, Italien
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Corrao G, Rea F, Carle F, Scondotto S, Allotta A, Lepore V, D'Ettorre A, Tanzarella C, Vittori P, Abena S, Iommi M, Spazzafumo L, Ercolanoni M, Blaco R, Carbone S, Giordani C, Manfellotto D, Galli M, Mancia G. Stratification of the risk of developing severe or lethal Covid-19 using a new score from a large Italian population: a population-based cohort study. BMJ Open 2021; 11:e053281. [PMID: 34794995 PMCID: PMC8602929 DOI: 10.1136/bmjopen-2021-053281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To develop a population-based risk stratification model (COVID-19 Vulnerability Score) for predicting severe/fatal clinical manifestations of SARS-CoV-2 infection, using the multiple source information provided by the healthcare utilisation databases of the Italian National Health Service. DESIGN Retrospective observational cohort study. SETTING Population-based study using the healthcare utilisation database from five Italian regions. PARTICIPANTS Beneficiaries of the National Health Service, aged 18-79 years, who had the residentship in the five participating regions. Residents in a nursing home were not included. The model was built from the 7 655 502 residents of Lombardy region. MAIN OUTCOME MEASURE The score included gender, age and 29 conditions/diseases selected from a list of 61 conditions which independently predicted the primary outcome, that is, severe (intensive care unit admission) or fatal manifestation of COVID-19 experienced during the first epidemic wave (until June 2020). The score performance was validated by applying the model to several validation sets, that is, Lombardy population (second epidemic wave), and the other four Italian regions (entire 2020) for a total of about 15.4 million individuals and 7031 outcomes. Predictive performance was assessed by discrimination (areas under the receiver operating characteristic curve) and calibration (plot of observed vs predicted outcomes). RESULTS We observed a clear positive trend towards increasing outcome incidence as the score increased. The areas under the receiver operating characteristic curve of the COVID-19 Vulnerability Score ranged from 0.85 to 0.88, which compared favourably with the areas of generic scores such as the Charlson Comorbidity Score (0.60). A remarkable performance of the score on the calibration of observed and predicted outcome probability was also observed. CONCLUSIONS A score based on data used for public health management accurately predicted the occurrence of severe/fatal manifestations of COVID-19. Use of this score may help health decision-makers to more accurately identify high-risk citizens who need early preventive or treatment interventions.
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Affiliation(s)
- Giovanni Corrao
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Federico Rea
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority of Sicily, Palermo, Italy
| | - Alessandra Allotta
- Department of Health Services and Epidemiological Observatory, Regional Health Authority of Sicily, Palermo, Italy
| | - Vito Lepore
- Regional Health Agency of Puglia, Bari, Italy
| | | | | | | | | | - Marica Iommi
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Liana Spazzafumo
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Regional Health Agency of Marche, Ancona, Italy
| | | | | | - Simona Carbone
- Department of Health Planning, Italian Health Ministry, Rome, Italy
| | | | - Dario Manfellotto
- Department of Internal Medicine, Hospital Fatebenefratelli, Rome, Italy
| | - Massimo Galli
- Institute of Tropical and Infectious Diseases, University of Milan L Sacco Hospital, Milan, Italy
| | - Giuseppe Mancia
- University of Milano-Bicocca, Milan, Italy
- Policlinico di Monza, Monza, Italy
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Bardazzi F, Rucci P, Rosa S, Loi C, Iommi M, Altobrando AD. Comorbid diseases associated with pemphigus: a case-control study. J Dtsch Dermatol Ges 2021; 19:1613-1619. [PMID: 34729897 DOI: 10.1111/ddg.14595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/25/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Pemphigus has been associated with physical and psychiatric comorbid diseases. This study aims to further investigate these associations in patients with pemphigus, and to analyze the relationships of comorbid conditions with sex and age, pemphigus disease area index score, diagnostic delay and cutaneous/mucous involvement. PATIENTS AND METHODS Patients with pemphigus were matched by age, gender and area of residence with eight controls each. The odds of comorbid conditions in patients vs. matched controls was determined using univariate conditional logistic regression models. Comorbid diseases significantly associated with the diagnosis of pemphigus at P < 0.05 in univariate models were subsequently included in a multivariable conditional logistic regression model with a forward procedure. RESULTS The study sample included 163 patients with pemphigus. Cardiovascular diseases, hyperlipidemia, autoimmune thyroid disorders, dermatological autoimmune/inflammatory conditions and cancer were the most prominent conditions at the time of diagnosis. In the multiple conditional regression analysis, the two diagnoses independently associated with patients with pemphigus were cancer and dermatological autoimmune/inflammatory conditions. In sensitivity analyses excluding four patients with paraneoplastic pemphigus, these associations were still significant. CONCLUSIONS Cancer and dermatological autoimmune/inflammatory conditions may represent possible triggering conditions for pemphigus and should be considered as early warning signs for the disease.
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Affiliation(s)
- Federico Bardazzi
- Department of Experimental, Diagnostic and Specialty Medicine - Dermatology - IRCCS Policlinico di Sant'Orsola, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Camilla Loi
- Department of Experimental, Diagnostic and Specialty Medicine - Dermatology - IRCCS Policlinico di Sant'Orsola, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Ambra Di Altobrando
- Department of Experimental, Diagnostic and Specialty Medicine - Dermatology - IRCCS Policlinico di Sant'Orsola, Bologna, Italy
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Ferrara F, Filippi F, Messori S, Iommi M, Patrizi A, D'Antuono A, Gaspari V, Chessa MA, Baraldi C, Bardazzi F. Fractional CO2 laser and vulvar lichen sclerosus: an alternative resource during maintenance therapy? A prospective study. Ital J Dermatol Venerol 2021; 157:247-253. [PMID: 34282866 DOI: 10.23736/s2784-8671.21.07066-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lichen sclerosus is an autoimmune dermatosis that in women typically involves vulvar area. This condition can strongly impact on the quality of life.To date, topical steroids are the most effective treatment, although adverse effects are possible, especially in long-term application. The aim of this study is to investigate the efficacy of fractional CO2 laser in reducing symptoms of vulvar lichen sclerosus (VLS) during maintenance therapy with topical steroids (application twice weekly or less);(ii) to assess how long this reduction of symptoms persists during followup; (iii) histological comparison before and after treatment.To our knowledge, this is the first prospective study evaluating this treatment in women with VLS. METHODS Women with a diagnosis of VLS were prospectively enrolled and treated with fractional CO2 laser every 2 months, for a total of 3 sessions.Four questionnaires were periodically administered: the Dermatology Quality of Life Index (DLQI), the Female Sexual Functional Index (FSFI) and 2 specific questionnaires created to assess the severity of disease. RESULTS 23 adult women were enrolled. The fractional CO2 laser treatment significantly improved the scores of all scales from baseline to T4 questionnaires. CONCLUSIONS Fractional CO2 laser proved to be effective on VLS symptoms and can be considered an alternative to corticosteroids during maintenance therapy. Larger studies with a control group and randomization are needed to safely generalize our findings.
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Affiliation(s)
- Francesca Ferrara
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Federica Filippi
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy -
| | - Stefano Messori
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonietta D'Antuono
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Valeria Gaspari
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marco A Chessa
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlotta Baraldi
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Federico Bardazzi
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Chessa MA, Filippi F, Iommi M, Patrizi A, Malosso M, Pepe F, Loi C, Bardazzi F. Mortality of patients with bullous pemphigoid in Italy: a retrospective study of a monocentric experience. Ital J Dermatol Venerol 2021; 157:55-61. [PMID: 33913666 DOI: 10.23736/s2784-8671.21.06840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Mortality of bullous pemphigoid(BP) is a variable parameter,depending especially on the area where the study was conducted.The 1-year mortality rate and the identification of clinictherapeutic factors with potential prognostic value in patients with BP were evaluated in a cohort from a single referral center. METHODS We have reviewed medical records of patients with BP diagnosed at the Sant'Orsola-Malpighi Hospital in Bologna(Italy) between 2005 and 2019.Data collected included sex,age at diagnosis,laboratory findings,severity of disease,dosage of systemic treatments,age at death and comorbidities.Only patients who had at least 1 year of follow-up were included. RESULTS 85 patients were included; the mortality rate was 7.1%.The mortality rate of patients treated with a moderate dosage of corticosteroids was no higher than that of patients treated with a low dosage.The log-rank test showed a statistically significant correlation between mortality and patients aged≥85,BP230 positive,and CCIS≥4. CONCLUSIONS Compared with similar studies,our results show a lower 1-year mortality rate.Advanced age at diagnosis and CCIS were confirmed as major independent factors associated with poor prognosis in BP.Administration of moderate dosage of oral corticosteroids seems to have an overall positive benefit-risk ratio,providing a good control of the disease and minimizing the risk of hospitalization,possible related complications and the mortality rate.
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Affiliation(s)
- Marco A Chessa
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Federica Filippi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy -
| | - Marica Iommi
- Advanced School for Health Policy, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marta Malosso
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesca Pepe
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Camilla Loi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Federico Bardazzi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Iommi M, Rosa S, Fusaroli M, Rucci P, Fantini MP, Poluzzi E. Modified-Chronic Disease Score (M-CDS): Predicting the individual risk of death using drug prescriptions. PLoS One 2020; 15:e0240899. [PMID: 33064757 PMCID: PMC7567358 DOI: 10.1371/journal.pone.0240899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/07/2020] [Accepted: 10/05/2020] [Indexed: 01/25/2023] Open
Abstract
Background Estimating the morbidity of a population is strategic for health systems to improve healthcare. In recent years administrative databases have been increasingly used to predict health outcomes. In 1992, Von Korff proposed a Chronic Disease Score (CDS) to predict 1-year mortality by only using drug prescription data. Because pharmacotherapy underwent many changes over the last 3 decades, the original version of the CDS has limitations. The aim of this paper is to report on the development of the modified version of the CDS. Methods The modified CDS (M-CDS) was developed using 33 variables (from drug prescriptions within two-year before 01/01/2018) to predict one-year mortality in Bologna residents aged ≥50 years. The population was split into training and testing sets for internal validation. Score weights were estimated in the training set using Cox regression model with LASSO procedure for variables selection. The external validation was carried out on the Imola population. The predictive ability of M-CDS was assessed using ROC analysis and compared with that of the Charlson Comorbidity Index (CCI), that is based on hospital data only, and of the Multisource Comorbidity Score (MCS), which uses hospital and pharmaceutical data. Results The predictive ability of M-CDS was similar in the training and testing sets (AUC 95% CI: training [0.760–0.770] vs. testing [0.750–0.772]) and in the external population (Imola AUC 95% CI [0.756–0.781]). M-CDS was significantly better than CCI (M-CDS AUC = 0.761, 95% CI [0.750–0.772] vs. CCI-AUC = 0.696, 95% CI [0.681–0.711]). No significant difference was found between M-CDS and MCS (MCS AUC = 0.762, 95% CI [0.749–0.775]). Conclusions M-CDS, using only drug prescriptions, has a better performance than the CCI score in predicting 1-year mortality, and is not inferior to the multisource comorbidity score. M-CDS can be used for population risk stratification, for risk-adjustment in association studies and to predict the individual risk of death.
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Affiliation(s)
- Marica Iommi
- Department of Biomedical and Neuromotor Sciences–Hygiene and Biostatistics Unit, University of Bologna, Bologna, Italy
- * E-mail:
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences–Hygiene and Biostatistics Unit, University of Bologna, Bologna, Italy
| | - Michele Fusaroli
- Department of Medical and Surgical Sciences–Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences–Hygiene and Biostatistics Unit, University of Bologna, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences–Hygiene and Biostatistics Unit, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences–Pharmacology Unit, University of Bologna, Bologna, Italy
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26
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Swart F, Bianchi G, Lenzi J, Iommi M, Maestri L, Raschi E, Zoli M, Ponti FD, Poluzzi E. Risk of hospitalization from drug-drug interactions in the Elderly: real-world evidence in a large administrative database. Aging (Albany NY) 2020; 12:19711-19739. [PMID: 33024058 PMCID: PMC7732312 DOI: 10.18632/aging.104018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/06/2020] [Accepted: 08/22/2020] [Indexed: 01/24/2023]
Abstract
The aim of this study was to assess the risk of hospitalization associated with the concomitant prescription of 10 highly prevalent drug-drug interactions (DDIs) among all individuals aged ≥65 residing in Bologna's area, Italy. We used incidence density sampling, and the effect of current (last month) and past (≥30 days before) exposure to DDI was investigated through conditional multivariable logistic regression analysis. Two DDIs were associated with increased hospitalization due to DDI related conditions: ACE-inhibitors/ diuretics plus glucocorticoids (current DDI: OR 2.36, 95% CI 1.94-2.87; past DDI: OR 1.36, 95% CI 1.12-1.65) and antidiabetic therapy plus current use of fluoroquinolones (OR 4.43, 95% CI 1.61-11.2). Non-Steroidal Anti-inflammatory Drugs (NSAIDs) increased the risk of re-bleeding in patients taking Selective Serotonin Reuptake Inhibitors (OR 5.56, 95% CI 1.24-24.9), while no significant effect was found in those without a history of bleeding episodes. Concomitant prescription of NSAIDs and ACE-inhibitors/diuretics in patients with a history of high-risk conditions was infrequent. Within the pattern of drug prescriptions in the older population of Bologna's area, we distinguished DDIs with actual clinical consequences from others that might be considered generally safe. Observed prescribing habits of clinicians reflect awareness of potential interactions in patients at risk.
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Affiliation(s)
- Floor Swart
- School of Medicine, Vrije University of Amsterdam, Amsterdam, The Netherlands
| | - Giampaolo Bianchi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy,Centre of Studies and Research on the Elderly, University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lorenzo Maestri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco Zoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy,Centre of Studies and Research on the Elderly, University of Bologna, Bologna, Italy
| | - Fabrizio De Ponti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy,Centre of Studies and Research on the Elderly, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy,Centre of Studies and Research on the Elderly, University of Bologna, Bologna, Italy
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27
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Gibertoni D, Voci C, Iommi M, D'Ercole B, Mandreoli M, Santoro A, Mancini E. Developing and validating an algorithm to identify incident chronic dialysis patients using administrative data. BMC Med Inform Decis Mak 2020; 20:185. [PMID: 32782026 PMCID: PMC7422518 DOI: 10.1186/s12911-020-01206-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/30/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Administrative healthcare databases are widespread and are often standardized with regard to their content and data coding, thus they can be used also as data sources for surveillance and epidemiological research. Chronic dialysis requires patients to frequently access hospital and clinic services, causing a heavy burden to healthcare providers. This also means that these patients are routinely tracked on administrative databases, yet very few case definitions for their identification are currently available. The aim of this study was to develop two algorithms derived from administrative data for identifying incident chronic dialysis patients and test their validity compared to the reference standard of the regional dialysis registry. METHODS The algorithms are based on data retrieved from hospital discharge records (HDR) and ambulatory specialty visits (ASV) to identify incident chronic dialysis patients in an Italian region. Subjects are included if they have at least one event in the HDR or ASV databases based on the ICD9-CM dialysis-related diagnosis or procedure codes in the study period. Exclusion criteria comprise non-residents, prevalent cases, or patients undergoing temporary dialysis, and are evaluated only on ASV data by the first algorithm, on both ASV and HDR data by the second algorithm. We validated the algorithms against the Emilia-Romagna regional dialysis registry by searching for incident patients in 2014 and performed sensitivity analyses by modifying the criteria to define temporary dialysis. RESULTS Algorithm 1 identified 680 patients and algorithm 2 identified 676 initiating dialysis in 2014, compared to 625 patients included in the regional dialysis registry. Sensitivity for the two algorithms was respectively 90.8 and 88.4%, positive predictive value 84.0 and 82.0%, and percentage agreement was 77.4 and 74.1%. CONCLUSIONS Algorithms relying on retrieval of administrative records have high sensitivity and positive predictive value for the identification of incident chronic dialysis patients. Algorithm 1, which showed the higher accuracy and has a simpler case definition, can be used in place of regional dialysis registries when they are not present or sufficiently developed in a region, or to improve the accuracy and timeliness of existing registries.
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Affiliation(s)
- Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy.
| | | | - Marica Iommi
- Advanced School for Health Policy, University of Bologna, Bologna, Italy
| | | | - Marcora Mandreoli
- Nephrology and Dialysis Unit, S. Maria della Scaletta Hospital, Imola, Italy
| | - Antonio Santoro
- Specialty School in Nephrology, University of Bologna, Bologna, Italy
| | - Elena Mancini
- Nephrology, Dialysis and Hypertension Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
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28
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Corradini AG, Asioli S, Morandi L, Brotto M, Righi A, Iommi M, Agostinelli C, Rucci P, Asioli S, Sapino A, Viale G, Foschini MP. Post-radiotherapy vascular lesions of the breast: immunohistochemical and molecular features of 74 cases with long-term follow-up and literature review. Histopathology 2020; 77:293-302. [PMID: 32043616 DOI: 10.1111/his.14090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/09/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 12/13/2022]
Abstract
AIMS A wide range of post-radiotherapy (RT) vascular lesions can occur, ranging from benign lymphangiomatous papules of the skin (BLAPs), to atypical vascular lesions (AVLs) and post-RT angiosarcomas (ASs). The relationship between benign and malignant post-RT breast lesions and their prognostic features are still controversial. The aims of this study were to investigate the relationship between benign and malignant mammary post-RT vascular lesions and to define post-RT AS prognostic features. METHODS AND RESULTS Seventy-four post-RT vascular lesion cases were obtained and stained with antibodies against CD34, CD31, D2-40, Ki67, and c-Myc. Mutational analysis was performed by deep sequencing for the following genes: KRAS, NRAS, HRAS, BRAF, PIK3CA, TP53, NOTCH1, PTEN, CDKN2A, EGFR, AKT1, CTNNB1, hTERT, and PTPRB. Post-RT AS cases were graded according to a previously reported breast AS grading system. AVL cases showed a low number of HRAS and hTERT mutations, whereas post-RT AS cases showed a high frequency of EGFR, TP53, HRAS and hTERT mutations. On follow-up, all BLAP and AVL patients were alive with no evidence of disease. Post-RT AS 5-year overall survival declined with the increase in grade, as follows: 85.7% for grade 1, 83.3% for grade 2, and 40.4% for grade 3. CONCLUSIONS Our findings confirm that BLAP and AVL have a good prognosis, and that post-RT AS prognosis is strongly related to histological grading. On molecular analysis, AVL and post-RT AS shared HRAS and hTERT mutations, suggesting a relationship between the two lesions.
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Affiliation(s)
- Angelo G Corradini
- Department of Biomedical and Neuromotor Sciences, Section of Anatomical Pathology at Bellaria Hospital, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomical Pathology at Bellaria Hospital, Bologna, Italy
| | - Luca Morandi
- Department of Biomedical and Neuromotor Sciences, Section of Anatomical Pathology at Bellaria Hospital, Bologna, Italy
| | - Maurizio Brotto
- Department of Pathology, Singleton Hospital, Swansea University, Abertawe Bro Morgannwg University Hospital Trust, Swansea, UK
| | - Alberto Righi
- Department of Pathology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marica Iommi
- Advanced School for Health Policy-Specialisation School for Public Administration, University of Bologna, Bologna, Italy
| | - Claudio Agostinelli
- Haematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Paola Rucci
- Advanced School for Health Policy-Specialisation School for Public Administration, University of Bologna, Bologna, Italy
| | - Silvia Asioli
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Anna Sapino
- Candiolo Cancer Institute-FPO-IRCCS, Candiolo (To), Italy.,Department of Medical Sciences, University of Torino, Torino, Italy
| | - Giuseppe Viale
- Department of Pathology and Laboratory Medicine, IBCSG Central Pathology Laboratory, European Institute of Oncology, Milan, Italy.,University of Milan, Milan, Italy
| | - Maria P Foschini
- Department of Biomedical and Neuromotor Sciences, Section of Anatomical Pathology at Bellaria Hospital, Bologna, Italy
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29
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Messina R, Dallolio L, Fugazzaro S, Rucci P, Iommi M, Bardelli R, Costi S, Denti M, Accogli MA, Cavalli E, Pagliacci D, Fantini MP, Taricco M. The Look After Yourself (LAY) intervention to improve self-management in stroke survivors: Results from a quasi-experimental study. Patient Educ Couns 2020; 103:1191-1200. [PMID: 31982203 DOI: 10.1016/j.pec.2020.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 08/01/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To test the efficacy of a self-management intervention for stroke survivors vs. usual care. METHODS Using a quasi-experimental study, participants were recruited from three public Italian hospitals. Questionnaires assessing self-efficacy (SSEQ), quality of life (SF-12), physical performance (SPPB), depression (GDS) and activities of daily living (MBI) were administered at baseline, discharge and two months after discharge. Mixed models with a propensity score were used between experimental group (EG) and control group (CG). Logistic models were used to compare the use of health services. RESULTS Eighty-two stroke survivors were enrolled in the EG and 103 in the CG. Self-efficacy in self-management improved in the EG compared to the CG during hospitalization. Improvements from baseline to discharge were found in the EG in the mental component of SF-12 and in MBI. The EG were 8.9 times more likely to contact general practitioners after discharge and 2.9 times to do regular exercise than CG. Notably, EG with higher education benefitted more from the intervention. CONCLUSION The intervention was efficacious in improving self-efficacy, mental health and activities of daily living. PRACTICE IMPLICATIONS Structured educational interventions based on problem-solving and individual goal setting may improve self-management skills in stroke survivors.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
| | - Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit-Local Health Authority-IRCCS of Reggio Emilia, Reggio-Emilia, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Marica Iommi
- Advanced School for Health Policy-Specialisation School for Public Administration, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Roberta Bardelli
- Physical Medicine and Rehabilitation Unit-Local Health Authority-IRCCS of Reggio Emilia, Reggio-Emilia, Italy
| | - Stefania Costi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences-University of Modena and Reggio-Emilia, Modena, Italy; Scientific Directorate-Local Health Authority-IRCCS of Reggio-Emilia, Reggio-Emilia, Italy
| | - Monica Denti
- Physical Medicine and Rehabilitation Unit-Local Health Authority-IRCCS of Reggio Emilia, Reggio-Emilia, Italy
| | - Monia Allisen Accogli
- Physical Medicine and Rehabilitation Unit-Local Health Authority-IRCCS of Reggio Emilia, Reggio-Emilia, Italy
| | - Enrica Cavalli
- University Hospital Authority St. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Donatella Pagliacci
- Department of Community Health Care Agency USL Tuscany, Northwest, Pisa, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Mariangela Taricco
- University Hospital Authority St. Orsola-Malpighi Polyclinic, Bologna, Italy
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30
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Gibertoni D, Mandreoli M, De Amicis S, Cantarelli C, Corradini M, Caruso F, Testa F, Gasperoni L, Orrico C, Brancaleoni F, Martelli D, Angelini ML, Ferri B, Flachi M, Iommi M, Santoro A. [The accuracy of hospital discharge records and their use in identifying and staging chronic kidney disease]. G Ital Nefrol 2019; 36:36-5-2019-9. [PMID: 31580547] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Administrative databases contain precious information that can support the identification of specific pathologies. Specifically, chronic kidney disease (CKD) patients could be identified using hospital discharge records (HDR); these should contain information on the CKD stage using subcategories of the ICD9-CM classification's 585 code (subcategories can be expressed just by adding a fourth digit to this code). To verify the accuracy of HDR data regarding the coding of CKD collected in the Italian region Emilia-Romagna, we analyzed the HDR records of patients enrolled in the PIRP project, which could easily be matched with eGFR data obtained through laboratory examinations. The PIRP database was used as the gold standard because it contains data on CKD patients followed up since 2004 in thirteen regional nephrology units and includes data obtained from reliable and homogeneous laboratory measurement. All HDR of PIRP patients enrolled between 2009 and 2017 were retrieved and matched with available laboratory data on eGFR, collected within 15 days before or after discharge. We analyzed 4.168 HDR, which were classified as: a) unreported CKD (n=1.848, 44.3%); b) unspecified CKD, when code 585.9 (CKD, not specified) or 586 was used (n=446, 10.7%); c) wrong CKD (n=833, 20.0%); d) correct CKD (n=1041, 25.0%). We noticed the proportion of unreported CKD growing from 32.9% in 2009 to 56.6% in 2017, and the correspondent proportion of correct CKDs decreasing from 25.4% to 22.3%. Across disciplines, Nephrology showed the highest concordance (69.1%) between the CKD stage specified in the HDRs and the stage reported in the matched laboratory exam, while none of the other disciplines, except for Geriatrics, reached 20% concordance. When the CKD stage was incorrectly coded, it was generally underestimated; among HDRs with unreported or unspecified CKD at least half of the discharges were matched with lab exams reporting CKD in stage 4 or 5. We found that the quality of CKD stage coding in the HDR record database was very poor, and insufficient to identify CKD patients unknown to nephrologists. Moreover, the growing proportion of unreported CKD could have an adverse effect on patients' timely referral to a nephrologist, since general practitioners might remain unaware of their patients' illness. Actions aimed at improving the training of the operators in charge of HDRs compilation and, most of all, at allowing the exploitation of the informative potential of HDRs for epidemiological research are thus needed.
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Affiliation(s)
- Dino Gibertoni
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna
| | | | - Sara De Amicis
- UO Nefrologia e Dialisi, Ospedale "Guglielmo da Saliceto", Piacenza
| | | | - Mattia Corradini
- UO Nefrologia e Dialisi, Arcispedale "S.Maria Nuova", Reggio Emilia
| | | | | | - Lorenzo Gasperoni
- UO Nefrologia, Dialisi e Trapianto, Ospedale S.Orsola-Malpighi, Bologna
| | - Catia Orrico
- UO Nefrologia, Dialisi e Ipertensione, Ospedale S.Orsola-Malpighi, Bologna
| | | | - Davide Martelli
- UO Nefrologia e Dialisi, Ospedale "S.Maria delle Croci", Ravenna
| | | | | | - Marta Flachi
- UO Nefrologia e Dialisi, Ospedale Infermi, Rimini
| | - Marica Iommi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna
| | - Antonio Santoro
- UO Nefrologia, Dialisi e Ipertensione, Ospedale S.Orsola-Malpighi, Bologna
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31
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Asioli S, Righi A, Iommi M, Baldovini C, Ambrosi F, Guaraldi F, Zoli M, Mazzatenta D, Faustini-Fustini M, Rucci P, Giannini C, Foschini MP. Validation of a clinicopathological score for the prediction of post-surgical evolution of pituitary adenoma: retrospective analysis on 566 patients from a tertiary care centre. Eur J Endocrinol 2019; 180:127-134. [PMID: 30481158 DOI: 10.1530/eje-18-0749] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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: 09/11/2018] [Accepted: 11/26/2018] [Indexed: 11/08/2022]
Abstract
Objective and design A clinicopathological score has been proposed by Trouillas et al. to predict the evolution of pituitary adenomas. Aim of our study was to perform an independent external validation of this score and identify other potential predictor of post-surgical outcome. Methods The study sample included 566 patients with pituitary adenomas, specifically 253 FSH/LH-secreting, 147 GH-secreting, 85 PRL-secreting, 72 ACTH-secreting and 9 TSH-secreting tumours with at least 3-year post-surgical follow-up. Results In 437 cases, pituitary adenomas were non-invasive, with low (grade 1a: 378 cases) or high (grade 1b: 59 cases) proliferative activity. In 129 cases, tumours were invasive, with low (grade 2a: 87 cases) or high (grade 2b: 42 cases) proliferative activity. During the follow-up (mean: 5.8 years), 60 patients developed disease recurrence or progression, with a total of 130 patients with pituitary disease at last follow-up. Univariate analysis demonstrated a significantly higher risk of disease persistence and recurrence/progression in patients with PRL-, ACTH- and FSH/LH-secreting tumours as compared to those with somatotroph tumours, and in those with high proliferative activity (grade 1b and 2b) or >1 cm diameter. Multivariate analysis confirmed tumour type and grade to be independent predictors of disease-free-survival. Tumour invasion, Ki-67 and tumour type were the only independent prognostic factors of disease-free survival. Conclusions Our data confirmed the validity of Trouillas' score, being tumour type and grade independent predictors of disease evolution. Therefore, we recommend to always consider both features, together with tumour histological subtype, in the clinical setting to early identify patients at higher risk of recurrence.
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Affiliation(s)
- S Asioli
- Department of Biomedical and Neuromuscular Sciences, Section of Anatomic Pathology 'M. Malpighi' at Bellaria Hospital, University of Bologna
- Pituitary Unit - Center for the Diagnosis and Treatment of Hypothalamic and Pituitary Diseases, IRCCS Istituto delle Scienze Neurologiche di Bologna
| | - A Righi
- Department of Pathology, IRCCS Rizzoli Institute
| | - M Iommi
- University of Bologna, Unit of Hygiene and Biostatistics
| | - C Baldovini
- Department of Biomedical and Neuromuscular Sciences, Section of Anatomic Pathology 'M. Malpighi' at Bellaria Hospital, University of Bologna
| | - F Ambrosi
- Department of Biomedical and Neuromuscular Sciences, Section of Anatomic Pathology 'M. Malpighi' at Bellaria Hospital, University of Bologna
| | - F Guaraldi
- Pituitary Unit - Center for the Diagnosis and Treatment of Hypothalamic and Pituitary Diseases, IRCCS Istituto delle Scienze Neurologiche di Bologna
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - M Zoli
- Pituitary Unit - Center for the Diagnosis and Treatment of Hypothalamic and Pituitary Diseases, IRCCS Istituto delle Scienze Neurologiche di Bologna
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - D Mazzatenta
- Pituitary Unit - Center for the Diagnosis and Treatment of Hypothalamic and Pituitary Diseases, IRCCS Istituto delle Scienze Neurologiche di Bologna
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - M Faustini-Fustini
- Pituitary Unit - Center for the Diagnosis and Treatment of Hypothalamic and Pituitary Diseases, IRCCS Istituto delle Scienze Neurologiche di Bologna
| | - P Rucci
- University of Bologna, Unit of Hygiene and Biostatistics
| | - C Giannini
- Department of Pathology & Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - M P Foschini
- Department of Biomedical and Neuromuscular Sciences, Section of Anatomic Pathology 'M. Malpighi' at Bellaria Hospital, University of Bologna
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Rucci P, Gibertoni D, Lenzi J, Piazza A, Saponaro A, Iommi M, Rizzo R, Fantini MP. Physical multimorbidity and mental health in Italy. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.200] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P Rucci
- Department of Biomedical and Neuromotor Sciences, Bologna, Italy
| | - D Gibertoni
- Department of Biomedical and Neuromotor Sciences, Bologna, Italy
| | - J Lenzi
- Department of Biomedical and Neuromotor Sciences, Bologna, Italy
| | - A Piazza
- Local Health Authority, Bologna, Italy
| | - A Saponaro
- Regional Health and Social Authority, Bologna, Italy
| | - M Iommi
- School of Economics, Management and Statistics, University of Bologna, Bologna, Italy
| | - R Rizzo
- School of Economics, Management and Statistics, University of Bologna, Bologna, Italy
| | - MP Fantini
- Department of Biomedical and Neuromotor Sciences, Bologna, Italy
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