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Mehanović E, Rosso G, Cuomo GL, Diecidue R, Maina G, Costa G, Vigna-Taglianti F. Risk factors for mortality after hospitalization for suicide attempt: results of 11-year follow-up study in Piedmont Region, Italy. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1039-1051. [PMID: 37552335 DOI: 10.1007/s00127-023-02544-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Suicide attempters are at high risk of premature death, both for suicide and for non-suicidal causes. The aim of this study is to investigate risk factors and temporal span for mortality in a cohort of cases admitted to hospital for suicide attempt. METHODS The cohort included 1489 patients resident in Piedmont Region, North West of Italy, who had been admitted to hospital or emergency department for suicide attempt between 2010 and 2020. Cox regression models were used to identify risk factors for death. The final multivariate model included gender, age, area deprivation index, family composition, psychiatric disorders, malignant neoplasms, neurological disorders, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and intracranial injury or skull fracture. RESULTS During the observation period, 7.3% of patients died. The highest mortality was observed within the first 12 months after suicide attempt, and remained elevated for many years afterwards. Male gender, older age, high deprivation index of the census area, single-parent family, mood disorders, malignant neoplasms, diabetes mellitus and intracranial injuries or skull fracture were independent predictors of death. Risk factors for natural and unnatural causes of death were also identified. CONCLUSIONS The mortality risk of suicide attempters is very high, both in the months immediately following the attempt and afterwards. The identification of high-risk groups can help to plan outpatient care following the hospital discharge. Our findings urge the need to design strategies for the assistance and care of these patients at long term in order to reduce the unfavourable outcomes.
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Affiliation(s)
- Emina Mehanović
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy.
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy.
| | - Gianluca Rosso
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gian Luca Cuomo
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Giuseppe Costa
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy
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Mehanović E, Rosso G, Cuomo GL, Diecidue R, Maina G, Costa G, Vigna-Taglianti F. Risk Factors for Suicide Reattempt among Adolescents and Young Adults: The Role of Psychiatric Disorders. Psychiatr Q 2024; 95:69-84. [PMID: 38057631 DOI: 10.1007/s11126-023-10064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
Suicidal behaviour among young people is a serious public health concern. Each suicide attempt is related to further suicide attempts and completed suicide. This study aims to explore risk factors associated with repeated suicide attempt among adolescents and young adults. The cohort included 510 patients aged 12-29 years residing in Piedmont Region in North-Western Italy, who had been admitted to hospital or emergency department with a diagnosis of suicide attempt between 2010 and 2020. Cox regression models were used to evaluate potential risk factors for repeated suicide attempt. During the 11-years follow-up, 20.6% of adolescents and young adults repeated suicide attempt, 24.8% of females and 12.3% of males. Nearly 90% of youth who attempted suicide had a diagnosis of psychiatric disorder. After adjustment, younger age of onset of suicidal behaviour, and diagnosis of schizophrenia, bipolar disorder, depressive disorder, anorexia nervosa and personality disorder were significantly associated with repeated suicide attempt. The early identification of patients at higher risk of repetition of suicidal behaviour is of crucial importance. Better understanding of risk factors and effective treatment of mental disorders could help suicide prevention to reduce the burden of the problem among young people. Special attention should be paid during the initial months following discharge from hospital or emergency department, when suicide reattempt risk is very high.
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Affiliation(s)
- Emina Mehanović
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy.
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy.
| | - Gianluca Rosso
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gian Luca Cuomo
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Giuseppe Costa
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy
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Faggiano F, Mathis F, Diecidue R, Vigna-Taglianti F, Paola Caria M, Colledge S, Hickman M, Bargagli A, Davoli M. Opioid overdose risk during and after drug treatment for heroin dependence: An incidence density case-control study nested in the VEdeTTE cohort. Drug Alcohol Rev 2020; 40:281-286. [PMID: 32969097 DOI: 10.1111/dar.13173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS To corroborate protective effects of a range of drug treatment modalities against overdose mortality risk. DESIGN AND METHODS Nested case-control study, with incidence density sampling, selecting controls retrospectively at each case event. Cases and controls came from a sub-cohort of opioid-dependent patients (n = 4444) from two Italian regions (Lazio and Piedmont). From 1998 to 2005, there were 91 overdose deaths (cases) matched to 352 controls. The primary outcome was overdose mortality and the primary exposure was drug treatment: opioid agonist treatment (OAT), opioid detoxification, residential community, psychosocial and other pharmacological treatment. Conditional logistic regression models generated intervention effects comparing mortality risk in and out of treatment, adjusting for confounding variables. RESULTS Overall, drug treatment reduced overdose mortality risk by 80% [adjusted odds ratio (AOR) 0.18, 95% confidence interval (CI) 0.10-0.33, P < 0.001] compared to being out of treatment. There was a particularly strong protective effect of OAT on overdose mortality (AOR 0.08, 95% CI 0.03-0.23, P < 0.001) compared to being out of treatment. There was evidence of a substantially elevated risk of overdose in the first month of leaving treatment (AOR 23.50, 95% CI 7.84-70.19, P < 0.001) compared to being in treatment. DISCUSSION AND CONCLUSIONS The nested case-control design strengthened earlier findings that OAT in Italy has strong protective effects on overdose mortality risk, much stronger than has been previously seen in other Western European settings.
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Affiliation(s)
- Fabrizio Faggiano
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Federica Mathis
- Piedmont Centre for Drug Addiction Epidemiology, A.S.L. TO3, Torino, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, A.S.L. TO3, Torino, Italy
| | - Federica Vigna-Taglianti
- Piedmont Centre for Drug Addiction Epidemiology, A.S.L. TO3, Torino, Italy.,Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Maria Paola Caria
- Department of Translational Medicine, Avogadro University, Novara, Italy
| | - Samantha Colledge
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annamaria Bargagli
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Yagnik A, Feldman G, Diecidue R, Taub D. Development of a Cause-Based Treatment for Nitrogen Containing Bisphosphonate Induced MRONJ. J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.joms.2019.06.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vigna-Taglianti F, Brambilla R, Priotto B, Angelino R, Cuomo G, Diecidue R. Problematic internet use among high school students: Prevalence, associated factors and gender differences. Psychiatry Res 2017; 257:163-171. [PMID: 28759791 DOI: 10.1016/j.psychres.2017.07.039] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [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: 08/09/2016] [Revised: 04/24/2017] [Accepted: 07/23/2017] [Indexed: 12/20/2022]
Abstract
This study aimed to measure the prevalence of Problematic Internet Use (PIU) among high school students and to identify factors associated with PIU underlining gender differences. The students filled a self-administered, anonymous questionnaire collecting information on demographic characteristics and patterns of Internet use. Multiple logistic regression analysis was performed to identify factors associated with PIU in the overall sample and by gender. Twenty-five schools and 2022 students participated in the survey. Prevalence of PIU was 14.2% among males and 10.1% among females. Males 15-year-olds and females 14-year-olds had the highest PIU prevalence that progressively lowered with age among females. Only 13.5% of pupils declared parents controlled their Internet use. The sensation of feeling lonely, the frequency of use, the number of hours of connection, and visiting pornographic websites were associated with the risk of PIU in both genders. Attending vocational schools, the activities of chatting and file downloading, and the location of use at Internet point among males, and younger age among females were associated with PIU, whilst information searching was protective among females. PIU could become a public health problem in the next years. The physical and mental health consequences should be studied.
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Affiliation(s)
- Federica Vigna-Taglianti
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino, Italy; Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Torino, Italy.
| | - Romeo Brambilla
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino, Italy; Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Torino, Italy
| | - Bruna Priotto
- Department of Addictions, ASL TO3, Pinerolo, Torino, Italy
| | - Remo Angelino
- Department of Addictions, ASL TO3, Pinerolo, Torino, Italy
| | - GianLuca Cuomo
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Torino, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Torino, Italy
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Maremmani AGI, Pani PP, Trogu E, Vigna-Taglianti F, Mathis F, Diecidue R, Kirchmayer U, Amato L, Ghibaudi J, Camposeragna A, Saponaro A, Davoli M, Faggiano F, Maremmani I. The impact of psychopathological subtypes on retention rate of patients with substance use disorder entering residential therapeutic community treatment. Ann Gen Psychiatry 2016; 15:29. [PMID: 27833645 PMCID: PMC5101731 DOI: 10.1186/s12991-016-0119-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/13/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A specific psychopathology of addiction has been proposed and described using the self-report symptom inventory (SCL-90), leading to a 5-factor aggregation of psychological/psychiatric symptoms: 'worthlessness and being trapped', 'somatic symptoms', 'sensitivity-psychoticism', 'panic-anxiety' and 'violence-suicide' in various populations of patients with heroin use disorder (HUD) and other substance use disorders (SUDs). These clusters of symptoms, according to studies that have highlighted the role of possible confounding factors (such as demographic and clinical characteristics, active heroin use, lifetime psychiatric problems and kind of treatment received by the patients), seem to constitute a trait rather than a state of the psychological structure of addiction. These five psychopathological dimensions defined on the basis of SCL-90 categories have also been shown to be correlated with the outcomes of a variety of agonist opioid treatments. The present study aims to test whether the 5-factor psychopathological model of addiction correlates with the outcome (retention rate) of patients with SUDs entering a therapeutic community (TC) treatment. METHODS 2016 subjects with alcohol, heroin or cocaine dependence were assigned to one of the five clusters on the basis of the highest SCL-90 factor score shown. Retention in treatment was analysed by means of the survival analysis and Wilcoxon statistics for comparison between the survival curves. The associations between the psychopathological subtypes defined by SCL-90 categories and length of retention in treatment, after taking into account substance of abuse and other sociodemographic and clinical variables, were summarized using Cox regression. RESULTS Patients with cocaine use disorder (CUD) showed poorer outcomes than those with heroin dependence (HUD). Prominent symptoms of "worthlessness-being trapped" lead to a longer retention in treatment than in the case of the other four prominent psychopathological groups. At the multivariate level, age, detoxified status and total number of psychopathological symptoms proved to influence outcome negatively, especially in CUD. Somatic symptoms and violence-suicide symptoms turned out to correlate with dropout from residential treatment. CONCLUSIONS The SCL-90 5-factor dimensions can be appropriately used as a prognostic tool for drug-dependent subjects entering a residential treatment.
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Affiliation(s)
- Angelo G I Maremmani
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67, 56100 Pisa, Italy ; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy
| | - Pier Paolo Pani
- Social and Health Services, Cagliari Public Health Trust (ASL Cagliari), Cagliari, Italy
| | - Emanuela Trogu
- Department of Psychiatry, Cagliari Public Health Trust (ASL Cagliari), Cagliari, Italy
| | - Federica Vigna-Taglianti
- Piedmont Centre for Drug Addiction Epidemiology, ASLTO3, Grugliasco, Turin, Italy ; Department of Clinical and Biological Sciences, San Luigi Gonzaga University, Turin, Italy
| | - Federica Mathis
- Piedmont Centre for Drug Addiction Epidemiology, ASLTO3, Grugliasco, Turin, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASLTO3, Grugliasco, Turin, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Latium Regional Health Service, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Latium Regional Health Service, Rome, Italy
| | - Joli Ghibaudi
- National Coordination Hospitality Communities (CNCA), Rome, Italy
| | | | - Alessio Saponaro
- Regional Epidemiological Observatory, Emilia Romagna Regional Health Service, Bologna, Italy
| | - Marina Davoli
- Department of Epidemiology, Latium Regional Health Service, Rome, Italy
| | - Fabrizio Faggiano
- Department of Translational Medicine, Avogadro University, Novara, Italy
| | - Icro Maremmani
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67, 56100 Pisa, Italy ; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy ; G. De Lisio Institute of Behavioural Sciences, Pisa, Italy
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Pani PP, Maremmani AGI, Trogu E, Vigna-Taglianti F, Mathis F, Diecidue R, Kirchmayer U, Amato L, Ghibaudi J, Camposeragna A, Saponaro A, Davoli M, Faggiano F, Maremmani I. Psychopathology of addiction: May a SCL-90-based five dimensions structure be applied irrespectively of the involved drug? Ann Gen Psychiatry 2016; 15:13. [PMID: 27118983 PMCID: PMC4845431 DOI: 10.1186/s12991-016-0100-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We previously found a five cluster of psychological symptoms in heroin use disorder (HUD) patients: 'worthlessness-being trapped', 'somatic-symptoms', 'sensitivity-psychoticism', 'panic-anxiety', and 'violence-suicide'. We demonstrated that this aggregation is independent of the chosen treatment, of intoxication status and of the presence of psychiatric problems. METHODS 2314 Subjects, with alcohol, heroin or cocaine dependence were assigned to one of the five clusters. Differences between patients dependent on alcohol, heroin and cocaine in the frequency of the five clusters and in their severity were analysed. The association between the secondary abuse of alcohol and cocaine and the five clusters was also considered in the subsample of HUD patients. RESULTS We confirmed a positive association of the 'somatic symptoms' dimension with the condition of heroin versus cocaine dependence and of the 'sensitivity-psychoticism' dimension with the condition of alcohol versus heroin dependence. 'Somatic symptoms' and 'panic anxiety' successfully discriminated between patients as being alcohol, heroin or cocaine dependents. Looking at the subsample of heroin dependents, no significant differences were observed. CONCLUSIONS The available evidence coming from our results, taken as a whole, seems to support the extension of the psychopathological structure previously observed in opioid addicts to the population of alcohol and cocaine dependents.
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Affiliation(s)
- Pier Paolo Pani
- Social and Health Services, Cagliari Public Health Trust (ASL Cagliari), Cagliari, Italy
| | - Angelo G I Maremmani
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67, 56100 Pisa, Italy ; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca Italy
| | - Emanuela Trogu
- Department of Psychiatry, Cagliari Public Health Trust (ASL Cagliari), Cagliari, Italy
| | - Federica Vigna-Taglianti
- Piedmont Centre for Drug Addiction Epidemiology, ASLTO3, Grugliasco, Province of Turin Italy ; Department of Clinical and Biological Sciences, San Luigi Gonzaga University, Turin, Regione Gonzole 10, 10043 Orbassano, Province of Turin Italy
| | - Federica Mathis
- Piedmont Centre for Drug Addiction Epidemiology, ASLTO3, Grugliasco, Province of Turin Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASLTO3, Grugliasco, Province of Turin Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Latium Regional Health Service, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Latium Regional Health Service, Rome, Italy
| | - Joli Ghibaudi
- National Coordination Hospitality Communities (CNCA), Rome, Italy
| | | | - Alessio Saponaro
- Regional Epidemiological Observatory, Emilia Romagna Regional Health Service, Bologna, Italy
| | - Marina Davoli
- Department of Epidemiology, Latium Regional Health Service, Rome, Italy
| | - Fabrizio Faggiano
- Department of Translational Medicine, Avogadro University, Novara, Italy
| | - Icro Maremmani
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67, 56100 Pisa, Italy ; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca Italy ; G. De Lisio Institute of Behavioural Sciences, Pisa, Italy
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Pani PP, Trogu E, Vigna-Taglianti F, Mathis F, Diecidue R, Kirchmayer U, Amato L, Davoli M, Ghibaudi J, Camposeragna A, Saponaro A, Faggiano F, Maremmani AGI, Maremmani I. Psychopathological symptoms of patients with heroin addiction entering opioid agonist or therapeutic community treatment. Ann Gen Psychiatry 2014; 13:35. [PMID: 25435897 PMCID: PMC4247563 DOI: 10.1186/s12991-014-0035-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 10/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between substance use disorders and psychiatric pathology is still an open question. The main aim of the present study was to verify whether the five psychopathological dimensions identified through the SCL-90 tool in a previous study carried out on patients with heroin addiction entering an outpatient opioid agonist treatment (OAT) were also observable in those entering a residential treatment community (TC). Further aims were to look at differences in the psychopathological profiles of patients entering a TC versus an OAT treatment and at the correlation between gender and the observed psychopathology. METHODS A confirmatory factor analysis was performed on the results of SCL-90 filled by 1,195 patients with heroin dependence entering TC treatment. It replicates the extraction method previously used on 1,055 OAT patients with heroin addiction by using a principal component factor analysis (PCA). The association between the kind of treatment received (TC or OAT), gender, and the psychopathological dimensions was assessed through logistic regression and general linear model (GLM) analysis. RESULTS The PCA carried out on the SCL-90 results of patients entering a TC yielded a five-factor solution, confirming the same dimensions observed in patients entering an OAT: 'worthlessness and being trapped', 'somatization', 'sensitivity-psychoticism', 'panic anxiety', and 'violence-suicide'. The logistic regression analysis showed a statistically significant association between 'somatization' and 'violence-suicide' severity score and OAT. GLM analysis showed that psychopathological factorial scores for 'worthlessness-being trapped', 'somatic symptoms', and 'panic anxiety' dimensions were more severe in OAT vs TC male patients and in TC vs OAT female ones. 'Violence suicide' followed the same severity pattern for males, but did not differ in TC vs OAT females, while 'sensitivity-psychoticism' did not differ in OAT vs TC patients. The five dimensions did not differ in OAT males vs females. CONCLUSIONS Our research appears to confirm the existence of a specific aggregation of psychological/psychiatric features within the category of individuals with heroin addiction. It also shows a correlation between the dominant psychopathological subgroup and the assignment to TC versus OAT. Further research is needed to clarify the differences between the five psychopathological subgroups and their determinants.
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Affiliation(s)
- Pier Paolo Pani
- Social and Health Services, Cagliari Health Public Trust (ASL Cagliari), Cagliari, Italy
| | - Emanuela Trogu
- Department of Psychiatry, Cagliari Health Public Trust (ASL Cagliari), Cagliari, Italy
| | - Federica Vigna-Taglianti
- Piedmont Centre for Drug Addiction Epidemiology, ASLTO3 Grugliasco, Turin, Italy ; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Federica Mathis
- Piedmont Centre for Drug Addiction Epidemiology, ASLTO3 Grugliasco, Turin, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASLTO3 Grugliasco, Turin, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Joli Ghibaudi
- National Coordination Hospitality Communities (CNCA), Rome, Italy
| | | | - Alessio Saponaro
- Regional Epidemiologic Observatory, Emilia Romagna Regional Health Service, Bologna, Italy
| | - Fabrizio Faggiano
- Department of Translational Medicine, Avogadro University, Novara, Italy
| | - Angelo Giovanni Icro Maremmani
- Department of Neurosciences, Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, University of Pisa, Pisa, Italy ; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy
| | - Icro Maremmani
- Department of Neurosciences, Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, University of Pisa, Pisa, Italy ; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy ; G. De Lisio Institute of Behavioural Sciences, Pisa, Italy
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Gates J, Dobbs R, Diecidue R. Oral Manifestatins of Posttransplant Lymphoproliferative Disorder. J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.joms.2013.06.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hersh B, Diecidue R, Taub D, Gold L. Poster 47: Primary Central Adenoid Cystic Carcinoma of the Mandible: Report of a Case and Review of the Literature. J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.joms.2012.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Winans D, Diecidue R, Taub D, Gold L. Poster 34: The Osteochondroma of the Temporomandibular Joint; an Ablative Approach: A Case Series and Review of Literature. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2011.06.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Weber Z, Diecidue R, Gold L, Taub D, Ertel A, Fortina P, Scott K, Feldman G. Poster 38: Novel Mutations in Coiled Coil Domain Containing Protein 91: A Genetic Link to Tumors in Bone. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2011.06.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Salamina G, Diecidue R, Vigna-Taglianti F, Jarre P, Schifano P, Bargagli AM, Davoli M, Amato L, Perucci CA, Faggiano F. Effectiveness of therapies for heroin addiction in retaining patients in treatment: results from the VEdeTTE study. Subst Use Misuse 2010; 45:2076-92. [PMID: 20438317 DOI: 10.3109/10826081003791932] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [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] [Indexed: 11/13/2022]
Abstract
Treatment is effective in reducing heroin use and clinical and social problems among heroin addicts. The effectiveness is related to the duration of treatment. "VEdeTTE" is an Italian longitudinal study funded by the Ministry of Health to evaluate the effectiveness of treatments provided by the National Health Services. The study involved 115 drug treatment centers and 10,454 heroin users. Clinical and personal information were collected at intake through a structured interview. Treatments were recorded using a standardized form. Survival analysis and Cox Proportional Hazard model were used to evaluate treatment retention. Five thousand four hundred and fifty-seven patients who started a treatment in the 18 months of the study were included in the analysis: 43.2% received methadone maintenance therapy (MMT), 10.5% therapeutic community, and 46.3% abstinence-oriented therapy (AOT). The likelihood of remaining in treatment was 0.5 at 179 days. The median daily dose of methadone was 37 mg. Psychotherapy was provided in 7.6% of patients receiving methadone and 4.9% of those in therapeutic community. Type of therapy was the strongest predictor of retention, with AOT showing the lowest retention. In MMT patients, retention improved according to dose. Living alone, psychiatric comorbidity and cocaine use increased the risk of dropout. Psychotherapy associated halved the risk of dropout.
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Affiliation(s)
- Giuseppe Salamina
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Italy
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Davoli M, Bargagli AM, Perucci CA, Schifano P, Belleudi V, Hickman M, Salamina G, Diecidue R, Vigna-Taglianti F, Faggiano F. Risk of fatal overdose during and after specialist drug treatment: the VEdeTTE study, a national multi-site prospective cohort study. Addiction 2007; 102:1954-9. [PMID: 18031430 DOI: 10.1111/j.1360-0443.2007.02025.x] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.9] [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] [Indexed: 12/01/2022]
Abstract
BACKGROUND Specialist drug treatment is critical to overdose prevention; methadone maintenance is effective, but we lack evidence for other modalities. We evaluate the impact of a range of treatments for opiate dependence on overdose mortality. METHODS Prospective cohort study of 10,454 heroin users entering treatment 1998-2001 in Italy followed-up for 10,208 person-years in treatment and 2,914 person-years out of treatment. Standardized overall mortality ratios (SMR) estimate excess mortality risk for heroin users in and out of treatment compared to the general population. Cox models compare the hazard ratio (HR) of overdose between heroin users in treatment and out of treatment. RESULTS There were 41 overdose deaths, 10 during treatment and 31 out of treatment, generating annual mortality rates of 0.1% and 1.1% and SMRs of 3.9 [95% confidence interval (CI) 2.8-5.4] and 21.4 (16.7-27.4), respectively. Retention in any treatment was protective against overdose mortality (HR 0.09 95% CI 0.04-0.19) compared to the risk of mortality out of treatment, independent of treatment type and potential confounders. The risk of a fatal overdose was 2.3% in the month immediately after treatment and 0.77% in the subsequent period; compared to the risk of overdose during treatment the HR was 26.6 (95% CI 11.6-61.1) in the month immediately following treatment and 7.3 (3.3-16.2) in the subsequent period. CONCLUSIONS We demonstrate that a range of treatments for heroin dependence reduces overdose mortality risk. However, the considerable excess mortality risk in the month following treatment indicates the need for greater health education of drug users and implementation of relapse and overdose death prevention programmes. Further investigation is needed to measure and weigh the potential benefits and harms of short-term therapies for opiate use.
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Vigna-Taglianti FD, Mathis F, Diecidue R, Burroni P, Iannaccone A, Lampis F, Zuccaro P, Pacifici R, Versino E, Davoli M, Faggiano F. A follow-up study of heroin addicts (VEdeTTE2): study design and protocol. Subst Abuse Treat Prev Policy 2007; 2:9. [PMID: 17362515 PMCID: PMC1838901 DOI: 10.1186/1747-597x-2-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 03/15/2007] [Indexed: 11/29/2022]
Abstract
Background In Italy, a large cohort study (VEdeTTE1) was conducted between 1998–2001 to evaluate the effectiveness of treatments in reducing mortality and increasing treatment retention among heroin addicts. The follow-up of this cohort (VEdeTTE2) was designed to evaluate the effectiveness of treatments on long-term outcomes, such as rehabilitation and social re-integration. The purpose of this paper is to describe the protocol of the VEdeTTE2 study, and to present the results of the pilot study carried out to assess the feasibility of the study and to improve study procedures. Methods The source population for the VEdeTTE2 study was the VEdeTTE1 cohort, from which a sample of 2,200 patients, traced two or more years after enrolment in the cohort, were asked to participate. An interview investigates drug use; overdose; family and social re-integration. Illegal activity are investigated separately in a questionnaire completed by the patient. Patients are also asked to provide a hair sample to test for heroin and cocaine use. Information on treatments and HIV, HBV and HCV morbidity are obtained from clinical records. A pilot phase was planned and carried out on 60 patients. Results The results of the pilot phase pointed out the validity of the procedures designed to limit attrition: the number of traced subjects was satisfactory (88%). Moreover, the pilot phase was very useful in identifying possible causes of delays and attrition, and flaws in the instruments. Improvements to the procedures and the instruments were subsequently implemented. Sensitivity of the biological test was quite good for heroin (78%) but lower for cocaine (42.3%), highlighting the need to obtain a hair sample from all patients. Conclusion In drug addiction research, studies investigating health status and social re-integration of subjects at long-term follow-up are lacking. The VEdeTTE2 study aims to investigate these outcomes at long-term follow-up. Results of the pilot phase underline the importance of the pilot phase when planning a follow-up study.
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Affiliation(s)
- Federica D Vigna-Taglianti
- Piedmont Centre for Drug Addiction Epidemiology, ASL 5 – Grugliasco, Italy
- Department of Clinical and Experimental Medicine, Avogadro University, Novara, Italy
| | - Federica Mathis
- Piedmont Centre for Drug Addiction Epidemiology, ASL 5 – Grugliasco, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASL 5 – Grugliasco, Italy
| | | | | | - Fabio Lampis
- Drug Abuse Treatment Centre, ASL TO 1, Turin, Italy
| | | | | | | | | | - Fabrizio Faggiano
- Piedmont Centre for Drug Addiction Epidemiology, ASL 5 – Grugliasco, Italy
- Department of Clinical and Experimental Medicine, Avogadro University, Novara, Italy
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Hegedus F, Diecidue R, Taub D, Nyirady J. Non-surgical treatment modalities of facial photodamage: practical knowledge for the oral and maxillofacial professional. Int J Oral Maxillofac Surg 2006; 35:389-98. [PMID: 16352420 DOI: 10.1016/j.ijom.2005.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2004] [Revised: 08/28/2005] [Accepted: 09/15/2005] [Indexed: 11/23/2022]
Abstract
With the increasing interest in cosmetic procedures, oral and maxillofacial surgeons are being asked not only to improve oral health and aesthetics but to extend their expertise to provide advice on improving the overall appearance of the face. For the discerning patient, improving overall facial skin appearance is becoming an integral part of the process of surgical cosmetic procedures. Here, some of the non-surgical options available for the treatment of photodamaged skin are reviewed and an overview of the specific treatments in this category provided. Sun avoidance and protection from harmful rays with appropriate sunscreens are primary to maintaining healthy skin and appearance. Among treatment options, topical treatments with preparations such as retinoids, alpha-hydroxy acids and antioxidants have been shown to provide some benefit and are relatively easy to use albeit with appropriate precautions and professional guidance. As a second-level option, facial rejuvenation procedures such as botulinum toxin injection, soft tissue augmentation with collagen or hyaluronic acid gel, skin resurfacing, use of chemical peels, dermabrasion and laser resurfacing procedures can be used but require administration by qualified practitioners. Overall, these treatments may be used to complement rehabilitative, reconstructive, or cosmetic oral and maxillofacial surgery to further improve and complement surgical results.
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Affiliation(s)
- F Hegedus
- Department of Oral and Maxillofacial Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
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Schifano P, Bargagli AM, Belleudi V, Amato L, Davoli M, Diecidue R, Versino E, Vigna-Taglianti F, Faggiano F, Perucci CA. Methadone treatment in clinical practice in Italy: need for improvement. Eur Addict Res 2006; 12:121-7. [PMID: 16778432 DOI: 10.1159/000092113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Methadone at appropriate doses has been demonstrated to be the most effective means for retaining patients in treatment and suppressing heroin use. AIM To describe the modalities of day-to-day provision of methadone maintenance treatments (MMT) in Italian public health centres and to analyze the duration of MMTs by dose and by association with psychosocial treatments. PATIENTS AND METHODS We analyzed 8,378 subjects, 18 years of age or over, enrolled between September 1998 and March 2001 in one of 115 public treatment centres for heroin dependence in Italy. Treatment data were collected for each subject from enrolment to the end of the study period (maximum of 18 months). RESULTS Of the total of 29,495 treatments delivered, 21.0% were methadone maintenance, and 34.4% were methadone detoxification. Fifty percent of MMTs offered had a mean dose less than or equal to 40 mg/day, and only 19% had doses higher than or equal to 60 mg/day; treatments with doses higher than 60 mg/day lasted longer than treatments with lower doses. Differences in treatment length were observed between MMTs associated with a psychosocial treatment and those offered alone, only for doses <60 mg/day. CONCLUSIONS In Italy, MMTs are delivered at inappropriate doses in more than 80% of the cases. The increase of methadone doses to adequate levels as indicated by the literature is necessary to ensure proper and effective use of MMTs in public treatment centres for heroin users.
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Affiliation(s)
- R Diecidue
- Department of Oral and Maxillofacial Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
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