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Cortellini A, Gambale E, Cannita K, Brocco D, Parisi A, Napoleoni L, Masedu F, Irtelli L, De Tursi M, Natoli C, Ficorella C. Multicentric retrospective analysis of platinum-pemetrexed regimens as first-line therapy in non-squamous non-small cell lung cancer patients: A "snapshot" from clinical practice. Thorac Cancer 2017; 9:241-252. [PMID: 29388383 PMCID: PMC5792744 DOI: 10.1111/1759-7714.12570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 10/13/2017] [Revised: 11/04/2017] [Accepted: 11/04/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The major challenge for treating non-squamous (non-Sq) non-small cell lung cancer (NSCLC) patients without actionable biomarkers is the actual selection of proper treatment, weighing expected clinical outcomes and safety profile. METHODS Consecutive non-Sq NSCLC patients were treated with platinum-pemetrexed (PP) doublets in clinical practice. Subgroup analyses were conducted in patients treated with standard (s)PP and modified (m)PP doublets (because of age, performance status, and/or comorbidities) and in patients treated with cisplatin-based and carboplatin-based PP doublets. Activity, efficacy, safety, and toxicities were evaluated. RESULTS From November 2009 to April 2017, 111 patients were treated: 87 (78.4%) with sPP and 24 (21.6%) with mPP; 76 (68.5%) with cisplatin-based and 35 (31.5%) with carboplatin-based regimens. The objective response rate (ORR), median progression-free survival (PFS), and median overall survival (OS) were 49.0%, 7, and 13 months in the entire patient population, respectively. We found no significant differences in ORR, median PFS, and median OS between sPP and mPP. Cisplatin-based PP showed higher ORR (53.7%) versus carboplatin-based PP (38.7%) and longer PFS (7 vs. 6 months; P = 0.028) and OS (18 vs. 11 months; P = 0.006). We confirm that carboplatin has a better toxicity profile than cisplatin. The received dose-intensities were ~80% of standard full doses. CONCLUSIONS Accurate management allowed us to treat the majority of advanced non-Sq NSCLC patients with PP combination therapy without significant differences in ORR, median PFS, and median OS. Even considering the selection bias, our data seems to confirm the greater effectiveness of cisplatin-based over carboplatin-based regimens.
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Affiliation(s)
- Alessio Cortellini
- Medical Oncology Unit, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Katia Cannita
- Medical Oncology Unit, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Davide Brocco
- Medical Oncology Unit, SS Annunziata Hospital, Chieti, Italy
| | - Alessandro Parisi
- Medical Oncology Unit, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luca Napoleoni
- Medical Oncology Unit, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luciana Irtelli
- Medical Oncology Unit, SS Annunziata Hospital, Chieti, Italy
| | - Michele De Tursi
- Department of Medical and Oral and Sciences and Biotechnologies, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Clara Natoli
- Department of Medical and Oral and Sciences and Biotechnologies and CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Corrado Ficorella
- Medical Oncology Unit, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Sabetti L, Masedu F, Tresca C, Bianchi F, Valenti M. The use of choline in association with the Bangerter filters for the treatment of amblyopia. Int J Ophthalmol 2017; 10:1777-1778. [PMID: 29181325 DOI: 10.18240/ijo.2017.11.22] [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: 02/04/2017] [Accepted: 05/22/2017] [Indexed: 11/23/2022] Open
Abstract
The study investigated the effects of choline combined with Bangerter filter in the treatment of amblyopia. All amblyopic subjects used a Bangerter filter on the corrective spectacle lens (1d over the left eye, 1d over the right eye). Choline was then administered orally to 39 patients once daily, five days per week for the entire study period. Subjects treated with the Bangerter filter showed a mean visual acuity of 0.27 logMAR; at 12mo of treatment, the mean visual acuity reached 0.09 logMAR. Patients treated with the Bangerter filter and citicoline showed a mean visual acuity of 0.35 logMAR; at 12mo of treatment, the mean visual acuity reached 0.01 logMAR. No significant changes in the angle of deviation were observed in both groups. Subjects in both forms of amblyopia therapies demonstrated an increase in visual acuity. However, these effects were markedly enhanced when coupled with the administration of choline. Findings suggest that the effects are particularly relevant in the more severe amblyopic cases.
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Affiliation(s)
- Lelio Sabetti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila 67100, Italy
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila 67100, Italy
| | - Chiara Tresca
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila 67100, Italy
| | - Federica Bianchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila 67100, Italy
| | - Marco Valenti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila 67100, Italy
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Guadagni S, Fiorentini G, Clementi M, Palumbo G, Palumbo P, Chiominto A, Baldoni S, Masedu F, Valenti M, Tommaso AD, Fabi B, Aliberti C, Sarti D, Guadagni V, Pellegrini C. Does Locoregional Chemotherapy Still Matter in the Treatment of Advanced Pelvic Melanoma? Int J Mol Sci 2017; 18:ijms18112382. [PMID: 29120401 PMCID: PMC5713351 DOI: 10.3390/ijms18112382] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 01/19/2023] Open
Abstract
Pelvic Melanoma relapse occurs in 15% of patients with loco regional metastases, and 25% of cases do not respond to new target-therapy and/or immunotherapy. Melphalan hypoxic pelvic perfusion may, therefore, be an option for these non-responsive patients. Overall median survival time (MST), stratified for variables, including BRAF V600E mutation and eligibility for treatments with new immunotherapy drugs, was retrospectively assessed in 41 patients with pelvic melanoma loco regional metastases. They had received a total of 175 treatments with Melphalan hypoxic perfusion and cytoreductive excision. Among the 41 patients, 22 (53.7%) patients exhibited a wild-type BRAF genotype, 11 of which were not eligible for immunotherapy. The first treatment resulted in a 97.5% response-rate in the full cohort and a 100% response-rate in the 22 wild-type BRAF patients. MST was 18 months in the full sample, 20 months for the 22 wild-type BRAF patients and 21 months for the 11 wild-type BRAF patients not eligible for immunotherapy. Melphalan hypoxic perfusion is a potentially effective treatment for patients with pelvic melanoma loco regional metastases that requires confirmation in a larger multicenter study.
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Affiliation(s)
- Stefano Guadagni
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Giammaria Fiorentini
- Department of Oncology and Hematology, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy.
| | - Marco Clementi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Giancarlo Palumbo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Paola Palumbo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Alessandro Chiominto
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Stefano Baldoni
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Marco Valenti
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Ambra Di Tommaso
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Bianca Fabi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Camillo Aliberti
- Department of Radiology, Institute for the Research and Treatment of Cancer, 35128 Padova, Italy.
| | - Donatella Sarti
- Department of Oncology and Hematology, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy.
| | - Veronica Guadagni
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.
| | - Cristina Pellegrini
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
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Mercadante S, Masedu F, Balzani I, De Giovanni D, Montanari L, Pittureri C, Bertè R, Russo D, Ursini L, Marinangeli F, Aielli F. Prevalence of delirium in advanced cancer patients in home care and hospice and outcomes after 1 week of palliative care. Support Care Cancer 2017; 26:913-919. [PMID: 28980071 DOI: 10.1007/s00520-017-3910-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 06/21/2017] [Accepted: 09/25/2017] [Indexed: 01/24/2023]
Abstract
AIM The aim of this study was to assess the prevalence of delirium in advanced cancer patients admitted to different palliative care services in Italy and possible related factors. The secondary outcome was to assess the changes of delirium after 1 week of palliative care. METHODS A consecutive sample of patients was screened for delirium in period of 1 year in seven palliative care services. General data, including primary tumor, age, gender, concomitant disease, palliative prognostic score (PaP), and Karnofsky status, were collected. Possible causes or factors associated with delirium were looked for. The Edmonton Symptom Assessment Scale was used to assess physical and psychological symptoms and the Memorial Delirium Assessment Scale (MDAS) to assess the cognitive status of patients, at admission (T0) and 1 week after palliative care (T7). RESULTS Of 848 patients screened, 263 patients were evaluated. Sixty-six patients had only the initial evaluation. The mean Karnofsky status was 34.1 (SD = 6.69); the mean PaP score at admission was 6.9 (SD = 3.97). The mean duration of palliative care assistance, equivalent to survival, was 38.4 days (SD = 48, range 2-220). The mean MDAS values at admission and after 1 week of palliative care were 6.9 (SD = 6.71) and 8.8 (SD = 8.26), respectively. One hundred ten patients (41.8%) and 167 patients (67.3%) had MDAS values ≥ 7 at admission and after 1 week of palliative care, respectively. Age, dehydration, cachexia, chemotherapy in the last three months, and intensity of drowsiness and dyspnea were independently associated with a MDAS > 7. A worsening of drowsiness, the use of opioids, and the use of corticosteroids were independently associated with changes of MDAS from T0 to T7. CONCLUSION Although the prevalence of delirium seems to be similar to that reported in other acute settings, delirium tended to worsen or poorly responded to a palliative care treatment. Some clinical factors were independently associated with delirium. This information is relevant for decision-making when delirium does not change despite a traditional intervention. Continuous assessment of delirium should be performed in these settings to detect deterioration of cognitive function. Further studies should elucidate whether an earlier approach to palliative care would decrease the prevalence of delirium at a late stage of disease.
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Affiliation(s)
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Isabella Balzani
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì-Cesena, Italy
| | | | | | | | - Raffaella Bertè
- Palliative Care, Oncology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Laura Ursini
- "Casa Margherita" Hospice, ASL 01 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
| | - Franco Marinangeli
- Anesthesiology and Pain Medicine, Department of Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federica Aielli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Tortorella F, Pavaci S, Fioretti AB, Masedu F, Lauriello M, Eibenstein A. The short hyperacusis questionnaire: A tool for the identification and measurement of hyperacusis in the Italian tinnitus population. Audiol Res 2017; 7:182. [PMID: 29071058 PMCID: PMC5641829 DOI: 10.4081/audiores.2017.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/10/2017] [Accepted: 08/10/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Federica Tortorella
- Department of Applied Clinical Sciences and Biotechnology, L'Aquila University, L'Aquila
| | - Silva Pavaci
- Department of Applied Clinical Sciences and Biotechnology, L'Aquila University, L'Aquila
| | | | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, L'Aquila University, L'Aquila
| | - Maria Lauriello
- Department of Applied Clinical Sciences and Biotechnology, L'Aquila University, L'Aquila
| | - Alberto Eibenstein
- Department of Applied Clinical Sciences and Biotechnology, L'Aquila University, L'Aquila.,Tinnitus Center, European Hospital, Rome, Italy
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Guadagni S, Palumbo G, Fiorentini G, Clementi M, Marsili L, Giordano AV, Masedu F, Valenti M. Surgical versus percutaneous isolated pelvic perfusion (IPP) for advanced melanoma: comparison in terms of melphalan pharmacokinetic pelvic bio-availability. BMC Res Notes 2017; 10:411. [PMID: 28810925 PMCID: PMC5558752 DOI: 10.1186/s13104-017-2738-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 01/13/2017] [Accepted: 08/07/2017] [Indexed: 01/19/2023] Open
Abstract
Background Isolated pelvic perfusion (IPP) can be used to treat unresectable melanoma metastases of the pelvis. IPP can be performed either by surgical or percutaneous approaches, using different balloon catheters. The aim of this study was to examine whether the surgical and percutaneous approaches were comparable with respect to tumor drug exposure in the pelvis. Methods A pharmacokinetic study was performed in 5 melanoma patients treated with surgical IPP and five with percutaneous IPP. Both groups received melphalan at the dose of 30 mg/m2. Melphalan pharmacokinetic analyses were performed and the main parameter used to evaluate pelvic tumor drug-exposure was the ratio of areas under the melphalan plasma concentration curves in the pelvis and the systemic compartment, during the perfusion time (AUC0 to 20). Non-parametric Mann–Whitney tests were employed for statistical comparisons. Results The median and interquartile range (IQR) values of the ratios between melphalan AUC0 to 20 in pelvic and systemic compartments were 7.9 (IQR 7.2 to 9.9) and 5 (IQR 4 to 7.9) for surgical and percutaneous IPPs, respectively (p = 0.209). Conclusions Tumor exposure to drug using these two methods did not statistically differ and both methods, therefore, can be adopted interchangeably, utilizing a perfusion blood flow rate of approximately 120 ml/min. The small sample size is a limitation of this study but our preliminary results can be used to calculate the effect size of a larger trial. Trial Registration Clinical Trials.gov Identifier NCT01920516; date of trial registration: August 6, 2013 Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2738-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefano Guadagni
- Department of Applied Clinical Sciences and Biotecnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy.
| | - Giancarlo Palumbo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Giammaria Fiorentini
- Medical Oncology Unit, Department of Oncology and Hematology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - Marco Clementi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Luca Marsili
- Department of Applied Clinical Sciences and Biotecnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Aldo Victor Giordano
- Department of Applied Clinical Sciences and Biotecnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotecnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Marco Valenti
- Department of Applied Clinical Sciences and Biotecnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
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Guadagni S, Fiorentini G, Clementi M, Palumbo G, Chiominto A, Cappelli S, Masedu F, Valenti M. Melphalan hypoxic perfusion with hemofiltration for melanoma locoregional metastases in the pelvis. J Surg Res 2017; 215:114-124. [PMID: 28688635 DOI: 10.1016/j.jss.2017.03.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/17/2017] [Accepted: 03/30/2017] [Indexed: 01/19/2023]
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Tepedino M, Masedu F, Chimenti C. Comparative evaluation of insertion torque and mechanical stability for self-tapping and self-drilling orthodontic miniscrews - an in vitro study. Head Face Med 2017; 13:10. [PMID: 28558821 PMCID: PMC5450203 DOI: 10.1186/s13005-017-0143-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 05/18/2016] [Accepted: 05/23/2017] [Indexed: 12/02/2022] Open
Abstract
Background The aim of the present study was to evaluate the relationship between insertion torque and stability of miniscrews in terms of resistance against dislocation, then comparing a self-tapping screw with a self-drilling one. Methods Insertion torque was measured during placement of 30 self-drilling and 31 self-tapping stainless steel miniscrews (Leone SpA, Sesto Fiorentino, Italy) in synthetic bone blocks. Then, an increasing pulling force was applied at an angle of 90° and 45°, and the displacement of the miniscrews was recorded. Results The statistical analysis showed a statistically significant difference between the mean Maximum Insertion Torque (MIT) observed in the two groups and showed that force angulation and MIT have a statistically significant effect on miniscrews stability. For both the miniscrews, an angle of 90° between miniscrew and loading force is preferable in terms of stability. Conclusions The tested self-drilling orthodontic miniscrews showed higher MIT and greater resistance against dislocation than the self-tapping ones. Electronic supplementary material The online version of this article (doi:10.1186/s13005-017-0143-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Viale S.Salvatore, Edificio Delta 6, 67100, L'Aquila, Italy.
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Viale S.Salvatore, Edificio Delta 6, 67100, L'Aquila, Italy
| | - Claudio Chimenti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Viale S.Salvatore, Edificio Delta 6, 67100, L'Aquila, Italy
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Mazza M, Mariano M, Peretti S, Masedu F, Pino MC, Valenti M. The Role of Theory of Mind on Social Information Processing in Children With Autism Spectrum Disorders: A Mediation Analysis. J Autism Dev Disord 2017; 47:1369-1379. [DOI: 10.1007/s10803-017-3069-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
BACKGROUND The aim of this study was to assess the phenomenon of episodic breathlessness in advanced cancer patients followed by palliative care services at home. METHODS A consecutive sample of patients with advanced cancer, admitted to home care for a period of six months, was surveyed. The presence of background breathlessness and episodic breathlessness, their intensity, and drugs used for their treatment were collected. Factors inducing episodic breathlessness, and its influence on daily activities were investigated. RESULTS Three hundred forty-seven advanced cancer patients admitted to home palliative care were surveyed. The prevalence of breathlessness was 35.3%. The mean intensity of breathlessness was 3.8 (SD 1.96), out of a maximum score of 10 for worst imaginable. Sixty patients (49.2%) were receiving drugs for background breathlessness. In the multivariate analysis the risk of breathlessness increased with cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer while it decreased in patients with a better performance status. The prevalence of episodic breathlessness in patients with background breathlessness was 79.5% and its mean intensity was 7.1 (SD 1.5, range 2-10). The mean duration of episodic breathlessness was 28.6 minutes (SD 47.1, range 1-300 minutes). Forty-three patients (44.3%) were receiving one or more drugs as needed. The majority of episodic breathlessness events were triggered by activity. Episodic breathlessness was interfering with daily activities in 65 patients (67%). Episodic breathlessness wasn't associated with any variable taken into consideration. CONCLUSION This study showed that episodic breathlessness frequently occurs in advanced cancer patients admitted to home care, is severe in intensity, is triggered in most cases by activity, and is characterized by a short duration which requires rapid measures.
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Affiliation(s)
| | - Flavio Fusco
- b Palliative Home Care Unit , ASL 3 , Genova , Italy
| | | | - Claudio Cartoni
- d Home Care Service of the Rome Section of the Italian Association Against Leukemias , Rome , Italy
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Mercadante S, Adile C, Ferrera P, Masedu F, Valenti M, Aielli F. Sleep disturbances in advanced cancer patients admitted to a supportive/palliative care unit. Support Care Cancer 2016; 25:1301-1306. [DOI: 10.1007/s00520-016-3524-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
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Ruscitti P, Cipriani P, Masedu F, Iacono D, Ciccia F, Liakouli V, Guggino G, Carubbi F, Berardicurti O, Di Benedetto P, Valenti M, Triolo G, Valentini G, Giacomelli R. Adult-onset Still's disease: evaluation of prognostic tools and validation of the systemic score by analysis of 100 cases from three centers. BMC Med 2016; 14:194. [PMID: 27903264 PMCID: PMC5131497 DOI: 10.1186/s12916-016-0738-8] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [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: 07/16/2016] [Accepted: 11/03/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Adult-onset Still's disease (AOSD) is rare inflammatory disease of unknown etiology that usually affects young adults. The more common clinical manifestations are spiking fevers, arthritis, evanescent rash, elevated liver enzymes, lymphadenopathy, hepatosplenomegaly, and serositis. The multi-visceral involvement of the disease and the different complications, such as macrophage activation syndrome, may strongly decrease the life expectancy of AOSD patients. METHODS This study aimed to identify the positive and negative features correlated with the outcome of patients. A retrospective analysis of AOSD patients prospectively admitted to three rheumatologic centers was performed to identify the clinical features present at the time of diagnosis and to predict the possible outcome. Furthermore, we investigated the as yet to be validated prognostic value of the systemic score previously proposed. RESULTS One hundred consecutive AOSD patients were enrolled. The mean systemic score showed that the majority of patients had a multi-organ involvement. Sixteen patients showed different complications, mainly the macrophage activation syndrome. A strong increase of inflammatory markers was observed. All patients received steroids at different dosages, 55 patients in association with immunosuppressive drugs and 32 in association with biologic agents. Sixteen patients died during the follow-up. Regression analysis showed that the higher values of the systemic score and the presence of AOSD-related complications, assessed at the time of diagnosis, were significantly correlated with patient mortality. A prognostic impact of the systemic score of ≥ 7.0 was reported. CONCLUSIONS Our study showed that a higher systemic score and the presence of AOSD-related complications at the time of diagnosis were significantly associated with mortality. Of note, a cut-off at 7.0 of the systemic score showed a strong prognostic impact in identifying patients at risk of AOSD-related death.
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Affiliation(s)
- Piero Ruscitti
- Rheumatology Section, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100, L'Aquila, Italy.
| | - Paola Cipriani
- Rheumatology Section, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100, L'Aquila, Italy
| | - Francesco Masedu
- Medical Statistic Section, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Daniela Iacono
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Francesco Ciccia
- Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Vasiliki Liakouli
- Rheumatology Section, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100, L'Aquila, Italy
| | - Giuliana Guggino
- Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Francesco Carubbi
- Rheumatology Section, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100, L'Aquila, Italy
| | - Onorina Berardicurti
- Rheumatology Section, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100, L'Aquila, Italy
| | - Paola Di Benedetto
- Rheumatology Section, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100, L'Aquila, Italy
| | - Marco Valenti
- Medical Statistic Section, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Giovanni Triolo
- Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Gabriele Valentini
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Roberto Giacomelli
- Rheumatology Section, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100, L'Aquila, Italy
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63
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Ruscitti P, Cipriani P, Ciccia F, Masedu F, Liakouli V, Carubbi F, Berardicurti O, Guggino G, Di Benedetto P, Di Bartolomeo S, Valenti M, Triolo G, Giacomelli R. Prognostic factors of macrophage activation syndrome, at the time of diagnosis, in adult patients affected by autoimmune disease: Analysis of 41 cases collected in 2 rheumatologic centers. Autoimmun Rev 2016; 16:16-21. [PMID: 27664384 DOI: 10.1016/j.autrev.2016.09.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [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: 07/22/2016] [Accepted: 07/29/2016] [Indexed: 12/21/2022]
Abstract
Macrophage activation syndrome (MAS) is a rare, life-threatening disease in which early diagnosis and aggressive therapeutic strategy may improve the outcome. Due to its rarity, epidemiologic data are still lacking. Hyperferritinemia is frequently associated with MAS and might modulate the cytokine storm, which is involved in the development of multiple organ failure. In this paper, we investigated clinical data, treatments, and outcome of a homogeneous cohort of 41 adult MAS patients, complicating autoimmune rheumatic diseases. MAS-related death occurred in 17 patients (42.5%) during the follow-up, and older age and increased serum ferritin levels, at the time of diagnosis, were significantly associated with mortality. In conclusion, adult MAS is associated with high mortality rate. Some clinical features at diagnosis may be predictive of MAS-associated death.
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Affiliation(s)
- Piero Ruscitti
- Division of Rheumatology, University of L'Aquila, L'Aquila, Italy
| | - Paola Cipriani
- Division of Rheumatology, University of L'Aquila, L'Aquila, Italy
| | | | - Francesco Masedu
- Division of Medical Statistic Unit, University of L'Aquila, L'Aquila, Italy
| | | | | | | | | | | | | | - Marco Valenti
- Division of Medical Statistic Unit, University of L'Aquila, L'Aquila, Italy
| | - Giovanni Triolo
- Division of Rheumatology, University of Palermo, Palermo, Italy
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64
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Mercadante S, Masedu F, Valenti M, Mercadante A, Aielli F. The characteristics of advanced cancer patients followed at home, but admitted to the hospital for the last days of life. Intern Emerg Med 2016; 11:713-8. [PMID: 26895033 DOI: 10.1007/s11739-016-1402-1] [Citation(s) in RCA: 20] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
Information regarding advanced cancer patients followed at home who are admitted to the hospital in the last days of life are lacking. The aim of this study was to assess the characteristics of patients who were hospitalized in the last days of life after being assisted by a home palliative care team. The secondary outcome was to identify possible risk factors for hospitalization. The charts were analyzed of a consecutive sample of advanced cancer patients admitted to hospital wards in the last days of life after being followed at home by a palliative care team. Of 550 consecutive patients followed at home, 138 (25.1 %) were admitted to the hospital. Younger patients were more likely to die in the hospital. In a logistic risk analysis adjusted for age, patients with lung and head-neck cancer were more likely to die in the hospital. Patients having a female relative or a female consort as a caregiver were more likely to die at home. CAGE-positive patients (7.25 %), and patients with a shorter period of home assistance were more likely transported to hospital before dying (p = 0.00 and p < 0.024, respectively). The most frequent reason for hospital admission was dyspnea. Admission was more frequent to the oncology ward. Patients who were admitted to the hospital died after a mean of 10.2 days (SD 8.2, range 0-40). This study provides preliminary data on the risk factors of hospitalization at the end of life for advanced cancer patients followed at home.
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Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena Cancer Center and University of Palermo, Via San Lorenzo 312, 90146, Palermo, Italy.
| | - Francesco Masedu
- Section of Clinical Epidemiology and Environmental Medicine, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Marco Valenti
- Section of Clinical Epidemiology and Environmental Medicine, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | | | - Federica Aielli
- "L'Aquila per la Vita" Home Care Unit and Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
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65
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Servello A, Fioretti A, Gualdi G, Di Biasi C, Pittalis A, Sollaku S, Pavaci S, Tortorella F, Fusetti M, Valenti M, Masedu F, Cacciafesta M, Marigliano V, Ettorre E, Pagliarella M. Olfactory Dysfunction, Olfactory Bulb Volume and Alzheimer's Disease: Is There a Correlation? A Pilot Study1. J Alzheimers Dis 2016; 48:395-402. [PMID: 26402003 DOI: 10.3233/jad-150232] [Citation(s) in RCA: 20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Olfactory dysfunction is present since the earliest stage of Alzheimer's disease (AD). In AD patients, the olfactory impairment has been correlated with atrophy of some structures of the olfactory system, but the role of the olfactory bulb remains unclear. OBJECTIVE The aim of our work is to test if patients suffering from AD exhibit a statistically significant reduction of the average volume of the olfactory bulb (OBV) compared to healthy subjects. METHODS 78 subjects were enrolled in the study and divided into three groups: 28 healthy elderly (22 females, 6 males, mean age 69.4 ± 9.2), 25 patients with mild cognitive impairment (MCI) amnestic type (14 females, 11 males, mean age 74.5 ± 7.5), and 25 mild AD patients (14 females, 11 males, mean age 73.7 ± 6.8). Every subject underwent an MRI study of the olfactory bulb and an olfactory assessment with the Sniffin' Stick Extended Test. RESULTS The statistical analysis showed no correlation between the OBV and MCI or AD. Moreover, olfactory function and OBV were not correlated in any of the three groups. CONCLUSION The reduction of OBV does not seem to represent an index of neuronal damage in the earliest stages of AD.
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Affiliation(s)
- Adriana Servello
- Department of Public Health and Infectious Disease, La Sapienza, University of Rome, Rome, Italy
| | - Alessandra Fioretti
- Department of Applied Clinical Sciences and Biotechnologies, University of L'Aquila, L'Aquila, Italy
| | - Gianfranco Gualdi
- Radiology, Umberto I Hospital, Department of Emergency, La Sapienza, University of Rome, Rome, Italy
| | - Claudio Di Biasi
- Radiology, Umberto I Hospital, Department of Emergency, La Sapienza, University of Rome, Rome, Italy
| | - Angelo Pittalis
- Radiology, Umberto I Hospital, Department of Emergency, La Sapienza, University of Rome, Rome, Italy
| | - Saadi Sollaku
- Radiology, Umberto I Hospital, Department of Emergency, La Sapienza, University of Rome, Rome, Italy
| | - Silva Pavaci
- Department of Applied Clinical Sciences and Biotechnologies, University of L'Aquila, L'Aquila, Italy
| | - Federica Tortorella
- Department of Applied Clinical Sciences and Biotechnologies, University of L'Aquila, L'Aquila, Italy
| | - Marco Fusetti
- Department of Applied Clinical Sciences and Biotechnologies, University of L'Aquila, L'Aquila, Italy
| | - Marco Valenti
- Section of Clinical Epidemiology, Department of Applied Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Masedu
- Section of Clinical Epidemiology, Department of Applied Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mauro Cacciafesta
- Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza, University of Rome, Rome, Italy
| | - Vincenzo Marigliano
- Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza, University of Rome, Rome, Italy
| | - Evaristo Ettorre
- Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza, University of Rome, Rome, Italy
| | - Martina Pagliarella
- Department of Applied Clinical Sciences and Biotechnologies, University of L'Aquila, L'Aquila, Italy
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66
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Cipriani P, Berardicurti O, Masedu F, D'Onofrio F, Navarini L, Ruscitti P, Maruotti N, Margiotta D, Liakouli V, Di Benedetto P, Carubbi F, Valenti M, Cantatore F, Afeltra A, Giacomelli R. SAT0489 Biologic Therapies and Infections in The Daily Practice: A Study on Historical Cohort from 3 Italian Rheumatologic Units. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4717] [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: 11/04/2022]
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67
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Ruscitti P, Cipriani P, Ciccia F, Masedu F, Iacono D, Liakouli V, Guggino G, Carubbi F, Berardicurti O, Di Benedetto P, Valenti M, Triolo G, Valentini G, Giacomelli R. FRI0504 Prognostic Factors of Adult Onset Still's Disease: Analysis of 100 Cases in 3 Tertiary Referral Centers. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3955] [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: 11/03/2022]
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68
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Mercadante S, Aielli F, Masedu F, Valenti M, Verna L, Mercadante A, Porzio G. Pattern of symptoms and symptomatic treatment in adults and the aged population: a retrospective analysis of advanced cancer patients followed at home. Curr Med Res Opin 2016; 32:893-8. [PMID: 26824824 DOI: 10.1185/03007995.2016.1149055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Indexed: 11/23/2022]
Abstract
Context Data regarding symptom burden and symptomatic drugs in palliative population in different classes of age are lacking. Objective The aim of this retrospective study was to assess the symptom burden, and the profile of symptomatic drugs in the last four weeks of life in adults and older cancer patients followed at home. Methods Charts of 412 patients were retrospectively analyzed by using a backward analysis. Patients were divided into three groups: adults (<65 years, A), old (65-74 years, O1), very old (75-84 years, O2), and the oldest (≥85 years, O3). Results At -4W Karnofsky status was significantly lower for older people (p = 0.03). No significant effect of age on the vector of symptoms was found (p = 0.07). A significant decrease in intensity of pain and nausea, and an increase in intensity of all other symptoms was found through the four weeks of the study (p = 0.00). No differences of drug pattern among the age categories were found. The use of symptomatic drugs decreased over time, except for opioids. Age statistically affected NSAID use, neuroleptic use, and antiemetics over time. Conclusion The burden of symptoms worsened in the last four weeks of life, except for pain and nausea, but did not differ among the age subgroups. The use of NSAIDs, neuroleptics, and antiemetics changed, while the frequency of opioid use was unchanged until death.
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Affiliation(s)
- Sebastiano Mercadante
- a Anesthesia and Intensive Care & Pain Relief and Supportive Care, La Maddalena Cancer Center and University of Palermo , Palermo , Italy
| | - Federica Aielli
- b 'L'Aquila per la Vita' Home Care Unit and Department of Applied Clinical Sciences and Biotechnology , University of L'Aquila , L'Aquila , Italy
| | - Francesco Masedu
- c Department of Applied Clinical Sciences and Biotechnology , Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila , L'Aquila , Italy
| | - Marco Valenti
- c Department of Applied Clinical Sciences and Biotechnology , Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila , L'Aquila , Italy
| | - Lucilla Verna
- b 'L'Aquila per la Vita' Home Care Unit and Department of Applied Clinical Sciences and Biotechnology , University of L'Aquila , L'Aquila , Italy
| | | | - Giampiero Porzio
- b 'L'Aquila per la Vita' Home Care Unit and Department of Applied Clinical Sciences and Biotechnology , University of L'Aquila , L'Aquila , Italy
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69
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Masedu F, Valenti M. [Mortality data in L'Aquila (Central Italy): few evidence, a lot of concerns]. Epidemiol Prev 2016; 40:68-69. [PMID: 27291213 DOI: 10.19191/ep16.2s1.p068.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The use of mortality data in L'Aquila public health post-earthquake experience considered as a population's health status indicator is completely missed. The deficit of regional and local epidemiological network in the period preceding the earthquake has clearly revealed a lack of specific activity, for example public reporting of morbidity and mortality in the seismic crater. This absence of a systematic use of current statistics needs a serious reflection concerning investments that regional public health needs to carry out on this topic.
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Affiliation(s)
- Francesco Masedu
- Dipartimento di scienze cliniche applicate e biotecnologiche, Università degli Studi dell'Aquila.
| | - Marco Valenti
- Dipartimento di scienze cliniche applicate e biotecnologiche, Università degli Studi dell'Aquila
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70
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Mercadante S, Aielli F, Adile C, Valle A, Fusco F, Ferrera P, Caruselli A, Cartoni C, Marchetti P, Bellavia G, Cortegiani A, Masedu F, Valenti M, Porzio G. Epidemiology and Characteristics of Episodic Breathlessness in Advanced Cancer Patients: An Observational Study. J Pain Symptom Manage 2016; 51:17-24. [PMID: 26416339 DOI: 10.1016/j.jpainsymman.2015.07.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 02/27/2015] [Revised: 06/29/2015] [Accepted: 07/13/2015] [Indexed: 11/15/2022]
Abstract
CONTEXT Episodic breathlessness is a relevant aspect in patients with advanced cancer. OBJECTIVES The aim of this study was to assess the different aspects of this clinical phenomenon. METHODS A consecutive sample of patients with advanced cancer admitted to different settings for a period of six months was surveyed. The presence of background breathlessness and episodic breathlessness, their intensity (numerical scale 0-10), and drugs used for treatment were collected. Factors inducing episodic breathlessness and its influence on daily activities were investigated. RESULTS Of 921 patients, 29.3% (n = 269) had breathlessness and 134 patients (49.8%) were receiving drugs for background breathlessness. In the multivariate analysis, the risk of breathlessness increased with chronic obstructive pulmonary disease, although it decreased in patients receiving disease-oriented therapy and patients with gastrointestinal tumors. The prevalence of episodic breathlessness was 70.9% (n = 188), and its mean intensity was 7.1 (SD 1.6). The mean duration of untreated episodic breathlessness was 19.9 minutes (SD 35.3); 41% of these patients were receiving drugs for episodic breathlessness. The majority of episodic breathlessness events (88.2%) were triggered by activity. In the multivariate analysis, higher Karnofsky Performance Status levels were significantly related to episodic breathlessness, although patients receiving disease-oriented therapy were less likely to have episodic breathlessness. CONCLUSION This study showed that episodic breathlessness frequently occurs in patients with breathlessness in the advanced stage of disease, has a severe intensity, and is characterized by rapid onset and short duration, which require rapid measures.
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Affiliation(s)
| | - Federica Aielli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; "L'Aquila per la Vita" Home Care Unit, L'Aquila, Italy
| | - Claudio Adile
- Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | | | | | - Patrizia Ferrera
- Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | | | - Claudio Cartoni
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Home Care Service of the Rome Section of the Italian Association Against Leukemias (Rome AIL), Rome, Italy
| | - Paolo Marchetti
- Clinical and Molecular Medicine Department, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | | | - Andrea Cortegiani
- Section of Anesthesia, Analgesia, Intensive Care and Emergency, Department of Biopathology, Medical and Forensic Biotechnologies, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | - Francesco Masedu
- Section of Clinical Epidemiology and Environmental Medicine, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Valenti
- Section of Clinical Epidemiology and Environmental Medicine, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giampiero Porzio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; "L'Aquila per la Vita" Home Care Unit, L'Aquila, Italy
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71
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Mercadante S, Aielli F, Adile C, Ferrera P, Valle A, Cartoni C, Pizzuto M, Caruselli A, Parsi R, Cortegiani A, Masedu F, Valenti M, Ficorella C, Porzio G. Sleep Disturbances in Patients With Advanced Cancer in Different Palliative Care Settings. J Pain Symptom Manage 2015; 50:786-92. [PMID: 26311122 DOI: 10.1016/j.jpainsymman.2015.06.018] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [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: 04/06/2015] [Revised: 06/08/2015] [Accepted: 07/06/2015] [Indexed: 11/15/2022]
Abstract
CONTEXT Information regarding sleep disturbances in the population with advanced cancer is meager. OBJECTIVES To assess the prevalence of sleep disturbances and possible correlations with associated factors in a large number of patients with advanced cancer admitted to different palliative care settings. METHODS This was an observational study performed in different settings of palliative care. A consecutive sample of patients with advanced cancer was prospectively assessed for a period of six months. Epidemiological and clinical data, treatments received in the last month, Karnofsky status, Edmonton Symptom Assessment System scores, and concomitant medical treatment were recorded. Patients were administered the Athens Insomnia Scale and the Hospital Anxiety and Depression Scale (HADS). RESULTS A total of 820 patients were surveyed. Mean age was 69.7 years (SD 12.7), and 429 patients were males. Consistent sleep disturbances (moderate to maximum) were found in 60.8% of patients. Aged patients were less likely to have sleep disturbances, whereas a poor Karnofsky level was significantly associated with sleep problems. Breast, gastrointestinal, head and neck, lung, and prostate cancers were associated with sleep problems. Patients who had a secondary school or undergraduate education had less sleep disturbances. Hormone therapy and use of opioids and corticosteroids were positively associated with sleep disturbances, and there was a positive correlation of HADS-Anxiety and HADS-Depression scores with sleep disturbances. CONCLUSION More than 60% of palliative care patients have relevant sleep disturbances. Several factors associated with sleep disorders have been identified and should prompt physicians to make a careful examination and subsequent treatment of these disturbances.
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Affiliation(s)
| | - Federica Aielli
- Supportive Care Task Force, University of L'Aquila, L'Aquila, Italy
| | - Claudio Adile
- Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | - Patrizia Ferrera
- Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | | | - Claudio Cartoni
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Home Care Service of the Rome Section of the Italian Association Against Leukemias, Rome, Italy
| | - Massimo Pizzuto
- Palliative Care Unit, Istituti Clinici di Perfezionamento Hospital, Milan, Italy
| | - Amanda Caruselli
- Home Care Program, SAMO, Palermo, Italy; Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | | | - Andrea Cortegiani
- Department of Biopathology, Medical and Forensic Biotechnologies, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | - Francesco Masedu
- Section of Clinical Epidemiology and Environmental Medicine, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Valenti
- Section of Clinical Epidemiology and Environmental Medicine, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Giampiero Porzio
- Supportive Care Task Force, University of L'Aquila, L'Aquila, Italy
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Di Stasi SM, De Carlo F, Pagliarulo V, Masedu F, Verri C, Celestino F, Riedl C. Hexaminolevulinate hydrochloride in the detection of nonmuscle invasive cancer of the bladder. Ther Adv Urol 2015; 7:339-50. [PMID: 26622319 DOI: 10.1177/1756287215603274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Clinical trials have shown that hexaminolevulinate (HAL) fluorescence cystoscopy improves the detection of bladder tumors compared with standard white-light cystoscopy, resulting in more efficacious treatment. However, some recent meta-analyses report controversially on recurrence-free rates with this procedure. A systematic review of literature was performed from December 2014 to January 2015 using the PubMed, Embase and Cochrane databases for controlled trials on photodynamic diagnosis (PDD) with HAL. A total of 154 publications were found up to January 2015. Three of the authors separately reviewed the records to evaluate eligibility and methodological quality of clinical trials. A total of 16 publications were considered eligible for analysis. HAL-PDD-guided cystoscopy increased overall tumor detection rate (proportion difference 19%, 95% confidence interval [CI] 0.152-0.236) although the benefit was particularly significant in patients with carcinoma in situ (CIS) lesion (proportion difference 15.7%, 95% CI 0.069-0.245) and was reduced in papillary lesions (Ta proportion difference 5.9%, 95% CI 0.014-0.103 and T1 proportion difference 1.2%, 95% CI 0.033-0.057). Moreover, there were 15% of patients (95% CI 0.098-0.211) with at least one additional tumor seen with PDD. With regard to recurrence rates, the data sample was insufficient for a statistical analysis, although the evaluation of raw data showed a trend in favor of HAL-PDD. This meta-analysis confirms the increased tumor detection rate by HAL-PDD with a most pronounced benefit for CIS lesion.
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Affiliation(s)
- Savino M Di Stasi
- Department of Experimental Medicine and Surgery, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy
| | - Francesco De Carlo
- Department of Experimental, Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Vincenzo Pagliarulo
- Department of Emergency and Organs Transplantation, 'Aldo Moro' University, Bari, Italy
| | - Francesco Masedu
- Department of Medicine and Public Health, University of L'Aquila, L'Aquila, Italy
| | - Cristian Verri
- Department of Experimental, Medicine and Surgery, Tor Vergata University, Rome, Italy
| | | | - Claus Riedl
- Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria
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73
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Di Giminiani R, Masedu F, Padulo J, Tihanyi J, Valenti M. The EMG activity-acceleration relationship to quantify the optimal vibration load when applying synchronous whole-body vibration. J Electromyogr Kinesiol 2015; 25:853-9. [PMID: 26443890 DOI: 10.1016/j.jelekin.2015.09.004] [Citation(s) in RCA: 18] [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: 12/10/2014] [Revised: 09/04/2015] [Accepted: 09/11/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To date are lacking methodological approaches to individualizing whole-body vibration (WBV) intensity. The aim of this study was: (1) to determine the surface-electromyography-root-mean-square (sEMG(RMS))-acceleration load relationship in the vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF), lateral gastrocnemius (LG) muscles during synchronous WBV, and (2) to assess the reliability of the acceleration corresponding to the maximal sEMG(RMS). METHODS Twenty-five sportsman voluntarily took part in this study with a single-group, repeated-measures design. All subjects postured themselves in an isometric half-squat during nine trials in the following conditions: no vibrations and random vibrations of different acceleration loads (from 0.12 to 5.72 g). RESULTS The sEMG(RMS) were dependent on the acceleration loads in the VL (p = 0.0001), LG (p = 0.0001) and VM (p = 0.011) muscles; while RF was not affected by the acceleration loads (p = 0.508). The comparisons among the sEMG(RMS)-accelerations relationships revealed a significant difference between the LG and the others muscles (p = 0.001). No significant difference was found between the different thigh muscles (p > 0.05). The intra-class correlation coefficient ranged from 0.87 to 0.99 for the measurements performed on the LG, VL and VM. CONCLUSIONS The sEMG(RMS)-acceleration relationship in the VL, VM and LG is a reliable test to individualize the WBV intervention.
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Affiliation(s)
- Riccardo Di Giminiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy.
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | - Johnny Padulo
- University eCampus, Novedrate, COMO, Italy; Tunisian Research Laboratory "Sport Performance Optimization" National Center of Medicine and Science in Sports (CNMSS), Tunis, Tunisia
| | - Jozsef Tihanyi
- Department of Biomechanics, Faculty of Physical Education and Sport Sciences, Semmelweis University, Budapest, Hungary
| | - Marco Valenti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
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74
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Celestino F, Verri C, De Carlo F, Zampa G, Pagliarulo V, Masedu F, Di Stasi SM. Urothelial carcinoma of the prostatic urethra: Long-term follow-up study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15639] [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: 11/20/2022] Open
Affiliation(s)
| | - Cristian Verri
- Department of Surgery/Urology, Tor Vergata University, Rome, Italy
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Di Stasi SM, Riedl C, Giannantoni A, Verri C, Celestino F, De Carlo F, Masedu F, Valenti M. PD17-02 IS INTRAVESICAL BCG ALONE STILL THE ONLY TRULY EFFECTIVE INTRAVESICAL THERAPY FOR NON-MUSCLE INVASIVE BLADDER CANCER? J Urol 2015. [DOI: 10.1016/j.juro.2015.02.659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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76
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Mazzone P, Scarnati E, Masedu F, Valeriani M, Insola A. Somatosensory evoked responses and lead position for deep brain stimulation in the brainstem: their relationships are helpful in the precise targeting of the pedunculopontine tegmental nucleus. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.077] [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] Open
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Masedu F, Mazza M, Di Giovanni C, Calvarese A, Tiberti S, Sconci V, Valenti M. Facebook, quality of life, and mental health outcomes in post-disaster urban environments: the l'aquila earthquake experience. Front Public Health 2014; 2:286. [PMID: 25566527 PMCID: PMC4273552 DOI: 10.3389/fpubh.2014.00286] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/07/2014] [Indexed: 11/15/2022] Open
Abstract
Background: An understudied area of interest in post-disaster public health is individuals’ use of social networks as a potential determinant of quality of life (QOL) and mental health outcomes. A population-based cross-sectional study was carried out to examine whether continual use of online social networking (Facebook) in an adult population following a massive earthquake was correlated with prevalence of depression and post-traumatic stress disorders (PTSD) and QOL outcomes. Methods: Participants were a sample of 890 adults aged 25–54 who had been exposed to the L’Aquila earthquake of 2009. Definition of “user” required a daily connection to the Facebook online social network for more than 1 h per day from at least 2 years. Depression and PTSD were assessed using the Screening Questionnaire for Disaster Mental Health. QOL outcomes were measured using the World Health Organisation Quality of Life BREF (WHOQOL-BREF) instrument. Logistic regression was carried out to calculate the prevalence odds ratios (POR) for social network use and other covariates. Results: Two hundred and twenty one of 423 (52.2%) men, and 195 of 383 (50.9%) women, had been using Facebook as social network for at least 2 years prior to our assessment. Social network use correlated with both depression and PTSD, after adjusting for gender. A halved risk of depression was found in users vs. non-users (POR 0.50 ± 0.16). Similarly, a halved risk of PTSD in users vs. non-users (POR 0.47 ± 0.14) was found. Both men and women using online social networks had significantly higher QOL scores in the psychological and social domains of the WHOQOL-BREF. Conclusion: Social network use among adults 25–54 years old has a positive impact on mental health and QOL outcomes in the years following a disaster. The use of social networks may be an important tool for coping with the mental health outcomes of disruptive natural disasters, helping to maintain, if not improve, QOL in terms of social relationships and psychological distress.
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Affiliation(s)
- Francesco Masedu
- Section of Environmental Medicine and Clinical Epidemiology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila , L'Aquila , Italy
| | - Monica Mazza
- Section of Neuropsychology, Department of Life, Health and Environmental Sciences, University of L'Aquila , L'Aquila , Italy
| | - Chiara Di Giovanni
- Department of Mental Health, Local Health Agency of the National Health System , L'Aquila , Italy
| | - Anna Calvarese
- Department of Mental Health, Local Health Agency of the National Health System , L'Aquila , Italy
| | - Sergio Tiberti
- Section of Environmental Medicine and Clinical Epidemiology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila , L'Aquila , Italy
| | - Vittorio Sconci
- Department of Mental Health, Local Health Agency of the National Health System , L'Aquila , Italy
| | - Marco Valenti
- Section of Environmental Medicine and Clinical Epidemiology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila , L'Aquila , Italy ; Department of Mental Health, Local Health Agency of the National Health System , L'Aquila , Italy
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Mazza M, Pino MC, Mariano M, Tempesta D, Ferrara M, De Berardis D, Masedu F, Valenti M. Affective and cognitive empathy in adolescents with autism spectrum disorder. Front Hum Neurosci 2014; 8:791. [PMID: 25339889 PMCID: PMC4187579 DOI: 10.3389/fnhum.2014.00791] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [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: 06/06/2014] [Accepted: 09/17/2014] [Indexed: 01/10/2023] Open
Abstract
The broad construct of empathy incorporates both cognitive and affective dimensions. Recent evidence suggests that the subjects with autistic spectrum disorder (ASD) show a significant impairment in empathic ability. The aim of this study was to evaluate the cognitive and affective components of empathy in adolescents with ASD compared to controls. Fifteen adolescents with ASD and 15 controls underwent paper and pencil measures and a computerized Multifaceted Empathy Test. All measures were divided into mentalizing and experience sharing abilities. Adolescents with ASD compared to controls showed deficits in all mentalizing measures: they were incapable of interpreting and understanding the mental and emotional states of other people. Instead, in the sharing experience measures, the adolescents with ASD were able to empathize with the emotional experience of other people when they express emotions with positive valence, but were not able to do so when the emotional valence is negative. These results were confirmed by the computerized task. In conclusion, our results suggest that adolescents with ASD show a difficulty in cognitive empathy, whereas the deficit in affective empathy is specific for the negative emotional valence.
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Affiliation(s)
- Monica Mazza
- Department of Life, Health and Environmental Sciences, University of L'Aquila L'Aquila, Italy
| | - Maria C Pino
- Department of Life, Health and Environmental Sciences, University of L'Aquila L'Aquila, Italy
| | - Melania Mariano
- Department of Life, Health and Environmental Sciences, University of L'Aquila L'Aquila, Italy
| | - Daniela Tempesta
- Department of Life, Health and Environmental Sciences, University of L'Aquila L'Aquila, Italy
| | - Michele Ferrara
- Department of Life, Health and Environmental Sciences, University of L'Aquila L'Aquila, Italy
| | - Domenico De Berardis
- Psychiatric Service of Diagnosis and Treatment, Department of Mental Health, G. Mazzini Hospital Teramo, Italy
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, Section of Clinical Epidemiology and Environmental Medicine University of L'Aquila L'Aquila, Italy
| | - Marco Valenti
- Department of Applied Clinical Sciences and Biotechnology, Section of Clinical Epidemiology and Environmental Medicine University of L'Aquila L'Aquila, Italy ; Reference Regional Centre for Autism, Abruzzo Region Health System L'Aquila, Italy
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De Carlo F, Celestino F, Verri C, Masedu F, Liberati E, Di Stasi SM. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: surgical, oncological, and functional outcomes: a systematic review. Urol Int 2014; 93:373-83. [PMID: 25277444 DOI: 10.1159/000366008] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/17/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Despite the wide diffusion of minimally invasive approaches, such as laparoscopic (LRP) and robot-assisted radical prostatectomy (RALP), few studies compare the results of these techniques with the retropubic radical prostatectomy (RRP) approach. The aim of this study is to compare the surgical, functional, and oncological outcomes and cost-effectiveness of RRP, LRP, and RALP. METHODS A systematic review of the literature was performed in the PubMed and Embase databases in December 2013. A 'free-text' protocol using the term 'radical prostatectomy' was applied. A total of 16,085 records were found. The authors reviewed the records to identify comparative studies to include in the review. RESULTS 44 comparative studies were identified. With regard to the perioperative outcome, LRP and RALP were more time-consuming than RRP, but blood loss, transfusion rates, catheterisation time, hospitalisation duration, and complication rates were the most optimal in the laparoscopic approaches. With regard to the functional and oncological results, RALP was found to have the best outcomes. CONCLUSION Our study confirmed the well-known perioperative advantage of minimally invasive techniques; however, available data were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes. On the contrary, cost comparison clearly supports RRP.
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Affiliation(s)
- Francesco De Carlo
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
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Valenti M, La Malfa G, Tomassini A, Masedu F, Tiberti S, Sorge G. Burnout among therapists working with persons with autism after the 2009 earthquake in L'Aquila, Italy: a longitudinal comparative study. J Psychiatr Ment Health Nurs 2014; 21:234-40. [PMID: 23552108 DOI: 10.1111/jpm.12054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2013] [Indexed: 11/29/2022]
Abstract
The aim of this study was to follow up the occurrence of burnout in therapists of children and adolescents with autism experiencing the 2009 earthquake in L'Aquila, and to discuss implications for burnout prevention after disasters. A longitudinal study was carried out, measuring burnout outcomes according to the Maslach Burnout Inventory in 11 exposed and 53 unexposed therapists. Staff in the exposed group appeared to report significantly higher levels of emotional exhaustion after 1 and 2 years of follow-up than the unexposed staff. As to lack of personal accomplishment, the exposed groups shows increasingly lower scores with respect to the unexposed group, with personal accomplishment (PA) values falling from 41.0 [standard deviation (SD) 3.7] to 33.4 (SD 4.1) after 2 years, whereas PA values remain stable over time in the unexposed group. As to depersonalization, data show no significant difference between groups. Burnout occurrence is induced by the exceptional stressors related with natural disasters like earthquakes. Efforts are required to help mental health workers, including psychiatric nurses, to cope with the devastating situation determined by an earthquake. A periodical monitoring of mental health status is recommended in mental health works, especially with regard to help with post-traumatic stress disorder, coping with work and therapeutic relationships, family and social life and economic impact.
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Affiliation(s)
- M Valenti
- Department of Psychiatry, Careggi Hospital Agency, Florence, Italy
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81
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Valenti M, Fujii S, Kato H, Masedu F, Tiberti S, Sconci V. Validation of the Italian version of the Screening Questionnaire for Disaster Mental Health (SQD) in a post-earthquake urban environment. Ann Ist Super Sanita 2013; 49:79-85. [PMID: 23535134 DOI: 10.4415/ann_13_01_13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Aim of this study was to implement and validate the Italian version of the Screening Questionnaire for Disaster Mental Health (SQD), a tool for the screening of post-traumatic stress disorder (PTSD) and depression in the long-term aftermaths of a natural disaster. METHODS A convenience sample of 116 subjects living in L'Aquila after the 2009 earthquake were administered the SQD and two gold-standard instruments for PTSD and depression. Reliability, concurrent validity and convergent validity of SQD were estimated. RESULTS Cronbach's alpha was 0.86. Concurrent validity as measured by the Spearman correlation coefficient resulted statistically significant both for PTSD and depression SQD subscales, as well as convergent validity as measured by ROC-AUC method. CONCLUSIONS SQD is a valid, efficient and easy-to-use screening instrument for PTSD and depression after natural disasters.
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Affiliation(s)
- Marco Valenti
- Dipartimento di Scienze Cliniche Applicate, Università dell'Aquila, L'Aquila, Italy.
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82
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Valenti M, Masedu F, Mazza M, Tiberti S, Di Giovanni C, Calvarese A, Pirro R, Sconci V. A longitudinal study of quality of life of earthquake survivors in L'Aquila, Italy. BMC Public Health 2013; 13:1143. [PMID: 24314066 PMCID: PMC4029473 DOI: 10.1186/1471-2458-13-1143] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 12/03/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND People's well-being after loss resulting from an earthquake is a concern in countries prone to natural disasters. Most studies on post-earthquake subjective quality of life (QOL) have focused on the effects of psychological impairment and post-traumatic stress disorder (PTSD) on the psychological dimension of QOL. However, there is a need for studies focusing on QOL in populations not affected by PTSD or psychological impairment. The aim of this study was to estimate QOL changes over an 18-month period in an adult population sample after the L'Aquila 2009 earthquake. METHODS The study was designed as a longitudinal survey with four repeated measurements performed at six monthly intervals. The setting was the general population of an urban environment after a disruptive earthquake. Participants included 397 healthy adult subjects. Exclusion criteria were comorbidities such as physical, psychological, psychiatric or neurodegenerative diseases at the beginning of the study. The primary outcome measure was QOL, as assessed by the WHOQOL-BREF instrument. A generalised estimating equation model was run for each WHOQOL-BREF domain. RESULTS Overall, QOL scores were observed to be significantly higher 18 months after the earthquake in all WHOQOL-BREF domains. The model detected an average increase in the physical QOL scores (from 66.6 ± 5.2 to 69.3 ± 4.7), indicating a better overall physical QOL for men. Psychological domain scores (from 64.9 ± 5.1 to 71.5 ± 6.5) were observed to be worse in men than in women. Levels at the WHOQOL domain for psychological health increased from the second assessment onwards in women, indicating higher resiliency. Men averaged higher scores than women in terms of social relationships and the environmental domain. Regarding the physical, psychological and social domains of QOL, scores in the elderly group (age > 60) were observed to be similar to each other regardless of the significant covariates used. CONCLUSIONS WHOQOL-BREF scores of the psychological domain displayed trends conditioned by age and education: older subjects experienced less satisfaction with psychological health on average. Less-educated subjects always demonstrated the worst QOL scores. Gender, age and education impacted the variability of QOL in the environmental dimension in the elderly.
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Affiliation(s)
- Marco Valenti
- Department of Applied Clinical Sciences and Biotechnology, Section of Clinical Epidemiology and Environmental Medicine, University of L’Aquila, Via Vetoio, Coppito 2, 67100 L’Aquila, Italy
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, Section of Clinical Epidemiology and Environmental Medicine, University of L’Aquila, Via Vetoio, Coppito 2, 67100 L’Aquila, Italy
| | - Monica Mazza
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazza S. Tommasi, Coppito, 67100, L’Aquila, Italy
| | - Sergio Tiberti
- Department of Applied Clinical Sciences and Biotechnology, Section of Clinical Epidemiology and Environmental Medicine, University of L’Aquila, Via Vetoio, Coppito 2, 67100 L’Aquila, Italy
| | - Chiara Di Giovanni
- Department of Mental Health, Territorial Health Agency ASL1, P.O. Collemaggio, 67100 L’Aquila, Italy
| | - Anna Calvarese
- Department of Mental Health, Territorial Health Agency ASL1, P.O. Collemaggio, 67100 L’Aquila, Italy
| | - Roberta Pirro
- Department of Mental Health, Territorial Health Agency ASL1, P.O. Collemaggio, 67100 L’Aquila, Italy
| | - Vittorio Sconci
- Department of Mental Health, Territorial Health Agency ASL1, P.O. Collemaggio, 67100 L’Aquila, Italy
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Di Giminiani R, Masedu F, Tihanyi J, Scrimaglio R, Valenti M. The interaction between body position and vibration frequency on acute response to whole body vibration. J Electromyogr Kinesiol 2013; 23:245-51. [DOI: 10.1016/j.jelekin.2012.08.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/12/2012] [Accepted: 08/28/2012] [Indexed: 11/30/2022] Open
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Valenti M, Ciprietti T, Egidio CD, Gabrielli M, Masedu F, Tomassini AR, Sorge G. Adaptive response of children and adolescents with autism to the 2009 earthquake in L'Aquila, Italy. J Autism Dev Disord 2012; 42:954-60. [PMID: 21717269 PMCID: PMC3360871 DOI: 10.1007/s10803-011-1323-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The literature offers no descriptions of the adaptive outcomes of people with autism spectrum disorder (ASD) after natural disasters. Aim of this study was to evaluate the adaptive behaviour of participants with ASD followed for 1 year after their exposure to the 2009 earthquake in L'Aquila (Italy) compared with an unexposed peer group with ASD, by administering the Italian form of the Vineland Adaptive Behaviour Scales (VABS) at baseline, 6 months and 1 year after the earthquake. Exposed participants declined dramatically in their adaptive behaviour during the first months after the earthquake (p < 0.01 for all VABS dimensions). However, immediate intensive post-disaster intervention allowed children and adolescents with autism showing a trend towards partial recovery of adaptive functioning.
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Affiliation(s)
- Marco Valenti
- Department of Medicine and Public Health, University of L'Aquila, Coppito Hospital Building Delta 6, 67100 L'Aquila, Italy.
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Stratta P, de Cataldo S, Bonanni R, Valenti M, Masedu F, Rossi A. Mental health in L’Aquila after the earthquake. Annali dell'Istituto Superiore di Sanità 2012; 48:132-7. [DOI: 10.4415/ann_12_02_05] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Paolo Stratta
- Centro di Salute Mentale, Azienda Sanitaria Locale 1, L’Aquila, Italy
| | | | - Roberto Bonanni
- Centro di Salute Mentale, Azienda Sanitaria Locale 1, L’Aquila, Italy
| | - Marco Valenti
- Dipartimento di Medicina e Salute Pubblica, Università degli Studi dell’Aquila, L’Aquila, Italy
| | - Francesco Masedu
- Dipartimento di Medicina e Salute Pubblica, Università degli Studi dell’Aquila, L’Aquila, Italy
| | - Alessandro Rossi
- Dipartimento di Medicina Sperimentale, Università degli Studi dell’Aquila, L’Aquila, Italy
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Di Stasi SM, Verri C, Liberati E, Zampa G, Masedu F, Valenti M. Intravesical sequential BCG and electromotive mitomycin versus BCG alone in high risk non-muscle invasive bladder cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.4572] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4572 Background: In 2006, we reported that intravesical sequential bacillus Calmette-Guérin (BCG) and electromotive mitomycin in high risk non-muscle invasive bladder cancer leads to higher disease-free interval, lower recurrence and progression, and to improved overall survival and disease-specific survival compared with BCG alone. After an additional 6 years of follow-up, we now report estimated 16-year results. Methods: From 1994 through 2002, we randomly assigned 212 patients with high risk non.muscle invasive bladder cancer to 81 mg BCG infused over 120 min once a week for 6 weeks (n=105) or to 81 mg BCG infused over 120 min once a week for 2 weeks, followed by 40 mg electromotive mitomycin (intravesical electric current 20 mA for 30 min) once a week as one cycle for three cycles (n=107). Complete responders underwent maintenance treatment: those assigned BCG alone had one infusion of 81 mg BCG once a month for 10 months, and those assigned BCG and mitomycin had 40 mg electromotive mitomycin once a month for 2 months, followed by 81 mg BCG once a month as one cycle for three cycles. The primary endpoint was disease-free interval. Analyses were done by intention to treat. Results: Median follow-up was 121 months (IQR 70.5–163.5). Patients assigned sequential BCG and electromotive mitomycin had higher disease-free interval than did those assigned BCG alone (79 months [95% CI 27–139] vs 26 months [11–113]; difference between groups 53 months [39–67], log-rank p=0.0002). Patients assigned sequential BCG and electromotive mitomycin also had lower recurrence (45% [35–55] vs 62% [50–72], difference between groups 17% [6–28], log-rank p=0.0002); progression (12% [3–21] vs 28% [17.5–38.5], difference between groups 16% [5–27], log-rank p=0.003); overall mortality (44% [33–55] vs 59% [43–75], difference between groups 15% [2–28], log-rank p=0.01); and disease-specific mortality (9% [2.5– 15.5] vs 23% [11–34], difference between groups 14% [4–24], log-rank p=0.0055). Conclusions: In patients with high risk non-muscle invasive bladder cancer intravesical BCG combined with electromotive mitomycin provided better results than BCG alone in terms of higher remission rates and longer remission times.
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Affiliation(s)
| | - Cristian Verri
- Department of Surgery/Urology, Tor Vergata University, Rome, Italy
| | - Emanuele Liberati
- Operative Unit of Urologic Oncology, Policlinico Casilino, Rome, Italy
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Di Stasi SM, Verri C, Liberati E, Micali F, Masedu F, Valenti M. 1669 INTRAVESICAL ADJUVANT ELECTROMOTIVE MITOMYCIN-C IN PATIENTS WITH INTERMEDIATE-RISK NON-MUSCLE INVASIVE BLADDER CANCER A RANDOMIZED CONTROLLED TRIAL. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1527] [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: 10/28/2022]
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Di Stasi SM, Verri C, Liberati E, Masedu F, Topazio L, Valenti M. 1670 INTRAVESICAL SEQUENTIAL BACILLUS CALMETTE-GUÉRIN AND ELECTROMOTIVE MITOMYCIN VERSUS BACILLUS CALMETTE-GUÉRIN ALONE FOR STAGE PT1 UROTHELIAL BLADDER CANCER. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Valenti M, Vinciguerra MG, Masedu F, Tiberti S, Sconci V. A before and after study on personality assessment in adolescents exposed to the 2009 earthquake in L'Aquila, Italy: influence of sports practice. BMJ Open 2012; 2:bmjopen-2012-000824. [PMID: 22654091 PMCID: PMC3367144 DOI: 10.1136/bmjopen-2012-000824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To assess and estimate the personality changes that occurred before and after the 2009 earthquake in L'Aquila and to model the ways that the earthquake affected adolescents according to gender and sport practice. The consequences of earthquakes on psychological health are long lasting for portions of the population, depending on age, gender, social conditions and individual experiences. Sports activities are considered a factor with which to test the overall earthquake impact on individual and social psychological changes in adolescents. DESIGN Before and after design. SETTING Population-based study conducted in L'Aquila, Italy, before and after the 2009 earthquake. PARTICIPANTS Before the earthquake, a random sample of 179 adolescent subjects who either practised or did not practise sports (71 vs 108, respectively). After the earthquake, of the original 179 subjects, 149 were assessed a second time. PRIMARY OUTCOME MEASURE Minnesota Multiphasic Personality Inventory-Adolescents (MMPI-A) questionnaire scores, in a supervised environment. RESULTS An unbalanced split plot design, at a 0.05 significance level, was carried out using a linear mixed model with quake, sex and sports practice as predictive factors. Although the overall scores indicated no deviant behaviours in the adolescents tested, changes were detected in many individual content scale scores, including depression (A-dep score mean ± SEM: before quake =47.54±0.73; after quake =52.67±0.86) and social discomfort (A-sod score mean ± SEM: before quake =49.91±0.65; after quake =51.72±0.81). The MMPI-A profiles show different impacts of the earthquake on adolescents according to gender and sport practice. CONCLUSIONS The differences detected in MMPI-A scores raise issues about social policies required to address the psychological changes in adolescents. The current study supports the idea that sport should be considered part of a coping strategy to assist adolescents in dealing with the psychological effects of the earthquakes on their personalities.
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Affiliation(s)
- Marco Valenti
- Department of Medicine and Public Health, University of L'Aquila, L'Aquila, Italy
| | - Maria Giulia Vinciguerra
- Department of Applied Clinical Sciences, School of Sports Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Masedu
- Department of Medicine and Public Health, University of L'Aquila, L'Aquila, Italy
| | - Sergio Tiberti
- Department of Medicine and Public Health, University of L'Aquila, L'Aquila, Italy
| | - Vittorio Sconci
- Department of Mental Health, Local Health Agency of the National Health System, L'Aquila, Italy
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Valenti M, Masedu F, Tiberti S. Focus on coal power station installations and population health. Ann Ist Super Sanita 2011; 47:305-9. [PMID: 21952157 DOI: 10.4415/ann_11_03_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Damage to health associated with emissions from coal power stations can vary greatly from one location to another depending on the size of the plant, location and the characteristics of the population. Population-based studies conducted by independent groups in different locations around the world show effects on health in populations at higher risk, but failed to definitely demonstrate direct effects on morbidity and mortality, to be exclusively attributed to the presence of active power stations. However, evidence on the role of micropollutants from power station activities suggests that a complete and thorough analysis should be made on the environmental cycle. Therefore danger should in any case be assessed as carefully as possible while assuming, at most, that all micropollutants may come into direct contact with man through the various potential pathways throughout their entire lifetime, regardless of the factors that reduce their presence.
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Affiliation(s)
- Marco Valenti
- Dipartimento Medicina e Sanità Pubblica, Università degli Studi dell’Aquila,Italy.
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91
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Di Stasi SM, Valenti M, Verri C, Liberati E, Giurioli A, Leprini G, Masedu F, Ricci AR, Micali F, Vespasiani G. Electromotive instillation of mitomycin immediately before transurethral resection for patients with primary urothelial non-muscle invasive bladder cancer: a randomised controlled trial. Lancet Oncol 2011; 12:871-9. [DOI: 10.1016/s1470-2045(11)70190-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [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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92
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Tiberti S, Masedu F, Valenti M. [COPD: cross-sectional study of prevalence and screening program in a risk area of the Po River delta in Italy]. Ann Ig 2010; 22:583-599. [PMID: 21425655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Many population-based screening programs for the detection of COPD were reported and debated in the literature and public health practice. The use of portable spirometers, which minimize management costs and avoid the take in charge in housepatient or hospital centers, is now a common practice for COPD detection in the medical practitioner setting. The aim of this study was to estimate the prevalence of COPD within a population-based screening in the Po river delt area in Italy, which is characterized by high density of factories and the presence of an electric power station in Porto Tolle. The study design required a one-year follow up for a two stage questionnaire administration and spirometric examination. Anamnestic, clinical and spirometric investigations were performed by a sample of resident medical practitioners. The catchment area included 112,721 inhabitants, and a multi-stage sample of 2872 people was selected. Prevalence of overall respiratory diseases, as well as of COPD, is quite similar to the figures expected according to national and European prevalence data. COPD prevalence ranges between 1.9-5.4% in males and 1.6-3.8% in females, whereas overall respiratory diseases range between 6.2-15.4% in males and 4.9-11.1% in females. Prevalence odds ratio confirm active and passive cigarette smoking as the main determinant for COPD.
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Affiliation(s)
- S Tiberti
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università dell'Aquila, Ospedale S. Salvatore.
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93
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Valenti M, Cerbo R, Masedu F, De Caris M, Sorge G. Intensive intervention for children and adolescents with autism in a community setting in Italy: a single-group longitudinal study. Child Adolesc Psychiatry Ment Health 2010; 4:23. [PMID: 20809976 PMCID: PMC2936871 DOI: 10.1186/1753-2000-4-23] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 09/01/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Previous studies have shown favourable results with intensive behavioural treatment for children with autism: evidence has emerged that treatment can be successfully implemented in a community setting and in adolescent participants. The aim of this study was to describe the 2-year adaptive functioning outcome of children and adolescents with autism treated intensively within the context of special autism centres, as well as to evaluate family satisfaction with the activity of the centres. METHODS Sixty participants with autism (20 females and 40 males, aged between 4 and 18 years) attending the semi-residential rehabilitation centres for autism located in the Abruzzo region (Central Italy) were followed up and their adaptive functioning was evaluated both at baseline and after one and two years using the Vineland Adaptive Behaviour Scales (VABS). Parents' satisfaction with the service was evaluated using the Orbetello Satisfaction Scale for Children and Adolescent Mental Health. RESULTS The increase in VABS scores was significant on several domains in the different gender and age categories. It is worth noting that male children had improved a great deal (roughly, an effect size >0.20) in the domains of communication, daily living and motor skills (effect sizes 0.34, 0.45 and 0.27 respectively) whereas in male adolescents, a notable increase in VABS scores was recorded in the domain of socialization only (effect size 0.23). On the other hand, adaptive behaviour in female children increased in the domains of socialization and motor skills (effect sizes 0.27 and 0.42 respectively) whereas in female adolescents, good results were achieved in the domains of daily living, socialization and motor skills (effect sizes 0.22, 0.26 and 0.20 respectively).The level of satisfaction of users of the service over time was found to be substantial, even when they had recently started the program. CONCLUSIONS Our results support the implementation of special autism treatment community centres, based on a parent co-directed rehabilitative, intensive and early intervention. Further experimental research designed to document the effectiveness of services provided to children and adolescents with autism in the community is recommended.
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Affiliation(s)
- Marco Valenti
- Department of Medicine and Public Health, University of L'Aquila, Italy.
| | - Renato Cerbo
- Reference Regional Centre for Autism, Abruzzo Region Health System, L'Aquila, Italy
| | - Francesco Masedu
- Department of Medicine and Public Health, University of L'Aquila, Italy
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94
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Valenti M, Porzio G, Aielli F, Verna L, Cannita K, Manno R, Masedu F, Marchetti P, Ficorella C. Physical exercise and quality of life in breast cancer survivors. Int J Med Sci 2008; 5:24-8. [PMID: 18219372 PMCID: PMC2204041 DOI: 10.7150/ijms.5.24] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [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: 12/06/2007] [Accepted: 01/08/2008] [Indexed: 01/04/2023] Open
Abstract
An important goal for cancer patients is to improve the quality of life (QOL) by maximising functions affected by the disease and its therapy. Preliminary research suggests that exercise may be an effective intervention for enhancing QOL in cancer survivors. Research has provided preliminary evidence for the safety, feasibility, and efficacy of exercise training in breast cancer survivors. The aim of this study was to assess the association between physical exercise and quality of life in a population of female breast cancer survivors, followed up from diagnosis to the off-treatment time period, and investigated about their exercise habits in pre-diagnosis.A total of 212 female breast cancer survivors consecutively registered from January 2002 to December 2006 at a Supportive Care Unit in an Italian Oncology Department were enrolled. Exercise behaviour was assessed by the Leisure Score Index (LSI) of the Godin Leisure-Time Exercise Questionnaire. Patients were asked to report their average weekly exercise for three cancer-related time periods, i.e. pre-diagnosis, during active treatment and off-treatment. Quality of life was assessed by the Italian version of the WHOQOL-BREF standardised instrument. Statistical analysis indicated significant differences across the cancer-relevant time-periods for all exercise behaviour outcomes: the exercise behaviour was significantly lower during both on- and off- treatment than during prediagnosis; exercise during active treatment was significantly lower than during off-treatment. QOL strongly decreases during active treatment. Significant correlations were found between total exercise on- and off-treatment and all QOL indicators. Strenuous exercise is strongly correlated with QOL. Absent/mild exercise seems to be inversely correlated with a positive perception of disease severity and with quality of life on all axes. Need clearly results for inclusion of physical activity programs in comprehensive, complementary treatment regimes for breast cancer patients in Italian oncology departments.
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Affiliation(s)
- Marco Valenti
- Biostatistics, Epidemiology Unit, Faculty of Movement, Sport Science, Department of Medicine, Public Health, University of L'Aquila. L'Aquila, Italy.
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95
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Corbacelli A, Cutilli T, Marinangeli F, Ciccozzi A, Corbacelli C, Necozione S, Masedu F, Varrassi G. Cervical pain and headache in patients with facial asymmetries: the effect of orthognathic surgical correction. Minerva Anestesiol 2007; 73:281-9. [PMID: 17380104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
AIM Facial asymmetries are often associated with cervicobrachial pain and headache. The aim of the study was to evaluate the influence of surgical orthognathic correction of facial asymmetries on the intensity of cervicobrachial pain and headache in the short and long term. METHODS Thirty-two patients affected by maxillomandibular asymmetries associated with pain referred to occipital, cervical, dorsal and scapulohumeral areas who were undergoing orthodontic surgical correction were enrolled in the study. The pain intensity at rest and on fibromyalgia trigger points was assessed using a 0-10 Visual Analogue Scale (VAS) preoperatively (T(0)) and 5 days (T(1)), 6 months (T(2)) and 12 months (T(3)) after surgery. Functional limitation was evaluated by the same method at T(0),T(2) and T(3). RESULTS VAS scores at rest were significantly lower at T(1), T(2) and T(3) compared to T0 in every area to which pain was referred. After 12 months (T(3)), pain at rest was completely absent in 23 patients (71.8%) in the occipital region, in 23 patients (71.8%) in the cervical area, in 22 patients (68.7%) in the dorsal area, and in 28 patients (87.5%) in the scapulohumeral area. In the other patients, the pain scores in all areas were < 1 (0.77, 0.83, 0.95, 0.5 in the occipital, cervical, dorsal, and scapulohumeral areas respectively). The VAS at neck fibromyalgia points were significantly reduced at T(1), T(2), T(3) and functional limitation was improved at T(3) and T(4) (P=0.00). CONCLUSION This study appears to demonstrate the utility of orthognathic surgery when facial asymmetry is associated with cranial-cervicobrachial pain syndrome, presumably through a new musculoskeletal rearrangement of stomatognathic apparatus. Indeed, the surgical correction has resulted in morphological, functional and symptomatic effects.
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Affiliation(s)
- A Corbacelli
- Department of Surgical Sciences, Maxillofacial Surgery Institute, University of L'Aquila, L'Aquila, Italy
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96
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Tombolini V, Raffetto N, Santarelli M, Valeriani M, Necozione S, Masedu F, Enrici RM. Carcinoma of the vulva: clinical results of exclusive and adjuvant radiotherapy. Anticancer Res 2005; 25:3089-94. [PMID: 16080570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the historical cohort of 61 patients with carcinoma of the vulva, treated with radiation therapy from 1986 to 1997. PATIENTS AND METHODS Twenty-seven patients were submitted to radiation therapy alone and 34 received radiotherapy post limited surgery in early stages and post radical vulvectomy in advanced stages. The dose range varied from 59 to 63 Gy in post-operative patients and 65 Gy to 71 Gy in curative patients. RESULTS Five-year Overall Survival (OS) and Disease-Free Survival (DFS) for patients treated with irradiation alone and for those treated with post-operative radiotherapy were 50.8% and 69.7%, respectively, without significant statistical difference. For OS multivariate analysis showed statistical difference for stage and age variables, and for stage variable in the case of DFS. CONCLUSION In early stage vulvar cancer patients OS and DFS are good, with high control rate and low incidence of adverse effect. In loco-regionally-advanced patients, especially in those with stage IV or with > 2 positive lymph nodes, the outcomes are poor.
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97
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Di Orio F, Masedu F. [Interpretations and therapies of pain during modern and ancient age]. Med Secoli 2004; 16:43-69. [PMID: 15685798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The problem of pain has always been a cornerstone in reflections of mankind, privileged place to endeavour a comprehensive understanding of his own meaning. So we are not surprised realising how many thinkers identified the problem of pain with the essential issue in order to characterise man. Pain has been and is, despite its widespread removal in modern western cultures, both a constructive and destructive strength of our deeper sense. History of pain has been mainly, but not only, history against pain, struggle with this, prima facie, contradictory aspect of human condition. We'll trace out a path, spanning many centuries, looking for strategies to cope with physical pain. This choice is justified by the amount of therapeutic achievements concerned the control of pain during the 19th century compared with those of the preceding ages. This division underlines the progress achieved in this field during the last two centuries and make clear the difficulties encountered by Medicine and allied sciences in getting operative scientific credit. In the background there are the problems of palliative cares, euthanasia, and the hope to approach death with dignity.
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98
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Necozione S, Masedu F, Cofini V, di Orio F. [Quality of health care services as perceived by the customers: issues of method or context?]. Ann Ig 2002; 14:511-20. [PMID: 12638355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Customer satisfaction is considered an important indicator of the quality of care. Its definition as well as the identification of the variables which affect it, rise many cultural and methodological issues. In order to give a contribution to the debate on such topics, we compared the patients' satisfaction detected before and after the transferral of the San Salvatore Hospital of L'Aquila to new and functional structures. The comparison aimed at evaluating the methodological and cultural entailments involved in customers satisfaction surveys, which focus the improvements in terms of health care as well as variation of satisfaction. The presence of contradictory elements in the expression of the satisfaction referred to the technical and informative aspects, seems to indicate that patients can express an high satisfaction degree independently from the real professional and technical quality performed. Such evidences, that anyway must be interpreted according with the methodological cautions of a non validated questionnaire, should foster stronger efforts in promoting sanitary education of the customers, devoted to the specific rights involved, as well as in making use of rigorous methodologies to detect the phenomenon.
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Affiliation(s)
- S Necozione
- Dipartimento di Medicina Interna E Sanità Pubblica, Università degli Studi di L'Aquila, Facoltà di Medicina e Chirurgia, Via Vetoio, Blocco 11/B, Coppito, 67100 L'Aquila.
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99
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Abstract
The main objectives of type 1 diabetes mellitus (DM) management include keeping glycemia levels within the euglycemic range to prevent complications. Daily self-monitoring is an important problem for many diabetic patients, particularly for adolescents. The aim of this study was to evaluate the determinants of poor daily self-monitoring, focusing on the patients' parents' perception of the problem. In order to evaluate parents' awareness of their children's disease-monitoring status, we carried out a cross-sectional investigation of a sample of children and adolescents from a population-based register, with the corresponding population of parents. To collect our data, we used a 33-item questionnaire, separately administered by diabetologists to both parents and children. We estimated the concordance with respect to patients' and parents' answers. Adolescents followed their overall medical prescriptions more regularly (48.8%) than children (29.7%), but most frequently they forgot to use glycemic tests (adolescents 42.4%, children 29.7%). A major duration of disease affected HbA1c levels (values > 8%) of patients younger than 14 years (pFisher = 0.016). Our results indicate a worse compliance of adolescents with respect to children in attending to daily self-monitoring, not just regarding daily glycemic levels but also the course of daily activities such as going to school, studying, working, and simulating symptoms and signs of hypo-hyperglycemia. Parents mostly ignored their child's self-monitoring status and the related motivations.
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Affiliation(s)
- E Altobelli
- Section of Epidemiology, Department of Internal Medicine and Public Health, University of L'Aquila, Via Vetoio, Blocco 11/B, I-67100 Coppito, AQ, Italy
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100
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Masedu F, Valenti M. [Counterfactual prevention]. Epidemiol Prev 1997; 21:90-1. [PMID: 9378188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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