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Marinescu M, Oprea VD, Nechita A, Tutunaru D, Nechita LC, Romila A. The Use of Brain Natriuretic Peptide in the Evaluation of Heart Failure in Geriatric Patients. Diagnostics (Basel) 2023; 13:diagnostics13091512. [PMID: 37174904 PMCID: PMC10177186 DOI: 10.3390/diagnostics13091512] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/15/2023] Open
Abstract
Heart failure is one of the main morbidity and mortality factors in the general population and especially in elderly patients. Thus, at the European level, the prevalence of heart failure is 1% in people under 55 years of age but increases to over 10% in people over 70 years of age. The particularities of the elderly patient, which make the management of heart failure difficult, are the presence of comorbidities, frailty, cognitive impairment and polypharmacy. However, elderly patients are under-represented in clinical trials on the diagnosis and treatment of heart failure. The need for complementary methods (biomarkers) for differential and early diagnosis of heart failure is becoming more and more evident, even in its subclinical stages. These methods need to have increased specificity and sensitivity and be widely available. Natriuretic peptides, in particular B-type natriuretic peptide (BNP) and its fraction NTproBNP, have gained an increasingly important role in the screening, diagnosis and treatment of heart failure in recent years.
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Affiliation(s)
- Mihai Marinescu
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Violeta Diana Oprea
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Aurel Nechita
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Ioan" Emergency Clinical Hospital for Children, 800487 Galați, Romania
| | - Dana Tutunaru
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Luiza-Camelia Nechita
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Aurelia Romila
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
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Makizako H, Nakai Y, Shiratsuchi D, Akanuma T, Yokoyama K, Matsuzaki-Kihara Y, Yoshida H. Perceived declining physical and cognitive fitness during the COVID-19 state of emergency among community-dwelling Japanese old-old adults. Geriatr Gerontol Int 2021; 21:364-369. [PMID: 33576180 PMCID: PMC8013798 DOI: 10.1111/ggi.14140] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 12/17/2022]
Abstract
Aim Perceived health status, including physical and cognitive fitness, will be negatively associated with future health conditions among old‐old adults. The coronavirus disease 2019 (COVID‐19) pandemic has caused sudden changes in lifestyle. Thus, this study examined the associations of participation in an exercise class before the COVID‐19 pandemic and the exercise habits and disruption to the rhythms of daily life during the COVID‐19 state of emergency with perceived declining physical and cognitive fitness among community‐dwelling old‐old adults. Methods In July 2020, we carried out a mail survey of community‐dwelling old‐old adults aged between 77 and 99 years in Bibai, Hokkaido, Japan, to determine their perceived declining physical and cognitive fitness during the COVID‐19 state of emergency. Results Of the 774 responders, 339 (43.8%) participants reported a decline in physical fitness, whereas 259 (33.5%) perceived declining cognitive fitness during the COVID‐19 state of emergency. In a multivariate logistic regression model adjusted for potential confounders, exercise habits during the COVID‐19 state of emergency were significantly associated with a lower perception of declining physical fitness. Disruption to the rhythms of daily life during the COVID‐19 state of emergency was significantly associated with a higher perception of declining physical and cognitive fitness. Conclusions Approximately half and more than one‐third of community‐dwelling old‐old adults perceived declining physical and cognitive fitness, respectively, during the COVID‐19 state of emergency. During this period, exercise habits were positively correlated with perceived health status among old‐old adults, whereas disruption to the rhythms of daily life was negatively correlated. Geriatr Gerontol Int 2021; 21: 364–369.
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Affiliation(s)
- Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Yuki Nakai
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Daijo Shiratsuchi
- Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan.,Department of Rehabilitation, Japan Community Health Care Organization Kumamoto General Hospital, Kumamoto, Japan
| | - Tomomi Akanuma
- Bibai City Department of Health and Welfare Aged Care Division, Bibai, Japan
| | - Kaori Yokoyama
- Bibai City Department of Health and Welfare Aged Care Division, Bibai, Japan
| | - Yuriko Matsuzaki-Kihara
- Rehabilitation Department, Health and Medical Faculty, Japan Health Care College, Sapporo, Japan
| | - Hiroto Yoshida
- Graduate School of Health and Environment Science, Tohoku Bunka Gakuen University, Sendai, Japan
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Rampersad C, Brar R, Connelly K, Komenda P, Rigatto C, Prasad B, Bohm C, Tangri N. Association of Physical Activity and Poor Health Outcomes in Patients With Advanced CKD. Am J Kidney Dis 2021; 78:391-398. [PMID: 33581165 DOI: 10.1053/j.ajkd.2020.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Abstract
RATIONALE & OBJECTIVE Chronic kidney disease (CKD) is associated with declining physical function and activity. In the general population, lower physical activity is associated with poorer quality of life and greater all-cause mortality. The aim of this study was to assess if lower physical activity levels are associated with adverse health outcomes in patients with advanced CKD. STUDY DESIGN A multicenter prospective cohort study. SETTING & PARTICIPANTS 579 adult patients with CKD glomerular filtration rate categories 4 and 5 (G4-G5) treated at 4 Canadian multidisciplinary kidney health clinics between 2012 and 2018. EXPOSURE Patient-reported measures of physical activity using the Physical Activity Scale for the Elderly (PASE) questionnaire and subsequently stratified PASE scores into tertiles. OUTCOME All-cause mortality, progression to kidney failure, and future falls. ANALYTICAL APPROACH Outcomes were analyzed using time-dependent proportional hazards models and logistic regression models. RESULTS In 1,193 days of follow-up observation, 118 patients died, 204 progressed to dialysis, and 129 reported a fall. When compared with low physical activity, higher levels of physical activity were associated with a 52% lower all-cause mortality (adjusted HR, 0.48; 95% CI, 0.27-0.85) in models adjusted for age, sex, and comorbidity. No associations were detected between higher levels of physical activity and either slower progression to kidney failure or a lower rate of future falls. LIMITATIONS Physical activity and falls were self-reported. Our population was of limited racial/ethnic diversity, which may affect generalizability. Findings were observational and do not indicate whether interventions targeting physical activity may affect adverse health outcomes. CONCLUSIONS Higher levels of physical activity were associated with about 50% lower all-cause mortality in the advanced CKD population. These findings are consistent with a potential benefit from maintained physical activity as patients approach kidney failure.
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Affiliation(s)
- Christie Rampersad
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Ranveer Brar
- Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Kelsey Connelly
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Paul Komenda
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Claudio Rigatto
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Bhanu Prasad
- Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Clara Bohm
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Navdeep Tangri
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
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Sanchez-Sanchez JL, Izquierdo M, Carnicero-Carreño JA, García-García FJ, Rodríguez-Mañas L. Physical activity trajectories, mortality, hospitalization, and disability in the Toledo Study of Healthy Aging. J Cachexia Sarcopenia Muscle 2020; 11:1007-1017. [PMID: 32163233 PMCID: PMC7432572 DOI: 10.1002/jcsm.12566] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/03/2019] [Accepted: 02/09/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Physical activity (PA) is a recognized contributor to healthy aging. However, the majority of studies exploring its associations with adverse outcomes in cohorts of older adults use single-time PA estimates, which do not consider its dynamic nature. The aim of the present study is to explore the presence of different PA trajectories in the Toledo Study of Healthy Aging and their association with adverse outcomes. Our hypothesis is that prospectively maintaining or increasing PA is associated with a reduced risk of adverse outcomes. METHODS We used data from 1679 participants enrolled in the Toledo Study of Healthy Aging. Trajectories based on the Physical Activity Scale for the Elderly were identified using group-based trajectory modelling. Cox and logistic regression were used to investigate associations between PA trajectories and mortality and hospitalization, and incident and worsening disability, respectively. Mortality was ascertained by linkage to the Spanish National Death Index; disability was evaluated through the Katz Index; and hospitalization was defined as the first admission to Toledo Hospital. Models were adjusted by age, sex, smoking, Charlson Index, education, cognitive impairment, polypharmacy, and Katz Index at Wave 2. RESULTS We found four PA-decreasing and one PA-increasing trajectories: high PA-consistent (n = 566), moderate PA-mildly decreasing (n = 392), low PA-increasing (n = 237), moderate PA-consistent (n = 191), and low PA-decreasing (n = 293). Belonging to the high PA-consistent trajectory group was associated with reduced risks of mortality as compared with the low PA-decreasing group [hazard ratio (HR) 1.68; 95% confidence interval (CI) = 1.21-2.31] and hospitalization compared with the low PA-increasing and low PA-decreasing trajectory groups (HR 1.24; 95% CI = 1.004-1.54 and HR 1.25; 95% CI = 1.01-1.55, respectively) and with lower rates of incident [odds ratio (OR) 3.14; 95% CI = 1.59-6.19] and worsening disability (OR 2.16; 95% CI = 1.35-3.45) in relation to the low PA-decreasing trajectory group and at follow-up. Increasing PA during late life (low PA-increasing group) was associated with lower incident disability rates (OR 0.38; 95% CI = 0.19-0.82) compared with decreasing PA (low PA-decreasing group), despite similar baseline PA. CONCLUSIONS Our results suggest that sustaining higher PA levels during aging might lead to healthy aging, characterized by a reduction in adverse outcomes. Our study supports the need for enhancing PA participation among older populations, with the goal of reducing personal and economic burden in a worldwide aging population.
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Affiliation(s)
- Juan Luis Sanchez-Sanchez
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IDISNA, Pamplona, Navarra, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IDISNA, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Antonio Carnicero-Carreño
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
| | - Fransico José García-García
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Geriatrics Department, Virgen Del Valle Hospital, Toledo, Spain
| | - Leocadio Rodríguez-Mañas
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Geriatrics Department, Getafe University Hospital, Ctra. de Toledo, Getafe, Spain
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Bielemann RM, LaCroix AZ, Bertoldi AD, Tomasi E, Demarco FF, Gonzalez MC, Crespo da Silva PA, Wendt A, Mohnsam da Silva IC, Brage S, Ekelund U, Pratt M. Objectively Measured Physical Activity Reduces the Risk of Mortality among Brazilian Older Adults. J Am Geriatr Soc 2020; 68:137-146. [PMID: 31592540 DOI: 10.1111/jgs.16180] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Use of objectively measured physical activity (PA) in older adults to assess relationship between PA and risk of all-causes mortality is scarce. This study evaluated the associations of PA based on accelerometry and a questionnaire with the risk of mortality among older adults from a city in Southern Brazil. DESIGN A cohort study. SETTING Urban area of Pelotas, Southern Brazil. PARTICIPANTS A representative sample of older adults (≥60 y) from Pelotas, enrolled in 2014. MEASUREMENTS Overall physical activity (mg), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were estimated by raw accelerometer data. The International Physical Activity Questionnaire estimated leisure time and commuting PA. Hazard ratios (excluding deaths in the first 6 mo) stratified by sex were estimated by Cox regression analysis considering adjustment for confounders. RESULTS From the 1451 older adults interviewed in 2014, 145 died (10%) after a follow-up of an average 2.6 years. Men and women in the highest tertile of overall PA had on average a 77% and 92% lower risk of mortality than their less active counterparts (95% confidence interval [CI] = .06-.84 and 95% CI = .01-.65, respectively). The highest tertile of LPA was also related to a lower risk of mortality in individuals of both sexes (74% and 91% lower risk among men and women, respectively). MVPA statistically reduced the risk of mortality only among women (hazard ratio [HR] = .30 and HR = .07 in the second and third tertiles). Self-reported leisure-time PA was statistically associated with a lower risk of mortality only among men. Women in the highest tertiles of commuting PA showed a lower risk of mortality than those in the reference group. CONCLUSION Accelerometry-based PA was associated with a lower risk of mortality among Brazilian older adults. Older individuals should practice any type of PA. J Am Geriatr Soc 68:137-146, 2019.
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Affiliation(s)
- Renata M Bielemann
- Post-Graduate Program in Nutrition and Foods, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Andrea Z LaCroix
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California
| | - Andréa D Bertoldi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Elaine Tomasi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Flávio F Demarco
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Maria Cristina Gonzalez
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | | | - Andrea Wendt
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Inácio Crochemore Mohnsam da Silva
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Michael Pratt
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California
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Muscari A, Bianchi G, Forti P, Magalotti D, Pandolfi P, Zoli M. Inverse Association Between Neck Pain and All-Cause Mortality in Community-Dwelling Older Adults. PAIN MEDICINE 2019; 19:2377-2386. [PMID: 29220527 DOI: 10.1093/pm/pnx306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective In a previous study, we found an apparent protective effect of neck pain on all-cause mortality in subjects older than age 85 years. The present longitudinal investigation was performed to verify this unexpected finding in a larger sample and to establish its significance. Design Population follow-up study. Setting Three towns of Northern Italy. Subjects We examined 5,253 community-dwelling residents age 65-102 years (55% female). Methods Through a postal questionnaire, baseline information was obtained concerning cardiovascular risk factors, self-rated health, physical activity, cardiovascular events, medical therapy, and presence of pain in the main joints. Seven-year all-cause mortality was the end point. Results During follow-up, 1,250 people died. After adjustment for age, sex, anti-inflammatory drugs, physical activity, and main risk factors, neck pain was inversely associated with mortality (hazard ratio = 0.74, 95% confidence interval = 0.64-0.86, P < 0.001). This association was present, with high significance, in each of the eight following subgroups: men, women, age 65-74 years, age 75-84 years, age ≥85 years and residents of each of the three towns. The subjects without neck pain (N = 3,158) were older, more often men, less often hypercholesterolemic, less physically active, and had more frequently had a stroke than the subjects with neck pain (N = 2,095). There were no differences in the causes of death between subjects with or without neck pain. Conclusion This study has confirmed the existence of an independent inverse association between neck pain and mortality in the elderly, suggesting that reduced sensitivity to neck pain may be a new marker of frailty.
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Affiliation(s)
- Antonio Muscari
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giampaolo Bianchi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paola Forti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Donatella Magalotti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paolo Pandolfi
- Department of Public Health, AUSL Bologna, Epidemiological and Health Promotion Unit, Bologna, Italy
| | - Marco Zoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Muscari A, Spiller I, Bianchi G, Fabbri E, Forti P, Magalotti D, Pandolfi P, Zoli M. Predictors of cognitive impairment assessed by Mini Mental State Examination in community-dwelling older adults: relevance of the step test. Exp Gerontol 2018; 108:69-76. [PMID: 29601853 DOI: 10.1016/j.exger.2018.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/21/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Several predictors of cognitive impairment assessed by Mini Mental State Examination (MMSE) have previously been identified. However, which predictors are the most relevant and what is their effect on MMSE categories remains unclear. METHODS Cross-sectional and longitudinal study using data from 1116 older adults (72.6 ± 5.6 years, 579 female), 350 of whom were followed for 7 years. At baseline, the following variables were collected: personal data, marital status, occupation, anthropometric measures, risk factors, previous cardiovascular events, self-rated health and physical activity during the last week. Furthermore, routine laboratory tests, abdominal echography and a step test (with measurement of the time needed to ascend and descend two steps 20 times) were performed. The associations of these variables with cross-sectional cognitive deficit (MMSE < 24) and longitudinal cognitive decline (decrease of MMSE score over 7 years of follow-up) were investigated using logistic regression models. RESULTS Cross-sectional cognitive deficit was independently associated with school education ≤ 5 years, prolonged step test duration, having been blue collar or housewife (P ≤ 0.0001 for all) and, with lower significance, with advanced age, previous stroke and poor recent physical activity (P < 0.05). Longitudinal cognitive decline was mainly associated with step test duration (P = 0.0001) and diastolic blood pressure (P = 0.0002). The MMSE categories mostly associated with step test duration were orientation, attention, calculation and language, while memory appeared to be poorly or not affected. CONCLUSIONS In our cohort of older adults, step test duration was the most relevant predictor of cognitive impairment.
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Affiliation(s)
- Antonio Muscari
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Ilaria Spiller
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Giampaolo Bianchi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Elisa Fabbri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Paola Forti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Donatella Magalotti
- Medical Department of Continuity of Care and Disability, S.Orsola-Malpighi Hospital, Bologna, Italy.
| | - Paolo Pandolfi
- Epidemiological and Health Promotion Unit, Department of Public Health, AUSL Bologna, Bologna, Italy.
| | - Marco Zoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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