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Carvalho Silva R, Oliva F, Barlati S, Perusi G, Meattini M, Dashi E, Colombi N, Vaona A, Carletto S, Minelli A. Childhood neglect, the neglected trauma. A systematic review and meta-analysis of its prevalence in psychiatric disorders. Psychiatry Res 2024; 335:115881. [PMID: 38579459 DOI: 10.1016/j.psychres.2024.115881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024]
Abstract
Traumatic events increase risk of mental illnesses, but childhood neglect prevalence in psychiatric disorders is understudied. This systematic review and meta-analysis assessed neglect prevalence, including emotional neglect (EN) and physical neglect (PN), among adults with psychiatric disorders. We conducted a systematic search and meta-analysis in 122 studies assessing different psychiatric disorders. Prevalence was 46.6% (95%CI[34.5-59.0]) for unspecified neglect (Ne), 43.1% (95%CI[39.0-47.4]) for EN, and 34.8% (95%CI[30.6-39.2]) for PN. Although a moderating effect of the psychiatric diagnostic category was not confirmed, some clinical diagnoses had significantly lower prevalence rates than others. Patients with bipolar disorder and major depressive disorder showed lower prevalence rates of EN and PN, whereas lower prevalence was found in psychotic disorders and eating disorders for PN only. Neglect assessment was a significant moderator for Ne and PN. No moderating effect of age and sex on neglect prevalence was found. Heterogeneity levels within and between psychiatric diagnostic categories remained high. This is the first meta-analysis examining diverse types of neglect prevalence considering different psychiatric diagnoses. Our results explore the prevalence of childhood neglect and its subtypes among adults with psychiatric disorders, contributing to understanding the nuanced interplay between neglect and specific psychiatric conditions, and guiding interventions for affected individuals.
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Affiliation(s)
- Rosana Carvalho Silva
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesco Oliva
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy; Clinical Psychology Unit, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Perusi
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mattia Meattini
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Elona Dashi
- Department of Neuroscience, University Hospital Center "Mother Theresa", Tirane, Albania
| | - Nicoletta Colombi
- Federated Library of Medicine "F. Rossi", University of Torino, Torino, Italy
| | - Alberto Vaona
- Azienda Ulss9, Department Cure Primarie, Verona, Italy
| | - Sara Carletto
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy; Clinical Psychology Unit, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Veronese N, Demurtas J, Thompson T, Solmi M, Pesolillo G, Celotto S, Barnini T, Stubbs B, Maggi S, Pilotto A, Onder G, Theodoratou E, Vaona A, Firth J, Smith L, Koyanagi A, Ioannidis JP, Tzoulaki I. Effect of low-dose aspirin on health outcomes: An umbrella review of systematic reviews and meta-analyses. Br J Clin Pharmacol 2020; 86:1465-1475. [PMID: 32488906 PMCID: PMC7373714 DOI: 10.1111/bcp.14310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/13/2020] [Accepted: 03/23/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS This study aimed to use an umbrella review methodology to capture the range of outcomes that were associated with low-dose aspirin and to systematically assess the credibility of this evidence. METHODS Aspirin is associated with several health outcomes, but the overall benefit/risk balance related to aspirin use is unclear. We searched three major databases up to 15 August 2019 for meta-analyses of observational studies and randomized controlled trials (RCTs) including low-dose aspirin compared to placebo or other treatments. Based on random-effects summary effect sizes, 95% prediction intervals, heterogeneity, small-study effects and excess significance, significant meta-analyses of observational studies were classified from convincing (class I) to weak (class IV). For meta-analyses of RCTs, outcomes with random effects P-value < .005 and a moderate/high GRADE assessment, were classified as strong evidence. From 6802 hits, 67 meta-analyses (156 outcomes) were eligible. RESULTS Observational data showed highly suggestive evidence for aspirin use and increased risk of upper gastrointestinal bleeding (RR = 2.28, 95% CI: 1.97-2.64). In RCTs of low-dose aspirin, we observed strong evidence for lower risk of CVD in people without CVD (RR = 0.83; 95% CI: 0.79-0.87) and in general population (RR = 0.83; 95% CI: 0.79-0.89), higher risk of major gastrointestinal (RR = 1.47; 95% CI: 1.26-1.72) and intracranial bleeding (RR = 1.34; 95% CI: 1.18-1.53), and of major bleedings in people without CVD (RR = 1.62; 95% CI: 1.26-2.08). CONCLUSION Compared to other active medications, low-dose aspirin had strong evidence for lower risk of bleeding, but also lower comparative efficacy. Low-dose aspirin significantly lowers CVD risk and increases risk of bleeding. Evidence for multiple other health outcomes is limited.
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Affiliation(s)
- Nicola Veronese
- National Research CouncilNeuroscience InstituteAging BranchPaduaItaly
- Geriatrics Unit, Department of Geriatric Care, Ortho Geriatrics and Rehabilitation, Frailty AreaE.O. Galliera HospitalGenoaItaly
| | - Jacopo Demurtas
- Primary Care DepartmentAzienda USL Toscana Sud EstGrossetoItaly
- Clinical and Experimental Medicine PhD ProgramUniversity of Modena and Reggio EmiliaModenaItaly
| | - Trevor Thompson
- Faculty of Health, Social Care and Education, Anglia Ruskin UniversityChelmsfordUK
| | - Marco Solmi
- Department of NeuroscienceUniversity of PadovaPaduaItaly
| | | | - Stefano Celotto
- Primary Care DepartmentAlto Friuli—Collinare—Medio FriuliUdineItaly
| | | | - Brendon Stubbs
- Physiotherapy DepartmentSouth London and Maudsley NHS Foundation TrustDenmark HillLondonUK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonDe Crespigny ParkLondonUK
| | - Stefania Maggi
- National Research CouncilNeuroscience InstituteAging BranchPaduaItaly
| | - Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, Ortho Geriatrics and Rehabilitation, Frailty AreaE.O. Galliera HospitalGenoaItaly
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli, IRCCS and Università Cattolica del Sacro CuoreRomeItaly
| | - Evropi Theodoratou
- Centre for Global Health Research, Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUK
| | - Alberto Vaona
- Primary Care DepartmentAzienda ULSS20 VeronaVeronaItaly
| | - Joseph Firth
- NICM Health Research InstituteUniversity of Western SydneyPenrithAustralia
- Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise SciencesAnglia Ruskin UniversityCambridgeUK
| | - Ai Koyanagi
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMMadridSpain
- Research and Development UnitParc Sanitari Sant Joan de Déu, Universitat de BarcelonaBarcelonaSpain
| | - John P.A. Ioannidis
- Stanford Prevention Research Center, Department of MedicineStanford University Medical SchoolStanfordCaliforniaUSA
- Department of Health Research and PolicyStanford University School of MedicineStanfordCaliforniaUSA
- Department of StatisticsStanford University School of Humanities and SciencesStanfordCaliforniaUSA
- Department of Biomedical Data ScienceStanford University School of MedicineStanfordCaliforniaUSA
| | - Ioanna Tzoulaki
- Centre for Global Health Research, Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
- MRC‐PHE Centre for Environment, School of Public HealthImperial College LondonUK
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Bolzetta F, Veronese N, Stubbs B, Noale M, Vaona A, Demurtas J, Celotto S, Cacco C, Cester A, Caruso MG, Reddavide R, Notarnicola M, Maggi S, Koyanagi A, Fornaro M, Firth J, Smith L, Solmi M. The Relationship between Dietary Vitamin K and Depressive Symptoms in Late Adulthood: A Cross-Sectional Analysis from a Large Cohort Study. Nutrients 2019; 11:nu11040787. [PMID: 30959758 PMCID: PMC6520944 DOI: 10.3390/nu11040787] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/26/2019] [Accepted: 03/29/2019] [Indexed: 12/11/2022] Open
Abstract
Few studies assessed the associations between dietary vitamin K and depressive symptoms. We aimed to investigate the association between dietary vitamin K and depressive symptoms in a large cohort of North American People. In this cross-sectional analysis, 4,375 participants that were aged 45⁻79 years from the Osteoarthritis Initiative were included. Dietary vitamin K intake was collected through a semi-quantitative food frequency questionnaire and categorized in quartiles. Depressive symptoms were diagnosed using the 20-item Center for Epidemiologic Studies-Depression (CES-D) ≥ 16. To investigate the associations between vitamin K intake and depressive symptoms, logistic regression analysis were run, which adjusted for potential confounders. Overall, 437 (=10%) subjects had depressive symptoms. After adjusting for 11 confounders, people with the highest dietary vitamin K intake had lower odds of having depressive symptoms (OR = 0.58; 95%CI: 0.43⁻0.80). This effect was only present in people not taking vitamin D supplementation. In conclusion, higher dietary vitamin K intake was significantly associated with a lower presence of depressive symptoms, also after accounting for potential confounders. Future longitudinal research is required to explore the directionality of the association.
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Affiliation(s)
- Francesco Bolzetta
- Medical Department, Geriatric Unit, Azienda ULSS (Unità Locale Socio Sanitaria) 3 "Serenissima", 30031 Dolo-Mirano District, Italy.
| | - Nicola Veronese
- Aging Branch, Neuroscience Institute, National Research Council, 35128 Padua, Italy.
- National Institute of Gastroenterlogy, Research Hospital, IRCCS De Bellis, Castellana Grotte, 70013 Bari, Italy.
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK.
- Faculty of Health, Social care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, UK.
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King's College London, De Crespigny Park, London SE5 8AF, UK.
| | - Marianna Noale
- Aging Branch, Neuroscience Institute, National Research Council, 35128 Padua, Italy.
| | - Alberto Vaona
- Primary Care Department, Azienda ULSS20 Verona, 37122 Verona, Italy.
| | - Jacopo Demurtas
- Primary Care Department, Azienda USL Toscana Sud Est, 58100 Grosseto, Italy.
| | - Stefano Celotto
- Primary Care Department, Aziendale AAS3 Alto Friuli ⁻ Collinare ⁻ Medio Friuli, 33013 Udine, Italy.
| | | | - Alberto Cester
- Medical Department, Geriatric Unit, Azienda ULSS (Unità Locale Socio Sanitaria) 3 "Serenissima", 30031 Dolo-Mirano District, Italy.
| | - Maria Gabriella Caruso
- National Institute of Gastroenterlogy, Research Hospital, IRCCS De Bellis, Castellana Grotte, 70013 Bari, Italy.
| | - Rosa Reddavide
- National Institute of Gastroenterlogy, Research Hospital, IRCCS De Bellis, Castellana Grotte, 70013 Bari, Italy.
| | - Maria Notarnicola
- National Institute of Gastroenterlogy, Research Hospital, IRCCS De Bellis, Castellana Grotte, 70013 Bari, Italy.
| | - Stefania Maggi
- Aging Branch, Neuroscience Institute, National Research Council, 35128 Padua, Italy.
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, 28029 Barcelona, Spain.
| | - Michele Fornaro
- New York State Psychiatric Institute, Columbia University, New York, NY 10027, USA.
| | - Joseph Firth
- NICM Health Research Institute, University of Western Sydney, Penrith, NSW 2751, Australia.
- Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, UK.
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK.
| | - Marco Solmi
- Department of Neuroscience, University of Padova, 35122 Padova, Italy.
- Padova Neuroscience Center, University of Padova, 35122 Padova, Italy.
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Veronese N, Stubbs B, Koyanagi A, Vaona A, Demurtas J, Schofield P, Maggi S. Mitochondrial genetic haplogroups and cardiovascular diseases: Data from the Osteoarthritis Initiative. PLoS One 2019; 14:e0213656. [PMID: 30921349 PMCID: PMC6438497 DOI: 10.1371/journal.pone.0213656] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 02/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background Some case-control studies reported that mitochondrial haplogroups could be associated with the onset of cardiovascular diseases (CVD), but the literature regarding this topic is limited. We aimed to investigate whether any mitochondrial haplogroup carried a higher or lower risk of CVD in a large cohort of North American people affected by knee osteoarthritis or at high risk for this condition. Materials and methods A longitudinal cohort study including individuals from the Osteoarthritis Initiative was done. Haplogroups were assigned through a combination of sequencing and PCR-RFLP techniques. All the mitochondrial haplogroups have been named following this nomenclature: HV, JT, UK, IWX, and superHV/others. The strength of the association between mitochondrial haplogroups and incident CVD was evaluated through a Cox’s regression analysis, adjusted for potential confounders, and reported as hazard ratios (HRs) with their 95% confidence intervals (CIs). Results Overall, 3,288 Caucasian participants (56.8% women) with a mean age of 61.3±9.2 years without CVD at baseline were included. During a median follow-up of 8 years, 322 individuals (= 9.8% of baseline population) developed a CVD. After adjusting for 11 potential confounders at baseline and taking those with the HV haplotype as reference (the most frequent), those with JT carried a significant lower risk of CVD (HR = 0.75; 95%CI: 0.54–0.96; p = 0.03). Participants with the J haplogroup had the lowest risk of CVD (HR = 0.71; 95%CI: 0.46–0.95; p = 0.02). Conclusions The presence of JT haplogroups (particularly J) may be associated with a reduced risk of CVD. However, this result was not based on a high level of statistical significance. Thus, future research with larger sample size is needed to assess whether our results can be corroborated.
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Affiliation(s)
- Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, National Institute of Gastroenterology “S. De Bellis” Research Hospital, Castellana Grotte (Ba), Italy
- * E-mail:
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Alberto Vaona
- Primary Care Department, Azienda ULSS20 Verona, Verona, Italy
| | - Jacopo Demurtas
- Primary Care Department, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - Patricia Schofield
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padova, National Institute of Gastroenterology “S. De Bellis” Research Hospital, Castellana Grotte (Ba), Italy
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Veronese N, Demurtas J, Pesolillo G, Celotto S, Barnini T, Calusi G, Caruso MG, Notarnicola M, Reddavide R, Stubbs B, Solmi M, Maggi S, Vaona A, Firth J, Smith L, Koyanagi A, Dominguez L, Barbagallo M. Magnesium and health outcomes: an umbrella review of systematic reviews and meta-analyses of observational and intervention studies. Eur J Nutr 2019; 59:263-272. [PMID: 30684032 DOI: 10.1007/s00394-019-01905-w] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/17/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To map and grade all health outcomes associated with magnesium (Mg) intake and supplementation using an umbrella review. METHODS Umbrella review of systematic reviews with meta-analyses of observational studies and randomized controlled trials (RCTs) using placebo/no intervention as control group. We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values, 95% prediction intervals, heterogeneity, small-study effects and excess significance. For meta-analyses of RCTs, outcomes with a random-effect p value < 0.005 and a high-GRADE assessment were classified as strong evidence. RESULTS From 2048 abstracts, 16 meta-analyses and 55 independent outcomes were included (36 in RCTs and 19 in observational studies). In RCTs of Mg versus placebo/no active treatment, 12 over 36 outcomes reported significant results (p < 0.05). A strong evidence for decreased need for hospitalization in pregnancy and for decreased risk of frequency and intensity of migraine relapses in people with migraine was observed using the GRADE assessment. In observational studies, 9/19 outcomes were significant (p < 0.05). However, only one outcome presented highly suggestive evidence (lower incidence of type 2 diabetes in people with higher Mg intake at baseline) and one suggestive (lower incidence of stroke associated with higher Mg intake at baseline). CONCLUSION Strong evidence according to the GRADE suggests that Mg supplementation can decrease the risk of hospitalization in pregnant women and reduce the intensity/frequency of migraine. Higher Mg intake is associated with a decreased risk of type 2 diabetes and stroke with highly suggestive and suggestive evidence, respectively, in observational studies.
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Affiliation(s)
- Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Via Giustiniani, 2, 35128, Padova, Italy. .,Research Hospital, National Institute of Gastroenterlogy, IRCCS De Bellis, Castellana Grotte, BA, Italy.
| | - Jacopo Demurtas
- Primary Care Department, Azienda USL Toscana Sud Est, Grosseto, Italy
| | | | - Stefano Celotto
- Primary Care Department, Azienda per l'Assistenza Sanitaria 3 Alto Friuli -Collinare -Medio Friuli, Udine, Italy
| | | | - Giovanni Calusi
- Primary Care Department, Azienda USL Toscana Centro, Prato, Italy
| | - Maria Gabriella Caruso
- Research Hospital, National Institute of Gastroenterlogy, IRCCS De Bellis, Castellana Grotte, BA, Italy
| | - Maria Notarnicola
- Research Hospital, National Institute of Gastroenterlogy, IRCCS De Bellis, Castellana Grotte, BA, Italy
| | - Rosa Reddavide
- Research Hospital, National Institute of Gastroenterlogy, IRCCS De Bellis, Castellana Grotte, BA, Italy
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, SE5 8AZ, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Box SE5 8AF, London, UK.,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Marco Solmi
- Neuroscience Department, University of Padova, Padova, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Via Giustiniani, 2, 35128, Padova, Italy
| | - Alberto Vaona
- Primary Care Department, Azienda ULSS20 Verona, Verona, Italy
| | - Joseph Firth
- NICM Health Research Institute, University of Western Sydney, Penrith, Australia.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, 28029, Madrid, Spain.,Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 0883, Barcelona, Spain
| | - Ligia Dominguez
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
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Luchini C, Nottegar A, Vaona A, Stubbs B, Demurtas J, Maggi S, Veronese N. Female-specific association among I, J and K mitochondrial genetic haplogroups and cancer: A longitudinal cohort study. Cancer Genet 2018; 224-225:29-36. [PMID: 29778233 DOI: 10.1016/j.cancergen.2018.04.003] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/03/2018] [Indexed: 02/07/2023]
Abstract
Recent studies highlighted the role of mitochondrial dysregulation in cancer, suggesting that the different mitochondrial haplogroups might play a role in tumorigenesis and risk of cancer development. Our aim is to investigate whether any mitochondrial haplogroups carried a significant higher risk of cancer development in a large prospective cohort of North American people. The haplogroup assignment was performed by a combination of sequencing and PCR-RFLP techniques. Our specific outcome of interest was the incidence of any cancer during follow-up period. Overall, 3222 participants were included in the analysis. Women having I, J, K haplogroup reported a significant higher incidence of cancer compared to people with other haplogroups (p < 0.0001), whilst in men non association was found. In the multivariate analysis, women having I, J, K mitochondrial haplogroup reported a 50% increased risk of cancer (HR = 1.50; 95%CI: 1.04-2.16; p = 0.03). This gender-linked association may be partly explained by the role of mitochondrial function in female-specific (e.g. BRCA-driven) oncogenesis, but further studies are needed to better understand this potential correlation. Our findings may have important implications for cancer epidemiology and prevention.
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Affiliation(s)
- Claudio Luchini
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Piazzale Scuro, 10, 37134 Verona, Italy.
| | - Alessia Nottegar
- Department of Surgery, Section of Anatomical Pathology, San Bortolo Hospital, Vicenza, Italy
| | - Alberto Vaona
- Primary Care Department, Azienda ULSS20 Verona, Verona, Italy
| | - Brendon Stubbs
- South London and Maudsley NHS FoundationTrust, Denmark Hill, London SE5 8AZ, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8 AF, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Jacopo Demurtas
- Primary Care Department, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy; Institute for clinical Research and Education in Medicine (IREM), Padova, Italy
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Abstract
BACKGROUND The use of e-learning, defined as any educational intervention mediated electronically via the Internet, has steadily increased among health professionals worldwide. Several studies have attempted to measure the effects of e-learning in medical practice, which has often been associated with large positive effects when compared to no intervention and with small positive effects when compared with traditional learning (without access to e-learning). However, results are not conclusive. OBJECTIVES To assess the effects of e-learning programmes versus traditional learning in licensed health professionals for improving patient outcomes or health professionals' behaviours, skills and knowledge. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other databases and three trial registers up to July 2016, without any restrictions based on language or status of publication. We examined the reference lists of the included studies and other relevant reviews. If necessary, we contacted the study authors to collect additional information on studies. SELECTION CRITERIA Randomised trials assessing the effectiveness of e-learning versus traditional learning for health professionals. We excluded non-randomised trials and trials involving undergraduate health professionals. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data and assessed risk of bias. We graded the certainty of evidence for each outcome using the GRADE approach and standardised the outcome effects using relative risks (risk ratio (RR) or odds ratio (OR)) or standardised mean difference (SMD) when possible. MAIN RESULTS We included 16 randomised trials involving 5679 licensed health professionals (4759 mixed health professionals, 587 nurses, 300 doctors and 33 childcare health consultants).When compared with traditional learning at 12-month follow-up, low-certainty evidence suggests that e-learning may make little or no difference for the following patient outcomes: the proportion of patients with low-density lipoprotein (LDL) cholesterol of less than 100 mg/dL (adjusted difference 4.0%, 95% confidence interval (CI) -0.3 to 7.9, N = 6399 patients, 1 study) and the proportion with glycated haemoglobin level of less than 8% (adjusted difference 4.6%, 95% CI -1.5 to 9.8, 3114 patients, 1 study). At 3- to 12-month follow-up, low-certainty evidence indicates that e-learning may make little or no difference on the following behaviours in health professionals: screening for dyslipidaemia (OR 0.90, 95% CI 0.77 to 1.06, 6027 patients, 2 studies) and treatment for dyslipidaemia (OR 1.15, 95% CI 0.89 to 1.48, 5491 patients, 2 studies). It is uncertain whether e-learning improves or reduces health professionals' skills (2912 health professionals; 6 studies; very low-certainty evidence), and it may make little or no difference in health professionals' knowledge (3236 participants; 11 studies; low-certainty evidence).Due to the paucity of studies and data, we were unable to explore differences in effects across different subgroups. Owing to poor reporting, we were unable to collect sufficient information to complete a meaningful 'Risk of bias' assessment for most of the quality criteria. We evaluated the risk of bias as unclear for most studies, but we classified the largest trial as being at low risk of bias. Missing data represented a potential source of bias in several studies. AUTHORS' CONCLUSIONS When compared to traditional learning, e-learning may make little or no difference in patient outcomes or health professionals' behaviours, skills or knowledge. Even if e-learning could be more successful than traditional learning in particular medical education settings, general claims of it as inherently more effective than traditional learning may be misleading.
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Affiliation(s)
- Alberto Vaona
- Azienda ULSS 20 ‐ VeronaPrimary CareOspedale di MarzanaPiazzale Ruggero Lambranzi 1VeronaItaly37142
| | - Rita Banzi
- IRCCS ‐ Mario Negri Institute for Pharmacological ResearchLaboratory of Regulatory Policiesvia G La Masa 19MilanItaly20156
| | - Koren H Kwag
- IRCCS Galeazzi Orthopaedic InstituteClinical Epidemiology UnitVia R. Galeazzi, 4MilanItaly20161
| | - Giulio Rigon
- Azienda ULSS 20 ‐ VeronaPrimary CareOspedale di MarzanaPiazzale Ruggero Lambranzi 1VeronaItaly37142
| | | | - Valentina Pecoraro
- IRCCS ‐ Mario Negri Institute for Pharmacological ResearchLaboratory of Regulatory Policiesvia G La Masa 19MilanItaly20156
| | - Irene Tramacere
- Fondazione IRCCS Istituto Neurologico Carlo BestaDepartment of Research and Clinical Development, Scientific DirectorateVia Giovanni Celoria, 11MilanItaly20133
| | - Lorenzo Moja
- University of MilanDepartment of Biomedical Sciences for HealthVia Pascal 36MilanSwitzerland20133
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Demurtas J, Alba N, Rigon G, Nesoti MV, Bovo C, Vaona A. Epidemiological trends and direct costs of diabetes in a Northern Italy area: 2012 health administrative records analysis LHT n. 20 Verona. Prim Care Diabetes 2017; 11:570-576. [PMID: 28663023 DOI: 10.1016/j.pcd.2017.06.001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This analysis estimates type 1 and type 2 diabetes direct costs in 2012, in terms of hospital care, outpatient visits, diagnostics and medications, in a local healthcare trust in Northern Italy (ULSS n.20 Verona). METHODS The Johns Hopkins Adjusted Clinical Group (ACG®) System was used to analyze data, including hospital discharges, emergency room admissions, medical encounter records, disease registries, copayment exemptions, home care services, psychiatric services, rehabilitation services, and medications. Data from general practitioners and nursing homes were not directly available. Patients obtained from the first analysis were subsequently divided in two groups (type 1 and type 2 diabetes) according to ATC drug classification system and age. Costs were estimated from inpatient and outpatients fees and drugs costs. RESULTS ULSS n. 20 takes care of about 480.000 people. We identified 974 people affected by type 1 diabetes (prevalence 0,2%) and 24.087 people affected by type 2 diabetes (prevalence 5,0%) among the residents in 2012. Hospitalization mean annual cost was 4.753,50€ (SD 9.330,19€) for type 1 diabetes and 1.718,08€ (SD 5.087,34€) for type 2 diabetes. Outpatient care mean annual cost was 1.401,76€ (SD 4.394,88€) for type 1 diabetes and 669,15€ (SD 2.121,24€) for type 2 diabetes. Medications mean annual cost was 1,369,35€ (SD1.781,18€) for type 1 diabetes and 874,07€ (SD 2.832,2€) for type 2 diabetes. CONCLUSIONS ACG® diabetes data analysis agrees with data obtained by more expensive methods and seems to be a comprehensive and applicable tool to analyze chronic diseases dynamics in the Italian setting in order to prioritize future research and analyze the effects of interventions aimed to ensure the sustainability of public health services. Because of the combination between prevalence data and epidemiological trends, we could be at the eve of a dramatic increase of diabetes costs with major concerns for the Italian NHS ability to withstand.
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MESH Headings
- Administrative Claims, Healthcare
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Ambulatory Care/economics
- Ambulatory Care/trends
- Child
- Child, Preschool
- Databases, Factual
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/economics
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/therapy
- Drug Costs/trends
- Female
- Health Care Costs/trends
- Health Services Needs and Demand/economics
- Health Services Needs and Demand/trends
- Health Services Research
- Hospital Costs/trends
- Humans
- Hypoglycemic Agents/economics
- Hypoglycemic Agents/therapeutic use
- Infant
- Infant, Newborn
- Italy/epidemiology
- Male
- Middle Aged
- Models, Economic
- Needs Assessment/economics
- Needs Assessment/trends
- Prevalence
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- J Demurtas
- Primary Care Department, LHT South-East Tuscany, Grosseto, Italy
| | - N Alba
- Management Control Unit, Azienda ULSS20 Verona, Via della Valverde 42, 37122 Verona, Italy
| | - G Rigon
- Primary Care Department, Azienda ULSS20 Verona, Via della Valverde 42, 37122 Verona, Italy.
| | - M V Nesoti
- Medical Direction Unit Azienda Ospedaliera di Verona, Via della Valverde 42, 37122 Verona, Italy
| | - C Bovo
- Azienda Ospedaliero-Universitaria di Verona, Italy
| | - A Vaona
- Primary Care Department, Azienda ULSS20 Verona, Via della Valverde 42, 37122 Verona, Italy
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Vaona A, Del Zotti F, Girotto S, Marafetti C, Rigon G, Marcon A. Data collection of patients with diabetes in family medicine: a study in north-eastern Italy. BMC Health Serv Res 2017; 17:565. [PMID: 28814303 PMCID: PMC5559811 DOI: 10.1186/s12913-017-2508-5] [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: 05/11/2017] [Accepted: 08/04/2017] [Indexed: 12/25/2022] Open
Abstract
Background Studies on data collection and quality of care in Italian family medicine are lacking. The aim of this study was to assess the completeness of data collection of patients with diabetes in a large sample of family physicians in the province of Verona, Veneto region, a benchmark for the Italian National Health System. Methods We extracted the data on all the patients with diabetes from the electronic health records of 270 family physicians in 2006 and 2009. We reported the percentage of patients with data recorded for 12 indicators of performance derived from the National Institute for Clinical Excellence diabetes guidelines. Secondarily, we assessed quality of care using the Q-score (the lower the score, the greater the risk of cardiovascular events). Results Patients with diabetes were 18,507 in 2006 and 20,744 in 2009, and the percentage of patients registered as having diabetes was 4.9% and 5.4% of the total population, respectively (p < 0.001). Data collection improved for all the indicators between 2006 and 2009 but the performance was still low at the end of the study period: patients with no data recorded were 42% in 2006 and 32% in 2009, while patients with data recorded for ≥5 indicators were 9% in 2006 and 17% in 2009. The Q-score improved (mean ± SD, 20.7 ± 3.0 in 2006 vs 21.3 ± 3.6 in 2009, p < 0.001) but most patients were at increased risk of cardiovascular events in both years (Q-score ≤ 20). Conclusions We documented an improvement in data collection and quality of care for patients with diabetes during the study period. Nonetheless, data collection was still unsatisfactory in comparison with international benchmarks in 2009. Structural interventions in the organization of family medicine, which have not been implemented since the study period, should be prioritised in Italy. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2508-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alberto Vaona
- Federazione Italiana Medici di Medicina Generale (FIMMG), Centro Studi FIMMG Verona, Verona, Italy
| | - Franco Del Zotti
- Federazione Italiana Medici di Medicina Generale (FIMMG), Centro Studi FIMMG Verona, Verona, Italy
| | - Sandro Girotto
- Federazione Italiana Medici di Medicina Generale (FIMMG), Centro Studi FIMMG Verona, Verona, Italy
| | - Claudio Marafetti
- Federazione Italiana Medici di Medicina Generale (FIMMG), Centro Studi FIMMG Verona, Verona, Italy
| | - Giulio Rigon
- Federazione Italiana Medici di Medicina Generale (FIMMG), Centro Studi FIMMG Verona, Verona, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134, Verona, Italy.
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Veronese N, Stubbs B, Solmi M, Vaona A, Demurtas J, Carvalho AF, Koyanagi A, Thompson T, Zoratti M, Maggi S. Mitochondrial genetic haplogroups and depressive symptoms: A large study among people in North America. J Affect Disord 2017; 217:55-59. [PMID: 28391108 PMCID: PMC5482362 DOI: 10.1016/j.jad.2017.03.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Received: 01/28/2017] [Revised: 03/24/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND A possible relationship between mitochondrial haplogroups and psychiatric diseases (e.g. schizophrenia and bipolar disorder) has been postulated, but data regarding depression is still limited. We investigated whether any mitochondrial haplogroup carried a significant higher risk of depressive symptoms in a large prospective cohort of North American people included in the Osteoarthritis Initiative. METHODS Cross sectional data was derived from the Osteoarthritis Initiative. The haplogroup was assigned through a combination of sequencing and PCR-RFLP techniques. All the mitochondrial haplogroups were named following this nomenclature: H, U, K, J, T, V, SuperHV, I, W, X or Others. Depression was ascertained through the 20-item Center for Epidemiologic Studies-Depression (CES-D), with ≥16 indicating depressive symptoms. RESULTS Overall, 3601 Caucasian participants (55.9% women), mean age of 61.7±9.3 years were included. No difference was observed in mitochondrial haplogroups frequency among those with depressive symptoms (n=285, =7.9% of the baseline population) compared to participants with no depressive symptoms (N=3316) (chi-square test=0.53). Using a logistic regression analysis, adjusted for eight potential confounders, with those having the haplogroup H as the reference group (the most common haplogroup), no significant mitochondrial haplogroup was associated with prevalent depressive symptoms. The same results were evident in secondary analysis in which we matched depressed and non-depressed participants for age and sex. LIMITATIONS Cross-sectional design; only CES-D for evaluating mood; participants not totally representative of general population. CONCLUSIONS We found no evidence of any relationship between specific mitochondrial haplogroups and depressive symptoms. Future longitudinal research is required to confirm/ refute these findings.
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Affiliation(s)
- Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy; Institute for clinical Research and Education in Medicine (IREM), Padova, Italy.
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom,Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8 AF, United Kingdom,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Marco Solmi
- Institute for clinical Research and Education in Medicine (IREM), Padova, Italy,Department of Neurosciences, University of Padova, Padova, Italy
| | - Alberto Vaona
- Primary Care Department, Azienda ULSS20 Verona, Verona, Italy
| | - Jacopo Demurtas
- Primary Care Department, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - Andre F. Carvalho
- Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain
| | - Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - Mario Zoratti
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy,Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
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11
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Veronese N, Stubbs B, Noale M, Solmi M, Vaona A, Demurtas J, Nicetto D, Crepaldi G, Schofield P, Koyanagi A, Maggi S, Fontana L. Fried potato consumption is associated with elevated mortality: an 8-y longitudinal cohort study. Am J Clin Nutr 2017; 106:162-167. [PMID: 28592612 PMCID: PMC5486204 DOI: 10.3945/ajcn.117.154872] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 02/12/2017] [Accepted: 04/20/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Few studies have assessed the association between potato consumption and mortality.Objective: We investigated whether potato consumption (including fried and unfried potatoes) is associated with increased premature mortality risk in a North American cohort.Design: A longitudinal analysis included 4440 participants aged 45-79 y at baseline with an 8-y follow-up from the Osteoarthritis Initiative cohort study. Potato consumption (including fried and unfried potatoes) was analyzed by using a Block Brief 2000 food-frequency questionnaire and categorized as ≤1 time/mo, 2-3 times/mo, 1 time/wk, 2 times/wk, or ≥3 times/wk. Mortality was ascertained through validated cases of death. To investigate the association between potato consumption and mortality, Cox regression models were constructed to estimate HRs with 95% CIs, with adjustment for potential confounders.Results: Of the 4400 participants, 2551 (57.9%) were women with a mean ± SD age of 61.3 ± 9.2 y. During the 8-y follow-up, 236 participants died. After adjustment for 14 potential baseline confounders, and taking those with the lowest consumption of potatoes as the reference group, participants with the highest consumption of potatoes did not show an increased risk of overall mortality (HR: 1.11; 95% CI: 0.65, 1.91). However, subgroup analyses indicated that participants who consumed fried potatoes 2-3 times/wk (HR: 1.95; 95% CI: 1.11, 3.41) and ≥3 times/wk (HR: 2.26; 95% CI: 1.15, 4.47) were at an increased risk of mortality. The consumption of unfried potatoes was not associated with an increased mortality risk.Conclusions: The frequent consumption of fried potatoes appears to be associated with an increased mortality risk. Additional studies in larger sample sizes should be performed to confirm if overall potato consumption is associated with higher mortality risk. This trial was registered at clinicaltrials.gov as NCT00080171.
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Affiliation(s)
- Nicola Veronese
- National Research Council, Aging Branch, Neuroscience Institute, Padua, Italy;,Institute for Clinical Research and Education in Medicine, Padua, Italy
| | - Brendon Stubbs
- Physiotherapy Department, South London;,Maudsley NHS Foundation Trust, London, United Kingdom;,Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom;,Faculty of Health, Social Care, and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Marianna Noale
- National Research Council, Aging Branch, Neuroscience Institute, Padua, Italy
| | - Marco Solmi
- Institute for Clinical Research and Education in Medicine, Padua, Italy; .,Department of Neurosciences, University of Padua, Padua, Italy
| | - Alberto Vaona
- Primary Care Department, Azienda Local Health Unit (ULSS) 20 Verona, Verona, Italy
| | - Jacopo Demurtas
- Primary Care Department, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - Davide Nicetto
- Local Health Services Unit, Azienda Social and Health Unit (APSS) Trento, Trento, Italy
| | - Gaetano Crepaldi
- National Research Council, Aging Branch, Neuroscience Institute, Padua, Italy
| | - Patricia Schofield
- Faculty of Health, Social Care, and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain
| | - Stefania Maggi
- National Research Council, Aging Branch, Neuroscience Institute, Padua, Italy
| | - Luigi Fontana
- Department of Clinical and Experimental Sciences, Brescia University Medical School, Brescia, Italy; .,CEINGE Biotecnologie Avanzate, Naples, Italy; and.,Division of Geriatrics and Nutritional Science, Washington University, St. Louis, MO
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12
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Veronese N, Stubbs B, Noale M, Solmi M, Pilotto A, Vaona A, Demurtas J, Mueller C, Huntley J, Crepaldi G, Maggi S. Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study. J Am Med Dir Assoc 2017; 18:624-628. [PMID: 28396180 PMCID: PMC5484754 DOI: 10.1016/j.jamda.2017.02.009] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate whether polypharmacy is associated with a higher incidence of frailty in a large cohort of North Americans during 8 years of follow-up. DESIGN Longitudinal study, follow-up of 8 years. PARTICIPANTS A total of 4402 individuals at high risk or having knee osteoarthritis free from frailty at baseline. MEASUREMENTS Details regarding medication prescription were captured and categorized as 0-3, 4-6, and ≥7. Frailty was defined using the Study of Osteoporotic Fracture index as the presence of ≥2 out of (1) weight loss ≥5% between baseline and the subsequent follow-up visit; (2) inability to do 5 chair stands; and (3) low energy level according to the Study of Osteoporotic Fracture definition. Cox's regression models calculating a hazard ratio (HR) with 95% confidence intervals (CIs), adjusted for potential confounders, were undertaken. RESULTS During the 8-year follow-up, from 4402 participants at baseline, 361 became frail. Compared with participants taking 0-3 medications, the incidence of frailty was approximately double in those taking 4-6 medications and 6 times higher in people taking ≥7 medications. After adjusting for 11 potential baseline confounders, participants using 4-6 medications had a higher risk of frailty of 55% (HR = 1.55; 95% CI 1.22-1.96; P < .0001), whereas those using more than 7 drugs were at approximately 147% (HR = 2.47; 95% CI 1.78-3.43; P < .0001). Each additional drug used at the baseline increased the risk of frailty at the follow-up of 11% (HR = 1.11; 95% CI 1.07-1.15; P < .0001). CONCLUSIONS Polypharmacy is associated with a higher incidence of frailty over 8-year follow-up period. Our data suggest evidence of a dose response relationship. Future research is required to confirm our findings and explore underlying mechanisms.
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Affiliation(s)
- Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy; Institute for clinical Research and Education in Medicine, IREM, Padua, Italy; Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy.
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Faculty of Health, Social care and Education, Anglia Ruskin University, Chelmsford, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King's College London, London, United Kingdom
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Marco Solmi
- Institute for clinical Research and Education in Medicine, IREM, Padua, Italy; Department of Neurosciences, University of Padova, Padova, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Alberto Vaona
- Primary Care Department, Azienda ULSS20 Verona, Verona, Italy
| | - Jacopo Demurtas
- Primary Care Department, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - Christoph Mueller
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King's College London, London, United Kingdom
| | - Jonathan Huntley
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King's College London, London, United Kingdom
| | - Gaetano Crepaldi
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
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Abstract
BACKGROUND Since 1879, the year of the first documented medical telephone consultation, the ability to consult by telephone has become an integral part of modern patient-centred healthcare systems. Nowadays, upwards of a quarter of all care consultations are conducted by telephone. Studies have quantified the impact of medical telephone consultation on clinicians' workload and detected the need for quality improvement. While doctors routinely receive training in communication and consultation skills, this does not necessarily include the specificities of telephone communication and consultation. Several studies assessed the short-term effect of interventions aimed at improving clinicians' telephone consultation skills, but there is no systematic review reporting patient-oriented outcomes or outcomes of interest to clinicians. OBJECTIVES To assess the effects of training interventions for clinicians' telephone consultation skills and patient outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other electronic databases and two trial registers up to 19 May 2016, and we handsearched references, checked citations and contacted study authors to identify additional studies and data. SELECTION CRITERIA We considered randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted time series studies evaluating training interventions compared with any control intervention, including no intervention, for improving clinicians' telephone consultation skills with patients and their impact on patient outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias of eligible studies using standard Cochrane and EPOC guidance and the certainty of evidence using GRADE. We contacted study authors where additional information was needed. We used standard methodological procedures expected by Cochrane for data analysis. MAIN RESULTS We identified one very small controlled before-after study performed in 1989: this study used a validated tool to assess the effects of a training intervention on paediatric residents' history-taking and case management skills. It reported no difference compared to no intervention, but authors did not report any quantitative analyses and could not supply additional data. We rated this study as being at high risk of bias. Based on GRADE, we assessed the certainty of the evidence as very low, and consequently it is uncertain whether this intervention improves clinicians' telephone skills.We did not find any study assessing the effect of training interventions for improving clinicians' telephone communication skills on patient primary outcomes (health outcomes measured by validated tools or biomedical markers or patient behaviours, patient morbidity or mortality, patient satisfaction, urgency assessment accuracy or adverse events). AUTHORS' CONCLUSIONS Telephone consultation skills are part of a wider set of remote consulting skills whose importance is growing as more and more medical care is delivered from a distance with the support of information technology. Nevertheless, no evidence specifically coming from telephone consultation studies is available, and the training of clinicians at the moment has to be guided by studies and models based on face-to-face communication, which do not consider the differences between these two communicative dimensions. There is an urgent need for more research assessing the effect of different training interventions on clinicians' telephone consultation skills and their effect on patient outcomes.
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Affiliation(s)
- Alberto Vaona
- Azienda ULSS 20 ‐ VeronaPrimary CareOspedale di MarzanaPiazzale Ruggero Lambranzi 1VeronaItaly37142
| | - Yannis Pappas
- University of BedfordshireInstitute for Health ResearchPark SquareLutonBedfordUKLU1 3JU
| | - Rumant S Grewal
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthThe Reynolds Building, Charing Cross CampusSt Dunstans RoadLondonLondonUKW6 8RP
| | - Mubasshir Ajaz
- University of BedfordshireInstitute for Health ResearchPark SquareLutonBedfordUKLU1 3JU
| | - Azeem Majeed
- Imperial College LondonDepartment of Primary Care and Public HealthThe Reynolds Building, Charing Cross CampusSt Dunstan's RoadLondonUKW6 8RP
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #03‐08Nexus@one‐northSingaporeSingapore138543
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
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14
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La Mantia L, Di Pietrantonj C, Rovaris M, Rigon G, Frau S, Berardo F, Gandini A, Longobardi A, Weinstock‐Guttman B, Vaona A. Interferons-beta versus glatiramer acetate for relapsing-remitting multiple sclerosis. Cochrane Database Syst Rev 2016; 11:CD009333. [PMID: 27880972 PMCID: PMC6464642 DOI: 10.1002/14651858.cd009333.pub3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Interferons-beta (IFNs-beta) and glatiramer acetate (GA) were the first two disease-modifying therapies (DMTs) approved 20 years ago for the treatment of multiple sclerosis (MS). DMTs' prescription rates as first or switching therapies and their costs have both increased substantially over the past decade. As more DMTs become available, the choice of a specific DMT should reflect the risk/benefit profile, as well as the impact on quality of life. As MS cohorts enrolled in different studies can vary significantly, head-to-head trials are considered the best approach for gaining objective reliable data when two different drugs are compared. The purpose of this systematic review is to summarise available evidence on the comparative effectiveness of IFNs-beta and GA on disease course through the analysis of head-to-head trials.This is an update of the Cochrane review 'Interferons-beta versus glatiramer acetate for relapsing-remitting multiple sclerosis' (first published in the Cochrane Library 2014, Issue 7). OBJECTIVES To assess whether IFNs-beta and GA differ in terms of safety and efficacy in the treatment of people with relapsing-remitting (RR) MS. SEARCH METHODS We searched the Trials Register of the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group (08 August 2016) and the reference lists of retrieved articles. We contacted authors and pharmaceutical companies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing directly IFNs-beta versus GA in study participants affected by RRMS. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. MAIN RESULTS Six trials were included and five trials contributed to this review with data. A total of 2904 participants were randomly assigned to IFNs (1704) and GA (1200). The treatment duration was three years for one study, two years for the other four RCTs while one study was stopped early (after one year). The IFNs analysed in comparison with GA were IFN-beta 1b 250 mcg (two trials, 933 participants), IFN-beta 1a 44 mcg (three trials, 466 participants) and IFN-beta 1a 30 mcg (two trials, 305 participants). Enrolled participants were affected by active RRMS. All studies were at high risk for attrition bias. Three trials are still ongoing, one of them completed.Both therapies showed similar clinical efficacy at 24 months, given the primary outcome variables (number of participants with relapse (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.87 to 1.24) or progression (RR 1.11, 95% CI 0.91 to 1.35). However at 36 months, evidence from a single study suggests that relapse rates were higher in the group given IFNs than in the GA group (RR 1.40, 95% CI 1.13 to 1.74, P value 0.002).Secondary magnetic resonance imaging (MRI) outcomes analysis showed that effects on new or enlarging T2- or new contrast-enhancing T1 lesions at 24 months were similar (mean difference (MD) -0.15, 95% CI -0.68 to 0.39, and MD -0.14, 95% CI -0.30 to 0.02, respectively). However, the reduction in T2- and T1-weighted lesion volume was significantly greater in the groups given IFNs than in the GA groups (MD -0.58, 95% CI -0.99 to -0.18, P value 0.004, and MD -0.20, 95% CI -0.33 to -0.07, P value 0.003, respectively).The number of participants who dropped out of the study because of adverse events was similar in the two groups (RR 0.95, 95% CI 0.64 to 1.40).The quality of evidence for primary outcomes was judged as moderate for clinical end points, but for safety and some MRI outcomes (number of active T2 lesions), quality was judged as low. AUTHORS' CONCLUSIONS The effects of IFNs-beta and GA in the treatment of people with RRMS, including clinical (e.g. people with relapse, risk to progression) and MRI (Gd-enhancing lesions) measures, seem to be similar or to show only small differences. When MRI lesion load accrual is considered, the effect of the two treatments differs, in that IFNs-beta were found to limit the increase in lesion burden as compared with GA. Evidence was insufficient for a comparison of the effects of the two treatments on patient-reported outcomes, such as quality-of-life measures.
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Affiliation(s)
- Loredana La Mantia
- I.R.C.C.S. Santa Maria Nascente ‐ Fondazione Don GnocchiUnit of Neurorehabilitation ‐ Multiple Sclerosis CenterVia Capecelatro, 66MilanoItaly20148
| | - Carlo Di Pietrantonj
- Local Health Unit Alessandria‐ ASL ALRegional Epidemiology Unit SeREMIVia Venezia 6AlessandriaAlessandriaItaly15121
| | - Marco Rovaris
- I.R.C.C.S. Santa Maria Nascente ‐ Fondazione Don GnocchiUnit of Neurorehabilitation ‐ Multiple Sclerosis CenterVia Capecelatro, 66MilanoItaly20148
| | - Giulio Rigon
- Azienda ULSS 20 ‐ VeronaPrimary CareVia Vivaldi, 11VeronaItaly37138
| | | | - Francesco Berardo
- Azienda Ospedaliera di Verona ‐ Department of PharmacyDrug Efficacy Evaluation Unit (UVEF) ‐ Veneto Regional Drug Information CenterPiazzale Stefani 1VeronaItaly37126
| | - Anna Gandini
- Azienda ULSS 21 ‐ LegnagoRegional Health ServiceVia Gianella 1LegnagoVareseItaly37045
| | - Anna Longobardi
- Azienda ULSS 20 ‐ VeronaPrimary CareVia Vivaldi, 11VeronaItaly37138
| | - Bianca Weinstock‐Guttman
- SUNY University of BuffaloDirector, Jacobs MS Center and Pediatric MS Center of Excellence100 High StreetBuffaloNew YorkUSA14203
| | - Alberto Vaona
- Azienda ULSS 20 ‐ VeronaPrimary CareVia Vivaldi, 11VeronaItaly37138
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Marcon A, Vaona A, Rigon G, Carazzolo M, Del Zotti F, Girotto S, Marafetti C. [Assessment of a project for integrated management of care given to patients with type-2 diabetes in the Local Health Authority 21 of Legnago (Veneto Region, Northern Italy) in the period 2010-2012]. Epidemiol Prev 2016; 40:344-354. [PMID: 27764931 DOI: 10.19191/ep16.5.p344.109] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBIETTIVI: descrivere, nella ASL 21 di Legnago (VR), l'andamento di alcuni indicatori sanitari tra il 2009, anno precedente all'avvio di un progetto triennale per la gestione integrata dell'assistenza al paziente con diabete mellito di tipo 2, e il 2012, ultimo anno del progetto. DISEGNO: studio longitudinale trasversale ripetuto. SETTING E PARTECIPANTI: tutti i pazienti diabetici di tipo 2 della ASL 21, identificati nei database aziendali (in base a esenzioni per patologia, accessi al servizio diabetologico, consumo di farmaci antidiabetici e strisce per la determinazione della glicemia) e nelle cartelle cliniche dei medici di famiglia. PRINCIPALI MISURE DI OUTCOME: numero di test diagnostici e di follow-up erogati, consumo di farmaci, prestazioni specialistiche, accessi al pronto soccorso, ricoveri e mortalità. RISULTATI: nonostante un calo generalizzato (-3,1%) nei test erogati dalla ASL 21 ai suoi assistititi nel periodo 2009-2012, l'analisi ha documentato un marcato aumento per gli esami previsti nella gestione del diabete, quali curve da carico glicemico (+104,3%), emoglobina glicata (+19,0%) e microalbuminuria (+296,1%). I soggetti identificati come diabetici sono aumentati da 8.084 nel 2009 (5,2%) a 9.221 nel 2012 (5,9%). Sono stati osservati aumenti nella prevalenza di pazienti visitati presso un servizio diabetologico (dal 22,6% al 39,0%), nonché negli utilizzatori di metformina (dal 28,0% al 37,5%), insuline (dal 13,5% al 18,3%) e incretine (dall'1,4% al 9,0%). Il consumo di sulfaniluree è, invece, calato (dal 49,9% al 40,8%), come anche l'erogazione di alcune prestazioni specialistiche, gli accessi al pronto soccorso e i ricoveri, mentre il tasso di mortalità è rimasto stabile (29,6 decessi x1.000/anno). CONCLUSIONE: durante il periodo di implementazione del progetto sembra essersi verificato un aumento della sensibilità diagnostica e una maggiore presa in carico del paziente diabetico. Anche se la natura osservazionale dello studio non consente di dimostrare una relazione causa-effetto, i risultati sembrano supportare l'ipotesi che la gestione integrata della patologia migliori l'appropriatezza dell'assistenza.
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Affiliation(s)
- Alessandro Marcon
- Sezione di epidemiologia e statistica medica, Dipartimento di diagnostica e sanità pubblica, Università di Verona.
| | - Alberto Vaona
- Centro studi Federazione italiana medici di medicina generale, Verona
| | - Giulio Rigon
- Centro studi Federazione italiana medici di medicina generale, Verona
| | - Marco Carazzolo
- Ufficio informatico, Azienda sanitaria locale 21, Legnago (VR)
| | - Franco Del Zotti
- Centro studi Federazione italiana medici di medicina generale, Verona
| | - Sandro Girotto
- Centro studi Federazione italiana medici di medicina generale, Verona
| | - Claudio Marafetti
- Centro studi Federazione italiana medici di medicina generale, Verona
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La Mantia L, Di Pietrantonj C, Rovaris M, Rigon G, Frau S, Berardo F, Gandini A, Longobardi A, Weinstock-Guttman B, Vaona A. Comparative efficacy of interferon β versus glatiramer acetate for relapsing-remitting multiple sclerosis. J Neurol Neurosurg Psychiatry 2015; 86:1016-20. [PMID: 25550414 DOI: 10.1136/jnnp-2014-309243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/25/2014] [Indexed: 11/04/2022]
Abstract
Interferon β (INFβ) and glatiramer acetate (GA) are widely used in patients with relapsing-remitting multiple sclerosis (RRMS). However, it is still unclear whether they have different efficacy. We performed a systematic search of head-to-head trials for gaining objective reliable data to compare the two drugs, using the Cochrane Collaboration methodology. We identified five randomised-controlled trials (RCTs) (2858 participants) comparing directly INFβ versus GA in RRMS. All studies were at high risk for attrition bias. Both therapies showed similar efficacy at 24 months, considering clinical (patients with relapse or progression) and one MRI activity (enhancing lesions) measure. At 3 years, evidence from a single study showed that the relapse rate was higher in the INFβ group than in the GA group (risk ratio 1.40, 95% CI 1.13 to 1.74, p 0.002). However, the average reduction in T2-weighted and T1-weighted lesion volume was significantly greater in the INFβ group than in the GA group (mean difference (MD) -0.58, 95% CI -0.99 to -0.18, p 0.004, and MD -0.20, 95% CI -0.33 to -0.07, p 0.003, respectively). The number of participants who dropped out of the studies because of adverse events was similar in the two groups. These data support clinicians in the use of these therapies, based on their similar safety and efficacy in the prevention of disease activity, although the different effect on MRI measures and the different tolerability might have a role in the therapeutic choice at the individual level.
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Affiliation(s)
- Loredana La Mantia
- Unit of Neurorehabilitation-Multiple Sclerosis Center, IRCCS Santa Maria Nascente-Fondazione Don Gnocchi, Milano, Italy Department of Neurosciences-Multiple Sclerosis Centre, AO Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Carlo Di Pietrantonj
- Regional Epidemiology Unit SeREMI- CochraneVaccines Field, Local Health Unit Alessandria-ASL AL, Alessandria, Italy
| | - Marco Rovaris
- Unit of Neurorehabilitation-Multiple Sclerosis Center, IRCCS Santa Maria Nascente-Fondazione Don Gnocchi, Milano, Italy
| | - Giulio Rigon
- Primary Care, Azienda ULSS 20 Verona, Verona, Italy
| | | | - Francesco Berardo
- Drug Efficacy Evaluation Unit (UVEF)-Veneto Regional Drug Information Center, Azienda Opsedaliera di Verona-Department of Pharmacy, Verona, Italy
| | - Anna Gandini
- Regional Health Service, Azienda ULSS 21-Legnago, Legnago, Italy
| | | | - Bianca Weinstock-Guttman
- Director Jacobs MS Center and Pediatric MS Center of Excellence, SUNY University of Buffalo, Buffalo, New York, USA
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Affiliation(s)
- Alberto Vaona
- Azienda ULSS 20 - Verona; Primary Care; Ospedale di Marzana Piazzale Ruggero Lambranzi 1 Verona Italy 37142
| | - Giulio Rigon
- Azienda ULSS 20 - Verona; Primary Care; Ospedale di Marzana Piazzale Ruggero Lambranzi 1 Verona Italy 37142
| | - Rita Banzi
- IRCCS - Mario Negri Institute for Pharmacological Research; Laboratory of Regulatory Policies; via G La Masa 19 Milan Italy 20156
| | - Koren H Kwag
- IRCCS Galeazzi Orthopaedic Institute; Clinical Epidemiology Unit; Via R. Galeazzi, 4 Milan Italy 20161
| | - Danilo Cereda
- University of Milan; Department of Public Health; Milan Italy
| | - Valentina Pecoraro
- IRCCS - Mario Negri Institute for Pharmacological Research; Laboratory of Regulatory Policies; via G La Masa 19 Milan Italy 20156
| | - Lorenzo Moja
- University of Milan; Department of Biomedical Sciences for Health; Via Pascal 36 Milan Italy 20133
| | - Stefanos Bonovas
- University of Milan; Department of Biomedical Sciences for Health; Via Pascal 36 Milan Italy 20133
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Abstract
We evaluated the quality of telephone triage and the appropriateness of the decisions resulting from it at a primary care out-of-hours service. Four simulated clinical cases were used in the Incognito Standardized Patient method: an adult with nosebleed, an adult with fever, a child with fever and a child with vomiting. There was a set of obligatory questions for each case, translated from those used in a previous study. Quality was assessed by the proportion of questions asked by the call-handlers during telephone triage versus those that should have been asked. A total of 22 out-of-hours doctors were involved in the study, working in two different locations in the Verona city area. Over a 4-month period each of the four simulated clinical cases was used five times in calls to the two centres involved. The proportion of obligatory questions asked compared to those expected to be asked was 27-36%. On three occasions out of the 40 simulations, all of which were considered to be manageable by telephone, the patient was advised to go to an outpatient clinic for a face-to-face evaluation. The average duration of the calls was 3 min 47 s. The quality of telephone triage in the regions studied was low and provided considerable room for improvement. This is relevant to patient safety and risk management of the service.
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Affiliation(s)
- Alberto Pasini
- Primary Care Department, Azienda ULSS 22, Villafranca, Italy
| | - Giulio Rigon
- Primary Care Department, Azienda ULSS 20, Verona, Italy
| | - Alberto Vaona
- Primary Care Department, Azienda ULSS 20, Verona, Italy
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Moja L, Kwag KH, Lytras T, Bertizzolo L, Brandt L, Pecoraro V, Rigon G, Vaona A, Ruggiero F, Mangia M, Iorio A, Kunnamo I, Bonovas S. Effectiveness of computerized decision support systems linked to electronic health records: a systematic review and meta-analysis. Am J Public Health 2014; 104:e12-22. [PMID: 25322302 DOI: 10.2105/ajph.2014.302164] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We systematically reviewed randomized controlled trials (RCTs) assessing the effectiveness of computerized decision support systems (CDSSs) featuring rule- or algorithm-based software integrated with electronic health records (EHRs) and evidence-based knowledge. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects. Information on system design, capabilities, acquisition, implementation context, and effects on mortality, morbidity, and economic outcomes were extracted. Twenty-eight RCTs were included. CDSS use did not affect mortality (16 trials, 37395 patients; 2282 deaths; risk ratio [RR] = 0.96; 95% confidence interval [CI] = 0.85, 1.08; I(2) = 41%). A statistically significant effect was evident in the prevention of morbidity, any disease (9 RCTs; 13868 patients; RR = 0.82; 95% CI = 0.68, 0.99; I(2) = 64%), but selective outcome reporting or publication bias cannot be excluded. We observed differences for costs and health service utilization, although these were often small in magnitude. Across clinical settings, new generation CDSSs integrated with EHRs do not affect mortality and might moderately improve morbidity outcomes.
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Affiliation(s)
- Lorenzo Moja
- Lorenzo Moja is with the Department of Biomedical Sciences for Health, University of Milan, and the Unit of Clinical Epidemiology, IRCCS Orthopedic Institute Galeazzi, Milan, Italy. Koren H. Kwag is with the Unit of Clinical Epidemiology, IRCCS Orthopedic Institute Galeazzi, Milan. Theodore Lytras is with the Department of Epidemiological Surveillance and Intervention, Hellenic Centre for Disease Control and Prevention, Athens, Greece, the Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain, and the Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona. Lorenzo Bertizzolo and Francesca Ruggiero are with the Department of Biomedical Sciences for Health, University of Milan. Linn Brandt is with the Department of Internal Medicine, Inland Hospital Trust, Oslo, Norway, the Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, and HELSAM, University of Oslo. Valentina Pecoraro is with the University of Milan. Giulio Rigon and Alberto Vaona are with Azienda ULSS 20, Verona, Italy. Massimo Mangia is with Medilogy SRL, Milan. Alfonso Iorio is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario. Ilkka Kunnamo is with Duodecim Medical Publications Ltd, Helsinki, Finland. Stefanos Bonovas is with the Laboratory of Drug Regulatory Policies, IRCCS Mario Negri Institute for Pharmacological Research, Milan, and the Department of Pharmacology, School of Medicine, University of Athens, Athens
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20
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Moja L, Liberati EG, Galuppo L, Gorli M, Maraldi M, Nanni O, Rigon G, Ruggieri P, Ruggiero F, Scaratti G, Vaona A, Kwag KH. Barriers and facilitators to the uptake of computerized clinical decision support systems in specialty hospitals: protocol for a qualitative cross-sectional study. Implement Sci 2014; 9:105. [PMID: 25163794 PMCID: PMC4159504 DOI: 10.1186/s13012-014-0105-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/06/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Computerized clinical decision support systems (CDSSs) have been shown to improve the efficiency and quality of patient care by connecting healthcare professionals with high quality, evidence-based information at the point-of-care. The mere provision of CDSSs, however, does not guarantee their uptake. Rather, individual and institutional perceptions can foster or inhibit the integration of CDSSs into routine clinical workflow. Current studies exploring health professionals' perceptions of CDSSs focus primarily on technical and usability issues, overlooking the social or cultural variables as well as broader administrative or organizational roles that may influence CDSS adoption. Moreover, there is a lack of data on the evolution of perceived barriers or facilitators to CDSS uptake across different stages of implementation. METHODS We will conduct a qualitative, cross-sectional study in three Italian specialty hospitals involving frontline physicians, nurses, information technology staff, and members of the hospital board of directors. We will use semi-structured interviews following the Grounded Theory framework, progressively recruiting participants until no new information is gained from the interviews. DISCUSSION CDSSs are likely to become an integral and diffuse part of clinical practice. Various factors must be considered when planning their introduction in healthcare settings. The findings of this study will guide the development of strategies to facilitate the successful integration of CDSSs into the regular clinical workflow. The evaluation of diverse health professionals across multiple hospital settings in different stages of CDSS uptake will better capture the complexity of roles and contextual factors affecting CDSS uptake.
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Affiliation(s)
- Lorenzo Moja
- />Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, Milan, 20133 Italy
- />Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, Milan, 20161 Italy
| | - Elisa Giulia Liberati
- />Dipartimento di Psicologia, Università Cattolica del Sacro Cuore di Milano, L.go Gemelli 1, Milan, 20123 Italy
| | - Laura Galuppo
- />Dipartimento di Psicologia, Università Cattolica del Sacro Cuore di Milano, L.go Gemelli 1, Milan, 20123 Italy
| | - Mara Gorli
- />Dipartimento di Psicologia, Università Cattolica del Sacro Cuore di Milano, L.go Gemelli 1, Milan, 20123 Italy
| | - Marco Maraldi
- />Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via G.C.Pupilli 1, Bologna, 40136 Italy
| | - Oriana Nanni
- />IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Via Piero Maroncelli 40, Meldola, 47014 FC Italy
| | - Giulio Rigon
- />Azienda ULSS 20, P.le Lambranzi 1, Verona, 37034 Italy
| | - Pietro Ruggieri
- />Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via G.C.Pupilli 1, Bologna, 40136 Italy
| | - Francesca Ruggiero
- />Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, Milan, 20133 Italy
| | - Giuseppe Scaratti
- />Dipartimento di Psicologia, Università Cattolica del Sacro Cuore di Milano, L.go Gemelli 1, Milan, 20123 Italy
| | - Alberto Vaona
- />Azienda ULSS 20, P.le Lambranzi 1, Verona, 37034 Italy
| | - Koren Hyogene Kwag
- />Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, Milan, 20161 Italy
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La Mantia L, Di Pietrantonj C, Rovaris M, Rigon G, Frau S, Berardo F, Gandini A, Longobardi A, Weinstock-Guttman B, Vaona A. Interferons-beta versus glatiramer acetate for relapsing-remitting multiple sclerosis. Cochrane Database Syst Rev 2014:CD009333. [PMID: 25062935 DOI: 10.1002/14651858.cd009333.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Interferons (IFNs)-beta and glatiramer acetate (GA) were the first two disease-modifying therapies (DMTs) approved 15 years ago for the treatment of multiple sclerosis (MS). DMTs prescription rates as first or switching therapies and their costs have increased substantially over the past decade. As more DMTs become available, the choice of a specific DMT should reflect the risk/benefit profile, as well as the impact on quality profile. As MS cohorts enrolled in different studies can vary significantly, head-to-head trials are considered the best approach for gaining objective reliable data when two different drugs are compared. The purpose of this study is to summarise available evidence on the comparative effectiveness of IFNs-beta and GA on disease course through a systematic review of head-to-head trials. OBJECTIVES To assess whether IFNs-beta and GA differ in terms of safety and efficacy in the treatment of patients with relapsing-remitting MS (RRMS). SEARCH METHODS We searched the Trials Specialised Register of the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group (29 October 2013) and the reference lists of retrieved articles. We contacted trialists and pharmaceutical companies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing directly IFNs-beta versus GA in study participants affected by RRMS. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by The Cochrane Collaboration. MAIN RESULTS Five trials contributed to this review. A total of 2858 participants were randomly assigned to IFNs (1679) and GA (1179). The treatment duration was three years for one study and two years for the other four RCTs. The IFNs analysed in comparison with GA were IFN-beta 1b 250 mcg (two trials, 933 participants), IFN-beta 1a 44 mcg (two trials, 441 participants) and IFN-beta 1a 30 mcg (two trials, 305 participants). Enrolled participants were affected by active RRMS. All studies were at high risk for attrition bias.Both therapies showed similar clinical efficacy at 24 months, given the primary outcome variables (number of participants with relapse (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.87 to 1.24) or progression (RR 1.11, 95% CI 0.91 to 1.35)). However at 36 months, evidence from a single study suggests that relapse rates were higher in the group given IFNs than in the GA group (RR 1.40, 95% CI 1.13 to 1.7, P value 0.002).Secondary magnetic resonance imaging (MRI) outcomes analysis showed that effects on new or enlarging T2- or gadolinium (Gd)-enhancing lesions at 24 months were similar (mean difference (MD) -0.01, 95% CI -0.28 to 0.26, and MD -0.14, 95% CI -0.30 to 0.02, respectively). However, the reduction in T2- and T1-weighted lesion volume was significantly greater in the groups given IFNs than in the GA groups (MD -0.58, 95% CI -0.99 to -0.18, P value 0.004, and MD -0.20, 95% CI -0.33 to -0.07, P value 0.003, respectively).The number of participants who dropped out of the study because of adverse events was similar in the two groups (RR 0.95, 95% CI 0.64 to 1.40).The quality of evidence for primary outcomes was judged as moderate for clinical end points, but for safety and some MRI outcomes (number of active T2 lesions), quality was judged as low. AUTHORS' CONCLUSIONS The effects of IFNs-beta and GA in the treatment of patients with RRMS, including clinical (e.g. patients with relapse, risk to progression) and MRI (Gd-enhancing lesions) activity measures, seem to be similar or to show only small differences. When MRI lesion load accrual is considered, the effect of the two treatments differs, in that IFNs-beta were found to limit the increase in lesion burden as compared with GA. Evidence was insufficient for a comparison of the effects of the two treatments on patient-reported outcomes, such as quality of life measures.
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Affiliation(s)
- Loredana La Mantia
- Unit of Neurorehabilitation - Multiple Sclerosis Center, I.R.C.C.S. Santa Maria Nascente - Fondazione Don Gnocchi, Via Capecelatro, 66, Milano, Italy, 20148
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Minelli A, Vaona A. Effectiveness of cognitive behavioral therapy in the treatment of fibromyalgia syndrome: a meta-analytic literature review. Reumatismo 2012; 64:151-7. [DOI: 10.4081/reumatismo.2012.151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 02/22/2012] [Accepted: 02/16/2012] [Indexed: 11/22/2022] Open
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Vaona A, Marcon A, Rava M, Buzzetti R, Sartori M, Abbinante C, Moser A, Seddaiu A, Prontera M, Quaglio A, Pallazzoni P, Sartori V, Rigon G. Quality evaluation of JAMA Patient Pages on diabetes using the Ensuring Quality Information for Patient (EQIP) tool. Prim Care Diabetes 2011; 5:257-263. [PMID: 21917537 DOI: 10.1016/j.pcd.2011.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 08/15/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022]
Abstract
CONTEXT Many medical journals provide patient information leaflets on the correct use of medicines and/or appropriate lifestyles. Only a few studies have assessed the quality of this patient-specific literature. OBJECTIVE The purpose of this study was to evaluate the quality of JAMA Patient Pages on diabetes using the Ensuring Quality Information for Patient (EQIP) tool. METHOD A multidisciplinary group of 10 medical doctors analyzed all diabetes-related Patient Pages published by JAMA from 1998 to 2010 using the EQIP tool. Inter-rater reliability was assessed using the percentage of observed total agreement (p(o)). A quality score between 0 and 1 (the higher score indicating higher quality) was calculated for each item on every page as a function of raters' answers to the EQIP checklist. A mean score per item and a mean score per page were then calculated. DATA SUMMARY We found 8 Patient Pages on diabetes on the JAMA web site. The overall quality score of the documents ranged between 0.55 (Managing Diabetes and Diabetes) and 0.67 (weight and diabetes). p(o) was at least moderate (>50%) for 15 of the 20 EQIP items. Despite generally favorable quality scores, some items received low scores. The worst scores were for the item assessing provision of an empty space to customize information for individual patients (score=0.01, p(o)=95%) and patients involvement in document drafting (score=0.11, p(o)=79%). CONCLUSIONS The Patient Pages on diabetes published by JAMA were found to present weak points that limit their overall quality and may jeopardize their efficacy. We therefore recommend that authors and publishers of written patient information comply with published quality criteria. Further research is needed to evaluate the quality and efficacy of existing written health care information.
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Minelli A, Zambello F, Vaona A. [Effectiveness of cognitive-associated with behavioral therapy psychopharmacological depression. Literature review meta-analyses]. Riv Psichiatr 2011; 46:18-23. [PMID: 21446108] [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
AIM The main focus is to analyze meta-analyses literature inherent the efficacy of cognitive behavioural therapy (CBT) with pharmacological therapy in the treatment of depression in adults rather than pharmacological therapy alone. METHODS Systematic research via PubMed, fixed subset criteria. RESULTS The methanalitic review underlie that the combination of CBT with drug therapy is significantly more effective compared to single pharmacological treatment in adult depression in terms of clinical response and symptomatic improvement. In addition the CBT improves adherence to treatment and reduces the risk of relapse. DISCUSSION Even though there is only a moderate evidence that combined therapy (pharmacological plus CBT treatment) is better than pharmacological treatment alone on depressive symptoms, the results support the important impact on NHS policies, allowing future implementation of CBT therapy in public services.
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Zambello F, Vaona A. [ECT. A critical review of meta-analyses]. Riv Psichiatr 2009; 44:337-340. [PMID: 20066822] [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: 05/28/2023]
Abstract
BACKGROUND This review is aimed to analize meta-analyses relating ECT in order to evaluate efficacy and safety of this tool compared to sham ECT, placebo as well as psychopharmacology. METHODS Systematic reviews cited in PubMed, using specific subsets. RESULTS The meta-analyses agree in outstanding the clinical effectiveness of ECT compared to other kinds of therapy. The main conclusion of the present work, which is related to the safety of this tool would like to reduce the warnings about ECT. These conclusions at present still lack of good quality evidence. DISCUSSION ECT nowadays is still a tool lacking of quality evidence, but it looks of relevant effectiveness and safety. Because of this, ECT as a technique should get more attention in clinical research and moreover in clinical practice.
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Affiliation(s)
- Francesco Zambello
- Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Ospedale S. Maria del Carmine, Rovereto, TN.
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26
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Saggin P, Vaona A. [Prenatal diagnosis of dacryocystocele]. Radiol Med 1997; 93:155-6. [PMID: 9380860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- P Saggin
- Servizio di Radiologia, Casa di cura Villa Berica, Vicenza
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Pizzighella S, Pisoni G, Bevilacqua F, Vaona A, Palù G. Simultaneous polymerase chain reaction detection and restriction typing for the diagnosis of human genital papillomavirus infection. J Virol Methods 1995; 55:245-56. [PMID: 8537462 DOI: 10.1016/0166-0934(95)00063-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A polymerase chain reaction method has been developed which allows the simultaneous detection of the majority of clinically relevant HPV types. Degenerate HPV-specific primers direct the one-step amplification of a DNA region spanning E1 and E7 genes. This enables an immediate distinction between the two groups of papillomaviruses, characterized by high or low oncogenic potential, simply from the size of amplified DNA. The PCR product can be subjected to a second round of amplification with internal primers, which are specific for 7 high-risk HPV types, HPV-16, -18, -31, -33, -35, -45 and -58. Precise identification of one-step or two-step amplified DNA is done by endonuclease digestion with one or two enzymes. The detection sensitivity, which has been assessed using cloned HPV genomes and HeLa and CaSki cell lines, varies from a few tens to a few hundreds of viral genome equivalents. The accuracy of the method has been confirmed by examining cervical scrapings of 44 patients.
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Affiliation(s)
- S Pizzighella
- University of Padua, School of Medicine, Microbiology Department, Italy
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Padovani G, Berzacola R, Vaona A, Marchi M. [Cystic microglandular hyperplasia of the cervix uteri. Presentation of 2 clinical cases]. Minerva Ginecol 1989; 41:475-8. [PMID: 2622589] [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: 01/01/2023]
Abstract
Two cases of cystic microglandular hyperplasia of the cervix, one with exocervical and the other with endocervical site are reported. These clinical cases were presented because of the rarity of this type of lesion and because of the difficulty of differentiating them from a well-differentiated cervical adenocarcinoma; noteworthy is the lack of a progestinic climate in the two patients, a situation that is considered highly predisposing.
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29
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Padovani G, Vaona A, Sartori M. [Ultrasonic aspects and clinical significance of the amniotic band syndrome]. Minerva Ginecol 1989; 41:397-9. [PMID: 2682382] [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: 01/02/2023]
Abstract
The Authors report one case of amniotic band syndrome identified in the second trimester of pregnancy. Amniotic band syndrome appears to be sufficiently common. The spectrum of possible malformations suggests caution in the evaluation of such findings.
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30
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Padovani G, Zenorini MT, Vaona A, Beltramello A. [Endocrine aspects of the empty sella syndrome]. Minerva Ginecol 1986; 38:929-35. [PMID: 3808427] [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: 01/07/2023]
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31
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Vaona A, Larizza E, Mingrone G, Sacco A, Bonadeo F, Panizzolo G. [Total parenteral nutrition in cancer patients]. Ann Osp Maria Vittoria Torino 1986; 29:172-9. [PMID: 3124701] [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: 01/04/2023]
Abstract
The authors analyse the results obtained in a study of 28 cancer patients managed with total parenteral nutrition (TPN) for a period variant from 5 to 19 days. The results fully justify the usefulness of the TPN in cancer patients before the treatment against the cancer.
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Affiliation(s)
- A Vaona
- Ospedale Maria Vittoria di Torino, Divisione Medicina I
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32
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Remonda G, Vaona A, Morachioli N, Ribero F. [Adenocarcinoma of the appendix (a report of two cases)]. Ann Osp Maria Vittoria Torino 1982; 25:21-8. [PMID: 7185309] [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: 01/23/2023]
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