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Borgonovo F, Lovaglio PG, Mariani C, Berta P, Cossu MV, Rizzardini G, Vittadini G, Capetti AF. Analysis and clinical determinants of post-COVID-19 syndrome in the Lombardy region: evidence from a longitudinal cohort study. BMJ Open 2024; 14:e075185. [PMID: 38320835 PMCID: PMC10860093 DOI: 10.1136/bmjopen-2023-075185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE To define macro symptoms of long COVID and to identify predictive factors, with the aim of preventing the development of the long COVID syndrome. DESIGN A single-centre longitudinal prospective cohort study conducted from May 2020 to October 2022. SETTING The study was conducted at Luigi Sacco University Hospital in Milan (Italy). In May 2020, we activated the ARCOVID (Ambulatorio Rivalutazione COVID) outpatient service for the follow-up of long COVID. PARTICIPANTS Hospitalised and non-hospitalised patients previously affected by COVID-19 were either referred by specialists or general practitioners or self-referred. INTERVENTION During the first visit, a set of questions investigated the presence and the duration of 11 symptoms (palpitations, amnesia, headache, anxiety/panic, insomnia, loss of smell, loss of taste, dyspnoea, asthenia, myalgia and telogen effluvium). The follow-up has continued until the present time, by sending email questionnaires every 3 months to monitor symptoms and health-related quality of life. PRIMARY AND SECONDARY OUTCOME MEASURES Measurement of synthetic scores (aggregation of symptoms based on occurrence and duration) that may reveal the presence of long COVID in different clinical macro symptoms. To this end, a mixed supervised and empirical strategy was adopted. Moreover, we aimed to identify predictive factors for post-COVID-19 macro symptoms. RESULTS In the first and second waves of COVID-19, 575 and 793 patients (respectively) were enrolled. Three different post-COVID-19 macro symptoms (neurological, sensorial and physical) were identified. We found significant associations between post-COVID-19 symptoms and (1) the patients' comorbidities, and (2) the medications used during the COVID-19 acute phase. ACE inhibitors (OR=2.039, 95% CI: 1.095 to 3.892), inhaled steroids (OR=4.08, 95% CI: 1.17 to 19.19) and COVID therapies were associated with increased incidence of the neurological macro symptoms. Age (OR=1.02, 95% CI: 1.01 to 1.04), COVID-19 severity (OR=0.42, 95% CI: 0.21 to 0.82), number of comorbidities (OR=1.22, 95% CI: 1.01 to 1.5), metabolic (OR=2.52, 95% CI: 1.25 to 5.27), pulmonary (OR=1.87, 95% CI: 1.10 to 3.32) and autoimmune diseases (OR=4.57, 95% CI: 1.57 to 19.41) increased the risk of the physical macro symptoms. CONCLUSIONS Being male was the unique protective factor in both waves. Other factors reflected different medical behaviours and the impact of comorbidities. Evidence of the effect of therapies adds valuable information that may drive future medical choices.
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Affiliation(s)
- Fabio Borgonovo
- Infectious Diseases, Luigi Sacco University Hospital, Milano, Italy
| | - Pietro Giorgio Lovaglio
- Interuniversity Research Centre on Public Services (CRISP), Department of Statistics and Quantitative Methods, University Bicocca-Milan, Milan, Italy
| | - Chiara Mariani
- Infectious Diseases, Luigi Sacco University Hospital, Milano, Italy
| | - Paolo Berta
- Interuniversity Research Centre on Public Services (CRISP), Department of Statistics and Quantitative Methods, University Bicocca-Milan, Milan, Italy
| | | | | | - Giorgio Vittadini
- Interuniversity Research Centre on Public Services (CRISP), Department of Statistics and Quantitative Methods, University Bicocca-Milan, Milan, Italy
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Cornaggia CM, Lovaglio PG, Riva MA, Mazzucchelli M, Piscitelli D, Vittadini G. The effect of differently modulated communications on the covid-19 pandemic in the young population. Riv Psichiatr 2023; 58:50-58. [PMID: 37070331 DOI: 10.1708/4022.39974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Media communication during the covid-19 pandemic has been relevant for the population to receive information about the ongoing number of cases, deaths, and social restriction measures. Notably, the effects of the communication methods on young adults during the covid-19 pandemic have not been studied. Therefore the present study aimed to investigate the influence of communication modality about covid-19 on the perception of risk and judgment among young adults. METHODS A double-blind cross-sectional study was designed. Three hundred four subjects (age range19-25 years old) saw a 4-minute video concerning data communication on the covid-19 pandemic and compiled an online questionnaire about their perceptions. Two videos were randomized, one presenting the covid-19 data negatively (HARD video) while the other showed a positive ongoing resolution of the pandemic (SOFT video). Association tests and nominal logistic regression were used to evaluate differences in responses among the two groups. RESULTS The two videos lead to different reactions. Participants showed higher disagreement concerning the video content in the "SOFT" group compared to the "HARD" group. The responses of the "SOFT" group were more to be optimistic (OR=2.87, 95% CI 1.311-6.27) than those who had seen the "HARD" video. The sense of helplessness was lower in the "SOFT" compared "HARD" group (OR=3.02, 95% CI 1.311-6.96). The perception of fear was higher for the "HARD" group (OR=2.91, 95% CI 1.21-7-02). DISCUSSION The modality of data presentation influenced the perception and feelings about the covid-19 pandemic. Likely, pre-existing perception of a pessimistic perspective was present in both groups; thus, the video did not lead to any change in the behavior. CONCLUSIONS The phobic or counter-phobic reactions shown in the study participants highlighted the importance of the reliability of the information received and how previous feelings may influence the perception of the information.
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Affiliation(s)
- Cesare Maria Cornaggia
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy - Cognitive Neuro-Rehabilitation Unit, "Zucchi" Clinical Institutes, San Donato Group, Carate Brianza (MB), Italy
| | - Pietro G Lovaglio
- Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy - CRISP - Interuniversity Research Centre on Public Services, University of Milano Bicocca, Milan, Italy
| | - Michele A Riva
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy - Occupational Health Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Miryam Mazzucchelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy - Cognitive Neuro-Rehabilitation Unit, "Zucchi" Clinical Institutes, San Donato Group, Carate Brianza (MB), Italy
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy - School of Physical and Occupational Therapy, McGill University, Montréal, Canada
| | - Giorgio Vittadini
- Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy - CRISP - Interuniversity Research Centre on Public Services, University of Milano Bicocca, Milan, Italy
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Salvioni L, Testa F, Sulejmani A, Pepe F, Giorgio Lovaglio P, Berta P, Dominici R, Leoni V, Prosperi D, Vittadini G, Colombo M, Fiandra L. Surfactant protein D (SP-D) as a biomarker of SARS-CoV-2 infection. Clin Chim Acta 2022; 537:140-145. [PMCID: PMC9617654 DOI: 10.1016/j.cca.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
Background Surfactant protein-D (SP-D) is a lung-resident protein that has emerged as a potential biomarker for COVID-19. Previous investigations on acute respiratory distress syndrome patients demonstrated a significant increment of SP-D serum levels in pathological conditions. Since SP-D is not physiologically permeable to alveoli-capillary membrane and poorly expressed by other tissues, this enhancement is likely due to an impairment of the pulmonary barrier caused by prolonged inflammation. Methods A retrospective study on a relatively large cohort of patients of Hospital Pio XI of Desio was conducted to assess differences of the hematic SP-D concentrations among COVID-19 patients and healthy donors and if SP-D levels resulted a risk factor for disease severity and mortality. Results The first analysis, using an ANOVA-model, showed a significant difference in the mean of log SP-D levels between COVID-19 patients and healthy donors. Significant variations were also found between dead vs survived patients. Results confirm that SP-D concentrations were significantly higher for both hospitalized COVID-19 and dead patients, with threshold values of 150 and 250 ng/mL, respectively. Further analysis conducted with Logistic Mixed models, highlighted that higher SP-D levels at admission and increasing differences among follow-up and admission values resulted the strongest significant risk factors of mortality (model predictive accuracy, AUC = 0.844). Conclusions The results indicate that SP-D can be a predictive marker of COVID-19 disease and its outcome. Considering its prognostic value in terms of mortality, the early detection of SP-D levels and its follow-up in hospitalized patients should be considered to direct the therapeutic intervention.
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Affiliation(s)
- Lucia Salvioni
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, P.zza della Scienza 2, 20126 Milan, Italy
| | - Filippo Testa
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, P.zza della Scienza 2, 20126 Milan, Italy
| | - Adela Sulejmani
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Francesca Pepe
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Pietro Giorgio Lovaglio
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy
| | - Paolo Berta
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy
| | - Roberto Dominici
- Laboratory of Clinical Biochemistry, Ospedale Pio XI of Desio, ASST-Brianza, via Mazzini 1, 20833 Desio, Italy
| | - Valerio Leoni
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy,Laboratory of Clinical Biochemistry, Ospedale Pio XI of Desio, ASST-Brianza, via Mazzini 1, 20833 Desio, Italy
| | - Davide Prosperi
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, P.zza della Scienza 2, 20126 Milan, Italy
| | - Giorgio Vittadini
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy
| | - Miriam Colombo
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, P.zza della Scienza 2, 20126 Milan, Italy,Corresponding authors
| | - Luisa Fiandra
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, P.zza della Scienza 2, 20126 Milan, Italy,Corresponding authors
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Rossi C, Berta P, Curello S, Lovaglio PG, Magoni M, Metra M, Roccaro AM, Verzillo S, Vittadini G. The impact of COVID-19 pandemic on AMI and stroke mortality in Lombardy: Evidence from the epicenter of the pandemic. PLoS One 2021; 16:e0257910. [PMID: 34597292 PMCID: PMC8486095 DOI: 10.1371/journal.pone.0257910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/15/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The first Covid-19 epidemic outbreak has enormously impacted the delivery of clinical healthcare and hospital management practices in most of the hospitals around the world. In this context, it is important to assess whether the clinical management of non-Covid patients has not been compromised. Among non-Covid cases, patients with Acute Myocardial Infarction (AMI) and stroke need non-deferrable emergency care and are the natural candidates to be studied. Preliminary evidence suggests that the time from onset of symptoms to emergency department (ED) presentation has significantly increased in Covid-19 times as well as the 30-day mortality and in-hospital mortality. METHODS We check, in a causal inference framework, the causal effect of the hospital's stress generated by Covid-19 pandemic on in-hospital mortality rates (primary end-point of the study) of AMI and stroke over several time-windows of 15-days around the implementation date of the State of Emergency restrictions for COVID-19 (March, 9th 2020) using two quasi-experimental approaches, regression-discontinuity design (RDD) and difference-in-regression-discontinuity (DRD) designs. Data are drawn from Spedali Civili of Brescia, one of the most hit provinces in Italy by Covid-19 during March and May 2020. FINDINGS Despite the potential adverse effects on expected mortality due to a longer time to hospitalization and staff extra-burden generated by the first wave of Covid-19, the AMI and stroke mortality rates are overall not statistically different during the first wave of Covid-19 than before the first peak. The obtained results provided by RDD models are robust also when we account for seasonality and unobserved factors with DRD models. INTERPRETATION The non-statistically significant impact on mortality rates for AMI and stroke patients provides evidence of the hospital ability to manage -with the implementation of a dual track organization- the simultaneous delivery of high-quality cares to both Covid and non-Covid patients.
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Affiliation(s)
| | - Paolo Berta
- Department of Statistics and Quantitative Methods and CRISP, University of Milan-Bicocca, Milan, Italy
| | | | - Pietro Giorgio Lovaglio
- Department of Statistics and Quantitative Methods and CRISP, University of Milan-Bicocca, Milan, Italy
| | | | - Marco Metra
- ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Stefano Verzillo
- European Commission, Joint Research Centre (JRC), Ispra, Italy
- * E-mail:
| | - Giorgio Vittadini
- Department of Statistics and Quantitative Methods and CRISP, University of Milan-Bicocca, Milan, Italy
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Zambon A, Airoldi C, Corrao G, Cibin M, Agostini D, Aliotta F, Movalli M, Biondini F, Bizzi P, Zucchi G, Cerizza G, Dattola A, Marmora A, Vittadini G, Girardi F, Liberto L, Hinnenthal I, Sodano AJ, Vizzuso P, Majolino E, Mioni D, Pedretti L, Ranaletti P, Forghieri M, Spolaor G, Giorgi I. Prevalence of Polysubstance Abuse and Dual Diagnosis in Patients Admitted to Alcohol Rehabilitation Units for Alcohol-Related Problems in Italy: Changes in 15 Years. Alcohol Alcohol 2017; 52:699-705. [DOI: 10.1093/alcalc/agx061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/21/2017] [Indexed: 11/13/2022] Open
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Colombi R, Martini G, Vittadini G. Determinants of transient and persistent hospital efficiency: The case of Italy. Health Econ 2017; 26 Suppl 2:5-22. [PMID: 28940917 DOI: 10.1002/hec.3557] [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] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 06/13/2017] [Accepted: 06/21/2017] [Indexed: 06/07/2023]
Abstract
In this paper, we extend the 4-random-component closed skew-normal stochastic frontier model by including exogenous determinants of hospital persistent (long-run) and transient (short-run) inefficiency, separated from unobserved heterogeneity. We apply this new model to a dataset composed by 133 Italian hospitals during the period 2008-2013. We show that average total inefficiency is about 23%, higher than previous estimates; hence, a model where the different types of inefficiency and hospital unobserved characteristics are not confounded allows us to get less biased estimates of hospital inefficiency. Moreover, we find that transient efficiency is more important than persistent efficiency, as it accounts for 60% of the total one. Last, we find that ownership (for-profit hospitals are more transiently inefficient and less persistently inefficient than not-for-profit ones, whereas public hospitals are less transiently inefficient than not-for-profit ones), specialization (specialized hospitals are more transiently inefficient than general ones; i.e., there is evidence of scope economies in short-run efficiency), and size (large-sized hospitals are better than medium and small ones in terms of transient inefficiency) are determinants of both types of inefficiency, although we do not find any statistically significant effect of multihospital systems and teaching hospitals.
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Affiliation(s)
- Roberto Colombi
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Gianmaria Martini
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Giorgio Vittadini
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Moscone F, Siciliani L, Vittadini G. Special issue on health economics and policy: Guest editors' introduction. Health Econ 2017; 26 Suppl 2:3-4. [PMID: 28940912 DOI: 10.1002/hec.3576] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/14/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, UK
| | - Giorgio Vittadini
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Moscone F, Tosetti E, Vittadini G. The impact of precarious employment on mental health: The case of Italy. Soc Sci Med 2016; 158:86-95. [PMID: 27115334 DOI: 10.1016/j.socscimed.2016.03.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 05/17/2015] [Revised: 03/04/2016] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
Abstract
Although there has been a sizeable empirical literature measuring the effect of job precariousness on the mental health of workers the debate is still open, and understanding the true nature of such relationship has important policy implications. In this paper, we investigate the impact of precarious employment on mental health using a unique, very large data set that matches information on job contracts for over 2.7 million employees in Italy followed over the years 2007-2011, with their psychotropic medication prescription. We examine the causal effects of temporary contracts, their duration and the number of contract changes during the year on the probability of having one or more prescriptions for medication to treat mental health problems. To this end, we estimate a dynamic Probit model, and deal with the potential endogeneity of regressors by adopting an instrumental variables approach. As instruments, we use firm-level probabilities of being a temporary worker as well as other firm-level variables that do not depend on the mental illness status of the workers. Our results show that the probability of psychotropic medication prescription is higher for workers under temporary job contracts. More days of work under temporary contract as well as frequent changes in temporary contract significantly increase the probability of developing mental health problems that need to be medically treated. We also find that moving from permanent to temporary employment increases mental illness; symmetrically, although with a smaller effect in absolute value, moving from temporary to permanent employment tends to reduce it. Policy interventions aimed at increasing the flexibility of the labour market through an increase of temporary contracts should also take into account the social and economic cost of these reforms, in terms of psychological wellbeing of employees.
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Grech G, Zhan X, Yoo BC, Bubnov R, Hagan S, Danesi R, Vittadini G, Desiderio DM. EPMA position paper in cancer: current overview and future perspectives. EPMA J 2015; 6:9. [PMID: 25908947 PMCID: PMC4407842 DOI: 10.1186/s13167-015-0030-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 02/08/2015] [Accepted: 02/26/2015] [Indexed: 12/31/2022]
Abstract
At present, a radical shift in cancer treatment is occurring in terms of predictive, preventive, and personalized medicine (PPPM). Individual patients will participate in more aspects of their healthcare. During the development of PPPM, many rapid, specific, and sensitive new methods for earlier detection of cancer will result in more efficient management of the patient and hence a better quality of life. Coordination of the various activities among different healthcare professionals in primary, secondary, and tertiary care requires well-defined competencies, implementation of training and educational programs, sharing of data, and harmonized guidelines. In this position paper, the current knowledge to understand cancer predisposition and risk factors, the cellular biology of cancer, predictive markers and treatment outcome, the improvement in technologies in screening and diagnosis, and provision of better drug development solutions are discussed in the context of a better implementation of personalized medicine. Recognition of the major risk factors for cancer initiation is the key for preventive strategies (EPMA J. 4(1):6, 2013). Of interest, cancer predisposing syndromes in particular the monogenic subtypes that lead to cancer progression are well defined and one should focus on implementation strategies to identify individuals at risk to allow preventive measures and early screening/diagnosis. Implementation of such measures is disturbed by improper use of the data, with breach of data protection as one of the risks to be heavily controlled. Population screening requires in depth cost-benefit analysis to justify healthcare costs, and the parameters screened should provide information that allow an actionable and deliverable solution, for better healthcare provision.
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Affiliation(s)
- Godfrey Grech
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Xianquan Zhan
- Key Laboratory of Cancer Proteomics of Chinese Ministry of Health, Xiangya Hospital, Central South University, Changsha, China
| | - Byong Chul Yoo
- Colorectal Cancer Branch, Division of Translational and Clinical Research I, Research Institute, National Cancer Center, Gyeonggi, 410-769 Republic of Korea
| | - Rostyslav Bubnov
- Clinical Hospital 'Pheophania' of State Management of Affairs Department, Kyiv, Ukraine ; Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Suzanne Hagan
- Dept of Life Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Romano Danesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Dominic M Desiderio
- Department of Neurology, University of Tennessee Center for Health Science, Memphis, USA
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Vittadini G, Beghi M, Mezzanzanica M, Ronzoni G, Cornaggia CM. Use of psychotropic drugs in Lombardy in time of economic crisis (2007-2011): a population-based study of adult employees. Psychiatry Res 2014; 220:615-22. [PMID: 25070175 DOI: 10.1016/j.psychres.2014.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 01/04/2014] [Revised: 05/08/2014] [Accepted: 06/04/2014] [Indexed: 11/25/2022]
Abstract
Over years, there has been an increase in the prescription of psychotropic drugs (PDs), particularly antidepressants (ADs). The aim of the study was to evaluate the consumption of PDs in adult employees in a productive area of Italy and the possible changes induced by the "economic crisis". The study is a retrospective survey in all adult employees in Lombardy, Northern Italy, aged >18 years in the period 2007-2011, classified by gender, age class, nationality, education and province. During the 5-year period, there were 3,554,860 employed adults in Lombardy, of whom 277,865 (7.8%) used PDs. The use of PDs (particularly ADs) was associated with being an Italian woman aged >55 years with a basic education, a blue collar job, and an unstable working position. In 39% of cases, the use of PDs was limited to one trimester. The increase in the number of prescriptions of PDs after the economic crisis was the same as before it. The increase in PD use can be attributed more to ADs and anti-epileptic drugs with anxiolytic properties. Although continuously increasing, the use of AD fluctuated and was greater during the fall and winter. The increase involved all the provinces in Lombardy in a similar manner.
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Affiliation(s)
- Giorgio Vittadini
- Department of Statistics, University of Milano Bicocca, Milan, Italy
| | | | - Mario Mezzanzanica
- CRISP, University of Milano Bicocca, Via Cadore 48, 20052 Monza MB, Milan, Italy
| | - Gloria Ronzoni
- CRISP, University of Milano Bicocca, Via Cadore 48, 20052 Monza MB, Milan, Italy
| | - Cesare Maria Cornaggia
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Milan, Italy; Forensic Psychiatric Hospital, Castiglione delle Stiviere, Mantua, Italy.
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Martini G, Berta P, Mullahy J, Vittadini G. The effectiveness-efficiency trade-off in health care: The case of hospitals in Lombardy, Italy. Reg Sci Urban Econ 2014; 49:217-231. [PMID: 31244500 PMCID: PMC6594706 DOI: 10.1016/j.regsciurbeco.2014.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
We study the presence and the magnitudes of trade-offs between health outcomes and hospitals' efficiency using a data set from Lombardy, Italy, for the period 2008-2011. Our goal is to analyze whether the pressures for cost containment may affect hospital performance in terms of population health status. Unlike previous work in this area, we analyze hospitals at the ward level so comparisons can be made across more homogeneous treatments. We focus on two different health outcomes: mortality and readmission rates. We find that there is a trade-off between mortality rates and efficiency, as more efficient hospitals have higher mortality rates. We also find, however, that more efficient hospitals have lower readmission rates. Moreover, we show that focusing the analysis at the ward level is essential, since there is evidence of higher mortality rates in general medicine and surgery, while in oncology mortality is lower in more efficient hospitals. Furthermore, we find that consideration of spatial processes is important since mortality rates are higher for hospitals subject to high degree of horizontal competition, but lower for those hospitals having strong competition but high efficiency. This implies that the interplay of efficient resource allocation and hospital competition is important for the sustainability and effectiveness of regional health care systems.
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Abstract
A recent method to specify and fit structural equation modeling in the Redundancy Analysis framework based on so-called Extended Redundancy Analysis (ERA) has been proposed in the literature. In this approach, the relationships between the observed exogenous variables and the observed endogenous variables are moderated by the presence of unobservable composites, estimated as linear combinations of exogenous variables. However, in the presence of direct effects linking exogenous and endogenous variables, or concomitant indicators, the composite scores are estimated by ignoring the presence of the specified direct effects. To fit structural equation models, we propose a new specification and estimation method, called Generalized Redundancy Analysis (GRA), allowing us to specify and fit a variety of relationships among composites, endogenous variables, and external covariates. The proposed methodology extends the ERA method, using a more suitable specification and estimation algorithm, by allowing for covariates that affect endogenous indicators indirectly through the composites and/or directly. To illustrate the advantages of GRA over ERA we propose a simulation study of small samples. Moreover, we propose an application aimed at estimating the impact of formal human capital on the initial earnings of graduates of an Italian university, utilizing a structural model consistent with well-established economic theory.
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Affiliation(s)
| | - Giorgio Vittadini
- a Department of Statistics and Quantitative Methods , University of Bicocca-Milan
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Gabba S, Giannini E, Borghi L, Fellegara G, Marcialis C, Grugni M, Foschini MP, Repetti E, Dorji T, Vittadini G, Grazioli V. Evaluation of hTERC (3q26) gain by fluorescence in situ hybridization (FISH) to predict the behavior of oral epithelial precursor lesions. EPMA J 2014. [PMCID: PMC4125941 DOI: 10.1186/1878-5085-5-s1-a57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Zambon A, Soares Pinto SP, Agostini D, Aliotta F, Biondini F, Bizzi P, Cerizza G, Dattola A, Forghieri M, Giorgi I, Girardi F, Hinnenthal IM, Jaretti Sodano A, Liberto L, Majolino E, Mioni D, Movalli M, Pedretti L, Propato A, Ranaletti P, Spolaor G, Vizzuso P, Zucchi G, Vittadini G. [Alcohol-addiction inpatient: characteristics of patients and rehabilitation program]. Minerva Med 2013; 104:193-206. [PMID: 23514996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The treatment of alcohol addiction in Italy has had a progressive evolution of therapeutic structures for in-and outpatients. During the last 20 years there had been a crescent presence of short residential treatment facilities (1-6 months) characterized by a high level of medical and psychotherapeutic intervention. About two years ago 12 of them jointed together in an association called CORRAL (COordinamento of Residenzialità Riabilitive Alcologiche). The aim of this study was to describe the socio-demographic medical and other characteristics of the patients coming for this type of treatment and to describe the characteristics of the residential treatment itself including referring and aftercare. METHODS Two thousand sixty-one hospitalized patients of the 12 rehabilitative alcohol units were examined by using a questionnaire and collecting various sociodemographic variables and clinical diagnosis of the patients. Even it was asked who had referred the patients, the characteristics of the residential treatment and of the planned aftercare. RESULTS The present residential facilities are mainly distributed in the North of Italy. The typical patient is male, with a high school instruction and with a comorbidity regarding psychiatric and liver disorders. The majority of the patients were referred by the public ambulatory services for addictions (SerT/SerD). The characteristics of the residential treatment were medical, pharmacological and psychotherapeutic interventions with a high intensity and the presence of a general-purpose staff. CONCLUSIONS This study outlined a model of residential rehabilitation of alcohol disorders characterized by short duration and a complex, intense therapeutic intervention mainly addressed to patients with a severe clinical condition and a low level of social problems. Further research should be useful to understand better which sort of patient characteristics obtain a better clinical result and for that even economically a major effectiveness from this type of residential treatment.
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Affiliation(s)
- A Zambon
- Dipartimento di Statistica, Università degli Studi Milano Bicocca, Milano, Italia
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15
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Berta P, Seghieri C, Vittadini G. Comparing health outcomes among hospitals: the experience of the Lombardy Region. Health Care Manag Sci 2013; 16:245-57. [PMID: 23529708 DOI: 10.1007/s10729-013-9227-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/22/2013] [Indexed: 10/27/2022]
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Giorgio Lovaglio P, Vittadini G. The balanced scorecard in health care: a multilevel latent variable approach. Jnl of Modelling in Management 2012. [DOI: 10.1108/17465661211208802] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Moscone F, Vittadini G. New evidence in health economics. Expert Rev Pharmacoecon Outcomes Res 2011; 11:45-6. [PMID: 21351856 DOI: 10.1586/erp.10.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The 2nd Health Econometrics Workshop took place at the Catholic University of Rome in Italy on 15-17 July 2010. The purpose of this meeting was to provide a forum where policy makers, economists and econometricians could discuss the use of statistical and econometric methods to address issues in the field of health economics. There were seven keynote speakers - leading scholars in the subject - invited to give their contributions: Alberto Holly, Stephen Hall, Badi Baltagi, William Greene, Andrew Jones, John Mullahy and Edward Norton. The meeting was attended by 50 participants from around the world, and 17 scientific papers were presented. Some of these works will be published in the forthcoming special issue of Empirical Economics.
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Monzani E, Erlicher A, Lora A, Lovaglio P, Vittadini G. Does community care work? A model to evaluate the effectiveness of mental health services. Int J Ment Health Syst 2008; 2:10. [PMID: 18601741 PMCID: PMC2488329 DOI: 10.1186/1752-4458-2-10] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 07/05/2008] [Indexed: 11/10/2022] Open
Abstract
The aim of this paper is to evaluate the effectiveness of community Mental Health Departments in Lombardy (Italy), and analyse the eventual differences in outcome produced by different packages of care. The survey was conducted in 2000 on 4,712 patients treated in ten Mental Health Departments. Patients were assessed at least twice in a year with HoNOS (Health of the Nation Outcome Scales). Data on treatment packages were drawn from the regional mental health information system, which includes all outpatient and day-care contacts, as well as general hospital and inpatient admissions provided by Mental Health Departments. Multilevel growth models were used for outcomes statistical analysis, expressed in terms of change of the total HoNOS score. On the whole, Mental Health Departments were effective in reducing HoNOS scores. The main predictor of improvement was treatment, while length of care, gender and diagnosis were weaker predictors. After severity adjustment, some packages of care proved more effective than others. Appropriate statistical methods, comprehensive treatment descriptions and routine outcome assessment tools are needed to evaluate the effectiveness of community mental health services in clinical settings.
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Affiliation(s)
- Emiliano Monzani
- Dipartimento di Salute Mentale dell'Azienda Ospedaliera "G, Salvini", Garbagnate Milanese, Italy.
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19
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Vittadini G, Lanfranco A. [Alcohol and drug addiction in the work place]. G Ital Med Lav Ergon 2008; 30:A39-A43. [PMID: 18700475] [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: 05/26/2023]
Abstract
Alcohol and drug addiction in the work place have always been an important but little known problem. These behaviours represent today one of the principal causes of work mishaps in Italy and are responsible for the marginalization of many subjects from the working world. Recently some laws (DPR 309/90 and Legge Quadro 125/2001) and their subsequent decrees have affronted this problem, highlighting its extreme complexity (diverse aspects in fact still remain to be solved from the organizational and legal-medical points of view). In the last few decades, Medicine and Occupational Psychology have focused on the relationship between employees' professional activity and private life, analyzing the problem of psychoactive substance abuse. In Anglo-Saxon countries, for example, Employee Assistance Programs (EAPs) have been implemented--a key element of which is the support to alcohol and drug abusers--in order to offer employees and their families help in coping with problems that could adversely impact their work and personal lives. After examining these laws, including their contradictory aspects, we propose two main modes of intervention: prevention focused on the identification of alternative behaviour and the promotion of self-help groups.
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Affiliation(s)
- G Vittadini
- U.O. Riabilitazione Alcologica, Fondazione S. Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS, Istituto Scientifico di Pavia, Italy.
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20
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Vittadini G, Bandirali M. [Alcohol and work: remaining sober and return to work]. Med Lav 2007; 98:521-526. [PMID: 18041473] [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: 05/25/2023]
Abstract
BACKGROUND One of the most complex alcohol-driven problems is the job loss and the subsequent attempts to return to a professional activity. METHODS In order to better understand the issue, an epidemiologic investigation was carried out on a group of 162 alcoholics whilst hospitalised in a specialised clinic. RESULTS The outcome shows the importance of remaining sober to keep or to be returned to one's own job. Unfortunately, local resources at hand, first of all joining an auto-mutual-help group, re still too little known and thus clearly underemployed. Therefore, an informative action within companies is highly desirable. Those alcoholics suffering from serious illnesses, especially mental ones represent a different issue. CONCLUSIONS For these people a higher involvement of public authorities is desirable in creating protected job openings.
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Affiliation(s)
- G Vittadini
- UO Riabilitazione alcologica - Fondazione Salvatore Maugeri IRCCS Pavia.
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21
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Vittadini G, Minotti SC, Fattore M, Lovaglio PG. On the relationships among latent variables and residuals in PLS path modeling: The formative-reflective scheme. Comput Stat Data Anal 2007. [DOI: 10.1016/j.csda.2006.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Capodaglio EM, Vittadini G, Bossi D, Sverzellati S, Facioli M, Montomoli C, Dalla Toffola E. A functional assessment methodology for alcohol dependent patients undergoing rehabilitative treatments. Disabil Rehabil 2004; 25:1224-30. [PMID: 14578062 DOI: 10.1080/09638280310001608573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 10/26/2022]
Abstract
PURPOSE We propose a functional assessment approach for patients with alcoholic dependence of working age undergoing aerobic training. The background is the WHO indication (ICIDH-2) to use measurable 'activities' as a means to assess the individual 'participation' in social life which also implies work capacity. Defining sustainable energetic levels for the individual is an important issue for both the quantification of an effective training and the evaluation of possible improvements following training. METHODS Fifty-six 'alcohol dependent' patients, as defined by DSM IV (Diagnostic and Statistical Manual of Mental Disorders), admitted to our Unit in a 16 month-period participated in the study. Eighteen healthy subjects served as controls (Group C). Out of all the 56 patients, 33 (Group A) underwent an aerobic training and 23 subjects (Group N) underwent the same pharmacological and psychological therapy but without aerobic training. Patients were assigned to the treatment (A) or no treatment (N) group according to a 'quasi-experimental' design (i.e. temporal selection criteria). The evaluation protocol consisted of submaximal symptom-limited tests. The tests consisted of bouts of 'basic' activities (walking, lifting, arm-work) to be performed at different intensities. We estimated the total energetic work (TW) performed in the tests by means of formulas available in the literature. The maximal energetic intensity (EI) reached during the tests was also estimated and expressed in MET (multiple of the basal metabolism). RESULTS Significant differences in work capacity were observed between patients and healthy subjects at baseline. Group A significantly increased TW after rehabilitation, while Group N did not increment their performance at the re-test. CONCLUSIONS The proposed approach could be useful in the functional assessment of deconditioned subjects with alcohol dependence in working age, and could monitor the changes in work capacity following training.
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Affiliation(s)
- E M Capodaglio
- CSAM (Centro Studi Attivitá Motorie), Centro Medico di Pavia, Pavia, Italy.
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Abstract
In the present study, we investigated the frequency of polyneuropathy in a sample of 296 alcoholics who were admitted to the 'S. Maugeri' Medical Centre for detoxification from October 1997 to November 1999. Results revealed a high frequency of polyneuropathy in the sample under study. The disorder was often clinically asymptomatic and demonstrable only on electroneurographic investigation. Significant correlations were found between polyneuropathy, the duration of alcoholism, the type of alcoholic beverage consumed (wine) and the presence of liver disease and macrocytosis.
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Affiliation(s)
- G Vittadini
- Alcohol-dependency Unit, Fondazione S. Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS, Istituto Scientifico di Pavia, Via A. Ferrata 4, 27100 Pavia, Italy
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Abstract
STUDY OBJECTIVE To investigate the utility of capture-recapture methods to estimate prevalence of subjects with alcohol related disorders using multiple incomplete lists. DESIGN This was a cross sectional study of alcohol related disorders in a large community. SETTING During 1997 identified cases with known alcohol related disorders were independently flagged by four sources (self help volunteering groups; psychiatric ambulatory; public alcohology service; hospital discharges). PATIENTS 381 records were flagged, corresponding to 349 individual cases from a target population resident in a northern Italy area. MAIN RESULTS The two sample capture-recapture estimates were clearly biased because of dependencies among sources. Estimates based on log-linear models showed prevalent counts ranged from 2297 (95% confidence intervals: 1524, 3794) to 2523 (95% confidence intervals: 1623, 4627) after adjustment for dependence among sources only or also for heterogeneity in catchability among age categories (< 50 and >/= 50 years), respectively. CONCLUSIONS The study suggests that capture-recapture is an appropriate approach for estimating prevalence of subjects with alcohol related problems who seek or need treatment and assistance when different lists of alcoholics can be obtained from different types of agencies involved with problematic use of alcohol. Critical factors are the complexity in case definition and the analysis of heterogeneity among people. Accurate estimates are needed to plan and evaluate public health interventions.
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Affiliation(s)
- G Corrao
- Department of Statistics, Faculty of Statistical Sciences, Chair of Medical Statistics and Epidemiology, University of Milan, Bicocca, Italy.
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25
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Giorgi I, Vittadini G, Omodeo O, Biscaldi G. [Alcoholism at the work setting]. G Ital Med Lav Ergon 2000; 22:47-51; discussion 62-3. [PMID: 10771759] [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: 02/16/2023]
Abstract
Alcoholism is a nation-wide problem because of the variability and severity of its associated phenomena. In Western European countries, according to the WHO, the use of alcohol is the direct or indirect cause of approximately 20% of hospital admissions of male adults of working age. In Italy, the number of lost working days due to sickness is four times greater in drinkers, as is the risk of serious accidents. In addition, alcohol accounts for 5% of disability payments. In the authors' experience, alcohol abuse is a widespread problem in the work setting, however its social and medical impact is still underestimated.
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Affiliation(s)
- I Giorgi
- Servizio di Psicologia, Fondazione Salvatore Maugeri, IRCCS, Istituto di Pavia
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26
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Biscaldi G, Fonte R, Paita L, Vittadini G, Caprotti M. [High resolution computerized tomography in the diagnosis of silicosis and mixed dust pneumoconiosis]. G Ital Med Lav Ergon 1999; 21:278-86. [PMID: 10771741] [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: 02/16/2023]
Abstract
The clinical observation, the work history, the analysis of pulmonary function tests and, mainly, the conventional x-ray chest radiograms have represented, til now, the diagnostic basis for pneumoconiosis (silicosis, mixed dust pneumoconiosis, asbestosis). Recently, the high resolution chest tomography (HRCT) has been introduced into the diagnostic procedures: such method seems to have its main application in the assessment of incipient clinical pictures of pneumoconiosis, particularly when characterized by normal pulmonary function tests. 75 silica- and mixed dust exposed workers were submitted to both radiologic methods. The great majority of them had already been recognized to be affected by asbestosis. The statistical analysis (Cohen K) showed a satisfactory agreement between radiographic and tomographic I.L.O. classes. However, high resolution tomography appeared to be more accurate in the assessment of less severe clinical pictures. In conclusion, we underline the importance of high resolution chest tomography in the evaluation of individual clinical cases, particularly when forensic problems are involved.
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Affiliation(s)
- G Biscaldi
- Fondazione S. Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS di Pavia
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27
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Biscaldi G, Fonte R, Paita L, Vittadini G, Caprotti M. [High resolution computerized tomography in the diagnosis of asbestosis]. G Ital Med Lav Ergon 1999; 21:271-7. [PMID: 10771740] [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: 02/16/2023]
Abstract
The clinical observation, the work history, the analysis of pulmonary function tests and, mainly, the conventional x-ray chest radiograms have represented, til now, the diagnostic basis for pneumoconiosis (silicosis, mixed dust pneumoconiosis, asbestosis). Recently, the high resolution chest tomography (HRCT) has been introduced into the diagnostic procedures: such method seems to have its main application in the assessment of incipient clinical pictures of pneumoconiosis, particularly when characterized by normal pulmonary function tests. Asbestos fibers exposed workers were submitted to both radiologic methods. The great majority of them had already been recognized to be affected by asbestosis. A considerable statistical agreement (Cohen K) was observed between radiographic and tomographic I.L.O. classes. In conclusion, high resolution chest tomography doesn't appear to be an indispensable test for the diagnosis in admitted subjects, but we underline its importance in the evaluation of pleural thickenings.
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Affiliation(s)
- G Biscaldi
- Fondazione S. Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS di Pavia
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28
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Biscaldi G, Vittadini G, Giorgi I, Fonte R, Maglio R, Nervi O. [Work and alcohol: considerations on a caseload of patients undergoing treatment]. G Ital Med Lav Ergon 1999; 21:54-7. [PMID: 10771719] [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: 02/16/2023]
Abstract
An enquiry into alcohol dependent subjects admitted to the clinical wards of the first section of Occupational Medicine belonging to Medicina Preventiva Occupazionale e di Comunità of University of Pavia for an alcohol disaddiction treatment has been performed through a phone interview. 289 patients have been contacted and time elapsed from admission to interview was one to three years. The questions focused alcohol abstinence, occupational position before and after admission, any improvement in the work sphere (relationship with the collegues), any feeling of empowerment of the work abilities and any increase in the responsibilities load. From our results we can conclude that alcohol disaddiction carried on during admission has positively contributed to the reinstatement of alcoholics patients.
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Affiliation(s)
- G Biscaldi
- Dipartimento di Medicina Preventiva occupazionale e di Comunità dell' Università degli Studi di Pavia
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29
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Vittadini G, Giorgi I. [A group therapy model in the rehabilitation fo alcoholism]. G Ital Med Lav Ergon 1998; 20:260-4. [PMID: 9987620] [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: 02/10/2023]
Abstract
At present group psychotherapy is one of the most important resources in the treatment of alcoholism. Among the various theoretical orientations present in this setting, the systemic approach has always favoured interventions designed to improve interpersonal relationships. More recently, the concepts of constructivism and "narrative" therapy have laid greater emphasis upon the relational and linguistic aspect of any individual problem. Starting from these premises, a systemic-constructivistic therapy group was created for persons with problems associated with alcohol, as part of an inpatient rehabilitation programme. Given the novelty of this initiative and the particular context, several solutions were adopted that may represent a proposal for the extension of the method. The characteristics and ways in which this particular group might evolve are discussed under four headings: 1) the characteristics of the group, 2) techniques for guiding the group, 3) the role and problems facing the therapist, and 4) the recurrent problems in the life of the group.
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Affiliation(s)
- G Vittadini
- Unità Operativa di Riabilitazione Alcologica,Fondazione S. Maugeri, IRCCS, Instituto di Pavia
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30
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Biscaldi G, Finozzi E, Fonte R, Malamani T, Vittadini G, Candura SM. [Evaluation of trends in occupational pathology in clinical cases]. G Ital Med Lav 1996; 18:115-20. [PMID: 9410782] [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: 02/05/2023]
Abstract
The study considered all patients admitted to the 1st Division of Occupational Medicine, Department of Preventive, Occupational and Community Medicine of the University of Pavia between January 1st 1989 and December 31st 1995 with a diagnosis of occupational disease. It was useful in illustrating the evolution of occupational disease as regards both changes in etiology and in the symptoms and systems involved. A decrease in the number of occupational diseases diagnosed from 1993 to 1995 was revealed, but it is difficult to draw any significant conclusions from these data since the need for hospitalization when diagnosing this type of disease has diminished greatly. Changes in legislation which have obliged employers to take precise preventive measures could also be partly responsible for this downward trend. The patients were, in almost all cases, at an initial stage of their disease. This is reassuring as far as the therapeutic and legal need for an early diagnosis is concerned. However, it remains unknown how often the causal relationship between work and disease was not suspected and therefore how many cases did not arrive to observation. Finally, the study confirmed the disappearance of some occupational diseases, such as benzene intoxication, common in the past, and the increase in "emerging" pathologies like allergies.
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Affiliation(s)
- G Biscaldi
- Dipartimento di Medicina Preventiva, Occupazionale e di Comunità dell'Università di Pavia
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31
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Moscato G, Galdi E, Scibilia J, Dellabianca A, Omodeo P, Vittadini G, Biscaldi GP. Occupational asthma, rhinitis and urticaria due to piperacillin sodium in a pharmaceutical worker. Eur Respir J 1995; 8:467-9. [PMID: 7789496 DOI: 10.1183/09031936.95.08030467] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [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: 01/27/2023]
Abstract
A 28 year old man with no history of atopy was referred to our hospital for possible work-related asthma. He had been employed in the production section of a pharmaceutical company for 2 yrs, and in the last 2 months he had complained of dyspnoea, wheezing, chest tightness, symptoms of rhinitis and a cutaneous rash when exposed to powdered antibiotics. Symptoms disappeared after being transferred to the packaging section. When the subject was admitted to our department he was asymptomatic. Basal lung function tests were in the normal range. Bronchial challenges with methacholine and with ultrasonically-nebulized distilled water were negative. Skin-prick test with piperacillin sodium gave a strong positive response at a very low concentration. Specific inhalation challenge with piperacillin sodium resulted in an immediate asthmatic reaction, and also reproduced rhinitis symptoms and the cutaneous rash. A control challenge with lactose, and the specific challenge test with cefuroxime sodium (another antibiotic to which the patient was exposed at the workplace) were negative. We conclude that piperacillin sodium is an agent that can cause occupational asthma.
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Affiliation(s)
- G Moscato
- Specialization School of Allergology and Clinical Immunology, University of Pavia, Italy
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32
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Biscaldi G, Vittadini G, Fonte R, Gabanelli P, Maglio R, Finozzi E. [Employment and alcohol: analysis of a clinical casuistic]. G Ital Med Lav 1995; 17:77-82. [PMID: 8991829] [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: 02/03/2023]
Abstract
The relationship between alcohol and work was studied in a group of 537 voluntary patients (393 male and 144 female) admitted to the department of Medicina del Lavoro, Pavia University for alcohol rehabilitation. The highest incidence of alcohol abuse was found in non-working subjects (pensioners, unemployed, housewives) although the start of excessive drinking takes place after beginning a working activity; a cause-effect relationship between these two factors can not be clearly determined, however. It is true that the stress provoked by this new condition (introduction to the work experience) can, in certain subjects, be a contributing factor in alcohol abuse. The increasingly lower age of initiation to alcohol reconfirms the need for prevention and instruction even at scholastic level. We can deduce how no working condition, low age and low education can constitute makers of risk for alcohol abuse.
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Affiliation(s)
- G Biscaldi
- Dipartimento di Medicina preventiva, occupazionale e comunità, Università degli Studi di Pavia
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33
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Vittadini G, Marraccini P, Giorgi I, Caramia G, Candura F. [The personal and familial alcohol habits in groups of young men at their first military draft exam]. Minerva Med 1992; 83:445-9. [PMID: 1522968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In order to evaluate alcoholic consumption in a group of young men from an area in northern Italy, 834 subjects (18 years old) were examined at their first military check up. They compiled a questionnaire dealing with their own and their fathers' alcoholic consumption, social status, cultural habits, tobacco and drug abuse. 14.3% of the group examined were teetotalers. The alcoholic consumption of the youths was 31.44 +/- 48.8 DS alcohol g/a day versus their fathers' consumption of 44.52 +/- 42.12 DS alcohol g/a day. This difference is statistically significant (t = -8.1 p less than 0.001). No difference in alcoholic consumption was found between employed and unemployed subjects. Artisans and traders evidenced the highest levels of alcohol consumption (F = 2.58, p less than 0.009). The youths changed their alcoholic habits with respect to their own parents, preferring beer to wine consumption, although no change was observed in their approach to the alcoholic problems. The beer, like alcohol, remains a sociable and reassuring drink with positive connotations, even tough it is not considered a traditional Italian drink.
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Affiliation(s)
- G Vittadini
- Dipartimento di Medicina Preventiva, Università degli Studi di Pavia
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34
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Marraccini P, Vittadini G, Ghittori S, Giorgi I, Bonelli S, Buonocore M, Imbriani M. [Evaluation of several neuropsychological parameters in subjects occupationally exposed to anesthetics]. G Ital Med Lav 1992; 14:75-8. [PMID: 1345725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
51 workers, occupationally exposed to anaesthetic gases and vapours (nitrous oxide, halothane, and isoflurane), were studied monitoring their environmental and biological exposure. Moreover, they were tested for visual reaction times and neurobehavioural batteries. There was no evidence of important neurotoxic effects nor of neurobehavioural problems with low concentrations of anaesthetics.
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Affiliation(s)
- P Marraccini
- Fondazione Clinica del Lavoro IRCCS, Centro Medico di Pavia
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35
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36
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Solerte SB, Fioravanti M, Ferrari E, Vittadini G, Battaglia A, Candura F. [Changes in the blood rheology and an audiometric deficit in a group of patients exposed to occupational noise pollution]. G Ital Med Lav 1991; 13:55-60. [PMID: 1845459] [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: 12/29/2022]
Abstract
Several hemorheologic and plasma proteic features were analyzed in workers exposed to acoustic defilement. Whole-blood viscosity was significantly increased (at every shear-rate considered) in patients with severe sensorineural hearing impairment; whereas plasma, serum and relative viscosity remained unchanged. These variations were independent of erythrocyte deformability and aggregation, and of plasma fibrinogen levels, resulted indeed in the normal range. On the contrary plasma fibronectin was significantly increased in patients with sensorineural hearing impairment, suggesting a microvascular endothelial damage in these subjects. The exposition to acoustic defilement during work activity may be considered as aetiological factor for the development and progression of sensorineural hearing impairment, and more extensively for the occurrence of cardiovascular complications.
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Affiliation(s)
- S B Solerte
- Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia
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37
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Biscaldi G, Vittadini G, Capellini R, Fonte R, Finozzi E, D'Avino A. [Alcohol and work: comments on a clinical case load]. G Ital Med Lav 1991; 13:65-9. [PMID: 1845461] [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: 12/29/2022]
Abstract
The relationship between alcohol and work was studied in a group of 260 voluntary patients (186 male and 74 female) admitted to the unit of Medicina del Lavoro, Pavia University for alcohol rehabilitation. The highest incidence of alcohol abuse was found in non-working subjects (pensioners, unemployed, housewives) although the start of excessive drinking takes place after beginning a working activity; a cause-effect relationship between these two factors can not be clearly determined, however. It is true that the stress provoked by this new condition (introduction to the work experience) can, in certain subjects, be a contributing factor in alcohol abuse. The increasingly lower age of initiation to alcohol reconfirms the need for prevention and instruction even at scholastic level.
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Affiliation(s)
- G Biscaldi
- Dipartimento di Medicina Preventiva, Occupazionale e di Comunità, Università di Pavia
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38
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Marraccini P, Giorgi I, Valoti E, Bressan M, Fantinato D, Tettamanti F, Vittadini G. [Evaluation of neuropsychological parameters in a group of metal mechanics occupationally exposed to radio frequencies]. Med Lav 1990; 81:414-21. [PMID: 2089245] [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: 12/30/2022]
Abstract
In view of the increasing interest in electromagnetic fields, the effects on behaviour were studied in a group of foundry workers following prolonged exposure to radiofrequencies. The results of behavioural tests revealed significant differences between the exposed and control groups as regards neuropsychological performance. Anxiety and depression tests, however, indicated no pathological alterations, in contrast to previous observations. Nevertheless, the results need to be confirmed by further, more detailed studies.
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Affiliation(s)
- P Marraccini
- Dipartimento di Medicina Preventiva Occupazionale e di Comunità. I Sezione di Medicina del Lavoro, Università di Pavia
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39
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40
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Abstract
The latent variables and errors of the Lisrel model are indeterminate even when the parameters of the model are perfectly identified. The reason for the indeterminacy is that the Lisrel model gives a solution in terms of estimation of latent variables by means of observed variables. The indeterminacy is relevant also in practice; the minimum correlation between equivalent latent variables, is often negative in empirical examples. The degree of indeterminacy of the latent variables depends on the data. The average minimum correlation is a linear combination of the eigenvalues of the correlation matrix of solutions and it is always included in weak bounds which depend on the same eigenvalues.
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41
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Cupella F, Giorgi I, Vittadini G. [Alcoholism and home environment]. G Ital Med Lav 1989; 11:139-44. [PMID: 2519745] [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: 01/01/2023]
Abstract
Alcoholism is a very important social problem in our Country. Nevertheless our knowledge about the frequency and the features of alcoholism in the household environment is poor; until recently this kind of alcoholism was considered a female problem. The authors studied two homogeneous groups of male and female alcoholics. Females have a greater tendency to drink in the household. This behaviour is due to socio-cultural condition rather than to different psychological features. The authors also reported the importance of the family in the etiology, evolution and treatment of alcoholism.
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Affiliation(s)
- F Cupella
- Fondazione Clinica del Lavoro S. Maugeri I.R.C.C.S., Pavia
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42
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Abstract
B-19036 is an octadentate chelate of the paramagnetic ion Gd3+ under investigation as a proton relaxation enhancer (PRE) in magnetic resonance (MR) proton imaging. Its relaxivity was determined at 0.5 T by pulse spectrometry in various biologic fluids and in liver tissue homogenate. The ligand selectivity versus gadolinium was assessed in comparison with that versus other ions of biologic interest. Acute toxicity was determined after intravenous (IV) and intracerebral administration to mice. Pharmacokinetic studies conducted in rats indicated that unlike Gd-DTPA, where excretion is exclusively renal, biliary route plays a significant role in the excretion of B-19036, suggesting its possible use for hepatobiliary imaging.
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Affiliation(s)
- G Vittadini
- Bracco Industria Chimica, S.p.A., Milan, Italy
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43
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Antoniazzi D, Marraccini P, Giorgi I, Biazzi L, Vittadini G. [Evaluation of various psychologic parameters in a group of workers occupationally exposed to radiofrequency]. G Ital Med Lav 1988; 10:193-200. [PMID: 3154341] [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
In this study effects on psyche caused by a protract exposure to radiofrequency are examined. 13 women, occupationally exposed to radiofrequency, were subjected to a series of psychological tests in order to verify possible psychological troubles. Results seem to demonstrate a significant presence of troubles concerning social relations, anxiety and depression.
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Affiliation(s)
- D Antoniazzi
- Dipartimento di Medicina Preventiva, Occupazionale e di Communità, Università di Pavia
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44
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Formenti A, Vittadini G. [Dehydration and rehydration of the human body. Physiopathologic and clinical considerations]. G Ital Med Lav 1988; 10:85-9. [PMID: 3076875] [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
Dehydration is a frequent and important problem either occupational or athletic. Equally important is the research for a correct rehydration. The most capable beverages for the rehydration are composed by water, carbohydrates (glucose and its polymers), and electrolytes, because the absorptions of water, glucose and sodium are correlated. Moreover these solutions if properly dosed and balanced do not slacken the gastric emptying and the fluid absorption, they replace part of the exhausted carbohydrates and guarantee a good plasma electrolyte balance. To these benefits can be added the organic "stress" reduction and the physical endurance enhancement.
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Affiliation(s)
- A Formenti
- Dipartimento di medicina preventiva, occupazionale e di communità dell'Università di Pavia, Fondazione clinica del lavoro, Salvalore Maugeri
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45
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Antoniazzi D, Vittadini G, Pugliese F, Rubini V, Biazzi L. [Various psychological parameters in subjects occupationally exposed to radiofrequencies]. G Ital Med Lav 1983; 5:271-5. [PMID: 6544230] [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: 04/05/2023]
Abstract
Because of increasing interest for electromagnetic fields biological effects we examined possible effects on behaviour produced by prolonged exposition to radiofrequencies on some wood industry workers. The results of psychological tests seem to prove a significant difference between exposed and control groups in the answers concerning social relations and anxiety. However these results have to be confirmed by other and more complete studies.
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46
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Antoniazzi D, Vittadini G, Pugliese F, Franco G, Rubini V, Biazzi L. [Proposal for evaluating the psychological effects of exposure to non-ionizing radiation in the work environment]. G Ital Med Lav 1983; 5:181-6. [PMID: 6679841] [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: 01/21/2023]
Abstract
Because of the growing national and international spreading of devices producing non-ionizing radiations, the AA consider the possibility of a deep study on some of the most precious and interesting effects, though controversial at the same time, described in occupationally exposed subjects: the psychological ones. Such a study, however, presents considerable difficulties because of the great deal of personal, domestic and social factors responsible for the arising of such a symptomatology. Therefore the AA suggest the use of a set of tests particularly aiming at leaving out such factors in the genesis of the psychological troubles; this set must be previously administered to a carefully selected sample in order to verify its accuracy, reliability, sensitivity and specificity, so that it will be possible to extend afterwards the research to larger samples of population.
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Candura F, Fonte R, Vittadini G. [Health risks related to the use of coal as a source of energy]. G Ital Med Lav 1983; 5:41-46. [PMID: 6667827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Because of new increase of coal use as energy source, hazards for environment and human health of coal cycle are debated, from its extration to its combustion, taking particularly care of this last stage. At last specific hazard of coal power station workers are briefly discussed.
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Bradamante S, Colombo S, Vittadini G. Utilization of deuterium labelling and 13C NMR spectroscopy in the investigation of the condensation of 1-Methyl-5-nitroimidazole-2-aldehyde and 2-Amino-4-methylpyrimidine. J Heterocycl Chem 1981. [DOI: 10.1002/jhet.5570180724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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49
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Bellomo G, Bellazzi R, Vittadini G, Fratino P. Insulin receptors in human mononuclear leucocytes. II. Binding and degradation of insulin in obese subjects. Boll Soc Ital Biol Sper 1979; 55:661-7. [PMID: 399190] [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: 12/15/2022]
Abstract
The binding of insulin to the receptors on circulating mononuclear cells of obese subjects is significantly decreased when compared to the binding in normal subjects. This fenomenon is due to the reduction of the number of insulin receptors rather than reduction in affinity. The insulin degradation is also reduced, but a very strong correlation, similar to that demonstrated in normal subjects exist between insulin binding to its receptors and insulin degradation.
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50
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Bellomo G, Bellazzi R, Vittadini G, Fratino P. Insulin receptors in human mononuclear leucocytes. I. Binding and degradation of insulin in normal subjects. Boll Soc Ital Biol Sper 1979; 55:654-60. [PMID: 399189] [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: 12/15/2022]
Abstract
The binding and degradation of 125I-Insulin were investigated in mononuclear leukocytes of normal subjects. The binding data analysis show that the insulin degradation is strictly correlated with the binding of the hormone to its receptors: these data suggest that the binding of insulin to specific receptor is the possible first step for its degradation.
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