Vito Lepore

Publications (15)79.72 Total impact

• Article: Association of aspirin use with major bleeding in patients with and without diabetes.

  Giorgia De Berardis, Giuseppe Lucisano, Antonio D'Ettorre, Fabio Pellegrini, Vito Lepore, Gianni Tognoni, Antonio Nicolucci
  [show abstract] [hide abstract]
  ABSTRACT: The benefit of aspirin for the primary prevention of cardiovascular events is relatively small for individuals with and without diabetes. This benefit could easily be offset by the risk of hemorrhage. To determine the incidence of major gastrointestinal and intracranial bleeding episodes in individuals with and without diabetes taking aspirin. A population-based cohort study, using administrative data from 4.1 million citizens in 12 local health authorities in Puglia, Italy. Individuals with new prescriptions for low-dose aspirin (≤300 mg) were identified during the index period from January 1, 2003, to December 31, 2008, and were propensity-matched on a 1-to-1 basis with individuals who did not take aspirin during this period. Hospitalizations for major gastrointestinal bleeding or cerebral hemorrhage occurring after the initiation of antiplatelet therapy. There were 186,425 individuals being treated with low-dose aspirin and 186,425 matched controls without aspirin use. During a median follow-up of 5.7 years, the overall incidence rate of hemorrhagic events was 5.58 (95% CI, 5.39-5.77) per 1000 person-years for aspirin users and 3.60 (95% CI, 3.48-3.72) per 1000 person-years for those without aspirin use (incidence rate ratio [IRR], 1.55; 95% CI, 1.48-1.63). The use of aspirin was associated with a greater risk of major bleeding in most of the subgroups investigated but not in individuals with diabetes (IRR, 1.09; 95% CI, 0.97-1.22). Irrespective of aspirin use, diabetes was independently associated with an increased risk of major bleeding episodes (IRR, 1.36; 95% CI, 1.28-1.44). In a population-based cohort, aspirin use was significantly associated with an increased risk of major gastrointestinal or cerebral bleeding episodes. Patients with diabetes had a high rate of bleeding that was not independently associated with aspirin use.
  JAMA The Journal of the American Medical Association 06/2012; 307(21):2286-94. · 30.03 Impact Factor
• Article: ALS multidisciplinary clinic and survival

  Stefano Zoccolella, Ettore Beghi, Guerrino Palagano, Angela Fraddosio, Vito Guerra, Vito Lepore, Isabella Laura Simone, Paolo Lamberti, Luigi Serlenga, Giancarlo Logroscino
  [show abstract] [hide abstract]
  ABSTRACT: Background Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease affecting motorneurons, for which there is no effective cure. Because of the multifactorial nature of impairment and disablity in ALS, multidisciplinary clinics (MDC) have been recently introduced in the management of ALS patients; their effects on survival remain, however, largely debated. Objective To compare survival of ALS patients who received their care at MDC with that of patients followed by general neurology clinics. Methods Source of the study was a prospective population-based registry of ALS established in Puglia, Southern Italy, in 1997. We examined survival of 126 out of 130 incident ALS cases that were diagnosed during the period 1998–99. Results 84 patients (67%) were enrolled and followed by MDC and the remaining 42 (33%) by general neurological clinics. No difference in median survival time from the diagnosis was observed between patients followed by ALS multidisciplinary (17.6 months) and general clinics (18 months). No beneficial effect was present among bulbar onset ALS (11.7 versus 23 months). In multivariate analysis management by ALS MDC was associated with only a 10% increase in survival probability at 12 months (HR: 0.91; 95%CI: 0.44–1.89; p = 0.9). Conclusions In this population-based series, we found that in Southern Italy management of ALS by multidisciplinary clinics does not improve survival, regardless of site of symptoms onset. Key words amyotrophic lateral sclerosis-multidisciplinary clinic-survival
  Journal of Neurology 04/2012; 254(8):1107-1112. · 3.47 Impact Factor
• Article: Rate of MMSE score change in Alzheimer's disease: influence of education and vascular risk factors.

  Francesco Roselli, Bruno Tartaglione, Francesco Federico, Vito Lepore, Giovanni Defazio, Paolo Livrea
  [show abstract] [hide abstract]
  ABSTRACT: To test whether higher education accelerates Alzheimer's Disease (AD) progression rate through an effect on the cognitive reserve capabilities of an individual. We investigated the influence of schooling and other demographic and clinical conditions (including age, sex, diabetes, arterial hypertension, and acetyl cholinesterase inhibitor--AcheI--therapy) on Mini Mental Status Examination (MMSE) score changes over time in 162 AD patients as well as the interaction of schooling with the above conditions using the Generalized Estimated Equation procedure. Generalized Estimated Equation procedure yielded an overall progression rate of 0.24 MMSE points per month. Patients with education > or = 8 years showed a faster cognitive decline. Male sex, occurrence of arterial hypertension and type II diabetes, and lack of AcheI therapy were associated to faster decline. Stratifying by gender, vascular risk factors, and AcheI therapy, we observed a significant interaction between education and time in the subgroup of patients who had vascular risk factors, and in those who were not treated with AcheI. These results confirm that schooling may be a significant predictor of cognitive decline as measured by MMSE in persons with AD and provide epidemiological support to "cognitive reserve" model.
  Clinical neurology and neurosurgery 12/2008; 111(4):327-30. · 1.30 Impact Factor
• Article: Predictors of long survival in amyotrophic lateral sclerosis: a population-based study.

  Stefano Zoccolella, Ettore Beghi, Guerrino Palagano, Angela Fraddosio, Vito Guerra, Vito Samarelli, Vito Lepore, Isabella Laura Simone, Paolo Lamberti, Luigi Serlenga, Giancarlo Logroscino
  [show abstract] [hide abstract]
  ABSTRACT: Although amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disorder, some ALS cases can survive beyond 10 years. However, the predictors of long survival in ALS patients remain uncertain. To define clinical predictors of long survival in a cohort of ALS incident cases. One hundred-thirty incidents cases, diagnosed in 1998--1999 and classified according to the El Escorial criteria (EEC), were enrolled from a prospective population-based registry established in Puglia, Italy. All but two cases were followed-up until death or November 30, 2006. Thirteen patients (high 10% of the survivors) were classified as long survivors (LS), 13 as short survivors (SS) (low 10%), and 102 as average survivors (AS). LS presented a lower frequency of bulbar onset (8% versus 29% of AS and 39% of SS; p=0.1) and a significantly longer time between symptom onset to diagnosis [(ODI): 13 months versus 10 and 6; p=0.0005]. In multivariate analysis, predictors of long survival were younger age at diagnosis (>65 compared to < or =45 years: odds ratio (OR):18.9; 95%CI: 1.8-194.7; p=0.04), longer interval onset-diagnosis (< or =9 months compared to >9 months, OR: 7.9; 95%CI: 1.3-47; p=0.02) and clinical features with predominant upper motor neuron signs (OR: 8.5; 95%CI: 1.1-64.2; p=0.04). In this population-based study, younger age, longer interval onset to diagnosis, and clinical features with predominance of upper motor signs predicted long survival, while EEC category at diagnosis did not.
  Journal of the Neurological Sciences 05/2008; 268(1-2):28-32. · 2.35 Impact Factor
• Article: ALS multidisciplinary clinic and survival. Results from a population-based study in Southern Italy.

  Stefano Zoccolella, Ettore Beghi, Guerrino Palagano, Angela Fraddosio, Vito Guerra, Vito Lepore, Isabella Laura Simone, Paolo Lamberti, Luigi Serlenga, Giancarlo Logroscino
  [show abstract] [hide abstract]
  ABSTRACT: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease affecting motorneurons, for which there is no effective cure. Because of the multifactorial nature of impairment and disablity in ALS, multidisciplinary clinics (MDC) have been recently introduced in the management of ALS patients; their effects on survival remain, however, largely debated. To compare survival of ALS patients who received their care at MDC with that of patients followed by general neurology clinics. Source of the study was a prospective population-based registry of ALS established in Puglia, Southern Italy, in 1997. We examined survival of 126 out of 130 incident ALS cases that were diagnosed during the period 1998-99. 84 patients (67%) were enrolled and followed by MDC and the remaining 42 (33%) by general neurological clinics. No difference in median survival time from the diagnosis was observed between patients followed by ALS multidisciplinary (17.6 months) and general clinics (18 months). No beneficial effect was present among bulbar onset ALS (11.7 versus 23 months). In multivariate analysis management by ALS MDC was associated with only a 10% increase in survival probability at 12 months (HR: 0.91; 95%CI: 0.44-1.89; p = 0.9). In this population-based series, we found that in Southern Italy management of ALS by multidisciplinary clinics does not improve survival, regardless of site of symptoms onset.
  Journal of Neurology 09/2007; 254(8):1107-12. · 3.47 Impact Factor
• Article: New natural history of interferon-beta-treated relapsing multiple sclerosis.

  Maria Trojano, Fabio Pellegrini, Aurora Fuiani, Damiano Paolicelli, Valentina Zipoli, Giovanni B Zimatore, Elisabetta Di Monte, Emilio Portaccio, Vito Lepore, Paolo Livrea, Maria Pia Amato
  [show abstract] [hide abstract]
  ABSTRACT: To investigate the impact of interferon-beta (IFNbeta) on disease progression in relapsing-remitting multiple sclerosis patients. A cohort of 1,504 relapsing-remitting multiple sclerosis (1,103 IFNbeta-treated and 401 untreated) patients was followed for up to 7 years. Cox proportional hazards regression adjusted for propensity score inverse weighting was used to assess the differences between the two groups for three different clinical end points: secondary progression (SP) and irreversible Expanded Disability Status Scale (EDSS) scores 4 and 6. Times from first visit and from date of birth were used as survival time variables. The IFNbeta-treated group showed a highly significant reduction in the incidence of SP (hazard ratio [HR], 0.38, 95% confidence interval [CI], 0.24-0.58 for time from 1st visit; HR, 0.36, 95% CI, 0.23-0.56 for time from date of birth; p < 0.0001), EDSS score of 4 (HR, 0.70, 95% CI, 0.53-0.94 for time from first visit; HR, 0.69, 95% CI, 0.52-0.93 for time from date of birth; p < 0.02), and EDSS score of 6 (HR, 0.60, 95% CI, 0.38-0.95 for time from first visit; HR, 0.54, 95% CI, 0.34-0.86 for time from date of birth; p < or = 0.03) when compared with untreated patients. SP and EDSS scores of 4 and 6 were reached with significant delays estimated by times from first visit (3.8, 1.7, and 2.2 years) and from date of birth (8.7, 4.6, and 11.7 years) in favor of treated patients. Sensitivity analysis confirmed findings. IFN-beta slows progression in relapsing-remitting multiple sclerosis patients.
  Annals of Neurology 04/2007; 61(4):300-6. · 11.09 Impact Factor
• Article: New natural history of interferon‐β–treated relapsing multiple sclerosis

  Maria Trojano MD, Fabio Pellegrini MscStat, Aurora Fuiani MD, Damiano Paolicelli MD, Valentina Zipoli MD, Giovanni B. Zimatore MD, Elisabetta Di Monte MD, Emilio Portaccio MD, Vito Lepore MD, Paolo Livrea MD, [......], Fabio Pellegrini, Aurora Fuiani, Damiano Paolicelli, Valentina Zipoli, Giovanni B. Zimatore, Elisabetta Di Monte, Emilio Portaccio, Vito Lepore, Paolo Livrea, Maria Pia Amato
  [show abstract] [hide abstract]
  ABSTRACT: Objective To investigate the impact of interferon-beta (IFNβ) on disease progression in relapsing-remitting multiple sclerosis patients.MethodsA cohort of 1,504 relapsing-remitting multiple sclerosis (1,103 IFNβ–treated and 401 untreated) patients was followed for up to 7 years. Cox proportional hazards regression adjusted for propensity score inverse weighting was used to assess the differences between the two groups for three different clinical end points: secondary progression (SP) and irreversible Expanded Disability Status Scale (EDSS) scores 4 and 6. Times from first visit and from date of birth were used as survival time variables.ResultsThe IFNβ–treated group showed a highly significant reduction in the incidence of SP (hazard ratio [HR], 0.38, 95% confidence interval [CI], 0.24–0.58 for time from 1st visit; HR, 0.36, 95% CI, 0.23–0.56 for time from date of birth; p < 0.0001), EDSS score of 4 (HR, 0.70, 95% CI, 0.53–0.94 for time from first visit; HR, 0.69, 95% CI, 0.52–0.93 for time from date of birth; p < 0.02), and EDSS score of 6 (HR, 0.60, 95% CI, 0.38–0.95 for time from first visit; HR, 0.54, 95% CI, 0.34–0.86 for time from date of birth; p ≤ 0.03) when compared with untreated patients. SP and EDSS scores of 4 and 6 were reached with significant delays estimated by times from first visit (3.8, 1.7, and 2.2 years) and from date of birth (8.7, 4.6, and 11.7 years) in favor of treated patients. Sensitivity analysis confirmed findings.InterpretationIFN-β slows progression in relapsing-remitting multiple sclerosis patients. Ann Neurol 2007;61:300–306
  Annals of Neurology 03/2007; 61(4):300 - 306. · 11.09 Impact Factor
• Article: Predictors of delay in the diagnosis and clinical trial entry of amyotrophic lateral sclerosis patients: a population-based study.

  Stefano Zoccolella, Ettore Beghi, Guerrino Palagano, Angela Fraddosio, Vito Samarelli, Paolo Lamberti, Vito Lepore, Luigi Serlenga, Giancarlo Logroscino
  [show abstract] [hide abstract]
  ABSTRACT: The El Escorial and the revised Airlie House diagnostic criteria for amyotrophic lateral sclerosis (ALS) were introduced to select patients for clinical trials. Heterogeneity of clinical presentation at onset and delay in diagnosis may decrease the likelihood for trial entry. Identify risk factors for delay in the diagnosis and trial exclusion. ALS incident cases were identified with El Escorial (EEC) and Airlie House criteria (AHC) through a population-based registry established in Puglia, Southern Italy, in the years 1998-99. 130 ALS incident cases were diagnosed with a median interval between onset of symptoms and diagnosis of 9.3 months and not different across both EEC and AHC categories. Twenty percent of cases were not eligible for clinical trials according to the AHC. About 5% of subjects in this series died with only lower motor neuron signs. Predictors for delay in the diagnosis were age between 65 and 75 years and spinal onset while fasciculations and cramps as first symptoms were predictors of exclusion from trials. In this population-based series, diagnostic delay was longer in subjects with spinal onset and age between 65 and 75 and fasciculation as first symptoms. About 80% of incident cases were trial eligible with AHC criteria. However, a significant number of subjects with ALS, characterized by a limited spread of signs, were not trial eligible while alive.
  Journal of the Neurological Sciences 01/2007; 250(1-2):45-9. · 2.35 Impact Factor
• Article: Antithrombotic treatment is strongly underused despite reducing overall mortality among high-risk elderly patients hospitalized with atrial fibrillation.

  Simona Monte, Alejandro Macchia, Fabio Pellegrini, Marilena Romero, Vito Lepore, Antonio D'Ettorre, Mario Saugo, Luigi Tavazzi, Gianni Tognoni
  [show abstract] [hide abstract]
  ABSTRACT: To assess the use of antithrombotic treatment (ATT) after hospitalization with atrial fibrillation (AF) and the attributable effectiveness of ATT during follow-up. On the basis of record linkage of administrative registers, 1812 patients discharged with AF were identified and followed-up for major clinical events up to 1 year. Mean age was 79 years. After hospitalization, 56% of the patients received ATT: 29% anticoagulants, 22% antiplatelets (APs), and 5% both agents. Among patients without comorbidities, 63.0% were exposed to ATT. Several factors significantly influence the use of antithrombotic agents, including increasing age [odds ratio (OR) 0.93 (95% confidence interval (CI), 0.92-0.95)], chronic obstructive pulmonary disease [0.77 (0.59-1.00)], malignancy [0.57 (0.39-0.82)], and previous use of ATT [4.56 (3.67-5.67)]. A significantly lower mortality was observed in patients exposed to ATT [hazard ratio (HR) 0.36 (95% CI, 0.28-0.47)], both to anticoagulants [0.23 (0.15-0.35)] and to APs [0.66 (0.50-0.86)]. ATT was associated with the reduction of thrombo-embolic events [0.52 (0.25-1.07)]. Major bleeding did not contribute to increased morbidity. Subgroups analysis, propensity score (PS), and sensitivity analysis confirmed these results. Our data demonstrated that ATT was underused, also in patients without comorbidities. Exposure to ATT is associated with improved survival among elderly high-risk community patients hospitalized with AF.
  European Heart Journal 10/2006; 27(18):2217-23. · 10.48 Impact Factor
• Article: Brain abscess: a need to screen for pulmonary arteriovenous malformations.

  Mauro Gallitelli, Vito Lepore, Giovanna Pasculli, Leonardo Di Gennaro, Giancarlo Logroscino, Aristide Carella, Robert Ingersoll White, Carlo Sabbà
  [show abstract] [hide abstract]
  ABSTRACT: Pulmonary arteriovenous malformations (PAVMs) are direct connections between an artery and a vein in the pulmonary circulation associated with hereditary hemorrhagic telangiectasia in up to 88% of cases. Patients with PAVMs are at increased risk of brain abscess (BA). This study aimed to provide preliminary data on the prevalence of PAVMs among BA patients. Administrative hospital discharge forms were used to identify patients with BA; possible PAVM patients were screened. 126 patients with BA were identified. Two patients had undiagnosed PAVMs at the time of admission for BA. The age-adjusted incidence of BA was 6.3 cases/1 million/year, with a male:female ratio of 2.0. Although PAVMs are rare conditions, they play a role in the development of BA. PAVMs are usually not recognized at the time of BA, thus exposing patients to life-threatening risks.
  Neuroepidemiology 02/2005; 24(1-2):76-8. · 2.31 Impact Factor
• Article: [Epidemiology without numbers: nurses tell their perception, and the management strategies, of the behavioral problems of the elderly].

  Fosca Andriolo, Morgan Bertollo, Sergio Bragagnolo, Luciano Caoduro, Marisa Caon, Monica Daminato, Dolores De Sabbata, Vittorina Dei Tos, Rosanna Favaro, Silvia Fraccaro, [......], Anna Malvestio, Daniela Mardegan, Palmira Pellizzon, Cinzia Tieppo, Paolo Totaro, Emma Visentin, Antonella Zanatta, Fernanda Zonta, Giovanna Cecchetto, Vito Lepore
  [show abstract] [hide abstract]
  ABSTRACT: To assess the practicability of caring strategies which rely on the subjective resources and insights of nursing personnel in the management of behavioral problems of the elderly. Following the indications of a training session, the nurses in charge of a residential geriatric department have been invited to express, through brief written accounts, their point of view on: 1. the definition(s) of behavioral problems; 2. the strategies adopted before or with or in the place of psychotropic drugs; 3. the experience gained from significative responses to non-pharmacological treatments. All the narratives by individual participants are reported to document, through the variability of their languages, concepts, interventions, the need as well as the possibilities of caring behaviors, where listening attitudes are practiced, thus allowing also a better awareness of original role opportunities. Narrative practices can usefully be incorporated into caring duties and contexts, and represent an important training tool, specifically relevant for the grey areas of medicine.
  Assistenza infermieristica e ricerca: AIR 26(1):24-31. · 0.35 Impact Factor
• Article: [Perception as an area of research].

  Gianni Tognoni, Vito Lepore
  Assistenza infermieristica e ricerca: AIR 23(1):34-5. · 0.35 Impact Factor
• Article: [Old and very old age, and "life expectancy"?].

  Vito Lepore, Giovanna Cecchetto, Paola Di Giulio, Luisa Saiani, Vito Samarelli, Mario Saugo, Marilena Romero, Veronica Scurti, Gianni Tognoni, Marta Valerio
  Assistenza infermieristica e ricerca: AIR 26(4):234-43. · 0.35 Impact Factor
• Article: [Prescriptions profile of the elderly population].

  Gianni Tognoni, Vito Lepore
  Assistenza infermieristica e ricerca: AIR 22(4):216-26. · 0.35 Impact Factor
• Article: [Administrative data as source for epidemiological research: clinical pathways of diabetic patients].

  Lara Monesi, Clara Rosso Fernandez, Antonio D'Ettorre, Marilena Romero, Elisa Sasso, Vito Lepore, Gianni Tognoni, Gabriella Monesi, Annalisa Ferrarese
  [show abstract] [hide abstract]
  ABSTRACT: Objectives 1. To assess if record linkage of two different databases could improve the quality and understand the epidemiology of diabetes and its complications. 2. To analyse how hospitalization relates to the natural history of the disease and to its pharmaceutical management. 3. To document how pharmacoepidemiology could be a challenging tool for clinicians. 4. To identify critical areas where improvement of care would be specifically important. METHODS: Data came from two large databases, the drugs prescription and the hospital discharge forms of the Local Health Unit of Rovigo, Italy, collected through 2000. A casecontrol design was adopted to compare two cohorts identified by prescription of antidiabetic vs any other drugs and the linkage to their hospitalizations over the index period. The study was focused on people > or = 50 year in order to concentrate the attention on NIDDM. A population of 5.603 patients were identified as diabetic and 63.155 were the controls. The prevalence of diabetes was 3.6% in the general population and 8.1% in 50 year and older. The hospitalizations analysis revealed differences between cases and controls in term of longer duration of stay (10.1 vs 8.4 days), higher in-hospital mortality (5.5% vs 5%) and higher presence of cardiovascular complications. Of the 2.922 hospitalizations registered for diabetics, 43% did not report the specific ICD-9-CM code for diabetic disease (250.x). Record linkage of these administrative databases offers new opportunities to improve the comprehension of the natural history of diabetic disease. The identification of diabetic patients from prescription data allows a more reliable picture of the hospitalization than the simple analyses of hospital discharge forms. Up to 43% of hospitalizations in the diabetic cohort did not report the specific diabetic disease diagnosis, compared to the 25% reported in a previous observation where linkage was not applied. The lack of this code registration during hospitalization can reflect a scant perception of the importance of diabetes as the major determinant of complications and could open a discussion table with other clinicians, general practitioners and health care professionals.
  Assistenza infermieristica e ricerca: AIR 22(2):81-90. · 0.35 Impact Factor