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ABSTRACT: The knowledge of natural history is essential for disease management. We evaluated the natural history (e.g. frequency and characteristics of symptoms and clinical outcome) of gallstones (GS) in a population-based cohort study.
A total of 11 229 subjects (6610 men, 4619 women, age-range: 29-69 years, mean age: 48 years) were studied. At ultrasonography, GS were present in 856 subjects (338 men, 455 women) (7.1%). GS were followed by means of a questionnaire inquiring about the characteristics of specific biliary symptoms.
At enrollment, 580 (73.1%) patients were asymptomatic, 94 (11.8%) had mild symptoms and 119 (15.1%) had severe symptoms. GS patients were followed up for a mean period of 8.7 years; 63 subjects (7.3%) were lost to follow up. At the end of the follow up, of the asymptomatic subjects, 453 (78.1%) remained asymptomatic; 61 (10.5%) developed mild symptoms and 66 (11.4%) developed severe symptoms. In subjects with mild symptoms, the symptoms disappeared in 55 (58.5%), became severe in 23 (24.5%), remained stable in 16 (17%); in subjects with severe symptoms, the symptoms disappeared in 62 (52.1%), became mild in 20 (16.8%) and remained stable in 37 (31.1%). A total of 189 cholecystectomies were performed: 41.3% on asymptomatic patients, 17.4% on patients with mild symptoms and 41.3% on patients with severe symptoms.
This study indicates that: (i) asymptomatic and symptomatic GS patients have a benign natural history; (ii) the majority of GS patients with severe or mild symptoms will no longer experience biliary pain; and (iii) a significant proportion of cholecystectomies are performed in asymptomatic patients. Expectant management still represents a valid therapeutic approach in the majority of patients.
Journal of Gastroenterology and Hepatology 04/2010; 25(4):719-24. · 2.87 Impact Factor
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ABSTRACT: To investigate the co-dispensing of contraindicated medications in patients using cisapride in an Italian population.
The study included patients who had at least one cisapride prescription dispensed between 1 April 1997 and 30 September 2000. The proportion of cisapride users with concomitant medications, the proportion of prescriptions of cisapride with an overlapping dispensing of a contraindicated medication and the proportion of person-days of cisapride use concomitant with contraindicated medications, were calculated.
In the 4-year study period, 249,740 total cisapride prescriptions, which corresponded to 382,835 packages, were dispensed to 91,204 users (52,442 female, 57.5%). Concomitant use of contraindicated drugs was identified in 4403 cisapride users (4.83%). Throughout the study period, there was an increase in the proportion of cisapride users with contraindicated co-prescriptions: 4.29% in 1997, 4.99% in 1998, 5.15% in 1999, but a decline to 3.34% in 2000. In each year, this figure was higher in males, with the highest proportion reported in 1999 (5.50%). A total of 7215 cisapride prescriptions (2.85%) were concomitant with contraindicated drugs, ranging from 2.27% in September 1998 to 3.55% in January 1999. Cisapride prescriptions were most frequently associated with macrolide antibiotics (1.14%) and class III antiarrhythmics (1.03%).
In the period 1997-2000, a substantial proportion of cisapride prescriptions were concomitant with contraindicated medications. In Italy in 1998, the National Health Authority issued a bulletin warning about the risk of serious arrhythmias after concomitant use of contraindicated drugs. Despite this warning, there was no reduction in contraindicated drug uses.
Pharmacoepidemiology and Drug Safety 08/2006; 15(7):469-76. · 2.53 Impact Factor
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MSCE Tommaso Staniscia MD,
MS Ferdinando Romano MD,
Davide Festi MD,
Warren B. Bilker PhD,
MSCE George A. Macones MD,
MPH Brian L. Strom MD,
Tommaso Staniscia, Ferdinando Romano,
Davide Festi,
Warren B. Bilker,
George A. Macones,
Brian L. Strom
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ABSTRACT: PurposeTo investigate the co-dispensing of contraindicated medications in patients using cisapride in an Italian population.Methods
The study included patients who had at least one cisapride prescription dispensed between 1 April 1997 and 30 September 2000. The proportion of cisapride users with concomitant medications, the proportion of prescriptions of cisapride with an overlapping dispensing of a contraindicated medication and the proportion of person-days of cisapride use concomitant with contraindicated medications, were calculated.ResultsIn the 4-year study period, 249 740 total cisapride prescriptions, which corresponded to 382 835 packages, were dispensed to 91 204 users (52 442 female, 57.5%). Concomitant use of contraindicated drugs was identified in 4403 cisapride users (4.83%). Throughout the study period, there was an increase in the proportion of cisapride users with contraindicated co-prescriptions: 4.29% in 1997, 4.99% in 1998, 5.15% in 1999, but a decline to 3.34% in 2000. In each year, this figure was higher in males, with the highest proportion reported in 1999 (5.50%). A total of 7215 cisapride prescriptions (2.85%) were concomitant with contraindicated drugs, ranging from 2.27% in September 1998 to 3.55% in January 1999. Cisapride prescriptions were most frequently associated with macrolide antibiotics (1.14%) and class III antiarrhythmics (1.03%).Conclusions
In the period 1997–2000, a substantial proportion of cisapride prescriptions were concomitant with contraindicated medications. In Italy in 1998, the National Health Authority issued a bulletin warning about the risk of serious arrhythmias after concomitant use of contraindicated drugs. Despite this warning, there was no reduction in contraindicated drug uses. Copyright © 2006 John Wiley & Sons, Ltd.
Pharmacoepidemiology and Drug Safety 06/2006; 15(7):469 - 476. · 2.53 Impact Factor
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ABSTRACT: The aim of this study was to describe the prevalence and distribution, by gender, of occlusal traits in a sample of Italian students aged 11-14 years (mean 13 +/- 1 years). Using standardized and validated recording criteria, a single operator measured the overjet, overbite, open bite, anterior and posterior crossbites, crowding, coincidence of the upper and lower midlines, and diastema, in 810 secondary school students (53.6 per cent males). Chi-square, t-test statistics, and odds ratios (ORs) with 95 per cent confidence intervals (CI) were used to investigate the relationship between gender and malocclusion characteristic. Logistic regression was used to further analyse the independent association between gender and each outcome measure. Ninety-three per cent of the subjects showed at least one occlusal trait, with one or two anomalies recorded in 63 per cent of children. The prevalence of occlusal traits ranged from 1.1 (negative overjet) to 54 per cent (upper and lower midlines not coincident). Males were more likely than females to show both an increased overbite and an increased overjet, although the latter result was not confirmed by logistic regression (P = 0.05). Multivariate analysis showed a negative association between overbite and misalignment of the lower incisors and lack of coincidence of the upper and lower midlines, whereas subjects with an increased overbite were more likely to have an increased overjet (all P < 0.01). Further studies are required in order to further clarify these findings and to provide accurate estimates of the orthodontic treatment need in Italian adolescents.
The European Journal of Orthodontics 01/2006; 27(6):601-6. · 0.89 Impact Factor
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ABSTRACT: The aim of the present cross-sectional analysis was to describe patterns and determinants of use of hormone replacement therapy (HRT) in a large sample of women attending mammographic screening.
Between 1999 and 2001, 8533 women aged 50-70 years were recruited by 11 screening centres, and structured interviews were made collecting information on socio-demographic characteristics, lifestyle habits, medical and reproductive history (overall response rate 87%).
Current HRT use was reported by 6.9% of women (n=585), the average duration of use being 3.5 years; 13.2% were ever HRT users. Binomial and multinomial logistic regression (MLR) analyses showed that younger age, higher educational level, past mammographic examination and history of bilateral oophorectomy were the major predictors of current and ever HRT use. Current use was also more frequently reported by women who were thinner, nulliparae, had had induced menopause, had a later onset of menopause, with history of oral contraceptive use and hysterectomy without bilateral oophorectomy. By contrast, those who were diabetics or had positive history of cardiovascular disease were less likely to be current HRT users. No differences were found in HRT use according to marital status, type of occupation, menopausal status, smoking, history of breast cancer, hypercholesterolemia, hypertension and phlebitis.
Our results support previous findings indicating that HRT use in Italian women is uncommon and of short duration. Current HRT users were less likely than non-users to report several characteristics associated with higher mortality and morbidity, in accordance with the healthy-user phenomenon described in other countries.
Maturitas 12/2004; 49(3):241-51. · 2.77 Impact Factor
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Domenico D'Antonio, Ferdinando Romano,
Eugenio Pontieri,
Giuseppe Fioritoni,
Claudia Caracciolo,
Stefano Bianchini,
Paola Olioso,
Tommaso Staniscia,
Roberta Sferra,
Stefania Boccia,
Antonella Vetuschi,
Giovanni Federico,
Eugenio Gaudio,
Giuseppe Carruba
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ABSTRACT: Candida lipolytica was recovered from the blood and the central venous catheter in a patient receiving allogeneic bone marrow transplantation. Two C. lipolytica strains from different geographical areas and the ATCC 9773 strain of C. lipolytica were used as controls. C. lipolytica was identified by standard methods. MICs indicated antifungal susceptibilities to amphotericin B, fluconazole, and itraconazole for all strains. In vitro testing and scanning electron microscopy showed that C. lipolytica was capable of producing large amounts of viscid slime material in glucose-containing solution, likely responsible for the ability of the yeast to adhere to catheter surfaces. Restriction fragment length polymorphisms revealed an identical profile for all clinical isolates, unrelated to those observed for the control strains. This finding suggested the absence of microevolutionary changes in the population of the infecting strain, despite the length of the sepsis and the potential selective pressure of amphotericin B, which had been administered to the patient for about 20 days. The genomic differences that emerged between the isolates and the control strains were indicative of a certain degree of genetic diversity between C. lipolytica isolates from different geographical areas.
Journal of Clinical Microbiology 05/2002; 40(4):1381-6. · 4.15 Impact Factor
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ABSTRACT: Despite the many efforts to delineate the clinical manifestations of gallbladder disease, the precise symptom complex associated with gallstones is still a matter of debate, and even the existence of gallstone-specific symptoms has been questioned. We carried out a large population-based cross-sectional study (MICOL) to identify symptoms significantly related to gallstones. Fourteen centers throughout Italy enrolled 29,504 subjects aged 30 to 69 years. All subjects were administered an ultrasonographic examination of the upper abdomen and a precoded questionnaire. All subjects were divided into 4 groups: 25,374 (86.0%) gallstone-free subjects (GF), 1,832 (6.2%) patients with gallstones not previously diagnosed (GNPD), 638 (2.2%) patients with gallstones previously diagnosed (GPD), 1,660 (5.6%) patients with a history of cholecystectomy for gallstones (CC). In logistic regression analysis, pain at epigastrium and, even more, pain at right hypocondrium were significantly associated with gallstones. For pain at right hypocondrium, this association progressively increased from GNPD (OR = 1.60, 95% CI = 0.97-2.65) to GPD (OR = 8.77, 95% CI = 5.27-14.61) to CC (OR = 59.40, 95% CI = 43.87-80.42). Absence of heartburn combined with right hypocondrium or epigastrium pain and intolerance to fried or fatty food were also significantly related to gallstones. We also found some pain characteristics significantly associated with gallstones, i.e., pain radiated to the right shoulder, forcing the patient to rest, occurring soon after meals or unrelated to meals, not relieved by bowel movements, and frequently accompanied by gallstone-related morbidities. We developed a probability tree reporting the cumulative probability of having gallstones for each combination of those symptoms and characteristics of pain significantly associated with gallstones. In conclusion, we have identified symptoms and signs significantly associated with gallstones. We have shown that there is an increase in frequency and severity of these symptoms and signs across the different stages of gallstone disease. We have proposed a complex of symptoms and signs significantly associated with gallstones that might help physicians in clinical decision making.
Hepatology 09/1999; 30(4):839 - 846. · 11.66 Impact Factor
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ABSTRACT: The health effects of low-dose ionizing radiation have been widely studied, but remain uncertain. Up-to-date knowledge about epidemiologic evidence for potential human health effects of low dose ionizing radiation is important for revising national radiation protection legislation. This review, conducted by a multidisciplinary research team of the Italian Institute of Social Medicine, evaluates epidemiologic studies published since July 2003. After careful selection, a total of 302 studies were reviewed. Greater emphasis was given to papers that analyzed data using standardized incidence and mortality ratios and to studies regarding occupational exposures in all workers, healthcare workers and aircrew members. Nevertheless, studies regarding A-bomb survivors of Hiroshima/Nagasaki, Chernobyl cleanup workers, patients exposed for medical reasons, and workers in nuclear plants were also included. Given the limitations of epidemiological studies and excluding the cosmic rays context, which requires further research, the authors conclude that harmful effects from exposures to ionizing radiation at doses lower than 100 mSv cannot be ruled out. Nevertheless, if any harmful health effects do exist, they are certainly very small. The implications for radiation protection, public health and forensic medicine are discussed.
Igiene e sanita pubblica 60(1-2):81-102.
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