1,721,110 research outputs found
Studi osservazionali sull’Ipertensione Idiopatica Intracranica: un valido strumento per la comprensione della malattia
Full text linkL’ipertensione idiopatica intracranica (IIH) è una patologia neurologica rara (incidenza <2/100.000/anno) caratterizzata da un’elevata pressione del liquor in assenza di tumori cerebrali, e colpisce prevalentemente le giovani donne obese (12-20/100.000/anno). La diagnosi è basata sulla presenza del papilledema e sulla misurazione della pressione intracranica: a seconda dei criteri diagnostici, il limite minimo è fissato in 250mmH2O oppure in 200mmH2O. La patologia si presenta in maniera disomogenea ed i segni/sintomi più comuni sono: cefalea (75% dei casi), vertigini (50%), oscuramento visivo transitorio (70%), tinnito (50%), distensione dello spazio periottico subaracnoideo (80%), sella vuota (75%), appiattimento posteriore dei globi oculari (60%), stenosi o riduzione del flusso a livello dei seni venosi intracranici (60%). La prognosi è tendenzialmente buona, ma il 25% dei pazienti può perdere la vista. L’eterogeneità dell’IIH rende difficile la conduzione di ampi RCT. Gli studi osservazionali sono utili poiché generano risultati preliminari ed ipotesi di ricerca che permettano di definire le variabili di interesse, ipotizzarne l’andamento nel tempo e determinare la dimensione campionaria per studi prospettici. In questo elaborato sono stati studiati l’associazione dei segni e sintomi con la conferma della diagnosi di IIH, l’impatto dell’obesità e del Binge Eating Disorder (BED), ed il profilo di disabilità dei pazienti.
Il primo studio presenta un’analisi retrospettiva dei dati clinici, radiologici e neuro-oftalmologici di 115 pazienti ricoverati a scopo diagnostico Lo studio ha mostrato che i segni/sintomi neuro-oftalmologici e radiologici sono più sensibili di quelli neurologici per confermare a diagnosi. Inoltre ha mostrato che la diagnosi di IIH viene confermata se coesistono 7 o più segni/sintomi, mentre non viene confermata se ve ne sono 4 o meno.
Il secondo studio parte dall’osservazione della forte associazione fra IIH ed obesità e fra BED ed obesità. I pazienti con BED rispondono meno bene degli obesi senza BED ai programmi di calo ponderale: tuttavia, non esiste letteratura rispetto all’associazione fra IIH e BED. Sono stati inclusi 57 pazienti ricoverati per accertamenti diagnostici: la diagnosi di IIH è stata confermata in 38 pazienti, il BED in 7 pazienti, di cui 6 con diagnosi di IIH (15.8%). In confronto ai pazienti non obesi, gli obesi (specie quelli con BED) hanno più spesso la diagnosi di IIH (P<.001), pressione intracranica superiore a 200mmH2O (P<.001) ed atrofia del nervo ottico (P=.002). Considerando il solo gruppo di pazienti con IIH, gli obesi con BED hanno un livello di pressione intracranica superiore a quello dei pazienti senza BED (340mmH20 vs.280 mmH20; P=.037), a parità di BMI.
Il terzo studio è motivato dalla scarsità di dati relativi alla valutazione di qualità di vita, ed all’assenza di studi che abbiano valutato la disabilità, nei pazienti con IIH. Sono stati arruolati 38 pazienti, che hanno compilato il WHODAS-12 (punteggio medio 23.6). I pazienti hanno completato l’iter diagnostico e compilato il MIDAS, il BDI-II ed il questionario SF-36. I risultati mostano l’importante disabilità dei pazienti arruolati (il WHODAS-12 ha un punteggio superiore a quello osservato in altri pazienti neurologici), ed il fatto che questa sia principalmente associata alla frequenza delle cefalee ed al tono dell’umore.
Questi studi sono di interesse clinico e gestionale poichè sono basati su di un campione fortemente rappresentativo di ciò che viene visto nella pratica quotidiana: i pazienti con caratteristiche suscettive di IIH. I dati qui descritti aprono nuove prospettive per la gestione clinica e di ricerca in una patologia rara come questa: la creazione di un network di centri che si occupino di IIH e di un registro di malattia e, nel breve termine, il completamento del follow-up – almeno a 12 mesi – dei parametri valutati al baseline.Idiopathic Intracranial Hypertension (IIH) is a rare neurological disease (incidence <2/100,000/year) whose main feature is a high CSF pressure in absence of brain tumors, and mainly affect young obese women (12-20/100,000/year). IIH diagnosis is based on presence of papilloedema and on the CSF pressure measurement: according to different criteria, the lower bound is 250 or 200mmH2O. The clinical presentation is not homogeneous and the most common signs/symptoms are: headache (75% of cases), vertigo (50%), transient visual obscuration (70%), tinnitus (50%), perioptic subarachnoid space distension (80%), empty sella (75%), posterior globe flattening (60%), transverse sinus narrowing (60%). Prognosis is generally positive, although up to 25% of patients may develop long-term permanent visual loss.
IIH heterogeneous presentation and rarity make planning of wide RCT difficult. Therefore, observational studies are of utility as the enable to generate preliminary results and research hypothesis that, in turn, enable to identify core-interest variables, hypothesize longitudinal trends and define sample size for prospective studies. In this report I presented the association of relevant signs/symptoms with IIH diagnosis, the impact of obesity and Binge Eating Disorder (BED) and, finally, patients’ disability profile.
The first study reports a retrospective analysis of clinical, radiological and neuro-ophtalmological data referred to 115 patients undertaking diagnostic procedures. It was showed that radiological and neuro-ophtalmological signs/symptoms were more relevant than neurological ones to confirm IIH diagnosis and that the presence of 7 or more signs/symptoms was associated to IIH confirmation, which conversely did not happen with 4 or less.
The second study moves from the evidence of a strong association between IIH and obesity, and between BED and obesity: obese-BED patients do not respond well to weight loss programs, but no literature exists on BED-IIH association. We included 57 patients, hospitalized for diagnostic purposes: IIH was confirmed in 38, BED in 7, six of whom had IIH (15.8%). Compared to non-obese ones, obese patients (particularly those with BED) were more likely to have IIH (P200mmH2O (P<.001) and optic nerve atrophy (P=.002). If the sub-group of IIH patients is taken into account, those with BED had higher intracranial pressure (340mmH20 vs.280 mmH20; P=.037) than the non-BED counterparts, while BMI levels were comparable.
The third study moves from the paucity of studies addressing patients’ quality of life, and the lack of studies addressing disability, in patients with IIH. We enrolled 38 patients which filled in the WHODAS-12 (average score: 23.6), the MIDAS, BDI-II and SF-36. Results show a relevant disability in these patients: WHODAS-12 average score was higher than that observed in many other neurological patients. Moreover, disability associated to IIH was mostly related to headaches frequency and mood level.
In conclusion, these studies are of clinical and management importance as they are based on a sample that is highly representative of daily clinical practice, i.e. patients with clinical features that enable to suppose IIH. The information herein reported opens to new perspectives for the clinical and research activities connected to a rare disease such as IIH: in the long-run, the importance of creating a network of centers with expertise in IIH and of a clinical registry; on a short-term, the importance of completing 12-months follow-up of baseline parameters
Ageing of people with Down's syndrome: a systematic literature review from 2000 to 2014
No full textLife expectancy of people with Down's syndrome (DS) has increased considerably, now exceeding 60 years. People with DS start to get old around the age of 45. By referring to the WHO's International Classification of Functioning, Disability and Health (ICF) biopsychosocial perspective, this study aimed to present an up-to-date review of the past 14 years of literature concerning the ageing of people with DS. PUBMED, PsycInfo and the Social Sciences Citation Index were searched for studies published between 2000 and 2014. Studies were selected if they were written in English, focused on people more than 45 years of age with DS, and if terms related to DS and ageing appeared in either the title or the abstract. A total of 30 studies were retrieved and their meaningful concepts were linked to the ICF. In total, 38 ICF categories were identified that were mainly related to intellectual functions (b117) (19%), general metabolic functions (b540) (7.4%), mobility of joint functions (b710), muscle power functions (b730) (4.2%), gait pattern functions (b770) (4.2%) and structure of the brain (s110) (4.3%). Only two studies considered environmental factors, and only one considered the joint analysis of health condition and environmental factors. Data about the ageing of people with DS are predominantly based on medical evaluations and descriptions of their physical impairments. Few attempts have been made towards a comprehensive assessment of elderly people with DS with a joint analysis of their health condition and its interaction with environmental factors
A Pilot Study on Function and Disability of Aging People with Down Syndrome in Italy
No full textAn increased life expectancy of people with Down syndrome (DS) and the occurrence of early aging are now recognized. However, few data exist on functioning and disability profile of early-aging people with DS, which takes into account how health conditions interact with environmental factors. Based on the World Health Organization’s International Classification of Functioning, Disabil- ity and Health (ICF), the authors collected preliminary data describing functioning and disability about early aging from 31 adults with DS aged 45 and older residing in the greater Milan, Italy, area. ICF checklist was used to collect data. Of the 31, 18 were women (mean age = 51.1), all were unmarried, 21 lived with their family, and 23 never worked. Few problems in body functions (e.g., vision and hearing, cognitions) and body structures (e.g., ear and eye structures, cardiovascular, endocrine, and digestive systems, skin structures) were reported. ICF categories within Activity and Participation domain emphasized the facilitating effect of environ- mental factors on activities related to domestic life (e.g., doing housework, acquisition of goods and services, preparation of meals). Within the Environmental Factors domain there are few barriers, mainly with respect to labor services, and very strong facilitating factors, particularly related to product of technology (for personal indoor and outdoor mobility and transportation) and the support of family members. The authors note that the findings can set out premises for further study on aging people with DS and their caregivers at national and international levels
Migraine Outcome Should Not Be Used to Determine Diagnosis, Severity, and Therapy: Moving Towards a Multiparametric Definition of Chronicity
Full text linkChronic migraine (CM) diagnosis is nowadays based on the threshold of 15 headache days/month for three consecutive months, of which at least eight have migraine headache features. In recent years, proposals for reducing the threshold to 8 days/month have been proposed. The sole frequency parameter, however, is partial considering the variability in frequency, pain severity, associated symptoms, such as nausea, osmophobia, and photophobia, and presence of aura, but also the variable response to treatment and the association with several comorbidities. Therefore, in our opinion, a multiparameter perspective has to be taken into account that considers the underlying pathophysiology, in particular the presence of tension-type-like pain, cutaneous allodynia, and reduced pain threshold. A paradigm change in the definition of chronic migraine moves far beyond the mere 8 vs. 15 days/month, but has ethical and practical implications for treatment: should patients be treated with the most effective prophylactic drugs, i.e., monoclonal antibodies (MABs), if they enter into a new definition of CM? How should clinicians deal with treatment escalation towards MABs? What is the role of associated conditions, response to treatments, lifestyle issues, and psychological factors? And, finally, which endpoint should we use to define effectiveness? Is improvement in headache frequency enough, or should we move towards disability, quality of life, or workplace productivity
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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