We aimed to investigate the association of the clinical variables of the metabolic syndrome (MS) and psychological parameters on health-related quality of life (HRQL) in obesity. In particular, our ...aim was to investigate the relative impact of physical symptoms, somatic diseases and psychological distress on both the physical and the mental domains of HRQL.
Cross-sectional study.
A cohort of 1822 obese outpatients seeking treatment in medical centers.
HRQL was measured by the standardized summary scores for physical (PCS) and mental (MCS) components of the Short Form 36 Health Survey (SF-36). Patients were grouped according to tertiles of PCS and MCS. Metabolic and psychological profiles of PCS and MCS tertiles were compared by discriminant analysis.
The profile of metabolic and psychological variables was tertile-specific in 62.4 and 68.3% of patients in the lowest and highest tertiles of PCS, respectively, while concordance was low in the mid-tertile (32.8%). Concordance was very high in the lowest (74.4%) and in the highest (75.5%) tertiles of MCS, and was fair in the mid-tertile (53.2%). The main correlates of PCS were obesity-specific and general psychological well-being, BMI, body uneasiness, binge eating, gender and psychiatric distress. Only hypertension and hyperglycemia qualified as correlates among the components of MS. The components of MS did not define MCS.
Psychological well-being is the most important correlate of HRQL in obesity, both in the physical and in the mental domains, whereas the features of MS correlate only to some extent with the physical domain of HRQL.
To investigate the predictive value for hepatic steatosis of a new software for the quantification of visceral fat by dual-energy X-ray absorptiometry (DXA) and to design new regions of interest ...(ROIs).
Adult volunteers were prospectively screened for hepatic steatosis by ultrasonography to obtain a well-balanced population according to the presence/absence of the disease. 90 adult patients without steatosis and 90 with steatosis (mild, 53.3%; moderate, 37.7%; and severe, 10.0%) were recruited. On the same day, all subjects were submitted to blood testing and to anthropometric and whole-body DXA for body composition evaluation. A new software for android visceral fat assessment was employed, and six new "liver-suited" ROIs as well as two modified android ROIs were designed. Their association with steatosis grade was tested by correlation analysis.
Fat mass (FM) of the new ROIs showed the highest correlation coefficients with steatosis grade (ρ = 0.610-0.619; p < 0.001), which was also confirmed by multivariate analysis. On the whole population, the new ROIs maintained the highest predictive role for liver steatosis, with areas under the receiver operating characteristic curve up to 0.820 ± 0.032. Inter- and intra-operator agreement for the new ROIs was excellent (k = 0.915-1.000 and k = 0.927-1.000).
New ROIs could be designed, standardized and implemented in DXA whole-body scan to provide more specific and predictive values of hepatic lipid content.
This is the first study to investigate the predictive value for hepatic steatosis of visceral and regional FM assessed on the hepatic site by DXA in comparison with ultrasonography, anthropometry and surrogate markers derived by previously validated algorithms (fatty liver index).
The structure-functional properties of milk proteins are relevant in food formulation. Recently, there has been growing interest in dynamic high-pressure homogenization effects on the ...rheological-structural properties of food macromolecules and proteins. The aim of this work was to evaluate the effects of different homogenization pressures on rheological properties of milk protein model systems. For this purpose, sodium caseinate (SC) and whey protein concentrate (WPC) were dispersed at different concentrations (1, 2, and 4%), pasteurized, and then homogenized at 0, 18MPa (conventional pressure, CP), 100MPa (high pressure, HP), and 150MPa (HP+). Differences in viscosity were observed between WPC and casein dispersions according to concentration, heat treatment, and homogenization pressure. Mechanical spectra described the characteristic behavior of solutions except for the WPC 4% pasteurized sample, in which a network formed but was broken after homogenization. Dispersions with different ratios of WPC and SC were also made. In these systems, pasteurization alone did not determine network formation, whereas homogenization alone promoted cold gelation. A total concentration of at least 4% was required for homogenization-induced gelation in pasteurized and unpasteurized samples. Gels with higher elastic modulus (G′) were obtained in more concentrated samples, and a bell-shaped behavior with the maximum value at HP was observed. The HP treatment produced stronger gels than the CP treatment. Similar G′ values were obtained when different concentrations, pasteurization conditions, and homogenization pressures were combined. Therefore, by setting appropriate process conditions, systems or gels with tailored characteristics may be obtained from dispersions of milk proteins.
Previous studies reported an impairment of both the physical and mental dimensions of quality of life in patients with cirrhosis. Very few data are available on the psychological impact of the ...disease and its relation to liver function.
To measure the psychological status of patients with cirrhosis in relation to the severity of the liver impairment.
One hundred and fifty-six patients with cirrhosis were studied. Two questionnaires (the Beck Depression Inventory and the Psychological General Well-Being Index) were self-administered in random order. Clinical and laboratory data were collected using standardised forms.
The global score of Psychological General Well-Being Index was severely reduced compared to Italian population norm. Among individual domains, the more severely affected was General Health, the less compromised was Positive Well-Being. A negative relation was found between Child–Pugh score (a comprehensive measure of disease severity) and global Psychological General Well-Being Index and several individual subscales. The Beck Depression Inventory scores were indicative of a depressed mood in over 50% of patients, in relation to the presence of clinical symptoms.
Patients with cirrhosis have signs of psychological distress and depression, as assessed by Beck Depression Inventory and Psychological General Well-Being Index, in relation to the severity of liver disease. Accordingly, a non-negligible number of patients warrant treatment.
Abstract Aims/hypothesis To estimate the prevalence and the direct cost of pharmacologically-treated diabetes in Italy. Methods The ARNO observatory database, containing the 20-year medical ...prescriptions of over 10 million Italian people, was used. Ten-year longitudinal data were available in 22 Local Health Districts (LHD). Subjects were classified as having diabetes when prescribed glucose-lowering drugs (oral agents or insulin) (311,979 individuals in 2006). The direct cost was calculated as the sum of drug use, financial compensation by LHD for the inpatient (hospital DRG) and outpatient activities (consultations, laboratory tests, radiology, etc.), all regulated by government contracts. Individuals with diabetes were compared with pharmacologically-treated subjects without diabetes, pair-matched for age, sex and general practitioner. Results In the 10-year period, the prevalence of pharmacologically-treated diabetes increased from 3.08% to 4.45% (P for trend, <0.001). The average pro capita cost totaled €2,589 in 2006 (95% confidence interval (CI), 2,584–2,594), corresponding to a rate ratio vs. no-diabetes of 1.54 (95% CI, 1.50–1.56). The cost of drugs was € 827 (rate ratio, 1.80 vs. no-diabetes; 95% CI, 1.79–1.82), that of service use, € 488 (rate ratio, 1.07 (0.93–1.25). Only 20% of the pharmaceutical cost was due to glucose-lowering drugs, a percentage stable through the years. The cost of any hospital admission, as defined by DRGs, was independent of diabetes, but the overall cost was much higher in diabetes due to much higher admission rates. Cardiovascular complications and renal failure accounted for the large majority of excess hospital cost. Conclusion The direct economic burden of pharmacologically-treated diabetes on the National Health System is very high, due to the growing prevalence of disease and the cost of complications.
Objectives: To investigate the causes of attrition reported by obese patients treated by medical centres. Design: Observational study. Setting: Obese patients enrolled in a long-term study involving ...18 Italian medical centres. Participants: A total of 940 obese patients (727 female; mean age, 49 years; mean BMI, 38.6 kg/m2). Measurements: Causes of attrition reported by dropouts during a structured telephone interview. Results: After a median observation period of 41 months (range, 25-50), 766 of 940 patients (81.5%) discontinued treatment. Sixty-two per cent of total dropout occurred in the first year of follow-up. Seventy-four per cent of dropouts reported a single primary reasons for treatment interruption. Two primary reasons were reported by 22.4% of patients, and three reasons by 3.4%. Practical difficulties, alone or in combination, were reported by more than half of dropouts (55%), and were the leading cause of attrition followed by perceived failure of treatment. Among practical difficulties, family problems or problems at work and logistics, coupled with health problems other than obesity, were the most frequent reasons of attrition, but also a perceived sense of abandonment or a bad interaction with therapists were frequently reported. Conclusion: Practical difficulties and psychological problems are the most important reasons of attrition reported by patients. A therapeutic alliance addressing these issues has a large potential to reduce treatment interruption and to improve outcome in obesity.
A third workshop on small-x physics, within the Small-x Collaboration, was held in Hamburg in May 2004 with the aim of overviewing recent theoretical progress in this area and summarizing the ...experimental status.
Aims
Progressive chronic kidney disease represents a dreadful complication of type 2 diabetes mellitus (T2DM). We tested the pattern of use and the renal effects of old glucose-lowering drugs in T2DM ...patients cared for by Italian general practitioners (GPs).
Methods
Data of 2606 T2DM patients were extracted from the databases of GPs, who do not have access to the most recent glucose-lowering drugs in Italy. The rate of kidney function decline was calculated by CKD-EPI
cr
, based on two consecutive creatinine values.
Results
Metformin was used in 55% of cases, either alone or with sulfonylureas/repaglinide, across the whole spectrum of CKD (from 66% in stage G1 to only 8% in G4). Sulfonylurea use peaked at 21–22% in stage G2–G3a, whereas repaglinide use significantly increased from 8% in G1 to 22% in G4. The median rate of CKD decline was − 1.64 mL/min/1.73 m
2
per year; it was higher in G1 (− 3.22 per year) and progressively lower with CKD severity. 826 cases (31.7%) were classified as fast progressors (eGFR decline more negative than − 5 mL/min/1.73 m
2
per year). The risk of fast progressing CKD was associated with increasing BMI, albuminuria, and sulfonylurea use, alone (OR, 1.47; 95% confidence interval, 1.16–1.85), or in association with metformin (OR, 1.40; 95% CI 1.04–1.88). No associations were demonstrated for metformin, cardiovascular and lipid lowering drug use.
Conclusion
In the setting of Italian family practice, sulfonylurea use is associated with progressive CKD in patients with T2DM. Metformin, at doses progressively reduced according to CKD stages, as recommended by guidelines, is not associated with fast progression.
Bisphenol A (BPA) is a xenoestrogen found in the environment, in consequence, for the biosensor detection of BPA we raised antibodies (polyclonal (PAbs) and monoclonal (MAbs)) against a structural ...analogue of BPA, 4,4 bis-(4-hydroxyphenyl) valeric acid (BVA). The kinetics of the MAb–BPA interaction were evaluated and the MAb providing the highest affinity was directly immobilized onto the sensor chip surface to evaluate a direct assay. Afterwards, the performance of the MAbs and the PAbs was compared in an inhibition assay using a BVA-coated chip.
The highest sensitivity (limit of detection (LOD) of 0.4
μg
L
−1) was obtained with MAb 12 in the direct assay. However, the inhibition assay was the most robust and the PAbs showed the highest sensitivity (LOD of 0.5–1
μg
L
−1). The antibodies were specific for BVA and BPA as only minor cross-reactivities were found toward structurally related compounds or other endocrine disruptors. In the inhibition assay (with a run time of 6
min), water samples spiked with BPA at different levels (0.5–50
μg
L
−1) resulted in recoveries varying between 68% and 121%. The sensitivity of the inhibition assay could be improved 40 times (LOD of 0.03
μg
L
−1 with the Mab 12-based assay) using solid phase extraction (SPE).
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