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Corrao G.,University of Milan Bicocca | Soranna D.,University of Milan Bicocca | Merlino L.,Operative Unit of Territorial Health Services | Monzani E.,Ca Granda Niguarda Hospital | And 2 more authors.
BMJ Open | Year: 2015

Objective: Little is known about the practice of predicting community-based care effectiveness of patients affected by schizophrenic disorders. We assessed predictors of treatment failure in a large sample of young people affected by schizophrenia. Methods: A cohort of 556 patients aged 18-35 years who were originally diagnosed with schizophrenia during 2005-2009 in a Mental Health Service (MHS) of the Italian Lombardy Region was identified. Intensity of mental healthcare received during the first year after index visit (exposure) was measured by patients' regularity in MHS attendance and the length of time covered with antipsychotic drug therapy. Patients were followed from index visit until 2012 for identifying hospital admission for mental disorder (outcome). A proportional hazards model was fitted to estimate the HR and 95% CIs for the exposure-outcome association, after adjusting for several covariates. A set of sensitivity analyses were performed in order to account for sources of systematic uncertainty. Results: During follow-up, 144 cohort members experienced the outcome. Compared with patients on low coverage with antipsychotic drugs (≤4 months), those on intermediate (5-8 months) and high (≥9 months) coverage, had HRs (95% CI) of 0.94 (0.64 to 1.40) and 0.69 (0.48 to 0.98), respectively. There was no evidence that regular attendance at the MHS affected the outcome. Conclusions: Patients in the early phase of schizophrenia and their families should be cautioned about the possible consequences of poor antipsychotic adherence. Physicians and decision makers should increase their contribution towards improving mental healthcare. Source

Ponzini R.,Consorzio Interuniversitario Lombardo per lElaborazione Automatica | Vergara C.,University of Bergamo | Rizzo G.,National Research Council Italy | Rizzo G.,San Raffaele Scientific Institute | And 6 more authors.
IEEE Transactions on Biomedical Engineering | Year: 2010

A common clinical practice during single-point Doppler analysis is to measure the centerline maximum velocity and to recover the time-averaged flow rate by exploiting an assumption on the shape of velocity profile ( a priori formula), either a parabolic or a flat one. In a previous study, we proposed a new formula valid for the peak instant linking the maximum velocity and the flow rate by including a well-established dimensionless fluid-dynamics parameter (the Womersley number), in order to account for the hemodynamics conditions (Womersley number-based formula). Several in silico tests confirmed the reliability of the new formula. Nevertheless, an in vivo confirmation is missing limiting the clinical applicability of the formula. An experimental in vivo protocol using cine phase-contrast MRI (2-D PCMRI) technique has been designed and applied to ten healthy young volunteers in three different arterial districts: the abdominal aorta, the common carotid artery, and the brachial artery. Each PCMRI dataset has been used twice: 1) to compute the value of the blood flow rate used as a gold standard and 2) to estimate the flow rate by measuring directly the maximum velocity and the diameter (i.e., emulating the intravascular Doppler data acquisition) and by applying to these data the a priori and the Womersley number-based formulae. All the in vivo results have confirmed that the Womersley number-based formula provides better estimates of the flow rate at the peak instant with respect to the a priori formula. More precisely, mean performances of the Womersley number-based formula are about three times better than the a priori results in the abdominal aorta, five times better in the common carotid artery, and two times better in the brachial artery. © 2006 IEEE. Source

Turiel M.,University of Milan | Gianturco L.,University of Milan | Ricci C.,University of Milan | Sarzi-Puttini P.,University of Milan | And 5 more authors.
Arthritis Care and Research | Year: 2013

Objective An association between systemic autoimmune diseases and atherosclerosis has been described in many connective tissue diseases, and this association is known to lead to increased cardiovascular morbidity and mortality. Systemic sclerosis (SSc) is characterized by multisystem organ inflammation, endothelial wall damage, and vasculopathy. There are many markers of endothelial dysfunction and/or atherosclerotic risk, such as asymmetric dimethylarginine (ADMA), arterial stiffness parameters, carotid intima-media thickness (CIMT), and coronary flow reserve (CFR) assessed by transthoracic echocardiography. The aim of this pilot study was to use various endothelial and atherosclerosis markers to identify early cardiovascular involvement in a group of SSc patients. Methods The study involved 20 patients (2 men and 18 women with a mean ± SD age of 52.96 ± 12.51 years) with diffuse SSc who had no signs or symptoms of cardiovascular disease (CVD) and 20 age- and sex-matched controls. All subjects underwent a dipyridamole echocardiographic stress test that included a determination of CFR and an evaluation of CIMT, arterial stiffness, and plasma ADMA levels. Results All of the arterial wall measurements of the patients with diffuse SSc were significantly different from those of the controls, and both right and left CIMT, pulse wave velocity, and stiffness index (β) were significantly elevated in the SSc patients compared to the healthy controls. Moreover, in patients with diffuse SSc, CFR was significantly lower (P = 0.0033) and plasma ADMA levels were higher (P < 0.0001) than in healthy controls. Conclusion SSc patients without any clinical evidence of CVD seem to have had subclinical atherosclerosis, which was suggested by early impairment of coronary microcirculation and macrovascular involvement. © 2013 by the American College of Rheumatology. Source

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