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Sanchez Jimenez J.,Service of Pediatrics | Herrero Espinet F.J.,Service of Pediatrics | Mengibar Garrido J.M.,Unit of Pediatric Endocrinology | Roca Antonio J.,Unitat de Epidemiologia | And 5 more authors.
Pediatric Allergy and Immunology | Year: 2014

Background: Obese children and adolescents have an increased risk for asthma. A few studies have evaluated the association of insulin resistance and asthma in obese pediatric populations. We examined whether there was a relationship between high degrees of insulin resistance and the presence of asthma in obese children and adolescents. Methods: A total of 153 patients aged 4-15 years with at or above the 95th percentile BMI for age were prospectively recruited. Assessments included diagnosis of asthma, skin prick test reactivity to common environmental aeroallergens, and HOMA estimated insulin resistance, with the median (2.22) used as a cutoff value to categorize insulin resistance. Results: There were 56 (36.6%) asthmatic and 97 (63.4%) non-asthmatic patients. HOMA values were significantly associated with positive skin tests (p = 0.008) and allergic asthma diagnosis (p = 0.016). Baseline insulin value was significantly associated with the risk of presenting asthma with positive skin testing (odds ratio 1.084, p = 0.037). Differences in age, BMI, and waist circumference were found between the groups of HOMA-IR <2.22 and ≥2.22. Waist circumference (WC) was significantly associated with FVC (p = 0.0001) and FEV1 (p < 0.0003); the greater the WC, the lower FVC and FEV1 values. Conclusions: Insulin resistance is a risk for allergic asthma in obese children and adolescents. Waist circumference was related to CVF and FEV1 impairment. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Source


Spandonaro F.,University of Rome Tor Vergata | Cappa M.,Unit of Pediatric Endocrinology | Castello R.,University of Verona | Chiarelli F.,University of Chieti Pescara | And 2 more authors.
Academic Psychiatry | Year: 2014

Introduction: Growth hormone (GH) consumption is the object of a particular attention by regulatory bodies, due to its financial impact; nevertheless, GH treatment has been demonstrated to be cost-effective and is, therefore, usually reimbursed by public health service systems. In Italy, significant differences in GH consumption between regions have been recorded. Different appropriateness in real practice is a possible explanation, but the proportion of drug wasted due to different combinations of therapeutic regimes and types of devices used in drug administration is a complementary explanation. Aim of the study is, therefore, to determine how much of the variability in GH consumption is actually due to differences in clinical practice, and how much to waste. Materials and methods: A model was settled to estimate the population with indication for GH administration, separately for children, transition subjects and adults, based on both the scientific evidence available and directly collected clinical evaluations. A systematic literature search was conducted using Cochrane Library (HTA and NHSEE) databases, Medline via Ovid, Econlit via Ovid, Embase. Conclusion: The model applied to the Italian population showed that there was apparently unexplainable over-prescription and potential under-prescription in various regions, ranging from 20 to 40 % less than the estimated theoretical consumption to over 200 %. Wastage, at level of single device, could amount to as much as 15 % of the consumption, demonstrating that price per mg is not in general a good proxy of the cost per mg of therapy. Our estimates of the wastage shows a significant potential gap in the model assessment of the HTA bodies, as far as they do not explicitly take into account the issue of wastage and, consequently, the actual variability in local clinical practice. © 2014 Italian Society of Endocrinology (SIE). Source


Spandonaro F.,University of Rome Tor Vergata | Cappa M.,Unit of Pediatric Endocrinology | Castello R.,University of Verona | Chiarelli F.,University of Chieti Pescara | And 2 more authors.
Journal of Endocrinological Investigation | Year: 2014

Introduction: Growth hormone (GH) consumption is the object of a particular attention by regulatory bodies, due to its financial impact; nevertheless, GH treatment has been demonstrated to be cost-effective and is, therefore, usually reimbursed by public health service systems. In Italy, significant differences in GH consumption between regions have been recorded. Different appropriateness in real practice is a possible explanation, but the proportion of drug wasted due to different combinations of therapeutic regimes and types of devices used in drug administration is a complementary explanation. Aim of the study is, therefore, to determine how much of the variability in GH consumption is actually due to differences in clinical practice, and how much to waste. Materials and methods: A model was settled to estimate the population with indication for GH administration, separately for children, transition subjects and adults, based on both the scientific evidence available and directly collected clinical evaluations. A systematic literature search was conducted using Cochrane Library (HTA and NHSEE) databases, Medline via Ovid, Econlit via Ovid, Embase. Conclusion: The model applied to the Italian population showed that there was apparently unexplainable over-prescription and potential under-prescription in various regions, ranging from 20 to 40 % less than the estimated theoretical consumption to over 200 %. Wastage, at level of single device, could amount to as much as 15 % of the consumption, demonstrating that price per mg is not in general a good proxy of the cost per mg of therapy. Our estimates of the wastage shows a significant potential gap in the model assessment of the HTA bodies, as far as they do not explicitly take into account the issue of wastage and, consequently, the actual variability in local clinical practice. © 2014 Italian Society of Endocrinology (SIE). Source


Rendina D.,University of Naples Federico II | Gianfrancesco F.,National Research Council Italy | De Filippo G.,Unit of Pediatric Endocrinology | Merlotti D.,University of Siena | And 6 more authors.
European Journal of Endocrinology | Year: 2010

Objective: FSH, via its receptor (FSHR), influences bone remodeling and osteoclast proliferation and activity. The aim of this study was to evaluate the influence of two single nucleotide polymorphisms (SNPs) of the FSHR gene on bone mineral density (BMD) and bone turnover markers (bone alkaline phosphatase and type I collagen C-telopeptides) in postmenopausal women. Methods: Two hundred and eighty-nine unrelated postmenopausal women were genotyped for the SNPs rs1394205 and rs6166. BMD was estimated using dual-energy X-ray absorptiometry and quantitative ultrasound (QUS) methodologies. Results: AA rs6166 women showed a lower BMD (femoral neck and total body), lower stiffness index (calcaneal QUS), and higher serum levels of bone turnover markers compared to GG rs6166 women. The prevalence of osteoporosis was significantly higher in AA rs6166 women compared with GG rs6166 women. These results were not influenced by circulating levels of FSH and estrogens. Conclusion: The SNP rs6166 of the FSHR gene significantly influences BMD in postmenopausal women. In particular, AA rs6166 women are at increased risk of postmenopausal osteoporosis compared with GG rs6166 women, independently of circulating levels of FSH and estrogens. Previous studies have demonstrated that this SNP influences cell and tissue response to hyperstimulation of FSHR in vivo and in vitro. Our study results appear in agreement with these experimental data and with known biological actions of FSH/FSHR system in bone homeostasis. © 2010 European Society of Endocrinology. Source


Gennari L.,University of Siena | Gianfrancesco F.,CNR Institute of Neuroscience | Di Stefano M.,University of Turin | Rendina D.,University of Naples Federico II | And 14 more authors.
Journal of Bone and Mineral Research | Year: 2010

Even though SQSTM1 gene mutations have been identified in a consistent number of patients, the etiology of Paget's disease of bone (PDB) remains in part unknown. In this study we analyzed SQSTM1 mutations in 533 of 608 consecutive PDB patients from several regions, including the high-prevalence area of Campania (also characterized by increased severity of PDB, higher number of familial cases, and peculiar phenotypic characteristics as giant cell tumor). Eleven different mutations (Y383X, P387L, P392L, E396X, M401V, M404V, G411S, D423X, G425E, G425R, and A427D) were observed in 34 of 92 (37%) and 43 of 441 (10%) of familial and sporadic PDB patients, respectively. All five patients with giant cell tumor complicating familial PDB were negative for SQSTM1 mutations. An increased heterogeneity and a different distribution of mutations were observed in southern Italy (showing 9 of the 11 mutations) than in central and northern Italy. Genotype-phenotype analysis showed only a modest reduction in age at diagnosis in patients with truncating versus missense mutations, whereas the number of affected skeletal sites did not differ significantly. Patients from Campania had the highest prevalence of animal contacts (i.e., working or living on a farm or pet ownership) without any difference between patients with or without mutation. However, when familial cases from Campania were considered, animal contacts were observed in 90% of families without mutations. Interestingly, a progressive age-related decrease in the prevalence of animal contacts, as well as a parallel increase in the prevalence of SQSTM1 mutations, was observed in most regions except in the subgroup of patients from Campania. Moreover, patients reporting animal contacts showed an increased number of affected sites (2.54±2.0 versus 2.19±1.9, p<.05) over patients without animal contacts. This difference also was evidenced in the subgroup of patients with SQSTM1 mutations (3.84±2.5 versus 2.76±2.2, p<.05). Overall, these data suggest that animal-related factors may be important in the etiology of PDB and may interact with SQSTM1 mutations in influencing disease severity. © 2010 American Society for Bone and Mineral Research. Source

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