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Donfrancesco R.,Sandro Pertini Hospital | Loprieno U.,International Medical Affairs Shire
Minerva Pediatrica | Year: 2015

Aim. In Italy, attention-deficit/hyperactivity disorder (ADHD) remains under-diagnosed. The Lifetime Impairment Survey assessed impairments/symptoms of ADHD in children across six European countries. Results relating to the Italian sample are discussed here. Methods. Parents/caregivers of children aged <20 years with ADHD (ADHD group) and without ADHD (control group) were invited to participate in an online survey. Participants answered questions relating to their eldest/only child. History of ADHD diagnosis was self-reported. Eight impairment and symptom scales and two summed scores were created to compare the ADHD and control groups; higher scores indicate greater impairment. Results. In Italy, 104 parents/caregivers of children with ADHD and 105 parents/ caregivers of children without ADHD participated in the survey (N.=83 and N.=84, respectively, after exclusion of participants with implausible answers). The ADHD group had higher mean (standard deviation) scores than the control group for home impairment (2.1 [0.5]) vs. 1.9 [0.4]; P<0.001), school impairment (2.8 [0.6] vs. 2.1 [0.6]; P<0.001), relationship impairment (2.3 [0.8] vs. 1.9 [0.7]; P<0.001) and comorbid symptoms (3.3 [0.7] vs. 2.5 [0.7]; P<0.001). Impairment at home and at school were correlated with each other (r=0.478; P<0.001) and with ADHD symptoms (r=0.321; P<0.001 and r=0.462; P<0.001, respectively), comorbid symptoms (r=0.231; P<0.05 and r=0.420; P<0.001), school failure (r=0.208; P<0.02 and r=0.320; P<0.001) and relationship impairments (r=0.432; P<0.01 and r=0.645; P<0.001). Conclusion. The daily lives of children with ADHD in Italy are significantly affected by impairments associated with ADHD. Children and adolescents with ADHD in Italy should receive prompt diagnosis and appropriate therapy. Source

Caci H.,Nice University Hospital Center | Doepfner M.,University of Cologne | Asherson P.,Kings College | Donfrancesco R.,Sandro Pertini Hospital | And 3 more authors.
European Psychiatry | Year: 2014

The Lifetime Impairment Survey assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children/adolescents from six European countries. Parents/caregivers of children/adolescents aged. <. 20 years with ADHD (ADHD group; n=535) and without ADHD (control group; n=424) participated in an online survey. History of ADHD diagnosis was self-reported. ADHD and control groups were compared using impairment and symptom scales; higher scores indicate greater impairment. Mean (SD) age at ADHD diagnosis was 7.0 (2.8) years, following consultation of 2.7 (2.6) doctors over 20.4 (23.9) months. Parents/caregivers (64%; 344/535) reported frustration with some aspect of the diagnostic procedure; 74% (222/298) were satisfied with their child's current medication. ADHD had a negative impact on children/adolescents in all aspects of life investigated. The ADHD group had a higher mean (SD) school impairment score (2.7 [0.7]) compared with the control group (2.1 [0.7]; P<0.001) and were more likely to be in the bottom of their class (P<. 0.001). These data provide insights into impairments associated with ADHD in childhood/adolescence, and identify areas for improvement in its management and treatment. © 2013 Elsevier Masson SAS. Source

Del Prato S.,University of Pisa | Nicolucci A.,Mario Negri Sud Consortium | Lovagnini-Scher A.C.,Diabetes Center | Turco S.,University of Naples Federico II | And 2 more authors.
Diabetes Technology and Therapeutics | Year: 2012

Background: We compared telecare and conventional self-monitored blood glucose (SMBG) programs for titrating the addition of one bolus injection of insulin glulisine in patients with type 2 diabetes uncontrolled on oral hypoglycemic agents for ≥3 months who were first titrated with basal insulin glargine. Methods: This randomized, multicenter, parallel-group study included 241 patients (mean screening glycosylated hemoglobin [HbA 1c], 8.8% [73mmol/mol]). In the run-in phase, any antidiabetes medication, except for metformin, was discontinued. Metformin was then up-titrated to 2g/day (1g twice daily) until study completion. Following run-in, all patients started glargine for 8-16 weeks, targeting fasting plasma glucose (FPG) ≤5.6mmol/L using conventional SMBG. Patients with FPG ≤7mmol/L added a glulisine dose at the meal with the highest postprandial plasma glucose excursion, titrated to target 2-h postprandial plasma glucose level <7.8mmol/L using telecare or SMBG for 24 weeks. Patients with FPG >7mmol/L at week 16 were withdrawn from the study. Results: After glargine titration, 224 patients achieved FPG ≤7mmol/L, without any difference between telecare and SBMG groups (mean±SD, 6.2±0.8 vs. 6.0±0. 9mmol/L, respectively). HbA 1c levels were lower following titration and were similar for telecare and SMBG (7.9±0.9% vs. 7.8±0.9% [63 vs. 62mmol/mol], respectively). Adding glulisine further reduced HbA 1c in both groups (-0.7% vs. -0.7%); 45.2% and 54.8% (P=0.14), respectively, of patients achieved HbA 1c ≤7.0% (≤53mmol/mol). Weight change and hypoglycemia were similar between groups. Conclusions: Patients adding one dose of glulisine at the meal with the highest postprandial plasma glucose excursion to titrated basal glargine achieved comparable improvements in glycemic control irrespective of traditional or telecare blood glucose monitoring. © Copyright 2012, Mary Ann Liebert, Inc.. Source

Hakimeh D.,Unfall Krankenhaus Marzan | Tripodi S.,Sandro Pertini Hospital
Italian Journal of Pediatrics | Year: 2013

The epidemic of childhood allergic disorders has been associated to the decline of infectious disease. However, exposure to many triggers (airborne viruses, tobacco smoke, pollution, indoor allergens, etc.) contribute to the disease. Breast feeding practices, nutrition, dietary and obesity also play a multifaceted role in shaping the observed worldwide trends of childhood allergies. Guidelines for treatment are available, but their implementation is suboptimal. Then developed countries are slowing learning integrating the development of suitable guidelines with implementation plans. Awareness, psychosocial and family factors strongly influence asthma and food allergy control. Moreover, monitoring tools are necessary to facilitate self-management. By taking into consideration these and many other pragmatic aspects, national public health programs to control the allergic epidemic have been successful in reducing its impact and trace the need for future research in the area. © 2013 Hakimeh and Tripodi; licensee BioMed Central Ltd. Source

De Santis F.,Sandro Pertini Hospital | Martini G.,Bressanone Hospital | Mani G.,Bressanone Hospital | Bernhard O.,Bressanone Hospital
Annals of Vascular Surgery | Year: 2014

While the possibility of development of a panarterial dilatation proximal to a long-standing high-flow posttraumatic arteriovenous fistula is well known, to the best of our knowledge, this event has never been described after vascular access for hemodialysis closure. We describe a man in whom a diffuse aneurysmal degeneration of the brachial artery has been highlighted 6 months after long-standing high-flow arteriovenous fistula closure. A 47-year-old man developed a painful pulsatile mass in the anterior distal third of his arm 6 months after long-standing high-flow arteriovenous fistula closure at the level of his elbow. A computed tomography scan revealed multiple "true" aneurysms of the brachial artery (BA) that appeared enlarged in toto. One of these aneurysms (near the BA bifurcation) presented with significant thrombus stratification. Surgery was recommended because of the major risk of peripheral embolization. Considering the anatomic characteristics of both the BA and aneurysm, no arterial substitution was performed and, after removal of the thrombus, the aneurysm diameter was reduced via direct arterial wall suture. The patient was discharged under oral anticoagulation. Aneurysmal degeneration of the donor artery after vascular access is relatively rare but represents a challenging problem. Operative or conservative management of these aneurysms should evaluate both the possible aneurysm-related complications and the feasibility of vascular reconstruction. In this context, the risk of additional donor artery and/or vascular reconstruction enlargement over time should also be considered. © 2014 Elsevier Inc. All rights reserved. Source

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