Health status in older hospitalized patients with cancer or non-neoplastic chronic diseases

BACKGROUND: Whether cancer is more disabling than other highly prevalent chronic diseases in the elderly is not well understood, and represents the objective of the present study. METHODS: We used data from the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) study, a large collaborative observational study based in community and university hospitals located throughout Italy. Our series consisted of three groups of patients with non-neoplastic chronic disease (congestive heart failure, CHF, N = 832; diabetes mellitus, N = 939; chronic obstructive pulmonary disease, COPD, N = 399), and three groups of patients with cancer (solid tumors without metastasis, N = 813; solid tumors with metastasis, N = 259; leukemia/lymphoma, N = 326). Functional capabilities were ascertained using the activities of daily living (ADL) scale, and categorical variables for dependency in at least 1 ADL or dependency in 3 or more ADLs were considered in the analysis. Cognitive status was evaluated by the 10-items Hodgkinson Abbreviated Mental Test (AMT). RESULTS: Cognitive impairment was more prevalent in patients with CHF (28.0%) or COPD (25.8%) than in those with cancer (solid tumors = 22.9%; leukemia/lymphoma = 19.6%; metastatic cancer = 22.8%). Dependency in at least 1 ADL was highly prevalent in patients with metastatic cancer (31.3% vs. 24% for patients with CHF and 22.4% for those with non-metastatic solid tumors, p < 0.001). In people aged 80 years or more, metastatic cancer was not associated with increased prevalence of physical disability. In multivariable analysis, metastatic cancer was associated with a greater prevalence of physical (OR 2.09, 95%CI 1.51–2.90) but not cognitive impairment (OR 1.34, 95%CI 0.94–1.91) with respect to CHF patients. Finally, diabetes was significantly associated with cognitive impairment (OR 1.40, 95%CI 1.11–1.78). CONCLUSION: Cancer should not be considered as an ineluctable cause of severe cognitive and physical impairment, at least not more than other chronic conditions highly prevalent in older people, such as CHF and diabetes mellitus

Research quality criteria in the evaluation of books

In the Italian context of research evaluation, research output in the Social Sciences and Humanities (SSH) presents problematic issues in classification, particularly for the Humanities. In the case of the Italian context, in fact, the SSH area features an extremely varied spectrum of disciplinary domains. The Italian national evaluation system for the Humanities applies a system in which research results are classified in correspondingly varied manner, based on the disciplinary affiliation of the researcher. This has problematic consequences in terms of increasing the numbers of items included in the classification, and still more severe ones concerning the quality criteria to be applied to each item. A particularly critical issue is that the criteria vary depending on the disciplinary domain under evaluation. Beginning from an illustration of the problems specific to the Italian context, the chapter proceeds to a comparative analysis of the research quality criteria for books in the SSH area as applied in several countries and international contexts. The analysis adopts a methodological approach that can be applied to assessment of other national and international classification systems, leading towards a shared European response to the problem of evaluation, in particular for books and book parts. The investigation articulates the dimensions of quality identified in both literature and practice, and offers a structured framework for analysis of the role of books in the evaluation process. The discourse is based on the case of the Italian SSH disciplinary domains and national evaluation exercise, which can be broadened to international and other national SSH research domains and, although the chapter deals with overall SSH, the discussion focuses on the Humanities. The Italian experience in this area is particularly strong, given the uniquely long history of the research area and its ramified development. The sources selected for analysis are the international ISO standards, national guidelines from Spain, Australia and New Zealand, and Italian academic classifications from the University of Turin and University of Bologna. The comparison is based on the classification of books and monographs as practiced under Italian national guidelines for research assessment