Burden of Crohn's disease: economics and quality of life aspects in Italy.

BACKGROUND: This was a prospective observational study designed to evaluate direct and indirect costs and quality of life for patients with Crohn's disease in Italy from the perspectives of the National Health System and of society. METHODS: A total of 162 male and female subjects aged 18-70 years with Crohn's disease in the active phase and a Crohn's Disease Activity Index score ≥150 were included in the study. Subjects were recruited from 25 Italian centers on a consecutive basis. The study consisted of four visits undertaken every 6 months with a follow-up period of 18 months. The study started on September 1, 2006 and was completed on April 12, 2010. Multivariate analyses were carried out on demographic characteristics, treatment costs based on the prescribed daily dose, resource use and other cost parameters, and changes in quality of life using the EQ5D questionnaire. RESULTS: Cost of illness per subject with Crohn's disease in Italy was estimated to be €15,521 per year, with direct costs representing 76% of total costs. Nonhealth care costs and loss of productivity accounted for 24% of total costs. Societal costs during the first months of enrolment were higher compared with costs in the final months of the study. Quality of life measured by the EQ-5D was 0.558 initially and then increased to 0.739, with a mean value of 0.677 during the enrolment period. The cost of illness was not correlated with age or gender. CONCLUSION: The cost of illness was correlated with quality of life; Crohn's disease had a negative impact on subjects' quality of life, and higher costs corresponded to a lower quality of life as measured with the EQ5D. Drug treatment may improve quality of life and reduce hospitalization costs. Our results appear to be in line with the results of other international cost-of-illness studie

The Case for Perspicuous Programming

This essay examines the nature of programs, classifies the traditional or enigmatic styles of programming, distinguishing template, prose and literate styles; notes the contrast between batch programs and interactive programs; and highlights the advantages of giving priority in developing interactive programs to the online documentation, and proposes that this documentation should be the principal target of development, with the executable program code being regarded of secondary and consequent

Circulating irisn is reduced in male patients with type 1 and type 2 Myotonic Dystrophies

Context: Myotonic dystrophies (DM) are dominantly inherited muscle disorders characterized by myotonia, muscle weakness, and wasting. The reasons for sarcopenia in DMs are uncleared and multiple factors are involved. Irisin, a positive hormone regulator of muscle growth and bone, may play a role. Objectives: To investigate (1) circulating irisin in a series of DM1 and DM2 male patients compared with healthy controls and (2) the relationships between irisin and anthropometric, metabolic and hormonal parameters. Design and study participants: This is a cross-sectional study. Fasting blood samples for glucometabolic, gonadic, bone markers, and irisin were collected from 28 ambulatory DM1, 10 DM2, and 23 age-matched healthy male subjects. Body composition and bone mineralization [bone mineral density (BMD)] were measured by DEXA. Echocardiographic assessment and visceral adiposity, namely, liver and epicardial fat, were investigated by ultrasound. Irisin released from cultured myotubes derived from 3 DM1, 3 DM2, and 3 healthy donors was assayed. Results: Plasma irisin levels were definitely lower in both DM1 and DM2 patients than in controls with no difference between DM1 and DM2. Irisin released from DM1 and DM2 myotubes was similar to that released from myotubes of the non-DM donors, though diabetic DM2 myotubes released more irisin than DM1 myotubes. There was no correlation between irisin and muscle strength or lean mass in both DM1 and DM2 patients. In DM1 patients, plasma irisin levels correlated negatively with oxygen consumption and positively with insulin resistance, while in DM2 patients plasma irisin levels positively correlated with fat mass at arms and legs levels. No correlation with visceral fat, left ventricular mass, and gonadal hormones could be detected. In both DM1 and DM2 patients, legs BMD parameters positively correlated with plasma irisin levels. Conclusion: Plasma irisin is reduced in both DM1 and DM2 male patients likely reflecting muscle mass reduction. Moreover, insulin resistance may contribute to modulation of plasma irisin in DM1 patients. The irisin-mediated cross talk muscle\u2013adipose tissue\u2013bone may be active also in the male myotonic dystrophies\u2019 model

Benign thyroid nodules treatment using Percutaneous Laser Ablation (PLA) and Radiofrequency Ablation (RFA)

Purpose: To evaluate the reduction over time of benign thyroid nodules treated using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA) by the same equipe. Materials and methods: Ninety patients (age 55.6\u2009\ub1\u200914.1 years) underwent ablation for benign thyroid nodule causing compression/aesthetic dissatisfaction from 2011. Fifty-nine (age 55.8\u2009\ub1\u200914.1 years) underwent RFA and 31 (age 55.2\u2009\ub1\u200914.2 years) PLA, ultrasound guided. Technical success, complications, duration of ablation and treatment, energy deployed, volumetric percentage reduction at 1, 6 and 12 months were derived. A regression model for longitudinal measurements was used with random intercept and random slope. Values are expressed as mean\u2009\ub1\u2009standard deviation or N (%). Results: Technical success was always obtained. No major complications occurred. Mean ablation time was 30.1\u2009\ub1\u200913.8 vs. 13.9\u2009\ub1\u20095.9\u2009min (p\u2009<\u2009.0001) and mean energy deployment was 5422.3\u2009\ub1\u20092484.5 J vs. 34 662.7\u2009\ub1\u200915 812.3 J in PLA vs. RFA group. Mean volume reduced from 20.3\u2009\ub1\u200916.4\u2009ml to 13.17\u2009\ub1\u200910.74\u2009ml (42%\u2009\ub1\u200917% reduction) at 1st month, 8.7\u2009\ub1\u20097.4\u2009ml (60%\u2009\ub1\u200915% reduction) at 6th month and 7.1\u2009\ub1\u20097.7\u2009ml (70%%\u2009\ub1\u200916% reduction) at 12th month, in PLA group, and from 32.7\u2009\ub1\u200919.5\u2009ml to 17.2\u2009\ub1\u200912.9\u2009ml (51%\ub115% reduction) at 1st month, 12.8\u2009\ub1\u20099.6\u2009ml (64\u2009\ub1\u200914% reduction) at 6th month and 9.9\u2009\ub1\u20099.2\u2009ml (74%\u2009\ub1\u200914% reduction) at 12th month in RFA group. No difference in time course of the relative volume reduction between the two techniques was found. Conclusions: RFA and PLA are similarly feasible, safe and effective in treating benign thyroid nodules when performed by the same equipe. RFA is faster than PLA but require significantly higher energy

A simplified biventricular defibrillator with fixed long detection intervals reduces implantable cardioverter defibrillator (ICD) interventions and heart failure hospitalizations in patients with non-ischaemic cardiomyopathy implanted for primary prevention: the RELEVANT [Role of long dEtection window programming in patients with LEft VentriculAr dysfunction, Non-ischemic eTiology in primary prevention treated with a biventricular ICD] study

To investigate the efficacy and safety of a cardiac resynchronization therapy with cardioverter-defibrillator (CRT-D) device with simplified ventricular tachycardia management in patients with non-ischaemic heart failure (HF) and primary prevention implantable cardioverter defibrillator (ICD) indication

Long term results of single session percutaneous ethanol injection in patients with large hepatocellular carcinoma

The objective of this study was to evaluate the indications for percutaneous ethanol injection (PEI) performed in a single session under general anesthesia for treating patients with cirrhosis and large (tumors > 5 cm) hepatocellular carcinoma (HCC), and relevant survival curve

Rational use of drugs in chronic pain treatment

Rational use of drugs in chronic pain treatmen

Data under 5 _oupatients and community studies

<p>Data extraction from systematic review of outpatients and community studies of peopple with diarrhoea (children under 5)</p