Disability-free life expectancy of Italian older adults: trends, inequalities, and applications

Italy's ageing population may pose challenges to the sustainability of the country's socioeconomic and healthcare systems. This depends on the (un)healthy ageing process. The disability status of mid-to-older adults is a crucial determinant of individuals' autonomy and participation in society. Disability-free life expectancy (DFLE) is an important metric for assessing the health and disability risks of the population in a summary indicator, neat of the age structure. Demographic changes also affect intergenerational relationships and in Italy, where grandparents play a significant role in caregiving, it is crucial to study their health evolution. This thesis aims to, first, detect the long-term trend of DFLE in Italy and to analyse the drivers of its change in terms of disability-specific mortality and dynamics of disability onset and recovery. Second, to shed light on gender, socioeconomic, and territorial inequalities in DFLE (and their intersections) and the factors driving these inequalities in terms of differences in mortality and disability risks. Third, to analyse the trend of the length of life to live as grandparents free from disability and understand how it is influenced by age-specific survival and grandparenthood-disability prevalence evolution. The thesis applies different demographic and statistical methods to different cross-sectional and longitudinal data and provides DFLE estimates, trends and applications for mid-to-older Italian men and women. The findings show that while DFLE at mid-to-older ages has increased, it has not always progressed as favourably as life expectancy. The greatest contribution to DFLE changes is the changes in the transition in and out of disability. There are notable differences in DFLE at older ages within the country, between genders and educational groups. Women have a life expectancy advantage, but their health disadvantage counterbalances it. The disadvantage in DFLE accumulates over education and region of residence, resulting in higher educated living in northern regions having more than double DFLE than lower educated living in southern regions. Health differences are also the major contributors to educational differences in DFLE. Italian grandmothers and grandfathers are gaining years of coexistence-life-time with their grandchildren in good functional health. Women can expect to live more years as disability-free grandmothers than men, but their share of disability-free grandmothers years over total years as grandmothers is lower than that for men. The increase in disability-free grandparenthood years is primarily led by improved survival and health conditions and, for men, by the postponement of grandparenthood to older ages

Gender and educational inequalities in disability-free life expectancy among older adults living in Italian regions

Background: Italy's life expectancy at age 65 is one of the highest in Europe, but its disability-free life expectancy (DFLE) is not so high. To understand this diverging pattern of longevity and health it is essential to consider indicators accounting for both mortality and morbidity, and to analyse the gender, social, and geographical inequities characterising them. Objective: The aim is to quantify the gender, social, and geographical inequalities in DFLE among Italian older adults and analyse the age-specific contribution of mortality and morbidity to those inequalities. Methods: This study draws on census-linked mortality data and disability prevalence for the years 2012-2014. DFLE at age 65 in Italian regions is computed by gender and educational attainment using the Sullivan method. Age-specific mortality-morbidity contributions to the gender and educational gaps in DFLE are calculated using the stepwise decomposition method. Results: Although at the national level older women and men share similar DFLE, these estimates hide important geographical and social inequalities. Women's health disadvantage completely outweighs their life expectancy advantage, resulting in lower DFLE. Educational inequalities in health are far more dramatic than those in mortality and the disadvantage in DFLE accumulates over education and region of residence. Conclusions: In Italy notable differences in DFLE are found between genders and between educational groups, suggesting the need for better health policies aimed at reducing inequalities. Contribution: This study provides novel empirical findings on gender, educational, and geographical inequalities in DFLE for Italian older adults and explains how age-specific mortality and morbidity contribute to shaping these inequalities

From narrative descriptions to MedDRA: automagically encoding adverse drug reactions

The collection of narrative spontaneous reports is an irreplaceable source for the prompt detection of suspected adverse drug reactions (ADRs). In such task qualified domain experts manually revise a huge amount of narrative descriptions and then encode texts according to MedDRA standard terminology. The manual annotation of narrative documents with medical terminology is a subtle and expensive task, since the number of reports is growing up day-by-day. Natural Language Processing (NLP) applications can support the work of people responsible for pharmacovigilance. Our objective is to develop NLP algorithms and tools for the detection of ADR clinical terminology. Efficient applications can concretely improve the quality of the experts\u2019 revisions. NLP software can quickly analyze narrative texts and offer an encoding (i.e., a list of MedDRA terms) that the expert has to revise and validate. MagiCoder, an NLP algorithm, is proposed for the automatic encoding of free-text descriptions into MedDRA terms. MagiCoder procedure is efficient in terms of computational complexity. We tested MagiCoder through several experiments. In the first one, we tested it on a large dataset of about 4500 manually revised reports, by performing an automated comparison between human and MagiCoder encoding. Moreover, we tested MagiCoder on a set of about 1800 reports, manually revised ex novo by some experts of the domain, who also compared automatic solutions with the gold reference standard. We also provide two initial experiments with reports written in English, giving a first evidence of the robustness of MagiCoder w.r.t. the change of the language. For the current base version of MagiCoder, we measured an average recall and precision of and , respectively. From a practical point of view, MagiCoder reduces the time required for encoding ADR reports. Pharmacologists have only to review and validate the MedDRA terms proposed by the application, instead of choosing the right terms among the 70\u202fK low level terms of MedDRA. Such improvement in the efficiency of pharmacologists\u2019 work has a relevant impact also on the quality of the subsequent data analysis. We developed MagiCoder for the Italian pharmacovigilance language. However, our proposal is based on a general approach, not depending on the considered language nor the term dictionary

Normalizing Spontaneous Reports into MedDRA: some Experiments with MagiCoder

Text normalization into medical dictionaries is useful to support clinical task. A typical setting is Pharmacovigilance (PV). The manual detection of suspected adverse drug reactions (ADRs) in narrative reports is time consuming and Natural Language Processing (NLP) provides a concrete help to PV experts. In this paper we carry on experiments for testing performances of MagiCoder, an NLP application designed to extract MedDRA terms from narrative clinical text. Given a narrative description, MagiCoder proposes an automatic encoding. The pharmacologist reviews, (possibly) corrects, and then validates the solution. This drastically reduces the time needed for the validation of reports with respect to a completely manual encoding. In previous work we mainly tested MagiCoder performances on Italian written spontaneous reports. In this paper, we include some new features, change the experiment design, and carry on more tests about MagiCoder. Moreover, we do a change of language, moving to English documents. In particular, we tested MagiCoder on the CADEC dataset, a corpus of manually annotated posts about ADRs collected from social media

Cyclopentenyl ethylamines active on CNS

Two new cyclopentenylethylamines were prepared and were submitted to a pharmacological screening together with some others previously described and now reprepared. All compounds exhibited different degrees of depressive activity on CNS and good analgesic activity. Compound 5, bearing a phenyl group on the carbon atom to which the amino group is connected, appears rather interesting being the most active as analgesic and the least toxic. Compounds 2 and 3 are able to antagonize in a certain degree lethal doses of physostigmine and also, respectively, of pentylenetetrazole and strychnine

Overview of the EvaLatin 2022 Evaluation Campaign

This paper describes the organization and the results of the second edition of EvaLatin, the campaign for the evaluation of Natural Language Processing tools for Latin. The three shared tasks proposed in EvaLatin 2022, i. e. Lemmatization, Part-of-Speech Tagging and Features Identification, are aimed to foster research in the field of language technologies for Classical languages. The shared dataset consists of texts mainly taken from the LASLA corpus. More specifically, the training set includes only prose texts of the Classical period, whereas the test set is organized in three sub-tasks: a Classical sub-task on a prose text of an author not included in the training data, a Cross-genre sub-task on poetic and scientific texts, and a Cross-time sub-task on a text of the 15th century. The results obtained by the participants for each task and sub-task are presented and discussed

Extracorporeal shock wave therapy in runners with a symptomatic heel spur

The aim of this paper is to assess the benefit to treat plantar fasciitis with low-dose energy extracorporeal shock wave therapy (ESWT) and the efficacy of such treatment to abate the painful symptoms allowing a rapid return to the running activity. Our study included 54 running athletes treated for plantar fasciitis associated with a heel spur who received four sessions (once weekly) of low-dose ESWT, and followed prospectively on average 45days, 6 and 24months after their last session. The clinical results were excellent in 59% of cases, good in 12%, satisfactory in 21% and distinctly unsatisfactory in 8%. No patient was observed a significant modification of the heel spur at the follow-up X-ray. The ultrasound examination at 24months showed a disappearance of the inflammation signs in 61% of cases. A strong correlation between ultrasound improvement and clinical results were found. Low-energy ESWT seems to be a good mean to treat plantar fasciitis in runners with a 71% of good or excellent results and a persistent improvement lasting 24months. A randomized multicentric study seems to be necessary to define the type of energy that should be used in the future to treat plantar fasciitis, in particular in the athletic patients, to allow a faster return to sports activitie

DYSPHORIA DIMENSIONAL MODEL FOR FEEDING AND EATING DISORDERS: A PRELIMINARY STUDY

Background: Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED) are severe psychiatric illnesses which represent the main expression of Feeding and Eating Disorders (FED). Clinicians agree that emotional and behavioural dysregulation play a crucial role in FED. Dysphoria could help us to better understand these components. Indeed, we define dysphoria as a generic state of dissatisfaction and emotional instability, without any specific features. Among the multitude of symptoms, we find that irritability, discontent, interpersonal resentment and surrender prevail. These dimensions correspond to the four subscales of Neapean Dysphoria Scale - Italian version (NDS-I). Dysphoria role in FED has not yet been investigated. Using this test, we can characterize dysphoria both in quantitative and qualitative terms. Accordingly, domain evaluation could discriminate these disorders allowing us to assess possible differential phenomenological expressions. Aims: The aim of this paper is to understand in which way the dimensional spectrum that composes dysphoria differs between Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorders through an observational comparative study. Subjects and methods: The enrolled sample (30 patients) is represented by patients with a history of FED (AN, BN or BED). Patients were males and females between the ages of 13 and 45 with a good knowledge of Italian language. Patients with severe cognitive impairment (MMSE <19) and civil incapacitation were excluded. Patients were recruited from the Psychiatric Service of the Santa Maria della Misericordia Hospital in Perugia (PG), and other residential and semi residential structures specialized in FED treatment (FED specialized center at Palazzo Francisci in Todi (PG), Nido delle Rondini in Todi (PG), BED (Binge Eating Disorders) center in Città della Pieve (PG) and ambulatory services for FED in Umbertide (PG)). We administered them the Neapen Dysphoria Scale – Italian Version (NDS-I), a specific dimensional test for dysphoria. Starting from the dataset, with the aid of the statistical program SPSS 20, we have carried out a comparison between disorders groups selected and NDS-I total score and subscales (irritability, discontent, interpersonal resentment, surrender). For this we have used the Mann-Whitney U test, a nonparametric test with 2 independent samples, by setting a significance level p<0.05. Conclusions: This study allowed us to better understand and characterize the most common Eating Disorders. Beyond that, despite the small sample size, we found in our analysis statistically significant difference in the expression of various dysphoria dimension spectrum inside our 3 groups

Susceptibility of different TMEM154 genotypes in three Italian sheep breeds infected by different SRLV genotypes.

Small ruminant lentiviruses (SRLV) belong to the Retroviridae family and can cause various diseases. One of the most impacting diseases is visna-maedi, a complex disease characterized by long latencies and chronic progressive inflammatory events affecting the nervous system, lungs, mammary gland, and articular joints. A single nucleotide polymorphism (rs408593969, c.103G>A, missense mutation E35K) in the ovine transmembrane protein gene 154 (TMEM154) was identified as protective against small ruminant lentivirus infection in different herds worldwide. However, there is evidence in the scientific literature of a breed-specificity of this protective effect and, furthermore, there are still limited studies regarding the association between the animal genotype and the infecting virus genotype. Thus, the aim of this study was to further investigate the association between the animal genotype for the suggested protective mutation and the infecting virus genotype, in three different sheep breeds reared in northern Italy. The results obtained only partially confirmed the data available in the literature, as the protective effect was confirmed only for SRLV genotype A clusters, while other genotypes (namely B and E) infected AA and GA animals. Further studies with an experimental infection of specific virus genotypes in hosts with specific genotypes are required to confirm the larger number of cases the results obtained in this study