The economic impact of moderate stage Alzheimer's disease in Italy: Evidence from the UP-TECH randomized trial

Background: There is consensus that dementia is the most burdensome disease for modern societies. Few cost-of-illness studies examined the complexity of Alzheimer's disease (AD) burden, considering at the same time health and social care, cash allowances, informal care, and out-of-pocket expenditure by families. Methods: This is a comprehensive cost-of-illness study based on the baseline data from a randomized controlled trial (UP-TECH) enrolling 438 patients with moderate AD and their primary caregiver living in the community. Results: The societal burden of AD, composed of public, patient, and informal care costs, was about �20,000/yr. Out of this, the cost borne by the public sector was �4,534/yr. The main driver of public cost was the national cash-for-care allowance (�2,324/yr), followed by drug prescriptions (�1,402/yr). Out-of-pocket expenditure predominantly concerned the cost of private care workers. The value of informal care peaked at �13,590/yr. Socioeconomic factors do not influence AD public cost, but do affect the level of out-of-pocket expenditure. Conclusion: The burden of AD reflects the structure of Italian welfare. The families predominantly manage AD patients. The public expenditure is mostly for drugs and cash-for-care benefits. From a State perspective in the short term, the advantage of these care arrangements is clear, compared to the cost of residential care. However, if caregivers are not adequately supported, savings may be soon offset by higher risk of caregiver morbidity and mortality produced by high burden and stress. The study has been registered on the website www.clinicaltrials.org (Trial Registration number: NCT01700556). Copyright � International Psychogeriatric Association 2015

Socioeconomic Predictors of the Employment of Migrant Care Workers by Italian Families Assisting Older Alzheimer's Disease Patients: Evidence from the Up-Tech Study

Background: The availability of family caregivers of older people is decreasing in Italy as the number of migrant care workers (MCWs) hired by families increases. There is little evidence on the influence of socioeconomic factors in the employment of MCWs. Method: We analyzed baseline data from 438 older people with moderate Alzheimer's disease (AD), and their family caregivers enrolled in the Up-Tech trial. We used bivariate analysis and multilevel regressions to investigate the association between independent variables - education, social class, and the availability of a care allowance - and three outcomes - employment of a MCW, hours of care provided by the primary family caregiver, and by the family network (primary and other family caregivers). Results: The availability of a care allowance and the educational level were independently associated with employing MCWs. A significant interaction between education and care allowance was found, suggesting that more educated families are more likely to spend the care allowance to hire a MCW. Discussion: Socioeconomic inequalities negatively influenced access both to private care and to care allowance, leading disadvantaged families to directly provide more assistance to AD patients. Care allowance entitlement needs to be reformed in Italy and in countries with similar long-term care and migration systems. � 2015 The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved

[Administration of glutathione and lipid peroxidation induced during fasting].

It is well known that lipid peroxidation may be initiated or exaggerated by conditions leading to hepatic GSH depletion or altered GSH/GSSG ratio. In our study we evaluated the effects of GSH administration on hepatic, bile and plasma GSH, GSSG and MDA in rats depleted of the tripeptide by a prolonged. fasting. An exteriorized biliary-duodenal fistula was established and GSH or saline solution was administered i.p. for a period of 6h. Rats treated with GSH exhibited an increased GSH and decreased GSSG biliary excretion. Whereas in control rats an opposite pattern was observed, namely enhanced GSSG and decreased GSH biliary excretion. While hepatic GSH and GSSG concentrations were comparable in the two groups, a significant increase in liver and plasma MDA production was found in controls compared to GSH treated rats. Our data suggest a protective role of GSH against the production of lipoperoxidation as evidenced by the decrease of hepatic, biliary and plasma MDA levels and by a decreased percentage of biliary GSSG. In addition, the significant increase of biliary GSH excretion, observed in rats treated with GSH compared to controls, may be due to an increased supply of the tripeptide which is known to be preferentially excreted into bile in the reduced form

Valutazione longitudinale del modello trans-diagnostico per i Disturbi del Comportamento Alimentare

INTRODUZIONE Il modello trans-diagnostico (TM) per i Disturbi del Comportamento Alimentare (DCA) (Fairburn et al, 2003) è stato sviluppato in modo da (a) sottolineare le caratteristiche comuni alla base dei DCA, e (b) estendere il valore esplicativo della precedente concettualizzazione Cognitivo-Comportamentale, proponendo quattro ulteriori meccanismi di mantenimento dei DCA: Bassa Autostima, Perfezionismo Clinico, Intolleranza alle Emozioni e Difficoltà Interpersonali. L'obiettivo dello studio è di: a) valutare per la prima volta la validità del TM in modo prospettico in un campione di adolescenti e b) analizzare eventuali differenze di genere nelle associazioni tra i quattro fattori delineati (Time 1 - Baseline), eccessiva preoccupazione per la forma e il peso corporeo (Time 2), restrizione alimentare, comportamenti d’abbuffata e di compensazione (Time 3). METODOLOGIA Lo studio ha coinvolto 732 adolescenti Italiani (Età media Time 1 = 15,5; 49% maschi) valutati annualmente con interviste cliniche e misure standardizzate per un periodo di due anni. Il modello teorico è stato posto a verifica empirica attraverso la tecnica dei modelli di equazioni strutturali nella configurazione completa, ovvero con variabili latenti; in ogni istanza sono stati controllati il BMI e i livelli precedenti di ogni variabile latente. RISULTATI Sia il modello di misurazione che il modello strutturale hanno riportato buoni indici di bontà di adattamento. Non essendosi riscontrate differenze di genere tra i coefficienti strutturali, verranno descritti i dati relativi all’intero campione. Le difficoltà interpersonali risultano direttamente associate alla bassa autostima. Il perfezionismo clinico, la bassa autostima e le difficoltà interpersonali influiscono indirettamente sulla restrizione alimentare attraverso l’eccessiva preoccupazione per la forma e il peso corporeo, mentre l’intolleranza alle emozioni è l’unica variabile latente direttamente associata alle abbuffate e alle condotte di compensazione. Sorprendentemente non è emersa alcuna relazione diretta tra la restrizione alimentare e il comportamento d’abbuffata. CONCLUSIONI Nonostante la validità del modello TM risulti solo parzialmente confermata, i nostri risultati indicano che a) soggetti maschili e femminili risultano simili rispetto alle caratteristiche nucleari del DCA b) fattori diversi dalla restrizione alimentare sembrano giocare un ruolo nello sviluppo del comportamento d’abbuffata c) le abbuffate e i comportamenti di compensazione possono servire per modulare stati emotivi intollerabili. BIBLIOGRAFIA Fairburn CG, Cooper Z, Shafran R (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. BehaviourResearch and Therapy, 41, 509–528