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

Neutrino oscillation studies with IceCube-DeepCore

AbstractIceCube, a gigaton-scale neutrino detector located at the South Pole, was primarily designed to search for astrophysical neutrinos with energies of PeV and higher. This goal has been achieved with the detection of the highest energy neutrinos to date. At the other end of the energy spectrum, the DeepCore extension lowers the energy threshold of the detector to approximately 10 GeV and opens the door for oscillation studies using atmospheric neutrinos. An analysis of the disappearance of these neutrinos has been completed, with the results produced being complementary with dedicated oscillation experiments. Following a review of the detector principle and performance, the method used to make these calculations, as well as the results, is detailed. Finally, the future prospects of IceCube-DeepCore and the next generation of neutrino experiments at the South Pole (IceCube-Gen2, specifically the PINGU sub-detector) are briefly discussed

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

An Update On The Role Of Adipokines In Arterial Stiffness And Hypertension

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Adipokines: Another Link Between Obesity And Hypertension

[No abstract available

Phenotypic Characteristics Of Resistant Hypertension In The Brazilian Population [características Fenotípicas Da Hipertensão Arterial Resistente Na População Brasileira]

Resistant hypertension (RH) is defined as blood pressure that remains above target in spite of the concurrent use of three or more classes of antihypertensive drugs at optimized doses (UCRH), with one of them being a diuretic. Moreover, patients whose blood pressure is controlled while using four or more antihypertensive medications are also considered controlled resistant hypertensive (CRH) subjects. Although this definition may be useful in terms of categorizing a larger group of resistant hypertensive individuals, as these two subgroups share high cardiovascular risk, some important clinical and pathophysiologic particularities need to be better evaluated, before considering resistant controlled and uncontrolled patients as part of the same group. We compared cardiovascular characteristics of these two subgroups with resistant hypertension. In spite of some similar features, the UCRH subgroup has cardiovascular phenotypes with worse prognosis, such as increased vascular stiffness and left ventricular hypertrophy, as well as more impaired endothelial function and lower nocturnal blood pressure dipping, among others. Considering these differences, the UCRH subgroup is associated with greater cardiovascular risk and may be considered as more resistant to antihypertensive treatment. In addition to the importance of better prevention and treatment of resistant hypertension by identifying early risk factors and optimizing drug therapy, some clinical implications must be considered when managing controlled and uncontrolled patients as similar to the resistant hypertension group.1006579582Calhoun, D.A., Jones, D., Textor, S., Goff, D.C., Murphy, T.P., Toto, R.D., Resistant hypertension: Diagnosis, evaluation, and treatment: A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research (2008) Circulation., 117 (25), pp. e510-e526Calhoun, D.A., Jones, D., Textor, S., Goff, D.C., Murphy, T.P., Toto, R.D., Resistant hypertension: Diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research (2008) Hypertension., 51 (6), pp. 1403-1419Lloyd-Jones, D.M., Evans, J.C., Larson, M.G., O'Donnell, C.J., Roccella, E.J., Levy, D., Differential control of systolic and diastolic blood pressure: Factors associated with lack of blood pressure control in the community (2000) Hypertension., 36 (4), pp. 594-599Cushman, W.C., Ford, C.E., Cutler, J.A., Margolis, K.L., Davis, B.R., Grimm, R.H., Success and predictors of blood pressure control in diverse North American settings: The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT) (2002) J Clin Hypertens (Greenwich)., 4 (6), pp. 393-404Pimenta, E., Gaddam, K.K., Oparil, S., Aban, I., Husain, S., Dell'Italia, L.J., Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: Results from a randomized trial (2009) Hypertension., 54 (3), pp. 475-481Cuspidi, C., Macca, G., Sampieri, L., Michev, I., Salerno, M., Fusi, V., High prevalence of cardiac and extracardiac target organ damage in refractory hypertension (2001) J Hypertens., 19 (11), pp. 2063-2070Salles, G.F., Cardoso, C.R., Pereira, V.S., Fiszman, R., Muxfeldt, E.S., Prognostic significance of a reduced glomerular filtration rate and interaction with microalbuminuria in resistant hypertension: A cohort study (2011) J Hypertens., 29 (10), pp. 2014-2023Salles, G.F., Fiszman, R., Cardoso, C.R., Muxfeldt, E.S., Relation of left ventricular hypertrophy with systemic inflammation and endothelial damage in resistant hypertension (2007) Hypertension., 50 (4), pp. 723-728Salles, G.F., Cardoso, C.R., Fiszman, R., Muxfeldt, E.S., Prognostic impact of baseline and serial changes in electrocardiographic left ventricular hypertrophy in resistant hypertension (2010) Am Heart J., 159 (5), pp. 833-840Gus, M., Silva, D.N., Fernandes, J., Cunha, C.P., Sant'Anna, G.D., Epworth's sleepiness scale in outpatients with different values of arterial blood pressure (2002) Arq Bras Cardiol., 78 (1), pp. 17-24Gus, M., Goncalves, S.C., Martinez, D., de Abreu Silva, E.O., Moreira, L.B., Fuchs, S.C., Risk for Obstructive Sleep Apnea by Berlin Questionnaire, but not daytime sleepiness, is associated with resistant hypertension: A case-control study (2008) Am J Hypertens., 21 (7), pp. 832-835Pedrosa, R.P., Krieger, E.M., Lorenzi-Filho, G., Drager, L.F., Recent advances of the impact of obstructive sleep apnea on systemic hypertension (2011) Arq Bras Cardiol., 97 (2), pp. e40-e47Pedrosa, R.P., Drager, L.F., Gonzaga, C.C., Sousa, M.G., de Paula, L.K., Amaro, A.C., Obstructive sleep apnea: The most common secondary cause of hypertension associated with resistant hypertension (2011) Hypertension., 58 (5), pp. 811-817Whaley-Connell, A., Johnson, M.S., Sowers, J.R., Aldosterone: Role in the cardiometabolic syndrome and resistant hypertension (2010) Prog Cardiovasc Dis., 52 (5), pp. 401-409Sowers, J.R., Whaley-Connell, A., Epstein, M., Narrative review: The emerging clinical implications of the role of aldosterone in the metabolic syndrome and resistant hypertension (2009) Ann Intern Med., 150 (11), pp. 776-783Drager, L.F., Queiroz, E.L., Lopes, H.F., Genta, P.R., Krieger, E.M., Lorenzi-Filho, G., Obstructive sleep apnea is highly prevalent and correlates with impaired glycemic control in consecutive patients with the metabolic syndrome (2009) J Cardiometab Syndr., 4 (2), pp. 89-95Martins, L.C., Conceicao, F.L., Muxfeldt, E.S., Salles, G.F., Prevalence and associated factors of subclinical hypercortisolism in patients with resistant hypertension (2012) J Hypertens., 30 (5), pp. 967-973Boer-Martins, L., Figueiredo, V.N., Demacq, C., Martins, L.C., Consolin-Colombo, F., Figueiredo, M.J., Relationship of autonomic imbalance and circadian disruption with obesity and type 2 diabetes in resistant hypertensive patients (2011) Cardiovasc Diabetol., 10, p. 24Ubaid-Girioli, S., Souza, A.L., Yugar-Toledo, J.C., Martins, L.C., Ferreira-Melo, S., Coelho, O.R., Aldosterone excess or escape: Treating resistant hypertension (2009) J Clin Hypertens (Greenwich)., 11 (5), pp. 245-252Boer-Martins, L., Figueiredo, V.N., Demacq, C., Martins, L.C., Faria, A.P., Moraes, C.D., Leptin and aldosterone in sympathetic activity in resistant hypertension with or without type 2 diabetes (2012) Arq Bras Cardiol., 99 (1), pp. 642-648de Souza, F., Muxfeldt, E., Fiszman, R., Salles, G., Efficacy of spironolactone therapy in patients with true resistant hypertension (2010) Hypertension., 55 (1), pp. 147-152Acelajado, M.C., Pisoni, R., Dudenbostel, T., Dell'Italia, L.J., Cartmill, F., Zhang, B., Refractory hypertension: Definition, prevalence, and patient characteristics (2012) J Clin Hypertens (Greenwich)., 14 (1), pp. 7-12Moreno Jr., H., Coca, A., Resistant and refractory hypertension: Reflections on pathophysiology and terminology (2012) Blood pressure., 21 (4), pp. 209-210Martins, L.C., Figueiredo, V.N., Quinaglia, T., Boer-Martins, L., Yugar-Toledo, J.C., Martin, J.F., Characteristics of resistant hypertension: Ageing, body mass index, hyperaldosteronism, cardiac hypertrophy and vascular stiffness (2011) J Hum Hypertens., 25 (9), pp. 532-538Figueiredo, V.N., Yugar-Toledo, J.C., Martins, L.C., Martins, L.B., de Faria, A.P., de Haro Moraes, C., Vascular stiffness and endothelial dysfunction: Correlations at different levels of blood pressure (2012) Blood Press, 21 (1), pp. 31-38Quinaglia, T., Martins, L.C., Figueiredo, V.N., Santos, R.C., Yugar-Toledo, J.C., Martin, J.F., Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension (2011) J Hum Hypertens., 25 (11), pp. 656-664de Haro Moraes, C., Figueiredo, V.N., de Faria, A.P., Barbaro, N.R., Sabbatini, A.R., Quinaglia, T., High-circulating leptin levels are associated with increased blood pressure in uncontrolled resistant hypertension (2012) J Hum Hypertens, , Jul 19[epub ahead of print

Resistant Hypertension Revisited: Definition And True Prevalence

[No abstract available]3271546Smith, S.M., Gong, Y., Handberg, E., Messerli, F.H., Bakris, G.L., Ahmed, A., Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension (2014) J Hypertens, 32, pp. 635-643Pepine, C.J., Handberg, E.M., Cooper-Dehoff, R.M., Marks, R.G., Kowey, P., Messerli, F.H., A calcium antagonist vs a noncalcium antagonist hypertension treatment strategy for patients with coronary artery disease: The International Verapamil-Trandolapril Study (INVEST): A randomized controlled trial. (2003) JAMA, 290, pp. 2805-2816Julius, S., Kjeldsen, S.E., Brunner, H., Hansson, L., Platt, F., Ekman, S., VALUE trial: Long-termblood pressure trends in 13,449 patients with hypertension and high cardiovascular risk (2003) Am J Hypertens, 16, pp. 544-548Furberg, C.D., Wright, J.T., Davis, B.R., Cutler, J.A., Alderman, M., Black, H., Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (2002) JAMA, 288, pp. 2981-2997Gupta, A.K., Nasothimiou, E.G., Chang, C.L., Sever, P.S., Dahlof, B., Poulter, N.R., Investigators A. Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): A risk score to identify those at high-risk (2011) J Hypertens, 29, pp. 2004-2013Black, H.R., Elliott, W.J., Grandits, G., Grambsch, P., Lucente, T., White, W.B., Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) Trial (2003) JAMA, 289, pp. 2073-2082Calhoun, D.A., Jones, D., Textor, S., Goff, D.C., Murphy, T.P., Toto, R.D., Resistant hypertension: Diagnosis, evaluation, and treatment. A scientific statement from the american heart association professional education committee of the council for high blood pressure research (2008) Hypertension, 51, pp. 1403-1419Garg, J.P., Elliott, W.J., Folker, A., Izhar, M., Black, H.R., Serv, R.U.H., Resistant hypertension revisited: A comparison of two university-based cohorts (2005) Am J Hypertens, 18, pp. 619-626Acelajado, M.C., Pisoni, R., Dudenbostel, T., Dell'Italia, L.J., Cartmill, F., Zhang, B., Refractory hypertension: Definition, prevalence, and patient characteristics (2012) J Clin Hypertens, 14, pp. 7-1

Deregulation Of Adipokines Related To Target Organ Damage On Resistant Hypertension

Resistant hypertension (RHTN) includes patients with controlled blood pressure (BP) (CRHTN) and uncontrolled BP (UCRHTN). In fact, RHTN patients are more likely to have target organ damage (TOD), and resistin, leptin and adiponectin may affect BP control in these subjects. We assessed the relationship between adipokines levels and arterial stiffness, left ventricular hypertrophy (LVH) and microalbuminuria (MA). This cross-sectional study included CRHTN (n=51) and UCRHTN (n=38) patients for evaluating body mass index, ambulatory blood pressure monitoring, plasma adiponectin, leptin and resistin concentrations, pulse wave velocity (PWV), MA and echocardiography. Leptin and resistin levels were higher in UCRHTN, whereas adiponectin levels were lower in this same subgroup. Similarly, arterial stiffness, LVH and MA were higher in UCRHTN subgroup. Adiponectin levels negatively correlated with PWV (r=-0.42, P<0.01), and MA (r=-0.48, P<0.01) only in UCRHTN. Leptin was positively correlated with PWV (r=0.37, P=0.02) in UCRHTN subgroup, whereas resistin was not correlated with TOD in both subgroups. Adiponectin is associated with arterial stiffness and renal injury in UCRHTN patients, whereas leptin is associated with arterial stiffness in the same subgroup. Taken together, our results showed that those adipokines may contribute to vascular and renal damage in UCRHTN patients. © 2014 Macmillan Publishers Limited All rights reserved.286388392Calhoun, D.A., Jones, D., Textor, S., Goff, D.C., Murphy, T.P., Toto, R.D., Resistant hypertension: Diagnosis, evaluation, and treatment: A scientific statement from the american heart association professional education committee of the council for high blood pressure research (2008) Circulation, 117, pp. e510-e526Vakili, B.A., Okin, P.M., Devereux, R.B., Prognostic implications of left ventricular hypertrophy (2001) Am Heart J, 141, pp. 334-341Vlek, A.L., Van Der Graaf, Y., Spiering, W., Algra, A., Visseren, F.L., Cardiovascular events and all-cause mortality by albuminuria and decreased glomerular filtration rate in patients with vascular disease (2008) J Intern Med, 264, pp. 351-360Laurent, S., Boutouyrie, P., Asmar, R., Gautier, I., Laloux, B., Guize, L., Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients (2001) Hypertension, 37, pp. 1236-1241Martins, L.C., Figueiredo, V.N., Quinaglia, T., Boer-Martins, L., Yugar-Toledo, J.C., Martin, J.F., Characteristics of resistant hypertension: Ageing, body mass index, hyperaldosteronism, cardiac hypertrophy and vascular stiffness (2011) J Hum Hypertens, 25, pp. 532-538Quinaglia, T., Martins, L.C., Figueiredo, V.N., Santos, R.C., Yugar-Toledo, J.C., Martin, J.F., Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension (2011) J Hum Hypertens, 25, pp. 656-664Fonseca-Alaniz, M.H., Takada, J., Alonso-Vale, M.I., Lima, F.B., Adipose tissue as an endocrine organ: From theory to practice (2007) J Pediatr (Rio J), 83, pp. S192-S203Chow, W.S., Cheung, B.M., Tso, A.W., Xu, A., Wat, N.M., Fong, C.H., Hypoadiponectinemia as a predictor for the development of hypertension: A 5-year prospective study (2007) Hypertension, 49, pp. 1455-1461Schutte, R., Huisman, H.W., Schutte, A.E., Malan, N.T., Leptin is independently associated with systolic blood pressure, pulse pressure and arterial compliance in hypertensive African women with increased adiposity: The POWIRS study (2005) J Hum Hypertens, 19, pp. 535-541Zhang, L., Curhan, G.C., Forman, J.P., Plasma resistin levels associate with risk for hypertension among nondiabetic women (2010) J Am Soc Nephrol, 21, pp. 1185-1191Fang, C., Lei, J., Zhou, S.X., Zhang, Y.L., Yuan, G.Y., Wang, J.F., Association of higher resistin levels with in?ammatory activation and endothelial dysfunction in patients with essential hypertension (2013) Chin Med J (Engl), 126, pp. 646-649Youn, J.C., Kim, C., Park, S., Lee, S.H., Kang, S.M., Choi, D., Adiponectin and progression of arterial stiffness in hypertensive patients (2011) Int J Cardiol, 163 (3), pp. 316-319Hong, S.J., Park, C.G., Seo, H.S., Oh, D.J., Ro, Y.M., Associations among plasma adiponectin, hypertension, left ventricular diastolic function and left ventricular mass index (2004) Blood Press, 13, pp. 236-242Wannamethee, S.G., Tchernova, J., Whincup, P., Lowe, G.D., Kelly, A., Rumley, A., Plasma leptin: Associations with metabolic, in?ammatory and haemostatic risk factors for cardiovascular disease (2007) Atherosclerosis, 191, pp. 418-426Zhu, W., Cheng, K.K., Vanhoutte, P.M., Lam, K.S., Xu, A., Vascular effects of adiponectin: Molecular mechanisms and potential therapeutic intervention (2008) Clin Sci (Lond), 114, pp. 361-374Kartal, O., Inal, V., Baysan, O., Saglam, K., Relationship between serum leptin levels and left ventricular hypertrophy in obese hypertensive patients (2008) Anatol J Cardiol, 8, pp. 342-346Schutte, A.E., Huisman, H.W., Schutte, R., Van Rooyen, J.M., Malan, L., Fourie, C.M.T., Adipokines and cardiometabolic function: How are they interlinked? (2010) Regul Peptides, 164, pp. 133-138De Haro Moraes, C., Figueiredo, V.N., De Faria, A.P., Barbaro, N.R., Sabbatini, A.R., Quinaglia, T., High-circulating leptin levels are associated with increased blood pressure in uncontrolled resistant hypertension (2013) J Hum Hypertens, 27, pp. 225-230De Faria, A.P.C., Demacq, C., Figueiredo, V.N., Moraes, C.H., Santos, R.C., Sabbatini, A.R., Hypoadiponectinemia and aldosterone excess are associated with lack of blood pressure control in subjects with resistant hypertension (2013) Hypertens Res, 36, pp. 1067-1072Laurent, S., Cockcroft, J., Van Bortel, L., Boutouyrie, P., Giannattasio, C., Hayoz, D., Expert consensus document on arterial stiffness: Methodological issues and clinical applications (2006) Eur Heart J, 27, pp. 2588-2605Lang, R.M., Bierig, M., Devereux, R.B., Flachskampf, F.A., Foster, E., Pellikka, P.A., Recommendations for chamber quantification: A report from the American Society of echocardiography's guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the european association of echocardiography, a branch of the european society of cardiology (2005) J Am Soc Echocardiogr, 18 (12), pp. 1440-1463(2000) World Health Organ Tech Rep ser, 894 (1-19), pp. 1-253. , Obesity: preventing and managing the global epidemic. 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