PARENT-CHILD ATTACHMENT WHEN PARENTING A CHILD WITH A DISABILITY

Parent-child attachment is a commonly researched topic, but parent-child attachment when a child has a disability has received limited attention in the literature. This study seeks to examine the impact of parenting a child with a disability on parent-child attachment. This study was conducted on a Facebook forum that posts about parenting with children who have developmental disabilities. This research study used a variety of methods and procedures. First, this study was conducted using quantitative methods. The research used a self-administered survey on the platform SurveyMonkey. The study used snowball sampling to recruit participants. To analyze the data, descriptive and bivariate statistics were conducted. This research was limited in its sample size which limits its generalizability for the whole population. Further research will need to be done with a larger sample size and possibly with specific developmental disabilities. This study could have an impact on the micro and macro social work field. On the micro level, this research could promote a greater understanding of parent-child attachment when parenting a child with a disability, which could help influence attachment-based interventions for disabled children. On the macro level, policy changes could be enacted to promote parents being a more active part of their child’s therapies

Plan de mobilité durable au collège René Cassin de Noidans-lès-Vesoul

Dans le cadre d'un itinéraire de découverte (IDD) sur l'éducation à l'environnement et au développement durable (EEDD), les élèves d'une classe de 5e du collège de Noidans-lès-Vesoul ont analysé leurs mobilités et tenté de répondre à deux questions : les déplacements des collégiens de Noidans, entre leur domicile et le collège, sont-ils durables ? Quelles actions mener pour rendre ces mobilités plus durables ? Une enquête de mobilité élaborée par les élèves de la classe a été menée auprès de tous les collégiens au printemps 2009. Le projet a été piloté par deux enseignants du collège de Noidans-lès-Vesoul, en partenariat avec le laboratoire ThéMA

Sex and age differences in health expenditure in Northern Italy

BACKGROUND: Little is known about the health care spending distribution across the age and sex gradient in European systems. The aim of the present study is to examine gender and age differences in health care utilization in Lombardy, Italy. METHODS: We analysed administrative data for the year 2010 in Lombardy (the largest Italian region, with about 10 million inhabitant) including spending for inpatient and outpatient services and pharmaceuticals. Data were aggregated across age and sex. RESULTS: Lombardy in 2010 spent around 10.2 billion €, 51% of which for women. Age-standardized per-patient expenditure was however 5% lower for females than for males on average. Per-patient spending on elderly women (>65) was around 75% of the spending on men of the same age group. Further, health expenditure was higher for men for the treatment of chronic diseases. Importantly, the difference persisted after allowance of history chronic conditions. CONCLUSIONS: Our results are in sharp contrast with the US based literature showing that health expenditure in women is greater than in men. This may reflect inadequate attention to health care of women in Ital

Cinacalcet adherence in dialysis patients with secondary hyperparathyroidism in Lombardy Region: clinical implications and costs

Background: Patients on dialysis often have secondary hyperparathyroidism (SHPT), a disorder associated with renal osteodystrophy, progressive vascular calcification, cardiovascular disease, and death. The objective of this retrospective observational study was to evaluate, in dialysis patients with SHPT, the impact of different levels of adherence to cinacalcet therapy on hospitalisations and direct healthcare costs charged to the Lombardy Regional Health Service (Italy). Methods: Data recorded in the administrative databases on all citizens undergoing dialysis between 1 January 2011 and 31 December 2011 were selected. For the aim of this study, patients with SHPT already on dialysis in the first 6 months of 2009 who had been treated with cinacalcet for at least 365 days were selected and retrospectively analysed through to end of 2012. Healthcare resource utilisation, cinacalcet adherence, and costs for medication, hospitalisations, and diagnostic/therapeutic procedures were estimated. Results: A total of 994 patients were identified (mean age 63.0 years, females 43.5%). The first patient tertile had an adherence to cinacalcet of <64.1%, whereas the third had an adherence of over 91.5%. Patients in the third adherence tertile experienced fewer all-causes hospitalisations than those in the first tertile (-19.2%; p=0.01423), fractures (-37.1%; p=0.59422), cardiovascular disease (-23.8%; p=0.04025), and sepsis (-32.3%; p=0.01386). The increase in costs for cinacalcet-adherent patients is almost completely offset by the reduction in costs for hospitalisations. Conclusions: The results of the analysis suggest that there may be some correlation between a high level of cinacalcet adherence and a decrease in hospitalisations

Clinical use, safety and effectiveness of novel high cost anticancer therapies after marketing approval: a record linkage study

Background: major clinical outcomes of anticancer drugs may differ between clinical trials and clinical practice. Administrative databases provide long-term information on safety and effectiveness of these drugs in large unselected populations and in selected subgroups of patients. In addition, these data provide complementary information on topics where evidence from randomized clinical trials is unavailable. Methods: this project will investigate 17 new targeted high cost drugs in Lombardy oncology practice between 2006 and 2010 using data from electronic healthcare databases. Specific objectives are: 1) to estimate the incidence of serious adverse events in clinical practice and their predictors; 2) to estimate survival and progression free survival and their predictors; 3) to compare major clinical outcomes according to different regimen of therapy. We will build a database by record linkage of several regional health service sources: the File F registry (in which the administration of the 17 drugs is recorded), the Regional hospital discharge forms (SDO ) database, the drug prescription database, the outpatients' services database, and the Registry Office database. Subjects resident in Lombardy who received at least one prescription of these drugs from 2006 to 2010 will be considered. Complications warranting hospitalization will be derived from the patients' SDO s after the first drug administration. Vital status will be obtained from the Registry Office database. Results: we will provide estimates of the incidence of serious adverse events of novel anticancer therapies, and of overall and disease free survival in clinical practice, overall and in selected subgroups. Conclusions: these data will contribute to a better effectiveness evaluation, particularly in patients under-represented in clinical trials

The CRACK programme: a scientific alliance for bridging healthcare research and public health policies in Italy

Healthcare utilisation databases, and other secondary data sources, have been used with growing frequency to assess health outcomes and healthcare interventions worldwide. Their increased popularity as a research tool is due to their timely availability, the large patient populations covered, low cost, and applicability for studying real-world clinical practice. Despite the need to measure Italian National Health Service performance both at regional and national levels, the wealth of good quality electronic data and the high standards of scientific research in this field, healthcare research and public health policies seem to progress along orthogonal dimensions in Italy. The main barriers to the development of evidence-based public health include the lack of understanding of evidence-based methodologies by policy makers, and of involvement of researchers in the policy process. The CRACK programme was launched by some academics from the Lombardy Region. By extensively using electronically stored data, epidemiologists, biostatisticians, pharmacologists and clinicians applied methods and evidence to several issues of healthcare research. The CRACK programme was based on their intention to remove barriers that thwart the process of bridging methods and findings from scientific journals to public health practice. This paper briefly describes aim, articulation and management of the CRACK programme, and discusses why it might find articulated application in Italy

Antihypertensive drug use during pregnancy: a population based study

Purpose. The study aimed at assessing if the European guideline on the use of antihyper-tensive drugs (AD) in pregnancy are followed in clinical practice. We also evaluated the association between the use of non-recommended drugs and individual characteristics. Methods. This study analyzed a cohort of 86 171 singleton deliveries occurring between 2009-2010 in the Lombardy region, Italy. Women with first prescription of AD during pregnancy were considered as incident users. Methyldopa, labetalol and nifedipine were considered as “recommended drugs”; all other AD were considered as “non-recommend-ed”. Odds Ratio and 95% confidence intervals were estimated.Results. Among the 1009 patients (1.2%) exposed to AD during pregnancy, 675 (66.9%) were incident users. Among the incident users, 31% received non-recommended drugs; this proportion decreased to 18% among women who started treatment in the third tri-mester. Women with at least four concomitant diseases had an elevated risk of receiving non-recommended drugs in pregnancy (OR 2.68; 95% CI 1.10-6.73).Conclusions. Exposure to recommended antihypertensives increased during pregnancy. Nevertheless, a fraction of users that continued or began treatment with non-recom-mended medications was still present. 

Mortality in a population exposed to dioxin after the Seveso, Italy, accident in 1976 : 25 years of follow-up

The Seveso accident in 1976 caused a large, populated area north of Milan, Italy, to be contaminated by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). In this study, the authors followed up the exposed population for chronic effects; this paper reports the results of the mortality follow-up extension for 1997-2001. The study cohort includes 278,108 subjects resident at the time of the accident or immigrating/born in the 10 years thereafter in three contaminated zones with decreasing TCDD soil levels (zone A, very high; zone B, high; zone R, low) and in a reference territory comprising surrounding, noncontaminated municipalities. Vital status and cause-of-death ascertainment were 99% complete. Adjusted rate ratios and 95% confidence intervals were calculated by using Poisson regression. Results confirmed previous findings of excesses of lymphatic and hematopoietic tissue neoplasms in zones A (six deaths; rate ratio = 2.23, 95% confidence interval: 1.00, 4.97) and B (28 deaths; rate ratio = 1.59, 95% confidence interval: 1.09, 2.33). These zones also showed increased mortality from circulatory diseases in the first years after the accident, from chronic obstructive pulmonary disease, and from diabetes mellitus among females. A toxic and carcinogenic risk to humans after high TCDD exposure is supported by the results of this study

Effectiveness of trastuzumab in first-line her2+ metastatic breast cancer after failure in adjuvant setting: a controlled cohort study

Background. The evidence supporting the use of trastuzumab (T) in a metastatic setting comes from studies that included (almost) only patients who never received prior T. We investigated the effectiveness of T as first-line therapy for metastatic breast cancer (mBC) in women previously treated with T in the adjuvant setting.Materials and Methods. By using record linkage of five administrative health care databases of Lombardy, Italy, we identified 2,046women treated with T for early breast cancer (eBC) in 2006-l2009, 96 of whom developed a metastasis and were retreated with T in first-line treatment for mBC (treatment group).We compared the overall survival (OS) of these women with that of 197 women treated with T in firstline treatment for mBC, who were treated with therapies other than T for early disease (control group).We computed Kaplan-Meier 2-year OS and used a proportional hazard model to estimate the multivariate hazard ratio (HR) of death in the intervention group compared with the control group, adjusted by age, use of endocrine therapy, and site of metastasis.Results. Two-year OS was 60.0% in the treatment group and 59.5% in the control group. The adjusted HR of death in the treatment group compared with the control group was 0.79 (95% confidence interval, 0.50\u20131.26).Conclusion. Our data provide convincing evidence that the outcome of women receiving first-line T treatment for mBC after T failure in the adjuvant setting is comparable to that of women not receiving T for eBC. These data are of specific interest, given the unavailability of data from randomized clinical trials