In Italy, the family constitutes the major caregiving response to the needs of the elderly who are no longer self-sufficient. These caregivers are often wives or daughters who have chosen to keep the patient at home with them. On average, three-quarters of the caregiver's day is devoted to the patient, a proportion that tends to increase linearly as the disease progresses. The primary aim of our study was to describe a group of Italian caregivers of patients with a diagnosis of dementia to assess their levels of stress. We then correlated these caregivers with a number of sociodemographic variables and the patients' degree of cognitive impairment and independence in daily life activities. The study was conducted on a sample group of 236 caregivers of patients with a diagnosis of Alzheimer's disease (AD) according to the DSM-IV criteria. Each caregiver took part in a sociodemographic interview and filled in two questionnaires: the Caregiver Burden Inventory (CBI), to quantify the caregiving workload and the Brief Symptom Inventory (BSI), to assess the level of anxiety and depression. Patients were administered the Mini-Mental State Examination (MMSE) to evaluate their level of cognitive impairment and the Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL) tests to quantify their level of independence. The analysis of the results shows that the average Italian caregiver of an AD patient is a woman, approximately 60 years old. The majority of caregivers are spouses, followed by children. In general, these caregivers work at home, are housewives or retired, and are personally involved in caring for the patients. The greater the level of a patient's cognitive impairment and the less independent they are, the greater amount of care and supervision they require, leaving less free time for the caregiver; this leads to higher levels of anxiety related to caregiving. Toward the final stages of the disease, patient care tasks take up nearly all of the caregiver's free time, leaving them only about two hours per week for themselves or their friends. In conclusion, the management of dementia patients places a particular burden on the caregiver and involves several economic and social costs. The burden becomes heavier as the disease progresses, since the increase of cognitive disorders and the resulting reduction of independence in daily life, together with the onset of behavioral symptoms, heighten the caregiver's distress, anxiety, and depression. Establishing a network of community services able to alleviate the burden on families is therefore a priority. Parallels can be drawn between the stresses documented for American caregivers and their Italian counterparts.

Aged↗

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Different perception of cognitive impairment, behavioral disturbances, and functional disabilities between persons with mild cognitive impairment and mild Alzheimer's disease and their caregivers.

Insight in dementia is a multifaceted concept and ability, which includes the persons' perception of their behavioral and cognitive symptoms and functional disability. This ability seems to deteriorate as dementia progresses. The aim of this study was to evaluate the level of insight in the cognitive, behavioral, and functional disorders in a group of persons with mild cognitive impairment (MCI) or mild AD (Alzheimer's disease) and to compare their perception of their illness with that of their caregivers. The study involved a group of 121 persons with MCI and mild AD and their caregivers. The persons with MCI and mild AD were administered the tests Mini-Mental State Examination, Instrumental Activities of Daily Living, Activities of Daily Living, Neuropsychiatric Inventory, Schedule for the Assessment of Insight, Clinical Insight Rating Scale, and a short interview. Major differences were identified between how the persons with MCI or mild AD and their caregivers perceived the persons' cognitive and behavioral disorders. The group with MCI or mild AD underestimated their deficits, which were considered serious and disabling by their caregivers.

Aged↗

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[Follow-up of allergic symptoms in a group of health workers sensitized to latex].

We studied 28 health care workers sensitised to latex and complaining of respiratory symptoms at work. All were females, aged 32 y (median), and had worked in the hospital for 12 y, in departments with high exposures (22 cases), moderate exposure (4 cases) or low exposure (2 cases) to rubber gloves. Twenty also complained of latex skin symptoms. Twenty-five (89%) were atopical (by prick test), and 16 (57%) had a personal history of allergic disease. Nine (32%) also had symptoms from exposure to latex outside work and 3 (10%) from food cross-reacting with latex. The specific inhalation test with latex gloves confirmed the diagnosis of asthma in 4 cases (14%) and of rhinitis in 13 cases (46%). We reinvestigated the workers 14 months (median) after the first examination to update exposure to latex, any allergic symptoms and adverse effects of relocation. At the follow-up, 3 workers (11%) had retired, all the others had stopped wearing powdered latex gloves, and 12 had changed their duties or the work-place. Ten (40%) of the 25 subjects still at work were without symptoms, 14 (56%) occasionally complained of mild symptoms and one of frequent rhinitis. Overall, we observed improvement of skin symptoms in 74% (14/19) of the cases and of respiratory symptoms in 56% (14/25) of the cases. Symptoms from exposure to latex outside work were still present in 6 subjects. The persistence of symptoms at work was significantly higher among workers who continued to work in departments with high/moderate latex glove exposure. The results of the study show that skin and respiratory symptoms among health care workers are related to the use of powdered latex gloves and confirm the importance of primary prevention.

Adult↗

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Primary non-Hodgkin lymphoma of the kidney.

Explore the source record for details and available documents.

Aged↗

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[Follow-up of symptoms, parameters of respiratory function, and data on specific sensitization in a group of subjects with latex-induced asthma and rhinitis].

We re-investigated 13 workers 6 years (SD 2) after the first diagnosis of asthma or rhinitis caused by latex, to update the exposure to latex, the eventual symptoms, respiratory function (spirometry and metacholine PD20 FEV1), skin prick test to common allergens and latex, RAST to latex, total IgE levels and eosinophils count in the blood. At the follow up, all the workers stopped wearing powdered latex gloves, but for 10 an indirect exposure to latex was still possible. All cases referred improvement of respiratory symptoms at work, but 7 workers occasionally complained of mild symptoms. No statistically significant variations of respiratory function test and of the immunological parameters were found. The workers with persistent respiratory symptoms at work had a longer duration of symptoms before the diagnosis (p = 0.02), if compared with workers without symptoms.

Asthma↗

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[Pleural plaques and ventilatory function: follow-up study].

We have evaluated, over a mean follow up period of 3.7 (SD 1.8) years, the lung function in a group of 103 workers, according to the presence (36 workers) or absence (67 workers) of pleural plaques at chest Rx-films/HRCT. A Generalized Estimating Equation (GEE) approach was used to investigate the relation between the loss of pulmonary function and (i) presence/absence of pleural plaques, (ii) smoking status, and (iii) work seniority in work places with exposure to asbestos. The mean age, at the first examination, was 49 (SD 6) years and work seniority 25 (SD 7) years. Multivariate GEE approach to age- and height-adjusted spirometric data (236 measures of VC, FEV1 and 234 determinations of TLC), showed that pleural plaques were not associated with significant loss of pulmonary function. Smokers (> or = 15 py), when compared with no-smokers, showed significant loss of VC (-5.3%, p < 0.05), FEV1 (-8.4%, p < 0.001) and TLC (-4.0%, p < 0.05). An occupational history in work places with exposure to asbestos (ship building/repairing) was significantly associated with a slight, but significant (p < 0.05), 10-year decrease in VC (-3.1%) and FEV1 (-4.9%).

Follow-Up Studies↗

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[A follow-up study of lung function among ex-asbestos workers with and without pleural plaques].

BACKGROUND: Pulmonary function testing is widely accepted as an integral part of medical surveillance of occupational lung diseases. There are several cross-sectional studies evaluating lung function among asbestos-exposed workers, but only few longitudinal surveys have been performed. OBJECTIVES: To evaluate, over a mean follow-up period of 3.7 (SD 1.8) years, the loss of lung function in a group of 103 workers with previous exposure to asbestos (mainly ship building/repairing), according to the presence or absence of pleural plaques at radiological examination. METHODS: Chest radiographic examination was used to ascertain the presence/absence of pleural plaques. If chest X-ray films were positive for pleural plaques, HRCT (High Resolution Computed Tomography) was used to exclude any parenchymal disease. The assessment of lung function over time included repeated measurement of vital capacity (VC), forced expiratory volume in one second (FEV1) and total lung capacity (TLC). Smoking was assessed in terms of pack-years. A Generalized Estimating Equations (GEE) approach to repeated spirometric measurement was used to investigate the relationship between the loss of pulmonary function and (i) presence/absence of pleural plaques, (ii) smoking status, and (iii) work seniority in workplaces with exposure to asbestos. RESULTS: In the ex-asbestos workers, mean age at the first examination was 49 (SD 6) years and work seniority averaged 25 (SD 7) years; 36% were non-smokers, 27% smoked < 15 pack-years, and 37% smoked > or = 15 pack-years. Thirty-six workers showed pleural plaques at radiological examination. Overall, 236 measurements of VC and FEV1, and 234 determinations of TLC were available. Multivariate GEE approach to age- and height-adjusted spirometric data showed that pleural plaques were not associated with a significant loss of pulmonary function during the follow-up. When compared with non-smokers, heavy smokers (> or = 15 pack-years) showed on average a significant loss of VC (-5.3%, IC 95%: -9.4 - -1.2%), FEV1 (-8.4%, IC 95%: -13.2 - -3.5%), and TLC (-4.0%, IC 95%: -7.4 - -0.5%). An occupational history of previous exposure to asbestos was significantly associated with an 10-year decrease in VC (-3.1%, IC 95%: -5.9 - -0.3%) and FEV1 (-4.9%, IC 95%: -8.3 - -1.5%). CONCLUSIONS: The results of this follow-up study showed that smoking and previous asbestos exposure were associated with a mild, but statistically significant, loss of lung function. Radiological findings of pleural plaques were not related to deterioration of lung function over the follow-up period.

Asbestosis↗

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Cerebellar subacute syndrome due to corticosteroid-responsive encephalopathy associated with autoimmune thyroiditis (also called "Hashimoto's encephalopathy").

The corticosteroid-responsive encephalopathy associated with autoimmune thyroiditis (the so-called "Hashimoto's Encephalopathy") is a rare disorder with multiple symptomatology, breaking out with an acute or subacute onset and having a relapsing course, not correlated to thyroid hormone levels, with autoimmune pathogenesis, and usually associated with Hashimoto's thyroiditis. In this paper, we report on a case study regarding a 46 year-old woman showing a subacute course cerebellar syndrome, associated with Hashimoto's thyroiditis, diagnosed as "Hashimoto's encephalopathy". The possible pathogenesis and the major aspects of the differential diagnostic sector are discussed with particular reference to an ataxic syndrome caused by a progressive non-familial adult onset cerebellar degeneration (PNACD), associated with the thyroid disease itself.

Adrenal Cortex Hormones↗

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Stiff person syndrome and motor mononeuropathy with conduction block: a singular association.

The "Stiff person syndrome"(SPS) is a rare dysimmune chronic neurological disorder, sometimes paraneoplastic, characterized by progressive stiffness, painful persistent or spasmodic muscle contractions, mostly involving spine and lower extremities. In 60 to 90 percent of cases, non-paraneoplastic forms are associated to the presence of anti-glutamic acid decarboxylase (anti-GAD) antibodies in the cerebrospinal fluid and in the serum, while anti-amphiphysin antibodies are frequently associated to paraneoplastic types. The relevant treatment consists of three basic approaches: increase in the inhibitory processes in charge of muscle activity control, re-modulation of the immune response, removal of any associated neoplasia. Indications regarding the efficacy of high-dose intravenous immunoglobulin (IVIG) also in this dysimmune pathology are on the increase. We described an unusual case of autoimmune SPS associated with an exclusively motor left peroneal nerve neuropathy, with conduction block, treated with high-dose intravenous immunoglobulin (IVIG), oral cyclosporine, sodium valproate, baclofen and diazepam.

Female↗

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[The role of the occupational health physician in the implementation of the European and Italian regulations on mechanical vibration at work].

The European Directive 2002/44/EC and the Italian Decree 187/2005 establish the minimum health and safety requirements regarding the exposure of workers to the risks arising from mechanical vibration. Excessive exposure to hand-arm vibration from powered processes or tools can cause disorders in the vascular, neurological and musculoskeletal systems of the upper limbs. Long-term occupational exposure to intense whole-body vibration is associated with an increased risk for disorders of the lumbar spine and the connected nervous system. The prevention of injuries or disorders caused by mechanical vibration at the workplace requires the implementation of administrative, technical and medical procedures. The role of the occupational health physician in the implementation of the health surveillance of vibration-exposed workers is discussed in the light of the requirements established by the European and Italian regulations. The health surveillance of vibration-exposed workers consists of pre-employment medical screening and subsequent clinical examinations at regular intervals. The aims of health surveillance are to make the worker aware of the hazards connected with exposure to mechanical vibration, to obtain baseline health data for comparison with the findings of subsequent periodical health examinations, to verify the presence of pathological conditions which may increase the risk of adverse health effects due to vibration exposure, to make a diagnosis of occupational or work-related disease, and to check the long-term effectiveness of preventive measures.

Europe↗

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