Biomedical subjects

G Bertolotti

Publications and source records attributed to G Bertolotti.

At least 19 recordsLinked to original sources

PubMed2005

A new questionnaire specifically designed for patients affected by chronic obstructive pulmonary disease; The Italian Health Status Questionnaire.

The aim of this study was to develop a specific and valid questionnaire for Italian COPD patients, living on the north or the south of Italy-which are two culturally distinct areas. The project consisted in three steps: (1) initial item set generation to identify items relevant to both genders, all ages and both regions; (2) item reduction including tests of regional specificity; (3) tests of internal validity using item-response theory using Rasch one-parameter modelling. Ninty-six COPD patients (mean aged 69 yr; 78 Male) completed the original set of 124 items of the Italian Health Status Questionnaire (IHSQ). Item reduction was carried out using an established standardised approach employing classical psychometric test theory. The internal construct validity of the 47 items that survived this process were tested to determine whether they constituted a unidimensional construct "impaired health due to COPD" using Rasch analysis. This showed that the questionnaire had very good psychometric properties, with an excellent Person Separation Index of 0.95 and no evidence of bias due to item-trait interaction (chi104(2)=127.1, P=n.s.). The combination of classical test theory and modern item-response methodology has produced a questionnaire with excellent measurement properties suitable for COPD patients whether from the north or south of Italy.

Adult↗

PubMed2003

Psychological and emotional aspects and pain.

A patient's psychological condition can be influenced by symptoms and, at the same time, it can influence the perception of symptoms. In psychological assessment, pain can modify the results of a questionnaire, so a patient's state at the moment of the evaluation should be taken into account. Questionnaires used in assessment do not always provide clear-cut answers concerning the individual psychological component. Moreover, difficulties in classifying headache patients does not permit correct comparisons between population samples whenever patients are not classified into well defined homogeneous groups. Overall, in the three groups examined - migraine, tension-type headache and cluster headache - it can be affirmed that with self-report assessment based on questionnaires, the tension-type headache subjects present a more interesting psychological profile for its clinical implications.

Cluster Headache↗

PubMed2002

EDU-CARE, a randomised, multicentre, parallel group study on education and quality of life in COPD.

Chronic obstructive pulmonary disease (COPD) represents one of the main causes of morbidity and mortality in the western world. Unfortunately, its therapy is largely palliative, the key aims of treatment being to reduce exacerbations, minimise symptoms, and improve patients' ability to perform their usual daily activities. In the absence of true disease-modifying treatments, the concept of rehabilitation has become important. In addition, it has been shown that educational and self-management programmes may play a role in the general treatment of COPD patients. This study was promoted by the Italian Association of Hospital Pulmonologists (AIPO) with the aim to verify changes and improvements induced by an educational programme validated by AIPO in patients with COPD. Edu-Care is a 6-month, multicentre, randomised, controlled, parallel-group study. In addition to treatment within the usual therapeutic schemes for COPD, patients were randomised to either the 'Educational' group, i.e. to receive a formal and structured educational programme, or the 'Normal General Advice' group, i.e. to receive the usual general advice given by general practitioners on life-style and on the disease's risk factors and treatment. A number of evaluations were performed: pulmonary function test, walking distance, quality of life, locus of control, register of number of exacerbations and hospital admissions. To date, of the 1,230 patients enrolled interim data are available from 1,003 patients. Males represent 85% of the study population. Smoking habit is quite a common status (21%). In the year prior to enrolment 34% of patients had one exacerbation, 49% 2-3 exacerbations, and 17% more than 3 exacerbations. Seventy-two percent of patients were not hospitalised over the year prior to enroLlment, while 22% were hospitalised once and 6% had more than 2 hospitalisations. Edu-Care is the first large study aimed to evaluate the efficacy of an educational programme for patients with COPD. AIPO wishes to make a contribution to this important field. This is the reason why Edu-Care includes a very large number of patients in numerous Italian centres throughout northern and southern Italy.

Activities of Daily Living↗

PubMed2002

Clinical validation of an anxiety and depression screening test for intensive in-hospital rehabilitation.

Routine hospital psychological care must necessarily make use of a clinically reliable screening instrument for the identification of the patients to be referred for a clinical interview with a psychologist. This study compared two tests for the evaluation of anxiety and depression that are widely used in the hospital setting: the Hospital Anxiety and Depression Scale (HADS) and Form A-D, consisting of the State-Trait Anxiety Inventory (STAI-X1) for the evaluation of anxiety, and the Depression Questionnaire (DQ) for measuring depression. The aim of the study was to identify which of these instruments is the most suitable for screening a population admitted at in-hospital intensive rehabilitation using the clinical interview-based psychological evaluation as the gold standard. Both of the tests showed a concordance with the clinical opinion expressed by the psychologist, whose judgement was guided by the use of the validation study evaluation form. The analyses confirmed the good correlation of the two instruments in measuring anxiety and depression. The sensitivity of the STAI-X1 (52%) was less than that of HADS section A (72%), but its specificity (99%) was greater than that observed with the application of the HADS Anxiety subscale (84%). Analysis of the ROC curves showed that the STAI-X1 percentages of sensitivity and specificity tended to balance at higher level with a cut-off point equal to the 80th percentile. The results of the analysis of the DQ demonstrated equivalence with the results obtained using HADS section D, with a cut-off point of the 90th percentile. On the basis of these results, and given that both the STAI-X1 and the DQ have a broadly based Italian normative population, we feel that they can be recommended for psychological screening of patients in an in-hospital intensive rehabilitation.

Adult↗

PubMed2001

Reliability of a questionnaire for evaluating the understanding of asthma.

The present study was designed to evaluate the repeatability of a questionnaire developed to assess the understanding that asthma patients have of their disease and, on the basis of its variability, estimate the sample size necessary for determining the efficacy of a future structured program on asthma knowledge. The repeatability of the Asthma Questionnaire (AQ) was evaluated by asking 89 patients to complete it twice within a period of 7-10 days without the subject being exposed to any programme on asthma knowledge between the two administrations. The AQ was demonstrated to have good content and face validity. Results showed that neither age nor sex had a significant influence on total scores, and that the degree of reliability was adequate (R = 0.769). The mean percentage of correct answers was observed to be approximately 70% in both sessions, suggesting a consistent area for possible improvement which could be targeted by means of an appropriately structured programme on asthma knowledge. For comparative purposes before and after the programme, or for measuring its efficacy, the AQ should be recommended. In conclusion the Asthma Questionnaire could provide a useful tool for the general practitioner, chest physician and other health professionals, to assess what the patient really does understand or does not, concerning asthma management, and hence be the starting point for a well-tailored educational intervention.

Adolescent↗

PubMed2001

Quality of Life Evaluation and Survival Study: a 3-yr prospective multinational study on patients with chronic respiratory failure.

Therapy of patients with chronic respiratory failure is mainly directed at minimizing symptoms in order to improve, or at least to prevent a deterioration of, patients' well-being. Under such circumstances, the perceived effect of therapies on patients' well-being and daily life represents the most important subjective outcome of treatment. Therefore, there is a need to provide a global estimate of health in patients on long term oxygen therapy or overnight home mechanical ventilation. The Maugeri Foundation Respiratory Failure Questionnaire (MRF28) is the first health status ("quality of life") questionnaire specifically developed for use in CRF and its items were selected to be applicable to patients with both obstructive and restrictive diseases. The Quality of Life Evaluation and Survival Study (QuESS) is a multinational study with the aim of re-evaluating the natural history of chronic respiratory failure in about 300 patients. To the authors knowledge, the Quality of Life Evaluation and Survival Study is the first study to evaluate the natural history of chronic respiratory failure in such a large number of subjects and with a complete set of data. In fact, both pathophysiologic and health status assessments will be made. Moreover, by collecting data on mortality, disease exacerbations and hospitalization, it will also be possible to verify the predictive ability of health status versus pathophysiology in terms of mortality and healthcare utilization.

Chronic Disease↗

PubMed1999

Despite good compliance, very low fat diet alone does not achieve recommended cholesterol goals in outpatients with coronary heart disease.

AIM: A low-saturated, low-cholesterol diet is important in the treatment of hypercholesterolaemia in patients with coronary heart disease. The aim of this study was to investigate the efficacy of a very low fat diet to achieve a targeted serum low density lipoprotein (LDL) cholesterol level (</=2.59mmol x l-1) in outpatients with coronary heart disease. METHODS: One hundred and twenty-six male patients (all ex-smokers) with coronary heart disease and a serum LDL cholesterol >3.37mmol x l-1 were investigated 12-14 weeks after an acute coronary event. After overnight fasting each patient had (a) his resting energy expenditure measured (indirect calorimetry using standard protocol) and (b) venous blood sampled from a forearm vein to determine lipid profile. All the patients were randomly allocated to four groups of treatment: Group A on a very low fat diet (resting energy expenditure-fat diet, where fat intake was </=20% resting energy expenditure): Group B on a low fat diet from the National Cholesterol Education program (National Cholesterol Education Program step 2 diet): Group C on resting energy expenditure-fat diet+simvastatin 10mg daily; Group D on National Cholesterol Education Program step 2 diet+simvastatin 10mg daily. For all patients the prescribed energy intakes were equal to their respective resting energy expenditures. RESULTS: At 6 months, the average decrease in serum LDL cholesterol was not different between Group A and Group B, but the increase in high density lipoprotein cholesterol (HDL) (+29%) observed in Group A led to a reduced LDL cholesterol/HDL cholesterol ratio (P<0.001). As expected, a more important serum lipid improvement was found in the groups supplemented with diet+drug association, but the decrease in LDL cholesterol was higher in Group C than in Group D (-37+/-9.7% vs -24. 5+/-15%;P<0.00001) as well as LDL cholesterol/HDL cholesterol ratio (P<0.001). No patient on diet alone achieved the recommended LDL cholesterol level </=2.59mmol x l-1. CONCLUSION: Diet alone does not allow patients with coronary heart disease to achieve the recommended blood cholesterol levels, even if its fat content is highly reduced.

Aged↗

PubMed1999

Analysis of factors that characterize health impairment in patients with chronic respiratory failure. Quality of Life in Chronic Respiratory Failure Group.

This study was designed to identify a core set of items that may characterize impaired health in chronic respiratory failure (CRF) since none of the questionnaires commonly used to measure impaired health in patients with CRF were developed for use in such patients. Questionnaire items, identified from several sources, were administered to 92 patients with stable severe chronic hypoxia or hypercapnia, together with physiological measures of disease severity, the Sickness Impact Profile (SIP) and the St George's Respiratory Questionnaire (SGRQ). Of the 152 items identified, only 28 correlated with patients' perceptions of overall health and were also independent of age, sex, disease or type of treatment and did not show floor or ceiling effects. Principal components analysis identified three specific factors: "daily activities", "cognitive function", and "invalidity". The total score for the whole 28-item set correlated with other measures of disease activity, including SGRQ (r = 0.86) and SIP (r = 0.70), but not spirometry. The interquartile range of the 28-item set was wider than that of the SGRQ or the SIP. This study characterized two areas of health impairment in chronic respiratory failure that had not previously been identified: effects of impaired cognitive function on daily life, and a sense of invalidity. The measurements properties of this 28-item set suggest that it may be a more discriminative instrument for patients with chronic respiratory failure than existing questionnaires.

Activities of Daily Living↗

PubMed1996

Neuroticism and type A behaviour pattern in healthy Italian blue-collar workers.

BACKGROUND: Even if type A behavior pattern is not a typical pattern of specific social class, in Italy no research study has been conducted on blue-collar workers. In the present study we sought to identify differences in the psychological profiles of type A and non-type A Italian blue-collar subjects. METHODS: Seventy-three healthy male blue-collar workers, aged 35-59 years, completed the CBA-2.0 Primary Scales (a battery of standardized questionnaires) and the Jenkins Activity Survey (JAS). Following the Structured Interview each subject was classified as type A1, A2, X, or B. In the present study, type X and B subjects were considered within the group referred to as type 'non-A'. RESULTS: The analysis of variance showed that the A1 subjects had higher neuroticism scores than the A2 and non-A subjects but revealed no differences in extraversion, anxiety, depression, obsession-compulsion scores. In the JAS only the 'speed and impatience' scale differentiated the three groups: the highest scores being obtained by the A1 subjects. Among the JAS scales, only correlations (Pearson) between speed and impatience, trait anxiety and neuroticism were found. CONCLUSION: In our Italian blue-collar sample, type A1 seems to define a subject with high neuroticism score. Finally, our results do not recommend the use of the JAS in Italy for measuring the type A behavior pattern.

Adult↗

PubMed1995

Dimensions of anger and hostility in cardiac patients, hypertensive patients, and controls.

Anger and hostility have long been considered important factors in the etiology of essential hypertension (EH) and coronary heart disease (CHD). This case-control study investigates the association of hostility, as measured by the Cook and Medley Hostility Scale (HO), and anger, as measured by the Multidimensional Anger Inventory (MAI), with CHD and EH in 80 CHD patients, 80 EH patients, and a control group of 80 healthy adults from Italy. Cases revealed significantly higher scores than controls in two subsets of HO and in two subscales of MAI. Some of these subscales appeared to be age-dependent. The results indicate that particular components of anger-hostility could be taken into consideration when studying psychological risk factors for CHD and EH.

Adult↗

PubMed1994

From mechanical ventilation to home-care: the psychological approach.

The mechanically ventilated individual has to cope with being in a situation of total dependence on a bodily external object for life-support. This condition may give rise to unprecedented psychological complaints, often concerning the patient's fear of death, feeling of abandonment, mutilation, and perceived changes of self-image. It is not only the patients but also their family members who will need help dealing with stressful situations, false beliefs, anxiety, and all the other emotions linked to mechanical ventilation. After discharge from the hospital, the immediate need to master and manage the home ventilator equipment may overshadow the psychological needs of the patients. Therefore, psychological support should be offered well before discharge, and periodically during ambulatory sessions. Another important factor associated with adaptation to mechanical ventilation and the following period at home, appears to be the level of communication within the family, and the degree of commitment between all family members. Helping patients and their family members to cope with technical and psychological aspects of mechanical ventilation will make the transition from the hospital environment to the home easier for both. From an ethical point of view, it is suggested that patients be informed that ventilation will not change the course of their underlying disease or prognosis.

Aftercare↗

PubMed1990

A computerized approach to cognitive behavioural assessment: an introduction to CBA-2.0 primary scales.

The Cognitive Behavioural Assessment-2.0 (CBA-2.0) Primary Scales is an automated assessment package investigating the cognitive-verbal response system. It consists of: (1) self-reports and questionnaires aimed at identifying and specifying patients' problems; (2) a group of programs and logical rules, implemented on personal computers, providing an editor with items, questionnaire scoring and an analysis of responses; (3) an intelligent program which analyzes the responses emerging from the questionnaires and forms hypotheses for the selection of Secondary Scales and for further assessment. The package is part of a research project aimed at reducing part of the decision-making process to an operational language and simulating behavioral therapists decisions in cases of clinical assessment.

Cognitive Behavioral Therapy↗

PubMed1989

Hemodynamic response to different types of mental stress in patients with recent myocardial infarction.

The purpose of this study was to analyze the cardiovascular effects induced by mental stress evoked by different stressors in patients with recent uncomplicated myocardial infarction. Twenty four males, aged 52 +/- 10 years, were studied 45 +/- 22 days after uncomplicated myocardial infarction in the absence of specific cardiovascular drugs. During electrocardiographic and hemodynamic monitoring with a Swan-Ganz catheter the patients underwent 4 different stressors: mental arithmetic, Sacks test, Raven progressive matrices, white noise. All hemodynamic parameters were significantly (p less than 0.001) modified by 3 of the 4 stressors, while noise significantly affected (p less than 0.005) only blood pressure. Mental arithmetic was more powerful in inducing hemodynamic effects than either the Sacks test or the Raven matrices. Thus, experimentally induced mental stress challenges the recently infarcted patient's cardiovascular system to a quantifiable extent, causing important increments in left ventricular filling pressure. Hemodynamic response is different depending on the stressor employed.

Adult↗

PubMed1989

[Stroop's color-word test as a mental stressor in the functional evaluation of recent myocardial infarction: comparison with arithmetic calculation].

To assess the power of Stroop's color-word test to induce cardiovascular arousal in cardiac patients, 10 postinfarct patients underwent Stroop's test, as well as the mental arithmetic test, which was assumed to be the gold standard. Both stressors induced significant increases in heart rate and blood pressure; the differences between these increases were not statistically significant. Stroop's test is a useful alternative to the mental arithmetic test in the study of cardiovascular responses to mental stress.

Adult↗

PubMed1989

[The association of arithmetic calculation and noise as a mental stressor in the functional evaluation of recent myocardial infarction].

To evaluate the possible augmented power of mental arithmetic when given to the subjects during noise, 12 postinfarct patients underwent mental arithmetic in the standard way and then the same stressor with a white noise: mental arithmetic significantly increased (p less than 0.05) the heart rate, while mental arithmetic and white noise significantly increased (p less than 0.05) heart rate, systolic and mean blood pressure, as well as skin conductance. Nevertheless, the increments in heart rate, blood pressure and skin conductance induced by the two different ways of stressing did not significantly differ. Thus, adding white noise to mental arithmetic does not seem to be useful to increase the power of mental arithmetic in order to elicit cardiovascular responses.

Blood Pressure↗

PubMed1989

Psychosocial responses to disease stimuli: preliminary findings.

In the present study cognitive-verbal differences are evaluated in chronic obstructive lung disease (COLD) patients. Nineteen subjects with chronic respiratory failure (CRF) and sixty subjects without CRF completed two psychometric instruments: CBA-2.0 primary scales and the respiratory illness opinion survey. The results show that social and psychological problems are connected to the severity of illness.

Adaptation, Psychological↗

PubMed1988

Natural methods for fertility control: a prospective study--First Part.

This study describes 4 years of verification of effectiveness and applicability of BBT and symptothermal methods. The couples chosen had to undergo a 6-month-long study phase, and be psychologically motivated and well trained in NFP. During this period, particular emphasis was given to the motivational factor, which was expanded in its anthropological, relational, pedagogical and, sometimes, moral contents. Four hundred and sixty couples entered the program, for a total of 8,140 cycles, in which BBT, cervical mucus, and intercourse were charted. The Pearl Index for unplanted pregnancies was 3.6. Twenty-five unplanned pregnancies occurred in couples using NFP for spacing, and no pregnancies were reported in limiters.

Adult↗

PubMed1987

Effects of propranolol, atenolol, and chlordesmethyldiazepam on response to mental stress in patients with recent myocardial infarction.

Stress testing was carried out by two stressors, mental arithmetic and Sacks-Levy's test in randomized sequence, in 64 male patients with a mean age of 51 +/- 7 years in NYHA Classes I or II within 3 months after acute myocardial infarction. The stress profile was obtained after drug withdrawal by continuous recording of electrocardiogram, frontal electromyogram, and peripheral skin temperature and conductance. Blood pressure was measured each minute by cuff. The patients were subdivided into 4 groups of 16 each and were studied in an identical fashion after a 48-h oral treatment with propranolol 120 mg daily, atenolol 100 mg daily, chlordesmethyldiazepam 2 mg daily, or placebo. During stress, signs of myocardial ischemia or pump failure were not observed; minor arrhythmias were recorded. Cardiovascular activation was observed with significant increments (p less than 0.001) in heart rate, systolic and diastolic blood pressures in all 4 groups for both stressors with a slightly greater effect of mental arithmetic; Sacks' test was more effective on the frontal electromyograph response. Following beta blockade the stress profile of heart rate was significantly lower and flattened. The stress profile of blood pressure was also lower, but the reduction in the increment during stress was not significant. No differences were observed in the effects of the two beta blockers; no significant changes were evident in the stress profile of the noncardiovascular psychophysiologic indexes. Stress profiles were not altered by the benzodiazepine. In conclusion beta-blocker agents seem to be more useful than anxiolytic drugs in preventing cardiovascular activation induced by mental stress in patients with recent myocardial infarction.

Adult↗