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G Casella

Publications and source records attributed to G Casella.

At least 19 recordsLinked to original sources
PubMed1992

The complementary effect of latrines and increased water usage on the growth of infants in rural Lesotho.

The effects of water quantity and sanitation, alone and in combination with each other, on infant weight gain and length gain were examined. Data on 119 infants were collected from 20 villages in rural Lesotho between July 1984 and January 1985. The interactions between sanitation and increased water usage for weight gain (p = 0.007) and length gain (p = 0.006) were significant after potential confounding was controlled. The biggest growth effects were dependent on families possessing a latrine and increasing their use of water during the warm, wet season. Infants gained 1.031 kg (95% confidence interval (CI) 0.420 to 1.642) and 2.028 cm (95% CI 0.523 to 3.533) more when both positive factors were present, as compared with only having a latrine. Increasing water usage compared with not increasing water usage resulted in only 0.105 kg (95% CI -0.175 to 0.385) more weight gain and -0.309 cm (95% CI -1.005 to 0.387) more length in the absence of a latrine. Similarly, infants gained 1.106 kg (95% CI 0.484 to 1.728) and 2.076 cm (95% CI 0.559 to 3.593) more if both factors were operating than did infants whose families only increased their water usage. In the nonincreased water group, the difference in growth between having and not having a latrine was 0.180 kg (95% CI -0.093 to 0.453) and -0.261 cm (95% CI -0.951 to 0.429). Water supply programs should emphasize use of more water for personal hygiene, and sanitation programs should install toilet facilities where water usage is high or has been increased because of an educational program.

Bias↗
PubMed1992

[Aortic stenosis and coronary pathology. Their implications for the transvalvular gradient].

To assess the incidence of coronary artery disease in patients with valvular aortic stenosis and its implication on peak systolic valvular gradient, 31 consecutive patients who underwent cardiac catheterization were examined. Associated significant coronary artery disease (> 50% reduction in luminal diameter evaluated in proximal segments and right dominant circulation) was present in 54.8% of patients. There was no difference in the distribution of risk factors among patients with and without significant luminal narrowings. The prevalence of coronary artery disease was found not to be significantly correlated with age (p = 0.276). There was no relationship between typical angina pectoris and the presence of coronary artery disease (p = 0.063). Fourty-seven percent of cases resulted free of chest pain. Ejection fraction was found to be significantly lower in patients with coronary artery disease (45 +/- 14.2%) than in patients without coronary artery disease (65.1 +/- 3.9%; p = 0.03) and a reverse relationship was observed between the presence of coronary artery disease and peak systolic valvular gradient (p = 0.006) which, in turn, correlated significantly with ejection fraction (r = 0.68; p = 0.023). These data demonstrate that the value of peak systolic valvular gradient, as the only index for the evaluation of the severity of aortic stenosis, is greatly limited in patients with associated coronary artery disease. Moreover, confirming the guidelines of the American College of Cardiology and of the American Heart Association task force, these data also stress the necessity of performing coronary angiography regardless angina pectoris is present or not.

Aged↗
PubMed1992

[The clinical and prognostic significance of symptomatic and silent ischemia on the exercise test in patients with a prior myocardial infarct].

The aim of the study was to assess clinical/prognostic significance of exercise-induced ischemia in patients with healed myocardial infarction. From May 1988 to January 1991, 777 consecutive patients underwent a symptom-limited (Bruce protocol) treadmill test at least 1 year after myocardial infarction. Clinical and ergometric data were entered in a prospective way in our data base. The exercise-test was positive in 231 out of 777 patients and 2 different subgroups were retrospectively identified depending on criteria of interruption: 156 patients with painless exercise-ST depression; 75 patients with painful exercise-ST depression. The main results (mean +/- SD) were analyzed with Student t test and chi 2 test. Patients with silent ischemia had longer exercise duration (547 +/- 153 s versus 395 +/- 173 s; p < 0.001) and higher double product (22.98 +/- 0.5 versus 19.71 +/- 0.4; p < 0.001) than symptomatic patients. Ischemic threshold was lower (double product: 17.98 +/- 0.4 versus 21.22 +/- 0.4; p < 0.001 with onset of ST depression at 297 +/- 148 s versus 448 +/- 147 s; p < 0.001) and time to ST normalization was longer (368 +/- 155 s versus 234 +/- 212 s; p < 0.001) in patients with painful ischemia. Patients with angina and ST depression had significantly higher prevalence of downsloping ST depression in the recovery phase (68% versus 37%; p < 0.001) and a higher prevalence of treadmill exercise score indicating high risk (49% versus 3.2%; p < 0.001). The 2 groups when compared with 99 patients with negative test post-AMI were significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Endoscopic polypectomy of the stomach].

Until 1970 endoscopy of the digestive tract was the only diagnostic method available. After this date, the introduction of endoscopic polypectomy enabled patients affected by these lesions to be treated, and at the same time considerably reduced their length of stay in hospital. The paper reports the results of 346 gastric polypectomies performed in 187 patients from 1974 to the present.

Adult↗
PubMed1990

Esophageal tumors--treatment by endoscopic intubation.

Esophageal tumors are often inoperable, because of the poor general condition of patients or the coexistence of metastatic disease. Endoscopic intubation is a safe method of palliation in these patients which can restore esophageal patency and lead to an improved nutritional status. At the Endoscopy Division of the National Cancer Institute in Milan, 141 patients with inoperable esophageal cancer underwent endoscopic intubation between 1978 and 1989. The 7-day mortality was 9/141 (6.3%) patients. In 114/132 surviving patients there was an improvement in the nutritional status and general condition. The complication rate was 17.7% (25/141 patients) and the mean survival was 5.9 months.

Adult↗
PubMed1990

The use of residuals for longitudinal data analysis: the example of child growth.

Health impact evaluations often measure changes in health status over part of a total life experience. The effects on health up to and including the start of the evaluation, which are embodied in the measure of initial health status, need to be removed while examining the effects that other variables exert during the evaluation period on final health status. Statistical models, which include initial health status as a covariate while examining the effects of other variables during the evaluation, confound the effects of a determinant during evaluation with preevaluation effects, because they do not differentiate between effects produced at different times by the same determinant. A residual model removes the preevaluation effects by regressing final health status on initial health status. The residuals from this regression are then regressed on the other predictor variables. In this paper, standard covariate adjustment, which includes all effects simultaneously, is compared with a two-part residual model using child growth as an example. The simultaneous model over- and underpredicts growth relative to the residual model depending on the age and initial body size of a child. In general, whenever initial (preintervention) and final (postintervention) measures of health outcome exist, the residual model should be considered on the basis of biologic and epidemiologic consideration, not solely on statistical optimality.

Anthropometry↗
PubMed1990

[The clinical evaluation of the severity of chronic heart failure: a comparison between the NYHA functional class and the Goldman scale].

Controversies exist about the functional evaluation of chronic heart failure; aim of this study has been the assessment of the feasibility of the Goldman classification, based on the metabolic cost of various daily physical activities, in a cohort of patients with mild to moderate heart failure, its relation to NYHA class and to the main clinical parameters currently used. We evaluated 114 patients (mean age 61 years) with mild to moderate heart failure due to idiopathic cardiomyopathy (78%), ischemic heart disease (14%) and others (8%). Based on the Goldman classification there were 82 patients (72%) in second and 28 (24%) in third class while 83 (73%) were in NYHA II class and 31 (27%) in NYHA III class. The concordance rate between Goldman second and NYHA II class was 84% and 64% between Goldman third and NYHA III class. The cardiothoracic ratio was statistically different in all 3 Goldman classes while this happened only in NYHA IIM and III versus IIS. Double product and duration of exercise were statistically different in all Goldman classes but only in NYHA II and III class. No relation was observed with ejection fraction on echocardiogram. In the subgroups analysis there was a linear positive relation between duration of exercise versus double product and cardiothoracic ratio versus cardiac volume. We conclude that Goldman class is a feasible method to assess quality of life in chronic heart failure and is more helpful and objective than NYHA class in determining the functional class of the patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Post-infarction rupture of the interventricular septum. Evaluation of the main clinical parameters and postoperative survival].

We reviewed 16 patients with ventricular septal rupture complicating myocardial infarction who underwent surgical repair between January 1984 and August 1987. Nine of them had anterior acute myocardial infarction (56%) and 7 inferior acute myocardial infarction (44%). The overall surgical mortality was 43.8%; in the group of patients with early treatment (less than 15 days after acute myocardial infarction) the mortality was 55%, while in the group with later treatment (16-30 days) the mortality was 28% (p-NS). Survival was unrelated to preoperative evidence of shock, magnitude of the shunt or the extent of coronary artery disease. We found a better in-hospital survival in the group of patients with ventricular septal rupture complicating anterior acute myocardial infarction (77%) vs inferior acute myocardial infarction (28%) with statistical significance (p less than 0.05). After a follow-up ranging from 1 to 40 months (mean: 17 months), 78% of the in-hospital survivors were alive and they were all in NYHA class II-III. We conclude that the major determinant of in-hospital survival in our patients was the anatomical site of acute myocardial infarction. Furthermore, we believe that the surgical repair of the ventricular septal defect is helpful in modifying the negative outcome of such an acute myocardial infarction complication.

Aged↗