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Biomedical subjects

S Negrini

Publications and source records attributed to S Negrini.

At least 37 records · Page 2Linked to original sources
PubMed2004

Reliability of the Scoliosis Research Society-22 Patient Questionnaire (Italian version) in mild adolescent vertebral deformities.

AIM: The reliability evaluation of the Italian version of the Scoliosis Research Society-22 Patient Questionnaire (SRS-22-I), administered to adolescents with mild vertebral deformities, is evaluated. METHODS STUDY DESIGN: forward-backward translation, pretest, final version according to a focus-group evaluation, and 1 week test/retest. POPULATION: pretest: 35 subjects (22 females), age range 8.5-19 years, 28 idiopathic scoliosis (17 degrees +/-7 degrees ), 7 hyperkyphosis (54 degrees +/-4 degrees ); test/retest: 20 subjects (11 females), age range 12-17.5 years, 15 idiopathic scoliosis (16 degrees +/-8 degrees ), 5 hyperkyphosis (55 degrees +/-5 degrees ). STATISTICAL ANALYSIS: Spearman rank test, percent of agreement. Statistical significance: 0.05. Software: Statgraphics 3.0. We calculated the results of the questionnaire and performed the statistical analysis using non parametric test because of the charcteristics of the data: this differ from previously published RESULTS RESULTS: Response rate was 100%. Total score: median 4 (range 3-5); results for different domains (median, range): function/activity 4 (3-5), pain 5 (3-5), self image/ appearance 3 (2-5), mental health 4 (3-5), satisfaction with management 4 (2-5). Time required to answer the questionnaire ranged from 5 to 20'; for 12 to 17.5 years old subjects from 5 to 10'. pretest showed difficulties with questions on pain; the questionnaire was changed accordingly. Spearman's rho ranged from 0.42 to 1, not significantly different from null value for questions 12 and 21. Percent of agreement (evaluated only for question 11a) was 100%. The ceiling and floor effects have been found high. CONCLUSIONS: The SRS-22-I was found to be reliable for young patients with mild vertebral deformities of different type. Lack of reliability for questions 12 and 21 should be better understood. Until now the psychometric properties of SRS-22 questionnaire have been evaluated only in USA populations, and in idiopathic scoliosis. Moreover, only one study has been proposed including patients with mild idiopathic scoliosis. This, together with the non-parametric statistical analysis used, could explain the high ceiling and floor effects we found in our data.

Journal Article↗
PubMed2004

Symptomatic efficacy of stabilizing treatment versus laser therapy for sub-acute low back pain with positive tests for sacroiliac dysfunction: a randomised clinical controlled trial with 1 year follow-up.

AIM: Back pain is a highly frequent condition due to many causes, although most of them cannot be established with certainty. It is also the current clinical and scientific belief that sacroiliac joint syndrome can be a specific low back pain cause. Nonetheless the existence of clinical tests aimed at highlighting the responsibility for lumbar pain secondary to sacroiliac dysfunction, it is not easy to diagnose it with either manual or instrumental means. Moreover, uncertainty is diffuse when facing a correct treatment for patients involved. The aim of this study was to verify, in patients with acute or sub-acute low back pain and positive sacroiliac signs, the efficacy of a stabilising therapy (orthosis and exercises, with previous mesotherapy) directly targeted to sacroiliac dysfunction versus a symptomatic usual care such as He-Ne laser therapy. METHODS: Over a period of 14 months, we recruited 22 patients (10 females, mean age 44+/-11) with acute and sub-acute low back pain and symptoms and signs suggesting a sacroiliac dysfunction. They were randomised in a Group laser (GL), 11 patients treated with He-Ne laser therapy targeting the sacroiliac region, and a Group stabilisation (GS), 11 patients treated with mesotherapy, a specific dynamic sacroiliac support (ILSA) and specific exercises. Outcome criteria included VAS, and Mens and Laslett sacroiliac tests. RESULTS: Out of 449 acute and sub-acute low back pain out-patients, 22 (4.9%) had symptoms and signs suggesting a sacroiliac dysfunction. A reduction of pain was achieved only in the GS. All pain-provocation and stability tests were negative both after the end of treatment and at the follow-up only in the GS. CONCLUSIONS: A targeted approach based on mesotherapy, a specific sacroiliac belt and specific stabilizing exercises proved its efficacy in acute and sub-acute low back pain patients with symptoms and signs suggesting a sacroiliac dysfunction. As soon as it will be possible to identify particular spine syndromes in the universe of non specific low back pain, there will also be the possibility to employ specific therapies.

Journal Article↗
PubMed2003

The upper body segmental movements during walking by young females.

OBJECTIVES: To characterise the physiological pattern of trunk and shoulders movements during walking and provide a reference for further studies on spine deformities. DESIGN: Implementation of a model for measuring spine and shoulder girdle movements during gait. Data collection on a population of eighteen, young, healthy, female subjects. BACKGROUND: The analysis of gait modifications in subjects with idiopathic scoliosis could offer an insight to better understand the functional relationship with the pathology. METHODS: Retroreflective markers were positioned on the main spine processes and acromions to be detected by a TV-based motion analysis system. A model of kinematic computation was implemented and integrated in a previously developed protocol for multifactorial gait analysis. Movements in the main reference planes and in relation to pelvis were analysed. RESULTS: The trunk was on average bent forward by 3.4 degrees with respect to standing; of the two physiological curves in the sagittal plane only lordosis changed during walking; in the frontal plane, a dynamic spine deformation appeared, that was maximum at heel strike-early stance; the trunk was bent controlaterally of the foot on the ground, while the shoulders remained stable; in the horizontal plane, the shoulders rotated contralaterally to the pelvis. CONCLUSIONS: In our population all the segmental movements analysed were smaller than 5 degrees during gait, except the angle of proximal curvature in the frontal plane, shoulder rotation, and angle between shoulders and pelvis; all the measured angles were far below their possible ranges of motion. RELEVANCE: Quantitative data on upper body kinematics as a complement to gait analysis can help understanding movement disorders and compensation strategies in several pathologies.

Adolescent↗
PubMed2002

Exercise for preventing and treating osteoporosis in postmenopausal women.

BACKGROUND: Osteoporosis is a condition resulting in an increased risk of skeletal fractures due to a reduction in the density of bone tissue. Prevention of osteoporotic-related fractures is dependent on the ability to detect individuals with low bone mass, including those women who are asymptomatic. Treatment of osteoporosis involves the use of either anti-resorptive (e.g. estrogen and bisphosphonate) or bone formation agents (e.g. fluoride and PTH). The value of exercise as an intervention for the prevention of postmenopausal bone loss is a controversial subject. OBJECTIVES: To examine the effectiveness of exercise therapy at preventing bone loss and fractures in postmenopausal women. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Group's specialised register, MEDLINE, EMBASE, Current Contents and the Cochrane Controlled Trials Registry up to January 2000 according to the methods suggested by Dickersin et al and Haynes et al and the Cochrane Handbook. We hand searched reference lists and consulted content experts. SELECTION CRITERIA: This review was proceeded by a peer reviewed protocol published in the Cochrane Library. Two reviewers independently selected all randomized controlled trials (RCTs) which met our predetermined inclusion criteria. DATA COLLECTION AND ANALYSIS: The same two reviewers abstracted the data using predetermined forms and assessed trial quality using a validated assessment tool. For dichotomous outcomes (fractures), relative risks were calculated using fixed effects models. For continuous data, weighted mean differences (WMD) of the percentage change from baseline were calculated. Where heterogeneity existed (determined by a chi square test), a random effects model was used. MAIN RESULTS: Eighteen randomized controlled trials (RCTs) met the inclusion criteria. The trials had a mean methodological quality score of 2.53. Aerobics, weight bearing and resistance exercises were all effective on the BMD of the spine. The WMD for the combined aerobics and weight bearing program on the spine was 1.79 [95%CI (0.58, 3.01)]. The analyzed results showed walking to be effective on both BMD of the spine 1.31[95%CI (-0.03, 2.65) and the hip 0.92[95%CI (0.21, 1.64). Aerobic exercise was effective in increasing BMD of the wrist 1.22[95%CI (0.71, 1.74)]. REVIEWER'S CONCLUSIONS: Aerobics, weight bearing and resistance exercises are all effective in increasing the BMD of the spine in postmenopausal women. Walking is also effective on the hip. The quality of the reporting of the trials in the meta-analysis was low, in particular, in the areas of allocation concealement and blinding.

Exercise↗
PubMed2002

The validity of clinical examination in adolescent spinal deformities.

STUDY DESIGN: retrospective study on the accuracy and reliability of two clinical tests for scoliosis in young patients. AIM: to evaluate the inter-observer reliability of three non-invasive clinical measurements: hump height (HH), axial trunk rotation (ATR), and distance of the spinous process from the plumb line (DP) in standing; to compare these results with the corresponding radiographic measurements, the Cobb angles (CA). POPULATION: 116 patients, 78 females and 38 males; 410 examinations have been performed (144 patients with brace and 266 without). METHODS: a database was created using the measurements of different clinical parameters obtained from two examiners that measured them independently and in the same conditions. The Cobb method has been used as a gold standard. RESULTS: our results show a very high inter-rater reliability for HH and ATR measurements. The DP shows a different inter-rater reliability for the thoracic (C7) and lumbar (L3) spine, in both cases lower than that in the frontal plane; the ICC of the thoracolumbar DP (D12) was very low. The correlation with the radiographic value was weak.

Adolescent↗
PubMed2001

General practitioners' management of low back pain: impact of clinical guidelines in a non-English-speaking country.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To evaluate the assessment of patients with low back pain by general practitioners (GPs) in a non-English-speaking country and to compare their behavior with AHCPR and CSAG clinical guidelines. SUMMARY OF BACKGROUND DATA: The diffusion of clinical guidelines (and their everyday application by health care professionals) is a significant problem. Because most guidelines are developed in English, concerns over their diffusion are obviously greater in non-English-speaking countries. METHODS: A questionnaire was sent to all the GPs in the province of Mantua, Italy (n = 318). The authors evaluated what examinations are routinely performed and what danger symptoms and signs prompt referral of patients. GPs indicated the frequency of their prescription of radiographs, computed tomography scans, magnetic resonance imaging, laboratory tests, and consultations. The findings were compared with a "gold standard": the AHCPR and CSAG clinical guidelines. RESULTS: The response rate was 68.2%. Only 28.0% of GPs perform all the tests considered important by the clinical guidelines, and 33.0% were aware of all the red flags. Correspondence with the clinical guideline recommendations ranged from 14.6% to 89.4%. There is a clear tendency to overprescribe examinations in acute cases, whereas in chronic cases underprescription is sometimes seen. CONCLUSIONS: In a non-English-speaking country the evaluation of low back pain by GPs does not reflect current recommendations, and the situation is seen to be worse than in English-speaking countries. Concerns over the diffusion of guidelines must therefore be considered greater in non-English-speaking countries, where thorough presentation to GPs of the existing "evidence-based" guidelines is to be recommended.

Cross-Sectional Studies↗
PubMed2001

Cardio-respiratory adjustments and cost of locomotion in school children during backpack walking (the Italian Backpack Study).

The use of a school backpack is one of the possible causes of back pain in children. Oxygen consumption (VO2), pulmonary ventilation, and heart rate (fc) were measured in 35 pre-pubertal subjects [17 girls and 18 boys, mean (SD) age 11.3 (0.6) years]. They took part in a four-step experiment: (1) standing for 5 min, (2) walking at 3 km.h(-1) for 7 min, (3) walking at 3 km.h(-1) for 7 min carrying a school backpack weighing 8 kg, and (4) walking at 7 km.h(-1) for 5 min with no load. The occurrence of back pain in the last 2-3 years and during the last 15 days was assessed for the subjects by means of a questionnaire. Mean (SD) standing VO2, was 215 (45) ml.min(-1) during walking at 3 km.h(-1), 503 (101) ml.min(-1) during walking without a load, and increased to 541 (98) ml.min(-1) during walking with a load (P<0.01). Carrying a backpack increased fc only minimally. The energy cost of walking at 3 km.h(-1) without the backpack was 10.0 (2.0) ml O2.m(-1), and with the backpack was 10.8 (1.9) ml O2.m(-1) (P< 0.01). The net energy cost of locomotion was 0.129 (0.032) ml.kg body mass(-1).m(-1) for the unloaded condition and slightly lower, at 0.123 (0.025) ml.kg body mass(-1).m(-1) during loaded walking (P < 0.05). Ventilation did not change significantly between unloaded and loaded conditions. When the data were assessed according to the occurrence of back pain, the fc/VO2 slope was significantly lower in children without back pain, even though the net energy cost of locomotion was similar. Overall, these data suggest that the cardiovascular effortrequired for locomotion while carrying a backpack is minimal. However, fatigability and back pain are more likely to take place in less physical performing subjects. Thus, the occurrence of back pain in schoolchildren during locomotion while carrying a backpack may improve with an improvement in their level of fitness.

Back↗
PubMed1999

Backpack as a daily load for schoolchildren.

34.8% of Italian schoolchildren carry more than 30% of their bodyweight at least once a week, exceeding limits proposed for adults. Given increasing evidence of back pain in children, the time has come to propose some limitations to backpack load.

Adolescent↗
PubMed1999

A pilot study on the safety and effectiveness of immunosuppression without prednisone after liver transplantation.

BACKGROUND: Corticosteroids are commonly used in the immunosuppression therapy after liver transplantation, yet are associated with considerable side effects. Retrospective studies have shown that corticosteroids can be safely withdrawn from months to years after transplant. We prospectively investigated the effects of early immunosuppression without the use of corticosteroids on graft outcome and transplant complications. METHODS: Forty-five patients undergoing liver transplantation were randomized to receive immunosuppression composed of cyclosporine microemulsion and azathioprine with (n=22) or without prednisone (n=23), in conventional doses. In those patients who received prednisone, this was withdrawn within 3 months after transplant. The median follow-up of survivors was 14 months (range: 6-24). The study end points were to determine graft survival and function, infectious complications, including hepatitis C virus (HCV)-RNA levels in HCV-infected recipients, acute rejection, kidney function, and metabolic complications. RESULTS: Eleven deaths occurred, 6 of which were in the prednisone group. Two-year survival did not differ between patients treated with or without prednisone (70.2% vs. 78.3%, P=0.83), nor did the causes of death. No differences were observed with regard to graft function, renal function, and infectious complications. In the subset of patients who received transplants for HCV-related cirrhosis, the dynamics of virus replication HCV-RNA was faster among those treated with prednisone. The incidence and severity of acute rejection was similar in the two groups. More than 80% of acute rejections in both groups were classified as mild or moderate and underwent spontaneous resolution. Only two patients in each group had severe acute rejection requiring additional treatment with high-dose steroids. Patients receiving prednisone tended to have greater biochemical signs of cholestasis, higher serum cholesterol and glucose levels, and more frequent insulin requirement than those treated without corticosteroids. CONCLUSIONS: Liver transplantation can be performed safely without using corticosteroids in the early postoperative course, and there is no need for routine aggressive steroid treatment of established acute rejections.

Adult↗
PubMed1998

Immunosuppression without prednisone after liver transplantion is safe and associated with normal early graft function: preliminary results of a randomized study.

Prednisone has been commonly considered the mainstay of immunosuppressive therapy after liver transplantation. Recent data suggest that prednisone withdrawal late after transplant reduces complications without affecting graft function. We report here the preliminary results of an open-label, randomized study aimed at investigating whether prednisone therapy can be completely avoided during the first 3 months after transplantation. Twenty-seven consecutive patients were randomized to receive double (group A: cyclosporine and azathioprine) or triple (group B: prednisone, cyclosporine, and azathioprine) immunosuppressive therapy after liver transplantation. Six patients died within the first 3 weeks in each group and were excluded from the calculations. The present results refer to 10 patients in group A and 11 in group B. The actuarial 1-year survival did not differ between the two groups (90.9% vs 88.8%). There were no differences with respect to infectious complications or episodes of histological acute graft rejections. Only one severe acute rejection occurred in group A and two in group B. During the first month after transplant, liver and kidney functions tended to be better in the group of patients treated without prednisone, although there were no differences in the mean cyclosporine blood levels. These data, though preliminary, indicate that early immunosuppression without the use of prednisone is safe and tends to be associated with improved liver and renal functions compared to conventional triple therapy.

Adult↗