Biomedical subjects

Stefano Paolucci

Publications and source records attributed to Stefano Paolucci.

10 recordsLinked to original sources

PubMed2006

Is sex a prognostic factor in stroke rehabilitation? A matched comparison.

BACKGROUND AND PURPOSE: We sought to assess the specific influence of sex on rehabilitation results. METHODS: A case-control study in 440 consecutive patients with sequelae of first ischemic stroke were enrolled in 2 subgroups (males and females) and matched for severity of stroke (evaluated by means of the Canadian Neurological Scale), age (within 1 year), and onset-admission interval (within 3 days). Functional data, evaluated by means of the Barthel Index and the Rivermead Mobility Index, were compared between subgroups. Logistic regressions were used to clarify the role of sex in affecting global autonomy and mobility. RESULTS: After rehabilitation treatment, a sex-related difference was observed essentially in the higher levels of response. Indeed, more men than women reached independence in both stair climbing and activities of daily living (ADL), with a higher response and effectiveness on mobility. In multivariate analyses, male patients had a 3 times higher probability than female patients of good autonomy in both stair climbing and ADL (odds ratio [OR]=3.22; 95% CI, 1.67 to 6.18 and OR=2.92; 95% CI, 1.63 to 5.42, respectively). Conversely, female patients had a higher risk of walking with a cane (OR=1.69; 95%, CI 1.04 to 2.76) or of partial autonomy with respect to ADL (OR=1.90; 95% CI, 1.25 to 2.91). No significant difference was found for the other functional parameters. CONCLUSIONS: Female sex is a mildly unfavorable prognostic factor in rehabilitation results after stroke.

Aged↗

PubMed2006

The Italian multicenter observational study on post-stroke depression (DESTRO).

Despite growing information, questions still surround various aspects of post-stroke depression (PSD). The Italian multicenter observational study Destro was designed to help clarify in a large sample the frequency and clinical impact of PSD. A total of 53 centers consecutively admitted 1064 patients with ischemic or hemorrhagic stroke, assessing them periodically in the first 9 months after the event. Patients with depression were followed for two years. Depression was diagnosed on clinical examination, verbal (Beck Depression Inventory) and non-verbal rating systems (Visual Analog Mood Scale), identifying the nosographic condition attributable to the mental state. The patient's clinical history, residual independence, and post-ictus quality of life were also taken into account. PSD was detected in 383 patients (36 %), most of whom had minor depression (80.17 %), with dysthymia, rather than major depression and adaptation disorder. About 80% developed depression within three months of the stroke. Cases with later onset tended to have less severe symptoms. Risk factors were a history of depression, severe disability, previous stroke and female sex, but not the type and site of the vascular lesion. PSD was not correlated with any increase in mortality or cerebrovascular recurrences, but these patients had lower autonomy and quality of life ratings. In conclusion, patients should be close observed in the first few weeks after a stroke in order to check for depression,which is more likely in those with clear risk factors and may spoil their quality of life.

Adolescent↗

PubMed2006

Functional status and factors influencing the rehabilitation outcome of people affected by above-knee amputation and hemiparesis.

OBJECTIVES: To evaluate the functional status of people with transfemoral amputation and hemiparesis and to identify the factors that influence rehabilitation outcome after inpatient treatment. DESIGN: Retrospective study. SETTING: Rehabilitation hospital. PARTICIPANTS: Forty-five patients (30 men, 15 women; mean age, 69+/-9y) with intact mental status affected by unilateral transfemoral amputation for vascular disease and mild or moderate hemiparesis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Barthel Index, Barthel Index effectiveness, and Locomotor Capabilities Index (LCI) scores were measured. The following factors were studied: side and cause of amputation, side and severity of hemiparesis, sequence and laterality of dual impairment, time interval between impairments, and hospital length of stay. RESULTS: At discharge, mean Barthel Index and LCI scores +/-1 standard deviation were 79+/-12 and 15+/-5.6, respectively; Barthel Index effectiveness was 55+/-23.8. Only 2 patients ambulated without walking aids. Barthel Index effectiveness was better in patients with mild hemiparesis than in patients with more severe impairment. Ipsilateral localization of dual impairment increased the probability of higher LCI scores. CONCLUSIONS: Selected patients with dual impairment can recover the ability to walk. Severity of hemiparesis and laterality were the 2 clinical factors that had the greatest influence on functional measures.

Activities of Daily Living↗

PubMed2005

Rehabilitation of left brain-damaged ischemic stroke patients: the role of comprehension language deficits. A matched comparison.

BACKGROUND: Aphasia is considered a risk factor for disability after stroke. The aim of this study was to assess the specific influence of aphasia on rehabilitation results. METHOD: A case-control study in consecutive left brain-damaged stroke inpatients, enrolled in three homogeneous subgroups [nonaphasic (NA) patients, aphasic with comprehension deficit (CD), and without comprehension deficit (NCD)] matched for age and onset-admission interval. Rehabilitation results (gain, efficiency, effectiveness of treatment, percentage and odds ratio of dropouts and of each degree of therapeutic response, assessed by Barthel Index and Rivermead Mobility Index) were compared among the subgroups. RESULTS: Two hundred and forty patients with sequelae of a first stroke were enrolled. CD patients, as compared with NCD and NA ones, had a significantly more severe basal neurological and functional status at admission, minor effectiveness on ADL and mobility, a higher percentage of low responders on ADL and urinary incontinence at discharge, and a risk of low therapeutic response on ADL nearly 4 times higher than the other patients (OR = 4.22, 95% CI = 1.90-9.38). The rehabilitative behavior between NCD and NA was similar. However, all subgroups (NA, CD and NCD) showed a significant improvement (p < 0.001) between their basal and discharge score, both on BI and RMI. CONCLUSIONS: Comprehension language deficit was confirmed to be a strong negative rehabilitation prognostic factor despite the speech therapy done by all CD patients.

Aged↗

PubMed2004

Cellular localization of TRPC3 channel in rat brain: preferential distribution to oligodendrocytes.

In the present work we describe the cellular localization of TRPC3 in non-excitable cells as compared to the neurons in normal rat brain. We performed a double labeling study for TRPC3 and one of the following cell-specific markers: mouse anti-glial fibrillary acidic protein (GFAP) for astrocytes; mouse anti-RIP for oligodendrocytes, or mouse anti-OX42 for microglia, or mouse anti-NeUN for neuronal nuclei or mouse anti-tyrosine hydroxylase (TH) for detection of dopaminergic neurons of the substantia nigra. Our double label immunofluorescence study showed that that TRPC3 is mainly localized in oligodendrocytes. These result were confirmed by the electron microscopy study, which showed TRPC3 immunoreactivity in oligodendrocytes. Consistent with the evidence that calcium homeostasis is important to oligodendrocytes for development, myelination, and demyelination [Microsc. Res. Tech. 52 (2001) 672], we can speculate that the distribution of TRPC3 in oligodendrocytes plays a role in myelination and or demyelination processes.

Animals↗

PubMed2003

Functional outcome of ischemic and hemorrhagic stroke patients after inpatient rehabilitation: a matched comparison.

BACKGROUND AND PURPOSE: The goal of this study was to assess the specific influence of stroke etiology on rehabilitation results. METHODS: This was a case-control study of 270 inpatients with sequelae of first stroke who were enrolled in homogeneous subgroups and matched for stroke severity, basal disability, age (within 1 year), sex, and onset admission interval (within 3 days) who were different only in terms of stroke origin, infarction versus hemorrhage. We compared the groups' length of stay, efficiency and effectiveness of treatment, and percentage of low and high responder patients. Odds ratios of dropouts and of low and high therapeutic response were also quantified. RESULTS: Compared with ischemic patients, hemorrhagic patients had significantly higher Canadian Neurological Scale and Rivermead Mobility Index scores at discharge; higher effectiveness and efficiency on the Canadian Neurological Scale, Barthel Index, and Rivermead Mobility Index; and a higher percentage of high responders on the Barthel Index. Hemorrhagic patients showed a probability of a high therapeutic response on the Barthel Index that was approximately 2.5 times greater than that of ischemic patients (odds ratio, 2.48; 95% confidence interval, 1.19 to 5.20; accuracy on prediction, 87.06%). CONCLUSIONS: The results of this study provide further evidence of better functional prognosis in stroke survivors with hemorrhagic stroke.

Aged↗

PubMed2003

Aging and stroke rehabilitation. a case-comparison study.

The aim of this study was to assess the specific influence of age on basal functional status and rehabilitation results. We conducted a case-comparison study on 150 stroke inpatients. They were enrolled in homogeneous subgroups, matched for severity of stroke (measured by Canadian Neurological Scale - CNS) and onset admission interval (within 3 days) and divided into five subgroups according to age: or=85 years. Even when severity of stroke was the same, increasing age was associated with greater disability in activities of daily living (ADL) and mobility, minor results of rehabilitation treatment and shorter length of stay. Patients >or=85 years were nearly ten times as likely to show a low response in ADL (OR = 9.28, 95% CI = 2.89-29.76) and nearly six times in mobility (OR = 6.13, 95% CI = 2.18-17.25) than younger patients. However, rehabilitation treatment was efficacious also in patients >or=85 years, with effectiveness of treatment 27.96% on ADL and 18.64% on mobility. On one hand our results confirm the unfavorable influence of age on functional outcome and on the other that inpatient rehabilitation is substantially effective also for very old patients, although less than for younger ones.

Activities of Daily Living↗

PubMed2002

Rasch analysis of the Rivermead Mobility Index: a study using mobility measures of first-stroke inpatients.

OBJECTIVE: To evaluate the validity and item unidimensionality of the Rivermead Mobility Index (RMI) by using Rasch analysis. DESIGN: Application of Rasch analysis on the RMI partial data set. SETTING: A stroke program at a rehabilitation hospital in Italy. PARTICIPANTS: A total of 308 consecutive patients (155 women, 153 men; avg age, 62.79+/-11.94 y) hospitalized between 1990 and 1996. Average interval between stroke onset and admission was 52.48+/-36.22 days. INTERVENTION: Medical inpatient rehabilitation. MAIN OUTCOME MEASURES: Patients' mobility status was assessed using the RMI administered at admission and discharge. Ratings were assigned by 4 staff members working as a team. We performed separate Rasch analyses on the RMI data, gathered from different groups of first stroke inpatients examined before and after rehabilitation treatment. RESULTS: asch analysis showed the overall good validity of the RMI, except for item 15, which did not fit the unidimensional continuum estimated through the Rasch rating model. CONCLUSION: The RMI is a unidimensional scale with a hierarchy of easy-to-hard test questions. Item difficulty level was stable when processed on different groups of patients assessed on different occasions.

Adolescent↗

PubMedDate not supplied

New developments on drug treatment rehabilitation.

Increasing interest has been directed to role of pharmaceuticals in the recovery of cerebrovascular events. However, only few scientific studies are available to date, and further research is needed. Amphetamine is the most extensively studied drug shown to promote recovery of function, although clinical data have lead to conflicting results. Other psychostimulants drugs have been proposed, as levodopa or methylphenidate, even if published data are still few. Recently, two studies have been published about the positive role of cholinesterase inhibitor donepezil on stroke recovery. However, such data must still be confirmed by randomized controlled trials. Antidepressant drugs have shown to be effective not only in improving depressive symptoms in stroke patients, but also in decreasing, although partially, the negative impact of poststroke depression on functional outcome. Serotoninergic agents may have a role in improving stroke recovery, in a fashion that is not dependent on their primary antidepressant activity. Last, it is important to be aware that certain drugs as clonidine, prazosin, dopamine receptor antagonists, benzodiazepines, phenytoin, and phenobarbital could have a detrimental effect on the poststroke recovery.

Antidepressive Agents↗

PubMedDate not supplied

Planning availability in stroke rehabilitation units.

The sequelae of cerebrovascular diseases constitute, and in the coming years will increasingly constitute, a major health problem. Stroke is already the leading cause of permanent invalidity, the second leading cause of dementia, and the third (on course to become the second) leading cause of death, after cardiovascular diseases and cancer. In view of the aging of the population and of the fact that stroke is strictly age-related, the incidence of stroke, in Italy, looks set to rise progressively over the coming years. In recent years, units have been set up for the specialist inpatient treatment of stroke victims, both in the acute phase (known as stroke units) and in the subsequent rehabilitative phase (stroke rehabilitation units), the aim being to improve both the management of these patients and, as a result, their functional outcome. Health policies and programming will have to take into account the need for more beds in both types of stroke unit.

Health Facility Planning↗