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Biomedical subjects

G Tognoni

Publications and source records attributed to G Tognoni.

At least 199 records · Page 11Linked to original sources
PubMed1987

Risk factors for myocardial infarction in young women.

The interim results of a case-control study of myocardial infarction in women below age 55 years conducted in northern Italy since January 1983 are presented, based on 168 cases of acute myocardial infarction and 251 hospital controls. Cigarette smoking was strongly related to myocardial infarction, with risk estimates elevated more than 10-fold for heavy (more than 25 cigarettes per day) smokers. Smoking-related relative risks were of similar magnitude in younger (less than 45 years) and in perimenopausal (45-54 years) women and were largely unaffected by allowance for several potential distorting factors. Other factors independently and strongly related to the risk of myocardial infarction were diabetes, hypertension, and history of coronary heart disease in more than one first-degree relative. Relative risks were also elevated in women who gave birth to their first child earlier (below age 20 years) and in oral contraceptive users. However, these estimates were not significant. The apparent positive associations with clinical history of hyperlipidemia, hypertension in pregnancy, and heavy coffee consumption could be explained largely in terms of confounding, but the protection conveyed by moderate alcohol consumption remained after multivariate analysis. Thus, the interim results of this investigation in a low incidence population confirm the importance of several risk factors previously described in data collected in Northern Europe and the United States. Furthermore, possibly because of the low baseline risk, the proportion of cases attributable to smoking in middle-aged women in this population may be even larger than that previously reported from higher incidence areas.

Adult↗
PubMed1987

Pattern of therapeutic intervention and role of psychiatric settings: a survey in two regions of Italy.

A survey of therapeutic intervention was conducted on 1513 patients treated in different psychiatric settings-psychiatric hospitals (PH), private facilities (PF), community mental health centers (CMHC) and psychiatric wards in general hospitals (PWGH). Psychotropic drugs, mainly neuroleptics and benzodiazepines, were widely prescribed irrespective of diagnosis, and 39% of patients treated with neuroleptics received two or more drugs. Psychotherapeutic intervention and social measures were administered in 21% and 20% of cases respectively, and 17% of patients received no treatment. The observed distribution of treatments over settings was compared with the expected one under the hypothesis that the two factors were independent. Differences between settings in therapeutic strategies, after adjustment for possible confounders (sex, age, education, diagnosis) were: no specific treatment was more than expected in PH and largely below unity in PF and PWGH, where treatment with psychotropic drugs alone was overrepresented; CMHC showed the most balanced therapeutic approach.

Adolescent↗
PubMed1987

Organization of services and pattern of psychiatric care in Nicaragua: result of a survey in 1986.

Organization of services and patterns of psychiatric care were studied in Nicaragua in 1986, 7 years after the substantial changes in health policy launched after the revolution. The overall re-organization of the system is indicated by the progressive abandoning of the mental hospital as the center of psychiatric care and the creation of 15 community-based mental health centers now functioning throughout the country. Quality of care judged through analysis of a consecutive sample of 342 patients seen by services over a month confirmed the positive orientation of the system which seemed able to deliver good care following the new perspective of "de-institutionalization". Some problems emerged to a large extent common to psychiatric care in industrialized countries looking at psychotropic drug use and at the relationship between primary health care and the psychiatric system especially when care delivered in urban and rural areas was compared.

Adolescent↗
PubMed1987

Antiemetic activity of high doses of metoclopramide combined with methylprednisolone versus metoclopramide alone in cisplatin-treated cancer patients: a randomized double-blind trial of the Italian Oncology Group for Clinical Research.

We designed a multicenter, double-blind randomized study to determine the safety and antiemetic effectiveness of intravenous (IV) methylprednisolone (P) combined with high-dose IV metoclopramide (MTC) v MTC alone in 200 untreated cancer patients receiving cisplatin chemotherapy. One hundred eighty-five patients were evaluable for treatment efficacy. MTC plus P was significantly superior to MTC alone in reducing the number and length of vomiting episodes (P = .001 and P = .0008, respectively) and the maximal intensity of nausea (P = .0124 with a score system; P = .0155 with a linear analogue scale) and length of nausea (P = .0056). The subgroup with a major incidence of nausea and vomiting was women, especially young women, outpatients, and those treated with higher doses of cisplatin. Side effects were low and equally distributed between the two treatment groups. We conclude that MTC plus P has greater antiemetic activity than MTC alone in patients receiving cisplatin chemotherapy.

Adult↗
PubMed1987

Clinical pharmacological and therapeutic considerations in general intensive care. A review.

The application of clinical pharmacological concepts and therapeutic standards in intensive care settings presents particularly difficult problems due to the lack of adequately controlled background information and the highly variable and rapidly evolving clinical conditions where drugs must be administered and their impact evaluated. In this review, an attempt has been made to discuss the available knowledge within the framework of a problem-oriented approach, which appears to provide a more clinically useful insight than a drug-centred review. Following a brief discussion of the scanty data and the most interesting models to which reference can be made from a pharmacokinetic point of view (the burn patient being taken as an example), the review concentrates on the main general intervention strategies in intensive care patients. These are based mainly on non-pharmacological measures (correction of fluid and electrolyte balance, total parenteral nutrition, enteral nutrition, oxygenation and ventilatory management) and are discussed with respect to the specific challenge they present in various clinical conditions and organ failure situations. In addition, 4 major selected clinical conditions where general management criteria and careful use of prophylactic and therapeutic drug treatments must interact to cope with the variety of presentations and problems are reviewed. These include: acute cerebral damage; anti-infective prophylaxis and therapy; cardiovascular emergencies; and problems of haemostasis. Each problem is analysed in such a way as to frame the pharmacological intervention in its broader context of the underlying (established or hypothesised) pathophysiology, with special attention being paid to those methodological issues which allow an appreciation of the degree of reliability of the data and the recommendations which appear to be practiced (often haphazardly) in intensive care units. The thorough review of the published literature provided (up to mid-1986) clearly shows that in this field the quality of randomised controlled and epidemiological studies is rather unsatisfactory. It would be highly beneficial to research and to clinical care if larger multicentric protocols and prospective epidemiological comparative investigations could be carried out to investigate more timely and adequately the variables which determine drug action, and the final outcome in the many subgroups of patients which must be considered in a proper stratification of intensive care unit populations.

Critical Care↗
PubMed1987

[Ethics 1987].

Explore the source record for details and available documents.

Education, Nursing↗
PubMed1986

Early prognosis of epilepsy. Effects of treatment in the first follow-up year.

A multicenter prospective investigation was conducted in 17 teaching and general hospitals in Italy to assess the efficacy of the care delivered to previously untreated patients with epilepsy. 175 cases were included and allocated to monotherapy. Only 112 cases completed the first year of follow-up. Of these, 59 (52.7%) were completely controlled and 53 (47.3%) had one or more seizure relapses. Controlled and uncontrolled patients were compared with respect to the main variables believed to influence non-responsiveness to standard therapy. The proportion of cases with relapses was significantly associated with the number of seizures reported before treatment was started. Selected seizure patterns (absences, myoclonic seizures) and prolonged disease duration were also reported more frequently among patients with recurrences. The implications of these findings are discussed with respect to drug response and prognosis of epilepsy.

Adolescent↗
PubMed1986

Homes for the elderly in Liguria.

A survey of 55 old people's homes in Liguria, a region in northern Italy, was carried out to investigate some social and demographic characteristics of the residents, their level of dependence and management. A total of 1666 residents was randomly selected and information was obtained from the records and from an interview with the care staff. Homes admitting only independent people were smaller than those admitting both dependent and independent people. Private homes tended to admit only independent people. The resident population showed relatively high geographical stability and a fair amount of outside support. Nearly half the residents were fully independent and 75% were prescribed at least one drug. 'Cerebroactive' drugs, psychotropic drugs, diuretics, and cardiac glycosides were extensively prescribed. Drug treatment was almost the only therapeutic intervention.

Activities of Daily Living↗
PubMed1986

Mental health care in Southern Italy: application of case-control methodology for the evaluation of the impact of the 1978 psychiatric reform.

A survey to analyse patients' characteristics and the care delivered to them was conducted in several psychiatric facilities, covering the whole range of care offered in the public sector in two regions of Southern Italy. A case-control method of analysis was chosen, and the relative risk estimates (RR), together with their 95% confidence intervals (CI), of being in custodial facilities were computed, comparing patients treated in custodial institutions ('cases') with those in community-based services ('controls') in respect of social and clinical variables. Factors more strongly associated with custodial treatment were: illiteracy (RR = 2.4), unmarried status (RR = 2.4), a history of prolonged illness (RR = 7.6), organic diagnosis (RR = 2.6), previous custodial treatment (RR = 3.9), and expected poor social functioning (RR = 2.4). The suitability and advantages of the case-control method of analysis in the field of psychiatric care evaluation are discussed.

Adult↗
PubMed1986

Oral contraceptives and cancers of the breast and of the female genital tract. Interim results from a case-control study.

We analysed data from a case-control investigation conducted in Milan, Northern Italy, to evaluate the relation between the use of combination oral contraceptives and the risk of cancers of the breast, ovary, endometrium and cervix uteri. For the present analysis, 776 cases of histologically confirmed breast cancer, 406 of epithelial ovarian cancer and 170 of endometrial cancer aged under 60 were compared with a group of 1,282 subjects below age 60 admitted for a spectrum of acute conditions apparently unrelated to oral contraceptive use or to any of the known or potential risk factors for the diseases under study. Likewise, 225 cases of invasive cervical cancer were compared with 225 age-matched inpatient controls, and 202 cases of cervical intra-epithelial neoplasia with 202 outpatient controls identified in the same screening clinics. The age-adjusted relative risk estimates for ever vs. never use of combination oral contraceptives were 1.04 (95% confidence interval (CI) 0.73-1.37) for breast cancer, 0.68 (95% CI = 0.48-0.97) for epithelial ovarian cancer, 0.50 (95% CI = 0.23-1.12) for endometrial cancer, 1.49 (95% CI = 0.88-2.55) for cervical cancer and 0.77 (95% CI = 0.50-1.18) for cervical intra-epithelial neoplasia. The risk of ovarian cancer decreased and that of invasive cervical cancer increased with longer duration of use. Neither duration of oral contraceptive use nor time since first or last use significantly altered a user's risk of other neoplasms considered. Likewise, analysis of sub-groups of age, parity or other potentially important covariates did not show any important interaction, and allowance for them by means of logistic regression did not materially modify any of the results. These data confirm that combination oral contraceptives confer some protection against ovarian and endometrial cancers but may increase the risk of invasive cervical cancer if used for several years, and indicate that the past or current pattern of oral contraceptive use in Italy is unlikely materially to affect the risk of breast cancer.

Adult↗