Fabio Ferretti

Socio-economic factors and suicide rates in European Union countries

Are socio-economic factors valid determinants of suicide? The modern sociological theory of suicide is based on Durkheims studies. In addition to these fundamental social determinants, modern theorists have put more attention on economic factors. The purpose of the research is to determine the relationship between suicide rates and socio-economic factors, such as demography, economic development, education, healthcare systems, living conditions and labour market. All data were collected from a Eurostat publication and they concern 25 European Union countries. In order to test this relationship, a discriminant analysis was performed using an ordinal dependent variable and a set of independent variables concerning socio-economic factors. A dataset of 37 independent variables was used. We estimated a model with five variables: annual growth rates for industry, people working in S&T (% of total employment), at-risk-of-poverty rate, all accidents (standardized rates), and healthcare expenditures (% of GDP). Highly significant values of Wilks Lambda assess a good discriminating power of the model. The accuracy too is very high: all cases are correctly classified by the model. Countries with high suicide rate levels are marked by high levels of at-risk-of-poverty rates, high annual growth rates for industry and low healthcare expenditures.

Association between stressful life events and autoimmune diseases: A systematic review and meta-analysis of retrospective case–control studies

BACKGROUND Evidence of a relationship between stressful life events and the onset of autoimmune diseases is not univocal and there are no meta-analyses in the literature on the question. AIM To look for differences in the number and type of stressful life events in the premorbid period between patients with autoimmune diseases and healthy subjects. METHOD Review of the literature in PubMed and Scopus (January 1963-May 2015). INCLUSION CRITERIA We included retrospective case-control studies that compared patients diagnosed with autoimmune disorders and controls regarding the incidence of stressful events occurring before diagnosis, and investigated said events with validated questionnaires. EFFECT-SIZE INDEXES By random effect meta-analysis, two independent researchers calculated effect-size indexes as the difference between the means of the clinical groups and the control group in relation to the combined standard deviation. RESULTS The database searches produced 2490 articles, 14 of which were selected (3201 patients). Analysis showed a moderate but significant mean effect-size index [d=0.63, p<0.01], suggesting that autoimmune disorders are effectively associated with major stressful events in the premorbid period. The relationship between stressful events and autoimmune disease was weaker in studies with a high proportion of female subjects [β=-0.004, p<0.01] and stronger in studies that considered a longer interval between stressors and onset of disease [β=0.16, p<0.01]. CONCLUSIONS The results of this meta-analysis suggest that stressors may play an important role in the etiopathogenesis of autoimmune disorders. Only prospective studies can provide more certain inference about the causality of this relationship.

Assessment of a Test for the Screening and Diagnosis of Celiac Disease

Celiac disease (CD) is an immune‐mediated intolerance to dietary gluten, affecting genetically predisposed individuals. ELISA‐based serological tests help to decide if further duodenal biopsy is necessary, for this the diagnostic kits have to be accurate, specific, and sensible. In this study, we investigate the performance of an ELISA that uses the purified cross‐linked complex of tissue transglutaminase and gliadin, referred as the “neoepitope” (AESKULISA® tTG New Generation), as antigen.

Adult obsessive–compulsive disorder and quality of life outcomes: A systematic review and meta-analysis

In the current literature, there are no meta-analyses assessing quality of life (QOL) in patients with obsessive-compulsive disorder (OCD). Knowledge of QOL domains mainly impaired in OCD could provide specific areas for intervention. The current meta-analysis assessed differences in global, work and social, family, and emotional QOL outcomes between patients with OCD and heathy controls. Age, gender and OCD severity were examined as moderators. Case-control studies were included if patients with primary OCD were compared with controls on QOL outcomes. Electronic databases (1966-October 2014) were searched. Thirteen case-control studies were included (n=26,015). Patients with OCD had significantly lower scores on QOL relative to controls, with moderate effect sizes on global QOL and large effect size on work and social, emotional and family QOL outcomes. Studies using higher percentages of female patients and patients with less severe OCD symptoms reported significantly lower QOL outcomes for patients with OCD than controls. Studies comparing patients with OCD and patients with other psychiatric disorders were not included. Treatments should address QOL in OCD, particularly emotional QOL. Additional strategies targeting QOL should be implemented for female patients with less severe OCD symptoms.

Detection of Autoantibodies Against Actin Filaments in Celiac Disease

Serum autoantibodies specifically directed toward intracellular cytoskeletal actin filaments (anti‐actin antibodies, AAA) were found to be associated with intestinal villous atrophy (IVA) in celiac disease (CD). The aim of this study was to assess IgA‐AAA with a commercial test that uses sections of rat intestinal epithelial cells in a well‐selected cohort of patients and to evaluate the relationship between the presence of serum IgA‐AAA and the severity of intestinal mucosa damage. J. Clin. Lab. Anal. 27:21–26, 2013.

Assessment of a combination screening assay for celiac disease.

PurposeA serological screening assay for celiac disease (CD), designed to simultaneously detect IgA and IgG anti-tissue transglutaminase (a-tTG) and IgA and IgG deamidated gliadin peptide antibodies (a-DGP), was recently developed. In this study, we establish the performance of this assay.MethodsWe enrolled 41 CD patients and 18 CD patients on gluten-free diets. The diagnosis of CD was based on histological and serological criteria, including concomitant positive serology tests (a-tTG, IgA anti-endomysial antibodies). As control population, we enrolled 169 subjects: 145 disease controls and 24 blood donors. In all cases, serum samples were tested for: IgA a-tTG, IgG a-tTG, IgA a-DGP, IgG a-DGP, IgA anti-endomysial antibodies (EMA), IgA and IgG for a-tTG and a-DGP in a single assay.ResultsThe new test, QUANTA Lite ™ h-tTG/DGP Screen, detects all IgA and IgG antibodies against atTG and a-DGP present in a sample. In our study, the test showed 100% sensitivity and 91.12% specificity.ConclusionsThis study showed additional value of the new h-tTG/DGP Screen assay, which proved superior to more conventional assays and can be considered the best initial test for CD. Further studies are necessary to determine whether combination of h-tTG/DGP Screen with IgA a-tTG or IgA a-DGP can be used to obviate the need for duodenal biopsy in high- and low-risk populationsA serological screening assay for celiac disease (CD), designed to simultaneously detect IgA and IgG anti-tissue transglutaminase (a-tTG) and IgA and IgG deamidated gliadin peptide antibodies (a-DGP), was recently developed. In this study, we establish the performance of this assay. We enrolled 41 CD patients and 18 CD patients on gluten-free diets. The diagnosis of CD was based on histological and serological criteria, including concomitant positive serology tests (a-tTG, IgA anti-endomysial antibodies). As control population, we enrolled 169 subjects: 145 disease controls and 24 blood donors. In all cases, serum samples were tested for: IgA a-tTG, IgG a-tTG, IgA a-DGP, IgG a-DGP, IgA anti-endomysial antibodies (EMA), IgA and IgG for a-tTG and a-DGP in a single assay. The new test, QUANTA Lite ™ h-tTG/DGP Screen, detects all IgA and IgG antibodies against atTG and a-DGP present in a sample. In our study, the test showed 100% sensitivity and 91.12% specificity. This study showed additional value of the new h-tTG/DGP Screen assay, which proved superior to more conventional assays and can be considered the best initial test for CD. Further studies are necessary to determine whether combination of h-tTG/DGP Screen with IgA a-tTG or IgA a-DGP can be used to obviate the need for duodenal biopsy in high- and low-risk populations

Health Services OutPatient Experience questionnaire: factorial validity and reliability of a patient-centered outcome measure for outpatient settings in Italy

Purpose The patient-centered approach to health care does not seem to be sufficiently developed in the Italian context, and is still characterized by the biomedical model. In addition, there is a lack of validated outcome measures to assess outpatient experience as an aspect common to a variety of settings. The current study aimed to evaluate the factorial validity, reliability, and invariance across sex of the Health Services OutPatient Experience (HSOPE) questionnaire, a short ten-item measure of patient-centeredness for Italian adult outpatients. The rationale for unidimensionality of the measure was that it could cover global patient experience as a process common to patients with a variety of diseases and irrespective of the phase of treatment course. Patients and methods The HSOPE was compiled by 1,532 adult outpatients (51% females, mean age 59.22 years, standard deviation 16.26) receiving care in ten facilities at the Santa Maria alle Scotte University Hospital of Siena, Italy. The sample represented all the age cohorts. Twelve percent were young adults, 57% were adults, and 32% were older adults. Exploratory and confirmatory factor analyses were conducted to evaluate factor structure. Reliability was evaluated as internal consistency using Cronbach’s α. Factor invariance was assessed through multigroup analyses. Results Both exploratory and confirmatory analyses suggested a clearly defined unidimensional structure of the measure, with all the ten items having salient loadings on a single factor. Internal consistency was excellent (α=0.95). Indices of model fit supported a single-factor structure for both male and female outpatient groups. Young adult outpatients had significantly lower scores on perceived patient-centeredness relative to older adults. No significant difference emerged on patient-centeredness between male and female outpatients. Conclusion The HSOPE questionnaire seemed to be a tool with high acceptability and excellent psychometric properties to measure patient-centeredness as a unidimensional construct. Limitations and implications for future research are discussed.

Does higher severity really correlate with a worse quality of life in obsessive-compulsive disorder? A meta-regression

Background Obsessive–compulsive disorder (OCD) is one of the leading causes of disability and reduced quality of life (QOL), with impairment in a number of domains. However, there is a paucity of literature on the association between severity of OCD symptoms and QOL, and the data that do exist are inconsistent. In addition, the role of severity in QOL has not been summarized as yet from a cross-generational perspective (ie, across childhood/adolescence and adulthood). Through meta-regression techniques, the current study summarized evidence about the moderator role of severity of OCD symptoms on differences in global QOL between individuals with OCD and controls. Methods Online databases were searched, and cross-sectional case–control studies comparing participants of all ages with OCD with controls on self-report QOL measures were included. Random-effect meta-regression techniques were used to comment on the role of illness severity in global QOL in individuals with OCD. Results Thirteen studies were included. A positive significant association emerged between OCD severity and effect sizes on global QOL: in samples with higher severity, there were narrower differences in QOL between patients with OCD and controls than in samples with lower severity. Such positive association was confirmed by a sensitivity analysis conducted on studies including only adults, where the difference in QOL ratings between patients and controls was significantly narrower when OCD severity was higher. Conversely, a negative association between severity and QOL was found in those studies including only children/adolescents, where the difference in QOL was significantly larger between patients and controls when OCD severity was higher. Conclusion QOL remains an important issue to address in the management of OCD in all age groups, irrespective of illness severity. Even in those with lower severity ratings, QOL may be considered as an important marker of treatment response.

Quality of life in children and adolescents with obsessive–compulsive disorder: a systematic review and meta-analysis

Obsessive–compulsive disorder (OCD) is a seriously impairing psychiatric condition that affects 1%–3% of youth. Investigating the quality of life (QOL) is an important issue for treatment planning of this disorder, as targeting symptoms without taking it into account may bias assessment and prognosis when the patient presents with reduced symptoms that do not correspond to improved QOL. However, QOL in young individuals with OCD has been understudied. This meta-analysis summarized current evidence that assessed differences in global, social and school QOL dimensions, between children/adolescents with OCD and screened controls. Age, sex and OCD severity were examined as moderators. Case–control studies were included if children/adolescents with primary OCD were compared with screened controls on validated self-reported QOL outcomes. Online databases (January 1966–January 2016) were searched. Five case–control studies were included (n=543, 17 effect sizes overall). On global QOL, a large effect size emerged (d=−1.16, P<0.001), suggesting that individuals with OCD had lower global QOL than controls. Moderate effect sizes emerged for school (d=−0.61, P<0.01) and social QOL (d=−0.54, P<0.01), respectively, indicating worse QOL on these domains for individuals with OCD. For samples with higher OCD severity, global QOL of individuals with OCD was lower than that for controls (β=−0.02, P<0.05). For samples with lower percentages of females, global QOL of individuals with OCD was more impaired (β=0.02, P<0.001). Age was not correlated with effect sizes. Assessment and treatment should target QOL for young males suffering from more severe OCD. The small number of included studies highlighted that QOL is under-recognized. Future research should focus on additional QOL domains and compare which ones are impaired among individuals with OCD compared with other psychiatric conditions. Overall, the results pointed out the importance of addressing QOL in both practice and research on assessment and treatment of children/adolescents with this condition.

Disturbi dell’umore e patologie glutine correlate@@@Mood disorders and gluten-related diseases

RiassuntoPremesse.Una reazione immunologica verso il glutine è descritta in diversi disturbi psichiatrici e, tra questi, la schizofrenia è quella maggiormente studiata, mentre sono ancora esigui i lavori sull’eventuale associazione tra glutine e disturbi dell’umore. Obiettivo del nostro studio è stato valutare la presenza di un profilo anticorpale correlato all’intolleranza al glutine in soggetti con disturbo dell’umore.Metodi.Sono stati reclutati 60 pazienti con diagnosi di disturbo bipolare o disturbo depressivo clinicamente classificati secondo i criteri DSM-IV-TR. Come controlli sani, sono stati arruolati 48 soggetti, selezionati in modo casuale tra gli accompagnatori non consanguinei dei pazienti. Al gruppo dei pazienti sono state somministrate le seguenti scale di valutazione diagnostica e psicopatologica: (a) Mini International Neuropsychiatric Interview (MINI), intervista clinica semistrutturata per la conferma diagnostica; (b) Hamilton Rating Scale for Depression (HAM-D) e Hamilton Rating Scale for Anxiety (HAM-A) per la valutazione della sintomatologia depressiva e ansiosa; (c) Positive and Negative Syndrome Scale (PANSS) e Young Mania Rating Scale per la valutazione dei sintomi psicotici e la gravità della sintomatologia maniacale. Al gruppo dei controlli è stata somministrata la Structured Clinical Interview for DSM-IV-Non Patients (SCID-NP) per escludere la presenza di una qualsiasi diagnosi psichiatrica attuale o lifetime. Sia sui pazienti sia sui controlli sono stati determinati gli anticorpi caratteristici della malattia celiaca (MC) o suggestivi di sensibilità al glutine non celiaca (NGCS). In particolare sono stati analizzati gli anticorpi anti-gliadina nativa (AGA) di classe IgA e IgG, gli anticorpi anti-peptidi deamidati della gliadina (DGP) di classe IgA e IgG, gli anticorpi anti-transglutaminasi (tTG) di classe IgA e IgG e gli EMA IgA. Le determinazioni anticorpali sono state eseguite con i metodi immunoenzimatici (ELISA) e in immunofluorescenza indiretta (IFI) prodotti dall’azienda Eurospital (Trieste, Italia).Risultati.La maggior parte dei valori anticorpali di AGA IgA/IgG, DGP IgA/IgG e tTG IgA da noi indagati non risultava particolarmente differente tra il gruppo dei pazienti e quello dei controlli con l’eccezione dei soli anti-tTG IgG: nel gruppo dei pazienti il valore medio è pari a 16,3 ± 11,8, mentre nei sani equivale a 11,2 ± 10,0 (p<0,007