Giorgia Molinengo

Quality of life and patient preferences: identification of subgroups of multiple sclerosis patients

PurposeThe aim of this study was to estimate preferences related to quality of life attributes in people with multiple sclerosis, by keeping heterogeneity of patient preference in mind, using the latent class approach.MethodsA discrete choice experiment survey was developed using the following attributes: activities of daily living, instrumental activities of daily living, pain/fatigue, anxiety/depression and attention/concentration. Choice sets were presented as pairs of hypothetical health status, based upon a fractional factorial design.ResultsThe latent class logit model estimated on 152 patients identified three subpopulations, which, respectively, attached more importance to: (1) the physical dimension; (2) pain/fatigue and anxiety/depression; and (3) instrumental activities of daily living impairments, anxiety/depression and attention/concentration. A posterior analysis suggests that the latent class membership may be related to an individual’s age to some extent, or to diagnosis and treatment, while apart from energy dimension, no significant difference exists between latent groups, with regard to Multiple Sclerosis Quality of Life-54 scales.ConclusionsA quality of life preference-based utility measure for people with multiple sclerosis was developed. These utility values allow identification of a hierarchic priority among different aspects of quality of life and may allow physicians to develop a care programme tailored to patient needs.

The use of psychoactive substances among Dutch and Italian adolescents: The contribution of personal and relational resources and vulnerabilities.

Adolescent substance use is constantly high or increasing in Western countries. There is still limited knowledge about the interrelations between the different substances and the diverse aspects of adolescent functioning that may affect this phenomenon. The present cross-national study is aimed to explore the presence of a constellation of different substances and the relationships between substance use and personal and relational resources and vulner-abilities drawn from the problem behaviour theory by Jessor, Donovan, and Costa (1991). The sample consisted of 970 Italian and Dutch adolescents. In both countries, cumulative scale analyses showed the presence of a constellation among the different types of substances. Furthermore, the higher the personal resources and the more positive the models the lower the use of different substances by both Dutch and Italian adolescents. Conversely, the higher the relational vulnerabilities the higher also was the involvement in drugs. However, the explained variance was lower with respect to illegal drugs other than marijuana. The findings are also discussed in terms of their suggestions for successful prevention.

Quality-of-life issues in survivors to anaphylactic reactions to drugs

The aim of this cross‐sectional observational study was to explore quality of life and well‐being in patients with drug‐induced anaphylaxis. Two validated tools were used: the Drug Hypersensitivity Quality‐of‐Life Questionnaire (DrHy‐Q) and the Psychological General Well‐Being Index (PGWBI). Sixty‐five patients (13 males) underwent data analysis. The mean DrHy‐Q score was 62.82 ± 12.1. Mean PGWBI score was 64.03 ± 17.66. DrHy‐Q score was significantly correlated with PGWBI total score (r = −0.314; P = 0.011) and with the following domains: Anxiety (r = −0.260; P = 0.036), Depressed mood (r = −0.406; P = 0.001), Positive well‐being (r = −0.251; P = 0.004), and General Health (r = −0.352; P = 0.004). Compared with the Italian reference population, patients had a significantly reduced PGWBI total and domain score. Our results highlight for the first time how impaired HRQoL and distress commonly feature in survivors to anaphylactic reactions to drug.

Age of initiation with different substances and relationships with resources and vulnerabilities: A cross-national study

There is still limited knowledge about the interrelations among the age of initiation of different substances and the diverse aspects of adolescent functioning. The present cross-national study aimed at exploring the presence of a time-order pattern of age of initiation of different substances and the relationships with personal and relational resources and vulnerabilities, drawn from the problem behaviour theory by Jessor et al. (1991). The sample consisted of 970 adolescents from Italy and The Netherlands, of whom 198 were fully initiated in alcohol, first tobacco use, regular tobacco smoking and marijuana. In both countries, cumulative scale analyses showed the presence of a pattern of age of initiation in the different types of substances. The earlier the age of onset of one substance, the earlier the age of onset of the other substances. Furthermore, the higher the personal resources and the healthy, conventional parents and friend models, the older the age of initiation of different substances by both Dutch and Italian adolescents. With respect to the use of alcohol, the higher the relational resources, the older the age of initiation. Conversely, the higher the adolescents perceived relational vulnerabilities, the younger their age of initiation in drugs. These findings suggest that preventive interventions might be more successful when they are precocious, enhance personal capabilities, and produce changes in the adolescent life context.

RhinAsthma patient perspective: A Rasch validation study

ABSTRACT Objective: In daily practice, Health-Related Quality of Life (HRQoL) tools are useful for supplementing clinical data with the patients perspective. To encourage their use by clinicians, the availability of tools that can quickly provide valid results is crucial. A new HRQoL tool has been proposed for patients with asthma and rhinitis: the RhinAsthma Patient Perspective—RAPP. The aim of this study was to evaluate the psychometric robustness of the RAPP using the Item Response Theory (IRT) approach, to evaluate the scalability of items and test whether or not patients use the items response scale correctly. Methods: 155 patients (53.5% women, mean age 39.1, range 16–76) were recruited during a multicenter study. RAPP metric properties were investigated using IRT models. Differential item functioning (DIF) was used for gender, age, and asthma control test (ACT). Results: The RAPP adequately fitted the Rating Scale model, demonstrating the equality of the rating scale structure for all items. All statistics on items were satisfactory. The RAPP had adequate internal reliability and showed good ability to discriminate among different groups of participants. DIF analysis indicated that there were no differential item functioning issues for gender. One item showed a DIF by age and four items by ACT. Conclusions: The psychometric evaluation performed using IRT models demonstrated that the RAPP met all the criteria to be considered a reliable and valid method of measurement. From a clinical perspective, this will allow physicians to confidently interpret scores as good indicators of Quality of Life of patients with asthma.

The Self-Efficacy in Multiple Sclerosis (SEMS) Scale

This research developed a new scale to evaluate Self-Efficacy in Multiple Sclerosis (SEMS). The aim of this study was to investigate dimensionality, item functioning, measurement invariance, and concurrent validity of the SEMS scale. Data were collected from 203 multiple sclerosis (MS) patients (mean age, 39.5 years; 66% women; 95% having a relapsing remitting form of MS). Fifteen items of the SEMS scale were submitted to patients along with measures of psychological well-being, sense of coherence, depression, and coping strategies. Data underwent Rasch analysis and correlation analysis. Rasch analysis indicates the SEMS as a multidimensional construct characterized by two correlated dimensions: goal setting and symptom management, with satisfactory reliability coefficients. Overall, the 15 items reported acceptable fit statistics; the scale demonstrated measurement invariance (with respect to gender and disease duration) and good concurrent validity (positive correlations with psychological well-being, sense of coherence, and coping strategies and negative correlations with depression). Preliminary evidence suggests that SEMS is a psychometrically sound measure to evaluate perceived self-efficacy of MS patients with moderate disability, and it would be a valuable instrument for both research and clinical applications.

Choose your outcomes: From the mean to the personalized assessment of outcomes in COPD. An exploratory pragmatic survey

BACKGROUND Patients expectations and needs may influence adherence in chronic obstructive pulmonary disease (COPD). The objectives of this survey were to assess the specific outcomes that patients expected their COPD treatment to improve (patients personal outcome [PPO]) and to evaluate how the ongoing therapy was able to reach this objective. METHODS We performed an exploratory pragmatic survey of COPD patients attending 2 university hospitals for scheduled follow-up visits. Patients had to indicate their PPO, the effect of ongoing treatment on the PPO, the symptom COPD of they expected treatment to improve and how this symptom is currently bothering them. Patients also underwent assessment of lung function and completed the COPD assessment test (CAT). RESULTS We analyzed data from 144 consecutive patients, (62.5% males; age range 54-94; mean age 73.88±8.33). A total of 23 different PPOs were scored, and 44.5% of patients reported an improvement ≥6 (mean 4.93±2.27 on a 0-10 points scale) due to ongoing treatment. The correlation between perceived improvement in PPO and CAT score was weak and negative (r=-0.13, p=0.11), whereas it was high and significant with FEV1 (r=.35, p=0.007). The clinical features patients most expected their ongoing treatment to improve were breathlessness (64.6% of patients), cough (13.9%), sputum production (11%) and episodes of exacerbation (8.3%), for which their scores were, respectively, 7.12±1.99, 6.8±2.24, 6.63±2.13, and 8.0±0.94. CONCLUSION Appropriate assessment of PPO could lead to better long-term management of COPD.

Young People, Alcohol and Norms: Italian Young People’s Opinions and Attitudes towards Alcohol Regulation

The study examines Italian young people’s opinions and attitudes towards alcohol policies in order to shed light on the potential challenges to the introduction of more restrictive policies. A mixed methods research design was employed. A CAWI survey and online forum targeted 15–25 year olds, resulting in 1,816 valid responses to the online questionnaires and 86 blog comments; focus groups were conducted with two different groups, aged 15–17 and 23–25, including 31 participants. The study indicated that young people are rather well informed about the law, and have generally positive opinions about alcohol-related regulation. Nevertheless, opinions and behaviours do not always match. Findings are consistent with more general reflections about the gap between attitudes and behaviours. A large majority of respondents express negative opinions about more restrictive alcohol availability norms. The study shows the lack of enforcement of current laws and the consequences of that on young people’s attitudes towards the law.

Preoccupazione, probabilità di accadimento e comportamenti preventivi rispetto al rischio alluvionale in una zona di montagna

Tramite un questionario strutturato e stata rilevata la preparazione ai disastri, la preoccupazione e la probabilita di accadimento per un evento alluvionale, intervistando un campione di 407 persone residenti in 9 comuni della Valle del Lys (Valle d’Aosta). Le analisi descrittive mostrano una relazione diretta fra la valutazione della probabilita di accadimento e la preoccupazione; fra quest’ultima e l’adozione di comportamenti preventivi e ulteriori relazioni con alcune caratteristiche socio-demografiche ed esperienziali degli intervistati. Le analisi multivariate, inoltre, evidenziano come la preparazione ai disastri sia positivamente associata alla preoccupazione, ma non alla valutazione della probabilita di accadimento.