Lara Gitto

Vitamin D Status and Mortality Risk in Patients with Chronic Kidney Disease

Several studies have shown that mineral metabolism disorders play a major role in determining a higher mortality rate for end-stage renal disease patients. Vitamin D deficiency is associated with cardiovascular events in hemodialysis patients. Recently, an association between vitamin D insufficiency and cardiovascular or renal events has been found, in patients with chronic renal failure who have not started renal replacement therapy yet. To further investigate this issue, we evaluated the relationship between blood levels of 25-hydroxyvitamin D (25-OH D; > or ≤30 ng/mL) and mortality or dialysis dependence in 104 incident consecutive patients with chronic kidney disease stages 3–5, over a period of 17 months, with a follow-up of 2 years in a cross-sectional analysis. The correlation between different levels of vitamin D and the risk of events has been estimated by using a probit model. Explanatory variables employed concerned age, sex, blood pressure, BMI, and number of co-morbid factors. The average 25-OH D concentration was of 30.13 ng/mL. During follow-up (>16 months), each patient experienced an average of 1.28 events. Vitamin D has been shown to reduce the probability of cardiovascular or renal events. Vitamin D intake for more than 12 months can reduce the probability of such events by 11.42%. Each co-morbid factor, instead, raises the probability of events by 29%. Lower probabilities of experiencing an adverse cardiovascular event might depend on higher levels of vitamin D. The influence of 25-OH D on survival in chronic kidney disease patients may be related to unrecognized factors that need to be further explored.

Adaptation of the Mishel Uncertainty of Illness Scale (MUIS) for chronic patients in Italy.

RATIONALE, AIMS AND OBJECTIVESnUncertainty is a component of the illness experience and is likely to increase the burden of managing chronic illness, as cardiac pathologies and renal diseases. The impact of uncertainty should be taken into account and addressed with targeted intervention programmes. The purpose of this study is to contribute to the diffusion of the assessment of uncertainty in illness by validating the Mishel uncertainty in illness scale (MUIS) on chronic Italian patients.nnnMETHODnThe MUIS questionnaire was administered to 200 patients suffering from cardiac diseases and 50 patients with renal diseases. A confirmatory factor analysis was run for each of the MUIS dimensions (ambiguity, inconsistency, complexity and unpredictability).nnnRESULTSnAfter some item reduction, three of the four MUIS scales, namely, ambiguity, inconsistency and complexity, exhibited satisfactory reliability coefficients (with Cronbachs alphas of, respectively, 0.796, 0.778 and 0.705), highly significant standardized regression weights and satisfactory/highly satisfactory fit indexes. Nevertheless, as the correlations among the scales mentioned earlier were high (all above 0.8) and statistically significant, the three subsets of ambiguity, complexity and inconsistency items were allowed to load onto a new single factor. A monodimensional uncertainty construct, grouping the majority of the items encompassed by these three MUIS scales, was successfully validated.nnnCONCLUSIONSnThis study provides researchers with an easy-to-administer instrument which is useful to investigate a crucial aspect related with patients quality of life. Although a unique uncertainty construct is proposed, the in-depth analysis of the replies to each single item of the MUIS could help to monitor patients emotional responses to the diagnosis and to the course of this disease and it might be useful to define appropriate strategies of coping and to focus on patients quests for simplicity and clarity of treatment.

Role of Emotional Intelligence as a Mediating Factor Between Uncertainty and Anxiety Hospital in Chronic Renal Patients

Renal diseases are distressing and it is, especially, the aspect of uncertainty that exerts an influence on patients’ emotional adjustment to illness. The present study investigates the relationship between uncertainty and trait emotional intelligence (EI), and the role of EI as mediator in the relationship between uncertainty, anxiety, and depression in nephropathy patients. Fifty patients were asked to complete a worksheet including the Hospital Anxiety and Depression Scale, Trait Emotional Intelligence Questionnaire—Short Form, and Mishel Uncertainty in Illness Scale. Structural equation modeling has been used to examine whether trait EI mediates the relationship between uncertainty, anxiety, and depression. Through structural equation modeling, it has been demonstrated that trait EI mediated the relationship between uncertainty, anxiety, and depression. These findings suggest to develop coaching programs aimed at strengthening nephropathy patients’ emotional responses to uncertainty; in this way, it could be possible to observe an improvement in patients’ quality of life.

Coping, uncertainty and health-related quality of life as determinants of anxiety and depression on a sample of hospitalized cardiac patients in Southern Italy

ObjectivesBeing hospitalized often causes psychological distress and compromises patients’ psychological well-being, thereby augmenting the burden of illness. The aim of this paper is to investigate two possible determinants of anxiety and depression among hospitalized cardiac patients, namely uncertainty in illness, and coping strategies, controlling for the perceived health-related quality of life, and distinguishing between borderline and pathological levels of anxiety and depression.MethodsData on anxiety, depression, coping style, uncertainty in illness and self-assessed quality of life concerning 200 cardiac inpatients from a university hospital were collected through validated questionnaires. A biprobit analysis, whose dependent variables are hospital anxiety and depression, was carried out.ResultsUncertainty in illness has a significant impact on the possibility of crossing the borderline level of both anxiety and depression. The coping strategy of Positive Reappraisal and Growth is inversely and significantly correlated to anxiety and depression, be it borderline or pathological; the Restraint Coping strategy is positively and significantly related to borderline anxiety.ConclusionsThe reduction of uncertainty in illness and the development of adequate coping strategies should be promoted in order to decrease the patients’ risk of crossing the borderline threshold of anxiety and depression.

Dialysis modality selection according to the medical care provided at dialysis units: An econometric analysis

The choice of dialysis treatment, as well as of the type of centre in which to receive it, can be the result of a selection process where perceived quality, and the reputation of medical centres and physicians, as well as other observable and unobservable factors play a key role. ESRD patients can choose among alternative treatments, namely HD, HDF and PD. While HD and HDF can be received at public hospitals and private centres, with no difference between the two options in terms of assistance provided, PD is mainly carried out at home.This paper considers the possibility of adopting different econometric techniques to model such simultaneous patients choice by the patients. After having examined conditional logit models and a multinomial logit framework that might suit our purposes, we selected a recursive bivariate probit model. The analysis tools presented in this paper proved to be appropriate in this context and succeeded in identifying a link between the selection of HD as a dialysis modality with patients characteristics, and type of dialysis centre.

An initial validation of the Italian Mishel Uncertainty Illness Scale (MUIS) for relapsing remitting multiple sclerosis patients

Multiple sclerosis is a chronic disease, likely to condition patients’ daily living and quality of life: given the unpredictability of frequency and severity of the attacks, patients experience a high level of uncertainty. While there have been many analyses whose purpose was to monitor multiple sclerosis (MS) patients’ quality of life, the role of uncertainty, that is peculiar to the disease, has not been adequately considered so far. The present study is aimed at filling this gap by validating for Italian MS patients the Mishel’s Uncertainty Illness Scale (MUIS). The MUIS has been developed in the USA context in order to assess four aspects of uncertainty: ambiguity, complexity, inconsistency and unpredictability. It has been largely applied in the cancer, cardiac and chronic illness population. Data employed in this study have been collected at two neurological centres in Messina (IRCCS Centro Studi Neurolesi “Bonino Pulejo” and Policlinico di Messina) in the first semester of 2013 and refer to 120 MS patients. The confirmatory factor analysis described in this study validates two of the four dimensions of MUIS, namely ambiguity and inconsistency. The validation, though partial, of the MUIS, allows the use of this instrument in studies investigating quality of life for Italian patients.

Dental anxiety in relation to aggressive characteristics of patients

Dental anxiety is defined as the response to a stressful stimulus that is specific to a dental context. The dental treatment itself may provoke excitation and aggressive response relating to multiple sources of motivation that have been examined by the literature. The hypothesis to test in the present paper is to what extent dental anxiety can be explained by looking at patients’ characteristics solely or by considering latent aggressiveness that could be manifested before and during the dental treatment. The results of the study should give some indications to dentists to better understand the presence of a greater or lesser anxiety associated with orthodontic treatment in order to provide an appropriate assistance and, eventually, to help patients in developing coping strategies. As a consequence, it should be clear how intervening on each component of dental anxiety and/or aggressiveness may have a positive impact on the outcome of dental treatment.

To what extent is long-term care representative of elderly care? A case study of elderly care financing in Lombardy, Italy

The ageing of European population has been rapidly increasing during the last decades, and the problem of elderly care financing has become an issue for policy-makers. Long-term care (LTC) financing is considered a suitable proxy of the resources committed to elderly care by each government, but the preciseness of this approximation depends on the extent to which LTC is representative of elderly care within each country. Since there is a broad heterogeneity in LTC funding, organization and setting among European States, it is difficult to find a common parameter representing the public resources destined to the elderly care. We address these topics employing as a case study an Italian region, Lombardy, which in terms of population, dimension, healthcare organization and economic development could be compared to other European countries. The method we suggest, which consists basically in a careful estimate of all the public resources employed in the provision of services exclusively destined to the elderly, could be applied, with the due differences, to other European countries or regions.