Mario Bolzan

Audiometric and Epidemiological Analysis of Elderly in the Veneto Region

Background: Presbyacusis, or age-related hearing loss, has become a problem of increasing social interest due to the rise in the mean age of the population. Investigations performed to date have generally been carried out with the aid of self-reporting questionnaires, without the support of objective findings. Objective: The purpose of this study was to analyze an extensive series of elderly people from different areas of the Veneto region to obtain an epidemiological descriptive analysis, as detailed as possible, of their presbyacusis, considering their hearing thresholds at various frequencies, distinguishing findings according to sex and age in classes and the geographical area where the survey was performed. Methods: The survey was carried out collecting information from the audiometric reports on 13,710 subjects of both sexes aged 60 years and over, with a proportion of males (M/F × 100) of 92.02%, referred spontaneously for hearing examination to the ENT departments of eight hospitals between 1986 and 1994. The catchment area includes three provincial capitals and five mainly rural municipalities. Results: The results show that the hearing threshold rises progressively with age in both sexes. The hearing loss is milder in women than in men, especially at the higher frequencies. No important differences emerged among findings recorded in their 80s and in their 90s or among findings in the different geographical areas considered. Conclusions: Statistical descriptive analysis confirms the typical trend of the audiometric curve in presbyacusis, tracing the typical audiometric curve of old age described in the literature. The mean values of the audiometric curve reveal no significant differences between people residing in the country and people living in the cities.

Advantages of the Closed Testing Method in Multiple Comparisons Procedures

This article deals with the use of the Closed Testing approach in Multiple Comparison Procedures (MCPs). MCPs occur when after rejection of a global hypothesis of no effect of a given treatment, a set of pairwise comparisons between levels of that treatment are performed in order to find out significant differences between levels. Given a set of partial hypotheses, such as the pairwise comparisons of an MCP, the Closed Testing approach concentrates on testing the family of all the non empty intersections of these partial hypotheses. The results of our simulation study highlight the advantages of closed testing methods and prove that they are more powerful than other classic MCPs controlling the FWER.

Predictive factors for oropharyngeal mycosis during radiochemotherapy for head and neck carcinoma and consequences on treatment duration. Results of mycosis in radiotherapy (MIR): A prospective longitudinal study

BACKGROUND AND PURPOSE Oropharyngeal mycosis (OPM) is a complication of radiotherapy (RT) treatments for head and neck (H&N) cancer, worsening mucositis and dysphagia, causing treatment interruptions and increasing overall treatment time. Prophylaxis with antifungals is expensive. Better patient selection through the analysis of prognostic factors should improve treatment efficacy and reduce costs. MATERIALS AND METHODS A multicentre, prospective, controlled longitudinal study, with ethics committee approval, examined H&N cancer patients who were candidates for curative treatments with radio-chemotherapy. Patients were divided in groups according to OPM appearance: before the starting of RT (cases), during RT (new cases) and never (no cases). RESULTS Of 410 evaluable patients, 20 were existing cases, 201 new cases and 189 did not report OPM. In our study OPM appears in 42.4% of people >70years and in 58.2% of younger individuals (p=0.0042), and in 68.6% of women versus 50.8% of men (p=0.0069). Mucositis and dysphagia were higher and salivation reduced among people with OPM (p<0.0000). Patients with OPM had longer hospitalization (p=0.0002) and longer (>12days) treatment interruptions (p=0.0288). CONCLUSIONS Patients with OPM had higher toxicity and a greater number of long treatment interruptions. Analyses of prognostic factors can help clinicians understand OPM distribution and select patients with the highest probability of OPM for antifungal prophylaxis.

An Evaluation of Performance of Territorial Services Center (TSC) by a Nonparametric Combination Ranking Method

The work presents some results about a national project IQuEL-2010, aimed to solve some problems associated to the digital divide by Territorial Services Center (TSC). A specific survey was carried out by sample of local operator in the three Italian provinces (Padova, Parma Pesaro-Urbino). We applied a nonparametric combination (NPC) ranking method on a set of nine dimensions related the public services supplied. The results show important differences among the provinces, at least for six out of nine TSC abilities or performances and producing a Global satisfaction ranking.

Evaluation in Terms of Annual Incidence Rate of Lung Cancer within the ULSSs of the Veneto Region (Italy) from Hospital Discharge Data (Years 1980–1982)

The annual incidence of lung cancer in aggregated territories (ULSS and Veneto Region) was assessed by a retrospective analysis of hospital discharge data from 1980–1982. The 1982 regional age and sex-specific prevalence and incidence rates (x 100,000 inhabitants), the deaths in period and the cumulative incidence rates were determined. Also calculated were the standardized incidence ratios, distinctly for sex and a truncated age range (35–64 years) and on the total as well as the standard errors. The results obtained demonstrated that the incidence rate in the Veneto is among the highest in Italy and that there is a nonhomogeneous distribution of incidence/prevalence in the various ULSSs within the Veneto. Previously held opinions on the effects of sex and age were also confirmed. Comparison of the results with those obtained from the deaths in period showed the method used for analysis to be reasonably practical and reliable. It could provide an alternative method to the more complex and expensive system currently adopted by the Population Registries.

Identifying a Bayesian Network for the Problem “Hospital and Families: The Analysis of Patient Satisfaction with Their Stay in Hospital”

In the evolution of the epidemiological profile of present day communities, the phenomena of “chronicity” and “disability” are more and more important. These phenomena find a natural place for their manifestation and for the research of their solution in the family context. The health of some members, in a family context, proves to be an experience which affects the whole family unit and the more the condition of the individual is one of suffering, the greater the hardship the family finds itself having to face. We can therefore talk of “family hardship” as the adverse condition, perceived by the family in various ways, which directly (e.g. due to the sudden onset of critical events) and/or indirectly (due to structural conditions of the family or the context of family life) prevents the carrying out of the functions necessary for the optimal achievement of expected objectives such as a better quality of life (Bolzan, M., 2002; Pless, I. B., 1984). However, an initial definition of family hardship stands on the three-dimensional level of: i) main family functions; ii) resources the family have at their disposal for the reaching of their own objectives; iii) the system of institutions and services in which the policies and interventions on health and care operate. On this level all the exchanges of relationships — between people united by a history of behaviours and by a dominant culture in which the social unity is linked to other social unities — commonly known as the “social network”, are activated.