A new tool for the evaluation of the rehabilitation outcomes in older persons. a machine learning model to predict functional status 1 year ahead

Purpose To date, the assessment of disability in older people is obtained utilizing a Comprehensive Geriatric Assessment (CGA). However, it is often difficult to understand which areas of CGA are most predictive of the disability. The aim of this study is to evaluate the possibility to early predict—1year ahead—the disability level of a patient using machine leaning models. Methods Community-dwelling older people were enrolled in this study. CGA was made at baseline and at 1year follow-up. After collecting input/independent variables (i.e., age, gender, schooling followed, body mass index, information on smoking, polypharmacy, functional status, cognitive performance, depression, nutritional status), we performed two distinct Support Vector Machine models (SVMs) able to predict functional status 1year ahead. To validate the choice of the model, the results achieved with the SVMs were compared with the output produced by simple linear regression models. Results 218 patients (mean age = 78.01; SD = 7.85; male = 39%) were recruited. The combination of the two SVMs is able to achieve a higher prediction accuracy (exceeding 80% instances correctly classified vs 67% instances correctly classified by the combination of the two linear regression models). Furthermore, SVMs are able to classify both the three categories, self sufficiently, disability risk and disability, while linear regression model separates the population only in two groups (self-sufficiency and disability) without identifying the intermediate category (disability risk) which turns out to be the most critical one. Conclusions The development of such a model can contribute to the early detection of patients at risk of self-sufficiency loss

Effetti del trattamento ortodontico sull'infiammazione dei tessuti parodontali: revisione sistematica della letteratura

Obiettivo: lo scopo della presente revisione è la valutazione dell'infiammazione dei tessuti parodontali in pazienti sottoposti a trattamento ortodontico. Materiali e Metodi: la ricerca è stata realizzata utilizzando Cochrane Oral Health Group, Medline e Embase. Tutti i lavori inclusi riportano l'indice di sanguinamento al sondaggio (BOP) come variabile principale. Le variazioni della profondità di sondaggio, del livello di attacco clinico, dell'indice gengivale e dell'indice parodontale sono riportati come variabili secondarie. Risultati: i dieci studi inclusi nell'analisi riportano 421 pazienti sottoposti a differenti trattamenti ortodontici. A causa della scarsa omogeneità tra i vari studi, non è stato possibile realizzare una meta-analisi. Conclusioni: con i propri limiti, i risultati mostrano un incremento dei parametri parodontali dopo trattamento ortodontico, indicando come l'accumulo e la composizione dei microbioti sub-gengivali possano influenzare e successivamente indurre un grado maggiore di infiammazione e BOP positivo

Association between serum vitamin D and metabolic syndrome in middle-aged and older adults and role of supplementation therapy with vitamin D

Objectives. To evaluate i) the correlation between vitamin D (vit. D) serum concentra-tions and metabolic syndrome (MetS); ii) the efficacy of 6 months supplementation therapy with vit. D. Method. 200 patients were enrolled. Blood analyses and anthropometric measurements were carried out. Patients with hypovitaminosis D received an oral supplement therapy. Results. 81% of the sample shows vit. D levels < 30 ng/mL. Rate of MetS was significant-ly higher in vit. D deficiency group than in vit D insufficiency (p = 0.009) and sufficiency (p = 0.002) groups. Vit. D shows a significant negative correlation with both waist circum-ference (WC) (ρ - 0.202 p = 0.004) and glycaemia values (FBG) (ρ -0.185 p = 0.009). After the supplementation therapy in a group of 60 subjects a significant increase in vit. D levels (p = 0.001) and a significant reduction in WC values (p = 0.001) were observed. Conclusions. MetS, WC and FBG appeared to be associated vit. D status and it is well-known that central obesity, with the inflammatory alterations thereto correlated that determine insulin resistance, can be considered the “primum movens” for the develop-ment of MetS

Efficacy and safety of spinning exercise in middle-aged and older adults with metabolic syndrome: randomized control trial

Background. Physical training should represent the primary therapeutic approach to prevent cardiovascular disease, overall in the subjects with metabolic syndrome (MetS). Few studies have been conducted to investigate the effects of spinning exercise on cardio-vascular weal. Despite this it has been emphasized that spinning puts strain on the cardiovascular system, questioning whether it can be recommended in the elderly. AIM. to assess whether a 6 months spinning training, combined with proper diet, is more effective than standard training programs and diet alone in improving metabolic abnormalities in elderly patients with MetS. DESIGN. Randomized clinical trial. SETTING. Rehabilitation Unit of the Department of Geriatric Sciences, Sapienza University of Rome POPULATION. elderly patients with MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) diagnostic criteria METHODS. Patients were randomly assigned to receive treatment with diet (group A, n = 10), with diet and general gymnastics program (group B, n = 10), with diet and spinning physical training program (group C, n = 10). The effects of interventions were assessed by differences in changes in components of  MetS and associated biomarkers between the three groups. RESULTS. Thirty patient were recruited at this study and all completed the 6 months protocol. During the study period we observed a significant reduction in  blood pressure (group C: systolic blood pressure p = 0.03; diastolic blood pressure p = 0.04 / group B: systolic blood pressure p = 0.001), in lipid profile (group B: plasma total cholesterl p < 0.0001; triglycerides p < 0.0001 / group C: plasma total cholesterol p  = 0.04); in fasting blood glucose (group B: p = 0.01; group C: p = 0.008); in Homeostatic Model Assessment of Insulin Resistance (HOMA) (group B: p = 0.01; group C: p = 0.001); in waist circumference (group C: p = 0.005; group A: p = 0.022; group B: p = 0.037). CONCLUSION. Our results confirm the effectiveness of spinning physical training combined with diet in the management of MetS. CLINICAL REHABILITATION IMPACT. The findings provide a preliminary evidence to support that spinning training may represent a useful and safe intervention in geriatric patients with multiple CV risk factors. The working group and the presence of an instructor may lead to increase the adherence to physical exercise

Association between epicardial fat thickness and cognitive function in elderly. A preliminary study

Background: Recent studies suggested that the visceral fat could exert a predictive role in the pathogenesis of dementia. The aims of the present study were to evaluate a) the possible correlation between the epicardial adipose tissue (EAT) thickness and the cognitive impairment; b) the possible predictive role of the EAT levels on cognitive functioning. Methods: 65 community-dwelling subjects were enrolled. The metabolic profile was assessed through the evaluation of the biochemical parameters whereas the EAT thickness was measured through the transthoracic echocardiography. The Mini Mental State Examination (MMSE) was also administered. Results EAT thickness values showed several significant correlations with the variables examined in the study and a strong negative correlation with the MMSE scores (r= -.68; p=.001) was found. The multiple linear regression analysis showed that the EAT thickness levels and the hypertension had a predictive effect on the MMSE scores. Conclusions These preliminary findings support the association between EAT thickness levels and cognitive impairment

Frog skin-derived peptides against corynebacterium jeikeium: correlation between antibacterial and cytotoxic activities

Corynebacterium jeikeium is a commensal bacterium that colonizes human skin, and it is part of the normal bacterial flora. In non-risk subjects, it can be the cause of bad body smell due to the generation of volatile odorous metabolites, especially in the wet parts of the body that this bacterium often colonizes (i.e., groin and axillary regions). Importantly, in the last few decades, there have been increasing cases of serious infections provoked by this bacterium, especially in immunocompromised or hospitalized patients who have undergone installation of prostheses or catheters. The ease in developing resistance to commonly-used antibiotics (i.e., glycopeptides) has made the search for new antimicrobial compounds of clinical importance. Here, for the first time, we characterize the antimicrobial activity of some selected frog skin-derived antimicrobial peptides (AMPs) against C. jeikeium by determining their minimum inhibitory and bactericidal concentrations (MIC and MBC) by a microdilution method. The results highlight esculentin-1b(1-18) [Esc(1-18)] and esculentin-1a(1-21) [Esc(1-21)] as the most active AMPs with MIC and MBC of 4–8 and 0.125–0.25 µM, respectively, along with a non-toxic profile after a short-and long-term (40 min and 24 h) treatment of mammalian cells. Overall, these findings indicate the high potentiality of Esc(1-18) and Esc(1-21) as (i) alternative antimicrobials against C. jeikeium infections and/or as (ii) additives in cosmetic products (creams, deodorants) to reduce the production of bad body odor

Montelukast therapy and psychological distress in chronic obstructive pulmonary disease (COPD): a preliminary report

Chronic obstructive pulmonary disease (COPD) is an alteration in which ventilatory function, exercise capacity and health status of patients progressively decline and it is characterized by an increase of inflammatory cytokines such as TNF-a, LTB4, IL-8, etc. In this study we considered twenty patients (15 males and 5 females; mean age: 72.8 6.3) with stable COPD. All patients were performed evaluation of psychological stress at enrollment and were treated with leukotriene receptor antagonists (montelukast tablets) 10 mg/day for 12 months. After 12 months we observed a significant decrease of serum levels of LTB4, IL-8 and also a decrease of the number of outpatient clinic visits, of the number of hospitalizations and of the duration of hospitalizatio

New frontiers of cognitive rehabilitation in geriatric age: the Mozart effect (ME)

The ME was described for the first time in 1993. Subsequently other studies with similar designs were performed. The present study, therefore, proposes: (i) to verify the existence of the benefits of exposure to music in elderly subjects with mild cognitive impairment (MCI), (ii) to explore whether it is possible to find any lasting improvement after training, conducted for a long period of time, with such musical pieces, in the measurable cognitive performances. The study we conducted showed that the ME is present in geriatric patients with MCI; the influence on spatial–temporal abilities remains constant in time if the stimulation is maintained. The continuation of our study will consist of increasing the number of individuals examined and in having them listen to music during the study of ECG rhythms and during the acquisition of cerebral functional magnetic resonance imaging (fMRI), and, at the same time, testing them by neuropsychometric methods

Impact of HIV on VA Dental Services: Report of a Survey

Objectives: This study assessed knowledge, attitudes, and behaviors related to the treatment of HIV-infected patients by Department of Veterans Affairs (VA) dental personnel. Methods : A questionnaire was mailed to all VA dentists, hygienists, and EFDA assistants and completed anonymously in May 1991. Descriptive results are reported along with comparisons between the findings from this study and a similar VA survey conducted in 1988, as well as several national surveys of non-VA dentists. Results : Nearly all VA respondents reported participation in some type of continuing education on HIV and infection control. They also reported high compliance with recommended infection control procedures. Furthermore, the findings suggest that VA dentists and hygienists have a high willingness to treat HIV-infected patients, far exceeding that expressed by non-VA dentists. However, a high level of anxiety related to occupational exposure to HIV seems to exist. Most respondents perceived a higher risk of HIV infection from commonly encountered occurrences in the workplace than actually exists based on current knowledge. Conclusions : While efforts to further reduce the risk of infection and improve care should continue, future efforts also should be directed toward reducing the anxiety of VA dental personnel in the treatment of infectious patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66390/1/j.1752-7325.1994.tb01215.x.pd