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1.
Francesco Attena 《Medicine, health care, and philosophy》2014,17(3):459-465
Improving the evidence in public health is an important goal for the health promotion community. With better evidence, health professionals can make better decisions to achieve effectiveness in their interventions. The relative failure of such evidence in public health is well-known, and it is due to several factors. Briefly, from an epistemological point of view, it is not easy to develop evidence-based public health because public health interventions are highly complex and indeterminate. This paper proposes an analytical explanation of the complexity and indeterminacy of public health interventions in terms of 12 points. Public health interventions are considered as a causal chain constituted by three elements (intervention, risk factor, and disease) and two levels of evaluation (risk factor and disease). Public health interventions thus differ from clinical interventions, which comprise two causal elements and one level of evaluation. From the two levels of evaluation, we suggest a classification of evidence into four typologies: evidence of both relations; evidence of the second (disease) but not of the first (risk factor) relation; evidence of the first but not of the second relation; and no evidence of either relation. In addition, a grading of indeterminacy of public health interventions is introduced. This theoretical point of view could be useful for public health professionals to better define and classify the public health interventions before acting. 相似文献
2.
Topical Nifedipine With Lidocaine Ointment <Emphasis Type="Italic">vs.</Emphasis> Active Control for Treatment of Chronic Anal Fissure 总被引:1,自引:1,他引:1
Perrotti P Bove A Antropoli C Molino D Antropoli M Balzano A De Stefano G Attena F 《Diseases of the colon and rectum》2002,45(11):1468-1475
PURPOSE: Chronic anal fissure may be treated by chemical or surgical sphincterotomy. The aim of this study was to test the efficacy of local application of nifedipine and lidocaine ointment in healing chronic anal fissure. METHODS: The study was performed according to a prospective, randomized, double-blind design. One hundred ten patients who gave informed consent were recruited. They received a clinical examination, a questionnaire to evaluate symptoms and pain, anorectal manometry, and anoscopy. Healing of anal fissure at Day 42 of therapy was defined as the primary efficacy variable of the study. Patients treated with nifedipine (n = 55) used topical 0.3 percent nifedipine and 1.5 percent lidocaine ointment every 12 hours for 6 weeks. The control group (n = 55) received topical 1.5 percent lidocaine and 1 percent hydrocortisone acetate ointment during therapy. Anal pressures were measured by recording resting and maximal voluntary contraction pressures at baseline and at Day 21. Long-term outcomes were determined after a median follow-up of 18 months. RESULTS: Healing of chronic anal fissure was achieved after 6 weeks of therapy in 94.5 percent of the nifedipine-treated patients (P < 0.001) as opposed to 16.4 percent of the controls. Mean anal resting pressure decreased from a mean value +/- standard deviation of 47.2 +/- 14.6 to 42 +/- 12.4 mmHg in the nifedipine group. This represents a mean reduction of 11 percent (P = 0.002). Changes of maximal voluntary contraction in nifedipine-treated patients were not significant. No changes in mean anal resting pressure and maximal voluntary contraction were observed in the control group. We did not observe any systemic side effect in patients treated with nifedipine. After the blinding was removed, recurrence of the fissure was observed in 3 of 52 patients in the nifedipine group within 1 year of treatment, and 2 of these patients healed with an additional course of topical nifedipine and lidocaine ointment. CONCLUSIONS: Our study clearly demonstrates that the therapeutic use of topical nifedipine and lidocaine ointment should be extended to the conservative treatment of chronic anal fissure. 相似文献
3.
Rago Anna Papa Andrea Antonio Attena Emilio Parisi Valentina Golino Paolo Nigro Gerardo Russo Vincenzo 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2021,35(5):1003-1007
Cardiovascular Drugs and Therapy - The purpose of the present study was to compare the long-term effectiveness and safety of newly initiated anticoagulation with edoxaban (EDO) versus uninterrupted... 相似文献
4.
Russo Vincenzo Bottino Roberta D’Andrea Antonello Silverio Angelo Di Maio Marco Golino Paolo Nigro Gerardo Valsecchi Orazio Attena Emilio Canonico Mario Enrico Galasso Gennaro Parodi Guido Scudiero Fernando 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2022,36(4):705-712
Cardiovascular Drugs and Therapy - The clinical course of COVID-19 may be complicated by acute respiratory distress syndrome (ARDS) and thromboembolic events, which are associated with high risk of... 相似文献
5.
Giuseppe Rengo Gennaro Pagano Dino Franco Vitale Roberto Formisano Klara Komici Laura Petraglia Valentina Parisi Grazia Daniela Femminella Claudio de Lucia Stefania Paolillo Alessandro Cannavo Emilio Attena Teresa Pellegrino Santo Dellegrottaglie Alessia Memmi Bruno Trimarco Alberto Cuocolo Pasquale Perrone Filardi Dario Leosco Nicola Ferrara 《European journal of nuclear medicine and molecular imaging》2016,43(13):2392-2400
Purpose
Sympathetic nervous system (SNS) hyperactivity is a salient characteristic of chronic heart failure (HF) and contributes to the progression of the disease. Iodine-123 meta-iodobenzylguanidine (123I-mIBG) imaging has been successfully used to assess cardiac SNS activity in HF patients and to predict prognosis. Importantly, SNS hyperactivity characterizes also physiological ageing, and there is conflicting evidence on cardiac 123I-mIBG uptake in healthy elderly subjects compared to adults. However, little data are available on the impact of ageing on cardiac sympathetic nerve activity assessed by 123I-mIBG scintigraphy, in patients with HF.Methods and results
We studied 180 HF patients (age?=?66.1?±?10.5 years [yrs]), left ventricular ejection fraction (LVEF?=?30.6?±?6.3 %) undergoing cardiac 123I-mIBG imaging. Early and late heart to mediastinum (H/M) ratios and washout rate were calculated in all patients. Demographic, clinical, and echocardiographic data were also collected. Our study population consisted of 53 patients aged >75 years (age?=?77.7?±?4.0 year), 67 patients aged 62–72 years (age?=?67.9?±?3.2 years) and 60 patients aged ≤61 year (age?=?53.9?±?5.6 years). In elderly patients, both early and late H/M ratios were significantly lower compared to younger patients (p?<?0.05). By multivariate analysis, H/M ratios (both early and late) and washout rate were significantly correlated with LVEF and age.Conclusions
Our data indicate that, in a population of HF patients, there is an independent age-related effect on cardiac SNS innervation assessed by 123I-mIBG imaging. This finding suggests that cardiac 123I-mIBG uptake in patients with HF might be affected by patient age.6.
7.
Prevalence of asthma among young men in a military recruitment office of South Italy 总被引:1,自引:0,他引:1
The prevalence of asthma was studied in 3065 male 18 year-olds, examined in a southern Italy (Basilicata) military recruitment office. The disease was evaluated by questionnaires, pulmonary function tests and specialist diagnosis. The point prevalence of asthma was 1.4%. The disturbance was more frequent in high versus a low level of maternal education (OR: 3.70; 95% CI: 2.00–6.88), in high versus a low level of paternal education (OR: 2.71; 95% CI: 1.48–4.98), in urban residence versus rural residence (OR: 3.04; 95% CI: 1.61–5.75), in first-borns versus nonfirst-borns (OR: 2.46; 95% CI: 1.33–4.53). Home environment (dampness, heating, crowding) was not significantly correlated to asthma. This reported prevalence of asthma is low, compared with overall European and Italian data. The higher risk in urban areas and high level of education has been confirmed. The association between asthma and first-borns is interesting and needs further investigation, focusing on maternal issues like the low maternal age and the mother–child interaction. 相似文献
8.
Attena F 《Medical hypotheses》1999,53(3):177-183
The author describes the possible causal models in both conventional and non-conventional therapies. Ontological determinism is used as a metaphysical assumption and linear causalism as a reference model. The linear causalism is here based on the following properties: sufficient condition, necessary condition, specificity, dose-response relationship, unidirectionality and externality. A subdivision of the therapy into two categories is then proposed: strong activity therapies, with strict causation, are close to linear causalism, and correspond to the therapeutic model of conventional medicine; weak activity therapies, with a much weaker type of causation, apparently tending towards indeterminacy, correspond to non-conventional medicines. Considering the internal state of a human being as a causal factor of therapeutic response, the difficulty in interpreting weak activity therapies is in part resolved and the differences with the strong activity therapies are also less pronounced. 相似文献
9.
D Montanaro G Ribera F Attena F Schioppa F Romano 《Bulletin of the World Health Organization》1983,61(6):981-986
A survey of the virological and epidemiological features of acute respiratory diseases in children admitted to hospital in Naples has been carried out; the results of three years of research are reported. 相似文献
10.
Case sheets are very important instruments for improving health care quality in hospitals. Despite their importance, they are very seldom used and filled in the right way. The study is based on an attempt to optimise case sheets editing; it implies multiple steps: 1. Project development; implementation of a pattern for assessing markers (thoroughness, clearness, reliability and record tracking); 2. Delivery of personal research protocols; 3. Early analysis, assessment of results; detection of severity; 4. Correctional interventions; 5. Secondary analysis; assessment of interventions. Although most indicators have shown an improvement, outcomes remain unsatisfactory, given the extent of shortfalls before intervention. 相似文献