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Rehabilitative Outcomes after Hip Fracture in a Special Care Unit for Persons with Dementia and Behavioral and Psychotic Symptoms

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Health 2015年第9期7卷 1175-1182页

作者： mauro colombo Silvia Vitali Chiara Cutaia Eleonora Marelli Antonio Guaita Geriatric Rehabilitation Unit/Intermediate Care Geriatric Institute “Camillo Golgi” Agency for Services to Persons (ASP) Golgi Redaelli Abbiategrasso Italy Golgi Cenci Foundation Abbiategrasso Italy Special Care Unit for Persons with Dementia/Intermediate Care Geriatric Institute “Camillo Golgi” Agency for Services to Persons (ASP) Golgi Redaelli Abbiategrasso Italy

Aim: Hip fracture implies severe problems to older people;special concerns regard persons with dementia, due either to cognitive impairment, or to behavioral and psychic symptoms. This study illustrates rehabilitative outcomes of these patients discharged by a special care unit ruled by “GentleCare” principles. Method: 54 patients [89% females, aged 82.3 years (range 66 - 94)] followed a post-surgery rehabilitative program carried out by a physiotherapist and an occupational therapist, supported by a psychologist. The multidimensional assessment consisted of cognition evaluation (Mini Mental State Examination, Clinical Dementia Rating, Global Deterioration Scale), functional evaluation (Barthel Index, Tinetti Gait and Balance, Bedford Alzheimer Nursing Severity scale), behavioral evaluation (UCLA Neuropsychiatric Inventory) and comorbidity evaluation (Cumulative Illness Rating Scale). Results: All parameters improved, including the 5 most frequent behavioral and psychic symptoms that usually preclude admission in ordinary rehabilitation units. 24% of improvement in Barthel Index total score was explained by agitation and apathy at discharge, in a multiple linear regression model: better functional levels corresponded to smoother behavioral problems. Most patients improved;70.5% of them were discharged to home. Conclusion: A prosthetic approach enables valuable results in the rehabilitation of severely demented patients with hip fracture also in presence of behavioral symptoms.

关键词： Hip Fracture Rehabilitation Special Care Unit for Dementia Gentle Care Behavioral and Psychotic Symptoms of Dementia

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Technology Usage among Elderly with Self-Reported Hearing Disability: Results from ***

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Health 2020年第4期12卷 353-367页

作者： Roberta Vaccaro mauro colombo Simona Abbondanza Elena Rolandi Laura Pettinato Antonio Guaita Golgi Cenci Foundation Abbiategrasso Italy Camillo Golgi Geriatric Insitute Abbiategrasso Italy

Background: Awareness of hearing disability in the elderly has adverse cognitive and functional consequences over time, in a longitudinal population-based study. Aim: To analyze the hypothesis that over time old people aware of hearing disability make less use of technology and lose more instrumental activities of daily living than peers with other self-reported hearing conditions. Methods: We analyzed 1171 healthy participants in the longitudinal population-based *** study. The consistency between self-reported hearing loss with clinician-evaluated hearing status (Whispered Voice Test;WVT), was categorized by consistency as: unaware of hearing loss (UHL), aware of hearing loss (AHL), only subjective hearing loss (OSHL), without hearing loss (noHL). Results: At baseline (2010), hearing loss was found in 159 [13.6% (95% CI: 11.7 - 15.7)] of the participants [28 = 17.6% (95% CI: 12.0 - 24.4) AHL;131 = 82.4% (95% CI: 75.6 - 88) UHL], while 23 [2.3% (95% CI: 1.4 - 3.4)] of the subjects with normal WVT had OSHL. Mobile phone usage was significantly associated with different consistency categories (p i.e. executive, memory and visuo-spatial) were independently associated with maintaining mobile phone usage and instrumental activities of daily living. Conclusion: Self-reported hearing disability is linked to subsequent loss of mobile phone usage and functional dependency. As cognitive performances independently influence technology usage and functional impairment, targeted preventive interventions should address functional impact of perceived hearing loss, but also encourage social participation and improve mobile phone usage. Trial registration: ***, NCT01345110;registered on April 29, 2011.

关键词： Technology Self-Reported Hearing Instrumental Activities Population-Based Study Cognition

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Homocysteinemia and Depression in Community-Dwelling Older Adults: The Cohort Longitudinal Study “InveCeAb” (Brain Aging in Abbiategrasso)

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Health 2024年第1期16卷 22-36页

作者： mauro colombo Annalisa Davin Elena Rolandi Michele Rossi Riccardo Ferrari Erica Spina Antonio Guaita Golgi Cenci Foundation Abbiategrasso Italy

Depression is a major health problem, especially for elderly people. According to the “homocysteine hypothesis of depression”, high homocysteine levels may cause depression of mood via cerebrovascular diseases. Whilst biologically plausible, such hypothesis needs yet confirmation. We aimed at: 1) studying the relationships between homocysteinemia (HCY) and depression in a community-dwelling cohort of people aged 70 to 75 years at baseline;2) investigating plasma levels of HCY and 3) comparing these levels between males and females, in the same population. We exploited the data from four waves (2010, 2012, 2014 and 2018) of the longitudinal study “InveCeAb”, with specific regard towards mood assessment, by Geriatric Depression Scale (GDS) scoring, and diagnosis of clinically relevant or subthreshold depression. HCY plasma levels were measured in the waves 2012, 2014 and 2018. Sample attrition was due mainly to death or overall worsening. No statistically significant differences were found in plasma homocysteine levels in each wave, according to depressive symptoms. No correlations were found between plasma HCY levels in each wave with their corresponding GDS scores, even after adjustment for folate and cobalamin blood concentrations. Dichotomized levels of HCY (≤15 vs >15 μM/l) were not associated with dichotomized GDS scores (≤4 vs higher), clinically relevant and subthreshold depression diagnosis and any antidepressive use, in any wave. First (2012) HCY levels increased with participants’ increasing age, cross-sectionally. Listwise HCY concentrations decreased along the 3 waves. HCY levels were always higher in males than in females. Our results may challenge the “homocysteine hypothesis” of depression, whilst supporting the role of high homocysteinemia as a marker of overall bad health.

关键词： Homocysteinemia Depression Aging Cohort

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The Remote Testing in Abbiategrasso (RTA) Study Protocol: A Counter-Balanced Crossover Trial to Assess the Feasibility of Direct-to-Home-Neuropsychology with Older People

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Health 2022年第5期14卷 586-598页

作者： Roberta Vaccaro Virginia Aglieri Elena Rolandi Michele Rossi Laura Pettinato Arcangelo Ceretti mauro colombo Antonio Guaita Golgi Cenci Foundation Abbiategrasso Milan Italy Department of Brain and Behavioral Sciences University of Pavia Pavia Italy Camillo Golgi Geriatric Institute Abbiategrasso Milan Italy

Background: The Sars-Cov-2 pandemic has accelerated the spreading of telemedicine, including TeleNeuroPsychology (TNP). Also in a non-pandemic scenario, TNP gives the advantage of reaching older subjects, which often have mobility or transportation limitations. Previous studies on the feasibility, acceptability and reliability of TNP provide promising indications. However, it remains unclear how elderly populations in Italy welcome this practice, in particular when carried out “direct-to-home” (DTH neuropsychology—DTH-NP), hence without assistance in setting up, i.e., the videoconference, and which tests validated in Italian populations show good comparability between remote (either by voice phone call or videoconference) and face-to-face administration. Aims: Here we present a study protocol aimed at assessing: 1) the recruitment rate in a study on DTH neuropsychological assessment through voice calls or videoconference, 2) the feasibility and acceptability of a DTH neuropsychological assessment, 3) the comparability between DTH and face-to-face neuropsychological assessments. Methods: Fifty-eight older adults (65 - 85 years) were recruited among donors of the Abbiategrasso Brain Bank and will undergo both a face-to-face and a DTH neuropsychological assessment in a counterbalanced cross-over design (Group 1: remote session first;Group 2: face-to-face session first). Recruitment rate will be first evaluated. Then, the responses to an acceptability questionnaire will be compared between the two administration modalities. Finally, the DTH-face-to-face comparability will be evaluated as good reliability of a DTH neuropsychological assessment and agreement between scores obtained in the two modalities. Discussion and Conclusion: This study protocol aims at describing the procedures allowing a more reliable implementation of DTH-NP in the Italian clinical and research contexts. The inclusion of both phone-call and videoconference DTH neuropsychological assessment will gi

关键词： Telehealth Neuropsychological Assessment Feasibility Study Counterbalanced Cross-Over Design

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Patients’ Expectations in a Geriatric Rehabilitation Ward: Matching with Actual Outcomes

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Health 2017年第11期9卷 1597-1604页

作者： mauro colombo Carla Facchini Achim Rusu Eleonora Marelli Giuseppe Procino Rosella Capuano Cristina Miramonti Antonio Guaita Geriatric Rehabilitation Unit/Intermediate Care Geriatric Institute “Camillo Golgi” Agency for Services to Persons (ASP) Golgi Redaelli Milano Italy Golgi Cenci Foundation Abbiategrasso Italy Sociology Department University of Milan Milano Italy

Aim: Person-centered care is a core issue in rehabilitation;the study aims at: 1) enquiring the outcome expectations of patients in a geriatric rehabilitation ward;2) matching outcome expectations with actual outcomes. Methods: Expectations of 186 patients [79.4 (8.7) years, 70% females] analyzed through a questionnaire. 80.6% of patients were discharged home;functional recovery = 17.7 (22) points in Barthel Index total score, and 5 (4.2) points in Barthel Index walking subscore;also conditions with nursing needs improved significantly. Results: Patients’ expectations were coded as: functional (31.4%), overall (29.6%), and clinical improvement (21.5%), discharge home (7%);no answers or explicit lack of expectations (7.5%). Walking ability recovery differed according to outcome expectations. Highest improvements were achieved by patients wishing clinical improvement, followed by those expecting functional or overall improvement (5 points) [p = 0.009 (Welch)/p = 0.041 (Brown- Forsythe)];worst improvement in walking ability (2.8 points) were got by patients faulting or declaring explicit failure of expectations. Conditions with nursing needs improved most in those expecting clinical improvements [p = 0.029 (Brown-Forsythe)], and less in case of expectation default. No further matching was found. Conclusions: Improvement in actual outcomes matched expected improvements in two circumstances: recovery in walking ability and in conditions with nursing needs. The high yield of different favorable outcomes may have masked the statistical significance for correspondence between actual and expected results. Special attention is worthy towards patients short of expectations, as their actual outcomes result poorer.

关键词： Expectations Outcomes Geriatric Rehabilitation Person-Centered Care

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Modification in self-rated health in patients discharged by a geriatric rehabilitation ward

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Health 2013年第6期5卷 94-98页

作者： Eleonora Marelli Giuseppe Procino Maria Cottino Giorgio Previderè Silvio Giorgi Davide Dell’Acqua Santina Bruno Marco Cairati Danila Ferrari Rosella Capuano mauro colombo Geriatric Institute “Camillo Golgi” Milan Italy Geriatric Institute “Camillo Golgi” Milan Italy

Self-rated health is a valuable outcome in geriatric rehabilitation besides objective results. The present work aims at measuring and analyzing overall health as it is perceived at admission into and at discharge from a geriatric rehabilitation ward. Overall health was self-appraised through a visual-analogue scale (VAS), spanning from 0 (worst) to 10 (best). We studied 1997 patients (70% females), aged 79 (standard deviation, s.d. 8.7) years;most were frail, either functionally, clinically and cognitively. 80% of patients were discharged to home after a length of stay lasting 47.5 (s.d. 22.7) days. At admission, 3/5 patients appraised favorably their overall health (VAS ≥ 6/10): at discharge, the proportion rose to 3/4, with a mean (s.d.) gain = 2 (2) points. The improvement in self-perceived health score positively correlates with the grade expressing clients’ overall satisfaction for the stay (p 0.001), and with discharge versus admission differences in: Barthel Index (BI) total score (p < 0.001), Tinetti total score, Mini Mental State Examination (MMSE), Geriatric Depression Scale (5?items GDS), pain (VAS 0 to 10). A Linear regression model predicting the changes in self-perceived health included changes in BI, MMSE, GDS, pain, dropping Tinetti test. Changes in self-rated health were positively correlated to functional gain adjusted for pre-morbid level, and to relative functional gain. By analysis of variance, health self-appraisal changed more favorably in patients discharged to home than for other social outcomes (all p < 0.001). As expected, trends in self-perceived health parallel improvements in objective functional gauges and subjective indicators.

关键词： Cognition Functional Gains Geriatric Rehabilitation Mood Pain Self-Rated Health

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Correction of hypovitaminosis D improved global longitudinal strain earlier than left ventricular ejection fraction in cardiovascular older adults after orthopaedic surgery

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Journal of Geriatric Cardiology 2018年第8期15卷 519-522页

作者： Matteo Briguglio Luigi Gianturco Daniele Stellat Chiara colombo Marika Bonadies Oscar Salat mauro Anselmi Giuseppe Banff Maurizio Turiel Cardiology Unit IRCCS Orthopaedic Institute Galeazzi Milan Italy Scientific Direction IRCCS Orthopaedic Institute Galeazzi Milan Italy University Vitae Salute San Raffaele Milan Italy

Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the nor- malization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months cal- cifediol supplementation with a starting dose at first post-operative day of 50 ~tg/die in liquid preparation. Down-titration to 20 Ixg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction （LVEF） and global longitudinal strain （GLS） during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of cal- cifediol supplementation were associated with a significant improvement of both LVEF （＋ 3.94%; 95% CI： -4.0789 to -0.8232; P 〈 0.01） and GLS （＋ 18.56%; Z = -5.895; P 〈 0.0001）. Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.

关键词： Global longitudinal strain Left ventricular ejection fraction Orthopedic surgery Transthoracic echocardiography Vitamin D

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The influence of arterial stiffness in heart failure:a clinical review

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Journal of Geriatric Cardiology 2021年第2期18卷 135-140页

作者： mauro Feola Department of Cardiology Ospedale Regina Montis RegalisMondovìItaly

Vascular aging in large arteries plays an important role in contributing to cardiovascular morbidity and mortality.[1]Structural changes include an increase in wall thickness,intima-media thickening ratio is widely at... 详细信息

关键词： aging stiffness attributed

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Precise Agriculture:Effective Deep Learning Strategies to Detect Pest Insects

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IEEE/CAA Journal of Automatica Sinica 2022年第2期9卷 246-258页

作者： Luca Butera Alberto Ferrante mauro Jermini mauro Prevostini Cesare Alippi Universitàdella Svizzera italiana Faculty of InformaticsLugano 6900Switzerland Agroscope Research Centre CadenazzoCadenazzo 6594Switzerland IEEE

Pest insect monitoring and control is crucial to ensure a safe and profitable crop growth in all plantation types,as well as guarantee food quality and limited use of *** aim at extending traditional monitoring by means of traps,by involving the general public in reporting the presence of insects by using *** includes the largely unexplored problem of detecting insects in images that are taken in noncontrolled ***,pest insects are,in many cases,extremely similar to other species that are ***,computer vision algorithms must not be fooled by these similar insects,not to raise unmotivated *** this work,we study the capabilities of state-of-the-art(SoA)object detection models based on convolutional neural networks(CNN)for the task of detecting beetle-like pest insects on nonhomogeneous images taken outdoors by different ***,we focus on disambiguating a pest insect from similar harmless *** consider not only detection performance of different models,but also required computational *** study aims at providing a baseline model for this kind of *** results show the suitability of current SoA models for this application,highlighting how FasterRCNN with a MobileNetV3 backbone is a particularly good starting point for accuracy and inference execution *** combination provided a mean average precision score of 92.66%that can be considered qualitatively at least as good as the score obtained by other authors that adopted more specific models.

关键词： Computer vision machine learning neural network pest insect pest monitoring Popillia japonica precise agriculture

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State of the art and computational aspects of time-dependent waiting models for non-signalised intersections

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Journal of Traffic and Transportation Engineering(English Edition) 2020年第6期7卷 808-831页

作者： Raffaele mauro Andrea Pompigna Department of Civil Environmental and Mechanical EngineeringUniversity of TrentoTrento 38123Italy

Time-dependent models are of great importance in highway engineering as they are appropriate for evaluating waiting times and queue lengths at intersections,which are integral parts of various activities in planning,verification and decision support for *** reviewing the literature of the main time-dependent models based on the coordinate transformation method and a discussion about some computational issues in time-evolution profiles for non-signalised intersections,the paper identifies the requirements these models have to satisfy in order to be used as"basic"cases for analysing complex evolutionary ***"basic"cases are presented with their timedependent equations for vehicle waiting times and vehicle number;they have been completed and dimensionally homogenised in this *** they are recursive,these formulas can be applied for sequential intervals in the time domain in both vehicles and passenger car *** closed-form expressions for state variables show to be mutually equivalent in comparison with discrete event simulation models and imbedded Markov chain *** all the three models the paper presents a common deterministic simplification for average waiting time,with good approximation results in the tested *** proposed time-dependent formulas will contribute to a better adherence to the real phenomena,compared to the extremely simplified and unrealistic methods suggested by the international manuals for level of service *** proposed formulas will be useful for current applications and possible future development in order to meet the emerging needs of road and transport engineering.

关键词： Traffic engineering Priority system Non-signalised intersections Time-dependent queue model Shared queue delay Coordinate transformation method

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