Papers by Piervincenzo Bondonio
G It Diabetol …, 2007
... Corrispondenza: dott.ssa Marina Trento, Laboratorio di Pedagogia Clinica, Dipartimento di Med... more ... Corrispondenza: dott.ssa Marina Trento, Laboratorio di Pedagogia Clinica, Dipartimento di Medicina Interna, Università di Torino, corso Dogliotti 14, 10126 Torino e-mail: [email protected] G It Diabetol Metab 2007;27:47-53 ...
Http Www Theses Fr, 1999
Le controle epigenetique par la methylation de l'adn joue un role fondamental dans la regulat... more Le controle epigenetique par la methylation de l'adn joue un role fondamental dans la regulation de l'expression des genes. L'etude de transgenes soumis a des variations de methylation est un moyen d'identifier des facteurs genetiques controlant celle-ci. Nous avons decrit des modifications de niveaux d'expression et de methylation des sequences du virus de l'hepatite b (vhb) dans deux lignees de souris transgeniques (e36 et pfc80), en fonction du fonds genetique. Differents facteurs modificateurs ont ete mis en evidence et nous nous sommes interesses plus particulierement a l'effet du fonds genetique balb/c. En effet, chez les individus issus d'un croisement entre un male e36 et une femelle balb/c, le transgene est totalement methyle de novo et son expression est reprimee. Ceci serait du a l'action combinee de plusieurs genes modificateurs dont les alleles balb/c ont un effet hypermethylant. Afin de comprendre les mecanismes d'action de tels genes, nous avons caracterise plus finement la structure du transgene. Nous avons egalement etudie le niveau de methylation des regions situees a proximite de son site d'insertion. Seul le niveau de methylation du transgene semble modifie par l'effet du fonds balb/c. Dans le but de cartographier les genes modificateurs responsables, nous avons etudie les descendants du croisement en retour femelle f1 (balb/c c57bl/6) male e36 (c57bl/6). Nous avons mesure le pourcentage de methylation du transgene vhb de 256 souris, par la technique de southern-blot. Le genotypage d'une partie de ces individus a ete effectue par la technique d'amplification de microsatellites par pcr, sur l'ensemble du genome. Une confrontation des resultats de genotypage et de phenotypage a mis en evidence une region du chromosome 13 associee a une augmentation importante du niveau de methylation du transgene vhb. D'autres regions d'effet mineur semblent impliquees dans la variation du phenotype.
Nutrition, Metabolism and Cardiovascular Diseases, 2013
Diabetes incidence is increasing worldwide [1,2] and novel management models are needed to curb i... more Diabetes incidence is increasing worldwide [1,2] and novel management models are needed to curb its health consequences and costs. ROMEO (ISRCTN19509463) [3], a randomized clinical trial, showed that group visits (Group Care, GC) result in better metabolic control and quality of life (QoL) than usual care in type 2 diabetes (T2DM). In ROMEO 815 patients aged <80, from 13 Italian diabetes clinics, were followed for 4 years by GC or usual care (Controls). By intention-to-treat analysis we compared the costs of group and usual care in the 581 patients (315 GC and 266 Controls) who completed ROMEO from the perspectives of the Italian National Health Service, with a microeconomic approach. Six components of direct costs, standardized to 2007, were calculated: training and equipment for GC, medication, personnel, diagnostics, clinical rooms and patients' transportation. Official prices of daily prescriptions [4] were multiplied by days between appointments. Salaries (physicians 1.01, nurses 0.37, dieticians 0.32, clerks 0.28 Euro/minute) were normalized to average gross pay and seniority [5]. Means and times of transportation from home to clinic were obtained by interviewing 303 patients (196 GC and 107 Controls). Staff training and starter kits cost 8.25 (7.07e9.43) Euro/ GC patient/year. Pharmaceutical expenditure was similar for patients on GC [Euro 385.98 (357.87e414.10)] and Controls [Euro 370.49 (340.29e400.68)], and was higher for antihypertensive than glucose-lowering agents. Due to regulatory limitations during ROMEO, very few patients were on statins. On average, group sessions were attended by 8.75 (8.40e9.10) patients. Each patient on GC spent 27.63 (25.72e29.55) minutes/year with a doctor, 14.53 (13.51e15.56) with a nurse, 3.90 (3.34e4.46) with a dietician, and 1.98 (1.95e2.01) with clerical staff. Times for Controls were 56.74 (54.28e59.21), 31.11 (28.09e34.14), 30.82 (26.35e35.30) and 8.75 min/year, respectively. Resulting staff costs were 35.09 (33.10e37.07) Euro/patient/ year for GC and 81.14 (77.17e85.10) for Controls (p < 0.001), the difference resulting mostly from reduced physicians'
Nutrition, Metabolism and Cardiovascular Diseases, 2005
Background and aims: We showed that continuing education can be embedded into routine diabetes ca... more Background and aims: We showed that continuing education can be embedded into routine diabetes care by seeing patients in small groups rather than individually. Group care was cost-effective in improving quality of life, knowledge of diabetes, health behaviours and clinical outcomes in people with type 2 diabetes. The aim of this study was to verify if group care can also be applied to type 1 diabetes. Methods and results: Randomized, controlled clinical trial comparing 31 patients managed by group care with 31 managed by traditional one-to-one care. A syllabus was built and later remodulated with the patients in a series of focus-group meetings. The primary end-point was changes in quality of life. Secondary endpoints were: knowledge of diabetes, health behaviours, HbA1c and circulating lipids. Differential costs to the Italian National Health System and to the patients were also calculated. After 3 years, quality of life improved among patients on group care, along with knowledge and health behaviours (p ! 0.001, all). Knowledge added its effects to those of group care by independently influencing behaviours (p Z 0.004) while quality of life changed independently of either (p ! 0.001). Among controls, quality of life worsened (p ! 0.001) whereas knowledge and behaviours remained unchanged. HDL cholesterol increased among patients on group care (p Z 0.027) and total cholesterol decreased in the controls (p ! 0.05). HbA1c Abbreviations: CdR, health behaviours (Condotte di Riferimento); DQOL, diabetes quality of life; GISED, Italian Study Group on Diabetes Education; INHS, Italian National Health System.
Diabetes Care, 2010
OBJECTIVE A trial was performed to establish whether our group care model for lifestyle intervent... more OBJECTIVE A trial was performed to establish whether our group care model for lifestyle intervention in type 2 diabetes can be exported to other clinics. RESEARCH DESIGN AND METHODS This study was a 4-year, two-armed, multicenter controlled trial in 13 hospital-based diabetes clinics in Italy (current controlled trials no. ISRCTN19509463). A total of 815 non–insulin-treated patients aged <80 years with ≥1 year known diabetes duration were randomized to either group or individual care. RESULTS After 4 years, patients in group care had lower A1C, total cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure, BMI, and serum creatinine and higher HDL cholesterol (P < 0.001, for all) than control subjects receiving individual care, despite similar pharmacological prescriptions. Health behaviors, quality of life, and knowledge of diabetes had become better in group care patients than in control subjects (P < 0.001, for all). CONCLUSIONS The favorable cl...
The paper deals with the role of culture as an activator of the local economy, with reference to ... more The paper deals with the role of culture as an activator of the local economy, with reference to the 30th International Book Fair of Turin (May 2017). An exercise for estimating the economic impact is performed along the three dimensions of direct, indirect, and induced effects. All in all, an economic impact of some 30 million euros is calculated, stemming from 6.9 million euros of direct effects from the supply side and 7.4 from the demand side. Organizing body’s budget data and more than 2,100 individual surveys are the main component of data source.
Diabetologia, 2002
Aims/hypothesis. Metabolic control worsens progressively in Type II (non-insulin-dependent) diabe... more Aims/hypothesis. Metabolic control worsens progressively in Type II (non-insulin-dependent) diabetes mellitus despite intensified pharmacological treatment and lifestyle intervention, when these are implemented on a one-to-one basis. We compared traditional individual diabetes care with a model in which routine follow-up is managed by interactive group visits while individual consultations are reserved for emerging medical problems and yearly checks for complications. Methods. A randomized controlled clinical trial of 56 patients with non-insulin-treated Type II diabetes managed by systemic group education and 56 control patients managed by individual consultations and education. Results. Observation times were 51.2±2.1 months for group care and 51.2±1.8 for control subjects. Glycated haemoglobin increased in the control group but not in the group of patients (p<0.001), in whom BMI decreased (p<0.001) and HDL-cholesterol increased (p<0.001). Quality of life, knowledge of diabetes and health behaviours improved with group care (p<0.001, all) and worsened among the control patients (p=0.004 to p<0.001). Dosage of hypoglycaemic agents decreased (p<0.001) and retinopathy progressed less (p<0.009) among the group care patients than the control subjects. Diastolic blood pressure (p<0.001) and relative cardiovascular risk (p<0.05) decreased from baseline in group patients and control patients alike. Over the study period, group care required 196 min and 756.54 US $ per patient, compared with 150 min and 665.77 US $ for the control patients, resulting in an additional 2.12 US $ spent per point gained in the quality of life score. Conclusion/interpretation. Group care by systemic education is feasible in an ordinary diabetes clinic and cost-effective in preventing the deterioration of metabolic control and quality of life in Type II diabetes without increasing pharmacological treatment. [Diabetologia (2002) 45:1231-1239] Keywords Type II diabetes, overweight, disease management, hypoglycaemic agents, diabetic retinopathy, health education, group visits, quality of life, health behaviours, cost-effectiveness.
Diabetes & metabolism, 1999
The purpose of this study was to analyse and compare the costs involved in screening for and trea... more The purpose of this study was to analyse and compare the costs involved in screening for and treating sight-threatening diabetic retinopathy in three different clinical settings. In the first setting, diabetologists screened using ophthalmoscopy and color photography, according to the St. Vincent Declaration guidelines, and selected patients for further assessment by a visiting ophthalmologist and for treatment in another hospital. In the second setting, all patients were regularly referred to ophthalmologists, either in the same hospital or elsewhere, for all aspects of eye care. In the third setting, screening was done again with ophthalmoscopy alone by diabetologists who followed the St. Vincent Declaration guidelines; however, further assessment and treatment were carried out in the eye department of the same hospital. Costs to the Italian National Health Service and to patients were calculated per screening performed and per patient subjected to laser treatment as a result of s...
Da molti anni, ormai, la pratica della gestione budgetaria si e affermata nel Ssn. Non sempre, tu... more Da molti anni, ormai, la pratica della gestione budgetaria si e affermata nel Ssn. Non sempre, tuttavia, il nuovo istituto riesce davvero a conseguire i risultati che si prefigge: soprattutto a veicolare le energie presenti nelle aziende sanitarie verso una gestione per obiettivi di significativo miglioramento delle performance aziendali. Il caso presentato, relativo a una Asl piemontese e descritto nei suoi sviluppi anche temporali, si distingue per realismo e gradualita nell’approccio utilizzato, per robusta concretezza dei risultati progressivamente ottenuti, per il coinvolgimento nella sua elaborazione e gestione di ampia parte del personale dell’azienda. Il saggio termina illustrando elementi di trasferibilita della buona pratica riscontrata e discutendo sue residue criticita.
Introduction Two years have passed from the completion of the 20th edition of the Winter Olympics... more Introduction Two years have passed from the completion of the 20th edition of the Winter Olympics which were held in Turin in February 2006. This period of time is certainly not sufficient for providing a final assessment of the event which takes into account medium term effects; it is, however, sufficient for the purposes of providing a temporary assessment which goes beyond any evaluations linked to the immediate aftermath of the event and the subsequent return to "normality"; such an assessment would attempt to determine the effects of the Games at various levels in addition to determining which of the latter should be considered points of strength or weakness. In order to evaluate these effects two facets of the problem must be taken into account. On the one hand, it is necessary to identify the effects of this edition of the Olympics in Turin on the overall Olympic movement. From this perspective, the legacy which Turin 2006 left for future Olympic events must be anal...
Different types of economic analyses are sometimes delivered to compare different health procedur... more Different types of economic analyses are sometimes delivered to compare different health procedures. In this chapter, we apply a cost-effectiveness analysis to a validated Group Care approach for diabetic patients, as compared with traditional, individually delivered care and education. Working on a differential basis, differential (and greater) costs associated with Group Care are opposed to its differential (and better) outcomes. Costs comprise differential direct costs, either paid by the Italian National Health System (mainly staff costs) or by patients (transportation and opportunity costs of time allocated to the two procedures). As the main endpoint in either case (a 4-year follow-up for type 2 with 90 patients, and a 3-year follow-up for type 1, with 62 patients, in both cases randomly assigned to the 2 competing procedures), we chose differential scores in perceived quality of life, which proved meaningful and statistically robust. Resulting cost-effectiveness ratios are EU...
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Papers by Piervincenzo Bondonio