BackgroundThe independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre‐DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐DM on survival outcomes in the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial.Methods and ResultsWe assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI‐HF trial, who were stratified by presence of DM (n=2852), pre‐DM (n=2013), and non‐DM (n=2070) at baseline. Compared with non‐DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐DM patients and those with pre‐DM. Cox regression analysis showed that DM, but not pre‐DM, was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01–1.29, respectively).ConclusionsPresence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.
This is the first comprehensive study of Italian youths'(9-18 years of age) attitudes and behaviors toward animals. Various aspects of child-animal relationships were analyzed, including pet ownership, pet attachment, pet loss, worries about pet, animal abuse (both perpetrated and witnessed), fears of animals, animals as a source of comfort, feelings toward road kill, and attitudes toward hunting, the use of furs and leather clothes, zoos, and the use of animals in circuses. Pupils from 12 schools anonymously completed a sixpage self-administered questionnaire. From the total number of questionnaires received (about 2,200), 800 (403 F and 397 M) were randomly selected, which represented each school and all ages, and analyzed. Through this instrument numerous quantitative and qualitative data were obtained, some of which were also examined in the light of other significant aspects of Italian culture. One basic assumption underpinning this research is that attitudes and behaviors toward animals should always be investigated within a theoretical framework that also takes cultural context into consideration. On the whole, our results indicate that animals play an important role in Italian youths' lives, a role which many adults tend to underestimate. Though our approach is preeminently descriptive, our findings can provide hypotheses that can be tested in future research.Despite there being evidence of pet-keeping since Roman antiquity (Bodson 2000), little is known about Italian children's or adults' attitudes to pet animals, the roles of pets in the Italian family, and how pets affect psychological well-being. Recently in Italian society, attention to people's relationships with animals and with nature at large has increased (Pagani in press). Traditionally, Italian culture has not generally been characterized by a deep interest in nature, compared, for example, with English-speaking countries. Indeed, it was especially in these countries that psychological and sociological research on human-animal interactions, in-❖ cluding cruelty toward animals, first developed. Since people's attitudes and behaviors are strongly influenced by cultural factors (e. g., Kardiner
As is maintained in the Seville Statement on Violence, the role of education in shaping human relations is fundamental. In order to develop effective educational interventions aiming to foster empathic relations, some important prerequisites need to be satisfied. One of these prerequisites, which is based on a constructivist model, is constituted by the identification and analysis of the pre-existing concepts and attitudes of those to whom interventions are directed, regarding the specific issues involved in the specific educational process. More effective positive changes can be obtained this way as they are generated from within the individuals themselves. Using this perspective, a study was conducted in Italian schools on the attitudes of young people between 9–18 years of age towards multiculturalism in contemporary society. The participants (N=350, 176 girls and 174 boys) were invited to write down anonymously their thoughts about multiculturalism. Their essays were quantitatively and qualitatively analysed. The aim was to obtain a deep understanding not only of the explicit but also of the implicit meaning of the texts and consequently also of the motivations underlying the participants' attitudes. Some of the results of this study are discussed and suggestions are made for the development of educational interventions aiming to foster young people's empathic attitudes.
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