86,755 research outputs found

    HPV vaccine hesitancy among parents of female adolescents: a pre-post interventional study

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    Human papillomavirus (HPV) is the most common sexually transmitted infection in female adolescents. The highest infection rate is found among individuals aged 15-24 years, and the HPV vaccine represents an opportunity to reduce the burden of cervical cancer caused by HPV types 16 and 18. The World Health Organization has defined girls aged 9e13 years as the priority target for HPV vaccination. In Italy, in accordance with international public health guidelines, HPV vaccination wasfree and actively offered to all girls during their 12th year of life (from the completion of 11 years until the age of 12 years) between 2007 and 2008, establishing a target vaccination coverage of 95% within 5 years of the start of the campaign

    A randomised controlled study on the use of anti-inflammatory drugs in patients with cancer pain on morphine therapy: Effects on dose-escalation and a pharmacoeconomic analysis

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    The role of non-steroidal anti-inflammatory drugs (NSAIDs) in cancer pain has been well established in the treatment of mild pain and in association with opioids in the treatment of moderate to severe pain. The aim of this study was to verify the effects of NSAIDs on morphine escalation in advanced cancer patients with pain followed-up at home and to assess the pharmacoeconomic implications. A prospective randomised controlled study was carried out in 156 consecutive advanced cancer patients with pain followed-up at home in the period December 1999-December 2000. In this group of patients, 47 were selected with pain progression after 1 week of opioid stabilisation. Patients were randomly assigned to one of two groups: group 'O' patients were treated with continuing opioid escalation according to their clinical needs; group 'OK' received ketorolac 60 mg/daily orally (p.o.) in three doses and then continued opioid escalation according to their clinical situation. Performance status, doses of morphine before and after starting treatment, mean weekly pain intensity (assessed by means of a numerical scale from 0 to 10), mean weekly symptoms intensity, adverse effects and pain mechanisms were recorded. Moreover, drug costs per day in both groups were calculated. Patients who received ketorolac in addition to morphine showed a better analgesia after a week in comparison to the group treated with morphine only (P=0.005). Thereafter, morphine escalation was slower and the maximum morphine dose was lower in the group treated with ketorolac. The incidence and the severity of gastric discomfort was more evident in patients treated with ketorolac, while constipation was significantly increased in patients who received morphine only. Drug costs per day were similar in both groups; statistical differences were observed in patients who started on lower morphine doses (<100 mg/daily) in the two groups (€4.3 in the ketorolac-morphine group versus €3.4 in the morphine group; P=0.012). The use of NSAIDs reduces the need for an opioid dose escalation or allows the use of lower doses. Their use is associated with a more intense gastric discomfort, but results in less opioid-related constipation. The eventual additive cost for NSAIDs therapy is negligible, especially in patients taking high doses of morphine. © 2002 Published by Elsevier Science Ltd

    Costruire testo: analisi di un processo di formazione all'intervista in psicologia.

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    Il lavoro, a partire dalla proposta per cui i dati si costruiscono più che si raccolgono, invita ad una riflessione sulle culture con le quali si possono costruire i dati utili alla ricerca sul testo, a partire da un caso di formazione all'Analisi Emozionale del Testo (AET) presso studenti di un Corso di Laurea in Psicologia

    Influenza vaccination of healthcare workers in Italy: could mandatory vaccination be a solution to protect patients?

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    Several studies have reported that influenza infections in healthcare workers (HCWs) can lead to nosocomial outbreaks. HCWs can potentially be infected with influenza every year, and may continue to work, encouraging the spread of the virus. Different strategies, such as informative interventions on influenza and influenza vaccination, ‘onsite’ vaccination weeks, communicative strategies through dedicated web and social media pages, and mandatory informed dissent form, were organized for HCWs working at the University Hospital of Palermo, during previous influenza seasons. However, the increased vaccination rates observed among HCWs still remain far from the 75% recommended by Public Health Authorities. The level of coverage observed in countries with mandatory vaccination policies for HCWs, could suggest the adoption of this strategy for increase influenza vaccination adherence in Italy

    The use of high doses of oxycodone in an acute palliative care unit.

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    A retrospective study of patients who were prescribed controlled-release oxycodone (CRO) in a period of 3 years (2006-2008) was performed. A total of 212 patients were prescribed at discharge CRO for background analgesia; 129, 43, and 40 patients were prescribed doses of oxycodone of less than 120 mg/day (group L), 120 to 240 mg/day (group M), and more than 240 mg/day (group L), respectively. No differences in gender, primary diagnosis, and pain mechanisms were found, but doses were significantly lower in older patients (P &lt; .0005). At discharge, adverse effects were mild and only a minority of patients were switched to other opioids. This study demonstrated that CRO administered in larger doses was safe and effective, showing versatility and flexibility similar to morphine. </jats:p

    The role of bisphosphonates in the treatment of painful metastatic bone disease: A review of phase III trials

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    Metastatic bone disease is a frequent cause of morbidity in advanced cancer patients with a subsequent high incidence of skeletal complications (fractures, hypercalcemia, spinal cord compression) and severe pain. The osteolytic process is mainly characterized by an osteoclastic activity of bone resorption and inflammatory activity provoked by various cytokines and prostaglandins. Bisphosphonates represent a new class of drugs with inhibitory activity on bone resorption and on inflammatory processes which revealed themselves to be efficacious in a series of clinical conditions such as tumour-induced hypercalcemia, Paget's disease, osteoporosis and metastatic bone disease. The aim of this review of the literature is to show the analgesic efficacy of the different bisphosphonates in phase III studies carried out on patients with metastatic bone disease. Medline and Cancerlit database from January 1984 to February 1998 have been considered. From the analysis of the published studies it appears that bisphosphonates and, in particular, intravenous Disodium Pamidronate, are not only able to slow down the progression of the disease and to reduce the onset of skeletal complications but also have an analgesic effect and the possibility of improving the quality of life, above all in patients with osteolytic metastases due to breast cancer and multiple myeloma. Bisphosphonates represent a further valid therapy to add to an already consolidated list of therapies such as radio, chemo and endocrine therapy, analgesic drugs, orthopaedic and physiatric in the pain management of patients with bone metastases. These drugs meet with the patients' compliance, are well-tolerated as well as having a good cost/efficacy profile. It still remains to be seen if the newer and more potent bisphosphonates such as Ibandronate and Zoledronate can be administered differently from the intravenous route such as by mouth or by patch which are readily accepted by the patient and, moreover, if these more potent drugs are able to prevent or delay the onset and/or the progression of bone metastases. Copyright (C) 1998 International Association for the Study of Pain. Published by Elsevier Science B.V

    Financial distress and its impact on symptom expression in advanced cancer patients

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    Aim: To assess financial distress (FD) and its impact on symptom expression and other quality of life issues Patients and methods: Advanced cancer patients admitted to inpatient and outpatient clinics were selected. Standard epidemiological data including age, gender, primary cancer diagnosis, and Karnofsky level were recorded. Data regarding marital status, number of cohabitants, religious belief, educational level, and family income (&lt; 1000, 1000–3.000, &gt; 3000 euros), as well as extra costs not covered by health care system, were collected. Symptom burden including FD was measured by Edmonton Symptom Assessment Scale (ESAS), FACT-G (Functional Assessment of Cancer Therapy-General), and HADS (Hospital Anxiety Depression scale) were measured. Results: Two hundred thirty-six patients were evaluated. The mean FD was 3.55 (SD 3.1). One hundred patients (42%) had a FD of ≥ 4. There was an inverse correlation between FD and income (P&nbsp;= 0.032). Most patients incurred in extra-costs, the most frequent being for drugs (n, 114). FD was inversely associated with age (P&nbsp;= 0.024), marital status (divorced or separated, P&nbsp;= 0.005), ESAS anxiety (P&nbsp;= 0.006), total ESAS (P&nbsp;= 0.019), physical well-being (P&nbsp;= 0.033), poor social family well-being (P&nbsp;= 0.004), emotional well-being (P&nbsp;= 0.045), poor functional well-being (P&nbsp;= 0.019), HADS-A (P&nbsp;= 0.003), and global HADS (P&nbsp;= 0.034). Family income was inversely related to age (P&nbsp;= 0.023), education level (P&nbsp;&lt; 0.0005), less number of hospital admissions in the last month (P&nbsp;= 0.020), physical well-being (P&nbsp;= 0.039), social/family well-being (P&nbsp;= 0.020), and total well-being (P&nbsp;= 0.001). Conclusion: FD is very common in advanced cancer patients. FD was associated with anxiety, depression, and poor quality of life. The screening of FD may allow to develop effective interventions of social support
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