73 research outputs found
Musculoskeletal pain in schoolchildren across puberty: A 3-year follow-up study
No full textBACKGROUND: Chronic Musculoskeletal Pain (MSP) in children can be due to
non-inflammatory conditions, such as the benign joint hypermobility syndrome
(BJHS) or idiopathic MSP (IMSP). Aim of the study was to evaluate type and
persistence of MSP in a cohort of schoolchildren with MSP followed for 3 years,
in order to identify the main risk factors.
METHODS: Healthy schoolchildren, aged 8-13 years, underwent a general and
rheumatologic examination, focusing on presence of chronic MSP, defined as
continuous or recurrent pain lasting more than 3 months and heavily interfering
with daily life activities, presence of generalized joint hypermobility, the body
mass index and the pubertal stage. All symptomatic subjects were re-evaluated 3
years later with the same methods.
RESULTS: Seventy of the 88 symptomatic subjects of the initial cohort of 289 were
re-evaluated 3 years later. Of these, 38 (54.3 %) still presented MSP, including
19 with BJHS and 19 with IMSP. Main symptoms were lower limbs arthralgia and
myalgia. MSP persisted more in females than in males (p = 0.038) and in pubertal
rather than pre-pubertal subjects (p = 0.022); these subjects recovered
significantly more both from BJHS (p = 0.004) and IMSP (p = 0.016). Gender did
not influence the distribution of MSP according to pubertal stage.
CONCLUSIONS: Female gender, BJHS and pubertal stage are important risk factors
for persistence of MSP. Further studies are needed to evaluate the natural
history of MSP towards adulthood and the role of the pubertal age
Tonsillectomy efficacy in children with PFAPA syndrome is comparable to the standard medical treatment: a long-term observational study
No full textTonsillectomy has recently been suggested as an effective treatment for PFAPA syndrome but little is known about its long-term efficacy. We compared the clinical features and the long-term outcome of a large cohort of patients with PFAPA syndrome treated with tonsillectomy or with standard medical treatment
Disease course and long-term outcome of juvenile localized scleroderma: Experience from a single pediatric rheumatology Centre and literature review
No full textMethotrexate in Linear Scleroderma: long-term efficacy in 50 children from a single Pediatric Rheumatology Centre
No full textOBJECTIVE: to study disease course and long-term outcome of children with Linear Scleroderma (LiS) treated with methotrexate (MTX) since diagnosis.METHODS: Retrospective and cross-sectional study including consecutive children with LiS treated with MTX for >1 year and with at least 2 years follow-up. Disease course was analyzed by number of relapses and treatment changes. Relapse-free survival (RFS) was examined by Kaplan-Meier analysis comparing patients with LiS and other JLS subtypes. Disease activity and damage were assessed by Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) and thermography.RESULTS: Fifty patients with mean follow-up 7.8 years and MTX treatment duration 3.1 years were included. Sixteen percent did not respond to first course of MTX and 16% had at least one flare. Complete remission was observed in 18.2% patients with 2-5 years follow-up, 80.0% by 10 years and 87.5% by >10 years. No significant difference in RFS between patients with LiS and 17 with other JLS subtypes was observed. Tissue damage was mild in 42% patients, moderate in 32% and severe in 26%. No significant correlation between severity of tissue damage and LiS subtype, disease duration, relapses and remission emerged. Treatment duration was significantly related to disease relapses (p<0.05) and severity of tissue damage (p<0.005).CONCLUSION: Most patients with LiS treated with MTX achieve complete and long-lasting remission. Overall aesthetic and functional sequelae are moderate, probably because tissue damage establishes early and treatment likely stabilizes it. Early diagnosis and MTX treatment as well as long-term monitoring are crucial to improve outcome and promptly identify flares
Joint hypermobility, growing pain and obesity are mutually exclusive as causes of musculoskeletal pain in schoolchildren
No full textObjective: Chronic musculoskeletal pain (MSP) is common in children and can be due to several non-inflammatory conditions such as the benign joint hypermobility syndrome (BJHS), and growing pains (GP). We evaluated frequency, risk factors and causes of MSP in a large cohort of healthy schoolchildren. Methods: We conducted a cross sectional study in a cohort of healthy schoolchildren, aged 8-13 years, by collecting information and performing a physical examination. The anamnesis was focused on family history for MSP, presence and sites of MSP interfering with the regular daily activities during the previous 6 months and presence of GP. Physical examination included body mass index, pubertal stage and musculoskeletal examination focused on the presence of hypermobility according to the Beighton criteria. Results: Two hundred and eighty-nine schoolchildren, 143 females and 146 males, participated in the study. Chronic MSP occurred in 30.4% of subjects, BJHS occurred in 13.2%. GJH was more frequent in symptomatic subjects than in asymptomatic ones (p=0.054). Symptomatic subjects were more frequently pre-pubertal than pubertal (p=0.006). In general, GP, BJHS and obesity (OB) were mutually exclusive as causes of MSP as, among 88 symptomatic subjects, 52.3% had GP, 40.9% presented BJHS, 4.5% were OB and only two (2.3%) presented both BJHS and OB. After puberty, GP persisted in 66.7%, BJHS in 26.7% and in association with OB in 6.7%. Conclusion: Approximately one third of schoolchildren suffer from MSP. BJHS, GP and OB are mutually exclusive as causes of MSP in schoolchildren. Pubertal stage plays an important role in the physiopathology of this condition
Le preoccupazioni degli infermieri coinvolti in un progetto di riorganizzazione dipartimentale
No full textIl cambiamento provoca generalmente
reazioni, non sempre positive ma fisiologiche. Obiettivo.
Descrivere le reazioni al cambiamento prima e ad un
anno dalla sua introduzione. Metodi. È stato somministrato
un questionario ad un gruppo di infermieri trasferiti in
un nuovo polo chirurgico organizzato in modo molto diverso.
Risultati. Gli infermieri sono moderatamente preoccupati
e lo rimangono ad un anno dal cambiamento. Aumentano
le preoccupazioni sulle conseguenze del cambiamento
per i pazienti e per sé. I più preoccupati ad un anno
solo gli infermieri con 4-14 anni di anzianità. Conclusioni.
Le preoccupazioni sono fisiologiche, è utile però conoscerle
per valutare come sostenere gli infermieri
Strategic use of levofolinic acid for methotrexate-induced side effects in juvenile idiopathic arthritis: a prospective observational study
No full textObjectiveTo evaluate the efficacy of levofolinic acid (LVF) administered 48 h before methotrexate (MTX) in reducing gastrointestinal side effects without interference with drug efficacy.MethodsA prospective observational study was performed including patients with Juvenile Idiopathic Arthritis (JIA) reporting significant gastrointestinal discomfort after MTX despite taking a dose of LVF 48 h after MTX. Patients with anticipatory symptoms were excluded. A LVF supplemental dose was added 48 h before MTX and patients were followed every 3-4 months. At each visit data on gastrointestinal symptoms, disease activity (JADAS, ESR, CRP values) and treatment changes were collected. Friedman test for repeated measures analyzed differences between these variables over time.ResultsTwenty-one patients were recruited and followed for at least 12 months. All patients received MTX subcutaneously (mean 9.54 mg/m2) and LVF 48 h before and after MTX (mean 6.5 mg/dose), 7 received a biological agent too. Complete remission of gastrointestinal side effects was reported in 61.9% of study patients at first visit (T1) and increased over time (85.7%, 95.2%, 85.7% and 100% at T2, T3, T4, T5, respectively). MTX efficacy was maintained as showed by significant reduction of JADAS and CRP (p = 0.006 and 0.008) from T1 to T4 and it was withdrawn for remission in 7/21.ConclusionsLVF given 48 h before MTX significantly reduced gastrointestinal side effects and did not reduce drug's efficacy. Our results suggest that this strategy may improve compliance and quality of life in patients with JIA and other rheumatic diseases treated with MTX
Mycophenolate mofetil for methotrexate-resistant juvenile localized scleroderma
No full textOBJECTIVES: To investigate safety and efficacy of MMF in patients with severe or MTX-refractory juvenile localized scleroderma.METHODS: Consecutive juvenile localized scleroderma patients undergoing systemic treatment were included in a retrospective longitudinal study. Patients treated with MMF because they were refractory or intolerant to MTX (MMF-group) were compared with responders to MTX (MTX-group). Disease activity was assessed by Localized Scleroderma Cutaneous Assessment Tool and thermography. Disease course was established on the number of relapses and treatment changes. Relapse-free survival was examined by Kaplan-Meier analysis.RESULTS: MMF and MTX groups included 22 and 47 patients, respectively. No significant difference in demographics, follow-up duration and treatment before diagnosis was observed between groups. The most represented clinical subtypes in the MMF-group were pansclerotic morphea and mixed subtype (P=0.008 and P=0.029, respectively), and linear scleroderma of the face in the MTX-group (P=0.048). MMF was started because of MTX resistance (18 patients), relapse during MTX tapering/withdrawal (3 patients) and anaphylaxis to MTX (1 patient). After mean 9.4years of follow-up, 90.9% of patients on MMF and 100% of those on MTX had inactive disease. No significant difference in relapse-free survival between the groups was found (P=0.066, log-rank test), although MMF likely induced more persistent remission. MMF was well tolerated and combination of MMF and MTX did not increase its efficacy.CONCLUSION: The present study adds strong evidence on the efficacy and tolerance of MMF in severe and/or MTX-refractory juvenile localized scleroderma. Further controlled studies are needed to prove its efficacy as first line treatment
Is intraartucular corticosteroid injection an effective therapy for TMJ involvement in Juvenile Idiopatic Arthritis ?
No full textAdolescent gambling behavior: a gender oriented prevention strategy is required?
No full textBACKGROUND: Studies published on gender-related differences in the gambling behavior of adolescents have focused mainly on psychological and social factors. The aim of this study was to develop separate risk factor models for male and female adolescents, considering the environmental, psychological, behavioral and socio-economic factors related to their gambling. METHODS: A survey was conducted through a questionnaire developed on a dedicated web site in 2014 on a representative sample of the Italian 15–19-years-old population, including 34,922 students attending 438 secondary schools. The SOGS-RA questionnaire was used to measure gambling behavior. To verify the risk factors associated with gambling a logistic regression stratified by gender was performed. RESULTS: In our representative sample of Italian adolescents nationwide, the prevalence of each level of gambling was higher in males than in females. The logistic regression stratified by gender found that for both genders, gambling was positively associated with internet surfing, playing sports, getting into a fight, having unprotected sex, pulling stunts, drinking alcohol at least once in the previous month, having not a satisfactory relationship with teachers, receiving pocket money from parents, spending each week much money and having someone in the family (father, sister/brother, other relatives) who gambles. On the other hand, having poor or average school marks, going to ED in the previous year, smoking at least once in the previous month, having dissatisfied with relationships with father and having a lower family income than their friends was only associated with gambling in boys. Having an accident or injury in the previous year and having a mother who gambled was associated only in girls with higher odd of at risk or problem gambling behavior. A low psychological distress is protective only in girls for risk of gambling. CONCLUSIONS: Understanding the gender-related differences, and how they emerge in younger people at the start of their gambling careers, can suggest how best to educate individuals, families and the community on the topic of gambling. Programs to prevent substance use and abuse should be multifaceted, and include efforts to prevent gambling with a gender perspective approach
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