1,720,961 research outputs found
LE COPERTURE PER LA VACCINAZIONE ANTI-HPV RAGGIUNTE NELLA ASL ROMA B
No full textIntroduzione. Si stimano 500000 nuovi casi/anno, nel mondo, e 3500, in Italia, di carcinoma della cervice uterina. È il primo tumore riconosciuto dall’OMS come interamente riconducibile ad un agente infettivo, lo Human Papillomavirus; grazie allo sviluppo di vaccini anti-HPV ne è possibile la prevenzione primaria. Dal 2007/08 la vaccinazione è offerta attivamente e gratuitamente in tutte le regioni italiane alle ragazze nel 12° anno di vita. Nel Lazio la gratuità è garantita fino ai 18 anni. Scopo dello studio è valutare le coperture vaccinali raggiunte ad oggi per anti-HPV nelle ragazze delle coorti di nascita 1997-2001 residenti nell’area di appartenenza della ASLRomaB.
Metodi. Sono stati analizzati i dati raccolti dalla anagrafe vaccinale della ASLRomaB, distinti per distretto, dal 16 giugno 2008 al 31 marzo 2015, relativi alle coorti di nascita oggetto di chiamata attiva e gratuita. La valutazione dei dati ha riguardato ciascuna dose prevista per il completamento del ciclo vaccinale.
Risultati. Per la prima dose vaccinale si verifica un trend in lieve crescita dalle coorti 1997-98 alle coorti 1999-2000, si osserva invece un decremento di oltre il 5% per la coorte 2001 rispetto alla coorte 2000. L’andamento risulta simile ai dati rinvenuti nel Lazio, dove un calo si registra già dalla coorte 2000. Non tutte le ragazze completano il ciclo vaccinale determinando un decremento di circa il 3% per le coperture della terza dose (stabilizzatesi intorno al 71%) rispetto alla prima, in analogia a quanto registrato nel Lazio. Si riscontrano tra i risultati dei 4 distretti dell’ASLRomaB delle diversità i cui motivi sono in corso di valutazione. Si stanno analizzando i dati relativi alla coorte 2002.
Conclusioni. Le osservazioni effettuate ed in corso, individuate le possibili cause dei risultati non soddisfacenti, sono finalizzate all’attuazione di strategie migliorative
Evoluzione dei casi ASCUS HPV +, LSIL e CIN2+ trattati nella coorte delle invitate nel 2013 al test di 1° livello dello screening citologico della ASL ROMA B
No full textIntroduzione : Lo screening per il cervicocarcinoma (CC) è finalizzato alla riduzione della mortalità e dell’incidenza della malattia mediante l’identificazione e il trattamento delle lesioni displastiche di grado elevato o più severe (CIN2+) . Obiettivo dello studio è valutare, nel territorio della ASL Roma B, la percentuale di casi ASCUS HPV + e LSIL evoluti in CIN2+ nelle donne sottoposte a screening per CC, nonché la percentuale di recidiva dei casi CIN2+ trattati.
Materiali e metodi: Le donne invitate ad effettuare il Pap test (PT) al 1° livello di screening nel periodo 01/01/2013-31/12/2013 sono state 61487: il 24% delle donne ha aderito e di queste il 3,2% (465 donne) è risultato positivo per lesioni di alto e basso grado al PT. Sono stati esaminati i referti delle donne con PT positivo, valutando i dati citologici e istologici dell’approfondimento (prima colposcopia con eventuale biopsia) e dei successivi follow up (FU =nuovo PT seguito da colposcopia con eventuale biopsia) fino al 30/06/2015.
Risultati: Dei PT di 1° livello il 60% è risultato LSIL ed il 23% ASCUS HPV +. L’approfondimento è stato eseguito in più del 90% dei casi: la CIN2+ è stata evidenziata nel 6% delle donne con PT LSIL (VPP 6%) e nel 14,4% con ASCUS HPV + (VPP 14,4%). Nei successivi FU si osserva un trend discendente sia per l’adesione delle donne che per il n ° di CIN2+ diagnosticati. La CIN2+ è stata diagnosticata in : • 65 casi (15%) dei 435 con PT positivo che hanno eseguito l’approfondimento (93,5%) •13 casi (4,5%) dei 287 che si sono presentati al 1°FU (66%). Sono state trattate con LEEP 51 casi dei 65 evidenziati all’approfondimento (79%) e tutti i 13 casi emersi al FU (100%). Solo in 2 casi è stata osservata una recidiva. I casi di cancro diagnosticati nella coorte è stato 6 (1 al PT di 1° livello, 4 all’approfondimento, 1 al FU). Conclusioni: Lo studio ha consentito di verificare sia l’andamento delle lesioni cervicali che l’attività di screening nel territorio della ASL Roma B. Il VPP di CIN2+ per citologia ASCUS HPV + (VPP 14,4%) si discosta lievemente dal valore medio nazionale (VPP medio nazionale 16,6%). Il VPP di CIN2+ per citologia LSIL (VPP 6%) invece è sensibilmente più basso rispetto ai valori medi nazionali (VPP 15%): questo dato potrebbe evidenziare la necessità di una rivalutazione della gestione dei casi LSIL. La Detection Rate di CIN2+ con conferma istologica (DR 4,43‰) risulta invece leggermente più alta rispetto alla media nazionale (D.R. media nazionale 3,5‰). Altra osservazione importante è il trend discendente dell’adesione delle donne ai successivi FU dopo approfondimento soprattutto i casi con PT LSIL e ASCUS HPV+, mentre maggiore è l’adesione delle donne con PT di 1° livello HSIL e ASCH e di quelle trattate in screening
Radiofrequency and diathermy haemorrhoidectomy: early and late complications
No full textRadiofrequency and diathermy haemorrhoidectomy:
early and late complications
Aim: Milligan-Morgan haemorrhoidectomy is the most effective technique for the
surgical treatment of haemorrhoids, but is followed by severe pain, bleeding, soiling,
stenosis and slow return to daily activities. In order to prevent these consequences
new devices that use radiofrequency are used. We compared radiofrequency (RH)
and diatermy hemorrhoidectomy (DH) both for early and late complications.
Methods: Between 2012 and 2016, 82 patients were divided into two groups: 42 in
RH and 40 in DH. We analyzed: operative time, number of piles removed,
postoperative pain, bleeding, stenosis, soiling/minor incontinence, time off-work,
wound healing time and general satisfaction.
Results: Pain score were lower in the RH than DH, (mean VAS after 1 week 3,53 vs
4,22), such as operative time (RH 25 min vs DH 33 min). We removed on average
2,8 piles in RH vs 1,78 in DH. Temporary soiling/minor incontinence rates were
similar, while time off-work, wound healing time and overall satisfaction showed a
superiority of radiofrequency.
Conclusion: Radiofrequency haemorrhoidectomy is more effective than diatermy,
both for early and late complications, with faster recovery and better overall
satisfaction. Further randomized controlled trials are required to confirm these
preliminary results
Paucisymptomatic gastric anisakiasis: endoscopical removal of Anisakis sp. larva
Full text linkAnisakiasis is increasing worldwide, even in Europe and in the Mediterranean region due to the
increased practice of raw fish consumption. Usually, a detailed food history is the key to the diagnosis. A
52-year-old woman affected by pathological obesity underwent esophagogastroduodenoscopy (EGD) for
a 1-year history of epigastric pain. In the gastric fundus, an Anisakis sp. larva, was casually detected. The
nematode was successfully removed with a biopsy forceps. In this case, the finding of the parasite was
casual, being detected during an accurate EGD performed for a 1-year history of epigastric pain in the
patient
Intolerance of Uncertainty, Anxiety Sensitivity and Health Distress Predicted Self-Reported and Clinician Rated Pain During Upper Endoscopy Though Pain Catastrophizing
No full textCONTROL ID: 2910419
CURRENT CATEGORY: Clinical Practice
CURRENT SUBCATEGORY/DESCRIPTORS: Patient Reported Outcomes: IBD, GERD, Functional Disorders, Other
PRESENTATION TYPE: AGA Institute Oral or Poster
PRESENTER: Rossella Palma
PRESENTER (EMAIL ONLY): [email protected]
Abstract
TITLE: INTOLERANCE OF UNCERTAINTY, ANXIETY SENSITIVITY AND HEALTH DISTRESS PREDICTED SELFREPORTED
AND CLINICIAN RATED PAIN DURING UPPER ENDOSCOPY THOUGH PAIN CATASTROPHIZING
AUTHORS (LAST NAME, FIRST NAME): Palma, Rossella1
; Pontone, Stefano1
; Panetta, Cristina1
; La Spina, Gaia3
;
Foglia, Anastasia3
; Raniolo, Marilena1
; Tomai, Manuela2
; Lauriola, Marco3
INSTITUTIONS (ALL):
1. Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy.
2. Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Rome, Italy.
3. Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy.
ABSTRACT BODY:
Abstract Body: Background: Endoscopic examination is stressful for patients, producing anxiety and fear, which
increase pain and discomfort. According to the fear-anxiety-avoidance model1
pain perception is affected by
catastrophizing thoughts. Other dispositions influence PC and pain perceptions. Intolerance of Uncertainty (IU) has
been recognized as related to chronic pain and anxiety2
. Anxiety Sensitivity (AS) was associated with PC, chronic
pain and accounted for the relationship of pain with anxious arousal3,4
.
Methods: 39 patients referred for upper endoscopy at the Endoscopy Unit of SAPIENZA University of Rome
participated in this study. Before endoscopy, patients completed the following scales: Anxiety Sensitivity Index (ASI);
Intolerance of Uncertainty Index (IUI); Hospital Anxiety and Depression Scale (HADS), Penn State Worry
Questionnaire (WQ). During endoscopy pain was rated by the Pain Assessment in Advanced Dementia Scale
(PAINAD). After endoscopy, patients reported about pain during the procedure (SR-PAIN). The Pain Catastrophizing
Scale (PCS) was also administered to assesses patient’s aptitude for catastrophic pain. Pain ratings were blinded as
to psychological test results. The study was approved by the local ethical committee.
Results: A non parametric mediation model for small samples (PLS-SEM, Fig. 1) was fitted to the data (R2
= .57 and
.25 for SR-Pain and PAINAD, respectively). IU was associated with WQ, AS, and HADS. In turn, both AS and HADS
predicted PC. In turn, PC was associated with SR-PAIN and with PAINAD. Indirect effects of IU on SR-PAIN and
PAINAD were both significant. HADS but not WQ predicted SR-PAIN. AS was predictive of both pain variables and
mediated the effect of IU (Tab. 1).
Conclusion: IU affected pain and discomfort through increasing anxiety sensitivity, health distress, and pain
catastrophizing. This model was consistent with the fear-anxiety-avoidance model1
and with recent evidence showing
that affective dispositions affect one’s experience of pain2–4. This is the first study showing a relation between IU and
AS with painduring a medical procedure.
1. Asmundson G, Norton P, Vlaeyen J. Fear-avoidance models of chronic pain: An overview. In: Press OU, ed.
Understanding and Treating Fear of Pain. ; 2004:26-43.
2. Fischerauer SF, Talaei-Khoei M, Vissers FL, et al. Pain anxiety differentially mediates the association of pain
intensity with function depending on level of intolerance of uncertainty. J Psychiatr Res. 2018;97(0):30-37.
3. Ramírez-Maestre C, Esteve R, Ruiz-Párraga G, et al. The Key Role of Pain Catastrophizing in the Disability of
Patients with Acute Back Pain. Int J Behav Med. 2017;24(2):239-248.
4. Zvolensky MJ, Bakhshaie J, Paulus DJ, et al. Exploring the Mechanism Underlying the Association Between Pain
Intensity and Mental Health Among Latinos. J Nerv Ment Dis. 2017;205(4):300-307.
TABLE:
Note: The PDF table below is only an approximation of the HTML content and may not match formatting exactly.
Tab 1. Indirect effects for independent variables in Partial Least Squares Structural Equation
Modeling (PLS-SEM). Estimates are based on 5000 bootstrap resampings.
Indirect
Effect
Original
Sample
Mean
Bootstrap
Samples
Mean
Bootstrap
Samples SD
t-value p-level
WQ ---> SR
Pain
0.123 0.121 0.133 0.929 0.353
AS ---> SR
Pain
0.331 0.346 0.125 2.644 0.008
HADS --->
SR Pain
0.245 0.240 0.125 1.967 0.049
IU ---> PCS 0.416 0.445 0.116 3.574 0.000
WQ --->
PAINAD
0.081 0.088 0.099 0.816 0.415
AS --->
PAINAD
0.216 0.244 0.109 1.988 0.047
HADS --->
PAINAD
0.160 0.167 0.093 1.727 0.084
IU --->
PAINAD
0.205 0.246 0.102 2.010 0.045
IU ---> SR
PAIN
0.314 0.342 0.093 3.359 0.001
WQ = Worry Questionnaire PSWQ-A
SR Pain = Patient's Self-Reported Pain
AS = Anxiety Sensitivity Index
HADS = Hospital Anxiety and Depression Scale
IU = Intolerance of Uncertainty
PCS = Pain Catastrophizing Scale
PAINAD = Physcian Rated Pain by Pain Assessment in Advanced Dementia
Fig. 1. Partial Least Squares Structural Equations Modeling (PLS-SEM). Model fitted to upper endoscopy patient
data. Blue circles represent latent variables. Yellow rectangles represent empirical indicators. Estimates are
standardized regression path coefficients. Bold arrows connecting latent variables represent significant effects (p <
.05)
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Intolerance of Uncertainty and Anxiety-Related Dispositions Predict Pain During Upper Endoscopy
Full text linkAlthough sedatives can defuse anxiety and relieve pain, Esophagogastroduodenoscopy (EGD) still is uncomfortable and threatening for some patients. Identifying patients who tolerate digestive endoscopy less well remains difficult. Using a prospective design and a multimodal assessment of pain, the present study evaluated how anxiety-related variables predicted subsequent pain outcomes. Sixty-two consecutive patients referred for elective EGD were assessed for intolerance of uncertainty (IU), procedure-related worries, anxiety sensitivity and health distress before endoscopy. During endoscopy, a doctor rated patients’ pain behavior. After complete recovery from sedation, the patients retrospectively rated endoscopy pain and situation specific catastrophizing thoughts. Descriptive analyses showed that patients undergoing EGD for the first time were more distressed and anxious than patients accustomed to the procedure and needed a higher sedative dose. Notwithstanding sedation, the behavioral rating of pain was above the cut-off value for probable pain for more than half of the patients. IU assessed before endoscopy predicted situational pain catastrophizing (PC) and self-reported pain after endoscopy through procedure related worries. Situational PC not only mediated the effect of worry, but also female gender and younger age were associated with self-reported pain through increased catastrophizing thoughts. Health distress and anxiety sensitivity predicted PC only for women, younger patients, and those not accustomed to the procedure. Our study showed that psychological preparation before sedation is needed especially for first-timers, women, and younger patients, addressing maladaptive cognitive beliefs and acquainting patients with the somatic sensations that they might experience during the procedure
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