Search

Introduction: The aim of the study was to conduct a cross sectional study on pain among inpatients and outpatients in a large teaching hospital., Methods: The study was carried out at the Policlinico "Umberto I", Rome, in October 2009, using a questionnaire developed by Gigi Ghirotti Foundation. The pain intensity was graded mild (VAS scale 1-3), moderate (VAS 4-6) and severe (7-10)., Results: The participants were 825 patients (response rate 75.8%), aged over or equal 18 years, 435 females (median age 54, range 18-95) and 390 males (median age 60, range 19-89). 420 patients (50.9%) declared to feel pain during the hospitalization, and among them 84.3% received adequate therapy. 23.3% of responders presented a pain score over 8, with patients admitted to internal medicine wards with highest score (p = 0.037). The pain control (score ³ 6) was obtained in 71.4% patients. Pain and severe pain perception was higher among females (55.6% and 36.1% vs 45.6% and 29.2%, respectively) (p = 0.004 and p = 0.036). The multivariate analysis showed that the following variables are positively associated to the dependent variable "how much pain do you feel in this moment?": female gender (p < 0.001), length of stay (p = 0.081), admission in medical wards (p = 0.028), being admitted in ordinary way (p = 0.004), while if the patients filled in the questionnaire was inversely associated (p < 0.001)., Conclusions: The application of the guidelines on free pain hospital is increasing, however we must consider that almost one fifth of the patients who suffered pain within the hospital did not receive any treatment for that.

The aim of the study is showing the results of the experience of "Hospital without pain" in the Lazio Region, in order to plan a specific regional project. This was a cross-sectional study conducted through the administration of a questionnaire during the month of October 2007, sent by the Social Department of the Regional Direction Health Planning to the General Directors of Local Health units, Hospital Trusts and Teaching Hospitals. 24 hospitals entered the study (response rate 80%). 37.5% of responders declare that pain level is routinely controlled by a trained health professional, mainly in smaller hospitals (50% vs. 20% in larger ones). In most hospitals (62.5%), pain monitoring is based on the use of the Visual analogue scale (VAS), whereas other scales are less frequently used (20.8%). VAS is mainly used in roman hospitals (84.6%) (p = 0.033). In 10 hospitals (41.7%) there are pain management tools inserted in the clinical chart, and in 14 hospitals (58.3%) specific protocols have been developed and implemented for the treatment of acute and chronic pain. In the last case, these protocols are predominant in the roman (76.9%; p = 0.045), larger (80%; p = 0.069) and teaching hospitals (100%; p = 0.064). The management of pain in the Lazio Region shows a high heterogeneity, both in terms of geographical and dimensional issues. This study highlighted critical elements to be considered for the improvement of the situation at the regional level.

Aim: Adiponectin, leptin and insulin play an important role in the control of growth and glyco-metabolic homeostasis both during pre- and post-natal life. In order to find out markers indicative of post-natal growth, we evaluated circulating levels of these growth factors in full term small for gestational age (SGA) children, during the first 2 years of life, correlating them with the auxological parameters., Methods: Fourteen SGA (8 males and 6 females) and 16 AGA (appropriate for gestional age) infants (7 males and 9 females) have been included in this study, recording length, weight, body mass index (BMI), adiponectin, leptin and insulin levels at birth. In SGA subjects, these biochemical and clinical parameters have also been evaluated at the first and at the second year of age., Results: AGA and SGA adiponectin and insulin levels at birth did not show statistically significant differences, while leptin concentrations were significantly (P=0.011) lower in SGA children (median 418.49, range 157.68-903.67 pg/mL) in comparison with AGA ones (median 811.71, range 312.50-3085.95 pg/mL)., Conclusions: In conclusion, at birth adiponectin and insulin levels do not differ between AGA and SGA subjects while leptin concentrations are significantly lower in SGA infants and positively correlated to the birthweight.

Intrauterine growth retardation (IUGR) refers to the fetal growth pattern and assumes that at least 2 intrauterine growth assessments are performed, indicating a low growth velocity in the fetus. The term "small for gestational age" (SGA) does not refer to fetal growth but to the size of the infant at birth. Infants with SGA have a low weight and/or length for their gestational age at birth below the 10(th) percentile or -2 SD. Approximately 3-5% of all newborns are born SGA. The etiology of SGA/IUGR is not known. The majority (80-85%) of infants born SGA catch-up within the normal range by 2 years of age. SGA has also been associated with increased prevalence of hypertension and dyslipidaemia at a relatively young age. Most controlled trials have shown a beneficial effect of GH treatment. The growth response seems to be due to the cumulative dose received, parenteral adjusted height standard deviation score (SDS) and bone age pretreatment, baseline overnight peak of GH and IGF-I levels. During GH treatment, children born SGA show a significant increase in fasting levels of insulin and proinsulin and a decrease in insulin sensitivity. Fasting glucose levels significantly increase. All these effects are reversible upon interruption of treatment. However, fasting insulin concentrations as well as glucosylated hemoglobin must be carefully monitored during GH treatment. Total cholesterol, LDL cholesterol and the atherogenic index significantly decrease during GH treatment. An acceleration of bone maturation with GH treatment has been reported even though a gain in height SDS for bone age is demonstrated.

Objective: To describe the setting up of the Abruzzo Region (Italy) Service for Prevention and Epidemiological Register of Handicaps, to show prevalence data of occurring diseases and fit regression models aimed at explicating disease occurrence in terms of risk factors; to discuss services access data in terms of their efficacy in fitting social and health needs., Setting and Design: We managed data obtained from a regional information system, based upon primary information sources operating in the Local Health Agencies (i.e. school medicine services, general practitioners, paediatricians, familiar counseling services, rehabilitation centers) and specialistic structures for diagnostic detection (multidisciplinary school équipes, hospital division of infant neuropsychiatry, outpatient infant neuropsychiatry services). The data managing model is a population-based epidemiological register. The target population is the 0-24 years population of the Abruzzo Region., Main Outcome Measures: Occurrence data are expressed as prevalence rates, using standardisation according to the global population of the area of interest. Diagnoses have been defined according to the standard ICD-9 and ICD-10 criteria; definition of handicaps has been made according to the WHO classification (1981). Association between indicator (socio-demographic and anamnestic) variables and occurrence of disease has been fitted by logistic regression models., Results: Prevalence estimates obtained for the main infant neuropsychiatric diseases, as well as for the main handicap-determining genetic and/or congenital diseases, are consistent with the findings of literature in similar settings. An exception is the high occurrence of hyperkinetic disorders in both sexes. Rehabilitation is the main health need for all diagnostic axes. With respect to social needs, school and home personal care seem to be scarcely relevant if related to disease prevalence. Logistic regression analysis indicates socio-economic status and presence of handicapped relatives in the family as factors associated with the occurrence of disease. Respectively, the two factors are negatively associated with the occurrence of hyperkinetic disorders and positively associated with occurrence of mental retardation. Moreover, living in a natural family is negatively associated with evolutive disorders., Conclusions: This is a report about the preliminary results obtained by a specialised register for infant psychological and neurological handicaps. The findings suggest, as operating indications, the standardisation of diagnostic procedures and the definition of common managing guidelines in different areas. Anyhow, the findings of this report highlight the importance of an epidemiological knowledge of handicap in order to design correct prevention strategies and health services planning.

Gonadal impairment has been observed in patients who underwent bone marrow transplantation with TBI-containing cytoreductive regimen. In order to study the effects of radiations on the pituitary and gonadal hormones 12-18 months after transplantation sexual development and plasma levels of gonadotropins, estradiol, and testosterone were evaluated in 9 patients (4 boys and 5 girls, age range 11-20 years). The preliminary results of this study show that TBI produces in both sexes a gonadal impairment, as shown by the high plasma levels of gonadotropins. Nevertheless, the gonadal damage seems to be more important in girls and we suppose a greater sensitivity to radiation injury of the ovary than of the testis.

In this double-blind clinical trial we compared the prophylactic efficacy of the calcium-entry blocker flunarizine (15 mg nocte) with that of pizotifen (1,5 mg nocte). In 30 patients affected by classical and common migraine. During a two months treatment both drugs showed a good efficacy. Flunarizine tended to more markedly suppress severity of pain and duration of attacks than pizotifen. Daytime drowsiness and weight gain occurred with both drugs; the first side effect was more evident in the group treated with flunarizine, the second one in the group treated with pizotifen.

The Authors report their experience in a "double-blind" study in patients affected by chronic primitive headache. 30 patients have been examined: the first one were prescribed amitriptyline, the other one amitriptyline plus lithium association for 30 days. The study pointed out treatments have been effective in reducing frequency, duration and intensity of headache, even though the amitriptyline is more effective in the prophylaxis of chronic headache, whilst amitriptyline plus lithium association seems to be more effective in subacute headache.

25 patients with subcontinual primary headache were treated with Tiapride an Placebo in a controlled double-blind study. The duration of trial was 13 weeks. Blood samples were taken to value PRL in 10 patients and in 10 normal subjects. During the pharmacological trial no side-effects appeared. Authors refer results elaborated through statistical examinations. Tiapride is useful to reduce the frequency of the attacks (in 65% of the patients) with percentage of improvement statistically significant in comparison with placebo. Headache index appears influenced although in non statistically significant way.