The use of sublingual fentanyl for breakthrough pain by using doses proportional to opioid basal regimen.

Abstract OBJECTIVE: The aim of this study was to prospectively assess the efficacy and safety of sublingual fentanyl (SLF) in doses proportional to opioid doses used for background analgesia for the treatment of BTP of cancer patients. METHODS: A sample of patients admitted to an acute palliative care unit, presenting breakthrough pain (BTP) episodes and receiving stable doses of opioids for background pain was selected to assess the efficacy and safety of SLF used in doses proportional to the basal opioid regimen used for the management of BTP. For each patient, data from four consecutive episodes were collected. For each episode, nurses collected changes in pain intensity and adverse effects when pain got severe (T0), and 5, 10, and 15 minutes after SLF was given (T15). RESULTS: Seventy patients were recruited for the study. The mean age was 61.7 (\ub111.5). Forty-one patients were males. A total of 173 episodes of BTP were recorded (mean 2.5 episodes/patient). In 19 events, documentation regarding changes in pain intensity was incomplete. Of the 154 evaluable episodes, 143 were successfully treated (92%). Mean doses of SLF were 637 \ub5g (SD 786), and 51 patients (72.8%) received SLF doses 65800 \ub5g. When compared to younger adult patients, older patients received significantly lower doses of SLF (p < 0.0005) [DOSAGE ERROR CORRECTED], similarly to their lower basal opioid regimen. Pain intensity significantly decreased at T5, 10 and T15 (p < 0.0005). The number of patients with a pain reduction of more than 33% at T5, T10, and T15 were 11, 79, and 137, respectively, and the number of patients with a reduction in pain intensity of more than 50% were 1, 21, 114 at the same intervals, respectively. No differences in changes in pain intensity for gender (p < 0.9) or age (p < 0.85) were observed. No significant changes in the number of patients reporting adverse effects of mild-moderate intensity were reported after SLF administration in comparison with baseline, and no adverse effects severe enough in intensity to require medical intervention were observed. Limitations of this study are represented by the uncontrolled design. CONCLUSION: This study suggests that SLF given in doses proportional to the basal opioid regimen for the management of BTP is safe and effective in clinical practice

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

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

Decline in hospitalization rates for herpes zoster in Italy (2003–2018): reduction in the burden of disease or changing of hospitalization criteria?

Background: Herpes Zoster (HZ) is a very demanding disease caused by the reactivation of latent Varicella Zoster Virus. The main aim of this study was to estimate the burden of the HZ hospitalizations in Italy from 2003 to 2018 evaluating temporal trends. Methods: Retrospective population-based study analyzing Hospital Discharge Records. Hospitalization records reporting the ICD-9 CM 053.X code in the principal diagnosis or in any of the five secondary diagnoses were considered as cases. Trends of hospitalization rates have been evaluated by Joinpoint analyses. Results: Overall, 99,036 patients were hospitalized with HZ in the 16-year period of the study, and 83,720 (84.5%) of these patients were over 50&nbsp;years. Hospitalization rate was 10.4 per 100,000 persons/year with a significant decreasing trend from 13.9 in 2003–2006 to 7.8 in 2015–2018 (p &lt; 0.001). Hospitalization rates showed a 20-fold higher risk among subjects aged over 80&nbsp;years and 11-fold higher risk among 70–79-year-old subjects with respect to those aged less than 50&nbsp;years. Over time, a statistically significant increase was observed for the case fatality rate (from 1.2 to 1.7%; p &lt; 0.001) and the median length of stay (from 7 to 8&nbsp;days; p &lt; 0.001). Conclusions: Zoster is a disease that causes hospitalization as relatively frequent complication and the observed reduced trend over time could be due to a restriction in hospitalization criteria instead of a reduced burden of disease. The decreasing trend should be carefully interpreted, since it could have an impact on promoting herpes zoster vaccination

Breakthrough pain in patients with abdominal cancer pain.

Abstract OBJECTIVE: Characterization of breakthrough cancer pain (BTcP) in patients with abdominal cancer is lacking. The aim of this study was to assess the characteristics of BTcP in patients with abdominal cancer pain. PATIENTS AND METHODS: In an observational cohort study, from a consecutive sample of patients admitted to a pain relief and supportive care unit for a period of 13 months, patients with abdominal disease due to cancer, including primary cancer or metastases, were assessed for the presence of chronic abdominal pain; its mechanism, intensity of background pain, and pain flares, which were distinguishable from the baseline pain, were recorded. Patients presenting with pain flares were assessed regarding the causes and the possible factors associated with it. Patients were reassessed when background pain control was considered optimal. RESULTS: From a sample of 522 patients admitted to an acute pain relief and palliative care unit in a period of 13 months, 100 patients with abdominal disease were available. The mean age was 65.3 years (SD\ub111.4); of the 100 patients, 45 (45%) were males. The mean Karnofsky status was 47.7 (SD\ub111.1). At admission (T0), 67 patients (67%) had background pain with mean pain intensity of 4.9 (SD\ub11.6). Sixty-one patients of those with background pain (91%) had superimposed and well-distinguished pain flares. After analgesic optimization (T1), the mean background pain intensity was 1.7 (SD\ub11.2), and 55.2% of patients had BTcP episodes. The difference with T0 was significant (P<0.0005). CONCLUSIONS: This preliminary study provides new insights on the characteristics of BTcP in a subclass of patients with abdominal disease. It has been estimated that about 55% of patients with well-controlled background pain will develop BTcP episodes. This percentage was higher (about 90%) in patients who presented with uncontrolled background pain, underlying the need to better characterize patients with BTcP, only after a careful optimization of basal pain, as considered by the definition of BTcP

Changes of QTc interval after opioid switching to oral methadone.

Abstract A consecutive sample of patients who were switched from strong opioids to methadone in a period of 1 year was surveyed. QTc was assessed before switching (T0) and after achieving adequate analgesia and an acceptable level of adverse effects (Ts). Twenty-eight of 33 patients were switched to methadone successfully. The mean initial methadone doses at T0 were 67.1 mg/day (SD \ub180.2, range 12-390). The mean QTc interval at T0 was 400 ms (SD \ub130, range 330-450). The mean QTc interval at Ts (median 5 days) was 430 ms (SD \ub126, range 390-500). The difference (7.7 %) was significant (p\u2009<\u20090.0005). Only two patients had a QTc of 500 ms. No serious arrhythmia was observed. At the linear regression analysis, there was no significant association between mean opioid doses expressed as oral morphine equivalents and QTc at T0 (p\u2009=\u20090.428), nor between mean methadone doses and QTc at Ts (p\u2009=\u20090.315). No age differences were found with previous opioid doses (p\u2009=\u20090.917), methadone doses (p\u2009=\u20090.613), QTc at T0 (p\u2009=\u20090.173), QTc at Ts (p\u2009=\u20090.297), and final opioid-methadone conversion ratio (p\u2009=\u20090.064). While methadone used for opioids switching seems to be an optimal choice to improve the opioid response in patients poorly responsive to the previous opioid, the possible QTc prolongation should be of concern despite not producing clinical consequences in this group of patients. A larger number of patients should be assessed to quantify the risk of serious arrhythmia

Association of the Individual and Context Inequalities on the Breastfeeding: A Study from the Sicily Region

Despite the advantages of breastfeeding being widely recognized, the economic level can have an influence on breastfeeding rates, with rich women breastfeeding longer than poor in high-income countries. In Italy, socio-economic differences affect breastfeeding start and continuation among most deprived people, such as in Southern Italy. The objective of the study was to evaluate the prevalence of the initiation and continuation of exclusive breastfeeding and its association with the levels of socio-economic deprivation in Sicily. A prospective cohort study with a two-phase survey in three breastfeeding detection times was conducted. Overall, 1,055 mothers were recruited with a mean age of 31 years. Breastfeeding decreased from 86% during hospitalization to 69% at the first month and 42% at the sixth month, yet at the same time, exclusive breastfeeding increased from 34% to 38% during hospitalization to the first month and went down to 20.2% at the sixth month. The adjusted multivariate analysis showed no association with individual inequalities. On the other hand, the context inequalities had a significant association with the risk of not following exclusive breastfeeding in the deprived class (odds ratio (OR): 2.08, confidence interval (CI) 95% 1.01-4.27) and in the very deprived class (OR: 1.83, CI 95% 1.00-3.38) at the six-month survey. These results indicate that the context inequalities begin to emerge from the return home of the mother and the child