Assessment of the prevalence and risk factors of low back pain in operating room health workers: An observational study in Italy

Aim: The aim of this study was to assess the prevalence of low back pain (LBP) among healthprofessionals and the possible risk factors. Methods: The study was carried out from April 2018 to October 2018 among all health workers of the Orthopaedic Clinic and the Emergency Department of “Policlinico Umberto I” in Rome. LBP was assessed using the Nordic Questionnaire Musculoskeletal Disorders in the section on lumbar pain. The type of physical activity carried out as prevention was investigated by use of the International Physical Activity Questionnaires. The overall state of health and lifestyle was deter- mined by the Short Form 12-item Health Survey. Job satisfaction and perceived work stress were assessed through the 15-questions of Karasek’s Questionnaire. The intensity of the low back pain was assessed using a Numerical Rating Scale. A univariate analysis was conducted to assess the associations between socio-demographic and working variables. Multiple logistic regression mod- els were used to assess independent correlates of LBP. Results: One hundred thirteen subjects were enrolled, 52 women and 61 men. The annual period- prevalence of lumbar musculoskeletal disorder was found on 79.6% of participants with LBP. Mean value evidence of NRS was 2.66. The highest LBP risk over the 12 months was found in groups with high job demand (OR = 1.18; 95%CI: 1.01 – 1.38), low decision-making opportunities (for decision latitude OR = 0.87; (0-76 – 1.0), and low levels of physical activity (OR = 0.75; 95%CI: 0.64 – 0.89). Conclusion: The working environment is a potential risk factor for the development of LBP and is suitable for prevention programmes. The protective effect of physical activity and work-related stress management indicate room for improvements for the prevention of LBP in these HCWs. Conflicts of interest: None declared

Assessment of the prevalence and risk factors of low back pain in operating room health workers: An observational study in Italy

Aim: The aim of this study was to assess the prevalence of low back pain (LBP) among healthprofessionals and the possible risk factors. Methods: The study was carried out from April 2018 to October 2018 among all health workers of theOrthopaedic Clinic and the Emergency Department of “Policlinico Umberto I” in Rome. LBP wasassessed using the Nordic Questionnaire Musculoskeletal Disorders in the section on lumbar pain.The type of physical activity carried out as prevention was investigated by use of theInternational Physical Activity Questionnaires. The overall state of health and lifestyle wasdeter- mined by the Short Form 12-item Health Survey. Job satisfaction and perceived work stresswere assessed through the 15-questions of Karasek’s Questionnaire. The intensity of the low backpain was assessed using a Numerical Rating Scale. A univariate analysis was conducted to assess theassociations between socio-demographic and working variables. Multiple logistic regression mod- elswere used to assess independent correlates of LBP. Results: One hundred thirteen subjects were enrolled, 52 women and 61 men. The annual period-prevalence of lumbar musculoskeletal disorder was found on 79.6% of participants with LBP.Mean value evidence of NRS was 2.66. The highest LBP risk over the 12 months was found in groupswith high job demand (OR = 1.18; 95%CI: 1.01 – 1.38), low decision-making opportunities (fordecision latitude OR = 0.87; (0-76 – 1.0), and low levels of physical activity (OR = 0.75; 95%CI:0.64 – 0.89). Conclusion: The working environment is a potential risk factor for the development of LBP and issuitable for prevention programmes. The protective effect of physical activity and work-relatedstress management indicate room for improvements for the prevention of LBP in these HCWs. Conflicts of interest: None declared

Designing a broad-spectrum integrative approach for cancer prevention and treatment.

Targeted therapies and the consequent adoption of "personalized" oncology have achieved notable successes in some cancers; however, significant problems remain with this approach. Many targeted therapies are highly toxic, costs are extremely high, and most patients experience relapse after a few disease-free months. Relapses arise from genetic heterogeneity in tumors, which harbor therapy-resistant immortalized cells that have adopted alternate and compensatory pathways (i.e., pathways that are not reliant upon the same mechanisms as those which have been targeted). To address these limitations, an international task force of 180 scientists was assembled to explore the concept of a low-toxicity "broad-spectrum" therapeutic approach that could simultaneously target many key pathways and mechanisms. Using cancer hallmark phenotypes and the tumor microenvironment to account for the various aspects of relevant cancer biology, interdisciplinary teams reviewed each hallmark area and nominated a wide range of high-priority targets (74 in total) that could be modified to improve patient outcomes. For these targets, corresponding low-toxicity therapeutic approaches were then suggested, many of which were phytochemicals. Proposed actions on each target and all of the approaches were further reviewed for known effects on other hallmark areas and the tumor microenvironment. Potential contrary or procarcinogenic effects were found for 3.9% of the relationships between targets and hallmarks, and mixed evidence of complementary and contrary relationships was found for 7.1%. Approximately 67% of the relationships revealed potentially complementary effects, and the remainder had no known relationship. Among the approaches, 1.1% had contrary, 2.8% had mixed and 62.1% had complementary relationships. These results suggest that a broad-spectrum approach should be feasible from a safety standpoint. This novel approach has potential to be relatively inexpensive, it should help us address stages and types of cancer that lack conventional treatment, and it may reduce relapse risks. A proposed agenda for future research is offered

Designing a broad-spectrum integrative approach for cancer prevention and treatment.

Targeted therapies and the consequent adoption of "personalized" oncology have achieved notable successes in some cancers; however, significant problems remain with this approach. Many targeted therapies are highly toxic, costs are extremely high, and most patients experience relapse after a few disease-free months. Relapses arise from genetic heterogeneity in tumors, which harbor therapy-resistant immortalized cells that have adopted alternate and compensatory pathways (i.e., pathways that are not reliant upon the same mechanisms as those which have been targeted). To address these limitations, an international task force of 180 scientists was assembled to explore the concept of a low-toxicity "broad-spectrum" therapeutic approach that could simultaneously target many key pathways and mechanisms. Using cancer hallmark phenotypes and the tumor microenvironment to account for the various aspects of relevant cancer biology, interdisciplinary teams reviewed each hallmark area and nominated a wide range of high-priority targets (74 in total) that could be modified to improve patient outcomes. For these targets, corresponding low-toxicity therapeutic approaches were then suggested, many of which were phytochemicals. Proposed actions on each target and all of the approaches were further reviewed for known effects on other hallmark areas and the tumor microenvironment. Potential contrary or procarcinogenic effects were found for 3.9% of the relationships between targets and hallmarks, and mixed evidence of complementary and contrary relationships was found for 7.1%. Approximately 67% of the relationships revealed potentially complementary effects, and the remainder had no known relationship. Among the approaches, 1.1% had contrary, 2.8% had mixed and 62.1% had complementary relationships. These results suggest that a broad-spectrum approach should be feasible from a safety standpoint. This novel approach has potential to be relatively inexpensive, it should help us address stages and types of cancer that lack conventional treatment, and it may reduce relapse risks. A proposed agenda for future research is offered.Multiple funders. See acknowledgments within article for details.This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.semcancer.2015.09.00

Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival.ResultsIn the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P=0.52) and 22.4% (97.5% CI: 17.2-28.3, P<0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline.ConclusionsTocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline.Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092)