Improving quality of care for cancer pain: an Italian five-year project

Background: cancer pain is still undertreated as for inappropriate use of opioids, as for reason related to other factors. To increase knowledge of cancer pain, the “Mario Negri” Institute promote a series of initiatives to improve the quality of care and patients’ outcomes. Methods: a series of activities were launched including literature review, clinical studies and training schemes. Results: literature reviews shown a prevalence of undertreatment ranged from 8% to 82% and a raw prevalence of BTcP (Breakthrough Cancer Pain) of 51%. In the outcome research study mean worst pain at baseline was 6.8, and 38.3% received a strong opioids. Prevalence of BTcP was 40.3%, and 33.9% of the patients were not receiving rescue therapy at the study inclusion. About analgesic effectiveness of oral and transdermal opioids (TD), treatments with TD were associated with a lower probability to switch (OR=0.83) and to drop out from the study (OR=0.68). Conclusions: the initiative, still ongoing, has allowed a) the creation of a unit for the study and evaluation of cancer pain, b) the production of clinical evidence about the epidemiology, quality and effects of cancer pain management in Italy, c) the design and promotion of a Randomized Controlled Trial to evaluate the effectiveness of four major opioids

New Treatments for Myelodysplastic Syndromes

In the last decade, significant advances have been made in the treatment of patients with Myelodysplastic Syndromes (MDS). Although best supportive care continues to have an important role in the management of MDS, to date the therapeutic approach is diversified according to the IPSS risk group, karyotype, patient’s age, comorbidities, and compliance. Hematopoietic growth factors play a major role in lower risk MDS patients, and include high dose erithropoiesis stimulating agents and thrombopoietic receptor agonists. Standard supportive care should also include iron chelating therapy to reduce organ damage related to iron overload in transfusion-dependent patients. Biologic therapies have been introduced in MDS, as lenalidomide, which has been shown to induce transfusion independence in most lower risk MDS patients with del5q. Hypomethylating agents have shown efficacy in INT-2/high risk MDS patients, reducing the risk of leukemic transformation and increasing survival. Other agents under development for the treatment of MDS include histone deacetylase inhibitors, farnesyltransferase inhibitors, clofarabine and ezatiostat

Pain management and outcomes in cancer patients: comparison between oncological and palliative sets of care

Background: medical oncologists and palliative care physicians have different tasks even if they play a similar role when coping with pain of their patients. In spite of this converging goal, oncologists and palliative care therapists can not have the same approach and impact in managing pain. This study analyzes how pain is treated and which outcomes derive from in 1 461 cancer patients separately cared by oncologists or palliative care physicians. Methods: data derive from an observational, multicentre, prospective, longitudinal study carried out in 110 Italian hospitals. After inclusion, the data were recorded weekly for a 28 days period of follow-up. Results: 876 patients (60%) were cared by oncologists and 585 (40%) by palliative care physicians. The two professional categories tended to similarly manage the drugs of WHO analgesic ladder, while rescue and adjuvant therapies were more frequently used by palliative care physicians. Opioids daily dose increased from 68.3 to 92.5 mg/day (Effect size=0.282) among oncologists and from 70.8 to 107.8 mg/day (Effect size=0.402) among palliative care physicians. The switch of opioids was applied in 12.3% and in 19.1% (p=0.1634), respectively. Pain intensity decreased in both groups but more strongly in the palliative context. The full responders patients were 50% in oncology wards and 58.9% in palliative care (p=0.0588). Conclusions: this study indicates how much oncologists and palliative care physicians differ in managing cancer pain. The observational nature of this study reflects the natural and unaffected choice of the professionals. As intrinsic limit the study only describes their behaviors without a stringent comparative evaluation

Measles Aerosol Vaccine Project

AbstractAerosol delivery of measles vaccine to the respiratory mucosa, mimicking the natural route of transmission for measles virus, is the most promising non-injectable method of measles vaccination studied so far. A phase II/III study is underway in India to confirm that its efficacy is equivalent to that of existing routes of administration. Studies suggest aerosolized measles vaccine appears to be equally or more immunogenic than subcutaneous vaccine in children 9 months and older. Aerosol delivery devices are available or being developed, and could be used by lay people with limited training, and would avoid issues of injection safety. Measles vaccine is not licensed for respiratory administration. Administration of the current measles vaccine via the respiratory route is being comprehensively studied to achieve licensure for international use under the auspices of the WHO's Measles Aerosol Project. The most suitable aerosol administration device for use in low resource environments is being evaluated in such studies

Cancer incidence and congenital anomalies evaluation in the contaminated sites of Sesto San Giovanni – the SENTIERI Project

The Italian Institute for Environmental Protection and Research defines National Priority Contaminated Sites (NPCSs) as land where hazardous substances are likely to pose a risk to human health. SENTIERI was the first national project evaluating the health status of residents in NPCSs. We have extended, for the site of Sesto San Giovanni, the evaluation to cancer incidence and congenital anomalies (CAs). We have found an overall protective effect of living in the NPCS for overall cancer incidence in all ages and no association in paediatric, adolescent and young adults’ population. We have found an excess risk for bladder cancer, leukaemia, lymphoid leukaemia and chronic lymphocytic leukaemia in men and for lung and breast cancer in women. For the paediatric and adolescent population, we have found an excess in embryonic tumours. Total CAs were not different from expected, while we have found excesses regarding congenital ear, face and neck, digestive system and chromosomal defects

Does response to vagus nerve stimulation for drug-resistant epilepsy differ in patients with and without Lennox–Gastaut syndrome?

Introduction: Literature on outcomes of patients with Lennox–Gastaut syndrome (LGS) receiving adjunctive vagus nerve stimulation (VNS) lacks information on seizure types and the time course of therapeutic effects. We have therefore performed what is to our knowledge the largest and most in-depth analysis of the effectiveness of VNS in LGS patients paying special attention to the impact of VNS Therapy on individual seizure types. Methods: The VNS Therapy Outcomes Registry includes over 7000 patients. A propensity score matching method was employed to match patients with LGS to non-LGS patients with drug-resistant epilepsy (DRE). Overall seizure frequencies were assessed prior to implantation and at 3-, 6-, 12-, 18-, and 24-month follow-ups to derive the main study outcomes: response rates and time to first response.Results: A total of 564 LGS patients with sufficient data were identified in the registry and matched 2:1 to 1128 non-LGS patients. Responder rates at 24 months were 57.5% in the LGS group and 61.5% in the non-LGS group. Median seizure frequency reduction at 24 months was 64.3% versus 66.7% in the LGS versus non-LGS group, respectively. In both groups, VNS was most effective at reducing focal aware seizures, “other” seizures, generalized-onset non-motor seizures, and drop attacks with relative reduction rates for these seizure types at 24 months exceeding 90% in both groups. Time-to-first response did not differ between the groups; however, there was a significantly higher proportion of patients who regressed from bilateral tonic–clonic (BTC) seizure response in the LGS group versus the non-LGS group at 24 months: 22.4% versus 6.7%; p =.015. Conclusions: Although limited by its retrospective design, the study shows that the effectiveness of VNS is comparable in DRE patients with and without LGS; however, LGS patients may be more prone to fluctuating control of BTCs.</p

Artificial Intelligence-Based Optimization of Industrial Membrane Processes

AbstractArtificial intelligence (AI) is gaining acceptance for modern control systems in various applications in daily life including the Chemical process industry. Above all, application of AI is increasing in the field of membrane-based treatment where it shows great potential until now. Membrane separations are generally recognized as energy-efficient processes. In particular, membrane desalination, forward osmosis, energy generation, and biomass treatment have shown substantial potential in modern industries, such as wastewater treatment, pharmaceuticals, petrochemicals, and natural products. All these industries consume more than 20% of total energy consumption in the world. Moreover, the laboratory research outcomes illuminate the way to better membrane design and development, including advanced process control and optimization. The membrane processes with existing technologies for a sustainable environment could be integrated with the AI model. This review summarizes several membrane-based water treatment designs and plant performances where artificial intelligence is being used to minimize waste generation and lead to cleaner production

Editorial

Escrever o Editorial da Revista de Atenção Primária à Saúde – APS –, quando ela completa 15 anos de exis- tência, é uma grande satisfação. Tenho muito orgulho de fazer parte de sua história desde 1998 quando, junto com Neuza Mauad, Elaine Reis Brandão, JoseteMasini Sampaio e Rita Maria Rodrigues Bastos, criamos o pri- meiro número da revista. A ideia de uma revista desta natureza surgiu no Núcleo de Assessoria, Treinamento e Estudos em Saúde – NATES – da Universidade Federal de Juiz de Fora que, desde a sua fundação, em 1996, mantém o compromisso de trabalhar a APS como eixo de pesquisa, ensino e extensão. Seus coordenadores, naquele momento, Celso Pimenta, Estela Campos e Maria Teresa Bustamante buscaram junto ao Ministério da Saúde o apoio financeiro necessário e confiaram a nós esta relevante tarefa

Capacidade para o trabalho e saúde dos vigilantes de uma Universidade pública

Objetivo: evaluar la capacidad para el trabajo y el estado de salud de los guardias de seguridad de una Universidad Pública. Métodos: estudio transversal, descriptivo y analítico llevado a cabo con 119 guardias de seguridad. Se utilizaron los siguientes instrumentos: Índice de Capacidad para el Trabajo (ICT), Cuestionario de salud del paciente (PHQ-9), Cuestionario internacional de actividad física (IPAQ corto), Test de identificación de disturbios en el uso de alcohol (AUDIT), Estudio de resultados médicos (MOS), y Demanda-Control-Apoyo (DCS). Se utilizaron estadísticas descriptivas para describir las muestras en estudio y se utilizó el coeficiente de correlación de Spearman para evaluar el ICT. El nivel de significancia fue establecido al 5%. Resultados: las muestras estaban compuestas por hombres, de edad promedio 54.9 años (DE=5.7); el 80% tenia pareja y un 75% tenía educación básica. La mayoría (95%) solamente tenía un trabajo y el promedio de tiempo de servicio era de 24.8 años (DE=11) en un rango entre 3 y 43 años. El 88.9% trabajaban ≤40 horas y el 75% no trabajaban en horarios nocturnos o rotativos. El promedio de puntuación alcanzado en capacidad para el trabajo fue bueno (40.7 puntos), con una correlación significativa en relación al soporte social en el trabajo (valor de p=0.002), condiciones de salud (p=0.094) y síntomas de depresión (p=0.054). Conclusión: este estudio mostró que muchas características afectan la puntuación de capacidad para el trabajo. Considerando los resultados, notamos que se deben promover los hábitos de vida saludable y una reorganización de los ambientes de trabajo.Objetivo: avaliar a capacidade para o trabalho e o estado de saúde dos vigilantes de uma Universidade pública. Métodos: foi desenvolvido um estudo transversal, descritivo e analítico com 119 vigilantes. Foram utilizados os seguintes instrumentos: Índice de Capacidade para o Trabalho (ICT), Questionário sobre a Saúde do Paciente (PHQ-9), Questionário Internacional de Atividade Física (IPAQ curto), Teste de Identificação dos Transtornos Devido ao Uso de Álcool (AUDIT), Escala de Apoio Social utilizada no Medical Outcomes Study (MOS) e Demanda-Controle-Apoio Social no Trabalho (DCS). Foi utilizada estatística descritiva para descrever a amostra do estudo e utilizado o coeficiente de correlação de Spearman para avaliar o ICT. O nível de significância adotado foi de 5%. Resultados: a amostra foi composta por homens: media de idade de 54,9 anos (DP=5,7); 80% casados e 75% tem ensino fundamental. A maioria (95%) tem apenas um emprego, a méd dia do tempo de servicçoe foi de 24,8 anos (DP=11), variando de 3 a 43 anos. 88,9% trabalhavam ≤ 40 horas e 75% não trabalhavam à noite ou em turnos alternantes. O valor médio da capacidade para o trabalho foi bom (40,7 pontos), com associação significativa com apoio social no trabalho (p= 0,002), condições de saúde (p=0,094) e sinais e sintomas de depressão (p=0.054). Conclusão: esse estudo mostrou que muitas características podem afetar a capacidade para o trabalho. Considerando os resultados, pode-se notar que hábitos de vida saudáveis e a reorganização do ambiente de trabalho devem ser estimulados.Objective: to evaluate the work ability and health status of security guards at a public University. Methods: a cross-sectional, descriptive, and analytical study was carried with 119 security guards. The following instruments were used: Work Ability Index (WAI), Patient Health Questionnaire (PHQ-9), International Physical Activity Questionnaire (IPAQ, short), Alcohol Use Disorders Identification Test (AUDIT), Medical Outcomes Study (MOS), and Demand-Control-Support (DCS). Descriptive statistics were used to describe the study samples and the Spearman's coefficient correlation was performed to assess the WAI. Significance level was set at 5%. Results: samples were composed by men; the mean age was 54.9 years (SD=5.7); 80% had partners, and 75% had basic education. The majority (95%) had only one job, the average length of service was 24.8 years (SD=11), ranging from 3 to 43 years. 88.9% worked ≤40 hours and 75% did not work at night shift or rotating shifts. The average score given to work ability was good (40.7 points), with significant correlation to social support at work (p-value=0.002), health conditions (p-value=0.094), and depression symptoms (p-value=0.054). Conclusion: this study showed that many characteristics might affect the work ability scores. Considering the results, we note that healthy life habits and a reorganization of work environments should be encouraged

Work ability and health of security guards at a public University: a cross-sectional study

Objective: to evaluate the work ability and health status of security guards at a public University. Methods: a cross-sectional, descriptive, and analytical study was carried with 119 security guards. The following instruments were used: Work Ability Index (WAI), Patient Health Questionnaire (PHQ-9), International Physical Activity Questionnaire (IPAQ, short), Alcohol Use Disorders Identification Test (AUDIT), Medical Outcomes Study (MOS), and Demand-Control-Support (DCS). Descriptive statistics were used to describe the study samples and the Spearman’s coefficient correlation was performed to assess the WAI. Significance level was set at 5%. Results: samples were composed by men; the mean age was 54.9 years (SD=5.7); 80% had partners, and 75% had basic education. The majority (95%) had only one job, the average length of service was 24.8 years (SD=11), ranging from 3 to 43 years. 88.9% worked ≤40 hours and 75% did not work at night shift or rotating shifts. The average score given to work ability was good (40.7 points), with significant correlation to social support at work (p-value=0.002), health conditions (p-value=0.094), and depression symptoms (p-value=0.054). Conclusion: this study showed that many characteristics might affect the work ability scores. Considering the results, we note that healthy life habits and a reorganization of work environments should be encouraged