Risk of second primary malignancies in women with breast cancer: Results from the European prospective investigation into cancer and nutrition (EPIC).

Women with a diagnosis of breast cancer are at increased risk of second primary cancers, and the identification of risk factors for the latter may have clinical implications. We have followed-up for 11 years 10,045 women with invasive breast cancer from a European cohort, and identified 492 second primary cancers, including 140 contralateral breast cancers. Expected and observed cases and Standardized Incidence Ratios (SIR) were estimated using Aalen-Johansen Markovian methods. Information on various risk factors was obtained from detailed questionnaires and anthropometric measurements. Cox proportional hazards regression models were used to estimate the role of risk factors. Women with breast cancer had a 30% excess risk for second malignancies (95% confidence interval-CI 18-42) after excluding contralateral breast cancers. Risk was particularly elevated for colorectal cancer (SIR, 1.71, 95% CI 1.43-2.00), lymphoma (SIR 1.80, 95% CI 1.31-2.40), melanoma (2.12; 1.63-2.70), endometrium (2.18; 1.75-2.70) and kidney cancers (2.40; 1.57-3.52). Risk of second malignancies was positively associated with age at first cancer, body mass index and smoking status, while it was inversely associated with education, post-menopausal status and a history of full-term pregnancy. We describe in a large cohort of women with breast cancer a 30% excess of second primaries. Among risk factors for breast cancer, a history of full-term pregnancy was inversely associated with the risk of second primary cancer.

Evaluation of the galactogogue effect of silymarin on mothers of preterm newborns (<32 weeks).

Hypogalactia has a relative high frequency in women having delivered preterm infants, who often have difficulties in maintaining a sufficient production of milk for their infants' needs over prolonged periods of time. Recent studies have shown a potential galactogogue effect of silymarin on milk production in animal models (cows and rats) and in humans (mothers of term newborns); nonetheless, none of the studies conducted on humans consisted of double-blind randomized clinical trials and no data are available concerning mothers who delivered preterm infants. The aim of our study was to assess the efficacy of silymarin (BIO-C®) as galactogogue and its tolerability in mothers who delivered preterm infants. We enrolled 50 mothers at 10±1 days post-partum who had delivered infants at ® and placebo arms. No adverse events were observed in the 2 arms among mothers and infants, and silymarin and its metabolites were not detectable in the analyzed human milk samples. Further investigation on specific patient groups affected by hypogalactia, defined according to stricter criteria, should be planned to assess the efficacy of the product in increasing milk production.

[Premature departure from pediatric emergency department: retrospective analysis and preventive strategies.] / Abbandoni spontanei in pronto soccorso pediatrico: analisi retrospettiva e possibili strategie preventive.

. Premature departure from pediatric emergency department: retrospective analysis and preventive strategies. INTRODUCTION: The overcrowding of Emergency Departments (EDs) is a major cause of increased waiting time for the medical evaluation and dissatisfaction of children and their families, who often decide to leave before the visit is completed. AIM: To describe the characteristics of children who leave a second-level Pediatric ED before the medical examination. METHODS: Retrospective descriptive analysis of children who leave before the medical evaluation at the ED of the Regina Margherita Children's Hospital of Turin, Italy between June and November 2018. Data were obtained from the Hospital's informatic registry. RESULTS: 1351 children left the ED during the study period (6.7% of total visits); 9 of them (0.7%) had received a high triage priority code. The highest leaving rate was recorded in November, on the evening-slot and in children ageing 1-10 years. The average and median waiting time of those who left the ED before the medical examination were respectively 131 and 124 minutes. Fever and gastrointestinal problems were the most frequent reasons of access. Overall, 19.8% of children received nursing care during the triage. The revolving door rate was 6.0%. CONCLUSION: Low priority of urgency, long waiting times, access during periods of increased influx and the age between 1 and 10 years were major factors leading to leave Pediatric ED before the medical evaluation. Further studies are needed to investigate how many early leavings are due to ineffective nursing in the triage setting.

OC16 - Calculation skills and e-learning platform: study pre-post test on students of paediatric nursing in Italy.

UNLABELLED: Theme: Child protection and managing risk. Errors in medication is a very recurring problem in paediatric units and for that reason paediatric nursing students have to possess good mathematical skills (Doherty C, 2012). It is important to evaluate these competences during their university nursing degree (Harvey 2009). This problem has been discussed and it was subsequently decided to introduce 'Clinical and Practical pharmacology' lessons like a mandatory subject. AIM: Evaluate the paediatric nursing students learning curve before and after 'Clinical and Practical pharmacology' lessons, job placement and through an e-learning platform. METHODS: A before and after experimental study, using a non-randomized test, administered at different academic phases was used. RESULTS: Learning curve had an increase from 54.09 % to 82.65 %. In particular, that result is significant before 'Clinical and Practical pharmacology' lessons and at final test (p<0.00578). CONCLUSION: These study results are helpful for increased training action and to develop a customized e-learning platform.

[Burnout and risk of burnout in the teams of bone marrow transplant:a multicentre Italian survey]. / Il burnout e il rischio di burnout nelle equipe di trapianto di midollo osseo: uno studio multicentrico italiano.

UNLABELLED: . Burnout and risk of burnout in the Italian teams of bone marrow transplant: a multicentre survey. INTRODUCTION: The term burnout is used to describe a state of work-related psychological distress in healthcare employees characterized by three related, but independent, components: emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). AIM: The aim of this study was to evaluate the prevalence of burnout and stress symptoms in physicians, nurses, and other healthcare professionals in Italian Bone Marrow Transplantation Units. METHODS: All personnel of a multidisciplinary group of the Italian Group of Bone Marrow Transplantation were asked to answer two different validated questionnaires: the Maslach Burnout Inventory (MBI) and the General Health Questionnaire (GHQ-12) for the assessment of general wellbeing. Logistic regression was used to investigate possible risk factors for burnout. RESULTS: This study showed a relatively low burnout prevalence (3.7%), however about 43.5% of health workers were at risk for developing a burnout syndrome. No personal or center characteristics seemed related to burnout risk, but there was a strong correlation between higher scores from the general health questionnaire and burnout risk. CONCLUSIONS: Results from our survey suggest that burnout is a relevant problem in transplant teams and as such strategies should be implemented to prevent it.

Pain assessment in children undergoing venipuncture: the Wong-Baker faces scale versus skin conductance fluctuations.

The aim of this study was to evaluate the efficacy of the subjective Wong-Baker faces pain rating scale (WBFS) and of the objective skin conductance fluctuation (SCF) test in assessing pain in children undergoing venipuncture. One-hundred and fifty children (aged 5-16 years) entered the study. All underwent venipuncture at the antecubital fossa to collect blood specimens for routine testing in the same environmental conditions. After venipuncture, the children indicated their pain intensity using the WBFS, whereas the number of SCFs was recorded before, during and after venipuncture. So, pain level was measured in each child with WBFS and SCF. We found that the level of WBFS-assessed pain was lower in all children, particularly those above 8 years of age, than SCF-assessed pain (p < 0.0001). Moreover, the number of SCFs was significantly higher during venipuncture than before or after venipuncture (p < 0.0001). At multivariate regression analysis, age and previous experience of venipuncture influenced the WBFS (ß = -1.81, p < 0.001, and ß = -0.86, p < 0.001, respectively) but not SCFs. In conclusion, although both procedures can be useful for research and clinical practice, our findings show that WBFS was affected by age and previous venipuncture, whereas SCF produced uniform data. If verified in other studies, our results should be taken into account when using these tools to evaluate pain in children.