Chronic Non-cancer Pain Management in a Tertiary Pain Clinic Network: a Retrospective Study.

INTRODUCTION: Chronic pain is a distressing condition that should be treated in specialized pain clinics. Pain clinics offer a holistic, evidence-based approach, including pharmacological, complementary, and invasive treatments. This study aimed to provide preliminary information regarding chronic pain treatments and identify reasons for accessing an important hub-spoke pain clinic network. METHODS: A retrospective multicenter cross-sectional study was carried out. A total of 1606 patients' records were included. Patients were selected from the 26 pain clinics of a single region in Italy. Univariate and multivariate logistic regression models were used. RESULTS: Multivariate models showed that the use of opioids were considered effective for severe or moderate pain [odds ratio (OR) 0.41; 95% 0.33-0.51], while the use of invasive treatments (OR 2.45; 95% 1.95-3.06) and the use of complementary therapy (OR 1.87; 95% 1.38-2.51) were associated with severe or moderate pain. Overall, age, sex, nonsteroidal anti-inflammatory drugs (NSAID) use, a combination of NSAIDs, complementary therapies, and a combination of opioids and invasive treatments did not seem to be significantly associated with the nature of pain. Multivariate models confirmed that clinical parameters such as the nature of pain, multi-diagnosis, more than one site of pain, treatments, and general practitioner, but not the severity of pain and use of invasive treatments, had an impact on the choice of a pain clinic. CONCLUSION: Opioids are useful in managing moderate or severe chronic pain. Multimodal approaches are used for the management of chronic pain. Moreover, it is not clear how patients are addressed to access different pain clinics (spoke versus hub) networks. More widespread adoption is needed for an interdisciplinary approach to managing chronic pain and adopting guideline recommendations, and rigorous research is required to provide more substantial evidence and support clinical practice.

Global health education for medical students in Italy.

BACKGROUND: Global health education (GHE) in Italy has spread since the first decade of 21st century. The presence of global health (GH) courses in Italy was monitored from 2007 to 2013. In 2019, a new survey was proposed to assess the availability of educational opportunities in Italian medical schools. METHODS: An online survey was carried out using a questionnaire administered to a network of interested individuals with different roles in the academic world: students, professors, and members of the Italian Network for Global Health Education. The features of courses were analysed through a score. RESULTS: A total of 61 responses were received from affiliates of 33 out of the 44 medical schools in Italy. The national mean of GH courses for each faculty was 1.2, reflecting an increase from 2007. The courses increased nationwide, resulting in a dispersed GHE presence in northern, central and southern Italy. One of the most critical points was related to the nature of "elective" courses, which were not mandatory in the curricula. Enrollees tended to be students genuinely interested in GH issues. Some community and service-learning experiences, referred to as GH gyms, were also detected at national and international levels. CONCLUSIONS: GHE has spreading in Italy in line with the vision of the Italian Network for Global Health Education. Although progress has been made to disperse GH courses around the country, more academic commitment is needed to include GH in the mandatory curricula of medical schools and other health faculties.

A service-learning experience in a free medical centre for undocumented migrants and homeless people.

BACKGROUND: Service-learning experiences, informed by the realities of poverty and marginalization, are important for the education of future health professionals in order to commit them to tackling health inequalities and working with underserved populations. At the Caritas Medical Centre for undocumented migrants and homeless in Rome, students obtain an educational experience of service. The aim of this study is to try to measure the long-term impact of this experience on the professional and life choices of the student participants. METHODS: A questionnaire was designed and distributed by email to all 19-29 years old participants in the experience. Responses were collected and analysed in a quantitative descriptive way and in a qualitative way using the knowledge, skills and attitudes model. RESULTS: One hundred and seven students responded from the total 763 questionnaires distributed. Ninety-five percent of participants expressed a very high overall satisfaction, 93% declared that the experience influenced his/her future personal choices, and 84% found that the experience influenced their professional choices. Results were arranged into 6 categories of comments: knowledge about the realities of migration, poverty, and marginalization; relational skills; collaborative skills; attitudes towards migrants, poor people and others; Attitudes towards future professions; Attitudes towards life. A final category was listed with self-reflective questions related to the experience. CONCLUSION: This research shows the importance of service-learning experiences made during academic studies from young students of medicine and other faculties. Developing a relationship with marginalized and homeless people, within a voluntary service setting, can influence the future professional and personal choices of students. Universities should recognize the value of such experiences and establish partnerships with non-profit organizations to allow future health professionals to confront health inequities and commit themselves to their reduction.

Long-term impact of Global Health educational experiences in Rome: an attempt of measurement.

BACKGROUND: Global health education (GHE) is spreading in Europe and in other parts of the world. Since 2008, Sapienza University of Rome has offered activities to medical and other health profession students related to global health (GH), which is grounded in the theory of social determinants of health and inspired by social justice. The educational activities included elective courses as well as community and service-learning experiences, referred to as GH gyms. This study attempts to measure the long-term impact of these educational experiences, especially to demonstrate their influence on the perceived social responsibility of future health professionals. METHODS: A questionnaire was elaborated and tested on a small sample of participants. It was sent to participants by e-mail. Quantitative results were analysed through descriptive statistics and qualitative answers were carefully read and classified. RESULTS: A total of 758 students from different faculties took part to the educational experiences. Only 488 e-mail addresses were available. One hundred and five (21.5%) questionnaires were returned. Participation in GH gyms was perceived to have had a higher influence on future professional and personal choices, when compared to participation in elective GH courses. CONCLUSIONS: The study shows that consideration of health and social issues related with inequities in health and the use of interactive teaching methodologies had important effects on social responsibility of a large number of students. As there could be a selection bias among respondents, more research is needed to understand the impact of GH educational experiences. The inclusion of global health education in health and social curricula and the use of interactive methodologies with a correct evaluation of results are the indications that emerge from this research, together with the necessity of a strong involvement of students, professors and the whole academic reality.

Medical education: an Italian contribution to the discussion on global health education.

BACKGROUND: In Italy an important contribution to the spread of global health education (GHE) grew from the establishment and work of the Italian Network for Global Health Education (INGHE). INGHE gave a national shared definition of global health (GH), grounded in the theory of determinants of health, inspired by a vision of social justice, and committed to reduce health inequities. The aim of this article is to share with the international community INGHE's point of view on Medical Education. METHODS: To express its view of medical education at the national level, INGHE established a dedicated commission, which elaborated a first draft of the document and then shared and discussed it with all other members. RESULTS: INGHE elaborated a paper where it explained the need to change medical education in order to prepare future health professionals for the challenges of the globalized and unequal world. In this article the authors summarize the experience of INGHE and share with the international community its document. CONCLUSIONS: The authors believe it is necessary now, more than ever, to insert this new approach to health at social and academic levels. Students should play a fundamental role in the spread of GHE, and activities related with GHE could be considered an important part of the third mission of universities to promote social justice.

Epidemiology of Chronic Pain in the Latium Region, Italy: A Cross-Sectional Study on the Clinical Characteristics of Patients Attending Pain Clinics.

In Italy, chronic pain affects more than a quarter of the population, whereas the average European prevalence is 21%. This high prevalence might be due to the high percentage of Italian people who do not receive treatment, even after the passing of law 38/2010 (the right to access pain management in Italy), which created a regional network for the diagnosis and treatment of noncancer chronic pain. Italian epidemiologic studies on chronic pain are scanty, and this observational, multicenter, cross-sectional study is the first to investigate the clinical characteristics of patients who attended the pain management clinics in the Latium Region, Italy, for the management of their noncancer chronic pain. A total of 1,606 patients (mean age 56.8 years, standard deviation ± 11.4), 67% women, were analyzed. Severe pain was present in 54% of the sample. Women experienced pain and had it in two or more sites more often than men (57% vs. 50%, p = .02; and 55.2% vs. 45.9%, p < .001, respectively). Chronic pain was musculoskeletal (45%), mixed (34%), and neuropathic (21%). In more than 60% of the cases, chronic pain was continuous, and in 20% it had lasted for more than 48 months; long-lasting pain was often neuropathic. Low back (33.4%) and lower limbs (28.2%) were the main locations. Severe intensity of pain was statistically significantly associated with female gender (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.06-1.84); with International Classification of Diseases, Ninth Revision, codes for chronic pain syndrome (OR 2.14; 95% CI 1.55-2.95); and with continuous pain (OR 2.02; 95% CI 1.54-2.66). Neuropathic pain and mixed pain were significantly associated with number of sites, and a trend seemed to be present (OR 2.11 and 3.02 for 2 and 3 + sites; 95% CI 1.59-2.79 and 2.00-4.55, respectively).

Evaluation of Borama tuberculosis control program in Somaliland, Somalia.

INTRODUCTION: The Borama TB program in Somalia lost resources for TB operations in 2003. We evaluated the impact of the loss on the program. METHODOLOGY: Pre-event (2002-2003) and post-event (2007) design were used. All TB patients registered in Borama and a sample of four months from Hargeisa (comparison) TB patients in both periods were abstracted. The following TB treatment outcomes were estimated: treatment success, treatment failure, case fatality, treatment interruption and transfer rates, along with percentage of patients with sputum specimen prior to treatment, percentage of patients from neighboring countries, and monthly average patients enrolled in treatment. The pre-event to post-event outcomes and measures were compared using descriptive and multivariate analyses. RESULTS: In total, 3,367 TB cases were abstracted. In Borama, the TB treatment success rate increased 6% in the post-event. The treatment failure and interruption rates both declined 75%. Monthly average TB patients declined 55%. Percentage of patients smear tested prior to the initiation of the treatment declined 9%. Percentage of TB patients from neighboring countries and other parts of Somalia declined 51%. Treatment interruption/transfer rates declined significantly in the post-event, compared to the pre-event period. Treatment failure/death rate did not change in the post-event period. In Hargeisa, the treatment success, failure/death, and interruption/transfer rates were similar in both periods. The RR did not change in these measures after adjusting for age and gender. CONCLUSIONS: This study indicates a significant setback to the Borama TB control program in the majority of measures evaluated, except the TB success rate.

Microbiological Analysis of Surfaces of Leonardo Da Vinci's Atlantic Codex: Biodeterioration Risk.

Following the discovery of discoloration on some pages of the Atlantic Codex (AC) of Leonardo da Vinci kept in the Biblioteca Ambrosiana in Milan, some investigations have been carried out to verify the presence of microorganisms, such as bacteria and fungi. To verify the presence of microorganisms a noninvasive method of sampling has been used that was efficient and allowed us to highlight the microbial facies of the material that was examined using conventional microbiological techniques. The microclimatic conditions in the storage room as well as the water content of the volume were also assessed. The combined observations allowed the conclusion that the discoloration of suspected biological origin on some pages of AC is not related to the presence or current attack of microbial agents.

[Etiology and prevalence of chronic pain in adults: a narrative review]. / La Prevalenza del Dolore Cronico Non Oncologico nell'Adulto e Patologie Associate: una revisione narrativa della letteratura.

The chronic nonmalignant pain is an underestimated epidemiologic health problem. It is a disease in its own right. It is one of the major reasons because patients use health service. The magnitude of chronic pain is in terms of human suffering and costs to society. The aim of this review is to identify the diagnosis and the prevalence of nonmalignant chronic pain in the adults. We have done a review of the literature from 1998 to 2012 using the virtual newspaper libraries starting from data bases (Pub-Med, CINAHL, Cochrane). We have made a narrative review of the articles obtained. Excluding topics of headache, pain for pediatric and geriatric groups, cancer pain and disease-specific items. Studies were classified for year, author sample, methods, age groups and definition of pain. We have obtained 7 articles. These epidemiological studies conducted in different part of the world, reported prevalence rates of chronic pain ranging from 16-53%. They shows a high heterogeneity of results concerning diagnosis and methods. Although limited the number of articles, show the high complexity of the phenomenon.

The use of complementary therapies for chronic pain in Italian hospices.

PURPOSE: Although there has been an increase in the use of CT (Complementary Therapy) in Europe, little is known about CT available in Italian hospices. The present study is aimed at assessing the diffusion and typologies of CT used to treat chronic pain in Italian hospices. METHODS. An online survey was e-mailed to a regional sample of 16 hospices, which included questions on common CT used to treat malignant or nonmalignant chronic pain, and the barriers to their utilization. RESULTS: The response rate was 81%. Only 5 hospices (38%) offered CT with conventional treatment. Massage therapy was the most common type of CT used, followed by naturopathy, nurturing touch, hypnotherapy, guided imagery, and aromatherapy. Barriers to the delivery of CT included insufficient knowledge of CT by staff, limited knowledge, and lack of funding. CONCLUSIONS: Although limited to Lazio hospices, this survey shows a partial use of CT for the treatment of chronic pain, caused by economic and cultural barriers.

Scripta manent? Assessing microbial risk to paper heritage.

Paper, like all other cultural heritage materials, degrades over time, but conservation slows down the rate of its deterioration. There is a long history of cooperation between microbiologists and conservators of libraries and archival materials, but current approaches addressing paper deterioration need urgent reassessment to take full advantage of modern microbiological methodologies. The present article discusses what we believe are the current priority research areas in assessing microbial risk to paper heritage, and reports studies on a 13th century Italian manuscript and on Leonardo da Vinci's Atlantic Codex which illustrate the problems and challenges encountered when dealing with microbial investigations of paper artworks. The potential of using a more advanced microbiological approach is highlighted.

[Outlook and problems of microbiological sampling in public catering establishments in light of the new European regulations]. / Ristorazione collettiva e controlli microbiologici: problematiche e prospettive alla luce delle nuova normativa europea.

Modern society is structured in such a way that more food is eaten outside the home and therefore the hygienic standards of food production and organoleptic characteristics of foods provided by catering establishments is of increasing importance. In order to obtain a complete view of the hygienic standards of the food production cycle, however, it is not sufficient to show that pathogenic microroganisms are absent, but it is also useful to measure the number of microroganisms which do not constitute a hazard to health but whose presence may alter the quality of food products or be an index of inadequate hygienic practices. Microbiological testing plays a fundamental role in the evaluation of the quality of a food product and according to the Codex Alimentarius, limits should be set based on absolute criteria, according to legislation requirements or on relative criteria based on contamination trends over time within the production process The new European food hygiene regulations CE 852/04 e 2073/05 promote a more advanced and correct view of microbiological controls, with respect to pre-existing national legislation, placing emphasis also on the production process of foodstuffs and not only on the final product. In addition, controls are explicitly considered as a tool to verify that food business operators comply with hygiene requirements. The aim of evaluating microbiological data should be to assess trends in the various analytical parameters and search for possible contamination indicators, in order to perform a thorough analysis based on inspections that evaluate the efficacy of food safety procedures put in place by food business operators, with sampling aimed at verifying quick simple and low cost index parameters Regarding the interpretation of collected data it should be underscored that the presence of a large variability points to presence of inadequate hygiene procedures, considering that the main obligation of each food business operator is to put in place, implement and maintain procedures based on the HACCP principles.

Analysis of the shift of the transmission pattern for hepatitis C in a community in Central Italy.

Anti-HCV and HCV-RNA prevalence among adults from an isolated Central Italian community were 16.3% and 9.0%; 3.0%, 2.3% among 25-to-49-year-olds, 27.6%, 14.7% among older subjects. 1b genotype prevailed (88.5%). 1a, la/1b, 4 were also isolated. Seropositivity was associated with age > 50 years, public dental health care, glass syringe use, surgical interventions. The transmission pattern seems to be shifting from that typical of Southern Italy (high prevalence, particularly in the elderly, 1b genotype predominant, various routes of transmission involved, cohort effect), to that typical of Europe (lower prevalence, particularly among younger adults, other genotypes involved, association with intravenous drug use and immigrants).

Detection and quantification of dental unit water line contamination by oral streptococci.

OBJECTIVE: (1) To investigate the prevalence of oral streptococci (OS) and biological indicators of water contamination by oral fluids in water from dental unit water lines (DUWs) by detection and quantification and of saprophytes indigenous to the oral cavity. (2) To test whether measurement of the total cultivable mesophilic flora (TCF), the parameter commonly used to monitor water quality in DUWs, is an effective predictor for OS contamination. DESIGN: Survey of 21 dental units equipped with antiretraction devices. Water samples were collected from air-water syringes, cup fillers, tap water, and before and during the working day. SETTING: Units were from 7 public dental offices selected for convenience from among those in proximity of the microbiological laboratory. METHODS: For detection of OS, samples were plated on an enriched medium, to revitalize the organisms. Colonies were subcultured on a selective medium and biochemically identified (lower detection limit, 1 cfu/mL). For measurement of the TCF, samples were plated on a nutrient-poor medium. Cultures with colony counts greater than 200 cfu/mL were considered to be TCF positive. The sensitivity and specificity of TCF positivity in predicting OS detection was calculated. RESULTS: Prevalence rates for OS contamination and for TCF positivity were, respectively, 34.4% (11 of 32 samples) and 25.0% (8 of 32 samples) for syringes, 27.8% (10 of 36 samples) and 8.3% (3 of 36 samples) for cup fillers, and 0.0% (0 of 7 samples) for tap water. OS contamination levels ranged from 1 to 6 cfu/mL. No statistically significant differences were found between samples obtained before and during the working day. TCF positivity did not predict OS contamination effectively, because of low sensitivity. CONCLUSIONS: Given the absence of OS in tap water, the reported prevalence of OS contamination suggests that oral fluids are aspirated during dental therapy with relatively high frequency and that DUWs can potentially expose successive patients to bloodborne cross-infections.

[Oral cancers and the need for secondary prevention programs]. / Considerazioni sul carcinoma del cavo orale e sulla necessità di implementare programmi di prevenzione secondaria.

Each year, 250,000 people all over the world develop oral cancer, while 130,000 die for this condition. In Italy, these figures are 6000 and 3000, respectively. The 53% average survival rate in five years is one of the lowest, although it increases to 72-86% if oral cancer is diagnosed at the TNM stage I. However, in more than half the cases this condition is diagnosed at more severe stages. This situation can improve significantly because the oral cavity can be easily checked and the cancer is often predictable by precancerous lesions. Since alcohol and tobacco are responsible for 75% of cases, primary prevention basically relies on their control. Secondary prevention, aimed at the early detection of this condition, is based on the examination of oral mucosae and can be performed by dentists, dental hygienists or the patients themselves. The first step to take is to foster information among the subjects at risk, namely people over 40. The authors suggest that educational programs should be held by health professionals so as to teach patients how to perform selfexamination and address to hospitals in case of suspected cancerous lesions.