Sun-safe behaviours, personal risk, level of concern, and knowledge about cutaneous melanoma in italy: time for social marketing?

INTRODUCTION: The incidence of cutaneous melanoma is increasing, although 80-95% of all deaths caused by melanoma can be avoided through protective behaviours. There is evidence that social marketing as an approach in public health can improve health-related behaviours and encourage sun-safe behaviours. METHODS: A multicentre survey was conducted to collect and compare data about cutaneous melanoma risk, knowledge, concern, and protective behaviours across Northern, Central, and Southern Italy, and explore how these data could potentially inform a social marketing intervention to improve sun-safe behaviours. Data were analysed using descriptive and inferential statistics. RESULTS: A total of 1,028 questionnaires were collected. Apart from 'Personal Risk' no statistically significant differences were found between the three regions. About 30% (n = 344) of the total sample had high levels of personal risk, and low levels of concern and protective behaviour, and over 70% (n = 711) gave priority to sun tanning. The worst scores were related to knowledge about melanoma (30% wrong answers, and over 40% 'don't know'). Protective behaviour was moderately correlated with age (p = 0.03). Personal risk was significantly higher in women (10.84 vs 10.05), and lower in individuals with a degree (9.46 vs 11.38; p < 0.001). CONCLUSIONS: Over 70% of our sample gave priority to sun tanning, which combined with low levels of concern and knowledge about melanoma, and high levels of personal risk, confirm that much still needs to be done in terms of melanoma prevention, but all these are aspects that could be effectively addressed through social marketing interventions.

Developing a Stoma Acceptance Questionnaire to improve motivation to adhere to enterostoma self-care.

INTRODUCTION: In stoma care, patient education is often weak in terms of improving patients' level of acceptance of living with a stoma. Self-care educational interventions in enterostomal patients, which according to Orem's Theory should take into account these patients' specific needs, require instruments that measure patients' stoma acceptance to improve motivation based on the resumption of activities they used to carry out before having a stoma. The aim of the study was to develop an instrument that measures the level of stoma acceptance to improve motivation to adhere to enterostoma self-care. METHODS: Aspects that improve stoma acceptance and consequently motivation to adhere to enterostoma self-care were identified through 10 focus groups. In the focus groups, the motivation indicators were grouped, categorised and results entered into a Stoma Acceptance Questionnaire (SAQ). The SAQ was then piloted with 104 enterostomal patients from three general hospitals. To assess the construct validity of the SAQ, Mokken Scaling was used to explore the latent structure of the SAQ. Mokken scaling is a non-parametric method that falls under the umbrella of methods described as item response theories (IRT). RESULTS: The theme "Living with a stoma"; "Autonomy"; "Support"; "Ability to deal with stoma", plus a common underlying theme: "Stoma acceptance" were dissussed by the Focus Groups. The experts identified the items of the (SAQ) through these themes. Mokken Scaling identified the "resumption of enterostomal patients' normal activities" as a measure of stoma acceptance, thus confirming the construct validity of the SAQ. CONCLUSIONS: The tool proposed affords a pioneering example of how this gap can be bridged. Indeed, the SAQ could enable nurses adopting a standardized approach for the assessment of enterostomal patients' motivation to resume their normal activities and identify needs linked to this. The SAQ could also be used to measure the effectiveness of psychosocial and educational interventions aimed at improving stoma acceptance.

Intrathecal baclofen therapy in patients with severe spasticity.

Spasticity has been described as "a motor disorder, characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex as one component of the upper motor neuron syndrome". In patients with complete spinal cord lesions, severe untreatable spasticity can make movement, sitting and hygiene difficult or impossible while it may alter gait and personal care in patients with partial lesions. From a clinical point of view, it is useful to distinguish spinal cord spasticity from supraspinal spasticity. Traditionally, the Ashworth scale is the most widely used to quantify the tone of single muscles. In order to quantify hypereflexia, the Reflex Scale is also used. In the spinal spasticity which is characterized by spasms, the Spasm Frequency Scale is useful in order to monitor their frequency. Initially, management of spasticity is based on non-invasive treatments that later become more invasive. The first approach. the conservative treatment, usually includes elimination of the nociceptive stimuli, rehabilitative therapy (physical and occupational), orthopaedic prostheses and plaster corsets. These treatments, do not resolve spasticity in about 33% of cases. In these severe cases, more invasive procedures such as muscle infiltrations with botulin toxin and intrathecal baclofen infusion can be used.

The prevalence of pain in multiple sclerosis: a multicenter cross-sectional study.

In a multicenter cross-sectional study, the authors assessed pain in patients with multiple sclerosis (MS) using a symptom-oriented approach. Out of 2,077 questionnaires, we used 1,672 for data analysis. Pain and frequencies included trigeminal neuralgia 2%, Lhermitte's sign 9%, dysesthetic pain 18.1%, back pain 16.4%, and painful tonic spasms 11%. Comparison between different groups showed significant differences for age, Expanded Disability Status Scale, disease duration, and disease course, but not for sex. This study underlines the relevance of pain in the clinical history of MS.

Effects of felbamate on brain polyamine changes following transient cerebral ischemia in the Mongolian gerbil.

We sought to determine whether treatment with felbamate was capable to reduce the accumulation of putrescine induced by transient forebrain ischemia in the Mongolian gerbil. Gerbils underwent 10 min ligation of common carotid arteries followed by recirculation. Immediately after the release of the arterial occlusion, felbamate (75 and 150 mg kg(-1) i.p.) was administered. Putrescine and polyamine levels were measured in hippocampus and striatum at 1, 8, 24 and 48 h after recirculation. Putrescine levels appeared enhanced already 8 h after the release of the arterial occlusion and kept increasing up to 48 h in the hippocampus and striatum. No significant changes in spermidine levels during recirculation were detected. Conversely, spermine appeared to decrease in the hippocampus while it did not show changes in the striatum. Felbamate significantly reduced the ischemia induced changes in putrescine brain content only at the dose of 150 mg kg(-1) i.p.

R3 nociceptive reflex in multiple sclerosis patients with paroxysmal symptoms treated with gabapentin.

Gabapentin (GBP) is a new, well-tolerated antiepileptic drug found to be effective for painful paroxysmal symptoms (PS) in multiple sclerosis (MS). The aim of this study was to obtain a neurophysiological evaluation of the effects of GBP on the nociceptive system of MS patients suffering PS. We studied 10 MS patients, 6 males, 4 females (mean age 47.3 years), suffering PS (3 had trigeminal neuralgia, 1 painful tonic spasms and 6 dysesthetic or paresthetic symptoms). Three patients were, at the same time, also being treated with carbamazepine. Pain was evaluated by means of the Visual Faces Scale. R3 nociceptive reflex was recorded after 2 weeks' treatment. R3 thresholds and latencies were evaluated and a statistical analysis was performed. A significant variation was found in R3 thresholds between the values recorded before and during GBP treatment; no significant variation was observed in R3 latencies.

Nociceptive R3 reflex in relapsing-remitting multiple sclerosis patients.

Pain in multiple sclerosis (MS) patients has only recently been recognised as a genuine symptom of this disease. It is important to determine whether this pain is the consequence of another symptom of MS or whether it is due to a demyelinating lesion affecting pain pathways. A close relationship has been found between the R3 component of the blink reflex and the pain threshold. The aim of this work was to carry out an objective evaluation of the nociceptive system in MS patients by means of the R3 component of the blink reflex. The study was performed on 20 healthy volunteers and on 20 clinically defined relapsing-remitting MS patients with EDSS not > 3.5, normal R1 and R2 components of the blink-reflex, personal and family anamnesis negative for migraine and trigeminal neuralgia; the patients were not taking drugs at the time of the test. A significant difference was found, between healthy volunteers and patients, for R3 threshold, pain threshold and R3 latency.

Enhanced spasticity in primary progressive MS patients treated with interferon beta-1b.

Spasticity is a disabling symptom of MS that is enhanced during interferon beta-lb (IFNbeta-1b) treatment. Nineteen patients with primary progressive MS were treated with IFNbeta-1b; an additional 19 patients did not receive this treatment. Thirteen of the 19 patients treated with IFNbeta-1b had increased spasticity requiring increased antispasticity drug administration. This observation suggests that further studies are needed before interferons can be so widely used in primary progressive MS patients.

The first in vivo experience of the effects of the continuous intrathecal infusion of clonidine on the locus coeruleus in the regulation of cerebral blood flow: a TCD study.

UNLABELLED: This was a study of the action of continuous intrathecal clonidine infusion on the locus coeruleus in the regulation of cerebral blood flow (CBF) by means of a test of the activation of the locus coeruleus (cold pressure test, CPT). METHOD: The effects on CBF of intrathecal clonidine used for analgesic purposes in a patient with a chronic painful benign syndrome were studied by means of transcranial Doppler sonography (TCD) before and after administering the CPT. RESULTS: TCD with the infusion device activated revealed an increase in CBF velocities compared with those recorded when the device was inactivated. During CPT with the infusion device inactivated, TCD showed a decrease in CBF velocity: this decrease was less when the device was activated. CONCLUSIONS: Our results suggest that the intracerebral vascular responses induced by CPT and intrathecal clonidine infusion may be related to a sympathetic regulating mechanism of cerebral vascularization, possibly mediated by locus coeruleus.

In vitro activity of cefdinir against respiratory pathogens isolated in Sicily with reference to beta-lactamase production.

The in vitro activity of cefdinir (CI-983, FK-482), an orally absorbed aminothiazolyl cephalosporin, was evaluated against all 287 strains of Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Streptococcus pyogenes in comparison with cefaclor, cefuroxime, amoxicillin, amoxicillin-clavulanic acid, erythromycin and cotrimoxazole. The bactericidal activity of cefdinir, cotrimoxazole, amoxicillin-clavulanic acid and erythromycin was determined against H. influenzae, M. catarrhalis and S. pneumoniae. With the exception of one beta-lactamase negative ampicillin-resistant strain of H. influenzae (resistant to all antibiotics tested), no resistance to cefdinir was observed (MIC < or = 1 mg/l). Cefdinir was active against H. influenzae, H. parainfluenzae and M. catarrhalis regardless of whether or not they produced beta-lactamase. In general, the inhibitory concentrations of cefdinir against H. influenzae, H. parainfluenzae and M. catarrhalis were similar to those of amoxicillin/clavulanic acid, one or two dilutions lower than those of cefuroxime and four dilutions lower than those of cefaclor and cotrimoxazole. Against S. pneumoniae and S. pyogenes cefdinir had the same activity as cefuroxime and amoxicillin but was more effective than the other antibiotics tested. Kinetic studies showed that cefdinir was rapidly bactericidal at concentrations 2 and 4 times the minimum inhibitory concentration (MIC): a reduction of 99.9% in CFU values was generally observed after 6-8 h.

Cefetamet pivoxil: comparable evaluation with other orally available antibiotics against selected species of respiratory pathogens.

Cefetamet pivoxil, the prodrug ester of cefetamet, is a new third-generation cephalosporin with a broad spectrum of activity. The in vitro activity of cefetamet was superior to that of cefaclor, ceftibuten, amoxicillin plus clavulanic acid, and amoxicillin alone when tested against 403 strains of freshly isolated upper and lower respiratory tract pathogens. Cefetamet killed 100% Haemophilus influenzae and H. parainfluenzae, including beta-lactamase-producing strains, at < or = 0.25 mg/l, Streptococcus pyogenes and S. pneumoniae at < or = 0.5 mg/l, S. agalactiae at < or = 0.1 mg/l, and streptococci at < or = 2.0 mg/l. Moreover, at < or = 4 mg/l (breaking point), cefetamet was also highly effective against Escherichia coli (94%), Klebsiella pneumoniae (92%), K. oxytoca (91%) and, at 1 mg/l, against Moraxella catarrhalis (90%), including beta-lactamase-producing strains. Furthermore, time-killing analyses at 4 x MIC demonstrated that cefetamet was bactericidal against beta-lactamase-producing H. influenzae, M. catarrhalis, and K. pneumoniae within 6 h and S. pneumoniae within 4 h. Hydrolysis studies confirmed cefetamet's stability to TEM1 and SHV1, the most common enterobacterial beta-lactamases.

Sleep spindles in the initial stages of the vegetative state.

The aim of this study was to look for the presence of spindling in the different stages of remission of the vegetative state to underline all possible correlations with lesional sites, severity of coma and final outcome. The nocturnal polygraphic recordings from 30 patients were examined: 20 (15M, 5F, mean age 31.7 years, range 16-41) had originally suffered a traumatic brain injury, 10 (4M, 6F, mean age 40.5 years, range 24-48) had hypoxic brain lesions. Evidence of spindling, always reduced in density and duration, was found in 44% of these patients, prevalently in the traumatic patients (53.3% versus 30% of hypoxic patients). No subjects in the full stage 0, 0-1 of the vegetative state (apallic syndrome) presented spindling. No significant correlation was found between spindling and the following parameters: gender, the time between the onset of coma and the polygraphic recording, or the site of the lesion.

Sleep in the last remission stages of vegetative state of traumatic nature.

Polygraphic studies were carried out on 20 patients (13 male, 7 female, average age 25.3 years) in the last remission stages of a traumatically caused vegetative state (apallic syndrome: stages V-VIII according to Gerstenbrand's classification). The presence of all the stages of NREM and REM sleep was observed in all patients, as was typical spindling activity. With respect to patients in the first remission stages of vegetative state, the total sleep time (TST) was seen to increase as a percentage of the total time in bed (95%) and with respect to TST, the periods of waking after a period of sleep diminished (wake after sleep onset: 9.73%). Stage I decreased (10.39%), while stages II-III-IV increased (32.36%, 4.29% and 6.04% respectively). There was a clear increase in the REM percentage (37.19%); spindling rate and index both increased (4.9/min and 12.1 respectively).