Clinical evaluation of switching from immediate-release to prolonged-release lithium in bipolar patients, poorly tolerant to lithium immediate-release treatment: A randomized clinical trial

AIM

The effect of switching from lithium immediate release (Li-IR) to lithium prolonged release (Li-PR) on lithium-induced tremor after 1 and 12 weeks of treatment was evaluated in a randomized, multicenter, open trial, in bipolar patients from the participating sites with a tremor severity ≥2 (Udvalg for Kliniske Undersøgelser [UKU] rating scale) despite optimal lithium titration.

METHODS

The primary endpoint was the evaluation of tremor by means of the UKU scale after 1 week of treatment. Secondary endpoints included manic Young Mania Rating Scale (YMRS) and depressive symptoms (Montgomery-Asberg Depression Rating Scale), a global assessment of the patient's status (Clinical Global Impression), polyuria/polydipsia (UKU item 3.8) and patient-reported outcomes.

RESULTS

Owing to difficulties in including suitable patients the enrollment phase was closed when 73 patients were randomized. Notwithstanding the lower number of patients, in the modified intention-to-treat population (n = 70) the primary endpoint was statistically significant: tremor improved after 1 week in 62.9% in Li-PR group against 20.0% of patients in Li-IR group (p = .0006; two-tailed Fisher's exact test). The difference remained statistically significant after 4 (p = .0031) and 12 weeks (p = .0128). The same analysis performed in the PP population confirmed these results. Among the secondary endpoints, only the factor convenience of the treatment satisfaction questionnaire showed a statistically significant difference between groups. There were no apparent differences in the safety profile of the two formulations.

CONCLUSIONS

This study is the first comparative documentation of a potential benefit of the prolonged-release formulation in reducing the symptom tremor, a well-known adverse effect of lithium therapy. Indeed, the study results should be interpreted taking into account the sample size lower than planned.

Safety and tolerability of a novel oral nutritional supplement in healthy volunteers

BACKGROUND AND OBJECTIVE

Foods for Special Medical Purposes (FSMPs) are formulated to support the nutritional needs of subjects with impaired capacity to ingest, digest or absorb ordinary food or nutrients. Polglumyt® is a proprietary highly purified, high quality glycogen obtained from mussels. Here we report the results of a single-center, single dose, open label, single arm study carried out to investigate acceptance (i.e. gastrointestinal tolerance and palatability), metabolic profile and safety of a low osmolarity, high-density energy Polglumyt®-based drink (the investigational product, IP) as a novel FSMP.

METHODS

Twelve healthy subjects received a single oral administration of the IP under fasting conditions. The study endpoints were: changes in gastrointestinal system tolerability at 3 h, 6 h and 24 h after IP intake; IP palatability evaluation; metabolic evaluation through the kinetic profile of circulating glucose, insulin and C-peptide from 0 h to 6 h after IP intake and changes from baseline in circulating triglycerides at 3 h and 6 h after IP intake.

RESULTS

The IP showed a good gastrointestinal tolerability and an acceptable palatability. The IP did not affect the physiological glycemic profile and the triglycerides levels 6 h after the intake. The IP was well tolerated by study subjects, with no or minor adverse events.

CONCLUSIONS

The study results encourage additional clinical investigations on the IP as a novel FSMP in patients with impaired digestion or gastrointestinal absorption, unable to assume an ordinary diet, e.g. patients undergoing invasive gastrointestinal surgery, elderly or oncological patients, even with certain metabolic disorders.

Quit attempts and smoking cessation in Italian adults (25-64 years): factors associated with attempts and successes

Background

Over the past 50 years there was a substantial decrease in the prevalence of smoking in Italy. The objective of this work is to describe attempts to quit and cessation success in Italian smokers.

Methods

A surveillance on health-related behaviors (PASSI) was conducted in 2007-13 on a sample of 203 610 Italian adults 25-64 years of age. An analysis of smokers' characteristics and behaviors was performed, focusing on attempts to quit and quit success. Data from national surveys (ISTAT) from 1983 to 2013 (Italian adults, 25-64 years of age, 1983: 46 634; 1987: 40 915; 1990: 36 622; 2000: 77 531; 2005: 71 032; 2013: 64 205) were used to explore if a cessation trend in Italy exists.

Results

Smokers who quit in the previous year and were still abstinent when interviewed increased from 1990 to 2013. In the years 2011-13, 38% of people who had smoked in the last 12 months reported at least a quit attempt during the same period and 7% were still abstinent when interviewed. An association of successful recent quit attempts with higher educational level, absence of economic difficulties and younger age was found. In the years 2007-13, the great majority tried to stop unaided. Having received assistance from a cessation program did not increase the probability of enduring abstinence.

Conclusions

In Italy interventions to drive more smokers to quit should be focused in particular on disadvantaged groups. Initiatives have to be studied not only to incentive more smokers to try to quit, but also to maintain abstinence over time.

Preliminary investigation on tick fauna in the neighborhood of Tarquinia, Lazio, Italy

INTRODUCTION

This study represents a preliminary inquiry on tick fauna composition carried out in Maremma, Central Italy, where very few data are available.

MATERIALS AND METHODS

The study area was selected in the limestone hills surrounding Tarquinia town, on the base of suitable elements directly affecting the tick occurrence and the possible circulation of tick-borne pathogens, such as wild cattle rearing, kind of vegetation and human activities. Since a proper understanding of tick ecology is critical in predicting the risk of tick-borne pathogen transmission in a given area, a series of surveys was planned in such area in 2011.

RESULTS

One hundred fifty-four ticks belonging to 4 genera and 6 species, namely Ixodes ricinus (n. = 109; 70%), Rhipicephalus bursa (n. = 18; 12%), Rhipicephalus turanicus (n. = 14; 9%), Rhipicephalus sanguineus (n. = 6; 4%), Hyalomma marginatum (n. = 4; 3%) and Dermacentor marginatus (n. = 3; 2%) were identified and reported for the area.

DISCUSSION

The results of this acarological research represent a significant contribution to the knowledge of the tick fauna of rural areas in Northern Lazio Region, as first step toward a future molecular investigation on pathogen circulation.

[Behavioural risk factors in L'Aquila (Central Italy) 3-5 years after the 2009 earthquake]

OBJECTIVES

to evaluate the long-term impact on the health of the general population of L'Aquila earthquake that occurred on April 6th, 2009.

DESIGN, SETTING AND PARTICIPANTS

three consecutive surveys were performed on samples of the population of 18-69 years resident in L'Aquila and in the other towns affected by the earthquake. Data on health-related quality of life, depressive disorders, behaviour risk factor, and adoption of preventive measures were collected through telephone interviews in 2007-2008, in 2010, and in 2011-2014.

RESULTS

the prevalence of individuals who declared to have economic difficulties increased after 3-5 years from the earthquake (8% in 2010 vs. 14% in 2011-2014). Nevertheless, health-related quality of life improved (decrease of unhealthy days: 7 in 2010 vs. 5 in 2011-2014), while the prevalence of depressive symptoms decreased so that it reached the national average rates (16% in 2010 vs. 7% in 2011-2014). Lack of physical activity, a serious consequence of the first period after the earthquake, became less habitual (39% in 2010 vs. 27% in 2011-2014), probably due to an improvement in the urban redevelopment. The prevalence of smoking and harmful use of alcohol is high (34% and 21%), mostly among young adults.

CONCLUSIONS

3-5 years after the earthquake of L'Aquila, compared to 2010 the quality of life related to health is improved (except in people with at least one chronic disease), and the frequency of depressive symptoms decreased, a sign of an extended recovery from conditions caused by the earthquake, despite of an increasing economic difficulties. On the other hand, we must emphasize critical elements, such as the high prevalence of smoking and consumption of alcoholic beverages other than as part of the meals, especially among young people, and very frequent physical inactivity, particularly among the elderly, although lower than in 2010. Finally, adherence to preventive measures and screening for cancer, and adoption of road safety devices could be improved.

Cancer screening uptake: association with individual characteristics, geographic distribution, and time trends in Italy

BACKGROUND

In Italy, organized screening programmes invite the vast majority of the population for cervical and breast cancer, and about one half of the population for colorectal cancer. Programme activity and quality are closely monitored. Nevertheless, there is a vast spontaneous activity, both public and private, for which information on service and coverage is missing. To estimate actual population coverage for the three types of screening the extent of spontaneous screening needs to be known.

METHODS

PASSI is a national telephone-interview surveillance system that continuously collects information about behavioural health risk factors and the diffusion of preventive health interventions. From 2010 to 2013, more than 151,000 18- to 69-year-olds were interviewed. During 2013, 136 out of 147 Italian local health authorities participated in the survey. Information about screening includes: test uptake (Pap smear, HPV, mammography, faecal occult blood test, colonoscopy), date of the last test, provider of the last test (whether paid or for free, proxy of the organized screening programme), reason for not participating in screening, and screening promotion/recommendation received. Individual information on socio-economic characteristics is available.

RESULTS

Seventy-seven percent of the 25-64 year-old women interviewed said they had undergone a Pap smear or HPV test in the three years before the interview, 40%within the screening programme, 37% spontaneously and paying. Seventy percent of the 50-69 year-old women interviewed reported having had a mammography in the two years before the interview, 51% within the screening programme, 19% spontaneously and paying. Thirty-eight percent of the 50-69 year olds interviewed reported having undergone colorectal screening in the two years before the interview, 31% within the screening programme, 7% spontaneously and paying. All three screening programmes showed a decreasing North-South trend in coverage. From 2010 to 2013, coverage increased for all types of screening; the trend was stronger in the South; the increase was mostly due to the tests performed within the organized programmes. People with low education, economic problems, and immigrants from high migration pressure countries had lower coverage levels. In regions with well-implemented organized screening programmes, test coverage was higher and differences for socio-economic factors were smaller than in regions with incomplete programme activation.

Detection of microbial agents in ticks collected from migratory birds in central Italy

Tick species characterization and molecular studies were performed within ornithological surveys conducted during 2010 and 2011 in the Lazio Region of central Italy. A total of 137 ticks were collected from 41 migratory birds belonging to 17 species (four partial migrants and 13 long-distance migrants). Most ticks were nymphs, with a predominance of Hyalomma marginatum marginatum and H. m. rufipes, and a small portion of Ixodes and Amblyomma species. All tick species analyzed were infected, and the molecular pathogen recognition revealed the presence of Rickettsia aeschlimannii, Rickettsia africae, Erlichia spp., Coxiella burnetii, Borrelia burgdorferi sensu lato group, and Babesia microti, whereas no genomic DNA of Bartonella spp. or Francisella tularensis was detected. The results of the survey show that H. marginatum ticks appear to be a vector of microbial agents that may affect human and animal health and that migratory birds may be an important carrier of these ticks. Additional studies are needed to better investigate the role of migratory birds in the epidemiology of these pathogens.

Seasonal dynamics of tick species in an urban park of Rome

Regular collections were obtained in the Natural Reserve of the Insugherata of Rome during 2011 in order to obtain the tick species composition and the respective seasonal dynamics of the area. A total of 325 ticks was collected in selected sites by means of drag sampling. Among the identified species, Rhipicephalus turanicus was the most abundant (72.3%), followed by Ixodes ricinus (19.7%), Dermacentor marginatus (6.5%), Haemaphysalis punctata (1.2%), and Rhipicephalus bursa (0.3%). R. turanicus occurred mainly in pastures, showing a mono-modal seasonal activity pattern from spring to early summer. Questing I. ricinus were prevalent in woodland from October to May, and the seasonal trend of specimens showed a weak peak in winter. Although adult D. marginatus exhibited seasonal dynamics similar to I. ricinus, with an activity period from October to April, this species occurred in a different environment (pasture) and with considerably lower densities. Haemaphysalis punctata and R. bursa were rare, with an apparent autumn and autumn-winter seasonal activity, respectively. While the species diversity recorded appears as an unequivocal consequence of the natural state of the park, the remarkable R. turanicus density could be a direct effect of the recent introduction of wild boar, as carriers, from the close Veio Park. The presence of the species, a proven vector of various diseases in humans and domestic animals, is discussed in the light of the possible risk of tick-bite exposure of park workers and visitors.