Toward Adoption of Health Risk Assessment in Population-Based and Clinical Scenarios: Lessons From JADECARE.

Introduction: Health risk assessment (HRA) strategies are cornerstone for health systems transformation toward value-based patient-centred care. However, steps for HRA adoption are undefined. This article analyses the process of transference of the Adjusted Morbidity Groups (AMG) algorithm from the Catalan Good Practice to the Marche region (IT) and to Viljandi Hospital (EE), within the JADECARE initiative (2020-2023). Description: The implementation research approach involved a twelve-month pre-implementation period to assess feasibility and define the local action plans, followed by a sixteen-month implementation phase. During the two periods, a well-defined combination of experience-based co-design and quality improvement methodologies were applied. Discussion: The evolution of the Catalan HRA strategy (2010-2023) illustrates its potential for health systems transformation, as well as its transferability. The main barriers and facilitators for HRA adoption were identified. The report proposes a set of key steps to facilitate site customized deployment of HRA contributing to define a roadmap to foster large-scale adoption across Europe. Conclusions: Successful adoption of the AMG algorithm was achieved in the two sites confirming transferability. Marche identified the key requirements for a population-based HRA strategy, whereas Viljandi Hospital proved its potential for clinical use paving the way toward value-based healthcare strategies.

Bibliometric Network Analysis on Rapid-Onset Opioids for Breakthrough Cancer Pain Treatment.

BACKGROUND AND OBJECTIVES: Proper breakthrough cancer pain (BTcP) management is of pivotal importance. Although rapid-acting, oral and nasal transmucosal, fentanyl formulations (rapid-onset opioids, ROOs) are licensed for BTcP treatment, not all guidelines recommend their use. Presumably, some research gaps need to be bridged to produce solid evidence. We present a bibliometric network analysis on ROOs for BTcP treatment. METHODS: Documents were retrieved from the Web of Science (WOS) online database. The string was "rapid onset opioids" or "transmucosal fentanyl" and "breakthrough cancer pain". Year of publication, journal metrics (impact factor and quartile), title, document type, topic, and clinical setting (in-patients, outpatients, and palliative care) were extracted. The software tool VOSviewer (version 1.6.17) was used to analyze the semantic network analyzes, bibliographic coupling, journals analysis, and research networks. RESULTS: 502 articles were found in WOS. A declining trend in published articles from 2014 to 2021 was observed. Approximately 50% of documents regard top quartile (Q1) journals. Most articles focused on ROOs efficacy, but abuse and misuse issues are poorly addressed. With respect to article type, we calculated 132 clinical investigations. The semantic network analysis found interconnections between the terms "breakthrough cancer pain," "opioids," and "cancers." The top co-cited article was published in 2000 and addressed pain assessment. The largest number of partnerships regarded the United States, Italy, and England. CONCLUSION: In this research area, most articles are published in top-ranked journals. Nevertheless, paramount topics should be better addressed, and the implementation of research networks is needed.

Therapeutic stays of belarusian children in Italy: evaluation of their mental status, psychological consequences and physical health status.

BACKGROUND: Therapeutic stays are a phenomenon of temporary reception of unaccompanied foreign children from contaminated areas in Belarus, Ukraine and Russia. Aim of the study was to analyze the physical and mental health status of children in therapeutic stays in Italy and the possible presence of a state of child abuse and neglect. METHODS: The survey was conducted on a total of 55 children, 25 of which belonging to the treatment group composed of 25 Belarusian children in temporary stays in Italy, and the remaining 30 to the control group composed of 30 italian children. Data were collected between July 2019 and July 2020. The evaluation included a careful medical history, an accurate physical examination and an interview, focusing on several factors that can be use as indicators of child maltreatment, intended as physical and emotional neglect. RESULTS: The survey was conducted on a total of 55 children, 25 of which belonging to the treatment group, and the remaining 30 to the control group. Of the 25 children in the treatment group, 8 (32%) are male and 17 (68%) are female, while of the 30 children in the control group, 14 (47%) are male and 16 are female (53%). For each child, we considered the Body Mass Index (BMI), the presence of dental caries, and the showing of learning disabilities or hypoacusis. These parameters can be used as indicators of child maltreatment. The analysis of BMI in the two groups shows that the BMI in the treatment group is significantly lower than the BMI in the control group (P=0.004). In the treatment group 7 (28%) children showed some form of caries whereas in the control group no forms of caries were detected. This result itself shows quite a relevant trend, and to have a quantitative measure of its statistical significancy, we performed a permutation test. The results show that the incidence of dental caries in the treatment group is significantly higher than in the control group (P=0.0023). We used the same procedure to analyse data on the presence of learning disabilities or hypoacusis. The P values we obtained are not significant, but the results still seem to show that there might be a trend of a higher incidence of learning disabilities and hypoacusis in the treatment group, and an extensive study with a larger sample might shed more light on the topic. CONCLUSIONS: This study shows that there are indications that suggest a higher risk of child maltreatment in the group of Belarusian children, where maltreatment is understood as physical and emotional neglect to which children are subjected in the institutions and in the group homes where they live. Despite showing only partially significant results, our work could be a starting point for more extensive studies on the topic. These future studies could be extended to other larger samples and other potential maltreatment factors could be evaluated.

Length-weight growth analysis up to 12 months of age in three groups according to the dietary pattern followed from pregnant mothers and children during the first year of life.

BACKGROUND: The aim of the present study is to analyse the length-weight growth up to 12 months of age in three groups considering the respective dietary pattern followed from the pregnant mothers and from the infants during the first year of the life. Moreover, the cultural inference of vegetarianism has been studied. METHODS: Between September 2017 and May 2018, more than 100 mothers have been proposed to participate in this study. As a result of preliminary evaluation, which ensures the presence of inclusion criteria and the absence of exclusion criteria, 55 mothers and their 63 children have been enrolled and assessed with a questionnaire previously created for the study. RESULTS: A statistically significant difference has emerged between the omnivorous and the vegan group from the comparison for the weight of children at birth, 6 months and 12 months, both when expressed in grams and when expressed in growth percentiles. Furthermore, between the two children groups just mentioned, a significant difference has emerged from the comparison for the length expressed in growth percentiles at 12 months and for the body mass index at 6 months. No statistically significant differences have emerged between the omnivorous group and the lacto-ovo/lactovegetarian group and between the latter and the vegan one. CONCLUSIONS: Although differences between the three groups of children have emerged with regard to some anthropometric parameters, their length-weight growth during the first year of life has been harmonic and physiological regardless of the type of planned diet.

Epidemiology of enuresis: a large number of children at risk of low regard.

AIM: To describe the epidemiological aspects of nocturnal enuresis (NE). In this study we identify the prevalence and the familial conditions in a large, representative sample of children with monosymptomatic NE (MNE) and nonmonosyptomatic NE (NMNE). MATERIAL AND METHODS: In this descriptive-analytic study the Italian Society of Pediatrics (SIP) promoted a prevalence study of NE using a questionnaire involved 320 primary care Pediatricians from Northern, Central and Southern Italy, from January 2019 to July 2019, with a total of 130,000 children analyzed by questionnaire related to epidemiology and type of NE, familiarity, quality of sleep, eating and drinking habits, pharmacological and psychological/behavioural interventions and family involvement. RESULTS: 270/320 (84.4%) Paediatrician replied to our questionnaire. We enrolled a total of 9307/130,000 (7.2%) children with NE, aged between 5 and 14 years: 2141 diagnosed with MNE and 7176 qualified as NMNE. Poor quality of sleep were reported in 7064 patients; 90% of children did not consider a dietary and drinking recommendation. Pediatrician reported a total of 54.1% of parents who declared to have a negative reaction to their children because of the bedwetting. A percentage of 71.4% of parents declared to use or to have used alternative therapies and not to prefer, at first, a pharmacological intervention. CONCLUSION: The choice of treatment should include psychological/behavioural interventions in all cases to improve the therapeutic outcome. All primary care Pediatricians should be aware of the all aspects of NE to choose the best way to treat every patient.

The impact of lacto-ovo-/lacto-vegetarian and vegan diets during pregnancy on the birth anthropometric parameters of the newborn.

Introduction: The data in the literature on the appropriateness of vegetarian diets during pregnancy and the impact on the birth anthropometric parameters of the newborn are divergent and conflicting. The aim of the present study is to compare the birth anthropometric parameters of three groups of children distinguished according to the dietary pattern followed by their mothers during pregnancy. Moreover, the second aim is to study the cultural inference of vegetarianism.Materials and methods: Between September 2017 and May 2018, from the Pediatric Service of the Campus Bio-Medico University Hospital of Rome and vegetarian-oriented societies, detailed information have been provided to all mothers who showed interest in participating in the study. More than 100 mothers gave their consent, but in consideration of the criteria of inclusion and exclusion only 55 with the respective children (for a total of 63 kids) have been enlisted in the study. Based on the dietary pattern followed by women during pregnancy, the participants have been divided into three groups: vegan group, lacto-ovo-/lacto-vegetarian group, and omnivorous group. The data necessary for the study have been collected through a questionnaire previously created and sent electronically to 55 enrolled mothers.Results: From our statistical analysis, it has emerged that birth weight, both when expressed in grams and when expressed in growth percentiles, of the vegan mothers' children is lower than that of the omnivorous mothers' children. No significant difference has emerged from the comparison for the length, cranial circumference and BMI at birth between the three groups.Conclusion: Although from our study statistically significant differences in birth weight between the vegan group and the omnivorous one has emerged, the values of this anthropometric parameter were all included within the physiological range decided by the experts in the field. From this, it emerges that the planning of any type of diet with experts in the field is indispensable to ensure a physiological development of the fetus, but given the limited number of participants we cannot draw unequivocal and certain conclusions on this subject.

Physical, psychological and social impact of school violence on children.

Violence against children includes all forms of violence against people under 18 years old whether perpetrated by parents or other caregivers, peers, partners, teacher or strangers. This is a public health, human rights, and social problem: levels of violence against children are frightfully high and it is estimated that up to 1 billion children aged 2-17 years, have experienced a type of violence. Very few studies provided physical violence perpetrated at school but it can have a physical impact, causing psychological distress, permanent physical disability and long-term physical or mental ill-health. Children who experienced any type of violence at school may develop reactive attachment disorder, modest physical inactivity, overweight or obesity, diabetes, smoking habits, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease and other negative outcomes. Evidence from international studies clearly shows that nonviolent, positive discipline delivers better results, while any type of violence is associated with many negative one.

Gambling disorder in adolescents: what do we know about this social problem and its consequences?

Gambling disorder (GD) is a psychiatric condition and it is characterized by a maladaptive pattern of gambling behavior that persists despite negative consequences in major areas of life functioning. In Italy, CNR (National Research Council) underlined how over 17 million, 42.8% of the population aged 15-64 have a gambling behavior. Among them, there are over one million students, aged 15-19, equal to 44.2% of Italian students; the number of minors in Italy with GD in 2017 was 580,000, equal to 33.6%. Various psychosocial treatment models have been adapted for GD; on the other hand no drug has received regulatory approval in any jurisdiction as a specific psychopharmacological treatment for GD. Family therapy interventions for treatment of substance abuse problems have been adapted for adolescents GD. Given the increasing overall prevalence of adolescent gambling, it is imperative that Pediatricians appreciate that gambling problems can also afflict adolescents. In conclusion underage gambling appears to be associated positively with alcohol, tobacco and other substance use, as well as with other individual behaviors, therefore we need that collaborative efforts between scientific societies, government and stake holders can influence the uptake of research findings necessary to implement social policies and design effective public health intervention options. Educational-based problem gambling prevention programs are important avenues in targeting at-risk behaviors among adolescents to prevent an escalation of problematic behaviors into adulthood.

Desmopressin 120 mcg, 180 mcg, 240 mcg: The right treatment for the right patient.

BACKGROUND: The first-line drug therapy for patients with nocturnal enuresis (NE) associated with nocturnal polyuria and normal bladder function is desmopressin (dDAVP). OBJECTIVE: To evaluate if increasing dose of oral desmopressin lyophilisate (MELT) can improve response rates to dDAVP and is useful in enuretic children. MATERIALS AND METHODS: We enrolled a total of 260 children all diagnosed with NE. Enuretic children were treated with increasing MELT at a dose of 120, 180 and 240 mcg a day. RESULTS: We included in our study a total of 237 children, 164 males (69.2%) and 73 females (30.8%) aged between 5 and 18 years (mean age 10.32 ± 2.52 years). Of the 237 patients enrolled in the study and treated with MELT 120 mcg, a full response was achieved in 135 (56.9%). A partial response was achieved in 21 (8.9%) patients, therefore the dose was increased up to 180 mcg, with further improving symptoms (14.3%) or full response (9.5%), and up to 240 mcg, without usefulness. CONCLUSIONS: MELT at the dose of 120 mcg resulted efficacy and safety; the increased dose up to 180 mcg resulted poorly efficacy; finally, the further increase up to 240 mcg did not improve the symptoms with the increased risk of side effects.

The adverse effects of oral desmopressin lyophilisate (MELT): personal experience on enuretic children.

OBJECTIVE: The aim of this study was to evaluate adverse effects of oral desmopressin lyophilisate (MELT) in enuretic children. MATERIAL AND METHODS: We enrolled 260 children with nocturnal enuresis (NE) referred to the Pediatric Service, 'Campus Bio-Medico' University of Rome, from April 2014 to April 2017 in the study, of these 23 were excluded. The study was characterized by 2 phases. During Phase 1 a careful patient's medical history was obtained and physical examination was performed. After 3 months of treatment with MELT (Minirin/DDAVP®) at the dose of 120 mcg a day, a micturition diary was kept, adherence to therapy and any possible adverse effects were checked during the Phase 2. The study was carried out in compliance with the Helsinki Declaration. RESULTS: Among 237 patients included in the study 11 male and 6 female (n=17; 7.2%) patients with a mean age 10.06±2.49 years, reported 22 adverse effects, with an absolute risk of 7.17%. In particular, 5 neurological symptoms, 3 gastrointestinal effects, 4 sleep disturbances, 8 psycho-behavioral disorders, 2 symptoms of fatigue were reported. CONCLUSION: In our study MELT with its higher bioavailability guaranteed lower frequency of adverse effects which resolved spontaneously and rapidly. The MELT formulation actually represents the first line and safe treatment for the NE.