The development of the International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY) Core Sets: a systematic review.

PURPOSE: The aim of this systematic review is to verify the development of the International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY), investigating methodology and how many core sets have been created. METHODS: Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to carry out the systematic review. Six bibliographic databases were searched: MEDLINE, SCOPUS, Web of Sciences, CINHAL, PEDro, and OT Seeker. Papers included in the study have the following characteristics: (a) pediatric population with different health conditions, (b) assessment of ICF domains, (c) development of ICF-CY core set in different health conditions, and (d) recommendation for clinical uses. RESULTS: Search strategies allowed to identify 270 research papers. After the elimination of duplicates, 154 articles were analyzed. Finally, 28 records were included for qualitative synthesis. Twelve different ICF-CY Core Sets were identified. Autism spectrum disorder, attention-deficit/hyperactivity disorder, and cerebral palsy were the main health conditions studied at international level. Most of the studies involved international experts using Cieza' methodology to inform ICF-CY Core Set. CONCLUSIONS: After 15 years since the adoption of ICF-CY, it still finds some barriers to use. Concrete actions should be taken to develop further core sets following a rigorous methodology and to contribute implementing the ICF framework.Implication for rehabilitationIn 15 years since the implementation of International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY), only 12 core sets have been developed.To develop ICF-CY Core Set, health professionals should follow methodology described by Cieza et al.Strong collaboration between low- and middle-income countries and high-income countries are recommended.

Early factors associated with risk of developmental coordination disorder in very preterm children: A prospective area-based cohort study in Italy.

BACKGROUND: Developmental coordination disorder (DCD) is a motor disorder of unknown aetiology that may have long-term consequences on daily activities, and psychological and physical health. Studies investigating risk factors for DCD have so far provided inconsistent results. OBJECTIVES: To assess, using a parent-report screening tool, risk of DCD in school-age very preterm children born in Italy, and investigate the associated early biomedical and sociodemographic factors. METHODS: A prospective area-based cohort (804 children, response rate 73.4%) was assessed at 8-11 years of age in three Italian regions. Perinatal data were abstracted from medical records. DCD risk was measured using the Italian-validated version of the Developmental Coordination Disorder Questionnaire (DCDQ-IT). For this study, children with cognitive deficit (i.e. intelligence quotient <70), cerebral palsy, severe vision and hearing disabilities, and other impairments affecting movement were excluded. A total of 629 children were analysed. We used inverse probability weighting to account for loss to follow-up, and multilevel, multivariable modified Poisson models to obtain adjusted risk ratio (aRR) and 95% confidence interval (CI). Missing values in the covariates were imputed. RESULTS: 195 children (weighted proportion 31.8%, 95% CI 28.2, 35.6) scored positive on the DCDQ-IT, corresponding to the 15th centile of the reference Movement-ABC test. Factors associated with overall DCD risk were male sex (aRR 1.35, 95% CI 1.05, 1.73), intrauterine growth restriction (aRR 1.45, 95% CI 1.14, 1.85), retinopathy of prematurity (aRR 1.62, 95% CI 1.07, 2.45), and older maternal age at delivery (aRR 1.39, 95% CI 1.09, 1.77). Complete maternal milk feeding at discharge from the neonatal unit and higher parental socio-economic status were associated with decreased risk. CONCLUSIONS: Both biomedical and sociodemographic factors increase DCD risk. These findings can contribute to elucidating the origins of this disorder, and assist in the identification of children at risk for early referral and intervention.

Use of rehabilitation pathways in women with breast cancer in the first 12 months of the disease: a retrospective study.

BACKGROUND: Breast cancer (BC) presents important physical and psychological challenges that should be appropriately addressed through continuous, integrated and individualized rehabilitation programs after treatment. In this study, we aimed to collect more information on the rehabilitation patterns and utilization of healthcare services by women with BC. METHODS: We retrospectively analyzed data from two archives of the Lazio Regional Health System Database to assess rehabilitation patterns in women diagnosed with BC in the Lazio region (Italy) in 2008. RESULTS: A total of 5538 women diagnosed with BC were considered in the present study. Most patients (81.7%) received outpatient rehabilitative care, consisting mainly of pathology-related interventions and, more rarely, disability-related interventions (mainly motor rehabilitation and rarely cognitive or psychological therapy). Few patients followed an inpatient (1.3%) or an intensive outpatient rehabilitation program (1.0%). CONCLUSION: Most patients do not receive adequate rehabilitation care during the first year after diagnosis. More information and better rehabilitation services should be provided to help patients with BC access rehabilitation programs. The study also suggests the importance of psychosocial and cognitive interventions, which is a major unmet need in women with BC.

Impact of the COVID-19 pandemic on the Emergency Department of a tertiary children's hospital.

BACKGROUND: Italy was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020. We describe how the pandemic affected Emergency Department (ED) accesses in a tertiary children's hospital, composed by two different pediatric centers, one located in Rome's city center and the second, Palidoro (regional COVID-19 center), in its surrounding metropolitan area, both in the Lazio region, analyzing the profile of admitted patients during the pandemic period in terms of their general characteristics (at presentation in the ED's) and urgent hospitalizations compared to prepandemic period. METHODS: The study compare the period between the 21st of February and the 30th of April 2020, covering the three phases of the national responses (this period will be referred to as the pandemic period) with the same period of 2019 (prepandemic period). The study analyzes the number of ED visits and urgent hospitalizations and their distribution according to selected characteristics. RESULTS: The reduction of ED visits was 56 and 62%, respectively in Rome and Palidoro centers. The higher relative decline was encountered for Diseases of Respiratory System, and for Diseases of the Nervous System and Sense Organs. A doubling of the relative frequency of hospitalizations was observed, going from 14.2 to 24.4% in Rome and from 6.4 to 10.3% in Palidoro. In terms of absolute daily numbers the decrease of urgent hospitalizations was less sharp than ED visits. For pathologies such as peritonitis, tumors or other possible life-treathening conditions we did not observe a significative increase due to delayed access. CONCLUSIONS: In the pandemic period there was a general reduction in the number of children referred to ED, such reduction was greater in low-acuity levels. The reduction for respiratory tract infections and other communicable diseases during school closure and the national lockdown must make us reflect on the possible impact that these conditions may have on the health system, in particular the ED, at the reopening of schools. The major problem remains the fear for possible diagnostic delays in life-threatening or crippling diseases; our study doesn't demonstrate an increase in number or significant delay in some serious conditions such as tumors, peritonitis, diabetic ketoacidosis, ileo-colic intussusception and testis/ovary torsion. A continuous, deep re-organizational process step by step of the ED is nececessary in the present and upcoming pandemic situation.

Low socio-economic conditions and prematurity-related morbidities explain healthcare use and costs for 2-year-old very preterm children.

AIM: To estimate healthcare use and related costs for 2-year-old very preterm (VP) children after discharge from the neonatal unit. METHODS: As part of a European project, we recruited an area-based cohort including all VP infants born in three Italian regions (Lazio, Emilia-Romagna and Marche) in 2011-2012. At 2 years corrected age, parents completed a questionnaire on their child health and healthcare use (N = 732, response rate 75.6%). Cost values were assigned based on national reimbursement tariffs. We used multivariable analyses to identify factors associated with any rehospitalisation and overall healthcare costs. RESULTS: The most frequently consulted physicians were the paediatrician (85% of children), the ophthalmologist (36%) and the neurologist/neuropsychiatrist (26%); 38% of children were hospitalised at least once after the initial discharge, for a total of 513 admissions and over one million euros cost, corresponding to 75% of total healthcare costs. Low maternal education and parental occupation index, congenital anomalies and postnatal prematurity-related morbidities significantly increased the risk of rehospitalisation and total healthcare costs. CONCLUSION: Rehospitalisation and outpatient care are frequent in VP children, confirming a substantial health and economic burden. These findings should inform the allocation of resources to preventive and rehabilitation services for these children.

Pre-natal folic acid and iron supplementation and atopic dermatitis in the first 6 years of life.

Exposure in utero has been suggested to influence health later in life. The aim of this study was to investigate, if the use of prenatal food supplements was associated with atopic dermatitis in the offspring. Mothers who gave birth in the hospital G. B. Grassi were invited to participate in the study (n = 395). Information on socio-demographic characteristics, clinical data of the mothers and babies, vegetables and fruit intake, food avoidance, and food supplements use during pregnancy, depression status, and environmental exposure was obtained for all subjects in the hospital at the time of delivery. Data on breastfeeding practice, introduction of weaning foods, day care attendance, and atopic dermatitis were collected in the postnatal follow-ups. Logistic regression was applied to estimate odds ratio (OR) and 95% confidence intervals (CI). Children in which mothers used both iron and folic acid supplementation had a fourfold decreased risk of developing atopic dermatitis [OR = 0.22; 95% confidence interval (CI) 0.06-0.79, p = 0.02], after adjusting for possible confounding factors. Findings suggest an independent and protective effect of prenatal folic acid and iron supplementation for atopic dermatitis in children.

Breastfeeding outcomes in European NICUs: impact of parental visiting policies.

OBJECTIVE: The documented benefits of maternal milk for very preterm infants have raised interest in hospital policies that promote breastfeeding. We investigated the hypothesis that more liberal parental policies are associated with increased breastfeeding at discharge from the neonatal unit. DESIGN: Prospective area-based cohort study. SETTING: Neonatal intensive care units (NICUs) in 19 regions of 11 European countries. PATIENTS: All very preterm infants discharged alive in participating regions in 2011-2012 after spending >70% of their hospital stay in the same NICU (n=4407). MAIN OUTCOME MEASURES: We assessed four feeding outcomes at hospital discharge: any and exclusive maternal milk feeding, independent of feeding method; any and exclusive direct breastfeeding, defined as sucking at the breast. We computed a neonatal unit Parental Presence Score (PPS) based on policies regarding parental visiting in the intensive care area (range 1-10, with higher values indicating more liberal policies), and we used multivariable multilevel modified Poisson regression analysis to assess the relation between unit PPS and outcomes. RESULTS: Policies regarding visiting hours, duration of visits and possibility for parents to stay during medical rounds and spend the night in unit differed within and across countries. After adjustment for potential confounders, infants cared for in units with liberal parental policies (PPS≥7) were about twofold significantly more likely to be discharged with exclusive maternal milk feeding and exclusive direct breastfeeding. CONCLUSION: Unit policies promoting parental presence and involvement in care may increase the likelihood of successful breastfeeding at discharge for very preterm infants.

Local transmission of chikungunya in Rome and the Lazio region, Italy.

On September 7, 2017, three potentially autochthonous cases of chikungunya were notified in the Lazio region. An Outbreak investigation based on established surveillance system data and molecular analysis of viral variant(s) were conducted. Epidemiological analysis suggested the occurrence of 3 main foci of local transmission. The major focus involved 317 cases with epidemiological link with the area of Anzio. The other two foci occurred in Rome (80 cases) and Latina (8 cases). Cumulative incidence in Anzio and Latina were 331.4 and 7.13 per 100,000 residents, respectively. Cumulative incidences ranged from 1.4 to 14.3/100,000 residents in Rome. This is the first report of a chikungunya outbreak involving a densely populated urban area in a western country. The outbreak probably started in Anzio, spread by continuity to neighbouring villages, and then to the metropolitan area of Rome and to the Latina area favoured by the touristic nature of the Anzio area.

Molecular Characterization of Autochthonous Chikungunya Cluster in Latium Region, Italy.

We report partial molecular characterization of isolates from an autochthonous chikungunya virus cluster in Latium Region. E1 sequences from 3 patients differ substantially from sequences from the 2007 outbreak in Italy and lack the A226V substitution associated with increased viral fitness in the Aedes albopictus mosquito vector.

Full-Length Genome Sequence of a Chikungunya Virus Isolate from the 2017 Autochthonous Outbreak, Lazio Region, Italy.

We report here the genome sequence of a human chikungunya virus isolate from the ongoing autochthonous outbreak in central Italy. The sequence (East-Central-South African lineage, Indian Ocean sublineage), which is similar to recent sequences from Pakistan and India, shows E1 and E2 signatures of strains whose main mosquito vector is Aedes aegypti, although Aedes albopictus is the vector in Italy.

Maternal Education Is Associated with Disparities in Breastfeeding at Time of Discharge but Not at Initiation of Enteral Feeding in the Neonatal Intensive Care Unit.

OBJECTIVE: To investigate the relationship between maternal education and breastfeeding in very preterm infants admitted to neonatal intensive care units. STUDY DESIGN: This prospective, population-based cohort study analyzed the data of all very preterm infants admitted to neonatal care during 1 year in 3 regions in Italy (Lazio, Emilia-Romagna, and Marche). The use of mothers' own milk was recorded at initial enteral feedings and at hospital discharge. We used multilevel logistic analysis to model the association between maternal education and breastfeeding outcomes, adjusting for maternal age and country of birth. Region was included as random effect. RESULTS: There were 1047 very preterm infants who received enteral feeding, and 975 were discharged alive. At discharge, the use of mother's own milk, exclusively or not, and feeding directly at the breast were significantly more likely for mothers with an upper secondary education or higher. We found no relationship between maternal education and type of milk at initial enteral feedings. However, the exclusive early use of the mother's own milk at initial feedings was related significantly with receiving any maternal milk and feeding directly at the breast at discharge from hospital, and the association with feeding at the breast was stronger for the least educated mothers. CONCLUSION: In this population-based cohort of very preterm infants, we found a significant and positive association between maternal education and the likelihood of receiving their mother's own milk at the time of discharge. In light of the proven benefits of maternal milk, strategies to support breastfeeding should be targeted to mothers with less education.

Gestational age and hospital utilization: three-years follow-up of an area-based birth cohort.

OBJECTIVE: To investigate differences by gestational age in emergency department visits and re-hospitalizations during the three years following childbirth discharge. METHODS: We performed a historical cohort study in Lazio Region, Italy, for infants born in 2007-2008 to resident mothers. Health administrative data were used. Analysis was performed by multinomial logistic regression. RESULTS: Of 90 545 infants, more than 50% had at least one emergency department visit, and 18.8% at least one re-hospitalization. After the exclusion of infants with congenital anomalies, relative risk ratios of re-hospitalization and, to a lesser extent, of emergency department visits increased by decreasing gestational age; the two events were also higher for mothers ≤35 years of age, with low education and of Italian nationality. Residency outside the metropolitan area was associated with an increased risk of re-hospitalization and a decreased risk of emergency department visits. CONCLUSION: During the three years following childbirth discharge, re-hospitalizations and, to a lesser extent, emergency department use are inversely related to gestational age at birth; socio-demographic factors have an effect on the risk of infant use of hospital resources independent of gestational age.

Rehabilitation pathways in adult brain tumor patients in the first 12 months of disease. A retrospective analysis of services utilization in 719 patients.

PURPOSE: Although previous studies have demonstrated the efficacy of rehabilitation programs for brain tumor (BT) patients and the positive impact on quality of life of functional gain, there are few studies focusing on specific rehabilitation management of brain tumor patients. METHODS: With the aim to evaluate the pattern of rehabilitation care and health services utilization in patients with brain tumor, we retrospectively analyzed administrative data on a large cohort of brain tumor patients diagnosed during the period 2008-2009 in the Lazio Region. Pattern of rehabilitation care was analyzed during a follow-up of 12 months after diagnosis. Data for this study were gathered and linked from two sources: (1) hospital discharge records stored into the Lazio Regional Health System database and (2) rehabilitation pathways database including inpatient and outpatient interventions files. RESULTS: We identified 789 patients with an ICD-9-CM code of 191.** in the Regional Health System databases in the study period. Among 719 patients included in this study, 92 (12.8 %) were treated with inpatient rehabilitation program, 22 (3.1 %) received an outpatient personalized program with intensive rehabilitation plan, and 85 (11.8 %) received outpatients rehabilitation interventions. CONCLUSIONS: Our retrospective analysis on the rehabilitation service utilization in a large cohort of BT patients shows that a limited number of patients received rehabilitation interventions during the first year after diagnosis. Nevertheless, the rehabilitation needs in BT patients are largely unmet and the lack of defined physical and cognitive rehabilitation strategies may negatively affect the functional independence and the short- and long-term quality of life.

Prevalence of parkinsonism estimated using the drug prescription archive: a possible method to estimate the prevalence of a chronic neurological disease?

Many surveys estimated prevalence of parkinsonism, with results varying largely. We used prescription records of medications for parkinsonism to estimate the prevalence of this condition. Retrospective survey based on Lazio (Italy) regional drugs' prescriptions registry. Cases of parkinsonism were defined as those who received a medication for parkinsonism (Dopa and dopa derivatives or Monoamine oxidase B-inhibitors) for at least 6 months in a 5-year period (2005-2009). Crude and standardized prevalence rates at June 2009 were calculated. Crude and standardized prevalence rates of parkinsonism in Lazio were, respectively, 283 per 100,000 (95 % CI 278-287), and 294 per 100,000 (95 % CI 289-298), higher in men than in women (292 per 100,000 vs. 274 per 100,000). The highest overall prevalence rate was observed among people aged 85-89 years (246 per 100,000), while the lowest in subjects aged <65 (38 per 100,000). Prevalence rates in people older than 65 and older 75 were, respectively, 1275 per 100,000 and 1912 per 100,000. Using a regional drug registry, based on currently available health information systems, may be a suitable method to estimate prevalence of parkinsonism, which is essential for public health programming, the more in presence of a demographic shift as the current one.

Breastfeeding initiation rates among immigrant women in central Italy between 2006 and 2011.

OBJECTIVE: This study was aimed at evaluating differences in breastfeeding initiation rates by maternal place of birth among women giving birth in one of 14 hospitals in Lazio, Italy, between 2006 and 2011. METHODS: The data on 14 hospitals for this study were taken from a survey on healthy newborns carried out during the month of October each year. It collected information on maternal characteristics and infant feeding during the hospital stay. The exposure variable was maternal place of birth. The outcome variable was infant feeding during hospital stay classified as exclusive breastfeeding, predominant breastfeeding (PBF), complementary feeding or formula feeding. Both a descriptive analysis and a logistic regression on infant feeding (exclusive/PBF versus partial or non-breastfeeding) by maternal place of birth were carried out. The logistic regression model was adjusted for confounding factors. A random effect model was used to take into account the correlation of data among the hospitals. RESULTS: Among the 6505 mothers included in this study, 18.7% were born in non-industrialized countries. Overall, 64.9% of mothers exclusively breastfed their babies, with lower prevalence among Asiatic mothers. The logistic model confirmed that breastfeeding was lower among infants born to Asian mothers (OR: 0.52; 95% CI: 0.35-0.77) compared with other groups, taking into account the effect of the other variables included in this model. Intracluster correlation was equal to 26%, showing that the hospital's model of care is a strong predictor of the initiation of breastfeeding. CONCLUSIONS: These data are useful for targeting disadvantaged groups when promoting breastfeeding.

Determinants of exclusive breastfeeding cessation: identifying an "at risk population" for special support.

UNLABELLED: A study was conducted with 542 women, who gave birth in the hospital G.B. Grassi in Rome, to investigate risk factors for exclusive breastfeeding. Clinical data was collected from clinical records at delivery. Information on psycho-socio-demographic characteristics was obtained by standardized questionnaires at delivery. Data on breastfeeding practice and the use of pacifier were collected at delivery and for 24 weeks' postpartum. The outcome of the study was exclusive breastfeeding for at least 4 months (yes/no). In the multivariate analysis, planned caesarean (OR 2.40, 95 % CI 1.06-5.43) and women with two or more psychological distress conditions (past episodes of depression, insomnia, perceive birth as a traumatic event) versus none were at a greater odds of stopping exclusive breastfeeding before 4 months (OR 3.42, 95 % CI 1.15-10.2). The use of pacifiers within the first 2 weeks postpartum (OR 2.38, 95 % CI 1.35-4.20) but not after 2 weeks (OR 0.86, 95 % CI 0.43-1.72) versus no use was also associated with an increased odds. A protective effect was found for antenatal classes (OR 0.57, 95 % CI 0.35-0.95). CONCLUSION: This study suggests that the type of delivery, antenatal classes, psychological distress conditions and the use of pacifiers in the first 2 weeks of a baby's life are independent factors associated with exclusive breastfeeding.

Mortality and major morbidities in very preterm infants born from assisted conception or naturally conceived: results of the area-based ACTION study.

BACKGROUND: The use of assisted conception (AC) has been associated with higher risk of adverse perinatal outcome. Few data are available on the outcome of AC-neonates when pregnancy ends before 32 weeks of gestational age.The aim of this study was to compare the short-term outcome of AC- and naturally conceived preterm infants <32 weeks gestation. METHODS: The area-based cohort study ACTION collected data on births 22-31 weeks gestation occurred in 2003-05 in 6 Italian regions. Infants born to 2529 mothers with known mode of conception were studied. The main outcomes were hospital mortality and survival free from major morbidities (IVH grade 3-4, cPVL, ROP stage ≥3, BPD), and were assessed separately for single and multiple infants. Other outcomes were also investigated. Multivariable logistic analyses were used to adjust for maternal and infants' characteristics. To account for the correlation of observations within intensive care units, robust variance and standard error estimates of regression parameters were computed. RESULTS: AC was used in 6.4% of mothers. Infants were 2934; 314 (10.7%) were born after AC. Multiples were 86.0% among AC and 21.7% among non-AC babies. In multivariable analysis no statistically significant difference in hospital mortality and survival without major morbidities was found between AC and non-AC infants. The risk of BPD was lower in AC than in non-AC multiples (aOR 0.41, CI 0.20-0.87), and this finding did not change after controlling for mechanical ventilation (aOR 0.42, CI 0.20-0.85) or presence of a patent ductus arteriosus (aOR 0.39, CI 0.18-0.84). CONCLUSION: When the analysis is restricted to very preterm infants and stratified by multiplicity, no significant associations between AC and increased risk of short-term mortality and survival without major morbidities emerge. This result is consistent with previous studies, and may confirm the hypothesis that the adverse effects of AC are mediated by preterm birth. However, larger appropriately powered studies are needed before definitely excluding the possibility of adverse events linked to AC in infants born before 32 weeks gestation.

Piccolipiù, a multicenter birth cohort in Italy: protocol of the study.

BACKGROUND: The fetal and infant life are periods of rapid development, characterized by high susceptibility to exposures. Birth cohorts provide unique opportunities to study early-life exposures in association with child development and health, as well as, with longer follow-up, the early life origin of adult diseases. Piccolipiù is an Italian birth cohort recently set up to investigate the effects of environmental exposures, parental conditions and social factors acting during pre-natal and early post-natal life on infant and child health and development. We describe here its main characteristics. METHODS/DESIGN: Piccolipiù is a prospective cohort of expected 3000 newborns, who will be recruiting in six maternity units of five Italian cities (Florence, Rome, Trieste, Turin and Viareggio) since October 2011. Mothers are contacted during pregnancy or at delivery and are offered to participate in the study. Upon acceptance, their newborns are recruited at birth and followed up until at least 18 years of age. At recruitment, the mothers donate a blood sample and complete a baseline questionnaire. Umbilical cord blood, pieces of umbilical cord and heel blood spots are also collected. Postnatal follow-up currently occurs at 6, 12, and 24 months of age using on-line or postal self administered questionnaire; further questionnaires and medical examinations are envisaged. Questionnaires collect information on several factors, including mother's and/or child's environmental exposures, anthropometric measures, reproductive factors, diet, supplements, medical history, cognitive development, mental health and socioeconomic factors. Health promotion materials are also offered to parents. DISCUSSION: Piccolipiù will broaden our understanding of the contribution of early-life factors to infant and child health and development. Several hypotheses on the developmental origins of health can be tested or piloted using the data collected from the Piccolipiù cohort. By pooling these data with those collected by other existing birth cohorts it will be possible to validate previous findings and to study rare exposures and outcomes.