RESUMEN
Childhood obesity is a major public health problem in industrialized countries. The aim of this study was to estimate the risk of obesity at age 5 based on BMI categories at age 3 and changes in BMI z-score from birth to 3â¯years of age. In this population-based study BMI data of 5173 children were collected at ages 3 and 5 and were linked to information relative to birth weight. The prevalence of obesity at age 5 was 3.8%. The risk of obesity for children born large for gestational age was 6.5%, while it was 18.6% for children overweight at age 3 and 62% for children who were obese at 3. An increase in BMI z-score from birth to 3â¯years increases the risk of obesity at age 5 (OR for increase of one standard deviation 2.8%; 95% CI: 2.46-3.20), but adjusting for BMI z-score at age 3, the effect of trajectory disappears (OR 1.08 95% CI: 0.9-1.29). In other words, if one targeted early preventive interventions to 3-year-olds affected by overweight/obesity (only 9.8% of the study cohort), one could possibly address 71% of children potentially affected by obesity at age 5.
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Peso al Nacer , Índice de Masa Corporal , Obesidad Infantil/epidemiología , Preescolar , Femenino , Humanos , Italia/epidemiología , Masculino , Sobrepeso/epidemiología , Prevalencia , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND/AIM: The aim of the present study was to assess the association between PM2.5, its sources, and preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) in a large open residential cohort (Supersito Project in the Emilia-Romagna Region - Northern Italy). METHODS: We collected 2012-2014 pregnancy and childbirth data from Birth Assistance Certificates and selected the pregnancies of interest. PTBs (gestational age < 37 weeks), LBW (weight < 2500 g), and SGA (newborns weighing ≤ 10th age and pregnancy week-specific percentile) were considered. Three-year measurements of daily concentrations and constituents of PM2.5 were available at four sites and were analyzed through a source apportionment approach identifying 6 sources (traffic, biomass burning, oil combustion, anthropogenic mix, and two secondary factors). Exposure to PM2.5 and sources was calculated at address level. Using logistic regression models, associations between exposure and outcomes were derived, applying single-pollutant and two-pollutant models, to verify the independent effect of each source. RESULTS: The study included 23,708 neonates born to 23,415 women, among whom 1,311 PTB, 424 LBW, and 1,354 SGA occurred. PTB was the only outcome associated with PM2.5 mass (OR 1.03, 95% CI 1.002-1.058 per 1 µg/m3). Traffic, oil combustion and secondary sulfates and organics showed independent effects on PTB. Exposure to secondary nitrates was associated with a lower risk of PTB. There was no association between LBW or SGA and source-specific PM2.5 components or the residual PM2.5 related to all other sources. CONCLUSION: This study found an association between PTB and PM2.5. Traffic, secondary sulfates, and organic and oil combustion were the sources with most consistent association.
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Contaminantes Atmosféricos , Contaminación del Aire , Nacimiento Prematuro , Contaminantes Atmosféricos/análisis , Contaminantes Atmosféricos/toxicidad , Contaminación del Aire/análisis , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Italia/epidemiología , Exposición Materna/efectos adversos , Material Particulado/análisis , Material Particulado/toxicidad , Embarazo , Nacimiento Prematuro/inducido químicamente , Nacimiento Prematuro/epidemiologíaRESUMEN
OBJECTIVES: to explain differences in effectiveness of paediatrician-led motivational interviewing (MI) in decreasing body mass index (BMI) between children of mothers with low or high education level. DESIGN: secondary analysis of a randomised control trial. SETTING AND PARTICIPANTS: individually randomized controlled trial previously conducted from 2011 to 2013 in the province of Reggio Emilia (Emilia-Romagna Region, Northern Italy). Eligible participants included in the trial were 372 (187 in the MI group and 185 in the control group) overweight children (BMI percentile >= 85th and < 95th) aged between 4 and 7 years, residing in the province of Reggio Emilia and under the care of paediatrician for >= 12 months. The intervention included 5 MI sessions based on the transtheoretical model of addiction and behavioural change delivered at 1, 4, 7, and 12 months after the baseline visit, when families had to define specific goals in changing physical activity (PA) and diet behaviours. MAIN OUTCOME MEASURES: primary: BMI score variation (ΔBMI) from baseline to 12 months; secondary: percentage of changes in parent-reported PA and dietary behaviours. RESULTS: a significant effect of MI on ΔBMI in children whose mothers had high education level (ΔBMI = -0.62; 95%CI -0.92;-0.32) were observed. Children of women with high education level in MI group had more improvements in set unstructured PA, decreasing screen time and sweet snacks consumption, while children with less educated mothers had improvements in consuming more vegetable soup and less desserts, sweet snacks, and sugary beverages. Highly educated mothers chose for their children to drink fewer sugary beverages and to increase PA. Less educated mothers most frequently chose as goals having breakfast, eating more fruit and vegetables, eating fewer snacks, and having less screen time. Overall achievement was similar in the two strata for diet goals, but higher for PA goals in the high education level stratum. CONCLUSIONS: MI intervention was not effective in reducing BMI in children of mothers with low education level. This does appear to be weakly or not associated with goal choices and achievement within MI, it is rather an effect of unmeasured behaviours which possibly mediate association between MI and BMI reduction.
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Escolaridad , Obesidad Infantil , Índice de Masa Corporal , Niño , Dieta , Femenino , Humanos , Lactante , Italia/epidemiología , Madres , Sobrepeso , Obesidad Infantil/epidemiología , Obesidad Infantil/prevención & controlRESUMEN
BACKGROUND: the Italian National Prevention Plan (PNP) posed the standard to be achieved by Regions for the prevention of obesity in childhood and adolescence. The PNP also set up a monitoring system to assess the impact of implemented policies. OBJECTIVES: to develop a conceptual model to facilitate interpretation of variation in outcome indicators. METHODS: after a systematic review, the DPSEEA («Driving forces¼, «Pressures¼, «State¼, «Exposure¼, «Effect¼, «Actions¼) was identified as the more appropriate framework to assess the results of preventive policies. Factors for each component of the framework were identified and indicators that allow measuring the changing of each of these factors were defined. RESULTS: the included «driving forces¼ were related to the profit-led food industry, to the nutrition environment at school, and to household-level factors. Among the «pressures¼, parenting behaviours, food provided by school canteens, sociocultural factors, social context, physical activity (PA), opportunities at school or after-school were included. In the State, the high consumption of processed food, the large quantities of high-calorie food easy available, the consumption of carbonated and sugar-sweetened beverages, the reduced social function of mealtimes in families, the early cessation of breastfeeding, the reduction of outdoors activity, active transportation, and PA at school for children were identified. The «exposure¼ factors were the reduced opportunities of doing PA and the over-consumption of calories that influence the «effect¼, described as the prevalence of children and adolescents affected by obesity. CONCLUSIONS: through the DPSEEA, a conceptual model was set up; it allows to place in the causal chain the «actions¼ and the mechanisms through which these actions should impact on the «exposure¼ (PA and over-consumption of calories), making the rationale of process and impact indicators explicit.
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Obesidad Infantil , Adolescente , Niño , Ingestión de Energía , Comida Rápida , Humanos , Italia/epidemiología , Obesidad Infantil/epidemiología , Obesidad Infantil/prevención & control , Instituciones AcadémicasRESUMEN
OBJECTIVES: the Italian National Prevention Plan (PNP) posed the standard to be achieved by Italian Regions for the implementation of cervical, breast, and colorectal cancer screening: to invite all of the target populations and to increase the screening uptake up to 50%, 60%, and 50%, respectively, the standard defined by the Essential Levels of Care (LEA). Moreover, for cervical cancer screening, it requires the implementation of HPV-DNA test and, for breast cancer screening, the PNP demands for the definition of diagnostic and follow up pathways for high familial risk women. The PNP also set up a monitoring system to assess the impact of implemented policies. A conceptual model has been defined to facilitate interpretation of variation in outcome indicators. DESIGN: after a systematic review, the DPSEEA (Driving forces, Pressure, State, Exposure, Effect, Actions) was identified as the more appropriate framework to assess the results of preventive policies. Factors for each component of the model were identified and indicators that allow measuring the changing of each of these factors were defined. RESULTS: among the "driving forces", the trust in the health care system and the social capital were included. The presence of opportunistic screening, the competing private clinical activity, the commitment of General Practitioners and "medical" leaders, the attitude to cooperation and to patients' involvement, and the level of agreement between the positions of scientific societies and the recommendations implemented in organized screening programmes were included in the "pressures". In "state", the availability of technological and human resources, the level of management skills and of accessibility were identified. The "exposure" was defined as the coverage of active invitation of the target population and the uptake of screening tests. The "exposure" factors influence the "effect", described as the impact on anticipation of cancer diagnosis, on disease incidence (for cervical and colorectal cancer) and prognosis. The changing in screening programs performance modifies the impact of invitation coverage and test uptake ("exposure"). CONCLUSIONS: through the DPSEEA framework, we set up a logical conceptual model, which includes implementable actions and the mechanisms through which these actions should impact on the "exposure" (invitation coverage and screening uptake) and on the screening performance (quality).
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Neoplasias de la Mama/prevención & control , Neoplasias Colorrectales/prevención & control , Interpretación Estadística de Datos , Detección Precoz del Cáncer/estadística & datos numéricos , Modelos Estadísticos , Indicadores de Calidad de la Atención de Salud , Neoplasias del Cuello Uterino/prevención & control , Femenino , Programas de Gobierno , Humanos , ItaliaRESUMEN
INTRODUCTION: Describing and monitoring socioeconomic inequalities in health are the prerequisite for planning equity policies. In Italy, some cities have integrated personal information from the municipal registries with Census data and with data from healthcare information systems to set up Longitudinal Metropolitan Studies (LMS). Under the coordination of the Italian National Institute for Health, Migration, and Poverty (NIHMP), six cities in the LMS network have contributed to the present monograph: Turin, Venice, Reggio Emilia, Modena, Bologna, and Rome. MORTALITY RESULTS. Significant socioeconomic differences by level of education were seen in all the participating centres. People who live alone or in single-parent households are more likely to die, as are those living in a substandard dwelling. Immigrants resident in the six cities included in the study showed lower all-cause mortality than Italians (males: MRR 0.83; 95%CI 0.78-0.90 - females: MRR 0.70; 95%CI 0.64-0.77). Sub-Saharan Africans experienced a significant higher mortality than Italians (males: MRR 1.33; 95%CI 1.12-1.59 - females: MMR 1.69; 95%CI 1.31-2.17). Immigrants had a neonatal and post-neonatal mortality risk about 1.5 times higher than Italians (neonatal: OR 1.71; 95%CI 1.22-2.39 - post-neonatal: OR 1.63; 95%CI 1.03-2.57). A difference between Italians and immigrants was also observed for mortality in children aged 1-4 years, though less marked (OR 1.24; 95%CI 0.73-2.11). Excesses concerned particularly immigrants from North Africa and from sub-Saharan Africa as well as those residing in Italy for >5 years. HOSPITALISATION RESULTS. Hospitalisation rates are lower for immigrants than for Italians, except when due to infectious diseases, blood disorders, and, among women, for reasons linked to pregnancy and childbirth. Avoidable hospitalisation rates of adults from low migratory pressure Countries are lower than or equal to those of Italians. On the contrary, adults from low migratory pressure Countries show higher avoidable hospitalisation rates compared to Italians in every cohort, with the exception of Rome (RR 0.81; 95%CI 0.78-0.85), with RR ranging from 1.08 (95%CI 0.96-1.22) in Venice to 1.64 (95%CI 1.47-1.83) in Modena. CONCLUSIONS: Maternal and child health is the most critical area of health for immigrant population. Considering the importance that the issue of health equity has taken on in the political agenda, the data presented in this volume are a great asset, particularly in light of the long recession and the social crisis that have impacted the Country.
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Emigrantes e Inmigrantes , Salud de las Minorías , Adolescente , Adulto , Niño , Preescolar , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Lactante , Recién Nacido , Italia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Salud de las Minorías/estadística & datos numéricos , Mortalidad , Factores Socioeconómicos , Salud Urbana , Adulto JovenRESUMEN
BACKGROUND: In Italy, Mesothelioma Registries (MRs) have been established by law for the epidemiological surveillance of occupational cancers. MRs collect information about asbestos exposure of incident cases, through interviews. In the Emilia-Romagna region, MR was implemented in 1996 and extended its network of health professionals who report suspected mesothelioma in 2001 and 2007. OBJECTIVES: This study evaluated the impact of the extension of the network on MR sensitivity and timeliness. METHODS: Mesothelioma cases were analysed in three subsequent periods: 1996-2001 (before any network extension), 2002-2007 (after first extension) and 2008-2014 (after second extension). Sensitivity was evaluated by the proportion of cases directly reported by the network out of the total number of incident cases; reporting and interview timeliness were assessed by median times between diagnosis and, respectively, reporting and interview. Pleural mesothelioma reporting timeliness was also evaluated by use of quantile regression models, stratified by diagnostic certainty and adjusted by sex and age. RESULTS: Sensitivity increased from 79.4% (1996-2001), to 89.0% (2002-2007) and to 91.4% (2008-2013). For mesothelioma with diagnostic certainty, we recorded considerably reduced reporting times from the 50th percentile on, whereas for uncertain mesothelioma relevant reductions were observed also in the lower percentiles. A reduced time to interview was observed too, which was more significant for uncertain cases. The proportion of patients directly interviewed increased from 33.5% (1996-2001), to 39.1% (2002-2007), to 49.5% (2008-2014). CONCLUSIONS: The extended network improved the MR sensitivity and allowed shorter reporting and interview times and more frequent patient interviews, thus improving accuracy of exposure definition.
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Amianto/efectos adversos , Monitoreo Epidemiológico , Mesotelioma/epidemiología , Mesotelioma/etiología , Exposición Profesional/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
Despite a rapid increase in immigration from low-income countries, studies on immigrants' mortality in Italy are scarce. We aimed to describe differences in all and cause-specific mortality among immigrants and Italians residing in Turin and Reggio Emilia (Northern Italy), two cities participating in the Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS). We used individual data from the municipal population registers linked to the cause of death registers. All people aged 1-64 years residing between 2001 and 2010 were enrolled (open cohort) and followed up until 2013. The mortality of citizens from high migratory pressure countries (as a whole, and for each macro-area group) was compared with that of Italians; differences were estimated by Poisson regression adjusted by age and calendar year mortality rate ratios (MRRs), and by age-standardized mortality ratios for the analysis of cause-specific mortality. Compared with Italians, immigrants had lower overall mortality (MRR for men: 0.82, 95 % CI: 0.75-0.90; for women: 0.71, 95 % CI: 0.63-0.81). Sub-Saharan Africans experienced a significant higher mortality than Italians (MRR for men 1.29, 95 % CI: 1.03-1.61; for women: 1.70, 95 % CI: 1.22-2.36). Higher mortality for immigrants compared to Italians was observed for infectious diseases, congenital anomalies, some site-specific tumours and homicide mortality. Our study showed heterogeneity in mortality across the macro-areas of origin, and in particular Sub-Saharan Africans seemed to be a vulnerable population. The extension to other cohorts of IN-LiMeS will allow the health status of immigrants and vulnerable groups to be studied and monitored in more depth.
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Causas de Muerte , Emigrantes e Inmigrantes/estadística & datos numéricos , Emigración e Inmigración/estadística & datos numéricos , Mortalidad/etnología , Sistema de Registros , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Italia/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Población Urbana , Adulto JovenAsunto(s)
COVID-19 , Pandemias , Adolescente , Niño , Humanos , Italia/epidemiología , Pandemias/prevención & control , SARS-CoV-2 , Instituciones AcadémicasRESUMEN
BACKGROUND: The few studies that have investigated the relationship between emissions from municipal solid-waste incinerators and adverse pregnancy outcomes have had conflicting results. We conducted a study to assess the effects of air emissions from the eight incinerators currently in operation in the Emilia-Romagna Region of Italy on reproductive outcomes (sex ratio, multiple births, preterm births, and small for gestational age [SGA] births). METHODS: We considered all births (n = 21,517) to women residing within a 4-km radius of an incinerator at the time of delivery during the period 2003-2010 who were successfully linked to the Delivery Certificate database. This source also provided information on maternal characteristics and deliveries. Each newborn was georeferenced and characterized by a specific level of exposure to incinerator emissions, categorized in quintiles of PM10, and other sources of pollution (NOx quartiles), evaluated by means of ADMS-Urban system dispersion models. We ran logistic regression models for each outcome, adjusting for exposure to other pollution sources and maternal covariates. RESULTS: Incinerator pollution was not associated with sex ratio, multiple births, or frequency of SGA. Preterm delivery increased with increasing exposure (test for trend, P < 0.001); for the highest versus the lowest quintile exposure, the odds ratio was 1.30 (95% confidence interval = 1.08-1.57). A similar trend was observed for very preterm babies. Several sensitivity analyses did not alter these results. CONCLUSIONS: Maternal exposure to incinerator emissions, even at very low levels, was associated with preterm delivery.
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Contaminantes Atmosféricos/efectos adversos , Contaminación del Aire/efectos adversos , Incineración , Exposición Materna/efectos adversos , Nacimiento Prematuro/epidemiología , Adulto , Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , Bases de Datos Factuales , Femenino , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Italia/epidemiología , Masculino , Exposición Materna/estadística & datos numéricos , Progenie de Nacimiento Múltiple/estadística & datos numéricos , Embarazo , Nacimiento Prematuro/inducido químicamente , Razón de Masculinidad , Adulto JovenRESUMEN
BACKGROUND: The primary aim of this study was to assess the effect of immigrant status on Emergency Room (ER) utilisation by children under age one, considering all, non-urgent, very urgent, and followed by hospitalisation visits. The second aim was to investigate the role played by mother's educational level in the relationship between citizenship and ER utilisation. METHODS: The cohort study included all healthy singleton live births in the years 2008-2009 and residing in the province of Reggio Emilia, followed for the first year of life in order to study their ER visits. The outcomes were the ER utilisation rate for all, non-urgent, very urgent, and followed by hospitalisation visits. The main explanatory variable was mother's citizenship. Other covariates were mother's educational level, maternal age, parity, and child gender. Multivariate analyses (negative binomial regression and zero inflated when appropriate) were performed. Adjusted utilisation Rate Ratios (RR) and their 95% Confidence Intervals (95% CI) were calculated. Trend for age in months by citizenship is depicted. RESULTS: There were 3,191 children (36.4%) with at least one ER visit in the first year of life. Adjusted RR show a significantly greater risk of ER visit for immigrants than for Italians: (RR 1.51; 95% CI 1.39-1.63). Immigrants also had a higher risk of non-urgent visits (RR 1.72; 95% CI 1.48-2.00) and for visits followed by hospitalizations (RR 1.58; 95% CI 1.33-1.89). For very urgent visits, the immigrants had a slightly higher risk compared to Italians (RR 1.25; 95% CI 0.98-1.59).The risk of ER visits is higher in the first two months of life (RR(1st vs 3rd-12th) 2.08; 95% CI 1.93-2.24 and RR(2nd vs 3rd-12th) 1.45; 95% CI 1.33-1.58, respectively). Considering all visits, the ER utilisation rate was inversely related with maternal education only for Italians (low educational level 44.0 and high educational level 73.9 for 100 children; p value for trend test < 0.001). CONCLUSIONS: Our study observed a higher use of ER services by immigrant children and, to a lesser extent, by children of less educated Italian mothers. In immigrants, the excess is mostly due to non-urgent visits and only slightly to high acute conditions.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Emigrantes e Inmigrantes/estadística & datos numéricos , Adulto , Escolaridad , Femenino , Humanos , Lactante , Recién Nacido , Italia/epidemiología , Masculino , Edad Materna , Paridad , Factores Sexuales , Factores Socioeconómicos , Adulto JovenRESUMEN
PURPOSE: The objective of this study was to assess whether the EQ-5D independently predicts all-cause mortality and first hospitalization in a generic elderly population and to evaluate the relationship between the EQ-5D "Class of problems," the EQ-5D index, the EQ-Visual Analogue Scale (EQ-VAS), and the number of hospitalizations occurring over a 2-year period. METHODS: The data were collected in a longitudinal study (over 5 years) conducted on 9,644 elderly people in northern Italy with 5,256 completed questionnaires returned. Multivariate Cox's proportional hazards models were used to assess the effect of the EQ-5D questionnaire on 12 and 24 month mortality and first hospitalization risk, controlling for sociodemographic and medical covariates. Multivariate Zero-Inflated Poisson models were performed to test the association between the EQ-5D "Class of problems," the EQ-5D index and EQ-VAS and the number of hospitalizations over 2 years. RESULTS: The EQ-5D "Class of problems," EQ-5D index, and EQ-VAS were consistently associated with mortality and first hospitalization rates. The EQ-VAS was associated with the number of hospitalizations over 2 years, though the EQ-5D "Class of problems" and EQ-5D index were not. CONCLUSIONS: The EQ-5D questionnaire is a useful predictor of mortality and first hospitalization in a generic elderly population in Italy. This suggests that it would be a good instrument for evaluating the effect of social/medical actions in a population-based study.
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Hospitalización/estadística & datos numéricos , Mortalidad , Calidad de Vida , Encuestas y Cuestionarios , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Italia , Estimación de Kaplan-Meier , Estudios Longitudinales , Masculino , Modelos de Riesgos ProporcionalesRESUMEN
Childhood obesity is a high prevalence condition that causes a high burden of disease in adulthood. Mobile phone app are increasingly used to prevent it. We summarized the evidence on the effectiveness of mobile apps for devices used by parents to prevent and treat childhood and adolescent obesity. An update of a systematic review of the literature (De Lepeleere et al., 2017) was carried out. PubMed, Embase, Cochrane, CINAHL, PsycINFO, Scopus, and ERIC were searched up to 2020. The included studies should target children 1-18 years, compare an app aimed at preventing or treating overweight and obesity, as stand-alone intervention or as part of a complex program, installed on parents' mobile devices, to no intervention or an intervention without the app. Outcomes related to weight status, diet, and physical activity (PA) behaviors were considered. Nineteen studies (14 RCTs and 5 non-randomized trials) were included. The app was mainly used to record food consumption and PA, to set goals, to view progress, and send health promotion messages. One study reported a significant decrease and one a suggestive decrease in anthropometric measures in obese and overweight children, while other studies observed no effect. One study reported a significant increase in PA. Six interventions proved to be effective in changing dietary behaviors. Interventions targeting overweight and/or obese children had the most positive results. All studies reported high acceptability and feasibility of interventions. The differences between interventions and the small sample size of the studies did not allow this review to reach conclusion on effectiveness.
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BACKGROUND/AIM: The relationship between air pollution and respiratory morbidity has been widely addressed in urban and metropolitan areas but little is known about the effects in non-urban settings. Our aim was to assess the short-term effects of PM10 and PM2.5 on respiratory admissions in the whole country of Italy during 2006-2015. METHODS: We estimated daily PM concentrations at the municipality level using satellite data and spatiotemporal predictors. We collected daily counts of respiratory hospital admissions for each Italian municipality. We considered five different outcomes: all respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), lower and upper respiratory tract infections (LRTI and URTI). Meta-analysis of province-specific estimates obtained by time-series models, adjusting for temperature, humidity and other confounders, was applied to extrapolate national estimates for each outcome. At last, we tested for effect modification by sex, age, period, and urbanization score. Analyses for PM2.5 were restricted to 2013-2015 cause the goodness of fit of exposure estimation. RESULTS: A total of 4,154,887 respiratory admission were registered during 2006-2015, of which 29% for LRTI, 12% for COPD, 6% for URTI, and 3% for asthma. Daily mean PM10 and PM2.5 concentrations over the study period were 23.3 and 17 µg/m3, respectively. For each 10 µg/m3 increases in PM10 and PM2.5 at lag 0-5 days, we found excess risks of total respiratory diseases equal to 1.20% (95% confidence intervals, 0.92, 1.49) and 1.22% (0.76, 1.68), respectively. The effects for the specific diseases were similar, with the strongest ones for asthma and COPD. Higher effects were found in the elderly and in less urbanized areas. CONCLUSIONS: Short-term exposure to PM is harmful for the respiratory system throughout an entire country, especially in elderly patients. Strong effects can be found also in less urbanized areas.
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Contaminación del Aire , Material Particulado , Anciano , Contaminación del Aire/estadística & datos numéricos , Hospitalización , Humanos , Italia/epidemiología , Material Particulado/efectos adversos , UrbanizaciónRESUMEN
OBJECTIVE: The aim of the study is to compare Italian and immigrant accesses to Emergency Room (ER) Services in the province of Reggio Emilia, with particular attention to time differences and to potentially inappropriate accesses. SETTING AND PARTICIPANTS: the database of ER accesses in the province of Reggio Emilia was analyzed for the years 2007- 2010. In the analysis of the resident population all autochthonous citizens and all immigrants from Developed Countries were considered Italians, while citizens from Developing Countries were Immigrants. Temporary Immigrants were those immigrants with residence and citizenship in a Developing Country. MAIN OUTCOME MEASURES: A descriptive analysis was conducted using demographic variables related to patients (age, gender, citizenship and residence) and variables related to access (admission emergency codes, cause of admission, hour, day of the week, month and discharge modality). Standardized access Ratios (SRs) were calculated for the resident population, together with 95%Confidence Intervals (95% CI). The SRs were calculated separately for children and for adults. RESULTS: In the years 2007-2010, 562,658 accesses to ER were recorded for Italians, 95,300 accesses for Immigrants and 6,800 for the Temporary Immigrants. Access rates for resident Immigrants were higher than Italian ones. In 2010, the SR for men was 1.24 (95%CI 1.22-1.27) while for women it was 1.18 (95%CI 1.15-1.27). Considering only non-urgent accesses, the SRs were even higher (SR men=1.65, 95% CI 1.58-1.72, women=1.43, 95% CI 1.36-1.50). Similar findings were observed in children. CONCLUSION: Immigrants access the ER services more than Italians do.They also show more non-urgent accesses in comparison with Italians. This finding is consistent with results of studies conducted in other European countries and it underlines the necessity to reorganize primary care in order to better meet immigrants' needs.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Emigrantes e Inmigrantes/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Migrantes/estadística & datos numéricos , Adolescente , Adulto , África/etnología , Asia/etnología , Niño , Preescolar , Países en Desarrollo , Grupos Diagnósticos Relacionados , Europa Oriental/etnología , Femenino , Necesidades y Demandas de Servicios de Salud , Disparidades en el Estado de Salud , Humanos , Lactante , Italia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenAsunto(s)
Ingestión de Alimentos , Ejercicio Físico , Entrevista Motivacional , Visita a Consultorio Médico , Sobrepeso/prevención & control , Padres , Pediatría , Adulto , Antropometría , Índice de Masa Corporal , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Estudios de Seguimiento , Guías como Asunto , Sistemas Prepagos de Salud , Humanos , Italia , Masculino , Entrevista Motivacional/métodos , Sobrepeso/terapia , Obesidad Infantil/prevención & controlRESUMEN
BACKGROUND: Anticipatory guidance for parents is commonly used to improve parenting skills. The objective of this pre/post-intervention controlled study was to evaluate the effectiveness of a periodic newsletter with advice on childcare and development in improving parenting self-efficacy. METHODS: This was a non-randomized pre/post-intervention controlled study. All the parents of children born between September 2014 and December 2015 resident in the S. Ilario d'Enza municipality (Italy) received eight Baby Newsletters. Parents resident in other municipalities of the same Health District were the control. Parents with linguistic barriers or with preterm or hospitalized children were excluded. Improvement in parenting self-efficacy was measured through the TOPSE (Tool to Measure Parenting Self-Efficacy) questionnaire during the first week (t0) after delivery and at 5 (t1) and 12 months (t2) of life at two vaccination appointments. A score ranging from 0 to 60 was computed for each of the eight domains investigated by the TOPSE. Variations of each TOPSE score between delivery and 12 months in the two groups were compared, adjusting for parity, education, age of parents, and child's sex, and stratifying by parity and education. RESULTS /FINDINGS: One hundred thirty-six families accepted to participate in the study. Scores at 12 months were higher than 1 week after delivery in both groups for all TOPSE domains. The improvement was slightly stronger in the Newsletter group for almost all the skills except learning and knowledge [difference in the mean of variation: -0.48 (95% CI: - 3.17; 2.21)]; the difference was significant only for play and enjoyment [2.18 (95% CI: 0.12; 4.25)]. The increase in scores in almost all domains was more pronounced for parents with high education level at first child. CONCLUSIONS: The intervention was effective in improving parents' ability to play. However, it risks worsening existing differences between parents with high and with low education levels. TRIAL REGISTRATION: Clinical trial registration: NCT03268408 .
Asunto(s)
Educación no Profesional , Responsabilidad Parental , Padres/educación , Padres/psicología , Autoeficacia , Adulto , Estudios Controlados Antes y Después , Femenino , Humanos , Italia , Masculino , Periódicos como Asunto , Juego e Implementos de Juego , Encuestas y CuestionariosRESUMEN
BACKGROUND: Anticoagulant concentration in plasma units is extremely variable. Understanding the underlying causes of this variability could help personalise plasmapheresis procedures in order to optimise the risk-benefit ratio. We studied the association between anticoagulant solution A (usually ACD-A, Citrate Dextrose Solution A) volume in plasma units and donor characteristics to build a model to determine the needed weight of the final plasma unit to have an 80% probability of reaching 600 mL net plasma. MATERIALS AND METHODS: We experimentally measured ACD-A in 296 plasma units from an Italian blood donor centre, where machines are set for the collection of 700 g of plasma. Next, we built a statistical model to predict how the final volume of the unit should be set to obtain 50%, 80% or 90% probability of having at least 600 mL net plasma. RESULTS: ACD-A volume was associated with haemoglobin, total proteins and triglycerides. Donors with low haemoglobin reach an 80% probability of at least 600 mL net plasma with units of approximately 690 g, while 720 g are needed for donors with high haemoglobin levels. For total proteins and triglycerides, plasma units may vary within a range of ±20 g. DISCUSSION: Our model, based on easily measurable individual characteristics, makes it possible to customise plasmapheresis procedures by determining the blood volume to be processed for each donor. Tailored plasma donations might result in both a reduction in adverse events and an increase in the quality of collected plasma.