Reduction incidence of myocardial infarction associated with a national legislative ban on smoking.

AIM: The aim of the present study was to assess change in admissions for acute myocardial infarction (AMI) in the period immediately subsequent to the coming into force of law no. 3/2003 ''Protection of the health of non-smokers''. METHODS: Four Italian regions (Piedmont, Friuli Venezia Giulia, Lazio and Campania) took part in the study. Data regarding admissions for AMI were taken from the daily discharge papers of patients aged between 40 and 64 (cod. ICD9-CM 410.), in the period 10 January-10 March 2001-2005. Repeated admissions were excluded. Admission rates standardised by age and overall total, and specifically by region, age and gender were calculated. The hypothesis of a significant reduction between 2005 and 2004 was also checked. RESULTS: The results showed a decrease in the number of cases and in the standardised rates between 2004 and 2005. The number of admissions estimated with a linear regression model for 2005 was significantly higher than that really observed (+13%). The decrease between the 2005 and 2004 rates was noteworthy for all four regions. Analysis by gender shows that the effect is observed only in male patients and in the age classes 45-49 and 50-54. CONCLUSION: This study shows that there has been an appreciable reduction in the incidence of heart attacks in the period immediately subsequent to the coming into force of the non-smoking Law in the populations surveyed, and that this reduction mainly regards men of working age. The reduction reverses a trend that has been evident for a number of years, namely that of a decidedly upward trend in the number of admissions for AMI.

Influenza outbreaks and hospital bed occupancy in Rome (Italy): current management does not accommodate for seasonal variations in demand.

OBJECTIVE: Our goal was to assess how different hospital wards react to influenza epidemics, and whether related specialties cooperate in coping with winter bed crises. STUDY DESIGN: The Lazio Hospital Information System (HIS) dataset from July 1998 to June 2001 was used for the study. The HIS collects data on all hospital discharges. We considered diagnosis-related groups (DRG) as the reason for hospital stay and used DRG to classify admissions as influenza related or influenza unrelated. Time series analysis of daily bed occupancy in different specialty areas by influenza-related and influenza-unrelated cases was performed. Generalized additive models (GAMs) were used to take the effect of short-term and seasonal bed occupancy into account on influenza-related occupancy. RESULTS: Influenza-related bed occupancy ranges from 770 patients/day during the influenza season to 525 patients/day during the rest of the year. Daily occupancy by influenza-related cases represents 2.8% of total hospital occupancy and 7% of general medicine occupancy during the influenza season. When comparing the influenza season with the rest of the year, general medicine occupancy by influenza-related cases increases by 51% versus the 25-32% increase in other specialty wards. Little change in daily occupancy by influenza-unrelated cases was observed in all specialties when comparing the influenza season with the rest of the year. CONCLUSIONS: Hospital specialty wards react poorly and single handedly to a minor and predictable burden. Any winter bed crisis in the Lazio region is probably the result of defective management of available beds more than excess in demand.

Intrauterine rupture of the intrauterine device "ML Cu 250": an uncommon complication: presentation of a case.

We have reported on fragmentation on removal of an ML Cu 250. The patient's management is discussed and the possible causes of fragmentation presented, with special reference to the IUD materials and/or design.

PIP: This paper presents a case of fragmentation on removal of an ML Cu 250 IUD. This device, which was introduced in 1974, has been widely and successfully used in multiparous and nulliparous women. The device is built as a small idented crown over a vertical copper-coiled stem. The patient in this case, a 36-year old woman with 3 previous vaginal deliveries, was seen for removal of the device 26 months after insertion. When vaginal extraction was attempted, the nylon string of the IUD broke. Ecotomography and x-rays revealed the IUD to be in a transversal position on the uterine fundus. A hysterectomy was deemed necessary for removal. At 1st effort, only the stem was removed. Further attempts yielded a fragment of the crown. Other fragments were not found after repeated trials. Although shedding of the IUD's copper coil is not uncommon in longterm IUD users, intrauterine fragmentation of the IUD frame is a rare complication. The literature includes 3 other reports of this complication in ML Cu 250 acceptors. This device is thought to be vulnerable to intrauterine fragmentation because of the combined effect of deep adhesions to the endometrium and low resistance points of the device frame. It is hypothesized that the adhesion is dependent on the crown teeth, which become embedded in the endometrial mucosa and determine both stiffness and high resistance to extraction. Comparative resistance trials are currently being conducted on several IUDs. Until the results of these trials become available, selective use and very cautious removal of the ML Cu 250 are advised.

The assessment of IUD mechanical resistance: an experimental model.

An experimental model to assess IUD resistance to mechanical fatigue is presented by which the performance of several IUD models has been tested both new and after variable intrauterine use, up to 33 months. According to the results of this study, IUD resistance decreases exponentially with time, and IUD shape apparently affects resistance. Therefore, prolonged intrauterine use apparently increases rupture liability. Moreover, it is suggested that some IUD features can minimize chances of intrauterine rupture and/or fragmentation.

[Mechanical resistance of intrauterine devices. Experimental evaluation]. / La resistenza meccanica dei dispositivi intrauterini. Una valutazione sperimentale.

In view of the possible intracavitary breakage of an IUD, an experimental model was created to evaluate resistance to mechanical stress in new IUDs and IUDs which had been used for varying periods (6-12-24 months). The results of the study showed that, in addition to a slight inhomogeneity of the product which is probably due to incorrect industrial manufacturing procedures, there is also a correlation between the risk of breakage and intrauterine ageing which is particularly evident in some IUDS.

Cyclic fluctuations in hospital bed occupancy in Roma (Italy): supply or demand driven?

The objective of this study was to assess hospital bed occupancy both by planned and unplanned cases, and to assess how supply and demand affect bed occupancy. Data was obtained from the Lazio Hospital Information System (HIS) dataset on all hospital discharges from July 1998 to June 2001. Using Diagnosis Related Groups (DRG) as the reason for hospital stay, admissions were classified into four categories: 'planned stay', 'presumed planned stay', 'presumed unplanned stay', and 'unplanned stay'. Time series analysis of daily bed occupancy by category of stay was performed. Generalized Additive Models (GAMs) were used to asses the effect of weekdays and holidays on bed occupancy. Fluctuations in daily occupancy were observed in all categories of stay-in general, bed occupancy decreased over weekends, on national holidays, and during the major holiday season of August. In comparison with unplanned stays, the largest fluctuations were observed for planned stays while presumed planned and unplanned stays showed lesser fluctuations. It is possible to distinguish planned and unplanned hospital stays by using DRG grouping. Cyclic rigidities in the supply of services rather than the availability of beds or demand for beds seem to dictate hospital use in Roma so that restrictions in services hamper any reallocation of beds for 'planned stay' when demand for 'unplanned stay' beds declines.

[Differences in in-hospital mortality in patients treated with aortocoronary bypass for cardiopathic ischemia, Rome 1996]. / Differenze di mortalità intraospedaliera in pazienti sottoposti a bypass aortocoronarico per cardiopatia ischemica, Roma 1996.

Data from Health Information Systems (HIS) have been used in recent years to evaluate effectiveness and quality of care. We analyzed in-hospital mortality occurring within 30 days following operation among 1984 patients (age > or = 35 yrs, males 84%) who underwent Coronary Artery Bypass Graft (CABG) surgery in seven hospitals in Rome in 1996. Data were extracted from the Lazio HIS run by the Regional Health Authority. The HIS database includes up to four diagnoses and surgical procedures (ICD-9); the following variables were considered a priori risk factors: type of ischemic disease, comorbidities, and others surgical interventions during the same admission. Logistic regression was performed in order to evaluate the association between hospital and risk of mortality after adjusting for potential confounders (ORs and 95% CI). The overall in-hospital mortality was 4.7% (ranged from 0.0 to 14.7%). Predictors of outcome included: older age, acute myocardial infarction, chronic myocardial ischemia, other heart diseases, chronic renal diseases, peripheral vascular diseases, other heart and vascular interventions. Statistically significant variability in mortality was observed across hospitals; taking hospital A as reference, hospitals D and E showed the highest risks (OR = 6.36 and OR = 3.12, respectively). We conclude that the observed differences in mortality rates among hospitals cannot be explained by differences in case mix, nor by varying coding styles. They are likely to reflect differences in currently unknown aspects of patient care.

[The major nerve trunks are not the primary action site of intravenous regional anesthesia]. / I tronchi nervosi di maggior calibro non costituiscono il sito d'azione primario dell'anestesia regionale intravenosa.

In a patient suffering from a deep penetrating wound of the left forearm and radial nerve injury, the administration of intravenous regional anesthesia (IVRA) was followed by prompt analgesia of the whole arm while intense pain could still be elicited by stimulating radial nerve stump. Complete radial nerve block was present 10 min later confirming that initial blockade of nerve terminals substantially contributes to IVRA and suggesting that a 10 min delay is indicated for optimal analgesia after IVRA whenever a major nerve injury is suspected.

[In clinical use conditions naloxone does not antagonize the effects of ketamine]. / In condizioni di impiego clinico il naloxone non antagonizza l'azione della ketamina.

PIP: 20 women undergoing voluntary induced abortion for the first time who were 25-35 years old and weighed 55-65 kg. received .2 mg/kg diazepam iv and 2 mg/kg ketamine iv. 5 and 10 minutes after starting of anesthesia, 10 patients received 4 mcg/kg naloxone iv for a total dose of 8 mcg/kg. The remaining 10 patients received 2 ml of physiological solution iv twice. The interval between the administration and onset of anesthesia was 78 + or - 10.3 seconds in the control group and 79.1 + or - 12.9 seconds in the treatment group. The duration of anesthesia was 7.5 + or - .8 minutes in controls and 7.4 + or - 1 minute in the naloxone-treated group. The recuperation as measured by answering simple commands was 23.8 = or - 3 minutes in controls and 24 + or - 4.2 minutes in the naloxone group. Recognition of persons was 36.5 + or - 5.3 minutes and 36 + or - 5.2 minutes, respectively; and the regaining of spacial- temporal orientation took 75 + or - 9.8 minutes and 73.8 + or - 12.2 minutes, respectively. These figures were without statistical significance. There were 13 and 14 instances of side effects in controls and the naloxone treatment group, respectively. 1 case of delirium occurred in both groups; 3 cases of diplopia in both groups; 6 and 5 instances of floating, respectively; 3 and 4 instances of vertigo, respectively; and 1 case of vomiting in the naloxone group. 1 patient in each group considered the experience unpleasant, 4 patients each were unaffected, and 1 each judged it pleasant. The score on the scale of analgesia was 2.4 + or - 1.2 in the control group and 2.3 + or - .9 in the naloxone-treated group. In conclusion, clinical doses of naloxone did not appreciably modify the action of ketamine, and clinical doses of ketamine do not interfere the opiate receptors.^ieng

The adjusted contraceptive score (ACS) improves the overall performance of behavioural and barrier contraceptive methods.

PIP: The Adjusted Contraceptive Score (ACS), a new scoring method that was designed to help health providers and acceptors to select the most appropriate behavioral or barrier contraceptive method, was found to positively affect contraceptive performance. In this study, 100 women who applied to an Italian clinic for contraceptive counseling were administered the ACS and 100 controls also attending the clinic were given conventional contraception counseling. The following methods were available to cases and controls: diaphragm, condom, basal temperature, Billings method, Ogino method, and coitus interruptus. At a follow-up interview 12-15 months after the initial clinic visit, study participants were questioned about the number and type of contraceptive methods they had been using. Cases who were administered the ACS reported a significantly lower number of contraceptive choices at follow-up (150 choices total) compared with at the initial visit (224 choices) or the number reported by controls at follow-up (181 choices). Also recorded among those administered the ACS were reduced use of coitus interruptus and the Ogino method and increased reliance on the diaphragm and basal body temperature. Moreover, the occurrence of pregnancy in the follow-up period was markedly less among women administered the ACS (4.2%) than among controls (10.8%). Use of the ACS thus appears to represent a means of achieving effective fertility control among women who cannot use oral contraceptives or the IUD.^ieng

Chlamydial infection and male infertility: an epidemiological study.

Chlamydia-positive genitourinary infections are common causes of male and female infertility. Semen abnormalities are often associated with Chlamydia infections. A large population of male patients, admitted to our clinic for genitourinary infection, were examined for genitourinary pathogens, including Chlamydia, and for semen abnormalities. There were higher abnormalities semen in Chlamydia-infected patients than either non-Chlamydia-infected or healthy controls. Chlamydia therapy by antimicrobial agents improved semen characteristics. Chlamydia infection contributes to seminal fluid abnormalities and probably to male infertility. A search for chlamydial infection is warranted whenever semen abnormalities are noted. An antimicrobial therapy improves semen quality when effective in eradicating Chlamydia.

Improved lung-thorax compliance in the premature rabbit neonate after treatment with dibuturyladenosine-3':5'-cyclic monophosphate.

Premature rabbit neonates, delivered on day 28 of gestation, were treated with a single dose of dibuturyladenosine-3':5'-cyclic monophosphate (cyclic AMP), 300 mg/kg, immediately after delivery, saline-injected litter-mates serving as controls. All animals were kept in body plethysmographs and ventilated artificially with 100% oxygen for 1 h, with a maximal tidal volume of 10 ml/kg body weight. Lung-thorax compliance was significantly improved in animals treated with cyclic AMP, both 30 and 60 min after onset of ventilation (0.92 +/- 0.09 vs. 0.59 +/- 0.08 ml/cm H2O.kg and 0.96 +/- 0.09 vs. 0.53 +/- 0.08, p less than 0.005), but there was no improvement in alveolar air expansion, evaluated histologically. Phosphatidylglycerol was absent in alveolar wash from all control animals, but present in 3 of the 8 pooled samples from the animals treated with cyclic AMP; this difference was not statistically significant, however.

Hepatitis A, B, C and D in a community in Italy of immigrants from NE Africa.

A total of 213 subjects from a community in Italy of immigrants from Somalia and other NE African countries were enrolled in this study to evaluate the prevalence of HAV, HBV, HCV and HDV infections and to assess their possible risk factors. Of the subjects, 45 per cent (96) were female and 24 per cent (52) were under 12 years old. The age range was from 1 to 67 years and the mean age was 24 years. Eighty-three per cent (177 subjects) were born in Somalia, 10 per cent (21 subjects) in Ethiopia, and the rest in Djibouti, Egypt or Saudi Arabia. The 213 subjects were administered a questionnaire which covered socio-demographic characteristics and risk factors resulting from Western medical practice, traditional medicine, personal behaviour and living conditions. Blood was drawn from 209 subjects to ascertain the presence of HbsAg, HBeAg, anti-HAV, anti-HBc, anti-HBs, anti-HCV and anti-HDV. The results of this study show an HAV prevalence of 96 per cent (an 87.5 per cent prevalence in children under 12), and an HBV prevalence of 32 per cent (a 3.3 per cent prevalence of HBsAg carriers). No subject under 11 was HBV positive and no woman tested positive for HBeAg, confirming the extreme unlikelihood of vertical transmission of HBV. The prevalence of HBV is closely correlated with age (ranging from 2 per cent in those under 12 to 59 per cent in subjects over 39).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of aminophylline on lung maturation in preterm rabbit fetuses.

Pregnant rabbit does were treated intravenously with aminophylline (6 mg/kg/day) from the twenty-fifth day after the day of mating, and the fetuses were delivered by hysterotomy on the twenty-eighth day. One group of neonates was breathing air, and another group 100% oxygen. Lung mechanics were evaluated in the newborn animals during spontaneous or artificial ventilation, and the lungs were studied histologically with particular reference to the alveolar volume density. In one series of experiments, the lungs were washed and the lavage fluid was analyzed for phosphatidylcholine and phosphatidylglycerol. Aminophylline-treated litters had greater body weights, an improved survival rate, and an increased amount of phosphatidylglycerol in lung lavage fluid. Respiratory frequency was increased in aminophylline-treated animals breathing air, but data on lung compliance showed no significant difference between treated and control animals. In the present model, the beneficial effect of aminophylline can be attributed largely to a combination of accelerated fetal growth and improved postnatal regulation of breathing and less to a specific influence on the biochemical and functional maturation of the lung.