RESUMO
OBJECTIVE: To assess the separate and combined associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain with the risks of pregnancy complications and their population impact. DESIGN: Individual participant data meta-analysis of 39 cohorts. SETTING: Europe, North America, and Oceania. POPULATION: 265 270 births. METHODS: Information on maternal pre-pregnancy BMI, gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used. MAIN OUTCOME MEASURES: Gestational hypertension, pre-eclampsia, gestational diabetes, preterm birth, small and large for gestational age at birth. RESULTS: Higher maternal pre-pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes, and large for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared with normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (odds ratio 2.51, 95% CI 2.31- 2.74). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large for gestational age infants was attributable to excessive gestational weight gain. CONCLUSIONS: Maternal pre-pregnancy BMI and gestational weight gain are, across their full ranges, associated with risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre-pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity. TWEETABLE ABSTRACT: Promoting a healthy body mass index and gestational weight gain might reduce the population burden of pregnancy complications.
Assuntos
Índice de Massa Corporal , Ganho de Peso na Gestação/fisiologia , Sobrepeso/complicações , Complicações na Gravidez/etiologia , Adulto , Austrália/epidemiologia , Peso ao Nascer , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , América do Norte/epidemiologia , Razão de Chances , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de RiscoRESUMO
STUDY DESIGN: Retrospective study. OBJECTIVE: To compare the rehabilitation outcomes of non-traumatic and traumatic spinal cord injury patients. SETTING: Spinal cord unit of a rehabilitation hospital in Italy. PATIENTS AND METHODS: In total, 380 patients at first rehabilitation stay after the lesion (144 traumatic patients and 236 non-traumatic patients; 244 men and 136 women; mean age 46.1±19.9 years; mean lesion to admission time 49.6±39.8 days). INTERVENTIONS: Not applicable. MEASURES: American Spinal Injury Association standards; Barthel index (BI), Rivermead mobility index and walking index for spinal cord injury. STATISTICAL ANALYSIS: Poisson regression models with relative risks and 95% confidence intervals adjusted for the following confounders: age, sex, lesion level and Asia impairment. Models were stratified by age because a strong interaction between different variables and age was found. RESULTS: Traumatic and non-traumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower BI score at admission and significantly better improvement in the BI score by discharge. The two populations were discharged with similar functional outcome. No significant differences were found with regard to the others outcomes. CONCLUSIONS: In clinically stable patients, spinal cord injury etiology does not seem to affect the rehabilitative prognosis. At admission, traumatic patients show lower autonomy in daily life activities, probably because of the associated lesions that these patients often have. At discharge, traumatic and non-traumatic spinal cord lesion patients achieved similar results with regard to neurological and functional improvement.
Assuntos
Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/reabilitação , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/reabilitação , Adulto , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Doenças da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Resultado do TratamentoRESUMO
SETTING: Lazio region (5.15 million, including Rome, 2.8 million), Italy. OBJECTIVE: To monitor pulmonary tuberculosis (TB) epidemiology from 1997 to 2003. DESIGN: We used data from the mandatory National Infectious Diseases Surveillance system, the regional Hospital Information System and the regional Mortality Register. The number of prevalent pulmonary TB cases hospitalised was determined by linking notifications and hospitalisations. To estimate incidence, we excluded all cases with previous TB hospitalisations since 1995, and those reported as a secondary diagnosis in the Hospital Information System. Mortality rates were ascertained from mortality records reporting TB as the principal cause of death. RESULTS: The record linkage identified 4885 incident cases, 9010 hospital prevalent cases and 217 deaths. Incidence decreased from 15/100000 in 1997 to 11 in 2003, and consistent decreases were also observed in hospitalisation prevalence and mortality (P for trend <0.0005, <0.0005 and =0.063, respectively). The number of AIDS-related TB cases dropped from 85 to 49 (P < 0.0005). The number of incident cases in non-Italians increased significantly, from 171 to 267 (P < 0.0005). Notification underreporting was estimated at 39%. CONCLUSIONS: Despite a decreasing trend, TB incidence is still over 10/100000 in Lazio region. Targeted interventions for immigrant populations are essential for controlling TB.
Assuntos
Hospitalização/estatística & dados numéricos , Tuberculose Pulmonar/mortalidade , Adolescente , Adulto , Criança , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Vigilância da PopulaçãoRESUMO
OBJECTIVE: To investigate the relationship between lesion severity and other clinical factors and bladder function recovery. PATIENTS AND METHODS: The charts of 269 patients with traumatic and non traumatic spinal cord lesion (SCL) were reviewed and the following information was recorded: lesion to admission time, injury variables, length of stay and neurological status. At five months, urological outcome was assessed by voiding modalities, and urodynamics according to International Continence Society. Logistic approach with univariate and multivariate analysis. RESULTS: Both ASIA impairment at admission and age were significantly correlated with bladder function outcome. None of the patients with ASIA A impairment at admission reached volitional voiding at five months. ASIA B patients had a 90% lower probability of achieving good bladder control and ASIA C ones a 65% lower than ASIA D patients (p < 0.05). Older patients had a significant lower probability (60%) of achieving volitional voiding than younger ones (p < 0.05). Of the 121 patients with ASIA D impairment at discharge only 78 voided spontaneously and showed a higher frequency of cervical lesions and a lower frequency of detrusor-external sphincter dyssynergia. DISCUSSION AND CONCLUSION: Bladder recovery in patients with complete SCL is limited. ASIA B patients showed a better neurological recovery and, concurrently, better bladder function recovery than ASIA A patients, thus demonstrating the importance of sensation preservation for recovery. Younger patients show better bladder recovery than older ones, probably because of different efficiency of spinal cord plasticity. Finally, patients with good neurological recovery may not achieve volitional voiding. Patients with bladder function recovery show a higher frequency of central cord and Brown-Sequard syndromes (with better prognosis) and a lower frequency of detrusor-sphincter dyssynergia.
Assuntos
Cauda Equina/lesões , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Urinaria Neurogênica/reabilitação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença , Estatísticas não ParamétricasRESUMO
Aim of the study is to describe the characteristics of road, home and work-related traumas among adult immigrants born in non-industrialised Countries, and to compare the consequent probability of hospitalisation with Italian adults in Lazio Region, year 2000. Source of data is the Emergency-based Surveillance System, which collects all the emergency ward visits in Lazio region. Accident incidence has been estimated using alternatively the residence permits and the roman resident population born in non-industrialised Countries. The 7.7% of all the emergency visits of immigrants are trauma-related. Road traffic accident visits are more appropriate and urgent. Immigrants have a higher risk of hospitalisation both for road and home accidents compared to the Italians (OR = 1.59 and OR = 1.37 respectively). Immigrants use emergency wards for severe and urgent trauma-related accidents, they have higher probability of hospitalisation compared to the Italians. Our analysis highlights the necessity to improve tools to study immigrant health.
Assuntos
Acidentes/estatística & dados numéricos , Países em Desenvolvimento , Serviço Hospitalar de Emergência/estatística & dados numéricos , Emigração e Imigração/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Itália , Masculino , Prontuários Médicos/estatística & dados numéricosRESUMO
We evaluated the association between exposure to environmental tobacco smoke (ETS) from husbands who smoke and plasma levels of antioxidant vitamins among nonsmoking women. A total of 1249 women from four areas in Italy answered a self-administered questionnaire, reported their diets on a food frequency questionnaire, had a medical examination, and gave their blood for alpha and beta-carotene, retinol, L-ascorbic acid, alpha-tocopherol, and lycopene determinations. Urinary cotinine was used to evaluate the level of recent exposure to ETS. After adjusting for study center, age and education, we found no association between ETS exposure and daily nutrient intake of beta-carotene, retinol, L-ascorbic acid, and alpha-tocopherol. However, we found an inverse dose-response relationship between intensity of current husband's smoke and concentrations of plasma beta-carotene and L-ascorbic acid. The associations remained even after controlling for daily beta-carotene and vitamin C intake and for other potential confounders (vitamin supplementation, alcohol consumption, and body mass index). Moreover, when urinary cotinine was considered as the exposure variable, a significant inverse association with plasma beta-carotene was found. The findings may be of interest to explain the biological mechanism that link ETS exposure with lung cancer and ischemic heart diseases.
Assuntos
Ácido Ascórbico/sangue , Poluição por Fumaça de Tabaco/efeitos adversos , beta Caroteno/sangue , Adulto , Idoso , Estudos Transversais , Exposição Ambiental , Feminino , Humanos , Neoplasias Pulmonares/etiologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/etiologia , CônjugesRESUMO
The aim of this study was to evaluate whether risk factors associated with cardiovascular or respiratory diseases and lung cancer occur differently among nonsmoking women in Italy with and without exposure to environmental tobacco smoke (ETS) from husbands that smoke. We performed a cross-sectional study of 1,938 nonsmoking women in four areas of Italy. Data on respiratory and cardiovascular risk factors and on diet were collected using self-administered questionnaires. Medical examinations and blood tests were administered; urine cotinine levels were measured. Nonsmoking women ever exposed to husbands' smoking were compared with unexposed women for several factors: education, husband's education, household crowding, number of children, current or past occupation, exposure to toxic substances at work, parental diseases, self-perceived health status, physician-diagnosed hypertension, hypercholesterol, diabetes, osteoporosis, chronic respiratory diseases, blood pressure medications, lifestyle and preventive behaviors, dietary variables, systolic and diastolic blood pressure, body mass index, waist-hip ratio, triceps skin folds, plasma antioxidant (pro-) vitamins (- and ss-carotene, retinol, l-ascorbic acid, -tocopherol, lycopene), serum total and HDL cholesterol, and triglycerides. Women married to smokers were more likely to be less educated, to be married to a less educated husband, and to live in more crowded dwellings than women married to nonsmokers. Women married to smokers were significantly less likely to eat cooked [odds ratio (OR) = 0.72; 95% confidence interval (CI), 0.55-0.93] or fresh vegetables (OR = 0.63; CI, 0.49-0.82) more than once a day than women not exposed to ETS. Exposed women had significantly higher urinary cotinine than unexposed subjects (difference: 2.94 ng/mg creatinine). All the other variables were not more prevalent among exposed compared to unexposed subjects. The results regarding demographic factors are easily explained by the social class distribution of smoking in Italy. A lower intake of vegetables among exposed women in our study is consistent with the available literature. Overall, our results do not support previous claims of more frequent risk factors for cardiovascular and pulmonary diseases among ETS-exposed subjects. In Italy, as elsewhere in Europe and North America, women who have never smoked but are married to smokers are likely to be of lower social class than those married to never-smokers. However, once socioeconomic differences are considered, the possibility of confounding in studies on the health effects of ETS is minimal.
Assuntos
Doenças Cardiovasculares/etiologia , Exposição Ambiental , Neoplasias Pulmonares/etiologia , Doenças Respiratórias/etiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Fatores de Confusão Epidemiológicos , Cotinina/urina , Demografia , Dieta , Estudos Epidemiológicos , Feminino , Humanos , Incidência , Itália/epidemiologia , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Respiratórias/epidemiologia , Medição de Risco , CônjugesRESUMO
Cancer is said to be due to nutrition in 35 cases out of 100, ranging from 10 to 70% by sites. Saturated fats show a positive relationship with cancer, while vitamins, vegetables and cereals show a negative relation with it. This work was aimed at studying the relationship between nutrition and cancer in different Italian areas. Cancer mortality rates collected in 94 National Health units over the period 1980-82 have been correlated with the average food consumption of individuals registered in the same units. All the nutrient groups have shown evidence of a correlation between nutrient intake and mortality rates. Fats, animal proteins and saturated fatty acids showed the strongest positive correlations; vegetable proteins, fibre, carbohydrates, oleic acid, vitamins C and B1 gave negative correlations. Thus, it can be concluded that (a) this ecological analysis has confirmed previous hypotheses concerning the role of vegetables in cancer prevention and (b) the relation between nutrition and cancer mortality could be even stronger if applied to the whole population, since a 1-g increase in vegetable protein consumption would result in a reduction of 2.5 cases out of 100, a 1-g increase in fibre would result in a reduction of four cases out of 100 and a 1-g increase in animal fat would result in an increase of one case out of 100.
Assuntos
Comportamento Alimentar , Neoplasias/mortalidade , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Gorduras na Dieta/administração & dosagem , Fibras na Dieta/administração & dosagem , Proteínas Alimentares/administração & dosagem , Feminino , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Proteínas de Vegetais Comestíveis/administração & dosagem , Fatores de Risco , Estatística como AssuntoRESUMO
OBJECTIVE: The objective of this article is to assess the prevalence of somatic symptoms and of gastrointestinal (GI) syndromes in abused "non-patient" women and the association with the time of perpetration, type, and severity of abuse. METHODS: Sixty-seven women, 18-58 years, receiving shelter in anti-violence associations were invited to fill out an anonymous questionnaire with a medical and an abuse section. The severity of abuse was expressed as the 0-6 Abuse Severity Measure (ASM). The association between abuse characteristics and the number of symptoms, and GI syndromes was assessed by Poisson regression model. RESULTS: Most women suffered from childhood and adulthood sexual and physical abuse. They reported a mean of 5.1 GI symptoms (range 0-13; median 5; IQR 6) and of 1.3 extra-GI symptoms (range 0-6; median 1; IQR 2); 30% of women matched the Rome II Criteria for one, 36% for two, and 4.4% for three or more syndromes, respectively. Women with an ASM of 5-6, having suffered from both sexual and physical abuse, reported significantly (p = 0.02) more GI symptoms, but not extra-GI ones (p = 0.07), and met criteria for more GI syndromes than women with an ASM ≤4 and those reporting only one type of abuse. No association was found between the time of perpetration of the abuse and the number of GI and extra-GI symptoms. CONCLUSIONS: Symptoms in abused "non-patient" women mainly concern the abdomen and the GI tract. A history of severe, combined physical and sexual abuse is associated with a higher number of GI symptoms.
Assuntos
Poluentes Atmosféricos/toxicidade , Exposição Ambiental/efeitos adversos , Hospitalização/estatística & dados numéricos , Doenças Respiratórias/epidemiologia , Emissões de Veículos/toxicidade , Criança , Métodos Epidemiológicos , Feminino , Seguimentos , Humanos , Masculino , Fatores de Risco , Cidade de Roma/epidemiologiaAssuntos
Gorduras Insaturadas na Dieta/administração & dosagem , Neoplasias/mortalidade , Óleos de Plantas/administração & dosagem , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Dieta , Comportamento Alimentar , Feminino , Humanos , Lactente , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Azeite de OlivaAssuntos
Parto Obstétrico , Maternidades , Hospitais Universitários , Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Feminino , Maternidades/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Motivação , Parto Normal/estatística & dados numéricos , Gravidez , Cidade de Roma , Fatores Socioeconômicos , Fatores de TempoRESUMO
The consistent association seen between family size and childhood allergy has led to the 'hygiene hypothesis', namely that a lower frequency of infections in early childhood is associated with an increased risk of asthma and hay fever. Maternal atopy, however, is a strong predictor of childhood asthma and hay fever. If maternal atopy is inversely related to the number of siblings then the role of siblings in the development of childhood atopy, the basic tenet of the 'hygiene hypothesis', is challenged. We evaluated the association between number of pregnancies and number of live births with lifetime occurrence of maternal wheeze, asthma, allergic rhinitis, and allergic conjunctivitis in a cross-sectional study in four areas in Italy. A total of 1755 (35-74 year old) nonsmoking women filled a questionnaire on reproductive history as well as on lifetime occurrence of symptoms/diseases. The number of live births was inversely related to lifetime allergic rhinitis (P-value for trend=0.031) and allergic conjunctivitis (P-value for trend=0.011). The odds ratios for those with 4+ children (in comparison with those having 0-1) were: 0.53 (95% CI: 0.27-1.04) and 0.42 (95% CI: 0.22-0.81), respectively. A similar trend was seen for number of pregnancies, although not statistically significant. No association was found between number of pregnancies and number of live births with wheeze or asthma. The results may be interpreted as an indication that maternal atopy influences pregnancy outcomes or that pregnancy itself has an effect on maternal atopy.
Assuntos
Hipersensibilidade/epidemiologia , Mães/estatística & dados numéricos , Paridade , Adulto , Idoso , Asma/epidemiologia , Conjuntivite Alérgica/epidemiologia , Estudos Transversais , Feminino , Humanos , Hipersensibilidade/complicações , Incidência , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Resultado da Gravidez , Sons Respiratórios , Rinite/epidemiologia , Rinite/etiologia , Inquéritos e QuestionáriosRESUMO
The current study evaluated the association between individual and area-based indicators of socioeconomic status and the prevalence, severity, and lifetime hospitalisation for asthma in children. The representative sample of 4,027 children from Rome, aged 6-7 yrs, used for the 1994 ISAAC (International Study on Asthma and Allergies in Childhood) initiative, was selected. Individual and small area indicators of socioeconomic status were used. Individual data on parents' education and on childhood asthma were gathered from self-administered parental questionnaires. Two small-area indicators (socioeconomic status index (SES) and average income in 1994) were derived using information available at the census tract of residence. Logistic regression models were used to estimate the association of parental education and small area indicators with asthma prevalence, severity, and hospitalisation. Parental smoking was considered in the analysis as a potential confounder. Prevalence of physician diagnosis of asthma (11.3%) increased as father's education decreased. Prevalence of severe asthma (1.6%) increased as maternal and paternal educational levels decreased. Lifetime hospitalisation for asthma (2.8%) was strongly associated with both parental education and small-area indicators of social disadvantage, even when considered simultaneously in the same logistic model. Socioeconomic conditions are associated with asthma occurrence, its severity, and hospitalisation. The association was stronger for asthma severity and hospitalisation. Individual indicators correlated better with the outcomes than area-based indicators. However, living in an underprivileged area is a strong independent predictor of hospital admission for asthma.
Assuntos
Asma/epidemiologia , Características da Família , Indicadores Básicos de Saúde , Hospitalização/estatística & dados numéricos , Características de Residência , Classe Social , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Cidade de Roma/epidemiologia , Índice de Gravidade de DoençaRESUMO
We conducted a 5-year cohort study among 162 self-sufficient residents in a public home for the elderly in Rome, Italy, to evaluate the association between the consumption of specific food groups and nutrients and overall 5-year survival. We used a validated, semiquantitative food-frequency questionnaire to assess diet at baseline. Individuals consuming citrus fruit at least twice a week had an adjusted risk of dying that was half that of individuals who consumed citrus fruit less than once a week [relative risk (RR) = 0.52; 95% confidence interval (CI) = 0.28-0.95] (with adjustment for gender, age, education, body mass index, smoking status, cognitive function, and chronic diseases). The adjusted RRs of mortality were 0.38 (95% CI = 0.14-1.01) for consumption of milk and yogurt at least three times a week vs less than once a week; 0.21 (95% CI = 0.08-0.35) for moderate consumption of espresso coffee (1-2 cups weekly) vs less than once a week; and 0.35 (95% CI = 0.17-0.69) for > 2 cups a week of espresso coffee vs less than once a week. High levels of intake of ascorbic acid, riboflavin, and linoleic acid were associated with 50-60% decreases in mortality risk. High consumption of meat was associated with a higher risk of mortality (RR = 9.72; 95% CI = 2.68-35.1) among subjects with chronic diseases. Our findings indicate that frequent consumption of citrus fruit, milk, and yogurt; low consumption of meat; and high intake of vitamin C, riboflavin, and linoleic acid are associated with longevity.
Assuntos
Dieta , Expectativa de Vida , Estado Nutricional , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Gorduras na Dieta , Feminino , Frutas , Humanos , Masculino , Mortalidade , Medição de Risco , Análise de SobrevidaRESUMO
The effect of dietary factors on asthma is controversial. This study examined food consumption and the use of fats in relation to wheezing and allergic rhinitis in children. Baseline questionnaire data on individual and family characteristics were recorded by parents of 5,257 children aged 6-7 yrs living in central Italy participating in the International Study on Asthma and Allergies in Childhood study. A total of 4,104 children (78.1%) were reinvestigated after 1 yr using a second parental questionnaire to record occurrence of respiratory symptoms over the intervening 12 months. Consumption of foods rich in antioxidants, such as vitamins C and E, animal fats, and food containing omega-3 fatty acids were investigated using a food-frequency questionnaire. Frequency of use of fats was also evaluated. Wheezing, shortness of breath with wheeze, and symptoms of allergic rhinitis in the past 12 months were considered. Intake of cooked vegetables, tomatoes, and fruit were protective factors for any wheeze in the last 12 months and shortness of breath with wheeze. Consumption of citrus fruit had a protective role for shortness of breath with wheeze. Consumption of bread and margarine was associated with an increased risk of wheeze, while bread and butter was associated with shortness of breath with wheeze. Dietary antioxidants in vegetables may reduce wheezing symptoms in childhood, whereas both butter and margarine may increase the occurrence of such symptoms.