Fetal cystic hygroma: the importance of natural history.

OBJECTIVES: To evaluate the natural history of cystic hygroma (CH) in fetal and neonatal periods to enrich parental counselling. Ultrasonographic characteristics, associated syndromes, chromosomal anomalies, fetal cardiac pathology and life after birth were considered. STUDY DESIGN: From May 1985 to September 2010, 207 pregnancies were seen the authors' centre with suspected vascular-lymphatic fetal malformation: 156 of them had CH. Cases were followed up by telephone interview to determine fetal and neonatal outcomes. Chi-squared test was used for statistical analysis. RESULTS: Among the 156 cases of CH, the condition was septated in 75% of cases, associated with other pathologies in 74%, and retronuchal in 88%. Intrauterine regression was seen in 36% of cases, with complete disappearance in 77%. The karyotype was normal in 55% of cases. Follow-up was completed in 85 cases and revealed 54 spontaneous abortions (63%) and 31 live births (37%). Amongst these, 21 out of 31 children had a favourable outcome (68%). A negative embryo-fetal outcome was significantly associated with CH being associated with other pathologies, such as hydrops, retronuchal position and altered karyotype. Spontaneous regression or resolution of CH was associated with live births. CONCLUSIONS: The management of pregnancies with a diagnosis of fetal CH requires knowledge of natural history of the malformation for appropriate parental counselling.

Precalcaneal congenital fibrolipomatous hamartoma: report of 2 cases.

Precalcaneal congenital fibrolipomatous hamartoma is a benign condition of infancy that is possibly underdiagnosed because of the lack of reports in the literature. Lesions become evident after the first months of life and may be troublesome to parents and physicians. Patients are frequently referred to the pediatric surgeon for evaluation. We report and discuss 2 typical cases.

Prevention of congenital rubella and congenital varicella in Europe.

Despite the availability of safe and efficacious vaccines, cases of congenital rubella and varicella syndrome still occur in Europe. As of 2004, several countries had high proportions of women of childbearing age that were susceptible to rubella and varicella virus infection.

[Health care quality in paediatric oncology: the role of communicational and relational aspects]. / Qualità dell'assistenza in oncologia pediatrica: l'importanza degli aspetti relazionali e comunicativi.

The object of our study was to evaluate health care perception by families of children affected by oncological diseases admitted to hospitals. The main aim was to investigate the importance of availability of particular services and of clients' satisfaction for them in determining high quality levels in health care. A survey was carried out in two reference centres for treating children's cancer in Italy, one in North and the other in Central Italy. The study was performed interviewing, by a questionnaire, in hospital children's parents about perception and judgment on health care. Descriptive statistical analyses were carried out. Mann-Whitney and Chi square tests were used setting the statistical significance at p < or = 0.05. We administered 53 questionnaires. Five (9.4%) negative judgment of quality of health care were observed. The evaluation of communicative ways and the relationship between psychologists and families influenced significantly the final judgment of quality of medical-nursing care. Our study highlights the importance of high quality psychological and sociological supports in the treatment of oncological children and in determining perceived quality of medical-nursing assistance. Finally, the importance of communication between medical staff and oncological children's parents was confirmed.

[Appropriateness of admission and hospital stay in pediatric wards: the case of a teaching hospital in Rome]. / Appropriatezza del ricovero e della degenza in reparti pedia- trici: l'esperienza di un Policlinico Universitario di Roma.

The objective of our study was to evaluate the appropriateness of admission and hospital stay in pediatric wards of a Teaching Hospital in Rome using the Italian version of pediatric Appropriateness Evaluation Protocol (AEP). We reviewed 263 medical records of patients admitted in hospital during 2004. For each hospitalisation a judge on appropriateness/inappropriateness of admission and hospital stay was elaborated. We retrieved also data on type of ward, date, time and type of admission, date of discharge and data related to each patient. We carried out an univariate and a multivariate logistic regression analysis. Our results showed that the risk of an inappropriate admission is associated to residence out of Rome (OR = 2.45; CI 95%: 1.35-4.47) while the urgent admission is protective against inappropriateness (OR = 0.14; CI 95%: 0.07-0.25). The inappropriate hospital stay is associated to inappropriate admission (OR = 5.82; CI 95%: 3.17-10.70) and hospitalisation in a medical ward (OR = 3.26; CI 95%: 1.81-5.90). Stay in hospital in spring or summer periods is protective against hospitalisation inappropriateness (OR = 0.52; CI 95%: 0.30-0.91). The percentage of inappropriate admission and hospital stay is, respectively, 42.1%, and 50.2%, thus pointing out that there is the need of organisational interventions to reduce inappropriate hospitalisations.

HPV vaccine efficacy in preventing persistent cervical HPV infection: a systematic review and meta-analysis.

INTRODUCTION: We performed a pooled analysis of randomised clinical trials (RCT) on HPV vaccine efficacy in preventing cervical persistent infection. METHODS: We carried out a bibliographic search on electronic databases and we selected RCT to perform the meta-analyses. RESULTS: We selected five studies. The first meta-analysis, including all studies, showed an important reduction of the risk of infection from HPV 16 in vaccinated cohort [RR 0.10 (95% CI: 0.07-0.15)]. The second and third meta-analyses, including only studies on bivalent and tetravalent vaccines, showed a RR of 0.13 (95% CI: 0.09-0.20) for HPV 16 infections and a RR of 0.22 (95% CI: 0.13-0.38) for HPV 18 ones. DISCUSSION: HPV vaccine efficacy in preventing persistent infection is high but there is the need for further studies on the duration of immunization and long-term vaccine efficacy.

[Socio-demographic determinants of the risk of inappropriate hospital use]. / Determinanti socio-demografiche del rischio di inappropriatezza organizzativa delle prestazioni ospedaliere.

The aim of the study was to investigate the association between socio-demographic variables and "at high risk of inappropriateness" of hospital admissions. We used hospital admissions data of Local Health Unit (LHU) Rome H (year 2004). We investigated the relationship between socio-demographic variables (sex, age, job activity, marital status, nationality, place of residence, educational level) and a high risk of inappropriate hospital stay. We computed univariate and multivariate analysis using chi2 test and logistic regression model. Out of 32,233 hospital admissions, 4685 (14.5%) resulted at high risk of inappropriateness. The following variables were associated with high risk of inappropriateness: age (for patients aged 0-15 and 46-65 OR: 1.83 (95% C.I.: 1.57-2.13) and 1.56 (95% C.I.: 1.42-1.72) respectively); job activity (for employed OR: 1.98 (95% C.I.: 1.81-2.17), for students OR: 1.34 (95% C.I.: 1.16-155)); marital status (for unmarried OR: 1.37 (95% C.I.: 1.23-1.51)); place of residence (for patients belonging to LHU Rome H OR:1.09 (95% C.I.: 1.02-1.78)); nationality (for foreign nationals OR: 0.71 (95% C.I.: 0.58-0.87)); educational level (for high school degree and graduated people OR: 0.89 (95% C.I.: 0.81-0.98)). Our study demonstrates that socio-demographic variables are related to the high risk of inappropriate hospital admissions. We believe that these variables could be considered as potential factors to modulate the offer of health services.

Epidemiology and direct medical costs of human leishmaniasis in Italy.

INTRODUCTION: In the last decades, visceral Leishmaniasis infection rate has increased in Western Mediterranean areas. Epidemiological data show that in Italy, especially in some regions, the prevalence of canine form is high. The aim of this study is to evaluate the epidemiological setting of Leishmaniasis in Italy, according to age groups and geographical areas, and to estimate the associated direct medical costs. METHODS: The study examined the ordinary and day-hospital discharges and the respective mean of hospital length of stay for Leishmaniasis and visceral Leishmaniasis in Italy, during the period 1999-2003. Moreover, we collected data about notifications of Leishmaniasis, from 1993 to 2004, and mortality due to this infectious disease, from 1993 to 1998. We evaluated the prevalence rates of discharges, the visceral and cutaneous Leishmaniasis notifications incidence rates and the mortality rates from disease, per 1,000,000 residents. Costs analysis was performed getting DRG number 423 rate, which corresponds to "other diagnosis related to infectious and parasitary diseases". RESULTS: Ordinary discharges decreased in the study period, while day-hospital discharges increased. Sicilia, Campania and Lazio regions showed the highest number of ordinary hospital discharges for Leishmaniasis (prevalence rates were respectively 16.29, 15.02 and 12.83 per 1,000,000 residents, in 2003). Campania and Sicilia showed also the highest prevalence rates of day-hospital discharges (respectively 17.29 and 35.39 per 1,000,000 residents in 2003). The analysis of incidence rates of notifications showed a cyclic trend of the visceral form of the disease, with the highest rates observed in the group aged 0-14 years (incidence rates per 1,000,000: 7.46 in 1996 and 8.59 in 2000). The highest mortality rates were observed in the group aged over 65 years; low but constant mortality rates for Leishmaniasis were seen in the age group 25-64 years. Direct costs for both ordinary and day-hospital admissions were: 1,561,218.46 Euro in 1999; 1,637,256.44 Euro in 2000; 1,459,892.92 Euro in 2001, 1,468,983.58 Euro in 2002 and 1,370,227.80 Euro in 2003. DISCUSSION: Discharges for Leishmaniasis showed non-homogeneous trend in Italy, especially in coastal Regions. Leishmaniasis notifications have slowly increased after 1993 and a high number of notifications was observed in the 0-14 years old group. The highest mortality rates were reported in the extreme age-groups: mortality was relevant for patients over 65 years. Moreover, cost analysis showed that health care of human Leishmaniasis requires long time of hospitalization with consequent high costs. Conclusion. Preventive measures have to be turned to extreme age groups. For future studies issues such as high costs of treating disease, cost-effectiveness evaluation of the 'current therapeutic approach compared to preventive interventions on dogs and vector insects would be of interest.