[Validation of an algorithm for identifying cases with congenital malformations by using hospital discharge records]. / Validazione di un algoritmo per l'identificazone di casi con malformazioni congenite nelle schede di dimissione ospedaliera.

OBJECTIVES: to evaluate and validate the use of an algorithm designed to identify in hospital discharge records (SDO) cases with congenital malformations (MC) at birth and/or reported in hospitalizations within the first year of life using as gold standard the Congenital malformation Registry of the Local Health Unit of Mantova, Northern Italy, (RMC-MN), which controls all the medical records of infants born to mothers living in the province. DESIGN: an algorithm designed for the identification of malformed cases in the SDO database using two modules, one for identification of cases potentially malformed and one for their validation was used. A comparison of the results with those observed by the RMC-MN was then conducted. SETTING AND PARTICIPANTS: data of the SDO and the RMC-MN for the period 2010-2011 relative to those detected in newborns within the first year of life in the resident population in the province. RESULTS: of 8,042 infants born to mothers residing in the province of Mantova, 7,367 were excluded by the algorithm as malformed with the exception of only one false negative (negative predictive value - NPV: 99.99%); in the remaining 675 cases (8.4%) there was at least one code of congenital malformation. The algorithm has also included 396 cases (4.9%) with isolated minor malformations or diseases considered not malformations, of which 23 were false negatives (NPV: 94.2%). In the remaining 279 cases potentially malformed the algorithm considered as validated 169 cases (60.6%), including 11 false positives (positive predictive value - PPV: 93.5%). In the remaining 110 cases to evaluate, 46 were true positives (PPV: 41.8%). CONCLUSIONS: the proposed instrument has identified correctly SDO in 89.4% of cases registered by the RMC-MN to produce a small number of false positives among the validated cases (6.5%) and effectively exclude inappropriate cases (94.2%). The authors suggest a judicious use of the instrument, which should be led by experts of SDO, clinical and epidemiology of congenital malformations.

Fetal Exposure to Maternal Pregnancy Complications and Respiratory Health in Childhood.

Background: A number of studies have highlighted that prenatal adverse events can affect the offspring's health status. We evaluated whether pregnancy complications might affect the respiratory health of the offspring during infancy and childhood. Methods: In 2006, all the children (3-14 years, N = 3,907) living in the Viadana district (Mantua, Italy) were surveyed through a parental questionnaire about pregnancy complications (hypertensive disorders, febrile infections, gynecological infections) and early-life and current respiratory diseases. Hospital discharge records for respiratory diseases were obtained for a 6-year follow-up period (2007-2012). Association estimates were adjusted for maternal smoking during pregnancy, maternal age at delivery, type and term of delivery, and other potential confounders. Results: A total of 3,617 (93%) children were included in the analyses. Pregnancy complications were significantly associated with higher risk of respiratory diseases during infancy and childhood. In particular, children exposed to gynecological infections were more likely to have bronchitis [odds ratio (OR): 1.48, 95% confidence interval (95% CI): 1.04-2.10], pneumonia (OR: 2.05, 95% CI: 1.10-3.81), and wheezing (OR: 1.49, 95% CI: 1.00-2.23) at 0-2 years; to report asthma (OR: 3.57, 95% CI: 1.59-8.04) and cough/phlegm (OR: 2.68, 95% CI: 1.67-4.31) at the time of the survey; and to be hospitalized for respiratory diseases (hospitalization hazard ratio: 1.74, 95% CI: 1.02-2.97) in the 6-year follow-up. There was a significant association between febrile infections and wheezing in infancy, even in children whose mothers did not use paracetamol or antibiotics during pregnancy. Conclusions: This observational study suggests that pregnancy complications, especially gynecological infections, might affect the offspring's respiratory health throughout infancy and childhood.

Children living near chipboard and wood industries are at an increased risk of hospitalization for respiratory diseases: a prospective study.

Pollutants emitted from wood processing factories may be harmful to the health of the population. The aim of this prospective cohort study was to evaluate whether proximity to wood factories was associated with the risk of hospital admissions in children living in the Viadana district (Italy), where two big chipboard industries and other smaller wood factories (sawmills, multi-strata layer manufacturing) are located. In 2006, children (3-14 years) living in the Viadana district were surveyed through a parental questionnaire (n=3854), their home/school addresses were geocoded and the distances to the wood industries were calculated. Hospital discharge records for the years 2007-2009 were obtained. Cox proportional hazard regression models were used to estimate the association between hospitalization rates and distance to the factories, adjusting for sex, age, nationality, parents' education, exposure to passive smoking and reported traffic near home. During the 3-year follow-up, the risk of hospitalization for all diagnoses (Hospitalization Hazard Ratio, HHR=1.55; 95% CI: 1.24-1.95) and for respiratory diseases (HHR=1.80; 95% CI: 1.14-2.86) was greater in the children living close (<2 km) to the chipboard industries, with respect to the children who lived at ≥2 km from any wood factory. The children living close to the smaller wood factories were also at increased risk of hospitalization for respiratory diseases (HHR=1.74; 95% CI: 1.06-2.85). This study highlights a health problem for the children living close to chipboard and wood factories in the Viadana district. Further research should develop accurate exposure models based on objective measurements of air pollution in order to confirm these findings.

Outdoor formaldehyde and NO2 exposures and markers of genotoxicity in children living near chipboard industries.

BACKGROUND: Industrial air pollution is a public health hazard. Previous evidence documented increased respiratory symptoms and hospitalizations in children who live near the factories in the largest chipboard manufacturing district in Italy (Viadana). OBJECTIVES: We evaluated the association of outdoor exposure to formaldehyde and nitrogen dioxide (NO2) with markers of early genotoxic damage in oral mucosa cells of randomly selected children (6-12 years of age) living in Viadana. METHODS: In 2010-2011, DNA strand breaks and nuclear abnormalities were evaluated in exfoliated buccal cells by the comet and micronucleus assays, respectively, and formaldehyde and NO2 were monitored by passive sampling. Annual exposure estimates to pollutants were assigned to children's houses by spatial interpolation. RESULTS: Of 656 children, 413 (63%) participated. Children living near (< 2 km) the chipboard industries had the highest average exposure to formaldehyde and NO2 (p < 0.001). A 1-SD increase in formaldehyde (0.20 µg/m(3)) was associated with a 0.13% (95% CI: 0.03, 0.22%) higher comet tail intensity, a 0.007 (95% CI: 0.001, 0.012) higher tail moment, and a 12% relative increase [relative risk (RR) = 1.12; 95% CI: 1.02, 1.23] in nuclear buds. A 1-SD NO2 increase (2.13 µg/m(3)) was associated with a 0.13% (95% CI: 0.07, 0.19%) increase in binucleated cells and a 16% relative increase (RR = 1.16; 95% CI: 1.06, 1.26) in nuclear buds. CONCLUSIONS: Exposure to pollutants was associated with markers of genotoxicity in exfoliated buccal cells of children living in a region with chipboard industries. These findings, combined with previously reported associations between chipboard industrial activities and respiratory outcomes in children, add to concerns about potential adverse effects of industry-related exposures in the Viadana district.

Spatial analysis of binary health indicators with local smoothing techniques The Viadana study.

INTRODUCTION: When pollution data from a monitoring network is not available, mapping the spatial distribution of disease can be useful to identify populations at risk and to suggest a potential role for suspected emission sources. We aimed at obtaining a continuous spatial representation of the prevalence of symptoms that are potentially associated with the exposure to the pollutants emitted from the wood factories in the children who live in the district of Viadana (Northern Italy). METHODS: In 2006, all the parents of the children aged 3-14 years residing in the Viadana district (n = 3854), filled in a questionnaire on respiratory symptoms, irritation symptoms of the eyes and skin, use of health services. The children's residential addresses were also collected and geocoded. Generalized additive models and local weighted regression (LOWESS) were used to estimate the distribution of the symptoms, to test for spatial trends of the symptoms' prevalence and to control for potential confounders. Permutation tests were used to identify the areas of significantly increased risk ("hot spots"). RESULTS: The prevalence of respiratory symptoms, eye symptoms and the use of health services showed a statistically significant spatial variation (p < 0.05), but skin symptoms did not. Symptoms' prevalence was lower in the northern part of the district, where no wood factories were present, and it was higher in the southern part, where the two big chipboard industries were located. Hot spots were identified fairly near to one of the two chipboard industries in the district. CONCLUSIONS: The north-to-south trend in the prevalence of respiratory and eye symptoms, but not of skin symptoms, as well as the location of hot spots, are consistent with the potential exposure to air pollutants both emitted by the wood factories and related to traffic. In these "high risk areas" monitoring of pollution and preventive actions are clearly needed.

Proximity to wood industries and respiratory symptoms in children: a sensitivity analysis.

Increased prevalence of respiratory and irritation symptoms was found in children who live near a large wood industrial park. Proximity to the wood industries was used as indicator of exposure. This study describes a sensitivity analysis for the results of the survey. All the children (3-14 years) living in the area were surveyed through a parental questionnaire (n=3854) and their addresses were geocoded. The distances from each child's home and school to the closest industry were combined, weighted and used as an indicator of exposure. A sensitivity analysis was performed to check 1) the robustness of the results to the choice of weights used for defining the exposure indicator, 2) the effect of outliers on risk estimates and 3) the sensitivity on the functional form used for modeling the dose-response function. The choice of the weights did not influence the association between proximity to the industries and respiratory symptoms. Excluding the subjects who lived far away from the industries showed that in a radius of 5km from the industries the study did not had enough power to estimate a gradient in the dose-response function. Besides, results were sensitive to the choice of the functional form used for modeling the minimum distance. The sensitivity analyses confirmed the overall increasing trend of respiratory symptoms with proximity to the industries and pointed out that all the assumptions made for defining a proxy of exposure need to be carefully checked.

Incidence of respiratory and allergic symptoms in Italian and immigrant children.

BACKGROUND: Immigration usually implies a complete change of the environment where one lives. Hence, studies on immigrants may help to disentangle genetic and environmental determinants of disease. We investigated whether the incidence of allergic and respiratory symptoms differed for Italian and immigrant children living in one area of Northern Italy. METHODS: In December 2006, all the children (3-14 years) living in the Viadana district were surveyed through a parental questionnaire (response rate = 99%, n = 3854). Retrospective incidences of several symptoms were compared across different ethnic groups. RESULTS: Parental asthma, allergic rhinitis and eczema were less frequent in immigrant children than in Italian children. Wheezing and eczema incidences were lower in children born to foreign parents (especially if born abroad, incidence rate ratio (IRR) = 0.47, 95% CI: 0.26-0.82 and IRR = 0.43, 95% CI: 0.23-0.83, respectively), with respect to Italian children, while the occurrence of nasal allergies was similar among the ethnic groups. The greatest incidence of persistent cough/phlegm was observed in children born in Italy to foreign parents (IRR = 1.98, 95% CI: 1.06-3.71) and in children whose parents had chronic bronchitis (IRR = 2.57, 95% CI: 1.52-4.33). CONCLUSIONS: Considering the distribution of parental atopic diseases and the low disease prevalence in the immigrants' countries of origin, we suggest that nasal allergies may be more sensitive than wheezing or eczema to the change in the environment related to migration. Genetic or environmental factors clustered into families seem to have a role on chronic bronchitis.

Proximity to wood factories and hospitalizations for respiratory diseases in children.

BACKGROUND: Exposure to air pollutants emitted by wood industries has been associated with increased prevalence of respiratory and irritation symptoms. OBJECTIVES: To study whether proximity to wood industries was associated with risk of hospitalization for respiratory diseases in children. METHODS: In December 2006, the large majority of the children (3-14 years) living in the Viadana district (Northern Italy) were surveyed through a parental questionnaire (n=3854). Hospital discharge records for respiratory diseases (2002-2006) were obtained from the local Health Unit. The children were geocoded and the distance from their home/school to the wood industries was used as exposure indicator. Poisson regression models were used to assess the association between the distance and hospitalizations. RESULTS: The hospitalization rates for respiratory diseases increased with proximity to the wood industries: they were 7.55 (95% CI 5.58, 10.22) ×1000 person-year for those who lived far from any wood industry, 11.84 (95% CI 8.87, 15.81) ×1000 person-year for those <2km from the small wood factories and 16.61 (95% CI: 13.57, 20.33) ×1000 person-year for those living within 2km from the two big chipboard industries. CONCLUSIONS: Proximity to wood industries is associated with a higher risk of hospitalization for respiratory diseases and respiratory symptoms in children. Studies with direct measures of exposure are needed and a follow-up of exposed population is advisable.

Proximity to chipboard industries increases the risk of respiratory and irritation symptoms in children: the Viadana study.

Emissions related to wood production processes are a recognized health hazard for professionally exposed subjects. The health effects of living close to wood industries are not known, particularly in the pediatric population. We aimed at investigating if living close to chipboard industries is a health hazard for the children in the Viadana district (Northern Italy). In December 2006, all the children (3-14 years) living in the Viadana district, where two big chipboard industries are located, were surveyed through a parental questionnaire (n=3854). The children were geocoded, and the distance of their houses/schools from the closest wood plant was computed. Independently of sex, age, nationality, residential area, traffic, parents' education, passive/parental smoking, questionnaire compiler and his/her environmental concern, the children living at <2 km from chipboard industries had a greater prevalence of respiratory (OR=1.33, 95%CI: 1.11, 1.60), cough/phlegm (OR=1.43, 95%CI: 1.08, 1.88), nose/throat/mouth (OR=1.47, 95%CI: 1.23, 1.75), eye (OR=1.24, 95%CI: 1.04, 1.48) symptoms, school-days lost (OR=1.24, 95%CI: 1.04, 1.48), and emergency (OR=2.14, 95%CI: 1.47, 3.11) and hospital (OR=2.21, 95%CI: 1.17, 4.18) admissions. There was an inverse dose-response relationship between the adverse health outcomes considered and the distance from the plants. The attributable fractions for the children living close to the chipboard industries were substantial, ranging from 13% (eye symptoms) to 27% (cough/phlegm). The present findings suggest that emissions from chipboard industries might have a serious impact on children's health status and should therefore be reduced and closely monitored.