Precision Measurement of the Lamb Shift in Muonium.

We report a new measurement of the n=2 Lamb shift in Muonium. Our result of 1047.2(2.3)_{stat}(1.1)_{syst} MHz comprises an order of magnitude improvement upon the previous best measurement. This value matches the theoretical calculation within 1 standard deviation allowing us to set limits on Lorentz and CPT violation in the muonic sector, as well as on new physics coupled to muons and electrons which could provide an explanation of the muon g-2 anomaly.

Transcranial color Doppler in stroke-free adult patients with sickle cell disease.

The threshold velocity ≥200 cm/s at transcranial Doppler (TCD) evaluation is a useful cut-off for preventing the stroke (STOP trial) in pediatric patients with sickle cell disease (SCD), term including different types of sickle genotypes. Scanty data are available for adult SCD patients. We compared intracranial blood flow velocities between adult SCD patients and controls using transcranial color Doppler (TCCD), measuring the peak of systolic velocity (PSV) with the insonation angle correction and the pulsatility index (PI), an indicator of endothelial elasticity. Fifty-three adult SCD patients (aged >18 years) were enrolled (15 sickle cell anemia, 26 sickle cell thalassemia, and 12 HbS/HbC). None of the patients presented neurological signs. PSVs in middle cerebral artery (MCA) were higher in SCD patients than in controls (p = 0.001). In sickle cell anemia patients, PSVs were higher when compared to HbS/ßThal (p < 0.0060) and HbS/HbC patients (p < 0.0139). PI was within the lower range of normality in SCD patients compared to controls. Moreover, MCA-PSV was higher with lower Hb levels and higher HbS%; PI did not change with variation of Hb levels and HbS%.PSV and PI in SCD adult patients could be a relevant index to indicate the abnormal cerebral blood flow and to detect the sickle endothelial damage, in order to prevent cerebrovascular accidents.

Personal and occupational factors contributing to biomechanical risk of the distal upper limb among dairy workers in the Lombardy region of Italy.

Biomechanical overload in the wrist flexor and extensor muscles, together with awkward hand positions during work activities, can result in occupational wrist and hand disorders. Dairy workers, specifically those that work in the milking parlor, are exposed to highly repetitive and forceful exertions of the upper limb throughout their work shift. There are very few studies that have investigated the determinants that contribute to the risk of distal upper limb musculoskeletal disorders among dairy workers. The purpose of the present study was to identify the variables affecting the biomechanical overload of the distal upper limb among milking parlor workers, define risk profiles, and propose possible interventions to reduce the high physical loads to the distal upper limb during milking activities. Forty male workers from the three most common milking parlor systems in Lombardy Italy were recruited to participate in this study. Multiple correspondence analysis of personal characteristics and occupational risk factors, followed by cluster analysis, led to the identification of three distinct groups of workers. Low, medium and high risk profiles were assigned to each group based on the risk assessments performed using the Strain Index and electromyography of the distal upper limb. The main risk determinants were workstation characteristics, work organization and milking routine. A well-organized milking routine, milking cluster weight below 2.4 kg or the use of supporting arms for the milking cluster may reduce the risk of biomechanical overload.

Moving ahead in diabetics' cancer screening; food for thought from the Hellenic experience.

Although data from literature suggest that diabetic women are frequently under screened for gynaecological cancers little is known about screening implementation for other cancers for both genders. This study investigates comprehensive cancer screening practices of diabetics as compared with non-diabetics; analyses screening patterns both by gender and level of evidence and reveals target subgroups that should be paid more attention for screening implementation. 675 diabetics vs. 5772 non-diabetic Greek individuals entered the PACMeR 02 cancer screening study. Diabetic women reported significantly lower performance for the sex-specific evidence-based cancer screening tests and digital rectal examination (DRE) as compared with non-diabetics (P < 0.05). Diabetic women older than 60 years old, of elementary education, housewives and farmers showed the lowest performance rates (P < 0.01). Prostate cancer screening was higher among diabetic men with ultrasound and DRE reaching statistical significance (P < 0.05). Subgroups analysis did not reveal a hidden relationship. Both genders of diabetics reported never performing skin examination at higher rates (P < 0.001), although screening intent is extremely low in both diabetics and non-diabetics (<1%). Evidence-based screening coverage was inconsistent in both genders independently by the diabetic status. Primary care efforts should be provided to implement presymptomatic cancer control.

The impact of automatic devices for capillary blood collection on efficiency and pain response in newborns: A randomized controlled trial.

BACKGROUND: The heel stick is the method of choice in most neonatal units for capillary blood sampling, and it represents the most common event among all painful procedures performed on newborns. The type and design of heel stick device and the clinical procedure to collect a blood sample may have an impact on newborn pain response as well. OBJECTIVE: To compare the pain response and efficiency of different automated devices for capillary blood collection in newborns. DESIGN: Randomized clinical trial. SETTING: Postnatal ward of a tertiary-care university hospital in Italy. PARTICIPANTS: Newborn infants at gestational age ≥34 weeks undergoing the metabolic screening test after the 49th hour of life. METHODS: A total of 762 neonates were recruited and randomized into 6 groups (127 babies in each group) assigned to 6 different capillary blood collection devices (Ames Minilet™ Lancet; Cardinal Health Gentleheel®; Natus Medical NeatNick™; BD Quikheel™ Lancet; Vitrex Steriheel® Baby Lancet; Accriva Diagnostics Tenderfoot®). MAIN OUTCOME MEASURES: The following data were collected and assessed for each of the 6 groups evaluated: a) number of heel sticks, b) pain score according to the Neonatal Infant Pain Scale (NIPS) and c) need to squeeze the heel. RESULTS: The Ames Minilet™ Lancet device was found to perform by far the worst compared to the five device underexamination: it required the highest number of sticks (mean=3.91; 95% CI: 3.46-4.36), evoked the most intense pain (mean=3.98; 95% CI: 3.77-4.20), and most frequently necessitated squeezing the heel (92.9%; 95% CI: 86.9-96.3). The five devices under examination appeared to be similar in terms of the number of sticks required, but differed slightly in NIPS score and in need to squeeze the heel. CONCLUSION: The Accriva Diagnostics Tenderfoot® device demonstrated the greatest efficiency for blood sampling and evoked the least pain. With this device, the metabolic screening test could be performed with a single skin incision in the large majority of infants (98.4%), heel squeezing was limited to only 6.3% of infants, and the NIPS score turns out to be lower than other devices in our study (1.22; 95% CI 1.05-1.39).

Pre-induction cervical ripening with prostaglandin E2 gel: intracervical versus intravaginal route.

The aim of our study was to evaluate the best method for cervical ripening before a classical induction with amniotomy and oxytocin. One hundred term pregnant patients who presented an unfavorable cervix and an indication for the induction of labor were assigned randomly to either 0.5 mg prostaglandin (PG) E2 gel intracervically (N = 52) or 3 mg PGE2 gel intravaginally (N = 48). The intravaginal gel had a greater effect on cervical ripening according to a modification of the Bishop score than did intracervical gel, but it had a higher incidence of side effects.

Construction of a socio-economic index to facilitate analysis of health data in developing countries.

In order to plan, implement and monitor health interventions for the most deprived sector of the population, it is necessary to identify socioeconomic groups at risk. Multiple Correspondence Analysis was used to construct a socio-economic index based on data collected from a sample of 2698 households in South-West district of the Ugandan Republic in 1988. This study is a part of the baseline survey done by the Government of Uganda in collaboration with UNICEF. Its aim was to reduce the incidence of death of children below 5 years from diarrhea. Two factorial axes, representing respectively the socio-cultural and the anthropological conditions, explained more than 80% of the total variability. Among the 11 variables employed the most useful in characterizing the socio-economic classification were: father's occupation, parent's literacy, father's professional position and ownership of a radio. A classification in 7 levels was obtained. The first two levels are characterized as professionals and civil servants. The bottom two levels include households where both parents are illiterate and where father's primary activity is agricultural at a subsistence level. The three middle levels represent a transitional situation. In order to classify the family into the different levels, the other related variables, such as father's professional position or ownership of radio or father's religion or presence of latrine proved to be very useful. A flow chart which identifies which level a household belongs to was constructed. A general and valid observation is that families classified into the last two levels (6 and 7) constituted the population at risk for health conditions.

Structural analysis of a set of socioeconomic indexes as an aid in defining the socioeconomic level of a family: results from an italian multicentric survey.

The study of possible associations between social and health factors was one of the purposes of the multicentric Italian survey of perinatal preventive medicine. To get a concise and coherent social indicator, which could be useful to this study, we explored the socioeconomic information systematically collected on the parents of 12,058 babies born in 1973-1975 in four centres (Trieste, Milan, Parma and Bari), which reflect some of the heterogeneous aspects of Italy. The Correspondence analysis indicated that the seven considered indexes, concerning both parents' education levels and occupations, dwelling quality and the length of father's residence in the area in which the baby was born, were highly and similarly correlated in each centre. The Dynamic cluster analysis enabled us to bring together the socioeconomic profiles of the families into six classes, on the basis of their similarities, which depend only upon the multivariate distribution of the seven categorical variables under study. Therefore, the attained classification not only is independent of whatever score is assigned to the socioeconomic categories but also allows for the strong interactions between the variables and exploits all the available information. Our six classes were found to be rather similar to the six socioeconomic groups (S.E.G.) of the U.K. Registrar General and to show some resemblance to certain social groups defined by other classifications adopted in obstetric and pediatric field. The socioeconomic indicator constructed here should enable us to find out how much, in different areas of Italy, the social classes may account for inequalities in health conditions and care of the mother and her baby.

Anthropometry as a predictor for mortality among Ugandan children, allowing for socio-economic variables.

Length, height, weight and mid-upper arm circumference (MUAC) were measured in 4320 children aged between 0 and 59 months, and their socio-economic status was assessed, in 31 villages in Southwest Uganda during March-April 1988. A follow-up survey assessed the mortality of the children during the 12 months following anthropometry. Mortality rates were higher in those with low anthropometric indices at the first survey. MUAC was the most sensitive predictor of mortality followed by weight-for-age, height-for-age and weight-for-height. MUAC increased the predictive power of other parameters whereas the other parameters did not increase the predictive power of MUAC. MUAC below 12.5, 11.5 and 10.5 cm predicted 10.9%, 18.7% and 36.5% of the deaths respectively. Nutritional status was worse in the low socio-economic group but the predictive power of anthropometry for mortality was not influenced by socio-economic status. This suggests that nutrition per se has an influence on mortality which is independent of socio-economic status.

Weight growth in infants born to mothers who smoked during pregnancy.

OBJECTIVE: To determine whether maternal smoking during pregnancy causes impairment in growth after birth. DESIGN: Longitudinal study. SETTING: Six medical university centres of six towns of north, central, and south Italy. SUBJECTS: 12,987 babies (10,238 born from non-smoking mothers, 2276 from mothers smoking one to nine cigarettes a day, and 473 from mothers smoking > or = 10 cigarettes a day) entered the study. MAIN OUTCOME MEASURES: Difference in weight gain between children born to smoking mothers and those born to non-smoking mothers. Weight was measured at birth and at 3 and 6 months of age. Maternal smoking habit was derived from interview on third or fourth day after delivery. RESULTS: Compared with children born to mothers who did not smoke during pregnancy, the birth weights of children born to mothers who smoked up to nine cigarettes a day were 88 g (girls) and 107 g (boys) lower; in children born to mothers who smoked > or = 10 cigarettes a day weights were 168 g and 247 g lower. At six months of age for the first group the mean weight for girls was 9 g (95% confidence interval -47 g to 65 g) higher and for boys 64 g (-118 g to -10 g) lower than that of children born to mothers who did not smoke. The corresponding figures for the second group were 28 g (-141 g to 85 g) lower for girls and 24 g (-136 g to 88 g) lower for boys. CONCLUSIONS: The deficits of weight at birth in children born to mothers who smoked during pregnancy are overcome by 6 months of age. These deficits are probably not permanent when smoking habit during pregnancy is not associated with other unfavourable variables (such as lower socioeconomic class).

[Education of the hypertensive patient: are educational booklets useful?]. / L'educazione del paziente iperteso: sono utili gli opuscoli informativi?

A good level of knowledge about hypertension can improve patients' compliance to treatment so achieve better therapeutic results. The aim of our study was to evaluate the degree of knowledge about their disease in hypertensives followed in a hospital out-patient unit; and whether an informative booklet could increase this awareness. The patients were presented a questionnaire on the following items: 1. their interest in health news as presented by the mass-media and their judgement on physicians' willingness to provide information about hypertension; 2. the health hazards of being hypertensive; 3. the importance of a family history of hypertension; 4. life style and blood pressure; 5. the reasons for treating hypertension and the length of treatment. Upon completion of the questionnaire, the patients were handed out a booklet in which these same topics were analyzed. At the next follow-up visit, they were invited to answer a set of questions quite similar to the first ones, but presented in a different verbal form. 200 patients completed the first questionnaire; 159, both of them. Basically, they show a high degree of correct knowledge about their disease, giving between 77% and 94% of correct answers to the different questions. After the booklet, for most of the questions the percentage of correct answers remains the same; when it does change, this is usually for the worse. Simply handing out a booklet doesn't help patients to better understand their disease. On the contrary it may have an opposite effect, inducing some degree of confusion.

[Birth weight of infants born between the 23rd and 42nd gestational week in Italy]. / Distribuzione del peso nei nati tra la 23a e la 42a settimana di gestazione in Italia.

The Italian distribution of birth weight has been computed using information routinely collected by the Italian Central Institute of Statistics on about 1,150,000 births in the period 1984-1985. Individual records include data on birth weight for single/multiple births for 28th-42nd gestational weeks and for delivery modalities for 23rd-27th gestational weeks, according to sex. This analysis shows, from a large national data-set, distribution of weight at birth from a Southern European population, providing to obstetrics and perinatologists curves of fetal growth more directly representative of the population under their care.

Behaviour during attacks and assessment of intensity in primary headaches of children and adolescents.

Assessment of attack intensity in primary headaches of paediatric age has not received great attention in the literature to date and in the international classification the criteria to define pain intensity are also not specified. The purpose of this research was to evaluate whether behaviour during attacks, reported by the child or a parent, can be used as a measure of attack disability, and so as an indirect measure of attack intensity in primary headaches of children and adolescents. The subjects were 320 patients aged between 3 and 14 years (mean age 9.9 years, SD 2.6 years) affected by primary recurrent headaches and first seen at a headache clinic. Twelve variables taken from their history were considered and sequentially analysed with multiple correspondence analysis and cluster analysis. Five types of behaviour during attacks were identified: (i) the child (or the parent) is unable to answer the questions or the child has no limitation in activities; (ii) the child may have some activity limitation, but only in lively games; (iii) the child has limitations in daily life with regard also to quiet activities; (iv) at least during some attacks the child lies down with closed eyes or in the dark; (v) during each attack the child lies down with closed eyes or in the dark. The least important variables for the identification of the five behaviour types were studying at school and absence from school. There are some limitations in considering child's behaviour as a measure of attack intensity/disability; one of these is the fact that it was found to be related to the educational level of the mother. However, behaviour during attacks, reported by the child or the parent, provides useful information independently of child's age and, together with the score of pain, when this is given, it can be used as measure of attack intensity.

Proportionality of small for gestational age babies as a predictor of neonatal mortality and morbidity.

Neonatal mortality and morbidity of 2609 babies who weighed less than the fifth centile for gestational age were studied in order to evaluate the relationship between the type of intrauterine growth retardation and the short-term prognosis after birth. Of these babies, 1175 had both a birthweight and head circumference below the fifth centile ('proportionately small'); the others, whose body weight was below but head circumference above the fifth centile, were defined as 'disproportionately small'. The former group showed a consistently higher risk of death during the neonatal period. Morbidity defined by birth asphyxia, respiratory distress and neonatal infections was higher in those proportionately small babies who were delivered at term. The picture reversed for hyperbilirubinaemia, which was more frequent among disproportionately small babies. Proportionality, defined on the basis of the correspondence between birthweight and head circumference centiles, appears to be a simple and non-invasive clinical method to identify babies who are at higher risk of adverse outcome.

[Standards of birth weight in Italy]. / Standard di peso alla nascita in Italia.

The Italian standards of birth weight have been computed using information routinely collected by the Italian Central Institute of Statistics on about 1,200,000 births in the period 1984-1985. Individual records include data on birth weight and main fetal and maternal characteristics and delivery modalities. The crude and smoothed 5th, 10th, 50th, 90th and 95th centiles of weight at birth as function of gestational age according to sex, type of birth, maternal age and parity are presented. Centiles of weight at birth were higher (about 5%) in males than in females in all gestational ages: for example the 50th centile of weight at 40 weeks gestation was 3479 g in males and 3332 g in females. Between the 28th and the 32nd week the 50th centile of birth weight for multiple births grew at a rate similar to that of singletons; but beyond 32 weeks the weight growth in multiple birth was markedly lower than in singleton ones, the median multiple birth weight reaching the 10th centile of singleton at 38 weeks. The values of centiles increased with parity in both sexes and all gestational ages. The difference was however limited: for example with reference to the 50th centile the value for births in women reporting three or more births was about 5% higher than in those reporting no previous birth. Likewise, centiles of weight were higher in older women, but the difference tended to disappear after 36 weeks gestation. This analysis shows from a large national data-set standards of weight at birth from a Southern European population, providing to obstetrics and perinatologists curves of fetal growth more directly representative of the population under their care.

Weight, height and arm circumference of children under 5 in the district of Mbarara, south-west Uganda.

This paper describes the growth of weight, height and arm circumference (MUAC) in children aged under 5 years and living in the south-west area of Uganda. The survey was carried out in 1988 and was based on a random sample of 31 villages of the Mbarara district. A total of 4320 children were measured by a team of 20 trained assessors. From these children a reference group was made up of the 3654 known to be still alive after 1 year. Growth charts were drawn by smoothing the non-parametric percentiles of the distribution of height, weight and MUAC for age and of weight for height. The anthropometric characteristics of children living in south-west Uganda differ considerably from those of children on which the FELS/NCHS/WHO references are based. Between 1 and 5 years of age, the median difference between Mbarara and American children increases from 1.5 to 3 kg for weight, from 4 to 7 cm for height, and from 1.5 to 2.5 cm for MUAC. These results imply that the use of the international reference may lead to low specificity and predictive values in screening malnourished children living in an underdeveloped country such as Uganda. The charts here proposed may apply to populations with a lifestyle similar to that of inhabitants of south-west Uganda, both from a nutritional and socioeconomic viewpoint.

Vaginal operative deliveries in Italy.

OBJECTIVE: To analyze the trends in vaginal operative deliveries in Italy. DESIGN: Analysis of information on all deliveries after the 28th week of gestation, routinely collected by the Italian Central Institute of Statistics using a standard form. SETTING: National data on all Italian deliveries in the period 1981-85. SUBJECTS: All deliveries occurred in Italy in the period. RESULTS: Forceps and vacuum delivery were reported in 1981 respectively in 0.9 and 2.1/100 deliveries. Similar percentages were observed during the whole considered quinquennium for vacuum extraction, but the forceps delivery rate decreased to 0.6/100 in 1985. Nulliparous women more frequently had an operative vaginal delivery: the rates of forceps and vacuum deliveries were respectively 1.1 and 3.7/100 in nulliparae and 0.3 and 1.0 in women reporting one or more previous births. There was a direct relationship between vacuum delivery rate and birth weight: vacuum deliveries were reported for respectively 0.9 and 2.3/100 infants weighing less than 2500 g and > or = 2500 g. Likewise, vaginal operative deliveries were more frequent in term or post-term births, and vacuum deliveries among singleton births than multiple ones (2.3 vs 1.7/100 deliveries). CONCLUSIONS: Operative vaginal delivery rates in Italy in the mid 1980's were lower than in most developed countries. The reasons for forceps and vacuum extraction were similar to other developed countries with regard to obstetric determinants, but some differences emerged for socio-demographic factors.