-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND AND AIMS: This analysis investigates the poorly-known effect of local prevalence of childhood obesity on mothers' perception of their children's weight status. METHODS AND RESULTS: In 2008, a national nutritional survey of children attending the third grade of elementary school was conducted in Italy. Children were measured and classified as underweight, normal weight, overweight and obese, using the International Obesity Task Force cut-offs for body mass index (BMI). A parental questionnaire included parental perception of their child's weight status (underweight, normal, a little overweight and a lot overweight). Regions were classified by childhood obesity prevalence (<8%, 8-12%, ≥13%). The association between incorrect maternal perception and regional obesity prevalence, and maternal and child characteristics were examined using bivariate and logistic regression analyses. Complete data were available for 37 590 children, of whom 24% were overweight and 12% obese. Mothers correctly identified the status of 84% of normal weight, 52% of overweight and 14% of obese children. Among overweight children, factors associated with underestimation of the child's weight included lower maternal education (adjusted odds ratio, aOR, 1.9; 95% confidence interval (CI) 1.6-2.4), residence in a high-obesity region (aOR 2.2; 95% CI 1.9-2.6), male gender (aOR 1.4; 95% CI 1.2-1.6) and child's BMI. CONCLUSION: Higher regional obesity prevalence is associated with lower maternal perception, suggesting that what is common has a greater likelihood of being perceived as normal. As perception is a first step to change, it may be harder to intervene in areas with high-obesity prevalence where intervention is most urgent.
Nutrition, metabolism, and cardiovascular diseases: NMCD 12/2011; · 3.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To estimate the prevalence of childhood overweight and obesity among Italian schoolchildren and to examine geographic differences and present and future implications for health care, we used data from a nationwide representative survey performed in May 2008 among third-grade students in 18 of Italy's 21 regions. Cluster sampling was used to identify classes for participation. The study population included all children aged 8-9 years whose parents agreed to opt-out consent. Parents, children and teachers completed brief questionnaires, and children were weighed and measured by trained staff using standardized equipment. Consent was obtained for 97% of 50 197 third-graders, of whom 44 676 (89%) met study inclusion criteria. Obesity levels (defined using International Obesity Task Force cut-offs) ranged from 7.5% (95% confidence intervals 6.7-8.2) in the north to 16.6% (95% confidence intervals 15.8-17.4) in the south. Behaviours known to be associated with obesity also showed geographic differences. The estimated burden of obesity-related pathologies also increased from north to south. These findings suggest the need for community as well as individual interventions in all areas of the country but with particular attention to the south.
Obesity Reviews 09/2009; 11(1):2-10. · 7.04 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of the document is to define the most appropriate indications and health-care procedures for tonsillectomy and adenoidectomy and is intended for use by paediatricians, general practitioners, and otolaryngologists involved in the treatment of adenotonsillar pathologies. After a systematic review and grading of evidences from the literature, the document was drafted by a multidisciplinary panel with identified key clinical questions related to indications for surgery, surgical and anaesthesiology procedures, clinical management and organizational issues. It should be stressed that the document was not aimed at providing graded recommendations per se, but to offer suggestions and advices. The document will be updated within December 2006.
International Journal of Pediatric Otorhinolaryngology 05/2005; 69(4):497-500. · 1.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To examine the characteristics of women attending antenatal classes and evaluate the effects of these classes on mothers' and babies' health.
A population-based observational study on care during pregnancy, delivery and in the postnatal period was carried out in 1995-96. A total of 9004 women resident in 13 regions of Italy who delivered in a 4-month period were interviewed. The outcomes studied were attendance at antenatal classes, Cesarean section, bottle feeding, satisfaction with the experience of childbirth, knowledge of contraception, breast feeding and baby care.
A total of 2065 (23.0%) women attended antenatal classes. Women without previous children, those with a higher level of education and office workers were more likely to attend classes. Women who attended antenatal classes had a much lower risk of Cesarean section and were about half as likely to bottle feed while in hospital compared with non-attenders. They received better information on contraception, breast feeding and baby care. Women who attended classes and applied the techniques learned were more satisfied with the experience of childbirth.
Antenatal classes seem to improve women's knowledge and competence. This may provide a defence against the tendency to overmedicalize pregnancy and childbirth.
Journal of Maternal-Fetal and Neonatal Medicine 03/2003; 13(2):94-101. · 1.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There exists conflicting evidence regarding the higher risk of hysterectomy among women of a lower educational and economic level. This study aims to assess whether in Italy socioeconomic level is related to hysterectomy undertaken for different medical reasons.
An area based index was used to assign socieconomic status (SES; four levels defined) to 3141 women (aged 35 years or older) who underwent a hysterectomy in 1997 and were residing in Rome. Data were taken from hospital discharge records. Direct age standardised hospitalisation rates by SES level were calculated for overall hysterectomies and for those performed for either malignant or non-malignant causes. Statistical differences were detected using the ratios of standardised rates and the test for linear trend.
The hysterectomy rate was 36.7 per 10 000 women aged 35 years or more. Hysterectomy for uterine leiomyoma accounted for 41% of all operations and was more frequent among women aged 35-49 years than for those aged 50 years or more (crude rates: 28.6 and 7.7 per 10 000, respectively). The risk of hysterectomy was 35% higher for the lowest SES group, compared with the highest group. No association was found between SES and hysterectomy rates for malignant causes, although less affluent women in age group 35-49 years had 87% higher risk of hysterectomy compared with most affluent women. The inverse association between SES and hysterectomy rates attributable to non-malignant causes was statistically significant for women aged 35-49 years but not for those aged 50 years or more.
The inverse relation between hysterectomy and SES is largely attributable to benign disorders of the uterus, namely leiomyoma and prolapse. More affluent women may have a greater uptake of less invasive techniques for removing uterine leiomyoma compared with less affluent women, who are more likely to undergo unnecessary hysterectomies irrespective of their reproductive age.
Journal of Epidemiology & Community Health 07/2002; 56(6):461-5. · 3.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To describe the use of drugs among Italian women during pregnancy and to compare it with other reports in Italy from the last 10 years.
A random sample of women who delivered in 1995-1996 were interviewed with regard to the care they received during pregnancy, delivery and the post-natal period. Information on antenatal care included maternal reports on the use of drugs during pregnancy.
Of the 9004 women interviewed, 75% took at least one drug during pregnancy. Users took a median number of two drugs. Iron (51%) and vitamins (25%) dominate prescriptions throughout pregnancy. Fifteen percent of women reported treatment for threatened abortion and 27% for risk of pre-term delivery. The data do not differ from the drug exposure profile during pregnancy reported in other Italian studies. Logistic regression analysis of drug use (excluding haematologicals and nutritionals) shows an increased risk of usage for older women, the better educated, for those who reported health problems and those who had compulsory bed rest and/or hospitalisation during pregnancy.
Seventy-five percent of the women reported use of at least one drug during pregnancy. Haematological and nutritional drugs are over prescribed. Although hormones have been clearly proven to be ineffective in preventing threatened abortion, the study shows an almost unchanged and out of date prescription pattern of progestational drugs. In order to avoid unnecessary exposure to potential risk, maternity care procedures should be reviewed and strictly related to an "evidence-based" approach.
European Journal of Clinical Pharmacology 08/2000; 56(4):323-8. · 2.85 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In 1995-96 a knowledge, attitude and practise (KAP) survey on care during pregnancy, delivery and in the post-natal period was carried out by the National Institute of Health in Italy. Of the 9004 women interviewed, 23% have attended antenatal classes (36% in hospitals, 51% in maternal and child health, MCH, clinics and 13% privately). Women attending these classes tend to be well-educated, primigravidae and resident in the North. Women who attend antenatal classes, especially at MCH clinics, have a lower risk of caesarean section (OR = 0.60), of bottle feeding while in hospital (OR = 0.45) and of receiving no information on contraception (OR = 0.31). Women who attend classes and are able to apply the technique learnt have a reduced risk of being dissatisfied with the experience of childbirth (OR = 0.72), whereas the others have an increased risk of dissatisfaction (OR = 1.87).
Annali dell'Istituto superiore di sanita 02/2000; 36(4):465-78. · 0.94 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In 1995-96 a KAP (knowledge, attitude and practice) survey on care during pregnancy, delivery and in the post-natal period was carried out in Italy by the National Institute of Health (Istituto Superiore di Sanità). A sample of 9004 women was interviewed in 13 regions within two months of the delivery. Care during pregnancy was generally at a good standard, but with an excessive use of some medical procedures. The level of knowledge was often low and some non-invasive but effective methods for preventing negative outcomes were not widely adopted. Many women were ill informed about the procedures to which they were subjected and their degree of satisfaction was often low. In general, a wide geographic variability and a lack of continuity in pre- and post-natal care were observed.
Annali dell'Istituto superiore di sanita 02/1999; 35(2):289-96. · 0.94 Impact Factor
-
Annali di igiene: medicina preventiva e di comunità 7(3):165-77.
-
[show abstract]
[hide abstract]
ABSTRACT: In October 2007, the Italian Ministry of Health, the Centre for Disease Control and the Regions entrusted the National Institute of Health with the coordination of the initiative "Okkio alla Salute"--Promotion of healthy lifestyle and growth in primary school children. This programme is linked to the European programme "Gaining health" and the National Plan for Prevention. The objective of the project was to develop and maintain a monitoring system for both the health services and the schools that could also be used to better target public health interventions. The first national survey to estimate the prevalence of overweight and obesity in children and to collect information on diet and physical activity has been conducted in close collaboration with the individual regions. In the first nine months of the project, 1025 health workers and approximately 1500 school teachers have received training, and, using standardised methods, they have collected data and weighed and measured nearly 45000 third grade students (median age 8.8 years) in 2000 schools throughout the country. Participation rates have exceeded 95%. The results obtained to date indicate that the methodology is sustainable using existing health and educational resources and can be adopted as a national surveillance system.
Annali di igiene: medicina preventiva e di comunità 20(4):337-44.
-
[show abstract]
[hide abstract]
ABSTRACT: The number of immigrant women in Italy has increased from 260,000 in 1991 to at least 750,000 in 2003. This article describes the health situation of these women, in particular it deals with reproductive health. Immigrant women are generally young, in good health and they go to the health services mainly for pregnancy, delivery, spontaneous and induced abortion. Forty-eight per cent of acute hospital admissions and 56 per cent of day hospital admissions in 2002 were related to reproduction. Among foreign citizens, the induced abortion rate is three times higher than that reported among Italians, while the risk of spontaneous abortion is similar (97 per thousand and 101 per thousand, respectively). In general, the data show that immigrant women in Italy live in deprived social conditions, which can influence their reproductive choices and their access to health services. In order to take account of their particular needs, it is necessary to modify the health services and plan public health interventions especially for the prevention of induced abortion.
Annali di igiene: medicina preventiva e di comunità 17(3):231-41.
-
G Baglio,
L Cacciani,
P A Napoli,
S Geraci,
F Motta,
R Rossano,
I D'Ascanio,
M E Trillò,
T S Ciuta,
M E Grandolfo,
G Guasticchi
[show abstract]
[hide abstract]
ABSTRACT: Several studies conducted in Rome have shown low levels of vaccination coverage in gypsy communities. Thus a vaccination campaign targeting to 2400 gypsy children aged 0-13 years, present in 32 settlements in Rome, was conducted in 2002. The campaign was related to vaccinations required and recommended in Italy: diphtheria, tetanus, hepatitis B, pertussis (whooping cough), haemophilus influenzae and measles. In the majority of cases it was decided to carry out the vaccinations directly in the gypsy settlements, in accordance with the methods of pulse immunisation. In the case of small settlements a strategy for reorienting the population to vaccination centres was adopted. Around 2000 children were vaccinated, equivalent to 80% of the paediatric population present during the period. The number of children who have never been vaccinated has decreased from 40% prior to the campaign to 9% after the third week. Vaccination coverage in medium- and small-sized settlements (<200 inhabitants) after the campaign shows values of over 70%; in the large settlements, more modest increases have been recorded and coverage has rarely exceeded 50%. This experience has highlighted the importance of networking between public healthcare institutions and non-profit organisations. The mobilisation of a wide range of competences has thus enabled the attainment of a high level of effectiveness.
Annali di igiene: medicina preventiva e di comunità 17(3):197-207.
-
[show abstract]
[hide abstract]
ABSTRACT: The use of hospital discharge abstracts in estimating the outcome of hospital care represents an ongoing interest in public health. However standardized methodologies are still not available. We carried out a retrospective study to estimate the association between demographic and clinical characteristics and in-hospital mortality after stroke by using administrative data from the Hospital Information System in Lazio Region. We also assessed the relationship between the presence of neurology services and the outcome. We found 12,781 incident episodes of stroke (main diagnosis ICD-9: 430-431-434-436) (49.3% male, mean age = 74 years) admitted in 126 hospitals in the Lazio region for the period 1999-2000. From the hospital discharge abstracts we collected patient demographic and clinical data. The hospitals were classified in centres with and without neurology services. Admissions to hospitals with neurology services were evaluated as predictors of in-hospital mortality after adjustment for gender, age, residence, education, source of admission, type of stroke, heart disease, kidney disease and history of atrial fibrillation. In-hospital mortality (within 30 day) was 25.1%. Female gender, advanced age, residence in Rome, urgent transport, kidney disease and history of atrial fibrillation were associated with an increased risk. Hemorrhagic stroke (ICD-9 = 430-431) had a worse outcome than ischemic stroke (ICD-9 = 434) and acute undefined cerebrovascular disease (ICD-9 = 436). Patients admitted to hospitals with neurology services showed a significantly decreased risk (OR = 0.88, IC95% = 0.79-0.98), particularly in occlusion of cerebral artery (ICD-9 = 434) and in undefined cerebrovascular disease (ICD-9 = 436). Demographic and clinical variables are associated with the outcome of hospitalised stroke patients. Admissions of acute stroke patients in specialized hospitals seem to play a role in reducing the risk of in-hospital mortality.
Annali di igiene: medicina preventiva e di comunità 16(1-2):351-64.
-
[show abstract]
[hide abstract]
ABSTRACT: PRUO, a modified version of AEP, is a widely used clinical-based tool to evaluate hospital appropriateness in Italy. We developed the APPRO method for assessing organizational appropriateness using administrative data. APPRO estimates the amount of inappropriate hospitalisation, giving consideration to severity of illness through APR-DRG classification system. The aims of the study were to: measure the agreement between evaluators using PRUO; investigate the relation between APR-DRG severity subgroups and PRUO assessment; asses the validity of APPRO method comparing its performance to PRUO results. We selected 361 hospital episodes assigned to DRG 39 ("lens procedures with or without vitrectomy") and 242 hospital episodes assigned to DRG 183 ("miscellaneous of digestive disorders, age > 17") from three hospitals in 2000. Clinical records were independently evaluated by two pairs of physicians using PRUO. Proportions of inappropriate episodes by hospital and DRG were also estimated through APPRO using data from Lazio regional hospital information system. The agreement between the two pairs of evaluators was high (k=0.93; p<0.0001). We observed no statistically significant association between APR-DRG severity subgroups and inappropriate hospitalisation found by PRUO. APPRO underestimates rates of inappropriate hospitalisation compared to PRUO. It depends on the different characteristics of the tools and particularly on the caution of APPRO in performing the evaluation using routine data.
Annali di igiene: medicina preventiva e di comunità 16(1-2):79-94.
-
[show abstract]
[hide abstract]
ABSTRACT: Aim of the study was to describe frequency, causes, regional variations, setting and risk of mortality of tonsillectomy and adenoidectomy in Italy. The study is based on hospital discharge data for the years 1998-2000 provided by the Ministry of Health.
During the year 2000, 61.280 tonsillectomy with or without adenoidectomy and 32.655 adenoidectomy alone were performed in Italy. ICD-9-CM codes reported on discharge abstracts indicated that the most frequent causes of tonsillectomy were chronic tonsillitis (45%) and hypertrophy of tonsils and adenoids (43%). The total tonsillectomy rate was 10.6 x 10.000 (CI 10.5-10.7) in 2000, and it was stable throughout the study period. We observed a wide geographical variability of regional tonsillectomy rates, standardised by age and sex. They ranged from 3.5 x 10.000 (CI 3.1-4.0) in Basilicata to 19.0 (CI 18.6-19.5) in Piemonte. We found an inverse correlation (r = -0.50) between regional tonsillectomy rates for tonsillitis and minimum temperatures recorded in capitals of the regions. Most operations were performed in the acute setting with a hospital stay longer than one day. The mortality risk associated to surgery was estimated to be at least of one case over 95.000 operations.
The observed variability of regional tonsillectomy rates, only partly explained by weather differences, may be ascribed to disagreement among physicians. Inappropriate variations and setting were the two main reasons conducive to the development of the guidelines "Clinical and organisational appropriateness of tonsillectomy and/or adenoidectomy in Italy", in the frame of LINCO project and of the Italian National Program for Guidelines.
La Pediatria medica e chirurgica: Medical and surgical pediatrics 26(3):179-86.
-
[show abstract]
[hide abstract]
ABSTRACT: 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.
Annali di igiene: medicina preventiva e di comunità 17(4):335-42.
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study is to assess effectiveness of surgical treatment for hypospadia in the Regione Lazio (Italy). Hospital discharge data concerning surgical repair of hypospadia between 1996-1998 were analysed in order to: 1. estimate the trend of demand for hypospadia treatment; 2. correlate clinical results with the type of Surgical Unit of admission (general pediatric, urological, plastic); 3. correlate surgical results with the workload of the Unit; 4. quantify the general risk of a secondary treatment.
The source of data was the Hospital Information System of the Regione Lazio. Cases have been grouped according to Health District, age at first operation, interval to re-hospitalization after the first treatment for hypospadia.
Age at first operation progressively declined in the last years. The annual risk of readmission and reoperation after the first surgical treatment, calculated on a group of 521 cases in 1996, are respectively 6.6% and 5%.
The demand for hypospadia surgery in children was, as expected, stable in the time. However, a tendency to an earlier correction has been observed, mainly in the first and second year of life. Nearly all (99%) of the surgery for hypospadia in the Regione Lazio is performed in four hospitals; one of them accounts for three quarters of the workload. During the observed period a progressive reduction of hospital stay was seen. In the hospital with the best results in term of surgical efficiency, a significant number of patients is treated on a Day Surgery basis. Institutions treating less than 50 cases per year show a significantly high rate of re-hospitalisation within 12 months.
La Pediatria medica e chirurgica: Medical and surgical pediatrics 24(3):223-7.
-
[show abstract]
[hide abstract]
ABSTRACT: In 2007 the Italian Ministry of Health/CCM promoted and funded the project "System of surveys of behavioral risks in ages 6-17", coordinated by the National Institute of Health. One of the aims of the project is the definition and implementation of a data collection system on the weight of primary school children, their eating habits, physical activity and school initiatives favoring the healthy growth of children, called "OKkio alla SALUTE". In 2008 the first survey of OKkio was conducted in 18 Italian regions. 45,590 third grade school children in 2610 classes participated. Information was collected from 2461 schools. The responses of the head teachers showed that 64% of the schools have a canteen, used by 70% of children. Only 12% of schools include the provision of a balanced mid-morning snack. Frequently there are educational activities related to physical activity and healthy eating that, in some cases, also involve the families of the children. 29% of the schools cannot guarantee two hours of physical activity as suggested by the school curriculum because of the lack or inadequacy of the gym or the structure of the timetables. The information gathered through the cooperation of school administrators, teachers and health workers, has helped to describe the major health educational activities of the school, that is confirmed to be the ideal venue for promoting healthy lifestyles in young people.
Annali di igiene: medicina preventiva e di comunità 22(6):555-62.
-
Annali di igiene: medicina preventiva e di comunità 6(4-6):525-37.
