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Dobrina R, Donati D, Giangreco M, De Benedictis A, Schreiber S, Bicego L, Scarsini S, Buchini S, Kwok SWH, Lam SC. Nurses' compliance to standard precautions prior to and during COVID-19. Int Nurs Rev 2024; 71:20-27. [PMID: 36696268 DOI: 10.1111/inr.12830] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/31/2022] [Indexed: 01/26/2023]
Abstract
AIMS To measure nurses' compliance with standard precautions during the COVID-19 pandemic, compare findings with previous assessments and describe the barriers affecting nurses' compliance. BACKGROUND Healthcare providers' compliance with standard precautions is still limited worldwide. Implementation of infection control policies in hospitals is needed internationally, especially during a pandemic. Surprisingly, studies exploring nurses' compliance with standard precautions are lacking during COVID-19. METHODS A multicenter cross-sectional study was adopted in two Italian hospitals. Nurses' compliance with standard precautions was measured through The Compliance with Standard Precautions Scale (Italian version). An open-ended question explored the barriers to nurses' compliance with standard precautions. Reporting, followed the STROBE guidelines. RESULTS A total of 201 nurses were enrolled in 2020. Nurses' compliance with standard precautions was suboptimal. A statistically significant improvement in the compliance rate with standard precautions was observed between pre- and during COVID-19 assessments. High compliance was found in the appropriate use of surgical masks, gloves and sharps disposal. Nurses perceived personal, structural and organizational barriers to standard precautions adherence. CONCLUSION Nurses' compliance with standard precautions was not 100%, and different factors impeded nurses to work safely. Our findings provide institutional leaders and educators with the basis for implementing policies to optimize nurse safety, well-being and patient care. IMPLICATIONS FOR NURSING AND HEALTH POLICIES Nurses have the right to work safely, and when the shortage of personal protective equipment and nurses during an emergency threatens healthcare quality worldwide, policymakers are challenged to act by establishing an effective allocation of resources for consistent compliance with standard precautions. Moreover, nurses should actively engage in the implementation of infection control policies to improve safe behaviours among citizens and students accessing hospitals.
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Affiliation(s)
- Raffaella Dobrina
- Healthcare Professions Department, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', via dell'Istria 65/1, Trieste, Italy
| | - Daniele Donati
- Research Unit Nursing Science, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 200, Rome, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', via dell'Istria 65/1, Trieste, Italy
| | - Anna De Benedictis
- Healthcare Professions Department, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 200 Rome, Rome, Italy
| | - Silvana Schreiber
- Healthcare Professions Department, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', via dell'Istria 65/1, Trieste, Italy
| | - Livia Bicego
- Healthcare Professions Department, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', via dell'Istria 65/1, Trieste, Italy
| | - Sara Scarsini
- Healthcare Department, Azienda Sanitaria Universitaria 'Friuli Centrale', via Pozzuolo 330, Udine, Italy
| | - Sara Buchini
- Healthcare Professions Department, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', via dell'Istria 65/1, Trieste, Italy
| | - Stephen Wai Hang Kwok
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong S.A.R., China
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Taddio A, Della Paolera S, Abbagnato L, Agrusti A, Badolato R, Biscaro F, Caorsi R, Consolaro A, Dellepiane RM, Fabi M, Floretta I, Gattorno M, Giangreco M, La Torre F, Maggio MC, Mambelli L, Mauro A, Mastrolia MV, Meneghel A, Montin D, Ricci F, Simonini G, Smarrazzo A, Sottile R, Stucchi S, Tardi M, Verdoni L, Zuccotti G, Zunica F, Ravelli A, Cattalini M. Early anakinra treatment improves cardiac outcome of multisystem inflammatory syndrome in children, regardless of disease severity. Rheumatology (Oxford) 2024; 63:366-375. [PMID: 37647645 DOI: 10.1093/rheumatology/kead381] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/13/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE The main aim of this study was to define the best treatment option for multisystem inflammatory syndrome in children (MIS-C) and to analyse the role of anakinra. METHODS This is a multicentre retrospective cohort study. Patients were treated according to the attending physician's decision. The patients were divided into four groups on the basis of the first treatment at time of admittance: (i) IVIG, (ii) IVIG and methylprednisolone (≤2 mg/kg/day), (iii) IVIG with high-dose methylprednisolone (>2 mg/kg/day) and (iv) anakinra with or without IVIG and/or methylprednisolone. Primary outcomes were defined as the presence of at least one of the following features: death, the failure of initial treatment, meaning the need for additional treatment for clinical worsening and cardiac involvement at the end of follow-up. RESULTS Two hundred thirty-nine patients were recruited. At univariate analysis, persistent heart involvement at discharge was more frequent in those not receiving anakinra as initial treatment (3/21 vs 66/189; P = 0.047). After comparisons between the four treatment regimens, adjusting for the propensity score, we observed that early treatment with anakinra was associated with a lower probability of developing persistent heart disease at the end of follow-up (odds ratio: 0.6; 95% CI: 0.4-1.0). CONCLUSION We report that early treatment with anakinra is safe and very effective in patients with severe MIS-C. In addition, our study suggests that early treatment with anakinra is the most favourable option for patients with a higher risk of developing a severe disease outcome.
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Affiliation(s)
- Andrea Taddio
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
- University of Trieste, Trieste, Italy
| | - Sara Della Paolera
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | - Raffaele Badolato
- Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Francesca Biscaro
- Division of Pediatrics, Presidio Ospedaliero di Treviso, Treviso, Veneto, Italy
| | - Roberta Caorsi
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Gaslini, Genova, Italy
| | - Alessandro Consolaro
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini and DINOGMI, Università di Genova, Genoa, Italy
| | - Rosa Maria Dellepiane
- SC Pediatria-Immunoreumatologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | | | - Marco Gattorno
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Gaslini, Genova, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Francesco La Torre
- Pediatric Rheumatology Center, Pediatric Unit, "Giovanni XXIII", Pediatric Hospital, Bari, Italy
| | - Maria Cristina Maggio
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Lorenzo Mambelli
- Department of Paediatrics, Santa Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy
| | - Angela Mauro
- Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Vincenza Mastrolia
- Rheumatology Unit, ERN ReCONNET center Meyer Children's Hospital IRCCS University of Florence, Florence, Italy
| | - Alessandra Meneghel
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Davide Montin
- Department of Pediatrics and Public Health, University of Turin, Turin, Italy
| | - Francesca Ricci
- Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Gabriele Simonini
- Rheumatology Unit, ERN ReCONNET center Meyer Children's Hospital IRCCS University of Florence, Florence, Italy
| | - Andrea Smarrazzo
- U.O.C. Pediatria Multispecialistica - IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Rita Sottile
- Department of Paediatrics, Pediatria 2, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Sara Stucchi
- Department of Paediatrics, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Maria Tardi
- Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lucio Verdoni
- Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, University of Milan, Children's Hospital V Buzzi, Milan, Italy
| | - Fiammetta Zunica
- Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Angelo Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini and Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Universitá degli Studi di Genova, Genoa, Italy
| | - Marco Cattalini
- Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
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Ferrante D, Angelini A, Barbiero F, Barbone F, Bauleo L, Binazzi A, Bovenzi M, Bruno C, Casotto V, Cernigliaro A, Ceppi M, Cervino D, Chellini E, Curti S, De Santis M, Fazzo L, Fedeli U, Fiorillo G, Franchi A, Gangemi M, Giangreco M, Rossi PG, Girardi P, Luberto F, Massari S, Mattioli S, Menegozzo S, Merlo DF, Michelozzi P, Migliore E, Miligi L, Oddone E, Pernetti R, Perticaroli P, Piro S, Addario SP, Romeo E, Roncaglia F, Silvestri S, Storchi C, Zona A, Magnani C, Marinaccio A. Cause specific mortality in an Italian pool of asbestos workers cohorts. Am J Ind Med 2024; 67:31-43. [PMID: 37855384 DOI: 10.1002/ajim.23546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Asbestos is a known human carcinogen and is causally associated with malignant mesothelioma, lung, larynx and ovarian cancers. METHODS Cancer risk was studied among a pool of formerly asbestos-exposed workers in Italy. Fifty-two Italian asbestos cohorts (asbestos-cement, rolling-stock, shipbuilding, and other) were pooled and their mortality follow-up was updated to 2018. Standardized mortality ratios (SMRs) were computed for major causes of death considering duration of exposure and time since first exposure (TSFE), using reference rates by region, age and calendar period. RESULTS The study included 63,502 subjects (57,156 men and 6346 women): 40% who were alive, 58% who died (cause known for 92%), and 2% lost to follow-up. Mortality was increased for all causes (SMR: men = 1.04, 95% confidence interval [CI] 1.03-1.05; women = 1.15, 95% CI 1.11-1.18), all malignancies (SMR: men = 1.21, 95% CI 1.18-1.23; women = 1.29, 95% CI 1.22-1.37), pleural and peritoneal malignancies (men: SMR = 10.46, 95% CI 9.86-11.09 and 4.29, 95% CI 3.66-5.00; women: SMR = 27.13, 95% CI 23.29-31.42 and 7.51, 95% CI 5.52-9.98), lung (SMR: men = 1.28, 95% CI 1.24-1.32; women = 1.26, 95% CI 1.02-1.53), and ovarian cancer (SMR = 1.42, 95% CI 1.08-1.84). Pleural cancer mortality increased during the first 40 years of TSFE (latency), reaching a plateau thereafter. CONCLUSIONS Analyses by time-dependent variables showed that the risk for pleural neoplasms increased with latency and no longer increases at long TSFE, consistent with with asbestos clearance from the lungs. Peritoneal neoplasm risk increased over all observation time.
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Affiliation(s)
- Daniela Ferrante
- Department of Translational Medicine, Università del Piemonte Orientale and CPO Piemonte, Novara, Italy
| | - Alessia Angelini
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Fabiano Barbiero
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Fabio Barbone
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Lisa Bauleo
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority, Rome, Italy
| | - Massimo Bovenzi
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
| | - Caterina Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, Roma, Italy
| | - Veronica Casotto
- Epidemiological Department, Azienda Zero, Padova, Veneto Region, Italy
| | | | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniela Cervino
- Department of Public Health, Azienda USL di Bologna, Bologna, Italy
| | | | - Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, Roma, Italy
| | - Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Roma, Italy
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Padova, Veneto Region, Italy
| | - Germano Fiorillo
- Unit of Occupational Medicine-Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Alberto Franchi
- Department of Public Health, Azienda USL di Bologna, Bologna, Italy
| | - Manuela Gangemi
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, Torino, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Girardi
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, Venice, Italy
| | - Ferdinando Luberto
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Massari
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority, Rome, Italy
| | - Stefano Mattioli
- Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | - Simona Menegozzo
- Unit of Occupational Medicine-Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | | | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, Torino, Italy
| | - Lucia Miligi
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine-University of Pavia, Pavia, Italy
| | - Roberta Pernetti
- Department of Public Health, Experimental and Forensic Medicine-University of Pavia, Pavia, Italy
| | | | - Sara Piro
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | - Elisa Romeo
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Stefano Silvestri
- Department of Translational Medicine, Università del Piemonte Orientale and CPO Piemonte, Novara, Italy
| | - Cinzia Storchi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, Roma, Italy
| | - Corrado Magnani
- Department of Translational Medicine, Università del Piemonte Orientale and CPO Piemonte, Novara, Italy
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority, Rome, Italy
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Gentile L, Boscarelli A, Giangreco M, Guida E, Scarpa MG, Olenik D, Schleef J, Codrich D. Management of pleural effusion and empyema in a third-level pediatric surgical center. Minerva Pediatr (Torino) 2023:S2724-5276.23.07420-7. [PMID: 37906133 DOI: 10.23736/s2724-5276.23.07420-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Pleural effusion and empyema are frequent complications of acute bacterial pneumonia in children. To date, evidence regarding the optimal treatment of this condition is limited in the literature. METHODS Patients with pleural effusion and empyema admitted at our Department of Pediatric Surgery over the last ten years were enrolled in this retrospective study, and successively compared with the clinical charts of patients treated before the introduction of a new diagnostic and therapeutic algorithm. In particular, primary outcomes investigated between pre- and postalgorithm period were the use of diagnostic tools and antibiotics, the need for additional therapeutic approaches, complications, and the length of stay. RESULTS After the introduction of the new algorithm there were a decrease in the use of chest radiography for re-evaluation (100% vs. 79%, P=0.003), a more focused use of computed tomography (68% vs. 15%, P=0.001), and a decrease in the use of a second computed tomography (18% vs. 3%, P=0.07); in favor of an increase in the use of the ultrasound scan (40% vs. 100%, P=0.001). There was also a shift from the use of chest tube drainage alone to the use of drainage for urokinase administration (50% vs. 92.3%, P=0.001), and a statistically significant decrease in the need for video-assisted thoracoscopic surgery (25% vs. 7.7%, P=0.001). CONCLUSIONS The introduction of a diagnostic and therapeutic algorithm for the management of pediatric pleural effusion and empyema has notably resulted in a decrease in the utilization of radiography and computed tomography and an increase in the use of ultrasonography, reducing unnecessary radiation exposure in children and overall costs.
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Affiliation(s)
- Lucrezia Gentile
- Faculty of Medicine and Surgery, University of Trieste, Trieste, Italy
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy -
| | - Manuela Giangreco
- Unit of Clinical Epidemiology and Public Health Research, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery and Urology, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
| | - Maria Grazia Scarpa
- Department of Pediatric Surgery and Urology, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
| | - Damiana Olenik
- Department of Pediatric Surgery and Urology, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
- Department of Surgery, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
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5
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Cozzi G, Sovtic A, Garelli D, Krivec U, Silvagni D, Corsini I, Colombo M, Giangreco M, Giannattasio A, Milani GP, Minute M, Marchetti F, Gatto A, Debbia C, Gortan AJ, Massaro M, Hatziagorou E, Ravidà D, Diamand R, Jones E, Visekruna J, Zago A, Barbi E, Amaddeo A, Cortellazzo Wiel L. SARS-CoV-2-related bronchiolitis: a multicentre international study. Arch Dis Child 2023; 108:e15. [PMID: 37130726 DOI: 10.1136/archdischild-2023-325448] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Bronchiolitis is the main acute lower respiratory tract infection in infants. Data regarding SARS-CoV-2-related bronchiolitis are limited. OBJECTIVE To describe the main clinical characteristics of infants with SARS-CoV-2-related bronchiolitis in comparison with infants with bronchiolitis associated with other viruses. SETTING, PATIENTS, INTERVENTIONS A multicentre retrospective study was conducted in 22 paediatric emergency departments (PED) in Europe and Israel. Infants diagnosed with bronchiolitis, who had a test for SARS-CoV-2 and were kept in clinical observation in the PED or admitted to hospital from 1 May 2021 to 28 February 2022 were considered eligible for participation. Demographic and clinical data, diagnostic tests, treatments and outcomes were collected. MAIN OUTCOME MEASURES The main outcome was the need for respiratory support in infants testing positive for SARS-CoV-2 compared with infants testing negative. RESULTS 2004 infants with bronchiolitis were enrolled. Of these, 95 (4.7%) tested positive for SARS-CoV-2. Median age, gender, weight, history of prematurity and presence of comorbidities did not differ between the SARS-CoV-2-positive and SARS-CoV-2-negative infants. Human metapneumovirus and respiratory syncytial virus were the viruses most frequently detected in the group of infants negative for SARS-CoV-2.Infants testing positive for SARS-CoV-2 received oxygen supplementation less frequently compared with SARS-CoV-2-negative patients, 37 (39%) vs 1076 (56.4%), p=0.001, OR 0.49 (95% CI 0.32 to 0.75). They received less ventilatory support: 12 (12.6%) high flow nasal cannulae vs 468 (24.5%), p=0.01; 1 (1.0%) continuous positive airway pressure vs 125 (6.6%), p=0.03, OR 0.48 (95% CI 0.27 to 0.85). CONCLUSIONS SARS-CoV-2 rarely causes bronchiolitis in infants. SARS-CoV-2-related bronchiolitis mostly has a mild clinical course.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Aleksandar Sovtic
- Institute for Health Protection of Mother and Child of Serbia 'Dr Vukan Cupic', Beograd, Serbia
- University of Belgrade Faculty of Medicine, Beograd, Serbia
| | | | - Uros Krivec
- Department of Pediatric Pulmology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Davide Silvagni
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Ilaria Corsini
- IRCCS Policlinico Ospedaliero Universitario di Bologna, Bologna, Italy
| | - Marco Colombo
- Pediatric Emergency Deparment, Ospedale Filippo del Ponte, ASST Sette Laghi, Varese, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Gregorio Paolo Milani
- Paediatric Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Marta Minute
- Ospedale Regionale Ca Foncello Treviso, Treviso, Italy
| | | | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Carla Debbia
- Emergency Departement, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Marta Massaro
- Ospedale Santa Maria degli Angeli di Pordenone, Pordenone, Italy
| | - Elpis Hatziagorou
- Pediatric Pulmonology Unit, 3rd Pediatric Dept, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Domenico Ravidà
- Institute of Pediatrics of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Raz Diamand
- Ruth Rappaport Children's Hospital, Haifa, Israel
| | | | - Jelena Visekruna
- Institute for Health Protection of Mother and Child of Serbia 'Dr Vukan Cupic', Beograd, Serbia
| | | | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
- University of Trieste, Trieste, Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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6
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Dobrina R, Bicego L, Giangreco M, Cassone A, Schreiber S, Buchini S, Piazza M, Muzzatti B, Rigoni P. A multi-method quasi-experimental study to assess compassion satisfaction/fatigue in nurses, midwives and allied health professionals receiving a narrative medicine intervention. J Adv Nurs 2023; 79:3595-3608. [PMID: 37089066 DOI: 10.1111/jan.15686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 03/20/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
AIMS To: (1) measure the impact of a narrative medicine intervention on compassion fatigue and compassion satisfaction of nurses, midwives and allied health professionals; (2) explore participants' working experiences and (3) their impressions of the intervention. DESIGN Multi-methods, quasi-experimental before-after intervention design. METHODS The intervention consisted of 20 narrative medicine sessions (60 h). Healthcare providers (N = 48) from a mother-and-child hospital in Italy completed the 'Professional quality of life' questionnaire before and after the intervention (January 2020-April 2021). Baseline scores served as internal controls. Open-ended questions explored participants' touching experiences at work and their evaluation of the intervention. A thematic content analysis was performed. Reporting followed the TREND and SRQR guidelines. RESULTS The differences before-after intervention in compassion satisfaction or fatigue scores were not statistically significant. Three themes emerged from participants' touching experiences: "Witnessing death and sufferance"; "Witnessing violence" and "Organizational stressors during COVID-19". A statistically significantly higher median score for post-intervention compassion satisfaction was found among participants who reported at least one touching experience compared to those who had no touching experience. Four themes emerged from the reported strengths of the program: "Learning to exteriorize feelings"; "Team building"; "Useful to rework personal/professional journey" and "Develops professional empowerment". Two themes emerged from reported weaknesses: "Programme organization" and "Participants' difficulties in sharing experiences". CONCLUSION A time-limited narrative medicine intervention is not sufficient to produce significant changes in satisfaction or compassion fatigue, especially if implemented during a pandemic. However, such an intervention holds promise for supporting nurses and midwives' professional empowerment and promoting continuity of compassionate care. IMPACT For those at risk of compassion fatigue, policymakers need to invest in training in narrative medicine, which promotes team building, and employee well-being and thus favours compassionate care. Such programmes should be offered to undergraduate students to nurture compassion and attention to self. PATIENT OR PUBLIC CONTRIBUTION Does not apply as the study only includes health care providers.
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Affiliation(s)
- Raffaella Dobrina
- Healthcare Professions Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Livia Bicego
- Healthcare Professions Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Andrea Cassone
- Healthcare Professions Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Silvana Schreiber
- Healthcare Professions Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Sara Buchini
- Healthcare Professions Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Maria Piazza
- Obstetrics and Gynaecology Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Barbara Muzzatti
- Alcohology Unit, Department of Addiction, Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
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Dobrina R, Cassone A, Dal Cin M, Ronfani L, Giangreco M, Schreiber S, Zanchiello S, Starec A, Brunelli L, Brumatti LV, Bicego L. Study protocol for a randomised controlled trial to determine the effectiveness of a mHealth application as a family supportive tool in paediatric otolaryngology perioperative process (TONAPP). Trials 2023; 24:355. [PMID: 37231477 DOI: 10.1186/s13063-023-07376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Otorhinolaryngology (ORL) surgery is common in children, but hospitalisation, surgery, and home care after discharge are stressful experiences for young patients and their family caregivers. Findings from literature highlight a lack of time in hospitals to support ORL surgery children and their caregivers through the perioperative process, along with the risks of caregivers' autonomous web or social media resources investigation. Therefore, this study aims to evaluate the effectiveness of a mobile health application with content to support ORL patients and their caregivers in the perioperative period to reduce caregiver anxiety and child distress compared to standard care. METHODS An open-label, two-arm randomised control trial design is being adopted. The intervention consists of a mobile health application with content to support ORL patients and their caregivers during the perioperative period. One hundred eighty participants will be enrolled and randomly assigned to the experimental group using the mHealth application or the control group. The control group receives standard information and education about the ORL perioperative period from healthcare providers orally or through brochures. The primary outcome is the difference between the intervention and control groups in preoperative caregiver state anxiety. Secondary outcome measures include children's distress before surgery and family preparation for hospitalisation. DISCUSSION The results of this study will be critical to the implementation of a new and safe model for the management of care and education in paediatrics. This model can achieve positive organisational and health outcomes by supporting continuity of care and empowering citizens to have informed participation and satisfaction in paediatric health promotion and management. TRIAL REGISTRATION Trial identifier: NCT05460689 registry name: ClinicalTrials.gov. Date of registration: July 15, 2022. Last update posted: February 23, 2023.
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Affiliation(s)
- Raffaella Dobrina
- Healthcare Professions Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
| | - Andrea Cassone
- Healthcare Professions Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Margherita Dal Cin
- Department of Health Prevention, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Silvana Schreiber
- Healthcare Professions Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | - Laura Brunelli
- Healthcare Professions Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Liza Vecchi Brumatti
- Scientific Direction, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
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8
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Vedovo F, Pavan N, Bertolotto M, Giangreco M, Chiapparrone G, Ongaro L, Currò F, Liguori G, Barbone F, Trombetta C. Neoclitoral location may affect sexual function in transgender women: a preliminary pelvic MRI study. Int J Impot Res 2023:10.1038/s41443-023-00716-2. [PMID: 37179422 DOI: 10.1038/s41443-023-00716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
Assigned female at birth with anorgasmia possess a smaller clitoral glans and clitoral components farther from the vagina lumen than women with normal orgasmic function. There are no studies evaluating this correlation in operated transgender women. We evaluated whether differences in MRI measurements of neoclitoris volume and distance between the neoclitoris and the neovagina were correlated with differences in sexual function. We recruited for a prospective survey study 40 operated male to female patients (oMtF) who had undergone genital gender affirming surgery and postoperative pelvic MRI. Individual pelvic MRIs were reviewed by two blinded investigators, the three axes of the neoclitoris were measured and the volume was calculated using the ellipsoid formula. The distance between the neoclitoris and the neovagina was also measured. Sexual functioning was assessed using the Female Sexual Function Index (FSFI) and the operated Male to Female Sexual Function Index (oMtFSFI). Mean scores differences in FSFI, oMtFSFI were examined; associations with clitoral size, location, sexual functioning and demographical variables were investigated as well. The response rate was 55%, 11 MtFs operated with pubic neoclitoris technique (PNT) and 11 with neo-urethroclitoroplasty according to Petrović (NCP). The NCP group presented a neoclitoris mean volume of 1.04 (SD 0.39) cc vs 1.31 (SD 0.78) cc of the other group (p = 0.55). The mean distance between neoclitoris and neovagina was 4.20 (SD 0.57) cm in the PNT group and 2.55 (SD 0.45) in the NCP group (p < 0.001). Patients who had undergone NCP achieved a higher FSFI and oMtFSFI mean Total Score than those operated with the previous technique (FSFI 25.81 SD 3.02 vs 18.62 SD 9.92 p = 0.08; oMtFSFI 37.63 SD 8.28 vs 43.36 SD 13.02 p = 0.23). According to pelvic MRI measurements, this study suggests a correlation between neoclitoral location and oMtF sexual satisfaction.
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Affiliation(s)
- Francesca Vedovo
- Urologic Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy.
| | - Nicola Pavan
- Urologic Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Michele Bertolotto
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health-IRCCS "BurloGarofolo", Trieste, Italy
| | - Gaetano Chiapparrone
- Urologic Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Luca Ongaro
- Urologic Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Francesca Currò
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Giovanni Liguori
- Urologic Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Fabio Barbone
- Institute for Maternal and Child Health-IRCCS "BurloGarofolo", Trieste, Italy
- University of Udine, Medical Area, Udine, Italy
| | - Carlo Trombetta
- Urologic Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
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Pani P, Carletti C, Giangreco M, Knowles A, Clagnan E, Gobbato M, Del Zotto S, Cattaneo A, Ronfani L. Monitoring gestational weight gain: setting up a regional surveillance system in Italy. BMC Public Health 2023; 23:132. [PMID: 36653835 PMCID: PMC9850588 DOI: 10.1186/s12889-023-15028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In many countries, including Italy, there are few national data on pre-pregnancy Body Mass Index (BMI) and gestational weight gain (GWG), despite these being important predictors of maternal and neonatal health outcomes. This dearth of information makes it difficult to develop and monitor intervention policies to reduce the burden of disease linked to inadequate BMI status and/or GWG in pregnant women. This study describes the setting up and initial implementation of a regional surveillance system on pre-pregnancy BMI and GWG. METHODS Between 1 January 2017 and 31 December 2018, anthropometric data were collected from all pregnant women accessing public health services in the Friuli Venezia Giulia region (Italy) for first ultrasound check (T1) and at delivery (T2). Anthropometric data collected at T1 (self-reported pre-pregnancy weight and measured weight and height) and T2 (measured weight and self-reported pre-pregnancy weight and height) were compared. RESULTS The system was able to reach 43.8% of all the women who gave birth in the region, and provided complete data for 6400 women of the 7188 who accessed the services at T1. At the beginning of pregnancy 447 (7.0%) women were underweight, 4297 (67.1%) had normal weight, 1131 (17.7%) were overweight and 525 (8.2%) had obesity. At delivery, 2306 (36.0%) women were within the appropriate weight gain range, while for 2021 (31.6%) weight gain was insufficient and for 2073 (32.4%) excessive. Only minor differences were observed between measured and self-reported anthropometric data. CONCLUSIONS The surveillance system offers an overview of the weight status of women during pregnancy. About 1/3 of women entered pregnancy with unsatisfactory BMI and 2/3 did not achieve the recommended weight gain. This surveillance system can be an effective tool to guide public health interventions.
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Affiliation(s)
- Paola Pani
- grid.418712.90000 0004 1760 7415Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Via Dell’Istria 65/1, 34137 Trieste, Italy
| | - Claudia Carletti
- grid.418712.90000 0004 1760 7415Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Via Dell’Istria 65/1, 34137 Trieste, Italy
| | - Manuela Giangreco
- grid.418712.90000 0004 1760 7415Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Via Dell’Istria 65/1, 34137 Trieste, Italy
| | - Alessandra Knowles
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Via Dell'Istria 65/1, 34137, Trieste, Italy.
| | - Elena Clagnan
- SC Pianificazione Programmazione E Controllo Direzionale, ARCS – Azienda Regionale di Coordinamento per la Salute Regione Autonoma Friuli Venezia Giulia, Via Pozzuolo, 330 – 33100, Udine, Italy
| | - Michele Gobbato
- SC Pianificazione Programmazione E Controllo Direzionale, ARCS – Azienda Regionale di Coordinamento per la Salute Regione Autonoma Friuli Venezia Giulia, Via Pozzuolo, 330 – 33100, Udine, Italy
| | - Stefania Del Zotto
- SC Pianificazione Programmazione E Controllo Direzionale, ARCS – Azienda Regionale di Coordinamento per la Salute Regione Autonoma Friuli Venezia Giulia, Via Pozzuolo, 330 – 33100, Udine, Italy
| | | | - Luca Ronfani
- grid.418712.90000 0004 1760 7415Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Via Dell’Istria 65/1, 34137 Trieste, Italy
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10
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Cozzi G, Grillone A, Zuliani E, Giangreco M, Zanchi C, Abbracciavento G, Barbi E, Amaddeo A. Suicide attempts and eating disorders in adolescents, the mental health wave of the second year of the COVID-19 pandemic: A paediatric emergency department perspective. Front Pediatr 2023; 11:1078274. [PMID: 36762280 PMCID: PMC9905671 DOI: 10.3389/fped.2023.1078274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
AIM We compared adolescents' visits to a tertiary-level paediatric emergency department (PED) in Italy during the pre-pandemic year and the first and second years of the COVID-19 pandemic, focusing on mental health presentations. METHODS This was a retrospective study. We collected the number of visits, the demographical features, triage codes, discharge diagnoses, and outcomes of adolescents 13-17 years old who accessed the PED from 1 March 2019 to 28 February 2022. RESULTS During the study period, 13,410 adolescents accessed the PED. The number of visits related to mental health problems was 304 (6.4%) in the second year of the pandemic and 306 (5.6%) in the pre-pandemic year, p = 0.07. In the same periods, females' prevalence was higher, 220 (72.4%) vs. 197 (64.4%), p = 0.03. The absolute number of subjects needing admission increased, 44 vs. 34, p = 0.21, and more urgent psychiatric consultations were needed, 161 vs. 114, p < 0.0001. The number of suicide attempts was 23 vs. 8, +188%, p = 0.01. The number of adolescents with eating disorders was 21 vs. 5, +320%, p = 0.001. CONCLUSION PED visits for suicide attempts and eating disorders in adolescents sharply increased in the second year of the pandemic.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | - Manuela Giangreco
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Chiara Zanchi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.,University of Trieste, Trieste, Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
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11
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Starc M, Giangreco M, Centomo G, Travan L, Bua J. Extrauterine growth restriction in very low birth weight infants according to different growth charts: A retrospective 10 years observational study. PLoS One 2023; 18:e0283367. [PMID: 37079523 PMCID: PMC10118091 DOI: 10.1371/journal.pone.0283367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/07/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Extrauterine growth restriction (EUGR) is common among very low birth weight (VLBW) infants and associated with poor neurodevelopmental outcomes. There are two types of EUGR definitions (cross-sectional and longitudinal) and many growth charts for monitoring postnatal growth. Aims of our study were 1) to compare the rate of small for gestational rate (SGA) and EUGR in a population of VLBW infants, both according to different growth charts (Fenton, INeS charts and Intergrowth-21) and different definitions; 2) to identify risk factors for EUGR. METHODS This is a single centre retrospective observational study, including all VLBW infants born between January 2009 and December 2018. Anthropometric measures were obtained at birth and at discharge and presented as z-scores according to three growth charts (Fenton, INeS charts, Intergrowth-21). Maternal, clinical and nutritional data were retrieved from clinical records. RESULTS 228 VLBW were included. Percentage of SGA did not change significantly according to the three different growth charts (Fenton 22.4%, INeS charts 22.8%, Intergrowth 28.2%, p 0.27). Prevalence of EUGR was significantly higher when INeS and Fenton charts were used, compared to Intergrowth charts regardless of EUGR-definition (cross sectional-EUGR: Fenton 33.5%, INeS charts 40.9%, Intergrowth-21 23.8%, p 0.001; longitudinal-EUGR (loss of 1SDS): Fenton 15%, INeS charts 20.4%, Intergrowth 4%, p <0.001). In our population a longer time to reach 100 ml/kg/day of enteral feeding increased of 18% the risk of longitudinal EUGR. Late onset sepsis and retinopathy of prematurity were associated with an increased risk of longitudinal EUGR, although not significantly, while having a preeclamptic mother was associated with a reduced risk. CONCLUSIONS We confirmed a wide variability of EUGR rates when using different charts and definitions, highlighting that Intergrowth-21 charts identify less EUGR when compared to INeS and Fenton charts. Standardized criteria for defining EUGR are warranted in order to facilitate comparisons between studies and to improve the nutritional management of VLBW infants.
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Affiliation(s)
- Meta Starc
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Neonatal Intensive Care Unit, Trieste, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Clinical Epidemiology and Public Health Research Unit, Trieste, Italy
| | - Giacomo Centomo
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Neonatal Intensive Care Unit, Trieste, Italy
| | - Laura Travan
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Neonatal Intensive Care Unit, Trieste, Italy
| | - Jenny Bua
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Neonatal Intensive Care Unit, Trieste, Italy
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12
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Cozzi G, Tessitore A, Giangreco M, Cogo P, Valentini E, Salis S, Pascolo P, Barbi E. SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern. Acta Paediatr 2022; 111:2362-2368. [PMID: 36114734 PMCID: PMC9826455 DOI: 10.1111/apa.16544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 01/11/2023]
Abstract
AIM According to the Italian national statistical institute, severe bacterial infections (SBI) in Italy are responsible for 1.7% of mortality under 5 years of age and their recognition is often challenging, especially in the first stages of the disease. We tried to estimate the prevalence of SBI in our target population and to identify signs and symptoms that could guide in the initial evaluation of a child with a possible SBI. METHODS We designed a prospective, multicentre study and enrolled patients aged 0-14 years at the first evaluation to the emergency department with an acute illness lasting a maximum of 5 days. The presence of variables suggestive of SBI was collected for every enrolled patient. One week after the enrolment, every patient was followed up by telephone. RESULTS SBI is more likely to be detected with the 'gut feeling' in both univariate and multivariate models (univariate OR: 7.16, 95% CI: 4.08-12.56; multivariate OR: 5.34, 95% CI: 2.78-10.25), while abnormal breathing pattern resulted significative only in univariate model (OR 3.83, 95% CI: 1.98-7.40). Nevertheless, their associated sensitivity is low. CONCLUSION SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health ‐ IRCCS Burlo GarofoloTriesteItaly
| | | | - Manuela Giangreco
- Institute for Maternal and Child Health ‐ IRCCS Burlo GarofoloTriesteItaly
| | - Paola Cogo
- Department of MedicineUniversity Hospital of UdineUdineItaly
| | - Elena Valentini
- Department of MedicineUniversity Hospital of UdineUdineItaly
| | - Simona Salis
- Pediatric Clinic, Maternal and Child DepartmentSant'Antonio Hospital, San Daniele del FriuliItaly
| | - Paola Pascolo
- Pediatric Clinic, Maternal and Child DepartmentSan Polo HospitalMonfalconeItaly
| | - Egidio Barbi
- Institute for Maternal and Child Health ‐ IRCCS Burlo GarofoloTriesteItaly,University of TriesteTriesteItaly
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13
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Cozzi G, Cortellazzo Wiel L, Amaddeo A, Gatto A, Giangreco M, Klein-Kremer A, Bosis S, Silvagni D, Debbia C, Nanni L, Chiappa S, Minute M, Corsini I, Morabito G, Gortan AJ, Colombo M, Marchetti F, Garelli D, Piffer A, Cardinale F, Levy N, Curatola A, Gojsina B, Basu S, Barbi E, Sovtic A. Prevalence of SARS-CoV-2 positivity in infants with bronchiolitis: a multicentre international study. Arch Dis Child 2022; 107:archdischild-2021-323559. [PMID: 35705371 PMCID: PMC9240451 DOI: 10.1136/archdischild-2021-323559] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/28/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bronchiolitis is the leading acute respiratory tract infection in infants during the winter season. Since the beginning of the SARS-CoV-2 pandemic, a reduction in the number of bronchiolitis diagnoses has been registered. OBJECTIVE The present study aimed to describe the incidence and clinical features of bronchiolitis during the 2020-2021 winter season in a large cohort of children in Europe and Israel, and to clarify the role of SARS-CoV-2. SETTING, PATIENTS, INTERVENTIONS We conducted a multicentre observational cross-sectional study in 23 paediatric emergency departments in Europe and Israel. Clinical and demographic data about all the cases of infants diagnosed with bronchiolitis from 1 October 2020 to 30 April 2021 were collected. For each enrolled patient, diagnostic tests, treatments and outcomes were reported. MAIN OUTCOME MEASURES The main outcome was the prevalence of SARS-CoV-2-positive bronchiolitis. RESULTS Three hundred and fourteen infants received a diagnosis of bronchiolitis during the study period. Among 535 infants who tested positive for SARS-CoV-2, 16 (3%) had bronchiolitis. Median age, male sex predominance, weight, history of prematurity and presence of comorbidities did not differ between the SARS-CoV-2-positive and SARS-CoV-2-negative groups. Rhinovirus was the most common involved pathogen, while respiratory syncytial virus (RSV) was detected in one case. SARS-CoV-2 bronchiolitis had a mild clinical course, with one patient receiving oxygen supplementation and none requiring paediatric or neonatal intensive care unit admission. CONCLUSIONS During the SARS-CoV-2 pandemic, a marked decrease in the number of bronchiolitis diagnoses and the disappearance of the RSV winter epidemic were observed. SARS-CoV-2-related bronchiolitis was rare and mostly displayed a mild clinical course.
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Affiliation(s)
- Giorgio Cozzi
- IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | | | | | - Antonio Gatto
- Policlinico Universitario Agostino Gemelli, Roma, Italy
| | | | | | - Samantha Bosis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Silvagni
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Carla Debbia
- Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Genova, Italy
| | - Laura Nanni
- Azienda Ospedaliero Universitaria Meyer, Firenze, Italy
| | | | - Marta Minute
- Ospedale Regionale Ca Foncello Treviso, Treviso, Italy
| | - Ilaria Corsini
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | | | | | | | | | | | - Arianna Piffer
- Regional Hospital of Bellinzona and Valli, Bellinzona, Switzerland
| | | | - Nitai Levy
- Ruth Rappaport Children's Hospital, Haifa, Israel
| | | | - Bojana Gojsina
- Institute for Health Protection of Mother and Child of Serbia 'Dr Vukan Cupic', Beograd, Serbia
- University of Belgrade Faculty of Medicine, Beograd, Serbia
| | | | - Egidio Barbi
- IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
- University of Trieste, Trieste, Italy
| | - Aleksandar Sovtic
- Institute for Health Protection of Mother and Child of Serbia 'Dr Vukan Cupic', Beograd, Serbia
- University of Belgrade Faculty of Medicine, Beograd, Serbia
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14
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Tornese G, Carletti C, Giangreco M, Nisticò D, Faleschini E, Barbi E. Carbohydrate Tolerance Threshold for Unannounced Snacks in Children and Adolescents With Type 1 Diabetes Using an Advanced Hybrid Closed-Loop System. Diabetes Care 2022; 45:1486-1488. [PMID: 35522033 PMCID: PMC9210515 DOI: 10.2337/dc21-2643] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/28/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To find a carbohydrate (CHO) tolerance threshold for unannounced snacks to avoid the 2 h increase in glycemia (difference between pre- and postmeal blood glucose [ΔBG]) ≥50 mg/dL in advanced hybrid closed-loop (a-HCL) users. RESEARCH DESIGN AND METHODS Fourteen children and adolescents with type 1 diabetes (7 females; mean age [± SD] 14.5 ± 3.6 years), users of the Medtronic MiniMed 780G, participated in the study. For 12 days, they did not perform insulin bolus before breakfasts, with defined different quantities and types of CHO, with or without fats, performing blood glucose (BG) before and 2 h after the meal. RESULTS A cutoff of 19.8 g of total CHO was found to determine a ΔBG of 50 mg/dL. BG never exceeded 250 mg/dL. Mean time in range was ≥70% in the 2 h following each snack. CONCLUSIONS Unannounced snacks of up to 20 g of CHO can avoid ΔBG ≥50 mg/dL in MiniMed 780G users, although unannounced meals of up to 30 g of CHO are safe.
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Affiliation(s)
- Gianluca Tornese
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | - Claudia Carletti
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | - Daniela Nisticò
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Elena Faleschini
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
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15
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Cozzi G, Blasutig F, De Nardi L, Giangreco M, Barbi E, Amaddeo A. The first winter of social distancing improved most of the health indexes in a paediatric emergency department. Acta Paediatr 2022; 111:1027-1033. [PMID: 35080037 PMCID: PMC9303403 DOI: 10.1111/apa.16271] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/23/2022]
Abstract
Aim We compared visits to a tertiary level paediatric emergency department (PED) in Italy, during winter 2020–2021, when COVID‐19 social distancing measures were in place, with winter 2019–2020. Methods This was a retrospective analysis of an electronic database. We obtained the number of visits and the ages, main complaints, triage codes, discharge diagnoses and outcomes of patients who accessed the PED from the 1 October 2020 to 28 February 2021. These were compared to the same period in 2019–2021. Results Visits fell by 52%, from 10982 in 2019–2020 to 5317 in 2020–2021 (p < 0.0001). The reductions were 52% in neonates, 58% in infants, 53% in toddlers, 61% in preschool children, 48% in school children and 46% in adolescents. Non‐urgent and urgent triage codes declined. Respiratory and gastrointestinal infections fell by 72% and 71% respectively. Injuries declined by 42%, mainly among adolescents. Accidental intoxication, psychiatric symptoms and substance or alcohol abuse declined by 24%, 33% and 64%. Hospital admissions reduced by 8% and admissions to intensive care fell by 29%. Conclusion During the first winter of pandemic social distancing visits to an Italian PED fell by 52%, with higher reductions in younger children and infants, and hospital admissions fell by 8%.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Francesca Blasutig
- Department of Medicine University of Trieste Surgery and Health Sciences Trieste Italy
| | - Laura De Nardi
- Department of Medicine University of Trieste Surgery and Health Sciences Trieste Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
- Department of Medicine University of Trieste Surgery and Health Sciences Trieste Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
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16
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Peinkhofer M, Bossini B, Penco A, Giangreco M, Pellegrin MC, Vidonis V, Vittori G, Grassi N, Faleschini E, Barbi E, Tornese G. Reduction in pediatric growth hormone deficiency and increase in central precocious puberty diagnoses during COVID 19 pandemics. Ital J Pediatr 2022; 48:49. [PMID: 35346309 PMCID: PMC8960104 DOI: 10.1186/s13052-022-01238-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 03/08/2022] [Indexed: 01/14/2023] Open
Abstract
Abstract
Background
While several studies have been published so far on the effect of COVID-19 pandemic on health care for non-COVID-19 diseases, to date no study evaluated the impact of the COVID-19 pandemic on the entire field of pediatric endocrinology. This study aimed to evaluate differences in pediatric endocrine stimulation tests after the advent of COVID-19 pandemics.
Methods
Retrospective study with data collection for pediatric endocrine stimulation tests performed in 2019 and 2020 in a tertiary center.
Results
Overall, 251 tests were performed on 190 patients in 2020, compared to 278 tests on 206 patients in 2019 (− 10% tests; − 8% children evaluated). A significant reduction was found in tests to diagnose growth hormone deficiency (GHD) (− 35%), while LHRH tests increased (+ 22%). A reduction of 30% in GHD diagnosis was observed. Central precocious puberty (CPP) diagnosis increased by 38% compared to 2019, mainly in females.
Conclusion
This study found a significant reduction of tests investigating GHD during COVID-19 pandemics. It also showed a clinically meaningful increase in cases of CPP in girls. These results suggest the need for families and pediatricians to monitor children’s growth during isolation and enlighten new perspectives towards conditions associated with lockdown restrictions as increased screen time, social isolation, and children’s anxiety as possible triggers of CPP.
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17
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Cozzi G, Passaglia L, Agrusti A, Giangreco M, Giorgi R, Barbi E. Adolescents' Utilization of a Tertiary-Level Pediatric Emergency Department in Italy. Front Pediatr 2022; 10:750403. [PMID: 35359905 PMCID: PMC8960306 DOI: 10.3389/fped.2022.750403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Aim Describe the use of the emergency department of a tertiary-level children's hospital in Italy by adolescents. Methods This retrospective study was based on the medical records of patients aged 13 to 17 years, who accessed the emergency department of the Institute for Maternal and Child Health of Trieste, from 1 January to 31 December 2018. The primary outcome was to describe the leading causes of access, diagnoses, rate of hospitalization, and ward of destination among adolescent patients. Results During the study period, 24,599 patients accessed the department. Among them, 3,062 were adolescents, for a total of 3,895 unscheduled visits. The principal causes of access were trauma (45.3%) and organic diseases (38.8%). Two hundred and forty nine adolescents (6.4%) had mental health problems. One hundred and forty two adolescents (3.6%) Were Admitted to the Hospital, 54 of Whom (38%) to the Neuropsychiatric Ward, for Mental Health Problems. Conclusions Among adolescents seen in this Italian tertiary-level children's hospital, mental health problems represented a small proportion of emergency department visits but were the leading cause of urgent hospitalization.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | - Manuela Giangreco
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Rita Giorgi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- University of Trieste, Trieste, Italy
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18
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Catamo E, Robino A, Tinti D, Dovc K, Franceschi R, Giangreco M, Gasparini P, Barbi E, Cauvin V, Rabbone I, Battelino T, Tornese G. Altered Taste Function in Young Individuals With Type 1 Diabetes. Front Nutr 2022; 8:797920. [PMID: 35096943 PMCID: PMC8790289 DOI: 10.3389/fnut.2021.797920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/08/2021] [Indexed: 01/08/2023] Open
Abstract
Past studies on altered taste function in individuals with type 1 diabetes have yielded inconsistent results. We therefore evaluated taste recognition and possible association with personal and diseases characteristics in young individuals with type 1 diabetes and healthy controls. Taste recognition and intensity for 6-n-propylthiouracil (PROP), quinine, citric acid, sucrose, and sodium chloride were assessed using a filter paper method in 276 participants with type 1 diabetes and 147 healthy controls. Personal and clinical data were recorded for all participants during a baseline visit. Regression analysis was adjusted for sex, age, and standardized BMI. Overall, 47% of participants with type 1 diabetes vs. 63.5% of healthy controls recognized all tastes (p = 0.006). Moreover, a lower capacity for recognizing the bitter taste of PROP and the sour taste of citric acid was found in participants with type 1 diabetes compared to healthy controls (p = 0.014 and p = 0.003, respectively). While no significant effect of glycemic control on taste recognition was found, an association with lower age at onset emerged. Our findings suggest an impaired taste perception in individuals with type 1 diabetes, possibly linked to age at onset.
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Affiliation(s)
- Eulalia Catamo
- Institute for Maternal and Child Health, Scientific Institute for Research, Hospitalization and Healthcare Burlo Garofolo (IRCCS), Trieste, Italy
| | - Antonietta Robino
- Institute for Maternal and Child Health, Scientific Institute for Research, Hospitalization and Healthcare Burlo Garofolo (IRCCS), Trieste, Italy
| | - Davide Tinti
- Center for Pediatric Diabetology, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Klemen Dovc
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Manuela Giangreco
- Institute for Maternal and Child Health, Scientific Institute for Research, Hospitalization and Healthcare Burlo Garofolo (IRCCS), Trieste, Italy
| | - Paolo Gasparini
- Institute for Maternal and Child Health, Scientific Institute for Research, Hospitalization and Healthcare Burlo Garofolo (IRCCS), Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health, Scientific Institute for Research, Hospitalization and Healthcare Burlo Garofolo (IRCCS), Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Vittoria Cauvin
- Division of Pediatrics, S. Chiara General Hospital, Trento, Italy
| | - Ivana Rabbone
- Center for Pediatric Diabetology, A.O.U. Città della Salute e della Scienza, Torino, Italy.,Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gianluca Tornese
- Institute for Maternal and Child Health, Scientific Institute for Research, Hospitalization and Healthcare Burlo Garofolo (IRCCS), Trieste, Italy
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Scrimin F, Campisciano G, Comar M, Ragazzon C, Davanzo R, Quadrifoglio M, Giangreco M, Stabile G, Ricci G. IgG and IgA Antibodies Post SARS-CoV-2 Vaccine in the Breast Milk and Sera of Breastfeeding Women. Vaccines (Basel) 2022; 10:vaccines10010125. [PMID: 35062786 PMCID: PMC8778843 DOI: 10.3390/vaccines10010125] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023] Open
Abstract
The COVID-19 pandemic has carried massive global health and economic burden that is currently counteracted by a challenging anti-COVID-19 vaccination campaign. Indeed, mass vaccination against COVID-19 is expected to be the most efficacious intervention to mitigate the pandemic successfully. The primary objective of the present study is to test the presence of neutralizing anti-SARS-CoV-2 antibodies (IgA and IgG) in the breast milk and sera samples from vaccinated women at least 20 days after the complete vaccine cycle. A secondary aim is to compare the IgG antibodies level in maternal serum and breast milk. The third target is to evaluate the presence of the IgG antibodies in breast milk after several weeks from the vaccination. Finally, we collected information on the health status of infants in the days following maternal vaccination. Forty-two mothers were enrolled in the study. Thirty-six received the Pfizer/BioNTech vaccine, four the Astra Zeneca vaccine, one the Moderna vaccine and another woman Astra Zeneca in the first dose and Pfizer/BioNTech in the second dose. All 42 milk samples confirmed the presence of anti-SARS-CoV-2 IgG, and none showed IgA presence. Regarding the matched 42 sera samples, 41 samples detected IgG presence, with one sample testing negative and only one positive for seric IgA. None of the 42 infants had fever or changes in sleep or appetite in the seven days following the maternal vaccination. The level of IgG antibodies in milk was, on average, lower than that in maternal serum. According to our analysis, the absence of IgA could suggest a rapid decrease after vaccination even if frequent breastfeeding could favour its persistence. IgG were present in breast milk even 4 months after the second vaccine dose. Information on the immunological characteristics of breast milk could change mothers’ choices regarding breastfeeding.
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Affiliation(s)
- Federica Scrimin
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.S.); (M.Q.); (G.R.)
| | - Giuseppina Campisciano
- Department of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (M.C.)
| | - Manola Comar
- Department of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (M.C.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Chiara Ragazzon
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Riccardo Davanzo
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Mariachiara Quadrifoglio
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.S.); (M.Q.); (G.R.)
| | - Manuela Giangreco
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Guglielmo Stabile
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.S.); (M.Q.); (G.R.)
- Correspondence:
| | - Giuseppe Ricci
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.S.); (M.Q.); (G.R.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy;
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20
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Cozzi G, Cognigni M, Busatto R, Grigoletto V, Giangreco M, Conte M, Barbi E. Adolescents' pain and distress during peripheral intravenous cannulation in a paediatric emergency setting. Eur J Pediatr 2022; 181:125-131. [PMID: 34218317 PMCID: PMC8760195 DOI: 10.1007/s00431-021-04169-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/24/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Abstract
The objective of the study is to investigate pain and distress experienced by a group of adolescents and children during peripheral intravenous cannulation in a paediatric emergency department. This cross-sectional study was performed between November 2019 and June 2020 at the paediatric emergency department of the Institute for Maternal and Child Health of Trieste, Italy. Eligible subjects were patients between 4 and 17 years old undergoing intravenous cannulation, split into three groups based on their age: adolescents (13-17 years), older children (8-12 years), and younger children (4-7 years). Procedural distress and pain scores were recorded through validated scales. Data on the use of topical anaesthesia, distraction techniques, and physical or verbal comfort during procedures were also collected. We recruited 136 patients: 63 adolescents, 48 older children, and 25 younger children. There was no statistically significant difference in the median self-reported procedural pain found in adolescents (4; IQR = 2-6) versus older and younger children (5; IQR = 2-8 and 6; IQR = 2-8, respectively). Furthermore, no significant difference was observed in the rate of distress between adolescents (79.4%), older (89.6%), and younger (92.0%) children. Adolescents received significantly fewer pain relief techniques.Conclusion: This study shows that adolescents experience similar pain and pre-procedural distress as younger children during peripheral intravenous cannulation. What is Known: • Topical and local anaesthesia, physical and verbal comfort, and distraction are useful interventions for pain and anxiety management during intravenous cannulation in paediatric settings. • No data is available on pain and distress experienced by adolescents in the specific setting of the emergency department. What is New: • Adolescents experienced high levels of pre-procedural distress in most cases and similar levels of pain and distress when compared to younger patients • The number of pain relief techniques employed during procedures was inversely proportional to patient's age, topical or local anaesthesia were rarely used.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | | | - Manuela Giangreco
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Mariasole Conte
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy ,University of Trieste, Trieste, Italy
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21
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Spezzotto G, Boscarelli A, Giangreco M, Ceschiutti G, Codrich D, Scarpa MG, Iaquinto M, Olenik D, Guida E, Schleef J. Management of Primary Spontaneous Pneumothorax in a Third-Level Pediatric Surgical Center: A Retrospective Study. Front Pediatr 2022; 10:945641. [PMID: 35832585 PMCID: PMC9271819 DOI: 10.3389/fped.2022.945641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The management of primary spontaneous pneumothorax (PSP) in pediatrics remains controversial. The aim of this study was to investigate the risk of recurrence after non-surgical treatment vs. surgery, the difference in the length of stay (LOS) between various treatment options, and the role of computed tomography (CT) in the management of PSP. MATERIALS AND METHODS We retrospectively reviewed patients admitted to our Pediatric Surgery Unit for an episode of PSP between June 2009 and July 2020. Medical records including clinical presentation at admission, diagnostics, treatments, complications, and LOS were collected. RESULTS Twenty-three patients (22 males and 1 female) were included in this study. Median age was 15.65 (range 9-18). Chest X-rays were performed in all patients and showed 5 small (22%) and 18 large (78%) PSP. Chest drain was used for large PSP (≥2 cm) if the patient was clinically unstable. Eleven patients (48%) were managed non-operatively with observation alone and a recurrence rate of 18%, chest drain was used in 11 patients with a recurrence rate of 36%, and surgery was deemed necessary as a first treatment choice in one case. Six patients (27%) had an episode of relapse after non-operative management or chest drain placement. Following surgery, a relapse occurred in 2 of the 6 patients. Chest drain insertion was associated with a longer LOS than observation alone (6.36 vs. 2.4 days), and surgery resulted in a longer LOS than other types of treatment (P = 0.001). CONCLUSION According to our experience, small PSP or clinically stable larger PSP can be treated conservatively with observation alone. Operative management should be taken into consideration in children with large symptomatic PSP, persistent air leak, and/or relapse after chest drain insertion.
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Affiliation(s)
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giulia Ceschiutti
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Maria-Grazia Scarpa
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marianna Iaquinto
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Damiana Olenik
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.,Surgical Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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Pessa Valente E, Cattaneo A, Sola MV, Travan L, Quintero Romero S, Milinco M, Decorti C, Giornelli R, Braida C, Dalmin P, Giangreco M, Ronfani L. Problem-based learning for in-service training on breastfeeding in Friuli Venezia Giulia, Italy. Int Breastfeed J 2021; 16:89. [PMID: 34838079 PMCID: PMC8626965 DOI: 10.1186/s13006-021-00439-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background Problem-Based Learning (PBL) is extensively used in pre- and post-graduate teaching programmes. However, it has been seldom used for in-service training and continuing medical education. We aimed to develop a PBL curriculum for a short in-service training on breastfeeding for maternal and child health professionals, and to assess the effect of these courses on their knowledge and skills. Also, the project aimed at increasing exclusive breastfeeding rates and duration in an Italian region. Methods After initial training on PBL and an assessment of the learning needs of about 400 health professionals, a small working group developed learning objectives, designed a curriculum, produced manuals, and shaped assessment tools for a new PBL course on breastfeeding. The field test of the new course allowed selection of the tutors for the scaling up of the training to the whole region. During this extension phase, participants were asked to complete an evaluation questionnaire. In addition, the health professionals who attended the PBL courses in 2019 were asked to complete an online survey to assess knowledge, attitudes and practices (KAP) just before, soon after the course, and 4–6 months later. Results The new 29 − hour PBL course, to be delivered in four days over four consecutive weeks, gives priority to tutorial groups and practical activities (71% of the total time). Supervised clinical practices absorb 16% of time. Ethics, communication and woman-centred clinical management content run throughout the four days and all activities. The three manuals, for tutors, participants and practical activities, facilitate the tasks and performance of tutors and participants. After the field test, 32 regional tutors ran courses for 562 health professionals. The analysis of the evaluation showed a high level of satisfaction for perceived effectiveness, relevance to practice, and educational quality. The KAP questionnaires indicated a general improvement after the course and retention after 4–6 months. Conclusions Despite some predictable shortcomings, this new PBL approach for short in-service training courses on breastfeeding showed encouraging results as far as participants’ satisfaction and KAP are concerned. The possible effects on rates and duration of exclusive breastfeeding need further research. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00439-4.
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Affiliation(s)
- Emanuelle Pessa Valente
- WHO Collaborating Center for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | - Laura Travan
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Mariarosa Milinco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Cinzia Decorti
- Centre for Training Activities, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Roberta Giornelli
- Health Promotion and Prevention, Regional Health Directorate, Trieste, Italy
| | - Cinzia Braida
- Health Promotion and Prevention, Regional Health Directorate, Trieste, Italy
| | - Patrizia Dalmin
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
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23
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Cozzi G, Cortellazzo Wiel L, Bassi A, Giangreco M, Dibello D, Rozzo M, Di Carlo V, Genovese MRL, Barbi E. Need for pharmacological analgesia after cast immobilisation in children with bone fractures: an observational cross-sectional study. Emerg Med J 2021; 39:595-600. [PMID: 34649940 DOI: 10.1136/emermed-2020-210989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 09/28/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Bone fractures are a common reason for children and adolescents to seek evaluation in the ED. Little is known about the pain experienced after cast immobilisation and discharge from the ED and its optimal management. We aimed to investigate the administration of pharmacological analgesia in the first days after cast immobilisation and to identify possible influencing variables. METHODS A prospective observational cross-sectional study was conducted at the ED of the children's hospital, Institute for Maternal and Child Health of Trieste, Italy, from October 2019 to June 2020. Patients aged 0-17 years with bone fractures were included. The primary outcome was the administration of analgesia during the 10 days following discharge, while secondary outcomes were the associated variables, including age, gender, fracture type and location, the mean limitation in usual activities and the frequency of re-evaluation at the ED for pain. Data were recorded through a questionnaire, completed by caregivers and collected by the researchers mainly through a telephone interview. The primary endpoint was evaluated as the ratio between the number of children who took at least one analgesic dose and the total enrolled children, while Χ2 or Fisher's exact tests were used to assess secondary outcomes. RESULTS During the study period, 213 patients, mean age 10 years (IQR: 8-13), were enrolled. Among them, 137 (64.3%) did not take any analgesic during follow-up. Among children who were administered analgesia, 22 (28.9%) received it only on the first day, and 47 (61.8%) for less than 5 days. One hundred and sixty one patients (75.6%) did not report any limitation in usual activities because of pain. The administration of analgesia was not related to the child's age, gender or fracture site. Displaced fractures were associated with significantly more frequent analgesia being taken (OR 5.5, 95% CI 1.4 to 21.0). CONCLUSION Although some studies recommend scheduled analgesic treatment after discharge for bone fractures, this study would suggest analgesia on demand in children with non-displaced fractures, limiting scheduled analgesia to children with displaced fractures.
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Affiliation(s)
- Giorgio Cozzi
- Department of Paediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Luisa Cortellazzo Wiel
- Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Anna Bassi
- Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Manuela Giangreco
- Department of Paediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Daniela Dibello
- UOC Orthopedics and Traumatology, Giovanni XXIII Pediatric Hospital, Bari, Italy
| | - Marco Rozzo
- Department of Paediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Valentina Di Carlo
- Department of Paediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy
| | | | - Egidio Barbi
- Department of Paediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy.,Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Catelan D, Giangreco M, Biggeri A, Barbone F, Monasta L, Ricci G, Romano F, Rosolen V, Zito G, Ronfani L. Spatial Patterns of Endometriosis Incidence. A Study in Friuli Venezia Giulia (Italy) in the Period 2004-2017. Int J Environ Res Public Health 2021; 18:ijerph18137175. [PMID: 34281113 PMCID: PMC8297028 DOI: 10.3390/ijerph18137175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
Background: Diagnosis of endometriosis and evaluation of incidence data are complex tasks because the disease is identified laparoscopically and confirmed histologically. Incidence estimates reported in literature are widely inconsistent, presumably reflecting geographical variability of risk and the difficulty of obtaining reliable data. Methods: We retrieved incident cases of endometriosis in women aged 15–50 years using hospital discharge records and pathology databases of the Friuli Venezia Giulia region in the calendar period 2004–2017. We studied the spatial pattern of endometriosis incidence applying Bayesian approaches to Disease Mapping, and profiled municipalities at higher risk controlling for multiple comparisons using both q-values and a fully Bayesian approach. Results: 4125 new cases of endometriosis were identified in the age range 15 to 50 years in the period 2004–2017. The incidence rate (x100 000) is 111 (95% CI 110–112), with a maximum of 160 in the age group 31–35 years. The geographical distribution of endometriosis incidence showed a very strong north-south spatial gradient. We consistently identified a group of five neighboring municipalities at higher risk (RR 1.31 95% CI 1.13; 1.52), even accounting for ascertainment bias. Conclusions: The cluster of 5 municipalities in the industrialized and polluted south-east part of the region is suggestive. However, due to the ecologic nature of the present study, information on the patients’ characteristics and exposure histories are limited. Individual studies, including biomonitoring, and life-course studies are necessary to better evaluate our findings.
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Affiliation(s)
- Dolores Catelan
- Unit of Biostatistics, Epidemiology and Public Health Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy;
| | - Manuela Giangreco
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (L.M.); (G.R.); (F.R.); (V.R.); (G.Z.); (L.R.)
- Correspondence: ; Tel.: +39-040-3785401
| | - Annibale Biggeri
- Department of Statistics, Computer Science, Applications ‘G. Parenti’ (DiSIA), University of Florence, 50134 Firenze, Italy;
| | - Fabio Barbone
- Department of Medical Area, University of Udine, 33100 Udine, Italy;
| | - Lorenzo Monasta
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (L.M.); (G.R.); (F.R.); (V.R.); (G.Z.); (L.R.)
| | - Giuseppe Ricci
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (L.M.); (G.R.); (F.R.); (V.R.); (G.Z.); (L.R.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Federico Romano
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (L.M.); (G.R.); (F.R.); (V.R.); (G.Z.); (L.R.)
| | - Valentina Rosolen
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (L.M.); (G.R.); (F.R.); (V.R.); (G.Z.); (L.R.)
| | - Gabriella Zito
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (L.M.); (G.R.); (F.R.); (V.R.); (G.Z.); (L.R.)
| | - Luca Ronfani
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (L.M.); (G.R.); (F.R.); (V.R.); (G.Z.); (L.R.)
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Pennesi M, Amoroso S, Pennesi G, Giangreco M, Cattaruzzi E, Pesce M, Busetti M, Barbi E, Conversano E. Is ultrasonography mandatory in all children at their first febrile urinary tract infection? Pediatr Nephrol 2021; 36:1809-1816. [PMID: 33481100 DOI: 10.1007/s00467-020-04909-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/29/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study investigated whether performing kidney ultrasound (KUS) only in children presenting either a pathogen other than E. coli at their first febrile urinary tract infection (fUTI) or experiencing fUTI recurrence would increase missed diagnoses of kidney anomalies. METHODS Patients aged 2-36 months with fUTI who underwent KUS evaluation from 2 January 2013 to 31 June 2018 were enrolled. Cystourethrography was performed after pathological KUS or recurring fUTIs. Thereafter, we retrospectively assessed the detection rate of kidney anomalies through performing KUS only in patients with atypical pathogen at first fUTI or with recurring fUTIs. RESULTS In 263 patients included, the isolated pathogen was E. coli in 223 cases (84.8%) and atypical in 40 cases (15.2%). KUS detected kidney anomalies in 14/223 (6.3%) of fUTIs caused by E. coli and in 11/40 (27.5%) of fUTIs caused by an atypical pathogen (OR 5.5, 95%CI 2.5-14.5). Cystourethrography was performed in 40 patients and vesicoureteral reflux (VUR) found in 20 cases. None of the high grade VUR diagnoses or other kidney anomalies would have been lost through a different diagnostic protocol that required the presence of an atypical pathogen at the first fUTI or a fUTI recurrence to perform the KUS. CONCLUSIONS A diagnostic protocol that requires presence of an atypical pathogen at the first fUTI or a second episode of fUTI to perform the KUS would allow a reduction in the number of negative ultrasounds with a negligible risk of missed diagnoses of kidney anomalies.
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Affiliation(s)
- Marco Pennesi
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Stefano Amoroso
- University of Trieste, Piazzale Europa 1, 34127, Trieste, Italy.
| | | | - Manuela Giangreco
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Marco Pesce
- University of Trieste, Piazzale Europa 1, 34127, Trieste, Italy
| | - Marina Busetti
- Microbiology Unit, University Hospital ASUITS, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.,University of Trieste, Piazzale Europa 1, 34127, Trieste, Italy
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Cognigni M, D'Agostin M, Schiulaz I, Giangreco M, Carletti C, Faleschini E, Barbi E, Tornese G. HbA1c and BMI after lockdown for COVID-19 in children and adolescents with type 1 diabetes mellitus. Acta Paediatr 2021; 110:2206-2207. [PMID: 33709538 PMCID: PMC8251158 DOI: 10.1111/apa.15838] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 12/23/2022]
Affiliation(s)
| | | | | | - Manuela Giangreco
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Claudia Carletti
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Elena Faleschini
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Egidio Barbi
- University of Trieste Trieste Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
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Cattalini M, Della Paolera S, Zunica F, Bracaglia C, Giangreco M, Verdoni L, Meini A, Sottile R, Caorsi R, Zuccotti G, Fabi M, Montin D, Meneghel A, Consolaro A, Dellepiane RM, Maggio MC, La Torre F, Marchesi A, Simonini G, Villani A, Cimaz R, Ravelli A, Taddio A. Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey. Pediatr Rheumatol Online J 2021; 19:29. [PMID: 33726806 PMCID: PMC7962084 DOI: 10.1186/s12969-021-00511-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/28/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. METHODS The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. RESULTS One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. CONCLUSION Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths.
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Affiliation(s)
- Marco Cattalini
- Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | | | - Fiammetta Zunica
- Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Claudia Bracaglia
- Division of Rheumatology, Bambino Gesù Children's Hospital, IRCCS, Pizza di Sant'Onofrio, 4, 00165, Rome, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy
| | - Lucio Verdoni
- Paediatric Department, Hospital Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Antonella Meini
- Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Rita Sottile
- Department of Paediatrics, Pediatria 2, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80129, Naples, Italy
| | - Roberta Caorsi
- UOSD Centro Malattie Autoinfiammatorie ed Immunodeficienze, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, University of Milan, Children's Hospital V Buzzi, Via Lodovico Castelvetro 32, 20154, Milan, Italy
| | - Marianna Fabi
- Department of Pediatrics, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, Via Giuseppe Masserenti 9, 40138, Bologna, Italy
| | - Davide Montin
- Department of Pediatrics and Public Health, University of Turin, Via Giuseppe Verdi 8, 10124, Turin, Italy
| | - Alessandra Meneghel
- Department of Woman's and Child's Health, University of Padova, Via 8 Febbraio 1848, 35122, Padua, Italy
| | - Alessandro Consolaro
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini and DINOGMI, Università di Genova, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Rosa Maria Dellepiane
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy
| | - Maria Cristina Maggio
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, Via del Vespro 133, 90127, Palermo, Italy
| | - Francesco La Torre
- Pediatric Rheumatology Center, Pediatric Unit, "Giovanni XXIII", Pediatric Hospital, Via Giovanni Amendola 207, 70126, Bari, Italy
| | - Alessandra Marchesi
- Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Gabriele Simonini
- Pediatric Rheumatology Unit, AOU Meyer, University of Florence, Via Gaetano Pieraccini 24, 50139, Florence, Italy
| | - Alberto Villani
- Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda 19, 20122, Milan, Italy
| | - Angelo Ravelli
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini and DINOGMI, Università di Genova, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Andrea Taddio
- University of Trieste, Piazzale Europa, 2, Trieste, Italy.
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy.
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Cattalini M, Della Paolera S, Zunica F, Bracaglia C, Giangreco M, Verdoni L, Meini A, Sottile R, Caorsi R, Zuccotti G, Fabi M, Montin D, Meneghel A, Consolaro A, Dellepiane RM, Maggio MC, La Torre F, Marchesi A, Simonini G, Villani A, Cimaz R, Ravelli A, Taddio A. Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey. Pediatr Rheumatol Online J 2021. [PMID: 33726806 DOI: 10.1186/s12969-021-0051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. METHODS The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. RESULTS One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. CONCLUSION Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths.
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Affiliation(s)
- Marco Cattalini
- Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | | | - Fiammetta Zunica
- Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Claudia Bracaglia
- Division of Rheumatology, Bambino Gesù Children's Hospital, IRCCS, Pizza di Sant'Onofrio, 4, 00165, Rome, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy
| | - Lucio Verdoni
- Paediatric Department, Hospital Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Antonella Meini
- Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Rita Sottile
- Department of Paediatrics, Pediatria 2, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80129, Naples, Italy
| | - Roberta Caorsi
- UOSD Centro Malattie Autoinfiammatorie ed Immunodeficienze, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, University of Milan, Children's Hospital V Buzzi, Via Lodovico Castelvetro 32, 20154, Milan, Italy
| | - Marianna Fabi
- Department of Pediatrics, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, Via Giuseppe Masserenti 9, 40138, Bologna, Italy
| | - Davide Montin
- Department of Pediatrics and Public Health, University of Turin, Via Giuseppe Verdi 8, 10124, Turin, Italy
| | - Alessandra Meneghel
- Department of Woman's and Child's Health, University of Padova, Via 8 Febbraio 1848, 35122, Padua, Italy
| | - Alessandro Consolaro
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini and DINOGMI, Università di Genova, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Rosa Maria Dellepiane
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy
| | - Maria Cristina Maggio
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, Via del Vespro 133, 90127, Palermo, Italy
| | - Francesco La Torre
- Pediatric Rheumatology Center, Pediatric Unit, "Giovanni XXIII", Pediatric Hospital, Via Giovanni Amendola 207, 70126, Bari, Italy
| | - Alessandra Marchesi
- Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Gabriele Simonini
- Pediatric Rheumatology Unit, AOU Meyer, University of Florence, Via Gaetano Pieraccini 24, 50139, Florence, Italy
| | - Alberto Villani
- Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda 19, 20122, Milan, Italy
| | - Angelo Ravelli
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini and DINOGMI, Università di Genova, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Andrea Taddio
- University of Trieste, Piazzale Europa, 2, Trieste, Italy.
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy.
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Campisciano G, Zanotta N, Petix V, Giangreco M, Ricci G, Maso G, Comar M, De Seta F. Vaginal Dysbiosis and Partial Bacterial Vaginosis: The Interpretation of the "Grey Zones" of Clinical Practice. Diagnostics (Basel) 2021; 11:diagnostics11020191. [PMID: 33525708 PMCID: PMC7911636 DOI: 10.3390/diagnostics11020191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/15/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022] Open
Abstract
Bacterial vaginosis (BV) affects one-third of reproductive age women, increasing the risk of acquiring sexually transmitted infections (STIs) and posing a risk for reproductive health. The current diagnosis with Gram stain (Nugent Score) identifies a transitional stage named partial BV or intermediate microbiota, raising the problem of how to clinically handle it. We retrospectively analyzed cervicovaginal swabs from 985 immunocompetent non-pregnant symptomaticspp. women (vaginal discharge, burning, itching) by Nugent score and qPCR for BV, aerobic or fungal vaginitis, and STIs (Mycoplasmas spp., Chlamydia t., Trichomonas v., and Neisseria g.). Nugent scores 0–3 and 7–10 were confirmed in 99.3% and 89.7% cases, respectively, by qPCR. Among Nugent scores 4–6 (partial BV), qPCR identified 46.1% of BV cases, with 37.3% of cases negative for BV, and only 16.7% of partial BV. Gram staining and qPCR were discordant (p value = 0.0001) mainly in the partial BV. Among the qPCR BV cases, the presence of aerobic vaginitis and STIs was identified, with a significant association (p < 0.0001) between the STIs and partial BV/overt BV. qPCR is more informative and accurate, and its use as an alternative or in combination with Gram staining could help clinicians in having an overview of the complex vaginal microbiota and in the interpretation of partial BV that can correspond to vaginitis and/or STIs.
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Affiliation(s)
- Giuseppina Campisciano
- Advanced Laboratory of Translational Microbiology, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Via dell’Istria 65, 34137 Trieste, Italy; (G.C.); (N.Z.); (V.P.)
| | - Nunzia Zanotta
- Advanced Laboratory of Translational Microbiology, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Via dell’Istria 65, 34137 Trieste, Italy; (G.C.); (N.Z.); (V.P.)
| | - Vincenzo Petix
- Advanced Laboratory of Translational Microbiology, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Via dell’Istria 65, 34137 Trieste, Italy; (G.C.); (N.Z.); (V.P.)
| | - Manuela Giangreco
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Via dell’Istria 65/1, 34137 Trieste, Italy;
| | - Giuseppe Ricci
- Obstetrics and Gynecology, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Via dell’Istria 65, 34137 Trieste, Italy; (G.R.); (G.M.); (F.D.S.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Gianpaolo Maso
- Obstetrics and Gynecology, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Via dell’Istria 65, 34137 Trieste, Italy; (G.R.); (G.M.); (F.D.S.)
| | - Manola Comar
- Advanced Laboratory of Translational Microbiology, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Via dell’Istria 65, 34137 Trieste, Italy; (G.C.); (N.Z.); (V.P.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
- Correspondence: ; Tel.: +39-040-3785527
| | - Francesco De Seta
- Obstetrics and Gynecology, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Via dell’Istria 65, 34137 Trieste, Italy; (G.R.); (G.M.); (F.D.S.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
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Penco A, Bossini B, Giangreco M, Vidonis V, Vittori G, Grassi N, Pellegrin MC, Faleschini E, Barbi E, Tornese G. Should Pediatric Endocrinologists Consider More Carefully When to Perform a Stimulation Test? Front Endocrinol (Lausanne) 2021; 12:660692. [PMID: 33828534 PMCID: PMC8021019 DOI: 10.3389/fendo.2021.660692] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Pediatric endocrinology rely greatly on hormone stimulation tests which demand time, money and effort. The knowledge of the pattern of pediatric endocrinology stimulation tests is therefore crucial to optimize resources and guide public health interventions. Aim of the study was to investigate the distribution of endocrine stimulation tests and the prevalence of pathological findings over a year and to explore whether single basal hormone concentrations could have saved unnecessary stimulation tests. METHODS Retrospective study with data collection for pediatric endocrine stimulation tests performed in 2019 in a tertiary center. RESULTS Overall, 278 tests were performed on 206 patients. The most performed test was arginine tolerance test (34%), followed by LHRH test (24%) and standard dose Synachthen test (19%), while the higher rate of pathological response was found in insulin tolerance test to detect growth hormone deficiency (81%), LHRH test to detect central precocious puberty (50%) and arginine tolerance test (41%). No cases of non-classical-congenital adrenal hyperplasia were diagnosed. While 29% of growth hormone deficient children who performed an insulin tolerance test had a pathological peak cortisol, none of them had central adrenal insufficiency confirmed at low dose Synacthen test. The use of basal hormone determinations could save up to 88% of standard dose Synachthen tests, 82% of arginine tolerance + GHRH test, 61% of LHRH test, 12% of tests for adrenal secretion. CONCLUSION The use of single basal hormone concentrations could spare up to half of the tests, saving from 32,000 to 79,000 euros in 1 year. Apart from basal cortisol level <108 nmol/L to detect adrenal insufficiency and IGF-1 <-1.5 SDS to detect growth hormone deficiency, all the other cut-off for basal hormone determinations were found valid in order to spare unnecessary stimulation tests.
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Affiliation(s)
| | - Benedetta Bossini
- University of Trieste, Trieste, Italy
- *Correspondence: Benedetta Bossini, ; Gianluca Tornese,
| | - Manuela Giangreco
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Viviana Vidonis
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Giada Vittori
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Nicoletta Grassi
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | | | - Elena Faleschini
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
- *Correspondence: Benedetta Bossini, ; Gianluca Tornese,
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Cortellazzo Wiel L, Conversano E, Giangreco M, Fagotto L, Genovese MRL, Badina L, Longo G, Barbi E, Berti I. Natural history and predictors of recovery in children with chronic spontaneous urticaria. Pediatr Allergy Immunol 2021; 32:201-204. [PMID: 32460386 DOI: 10.1111/pai.13299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/26/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Manuela Giangreco
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | - Laura Badina
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giorgio Longo
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Irene Berti
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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32
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Pensiero S, Diplotti L, Visalli G, Ronfani L, Giangreco M, Barbi E. Minimally-Invasive Surgical Approach to Congenital Dacryostenosis: Proposal for a New Protocol. Front Pediatr 2021; 9:569262. [PMID: 33681096 PMCID: PMC7928362 DOI: 10.3389/fped.2021.569262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Congenital dacryostenosis is one of the most common ophthalmological disorders in infants, with a high spontaneous resolution rate. In patients unresponsive to conservative treatment, the first-line approach is lacrimal drainage system probing, thought there is no clear consensus on optimal timing of surgery. The optimal treatment of patients unresponsive to primary probing is also controversial. Objectives: The aim of this study is to assess the optimal timing of probing in children with congenital dacryostenosis. Other purposes are to evaluate the efficacy of repeated probing and dacryointubation in patients unresponsive to the initial surgery without evident lacrimal outflow dysgenesis, and to determine the epidemiology of these maldevelopments. Methods: A retrospective consecutive cohort study was conducted in 625 eyes of 457 patients aged 7-48 months who underwent surgery for dacryostenosis. Patients were divided into 4 cohorts according to the timing of surgery. Data were analyzed using Fisher's test. Results: The success rate of primary probing was high, without significant differences between cohorts. One-third of recurrences were related to maldevelopments, the other two-thirds were treated with a second probing or dacryointubation, with high success rates, that did not significantly differ between the procedures. All cases unresponsive to the second surgery were resolved with dacryointubation. Conclusions: Probing is highly effective and its outcome is not affected by timing of surgery. Nevertheless, we advocate for early intervention, in order to identify possible maldevelopments, which require more invasive management. In patients unresponsive to primary probing, without evident maldevelopments, repeated probing should still be considered as the first-line approach, since it's less invasive but similarly effective to dacryointubation.
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Affiliation(s)
- Stefano Pensiero
- Department of Ophthalmology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Laura Diplotti
- Department of Ophthalmology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Gianluca Visalli
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.,Department of Pediatrics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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Michieletto P, Pensiero S, Diplotti L, Ronfani L, Giangreco M, Danieli A, Bonanni P. Strabismus surgery in Angelman syndrome: More than ocular alignment. PLoS One 2020; 15:e0242366. [PMID: 33186391 PMCID: PMC7665582 DOI: 10.1371/journal.pone.0242366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/01/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To report and evaluate strabismus surgery in children with Angelman syndrome, in order to optimize and standardize surgical approach. Other purposes are to understand the possible relation between ocular findings and motor ability, and between improvement in ocular alignment and changes in motor skills in this population. DESIGN Observational cross-sectional study. METHODS Medical records of pediatric patients with Angelman syndrome, who underwent strabismus surgery, were investigated. Collected data included: genotype, gender, age at the time of surgery, refractive error, pre-operative strabismus, surgical procedure, surgical outcome, gross and fine motor development assessment pre- and post-operatively. RESULTS Seventeen subjects, aged 3-15 years, were investigated. Fourteen patients were exotropic, three esotropic. Most patients presented astigmatism. Considering the exaggerated response to standard amounts of surgery and the risk of consecutive strabismus on long term follow-up reported by previous studies in children with developmental delay, a reduction of the amount of strabismus surgery was applied. Post-operatively, all patients presented with a significative reduction of the baseline deviation angle, with all esotropic patients and 7 exotropic patients (59%) achieving orthotropia. The surgical outcomes were variable according to the type and the amount of baseline strabismus, but no case presented with exaggerated surgical response. At baseline, patients showed important delays in all motor abilities, and, post-operatively, presented a significant improvement in walking and fine motor tasks. Pre- and post-operative motor abilities were negatively correlated to astigmatism, anisometropia, and amount of deviation. CONCLUSIONS According to our data, the standard nomograms for strabismus surgery may be successfully applied in subjects with Angelman syndrome and exotropia. Our data suggest that the reduction of the deviation angle improves motor skills in strabismic pediatric patients with Angelman syndrome.
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Affiliation(s)
- Paola Michieletto
- Ophthalmology Service, Scientific Institute IRCCS Eugenio Medea, Conegliano-Pieve di Soligo (TV), Italy
| | - Stefano Pensiero
- Department of Ophthalmology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
| | - Laura Diplotti
- Department of Ophthalmology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
- * E-mail:
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
| | - Alberto Danieli
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute IRCCS Eugenio Medea, Conegliano-Pieve di Soligo (TV), Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute IRCCS Eugenio Medea, Conegliano-Pieve di Soligo (TV), Italy
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Cozzi G, Zanchi C, Giangreco M, Rabach I, Calligaris L, Giorgi R, Conte M, Moressa V, Delise A, Poropat F. The impact of the COVID-19 lockdown in Italy on a paediatric emergency setting. Acta Paediatr 2020; 109:2157-2159. [PMID: 32598519 PMCID: PMC7361857 DOI: 10.1111/apa.15454] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Chiara Zanchi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Ingrid Rabach
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Lorenzo Calligaris
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Rita Giorgi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Mariasole Conte
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Valentina Moressa
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Anna Delise
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Federico Poropat
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
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Castriotta L, Giangreco M, Cogliati-Dezza MG, Spanò M, Atrigna E, Ehrenfreund C, Rosolen V, Paoletti F, Barbone F. Measuring the impact of a social programme on healthcare: a 10-year retrospective cohort study in Trieste, Italy. BMJ Open 2020; 10:e036857. [PMID: 32709652 PMCID: PMC7413194 DOI: 10.1136/bmjopen-2020-036857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Poor social conditions are strong determinants of poor health but positive health and healthcare changes caused by social interventions are difficult to demonstrate. In 2006, in Trieste (Italy), a social intervention known as 'Habitat Microaree' (HM) project was implemented in eight deprived neighbourhoods. In 2016, an observational study was launched to assess the impact of the HM project on healthcare. DESIGN Retrospective cohort study. SETTING The eight geographically defined neighbourhoods of Trieste involved in the 2006 HM project, accounting for a total of 11 380 residents. PARTICIPANTS Participants were all residents in the intervention areas. By means of a propensity score based on deprivation index, age, sex, Charlson index and drug utilisation, a non-participating, comparison group was defined. INTERVENTION The community-based intervention consisted of facilitating access to social services and outpatient healthcare facilities, coordinating intersectoral public services and specifically planning hospital discharge. These services were not provided in other areas of the city. OUTCOME MEASURES Hospital admissions and emergency department access. RESULTS We followed 16 256 subjects between 2008 and 2015. Living in microareas was associated with an HR for first hospital admission, for all causes, of 0.95 (95% CI 0.91 to 0.99); while the HR for urgent admissions in females was 0.92 (95% CI 0.85 to 1.00). The HR for psychiatric disorders, in females, was 0.39 (95%CI 0.18 to 0.82); in particular, the HR for psychosis was 0.15 (95% CI 0.05 to 0.51). The HR for acute respiratory diseases in females was 0.44 (95% CI 0.21 to 0.95). In males, the HR for genitourinary diseases and heart diseases were 0.65 (95% CI 0.42 to 1.01) and 0.72 (95% CI 0.54 to 0.97), respectively. Concerning urgent multiple admissions, the OR for fractures in females was 0.75 (95% CI 0.58 to 0.97). CONCLUSION In the study period, the effects on healthcare appear evident, especially in females.
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Affiliation(s)
- Luigi Castriotta
- Istituto di Igiene ed Epidemiologia Clinica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, Trieste, Italy
| | | | - Marco Spanò
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Enrico Atrigna
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | | | - Valentina Rosolen
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, Trieste, Italy
| | - Flavio Paoletti
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Fabio Barbone
- Department Medical Area - DAME, Università degli Studi di Udine, Udine, Italy
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Monasta L, Giangreco M, Ancona E, Barbone F, Bet E, Boschian-Bailo P, Cacciaguerra G, Cagnacci A, Canton M, Casarotto M, Comar M, Contardo S, De Agostini M, De Seta F, Del Ben G, Di Loreto C, Driul L, Facchin S, Giornelli R, Ianni A, La Valle S, Londero AP, Manfè M, Maso G, Mugittu R, Olivuzzi M, Orsaria M, Pecile V, Pinzano R, Pirrone F, Quadrifoglio M, Ricci G, Ronfani L, Salviato T, Sandrigo E, Smiroldo S, Sorz A, Stampalija T, Urriza M, Vanin M, Verardi G, Alberico S. Retrospective study 2005-2015 of all cases of fetal death occurred at ≥23 gestational weeks, in Friuli Venezia Giulia, Italy. BMC Pregnancy Childbirth 2020; 20:384. [PMID: 32611322 PMCID: PMC7329413 DOI: 10.1186/s12884-020-03074-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background Intrauterine fetal death (IUFD) is a tragic event and, despite efforts to reduce rates, its incidence remains difficult to reduce. The objective of the present study was to examine the etiological factors that contribute to the main causes and conditions associated with IUFD, over an 11-year period in a region of North-East Italy (Friuli Venezia Giulia) for which reliable data in available. Methods Retrospective analysis of all 278 IUFD cases occurred between 2005 and 2015 in pregnancies with gestational age ≥ 23 weeks. Results The incidence of IUFD was 2.8‰ live births. Of these, 30% were small for gestational age (SGA), with immigrant women being significantly over-represented. The share of SGA reached 35% in cases in which a maternal of fetal pathological condition was present, and dropped to 28% in the absence of associated pathology. In 78 pregnancies (28%) no pathology was recorded that could justify IUFD. Of all IUFDs, 11% occurred during labor, and 72% occurred at a gestational age above 30 weeks. Conclusion The percentage of IUFD cases for which no possible cause can be identified is quite high. Only the adoption of evidence-based diagnostic protocols, with integrated immunologic, genetic and pathologic examinations, can help reduce this diagnostic gap, contributing to the prevention of future IUFDs.
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Affiliation(s)
- Lorenzo Monasta
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
| | - Manuela Giangreco
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Emanuele Ancona
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | - Fabio Barbone
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Elisa Bet
- SC Ostetricia e Ginecologia Pordenone, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | - Pierino Boschian-Bailo
- SC Ostetricia e Ginecologia Gorizia - Monfalcone, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Giovanna Cacciaguerra
- SC Ostetricia e Ginecologia Palmanova - Latisana, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Angelo Cagnacci
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.,Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy
| | - Melania Canton
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Maddalena Casarotto
- SC Ostetricia e Ginecologia Pordenone, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | - Manola Comar
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Simona Contardo
- SC Ostetricia e Ginecologia San Vito - Spilimbergo, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | - Michela De Agostini
- SC Ostetricia e Ginecologia Palmanova - Latisana, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Francesco De Seta
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Del Ben
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | - Carla Di Loreto
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.,Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy
| | - Lorenza Driul
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.,Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy
| | - Stefano Facchin
- SC Ostetricia e Ginecologia Palmanova - Latisana, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Roberta Giornelli
- SC Ostetricia e Ginecologia Gorizia - Monfalcone, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Annalisa Ianni
- SOC Ostetricia e Ginecologia San Daniele - Tolmezzo, Azienda per l'Assistenza Sanitaria N. 3 - Alto Friuli-Collinare-Medio Friuli, Gemona del Friuli, Udine, Italy
| | - Santo La Valle
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | | | - Marciano Manfè
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | - Gianpaolo Maso
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Raffaela Mugittu
- SC Ostetricia e Ginecologia Gorizia - Monfalcone, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Monica Olivuzzi
- SOC Ostetricia e Ginecologia San Daniele - Tolmezzo, Azienda per l'Assistenza Sanitaria N. 3 - Alto Friuli-Collinare-Medio Friuli, Gemona del Friuli, Udine, Italy
| | - Maria Orsaria
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Vanna Pecile
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Roberta Pinzano
- SC Ostetricia e Ginecologia San Vito - Spilimbergo, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | - Francesco Pirrone
- SC Ostetricia e Ginecologia Pordenone, Azienda per l'Assistenza Sanitaria N. 5 - Friuli Occidentale, Pordenone, Italy
| | | | - Giuseppe Ricci
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Elisa Sandrigo
- SC Ostetricia e Ginecologia Gorizia - Monfalcone, Azienda per l'Assistenza Sanitaria N. 2 - Bassa Friulana-Isontina, Gorizia, Italy
| | - Silvia Smiroldo
- SOC Ostetricia e Ginecologia, Policlinico S. Giorgio S.p.A, Pordenone, Italy
| | - Alice Sorz
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Tamara Stampalija
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Marianela Urriza
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Michele Vanin
- SOC Ostetricia e Ginecologia San Daniele - Tolmezzo, Azienda per l'Assistenza Sanitaria N. 3 - Alto Friuli-Collinare-Medio Friuli, Gemona del Friuli, Udine, Italy
| | - Giuseppina Verardi
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Salvatore Alberico
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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Lega I, Maraschini A, D'Aloja P, Andreozzi S, Spettoli D, Giangreco M, Vichi M, Loghi M, Donati S. Maternal suicide in Italy. Arch Womens Ment Health 2020; 23:199-206. [PMID: 31104119 DOI: 10.1007/s00737-019-00977-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/03/2019] [Indexed: 01/01/2023]
Abstract
Suicide has been identified as one of the most common causes of death among women within 1 year after the end of pregnancy in several high-income countries. The aim of this study was to provide the first estimate of the maternal suicide ratio and a description of the characteristics of women who died by suicide during pregnancy or within 1 year after giving birth, induced abortion or miscarriage (i.e., maternal suicide) in 10 Italian regions, covering 77% of total national births. Maternal suicides were identified through the linkage between regional death registries and hospital discharge databases. Background population data was collected from the national hospital discharge, abortion and mortality databases. The previous psychiatric history of the women who died by maternal suicide was retrieved from the regionally available data sources. A total of 67 cases of maternal suicide were identified, corresponding to a maternal suicide ratio of 2.30 per 100,000 live births in 2006-2012. The suicide rate was 1.18 per 100,000 after giving birth (n = 2,876,193), 2.77 after an induced abortion (n = 650,549) and 2.90 after a miscarriage (n = 379,583). The majority of the women who died by maternal suicide (34/57) had a previous psychiatric history; 15/18 previously diagnosed mental disorders were not registered along with the index pregnancy obstetric records. Suicide is a relevant cause of maternal death in Italy. The continuity of care between primary, mental health and maternity care were found to be critical. Clinicians should be aware of the issue, as they may play an important role in preventing suicide in their patients.
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Affiliation(s)
- Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy.
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Paola D'Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Silvia Andreozzi
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Daniela Spettoli
- SaPeRiDoC -Documentation Centre on Perinatal and Reproductive Health, Primary Care Service, Regional Health Authority of Emilia-Romagna, Bologna, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Monica Vichi
- Service of Statistics, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Marzia Loghi
- Integrated System for Health, Social Assistance, Welfare and Justice - Directorate for Social Statistics and Population Census - ISTAT, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
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Claps F, Pavan N, Umari P, Rizzo M, Barbone F, Giangreco M, Liguori G, Mir CM, Bussani R, Trombetta C. Incidence, predictive factors and survival outcomes of incidental prostate cancer in patients who underwent radical cystectomy for bladder cancer. Minerva Urol Nephrol 2020. [PMID: 32026664 DOI: 10.23736/s0393-2249.20.03646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to analyze the incidence, preoperative findings, pathological features and prognosis in patients with incidental prostate cancer (iPCa) detected at radical cystectomy (RC) for bladder cancer (BCa). METHODS We retrospectively reviewed data of patients who underwent RC for BCa at our Institution between January 2005 and March 2018. Data regarding patient's history, preoperative digital rectal examination (DRE), total serum PSA level were collected from the chart review. Univariable and multivariable Cox regression models addressed the association of iPCa with recurrence-free survival (RFS) and overall survival (OS). RESULTS We obtained a final study cohort of 177 patients. Median age was 69 years (IQR 42-89) and 80(45.2%) patients had iPCa. Patients with iPCa had higher age, preoperative PSA levels and a significant rate of suspicious DRE (all P<0.05). Four patients had BCR during a median follow-up of 28 months (IQR 6-159) and none died for prostate cancer. In multivariable analyses adjusted for age, bladder cancer BCa pT and pN stage and LVI the ten-years RFS and OS rates were not impacted by iPCa regardless of whether it is a clinically significant cancer or not (HR=1.25, 95% CI: 0.65-2.38, P=0.51 vs. HR=1.37, 95% CI: 0.71-2.64, P=0.35) (HR=1.04, 95% CI: 0.53-1.86, P=0.89 vs. HR=1.20, 95% CI: 0.22-6.72, P=0.83). CONCLUSIONS iPCa is quite common in our study group and most of cases are organ-confined and well differentiated. Regardless of clinical relevance, iPCa does not have an impact on survival outcomes as BCa is driving the prognosis of these patients.
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Affiliation(s)
- Francesco Claps
- Urology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Urology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy -
| | - Paolo Umari
- Department of Urology, A. Avogadro University of Eastern Piedmont, Novara, Italy
| | - Michele Rizzo
- Urology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Fabio Barbone
- IRCCS Burlo Garofalo Children's Hospital, University of Trieste, Trieste, Italy
| | - Manuela Giangreco
- Institute of Hygiene and Clinical Epidemiology, University of Udine, Udine, Italy
| | - Giovanni Liguori
- Urology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Carmen M Mir
- Department of Urology, Valencian Oncology Institute and Foundation (IVO), Valencia, Spain
| | - Rossana Bussani
- Institute of Pathological Anatomy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Carlo Trombetta
- Urology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Claps F, Pavan N, Umari P, Rizzo M, Barbone F, Giangreco M, Liguori G, Mir CM, Bussani R, Trombetta C. Incidence, predictive factors and survival outcomes of incidental prostate cancer in patients who underwent radical cystectomy for bladder cancer. Minerva Urol Nephrol 2020; 73:349-356. [PMID: 32026664 DOI: 10.23736/s2724-6051.20.03646-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to analyze the incidence, preoperative findings, pathological features and prognosis in patients with incidental prostate cancer (iPCa) detected at radical cystectomy (RC) for bladder cancer (BCa). METHODS We retrospectively reviewed data of patients who underwent RC for BCa at our Institution between January 2005 and March 2018. Data regarding patient's history, preoperative digital rectal examination (DRE), total serum PSA level were collected from the chart review. Univariable and multivariable Cox regression models addressed the association of iPCa with recurrence-free survival (RFS) and overall survival (OS). RESULTS We obtained a final study cohort of 177 patients. Median age was 69 years (IQR 42-89) and 80(45.2%) patients had iPCa. Patients with iPCa had higher age, preoperative PSA levels and a significant rate of suspicious DRE (all P<0.05). Four patients had BCR during a median follow-up of 28 months (IQR 6-159) and none died for prostate cancer. In multivariable analyses adjusted for age, bladder cancer BCa pT and pN stage and LVI the ten-years RFS and OS rates were not impacted by iPCa regardless of whether it is a clinically significant cancer or not (HR=1.25, 95% CI: 0.65-2.38, P=0.51 vs. HR=1.37, 95% CI: 0.71-2.64, P=0.35) (HR=1.04, 95% CI: 0.53-1.86, P=0.89 vs. HR=1.20, 95% CI: 0.22-6.72, P=0.83). CONCLUSIONS iPCa is quite common in our study group and most of cases are organ-confined and well differentiated. Regardless of clinical relevance, iPCa does not have an impact on survival outcomes as BCa is driving the prognosis of these patients.
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Affiliation(s)
- Francesco Claps
- Urology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Urology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy -
| | - Paolo Umari
- Department of Urology, A. Avogadro University of Eastern Piedmont, Novara, Italy
| | - Michele Rizzo
- Urology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Fabio Barbone
- IRCCS Burlo Garofalo Children's Hospital, University of Trieste, Trieste, Italy
| | - Manuela Giangreco
- Institute of Hygiene and Clinical Epidemiology, University of Udine, Udine, Italy
| | - Giovanni Liguori
- Urology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Carmen M Mir
- Department of Urology, Valencian Oncology Institute and Foundation (IVO), Valencia, Spain
| | - Rossana Bussani
- Institute of Pathological Anatomy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Carlo Trombetta
- Urology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Berti I, Badina L, Cozzi G, Giangreco M, Bibalo C, Ronfani L, Barbi E, Ventura A, Longo G. Early oral immunotherapy in infants with cow's milk protein allergy. Pediatr Allergy Immunol 2019; 30:572-574. [PMID: 30950113 DOI: 10.1111/pai.13057] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Irene Berti
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Laura Badina
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Giorgio Cozzi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Luca Ronfani
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.,University of Trieste, Trieste, Italy
| | - Alessandro Ventura
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.,University of Trieste, Trieste, Italy
| | - Giorgio Longo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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Barbone F, Barbiero F, Belvedere O, Rosolen V, Giangreco M, Zanin T, Pisa FE, Meduri S, Follador A, Grossi F, Fasola G. Impact of low-dose computed tomography screening on lung cancer mortality among asbestos-exposed workers. Int J Epidemiol 2019; 47:1981-1991. [PMID: 30325420 DOI: 10.1093/ije/dyy212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/17/2022] Open
Abstract
Background We previously showed that low-dose computed tomography (LDCT) screening in asbestos-exposed workers is effective in detecting lung cancer (LC) at an early stage. Here, we evaluate whether LDCT screening could reduce mortality from LC in such a high-risk population. Methods Within a cohort of 2433 asbestos-exposed men enrolled in an Occupational Health surveillance programme, we compared mortality between the participants in the ATOM002 study (LDCT-P, N = 926) and contemporary non-participants (LDCT-NP, N = 1507). We estimated standardized mortality ratios for the LDCT-P and LDCT-NP populations using regional and national rates (SMR_FVG and SMR_ITA, respectively). We compared survival for all causes, all neoplasms, LC and malignant neoplasm of pleura (MNP) between LDCT-P and LDCT-NP using Cox proportional hazard models adjusted for age, smoking history, asbestos exposure level and comorbidities. Results A reduction in mortality from LC was observed in the LDCT-P group compared with regional and national figures (SMR_FVG = 0.55, 95% confidence interval (CI) 0.24-1.09; SMR_ITA = 0.51, 95% CI 0.22-1.01); this was not the case for the LDCT-NP group (SMR_FVG = 2.07, 95% CI 1.53-2.73; SMR_ITA = 1.98, 95% CI 1.47-2.61). A strong reduction in LC mortality was observed for the LDCT-P compared with the LDCT-NP [hazard ratio (HR) = 0.41, 95% CI 0.17-0.96]. Mortality was also reduced for all causes (HR = 0.61, 95% CI 0.44-0.84), but not for all neoplasms (HR = 0.97, 95% CI 0.62-1.50) and MNP (HR = 0.86, 95% CI 0.31-2.41) within the LDCT-P population. Conclusions In our cohort, participation in the LDCT screening study was associated with reduced mortality from LC. This finding supports the use of LDCT in surveillance programmes for asbestos-exposed workers.
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Affiliation(s)
- Fabio Barbone
- Dipartimento di Area Medica, University of Udine, Udine, Italy.,Institute of Hygiene and Clinical Epidemiology, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Fabiano Barbiero
- Dipartimento di Area Medica, University of Udine, Udine, Italy.,Occupational Health and Safety Department, Local Health Authority No 3 'SERENISSIMA', Veneto Region, Mestre, Italy
| | - Ornella Belvedere
- Department of Oncology, York Teaching Hospitals NHS Foundation Trust, York, UK
| | | | | | - Tina Zanin
- Occupational Health and Safety Department, Local Health Authority No 2 (ASS2), Friuli Venezia Giulia Region, Gorizia, Italy
| | - Federica E Pisa
- Institute of Hygiene and Clinical Epidemiology, Azienda Sanitaria Universitaria Integrata, Udine, Italy.,Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany
| | - Stefano Meduri
- Department of Radiology, Latisana Hospital, Latisana, Italy
| | - Alessandro Follador
- Dipartimento ad Attività Integrata di Oncologia, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Francesco Grossi
- Division of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianpiero Fasola
- Dipartimento ad Attività Integrata di Oncologia, Azienda Sanitaria Universitaria Integrata, Udine, Italy
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Pierannunzii L, Di Benedetto P, Carulli C, Fiorentino G, Munegato D, Panascì M, Potestio D, Randelli F, Della Rocca F, Rosolen V, Giangreco M, Santori N. Mid-term outcome after arthroscopic treatment of femoroacetabular impingement: development of a predictive score. Hip Int 2019; 29:303-309. [PMID: 29987953 DOI: 10.1177/1120700018786025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To build a post-arthroscopy outcome-predictive score (POPS) associated with the likelihood of lasting benefit after arthroscopic treatment of femoroacetabular impingement (FAI) and based solely on unambiguous preoperative information. METHODS A population of 220 FAI patients, operated on with standard techniques by orthopaedic surgeons trained in hip arthroscopy in 6 different centres, was evaluated physically or by telephone interview 2 to 5 years after surgery. The criteria of successful mid-term outcome (SMO) were agreed upon by all authors. A multivariate logistic regression, adjusted for patient's age and centre, was applied to predict SMO. In the model, the variables associated with the outcome were included and the relative ORs (odds ratios) were used to compute the FAI-POPS (FAI - post-arthroscopy outcome-predictive score). A ROC (receiver operating characteristic) curve was plotted and the optimum cut-off was calculated. RESULTS 155 patients out of 220 showed a successful mid-term outcome. The optimum cut-off of FAI-POPS was calculated to be 6.3 and with this threshold it proved a sensitivity of 0.66 and a specificity of 0.69, a positive predictive value of 0.84 and a negative predictive value of 0.46. CONCLUSIONS The standard arthroscopic treatment of FAI resulted in satisfactory persistent symptom relief for about 70% of patients. No or minimal osteoarthritis, short time elapsed from the appearance of symptoms and high preoperative modified Harris Hip Score are independent predictive factors of SMO. The FAI-POPS is obtained as sum of 3 odds ratios corresponding to the above prognostic factors and is a useful predictor of mid-term outcome after conventional arthroscopic FAI treatment.
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Affiliation(s)
| | - Paolo Di Benedetto
- 2 Clinica Ortopedica, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | | | - Gennaro Fiorentino
- 4 Department of Orthopaedics and Traumatology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Daniele Munegato
- 5 Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | | | - Filippo Randelli
- 8 Hip Department and Trauma, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy
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Cegolon L, Mastrangelo G, Campbell OM, Giangreco M, Alberico S, Monasta L, Ronfani L, Barbone F. Correction: Length of stay following cesarean sections: A population based study in the Friuli Venezia Giulia region (North-Eastern Italy), 2005-2015. PLoS One 2019; 14:e0213939. [PMID: 30861054 PMCID: PMC6413933 DOI: 10.1371/journal.pone.0213939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0210753.].
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Cegolon L, Mastrangelo G, Campbell OM, Giangreco M, Alberico S, Montasta L, Ronfani L, Barbone F. Length of stay following cesarean sections: A population based study in the Friuli Venezia Giulia region (North-Eastern Italy), 2005-2015. PLoS One 2019; 14:e0210753. [PMID: 30811413 PMCID: PMC6392330 DOI: 10.1371/journal.pone.0210753] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/01/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Births by cesarean section (CS) usually require longer recovery time, and as a result women remain hospitalized longer following CS than vaginal delivery (VD). A number of strategies have been proposed to reduce avoidable health care costs associated with childbirth. Among these, the containment of length of hospital stay (LoS) has been identified as an important quality indicator of obstetric care and performance efficiency of maternity centres. Since improvement of obstetric care at hospital level needs quantitative evidence, we compared the maternity services of an Italian region on LoS post CS. METHODS We conducted a population-based study in Friuli Venezia Giulia (FVG), a region of North-Eastern Italy, collecting data from all its 12 maternity centres (coded from A to K) during 2005-2015. We fitted a multivariable logistic regression using LoS as a binary outcome, higher/lower than the international early discharge (ED) cutoffs for CS (4 days), controlling for hospitals as well as several factors related to the clinical conditions of the mothers and the newborn, the obstetric history and socio-demographic background. Results were expressed as adjusted odds ratios (aOR) with 95% confidence interval (95%CI). Population attributable risks (PARs) were also calculated as proportional variation of LoS>ED for each hospital in the ideal scenario of having the same performance as centre J (the reference) during calendar year 2015. Results were expressed as PAR with 95%CI. Differences in mean LoS were also investigated with a multivariable linear regression model including the same explanatory factors of the above multiple logistic regression. Results were expressed as adjusted regression coefficients (aRC) with 95%CI. RESULTS Although decreasing over the years (5.0 ± 1.7 days in 2005 vs. 4.4 ± 1.7 days in 2015), the pooled mean LoS in the whole FVG during these 11 years was still 4.7 ± 1.7 days, higher than respective international ED benchmark. The significant decreasing trend of LoS>ED over time in FVG (aOR = 0.89; 95%CI: 0.88; 0.90) was marginal as compared to the variability of LoS>ED observed among the various maternity services. Regardless it was expressed as aRC or aOR, LoS after CS was lowest in hospital C, highest in hospital D and intermediate in centres I, K, G, F, A, H, E, B and J (in descending order). The aOR of LoS being longer than ED ranged from 1.63 (95%CI:1.46; 1.81) in hospital B up to 32.09 (95%CI: 25.68; 40.10) in facility D. When hospitals were ranked by PAR the same pattern was found, even if restricting the analysis to low risk pregnancies. CONCLUSIONS Although significantly decreasing over time, the mean LoS in FVG during 2005-2015 was 4.7 days, higher than the international threshold recommended for CS. There was substantial variability in LoS by facility centre, suggesting that internal organizational processes of single hospitals should be improved by enforcing standardized guidelines and using audits, economic incentives and penalties if need be.
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Affiliation(s)
- Luca Cegolon
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”,Trieste, Italy
- Local Health Unit N.2 “Marca Trevigiana”, Public Health Department, Veneto Region, Treviso, Italy
- * E-mail: ,
| | - Giuseppe Mastrangelo
- Padua University, Department of Cardio-Thoracic & Vascular Sciences, Padua, Italy
| | - Oona M. Campbell
- London School of Hygiene & Tropical Medicine, Faculty of Epidemiology & Population Health, MARCH Centre, London, United Kingdom
| | - Manuela Giangreco
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”,Trieste, Italy
| | - Salvatore Alberico
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”,Trieste, Italy
| | - Lorenzo Montasta
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”,Trieste, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”,Trieste, Italy
| | - Fabio Barbone
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”,Trieste, Italy
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Barbiero F, Zanin T, Pisa FE, Casetta A, Rosolen V, Giangreco M, Negro C, Bovenzi M, Barbone F. Cancer incidence in a cohort of asbestos-exposed workers undergoing health surveillance. Int Arch Occup Environ Health 2018; 91:831-841. [PMID: 29869702 DOI: 10.1007/s00420-018-1326-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/22/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To compare a local cohort of 2488 men occupationally exposed to asbestos and enrolled in a public health surveillance program with the 1995-2009 cancer incidence of the general population of Friuli Venezia Giulia (FVG) region, Northeast Italy, we conducted a historical cohort study. METHODS Standardized incidence ratios (SIRs), with 95% confidence interval (95% CI), for specific cancer sites were estimated in the cohort and in subgroups of workers employed in shipbuilding between 1974 and 1994. For internal comparisons, we calculated incidence rate ratios (IRRs) for all cancers, lung cancer and mesothelioma, by level of exposure to asbestos and sector of employment adjusted for smoking habits and age at start of follow-up. RESULTS Among cohort members the SIR was 8.82 (95% CI 5.95-12.61) for mesothelioma and 1.61 (95% CI 1.26-2.04) for lung cancer. In subgroup analyses, the SIR for lung cancer in subjects hired in shipbuilding between 1974 and 1984 was 2.09 (95% CI 1.32-3.13). In the overall cohort, a borderline increased incidence was also found for stomach cancer (SIR = 1.53 95% CI 0.96-2.31). Internal comparisons within the cohort show that among men with high asbestos exposure level the relative risk was almost threefold for lung cancer (IRR = 2.94 95% CI 1.01-8.57). CONCLUSIONS This cohort experienced an excess in the incidence of both mesothelioma and lung cancer, showing increasing incidence rates at higher level of asbestos exposure. For lung cancer, the relative incidence was highest among workers hired in shipbuilding between 1974 and 1984.
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Affiliation(s)
- Fabiano Barbiero
- Dipartimento di Area Medica, University of Udine, Via Colugna 50, 33100, Udine, Italy.,Health and Safety at Work Department (SPISAL), Local Health Authority No 12, Region of Veneto, Mestre, Italy
| | - Tina Zanin
- Health and Safety at Work Department, Local Health Authority No 2 (ASS2), Region of Friuli Venezia Giulia, Gorizia, Italy
| | - Federica E Pisa
- Dipartimento di Area Medica, University of Udine, Via Colugna 50, 33100, Udine, Italy.,Institute of Hygiene and Clinical Epidemiology, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Anica Casetta
- Dipartimento di Area Medica, University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Valentina Rosolen
- Dipartimento di Area Medica, University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Manuela Giangreco
- Dipartimento di Area Medica, University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Corrado Negro
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Massimo Bovenzi
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Fabio Barbone
- Dipartimento di Area Medica, University of Udine, Via Colugna 50, 33100, Udine, Italy. .,Institute of Hygiene and Clinical Epidemiology, Azienda Sanitaria Universitaria Integrata, Udine, Italy. .,Department of Medical Sciences, University of Trieste, Trieste, Italy.
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Ongaro E, Gerratana L, Cinausero M, Pelizzari G, Poletto E, Giangreco M, Andreetta C, Pizzolitto S, Di Loreto C, Minisini AM, Mansutti M, Russo S, Fasola G, Puglisi F. Comparison of primary breast cancer and paired metastases: biomarkers discordance influence on outcome and therapy. Future Oncol 2018. [PMID: 29527957 DOI: 10.2217/fon-2017-0384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Discordance between primary tumor and paired metastases biology has been widely detected in metastatic breast cancer. The aim of this study was to evaluate the prognostic impact of Ki67, estrogen receptor (ER), progesterone receptor (PR) and HER2 discordance. METHODS We retrospectively analyzed a cohort of 544 patients affected by metastatic breast cancer. Variation in ER, PR, Ki67 and HER2 expression between primary site and recurrence was tested through the McNemar test. RESULTS A significant variation was observed in respect to ER, PR and Ki67 status (12.65%, p = 0.0072; 49.71%, p < 0.0001; 35%, p < 0.0001, respectively). Among patients with ER or PR discordance, the driver of therapeutic decisions was the ER status. Moreover, we observed a therapy-related reduction of ER in taxanes or aromatase inhibitors-exposed patients (odds ratio: 3.59; 95% CI: 1.66-7.77; p = 0.001 and odds ratio: 2.07; 95% CI: 0.96-4.44; p = 0.06, respectively). CONCLUSION Biopsy of metastatic lesions may influence the decision-making process translating into better outcome.
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Affiliation(s)
- Elena Ongaro
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy.,Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata Policlinico GB Rossi, Pz.le LA Scuro 10, 37134 Verona (VR), Italy
| | - Lorenzo Gerratana
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy.,Department of Medicine (DAME), University of Udine, Pz.le Kolbe 3, 33100 Udine (UD), Italy
| | - Marika Cinausero
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy.,Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata Policlinico GB Rossi, Pz.le LA Scuro 10, 37134 Verona (VR), Italy
| | - Giacomo Pelizzari
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy.,Department of Medicine (DAME), University of Udine, Pz.le Kolbe 3, 33100 Udine (UD), Italy
| | - Elena Poletto
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Manuela Giangreco
- Department of Medicine (DAME), University of Udine, Pz.le Kolbe 3, 33100 Udine (UD), Italy.,Institute of Hygiene & Clinical Epidemiology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Claudia Andreetta
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Stefano Pizzolitto
- Department of Pathology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Carla Di Loreto
- Department of Medicine (DAME), University of Udine, Pz.le Kolbe 3, 33100 Udine (UD), Italy.,Institute of Pathology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Alessandro Marco Minisini
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Mauro Mansutti
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Stefania Russo
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Gianpiero Fasola
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Pz.le Kolbe 3, 33100 Udine (UD), Italy.,Department of Clinical Oncology, CRO Aviano National Cancer Institute, Via Franco Gallini 2, 33081 Aviano (PN), Italy
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Barbiero F, Zanin T, Pisa FE, Casetta A, Rosolen V, Giangreco M, Negro C, Bovenzi M, Barbone F. Mortality in a cohort of asbestos-exposed workers undergoing health surveillance. Med Lav 2018; 109:83-86. [PMID: 29701625 PMCID: PMC7682175 DOI: 10.23749/mdl.v109i2.5865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/17/2018] [Indexed: 11/18/2022]
Abstract
Background: The coastal area of Friuli Venezia Giulia (FVG) region, north-eastern Italy, was characterized by work activities in which asbestos was used until the early 1990s, particularly in shipbuilding. A public health surveillance program (PHSP) for asbestos-exposed workers was established, although limited evidence exists about the efficacy of such programs in reducing disease occurrence and mortality. Objectives: To compare mortality in a cohort of 2,488 men occupationally exposed to asbestos, enrolled in a PHSP in FVG between the early 1990s and 2008, with that of the general population of FVG and Italy. Methods: Standardized Mortality Ratios (SMR), with 95% Confidence Interval (95% CI), for all causes, all cancers, lung (LC) and pleural cancer (PC) were estimated in the cohort and in subgroups of workers with the first hire in shipbuilding that caused asbestos exposure (<1974, 1974-1984, 1985-1994). Results: A strong excess in mortality for PC with reference to FVG (SMR=6.87, 95% CI 4.45-10.17) and Italian population (SMR=13.95, 95% CI 9.02-20.64) was observed. For LC, the FVG-based SMR was 1.49 (95% CI 1.17-1.89) and the Italy-based 1.43 (95% CI 1.12-1.81). Mortality among workers with the first hire in shipbuilding before 1974 was high for PC (FVG-based SMR=8.98, 95% CI 5.56-13.75; Italy-based SMR=18.41, 95% CI 11.40-28.17) and for LC (FVG-based SMR =1.60, 95% CI 1.18-2.11; Italy-based SMR=1.54, 95% CI 1.14-2.03). Further, for LC between 1974 and 1984, the FVG-based SMR was 2.45 (95% CI 1.06-4.82), and the Italy-based SMR was 2.33 (95% CI 1.01-4.60). Conclusions: This cohort experienced an excess mortality for pleural and lung cancer, compared with regional and national populations. For lung cancer, the excess was stronger in workers with the first hire in shipbuilding before 1985, suggesting a key role of asbestos exposure.
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Affiliation(s)
- Fabiano Barbiero
- Department of Medical Area (DAME), University of Udine, Udine, Italy Health and Health and Safety at Work Department (SPISAL), Local Health Authority N. 12, Region of Veneto, Mestre, Italy.
| | - Tina Zanin
- Health and Safety at Work Department. Local Health Authority No 2 (ASS2), Region of Friuli Venezia Giulia, Gorizia, Italy.
| | - Federica Edith Pisa
- Department Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy.
| | - Anica Casetta
- Department of Medical Area (DAME), University of Udine, Udine, Italy.
| | - Valentina Rosolen
- Department of Medical Area (DAME), University of Udine, Udine, Italy.
| | - Manuela Giangreco
- Department of Medical Area (DAME), University of Udine, Udine, Italy.
| | - Corrado Negro
- Clinical Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy.
| | - Massimo Bovenzi
- Clinical Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy.
| | - Fabio Barbone
- Department of Medical Area (DAME), University of Udine, Udine, Italy.
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Cojutti P, Giangreco M, Isola M, Pea F. Limited sampling strategies for determining the area under the plasma concentration–time curve for isoniazid might be a valuable approach for optimizing treatment in adult patients with tuberculosis. Int J Antimicrob Agents 2017; 50:23-28. [DOI: 10.1016/j.ijantimicag.2017.01.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/21/2016] [Accepted: 01/22/2017] [Indexed: 11/27/2022]
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Barbiero F, Giangreco M, Pisa FE, Negro C, Bovenzi M, Rosolen V, Barbone F. [Not Available]. Med Lav 2016; 107:307-314. [PMID: 27468090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/31/2016] [Accepted: 06/22/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The incidence of mesothelioma in Italy shows wide geographical variation, with the highest incidence rates in Genoa and Friuli Venezia Giulia (FVG). For mesothelioma, national standard incidence rates are not available prior to the calendar year 2006. OBJECTIVES To estimate the Standardized Incidence rate Ratio (SIR) of mesothelioma in a cohort of former workers undergoing health surveillance because of previous asbestos exposure, when sex-, age-, and calendar year-specific rates of the national standard are not available and the number of expected cases calculated from the regional rates is biased by the size of the study cohort. METHODS We conducted a sensitivity analysis in a cohort of 2,488 men. We considered every Italian cancer registry available with complete data in the period 1995-2007 (N=14). We calculated, for each year and age group, the corresponding weighted mean rate of 10 registries of North-Italy (Mean W10), the weighted mean rate of all 14 registries available (Mean W14) and considered FVG standard rate. RESULTS During the period 1995-2007, we observed 25 incident cases of mesothelioma with expected cases that varied between 2.00 (Mean W14) and 2.56 (FVG standard rate), with a SIR of 12.49 (CI95% 8.08-18.48) and 9.76 (CI95% 6.32-14.45) respectively. CONCLUSIONS Our results show that the use of FVG rates as standard does not lead to significant distortions in the calculation of the expected cases. However, distortion is remarkable in the SIRs estimation. Using a weighted mean standard incidence rate may be a valid alternative for SIR estimate when national standard rates are not available.
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Affiliation(s)
- Fabiano Barbiero
- Dipartimento di Scienze Mediche e Biologiche, Università di Udine, Udine, Italia Dipartimento di Medicina Clinica e Sperimentale, Università di Parma, Parma, Italia Servizio Prevenzione Igiene e Sicurezza negli Ambienti di Lavoro (SPISAL), ULSS n. 12, Mestre, Italia.
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Fasola G, Grossi F, Belvedere O, Follador A, Zanin T, Cassetti P, Meduri S, Cattaneo M, Giavarra M, Pelizzari G, Giangreco M, Pisa FE, Rosolen V, Barbiero F, Barbone F. Screening with low-dose computed tomography (LDCT) of asbestos-exposed subjects and lung cancer (LC) mortality. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | | | | | - Tina Zanin
- University of Udine, San Giorgio Di Nogaro, Italy
| | | | | | - Monica Cattaneo
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Marco Giavarra
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Manuela Giangreco
- Dept. of Medical and Biological Sciences, Udine University, Udine, Italy
| | | | - Valentina Rosolen
- Dept. of Medical and Biological Sciences, Udine University, Udine, Italy
| | - Fabiano Barbiero
- Dept.of Medical and Biological Sciences, Udine University, Udine, Italy
| | - Fabio Barbone
- Dept. of Medical and Biological Sciences, Udine University, Udine, Italy
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