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Pellegrino A, Calabrese M, Boddi M, Vacirca I, Baccari C, Bonvicini L, Venturelli F, Petrelli A, Di Napoli A, Perticone M, Rossi PG, Modesti PA. Cardiovascular risk and access to primary care: Comparisons among Chinese documented and undocumented immigrants. Diabetes Res Clin Pract 2024; 210:111645. [PMID: 38554810 DOI: 10.1016/j.diabres.2024.111645] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
AIMS The aim of this study was to examine main risk factors of undocumented Chinese migrants living in Italy when compared with Chinese migrants registered with National Health Service (NHS). METHODS A cohort of 3435 Chinese first-generation immigrants living in Prato underwent blood pressure (BP) measurement and blood tests. Hypertension was diagnosed for BP ≥ 140/90 mmHg at 2 visits, and/or antihypertensive drug use; type 2 diabetes (T2DM) for fasting glucose ≥ 126 mg/dL at 2 visits, and/or use of hypoglycemic drugs; hypercholesterolemia (HC) for cholesterol ≥ 240 mg/dL and/or statins use. Subjects diagnosed with hypertension, T2DM, or HC unaware of their condition were considered newly diagnosed. Comparisons were performed using multivariable adjusted logistic regression analysis. RESULTS A large proportion of Chinese migrants were undocumented (1766, 51 %); newly diagnoses of risk factors were performed especially among undocumented migrants; registration with NHS was associated with higher level of awareness for hypertension and T2DM and with 6 times higher rate of treatment for T2DM. Only a small minority of subjects with high cholesterol were treated with statins. CONCLUSIONS Undocumented immigrants had high prevalence of risk factors with lower levels of awareness than migrants registered with the NHS. Health policies targeting this hard-to-reach population needs to be improved.
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Affiliation(s)
- Alessio Pellegrino
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Maria Calabrese
- Diabetology Unit, Ospedale Misericordia e Dolce, Prato, Italy
| | - Maria Boddi
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Irene Vacirca
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cecilia Baccari
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Alessio Petrelli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Anteo Di Napoli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pietro Amedeo Modesti
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy.
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Djuric O, Larosa E, Cassinadri M, Cilloni S, Bisaccia E, Pepe D, Bonvicini L, Vicentini M, Venturelli F, Giorgi Rossi P, Pezzotti P, Mateo Urdiales A, Bedeschi E. Effect of an enhanced public health contact tracing intervention on the secondary transmission of SARS-CoV-2 in educational settings: The four-way decomposition analysis. eLife 2024; 13:e85802. [PMID: 38416129 PMCID: PMC10901504 DOI: 10.7554/elife.85802] [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: 12/23/2022] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
Background The aim of our study was to test the hypothesis that the community contact tracing strategy of testing contacts in households immediately instead of at the end of quarantine had an impact on the transmission of SARS-CoV-2 in schools in Reggio Emilia Province. Methods We analysed surveillance data on notification of COVID-19 cases in schools between 1 September 2020 and 4 April 2021. We have applied a mediation analysis that allows for interaction between the intervention (before/after period) and the mediator. Results Median tracing delay decreased from 7 to 3.1 days and the percentage of the known infection source increased from 34-54.8% (incident rate ratio-IRR 1.61 1.40-1.86). Implementation of prompt contact tracing was associated with a 10% decrease in the number of secondary cases (excess relative risk -0.1 95% CI -0.35-0.15). Knowing the source of infection of the index case led to a decrease in secondary transmission (IRR 0.75 95% CI 0.63-0.91) while the decrease in tracing delay was associated with decreased risk of secondary cases (1/IRR 0.97 95% CI 0.94-1.01 per one day of delay). The direct effect of the intervention accounted for the 29% decrease in the number of secondary cases (excess relative risk -0.29 95%-0.61 to 0.03). Conclusions Prompt contact testing in the community reduces the time of contact tracing and increases the ability to identify the source of infection in school outbreaks. Although there are strong reasons for thinking it is a causal link, observed differences can be also due to differences in the force of infection and to other control measures put in place. Funding This project was carried out with the technical and financial support of the Italian Ministry of Health - CCM 2020 and Ricerca Corrente Annual Program 2023.
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Affiliation(s)
- Olivera Djuric
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
- Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), University of Modena and Reggio EmiliaModenaItaly
| | - Elisabetta Larosa
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Mariateresa Cassinadri
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Silvia Cilloni
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Eufemia Bisaccia
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Davide Pepe
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Francesco Venturelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di SanitàRomeItaly
| | | | - Emanuela Bedeschi
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
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Sileo FG, Bonvicini L, Mancuso P, Vicentini M, Aguzzoli L, Khalil A, Giorgi Rossi P. COVID-19 incidence in women of reproductive age: a population-based study in Reggio Emilia, northern Italy. BMC Pregnancy Childbirth 2023; 23:726. [PMID: 37833634 PMCID: PMC10576401 DOI: 10.1186/s12884-023-06044-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Despite being at higher risk of severe disease and pregnancy complications, evidence on susceptibility to SARS-CoV-2 infection in pregnancy is still limited. The aim of the study is to compare the likelihood of undergoing a SARS-CoV-2 test and testing positive for COVID-19 in pregnancy and puerperium with that of the general female population of reproductive age. METHODS This is a retrospective population-based cohort study including 117,606 women of reproductive age (March 2020-September 2021) with 6608 (5.6%) women having ≥ 1 pregnancy. Women were linked to the pregnancy registry to be classified as "non-pregnant", "pregnant", and "puerperium"; then, according to the national case-based integrated COVID-19 surveillance system, all women undergoing a SARS-CoV-2 test during the study period were identified. The Incidence Rate Ratio was calculated to compare the likelihood of being tested for SARS-CoV-2 in pregnant, puerperium and non-pregnant women among all women included. The likelihood of having a COVID-19 diagnosis was calculated using two comparators (not-pregnant women and the person-time before/after pregnancy) by means of Cox proportional hazards models, adjusting for age and with the cluster option to control standard error calculation in repeated pregnancies. Only first infection and swabs before the first one positive were included. RESULTS The probability of being tested for SARS-CoV-2 was 4.9 (95% CI: 4.8-5.1) and 3.6 times higher (95%CI: 3.4-3.9) in pregnancy (including spontaneous miscarriages) and in the puerperium, respectively. The Hazard Ratio (HR) of covid-19 diagnosis during pregnancy vs. non-pregnancy was 1.17 (95% CI 1.03-1.33) with similar results when comparing the risk during pregnancy with that of the same women outside pregnancy (puerperium excluded), with an HR of 1.13 (95% CI 0.96-1.33); the excess decreased when excluding the test performed at admission for delivery (HR 1.08 (95%CI 0.90-1.30). In the puerperium, the HR was 0.62 (95% CI 0.41-0.92) comparing women with ≥ 1childbirth with all other women and excluding the first two weeks of puerperium. CONCLUSIONS Women during pregnancy showed a small increase in the risk of infection, compatible with a higher likelihood of being tested. A lower probability of infection during the puerperium was observed during the entire pandemic period, suggesting likely protective behaviors which were effective in reducing their probability of infection.
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Affiliation(s)
- Filomena Giulia Sileo
- Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Via Campi 80, 41125, Modena, Italy
- Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale -IRCCS Di Reggio Emilia, Via Giovanni Amendola 2, 42123, Reggio Emilia, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda Unità Sanitaria Locale -IRCCS Di Reggio Emilia, Via Giovanni Amendola 2, 42123, Reggio Emilia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale -IRCCS Di Reggio Emilia, Via Giovanni Amendola 2, 42123, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale-IRCCS, Viale Risorgimento, 80, 42123, Reggio Emilia, Italy
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, Blackshaw Road, TootingLondon, SW17 0QT, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale -IRCCS Di Reggio Emilia, Via Giovanni Amendola 2, 42123, Reggio Emilia, Italy.
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Simeon V, Venturelli F, Bauleo L, Carugno M, Mataloni F, Bonvicini L. [Young researchers no more young: who are we?]. Recenti Prog Med 2023; 114:306-308. [PMID: 37229670 DOI: 10.1701/4042.40216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
To reflect on the present and the future of the "millennial" epidemiologists in Italy, the starting question is who are we? The online survey "I giovani ricercatori non più giovani: chi siamo? #GIOVANIDENTRO" was launched in 2022 and advertised at conferences of the Italian association of epidemiology to gather voices from all over Italy. Information on training, job position, attitudes and difficulties encountered in our profession and in scientific production activity has been collected and contextualized to answer the starting question and provide food for thought for the perspectives of our profession.
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Affiliation(s)
- Vittorio Simeon
- Dipartimento di Salute mentale e fisica e medicina preventiva, Università della Campania "L. Vanvitelli"
| | | | - Lisa Bauleo
- Dipartimento di Epidemiologia del Servizio sanitario regionale del Lazio, Asl Roma 1
| | - Michele Carugno
- Dipartimento di Scienze cliniche e di comunità, Università di Milano; SC Medicina del Lavoro - SS Epidemiologia, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milano
| | - Francesca Mataloni
- Dipartimento di Epidemiologia del Servizio sanitario regionale del Lazio, Asl Roma 1
| | - Laura Bonvicini
- Servizio di Epidemiologia, Azienda Usl-Irccs di Reggio Emilia
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Venturelli F, Mataloni F, Bauleo L, Bonvicini L, Simeon V, Carugno M. [Millennials looking for their place in epidemiology.]. Recenti Prog Med 2023; 114:303-305. [PMID: 37229669 DOI: 10.1701/4042.40215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The "millennial" epidemiologists, born between the beginning of the 80s and the end of the 90s, are the generation that most of all, today, lives between the present and the future of this discipline. This issue of Recenti Progressi in Medicina aims to talk about what young (and no longer young) epidemiologists and public health researchers are dealing with and to reflect on the most relevant topics in our field, with an eye to the future. Starting from the profile of the "millennial" epidemiologists in Italy and the topics on which they work, the issue develops through three parts dealing with relevant topics for the present and the future of Public health. The first part deals with the important issue of finding a balance between the protection of personal data and the protection of health through a dialogue between researchers, jurists and citizens. The second part aims to clarify the issue of big data and its implications for producing health. The third part touches on four relevant topics for the perspectives of epidemiology through reflections and application examples of machine learning, integration between pharmacoepidemiology and environmental epidemiology, health prevention and promotion involving citizens and other stakeholders, and epidemiology of mental health. In a constantly changing world, challenges for those who work to produce health are not lacking, as is the determination to face them. With this issue, we hope to contribute to the awareness of who we are and our potential, to help millennials (but not only) find their place in epidemiology, today and tomorrow.
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Affiliation(s)
| | - Francesca Mataloni
- Dipartimento di Epidemiologia del Servizio sanitario regionale del Lazio, Asl Roma 1
| | - Lisa Bauleo
- Dipartimento di Epidemiologia del Servizio sanitario regionale del Lazio, Asl Roma 1
| | - Laura Bonvicini
- Servizio di Epidemiologia, Azienda Usl-Irccs di Reggio Emilia
| | - Vittorio Simeon
- Dipartimento di Salute mentale e fisica e medicina preventiva, Università della Campania "L. Vanvitelli"
| | - Michele Carugno
- Dipartimento di Scienze cliniche e di comunità, Università di Milano; SC Medicina del Lavoro - SS Epidemiologia, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milano
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Bauleo L, Carugno M, Bonvicini L, Simeon V, Venturelli F, Mataloni F. [Protect your data and protect yourself: balancing privacy and health protection in Public health.]. Recenti Prog Med 2023; 114:316-318. [PMID: 37229672 DOI: 10.1701/4042.40218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The General data protection regulation (Gdpr) of 2016, implemented since 2018, has become a crucial issue in the field of epidemiology. The Gdpr concerns the protection of personal data, which includes all information that identifies or can identify a natural person, providing information about their habits, health status, and lifestyle, and regulates their processing. Epidemiological studies rely on the use of personal data and their interconnection. The introduction of this regulation is marking an important transition for the work of epidemiologists. There is a need to understand how this can coexist with the research activities that have always been carried out in epidemiology and public health. This section aims to lay the foundations for a discussion on the topic and provide a framework for researchers and epidemiologists that answers some of the doubts that accompany daily work.
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Affiliation(s)
- Lisa Bauleo
- Dipartimento di Epidemiologia del Servizio sanitario regionale del Lazio, Asl Roma 1
| | - Michele Carugno
- Dipartimento di Scienze cliniche e di comunità, Università di Milano; SC Medicina del Lavoro - SS Epidemiologia, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milano
| | - Laura Bonvicini
- Servizio di Epidemiologia, Azienda Usl-Irccs di Reggio Emilia
| | - Vittorio Simeon
- Dipartimento di Salute mentale e fisica e medicina preventiva, Università della Campania "Luigi Vanvitelli"
| | | | - Francesca Mataloni
- Dipartimento di Epidemiologia del Servizio sanitario regionale del Lazio, Asl Roma 1
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Ottone M, Bartolini L, Bonvicini L, Giorgi Rossi P. The effect of diabetes on COVID-19 incidence and mortality: Differences between highly-developed-country and high-migratory-pressure-country populations. Front Public Health 2023; 11:969143. [PMID: 36969620 PMCID: PMC10031649 DOI: 10.3389/fpubh.2023.969143] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
The objective of this study was to compare the effect of diabetes and pathologies potentially related to diabetes on the risk of infection and death from COVID-19 among people from Highly-Developed-Country (HDC), including Italians, and immigrants from the High-Migratory-Pressure-Countries (HMPC). Among the population with diabetes, whose prevalence is known to be higher among immigrants, we compared the effect of body mass index among HDC and HMPC populations. A population-based cohort study was conducted, using population registries and routinely collected surveillance data. The population was stratified into HDC and HMPC, according to the place of birth; moreover, a focus was set on the South Asiatic population. Analyses restricted to the population with type-2 diabetes were performed. We reported incidence (IRR) and mortality rate ratios (MRR) and hazard ratios (HR) with 95% confidence interval (CI) to estimate the effect of diabetes on SARS-CoV-2 infection and COVID-19 mortality. Overall, IRR of infection and MRR from COVID-19 comparing HMPC with HDC group were 0.84 (95% CI 0.82-0.87) and 0.67 (95% CI 0.46-0.99), respectively. The effect of diabetes on the risk of infection and death from COVID-19 was slightly higher in the HMPC population than in the HDC population (HRs for infection: 1.37 95% CI 1.22-1.53 vs. 1.20 95% CI 1.14-1.25; HRs for mortality: 3.96 95% CI 1.82-8.60 vs. 1.71 95% CI 1.50-1.95, respectively). No substantial difference in the strength of the association was observed between obesity or other comorbidities and SARS-CoV-2 infection. Similarly for COVID-19 mortality, HRs for obesity (HRs: 18.92 95% CI 4.48-79.87 vs. 3.91 95% CI 2.69-5.69) were larger in HMPC than in the HDC population, but differences could be due to chance. Among the population with diabetes, the HMPC group showed similar incidence (IRR: 0.99 95% CI: 0.88-1.12) and mortality (MRR: 0.89 95% CI: 0.49-1.61) to that of HDC individuals. The effect of obesity on incidence was similar in both HDC and HMPC populations (HRs: 1.73 95% CI 1.41-2.11 among HDC vs. 1.41 95% CI 0.63-3.17 among HMPC), although the estimates were very imprecise. Despite a higher prevalence of diabetes and a stronger effect of diabetes on COVID-19 mortality in HMPC than in the HDC population, our cohort did not show an overall excess risk of COVID-19 mortality in immigrants.
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Roncaglia F, Bonvicini L, Kendall S, Panza C, Ferraroni M, Giorgi Rossi P. Validation of the Italian version of the Tool to Measure Parenting Self-Efficacy questionnaire using data from an intervention study. Child Care Health Dev 2023; 49:189-200. [PMID: 35817590 DOI: 10.1111/cch.13032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/28/2022] [Accepted: 06/23/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Parent self-efficacy (PSE), parents' confidence in their ability to successfully raise their children, has proved to be a powerful direct predictor of specific positive parenting practices. The aim of this study was to validate the Italian version of the Tool to Measure Parenting Self-Efficacy (TOPSE) using data from the questionnaires previously completed in a controlled before-after study conducted in 2015 to evaluate a newsletter programme to help improve parenting. Mothers and fathers of newborns were asked to complete the TOPSE at the child's birth (t0), at 6 months (t1) and at 12 months (t2): 265 TOPSE questionnaires were collected at t0 (43%), 158 at t1 (26%) and 188 at t2 (31%). METHODS We measured internal reliability using Cronbach's alpha for each of the eight domains of the TOPSE. The intracluster correlation coefficient (ICC) was used to evaluate the external reliability only for parents with more than one child. Responsiveness was measured by testing the ability of the questionnaire to detect differences between groups and times that we expected to be measurable, based on consolidated findings in the literature. Mean scores of PSE improved from t0 to t2 (Hypothesis 1), PSE was lower at baseline for first-time parents than for those with multiple children (Hypothesis 2) and the improvement from t0 to t2 was stronger for first-time parents than for parents with multiple children (Hypothesis 3). RESULTS AND CONCLUSION Based on our sample of questionnaires, the Italian version of the TOPSE was reliable for almost all of the domains except for Emotion, Self-acceptance and Learning, which could be refined by re-framing or dropping one item. External reliability was moderate, bearing in mind that the questionnaire was repeated at different times over 12 months, during which parents normally change. Responsiveness was good, especially for the Emotion and Empathy domains.
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Affiliation(s)
| | - Laura Bonvicini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Monica Ferraroni
- Branch of Medical Statistics, Biometry, and Epidemiology 'G. A. Maccacaro', Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Djuric O, Larosa E, Cassinadri M, Cilloni S, Bisaccia E, Pepe D, Vicentini M, Venturelli F, Bonvicini L, Giorgi Rossi P, Pezzotti P, Mateo Urdiales A, Bedeschi E. Surveillance, contact tracing and characteristics of SARS-CoV-2 transmission in educational settings in Northern Italy, September 2020 to April 2021. PLoS One 2022; 17:e0275667. [PMID: 36215304 PMCID: PMC9550042 DOI: 10.1371/journal.pone.0275667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/20/2021] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The role of school contacts in the spread of the virus and the effectiveness of school closures in controlling the epidemic is still debated. We aimed to quantify the risk of transmission of SARS-CoV-2 in the school setting by type of school, characteristics of the index case and calendar period in the Province of Reggio Emilia (RE), Italy. The secondary aim was to estimate the speed of implementation of contact tracing. METHODS A population-based analysis of surveillance data on all COVID-19 cases occurring in RE, Italy, from 1 September 2020, to 4 April 2021, for which a school contact and/or exposure was suspected. An indicator of the delay in contact tracing was calculated as the time elapsed since the index case was determined to be positive and the date on which the swab test for classmates was scheduled (or most were scheduled). RESULTS Overall, 30,184 and 13,608 contacts among classmates and teachers/staff, respectively, were identified and were recommended for testing, and 43,214 (98.7%) underwent the test. Secondary transmission occurred in about 40% of the investigated classes, and the overall secondary case attack rate was 4%. This rate was slightly higher when the index case was a teacher but with almost no differences by type of school, and was stable during the study period. Speed of implementation of contact tracing increased during the study period, with the time from index case identification to testing of contacts being reduced from seven to three days. The ability to identify the possible source of infection in the index case also increased. CONCLUSIONS Despite the spread of the Alpha variant during the study period in RE, the secondary case attack rate remained stable from school reopening in September 2020 until the beginning of April 2021.
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Affiliation(s)
- Olivera Djuric
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Biomedical, Metabolic and Neural Sciences, Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Public Health Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Larosa
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mariateresa Cassinadri
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Cilloni
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eufemia Bisaccia
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Pepe
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Venturelli
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Emanuela Bedeschi
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Bonvicini L, Pingani I, Venturelli F, Patrignani N, Bassi MC, Broccoli S, Ferrari F, Gallelli T, Panza C, Vicentini M, Giorgi Rossi P. Effectiveness of mobile health interventions targeting parents to prevent and treat childhood Obesity: Systematic review. Prev Med Rep 2022; 29:101940. [PMID: 36161123 PMCID: PMC9501985 DOI: 10.1016/j.pmedr.2022.101940] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 12/05/2022] Open
Abstract
Mobile apps are increasingly used in childhood obesity prevention to monitor food intake and PA, and send health messages. The studies' small sample size and the heterogeneous interventions prevent this review to conclude on effectiveness. The overall picture shows a trend toward improvement in some interventions, while others were essentially ineffective. The high acceptability and the widespread use of mobile apps, support new research to develop effective, trustworthy apps.
Childhood obesity is a high prevalence condition that causes a high burden of disease in adulthood. Mobile phone app are increasingly used to prevent it. We summarized the evidence on the effectiveness of mobile apps for devices used by parents to prevent and treat childhood and adolescent obesity. An update of a systematic review of the literature (De Lepeleere et al., 2017) was carried out. PubMed, Embase, Cochrane, CINAHL, PsycINFO, Scopus, and ERIC were searched up to 2020. The included studies should target children 1–18 years, compare an app aimed at preventing or treating overweight and obesity, as stand-alone intervention or as part of a complex program, installed on parents’ mobile devices, to no intervention or an intervention without the app. Outcomes related to weight status, diet, and physical activity (PA) behaviors were considered. Nineteen studies (14 RCTs and 5 non-randomized trials) were included. The app was mainly used to record food consumption and PA, to set goals, to view progress, and send health promotion messages. One study reported a significant decrease and one a suggestive decrease in anthropometric measures in obese and overweight children, while other studies observed no effect. One study reported a significant increase in PA. Six interventions proved to be effective in changing dietary behaviors. Interventions targeting overweight and/or obese children had the most positive results. All studies reported high acceptability and feasibility of interventions. The differences between interventions and the small sample size of the studies did not allow this review to reach conclusion on effectiveness.
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Affiliation(s)
- Laura Bonvicini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Pingani
- Graduated in Human Nutrition Sciences at the San Raffaele University of Rome, Rome, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Corresponding author at: Via Amendola, 2 42122 Reggio Emilia.
| | | | - Maria Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Francesca Ferrari
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Massimo Vicentini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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11
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Giorgi Rossi P, Ronco G, Mancuso P, Carozzi F, Allia E, Bisanzi S, Gillio-Tos A, De Marco L, Rizzolo R, Gustinucci D, Del Mistro A, Frayle H, Confortini M, Iossa A, Cesarini E, Bulletti S, Passamonti B, Gori S, Toniolo L, Barca A, Bonvicini L, Venturelli F, Benevolo M. Performance of HPV E6/E7 mRNA Assay as Primary Screening Test. Results from the NTCC2 Trial. Int J Cancer 2022; 151:1047-1058. [PMID: 35579975 DOI: 10.1002/ijc.34120] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/17/2022] [Accepted: 04/23/2022] [Indexed: 11/11/2022]
Abstract
As the primary screening test, E6/E7 mRNA has shown similar sensitivity for CIN3+ and lower positivity rate than the HPV DNA test. Nevertheless, the overall mRNA positivity is too high for immediate colposcopy, making a triage test necessary. The aim was to estimate the mRNA performance as a primary test with different triage strategies. All HPV DNA-positives were tested for mRNA, cytology and p16/ki67. A sample of HPV DNA-negatives were also tested for mRNA to estimate test specificity. We included all CIN3+ histologically diagnosed within 24 months since recruitment. Of the 41127 participants, 7.7% were HPV DNA-positive, of which 66.4% were mRNA-positive. Among the HPV DNA-negatives, 10/1108 (0.9%) were mRNA-positive. Overall, 97 CIN3+ were found. If mRNA was used as the primary test, it would miss about 3% of all CIN3+ with a 22% reduction of positivity compared to HPV DNA. The weighted specificity estimate for <CIN2 was 94.5% (95% CI=93.9%-94.9%) and sensitivity for CIN3+ was 96.9% (95% CI=91.3%-99.1%). If all the weighted estimated 6.0% mRNA-positive women had been referred to colposcopy, PPV for CIN3+ would have been 4.2%. Cytology or p16/ki67 triage would decrease immediate referral to 1.7% and 2.0%, increasing PPV to 11.2% and 11.7%, respectively; total colposcopy referral would be 4.0% and 3.9%, respectively. As the primary screening test, the mRNA assay showed a positivity rate lower than that of HPV DNA, with a small number of CIN3+ missed. Triage with cytology or p16/ki67 would only marginally decrease overall colposcopy referral.
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Affiliation(s)
- Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention (CPO), Turin, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Francesca Carozzi
- Institute for cancer research, prevention and clinical network (ISPRO), Florence, Italy
| | - Elena Allia
- Centre for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
| | - Simonetta Bisanzi
- Institute for cancer research, prevention and clinical network (ISPRO), Florence, Italy
| | - Anna Gillio-Tos
- Centre for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
| | - Laura De Marco
- Centre for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy.,Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | | | | | | | - Helena Frayle
- Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - Massimo Confortini
- Institute for cancer research, prevention and clinical network (ISPRO), Florence, Italy
| | - Anna Iossa
- ISPRO Oncological Network, Prevention and Research Institute, Screening Unit, Florence, Italy
| | - Elena Cesarini
- Laboratorio Unico di Screening USL Umbria1, Perugia, Italy
| | | | | | - Silvia Gori
- Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | | | | | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Maria Benevolo
- IRCCS - Regina Elena National Cancer Institute, Rome, Italy
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12
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Renzi M, Scortichini M, Forastiere F, De' Donato F, Michelozzi P, Davoli M, Gariazzo C, Viegi G, Stafoggia M, Ancona C, Bucci S, De' Donato F, Michelozzi P, Renzi M, Scortichini M, Stafoggia M, Bonafede M, Gariazzo C, Marinaccio A, Argentini S, Sozzi R, Bonomo S, Fasola S, Forastiere F, La Grutta S, Viegi G, Cernigliaro A, Scondotto S, Baldacci S, Maio S, Licitra G, Moro A, Angelini P, Bonvicini L, Broccoli S, Ottone M, Rossi PG, Colacci A, Parmagnani F, Ranzi A, Galassi C, Migliore E, Bisceglia L, Chieti A, Brusasca G, Calori G, Finardi S, Nanni A, Pepe N, Radice P, Silibello C, Tinarelli G, Uboldi F, Carlino G. A nationwide study of air pollution from particulate matter and daily hospitalizations for respiratory diseases in Italy. Sci Total Environ 2022; 807:151034. [PMID: 34666080 DOI: 10.1016/j.scitotenv.2021.151034] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND/AIM The relationship between air pollution and respiratory morbidity has been widely addressed in urban and metropolitan areas but little is known about the effects in non-urban settings. Our aim was to assess the short-term effects of PM10 and PM2.5 on respiratory admissions in the whole country of Italy during 2006-2015. METHODS We estimated daily PM concentrations at the municipality level using satellite data and spatiotemporal predictors. We collected daily counts of respiratory hospital admissions for each Italian municipality. We considered five different outcomes: all respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), lower and upper respiratory tract infections (LRTI and URTI). Meta-analysis of province-specific estimates obtained by time-series models, adjusting for temperature, humidity and other confounders, was applied to extrapolate national estimates for each outcome. At last, we tested for effect modification by sex, age, period, and urbanization score. Analyses for PM2.5 were restricted to 2013-2015 cause the goodness of fit of exposure estimation. RESULTS A total of 4,154,887 respiratory admission were registered during 2006-2015, of which 29% for LRTI, 12% for COPD, 6% for URTI, and 3% for asthma. Daily mean PM10 and PM2.5 concentrations over the study period were 23.3 and 17 μg/m3, respectively. For each 10 μg/m3 increases in PM10 and PM2.5 at lag 0-5 days, we found excess risks of total respiratory diseases equal to 1.20% (95% confidence intervals, 0.92, 1.49) and 1.22% (0.76, 1.68), respectively. The effects for the specific diseases were similar, with the strongest ones for asthma and COPD. Higher effects were found in the elderly and in less urbanized areas. CONCLUSIONS Short-term exposure to PM is harmful for the respiratory system throughout an entire country, especially in elderly patients. Strong effects can be found also in less urbanized areas.
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Affiliation(s)
- Matteo Renzi
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy.
| | - Matteo Scortichini
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
| | - Francesco Forastiere
- CNR Institute of Biomedical Research and Innovation (IRIB), Palermo, Italy; Environmental Research Group, School of Public Health, Imperial College, London, UK
| | - Francesca De' Donato
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
| | - Paola Michelozzi
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
| | - Marina Davoli
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
| | - Claudio Gariazzo
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Monteporzio Catone (RM), Italy
| | - Giovanni Viegi
- CNR Institute of Biomedical Research and Innovation (IRIB), Palermo, Italy; CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
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Catellani C, Ravegnini G, Sartori C, Righi B, Lazzeroni P, Bonvicini L, Poluzzi S, Cirillo F, Predieri B, Iughetti L, Giorgi Rossi P, Angelini S, Street ME. Specific miRNAs Change After 3 Months of GH treatment and Contribute to Explain the Growth Response After 12 Months. Front Endocrinol (Lausanne) 2022; 13:896640. [PMID: 35813630 PMCID: PMC9256936 DOI: 10.3389/fendo.2022.896640] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/21/2022] [Indexed: 11/20/2022] Open
Abstract
CONTEXT There is growing evidence of the role of epigenetic regulation of growth, and miRNAs potentially play a role. OBJECTIVE The aim of this study is to identify changes in circulating miRNAs following GH treatment in subjects with isolated idiopathic GH deficiency (IIGHD) after the first 3 months of treatment, and verify whether these early changes can predict growth response. DESIGN AND METHODS The expression profiles of 384 miRNAs were analyzed in serum in 10 prepubertal patients with IIGHD (5 M, 5 F) at two time points before starting GH treatment (t-3, t0), and at 3 months on treatment (t+3). MiRNAs with a fold change (FC) >+1.5 or <-1.5 at t+3 were considered as differentially expressed. In silico analysis of target genes and pathways led to a validation step on 8 miRNAs in 25 patients. Clinical and biochemical parameters were collected at baseline, and at 6 and 12 months. Simple linear regression analysis and multiple stepwise linear regression models were used to explain the growth response. RESULTS Sixteen miRNAs were upregulated and 2 were downregulated at t+3 months. MiR-199a-5p (p = 0.020), miR-335-5p (p = 0.001), and miR-494-3p (p = 0.026) were confirmed to be upregulated at t+3. Changes were independent of GH peak values at testing, and levels stabilized after 12 months. The predicted growth response at 12 months was considerably improved compared with models using the common clinical and biochemical parameters. CONCLUSIONS MiR-199a-5p, miR-335-5p, and miR-494-3p changed after 3 months of GH treatment and likely reflected both the degree of GH deficiency and the sensitivity to treatment. Furthermore, they were of considerable importance to predict growth response.
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Affiliation(s)
- Cecilia Catellani
- Department of Mother and Child, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Gloria Ravegnini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Chiara Sartori
- Department of Mother and Child, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Beatrice Righi
- Department of Mother and Child, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pietro Lazzeroni
- Department of Mother and Child, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Poluzzi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Cirillo
- Department of Mother and Child, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sabrina Angelini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Maria Elisabeth Street
- Department of Mother and Child, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- *Correspondence: Maria Elisabeth Street,
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Monelli F, Besutti G, Djuric O, Bonvicini L, Farì R, Bonfatti S, Ligabue G, Bassi MC, Damato A, Bonelli C, Pinto C, Pattacini P, Giorgi Rossi P. The Effect of Diffuse Liver Diseases on the Occurrence of Liver Metastases in Cancer Patients: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:2246. [PMID: 34067076 PMCID: PMC8124499 DOI: 10.3390/cancers13092246] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 12/14/2022] Open
Abstract
This systematic review with meta-analysis aimed to assess the effect of diffuse liver diseases (DLD) on the risk of synchronous (S-) or metachronous (M-) liver metastases (LMs) in patients with solid neoplasms. Relevant databases were searched for systematic reviews and cross-sectional or cohort studies published since 1990 comparing the risk of LMs in patients with and without DLD (steatosis, viral hepatitis, cirrhosis, fibrosis) in non-liver solid cancer patients. Outcomes were prevalence of S-LMs, cumulative risk of M-LMs and LM-free survival. Risk of bias (ROB) was assessed using the Newcastle-Ottawa Scale. We report the pooled relative risks (RR) for S-LMs and hazard ratios (HR) for M-LMs. Subgroup analyses included DLD, primary site and continent. Nineteen studies were included (n = 37,591 patients), the majority on colorectal cancer. ROB appraisal results were mixed. Patients with DLD had a lower risk of S-LMs (RR 0.50, 95% CI 0.34-0.76), with a higher effect for cirrhosis and a slightly higher risk of M-LMs (HR 1.11 95% CI, 1.03-1.19), despite a lower risk of M-LMs in patients with vs without viral hepatitis (HR 0.57, 95% CI 0.40-0.82). There may have been a publication bias in favor of studies reporting a lower risk for patients with DLD. DLD are protective against S-LMs and slightly protective against M-LMs for viral hepatitis only.
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Affiliation(s)
- Filippo Monelli
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy;
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Giulia Besutti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy;
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Olivera Djuric
- Epidemiology Unit, AUSL- IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (O.D.); (L.B.); (P.G.R.)
- Center for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Laura Bonvicini
- Epidemiology Unit, AUSL- IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (O.D.); (L.B.); (P.G.R.)
| | - Roberto Farì
- Radiology Unit, AOU Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy; (R.F.); (S.B.); (G.L.)
| | - Stefano Bonfatti
- Radiology Unit, AOU Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy; (R.F.); (S.B.); (G.L.)
| | - Guido Ligabue
- Radiology Unit, AOU Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy; (R.F.); (S.B.); (G.L.)
| | - Maria Chiara Bassi
- Medical Library, AUSL- IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Angela Damato
- Oncology Department, AUSL- IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.D.); (C.B.); (C.P.)
| | - Candida Bonelli
- Oncology Department, AUSL- IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.D.); (C.B.); (C.P.)
| | - Carmine Pinto
- Oncology Department, AUSL- IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.D.); (C.B.); (C.P.)
| | - Pierpaolo Pattacini
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Paolo Giorgi Rossi
- Epidemiology Unit, AUSL- IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (O.D.); (L.B.); (P.G.R.)
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15
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Giorgi Rossi P, Carozzi F, Ronco G, Allia E, Bisanzi S, Gillio-Tos A, De Marco L, Rizzolo R, Gustinucci D, Del Mistro A, Frayle H, Confortini M, Iossa A, Cesarini E, Bulletti S, Passamonti B, Gori S, Toniolo L, Barca A, Bonvicini L, Mancuso P, Venturelli F, Benevolo M. p16/ki67 and E6/E7 mRNA Accuracy and Prognostic Value in Triaging HPV DNA-Positive Women. J Natl Cancer Inst 2021; 113:292-300. [PMID: 32745170 PMCID: PMC7936054 DOI: 10.1093/jnci/djaa105] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/12/2020] [Accepted: 07/23/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The study presents cross-sectional accuracy of E6 and E7 (E6/E7) mRNA detection and p16/ki67 dual staining, alone or in combination with cytology and human papillomavirus (HPV)16/18 genotyping, as a triage test in HPV DNA-positive women and their impact on cervical intraepithelial neoplasia (CIN2+) overdiagnosis. METHODS Women aged 25-64 years were recruited. HPV DNA-positive women were triaged with cytology and tested for E6/E7 mRNA and p16/ki67. Cytology positive women were referred to colposcopy, and negatives were randomly assigned to immediate colposcopy or to 1-year HPV retesting. Lesions found within 24 months since recruitment were included. All P values were 2-sided. RESULTS 40 509 women were recruited, and 3147 (7.8%) tested HPV DNA positive; 174 CIN2+ were found: sensitivity was 61.0% (95% confidence interval [CI] = 53.6 to 68.0), 94.4% (95% CI = 89.1 to 97.3), and 75.2% (95% CI = 68.1 to 81.6) for cytology, E6/E7 mRNA, and p16/ki67, respectively. Immediate referral was 25.6%, 66.8%, and 28.3%, respectively. Overall referral was 65.3%, 78.3%, and 63.3%, respectively. Cytology or p16/ki67, when combined with HPV16/18 typing, reached higher sensitivity with a small impact on referral. Among the 2306 HPV DNA-positive and cytology-negative women, relative CIN2+ detection in those randomly assigned at 1-year retesting vs immediate colposcopy suggests a -28% CIN2+ regression (95% CI = -57% to +20%); regression was higher in E6/E7 mRNA-negatives (Pinteraction = .29). HPV clearance at 1 year in E6/E7 mRNA and in p16/ki67 negative women was about 2 times higher than in positive women (Pinteraction < .001 for both). CONCLUSIONS p16/ki67 showed good performance as a triage test. E6/E7 mRNA showed the highest sensitivity, at the price of too high a positivity rate to be efficient for triage. However, when negative, it showed a good prognostic value for clearance and CIN2+ regression.
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Affiliation(s)
- Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Carozzi
- ISPRO Oncological Network, Prevention and Research Institute, Regional Laboratory of Cancer Prevention Unit, Florence, Italy
| | - Guglielmo Ronco
- International Agency for Research on Cancer, Lyon, France
- Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Elena Allia
- Center for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
| | - Simonetta Bisanzi
- ISPRO Oncological Network, Prevention and Research Institute, Regional Laboratory of Cancer Prevention Unit, Florence, Italy
| | - Anna Gillio-Tos
- Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Laura De Marco
- Center for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
- Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Raffaella Rizzolo
- Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Daniela Gustinucci
- Laboratorio Unico di Screening, Unità Sanitaria Locale Umbria1, Perugia, Italy
| | | | | | - Massimo Confortini
- ISPRO Oncological Network, Prevention and Research Institute, Regional Laboratory of Cancer Prevention Unit, Florence, Italy
| | - Anna Iossa
- ISPRO Oncological Network, Prevention and Research Institute, Screening Unit, Florence, Italy
| | - Elena Cesarini
- Laboratorio Unico di Screening, Unità Sanitaria Locale Umbria1, Perugia, Italy
| | - Simonetta Bulletti
- Laboratorio Unico di Screening, Unità Sanitaria Locale Umbria1, Perugia, Italy
| | - Basilio Passamonti
- Laboratorio Unico di Screening, Unità Sanitaria Locale Umbria1, Perugia, Italy
| | - Silvia Gori
- Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Laura Toniolo
- Azienda Unità Locale Socio Sanitaria 6, Este, Padua, Italy
| | | | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Benevolo
- IRCCS-Regina Elena National Cancer Institute, Rome, Italy
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Broccoli S, Bonvicini L, Djuric O, Candela S, Davoli AM, Ferrari E, Panza C, Storani S, Tamelli M, Fabbri A, Giorgi Rossi P. Understanding the association between mother's education level and effectiveness of a child obesity prevention intervention: a secondary analysis of an RCT. Epidemiol Prev 2021; 44:153-162. [PMID: 33415958 DOI: 10.19191/ep20.5-6.s1.p153.085] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to explain differences in effectiveness of paediatrician-led motivational interviewing (MI) in decreasing body mass index (BMI) between children of mothers with low or high education level. DESIGN secondary analysis of a randomised control trial. SETTING AND PARTICIPANTS individually randomized controlled trial previously conducted from 2011 to 2013 in the province of Reggio Emilia (Emilia-Romagna Region, Northern Italy). Eligible participants included in the trial were 372 (187 in the MI group and 185 in the control group) overweight children (BMI percentile >= 85th and < 95th) aged between 4 and 7 years, residing in the province of Reggio Emilia and under the care of paediatrician for >= 12 months. The intervention included 5 MI sessions based on the transtheoretical model of addiction and behavioural change delivered at 1, 4, 7, and 12 months after the baseline visit, when families had to define specific goals in changing physical activity (PA) and diet behaviours. MAIN OUTCOME MEASURES primary: BMI score variation (ΔBMI) from baseline to 12 months; secondary: percentage of changes in parent-reported PA and dietary behaviours. RESULTS a significant effect of MI on ΔBMI in children whose mothers had high education level (ΔBMI = -0.62; 95%CI -0.92;-0.32) were observed. Children of women with high education level in MI group had more improvements in set unstructured PA, decreasing screen time and sweet snacks consumption, while children with less educated mothers had improvements in consuming more vegetable soup and less desserts, sweet snacks, and sugary beverages. Highly educated mothers chose for their children to drink fewer sugary beverages and to increase PA. Less educated mothers most frequently chose as goals having breakfast, eating more fruit and vegetables, eating fewer snacks, and having less screen time. Overall achievement was similar in the two strata for diet goals, but higher for PA goals in the high education level stratum. CONCLUSIONS MI intervention was not effective in reducing BMI in children of mothers with low education level. This does appear to be weakly or not associated with goal choices and achievement within MI, it is rather an effect of unmeasured behaviours which possibly mediate association between MI and BMI reduction.
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Affiliation(s)
- Serena Broccoli
- Epidemilogy Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia (Italy)
| | - Laura Bonvicini
- Epidemilogy Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia (Italy);
| | - Olivera Djuric
- Epidemilogy Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia (Italy).,Center for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia (Italy)
| | - Silvia Candela
- Epidemilogy Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia (Italy)
| | - Anna Maria Davoli
- Primary Care Department, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia (Italy)
| | - Elena Ferrari
- Primary Care Department, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia (Italy)
| | - Costantino Panza
- Primary Care Department, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia (Italy)
| | - Simone Storani
- Primary Care Department, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia (Italy)
| | - Marco Tamelli
- Azienda USL-IRCSS di Reggio Emilia, Public Health Department, Reggio Emilia (Italy)
| | - Alessandra Fabbri
- Azienda USL-IRCSS di Reggio Emilia, Public Health Nutrition Unit, Reggio Emilia (Italy)
| | - Paolo Giorgi Rossi
- Epidemilogy Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia (Italy)
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Panza C, Volta A, Broccoli S, Bonvicini L, Kendall S, Marchesi M, Giorgi Rossi P. Evaluation of an intervention aimed at supporting new parents: the Baby Newsletter project. Ital J Pediatr 2020; 46:123. [PMID: 32887637 PMCID: PMC7487811 DOI: 10.1186/s13052-020-00886-5] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Anticipatory guidance for parents is commonly used to improve parenting skills. The objective of this pre/post-intervention controlled study was to evaluate the effectiveness of a periodic newsletter with advice on childcare and development in improving parenting self-efficacy. Methods This was a non-randomized pre/post-intervention controlled study. All the parents of children born between September 2014 and December 2015 resident in the S. Ilario d’Enza municipality (Italy) received eight Baby Newsletters. Parents resident in other municipalities of the same Health District were the control. Parents with linguistic barriers or with preterm or hospitalized children were excluded. Improvement in parenting self-efficacy was measured through the TOPSE (Tool to Measure Parenting Self-Efficacy) questionnaire during the first week (t0) after delivery and at 5 (t1) and 12 months (t2) of life at two vaccination appointments. A score ranging from 0 to 60 was computed for each of the eight domains investigated by the TOPSE. Variations of each TOPSE score between delivery and 12 months in the two groups were compared, adjusting for parity, education, age of parents, and child’s sex, and stratifying by parity and education. Results /findings One hundred thirty-six families accepted to participate in the study. Scores at 12 months were higher than 1 week after delivery in both groups for all TOPSE domains. The improvement was slightly stronger in the Newsletter group for almost all the skills except learning and knowledge [difference in the mean of variation: -0.48 (95% CI: − 3.17; 2.21)]; the difference was significant only for play and enjoyment [2.18 (95% CI: 0.12; 4.25)]. The increase in scores in almost all domains was more pronounced for parents with high education level at first child. Conclusions The intervention was effective in improving parents’ ability to play. However, it risks worsening existing differences between parents with high and with low education levels. Trial registration Clinical trial registration: NCT03268408.
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Affiliation(s)
| | - Alessandro Volta
- Primary Care Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Serena Broccoli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Ottone M, Broccoli S, Parmagnani F, Giannini S, Scotto F, Bonvicini L, Luberto F, Bacco D, Trentini A, Poluzzi V, Angelini P, Colacci A, Giorgi Rossi P, Ranzi A. Source-related components of fine particulate matter and risk of adverse birth outcomes in Northern Italy. Environ Res 2020; 186:109564. [PMID: 32668539 DOI: 10.1016/j.envres.2020.109564] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/15/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND/AIM The aim of the present study was to assess the association between PM2.5, its sources, and preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) in a large open residential cohort (Supersito Project in the Emilia-Romagna Region - Northern Italy). METHODS We collected 2012-2014 pregnancy and childbirth data from Birth Assistance Certificates and selected the pregnancies of interest. PTBs (gestational age < 37 weeks), LBW (weight < 2500 g), and SGA (newborns weighing ≤ 10th age and pregnancy week-specific percentile) were considered. Three-year measurements of daily concentrations and constituents of PM2.5 were available at four sites and were analyzed through a source apportionment approach identifying 6 sources (traffic, biomass burning, oil combustion, anthropogenic mix, and two secondary factors). Exposure to PM2.5 and sources was calculated at address level. Using logistic regression models, associations between exposure and outcomes were derived, applying single-pollutant and two-pollutant models, to verify the independent effect of each source. RESULTS The study included 23,708 neonates born to 23,415 women, among whom 1,311 PTB, 424 LBW, and 1,354 SGA occurred. PTB was the only outcome associated with PM2.5 mass (OR 1.03, 95% CI 1.002-1.058 per 1 μg/m3). Traffic, oil combustion and secondary sulfates and organics showed independent effects on PTB. Exposure to secondary nitrates was associated with a lower risk of PTB. There was no association between LBW or SGA and source-specific PM2.5 components or the residual PM2.5 related to all other sources. CONCLUSION This study found an association between PTB and PM2.5. Traffic, secondary sulfates, and organic and oil combustion were the sources with most consistent association.
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Affiliation(s)
- Marta Ottone
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Serena Broccoli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Parmagnani
- Centre for Environmental Health and Prevention, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena, Italy
| | - Simone Giannini
- Centre for Environmental Health and Prevention, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena, Italy
| | - Fabiana Scotto
- Regional Centre for Urban Areas, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Bologna, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ferdinando Luberto
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Dimitri Bacco
- Regional Centre for Urban Areas, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Bologna, Italy
| | - Arianna Trentini
- Regional Centre for Urban Areas, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Bologna, Italy
| | - Vanes Poluzzi
- Regional Centre for Urban Areas, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Bologna, Italy
| | - Paola Angelini
- Public Health Service, Emilia-Romagna Region, Bologna, Italy
| | - Annamaria Colacci
- Centre for Environmental Health and Prevention, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Ranzi
- Centre for Environmental Health and Prevention, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena, Italy.
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Giorgi Rossi P, Ferrari F, Amarri S, Bassi A, Bonvicini L, Dall'Aglio L, Della Giustina C, Fabbri A, Ferrari AM, Ferrari E, Fontana M, Foracchia M, Gallelli T, Ganugi G, Ilari B, Lo Scocco S, Maestri G, Moretti V, Panza C, Pinotti M, Prandini R, Storani S, Street ME, Tamelli M, Trowbridge H, Venturelli F, Volta A, Davoli AM. Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study. JMIR Mhealth Uhealth 2020; 8:e16165. [PMID: 32357123 PMCID: PMC7308901 DOI: 10.2196/16165] [Citation(s) in RCA: 8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/04/2020] [Accepted: 02/21/2020] [Indexed: 11/26/2022] Open
Abstract
Background Childhood obesity prevention is a public health priority in industrialized countries. The Reggio Emilia Local Health Authority has implemented a program involving primary and secondary prevention as well as the care of obese children. There are many health-promoting mobile apps, but few are targeted to children and very few are sponsored by public health agencies. Objective The goal of the research was to describe the process and tools adopted to cocreate a mobile app sponsored by the Reggio Emilia Local Health Authority to be installed in parents’ phones aimed at promoting child health and preventing obesity. Methods After stakeholder mapping, a consulting committee including relevant actors, stakeholders, and users was formed. Key persons for childhood obesity prevention were interviewed, focus groups with parents and pediatricians were conducted, and community reporting storytelling was collected. The results of these activities were presented to the consulting committee in order to define the functionalities and contents of the mobile app. Results Three key trends emerged from community reporting: being active, playing, and being outdoors; time for oneself, family, and friends; and the pressures of life and work and not having time to be active and socialize. In focus groups, interviews, and labs, mothers showed a positive attitude toward using an app to manage their children's weight, while pediatricians expressed concerns that the app could increase their workload. When these findings were explored by the consulting committee, four key themes were extracted: strong relationships with peers, family members, and the community; access to safe outdoor spaces; children’s need for age-appropriate independence; and professional support should be nonjudgmental and stigma-free. It should be a dialogue that promotes family autonomy. The app functions related to these needs include the following: (1) newsletter with anticipatory guidance, recipes, and vaccination and well-child visit reminders; (2) regional map indicating where physical activity can be done; (3) information on how to manage emergencies (eg, falls, burns, fever); (4) module for reinforcing the counseling intervention conducted by pediatricians for overweight children; and (5) a function to build a balanced daily diet. Conclusions The pilot study we conducted showed that cocreation in health promotion is feasible, with the consulting committee being the key co-governance and cocreation tool. The involvement of stakeholders in this committee made it possible to expand the number of persons and institutions actively contributing to the project.
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Affiliation(s)
- Paolo Giorgi Rossi
- Servizio Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Ferrari
- Servizio Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sergio Amarri
- Pediatria Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Bassi
- Dipartimento di scienze politiche e sociali, Università di Bologna, Bologna, Italy
| | - Laura Bonvicini
- Servizio Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Dall'Aglio
- Servizio Tecnologie Informatiche e Telematiche Interaziendale, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Claudia Della Giustina
- Servizio Igiene degli Alimenti e Nutrizione, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Fabbri
- Servizio Igiene degli Alimenti e Nutrizione, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Maria Ferrari
- Dipartimento di Salute Pubblica, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Ferrari
- Pediatra di libera scelta, Dipartimento di cure primarie, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marta Fontana
- Pediatria Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Foracchia
- Servizio Tecnologie Informatiche e Telematiche Interaziendale, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giulia Ganugi
- Dipartimento di scienze politiche e sociali, Università di Bologna, Bologna, Italy
| | - Barbara Ilari
- Medicina dello Sport e Prevenzione Cardiovascolare, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Lo Scocco
- Pediatria Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianluca Maestri
- Dipartimento di scienze politiche e sociali, Università di Bologna, Bologna, Italy
| | - Veronica Moretti
- Dipartimento di scienze politiche e sociali, Università di Bologna, Bologna, Italy
| | - Costantino Panza
- Pediatra di libera scelta, Dipartimento di cure primarie, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mirco Pinotti
- Dipartimento di cure primarie, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Riccardo Prandini
- Dipartimento di scienze politiche e sociali, Università di Bologna, Bologna, Italy
| | - Simone Storani
- Dipartimento di cure primarie, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Elisabeth Street
- Pediatria Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Tamelli
- Servizio di igiene pubblica, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Francesco Venturelli
- Servizio Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Volta
- Dipartimento di cure primarie, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Maria Davoli
- Pediatra di libera scelta, Dipartimento di cure primarie, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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- Cocreation of Service Innovation in Europe Project, Reggio Emilia, Italy
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Broccoli S, Djuric O, Bonvicini L, Davoli AM, Ferrari E, Ferrari F, Street ME, Giorgi Rossi P. Early life weight patterns and risk of obesity at 5 years: A population-based cohort study. Prev Med 2020; 134:106024. [PMID: 32061684 DOI: 10.1016/j.ypmed.2020.106024] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 12/27/2022]
Abstract
Childhood obesity is a major public health problem in industrialized countries. The aim of this study was to estimate the risk of obesity at age 5 based on BMI categories at age 3 and changes in BMI z-score from birth to 3 years of age. In this population-based study BMI data of 5173 children were collected at ages 3 and 5 and were linked to information relative to birth weight. The prevalence of obesity at age 5 was 3.8%. The risk of obesity for children born large for gestational age was 6.5%, while it was 18.6% for children overweight at age 3 and 62% for children who were obese at 3. An increase in BMI z-score from birth to 3 years increases the risk of obesity at age 5 (OR for increase of one standard deviation 2.8%; 95% CI: 2.46-3.20), but adjusting for BMI z-score at age 3, the effect of trajectory disappears (OR 1.08 95% CI: 0.9-1.29). In other words, if one targeted early preventive interventions to 3-year-olds affected by overweight/obesity (only 9.8% of the study cohort), one could possibly address 71% of children potentially affected by obesity at age 5.
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Affiliation(s)
- Serena Broccoli
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Olivera Djuric
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy; Center for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy.
| | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Anna Maria Davoli
- Primary Care Pediatrician, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Elena Ferrari
- Primary Care Pediatrician, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Francesca Ferrari
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Maria Elisabeth Street
- Division of Paediatric Endocrinology and Diabetology Department of Mother and Child, IRCCS di Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
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21
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Petrelli A, Di Napoli A, Agabiti N, Barbieri G, Bardin A, Bargagli AM, Biggeri A, Bonvicini L, Broccoli S, Cacciani L, Canova C, Caranci N, Costa G, Dalla Zuanna T, Davoli M, Di Girolamo C, Ferracin E, Giorgi Rossi P, Grisotto L, Marino C, Pacelli B, Simonato L, Spadea T, Strippoli E, Zengarini N. [Immigrants' health and socioeconomic inequalities of overall population residing in Italy evaluated through the Italian network of Longitudinal Metropolitan Studies]. Epidemiol Prev 2020; 43:1-80. [PMID: 31744272 DOI: 10.19191/ep19.5-6.s1.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Describing and monitoring socioeconomic inequalities in health are the prerequisite for planning equity policies. In Italy, some cities have integrated personal information from the municipal registries with Census data and with data from healthcare information systems to set up Longitudinal Metropolitan Studies (LMS). Under the coordination of the Italian National Institute for Health, Migration, and Poverty (NIHMP), six cities in the LMS network have contributed to the present monograph: Turin, Venice, Reggio Emilia, Modena, Bologna, and Rome. MORTALITY RESULTS. Significant socioeconomic differences by level of education were seen in all the participating centres. People who live alone or in single-parent households are more likely to die, as are those living in a substandard dwelling. Immigrants resident in the six cities included in the study showed lower all-cause mortality than Italians (males: MRR 0.83; 95%CI 0.78-0.90 - females: MRR 0.70; 95%CI 0.64-0.77). Sub-Saharan Africans experienced a significant higher mortality than Italians (males: MRR 1.33; 95%CI 1.12-1.59 - females: MMR 1.69; 95%CI 1.31-2.17). Immigrants had a neonatal and post-neonatal mortality risk about 1.5 times higher than Italians (neonatal: OR 1.71; 95%CI 1.22-2.39 - post-neonatal: OR 1.63; 95%CI 1.03-2.57). A difference between Italians and immigrants was also observed for mortality in children aged 1-4 years, though less marked (OR 1.24; 95%CI 0.73-2.11). Excesses concerned particularly immigrants from North Africa and from sub-Saharan Africa as well as those residing in Italy for >5 years. HOSPITALISATION RESULTS. Hospitalisation rates are lower for immigrants than for Italians, except when due to infectious diseases, blood disorders, and, among women, for reasons linked to pregnancy and childbirth. Avoidable hospitalisation rates of adults from low migratory pressure Countries are lower than or equal to those of Italians. On the contrary, adults from low migratory pressure Countries show higher avoidable hospitalisation rates compared to Italians in every cohort, with the exception of Rome (RR 0.81; 95%CI 0.78-0.85), with RR ranging from 1.08 (95%CI 0.96-1.22) in Venice to 1.64 (95%CI 1.47-1.83) in Modena. CONCLUSIONS Maternal and child health is the most critical area of health for immigrant population. Considering the importance that the issue of health equity has taken on in the political agenda, the data presented in this volume are a great asset, particularly in light of the long recession and the social crisis that have impacted the Country.
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Affiliation(s)
- Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma;
| | - Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma;
| | - Nera Agabiti
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Giulia Barbieri
- Dipartimento di scienze cardio-toraco-vascolari e sanità pubblica, Università degli Studi di Padova
| | - Andrea Bardin
- Dipartimento di scienze cardio-toraco-vascolari e sanità pubblica, Università degli Studi di Padova
| | - Anna Maria Bargagli
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Annibale Biggeri
- Dipartimento di statistica, informatica, applicazioni "G. Parenti", Università di Firenze, Firenze
| | - Laura Bonvicini
- Servizio di epidemiologia, Azienda unità sanitaria locale, IRCCS Reggio Emilia, Italia
| | - Serena Broccoli
- Servizio di epidemiologia, Azienda unità sanitaria locale, IRCCS Reggio Emilia, Italia
| | - Laura Cacciani
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Cristina Canova
- Dipartimento di scienze cardio-toraco-vascolari e sanità pubblica, Università degli Studi di Padova
| | - Nicola Caranci
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
| | - Giuseppe Costa
- SC a DU Servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO).,Dipartimento di scienze cliniche e biologiche, Università di Torino, Torino
| | - Teresa Dalla Zuanna
- Dipartimento di scienze cardio-toraco-vascolari e sanità pubblica, Università degli Studi di Padova
| | - Marina Davoli
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Chiara Di Girolamo
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna.,Dipartimento di scienze mediche e chirurgiche, Alma Mater Studiorum, Università di Bologna, Bologna
| | - Elisa Ferracin
- SC a DU Servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO)
| | - Paolo Giorgi Rossi
- Servizio di epidemiologia, Azienda unità sanitaria locale, IRCCS Reggio Emilia, Italia
| | - Laura Grisotto
- Dipartimento di statistica, informatica, applicazioni "G. Parenti", Università di Firenze, Firenze
| | - Claudia Marino
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Barbara Pacelli
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
| | - Lorenzo Simonato
- Dipartimento di scienze cardio-toraco-vascolari e sanità pubblica, Università degli Studi di Padova
| | - Teresa Spadea
- SC a DU Servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO)
| | - Elena Strippoli
- SC a DU Servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO)
| | - Nicolás Zengarini
- SC a DU Servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO)
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Venturelli F, Ferrari F, Broccoli S, Bonvicini L, Mancuso P, Bargellini A, Giorgi Rossi P. The effect of Public Health/Pediatric Obesity interventions on socioeconomic inequalities in childhood obesity: A scoping review. Obes Rev 2019; 20:1720-1739. [PMID: 31468647 PMCID: PMC6899709 DOI: 10.1111/obr.12931] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 01/16/2023]
Abstract
Childhood obesity has a strong social gradient. This scoping review aims to synthesize the evidence on the impact on inequalities of non-targeted interventions to reduce the prevalence of childhood and adolescent obesity in high-income countries. We updated a review by Hillier-Brown, searching up to 31 December 2017 on MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO, with no limitations on study design. Fifty-eight studies describing 51 interventions were included: 31 randomized clinical trials and 27 non-randomized trials, with sample sizes from 67 to 2,700,880 subjects. The majority were implemented in the school setting at a community level; the others were in health services or general population setting and targeting individuals or the system. Twenty-nine interventions proved to be effective overall; seven others had an effect only in a subgroup, while 15 proved not to be effective. All types of included interventions can increase inequalities. Moreover, some interventions had opposite effects based on the socioeconomic characteristics. Any kind of intervention can reduce equity. Consequences are difficult to predict based on intervention construct. Complex interventions acting on multiple targets, settings, and risk factors are more effective and have a lower risk of increasing inequalities.
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Affiliation(s)
- Francesco Venturelli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Ferrari
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Serena Broccoli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Annalisa Bargellini
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Vurro F, Merolle L, Marraccini C, Parisi M, Canovi L, Erta B, Santachiara A, Bonvicini L, Giorgi Rossi P, Baricchi R, Pertinhez TA. Quantitative assessment of the anticoagulant in plasma units collected by plasmapheresis. Transfusion 2019; 59:2113-2120. [PMID: 30875439 DOI: 10.1111/trf.15244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND To date, the quantification of the anticoagulant (ACD-A) in plasma units has been based on theoretical calculations. An accurate quantification could help minimize the risks associated with plasmapheresis, given that the total ACD-A used during the procedure is distributed between the donor and the plasma unit. Our aim was to experimentally quantify the volume of ACD-A in units collected by plasmapheresis. STUDY DESIGN AND METHODS We used proton nuclear magnetic resonance spectroscopy to measure the ACD-A volume in 295 plasma units collected by the Azienda USL-IRCCS of Reggio Emilia, Italy. We analyzed the determinants of the differences between estimated and measured ACD-A through multivariate regression models. RESULTS The experimentally measured ACD-A in plasma units was variable, with 45% of the samples showing a discrepancy of more than 15 mL compared to the manufacturer's estimate. ACD-A was underestimated for higher density of the units (p < 0.0005); a weak association was also observed with triglycerides (underestimated for higher levels, p = 0.015) and sex (overestimated in females, p = 0.008), but our model explained only 35% of the individual variability. CONCLUSION The manufacturer's algorithms do not accurately estimate the ACD-A in units collected by plasmapheresis. Donor-related characteristics may affect ACD-A distribution between donor and plasma unit, thereby explaining the discrepancies between estimate and measurement. Errors in the estimate of the ACD-A actually received by donors could hamper studies on dose-response relationship between anticoagulant and adverse reactions. Our work should stimulate research on tailored procedures aimed at minimizing the anticoagulant received by donors and increasing plasmapheresis safety.
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Affiliation(s)
- Filippo Vurro
- Istituto dei Materiali per Elettronica e il Magnetismo (CNR-IMEM), Parma, Italy
| | - Lucia Merolle
- Transfusion Medicine Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | | | - Maura Parisi
- Transfusion Medicine Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Laura Canovi
- Transfusion Medicine Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Barbara Erta
- Transfusion Medicine Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | | | | | | | - Roberto Baricchi
- Transfusion Medicine Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Thelma A Pertinhez
- Transfusion Medicine Unit, Azienda USL-IRCCS, Reggio Emilia, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
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Pirastu R, Scondotto S, Baccini M, Barone Adesi F, Bonvicini L, Cesaroni G, Pagano E, Pasetto R, Zengarini N. [The XLI Conference of the Italian Epidemiological Association. Epidemiology nowadays: evidence, communication, and participation]. Epidemiol Prev 2017; 41:230-231. [PMID: 29119752 DOI: 10.19191/ep17.5-6.p230.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Bauleo L, Bonvicini L, Carugno M, Giraudo M, Mataloni F, Popovic M, Renzi M, Simeon V. [If I say John Snow, what do you think?]. Epidemiol Prev 2017; 41:159-161. [PMID: 28929708 DOI: 10.19191/ep17.3-4.p159.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Lisa Bauleo
- Dipartimento di epidemiologia del Sistema sanitario regionale, Regione Lazio, ASL Roma 1
| | - Laura Bonvicini
- Servizio interaziendale di epidemiologia, AUSL Reggio Emilia e IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia
| | - Michele Carugno
- Dipartimento di scienze cliniche e di comunità, Università degli Studi di Milano
| | | | - Francesca Mataloni
- Dipartimento di epidemiologia del Sistema sanitario regionale, Regione Lazio, ASL Roma 1
| | - Maja Popovic
- Dipartimento di scienze mediche, Università degli Studi di Torino
| | - Matteo Renzi
- Dipartimento di epidemiologia del Sistema sanitario regionale, Regione Lazio, ASL Roma 1.
| | - Vittorio Simeon
- Unità di statistica medica, Università degli Studi della Campania, Napoli
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Abstract
The heterogeneity among children with learning disabilities still represents a barrier and a challenge in their conceptualization. Although a dimensional approach has been gaining support, the categorical approach is still the most adopted, as in the recent fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The introduction of the single overarching diagnostic category of specific learning disorder (SLD) could underemphasize interindividual clinical differences regarding intracategory cognitive functioning and learning proficiency, according to current models of multiple cognitive deficits at the basis of neurodevelopmental disorders. The characterization of specific cognitive profiles associated with an already manifest SLD could help identify possible early cognitive markers of SLD risk and distinct trajectories of atypical cognitive development leading to SLD. In this perspective, we applied a cluster analysis to identify groups of children with a Diagnostic and Statistical Manual-based diagnosis of SLD with similar cognitive profiles and to describe the association between clusters and SLD subtypes. A sample of 205 children with a diagnosis of SLD were enrolled. Cluster analyses (agglomerative hierarchical and nonhierarchical iterative clustering technique) were used successively on 10 core subtests of the Wechsler Intelligence Scale for Children-Fourth Edition. The 4-cluster solution was adopted, and external validation found differences in terms of SLD subtype frequencies and learning proficiency among clusters. Clinical implications of these findings are discussed, tracing directions for further studies.
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Affiliation(s)
- Michele Poletti
- 1 Child and Adolescent Neuropsychiatry Service, AUSL of Reggio Emilia, Italy
| | - Elisa Carretta
- 2 Inter-Institutional Epidemiological Unit, AUSL of Reggio Emilia, Italy
- 3 Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Laura Bonvicini
- 2 Inter-Institutional Epidemiological Unit, AUSL of Reggio Emilia, Italy
- 3 Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Paolo Giorgi-Rossi
- 2 Inter-Institutional Epidemiological Unit, AUSL of Reggio Emilia, Italy
- 3 Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy
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Broccoli S, Davoli AM, Bonvicini L, Fabbri A, Ferrari E, Montagna G, Panza C, Pinotti M, Storani S, Tamelli M, Candela S, Bellocchio E, Giorgi Rossi P. Motivational Interviewing to Treat Overweight Children: 24-Month Follow-Up of a Randomized Controlled Trial. Pediatrics 2016; 137:peds.2015-1979. [PMID: 26702030 DOI: 10.1542/peds.2015-1979] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pediatrician-led motivational interviewing can be an effective way of controlling BMI in overweight children in the short term. Its long-term efficacy is unknown. The primary aim was to determine whether the short-term (12-month) impact of family pediatrician-led motivational interviews on the BMI of overweight children could be sustained in the long term (24 months), in the absence of any other intervention. METHODS Children were recruited in 2011 by family pediatricians working in the province of Reggio Emilia, Italy, and randomly allocated to receive either 5 interviews delivered over a 12-month period or usual care. Eligible participants were all 4- to 7-year-old overweight children resident in the province of Reggio Emilia who had been receiving care from the pediatrician for ≥ 12 months. The primary outcome of this study was individual variation in BMI between the baseline visit and the 24-month follow-up, assessed by pediatricians not blinded to treatment group allocation. RESULTS Of 419 eligible families, 372 (89%) participated; 187 children were randomized to receive intervention and 185 to usual care. Ninety-five percent of the children attended the 12-month follow-up, and 91% attended the 24-month follow-up. After the 12-month intervention period, BMI in the intervention group increased less than in the control group (0.46 and 0.78, respectively; difference -0.32; P = .005). At the 24-month follow-up, the difference had disappeared (1.52 and 1.56, respectively; difference -0.04; P = .986). CONCLUSIONS The intervention lost its effectiveness within 1 year of cessation. Sustainable boosters are required for weight control and obesity prevention.
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Affiliation(s)
- Serena Broccoli
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy;
| | | | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy
| | | | | | | | | | - Mirco Pinotti
- Primary Health Care, Local Health Authority, Reggio Emilia, Italy
| | - Simone Storani
- Promotion Health Researchers, League Against Cancer, Reggio Emilia, Italy
| | - Marco Tamelli
- Promotion Health Researchers, League Against Cancer, Reggio Emilia, Italy
| | - Silvia Candela
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy
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Bonvicini L, Broccoli S, Davoli AM, Fabbri A, Ferrari E, Bellocchio E, Giorgi Rossi P. The weight status of preschool children: a population survey of BMI and lifestyle characteristics. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Broccoli S, Bonvicini L, Panza C, Volta A, Bellochio E, Tamagnini L, Sacchettini C, Giorgi Rossi P. Evaluation of an intervention aimed at supporting new parents: study protocol and enrolment results. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Broccoli S, Davoli AM, Albertini P, Bonvicini L, Fabbri A, Ferrari E, Ferrari F, Montagna G, Panza C, Storani S, Candela S, Bellocchio E, Giorgi Rossi P. [Motivational interviewing to treat overweight children and their parents in paediatrician's medical office: good results, but one year is not sufficient]. Epidemiol Prev 2015; 39:393. [PMID: 26554693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Serena Broccoli
- Servizio interaziendale di epidemiologia, Azienda unità sanitaria locale, Reggio Emilia.
- Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia
| | | | - Paola Albertini
- Centro elaborazione dati, Azienda Unità sanitaria locale, Reggio Emilia
| | - Laura Bonvicini
- Servizio interaziendale di epidemiologia, Azienda unità sanitaria locale, Reggio Emilia
- Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia
| | - Alessandra Fabbri
- Servizio di igiene degli alimenti e nutrizione (SIAN), Azienda unità sanitaria locale, Reggio Emilia
| | | | - Francesca Ferrari
- Servizio interaziendale di epidemiologia, Azienda unità sanitaria locale, Reggio Emilia
- Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia
| | | | | | - Simone Storani
- Programma cure primarie, Azienda unità sanitaria locale, Reggio Emilia
| | - Silvia Candela
- Servizio interaziendale di epidemiologia, Azienda unità sanitaria locale, Reggio Emilia
- Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia
| | - Eletta Bellocchio
- Programma cure primarie, Azienda unità sanitaria locale, Reggio Emilia
| | - Paolo Giorgi Rossi
- Servizio interaziendale di epidemiologia, Azienda unità sanitaria locale, Reggio Emilia
- Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia
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Candela S, Bonvicini L, Ranzi A, Baldacchini F, Broccoli S, Cordioli M, Carretta E, Luberto F, Angelini P, Evangelista A, Marzaroli P, Giorgi Rossi P, Forastiere F. Exposure to emissions from municipal solid waste incinerators and miscarriages: a multisite study of the MONITER Project. Environ Int 2015; 78:51-60. [PMID: 25765761 DOI: 10.1016/j.envint.2014.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Miscarriages are an important indicator of reproductive health but only few studies have analyzed their association with exposure to emissions from municipal solid waste incinerators. This study analyzed the occurrence of miscarriages in women aged 15-49years residing near seven incinerators of the Emilia-Romagna Region (Northern Italy) in the period 2002-2006. METHODS We considered all pregnancies occurring in women residing during the first trimester of pregnancy within a 4km radius of each incinerator. Addresses were geocoded and exposures were characterized by a dispersion model (ADMS Urban model) producing pollution maps for incinerators based on PM10 stack measurements and for other pollution sources based on NOx ground measurements. Information on pregnancies and their outcomes was obtained from the Hospital Discharge Database. Simplified True Abortion Risks (STAR)×100 estimated pregnancies were calculated. We ran logistic regressions adjusting for maternal characteristics, exposure to other sources of pollution, and sites, considering the whole population and stratifying by miscarriage history. RESULTS The study analyzed 11,875 pregnancies with 1375 miscarriages. After adjusting for confounders, an increase of PM10 due to incinerator emissions was associated with an increased risk of miscarriage (test for trend, p=0.042). The odds ratio for the highest quartile of exposed versus not exposed women was 1.29, 95% CI 0.97-1.72. The effect was present only for women without previous miscarriages (highest quartile of exposed versus not exposed women 1.44, 95% CI 1.06-1.96; test for trend, p=0.009). CONCLUSION Exposure to incinerator emissions is associated with an increased risk of miscarriage. This result should be interpreted with those of a previous study on reproductive health conducted in the same area that observed an association between incinerator exposure and preterm births.
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Affiliation(s)
- S Candela
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - L Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - A Ranzi
- Regional Reference Centre on Environment and Health, ARPA Emilia-Romagna Region, Modena, Italy.
| | - F Baldacchini
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - S Broccoli
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - M Cordioli
- Regional Reference Centre on Environment and Health, ARPA Emilia-Romagna Region, Modena, Italy.
| | - E Carretta
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - F Luberto
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - P Angelini
- Public Health Service, Emilia-Romagna Region, Italy.
| | - A Evangelista
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - P Marzaroli
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - P Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - F Forastiere
- Department of Epidemiology, Lazio Region, Italy.
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Bonvicini L, Candela S, Evangelista A, Bertani D, Casoli M, Lusvardi A, Messori A, Giorgi Rossi P. Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes. BMC Pregnancy Childbirth 2014; 14:72. [PMID: 24533853 PMCID: PMC4015597 DOI: 10.1186/1471-2393-14-72] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 02/05/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common.The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. METHODS DESIGN Observational population-based study. SETTING Reggio Emilia Province. POPULATION 5957 women resident in the province who delivered between October 2010 and November 2011. MAIN OUTCOME MEASURES CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson's Group. RESULTS Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93-1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30-6.08). CS frequency was higher in private care for all Robson's classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services. CONCLUSIONS The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes.
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Affiliation(s)
- Laura Bonvicini
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale and IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Silvia Candela
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale and IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy
| | - Daniela Bertani
- UO Salute Donna e Infanzia, AUSL of Reggio Emilia, Reggio Emilia, Italy
| | - Morena Casoli
- UO Salute Donna e Infanzia, AUSL of Reggio Emilia, Reggio Emilia, Italy
| | | | - Antonella Messori
- Programma Materno Infantile, AUSL of Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale and IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
- Epidemiology Unit, Local Health Trust of Reggio Emilia, via Amendola 2, Reggio Emilia, Italy
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Ballotari P, D’Angelo S, Bonvicini L, Broccoli S, Caranci N, Candela S, Rossi PG. Effects of immigrant status on Emergency Room (ER) utilisation by children under age one: a population-based study in the province of Reggio Emilia (Italy). BMC Health Serv Res 2013; 13:458. [PMID: 24176109 PMCID: PMC4228415 DOI: 10.1186/1472-6963-13-458] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 10/28/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The primary aim of this study was to assess the effect of immigrant status on Emergency Room (ER) utilisation by children under age one, considering all, non-urgent, very urgent, and followed by hospitalisation visits. The second aim was to investigate the role played by mother's educational level in the relationship between citizenship and ER utilisation. METHODS The cohort study included all healthy singleton live births in the years 2008-2009 and residing in the province of Reggio Emilia, followed for the first year of life in order to study their ER visits. The outcomes were the ER utilisation rate for all, non-urgent, very urgent, and followed by hospitalisation visits. The main explanatory variable was mother's citizenship. Other covariates were mother's educational level, maternal age, parity, and child gender. Multivariate analyses (negative binomial regression and zero inflated when appropriate) were performed. Adjusted utilisation Rate Ratios (RR) and their 95% Confidence Intervals (95% CI) were calculated. Trend for age in months by citizenship is depicted. RESULTS There were 3,191 children (36.4%) with at least one ER visit in the first year of life. Adjusted RR show a significantly greater risk of ER visit for immigrants than for Italians: (RR 1.51; 95% CI 1.39-1.63). Immigrants also had a higher risk of non-urgent visits (RR 1.72; 95% CI 1.48-2.00) and for visits followed by hospitalizations (RR 1.58; 95% CI 1.33-1.89). For very urgent visits, the immigrants had a slightly higher risk compared to Italians (RR 1.25; 95% CI 0.98-1.59).The risk of ER visits is higher in the first two months of life (RR(1st vs 3rd-12th) 2.08; 95% CI 1.93-2.24 and RR(2nd vs 3rd-12th) 1.45; 95% CI 1.33-1.58, respectively). Considering all visits, the ER utilisation rate was inversely related with maternal education only for Italians (low educational level 44.0 and high educational level 73.9 for 100 children; p value for trend test < 0.001). CONCLUSIONS Our study observed a higher use of ER services by immigrant children and, to a lesser extent, by children of less educated Italian mothers. In immigrants, the excess is mostly due to non-urgent visits and only slightly to high acute conditions.
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Affiliation(s)
- Paola Ballotari
- Servizio Interaziendale di Epidemiologia, ASL di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Stefania D’Angelo
- Servizio Interaziendale di Epidemiologia, ASL di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Laura Bonvicini
- Servizio Interaziendale di Epidemiologia, ASL di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Serena Broccoli
- Servizio Interaziendale di Epidemiologia, ASL di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Nicola Caranci
- Regional Agency for Health and Social Care Emilia-Romagna Region, Viale Aldo Moro 21, Bologna, Italy
| | - Silvia Candela
- Servizio Interaziendale di Epidemiologia, ASL di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, ASL di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
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Davoli AM, Broccoli S, Bonvicini L, Fabbri A, Ferrari E, D'Angelo S, Di Buono A, Montagna G, Panza C, Pinotti M, Romani G, Storani S, Tamelli M, Candela S, Giorgi Rossi P. Pediatrician-led motivational interviewing to treat overweight children: an RCT. Pediatrics 2013; 132:e1236-46. [PMID: 24144717 DOI: 10.1542/peds.2013-1738] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [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: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of family pediatrician-led motivational interviews (MIs) on BMI of overweight (85th ≥ BMI percentile ≥ 95 th) children aged 4 to 7 years. METHODS All the family pediatricians working in Reggio Emilia Province (Italy) were invited to participate in the study; 95% accepted. Specific training was provided. Parents were asked to participate in the trial if they recognized their child as overweight. Children were individually randomly assigned to MIs or usual care. All children were invited for a baseline and a 12-month visit to assess BMI and lifestyle behaviors. The usual care group received an information leaflet, and the intervention group received 5 MI family meetings. The primary outcome was the individual variation of BMI, assessed by pediatricians unblinded to treatment groups. RESULTS Of 419 eligible families, 372 (89%) participated; 187 children were randomized to MIs and 185 to the usual care group. Ninety-five percent of the children attended the 12-month visit. The average BMI increased by 0.49 and 0.79 during the intervention in the MI and control groups, respectively (difference: -0.30; P = .007). MI had no effect in boys or in children whose mothers had a low educational level. Positive changes in parent-reported lifestyle behaviors occurred more frequently in the MI group than in the control group. CONCLUSIONS The pediatrician-led MI was overall effective in controlling BMI in these overweight children aged 4 to 7 years, even though no effect was observed in male children or when the mother's education level was low.
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Affiliation(s)
- Anna Maria Davoli
- Epidemiology Unit, Local Health Authority of Reggio Emilia, via Amendola 2, Reggio Emilia, Italy.
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Bonvicini L, Broccoli S, D'Angelo S, Candela S. [Emergency room services utilization in the province of Reggio Emilia: a comparison between immigrants and Italians]. Epidemiol Prev 2011; 35:259-266. [PMID: 22166771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The aim of the study is to compare Italian and immigrant accesses to Emergency Room (ER) Services in the province of Reggio Emilia, with particular attention to time differences and to potentially inappropriate accesses. SETTING AND PARTICIPANTS the database of ER accesses in the province of Reggio Emilia was analyzed for the years 2007- 2010. In the analysis of the resident population all autochthonous citizens and all immigrants from Developed Countries were considered Italians, while citizens from Developing Countries were Immigrants. Temporary Immigrants were those immigrants with residence and citizenship in a Developing Country. MAIN OUTCOME MEASURES A descriptive analysis was conducted using demographic variables related to patients (age, gender, citizenship and residence) and variables related to access (admission emergency codes, cause of admission, hour, day of the week, month and discharge modality). Standardized access Ratios (SRs) were calculated for the resident population, together with 95%Confidence Intervals (95% CI). The SRs were calculated separately for children and for adults. RESULTS In the years 2007-2010, 562,658 accesses to ER were recorded for Italians, 95,300 accesses for Immigrants and 6,800 for the Temporary Immigrants. Access rates for resident Immigrants were higher than Italian ones. In 2010, the SR for men was 1.24 (95%CI 1.22-1.27) while for women it was 1.18 (95%CI 1.15-1.27). Considering only non-urgent accesses, the SRs were even higher (SR men=1.65, 95% CI 1.58-1.72, women=1.43, 95% CI 1.36-1.50). Similar findings were observed in children. CONCLUSION Immigrants access the ER services more than Italians do.They also show more non-urgent accesses in comparison with Italians. This finding is consistent with results of studies conducted in other European countries and it underlines the necessity to reorganize primary care in order to better meet immigrants' needs.
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Affiliation(s)
- Laura Bonvicini
- Servizio di epidemiologia, Dipartimento di sanità pubblica, Azienda USL di Reggio Emilia.
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