613 research outputs found
Sleep disordered breathing in children: what a pediatrician needs to know?
Obstructive sleep disordered breathing (SDB) is defined by the presence of recurrent partial or complete
upper airway obstruction (hypopneas, obstructive or mixed apneas) with disruption of normal oxygenation,
ventilation and sleep pattern. SDB is quite common in otherwise healthy children but the prevalence in children
with congenital and genetic diseases is higher often with a more severe form of OSAS. Its consequences encompassed
metabolic, cardiovascular and neurocognitive alterations. Clinical symptoms vary according to age, with
some diurnal and nocturnal symptoms. No questionnaire had demonstrated a good reliability for the diagnosis of
SDB and for the prediction of its severity. The mainstem of treatment is represented by adenotonsillectomy, with
a good response in almost two tiers of patients. For those who failed to improve or who relapse other therapeutic
options may be continuous positive pressure (CPAP) or noninvasive ventilation (NIV)
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Predicting costs of mental health care: a critical literature review
Cost evaluation research in the mental health field is being increasingly recognized as a way to achieve a more effective deployment of scarce resources. However, there is a paucity of studies that seek to identify predictors of psychiatric service utilization and costs. This paper aims to critically review the published research in the field of psychiatric service utilization and costs, and discusses current methodological developments in this field
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The difficult task of predicting the costs of community-based mental health care. A comprehensive case register study.
Previous studies have attempted to forecast the costs of mental health care, using clinical and individual variables; the inclusion of ecological measures could improve the knowledge of predictors of psychiatric service utilisation and costs to support clinical and strategic decision-making
Social distancing measures for COVID-19 are changing winter season
Health authorities worldwide have
adopted measures of social distancing
and movement restrictions, in addition
to other public health measures to reduce
exposure and to suppress interhuman
SARS-CoV-
2 transmission. In Italy, a
national lockdown with school closure
was introduced from March to May 2020.
From November 2020, Italy has been
divided into zones according to regional
epidemiological data, with primary
schools reopened, associated with the
mandatory use of face masks and different
levels of social distance measures. For
children with symptoms suggestive of
COVID-19, the surveillance mechanism
for the control of SARS-CoV-
2 infection
is based on the performance of a real-time
PCR on a nasopharyngeal swab. A
diagnostic test has been introduced at the
tertiary-level
university hospital, Institute
for Maternal and Child Health, IRCCS
\u201cBurlo Garofolo\u201d of Trieste, consisting of
a multiple nucleic acid amplification assay
for 13 common viral respiratory pathogens
on nasopharyngeal swab (Respiratory
Flow Chip assay (Vitro, Sevilla,
Spain), including SARS-CoV-
2, influenza
A and B, adenovirus, other coronaviruses,
parainfluenza virus 1\u20134, enteroviruses,
bocavirus, metapneumovirus, respiratory
syncytial virus (RSV), rhinoviruses, Bordetella
pertussis, Bordetella parapertussis
and Mycoplasma pneumoniae. Before
routine utilisation, international standard
quality control samples for each pathogen
were used for test validation, and no
cross-detection
was found between the
different pathogens. Criteria for testing
referral did not change during the study
period. Weekly variability of the number
of total tests performed was due to the
normal variations of acute illness. During
the last winter season, from September
2020 (week 39) to February 2021 (week
7), 1138 nasopharyngeal swabs were
tested for patients younger than 17 years
old (figure 1). No influenza A or B nor
RSV was detected during this period.
The most common pathogen was rhinovirus
(n=505), followed by adenoviruses
(n=131), other coronaviruses (n=101)
and SARS-CoV-
2 (n=57). Our data show
that common winter pathogens circulation
changed, and influenza virus and RSV
did not produce a seasonal epidemic in
the 2020\u20132021 winter season. These data
suggest that social distancing measures
and mask wearing profoundly changed
the seasonality of winter paediatric respiratory
infections that are mainly spread
by respiratory droplets. The reasons why
rhinovirus remains the main pathogen
despite social distancing and face mask
use are still a matter of debate. Similar
data showing a decrease of common viral
respiratory infections during the winter
season have recently been reported in the
southern hemisphere.1\u20134 Our data refer
to a single institute, covering paediatric
population of the Trieste Province (about
230 000 inhabitants), limiting the generalisation
of our findings. However, our
results highlight the need for continuing
surveillance for the delayed spread of such
viruses during spring and summer
Suicide mortality among psychiatric patients in Northeast Italy: a 10-year cohort study
Aims: The present study investigated the relationship between suicide mortality and contact with a community mental health centre (CMHC) among the adult population in the Veneto Region (northeast Italy, population 4.9 million). Specifically, it estimated the effects of age, gender, time elapsed since the first contact with a CMHC, calendar year of diagnosis and diagnostic category on suicide mortality and modality. Methods: The regional mortality archive was linked to electronic medical records for all residents aged 18-84 years who had been admitted to a CMHC in the Veneto Region in 2008. In total, 54 350 subjects diagnosed with a mental disorder were included in the cohort and followed up for a period of 10 years, ending in 2018. Years of life lost (YLL) were computed and suicide mortality was estimated as a mortality rate ratio (MRR). Results: During the follow-up period, 4.4% of all registered deaths were from suicide, but, given the premature age of death (mean 52.2 years), suicide death accounted for 8.7% of YLL; this percentage was particularly high among patients with borderline personality disorder (27.2%), substance use disorder (12.1%) and bipolar disorder (11.5%) who also presented the highest suicide mortality rates. Suicide mortality rates were halved in female patients (MRR 0.45; 95% CI 0.37-0.55), highest in patients aged 45-54 years (MRR 1.56; 95% CI 1.09-2.23), and particularly elevated in the 2 months following first contact with CMHCs (MRR 10.4; 95% CI 5.30-20.3). A sensitivity analysis restricted to patients first diagnosed in 2008 confirmed the results. The most common modalities of suicide were hanging (47%), jumping (18%), poisoning (13%) and drowning (10%), whereas suicide from firearm was rare (4%). Gender, age at death and time since first contact with CMHCs influenced suicide modality. Conclusions: Suicide prevention strategies must be promptly initiated after patients' first contact with CMHCs. Patients diagnosed with borderline personality disorder, substance use disorder and bipolar disorder may be at particularly high risk for suicide
Suicide Mortality among Psychiatric Patients in Northeast Italy. A 10-year Cohort Study
Aims
The present study investigated the relationship between suicide mortality and contact with a community mental health centre (CMHC) among the adult population in the Veneto Region (northeast Italy, population 4.9 million). Specifically, it estimated the effects of age, gender, time elapsed since the first contact with a CMHC, calendar year of diagnosis and diagnostic category on suicide mortality and modality.
Methods
The regional mortality archive was linked to electronic medical records for all residents aged 18–84 years who had been admitted to a CMHC in the Veneto Region in 2008. In total, 54 350 subjects diagnosed with a mental disorder were included in the cohortand followed up for a period of 10 years, ending in 2018. Years of life lost (YLL) were computed and suicide mortality was estimated as a mortality rate ratio (MRR).
Results
During the follow-up period, 4.4% of all registered deaths were from suicide, but, given the premature age of death (mean 52.2 years), suicide death accounted for 8.7% of YLL; this percentage was particularly high among patients with borderline personality disorder (27.2%), substance use disorder (12.1%) and bipolar disorder (11.5%) who also presented the highest suicide mortality rates. Suicide mortality rates were halved in female patients (MRR 0.45; 95% CI 0.37–0.55), highest in patients aged 45–54 years (MRR 1.56; 95% CI 1.09–2.23), and particularly elevated in the 2 months following first contact with CMHCs (MRR 10.4; 95% CI 5.30–20.3). A sensitivity analysis restricted to patients first diagnosed in 2008 confirmed the results. The most common modalities of suicide were hanging (47%), jumping (18%), poisoning (13%) and drowning (10%), whereas suicide from firearm was rare (4%). Gender, age at death and time since first contact with CMHCs influenced suicide modality.
Conclusions
Suicide prevention strategies must be promptly initiated after patients’ first contact with CMHCs. Patients diagnosed with borderline personality disorder, substance use disorder and bipolar disorder may be at particularly high risk for suicide
Case Report: Simil-Appendicitis Presentation May Precede Cardiac Involvement in MIS-C Patient
Introduction: Multisystem inflammatory syndrome in children (MIS-C) is a new clinical entity characterized by a systemic hyperinflammation triggered by SARS-CoV-2 infection in children and adolescents. This condition could potentially involve all organs with main complications concerning cardiovascular system. Despite up to 90% of patients complain gastrointestinal symptoms (nausea, vomit, and diarrhea), a presentation mimicking acute appendicitis has rarely been reported, and can be the presenting feature of the disease, potentially leading to misdiagnosis and delayed treatment.
Case Description: A 15-year-old boy presented to the Emergency Department for a 2-day history of fever, vomiting, and mild abdominal pain. One month before, the patient complained ageusia and anosmia while his mother tested positive for Sars-CoV2 nasopharyngeal swab. At admission, laboratory tests showed leukocytosis with lymphopenia and elevation of inflammatory markers, while cardiac enzymes, electrocardiogram and echocardiography were unremarkable. An abdominal ultrasound displayed a thickening of terminal ileus and cecum with ascites. Because of the worsening abdominal pain and a physical examination suggestive of acute appendicitis, a laparoscopy was performed but no surgical condition was found. After surgery, fever and generalized malaise persisted, so a cardiac evaluation was repeated, showing a relevant increase in inflammatory markers and cardiac enzymes. Electrocardiogram demonstrated a QTc prolongation with mild decrease in left ventricular ejection fraction at echocardiogram. A MIS-C was diagnosed and intravenous immunoglobulin along with a steroid treatment started. After 36 h, the patient presented a complete clinical recovery with fever cessation. Cardiac anomalies normalized in 3 weeks. Conclusion: MIS-C has been defined as a systemic inflammation, involving at least two organs, after a previous SARS-CoV2 infection in children and adolescents. Physicians should be aware that while gastrointestinal manifestations are common, a pseudo appendicitis presentation may also occur, leading to misdiagnosis and delayed treatment. This report suggests that in patients with symptoms suggestive of an acute appendicitis, the presence of lymphopenia, hypoalbuminemia and ultrasound images of terminal ileus inflammation, should raise the suspect for MIS-C even without initial overt signs of cardiac involvement
The first winter of social distancing improved most of the health indexes in a paediatric emergency department
Aim We compared visits to a tertiary level paediatric emergency department (PED) in Italy, during winter 2020-2021, when COVID-19 social distancing measures were in place, with winter 2019-2020. Methods This was a retrospective analysis of an electronic database. We obtained the number of visits and the ages, main complaints, triage codes, discharge diagnoses and outcomes of patients who accessed the PED from the 1 October 2020 to 28 February 2021. These were compared to the same period in 2019-2021. Results Visits fell by 52%, from 10982 in 2019-2020 to 5317 in 2020-2021 (p < 0.0001). The reductions were 52% in neonates, 58% in infants, 53% in toddlers, 61% in preschool children, 48% in school children and 46% in adolescents. Non-urgent and urgent triage codes declined. Respiratory and gastrointestinal infections fell by 72% and 71% respectively. Injuries declined by 42%, mainly among adolescents. Accidental intoxication, psychiatric symptoms and substance or alcohol abuse declined by 24%, 33% and 64%. Hospital admissions reduced by 8% and admissions to intensive care fell by 29%. Conclusion During the first winter of pandemic social distancing visits to an Italian PED fell by 52%, with higher reductions in younger children and infants, and hospital admissions fell by 8%
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