Variability of adenoidectomy/tonsillectomy rates among children of the Veneto Region, Italy

<p>Abstract</p> <p>Background</p> <p>Despite national guidelines in 2003 aimed at limiting the recourse to tonsillectomy and/or adenoidectomy (A/T), the latter are among the most frequent pediatric surgeries performed in Italy. Aim of the study is to investigate variability of A/T rates among children of the Veneto Region, Italy.</p> <p>Methods</p> <p>All discharges of Veneto residents with Diagnosis-Related Groups 57–60 and ICD9-CM intervention codes 28.2 (tonsillectomy), 28.3 (adenotonsillectomy), 28.6 (adenoidectomy) were selected in the period 2000–2006 for a descriptive analysis. A multilevel Poisson regression model was applied to estimate Incidence Rate Ratios (IRR) with 95% Confidence Intervals (CI) for A/T surgery among children aged 2–9 years in 2004–2006, while taking into account clustering of interventions within the 21 Local Health Units.</p> <p>Results</p> <p>Through 2000–2006, the overall number of A/T surgeries decreased (-8%); there was a decline of adenoidectomies (-20%) and tonsillectomies (-8%), whereas adenotonsillectomies raised (+18%). Analyses on children aged 2–9 resulted in an overall rate of 14.4 surgeries per 1000 person-years (16.1 among males and 12.5 among females), with a wide heterogeneity across Local Health Units (range 8.1–27.6). At random intercept Poisson regression, while adjusting for sex and age, intervention rates were markedly lower among foreign than among Italian children (IRR = 0.57, CI 0.53–0.61). A/T rates in the 10–40 age group (mainly tonsillectomies) computed for each Local Health Unit and introduced in the regression model accounted for 40% of the variance at Local Health Unit level of pediatric rates (mainly adenoidectomies and adenotonsillectomies).</p> <p>Conclusion</p> <p>A/T rates in the Veneto Region, especially adenoidectomies among children aged 2–9 years, remain high notwithstanding a decrease through 2000–2006. A wide heterogeneity according to nationality and Local Health Units is evident. The propensity to A/T surgery of each Local Health Unit is similar in different age groups and for different surgical indications.</p

A Prospective Longitudinal Study of Shyness from Infancy to Adolescence: Stability, Age-Related Changes, and Prediction of Socio-Emotional Functioning

This longitudinal, population-based and prospective study investigated the stability, age-related changes, and socio-emotional outcomes of shyness from infancy to early adolescence. A sample of 921 children was followed from ages 1.5 to 12.5 years. Parent-reported shyness was assessed at five time points and maternal- and self-reported social skills and symptoms of anxiety and depression were assessed at age 12.5 years. Piecewise latent growth curve analysis was applied, with outcomes regressed on latent shyness intercept and slope factors. Results showed moderate stability and increasing levels of shyness across time, with more variance and a steeper increase in early as compared to mid-to-late childhood. Both stable shyness and increased shyness in mid-to-late (but not early) childhood predicted poorer social skills and higher levels of anxiety and depression symptoms in early adolescence. The implications of the evidence for two developmental periods in shyness trajectories with differential impact on later socio-emotional functioning are discussed

Shyness, Unsociability, and Socio-Emotional Functioning at Preschool: The Protective Role of Peer Acceptance

In present study, we examined the protective role of peer acceptance in the links between two subtypes of social withdrawal (shyness, unsociability) and indices of young children’s socio-emotional functioning. Participants were N = 112 Italian preschool children (n = 54 boys) aged 36–74 months (M = 56.85 months, SD = 10.14). Multi-source assessments included: (1) parental ratings of children’s shyness and unsociability; (2) teacher ratings of children’s internalizing problems, externalizing problems, and social competence; (3) child interview assessments of preference for solitary play; and (4) peer (sociometric) ratings of peer acceptance. Among the results, shyness was associated with internalizing problems at preschool, whereas unsociability was related to a preference for solitary play. In addition, results from multiple regression analyses indicated significant interactions between peer acceptance and both shyness and unsociability in the association with indices of socio-emotional functioning. For example, at lower levels of peer acceptance, shyness was positively related to children’s preference for solitary play, whereas children’s unsociability was associated with externalizing problems. In contrast, these relations were attenuated at higher levels of peer acceptance. Findings are discussed in term of the potential protective role of young children’s peer acceptance for different subtypes of social withdrawal during early childhood