Nutritional behavior and attitudes in food allergic children and their mothers

BACKGROUND: Avoidance of food allergens requires adapting dietetic habits, changing nutritional approach. A restriction of food choice can result in a monotonous diet and impact social life. This study investigated the impact of food allergy on nutritional behavior and attitudes of patients and their families. METHODS: A survey involving mothers of food allergic children aged 0–16 years was carried out. We primarily studied the variables related to the child (age, gender, clinical history, food and social events attitudes). In addition, Spielberg Trait-Anxiety Inventory (STAI-T) test was applied to the mothers. We assessed separately the associations between characteristics of child-mother pairs and diet monotony, and attendance to social events, by means of proportional odds regression models. RESULTS: Nearly 10% of the 124 participants completely banned allergenic foods at home and 15.3% consumed their meals separately. More than one fourth attended parties rarely or never. Most of the participants reported a “monotonous diet”. Model results suggested significant associations between child age (p = 0.05), mother age (p = 0.05), number of excluded foods (p = 0.003) and monotony of the diet. The attendance of social events was inversely associated with the number of excluded foods (p = 0.04) and the mother’s STAI-T T-score (p = 0.04). CONCLUSIONS: The results highlighted the impact of food allergy in reducing interest about food and influencing patients’ approach to social life. It is important to support families in managing allergens avoidance

Xenon Anesthesia Improves Respiratory Gas Exchanges in Morbidly Obese Patients

Background. Xenon-in-oxygen is a high density gas mixture and may improve PaO2/FiO2 ratio in morbidly obese patients uniforming distribution of ventilation during anesthesia. Methods. We compared xenon versus sevoflurane anesthesia in twenty adult morbidly obese patients (BMI > 35) candidate for roux-en-Y laparoscopic gastric bypass and assessed PaO2/FiO2 ratio at baseline, at 15 min from induction of anaesthesia and every 60 min during surgery. Differences in intraoperative and postoperative data including heart rate, systolic and diastolic pressure, oxygen saturation, plateau pressure, eyes opening and extubation time, Aldrete score on arrival to the PACU were compared by the Mann-Whitney test and were considered as secondary aims. Moreover the occurrence of side effects and postoperative analgesic demand were assessed. Results. In xenon group PaO2-FiO2 ratio was significantly higher after 60 min and 120 min from induction of anesthesia; heart rate and overall remifentanil consumption were lower; the eyes opening time and the extubation time were shorter; morphine consumption at 72 hours was lower; postoperative nausea was more common. Conclusions. Xenon anesthesia improved PaO2/FiO2 ratio and maintained its distinctive rapid recovery times and cardiovascular stability. A reduction of opioid consumption during and after surgery and an increased incidence of PONV were also observed in xenon group

Acute respiratory virus emergency department admissions in a tertiary care hospital in Central Italy and the relative impact on bed occupancy, January 2017-May 2022

Acute Respiratory Infections (ARIs) have a relevant impact on public health in terms of prevalence and costs associated with the diseases. This concern highlighted the need to adopt accurate surveillance systems to respond to new emergencies and meet the demand for access to care. The objective of our work is to set up, at the Azienda Ospedaliero-Universitaria Pisana (AOUP), an automated syndromic surveillance for ARI

NUOVI STRUMENTI DIAGNOSTICI E NUOVE PROSPETTIVE PER LA SALUTE DELL\u2019OSSO

Sebbene l'osso trabecolare rappresenti solo il 20% dello scheletro, la resistenza dell\u2019osso \ue8 fortemente influenzata, oltre che dalla densit\ue0, anche dalla micro-architettura della struttura trabecolare. Un metodo diagnostico innovativo di recente introduzione, BESTEST\uae, mediante il BSI (Bone Structure Index) misura la risposta elastica alle sollecitazioni da parte della struttura ossea, ricavata da simulazioni di carico condotte con metodi ingegneristici su una biopsia virtuale del paziente, ottenuta da radiogrammi planari dell'epifisi prossimale della mano. I risultati dell\u2019esame sono espressi in termini statistici, BSI_T-score e BSI_Z-score, di significato analogo ma non correlati a quelli utilizzati in densitometria. \uc8 ben noto che i regolatori ipofisari, gli inibitori dell'aromatasi e il tamoxifene nelle donne in pre-menopausa e i chemioterapici hanno tutti un impatto negativo sulla salute delle ossa poich\ue9, bloccando l'attivit\ue0 degli estrogeni o degli androgeni, aumentano il turnover osseo portando ad un rischio crescente di fratture. L'incidenza globale del rischio di fratture nei pazienti in trattamento ormonale per carcinoma mammario varia dall'1,37% all'11%. In questo lavoro, vengono discussi i risultati preliminari ottenuti nella valutazione del BSI_T-score in 100 pazienti di sesso femminile sottoposte a trattamento per carcinoma del seno. I risultati dimostrano che la micro-architettura ossea \ue8 effettivamente influenzata dal trattamento oncologico e che il BESTEST\uae pu\uf2 fornire un prezioso aiuto alla densitometria nella valutazione di queste alterazioni, specialmente quando associate a fratture. Questo studio preliminare fornisce inoltre una base razionale per ulteriori e pi\uf9 approfondite indagini sull'uso di questa nuova tecnica, rapida e sicura, per monitorare l'effetto delle terapie contro il cancro della mammella sulle alterazioni della micro-architettura ossea

The "Snacking Child" and its social network: some insights from an italian survey

<p>Abstract</p> <p>Background</p> <p>The hypothesis underlying this work is that the social network of a child might have an impact on the alimentary behaviors, in particular for what concerns snack consumption patterns.</p> <p>Methods</p> <p>1215 Italian children 6-10 ys old were interviewed using a CATI facility in January 2010. 608 "snackers" and 607 "no-snackers" were identified. Information regarding family composition, child and relatives BMI, mother perception of child weight, child, father and mother physical activity, TV watching, social network, leisure time habits and dietary habits of peers, were collected. Association of variables with the status of snacker was investigated using a multivariable logistic regression model.</p> <p>Results</p> <p>Snackers children seem to be part of more numerous social network (1.40 friends vs 1.14, p = 0.042) where the majority of peers are also eating snacks, this percentage being significantly higher (89.5 vs 76.3, p < 0.001) than in the "no-snacker" group. The snacking group is identified by the fact that it tends to practice at least 4 hours per week of physical activity (OR: 1.36, CI: 1.03-1.9). No evidence of an association between snacking consumption and overweight status has been shown by our study.</p> <p>Conclusions</p> <p>The snacking child has more active peer-to-peer social relationships, mostly related with sport activities. However, spending leisure time in sportive activities implies being part of a social environment which is definitely a positive one from the point of view of obesity control, and indeed, no increase of overweight/obesity is seen in relation to snack consumption.</p

MONITORING ICU PERFORMANCE: A CRITICAL ASSESSMENT OF COMMONLY USED TOOLS

Measuring healthcare outcomes and clinical performance is perceived as a fundamental strategy to rationalize the health system and better the quality of care. Critical care, with its high costs and high mortality rates, has been well scrutinized from the start, and severity scores or other acuity adjustments systems were first introduced in the 1980s. In fact, ICUs are a small portion of the health care system, but they still represent an important and disproportionate segment of medical care and costs. In order to evaluate clinical performance, almost three questions need to have an answer: (i) How to benchmark clinical performance? (ii) How to immediately identify a worsening in clinical performance? (iii) How to investigate the causes of worsening? Risk adjustment tools are devoted to manage the first issue. Observational studies that compare groups, services, facilities, providers and treatments must consider the possible differences already existing in their respective populations, and thus the differences in patient characteristics that can determine care outcomes. Particularly, mortality depends not only on the quality of care delivered but also on the patient’s underlying health status, physiologic reserve, and admitting diagnosis. Therefore, the goal of an investigator is to take into account the possible confounding effect of the different distribution (among groups, services, facilities, providers or treatments) of “a priori” characteristics which can influence the occurrence of the outcome. Risk adjustment procedures usually are based on the construction, by mean of a logistic model, of a prognostic scoring system used to define the “a priori" risk (patients’ severity). The application of this severity measure leads to obtain a direct estimate of the probability of the outcome for every patient. Therefore, the expected outcome for the study population can be calculated as the sum of the outcome probability for each patient. Finally, the expected outcome can be compared with the observed outcome. Given the possibility to calculate the number of events expected in a group, how should an ICU verify whether the number of actual deaths is greater than the number of expected deaths? Tools of statistical quality control finalized to detect shifts in performance levels have been borrowed from industry or expressly created to monitor clinical procedures; these tools are based on sequential monitoring of performance over time and indicate whether the overall performance is better or worse than expected on the basis of the predicted risk of failure, estimated using a statistical model for risk adjustment; they are asked to early recognize a worsening in quality of care and to distinguish between random variation and special-cause variation detecting chance contribution to the performance deterioration. Particularly, the Variable Life-Adjusted Display (VLAD), based on the cumulative sum (CUSUM) method, provides valuable visual aids to evaluate clinical performance giving an alarm when the observed performance is worse than the expected. However, when a signal occurs it does not prove that a problem exists, but it suggests the opportunity to investigate for an explanation of the observed- expected difference. During the PhD course three main issues have been investigated: 1. When differences between observed and expected clinical performance is observed, it is impossible to assume that patient population is adequately modeled by the risk adjustment. Particularly, in evaluating elective surgical patients, predictive models based on a standard logistic functional form seem to systematically overestimate the expected probability of death. Methodological aspects implicated in this behavior have been explored and approaches alternative to the logistic model have been proposed; 2. Assuming that confounding is correctly modeled, monitoring performance tools need to be able to early detect a change, therefore the ability of the Variable Life-Adjusted Display (VLAD) has been investigated and the delay in signaling quantified; 3. When a negative worsening in clinical performance is observed, the investigation for a possible explanation could be arduous: it requires an analysis technique able to model complex interactions or patterns that may exist in the data. Unfortunately, traditional modeling methodologies, as regression techniques, may not be able to identify these interactions, and the application of more complex techniques need to be experimented. Modeling techniques other than linear model have been applied in order to evaluate if they are more able to guide and support interpretation of covariates role in determining a change in clinical performance