Road traffic injuries in the province of Grosseto

Introduction. Road traffic injuries constitute a major public health issue. The Province of Grosseto is one of the territories most affected in the Region of Tuscany. The objective of the study, part of the Road Safety Provincial Council?s project, is to describe the epidemiology of the road accidents in order to contribute to the reduction of the burden of deaths and injuries. Methods. The data relative to road accidents occurring in the Province were drawn from the various sources available: Death Certificates (1991-2005), Police Reports (1991-2003), Hospital Discharge Records (1996-2005), Emergency Room visits (2004-2005). Results. On average, each year road accidents cause 30 deaths, at least 530 hospitalizations, and approximately 3,300 Emergency Room visits. The standardized mortality rate (2003-2005, males: 20.6; females: 6.0), the mortality ratio (2003: 34.6 deaths for every 1,000 accidents), and the severity ratio (2003: 1,432 injured for every 1,000 accidents) are higher than regional figures. Discussion. The greater relative number of fatalities, casualties and crashes can be explained by various physical and social environmental factors such as vast flatland, few greater urban settlements, deprived area. The territory specifically demonstrates an accentuated seasonality in August, a month in which a peak in both the number of accidents and their severity is reported, brought about by the intense volume of commuter and transit traffic, and highlighted by the fact that in that same month approximately half of Emergency Room visits concern non-residents. Conclusion. The complexity of the issue, the number of determinant factors involved, and the disproportionately greater impact on the more disadvantaged and vulnerable segments of society require the development of inter-sectoral strategies and the sharing of responsibility among individuals, groups and communities

Nutritional surveillance in Tuscany: maternal perception of nutritional status of 8-9 y-old school-children

Introduction. Overweight and obesity in the developmental age has become a public health problem. For this reason, prevention projects must be developed in advance with the aim to involve not only children, but their parents as well. Our objective is to evaluate the accuracy of the mothers? perceptions of adolescent nutritional status. Methods. Cross-sectional study. We selected a statistical sample of 3,076 subjects (1,583 males, 1,493 females), 8-9 y-old school-children of 164 3rd-grade elementary school classes from throughout Tuscany, as well as their mothers. The mothers? information was gathered via self-administered questionnaires, while the children were given an eating behaviour survey under the supervision of qualified personnel. Mothers? education level (self-reported) height and weight were collected; children?s height and weight were measured. The former were asked how they perceived their children?s body image. Results. A correlation exists between the mothers? perceptions of the nutritional state of their children via the silhouettes and the BMI classes of the children, which is equal to 80% with a k-Cohen for agreement equal to 0.58 (SE = 0.02; P : 0.0001). However, no correlation exists between the mothers? responses to the question ?In your opinion, is your child ??? and the child?s actual BMI class (the exact percentage correlation is equal to 75%, with a k-Cohen for agreement equal to 0.43 SE = 0.014; P : 0.0001). Discussion. Mothers have an accurate perception of the nutritional status of their children, correctly choosing the silhouette that corresponds to the child?s BMI profile without variation by gender. We can assume that mothers in our sample have a good concept about healthy nutritional status

Nutritional Surveillance in Tuscany: eating habits at breakfast, mid-morning and afternoon snacks among 8-9 y-old children

Introduction.The prevalence of overweight and obesity in children is rapidly increasing in many countries. For that it has been interesting to investigate the eating habits of 8-9 y-old Tuscany children by paying attention to their meals frequency per day and their food choices in total and in relation to children?s Body Mass Index (BMI) classes. In addition we considered some environment factors that could affect the children eating behaviours, such as mother?s BMI and their education level. Methods. A statistical sample of 3,076 (1,583 males, 1,493 females), 8-9 year-old school-children was collected; weight and height were measured using standardized personnel and instruments. BMI classes were calculated using Cole et al.?s cutoff for children and adolescents. In order to evaluate the consumption frequency of individual meals and various foods, a Food Frequency Questionnaire (FFQ) was used, which was completed by the children themselves at school. A self-administered questionnaire revealed the weight and height of parents and their educational levels. Three educational levels were established: high, medium and low. Results. The results showed that 92.3% of children ate breakfast from 4-7 times a week, the vast majority at home, while only 3% declared consuming breakfast never or almost never. The most preferred breakfast consisted of milk and biscuits for all children?s BMI classes. 95.9% of children reported having mid-morning snack at school; fruit juice and tea are the most frequently consumed liquid foods, and pizza, salami sandwiches and pre-packaged snacks are the most frequently consumed solid foods in all BMI classes. 93.6% ate afternoon snack for the most part at home, even if 12% of children reported consuming it elsewhere; fruit juice and tea with pizza, sandwiches and pre-packaged snacks are still the most highly consumed foods by all children?s BMI classes. The consumption frequency of breakfast (P inf. 0.001), mid-morning (P inf. 0.05) and afternoon snack (P inf. 0.05) of 8-9 y-old Tuscany children decrease with increase the children?s BMI classes. The same tendency may be noted for the consumption frequency of breakfast in relation to mother?s BMI (P inf. 0.05) and their education level (P inf. 0.05). This data strengthens the thesis that some home environments can affect the children?s eating behaviours. Conclusion. No substantial differences in food choices at the meals analyzed were determined among normal weight, over weight and obese children. Children of normal weight had a greater tendency to consume meals more regularly. Mother?s BMI and their education level can have influence on children?eating behaviours

Intensive follo w-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

The aim of the study was to prospectively evaluate an intensive follow-up programme using serial tumour marker estimations and contrast-enhanced computed tomography (CT) of the chest and abdomen in patients undergoing potentially curative resection of colorectal liver metastases. Seventy-six consecutive patients having undergone potentially curative resections of colorectal liver metastases in a single unit were followed up with a protocol of 3 monthly carcinoembryonic antigen and carbohydrate antigen 19-9 estimations and contrast-enhanced spiral CT of the chest, abdomen and pelvis for the first 2 years following surgery and 6 monthly thereafter. The median period of follow-up was 24 months (range 18–60). Recurrent tumour was classed as early if within 6 months of liver resection. Thirty-seven of the 76 patients (49%) developed recurrence on follow-up. Nineteen recurrences were in the liver alone (51%), 16 liver and extrahepatic (43%) and two extrahepatic alone (6%). Of the 19 patients with isolated liver recurrence, eight developed within 6 months of liver resection none of which were resectable. Of the 11 recurrences after 6 months, five (45%) were resectable. Of the 37 recurrences, CT indicated recurrence despite normal tumour markers in 19 patients. Tumour markers suggested recurrence before imaging in 12 and concurrently with imaging in 6. In the 12 patients who presented with elevated tumour markers before imaging, there was a median lag period of 3 months (range 1–21) in recurrence being detected on further serial imaging. Seventeen patients who developed recurrence had normal tumour markers before initial resection of their liver metastases. Of these 17, 10 (58%) had an elevation of tumour markers associated with recurrence. Over a median follow-up of 2 years following liver resection, the use of CT or tumour markers alone would have failed to demonstrate early recurrence in 12 and 18 patients respectively. A combination of tumour markers and CT detected significantly more (P<0.05) recurrence than either modality alone. Tumour markers and CT should be used in combination in the follow-up of patients with resected colorectal liver metatases, including patients whose markers are normal at the time of initial liver resection

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

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