%0 Journal Article %J Acta Paediatr %D 2019 %T Administering analgesia sublingually is a suitable option for children with acute abdominal pain in the emergency department. %A Cozzi, Giorgio %A Zanchi, Chiara %A Chiaretti, Antonio %A Tipo, Vincenzo %A Cernich, Marta %A D'Anna, Carolina %A Fantacci, Claudia %A Conversano, Ester %A Zanon, Davide %A Ronfani, Luca %A Barbi, Egidio %X

AIM: Acute abdominal pain is a frequent complaint in children attending emergency departments. The aim of this study was to investigate the pain score reductions when children with acute abdominal pain received medication sublingually.

METHODS: We carried out a multicentre randomised controlled trial in three children's hospitals in Italy between March 2015 and June 2017. Children from four to 18 years of age with acute abdominal pain were recruited if their self-reported pain was at least six on a scale from 0-10. The children were randomised to receive ketorolac 0.5 mg/kg (n = 70) or tramadol 2 mg/kg (n = 70) sublingually or a melt in the mouth powder of 20 mg/kg paracetamol (n = 70). The main study outcome was the pain scores for the three drugs after two hours.

RESULTS: The 210 children (58.6% girls) had a median age of 12 years with an interquartile range of 9-14.3. The median pain scores at two hours were not significantly different between ketorolac 2.0 (interquartile ranges, IQR 0.0-4.3) and tramadol 3.0 (IQR 1.0-5.0) vs paracetamol 3.0 (IQR 0.8-5.0). The median pain reductions were all 5.0 points.

CONCLUSION: Delivering analgesia sublingually was a suitable option for pain relief in children with acute abdominal pain in the emergency department.

%B Acta Paediatr %V 108 %P 143-148 %8 2019 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/30043434?dopt=Abstract %R 10.1111/apa.14514 %0 Journal Article %J J Pediatr Gastroenterol Nutr %D 2019 %T Changing Epidemiology of Liver Involvement in Children With Celiac Disease. %A Benelli, Elisa %A Naviglio, Samuele %A De Leo, Luigina %A Stera, Giacomo %A Giangreco, Manuela %A Ronfani, Luca %A Villanacci, Vincenzo %A Martelossi, Stefano %A Ventura, Alessandro %A Not, Tarcisio %X

OBJECTIVES: Available data indicate that liver involvement is present in a significant proportion of children with celiac disease (CD) at the diagnosis (elevated transaminases 15%-57%, autoimmune liver disease 1%-2%). We sought to evaluate prevalence, clinical course, and risk factors for liver involvement in a large cohort of children with CD.

METHODS: Children (age 0-18 years) diagnosed with CD from March 2010 to April 2016 were enrolled. Liver involvement was considered to be present when alanine transaminase (ALT) levels were >40 U/L (hypertransaminasemia [HTS]). Patients with HTS were re-evaluated after at least 12 months of a gluten-free diet.

RESULTS: CD was diagnosed in 806 patients during the study period; of these, ALT levels were available for 700 patients (86.9%), and were elevated in 27 (3.9%, HTS group); median ALT and aspartate transaminase levels in the HTS group were 57 U/L (interquartile range 49-80 U/L) and 67 U/L (interquartile range 53-85 U/L), respectively. Younger age, malabsorption symptoms, and low hemoglobin or ferritin were significantly more common in the HTS group at univariate analysis. At multivariate analysis, only age ≤4.27 years correlated with risk of liver involvement (odds ratio 3.73; 95% confidence interval: 1.61-8.66). When retested on a gluten-free diet, all but 3 patients normalized ALT levels; of these, 1 was diagnosed with sclerosing cholangitis.

CONCLUSIONS: Liver involvement in celiac children is now less frequent than previously reported, possibly due to changing CD epidemiology. Younger age is the only risk factor. Associated autoimmune liver disease is rare.

%B J Pediatr Gastroenterol Nutr %V 68 %P 547-551 %8 2019 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/30499881?dopt=Abstract %R 10.1097/MPG.0000000000002209 %0 Journal Article %J Ital J Pediatr %D 2018 %T Impact of near infrared light in pediatric blood drawing Centre on rate of first attempt success and time of procedure. %A Conversano, Ester %A Cozzi, Giorgio %A Pavan, Matteo %A Minute, Marta %A Gortan, Elena %A Montico, Marcella %A Vecchi Brumatti, Liza %A Ronfani, Luca %A Barbi, Egidio %K Adolescent %K Age Factors %K Child %K Child, Preschool %K Female %K Humans %K Infant %K Infant, Newborn %K Infrared Rays %K Lighting %K Male %K Phlebotomy %K Time Factors %X

BACKGROUND: Peripheral blood access and venipuncture are a stressful and painful experience in pediatric patients; moreover, it is estimated that more than one attempt is required to achieve the procedure in about one third of children. For this reason, we investigated if Near-infrared light technology routinely used, could give an advantage to venipuncture in a pediatric blood center setting.

METHODS: We conducted an open, pseudo-randomized controlled trial with two parallel arms, in the blood-drawing center, with enrolment of 115 patients between 0 and 18 years, in 14 consecutive working days. Fifty-three subjects were enrolled in group 1 (VeinViewer®) and 62 in group 2 (control group). We divided patients into three subgroups considering their age (< 5 years, 6-10 years, > 10 years). The primary study outcome was to assess if the use of VeinViewer® was associated with a reduction of time to perform blood sampling. The secondary outcome was to analyze VienViewer®'s impact on first attempt success rate in blood sampling.

RESULTS: No difference was found regarding the duration of blood sampling between the two groups, even after stratifying the patients into the three age subgroups. There was no difference between the two groups in the success at the first attempt in blood sampling.

CONCLUSIONS: Routine use of VeinViewer® is not useful to reduce time of the procedure during venipuncture.

TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov, with number NCT03277092 , on September 8, 2017.

%B Ital J Pediatr %V 44 %P 60 %8 2018 May 25 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29801519?dopt=Abstract %R 10.1186/s13052-018-0501-1 %0 Journal Article %J Ther Clin Risk Manag %D 2018 %T Meconium-stained amniotic fluid: a risk factor for postpartum hemorrhage. %A Bouchè, Carlo %A Wiesenfeld, Uri %A Ronfani, Luca %A Simeone, Roberto %A Bogatti, Paolo %A Skerk, Kristina %A Ricci, Giuseppe %X

Background/aim: Clinical data with respect to the impact of meconium on the risk of maternal hemorrhage are scarce. Therefore, in this study, we aimed to determine whether meconium-stained amniotic fluid (MSAF) represents a risk factor for postpartum hemorrhage (PPH) after vaginal delivery in a large unselected population.

Patients and methods: A retrospective cohort study evaluated 78,542 consecutive women who had a vaginal delivery between 24th and 44th weeks of gestation. The women who had undergone cesarean section were excluded to avoid possible bias. Postpartum blood loss was measured with graduated blood sack. Postpartum blood loss between 1,000 and 2,000 mL and >2,000 mL were classified as moderate and severe PPH, respectively.

Results: A total of 74,144 patients were available for analysis. According to the color of amniotic fluid (AF), two groups of patients were identified: MSAF (n=10,997) and clear AF (n=63,147). The rates of severe and massive PPH were found to be significantly higher in the MSAF group than that of clear AF group (OR=1.3, 95% CI: 1.2-1.5, <0.001 and OR=2.5, 95% CI: 1.5-4.2, <0.001). Operative vaginal delivery rate was found to be higher in the MSAF group than that of clear AF group, but the difference was only borderline significant (OR=1.5, 95% CI: 1.0-2.2, =0.05). There were no significant differences between the MSAF and the clear AF groups with respect to episiotomies, second- or third-degree perineal tears, vaginal-perineal thrombus, cervical lacerations, vaginal births after cesarean section, twin deliveries, and placental retention rates.

Conclusion: To the best of our knowledge, this is the first clinical study that has investigated the role of MSAF as a risk factor for PPH after vaginal delivery in an unselected population. Our results suggest that MSAF is significantly associated with higher risk of moderate and severe PPH than clear AF.

%B Ther Clin Risk Manag %V 14 %P 1671-1675 %8 2018 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30254448?dopt=Abstract %R 10.2147/TCRM.S150049 %0 Journal Article %J Pediatr Blood Cancer %D 2018 %T Multicenter randomized, double-blind controlled trial to evaluate the efficacy of laser therapy for the treatment of severe oral mucositis induced by chemotherapy in children: laMPO RCT. %A Gobbo, Margherita %A Verzegnassi, Federico %A Ronfani, Luca %A Zanon, Davide %A Melchionda, Fraia %A Bagattoni, Simone %A Majorana, Alessandra %A Bardellini, Elena %A Mura, Rosamaria %A Piras, Alessandra %A Petris, Maria Grazia %A Mariuzzi, Maria Livia %A Barone, Angelica %A Merigo, Elisabetta %A Decembrino, Nunzia %A Vitale, Marina Consuelo %A Berger, Massimo %A Defabianis, Patrizia %A Biasotto, Matteo %A Ottaviani, Giulia %A Zanazzo, Giulio Andrea %X

OBJECTIVES: To demonstrate the efficacy of laser photobiomodulation (PBM) compared to that of placebo on severe oral mucositis (OM) in pediatric oncology patients. The primary objective was the reduction of OM grade (World Health Organization [WHO] scale) 7 days after starting PBM. Secondary objectives were reduction of pain, analgesic consumption, and incidence of side effects.

METHODS: One hundred and one children with WHO grade > 2 chemotherapy-induced OM were enrolled in eight Italian hospitals. Patients were randomized to either PBM or sham treatment for four consecutive days (days +1 to +4). On days +4, +7, and +11, OM grade, pain (following a 0-10 numeric pain rating scale, NRS) and need for analgesics were evaluated by an operator blinded to treatment.

RESULTS: Fifty-one patients were allocated to the PBM group, and 50 were allocated to the sham group. In total, 93.7% of PBM patients and 72% of sham patients had OM grade < 3 WHO on day +7 (P = 0.01). A significant reduction of pain was registered on day +7 in the PBM versus sham group (NRS 1 [0-3] vs. 2.5 [1-5], P < 0.006). Reduced use of analgesics was reported in the PBM group, although it was not statistically significant. No significant adverse events attributable to treatment were recorded.

CONCLUSIONS: PBM is a safe, feasible, and effective treatment for children affected by chemotherapy-induced OM, as it accelerates mucosal recovery and reduces pain.

%B Pediatr Blood Cancer %V 65 %P e27098 %8 2018 Aug %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/29727048?dopt=Abstract %R 10.1002/pbc.27098 %0 Journal Article %J Public Health Nutr %D 2018 %T Nutrient intakes in an Italian population of infants during the complementary feeding period. %A Concina, Federica %A Pani, Paola %A Bravo, Giulia %A Barbone, Fabio %A Carletti, Claudia V %A Knowles, Alessandra %A Ronfani, Luca %A Parpinel, Maria %X

OBJECTIVE: To describe the nutrient intakes of an Italian cohort of infants at 6, 9 and 12 months of age.

DESIGN: Dietary data were collected using a food diary at three follow-ups (6, 9 and 12 months of age of infants). The infants' dietary data were used to estimate nutrient intakes using the Italian food composition database integrated with data from nutritional labels and the literature. The mean and standard deviation, median and interquartile range, minimum and maximum, and 5th, 25th, 75th and 95th percentiles were calculated for the daily intake of twenty-eight nutrients, with sex differences evaluated using parametric/non-parametric statistical methods.

SETTING: A prospective population-based birth cohort.SubjectInfants (n 400) living in the urban area of Trieste (Italy).

RESULTS: The sex distribution was fairly balanced at each follow-up. The mean daily intakes of energy and the other twenty-seven nutrients considered were greater in males at all follow-ups. In particular, a significant statistical difference was observed in higher male consumption of cholesterol at 9 months and in energy and carbohydrate intakes at 12 months (P < 0·05). The mean daily intake of proteins was greater than that recommended by the Italian Dietary Reference Values at all follow-ups.

CONCLUSIONS: These preliminary results provide a useful basis for understanding the nutrient intake patterns of infants in this area of Italy during the first year of life.

%B Public Health Nutr %V 21 %P 3018-3026 %8 2018 Nov %G eng %N 16 %1 http://www.ncbi.nlm.nih.gov/pubmed/30157987?dopt=Abstract %R 10.1017/S136898001800201X %0 Journal Article %J Pediatr Emerg Care %D 2018 %T Pain Intensity and Risk of Bone Fracture in Children With Minor Extremity Injuries. %A Zanchi, Chiara %A Giangreco, Manuela %A Ronfani, Luca %A Germani, Claudio %A Giorgi, Rita %A Calligaris, Lorenzo %A Norbedo, Stefania %A Liccari, Giulio %A Cozzi, Giorgio %A Barbi, Egidio %X

OBJECTIVES: Injuries are one of the most common causes of pediatric emergency department (ED) visit. The aim of this study was to investigate the relationship between the intensity of pain at the ED visit of children presenting with an extremity injury and the risk of fracture.

METHODS: We conducted a retrospective study, considering all patients presenting to the ED of a children's hospital in Italy, with an accidental extremity injury, between May and December 2015. We selected all children aged 8 to 17 years who underwent an x-ray. Children with major, multiple, or nonextremity injuries were excluded. Age, sex, spontaneous and palpation pain, local swelling, time between injury, and medical evaluation were recorded. Sensibility and specificity of spontaneous and palpation pain in detecting a fracture were calculated.

RESULTS: We reviewed 994 medical records; of these, 344 (34.6%) reported a fracture. Children's median age was 12 years (interquartile range [IQR], 10-14). Median spontaneous pain at the ED visit was not significantly different between children with and without a fracture: 4.0 (1.0-6.0) and 5 (1.0-6.0), respectively (P = 0.129). Children with mild palpation pain and children without an increase of pain of at least 2 points between spontaneous and palpation pain were fractured in 3.2% and 0.97% of cases, respectively.

CONCLUSIONS: In this series, pain intensity in children with a minor extremity injury was not a good marker of fracture. Nevertheless, children with mild palpation pain or with a mild increase of pain between spontaneous and palpation pain had a low risk of fracture.

%B Pediatr Emerg Care %8 2018 Jan 23 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29369266?dopt=Abstract %R 10.1097/PEC.0000000000001418 %0 Journal Article %J Pediatr Emerg Care %D 2018 %T Red Flags in Torticollis: A Historical Cohort Study. %A Starc, Meta %A Norbedo, Stefania %A Tubaro, Martina %A Ronfani, Luca %A Bassanese, Giulia %A Barbi, Egidio %K Adolescent %K Child %K Child, Preschool %K Cohort Studies %K Emergency Service, Hospital %K Female %K Hospitalization %K Humans %K Male %K Retrospective Studies %K Torticollis %X

OBJECTIVE: This study aimed to assess the spectrum of pathologies responsible for torticollis in children presenting to the emergency department and to evaluate the associated symptoms to determine clinical red flags for hospitalization.

METHODS: This was a historical retrospective cohort study. Medical records of children evaluated in our emergency department for torticollis from 2008 to 2013 were reviewed.

RESULTS: Among 392 identified patients, 61% had postural torticollis,19.4% infection related, 16.3% traumatic, and 3.5% other. Twenty-five patients (6.4%) were hospitalized. Four variables were strongly and independently related to the severe outcome: fever, sore throat, headache, and age.

CONCLUSIONS: The association of 2 or 3 of these 4 features carried a risk of 32% and 58%, respectively, of having a severe illness.

%B Pediatr Emerg Care %V 34 %P 463-466 %8 2018 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/29298248?dopt=Abstract %R 10.1097/PEC.0000000000001377 %0 Journal Article %J PLoS One %D 2017 %T Adolescent Admissions to Emergency Departments for Self-Injurious Thoughts and Behaviors. %A Zanus, Caterina %A Battistutta, Sara %A Aliverti, Renata %A Montico, Marcella %A Cremaschi, Silvana %A Ronfani, Luca %A Monasta, Lorenzo %A Carrozzi, Marco %K Adolescent %K Child %K Female %K Humans %K Incidence %K Italy %K Male %K Medical Records %K Patient Admission %K Retrospective Studies %K Self-Injurious Behavior %K Sex Factors %K Suicidal Ideation %K Suicide, Attempted %X

The objective of the present study was to describe the incidence and the characteristics of Self-Injurious Thoughts and Behaviors (SITBs), among adolescents aged 11-18 admitted, over a two year period, to all the Emergency Departments of a Region of North-eastern Italy through a comprehensive analysis of medical records. A two-step search was performed in the regional ED electronic database. First, we identified the cases that had been clearly diagnosed as SITBs by an Emergency Department physician. Secondly, suspect cases were detected through a keyword search of the database, and the medical records of these cases were hand screened to identify SITBs. The mean annual incidence rate of SITBs was 90 per 100,000 adolescents aged 11-18 years. Events were more frequent in females. Drug poisoning was the most frequently adopted method (54%). In 42% of cases a diagnosis of SITB was not explicitly reported by the physician. In 65% of cases adolescents were discharged within hours of admission. Only 9% of patients started a psychiatric assessment and treatment program during hospital stay. This research confirms the high incidence of SITBs among adolescents and highlights the difficulty in their proper diagnosis and management. Such difficulty is confirmed by the fact that only a few patients, even among those with a clear diagnosis, were sent for psychiatric assessment. Correct identification and management of SITB patients needs to be improved, since SITBs are an important public health problem in adolescence and one of the main risk factors for suicide.

%B PLoS One %V 12 %P e0170979 %8 2017 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/28125701?dopt=Abstract %R 10.1371/journal.pone.0170979 %0 Journal Article %J Pediatrics %D 2017 %T Antibiotic Prophylaxis for Urinary Tract Infection-Related Renal Scarring: A Systematic Review. %A Hewitt, Ian K %A Pennesi, Marco %A Morello, William %A Ronfani, Luca %A Montini, Giovanni %K Acute Disease %K Antibiotic Prophylaxis %K Child %K Cicatrix %K Humans %K Kidney %K Pyelonephritis %K Urinary Tract Infections %X

CONTEXT: Acute pyelonephritis may result in renal scarring. Recent prospective studies have shown a small benefit of antibiotic prophylaxis in preventing symptomatic and febrile urinary tract infections (UTIs), while being underpowered to detect any influence in prevention of renal damage.

OBJECTIVES: Review of the literature and a meta-analysis to evaluate the effect of antibiotic prophylaxis on UTI-related renal scarring.

DATA SOURCES: Medline, Embase, and Cochrane Controlled Trials Register electronic databases were searched for studies published in any language and bibliographies of identified prospective randomized controlled trials (RCTs) performed and published between 1946 and August 2016.

STUDY SELECTION: Subjects 18 years of age or younger with symptomatic or febrile UTIs, enrolled in prospective RCTs of antibiotic prophylaxis where Tc dimercaptosuccinic acid scans were performed at entry into the study and at late follow-up to detect new scar formation.

DATA EXTRACTION: The literature search, study characteristics, inclusion and exclusion criteria, and risk of bias assessment were independently evaluated by 2 authors.

RESULTS: Seven RCTs (1427 subjects) were included in the meta-analysis. Our results show no influence of antibiotic prophylaxis in preventing renal scarring (pooled risk ratio, 0.83; 95% confidence interval, 0.55-1.26) as did a subanalysis restricted to those subjects with vesicoureteral reflux (pooled risk ratio, 0.79; 95% confidence interval, 0.51-1.24).

LIMITATIONS: Limitations include the small number of studies, short duration of follow-up, and insufficient children with high-grade dilating reflux and/or renal dysplasia enrolled in the studies.

CONCLUSIONS: Antibiotic prophylaxis is not indicated for the prevention of renal scarring after a first or second symptomatic or febrile UTI in otherwise healthy children.

%B Pediatrics %V 139 %8 2017 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/28557737?dopt=Abstract %R 10.1542/peds.2016-3145 %0 Journal Article %J JAMA Pediatr %D 2017 %T Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study. %A Kassebaum, Nicholas %A Kyu, Hmwe Hmwe %A Zoeckler, Leo %A Olsen, Helen Elizabeth %A Thomas, Katie %A Pinho, Christine %A Bhutta, Zulfiqar A %A Dandona, Lalit %A Ferrari, Alize %A Ghiwot, Tsegaye Tewelde %A Hay, Simon I %A Kinfu, Yohannes %A Liang, Xiaofeng %A Lopez, Alan %A Malta, Deborah Carvalho %A Mokdad, Ali H %A Naghavi, Mohsen %A Patton, George C %A Salomon, Joshua %A Sartorius, Benn %A Topor-Madry, Roman %A Vollset, Stein Emil %A Werdecker, Andrea %A Whiteford, Harvey A %A Abate, Kalkidan Hasen %A Abbas, Kaja %A Damtew, Solomon Abrha %A Ahmed, Muktar Beshir %A Akseer, Nadia %A Al-Raddadi, Rajaa %A Alemayohu, Mulubirhan Assefa %A Altirkawi, Khalid %A Abajobir, Amanuel Alemu %A Amare, Azmeraw T %A Antonio, Carl A T %A Arnlöv, Johan %A Artaman, Al %A Asayesh, Hamid %A Avokpaho, Euripide Frinel G Arthur %A Awasthi, Ashish %A Ayala Quintanilla, Beatriz Paulina %A Bacha, Umar %A Betsu, Balem Demtsu %A Barac, Aleksandra %A Bärnighausen, Till Winfried %A Baye, Estifanos %A Bedi, Neeraj %A Bensenor, Isabela M %A Berhane, Adugnaw %A Bernabe, Eduardo %A Bernal, Oscar Alberto %A Beyene, Addisu Shunu %A Biadgilign, Sibhatu %A Bikbov, Boris %A Boyce, Cheryl Anne %A Brazinova, Alexandra %A Hailu, Gessessew Bugssa %A Carter, Austin %A Castañeda-Orjuela, Carlos A %A Catalá-López, Ferrán %A Charlson, Fiona J %A Chitheer, Abdulaal A %A Choi, Jee-Young Jasmine %A Ciobanu, Liliana G %A Crump, John %A Dandona, Rakhi %A Dellavalle, Robert P %A Deribew, Amare %A deVeber, Gabrielle %A Dicker, Daniel %A Ding, Eric L %A Dubey, Manisha %A Endries, Amanuel Yesuf %A Erskine, Holly E %A Faraon, Emerito Jose Aquino %A Faro, Andre %A Farzadfar, Farshad %A Fernandes, Joao C %A Fijabi, Daniel Obadare %A Fitzmaurice, Christina %A Fleming, Thomas D %A Flor, Luisa Sorio %A Foreman, Kyle J %A Franklin, Richard C %A Fraser, Maya S %A Frostad, Joseph J %A Fullman, Nancy %A Gebregergs, Gebremedhin Berhe %A Gebru, Alemseged Aregay %A Geleijnse, Johanna M %A Gibney, Katherine B %A Gidey Yihdego, Mahari %A Ginawi, Ibrahim Abdelmageem Mohamed %A Gishu, Melkamu Dedefo %A Gizachew, Tessema Assefa %A Glaser, Elizabeth %A Gold, Audra L %A Goldberg, Ellen %A Gona, Philimon %A Goto, Atsushi %A Gugnani, Harish Chander %A Jiang, Guohong %A Gupta, Rajeev %A Tesfay, Fisaha Haile %A Hankey, Graeme J %A Havmoeller, Rasmus %A Hijar, Martha %A Horino, Masako %A Hosgood, H Dean %A Hu, Guoqing %A Jacobsen, Kathryn H %A Jakovljevic, Mihajlo B %A Jayaraman, Sudha P %A Jha, Vivekanand %A Jibat, Tariku %A Johnson, Catherine O %A Jonas, Jost %A Kasaeian, Amir %A Kawakami, Norito %A Keiyoro, Peter N %A Khalil, Ibrahim %A Khang, Young-Ho %A Khubchandani, Jagdish %A Ahmad Kiadaliri, Aliasghar A %A Kieling, Christian %A Kim, Daniel %A Kissoon, Niranjan %A Knibbs, Luke D %A Koyanagi, Ai %A Krohn, Kristopher J %A Kuate Defo, Barthelemy %A Kucuk Bicer, Burcu %A Kulikoff, Rachel %A Kumar, G Anil %A Lal, Dharmesh Kumar %A Lam, Hilton Y %A Larson, Heidi J %A Larsson, Anders %A Laryea, Dennis Odai %A Leung, Janni %A Lim, Stephen S %A Lo, Loon-Tzian %A Lo, Warren D %A Looker, Katharine J %A Lotufo, Paulo A %A Magdy Abd El Razek, Hassan %A Malekzadeh, Reza %A Markos Shifti, Desalegn %A Mazidi, Mohsen %A Meaney, Peter A %A Meles, Kidanu Gebremariam %A Memiah, Peter %A Mendoza, Walter %A Abera Mengistie, Mubarek %A Mengistu, Gebremichael Welday %A Mensah, George A %A Miller, Ted R %A Mock, Charles %A Mohammadi, Alireza %A Mohammed, Shafiu %A Monasta, Lorenzo %A Mueller, Ulrich %A Nagata, Chie %A Naheed, Aliya %A Nguyen, Grant %A Nguyen, Quyen Le %A Nsoesie, Elaine %A Oh, In-Hwan %A Okoro, Anselm %A Olusanya, Jacob Olusegun %A Olusanya, Bolajoko O %A Ortiz, Alberto %A Paudel, Deepak %A Pereira, David M %A Perico, Norberto %A Petzold, Max %A Phillips, Michael Robert %A Polanczyk, Guilherme V %A Pourmalek, Farshad %A Qorbani, Mostafa %A Rafay, Anwar %A Rahimi-Movaghar, Vafa %A Rahman, Mahfuzar %A Rai, Rajesh Kumar %A Ram, Usha %A Rankin, Zane %A Remuzzi, Giuseppe %A Renzaho, Andre M N %A Roba, Hirbo Shore %A Rojas-Rueda, David %A Ronfani, Luca %A Sagar, Rajesh %A Sanabria, Juan Ramon %A Kedir Mohammed, Muktar Sano %A Santos, Itamar S %A Satpathy, Maheswar %A Sawhney, Monika %A Schöttker, Ben %A Schwebel, David C %A Scott, James G %A Sepanlou, Sadaf G %A Shaheen, Amira %A Shaikh, Masood Ali %A She, June %A Shiri, Rahman %A Shiue, Ivy %A Sigfusdottir, Inga Dora %A Singh, Jasvinder %A Silpakit, Naris %A Smith, Alison %A Sreeramareddy, Chandrashekhar %A Stanaway, Jeffrey D %A Stein, Dan J %A Steiner, Caitlyn %A Sufiyan, Muawiyyah Babale %A Swaminathan, Soumya %A Tabarés-Seisdedos, Rafael %A Tabb, Karen M %A Tadese, Fentaw %A Tavakkoli, Mohammad %A Taye, Bineyam %A Teeple, Stephanie %A Tegegne, Teketo Kassaw %A Temam Shifa, Girma %A Terkawi, Abdullah Sulieman %A Thomas, Bernadette %A Thomson, Alan J %A Tobe-Gai, Ruoyan %A Tonelli, Marcello %A Tran, Bach Xuan %A Troeger, Christopher %A Ukwaja, Kingsley N %A Uthman, Olalekan %A Vasankari, Tommi %A Venketasubramanian, Narayanaswamy %A Vlassov, Vasiliy Victorovich %A Weiderpass, Elisabete %A Weintraub, Robert %A Gebrehiwot, Solomon Weldemariam %A Westerman, Ronny %A Williams, Hywel C %A Wolfe, Charles D A %A Woodbrook, Rachel %A Yano, Yuichiro %A Yonemoto, Naohiro %A Yoon, Seok-Jun %A Younis, Mustafa Z %A Yu, Chuanhua %A Zaki, Maysaa El Sayed %A Zegeye, Elias Asfaw %A Zuhlke, Liesl Joanna %A Murray, Christopher J L %A Vos, Theo %K Adolescent %K Adolescent Health %K Age Factors %K Cause of Death %K Child %K Child Health %K Child Mortality %K Disabled Children %K Female %K Global Burden of Disease %K Global Health %K Humans %K Male %K Pregnancy %K Pregnancy Complications %K Risk Factors %K Sex Factors %K Wounds and Injuries %X

Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.

Objective: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.

Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.

Findings: Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.

Conclusions and Relevance: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

%B JAMA Pediatr %V 171 %P 573-592 %8 2017 Jun 01 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/28384795?dopt=Abstract %R 10.1001/jamapediatrics.2017.0250 %0 Journal Article %J Acta Paediatr %D 2017 %T First-time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream. %A Cozzi, Giorgio %A Borrometi, Fabio %A Benini, Franca %A Neri, Elena %A Rusalen, Francesca %A Celentano, Loredana %A Zanon, Davide %A Schreiber, Silvana %A Ronfani, Luca %A Barbi, Egidio %K Anesthetics, Local %K Catheterization, Peripheral %K Child %K Child, Preschool %K Female %K Hot Temperature %K Humans %K Lidocaine %K Lidocaine, Prilocaine Drug Combination %K Male %K Pain %K Phlebotomy %K Prilocaine %K Tetracaine %X

AIM: More than 50% of children report apian during venepuncture or intravenous cannulation and using local anaesthetics before needle procedures can lead to different success rates. This study examined how many needle procedures were successful at the first attempt when children received either a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream.

METHODS: We conducted this multicentre randomised controlled trial at three tertiary-level children's hospitals in Italy in 2015. Children aged three to 10 years were enrolled in an emergency department, paediatric day hospital and paediatric ward and randomly allocated to receive a warm lidocaine and tetracaine patch or EMLA cream. The primary outcome was the success rate at the first attempt.

RESULTS: The analysis included 172 children who received a warm lidocaine and tetracaine patch and 167 who received an EMLA cream. The needle procedure was successful at the first attempt in 158 children (92.4%) who received the warm patch and in 142 children (85.0%) who received the cream (p = 0.03). The pain scores were similar in both groups.

CONCLUSION: This study showed that the first-time needle procedure success was 7.4% higher in children receiving a warm lidocaine and tetracaine patch than EMLA cream.

%B Acta Paediatr %V 106 %P 773-778 %8 2017 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/28130888?dopt=Abstract %R 10.1111/apa.13764 %0 Journal Article %J Acta Paediatr %D 2016 %T Body mass index curves for Italian preterm infants are comparable with American curves for infants born before 34 weeks of gestational age. %A Paviotti, Giulia %A Monasta, Lorenzo %A Ronfani, Luca %A Montico, Marcella %A Copertino, Marco %A De Cunto, Angela %A Demarini, Sergio %X

AIM: Body mass index (BMI)-for-age curves have been developed in the USA, but not compared with other populations. This study created gender-specific intrauterine BMI-for-age curves for Italian preterm infants and compared them with the USA version.

METHODS: Data on 92 262 newborn infants, born at 26-42 weeks of gestational age in the north-eastern Italian region of Friuli Venezia Giulia between 2005 and 2013, were analysed to create gender-specific BMI-for-age curves. Gender-specific and age-specific BMI Z scores for Italian infants were calculated using the parameters of the USA growth curves and the World Health Organization charts.

RESULTS: Gender-specific BMI-for-age at birth curves were developed for premature Italian infants from 26 gestational weeks. The comparison with the USA charts showed no significant difference in BMI percentiles in Italian infants born at ≤33 gestational weeks, but infants born at ≥34 gestational weeks had a significantly higher BMI than the USA population, by 0.2 standard deviations.

CONCLUSION: We developed the first European BMI-for-age at birth curves for premature infants. According to our findings, the Italian curves were comparable to the USA curves for the subgroup of infants born at ≤33 gestational weeks, but not ≥34 gestational weeks.

%B Acta Paediatr %V 105 %P 483-9 %8 2016 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26871711?dopt=Abstract %R 10.1111/apa.13364 %0 Journal Article %J Acta Paediatr %D 2016 %T Hand-held computers can help to distract children undergoing painful venipuncture procedures. %A Crevatin, Franca %A Cozzi, Giorgio %A Braido, Elena %A Bertossa, Gabriella %A Rizzitelli, Patrizia %A Lionetti, Daniela %A Matassi, Daniela %A Calusa, Dorotea %A Ronfani, Luca %A Barbi, Egidio %X

AIM: Needle-related procedures can be painful for children, and distraction provides ideal pain relief in blood-drawing centres. This study assessed the effectiveness of playing a computer game during venipuncture, compared with low-tech distraction by a nurse.

METHODS: We conducted this prospective, randomised controlled trial at the blood-drawing centre of a tertiary-level children's hospital in Italy. Half of the 200 children played Angry Birds on a hand-held computer while the other half were distracted by a second, specifically trained nurse who sang to them, read a book, blew bubbles or played with puppets. Pain was measured using a faces pain scale for children aged 4-7 years and a numeric scale for children aged 8-13 years.

RESULTS: The 200 children had a median age of eight years. Children reported significant pain in 16 cases (16%) in the hand-held computer distraction group and in 15 cases (15%) in the nurse-led low-tech distraction group (p = 0.85). The procedural success rate at the first attempt was not different in the two groups.

CONCLUSION: Playing a game on a hand-held computer meant that only one in six children reported pain during venipuncture, but it was not superior to being distracted by nurses.

%B Acta Paediatr %V 105 %P 930-4 %8 2016 Aug %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27128220?dopt=Abstract %R 10.1111/apa.13454 %0 Journal Article %J PLoS One %D 2016 %T Incidence and Estimated Prevalence of Endometriosis and Adenomyosis in Northeast Italy: A Data Linkage Study. %A Morassutto, Caterina %A Monasta, Lorenzo %A Ricci, Giuseppe %A Barbone, Fabio %A Ronfani, Luca %X

Despite being quite frequent and having serious implications in terms of symptomatology and fertility, data on incidence and prevalence of endometriosis and adenomyosis following gold standard definitions are dramatically lacking. The average time from onset of symptoms to diagnosis in industrialized countries still ranges from five to ten years. Using the regional centralized data linkage system, we calculated incidence and prevalence of endometriosis and adenomyosis in the female population of Friuli Venezia Giulia region, Italy, for the years 2011-2013. Cases were defined as new diagnoses from hospital discharge records, following procedures allowing direct visualization for endometriosis and hysterectomy for adenomyosis, with or without histological confirmation. Diagnoses were considered "new" after verifying women had not been diagnosed in the previous ten years. Incidence of endometriosis and adenomyosis in women aged 15-50 years is 0.14%. Prevalence, estimated from incidence, is 2.00%. Adenomyosis, representing 28% of all diagnoses, becomes increasingly prevalent after the age of 50 years. Our results shows how the study of both endometriosis and adenomyosis should not be limited to women of premenopausal age. Further efforts are needed to sensitize women and health professional, and to find new data linkage possibilities to identify undiagnosed cases.

%B PLoS One %V 11 %P e0154227 %8 2016 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27101396?dopt=Abstract %R 10.1371/journal.pone.0154227 %0 Journal Article %J Acta Paediatr %D 2015 %T Analgesia by cooling vibration during venipuncture in children with cognitive impairment. %A Schreiber, Silvana %A Cozzi, Giorgio %A Rutigliano, Rosaria %A Assandro, Paola %A Tubaro, Martina %A Cortellazzo Wiel, Luisa %A Ronfani, Luca %A Barbi, Egidio %X

AIM: Children with cognitive impairment experience pain more frequently than healthy children and are more likely to require venipuncture or intravenous cannulation for various procedures. They are frequently unable to report pain and often receive poor pain assessment and management. This study assessed the effectiveness of physical analgesia during vascular access in children with cognitive impairments.

METHODS: We conducted a prospective randomised controlled study at a tertiary-level children's hospital in Italy from April to May 2015 to assess whether a cooling vibration device called Buzzy decreased pain during venipuncture and intravenous cannulation in children with cognitive impairment. None of the children had verbal skills and the main cognitive impairments were cerebral palsy, epileptic encephalopathy and genetic syndromes.

RESULTS: We tested 70 children with a median age of nine years: 34 in the Buzzy group and 36 in the no-intervention group. Parents were trained in the use of the Noncommunicating Children's Pain Checklist - postoperative version scale, and they reported no or mild procedural pain in 32 cases (91.4%) in the Buzzy group and in 22 cases (61.1%) in the no-intervention group (p = 0.003).

CONCLUSION: Cooling vibration analgesia during vascular access reduced pain in children with cognitive impairment.

%B Acta Paediatr %8 2015 Sep 24 %G ENG %1 http://www.ncbi.nlm.nih.gov/pubmed/26401633?dopt=Abstract %R 10.1111/apa.13224 %0 Journal Article %J Epidemiol Prev %D 2015 %T [Breastfeeding in the first months of life: data from the "Piccolipiù" cohorts]. %A Farchi, Sara %A Ronfani, Luca %B Epidemiol Prev %V 39 %P 392 %8 2015 Sep-Dec %G ita %N 5-6 %1 http://www.ncbi.nlm.nih.gov/pubmed/26554692?dopt=Abstract %0 Journal Article %J Arch Dis Child %D 2015 %T Coeliac disease in the ERA of the new ESPGHAN and BSPGHAN guidelines: a prospective cohort study. %A Benelli, Elisa %A Carrato, Valentina %A Martelossi, Stefano %A Ronfani, Luca %A Not, Tarcisio %A Ventura, Alessandro %X

OBJECTIVE: To evaluate the consequences of the last European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) guidelines for the diagnosis of coeliac disease (CD) by means of a prospective study.

DESIGN: Prospective cohort study.

SETTING: Institute for Maternal and Child Health IRCCS Burlo Garofolo (Trieste, Italy).

PATIENTS: Children diagnosed with CD without a duodenal biopsy (group 1), following the last ESPGHAN and BSPGHAN guidelines, and children diagnosed with a duodenal biopsy, matched for sex, age and year of diagnosis (group 2), were prospectively enrolled over a 3-year period. All patients were put on a gluten-free diet (GFD) and were followed up for clinical conditions and laboratory testing at 6 months every year since diagnosis (median follow up: 1.9 years).

OUTCOME MEASURES: Resolution of symptoms, body mass index, laboratory testing (haemoglobin, anti-transglutaminase IgA), adherence to a GFD, quality of life, and supplementary post-diagnosis medical consultations.

RESULTS: 51 out of 468 (11%) patients were diagnosed without a duodenal biopsy (group 1; median age 2.1 years) and matched to 92 patients diagnosed with a biopsy (group 2; median age 2.4 years). At the end of follow-up the two groups were statistically comparable in terms of clinical and nutritional status, anti-transglutaminase IgA antibody titres, quality of life, adherence to a GFD, and number of supplementary medical consultations.

CONCLUSIONS: On the basis of this prospective study, diagnosis of CD can be reliably performed without a duodenal biopsy in approximately 11% of cases. At least during a medium-term follow-up, this approach has no negative consequences relating to clinical remission, adherence to diet, and quality of life of children with CD.

%B Arch Dis Child %8 2015 Nov 17 %G ENG %1 http://www.ncbi.nlm.nih.gov/pubmed/26578746?dopt=Abstract %R 10.1136/archdischild-2015-309259 %0 Journal Article %J Pediatr Rheumatol Online J %D 2015 %T Genetic profiling of autoinflammatory disorders in patients with periodic fever: a prospective study. %A De Pieri, Carlo %A Vuch, Josef %A De Martino, Eleonora %A Bianco, Anna M %A Ronfani, Luca %A Athanasakis, Emmanouil %A Bortot, Barbara %A Crovella, Sergio %A Taddio, Andrea %A Severini, Giovanni M %A Tommasini, Alberto %K Adolescent %K Carrier Proteins %K Child %K Cryopyrin-Associated Periodic Syndromes %K Cytoskeletal Proteins %K Familial Mediterranean Fever %K Female %K Fever %K Gene Expression Profiling %K Genotype %K Hereditary Autoinflammatory Diseases %K Humans %K Intracellular Signaling Peptides and Proteins %K Logistic Models %K Male %K Mutation %K Phosphotransferases (Alcohol Group Acceptor) %K Prospective Studies %K Receptors, Tumor Necrosis Factor, Type I %K Syndrome %X

BACKGROUND: Periodic fever syndromes (PFS) are an emerging group of autoinflammatory disorders. Clinical overlap exists and multiple genetic analyses may be needed to assist diagnosis. We evaluated the diagnostic value of a 5-gene sequencing panel (5GP) in patients with undiagnosed PFS.

METHODS: Simultaneous double strand Sanger sequencing of MEFV, MVK, TNFRSF1A, NLRP3, NLRP12 genes was performed in 42 patients with unexplained PFS. Clinical features were correlated with genetic results.

RESULTS: None of 42 patients analyzed displayed a causative genotype. However, single or multiple genetic variants of uncertain significance were detected in 24 subjects. Only in 5 subjects a definite diagnosis was made by taking into account both genetic and clinical data (2 TRAPS syndrome; 2 FMF; 1 FCAS). Statistical analysis showed that patients carrying genetic variants in one or more of the five selected genes displayed a significantly lower response to glucocorticoids compared with subjects who had completely negative genetic results.

CONCLUSIONS: The sequencing of multiple genes is of little help in the diagnostics of PFS and can often lead to results of uncertain interpretation, thus the clinically driven sequencing of single genes should remain the recommended approach. However, the presence of single or multiple genetic variants of uncertain significance, even if not allowing any specific diagnosis, correlated with a poorer response to glucocorticoids, possibly indicating a multifactorial subgroup of PFS with differential response to pharmacological treatment.

%B Pediatr Rheumatol Online J %V 13 %P 11 %8 2015 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/25866490?dopt=Abstract %R 10.1186/s12969-015-0006-z %0 Journal Article %J JAMA Oncol %D 2015 %T The Global Burden of Cancer 2013. %A Fitzmaurice, Christina %A Dicker, Daniel %A Pain, Amanda %A Hamavid, Hannah %A Moradi-Lakeh, Maziar %A MacIntyre, Michael F %A Allen, Christine %A Hansen, Gillian %A Woodbrook, Rachel %A Wolfe, Charles %A Hamadeh, Randah R %A Moore, Ami %A Werdecker, Andrea %A Gessner, Bradford D %A Te Ao, Braden %A McMahon, Brian %A Karimkhani, Chante %A Yu, Chuanhua %A Cooke, Graham S %A Schwebel, David C %A Carpenter, David O %A Pereira, David M %A Nash, Denis %A Kazi, Dhruv S %A De Leo, Diego %A Plass, Dietrich %A Ukwaja, Kingsley N %A Thurston, George D %A Yun Jin, Kim %A Simard, Edgar P %A Mills, Edward %A Park, Eun-Kee %A Catalá-López, Ferrán %A deVeber, Gabrielle %A Gotay, Carolyn %A Khan, Gulfaraz %A Hosgood, H Dean %A Santos, Itamar S %A Leasher, Janet L %A Singh, Jasvinder %A Leigh, James %A Jonas, Jost %A Sanabria, Juan %A Beardsley, Justin %A Jacobsen, Kathryn H %A Takahashi, Ken %A Franklin, Richard C %A Ronfani, Luca %A Montico, Marcella %A Naldi, Luigi %A Tonelli, Marcello %A Geleijnse, Johanna %A Petzold, Max %A Shrime, Mark G %A Younis, Mustafa %A Yonemoto, Naohiro %A Breitborde, Nicholas %A Yip, Paul %A Pourmalek, Farshad %A Lotufo, Paulo A %A Esteghamati, Alireza %A Hankey, Graeme J %A Ali, Raghib %A Lunevicius, Raimundas %A Malekzadeh, Reza %A Dellavalle, Robert %A Weintraub, Robert %A Lucas, Robyn %A Hay, Roderick %A Rojas-Rueda, David %A Westerman, Ronny %A Sepanlou, Sadaf G %A Nolte, Sandra %A Patten, Scott %A Weichenthal, Scott %A Abera, Semaw Ferede %A Fereshtehnejad, Seyed-Mohammad %A Shiue, Ivy %A Driscoll, Tim %A Vasankari, Tommi %A Alsharif, Ubai %A Rahimi-Movaghar, Vafa %A Vlassov, Vasiliy V %A Marcenes, W S %A Mekonnen, Wubegzier %A Melaku, Yohannes Adama %A Yano, Yuichiro %A Artaman, Al %A Campos, Ismael %A MacLachlan, Jennifer %A Mueller, Ulrich %A Kim, Daniel %A Trillini, Matias %A Eshrati, Babak %A Williams, Hywel C %A Shibuya, Kenji %A Dandona, Rakhi %A Murthy, Kinnari %A Cowie, Benjamin %A Amare, Azmeraw T %A Antonio, Carl Abelardo %A Castañeda-Orjuela, Carlos %A van Gool, Coen H %A Violante, Francesco %A Oh, In-Hwan %A Deribe, Kedede %A Soreide, Kjetil %A Knibbs, Luke %A Kereselidze, Maia %A Green, Mark %A Cárdenas, Rosario %A Roy, Nobhojit %A Tillman, Taavi %A Li, Yongmei %A Krueger, Hans %A Monasta, Lorenzo %A Dey, Subhojit %A Sheikhbahaei, Sara %A Hafezi-Nejad, Nima %A Kumar, G Anil %A Sreeramareddy, Chandrashekhar T %A Dandona, Lalit %A Wang, Haidong %A Vollset, Stein Emil %A Mokdad, Ali %A Salomon, Joshua A %A Lozano, Rafael %A Vos, Theo %A Forouzanfar, Mohammad %A Lopez, Alan %A Murray, Christopher %A Naghavi, Mohsen %X

IMPORTANCE: Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies.

OBJECTIVE: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013.

EVIDENCE REVIEW: The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs.

FINDINGS: In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries.

CONCLUSIONS AND RELEVANCE: Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation.

%B JAMA Oncol %V 1 %P 505-27 %8 2015 Jul %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/26181261?dopt=Abstract %R 10.1001/jamaoncol.2015.0735 %0 Journal Article %J Lancet %D 2015 %T Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. %A Forouzanfar, Mohammad H %A Alexander, Lily %A Anderson, H Ross %A Bachman, Victoria F %A Biryukov, Stan %A Brauer, Michael %A Burnett, Richard %A Casey, Daniel %A Coates, Matthew M %A Cohen, Aaron %A Delwiche, Kristen %A Estep, Kara %A Frostad, Joseph J %A Astha, K C %A Kyu, Hmwe H %A Moradi-Lakeh, Maziar %A Ng, Marie %A Slepak, Erica Leigh %A Thomas, Bernadette A %A Wagner, Joseph %A Aasvang, Gunn Marit %A Abbafati, Cristiana %A Abbasoglu Ozgoren, Ayse %A Abd-Allah, Foad %A Abera, Semaw F %A Aboyans, Victor %A Abraham, Biju %A Abraham, Jerry Puthenpurakal %A Abubakar, Ibrahim %A Abu-Rmeileh, Niveen M E %A Aburto, Tania C %A Achoki, Tom %A Adelekan, Ademola %A Adofo, Koranteng %A Adou, Arsène K %A Adsuar, José C %A Afshin, Ashkan %A Agardh, Emilie E %A Al Khabouri, Mazin J %A Al Lami, Faris H %A Alam, Sayed Saidul %A Alasfoor, Deena %A Albittar, Mohammed I %A Alegretti, Miguel A %A Aleman, Alicia V %A Alemu, Zewdie A %A Alfonso-Cristancho, Rafael %A Alhabib, Samia %A Ali, Raghib %A Ali, Mohammed K %A Alla, François %A Allebeck, Peter %A Allen, Peter J %A Alsharif, Ubai %A Alvarez, Elena %A Alvis-Guzmán, Nelson %A Amankwaa, Adansi A %A Amare, Azmeraw T %A Ameh, Emmanuel A %A Ameli, Omid %A Amini, Heresh %A Ammar, Walid %A Anderson, Benjamin O %A Antonio, Carl Abelardo T %A Anwari, Palwasha %A Argeseanu Cunningham, Solveig %A Arnlöv, Johan %A Arsenijevic, Valentina S Arsic %A Artaman, Al %A Asghar, Rana J %A Assadi, Reza %A Atkins, Lydia S %A Atkinson, Charles %A Avila, Marco A %A Awuah, Baffour %A Badawi, Alaa %A Bahit, Maria C %A Bakfalouni, Talal %A Balakrishnan, Kalpana %A Balalla, Shivanthi %A Balu, Ravi Kumar %A Banerjee, Amitava %A Barber, Ryan M %A Barker-Collo, Suzanne L %A Barquera, Simon %A Barregard, Lars %A Barrero, Lope H %A Barrientos-Gutierrez, Tonatiuh %A Basto-Abreu, Ana C %A Basu, Arindam %A Basu, Sanjay %A Basulaiman, Mohammed O %A Batis Ruvalcaba, Carolina %A Beardsley, Justin %A Bedi, Neeraj %A Bekele, Tolesa %A Bell, Michelle L %A Benjet, Corina %A Bennett, Derrick A %A Benzian, Habib %A Bernabe, Eduardo %A Beyene, Tariku J %A Bhala, Neeraj %A Bhalla, Ashish %A Bhutta, Zulfiqar A %A Bikbov, Boris %A Bin Abdulhak, Aref A %A Blore, Jed D %A Blyth, Fiona M %A Bohensky, Megan A %A Bora Başara, Berrak %A Borges, Guilherme %A Bornstein, Natan M %A Bose, Dipan %A Boufous, Soufiane %A Bourne, Rupert R %A Brainin, Michael %A Brazinova, Alexandra %A Breitborde, Nicholas J %A Brenner, Hermann %A Briggs, Adam D M %A Broday, David M %A Brooks, Peter M %A Bruce, Nigel G %A Brugha, Traolach S %A Brunekreef, Bert %A Buchbinder, Rachelle %A Bui, Linh N %A Bukhman, Gene %A Bulloch, Andrew G %A Burch, Michael %A Burney, Peter G J %A Campos-Nonato, Ismael R %A Campuzano, Julio C %A Cantoral, Alejandra J %A Caravanos, Jack %A Cárdenas, Rosario %A Cardis, Elisabeth %A Carpenter, David O %A Caso, Valeria %A Castañeda-Orjuela, Carlos A %A Castro, Ruben E %A Catalá-López, Ferrán %A Cavalleri, Fiorella %A Cavlin, Alanur %A Chadha, Vineet K %A Chang, Jung-Chen %A Charlson, Fiona J %A Chen, Honglei %A Chen, Wanqing %A Chen, Zhengming %A Chiang, Peggy P %A Chimed-Ochir, Odgerel %A Chowdhury, Rajiv %A Christophi, Costas A %A Chuang, Ting-Wu %A Chugh, Sumeet S %A Cirillo, Massimo %A Claßen, Thomas K D %A Colistro, Valentina %A Colomar, Mercedes %A Colquhoun, Samantha M %A Contreras, Alejandra G %A Cooper, Cyrus %A Cooperrider, Kimberly %A Cooper, Leslie T %A Coresh, Josef %A Courville, Karen J %A Criqui, Michael H %A Cuevas-Nasu, Lucia %A Damsere-Derry, James %A Danawi, Hadi %A Dandona, Lalit %A Dandona, Rakhi %A Dargan, Paul I %A Davis, Adrian %A Davitoiu, Dragos V %A Dayama, Anand %A de Castro, E Filipa %A De la Cruz-Góngora, Vanessa %A De Leo, Diego %A de Lima, Graça %A Degenhardt, Louisa %A del Pozo-Cruz, Borja %A Dellavalle, Robert P %A Deribe, Kebede %A Derrett, Sarah %A Des Jarlais, Don C %A Dessalegn, Muluken %A deVeber, Gabrielle A %A Devries, Karen M %A Dharmaratne, Samath D %A Dherani, Mukesh K %A Dicker, Daniel %A Ding, Eric L %A Dokova, Klara %A Dorsey, E Ray %A Driscoll, Tim R %A Duan, Leilei %A Durrani, Adnan M %A Ebel, Beth E %A Ellenbogen, Richard G %A Elshrek, Yousef M %A Endres, Matthias %A Ermakov, Sergey P %A Erskine, Holly E %A Eshrati, Babak %A Esteghamati, Alireza %A Fahimi, Saman %A Faraon, Emerito Jose A %A Farzadfar, Farshad %A Fay, Derek F J %A Feigin, Valery L %A Feigl, Andrea B %A Fereshtehnejad, Seyed-Mohammad %A Ferrari, Alize J %A Ferri, Cleusa P %A Flaxman, Abraham D %A Fleming, Thomas D %A Foigt, Nataliya %A Foreman, Kyle J %A Paleo, Urbano Fra %A Franklin, Richard C %A Gabbe, Belinda %A Gaffikin, Lynne %A Gakidou, Emmanuela %A Gamkrelidze, Amiran %A Gankpé, Fortuné G %A Gansevoort, Ron T %A García-Guerra, Francisco A %A Gasana, Evariste %A Geleijnse, Johanna M %A Gessner, Bradford D %A Gething, Pete %A Gibney, Katherine B %A Gillum, Richard F %A Ginawi, Ibrahim A M %A Giroud, Maurice %A Giussani, Giorgia %A Goenka, Shifalika %A Goginashvili, Ketevan %A Gomez Dantes, Hector %A Gona, Philimon %A Gonzalez de Cosio, Teresita %A González-Castell, Dinorah %A Gotay, Carolyn C %A Goto, Atsushi %A Gouda, Hebe N %A Guerrant, Richard L %A Gugnani, Harish C %A Guillemin, Francis %A Gunnell, David %A Gupta, Rahul %A Gupta, Rajeev %A Gutiérrez, Reyna A %A Hafezi-Nejad, Nima %A Hagan, Holly %A Hagstromer, Maria %A Halasa, Yara A %A Hamadeh, Randah R %A Hammami, Mouhanad %A Hankey, Graeme J %A Hao, Yuantao %A Harb, Hilda L %A Haregu, Tilahun Nigatu %A Haro, Josep Maria %A Havmoeller, Rasmus %A Hay, Simon I %A Hedayati, Mohammad T %A Heredia-Pi, Ileana B %A Hernandez, Lucia %A Heuton, Kyle R %A Heydarpour, Pouria %A Hijar, Martha %A Hoek, Hans W %A Hoffman, Howard J %A Hornberger, John C %A Hosgood, H Dean %A Hoy, Damian G %A Hsairi, Mohamed %A Hu, Guoqing %A Hu, Howard %A Huang, Cheng %A Huang, John J %A Hubbell, Bryan J %A Huiart, Laetitia %A Husseini, Abdullatif %A Iannarone, Marissa L %A Iburg, Kim M %A Idrisov, Bulat T %A Ikeda, Nayu %A Innos, Kaire %A Inoue, Manami %A Islami, Farhad %A Ismayilova, Samaya %A Jacobsen, Kathryn H %A Jansen, Henrica A %A Jarvis, Deborah L %A Jassal, Simerjot K %A Jauregui, Alejandra %A Jayaraman, Sudha %A Jeemon, Panniyammakal %A Jensen, Paul N %A Jha, Vivekanand %A Jiang, Fan %A Jiang, Guohong %A Jiang, Ying %A Jonas, Jost B %A Juel, Knud %A Kan, Haidong %A Kany Roseline, Sidibe S %A Karam, Nadim E %A Karch, André %A Karema, Corine K %A Karthikeyan, Ganesan %A Kaul, Anil %A Kawakami, Norito %A Kazi, Dhruv S %A Kemp, Andrew H %A Kengne, Andre P %A Keren, Andre %A Khader, Yousef S %A Khalifa, Shams Eldin Ali Hassan %A Khan, Ejaz A %A Khang, Young-Ho %A Khatibzadeh, Shahab %A Khonelidze, Irma %A Kieling, Christian %A Kim, Daniel %A Kim, Sungroul %A Kim, Yunjin %A Kimokoti, Ruth W %A Kinfu, Yohannes %A Kinge, Jonas M %A Kissela, Brett M %A Kivipelto, Miia %A Knibbs, Luke D %A Knudsen, Ann Kristin %A Kokubo, Yoshihiro %A Kose, M Rifat %A Kosen, Soewarta %A Kraemer, Alexander %A Kravchenko, Michael %A Krishnaswami, Sanjay %A Kromhout, Hans %A Ku, Tiffany %A Kuate Defo, Barthelemy %A Kucuk Bicer, Burcu %A Kuipers, Ernst J %A Kulkarni, Chanda %A Kulkarni, Veena S %A Kumar, G Anil %A Kwan, Gene F %A Lai, Taavi %A Lakshmana Balaji, Arjun %A Lalloo, Ratilal %A Lallukka, Tea %A Lam, Hilton %A Lan, Qing %A Lansingh, Van C %A Larson, Heidi J %A Larsson, Anders %A Laryea, Dennis O %A Lavados, Pablo M %A Lawrynowicz, Alicia E %A Leasher, Janet L %A Lee, Jong-Tae %A Leigh, James %A Leung, Ricky %A Levi, Miriam %A Li, Yichong %A Li, Yongmei %A Liang, Juan %A Liang, 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BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.

METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.

FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.

INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

FUNDING: Bill & Melinda Gates Foundation.

%B Lancet %V 386 %P 2287-323 %8 2015 Dec 5 %G eng %N 10010 %1 http://www.ncbi.nlm.nih.gov/pubmed/26364544?dopt=Abstract %R 10.1016/S0140-6736(15)00128-2 %0 Journal Article %J Lancet %D 2015 %T Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. %A Murray, Christopher J L %A Barber, Ryan M %A Foreman, Kyle J %A Abbasoglu Ozgoren, Ayse %A Abd-Allah, Foad %A Abera, Semaw F %A Aboyans, Victor %A Abraham, Jerry P %A Abubakar, Ibrahim %A Abu-Raddad, Laith J %A Abu-Rmeileh, Niveen M %A Achoki, Tom %A Ackerman, Ilana N %A Ademi, Zanfina %A Adou, Arsène K %A Adsuar, José C %A Afshin, Ashkan %A Agardh, Emilie E %A Alam, Sayed Saidul %A Alasfoor, Deena %A Albittar, Mohammed I %A Alegretti, Miguel A %A Alemu, Zewdie A %A Alfonso-Cristancho, Rafael %A Alhabib, Samia %A Ali, Raghib %A Alla, François %A Allebeck, Peter %A AlMazroa, Mohammad A %A 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Valery L %A Felson, David T %A Fereshtehnejad, Seyed-Mohammad %A Fernandes, Jefferson G %A Ferrari, Alize J %A Fitzmaurice, Christina %A Flaxman, Abraham D %A Fleming, Thomas D %A Foigt, Nataliya %A Forouzanfar, Mohammad H %A Fowkes, F Gerry R %A Paleo, Urbano Fra %A Franklin, Richard C %A Fürst, Thomas %A Gabbe, Belinda %A Gaffikin, Lynne %A Gankpé, Fortuné G %A Geleijnse, Johanna M %A Gessner, Bradford D %A Gething, Peter %A Gibney, Katherine B %A Giroud, Maurice %A Giussani, Giorgia %A Gomez Dantes, Hector %A Gona, Philimon %A Gonzalez-Medina, Diego %A Gosselin, Richard A %A Gotay, Carolyn C %A Goto, Atsushi %A Gouda, Hebe N %A Graetz, Nicholas %A Gugnani, Harish C %A Gupta, Rahul %A Gupta, Rajeev %A Gutiérrez, Reyna A %A Haagsma, Juanita %A Hafezi-Nejad, Nima %A Hagan, Holly %A Halasa, Yara A %A Hamadeh, Randah R %A Hamavid, Hannah %A Hammami, Mouhanad %A Hancock, Jamie %A Hankey, Graeme J %A Hansen, Gillian M %A Hao, Yuantao %A Harb, Hilda L %A Haro, Josep Maria %A Havmoeller, Rasmus %A Hay, Simon I %A Hay, Roderick J %A Heredia-Pi, Ileana B %A Heuton, Kyle R %A Heydarpour, Pouria %A Higashi, Hideki %A Hijar, Martha %A Hoek, Hans W %A Hoffman, Howard J %A Hosgood, H Dean %A Hossain, Mazeda %A Hotez, Peter J %A Hoy, Damian G %A Hsairi, Mohamed %A Hu, Guoqing %A Huang, Cheng %A Huang, John J %A Husseini, Abdullatif %A Huynh, Chantal %A Iannarone, Marissa L %A Iburg, Kim M %A Innos, Kaire %A Inoue, Manami %A Islami, Farhad %A Jacobsen, Kathryn H %A Jarvis, Deborah L %A Jassal, Simerjot K %A Jee, Sun Ha %A Jeemon, Panniyammakal %A Jensen, Paul N %A Jha, Vivekanand %A Jiang, Guohong %A Jiang, Ying %A Jonas, Jost B %A Juel, Knud %A Kan, Haidong %A Karch, André %A Karema, Corine K %A Karimkhani, Chante %A Karthikeyan, Ganesan %A Kassebaum, Nicholas J %A Kaul, Anil %A Kawakami, Norito %A Kazanjan, Konstantin %A Kemp, Andrew H %A Kengne, Andre P %A Keren, Andre %A Khader, Yousef S %A Khalifa, Shams Eldin A %A Khan, Ejaz A %A Khan, Gulfaraz %A Khang, Young-Ho %A Kieling, Christian %A Kim, Daniel %A Kim, Sungroul %A Kim, Yunjin %A Kinfu, Yohannes %A Kinge, Jonas M %A Kivipelto, Miia %A Knibbs, Luke D %A Knudsen, Ann Kristin %A Kokubo, Yoshihiro %A Kosen, Soewarta %A Krishnaswami, Sanjay %A Kuate Defo, Barthelemy %A Kucuk Bicer, Burcu %A Kuipers, Ernst J %A Kulkarni, Chanda %A Kulkarni, Veena S %A Kumar, G Anil %A Kyu, Hmwe H %A Lai, Taavi %A Lalloo, Ratilal %A Lallukka, Tea %A Lam, Hilton %A Lan, Qing %A Lansingh, Van C %A Larsson, Anders %A Lawrynowicz, Alicia E B %A Leasher, Janet L %A Leigh, James %A Leung, Ricky %A Levitz, Carly E %A Li, Bin %A Li, Yichong %A Li, Yongmei %A Lim, Stephen S %A Lind, Maggie %A Lipshultz, Steven E %A Liu, Shiwei %A Liu, Yang %A Lloyd, Belinda K %A Lofgren, Katherine T %A Logroscino, Giancarlo %A Looker, Katharine J %A Lortet-Tieulent, Joannie %A Lotufo, Paulo A %A Lozano, Rafael %A Lucas, Robyn M %A Lunevicius, Raimundas %A Lyons, Ronan A %A Ma, Stefan %A MacIntyre, Michael F %A Mackay, Mark T %A Majdan, Marek %A Malekzadeh, Reza %A Marcenes, Wagner %A Margolis, David J %A Margono, Christopher %A Marzan, Melvin B %A Masci, Joseph R %A Mashal, Mohammad T %A Matzopoulos, Richard %A Mayosi, Bongani M %A Mazorodze, Tasara T %A Mcgill, Neil W %A McGrath, John J %A McKee, Martin %A McLain, Abigail %A Meaney, Peter A %A Medina, Catalina %A Mehndiratta, Man Mohan %A Mekonnen, Wubegzier %A Melaku, Yohannes A %A Meltzer, Michele %A Memish, Ziad A %A Mensah, George A %A Meretoja, Atte %A Mhimbira, Francis A %A Micha, Renata %A Miller, Ted R %A Mills, Edward J %A Mitchell, Philip B %A Mock, Charles N %A Mohamed Ibrahim, Norlinah %A Mohammad, Karzan A %A Mokdad, Ali H %A Mola, Glen L D %A Monasta, Lorenzo %A Montañez Hernandez, Julio C %A Montico, Marcella %A Montine, Thomas J %A Mooney, Meghan D %A Moore, Ami R %A Moradi-Lakeh, Maziar %A Moran, Andrew E %A Mori, Rintaro %A Moschandreas, Joanna %A Moturi, Wilkister N %A Moyer, Madeline L %A Mozaffarian, Dariush %A Msemburi, William T %A Mueller, Ulrich O %A Mukaigawara, Mitsuru %A Mullany, Erin C %A Murdoch, Michele E %A Murray, Joseph %A Murthy, Kinnari S %A Naghavi, Mohsen %A Naheed, Aliya %A Naidoo, Kovin S %A Naldi, Luigi %A Nand, Devina %A Nangia, Vinay %A Narayan, K M Venkat %A Nejjari, Chakib %A Neupane, Sudan P %A Newton, Charles R %A Ng, Marie %A Ngalesoni, Frida N %A Nguyen, Grant %A Nisar, Muhammad I %A Nolte, Sandra %A Norheim, Ole F %A Norman, Rosana E %A Norrving, Bo %A Nyakarahuka, Luke %A Oh, In-Hwan %A Ohkubo, Takayoshi %A Ohno, Summer L %A Olusanya, Bolajoko O %A Opio, John Nelson %A Ortblad, Katrina %A Ortiz, Alberto %A Pain, Amanda W %A Pandian, Jeyaraj D %A Panelo, Carlo Irwin A %A Papachristou, Christina %A Park, Eun-Kee %A Park, Jae-Hyun %A Patten, Scott B %A Patton, George C %A Paul, Vinod K %A Pavlin, Boris I %A Pearce, Neil %A Pereira, David M %A Perez-Padilla, Rogelio %A Perez-Ruiz, Fernando %A Perico, Norberto %A Pervaiz, Aslam %A Pesudovs, Konrad %A Peterson, Carrie B %A Petzold, Max %A Phillips, Michael R %A Phillips, Bryan K %A Phillips, David E %A Piel, Frédéric B %A Plass, Dietrich %A Poenaru, Dan %A Polinder, Suzanne %A Pope, Daniel %A Popova, Svetlana %A Poulton, Richie G %A Pourmalek, Farshad %A Prabhakaran, Dorairaj %A Prasad, Noela M %A Pullan, Rachel L %A Qato, Dima M %A Quistberg, D Alex %A Rafay, Anwar %A Rahimi, Kazem %A Rahman, Sajjad U %A Raju, Murugesan %A Rana, Saleem M %A Razavi, Homie %A Reddy, K Srinath %A Refaat, Amany %A Remuzzi, Giuseppe %A Resnikoff, Serge %A Ribeiro, Antonio L %A Richardson, Lee %A Richardus, Jan Hendrik %A Roberts, D Allen %A Rojas-Rueda, David %A Ronfani, Luca %A Roth, Gregory A %A Rothenbacher, Dietrich %A Rothstein, David H %A Rowley, Jane T %A Roy, Nobhojit %A Ruhago, George M %A Saeedi, Mohammad Y %A Saha, Sukanta %A Sahraian, Mohammad Ali %A Sampson, Uchechukwu K A %A Sanabria, Juan R %A Sandar, Logan %A Santos, Itamar S %A Satpathy, Maheswar %A Sawhney, Monika %A Scarborough, Peter %A Schneider, Ione J %A Schöttker, Ben %A Schumacher, Austin E %A Schwebel, David C %A Scott, James G %A Seedat, Soraya %A Sepanlou, Sadaf G %A Serina, Peter T %A Servan-Mori, Edson E %A Shackelford, Katya A %A Shaheen, Amira %A Shahraz, Saeid %A Shamah Levy, Teresa %A Shangguan, Siyi %A She, Jun %A Sheikhbahaei, Sara %A Shi, Peilin %A Shibuya, Kenji %A Shinohara, Yukito %A Shiri, Rahman %A Shishani, Kawkab %A Shiue, Ivy %A Shrime, Mark G %A Sigfusdottir, Inga D %A Silberberg, Donald H %A Simard, Edgar P %A Sindi, Shireen %A Singh, Abhishek %A Singh, Jasvinder A %A Singh, Lavanya %A Skirbekk, Vegard %A Slepak, Erica Leigh %A Sliwa, Karen %A Soneji, Samir %A Søreide, Kjetil %A Soshnikov, Sergey %A Sposato, Luciano A %A Sreeramareddy, Chandrashekhar T %A Stanaway, Jeffrey D %A Stathopoulou, Vasiliki %A Stein, Dan J %A Stein, Murray B %A Steiner, Caitlyn %A Steiner, Timothy J %A Stevens, Antony %A Stewart, Andrea %A Stovner, Lars J %A Stroumpoulis, Konstantinos %A Sunguya, Bruno F %A Swaminathan, Soumya %A Swaroop, Mamta %A Sykes, Bryan L %A Tabb, Karen M %A Takahashi, Ken %A Tandon, Nikhil %A Tanne, David %A Tanner, Marcel %A Tavakkoli, Mohammad %A Taylor, Hugh R %A Te Ao, Braden J %A Tediosi, Fabrizio %A Temesgen, Awoke M %A Templin, Tara %A Ten Have, Margreet %A Tenkorang, Eric Y %A Terkawi, Abdullah S %A Thomson, Blake %A Thorne-Lyman, Andrew L %A Thrift, Amanda G %A Thurston, George D %A Tillmann, Taavi %A Tonelli, Marcello %A Topouzis, Fotis %A Toyoshima, Hideaki %A Traebert, Jefferson %A Tran, Bach X %A Trillini, Matias %A Truelsen, Thomas %A Tsilimbaris, Miltiadis %A Tuzcu, Emin M %A Uchendu, Uche S %A Ukwaja, Kingsley N %A Undurraga, Eduardo A %A Uzun, Selen B %A Van Brakel, Wim H %A van de Vijver, Steven %A van Gool, Coen H %A van Os, Jim %A Vasankari, Tommi J %A Venketasubramanian, N %A Violante, Francesco S %A Vlassov, Vasiliy V %A Vollset, Stein Emil %A Wagner, Gregory R %A Wagner, Joseph %A Waller, Stephen G %A Wan, Xia %A Wang, Haidong %A Wang, JianLi %A Wang, Linhong %A Warouw, Tati S %A Weichenthal, Scott %A Weiderpass, Elisabete %A Weintraub, Robert G %A Wenzhi, Wang %A Werdecker, Andrea %A Westerman, Ronny %A Whiteford, Harvey A %A Wilkinson, James D %A Williams, Thomas N %A Wolfe, Charles D %A Wolock, Timothy M %A Woolf, Anthony D %A Wulf, Sarah %A Wurtz, Brittany %A Xu, Gelin %A Yan, Lijing L %A Yano, Yuichiro %A Ye, Pengpeng %A Yentür, Gökalp K %A Yip, Paul %A Yonemoto, Naohiro %A Yoon, Seok-Jun %A Younis, Mustafa Z %A Yu, Chuanhua %A Zaki, Maysaa E %A Zhao, Yong %A Zheng, Yingfeng %A Zonies, David %A Zou, Xiaonong %A Salomon, Joshua A %A Lopez, Alan D %A Vos, Theo %K Aged %K Chronic Disease %K Communicable Diseases %K Female %K Global Health %K Health Transition %K Humans %K Life Expectancy %K Male %K Middle Aged %K Mortality, Premature %K Quality-Adjusted Life Years %K Socioeconomic Factors %K Wounds and Injuries %X

BACKGROUND: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development.

METHODS: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time.

FINDINGS: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries.

INTERPRETATION: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

FUNDING: Bill & Melinda Gates Foundation.

%B Lancet %V 386 %P 2145-91 %8 2015 Nov 28 %G eng %N 10009 %1 http://www.ncbi.nlm.nih.gov/pubmed/26321261?dopt=Abstract %R 10.1016/S0140-6736(15)61340-X %0 Journal Article %J Acta Paediatr %D 2015 %T Nasal irrigation with saline solution significantly improves oxygen saturation in infants with bronchiolitis. %A Schreiber, Silvana %A Ronfani, Luca %A Ghirardo, Sergio %A Minen, Federico %A Taddio, Andrea %A Jaber, Mohamad %A Rizzello, Elisa %A Barbi, Egidio %X

AIM: Published guidelines do not recommend nasal irrigation in bronchiolitis, but it is common practice in Italy, despite a lack of data on its benefits or adverse effects. This single-blind, multicentre, randomised controlled trial compared nasal irrigation using either isotonic 0.9% sodium chloride or hypertonic 3% sodium chloride with simple supportive care in infants with bronchiolitis.

METHOD: We randomly assigned 133 Infants up one year of age, who were admitted to the emergency department with bronchiolitis and an oxygen saturation (SpO2) of between 88-94%, to the isotonic (n=47), hypertonic (n=44) or standard care (n=42) groups. Variations in SpO2 and the wheeze, air exchange, respiratory rate, muscle use (WARM) respiratory distress score were recorded at zero, five, 15, 20 and 50 minutes.

RESULTS: Five minutes after the intervention, the median SpO2 value (95%) in the isotonic group was higher than both the hypertonic (94%) and the standard care (93%) groups. The differences between the isotonic and standard treatment groups were statistically significant at each time point, while the hypertonic group only reached significantly higher values after 50 minutes. However, the WARM score did not improve.

CONCLUSION: A single nasal irrigation with saline solution significantly improved oxygen saturation in infants with bronchiolitis. This article is protected by copyright. All rights reserved.

%B Acta Paediatr %8 2015 Nov 26 %G ENG %1 http://www.ncbi.nlm.nih.gov/pubmed/26607495?dopt=Abstract %R 10.1111/apa.13282 %0 Journal Article %J Arch Dis Child %D 2015 %T Normal saline flushes performed once daily maintain peripheral intravenous catheter patency: a randomised controlled trial. %A Schreiber, Silvana %A Zanchi, Chiara %A Ronfani, Luca %A Delise, Anna %A Corbelli, Alessandra %A Bortoluzzi, Rosamaria %A Taddio, Andrea %A Barbi, Egidio %K Adolescent %K Catheterization, Peripheral %K Catheters, Indwelling %K Child %K Child, Preschool %K Equipment Failure %K Female %K Humans %K Infant %K Male %K Outcome Assessment (Health Care) %K Risk Assessment %K Sodium Chloride %K Therapeutic Irrigation %X

OBJECTIVE: Recent evidence supports the use of normal saline flushes in place of heparin to maintain the patency of peripheral intravenous locks (IVLs); however, there are no data regarding the recommended flush frequency.

STUDY DESIGN: This was an open, non-inferiority, randomised controlled trial. Children with IVLs, aged 1-17 years, were randomly assigned to receive saline flushing every 12 h (group A) or every 24 h (group B). The main outcome was the maintenance of catheter patency.

RESULTS: Four hundred patients were randomised; 198 subjects were analysed in the 12 h group and 199 in the 24 h group (three patients were lost at follow-up). Occlusion occurred in 15 children (7.6%) in group A versus 9 (4.5%) in group B (p=0.21). The difference in catheter patency was +3.1% in favour of the 24 h group (95% CI -1.6% to 7.7%), showing the non-inferiority of the 24 h procedure (the non-inferiority margin was set at -4%). Catheter-related complications were not different between the two groups (12.1% in group A vs 9.5% in group B; p=0.42).

CONCLUSIONS: A flushing procedure with one flush per day allows maintenance of catheter patency without an increase in catheter-related complications. We propose a simplification of the flushing procedure with only one flush per day, thereby reducing costs (materials use and nursing time), labour and unnecessary manipulation of the catheters which can cause distress in younger children and their parents.

TRIAL REGISTRATION NUMBER: The study is registered in the international database ClinicalTrial.gov under registration number NCT02221024.

%B Arch Dis Child %V 100 %P 700-3 %8 2015 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/25589559?dopt=Abstract %R 10.1136/archdischild-2014-307478 %0 Journal Article %J BMC Pregnancy Childbirth %D 2015 %T Risk-adjusted operative delivery rates and maternal-neonatal outcomes as measures of quality assessment in obstetric care: a multicenter prospective study. %A Maso, Gianpaolo %A Monasta, Lorenzo %A Piccoli, Monica %A Ronfani, Luca %A Montico, Marcella %A De Seta, Francesco %A Parolin, Sara %A Businelli, Caterina %A Travan, Laura %A Alberico, Salvatore %X

BACKGROUND: Although the evaluation of caesarean delivery rates has been suggested as one of the most important indicators of quality in obstetrics, it has been criticized because of its controversial ability to capture maternal and neonatal outcomes. In an "ideal" process of labor and delivery auditing, both caesarean (CD) and assisted vaginal delivery (AVD) rates should be considered because both of them may be associated with an increased risk of complications. The aim of our study was to evaluate maternal and neonatal outcomes according to the outlier status for case-mix adjusted CD and AVD rates in the same obstetric population.

METHODS: Standardized data on 15,189 deliveries from 11 centers were prospectively collected. Multiple logistic regression was used to estimate the risk-adjusted probability of a woman in each center having an AVD or a CD. Centers were classified as "above", "below", or "within" the expected rates by considering the observed-to-expected rates and the 95% confidence interval around the ratio. Adjusted maternal and neonatal outcomes were compared among the three groupings.

RESULTS: Centers classified as "above" or "below" the expected CD rates had, in both cases, higher adjusted incidence of composite maternal (2.97%, 4.69%, 3.90% for "within", "above" and "below", respectively; p = 0.000) and neonatal complications (3.85%, 9.66%, 6.29% for "within", "above" and "below", respectively; p = 0.000) than centers "within" CD expected rates. Centers with AVD rates above and below the expected showed poorer and better composite maternal (3.96%, 4.61%, 2.97% for "within", "above" and "below", respectively; p = 0.000) and neonatal (6.52%, 9.77%, 3.52% for "within", "above" and "below", respectively; p = 0.000) outcomes respectively than centers with "within" AVD rates.

CONCLUSIONS: Both risk-adjusted CD and AVD delivery rates should be considered to assess the level of obstetric care. In this context, both higher and lower-than-expected rates of CD and "above" AVD rates are significantly associated with increased risk of complications, whereas the "below" status for AVD showed a "protective" effect on maternal and neonatal outcomes.

%B BMC Pregnancy Childbirth %V 15 %P 20 %8 2015 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/25751768?dopt=Abstract %R 10.1186/s12884-015-0450-2 %0 Journal Article %J Arch Dis Child Fetal Neonatal Ed %D 2014 %T Can body mass index accurately predict adiposity in newborns? %A De Cunto, Angela %A Paviotti, Giulia %A Ronfani, Luca %A Travan, Laura %A Bua, Jenny %A Cont, Gabriele %A Demarini, Sergio %K Adiposity %K Adult %K Anthropometry %K Body Composition %K Body Mass Index %K Cross-Sectional Studies %K Female %K Gestational Age %K Humans %K Infant, Newborn %K Male %K Mothers %K Plethysmography %K Predictive Value of Tests %K Regression Analysis %K Reproducibility of Results %K Sex Factors %X

Body mass index (BMI) is correlated with body fatness and risk of related diseases in children and adults. Proportionality indexes such as BMI and ponderal index (PI) have been suggested as complementary measures in neonatal growth assessment. Yet, they are still not used in neonates and their correlation with fatness is unknown. The aim of the study was to test the hypothesis that BMI z-score would predict neonatal adiposity. Body composition measurements (ie, fat mass, fat-free mass) by air displacement plethysmography (PEA POD, LMI, Concord-USA), weight and length were obtained in 200 infants ≥36 weeks' gestational age (GA) at birth. Linear regression analysis showed a direct association between BMI z-score and %fat mass (r(2)=0.43, p<0.0001). This association was confirmed independently from sex, GA and maternal prepregnancy BMI. BMI z-score predicted adiposity better than PI. However, both BMI z-score and PI were poor predictors of adiposity at birth.

%B Arch Dis Child Fetal Neonatal Ed %V 99 %P F238-9 %8 2014 May %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/24302686?dopt=Abstract %R 10.1136/archdischild-2013-305386 %0 Journal Article %J Int J Paediatr Dent %D 2014 %T Class IV laser therapy as treatment for chemotherapy-induced oral mucositis in onco-haematological paediatric patients: a prospective study. %A Chermetz, Maddalena %A Gobbo, Margherita %A Ronfani, Luca %A Ottaviani, Giulia %A Zanazzo, Giulio A %A Verzegnassi, Federico %A Treister, Nathaniel S %A Di Lenarda, Roberto %A Biasotto, Matteo %A Zacchigna, Serena %X

BACKGROUND: Oral mucositis is a debilitating side effect of chemotherapy. Laser therapy has recently demonstrated efficacy in the management of oral mucositis (OM).

AIM: This prospective study was conducted to evaluate the efficacy of class IV laser therapy in patients affected by OM.

DESIGN: Eighteen onco-haematological paediatric patients receiving chemotherapy and/or haematopoietic stem cell transplantation, prior to total body irradiation, affected by OM, were enrolled in this study. Patients were treated with class IV laser therapy for four consecutive days; the assessment of OM was performed through WHO Oral Mucositis Grading Objective Scale, and pain was evaluated through visual analogue scale. Patients completed a validated questionnaire, and photographs of lesions were taken during each session. Patients were re-evaluated 11 days after the first day of laser therapy.

RESULTS: All patients demonstrated improvement in pain sensation, and all mucositis was fully resolved at the 11-day follow-up visit, with no apparent side effects. Laser therapy was well tolerated with remarkable reduction in pain associated with oral mucositis after 1-2 days of laser therapy.

CONCLUSIONS: Given class IV laser therapy appears to be safe, non-invasive, and potentially effective, prospective, randomized, controlled trials are necessary to further assess efficacy and to determine optimal treatment parameters.

%B Int J Paediatr Dent %V 24 %P 441-9 %8 2014 Nov %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/24372909?dopt=Abstract %R 10.1111/ipd.12090 %0 Journal Article %J Acta Paediatr %D 2014 %T A comparison of three scales for measuring pain in children with cognitive impairment. %A Massaro, Marta %A Ronfani, Luca %A Ferrara, Giovanna %A Badina, Laura %A Giorgi, Rita %A D'Osualdo, Flavio %A Taddio, Andrea %A Barbi, Egidio %X

AIM: Pain is a neglected problem in children with cognitive impairments, and few studies compare the clinical use of specific pain scales. We compared the Non-Communicating Children's Pain Checklist Postoperative Version (NCCPC-PV), the Echelle Douleur Enfant San Salvador (DESS) and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). The first two were developed for children with cognitive impairment, and the third is a more general pain scale.

METHODS: Two external observers and the child's caregiver assessed 40 children with cognitive impairment for pain levels. We assessed inter-rater agreement, correlation, dependence on knowledge of the child's behaviour, simplicity and adequacy in pain rating according to the caregiver for all three scales.

RESULTS: The correlation between the NCCPC-PV and the DESS was strong (Spearman correlation coefficient = 0.76) and better than between each scale and the CHEOPS. Although the DESS showed better inter-rater agreement, it was more dependent on familiarity with the child and was judged more difficult to use by all observers. The NCCPC-PV was the easiest use and the most appropriate for rating the child's pain.

CONCLUSION: The NCCPC-PV was the easiest to use for pain assessment in cognitively impaired children and should be adopted in clinical settings.

%B Acta Paediatr %V 103 %P e495-500 %8 2014 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/25040148?dopt=Abstract %R 10.1111/apa.12748 %0 Journal Article %J Arch Dis Child %D 2014 %T Diagnostic accuracy of ultrasonography for hand bony fractures in paediatric patients. %A Neri, Elena %A Barbi, Egidio %A Rabach, Ingrid %A Zanchi, Chiara %A Norbedo, Stefania %A Ronfani, Luca %A Guastalla, Veronica %A Ventura, Alessandro %A Guastalla, Pierpaolo %K Adolescent %K Child %K Child, Preschool %K Cross-Sectional Studies %K Double-Blind Method %K Emergency Service, Hospital %K Female %K Fractures, Bone %K Hand Bones %K Humans %K Italy %K Male %K Sensitivity and Specificity %X

OBJECTIVE: Hand fractures are common in childhood, and radiography is the standard diagnostic procedure. US has been used to evaluate bone injuries, mainly in adults for long-bone trauma; there are only a few studies about hand fractures in children. The purpose of this study was to evaluate and confirm the safety and applicability of the US diagnostic procedure in comparison to X-ray diagnosis.

STUDY DESIGN: This cross-sectional study involved a convenience sample of young patients (between 2 and 17 years old) who were taken to the emergency department due to hand trauma. After clinical assessment, patients with a suspected hand fracture first underwent X-ray, and subsequently US examination by two different operators; a radiologist experienced in US and a trained emergency physician in "double-blind" fashion. US and radiographic findings were then compared, and sensitivity as well as specificity was calculated.

RESULTS: A total of 204 patients were enrolled in the study. Seventy-nine fractures of phalanges or metacarpals were detected by standard radiography. When US imaging was performed by an expert radiologist, 72 fractures were detected with sensitivity and a specificity of 91.1% and 97.6%, respectively. Sensitivity and specificity were found to be (respectively) 91.5% and 96.8% when US was performed by the ED physicians.

CONCLUSIONS: US imaging showed excellent sensitivity and specificity results in the diagnosis of hand fractures in children. The study also showed a great agreement between the results of the US carried out by the senior radiologist and those carried out by the paediatric emergency physician, suggesting that US can be performed by an ED physician, allowing a rapid and accurate evaluation in ED and could become the first diagnostic approach whenever a hand fracture is suspected.

%B Arch Dis Child %V 99 %P 1087-90 %8 2014 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/24951462?dopt=Abstract %R 10.1136/archdischild-2013-305678 %0 Journal Article %J Lancet %D 2014 %T Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. %A Murray, Christopher J L %A Ortblad, Katrina F %A Guinovart, Caterina %A Lim, Stephen S %A Wolock, Timothy M %A Roberts, D Allen %A Dansereau, Emily A %A Graetz, Nicholas %A Barber, Ryan M %A Brown, Jonathan C %A Wang, Haidong %A Duber, Herbert C %A Naghavi, Mohsen %A Dicker, Daniel %A Dandona, Lalit %A Salomon, Joshua A %A Heuton, Kyle R %A Foreman, Kyle %A Phillips, David E %A Fleming, Thomas D %A Flaxman, Abraham D %A Phillips, Bryan K %A Johnson, Elizabeth K %A Coggeshall, Megan S %A Abd-Allah, Foad %A Abera, Semaw Ferede %A Abraham, Jerry P %A Abubakar, Ibrahim %A Abu-Raddad, Laith J %A Abu-Rmeileh, Niveen Me %A Achoki, Tom %A Adeyemo, Austine Olufemi %A Adou, Arsène Kouablan %A Adsuar, José C %A Agardh, Emilie Elisabet %A Akena, Dickens %A Al Kahbouri, Mazin J %A Alasfoor, Deena %A Albittar, Mohammed I %A Alcalá-Cerra, Gabriel %A Alegretti, Miguel Angel %A Alemu, Zewdie Aderaw %A Alfonso-Cristancho, Rafael %A Alhabib, Samia %A Ali, Raghib %A Alla, François %A Allen, Peter J %A Alsharif, Ubai %A Alvarez, Elena %A Alvis-Guzmán, Nelson %A Amankwaa, Adansi A %A Amare, Azmeraw T %A Amini, Hassan %A Ammar, Walid %A Anderson, Benjamin O %A Antonio, Carl Abelardo T %A Anwari, Palwasha %A Arnlöv, Johan %A Arsenijevic, Valentina S Arsic %A Artaman, Ali %A Asghar, Rana J %A Assadi, Reza %A Atkins, Lydia S %A Badawi, Alaa %A Balakrishnan, Kalpana %A Banerjee, Amitava %A Basu, Sanjay %A Beardsley, Justin %A Bekele, Tolesa %A Bell, Michelle L %A Bernabe, Eduardo %A Beyene, Tariku Jibat %A Bhala, Neeraj %A Bhalla, Ashish %A Bhutta, Zulfiqar A %A Abdulhak, Aref Bin %A Binagwaho, Agnes %A Blore, Jed D %A Basara, Berrak Bora %A Bose, Dipan %A Brainin, Michael %A Breitborde, Nicholas %A Castañeda-Orjuela, Carlos A %A Catalá-López, Ferrán %A Chadha, Vineet K %A Chang, Jung-Chen %A Chiang, Peggy Pei-Chia %A Chuang, Ting-Wu %A Colomar, Mercedes %A Cooper, Leslie Trumbull %A Cooper, Cyrus %A Courville, Karen J %A Cowie, Benjamin C %A Criqui, Michael H %A Dandona, Rakhi %A Dayama, Anand %A De Leo, Diego %A Degenhardt, Louisa %A del Pozo-Cruz, Borja %A Deribe, Kebede %A Des Jarlais, Don C %A Dessalegn, Muluken %A Dharmaratne, Samath D %A Dilmen, Uğur %A Ding, Eric L %A Driscoll, Tim R %A Durrani, Adnan M %A Ellenbogen, Richard G %A Ermakov, Sergey Petrovich %A Esteghamati, Alireza %A Faraon, Emerito Jose A %A Farzadfar, Farshad %A Fereshtehnejad, Seyed-Mohammad %A Fijabi, Daniel Obadare %A Forouzanfar, Mohammad H %A Fra Paleo, Urbano %A Gaffikin, Lynne %A Gamkrelidze, Amiran %A Gankpé, Fortuné Gbètoho %A Geleijnse, Johanna M %A Gessner, Bradford D %A Gibney, Katherine B %A Ginawi, Ibrahim Abdelmageem Mohamed %A Glaser, Elizabeth L %A Gona, Philimon %A Goto, Atsushi %A Gouda, Hebe N %A Gugnani, Harish Chander %A Gupta, Rajeev %A Gupta, Rahul %A Hafezi-Nejad, Nima %A Hamadeh, Randah Ribhi %A Hammami, Mouhanad %A Hankey, Graeme J %A Harb, Hilda L %A Haro, Josep Maria %A Havmoeller, Rasmus %A Hay, Simon I %A Hedayati, Mohammad T %A Pi, Ileana B Heredia %A Hoek, Hans W %A Hornberger, John C %A Hosgood, H Dean %A Hotez, Peter J %A Hoy, Damian G %A Huang, John J %A Iburg, Kim M %A Idrisov, Bulat T %A Innos, Kaire %A Jacobsen, Kathryn H %A Jeemon, Panniyammakal %A Jensen, Paul N %A Jha, Vivekanand %A Jiang, Guohong %A Jonas, Jost B %A Juel, Knud %A Kan, Haidong %A Kankindi, Ida %A Karam, Nadim E %A Karch, André %A Karema, Corine Kakizi %A Kaul, Anil %A Kawakami, Norito %A Kazi, Dhruv S %A Kemp, Andrew H %A Kengne, Andre Pascal %A Keren, Andre %A Kereselidze, Maia %A Khader, Yousef Saleh %A Khalifa, Shams Eldin Ali Hassan %A Khan, Ejaz Ahmed %A Khang, Young-Ho %A Khonelidze, Irma %A Kinfu, Yohannes %A Kinge, Jonas M %A Knibbs, Luke %A Kokubo, Yoshihiro %A Kosen, S %A Defo, Barthelemy Kuate %A Kulkarni, Veena S %A Kulkarni, Chanda %A Kumar, Kaushalendra %A Kumar, Ravi B %A Kumar, G Anil %A Kwan, Gene F %A Lai, Taavi %A Balaji, Arjun Lakshmana %A Lam, Hilton %A Lan, Qing %A Lansingh, Van C %A Larson, Heidi J %A Larsson, Anders %A Lee, Jong-Tae %A Leigh, James %A Leinsalu, Mall %A Leung, Ricky %A Li, Yichong %A Li, Yongmei %A de Lima, Graça Maria Ferreira %A Lin, Hsien-Ho %A Lipshultz, Steven E %A Liu, Shiwei %A Liu, Yang %A Lloyd, Belinda K %A Lotufo, Paulo A %A Machado, Vasco Manuel Pedro %A Maclachlan, Jennifer H %A Magis-Rodriguez, Carlos %A Majdan, Marek %A Mapoma, Christopher Chabila %A Marcenes, Wagner %A Marzan, Melvin Barrientos %A Masci, Joseph R %A Mashal, Mohammad Taufiq %A Mason-Jones, Amanda J %A Mayosi, Bongani M %A Mazorodze, Tasara T %A Mckay, Abigail Cecilia %A Meaney, Peter A %A Mehndiratta, Man Mohan %A Mejia-Rodriguez, Fabiola %A Melaku, Yohannes Adama %A Memish, Ziad A %A Mendoza, Walter %A Miller, Ted R %A Mills, Edward J %A Mohammad, Karzan Abdulmuhsin %A Mokdad, Ali H %A Mola, Glen Liddell %A Monasta, Lorenzo %A Montico, Marcella %A Moore, Ami R %A Mori, Rintaro %A Moturi, Wilkister Nyaora %A Mukaigawara, Mitsuru %A Murthy, Kinnari S %A Naheed, Aliya %A Naidoo, Kovin S %A Naldi, Luigi %A Nangia, Vinay %A Narayan, K M Venkat %A Nash, Denis %A Nejjari, Chakib %A Nelson, Robert G %A Neupane, Sudan Prasad %A Newton, Charles R %A Ng, Marie %A Nisar, Muhammad Imran %A Nolte, Sandra %A Norheim, Ole F %A Nowaseb, Vincent %A Nyakarahuka, Luke %A Oh, In-Hwan %A Ohkubo, Takayoshi %A Olusanya, Bolajoko O %A Omer, Saad B %A Opio, John Nelson %A Orisakwe, Orish Ebere %A Pandian, Jeyaraj D %A Papachristou, Christina %A Caicedo, Angel J Paternina %A Patten, Scott B %A Paul, Vinod K %A Pavlin, Boris Igor %A Pearce, Neil %A Pereira, David M %A Pervaiz, Aslam %A Pesudovs, Konrad %A Petzold, Max %A Pourmalek, Farshad %A Qato, Dima %A Quezada, Amado D %A Quistberg, D Alex %A Rafay, Anwar %A Rahimi, Kazem %A Rahimi-Movaghar, Vafa %A ur Rahman, Sajjad %A Raju, Murugesan %A Rana, Saleem M %A Razavi, Homie %A Reilly, Robert Quentin %A Remuzzi, Giuseppe %A Richardus, Jan Hendrik %A Ronfani, Luca %A Roy, Nobhojit %A Sabin, Nsanzimana %A Saeedi, Mohammad Yahya %A Sahraian, Mohammad Ali %A Samonte, Genesis May J %A Sawhney, Monika %A Schneider, Ione J C %A Schwebel, David C %A Seedat, Soraya %A Sepanlou, Sadaf G %A Servan-Mori, Edson E %A Sheikhbahaei, Sara %A Shibuya, Kenji %A Shin, Hwashin Hyun %A Shiue, Ivy %A Shivakoti, Rupak %A Sigfusdottir, Inga Dora %A Silberberg, Donald H %A Silva, Andrea P %A Simard, Edgar P %A Singh, Jasvinder A %A Skirbekk, Vegard %A Sliwa, Karen %A Soneji, Samir %A Soshnikov, Sergey S %A Sreeramareddy, Chandrashekhar T %A Stathopoulou, Vasiliki Kalliopi %A Stroumpoulis, Konstantinos %A Swaminathan, Soumya %A Sykes, Bryan L %A Tabb, Karen M %A Talongwa, Roberto Tchio %A Tenkorang, Eric Yeboah %A Terkawi, Abdullah Sulieman %A Thomson, Alan J %A Thorne-Lyman, Andrew L %A Towbin, Jeffrey A %A Traebert, Jefferson %A Tran, Bach X %A Dimbuene, Zacharie Tsala %A Tsilimbaris, Miltiadis %A Uchendu, Uche S %A Ukwaja, Kingsley N %A Uzun, Selen Begüm %A Vallely, Andrew J %A Vasankari, Tommi J %A Venketasubramanian, N %A Violante, Francesco S %A Vlassov, Vasiliy Victorovich %A Vollset, Stein Emil %A Waller, Stephen %A Wallin, Mitchell T %A Wang, Linhong %A Wang, XiaoRong %A Wang, Yanping %A Weichenthal, Scott %A Weiderpass, Elisabete %A Weintraub, Robert G %A Westerman, Ronny %A White, Richard A %A Wilkinson, James D %A Williams, Thomas Neil %A Woldeyohannes, Solomon Meseret %A Wong, John Q %A Xu, Gelin %A Yang, Yang C %A Yano, Yuichiro %A Yentur, Gokalp Kadri %A Yip, Paul %A Yonemoto, Naohiro %A Yoon, Seok-Jun %A Younis, Mustafa %A Yu, Chuanhua %A Jin, Kim Yun %A El Sayed Zaki, Maysaa %A Zhao, Yong %A Zheng, Yingfeng %A Zhou, Maigeng %A Zhu, Jun %A Zou, Xiao Nong %A Lopez, Alan D %A Vos, Theo %K Age Distribution %K Epidemics %K Female %K Global Health %K HIV Infections %K Humans %K Incidence %K Malaria %K Male %K Mortality %K Organizational Objectives %K Sex Distribution %K Tuberculosis %X

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration.

METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets.

FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990.

INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action.

FUNDING: Bill & Melinda Gates Foundation.

%B Lancet %V 384 %P 1005-70 %8 2014 Sep 13 %G eng %N 9947 %1 http://www.ncbi.nlm.nih.gov/pubmed/25059949?dopt=Abstract %R 10.1016/S0140-6736(14)60844-8 %0 Journal Article %J Lancet %D 2014 %T Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. %A Kassebaum, Nicholas J %A Bertozzi-Villa, Amelia %A Coggeshall, Megan S %A Shackelford, Katya A %A Steiner, Caitlyn %A Heuton, Kyle R %A Gonzalez-Medina, Diego %A Barber, Ryan %A Huynh, Chantal %A Dicker, Daniel %A Templin, Tara %A Wolock, Timothy M %A Ozgoren, Ayse Abbasoglu %A Abd-Allah, Foad %A Abera, Semaw Ferede %A Abubakar, Ibrahim %A Achoki, Tom %A Adelekan, Ademola %A Ademi, Zanfina %A Adou, Arsène Kouablan %A Adsuar, José C %A Agardh, Emilie E %A Akena, Dickens %A Alasfoor, Deena %A Alemu, Zewdie Aderaw %A Alfonso-Cristancho, Rafael %A Alhabib, Samia %A Ali, Raghib %A Al Kahbouri, Mazin J %A Alla, François %A Allen, Peter J %A AlMazroa, Mohammad A %A Alsharif, Ubai %A Alvarez, Elena %A Alvis-Guzmán, Nelson %A Amankwaa, Adansi A %A Amare, Azmeraw T %A Amini, Hassan %A Ammar, Walid %A Antonio, Carl A T %A Anwari, Palwasha %A Arnlöv, Johan %A Arsenijevic, Valentina S Arsic %A Artaman, Ali %A Asad, Majed Masoud %A Asghar, Rana J %A Assadi, Reza %A Atkins, Lydia S %A Badawi, Alaa %A Balakrishnan, Kalpana %A Basu, Arindam %A Basu, Sanjay %A Beardsley, Justin %A Bedi, Neeraj %A Bekele, Tolesa %A Bell, Michelle L %A Bernabe, Eduardo %A Beyene, Tariku J %A Bhutta, Zulfiqar %A Bin Abdulhak, Aref %A Blore, Jed D %A Basara, Berrak Bora %A Bose, Dipan %A Breitborde, Nicholas %A Cárdenas, Rosario %A Castañeda-Orjuela, Carlos A %A Castro, Ruben Estanislao %A Catalá-López, Ferrán %A Cavlin, Alanur %A Chang, Jung-Chen %A Che, Xuan %A Christophi, Costas A %A Chugh, Sumeet S %A Cirillo, Massimo %A Colquhoun, Samantha M %A Cooper, Leslie Trumbull %A Cooper, Cyrus %A da Costa Leite, Iuri %A Dandona, Lalit %A Dandona, Rakhi %A Davis, Adrian %A Dayama, Anand %A Degenhardt, Louisa %A De Leo, Diego %A del Pozo-Cruz, Borja %A Deribe, Kebede %A Dessalegn, Muluken %A deVeber, Gabrielle A %A Dharmaratne, Samath D %A Dilmen, Uğur %A Ding, Eric L %A Dorrington, Rob E %A Driscoll, Tim R %A Ermakov, Sergei Petrovich %A Esteghamati, Alireza %A Faraon, Emerito Jose A %A Farzadfar, Farshad %A Felicio, Manuela Mendonca %A Fereshtehnejad, Seyed-Mohammad %A de Lima, Graça Maria Ferreira %A Forouzanfar, Mohammad H %A França, Elisabeth B %A Gaffikin, Lynne %A Gambashidze, Ketevan %A Gankpé, Fortuné Gbètoho %A Garcia, Ana C %A Geleijnse, Johanna M %A Gibney, Katherine B %A Giroud, Maurice %A Glaser, Elizabeth L %A Goginashvili, Ketevan %A Gona, Philimon %A González-Castell, Dinorah %A Goto, Atsushi %A Gouda, Hebe N %A Gugnani, Harish Chander %A Gupta, Rahul %A Gupta, Rajeev %A Hafezi-Nejad, Nima %A Hamadeh, Randah Ribhi %A Hammami, Mouhanad %A Hankey, Graeme J %A Harb, Hilda L %A Havmoeller, Rasmus %A Hay, Simon I %A Pi, Ileana B Heredia %A Hoek, Hans W %A Hosgood, H Dean %A Hoy, Damian G %A Husseini, Abdullatif %A Idrisov, Bulat T %A Innos, Kaire %A Inoue, Manami %A Jacobsen, Kathryn H %A Jahangir, Eiman %A Jee, Sun Ha %A Jensen, Paul N %A Jha, Vivekanand %A Jiang, Guohong %A Jonas, Jost B %A Juel, Knud %A Kabagambe, Edmond Kato %A Kan, Haidong %A Karam, Nadim E %A Karch, André %A Karema, Corine Kakizi %A Kaul, Anil %A Kawakami, Norito %A Kazanjan, Konstantin %A Kazi, Dhruv S %A Kemp, Andrew H %A Kengne, Andre Pascal %A Kereselidze, Maia %A Khader, Yousef Saleh %A Khalifa, Shams Eldin Ali Hassan %A Khan, Ejaz Ahmed %A Khang, Young-Ho %A Knibbs, Luke %A Kokubo, Yoshihiro %A Kosen, Soewarta %A Defo, Barthelemy Kuate %A Kulkarni, Chanda %A Kulkarni, Veena S %A Kumar, G Anil %A Kumar, Kaushalendra %A Kumar, Ravi B %A Kwan, Gene %A Lai, Taavi %A Lalloo, Ratilal %A Lam, Hilton %A Lansingh, Van C %A Larsson, Anders %A Lee, Jong-Tae %A Leigh, James %A Leinsalu, Mall %A Leung, Ricky %A Li, Xiaohong %A Li, Yichong %A Li, Yongmei %A Liang, Juan %A Liang, Xiaofeng %A Lim, Stephen S %A Lin, Hsien-Ho %A Lipshultz, Steven E %A Liu, Shiwei %A Liu, Yang %A Lloyd, Belinda K %A London, Stephanie J %A Lotufo, Paulo A %A Ma, Jixiang %A Ma, Stefan %A Machado, Vasco Manuel Pedro %A Mainoo, Nana Kwaku %A Majdan, Marek %A Mapoma, Christopher Chabila %A Marcenes, Wagner %A Marzan, Melvin Barrientos %A Mason-Jones, Amanda J %A Mehndiratta, Man Mohan %A Mejia-Rodriguez, Fabiola %A Memish, Ziad A %A Mendoza, Walter %A Miller, Ted R %A Mills, Edward J %A Mokdad, Ali H %A Mola, Glen Liddell %A Monasta, Lorenzo %A de la Cruz Monis, Jonathan %A Hernandez, Julio Cesar Montañez %A Moore, Ami R %A Moradi-Lakeh, Maziar %A Mori, Rintaro %A Mueller, Ulrich O %A Mukaigawara, Mitsuru %A Naheed, Aliya %A Naidoo, Kovin S %A Nand, Devina %A Nangia, Vinay %A Nash, Denis %A Nejjari, Chakib %A Nelson, Robert G %A Neupane, Sudan Prasad %A Newton, Charles R %A Ng, Marie %A Nieuwenhuijsen, Mark J %A Nisar, Muhammad Imran %A Nolte, Sandra %A Norheim, Ole F %A Nyakarahuka, Luke %A Oh, In-Hwan %A Ohkubo, Takayoshi %A Olusanya, Bolajoko O %A Omer, Saad B %A Opio, John Nelson %A Orisakwe, Orish Ebere %A Pandian, Jeyaraj D %A Papachristou, Christina %A Park, Jae-Hyun %A Caicedo, Angel J Paternina %A Patten, Scott B %A Paul, Vinod K %A Pavlin, Boris Igor %A Pearce, Neil %A Pereira, David M %A Pesudovs, Konrad %A Petzold, Max %A Poenaru, Dan %A Polanczyk, Guilherme V %A Polinder, Suzanne %A Pope, Dan %A Pourmalek, Farshad %A Qato, Dima %A Quistberg, D Alex %A Rafay, Anwar %A Rahimi, Kazem %A Rahimi-Movaghar, Vafa %A ur Rahman, Sajjad %A Raju, Murugesan %A Rana, Saleem M %A Refaat, Amany %A Ronfani, Luca %A Roy, Nobhojit %A Pimienta, Tania Georgina Sánchez %A Sahraian, Mohammad Ali %A Salomon, Joshua A %A Sampson, Uchechukwu %A Santos, Itamar S %A Sawhney, Monika %A Sayinzoga, Felix %A Schneider, Ione J C %A Schumacher, Austin %A Schwebel, David C %A Seedat, Soraya %A Sepanlou, Sadaf G %A Servan-Mori, Edson E %A Shakh-Nazarova, Marina %A Sheikhbahaei, Sara %A Shibuya, Kenji %A Shin, Hwashin Hyun %A Shiue, Ivy %A Sigfusdottir, Inga Dora %A Silberberg, Donald H %A Silva, Andrea P %A Singh, Jasvinder A %A Skirbekk, Vegard %A Sliwa, Karen %A Soshnikov, Sergey S %A Sposato, Luciano A %A Sreeramareddy, Chandrashekhar T %A Stroumpoulis, Konstantinos %A Sturua, Lela %A Sykes, Bryan L %A Tabb, Karen M %A Talongwa, Roberto Tchio %A Tan, Feng %A Teixeira, Carolina Maria %A Tenkorang, Eric Yeboah %A Terkawi, Abdullah Sulieman %A Thorne-Lyman, Andrew L %A Tirschwell, David L %A Towbin, Jeffrey A %A Tran, Bach X %A Tsilimbaris, Miltiadis %A Uchendu, Uche S %A Ukwaja, Kingsley N %A Undurraga, Eduardo A %A Uzun, Selen Begüm %A Vallely, Andrew J %A van Gool, Coen H %A Vasankari, Tommi J %A Vavilala, Monica S %A Venketasubramanian, N %A Villalpando, Salvador %A Violante, Francesco S %A Vlassov, Vasiliy Victorovich %A Vos, Theo %A Waller, Stephen %A Wang, Haidong %A Wang, Linhong %A Wang, XiaoRong %A Wang, Yanping %A Weichenthal, Scott %A Weiderpass, Elisabete %A Weintraub, Robert G %A Westerman, Ronny %A Wilkinson, James D %A Woldeyohannes, Solomon Meseret %A Wong, John Q %A Wordofa, Muluemebet Abera %A Xu, Gelin %A Yang, Yang C %A Yano, Yuichiro %A Yentur, Gokalp Kadri %A Yip, Paul %A Yonemoto, Naohiro %A Yoon, Seok-Jun %A Younis, Mustafa Z %A Yu, Chuanhua %A Jin, Kim Yun %A El Sayed Zaki, Maysaa %A Zhao, Yong %A Zheng, Yingfeng %A Zhou, Maigeng %A Zhu, Jun %A Zou, Xiao Nong %A Lopez, Alan D %A Naghavi, Mohsen %A Murray, Christopher J L %A Lozano, Rafael %K Age Distribution %K Cause of Death %K Female %K Global Health %K HIV Infections %K Humans %K Maternal Mortality %K Models, Statistical %K Organizational Objectives %K Pregnancy %K Pregnancy Complications, Infectious %K Risk Factors %K Socioeconomic Factors %K Time Factors %X

BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.

METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.

FINDINGS: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.

INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.

FUNDING: Bill & Melinda Gates Foundation.

%B Lancet %V 384 %P 980-1004 %8 2014 Sep 13 %G eng %N 9947 %1 http://www.ncbi.nlm.nih.gov/pubmed/24797575?dopt=Abstract %R 10.1016/S0140-6736(14)60696-6 %0 Journal Article %J Lancet %D 2014 %T Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. %A Wang, Haidong %A Liddell, Chelsea A %A Coates, Matthew M %A Mooney, Meghan D %A Levitz, Carly E %A Schumacher, Austin E %A Apfel, Henry %A Iannarone, Marissa %A Phillips, Bryan %A Lofgren, Katherine T %A Sandar, Logan %A Dorrington, Rob E %A Rakovac, Ivo %A Jacobs, Troy A %A Liang, Xiaofeng %A Zhou, Maigeng %A Zhu, Jun %A Yang, Gonghuan %A Wang, Yanping %A Liu, Shiwei %A Li, Yichong %A Ozgoren, Ayse Abbasoglu %A Abera, Semaw Ferede %A Abubakar, Ibrahim %A Achoki, Tom %A Adelekan, Ademola %A Ademi, Zanfina %A Alemu, Zewdie Aderaw %A Allen, Peter J %A AlMazroa, Mohammad AbdulAziz %A Alvarez, Elena %A Amankwaa, Adansi A %A Amare, Azmeraw T %A Ammar, Walid %A Anwari, Palwasha %A Cunningham, Solveig Argeseanu %A Asad, Majed Masoud %A Assadi, Reza %A Banerjee, Amitava %A Basu, Sanjay %A Bedi, Neeraj %A Bekele, Tolesa %A Bell, Michelle L %A Bhutta, Zulfiqar %A Blore, Jed D %A Basara, Berrak Bora %A Boufous, Soufiane %A Breitborde, Nicholas %A Bruce, Nigel G %A Bui, Linh Ngoc %A Carapetis, Jonathan R %A Cárdenas, Rosario %A Carpenter, David O %A Caso, Valeria %A Castro, Ruben Estanislao %A Catalá-López, Ferrán %A Cavlin, Alanur %A Che, Xuan %A Chiang, Peggy Pei-Chia %A Chowdhury, Rajiv %A Christophi, Costas A %A Chuang, Ting-Wu %A Cirillo, Massimo %A da Costa Leite, Iuri %A Courville, Karen J %A Dandona, Lalit %A Dandona, Rakhi %A Davis, Adrian %A Dayama, Anand %A Deribe, Kebede %A Dharmaratne, Samath D %A Dherani, Mukesh K %A Dilmen, Uğur %A Ding, Eric L %A Edmond, Karen M %A Ermakov, Sergei Petrovich %A Farzadfar, Farshad %A Fereshtehnejad, Seyed-Mohammad %A Fijabi, Daniel Obadare %A Foigt, Nataliya %A Forouzanfar, Mohammad H %A Garcia, Ana C %A Geleijnse, Johanna M %A Gessner, Bradford D %A Goginashvili, Ketevan %A Gona, Philimon %A Goto, Atsushi %A Gouda, Hebe N %A Green, Mark A %A Greenwell, Karen Fern %A Gugnani, Harish Chander %A Gupta, Rahul %A Hamadeh, Randah Ribhi %A Hammami, Mouhanad %A Harb, Hilda L %A Hay, Simon %A Hedayati, Mohammad T %A Hosgood, H Dean %A Hoy, Damian G %A Idrisov, Bulat T %A Islami, Farhad %A Ismayilova, Samaya %A Jha, Vivekanand %A Jiang, Guohong %A Jonas, Jost B %A Juel, Knud %A Kabagambe, Edmond Kato %A Kazi, Dhruv S %A Kengne, Andre Pascal %A Kereselidze, Maia %A Khader, Yousef Saleh %A Khalifa, Shams Eldin Ali Hassan %A Khang, Young-Ho %A Kim, Daniel %A Kinfu, Yohannes %A Kinge, Jonas M %A Kokubo, Yoshihiro %A Kosen, Soewarta %A Defo, Barthelemy Kuate %A Kumar, G Anil %A Kumar, Kaushalendra %A Kumar, Ravi B %A Lai, Taavi %A Lan, Qing %A Larsson, Anders %A Lee, Jong-Tae %A Leinsalu, Mall %A Lim, Stephen S %A Lipshultz, Steven E %A Logroscino, Giancarlo %A Lotufo, Paulo A %A Lunevicius, Raimundas %A Lyons, Ronan Anthony %A Ma, Stefan %A Mahdi, Abbas Ali %A Marzan, Melvin Barrientos %A Mashal, Mohammad Taufiq %A Mazorodze, Tasara T %A McGrath, John J %A Memish, Ziad A %A Mendoza, Walter %A Mensah, George A %A Meretoja, Atte %A Miller, Ted R %A Mills, Edward J %A Mohammad, Karzan Abdulmuhsin %A Mokdad, Ali H %A Monasta, Lorenzo %A Montico, Marcella %A Moore, Ami R %A Moschandreas, Joanna %A Msemburi, William T %A Mueller, Ulrich O %A Muszynska, Magdalena M %A Naghavi, Mohsen %A Naidoo, Kovin S %A Narayan, K M Venkat %A Nejjari, Chakib %A Ng, Marie %A de Dieu Ngirabega, Jean %A Nieuwenhuijsen, Mark J %A Nyakarahuka, Luke %A Ohkubo, Takayoshi %A Omer, Saad B %A Caicedo, Angel J Paternina %A Pillay-van Wyk, Victoria %A Pope, Dan %A Pourmalek, Farshad %A Prabhakaran, Dorairaj %A Rahman, Sajjad U R %A Rana, Saleem M %A Reilly, Robert Quentin %A Rojas-Rueda, David %A Ronfani, Luca %A Rushton, Lesley %A Saeedi, Mohammad Yahya %A Salomon, Joshua A %A Sampson, Uchechukwu %A Santos, Itamar S %A Sawhney, Monika %A Schmidt, Jürgen C %A Shakh-Nazarova, Marina %A She, Jun %A Sheikhbahaei, Sara %A Shibuya, Kenji %A Shin, Hwashin Hyun %A Shishani, Kawkab %A Shiue, Ivy %A Sigfusdottir, Inga Dora %A Singh, Jasvinder A %A Skirbekk, Vegard %A Sliwa, Karen %A Soshnikov, Sergey S %A Sposato, Luciano A %A Stathopoulou, Vasiliki Kalliopi %A Stroumpoulis, Konstantinos %A Tabb, Karen M %A Talongwa, Roberto Tchio %A Teixeira, Carolina Maria %A Terkawi, Abdullah Sulieman %A Thomson, Alan J %A Thorne-Lyman, Andrew L %A Toyoshima, Hideaki %A Dimbuene, Zacharie Tsala %A Uwaliraye, Parfait %A Uzun, Selen Begüm %A Vasankari, Tommi J %A Vasconcelos, Ana Maria Nogales %A Vlassov, Vasiliy Victorovich %A Vollset, Stein Emil %A Waller, Stephen %A Wan, Xia %A Weichenthal, Scott %A Weiderpass, Elisabete %A Weintraub, Robert G %A Westerman, Ronny %A Wilkinson, James D %A Williams, Hywel C %A Yang, Yang C %A Yentur, Gokalp Kadri %A Yip, Paul %A Yonemoto, Naohiro %A Younis, Mustafa %A Yu, Chuanhua %A Jin, Kim Yun %A El Sayed Zaki, Maysaa %A Zhu, Shankuan %A Vos, Theo %A Lopez, Alan D %A Murray, Christopher J L %K Child Mortality %K Child, Preschool %K Global Health %K Humans %K Infant %K Infant Mortality %K Infant, Newborn %K Organizational Objectives %K Risk Factors %K Socioeconomic Factors %X

BACKGROUND: Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.

METHODS: We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.

FINDINGS: We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.

INTERPRETATION: Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.

FUNDING: Bill & Melinda Gates Foundation, US Agency for International Development.

%B Lancet %V 384 %P 957-79 %8 2014 Sep 13 %G eng %N 9947 %1 http://www.ncbi.nlm.nih.gov/pubmed/24797572?dopt=Abstract %R 10.1016/S0140-6736(14)60497-9 %0 Journal Article %J Eur J Oncol Nurs %D 2014 %T Management of central venous catheters in pediatric onco-hematology using 0.9% sodium chloride and positive-pressure-valve needleless connector. %A Buchini, Sara %A Scarsini, Sara %A Montico, Marcella %A Buzzetti, Roberto %A Ronfani, Luca %A Decorti, Cinzia %K Adolescent %K Catheter Obstruction %K Catheterization, Central Venous %K Central Venous Catheters %K Child %K Child, Preschool %K Cohort Studies %K Equipment Design %K Female %K Hematology %K Humans %K Infant %K Infant, Newborn %K Italy %K Male %K Oncology Nursing %K Pediatric Nursing %K Practice Guidelines as Topic %K Retrospective Studies %K Sodium Chloride %X

PURPOSE: To describe, in a sample of pediatric onco-hematological patients, the rate of occlusions in unused central venous catheters (CVC) flushed once a week with a 0.9% sodium chloride solution through a positive-pressure-valve needleless connector.

METHOD: Retrospective cohort study. Subjects aged 0-17 years were identified through a manual search in medical and nursing records and were observed for two years or until the occurrence of one of the following events: start or resume of continuous infusion; CVC removal; death. The primary study outcome was the frequency of CVC occlusion (partial or complete).

RESULTS: Fifty-one patients were identified (median age 6 years). The median duration of follow-up was 169 days (IQR 111-305). During the follow up period, 14 patients (27%) had one CVC occlusion, in 2 cases (4%) the occlusion was complete, in 12 (23%) partial. All the occlusions were solved without the need for catheter removal. The lumen diameter ≤ 4.2 vs > 4.2 French showed a statistically significant association with occlusion at multivariate analysis (OR 4.0; 95% CI 1.1-14.7).

CONCLUSIONS: Our findings are reassuring with respect to the management of the CVC using the adopted protocol. The study provides useful information for patient care, by verifying the performance of the adopted CVC management protocol and by identifying critical areas for nursing care.

%B Eur J Oncol Nurs %V 18 %P 393-6 %8 2014 Aug %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/24735747?dopt=Abstract %R 10.1016/j.ejon.2014.03.010 %0 Journal Article %J BMC Pediatr %D 2014 %T Piccolipiù, a multicenter birth cohort in Italy: protocol of the study. %A Farchi, Sara %A Forastiere, Francesco %A Vecchi Brumatti, Liza %A Alviti, Sabrina %A Arnofi, Antonio %A Bernardini, Tommaso %A Bin, Maura %A Brescianini, Sonia %A Colelli, Valentina %A Cotichini, Rodolfo %A Culasso, Martina %A De Bartolo, Paolo %A Felice, Laura %A Fiano, Valentina %A Fioritto, Alessandra %A Frizzi, Alfio %A Gagliardi, Luigi %A Giorgi, Giulia %A Grasso, Chiara %A La Rosa, Francesca %A Loganes, Claudia %A Lorusso, Paola %A Martini, Valentina %A Merletti, Franco %A Medda, Emanuela %A Montelatici, Veronica %A Mugelli, Isabella %A Narduzzi, Silvia %A Nisticò, Lorenza %A Penna, Luana %A Piscianz, Elisa %A Piscicelli, Carlo %A Poggesi, Giulia %A Porta, Daniela %A Ranieli, Antonella %A Rapisardi, Gherardo %A Rasulo, Assunta %A Richiardi, Lorenzo %A Rusconi, Franca %A Serino, Laura %A Stazi, Maria Antonietta %A Toccaceli, Virgilia %A Todros, Tullia %A Tognin, Veronica %A Trevisan, Morena %A Valencic, Erica %A Volpi, Patrizia %A Ziroli, Valentina %A Ronfani, Luca %A Di Lallo, Domenico %K Adolescent %K Child %K Child Development %K Child Welfare %K Child, Preschool %K Cohort Studies %K Environmental Exposure %K Humans %K Infant %K Infant, Newborn %K Italy %K Prospective Studies %K Socioeconomic Factors %X

BACKGROUND: The fetal and infant life are periods of rapid development, characterized by high susceptibility to exposures. Birth cohorts provide unique opportunities to study early-life exposures in association with child development and health, as well as, with longer follow-up, the early life origin of adult diseases. Piccolipiù is an Italian birth cohort recently set up to investigate the effects of environmental exposures, parental conditions and social factors acting during pre-natal and early post-natal life on infant and child health and development. We describe here its main characteristics.

METHODS/DESIGN: Piccolipiù is a prospective cohort of expected 3000 newborns, who will be recruiting in six maternity units of five Italian cities (Florence, Rome, Trieste, Turin and Viareggio) since October 2011. Mothers are contacted during pregnancy or at delivery and are offered to participate in the study. Upon acceptance, their newborns are recruited at birth and followed up until at least 18 years of age. At recruitment, the mothers donate a blood sample and complete a baseline questionnaire. Umbilical cord blood, pieces of umbilical cord and heel blood spots are also collected. Postnatal follow-up currently occurs at 6, 12, and 24 months of age using on-line or postal self administered questionnaire; further questionnaires and medical examinations are envisaged. Questionnaires collect information on several factors, including mother's and/or child's environmental exposures, anthropometric measures, reproductive factors, diet, supplements, medical history, cognitive development, mental health and socioeconomic factors. Health promotion materials are also offered to parents.

DISCUSSION: Piccolipiù will broaden our understanding of the contribution of early-life factors to infant and child health and development. Several hypotheses on the developmental origins of health can be tested or piloted using the data collected from the Piccolipiù cohort. By pooling these data with those collected by other existing birth cohorts it will be possible to validate previous findings and to study rare exposures and outcomes.

%B BMC Pediatr %V 14 %P 36 %8 2014 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/24506846?dopt=Abstract %R 10.1186/1471-2431-14-36 %0 Journal Article %J BMC Pediatr %D 2014 %T Promoting effective child development practices in the first year of life: does timing make a difference? %A Roia, Anna %A Paviotti, Elena %A Ferluga, Valentina %A Montico, Marcella %A Monasta, Lorenzo %A Ronfani, Luca %A Tamburlini, Giorgio %X

BACKGROUND: There is an increasing need for parenting programs aimed at promoting parent-child interaction. A variety of interventions have been proposed. The use of audiovisual materials for parents has been shown to be effective but limited information is available on the optimal timing for its use, particularly for new parents during the first year of life of their children. The aim of this study is to compare the effectiveness of a video administered at two different times to first-time parents in modifying parental knowledge, attitudes and intentions with regards to effective care practices.

METHODS: Open randomized controlled trial carried out in a referral mother and child hospital. Eligible parents were randomly assigned to receive a video at one month (early intervention) or at seven months (late intervention) of age of their child. The video addressed four specific activities related to early child development: reading aloud to the baby, early exposure to music, promotion of early socialization for parents and for children. The primary outcome was the proportion of parents who declared that their knowledge, attitudes and intentions changed after having seen the video at one or seven months of age of the child.

RESULTS: One hundred and five families were randomly allocated either to the early (53) or to the late (52) intervention group. For 99 families (52 in the early and 47 in the late group) a complete outcome evaluation was available. Parents included in the early administration group more frequently reported modifications in their knowledge of the suggested practices while parents in the late group more frequently reported a change in their attitudes. This finding was consistent across all four practices. The video was found to influence parental intentions in the great majority of interviewed parents with no significant difference between groups (82.7% and 87.2% in the early and late intervention group, respectively).

CONCLUSIONS: Audiovisual materials can be an effective complementary tool in programs aimed at supporting parents, particularly those dealing with their first baby. The results provide some useful insights into the differential benefits of using audiovisual aids at different times during the first year of life of the baby.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02120430.

%B BMC Pediatr %V 14 %P 222 %8 2014 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/25193490?dopt=Abstract %R 10.1186/1471-2431-14-222 %0 Journal Article %J Front Hum Neurosci %D 2014 %T Rhythm perception and production predict reading abilities in developmental dyslexia. %A Flaugnacco, Elena %A Lopez, Luisa %A Terribili, Chiara %A Zoia, Stefania %A Buda, Sonia %A Tilli, Sara %A Monasta, Lorenzo %A Montico, Marcella %A Sila, Alessandra %A Ronfani, Luca %A Schön, Daniele %X

Rhythm organizes events in time and plays a major role in music, but also in the phonology and prosody of a language. Interestingly, children with developmental dyslexia-a learning disability that affects reading acquisition despite normal intelligence and adequate education-have a poor rhythmic perception. It has been suggested that an accurate perception of rhythmical/metrical structure, that requires accurate perception of rise time, may be critical for phonological development and subsequent literacy. This hypothesis is mostly based on results showing a high degree of correlation between phonological awareness and metrical skills, using a very specific metrical task. We present new findings from the analysis of a sample of 48 children with a diagnosis of dyslexia, without comorbidities. These children were assessed with neuropsychological tests, as well as specifically-devised psychoacoustic and musical tasks mostly testing temporal abilities. Associations were tested by multivariate analyses including data mining strategies, correlations and most importantly logistic regressions to understand to what extent the different auditory and musical skills can be a robust predictor of reading and phonological skills. Results show a strong link between several temporal skills and phonological and reading abilities. These findings are discussed in the framework of the neuroscience literature comparing music and language processing, with a particular interest in the links between rhythm processing in music and language.

%B Front Hum Neurosci %V 8 %P 392 %8 2014 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/24926248?dopt=Abstract %R 10.3389/fnhum.2014.00392 %0 Journal Article %J BMC Pregnancy Childbirth %D 2014 %T The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study. %A Alberico, Salvatore %A Montico, Marcella %A Barresi, Valentina %A Monasta, Lorenzo %A Businelli, Caterina %A Soini, Valentina %A Erenbourg, Anna %A Ronfani, Luca %A Maso, Gianpaolo %K Adolescent %K Adult %K Birth Weight %K Body Height %K Body Mass Index %K Diabetes, Gestational %K Female %K Fetal Macrosomia %K Gestational Age %K Humans %K Infant, Newborn %K Italy %K Middle Aged %K Obesity %K Pregnancy %K Pregnancy in Diabetics %K Prospective Studies %K Risk Factors %K Weight Gain %K Young Adult %X

BACKGROUND: It is crucial to identify in large population samples the most important determinants of excessive fetal growth. The aim of the study was to evaluate the independent role of pre-pregnancy body mass index (BMI), gestational weight gain and gestational diabetes on the risk of macrosomia.

METHODS: A prospective study collected data on mode of delivery and maternal/neonatal outcomes in eleven Hospitals in Italy. Multiple pregnancies and preterm deliveries were excluded. The sample included 14109 women with complete records. Associations between exposure variables and newborn macrosomia were analyzed using Pearson's chi squared test. Multiple logistic regression models were built to assess the independent association between potential predictors and macrosomia.

RESULTS: Maternal obesity (adjusted OR 1.7, 95% CI 1.4-2.2), excessive gestational weight gain (adjusted OR 1.9, 95% CI 1.6-2.2) and diabetes (adjusted OR 2.1, 95% CI 1.5-3.0 for gestational; adjusted OR 3.0, 95% CI 1.2-7.6 for pre-gestational) resulted to be independent predictors of macrosomia, when adjusted for other recognized risk factors. Since no significant interaction was found between pre-gestational BMI and gestational weight gain, excessive weight gain should be considered an independent risk factor for macrosomia. In the sub-group of women affected by gestational or pre-gestational diabetes, pre-gestational BMI was not significantly associated to macrosomia, while excessive pregnancy weight gain, maternal height and gestational age at delivery were significantly associated. In this sub-population, pregnancy weight gain less than recommended was not significantly associated to a reduction in macrosomia.

CONCLUSIONS: Our findings indicate that maternal obesity, gestational weight gain excess and diabetes should be considered as independent risk factors for newborn macrosomia. To adequately evaluate the clinical evolution of pregnancy all three variables need to be carefully assessed and monitored.

%B BMC Pregnancy Childbirth %V 14 %P 23 %8 2014 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/24428895?dopt=Abstract %R 10.1186/1471-2393-14-23 %0 Journal Article %J Clin Exp Rheumatol %D 2014 %T Serum amyloid protein A concentration in cryopyrin-associated periodic syndromes patients treated with interleukin-1 beta antagonist. %A Pastore, Serena %A Paloni, Giulia %A Caorsi, Roberta %A Ronfani, Luca %A Taddio, Andrea %A Lepore, Loredana %K Adolescent %K Adult %K Amyloidosis %K Child %K Child, Preschool %K Cryopyrin-Associated Periodic Syndromes %K Drug Monitoring %K Female %K Humans %K Immunosuppressive Agents %K Interleukin-1beta %K Male %K Middle Aged %K Serum Amyloid A Protein %K Treatment Outcome %K Young Adult %X

OBJECTIVES: Cryopyrin-associated periodic syndromes (CAPS) are a group of chronic, relapsing autoinflammatory disorders which may be complicated by systemic AA amyloidosis. The aim of our study was to evaluate serum amyloid protein A (SAA) level in CAPS patients treated with Interleukin-1beta (IL-1β) antagonist and to correlate its level with treatment response.

METHODS: All patients of CAPS Italian Register treated with IL-1β inhibitor were enrolled. SAA levels before starting therapy, and at last visit were evaluated. Patients were then divided in complete responders and partial responders.

RESULTS: Twenty-five patients were enrolled. SAA level before starting therapy was increased (median 118.5 mg/L, IQR 96.4-252.8; normal value <6.4 mg/L), while at last visit SAA was significantly reduced (median 4.3 mg/L, IQR 2.3-12.7) (p<0.001). However 12 patients still presented SAA levels beyond normal range, 10/25 patients (40%) showed a complete response to treatment. Conversely, 15 patients presented only a partial response, of which 12 for increased SAA value and 3 for increased CRP value. Patients with partial response had SAA values significantly higher than patients with complete response (median 12.6 mg/L; IQR 8.3-20.0 vs. 2.7 mg/L; IQR 1.6-4.1, p<0.001).

CONCLUSIONS: Our results confirm the long term efficacy of anti IL-1β treatment in CAPS and the decrease of SAA levels; however 48% of patients still presented SAA elevation despite treatment. The real risk of these patients in developing amyloidosis is not clear but the persistent increase of SAA needs a close follow-up.

%B Clin Exp Rheumatol %V 32 %P S63-6 %8 2014 Jul-Aug %G eng %N 4 Suppl 84 %1 http://www.ncbi.nlm.nih.gov/pubmed/25069027?dopt=Abstract %0 Journal Article %J J Hum Lact %D 2013 %T Breastfeeding and neonatal weight loss in healthy term infants. %A Davanzo, Riccardo %A Cannioto, Zemira %A Ronfani, Luca %A Monasta, Lorenzo %A Demarini, Sergio %K Apgar Score %K Breast Feeding %K Delivery, Obstetric %K Gestational Age %K Humans %K Infant, Newborn %K Length of Stay %K Patient Readmission %K Retrospective Studies %K Seasons %K Weight Loss %X

BACKGROUND: Neonatal weight loss is universally recognized, yet poorly understood. Limited professional consensus exists on the definition of lower limit of safe weight loss.

OBJECTIVE: Our aim was to assess the extent of neonatal weight loss and its association with selected clinical variables in a population of healthy term infants cared for using a specific protocol on weight loss.

METHODS: We retrospectively considered 1003 infants consecutively admitted to the regular nursery of the Institute for Maternal and Child Health "Burlo Garofolo" (Trieste, Italy). We studied the relationship of selected variables with neonatal weight loss recorded during the hospital stay. We also analyzed all readmissions in the first month of life as a result of weight loss and its complications.

RESULTS: We observed a mean absolute weight loss of 228 g ± 83g, and a mean percent weight loss of 6.7% ± 2.2%. Weight loss ≥ 10% and > 12% were 6% and 0.3%, respectively. In multivariate logistic regression, cesarean section, hot season, any formula feeding, and jaundice not requiring phototherapy were independently associated with neonatal weight loss ≥ 8%. Conversely, low gestational age status was associated with lower weight loss. Readmission within the first month of life because of dehydration occurred in 0.3% of infants.

CONCLUSIONS: Breastfeeding, compared to formula feeding, may not be a risk factor for greater early neonatal weight loss, at least in contexts in which weight is routinely monitored, breastfeeding is repeatedly assessed and appropriately supported, and careful supplementation is prescribed to limit and promptly treat excess weight loss and its related complications.

%B J Hum Lact %V 29 %P 45-53 %8 2013 Feb %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/22554678?dopt=Abstract %R 10.1177/0890334412444005 %0 Journal Article %J J Hum Lact %D 2013 %T Breastfeeding at NICU discharge: a multicenter Italian study. %A Davanzo, Riccardo %A Monasta, Lorenzo %A Ronfani, Luca %A Brovedani, Pierpaolo %A Demarini, Sergio %K Breast Feeding %K Humans %K Infant, Low Birth Weight %K Infant, Newborn %K Infant, Premature %K Intensive Care Units, Neonatal %K Italy %K Logistic Models %K Multivariate Analysis %K Patient Discharge %X

BACKGROUND: Human milk is the optimal form of nutrition for infants, especially sick or compromised infants, yet international data suggest that breastfeeding (feeding at the breast) and the use of expressed human milk (mother's and donor's milk) are limited in patients cared for in the neonatal intensive care unit (NICU).

OBJECTIVE: The goal of this study was to examine feeding status at hospital discharge among high risk infants.

METHODS: We used the 1991 World Health Organization infant feeding definitions, applied to the 72 hour period preceding discharge from the NICU. The study sample consisted of all high risk infants discharged from July 1, 2005, to June 30, 2006 from 13 Italian NICUs. Data on infant feeding in the last 72 hours were collected at discharge from the medical records.

RESULTS: We recorded data from 2948 subjects with a median gestational age of 35 weeks (IQR, 32-38), a median birth weight of 2200 g (IQR, 1630-2920) and a median length of stay of 16 days (IQR, 8-33). At discharge, 28% of all infants were fed exclusively with human milk: 31%, 25%, 22% and 33% respectively in the <1500 g, 1500-2000 g, 2000-2499 g and ≥ 2500 g birth weight categories. The proportion of infants not fed with human milk varied from 6 to 82% across different centers.

CONCLUSION: Our study found limited breastfeeding and use of human milk among the NICU infants at discharge. At discharge, infants with a birth weight 1500-2499 g were fed exclusively with human milk less than those in higher or lower birth weight categories.

%B J Hum Lact %V 29 %P 374-80 %8 2013 Aug %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22821726?dopt=Abstract %R 10.1177/0890334412451055 %0 Journal Article %J J Pediatr Gastroenterol Nutr %D 2012 %T Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report. %A Giersiepen, Klaus %A Lelgemann, Monika %A Stuhldreher, Nina %A Ronfani, Luca %A Husby, Steffen %A Koletzko, Sibylle %A Korponay-Szabó, Ilma R %K Autoantibodies %K Biological Markers %K Celiac Disease %K Child %K Gliadin %K GTP-Binding Proteins %K Humans %K Immunoglobulin A %K Immunoglobulin G %K Point-of-Care Systems %K Sensitivity and Specificity %K Transglutaminases %X

OBJECTIVE: The aim of this study was to summarise the evidence from 2004 to September 2009 on the performance of laboratory-based serological and point of care (POC) tests for diagnosing coeliac disease (CD) in children using histology as reference standard.

PATIENTS AND METHODS: We searched MEDLINE and EMBASE for studies reporting on children for tests based on IgA and IgG anti-gliadin (AGA), endomysial (EmA), anti-transglutaminase-2 (TG2), and anti-deamidated gliadin peptides (DGP) antibodies or POC tests. For inclusion, histological analysis of duodenal biopsies and sensitivity and specificity for index tests had to be reported. Data were pooled and summary measures calculated for sensitivity, specificity, positive and negative likelihood ratios ("LR+", "LR-"), and diagnostic odds ratios (DOR). In case of elevated statistical heterogeneity, studies reaching 90% sensitivity or specificity were reported.

RESULTS: A total of 2510 articles were reviewed; 16 entered meta-analysis, reporting on 3110 patients (1876 with CD, 1234 without CD). For IgA-EmA, sensitivity was ≥90% in 7/11 studies and pooled specificity 98.2%. For IgA-anti-TG2, 11/15 studies yielded sensitivities ≥90% and 13/15 specificities ≥90%. For IgA-DGP, sensitivity ranged between 80.7% and 95.1% (specificity 86.3%-93.1%); for IgG-DGP between 80.1% and 98.6% (specificity 86.0-96.9%). IgA-EmA had the highest pooled DOR (554) and LR+ (31.8) for a laboratory test, followed by IgA-anti-TG2, IgG-DGP, IgA-DGP and IgA-AGA. POC tests showed a pooled sensitivity of 96.4% for IgA-TG2 (specificity 97.7%).

CONCLUSIONS: IgA-EmA and IgA-anti-TG2 tests appear highly accurate to diagnose CD. IgG-anti-DGP tests may help in excluding CD. IgA-AGA and IgA-DGP tests show inferior accuracy. POC tests may achieve high accuracy in the hands of experienced readers, but IgA-anti-TG2/EmA were superior.

%B J Pediatr Gastroenterol Nutr %V 54 %P 229-41 %8 2012 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/22266486?dopt=Abstract %R 10.1097/MPG.0b013e318216f2e5 %0 Journal Article %J PLoS One %D 2012 %T Burden of disease caused by otitis media: systematic review and global estimates. %A Monasta, Lorenzo %A Ronfani, Luca %A Marchetti, Federico %A Montico, Marcella %A Vecchi Brumatti, Liza %A Bavcar, Alessandro %A Grasso, Domenico %A Barbiero, Chiara %A Tamburlini, Giorgio %K Cost of Illness %K Hearing Loss %K Humans %K Internationality %K Otitis Media %X

BACKGROUND: Otitis media (OM) is a leading cause of health care visits and drugs prescription. Its complications and sequelae are important causes of preventable hearing loss, particularly in developing countries. Within the Global Burden of Diseases, Injuries, and Risk Factors Study, for the year 2005 we estimated the incidence of acute OM, chronic suppurative OM, and related hearing loss and mortality for all ages and the 21 WHO regional areas.

METHODS: We identified risk factors, complications and sequelae of OM. We carried out an extensive literature review (Medline, Embase, Lilacs and Wholis) which lead to the selection of 114 papers comprising relevant data. Data were available from 15 of the 21 WHO regions. To estimate incidence and prevalence for all countries we adopted a two stage approach based on risk factors formulas and regression modelling.

RESULTS: Acute OM incidence rate is 10.85% i.e. 709 million cases each year with 51% of these occurring in under-fives. Chronic suppurative OM incidence rate is 4.76 ‰ i.e. 31 million cases, with 22.6% of cases occurring annually in under-fives. OM-related hearing impairment has a prevalence of 30.82 per ten-thousand. Each year 21 thousand people die due to complications of OM.

CONCLUSIONS: Our study is the first attempt to systematically review the available information and provide global estimates for OM and related conditions. The overall burden deriving from AOM, CSOM and their sequelae is considerable, particularly in the first five years of life and in the poorest countries. The findings call for incorporating OM-focused action within preventive and case management strategies, with emphasis on the more affected.

%B PLoS One %V 7 %P e36226 %8 2012 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/22558393?dopt=Abstract %R 10.1371/journal.pone.0036226 %0 Journal Article %J Breastfeed Med %D 2012 %T Does the LATCH score assessed in the first 24 hours after delivery predict non-exclusive breastfeeding at hospital discharge? %A Tornese, Gianluca %A Ronfani, Luca %A Pavan, Carla %A Demarini, Sergio %A Monasta, Lorenzo %A Davanzo, Riccardo %K Adult %K Breast Feeding %K Female %K Health Promotion %K Humans %K Infant, Newborn %K Italy %K Logistic Models %K Multivariate Analysis %K Patient Care Planning %K Patient Discharge %K Prospective Studies %K Risk Assessment %K ROC Curve %K Sensitivity and Specificity %K Social Support %X

AIM: The aims of this study were to analyze the relationship between the LATCH score assessed in the first 24 hours after delivery and non-exclusive breastfeeding at discharge and to identify a cutoff for the LATCH score in order to identify women with higher risk of non-exclusive breastfeeding who may need additional breastfeeding support.

SUBJECTS AND METHODS: We conducted a prospective observational study in the Maternity Ward of the Institute for Maternal and Child Health "Burlo Garofolo" (Trieste, Italy) and collected data from 299 mother-infant dyads.

RESULTS: The rate of nonexclusive breastfeeding was inversely related to the LATCH score (p<0.001) with non-exclusive breastfeeding infants scoring less (6.9) than infants exclusively breastfed at discharge (7.6) (p=0.001). In multivariate analysis, non-exclusive breastfeeding was also associated with cesarean section, primiparity, and infant phototherapy. In order to support maternity staff in providing targeted interventions, we identified four LATCH score cutoffs associated with as many risk groups for non-exclusive breastfeeding at discharge.

CONCLUSIONS: The LATCH score is a useful tool to identify mother-infant pairs who might benefit from additional skilled support in specific subgroups at risk of non-exclusive breastfeeding at discharge. Future research is needed to explore if the LATCH score assessed in the first days of life can also predict the duration of breastfeeding.

%B Breastfeed Med %V 7 %P 423-30 %8 2012 Dec %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/22313393?dopt=Abstract %R 10.1089/bfm.2011.0120 %0 Journal Article %J BMC Pediatr %D 2012 %T Management of cryptorchidism: a survey of clinical practice in Italy. %A Marchetti, Federico %A Bua, Jenny %A Tornese, Gianluca %A Piras, Gianni %A Toffol, Giacomo %A Ronfani, Luca %K Child, Preschool %K Chorionic Gonadotropin %K Cryptorchidism %K Gonadotropin-Releasing Hormone %K Guideline Adherence %K Humans %K Infant %K Italy %K Male %K Middle Aged %K Orchiopexy %K Pediatrics %K Physician's Practice Patterns %K Practice Guidelines as Topic %K Questionnaires %K Retrospective Studies %K Treatment Outcome %X

BACKGROUND: An evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. In Italy, current practices on UT management are little known. Our aim was to describe the current management of UT in a cohort of Italian children in comparison with the Consensus guidelines. As management of retractile testis (RT) differs, RT cases were described separately.

METHODS: Ours is a retrospective, multicenter descriptive study. An online questionnaire was filled in by 140 Italian Family Paediatricians (FP) from Associazione Culturale Pediatri (ACP), a national professional association of FP. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006. Data on 169 children were obtained. Analyses were descriptive.

RESULTS: Overall 24% of children were diagnosed with RT, 76% with UT. Among the latter, cryptorchidism resolved spontaneously in 10% of cases at a mean age of 21.6 months. Overall 70% of UT cases underwent orchidopexy at a mean age of 22.8 months (SD 10.8, range 1.2-56.4), 13% of whom before 1 year. The intervention was performed by a paediatric surgeon in 90% of cases, with a success rate of 91%. Orchidopexy was the first line treatment in 82% of cases, while preceded by hormonal treatment in the remaining 18%. Hormonal treatment was used as first line therapy in 23% of UT cases with a reported success rate of 25%. Overall, 13 children did not undergo any intervention (mean age at last follow up 39.6 months). We analyzed the data from the 5 Italian Regions with the largest number of children enrolled and found a statistically significant regional difference in the use of hormonal therapy, and in the use of and age at orchidopexy.

CONCLUSIONS: Our study showed an important delay in orchidopexy. A quarter of children with cryptorchidism was treated with hormonal therapy. In line with the Consensus guidelines, surgery was carried out by a paediatric surgeon in the majority of cases, with a high success rate.

%B BMC Pediatr %V 12 %P 4 %8 2012 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/22233418?dopt=Abstract %R 10.1186/1471-2431-12-4 %0 Journal Article %J Invest New Drugs %D 2012 %T The negative prognostic value of TRAIL overexpression in oral squamous cell carcinomas does not preclude the potential therapeutic use of recombinant TRAIL. %A Carinci, Francesco %A Monasta, Lorenzo %A Rubini, Corrado %A Stramazzotti, Daniela %A Palmieri, Annalisa %A Melloni, Elisabetta %A Knowles, Alex %A Ronfani, Luca %A Zauli, Giorgio %A Secchiero, Paola %K Adult %K Aged %K Aged, 80 and over %K Antineoplastic Agents %K Apoptosis %K Carcinoma, Squamous Cell %K Female %K Flow Cytometry %K HL-60 Cells %K Humans %K Immunohistochemistry %K Male %K Middle Aged %K Mouth Neoplasms %K Predictive Value of Tests %K Prognosis %K Proportional Hazards Models %K Recombinant Proteins %K Risk Assessment %K Risk Factors %K Survival Analysis %K TNF-Related Apoptosis-Inducing Ligand %K Tumor Markers, Biological %K Up-Regulation %K Young Adult %B Invest New Drugs %V 30 %P 810-8 %8 2012 Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21086019?dopt=Abstract %R 10.1007/s10637-010-9586-0 %0 Journal Article %J Cochrane Database Syst Rev %D 2012 %T Oral zinc for treating diarrhoea in children. %A Lazzerini, Marzia %A Ronfani, Luca %K Acute Disease %K Age Factors %K Child %K Child, Preschool %K Diarrhea %K Humans %K Infant %K Randomized Controlled Trials as Topic %K Time Factors %K Trace Elements %K Zinc %X

BACKGROUND: In developing countries, diarrhoea causes around two million child deaths annually. Zinc supplementation during acute diarrhoea is currently recommended by the World Health Organization and UNICEF.

OBJECTIVES: To evaluate oral zinc supplementation for treating children with acute or persistent diarrhoea.

SEARCH METHODS: In February 2012, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2011, Issue 11), MEDLINE, EMBASE, LILACS, CINAHL, mRCT, and reference lists. We also contacted researchers.

SELECTION CRITERIA: Randomized controlled trials comparing oral zinc supplementation with placebo in children aged one month to five years with acute or persistent diarrhoea, including dysentery.

DATA COLLECTION AND ANALYSIS: Both authors assessed trial eligibility and risk of bias, extracted and analysed data, and drafted the review. Diarrhoea duration and severity were the primary outcomes. We summarized dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD) with 95% confidence intervals (CI). Where appropriate, we combined data in meta-analyses (using the fixed- or random-effects model) and assessed heterogeneity.The quality of evidence has been assessed using the GRADE methods

MAIN RESULTS: Twenty-four trials, enrolling 9128 children, met our inclusion criteria. The majority of the data is from Asia, from countries at high risk of zinc deficiency, and may not be applicable elsewhere.Acute diarrhoeaThere is currently not enough evidence from well conducted randomized controlled trials to be able to say whether zinc supplementation during acute diarrhoea reduces death or hospitalization (very low quality evidence).In children aged greater than six months with acute diarrhoea, zinc supplementation may shorten the duration of diarrhoea by around 10 hours (MD -10.44 hours, 95% CI -21.13 to 0.25; 2091 children, five trials, low quality evidence), and probably reduces the number of children whose diarrhoea persists until day seven (RR 0.73, 95% CI 0.61 to 0.88; 3865 children, six trials, moderate quality evidence). In children with signs of moderate malnutrition the effect appears greater, reducing the duration of diarrhoea by around 27 hours (MD -26.98 hours, 95% CI -14.62 to -39.34; 336 children, three trials, high quality evidence).Conversely, In children aged less than six months, the available evidence suggests zinc supplementation may have no effect on mean diarrhoea duration (MD 5.23 hours, 95% CI -4.00 to 14.45; 1334 children, two trials, low quality evidence), and may even increase the proportion of children whose diarrhoea persists until day seven (RR 1.24, 95% CI 0.99 to 1.54; 1074 children, one trial, moderate quality evidence).No trials reported serious adverse events, but zinc supplementation during acute diarrhoea causes vomiting in both age groups (RR 1.59, 95% 1.27 to 1.99; 5189 children, 10 trials, high quality evidence).Persistent diarrhoeaIn children with persistent diarrhoea, zinc supplementation probably shortens the duration of diarrhoea by around 16 hours (MD -15.84 hours, 95% CI -25.43 to -6.24; 529 children, five trials, moderate quality evidence).

AUTHORS' CONCLUSIONS: In areas where the prevalence of zinc deficiency or the prevalence of moderate malnutrition is high, zinc may be of benefit in children aged six months or more.The current evidence does not support the use of zinc supplementation in children below six months of age.

%B Cochrane Database Syst Rev %V 6 %P CD005436 %8 2012 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/22696352?dopt=Abstract %R 10.1002/14651858.CD005436.pub3 %0 Journal Article %J Ethn Dis %D 2012 %T Review of the scientific literature on the health of the Roma and Sinti in Italy. %A Monasta, Lorenzo %A Erenbourg, Anna %A Restaino, Stefano %A Lutje, Vittoria %A Ronfani, Luca %K Gypsies %K Health Services Accessibility %K Health Status %K Housing %K Humans %K Italy %K Minority Groups %K Prejudice %X

BACKGROUND: Roma and Sinti in Italy are excluded from the rest of society, often live in precarious housing conditions and have poor access to health services. In Italy, the Roma and Sinti minority (.3% of the overall population) is scarcely represented if compared with other European countries.

METHODS: To establish what is known and how Roma and Sinti health is studied in Italy, we conducted a review of the scientific literature, including articles published between 2000 and 2010, found in Medline, Embase and Web of Science.

RESULTS: We analyzed 15 relevant articles out of 32 references. Four papers describe rare autosomal recessive disorders. Four illustrate outbreaks of measles. The remaining papers describe health conditions suffered by this minority. All but two, however, are based on data collected at health services.

CONCLUSIONS: The lack of prevalence data and analysis of determinants is a detriment to the health of the Roma and Sinti populations in Italy. Participatory research and evidence-based interventions are needed to improve health outcomes and living conditions of the Roma and Sinti people.

%B Ethn Dis %V 22 %P 367-71 %8 2012 Summer %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22870583?dopt=Abstract %0 Journal Article %J PLoS One %D 2012 %T The submerged dyslexia iceberg: how many school children are not diagnosed? Results from an Italian study. %A Barbiero, Chiara %A Lonciari, Isabella %A Montico, Marcella %A Monasta, Lorenzo %A Penge, Roberta %A Vio, Claudio %A Tressoldi, Patrizio Emanuele %A Ferluga, Valentina %A Bigoni, Anna %A Tullio, Alessia %A Carrozzi, Marco %A Ronfani, Luca %K Area Under Curve %K Child %K Cross-Sectional Studies %K Delayed Diagnosis %K Dyslexia %K Female %K Humans %K Italy %K Male %K Neuropsychological Tests %K Prevalence %K Questionnaires %K ROC Curve %X

BACKGROUND: Although dyslexia is one of the most common neurobehavioral disorders affecting children, prevalence is uncertain and available data are scanty and dated. The objective of this study is to evaluate the prevalence of dyslexia in an unselected school population using clearly defined and rigorous diagnostic criteria and methods.

METHODS: Cross sectional study. We selected a random cluster sample of 94 fourth grade elementary school classes of Friuli Venezia Giulia, a Region of North Eastern Italy. We carried out three consecutive levels of screening: the first two at school and the last at the Neuropsychiatry Unit of a third level Mother and Child Hospital. The main outcome measure was the prevalence of dyslexia, defined as the number of children positive to the third level of screening divided by the total number of children enrolled.

RESULTS: We recruited 1774 children aged 8-10 years, of which 1528 received parents' consent to participate. After applying exclusion criteria, 1357 pupils constituted the final working sample. The prevalence of dyslexia in the enrolled population ranged from 3.1% (95% CI 2.2-4.1%) to 3.2% (95% CI 2.4-4.3%) depending on different criteria adopted. In two out of three children with dyslexia the disorder had not been previously diagnosed.

CONCLUSIONS: This study shows that dyslexia is largely underestimated in Italy and underlines the need for reliable information on prevalence, in order to better allocate resources both to Health Services and Schools.

%B PLoS One %V 7 %P e48082 %8 2012 %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/23118930?dopt=Abstract %R 10.1371/journal.pone.0048082 %0 Journal Article %J PLoS One %D 2011 %T Circulating TRAIL shows a significant post-partum decline associated to stressful conditions. %A Zauli, Giorgio %A Monasta, Lorenzo %A Rimondi, Erika %A Vecchi Brumatti, Liza %A Radillo, Oriano %A Ronfani, Luca %A Montico, Marcella %A D'Ottavio, Giuseppina %A Alberico, Salvatore %A Secchiero, Paola %K Adult %K Biological Markers %K C-Reactive Protein %K Female %K Fetal Blood %K Fetal Distress %K Humans %K Labor, Obstetric %K Logistic Models %K Multivariate Analysis %K Postpartum Period %K Pregnancy %K Pregnancy Outcome %K Statistics, Nonparametric %K Stress, Physiological %K TNF-Related Apoptosis-Inducing Ligand %X

BACKGROUND: Since circulating levels of TNF-related apoptosis inducing ligand (TRAIL) may be important in the physiopathology of pregnancy, we tested the hypothesis that TRAIL levels change at delivery in response to stressful conditions.

METHODS/PRINCIPAL FINDINGS: We conducted a longitudinal study in a cohort of 73 women examined at week 12, week 16, delivery and in the corresponding cord blood (CB). Serum TRAIL was assessed in relationship with maternal characteristics and to biochemical parameters. TRAIL did not vary between 12 (67.6±27.6 pg/ml, means±SD) and 16 (64.0±16.2 pg/ml) weeks' gestation, while displaying a significant decline after partum (49.3±26.4 pg/ml). Using a cut-off decline >20 pg/ml between week 12 and delivery, the subset of women with the higher decline of circulating TRAIL (41.7%) showed the following characteristics: i) nullipara, ii) higher age, iii) operational vaginal delivery or urgent CS, iv) did not receive analgesia during labor, v) induced labor. CB TRAIL was significantly higher (131.6±52 pg/ml) with respect to the corresponding maternal TRAIL, and the variables significantly associated with the first quartile of CB TRAIL (<90 pg/ml) were higher pre-pregnancy BMI, induction of labor and fetal distress. With respect to the biochemical parameters, maternal TRAIL at delivery showed an inverse correlation with C-reactive protein (CRP), total cortisol, glycemia and insulin at bivariate analysis, but only with CRP at multivariate analysis.

CONCLUSIONS: Stressful partum conditions and elevated CRP levels are associated with a decrease of circulating TRAIL.

%B PLoS One %V 6 %P e27011 %8 2011 %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/22194780?dopt=Abstract %R 10.1371/journal.pone.0027011 %0 Journal Article %J BMC Pregnancy Childbirth %D 2011 %T "GINEXMAL RCT: Induction of labour versus expectant management in gestational diabetes pregnancies". %A Maso, Gianpaolo %A Alberico, Salvatore %A Wiesenfeld, Uri %A Ronfani, Luca %A Erenbourg, Anna %A Hadar, Eran %A Yogev, Yariv %A Hod, Moshe %K Adolescent %K Adult %K Cesarean Section %K Diabetes, Gestational %K Female %K Gestational Age %K Humans %K Intention to Treat Analysis %K Labor, Induced %K Patient Selection %K Pregnancy %K Pregnancy Outcome %K Research Design %K Watchful Waiting %K Young Adult %X

BACKGROUND: Gestational diabetes (GDM) is one of the most common complications of pregnancies affecting around 7% of women. This clinical condition is associated with an increased risk of developing fetal macrosomia and is related to a higher incidence of caesarean section in comparison to the general population. Strong evidence indicating the best management between induction of labour at term and expectant monitoring are missing.

METHODS/DESIGN: Pregnant women with singleton pregnancy in vertex presentation previously diagnosed with gestational diabetes will be asked to participate in a multicenter open-label randomized controlled trial between 38+0 and 39+0 gestational weeks. Women will be recruited in the third trimester in the outpatient clinic or in the Day Assessment Unit according to local protocols. Women who opt to take part will be randomized according to induction of labour or expectant management for spontaneous delivery. Patients allocated to the induction group will be admitted to the obstetric ward and offered induction of labour via use of prostaglandins, Foley catheter or oxytocin (depending on clinical conditions). Women assigned to the expectant arm will be sent to their domicile where they will be followed up until delivery, through maternal and fetal wellbeing monitoring twice weekly. The primary study outcome is the Caesarean section (C-section) rate, whilst secondary measurements are maternal and neonatal outcomes. A total sample of 1760 women (880 each arm) will be recruited to identify a relative difference between the two arms equal to 20% in favour of induction, with concerns to C-section rate. Data will be collected until mothers and newborns discharge from the hospital. Analysis of the outcome measures will be carried out by intention to treat.

DISCUSSION: The present trial will provide evidence as to whether or not, in women affected by gestational diabetes, induction of labour between 38+0 and 39+0 weeks is an effective management to ameliorate maternal and neonatal outcomes. The primary objective is to determine whether caesarean section rate could be reduced among women undergoing induction of labour, in comparison to patients allocated to expectant monitoring. The secondary objective consists of the assessment and comparison of maternal and neonatal outcomes in the two study arms. .

%B BMC Pregnancy Childbirth %V 11 %P 31 %8 2011 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/21507262?dopt=Abstract %R 10.1186/1471-2393-11-31 %0 Journal Article %J Am J Obstet Gynecol %D 2010 %T Risk of preterm delivery in relation to maternal use of psychotropic medications during pregnancy: methodological issues. %A Erenbourg, Anna %A Wiesenfeld, Uri %A Ronfani, Luca %K Benzodiazepines %K Confounding Factors (Epidemiology) %K Data Interpretation, Statistical %K Female %K Humans %K Multivariate Analysis %K Pregnancy %K Premature Birth %K Psychotropic Drugs %B Am J Obstet Gynecol %V 203 %P e12-3; author reply e13 %8 2010 Oct %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/20541734?dopt=Abstract %R 10.1016/j.ajog.2010.04.044