A prospective study of 1004 consecutive deliveries was carried out to investigate the effect of passive smoking during pregnancy on a set of perinatal parameters. The data set was a cooperative study involving 11 Italian cities, distributed nationally. The study group was divided in three categories according to the mother's cigarette smoke exposure during pregnancy, ie, not smokers, passive smokers, direct smokers. Potential confounders, including paternal characteristics, were adjusted for by multiple linear regression analysis. A mean reduction of 16 g (p less than 0.07) in birthweight and a decrease in birth length of 0.05 cm (p less than 0.08) were found for each hour of antenatal passive smoke exposure. No or slight effects were reported for the other perinatal parameters considered.
ContextChildren’s cough is a daily concern for most pediatricians. The management of both acute and chronic cough requires a systematic and comprehensive approach. Despite the approved protocols for management, the pediatric assessment of cough and the corresponding prescribing attitude frequently do not fit these protocols, which can be affected by parental suggestions – sometimes substantially.ObjectiveThe objective of this study was to investigate both the perception and the behavior of a representative sample of Italian pediatricians toward cough in real life.MethodsA specific questionnaire consisting of 18 questions was prepared. The questionnaire was completed by 300 pediatricians (all members of PAIDOSS: Italian National Observatory on Health of Childhood and Adolescence) who represented ~300,000 children.ResultsA vast majority of children have cough throughout the year (99.3% of respondents have cough during autumn/winter and 64.7% in spring/summer). Allergic disease is the most frequent suspected cause of chronic cough in children (53%), and this is supported by the high demand for consultations: 73% seek the opinion of allergologists, 62% of otorhinolaryngologists and only 33% of pulmonologists. The majority of pediatricians (92%) reported that they prescribe therapy in acute cough regardless of cough guidelines. Moreover, the survey pointed out the abuse of aerosol therapy (26% in acute cough and 38% in chronic cough) and of antibiotics prescription (22% in acute cough and 42% in chronic cough).ConclusionOur survey suggests that some Italian pediatricians’ therapeutic attitudes should be substantially improved in order to achieve better management of cough in children and to minimize the burden of cough.
Background: Paediatricians rarely devote any time to screening and treatment for parental tobacco use. The present project is part of a Global Alliance against Chronic Respiratory Diseases (GARD)-Italy Demonstration Project, aimed to increase the skills of primary care physicians and paediatricians as "promoter of smoking cessation". The aims of this study were: (I) to identify latent classes of barriers and incentives for smoking cessation counseling among paediatricians using latent class analysis (LCA); (II) to investigate risk factors for inclusion into the identified classes.Methods: In 2018, 1,500 Italian paediatricians were invited to complete an online survey on passive smoke exposure in children. LCA was used to discover underlying response patterns, and to identify respondent groups with similar attitudes toward passive smoke exposure in children. Multinomial logistic regression helped investigate which explanatory variables influenced inclusion into a class. A P value <0.05 was considered significant.Results: The overall response rate was 71% (n=1,071/1,500). Three classes were identified: Class 1 "passive" (n=226, 21.10%); Class 2 "unmotivated" (n=124, 11.58%); and Class 3 "proactive" (n=721, 67.32%).Assuming Class 3 as reference, ever having been a smoker was borderline associated (P=0.052) with increased probability of inclusion into Class 1 (OR =1.43, 95% CI, 1.00-2.06). Having 6-15 or ≥15 years of work experience versus having less than five years was associated with decreased probability of being in the "passive" class (OR =0.46, 95% CI, 0.22-0.96 and OR =0.49, 95% CI, 0.27-0.87, respectively), as was discussing parents' addiction to alcohol/drugs (OR =0.50, 95% CI, 0.33-0.76). Conclusions: We identified three profiles among Italian paediatricians related to barriers and incentives for smoking cessation promotion. Tailored educational interventions for paediatricians are required to promote smoking cessation programs.
Nonalcoholic fatty liver disease (NAFLD) is a multifactorial disorder closely associated with the metabolic syndrome and is the most common cause of abnormal liver function tests (LFTs) in children. NAFLD is set to become the major cause of liver transplantation in adults, and while it is rare for children to develop end-stage liver disease from NAFLD, they may become cirrhotic as adults. Understanding and managing NAFLD in children may represent a method to intervene early and alter the disease process. Furthermore, children with steatosis require careful assessment as it may be secondary to other conditions (e.g., Wilson's disease [WD]). For these reasons, pediatric NAFLD is of high importance to all gastroenterologists, hepatologists, and pediatricians. NAFLD refers to a spectrum of diseases, ranging from hepatic steatosis ("simple steatosis" or nonalcoholic fatty liver [NAFL]) to nonalcoholic steatohepatitis (NASH) with or without fibrosis, to end-stage liver disease. Diagnosis requires radiological (or histological) demonstration of steatosis, exclusion of secondary causes, and no significant alcohol intake.
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