Purpose The coronavirus lockdown in Italy ended, but the postlockdown phase may be even more challenging than the outbreak itself if the impact on mental health is considered. To date, little evidence is available about the effect of lockdown release in terms of adolescent health from the perspective of an emergency department (ED). Methods We reviewed data on ED arrivals of adolescents and young adults (aged 13–24 years) in the weeks immediately before and after the Italian lockdown release in 2020, and in the same periods in 2019, with a focus on cases of severe alcohol abuse, psychomotor agitation, and other mental issues. Results The relative frequency of severe alcohol intoxications increased from .88% during the last part of the lockdown to 11.3% after lockdown release. When comparing these data with the same period in 2019, a highly significant difference emerged, with severe alcohol intoxications accounting for 11.31% of ED visits versus 2.96%, respectively. The relative frequency of ED arrivals related to psychomotor agitation or other mental health issues was not significantly increased after lockdown release. Conclusions This report suggests that emergency services should be prepared for a possible peak of alcohol intoxication-related emergencies in adolescents and young adults. The connection between alcohol abuse and mental health should not be overlooked.
Introduction: Pleuropulmonary blastoma (PPB) is a rare, aggressive mesenchymal tumor of childhood. The Italian Tumori Rari in Età Pediatrica (TREP) Registry was the first in Europe dedicated to prospective data collection on rare pediatric tumors. We analyzed data from an Italian series of patients with PPB, focusing on the role of the TREP Project. Methods: We considered patients aged 0–14 with histologically confirmed diagnosis, registered in population-based cancer registries (before 2000) or the TREP Registry (2000 to 2014), and analyzed data on clinical characteristics, treatment, and outcome. Event-free survival (EFS) and overall survival (OS) were estimated. Relevant prognostic factors were identified performing a univariate analysis. Results: Thirty-seven cases were included (7 type I, 13 type II, 17 type III). The average diagnosis rate rose from 1.10 to 1.73 cases/year after the TREP Project started. All patients underwent surgery, 33 received chemotherapy, and 9 had radiotherapy. The median follow-up was 8.7 years. For type I, II, and III, respectively, the 5-year OS was 85.7% (33.4–97.9), 52.7% (23.4–75.5), and 57.8% (31.1–77.3); the 5-year EFS was 85.7% (33.4–97.9), 52.7% (23.4–75.5), and 52.9% (27.6–73.0). Favorable prognostic factors for EFS were Intergroup Rhabdomyosarcoma Study (IRS) stage I ( p = 0.03) and T1 tumor ( p = 0.05). A total of 78.3% of patients who had chemotherapy after 2000 received a standardized treatment. Conclusions: The TREP Registry showed an excellent capacity for registering cases of PPB. Patients received homogeneous treatment after the TREP Project started. Long-term outcomes were excellent for type I and unsatisfactory for type II and III. Tumor invasiveness and IRS stage were of prognostic value.
Short stature is a common referral in paediatric endocrinology. The role of the target height (TH) is fundamental in its diagnostic management. In order to investigate for growth hormone deficiency (GHD), one of the clinical criteria in several guidelines is a height <−1.5 standard deviation score (SDS) compared to TH. 1 Despite the importance of reliable measures, the calculation of TH is often entrusted to reported parental heights. Although previous studies showed a substantial error in referred heights, with a trend to overestimate it, 2,3 only two studies assessed the influence of both parents' reported heights on TH 4,5 and none of them, concurrently, considered children's data nor the impact of an inaccurate TH.This observational study aimed to verify whether parents of children referred for short stature tend to overestimate their height more than other parents and to verify how many children could be improperly tested for GHD. 1 | MATERIAL AND ME THODSWe consecutively enrolled 130 individuals referred to the Endocrine Unit of the Institute for Maternal and Child Health 'Burlo Garofolo' when both parents were present, divided into 2 categories (65 trios each) according to the reason for referral (independently from actual height): 'short stature' (SS) and 'no short stature' (noSS). Parents' age, nationality and self-reported height (R-PHt) were recorded after explaining that an accurate estimate of their height was required for their children's medical care. Parents and children were then measured (M-PHt and CHt, respectively) using a Harpenden stadiometer.TH was calculated with the formula: (paternal height + maternal height)/2 −6 for females and +6 for males using Growth Calculator 3 Software, as well as SDS for heights and TH according to Italian reference charts.Due to the nature of the study, we used existing institutional generic ethical approval and informed consent. The study was approved by the Institutional Review Committee (RC33/18).Data were presented as percentages, median and interquartile ranges. Mann-Whitney rank-sum tests and two-tailed Fisher's exact tests were performed to evaluate the relations between variables. Wilcoxon signed-rank test was used to check the differences of paired data. Bivariate and multivariate linear regressions were carried out to study associations between and among independent variables. A P-value < .05 was considered statistically significant.Statistical analysis was conducted using JMP™ software (v.15.1.0). | RE SULTSData on children and parents are reported in Table 1.The overall median discrepancy between R-PHt and M-PHt was 1.2 cm (range −9 ÷ 8.8), 35% of parents having a discrepancy >±2 cm, with no significant differences between mothers and fathers. Parents were concordant in misreporting in 62% of the cases (58% overestimation, 4% underestimation). The median difference between paternal and maternal discrepancy was 0.3 cm (IQR −1 ÷ 1.8) and maternal misreporting prevailed in 54% of the cases.The discrepancy between R-PHt and M-PHt was higher in parents w...
Background Italy was the first European country to experience a massive outbreak of Sars-coV-2 in March 2020. Severe measures were introduced to face the pandemic, significantly impacting all healthcare services, including pediatric palliative care (PPC) networks. We investigated how the Covid-19 pandemic modified the provision of PPC services in Friuli Venezia Giulia, Italy. Both the acute and long-term impacts on the families were addressed. Methods We administered a retrospective three-sections online questionnaire to the eligible families assisted by our regional PPC network. Inclusion criteria were: child needing specialistic PPC, adequate knowledge of the Italian language, being in charge of the PPC regional network of Friuli Venezia Giulia from February 1, 2020. The three sections examined the same issues in different periods: the pre-covid period (until February 29, 2020), the lockdown period (March 1, 2020, to April 30, 2020), and the post-lockdown period (May 2021). Results Twelve patients were included. During the lockdown period, 54.6% of children had to stop physiotherapy sessions, while, among those who continued, 80.0% experienced a reduction in the sessions’ frequency. In the post-lockdown period, 45.5% of children did not have physiotherapy as often as before the pandemic onset. Overall, the access to medical visits during the lockdown and after its end was significantly reduced (p = 0.01). The level of support perceived by the families descended from grade 3 (intermediate) in the pre-covid period to 2 (low) during the lockdown (p < 0.05) and returned to grade 3 in the post-lockdown period. Conclusion The COVID-19 pandemic and the related restrictions impacted the families and caused a transitory contraction of the perceived support. The most significant change was reduced access to medical visits and physiotherapy, which lasted over a year after the start of the pandemic.
The objective of the study is to investigate pain and distress experienced by a group of adolescents and children during peripheral intravenous cannulation in a paediatric emergency department. This cross-sectional study was performed between November 2019 and June 2020 at the paediatric emergency department of the Institute for Maternal and Child Health of Trieste, Italy. Eligible subjects were patients between 4 and 17 years old undergoing intravenous cannulation, split into three groups based on their age: adolescents (13–17 years), older children (8–12 years), and younger children (4–7 years). Procedural distress and pain scores were recorded through validated scales. Data on the use of topical anaesthesia, distraction techniques, and physical or verbal comfort during procedures were also collected. We recruited 136 patients: 63 adolescents, 48 older children, and 25 younger children. There was no statistically significant difference in the median self-reported procedural pain found in adolescents (4; IQR = 2–6) versus older and younger children (5; IQR = 2–8 and 6; IQR = 2–8, respectively). Furthermore, no significant difference was observed in the rate of distress between adolescents (79.4%), older (89.6%), and younger (92.0%) children. Adolescents received significantly fewer pain relief techniques.Conclusion: This study shows that adolescents experience similar pain and pre-procedural distress as younger children during peripheral intravenous cannulation. What is Known:• Topical and local anaesthesia, physical and verbal comfort, and distraction are useful interventions for pain and anxiety management during intravenous cannulation in paediatric settings. • No data is available on pain and distress experienced by adolescents in the specific setting of the emergency department. What is New:• Adolescents experienced high levels of pre-procedural distress in most cases and similar levels of pain and distress when compared to younger patients• The number of pain relief techniques employed during procedures was inversely proportional to patient’s age, topical or local anaesthesia were rarely used
Objectives: Patients with inflammatory bowel disease (IBD) may have diet-related beliefs that lead to restrictive dietary behaviours. This study aimed to evaluate dietary beliefs in young patients with IBD and their parents and the presence of restrictive behaviours. Methods: A questionnaire regarding dietary beliefs was administered to IBD patients aged 8-17 years and their parents. A Food Frequency Questionnaire was administered to patients with IBD and a peer control group. Results: Seventy-five patients and 105 parents were interviewed. Twenty-seven (36%) patients and 39 (37.1%) parents believed that dietary modifications could control the IBD course. Twenty-five (33.0%) patients and 33 (33.0%) parents believe that some dietary components can prevent relapse or improve symptoms (mainly abdominal pain and diarrhoea), while 36 (48%) patients and 60 (60.0%) parents believe that some foods can induce or worsen symptoms during an IBD flare. Patients believe that milk, dairy, fried and spicy foods, sweets and carbonated drinks could have a negative effect on IBD while fruits, vegetables and rice could have a positive impact. Parents believe that fruits and vegetables have a negative effect. Responses did not differ among patients classified according to IBD phenotype, activity status, or current therapies. Compared to controls, young patients with IBD have reduced daily consumption of milk, lunch meat, raw and cooked vegetables. Conclusions: About one-third of paediatric patients with IBD and their parents have dietary beliefs that lead to restrictive dietary behaviours.
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