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Biomedical subjects

M E Grandolfo

Publications and source records attributed to M E Grandolfo.

At least 19 recordsLinked to original sources
PubMed2000

Drug use in pregnancy among Italian women.

OBJECTIVE: To describe the use of drugs among Italian women during pregnancy and to compare it with other reports in Italy from the last 10 years. METHODS: A random sample of women who delivered in 1995-1996 were interviewed with regard to the care they received during pregnancy, delivery and the post-natal period. Information on antenatal care included maternal reports on the use of drugs during pregnancy. RESULTS: Of the 9004 women interviewed, 75% took at least one drug during pregnancy. Users took a median number of two drugs. Iron (51%) and vitamins (25%) dominate prescriptions throughout pregnancy. Fifteen percent of women reported treatment for threatened abortion and 27% for risk of pre-term delivery. The data do not differ from the drug exposure profile during pregnancy reported in other Italian studies. Logistic regression analysis of drug use (excluding haematologicals and nutritionals) shows an increased risk of usage for older women, the better educated, for those who reported health problems and those who had compulsory bed rest and/or hospitalisation during pregnancy. CONCLUSION: Seventy-five percent of the women reported use of at least one drug during pregnancy. Haematological and nutritional drugs are over prescribed. Although hormones have been clearly proven to be ineffective in preventing threatened abortion, the study shows an almost unchanged and out of date prescription pattern of progestational drugs. In order to avoid unnecessary exposure to potential risk, maternity care procedures should be reviewed and strictly related to an "evidence-based" approach.

Adult↗
PubMed2000

Sex education in secondary schools: an Italian experience.

PURPOSE: To evaluate the impact on Italian teenagers' knowledge and attitudes of an experimental program in sex education. METHODS: The program consisted of five workshops in five public secondary schools in Rome. The impact of the program was evaluated with three questionnaires designed for this study. A pretest evaluated baseline knowledge, a posttest measured the gain in knowledge, and a third questionnaire estimated retention of information 4-6 months later. Three hundred seventy-six students attending secondary school participated in the program. Thirteen questions were selected for the analysis, and improvement was measured by the difference between pretest and posttest scores. RESULTS: Ninety-six percent of the sample was in favor of sex education programs in schools. The students had an average 50% gain in the percentage of correct answers following the course. The mean score based on the number of correct answers to questions showed a baseline value of 5.00, a posttest value of 11.80, and a test value 4-6 months later of 10.7. Results showed students' positive attitude toward school sex education courses, low baseline knowledge, and a good ability to learn. CONCLUSIONS: In Italy there is a need for collaboration between schools and local health services to promote knowledge and prevention in reproductive health among teenagers.

Adolescent↗
PubMed1999

Surveillance of acute flaccid paralysis in Italy: 1996-1997. AFP Study Group. Acute flaccid paralysis.

The last case of poliomyelitis due to transmission of indigenous wild poliovirus occurred in Italy in 1982. To achieve the certification of the eradication of poliomyelitis in Italy, an active surveillance of acute flaccid paralysis (AFP) in the population aged less than 15 years was set up following the World Health Organization (WHO) guidelines. The survey started in 1996 with a pilot study involving 4 out of 21 regions, and was gradually extended to a national level in 1997. The two-year survey identified five patients with diagnosis of vaccine associated paralytic poliomyelitis (VAPP). Polioviruses type 2 and 3 Sabin-like were isolated and characterized in three of them. In the remaining two cases, samples were collected late after the onset of symptoms, and poliovirus could not be isolated. No wild polioviruses were detected during the survey. The rate of non-polio AFP found in Italy in 1997 was 0.61 cases per 100,000, which is lower than the level of 1.0 case per 100,000 considered as acceptable by the WHO. This was mainly due to the delay in organizing the hospital network and starting the active search of AFP cases in the largest and most densely populated regions. Therefore, the overall rate of AFP found in Italy underestimates the global effectiveness of the program, which however will be better evaluated in the next few years. This study is the first systematic attempt to determine the rate of AFP in Italy.

Adolescent↗
PubMed1999

[Congenital forms of hypothyroidism: study of risk factors and preventive interventions].

Maternal and child health represents one of the most relevant fields of interest in public health and particular attention is given to congenital pathologies. In Italy, the incidence of congenital hypothyroidism (CH) is 1:3200 live birth. CH is diagnosed at birth by neonatal thyroid screening. This allows a precocious onset of substitutive therapy which avoids severe psychomotor deficits in infants with CH. Moreover, the newborn screening program have permitted to identify transient disorders of thyroid function in newborns. These are essentially due to neonatal, maternal and environmental risk factors, especially iodine deficiency. The National Register (NR) of infants with CH was established in 1987. The aim of the NR is to provide disease surveillance and to monitor efficiency and effectiveness of neonatal screening. Furthermore, the NR represents an useful tool for developing epidemiological studies to identify possible environmental and/or familial risk factors of CH.

Case-Control Studies↗
PubMed1999

[Care in pregnancy, labor, and during the puerperium in Italy].

In 1995-96 a KAP (knowledge, attitude and practice) survey on care during pregnancy, delivery and in the post-natal period was carried out in Italy by the National Institute of Health (Istituto Superiore di Sanità). A sample of 9004 women was interviewed in 13 regions within two months of the delivery. Care during pregnancy was generally at a good standard, but with an excessive use of some medical procedures. The level of knowledge was often low and some non-invasive but effective methods for preventing negative outcomes were not widely adopted. Many women were ill informed about the procedures to which they were subjected and their degree of satisfaction was often low. In general, a wide geographic variability and a lack of continuity in pre- and post-natal care were observed.

Cross-Sectional Studies↗
PubMed1999

[Family health services and preventive strategies].

Health promotion is effective if it is based on the active offer of preventive measures to the target population. The active offer must be sustained by non standardised communication procedures, with the aim of producing empowerment of involved people. People, who are socially deprived and therefore at high risk, are hard to reach. They need special attention and resources. Prevention services and, in particular, those devoted to women, children and adolescents must be sufficiently diffused among the population. They must change from being dependent on demand to being based on active offer of preventive measures.

Adolescent↗
PubMed1999

[Evolution of voluntary interruption of pregnancy in Italy from its legalization until today].

Induced abortion was legalized in Italy in 1978. After an initial increase in the incidence, from 187,631 in 1979 to 234,801 in 1983, induced abortion has steadily decreased to 140,398 in 1996. Analysis of the abortion rates has shown that the main decrease has been among married women aged 25-35, while there has been an increase among unmarried women. Women with lower levels of education tend to have higher rates and housewives have higher rates than women in paid work. Programmes for the prevention of induced abortion should be directed at directed at easily accessible groups: women who have just delivered a baby, couples who marry, teenagers in school and women who have already had an induced abortion. In any case, the need for rationalisation of the procedure to obtain an induced abortion is urgent.

Abortion, Legal↗
PubMed1999

[Control of congenital toxoplasmosis in Italy: The project of the Istituto Superiore di Sanità].

Toxoplasma gondii infection during pregnancy is a public health concern; many resources are used in diagnostic and therapeutic activities, sometime with a low benefit/cost due to lack of standardization in practices. In the lack of suitable epidemiological knowledge at national level regarding the congenital toxoplasmosis trend in Italy, an evaluation of the public health impact of this pathology is required. The Istituto Superiore di Sanità (ISS) has worked out a project on a prevalence-incidence study at national level, performing standard reference methods for diagnosis and both case definition and case management. Furthermore, the ISS urges all the involved centers on congenital toxoplasmosis to set up a network for an active collaboration to this project.

Female↗
PubMed1999

[Incidence of measles in Italy in the 1985-1994 period].

Measles notifications in Italy underestimate the actual incidence by a factor of ten, as it is ascertained by seroepidemiological investigation. In the decade 1980-89, 45,000 measles cases were notified, on average, per year. Since 1988 mass vaccination campaigns were implemented in several Italian regions. The strategy aimed to offer the prophylaxis actively to all children aged 13 months to 8-12 year for whom a sure recollection of measles was absent. The study has aimed to evaluate the impact of the strategy that worked in the period 1989-91, on the standardised average annual incidence of measles notification, comparing the periods 1985-89 and 1990-94. A reduction of 45% resulted all over Italy. On the contrary the incidence of chickenpox notifications has increased, indicating that the notification system did not worse.

Adolescent↗
PubMed1999

[Pilot study on compulsory vaccination coverage].

The disappearance of diphtheria and poliomyelitis is the best evidence of the efficacy of the vaccination strategies adopted in Italy. The active offer of the prophylaxis, reinforced by law, has characterised the operational aspects of the strategy. The active surveillance system is the main tool to take under control the effectiveness of health services responsible for vaccination. This system could be more easily implemented if the health services will be given a specific software aiming to handle and evaluate vaccination registers. The present pilot study, performed in the regions Marche and Sardegna, is an example of active surveillance and it is based on the ARVA software produced by the Istituto Superiore di Sanità. The results show a good level of coverage (> 95%) within the second year of life. Unsatisfactory results were obtained on the timing of vaccinations, as recommended by the vaccination schedule, mostly for the third doses.

Diphtheria-Tetanus-Pertussis Vaccine↗
PubMed1998

Seroepidemiological evaluation of 1989-91 mass vaccination campaigns against measles, in Italy.

In 1989-91 anti-measles vaccination campaigns were conducted in several Italian regions to vaccinate all children aged between 13 months and 10-12 years without a history of measles or measles vaccination. This study was conducted to evaluate serological status after the mass vaccination campaigns. In 1994, capillary blood samples were collected from randomly selected children, aged 2-14 years, living in 13 local health units. Antibody titres were determined by ELISA. Blood spot samples were analysed for 4114 (75.6%) of 5440 selected children. Among the 835 that reported measles before 1990, 806 (96.5%) were immune and of the 2798 vaccinated, 2665 (95.2%) were immune. The Edmoston-Zagreb (E-Z) strain vaccine was associated with a lower level of immunity than the Schwarz (SW) strain. A history of measles identified almost all immune children. Vaccination with the SW strain conferred persistent immunity (at least 5 years) in 98% of vaccinees. The strategy was able to unite natural and induced immunity.

Antibodies, Viral↗
PubMed1998

[Transient congenital hypothyroidism in iodine deficiency areas. Gruppo di Studio per il Registro Nazionale degli Ipotiroidei Congeniti].

On the basis of data collected in the National Register of infants with congenital hypothyroidism (CH), a mean incidence of 1 case of CH to 3200 live births has been estimated in Italy. Nevertheless a higher incidence (> 1:2000) than national mean value has been observed in several districts of our country. The aim of this study was to verify a possible occurrence of transient hypothyroidism (TH) in these areas. Results of our study showed that the proportion of infants with thyroid in situ was significantly higher in the areas with very high CH incidence than in the remaining parts of the country. Also serum TSH levels at confirmation showed a less severe hypothyroidism in infants of these areas when compared with the other CH infants. Furthermore, preliminary results of diagnosis reevaluation showed 58% of TH in the areas with CH incidence > 1:2000. Lower percentages of TH have been observed in the other areas in relation to the decreasing of CH incidence. Most of the high CH incidence areas are historically affected by iodine deficiency. This observation supports the hypothesis that iodine deficiency can contribute to the occurrence of transient disorders of thyroid function in our population and stresses the need of promoting diffusion of an adequate iodine prophylaxis.

Congenital Hypothyroidism↗
PubMed1998

[Ethical aspects of strategies for prevention].

Prevention must be offered actively to all sections of the target population. The spontaneous process select people at lower risk. The active offer of preventive measures must be modulated on the difficulty to be reached of the different sections of the target population. The main problem of prevention is that the risk factors of non compliance are the same for a higher incidence or prevalence of events or conditions. The efficacy of a preventive strategy is valuable observing a reduction of the incidence or prevalence of preventable events or conditions in a definite period of time and in a defined community. In the case of prevention ethical and professional quality coincide.

Clinical Competence↗
PubMed1997

Prevention of allergies of infants: breast-feeding and special formulas. Influence on the response to immunization.

Infant formulas containing partially hydrolyzed cow milk-proteins are used for the prevention of allergy when maternal milk is not available, and, in preterm infants, also for improving gastric emptying. The nutritional adequacy of such formulas has not yet been completely defined. As the type of feeding may influence the antibody response to immunization, the aim of the present study was to evaluate the antibody response to oral polio virus immunization in term infants and to acellular pertussis and hepatitis B immunization in preterm infants, exclusively fed a partially hydrolyzed cow-milk formula during the first 5 months of life, in comparison with exclusively breast-fed infants. Active immune response occurred in all the infants after the second dose of immunization and no significant difference in the antibody titres was found according to the type of milk. On the basis of these results, it seems that protein nutrition based exclusively on a partially hydrolyzed formula does not impair the response to immunization in both preterm and term infants.

Analysis of Variance↗
PubMed1996

Reducing pain of first trimester abortion under local anaesthesia.

The study aimed to estimate the pain related to first trimester abortion under local and general anaesthesia. One hundred and eighty-one women undergoing abortion of first trimester under local anaesthesia and 198 under general anaesthesia were interviewed 1 h after the end of the procedure. About 50% of all women described their experience as less painful than expected. Over 50% of the women described the pain during the procedure as mild or moderate according to the verbal rating scale. The step-up logistic regression analyses identified four important variables: time interval less than 2 min from local anaesthesia injection to the beginning of the procedure (RR = 3), lack of choice between local and general anaesthesia (RR = 1.9), history of frequent use of analgesics (RR = 1.9) and nulliparity (RR = 1.7). These data indicate that skillfully performed abortion with local anaesthesia is a procedure tolerated by most women. Moreover, because it carries lower risk of complications and costs less, its use should be encouraged.

Abortion, Induced↗
PubMed1996

Persistence of immunity to poliomyelitis among a southern population that received four doses of OPV 5 to over 15 years before.

The immune status against polioviruses was investigated in a population of 545 students aged 11-20 years residing in the Neapolitan area, who had completed the vaccination cycle with four doses of OPV 5 to over 15 years before. Assuming as unprotected those individuals without detectable neutralizing antibodies at the dilution 1:2, nobody resulted without protection against all types of poliovirus; 0.7% lacked antibodies only against type 1, 0.6% only against type 3 and none against type 2. A very slight decreasing trend was observed for GMT values in function of the distance from the last dose of OPV for polio 1 and 2, but not for polio 3. As expected, GMT values for polio 2 resulted higher than those for polio 1 and both were higher than those for polio 3, when calculated by age groups as well as by distance groups. The last four Italian cases of autochthonous paralytic poliomyelitis, occurred in the period 1981/83, regarded unvaccinated children aged 6 months-2 years, residing in the same geographical area to which the study population belong. In the same area a delay of immunization practices was also ascertained in the recent past. Results of this study confirm that a priority for public health services is to devote their human and economic resources to reduce the vaccination delay more than administrate a further fifth dose of OPV at the age of twelve.

Adolescent↗
PubMed1994

[Neonatal screening in congenital hypothyroidism in Italy. The National Registry].

Neonatal screening for congenital hypothyroidism (CH) began in Italy in 1977 and then progressively developed covering 97% of live births in 1992. The National Register of infants with congenital hypothyroidism was established in 1987 as a project of the Health Ministry and is coordinated by the Italian Institute of Health. The aim of the Register is to provide disease surveillance, to monitor the efficiency and effectiveness of neonatal screening and to allow the identification of possible etiological risk factors in congenital hypothyroidism. The results of the Register provided valuable epidemiological informations about congenital hypothyroidism in Italy and evidenced several areas in whom an increased incidence probably caused by iodine deficiency was observed. Discussion of Register data during annual national meetings has allowed an improvement of the screening program with particular regard to the beginning of therapy with L-thyroxine and its dose. Because of the wide spectrum of collected information, the National Register represents a useful tool for developing of collaborative studies concerning some aspects of CH not yet completely elucidated.

Congenital Hypothyroidism↗