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Mariani G.,University of Ferrara | Napolitano M.,University of Palermo | Dolce A.,National Institute of Statistics | Batorova A.,University Hospital | And 9 more authors.
Thrombosis and Haemostasis | Year: 2013

Patients with inherited factor VII (FVII) deficiency display different clinical phenotypes requiring ad hoc management. This study evaluated treatments for spontaneous and traumatic bleeding using data from the Seven Treatment Evaluation Registry (STER). One-hundred one bleeds were analysed in 75 patients (41 females; FVII coagulant activity <1-20%). Bleeds were grouped as haemarthroses (n=30), muscle/subcutaneous haematomas (n=16), epistaxis (n=12), gum bleeding (n=13), menorrhagia (n=16), central nervous system (CNS; n=9), gastrointestinal (GI; n=2) and other (n=3). Of 93 evaluable episodes, 76 were treated with recombinant, activated FVII (rFVIIa), eight with fresh frozen plasma (FFP), seven with plasma-derived FVII (pdFVII) and two with prothrombin-complex concentrates. One-day replacement therapy resulted in very favourable outcomes in haemarthroses, and was successful in muscle/subcutaneous haematomas, epistaxis and gum bleeding. For menorrhagia, single- or multiple-dose schedules led to favourable outcomes. No thrombosis occurred; two inhibitors were detected in two repeatedly treated patients (one postrFVIIa, one post-pdFVII). In FVII deficiency, most bleeds were successfully treated with single 'intermediate' doses (median 60 μg/kg) of rFVIIa. For the most severe bleeds (CNS, GI) short- or long-term prophylaxis may be optimal. © Schattauer 2013.


Federico B.,University of Cassino and Southern Lazio | Federico B.,Erasmus Medical Center | Mackenbach J.P.,Erasmus Medical Center | Eikemo T.A.,Erasmus Medical Center | And 3 more authors.
Journal of Epidemiology and Community Health | Year: 2013

Background: Previous studies have shown that mortality inequalities are smaller in Italy than in most European countries. This may be due to the weak association between socioeconomic status and smoking in Italy. However, most published studies were based on data from a single city in northern Italy (Turin). In this study, we aimed to assess the size of mortality inequalities in Italy as a whole, their geographical pattern of variation within Italy, and the contribution of smoking to these inequalities. Methods: Participants in the National Health Interview Survey 1999-2000 were followed up for mortality until 31 December 2007. Using Cox regression, we computed the age-adjusted relative index of inequality (RII) for allcause mortality with and without controlling for smoking status and intensity. Education was used as an indicator of socioeconomic status. Results: Among 72 762 individuals aged 30-74 years at baseline, 4092 died during the follow-up. The ageadjusted RII of mortality was 1.69 (95% CI 1.44 to 2.00) among men and 1.43 (95% CI 1.13 to 1.82) among women. Among men, inequalities were larger in both northern and southern regions than in the middle of the country, whereas among women they were larger in the south. After controlling for smoking RII decreased to 1.63 (95% CI 1.38 to 1.92) among men and increased to 1.54 (95% CI 1.21 to 1.96) among women. The geographical variation in mortality inequalities was not affected by smoking adjustment. Conclusions: Mortality inequalities in Italy are smaller than in most European countries. This is due, among other factors, to the weak socioeconomic pattern of smoking over the past decades in Italy.


Ndawinz J.D.A.,French Institute of Health and Medical Research | Chaix B.,French Institute of Health and Medical Research | Koulla-Shiro S.,Central Hospital | Delaporte E.,Montpellier University | And 7 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2013

Objectives: Many people living with HIV/AIDS in resource-limited settings begin antiretroviral therapy (ART) at low CD4 counts. Here, we investigated the simultaneous effect of individual-, facility- and regional-level factors on late ART initiation. Methods: We conducted a survey in a nationally representative sample of 55 HIV treatment facilities in Cameroon. Medical records of 4935 patients >15 years of age who initiated ART in the month of October during the period 2007-10 were reviewed to gather individual characteristics. Late ART initiation was defined as CD4 count≤100 cells/mm3. Facility- and regional-level characteristics were also collected. Two-level regression logistic models were used to identify factors associated with late ART initiation. Results: Late ART initiation was associated with being a male younger than 45 years versus female younger than 45 years [adjusted OR (AOR)=1.5, 95% CI: 1.3-1.7] and initiating ART in the period 2007-09 versus 2010 (AOR=1.2, 95% CI: 1.0-1.4). Late initiation was more likely in central than in district hospitals (AOR=1.3, 95% CI: 1.1-1.6) and in hospitals without a mother-to-child transmission programme (AOR=1.9, 95% CI: 1.3-2.8). Living in a region with a higher comprehensive knowledge of HIV/AIDS was associated with not initiating ART late (AOR=0.8, 95% CI: 0.6-1.0). Conclusions: This study shows that risk factors associated with late ART initiation operate at multiple levels and that multilevel interventions are therefore necessary to promote earlier HIV testing and treatment ©The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Mariani G.,University of L'Aquila | Dolce A.,National Institute of Statistics | Batorova A.,University Hospital | Auerswald G.,Central Hospital | And 5 more authors.
British Journal of Haematology | Year: 2011

Excessive bleeding represents a major complication of surgical interventions and its control is especially relevant in patients with Congenital Bleeding Disorders (CBD). In factor VII (FVII) deficiency, scanty data on surgery is available to guide treatment strategies. The STER (Seven Treatment Evaluation Registry) is a multi-centre, prospective, observational, web-based study protocol providing the frame for a structured and detailed data collection. Inhibitor occurrence was checked in a centralized fashion. Forty-one surgical operations (24 'major' and 17 'minor') were performed in 34 subjects with a carefully characterized FVII deficiency under the coverage of recombinant activated Factor VII (rFVIIa). Bleeding occurred during three major interventions of orthopaedic surgery, but rFVIIa was given at very low dose in each case. An antibody to FVII was observed in one patient who underwent a multiple dental extraction. No thromboses were reported during the 30-d follow up period. Replacement therapy with rFVIIa proved effective when suitable doses were used, which, during the period of maximum bleeding risk (the day of operation), were calculated (Receiver Operated Characteristic analysis) to be of at least 13 μg/kg/body weight per single dose and no less than three administrations. This indication is important especially in the case of major surgery. © 2010 Blackwell Publishing Ltd.


Marinacci C.,Epidemiology Unit | Grippo F.,National Institute of Statistics | Pappagallo M.,National Institute of Statistics | Sebastiani G.,National Institute of Statistics | And 4 more authors.
European Journal of Public Health | Year: 2013

Background: There is extensive documentation on social inequalities in mortality across Europe, showing heterogeneity among countries. Italy contributed to this comparative research, through longitudinal systems from northern or central cities of the country. This study aims to analyse educational inequalities in general and cause-specific mortality in a sample of the Italian population. Methods: Study population was selected within a cohort of 123 056 individuals, followed up for mortality through record linkage with national archive of death certificates for the period 1999-2007. People aged between 25 and 74 years were selected (n = 81 763); relative risks of death by education were estimated through Poisson models, stratified according to sex and adjusted for age and geographic area of residence. Heterogeneity of risks by area of residence was evaluated. Results: Men and women with primary education or less show 79% and 63% higher mortality risks, respectively, compared with graduates. Mortality risks seem to frequently increase with decreasing education, with a significant linear trend among men. For men, social inequalities appear related to mortality due to diseases of the circulatory system and to all neoplasms, whereas for women, they are related to inequalities in cancer mortality. Conclusions: Results from the first follow-up of a national sample highlight that Italy presents significant differences in mortality according to the socio-economic conditions of both men and women. These results not only challenge policies aimed at redistributing resources to individuals and groups, but also those policies that direct programmes and resources for treatment and prevention according to the different health needs. © 2013 The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.


Napolitano M.,University of L'Aquila | Giansily-Blaizot M.,Montpellier University | Dolce A.,National Institute of Statistics | Schved J.F.,Montpellier University | And 10 more authors.
Haematologica | Year: 2013

Because of the very short half-life of factor VII, prophylaxis in factor VII deficiency is considered a difficult endeavor. The clinical efficacy and safety of prophylactic regimens, and indications for their use, were evaluated in factor VII-deficient patients in the Seven Treatment Evaluation Registry. Prophylaxis data (38 courses) were analyzed from 34 patients with severe factor VII deficiency (<1-45 years of age, 21 female). Severest phenotypes (central nervous system, gastrointestinal, joint bleeding episodes) were highly prevalent. Twenty-one patients received recombinant activated factor VII (24 courses), four received plasma-derived factor VII, and ten received freshfrozen plasma. Prophylactic schedules clustered into "frequent" courses (three times weekly, n=23) and "infrequent" courses (≤2 times weekly, n=15). Excluding courses for menorrhagia, "frequent" and "infrequent" courses produced 18/23 (78%) and 5/12 (41%) "excellent" outcomes, respectively; relative risk, 1.88; 95% confidence interval, 0.93-3.79; P=0.079. Long-term prophylaxis lasted from 1 to >10 years. No thrombosis or new inhibitors occurred. In conclusion, a subset of patients with factor VII deficiency needed prophylaxis because of severe bleeding. Recombinant activated factor VII schedules based on "frequent" administrations (three times weekly) and a 90 μg/kg total weekly dose were effective. These data provide a rationale for long-term, safe prophylaxis in factor VII deficiency (clinicaltrials.gov: NCT01269138). © 2013 Ferrata Storti Foundation.


Zucchetto A.,Centro Of Riferimento Oncologico | Suligoi B.,Instituto Superiore Of Sanita | De Paoli A.,Centro Of Riferimento Oncologico | Pennazza S.,National Institute of Statistics | And 7 more authors.
Clinical Infectious Diseases | Year: 2010

During the period 1999-2006, non-AIDS-defining cancers accounted for 7.4% of deaths among Italian people with AIDS. The risk of death was 6.6-fold higher than in the general population, being particularly elevated for virus-related cancers. The study findings highlighted the importance of monitoring the cancer burden on mortality for people with AIDS. © 2010 by the Infectious Diseases Society of America. All rights reserved.


Salvatore M.A.,National Institute of Statistics | Baglio G.,Instituto per Lo Sviluppo della Formazione Professionale Dei Lavoratori ISFOL | Cacciani L.,Instituto per Lo Sviluppo della Formazione Professionale Dei Lavoratori ISFOL | Spagnolo A.,Instituto per Lo Sviluppo della Formazione Professionale Dei Lavoratori ISFOL | Rosano A.,Instituto per Lo Sviluppo della Formazione Professionale Dei Lavoratori ISFOL
Journal of Immigrant and Minority Health | Year: 2013

In Italy, work-related injuries among immigrant workers are an emerging concern. In this study, we compared the occurrence of work-related injuries between legally residing immigrants from High Migration Pressure Countries and Italians and evaluated the associations with potential risk factors. Using data from the 2007 Labour Force Survey conducted by Italy's National Institute of Statistics, we examined the relationship between the occurrence of work-related injuries in the previous 12 months and being an immigrant among a nationally representative sample. The occurrence of work-related injuries was significantly higher among immigrant males compared to Italian males (adjusted OR = 1.82; 95 % CI 1.53-2.16), particularly in the construction sector, for which the results showed a U-shaped trend of the odds ratios of injuries for immigrants compared to Italians with increasing number of years of work in the same job. No associations were found among women. The findings suggest that prevention programs need to be implemented to limit the burden of work-related injuries among immigrants. © 2012 Springer Science+Business Media, LLC.


Singh P.N.,Loma Linda University | Yel D.,World Health Organization | Kheam T.,National Institute of Statistics | Hurd G.,Loma Linda University | Job J.S.,Loma Linda University
Tobacco Induced Diseases | Year: 2013

Background: Cambodia has very high rates of tuberculosis and smoked tobacco use among adults. Efforts to control both tobacco use and tuberculosis in Cambodia need to be informed by nationally representative data. Our objective is to examine the relation between daily cigarette smoking and lifetime tuberculosis (TB) history in a national sample of adults in Cambodia. Methods. In 2011, a multi-stage, cluster sample of 15,615 adults (ages 15 years and older) from all regions of Cambodia were administered the Global Adult Tobacco Survey by interviewers from the National Institute of Statistics of Cambodia. Results: Our findings include: 1) among daily smokers, a significant positive relation between TB and number of cigarettes smoked per day (OR = 1.70 [95% CI 1.01, 2.87]) and pack-years of smoking (OR = 1.53 [95% CI 1.05, 2.25]) 2) a non-significant 58% increase in odds of ever having being diagnosed with TB among men who smoked manufactured cigarettes (OR = 1.58 [95% CI 0.97, 2.58]). Conclusion: In Cambodia, manufactured cigarette smoking was associated with lifetime TB infection and the association was most evident among the heaviest smokers (> 1 pack per day, > 30 pack years). © 2013 Singh et al.; licensee BioMed Central Ltd.


PubMed | Maternal child health and nutrition, University of Paris Descartes and National Institute of Statistics
Type: | Journal: Journal of health, population, and nutrition | Year: 2016

Early initiation of breastfeeding after birth is a key behavioral health factor known to decrease neonatal mortality risks. Yet, few demographic studies examined how a community-based intervention impacts postpartum breastfeeding among the socio-economically deprived population in Sub-Saharan Africa. A post-intervention evaluation was conducted in 2011 to measure the effect of a UNICEF-led behavior change communication program promoting child health care in rural Niger.A quantitative survey is based on a post hoc constitution of two groups of a study sample, exposed and unexposed households. The sample includes women aged 15-49 years, having at least one child less than 24 months born with vaginal delivery. Rate ratio for bivariate analysis and multivariate logistic regression were applied for statistical analysis. The outcome variable is the initiation of breastfeeding within the first hour of birth. Independent variables include other behavioral outcome variables, different types of communication actions, and socio-demographic and economic status of mothers.The gaps in socio-economic vulnerability between the exposed and unexposed groups imply that mothers deprived from accessing basic health services and hygiene facilities are likely to be excluded from the communication actions. Mothers who practiced hand washing and used a traditional latrine showed 2.0 times more likely to initiate early breastfeeding compared to those who did not (95 % CI 1.4-2.7; 1.3-3.1). Home visits by community volunteers was not significant (AOR 1.2; 95 % CI 0.9-1.5). Mothers who got actively involved in exclusive breastfeeding promotion as peers were more likely to initiate breastfeeding within the first hour of birth (AOR 2.0; 95 % CI 1.4-2.9).A multi-sectorial approach combining hygiene practices and optimal breastfeeding promotion led to supporting early initiation of breastfeeding. A peer promotion of child health care suggests a model of behavior change communication strategy as a response to socio-economic disparity.

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