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Foltran F.,University of Padua | Ballali S.,Prochild ONLUS | Passali F.M.,University of Rome Tor Vergata | Morra B.,San Giovanni Battista Molinette Hospital | And 4 more authors.
International Journal of Pediatric Otorhinolaryngology | Year: 2012

Background: Very recently, some attempts have been made to start a systematic collection of foreign bodies (FB) in view of using them to characterize the risk of chocking in terms of size, shape and consistency of the FB. However, most of the epidemiologic evidence on foreign bodies in children comes from single-center retrospective studies, without any systematic geographical and temporal coverage. This paper is aimed at providing an estimate of the distribution of foreign body's injuries in children according to gender, age, type of FB, site of obstruction, clinical presentation, diagnostic/therapeutic procedures, complications, as emerging from a meta-analytic review of published papers. Methods: A free text search on PubMed database ((foreign bodies) OR (foreign body)) AND ((aspiration) OR (airways) OR (tracheobronchial) OR (nasal) OR (inhalation) OR (obstruction) OR (choking) OR (inhaled) OR (aspirations) OR (nose) OR (throat) OR (asphyxiation)) AND ((children) OR (child)) finalized to identify all English written articles referring to foreign body inhalation over a 30. years period (1978-2008) was performed. The target of the analysis has been defined as the proportion of injuries as reported in the studies, stratified according to children demographic characteristics, type of FB, site of obstruction. The pooled proportions of FB were calculated using the DerSimonian and Laird approach. Results: 1699 papers were retrieved and 1063 were judged pertinent; 214 English written case series were identified, among them 174 articles were available and have been included in the analysis. Airway foreign body most commonly occurs in young children, almost 20% of children who have inhaled foreign bodies being between 0 and 3. years of age. Organic FB, particularly nuts, are the most documented objects while, among inorganic FBs, the greatest pooled proportion has been recorded for magnets, which can be particularly destructive in each location. Non specific symptoms or a complete absence of symptoms are not unusual, justifying mistaken or delayed diagnosis. Acute and chronic complications seem to occur in almost 15% of patients. Conclusions: Even if an enormous heterogeneity among primary studies seems to exist and even if the absence of variables standardized definitions across case series, including class age definition and symptoms and signs descriptions, seriously impairs studies comparability, our results testify the relevant morbidity associated with foreign body inhalation in children, stressing the importance of preventive measures. © 2012 Elsevier Ireland Ltd.


Vecchio M.G.,Prochild ONLUS | Berchialla P.,University of Turin | Didier N.,Sociedad Pino y Didier ltd | Cayul O.,Sociedad Pino y Didier ltd | And 3 more authors.
Open Obesity Journal | Year: 2013

The prevalence of obesity and overweight in children and adolescents during the last decades has reached the epidemic level in both developed and in developing countries. Besides the genetic aspects, which represent one of the motivating factors in the progress of obesity, the shift in the energetic balance also plays a significant role in the development of obesity. TV viewing and the high-calorie snack foods consumption have come under more scrutiny as potential causes of increased obesity in children and adolescents. The aim of the present work was to develop an instrument that allows to estimate the Chilean children's brand awareness. We developed the IBAI (International Brand Awareness Instrument), an age-appropriate instrument that uses twelve sheets with pictures of food logos to test children's recall and recognition. The IBAI was presented to a sample of 80 children aged from 3 to 10 years, enrolled in the city of Santiago de Chile. The instrument allowed distinguishing different kinds of children's brand awareness. Considering the total score reached by each child, the majority of the children for both genders showed a medium-low brand awareness (32.5%) followed by medium-high brand awareness (31.3%), high brand awareness (23.8%) and low brand awareness (12.5%). Although the study confirmed the moderate brand logo recognition in the children tested, it did not demonstrate a close relationship between this and the children's reported eating behaviors, food knowledge and preferences. © Vecchio et al.


Sih T.,University of Sao Paulo | Sih T.,University of Siena | Bunnag C.,Mahidol University | Bunnag C.,University of Siena | And 6 more authors.
International Journal of Pediatric Otorhinolaryngology | Year: 2012

Rationale and aim: This paper has the object to present the impact of nuts' and seeds' injuries withdrawing data from the Susy Safe registry, highlighting that as for other foreign bodies the main item efficiently and substantially susceptible to changes to decrease the accidents' rates is the education of adults and children, that can be shared with parents both from pediatricians and general practitioners. Indeed labeling and age related warnings have also a fundamental relevance in prevention. Methods: The present study draws its data from the Susy Safe registry. Details on injuries are entered in the Susy Safe Web-registry through a standardized case report form, that includes information regarding: children age and gender, features of the object, circumstances of injury (presence of parents and activity) and hospitalization's details (lasting, complications and removal details). Cases are prospectively collected using the Susy Safe system from 06/2005; moreover, also information regarding past consecutive cases available in each centre adhering to the project have been entered in the Susy Safe registry. Results: Nuts and seeds are one of the most common food item retrieved in foreign bodies injuries in children. In Susy Safe registry they represent the 38% in food group, and almost the 10% in general cases. Trachea, bronchi and lungs were the main location of FB's retrieval, showing an incidence of 68%. Hospitalization occurred in 83% of cases, showing the major frequency for foreign bodies located in trachea. This location was also the principal site of complications, with a frequency of 68%. There were no significant associations between these outcomes and the age class of the children. The most common complications seen (22.4%) was bronchitis, followed by pneumonia (19.7%). Adult presence was recorded as positive in 71.2% of cases, showing an association (p value 0.009) between the adult supervision and the hospitalization outcome. On the contrary there was a non significant association between adult presence and the occurrence of complications. In 80.7% of cases, the incident happened while the child was eating. Among those cases, 88.6% interested trachea, lungs and bronchi. Conclusions: Food-related aspiration injuries are common events for young children, particularly under 4 years of age, and may lead to severe complication.There is a need to study in more depth specific characteristics of foreign bodies associated with increased hazard, such as size, shape, hardness or firmness, lubricity, pliability and elasticity, in order to better identify risky foods, and more precisely described the pathogenetic pathway. Parents are not adequately conscious and aware toward this risk; therefore, the number and severity of the injuries could be reduced by educating parents and children. Information about food safety should be included in all visits to pediatricians in order to make parents able to understand, select, and identify key characteristics of hazardous foods and better control the hazard level of various foods. Finally, preventive measures including warning labels on high-risk foods could be implemented. © 2012 Elsevier Ireland Ltd.


Sarafoleanu C.,Sfanta Maria Hospital | Ballali S.,Prochild ONLUS | Gregori D.,University of Padua | Bellussi L.,University of Siena | Passali D.,University of Siena
International Journal of Pediatric Otorhinolaryngology | Year: 2012

Background: Foreign bodies (FB) injuries are an issue that has been recognized and investigated since many years; despite that, the impact of this subject in literature and research is still small. Such kind of injuries identifies all incidents due to ingestion, inhalation, insertion and aspiration of an object into the aero digestive tract. FBs injuries located in the upper airways can be a very serious event, sometimes resulting in fatal outcome. Methods: A retrospective study was performed on FB injuries in the aerodigestive tract in paediatric patients 1-17 years old, recorded from the ENT Department of the M. S. Curie Hospital in Bucharest. Results: 455 cases were reported from the M. S. Curie Hospital, ENT Department. Prevalence in female patients is higher than the males (225 males and 230 females). Mean age observed was 4.12 years. The distribution of injuries according to the retrieval location showed a higher prevalence in the nose (44.62% of cases), with a higher occurrence in females (50.74%) followed by the digestive system (24.28% of cases) were the distribution between males and females is equal. The highest prevalence was represented by nuts and seed (23.96%), followed by marble and coins (respectively 12.75% and 12.53%). Conclusions: As generally described in scientific literature, injuries usually concerned toddlers and preschoolers, while school-aged children less often place foreign objects in their noses. Our results confirm the fact that when passive preventive strategies are not practical, active strategies that promote behaviour change are necessary. Active strategies require that a caregiver changes his or her behaviour each time the child begins an activity that has the potential to cause injury. Education is critical to these active strategies and plays a complementary role to environmental changes and legal mandates. © 2012 Elsevier Ireland Ltd.


Ballali S.,PROCHILD Onlus | Lanciai F.,Food Research and Innovation Srl
International Journal of Food Sciences and Nutrition | Year: 2012

Diabetes shows a wide range of variation in prevalence around the world and it is expected to affect 300 million by the year 2025. In a prevention framework where banning policies and educational strategies lead the interventions, functional foods (FFs) with their specific health effects could, in the future, indicate a new mode of thinking about the relationships between food and health in everyday life. Functional ingredients, such as stevioside, cinnamon, bitter melon, garlic and onion, ginseng, Gymnema sylvestre and fenugreek, have been addressed for their specific actions towards different reactions involved in diabetes development. New strategies involving the use of FF should be validated through large-scale population trials, considering validated surrogate end points to evaluate the effect of FF in prevention of chronic diseases such as type 2 diabetes mellitus. © 2011 Informa UK, Ltd.


PubMed | University of Padua, Prochild ONLUS, Tbilisi State Medical University and Miashvili Central Children Hospital
Type: | Journal: International journal of pediatric otorhinolaryngology | Year: 2016

Suffocation due to foreign bodies (FB) is a leading cause of death in children aged 0-3. No data from the former U.S.S.R. are available in the international scientific literature.Consecutive patients admitted at the Iashvili Central Children Hospital in Tbilisi, Georgia from 1989 to 2011 were analyzed. Injuries in the upper airways due to foreign bodies inhalation were collected and compared with the Susy Safe Registry and the pooled estimates of the meta-analysis.2896 cases were collected. Distribution of injuries in children younger than 3 years was significantly higher than in the Susy Safe Registry and in the High-Income countries in the meta-analysis. Percentage of injuries due to organic objects (86%) was significantly higher than in published data.Since Georgia is not showing any substantial difference, both in epidemiology and treatment of foreign bodies injuries, as compared to the other case series, translation of public health initiatives from other most advanced prevention experiences is possible and it is likely to be effective.Level V, Epidemiological case series.


PubMed | University of Padua, Prochild ONLUS, Hospital Of Clinicas Jose Of San Martin, Hospital Of Pediatria Juan P Garrahan and San Daniele del Friuli Hospital
Type: Journal Article | Journal: International journal of pediatric otorhinolaryngology | Year: 2015

To provide an epidemiological framework of symptoms related to Foreign Body (FB) injuries due to Button Battery (BB).Data on BB ingestion/inhalation have been obtained from the ButtonBatteryDB. The ButtonBatteryDB is a database collecting information on BB injuries in children (0-18 years of age). Data on 348 BB injures have been derived from the Registry of Foreign Body Injuries Susy Safe (269 cases) and from published scientific literature reporting case reports of FB injuries (79 cases).Most of injured children were male and BBs were found more often in the mouth/esophagus/stomach (ICD935) and in the nose (ICD932). Analyzing symptoms related to BB located in the esophagus/mouth/stomach, we found that children had higher probability of experiencing dysphagia (30.19%, 95% C.I. 17.83-42.55), fever and cough (26.42%, 95% C.I. 14.55-38.28), compared to the other symptoms. Referring to the probability that symptoms occurred simultaneously, fever and cough are more likely (3.72%, 95% C.I. 1.0-6-43) to jointly showing up in children with BB in mouth/esophagus/stomach (ICD935), followed by fever and dysphagia (2.66%, 95% C.I. 0.36-4.96) and by fever and irritability/crying, fever and drooling, dysphagia and irritability/crying (2.13% C.I. 0.00-4.19, 95% C.I.)These findings provide new insight in clinical presentation of BB injuries: the identification of unique patterns of symptoms related to BB injuries is useful to perform an early diagnosis (and to guarantee a prompt medical reaction), also when the injury is un-witnessed.


Gregori D.,University of Padua | Ballali S.,Prochild ONLUS | Vogele C.,University of Luxembourg | Gafare C.E.,University of Buenos Aires | And 2 more authors.
International Journal of Food Sciences and Nutrition | Year: 2014

Nutrition labels on pre-packaged foods have been widely used as a medium to foster healthier eating habits in the general population, to contribute to a reduction in the incidence and prevalence of diet-related conditions. Yet, there is no convincing evidence that food labels are an effective means to achieve the desired effect at population level. Several factors have been suggested to account for this decoupling of efficacy, e.g. difficulties in understanding the information on food-labels. The present article presents the results of a survey on Europeans' understanding of nutritional labels and evaluation on the communication tools for their diffusion. A total of 7550 phone interviews were conducted in 16 European Countries: Austria, Belgium, Denmark, France, Germany, Greece, Italy, the Netherlands, Poland, Portugal, Czech Republic, Slovenia, Spain, Sweden, United Kingdom and Hungary. Consumers were asked about their opinion on nutritional information provided at different levels and their commitment to healthy behaviour. © 2014 Informa UK Ltd.


Ballali S.,Prochild Onlus | Vecchio M.G.,Prochild Onlus | Chiffi D.,University of Padua | Gafare C.E.,University of Buenos Aires | Gregori D.,University of Padua
Open Obesity Journal | Year: 2013

Obesity has become, nowadays, a global concern affecting both developed and developing countries. Nutrition and physical activity represent the major factors influencing energy balance and subsequently weight status. Deciding toward an appropriate intake of all nutrients is seen as necessary to maintain a wholesome lifestyle: among nutrients, sugar plays a major role and its consumption has long been seen as an issue in public health, due to its possible role in displacing or diluting nutrients in the diet and contributing to the epidemic of obesity. A research on Pubmed was assessed to evaluate the impact of confectionery consumption, as sugar source, on the daily energy intake. The studies considered in the current paper generally failed to show that confectionery consumption leads necessarily to a shift of energy intake. Anyway, considering that till now, very few works on this topic were conducted, more researches are necessary to demonstrate the effective influence of confectionery on daily energy intake. © Ballali et al.


Chinski A.,University of Buenos Aires | Foltran F.,University of Padua | Gregori D.,University of Padua | Ballali S.,Prochild ONLUS | And 2 more authors.
International Journal of Pediatric Otorhinolaryngology | Year: 2012

Rationale and aim: Foreign bodies (FB) aspiration, ingestion, insertion or inhalation can be a serious occurrence, resulting in fatality if not promptly recognized and solved. The aim of the current paper is to present foreign body ingestion's cases observed at the Children's Hospital Gutierrez in Buenos Aires in 5 years of ORL activity and to compare main findings with data coming from other well known already published case series. Methods: A prospective study was realized on children having ingested, inhaled, aspirated or introduced FBs, with regard to age and sex distribution, FB's type, dimensions and consistency, FB's location, clinical presentation, removal and occurrence of complications. Results: FBs retrieved amounted to 2336 cases. The most common location was the nose (66.7%), where the most frequent FBs retrieved were inorganic (72.7%) and occurred in children younger than 3 years old (54.2%), the only position where children younger than 3 years are a majority in respect to the older ones. The presence of the adult was seen in the preponderance of cases (88.4%). Symptoms varied between the different anatomical systems, with cough as predominant when concerning aspiration, local pain or inflammation in inhalation and insertion, and vomiting in for the FBs ingestion cases. All the foreign bodies retrieved were clustered in categories, due to necessity when extremely various and with low absolute frequency. The most common FBs retrieved were pearls (20.2%), followed by stationery products (mostly rubbers) and coins. Complications had a low rate in all the studies. Conclusions: The study stresses the importance of primary prevention, seen as the active care of adults toward children manipulating foreign bodies potentially dangerous. This presence may not avoid the event, but in case of FBs aspiration, ingestion, insertion or inhalation, it could be the main factor leading to a faster and correct treatment. Prompt removal of the foreign body decreases the risk of complications, resulting in a lower length of hospitalization.Symptoms were various and differed in all the studies, showing that their wide amount indicates the importance of registries to early recognize and therefore treat a pathology that might be mistaken for something different due to unspecific signs. Secondary prevention with specific training of doctors on clinical post-trauma guidelines for treatment and active participation of doctors to the broadening of the current registries seem to be other ways for lowering the outburst of FBs injuries. © 2012 Elsevier Ireland Ltd.

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