Mortality due to sudden infant death syndrome in Northern Italy, 1990-2000: a baseline for the assessment of prevention campaigns.

The aim of this paper is to estimate the infant mortality rate and the incidence of sudden infant death syndrome (SIDS) in Lombardy, Northern Italy, in the period 1990-2000 and to provide basic information for a subsequent comparison of the SIDS incidence before and after the risk-intervention campaign. A retrospective epidemiological study was carried out using all deaths of resident infants occurring up to 1 year of age as recorded by the health districts mortality registries of the Lombardy region, between 1990 and 2000. The infant mortality rate was 4.1 per 1000 live births, with a significant decreasing trend. This decrease is mainly due to the fall in mortality for congenital malformations and perinatal diseases. The SIDS incidence rate was 0.13 per 1000 live births; the annual incidence of SIDS during the study period decreased significantly by 60% from 0.20 to 0.08 deaths per 1000 live births (P = 0.001). When 'possible SIDS deaths', not directly labelled as SIDS, were also considered, the rate of SIDS was 0.54 per 1000 live births. The incidence of SIDS in Northern Italy appears much lower than anticipated. SIDS remains the single leading cause of death in the first year of life after the early neonatal period.

[Infant mortality and sudden crib death in Lombardy]. / Mortalità infantile e morte improvvisa in culla in Lombardia.

OBJECTIVE: To estimate the infant mortality rate and the incidence of Sudden Infant Death Syndrome (SIDS) which is not known in Italy. DESIGN: Retrospective mortality study using all deaths of resident infants occurring up to one year of age as recorded by the Italian Institute of Statistics, between 1994 and 1996. SETTING: Lombardy, Northern Italy. MAIN OUTCOME MEASURES: Infant mortality rate (deaths occurring in the 1st year of life), early neonatal mortality rate (1st-7th days of life), late neonatal mortality rate (8th day of life-1st month of life), post-neonatal rate (1st month-one year of life), and incidence of SIDS (Sudden Infant Death Syndrome). RESULTS: The infant mortality rate was 4.76 per 1,000 live births, with no significant differences among the three years and lower than the Italian rates. The SIDS incidence rate was 0.14 per 1,000 live births, and 0.39 per 1,000 live births when deaths not directly labelled as SIDS were considered. SIDS was the single leading cause of death in the first year of life after the early-neonatal period. CONCLUSIONS: The decrease of the infant mortality rate is due to the drop in mortality for congenital malformations and perinatal diseases. The incidence of SIDS in Northern Italy turns out to be low, while SIDS remains the single leading cause of death in the first year of life after the early neonatal period.

Experience with external quality assessment of drugs of abuse testing in the Lombardy Region in Italy.

Following up previous experience with External Quality Assessment (EQA) and Proficiency Testing Programs (PTP) on drugs of abuse (DoA) testing in Italy and in other European countries, the government of the Lombardy Region, first among Italian regions, established in 1995 a compulsory EQA scheme for laboratories authorized to perform these tests. The purpose of the present work is the description of the program and the overall evaluation of the results obtained in the first three annual cycles (1995-1998). During each annual cycle laboratories received 22 urine samples; some samples were collected from patients ("real samples") and some were "spiked" urine samples. Both types of samples could contain the following substances/classes of substances: opiates, cocaine, cannabinoids, methadone, buprenorphine, benzodiazepines, barbiturates. Type A laboratories used an immunological screening method; they expressed the results as concentrations. Type B laboratories, authorized to perform screening methods followed by confirmatory techniques, searched for and identified single substances and provided an interpretation on possibly taken drugs. During the study period the laboratories produced about 21,000 analytical results. Among them, false-negative results were 0.9% of true positives, and false-positive results were 0.7% of true negatives. Performance using the spiked samples was better than using real samples, and performance of type B laboratories better than that of type A. The results obtained during the program are consistent with those of other quality control programs. This program, in addition, has provided information on the status of DoA testing in the Lombardy region's laboratories, in particular on their analytical performance, on the quality of interpretation of results and on a degree of improvement achieved during the program.