Early childhood eye diseases and perinatal risk factors: potential of record linkage between current information flows.

BACKGROUND: The aim of this study was to analyze the occurrence of specific maternal, obstetric or neonatal factors, by performing a comparison between children with refractive error, strabismus and/or amblyopia (cases) and unaffected children (controls) in the province of Trento (North-East Italy). METHODS: In 2012-2014, 14,346 children attending the second year of nursery school were assessed through the preschool orthoptic screening scheme (covering 91% of the preschool population). Record linkage was performed between the orthoptic screening database and birth records (birth confirmation certificate database) for the corresponding birth cohorts (2008-2010), to examine specific maternal factors (age, smoking, nationality/race), obstetric factors (type of delivery) and neonatal factors (gestational age, weight at birth, Apgar Score, congenital birth defects, hospitalization at birth). The correlations were investigated using univariate and multivariate analysis in accordance with the logistic regression method. RESULTS: During orthoptic screening, 6.4% of children were found to have at least one refractive error, with astigmatism being the most common condition (5.1%). 1.9% of children were found to have strabismus and 1.8% amblyopia. Multivariate logistic regression analysis showed that the risk of developing a refractive error is associated with: maternal age ≥45 years, foreign nationality, vacuum-assisted delivery and neonatal weight <1500 grams. An excessive risk of strabismus was observed in children whose mother had smoked during pregnancy (adjusted OR=1.64). CONCLUSIONS: Preschool orthoptic screening is a well-consolidated practice in the province of Trento, with adhesion values consistently over 90%. Studies of this type show the potential of record linkage between current information flows.

Breastfeeding during the first year of life: estimates using records generated in general pediatrics.

BACKGROUND: The monitoring of breastfeeding during a child's first year of life is highly recommended. The proportion of children who are exclusively breastfed for at least six months is a strong indicator of breastfeeding promotion in the community. The objectives of the study were to survey the exclusive breastfeeding of children during the first year of life for cohorts born in Trentino (north-eastern Italy) in 2009 to 20013, to evaluate the decrease of exclusive breastfeeding at 6 months and to analyze possible relationships between the maintenance of breastfeeding up to the age of 6 months and certain maternal socio-demographic characteristics, as well as clinical aspects of the pregnancy and birth. METHODS: Cohorts born in Trentino between 2009 and 2013 were studied, calculating the proportion of infants who were breastfed upon discharge from the hospital (source: data on the CedAP informative flow, that is the Italian Certificate of Delivery Assistance data-base). The data provided on the 12-Month Health Evaluation Form found in the Pediatric Health Booklet, completed by regional family pediatricians, was linked with that of the respective CedAP (96.7% linkage). The trend for exclusive breastfeeding and its monthly decrease was analyzed. The maintenance of exclusive breastfeeding until the age of 6 months was analyzed in relation to citizenship, area of residence, maternal education level and employment status, parity, single or multiple birth, infant exposure to passive smoke and attendance or non-attendance of a state-promoted childbirth preparation course. This final variable was studied solely for primiparous women, who are generally most likely to attend a childbirth preparation course. All results were adjusted for the following potential confounding variables: "birth type," "prematurity" and "feeding method upon discharge from the hospital." RESULTS: CedAP data revealed that 83.5% of live infants were exclusively breastfed and that this percentage decreased to 34.7% by the age of 6 months (35.4% among full-term infants and 27% among premature infants). Data from the Province of Trento demonstrates that exclusive breastfeeding up to the age of 6 months is influenced by the mother's citizenship, area of residence and education level, but not by her employment status. In addition, the study revealed a significant association with parity, passive smoke exposure and attendance of a childbirth preparation course. CONCLUSIONS: The Pediatric Health Booklet with its information on the state of health of children (in combination with data from the CedAP) offers a valid tool for monitoring breastfeeding during the first year of life. Data confirmed a decrease in the rate of breastfeeding between birth and the first month of life and between the first and sixth months of living at home. The results regarding the conditions that favour and discourage breastfeeding suggest potential public health care measures to improve children's health.

Surveillance of childhood overweight: comparison of "OKkio alla SALUTE" survey and general paediatrics data in the Province of Trento.

Estimates of childhood overweight and obesity for the Province of Trento provided by the 2014 "OKkio alla SALUTE" survey (Italian national surveillance system for weight and nutrition in children) were compared with estimates provided by paediatric health forms. The Province of Trento is the only region that makes use of the information gathered through these forms, which are completed by primary care paediatricians as part of the 6-year health evaluation. OKkio alla SALUTE data for children, obtained from students enrolled in the third year of primary school in 2014 (845 children aged 8-9 years), were compared with data collected at the age of 6 for cohorts born in 2006, evaluated in 2012-2013 (3101 subjects). The following prevalence figures were obtained from OKkio alla SALUTE and the 6-year paediatrician evaluation respectively: overweight, 17.4% vs 11.7%; obese, 4.1% vs 4.5%; severely obese, 1.4% vs 1.0%. The two information sources provide similar estimates, suggesting the potential for their integrated use.