Bioelectrical Impedance Vector Analysis and Mini Nutritional Assessment in elderly nursing home residents.

OBJECTIVE: The aim of this study was to establish the presence of malnutrition in elderly institutionalized people through Mini Nutritional Assessment (MNA) scores and to observe the changes of nutritional status through the Bioelectrical Impedance Vector Analysis (BIVA). DESIGN: Observational study. SETTING: Nursing home located in the territory of Florence (Italy). PARTICIPANTS: 463 elderly individuals from twelve nursing homes, all aged 65 yrs or over. MEASUREMENTS: We carried out the MNA and measured the bioelectrical parameters of resistance (R) and reactance (Xc), with standard, tetrapolar analysis at 50 kHz frequency; these bioelectrical parameters were interpreted according to BIVA analysis. RESULTS: According to the MNA score, 23.1% of the women and 20.4% of the males are malnourished (MNA < 17), 60.0% and 52.8%, respectively, are at risk for malnutrition (17 ≤ MNA ≤ 23.5). Malnourished, at-risk and well-fed subjects differ significantly (p < 0.05) in their mean scores obtained in each of the MNA areas. Fifteen of eighteen MNA items show a significant correlation to the total MNA score (p < 0.001). The items not significantly related to the MNA global score were those concerning protein intake, independence and number of medicinal drugs taken. In both genders, the decrease of the MNA score increases the proportion of subjects placed outside the 95% confidence ellipse on the BIVA tolerance graph. CONCLUSION: A routine assessment of nutritional status through BIVA analysis combined with more "traditional" tools like the MNA could be useful for recognizing malnutrition and the risk of malnutrition in the elderly as these instruments provide complete information and are easy to use even with heavily impaired subjects.

[Biological contamination by micromycetes in dried Boletus edulis: research of aflatoxin B1, B2 G1, G2 and ochratoxin A]. / Contaminazione da funghi filamentosi su Boletus edulis essiccato: ricerca di aflatossina B1, B2 G1, G2 e ocratossina A.

Aim of this survey is to identify those filamentous fungi which parasite Boletus edulis and its group and check the potential presence of secondary metabolites, specifically aflatoxin B1, total aflatoxins and ochratoxin A, in order to assess the risk to consumers' health. Forty samples of dried Boletus edulis, collected by two food industries which distribute the product in many Italian regions, have been analysed. The sampling plan has been conducted from November 2005 to March 2006, collecting 50 g from each commercial category of dried Boletus edulis available in the factory at the time of sampling. All the samples have been tested by visual macroscopic and stereoscopic assays; for some samples--those referred to commercial category presumably at higher risk--we have performed cultural assays as well, typization of isolated micromycetes, extraction and quantification of aflatoxins and ochratoxin A. Mycotoxin detection has been made by HPLC, using the UNI EN 14123 and UNI EN 14132 standard methods, respectively applied to aflatoxins determination in peanuts, pistachios, figs and paprika and to ochratoxin A in barley and coffee. Non pathogenic micromycetes, common in food products, have been frequently observed in cultural assays, while Aspergillus flavus and Aspergillus niger have been found in some samples. However the concentration of aflatoxins was always under the quantification limit. The survey confirm that, if the cold chain is kept throughout the process and the distribution, Boletus edulis and analogue mycetes are not a favourable substratum for the growth and the development of moulds.

[Body composition, nutritional habits and functional abilities in a sample of eight year old children]. / Composizione corporea, abitudini alimentari e abilita funzionali in un campione di bambini di 8 anni.

Aim of this study is the evaluation of body composition (proxy of nutritional status) and its correlation with functional abilities in a sample of 8-year-old children living in a florentine municipality. We have collected, for each subject, anthropometric variables (weight, height) and carried out bioelectrical impedance test and a group of physical tests to measure strength and physical ability. The results of vectorial interpretation of BIA, together with the analysis of the so called fitness tests, show a comprehensive good body composition and a very low prevalence of obesity for both genders. This fact is confirmed also by data about living and nutrition habits: scarce use of PC and TV (less than two hours a day) and, on the other hand, enough time spent to play in open spaces and to make sport.

[Mobile phone use while driving in Fiorentine area: results of the new survey]. / Utilizzo del telefono cellulare alla guida nel territorio fiorentino: i risultati della nuova indagine.

Despite the growing evidence that the use of hand-held mobile phone while driving increases the risk of motor vehicle crashes and the banning by law, in many countries, of this kind of use, this behaviour is more and more spreading. Following a survey we have conducted in 2004, in 2005 we have realized in florentine area a monthly monitoring about this incorrect use of phoning while driving. Overall, 15001 vehicles were observed, and the prevalence of mobile phone use while driving was 2.6%, higher if compared with that referred to the previous year (1.8%). The association between mobile, hand-held, phone use and the considered variables (the same of the 2004 study) is always statistically significant and the conditions with the highest probability of meeting a phoning driver are showed by regression analysis. Intervention for reducing the spread of this behaviour is needed, especially if we consider the recent technological innovations introduced in the new models of mobile phones, which offer new distractions for drivers, the uncertainty of the absence of risk in using hand-free phone and the scarcely proved long-term effectiveness of legislation banning this use.

A pilot survey of child restraint and seating position in cars in Florence Health Authority area.

To investigate the use of child restraint and seating position in Florence, in the Centre of Italy, after the introduction of the New Italian road traffic law, a survey has been conducted. Direct observations were made in the areas related to three schools attended by children of different age groups, to determine the presence of child car seats and their positioning as well as child positioning in case of absence of the seat. A total of 328 vehicles have been observed; in 48.5% of the cars, seats for children were present, 39% were used, and 9% were not used. The presence of child restraint and its use differed according to age, school opening and closing time and number of children on board. When restraints were not present, children were mostly (38%) located on the front seat without an accompanying adult. Child seats were prevalently located in the rear. In spite of the introduction of New Italian road traffic law, in the study area the modality of children's transport in cars was frequently not correct, which constitutes a risk for the health of this specific target group.

[Mobile phone use while driving in Florence health district area]. / Utilizzo del telefono cellulare alla guida: l'esperienza fiorentina.

The practice of driving while using hand-held mobile phones is diffused in numerous countries, even though it has been demonstrated that they increase the risk of traffic accidents, and such use has consequently been prohibited. Because of the lack of Italian data on the spread of this behaviour a study was done in June 2004 on drivers' use of hand-held mobile phones in the Florence Health Authority area. The study was performed by direct observation from 4 watching-points (1 for each zone) which allowed for observation of several types of vehicles, on varying road conditions, in 5 hour time bands. Overall, 9387 vehicles were observed and the prevalence of mobile phone use while driving was found to be 1.8%. The greatest prevalence of mobile phone use was found in the following conditions: in the Northwest zone (2.8%), in the city suburbs (2.8%), on Tuesdays (3.0%), among drivers not using safety belts (3.0%), and among subjects driving alone (2.1%). Logistic regression analysis has shown a statistically significant association between mobile phone use and the zone, the number of persons in the vehicle, and seat belt use. Mobile phone use while driving is therefore a diffused practice that is particularly common among drivers who engage in other high-risk driving behaviours.

[An epidemiological evaluation of proximal femur fracture on a population living in the area of the Florence Local Health Trust]. / Valutazione epidemiologica della frattura dell'estremità prossimale del femore nella popolazione residente nel territorio della Azienda Sanitaria di Firenze.

Proximal femur fracture is a relevant issue of public health due to its high prevalence in elderly people and high social costs. We performed an epidemiological description of the event based on the data derived from the hospital discharge reports over a 5-year period, from 1997 to 2001, referred to a mean population of 796,990 persons. During this period, the disease incidence rate, estimated on hospital admissions, is high (higher than national average), although rather constant over years: average values are 777.92/100,000 in the >65 age group, 2627.08/100,000 in the >85 age group, and 1264.25/100,000 in the 80-84 age class. Incidence rate shows an exponential increase with age starting from the age of 50 and in the elderly age classes women exhibit around twofold values. Besides, the mean length of hospitalization is higher in the elderly age classes. Regarding 4 selected kinds of surgical intervention we made and verified the hypothesis of a correlation between length of stay in hospital before the intervention and two outcome indicators: length of stay in hospital after the intervention (data fail to confirm our hypothesis) and in-hospital mortality (data confirm our hypothesis: mean length of stay in hospital before the intervention is significantly higher in the group of dead patients than in the group of home discharged patients).

Factors influencing hospital infection control policies in Italian hospitals.

A study was undertaken to determine the resources available in Italian hospitals for the control of nosocomial infections and the factors favouring a successful approach. During January-May 2000 a questionnaire about infection control was sent to the hospital health director of all Italian National Health System hospitals treating acute patients and with more than 3500 admissions in 1999. An active programme was defined as a hospital infection control committee (HICC) meeting at least four times in 1999, the presence of a doctor with infection control responsibilities, a nurse employed in infection control and at least one surveillance activity and one infection control guideline issued or updated in the past two years. There was a response rate of 87.5% (463/529). Almost fifteen percent (69/463) of hospitals had an active programme for Infection Control and 76.2% (353/463) had a HICC. Seventy-one percent (330/463) of the hospitals had a hospital infection control physician and 53% (250/463) had infection control nurses. Fifty-two percent (242/463) reported at least one surveillance activity and 70.8% (328/463) had issued or updated at least one guidance document in the last two years. The presence of regional policies [odds ratio (OR) 8.7], operative groups (OR 4.2), at least one full-time nurse (OR 4.6) and a hospital annual plan which specified infection control (OR 2.1) were statistically associated with an active programme in the multivariate analysis.

[From the introduction to the possibility of moving beyond immunization obligation: considerations on the need for a guided procedure]. / Dall'introduzione al possibile superamento dell'obbligo vaccinale: considerazioni sulla necessità di un percorso guidato.

In Italy until sec. XIX, the beginning of vaccination duty allows to obtain some weighty aims in Public Health, like small pox eradication, polio and diphtheria elimination, or like the great reduction of tetanus and hepatitis B incidence. At the some, however, the vaccination duty doesn't allow to develop a "vaccination conscience" to do to accept the vaccines like the most important instrument, for effectiveness and utility, in the infectious diseases prevention. So, if from a side it's necessary to leave the vaccination duty from the another side it's necessary to make e leaded way of health education in the people and it's necessary to make a share of resources and aims in the sanitary world.

Prevalence of hepatitis A virus infection in sewage plant workers of Central Italy: is indication for vaccination justified?

Prevalence of antibodies to hepatitis A virus (HAV) was studied in a group of 65 sewage plant workers living in Tuscany, Central Italy. In order to evaluate the effect of several confounders (age, place of birth, income, educational degree, sea-food consumption, etc.), subjects under study were matched with 160 other workers residing in the same area. Anti-HAV was detected in about 51% of sewage workers and 44% of other employees. The difference was not statistically significant. Both univariate and multivariate analysis showed that the main variables related to previous HAV infection were increasing age (P<0.001), birth in Southern Italy (P<0.01) and lower educational degree (P<0.001). Although other studies in Northern and Central Europe showed a slightly higher risk of infection in sewage workers versus general population, lack of evidence of occupational risk in Italy might be explained by the relative importance of a higher degree of viral circulation in the past. The changing epidemiology of HAV infection in Italy with increasing numbers of susceptibles in adults and the potential occupational risk suggest that the present indication to immunize sewage plant workers against hepatitis A should be maintained.

[Estimate of underreporting of infectious diseases through a sentinel network of pediatricinas in the area of local health unit of Florence]. / Stima della sottonotifica di alcune malattie infettive attraverso una rete di pediatri sentinella nella ASL di Firenze.

The aim of this study was to evaluate the underreporting of some infectious diseases in the pediatric population in the Local Health Unit of Florence in the period 15.09.1997-14.09.1998. Data from the current notification system and from an a hoc sentinel network were used. Nine family pediatricians voluntarily participated in the sentinel network, notifying all cases of measles, mumps, pertussis, rubella, scarlet fever and chickenpox diagnosed in the population of children under their professional responsibility, in the period of the study. Chickenpox was the most frequent disease (2,043 cases equal to 73.5% of total notifications). The notification rate for chickenpox obtained with the sentinel network was 41.6 per 1,000 children, meanwhile the notification rate obtained with the current notification system was 23.7 per 1,000. The notification rate for scarlet fever was 24.1 per 1,000 with the sentinel network and 6.0 per 1000 with the current notification system. The underreporting for the two diseases was respectively 43% and 75%. Voluntary participation of physicians in sentinel network guarantees data of good quality, making these networks very useful tools for the epidemiologic evaluation of infectious diseases with benign prognosis.

Impact of routine infant and adolescent hepatitis B vaccination in Tuscany, Central Italy.

BACKGROUND: In Italy routine infant and adolescent immunization against hepatitis B was introduced in 1991. OBJECTIVE: Evaluation of (1) coverage with three doses of hepatitis B vaccine in infants and adolescents; (2) seroconversion to anti-hepatitis B surface antigen antibody (anti-HBs) in adolescents receiving three doses of vaccine; (3) concordance of coverage rates in infants with prevalence of neutralizing antibodies in sera from anonymous children; (4) trend of notified cases of acute hepatitis B. METHODS: A sample of infants and adolescents living in Tuscany was studied during 6 years (1992 through 1997) by matching birth records and immunization certificates. Sera from 139 adolescents who completed the vaccination course and from 159 anonymous children belonging to immunized cohorts (1 to 5 years) were tested with a quantitative anti-HBs assay. Incidence of acute hepatitis B by age was calculated from regional statistics on notified infectious diseases between 1992 and 1996. RESULTS: Overall 10,606/11,164 (95%) infants and 10,599/11,100 (95%) adolescents received 3 doses of vaccine. Seroconversion to anti-HBs was detected in 98% of adolescent vaccinees. Anti-HBs titers > or =10 IU/l were detected in 87% of children. A 49% decline of acute hepatitis B cases was registered between 1992 and 1996 in 15- to 24-year-olds living in Tuscany. No case occurred in vaccinated adolescents. CONCLUSIONS: Coverage against hepatitis B is excellent in cohorts subject to mandatory immunization. If efforts to vaccinate are maintained at these levels, elimination of hepatitis B virus transmission could occur within few decades in Italy.

Prevalence of diphtheria toxin antibodies in human sera from a cross-section of the Italian population.

A polycentric study was carried out between 1993 and 1995 in order to evaluate diphtheria immunity on a representative sample of population from different areas of Italy. To determine diphtheria antitoxin, sera from 5187 apparently healthy subjects, divided according to sex and age groups, were titrated using an ELISA indirect method. A basic protective titre of diphtheria antitoxin (> 0.01 IU ml-1) was found in 4080 (78.6%) subjects. No statistically significant differences between males and females were observed. Our findings show that the proportion of susceptibles increases with age and a high proportion of adults no longer has diphtheria antitoxin at protective levels since toxigenic C. diphtheriae circulation is presently lacking in Italy.

[The use of hydrophobic PALL BB22-15MS filters in cross-infection prevention during anesthesia]. / Impiego dei filtri idrofobici PALL BB22-15MS nella prevenzione delle infezioni crociate in corso di anestesia.

OBJECTIVE: Microbiological testing evaluations of hygienic procedure properties using PALL BB22-15MS filters to prevent contamination of "single use" breathing circuits during anesthesia. DESIGN: Prospective study. SETTING: Two operating rooms in a University hospital. PATIENTS: One hundred and thirty eight patients underwent general anesthesia for urologic surgery procedures. Patients with positive tests for HIV, B and C hepatitis and those considered to be at risk for HIV infection were excluded. The study was divided into five phases on the basis of times of usage of the same circuit for an increasing number of patients: in phase I, microbiological tests were performed on 4 circuits used on 4 different patients; in phase II the same tests were performed on 2 circuits each used on two different groups of three patients; in phase III, a circuit was used on a group of 15 patients and another on a group of 16 patients and the results were analysed; in phase IV a circuit used in a group of 32 patients was evaluated and phase V involved the analysis of a circuit that was used in a group of 65 patients. INTERVENTIONS: A filter was left in place between the patient and the circuit's Y-piece during all phases of anesthesia. The level of microbial contamination of breathing circuits was analysed in order to evaluate the reliability of the procedure. RESULTS: All analysed circuits remained uncontaminated. Staphylococcus hominis was revealed in respiratory circuit no. 6 of phase II, probably as a consequence of secondary contamination. CONCLUSIONS: Our results confirm that this procedure with the routine placement of a PALL BB22-15MS filter at the circuit's Y-piece can provide an adequate level of protection against cross-infections during anesthesia. The hygienic protocol proposed may allow the change of the anesthetic breathing only once a month.