Evaluation of functionality-mobility in patients with skeletal dysplasias. Application of the STEMS tool ("everyday symptoms and mobility screening tool for skeletal dysplasias").

Individuals with differing forms of skeletal dysplasias (SD) frequently report impaired mobility and symptoms. With the objetive to evaluate mobility and associated symptoms in people with SD at an Argentinian pediatric hospital, using an Argentinian version of the Screening Tool for Everyday Mobility and Symptoms (STEMS), a simple questionnaire that allows clinicians to quickly identify the presence of symptoms associated with mobility in people with SD, while considering different environmental settings and the use of assistive devices, an analytical study of a consecutive sample of patients older than 5 years with SD and their affected relatives was carried out.Diagnosis, comorbidities, socioenvironmental, therapeutic, auxological and mobility variables were recorded. The presence and intensity of symptoms was noted through use of both the STEMS and validated scales. Descriptive, association and correlation analyzes were performed. One hundred and nineteen individuals with SD were enrolled in the study and divided into groups: Osteogenesis Imperfecta (OI, n = 55), Achondroplasia (ACH, n = 36) and Other SD resulting in disproportionate short stature (n = 28). Mobility assistive devices were almost exclusively used by individuals with OI. They were more frequently used by individuals with overweight and obesity, more severe form of the disease and in the outdoor settings. Two thirds (66.4%) of the individuals assessed in this study reported pain, 87.4% reported fatigue, and 58.8% reported both pain and fatigue. The intensity of symptoms was similar between groups and correlated with age and auxological variables. The STEMS was clear, easy and quick to use for identifying presence of pain and fatigue in this population group. The STEMS proved to be a simple and useful tool for evaluating functional mobility and associated symptoms in our population of individuals with SD.

A Logical Modeling of Severe Ignorance.

In the logical context, ignorance is traditionally defined recurring to epistemic logic. In particular, ignorance is essentially interpreted as "lack of knowledge". This received view has - as we point out - some problems, in particular we will highlight how it does not allow to express a type of content-theoretic ignorance, i.e. an ignorance of φ that stems from an unfamiliarity with its meaning. Contrarily to this trend, in this paper, we introduce and investigate a modal logic having a primitive epistemic operator I, modeling ignorance. Our modal logic is essentially constructed on the modal logics based on weak Kleene three-valued logic introduced by Segerberg (Theoria, 33(1):53-71, 1997). Such non-classical propositional basis allows to define a Kripke-style semantics with the following, very intuitive, interpretation: a formula φ is ignored by an agent if φ is neither true nor false in every world accessible to the agent. As a consequence of this choice, we obtain a type of content-theoretic notion of ignorance, which is essentially different from the traditional approach. We dub it severe ignorance. We axiomatize, prove completeness and decidability for the logic of reflexive (three-valued) Kripke frames, which we find the most suitable candidate for our novel proposal and, finally, compare our approach with the most traditional one.

Growth in height and body proportion from birth to adulthood in hereditary hypophosphatemic rickets: a retrospective cohort study.

PURPOSE: Patients with hereditary hypophosphatemic rickets are short and disproportionate and very little information is available on segmental growth, but the body disproportion at adulthood leads us to think that the growth velocity of legs is slower. METHODS: A total of 96 children were included and molecular testing was carried out in 42. Children who reached adult height were classified into two groups according to their compliance to conventional treatment (phosphate supplement and calcitriol). Individual growth records of height and sitting height/height were plotted using Argentine reference data in 96 children and growth curves were estimated by fitting Preece-Baines Model 1 in 19 of the children. RESULTS: Molecular testing revealed sequence deleterious alterations or large deletions in 36/42 patients. During childhood, 76% of children grew below - 1.88 standard deviation score (SDS) and 97% had body disproportion. During adolescence, the mean peak height velocity for the good and poor compliance to treatment groups was 7.8 (0.6) and 5.4 (0.4) cm/year in boys and 7.0 (0.7) and 5.2 (0.8) cm/year in girls, respectively. At adulthood, the median sitting height/height ratio was 2.32 and 6.21 SDS for the good and poor compliance to treatment groups, respectively. The mean pubertal growth spurt of the trunk was -0.8 (1.4) SDS, with a short pubertal growth spurt of - 1.8 (0.4) SDS for limbs in the good compliance group. Median adult height in 13/29 males and 30/67 females was -4.56 and -3.16 SDS, respectively. CONCLUSION: For all patients the growth spurt was slower, secondary to a short growth spurt of limbs, reaching a short adult height with body disproportion that was more prominent in the poor compliance group.

Early childhood vaccination coverage and timeliness by macro-area of origin in children born to foreign women residing in Italy.

OBJECTIVES: Country of origin might affect vaccine uptake in children born to immigrants. We aimed to evaluate differences in childhood vaccination coverage (VC) and timeliness by macro-area of origin of foreign mothers residing in Italy. STUDY DESIGN: Multicentre retrospective birth cohorts. METHODS: We analysed data of 23,287 children born in 2009-2014 to foreign women in the cities of Rome, Turin and Treviso. We retrieved data through record-linkage of the population, vaccination and birth registries. We estimated VCs at different ages for vaccines against tetanus, measles and meningococcal group-C, using the Kaplan-Meier method. Factors associated with vaccine uptake were evaluated using multilevel Poisson models. RESULTS: Estimates of VC at any age and for all antigens were significantly lower in children born to women from Asia and higher in children born to women from Africa, as compared to other macro-areas. Similar differences by area of origin were observed for timeliness; independently of mother's sociodemographic characteristics and neonatal outcomes, the probability of delay vaccination after 2 years of age for each antigen was highest in children born to women from Asia. The risk of missed vaccination for all antigens was significantly higher in children born to younger and unemployed women. CONCLUSIONS: Factors related to area of origin (e.g., cultural habits, language skills) are likely to affect parents' decision to vaccinate their children. These factors, as well as sociodemographic characteristics, should be adequately investigated and addressed to increase vaccine uptake in foreign children, especially those born to Asian women.

Pubertal growth in height, sitting height and leg length in achondroplasia.

Background: Children with achondroplasia (ACH) appear to lack a pubertal growth spurt in height.Aim To explore the growth spurt in height and its segments sitting height and leg length, in a large sample of ACH cases using growth curve modelling.Subjects and methods: Height and sitting height were measured longitudinally in ACH children, and the data were analysed using the SITAR (SuperImposition by Translation and Rotation) growth model, which estimates a mean growth curve and random effects for individuals defining differences in size, pubertal timing and intensity.Results: Out of 402 ACH children, 85 boys and 75 girls aged 7-20 years had respectively 529 and 454 measurements of height and sitting height, with leg length calculated by difference. SITAR analysis identified peaks in mean height velocity at 13.3 and 11.3 years in boys and girls, with peak velocities of 4.3 and 4.4 cm/year. Mean peak velocity for sitting height was 3.0 cm/year, but leg length showed no peak. The SITAR models explained 92% to 99% of the cross-sectional variance.Conclusion: ACH children do experience a growth spurt in puberty, but only half that of control children. The spurt is due entirely to sitting height, with no leg length spurt.

Uso de la antropometría para la evaluación nutricional en pacientes internados en un hospital pediátrico de alta complejidad: su aplicabilidad y limitaciones / The use of anthropometry in the nutritional evaluation of inpatients at a tertiary-care pediatric hospital: applicability and limitations

Introducción: En el niño hospitalizado, la valoración del estado nutricional es un indicador relevante. Si bien existen diferentes métodos de evaluación, las mediciones antropométricas brindan información objetiva aunque no siempre pueden completarse en las primeras horas de ingreso. Debido a su importancia clínica, el objetivo de este estudio fue analizar la aplicabilidad y las posibles dificultades técnicas en su realización, así como el estado nutricional, basado en mediciones de peso y estatura, de todos los niños que ingresaron a salas de cuidados intermedios y moderados (CIM) de un hospital pediátrico de alta complejidad. Material y Métodos: Estudio observacional, descriptivo y transversal. Un único observador entrenado realizó la medición de peso y estatura, en las primeras 48 horas de ingreso al CIM, de todos los niños ingresados entre diciembre 2011 y febrero 2012. Se analizó el estado nutricional mediante indicadores antropométricos y las causas que imposibilitaron la realización de la antropometría. También se registró la presencia y condiciones del instrumental en sala. Resultados: Las mediciones antropométricas y la evaluación del estado nutricional a partir de ellas se realizó en el 76% (543/714) y 71,7% (512/714) de los niños ingresados, respectivamente. El 34,5% mostró compromiso nutricional (déficit/exceso). Las causas más frecuentes que impidieron la realización de la antropometría en las primeras 48 horas del ingreso fueron: 35,7% imposibilidad de movilizarse, 25,1% niños que por su condición requerían de técnicas o instrumentos adaptados, 39,2% otras situaciones como: aislamiento de contacto, mal estado general, presencia de drenajes, ausencia por procedimientos. Conclusiones: Las mediciones antropométricas brindan datos objetivos del estado nutricional al ingreso; sin embargo aún con personal entrenado, el 28,3% de los niños no pudo ser evaluado en las primeras horas de ingreso hospitalario. Conocer las utilidades y limitantes de la antropometría para la evaluación del estado nutricional en un hospital de alta complejidad, resulta información valiosa para el proceso de búsqueda de otras estrategias que mejor se adapten a cada situación (AU)

Introduction: In the hospitalized child, the assessment of nutritional status is a relevant indicator. Although different methods of evaluation exist, anthropometric measurements provide objective information; however they may not always be completed within the first few hours of entry. Due to its clinical importance, the objective of this study was to analyze the applicability and the possible technical difficulties in its realization and the nutritional status, based on measurements of weight and height, of all the children who entered to intermediate and moderate care units (CIM) in a third level pediatric hospital. Material and Methods: Observational, descriptive and transverse study. A single trained observer measured weight and height in the first 48 hours of admission to the CIM of all children admitted between December 2011 and February 2012. The nutritional status was analyzed using anthropometric indicators and the causes that made it impossible to perform anthropometry were recorded. The presence and conditions of the instruments in the room were also recorded. Results: Anthropometric measurements and assessment of nutritional status were performed in 76% (543/714) and 71.7% (512/714) of the children admitted, respectively. 34.5% showed nutritional compromise (deficit / excess). The most frequent causes that prevented the anthropometry in the first 48 hours of admission were: 35.7% inability to be mobilized, 25.1% children who, due to their condition, required adapted techniques or instruments, 39.2% other situations such as: contact insulation, poor general condition, presence of drainage, absence by procedures. Conclusions: Anthropometric measurements provide objective data on nutritional status at admission; even with trained personnel, 28.3% of the children could not be evaluated in the first hours of hospital admission. Knowing the uses and limitations of anthropometry for the evaluation of nutritional status in a third level hospital, is valuable information for the process of finding other strategies that best suit each situation (AU)

Referencias argentinas de estatura sentada y longitud de miembros inferiores de 0 a 18 años / Argentine reference values for sitting height and lower limb length between 0 and 18 years of age

Para el seguimiento del crecimiento de niños con severa malformación de miembros inferiores o de columna, disponer de referencias de estatura sentada (ES) y de miembros inferiores (MI) según edad es una herramienta de gran utilidad. Objetivos: estimar los centilos de ES y MI para ambos sexos, entre 0 a 18 años de edad y evaluar la utilidad de estas referencias en niños con malformaciones localizadas en MI o columna. Material y Métodos: los centilos 3°,10°, 25°, 50°, 75°, 90° y 97° de ES y MI según Edad (SE/E y MI/E) fueron estimados en una población sana de 4803 y 4818 varones y mujeres respectivamente, por el método LMS que utiliza la transformación BOX-COX para normalizar la distribución de los datos a cada edad. Resultados: en los primeros años de edad, la mediana de ES en ambos sexos fue similar. Entre los 11 y 13 años, las niñas tuvieron una ES mayor a la de los varones, pero luego se invirtió y se mantuvo así hasta la adultez. En MI la mediana también fue similar en ambos sexos durante los primeros años, pero a partir de los 12 el incremento fue mayor en los varones. A los 12 años la diferencia fue 0,71 cm, finalizando con 9 cm a los 18 años. El uso de estas referencias en niños con malformaciones de columna ó MI mostró un crecimiento patológico de estatura total y del segmento corporal comprometido, con un tamaño y crecimiento normal del segmento no afectado. Conclusión: los centilos de segmentos corporales según la edad constituyen una herramienta útil para la supervisión del crecimiento de niños con severa malformación de columna o miembros inferiores (AU)

For the follow-up of growth of children with severe lower-limb or spinal deformities, reference values for sitting height (SH) and lower-limb (LL) length according to age are extremely useful. Aims: To define percentiles of SH and LL for both sexes between 0 and 18 years of age and evaluate the usefulness of these references in children with LL or spinal deformities. Material and Methods: 3rd,10th, 25th, 50th, 75th, 90th, and 97th percentiles for SH and LL according to age (SE/age and LL/age) were estimated for a healthy population of 4803 and 4818 boys and girls, respectively, with the LMS method that uses the Box-Cox power exponential (BCPE) to normalize data distribution for age. Results: In the first years of life, mean SH was similar for both sexes. Between 11 and 13 years of age, girls had a greater SH than boys, but this relationship subsequently inverted and remained so until adulthood. The median length of LL was also similar in the first years of life, but after 12 years of age growth was increased in boys. At 12 years of age the difference was 0.71 cm, with a final difference of 9 cm at 18 years of age. The use of these reference values in children with spinal or LL deformities showed pathological growth of the whole body and the body segment involved with normal growth of the nonaffected segment. Conclusion: percentiles of the body segments according to age are a useful tool for the monitoring of growth of children with severe deformities of the spine or lower limbs (AU)

Estatura final de una población de prematuros con muy bajo peso al nacer / Final height in a population of preterm infants with very low birth weight

Los niños nacidos prematuros de muy bajo peso, tienen una mayor frecuencia de baja talla a la edad adulta. En la Argentina no contamos con reportes de estatura final de estos niños. Se evaluaron el peso y estatura de 46 jóvenes de la ciudad de Buenos Aires con antecedentes de prematurez y muy bajo peso al nacer egresados de 7 unidades neonatales de la ciudad de Buenos Aires y conurbano bonaerense, entre los años 1990 y 1995. Los 46 jóvenes (27 mujeres) tenían una edad promedio de 18.97 años (16.04 - 22.93). La estatura media de las mujeres fue de -0,71 sDS (0.20) y -0.75 sDS (0.22) en varones. Se detectó baja estatura en 2 mujeres (7.4%) y 1 varón (5.3%). La incidencia global de baja estatura es de 6.5% (AU)

Infants born prematurely with a very low birth weight more often have short stature in adulthood. In Argentina there are no reports on final height in these children. We evaluated weight and height of 46 adolescents and young adults from the city of Buenos Aires with a history of prematurity and very low birth weight who were discharged from seven Departments of Neonatology in the city of Buenos Aires and Greater Buenos Aires between 1990 y 1995. The 46 youth (27 females) had a mean age of 18.97 years (16.04 ­ 22.93). Mean height of the women was -0.71 SDS (0.20) and mean height of the men was -0.75 SDS (0.22). Low stature was observed in two women (7.4%) and one man (5.3%). Overall incidence of short stature was 6.5%. (AU)

Exostosis múltiple. Revisión clínica y radiológica de 45 pacientes en seguimiento en las clínicas de displasias esqueléticas del Hospital Garrahan / Multiple exostoses. Clinical and radiological review of 45 patients followed-up at the unit of clinics of skeletal dysplasias at the Garrahan Hospital

La exostosis múltiple es una enfermedad poco frecuente, autosómica dominante, caracterizada por la presencia de múltiles proyecciones ósas rodeadas de cartílago, producto de un crecimiento anárquico del tejido óseo, ubicadas más frecuentemente en las metáfisis de los huesos largos. La prevalencia estimada de esta condición es 1 en 50000. Los genes supresores de tumores involucrados son EXT1-2 y 3. El objetivo de este estudio fue analizar las características clínicas y radiológicas de los pacientes con exostosis múltiple registrados en la base de datos del servicio de crecimiento y desarrollo desde enero de 1998 a enero de 2008. El número final de la población fue 45, 60% varones, mediana edad a la última consulta 10,6 (r: 3,48 û 17,08) años. Resultados: mediana de edad de la primer exostosis fue 1,88 (r: RN û 12,0) años. Las localizaciones fueron 52% miembros, 19% escápulas, 16% parrilla costal y 13% otras. No diferencias significativas por sexo ni forma de presentación familiar. El 100% de los niños mostró algún hueso largo afectado, 78,3% hueso plano y 30,8% columna. Los síntomas asociados fueron dolor (52%), alteración del eje de miembros superiores (50%) y de miembros inferiores (44,7%), alteración de la función de miembros superiores (38%) y de miembros inferiores (35%). Cinco pacientes presentaron retraso mental. La mayoría de los niños creció debajo del centilo 50. El 50% de los niños requirió alguna cirugía durante su seguimiento. El número de cirugías se asoció a alteración funcional. Un niño presentó asociación de exostosis múltiple con hipocondroplasia. No encontramos antecedentes de malignización. Conclusiones: Las complicaciones observadas en nuestra población fueron semejantes a las descriptas en la literatura siendo el dolor una de las más frecuentes. No encontramos asociación de las mismas con el sexo masculino

Crecimiento en niños con Síndrome de Sotos / Growth in children with Sotos syndrome

El síndrome de Sotos se caracteriza por macrosomía, retraso del desarrollo, rasgos faciales típicos y alteraciones cerebrales. En el año 2002 se identificó al gen responsable de ésta patología NSD1, localizado en el brazo largo del cromosoma 5 (5q35.2-q35.3). El objetivo del trabajo fue describir las curvas de crecimiento de 6 niños con diagnóstico clínico de síndrome de Sotos seguidos en los Servicios de Crecimiento y Desarrollo y Genética del Hospital de Pediatría J. P. Garrahan. Material y Métodos: Se realizó un estudio de serie de casos, retrospectivo, observacional, descriptivo por revisión de historias clínicas, de los datos antropométricos (peso, estatura, perímetro cefálico, longitud tronco, estatura de ambos padres) edad ósea, desarrollo puberal y características clínicas. Se analizaron las curvas de distancia. Se calculó la diferencia de puntaje z de estatura y perímetro cefálico al nacer, 2, 6 años y al final del seguimiento. Resultados: la mediana de peso y longitud corporal al nacer fue estadísticamente mayor que la población argentina (p<0,05). Durante el primer y segundo año de vida se observó aceleración del crecimiento, siendo más evidente en estatura y perímetro cefálico que en peso. Luego de esa edad todos los niños mostraron macrocefalia y el 83% (5/6) alta estatura para la población con crecimiento normal. La mediana de puntaje z de IMC fue 0,61 (r: 0,12/1,80). Todos los niños mostraron tendencia a miembros largos. 67% presentó edad ósea avanzada. Uno de cinco niños mostró inicio puberal temprano: 9,21 años de edad. Conclusiones: La curva de crecimiento de estos seis niños con diagnostico de síndrome de Sotos muestran un patrón similar. La macrocefalia y alta estatura, presentes a partir de los dos años de edad, fue la principal característica de estos niños. El IMC fue normal en todos los niños

Crecimiento en niños con síndrome de Sotos / Growth in children with Sotos syndrome

El síndrome de Sotos se caracteriza por macrosomía, retraso del desarrollo, rasgos faciales típicos y alteraciones cerebrales. En el año 2002 se identificó al gen responsable de ésta patología NSD1, localizado en el brazo largo del cromosoma 5 (5q35.2-q35.3). El objetivo del trabajo fue describir las curvas de crecimiento de 6 niños con diagnóstico clínico de síndrome de Sotos seguidos en los Servicios de Crecimiento y Desarrollo y Genética del Hospital de Pediatría J. P. Garrahan. Material y Métodos: Se realizó un estudio de serie de casos, retrospectivo, observacional, descriptivo por revisión de historias clínicas, de los datos antropométricos (peso, estatura, perímetro cefálico, longitud tronco, estatura de ambos padres) edad ósea, desarrollo puberal y características clínicas. Se analizaron las curvas de distancia. Se calculó la diferencia de puntaje z de estatura y perímetro cefálico al nacer, 2, 6 años y al final del seguimiento. Resultados: la mediana de peso y longitud corporal al nacer fue estadísticamente mayor que la población argentina (p<0,05). Durante el primer y segundo año de vida se observó aceleración del crecimiento, siendo más evidente en estatura y perímetro cefálico que en peso. Luego de esa edad todos los niños mostraron macrocefalia y el 83% (5/6) alta estatura para la población con crecimiento normal. La mediana de puntaje z de IMC fue 0,61 (r: 0,12/1,80). Todos los niños mostraron tendencia a miembros largos. 67% presentó edad ósea avanzada. Uno de cinco niños mostró inicio puberal temprano: 9,21 años de edad. Conclusiones: La curva de crecimiento de estos seis niños con diagnostico de síndrome de Sotos muestran un patrón similar. La macrocefalia y alta estatura, presentes a partir de los dos años de edad, fue la principal característica de estos niños. El IMC fue normal en todos los niños.

Exostosis múltiple: Revisión clínica y radiológica de 45 pacientes en seguimiento en las clínicas de displasias esqueléticas del Hospital Garrahan / Multiple exostoses. Clinical and radiological review of 45 patients followed-up at the unit of clinics of skeletal dysplasias at the Garrahan Hospital

La exostosis múltiple es una enfermedad poco frecuente, autosómica dominante, caracterizada por la presencia de múltiles proyecciones ósas rodeadas de cartílago, producto de un crecimiento anárquico del tejido óseo, ubicadas más frecuentemente en las metáfisis de los huesos largos. La prevalencia estimada de esta condición es 1 en 50000. Los genes supresores de tumores involucrados son EXT1-2 y 3. El objetivo de este estudio fue analizar las características clínicas y radiológicas de los pacientes con exostosis múltiple registrados en la base de datos del servicio de crecimiento y desarrollo desde enero de 1998 a enero de 2008. El número final de la población fue 45, 60% varones, mediana edad a la última consulta 10,6 (r: 3,48 – 17,08) años. Resultados: mediana de edad de la primer exostosis fue 1,88 (r: RN – 12,0) años. Las localizaciones fueron 52% miembros, 19% escápulas, 16% parrilla costal y 13% otras. No diferencias significativas por sexo ni forma de presentación familiar. El 100% de los niños mostró algún hueso largo afectado, 78,3% hueso plano y 30,8% columna. Los síntomas asociados fueron dolor (52%), alteración del eje de miembros superiores (50%) y de miembros inferiores (44,7%), alteración de la función de miembros superiores (38%) y de miembros inferiores (35%). Cinco pacientes presentaron retraso mental. La mayoría de los niños creció debajo del centilo 50. El 50% de los niños requirió alguna cirugía durante su seguimiento. El número de cirugías se asoció a alteración funcional. Un niño presentó asociación de exostosis múltiple con hipocondroplasia. No encontramos antecedentes de malignización. Conclusiones: Las complicaciones observadas en nuestra población fueron semejantes a las descriptas en la literatura siendo el dolor una de las más frecuentes. No encontramos asociación de las mismas con el sexo masculino.

Síndrome de coalición tarso-carpiana: un caso familiar / Tarsal-carpal coalition syndrome: a familial case

El síndrome de coalición tarso-carpiana (TCC OMIM #186570) es una entidad poco frecuente, de herencia autosómica dominante, caracterizada por fusión progresiva de los huesos del carpo, el tarso y las falanges, el primer metacarpiano corto y la fusión humero-radial. Se han descrito en algunas familias mutaciones del gen NOG. En este trabajo describimos la forma de presentación de un caso familiar con fusión carpo-tarsiana que consultó en una clínica de displasias esqueléticas y sus diagnósticos diferenciales(AU)

Tarsal-carpal coalition syndrome (TCC, OMIM #186570) is an autosomal dominant disorder characterised by fusion of the carpals, tarsals, and phalanges, with the short first metacarpals causing brachydactyly and humeroradial fusion. Mutations in the NOG gene have been reported in many families. We describe a family with carpal tarsal fusion seen at a Skeletal Dysplasia Clinic and look at the differential diagnoses(AU)

[Tarsal-carpal coalition syndrome: a familial case]. / Síndrome de coalición tarso-carpiana: un caso familiar.

Tarsal-carpal coalition syndrome (TCC, OMIM #186570) is an autosomal dominant disorder characterised by fusion of the carpals, tarsals, and phalanges, with the short first metacarpals causing brachydactyly and humeroradial fusion. Mutations in the NOG gene have been reported in many families. We describe a family with carpal tarsal fusion seen at a Skeletal Dysplasia Clinic and look at the differential diagnoses.

[Mortality results in SENTIERI Project]. / Risultati dell'analisi della mortalità nel Progetto SENTIERI.

SENTIERI Project (Mortality study of residents in Italian polluted sites) studies mortality of residents in 44 sites of national interest for environmental remediation (Italian polluted sites, IPS). The epidemiological evidence of the causal association between causes of death and exposures was a priori classified into one of these three categories: Sufficient (S), Limited (L) and Inadequate (I). In these sites various environmental exposures are present. Asbestos (or asbestiform fibres as in Biancavilla) has been the motivation for defining six sites as IPSs (Balangero, Emarese, Casale Monferrato, Broni, Bari-Fibronit, Biancavilla). In five of these, increases in malignant neoplasm or pleura mortality are detected; in four of them, results are consistent in both genders. In six other sites (Pitelli, Massa Carrara, Aree del Litorale Vesuviano, Tito, "Aree industriali della Val Basento", Priolo), where other sources of environmental pollution in addition to asbestos are reported, mortality from malignant neoplasm of pleura is increased in both genders in Pitelli, Massa Carrara, Priolo, "Litorale vesuviano". In the time span 1995-2002, a total of 416 extra cases of malignant neoplasm of pleura are detected in the twelve asbestos-polluted sites. Asbestos and pleural neoplasm represent an unique case. Unlike mesothelioma, most causes of death analyzed in SENTIERI have multifactorial etiology; furthermore, in most IPSs multiple sources of different pollutants are present, sometimes concurrently with air pollution from urban areas: in these cases, drawing conclusions on the association between environmental exposures and specific health outcomes might be complicated. Notwithstanding these difficulties, in a number of cases an etiological role could be attributed to some environmental exposures. The attribution could be possible on the basis of increases observed in both genders and in different age classes, and the exclusion of a major role of occupational exposures was thus allowed. For example, a role of emissions from refineries and petrochemical plants was hypothesized for the observed increases in mortality from lung cancer and respiratory diseases in Gela and Porto Torres; a role of emissions from metal industries was suggested to explain increased mortality from respiratory diseases in Taranto and in Sulcis-Iglesiente-Guspinese. An etiological role of air pollution in the raise in congenital anomalies and perinatal disorders was suggested in Falconara Marittima, Massa-Carrara, Milazzo and Porto Torres. A causal role of heavy metals, PAH's and halogenated compounds was suspected for mortality from renal failure in Massa Carrara, Piombino, Orbetello, "Basso bacino del fiume Chienti" and Sulcis-Iglesiente-Guspinese. In Trento-Nord, Grado and Marano, and "Basso bacino del fiume Chienti" increases in neurological diseases, for which an etiological role of lead, mercury and organohalogenated solvents is possible, were reported. The increase for non-Hodgkin lymphomas in Brescia was associated with the widespread PCB pollution. Mortality for causes of death with a priori Sufficient or Limited evidence of association with the environmental exposure exceeds the expected figures, with a SMR of 115.8% for men (90% IC 114.4-117.2; 2 439 extra deaths) and 114.4% for women (90% CI 112.4-116.5; 1 069 extra deaths). These excesses are also observed when analysis is extended to all the causes of death (i.e. with no restriction to the ones with a priori Sufficient or Limited evidence): for a total of 403 692 deaths (both men and women), an excess of 9 969 deaths is observed, with an average of about 1 200 extra deaths per year. Most of these excesses are observed in IPSs located in Southern and Central Italy. The procedures and results of the evidence evaluation are presented in a 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI.

[Effect of misclassification of the place of residence on incidence estimates: the example of child cancer in a local health authority in Rome, Italy]. / Misclassificazione della residenza nelle schede di Dimissione Ospedaliera ed effetti sulle stime di incidenza: l'esempio dei tumori in età pediatrica nella ASL RMD.

A study on cancer of the lymphatic and hematopoietic tissue among residents aged 0-14 years was conducted by the Local Health Unit RMD (Rome, Italy; period 2003-09; codes of the International Classification of Diseases, Ninth Revision, Clinical Modification: 200-208). Age and gender Standardized Mortality and Hospitalization Ratios were computed in order to compare observed and expected cases, using municipal rates as reference. Place of residence at the time of admission, as recorded in the Hospital Registry, was compared with the information recorded in the Municipal Registers and the correlation between the two sources was calculated by Cohen's Kappa. No mortality nor morbidity excesses were observed in the study area. Although 14% of children were not confirmed as being resident at the time of admission, the Cohen's Kappa indicates a strong correlation between the Municipal Registry and the Hospital Registry (84%). The analyses restricted to children with ascertained residence did not yield different results. For those whose residence was not confirmed, the mismatch of information between the Municipality Registry and the Hospital Registry needs to be clarified.

Osteogénesis imperfecta. Evaluación clínica, funcional y multidisciplinaria de 65 pacientes / Osteogenesis imperfecta. Clinical, functional and multidisciplinary evaluation of 65 patients

Introducción: La osteogénesis imperfecta es una enfermedad caracterizada por fragilidad ósea, baja estatura, alteración dentaria, escleras azules, sordera prematura y una amplia variabilidad clínica. No existe tratamiento curativo pero sí varias medidas terapéuticas para mejorar la calidad de vida. Pacientes y métodos: Se evaluaron 65 niños atendidos en forma multidisciplinaria en un hospital pediátrico de julio a diciembre del 2007. Resultados: De los 65 pacientes, 35 corresponden al tipo I y 30 a los tipos III–IV. La edad media fue de 7,76 años (rango 1,89–19,91). El tiempo de seguimiento promedio fue de 4,75 años. La mayoría de los niños estaban escolarizados para la edad. El déficit de estatura promedio fue de -1,4 sDS para el tipo I y de -5,64 sDS para el tipo III–IV. El 19% presentó sobrepeso y el 11% obesidad. La edad promedio de enclavijado en miembros inferiores fue de 6,5 años. El 44,6% de los niños presentó escoliosis y se correlacionó a la severidad de la enfermedad. La evaluación de la funcionalidad motriz por la escala de Bleck mostró que el 93% de los niños con formas leves presentaban marcha útil así como el 28% de las formas severas. La silla de rueda fue utilizada por el 25% de los niños. La herencia familiar se constató en el 65% de los casos. Conclusiones: La complejidad y la variabilidad de la enfermedad requieren un tratamiento multidisciplinario (AU)

Introduction: Osteogenesis Imperfecta (OI) is a genetic disease, in which the main clinical features are increased bone fragility, pathological fractures, blue sclera, dentinogenesis imperfecta and conductive or mixed hearing loss. Clinical variability is wide. Although there is no curative treatment, there are several therapeutic tools capable of improving the course of the condition and patient quality of life. Patients and methods: Sixty-five children seen in a Paediatric Hospital during six months in 2007 were evaluated. Results: Thirty-five were type I OI, and thirty were types III and IV. Median age was 7.8 years (range 1.9 19.2); mean length of follow up was 4.7 years. The majority of children attended regular school for their corresponding age. Mean height was −1.4 sDS and −5.64 sDS in types I and III and IV respectively. Nineteen percent of patients were overweight and 11% were obese. Mean age at first orthopaedic surgery inserting telescopic rods was 6.5 years. Scoliosis was present in 44.6% of patients and was directly related to severity. Bleck’s motor scale showed that 93% of patients with mild forms and 29% of severe forms had a sustainable walking ability. A wheelchair was used by 25% of patients. Family inheritance was confirmed in 65% of cases. Conclusions: Integral care using a multidisciplinary approach is required due to the complexity and clinical variability of the condition(AU)

[Osteogenesis imperfecta. Clinical, functional and multidisciplinary evaluation of 65 patients]. / Osteogénesis imperfecta. Evaluación clínica, funcional y multidisciplinaria de 65 pacientes.

INTRODUCTION: Osteogenesis Imperfecta (OI) is a genetic disease, in which the main clinical features are increased bone fragility, pathological fractures, blue sclera, dentinogenesis imperfecta and conductive or mixed hearing loss. Clinical variability is wide. Although there is no curative treatment, there are several therapeutic tools capable of improving the course of the condition and patient quality of life. PATIENTS AND METHODS: Sixty-five children seen in a Paediatric Hospital during six months in 2007 were evaluated. RESULTS: Thirty-five were type I OI, and thirty were types III-IV. Median age was 7.8 years (range 1.9-19.2); mean length of follow up was 4.7 years. The majority of children attended regular school for their corresponding age. Mean height was -1.4 sDS and -5.64 sDS in types I and III-IV respectively. Nineteen percent of patients were overweight and 11% were obese. Mean age at first orthopaedic surgery inserting telescopic rods was 6.5 years. Scoliosis was present in 44.6% of patients and was directly related to severity. Bleck's motor scale showed that 93% of patients with mild forms and 29% of severe forms had a sustainable walking ability. A wheelchair was used by 25% of patients. Family inheritance was confirmed in 65% of cases. CONCLUSIONS: Integral care using a multidisciplinary approach is required due to the complexity and clinical variability of the condition.