What's growing on General Practitioner's stethoscope?

BACKGROUND: Non-critical medical devices, as stethoscopes, have long been considered as vectors in microorganisms' transmission. Cleaning standards for non-critical medical equipment are often unclear. This study was designed to assess the attitude of General Practitioners (GPs) towards cleaning their stethoscope and the degree of microbiological contamination of doctor's instrument in outpatient setting. STUDY DESIGN: Observational, crossover study. METHODS: A structured questionnaire was administered to GPs to test their knowledge about medical instrument's cleanliness recommendations and the surface of the diaphragm of their stethoscopes was analyzed for bacteriological isolates using mass spectrometry technique. RESULTS: Most of GPs declared they don't know cleaning recommendations for non-critical medical devices and a relevant bacterial growth was identified on the majority of the stethoscopes' membranes. Almost all microbiological isolates resulted typically found in cutaneous flora. CONCLUSIONS: We can't state that the GP's stethoscopes feature a risk of transmission for microbiological pathogens; anyway, because of the level of contamination we observed, cleaning recommendations to disinfect instruments on a regular basis should be better indicated.

Nutritional status, dietary habits, nutritional knowledge and self-care assessment in a group of older adults attending community centres in Pavia, Northern Italy.

BACKGROUND: The population of industrialised countries is ageing as a consequence of an increase in life expectancy. As a result of the increasing ageing process, the assessment of nutritional status and dietary habits, as well as the assessment of self-care, is needed to plan selected actions aimed at improving the quality of life in the third and fourth life spans. METHODS: A cross-sectional study was carried out on a randomly selected sample of 200 healthy older adults (≥65 years old), attending community centres for older people in Pavia, Northern Italy. Ninety-two percent of the recruited subjects participated in the survey. Anthropometric measurements and the Mini Nutritional Assessment were performed. Dietary habits, nutritional knowledge and self-care were investigated using a questionnaire administered by two dietitians. RESULTS: The majority of subjects were low socio-economic status and overweight [mean (SD) body mass index = 28.4 (4.3) kg/m(2) ], 12% were malnourished according to their Mini Nutritional Assessment score and the majority of the arm muscle circumference measurements were below the 10th percentile, predicting accelerated loss of lean mass, even in the healthy independently living older adults. Only 30% of the sample had adequate dietary habits, whereas the ability to self-care was good for the whole sample. CONCLUSIONS: The unhealthy and unbalanced diet, frequently too rich in sugar and fats and low in protein intake, might explain being overweight and the loss of lean mass in the study subjects.

[18F]FDG-PET/CT monitoring early identifies advanced ovarian cancer patients who will benefit from prolonged neo-adjuvant chemotherapy.

AIM: The most accepted standard duration of neoadjuvant chemotherapy (na-CHT) before debulking surgery for advanced ovarian cancer (AOC) is 3 courses. However a percentage of patients could benefit from additional courses. [(18)F]FDG-PET/CT monitoring during na-CHT could predict early pathological response and allow the delivery of an optimal na-CHT duration. METHODS: Consecutive patients with AOC unsuitable for optimal up front surgery and fit for na-CHT were monitored by FDG-PET/CT at baseline and after 3 and 6 courses of carboplatin-paclitaxel CHT. At the end of na-CHT patients were re-evaluated to undergo definitive optimal surgery (i.e. without post-surgical residual disease). Percentage changes in maximal standardized uptake value (∆-SUVmax) were compared with the pathological response. Only patients with pathological complete response (pCR) or minimal residual disease (pMRD) were considered as pathological responders (pR), while all the other cases were considered non-responders (NR). RESULTS: Baseline FDG-PET/CT was abnormal in all 42 enrolled patients (median SUVmax 11, range 3-20). After 3 and 6 courses median SUVmax decreased to 3 (<2-21) and <2, i.e. value equal to normal surrounding tissues uptake (<2-17), respectively. After 3 courses, 17 (40%) patients presented ∆-SUVmax=100%, (i.e. SUVmax <2): 15 of them (88%) subsequently resulted pR and achieved no postsurgical residual disease at the end of na-CHT, while 2 (12%) were NR with postsurgical residual tumor ≤ 1cm. Out of 25 patients with ∆-SUVmax <100% after 3 courses, 6 (24%) were pR and 19 (76%) NR at the end of na-CHT. CONCLUSION: Patients with AOC who present normalization of SUVmax after 3 courses of na-CT have a high likelihood of benefiting from 3 additional courses in order to obtain pCR or pMDR and receiving optimal surgery.

Changes in nutritional status and body composition during enzyme replacement therapy in adult-onset type II glycogenosis.

BACKGROUND: In adult glycogen storage disease type II (GSDII), a single-gene mutation causes reduction of the lysosomal enzyme acid alpha-glucosidse. This produces a chronic proximal myopathy with respiratory involvement. Enzyme replacement treatment (ERT) has recently become available and is expected to improve muscle strength. This should result in increased lean body mass. In this study we evaluate body composition and nutritional status in GSDII, and assess whether these parameters changed during treatment. METHODS: Seventeen patients with late-onset GSDII, aged 52.6 +/- 16.8 years, received ERT for >18 months. Dietary habits and metabolic profiles of glucids, lipids, and proteins were assessed. Body composition was calculated using anthropometry and bioelectrical impedence analysis. RESULTS: On inclusion, we found increased fat mass (FM) in five patients in severe disease stage; all had normal body mass index (BMI). FM correlated inversely, and lean mass (LM) directly, with creatine kinase, prealbumin and albumin levels. After treatment, BMI and FM significantly increased, while LM only showed a trend toward increase. Prealbumin and albumin levels increased as early as after the first months of ERT. DISCUSSION: Body mass index value may underestimate FM in patients in severe stage of disease, due to altered body composition. In severely affected patients, laboratory parameters revealed a relative protein malnutrition, that was reversed by ERT, this reflecting restoration of normal muscle metabolic pathways. Increased BMI may indicate a reduction in energy consumption during exercise or respiration, along with clinical improvement.

Overweight and blood pressure: results from the examination of a selected group of adolescents in northern Italy.

OBJECTIVE: The aim of the present study was to investigate blood pressure (BP) levels and their relationship with different indices of body fat in a group of adolescents, in order to evaluate the prevalence of hypertension and plan preventive and corrective strategies. DESIGN: Cross-sectional study in primary care. SETTING: All high schools in the Aosta Valley region, northern Italy. SUBJECTS: Five hundred and thirty-two adolescents of both sexes, aged 15.4 (standard deviation 0.7) years. The following parameters were measured: body weight, body height, body mass index (BMI), four skinfold thicknesses, body fat mass, waist and hip circumferences and BP. RESULTS: BMI data indicated a high prevalence of overweight subjects in both sexes, but higher in males, while the prevalence rate of obese adolescents was lower. Of the total, 11.8 % of subjects suffered from systolic hypertension, while 6.9 % suffered from diastolic hypertension. In linear correlation analysis, BMI and all adiposity indices, except waist:hip ratio, were found to be significantly associated (P ranging between 0.05 and 0.001) with both systolic BP and diastolic BP in both sexes, with r ranging between 0.152 and 0.359. Multiple regression analysis with the stepwise method showed BMI and body fat mass to have the strongest association (P < 0.001) with BP, with r ranging between 0.275 and 0.359. CONCLUSION: Unless reversed, these conditions are worrying and predict the possible development of cardiovascular disease in adulthood. There is a pressing need to develop a comprehensive medical and nutrition plan, together with preventive and corrective strategies, in school programmes.

BMI values and other anthropometric and functional measurements as predictors of obesity in a selected group of adolescents.

BACKGROUND: Obesity is well known to be a problem all over the world: WHO data report that one billion subjects are overweight and 300 million are obese. Epidemiological data (IOTF) show that prevalence rates are increasing not only in industrialized countries, but also in developing countries, especially as far as the adolescent population is concerned. AIM OF THE STUDY: To select adolescents at risk of obesity by BMI calculation and by other anthropometric and functional measurements in the Aosta Valley Mountain Region (Northern Italy). METHODS: 532 adolescents were recruited and participated in the study (254 males and 278 females, aged 15.4 +/- 0.7). According to standard methods, the following parameters were measured: weight and height for BMI calculation, four skin folds (mid-triceps,mid-biceps, subscapular and supra-iliac) to compute body fat mass,waist and hip circumferences, systolic (SBP) and diastolic (DBP) blood pressure. Parental weight and height, educational and socio-economic status were requested from the parents using a questionnaire. RESULTS: Percentages of overweight and obese boys were 20.9% and 4.7% respectively, and percentages of overweight and obese girls were 14.7% and 1.1% respectively (using Cole's cut off point reference standard). Mean body fat mass percentages (males = 19.3 +/- 5.6%, females 23.3 +/- 4.4%) showed males at risk of obesity, as indicated by a higher prevalence rate of overweight and obesity in this gender. Positive correlations (p <0.01) were found between BMI and the following parameters: mid-triceps skinfolds, body fat mass percentage,waist and hip circumferences, but no correlation emerged with WHR; body fat mass positively correlates (p <0.01) with waist and hip circumferences; students' BMI positively correlates with blood pressure (p <0.01),with parental BMI and shows a positive trend towards parental low education and socioeconomic levels. CONCLUSIONS: Overweight and obesity prevalence rates are higher in males than in females according to literature data; family influences weight condition. The correlations that emerged show that BMI is a good adiposity index also in adolescents, it acts as an indicator of cardiovascular risk condition and is influenced by parental BMI.

Validation of the Dutch Eating Behaviour Questionnaire parent version (DEBQ-P) in the Italian population: a screening tool to detect differences in eating behaviour among obese, overweight and normal-weight preadolescents.

OBJECTIVE: To validate the Dutch Eating Behaviour Questionnaire Parent version (DEBQ-P) in the Italian population and investigate the differences in eating behaviour among Italian normal-weight, overweight and obese preadolescents. DESIGN: A cross-sectional validation study. Participants were measured and the approved translation of the questionnaire was administered to their parents. SETTING: : Three school communities in the province of Bergamo, Northern Italy. SUBJECTS: A total of 312 preadolescents (mean age 12.9 y; s.d. 0.8, both sexes) from three secondary schools of the province of Bergamo, Northern Italy, and their parents were invited to participate to the study. Informed written consent was obtained from each subject and their parents. Students were measured and their parents filled in the approved translation of the DEBQ-P. Recruitment was opportunistic and school based. RESULTS: Factor and internal consistency analysis confirmed the factor structure of the DEBQ-P and the high internal consistency of its three scales. Variance analysis showed that eating behaviour of Italian normal-weight, overweight and obese preadolescents differs significantly only in regards to the 'restrained eating' scale (F 19.29, P < 0.001), with overweight and obese scoring higher. CONCLUSIONS: The DEBQ-P can be used for screening projects regarding eating behaviour in the Italian population. The association between restrained eating and weight status was confirmed for both sexes, but the relationship between external eating and emotional overeating and overweight requires further exploration.

[Adolescent Body Mass Index data: what differences result using different reference standard curves?]. / Indice di Massa Corporea e adolescenti: quali le differenze utilizzando diversi standard di riferimento?

Childhood and adolescent obesity prevalence rates have steadily increased both in industrialised and developing countries in the last years. Data from literature show that BMI is an acceptable indicator to assess overweight and obesity also in children and adolescents. Different reference standard curves for BMI exist: the percentiles of Rolland-Chacherà, Luciano, the National Center for Health Statistics, Cole and Cacciari. Nevertheless, different cut off points are used by the authors to identify underweight, overweight and obesity. The aim of the present study was to investigate what differences can emerge when comparing adolescent BMI using different references standard curves. Five hundreds and thirty-five adolescent subjects, aged 15.4 +/- 0.7 years, were recruited in Aosta Valley (Northen Italy). BMI was calculated according to the following equation: BMI = weight/height2 (kg/m2). The data obtained were distributed according to BMI percentiles and than compared with references standard curves. The comparison shows different results especially when underweight, overweight and obesity are identified. In conclusion, it can be asserted that BMI is an useful indicator to assess adiposity (overweight and obesity) in adolescent, but one should be cautious when comparing results based on different references.

Study design of a total reference diet for a population in Northern Italy.

A market based of 91 food items was purchased in Northern Italy, based on a list taken from a food survey previously conducted in the same area. The food items from the survey were grouped into 14 categories. Food samples were collected, homogenized, and frozen for the analysis of both the nutrient content and the levels of mineral contaminants. The study design and decision processes behind the choice of type and quantity of each food are explained. The relative quantities of each food group were compared with those from two similar studies. Finally, energy, nutrients, and mineral contaminants obtained by direct analysis were compared with the calculations given on the food composition tables. The comparison between the analyzed and calculated data only showed marked differences in phosphorus, sodium, potassium, and copper intakes.

Urinary 1-hydroxypyrene as a marker of exposure to pyrene: an epidemiological survey on a general population group.

Urinary levels of 1-hydroxypyrene in a general adult population group are studied. Experimental data are not normally distributed; statistical analysis required a base 10 logarithmic transformation of data. The concentrations of urinary 1-hydroxypyrene measured were expressed as microgram g-1 urinary creatinine and are comparable with those reported by other authors, both for smoker and non-smoker subgroups. Multiple regression analysis shows that, for smokers, the number of cigarettes smoked per day and the body mass index (BMI) significantly influence the levels of urinary 1-hydroxypyrene expressed as microgram g-1 urinary creatinine, whereas no personal or behavioural variable (age, sex, alcohol consumption, dietary intake of pyrene, BMI) modified the 1-hydroxypyrene levels for non-smokers.

Plasma lysosomal glycohydrolases in a general population.

In this study we evaluated the differences in plasma levels of some glycohydrolases of lysosomal origin that appear to be the most interesting for possible usefulness for diagnosis (N-acetyl-beta-D-glucosaminidase, beta-D-glucuronidase, alpha-D-galactosidase, beta-D-galactosidase, alpha-L-fucosidase and alpha-D-mannosidase) in a general population of 417 subjects, as related to age and sex and also to body mass and to some habits, such as smoking and consumption of alcohol. The enzymatic activities were assayed by fluorimetric techniques with 4-methylumbelliferyl-glycosides as substrates. Particular attention was given to some technical aspects. Enzymatic activity was preserved by addition of ethylene glycol and stable liquid material was employed for calibration purposes. Blood was sampled rigorously at the same time of day and all the samples were obtained within a short period of time to exclude effects of the circadian and circannual rhythms. beta-Glucuronidase levels were the most affected by sex and body mass. beta-D-Galactosidase was not affected by differences in age, sex, body mass or by smoking, but appeared to be the most sensitive to modification by alcohol consumption. The data in this report emphasize that, whenever changes or differences in the levels of lysosomal enzymes in body fluids are studied, it is essential to have a reference population rigorously correlated with the study population. When possible, repetitive measurements in the same subject could better indicate a clinical trend.

[Distribution of blood lead level in a general population]. / Distribuzione della piombemia in una popolazione generale.

The goal of this study was to evaluate the distribution of blood lead level (B.L.L.) in a general adult population aged between 20 and 79 years non professionally exposed to lead, and to verify the influence on B.L.L. of demographic variables (i.e. sex and age), behavioural habits (i.e. alcohol consumption and cigarette smoking), and anthropometric variables (i.e. body mass index--BMI). We studied the distribution of B.L.L. by explorative analysis method (E.D.A.), which showed that data did not follow a Gaussian distribution. Distribution fit to normality was determined by Shapiro-Wilk test, that identified the natural logarithm of B.L.L. as the best transformation in order to normalize the parameter. According to literature data, sex appears one of the most important variable in determining B.L.L. In both sexes we found a direct relation between B.L.L. and age. Alcohol consumption emerged as the third most important variable that influences B.L.L. BMI and cigarette smoking do not influence data distribution.

Trace element reference values in tissues from inhabitants of the European Union. IX. Harmonization of statistical treatment: blood cadmium in Italian subjects.

Obtaining reliable trace element reference values in tissues and fluids from inhabitants of the European Union relies on the availability of standardized and harmonized protocols for the statistical treatment of the data on trace element levels in general European populations. In this context, cadmium was measured in the blood (BCd) of 514 Italian inhabitants from the Lombardy region and the results statistically treated and presented according to a procedure which includes: simple descriptive statistics and graphical analysis such as stem and leaf and box-plot representations (average BCd levels were 0.62 microgram/l; geometric mean, 0.51 microgram/l; median, 0.50 microgram/l; mode, 0.30 microgram/l; 95th percentile, 1.48 micrograms/l; 5th percentile, 0.20 microgram/l); p-p plot, Shapiro-Wilk and Lilliefors tests for normality (the distribution of the data is closer to the log-normal distribution and inconsistent with the hypothesis of normality); analysis of variance (BCd increases from 20 to about 60 years and then decreases; it is influenced by smoking but not by body mass and alcohol consumption and it is higher in men than in women); and step wise multiple regression analysis (BCd is influenced by the number of cigarettes/day and the total dose of exposure, cigarettes/day multiplied by smoking years). Tentative reference intervals for BCd based on the log transformation of the data are 0.14-1.82 micrograms Cd/l (whole population); 0.16-1.94 micrograms Cd/l (male) and 0.13-1.66 micrograms Cd/l (female); 0.24-2.68 micrograms Cd/l (smokers); and 0.14-1.27 micrograms Cd/l (non-smokers).