Assessment of weight gain during pregnancy: an Italian practical approach.

AIM: Weight increase during pregnancy is an extremely useful parameter since adequate weight gain is associated with better outcomes for the health of both the mother and the baby. On the other hand, if there is an inappropriate change in weight, either too much or too little, both mother and fetus are more greatly exposed to numerous complications with different degrees of seriousness. Therefore it is necessary to rely on appropriate guidelines that provide medical and obstetric personnel with clear directions regarding correct weight gain. Since the recommendations of the guidelines must be adapted to the patient's specific profile, establishing the ideal weight gain in numerical terms is not immediate. METHODS: The authors developed an instrument for estimating the ideal weight gain during pregnancy, which is quick and easy to use and takes the specific subject's characteristics into account, in order to allow a personalized evaluation. RESULTS: A pocket instrument was developed, with a circular shape and two sides (A and B). On side A, two concentric disks contain weight and height, which allow pre-pregnancy Body Mass Index (BMI) to be calculated. On side B, three concentric disks contain respectively: a solar calendar, a calendar calculating the week of pregnancy and a window behind which the desired weight gain values scroll, divided by weight category. CONCLUSIONS: The authors believe that the instrument may be an additional helpful tool to control weight gain during pregnancy.

Is a modest weight loss significant in the improvement of dyslipidemic patients lipid profile.

AIM: The aim of the present study was to evaluate serum lipid abnormalities and the relationship with various factors in overweight and obese patients and to assess lipid profile modifications subsequent to weight loss in a subgroup of patients. METHODS: A sample of 110 obese out-patients first and a subgroup of 34 subjects afterwards, was selected at the Human Nutrition Research Centre of the University of Pavia for a retrospective analysis. The subjects recruited were all dyslipidemic, according to the American Clinical Guidelines for the assessment of cardiovascular risk. Differences in lipid profiles in subjects with different life habits were evaluated and in a subgroup of 34 subjects compared before and after a short-term moderate hypocaloric diet. RESULTS: Sample's mean age was 46.8+/-12.6 with a mean body mass index (BMI) of 32.1+/-4.8 kg/m2 (no difference with gender). The correlation analyses showed that total cholesterol (TC) concentrations were highly correlated with age (p<0.001); no correlation was found between TC and BMI, waist hip ratio (WHR), % body fat (BF%). Triglycerides (TG) concentrations were not related to age or BMI, however there was a significant correlation between TG and WHR and with waist circumference (WC) (p<0.001). The 34 subjects selected to take part in a dietary regimen, without significant changes in life habits, lost 5.1% of their initial weight and presented a significant improvement (p<0.001) in lipid profile. CONCLUSIONS: The high correlation between lipid profile and anthropometric measurements implies further longitudinal evaluation of the validity of the anthropometric indexes in the dyslipidemic patient management. Indeed, the results suggest that modest weight loss is sufficient to obtain a significant improvement in fasting serum lipid profile of dyslipidemic overweight patients.

[Evaluation of the needs of a population of hemodialysis patients in Rhône-Alpes]. / Evaluation des besoins en soins d'une population de patients hémodialysés en Rhône-Alpes.

The evaluation of the needs of patients with terminal renal insufficiency is necessary to determine the appropriate care programme. An evaluation of the medical and nursing needs, as well as those related to handicap (a total of 47 items) was undertaken on all hemodialysis patients in the Rhône-Alpes region. Only 34.4% were free of co-morbidity and 35.7% of significant handicap, 63.7% needed no other nursing care than that related to supervision of the dialysis and 16.9% were free of all the conditions studied. The patients treated in the centre required care needs than those treated in all other structures. The autodialysis population differs from that treated at home by a greater need for care due to handicaps, and from that treated in a dialysis centre by a lesser degree of handicap and less need for medical treatment. A level of theoretical unsuitability (needs incompatible with the statutory provisions for each type of treatment) was defined: it concerns 5% of the population in a dialysis centre and to 33% of the population on home dialysis. The needs evaluation grid could be used to quantify the requirements of a dialysis population and to arrange for the necessary resources.

Body uneasiness in overweight and obese Italian women seeking weight-loss treatment.

OBJECTIVE: It is known that the psychopathology of eating disorders is associated with body image disturbances, but little is known concerning the body image of obese subjects. The aim of this study was to assess body uneasiness in overweight and obese women in relation to their age, degree of obesity, the percentage and distribution of body fat mass, and eating disordered behaviours. METHOD: The study population consisted of 99 overweight and obese women with a mean age of 34.3 +/- 10.1 years and a mean body mass index (BMI) of 31.3 +/- 5.4 kg/m2, who completed two self-report questionnaires: the Bulimic Investigation Test Edinburgh (BITE) to assess disordered eating behaviours and the Body Uneasiness Test (BUT) to assess body image uneasiness. Pearson correlations were used to determine the associations between the BUT scores and age, anthropometric measures (BMI, waist and hip circumferences, waist/hip ratio, percentage of body fat mass) and the BITE scores. The most significant determinants of the BUT scores were also determined using a multiple linear regression model. RESULTS: Disordered eating behaviours were found in 7.1% of the patients. Neither BUT nor BITE scores correlated with age, but BITE scores correlated with BMI and hip circumference (p < 0.05). The overall BUT score increased with increasing BITE scores and higher indices of all of the anthropometric measures (p < 0.001) except for the percentage of body fat mass. Multiple linear regression analyses showed that, among the considered parameters, the only significant determinants of body uneasiness were disordered eating behaviours. CONCLUSIONS: Our results confirm that body uneasiness in an obese clinical population is closely associated with disordered eating behaviours, and suggest that it is not dependent on age, the degree of obesity, or the percentage or distribution of body fat mass.

Study of the variations of the cesarean sections rate in the Rhône-Alpes region (France): effect of women and maternity service characteristics.

OBJECTIVE: To analyze the variations of the rate of prophylactic cesarean sections and cesarean sections during labor according to the women's and maternity services' characteristics. STUDY DESIGN: The study population was a sample of 8470 women having delivered in one of the 86 maternity services of the Rhône-Alpes region (France) in 1990. The women's characteristics were risk factors for pregnancy or delivery. The maternity services' characteristics included those describing the service structure and the mode of recruitment. For the statistical analysis we used a two-level logistic model. RESULTS: After taking into account the women's characteristics, there remained a variation between the maternity services. This variation was in part explained by the type of recruitment of the maternity service. When the proportion of women with a previous cesarean section or a dystocia increased in the maternity service the cesarean sections rate decreased in women presenting similar characteristics. CONCLUSION: Thus, the maternity services which receive many "at risk" women tend to have higher cesarean section rates than the others. However, in comparison with women presenting similar characteristics, these same maternity services tend to perform fewer cesarean sections.

The effect of biannual applications of amine fluoride solution on caries incidence in permanent first molars: a 5-year study.

A randomized double-blind clinical trial was undertaken in a non-fluoridated community to assess the effectiveness of a minimal preventive intervention based on biannual applications of an amine fluoride (AmF) solution containing 1% fluoride. A total of 284 schoolchildren aged 6 years were recruited from a primary school in Milan, Italy, and randomly assigned to an experimental or a control group. The subjects of the experimental group received two applications each year of AmF to the permanent first molars and the control group subjects received similar applications of a placebo solution. Both in the experimental and control groups caries experience (DMFT) of the first molars was recorded every 6 months for 5 years. The mean DMFT scores in the experimental and control group were, respectively, 0.56 and 0.22 at the beginning and 1.14 and 1.75 at the end of the study. The preventive effect of the treatment became statistically significant only after 3 years. Survival analysis performed on the first molars that were sound at baseline showed that the topical AmF treatment caused, after 5 years, a significant reduction of caries incidence. This result confirms observations found in the international literature on the anticaries action of AmF. The administration rate used in this study seems to be useful for community preventive applications as it reduces the total amount of fluoride administered and the potential risks, and involves few personnel.

[Management of myocardial infarction in the Rhone-Alps area. Are there many variations in practice?]. / Prise en charge de l'infarctus du myocarde dans la région Rhône-Alpes. Existe-t-il une variation des pratiques?

The aim of this study was to determine the diagnostic and therapeutic strategies after myocardial infarction and to examine variations in medical and surgical practice with respect to the severity of disease, status of the hospital and patients' characteristics. The method used was a prospective study with follow-up at 30 days and 18 months. The subjects came from an exhaustive cohort of all patients admitted to hospital for myocardial infarction during the month of April 1991 in 57 public and private hospitals in the Rhone-Alps region (n = 311). The patients were identified after admission by consulting physicians of the Department of Social Security. The study included all patients with acute myocardial infarction with at least two of the three usual diagnostic criteria (prolonged, constrictive chest pain, enzyme increases and electrocardiographic changes). The study excluded patients who were dead before arrival at hospital. The parameters analysed included the clinical management, use of echocardiography, exercise stress testing, myocardial scintigraphy, coronary angiography, thrombolysis, angioplasty and coronary bypass surgery in the first 30 days after admission. The severity of infarction was assessed by seven clinical, enzymatic and electrocardiographic criteria by physicians from the Department of Social Security (pain, syncope, shock, left ventricular dysfunction, elevation of CPK > 1000 IU, anterior or extensive necrosis, arrhythmias). The mortality rate of this cohort was calculated from hospital statistics and then by enquiring in the town halls of the region. The demographic features of the cohort were marked by a predominance of men (69.5%) and a relatively high mean age (69 years; 23% over 80 years). Complementary investigations were used with the following frequencies: echocardiography, 61.1%; coronary angiography, 26.4%; exercise stress testing 22.8%; myocardial scintigraphy, 5.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Assessment of costs of health insurance, substitution therapy in chronic renal insufficiency]. / Evaluation du coût pour l'assurance maladie, des thérapeutiques substitutives de l'insuffisance rénale chronique (IRC).

The authors have studied the cost of the different treatments proposed in ESRD to patients attended by the same nephrologic team. For each patient they have isolated two consecutive periods of treatment, each six months apart. Treatment modifications noted between the two periods allowed the patient to be used as his own control. The results show that the costs are essentially composed of the dialysis sessions, hospitalisations and transport, and that their level and composition differ significantly between the different treatments. They derive a typology composed of three groups of patients, which differ in their treatment, age, duration of ESRD, complications, and total cost of treatment. They conclude that services should be organised in such a way that a range of different treatments can reasonably be provided, according to patient needs.

[Nutrition and health (not only dental)]. / Alimentazione e salute (non soltanto) dentale.

A correct alimentary education is a very important way to keep oneself in good health. From this statement, the Authors briefly illustrate the characteristics of a balanced diet and the effects of wrong nutritional habits, which are related to the most common oral diseases, dental caries in particular.

[The echocardiographic examination associated with the cold pressor test or the isometric force test in the evaluation of ischemic heart disease]. / L'esame ecocardiografico associato a cold pressor test o a sforzo isometrico nella valutazione della cardiopatia ischemica.

Sixteen angina patients were submitted to echocardiographic examination during the cold pressor test and during hand grip. Certain left ventricular function echocardiographic parameters were assessed in these subjects and in a further 14 patients presenting negative histories for cardiovascular diseases who represented the control group. Of the two tests associated with echocardiography, the cold pressor test appeared capable of inducing the more evident changes on left ventricular function compared to isometric effort in subjects suffering from ischaemic cardiopathy.

[Fluoridation of water in Europe. Review of the literature]. / La fluorizzazione delle acque in Europa. Revisione della letteratura.

The numerous studies proving that fluoride administration, mainly via fluoridated water, is undoubtedly the most reliable, efficient and economic technique for the prevention of dental decay are considered. However we should not underestimate the existence of a certain degree of distrust among the public or certain technical and bureaucratic problems which can interfere with the diffusion of this method. The experiments conducted in some countries where water fluoridation has been introduced are also reviewed.

[Salivary tests and clinical indexes in selection of caries risk groups. Critical review of the literature]. / Tests salivari e indici clinici nella selezione dei gruppi a rischio di carie: revisione critica della letteratura.

The Authors briefly illustrate some recent findings about the selection of high caries risk groups. The aim of this study is to review some of the main contributes of the literature of the last years. The attention has been mainly focused on the used experimental design. From this review it can be concluded that it is necessary a better comparability of the results among the different groups of researchers working on this problem. It could also be suggested an improvement of the predictive value of the tests by their combined use.