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In accidents which involve two-wheeled vehicles the helmet plays a life-saving role, but very little is known about the motorcycle rider's perception of the helmet. We evaluated the relationships between having been involved in an accident and dissatisfaction with the helmet, and between the perception of motorcycle riders and the objective features of the helmet. This was a case–control study: riders of motorized two-wheelers who had been involved in accidents (accident cases) were compared against a similarly interviewed sample of riders that had not been in accidents (control cases). Information about the driver, the vehicle and the helmet was collected in all interviews. To evaluate the relationships, logistic regressions were carried out. The majority of drivers were dissatisfied with their helmets, but no evidence was found to link this dissatisfaction with having been involved in an accident. The two most common complaints related to noisiness, followed by the helmet visor. Complaints did not seem to be statistically associated with physical features of the helmet. Deposited by bulk import 5/11/2013. SB.

BACKGROUND: Few data are available on the asthma burden in the general population. We evaluated the level and the factors associated with the asthma burden in Europe. METHODS: In 1999-2002, 1152 ad ...

The purpose of this work is to evaluate the effect of a specific motorcycle licence, held by car drivers, in responsibility for motorcycle-car crashes. The data were provided by a multicentric case-control study (MAIDS) regarding the risk of crash and serious injuries of motorcyclists. A non-parametric method, classification and regression tree (CART), was used to accomplish the objective, and then compared to standard unconditional logistic regression. Drivers owning a motorcycle licence turned out to be less responsible for motorcycle-car crashes than drivers who do not have one; both types of analysis are consistent with this result. It is reasonable to assume that car drivers who hold a motorcycle licence have acquired more ability in riding and controlling two wheeled vehicles than drivers without a licence, and this may help them in predicting motorcycles manoeuvres.

Background/Aims: Up to now, few cost-of-illness (COI) studies have estimated the cost of adult asthma at an individual level on general population samples. We sought to evaluate the cost of current asthma from the societal perspective in young Italian adults and the determinants of cost variation. Methods: In 2000, a COI study was carried out in the frame of the Italian Study on Asthma in Young Adults on 527 current asthmatics (20–44 years) screened out of 15,591 subjects from the general population in seven centres. Detailed information about direct medical expenditures (DMEs) and indirect costs due to asthma was collected at an individual level over the past 12 months. Results: The mean annual cost per patient was EUR 741 (95% CI: 599–884). DMEs represented 42.8% of the total cost, whereas the remaining 57.2% was indirect costs. The largest component of DMEs was medication costs (47.3%; 23.0% was due to hospitalization). The mean annual cost per patient ranged from EUR 379 (95% CI: 216–541)for well-controlled asthmatics to EUR 1,341 (95% CI: 978–1,706) for poorly controlled cases that accounted for 46.2% of the total cost. Poor control, coexisting chronic cough and phlegm, and low socio-economic status were significantly associated with high DMEs and indirect costs. Conclusions: In Italy, asthma-related costs were substantial even in unselected patients and were largely driven by indirect costs. Since about half of the total cost was due to a limited proportion of poorly controlled asthmatics, interventions aimed at these high-cost patients could reduce the economic burden of the disease.

Mental health and addiction services have traditionally evolved separately in many European countries, with policy reflecting this. Differences in severity profiles between users of the community addiction services with comorbidities of mental illness and substance misuse and those with substance misuse only were studied using a matched case-control study design, with regard to the main substance (opiates or cocaine) patients were dependent on. Patterns of substance abuse and diagnostic features were evaluated according to the Addiction Severity Index (ASI) and DSM-IV. Mentally ill substance abusers are significantly more likely to have used amphetamines, inhalants and having been polydrug users. They are particularly impaired in medical and family/social relationships ASI composite scores, but less in drug use. Severity profiles and needs of dually diagnosed patients require assessment and treatment skills that should be provided through adequate links with mental health system. Copyright © 2006 S. Karger AG.

The aim of this study was to describe changes in pharmacotherapy for asthma since the early 1990s in an international cohort of young and middle-aged adults. A total of 28 centres from 14 countries participated in a longitudinal study. The study included 8,829 subjects with a mean follow-up time of 8.7 yrs. Change in the prevalence of use for medication was expressed as absolute net change (95% confidence interval) standardised to a 10-yr period. The use of anti-asthmatics was found to have increased by 3.1% (2.4-3.7%) and the prevalence of symptomatic asthma by 4.0% (3.5-4.5%). In the sample with asthma in both surveys (n=423), the use of inhaled corticosteroids increased by 12.2% (6.6-17.8%). Despite this, only 17.2% were using inhaled corticosteroids on a daily basis at follow-up. Females with continuous asthma were more likely, compared with males, and smokers with asthma, to have started using inhaled corticosteroids since the first survey. The use of anti-asthmatics has increased in a pattern consistent with current consensus on treatment. However, despite increased use of inhaled corticosteroids, a large majority of subjects with symptomatic asthma do not use this treatment on a daily basis, particularly males and smokers with asthma.

The aim of this paper is to estimate the infant mortality rate and the incidence of sudden infant death syndrome (SIDS) in Lombardy, Northern Italy, in the period 1990-2000 and to provide basic information for a subsequent comparison of the SIDS incidence before and after the risk-intervention campaign. A retrospective epidemiological study was carried out using all deaths of resident infants occurring up to 1 year of age as recorded by the health districts mortality registries of the Lombardy region, between 1990 and 2000. The infant mortality rate was 4.1 per 1000 live births, with a significant decreasing trend. This decrease is mainly due to the fall in mortality for congenital malformations and perinatal diseases. The SIDS incidence rate was 0.13 per 1000 live births; the annual incidence of SIDS during the study period decreased significantly by 60% from 0.20 to 0.08 deaths per 1000 live births (P = 0.001). When 'possible SIDS deaths', not directly labelled as SIDS, were also considered, the rate of SIDS was 0.54 per 1000 live births. The incidence of SIDS in Northern Italy appears much lower than anticipated. SIDS remains the single leading cause of death in the first year of life after the early neonatal period.

SummaryAim — To point out the degree of satisfaction of psychotic patients and their family members in relation to the assistance given by the four Outpatient Mental Health Services in the Savona Department. Methods — patients with a diagnosis of psychosis were selected among those visited during the period from the 1st of January to the 30th of April 2002. VSSS—54 item, was utilized. Results — The analysis, conducted on 301 patients and 149 family members, highlighted: 1) a substantially positive assessment of the Services 2) the patients and their family members quite agreed on the evaluation of the different areas of satisfaction 3) Strong points: all the operators' human and professional skills 4) request of a better knowledge of the Service's programmes and more information to the public opinion 5) request of more collaboration with family doctors and other specialists 6) The worst criticism: the Service's response to night and holiday emergency. Conclusions — The patients and their family members reacted positively to the survey, that created more resistance on the part of the operators. The survey is not to be considered the final objective, but the point of departure for a new form of collaboration between the users and the operators.Declaration of Interestnone

The identification of the asthmatic `case' in epidemiological research is a controversial issue. This study was aimed at classifying asthmatic subjects using a statistical decision rule that minimised the misclassification rate with respect to the clinicians' diagnosis. The rule was defined by a combination of predictors that are easily observed in epidemiological studies (asthma-like questions, physiological tests) without necessarily including the clinical opinion of expert physicians. From pooled data on 1103 subjects at the three Italian centres of the European Community Respiratory Health Survey (ECRHS) a post-consensus clinicians' diagnosis of asthma was obtained, and seven predictors were selected from among 18 potential candidates (specificity ranged from 64 to 99%, but sensitivity ranged from 22 to 62%). This data set was processed with tree-structured classifier techniques (the Classification And Regression Trees, CART), classical discriminant analysis (Fisher's Linear Discriminant Function, LDF), and the neural network method (Multi-Layer Perceptron, MLP model). The results suggest that modifications of the `classification tree' provide a more useful decision rule, sensitive (93%) and specific (85%), than either LDF or MLP. The decision tree is readily interpretable from a clinical perspective and uses five out of the seven predictors (in descending hierarchical order: ever had asthma, current asthma, shortness of breath, atopy and wheezing and breathless). The findings seem to indicate a considerable success with respect to previous epidemiological studies and await repetition in other ECHRS populations.

SummaryObjective – To provide a multidimensional description about the pattern of patients recovered in some Psychiatric Rehabilitation Sevices, as emerging from identification of similar groups regarded the total severity. Design and Setting – A cross-sectional survey has been conducted on patients recovered in 4 Northern-Italy Psychiatric Rehabilitation Services. A statistical bottom-up analysis (Principal Components and Cluster Analysis) has been performed. Main outcome measures – Any patient has been evaluated using a questionnaire with well-known rating scales (BPRS-psychiatric rating, Katx index and IADL index, IDS index of comorbidity) together with informations on sex, age, social and economic state, psychiatic history, therapeutic devices and staff involvement. Results – We analyzed 455 patients. 267 (58.7%) male and the mean age is 58.517.9. After statistical analysis, 4 clusters of patients has been found: the first group (106 patients) is younger, descrided as not seriuosly compromised, mostly with psychotic problems; the second (96 patients, most of them woman with diagnosis of demetia) is much older, with serious problems of indipendency and comorbidity. The third (82 patients) and fourth (171 patients) group show intermediate patterns. The level of care requested by these groups has been provided. Conclusions – Our results show the usefulness of sophisticated statistical methods to describe patients recovered in psychiatric rehabilitation services. Moreover, our findings could be useful as good proposal to the people involved in this field, planning an active intervention in this area.

SUMMARYIntroduction — Many studies have been carried out recently to investigate the relationship between health conditions and family and self characteristics. Objectives — To identify family characteristics (such as type of family, socio-economic status, parent immigration, affection for parents, parents' psychological and physical health) and self characteristics (age, drug use, satisfaction for several life circumstances, psychosomatic symptomatology) that are differently distributed by sex and levels of psychological and physical distress among teen-agers. Methods — We carried out a cross-sectional study on a sample of teen-agers attending high schools in Pavia (Italy), using a self-administered questionnaire. The students were divided in four groups having different levels of psychological and physical distress, based on GHQ-30 (psychological distress indicator), on the number of hospital admissions and consultations to a physician in the last year (the last two are physical distress indicator). Data were analysed applying the multivariate analisy of Canonical Variate. Results — 1346 students were sampled, but only 1189 questionnaire were analysed: 36.8% regarding males and 63.2% females. The Canonical Variate analysis indicated that psycosomatic symptomatology, satisfaction for several life circumstances and affection for parents are important for describing the four distress groups. Conclusions — Only affection for parents has an important role on psychological and physical distress of adolescents, while family characteristics traditionally considered associated with psychological and physical distress in teen-agers (such as living with one or without parents, low socio-economic status) are not associated.

The European Community Respiratory Health Survey is an international survey of the general population which aims to establish whether there are significant variations in the prevalence of asthma among European countries. The present paper reports the prevalence of asthma and asthma-like symptoms in a sample of subjects living in three areas of northern Italy: Turin, Pavia, and Verona. Samples of residents 20–44 years old (3000 subjects in Turin and Verona and 1000 in Pavia) stratified by sex (M:E= 1/1) were randomly selected from local health authority lists in the three participating areas. To correct the observed prevalence estimate for nonresponse bias, a method proposed by Drane was applied. Of the sampled subjects, 86% (6031) participated in the survey. Two different definitions of asthma were adopted: 1) prevalence of asthma attack in the last 12 months; 2) prevalence of asthma attack or treatment with antiasthmatic drugs, or both wheezing apart from the common cold and wheezing with shortness of breath. This combination of symptoms has been called current asthma. According to these definitions, the prevalence of asthma attack was 3.47% (3.74%, in men and 3.14% in women), and the prevalence of current asthma was 5.01% (5.07% in men and 4.90% in women). The lowest prevalence was found in Pavia; the highest in Turin. Our findings support the hypothesis that the difference in prevalence reflects the difference in mortality.

RiassuntoSono descritte con la stessa metodologia impiegata in altre quattro aree italiane sedi di Registro psichiatrico dei casi, le caratteristiche del bacino di utenza, la tipologia e l'organizzazione dei Servizi della Regione Liguria. Il sistema informativo psichiatrico ligure nasce ufficialmente nel marzo 1987 con una deliberazione della Giunta Regionale che conferisce l'incarico di organizzazione del sistema informativo all'lstituto di Scienze Sanitarie Applicate dell'Università di Pavia. La fonte dei dati è rappresentata dai Servizi psichiatrici della Liguria, comprendenti 20 Servizi Territoriali di Salute Mentale (SSM), 9 Servizi Psichiatrici di Diagnosi e Cura (SPDC) e 2 Presidi Socio Sanitari (PSS). Il Registro psichiatrico è gestito a livello cartaceo in tutti i Servizi della Regione; tuttavia in 12 dei Servizi di Salute Mentale, in 2 dei Servizi Psichiatrici di Diagnosi e Cura e nei Presidi Socio Sanitari si è già passati ad una gestione informatizzata del Registro. La rilevazione dei dati è iniziata dal 1988 è nel 1989 è stata fatta la prima verifica regionale sulla funzionalità del sistema. I risultati relativi all'utenza dei servizi territoriali evidenziano tassi di prevalenza annua che vanno dal 200 al 500 per 100.000 abitanti. Per quanto concerne gli interventi residenziali, SPDC e PSS sono stati analizzati separatamente confermando peraltro il dato della letteratura cioè di una eccedenza di diagnosi di psicosi soprattutto tra i maschi ricove- rati in SPDC e tra le femmine ricoverate nei PSS. La struttura per eta evidenzia che si tratta di persone di età avanzata in particolare tra le donne.

several studies have shown that most road accidents are due to human factors, and that these are strongly linked to a drive's age and sex. The aim of this study is to test the role that some human factors play in road accidents by analysing current road accident data in the Province of Pavia, in Northern Italy.road accidents that occurred in 2004 were analysed by integrating the paper database of the vehicle licensing office, properly computerised, with the 911 database of the Province of Pavia. This study has been carried out by analysing 1.347 road accidents and the associated 2.908 drivers of motorised vehicles.Northern Italy, the Province of Pavia.the death rate of drivers of 2-wheeled vehicles is almost nine times higher than that of 4-wheeled vehicles. Analysis shows that females are twice as exposed to road accidents than males; it also shows the benefits of extensive road education training and of being aged 30-64 and older. Drivers who have already been punished and have had their driving license scores reduced are likely to respond rapidly when in a dangerous situation and also to be without blame after an accident. Motorcycle riders are 25 times more likely to suffer serious injury than drivers of cars. Additionally, the risk of a woman being seriously injured is higher than for a man.females, young drivers and motorcycle riders who have not previously been penalised for a previous traffic violation have a higher risk of being seriously injured; females and motorcycle riders are also at greater risk of being seriously injured. We hope that this analysis will be used to improve preventative interventions for road accidents.r.

SUMMARYAims– To evaluate the quality of acute psychiatric care concerning the management of violent behaviour and rapid tran-quilization.Methods– Data concerning 13 indicators, drawn from NICE recommendations, were collected in 19 Departments of Mental Health, in the frame of the SIEP-DIRECT's Project, to evaluate the implementation of NICE recommendations in Italian Mental Health Services.Results– In about two thirds of Departments of Mental Health (DMHs) professionals were trained in the management of violent behaviour, while written procedures existed only in one fourth of DMHs. About a half of the professionals working in Psychiatric Wards in General Hospital were trained in rapid tranquilization, while procedures on this topic are practically absent and specific care for monitoring intensively the heavily sedated patient was not frequent.Conclusions– Management of violent behaviour and rapid tranquilization are two critical areas in the care performed by Psychiatric Wards in General Hospital. Training on these topics is more frequent than implementation of procedures. NICE recommendations and SIEP indicators are useful tools for improving the quality of acute psychiatric care.Declaration of Interest: None.

During the 1990s Evidence-Based Medicine emphasized the need to promote evidence-based practice, leading to a rise of practice guidelines throughout medicine, and expanding the systematic use of scientific evidence in clinical decision-making. Though administrators, clinicians, advocates and researchers generally agree that they should provide the most effective mental health treatments, implementing evidence-based practices in standard settings is not straightforward. The NICE-Schizophrenia Guidelines (SG) were translated into Italian at a significant time as concerns upcoming review of National mental health care models. However, guidelines must be contextualized to the concrete care practices. Simply publishing and distributing clinical guidelines is not enough to change the practice of clinicians. National mental health services in England and in Italy, share principles – e.g. providing a universal and comprehensive service with equal access for all, free at the point of use, based on clinical need, not ability to pay – but also weaknesses such as difficulties in translating the best research evidence available to implementable clinical practice recommendations. To maximise the likelihood of NICE-SG being used, coherent dissemination and implementation strategies are needed. This article provides new insights about barriers and facilitators for adaptation and implementation of NICE-SG within Italian Mental Health Services

International audience; BACKGROUND: Epidemiologic evidence related to asthma control in patients from the general population is scanty. OBJECTIVES: We sought to assess asthma control in several European centers according to the Global Initiative for Asthma (GINA) guidelines and to investigate its determinants. METHODS: In the European Community Respiratory Health Survey II (1999-2002), 1241 adults with asthma were identified and classified into inhaled corticosteroid (ICS) users and non-ICS users in the last year. Control was assessed in both groups by using the GINA proposal (controlled, partly controlled, and uncontrolled asthma), and it was related to potential determinants. RESULTS: Only 15% (95% CI, 12% to 19%) of subjects who had used ICSs in the last year and 45% (95% CI, 41% to 50%) of non-ICS users had their asthma under control; individuals with uncontrolled asthma accounted for 49% (95% CI, 44% to 53%) and 18% (95% CI, 15% to 21%), respectively. Among ICS users, the prevalence of uncontrolled asthma showed great variability across Europe, ranging from 20% (95% CI, 7% to 41%; Iceland) to 67% (95% CI, 35% to 90%; Italy). Overweight status, chronic cough and phlegm, and sensitization to Cladosporium species were associated with poor control in ICS users. About 65% and 87% of ICS users with uncontrolled and partly controlled asthma, respectively, were on a medication regimen that was less than recommended by the GINA guidelines. CONCLUSION: Six of 7 European asthmatic adults using ICSs in the last year did not achieve good disease control. The large majority of subjects with poorly controlled asthma were using antiasthma drugs in a suboptimal way. A wide variability in asthma control emerged across Europe. CLINICAL IMPLICATIONS: Greater attention should be paid to asthma management and to the implementation of the GINA guidelines.

Background: A major reason of the poor control of asthma is that patients fail to adhere to their treatment. The aim of the study was to identify factors affecting changes in asthma treatment adherence in an international cohort. Methods: A follow-up study was carried out by means of a structured clinical interview in 971 subjects with asthma from 12 countries who participated in both the European Community Respiratory Health Survey: ECRHS-I (1990-94) and ECRHS-II (1998-2002). Subjects were considered adherent if they reported they normally took all the prescribed drugs. A logistic model was used to study the adjusted effect of the determinants. Results: The net change in adherence to anti-asthmatic treatment per 10 years of follow-up was -2% (95% Cl: -9.5, 5.5), 7.5% (-2.6, 17.6), 15.0% (6.6, 23.5) and 19.8% (4.1, 35.5), respectively, in Nordic, Mediterranean, Continental and extra-European areas. Among the 428 non-adherent subjects in ECRHS-I, having regular consultations with health care professionals was the strongest predictor of increased adherence (OR 3.32; 95% CI: 1.08-10.17). Among the 543 adherent subjects in ECRHS-I, using inhaled corticosteroids significantly predicted a persistence of adherence (OR 2.04; 95% CI: 1.11-3.75). No effect of gender, age, duration of the disease, smoking habit and educational level was observed. Conclusions: Our findings highlight the key role of doctors and nurses in educating and regularly reviewing the patients and support the efforts for an improvement of clinical Communication. (c) 2006 Elsevier Ltd. AU rights reserved.

Background The natural history of asthma severity is poorly known. Objective To investigate prognostic factors of asthma severity. Methods All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). Results Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV 1 % predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. Conclusion Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. Clinical implications Our results suggest that the evolution of asthma severity is to a large extent predictable.

BackgroundFew longitudinal data exist on the incidence of asthma in young adults and on the overall mortality risk due to asthma. A 7-year follow-up prospective study was performed to assess the incidence of asthma and mortality from all causes in a cohort of young adults.MethodsThe life status of a cohort of 6031 subjects, aged 20–44 years, who replied to a respiratory screening questionnaire between 1991 and 1992, was ascertained in 1999. A new questionnaire investigating the history of asthma was subsequently sent to the 5236 subjects who were still alive and residents in the areas of the study. 3880 subjects (74%) replied to the second questionnaire.ResultsThe incidence of adult-onset asthma was 15.3/10,000/year (95%CI:11.2–20.8). The presence of asthma-like symptoms (IRR:4.17; 95%CI:2.20–7.87) and allergic rhinitis (IRR:3.30; 95%CI:1.71–6.36) at baseline were independent predictors of the onset of asthma, which was more frequent in women (IRR:2.32; 95%CI:1.16–4.67) and increased in the younger generations.The subjects who reported asthma attacks or nocturnal asthma symptoms at baseline had an excess mortality risk from all causes (SMR = 2.05; 95%CI:1.06–3.58) in the subsequent seven years. The excess mortality was mainly due to causes not related to respiratory diseases.ConclusionAsthma occurrence is a relevant public health problem even in young adults. The likelihood of developing adult onset asthma is significantly higher in people suffering from allergic rhinitis, in women and in more recent generations. The presence of asthma attacks and nocturnal symptoms seems to be associated with a potential excess risk of all causes mortality.

Background: The guidelines for asthma recommend that the use of anti-inflammatory therapy should be adapted to the severity of the disease. However, few data are available to assess the adequacy of the use of drugs and its influence on the control of asthma in ‘real life’. Methods: The adequacy of the current use of anti-asthmatic medication according to the Global Initiative for Asthma (GINA) guidelines was assessed in a random sample of 400 asthmatics identified in the frame of the Italian Study on Asthma in Young Adults. Asthma severity was assessed using the GINA criteria; accordingly, a patient was classified as receiving inadequate treatment if his/her current use of drugs was lower than that suggested by the guidelines for the corresponding severity level. The absence of asthma attacks in the last 3 months was used as an indicator of the disease control. Results: Fifty-five percent of the patients had persistent asthma. Overall, 48% (95% CI 41.2–54.8) of persistent asthmatics were receiving inadequate treatment, and 66% (95% CI 59.5–72.4) had not used their medication daily over the past 3 months. Persistent asthmatics who were inadequately treated had a significantly greater frequency of asthma attacks (geometric mean ratio 3.7; 95% CI 2.1–6.6) than those using an adequate dose of medication. Mild and moderate persistent asthmatics using an adequate medication regimen reported a low number of asthma attacks (median 0). At the multivariate analysis, a good control of the disease was positively associated with an adequate dose of anti-inflammatory medication (OR = 2.2; 95% CI 1.1–4.5) and was negatively associated with a later onset of asthma (OR = 0.96; 95% CI 0.93–0.99) and severe asthma (OR = 0.37; 95% CI 0.17–0.81). Conclusions: Despite the increase in the use of inhaled corticosteroids, half of the persistent asthmatics from the general population are using a medication regimen below their severity level. When the use of drugs follows the GINA guideline recommendations, a good control of asthma is also achievable in the daily management of the disease, particularly in the case of mild and moderate asthmatics.

The purpose of this work is to evaluate the effect of a specific motorcycle licence, held by car drivers, in responsibility for motorcycle-car crashes. The data were provided by a multicentric case-control study (MAIDS) regarding the risk of crash and serious injuries of motorcyclists. A non-parametric method, classification and regression tree (CART), was used to accomplish the objective, and then compared to standard unconditional logistic regression. Drivers owning a motorcycle licence turned out to be less responsible for motorcycle-car crashes than drivers who do not have one; both types of analysis are consistent with this result. It is reasonable to assume that car drivers who hold a motorcycle licence have acquired more ability in riding and controlling two wheeled vehicles than drivers without a licence, and this may help them in predicting motorcycles manoeuvres.

To estimate the infant mortality rate and the incidence of Sudden Infant Death Syndrome (SIDS) which is not known in Italy.Retrospective mortality study using all deaths of resident infants occurring up to one year of age as recorded by the Italian Institute of Statistics, between 1994 and 1996.Lombardy, Northern Italy.Infant mortality rate (deaths occurring in the 1st year of life), early neonatal mortality rate (1st-7th days of life), late neonatal mortality rate (8th day of life-1st month of life), post-neonatal rate (1st month-one year of life), and incidence of SIDS (Sudden Infant Death Syndrome).The infant mortality rate was 4.76 per 1,000 live births, with no significant differences among the three years and lower than the Italian rates. The SIDS incidence rate was 0.14 per 1,000 live births, and 0.39 per 1,000 live births when deaths not directly labelled as SIDS were considered. SIDS was the single leading cause of death in the first year of life after the early-neonatal period.The decrease of the infant mortality rate is due to the drop in mortality for congenital malformations and perinatal diseases. The incidence of SIDS in Northern Italy turns out to be low, while SIDS remains the single leading cause of death in the first year of life after the early neonatal period.

The definition of asthma has always been a matter of discussion. The European Community Respiratory Health Survey (ECRHS) is a multinational survey designed to compare the prevalence of asthma in subjects aged 20 to 44 years throughout European countries. In each center a representative sample completed a self-administered screening questionnaire composed of nine dichotomous items. We propose a method for constructing a score for the ECRHS screening questionnaire and we validate the method with reference to the clinical diagnosis available for the Italian centers. Clinical diagnosis was made by a group of medical experts after examining the responses to a standardized clinical interview, respiratory function tests, and allergy tests. Before constructing a summary score, the number of latent factors/dimensions explaining correlations among the observed items was recognized. We identified only one factor/dimension underlying the screening questionnaire, so a summary score was determined by the Homogeneity Analysis by Alternating Least Square (HOMALS). Using best Receiver Operating Characteristic (ROC) threshold the diagnostic test of the score had sensitivity and specificity of 75.1 and 80.1%, respectively. The method of scoring is easily reproducible, and has the advantage of optimizing information recoded by the questionnaire.

Background: Few data are available on the management of asthma in the general population. The aim of this study was to evaluate the level of asthma control in Italian patients, a decade after the publication of the international guidelines. Materials and methods: Within the framework of a multicentre, population-based study on people aged 20–44 years, 18 873 subjects replied to a postal screening questionnaire (response rate = 72.7%) on the presence of asthma symptoms and exacerbations, and their impact on daily life. All subjects reporting having ever had a doctor diagnosis of asthma and either taking medicine for asthma when interviewed or having had an asthma attack in the last 12 months, were considered current asthmatics. Results: Of the screened subjects, 649 (3.4%) were current asthmatics. Of these, only 14% did not report exacerbations or had been symptom-free in the last 12 months. More than 20% of current asthmatics had their daily life activities seriously impaired and 54 patients (8%) had at least one hospital/emergency department admission as a result of asthma exacerbation in the last 12 months. The life impairment and the rates of hospitalization significantly increased as the control of the symptoms worsened. The use of asthma drugs was quite common in current asthmatics: 586 (90.2%) reported having been under pharmacological treatment in the last 12 months. Only 63 patients (10%) had the disease under control (neither symptoms nor life impairment): they had a significantly higher percentage of drug use (100%vs 89%) and of daily use prescriptions (50%vs 36%) than non/moderately controlled asthmatics. Poorly controlled asthmatics had a significantly higher percentage of women (63%vs 44%), of patients with the coexistence of chronic cough and phlegm (47%vs 30%) than moderately/well-controlled asthmatics. The comparison between our data and similar data collected in 1991 in Italy showed that the use of asthma drugs increased by about 12%, while the control of symptoms did not improve in the last decade. Conclusion: Despite the high percentage of drug users, the control of symptoms and exacerbations was overall poor in Italy and resulted in a heavy individual and social burden, pointing out that the guideline goals have far from been reached in Italy.

From January 1995 to August 1997 we evaluated prospectively the clinical presentation, laboratory findings and short-term survival of smear-positive pulmonary tuberculosis (TB) patients who sought care at our hospital. After providing informed, written consent, the patients were interviewed and laboratory tests were performed. Information about survivorship and death was collected through September 1998. Eighty-six smear-positive pulmonary TB patients were enrolled; 26.7% were HIV-seropositive. Seventeen HIV-seronegative pulmonary TB patients (19.8%) presented chronic diseases in addition to TB. In the multiple logistic regression analysis a CD4+ cell count or = 50 years were independently associated with decreased survival. Among HIV-seronegative persons, the presence of an additional disease increased the risk of death of almost six-fold. Use of antiretroviral drugs was associated with a lower risk of death among HIV-seropositive smear-positive pulmonary TB patients (RH = 0.32, 95% CI 0.10-0.92). In our study smear-positive pulmonary TB patients had a low short-term survival rate that was strongly associated with HIV infection, age and co-morbidities. Therapy with antiretroviral drugs reduced the short-term risk of death among HIV-seropositive patients after TB diagnosis.

Background: Italian data on the prevalence of allergic rhinitis are sparse and with wide variations, maybe because of different diagnostic criteria and methods of investigation. This study analyzes the information on rhinitis collected in northern Italy through standardized methods within the European Community Respiratory Health Survey. Methods: A screening questionnaire was sent by mail to a random sample of the general population aged 20–44 years, and nonresponders were contacted again by phone, achieving a final response rate of 86% (6031/7000). Among the responders, 914 randomly selected underwent a standardized clinical interview, skin prick test (SPT) and total and specific immunoglobulin (Ig)E determination. Results: The overall prevalence of self-reported allergic rhinitis was 15.9% (95% CI 15.0–16.8%). Allergic rhinitis was more common in men below 35 years and in women older than that (P = 0.006), in urban areas (P

We assessed the infectiousness of human immunodeficiency virus (HIV)-seropositive and HIV-seronegative individuals with pulmonary tuberculosis (TB) in a prospective cohort study. We enrolled, evaluated, and followed 104 close contacts of HIV-seropositive pulmonary TB patients and 256 close contacts of HIV-seronegative pulmonary TB patients using a standardized questionnaire, symptom review, chest radiograph, HIV serology, and tuberculin skin testing (TST). Contacts were followed foror = 12 mo. TB infection at enrollment was 27% (28/104) among contacts of HIV-seropositive TB patients and 35% (90/256) among contacts of HIV-seronegative TB patients (odds ratio [OR] = 0.68, 95% confidence interval [CI] 0.41 to 1.12; p = 0.130). TST conversion occurred in 21% (42/ 204) of subjects; 8% (5/63) of contacts of HIV-seropositive index cases and 26% (37/141) of contacts of HIV-seronegative index cases (OR = 0.24, 95% CI 0.09 to 0.65; p = 0.003). TB was diagnosed in nine contacts; eight were contacts of HIV-seronegative index cases. HIV seropositivity in the index case was independently associated with a lower risk of TB infection among contacts, even among household contacts younger than 15 yr of age. Contacts of HIV-seropositive persons with pulmonary TB were less likely to have a positive TST response at 1 yr of follow-up than contacts of HIV-seronegative persons.

Road accidents are a great problem in our society. To identify the major risk factors for road accidents in the province of Milan (Lombardy region, Italy), we analysed the police reports of more than 120 thousand road accidents that had occurred in 2004–2005. Using logistic regression, the adjusted odds ratios were calculated to estimate the likelihood of being injured or of dying rather than of being unhurt. Analysis were conducted for the drivers of all vehicle types collapsed, and separately for the drivers of each vehicle category. The most important findings are the following. The risks of being injured or of dying are higher for riders of two-wheeled vehicles compared to car drivers and decrease from bicycles to motorcycles to mopeds. Women have a higher risk of being injured (OR 1.98, 95%CI 1.91 to 2.05) but a lower risk of dying (OR=0.64, 95%CI 0.42 to 0.99). Compared with people younger than 30 years, people aged ≥65 have a higher risk of dying (OR 2.84, 95%CI 1.84 to 4.32). Accidents which occur during the night and during the week-end are more serious. Accidents on extra-urban roads are more dangerous than those in the urban area; accidents on motorways have a risk of death higher than those in urban areas (OR 2.05, 95%CI 1.43 to 2.95), while the risk of being injured is smaller (OR 0.44, 95%CI 0.42 to 0.46). The most dangerous accidents are the single-vehicle ones. The analysed database offers a consistent image of accidents in a broad metropolitan area, and supplies many elements of scientific evidence useful to plan preventive interventions.

Factor V and prothrombin-gene mutations are independent risk factors for venous thrombosis; it is debated whether a mutation in the gene encoding methylenetetrahydrofolate reductase, an enzyme involved in homocysteine metabolism, also increases the risk of venous thrombosis. Whether any of these mutations is associated with an increased risk of late fetal death is not known.We studied 67 women with a first episode of unexplained late fetal loss (fetal death after 20 weeks or more of gestation) and 232 women who had had one or more normal pregnancies and no late fetal losses. All the women were tested for the presence of three gene mutations. Women with other thrombophilic conditions were excluded from the study.Eleven of the 67 women with late fetal loss (16 percent) and 13 of the 232 control women (6 percent) had either the factor V or the prothrombin mutation. The relative risks of late fetal loss in carriers of the factor V and prothrombin mutations were 3.2 (95 percent confidence interval, 1.0 to 10.9) and 3.3 (95 percent confidence interval, 1.1 to 10.3), respectively. Thirteen percent of the women whose fetuses died and 20 percent of the control women were homozygous for the mutation in the methylenetetrahydrofolate reductase gene (relative risk, 0.8; 95 percent confidence interval, 0.5 to 1.2).Both the factor V and the prothrombin mutations are associated with an approximate tripling of the risk of late fetal loss.

In road accidents which involve two-wheeled vehicles the helmet plays a fundamental life-saving role. The driver9s perception can be influenced by some features of the helmet, such as noisiness, temperature, ventilation, field of vision and size. Using data collected in the European study COST 357 – PROHELM (Accident Prevention Options with Motorcycle Helmets), we evaluated the relationships between having been involved in an accident and dissatisfaction with the helmet and between the cognitive capacity of the motorcycle riders and the objective features of the helmet. It is a case-control study: riders of motorised two-wheelers who have been involved in accidents (cases) were compared with a sample of riders interviewed as control cases. The variables, collected using standardised procedures in the various countries, concern information about the driver, the vehicle and the helmet, perceptions and use of the helmet and accident circumstances (only for cases). To evaluate the relationships, logistic regressions were carried out. Dissatisfaction with the helmet is complained of by the majority of drivers (about 70%), but evidence of an association with being involved in an accident has not been found. The most common complaints are about noisiness, followed by visor. Complaints do not seem to be associated with the objective features of the helmet. These results provide useful information about helmet comfort and the main causes of dissatisfaction reported by riders. This information should be of value to helmet manufacturers and designers to increase the pleasure of the helmet.

Few studies are available regarding accidents involving trucks and even less is known about the cause. To fill in this lack of knowledge, we performed an analysis in order to identify the main causes of accidents involving trucks, using data obtained form European Truck Accident Causation a research conducted across France, Germany, Hungary, Italy, Slovenia, Spain and The Netherlands. Accidents involving at least one truck and one injured person have been investigated. Data collection started on April 2004 and finished on September 2006. Accidents were collected from sample areas representative of the national truck accident situation. The first investigation was on the spot of the accident as quickly as possible; if necessary, investigators investigated again the accident. Parameters on infrastructure, vehicles and people involved were evaluated. In total, 624 accidents have been investigated. The majority of truck drivers was professional drivers (97.0%) involved in the accident while working (86.8%). In 91.7% of cases the main accident cause is linked to human factors. The main cause varied according to the accident configuration. In accidents at intersection was the failure to observe road rules; in accidents in queue or during an overtaking manoeuvre was inattention; for accidents due to a lane departure were non-adapted speed and improper manoeuvre when turning; for single-vehicle accidents was overfatigue/falling asleep. This information can be used to give guidance to policy and decision makers for future action which can contribute to the improvement of road and occupational safety.

– Descriptive statistics derived from a psychiatric case register are presented. They may be useful for a more rational planning of new services, and provide a preliminary evaluation of the effects of the recent Act (1978) which has abolished large mental hospitals in Italy. Each component of the 1-year prevalence rates has been examined closely, and the results have indicated three main considerations: abolishing the large mental hospital does not abolish the long-stay patients still living in it, and these people will remain a heavy load on the mental health care system for a long time; the new Act has halved admission rates, but the decline may be a positive result if in-care and out-care are sufficiently integrated; treated out-patients tend to increase year by year, and they seem more and more to be “young men and middle-aged women” suffering from minor psychiatric disorders. Finally, a closer collaboration between planners and evaluators is suggested.

Data derived from a psychiatric case-register are presented on the attrition of the cohort of theold long-stay in-patients, and the accumulation of thenew long-stay cases in Lomest, a town in northern Italy, from 1975 to 1980. The characteristics of “high user” groups of out-patients attending the non-residential services are also described. The analysis seeks to provide some information on “who has been left behind” by the massive deinstitutionalization programme that has been carried out in Italy since 1970.

Descriptive statistics derived from four psychiatric case-register areas are presented. Attrition numbers of long-stay inpatients and the accumulation of high-user patients in non-residential facilities are discussed, with the aim of providing tentative suggestions for a more rational planning of services. Similarities and differences among various areas of Northern Italy are also described.

SUMMARYObjective – The study investigated eating disordered behaviours and life-habits correlated in a large sample of Northern Italian adolescents of both sexes. Methods – The study had a cross-sectional design. 2595 students (2,146 responders; mean age 17.2±1.7 years) attending high schools in Savona (Italy) in April and May 2001 were sampled. To assess eating attitudes, the Inventory for the Screening of Eating Disorders (ISED) was self-administered. Inquiries regarding possible risk factors for eating disorders were also made: socio-economic status, body weight, smoking and alcohol drinking habits, illegal drugs use. Results – Females scored significantly higher than males at ISED (13.4±7.7 vs. 7.6±5.8). 28.5% of females had a total ISED score above the cut-off point (18/19). Unhealthy eating behaviours were strongly associated with higher BMI, body image disturbance and illegal drugs use in both sexes; age had significant role only in males. No significant association between disordered eating behaviours and socio-economic status, smoking habit and alcohol consumption were found. Conclusions – Symptoms of eating disorders are quite spread in the Northern Italian female adolescents and associate with illegal drugs use. These data, with not negligible frequency of unhealthy eating behaviours and attitudes in males too, suggest that primary and secondary preventive interventions for teen-agers should be got ready.Declaration of Interest: 1) the study received the financial support by Regione Liguria and ASL 2 of Savona; 2) the study didn't receive any forms of financing by pharmaceutical company support and any honoraria for consultancies or interventions was received by each author in the last two years; 3) any other involvements that might be considered a conflict of interest in connection with the submitted article. The authors state that if and when the manuscript accepted for publication, they automatically agree to transfer the copyright to the publisher