Michele E. Grandolfo

Early life factors related to clinical manifestations of atopic disease but not to skin-prick test positivity in young children

The relative influence of early life events in the development of IgE‐mediated allergy is still undetermined. We investigated early life factors in relation to skin‐prick test positivity (SPT) and clinical manifestations of atopic disease in a population‐based sample of 201 Italian children (3 months−5 years), after considering their interactions with known determinants of allergy. Among them, 143 children had SPT performed to common allergens. Threatened abortions, general anesthesia at delivery, prematurity, birthweight < 2500 g, maternal smoking, dampness and gas heating exposure were all significantly related to an increased risk of frequent rhinitis in the absence of cold (18%). In utero smoking, threatened abortions, fetal health complications, infantile colic, maternal smoking in childhood (satisfactorily correlated with maternal expired CO during the survey) and respiratory infections were all independent determinants of frequent wheezing (23%). Doctors diagnosis of asthma (3%) was related to in utero smoking, being born in spring, infantile colic and respiratory infections. A simultaneous exposure to in utero smoking and infantile colic put the infants to a fourfold higher risk of frequent wheezing and to a ninefold risk of asthma, respectively. Having a pet and washing blankets at < 60°C were inversely related to frequent wheezing. Data confirmed also that maternal phenotype influences the inheritance of atopic disease. No event, except a low intake of fruit (< 3/week), was significantly associated with positive SPT (20%) or eczema. Besides allergic sensitization, other events, which occur early in life, seem critical to the development of IgE‐mediated allergy.

Vaccination campaign against hepatitis B for 12-year-old subjects in Italy

The vaccination campaign against hepatitis B for 12-year-old subjects in Italy was evaluated in 136 health districts (USL); 55 in the north, 69 in the centre, and 12 in the south, respectively. Out of the 113,230 eligible subjects born in 1981, 105, 989, (93.6%) completed the three dose series during the period 1993-1994. However, wide geographical differences are observed: the acceptance rate was as high as 97.9% (range 89.7-100.0) and 96.6% (range 76.0-100.0) in the north and in the centre, respectively; but only 65.1% in the south (range 26.8-100.0). Subjects were recruited in the north and in the centre mostly from the list of residents, while in the south more likely only from the list of people attending school. The school attendance in the south, not as good as in the other Italian areas, particularly among people belonging to a subgroup of the population economically disadvantaged, appears to be a strong determinant of the different vaccine coverage observed. Active efforts from health services in southern areas are necessary to reach subgroups of population who escape hepatitis B vaccination and who are also at high risk of HBV infection.

Smoking Behaviour before, during, and after Pregnancy: The Effect of Breastfeeding

Data for this study were obtained from a population-based follow-up study in 25 Italian Local Health Units (LHUs) to evaluate pregnancy, delivery, and postpartum care in Italy. A sample of 3534 women was recruited and interviewed within a few days of their giving birth and at 3, 6, and 12 months after delivery, by trained interviewers using questionnaires. The objective of the study was to evaluate changes in smoking behaviour from one interview to the next. Of 2546 women who completed the follow-up, smoking prevalences before and during pregnancy were 21.6% and 6.7%; smoking prevalences and smoking relapse at 3, 6, and 12 months were 8.1% and 18.5%, 10.3% and 30.3%, and 10.9% and 32.3%, respectively. Smoking during and after pregnancy was more likely among women who were less educated, single, not attending antenatal classes, employed, and not breastfeeding. The results show that women who are breastfeeding smoke less than not breastfeeding women, even after controlling for other predictors (i.e.,  smoking relapse at 12 months: OR = 0.43, 95%  CI:  0.19, 0.94). A low maternal mood increases the risk of smoking relapse within 6 months of about 73%. This study also suggests that prolonged breastfeeding reduces the risk of smoking relapse and that this reduction may be persistent in time. Interventions targeting breastfeeding promotion may also indirectly support smoking cessation, even in absence of specific interventions.

Response to poliovirus immunization and type of feeding in babies of atopic families

The aim of the present study was to investigate the antibody response to oral poliovirus immunization, and to evaluate the infection morbidity in a group of infants with a positive family history of atopy who were soy‐protein‐formula fed during the first 6 months of life. We have selected and followed from birth to 4 yr, 107 babies, 18 of whom were exclusively soy‐protein‐formula fed during the first 6 months of life. All infants were seen at our clinic at the ages of 1, 3, 6, 9, and 12 months, and once‐a‐year afterwards. They regularly received the oral vaccine against polioviruses at the ages of 3, 5 and 12 months. At age 6, 12 and 24 months, poliovirus type 1, 2 and 3 antibodies were detected. There was no significant difference of seroconversion in the babies, breast, soy or breast and soy fed. Furthermore, no increase in infection morbidity was observed in the soy‐protein‐formula fed infants. Our data shows that soy‐protein‐formula feeding in the first 6 months of life does not induce any abnormal antibody response to the oral poliovirus vaccination, as well as no increase in infection morbidity.

Influence of environmental iodine deficiency on neonatal thyroid screening results

During a multicentric pilot screening program for congenital hypothyroidism a comparison between the results obtained from Urbino, an area characterized by low iodine supply and endemic goiter, and Rome, a non-endemic area, has been made. The evaluation of neonatal urinary iodine excretion in the two areas showed significantly lower iodine urinary excretion levels in Urbino than in Rome. A shift of TSH at screening toward higher values as well as a higher percentage of recall in Urbino area than in Rome was observed. This finding, which well correlates with a low environmental iodine supply, emphasizes the importance of screening for congenital hypothyroidism as a suitable index of the presence and action of goitrogenic factors in the environment.

Reducing pain of first trimester abortion under local anaesthesia

The study aimed to estimate the pain related to first trimester abortion under local and general anaesthesia. One hundred and eighty-one women undergoing abortion of first trimester under local anaesthesia and 198 under general anaesthesia were interviewed 1 h after the end of the procedure. About 50% of all women described their experience as less painful than expected. Over 50% of the women described the pain during the procedure as mild or moderate according to the verbal rating scale. The step-up logistic regression analyses identified four important variables: time interval less than 2 min from local anaesthesia injection to the beginning of the procedure (RR = 3), lack of choice between local and general anaesthesia (RR = 1.9), history of frequent use of analgesics (RR = 1.9) and nulliparity (RR = 1.7). These data indicate that skillfully performed abortion with local anaesthesia is a procedure tolerated by most women. Moreover, because it carries lower risk of complications and costs less, its use should be encouraged.

Safety of measles immunization in egg‐allergic children

Measles vaccines are prepared in chick embryo fibroblast culture and used throughout the world. Since 1963 dramatic reductions in the incidence of measles have been observed where the vaccination was extensively applied in the pediatric population. The best results were observed when the target population in the initial phase was that which produced over 90% of cases in the pre‐vaccinal era. A possible limiting factor to the diffusion of measles vaccination is the assumption that allergy to egg proteins is a contraindication. In this paper current knowledge about the safety of measles immunization in children with egg allergy is discussed.

Inequalities in maternal care in Italy: the role of socioeconomic and migrant status

INTRODUCTION Maternal care is affected by socioeconomic factors. This study analyses the effect of maternal education, employment and citizenship on some antenatal and postnatal care indicators in Italy. METHODS Data are from two population-based follow-up surveys conducted to evaluate the quality of maternal care in 25 Italian Local Health Units in 2008/9 and 2010/1 (6942 women). Logistic models were applied and interactions among independent variables were explored. RESULTS Education and employment status affect antenatal and postnatal care indicators and migrant women are less likely to make use of health opportunities. Low education status exacerbates the initial social disadvantage of migrants. Migrant women are also more affected by socioeconomic pressure to restart working early, with negative impact on postnatal care. CONCLUSION Interventions focusing on womens empowerment may tackle inequalities in maternal care for those women, Italians or migrants, who have a worse initial maternal health literacy due to their lower socioeconomic conditions.

Seroepidemiological evaluation of 1989-91 mass vaccination campaigns against measles, in Italy.

In 1989-91 anti-measles vaccination campaigns were conducted in several Italian regions to vaccinate all children aged between 13 months and 10-12 years without a history of measles or measles vaccination. This study was conducted to evaluate serological status after the mass vaccination campaigns. In 1994, capillary blood samples were collected from randomly selected children, aged 2-14 years, living in 13 local health units. Antibody titres were determined by ELISA. Blood spot samples were analysed for 4114 (75.6%) of 5440 selected children. Among the 835 that reported measles before 1990, 806 (96.5%) were immune and of the 2798 vaccinated, 2665 (95.2%) were immune. The Edmoston-Zagreb (E-Z) strain vaccine was associated with a lower level of immunity than the Schwarz (SW) strain. A history of measles identified almost all immune children. Vaccination with the SW strain conferred persistent immunity (at least 5 years) in 98% of vaccinees. The strategy was able to unite natural and induced immunity.

Measles vaccine in egg allergic children: poor immunogenicity of the Edmoston‐Zagreb strain

Despite the fact that a number of recent studies have shown that measles/ mumps/rubella vaccine is safe for egg allergic children, many pediatricians are still concerned about immunization in egg allergic children. In Europe, a measles vaccine with the Edmoston‐Zagreb strain (EZMV) grown in human fibroblast culture has been developed and recommended for children with egg allergy. However, some doubt arises on the efficacy of this strain due to its weak immunogenicity. The aim of this study was to investigate the immunogenicity of the EZMV in comparison to the measles vaccine with the Schwarz strain (SWMV) grown in a chick embryo fibroblast culture.