Rita Campi

What can we do to improve child health in southern Italy

Southern Italy has one of the highest rates of poverty in Europe, and childrens health status in this region is alarming. Bonati and Campi outline the crucial policies that would address this crisis.

Suicide in Italian children and adolescents

BACKGROUND Data and statistics on suicide mortality in several countries have been published and discussed over the last few decades but gaps in knowledge are present in the epidemiology of suicide among Italian youths. METHODS Suicide mortality data for the years 1973-2002 were obtained from the Italian Central Institute of Statistics (ISTAT). Age-standardized mortality rates were calculated and examined for trends over time. RESULTS During the last 3 decades the Italian populations overall suicide rate increased slightly from 67.8 per million in 1973 to 76.7 in 2002. Suicide rates were higher in males than females (2.8:1) and in Northern compared to Southern Italy. Suicide rates increased with age from 4.4 per million for children 10-14 years old to 25.8 (15-19 years) and 95.6 (> or = 20 years). The major increase over time was observed for 15-19 year old males. LIMITATIONS Routine suicide mortality data have several weaknesses; these are especially, related to the level of accuracy in the certification of violent causes of death. CONCLUSION A national research programme to study suicidal behaviour and risk factors in children and adolescents is essential. The permanent monitoring of the situation, exploring gender and interpersonal issues with the aim to plan protective initiatives in an appropriate manner, is also fundamental.

Geographical epidemiology of antibacterials in the preschool age

BackgroundThematic maps allow a more rapid and immediate reading of the geographical differences in the distribution of data referred to a specific territory. The aim of this study was to show, for the first time, the application of some statistical and cartographic tools in the analysis of drug utilization in the pediatric population of an Italian region, and to assess the intra-regional difference in the antibiotic prescriptions.MethodsTo assess the type of geographic distribution of the prescriptions, the analyses were based on the standardized prevalence rate (z-score) calculated at the local health unit, health district, and municipality levels. Pearson’s coefficient of correlation was used to evaluate the correlation with hospitalization and the Moran’s I index was used to evaluate the existence of spatial autocorrelation. With the use of Getis-Ord’s G statistic, clusters of areas with high and low levels of prevalence were identified and mapped. The probability of receiving at least one prescription of antibacterials during the year for all the children included in the study was evaluated with a logistic regression model.ResultsWith the use of the maps it was possible to see that the prescriptions were not correlated with the health status of the population, but with the tendency of the pediatrician to prescribe drugs. This was also confirmed by the logistic regression model constructed to estimate the probability of receiving at least one prescription of antibacterials considering, as independent variables: age, sex, prevalence of hospitalizations in the district of residence, prescriptive attitude of the pediatrician, sex of the pediatrician, pediatrician’s age group, and duration of the pediatrician’s contract with the local health unit (LHU).ConclusionsThe priority actions to rationalize the use of antibacterials in the preschool age should concentrate on the active participation of the pediatricians in permanent education activities. Moreover, the competent authorities should increasing their efforts to limit unnecessary prescriptions and increase appropriateness of prescribing.RiassuntoIntroduzioneLe mappe tematiche consentono una più rapida ed immediata lettura delle differenze geografiche nella distribuzione di dati riferiti ad un territorio specifico. Lo scopo dello studio è mostrare, per la prima volta, l’applicazione di alcuni strumenti statistici e cartografici, nell’analisi dell’uso dei farmaci nella popolazione pediatrica di una regione italiana e valutare le differenze intra-regionali.MetodiPer valutare il tipo di distribuzione geografica delle prescrizioni, sono stati calcolati i tassi di prevalenza standardizzati (punteggi-z) a livello di ASL, Distretti Sanitari e Comuni. Per valutare la correlazione con le ospedalizzazioni è stato usato il coefficiente di correlazione di Pearson; per valutare l’esistenza di autocorrelazione spaziale è stato usato l’indice I di Moran. Tramite l’uso della statistica G di Getis-Ord sono stati identificati cluster di aree ad alto e basso livello di prevalenza. Infine con un modello di regressione logistica è stata stimata la probabilità di ricevere almeno una prescrizione nel corso dell’anno per tutti i pazienti inclusi nello studio.RisultatiCon l’uso delle mappe è possibile vedere che le prescrizioni non sono correlate con lo stato di salute della popolazione, ma sono correlate con l’attitudine prescrittiva del pediatra. Questo è confermato anche dal modello di regressione logistica costruito per stimare la probabilità di ricevere almeno una prescrizione considerando come variabili indipendenti l’età, il sesso, la prevalenza di ricoveri nel distretto di residenza, l’attitudine prescrittiva del pediatra, la classe di età del pediatra e la durata della convenzione del pediatra con l’Azienda Sanitaria Locale (ASL).ConclusioniGli interventi primari per razionalizzare l’uso degli antibiotici in età prescolare dovrebbero concentrarsi sulla partecipazione attiva dei pediatri in attività di educazione permanente. Inoltre il contenimento delle prescrizioni di ASL e Distretti dovrebbe prevedere un ulteriore controllo da parte delle autorità competenti in merito all’appropriatezza prescrittiva.

Italian paediatricians and off-label prescriptions: Loyal to regulatory or guideline standards?: Determining the rationality of off-label paediatric drug prescriptions

Aim: To evaluate the reason off‐label use exists in paediatric general practice and to distinguish between non‐compliance with respect to regulatory standards and non‐compliance with respect to guidelines in order to determine what this difference means in terms of rational prescribing. Methods: Information on patients visited by 35 general paediatricians in southern Italy was collected and their prescriptions analysed for off‐label status. Off‐label drug use in the Italian paediatric community setting was assessed. A sample indication, pharyngotonsillitis, was chosen and the related prescriptions analysed, distinguishing between non‐compliance with regulatory standards (i.e. off‐label use) and non‐compliance with guidelines, in order to determine the appropriateness of prescribing. Results: Information was collected on 9917 patients (8476 prescriptions). In all, 17% of prescriptions were off label. When the 1675 pharyngotonsillitis prescriptions were analysed, 8% were off label and 63% were not in accordance with the guidelines. On the other hand, 55% of these prescriptions did not adhere to the guidelines, but were not off label either.