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Trends in mortality for traffic accidents in Italy, 1997-2001
No full textBackground: The mortality due to traffic accidents is one of the main causes of death in Mediterranean countries among young people. It is considered a cause of death avoidable by primary prevention towards several risk factors. Mortality related to traffic accidents is also an important proxy indicator of population's alcohol and occasionally drug abuse.
Methods: Mortality rates for traffic accidents are calculated in Italy between 1997-2001 for: age, regions and gender. Mortality data were obtained from the Italian Population Register (ISTAT) and based on the ICD9-CM. Rates are directly standardised to the Italian standard population.
Results: Approximately 7,000 persons every year die for traffic accidents, with more elevated risk in the males (RR=3.5). We observed a global reduction in mortality rate for traffic accidents from 21.1/100,000 to 18.6/100,000 male and 5.9/100,000 to 5.3/100000 female. The mortality rates for traffic accidents in both sexes are highest among those aged 15-34 years and they increase again in those over 70 years. Among males the highest rates were observed in Northern Italy (Piemonte 24.3/100,000, Valle D'Aosta 27.4/100,000, Veneto 27.0/100,000, Friuli-Venezia-Giulia 26.5/100,000, Emilia Romagna 29.6/100,000) and in the central part of Italy (Marche 23.2/100,000, Molise 21.1/100,000 and Sardegna 22.4/100,000); among females the higher rates were always observed in Northern Italy (Piemonte 8.1/100,000, Veneto 8.2/100,000, Friuli-Venezia-Giulia 6.8/100,000 and Emilia Romagna 9.0/100,000) followed by the central part of Italy (Toscana 6.1/100,000, Umbria 6.3/100,000 and Marche 6.7/100,000). The southern part of Italy showed the lowest mortality rates in both sexes.
Conclusions: The general mortality rate by gender was influenced by the geographical area, probably due to a different exposure to risk factors (i.e. alcohol and drugs diffusion). Alcohol-related problems prevention strategies and primary prevention of the use of drugs should be implemented and alcoholic drinks should be forbidden to teenagers and drivers
Antibiotics or surgery for vesicoureteric reflux in children
No full textContext 1-2% of children have vesicoureteric reflux (VUR). VUR occurs in 25-40% of children with acute pyelonephritis. VUR can lead to renal scarring, hypertension, and end-stage renal disease. The best form of treatment for children with VUR is debated: no treatment, long-term antibiotic prophylaxis, surgery, or a combination of antibiotic prophylaxis and surgery. In children with recurrent urinary tract infections (UTIs) and progressive renal damage, despite antibiotic prophylaxis, surgical correction of VUR, especially high-grade VUR, is generally recommended. Starting point Danielle Wheeler and colleagues recently did a meta-analysis of ten randomised controlled trials (964 children) to evaluate whether any intervention for VUR is better than no treatment (Cochrane Database Syst Rev 2004; 3: CD001532). The main endpoints were incidence of UTIs, new or progressive renal damage, renal growth, hypertension, and glomerular filtration rate. They concluded that it is uncertain whether the identification of children with VUR is associated with clinically important benefit. The additional benefit of surgery over antibiotics is small. Where next? New strategies for management will require a tailored diagnostic and therapeutic approach, including noninvasive or less invasive diagnostic procedures, and a less aggressive therapeutic approach. Whether the common practice of cystourethrography as a first-fine investigation is warranted needs evaluation. The goal of paediatricians in the future, to prevent kidney damage, will probably be prevention of renal parenchymal injury and not necessarily the correction of ureterovesical junction anomalies. Because two main clinical pictures of VUR (diagnosed prenatally or postnatally with different age and sex distribution) can be identified, boys and girls will probably be managed differently. The factors responsible for congenital and acquired renal injury in children with VUR need to be studied
[Nosocomial infections in pediatric and neonatal intensive care: an epidemiological update.]
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