Work stress and menstrual patterns among American and Italian nurses.
OBJECTIVES: This study assessed whether job stress alters menstrual patterns among nurses working in 2 different settings: a tertiary care hospital in New York (99 nurses) and a university hospital in Rome (25 nurses). METHODS: Data on menstrual patterns were collected by a daily diary in which the nurses recorded their basal body temperature (BBT) and their menstrual bleeding status for a 3-month period. The BBT curves were used to classify cycles as biphasic or monophasic, and as adequate or inadequate with respect to the luteal phase. Job stress was evaluated by both objective (environmental and work characteristics) and subjective (perceived stress) criteria. RESULTS: The American nurses, especially those assigned to high stress units, had an increased risk for long and monophasic cycles [relative risk (RR) 4.3, 95% confidence interval (95% CI) 1.1-16.2 and RR 5.5, 95% CI 1.2-25.5, respectively]. Among those who perceived their stress at work to be high or reported strenuous work activity, the risk for longer cycles was also raised (RR 2.3, 95% CI 0.6-8.0 and RR 1.6, 95% CI 0.7-4.2, respectively). Luteal phase inadequacy followed the same pattern. Similar trends were observed in the Italian data. In addition, the rotating shiftwork pattern prevalent in the Italian group was possibly associated with higher rates of short cycles and inadequate luteal phases when compared with those of nurses working fixed shifts either day or night. CONCLUSIONS: Menstrual function may be affected by stressful work conditions. (+info)
The quality of abstracting medical information from the medical record: the impact of training programmes.
OBJECTIVE: To evaluate the impact of a programme of training, education and awareness on the quality of the data collected through discharge abstracts. STUDY DESIGN: Three random samples of hospital discharge abstracts relating to three different periods were studied. Quality control to evaluate the impact of systematic training and education activities was performed by checking the quality of abstracting medical records. SETTING: The study was carried out at the Istituto Dermopatico dell'Immacolata, a research hospital in Rome, Italy; it has 335 beds specializing in dermatology and vascular surgery. MEASURES: Error rates in discharge abstracts were subdivided into six categories: wrong selection of the principal diagnosis (type A); low specificity of the principal diagnosis (type B); incomplete reporting of secondary diagnoses (type C); wrong selection of the principal procedure (type D); low specificity of the principal procedure (type E); incomplete reporting of procedures (type F). A specific rate of errors modifying classification in diagnosis related groups was then estimated. RESULTS: Error types A, B and F dropped from 8.5% to 1.3%, from 15.8% to 1.6% and from 22% to 2.6% respectively. Error type D and E were zero in the third period of analysis (September-October 1997) compared with a rate of 0.7% and 4.1% in the third quarter of 1994. Error type C showed a slight decrease from 31.8% in 1994 to 27.2% in 1997. All differences in error types except incomplete reporting of secondary diagnoses were statistically significant. Five and a half per cent of cases were assigned to a different diagnoses related group after re-abstracting in 1997 as compared to 24.3% in the third quarter of 1994 and 23.8% in the first quarter of 1995. DISCUSSION: Training and continuous monitoring, and feedback of information to departments have proved to be successful in improving the quality of abstracting information at patient level from the medical record. The effort to increase administrative data quality at hospital level will facilitate the use of those data sets for internal quality management activities and for population-based quality of care studies. (+info)
Inequality in health: socioeconomic differentials in mortality in Rome, 1990-95.
STUDY OBJECTIVE: Population groups with a lower socioeconomic status (SES) have a greater risk of disease and mortality. The aim of this study was to investigate the relation between SES and mortality in the metropolitan area of Rome during the six year period 1990-1995, and to examine variations in mortality differentials between 1990-92 and 1993-95. DESIGN: Rome has a population of approximately 2,800,000, with 6100 census tracts (CTs). During the study period, 149,002 deaths occurred among residents. The cause-specific mortality rates were compared among four socioeconomic categories defined by a socioeconomic index, derived from characteristics of the CT of residence. MAIN RESULTS: Among men, total mortality and mortality for the major causes of death showed an inverse association with SES. Among 15-44 year old men, the strong positive association between total mortality and low SES was attributable to AIDS and overdose mortality. Among women, a positive association with lower SES was observed for stomach cancer, uterus cancer and cardiovascular disease, whereas mortality for lung and breast cancers was higher in the groups with higher SES. Comparing the periods 1990-92 and 1993-95, differences in total mortality between socioeconomic groups widened in both sexes. Increasing differences were observed for tuberculosis and lung cancer among men, and for uterus cancer, traffic accidents, and overdose mortality among women. CONCLUSIONS: The use of an area-based indicator of SES limits the interpretations of the findings. However, despite the possible limitations, these results suggest that social class differences in mortality in Rome are increasing. Time changes in lifestyle and in the prevalence of risk behaviours may produce differences in disease incidence. Moreover, inequalities in the access to medical care and in the quality of care may contribute to an increasing differentials in mortality. (+info)
Was the fetal alcohol syndrome recognized by the Greeks and Romans?
Ancient Greek and Roman philosophers/scientists are frequently quoted as expressing an awareness of potential harm associated with drinking during pregnancy. However, the statements attributed to these authors were not made by them. Instead, they are interpretations, presented in the form of verbatim statements, of their views relating to procreation. Although they did have something to say about the role of alcohol in procreation, it was the effects of drinking on the male body at the time of conception, and especially alcohol's effects on male body temperature, that concerned them. A cold body at the time of conception was believed to enhance the likelihood of conceiving a female, which to the Greeks and Romans was a 'deformity'. (+info)
Coronary artery bypass graft surgery: socioeconomic inequalities in access and in 30 day mortality. A population-based study in Rome, Italy.
OBJECTIVES: To evaluate whether coronary artery bypass graft (CABG) surgery is equally provided among different socioeconomic status (SES) groups in accordance with need. To estimate the association between SES and mortality occurring 30 days after CABG surgery. DESIGN: Individual socioeconomic index assigned with respect to the characteristics of the census tract of residence (level I = highest SES; level IV = lowest SES). Comparison of age adjusted hospital admission rates of ischaemic heart disease (IHD) and CABG surgery among four SES groups. Retrospective cohort study of all patients who underwent CABG surgery during 1996-97. SETTING: Rome (2 685 890 inhabitants) and the seven cardiac surgery units in the city. PARTICIPANTS: All residents in Rome aged 35 years or more. A cohort of 1875 CABG patients aged 35 years or more. MAIN OUTCOME MEASURES: Age adjusted hospitalisation rates for CABG and IHD and rate of CABG per 100 IHD hospitalisations by SES group, taking level I as the reference group. Odds ratios of 30 day mortality after CABG surgery, adjusted for age, gender, illness severity at admission, and type of hospital where CABG was performed. RESULTS: People in the lowest SES level experienced an excess in the age adjusted IHD hospitalisation rates compared with the highest SES level (an excess of 57% among men, and of 94% among women), but the rate of CABG per 100 IHD hospitalisations was lower, among men, in the most socially disadvantaged level (8.9 CABG procedures per 100 IHD hospital admissions in level IV versus 14.1 in level I rate ratio= 0.63; 95% CI 0.44, 0.89). The most socially disadvantaged SES group experienced a higher risk of 30 day mortality after CABG surgery (8. 1%) than those in the highest SES group (4.8%); this excess in mortality was confirmed even when initial illness severity was taken into account (odds ratio= 2.89; 95% CI 1.44, 5.80). CONCLUSIONS: The universal coverage of the National Health Service in Italy does not guarantee equitable access to CABG surgery for IHD patients. Factors related to SES are likely to influence poor prognosis after CABG surgery. (+info)
Exposure to benzene in urban workers: environmental and biological monitoring of traffic police in Rome.
OBJECTIVES: To evaluate the contribution of traffic fumes to exposure to benzene in urban workers, an investigation on personal exposure to benzene in traffic police from the city of Rome was carried out. METHODS: The study was performed from December 1998 to June 1999. Diffusive Radiello personal samplers were used to measure external exposures to benzene and alkyl benzenes during the workshift in 139 policemen who controlled medium to high traffic areas and in 63 office police. Moreover, as biomarkers of internal exposure to benzene, blood benzene, and urinary trans, trans-muconic and S-phenyl mercapturic acids were measured at the beginning and at the end of the workshift in 124 traffic police and 58 office police. RESULTS: Time weighted average (TWA) exposure to benzene was consistently higher among traffic police than among indoor workers (geometric mean 6.8 and 3.5 microg/m(3), respectively). Among the traffic police, the distribution of individual exposures was highly asymmetric, skewed toward higher values. Mean ambient benzene concentrations measured by municipal air monitoring stations during workshifts of traffic police were generally higher (geometric mean 12.6 microg/m(3)) and did not correlat with personal exposure values. In particular, no association was found between highest personal exposure scores and environmental benzene concentrations. Among the exposure biomarkers investigated, only blood benzene correlated slightly with on-shift exposure to benzene, but significant increases in both urinary trans, trans-muconic and S-phenylmercapturic acids were found in active smokers compared with non-smokers, irrespective of their job. CONCLUSION: The exposure to traffic fumes during working activities in medium to high traffic areas in Rome may give a relatively greater contribution to personal exposure to benzene than indoor sources present in confined environments. Smoking significantly contributed to internal exposure to benzene in both indoor and outdoor workers. (+info)
Screening for microcytemia in Italy: analysis of data collected in the past 30 years.
Extensive population surveys begun in Italy in 1943 revealed a high incidence of mycrocytemia. Health authorities established a national organization to combat microcytemia which financed and directed activities throughout Italy from 1955 to 1971. The work performed by the microcytemia centers in screening and prophylaxis is described. The results of a screening program underway since 1967 involving 46,559 students of the University of Rome are presented in detail. A preliminary survey of 256 families revealed that the incidence of subsequent births after the births of a child affected by Cooley's anemia was generally low. Results obtained to date are encouraging and justify more extensive programs for the prevention and treatment of microcytemia. (+info)
Rh system and intrauterine growth. Interaction with season of birth.
Based on the hypothesis that maternal-fetal genetic differences in membrane transport and signal transduction may influence intrauterine development, the recent acquisition on transport function of Rh protein prompted us to study the relationship between joint maternal-fetal Rh phenotype and birth weight. Considering that metabolic effect of maternal-fetal competition could be amplified by environmental conditions, we have investigated possible seasonal effects on such relationship. We have studied 5291 infants born in Sardinia in the period January 1993--December 1996 and 984 infants born in Rome during 1996. In Rh(-) mothers there is a significant association between season of birth and birth weight that shows the highest mean value in infants born in autumn (i.e. conceived in winter). The association is much more evident in male than in female infants. In male infants from Rh(-) mothers, the association between birth weight and season is significant in Rh(+) male newborns only. Recent observations by our group in NIDDM suggest that glucose transport in RBC may be related to D protein, thus we propose an interpretation of the present observation in terms of transport function. When the density of D protein in the infant is greater than in the mother, the balance is in favour of the infant who may attain a significant developmental advantage when conceived in the cold season. (+info)