Thursday, December 30, 2010

Bleach On Off White Clothes

Mucolytics contraindicated in children under 2 years: the note AIFA


quote in full the AIFA important note regarding the contraindication to the use of mucolytics in children under 2 years of age


Dear Doctor, Dear Doctor,

Office di Farmacovigilanza dell’ Agenzia Italiana del Farmaco (AIFA) ha condotto una revisione di sicurezza dell’intera classe dei mucolitici per uso orale e rettale.

I principi attivi coinvolti sono stati: acetilcisteina, carbocisteina, ambroxolo, bromexina, sobrerolo, neltenexina, erdosteina e telmesteina , contenuti in numerosi medicinali che sono per la maggior parte dispensabili senza obbligo di ricetta.

Questi farmaci hanno attività mucolitica e fluidificante e sono per lo più prescritti, o somministrati dal genitore, nel trattamento delle affezioni acute e croniche dell’apparato respiratorio.
Un’analisi dei dati francesi di farmacovigilanza ha messo highlighted an increase in cases of respiratory obstruction and worsening of respiratory diseases in children under 2 years and receiving mucolytics. In fact, the drainage capacity of the bronchial mucus is limited in this age group, due to the physiological characteristics of the respiratory tract.
reported adverse reactions occurred primarily affecting the respiratory system (worsening of bronchiolitis, increased cough, increased bronchial secretions, wheezing, difficulty breathing, vomiting viscous), were for the most serious and required the ' hospitalization. The risk of these adverse reactions and the absence of efficacy data for pediatric in acute bronchial diseases, has led France to contraindicate the use of mucolytics in children under 2 years of age.

The AIFA, after reviewing the safety data available mucolytics the country, there are few data to support the effectiveness of these drugs in children under 2 years and on the basis of French data, adopted a restrictive measure, currently under implementation, to prohibit the use of mucolytics, oral and rectal use in children under 2 years.
This measure involves the introduction in the Summaries of Product Characteristics and Package Leaflet of the following changes:

- controindicazione all’uso nei bambini di età inferiore ai 2 anni;

- avvertenza sul rischio di ostruzione bronchiale nei bambini di età inferiore ai 2 anni;

- inserimento del termine “ostruzione bronchiale” nel paragrafo “Effetti indesiderati”, qualora la segnalazione di tale reazione avversa sia stata riportata.

Il paragrafo “Posologia e modo di somministrazione” sarà aggiornato di conseguenza, laddove necessario.
Si precisa che la controindicazione non riguarda l’uso antidotico dei medicinali contenenti acetilcisteina.
A seguito dell’introduzione della controindicazione, le confezioni a base di sobrerolo e ambroxolo, dedicated exclusively to children younger than 2 years shall be subject to revocation.

It is therefore considered necessary to draw the attention of general practitioners, pediatricians and pharmacists telling them that:

- mucolytics are prescribed or recommended always after careful evaluation of the benefit / risk of each patient and never in children under 2 years of age;

- to inform / educate parents on the proper management of cough, appropriate use of mucolytics and the availability of alternative therapies in children;

- pharmacists to make this possible risks and contraindications below 2 years of the parent who requires a mucolytic in order to prevent improper use of children in that age group. The AIFA

take this opportunity to remind all doctors and pharmacists of the importance of reporting suspected adverse drug reactions, as an indispensable tool to confirm a favorable risk benefit ratio in the real conditions of use. The
this Information is also posted on the AIFA, which is recommended for regular consultation with the best information and professional service to the citizen.

This Information paper prepared by the AIFA, covers all medicinal products for oral and rectal containing acetylcysteine, carbocysteine, Ambroxol, bromexina, sobrerol, neltenexina, and erdosteina telmesteina, regardless of their mode of delivery and was distributed by the National Association of Pharmaceutical Industry of self-medication (Anif), and by Assogenerici Farmindustria .

The Office of the Italian Drug Pharmacovigilance

Tuesday, December 14, 2010

V.bernardelli , How Much

laugh and it will pass . Scientific research between smiles and tears

While in early October in Stockholm was awarded the Nobel Prize, Harvard University took place the ceremony of IgNobel , dubbed "the Nobel of the absurd." Every year - from 1991 to this part - the Improbable Research with its namesake magazine Annals of Improbable Research award recognition to those researchers who, with their publications "first make people laugh and then think" to "celebrate the unusual, honor the imaginative and stimulating people's interest in science, medicine and technology." IgNobel This year's prize for medicine went to two Dutch, Simon Rietveld and Ilja van Beest, who discovered that asthma symptoms can be treated with the mountains Russian . It would seem the joke of a joker, but it's really true. Type in PubMed believing. : Rietveld S, van Beest I. Rollercoaster asthma: when positive emotional stress interferes with dyspnea perception . Behave Res There. 2007; 45:977-87. All this seems even more absurd when you consider that this research (conducted on 25 women with severe asthma and of course a control group of 15 subjects) was financed by two agencies, the Netherlands Asthma Foundation and the Netherlands Organization for Scientific Research. Just out of curiosity, in this study the stress was induced by repeated turns on a roller coaster. The results showed that negative emotional stress and blood pressure have reached their peak just before the roller coaster ride, while positive emotional stress and heart rate immediately after. Furthermore, "dyspnea in women with asthma was higher just before the race compared to just after, even in subjects where there was a reduction in lung function induced by its own roller coaster." The authors conclude that "patients with chronic asthma if they tend to perceive stress and stimulates the association acquired in terms of dyspnea, wheezing, and families between positive or negative moods, promoting or under-perception or over-perception of dyspnea, depending on the emotional valence of a situation. " Translated in simple terms: if an asthmatic like roller coasters, you forget all her body a bit 'of his dyspnoea ...

Gianluca Tornese
Pediatrics
IRCCS "Burlo Garofolo", Trieste

Read the complete editorial published in the December issue of Medical and Child
laugh and it will pass. Scientific research between smiles and tears


Sunday, December 5, 2010

Dora The Explorer's Backpack Template

Physicians retire in the next 10 years


About 4 out of 10 doctors over the next dieci anni, andranno in pensione . A svestire il camice bianco saranno infatti 115 mila medici, oggi compresi nella fascia di età tra i 51 e i 59 anni, ovvero il 38% di tutta la popolazione medica attiva. Tra questi sono compresi il 48% dei medici dipendenti dei servizi sanitari regionali e Università, il 62% dei medici di famiglia, il 58% dei pediatri di libera scelta, il 55% degli specialisti convenzionati.

A scattare la fotografia è la Federazione nazionale degli Ordini dei medici (Fnomceo), nel corso della II Conferenza nazionale della professione medica, oggi a Roma.Secondo la Fnomceo, dall'analisi dei dati emerge chiaro un aspetto: "la formazione dei futuri camici bianchi è una vera emergenza, for which is an ad hoc project, effective, first requires that greater connectivity and flexibility in reports and 'rules of engagement' between the faculty of medicine and public and private accredited regional health services. "It is a project the Fnomceo is working to bring the new recruits to 'move with the times'. "The new doctor - says White - because of the extraordinary development of medical science as technological needs more tools to handle these unique resources. Which are expensive and have a number of problems, such as the appropriateness of their use. "For the president of Fnomceo, this scenario poses a series cascade other problems: the selection of access, the training content, training of specialists. That's why - he explains - we a number of proposals, which we believe redefine a training model that sees a strong integration between the traditional activity Universities and training activities of the NHS. " Universities and NHS, for White "must experience a moment of strong cooperation to overcome the emergency in quality".

Fnomceo The project is based on an integrated and continuous process that starts from access to medical studies at the end of professional activity. "It must be measured - White points out - not only with the evolution of technical and scientific knowledge, but also with the new definitions, new horizons and different cultural legitimacy and civil constantly reshape the goals of medicine and healthcare. "

not only university education, therefore, but also post-graduate training." In our system - White said - is unfortunately lagging behind a culture of promotion and evaluation of the quality of professionals and services. A critical thinking that would be wrong and counterproductive to resolve addressing them from the queue through the unique enhancement patterns of bureaucratic control and sanction inquisitors.

For Fnomceo, to train the doctors of the future, a key role to be played dalle Società medico scientifiche. "Realizzando al più presto - spiega il presidente Bianco - un modello di accreditamento istituzionale, così da garantire il loro riconoscimento in ruoli di interlocutori stabili, affidabili e autorevoli delle istituzioni sanitarie". Per Bianco, "lo stesso nuovo sistema di Educazione continua in medicina (Ecm) può, in prospettiva, offrire al bisogno di formazione continua dei medici e di tutti i professionisti sanitari non un frammentato e disorganico universo di soggetti a vocazione formativa, non sempre trasparenti, efficaci ed indipendenti, ma solo provider in grado di garantire lo sviluppo e la continuità di un sistema formativo affidabile e calibrato sulle esigenze dei singoli professionisti and organizations in which they operate. "

Source: Reuters Health

Friday, December 3, 2010

Red Tinged Cervical Mucus Before A Period

Recommendations of the Working Group on the use of Pediatric AIFA Fans



part of the monitoring of reports of suspected adverse reactions in recent years, shows a progressive increase in the number of reports of suspected adverse reactions to NSAIDs in children

The Pediatric Working Group AIFA intensified the argument and issued recommendations on.

See the article open access published in the December issue of Child and Medical

Cautions on the use of NSAIDs in children
Paediatric Working Group AIFA
Medical and Child 2010, 29, 654-6

Monday, November 29, 2010

Palladian Window Treatment Ideas

the Yellow Pages of Medical and Child: Paracetamol and asthma risk: it was a hoax (?)

Recent studies, particularly multicenter study ISAAC (Beasley R, et al. Lancet 2008, 372:1039-48) have suggested that use of paracetamol in the first period of life is associated with an increased risk of asthma and allergies in children of six- seven years. This hypothesis is also justified on the biological to the fact that paracetamol may increase the respiratory inflammation associated with the consumption of glutathione (and the consequent deterioration dello stress ossidativo) e sembra anche in grado di dirottare la risposta immunologica in senso TH2. Lo studio ISAAC, peraltro, come tutti gli altri che hanno documentato una relazione tra uso di paracetamolo e successivo rischio di asma, ha le debolezze di ogni studio retrospettivo; non prende in considerazione il fatto che il paracetamolo è spesso utilizzato durante le infezioni respiratorie che possono di per sé essere associate a un rischio di asma e, in particolare, non valuta se esiste una relazione dose-effetto tra esposizione al paracetamolo e asma.

In uno studio prospettico australiano ( Lowe AJ, et al. BMJ 2010;341:c4616 ) in cui 652 bambini sono stati seguiti dalla nascita fino a sette anni e le cui famiglie sono state intervistate 18 volte nei primi due anni di vita del bambino relativamente all’utilizzo di paracetamolo e al contesto clinico in cui il farmaco era stato utilizzato, viene negato che l’utilizzo del paracetamolo nei primi due anni di vita costituisca un fattore di rischio indipendente per lo sviluppo di asma e malattie allergiche nel bambino. Infatti, l’aumento assoluto del rischio di asma che appare dall’analisi dei dati grezzi scompare quando il risultato viene aggiustato, tenendo conto della frequenza delle infezioni respiratorie. L’utilizzo del paracetamolo al di fuori delle infezioni respiratorie non appare correlato al rischio di asma e, anche all’interno del gruppo che ha assunto il paracetamolo per infezioni tract, is not documented a dose-dependent relationship between intake of acetaminophen and the development of asthma. Free!

Thursday, November 18, 2010

Where To Order Airforce Condor

of antibiotics, defend your defense. Use with caution "

Launch campaign to increase awareness of proper use medicines. Conducted by the AIFA in collaboration with the National Institute of Health will end in January 2011.

Hungry for antibiotics. Italians spend over one billion euro a year (1037 million) in drug bactericides. A cost that almost half of it is useless, and consumption per capita which puts them in third place in Europe, preceded only by the Greeks and Cypriots, and first for the highest antibiotic resistance rates.

The alarm was launched by the Italian Drug Agency (AIFA) has presented a study at the start of the communication campaign of antibiotics, defend your defense. Use with caution " , which aims to raise awareness about the proper use of these medicines, in collaboration with the Higher Institute of Health and sponsored by the Ministry of Health. The

differenze regionali- Nel 2009 l’eccesso di spesa evitabile legato alla somministrazione e ai costi non appropriati degli antibiotici ha toccato quota 413,1 milioni di euro, con la Campania, la Puglia e la Sicilia che insieme determinano quasi il 60 per cento di tutto il surplus di consumi in Italia. L’Aifa ha infatti calcolato che se tutte le regioni si allineassero al consumo medio di quelle più virtuose (Bolzano, Friuli Venezia Giulia, Liguria, Veneto e Valle D’Aosta) con 17,25 dosi medie giornaliere ogni mille abitanti, si potrebbe ottenere un risparmio quantificato in 316,6 milioni di euro. Mentre se il costo per dose media giornaliera divenisse in tutte le regioni pari a quello della Lombardia (1,66 euro) si otterrebbe un risparmio di 155,8 milioni di euro.

Dunque, il risparmio complessivo che potrebbe derivare dall’effetto congiunto di una maggiore appropriatezza dei consumi e della riduzione dei costi è di 413,1 milioni di euro , pari al 3,7 per cento della spesa farmaceutica convenzionata nel 2009. A livello di singola regione, spiega ancora lo studio dell’Aifa, il risparmio ottenibile «inciderebbe considerevolmente sul valore dello sfondamento della loro spesa: nel Lazio per il 29 per cento, in Puglia per il 43 per cento e in Sardegna per il 20».

Il problema della resistenza -Oltre al capitolo legato ai costi, ci sono ragioni che incidono strettamente sulla salute dei cittadini. Alcuni germi patogeni importanti, ha spiegato il dg dell’Aifa, Guido Rasi, hanno già sviluppato livelli di antibiotico-resistenza che arrivano quasi al 100 per cento. Un esempio di questo fenomeno, ha ricordato a sua volta l’immunologo e capo dipartimento Malattie infettive dell’Iss, Gianni Rezza, «è il nuovo “superbatterio” Ndm-1 (New Delhi Metallo-beta-lactamase-1) che dal subcontinente indiano è arrivato anche in Europa, in particolare nel Regno Unito, mentre in Italia ci sono stati un paio di casi».

Il dato di prescizione e l'utilizzo razionale- Giova ricordare, poi, che i motivi più frequenti di prescrizione di Antibiotics are respiratory diseases (40.8 percent), followed by those affecting the genitourinary (18.4) and the digestive system (13.6). In detail, the greatest use is for cystitis (9.9 percent), pharyngitis (8.3 percent), acute bronchitis (5.7 percent). In 2009, 44 percent of citizens, 53 percent of children and 50 percent of the elderly has received at least one antibiotic prescription, and 15 percent of the elderly more than six.

"It is necessary that our citizens realize that antibiotics must be taken as prescribed by your doctor and if it is the doctor to prescribe, after verifying that the need - Says Guido Rasi, Director General of AIFA -. The early withdrawal of therapy is among the leading causes of development of resistance, because bacteria kills the weakest and "select" the stronger ones. To avoid this we must do it yourself. Cold or flu, for example, are not among the causes for which are given antibiotics, take them even in these cases put health at risk by encouraging the development of resistant germs. We must strive to make it clear to doctors and ordinary people that we are in danger of not having available effective drugs to cure diseases that today are no longer a threat but which could become. "

Adverse reactions -C 'is Finally, another aspect of the misuse of antibiotics (often those that were not used because it has not been concluded another round of treatment), that is what determines the adverse reactions. According to data provided by AIFA, the cases in Italy in 2009 were 1,643. Between 2002 and 2009 there were 8,833 reports. Episodes that have caused numerous victims: well 118 in the eight years of monitoring.

The November issue of Medical and Child article reports a series of rational use of antibiotic therapy in children:




Electro Dj Name Generator

acute lymphoblastic leukemia: a new international protocol signed by AIEOP


Siglato da otto diversi Paesi un protocollo per la cura e la terapia della leucemia linfoblastica acuta . Come sottolinea Fulvio Porta, presidente dell’ AIEOP: “Permetterà una diagnosi centralizzata. Oltre l’80% dei casi guarisce, ma la malattia è in aumento”

La leucemia infoblastica acuta rappresenta il 30% di tutti i tumori dei bambini e l’80% delle leucemie. Il picco di incidenza si registra tra i bambini di 4 anni e nelle bambine di 2 anni; quasi i due terzi dei casi riguardano piccoli tra i 2 e 6 anni.

I pediatri oncologi italiani siglano il nuovo protocollo internazionale della leucemia linfoblastica acuta dell'eta' pediatrica. Fulvio Porta, presidente dell'Associazione italiana di ematologia e oncologia pediatrica (Aieop), spiega: "Italia, Germania, Austria, Svizzera, Repubblica Ceca, Israele, Australia, Nuova Zelanda si alleano per la guarigione dei bambini leucemici con un identico protocollo di terapia. Verranno in tal modo applicate le piu' recenti acquisizioni derivate dalla ricerca condotta sia in Italia sia nella comunita' scientifica internazionale". Per la difficolta' e complessita' della valutazione diagnostica e prognostica, la scelta di protocolli di trattamento uniformi e' particolarmente importante. "Anche se la malattia e' in aumento - prosegue Porta - oggi oltre l'80% small reach the healing. "The new international program of care, which will deal with '1,000 new cases per year (350 in Italy) offers new hope to children with leukemia to be treated with the best therapy currently available.
In particular, all children suffering from acute lymphoblastic leukemia, treated in the Italian centers dell'Aieop, will be 'offered a centralized diagnosis and study of so-called minimal residual disease (evaluation of a leukemic cell in 10,000 white blood cells).




Saturday, November 13, 2010

Pokemon Emerald Where Do You Find Detox

BNF for children: a handbook of pediatric pharmaceutical service


Il BMJ, British Medical Journal in collaborazione con RPSGB, Royal Pharmaceutical Society of Great Britain , Pharmaceutical Press pubblica le serie British National Formulary (semestrale)
e il BNF for Children (annuale).

Pubblicato sotto l'autorità del Paediatric Formulary Committe, il BNF for Children (BNFC) fornisce informazione essenziale e pratica ai professionisti coinvolti nella prescrizione, dispensazione, monitoraggio e gestione of drugs in pediatrics. It helps in the safe, effective and appropriate use of medicines in the treatment of child health.

Actually BNF for Children, manual, quasi-pocket is much more of a handbook pharmaceutical useful for a safe use of medicines for children. It 'a communication tool but also a cultural practice in particular. Each drug is classified in a more comprehensive use of and within the paragraphs concerning the directions of use, possible side effects, dosages schematic for ages (of a practical utility that has no equal), they accepted the synthesis (updated annually) than it is evidence literature for a correct use of medicines in children.

In Italy in 2003 was published Guide of drugs in children. It was a unique experience, regained the form adapted to the Italian and British. Should be updated, implemented, for example, knowing that in England the Handbook is updated annually. But the impression is that we are far from this perspective.

The presentation of the BNF for children responds primarily to a goal of information. Perhaps figuring that the limitation period, as indicated in the memorandum, we are very close to what they do British colleagues or another nation. Why indeed the BNF for children is becoming more and more importance the European Union (the handbook is also available in some Italian libraries and is available on line), dreaming of having, in the near future, a European Handbook for prescription drugs in children. Medical and Child

promises to bring its next issue electronic cards to some drugs, as is proposed in the BNF for children. As an example of communication "international". Federico Marchetti



Conflict of interest: none



Thursday, November 11, 2010

Ftm Surgery With Medicaid

" Doctors do not stop to think "

I medici della prossima generazione come ragioneranno, con quali processi mentali arriveranno a formulare una diagnosi, a prescrivere una terapia? Se lo chiede sul Lancet Jerome Kassirer, l'ex direttore del New England Journal of Medicine. Il suo timore è che la facilità di accesso a risposte preconfezionate a quesiti clinici, la disponibilità di linee guida, revisioni sistematiche, abstract commentati possano avere degli effetti indesiderati. " In medicina il ragionamento richiede una enorme conoscenza di fatti sulla salute e sulla malattia, in materia di fisiologia, di benefici e rischi legati ai test e ai trattamenti ".

"Non basta", continua Kassirer, "aver imparato a risolvere problemi e a prendere decisioni, e non basta neanche sapere trovare informazioni; è anche necessario ricordare le informazioni e sapere come usarle. Dobbiamo evitare di produrre professionisti dipendenti da superficiali riassunti elettronici, formule opache e pareri di esperti. Devono essere in grado di ragionare in modo autonomo."

Timori fondati: le nuove tecnologie stanno provocando profondi cambiamenti nel modo in cui ci concentriamo, riflettiamo ed elaboriamo le informazioni. Compito di chi si dedica alla formazione è vigilare e aiutare le nuove generazioni a trovare il giusto equilibrio, a saper sfruttare le potenzialità dei nuovi media senza perdere di vista le dimensioni della complessità e della profondità.

Sono temi di grande attualità, in fondo quel che dice Kassirer è che, nel ragionamento clinico, vecchio e nuovo devono arrivare a una nuova sintesi. Temi che fanno parte di un dibattito culturale più ampio (e complesso), sul quale si sono confrontati recentemente, per esempio, Alessandro Baricco e Eugenio Scalfari, parlando di nuovi barbari, superficialità, leggerezza, complessità e profondità.

"I barbari, quelli che tu ed io vediamo come un'incombente realtà - scrive Scalfari a Baricco - sono ancora alla ricerca del futuro; gli imbarbariti stanno devastando il presente e contro di loro noi dobbiamo combattere per preservare il deposito dei valori che la modernità ha accumulato e dei quali l'epoca futura will use when it has finally reached its plenitude and its self-consciousness. I do not believe the contrast between depth and superficiality as an achievement and advancement. "

And who knows what would have said Calvin, who has spent a wonderful lightness to the wise ...

Sources: Kassirer JP. Does instant access to information compiled Undermine clinical cognition? Lancet, 2010, 376: 1510-1.
Scalfari E. The barbarians do not rise up our depth. La Repubblica, September 2, 2010

by: scientific thought Publisher

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Thursday, November 4, 2010

Black Stool And Alcohol

The development of taste in children


A very interesting article published in the October issue Child's Doctor and the development of taste in children.

Very often we wonder why a child and an adult have a preference for some foods, refusing others. The answer until now was based more on conjecture, assumption of bad habits, of "fixation" of blame. The article by Luigi
Greek and Gabriella Morini opens up new roads, first to know but also practical, for the interpretation that may be provided to parents and advice relate in particular to the weaning period. Reinforce the idea that weaning is a time before which any rigidity, any scheme can be mixed not only not helpful but also counterproductive. And this for several reasons and among them "learning" of taste, which has a certain genetic basis, as Paul reminds us, Gasparini, IRCCS Burlo Garofolo in Trieste in his editorial accompanying the article, but that may be partly changed.

As with everything, the taste, the choice of a food rather than another, is linked to about half to genetics, the other half to the environment: in the particular case, habit, e specialmente alle abitudini precoci, gestazione, allattamento, svezzamento. Si tratta di un primo approccio, insieme scientifico e antropologico, alla scienza dell’alimentazione applicata al bambino.

Questi i messaggi chiave che si possono ricavare dalla lettura del lavoro:

  1. I gusti sono 5: dolce, salato, amaro, acido e umami. Quest’ultimo è un gusto particolare, individuato di recente, associato al L-glutammato.
  2. Ciascuno di questi gusti ha una sua spiegazione funzionale, ed è stato elaborato dall’evoluzione in funzione di precisi benefici per l’individuo e per la specie.
  3. Il sistema sensoriale è comune per i diversi gusti e is based on specific receptors, present in all taste cells.
  4. The trend in children's taste is different (easier, mainly oriented to the sweet and fatty) and adults (most of which accept the nuances that show love and to have less well-defined preferences). These differences are due to learning.
  5. The infant prefers food that has already eaten through the amniotic fluid and then through breast milk intake of vegetable baby food is easier in breastfed infants than in bottle-fed.
  6. a stretch of neophobia (the rejection of new, that is the first baby food) produces a stable waste. Each new food should be supplied with patiently, in small quantities at a time, in 7-8 times, and shared some with his mother who, tasting the food, reassures the child.

What can recommend a pediatrician, what can parents do?
say Greek and Morini:
exposure, especially in times precocious prenatal, during breastfeeding, but especially at weaning. For example, the strongest predictor of fruit and vegetable consumption by children is the consumption of fruits and vegetables of his parents and his brothers. Traditionally, the mother of baby food tastes a little baby to encourage this reinforces the acceptance dell’alimento;
gratificazione : l’offerta ripetuta del cibo che è stato accettato rafforza le successive scelte dello stesso cibo. Al contrario, se si gratifica con “un cibo più buono” l’accettazione di un determinato alimento, questa gratificazione tende a screditare la scelta dell’alimento per cui si è dato il premio. Non bisogna distrarre il bambino con gratificazioni o distrazioni non alimentari: hanno un effetto contrario a quello desiderato.

Per approfondire:

Greco L, Morini G. Lo sviluppo del gusto nel bambino . Medico e Bambino 2010;29:509-513

Gasparini P. Sviluppo del gusto nel bambino: tra genetica and environment. Medical and Child 2010, 29:483-484

Related articles on weaning:

L. Piermarini Complementary feeding on demand: over weaning. Medical and Child 2006, 25:439-422

Tuesday, November 2, 2010

Calgary Car Auctions Online

Statement on benzo ( a) pyrene: an appeal to the Council of Ministers of the ACP, and SIP FIMP for children of Taranto











The Council of Ministers
The Minister for European Affairs, the Honourable Andrea Ronchi
the Minister of the Environment, Land and Sea, Stefania Prestigiacomo
To the Minister of Health, Hon Ferruccio Fazio
To the Minister of Infrastructure and Transport, Mr Matteoli
the Minister of Economic Development, Mr Silvio Berlusconi
the Minister of Agriculture, Food and Forestry Minister the Hon Giancarlo Galan
Foreign Affairs, Mr Franco Frattini
the Justice Minister Angelino Alfano
The Hon Minister of Economy and Finance Giulio Tremonti
the Hon Minister for Relations with the Regions and territorial cohesion, Mr Raffaele Lease

E for information to:
All Members of the Italian Parliament
All Members of the European Parliament
Italian news agencies

November 2, 2010

astonished when we have learned that our Government on 13/08/2010 by Legislative Decree No 155 has moved to December 31, 2012 the prohibition against exceeding the level of one nanogram per cubic meter for benzo (a) pyrene. This prohibition was in effect from 01/01/1999 to urban areas over 150,000 inhabitants.
surprising because injuries, including severe and irreversible effects on human health and children in particular, resulting from exposure to chemicals are now known and documented by extensive scientific literature. The commitment of the Governments priority therefore is to control and reduce the possibility for placing di sostanze tossiche nell’ambiente. Molto in questo senso è ancora da fare, ma molto è stato fatto grazie alla normativa europea e anche italiana a dimostrazione di una costante e doverosa attenzione dei Governi al problema.
Tale Decreto Legislativo di fatto mantiene ancora per 2 anni i cittadini italiani al rischio di esposizione a livelli elevati di questo pericolosissimo inquinante, svincolando le aziende inquinanti dall’obbligo di abbattere le emissioni in eccesso.
In particolare, mantiene in questa inaccettabile situazione di rischio i cittadini ed i bambini di Taranto, città in cui l’acciaieria più grande d’Europa, l’ILVA, immetterebbe, secondo i calcoli dell’ARPA Puglia, 98% of benzo (a) pyrene in the nearest neighborhood.
concern is also noted that, pursuant to Decree Law, the target value, one nanogram per cubic meter, even after a specified time, it should be noted that this does not involve "disproportionate cost".
E 'task of the scientific community to the attention of the Government to put the "human costs" due to exposure to benzo (a) pyrene, which, as stated in the Directive 2004/107/EC of the European Parliament, is a genotoxic carcinogen. We would also recall that the literature shows that exposure during pregnancy to high levels of benzo (a) pyrene comporti il rischio di ridurre il Quoziente Intellettivo del neonato, aumenti il rischio di malattie respiratorie del bambino e, poiché il feto può essere fino a 10 volte più suscettibile al danno del DNA, possa tramite esposizione prenatale incrementare molto il rischio cancerogeno.
Si chiede pertanto, in considerazione dei rischi per la salute sproporzionati ed inaccettabili derivanti dall’esposizione a livelli elevati di tale agente cancerogeno, che il Governo riveda le sue decisioni con la massima urgenza e ripristini integralmente la precedente normativa sul benzo(a)pirene.

In attesa di un Vostro riscontro, porgiamo distinti saluti.

Per l’Associazione Culturale Pediatri (ACP)
Paolo Siani – Presidente,
Annamaria Moschetti – Referente regionale ACP per la Puglia e la Basilicata

Per la Società Italiana di Pediatria (SIP)
Alberto Ugazio – Presidente

Per la Federazione Italiana Medici Pediatri (FIMP)
Giuseppe Mele – Presidente

Saturday, October 30, 2010

Non Attendants - Thank You Card Wording Wedding

Primary care in pediatrics: the situation in Europe

Per richiamare l’attenzione sull’importanza delle cure primarie l’OMS ha di recente lanciato lo slogan Primary health care -Now more than ever (The world health report. WHO, 2008). Se da un lato sembra ovvio che la figura di riferimento delle cure primarie in età pediatrica debba essere il pediatra (Cheng TC. Pediatrics 2004;113:1802-9), risultati soddisfacenti in termine di indicatori di salute pediatrica sono stati ottenuti anche in alcuni Paesi che escludono il pediatra dalle cure primarie (Katz M, et al. Pediatrics 2002;1098:788-96). Laddove è il medico di famiglia a occuparsi in prima battuta del bambino il dibattito è aperto su quanta pediatria il medico sappia effettivamente, sulle sue capacità di selezionare correttamente i bambini da inviare in ospedale e sulla scarsa garanzia data da questo sistema in termini di azione preventiva. Nei Paesi in cui le cure primarie ai bambini sono erogate da specialisti pediatri si teme invece che l’accesso non selezionato e diretto allo specialista pediatra produca un eccesso di intervento non necessario (costoso e potenzialmente dannoso) e che in prospettiva il numero degli specialisti pediatri non sarà più sufficiente (Stephenson T, et al. Arch Dis Child 2010;95:767-8).

Uno studio sponsorizzato the European Academy of Paediatrics covering 29 countries and is the picture of the organization of pediatric primary care in Europe (Van It D, et al. Arch Dis Child 2010; 95:791-5, see also the Italian translation stated on M & B site ). Things vary considerably from country to country, from the fact that the same childhood is considered in a different way (0-14 half, 0-18 or 0-19 and the other half). The countries where pediatric primary care are handled in the first instance to the pediatrician are only 7 (Israel, Czech Republic, Slovakia, Greece, Cyprus, Spain, Slovenia) and are in sharp decline (from 35% to 23%) compared to a survey a decade ago (M. Katz Pediatrics 2002; 109:788 - 96). Cala and the proportion of countries (from 47% to 35%) who have a mixed system (among them is put Italy) in which the pediatric primary care are performed by the pediatrician but also where you can choose from different individual family or is there a different approach because of the type of intervention (preventive or clinical care). They go hand
countries where primary care pediatric pass through the filter of the general practitioner / family doctor (18% to 41%). In these countries the training of pediatric general practitioner / family doctor only lasts an average of four months. It is perhaps

a work of little use to draw conclusions: it has the objective limit of not offering any evidence to evaluate the performance of the models adopted in different countries in terms of concrete health of children. But seem to work to read, a starting point to reflect in a moment of great uncertainty and identity crisis of Pediatrics.

From Yellow Pages of Medical and Child , October 2010



Friday, October 29, 2010

Where Can You Play Tech Deck Online

The treatment and prevention obesity of the child: experimental evidence

The central core of the issue of electronic journal of Medical and of Child October is on 'obesity , con proposte di lavoro per affrontare questo rilevante problema di salute pubblica, che hanno aspetti sicuramente interessanti e innovativi: con la "Ricerca" sui risultati preliminari di un progetto di fattibilità sulla formazione dei pediatri che viene dall'esperienza di Ferrara; con la presentazione del " Protocollo di studio" sulla prevenzione dell'obesità nei bambini tra 0-6 anni (basato su interventi evidence based), a cura della Gruppo di Lavoro sull'Obesità della Società Italiana di Pediatria Preventiva e Sociale (SIPPS).

Un invito alla lettura e a specifici commenti.

Qui di seguito i 10 interventi di prevention proposed in the study protocol "I love you "

The 10 preventive action including the indicators

Action
indicator

1
Breastfeeding
least 6 months

2
Weaning

Introducing complementary foods after 6 months

3
protein
controls (especially in the first 2 years
)

4
caloric beverages
Avoid juices, teas, soft drinks, tea
, etc..

5
Bottle
be suspended within 24 months

6
Transportation
do not use the stroller
after 3 years use of motorcycles and electric cars
, contribute to achieving
walk to school (Pedibus)

7
control BMI
Identify if there is the
Early adiposity rebound (before 6 years)

8
TV, games sedentary
Only after two years, maximum
8 hours / week

9
Game and lifestyle

Offer and encourage games of movement, suitable for different age of the child

10
correct portions for preschool
Using Photo Atlas
portions of food
(www.scottibassani.it)

Read

work full open access:

Brambilla P, G. Bedoya G, Bongiovanni C, Brusoni G, Di Mauro G, M Di Pietro, M. Giussani M, Gnecchi M, L Iughetti, M. Sticco M, Bernasconi S.
DRAFT preventing obesity in children between 0 and 6 years old "loves me" . Medical and Child
electronic pages
2010, 13 (8) http://www.medicoebambino.com/?id=PST1008_10.html

Tanas R, Caggese G, E Rossato, Desire And Limauro R, R Marcolongo . feasibility assessment project for training PEDIATRICIANS FOR THE PREVENTION AND TREATMENT OF OBESITY '. Medical and Child
electronic pages
2010, 13 (8) http://www.medicoebambino.com/?id=RIC1008_10.html

Main Topic see a doctor and Child on 'Obesity






Friday, October 22, 2010

Hostals Near Stansted Airport

approved the law on Dyslexia

Good news for the families of about 350 000 Italian students with dyslexia. These children and young people with specific learning difficulties - specific learning disorders (ie dyslexia (difficulty reading), dysgraphia / dysorthography (difficulty in demonstrations graphics) and dyscalculia (difficulty in performing calculations), all disorders that have nothing to do with their intellectual abilities but are often not recognized and in some cases causing misunderstanding on the part of teachers and discouraging unnecessary or difficult to study in boys . The Senate has approved a few months away from the room, a law that protects these students. The law allocates two million euro for 2010 and 2011 (one million per year) and provides custom training, the use of compensatory measures (personal computer, calculator) and also facilities for specific examinations including graduate students and the study of foreign languages. Parents of pupils primary with these disorders, whose diagnosis is reserved for the NHS, can avail of flexible working arrangements on work permits to better assist their children in school activities. In addition there is a specific training for teachers, for the early detection of these diseases and the application of educational rehabilitation.
Under the new law teachers must be aware of the fact that to assess, in a just and fair, students with dyslexia and learning disabilities are different criteria: for example, shorter tasks, privilege Oral Questions with respect to written tests, attention the content of the topics that the spelling errors, or the ability to solve a problem rather than the knowledge of the mnemonic tables.
The law envisages the need for special training for teachers also aimed "to acquire the expertise to find early signs of trouble." Another important aspect covered by the new rules is that concerning the diagnosis to be made within the scope of specialist treatments already provided by the NHS (in legislation) will be notified by the family to home school student.


IL TESTO DELLA LEGGE

Art. 1.
(Riconoscimento e definizione di dislessia, disgrafia, disortografia e discalculia).

1. La presente legge riconosce la dislessia, la disgrafia, la disortografia e la discalculia quali disturbi specifici di apprendimento, di seguito denominati «DSA», che si manifestano in presenza di capacità cognitive adeguate, in assenza di patologie neurologiche e di deficit sensoriali, ma possono costituire una limitazione importante for some activities of daily living.
2. For the purposes of this Act, the term dyslexia is a specific disorder that manifests as a difficulty in learning to read, particularly in the decipherment of linguistic signs, or in the correctness and speed of reading.
3. For the purposes of this Act, the term dysgraphia a specific disorder that manifests itself in writing difficulties in graphic design.
4. For the purposes of this Act shall mean dysorthography a specific disorder of writing that occurs in linguistic difficulties in the process of transcoding.
5. For the purposes of this Act, the term dyscalculia is a specific disorder that manifests as a difficulties in the automation of the calculation and processing of numbers.
6. Dyslexia, dysgraphia, dyscalculia and the dysorthography may exist separately or together.
7. In the interpretation of the definitions contained in paragraphs 2 to 5, taking account of developments in scientific knowledge.


Article 2.
(Purpose).

1. This Act seeks to achieve, for people with learning difficulties, the following purposes:
a)
guarantee the right to education;
b)
educational success, including measures of educational support, to ensure adequate training and promoting the development of potential;
c)
reduce the inconvenience and emotional relationships;
d)
adopt forms of verification and assessment appropriate to the training needs of students;
s)
prepare teachers and parents aware of issues in relation to the DSA;
f)
promote early diagnosis and rehabilitation didactic;
g )
increase communication and collaboration between family, scuola e servizi sanitari durante il percorso di istruzione e di formazione;
h)
assicurare eguali opportunità di sviluppo delle capacità in ambito sociale e professionale.


Art. 3.

(Diagnosi).

1. La diagnosi dei DSA è effettuata nell'ambito dei trattamenti specialistici già assicurati dal Servizio sanitario nazionale a legislazione vigente ed è comunicata dalla famiglia alla scuola di appartenenza dello studente. Le regioni nel cui territorio non sia possibile effettuare la diagnosi nell'ambito dei trattamenti specialist provided by the National Health Service may provide, within the limits of human resources, equipment and financial resources to existing legislation, the same diagnosis is made by specialists or accredited facilities.
2. For students who, despite adequate planning recovery activities targeted, have persistent difficulties, the school shall notify the appropriate family.
3. It is the responsibility of schools of all levels, including kindergarten, activate, after proper notice to interested families, early interventions, such as to identify suspected cases of DSA students on the basis of regional protocols for in Article 7, paragraph 1. The outcome of these activities is not, however, a diagnosis of ASD.

Article 4.
(Training at school).

1. For the years 2010 and 2011, in programs, teacher training and management of schools of all levels, including preschools, there shall be adequate preparation on issues relating to the DSA, aimed at capturing the expertise to find early signs and the consequent ability to apply teaching strategies, methodologies and proper assessment.
2. For the purposes of paragraph 1 shall be authorized an expenditure of a million euro for each of the years 2010 and 2011. The costs shall be covered through a corresponding use of the Reserve Fund for the authorized expenditure of more permanent nature of current writing in the estimates of the Ministry of Economy and Finance, as determined from Table C attached to the Law of 23 December 2009, n . 191.

Article 5.
(measures of teaching and educational support).

1. Students diagnosed with learning difficulties diritto a fruire di appositi provvedimenti dispensativi e compensativi di flessibilità didattica nel corso dei cicli di istruzione e formazione e negli studi universitari.
2. Agli studenti con DSA le istituzioni scolastiche, a valere sulle risorse specifiche e disponibili a legislazione vigente iscritte nello stato di previsione del Ministero dell'istruzione, dell'università e della ricerca, garantiscono:
a)
l'uso di una didattica individualizzata e personalizzata, con forme efficaci e flessibili di lavoro scolastico che tengano conto anche di caratteristiche peculiari dei soggetti, quali il bilinguismo, adottando una metodologia e una strategia educativa adeguate;
b)
l'introduzione di strumenti compensativi, compresi i mezzi di apprendimento alternativi e le tecnologie informatiche, nonché misure dispensative da alcune prestazioni non essenziali ai fini della qualità dei concetti da apprendere;
c)
per l'insegnamento delle lingue straniere, l'uso di strumenti compensativi che favoriscano la comunicazione verbale e che assicurino ritmi graduali di apprendimento, prevedendo anche, ove risulti utile, la possibilità dell'esonero.

3. Le misure di cui al comma 2 devono essere sottoposte periodicamente a monitoraggio per valutarne l'efficacia e il raggiungimento degli obiettivi.
4. Agli studenti con DSA sono guaranteed during the course of education and training in schools and universities, appropriate forms of monitoring and evaluation, including on the state exams and college entrance exams and the university.

Article 6.
(measures for family members).

1. Family members until the first grade students of the first cycle of DSA involved in helping with school activities at home are entitled to take advantage of flexible working hours.
2. The procedures for exercising the right referred to in paragraph 1 shall be determined dai contratti collettivi nazionali di lavoro dei comparti interessati e non devono comportare nuovi o maggiori oneri a carico della finanza pubblica.

Art. 7.
(Disposizioni di attuazione).

1. Con decreto del Ministro dell'istruzione, dell'università e della ricerca di concerto con il Ministro della salute, previa intesa in sede di Conferenza permanente per i rapporti tra lo Stato, le regioni e le province autonome di Trento e di Bolzano, si provvede, entro quattro mesi dalla data di entrata in vigore della presente legge, ad emanare linee guida per la predisposizione di protocolli regionali, to be concluded within the next six months, for early identification of activities under Article 3, paragraph 3.
2. The Minister for Education, Universities and Research, within four months from the date of entry into force of this law, by decree, identify the mode of training of teachers and directors referred to in Article 4, the educational measures and educational support provided for in Article 5, paragraph 2, and forms of assessment and evaluation aimed at implementing the provisions of Article 5, paragraph 4.
3. By decree of the Minister of Education, University and Research, to be taken within two months from the date of entry into force of this Act, shall be established Ministry of Education, University and Research is a Scientific Committee composed of experts with proven expertise in the DSA. The Committee has the task of inquiry as to the functions that this Act gives the Ministry of Education, University and Research. The members of the Committee is not entitled to any bonus. To any reimbursement of expenses shall be within the limits of available resources to current legislation included in the estimates of the Ministry of Education, University and Research.

Article 8.
(Powers of the special regions and autonomous provinces).

1. They are subject to the powers of the special regions and autonomous provinces of Trento and Bolzano, in accordance with their statutes and their implementing rules and the requirements of Title V of Part II of the Constitution.
2. Within three months from the date of entry into force of this Act, the special statute regions and autonomous provinces of Trento and Bolzano shall implement the provisions of the law.

Article 9.
(clause financial invariance).

1. Subject with Article 4, paragraph 2, the implementation of this Act shall not derive new or increased burdens on public finances.

Wednesday, October 13, 2010

Blank Lease Addendum Template

Vaccines and misinformation on Social Networking: Who's fault?


Rome, September 29 (Reuters Health) - Vaccination in Italy today "are like the witches of a few centuries ago, which they said anything." And 'the bitter observation Cristella Daniel Jacques, president of the Group of Vaccines Farmindustria that during a workshop in Rome today released the results of a research on the perception of vaccination on social networks in Italy, conducted by Sanofi Pasteur MSD. A photograph from which the vaccines out pretty bad, only on Facebook - visit every day 8 million people - there are 40 000 groups and 1,200 pages on vaccines, in 95% of cases with a negative image. Things are not better on YouTube (visited by 7 million users per day): In March there were 10,000 movies on vaccines, with 10 new videos every day, in 90% of negative cases, or on MySpace (200 million of users per day and 2 000 pages on the subject, in 70% of cases with a negative image). A bit 'better on Twitter (though in Italy has only 100 thousand visitors a day): 70 000 pages on vaccines, only 20% with a negative image. In general, however, social networks (and research has examined the eight most common) seem to reject this means of prevention.

"This aversion to vaccination is something old - said Giovanni Rezza Department of Infectious Diseases National Institute of Health - just look at the 'cartoons' on the alleged effects of nineteenth-century anti-smallpox vaccine developed in 1796 by Edward Jenner. " Images unlikely that make you smile, "but the anti-vaccination can cause serious damage, as happened in the case of whooping cough in Britain in the '70s," said Rezza.
"We are all victims of poor communication on vaccines - complains Cristella - Missing the authority figure who knows everything, flower billion of opinion leaders on the web, where you can find information confused, old, reliable e non mescolate fra loro". Proprio per sfatare miti e leggende sui vaccini, è stato presentato alla stampa un documento con 30 domande e risposte in materia, che sarà rielaborato e integrato, per costituire un Libro Bianco sulle vaccinazioni. Dalle reazioni dell'organismo, al contenuto dei vaccini, ai prodotti in fase di sviluppo, ai controlli, fino alle strategie di ricerca, in 30 punti si analizzano "i temi che sono apparsi più spesso confusi sul web. E' importante invece fare chiarezza, perché - dice Cristelli - la confusione fa male a tutti". E se il caso dell'influenza A/H1N1 e della campagna vaccinale disertata da cittadini e operatori è ancora fresco, Cristelli ha tenuto a dire che "l'H1N1 non è stata una good step for the industry in terms of finances and image. "And you still will see that reflected the story on the upcoming seasonal influenza vaccination campaign. In short, there is still too much confusion on this issue, even among the same health workers. As revealed by the fact that, during the influenza pandemic, just 10-15% of Italian doctors and nurses has been vaccinated. "The battle will be long - provides Cristella - but it is important to ensure that people get a source of reliable information, real and shared. "

A summary of the contents of the important meeting held in Rome on September 29 entitled" Vaccines word of mouth what a mess "promoted by Confindutria seem important, why take note of what should be the methods of communication to be followed in 2010 for a correct and adequate information to citizens. outstanding problem at the moment and that concerns not only the modern systems of social network but also the more traditional information systems: the television and print media.
The basic question remains the same, however: by whom and how social networks take their information and why the information is often distorted or even contrary to the evidence? The interesting white paper can give adequate answers (we hope), but it would be very useful to reflect, discuss and admit errors committed in the course of vaccination campaigns or projects not implemented with sufficient strength, innovative strategy and method of communication or otherwise proposed by contradictory and wrong methods, based on epidemiological assumptions inaccurate to say the least (see "pandemic" to the 'H1N1)? How about some immunizations that are offered on the national territory patchy? What can be said in these cases, the social network?
The Department of Prevention of the Ministry of Health, the National Health Council, the State-Regions Conference, the National Institute of Health, the AIFA, the CCM are the six establishment figures who have a voice in the field of immunization. Usually working in harmony, but often have different opinions. The convergence of institutional sources is therefore already a step , perhaps by establishing systems and innovative methods of communication, even using, effectively, socialnetwork. The revolution, also cultural, could start from there. Think about it ... maybe not from the tail of the problem but from the head.


Thursday, October 7, 2010

How To Shoot Depth Map On Camera

flu vaccine at risk groups: recommendations for the 2010-2011 season












On 1 October, on the recommendation of the Ministry of Health, began the campaign for vaccination against l'influenza stagionale.
Dopo il clamore vissuto lo scorso anno per la famosa pandemia influenzale, l'impressione è che quest'anno (ancora una volta paradossalmente) se ne parli poco. Qualcuno dirà che questo è un bene, un segnale magari positivo per ricondurre le campagne di informazione, su argomenti di sanità pubblica, in una ambito formale che riguarda i medici, i distretti territoriali e magari le Regioni.
Tuttavia, il problema è quello di capire, come discusso recentemente anche su Medico e Bambino, quali strumenti di comunicazione vanno utilizzati per rendere, un programma di prevenzione di salute pubblica, davvero efficace. Ricordate Topo Gigio lo scorso anno che cercava in tutti i modi di tranquillizare l'opinione pubblica? E ci sarebbe riuscito magari benissimo se a distanza di due minuti dalle sue parole, magari nel notiziario sulla stessa rete televisiva, non ci fossero stati gli annunci sconsiderati e contraddittori di morti e di raccomandazioni che cambiavano di giorno in giorno.
Qualcuno dice che, a fronte di una possibile pandemia, era meglio fare tutto ed anche di più, e che i mass-media non potevano fare altre che riflettere queste contraddizioni.
Il richiamo a quanto è successo lo scorso anno e a quanto non accade in questi giorni sui principali organismi di stampa (ma anche sui siti di medicina e pediatria) ha tuttavia un obiettivo di richiamo al significato vero, epidemiologicamente serio, dell'influenza stagionale e della vaccinazione per prevent it.
In fact, the recommendations published by the Ministry of Health led back to the problem of the 2010-11 influenza prevention and control in an area now "scientific" absolutely reasonable with the identification of those at risk as the only place to go and the active offer of free vaccine: "The vaccination campaign vacation, promoted and financially supported by the National Health Service is mainly addressed to those identified and classified at risk of severe and sometimes lethal complications, in case from contracting the flu. The free offer is also aimed at active people at risk who are engaged in specific social value. The inclusion healthy children aged between 6 months and 24 months (or up to 5 years) in the priority categories to be immunized against seasonal influenza is a topic currently under discussion by the international scientific community. This choice has already been made by Canadian and American health care and some EU countries but the data of vaccination coverage achieved so far is insufficient to assess the impact of this intervention. Therefore it is not considered necessary to promote programs offering free activities of seasonal influenza vaccine to children who do not present individual risk factors. "

You can read the entire document, which also shows the measures demonstrably effective protective equipment, types of vaccines available and false contraindications to the use of the vaccine, on the home page of Medical and Child heading report.
October issue of The Physician and Child will be published a summary of the recommendations by the Institute of Health. Do not forget to read it. In the meantime, let's once again serving to make the flu shot this time very useful for children and adolescents at risk and therefore have sources really need.
seriously, and information science, without contradictions. Federico Marchetti