The main objective of the Laboratory for Mother and Child Health is to ensure a better mother and child well-being by undertaking interdisciplinary and collaborative work in the field of public health.
In particular, the laboratory is involved:
- in the monitoring and epidemiological evaluation of the use and effects of drugs and vaccines
- in the evaluation of diagnostic and therapeutic pathways carried out in the paediatric population for neuropsychiatric disorders
- in the research methodology related to general hospital and paediatric community practices
- in studying the public health determinants of children’s well-being
- in the transfer of health information to the community.
Pharmacoepidemiology in the Lombardy Region
As part of the EPIFARM Project (Epidemiologia del Farmaco), the Laboratory for Mother and Child Health, financed in part by the Lombardy Region, evaluates the prescription profile of medicines in children. During 2019, the activities involved analysis of the paediatric drug prescriptions from 2018, the assessment of the prescription profile of antiepileptic drugs in women of child-bearing age and during pregnancy, and the evaluation of the diagnostic-therapeutic-assistance related programmes for children and adolescents with autism spectrum disorder.
The Lombardy Region’s ADHD Register
The Lombardy Region’s ADHD Register was launched in June 2011 within the project called “Sharing diagnostic-therapeutic approaches for ADHD in Lombardy” with the funding of the Lombardy Region. The project involves 18 referral Centres and the coordinator is the UONPIA (Child and Adolescent Neuropsychiatric Unit) of the A.O. Spedali Civili of Brescia. The project includes training initiatives for health care workers who provide assistance to ADHD patients and their families, initiatives to increase information on ADHD, and a regional register of the ADHD cases. The register was designed as a disease register and therefore collected information not only on the patients diagnosed with ADHD under pharmacological treatment (as foreseen by the national register), but also on all patients who visited the referral Centres for a suspected ADHD. The register then permits the: monitoring of diagnostic paths; defining of the prevalence of the disorder; monitoring of non pharmacological treatment programs as well; continuation of pharmacovigilance activity by extending the monitoring on the use of the drugs other than atomoxetine and methylphenidate; quantifying the workload for the referral Centres. At the end of 2019, 5,534 patients have been included in the register, 3,665 of whom had a confirmed ADHD diagnosis, 1,629 were not diagnosed for ADHD 240 were still under diagnostic evaluation. In the most cases patients were referred to the Centers by the school (31%) or the parents (16%). 3,665 of the 3,586 (98%) ADHD patients had an assigned treatment: 95 only pharmachological therapy, 2,903 a non pharmacological prescription and 588 none specific treatment. The most frequent comorbidities were learning disabilities (39%), oppositional/defiant disorder (15%) and sleep disorders (14%).
Coorte Nascita Project
The NASCITA study (NAscere e creSCere in ITAlia), coordinated by the Istituto di Ricerche Farmacologiche Mario Negri IRCCS’ Laboratory for Mother and Child Health in Milan in collaboration with the Associazione Culturale Pediatri (ACP), aims to follow the growth and health status of a cohort of children from birth and throughout the preschool period. The participating paediatricians will collect data on the newborns and on their parents during regular well-child visits and visits for illness. The data collected will serve to describe, check, and assess the development, growth, education and care of the children, and which factors may influence their well-being, over time and considering the different lifestyles. The analysis of this study will permit factors that are critical to the health and wellness of children to be identified. Thanks to this study it will be possible to, for example: evaluate the frequency and duration of breastfeeding, the timing and methods used in weaning, and which factors are associated with the choice to breastfeed; describe the growth (height, weight, BMI) of Italian children, estimate the percentage of overweight and obese children, and evaluate the risk factors for developing overweight/obesity; assess how well the care practices useful for the children’s development are known and implemented, for example reading out loud, listening to music, and what impact these practices have; estimate how frequent certain diseases are in the paediatric population (for example asthmatic bronchitis, allergies, diabetes, epilepsy) and evaluate which factors increase the risk of developing these diseases; estimate how many children with special needs there are and which services are present, and how well they meet the children’s needs, in the different geographical areas of Italy; assess to what extent educational and socialization programmes are guaranteed to children in the different geographical contexts. Enrolment of newborns began in April 2019. On 31/01/2020, 4106 newborns (M/F=1,04), followed by 168 family paediatricians, were participating in the cohort with their families. The distribution per geographical area reflects that of the Italian population: 48% live in the North, 19% in the Centre, and 33% in the South. A total of 2728 children underwent their second well-child visit (at 3 months) and 1230 their third (at 6 months).
Mother And Child Health During Pregnancy And The Post-Partum
BORN AT HOME. Since the early 1960s, home birth has become increasingly rare throughout the country. Today, about a thousand children are born every year in Italy outside of the hospital. This is a phenomenon that affects only a few regions and few parents who are very determined to counter the sometimes excessive medicalization of the birth pathway. In a country such as Italy, where 34% of deliveries (between 56% in Campania and 21% in Tuscany) are caesarean compared to the 15% indicated by the World Health Organization, home births don’t represent an alternative. The interest in home delivery arises from the need expressed by women to have more intimate, personalized assistance. In 2019 the laboratory continued its collaboration with The National Obstetricians for Home Births and Maternity Home Association to guarantee a study in which assistance during labour and physiological birth was assessed in agreement with national and international guidelines. The ideal condition is the presence of an obstetrician throughout the pregnancy, and during labour, so that the future mother (and the couple as a whole) receive non-invasive, appropriate assistance and are supported during the entire period. In this manner the obstetrician can also readily identify any possible contraindications to home birth. In 2019, 389 women planned a home birth or a birth in a maternity home, in line with the 2018 number (388), and their data were collected in the database. Rapporto CedAP. For some years now, the Maternal and Child Health Laboratory, in collaboration with the Lombardy Region, has been analyzing regional data collected through the Childbirth Assistance Certificate (CedAP). The CedAP survey, established by the Ministry of Health, is the main source of current data for those who deal with maternal-infant health at multiple levels, collecting socio-demographic information (on parents) and health information (on assistance and the newborn). The possibility of representing the characteristics of the assisted population in the Health Authorities and in the points of birth (evaluating the incidence of some risk factors), comparing the care practices of the different structures, verifying the temporal elements over the years are just some of the opportunities from the publication of CedAP data. Furthermore, these data constitute a potential planning and evaluation tool for maternal and child health.
Co-Operation With Countries With Limited Resources
As an expression, test, and original method of manifesting the choice to make the laboratory’s research transferable and accessible to all populations, the laboratory promoted and provided assistance to projects in, and for, the South of the world, in collaboration with Non-Governmental Organizations (NGOs) and the World Health Organization. The technical and organisational support for carrying out socio-sanitary projects in countries with limited resources continues.
Working Group For The “Convention On The Rights Of Childhood And Adolescent”. 30 Years After The Un Convention On Children’s Rights
In 2019, the Laboratory for Mother and Child Health also contributed to the drafting of the 10th Report of the CRC Group, a network to which 100 associations belong and with which a new monitoring period begins which will end with the next appointment in Geneva in 2023. There are worrying data from the recent observations of the UN Committee for our country: over 1.2 million children live in absolute poverty, and access to resources and services is not present throughout the country. Last February the UN Committee on the rights of the child and adolescent reiterated its previous concerns to Italy by recommending "the adoption of urgent measures to address the disparities existing between the regions regarding access to health services, to essential life, adequate housing and access to education for all minors throughout the country ". Disparities on a regional basis can, in fact, be considered a form of discrimination that affects the living conditions of children since they are more vulnerable. In the healthcare sector, significant differences have also been observed in the paediatric area for data relating to infant mortality, obesity and overweight, number of caesarean sections, and vaccination coverage. In terms of education, there are still important differences between regions regarding, for example, childcare services. The places offered cover 24% of the population, but a large gap remains between the northern and central areas and the southern areas: in the former, the 33% target is reached, and is even higher in some regions, in the South places are available only for 11.5% of children. There are many unresolved issues for the new government to address urgently, starting with the fight against child poverty (1,260,000 are minors living in absolute poverty, which correspond to over 725 thousand families) and protection from abuse and violence against children, with particular attention to their prevention. Compared to the situation of unaccompanied migrant minors, Italy has received 23 recommendations.
Within the public health emergency caused by the COVID-19 epidemic, the Laboratory has carried out several activities: “Staying at home for COVID” - From 6-20 April 2020, we conducted a national survey with the aim of collecting information on psychologically distressing experiences of Italians living in quarantine during the phase one of the COVID-19 emergency. Participants have filled out an online questionnaire, which consisted of 48 questions: demographic and physical symptoms data from the prior 14 days of quarantine were collected and psychological impact of quarantine was assessed by the “COVID-19 Peritraumatic Distress Index” (CPDI), an assessment tool validated in Italy and other countries. In total, 35.011 adults consented to participate into the study: the final sample comprised 20.158 respondents (of whom the 59.1% from Lombardy) who fully completed the questionnaire. More than 50% of responders reported a psychological distress of any degree, of whom 5% a severe psychological impact. Higher distress was associated with gender (female), first-second educational level, being unemployed and living in a ≤2 room house. People living close to the red zone (Nembro-Alzano) were more distressed than those who were living far from that specific area: a negative correlation between CPDI score and distance from place of residence to the red zone was found. About 10% of the participants reported moderate to severe depressive symptoms, 5% reported moderate to severe anxiety symptoms, and 4% reported moderate to severe physical symptoms. It’s possible to watch the study presentation webinar at the following link: https://www.youtube.com/watch?v=ocJKSn7-RLQ Distance learning during the COVID-19 pandemic: the experience of Primary and Italian Middle School Children. Between the 8th -15th of May 2020 a national survey, concerning distance learning during the pandemic and addressed to the mothers of primary and middle school children, was launched by the Laboratory for Mother and Child Health of the Mario Negri Research Institute. 2149 mothers took part to the research and a total of 1601 questionnaires were completed. 810 (50.7%) mothers were from the Lombardy Region, the one area that suffered the most from the virus in Italy and in the world at the time of the survey. The 71% were mothers of primary school students and the 29% of middle school; 2/3 were workers and most of them (63%) in smart working. Both mothers of primary (88%) and middle school children (70%) reported great difficulties in balancing work tasks and supporting children with distance learning. Challenging confirmed even after the quarantine period because of reducing contributes of grandparents or other figures of support. For about 2% of students was impossible to have access to the distance learning, and 1/3 had to share (spaces, tools and timing) with brothers and sisters in order to join the online video lessons and doing homework by using PC/tablet, books and printer. For about 2/3 of mothers, their children had difficulties with technologies, with school disorganisation in scheduling and managing online learning, and with teachers’ reachability. During video-lessons (2 hours on average), attention timing of 1/3 of children did not reach the 20 minutes and several breaks were needed, with an increment on level of restlessness (69%) and aggressiveness (33%) in the primary school children and anxiety (34%) in the middle school one. Two-thirds of mothers rejected the distance learning. The experience of ADHD students. As part of the study, particular attention was given to inattentive and hyperactive students assisted by the ADHD Regional Centre of Milano San Paolo and Carlo Hospital: students who were used to face with learning difficulties even before quarantine. A case-control study, composed of 92 ADHD students and 184 peer controls from the national survey study, highlighted the negative impact of distance learning concerning the loss of social, spatial and temporal contest, along with physical distance from teachers, absence of non-verbal feedback (eyes and physical contact), distractibility caused by the learning instruments, and lower involvement due to the tools scarce appeal and learning modalities conditions of use. Factors shared by all students, matter of disparity further more for the most fragile. The webinar study presentation is available on this link https://www.youtube.com/watch?v=DG_Gym5ZFjA Children in quarantine. This study was performed between May and June 2020: it directly involved a sample of 82 students living in Milan with video-interviews. The aim of the project was to investigate the psychological distress (anxiety and mood symptoms) and changes in routine among Italian primary and middle school students (aged 6 to 14) during the COVID-19 quarantine. The 80% of respondents reported that it was more difficult to focus during lessons, 2/3 found it more tiring, and almost half of the children and adolescents felt less committed to remote schooling. The perception of changes in eating habits was observed in 63% of the population, mainly in primary school students. More than half of the sample reported eating more during lockdown, with an increase in junk food consumption. Around 30% of the students had difficulties sleeping and wished to sleep in their parents’ bed. The main fear, shared by the 75.6% of the sample, is the thought that their family members could fall ill with COVID-19. 18 subjects (22%) had normal scores of anxiety, 54(65%) scored mild to moderate, and 10 (12%) had severe anxiety symptoms: in total 78 % scored positive for anxiety. There were no significant differences in anxiety levels between males and females, nor between primary and middle school students. Nearly half of the sample had significant mood symptoms, mainly associated with screen usage (more than two hours per day excluding time spent with distance learning) and with changes in dietary habits: in quantity and quality. Almost all the participants (90%) reported missing their friends a lot, infact the interviews were concluded with a question, asking the participants thefirst things they wanted to do when everything went back to normal: more than half of them wanted to meet their school mates or friends again. It’s possible to watch the study presentation webinar at the following link: https://www.youtube.com/watch?v=b9-R65mL_hs How elderly people experience the COVID-19 emergency? In collaboration with the Sindacato dei Pensionati (SPI) CGIL Lombardia (the Lombardy section of the CGIL pensioners’ unions), a questionnaire was developed with the aim to evaluate how people ≥65 years old experienced the COVID-19 emergency and the (first) lockdown period. A total of 1480 elderly living in Lombardy region participated to the survey. Nearly half of them reported that they had to change their habits during the first phase of the epidemics. Four out of ten felt abandoned and two thirds reported anxiety, fear or sadness. The female gender and living in the areas with the highest incidence of the infection were the variables associated with a greater risk of having a negative experience BaSCo Project. The Laboratory, in collaboration with the Associazione Culturale Pediatri Milano, is coordinating the study “Bambini Sospetti Covid” (BaSCo, children with suspect COVID-19). It is an observational study, involving 33 paediatricians practicing in Lombardy region, Italy, with the aim to describe the characteristics of children who had a diagnosis of COVID-19 through a molecular test and children who developed symptoms of COVID-19 in the February-May 2020 period without being tested, and to monitor their health status in the following months.
International Consensus on Cardiopulmonary Resuscitation.