Giovanni Ghirga - Academia.edu (original) (raw)
Papers by Giovanni Ghirga
Journal of Marine Science: Research & Development, Sep 23, 2013
Archivio per le scienze mediche, 1998
Epidemiologia e prevenzione, 2008
Epidemiologia e prevenzione
Italian Journal of Pediatrics, 2012
Introduction In this short essay, we would like to address a severe divergence observed in Italy ... more Introduction In this short essay, we would like to address a severe divergence observed in Italy between Life Expectancy (LE) and Healthy Life Expectancy (Healthy LE) and a unique trend of worsening in Healthy LE, compared to the other European countries. Both issues emerge in recent data by EUROSTAT Report. Methods The analysis used by the authors of the EUROSTAT report is based on Sullivan method which combines 2 type of variables: mortality and morbidity data. Results While several European countries started to deal with comparable data about LE since 1960, in Italy, analogous data were available for the first time in EUROSTAT Report only in 1985. In Italy, in the period 1985-2008, there was a good progressive increase in L.E., following the best European values. Nevertheless, while until 2004 Italy was among the European best countries in terms of both LE and Healthy LE at birth, four years later in 2008 there was a shocking loss of 10 years of Healthy LE at birth in newborn gir...
F1000posters, Apr 15, 2011
BACKGROUND. Over the past 20 years, there has been an increase in the incidence of children diagn... more BACKGROUND. Over the past 20 years, there has been an increase in the incidence of children diagnosed with all forms of invasive cancer. Leukemias and cancers of the brain and central nervous system account for more than half of the new cases. About one-third of childhood cancers are leukemias. The proportion of childhood leukaemia incidence in Great Britain attributable to natural background radiation has been estimated to be about 20%. Several studies have shown an increase in the incidence of leukemias in children living near nuclear power plants . In the late 1980s and early 1990s, increased incidence of childhood leukemia were reported near United Kingdom nuclear facilities but the cause or causes remained unknown because it was estimated that the radiation doses from these facilities were too low to explain the increased leukemia (1-4). In Germany, since a childhood leukemia cluster was first reported in 1980 in the vicinity of the nuclear plant Krümmel near Hamburg public anxieties have remained high (5,6).
Epidemiologia e prevenzione
Open Journal of Pediatrics, 2012
Background: Air pollution is a serious threat to children health. Given that children spend over ... more Background: Air pollution is a serious threat to children health. Given that children spend over 80% of their time indoors, understanding transport of pollutants from outdoor to indoor environments is important for assessing the impact of exposure to outdoor pollution on children health. The most common advice given during a smoke pollution episode is to stay indoors. How well this works depends on how clean the indoor air is and how pollutants from outdoor air contribute to pollutants load in indoor air. Objective: To assess the amount of outdoor air pollution coming indoors threatening children health. Methods: A Medline/EMBASE search of scientific articles was performed to evaluate the indoor-tooutdoor (I/O) concentration ratios of two main pollutants: ultrafine particles (UFP) and ozone (O 3 ). Result: Under infiltration condition, the highest I/O ratios (0.6 -0.9) were usually observed for larger UFP (70 -100 nm), while the lowest I/O ratios (0.1 -0.4) occurred typically around 10 -20 nm. O 3 I/O ratios vary according to air exchange and may be 0.6 -0.8 for interiors having a large volume exchange with outdoor air (i.e. open windows) and 0.3 -0.4 with conventional air conditioning systems. Conclusions: In the absence of indoor sources or activities, indoor UFP particles originate from outdoors. O 3 concentration indoors may reach concentration similar to outdoors. Environmental and energy policies must also explicitly account for all the impacts of fossil fuel combustion on child health and development.
Pediatric Emergency Care, 2001
Jaw-thrust and bag-mask ventilation usually provide adequate oxygenation in patients with acute i... more Jaw-thrust and bag-mask ventilation usually provide adequate oxygenation in patients with acute infectious upper-airway obstruction (AIUAO). It is the treatment of choice for patients on the way to hospital or in an emergency department until definitive stabilization is achieved with available resources. We report three fatal case studies showing ineffective bag-mask ventilation in AIUAO that raise concerns over this treatment. Case 1 is a 4-year-old patient with epiglottitis who suffered complete obstruction during transport to the hospital. Case 2 is a 3-year-old patient with epiglottitis who suffered complete obstruction during transport to the hospital. Case 3 is a 3-year-old child with viral laryngotracheitis and respiratory arrest just after the admission. Should the approach of bag-mask ventilation in AIUAO change to ventilate patients in the prone position? This approach offers two advantages. First, gravity helps the epiglottis fall forward, reducing the airway obstructions. Second, if the patient vomits during ventilation, the vomit will fall to the floor. During bag-mask ventilation in patients with severe partial airway obstruction, ventilation pressure is high. Gastric inflation may occur and rapidly distend the stomach. This gastric distension interferes with ventilation by elevating the diaphragm, resulting in a decreased lung volume. Cricoid pressure could prevent gastric distension in these instances and should be recommended.
Science of The Total Environment, 2011
Pediatric Emergency Care, 1999
Pediatric Emergency Care, 1991
International Journal of Epidemiology, 2012
Recent ecological studies in Great Britain 2 and Germany 3 also evaluated residence at diagnosis ... more Recent ecological studies in Great Britain 2 and Germany 3 also evaluated residence at diagnosis and found similar leukaemia risks in children <5 years of age living near (0-5 km) nuclear power stations ( ). The standardized incidence ratio (SIR) is 1.40 in Switzerland (CH), 1.36 in Great Britain (GB) and 1.41 in Germany (D). The relative risk (RR), defined by the ratio of SIR in the 5-km zone to SIR in the rest of the study region, is 1.46 in CH, 1.41 in GB and 1.45 in D. Each individual RR is not significant but a pooled analysis of the data yields RR ¼ 1.44 that is significant on the 1% level (P ¼ 0.007). So the Swiss data confirm the excess of leukaemia found in young children living near German and British NPPs. References 1 Spycher BD, Feller M, Zwahlen M et al. Childhood cancer and nuclear power plants in Switzerland: A census based cohort study. Int J Epidemiol 2011;40:1247-60. 2 Bithell JF, Keegan TJ, Kroll ME, Murphy MF, Vincent TJ. Childhood leukaemia near British nuclear installations: methodological issues and recent results. Radiat Prot Dosimetry 2008;132:191-97. 3 Kaatsch P, Spix C, Jung I, Blettner M. Childhood leukemia in the vicinity of nuclear power plants in Germany.
Italian Journal of Pediatrics, 2010
Background: Global warming and the established responsibility of the anthropogenic emissions of g... more Background: Global warming and the established responsibility of the anthropogenic emissions of greenhouse gases represent a strong push towards the construction of new nuclear power plants (NPPs) to cope with the growing energy needs. The toxicity of nuclear waste associated with the extreme difficulty of their disposal and increase in cancer mortality and incidence following occupational radiation exposure are considered the only health problems. Methods: A search of scientific articles and government documents published since was performed to evaluate cancer rate and mortality in residents, particularly children, in the vicinity of NPPs. Results: A recent well conducted state-of-the-art case-control study of childhood cancers in the areas around German NPPs (KiKK study) showed a statistically significant cancers (2.2-fold increase in leukemia and a 1.6-fold increase in solid tumor) among children under five years of age living in the inner 5 km circle around NPPs when compared to residence outside this area. These findings have been confirmed by two meta-analyses. Nevertheless, other UK, France, Spain and Finland studies did not find cancer incidence and/or death increase near NPPs. Conclusions: Increased cancer risk near NPPs remains in fact an open question. The stronger evidence from the KiKK study suggests there may well be such increases at least in children regardless of the country in which nuclear reactors are located. In fact, few months ago the U.S. Nuclear Regulatory Commission has asked the National Academy of Sciences (NAS) to perform a state-of-the-art study on cancer risk for populations surrounding NPPs.
Minerva pediatrica
To investigate if high dose inhaled beclomethasone dipropionate started early after upper respira... more To investigate if high dose inhaled beclomethasone dipropionate started early after upper respiratory tract infection (URTI) could reduce recurrent wheezing in infants. Twenty-six ambulatory infants, 7-12 months of age, with recurrent wheezing during upper respiratory tract infection participated. All experienced at least three wheezing attacks. Those with underlying lung or systemic disease were excluded. Infants were divided into two groups in an open unblinded manner, until 13 patients had been recruited for each group. The groups were similar in risk factors for recurrent wheezing. Four treatment periods of 5 days were planned for group 1. The dose regimen was nebulized beclomethasone 400 mg by mask tid for 5 days. Treatment was started at the very first sign of URTI prior to any sign of wheezing. Group 2 did not receive any preventive treatment and constituted the control group. Symptoms scores were recorded. The number of emergency room visits, hospital admissions and short courses with oral steroids was also noted. Twelve infants completed 48 treatment periods. Five visited the emergency room, only one during beclomethasone therapy. Six received oral steroids, two receiving beclomethasone. No patient was admitted to the hospital. Symptom scores were significantly lower during beclomethasone treatment (p<0.05). No apparent adverse events were reported. The infant with recurrent wheezing during URTI is a therapeutic challenge. Most of these infants have prodromal symptoms for about 24 hours before wheezing starts. In the present study we observed favorable results, decrease in the number the child wheezed and the number of acute attacks, when high dose inhaled beclomethasone is administered during this critical time.
Minerva pediatrica
The Authors describe the intraosseous administration of drugs and fluids in two patients: a prete... more The Authors describe the intraosseous administration of drugs and fluids in two patients: a preterm infant (gestational age 26 weeks, weight 850 g) with severe cardiopulmonary depression just after delivery, and a 15-day-old newborn with bronchopneumonia. The intraosseous infusion is safe and effective. At present, mainly in United States, it has an important role in pediatric emergency. It is indicated in all emergency situations where a vascular access must be rapidly obtained and in whom other methods of access to the vascular system have failed. After a short review on the history of this old procedure, used for the first time in 1922 for blood transfusions, the Authors describe its physiology, technique, complications, and contraindications.
Pediatric Emergency Care, 1989
Bacteremia is a potentially serious event which must be recognized early and treated aggressively... more Bacteremia is a potentially serious event which must be recognized early and treated aggressively to prevent progression to septicemia and septic shock. The pathophysiology of septicemia and shock includes inadequate tissue perfusion and oxygenation. Expansion of intravascular volume and pharmacologic cardiovascular support are designed to minimize resulting end-organ injury. Initial antibiotic therapy must be individualized and should include an agent or agents active against the common pathogens encountered in the specific clinical setting. Once the causative organism is isolated, therapy is targeted more narrowly. Despite the availability of a variety of newer antibiotics, the morbidity and mortality of septicemia and septic shock remain unacceptably high. Development of new pharmacologic agents active against the mediators of shock may offer future promise.
Journal of Marine Science: Research & Development, Sep 23, 2013
Archivio per le scienze mediche, 1998
Epidemiologia e prevenzione, 2008
Epidemiologia e prevenzione
Italian Journal of Pediatrics, 2012
Introduction In this short essay, we would like to address a severe divergence observed in Italy ... more Introduction In this short essay, we would like to address a severe divergence observed in Italy between Life Expectancy (LE) and Healthy Life Expectancy (Healthy LE) and a unique trend of worsening in Healthy LE, compared to the other European countries. Both issues emerge in recent data by EUROSTAT Report. Methods The analysis used by the authors of the EUROSTAT report is based on Sullivan method which combines 2 type of variables: mortality and morbidity data. Results While several European countries started to deal with comparable data about LE since 1960, in Italy, analogous data were available for the first time in EUROSTAT Report only in 1985. In Italy, in the period 1985-2008, there was a good progressive increase in L.E., following the best European values. Nevertheless, while until 2004 Italy was among the European best countries in terms of both LE and Healthy LE at birth, four years later in 2008 there was a shocking loss of 10 years of Healthy LE at birth in newborn gir...
F1000posters, Apr 15, 2011
BACKGROUND. Over the past 20 years, there has been an increase in the incidence of children diagn... more BACKGROUND. Over the past 20 years, there has been an increase in the incidence of children diagnosed with all forms of invasive cancer. Leukemias and cancers of the brain and central nervous system account for more than half of the new cases. About one-third of childhood cancers are leukemias. The proportion of childhood leukaemia incidence in Great Britain attributable to natural background radiation has been estimated to be about 20%. Several studies have shown an increase in the incidence of leukemias in children living near nuclear power plants . In the late 1980s and early 1990s, increased incidence of childhood leukemia were reported near United Kingdom nuclear facilities but the cause or causes remained unknown because it was estimated that the radiation doses from these facilities were too low to explain the increased leukemia (1-4). In Germany, since a childhood leukemia cluster was first reported in 1980 in the vicinity of the nuclear plant Krümmel near Hamburg public anxieties have remained high (5,6).
Epidemiologia e prevenzione
Open Journal of Pediatrics, 2012
Background: Air pollution is a serious threat to children health. Given that children spend over ... more Background: Air pollution is a serious threat to children health. Given that children spend over 80% of their time indoors, understanding transport of pollutants from outdoor to indoor environments is important for assessing the impact of exposure to outdoor pollution on children health. The most common advice given during a smoke pollution episode is to stay indoors. How well this works depends on how clean the indoor air is and how pollutants from outdoor air contribute to pollutants load in indoor air. Objective: To assess the amount of outdoor air pollution coming indoors threatening children health. Methods: A Medline/EMBASE search of scientific articles was performed to evaluate the indoor-tooutdoor (I/O) concentration ratios of two main pollutants: ultrafine particles (UFP) and ozone (O 3 ). Result: Under infiltration condition, the highest I/O ratios (0.6 -0.9) were usually observed for larger UFP (70 -100 nm), while the lowest I/O ratios (0.1 -0.4) occurred typically around 10 -20 nm. O 3 I/O ratios vary according to air exchange and may be 0.6 -0.8 for interiors having a large volume exchange with outdoor air (i.e. open windows) and 0.3 -0.4 with conventional air conditioning systems. Conclusions: In the absence of indoor sources or activities, indoor UFP particles originate from outdoors. O 3 concentration indoors may reach concentration similar to outdoors. Environmental and energy policies must also explicitly account for all the impacts of fossil fuel combustion on child health and development.
Pediatric Emergency Care, 2001
Jaw-thrust and bag-mask ventilation usually provide adequate oxygenation in patients with acute i... more Jaw-thrust and bag-mask ventilation usually provide adequate oxygenation in patients with acute infectious upper-airway obstruction (AIUAO). It is the treatment of choice for patients on the way to hospital or in an emergency department until definitive stabilization is achieved with available resources. We report three fatal case studies showing ineffective bag-mask ventilation in AIUAO that raise concerns over this treatment. Case 1 is a 4-year-old patient with epiglottitis who suffered complete obstruction during transport to the hospital. Case 2 is a 3-year-old patient with epiglottitis who suffered complete obstruction during transport to the hospital. Case 3 is a 3-year-old child with viral laryngotracheitis and respiratory arrest just after the admission. Should the approach of bag-mask ventilation in AIUAO change to ventilate patients in the prone position? This approach offers two advantages. First, gravity helps the epiglottis fall forward, reducing the airway obstructions. Second, if the patient vomits during ventilation, the vomit will fall to the floor. During bag-mask ventilation in patients with severe partial airway obstruction, ventilation pressure is high. Gastric inflation may occur and rapidly distend the stomach. This gastric distension interferes with ventilation by elevating the diaphragm, resulting in a decreased lung volume. Cricoid pressure could prevent gastric distension in these instances and should be recommended.
Science of The Total Environment, 2011
Pediatric Emergency Care, 1999
Pediatric Emergency Care, 1991
International Journal of Epidemiology, 2012
Recent ecological studies in Great Britain 2 and Germany 3 also evaluated residence at diagnosis ... more Recent ecological studies in Great Britain 2 and Germany 3 also evaluated residence at diagnosis and found similar leukaemia risks in children <5 years of age living near (0-5 km) nuclear power stations ( ). The standardized incidence ratio (SIR) is 1.40 in Switzerland (CH), 1.36 in Great Britain (GB) and 1.41 in Germany (D). The relative risk (RR), defined by the ratio of SIR in the 5-km zone to SIR in the rest of the study region, is 1.46 in CH, 1.41 in GB and 1.45 in D. Each individual RR is not significant but a pooled analysis of the data yields RR ¼ 1.44 that is significant on the 1% level (P ¼ 0.007). So the Swiss data confirm the excess of leukaemia found in young children living near German and British NPPs. References 1 Spycher BD, Feller M, Zwahlen M et al. Childhood cancer and nuclear power plants in Switzerland: A census based cohort study. Int J Epidemiol 2011;40:1247-60. 2 Bithell JF, Keegan TJ, Kroll ME, Murphy MF, Vincent TJ. Childhood leukaemia near British nuclear installations: methodological issues and recent results. Radiat Prot Dosimetry 2008;132:191-97. 3 Kaatsch P, Spix C, Jung I, Blettner M. Childhood leukemia in the vicinity of nuclear power plants in Germany.
Italian Journal of Pediatrics, 2010
Background: Global warming and the established responsibility of the anthropogenic emissions of g... more Background: Global warming and the established responsibility of the anthropogenic emissions of greenhouse gases represent a strong push towards the construction of new nuclear power plants (NPPs) to cope with the growing energy needs. The toxicity of nuclear waste associated with the extreme difficulty of their disposal and increase in cancer mortality and incidence following occupational radiation exposure are considered the only health problems. Methods: A search of scientific articles and government documents published since was performed to evaluate cancer rate and mortality in residents, particularly children, in the vicinity of NPPs. Results: A recent well conducted state-of-the-art case-control study of childhood cancers in the areas around German NPPs (KiKK study) showed a statistically significant cancers (2.2-fold increase in leukemia and a 1.6-fold increase in solid tumor) among children under five years of age living in the inner 5 km circle around NPPs when compared to residence outside this area. These findings have been confirmed by two meta-analyses. Nevertheless, other UK, France, Spain and Finland studies did not find cancer incidence and/or death increase near NPPs. Conclusions: Increased cancer risk near NPPs remains in fact an open question. The stronger evidence from the KiKK study suggests there may well be such increases at least in children regardless of the country in which nuclear reactors are located. In fact, few months ago the U.S. Nuclear Regulatory Commission has asked the National Academy of Sciences (NAS) to perform a state-of-the-art study on cancer risk for populations surrounding NPPs.
Minerva pediatrica
To investigate if high dose inhaled beclomethasone dipropionate started early after upper respira... more To investigate if high dose inhaled beclomethasone dipropionate started early after upper respiratory tract infection (URTI) could reduce recurrent wheezing in infants. Twenty-six ambulatory infants, 7-12 months of age, with recurrent wheezing during upper respiratory tract infection participated. All experienced at least three wheezing attacks. Those with underlying lung or systemic disease were excluded. Infants were divided into two groups in an open unblinded manner, until 13 patients had been recruited for each group. The groups were similar in risk factors for recurrent wheezing. Four treatment periods of 5 days were planned for group 1. The dose regimen was nebulized beclomethasone 400 mg by mask tid for 5 days. Treatment was started at the very first sign of URTI prior to any sign of wheezing. Group 2 did not receive any preventive treatment and constituted the control group. Symptoms scores were recorded. The number of emergency room visits, hospital admissions and short courses with oral steroids was also noted. Twelve infants completed 48 treatment periods. Five visited the emergency room, only one during beclomethasone therapy. Six received oral steroids, two receiving beclomethasone. No patient was admitted to the hospital. Symptom scores were significantly lower during beclomethasone treatment (p<0.05). No apparent adverse events were reported. The infant with recurrent wheezing during URTI is a therapeutic challenge. Most of these infants have prodromal symptoms for about 24 hours before wheezing starts. In the present study we observed favorable results, decrease in the number the child wheezed and the number of acute attacks, when high dose inhaled beclomethasone is administered during this critical time.
Minerva pediatrica
The Authors describe the intraosseous administration of drugs and fluids in two patients: a prete... more The Authors describe the intraosseous administration of drugs and fluids in two patients: a preterm infant (gestational age 26 weeks, weight 850 g) with severe cardiopulmonary depression just after delivery, and a 15-day-old newborn with bronchopneumonia. The intraosseous infusion is safe and effective. At present, mainly in United States, it has an important role in pediatric emergency. It is indicated in all emergency situations where a vascular access must be rapidly obtained and in whom other methods of access to the vascular system have failed. After a short review on the history of this old procedure, used for the first time in 1922 for blood transfusions, the Authors describe its physiology, technique, complications, and contraindications.
Pediatric Emergency Care, 1989
Bacteremia is a potentially serious event which must be recognized early and treated aggressively... more Bacteremia is a potentially serious event which must be recognized early and treated aggressively to prevent progression to septicemia and septic shock. The pathophysiology of septicemia and shock includes inadequate tissue perfusion and oxygenation. Expansion of intravascular volume and pharmacologic cardiovascular support are designed to minimize resulting end-organ injury. Initial antibiotic therapy must be individualized and should include an agent or agents active against the common pathogens encountered in the specific clinical setting. Once the causative organism is isolated, therapy is targeted more narrowly. Despite the availability of a variety of newer antibiotics, the morbidity and mortality of septicemia and septic shock remain unacceptably high. Development of new pharmacologic agents active against the mediators of shock may offer future promise.