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1. Impact of age on the selection of nuclear cardiology stress protocols: The INCAPS (IAEA nuclear cardiology protocols) study

Author

Al-Mallah, Mh, Pascual, Tnb, Mercuri, M, Vitola, Jv, Karthikeyan, G, Better, N, Dondi, M, Paez, D, Eistein, Aj, Bouyoucef, Se, Allam, Ah, Vangu, M, Rehani, Mm, Kashyap, R, Lele, V, Magboo, Vpc, Mahmarian, Jj, Mut, F, Alexánderson, E, Allam, A, Bom, H, Flotats, A, Jerome, S, Kaufmann, Pa, Luxenburg, O, Mahmarian, J, Shaw, Lj, Underwood, Sr, Amouri, W, Essabbah, H, Gassama, Ss, Makhdomi, Kb, El Mustapha, Gie, El Ouchdi, N, Qaïs, N, Soni, N, Vangu, W, Abazid, Rm, Adams, B, Agarwal, V, Alfeeli, Ma, Alnafisi, N, Bernabe, L, Bural, Gg, Chaiwatanarat, T, Chandraguptha, Jm, Cheon, Gj, Cho, I, Dogan, As, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, H-J, Kalawat, T, Kang, Wj, Keng, F, Klaipetch, A, Kumar, Pg, Lee, J, Lee, Ww, Lim, I, Macaisa, Cmm, Malhotra, G, Mittal, Br, Mohammad, Mh, Mohan, P, Mulyanto, Id, Nariman, D, Nayak, Un, Niaz, K, Nikolov, G, Obaldo, Jm, Ozturk, E, Park, Jm, Park, S, Patel, Cd, Phuong, Hk, Quinon, Ap, Rajini, Tr, Saengsuda, Y, Santiago, J, Sayman, Hb, Shinto, As, Sivasubramaniyan, V, Son, Mh, Sudhakar, P, Syed, Gms, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, Dn, Verma, A, Vutrapongwatana, U, Wang, Y, Won, Ks, Yao, Z, Yingsa-Nga, T, Yudistiro, R, Yue, Kt, Zafrir, N, Adrian, Sc, Agostini, D, Aguadé, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, Mt, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, Dc, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, De Faria, Db, Florimonte, L, Francini, Alberto, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, Del Giudice, E, Halliwell, S, Hansson, Mj, Harrison, C, Homans, F, Horton, F, Jȩdrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, Yh, Lázár, M, Leccisotti, L, Leners, N, Lindner, O, Lipp, Rw, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Mendiguchía, Cg, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, Sa, Romeo, Annunziata, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, Bg, Santos, Ai, Saranovic, S, Sarkozi, A, Schneider, Rp, Sciagra, R, Scotti, S, Servini, Z, Setti, Lr, Starck, S-A., Vajauskas, D, Veselý, J, Vieni, A, Vignati, A, Vito, I. M., Weiss, K, Wild, D, Zdraveska-Kochovska, M, Agüro, Rn, Alvarado, N, Barral, Cm, Beretta, M, Berrocal, I, Batista Cuellar, Jf, Cabral Chang, T-M, Cabrera Rodríguez, Lo, Canessa, J, Castro Mora, G, Claudia, Ac, Clavelo, Gf, Cruz, Af, Faccio, Ff, Fernández, Km, Gomez Garibo, Jr, Gonzalez, U, González, Pe, Guzzo, Ma, Jofre, J, Kapitán, M, Kempfer, G, Lopez, Jl, Massardo, Tv, Medeiros Colaco, I, Mesquita, Ct, Montecinos, M, Neubauer, S, Pabon, Lm, Puente, A, Rochela Vazquez, Lm, Serna Macias, Ja, Silva Pino, Ag, Tártari Huber, Fz, Tovar, Ap, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, Rj, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, Ga, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, Fp, Etherton, E, Fanning, Rj, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, C-L, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, Wh, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, Am, Smith, J, Szulc, Mc, Tanskersley, N, Tilkemeier, P, Valdez, Gd, Vrooman, R, Wawrowicz, D, Winchester, De, Alcheikh, A, Allen, B, Atkins, E, Bevan, J, Bonomini, C, Christiansen, J, Clack, L, Craig, E, Dixson, H, Duncan, I, Fredericks, S, Gales, S, Hampson, R, Hanley, T, Hartcher, K, Hassall, J, Kelley, B, Kelly, S, Kidd, T, De Kort, T, Larcos, G, Macdonald, W, Mcgrath, C, Murdoch, E, O'Malley, S, O'Rourke, M, Pack, M, Pearce, R, Praehofer, R, Ramsay, S, Scarlett, L, Smidt, K, Souvannavong, F, Taubman, K, Taylor, G, Tse, K, Unger, S, and Weale, J

Subjects
Ionizing radiation, Male, medicine.medical_specialty, Cross-sectional study, Cardiology, Guidelines, 030204 cardiovascular system & hematology, Radiation Dosage, Effective dose (radiation), NO, Cohort Studies, 03 medical and health sciences, Myocardial perfusion imaging, Age, 0302 clinical medicine, Internal medicine, Humans, Medicine, 030212 general & internal medicine, Tomography, Age Factors, Aged, Cross-Sectional Studies, Female, Middle Aged, Myocardial Perfusion Imaging, Positron-Emission Tomography, Practice Guidelines as Topic, Radiation Exposure, Retrospective Studies, Tomography, Emission-Computed, Single-Photon, Nuclear Energy, medicine.diagnostic_test, business.industry, Retrospective cohort study, Radiation exposure, Cohort, Emission-Computed, Cardiology and Cardiovascular Medicine, business, Single-Photon, Cohort study
Abstract

There is growing concern about radiation exposure from nuclear myocardial perfusion imaging (MPI), particularly among younger patients who are more prone to develop untoward effects of ionizing radiation, and hence US and European professional society guidelines recommend age as a consideration in weighing radiation risk from MPI. We aimed to determine how patient radiation doses from MPI vary across age groups in a large contemporary international cohort.Data were collected as part of a global cross-sectional study of centers performing MPI coordinated by the International Atomic Energy Agency (IAEA). Sites provided information on each MPI study completed during a single week in March-April 2013. We compared across age groups laboratory adherence to pre-specified radiation-related best practices, radiation effective dose (ED; a whole-body measure reflecting the amount of radiation to each organ and its relative sensitivity to radiation's deleterious effects), and the proportion of patients with ED ≤ 9 mSv, a target level specified in guidelines.Among 7911 patients undergoing MPI in 308 laboratories in 65 countries, mean ED was 10.0 ± 4.5 mSv with slightly higher exposure among younger age groups (trend p value 0.001). There was no difference in the proportion of patients with ED ≤ 9 mSv across age groups, or in adherence to best practices based on the median age of patients in a laboratory.In contemporary nuclear cardiology practice, the age of the patient appears not to impact protocol selection and radiation dose, contrary to professional society guidelines.

Published
2018
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2. Nuclear Cardiology Practices and Radiation Exposure in the Oceania Region: results From the IAEA Nuclear Cardiology Protocols Study (INCAPS)

Author

Biswas, S, Better, N, Pascual, TNB, Mercuri, M, Vitola, JV, Karthikeyan, G, Westcott, J, Alexanderson, E, Allam, AH, Al-Mallah, MH, Bom, HHS, Bouyoucef, SE, Flotats, A, Jerome, S, Kaufman, PA, Lele, V, Luxenburg, O, Mahmarian, JJ, Shaw, LJ, Underwood, SR, Rehani, M, Kashyap, R, Dondi, M, Paez, D, Einstein, AJ, Alcheikh, A, Allen, B, Kelley, B, Bonomini, C, McGrath, C, Atkins, E, Craig, E, Murdoch, E, Souvannavong, F, Larcos, G, Taylor, G, Dixson, H, Duncan, I, Bevan, J, Christiansen, J, Hassall, J, Weale, J, Hartcher, K, Smidt, K, Taubman, K, Tse, K, Clark, L, Scarlett, L, O'Rourke, M, Pack, M, Hampson, R, Pearce, R, Praehofer, R, Fredericks, S, Gales, S, Kelly, S, O'Malley, S, Ramsay, S, Unger, S, de Kort, T, Hanley, T, Kidd, T, Macdonald, W, Magboo, VPC, Mut, F, Meeks, JB, Rehani, MM, Allam, A, Bom, H, Kaufmann, PA, Mahmarian, J, Vitola, J, Amouri, W, Essabbah, H, Gassama, SS, Makhdomi, KB, El Mustapha, GIE, El Ouchdi, N, Qais, N, Soni, N, Vangu, W, Abazid, RM, Adams, B, Agarwal, V, Alfeeli, MA, Alnafisi, N, Bernabe, L, Bural, GG, Chaiwatanarat, T, Chandraguptha, JM, Cheon, GJ, Cho, I, Dogan, AS, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, HJ, Kalawat, T, Kang, WJ, Keng, F, Klaipetch, A, Kumar, PG, Lee, J, Lee, WW, Lim, I, Macaisa, CMM, Malhotra, G, Mittal, BR, Mohammad, MH, Mohan, P, Mulyanto, ID, Nariman, D, Nayak, UN, Niaz, K, Nikolov, G, Obaldo, JM, Ozturk, E, Park, JM, Park, S, Patel, CD, Phuong, HK, Quinon, AP, Rajini, TR, Saengsuda, Y, Santiago, J, Sayman, HB, Shinto, AS, Sivasubramaniyan, V, Son, MH, Sudhakar, P, Syed, GMS, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, DN, Verma, A, Vutrapongwatana, U, Wang, Y, Won, KS, Yao, Z, Yingsa-Nga, T, Yudistiro, R, Yue, KT, Zafrir, N, Adrian, SC, Agostini, D, Aguade, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, MT, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, DC, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, de Faria, DB, Florimonte, L, Francini, A, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, del Giudice, E, Halliwell, S, Hansson, MJ, Harrison, C, Homans, F, Horton, F, Jedrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, YH, Lazar, M, Leccisotti, L, Leners, N, Lindner, O, Lipp, RW, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Mendiguchia, CG, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, SA, Romeo, A, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, BG, Santos, AI, Saranovic, S, Sarkozi, A, Schneider, RP, Sciagra, R, Scotti, S, Servini, Z, Setti, LR, Starck, SA, Vajauskas, D, Vesely, J, Vieni, A, Vignati, A, Vito, IM, Weiss, K, Wild, D, Zdraveska-Kochovska, M, Aguro, RN, Alvarado, N, Barral, CM, Beretta, M, Berrocal, I, Cuellar, JFB, Chang, TMC, Rodriguez, LOC, Canessa, J, Mora, GC, Claudia, AC, Clavelo, GF, Cruz, AF, Faccio, FF, Fernandez, KM, Garibo, JRG, Gonzalez, U, Gonzalez, P, Guzzo, MA, Jofre, J, Kapitan, M, Kempfer, G, Lopez, JL, Massardo, TV, Colaco, IM, Mesquita, CT, Montecinos, M, Neubauer, S, Pabon, LM, Puente, A, Vazquez, LMR, Macias, JAS, Pino, AGS, Huber, FZT, Tovar, AP, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, RJ, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, GA, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, FP, Etherton, E, Fanning, RJ, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, CL, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, WH, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, AM, Smith, J, Szulc, M, Tanskersley, N, Tilkemeier, P, Valdez, GD, Vrooman, R, Wawrowicz, D, Winchester, DE, Dixon, H, and INCAPS Investigators Grp

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Oceania, 030204 cardiovascular system & hematology, Radiation Dosage, Effective dose (radiation), Sievert, 030218 nuclear medicine & medical imaging, NO, 03 medical and health sciences, Myocardial perfusion imaging, Radiation exposure, Aged, Female, Humans, Middle Aged, Myocardial Perfusion Imaging, Radiation Exposure, 0302 clinical medicine, Internal medicine, medicine, medicine.diagnostic_test, business.industry, Radiation dose, Cardiology, Cardiology and Cardiovascular Medicine, business
Abstract

Background There is concern about radiation exposure with radionuclide myocardial perfusion imaging (MPI). This sub-study of the International Atomic Energy Agency (IAEA) Nuclear Cardiology Protocols Study reports radiation doses from MPI, and use of dose-optimisation protocols in Australia and New Zealand (ANZ), and compares them with data from the rest of the world. Methods Data were collected from 7911 MPI studies performed in 308 laboratories worldwide in one week in 2013, including 439 MPI studies from 34 ANZ laboratories. For each laboratory, effective radiation dose (ED) and a quality index (QI) score (out of 8) based on pre-specified "best practices'' was determined. Results In ANZ patients, ED ranged from 0.9-17.9 milliSievert (mSv). Median ED was similar in ANZ compared with the rest of the world (10.0 (IQR: 6.5-11.7) vs. 10.0 (IQR 6.4-12.6, P=0.15), as were mean QI scores (5.5 +/- 0.7 vs. 5.4 +/- 1.3, P= 0.84). Use of stress-only imaging (17.6% vs. 31.8% of labs, P= 0.09) and weight-based dosing of technetium-99m (14.7% vs. 30.3%, P= 0.07) was lower in ANZ compared with the rest of the world but this difference was not statistically significant. Median ED was significantly lower in metropolitan versus nonmetropolitan laboratories (10.1 mSv vs. 11.6 mSv, P < 0.01), although mean QI scores were similar (5.4 +/- 0.8 vs. 5.5 +/- 0.7, P= 0.75). Conclusion Across ANZ, there is variability in ED from MPI, and use of radiation safety practices, particularly between metropolitan and non-metropolitan laboratories. Overall, ANZ laboratories have a similar median ED to laboratories in the rest of the world.

Published
2017

3. Nuclear cardiology practice and associated radiation doses in Europe: results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries

Author

Lindner, O., Pascual, Tn, Mercuri, M, Acampa, W, Burchert, W, Flotats, A, Kaufmann, Pa, Kitsiou, A, Knuuti, J, Underwood, Sr, Vitola, Jv, Mahmarian JJ, Karthikeyan, G, Better, N, Rehani, Mm, Kashyap, R, Dondi, M, Paez, D, Einstein, Aj, INCAPS Investigators Group: Pascual TN, Bouyoucef, Se, Lele, V, Magboo, Vp, Mut, F, Mahmarian, Jj, Meeks, Jb, Alexánderson, E, Allam, A, Al-Mallah, Mh, Bom, H, Jerome, S, Luxenburg, O, Mahmarian, J, Shaw, Lj, Vitola, J, Amouri, W, Essabbah, H, Gassama, Ss, Makhdomi, Kb, El Mustapha GI, El Ouchdi, N, Qaïs, N, Soni, N, Vangu, W, Abazid, Rm, Adams, B, Agarwal, V, Alfeeli, Ma, Alnafisi, N, Bernabe, L, Bural, Gg, Chaiwatanarat, T, Chandraguptha, Jm, Cheon, Gj, Cho, I, Dogan, As, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, Hj, Kalawat, T, Kang, Wj, Keng, F, Klaipetch, A, Kumar, Pg, Lee, J, Lee, Ww, Lim, I, Macaisa, Cm, Malhotra, G, Mittal, Br, Mohammad, Mh, Mohan, P, Mulyanto, Id, Nariman, D, Nayak, Un, Niaz, K, Nikolov, G, Obaldo, Jm, Ozturk, E, Park, Jm, Park, S, Patel, Cd, Phuong, Hk, Quinon, Ap, Rajini, Tr, Saengsuda, Y, Santiago, J, Sayman, Hb, Shinto, As, Sivasubramaniyan, V, Son, Mh, Sudhakar, P, Syed, Gm, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, Dn, Verma, A, Vutrapongwatana, U, Wang, Y, Won, Ks, Yao, Z, Yingsa-nga, T, Yudistiro, R, Yue, Kt, Zafrir, N, Adrian, Sc, Agostini, D, Aguadé, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, Mt, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, Dc, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, de Faria DB, Florimonte, L, Francini, A, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, del Giudice, E, Halliwell, S, Hansson, Mj, Harrison, C, Homans, F, Horton, F, Jędrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, Yh, Lázár, M, Leccisotti, L, Leners, N, Lindner, O, Lipp, Rw, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Mendiguchía, Cg, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, Sa, Romeo, A, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, Bg, Santos, Ai, Saranovic, S, Sarkozi, A, Schneider, Rp, Sciagra, R, Scotti, S, Servini, Z, Setti, Lr, Starck, Så, Vajauskas, D, Veselý, J, Vieni, A, Vignati, A, Vito, Im, Weiss, K, Wild, D, Zdraveska-Kochovska, M, Agüro, Rn, Alvarado, N, Barral, Cm, Beretta, M, Berrocal, I, Batista Cuellar JF, Cabral Chang TM, Cabrera Rodríguez LO, Canessa, J, Castro Mora, G, Claudia, Ac, Clavelo, Gf, Cruz Júnior AF, Faccio, Ff, Fernández, Km, Gomez Garibo JR, Gonzalez, U, E P, González, Guzzo, Ma, Jofre, J, Kapitán, M, Kempfer, G, Lopez, Jl, V T, Massardo, Medeiros Colaco, I, Mesquita, Ct, Montecinos, M, Neubauer, S, Pabon, Lm, Puente, A, Rochela Vazquez LM, Serna Macias JA, Silva Pino AG, Tártari Huber FZ, Tovar, Ap, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, Rj, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, Ga, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, Fp, Etherton, E, Fanning RJ Jr, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, Cl, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, Wh, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, Am, Smith, J, Szulc, M, Tanskersley, N, Tilkemeier, P, Valdez, Gd, Vrooman, R, Wawrowicz, D, Winchester, De, Alcheikh, A, Allen, B, Atkins, E, Bevan, J, Bonomini, C, Christiansen, J, Clack, L, Craig, E, Dixson, H, Duncan, I, Fredericks, S, Gales, S, Hampson, R, Hanley, T, Hartcher, K, Hassall, J, Kelley, B, Kelly, S, Kidd, T, de Kort, T, Larcos, G, Macdonald, W, Mcgrath, C, Murdoch, E, O'Malley, S, O'Rourke, M, Pack, M, Pearce, R, Praehofer, R, Ramsay, S, Scarlett, L, Smidt, K, Souvannavong, F, Taubman, K, Taylor, G, Tse, K, Unger, S, Weale, J., Lindner, Oliver, Pascual, Thomas N. B, Mercuri, Mathew, Acampa, Wanda, Burchert, Wolfgang, Flotats, Albert, Kaufmann, Philipp A, Kitsiou, Anastasia, Knuuti, Juhani, Underwood, S. Richard, Vitola, João V, Mahmarian, John J, Karthikeyan, Ganesan, Better, Nathan, Rehani, Madan M, Kashyap, Ravi, Dondi, Maurizio, Paez, Diana, Einstein, Andrew J., Columbia University Medical Center (CUMC), and Columbia University [New York]

Subjects
INCAPS Investigators Group, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, Computed tomography, Best practice, 030204 cardiovascular system & hematology, Myocardial perfusion scintigraphy, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, Nuclear Medicine and Imaging, Medicine, media_common, medicine.diagnostic_test, Radiation dose, Scientific, General Medicine, 3. Good health, Patient management, Europe, Nuclear Medicine & Medical Imaging, Radiology Nuclear Medicine and imaging, SPECT, Practice Guidelines as Topic, Cardiology, Original Article, Radiology, Societies, Scientific, medicine.medical_specialty, Best practices, 0299 Other Physical Sciences, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, Radiation Dosage, NO, 03 medical and health sciences, Internal medicine, media_common.cataloged_instance, Radiology, Nuclear Medicine and imaging, Medical physics, European Union, Quality of care, European union, Cardiac Imaging Technique, business.industry, Nuclear cardiology, PET, Cardiac Imaging Techniques, Nuclear Medicine, Positron-Emission Tomography, Radiology, Nuclear Medicine and Imaging, 1103 Clinical Sciences, business, Societies, Medical therapy, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Purpose Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis. Methods In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 - 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW). Results Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97.9 % of the patients, and a PET study in 2.1 %. The average effective dose of SPECT was 8.0 +/- 3.4 mSv (RoW 11.4 +/- 4.3 mSv; P < 0.001) and of PET was 2.6 +/- 1.5 mSv (RoW 3.8 +/- 2.5 mSv; P < 0.001). The mean effective doses of SPECT and PET differed between European regions (P < 0.001 and P = 0.002, respectively). The mean quality score was 6.2 +/- 1.2, which was higher than the RoW score (5.0 +/- 1.1; P < 0.001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6.4; P = 0.73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used. Conclusion In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the RoW. There is regional variation in effective dose in relation to the best practice quality score. A possible reason for the differences between Europe and the RoW could be the safety culture fostered by actions under the Euratom directives and the implementation of diagnostic reference levels. Stress-only imaging and weight-adjusted activity might be targets for optimization of European nuclear cardiology practice.

Published
2016
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4. Opportunities for improvement on current nuclear cardiology practices and radiation exposure in Latin America: Findings from the 65-country IAEA Nuclear Cardiology Protocols cross-sectional Study (INCAPS)

Author

Vitola, Jv, Mut, F, Alexanderson, E, Pascual, Tnb, Mercuri, M, Karthikeyan, G, Better, N, Rehani, Mm, Kashyap, R, Dondi, M, Paez, D, Einstein, Aj, Bouyoucef, Se, Allam, Ah, Vangu, M, Magboo, Vpc, Mahmarian, Jj, Allam, A, Bom, H, Flotats, A, Jerome, S, Kaufmann, Pa, Lele, V, Luxenburg, O, Mahmarian, J, Shaw, Lj, Underwood, Sr, Amouri, W, Essabbah, H, Gassama, Ss, Makhdomi, Kb, El Mustapha, Gie, El Ouchdi, N, Qaïs, N, Soni, N, Vangu, W, Abazid, Rm, Adams, B, Agarwal, V, Alfeeli, Ma, Alnafisi, N, Bernabe, L, Bural, Gg, Chaiwatanarat, T, Chandraguptha, Jm, Cheon, Gj, Cho, I, Dogan, As, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, H-J, Kalawat, T, Kang, Wj, Keng, F, Klaipetch, A, Kumar, Pg, Lee, J, Lee, Ww, Lim, I, Macaisa, Cmm, Malhotra, G, Mittal, Br, Mohammad, Mh, Mohan, P, Mulyanto, Id, Nariman, D, Nayak, Un, Niaz, K, Nikolov, G, Obaldo, Jm, Ozturk, E, Park, Jm, Park, S, Patel, Cd, Phuong, Hk, Quinon, Ap, Rajini, Tr, Saengsuda, Y, Santiago, J, Sayman, Hb, Shinto, As, Sivasubramaniyan, V, Son, Mh, Sudhakar, P, Syed, Gms, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, Dn, Verma, A, Vutrapongwatana, U, Wang, Y, Won, Ks, Yao, Z, Yingsa-Nga, T, Yudistiro, R, Yue, Kt, Zafrir, N, Adrian, Sc, Agostini, D, Aguadé, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, Mt, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, Dc, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, De Faria, Db, Florimonte, L, Francini, A, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, Del Giudice, E, Halliwell, S, Hansson, Mj, Harrison, C, Homans, F, Horton, F, Jȩdrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, Yh, Lázár, M, Leccisotti, L, Leners, N, Lindner, O, Lipp, Rw, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Mendiguchía, Cg, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, Sa, Romeo, A, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, Bg, Santos, Ai, Saranovic, S, Sarkozi, A, Schneider, Rp, Sciagra, R, Scotti, S, Servini, Z, Setti, Lr, Starck, S-A, Vajauskas, D, Veselý, J, Vieni, A, Vignati, A, Vito, I. M., Weiss, K, Wild, D, Zdraveska-Kochovska, M, Agüro, Rn, Alvarado, N, Barral, Cm, Beretta, M, Berrocal, I, Batista Cuellar, Jf, Cabral Chang, T-M, Cabrera Rodríguez, Lo, Canessa, J, Castro Mora, G, Claudia, Ac, Clavelo, Gf, Cruz, Af, Faccio, Ff, Fernández, Km, Gomez Garibo, Jr, Gonzalez, U, González, Pe, Guzzo, Ma, Jofre, J, Kapitán, M, Kempfer, G, Lopez, Jl, Massardo, Tv, Medeiros Colaco, I, Mesquita, Ct, Montecinos, M, Neubauer, S, Pabon, Lm, Puente, A, Rochela Vazquez, Lm, Serna Macias, Ja, Silva Pino, Ag, Tártari Huber, Fz, Tovar, Ap, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, Rj, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, Ga, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, Fp, Etherton, E, Fanning, Rj, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, C-L, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, Wh, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, Am, Smith, J, Szulc, Mc, Tanskersley, N, Tilkemeier, P, Valdez, Gd, Vrooman, R, Wawrowicz, D, Winchester, De, Alcheikh, A, Allen, B, Atkins, E, Bevan, J, Bonomini, C, Christiansen, J, Clack, L, Craig, E, Dixson, H, Duncan, I, Fredericks, S, Gales, S, Hampson, R, Hanley, T, Hartcher, K, Hassall, J, Kelley, B, Kelly, S, Kidd, T, De Kort, T, Larcos, G, Macdonald, W, Mcgrath, C, Murdoch, E, O'Malley, S, O'Rourke, M, Pack, M, Pearce, R, Praehofer, R, Ramsay, S, Scarlett, L, Smidt, K, Souvannavong, F, Taubman, K, Taylor, G, Tse, K, Unger, S, and Weale, J

Subjects
best practices, Latin America, Nuclear cardiology, PET, radiation dose, SPECT, Cardiology, Guideline Adherence, Health Care Surveys, Humans, Internationality, Middle Aged, Myocardial Perfusion Imaging, Practice Patterns, Physicians', Quality Assurance, Health Care, Quality Improvement, Radiation Exposure, Radiation Protection, Tomography, Emission-Computed, Utilization Review, medicine.medical_specialty, Latin Americans, Cross-sectional study, Practice Patterns, 030204 cardiovascular system & hematology, Effective dose (radiation), 030218 nuclear medicine & medical imaging, NO, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Radiology, Nuclear Medicine and imaging, Medical physics, Tomography, Physicians', Guideline adherence, business.industry, Radiation dose, Coronary heart disease, Radiation exposure, Health Care, Emission-Computed, Radiation protection, Cardiology and Cardiovascular Medicine, business, Quality Assurance
Abstract

Comparison of Latin American (LA) nuclear cardiology (NC) practice with that in the rest of the world (RoW) will identify areas for improvement and lead to educational activities to reduce radiation exposure from NC. INCAPS collected data on all SPECT and PET procedures performed during a single week in March-April 2013 in 36 laboratories in 10 LA countries (n = 1139), and 272 laboratories in 55 countries in RoW (n = 6772). Eight “best practices” were identified a priori and a radiation-related Quality Index (QI) was devised indicating the number used. Mean radiation effective dose (ED) in LA was higher than in RoW (11.8 vs 9.1 mSv, p

Published
2015

5. Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS)

Author

Einstein, Aj, Pascual, Tn, Mercuri, M, Karthikeyan, G, Vitola, Jv, Mahmarian, Jj, Better, N, Bouyoucef, Se, Hee-Seung Bom, H, Lele, V, Magboo, Vp, Alexánderson, E, Allam, Ah, Al-Mallah, Mh, Flotats, A, Jerome, S, Kaufmann, Pa, Luxenburg, O, Shaw, Lj, Underwood, Sr, Rehani, Mm, Kashyap, R, Paez, D, Dondi, M, INCAPS Investigators Group: Einstein AJ, Alexanderson, E, Allam, A, Bom, H, Mahmarian, J, Vitola, J, Amouri, W, Essabbah, H, Gassama, Ss, Makhdomi, Kb, El Mustapha GI, El Ouchdi, N, Qaïs, N, Soni, N, Vangu, W, Abazid, Rm, Adams, B, Agarwal, V, Alfeeli, Ma, Alnafisi, N, Bernabe, L, Bural, Gg, Chaiwatanarat, T, Chandraguptha, Jm, Cheon, Gj, Cho, I, Dogan, As, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, Hj, Kalawat, T, Kang, Wj, Keng, F, Klaipetch, A, Kumar, Pg, Lee, J, Lee, Ww, Lim, I, Macaisa, Cm, Malhotra, G, Mittal, Br, Mohammad, Mh, Mohan, P, Mulyanto, Id, Nariman, D, Nayak, Un, Niaz, K, Nikolov, G, Obaldo, Jm, Ozturk, E, Park, Jm, Park, S, Patel, Cd, Phuong, Hk, Quinon, Ap, Rajini, Tr, Saengsuda, Y, Santiago, J, Sayman, Hb, Shinto, As, Sivasubramaniyan, V, Son, Mh, Sudhakar, P, Syed, Gm, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, Dn, Verma, A, Vutrapongwatana, U, Wang, Y, Won, Ks, Yao, Z, Yingsa-nga, T, Yudistiro, R, Yue, Kt, Zafrir, N, Adrian, Sc, Agostini, D, Aguadé, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, Mt, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, Dc, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, de Faria DB, Florimonte, L, Francini, A, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, del Giudice, E, Halliwell, S, Hansson, Mj, Harrison, C, Homans, F, Horton, F, Jędrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, Yh, Lázár, M, Leccisotti, L, Leners, N, Lindner, O, Lipp, Rw, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Meeks, Jb, Mendiguchía, Cg, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, Sa, Romeo, A, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, Bg, Santos, Ai, Saranovic, S, Sarkozi, A, Schneider, Rp, Sciagra, R, Scotti, S, Servini, Z, Setti, Lr, Starck, Så, Vajauskas, D, Veselý, J, Vieni, A, Vignati, A, Vito, Im, Weiss, K, Wild, D, Zdraveska-Kochovska, M, Agüro, Rn, Alvarado, N, Barral, Cm, Beretta, M, Berrocal, I, Batista Cuellar JF, Cabral Chang TM, Cabrera Rodríguez LO, Canessa, J, Castro Mora, G, Claudia, Ac, Clavelo, Gf, Cruz Júnior AF, Faccio, Ff, Fernández, Km, Gomez Garibo JR, Gonzalez, U, E P, González, Guzzo, Ma, Jofre, J, Kapitán, M, Kempfer, G, Lopez, Jl, V T, Massardo, Medeiros Colaco, I, Mesquita, Ct, Montecinos, M, Neubauer, S, Pabon, Lm, Puente, A, Rochela Vazquez LM, Serna Macias JA, Silva Pino AG, Tártari Huber FZ, Tovar, Ap, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, Rj, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, Ga, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, Fp, Etherton, E, Fanning RJ Jr, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, Cl, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, Wh, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, Am, Smith, J, Szulc, M, Tanskersley, N, Tilkemeier, P, Valdez, Gd, Vrooman, R, Wawrowicz, D, Winchester, De, Alcheikh, A, Allen, B, Atkins, E, Bevan, J, Bonomini, C, Christiansen, J, Clack, L, Craig, E, Dixson, H, Duncan, I, Fredericks, S, Gales, S, Hampson, R, Hanley, T, Hartcher, K, Hassall, J, Kelley, B, Kelly, S, Kidd, T, de Kort, T, Larcos, G, Macdonald, W, Mcgrath, C, Murdoch, E, O'Malley, S, O'Rourke, M, Pack, M, Pearce, R, Praehofer, R, Ramsay, S, Scarlett, L, Smidt, K, Souvannavong, F, Taubman, K, Taylor, G, Tse, K, Unger, S, and Weale, J.

Subjects
Male, medicine.medical_specialty, Best practices, Cross-sectional study, Cardiology, Global Health, Radiation Dosage, Effective dose (radiation), NO, Myocardial perfusion imaging, Clinical Protocols, Internal medicine, medicine, Humans, Tomography, Nuclear cardiology, PET, Quality of care, Radiation dose, SPECT, Aged, Cross-Sectional Studies, Female, Guideline Adherence, Middle Aged, Myocardial Perfusion Imaging, Positron-Emission Tomography, Practice Guidelines as Topic, Professional Practice, Quality of Health Care, Radiation Exposure, Regression Analysis, Tomography, Emission-Computed, Single-Photon, Cardiology and Cardiovascular Medicine, medicine.diagnostic_test, business.industry, Radiation exposure, Positron emission tomography, Mauriceau–Smellie–Veit maneuver, Observational study, Emission-Computed, business, Single-Photon
Abstract

Aims To characterize patient radiation doses from nuclear myocardial perfusion imaging (MPI) and the use of radiation-optimizing ‘best practices’ worldwide, and to evaluate the relationship between laboratory use of best practices and patient radiation dose. Methods and results We conducted an observational cross-sectional study of protocols used for all 7911 MPI studies performed in 308 nuclear cardiology laboratories in 65 countries for a single week in March–April 2013. Eight ‘best practices’ relating to radiation exposure were identified a priori by an expert committee, and a radiation-related quality index (QI) devised indicating the number of best practices used by a laboratory. Patient radiation effective dose (ED) ranged between 0.8 and 35.6 mSv (median 10.0 mSv). Average laboratory ED ranged from 2.2 to 24.4 mSv (median 10.4 mSv); only 91 (30%) laboratories achieved the median ED ≤ 9 mSv recommended by guidelines. Laboratory QIs ranged from 2 to 8 (median 5). Both ED and QI differed significantly between laboratories, countries, and world regions. The lowest median ED (8.0 mSv), in Europe, coincided with high best-practice adherence (mean laboratory QI 6.2). The highest doses (median 12.1 mSv) and low QI (4.9) occurred in Latin America. In hierarchical regression modelling, patients undergoing MPI at laboratories following more ‘best practices’ had lower EDs. Conclusion Marked worldwide variation exists in radiation safety practices pertaining to MPI, with targeted EDs currently achieved in a minority of laboratories. The significant relationship between best-practice implementation and lower doses indicates numerous opportunities to reduce radiation exposure from MPI globally.

Published
2015

6. Nuclear cardiology practice and associated radiation doses in Europe: results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries

Author

Lindner, O, Pascual, TNB, Mercuri, M, Acampa, W, Burchert, W, Flotats, A, Kaufmann, PA, Kitsiou, A, Knuuti, J, Underwood, SR, Vitola, JV, Mahmarian, JJ, Karthikeyan, G, Better, N, Rehani, MM, Kashyap, R, Dondi, M, Paez, D, Einstein, AJ, Bouyoucef, SE, Lele, V, Magboo, VPC, Mut, F, Meeks, JB, Alexanderson, E, Allam, A, Al-Mallah, MH, Bom, H, Jerome, S, Luxenburg, O, Mahmarian, J, Shaw, LJ, Vitola, J, Amouri, W, Essabbah, H, Gassama, SS, Makhdomi, KB, El Mustapha, GIE, El Ouchdi, N, Qais, N, Soni, N, Vangu, W, Abazid, RM, Adams, B, Agarwal, V, Alfeeli, MA, Alnafisi, N, Bernabe, L, Bural, GG, Chaiwatanarat, T, Chandraguptha, JM, Cheon, GJ, Cho, I, Dogan, AS, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, H-J, Kalawat, T, Kang, WJ, Keng, F, Klaipetch, A, Kumar, PG, Lee, J, Lee, WW, Lim, I, Macaisa, CMM, Malhotra, G, Mittal, BR, Mohammad, MH, Mohan, P, Mulyanto, ID, Nariman, D, Nayak, UN, Niaz, K, Nikolov, G, Obaldo, JM, Ozturk, E, Park, JM, Park, S, Patel, CD, Phuong, HK, Quinon, AP, Rajini, TR, Saengsuda, Y, Santiago, J, Sayman, HB, Shinto, AS, Sivasubramaniyan, V, Son, MH, Sudhakar, P, Syed, GMS, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, DN, Verma, A, Vutrapongwatana, U, Wang, Y, Won, KS, Yao, Z, Yingsa-nga, T, Yudistiro, R, Yue, KT, Zafrir, N, Adrian, SC, Agostini, D, Aguade, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, MT, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, DC, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, de Faria, DB, Florimonte, L, Francini, A, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, del Giudice, E, Halliwell, S, Hansson, MJ, Harrison, C, Homans, F, Horton, F, Jedrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, YH, Lazar, M, Leccisotti, L, Leners, N, Lipp, RW, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Mendiguchia, CG, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, SA, Romeo, A, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, BG, Santos, AI, Saranovic, S, Sarkozi, A, Schneider, RP, Sciagra, R, Scotti, S, Servini, Z, Setti, LR, Starck, S-A, Vajauskas, D, Vesely, J, Vieni, A, Vignati, A, Vito, IM, Weiss, K, Wild, D, Zdraveska-Kochovska, M, Aguro, RN, Alvarado, N, Barral, CM, Beretta, M, Berrocal, I, Cuellar, JFB, Chang, TMC, Rodriguez, LOC, Canessa, J, Mora, GC, Claudia, AC, Clavelo, GF, Junior, AFC, Faccio, FF, Fernandez, KM, Garibo, JRG, Gonzalez, U, Gonzalez, PE, Guzzo, MA, Jofre, J, Kapitan, M, Kempfer, G, Lopez, JL, Massardo, TV, Colaco, IM, Mesquita, CT, Montecinos, M, Neubauer, S, Pabon, LM, Puente, A, Vazquez, LMR, Macias, JAS, Pino, AGS, Huber, FZT, Tovar, AP, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, RJ, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, GA, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, FP, Etherton, E, Fanning, RJ, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, C-L, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, WH, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, AM, Smith, J, Szulc, M, Tanskersley, N, Tilkemeier, P, Valdez, GD, Vrooman, R, Wawrowicz, D, Winchester, DE, Alcheikh, A, Allen, B, Atkins, E, Bevan, J, Bonomini, C, Christiansen, J, Clack, L, Craig, E, Dixson, H, Duncan, I, Fredericks, S, Gales, S, Hampson, R, Hanley, T, Hartcher, K, Hassall, J, Kelley, B, Kelly, S, Kidd, T, de Kort, T, Larcos, G, Macdonald, W, McGrath, C, Murdoch, E, O'Malley, S, O'Rourke, M, Pack, M, Pearce, R, Praehofer, R, Ramsay, S, Scarlett, L, Smidt, K, Souvannavong, F, Taubman, K, Taylor, G, Tse, K, Unger, S, Weale, J, Lindner, O, Pascual, TNB, Mercuri, M, Acampa, W, Burchert, W, Flotats, A, Kaufmann, PA, Kitsiou, A, Knuuti, J, Underwood, SR, Vitola, JV, Mahmarian, JJ, Karthikeyan, G, Better, N, Rehani, MM, Kashyap, R, Dondi, M, Paez, D, Einstein, AJ, Bouyoucef, SE, Lele, V, Magboo, VPC, Mut, F, Meeks, JB, Alexanderson, E, Allam, A, Al-Mallah, MH, Bom, H, Jerome, S, Luxenburg, O, Mahmarian, J, Shaw, LJ, Vitola, J, Amouri, W, Essabbah, H, Gassama, SS, Makhdomi, KB, El Mustapha, GIE, El Ouchdi, N, Qais, N, Soni, N, Vangu, W, Abazid, RM, Adams, B, Agarwal, V, Alfeeli, MA, Alnafisi, N, Bernabe, L, Bural, GG, Chaiwatanarat, T, Chandraguptha, JM, Cheon, GJ, Cho, I, Dogan, AS, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, H-J, Kalawat, T, Kang, WJ, Keng, F, Klaipetch, A, Kumar, PG, Lee, J, Lee, WW, Lim, I, Macaisa, CMM, Malhotra, G, Mittal, BR, Mohammad, MH, Mohan, P, Mulyanto, ID, Nariman, D, Nayak, UN, Niaz, K, Nikolov, G, Obaldo, JM, Ozturk, E, Park, JM, Park, S, Patel, CD, Phuong, HK, Quinon, AP, Rajini, TR, Saengsuda, Y, Santiago, J, Sayman, HB, Shinto, AS, Sivasubramaniyan, V, Son, MH, Sudhakar, P, Syed, GMS, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, DN, Verma, A, Vutrapongwatana, U, Wang, Y, Won, KS, Yao, Z, Yingsa-nga, T, Yudistiro, R, Yue, KT, Zafrir, N, Adrian, SC, Agostini, D, Aguade, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, MT, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, DC, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, de Faria, DB, Florimonte, L, Francini, A, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, del Giudice, E, Halliwell, S, Hansson, MJ, Harrison, C, Homans, F, Horton, F, Jedrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, YH, Lazar, M, Leccisotti, L, Leners, N, Lipp, RW, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Mendiguchia, CG, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, SA, Romeo, A, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, BG, Santos, AI, Saranovic, S, Sarkozi, A, Schneider, RP, Sciagra, R, Scotti, S, Servini, Z, Setti, LR, Starck, S-A, Vajauskas, D, Vesely, J, Vieni, A, Vignati, A, Vito, IM, Weiss, K, Wild, D, Zdraveska-Kochovska, M, Aguro, RN, Alvarado, N, Barral, CM, Beretta, M, Berrocal, I, Cuellar, JFB, Chang, TMC, Rodriguez, LOC, Canessa, J, Mora, GC, Claudia, AC, Clavelo, GF, Junior, AFC, Faccio, FF, Fernandez, KM, Garibo, JRG, Gonzalez, U, Gonzalez, PE, Guzzo, MA, Jofre, J, Kapitan, M, Kempfer, G, Lopez, JL, Massardo, TV, Colaco, IM, Mesquita, CT, Montecinos, M, Neubauer, S, Pabon, LM, Puente, A, Vazquez, LMR, Macias, JAS, Pino, AGS, Huber, FZT, Tovar, AP, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, RJ, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, GA, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, FP, Etherton, E, Fanning, RJ, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, C-L, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, WH, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, AM, Smith, J, Szulc, M, Tanskersley, N, Tilkemeier, P, Valdez, GD, Vrooman, R, Wawrowicz, D, Winchester, DE, Alcheikh, A, Allen, B, Atkins, E, Bevan, J, Bonomini, C, Christiansen, J, Clack, L, Craig, E, Dixson, H, Duncan, I, Fredericks, S, Gales, S, Hampson, R, Hanley, T, Hartcher, K, Hassall, J, Kelley, B, Kelly, S, Kidd, T, de Kort, T, Larcos, G, Macdonald, W, McGrath, C, Murdoch, E, O'Malley, S, O'Rourke, M, Pack, M, Pearce, R, Praehofer, R, Ramsay, S, Scarlett, L, Smidt, K, Souvannavong, F, Taubman, K, Taylor, G, Tse, K, Unger, S, and Weale, J

Abstract

PURPOSE: Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis. METHODS: In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 - 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW). RESULTS: Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97.9 % of the patients, and a PET study in 2.1 %. The average effective dose of SPECT was 8.0 ± 3.4 mSv (RoW 11.4 ± 4.3 mSv; P < 0.001) and of PET was 2.6 ± 1.5 mSv (RoW 3.8 ± 2.5 mSv; P < 0.001). The mean effective doses of SPECT and PET differed between European regions (P < 0.001 and P = 0.002, respectively). The mean quality score was 6.2 ± 1.2, which was higher than the RoW score (5.0 ± 1.1; P < 0.001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6.4; P = 0.73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used. CONCLUSION: In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the RoW. There is regional

Published
2016

8. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study

Author

Angel Carrasco-Sanz, Giorgina Kuli-Lito, Luigi Nigri, Donjeta Bali, Mehmet Vural, Ida Giardino, Julije Meštrović, Tudor Lucian Pop, Maria Teresa Balducci, Pietro Ferrara, Laszlo Losonczi, Massimo Pettoello-Mantovani, Doina Anca Plesca, Giovanni Corsello, Paola Nigri, Leyla Namazova-Baranova, Eli Somekh, and Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P.

Subjects
Male, Child abuse, medicine.medical_specialty, Violence, media_common.quotation_subject, education, Pilot Projects, Pediatrics, Abuse, RJ1-570, Neglect, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, 030225 pediatrics, Perception, Maltreatment, medicine, Humans, Child Abuse, Pediatricians, 030212 general & internal medicine, Child, Physician's Role, Curriculum, media_common, Multiple choice, business.industry, Research, Public health, Child Health, General Medicine, EXPOSE, Europe, Cross-Sectional Studies, Private practice, Family medicine, Female, business
Abstract

BackgroundChild abuse and neglect, or maltreatment, is a serious public health problem, which may cause long-term effects on children’s health and wellbeing and expose them to further adulthood vulnerabilities. Studies on child maltreatment performed in Europe are scarce, and the number of participants enrolled relatively small. The aim of this multi-national European pilot study, was to evaluate the level of understanding and perception of the concepts of child abuse and neglect by European paediatricians working in different medical settings, and the attitude toward these forms of maltreatment in their practice.MethodsThe study was performed by a cross-sectional, descriptive, online survey, made available online to European paediatricians members of 50 national paediatric, who belonged to four different medical settings: hospital, family care, university centres and private practice.The questionnaire, designed as a multiple choice questions survey, with a single answer option consisted of 22 questions/statements. Frequency analyses were applied. Most of the data were described using univariate analysis and Chi-squared tests were used to compare the respondents and answers and a significance level ofp ≤ 0.05 applied.ResultsFindings show that European paediatricians consider the training on child maltreatment currently provided by medical school curricula and paediatric residency courses to be largely insufficient and continuing education courses were considered of great importance to cover educational gaps. Physical violence was recognized by paediatricians mostly during occasional visits with a significant correlation between detecting abuse during an occasional visit and being a primary care paediatrician. Results also showed a reluctance by paediatricians to report cases of maltreatment to the competent judicial authorities.ConclusionsData of this study may provide useful contribution to the current limited knowledge about the familiarity of European paediatricians with child maltreatment and their skills to recognize, manage and contrast abusive childhood experiences in their practice. Finally, they could provide local legislators and health authorities with information useful to further improve public health approaches and rules able to effectively address shared risk and protective factors, which could prevent child abuse and neglect from ever occurring.

Published
2021
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9. Cerebrospinal Fluid Lactate and Glucose Levels as Predictors of Symptomatic Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage.

Author

Messina R, de Gennaro L, De Robertis M, Pop R, Chibbaro S, Severac F, Blagia M, Balducci MT, Bozzi MT, and Signorelli F

Subjects
Humans, Prospective Studies, Lactic Acid, Blood Glucose Self-Monitoring adverse effects, Blood Glucose, Cerebral Infarction complications, Subarachnoid Hemorrhage complications, Subarachnoid Hemorrhage surgery, Brain Ischemia complications, Vasospasm, Intracranial complications
Abstract

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a complex neurovascular syndrome with profound systemic effects associated with high rates of disability and mortality. Delayed cerebral ischemia (DCI), which encompasses all neurobiological events occurring in the subacute-late stage after aSAH, has a complex pathogenesis and can occur in the absence of instrumental vasospasm. Our aim was to assess the correlation between cerebrospinal fluid (CSF) lactate and glucose levels measured on the second or third day after aSAH with clinical deterioration caused by DCI and with 3-month functional outcome., Methods: This prospective study included all aSAH patients admitted between January 2020 and December 2021 who underwent external ventricular drain placement and CSF lactate and glucose measurement., Results: Among 133 aSAH patients, 48 had an external ventricular drain placed and early CSF lactate and glucose assessment. Independent predictors of symptomatic DCI were World Federation of Neurosurgical Societies grade IV-V (adjusted odds ratio [aOR] 25.8, 95% confidence interval [CI] 2.9-649.2, P = 0.012), elevated CSF glucose (aOR 28.8, 95% CI 3.3-775.2, P = 0.010), and elevated CSF lactate (aOR 14.7, 95% CI 1.9-205.7, P = 0.018). The only independent predictor of 3-month functional outcome was occurrence of symptomatic DCI (aOR 0.02, 95% CI 0.0-0.2, P = 0.01)., Conclusions: Elevated CSF lactate and glucose levels in the first 3 days following aSAH were independent predictors of subsequent DCI-related neurological impairment; the presence of instrumental vasospasm was not significantly correlated with DCI after multivariate adjustment. CSF lactate and glucose monitoring may represent a point-of-care test, which could potentially improve prediction of subacute neurological worsening and guide therapeutic choices. Further research with larger prospective cohorts is warranted., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Published
2023
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10. Prevalence of interstitial pneumonia suggestive of COVID-19 at 18 F-FDG PET/CT in oncological asymptomatic patients in a high prevalence country during pandemic period: a national multi-centric retrospective study.

Author

Albano D, Bertagna F, Alongi P, Baldari S, Baldoncini A, Bartolomei M, Boccaletto F, Boero M, Borsatti E, Bruno A, Burroni L, Capoccetti F, Castellani M, Cervino AR, Chierichetti F, Ciarmiello A, Corso A, Cuocolo A, De Rimini ML, Deandreis D, Dottorini ME, Esposito F, Farsad M, Gasparini M, Grana CM, Gregianin M, Guerra L, Loreti F, Lupi A, Martino G, Milan E, Modoni S, Morbelli S, Muni A, Nicolai E, Palumbo B, Papa S, Papaleo A, Pellerito R, Poti C, Romano P, Rossetti C, Rossini P, Rubini G, Ruffini L, Sacchetti G, Savelli G, Schiavariello S, Sciagrà R, Sciuto R, Seregni E, Sestini S, Sicolo M, Spanu A, Storto G, Balducci MT, Trifirò G, Versari A, Vignati A, Volterrani D, Calcagni ML, Marzola MC, Garufo A, Evangelista L, Maroldi R, Schillaci O, and Giubbini R

Subjects
Fluorodeoxyglucose F18, Humans, Italy, Pandemics, Positron Emission Tomography Computed Tomography, Prevalence, Retrospective Studies, SARS-CoV-2, COVID-19, Lung Diseases, Interstitial diagnostic imaging, Lung Diseases, Interstitial epidemiology
Abstract

Purpose: To assess the presence and pattern of incidental interstitial lung alterations suspicious of COVID-19 on fluorine-18-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) ([ 18 F]FDG PET/CT) in asymptomatic oncological patients during the period of active COVID-19 in a country with high prevalence of the virus., Methods: This is a multi-center retrospective observational study involving 59 Italian centers. We retrospectively reviewed the prevalence of interstitial pneumonia detected during the COVID period (between March 16 and 27, 2020) and compared to a pre-COVID period (January-February 2020) and a control time (in 2019). The diagnosis of interstitial pneumonia was done considering lung alterations of CT of PET., Results: Overall, [ 18 F]FDG PET/CT was performed on 4008 patients in the COVID period, 19,267 in the pre-COVID period, and 5513 in the control period. The rate of interstitial pneumonia suspicious for COVID-19 was significantly higher during the COVID period (7.1%) compared with that found in the pre-COVID (5.35%) and control periods (5.15%) (p < 0.001). Instead, no significant difference among pre-COVID and control periods was present. The prevalence of interstitial pneumonia detected at PET/CT was directly associated with geographic virus diffusion, with the higher rate in Northern Italy. Among 284 interstitial pneumonia detected during COVID period, 169 (59%) were FDG-avid (average SUVmax of 4.1)., Conclusions: A significant increase of interstitial pneumonia incidentally detected with [ 18 F]FDG PET/CT has been demonstrated during the COVID-19 pandemic. A majority of interstitial pneumonia were FDG-avid. Our results underlined the importance of paying attention to incidental CT findings of pneumonia detected at PET/CT, and these reports might help to recognize early COVID-19 cases guiding the subsequent management.

Published
2021
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11. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study.

Author

Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, and Ferrara P

Subjects
Child, Cross-Sectional Studies, Europe, Female, Humans, Male, Pilot Projects, Surveys and Questionnaires, Child Abuse prevention & control, Child Health, Pediatricians, Physician's Role
Abstract

Background: Child abuse and neglect, or maltreatment, is a serious public health problem, which may cause long-term effects on children's health and wellbeing and expose them to further adulthood vulnerabilities. Studies on child maltreatment performed in Europe are scarce, and the number of participants enrolled relatively small. The aim of this multi-national European pilot study, was to evaluate the level of understanding and perception of the concepts of child abuse and neglect by European paediatricians working in different medical settings, and the attitude toward these forms of maltreatment in their practice., Methods: The study was performed by a cross-sectional, descriptive, online survey, made available online to European paediatricians members of 50 national paediatric, who belonged to four different medical settings: hospital, family care, university centres and private practice. The questionnaire, designed as a multiple choice questions survey, with a single answer option consisted of 22 questions/statements. Frequency analyses were applied. Most of the data were described using univariate analysis and Chi-squared tests were used to compare the respondents and answers and a significance level of p ≤ 0.05 applied., Results: Findings show that European paediatricians consider the training on child maltreatment currently provided by medical school curricula and paediatric residency courses to be largely insufficient and continuing education courses were considered of great importance to cover educational gaps. Physical violence was recognized by paediatricians mostly during occasional visits with a significant correlation between detecting abuse during an occasional visit and being a primary care paediatrician. Results also showed a reluctance by paediatricians to report cases of maltreatment to the competent judicial authorities., Conclusions: Data of this study may provide useful contribution to the current limited knowledge about the familiarity of European paediatricians with child maltreatment and their skills to recognize, manage and contrast abusive childhood experiences in their practice. Finally, they could provide local legislators and health authorities with information useful to further improve public health approaches and rules able to effectively address shared risk and protective factors, which could prevent child abuse and neglect from ever occurring.

Published
2021
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12. [The health determinants in young children: testing a new surveillance system in Italy].

Author

Pizzi E, Spinelli A, Battilomo S, Azzarito C, Balducci MT, Bettinelli ME, Campostrini S, Germinario C, Mazzarella G, Mignuoli AD, Morbidoni M, Porchia S, Simeoni L, and Speri L

Subjects
Child, Preschool, Humans, Infant, Italy, Child Health, Population Surveillance
Abstract

In recent years, the scientific community has stressed the need to invest in the first 1,000 days of life - the time spanning between conception and the 2nd birthday - because it is during this period that the foundations of health are laid and whose effects will be present throughout the life and may influence the next generation. Taking this into account, in 2013 the National Centre for Disease Prevention and Control (CCM) of the Italian Ministry of Health promoted and financed a project to test a surveillance system of the main determinants of health concerning the child between the conception period and the 2nd years of life which are included in the National Programme "GenitoriPiù": folic acid before and during pregnancy, abstention from tobacco and alcohol during pregnancy and lactation, breastfeeding, infant sleep position, vaccination attitude, and early reading. The Project, started in January 2014 and ended in August 2016, has piloted the design, testing, and evaluation of the surveillance system with the view to national extension and the repeatability over time. The surveillance system has been designed to collect data through a questionnaire compiled by mothers in vaccination centres, in order to produce indicators which will enable territorial and intertemporal comparisons to be made. The project has shown the feasibility of this system, identifying favourable conditions and possible difficulties, and its ability to collect important information on children's health.

Published
2019
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