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Objective: this study evaluates the appropriateness of the clinical activities performed during hospitalization of patients with atherosclerosis without complications (Disease-related Group - DRG 133 in the Italian National Health System), at the Policlinico Universitario Federico II, Naples., Design and Setting: coded criteria PRUO - (Protocol for the revision of hospital use) have been used in order to quantify the appropriateness of 94 randomly selected clinical reports for 2001 and 2002. Two independent examiners have evaluated clinical reports, and a supervisor has decided upon the disagreements (majority rule). Appropriateness was rated by tertiles of age and hospital-stay length., Results: global appropriateness was 68%, and increased 93% when it was related to admission days and 64% when was related to the duration of the hospital-stay. Appropriateness of the use of hospital for DRG 133 diagnosis was more frequent for patients older than 70 years and for short duration of hospital stay. Logistic regression has confirmed the trends, indicating a robust statistical significance for the duration of hospital stay but not for age.

Chlorination by-products (CBPs) in drinking water have been associated with an increased risk of adverse pregnancy outcomes, including small for gestational age at term (term-SGA) and preterm delivery. Epidemiological evidence is weakened by a generally inaccurate exposure assessment, often at an ecological level. A case control study with incident cases was performed in nine Italian towns between October 1999 and September 2000. A total of 1,194 subjects were enrolled: 343 preterm births (26th-37th not completed week of pregnancy), 239 term-SGA (from 37th completed week, and weight less than the lowest 10th percentile) and 612 controls. Exposure was assessed both by applying a questionnaire on mothers' personal habits during pregnancy and by water sampling directly at mothers' homes. Levels of trihalomethanes (THMs) were low (median: 1.10 microg l(-1)), while chlorite and chlorate concentrations were relatively high (median: 216.5 microg l(-1) for chlorites and 76.5 microg l(-1) for chlorates). Preterm birth showed no association with CBPs, while term-SGA, when chlorite levels > or =200 microg l(-1) combined with low and high levels of inhalation exposure are considered, suggested a dose-response relationship (adjusted-Odds Ratios (ORs): 1.52, 95%CI: 0.91-2.54 and 1.70, 95%CI: 0.97-3.0, respectively). A weak association with high exposure levels of either THMs (> or =30 microg l(-1)), or chlorite or chlorate (> or =200 microg l(-1)) was also found (adjusted-OR: 1.38, 95%CI: 0.92-2.07). Chlorine dioxide treatment is widespread in Italy; therefore, chlorite levels should be regularly and carefully monitored and their potential effects on pregnancy further evaluated and better understood.

Cesarean deliveries (CS) are increasing in Italy, especially in the Campania region, where they reached a peak incidence of 52% in the year 2000. This study analyses CS rate variability by hospital type, foetal risk factors (low birth-weight, prematurity, plurality, anomalous presentations), maternal characteristics (age and parity) and delivery time. Data are drawn from birth certificates of 31,182 babies, that is 64.2% of all delivered in 65 out of 98 Campania birth-places. 16,251 (52%) babies are born by CS; 559 (1.8%) by operative vaginal delivery. The Attributable Risk for foetal risk factors is 6.9%. In absence of these the CS rate would be 48.5% instead of 52%. CS rate of primigravid women was 53.2%. 63% of CS take place during morning hours and 93% on working days. CS rate is higher in private than in public hospitals (58 vs 46%), though foetal risk factors are lower. Rate of older women was higher in public hospitals, rate of primigravid women was higher in private ones. Campania data confirm the marginal role of foetal risk factors in the increase of CS rate. In order to reduce CS rates it seems reasonable to offer special support to primigravid low risk mothers and to provide behavioural obstetrical guidelines for the peculiar Italian reality.