Changes in the Oswestry Disability Index after a 3-week in-patient multidisciplinary body weight reduction program in adults with obesity

The aim of this study was to examine the short-term changes in disability after an inpatient, multidisciplinary body weight reduction program (BWRP) in adults with obesity. A total of 160 individuals (males: 52, females: 108, BMI > 35 kg/m2) hospitalized for a 3-week multidisciplinary BWRP were recruited into the study. Body composition, lower limb muscle power, fatigue severity, and disability were measured at the beginning and end of the intervention by means of bioimpedance analysis, a stair climbing test (SCT), the Fatigue Severity Scale (FSS), and the Oswestry disability index (ODI), respectively. At the end of the 3-week BWRP, an average body weight reduction of 5.0 kg (CI 95% -5.3; -4.6, p < 0.001) was determined, as well as an improvement in all parameters measured. Clinically meaningful reductions in disability were observed in the moderate disability (Δ = -11.8% CI 95% -14.3; -9.3, p < 0.001) and severe disability (Δ = -15.9% CI 95% -19.6; -12.2, p < 0.001) groups. Reductions in disability were explained only by improvements in the SCT (Δ = -2.7 CI 95% -4.1; -1.4, p < 0.001) and the FSS (Δ = -0.3% CI 95% -0.4; -0.1, p < 0.001). These findings demonstrate the importance of incorporating approaches into a BWRP that increase lower limb muscle power and decrease fatigue severity and thus reduce disability in adults with obesity

Hypogonadotropic hypogonadism and pituitary hypoplasia as recurrent features in Ulnar-Mammary syndrome

Ulnar-mammary syndrome (UMS) is characterized by ulnar defects, and nipple or apocrine gland hypoplasia, caused by TBX3 haploinsufficiency. Signs of hypogonadism were repeatedly reported, but the mechanisms remain elusive. We aim to assess the origin of hypogonadism in two families with UMS. UMS was suspected in two unrelated probands referred to an academic center with delayed puberty because of the evident ulnar ray and breast defects in their parents. Clinical, biochemical and genetic investigations proved the existence of congenital normosmic IHH (nIHH) associated with pituitary hypoplasia in the two probands who were heterozygous for novel TBX3 pathogenic variants. The mutations co-segregated with delayed puberty, midline defects (nose, teeth and tongue anomalies) and other variable features of UMS in the two families (absent axillary hairs and nipple hypoplasia, asymmetrical features including unilateral ulnar or renal abnormalities). The combined analysis of these findings and of the previous UMS reports showed delayed puberty and other signs of hypogonadism in 79 and 37% of UMS males, respectively. Proband 1 was followed up to adulthood with persistence of nIHH. In conclusion, UMS should be suspected in patients with delayed puberty and midline defects, including pituitary hypoplasia, in the presence of mild cues for TBX3 mutation, even in the absence of limb malformations. In addition, TBX3 should be included among candidate genes for congenital nIHH

Sports activity limitation during the COVID-19 pandemic in young Italian athletes: impact on mental health in children, adolescents, and young adults

IntroductionThe closure of sports centres was implemented as a preventive measure to mitigate the transmission of SARS-CoV-2. Given the observed global decline in physical activity and concurrent rise in sedentary behaviour, even among younger age groups, a retrospective cross-sectional study was undertaken to evaluate the effects of this measure on mental health in children, adolescents, and young adults during the initial phases of the COVID-19 pandemic.MethodsA total of 1,717 non-professional athletes (age range: 6–25; 53.9% males, 44.6% females) completed an online questionnaire including widely used and validated measures for mental health assessment (SDQ and PGWB-S) and questions regarding sociodemographic characteristics (such as gender), physical activity, and screen time. The association between mental health and sociodemographic characteristics, physical activity, and screen time was evaluated by using univariate and multivariable logistic regression models.ResultsIn children and adolescents, the incidence of psychological difficulties was associated with not being physically active (OR = 1.49; 95% CI: 1.09, 2.07; p = 0.015). Engaging in physical activity during the period of closures, particularly if more than twice a week, was significantly associated with less psychological difficulties for children/adolescents (OR = 0.54; 95% CI: 0.35, 0.82; p = 0.004) and psychological symptoms (i.e., psychological well-being lower than the median) for youth/young adults (OR = 0.25; 95% CI: 0.14, 0.45; p &lt; 0.001). More psychological difficulties were also found in males for children and adolescents (OR = 1.37; 95% CI: 1.06, 1.79; p = 0.018). However, young adult males showed less psychological symptoms than females (OR = 0.35; 95% CI: 0.22, 0.55; p = 0.001). Additionally, a greater amount of screen time was associated with a higher incidence of psychological symptoms in the whole sample.ConclusionsOur results confirm the positive impact of physical activity on mental health during the COVID-19 pandemic among younger age groups. They also provide valuable insights into the risk-benefit relationship of interrupting sports activities as a preventive measure for infectious diseases

Emotional and Behavioral Impairment and Comorbid Eating Disorder Symptoms in Adolescents with Obesity: A Cross-Sectional Study

Background: The current study aims to assess the psychological conditions of Italian adolescents with obesity seeking an in-hospital multidisciplinary body weight reduction program, by exploring their psychological adjustment, emotional states, and co-occurring eating disorder symptoms. Methods: The study involved ninety-two consecutive Italian adolescents with obesity (31 males, 61 females), with a mean age ± SD: 16.4 ± 1.1 years and body mass index (BMI): 38.3 ± 6.04 kg/m2). The Strengths and Difficulties Questionnaire (SDQ), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Eating Attitude Test-26 (EAT-26) were used for the evaluations. Differences between genders, degrees of obesity (Group 1 = BMI SDS 2–2.99 and Group 2: BMI SDS > 3), and those with or without eating disorder symptoms (Group 1: EAT-26 ≤ 20 and Group 2: EAT-26 > 20) were explored. Results: The results showed that females reported higher scores on the Emotional Symptoms, Prosocial Behaviors, Total Difficulties, and Total Impact subscales of the SDQ, the BDI, both subscales of the STAI, and the Bulimia subscales of the EAT-26 than males, independently from the degrees of obesity. Participants with eating disorder symptoms (Group 2: EAT-26 > 20) showed higher scores on the Emotional Symptoms and Total Difficulties subscales of the SDQ, the BDI, and both subscales of the STAI than those of Group 1 (EAT-26 ≤ 20). Conclusions: The study explores the psychological conditions of adolescents with obesity. The results can inform appropriate treatment approaches for the management of obesity in developmental age groups, which not only take into account the medical and physical aspects of obesity, but also the behavioral, emotional, and social difficulties expressed by adolescents, in addition to specific eating disorder symptoms

An algorithm to identify patients with type 2 diabetes among undocumented migrants using data on drug dispensation by charities

An algorithm to identify patients with type 2 diabetes among undocumented migrants using data on drug dispensation by charities. Gianfrancesco Fiorini, Cesare Cerri, Antonello E Rigamonti, Silvia Bini, Nicoletta Marazzi, Alessandro Sartorio, Silvano G. Cella &nbsp; Abstract Background. Electronic databases of chronic diseases are available in many countries. Health data of residents, natives and documented migrants, are thus easily accessible. This does not happen for the growing population of undocumented migrants. Methods. We analysed the databases of two Italian non-governmental organisations (NGOs) containing the records of all drug dispensations to 12,386 undocumented migrants from January 1st, 2013 to December 31st, 2016, with the aim to identify treated for type 2 diabetes (T2D) on the basis of demographic data and dispensed medicines. Medications were identified according to the Anatomical Chemical Therapeutic (ATC) classification. All the patients with at least one dispensation per year of any A10 (antidiabetic) drug were selected. An algorithm to match this observation with the diagnosis of type 2 diabetes mellitus (T2D), on the basis of demographic data and use or not of insulin, was developed. The algorithm was validated in 400 diabetic and 400 non-diabetic patients randomly selected. Results. The algorithm correctly identified all patients (N=660) with T2D. When our patients were grouped according to ethnicity, we found that all ethnic groups contributed a comparable percentage of patients with T2D. Also, no difference was seen between the group of EU citizens living in poverty cared for by the NGOs and any of the ethnic groups. Conclusions. This algorithm can be used to identify patients treated for T2D when no diagnostic codes are available, as is frequently the case with undocumented migrants. Therefore it can be useful for many aspects of public health

Characterizing non-communicable disease trends in undocumented migrants over a period of 10 years in Italy

Abstract Undocumented migrants represent a large part of the population in Countries of the European Union (EU) such as Italy. Their health burden is not fully understood and likely to be related mainly to chronic conditions. Information on their health needs and conditions may help to target public health interventions but is not found in national public health databases. We conducted a retrospective observational study of non-communicable disease (NCD) burden and management in undocumented migrants receiving medical care from Opera San Francesco, a non-governmental organization (NGO) in Milan, Italy. We analyzed the health records of 53,683 clients over a period of 10 years and collected data on demographics, diagnosis and pharmacological treatments prescribed. 17,292 (32.2%) of clients had one or more NCD diagnosis. The proportion of clients suffering from at least one NCD increased from 2011 to 2020. The risk of having an NCD was lower in men than women (RR = 0.88, 95% CI 0.86–0.89), increased with age (p for trend < 0.001) and changed with ethnicity. African and Asian migrants had a lower risk than Europeans of cardiovascular diseases (RR 0.62 CI 0.58–0.67, RR 0.85 CI 0.78–0.92 respectively) and mental health disorders (RR 0.66 CI 0.61–0.71, RR 0.60 CI 0.54–0.67 respectively), while the risk was higher in Latin American people (RR 1.07 CI 1.01–1.13, RR 1.18 CI 1.11–1.25). There was a higher risk of diabetes in those from Asia and Latin America (RR 1.68 CI 1.44–1.97, RR 1.39 CI 1.21–1.60). Overall, migrants from Latin America had the greatest risk of chronic disease and this was true for diabetes, cardiovascular diseases and mental health disorders. Undocumented migrants demonstrate a significantly different health burden of NCDs, which varies with ethnicity and background. Data from NGOs providing them with medical assistance should be included in structuring public health interventions aimed at the prevention and treatment of NCDs. This could help to better allocate resources and address their health needs

Feasibility, Validity, and Reliability of the Italian Pediatric Quality of Life Inventory Multidimensional Fatigue Scale for Adults in Inpatients with Severe Obesity

This study was aimed to examine the feasibility, validity, and reliability of the Italian Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL™ MFS) for adult inpatients with severe obesity