METHODOLOGICAL ASPECTS IN THE DEVELOPMENT OF THE LIFESTYLE SURVEILLANCE TOOLKIT IN THE ASSO PROJECT

Following the presentation of the ASSO Project, as discussed in the previous issue of JSSL (Tabacchi G. 2011; 1-3: 267-269 ), one of the first objectives of the study is to develop helpful and efficient tools to create a webbased software for the collection of data on adolescent lifestyles. Different methods have been developed and used throughout Europe to collect information on adolescent lifestyles. In order to select the best methods to be used in the ASSO project, a Systematic Literature Review (SLR) on the most valid dietary and physical activity/fitness assessment methods used in the target population has been perfomed. After the SLR and a meta-analysis of the retrieved studies, different tools have been developed within ASSO, in order to create a userfriendly and cost-effective toolkit for the creation of a web-based software for the data collection. A Standard Operating Procedure (SOP) for data collection has been prepared and addressed to all the people involved in the preparation, administration and management of the questionnaires. The SOP has the purpose of standardizing methods and procedures to prevent systematic errors in the collection and reporting of data. Moreover, it is useful to provide reminders and guidelines of the correct way to deal with the information material related to the study, to perform the interviews, to manage the compilation of the questionnaire and to store the collected information. An informative letter on the project and the informed consent to be signed by the parents have been developed. After obtaining the parents’ consent, a list of all the students participating in the study will be prepared and an identification code and a password will be attributed to each student in order to respect the privacy

Southern Italian teenagers: The older they get, the unfit they become with girls worse than boys: A cohort epidemiological study: The adolescents surveillance system for the obesity prevention project (ASSO)

Italy comprises a high proportion of people who never exercised. Low physical activity levels in adolescents is a risk factor for several disorders. The aim of this cohort epidemiological study was to compare physical fitness profiles between boys and girls with regard to age and gender and to identify health and fitness-related markers that contribute to the make-up of Southern Italian teenagers. Eight hundred eleven teenagers were assessed for anthropometric measurements and completed the 5 ASSO-fitness tests battery. Data were analyzed with a 2-way analysis of variance (ANOVA) for repeated measures to compare the effect of both age and gender on the fitness components. The boys' anthropometric measurements were superior than the girls as expected [weight, height, body mass index (BMI), and waist circumference]; the overall BMI was found in the normality range. The overall teenagers' fitness markers were found to be quite poor with the boys outperforming the girls in all fitness tests. The weak cardiorespiratory performance of the female teenagers was remarkable. The under 16 years old (-16 yrs) girls outperformed the over 16 years old (+16yrs) girls. There were less significant differences when comparing (-16) and (+16) yrs old mixed-gender groups. There were no correlations between the (-16) and (+16) yrs when both genders were considered. The trend analysis showed the younger teenagers might be ''catching up'' the older ones in both contexts. Gender significantly influenced all variables. Although age did not influence cardiorespiratory fitness, the older the teenagers the worse their health and fitness markers become with the older girls worse than their younger peers. 1 2017 the Author(s).Funding/support: The Adolescents and Surveillance System for the Obesity prevention (ASSO)Project (code GR-2008-1140742, CUP I85J10000500001), funded by the Italian Ministry of Health.Scopu

Testosterone and aggressiveness.

Aggressiveness is an ancestral behavior common to all animal species. Its neurophysiological mechanisms are similar in all vertebrates. Males are generally more aggressive than females. In this review, aggressive behavior in rodents, monkeys, and man and the role of testosterone and brain serotonin levels have been considered. Interspecifi c aggressiveness in rats has been studied considering the mouse-killing behavior; the neonatal androgenization of females increases adult mousekilling as does the administration of testosterone in adults. Intraspecifi c aggressiveness was studied by putting two or more male rats (or mice) in the same cage; the condition of subjection or dominance is infl uenced by testosterone. In monkeys, testosterone is related to aggressiveness and dominance and, during the mating season, increases in testosterone levels and aggressive attitude are observed. In men, higher testosterone levels were obtained in perpetrators of violent crimes, in men from the army with antisocial behaviors, in subjects with impulsive behaviors, alcoholics and suicidals, in athletes using steroids, and during competitions. Aggressive and dominant behavior are distinguished. Testosterone infl uences both of these, even if man is usually inclined to affi rm his power without causing physical damage. Testosterone receptors are mainly in some hypothalamic neurons, where it is aromatized into estrogens, which determine the increase in aggressiveness. A relation between testosterone levels and diencephalic serotonin has been shown: in fact, the lack of serotonin increases aggressive behaviors both in animals and man. Testosterone also increases ADH levels in the medial amygdala, lateral hypothalamus, and preoptical medial area, involved in aggressive behaviors

Alcohol consumption and hormonal alterations related to muscle hypertrophy: a review

Detrimental effects of acute and chronic alcohol (ethanol) consumption on human physiology are well documented in the literature. These adversely influence neural, metabolic, cardiovascular, and thermoregulatory functions. However, the side effects of ethanol consumption on hormonal fluctuations and subsequent related skeletal muscle alterations have received less attention and as such are not entirely understood. The focus of this review is to identify the side effects of ethanol consumption on the major hormones related to muscle metabolism and clarify how the hormonal profiles are altered by such consumption

A meta-analysis of the validity of FFQ targeted to adolescents

Objective: The present work is aimed at meta-analysing validity studies of FFQ for adolescents, to investigate their overall accuracy and variables that can affect it negatively. Design: A meta-analysis of sixteen original articles was performed within the ASSO Project (Adolescents and Surveillance System in the Obesity prevention). Setting: The articles assessed the validity of FFQ for adolescents, compared with food records or 24 h recalls, with regard to energy and nutrient intakes. Subjects: Pearson’s or Spearman’s correlation coefficients, means/standard deviations, kappa agreement, percentiles and mean differences/limits of agreement (Bland–Altman method) were extracted. Pooled estimates were calculated and heterogeneity tested for correlation coefficients and means/standard deviations. A subgroup analysis assessed variables influencing FFQ accuracy. Results: An overall fair/high correlation between FFQ and reference method was found; a good agreement, measured through the intake mean comparison for all nutrients except sugar, carotene and K, was observed. Kappa values showed fair/moderate agreement; an overall good ability to rank adolescents according to energy and nutrient intakes was evidenced by data of percentiles; absolute validity was not confirmed by mean differences/limits of agreement. Interviewer administration mode, consumption interval of the previous year/6 months and high number of food items are major contributors to heterogeneity and thus can reduce FFQ accuracy. Conclusions: The meta-analysis shows that FFQ are accurate tools for collecting data and could be used for ranking adolescents in terms of energy and nutrient intakes. It suggests how the design and the validation of a new FFQ should be addressed

Factors associated with the subjective health complaints among adolescents: Results from the ASSO Project

Objectives. Subjective health complaints (e.g. headache and feeling low) are common among adolescents. The objective of this study was to identify the factors associated with the subjective health of adolescents from a population-based point of view. Material and methods. A sample of 712 students was recruited within the web-based Project ASSO (Adolescents and Surveillance System for the Obesity prevention), funded by the Italian Ministry of Health and piloted in Palermo. A 0-100 quantitative score (arbitrarily named "psychosomatic malaise index") based on the frequency of occurrence of seven subjective health complaints was created and used as outcome; socio-demographic characteristics, medical items and lifestyle data were collected as potential explanatory variables. Associations were evaluated through a bivariate analysis first, and a multiple linear regression model afterwards by correcting for confounders. Results. The psychosomatic malaise index averaged 49.0 within the girls and 36.8 within the boys. After adjustment, the psychosomatic malaise index was confirmed to be significantly higher in the females, subjects with a diagnosed disease, smokers and alcohol consumers. Conclusions. Beyond the female gender, incorrect lifestyles such smoking and drinking alcohol may play an important role in the quality of life of adolescents, and thus preventive actions by the public health services should be addressed mainly to avoid such habits in young populations. The work has been performed within the Adolescents and Surveillance System for the Obesity prevention (ASSO) Project (code GR-2008-1140742, CUP I85J10000500001), a project funded by the Italian Ministry of Health

How to find information on national food and nutrient consumption surveys across Europe: systematic literature review and questionnaires to selected country experts are both good strategies

The present research was conducted within the framework of the EURopean micronutrient RECommendations Aligned project. in order to identify the best practice in assessing nutrient intakes, a search strategy for collecting data from national food consumption surveys/studies in Europe was developed. Systematic literature searches were carried out on twenty-eight European and the four European Free Trade Association Countries. A questionnaire was also sent to two to five experts in each country. Systematic reviews using PubMed yielded 12 703 abstracts that were reduced to 200 studies using inclusion and exclusion criteria. Similarly, a search of ministry web sites yielded 3033 hits. and subsequently reduced to nine Surveys. Belgium, France, Germany, Ireland, Sweden, Spain and the United Kingdom were the countries with most data and Slovenia and Liechtenstein were those with the least. Seventy-eight expert questionnaires were obtained from all Countries except for Liechtenstein. Luxembourg and Slovakia. Detailed results and references are given. A systematic search and questionnaires are equally good at identifying national surveys across countries. Literature searching provides globally accessible and objective information albeit limited, whereas the questionnaire provides information that, depending upon responders, can be more complete. A combination of both strategies is recommended

Determinants of European parents' decision on the vaccination of their children against measles, mumps and rubella: A systematic review and meta-analysis

Low measles, mumps and rubella (MMR) immunization levels in European children highlight the importance of identifying determinants of parental vaccine uptake to implement policies for increasing vaccine compliance. The aim of this paper is to identify the main factors associated with partial and full MMR vaccination uptake in European parents, and combine the different studies to obtain overall quantitative measures. This activity is included within the ESCULAPIO project, funded by the Italian Ministry of Health. ORs and CIs were extracted, sources of heterogeneity explored and publication bias assessed. Forty-five papers were retrieved for the qualitative study, 26 of which were included in the meta-analysis. The following factors were associated with lower MMR vaccine uptake: misleading knowledge, beliefs and perceptions on vaccines (OR 0.57, CI 0.37-0.87); negative attitudes and behaviors toward vaccination (OR 0.71, CI 0.52-0.98); demographic characteristics, such as different ethnicity in Southern populations (OR 0.44, CI 0.31-0.61), higher child's age (OR 0.80, CI 0.76-0.85); low socio-economic status (OR 0.64, CI 0.51-0.80), especially low income (OR 0.39, CI 0.25-0.60) and education (OR 0.64, CI 0.48-0.84), high number of children (OR 0.54, CI 0.42-0.69), irregular marital status (OR 0.80, CI 0.66-0.96). The factors explaining heterogeneity were country location, administration modality, collection setting and responses reported on MMR alone or in combination. Findings from this study suggest policy makers to focus communication strategies on providing better knowledge, correct beliefs and perceptions on vaccines, and improving attitudes and behaviors in parents; and to target policies to people of ethnic minority from Southern Europe, low educated and deprived, with higher number of children and non-married marital status

How is the adequacy of micronutrient intake assessed across Europe? A systematic literature review

EURopean micronutrient RECommendations Aligned is a network of excellence funded by the European commission, and established to address the problem of differences between countries in micronutrient recommendations as well as to understand how nutritional information including requirements and adequacy of intake is processed among different population groups. The aims of the present paper were to review the methods used for the adequacy assessment of the intake of six micronutrients of public health concern (vitamin A, folate, vitamin B12, Fe, Zn and iodine) in non-European and European nutrition surveys carried out on the apparently healthy population and to compare in particular the adequacy across surveys for folate intake. A systematic literature review was conducted to identify nutrition surveys that assessed micronutrient intake adequacy. The search yielded 9049 records, out of which 337 were eligible for the selected micronutrients. The majority (83·9%) of the European surveys compared the adequacy of the nutrient intake against the Recommended Dietary Allowances (RDA); only a few surveys (8·0%) used the estimated average requirement cut-point method, while none of them used the probability approach. The comparison of folate inadequacy across eight countries revealed that about 25% of the adult female population had inadequate intakes when judged against the different recommendations used by the respective investigators, but nearly 75% had inadequate intakes when compared against the estimated average requirement cut-point value of 320μg/d. The present review showed that different methods were applied across Europe to estimate the adequacy of micronutrient intake, which led to different prevalence estimates of micronutrient inadequac

Design, Implementation, and Evaluation of the Adolescents and Surveillance System for the Obesity Prevention Project

The Adolescents Surveillance System for Obesity prevention (ASSO) Project aimed at developing standardized and web-based tools for collecting data on adolescents’ obesity and its potential determinants. This has been implemented and piloted in the local area of Palermo city, Italy. The aim of the present study is to provide an overview of the Project’s design, implementation, and evaluation, highlighting all the aspects for a potential scale-up of the surveillance system on the whole national territory and abroad, as a sustainable and effective source of data. The overall structure and management, the ASSO-toolkit, the ASSO-NutFit software, and all developed and used procedures for recruiting, training, and data collecting/analyzing are addressed. An interim evaluation has been performed through a feasibility study; a final Project evaluation has been performed reporting the Strengths, Weaknesses, Opportunities, and Threats (SWOT) and the attributes that a surveillance system should have. This article provides a detailed overview of the Project and highlights that ASSO can be considered a valid, logical, coherent, efficient, and sustainable surveillance system that is consistent with countries’ needs and priorities. The system developed by the ASSO Project provides high-quality data and complies with several characteristics typical of a suitable surveillance system. It has a potential of being adopted within the National Health Service and other countries’ Health Services for monitoring adolescents’ obesity and its determinants, such as food intakes, behaviors, physical activity, and fitness profiles