BMI from nutritional surveillance of 8-9 years old children in Tuscany (Italy)

Introduction. The latest increase in childhood obesity focused attention on the important consequences that this phenomenon may have on public health in relationship to the increasing risk that an obese child may become an obese adult. To deal with this problem, there is necessary to assess systematically the distribution of childhood nutritional status at different levels: international, regional and local. In this paper are presented data on underweight, overweight and obesity prevalence in third grade primary school children, aged 8/9 years in Tuscany (2008) and its distribution in relationship to the demographic breadth of their place of residence. Methods. Data from statistic sample of 2109 (1.091 males, 1.018 females), 8/9 years school-children were collected; weight and height were measured using standardised personnel and instruments. Exact month age was calculated between the data of measurement and that of birth. Body Mass Index (BMI) classes were calculated using Cole et al.?s epidemiologic cut-off for children and adolescents. Residence areas were divided into four classes based on the number of inhabitants ( inf. 10.000; 10.000-50.000; > 50.000; > 50.000 metropolitan). Results. The prevalence of underweight was 0.88% (0.76% in males and 1.01% in females), the prevalence of overweight was 23.43% (22.33% in males and 24.65% in females), the prevalence of obese was 7.95% (9.08% in males, 6.70% in females). The lowest prevalence of obese (6.46%) was found in towns with over 50.000 residents (metropolitan). Conclusion. The obesity prevalence in Tuscany children is still lower than that of the Italian National Survey, while the overweight prevalence it?s the same. Obesity prevalence (10.71%) is higher in municipalities with low residents number ( inf. 10.000)

Correlation between physical activity and sedentary behavior with healthy and unhealthy behaviors in Italy and Tuscan region: a cross sectional study

Introduction. Regular physical activity (PA) has associated with various positive health aspects such as a decreased risk of chronic or generic illnesses, furthermore, a sedentary lifestyle has been asso- ciated with health problems such as obesity. To examine the rela- tionship between patterns of PA, screen-based media use (SBM) and social health indicators within a specific demographic group and highlight the regional vs. national differences in these relationships. Methods. The data is drawn from the Health Behaviour in School-Aged Children (HBSC) database, a national cross-sec- tional survey in a representative sample (N = 3920) of students aged 11-13-15 years and compared to those of the Tuscan region (N = 3381). Variables considered other than PA and SBM use includes positive health indicators such as physical health status, quality of family and peer relationships, fruit consumption, break- fast consumption as well as negative health indicators, such as health complaints, smoking and alcohol use. Results. Some positive health indicators showed a positive cor- relation with PA. Students adopting healthy behaviours often met the Physical Activity Guide Line (PAGL). On the contrary, negative health indicators were associated with PAGL in a neg- ative way. In general SBM was positively related to several of the negative health indicators and vice versa. SBM was related in a positive fashion to tobacco use that repre- sents a protective factor. Discussion. The results show that met PAGL is associated with positive health indicators and that high levels of SBM use is asso- ciated with negative health indicators. The study also emphasizes the relationship between PA, SBM use and social factors. Increas- ing PA and decreasing SBM use should be an aim in general health behaviour promotion

Underweight and overweight among children and adolescents in Tuscany (Italy). Prevalence and short-term trends

Introduction. The recent increase in both childhood obesity and adolescent anorexia nervosa in developed countries has under-lined the important consequences that these trends may have on public health, as there is an increased risk that these conditions may become chronic diseases in adulthood. Therefore, it is necessary to monitor prevalence rates and trends in thinness and overweight (including obesity) among children and adolescents at different levels: international, national and sub-national. Since 2001/2002, a nutritional surveillance system has been implemented in the Tuscany Region to estimate the nutritional status and lifestyles of children and adolescents. The main objectives were to assess the prevalence of thinness, overweight and obesity among Tuscan children and adolescents and to provide baseline information on the prevalence of thinness, for the first time calculated according to the new international definitions, for geographical comparisons and descriptions of time trends. Methods. Independent cross-sectional sample surveys were conducted in 2002, 2004 and 2006 in Tuscany, North-Central Italy. Data were collected from stratified two-stage cluster samples of children aged 9 years (n = 3,048 in 2002 and n = 1,430 in 2006) and of adolescents aged 11-13-15 years (n = 1,066, n = 1185 and n = 1,160 in 2004 and n = 1,189, n = 1,211 and n = 1,178 in 2006, respectively). Weights and heights of primary school children were measured by means of standardized methods, while those of adolescents were self-reported. Decimal age was calculated from the date of birth to the date of measurement. Body Mass Index classes were calculated according to the International Obesity Task Force standards. Instead of the term underweight in children, we used the term thinness, which the World Health Organization uses to mean low Body Mass Index for age in adults and adolescents. According to Cole?s recently published cut-offs for thinness, we divided our Body Mass Index values below 18.5 into three grades. Results. This study presents data on the prevalence of different grades of nutritional status (thinness, normal weight, overweight and obesity) among Tuscan school-aged children from primary to high school (9-11-13-15-y-old), assessed by means of Body Mass Index, according to international definitions. From 2002 to 2006 the prevalence of thinness among children aged 9 years decreased from 4.6% to 4.2%, and the prevalence of normal weight from 63.7% to 62.4%; the prevalence of overweight (including obesity) rose from 31.7% to 33.4%. From 2004 to 2006, among pre-adolescents aged 11 years, the prevalence of thinness declined from 11.0% to 10.1%; the prevalence of normal weight rose from 68.4% to 70.2%, and the prevalence of overweight declined from 20.7% to 19.6%. Among adolescents aged 13 years, the prevalence of thinness declined from 9.8% to 8.0%; the prevalence of normal weight rose from 73.5% to 74.0%, and the prevalence of overweight from 16.8% to 17.9%. Among adolescents aged 15 years, the prevalence of thinness declined from 9.8% to 8.7%, and the prevalence of normal weight from 77.0% to 71.6%, while the prevalence of overweight rose from 13.3% to 19.7%. The 2006 data showed that the trend in the prevalence of overweight (including obesity) tended to decrease with age for both sexes, though more markedly in girls (from 34.0% at 9-y of age to 12.2% at 15-y of age) than in boys (from 32.8% at 9-y of age to 22.8% at 13-y of age to 27.5% at 15-y of age). By contrast, the prevalence of thinness increased with age in girls (from 4.9% at 9-y of age to 14,1% at 15-y of age), while boys presented a similar low prevalence at 9 and 15-y of age (3.3% and 3.1%), doubling the values at 11 and 13-y of age (7.5% and 6.5%). The trend in the prevalence of normal weight increased with age from 62.4% at 9-y of age to 74.0% at 13-y of age and to 71.6% at 15-y of age. Boys displayed a higher prevalence than girls only at 9-y of age (63.9% vs. 61.0%). Discussion. The results of this study allow us to analyze data from the nutritional surveillance system in Tuscany using recent definitions of Body Mass Index cut-off points among children, pre-adolescents and adolescents. As a rule, the trend in the prevalence of overweight (including obesity) among girls from 9-y to 15-y-old strongly decreased, while the prevalence of thinness increased. In boys, this decrease was less marked and the prevalence of thinness displayed an irregular trend, with an increment from 9-y to 11-y-old and a decrease from 13-y to 15-y old. The trend in the prevalence of normal weight increased with age, with a higher prevalence among boys than girls

Evaluation of maternal perception of children's weight and Body Mass Index in Tuscany, Italy

Background: The prevention of overweight is a high-priority public health task. The perception that parents have of their children’s nutritional status is a well recognized risk factor for obesity in children, so the aim of our study was to evaluate mothers’ perceptions of their children’s nutritional status. Methods: We conducted, in 2016, a cross-sectional study enrolling1710 children (third grade of all primary schools ) in Tuscany, as well as their mothers. Mothers’ information were collected through a self-administered questionnaire, while children (weighed and measured) filled a questionnaire under the supervision of qualified personnel. Results: 1449 children completed the questionnaire. 74.12% of mothers were able to correctly identify children BMI. The non correct classification tends to significantly decrease in presence of a high educational level compared to low educational level. Mothers’ BMI seems to not be associated with misclassification. The non correct classification was significantly associated with mothers’ opinion about their children’s eating habit. Conclusion: Our data confirmed that, in Tuscany, a limited percentage of mothers tend to misclassify the nutritional state of their children, but in order to maintain these encouraging results, further efforts should be done in order to make all mothers able to correctly evaluate their children. Statements:Authors declare no conflict of interest. The study was conducted according to the criteria set by the declaration of Helsinki and each subject signed an informed consent before participating to the study. Approval of the protocol was obtained from the institutional review board of the National Institute of Health, including the use of opt-out consent; that is, parents could refuse participation but the lack of a returned form was taken to imply consent to their child’s participation

Nutritional surveillance in Tuscany: maternal perception of nutritional status of 8-9 y-old school-children

Introduction. Overweight and obesity in the developmental age has become a public health problem. For this reason, prevention projects must be developed in advance with the aim to involve not only children, but their parents as well. Our objective is to evaluate the accuracy of the mothers? perceptions of adolescent nutritional status. Methods. Cross-sectional study. We selected a statistical sample of 3,076 subjects (1,583 males, 1,493 females), 8-9 y-old school-children of 164 3rd-grade elementary school classes from throughout Tuscany, as well as their mothers. The mothers? information was gathered via self-administered questionnaires, while the children were given an eating behaviour survey under the supervision of qualified personnel. Mothers? education level (self-reported) height and weight were collected; children?s height and weight were measured. The former were asked how they perceived their children?s body image. Results. A correlation exists between the mothers? perceptions of the nutritional state of their children via the silhouettes and the BMI classes of the children, which is equal to 80% with a k-Cohen for agreement equal to 0.58 (SE = 0.02; P : 0.0001). However, no correlation exists between the mothers? responses to the question ?In your opinion, is your child ??? and the child?s actual BMI class (the exact percentage correlation is equal to 75%, with a k-Cohen for agreement equal to 0.43 SE = 0.014; P : 0.0001). Discussion. Mothers have an accurate perception of the nutritional status of their children, correctly choosing the silhouette that corresponds to the child?s BMI profile without variation by gender. We can assume that mothers in our sample have a good concept about healthy nutritional status

Selection of reference genes for quantitative RT-PCR studies in striped dolphin (Stenella coeruleoalba) skin biopsies

BACKGROUND: Odontocete cetaceans occupy the top position of the marine food-web and are particularly sensitive to the bioaccumulation of lipophilic contaminants. The effects of environmental pollution on these species are highly debated and various ecotoxicological studies have addressed the impact of xenobiotic compounds on marine mammals, raising conservational concerns. Despite its sensitivity, quantitative real-time PCR (qRT-PCR) has never been used to quantify gene induction caused by exposure of cetaceans to contaminants. A limitation for the application of qRT-PCR is the need for appropriate reference genes which allow the correct quantification of gene expression. A systematic evaluation of potential reference genes in cetacean skin biopsies is presented, in order to validate future qRT-PCR studies aiming at using the expression of selected genes as non-lethal biomarkers. RESULTS: Ten commonly used housekeeping genes (HKGs) were partially sequenced in the striped dolphin (Stenella coeruleoalba) and, for each gene, PCR primer pairs were specifically designed and tested in qRT-PCR assays. The expression of these potential control genes was examined in 30 striped dolphin skin biopsy samples, obtained from specimens sampled in the north-western Mediterranean Sea. The stability of selected control genes was determined using three different specific VBA applets (geNorm, NormFinder and BestKeeper) which produce highly comparable results. Glyceraldehyde-3P-dehydrogenase (GAPDH) and tyrosine 3-monooxygenase (YWHAZ) always rank as the two most stably expressed HKGs according to the analysis with geNorm and Normfinder, and are defined as optimal control genes by BestKepeer. Ribosomal protein L4 (RPL4) and S18 (RPS18) also exhibit a remarkable stability of their expression levels. On the other hand, transferrin receptor (TFRC), phosphoglycerate kinase 1 (PGK1), hypoxanthine ribosyltransferase (HPRT1) and β-2-microglobin (B2M) show variable expression among the studied samples and appear as less suitable reference genes for data normalization. CONCLUSION: In this work, we have provided essential background information for the selection of control genes in qRT-PCR studies of cetacean skin biopsies, as a molecular technique to investigate ecotoxicological hazard in marine mammals. Of 10 HKGs tested, those encoding for YWHAZ and GAPDH appear as the most reliable control genes for the normalization of qRT-PCR data in the analysis of striped dolphin skin biopsies. Potentially useful reference genes are also those encoding for ribosomal proteins L4 and S18

Waiting times for prostate cancer: a review

Prostate cancer is one of the most common diagnosed cancer in men and the waiting time has become an important issue not only for clinical reasons, but mostly for the psychological implications on patients. The aim of our study was to review and analyze the literature on waiting times for prostate cancer. In February-March 2019 we performed a search for original peer-reviewed papers in the electronic database PubMed (MEDLINE). The key search terms were “prostate cancer AND waiting list”, “prostate cancer AND waiting times”. We included in our narrative review articles in Italian, English or French, published in 2009-2019 containing original data about the waiting times for prostate cancer. The literature search yielded 680 publications. Finally, we identified 8 manuscripts eligible for the review. The articles were published between 2010 and 2019; the studies involved a minimum of 16 to a maximum of 95,438 participants. Studies have been conducted in 6 countries. The waiting times from cancer suspicion to histopathological diagnosis and to treatment had an important reduction in the last years, and this constant decrease could lead to an increase of patients' satisfaction

Accreditation and Quality in the Italian National Health Care System: a 10 years long review

  Background: Italian accreditation and OECI accreditation are recognized as tools to ensure an adequate level of quality in healthcare setting. The aim of our study was to review the scientific literature about these topics looking for original experiences of accreditation.  Methods: In March-April 2019 we conducted a search on original peer-reviewed papers in the electronic database PubMed (MEDLINE). The key search terms were “accreditation AND Italy”, “hospital accreditation AND Italy”. We looked for studies published between 2009 and 2019, reporting information about Accreditation experiences. 13.  Results: The literature search yielded 562 publications. Finally, we identified 16 manuscripts eligible for the review. The studies were published between 2010 and 2016; they were conducted from 2007 to 2015; they involved a minimum of 1 to a maximum of 183 centres located in different Italian regions and cities. They concerned different fields such as oncology, haematology, health physics, health direction, paediatrics, and surgery. Accreditation led to a general enhancement of quality, and offered suggestions for further improvement.  Conclusion: Each healthcare system should achieve the best possible levels of quality and safety.  Accreditation, combined with further strategies could ensure the highest level of quality