Angela Spinelli

WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6-9-year-old children.

What is already known about this subject Overweight and obesity prevalence estimates among children based on International Obesity Task Force definitions are substantially lower than estimates based on World Health Organization definitions. Presence of a north–south gradient with the highest level of overweight found in southern European countries. Intercountry comparisons of overweight and obesity in primary‐school children in Europe based on measured data lack a similar data collection protocol.

WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6–9-year-old children from school year 2007/2008 to school year 2009/2010

BackgroundThe World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010.MethodsUsing cross-sectional nationally representative samples of 6−9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses.ResultsAt Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 − 31% of boys and 5 − 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change in mean BMI (range: from −0.4 to +0.3) and BMI-for-age Z-scores (range: from −0.21 to +0.14) varied statistically significantly across countries. The highest significant decrease in BMI-for-age Z-scores was found in countries with higher absolute BMI values and the highest significant increase in countries with lower BMI values. The highest significant decrease in overweight prevalence was observed in Italy, Portugal and Slovenia and the highest significant increase in Latvia and Norway.ConclusionsChanges in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation.

A national survey of the prevalence of childhood overweight and obesity in Italy

To estimate the prevalence of childhood overweight and obesity among Italian schoolchildren and to examine geographic differences and present and future implications for health care, we used data from a nationwide representative survey performed in May 2008 among third‐grade students in 18 of Italys 21 regions. Cluster sampling was used to identify classes for participation. The study population included all children aged 8–9 years whose parents agreed to opt‐out consent. Parents, children and teachers completed brief questionnaires, and children were weighed and measured by trained staff using standardized equipment. Consent was obtained for 97% of 50 197 third‐graders, of whom 44 676 (89%) met study inclusion criteria. Obesity levels (defined using International Obesity Task Force cut‐offs) ranged from 7.5% (95% confidence intervals 6.7–8.2) in the north to 16.6% (95% confidence intervals 15.8–17.4) in the south. Behaviours known to be associated with obesity also showed geographic differences. The estimated burden of obesity‐related pathologies also increased from north to south. These findings suggest the need for community as well as individual interventions in all areas of the country but with particular attention to the south.

Seeking medical help for subfecundity: a study based upon surveys in five European countries * † ‡

OBJECTIVE To study care-seeking behavior for infertility treatment in different European countries. DESIGN Multicenter surveys of randomly selected women in the child bearing age. SETTING Five countries participated in the study: Denmark, Germany, Italy, Poland, and Spain. Data were collected from 1991 to 1993 as part of a concerted action. PATIENTS Population-based samples of women 25 to 44 years of age. The sample sizes ranged from 442 women in Poland to 2,729 in Italy. Participation rates ranged from 54% in Germany to 87% in Denmark. Data were collected by means of a highly structured questionnaire used at a face-to-face interview. MAIN OUTCOME MEASURES Waiting time to pregnancy, time, and type of treatment for infertility. RESULTS Less than half of the infertile couples seek medical help in most European countries. The lowest proportion seeking help was found in Poland and the highest in Denmark. CONCLUSION The increasing demand for infertility treatment is expected to continue, because the potential unmet need is outspoken in most European countries.

Hospitalisation among immigrants in Italy

BackgroundImmigration is increasing in Italy. In 2003, 2.6 million foreign citizens lived in the country; 52% were men and the majority were young adults who migrated for work. The purpose of this study was to investigate differences in hospitalisation between immigrants and the resident population during the year 2000 in the Lazio region.MethodsHospital admissions of immigrants from Less Developed Countries were compared to those of residents. We measured differences in hospitalisation rates and proportions admitted.ResultsAdult immigrants have lower hospitalisation rates than residents (134.6 vs. 160.5 per thousand population for acute care; 26.4 vs. 38.3 for day care). However, hospitalisation rates for some specific causes (injuries, particularly for men, infectious diseases, deliveries and induced abortions, ill-defined conditions) were higher for immigrants than for residents. Immigrants under 18 years seem to be generally healthy; causes of admission in this group are similar to those of residents of the same age (respiratory diseases, injuries and poisoning). The only important differences are for infectious and parasitic diseases, with a higher proportion among immigrant youths.ConclusionThe low hospitalisation rates for foreigners may suggest that they are a population with good health status. However, critical areas, related to poor living and working conditions and to social vulnerability, have been identified. Under-utilisation of services and low day care rates may be partially due to administrative, linguistic, and cultural barriers. As the presence of foreigners becomes an established phenomenon, it is important to evaluate their epidemiological profile, develop instruments to monitor and fulfil their specific health needs and plan health services for a multi-ethnic population.

Adherence to the Mediterranean diet in Italian school children (The ZOOM8 Study)

Abstract The adherence to the Mediterranean diet (MD) of 1740 Italian 8–9-year-olds was evaluated using the KIDMED index and a descriptive analysis of it by socio-demographic and lifestyle factors was performed. Only 5.0% of the children resulted “high” adherers of MD (62.2% “average” and 32.8% “poor”). This scarce adherence was due to a low consumption of fruit, vegetables, legumes, dairy products and a high intake of commercially baked goods for breakfast and sweets. Hindrances to fruit, vegetables and pulses consumption were reported for one-third of the sample. The adherence rates did not differ significantly with BMI and gender. Adherence improved with: having lunch at school; liking lunch at school; breakfast with family; no free access to food; availability of fruit and pulses; liking vegetables; higher maternal education; lower child screen time; population size of place of residence. The results show it is important to improve family food habits and dietary knowledge.

Spontaneous abortion and maternal work in greenhouses.

BACKGROUND A positive association between maternal occupational exposure to pesticide and spontaneous abortion has been reported in some studies. Work in greenhouses may imply exposure of pregnant women to pesticides continuously and at elevated level. METHODS A total of 717 women working in greenhouses provided information on 973 pregnancies, including 110 spontaneous abortions. These pregnancies were classified as exposed or not exposed according to maternal occupation, re-entry activities and application of pesticides in greenhouses during at least 1 month in the first trimester of pregnancy. The ORs for spontaneous abortion were estimated through a generalised estimate equations model for all orders of pregnancy together, and through a logistic regression model limited to first pregnancies. RESULTS Increased risks of spontaneous abortion were found for maternal re-entry activities within 24 hr after pesticides were applied (all orders of pregnancy: OR 3.2, 95% CI 1.3-7.7; first pregnancies: OR 3.8, 95% CI 1.0-13.9) and for those who applied pesticides (all orders of pregnancy: OR 2.6, 95% CI 1.0-6.6; first pregnancies: OR 3.7, 95% CI 0.7-20,6) CONCLUSIONS The observed results support the hypothesis of an association between maternal work in greenhouses and spontaneous abortion. The main limitations of the study are lack of information on the specific chemicals used and the small number of pregnancies heavily exposed to pesticides.

Reducing pain of first trimester abortion under local anaesthesia

The study aimed to estimate the pain related to first trimester abortion under local and general anaesthesia. One hundred and eighty-one women undergoing abortion of first trimester under local anaesthesia and 198 under general anaesthesia were interviewed 1 h after the end of the procedure. About 50% of all women described their experience as less painful than expected. Over 50% of the women described the pain during the procedure as mild or moderate according to the verbal rating scale. The step-up logistic regression analyses identified four important variables: time interval less than 2 min from local anaesthesia injection to the beginning of the procedure (RR = 3), lack of choice between local and general anaesthesia (RR = 1.9), history of frequent use of analgesics (RR = 1.9) and nulliparity (RR = 1.7). These data indicate that skillfully performed abortion with local anaesthesia is a procedure tolerated by most women. Moreover, because it carries lower risk of complications and costs less, its use should be encouraged.

Severe obesity prevalence in 8- to 9-year-old Italian children: a large population-based study

Background and Objectives:Little information is available on severe obesity in childhood. This study estimates the prevalence of severe obesity in 8- to 9-year-old children resident in Italy and its association with gender, age, geographical area and parents’ nutritional status and education using the World Health Organization (WHO) and International Obesity Task Force (IOTF) criteria.Subjects/Methods:A nationally representative sample of grade 3 Italian students was measured in 2010 (N=42 431) using standardized instruments and methodology. Severe obesity in children was assessed using definitions provided by the WHO and by the IOTF. Prevalence was estimated within categories of sociodemographic variables and their independent effects were estimated using multivariate logistic regression.Results:The estimated prevalence of severe obesity in 2010 was 4.5% (95% confidence interval (CI): 4.2–4.7) according to the WHO definition and 2.7% (95% CI: 2.5–2.9) with IOTF cutoffs. These values were slightly lower than those observed in 2008. The prevalence was higher in males, in 8-year-old children and in the South. Parental low education and high body mass index were strongly associated with childhood severe obesity.Conclusion:According to the definition used, between 30 000 and 50 000 children aged 8–9 years suffer severe obesity in Italy.

Genetic amniocentesis: a risk factor for preterm delivery?

OBJECTIVE To determine whether genetic amniocentesis performed in the second trimester of pregnancy is associated with the risk of preterm delivery. STUDY DESIGN Case-control study performed in several departments of obstetrics and gynaecology of nine European countries. Three thousand and ninety-one preterm births and 5298 controls randomly selected from singleton births born at term during 1994-1997 were analysed. Logistic regression models were used to compare preterm births altogether and, separately, spontaneous preterm delivery and induced preterm delivery. RESULTS An increased risk of preterm delivery was found in women having second trimester genetic amniocentesis after taking account of other risk factors and confounding variables (odds ratios (OR)=1.59, 95% confidence intervals (95% CI): 1.31-1.92). The association was statistically significant and similar for spontaneous preterm delivery and induced preterm delivery. CONCLUSION The study shows an association between preterm delivery and genetic amniocentesis. In view of the wide use of amniocentesis, further research on the etiologic role of this prenatal diagnostic technique is needed.