Giovanni Baglio

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.

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.

Food consumption and nutrient intake in Italian school children: results of the ZOOM8 study

Abstract The food consumption and food habits of Italian third-class-primary-school children were assessed and their energy and nutrient intakes were compared with requirements. The study involved 1740 subjects (900 males and 840 females) aged 8–9 years, from the north, centre and south of Italy. Body weight and height were measured. Parents filled in a semi-quantitative Food Frequency Questionnaire for their child. The results showed that the diet of Italian children is unbalanced in terms of macronutrients and deficient in fiber. The average daily intakes of fruit (234 g/d), vegetables (134 g/d) and legumes (17 g/d), were lower than the nationally recommended ones. The percentages of energy intake from fats (41%) and from carbohydrates (45%) were higher and lower respectively than recommended. Low intakes of fiber (13.5 g/d) were reported. A national nutrition policy in Italy should focus on nutrition education programs in schools and for parents.

Dressed or undressed? How to measure children's body weight in overweight surveillance?

OBJECTIVE To simplify body weight measurement and, particularly, to encourage children and their parents to participate in the Italian nutritional surveillance system OKkio alla SALUTE, children were measured with clothes and then the weight was corrected for the estimated weight of the clothes. In the present study we compared the childrens weight measured in underwear, as recommended by the WHO (WWHO), with that obtained using the OKkio alla SALUTE protocol (WOK) and investigated how the latter affects the calculation of BMI and the assessment of overweight and obesity prevalence. DESIGN Weight (twice in close sequence, with and without clothing) and height were measured. A checklist was used to describe the type of clothing worn. The estimated weight of clothing was subtracted from the WOK. BMI was calculated considering both values of weight and height; ponderal status was defined using both the International Obesity Task Force and WHO BMI cut-offs. SETTING Thirty-seven third grade classes of thirteen primary schools in Rome and in two towns in the Lazio Region were recruited. SUBJECTS The anthropometric measurements were taken on 524 children aged 8-9 years. RESULTS The error in the calculation of BMI from WOK was very low, 0·005 kg/m2 (95 % CI -0·185, 0·195 kg/m2); the agreement between the percentages of overweight (not including obesity) and obese children calculated with the two methods was very close to 1 (κ = 0·98). CONCLUSIONS The error in BMI and in nutritional classification can be considered minor in a surveillance system for monitoring overweight/obesity, but eases the procedure for measuring children.

Immigrants’ health protection: political, institutional and social perspectives at international and Italian level

The issue of “immigrants’ health” has been the subject of increasing interest in recent years, both in scientific literature and in the declarations of international health institutions. Specifically, the Resolution of the 61st World Health Assembly (2008), and the Report of the European Parliament on the reduction of the inequalities in health within EU (2010) are worth highlighting. There is a clear convergence in the orientations recommended to local Governments regarding the health policies and interventions to be adopted in this sector. It may be stated that the health policies adopted in Italy in the 1980s have been pioneering in both European and international contexts. Enhanced by the unconditional recognition of the right to health, which is stated in the Italian Constitution, these orientations have been strongly suggested to the policymakers through effective lobbying efforts. Alongside ethical-legal recognition of the right to healthcare, the technical-scientific debate has also developed, especially following the publication of the WHO Report “Closing the gap in a generation” (2008). This has enabled the acknowledgement of the relevant role played by the socio-economic conditions which distinguish the different groups of immigrants. Moreover, the proposal of inter-sectorial policies and of an approach aimed at the empowerment of the community has become increasingly significant. In future, health protection for immigrants will be not only a priority as imposed by the recognition of health as a human right, but will also be more closely connected to capacities for the planning and support, at local level, of health promotion initiatives.

Work-related health problems among resident immigrant workers in Italy and Spain

Background : in both Spain and Italy the number of immigrants has strongly increased in the last 20 years, currently representing more than the 10% of workforce in each country. The segregation of immigrants into unskilled or risky jobs brings negative consequences for their health. The objective of this study is to compare prevalence of work-related health problems between immigrants and native workers in Italy and Spain. Methods : data come from the Italian Labour Force Survey (n=65 779) and Spanish Working Conditions Survey (n=11 019), both conducted in 2007. We analyzed merged datasets to evaluate whether interviewees, both natives and migrants, judge their health being affected by their work conditions and, if so, which specific diseases. For migrants, we considered those coming from countries with a value of the Human Development Index lower than 0.85. Logistic regression models were used, including gender, age, and education as adjusting factors. Results : migrants reported skin diseases (Mantel-Haenszel pooled OR=1.49; 95%CI: 0.59-3.74) and musculoskeletal problems among those employed in agricultural sector (Mantel-Haenszel pooled OR=1.16; 95%CI: 0.69-1.96) more frequently than natives; country-specific analysis showed higher risks of musculoskeletal problems among migrants compared to the non-migrant population in Italy (OR=1.17; 95% CI: 0.48-1.59) and of respiratory problems in Spain (OR=2.02; 95%CI: 1.02-4.0). In both countries the risk of psychological stress was predominant among national workers. Conclusions : this collaborative study allows to strength the evidence concerning the health of migrant workers in Southern European countries.

The validity of hospital administrative data for outcome measurement after hip replacement

Background : Because of the increasing availability of clinical information on the basis of electronically processed data obtained through the hospital discharge records in the HIS, large databases are being set up to develop risk adjustment models for outcome assessment. This study is aimed at assessing the validity of hospital discharge data from the Hospital Information System (HIS) of patients with hip arthroplasty. Methods : 677 records were extracted from the database of the pilot project “Lazio Region Hip Arthroplasty Register (Ripa-L)” and were compared to the corresponding HIS discharge records. The Ripa-L dataset was used as a reference to evaluate the completeness and accuracy of the socio-demographic and clinical HIS data. Results : Data such as the patients’ age and sex, principal diagnosis, and surgical procedures, showed a very high level of agreement. By contrast, clinical information about comorbidities on admission and in-hospital complications mostly showed unacceptable variances in the datasets. The sensitivity of hospital data reporting was generally very low for almost all conditions, with the highest value being observed for diabetes (58%) and the lowest for endocrine and peripheral venous diseases (4%). Conclusions : Gaps in clinical information may compromise the ability to carry out high quality appraisals. In particular, the underreporting of comorbidities in hospital administrative data may lead to misestimation of the providers’ skill and quality of care, as a consequence of imperfect risk-adjustment. Stakeholders should highlight the potentialities related to the use of high quality administrative datasets also in clinical evaluations by stimulating health professionals to further improve the quality of the collected data.

Il consenso informato nella cura del paziente con frattura del femore

Informed consent is fundamental in the process of care, except in case of urgent, lifesaving treatments. In Italy, the legal sources are the Italian Constitution, the numerous judgments of the courts and the current “Codice di Deontologia medica”. In clinical practice, as in the case of the elderly patient with hip fracture, the physician may encounter problems if the patient is incompetent and without legal representation.