Maria Teresa Tenconi

Major childhood infectious diseases and other determinants associated with type 1 diabetes: A case-control study

The objective of the study was to evaluate the association between infectious diseases and other events pertaining to childhood medical history and type 1 diabetes. A case-control study was carried out, taking as cases 159 type 1 diabetic patients (0–29 years) recorded from 1988 to 2000 within the population registry of the Pavia province (North Italy). As controls 318 non-diabetic subjects were matched by age and sex. A questionnaire was administered by standardised interviewers. Data were analysed by conditional logistic regression. Viral childhood diseases (OR 4.29; 95%CI 1.57–11.74) and bottle feeding (OR 1.83; 95%CI 1.08–3.09) were directly correlated to type 1 diabetes; an inverse correlation was found for vitamin D administration during lactation (0–14 years) (OR 0.31; 95%CI 0.11–0.86) and for history of scarlet fever in both sexes and age groups (OR 0.19; 95%CI 0.08–0.46). Most associations of the studied variables confirm already known findings. The significant inverse correlation of type 1 diabetes with scarlet fever history is a peculiar finding, the meaning of which is still obscure, although it has been recently described that streptococcal A infections are regulated by HLA class II alleles.

Role of socioeconomic indicators in the prediction of all causes and coronary heart disease mortality in over 12,000 men – The Italian RIFLE pooling project

The relationship of socioeconomic indicators (education, occupation and residence) to short-term all cause mortality and coronary heart disease (CHD) mortality was evaluated in an Italian population sample. Socioeconomic indicators (education, occupational level and residence) and major CHD risk factors were measured in 12,361 males aged 40–69 years; mortality data by cause were collected for the next 6 years. All cause and CHD mortality risk ratio (RR) in the different educational and occupational levels and residence were computed by Cox proportional hazards models. After 6 years 385 men died, of whom 105 were coronary fatalities. No association with educational level was found for all cause mortality (RR: 1.00 high, 0.71 medium, 0.77 low) and for CHD mortality (RR: 1.00 high, 0.39 intermediate, 0.71 low). Occupational level was significantly associated (p < 0.031) with all cause mortality (RR: 1.00 high-intermediate, 1.27 low). Urban vs. rural residence (RR: 1.00) showed a RR for all cause mortality of 1.33 (p < 0.011). Adjustment for bio-behavioral risk factors did not change the above results; only mortality for CHD of urban vs. rural residents increased (RR: 1.94, p = 0.004). In conclusion the negative association of mortality with occupational level, albeit not with education, indicates that occupation is a better indicator of socioeconomic status in Italy. Status incongruity as well as residence in an urban environment could be risk conditions for total and CHD mortality.

The "Quit and Win" campaign to promote smoking cessation in Italy: results and one year follow-up across three Italian editions (2000-2004)

The “Quit and Win” Campaign is a health promotion campaign that aims to encourage smoking cessation. It is in its fourth edition in Italy and in its sixth edition in Finland. In Italy, it originally started in one region (Veneto, the Italian Coordinating Centre) and has spread to incorporate 11 regions in its latest edition. The aim of this study is to assess the effectiveness, results and trends within the various editions of the campaign. This initiative has been carried out thanks to the collaboration and partnership that exists among the participating regions and the different community services. The involvement of local press and the media have also been utilized to promote the initiative. In addition to this, substantial efforts were made to inform general practitioners, chemists and other health care personnel of the scheme in order that they would promote it by disseminating brochures. Efforts were also made in order to secure sponsorship for the programme. The results from all of the Italian editions have shown an increase in the number of participants, from 5,938 participants in 2000 to 8,185 in 2004 (latest edition). This one ahowed, in 2004, a participation of 4,812 males (M) and 3,373 females (F), a rate of 58.7% and 41.2% respectively; with the largest amount of participants falling into the age class of 25-34 years, accounting for 35.5% M and 32.6% F. 43.4% M and 40.6% F had been smoking for 20 years or more. Strong smokers (> 40 cigarettes/day) accounted for 9.5% of M and 3.1% F. Among all subjects, 47.2% had previously attempted to quit smoking at least once or twice. Among those who had quit smoking for at least four weeks, 39.5% remained non-smokers after one year of follow-up (2004 edition). Most quitters didn’t use any support to replace the effects of the nicotine (79.7%) and half of them didn’t receive any support from those people around them (55.2%). Smokers received information about the campaign in the first edition mainly from health care personnel (46.3%), while in the latest edition the most frequently reported means of obtaining information was via the web-site (31.7%).

Executive Functioning in Older Adult Outpatients With Type 2 Diabetes Mellitus: A Preliminary Study

Given the multi-componential nature of executive functions, we compared 48 outpatients affected by Type 2 diabetes and 49 control subjects on the executive domains of inhibition, updating, shifting, and word fluency. Variables commonly associated with diabetes were considered in explaining the relationship between diabetes and executive functioning. Each participant underwent a clinical and cognitive (addressing the four executive domains) evaluation. Raw test scores were standardized per domain and compared between groups. Possible risk factors related to diabetes were examined. The diabetes group scored lower than the control subjects only in the inhibition measure, whereas no differences resulted in the other executive domains.

Infectious diseases and Type 1 diabetes in children

Type 1 diabetes (T1D) is an autoimmune disease triggered by environmental factors. Among those of infectious origin, viruses mostly associated to T1D are rubella virus, enteroviruses (Rotavirus, Coxackie B), Cytomegalovirus and mumps virus. The role of bacterial infections is still controversial, acting either as modulators or precipitating factors of an already started autoimmune process. Polymorphic genes of innate immunity, such as Toll-like receptors, nucleotide-binding oligomerization domain (NOD) 1 and NOD2 and mannose-binding lectin (MBL) genes, did not show a strict association with T1D onset, while protein tyrosine phosphatase (PTPN22), cytotoxic T-lymphocyte antigen (CTLA)4 and natural killer cells immunoglobulin-like receptor (KIR) genes appear to play an important role. However, the adaptive immune response genes (HLA) still provide the major contribution to T1D susceptibility. Here, we review the mechanism by which microorganisms might induce autoimmunity.

Process evaluation of European 'Healthy Stadia' program.

Healthy Stadia (HS) is a European public health pilot-program started in 2007 to support sports stadia in promoting the health of people who work and visit sports stadia, as well as inhabitants of the surrounding communities. The aim of this study is to describe the process evaluation of the program, from its beginning in July 2007 to December 2009, in order to assess the feasibility and sustainability of an HS network across Europe. The program involved nine associate partners involved in the coordination of activities at a local level, in the recruitment of stadia, in the development of specific program tasks and in the dissemination of the program at a national level. The activities of associate partners were evaluated through structured questionnaires administered every 6 months. The questionnaire response rate from associate partners was 77.8% for the first and third evaluations and 88.9% for the second and fourth evaluations. According to the evaluations results, several good practices such as alcohol prevention policies and those supporting people with disabilities were implemented in stadia over the course of the program. Conversely, practices supporting mental health and green transport were generally not achieved. The implemented activities mainly involved staff and visitors. Lack of human and economic resources, especially toward the end of the program, was considered the principal challenge for program development. In conclusion, the process evaluation presented the feasibility of the HS program and the development of health promoting practices in sport stadia over time.

Mr. Starbene e il Club dei Vincenti: assessing an anti-smoking campaign for school children

Background : People start smoking during childhood and adolescence and the age at which children start smoking is gradually falling: in 2005, it rose to 3.3% in the 11-to-14 year age group whereas in 2002 it was only 1.4% in the same age group. Methods : “Mr Starbene e il Club dei Vincenti”, part of a regional program, Liberi dal Fumo, was assessed through an experimental non-randomized study, by involving parents and teachers, using short questionnaires. The project’s objective was orienting fourth and fifth grade children towards a no-smoking lifestyle. The enrolled population was composed of 5,552 students in the treatment group and 4,758 controls. Results :: after two years, the number of children who had tried smoking but no longer smoked at the moment decreased by 16.3% in the treatment group, while it increased by 12.5% in the controls (p=0.000). The number of children who considered smoking a few cigarettes/day dangerous was higher in the treatment group (+8%) than in the controls (+4.4%) which suggests significant results vis-a-vis perceived smoking hazards. Children who claimed they would not smoke in the future decreased by 57.1% in the treated group as compared with a 21.4% reduction in the control group (p<0.001); children who said they would accept an offer of a cigarette decreased in the treated group (-12.5%), but not in the controls (p<0.001). The study pointed out also the influence of role-models in children attitudes toward smoking. Conclusions : The positive results of this project give rise to hope for the future, even if long term evaluation is necessary. The good scores obtained from the teachers are very positive because they make the project work.

Respiratory symptoms and pulmonary function in the population of Parona (PV) according to tobacco smoke exposure

Background: The health status of a population sample living in Parona (Pavia) was surveyed to evaluate the association between exposure to active and passive smoke and chronic respiratory symptoms. Methods : 483 subjects were studied. The protocol included a questionnaire administrated by a physician, pulmonary function test and blood analysis. Results : 124 subjects were current smokers, 104 subjects were past smokers and 252 were non-smokers. Sixty two (12.9%) of the subjects had pathological PFT: 48 (10%) had airflow obstruction and 14 (2.9%) had restriction of lung volumes. The prevalence of pathological tests was significantly higher in males than in females (p < 0.05). Most of pathological tests have been found in smokers: the prevalence was 16.9% in current smokers, 14.4% in quitters, 11.8% in ETS-exposed people and 9.4% in ETS-non-exposed. The frequency of pathological PFTs was significantly higher in subjects exposed (p< 0.05). The mean value of FVC% predicted tended to be lower in smokers, intermediate in ETS exposed subjects. Conclusions : Chronic respiratory symptoms were reported significantly more often by smokers. The prevalence of pathological pulmonary function tests was significantly higher and FVC tended to be lower in subjects exposed to active and/or passive smoking than in non-exposed. Our results demonstrate the health impact of smoke on the general population of a low polluted area. Besides smoking cessation, lowering ETS exposure could represent one of the most important tool to improve respiratory health, and may contribute to prevent and reduce progression to COPD .

Sulla organizzazione dello strato granulare esterno e della membrana limitante esterna nella retina di coniglio

SummaryThe organisation of the outer nuclear layer and the structure of the outer limiting membrane of rabbit retina have been studied. In specimens stained by the Golgi method it was observed that in the outer nuclear layer each Müller cell envelops with its thin lamellar expansions ten to fifteen rod and cone cell bodies.The only cytoplasmic organelles in rod and cone cell bodies are a few free ribosomes and smooth surfaced vesicles. Neurotubules are prominent in the outer and inner fibres of the rods and cones.The processes of the Müller cells are distinctive because of the presence of many glycogen granules and glial filaments. Also present but only found near the outer limiting membrane are mitochondria, occasional centrioles and cilia that lack inner fibres. Long microvilli originate from the Müller cell processes on the scleral side of the outer limiting membrane.The photoreceptor cells on the vitreal side of the outer limiting membrane are completely isolated from each other by glial processes. On the scleral side of the membrane, the inner segments of the photoreceptor cells are not completely isolated by glial processes and so are frequently found in mutual contact. In the outer nuclear layer the granule of each photoreceptor is surrounded by more than one glial process while the fibres are often deeply embedded in a single glial process and provided with a mesofibre.At the level of the outer limiting membrane the visual cells and the glial expansions enveloping them are joined together by a junctional complex formed by a zonula adhaerens interposed between two very short zonulae occludentes. The same junctional complex joins to each other the contiguous expansions of the Müller cells and the mesofibres of the visual elements.

Evaluation outcomes of a sex education strategy in high schools of Pavia (Italy).

Aim: We aimed to provide process and effectiveness evaluations of a sex education intervention realized with interactive techniques in high schools of Pavia (Italy). Methods: Six public high schools, divided into ‘treated’ and ‘control’ units, voluntarily joined this mixed-methods study. Only second-year classes were enrolled: treated adolescents followed a sex education course, performed by trained ‘near-peer educators’ (undergraduate medical students) with interactive techniques. All adolescents compiled an anonymous effectiveness evaluation questionnaire at baseline (pre-test) and 3 months later (post-test). Sexual knowledge and reported behavioural changes were compared between the two groups through linear mixed-effects models. The process was assessed through a satisfaction questionnaire for treated students, monitoring cards for working group members and cards/diaries for educators. Results: The final sample consisted of 547 treated and 355 control adolescents (mean age = 15.28 ± 0.61 years). Highly significant changes (p < 0.001) from pre-test to post-test, with strong improvements of treated adolescents, were evident for all knowledge items. No significant changes for behavioural items were reported. Process evaluation showed positive results in adolescents’ satisfaction, highlighting the need for more youth gathering places. Working group members and educators generally provided positive evaluations, although difficult communication was perceived. Conclusions: The intervention was effective in improving adolescents’ sexual knowledge. The present work highlighted that in Italy sex education in adolescence is still neglected: this could encourage misinformation and health-risk behaviour. Young people perceive the need for a serious health-promoting action in which they could play an active role, spreading educational messages with organized interactive methods.