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.

The methodology of the Italian HBSC 2010 study (Health Behaviour in School-aged Children).

Italy has participated in the Health Behaviour in School-aged Children (HBSC) study since 2000. These surveys collect data every four years on the well-being and health behaviour of boys and girls aged 11, 13 and 15. Until 2007, the coordination group of the University of Turin, Siena and Padua directly sent the questionnaires to each sampled school to collect the data. The sample of about 4500 students was nationally representative. In 2008 the HBSC became part of the project "Surveys on behavioral risks in children aged 6-17 years", coordinated by the National Institute of Health (ISS) and promoted by the Ministry of Health, in collaboration with the Ministry of Education, University and Research. For the first time, in 2010, the survey was conducted by health workers in collaboration with teachers in all regions with a representative sample, not just at the national level, but also at regional level. In the 2,504 sampled schools, 77,113 students (25,079 eleven-year-old, 26,048 thirteen-year-old and 25,986 fifteen-year-old) completed an anonymous questionnaire. Knowledge of the health-related behaviour of school-aged adolescents may help monitoring and enable policies for young people to be formulated and implemented.

[Surveillance system OKkio alla SALUTE: the role of primary school in the promotion of healthy life style--results in 2008]. / Il sistema di sorveglianza OKkio alla SALUTE: il ruolo della scuola primaria nella promozione di stili di vita salutari. Risultati 2008.

In 2007 the Italian Ministry of Health/CCM promoted and funded the project "System of surveys of behavioral risks in ages 6-17", coordinated by the National Institute of Health. One of the aims of the project is the definition and implementation of a data collection system on the weight of primary school children, their eating habits, physical activity and school initiatives favoring the healthy growth of children, called "OKkio alla SALUTE". In 2008 the first survey of OKkio was conducted in 18 Italian regions. 45,590 third grade school children in 2610 classes participated. Information was collected from 2461 schools. The responses of the head teachers showed that 64% of the schools have a canteen, used by 70% of children. Only 12% of schools include the provision of a balanced mid-morning snack. Frequently there are educational activities related to physical activity and healthy eating that, in some cases, also involve the families of the children. 29% of the schools cannot guarantee two hours of physical activity as suggested by the school curriculum because of the lack or inadequacy of the gym or the structure of the timetables. The information gathered through the cooperation of school administrators, teachers and health workers, has helped to describe the major health educational activities of the school, that is confirmed to be the ideal venue for promoting healthy lifestyles in young people.

Evaluating a nursing care delivery model using a quality improvement design.

The goal to develop and implement a new model of nursing care delivery grew out of administrative and shared governance initiatives to improve the quality of nursing care. This evaluative study used both quantitative and qualitative methods. Seven principles related to quality were identified and became the driving force behind the changes. Aspects of these changes in care delivery were piloted on a neurological unit and included implementation of collaborative rounds, a modular structure, role changes, and work redesign. Frequency distribution, questionnaire, focus group, and financial data indicated that there had been improvement in the delivery of care in addition to financial benefits. A considerable amount of the data provided evidence that supported continuing the changes.

Nursing/pharmacy interface: a TQM project.

W. Edwards Deming's seven-step quality improvement process provided a sequential pathway to facilitate problem-solving allowing the pharmacy and nursing departments to formulate a systems perspective rather than an individual point of view. Both departments identified problems with the Medication Administration Record and defined three key outcomes needed to signify process improvement.

Resource use in home care agencies.

Increasing use of home care services in the past decade has led to concern about the nature and number of services provided to clients. Because third party payers have used case mix measures to develop reimbursement systems for acute and long-term care facilities, it seems likely that similar measures will be developed for home care. Three types of home care agencies were studied to test the usefulness of routinely gathered clinical and financial data for predicting resources provided. The findings suggest that current data sources may be inadequate for predicting the actual delivery of services.

The dependency at discharge instrument as a measure of resource use in home care.

The dependency at discharge instrument, developed to evaluate the needs for care of hospitalized patients on the day of discharge, was tested for its usefulness in measuring resource consumption in home health care. The instrument evaluates dependency in relation to bathing/hygiene, activity, technical procedures, and monitoring signs and symptoms. The sample used in this study consisted of 150 subjects admitted to one of three types of home health care agencies. Interrater reliability and internal consistency of the instrument were high. Factor analysis produced results similar to those of the developers for three of the four scale items. The item concerning need for assistance with procedures had a much lower loading, indicating that it had little in common with the other items. Criterion-based validity was measured by testing the instrument's ability to predict the number of registered nurse and home health aide visits, and length of enrollment. Findings indicated that the instrument had a modest level of criterion-based validity in predicting the use of registered nurse and home health aide services for the hospital-affiliated agency, but was relatively ineffective for public health and for-profit agencies.

Sperm peroxidases and their possible role as glycoprotein-containing Con A and wheat germ lectin receptors.

Peroxidases have been detected in the membrane of the ejaculated normal spermatozoon; their distribution on the different zones of the gamete has been determined. This distribution is similar to that of the N-linked glycoprotein-containing oligosaccharides. Their resemblance and similarity to the plant peroxidases, which are glycoproteins with N-type oligosaccharides, suggest that the sperm peroxidases might be, at least partially, identical to concanavalin A (Con A) and wheat germ lectin glycoprotein-containing receptors.

Thermodynamics of cosmological matter creation.

A type of cosmological history that includes large-scale entropy production is proposed. These cosmologies are based on reinterpretation of the matter-energy stress tensor in Einstein's equations. This modifies the usual adiabatic energy conservation laws, thereby including irreversible matter creation. This creation corresponds to an irreversible energy flow from the gravitational field to the created matter constituents. This point of view results from consideration of the thermodynamics of open systems in the framework of cosmology. It is shown that the second law of thermodynamics requires that space-time transforms into matter, while the inverse transformation is forbidden. It appears that the usual initial singularity associated with the big bang is structurally unstable with respect to irreversible matter creation. The corresponding cosmological history therefore starts from an instability of the vacuum rather than from a singularity. This is exemplified in the framework of a simple phenomenological model that leads to a three-stage cosmology: the first drives the cosmological system from the initial instability to a de Sitter regime, and the last connects with the usual matter-radiation Robertson-Walker universe. Matter as well as entropy creation occurs during the first two stages, while the third involves the traditional cosmological evolution. A remarkable fact is that the de Sitter stage appears to be an attractor independent of the initial fluctuation. This is also the case for all the physical predictions involving the present Robertson-Walker universe. Most results obtained previously, in the framework of quantum field theory, can now be obtained on a macroscopic basis. It is shown that this description leads quite naturally to the introduction of primeval black holes as the intermediate stage between the Minkowski vacuum and the present matter-radiation universe. The instability at the origin of the universe is the result of fluctuations of the vacuum in which black holes act as membranes that stabilize these fluctuations. In short, black holes will be produced by and "inverse" Hawking radiation process and, once formed, will decompose into "real" matter through the usual Hawking radiation. In this way, the irreversible transformation of space-time into matter can be described as a phase separation between matter and gravitation in which black holes play the role of "critical nuclei."

Ketoconazole: a thromboxane synthetase and 5-lipoxygenase inhibitor with antimetastatic activity in B16-F10 melanoma.

Arachidonic acid metabolites have been implicated in the development of hematogenous tumor metastases. The purpose of this study was to determine the antimetastatic potential of ketoconazole, a thromboxane synthetase and 5-lipoxygenase inhibitor. One hundred seventy-four C57 black male mice were randomized to receive either placebo or 0.0057 mg/g of ketoconazole. Drug and placebo were delivered once daily by intraperitoneal injection beginning 24 hr prior to tumor injection and continuing until sacrifice. All animals were injected subcutaneously in the flank with 5 x 10(6) B16-F10 melanoma cells. Animals were sacrificed at 3 weeks (n = 60), 4 weeks (n = 84), and 5 weeks (n = 30). Metastases were assessed by circumferential inspection of the lungs of all animals at autopsy. Differences in survival and primary tumor mass between study groups were not statistically significant. Pulmonary metastases were present in 37/174 animals. Twenty-nine of the mice with metastases were in the placebo groups, and 8 were in the ketoconazole groups. The incidence of metastases was significantly reduced in the ketoconazole-treated mice compared to placebo both within each group and overall, P was less than 0.05 and 0.001, respectively. This effect was not mediated through changes in local tumor growth.

Cytochemical characterization and localization of oligomannosidic oligosaccharide receptors on the normal human spermatozoa using fluorescent lectins: comparison of different fixation procedures.

Similar locations of the Con A and wheat germ lectin receptors were obtained by using fluorescent lectins, in nonfixed spermatozoa and in spermatozoa fixed with formaldehyde and methanol, showing that in samples with the same previous treatment, worked out by the same operator, in which enough determinations have been performed to eliminate individual variations, the different procedures of fixation produced similar results. The locatizations obtained with fluorescent lectins confirm previous results, produced with the peroxidase technique, indicating that the lectins interact with oligomannosidic oligosaccharide receptors situated mainly in the equatorial segment of the acrosome and postnuclear cap. They also indicate the presence of similar receptors that were not detected previously on the neck and intermediate segment. The larger size of the lectin-peroxidase-diaminebenzidine reagent compared to that of the fluorescent lectins suggests that the new receptors are semicriptic and were not detected by steric effects in the first case, but were able to interact with lower volume, fluorescent probes. It is suggested that these oligomannosidic chains could be recognition signals for the elimination of incompetent sperm during their passage through the female reproductive track. Also these oligosaccharides and its possible metabolic variations could be involved in the interaction between the acrosome-reacted spermatozoa with the zone pellucida.