Focus on prevention, diagnosis and treatment of hypertension in children and adolescents.

The European Society of Hypertension has recently published its recommendations on prevention, diagnosis and treatment of high blood pressure in children and adolescents. Taking this contribution as a starting point the Study Group of Hypertension of the Italian Society of Pediatrics together with the Italian Society of Hypertension has conducted a reappraisal of the most recent literature on this subject. The present review does not claim to be an exhaustive description of hypertension in the pediatric population but intends to provide Pediatricians with practical and updated indications in order to guide them in this often unappreciated problem. This document pays particular attention to the primary hypertension which represents a growing problem in children and adolescents. Subjects at elevated risk of hypertension are those overweight, with low birth weight and presenting a family history of hypertension. However, also children who do not present these risk factors may have elevated blood pressure levels. In pediatric age diagnosis of hypertension or high normal blood pressure is made with repeated office blood pressure measurements that show values exceeding the reference values. Blood pressure should be monitored at least once a year with adequate methods and instrumentation and the observed values have to be interpreted according to the most updated nomograms that are adjusted for children's gender, age and height. Currently other available methods such as ambulatory blood pressure monitoring and home blood pressure measurement are not yet adequately validated for use as diagnostic instruments. To diagnose primary hypertension it is necessary to exclude secondary forms. The probability of facing a secondary form of hypertension is inversely proportional to the child's age and directly proportional to blood pressure levels. Medical history, clinical data and blood tests may guide the differential diagnosis of primary versus secondary forms. The prevention of high blood pressure is based on correct lifestyle and nutrition, starting from childhood age. The treatment of primary hypertension in children is almost exclusively dietary/behavioral and includes: a) reduction of overweight whenever present b) reduction of dietary sodium intake c) increase in physical activity. Pharmacological therapy will be needed rarely and only in specific cases.

Work-related injuries among immigrant workers in Italy.

In Italy, work-related injuries among immigrant workers are an emerging concern. In this study, we compared the occurrence of work-related injuries between legally residing immigrants from High Migration Pressure Countries and Italians and evaluated the associations with potential risk factors. Using data from the 2007 Labour Force Survey conducted by Italy's National Institute of Statistics, we examined the relationship between the occurrence of work-related injuries in the previous 12 months and being an immigrant among a nationally representative sample. The occurrence of work-related injuries was significantly higher among immigrant males compared to Italian males (adjusted OR = 1.82; 95 % CI 1.53-2.16), particularly in the construction sector, for which the results showed a U-shaped trend of the odds ratios of injuries for immigrants compared to Italians with increasing number of years of work in the same job. No associations were found among women. The findings suggest that prevention programs need to be implemented to limit the burden of work-related injuries among immigrants.

Dietary intake and physical activity of normal weight and overweight/obese adolescents.

Purpose. To evaluate the relationship between overweight/obesity and dietary/lifestyle factors among Italian adolescents. Methods. On a total of 756 adolescents with mean age 12.4 +/- 0.9, body mass index, food consumption, and time dedicated to after school physical activities and to TV viewing were determined. The data were analysed according to age, nutritional status, and gender. The analysis of variance and multiple logistic regression analysis were performed to investigate the association between dietary/lifestyle factors and overweight/obesity. Results. The percentages of overweight and obesity were, respectively, 28% and 9% among boys, 24% and 7% among girls. The overweight/obesity condition in both genders was associated with parental overweight/obesity (P < .001 for mother), less time devoted to physical activity (P < .001 for boys and P < .02 for girls) and being on a diet (P < .001). Direct associations were also observed between BMI and skipping breakfast and the lower number of meals a day (boys only). Conclusions. This pilot study reveals some important dietary and lifestyle behaviour trends among adolescents that assist with identification of specific preventive health actions.