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 evaluation's 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.

[Survey on smoking in nursing students]. / L'abitudine al fumo negli studenti del Corso di Laurea in Infermieristica dell'Università di Pavia.

The study reports the results of a survey about smoking collected by a self-administered questionnaire in nursing students at Pavia University. Responders were 393 (80%: M = 132, F = 261, mean age 24.66 +/- 5.64). 45% of the students (51.5% males and 41.8% females) were smokers. Cigarettes consumption was 12.33 cigarettes/day in males and 10.49 cigarettes/day in females; males began smoking at 16 years of age, while females at 17 years. Smoking in family members as well as father's educational level were positively associated to smoking. 66.5% of smokers stated they would like to quit and the most of them are pressed in this decision by family (49.7%) and friends (49.2%). The results of the study describe an unhealthy lifestyle: in future it seems necessary to organize counselling or interventions in order to quit smoking.

[Effectiveness of the project "I don't smoke, and you?" against smoking in a secondary school in Italy]. / Valutazione dell'efficacia del progetto "Io non fumo, e tu?", contro il tabagismo nella Scuola secondaria di I degrees grado.

"I don't smoke, and you?" is a project aimed at secondary school students and is part of a wider project called "Free from Smoke", implemented by the Lombardia Region and involving elementary and secondary school students. The project is a controlled non randomized study whose aim is to direct students toward a healthy and smoke-free way of living, by also involving parents and teachers. A total of 11,610 12 year-olds of both sexes were evaluated, 6392 of whom were enrolled in the program and 5218 of whom served as controls and only completed the questionnaire. Three years after the start of the program, a greater increase in the prevalence of smokers was found amongst the group of controls than amongst the enrolled group (108,3% vs +93.8%, p>0.001). The percentage of students who believe that smoking even a small number of cigarettes is harmful, increased in the enrolled group (+0.6%) while it diminished in controls (-2.1%). In addition, a strong association was found between receiving a weekly allowance and smoking habits. In conclusion, positive results were obtained as regards the prevalence of smokers and the perceived risk of smoking; however parents' attitude towards smoking and the availability of a weekly allowance were found to have a strong influence in students' smoking habits.

Evaluation of outcomes in SPA-treated osteoarthrosic patients.

INTRODUCTION: Osteoarthrosis is the most prevalent joints disorder and it is also the most frequent cause of physical disability in the elderly. When surgery is not indicated, symptomatic drugs are generally used. These treatments are frequently associated to balneotherapy. In fact, balneotherapy or spa therapy has been widely used in classical medicine as a cure for such diseases. The aim and significance of this study is to evaluate the impact of thermalism in subjects suffering from osteoarthrosis. METHODS: We randomly selected 220 osteoarthrosic subjects (STs = spa treatment subjects), aged from 40 to 90, that usually undergone mud pack therapy and balneotherapy at least once a year. They were enrolled in thermal establishments in the Euganean Basin. We also recruited, as control group, 172 osteoarthrosic subjects (NCs = normal care subjects) that never underwent any spa therapy. A questionnaire, comprehensive of a disability score, was administered by physicians to each subject. RESULTS: STs reported to suffer from osteoarthrosis for more years than NCs. Furthermore STs significantly suffered more than NCs from pain in several joints, and they also showed a more elevated average number of painful joints. In spite of that, STs used less drugs than NCs, and showed a higher degree of disability due to osteoarthrosis (p < 0.001). CONCLUSION: The regular use of mudpack and balneotherapy seem to improve the wellness, and the spa treatment seems to help the achievement of this goal. In this regard it might be important to encourage new investigations in order to assess in which measure thermal therapy contribute to the wellness improvement.

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.

Epidemiological evidence for the non-random clustering of the components of the metabolic syndrome: multicentre study of the Mediterranean Group for the Study of Diabetes.

OBJECTIVE: To determine: (a) whether the components of metabolic syndrome (MetS) cluster more frequently than predicted by chance alone and (b) whether increased risk for MetS is associated also with values of each component below, but close to the cutoff points defining MetS. RESEARCH DESIGN AND METHODS: Anthropometrical and biochemical measurements were performed and a dietary questionnaire was filled-in in 1833 randomly selected non-diabetic subjects, 916 men and 917 women, 20-74 years old, in nine centres in five Mediterranean countries. The prevalence of MetS and of possible combinations of its individual components was measured. The expected frequencies of the above combinations were calculated according to the mathematical formula of probabilities. RESULTS: The overall prevalence of MetS was 27.2%, but varied greatly among countries, from 5.8% in Algeria to 37.3% in Greece. The observed prevalence of each combination diagnostic of MetS was higher than the expected by chance. Thus, the observed overall prevalence of MetS was also higher than the expected, 27.2 vs 24.0%, P=0.03. Furthermore, for each individual component (except high-density lipoprotein), as values in the normal range, approached the cutoff point, the risk of having MetS (i.e. clustering of the other components) increased significantly (odds ratio 2.2-4.6, P<0.001). CONCLUSIONS: The MetS is not related to the Mediterranean type of diet and its prevalence varies greatly among five Mediterranean countries. The clustering of the components defining the MetS is not due to chance and moreover even 'high normal' levels of each component confer increased risk for the syndrome.

[Prevalence of risk factors for ischemic heart disease in a northern Italian adult population]. / Prevalenza dei fattori di rischio per le malattie ischemiche del cuore in una popolazione adulta del Nord Italia.

The aim of this study is to measure the prevalence of cardiovascular risk factors in Tavazzano (Lodi) inhabitants, in order to implement efficacious and preventive strategies at community level. In 1998 the target population consisted of 2055 adults (males and females) aged 35-64, living in Tavazzano (Lodi province). The examined population was made of 856 subjects (399 males and 457 females), with a participation rate equal to 41,6%. A questionnaire concerning medical history and life habits such as: smoking, alcohol consumption and physical activity was administered to each participant. Height, Weight, Systolic and Diastolic Blood Pressure, Fasting Blood Glucose, Total Cholesterol and triglycerides were collected. A 12-leads electrocardiogram, evaluated both with standard clinical criteria and Minnesota Code, was done for each subject. The results show a high prevalence of modifiable cardiovascular risk factors: hypertension (25,2%), smoking (26,1%), obesity (14,6%), hypercholesterolemia (27,5%), low physical activity (39,6%) mainly in males and with an increasing trend with age. These data indicate the need of preventive programmes addressed to the general population and to "subjects at risk", according to the National Health Plan 2003-2005.

Nutritional habits of subjects with Type 2 diabetes mellitus in the Mediterranean Basin: comparison with the non-diabetic population and the dietary recommendations. Multi-Centre Study of the Mediterranean Group for the Study of Diabetes (MGSD).

AIMS/HYPOTHESIS: The aim of this study was to compare the nutritional habits of Type 2 diabetic patients among Mediterranean countries and also with those of their background population and with the nutritional recommendations of the Diabetes and Nutrition Study Group. METHODS: We did a cross-sectional study of 1833 non-diabetic subjects and 1895 patients with Type 2 diabetes, in nine centres in six Mediterranean countries. A dietary questionnaire validated against the 3-Day Diet Diary was used. RESULTS: In diabetic patients the contribution of proteins, carbohydrates and fat to the energy intake varied greatly among centres, ranging from 17.6% to 21.0% for protein, from 37.7% to 53.0% for carbohydrates and from 27.2% to 40.8% for fat, following in every centre the trends of the non-diabetic population. Furthermore, diabetic patients compared to the corresponding background population had: (i). lower energy intake, (ii). lower carbohydrate and higher protein contribution to the energy intake, (iii). higher prevalence of obesity, ranging from 9 to 50%. The adherence to the nutritional recommendations for proteins, carbohydrate and fat was very low ranging from 1.4 to 23.6%, and still decreased when fibre was also considered. CONCLUSION/INTERPRETATION: In diabetic patients of the Mediterranean area: (i). dietary habits vary greatly among countries, according to the same trends of the background population; (ii). the prevalence of obesity is much lower than the 80% reported for patients with diabetes in Western countries; (iii). Carbohydrate intake is decreased with a complementary increase of protein and fat consumption, resulting to a poor compliance with the nutritional recommendations.

[Total and cause-specific mortality trends are analyzed in Pavia Province from 1991 to 2000]. / Andamento della mortalità nella Provincia di Pavia (1991-2000).

Age-standardized mean two-years mortality rates are compared with those ones of Lombardy region in 1991-1998 period. A decreasing trend of total mortality (-19%) consistent with the regional rates was noticed and a tendency to convergence at the end of the observation period. The reduction is more evident for cardiovascular diseases (-25.48% M and -26.77% F) and for cancer (-16.89% M and -10.6% F), where provincial rates are more markedly diminishing than those ones observed in Lombardy region. Among the specific causes of death, colon and stomach cancer mortality shows a fall in both sexes as well as lung cancer in males and breast cancer in females, while lung cancer mortality in women is increasing. Respiratory diseases mortality, after an initial reduction, shows a modest raise in males, while digestive system disease mortality, always higher than the regional one, decreases by 29.09% in males and 12.15% in females as well as external causes (-27.82% M and -28.37% F). On the contrary infectious disease mortality is increasing, following the regional trend. The mortality surveillance and the comparison of local rates with regional or national ones is the first step to evaluate the population health status for the provision of prevention and care.

Nutritional habits in the Mediterranean Basin. The macronutrient composition of diet and its relation with the traditional Mediterranean diet. Multi-centre study of the Mediterranean Group for the Study of Diabetes (MGSD).

OBJECTIVE: To compare the nutritional habits among six Mediterranean countries and also with the various official recommendations and the 'Mediterranean diet' as originally described. DESIGN: Cross-sectional study. SETTINGS: Three centres in Greece, two in Italy and one in Algeria, Bulgaria, Egypt and Yugoslavia. SUBJECTS: Randomly selected non-diabetic subjects from the general population, of age 35-60, not on diet for at least 3 months before the study. INTERVENTIONS: A dietary questionnaire validated against the 3-Day Diet Diary was used. Demographic data were collected and anthropometrical measurements done. RESULTS: All results were age adjusted. Energy intake varied in men, from 1825 kcal/day in Italy-Rome to 3322 kcal/day in Bulgaria and in women, from 1561 kcal/day in Italy-Rome to 2550 kcal/day in Algeria. Protein contribution (%) to the energy intake varied little, ranging from 13.4% in Greece to 18.5% in Italy-Rome, while fat ranged from 25.3% in Egypt to 40.2% in Bulgaria and carbohydrates from 41.5% in Bulgaria to 58.6% in Egypt. Fibre intake, g/1000 kcal, ranged from 6.8 in Bulgaria to 13.3 in Egypt and the ratio of plant to animal fat from 1.2 in Bulgaria to 2.8 in Greece. The proportion of subjects following the WHO and the Diabetes and Nutrition Study Group (DNSG) of the EASD recommendations for carbohydrates, fat and protein ranged from 4.2% in Bulgaria to 75.7% in Egypt. Comparison with the Mediterranean diet, as defined in the seven Country Study, showed significant differences especially for fruit, 123-377 vs 464 g/day of the Mediterranean diet, meat, 72-193 vs 35 g/day, cheese, 15-79 vs 13 g/day, bread, 126-367 vs 380 g/day. CONCLUSIONS: (a) Dietary habits of the 'normal' population vary greatly among the Mediterranean countries studied. (b) Egypt is closest to the DNSG recommendations. (c) Significant differences from the originally described Mediterranean diet are documented in most Mediterranean countries, showing a Westernization of the dietary habits.

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.

[Epidemiologic surveillance of ischemic heart disease in the population of Pavia in 1986-1995]. / Sorveglianza epidemiologica delle malattie ischemiche del cuore nella popolazione di Pavia nel decennio 1986-1995.

BACKGROUND: In Italy mortality for coronary heart disease is continuously decreasing in males and females. However, it is not yet clear how much of this decline is attributable to a longer survival of coronary heart disease patients or to a real decreased incidence in the population. The aim of this paper was to analyze coronary heart disease mortality trends in the population of Pavia, case-fatality rates and acute myocardial infarction attack rates. METHODS: Mortality surveillance was carried out by the Epidemiological Unit of the ASL of Pavia; acute myocardial infarction attack rates were estimated from regional admission data for the Pavia population. The target population (1991 Census) was represented by two groups: the first was equal to 49,326 residents (23,627 males and 25,699 females) 45-64 years of age, the second was equal to 17,208 residents (7236 males and 9972 females) 65-74 years of age. RESULTS: The decline in mortality was mainly observed in males aged 45-64. Acute myocardial infarction attack rates showed a decline in 45-64 men and an increase in the oldest age group. CONCLUSIONS: The surveillance of coronary heart disease epidemiological data from 1986 to 1995 in this population showed a decreased mortality mainly attributable to the decline of attack rates in the youngest and only to case-fatality rates in the oldest age group.

[Socioeconomic indicators and mortality for ischemic cardiopathy in the RIFLE population. The RIFLE Group. Risk Factors and Life Expectancy]. / Indicatori socio-economici e mortalità per cardiopatia ischemica nella popolazione RIFLE. Gruppo RIFLE.

The aim of this paper was to evaluate the relationship between socioeconomic indicators (education, occupation and residence) and short-term CHD mortality in an Italian population sample. Socioeconomic indicators and major CHD risk factors (BMI, SBP, DBP, TOT-CH, HDL-CH and TRIG) were measured in 15,315 males aged 40-69 years; mortality data by cause were collected for the next six years. CHD mortality risk ratio (RR) in the different educational and occupational levels and by residence was computed by Cox proportional hazards models. The association between socioeconomic indicators and CHD risk factors was explored by covariance and logistic regression analysis. After six years, 632 men died, 181 of whom because of coronary fatalities. No association with educational level was found for CHD mortality (RR = 1.00 high, 0.69 intermediate, 0.92 low), nor did occupational level show a significant association. Urban vs rural residence (RR = 1.00) showed a RR for CHD mortality of 1.35. Adjustment for bio-behavioral risk factors did not change the above results; only mortality for CHD of urban vs rural residents increased (RR = 1.63, p < 0.003). By considering the interaction between schooling and occupation, it was found that education appropriated to occupational level was a protective factor. The study does not indicate any association between education/occupational level and CHD mortality in male RIFLE population samples. The mean level of major CHD risk factors within different educational/occupational levels supports these results. Status incongruity as well as residence in an urban environment proved to be risk conditions for CHD mortality.

Central motor conduction after magnetic stimulation in diabetes.

Central motor conduction times (CMCTs), obtained by means of magnetic stimulation of the motor cortex and spinal roots, were studied in 138 patients affected by diabetes mellitus but with no signs or symptoms of central nervous system (CNS) involvement. CMCTs were significantly increased in diabetic patients (p < 0.001, t-test) with respect to normal controls, with values exceeding upper confidence limits (mean +/- 2.5 SD of controls) in about 30% of patients. There was no correlation between CMCT delay and type of diabetes (insulin-dependent or non-insulin-dependent), patient age, disease duration, degree of metabolic control compensation, presence or absence of retinopathy or nephropathy, and presence or absence of peripheral or autonomic neuropathy. CNS involvement in diabetes mellitus is discussed. Particular emphasis is given to the sensitivity and reliability of CMCTs obtained by means of magnetic stimulation as a tool in the early diagnosis of CNS functional alterations in diabetes mellitus.

IDDM in the province of Pavia, Italy, from a population-based registry.A descriptive study.

OBJECTIVE: To report the incidence of insulin-dependent diabetes mellitus (IDDM) in the Province of Pavia, Italy, in the 0- to 29-year-old age-group between 1988 and 1992. Urban versus rural residence, socioeconomic level, and family size of IDDM cases were also investigated. RESEARCH DESIGN AND METHODS: A prospective register was established in 1988 to collect all newly diagnosed IDDM patients with onset before 30 years of age. The primary data source was based on notification of new cases by hospitals, out-patient clinics, family doctors, and pediatricians. The secondary and independent data source consisted of the registries of prescriptions for insulin syringes in the health districts of the province. RESULTS: In 5 years (1988-1992), 66 cases of IDDM in the 0- to 29-year-old age-group were identified. The completeness of ascertainment was 100% for the combined sources. Age-adjusted (world-standardized) incidence rates per 100,000 (95% confidence interval) were 9.52 (6.42-13.61), 6.72 (4.68-9.34), and 8.27 (6.42-10.58), respectively, for the age-groups 0-14, 15-29, and 0-29. The rates were higher for residents in urban areas. The number of children in the families of IDDM patients was significantly higher than in the reference population. CONCLUSIONS: Our data indicate the concordance of IDDM incidence rates with the North-Italian rates and a possible association of the disease with environmental factors. These factors might enhance the susceptibility to IDDM in genetically predisposed individuals.

The relationship between education and risk factors for coronary heart disease. Epidemiological analysis from the nine communities study. The Research Group ATS-OB43 of CNR.

In nine samples of adult populations (2707 males and 2871 females, aged 20-59 years) we studied the relationship between educational level and several lifestyle factors at risk for coronary heart disease (CHD), (i.e., smoking, alcohol consumption, dietary fat intake, sedentary behaviour at work and leisure) and the association between education and certain CHD risk factors (i.e., total cholesterol, HDL-cholesterol, triglycerides, systolic and diastolic blood pressure, body mass index). The data were analyzed separately in samples from North, Central and Southern Italy. The results show that educational level is often associated to the lifestyle factors considered here. This association was positive for both men and women for physical activity at leisure and work stress and only for women with respect to smoking. It was negative for both men and women for alcohol consumption and physical activity at work and for men only for cigarette smoking. The age-adjusted mean levels of the CHD risk factors show some significant differences among subjects with different educational levels, which were not always the same for the three geographical areas. This was with the exception of BMI in females, which appears negatively associated to education in all areas. These differences decreased after adjustments were made for daily cigarette smoking, wine consumption and dietary fat intake. Education seems to play a determining role in lifestyle, however, its direct and indirect effects on some major CHD risk factors are somewhat different in areas at different socio-economic conditions.

Relation between diet composition and coronary heart disease risk factors.

STUDY OBJECTIVE: The aim was to evaluate dietary intakes and their correlation to some risk factors for coronary heart disease. DESIGN: The study was a population based survey with random sample selection stratified by age and sex. PARTICIPANTS: 352 adults living in a small town in Northern Italy took part in the study. Response rate was 46% among females and 48% among males. Refusal to take part was mainly due to the large number of tests involved. MEASUREMENTS AND MAIN RESULTS: Diets were high in protein (animal/vegetable ratio 1.7 in women and 1.4 in men) and in fat and low in carbohydrates. The hypercholesterolaemic and atherogenic potential of the diet, evaluated by the cholesterol/saturated fat index, was high in about 50% of the population. The thiamin and riboflavin intakes were lower than the Italian recommended allowances in more than 60% of the people tested, whereas the vitamin A intake was more than adequate in about 70%. A positive association was found in the younger groups (men and women 20-39 years old) between some nutrient components (energy, alcohol, total and saturated fats) and some blood lipids. In the older people blood lipids were correlated with body mass index. CONCLUSIONS: The overall data indicate that a correlation exists between dietary intake and some risk factors for coronary heart disease; dietary intervention, at least in young adults, is suggested.