Gluten-free meals in public catering.

BACKGROUND: The Piedmont Region, the Food Hygiene and Nutrition Services of the Local Healthcare Authorities of the Piedmont Region (coordinated by ASL TO 3), and the Italian Coeliac Association Piedmont Onlus, have created a theoretical-practical training pathway for Food Business Operators to ensure a safe gluten-free meal. STUDY DESIGN: The aim of the study is to perform a retrospective analysis of the data collected in order to assess whether the Food Business Operators will be able to manage in the short, medium and long term audits (3-month audits, 6-month audits and 1-year audits) all the production stages of a gluten-free meal (storage, production. METHODS: We have analysed the check-list used for assessing the gluten free meal, recorded from 2010 to 2016 by the staff of the Food Hygiene and Nutrition Services. They were filled out during three educational audits and they refer to 81 facilities. RESULTS: Two-hundred and forty-three audits were conducted (3 per facility). During all stages of production of gluten-free meals (short, medium and long term), non-compliant aspects had decreased (not statistically significant). The data analysis showed a slight increase in non-compliant aspects after a 1-year storage, the trend of non-compliant aspects slightly decreased during the three production stages, the service stage registered a slight upward trend, and finally, during the basic requirements stage and control plan stage, non-compliant aspects were in sharp decline (statistically significant). CONCLUSIONS: The decrease of non-compliance guarantees safety and protection of the celiac subject, even if storage and services must be monitored more carefully in the medium term.

Celiac disease and school food service in Piedmont Region: Evaluation of gluten-free meal.

INTRODUCTION: The Law 123/2005 recognizes celiac disease as a social disease and so Ministry of Public Health annually allocates specific resources to Regions for managing gluten-free meals in school canteens. Therefore in 2009 Piedmont Region approved a specific project, in collaboration with Food Hygiene and Nutrition Department (SIAN) of several ASL (Local Health Authority), including ASL TO3 as regional leader, and the "Italian Celiac Association - Piedmont and Valle d'Aosta". This project was intended to facilitate the natural integration of celiac people in social life. A retrospective analysis of data has been carried out to assess the management of gluten- free meal of school food services in Piedmont Region in 2010. Furthermore the intervention efficacy has been evaluated comparing the critical points observed in 2010 and 2012. METHODS: The object of the study includes primary and secondary schools that have provided gluten-free food service in Piedmont Region. These school were examined by SIAN staff. (the examination included the check of hygienic aspects and qualitative assessment of the meal). The data were collected using the same checklist throughout the region. All data were included in the unified regional system ("Reteunitaria"). RESULTS: The results show that 29% of the sampled schools (277) are acceptable in all eight sections (supply, storage, process analysis, equipment check, packaging and transport, distribution of meals, self-control plan and qualitative assessment), whereas 71% are inadequate for at least one of the profiles (60% does not perform the qualitative valuation of service) and in 18% of schools three to seven insufficiencies are observed. Correlations between the number of total insufficiencies and the most critical sections of the check list were performed (with lower scores in "good") such as process analysis, distribution of meals, self-control plan and qualitative assessment. The analysis process has achieved a high score in the field of deficiency for at least 3 parameters. Schools with a good self-control plan have a significant correlation with schools suitable for the analysis process, instead schools appeared insufficient in the process analysis have an increased chance of being insufficient also in the distribution of meals. The schools that provide a transported meal (municipalities highly populated, generally) have many differences in distribution of meals respect schools that prepare food in the school kitchen. In fact, 88% of school that provide a transported meal achieved an appropriate score in distribution of meals section and collected fewer failures in overall assessment than the others. 120 structures are included in the indirect comparison between the checklist's sections with criticisms, during years 2010 and 2012: in 2010 32% of schools were recorded acceptable in all of the eight sections of the checklist and in 2012 this percentage rose to 54%. An improvement can be observed in all areas, but a statistical significant result do not turn out. DISCUSSION AND CONCLUSIONS: Data show that carry on the control activities of production of gluten free meal in school canteens would be appropriate. Actions focused on improving the methods of preparing meal without gluten were recommended, especially in under populated municipalities with school kitchen on site. The constant presence of ASL staff in school has promoted important changes: cultural change and about the management of allergy and food intolerance. An improvement can be observed: a transition from a suspicion about "special diet" management to an appropriate and responsible management of meals for children and young people suffering from this specific condition.

Food supplements: survey of the ASL TO3.

INTRODUCTION: In recent years, the increase of the consumption of supplements reveals problems concerning the safety of use. Current legislation states that supplements must be free of any therapeutic purpose and must have quality guarantees for the users' safety. The operators of the of Hygiene, Food and Nutrition Service (SIAN) of ASL TO 3 (province of Turin) conducted a surveillance in order to asses the situation on the territory, to know the use and consumption in local gyms. During the official control at the manufacturers / packers of supplements, located on the territory of the ASL TO 3, labels of supplement produced / packed were acquired, to analyze the components indicated, to carry out a deep evaluation of the individual product . METHODS: Updating of the register of companies located in the territory of the ASL TO 3 was carried out; and during the period October 2011-March 2013 the labels of the products of these companies have been found and analyzed. The detailed content of the labels (ingredients, dose, method of recruitment, composition, etc. ..) was written in a database. It was also checked how many local gyms marketed supplements, and, in a small sample, a questionnaire was administered to visitors, in order to assess consumption. RESULTS: 355 labels were acquired and loaded on the database. 80% of them falls within the category of supplements based on ingredients derived from plants or similar. For these products was evaluated the presence on the label of not allowed plant extracts (according to the Ministerial Decree of 9 July 2012): only 2 products (of the same company) contained an ingredient not allowed. In all the examined labels was evaluated the presence of the substances for which there are specific warnings: 97% of the label is compliant and 3% are not in compliance. In the analyzed products the indications for use mainly found on the labels are related to increased demand and/or reduced intake, followed by antioxidant action. The study also evaluated the sale of supplements at gyms located on the territory of ASLTO3: 59 gyms are available on territory, but only in one of them supplements are sold. Some customers of these gyms have filled a questionnaire concerning the consumption of supplements. The processing of the questionnaires showed that 27% of respondents in the past 2 years used only occasionally food supplements. For 42% of the subjects the use of these products was to achieve weight loss, for 33% for athletes and 17% have used specific products in the case of particular physiological situations such as pregnancy and lactation. The reasons that lead to the use of dietary supplements, in all cases, are attributed to the improvement of health status. In addition, in 50% of cases the pharmacist has led to the use of these products or, alternatively, friends and relatives. The general practitioner is often not informed even in case of disturbances introduced after their use (seen in 8% of our sample). The majority of the sample (58%) said that they had benefited from the use of supplements and they are aware (68%) that there could be contraindications. CONCLUSIONS: A greater knowledge of the topic, with attention focused on the entire supply chain of the product, is essential to ensure the safety of consumers in the use of food supplements. For these reasons a more detailed check on the procedure is essential: selection and verification of suppliers (especially for raw materials coming from Eastern countries, because they are not subjected to a thorough inspection); traceability of products marketed; correspondence between manufactured and authorized products. Finally, promote an awareness campaign at all levels is necessary, including general practitioners for a conscious purchase.

Comparison of inter-observer reproducibility between conventional chest radiography and AMBER in the evaluation of silicosis.

The aims of this study were to test inter-observer and intraobserver agreement in the diagnosis of silicosis using conventional chest radiography and AMBER. One hundred and fifteen patients underwent chest x-rays and AMBER for the diagnosis of silicosis. Five readers blindly and independently evaluated the radiograms with standard ILO/UC classification scales. Reproducibility was assessed using ANOVA repeated measurements methods. AMBER showed a better technical quality of radiograms than conventional chest x-rays; interobserver reproducibility was high and similar (R = 0.75); intraobserver agreement between chest x-rays and AMBER was high ranging from 0.62 to 0.86 for the 5 readers. Notwithstanding the absence of standards for profusion classification, the interobserver reproducibility with AMBER was similar to that obtained with chest x-rays. Moreover, the intraobserver agreement in profusion scoring between AMBER and chest radiography was high, suggesting that AMBER and chest radiography provided similar information in the evaluation of silicosis.