The biological index of frailty: A new index for the assessment of frailty in human skeletal remains.

OBJECTIVE: Frailty is the physiological stress that individuals suffer during their life. In past populations, frailty is conventionally assessed through the occurrence of different biomarkers of biological stress. Some efforts have been made to propose indexes that combine all biomarkers. However, these indices have some critical limitations: they cannot be used on incomplete skeletons, do not consider the severity and/or healing of lesions, and assign equal importance to different biomarkers. To address these limitations, we propose a new index to assess frailty in skeletal individuals. MATERIAL AND METHODS: By statistically analyzing a large amount of osteological data available from the Museum of London, and using a Logit model, we were able to define a different weight for each reported biomarker of frailty, based on their importance in increasing the risk of premature death for the individuals. RESULTS: The biological index of frailty (BIF) is the weighted mean of all biomarkers scored on the individuals, according to a different degree of importance assigned to each one. It also considers the severity and healing of the biomarkers when this is relevant to diagnose frailty. We applied BIF on a sample of Monastics and Non-Monastics from medieval England and compared it with the skeletal index of frailty (SFI). DISCUSSION: BIF is the first frailty index that gives a different weight to each skeletal biomarker of stress, considers both severity and healing of the lesions, and can be applied on partial skeletal remains. The comparison with SFI showed that BIF is applicable to a larger number of skeletal individuals, revealing new differences between the Monastic and the Non-Monastic groups.

Autopsy or anatomical dissection: evidence of a craniotomy in a 17th-eighteenth century burial site (Ravenna, Italy).

Surgical procedures undergone in life, autopsies and anatomical preparations can all leave clearly identifiable traces on human skeletal remains. Several studies on skeletons from archeological contexts have identified traces of these practices. However, the distinction between medical/forensic autopsy and anatomical dissections for scientific research can be challenging. We report the case of a middle-aged female skeleton from the cemetery of the church of San Biagio (Ravenna, Italy), dating back to the 17th-19th centuries, that shows signs of a complete craniotomy. In an attempt to clarify the reason for this practice, we analyzed all pathological and non-pathological markers on the skeleton. We carried out anthropological analyses and osteometric measurements to determine the biological profile and the cranial capacity of the individual. Paleopathological investigation and analyses of traumatic injury patterns were carried out using both a morphological and a microscopic approach. While we observed that the craniotomy was performed with a rip saw, we identified perimortem blunt force trauma to the frontal bone and an osteolytic lesion on the inner surface of the frontal bone. No other pathology was recognizable on the skeleton. Our differential diagnosis confidently proved that the craniotomy was due to an autoptsy procedure and was not the result of an anatomical dissection. We believe that, among other possible reasons, failed surgery could likely be the motive behind the ordering of the autopsy.

Body image perception and body composition: assessment of perception inconsistency by a new index.

BACKGROUND: A correct perception of the body image, as defined by comparison with actual anthropometric analyses, is crucial to ensure the best possible nutritional status of each individual. Bioimpedance analysis (BIA) represents a leading technique to assess body composition parameters and, in particular, the fat mass. This study examined the self-perception of body image at various levels of adiposity proposing a new index. METHODS: We investigated 487 young Italian adults (mean age of males: 21.9 ± 2.4 years; mean age of females: 21.0 ± 2.2 years). Each subject could choose, on the Contour Drawing Rating Scale, the silhouette that he/she considered most resembling his/her perceived body image as well as his/her ideal body image. On each subject, we performed anthropometric measurements and determined the values of Fat mass and  %Fat with BIA. A new index, FAIFAT (Feel fat status minus Actual fat status Inconsistency), was developed to evaluate possible fat status perception inconsistencies by BIA. RESULTS: Based on ideal and feel body image comparison, women showed higher dissatisfaction than men and preferred slimmer silhouettes. FAIFAT values indicated that the fat status perception was correct in the majority of the examined individuals and only three subjects showed a serious misperception. CONCLUSIONS: Our findings suggest that FAIFAT is an appropriate index for assessing the perceived fat status from the body image when compared with data obtained by BIA. In a population, the use of this index will allow the correct identification of groups at risk for eating disorders.

Sex determination in cremated human remains using the lateral angle of the pars petrosa ossis temporalis: is old age a limiting factor?

The significant role of the petrous bone in sex assessment of skeletal human remains has been highlighted by several studies. In previous work we applied the method of the measurement of the lateral angle of the petrous bone to a sample of cremated human remains of known age and sex from an Italian crematorium; the low accuracy of sex classification obtained was probably due to the high number of elderly individuals in our sample. In this paper we investigate the relationship between age and alterations of the petrous bone, by applying the same methodology we used previously, measuring the lateral angle of the petrous bone, in a new sample group that was subdivided into three different age groups. Results showed a moderate rate of accuracy in sex assessment for the first two age groups, for which a new sex-discriminating sectioning point was found; however, the method was found not to be applicable for individuals over 70 years of age. Measurement of the lateral angle in adults aged between 20 and 70 years is a reliable method for sex assessment of cremated remains in conjunction with classical methods, in both archaeological and forensic contexts.

Violence in the Early Bronze Age. Diagnosis of skull lesions using anthropological, taphonomic and scanning electron microscopy techniques.

In this paper we present the study of a skull belonging to a young male from the Italian Bronze Age showing three perimortem injuries on the frontal and parietal bones; the peculiarity of the frontal injury is represented by its singular shape, which may be indicative of the weapon that caused the lesion. The aim of the present study is to examine the traumatic evidence in relation to possible etiological factors, in order to attempt to establish if the lesion occurred peri or post-mortem, and to evaluate if these traumatic injuries could be interpreted as an evidence of interpersonal violence, by combining anthropological, taphonomic and ESEM investigations. The combination of multidisciplinary methods of study can provide important new insights into inter-personal violence.

Performance prediction models based on anthropometric, genetic and psychological traits of Croatian sprinters.

Elite athletes differ from each other in their characteristics according to their discipline. This study aimed to identify performance predictors in elite Croatian sprinters taking into consideration their anthropometric, psychological and genetic characteristics. One hundred and four elite Croatian sprinters (68 males and 36 females) participated in this study. Of them, 38 are currently competing in the 100-metre dash. The others are former sprinters. The participants underwent direct anthropometric assessment. Participants were also tested by means of the Competitive State Anxiety Inventory-2 and for ACE and ACTN3 polymorphisms. Multiple linear regression analysis was applied to identify the best model for performance prediction. Different models were developed for males and females. Anthropometric traits accounted for 44% of the variance in performance for males, 62% for females. Once other traits (psychological for females) were entered into the model, no additional contribution to the variance was observed. The most significant predictors of higher running velocity were bicristal diameter and foot dimensions in males, and leg length and clean one-repetition maximum in females. The findings suggest that performance in sprinters is associated with anthropometric characteristics, with biomechanical implications that may be used to provide a more complete evaluation of sprinters' performance.

Stature estimation from tibia percutaneous length: New equations derived from a Mediterranean population.

Stature is a fundamental anthropometric character to trace the biological profile of a person. In some cases, when dismembered or mutilated bodies are discovered in a forensic context, it is essential to estimate stature from single districts of the body. Nevertheless, to date and worldwide, there are only few population-specific studies on stature estimation from leg length and none of them concerns modern populations in southern Europe. We attempted to fill this gap, focusing on the estimation of stature from the length of the tibia in a Mediterranean population (Italians). We carried out the current study on a sample of 374 Italian university students of both sexes (age range: 19.9-34.4). Both, actual stature and percutaneous length of tibia were measured and new equations were developed for stature estimation. We tested separate regression equations for each sex, as well as an equation for remains, whose sex is unknown. To assess their reliability, the equations were tested on a holdout sample of 30 individuals from the same population. Moreover, results of new specific linear regression equations were compared to others from the literature. We demonstrated that the newly proposed formulae (for males and combined sexes) and the ones by Olivier (for females) provided the most reliable estimations of stature for southern Europeans.

Sports activities in preschool children differed between those born to immigrants and native Italians.

AIM: Despite the health benefits of physical activity in early childhood, little is known about sports practices in preschool children with different ethnic origins. The aim of this study was to investigate the sport activity patterns in native and immigrant children in northern Italy. The influence of some child and family determinants on the child's practice of club-organised sport was analysed to plan interventions. METHODS: The study group comprised 2682 preschool children (49.5% girls) aged 5.9 ± 0.3, 2396 fathers and 2478 mothers. All the children had their height and weight measured and their parents completed a self-administered questionnaire on their child's sports participation and family characteristics. RESULTS: Sports activities were significantly more frequent in native Italian girls than in native Italian boys and immigrant girls. Multiple linear regression analysis showed that the weekly amount of club-organised sport in preschool children was related to the sex and migrant status in the whole sample, to paternal educational level and occupation in the native-born sample and to paternal body mass index, offspring and paternal occupation in the immigrant group. CONCLUSION: This study highlighted the need to develop specific interventions for native and immigrant preschool children to promote a healthy lifestyle.

Body image perception of African immigrants in Europe.

Nutritional disorders are now spreading worldwide both in developed and developing countries. Body image ideals and dissatisfaction have been linked to a number of poor health outcomes, including nutritional disorders. While previous studies have offered insight into weight status and body image perception of immigrants in North America, very few studies have analysed these aspects in migrants from Africa to Europe. Our review examines the effects of the migration process on beauty ideals and body dissatisfaction in African immigrants in Europe compared to residents in their own countries. The PubMed, PsycINFO and Google Scholar databases were searched for studies published from January 2000 till November 2015. Of the 730 titles identified, 26 met the inclusion criteria and were included in the present review. Among African residents, the body preferences depend on the country of residence and their socio-cultural status. Ethnic groups living in great isolation or with low incomes still have an ancestral idea of beauty, preferring a shapely body. However ethnic groups living in urban areas are moving toward Westernization of beauty ideals, preferring underweight or normal weight bodies. This review highlights that both residents and migrants are at high risk of nutritional disorders due to the adoption of Western beauty ideals. The results suggest that body dissatisfaction and BMI are increasing from Southern Africa to Europe according to a geographical gradient (described for females by Spearman's coefficient and linear regression, respectively). We emphasize the need for monitoring of the weight and psychological status of immigrants and the development of specific preventive strategies in European countries.

Weight status, fatness and body image perception of North African immigrant women in Italy.

OBJECTIVE: To investigate the nutritional status of North African (NA) immigrant women in Italy, analysing their body size, adiposity and body image perception in comparison to Italian natives and NA residents. DESIGN: The study utilized a cross-sectional design. Anthropometric traits were directly measured and a few indices were computed as proxy measures of nutritional status and adiposity. Body image perception was assessed using silhouette drawings. ANCOVA, adjusted for age, was used to compare anthropometric traits among different groups of women and the χ 2 test to analyse differences in the prevalence of nutritional status. SETTING: Italy and North Africa (Tunisia, Morocco). SUBJECTS: A sample of 433 women aged 18-60 years old: NA immigrants (n 105); Italians (n 100); Tunisians (n 104); Moroccans (n 124). RESULTS: Overweight/obesity prevalence was very high in immigrants (79·8 %). Immigrants had the highest BMI value, the greatest hip circumference and mid upper-arm circumference. Their triceps skinfold thickness was significantly higher than that of Italians, but lower than that of NA residents. CONCLUSIONS: NA immigrant women in Italy showed a higher incidence of overweight compared with Italians and NA residents. All groups showed a preference for a thinner body in comparison to their actual bodies and the immigrants are the most dissatisfied. Immigrants remain a high-risk group for obesity. Assessment of their body composition and health risk profile should be improved by using specific anthropometric measures that are easy to collect even in the case of large migration flows.

New specific bioelectrical impedance vector reference values for assessing body composition in the Italian-Spanish young adult population.

OBJECTIVE: Specific bioelectrical impedance vector analysis (spBIVA) is a recently proposed technique for the analysis of body composition. The aim of this study was to apply spBIVA to a sample of Italian and Spanish young adults and to define the new bioelectrical references for this Western Mediterranean population. METHODS: A sample of 440 individuals (220 from Italy, 220 from Spain; 213 men, 227 women) aged 18-30 years was considered. Anthropometric (height, weight, relaxed upper arm, waist, and calf girths) and bioelectrical (resistance, reactance; 50 kHz, 800 µA) measurements were taken. In order to verify the need for new references, specific bioelectrical values were compared to the reference values for U.S. adults and Italian elderly by tolerance ellipses and Student's t test. RESULTS: The mean specific bioelectrical values (resistivity, Rsp, and reactivity, Xcsp, Ohm·cm) were: Rsp (332.7 ± 41.7 Ω·cm), Xcsp (44.4 ± 6.8 Ω·cm), Zsp (335.6 ± 41.9 Ω·cm) and phase (7.6 ± 0.8°) in men; Rsp (388.6 ± 60 Ω·cm), Xcsp (43.7 ± 7.5 Ω·cm), Zsp (391.0 ± 60.3 Ω·cm) and phase (6.4 ± 0.7°) in women. Italo-Spanish bioelectrical vectors were mainly distributed (>90%) in the lower part of the tolerance ellipses for U.S. young adults, due to a shorter impedance (P < 0.001), indicative of a lower percent fat mass. Compared to Italian elders, they were mainly located in the left side (>90%), due to a higher phase (P < 0.001), indicative of higher body cell mass. CONCLUSIONS: These population and age-related differences indicate the need for new specific tolerance ellipses that can be used as references for assessing body composition in young adults from Western Mediterranean populations.

Anthropometric parameters in relation to glycaemic status and lipid profile in a multi-ethnic sample in Italy.

OBJECTIVE: To examine the health status of ethnic minorities in Italy. Furthermore, we aimed to assess the association between anthropometric and blood parameters connected with health status. DESIGN: A cross-sectional study. Anthropometric data were collected by direct measurements and blood glucose, total cholesterol and TAG were analysed. SETTING: Bologna, northern Italy. SUBJECTS: A multi-ethnic sample of adult immigrants and Roma. RESULTS: Significant correlations between anthropometric and blood parameters were found. Among the ethnic groups, Roma males had the highest values of glucose, total cholesterol and TAG. In the females the situation was more balanced among ethnic groups. CONCLUSIONS: The data from this survey indicate that poor health status is a very common problem among ethnic groups living in Italy, especially the Roma. The use of anthropometric parameters as rapid indicators of health status in screenings of a large number of subjects could be an effective and cheap method to provide preliminary indications on individuals or ethnic groups at greater risk of poor health.

Giovanni Battista Morgagni: facial reconstruction by virtual anthropology.

Multidisciplinary research was carried out on human skeletal remains to identify if they belonged to the famous pathologist Giovanni Battista Morgagni, who died at a very old age and was buried in a church in Padua. The purpose of this study was to analyze the skull, creating a virtual model necessary for facial reconstruction, so as to contribute to the identification of the skull. The skeletal remains were found buried in the Morgagni family grave. Based on preliminary anthropological evidence, that the skull might be ascribable to Giovanni Battista Morgagni, a digitized model of the skull was created and restored. From this, a virtual facial reconstruction was developed using an assumed relationship between the soft-tissues and the underlying skeletal structure. Finally, the anthropological profile and the face reconstruction were compared with historical documentation and the portrait of Morgagni by Pietro Danieletti, showing clear similarities. Virtual anthropological techniques create new perspectives for anthropological and medical studies and can be used successfully in the forensic sciences to make a positive identification, such as in this case, which has been examined by different experts with similar results.

Body composition and physical activity in Italian university students.

BACKGROUND: Increased sedentary lifestyle and prevalence of overweight/obesity are common in western countries. The purposes of this study were (i) to assess the main health-related anthropometric characteristics in a sample of students in relation to sex, amount of physical activity and sport discipline, and (ii) to investigate the accuracy of the Body Mass Index (BMI) and Waist-to-Stature Ratio (WSR) as indicators of body fat percentage (%F) in young adults. METHODS: 734 university students, both sexes, participated in the present research. A self-administered questionnaire acquired socio-demographic information (sex, age) and sport participation (hours/week, sport discipline). Anthropometric measurements and grip strength values were acquired according to standardized procedures. Body composition was assessed by means of the skinfold method. RESULTS: Most students had normal BMI, WSR and %F. There were significant statistical differences in all anthropometric traits between the two sexes. One-way ANOVAs within sex showed statistically significant differences in biceps skinfold, waist circumference (WC), WSR, body density (BD), %F and fat mass (FM) among different levels of physical activity in males; and in weight, BMI, arm girths and fat free mass (FFM) in females. One-way ANOVAs within sex showed statistically significant differences in arm girths, grip strength and FFM among different sport disciplines in males, and in height, weight, BMI, WC, relaxed arm girth, grip strength, FM and FFM in females. Despite the significant and positive correlation of BMI and WSR with %F both indices had poor sensitivity. CONCLUSIONS: Physical activity plays an important role in body composition parameters: the most active males had the least amount of FM and the most active females had the greatest amount of FFM. BMI and WSR are not accurate indices of adiposity in young adults.

Body image and weight perceptions in relation to actual measurements by means of a new index and level of physical activity in Italian university students.

BACKGROUND: Body image perception depends on anthropometric and psychological factors. Body dissatisfaction is influenced by the socio-cultural environment and is associated with eating disorders and low self-esteem. This study examined the body image perception, the degree of dissatisfaction and the weight status perception inconsistency in relation to sex, weight status and amount of physical activity in a sample of university students. METHODS: The participants were 734 university students (354 females aged 21.5 ± 2.9 yrs and 380 males aged 22.1 ± 3.6 yrs) recruited from the second year of the Sport Sciences degree program. A self-administered questionnaire was used to acquire socio-demographic and sport participation information. Height, weight, BMI and weight status were considered for each subject. Body image perception was assessed by a silhouette matching technique. A new index, FAI (Feel status minus Actual status Inconsistency), was used to assess weight status perception inconsistency. RESULTS: A large proportion of the sample had normal weight status. On average, females chose as feel status a significantly higher figure than the males (4.7 versus 3.8) and they would have liked to have a significantly thinner figure than the males (3.4 versus 3.6). Therefore, the mean FID (Feel minus Ideal Discrepancy) values (positive in both sexes) were significantly higher in females than in males, meaning higher dissatisfaction. The mean FAI values were positive in females and negative in males, indicating a tendency of the women to overestimate their weight status and of the men to underestimate it. Men were more physically active than women. Less active women showed significantly lower body weight and BMI than more active women. Men less engaged in physical activity showed significantly higher FID than more active men. CONCLUSIONS: These results show greater dissatisfaction and higher weight status perception consistency in females than in males among Italian university students examined. Our findings suggest that the FAI index can be very useful to evaluate the perceived weight status by body image in comparison to actual weight status assessed anthropometrically.

Psychosocial health among immigrants in central and southern Europe.

Migration exposes people to a number of risks that threaten their health, including those related to psychosocial health. Self-perceived health is usually the main indicator used to assess psychosocial health. Electronic databases were used to examine the literature on the psychosocial health of immigrants in Europe and of North Africans living in their own countries. Immigrants of various ethnic groups show a similar risk of psychosocial disorders but generally present a higher risk than the local population. This risk is related to gender (being higher in women), poor socio-economic status and acculturation, discrimination, time elapsed since migration and age on arrival in the new country. Although the stressors and situations the different ethnic groups experience in the host country may be shared, the way they deal with them may differ according to cultural factors. There is a need to collect detailed data on psychosocial health among the various immigrant groups in Europe, as well as to monitor this aspect in North African residents who lack access to specific services.

Health, growth and psychosocial adaptation of immigrant children.

The increasing population diversity in Europe demands clarification of possible ethnic influences on the growth and health of immigrant children and their psychosocial adaptation to the host countries. This article assesses recent data on immigrant children in Europe in comparison to European natives by means of a systematic review of the literature on growth patterns and data on children's health and adaptation. There were wide variations across countries in growth patterns and development of immigrant children and natives, with different trends in Central and Northern Europe with respect to Southern Europe. In general, age at menarche was lower in immigrant girls, while male pubertal progression seemed faster in immigrants than in European natives, even when puberty began after. Owing to the significant differences in anthropometric traits (mainly stature and weight), new reference growth curves for immigrant children were constructed for the largest minority groups in Central Europe. Possible negative effects on growth, health and psychosocial adaptation were pointed out for immigrant children living in low income, disadvantaged communities with a high prevalence of poor lifestyle habits. In conclusion, this review provides a framework for the health and growth of immigrant children in Europe in comparison to native-born children: the differences among European countries in growth and development of migrants and non-migrants are closely related to the clear anthropological differences among the ethnic groups due to genetic influences. Higher morbidity and mortality was frequently associated with the minority status of these children and their low socio-economic status. The observed ethnic differences in health reveal the need for adequate health care in all groups. Therefore, we provide suggestions for the development of health care strategies in Europe.

Obesity and physical activity in children of immigrants.

Childhood overweight and obesity have increased in recent decades, reaching alarming proportions. Children with a migrant background seem to be particularly at risk of developing overweight and obesity. This article provides an overview of the prevalence of overweight or obesity among North African (NA) children living in their own countries or as immigrants in Europe. The aim is to show the effect of the migration process on this trend and to discuss its possible contributing factors. Publications were identified by a systematic search of PubMed and the existing literature. Original longitudinal or cross-sectional studies on the prevalence of childhood and adolescent overweight and obesity and of physical activity among ethnic groups from North Africa compared with the native population were reviewed. The results confirmed that children of NA origin in Europe have higher levels of overweight and obesity than the native ones, especially girls. However, this trend can also be detected in urban areas of NA countries. Important factors contributing to the increase of overweight and obesity among children and adolescents are discussed, in particular the westernization of eating habits, the level of physical activity and body image perception. The review shows that factors linked to acculturation in the host society and others maintained from the country of origin come into play in determining childhood overweight and obesity among NA immigrants in Europe. The importance of health promotion targeting the groups most at risk of childhood overweight and obesity, i.e. aspects of a healthy diet and the benefits of physical activity, is underlined.

Prevalence of overweight and obesity in adults from North Africa.

The share of North African immigrants in Europe is growing continuously. In this review, we aimed to systematically analyse and describe the literature on weight status and physical activity in North African adults, both in their home country and after immigration to Europe. Existing data on North African residents and on North African immigrants in Europe were analysed by a systematic search on PUBMED. There is a wide variation among countries in the prevalence of overweight/obesity, with immigrants showing higher values. The overall results revealed a higher prevalence of overweight and obesity in females than in males in North African residents. Females also show higher levels of obesity among immigrants. In particular, literature reports indicate that 1.3-47.8% of North African residents and 3.6-49.4% of North African immigrants in adult age are overweight or obese. Physical inactivity is higher than 20% in males and 40% in females in North African residents. The highest frequency of physically inactive or lightly active people among immigrants was observed in first-generation Sudanese and Moroccans in Amsterdam (males: 57.1%; females: 74.2%), with increasing rates in second-generation females. The results underline a higher health risk in North African immigrants than in residents. Specific public health strategies should be adopted in various populations of North African origin to control the obesity epidemic.

The COURAGE Built Environment Outdoor Checklist: an objective built environment instrument to investigate the impact of the environment on health and disability.

UNLABELLED: A tool to assess the built environment, which takes into account issues of disability, accessibility and the need for data comparable across countries and populations, is much needed. The Collaborative Research on Ageing in Europe (COURAGE) in Europe Built Environment Outdoor Checklist (CBE-OUT) helps us to understand when features of the neighbourhood environment have either a positive or negative impact on the accessibility of neighbourhoods for healthy ageing. The CBE-OUT is composed of 128 items that can be recorded when present in the evaluated environment. Audits were performed in households randomly selected from each cluster of the sample for Finland, Poland and Spain, following precise rules defined by experts. Global scores were computed both section by section and in the overall checklist, rescaling the resulting scores from 0 (negative environment) to 100 (positive). The total number of completed CBE-OUT checklists was 2452 (Finland, 245; Poland, 972; and Spain, 1235). Mean global score for our sample is 49.3, suggesting an environment composed both of facilitating and hindering features. Significant differences were observed in the built environment features of the three countries and in particular between Finland and the other two. The assessment of features of built environment is crucial when thinking about ageing and enhanced participation. The COURAGE in Europe project developed this tool to collect information on built environment in an objective evaluation of environmental features and is a recommended methodology for future studies. KEY PRACTITIONER MESSAGE: The CBE-OUT checklist is an objective evaluation of the built environment and is centred on technical measurement of features present in the environment and has its foundations in the concepts of disability and accessibility operating in the International Classification of Functioning, Disability and Health (ICF) model. The CBE-OUT checklist can be analysed using both the total score and the single section score, allowing an evaluation of the facilitating or hindering role of the environment and is usable for predictive analysis of ageing trends. The CBE-OUT checklist makes it possible to collect information about the built environment by means of an objective evaluation of environment features and is a recommended methodology for future studies about the built environment.