[The plan for prevention of obesity of ASL RMB, Italy]. / Prevenzione dell'Obesità: l'esperienza del piano attuativo aziendale per la prevenzione dell'obesità in una ASL romana.

Lazio District, by pointing out the guidelines of the "Obesity and Overweight for Lazio District Plan" (DGR no1166, 23/12/05), enacts the "National Prevention Plan 2005-2007". The Public Health Service for Food and Nutrition has been the main player of the Plan; the District and Department of Health of the District had a technical and organizational support role. Within the development of the Plan for prevention of obesity of ASL RMB, a technical multidisciplinary group was constituted and three more programs were developed, all of them were dedicated to promotion and support of breast-feeding, prevention of obesity and overweight in childhood and adulthood. The educational activity concerning promotion and support of breast-feed ing actively involved operators from consultory rooms and hospital staff from ASL. The reports about nutritional surveillance allowed a careful analysis of the service conditions and priorities. Special criticality facets have been pointed out such as the high prevalence of overweight (31%) and obesity (7%), the habit of skipping breakfast, a low fruit and vegetables consumption, a generally sedentary lifestyle and, during the intervention, the parents' low involvement. In geriatric age cases, a high malnutrition risk both for overnutrition and undernutrition was found in the elderly groups that were checked; the diets' nutritional density as well as the physical activity aspect recover an important role in the intervention planning. Moreover the discussions with catering companies were an important aspect in order to make several target groups aware. The globally considered experience highlighted positive elements of mobilization, consensus, reorientation of activities and resources, giving proof of the significance of integration concerning specifical aims of different company services. Nevertheless, the carrying on of such activities needs resource investments in the specifical area and enlargement of activities especially for the multisector-based efforts.

[Smoking cessation and weight gain]. / Trattamento per la disassuefazione dal fumo ed incremento ponderale.

Cigarette smoking is the single most important preventable cause of death and illness. Smoking cessation is associated with substantial health benefits, but weight gain after smoking cessation is perceived to be a barrier against quitting smoking. The aim of the study was to analyse predictors of weight gain after smoking cessation. The sample included 1067 residents, aged 18-70 years, in a health district of Rome who answered to an anonymous postal questionnaire. Among them 482 were former smokers; 398 provided lifetime histories of both body weight and smoking and were considered in the analysis. 52.5% (49.3% M; 60.5% F) reported weight gain after smoking cessation; among these 25.4% reported a weight gain > or =5 kg. The multivariate logistic regression analysis showed a direct association between female gender (OR 1.9, CI 95% 1.1-3.2), age - 45 years (45-65 years: OR 2.5, CI 95% 1.4-4.4; > 64 years OR 2.1, CI 95% 1.0-4.0), number of cigarettes per day >20/day (OR 3.8, CI 95% 1.3-11.5) and weight gain after smoking cessation. The relevance of weight gain following smoking cessation suggests that health benefits associated with smoking cessation may to some extent be negated by the detrimental effects on health of associated weight gain. Smoking cessation programmes should therefore consider incorporating follow-up support to prevent weight gain; regular measurements of body weight together with dietary indications and increase of physical activity are basic factors to implement in the intervention of smoking cessation.

[Mini Nutritional Assessment (MNA) and nutritional risk in elderly. A proposal of nutritional surveillance system for the Department of Public Health]. / Il Mini Nutritional Assessment (MNA) e la valutazione del rischio nutrizionale in età geriatrica. Proposta di un modello operativo di sorveglianza nutrizionale all'interno del Dipartimento di Prevenzione.

Objective of the study is to present an intervention model to evaluate nutritional risk of institutionalised elderly, suitably with the aims and resources of the Hygiene of Nutrition Services, and to individuate predictive variables of nutritional vulnerability. 237 subjects from the residential homes of ASL RMB were involved in the study; to each subject was administered: a) the Mini Nutritional Assessment (MNA); b) a questionnaire for the analysis of the risk factors. Multivariate logistic regression analysis was performed to evaluate the influence of the risk factors on nutritional status. On the basis of BMI the prevalence of malnutrition is 6.5% and the prevalence of overweight and obesity is respectively 41.6% and 22.9%; on the basis of MNA, 5.1% of the subjects is malnourished and 60.3% at risk for malnutrition. The absence of chewing difficulties (OR 2.94; I.C. 1.46-5.91) and the habit to eat all foods served at meals (OR 2.83; I.C. 1.46-5.91) are associated with a good nutritional status. The age > or = 90 years is a risk factor for malnutrition at the limit of statistical significance (OR 0.44; I.C. 0.14-1.00). Carrying out the MNA resulted easy and quick, confirming the hypothesis for feasibility of this protocol in the Hygiene of Nutrition Services. The results highlight an high nutritional risk of the elderly nursing home residents and the importance of planning programs of nutritional surveillance with particular attention on masticatory function impairments, meal intake and on the oldest subjects among the elderly as a group greatly vulnerable. We believe that these areas are very important in defining public health intervention programs.

Evaluation of an experimental periodontal ligament for dental implants.

To improve the devices used in dental implantology, a new experimental supporting element has been developed. The device, made of titanium, poly(methylmethacrylate) and Dacron tissue, has been tested for the osteointegrability of its outer Dacron coat by implants in mandibular bone of rabbits. The Dacron filamentous tissue became incorporated by the bone at 3 month post-implantation. This might provide a reliable mechanical anchorage of the device and a barrier against epithelial proliferation and microbial contamination. Preliminary results relating to in vitro evaluation of the poly(methyl methacrylate)-Dacron fixation strength predict favourable mechanical behaviour at this interface and in the complete implanted device.

Increased osmiophilia of glycosaminoglycan-like structures after fixation with cetylpyridinium chloride in human colonic mucosa.

The effects on tissue ultrastructural appearance of fixation with cetylpyridinium chloride (CPC)-additioned formaldehyde were studied at the ultrastructural level in human colonic mucosa. We found that CPC did not impair tissue morphology and induced a remarkable osmiophilia in glycosamino-glycan-like structures, which did not require further staining.

Ultrastructural immunolocalization of laminin and fibronectin in human large intestinal mucosa.

The ultrastructural expression of laminin and fibronectin was studied in human colonic mucosa with a pre-embedding immunoperoxidase technique. Both antigens were present in epithelial basement membrane. The lamina densa was uniformly and homogeneously immunostained by both fibronectin and laminin, while the lamina rara showed discrete, positive sites occasionally connecting the lamina densa with the epithelial plasma membrane. In the lamina reticularis, fibronectin was diffusely positive, while laminin showed a discontinuous positivity only in the uppermost region in vicinity of the lamina densa. Collagen fibrils were regularly decorated by fibronectin-positive material. Basement membranes in the capillary wall showed a similar pattern of reactivity both with laminin and fibronectin. These results point out that laminin as well as fibronectin are integral components of intestinal mucosa basement membranes.

Sulphated glycosaminoglycans expression in the basement membranes of colorectal adenocarcinomas. Preliminary study: correlation with histological grading.

The expression of sulphated glycosaminoglycans was studied at the ultrastructural level by the high iron diamine technique in the basement membranes of 26 colorectal adenocarcinomas (10 well-differentiated, 7 moderately-differentiated, 9 poorly-differentiated). Sulphated glycosaminoglycan expression was highly variable. It was scored as regular (5 cases), slightly irregular (6 cases), highly irregular (15 cases). In general, poor histological differentiation could be correlated with absent or highly irregular expression. However, in a limited number of cases, severe alterations of basement membranes were also present in well-differentiated (2 cases) and moderately-differentiated (4 cases) tumours. Such a variability shows up a heterogeneity which is not revealed by histological grading.

Ultrastructure of the absorptive cell glycocalyx in hyperplastic colonic polyps after staining with alcian blue and high iron diamine.

The glycocalyx of absorptive cells in large intestinal hyperplastic polyp was characterized histochemically at the electron microscope level by the use of the Alcian Blue pH 2.5 and high iron diamine techniques with the aim of comparing their ability in preserving the fine reticular network of the structure. Both the reagents stained glycocalyx, indicating the presence of sulphated acidic glycoconjugates. However, they showed different degrees of condensation of the reactive sites. Alcian Blue preserved its filamentous appearance better.

Ultrastructural identification of sulphated glycoconjugates in the Golgi apparatus in human colonic absorptive cells.

The subcellular localization of sulphated glycoconjugates was determined at the ultrastructural level by using the high iron diamine (HID) technique for sulphate groups in the absorptive cells of human colonic mucosa. Stained material was observed on the apical plasma membrane, in intracytoplasmic vesicles and in the Golgi complex. In this organelle, the last two or three cisternae of the trans side and the trans-Golgi network (TGN) were labelled, as well as a variable number of coated and noncoated vesicles facing the trans side and surrounding trans-Golgi network. These findings point to the trans side of the Golgi apparatus and trans-Golgi network as the subcompartments functionally involved in the sulphation of glycoconjugates.

Expression of interphasic nucleolar organizer regions in normal, dysplastic and neoplastic colorectal mucosa.

Silver-binding nucleolar organizer region (Ag-NOR) expression in interphasic nuclei was studied in normal, dysplastic and neoplastic colorectal mucosa at the light microscope level and by means of an image analyser (IBAS II). Both methods showed a progressive increase in the mean number of Ag-NOR sites per nucleus from mild dysplasia to invasive carcinoma. Ag-NOR counts differed significantly in the various classes of lesions (P less than 0.001), except between moderate and severe dysplasia (P greater than 0.05). Severe dysplasia showed a mean number of NORs lower than that for invasive carcinoma though an overlap in the respective frequency distributions was observed. The mean of the variances of the mean dot areas per cell nucleus (pooled variance) also showed a step-wise increase from normal to neoplastic lesions, indicating a greater variability in NOR size as a characteristic of malignant cells. A similar increase was observed in the percentage of nuclear area occupied by Ag-NORs. The mean area per silver-stained dot was also measured in the different classes of lesions by IBAS II. Data obtained showed no significant differences among the values. In conclusion, the wide overlap between the frequency distributions does not allow consideration of the Ag-NOR count alone to be a reliable marker of malignant transformation in a single cell. It appears that the study of Ag-NOR number needs to be evaluated together with dot anisometry in order to be a useful criterion in distinguishing the biological behaviour of neoplastic lesions in colorectal mucosa.

Influence of cetylpyridinium chloride on the ultrastructural appearance of sulphated glycosaminoglycans in human colonic mucosa.

The effect of adding cetylpyridinium chloride to the fixative on the preservation of sulphated glycosaminoglycans (SGs) was studied in human normal colonic mucosa. SGs were visualized at the ultrastructural level through the application of Spicer's High Iron Diamine (HID) technique followed by a post-fixation with potassium ferrocyanide-reduced osmium tetroxide. SGs were mainly localized in basement membranes of epithelium and capillary wall and along collagen fibers. The morphology of the reactive sites depended on the presence of cetylpyridinium chloride, SGs being granular in absence of the salt and more or less elongated when cetylpyridinium chloride was added to the fixative. We suggest that the use of cetylpyridinium chloride during fixation may help to preserve SG molecule at the ultrastructural level.

Hepatitis B in children in Italy: incidence and risk factors: SEIEVA Collaborating Group. Sistema Epidemiologico Integrato dell'Epatite virale Acuta.

The objectives of the present report were to give a baseline picture of hepatitis B notification incidence rates in children before the campaign of mass vaccination for newborns and adolescents (12-13 years old), and to study the role of different risk factors. Data from a specific national surveillance system of acute viral hepatitis (SEIEVA, Sistema Epidemiologico Integrato dell'Epatite Virale Acuta) were used and acute hepatitis B cases were compared to acute hepatitis A patients with the case-control study method to estimate the associations with the considered risk factors. Since the system began, one hundred and sixty-three local health departments have joined SEIEVA covering 30% of the Italian population. The incidence of acute hepatitis B notifications among 0-14 aged children was 9 per 100,000 in 1985 and 1 per 100,000 in 1990. Such decline in incidence was observed in both the North and the South of Italy. Surgical interventions, dental therapy and household contacts with a HBsAg chronic carrier were found to be associated with acute hepatitis B. The point estimate of the odds ratio was 10 for the latter risk factor. Other preventive measures in addition to vaccination are needed to control the risk of hepatitis B infection and other parenteral diseases due to surgical intervention and dental therapy.