Determinants of weight, psychological status, food contemplation and lifestyle changes in patients with obesity during the COVID-19 lockdown: a nationwide survey using multiple correspondence analysis.

INTRODUCTION: The corona virus disease 2019 (COVID-19) pandemic forced most of the Italian population into lockdown from 11 March to 18 May 2020. A nationwide survey of Italian Clinical Nutrition and Dietetic Services (Obesity Centers or OCs) was carried out to assess the impact of lockdown restrictions on the physical and mental wellbeing of patients with obesity (PWO) who had follow-up appointments postponed due to lockdown restrictions and to compare determinants of weight gain before and after the pandemic. METHODS: We designed a structured 77-item questionnaire covering employment status, diet, physical activity and psychological aspects, that was disseminated through follow-up calls and online between 2 May and 25 June 2020. Data were analyzed by multiple correspondence analysis (MCA) and multiple linear regression. RESULTS: A total of 1,232 PWO from 26 OCs completed the questionnaires (72% female, mean age 50.2 ± 14.2 years; mean BMI 34.7 ± 7.6 kg/m2; 41% obesity class II to III). During the lockdown, 48.8% gained, 27.1% lost, while the remainder (24.1%) maintained their weight. The mean weight change was +2.3 ± 4.8 kg (in weight gainers: +4.0 ± 2.4 kg; +4.2% ± 5.4%). Approximately 37% of participants experienced increased emotional difficulties, mostly fear and dissatisfaction. Sixty-one percent reduced their physical activity (PA) and 55% experienced a change in sleep quality/quantity. The lack of online contact (37.5%) with the OC during lockdown strongly correlated with weight gain (p < 0.001). Using MCA, two main clusters were identified: those with unchanged or even improved lifestyles during lockdown (Cluster 1) and those with worse lifestyles during the same time (Cluster 2). The latter includes unemployed people experiencing depression, boredom, dissatisfaction and increased food contemplation and weight gain. Within Cluster 2, homemakers reported gaining weight and experiencing anger due to home confinement. CONCLUSIONS: Among Italian PWO, work status, emotional dysregulation, and lack of online communication with OCs were determinants of weight gain during the lockdown period.

[Elevated blood pressure in adolescents from Rome, Italy. Nutritional risk factors and physical activity]. / Valori elevati di pressione arteriosa: ruolo di fattori nutrizionali e stili di vita.

Aim of the study was to detect the prevalence of hypertension among 11-14 years old schoolchildren (n. 487, mean age 12.7 +/- 0.9). The influence on blood pressure (BP) of body mass index (BMI), dietary habits (frequency of breakfast and food items consumption) and life-style was also investigated. Hypertension was defined according to blood pressure tables for children and adolescents of the NIH-Fourth Report (systolic and diastolic BP >95th percentile for age and sex). Overweight and obesity were determined according to the International Obesity Task Force Dietary habits and life-style were investigated by specific questionnaires. The prevalence of overweight and obesity was respectively 31.8% and 10.3% of the subjects studied. Moreover 10.3% of them showed BP values between 90th and 95th percentile and 10.1% was hypertensive. In general the prevalence of overweight (p < 0.05), obesity (p < 0.001) and sedentary activity (p < 0.05) was higher in hypertensive adolescents. The multivariate logistic regression analysis showed a direct association between obesity (OR = 4.35; IC 95% = 2.24-8.44), sedentary life-style (OR = 2.38; IC 95% = 1.17-4.63) and hypertension. Food habits were not associated with BP levels. The results confirmed that an increase of cardiovascular risk in early age was correlated with the increase of the prevalence of obesity and sedentary life-style. Regular measurement of BP together with healthy dietary and life-style indications are recommended to overweight/obese children and adolescents.

[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.

Intralesional beta-interferon treatment of cervical intraepithelial neoplasia associated with human papillomavirus infection.

AIMS AND BACKGROUND: Interferons (IFN) have offered considerable advances in the therapy of genital warts even those associated with cervical intraepithelial neoplasia (CIN); intralesional therapy either alone or in combination with other modalities such as cryosurgery and laser surgery provides improved clearing and cure of these often recalcitrant lesions. The purpose of this study was to evaluate the effectiveness of intralesional IFN therapy in patients with CIN associated with human papillomavirus (HPV) infection. METHODS: Beta-IFN was injected intra-perilesionally into the cervix in 41 patients with CIN associated with HPV infection. RESULTS: The regimen of 3 million international units (IU) injected intralesionally daily in the 1st week and 3 times a week in the 2nd and 3rd weeks for a total of 11 injections and a total dosage of 33 million IU yielded an 80 percent cure rate and may be more advantageous than other treatment options in certain instances. Cytocolposcopic and histologic examination was carried out before and after treatment and 24 lesions were also analyzed for type-specific papillomaviruses using in situ DNA hybridization. CIN disappeared in 33 patients 6 months after the end of therapy. Side effects of intralesional IFN therapy are dose related and for the most part readily tolerated. CONCLUSIONS: Intralesional IFN proved to be effective treatment for CIN associated with HPV infection (cure rate: 80%) and well accepted because hospitalization is not required and no important side effects occur.

Idiopathic vulvodynia. Clinical evaluation of the pain threshold with acetic acid solutions.

Idiopathic vulvodynia is vulvar discomfort in which a diagnosis has not yet been established. As in other idiopathic pain syndromes, the involvement of primary afferent fibers (PAFs) has been postulated as playing a role in the pathogenesis and maintenance of idiopathic vulvodynia. Capsaicin induces the release of substance P (SP) by PAFs, producing vasodilation and increasing vascular permeability (neurogenic inflammation). Likewise, it has been shown that acid solutions can stimulate PAFs with the release of SP. To evaluate the pain threshold in women with idiopathic vulvodynia, 10 patients with vulvar pain but without significant vulvar physical changes and 10 asymptomatic controls received topically applied acetic acid solutions with increasing hydrogenionic concentrations (pH 3, 2.5, 2, 1.5, 1.2). Results related to pain threshold and pain time monitoring and intensity were analyzed with Fisher's exact and Wilcoxon's tests, respectively. Our data suggest that in idiopathic vulvodynia the pain threshold for acid solutions is decreased, probably in relation to increased sensitivity of PAFs involved in the transduction of painful signals.

Vulvar lichen sclerosus. Immunohistologic evaluation before and after therapy.

In 20 women with vulvar lichen sclerosus (LS) we analyzed the immunohistologic features of the dermal lymphoid infiltrate and the number of epidermal CD1a+ cells (Langerhans cells). Activated (HLA-Dr+) T cells, associated with CD1a+ accessory cells, were found in the dermis in all cases. The number of CD1a+ epidermal cells was increased, and the cells expressed strong HLA-DR+ staining. These findings suggest activation of the skin immune system in vulvar LS lesions. Conventional 2% testosterone therapy failed to modify the immunohistologic features. Clobetasol, 0.05%, application seemed more effective in down-regulating the skin's immune system activation profile.

Clinical and histologic effects of topical treatments of vulval lichen sclerosus. A critical evaluation.

A randomized study was conducted on 79 patients with vulval lichen sclerosus who were treated for three months with four topical drugs including testosterone (2%), progesterone (2%), clobetasol propionate (.05%) and a cream based preparation. To evaluate the efficacy of the treatments, patients were examined before and after therapy for symptoms, gross appearance of the lesions and histopathologic features. Patients treated with clobetasol had a better response than responses recorded in the other groups. Remission of symptoms occurred in 75% of patients treated with clobetasol compared to 20% treated with testosterone, 10% treated with progesterone and 10% treated with a cream based preparation. The clobetasol group was the only group with gross changes and histologic evaluations before and after treatment, that showed a highly significant difference (P < .001). In a condition characterized by epidermal atrophy, we observed a significant reduction in epidermal atrophy after treatment. This study suggests that clobetasol propionate (.05%) (a very potent topical steroid) is the therapy of choice in vulval lichen sclerosus.

Testosterone maintenance therapy. Effects on vulvar lichen sclerosus treated with clobetasol propionate.

OBJECTIVE: To evaluate the possible effects of topical testosterone as maintenance therapy after clobetasol propionate treatment. STUDY DESIGN: Thirty-two patients with biopsy-proven vulvar lichen sclerosus (LS), after 24 weeks of treatment with 0.05% clobetasol propionate cream, were randomly distributed into two groups of 16 each and treated for a further length of time (24 weeks) with testosterone 2% ointment or a cream-based preparation (placebo). The patients were examined before and after treatment for symptoms, gross aspects and histologic features. RESULTS: With clobetasol propionate all patients had a marked improvement (P < .001) in both clinical and histologic parameters. After clobetasol propionate therapy, the 16 testosterone-treated patients had significant worsening of their symptoms (P < .05%) and no evident changes in gross aspects (P = NS). The placebo-treated group had good symptomatic control of their disease, with no significant changes in symptoms or gross aspects (P = NS). CONCLUSION: After the good results obtained with clobetasol propionate, treatment with testosterone appeared to have a negative effect, while a regularly provided emollient cream was useful in symptom control.

[Human papillomavirus infections in the lower genital tract of women]. / Le infezioni da human papillomavirus (HPV) del basso tratto genitale femminile.

Viral infections of the lower female genital tract have gained increasing clinical, epidemiological and cyto-histopathological relevance in the last few years. From January 1981 to December 1990, 14,090 patients who referred to the center of cervical-vaginal-vulvar physiopathology of the Ob/Gyn Institute (University of Florence), underwent a cytologic, colposcopic and, if necessary, histologic examination. Patients were divided in two groups: the first group consisting of 8635 women and relating to the period 1981-1986, the second group consisting of 5455 patients and relating to the period 1987-1990. This division in groups was necessary because vulvoscopy (after 3-5% acetic acid application) was performed as a routine examination starting in 1987, so that the former period could not be considered homogeneous to the latter for vulvar results. About genital condylomatosis were made some observations: localization, morphology and the different prevalence in the various age groups verifying the statistic reliability using chi 2 test. Finally the association of intraepithelial neoplasias to HPV infection was related to the age of patients, localization and morphology of condylomatous lesions. In the first group 466 patients (5.4%) were affected by genital condylomatosis, 1041 patients (19.1%) were affected in the second group. The yearly prevalence of HPV infection increased during the decade of observation changing from 1.9% of 1981 to 21% of 1990. The prevalence of condylomatous lesions reduces significantly as the age increases (p < 0.0001) showing a maximum of prevalence under twenty-five years of age. Genital condylomatosis is localized in most cases (76%) in a single seat of the lower genital tract and cervical localization is the most commonly involved (43.13% in the first group; 42.65 in the second). Sporadic is the vaginal localization as the sole one. The vulvoperineal seat, after the cervical, is the most frequently involved (1st group: 29.82%; 2nd group: 31.03%). It seems that HPV infection assumes different morphologies according to its localization, generally flat on the cervix and florid at vulvo-vaginal level.(ABSTRACT TRUNCATED AT 400 WORDS)

[Clobetasol vs. testosterone in the treatment of lichen sclerosus of the vulvar region]. / Clobetasolo vs testosterone nel trattamento del lichen scleroso della regione vulvare.

The paper describes a study carried out in 40 patients affected by lichen sclerosus (LS) of the vulva. The mean age of patients was 60.9 years (range 27-83) and 31 were in menopause. Patients were divided randomly into two groups of 20. The symptoms (itching, burning, pain, dyspareunia), clinical aspects (atrophy, hyperkeratosis, sclerosis) and histological alterations (atrophy of the epithelium, edema, inflammatory infiltrate, fibrosis) were quantified in each patient by a score. The mean scores relating to the three parameters examined were then calculated for each group. One group was treated with testosterone propionate 2% and the other with a strong synthetic corticosteroid, clobetasol dipropionate 0.05%. After 24 weeks of treatment patients were again evaluated in relation to clinical (symptoms and clinical aspects) and histological parameters, following the procedure used before the start of treatment. The mean scores obtained were then compared with those before the start of treatment. Statistical analyses were performed using Student's t-test. Testosterone was found to be effective in relation to symptoms but no significant change was observed in relation to clinical aspects and histological alterations. It also caused major secondary effects which led to the suspension of treatment in one patient. Clobetasol was shown to be highly effective both in relation to symptoms and in terms of clinical aspects and histological alterations, and did not cause any noteworthy collateral effects, especially contact dermatitis. In the context of the objective parameters examined in this study, sclerosis and hyperkeratosis were easily modified by corticosteroid treatment in comparison to atrophy, especially in those patients with a longer duration of disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[Radiosurgical excision in the treatment of cervical intraepithelial neoplasia]. / La radiochirurgia escissionale (REP) nel trattamento della neoplasia cervicale intraepiteliale.

39 patients affected by CIN had undergone radio surgical excision. This non-traumatic method employs 3.8 MHz radio waves are employed to cut and/or coagulate. The radio surgical excision was carried out by a loop electrode, or microneedle, according to the colposcopic, histologic and microcolpohysteroscopic characteristics of the cervical lesion. In fact 14 patients, among whom 11 affected by CIN I and 4 by CIN II with a total visibility of squamous columnar junction and not extended lesion of the cervical canal, had undergone radio surgical excision through various dimensions loop according to the size of the tissue to be excised. Whereas 10 CIN II patients who had not entirely visible squamous columnar junction or large cervical canal lesion, and 14 CIN III patients underwent to radiosurgical conization through a subtle and extensible tungsten thread according to the size of the tissue to be excised. In the 100% of the both groups the recovery was confirmed after three and six months. Inno cases cervical canal stenosis was observed and the squamous columnar junction resulted well visible. In both groups no thermal damages on the excised tissue, which could create difficulties on the histological diagnosis, were observed. Therefore, this method resulted an easy and cheap technique to be executed in surgery with excellent results under the therapeutic and economical aspect.

[Treatment of female genital condylomatosis with intramuscular beta interferon]. / Trattamento della condilomatosi genitale femminile con beta-interferone per via intramuscolare.

Intramuscular injections of beta-interferon were used to treat a first group of 64 outpatients with clinically diagnosed genital condylomata at single doses of 3 x 10(6) IU for 10 consecutive days. A second group of 30 patients affected by HPV genital infection has been treated with placebo intramuscular injections. Patients were checked at 3, 6 and 12 months after therapy and twice during a one year follow-up after the disappearance of the warts. In the first group 29 patients (45.3%) were cured after 3 months, another 6 after 6 months and 1 patient after one year. In the second group only 3 (10%) patients were cured after 3 months, while in 2 cases (6.7%) lesions disappeared after 6 months (p value less than 0.001). Therapy was most effective on flat lesions in the cervical area. Follow-up of the patients with complete regression of lesions showed three recurrences of condylomatous lesion.

[Increase of hypertension among adolescents in Rome]. / Notevole aumento di soggetti ipertesi tra gli adolescenti romani.

AIM: The aim of this study was to investigate the prevalence of overweight/obese and hypertensive roman adolescents belonging to a medium-low social environment. The purpose of this research was also to find out the correlations between high blood pressure and obesity, dietary habits and physical activity. METHODS: Nutritional status of 474 subjects (age 12.7+/-0.9 years) of a low-medium social class public school was assessed by measuring height, weight and waist circumference according to international indications. Over-weight and obesity were defined by body mass index (BMI) according to International Obesity Task Force (IOTF). Blood pressure (BP) was measured in duplicate and hypertension was defined by international percentiles. Food habits and lifestyle were investigated by a questionnaire. Multivariate logistic regression was used to relate variables. RESULTS: The prevalence of overweight and obese adolescents was respectively 31.7% and 10.3% with a slight higher presence of males in both cases. The whole sample showed a prevalence of hypertension of 10.1%. Systolic and diastolic BP showed a direct association with BMI and waist circumference (P<0.01). BMI and systolic and diastolic BP were lower in active students (>7 h a week of physical activity). Food habits were not associated with hypertension. CONCLUSIONS: The high prevalence of hypertensive adolescents could be explained with the consistent number of overweight/obese subjects, their social medium-low context and their being sedentary. As reported in literature, all these factors may contribute to the ''metabolic syndrome'' aetiology.

[Vulval vestibular papillomatosis: anatomo-clinical study]. / La papillomatosi vestibolare vulvare: studio anatomo-clinico.

Vestibular papillomatosis of the vulva is only by some authors considered as a viral lesion, and its origin is controversial. A study of 44 women with vestibular papillomatosis was undertaken, and in all the cases biopsies of vulvar skin were taken. We did not reveal any presence of koilocytotic change suggestive of viral infection, and no human papillomavirus sequences were detected by DNA probe technique. These results suggest that this vestibular papillomatosis of the vulva can be considered as an anatomical variant of the vestibular mucosa. Only in case of viral over-infection, ablative treatment is justified.