[Knowledge of oral hygiene amongst adolescents in Lombardy, Italy]. / Le conoscenze sull'igiene dentale di un gruppo di adolescenti lombardi.

The study evaluated oral hygiene knowledge among a group of 12-year-old students in Lombardy, Italy (n=182). Two different questionnaires were administered, respectively to adolescents and to their parents. Results indicate a low level of general knowledge on this topic. Factors influencing knowledge include the number of learning sources and yearly access to a dental clinic. The described situation highlights the need to implement school-based educational interventions.

[The "Smoke-free hospital" project: prevalence of smokers in a large hospital in Pavia (Italy) from 2006 to 2010]. / Il progetto "Ospedale senza fumo": indagine sulla prevalenza dei fumatori nell'ambito dell'Azienda Ospedaliera di Pavia dal 2006 al 2010.

This study was conducted in the context of the "Smoke-free Hospital" project and its aims were to describe the prevalence of smokers among employees and patients of the Hospital of Pavia from 2006 to 2010, and to evaluate its determinants. The target population was represented by all employees (healthcare and other staff) and patients (inpatients and outpatients) of the Hospital of Pavia. Data collection took place by means of two self-administered and anonymous questionnaires (one for employees and one for patients). Overall, 3,996 employees and 2,301 patients completed the questionnaires. The prevalence of smokers among participating individuals remained largely unchanged in the observed period. The percentage of smokers among employees ranged from 21.88% in 2007 to 23% in 2006, while among patients it ranged from 16.67% in 2006 to 24.05% in 2008. Knowledge about tobacco-related issues was found to be poor and did not change over time. The low response rate did not allow us to generalize results to the entire target population. However, results indicate the need for health promotion campaigns both among hospital employees and among the general population, to raise awareness regarding the risks of tobacco smoking and to reduce the prevalence of smokers.

["Let's play with the Earth": a project of environmental education for primary school children]. / "Giochiamo con la Terra": un progetto di educazione ambientale per la scuola primaria.

OBJECTIVE: Raising awareness and knowledge in Pavia Public Primary School students, and indirectly in their parents, about environmental problems like waste recycling and energy saving, developing with games the concept of separate collection of rubbish; creating an environmentally conscious awareness and sense of responsibility towards sustainable behavior. DESIGN: The educational program lasted six months. Data collection was performed using anonymous questionnaires, administered to "treated" students at the beginning and at the end of the program. The "control" population only answered a single questionnaire at the end of the project. It was also carried out an assessment of the fallout of the project on parents, through a questionnaire at the beginning and at the end of the program. At the end of the educational intervention, a satisfaction questionnaire was administered to teachers. SETTING AND PARTICIPANTS: The enrolled population was composed of 1,358 students from 3rd, 4th and 5th classes of Public Primary Schools of the four Pavia School Districts: 938 "treated" students followed the program and 420 "controls" only answered the final questionnaire. MAIN OUTCOME MEASURES: The data concerning the pupils' knowledge are expressed in terms of frequencies: at first, we evaluated the comparison between "treated" students knowledge at the beginning and at the end of the program in each class, then we made the comparison between "treated" and "control" students at the end of the program. RESULTS: The comparison of the final questionnaires ("treated" students vs "controls") revealed in "treated" students higher knowledge of terms "waste" (94.5% vs 89.0%) and "separate collection" (97.3% vs 90.7%): the differences are statistically significant. Also the practice of separate collection of rubbish is more frequent in "treated" students' families than in "control" ones (83.5% vs 71.4%, p =0.0001).The analysis of teachers' satisfaction questionnaires showed positive ratings with high average scores for each item investigated. The analysis of parents' questionnaires revealed that 99.8% of them knows the meaning and 89% practice separate collection of rubbish. CONCLUSION: The program has proved effective in increasing students' short-term knowledge and making also families more interested in problems like waste recycling and separate collection of rubbish. The need of an awareness and environmental education campaign for the general population is apparent and the role of children, promoting knowledge and environmental behaviour changes in parents and community, has not to be underestimated.

[Evaluation of the efficacy of a school-based program to prevent tobacco smoking among adolescents in Lombardy (Italy)]. / Valutazione dell'efficacia del programma "Liberi di decidere", per la prevenzione del tabagismo nella Scuola Secondaria di secondo grado.

The program "Free to choose" was a school-based program aimed at encouraging secondary school students to lead healthy lifestyles and free from tobacco smoke. The project was part of a wider project named "Free from tobacco smoke", implemented in kindergarten, elementary and secondary schools in Lombardy (Italy). The "Free to choose" program was a controlled, non randomized study involving 2,145 subjects aged 16 years, of whom 1,063 participated in the activities laid out by the program (treatment group) and 1,082 only completed the questionnaires (control group). The program did not achieve the aim of reducing the number of subjects who start smoking. However, an increased awareness of the risks of smoking was observed among "treated" subjects as well as an increased number of non smokers who intend to refuse a cigarette if they were offered one.

[Surveillance of the health status of the population of the city of Parona (Italy), Phase 2]. / La sorveglianza dello stato di salute della popolazione del Comune di Parona (PV) (II Fase).

This study is part of a prospective study, which started in the year 2000, to monitor the health status of the population of the city of Parona, a previously agricultural area which has been transformed in a prevalently industrial area. This is the second phase of a project regarding the epidemiological surveillance of this population. The aim of the project was to detect changes in the health status of the population, particularly with regard to respiratory diseases associated with air pollution. Data was collected through the use of a questionnaire and a spirometry test. A control group was used in both parts of the study; control subjects lived in the city of Rovescala. In total 1484 subjects were invited by letter to participate and 399 (27%) accepted. The mean age of participants was 48 years (range 15-74 years). Only 149/399 (37%) subjects had participated in part 1 of the study. No significant changes were found in respiratory symptoms during the period considered. Three hundred eighty six subjects underwent spirometry testing, 36 of which (9%) were found to have an abnormal result. A moderately increased prevalence of obstructive airway signs on spirometry was registered in female participants, with respect to the year 2000 (5.9% vs 2.6%). On the other hand, the prevalence of restrictive signs remained similar in both males (1,7% vs 2,4%) and females (2% vs 1,5%). The spirometry changes detected in the149 subjects (65 male and 84 female) who participated in both parts of the study (parts 1 and 2) were most likely age-related. No significant differences were found with respect to the control group, although the prevalence of obstructive signs among males was greater in the city of Parona (9.2% vs 6.9%.

[Smoking habits among 13-18 year old students in Lombardy]. / L'abitudine al fumo tra gli studenti dai 13 ai 18 anni di età in Lombardia.

OBJECTIVE: to describe the prevalence of smokers among 13- 18-years-old students in Lombardy and to evaluate some related motives. DESIGN: a survey has been carried out with anonymous questionnaires, distributed at the beginning of the school year 2005-2006. SETTING: the study involved 3,593 classes of the third year of middle school and 2,893 classes of the second and the fifth year of high school, sampled among all the schools of Lombardy. PARTICIPANTS: the study interested 11,494 students aged either 13, 15 or 18. MAIN OUTCOME MEASURES: the prevalence of habitual smokers was 6%, 26.5% and 33.2%. RESULTS: a higher percentage of smokers report to have low school performances and to receive more than 15 euros as weekly tip. The number of smokers among family components and friends always appears higher for smoker students. Unemployed fathers and working mothers were higher among smokers. Both parents of smoker students have a lower educational level. CONCLUSION: an organized and systematic regional surveillance could highlight some characteristics of smoking habit among young students useful to set health education programs and to evaluate the efficacy of interventions already being carried out. Besides, it could enhance the awareness of the problem.

[New indications for the prevention of cardiovascular diseases]. / Nuovi indirizzi per la prevenzione delle malattie cardiocircolatorie.

Cardiovascular diseases represent the first cause of death and disability in Italy. The main reversible risk factors are high levels of LDL-cholesterol, hypertension, tobacco-smoking, diabetes and/or metabolic syndrome and poor physical activity (at leisure). The prevalence of these risk factors is high in adult Italian population. Cardiovascular diseases prevention should start early in life, with health promotion programs aimed at the acquisition of a healthy lifestyle in communities such as schools and worksites. Besides the "cardiovascular risk score" should be used by general practitioners in order to screen adult population and to lower risk factors levels.

[Survey among GP's about their smoking habits, opinions and behaviours in smoking prevention in Lombardy (Northern Italy)]. / Indagine conoscitiva sulle abitudini al fumo, le opinioni e l'attività di prevenzione del tabagismo tra i medici di medicina generale della Lombardia.

OBJECTIVE: to analyze smoking habits, opinions on smoking, curriculum and smoking prevention activities carried out by general practitioners in the Lombardy Region (Northern Italy). DESIGN AND PARTICIPANTS: between 2000 and 2002 a questionnaire about tobacco smoke retrieved from the European Project "GPs Empowerment" has been sent to 5348 general practitioners in the Lombardy Region. The questionnaire focuses on the difference of opinions and activity between smoking and non-smoking physicians. We analyzed 3571 questionnaires voluntarily filled. RESULTS: The prevalence of smokers among the general practitioners in the Lombardy Region was 22.3% (CI95% 21-24%), (M: 24.2%, CI 95% 22-26% and F: 17.8%, CI 95% 15-20%). Physicians could play a role in the prevention of tobacco: 98.7% (CI 95% 98-99%) agree about the effectiveness of counseling but only 65.6% (CI95% 64-67%) regularly counsel their patients about smoking-related diseases and quitting. In this paper, we estimated that 963% (CI95% 96-97%) non smoking GPs consider counseling useful for their patients vs 92.6% (CI 95% 91-94%) of smoking physicians (p <0. 001); GPs who think to represent a model for people are more frequent among non smokers (97.5%, CI95% 97-98% vs 89.3%, CI 95% 87-91%;p <0.001). Those who discuss with their patients about tobacco addiction and cessation are 68.9% (CI95% 67-71%) among non smokers vs 53.4% (CI 95% 50-54%) among smokers (p <0.001). Finally 67% (CI 95 % 65-69%) interviewed physicians lacked a specific training in smoking prevention. Among them, 87.4%(CI 95% 86-89%) would attend the courses. CONCLUSION: this finding could be useful for planning or enhancing activities aimed at improving preventive and cessation methods.

Evaluation outcomes of a sex education strategy in high schools of Pavia (Italy).

AIM: We aimed to provide process and effectiveness evaluations of a sex education intervention realized with interactive techniques in high schools of Pavia (Italy). METHODS: Six public high schools, divided into 'treated' and 'control' units, voluntarily joined this mixed-methods study. Only second-year classes were enrolled: treated adolescents followed a sex education course, performed by trained 'near-peer educators' (undergraduate medical students) with interactive techniques. All adolescents compiled an anonymous effectiveness evaluation questionnaire at baseline (pre-test) and 3 months later (post-test). Sexual knowledge and reported behavioural changes were compared between the two groups through linear mixed-effects models. The process was assessed through a satisfaction questionnaire for treated students, monitoring cards for working group members and cards/diaries for educators. RESULTS: The final sample consisted of 547 treated and 355 control adolescents (mean age = 15.28 ± 0.61 years). Highly significant changes (p < 0.001) from pre-test to post-test, with strong improvements of treated adolescents, were evident for all knowledge items. No significant changes for behavioural items were reported. Process evaluation showed positive results in adolescents' satisfaction, highlighting the need for more youth gathering places. Working group members and educators generally provided positive evaluations, although difficult communication was perceived. CONCLUSIONS: The intervention was effective in improving adolescents' sexual knowledge. The present work highlighted that in Italy sex education in adolescence is still neglected: this could encourage misinformation and health-risk behaviour. Young people perceive the need for a serious health-promoting action in which they could play an active role, spreading educational messages with organized interactive methods.

Dietary fat intake as risk factor for the development of diabetes: multinational, multicenter study of the Mediterranean Group for the Study of Diabetes (MGSD).

OBJECTIVE: To investigate the role of dietary factors in the development of type 2 diabetes. RESEARCH DESIGN AND METHODS: In the context of the Multinational MGSD Nutrition Study, three groups of subjects were studied: 204 subjects with recently diagnosed diabetes (RDM), 42 subjects with undiagnosed diabetes (UDM) (American Diabetes Association criteria-fasting plasma glucose [FPG] > or =126 mg/dl), and 55 subjects with impaired fasting glucose (IFG) (FPG > or =110 and <126 mg/dl). Each group was compared with a control group of nondiabetic subjects, matched one by one for center, sex, age, and BMI. Nutritional habits were evaluated by a dietary history method, validated against the 3-day diet diary. In RDM, the questionnaire referred to the nutritional habits before the diagnosis of diabetes. Demographic data were collected, and anthropometrical and biochemical measurements were taken. RESULTS: Compared with control subjects, RDM more frequently had a family history of diabetes (49.0 vs. 14.2%; P < 0.001), exercised less (exercise index 53.5 vs. 64.4; P < 0.01), and more frequently had sedentary professions (47.5 vs. 27.4%; P < 0.001). Carbohydrates contributed less to their energy intake (53.5 vs. 55.1%; P < 0.05), whereas total fat (30.2 +/- 0.5 vs. 27.8 +/- 0.5%; P < 0.001) and animal fat (12.2 +/- 0.3 vs. 10.8 +/- 0.3%; P < 0.01) contributed more and the plant-to-animal fat ratio was lower (1.5 +/- 0.1 vs. 1.8 +/- 0.1; P < 0.01). UDM more frequently had a family history of diabetes (38.1 vs. 19.0%; P < 0.05) and sedentary professions (58.5 vs. 34.1%; P < 0.05), carbohydrates contributed less to their energy intake (47.6 +/- 1.7 vs. 52.8 +/- 1.4%; P < 0.05), total fat (34.7 +/- 1.5 vs. 30.4 +/- 1.2%; P < 0.05) and animal fat (14.2 +/- 0.9 vs. 10.6 +/- 0.7%; P < 0.05) contributed more, and the plant-to-animal fat ratio was lower (1.6 +/- 0.2 vs. 2.3 +/- 0.4; P < 0.05). IFG differed only in the prevalence of family history of diabetes (32.7 vs. 16.4%; P < 0.05). CONCLUSIONS: Our data support the view that increased animal fat intake is associated with the presence of diabetes.