Characterizing Trends in the Use of Food Donations and Other Food-Related Community-Based Social Assistance Programs in a Cohort of New Food Bank Users in Quebec, Canada.

Objective: To characterize 12-month trends in the use of food donations and other food-related community-based social assistance programs (CB-SAPs) during the first year following the enrollment of new food bank (FB) users in Quebec, Canada. Methods: A cohort of 1,001 newly registered FB-users in Quebec from the Pathways Study were followed-up during 12-month following baseline assessment. Outcomes were monthly use of food donations and other food-related CB-SAPs. Main predictors were alternative food source utilization (AFSU) profiles: 1) exclusive-FB-users; 2) FB+fruit/vegetable-market-users; and 3) Multiple/diverse-AFS-users. Covariates included sociodemographic characteristics, health status, and major life events. We fit Bayesian hierarchical mixed-effect models, accounting for spatial clustering, temporal correlation, and censoring. Results: We observed an overall downward trend of food donation use among study completers (n = 745). Each AFSU profile had a distinctive monthly trend of food donation use, but probabilities of use across the three profiles overlapped, between 44% and 55%. The use of other food-related CB-SAPs was low and not correlated with AFSU profiles. Conclusion: De novo FB-users use food donations in different ways over time according to specific contextual AFSU profiles.

The Pathways study: a cohort study of new food-aid users in rural, semi urban, and urban areas of Quebec, Canada.

BACKGROUND: While considerable research has been conducted on household food insecurity (HFI), little research has examined the effects of food donation programs on users' living conditions. The Pathways study was established to investigate the long-term effects of food donation programs on food insecurity as well as other critical outcomes, such as diet, health, and social support. Herein, we describe the design of the Pathways Study and the participants' characteristics at baseline. METHODS: The Pathways study is a prospective cohort study of 1001 food-aid users in Quebec (Canada). We recruited newly registered users of food donation programs from 106 community-based food-aid organizations that partnered with the study. Baseline data were collected through face-to-face interviews from September 2018 to January 2020, with planned follow-up interviews at 12 and 24 months after enrollment. Household food insecurity, diet, food competencies, food shopping behaviors, perceived food environment, health status, social support and isolation, sociodemographic characteristics, housing conditions, negative life events, and the impacts of COVID-19 were assessed with validated questionnaires. RESULTS: The cohort included 1001 participants living in rural (n = 181), semi-urban (n = 250), and urban areas (n = 570). Overall, household food insecurity was reported as severe among 46.2% and moderate in 36.9% of participants. Severe household food insecurity was more prevalent in rural (51.4%) and urban (47.8%) areas compared to semi-urban (39%) areas. Overall, 76.1% of participants reported an annual income below C$20,000. Half (52%) had low education levels (high school or lower), 22.0% lived in single-parent households, and 52.1% lived alone. Most (62.9%) experienced at least one major financial crisis in the preceding year. CONCLUSIONS: Results show that newly registered users of food donation programs often have low-income and severe food insecurity, with major differences across geographical locations. The Pathways study is the first study designed to follow, over a 2-year period, a cohort of newly registered users of food donation programs and to quantify their trajectories of service use. Findings from the Pathways study might help adapt the community response to the strategies used by food-insecure households to feed themselves.

Engaging with community organizations to recruit and retain vulnerable adults: The Pathways Study.

•Researchers must overcome multiple barriers in recruiting and retaining research participants living in conditions of vulnerability.•A comprehensive recruitment strategy that combines various elements tailored to vulnerable populations is required.•Most studies describing recruitment and retention of participants from vulnerable populations pertain to clinical settings.•This study describes strategies and challenges in recruiting participants through community organizations.•This paper provides recommendations on recruiting and retaining people living in conditions of extreme vulnerability.

The epileptology of Aicardi-Goutières syndrome: electro-clinical-radiological findings.

OBJECTIVE: Although epileptic seizures occur in approximately a quarter of patients with Aicardi-Goutières syndrome (AGS), their phenotypic and electrophysiological characterization remains elusive. The aim of our study was to characterize epilepsy phenotypes and electroencephalographic (EEG) patterns in AGS and look for possible correlations with clinical, genetic and neuroradiological features. METHODS: We selected patients with an established AGS diagnosis followed at three Italian reference centers. Medical records, EEGs and MRI/CT findings were reviewed. EEGs were independently and blindly reviewed by three board-certified pediatric epileptologists. Chi square and Fisher's exact tests were used to test associations between epilepsy and EEG feature categories and clinical, radiological and genetic variables. RESULTS: Twenty-seven patients were enrolled. We reviewed 63 EEGs and at least one brain MRI scan per patient. Epilepsy, mainly in the form of epileptic spasms and focal seizures, was present in 37 % of the cohort; mean age at epilepsy onset was 9.5 months (range 1-36). The presence of epilepsy was associated with calcification severity (p = 0.016) and startle reactions (p = 0.05). Organization of EEG electrical activity appeared to be disrupted or markedly disrupted in 73 % of cases. Severe EEG disorganization correlated with microcephaly (p < 0.001) and highly abnormal MRI T2-weighted signal intensity in white matter (p = 0.022). Physiological organization of the EEG was found to be better preserved during sleep (87 %) than wakefulness (38 %). Focal slow activity was recorded in more than one third of cases. Fast activity, either diffuse or with frontal location, was more frequent in the awake state (78 %) than in sleep (50 %). Interictal epileptiform discharges (IEDs) were present in 33 % of awake and 45 % of sleep recordings. IEDs during sleep were associated with a higher risk of a epileptic seizures (p = 0.008). SIGNIFICANCE: The hallmarks of EEG recordings in AGS were found to be: disruption of electrical organization, the presence of focal slow and fast activity, and the presence of IEDs, both in patients with and in those without epilepsy. The associations between epilepsy and calcification and between EEG pattern and the finding of a highly abnormal white matter T2 signal intensity suggest a common anatomical correlate. However, the complex anatomical-electroclinical basis of AGS-related epilepsy still requires further elucidation.

What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review.

BACKGROUND: While responsible innovation in health (RIH) suggests that health innovations could be purposefully designed to better support health systems, little is known about the system-level challenges that it should address. The goal of this paper is thus to document what is known about health systems' demand for innovations. METHODS: We searched 8 databases to perform a scoping review of the scientific literature on health system challenges published between January 2000 and April 2016. The challenges reported in the articles were classified using the dynamic health system framework. The countries where the studies had been conducted were grouped using the human development index (HDI). Frequency distributions and qualitative content analysis were performed. RESULTS: Up to 1391 challenges were extracted from 254 articles examining health systems in 99 countries. Across countries, the most frequently reported challenges pertained to: service delivery (25%), human resources (23%), and leadership and governance (21%). Our analyses indicate that innovations tend to increase challenges associated to human resources by affecting the nature and scope of their tasks, skills and responsibilities, to exacerbate service delivery issues when they are meant to be used by highly skilled providers and call for accountable governance of their dissemination, use and reimbursement. In countries with a low and medium HDI, problems arising with infrastructure, logistics and equipment were described in connection with challenges affecting procurement, supply and distribution systems. In countries with a medium and high HDI, challenges included a growing demand for drugs and new technology and the management of rising costs. Across all HDI groups, the need for flexible information technologies (IT) solutions to reach rural areas was underscored. CONCLUSION: Highlighting challenges that are common across countries, this study suggests that RIH should aim to reduce the cost of innovation production processes and attend not only to the requirements of the immediate clinical context of use, but also to the vulnerabilities of the broader system wherein innovations are deployed. Policy-makers should translate system-level demand signals into innovation development opportunities since it is imperative to foster innovations that contribute to the success and sustainability of health systems.

Health-Related Quality of Life for Patients With Genetically Determined Leukoencephalopathy.

BACKGROUND: We attempted to characterize the health-related quality of life in patients with genetically determined leukoencephalopathies as it relates to the severity of clinical features and the presence or absence of a precise molecular diagnosis. METHODS: Health-related quality of life was assessed using the Pediatric Quality of Life Inventory model (Pediatric Quality of Life Inventory 4.0 Self- and Proxy-reports) on 59 patients diagnosed with genetically determined leukoencephalopathies. In total, 38 male and 21 female patients ranging from one to 32 years of age (mean nine years), as well as their parents, completed the Pediatric Quality of Life Inventory health-related quality of life measures. In addition, participants completed detailed standardized clinical assessments or questionnaires. The correlation between health-related quality of life results and the severity of the clinical features, as well as the presence or absence of a molecular diagnosis, were analyzed. RESULTS: Patients with more severe clinical features showed statistically significant lower total Pediatric Quality of Life Inventory scores. More specifically, lower health-related quality of life was noted in children with sialorrhea, gastrostomy, and dystonia and in children who use a wheelchair. CONCLUSIONS: Patients with more severe clinical features experience a lower quality of life. Our study further highlights the importance of addressing both physical and psychosocial issues and discussing perception of quality of life with both parents and children. A larger multicenter prospective study will be needed to further define the burden of these diseases and to identify modifiable factors.

What do we know about the needs and challenges of health systems? A scoping review of the international literature.

BACKGROUND: While there is an extensive literature on Health System (HS) strengthening and on the performance of specific HSs, there are few exhaustive syntheses of the challenges HSs are facing worldwide. This paper reports the findings of a scoping review aiming to classify the challenges of HSs investigated in the scientific literature. Specifically, it determines the kind of research conducted on HS challenges, where it was performed, in which health sectors and on which populations. It also identifies the types of challenge described the most and how they varied across countries. METHODS: We searched 8 databases to identify scientific papers published in English, French and Italian between January 2000 and April 2016 that addressed HS needs and challenges. The challenges reported in the articles were classified using van Olmen et al.'s dynamic HS framework. Countries were classified using the Human Development Index (HDI). Our analyses relied on descriptive statistics and qualitative content analysis. RESULTS: 292 articles were included in our scoping review. 33.6% of these articles were empirical studies and 60.1% were specific to countries falling within the very high HDI category, in particular the United States. The most frequently researched sectors were mental health (41%), infectious diseases (12%) and primary care (11%). The most frequently studied target populations included elderly people (23%), people living in remote or poor areas (21%), visible or ethnic minorities (15%), and children and adolescents (15%). The most frequently reported challenges related to human resources (22%), leadership and governance (21%) and health service delivery (24%). While health service delivery challenges were more often examined in countries within the very high HDI category, human resources challenges attracted more attention within the low HDI category. CONCLUSIONS: This scoping review provides a quantitative description of the available evidence on HS challenges and a qualitative exploration of the dynamic relationships that HS components entertain. While health services research is increasingly concerned about the way HSs can adopt innovations, little is known about the system-level challenges that innovations should address in the first place. Within this perspective, four key lessons are drawn as well as three knowledge gaps.

Associations between the local food environment and the severity of food insecurity among new families using community food security interventions in Montreal.

OBJECTIVES: To examine the association between the local food environment and the severity of food insecurity among new families using community food security interventions in Montreal. METHODS: In this cross-sectional study, we analyzed baseline data from 785 adults aged 18-65 years enrolled in the evaluation of the effects of organizations delivering community food security interventions in Montreal. The dependent variable was household food insecurity, while the independent variable was the local food environment, assessed through: location of the most frequently used grocery store, distance between the participant's residence and the community organization used, mode of transportation, walking time to the most frequently used grocery store, satisfaction with the acceptability and affordability of food available at the most frequently used grocery store, and self-reported difficulties in accessing food. We used polytomous logistic regression to estimate the association between household food insecurity and the local food environment. In all the models, we coded food security status in three categories: food security, moderate food insecurity and severe food insecurity. The last group was used as a reference group. RESULTS: Our data suggest that compared to households with severe food insecurity, those with moderate food insecurity (OR = 0.43, 95% CI: 0.28-0.62) and those with food security (OR = 0.13, 95% CI: 0.06-0.26) were less likely to report difficulties in accessing food due to food affordability. Food-secure households also had lower odds of reporting difficulties in accessing food due to transportation constraints (OR = 0.18, 95% CI: 0.06-0.55) compared with severe food-insecure households. Living a distance of between 1 and 2 km from the organization used was significantly correlated with moderate food insecurity (OR = 1.80, 95% CI: 1.12-2.88). CONCLUSION: The local food environment is associated with severity of household food insecurity among new families using community food security interventions in Montreal. Future studies should study the relationship between the local food environment and food insecurity across all dimensions of food access.

320-Row Multidetector CT Angiography in the Detection of Critical Cerebrovascular Anomalies.

BACKGROUND: The acquisition of a new 320-row multidetector computed tomography angiography (CTA) scanner at the Montreal Neurological Institute and Hospital has provided higher quality imaging with less radiation exposure and shorter time of acquisition. However, its reliability has not been fully proven in critical vascular lesions when it comes to replacing a more invasive examination such as cerebral angiography. We wished to validate the accuracy of this equipment to investigate four common indications for patients to undergo conventional digital subtraction angiography: subarachnoid hemorrhage, vasospasm, unusual intracerebral hemorrhage, and unruptured aneurysm. METHODS: Radiological reports and relevant imaging from 82 consecutive subjects who underwent a 320-row multidetector CTA followed by cerebral angiography from February 2010 to February 2014 were retrospectively analysed. A total of 102 cerebrovascular anomalies were found. Reports from both imaging modalities were compared to determine the diagnostic accuracy of CTA. RESULTS: The overall sensitivity and specificity of 320-row multidetector CTA for detecting cerebrovascular abnormalities were, respectively, 97.60% and 63.20%. Similar results were obtained for all four categories of clinical indications. CONCLUSION: Results obtained from CTA were consistent with those obtained on digital subtraction angiography regardless of the vascular pathology. To our knowledge, this study is the first validating the accuracy of 320-row CTA in diagnosing critical cerebrovascular lesions.

Paradoxically Decreased Mean Transit Time in Patients Presenting With Acute Stroke.

OBJECTIVE: Computed tomography perfusion (CTP) has become a mainstay in acute stroke management. The aim of this study was to investigate the occurrence of an unreported phenomenon of a paradoxically decreased mean transit time (MTT) in the cerebral area of ischemia. METHODS: In this retrospective study, patients with an acute anterior circulation ischemic stroke were selected. Computed tomography perfusion diffusion maps of all patients were reviewed by 2 blinded and experienced neuroradiologists. RESULTS: A total of 31 patients were included in the study. Eighteen subjects (58%) had a paradoxical MTT perfusion map, whereas only 13 (42%) had an expected CTP profile. No significant associations between the paradoxical MTT perfusion and the size of the infarct, the side of the occlusion, or the age of the patients were observed. However, a trend in collateral circulation status and paradoxical MTT was noted. CONCLUSIONS: A paradoxical MTT response is a frequent finding in CTP analysis of patients with acute stroke. Its presence is not associated to the location or size of the affected cerebral territory and could be related to the presence of collateral circulation.

Short-Term Effects of Traditional and Alternative Community Interventions to Address Food Insecurity.

BACKGROUND: Despite the effects of food insecurity on health are well documented, clear governmental policies to face food insecurity do not exist in western countries. In Canada, interventions to face food insecurity are developed at the community level and can be categorized into two basic strategies: those providing an immediate response to the need for food, defined "traditional" and those targeting the improvement of participants' social cohesion, capabilities and management of their own nutrition, defined "alternative". OBJECTIVE: The objective of this study was to evaluate the effects of food insecurity interventions on food security status and perceived health of participants. DESIGN: This was a longitudinal multilevel study implemented in Montreal, Quebec, Canada. Participants were recruited in a two-stage cluster sampling frame. Clustering units were community organizations working on food insecurity; units of analysis were participants in community food security interventions. A total of 450 participants were interviewed at the beginning and after 9 months of participation in traditional or alternative food security interventions. Food security and perceived health were investigated as dependent variables. Differences overtime were assessed through multilevel regression models. RESULTS: Participants in traditional interventions lowered their food insecurity at follow-up. Decreases among participants in alternative interventions were not statistically significant. Participants in traditional interventions also improved physical (B coefficient 3.00, CI 95% 0.42-5.59) and mental health (B coefficient 6.25, CI 95% 4.15-8.35). CONCLUSIONS: Our results challenge the widely held view suggesting the ineffectiveness of traditional interventions in the short term. Although effects may be intervention-dependent, food banks decreased food insecurity and, in so doing, positively affected perceived health. Although study findings demonstrate that food banks offer short term reprise from the effects of food insecurity, the question as to whether food banks are the most appropriate solution to food insecurity still needs to be addressed.

Neuroradiologic patterns and novel imaging findings in Aicardi-Goutières syndrome.

OBJECTIVE: To perform an updated characterization of the neuroradiologic features of Aicardi-Goutières syndrome (AGS). METHODS: The neuroradiologic data of 121 subjects with AGS were collected. The CT and MRI data were analyzed with a systematic approach. Moreover, we evaluated if an association exists between the neuroradiologic findings, clinical features, and genotype. RESULTS: Brain calcifications were present in 110 subjects (90.9%). Severe calcification was associated with TREX1 mutations and early age at onset. Cerebral atrophy was documented in 111 subjects (91.8%). Leukoencephalopathy was present in 120 children (99.2%), with 3 main patterns: frontotemporal, diffuse, and periventricular. White matter rarefaction was found in 54 subjects (50.0%), strongly associated with mutations in TREX1 and an early age at onset. Other novel radiologic features were identified: deep white matter cysts, associated with TREX1 mutations, and delayed myelination, associated with RNASEH2B mutations and early age at onset. CONCLUSIONS: We demonstrate that the AGS neuroradiologic phenotype is expanding by adding new patterns and findings to the classic criteria. The heterogeneity of neuroradiologic patterns is partly explained by the timing of the disease onset and reflects the complexity of the pathogenic mechanisms.

Food capacities and satisfaction in participants in food security community interventions in Montreal, Canada.

Food insecurity is steadily increasing in Canada. The objective of this paper is to determine if food capacities and satisfaction of recently enrolled participants in food security interventions are associated with the intervention having either a traditional or an alternative type of approach. Participants having recently accessed traditional (n = 711) or alternative community interventions (n = 113) in the Montreal metropolitan area, Canada, were interviewed with a questionnaire. The categorizing variable was participation in a community organization providing either traditional interventions, aimed to help people cope with the urgent need of food, or alternative interventions, aimed at first assistance, in addition to the creation of long-term solutions such as social integration and skills development. Participants' food and nutrition-related capacities and food satisfaction are studied. Multilevel regression models were used to assess whether participants took part in a traditional or alternative interventions. These interventions do not reach the same population. Relative to participants in alternative food security interventions, participants in traditional interventions demonstrated less capacity for accessing information about food safety and healthiness, and perceived their diet as less healthy. Traditional food security participants also paid less attention to the nutritional properties of food and reported less satisfaction with quantity, variety and taste of the food they accessed. The reasons why individuals who may benefit the most from alternative interventions were unlikely to participate should be investigated. The potential that food security interventions may inadvertently reinforce social inequalities in health should be considered in future intervention research.

320-Row Multidetector Computed Tomographic Angiogram in the Evaluation of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Pilot Study.

OBJECTIVE: To objectively assess the accuracy of 320-row multidetector computed tomographic (CT) angiography to diagnose cerebral vasospasm after a subarachnoid hemorrhage using a new quantitative method. METHODS: Fifty-four arterial segments were measured in 8 patients who had subarachnoid hemorrhage and underwent digital subtraction angiography within 24 hours after CT angiography for clinical suspicion of cerebral vasospasm. RESULTS: A correlation between arterial diameters measurements made on CT angiography and digital subtraction angiography was observed. The degree of vasospasm tended to be overestimated in the anterior circulation, with arterial diameters that were between 0.05 and 0.72 mm smaller than those on digital subtraction angiography. CONCLUSIONS: A quantitative approach can be used to objectively evaluate the ability of multidetector CT angiography to assess arterial diameter in patients with clinical symptoms of postsubarachnoid hemorrhage cerebral vasospasm. This pilot study also suggests that CT angiography may overestimate the degree of cerebral vasospasm in the anterior circulation.

Traditional and alternative community food security interventions in Montréal, Québec: different practices, different people.

Food insecurity is steadily increasing in developed countries. Traditional interventions adopted to tackle food insecurity, like food banks, address the urgent need for food. By contrast, alternative interventions, such as community gardens and kitchens, are oriented towards social integration and the development of mutual aid networks. The objective of this paper is to examine whether the populations served by traditional and alternative interventions in food security differ according to measures of vulnerability. We studied newly registered participants to food security interventions. Participants were selected from a random sample of food security community organizations in a two-stage cluster sampling frame. The categorizing variable was participation in a community organization providing either traditional interventions or alternative interventions. Seven measures of vulnerability were used: food security; perceived health; civic participation; perceived social support of the primary network, social isolation, income and education. Regression multilevel models were used to assess associations. 711 participants in traditional interventions and 113 in alternative interventions were enrolled in the study. Between group differences were found with respect to food insecurity, health status perception, civic participation, education and income, but not with respect to social isolation or perceived social support from primary social network. Traditional and alternative food security interventions seem to reach different populations. Participants in traditional interventions were found to have less access to resources, compared to those in alternative interventions. Thus, new participants in traditional interventions may have higher levers of vulnerability than those in alternative interventions.

Good practices and health policy analysis in European sports stadia: results from the 'Healthy Stadia' project.

Sport plays an important role within society and sports stadia provide significant settings for public health strategies. In addition to being places of mass gathering, stadia are often located in less affluent areas and are traditionally attended by 'harder to reach' communities. Unfortunately sports stadia and the clubs they host are rarely perceived as places that promote healthy lifestyles. Fast food, alcohol and tobacco are commonly advertized, served and consumed during sports games giving the spectators and TV fans contradictory messages concerning healthy choices. As part of a wider programme of work part-funded by the European Union, a study was therefore designed to explore current 'good practice' relating to positive health interventions in sports stadia across a number of European countries. Using a specially designed questionnaire, information about health policies and good practices relating to food offerings in stadia, physical activity promotion among local communities, tobacco policy, positive mental health initiatives, environmental sustainability practices and social responsibility policies were collected in 10 European countries (England and Northern Ireland, Finland, Georgia, Greece, Ireland, Italy, Latvia, Poland, Spain and Sweden) involving 88 stadia. The audit results show that stadia health policies differ considerably between specific countries and sports. Based on the literature analysed, the examples of good practices collected through the study, and the subsequent instigation of a European Healthy Stadia Network, it shows that there is considerable potential for stadia to become health promoting settings.

Reliability of cancer family history reported by parents in a case-control study of childhood leukemia.

PURPOSE: To investigate the reliability of family history of cancer reported by parents of children with acute lymphoblastic leukemia (ALL) and parents of healthy control children. METHODS: A total of 301 parents were selected based on positive or negative family history of cancer at baseline, case-control status, and gender of the respondent (mother or father). Baseline responses were compared with responses at the second interview using the same questionnaire. Reliability was measured using proportion of overall agreement, Cohen's kappa, and Cronbach's alpha; a logistic regression model was also used to assess the role of the case-control status on overall agreement as the dependent variable. RESULTS: The overall agreement between interviews was high and similar for cases (85 %) and controls (86 %); there were no consistent effects of respondent gender, age at first interview, or time elapsed between interviews on agreement measures. Agreement measures did not materially vary according to whether respondents were reporting about their mothers, fathers, or siblings. CONCLUSIONS: The study showed very good reliability of reporting family history among young parents of children affected with leukemia and parents of healthy control children.

["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.