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Aim: The study aimed to determine trends in the prevalence of underweight, overweight, obesity and their putative risk factors in different cohorts from a representative population of adolescents in Central Italy. Subject and methods: After random sampling, five cohorts of adolescents attending public high schools – aged 14 to 18 years – were evaluated from 2005 to 2018 (n: 25,174). Collected information included self-reported body mass index (BMI), descriptors of family environment, eating behaviour, physical activity, screen use, bullying victimisation, sexual behaviour (age at first intercourse, number of partners) and perceived psychological distress. For these data, between-cohort prevalence differences were used to esteem prevalence variations across time. In the 2018 cohort, the association between these factors and body weight was evaluated through multinomial regressions with sex-specific crude relative risk ratios for different BMI categories. Results: An increased prevalence of overweight was observed for both boys and girls. The study outlined a transition towards higher parental education and unemployment, reduced soft drinks consumption and higher psychological distress. Sex-specific changes were observed for physical and sexual activity, and a rising percentage of girls reported being bullied and distressing family relationships. Parental education and employment, together with physical activity, confirmed to be protective factors against pathological weight. The latter clustered with reduced soft drinks consumption, bullying victimisation, early sexual activity, worse family relationships and higher distress. Conclusion: An increased prevalence of both overweight and underweight was observed across time. Economic factors associated with unemployment and changes in behavioural patterns may have contributed to this trend.

Road traffic injuries are a major cause of mortality and morbidity in the Western world, and the relative contribution of alcohol to road traffic accidents has been well documented in [...], This article describes the potential contribution of alcohol and illicit drugs to increased risk of road accidents in Italy. Blood and urine samples were taken from patients admitted to five Emergency Rooms (ER) in metropolitan Florence, Italy, due to road traffic accidents within 3 hours of the accident. Seven hundred and thirty-five patients were tested to determine if alcohol and illicit drugs (amphetamines, opiates, cocaine, methadone, and cannabis) were present in urine and blood. Approximately 22% of patients were positive for at least one substance at night-time (20:00 to 5:59), and 18% were positive on the weekends (20:00 Friday to 05:59 Monday). Almost 80% of all alcohol-positive patients had a blood alcohol concentration (BAC) equal to or exceeding the legal limit. Findings indicated that alcohol and illicit drugs were important contributors to traffic accident risk and suggest prevention strategies for alcohol-related road accidents in Italy may need to follow those employed in other countries, including frequent and highly visible enforcement of drunk-driving laws. KEY WORDS: Road accidents, alcohol, psychoactive drugs, epidemiological study, BAC and emergency department, illicit drugs.

This section aims to describe the trend in alcohol consumption (and in consumption of wine in particular) in Italy over the last 30 years. To the best of our knowledge, [...], This article first considers all Italian national and local information sources dealing with alcohol consumption. Then the changes in amount and patterns of alcohol drinking which occurred in Italy during the last 30 years are examined. During the period of the 1970s to the 2000s wine intake dramatically decreased, while beer consumption, especially among youngsters, has increased. Also a decrease of risky drinkers and an increase in moderate drinkers is apparent. KEY WORDS: Statistical sources, national studies, ad hoc studies, decrease in amount of drinking.

Purpose: Adolescence represents a critical period for the onset of eating disorders (EDs). The present study aimed to provide the prevalence of individuals at risk for EDs psychopathology in a representative population of adolescents aged 14–19 and to characterize this population regarding interpersonal and psychological factors. Methods: The percentage of participants at risk for EDs in a representative high school population was assessed through the SCOFF screening questionnaire (cut-off score: 3) in the total sample (N: 6551) and in gender-based subgroups for different body mass index (BMI) categories. Odds ratios for being at risk of ED (SCOFF ≥ 3) were esteemed in a multivariable analysis including self-reported parental education, quality of family and peer relationships, bullying victimization, age at first sexual intercourse, and psychological distress. Results: A SCOFF score ≥ 3 was found in 31.0% of participants (boys: 19.4%; girls: 44.6%), with a greater prevalence among higher BMI categories. Bad family relationships, being bullied, having the first sexual intercourse before the age of 14, and experiencing high distress were associated with this risk condition. Among girls, bad peer relationships were associated with a low-risk SCOFF score. Conclusion: A remarkable percentage of adolescents reported significant body image or eating concerns. Screening programs are deeply needed, and particular attention should be devoted to interpersonal factors, such as the quality of family relationships and interactions with peers, which represent potential indicators of this vulnerability. Level of evidence: Level V – Cross-sectional study.

Prevalence rate of diabetes is high among migrants. Whether migrants are correctly addressed to a standard quality of care for diabetes and are properly followed up are the questions addressed by this retrospective cohort study. Compliance to one or repeated Guideline Composite Indicator (GCI), a standard process indicator of care quality, was tested in migrants compared to non-migrant Italian residents with diabetes, living in Tuscany Region, Italy, in years 2011–2015. For those with no GCI, the analysis was repeated for the chance of being tested by at least one or more HbA1c measurements. GCI compliance, in a single or repeated manner over time, was significantly less likely by about 15–20% among migrants (n= 3992) compared to non-migrants (n= 130,874), even after fully matching both cohorts. For those with no GCI, being tested by HbA1c was still significantly less likely among migrants. Being addressed to a standard quality of care is impaired among migrant patients with diabetes living in Tuscany compared to non-migrants. Migrants, moreover, have a significantly lower probability of adhering to guidelines or to be tested by HbA1c measurement over time.

Aims An exhaustive and updated estimation of cardiovascular disease burden and vascular risk factors is still lacking in European countries. This study aims to fill this gap assessing the global Italian cardiovascular disease burden and its changes from 1990 to 2017 and comparing the Italian situation with European countries.Methods All accessible data sources from the 2017 Global Burden of Disease study were used to estimate the cardiovascular disease prevalence, mortality and disability-adjusted life years and cardiovascular disease attributable risk factors burden in Italy from 1990 to 2017. Furthermore, we compared the cardiovascular disease burden within the 28 European Union countries.Results Since 1990, we observed a significant decrease of cardiovascular disease burden, particularly in the age-standardised prevalence (–12.7%), mortality rate (–53.8%), and disability-adjusted life years rate (–55.5%). Similar improvements were observed in the majority of European countries. However, we found an increase in all-ages prevalence of cardiovascular diseases from 5.75 m to 7.49 m Italian residents. Cardiovascular diseases still remain the first cause of death (34.8% of total mortality). More than 80% of the cardiovascular disease burden could be attributed to known modifiable risk factors such as high systolic blood pressure, dietary risks, high low density lipoprotein cholesterol, and impaired kidney function.Conclusions Our study shows a decline in cardiovascular mortality and disability-adjusted life years, which reflects the success in reducing disability, premature death and early incidence of cardiovascular diseases. However, the burden of cardiovascular diseases is still high. An approach that includes the cooperation and coordination of all stakeholders of the Italian National Health System is required to further reduce this burden.

During the coronavirus outbreak, a worldwide state of emergency and lockdown significantly affected the volunteer services for foreigners. The SARS-CoV-2 surveillance program was strengthened among migrants arriving in Italy. However, few screening measures for SARS-CoV2 infection have been conducted on the foreign population already present in Italy. In Tuscany, a great effort was made to know the epidemiological features of coronavirus outbreaks in the foreigners. Based on these premises, this study describes the prevalence and characteristics of SARS-CoV-2 infection in foreigners present in the Tuscan territory during the months of the highest incidence of this pandemic.

Non pharmacologic interventions like counselling and Traditional Chinese Medicine (TCM), have been shown to be effective for smoking cessation. In the present study we wanted to evaluate the effectiveness of counselling in smoking cessation combined with true or sham TCM.

SUMMARYAims– To describe the epidemiology of Suicide in Tuscany according to the triad of time, place and person. Methods– The 4, 764 cases of suicide, defined according to categories E950-E959 of ICD-9 in Tuscany over the period 1988–2002, were obtained from the Tuscan Mortality Register. Mortality indicators were calculated and analyzed. The spatial analysis was carried out by deriving Empirical Bayes Estimates for the 287 municipalities. Results– The crude mortality rate in the 2000–2002 is 7.8 per 100000 population (male: 12.4; female: 3.5). The age-standardized rate in the 2000–2002 is 5.8 per 100, 000 population (male: 9.6; female: 2.6). The highest risk for suicide, especially in the case of males, are concentrated in the southern hinterland Tuscany, in a cluster of rural municipalities that represent the old mining district of Tuscany. The SMRs according to residential municipality (population per square kilometre), confirm a greater risk of suicide for males residing in rural communities. Conclusions– The cluster of excessive mortality from suicide in Southern Tuscany could be the consequence of social determinants, related to the urban and social crisis following agriculture decline and mine closure.Declaration of Interest: none.

Nine European countries involved in the Biomed Project “Alcohol Consumption and Alcohol Problems Among Women in European Countries”; are described in relation to sociodemographic characteristics and drinking patterns. The populations of the nine countries, especially women, have become much older during the period 1950–1995. Also, women tend to have fewer children, and at an older age, so that the percentage of the younger age groups is decreasing. If we connect this to the fact that women now are more a part of the labor force than before, we might infer that the observed decrease in gender difference in alcohol use is to be explained in relation to economic factors. In terms of drinking patterns, a broad division can be made between two wide regions: (a) the northern dry area, where beer is the leading beverage, consumed on weekends and outside mealtimes; and (b) the southern, or Mediterranean, wet area, where wine is the main beverage, usually drunk at meals. However, the dispersion in alcohol consumption found among the study countries in 1961 declined considerably by 1997. In this respect, European countries are getting more similar, so that we may consider this phenomenon a “convergence”; of alcohol drinking in Europe. More generally, changes from a more traditional drinking pattern to a novel one from another country may be due to several factors, one of which is the increasing relevance of women in the drinking context. On the treatment side, such a relevance is nowadays visible through the better availability of both health services and nonstatutory organizations to take care of women affected with alcohol‐related problems.

The World Health Organization has suggested prioritizing preventive measures for communicable diseases, including the hepatitis B virus (HBV) infection. To reduce inequalities in health, we have conducted a study on the impact of HBV in prisons located in the region of Tuscany by recording the results of serum screening in clinical medical records, the objective being to increase anti-HBV vaccination in subjects susceptible to infection by means of an accelerated schedule. To further advance disease prevention, we conducted health promotion and education activities prior to a screening/vaccination program in Tuscany prisons ; both staff working in the prisons and the prisoners themselves were actively involved. The study started on 11 April 2016 and ended on 10 October 2017. In this paper, we report on the interventions carried out beforehand, such as training, information, and peer education. In addition to information in a previous study on the overall rate of inmate screening and vaccination, this article incorporates supplemental analysis to differentiate the rate of screening and vaccination among inmates previously present in this setting and those having recently arrived. For health staff, six courses were conducted on Continuing Education in Medicine. A total of 138 inmates of the main nationalities present were selected by justice, health and education staff as peer educators. Out of the 15 prisons participating in the screening and vaccination program, courses for prisoners were conducted in 10 prisons by a medical doctor and the International Organization for Migration cultural mediators, taking into account the multi-ethnic origins of the detainee population and applying a peer education approach. All prisoners received an HBV brochure in various languages. HBV screening was performed by the prisons’ sanitary staffs. Out of the 1075 inmates who needed screening, 70.9 % of those previously present and 93.6 % of the recently arrived agreed to undergo screening for HBV. Out of the 601 prisoners who required vaccination, 85.2 % of those previously present and 72 % of the recently arrived received the first dose. In conclusion, training, information, and a peer education approach could explain a high rate of adherence to a screening and vaccination program.