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Background and Objective : Participation in organised out-of-school leisure-time activities (OLTAs) has been shown to have a positive impact on community health practices and to lessen inequities in social and environmental opportunities among youths. According to the social capital theory, OLTAs foster bridging ties that allow individuals to forge new, wider-ranging social connections, increasing social integration and opportunities for identity-related exploration. This study aimed to describe participation in different types of OLTAs and its association with perceived life satisfaction, physical activity, tobacco use, alcohol consumption, and drunkenness in a representative sample of youths. Methods: A representative sample of 11-, 13- and 15-year-old students ( n = 47,799) was recruited throughout all Italian regions within the Italian 2013/2014 Health Behaviours in School-aged Children (HBSC) study. Data were collected according to the HBSC study protocol. Participants were compared on outcomes according to OLTA participation type (i.e., non-sport, sport-only, and mixed vs. no-OLTA). In accordance with the study sampling procedures, hierarchical logistic regression models were used. Results: Participation in OLTAs was significantly associated with high life satisfaction in all ages (sport-only: odds ratio (OR) = 1.67, 1.48 and 1.55 for 11- 13- and 15-year-olds; mixed: OR = 1.95, 1.60 and 1.45, respectively). Youths participating in OLTAs were more likely to meet physical activity recommendations and report lower rates of tobacco use and drunkenness. Conclusions: Participation in OLTAs showed a favourable impact on health behaviours. Thus, community organisations and clubs, whether supported by public investments, could contribute to the enhancement of beneficial health practices, by engaging and serving the community as a whole and further reducing inequities in both social and environmental opportunities., Competing Interests: All authors declare that they have no competing interests.

Objectives: To evaluate the 10-year outcomes of a regenerative surgical treatment of single peri-implantitis intrabony defects, by means of deproteinized bovine bone mineral with 10% collagen (DBBMC)., Material and Methods: The original population consisted of 26 patients with one crater-like defect, around either SLA or TPS dental implants, with a probing depth ≥6 mm and no implant mobility. After debridement and surface decontamination, the defects were filled with DBBMC. Subsequently, patients were placed in an individualized supportive peri-implant/periodontal therapy (SPT) program., Results: Fourteen patients (eight SLA and six TPS) reached the 10-year examination. The overall implant survival rate was 67%, 80% for the SLA, and 55% for the TPS implants. During SPT, five patients were lost to follow-up, eight patients needed additional antibiotic and/or surgical therapy, and seven patients had the implant removed. PD was reduced from 6.6 ± 1.3 to 3.2 ± 0.7 mm in SLA and from 7.2 ± 1.5 to 3.4 ± 0.6 mm in TPS. BOP decreased from 75.0 ± 31.2% to 7.5 ± 12.1% (SLA) and from 90.0 ± 12.9% to 30.0 ± 19.7% (TPS). Treatment success was found in 5 of the 12 SLA (42%) and in 4 of the 14 TPS (29%)., Conclusions: The proposed reconstructive treatment, followed by SPT, was able to maintain in function the majority of SLA implants, although the overall treatment success was limited and many of TPS implants were removed. Therefore, the decision to treat implants affected by peri-implantitis should be based on several factors, including surface characteristics., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The purpose of this study was to analyze changes in the prevalence of weight reduction behaviors (WRBs) among European adolescents from 26 countries between 2001/2002 and 2017/2018. The impact of the perception of body weight on WLB was also analyzed, with particular attention being paid to overestimation., Methods: The data of 639,194 European adolescents aged 11, 13, and 15 years who participated in the Health Behaviour in School-aged Children survey were analyzed. Age-standardized prevalence rates of WRB were estimated separately by survey round and gender for each country, using the overall 2017/2018 Health Behaviour in School-aged Children study population as the standard. Multivariate logistic regression analyses were used to assess WRB trends over time, adjusted for survey year, body mass index, body weight misperception, and family affluence and stratified by gender and age., Results: In the 26 countries examined, the overall age-adjusted prevalence rates of WRB were 10.2% among boys and 18.0% among girls. The prevalence of WRB was higher for girls, but in the more recent surveys, gender differences in WRB decreased. There was a significant increase in the percentage of WRB among boys in most countries. Among girls, most countries did not experience significant changes. Increases in body mass index and overestimation of body weight were significant factors increasing the risk of WRB in both genders., Conclusions: The change in the prevalence of WRB by gender warrants greater attention from researchers and practitioners alike., (Copyright © 2020. Published by Elsevier Inc.)

Objectives: The aim of this work was to study whether and to what extent selected connectedness variables (perceived family, peer, and school support) are protective factors against low life satisfaction and high health complaints in immigrant youth with different ethnic backgrounds, while also taking into account the effect of socioeconomic status (SES)., Methods: A representative sample of 47,799 students (15% immigrants, among whom 4980 were from non-Western countries) aged 11, 13, and 15 years were recruited from schools throughout Italy within the framework of the Italian 2013/2014 Health Behaviour in School-aged Children study. Bayesian network analyses were used to assess the association between connectedness variables, and low life satisfaction and high health complaints., Results: The connectedness variables family and school support were strong protective factors against both low life satisfaction and high health complaints (99% probability of relative risk < 1 in all subgroup comparisons). This protective role was still present when subgroups with high SES were compared. Peer support also showed a protective effect, though it was weaker., Conclusions: Our results show that, among immigrant youth, perceived high support can act as a moderator on the effect of environmental stressors. In line with international guidelines, these results confirm that public health professionals should create school interventions that foster a culture of inclusiveness, promote a supportive school environment, and engage families of immigrant youth.

Purpose: The relationship between thoracic-lumbar-sacral spine sagittal alignment and craniofacial morphology is still controversial. Evidence-based results are difficult to obtain and scientific studies are inhomogeneous. The aim of this study was to investigate the difference of thoracic-lumbar-sacral spine posture and cephalometric values comparing two groups of subjects with different cranial structure in the sagittal plane., Methods: Eighty-one subjects were consecutively selected and divided into two groups, according to the orientation of the condyle-orbital plane (CoOr) with respect to the superior maxilla (SpP): Group1: 49 subjects 11.6 (2.1) years showing posterior-rotation of CoOr: SpP^CoOr ≤ -2°, -4.1°(2.1°); Group2: 32 subjects 12.9 (2.3)years showing anterior-rotation of CoOr: SpP^CoOr ≥ 2°, 3.7°(1.9°). Each patient underwent in blinding, Spinal Mouse recording and cephalometry of the skull., Results: Group1 showed a significant forward tilting of the spine 4.4°(1.8°) with respect to Group2 2.4°(1.3°) (p < 0.0001) and higher values related to the vertical dimension of the skull: higher maxillary divergency (p < 0.0001), steep occlusal plane (p < 0.0007), higher gonial angle (p < 0.001)., Discussion: The results of this study showed a difference in the thoracic-lumbar-sacral spine inclination between groups with different craniofacial morphology. The achievement of this outcome is important to improve our multidisciplinary evaluation and treatment planning., (Copyright © 2019. Published by Elsevier Ltd.)

Objectives: The aim of this study is to report the 5-year outcomes of a coverage procedure of shallow maxillary soft tissue dehiscences, around single tissue-level implants., Material and Methods: The original population consisted of 16 patients presenting a single maxillary buccal implant soft tissue recession. A connective tissue graft, taken from the maxillary tuberosity, was inserted underneath a split-thickness envelope flap. After treatment, patients received individually tailored supportive periodontal therapy (SPT)., Results: Two patients were lost to follow-up, while one implant was removed due to peri-implantitis, before the final examination. At 5 years, complete implant soft tissue coverage was depicted in 8 out of 13 cases (62%). Mean soft tissue dehiscence coverage was 86%. Patients' esthetic evaluation showed the persistency of high VAS scores., Conclusions: Treatment of buccal soft tissue dehiscence around single implant, followed by regular supportive therapy, resulted in good esthetic and functional results in the majority of patients., Clinical Relevance: Within the limits of this study, the positive results suggest that the proposed technique may be a reliable option in selected cases.

Objectives: The aim of this work was to explore whether adolescent immigrants have worse or better perceived well-being, and whether this perception varies by ethnic background or between first- and second-generation immigrants, when compared with adolescents from the host population., Methods: A representative sample of 47,799 students (13.4% immigrants) aged 11, 13, and 15 years were recruited throughout all Italian regions within the framework of the Italian 2013/2014 Health Behaviour in School-aged Children study., Results: Adolescent immigrants from Eastern European and non-Western/non-European countries had a higher occurrence of health complaints and the highest risk of reporting low life satisfaction, which increased among the second generation. The risk of reporting bullying behaviours and physical fights was higher in first-generation immigrants and decreased in the second generation, independent of ethnic background., Conclusions: Italian welfare immigration policies do not seem to offer the same opportunities to all adolescent immigrant groups, which leads to differing effects on their well-being. To tackle these inequalities, Italy should increase its investment in education through early prevention initiatives, e.g. providing support in intercultural education and proper training to school teachers and staff.

The aim of this study was to investigate the long-term clinical conditions of periodontally compromised teeth treated by means of orthodontics after periodontal regeneration (GTR). Forty-eight patients affected by severe periodontitis who presented at least one nonmolar, malpositioned tooth with a pocket depth (PD) ≥ 7 mm, were consecutively enrolled in a private specialist practice. The treatment consisted of the following steps: infection control, provisional splinting, GTR, orthodontic treatment, final splinting, and supportive periodontal therapy (SPT). Thirty-six patients completed the 10-year study, as 12 were lost to follow-up. The total number of sites with PD ≥ 7 mm decreased from 25.4 ± 16.7 to 1.8 ± 2.1. PD of the teeth involved in the orthoperio treatment significantly decreased from 6.3 ± 1.5 mm to 3.1 ± 0.6 mm. One test tooth had to be extracted before the final examination due to root fracture, while two teeth lost vitality and received a root canal treatment. Eight episodes of recurrence, which required additional treatment, occurred during the 10 years of follow-up. The results of this study suggest that if a periodontal infection is under control, the orthodontic treatment does not reduce the long-term benefits of periodontal regeneration, even where the disease has caused massive tissue destruction.

The aim of the study was to evaluate the cephalometric differences and condylar asymmetry between patients with juvenile idiopathic arthritis (JIA) and normal control group. Sixty-two JIA patients with a latero-lateral cephalogram and orthopantomography, seeking for orthodontic therapy, and 62 normal matched subjects were comprised in the study. Cephalometric analysis was used for the evaluation of facial morphology while the method of Habets et al. (J Oral Rehabil 15(5): 465-471, 1988) was used to compare the condyles in orthopantomography. The significance of between-group differences was assessed using the Mann-Whitney test, as appropriate. The results showed a prevalence of the upper maxilla with hypomandibulia (class II), hyperdivergency with short vertical ramus posterior and posterior rotation of the mandible in JIA children (SNB, ANB, NSL/ML, Fh/ML, NL/ML, ArGo, ML P < 0.0001, ML/Oc P < 0.004, ArGo/GoGn P = 0.02, no difference for SNA). The condyles of the JIA group resulted highly asymmetric (P < 0.0001). The growth pattern of JIA patients resulted clearly different from normal subjects. This serious impairment of the cranial growth may be considered as an indicator of the need for early and continuous orthognatodonthic therapy during the entire period of development for all JIA patients, independently from temporomandibular joint signs or symptoms. To this end, it is important that rheumatologists and orthognathodontists set up a multidisciplinary treatment planned to control the side effects of a deranged growing pattern, to strictly avoid any orthodontic therapies that may worsen function and growth, and to promote treatments improving the physiology and biology of the cranial development.

Parental and peer support seems to be a favourable determining factor in the acculturation process among young immigrants. We aimed to assess the level of perceived support among first- and second-generation adolescent immigrants and compare it to that perceived by the adolescents from the host population. Using Italian HBSC survey data collected in 2013-2014, first- and second-generation immigrants aged 11, 13 and 15 years were classified according to their ethnic background as being from Western countries, Eastern European countries, or from non-Western/non-European countries. The domains of teacher, classmate, family, and peer support was measured through multidimensional, standardised, validated scales. Analyses were run on a 47,399 valid responses (2195 from Western countries, 2424 from Eastern European countries, and 2556 from non-Western/non-European countries). Adolescent immigrants from Eastern European countries and non-Western/non-European countries reported significantly lower support than their peers from the host population in all explored domains. Girls perceived a lower level of classmate and family support compared to boys across all ethnic backgrounds. We observed two different immigration patterns: the Western pattern, from more affluent countries, and the Eastern pattern. Among the latter, second-generation immigrants showed the lowest level of support in all domains. Increasing family connections and developing peer networks should favour the acculturation process among adolescent immigrants.

Objectives: The aim of this study was to evaluate the long-term results of the surgical treatment of single peri-implantitis intrabony defects, by means of deproteinized bovine bone mineral with 10% collagen (DBBMC)., Material and Methods: The original population consisted of 26 patients with one crater-like defect, around either sandblasted and acid-etched (SLA) or titanium plasma-sprayed (TPS) dental implants, with a probing depth (PD) ≥6 mm and no implant mobility (Roccuzzo et al. J Clin Periodontol. 2011; 38: 738). Implants were mechanically debrided and treated using EDTA gel and chlorhexidine gel. The bone defects were filled with DBBMC, and the flap was sutured around the non-submerged implant. Patients were placed on an individually tailored supportive periodontal therapy (SPT)., Results: Two patients were lost to follow-up. During SPT, additional antibiotic and/or surgical therapy was necessary in eight implants, and four of these were removed for biologic complications. At 7-year, the survival rate was 83.3% for SLA implants and 71.4% for TPS. PD was significantly reduced from 6.6 ± 1.3 to 3.2 ± 0.7 mm in SLA and 7.2 ± 1.5 to 3.4 ± 0.6 mm in TPS. Bleeding on probing decreased from 75.0 ± 31.2% to 7.5 ± 12.1% (SLA) and from 90.0 ± 12.9% to 30.0 ± 19.7% (TPS). When successful therapy was defined as PD ≤5 mm, absence of bleeding/suppuration on probing, and no further bone loss, treatment success was obtained in 2 of 14 (14.3%) of the TPS and in 7 of 12 (58.3%) of the SLA implants., Conclusions: Seven years after surgical treatment with DBBMC, patients, in an adequate SPT, maintained sufficient peri-implant conditions in many cases, particularly around SLA implants. Nevertheless, some patients required further treatment and some lost implants. The clinical decision on whether implants should be treated or removed should be based on several factors, including implant surface characteristics., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: The aim of this study was to evaluate the long-term clinical results around non-submerged implants placed after vertical alveolar ridge augmentation., Material and Methods: The original population consisted of two groups of partially edentulous patients (Clinical Oral Implants Research, 15, 2004, 73; Clinical Oral Implants Research, 18, 2007, 286), receiving a total of 82 implants, after a vertical bone augmentation of at least 4 mm. Following cementation of the fixed dental prostheses, patients were asked to follow an individualized supportive periodontal therapy (SPT) program for an appropriate clinical and radiographic follow-up., Results: At the 10-year examination, seven of the 41 patients were lost to follow-up. During SPT, additional antibiotic and/or surgical therapy was necessary in 18 implants, and four of these implants were removed for biological complications. The overall implant survival rate was 94.1%. The mean interproximal bone loss (BL) was 0.58 ± 0.57 mm., Conclusions: The results of this study confirmed that implants, placed after vertical augmentation and followed by an adequate SPT, offer predictable long-term results. Nevertheless, patients whose bone atrophy was consequence of a previous history of periodontitis presented a statistically significant greater BL., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: The primary aim of the present study was to examine the association between immigrant generation, family sociodemographic characteristics, and problem gambling severity in a large-scale nationally representative sample of Italian youth., Method: Data from the 2013-2014 Health Behaviour in School-aged Children (HBSC) Survey were used for cross-sectional analyses of adolescent problem gambling. Self-administered questionnaires were completed by a representative sample of 20,791 15-year-old students. Respondents' problem gambling severity, immigrant status, family characteristics (family structure, family affluence, perceived family support) and socio-demographic characteristics were individually assessed., Findings: Rates of adolescent at-risk/problem gambling were twice as high among first generation immigrants than non-immigrant students; the odds of being at-risk/problem gamblers were higher among first-generation immigrants than adolescents of other immigrant generations or non-immigrant. Not living with two biological or adoptive parents appears to be a factor that increases the risk of becoming a problem gambler in first generation immigrants., Conclusions: Immigrant status and family characteristics may play a key role in contributing to adolescent problem gambling., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Backgrounds and Aim: Unhealthy eating behaviours increase with age and have been associated with adverse health consequences in adulthood. We examined the influence of screen-based sedentary behaviours (SBs) on unhealthy food consumption, such as energy-dense foods and sweetened drinks, among a representative sample of nearly 60 000 adolescents and assessed the role of possible modifiers., Methods: Data come from the Italian 2009-10 Health Behaviour in School-aged Children (HBSC) survey. Data on Eating patterns, SBs, physical activity, peers network, BMI and socio-economic status (SES) were collected following the HBSC study protocol. Hierarchical logistic regression models were used., Results: Unhealthy food consumption was significantly associated with a lower intake of fruit and vegetables and with the increase of SBs in both sexes and in all ages. The risk was interestingly higher in normal weight adolescents, in those with wider relationships with peers and in low SES children., Conclusions: This study adds evidence to support the importance of investing more resources in educational initiatives both to increase parents' awareness to support adolescents on dietary choices and on time spent in screen-based behaviours, independently of their adiposity status; and to develop youth's ability to access and appropriately use media and technologies. Policy makers should also increase their attention on introducing regulatory policies on television food advertising to which youth are exposed., (© The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Purpose: The aims of this study were to assess the outcome of in vitro fertilization (IVF) in women with very low circulating anti-müllerian hormone (AMH) and to investigate factors affecting their probability of pregnancy., Methods: The outcome of 448 IVF cycles in 361 women with circulating AMH <0.5 ng/ml was retrospectively analyzed., Results: Cycle cancellation rate was 14.5 %; patients whose cycle was cancelled had significantly lower AMH than women who reached oocyte pickup (OPU). Among those who reached OPU, age significantly affected the success rate: despite comparable AMH levels, patients below 35 years obtained significantly more oocytes and a better clinical pregnancy rate (CPR)/OPU than patients aged 35-39 or 40-43 (31 % vs. 23.2 % vs. 10.2 %, respectively; p = 0.001). Differently, comparable IVF results were observed stratifying patients for AMH levels in the range 0.14-0.49 ng/ml. Multivariable logistic regression analysis confirmed that the probability of pregnancy was significantly affected by age, but not by small differences in AMH level., Conclusions: Women with very low (<0.5 ng/ml) AMH levels undergoing IVF still have reasonable chances of achieving a pregnancy, but their prognosis is significantly affected by chronological age. Very low AMH levels are associated with a relevant risk of cycle cancellation but should not be considered a reason to exclude a couple from IVF.

Objective: The aim of this research was to investigate the clinical conditions around dental implants placed in the posterior mandible of healthy or moderately periodontally compromised patients, in relation to the presence or not of keratinized mucosa (KT)., Materials and Methods: One hundred and twenty-eight patients who needed an implant in the posterior mandible were consecutively enrolled in a private specialist practice. Only one implant per patient was examined originally placed either within KT or alveolar (AM) mucosa. At 10 years, clinical and radiographic measures were recorded by a calibrated operator. The number of sites treated according to therapy modalities C and D (antibiotics and/or surgery) during the 10 years was also registered., Results: Ninety-eight patients completed the 10-year study. The absence of KT was associated with higher plaque accumulation, greater soft-tissue recession (REC), and a higher number of sites that required additional surgical and/or antibiotic treatment. Patient-reported outcomes regarding maintenance procedures presented major differences between the groups. In 11 of the 35 AM cases, additional free gingival graft (FGG) was successfully employed to reduce discomfort and to facilitate optimal plaque control., Conclusion: Implants that are not surrounded by KT are more prone to plaque accumulation and REC, even in patients exercising sufficient oral hygiene and receiving adequate supporting periodontal therapy (SPT). In selected cases, particularly in the edentulous posterior mandible, where ridge resorption leads to reduced vestibular depth and lack of KT, additional FGG can be beneficial to facilitate proper oral hygiene procedures., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To evaluate the efficacy of a reconstructive surgical procedure in single peri-implantitis infrabony defects., Methods: Seventy-five patients with one peri-implantitis crater-like lesion with pocket depth (PD) ≥ 6 mm, were included. Each defect was assigned to one characteristic class, by an independent examiner. After implant decontamination, defects were filled with deproteinized bovine bone mineral with 10% collagen., Results: At 1-year follow-up, four patients were lost and six implants removed. Treatment success, PD ≤ 5 mm and absence of suppuration/bleeding on probing (BOP), was obtained in 37 (52.1%) of the 71 implants examined. PD was significantly reduced by 2.92 ± 1.73 mm (p < 0.0001). BOP decreased from 71.5 ± 34.4% to 18.3 ± 28.6% (p < 0.0001). The mean number of deep pockets (≥ 6 mm) decreased from 3.00 ± 0.93 to 0.85 ± 1.35 (p < 0.0001)., Conclusions: These results confirm the possibility to successfully treat peri-implantitis lesions. There is lack of evidence of whether or not the resolution of the peri-implant disease is associated with the defect configuration. Due to the fact that complete resolution does not seem a predictable outcome, the clinical decision on whether implants should be treated should be based on several patient related elements., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Psychosomatic health complaints are significant indicators of adolescent well-being. The aim of this study is to describe the full set of interactions between health complaints and the presence of subjective resources, represented by the quality of relationships with parents and peers and by a positive school perception, in a population of 15-year-old adolescents. Smoking and alcohol consumption were also included in the analyses., Methods: Bayesian networks were built for males and females separately, in order to understand the interactions among all considered variables in a representative sample of 16 018 Italian adolescents participating in the Health Behaviour in School-Aged Children survey 2009-10., Results: The resulting networks show that school is the crucial node linking adolescents' well-being with parents and peer relationships, as well as with smoking and alcohol consumption., Conclusions: Adolescents' well-being, as well as the prevalence of typical risk behaviours, such as smoking and alcohol consumption, is mediated by the adolescents' academic stress. Therefore, public health interventions, to be effective, should consider addressing the school environment by making it a more inclusive environment promoting critical thinking and sense of belonging rather than just focusing on personal behaviours., (© The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Aims: Short QT syndrome (SQTS) is a rare arrhythmogenic inherited heart disease. Diagnosis can be challenging in subjects with slightly shortened QT interval at electrocardiogram. In this study we compared the QT interval behaviour during exercise in a cohort of SQTS patients with a control group, to evaluate the usefulness of exercise test in the diagnosis of SQTS., Methods and Results: Twenty-one SQTS patients and 20 matched control subjects underwent an exercise test. QT interval was measured at different heart rates (HRs), at rest and during effort. The relation between QT interval and HR was evaluated by linear regression analysis according to the formula: QT = β ×HR + α, where β is the slope of the linear relation, and α is the intercept. Rest and peak exercise HRs were not different in the two groups. Short QT syndrome patients showed lower QT intervals as compared with controls both at rest (276 ± 27 ms vs. 364 ± 25 ms, P < 0.0001) and at peak exercise (228 ± 27 ms vs. 245 ± 26 ms, P = 0.05), with a mean variation from rest to peak effort of 48 ± 14 ms vs. 120 ± 20 ms (P < 0.0001). Regression analysis of QT/HR relationship revealed a less steep slope for SQTS patients compared with the control group, never exceeding the value of -0.90 ms/beat/min (mean value -0.53 ± 0.15 ms/beat/min vs. -1.29 ± 0.30 ms/beat/min, P < 0.0001)., Conclusion: Short QT syndrome patients show a reduced adaptation of the QT interval to HR. Exercise test can be a useful tool in the diagnosis of SQTS., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)

Background: The purpose of this study was to assess recent changes in the prevalence of overweight (including obesity) among 11-, 13- and 15-year-olds in 33 countries from 2002 to 2010., Methods: Data from 25 countries from three consecutive survey cycles (2002, 2006 and 2010) that had at least 80% response rate for self-reported height, weight and age were analysed using logistic regression analysis., Results: Overweight prevalence increased among boys in 13 countries and among girls in 12 countries; in 10 countries, predominantly in Eastern Europe, an increase was observed for both boys and girls. Stabilization in overweight rates was noted in the remaining countries; none of the countries exhibited a decrease over the 8-year period examined. In the majority of countries (20/25) there were no age differences in trends in overweight prevalence., Conclusion: In over half of the countries examined overweight prevalence did not change during 2002-2010. However, increasing overweight prevalence was noted in many Eastern European countries over this time period. Overweight prevalence remained high in several countries in Europe and North America. These patterns call for continued research in youth overweight and highlight the need to understand cross-national differences by examining macro-level indicators. Such research should feed into developing sound translations and practices to prevent and reduce overweight in youth., (© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Objectives: To assess sex differences in clinical presentation, in-hospital and long-term outcome in ST-elevated myocardial infarction (STEMI) patients undergoing primary PCI (PPCI)., Background: Several studies have shown higher rates of mortality in women. These differences are not always confirmed after adjusting for confounding variables., Methods: From January 2007 to December 2011, 325 consecutive patients (23.1% females and 76.9% males) were prospectively treated and retrospectively analyzed. Primary outcome was in-hospital and long-term mortality., Results: Women were older (71.8±11.7 vs. 62.5±12.6years; p<0.0001), presented more renal failure (45.3% vs. 20.8%; p<0.0001) and severe haemodynamic impairment (9.3% vs. 3.6%; p=0.04). In-hospital overall mortality (14.7% vs. 4.8%; p=0.003) and cardiac death (12% vs. 2%; p=0.002) were significantly higher in women. The multivariate analysis identified age (OR 1.07; 95% CI: 1.01-1.13), resuscitated cardiac arrest (CCA) and cardiogenic shock (CS) (OR 15.31; 95% CI: 4.30-61.75), renal failure (OR 0.20; 95% CI: 0.06-0.68), but not sex (OR 1.49; 95% CI: 0.53-4.22) as independent prognostic factors of in-hospital mortality. During a median follow-up of 46.5months (IQR range 32.7-63.1months), long-term overall mortality (24.2% vs. 11.0%; p=0.007) and cardiac death (4.8% vs. 1.7%; p=0.02) were significantly higher in women. The multivariate analysis identified age (HR 1.06; 95% CI: 1.02-1.11), previous AMI (HR 3.9; 95% CI: 1.63-9.35), renal failure (HR 5.21; 95% CI: 2.12-12.85), technical success (HR 0.35; 95% CI: 0.14-0.84) but not sex (HR 0.90; 95% CI: 0.42-1.94) as independent prognostic factors of long-term mortality., Conclusions: Worse clinical presentation rather than sex may explain the excess of mortality in women with STEMI undergoing PPCI., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: This article presents the scope and development of the Health Behaviour in School-aged Children (HBSC) study, reviews trend papers published on international HBSC data up to 2012 and discusses the efforts made to produce reliable trend analyses., Methods: The major goal of this article is to present the statistical procedures and analytical strategies for upholding high data quality, as well as reflections from the authors of this article on how to produce reliable trends based on an international study of the magnitude of the HBSC study. HBSC is an international cross-sectional study collecting data from adolescents aged 11-15 years, on a broad variety of health determinants and health behaviours., Results: A number of methodological challenges have stemmed from the growth of the HBSC-study, in particular given that the study has a focus on monitoring trends. Some of those challenges are considered. When analysing trends, researchers must be able to assess whether a change in prevalence is an expression of an actual change in the observed outcome, whether it is a result of methodological artefacts, or whether it is due to changes in the conceptualization of the outcome by the respondents., Conclusion: The article present recommendations to take a number of the considerations into account. The considerations imply methodological challenges, which are core issues in undertaking trend analyses., (© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Life satisfaction (LS) is an indicator which is widely used for assessing the perception of a child's feeling about his life., Methods: LS is assessed in Health Behaviour in School-aged Children via the Cantril ladder with 10 steps indicating the worst and best possible life. This range of values (0-10) was dichotomized into 'low' (0-5) vs. 'high' (6-10). Countries, age groups and genders were compared based on the odds ratio (OR) of declaring a higher LS in 2010 with respect to 2002., Results: Analyzing the difference between 2002 and 2010, six countries from Western Europe show decreasing LS: Austria, Canada, Switzerland, Denmark, Finland and Greenland. In contrast, a group of Eastern European Countries, that is, Estonia, Croatia, Lithuania, Latvia, Russia and Ukraine, show a significant increase in LS. Data on gender and age differences confirm the lower rating of LS in girls and a decreasing rating with age., Conclusion: The LS scale appears to be a tool capable of discriminating the level of wellbeing of adolescent population among countries., (© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Self-rated health (SRH) in adolescence is known to be associated with health outcomes in later life. We carried out a trend analysis on data coming from three waves of data collected in 32 countries (mostly European) from 2002 to 2010 coming from the Health Behaviour in School-Aged Children surveys., Methods: SRH in adolescents was assessed using a Likert scale (excellent, good, fair and poor). Responses were dichotomized into 'excellent' vs. 'rest'. Country, age and gender groups were compared based on the odds ratio of declaring excellent SRH in 2010 with respect to 2002 and 2006., Results: The trend for European adolescents indicates an improvement over the last decade, although, in the majority of countries, a higher proportion of adolescents rate their health as excellent during the period 2002-06 with respect to the second half of the decade (2006-10).Girls were found to constantly rate their health as poorer, compared to their male peers, in all countries. Age has also a very stable trend towards a decreasing rating of health with increasing age., Conclusion: Decreased rating of health in the period 2006-10 may be a signal of the socio-economic difficulties of Europe in the last part of this decade., (© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Aims: There is conflicting evidence to support the concept that the years with diabetes preceding puberty may not contribute to the development of vascular complications. In this paper, duration-related prevalence of retinopathy was compared in patients who developed type 1 diabetes before and after pubertal age., Methods: Retrospective analysis of prospectively collected data of 1,483 patients was screened for retinopathy in 1991-2010, with diabetes onset at age ≤29, who were on insulin treatment and aged ≤60. Prepubertal age was defined as 0-12 in males and 0-11 in females., Results: A total of 647 patients had developed diabetes before and 836 after puberty. Cumulative prevalence of retinopathy was initially lower among those with prepubertal onset diabetes but rates became superimposable after 20-year duration. Patients with prepubertal onset diabetes had higher lifetime HbA1c and lower blood pressure than those who became diabetic after puberty., Conclusions/interpretation: Retinopathy is infrequent during childhood and develops later than in patients with post-pubertal onset diabetes. After 20-year duration, however, retinopathy becomes just as prevalent suggesting that, in the long term, prepubertal years do contribute to the development of retinopathy. In this series, higher blood pressure may have played a role in the earlier appearance of retinopathy in patients with diabetes onset after puberty, whereas worse metabolic control may have contributed to the late "catch-up" effect in those with prepubertal onset disease.

The purpose of this study was to evaluate the long-term clinical outcomes around implants placed in sites previously augmented with demineralized bovine bone mineral with 10% collagen (Bio-Oss Collagen, Geistlich). In this prospective study, 36 consecutive, healthy patients, in need of a single-tooth extraction (incisors, canines, and premolars) and implant replacement, were included. After tooth extraction, Bio-Oss Collagen was inserted in the socket and covered either with a double layer of collagen membrane (test) or with a few drops of a flowable polylactide polymer (control). Following a healing period of 4 to 6 months, a single nonsubmerged implant surgery was performed. After cementation of a single ceramic crown, patients were asked to follow an individualized supportive periodontal therapy program. Clinical and radiographic data were obtained after prosthesis delivery (baseline) and at the 10-year follow-up visit. At the 10-year examination, two patients were lost to follow-up. All implants demonstrated healthy peri-implant soft tissues as documented by standard parameters (full-mouth plaque score, full-mouth bleeding score, local bleeding on probing) in both groups. Mean soft tissue recession (REC) was 0.39 ± 0.54 mm for the test group and 0.50 ± 0.33 mm for the control, with no significant difference between the two groups. The results of this prospective study confirmed the long-term stability of the peri-implant marginal soft tissues supported by regenerated bone by means of the described technique using Bio-Oss Collagen. If the patient is properly followed throughout time, the risk for mucosal recession is low, with < 1 mm of mean REC after 10 years.

Objectives: The aim of this study was to compare the long-term outcomes of sandblasted and acid-etched (SLA) implants in patients previously treated for periodontitis and in periodontally healthy patients (PHP)., Material and Methods: One hundred and forty-nine partially edentulous patients were consecutively enrolled in private specialist practice and divided into three groups according to their periodontal condition: PHP, moderately periodontally compromised patients (PCP) and severely PCP. Implants were placed to support fixed prostheses, after successful completion of initial periodontal therapy. At the end of active periodontal treatment (APT), patients were asked to follow an individualized supportive periodontal therapy (SPT) program. Diagnosis and treatment of peri-implant biological complications were performed according to cumulative interceptive supportive therapy (CIST). At 10 years, clinical and radiographic measures were recorded by two calibrated operators, blind to the initial patient classification, on 123 patients, as 26 were lost to follow up. The number of sites treated according to therapy modalities C and D (antibiotics and/or surgery) during the 10 years was registered., Results: Six implants were removed for biological complications. The implant survival rate was 100% for PHP, 96.9% for moderate PCP and 97.1% for severe PCP. Antibiotic and/or surgical therapy was performed in 18.8% of cases in PHP, in 52.2% of cases in moderate PCP and in 66.7% cases in severe PCP, with a statistically significant differences between PHP and both PCP groups. At 10 years, the percentage of implants, with at least one site that presented a PD ≥ 6 mm, was, respectively, 0% for PHP, 9.4% for moderate PCP and 10.8% for severe PCP, with a statistically significant difference between PHP and both PCP groups., Conclusions: This study shows that SLA implants, placed under a strict periodontal control, offer predictable long-term results. Nevertheless, patients with a history of periodontitis, who did not fully adhere to the SPT, presented a statistically significant higher number of sites that required additional surgical and/or antibiotic treatment. Therefore, patients should be informed, from the beginning, of the value of the SPT in enhancing long-term outcomes of implant therapy, particularly those affected by periodontitis., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: This large prospective, randomized study was designed to compare the "mild" protocol with clomiphene citrate, low-dose gonadotropins and a GnRH-antagonist (CC/Gn/GnRH-ant protocol) with the "long" protocol with a GnRH-agonist and high-dose Gn for the controlled ovarian hyperstimulation (COH) of patients with expected poor ovarian responsiveness undergoing IVF., Materials and Methods: A total of 695 women with clinical, endocrine and ultrasound characteristics suggesting a low ovarian reserve and a poor responsiveness to COH were recruited and randomly assigned to receive the CC/Gn/GnRH-ant "mild" protocol (mild group, n = 355) or the "long" protocol with high-dose Gn (long group, n = 340)., Results: The "mild" stimulation led to significantly shorter follicular phase, lower consumption of exogenous Gn and lower peak estradiol level than the "long" regimen. With the "long" protocol, significantly less cycles were cancelled due to the lack of ovarian response; further, it obtained significantly more oocytes, more mature oocytes, more embryos, and a thicker endometrium. As for the final IVF outcome, however, the two stimulation regimens obtained comparable implantation rate, clinical pregnancy rate, and ongoing pregnancy rate at 12 weeks., Conclusions: In conclusion, the "mild" CC/Gn/GnRH-ant stimulation protocol is a valid alternative to the long protocol with high Gn dose as it obtains a comparable success rate and requires significantly less medications, with an obvious economical advantage.

Aim: The aim of this study was to evaluate the outcome of a soft tissue dehiscence coverage technique, at single non-submerged implant sites, presenting shallow isolated buccal mucosal recession., Material and Methods: Sixteen patients were included in this prospective study. A connective tissue graft (CTG) was harvested from the maxillary tuberosity. The donor soft tissue was de-epithelialized and trimmed with a mucotome for an optimal adaptation to the collar of the implant., Results: Surgery and healing proceeded with no complications and minimal post-operative discomfort. One-year follow-up demonstrated clinical and esthetic improvements. Treatment resulted in 89.6 ± 13.1% mean coverage, and complete implant soft tissue coverage was achieved in nine of 16 cases, corresponding to a 56.3%. The VAS esthetic analysis showed a significant improvement from 3.6 ± 0.2 to 8.5 ± 0.3., Conclusions: These positive preliminary results suggest that, by means of the surgical technique presented, buccal soft tissue dehiscences around single implants can be successfully treated. Additional Randomized controlled trials (RCTs) should be encouraged to assess the most effective variation to the technique in the various clinical situations and around implants of different designs., (© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.)

Objective: By correlating known diabetes duration with the prevalence of retinopathy, more than 10 years have been estimated to lapse between the onset and diagnosis of type 2 diabetes. Such calculations, however, assumed a linear model, included stages of retinopathy not specific to diabetes, and allowed 5 years for retinopathy to occur after the onset of diabetes. We calculated the duration of undiagnosed type 2 diabetes in outpatients screened for retinopathy in a hospital-based diabetes clinic after correcting these assumptions., Research Design and Methods: Diabetic patients (n = 12,074; 35,545 fundus examinations) were stratified into younger onset (YO; age at onset <30 years) or older onset (OO; age at onset ≥30 years), insulin treated (IT) or not IT (NIT), and with mild/more severe diabetic retinopathy (AnyDR) or moderate/more severe diabetic retinopathy (ModDR). The best-fitting equation correlating known duration among the OO-NIT group with the prevalence of ModDR was used to extrapolate time from appearance of retinopathy to diagnosis of type 2 diabetes. Time for retinopathy to develop after diabetes was calculated from the equation correlating the duration among the YO-IT group with appearance of ModDR., Results: There were 1,719 patients in the OO-NIT group with AnyDR and 685 with ModDR and 756 in the YO-IT group with AnyDR and 385 with ModDR. A linear model showed ModDR appeared 2.66 years before diagnosis among those in the OO-NIT group. A quadratic model suggested that ModDR appeared 3.29 years after diagnosis among those in the YO-IT group. The resulting estimate was 6.05 years (2.66 + 3.29) between the onset and diagnosis of diabetes, compared with 13.36 years using standard criteria., Conclusions: Using best-fitting models and stratifying by glucose-lowering treatment and severity of retinopathy substantially lowers the estimated duration of undiagnosed type 2 diabetes., (© 2014 by the American Diabetes Association.)

Aims/hypothesis: Most guidelines recommend annual screening for diabetic retinopathy (DR) but limited resources and the slow progression of DR suggest that longer recall intervals should be considered if patients have no detectable lesions. This study aimed to identify the cumulative incidence and time of development of referable DR in patients with no DR at baseline, classified by clinical characteristics., Methods: Analysis was performed of data collected prospectively over 20 years in a screening clinic based in a teaching hospital according to a consensus protocol. The cumulative incidence, time of development and relative risk of developing referable retinopathy over 6 years following a negative screening for DR were calculated in 4,320 patients, stratified according to age at onset of diabetes (<30 or ≥ 30 years), being on insulin treatment at the time of screening and known duration of diabetes (<10 or ≥ 10 years)., Results: The 6 year cumulative incidence of referable retinopathy was 10.5% (95% CI 9.4, 11.8). Retinopathy progressed within 3 years to referable severity in 6.9% (95% CI 4.3, 11.0) of patients with age at onset ≥ 30 years, who were on insulin treatment and had a known disease duration of 10 years or longer. The other patients, especially those with age at onset <30 years, on insulin and <10 years duration, progressed more slowly., Conclusions/interpretation: Screening can be repeated safely at 2 year intervals in any patient without retinopathy. Longer intervals may be practicable, provided all efforts are made to ensure adherence to standards in procedures and to trace and recall non-attenders.

Objectives: The aim of this study was to compare long-term outcomes of implants placed both in patients treated for periodontitis and in periodontally healthy patients (PHP)., Material and Methods: One hundred and twelve partially edentulous patients were consecutively enrolled in private specialist practice and divided into three groups according to their initial periodontal condition: PHP, moderately periodontally compromised patients (PCP) and severely PCP. Implants were placed to support fixed prostheses, after successful completion of initial periodontal therapy [full-mouth plaque score (FMPS) <25%, full-mouth bleeding score (FMBS) <25%]. At the end of active periodontal treatment (APT), patients were asked to follow an individualized supportive periodontal therapy (SPT) program. Diagnosis and treatment of peri-implant biological complications was performed according to cumulative interceptive supportive therapy. At 10 years, clinical measures were recorded by two calibrated operators, blinded to the initial patient classification, on 101 patients, as 11 were lost to follow-up. The number of sites treated according to therapy modalities C and D (antibiotics and/or surgery) during the 10 years was registered., Results: Eighteen implants were removed for biological complications. Antibiotic and/or surgical therapy was performed in 10.7% of cases in PHP, in 27% of cases in moderate PCP and in 47.2% cases in severe PCP, with a statistically significant differences between PHP and severe PCP (P = 0.002). At the final examination, the percentage of implants, with at least one site which presented a PD ≥6 mm, was respectively 1.7% for PHP, 15.9% for moderate PCP and 27.2% for severe PCP, with a statistically significant difference between PHP and moderate PCP (P = 0.005) and PHP and severe PCP (P = 0.0001)., Conclusion: Patients with a history of periodontitis presented a statistically significant higher number of sites which required additional treatment. Therefore, patients with a history of periodontitis should be informed that they are more at risk for peri-implant disease. This underlines the value of the SPT in enhancing long-term outcomes of implant therapy, particularly in subjects affected by periodontitis. Therefore, the approach for multiple preventive dental extractions and implant placement, based on the assumption the implants perform better than teeth, should be followed with extreme caution., (© 2011 John Wiley & Sons A/S.)

Objectives: The aim of this study was to investigate the clinical characteristics and the long-term course of a large cohort of patients with short QT syndrome (SQTS)., Background: SQTS is a rare channelopathy characterized by an increased risk of sudden death. Data on the long-term outcome of SQTS patients are not available., Methods: Fifty-three patients from the European Short QT Registry (75% males; median age: 26 years) were followed up for 64 ± 27 months., Results: A familial or personal history of cardiac arrest was present in 89%. Sudden death was the clinical presentation in 32%. The average QTc was 314 ± 23 ms. A mutation in genes related to SQTS was found in 23% of the probands; most of them had a gain of function mutation in HERG (SQTS1). Twenty-four patients received an implantable cardioverter defibrillator, and 12 patients received long-term prophylaxis with hydroquinidine (HQ), which was effective in preventing the induction of ventricular arrhythmias. Patients with a HERG mutation had shorter QTc at baseline and a greater QTc prolongation after treatment with HQ. During follow-up, 2 already symptomatic patients received appropriate implantable cardioverter defibrillator shocks and 1 had syncope. Nonsustained polymorphic ventricular tachycardia was recorded in 3 patients. The event rate was 4.9% per year in the patients without antiarrhythmic therapy. No arrhythmic events occurred in patients receiving HQ., Conclusions: SQTS carries a high risk of sudden death in all age groups. Symptomatic patients have a high risk of recurrent arrhythmic events. HQ is effective in preventing ventricular tachyarrhythmia induction and arrhythmic events during long-term follow-up., (Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this prospective study was to evaluate a regenerative surgical treatment modality for peri-implantitis lesions on two different implant surfaces., Materials and Methods: Twenty-six patients with one crater-like defect, around either TPS (Control) or SLA (Test) dental implants, with a probing depth (PD) ≥6 mm and no implant mobility, were included. The implant surface was mechanically debrided and treated using a 24% EDTA gel and a 1% chlorhexidine gel. The bone defect was filled with a bovine-derived xenograft (BDX) and the flap was sutured around the non-submerged implant., Results: One-year follow-up demonstrated clinical and radiographic improvements. PDs were significantly reduced by 2.1±1.2 mm in the Control implants and by 3.4±1.7 mm in the Test implants. Complete defect fill was never found around Controls, while it occurred in three out of 12 Test implants. Bleeding on probing decreased from 91.1±12.4% (Control) and 75.0±30.2% (Test) to 57.1±38.5% (p=0.004) and 14.6±16.7% (p=0.003), respectively. Several deep pockets (≥6 mm) were still present after surgical therapy around Controls., Conclusions: Surface characteristics may have an impact on the clinical outcome following surgical debridement, disinfection of the contaminated surfaces and grafting with BDX. Complete fill of the bony defect seems not to be a predictable result., (© 2011 John Wiley & Sons A/S.)

This study was aimed at evaluating whether the nitric oxide (NO)/cyclic GMP (cGMP) signaling pathway is altered in platelets from patients with an acute coronary syndrome (unstable angina and acute myocardial infarction). We investigated 10 patients with unstable angina (UA), 14 with acute myocardial infarction (AMI) and 14 age and sex-matched healthy subjects. The serum markers of platelet activation (sP-selectin), inflammation (TNF-alpha and erythrocyte sedimentation rate), thrombotic state (fibrinogen) and plaque disruption were significantly higher in both UA and AMI patients compared to the healthy controls. In their platelets we assessed the cGMP levels in basal conditions and after stimulation with sodium nitroprusside (SNP), and performed Western blot analysis of homogenates to measure the expression of soluble guanylate cyclase isoforms. Basal levels of cGMP (pmol/10(10) platelets) were significantly higher in platelets from UA patients (1,097 +/- 111; p < 0.0001) and AMI (1,122 +/- 77; p < 0.0001) compared to those collected from healthy controls (497 +/- 80). The platelets of AMI patients exhibited a lack of cGMP increase after SNP stimulation in comparison with UA patients. The phosphorylation of upstream (Akt1 protein kinase alpha and endothelial NO synthase) and downstream (vasodilator-stimulated phosphoprotein, VASP) signaling proteins of the NO/cGMP pathway was investigated: serine phosphorylation in Akt1, eNOS and VASP was enhanced in platelets from UA and AMI patients when compared to controls. Furthermore, in AMI patients the inhibitors of guanylate cyclase and cGMP-dependent protein kinase did not revert the VASP phosphorylation. These data suggest that platelets from AMI patients are more resistant to SNP stimulation, not only as cGMP production, but also in terms of VASP activation. From these ex vivo results we hypothesize that the increased inflammatory state which often accompanies patients with cardiovascular diseases might promote a platelet preactivation resulting in their reduced sensitivity to NO.

Objectives: The aim of this study was to evaluate the 2-year success rate of management of patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ)., Study Design: A prospective study was performed. Positive outcome variables were the resolution of symptoms and the status of the mucosa., Results: A total of 37 patients are described. The precipitating event was a dental extraction in 22 cases (59.5%). Thirteen patients (35.1%) underwent surgery, and 24 (64.9%) underwent antimicrobial therapy alone. After 2 years, 20 patients (54.1%) presented with soft tissue closure over previously exposed bone, and there were no statistical differences in gender, age, bisphosphonate treatment, or treatment modalities. Spontaneous lesions seemed to have a worse prognosis (P = .001)., Conclusions: Initial antimicrobial treatment, and later surgery for unresponsive patients, might be a feasible treatment modality for BRONJ. Because these results are not conclusive, it would be very interesting to know if this statement would be the same with a greater number of patients., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

Purpose: This study examined the relationship between age and gender with physical activity (PA) and how meeting of PA guidelines (PAGL) is related to socioeconomic status (SES) and sedentary behaviors (SB)., Methods: Data were collected from 11-, 13-, and 15-yr-old students in 32 countries participating in the Health Behaviour in School-aged Children (HBSC) survey 2001/2002. A self-completed questionnaire assessed weekly moderate-to-vigorous physical activity (MVPA) and SB for the past 7 d and MVPA for a typical week. SES was assessed using the Family Affluence Scale (FAS)., Results: None of the countries averaged enough MVPA to meet PAGL. The pattern of MVPA across age and gender was consistent among all countries. In all countries, older children were less active when compared with the youngest children; girls were significantly less active than boys were (mean hours per week of MVPA 3.52 +/- 1.88 vs 4.13 +/- 1.95) and were more likely to not meet the PAGL. SES was significantly associated with the amount of reported MVPA. SES and PAGL were not significantly related in seven countries, and a significant decrease in the influence of age was observed in these countries compared with other countries., Conclusions: Levels of MVPA during adolescence showed consistent patterns across countries in relation to age, gender, and social class. The limited effect of age on PA in countries where the influence of social class was less strong suggests the possibility of a moderating effect of context in the development of habits acquired during childhood.

Aims: Risk stratification of patients with Brugada electrocardiogram (ECG) is being strongly debated. Conflicting results have been suggested from international registries, which enrolled non-consecutive cases, studied with different programmed electrical stimulation (PES) protocols. The aim of this study was to prospectively evaluate the incidence of arrhythmic events and the prognostic role of clinical presentation, ECG, and of a standardized PES protocol in consecutive cases from a community-based population., Methods and Results: A total of 166 consecutive patients (45 +/- 14 years) with Brugada ECG were enrolled. Type 1 ECG was observed spontaneously in 72 (43%) and after pharmacological testing in 94 (57%). One hundred and three (62%) were asymptomatic, 58 (35%) had syncope, and five (3%) had a prior cardiac arrest. One hundred and thirty-five (81%) underwent PES with two extra stimuli up to ventricular refractoriness and 34% had ventricular fibrillation (VF) induced. Arrhythmic events occurred in nine patients at a mean follow-up of 30 +/- 21 months (2.2 events per 100 person-year): in three (60%) patients with aborted sudden death (aSD), five (8.6%) of those with syncope, and one (1%) of the asymptomatic. The only predictors of events were a history of syncope or aSD (P = 0.02) and induction at PES (P = 0.004)., Conclusion: Clinical presentation is the most important parameter in the risk stratification of patients with Brugada ECG. Programmed electrical stimulation seems valuable, particularly in patients with previous syncope.

Introduction: Genetic polymorphisms in the interleukin-1 gene cluster have been associated with the severity of periodontal diseases featured by a variable degree of destruction of connective tissue and bone, such as periodontitis and periimplantitis. This study was aimed to investigate if a link exists between such interleukin-1 gene polymorphisms and the development of gingival recessions during orthodontic treatment in Italian children., Methods: We evaluated, in 74 young Italian patients of both sexes, the -889 C/T polymorphism of the interleukin-1alpha gene and the -511 C/T and +3954 C/T polymorphisms of interleukin-1alpha gene by polymerase chain reactions-restriction fragment length polymorphism method using NcoI, AvaI and TaqI as restriction enzymes., Results: No association of interleukin-1 genotypes investigated and gingival recession occurring during orthodontic treatment were identified., Conclusion: In the population studied specific interleukin-1 genotypes (linked to a higher susceptibility to bone resorption in periodontal disease) there does not appear to be any association with the development of gingival recessions during orthodontic treatment.

The total number of children with incident cancer in Italy has never been specifically estimated. Specialized population-based Childhood Cancer Registries have only been operating in Piedmont (CCRP) and in the Marche region, while general population cancer registries cover about 20% of the Italian population. The number of expected cases of childhood cancer (0-14 years) in Italy in the period 2001-2015 has been estimated using CCRP incidence rates and annual percentage changes. The expected number of cases of all cancer types were 8,132, 8,672 and 8,944 in the periods 2001-2005, 2006-2010 and 2011-2015 respectively. These figures help evaluate the allocation of resources for the care of child cancer patients in Italy, and to estimate the number of cases expected to enter clinical trials.

Background: Environmental asbestos pollution can cause malignant mesothelioma, but few studies have involved dose-response analyses with detailed information on occupational, domestic, and environmental exposures., Objectives: In the present study, we examined the spatial variation of mesothelioma risk in an area with high levels of asbestos pollution from an industrial plant, adjusting for occupational and domestic exposures., Methods: This population-based case-control study included 103 incident cases of mesothelioma and 272 controls in 1987-1993 in the area around Casale Monferrato, Italy, where an important asbestos cement plant had been active for decades. Information collected included lifelong occupational and residential histories. Mesothelioma risk was estimated through logistic regression and a mixed additive-multiplicative model in which an additive scale was assumed for the risk associated with both residential distance from the plant and occupational exposures. The adjusted excess risk gradient by residential distance was modeled as an exponential decay with a threshold., Results: Residents at the location of the asbestos cement factory had a relative risk for mesothelioma of 10.5 [95% confidence interval (CI), 3.8-50.1), adjusted for occupational and domestic exposures. Risk decreased rapidly with increasing distance from the factory, but at 10-km the risk was still 60% of its value at the source. The relative risk for occupational exposure was 6.0 (95% CI, 2.9-13.0), but this increased to 27.5 (95% CI, 7.8-153.4) when adjusted for residential distance., Conclusions: This study provides strong evidence that asbestos pollution from an industrial source greatly increases mesothelioma risk. Furthermore, relative risks from occupational exposure were underestimated and were markedly increased when adjusted for residential distance.

The aim of this study was to compare the percentage of reverse-sequencing chewing cycles in 22 children [9 boys and 13 girls; mean age +/- SD, 8.6 +/- 1.3 and 8.8 +/- 1.5 years, respectively), with a unilateral right or left posterior crossbite, before and after therapy. The chewing cycles were recorded using a kinesiograph while the subjects masticated a soft and a hard bolus on both the crossbite and non-crossbite side. Chewing data were acquired before and 6 months after orthodontic treatment of the crossbite with an orthodontic functional appliance, the 'Function Generating Bite'. The results showed that, before therapy, the percentage of reverse-sequencing chewing cycles on the crossbite side was significantly higher than that on the normal side (P < 0.001) with both the soft and hard bolus. In addition, the percentage of reverse-sequencing chewing cycles on the crossbite side before therapy was significantly greater than after therapy with both a soft and hard bolus (P < 0.001). No significant differences were found in the percentage of reverse-sequencing chewing cycles on the non-crossbite side, before or after therapy, either with a soft or hard bolus.

Introduction: This report analysed the outcome of patients undergoing surgery for oral squamous cell carcinoma in order to identify the prognostic value of several factors., Patients: A total of 245 patients were studied who had undergone surgery for oral squamous cell carcinoma between 1989 and 2002, of whom 109 had received postoperative radiation therapy., Methods: For each patient, personal data, alcohol and tobacco consumption, symptoms, histological findings, treatment, and outcome were recorded and analysed statistically. Survival curves were calculated using the Kaplan-Meier algorithm, and the difference in survival among subgroups was examined., Results: The overall 5-year survival rate in the 245 patients was 63% (72.5% at 3 years). The differences in the 5-year survival were significant (p<0.05) for the site of origin, N and pN status, TNM stage, grading, status of the resection margins, osseous infiltration, and perineural invasion. Vascular involvement as a discriminator was not statistically significant. In patients undergoing radiation therapy, only perineural invasion negatively influenced the 5-year survival prognosis (p<0.01)., Conclusion: The overall survival rate was within the (previously) reported range. The prognostic value of many parameters is widely recognized; the combined evaluation of 'composite factors' is promising.

This article examines whether different types of welfare states mediate the effect of socioeconomic position on adolescents' health. The authors' main hypothesis is that countries with stronger redistributive policies will be more effective in weakening the association between socioeconomic position and health, thus reducing health inequalities. Analyses were carried out for Israel and 32 countries of Europe and North America. Data in the 2001-2002 Health Behavior in School-aged Children survey were collected through self-administered questionnaires distributed in schools to boys and girls 11, 13, and 15 years old. Socioeconomic position was measured with the Family Affluence Scale, based on reported consumption in the family. Health indicators were perceived health, general well-being, symptom load, and health behaviors. Social welfare regimes were classified using an expanded Esping-Andersen classification. The analysis supports the authors' hypothesis, at least partially. Social democratic and conservative welfare regimes rank lowest in the strength of association between low socioeconomic position and poor health, followed by liberal and other regime types, but it is more difficult to interpret data from Mediterranean and post-communist countries.

Background and Objectives: Several studies have been published on trends in childhood cancer incidence, with different patterns being reported. We present an analysis of cancer incidence trends in Piedmont (Italy) in 1967-2001 for the major categories of childhood malignant neoplasms., Design and Methods: The population-based Childhood Cancer Registry of Piedmont has recorded incident cases of malignant neoplasm in children (age 0-14) since 1967. Procedures for data collection and coding have been uniform throughout the study period. We calculated incidence rates per million children per year by sex and age-group. Trends were estimated using Poisson regression analysis, adjusted for age and sex and presented as the annual percent change (APC)., Results: Significant increases were observed for all malignant neoplasms combined (3360 cases, APC:1.3%, 95% CI:1.0% to 1.6%), leukemia (APC: 1.0%, 95% CI: 0.4% to 1.6%), central nervous system (CNS) tumors (APC of 2.3%, 95% CI: 1.6% to 3.1%) and neuroblastoma (APC: 2.3%, 95% CI: 1.0% to 3.5%). Acute lymphoblastic leukemia (APC 1.2%, 95% CI: 0.2% to 2.3%), and Acute non-lymphoblastic leukemia (APC 1.7%, 95% CI-0.6%, 4.1) both increased over time. Differences by age groups were observed for some tumor types, such as for neuroblastoma in infants (4.8% increase per year), leukemia in children aged 1-4 years (1.2%) and CNS tumors in children aged 10-14 (3.4%)., Interpretation and Conclusions: Our data suggest an increasing incidence of childhood cancer in general, and specifically for leukemia, CNS tumors and neuroblastoma in Piedmont in 1967-2001. The observed trends are unlikely to be explained by random variation, changes in exhaustiveness or quality of data collection and registration.