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The study aims to evaluate the health profile of first- and second-generation Romanian immigrants living in Italy compared to their adolescent peers in the country of origin (Romania) and the host population (Italian-borns). Analyses were performed on the 2013/2014 Health Behaviour in School-aged Children (HBSC) survey data. Romanian natives showed lower levels of health complaints and higher life satisfaction than Romanian migrants, who were similar to the host population, especially the second-generation ones. A comparable prevalence of being bullied was registered among Romanians, both native and immigrant, with significantly lower levels among Italian natives. Bullying others showed the second-generation migrants share a similar prevalence with the host population. The prevalence of liking school a lot was three times higher among the Romanian natives than among their peers living in Italy. Thanks to the HBSC data, this study is the first to examine the health of adolescent migrants from both the perspective of the host country and the population of origin. The results highlight the need for a more nuanced approach to studying immigrant populations, taking into account both the host country’s perspective and the health patterns of the population of origin.

Aging, a natural multifactorial process, increases Oxidative Stress (OS) and inflammatory responses. Sexual hormones could upregulate OS during lifespan, with opposite systemic effects: anti-oxidant protection and cellular pro-oxidant toxicity. Hormonal changes are crucial phases in human growth and aging, but their mediating role on OS is still incomplete. The main purpose of this work was to analyze the trend of OS during the lifespan and, in particular, during puberty and menopause. Data from standardized questionnaires and biological OS measurements (15-F2t-Isop) of 815 subjects (7–60 years old) from five previous studies (2009–2015) were analyzed. The age variable was categorized into two hormonal age windows: puberty and menopause. A regression model was performed to assess the association between 15-F2t-Isop and the hormonal age window, sex, weight, and smoking habits. The results showed a significant V-shape decrease of OS levels both during puberty [OR = −0.06 95% CI −0.07–−0.04, p = 0.41] and in menopause [OR = −1.01 95% CI −1.5–−0.5, p < 0.001], but only in females. Our results support the view that hormones, and specifically estrogen, could modulate OS, especially during puberty and menopause. The V-shape decreasing trend of OS may be related to intrinsic characteristics of estrogen, which is able to modulate and upregulate OS pro- and anti-oxidant mechanisms.

Comments on: Further studies of Bolivian crocidolite-Part IV: Fibre width, fibre drift and their relation to mesothelioma induction: Preliminary findings, by Ilgren EB, van Orden DR, Lee RJ, Kamiya YM, Hoskins JA.

(1) Aim: To summarize alcohol trends in the last 30 years (1985/6–2017/8) among 15-year-olds in Health Behaviour in School-aged Children (HBSC) countries (overall sample size: 413,399 adolescents; 51.55% girls) and to forecast the potential evolution in the upcoming 2021/22 HBSC survey. (2) Methods: Using 1986–2018 prevalence data on weekly alcohol consumption among 15-year-olds related to 40 HBSC countries/regions, a Bayesian semi-parametric hierarchical model was adopted to estimate trends making a clusterization of the countries, and to give estimates for the 2022 HBSC survey. (3) Results: An overall declining trend in alcohol consumption was observed over time in almost all the countries. However, compared to 2014, some countries showed a new increase in 2018 and 2021/22 estimates forecast a slight increase in the majority of countries, pointing out a potential bounce after a decreasing period in frequent drinking habits. (4) Conclusions: The clusterization suggested a homogenization of consumption habits among HBSC countries. The comparison between 2022 observed and expected data could be helpful to investigate the effect of risk behaviour determinants, including the pandemic impact, occurring between the last two waves of the survey.

The aim of this study was to describe physical activity, both moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA), in a large nationally representative sample of Italian adolescents, aged 11, 13 and 15, and to evaluate if Italian adolescents were in line with the 2020 WHO recommendations. In order to assess the possible impact of physical activity on adolescent psychological and social wellbeing, the associations between MVPA and VPA with life satisfaction, self-rated health and peer relationships were also explored. Data from the 2018 Italian Health Behaviour in School-aged Children (HBSC) survey on 58,976 adolescents were analysed. Logistic regression analysis was used to investigate the association between physical activity and self-rated health, life satisfaction and peer relationships. The association of the Family Affluence Scale with self-rated health, life satisfaction and peer relationships was also studied. The results showed that the majority of Italian adolescents did not meet current physical activity WHO guidelines on MPVA. The prevalence of adolescents claiming to be involved “at least four or more times per week” in VPA was 29%. Overall, our findings highlighted a positive association between MVPA and VPA and life satisfaction, self-rated health and peer support. Data from this study underlined the need to encourage physical activity, especially among older adolescents and girls, who claimed lower levels of MPVA and VPA.

The recent increase in electronic and social media use among young people has highlighted the importance of focusing on problematic social media use (PSMU) and the concurrent phenomenon of cyber aggression, as well as the role of social support. As part of the 2018 Health Behavior in School-aged Children study in Italy, this study aims to explore the role of family, peer, and teacher support in the association between cyberbullying and PSMU. Methods: Data were collected from 4183 school classes in Italy for a total of 58,976 adolescents aged 11, 13, and 15 years. The prevalence of cyber aggression (both cybervictimization and perpetration) and PSMU was estimated across subgroups of different age, gender, and geographical residence. A set of multivariable logistic regressions was then used to investigate the association between cyberbullying and PSMU, considering the effect of social support. Results: Cybervictimization was more frequent among girls than in boys. PSMU was higher in 11-year-old boys and 13-year-old girls; 8.3% and 12.7%, respectively. Social support was highest in 11-year-olds, for both sexes, and then decreased with increasing age. The risk of cyberbullying, both suffered and perpetrated, was higher in girls and in the presence of PSMU. Social support showed to be highly protective against PSMU and cyberbullying in all ages and both genders. Conclusion: Although cyber aggression is less represented in Italy than in other European countries, it is likely to increase. PSMU appears to be an important contributor to the risk of cyber aggression; however, social support has been shown to be capable of reducing the risk of both phenomena. Public health policies fostering familiar and school support can help protect adolescents’ mental health, reducing the risk of problematic media use and cyberbullying.

Recent studies have examined how the environment can influence obesity in young people. The research findings are conflicting: in some studies, green spaces have shown a protective association with obesity and urbanization has turned out to worsen this condition, while other studies contradicted these results. The aim of the study was to examine the relationships between greenness, urbanization, and weight status among Italian adolescents. Student data (11–13 years old) on weight and height, physical activity (PA), and demographic characteristics were extracted from the 2018 Health Behaviour in School-aged Children (HBSC) survey in Piedmont, Northwest of Italy. Data on Normalized Difference Vegetation Index (NDVI) and urbanization were obtained from satellite images and the National Institute of Statistics (ISTAT). A multilevel regression model was used to assess the association between NDVI, urbanization, and obesity, controlling for PA. Students living in greener areas reported a lower likelihood of being obese [OR = 0.11, 95% CI 0.02–0.56, p = 0.007], while students living in areas with a higher level of urbanization showed a significantly increased risk of obesity [OR = 2.3, 95% CI:1.14–4.6, p = 0.02]. Living surrounded by higher amounts of greenness and lower levels of urbanization may positively influence health status through lower risk of obesity among youth.

Objectives The global spread of electronic devices has made cyberbullying and problematic social media use (PSMU) emerging public health concerns. This study aimed to investigate the prevalence of cyberbullying and PMSU among adolescents in northwestern Italy. We also explored the association between cyberbullying and PSMU and whether this association was moderated by social support. Study design Data were collected as part of the Italian 2018 Health Behaviour in School-aged Children (HBSC) study in the Piedmont region; 186 school classes participated, comprising 3022 children aged 11, 13 and 15 years. The prevalence of cyberbullying and PSMU were estimated in subgroups of age and gender. Multivariate logistic regression was used to investigate the association between cyberbullying and PSMU, before and after taking into account social support. Results Girls reported higher cyber-victimisation and PSMU than boys (9.1% vs 6.0% and 10.2% vs 6.1%, respectively), and the risk of cyber-victimisation was higher in the presence of PSMU. This risk was attenuated in the presence of social support. Conclusions PSMU is an important driver of cyberbullying, although social support can mediate these behaviours. Public health interventions are needed to guide adolescents how to use social media appropriately and to prevent cyberbullying and the mental health problems they can provoke.

The question of whether orthodontic therapy by means of rapid palatal expansion (RPE) affects the spine during development is important in clinical practice. RPE is an expansive, fixed therapy conducted with heavy forces to separate the midpalatal suture at a rate of 0.2–0.5 mm/day. The aim of the study was to evaluate the influence of RPE on the curves of the spine of juvenile/adolescent idiopathic scoliosis patients. Eighteen patients under orthopedic supervision for juvenile/adolescent idiopathic scoliosis and independently treated with RPE for orthodontic reasons were included in the study: Group A, 10 subjects (10.4 ± 1.3 years), first spinal radiograph before the application of the RPE, second one during the orthodontic therapy with RPE, Group B, 8 patients (11.3 ± 1.6 years), first radiograph during the use of RPE second one after the removal. Group A showed a significant worsening of the Cobb angle (p ≤ 0.005) at the second radiograph after RPE. Group B showed a significant improvement of the Cobb angle (p = 0.01) at the second radiograph after removal of RPE. Based on the results, the use of RPE during adolescence might influence the spinal curves of patients with idiopathic scoliosis.

Background Several studies have shown that neighborhood greenness is associated with lower problematic behaviors in children and better perceived well being. While urbanization showed opposite results. The aim of the study was to assess the relationship between urbanization and greenness levels with perceived health, life satisfaction and health complaints on adolescents. Methods The study is based on data from 2018 Health Behavior in School-aged Children in the region of Piedmont(Italy), which involved 3022 11-,13-,15-year olds, sampled in 122 schools across the region. Every school was georeferenced. Greenneess was measured by Normalised Difference Vegetation Index (NDVI-satellite images) and urbanization by population density, traffic intensity (satellite measurements) and air pollution concentration (sampling stations). Health complaints were evaluated with a set of 8 psychosomatic symptoms(reported more than once a week). Life Satisfaction (LS) was measured by using the Cantril scale (low LS =6). Self-Rated Health was measured by means of a four points scale (fair or poor, good or excellent). Results More than 66% of adolescents reported frequent health complaints; 11% declared low life-satisfaction and 9% of adolescents scored poor or fair self-rated health. The proportion of the three variables increased with age in both genders, and was higher among girls. Gender differences increased from 11- to 15-years of age. Preliminary results showed a positive association between greenness and life satisfaction, urbanization and health complaints. Conclusions In times of increasing urbanization and reduced availability of green areas, characterizing the association between urbanization, greenness and perceived health is revealed to be the challenge for Public Health. Redefine the urban spaces accordingly requires collaboration between different disciplines. Coherently with the recent studies, communities can be actively involved through qualitative approaches. Key messages The topic of urban nature is becoming central for healthy and sustainable urban planning, not the least for population groups like adolescents and children. The relation between urbanization, with decreasing access to green spaces, and the impact on physical as well as mental health presents an important issue and a big challenge for Public Health.

(1) Aims: To explore temporal trends 2010–2018 of well-being among Italian adolescents and to evaluate potential explanatory factors. (2) Methods: Italian nationality representative samples of students aged 11, 13, and 15 years were recruited in 2010, 2014, and 2018; Health Behaviour in School-aged Children (HBSC), for an overall number of 165,000 teenagers. Multivariable logistic regression models were performed to fit the trends over time of life satisfaction (LS), psychological (PSY-HC) and somatic health complaints (SOM-HC) considering the contextual factors: school work pressure, social support (family, school, peers), socioeconomic status, geographic area, and immigration background; (3) Results: From 2010 to 2018 while LS was steady, health complaints increased, mainly for PSY-HC, in all age and gender groups. Trend of PSY-HC affected mainly 15-years-olds: rates among boys varied from 29.6% to 35.9% (OR: 1.13, 95%CI: 1.02–1.25); among girls from 49.1% to 63.3% (OR: 1.56, 95%CI: 1.42–1.72). High school work pressure and poor social support play a central role in worsening well-being outcomes; (4) Conclusions: Our findings pictured a remarkable worsening trend of teenagers’ well-being, especially among 15-year-old girls. Further research will be required to investigate this breaking up of the connection between psychophysical symptomatology and cognitive perception of life satisfaction.

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.

Background Childhood obesity is an important public health issue worldwide and includes different risk factors, such as environmental pollutants exposure or physical activity. Neighborhood composition and green spaces availability could contrast obesogenic lifestyles and promote healthy habits, whereas, urbanization and traffic volume exposure are inversely associated with physical activity and worsen effects on childhood health. Methods This project analyzed students involved in the HBSC survey from the Piedmont Region. Data were collected in 2018, following the protocol. All the subjects were georeferenced within buffers around schools. Green-spaces availability was measured by Normalised Difference Vegetation Index (NDVI-satellite images) while urbanization was calculated by population density, traffic intensity (satellite measurements) and air pollution concentration (sampling stations). Results Overall, the sample included 3022 subjects, with amount 50% male/female and 30% for each age group (11-13-15 years old). Concerning weight status, above 14% of the all sample is obese or overweight, with, respectively, 20% among boys and 11% among girls. Preliminary analyses showed an association between weight status and population density (rural vs urbanized areas). Currently, we are analyzing the association with greenness and the other measures of urbanization. Conclusions Our preliminary findings suggest that high urbanization levels impact health implementing weight in children. We are testing the hypothesis that greenness positively influences weight status and reduce negative effects of urbanization and air pollution. The managing of these risk factors must be deepened and corroborated by active preventive Public Health strategies for improving children health. Key messages Urbanization and greenness may influence weight status in children. Public Health strategies must be improved for children health.

Ercan, Oya/0000-0001-7397-2837; Finne, Emily/0000-0002-6736-0022; Tesler, Riki/0000-0001-6070-6193; Ojala, Kristiina/0000-0001-9081-1891; Furstova, Jana/0000-0003-4057-2540; Dzielska, Anna/0000-0001-7396-8504 WOS:000538880700011 PubMed ID: 32446612 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. (C) 2020 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine. Institute of Mother and Child in Warsaw, Poland [510-20-66]; European Regional Development Fund-Project "Effective Use of Social Research Studies for Practice" [CZ.02.1.01/0.0/0.0/16_025/0007294]; Juho Vainio Foundation (Finland) [284439] This article was also supported by the Institute of Mother and Child in Warsaw, Poland (grant No. 510-20-66), the research grants from the European Regional Development Fund-Project "Effective Use of Social Research Studies for Practice" (No. CZ.02.1.01/0.0/0.0/16_025/0007294), and the research grant from the Juho Vainio Foundation (Finland), (grant No. #284439).

The aim was to investigate the role of different forms of social support in early sexual intercourse and contraceptive use.The study sample included 18,918 15-year-olds who took part in the 2018 Italian Health Behaviour in School-aged Children study. Multivariable multilevel logistic regressions were performed taking into account geographical region and socioeconomic status.21.7% of adolescents reported early sexual intercourse. 71.9% used a condom at last sexual intercourse, 12.2% oral contraceptives 41.2% other contraceptive methods (multiple response question). High support from family and from teachers were associated with a lower likelihood of early sexual intercourse in both genders, while peer support was shown to increase this likelihood among boys. Adolescents with high social support were more likely to use condoms.Social support can have a positive influence on adolescents' sexual behaviour. Sexual education programmes should aim to engage peers and those significant adults who can influence adolescents' lives, in and out of school.

Background Cyberbullying seems to be an emerging public health issue worldwide. Several mental health problems have been reported in adolescents exposed to it. Spreading of smartphones and social networks in youths, requires to explore the eventually Electronic Media Communication (EMC) problematic use, in order to identify potentially negative health consequences in adolescents. This study aims to illustrate cyberbullying and to investigate whether an EMC inappropriate use could implicate an increased cybervictimization risk. Methods Data were collected as part of the Italian 2018 Health Behaviour in School-aged Children (HBSC) study for the Piedmont region, which involved 3022 children of 11, 13 and 15 years old. Prevalence of cybervictimization, cyberbullying and EMC problematic use were estimated in subgroups defined by age and gender. The link between EMC problematic use and cyber-victimization/bullying was examined through a multivariate logistic regression. Results The average frequency of cybervictimization in Piedmont was low (7,4%), in line with the average distribution in Italy. 13 years old girls reported the highest proportions of both cybervictimization and EMC problematic use (10,30% and 12,08% respectively). Adolescents who reported EMC problematic use showed an increased risk of cybervictimization (OR = 2,45; p Conclusions Despite the low prevalence of cyberbullying in Italy, our data showed a greater risk of cybervictimization when the EMC use is inappropriate. Further investigations, starting from the HBSC study, are required to explore the cyberbullying phenomenon in depth. Key messages Cybervictimization risk is higher in EMC problematic use. Public health intervention and educational programs are deemed necessary for a more responsible EMC use, in order to prevent cyberbullying and mental health problems in adolescents.

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). 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. 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

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.

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.

Obesity and exposure to second-hand tobacco smoking (SHS) may influence oxidative stress (OS) levels, especially in children. This study investigated body composition and SHS influence on OS induction in the paediatric population. The first purpose was identifying an appropriate BMI standard for adiposity assessment in OS investigations. Secondly, SHS and obesity were analysed as inductors of OS. The epidemiologic sample involved 330 children. Three BMI (body mass index) references (IOTF, CDC, and WHO) and an impedentiometric scale supplied body-composition measurements. Partecipants filled out a questionnaire and provided urinary samples for biomarker quantifications: isoprostane (15-F2t IsoP) and cotinine as OS and SHS biomarker, respectively. Obesity prevalence changed over different BMI references (14%, 21%, and 34% for IOTF, CDC, and WHO, respectively). Obese children, by IOTF, showed an increase of 56% in 15-F2t IsoP compared to those normal weight (p = 0.020). Children belonging to the third and the fourth cotinine quartile compared to those of the first quartile had higher 15-F2t IsoP (1.45 ng/mg, 95% CI: 1.06&ndash, 1.97, p = 0.020 and 2.04 ng/mg, 95% CI: 1.55&ndash, 2.69, p &lt, 0.0001, respectively). Obesity assessment in children requires appropriate BMI reference depending on research field. Both SHS exposure and obesity may increase OS in children.

Background: Surveillance programs have proven to be effective in reducing surgical site infection (SSI) rates. In 2008 Piedmont, which is a northwestern region of Italy, joined the Italian national surveillance system (Sistema Nazionale Sorveglianza Infezioni del Sito Chirurgico [SNICh]). The aims of this study were to evaluate SSI rates and trends in Piedmont from 2009 to 2015 for the two most frequently performed surgical procedures, hip arthroplasty and colon surgery, and to estimate whether the number of years of participation in a surveillance program and the number of monitored surgical procedures have an impact on the incidence of SSIs. Methods: Data were collected through the national surveillance system. Procedure-specific SSI rates were calculated, overall and by year of participation in the network. Trends in SSI rates were evaluated in relation to the duration of surveillance and the number of monitored procedures using Poisson regression analysis. Results: A total of 16,288 procedures were monitored from 37 hospitals. The overall adjusted SSI rates were 8.61% after 6,050 colon surgery procedures and 1.16% after 10,238 hip arthroplasty procedures. Each year of increase in participation was associated with a substantial risk reduction for SSI in both procedure categories: 7% for colon surgery (risk ratio [RR] 0.93; 95% confidence interval [CI] 0.89-0.97) and 20% (RR 0.80; 95% CI 0.73-0.88) for hip arthroplasty. Conversely, an increase in the number of monitored procedures was not associated with a substantial decrease in SSI risk: an overall RR of 0.99 (95% CI 0.98-1.00) and 1.00 (95% CI 0.99-1.00) was found for every one unit increase in the number of monitored procedures for colon surgery and hip arthroplasty respectively. Conclusions: These results support the efficacy of systematic surveillance in reducing SSIs, increasing with the number of years of participation, and suggest the volume of monitored procedures has no significant impact on SSI risk.

Cigarette smoking is often established during adolescence when other health-related risk behaviors tend to occur. The aim of the study was to further investigate the hypothesis that risky health behaviors tend to cluster together and to identify distinctive profiles of young adolescents based on their smoking habits. To explore the idea that smoking behavior can predict membership in a specific risk profile of adolescents, with heavy smokers being more likely to exhibit other risk behaviors, we reanalyzed the data from the 2014 Health Behaviour in School-Aged Children Italian survey of about 60,000 first- and third-grade junior high school (JHS) and second-grade high school (HS) students. A Bayesian approach was adopted for selecting the manifest variables associated with smoking; a latent class regression model was employed to identify smoking behaviors among adolescents. Finally, a health-related risk pattern associated with different types of smoking behaviors was found. Heavy smokers engaged in higher alcohol use and abuse and experienced school failure more often than their peers. Frequent smokers reported below-average academic achievement and self-rated their health as fair/poor more frequently than nonsmokers. Lifetime cannabis use and early sexual intercourse were more frequent among heavy smokers. Our findings provide elements for constructing a profile of frequent adolescent smokers and for identifying behavioral risk patterns during the transition from JHS to HS. This may provide an additional opportunity to devise interventions that could be more effective to improve smoking cessation among occasional smokers and to adequately address other risk behaviors among frequent smokers.

Cat scratch disease (CSD) is an infectious disease caused by Bartonella henselae, usually characterized by self-limiting regional lymphadenopathy and fever. Given the low clinical diagnostic sensitivity and specificity of conventional anti-B. henselae indirect immunofluorescence assays (IFAs), real-time polymerase chain reaction (PCR)-based detection of B. henselae is now being proposed as a more sensitive tool to diagnose CSD. Thus, here we have assessed the efficacy of real-time PCR in detecting B. henselae in different specimens from patients with suspected CSD and compared it to that of IFA. From March 2011 to May 2016, at the Microbiology and Virology Unit, Azienda Ospedaliera Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy, 115 clinical specimens (56 aspirated pus, 39 fresh lymph node biopsies, and 20 whole blood samples) and 99 sera from 115 patients with suspected CSD (62 females and 53 males between the ages of 3 months and 68 years) were analyzed by both real-time PCR, used in a qualitative way, and IFA (IgM and IgG) for the presence of B. henselae. For 16 patients, serological results were not available due to a clinical decision not to request the test. B. henselae DNA positivity was detected by real-time PCR in 37.39% of patients, while 62.61% of them were negative. Thus, patients were divided into two groups: real-time PCR+ (n = 43) and real-time PCR- (n = 72). Real-time PCR screening of whole blood, biopsies, and aspirated pus revealed B. henselae positivity in 40%, 38.46%, and 35.71% of patients, respectively. When we analyzed samples by IFA, we found the presence of B. henselae in 28 out of 99 (28.28%) patients, of which 11 (11.11%) belonged to the real-time PCR+ group and 17 (17.17%) to the real-time PCR- group. Among the 71 seronegative subjects, 16 (16.16%) were found positive for B. henselae by real-time PCR. Thus, by combining the results of both assays, we were able to increase the percentage of B. henselae positive specimens from 27.27% (real-time PCR) or 28.28% (IFA) to 44.44% (real-time PCR+IFA). Altogether, these findings indicate that the early detection of B. henselae in patients with suspicious CSD through combined real-time PCR and serological analyses can lead to a more accurate diagnosis of CSD, thereby allowing prompt and appropriate disease management.

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.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.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).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.

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 present study was to assess the effects of bisphenol (BP) exposure on pregnancy and neonatal life. We have (a) determined BP (BPA and BPS) concentration levels in a group of newborns and their mothers, (b) identified factors, habits, and devices possibly responsible for BP uptake, and (c) determined the effect of BP exposure. No significant correlations were detected between maternal and neonatal BP concentration levels. In newborns, positive correlations between pacifier use and BPS total (p = 0.04) and free BPS (p = 0.03) concentrations were detected. A significant correlation was also found between oral glucose administration and concentration levels of free BPA (p &lt, 0.05). Our study points to a central role of lifestyle, hospital procedures, and neonatal devices in inducing BP exposure, especially during the perinatal period. This is the first report of BP contamination in newborns due to widely non-alimentary products designed for newborn care, such as glucose-solution containers for BPA and pacifiers for BPS. Further studies are advocated in order to clarify both the impact of other BP forms on human health and development, as well as potential BPA exposure sources during neonatal and childhood life.

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.

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. 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). 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. 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. Within the limits of this study, the positive results suggest that the proposed technique may be a reliable option in selected cases.

Background A unique standardized national dataset on adolescent girls (21 regions) participating in the Italian Health Behaviour in School-aged Children Study (HBSC) was used to investigate the correlation between body mass index (BMI) and age at menarche. Methods Two independent nationally representative survey datasets: one on 15-year-olds (n = 6907, in 21 regions, year 2013/2014) and one on 11-year-olds (n = 10,128, in 20 regions, year 2009/2010) were analysed. The survey instrument was a self-report questionnaire. Median age at menarche and 95% confidence intervals (CIs) were estimated by means of Kaplan–Meier analysis. Hierarchical models were used to assess the relationship between BMI and age at menarche (months). “Region-level obesity” was measured as the prevalence of overweight/obesity (%) in each region. Results Region-level median age at menarche ranged between 12 years/3 months and 13 years/4 months. Region-level prevalence of overweight among 15-year-old girls ranged between 4 and 19%. Age at menarche was inversely associated with individual BMI (unstandardized regression coefficient beta = − 0.70; 95% CI, − 0.84 to − 0.56). Individual- and class-level measures of BMI accounted for 50% of the region-level variance in age at menarche. Conclusions The results show that overweight in childhood is in relation with the early puberty in girls. Future surveys may take into account this report to clarify if overweight is the cause or consequence of early menarche.

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. 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. 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. 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.

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.

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.

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.

Purpose. To assess inflammatory involvement of cornea in dry eye by means of confocal microscopy, evaluating the presence and distribution of Langherans cells (LCs). Methods: 98 eyes of 49 subjects were enrolled: 18 subjects affected by Sjögren Syndrome Dry Eye (SSDE), 17 with Non-Sjögren Syndrome Dry Eye (NSSDE), 14 healthy volunteeers. Dry eye symptoms, tear film, ocular surface damage and corneal confocal microscopy were analized. Results: A significant increase of LCs density was observed at sub-basal nerve plexus (SSDE = 79 cells/mm2 and NDE = 22 cells/mm2; p = 0,0031) and sub-epithelial nerve plexus (SSDE = 38 cells/mm2 and NDE = 3 cells/mm2; p = 0,0169) in central cornea of SSDE group. An increased number of LCs from the center to the periphery of the cornea was observed, significant only in healthy volunteers group. In dry eye patients there was an increase in LCs density in both peripheral and central cornea with a significant difference between NDE (14,66 cells/mm2) and SSDE (56,66 cells/mm2) only in central cornea (p = 0,0028). In SSDE group, mean density of LCs in central cornea results also superior to NSSDE group (29,33 cells/mm2). There was no correlation between LCs density and dry eye symptoms, tear film deficiency and ocular surface damage. Conclusion: This study demonstrates the activation of an inflammatory and immunological reaction in cornea of NSSDE and SSDE patients. Confocal microscopy can be an important diagnostic tool in evaluation and follow-up of dry eye disease.