WHAT'S KNOWN ON THIS SUBJECT: Obesity and overweight can seriously affect health outcomes. Many obesity prevention interventions have been proposed, but few have been effective. Motivational interviewing in primary care seems promising, but results in BMI control are controversial and require further investigation.WHAT THIS STUDY ADDS: This is the first study to demonstrate the effectiveness of pediatrician-led motivational interviewing for BMI control in overweight children aged 4 to 7 years. Nevertheless, no effect was observed in boys or when the mother' s education level was low.abstract OBJECTIVE: The aim of this study was to evaluate the effect of family pediatrician-led motivational interviews (MIs) on BMI of overweight (85th $BMI percentile $95th) children aged 4 to 7 years. METHODS:All the family pediatricians working in Reggio Emilia Province (Italy) were invited to participate in the study; 95% accepted. Specific training was provided. Parents were asked to participate in the trial if they recognized their child as overweight. Children were individually randomly assigned to MIs or usual care. All children were invited for a baseline and a 12-month visit to assess BMI and lifestyle behaviors. The usual care group received an information leaflet, and the intervention group received 5 MI family meetings. The primary outcome was the individual variation of BMI, assessed by pediatricians unblinded to treatment groups. RESULTS:Of 419 eligible families, 372 (89%) participated; 187 children were randomized to MIs and 185 to the usual care group. Ninety-five percent of the children attended the 12-month visit. The average BMI increased by 0.49 and 0.79 during the intervention in the MI and control groups, respectively (difference: -0.30; P = .007). MI had no effect in boys or in children whose mothers had a low educational level. Positive changes in parent-reported lifestyle behaviors occurred more frequently in the MI group than in the control group.

Italy was one of the countries most affected by the number of people infected and dead during the first COVID-19 wave. The authors describe the rapid rollout of a population health clinical and organizational response in preparedness and capabilities to support the first wave of the COVID-19 pandemic in the Italian province of Modena. The authors review the processes, the challenges faced, and describe how excess demand for hospital services was successfully mitigated and thus overwhelming the healthcare services avoided the collapse of the local health care system. An analysis of bed occupancy in the region predicted during the first weeks of the epidemic. The SEIR model estimated the number of infected people under different containment measures. Community resources were mobilized to reduce provincial hospitals' burden of care. A population health approach, based on a radical reorganization of the workflow and emergency patient management, was implemented. The bed saturation of the Modena Healthcare Agency was measured by an ad hoc, newly implemented intensive care unit (ICU) bed occupancy and COVID-19 centralized governance dashboard. ICU bed occupancy increased by 114%, avoiding saturation of the Modena Healthcare Agency system. The Emilia-Romagna region achieved a higher rate of ICU bed availability at 2.15 ICU beds per 10,000 inhabitants as compared with community 1 ICU bed availability prior to the pandemic. Rapid and radical local reorganization of regional efforts helped inform the successful development and implementation of strategic choices within the hospital and the community to prevent the saturation of key facilities.

BackgroundThe diabetes prevalence increases at an alarming rate around the world and understanding disparities in occurrence, care management, and health outcomes may be a starting point towards achieving more effective strategies to prevent and manage it. The aims of this study are to compare immigrants and Italians in terms of the differences in diabetes prevalence and to evaluate inequalities in disease management and glycaemic control by using information included in Reggio Emilia diabetes register.MethodsWe retrieved from the diabetes register subjects aged 20–74 on December 31st, 2009. Using citizenship, we created three main groups: Italy, High Developed Countries (HDC), and High Migration Pressure Countries (HMPC). These were split into sub-regions of origin. We calculated age-adjusted prevalence by gender and sub-region. Using logistic regression model, we analyzed the association between area of origin and following indicators: 1) not being in care of diabetes clinics; 2) not having glycated haemoglobin (HbA1c) test in 2010; 3) among those tested, having a HbA1c value > = 9% (75 mmol/mol).ResultsWe found 15,889 Italian and 1,295 HMPC citizens with diabetes. HMPC citizens had higher age-adjusted prevalence of diabetes than Italians (females 5.0% vs 3.6%; males 6.5% vs 5.5%). The excess was mostly due to a strong excess in immigrants from Southern Asia (females 9.7%, males 10.2%) and Northern Africa (females 9.3%, males 5.9%). HMPC citizens were cared for by diabetes clinics in a similar proportion than Italians (OR: 1.08; 95% CI: 0.93-1.25), but had a greater odds of not being tested for HbA1c (OR: 1.51; 95% CI: 1.34-1.71), as well as of having HbA1c values equal to or over 9% (OR: 2.06; 95% CI: 1.80-3.14). The outcomes were poorer in HMPC females for the first two outcomes, while there was no difference for the HbA1c values (Wald test for heterogeneity p = 0.0850; p = 0.0156; p = 0.6635, respectively).ConclusionsOur findings highlight the need for gender-oriented actions for prevention and early diagnosis of the diabetes to contrast the higher risk in Northern Africans and Southern Asians. Further studies are required to determine whether the protocols in use are adequate for different immigrant groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1403-4) contains supplementary material, which is available to authorized users.

The Italian Parliament has excluded hospital physicians from the application of the European Work Time Directive (EWTD), which imposes a maximum workweek of 48 h and compulsory resting periods. This resulted in extended and excessive work time for the category. This paper is aimed at evaluating the impact of this legislation gap, by assessing the presence of excessive work-related stress and risk for burnout syndrome among Italian physicians working in public hospitals. This observational study is based on an on-line survey conducted on a sample of 1925 Italian doctors (covering a wide range of age, work experience and contractual positions) from October 2014 to February 2015. The questionnaire included 30 questions concerning their personal and professional life (e.g., assessment of workloads, number of uncomfortable or extra shifts, unused days-off, etc.). On the basis of the results, it can be inferred that the average Italian doctor working in public hospitals is under considerable stress at work with negative consequences on his health. He is exposed to high risk of suffering from sleep disorders and cardiovascular diseases (due to the lack of time for private practice and eating regular meals). Overall, his perception is that his job worsens his quality of life. This study shows the relevance of the risk of burnout among Italian physicians employed in public hospitals due to severe workload and work conditions. The resulting impact on the quality of care and the significant cost involved -both in human and economic terms -calls for significant emergency measures by the Italian health work organization. An important increase and prolonged working time is associated with a worsening of the objective cognitive performance and an increase of clinical risk, but also to an increased risk of diseases for operators and of the burnout syndrome. Our survey shows that lack of application of the EWTD has adverse effects on the quality of life and performance of Italian doctors. Failure to respond by all Italian doctors is the greatest limitation of our survey.

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